Pregnancy and Pre Planning
I understand that not every pregnancy is planned, however, when you are preplanning and looking to maximise the chances of your pregnancy progressing smoothly, here are some things to consider to make it one of the best and most memorable.
Things To Consider
Type of Care
When looking to fall pregnant or considering having children, an important step to consider is how you want to be looked after during your pregnancy. Whether you would like to have care through the public or private hospital systems or get a private obstetrician? These are some of the very important types of care you can look into and find out which one suits your preference.
One important consideration you should reflect on before you are pregnant is the type of care and how you want to be looked after during your pregnancy, and in particular whether you are planning to have care through the public hospital system, or care with a private obstetrician. Care provided through the public hospital system is generally free, although there may still be some costs associated with blood tests, ultrasounds, etc.
If you are planning care with a private obstetrician, you will need to think about doctors fees and private hospital charges. Generally most private health insurance policies will cover your hospital costs, and may cover some but not all of the doctors’ fees. You will need to check your policy carefully to confirm what is covered. If you don’t yet have insurance, you will need to arrange a policy before you become pregnant. Take the time to explore what the different policies offer, as there can be considerable variation. Most policies require you to serve a waiting period before you are eligible for pregnancy-related events, so you will need to ensure that you are aware of any waiting period requirements.
If you are planning to have care through the public hospital system, you may not have much say over which hospital you will attend. Although there may be exceptions in some specific circumstances, you will usually be assigned to a hospital based on where you live. Once at the hospital, you also generally do not get to choose a specific doctor or midwife to look after you, but will be allocated to a team.
Remember when planning to see a private obstetrician, look for recommendation from family, friends or trusted health professionals. A personal recommendation is very helpful, just because someone you know was happy with their obstetrician, it doesn’t mean that you will automatically feel the same way. Do some research as well. You may find that someone has a particular interest or expertise in areas that are relevant to you. This is particularly the case if you have certain medical problems, or are anticipating a higher risk pregnancy. Ultimately, you need to feel comfortable and safe with the person you choose.
One way of helping to decide whether you have found the right person is to have a visit with them before you get pregnant. If you like them and feel comfortable, this will give you confidence for when you do become pregnant. If not, you will know that you need to continue your search. A pre-pregnancy visit will also give you the opportunity to discuss some of the health issues also mentioned below.
You can also arrange one of those with my clinic by getting in touch on the form on this page.
When planning for pregnancy, I always recommend eating a well-balanced diet containing foods from all of the five major food groups is important. It is also important to limit the intake of foods high in added sugars and saturated fats. It is helpful to be aware of these issues before you become pregnant. You should aim to enjoy fruits, vegetables, legumes, meats, fish, milk, yoghurt and cheese regularly.
Something to consider is Fish containing high levels of mercury (shark / flake, marlin, swordfish, orange roughy, catfish) as it should not be consumed more than once per fortnight. Other fish may be consumed once or twice per week.
Pregnant women should aim to avoid foods at high risk of Listeria, – which is a type of food poisoning which can be harmful to an unborn baby. There are many foods that have been associated with Listeria, and avoiding them can be challenging. Luckily, Listeria infection during pregnancy is rare, and most dietary guidelines recommend trying to avoid only the highest risk foods especially during pregnancy.
Some of these include: soft cheeses (including brie, camembert, blue cheeses, ricotta and feta), cold processed meats, bean sprouts, pâtés, raw egg, and pre-prepared salads. Be sure to cook and consume any meat well done rather than rare.
Consult your doctor if you’re overweight and planning a pregnancy. A discussion on an appropriate weight loss program prior to pregnancy is needed as severe dieting and weight loss during pregnancy are not recommended for mothers expecting.
When embarking on a pregnancy, the fitter you are, the better you will cope with the rigours of pregnancy, birth and caring for a newborn baby. Cardiovascular fitness, strength and flexibility are all important, and exercises that help strengthen your abdomen / core and pelvic floor are particularly important. Maintaining fitness during pregnancy is also recommended and will provide additional health benefits to you and your baby.
If you have health issues, you should consult your doctor before embarking on a vigorous exercise program. If you are already pregnant, you should consult a pregnancy care provider to discuss appropriate exercise plans to take in account your stage of pregnancy and personal circumstances.
Feel free to contact my office if you need assistance on this.
