Pre-Pregnancy GP Visits: 6 Reasons to Plan With Your Doctor - Dr Natalie Fonda
1) Pre-pregnancy health checks for peace of mind
Getting a thorough health check in preparation for pregnancy is a must. Grandma’s ramblings about prevention being better than cure have never been more relevant.
They’ll order blood tests and make sure your vaccinations are up-to-date. Contracting rubella and chickenpox while pregnant can cause serious problems with your baby. Hepatitis B immunisations should be considered for those in high-risk groups (which includes all pregnant women).
Any current medical conditions need to be carefully assessed and managed. Women with epilepsy, diabetes or asthma may need to have treatment plans updated before trying to get pregnant.
Your GP can also refer you for prenatal genetic carrier screening. More on this below.
2) Public vs private hospitals
Your GP will give you the low-down on having a baby through the public and private health systems.
Public obstetric care is mostly covered by Medicare and is free or significantly cheaper than private care. The quality of public care in Australia is exceptional, especially in larger hospitals such as the Royal Women’s.
You’ll be looked after by midwives throughout pregnancy and when giving birth – while seeing the occasional obstetrician. You can’t choose obstetricians, and you’re likely to see a different one each time. Some people find this lacks consistency in antenatal care.
Shared care is also an option for healthy women and low-risk pregnancies. You get to see the same doctor or midwife throughout your pregnancy, along with some hospital visits. There are often out-of-pocket expenses.
Private obstetric care is usually accessed through private health insurance. You need an obstetric level of cover for at least three months before falling pregnant.
There are out-of-pocket costs for an obstetrician and anaesthetist (if you use one). These can add up to more than $10,000, depending on where you live.
The good news is that you choose your obstetrician and the hospital at which to deliver your baby. You’ll likely have a private room, be allowed to recover for longer in your room and possibly even enjoy postnatal care in a fancy hotel upon leaving hospital.
Your obstetrician will care for you from 10 weeks pregnant until your baby is six weeks old. Public care is from 17 weeks until you’re discharged from hospital.
The public versus private decision can be a tricky one. A visit to your GP is golden in deciding which path bests suit your circumstances.
3) Medications before and after conception
Your GP will let you know which medications to take and those to avoid as part of your pregnancy care.
Certain vitamins and supplements are recommended for pregnancy. In general, you’ll need folic acid, which reduces the risk of spina bifida, and iodine for brain and nervous system development. I usually advise you start taking both around a month before falling pregnant.
Some medicines, herbal remedies and creams also need to be stopped before falling pregnant. Obviously, the contraceptive pill is out. Less obvious is the fact that it can take 3-6 months for regular periods to return after stopping certain contraceptives.
You can’t take many acne treatments when pregnant. You also need to stay away from particular antibiotics, cold and flu remedies and over the counter medicines, such as ibuprofen.
Vitamin A and certain supplements aren’t generally considered safe in pregnancy either.
4) Fertility and Falling pregnant
I often chuckle about how we spend our youth trying to avoid getting pregnant, only to be surprised when it doesn’t happen the instant we’re ready.
In fact, conceiving can be quite hard for many people. One in six couples has difficulty, according to Access Australia.
For women, the likelihood of in utero fertilisation decreases as we age. There’s a 20% chance of a 30 year old returning a positive pregnancy test during each cycle. For a 40 year old, it drops to 5%.
Visiting your GP when trying for a baby is essential. They’ll conduct a full medical and family history examination to see if you have any conditions that may require extra fertility care.
Your GP will advise on making good lifestyle choices that increase your chances – stop smoking, cut out alcohol and drugs, get regular exercise and manage your weight.
We’ll also debunk myths about the best time to have sex. The same goes for other wild theories, such as whether you should hug your knees after sex and avoid trampolining (the answers to both are no).
The time it takes to get pregnant is another question I’m asked every day. Some couples take one cycle; others take a decade. It’s generally advised women see a doctor for fertility advice following more than 12 months of regular unprotected sex – six months for women over 35 or if there’s a suspected fertility problem with either partner.
Your GP can refer you to a fertility specialist if needed – dependant on a range of factors, including your age and pre-existing medical conditions. Rest assured, not all referrals to a fertility specialist result in IVF. Other assistance can be provided, such as help with ovulation.
5) Singles and LGBTI family options: IVF, IUI and more
If you’re unable to fall pregnant naturally, your GP can outline your options. Medical science in this area is racing ahead at mind-blowing speeds.
Same-sex couples have many possibilities open to them for having a baby and giving birth. I recently met with two lovely ladies who were considering IVF ‘egg sharing’. This is where one partner’s eggs are used to create an embryo (genetic mother) which is then transferred to the other partner’s uterus (birth mother). What a delightful way to start a little family!
It’s also important to be aware of the many legal, financial and societal considerations. Again, your GP can point you the right direction to gain more information on such topics.
6) Genetic Carrier Screening
Advancements in reproductive medicine continually amaze me. Genetic carrier screening is no exception.
The screening is essentially a genetic test to determine if either parent has an increased chance of having a baby with certain genetic conditions. Such conditions can limit the quality of life as wells as the lifespan of a child. Examples include:
- Cystic fibrosis: 1 in 25 people are carriers / 1 in 2,500 people have the condition
- Fragile X syndrome: 1 in 250 / 1 in 4,000
- Spinal muscular atrophy: 1 in 40 / 1 in 6,000-10,000
Almost all children born with these genetic conditions show no family history. Being the case, I’ll provide you with all the info you need and leave the screening decision in your capable hands. There’s no wrong or right choice.
Genetic screening is conducted by sending off blood or saliva swabs for testing. Ideally, this is done before you fall pregnant. People who remain with the one fertile partner only need to be screened once.
In the event of a positive screening result, your options depend on whether you’re pregnant or not. Your GP can walk you through the choices.
It’s important to note that chromosomal conditions such as Down syndrome can’t be picked up by genetic carrier screening. Rather, we can conduct blood tests and ultrasound scans during your first trimester as part of your prenatal care.
Visit Mackenzie’s Mission for more information on genetic carrier screening. They’re currently seeking participants for a study that will screen for 750 childhood genetic conditions. Speak with your GP about eligibility to take part.
Health information, health services and links
- Pregnancy Birth and Baby
- Having a Baby in Victoria (State government website)
- Family Planning Victoria
- The Royal Women’s Hospital
- Health Direct (Federal Department of Health)
- Food Safety During Pregnancy
- Australia’s National Infertility Network
- Perinatal Anxiety & Depression Australia
- Money Smart – Having a baby