Monday, 24 November 2014

So you're going to have a baby.... A rough guide of what to do first

A faint pink line, a plus sign, a digital read out that screams PREGNANT. However you first discover that there is a little life growing inside you, it's a moment you'll never forget and comes with a huge range and mix of emotions. After chatting to a few friends (new mums, hopeful mums, not too far off mums and any other life stage centred around 'two becoming three' mums) and reflecting upon my own experience, I've realised that there can be a fair bit of confusion about what you should do when you find out you're pregnant straight away. So here is a rough guide of what to do first (and a bit before and later)...

Note: I've tried to include a few different perspectives here. AND, this information is specifically for women based in NSW, Australia as other states and countries may have different systems and ways of doing things.

Photo credit, Ryan

First: EMBRACE the new season!

Congratulations! It is my personal opinion that no matter what the situation or the circumstances surrounding a pregnancy's beginning, a new little human is an absolute joy and a beautiful miracle. I fully understand, though, that this can be an extremely difficult reality for some and I do want to be sensitive of this. No matter what path your journey takes after your pregnancy is discovered it will forever change you and be a significant time in your life. My number one tip is that whatever emotions surround finding out you are pregnant, embrace and accept the change. Spend time acknowledging the shift that is taking place in your life before barrelling on with the to do list.

For many this discovery will involve celebration. Sharing the news with your partner and those closest to you will be a priority and there are many clever ideas for revealing your pregnancy in creative ways. I do recommend to discuss in depth with your partner who should know when before posting it on Facebook and making it public. There is a higher risk of miscarriage in the first few months and this can lead some to keep it a secret until they are confident the pregnancy will progress well. Usually after the Nuchal Translucency Scan at twelve weeks, and the mark of the end of the first trimester, is a popular time to share the news with others. But do what you feel comfortable with. I found a good rule of thumb was to let people know who you would want support from if something did go wrong. Also note that grandparents-to-be can often be quite sensitive about the timing of pregnancy announcements. I recommend telling parents first to avoid unnecessary offence (it will be the first of many times). 

For those who are experiencing an unwanted pregnancy, as many surprises can be wanted surprises, I would encourage you to take LOTS of time to think through your options and get your head around the pregnancy. If you, or those around you, are struggling to accept the pregnancy I encourage you to seek support which is readily available. Follow the If You Need Help tab on this blog and under the Raising Children Network link there is contact information for counsellors and health professionals who can provide support and guide you through this time.

Second: Choose a health care provider to support you through the pregnancy

There are a few options with this one, but generally, most women see their trusted GP to organise a blood test to confirm the pregnancy as soon as the home pregnancy test comes back positive. (I waited a week after the first faint line appeared and then retested to double check. Really, a blood test is super sensitive, so even if your period isn't due yet, it will pick up the HCG chemical in your blood that means a little bubba is making its home in your uterus, so you don't have to wait and retest like I did.)

The first decision you have to make is whether you will be wanting to go to a public or private hospital. This is the debate in pregnancy and birth conversations and one of the trickier choices you will have to make bar choosing a baby name. In an effort to be concise and cover the all important money question I will try and outline the process of both.

Private Hospital
  • After seeing your GP and getting the good news, having chosen the private hospital you want to have the baby at, ask for a referral to your preferred obstetrician from your GP. Some people choose the obstetrician first and are happy to go to the hospital they work at. 
  • Ring up, book a consultation with the obstetrician and take your referral letter with you. Be prepared to pay the whole fee (could be anywhere from $100-$300) and you can claim it on medicare.
  • Your OB (obstetrician) will direct the rest of your antenatal visits, tests, liaise with the hospital etc.
  • This is only an option if you have private hospital cover with your health insurance that includes obstetrics cover (or if you are quite rich and can pay everything outright). For most private hospitals there is a gap that also must be paid (ball park anywhere from $500 to $5000 out of pocket for all the birth related part AND an epidural will cost you more). 
  • Health insurance does not cover your obstetrician antenatal visits (this is medicare), your scans and tests or the baby's check up before you leave hospital. 
  • You won't be able to get obstetrics cover after you're pregnant either. It is often a 12 month waiting period. (I.e. you must plan ahead).
Please note that this is a rough guide only, some individual hospitals and OBs may work slightly differently. 

