How to organise your antenatal care
Posted July 21, 2017
What to do now?
The best thing to do right now is to book in with your GP. At your first visit to your GP you will have an opportunity to discuss various aspects of antenatal care with him/her. You will be urged to commence daily folic acid 500mcg which has been proven to reduce the likelihood of neural tube defects in the baby. Your GP will guide you through antenatal/pregnancy care and suggest booking into antenatal care of which there are various options available.
Types of Antenatal Care
- Public system – The majority of women will opt to give birth in a public hospital. Obstetric care in the public system is of an extremely high quality and will largely be bulk billed provided you possess a valid medicare card. The public hospital will usually be the Angliss Hospital in Upper Ferntree Gully (the Emerald area does not fit into Casey Hospital, Berwick’s catchment) – you should book for antenatal care as soon as possible by visiting the Eastern Health website here.
You have 3 options for public antenatal care to chose:
- Midwife care (most common) – you will receive an appointment to see a midwife at around week 12-14 of your pregnancy
- GP shared care via an accredited obstetrically-trained GP (sadly not at Emerald) – list on is here.
- Obstetrician care – Some women prefer to see the same specialist through their pregnancy (which will incur costs) and then deliver at the Angliss. You can book via the Angliss and then see the specialist in their private rooms – list of obstetricians who provide public system deliveries at the Angliss Hospital is here.
- Private – You may elect to have your baby in a private hospital which offers a little more luxury than public care. This may be an option to those with Obstetric care on their private health insurance policies, but you must be aware that there are other extra costs involved in antenatal care which you should enquire about before booking in. The benefits of being booked into a private hospital for your delivery include having a private room for you and your partner to stay in after the birth and the guidance of a named Obstetrician through every step of your pregnancy. We advise selecting a local private hospital and Obstetrician and then booking in with that specialist for an early appointment. The main options are
- Calculating your dates – important for
- Calculated from the 1st day of your last normal period (LNMP) – can be difficult with irregular periods
- Expressed as weeks and days, eg 6 weeks + 4 days (6 +4).
- Normal pregnancies last about 40 weeks, with 37 weeks onwards being full term and 40 weeks being the expected date of delivery (EDD), EDD can be calculated as LNMP + 9 months + 7 days. Click here for an estimated birth date calculate.
- Pregnancy hormone/βHCG – a blood test to confirm pregnancy is optional – you will have already confirmed by having a missed period and at least 1 positive urine pregnancy test. It would be necessary if there is pain or uncertainty of pregnancy viability
- Routine booking blood tests – blood group, rubella, hepatitis, syphilis, HIV status – will be ordered by the clinician to be done at some point during the 1st trimester (1st 12 weeks)
- First Trimester Screening – Pregnant women are also offered the ‘combined screen’ by their GP which looks at the baby’s risk of having a chromosomal abnormality such as Down Syndrome. The test is a blood test to specifically be done between 10-12 weeks (the routine blood tests can be done at the same time as one blood test) and the result of this is combined with the results of the 1st trimester ultrasound scan (done at 12-14 weeks). The test incurs an out-of-pocket expense of around $100. This test is purely a screening investigation; abnormal results may lead to referral for confirmatory amniocentesis, a biopsy test to check the genetic/chromosomal make up which in itself carries a small risk of miscarriage. For more information click here.
- Non-Invasive Prenatal Testing/NIPT – This is also known as the ‘Harmony Test’, this is an extremely accurate blood test at assessing risk of Down Syndrome and other chromosomal abnormalities (as well as sex of the baby), eliminating the need for amniocentesis. It is available from 10 weeks of pregnancy and needs to be requested by your GP. It has a higher cost at several hundred dollars out-of-pocket, click here.
Your GP or specialist should advise you exactly when these need to be done and give you a request form for these so that you can book in at the radiology clinic. These often incur some costs unless they are performed at a public hospital such as the Angliss.
- 1st trimester viability/early scan – This may be requested after 6 weeks (any earlier the baby is too small to visualise) by your GP or obstetrician but this is not compulsory or necessary unless there are complications or concerns for the baby’s health.
- Nuchal Scan – Mothers will routinely be offered this scan as part of the combined screen which needs to be done at 12-13+6 This is the first formal scan you have and where the exact dates of the pregnancy confirmed by the actual size of your baby.
- Anomaly scan – This main scan takes place at 18-20 weeks. At this stage your baby will have grown to a good size so that most structures such as heart, lungs, limbs etc can be checked. This is the usual stage that you may request to find out the sex of your baby.
- Further growth scans may be organised if there is any concern about the baby’s growth.
At your specialist appointment the midwife/obstetrician will discuss various aspects of pregnancy and antenatal care. You will be offered antenatal classes which start at around 32 weeks and happen on a weekly basis for 6 weeks. Your partner can also attend these classes. The schedule of subsequent appointments will also be discussed. You will receive your antenatal notes at your booking appointment. Please always bring your antenatal notes and a urine sample to each appointment.
It is important to be aware that no one test or scan is an absolute guarantee of a healthy baby.