4. Other Lifestyle Factors
There is no doubt that if you are a smoker, I would recommend ceasing smoking prior to planning your pregnancy, rather than waiting until you are pregnant until you try to stop.
Smoking is a health risk whether you are pregnant or not. When considering pregnancy, please be aware of the negative impacts of smoking on pregnancy. These can include: Increased risks of miscarriage, preterm birth and stillbirth, effects on fetal growth and placental function. Smoking during pregnancy also increases the risk of SIDS (Sudden Infant Death Syndrome) and childhood asthma, even if you don’t smoke at all after the baby is born.
Although partner smoking may not have such significant risks to the pregnancy, having a smoker in the house can also increase the risks of childhood problems like SIDS and asthma. You should discuss with your partner the benefits of them ceasing smoking, as it can make it much harder for you to stop smoking. If you both stop together you will find it easier, and your family will reap the rewards.
Quitting smoking can be difficult. If you are contemplating pregnancy, you may benefit from speaking to your doctor, or contacting Quitline (137848, 13 QUIT).
I would recommend avoiding alcohol completely during pregnancy. That is because we don’t know if there is a “safe” amount of alcohol consumption in pregnancy, and if so, what that safe level is.
It is certainly the case that regular or heavy drinking in pregnancy has the potential to be harmful to an unborn baby, and should be avoided.
There are no illicit drugs that are considered safe in pregnancy. If you are using any illicit drugs regularly, I would recommend consulting your doctor, or a health professional to discuss the best strategy for managing this issue prior to commencing your pregnancy.
Folic acid supplementation has been shown to reduce the risk of a number of birth defects, including spina bifida. I recommend that you take a multivitamin supplement containing at least 400mg per day, for at least one month before you fall pregnant, and for the first three months of your pregnancy.
Iodine is important as an ingredient for the production of thyroid hormones. Thyroid hormones in turn are responsible for a range of body metabolism functions, and during pregnancy can have an impact on baby’s brain development.
In Australia, iodine intake has decreased in recent years. Seafood, breads, dairy products, seaweed and eggs are good sources of dietary iodine. In addition, for women who are planning pregnancy, who are pregnant, or who are breastfeeding, the National Health and Medical Research Council recommends taking a supplement containing at least 150 micrograms per day.
If you have a pre-existing thyroid condition, these recommendations may not apply to you, and you should discuss your specific requirements with your doctor before commencing a pregnancy.
A number of infections can cause problems if they occur during pregnancy. Some of these can be prevented or their effects minimised by vaccination. These include rubella, chickenpox and influenza (“the flu”). Most people in Australia are vaccinated against these conditions. However even if you have been vaccinated in the past to these diseases, your immunity can reduce over time, and you should consider consulting your doctor to assess your need for vaccinations if you are planning to get pregnant. Some vaccines can be given safely in pregnancy, and others are best avoided during or immediately prior to pregnancy. Your doctor will be able to give you advice as to which vaccines you should have, and their relative safety in pregnancy.
7. Health Check
Having a “check up” before you start trying to get pregnant is often a useful way of optimising your health for pregnancy. There is an opportunity to address any questions you have about the issues discussed above. If you have any health problems your doctor can discuss how to manage these leading into pregnancy. This may also include a review of any medications you are taking to ensure that they are appropriate and safe for pregnancy. Sometimes medications need to be changed, and this is best done pre-pregnancy rather than once you are pregnant.
As your doctor, I would give you the option of doing some blood tests to assess other aspects of your health in preparation for pregnancy. If you are overdue or nearly due for a pap smear or breast examination, it is preferable to get these done prior to your pregnancy. You can also discuss any concerns you may have. If you have had any previous episodes of mental health disorders (eg anxiety, depression, psychosis), developing a care plan is important, as sometimes pregnancy can cause these conditions to worsen temporarily.
You may choose to have your pre-pregnancy check with your general practitioner / family doctor, or with an obstetrician like myself. If you have specific concerns about pregnancy, it may be helpful to see an obstetrician. If you don’t have an obstetrician yet, you can use the pre-pregnancy check up as an opportunity to meet with one that you may be considering, to see if you feel comfortable with them before you embark on your pregnancy with them. If you choose to see an obstetrician, you will need a referral from your general practitioner. If you don’t have a referral, you will not receive any Medicare rebates, and the visit will therefore be more expensive.
Please call my rooms to arrange for a pre-pregnancy consultation.
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