Pregnancy

Pre-Pregnancy

Pre-pregnancy counselling is a counselling session conducted before you conceive, and is beneficial for the mother as well as the baby during the term of pregnancy. It helps in checking for possible risk factors during pregnancy and also gives a way to resolve any medical issues you may have before you become pregnant. Pre-pregnancy counselling and care will help you to become physically healthy and emotionally strong before you enter into the phase of pregnancy.

What happens during a pre-pregnancy counselling session?

You can discuss and clarify with your doctor, all the things that concern you before you get pregnant, like starting prenatal vitamins, diet or any hereditary health issues. Many important points will be discussed during your pre-pregnancy counselling session. They include:

Reproductive history

You doctor will discuss your menstrual history, use of contraceptives, any previous sexually transmitted diseases, vaginal infections and Pap test results.

Medical and surgical history: You should inform the doctor about any past health problems so that this can be controlled while you plan your pregnancy. Any past surgeries or hospitalizations should also be brought to the doctor's notice.

Current medications

Discuss with your doctor regarding any prescription, over-the-counter medications or herbal supplements that you may be currently taking. This can help the doctor plan your medications so as to prevent any potential problems during your pregnancy.

Weight

It is always better to have an ideal weight before you conceive. Gaining weight if you are underweight will reduce the risk of having a low birth-weight baby, and reducing weight if you are overweight will prevent the risk of high blood pressure during pregnancy.

Workplace and home environment

Your doctor will discuss potential hazards to conception or maintaining a pregnancy, such as exposure to lead or certain toxic solvents, radiation and cat faeces.

Lifestyle

The effect of certain habits like alcohol consumption, smoking and use of recreational drugs on pregnancy will be discussed. You and/or your partner may be advised to stop these habits for a healthy pregnancy.

Exercise

Inform your doctor about the type of exercises you perform or if you don't exercise. Based on this, you may be advised to continue normal exercises during pregnancy until your doctor suggests otherwise.

Diet

Having good dietary habits is beneficial during pregnancy. You will be advised to consume food rich in folic acid, calcium, fibre and other nutrients, and reduce the intake of caffeine, which is present in coffee, chocolates, soft drinks and medications, before getting pregnant.

Family health history

Inform your doctor about the presence of hereditary medical conditions and multiple births in the family.

Prenatal vitamins

You should start taking folic acid supplements before you conceive, as folic acid reduces the chances of neural tube defects in your baby.

Advice for older women

Women older than 35 years of age will be advised on the risks of infertility, abnormalities in the child and pregnancy complications, such as miscarriage and labour problems.

Your doctor may also recommend:

• Physical exam of your abdomen, heart, breasts, thyroid and lungs
• Pap smear and pelvic examination
• Lab tests to screen for hepatitis, HIV, rubella, syphilis and other conditions
• Chart menstrual cycles to monitor ovulation and determine the most favourable time to get pregnant
• Advise appropriate vaccinations against rubella or chickenpox, and recommend delay in conception for a month
• Conduct genetic counselling for older mothers or those with a risk of hereditary diseases to help you understand the chances of birth defects or intellectual disability in the child.

Pregnancy Care

What is Shared care?

Shared care with a local doctor provides an option for women to have some of their pregnancy care with their GP and some visits at the hospital’s antenatal clinic (or midwives’ clinic or birth centre).

Essentially, shared care with a local doctor is usually an option for women who have no pre-existing health conditions (such as diabetes) and whose pregnancies are progressing relatively normally with one baby (no twins or more). The local doctor would seek advice from an obstetric registrar or consultant at the hospital you are booked into if there were any health concerns or if complications arose. If complications do develop (such as high blood pressure, bleeding during pregnancy or the labour starting prematurely) then your care will most likely be transferred from the shared care arrangement to the doctors in the hospital’s antenatal clinic. Policies and guidelines for what is acceptable for care by local doctors will vary from hospital to hospital.

Shared care can be a convenient option for women who have a good relationship with their local doctor and find travelling to the hospital difficult (especially if they have other children). Most shared care arrangements require the GP to be accredited by the hospital you are attending.

If you require the services of a dietician, social worker, genetic counsellor, physiotherapist and childbirth educator, your local doctor will usually refer you to the services provided by the hospital you are booked into or services in the local community.

Pregnancy visits

Some of your pregnancy visits will be done at your local doctor’s rooms, and some will be done at the hospital by your chosen caregivers (antenatal clinic, midwives’ clinic or birth centre). Each hospital usually has their own recommended guidelines for how often you see your local doctor and how often you come to the hospital. Your GP may take bloods and order ultrasounds or these may be done by the maternity service at the hospital (depending on when your visits are scheduled throughout the pregnancy).

The Birth

Your local doctor will not be involved in your labour and birth.

Pain relief options

Pain relief availability will depend on your birthplace and will be in line with the care arrangements you have made with your hospital.

Postnatal care

Postnatal care will be in line with the care arrangements you have made with your hospital. Local doctors do not provide postnatal care home visits if you decide to go home early, but the hospital midwives can provide this.

6 to 8-week postnatal check

You can go back to your local doctor for your 6 to 8-week postnatal check or you may prefer to see a caregiver at the hospital, such as the antenatal clinic, midwives’ clinic or birth centre.