If you're planning on having a baby, it might be time to review all aspects of your
lifestyle. The planning stage of any pregnancy is the ideal opportunity to look
at diet, exercise, stress levels, cigarette and alcohol consumption as well as the
use of any medications.
Preparing for pregnancy
Pre-conception counseling
If you have a significant, underlying medical condition, it's important to seek
pre-conception counselling.
"In cases where women need specialist advice about the effect of their condition
on pregnancy, counselling is available at hospitals," says Dr Graeme Hughes, Senior
Lecturer in Obstetrics and Gynaecology at the University of NSW, Visiting Medical
Officer at the Royal Hospital for Women in Sydney and Clinical Director of IVF Australia
North Shore.
Your doctor should also confirm which forms of medication are safe to use during
your pregnancy.
Whether you're on medication, or not, Dr Hughes advises having a rubella test to
make sure you are immune to German measles, having screening tests for HIV and hepatitis
and quitting smoking before you get pregnant.
All women who are planning a pregnancy are also advised to take 0.5mg of folic acid
daily, up to three months in advance of trying to fall pregnant. This will help
to reduce the risk of a group of neurological conditions called neural tube defects
(such as spina bifida).
Fertility
In Australia, three out of five couples conceive within six months of trying, with
one in four couples taking between six and 12 months. Current statistics show that
one in eight Australian couples having regular, unprotected sexual intercourse fail
to conceive within a 12-month period, which may mean there is a problem.
Miscarriage occurs in 20-25 per cent of pregnancies, with 80 per cent of this figure
occurring in the first 12 weeks. It is believed that most early miscarriages result
from a chromosomal problem. If you have already suffered a miscarriage, try not
to get too anxious about your next pregnancy. Doctors say you are not necessarily
at increased risk of losing the baby.
Assisted conception
There are many causes of infertility, including problems with the production of
sperm or eggs, problems with the fallopian tubes or uterus, endometriosis, frequent
miscarriage and hormonal and auto-immune (antibody) disorders in men and women.
Twenty per cent of infertility cases are unexplained, however maternal age can be
a significant factor.
There are various options for couples looking into assisted conception. The choice
of treatment will be based on the difficulties facing the couples themselves, as
well as the findings of the investigating gynaecologist. The most common technique
is IVF-ET (in-vitro fertilisation and embryo transfer).
IVF-ET involves the woman having a series of hormone injections, which stimulate
the ovary to produce eggs. Next, several eggs are removed from the ovary using an
ultrasound guided technique. These are fertilized with sperm in a laboratory and
a small number of embryos are placed in the womb, where implantation and pregnancy
will hopefully occur.
According to Dr Stephen Steigrad, director of Reproductive Medicine at the Royal
Hospital for Women in Sydney, IVF has a pregnancy rate of 35-45 per cent for each
cycle of treatment in women under the age of 40 but there is an average 20 per cent
rate of early pregnancy loss.
There is no official upperage limit for participating in an assisted conception
programme. However the success rate decreases with age. A woman who conceives after
the age of 45, for instance, has a 55 per cent chance of losing the pregnancy within
the first three months.
The emotional burden on couples seeking assisted conception can also take its toll,
which is why counselling is offered as part of the treatment.
Pre natal care
Once your pregnancy is confirmed, usually at the six or eight-week stage, your doctor
will conduct a series of tests to check for such things as haemoglobin and rubella
status.
During pregnancy there are various sources of care to choose from, including care
by an obstetrician, general practitioner, midwife, or a combination of these practitioners.
Talk to your doctor, to friends, and to your local health centre to get information
about which may be the best option for you.
Regular visits to the caregiver you choose to monitor foetal progress, as well as
your health, start between eight and 14 weeks of pregnancy. These visits are usually
monthly until 28 weeks, then fortnightly, then weekly from 37 weeks.
Delivery suite or birth centre
Before deciding on the best place to give birth, you can tour hospitals and birth
centres. Women who want to experience a natural birth, or have considered a home
birth, often find that a birth centre at a hospital might be the best option. That's
because emergency facilities are at hand if necessary and you can be transferred
to a delivery suite if labour is more difficult than anticipated. Usually however,
she can experience labour and delivery in a homelike environment.
Antenatal classes
Many hospitals, birth centres and private practitioners run education programmes
for individuals and couples ranging from one-day workshops to eight-week courses.
Ask about the focus and philosophy behind the programme before you sign up as these
vary enormously. Classes usually commence at 28 weeks of pregnancy and are held
either privately, at hospitals, or at community venues.
Caesarian Section – what you need to know
At around 25 per cent, Australia has a relatively high caesarean-section delivery
rate in world terms. The rate of caesarean deliveries varies between hospitals and
there is a higher rate occurring among privately-insured patients.
Unfortunately, because of the surgery involved, there is a higher risk of problems
with a caesarean-section delivery than with a natural birth.
Caesarean section is often chosen as a means to reduce risk to the baby if the labour
or pregnancy are not progressing as they should.
Elective caesareans are planned during pregnancy and may be indicated for situations
such as:
- Malpresentation, e.g. if the baby is lying horizontally
- If the baby is sick or has restricted growth
- Placenta praevia, whereby the placenta is obstructing the birth canal.
Emergency caesareans are not planned but may be necessary when there is:
- Foetal distress
- Labour fails to progress, e.g. the cervix does not dilate or the baby does not progress
down the birth canal.
Drugs in pregnancy
Medication
If you are on regular medication, seek the advice of your obstetrician or GP if
you are already pregnant.
