When should you book for pregnancy care?

Congratulations, you’re having a baby! At TasOGS you can choose to book with us as soon as you know that you’re pregnant.

Booking early has the double advantage of ensuring you don’t miss out on the limited spots at TasOGS and allows us to offer you an ultrasound scan as early as 6 weeks.

Early ultrasounds have been shown to improve pregnancy outcomes by improving the accuracy of pregnancy dating. This reduces your risk of a post-dates pregnancy and in turn reduces the risk of stillbirth.

Most importantly, as we found ourselves when pregnant, an early scan allows you and your family to be reassured about the progress of your pregnancy.

Our TasOGS obstetricians Dr Kirsten Connan and Dr Tania Hingston, each care for only 10 new pregnant women and their families every month. Limiting the number of deliveries each month ensures that you will receive the personalised care we aim for at TasOGS and most importantly means you will always be safely supported by a well-rested obstetrician.

Booking early gives you the best chance to secure a spot at TasOGS, depending on your baby’s due date.

If you call and our TasOGS bookings are full for your due month, we will be able to recommend alternative Hobart obstetricians.

Booking early also provides you with an opportunity to consider the many genetic and chromosomal tests  that are now available in pregnancy – often requiring only a simple blood test. Many of these are best performed at 10 weeks gestation or earlier. This maintains your choice about continuing your pregnancy and keeps you well informed about any implications or management options.

When you book with TasOGS you will need to have a referral from your GP or specialist, and we will need to know your baby’s due date, whether calculated by yourself or provided by your GP. It’s an exciting time!

Good luck with the exciting and rewarding parenthood journey ahead!

Guilt and the Caesarean Section

As a mother of two young girls, a wife and a full-time medical specialist, I have tried hard to avoid the trap of ‘guilty parenting’. I am sure many of you know this challenge. There are never enough hours in the day to satisfy all the demands of life and I do not believe there are any true superwomen.

When it comes to parenting, my youngest daughter challenges me most, battling the reality that I am not the stay-at-home mother that she desires.

So what am I left to do?

The answer is simple. When I am working, my priority is the women I am privileged to care for and share with. When I am at home, my priority is my daughters, shared with my husband. Somewhere in the left over hours I find time for the other important parts of life – without all these I could never be the woman, mother, wife or medical specialist I strive to be.

Balancing these many dimensions of life is not easy. Importantly I must be kind to myself and choose to not let guilt be yet another emotion added to the mix.

I sometimes hear my obstetric colleagues talk of the guilt they see some women feeling having needed or chosen a caesarean section as their own birth experience. I find myself saddened that this guilt is a distressing reality for many women. How is it that as women's healthcare providers we have allowed this emotion to persist and perpetuate in our community?

A woman’s birthing journey should primarily be about safety. Safe mother. Safe baby.

The birth itself represents a profound life changing moment in every family’s life. But it is just that, one moment. Don’t get me wrong – I will always remember the first moment I laid eyes on my daughters. Their vaginal births were incredibly special moments in our lives. But being a parent is so much more than the birth moment.

As a parent you make daily decisions that you feel will be best for your family. As a mother or parent to be, it’s no different.

Choosing the way in which your baby is born is a very personal decision.

For most obstetricians and women, a vaginal birth beckons first. But if you need to choose a caesarean section, because it is safest for you physically or psychologically, or because it is the safest way for your baby, then that is the best decision. A decision each woman and her family should feel empowered to make if needed, guided and supported by their obstetrician. Remember: safe mother, safe baby.

With one in three Australian women having a caesarean section today, we can no longer call vaginal birth ‘normal’ – this is language from the past that carries unnecessary judgement.

So I challenge both my colleagues and their women to be kind and not to have any guilt about the way in which they birth. The focus should be on high quality medical care, parental education and support, and safely bringing a new life into the world.

The rest, including the route of exit, is important but still secondary to the experience and safety of each woman, her baby and their needs as unique individuals.

Planning for Pregnancy

Whether you are married, partnered, or single, you have lots to think about when considering getting pregnant and having a baby. For those of us that have needed to walk the IVF path to have our babies, we know all too well the planning (and financial costs) that can go into a pregnancy.

The timing of your pregnancy should always be considered in your decision.