Public Hospital
  • Option for anyone and free for those with a valid medicare card. You need to go to the hospital you live in area for (check their restrictions). 
  • Generally you need to call your local hospital and ask to be directed to the antenatal clinic as you want to book in for having a baby there.
  • Your details will be taken and in the NSW Health system, you often get told when to come and what to do by them.
  • OR you can find a participating GP who does shared care with your local hospital (ask around to find a good one, other mums, internet etc). You will need to do a book in visit at the hospital regardless of the care you have. This means you will see your GP for all your antenatal check ups and go to the hospital clinic once.
  • OR you can find a private midwife who does shared care with your local hospital (this is what I did first time and again you need to do a book in visit).
  • OR a newish program is Caseload Midwifery which is essentially the normal midwife care at the public hospital antenatal clinic, but you see the same midwife the whole time and they attend your birth and do your home visits after the baby is born (this is the option I will be aiming for next time).
This is a very rough guide and there is some excellent information about choosing and establishing care with the right provider you are comfortable with on this website: Birth Choices. There are also the options of attending a Birthing Centre, being a private patient in a public hospital (which is more along the private hospital way of doing things and still costs a bit) or home birth. (Midwives will tell you home birth is statistically safe in low risk pregnancies and that is fine. I will tell you that over half the women I know who are mums probably would have died in childbirth, or the baby would have died, if they weren't given prompt medical attention. That is all I will say about that. You just need to be comfortable and informed about your choices.) 

Third: Attend antenatal visits and have routine tests (if you want!)

Now the fun begins. Your first antenatal visit will have you issued with the all important yellow card. This is like your passport for being pregnant. Carry it with you. It has all your pregnancy related info on it and will need to be presented to any health care provider you see throughout your pregnancy. 

You will start by attending monthly visits with your obstetrician or midwife and they will check your progress. Some routine checks include the height of the uterus, baby's heartbeat, blood pressure, urine test, your weight, symptom checklist, how your diet and exercise is going, mental check ups and answering any questions you have. You will have an opportunity to talk about birth plans, organise antenatal birthing classes and anything else you are concerned about. For the first little while you will attend monthly, then fortnightly then in the last 1-2 months you will go weekly. 

There are a few routine, and not so routine, tests and scans that are performed in low risk and high risk pregnancies. This link provides a good overview of the tests and scans you can expect to have suggested throughout your pregnancy. It is important to realise that there are no tests that are mandatory in pregnancy. Some are highly recommended, but there are none that HAVE to be done. A lot of women don't realise this and end up spending money and doing anything they are offered. Consider your family history, age, risk category for your pregnancy and lifestyle before committing to getting every scan and jab on offer. I got the 12 week scan and blood test done, more out of excitement for seeing the baby than wanting to test for any disorders, the 20 week morphology scan which is the most suggested, the glucose test to check for gestational diabetes, a few general blood tests for levels and Rhesus factor and a 33 week scan to check my placenta's positioning. 

Fourth: Enjoy the journey

Nothing I post on this blog can prepare you for the crazy journey that is pregnancy and birth. Here are some final tips:

  • The best advice I received was to trust my own body and instincts and don't worry about anything unless you actually have a REASON to worry. Everything is probably fine.
  • Every pregnancy and birth story is really different. Don't assume anything based on others experience such as your mum's or aunty's traumatic birth or terrible heartburn. 
  • Chat to other mums and once you've made a decision, find a few others who agree with you and can support you in your decision (e.g. public or private hospital, not eating raw meat or not caring etc). Mum judgement is the worst, pregnancy is hard enough without feeling like someone is judging your choices.
  • If you feel like something isn't right or don't feel like your health care provider is listening to you/giving you good care, SPEAK UP and change. Your intuition is the best voice to listen to at this time.
  • Pamper yourself. It's tiring and a huge toll on your body. Take advantage of this time to get extra (or the first?) massage from your partner, get a pedicure, exercise, let others do it for you. I hear when the second comes around you don't quite get the same privileges. 

I hope this has given you some pointers about where to start. And sometimes you, obviously, don't want to go asking at the time you are trying to fall pregnant if you don't want it to be public. 

All the best!

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