Many forms of medication can still be taken during pregnancy, including insulin
for diabetics.
If you need painkillers during pregnancy, paracetamol is the recommended choice.
Aspirin and non-steroidal anti-inflammatories (used for conditions such as arthritis)
should be avoided, especially after the 30th week.
Recreational drugs
Alcohol
Alcohol passes easily through the placenta from the mother's bloodstream into her
baby's blood. So there's no recommended safe level of alcohol use during pregnancy,
as alcohol can cause damage to the unborn child.
Tobacco
Smoking by pregnant women is associated with low birth weight and premature birth,
as well as higher rates of respiratory illnesses in young children. So, please,
just quit.
Other Drugs
Not all illicit drugs result directly in birth defects. However cocaine use is thought
to be linked to a small head circumference and the use of narcotics often results
in the newborn suffering withdrawal symptoms and requiring intensive care after
birth. For these reasons, illicit drugs should not be taken during pregnancy. Consult
a drugs-in-pregnancy service or your doctor for help.
Age
Older women do have a slightly greater risk of having a baby with a chromosomal
abnormality. For this reason prenatal diagnostic tests are offered to women over
35 (or in some places over 37). They may also experience a slightly higher rate
of hypertension during pregnancy and caesarean-section deliveries.
Prenatal tests
A range of tests can be conducted at certain times during pregnancy to detect abnormalities
in the foetus. If you fall into an at-risk group, you may be offered Chorionic Villus
Sampling, Maternal Serum Testing and amniocentesis.
Ultrasound
First performed at around the 10-week stage, this checks the age of a pregnancy,
the number of babies, physical development, and identifies abnormalities of the
spine or organs. Ultrasound uses high-frequency soundwaves transmitted through the
abdomen or vagina via a transducer to create an image of the developing baby in
the uterus.
Chorionic Villus Sampling (CVS)
Pregnant women aged 35 or 37 and over, who have previously had a child with a chromosomal
abnormality such as Down Syndrome, or who are at risk or whose partners are at risk
of passing on certain inherited disorders, may be offered this test. CVS involves
the removal of placental tissue through the vaginal or abdominal wall under ultrasound
guidance.
The test is usually done between ten and 12 weeks of pregnancy. While the risk of
miscarriage associated with CVS is less than two per cent, doctors say that it's
important to realize that some of these miscarriages would have inevitably occurred.
Maternal Serum Testing
This tests the mother's blood and determines the level of three proteins produced
in pregnancy. Abnormal levels indicate the likelihood of a neural tube defect or
certain chromosomal abnormalities.
Maternal Serum Testing is done between 15 and 17 weeks and can indicate the risk
of having a baby with a birth defect. If the result indicates a high level of risk,
an ultrasound or amniocentesis may be recommended.
Amniocentesis
As with CVS, amniocentesis detects chromosomal abnormalities and some inherited
disorders. The test can be helpful for a similar group as CVS and for couples who
are in a high-risk group for having a child with a neural tube defect.
This procedure is done between weeks 14 and 19 and involves the insertion of a fine
needle into the uterus through the abdominal wall, with ultrasound monitoring the
position of the needle, to collect a sample of amniotic fluid which contains foetal
cells. It also has a small risk of miscarriage.
If an abnormality is confirmed, counselling will be offered to help you decide whether
to continue with the pregnancy.
Conditions aggravated by pregnancy
Diabetes
Diabetes in pregnancy may be pre-existing or gestational. If you have pre-existing
diabetes you need to seek pre-conception counselling to help you optimize control
of sugar levels and minimise risks.
Gestational diabetes refers to raised sugar levels or resistance to insulin that
develops during pregnancy. In severe cases insulin injections may be required.
Women with either category who have poorly controlled sugar levels are at risk of
having a very large baby.
Hypertension (High Blood Pressure)
Women with pre-existing hypertension are more likely to see their condition worsen
during the later stage of their pregnancy but the good news is that blood-pressure
medications help. Women with hypertension are at increased risk of developing superimposed
pre-eclampsia, where high blood pressure may lead to kidney or placental dysfunction.
Your obstetrician and physician will usually consult to ensure blood pressure is
well managed. High blood pressure that develops towards the end of pregnancy may
be pre-eclampsia. This condition requires close medical supervision before and during
labour.
Epilepsy
Women with epilepsy may find that they require more anticonvulsants during pregnancy.
Additionally, some drugs are not safe during pregnancy, so pre-conception counseling
is recommended.
Delivery
Whether labour occurs in a delivery suite or birth centre, the primary caregiver
during a normal delivery will be a midwife. It is her job to monitor the progress
of the labour and to provide support.
In Australia, the overall perinatal mortality rate (i.e. death at or soon after
birth occurs) is extremely low - at less than one per cent.
Pain management
There are various ways to help relieve the pain experienced during labour including
mental preparation, hot packs, showers, nitrous oxide gas, injectable drugs such
as pethidine, and epidural anaesthetic or analgesia.
Most birth educators recommend that you have a written plan for dealing with pain,
whether you want help from the beginning, or only as a last resort.
Assisted delivery
If any difficulties are encountered during the second stage of labour, for instance
if the baby is in distress, assisted birth may be necessary with either forceps
or a vacuum extractor (ventouse).
Post-natal care
In Australia, women generally remain in hospital one to six days after giving birth.
No matter how long you stay, you and your baby will be checked by a midwife or doctor
before you're discharged and you'll receive a range of information about postnatal
care.