Planning 6 months in advance

If you and your partner are thinking about pregnancy, I recommend you start planning six months in advance.

This gives you time to begin to track your menstrual cycle (period) and learn your body’s signs of ovulation (or lack there-of!). Most women need a cycle between 21 and 35 days to achieve ovulation (the release of an egg). On average you ovulate 14 days before the end of your cycle.

If you are one of the lucky women with a regular cycle length, you will then be able to predict your fertile window. This is usually from 5 days before ovulation to 2 days after.

There are also many handy apps and ovulation kits now available to help you track your cycle and predict this fertile window. If you are still struggling to determine when your fertile window is, or even if ovulation is happening, make sure you have a review with your GP or gynaecologist.

Women commonly ask me how often they need to have sex when they’re planning for a pregnancy.

Obviously you can have sex whenever you like with your partner! But if the goal is fertility, then having sex every second day during your fertile window is enough. Sperm can survive in the vagina for as long as 5 days, though typically last 3 days. An egg released from the ovary needs to be fertilised within 24-48 hours of ovulation to survive. It is these two factors, the longevity of sperm and eggs, that gives us the '5-and-2' fertile window.

Medical conditions

If you have any medication conditions that regularly require you to see a GP or specialist, you should discuss your plans for pregnancy with your doctor.

Although uncommon, there are occasionally medical conditions that place a pregnant woman’s life at risk or increase the risk of pregnancy complications. Knowing this before falling pregnant allows you to make an informed decision about your pregnancy – as well as allowing you and your obstetrician to plan your pregnancy and delivery together as a team.

Pre-pregnancy vitamins

One of the benefits of planning your pregnancy is that it gives you an important opportunity to start taking folate three months before falling pregnant. Folate-supplementation during pregnancy has many health benefits, most importantly it reduces the chance of congenital defects in babies, especially neural tubedefects, such as spina bifida. Most women will need to take 400 mcg of folic acid (folate) per day.

Once you are pregnant you should also take 125 mcg of iodine daily. Iodine deficiency is unfortunately still common in some parts of Australia and has important health consequences for babies.

Women with certain medical conditions may require high dose folic acid (2-5 mg per day). If you have a medical condition, please check with your GP or gynaecologist if you need this high dose folic acid.

You may choose to take your folic acid either as a folate tablet, or as part of a pregnancy multivitamin. Personally I recommend a daily pregnancy multivitamin, such as Elevit™ as these already include iodine, avoiding the need to take anything more than a single tablet.

Other medications in pregnancy

There are some medications that should be avoided in pregnancy, and your GP will be able to advise you on these.

However sometimes the risk to a mother and baby of not taking an important medication is greater than the risk of continuing the medication. For this reason it is important to talk with your GP or obstetrician if you take any regular prescription or over-the-counter medications before becoming pregnant.

The decision to stop, continue or change medications can sometimes be complex, and so is best managed in a personalised and collaborative way between you and your doctors.

Pre-pregnancy vaccinations

I also very strongly recommend that you check your rubella (German measles) and varicella (chicken pox) immunisation status before falling pregnant. This requires only a simple blood test with your GP or obstetrician/gynaecologist.

If you are not immune to one or both of these viruses you should see your GP and get vaccinated as soon as possible. However as these vaccines are not safe to have during pregnancy, you will then need to wait another 3 months before attempting to fall pregnant.

Once pregnant I also strongly recommend that all women receive the annual flu (influenza) vaccine. Pregnant women are unfortunately both at increased risk of catching seasonal flu and also more likely to become seriously unwell if they do contract it.

Pre-pregnancy diet, exercise and stress

Before pregnancy I strongly recommend that you stop smoking, stop drinking alcohol and begin or continue regular exercise. Ideally you should minimise your exposure to stressful environments and sleep deprivation (yes, easier said than done!). Your partner should also do the same.

Sometimes planning your pregnancy and the start or growing of your family can be a great reason further develop a positive and healthy lifestyle. What better way to bring a new life into the world!

So what’s ahead?

Now that you have a plan, great!

Achieving a pregnancy is often fabulous news, but it is also only the first step toward welcoming a healthy baby.

Make sure you see your GP as soon as you are pregnant. You will next need lots of information on preparing and planning for your safe and healthy pregnancy, along with the many rewarding years of parenthood ahead!