PREGNANCY: ANTENATAL CARE
You have a range of options for your antenatal care and delivery, including public or private hospital, birth centre, home birth, midwife, GP or specialist care. Availability and health insurance may limit your options. Despite the apparent differences, the fundamentals of antenatal care are similar, wherever they are offered.
The first antenatal appointment will usually be arranged for when you are seven to twelve weeks pregnant and this visit is usually the longest. You will be asked details of your past history and your family history, as there are some conditions which may affect, or be affected by pregnancy. It is important to know about diseases and genetically inherited conditions which run in your family or your partner’s family. You will be examined by a doctor, who will listen to your heart and lungs, and will usually take a pap smear and perform a pelvic examination. You will also be weighed, give a urine sample, and have some blood tests performed. These include a blood count (checking specifically for anaemia and iron deficiency), and screening tests for hepatitis, syphilis, rubella (German measles) immunity, and your blood group. These tests ate usually done on everyone because certain conditions can cause harm to the baby, and if they are identified, the appropriate management can be started. It is preferable to check for rubella immunity before getting pregnant, and if necessary be vaccinated at least three months before getting pregnant. If you are found not to be immune when you are actually pregnant you can be vaccinated when this pregnancy is over, so you will be immune in the future.
Knowing your blood group is important in pregnancy (but rarely at other times) because there is a condition called Rh immunisation which can affect some pregnancies (see further this chapter).
Appointments for a further visit and any specific tests required will usually be organised. The tests generally include an ultrasound at about eighteen to twenty weeks gestation. The reason behind the timing of this scan, which is usually the only one most women will have during a pregnancy, is that it is the best time to see the development and anatomy of the foetus. If there is a physical abnormality it is highly likely to be visible on this scan. Earlier scans do not give anatomical detail so well. If there is a major abnormality or problem it is better to know about it at eighteen to twenty weeks, rather than later, in case some action is needed. Assessing the gestation of the pregnancy at this stage is accurate to within seven days or so, and will show twins, triplets, etc.
Some practitioners also do a routine test for a bug called group B strep (streptococcus). A cotton-bud swab test is used to find out if this bug is present in the woman’s vagina at twenty-eight weeks gestation. It is a bug which often lives there and does no harm. In pregnancy, however, there is a small chance that during delivery the baby will come in contact with it, and a small number of babies may develop an infection. To prevent this happening, women found to have this bug at twenty-eight weeks can be offered an antibiotic during labour, and the baby can be given a dose of antibiotic when born. This substantially decreases the risk of infection to the baby.
When all of these things have been arranged, you will be given another appointment for about four to six weeks time. Visits for antenatal care are typically spaced about a month apart until twenty-eight weeks, then every two weeks until thirty-six weeks. After that, weekly visits would be recommended.
You will also be weighed and have your abdomen examined to measure the growth of the foetus. When the foetus is over twenty-eight or so weeks, the doctor or midwife will listen to it’s heartbeat, using a special little trumpet-like stethoscope or mini ultrasound machine.
Any abnormalities found in the course of the visits can be investigated, and any incidental problems dealt with. These visits are also when you can ask any questions you might have during your pregnancy, and when you can find out what to expect.
If problems arise during the pregnancy and you need extra medical care, you can contact your own doctor or, if you are attending a public hospital, you will have the facilities of the hospital’s emergency department available twenty-four hours a day. If you need admission to hospital before the baby is due, this can be arranged.
When the time comes to go to hospital to have your baby, you will be cared for by midwives (specially trained obstetric nurses) and your own doctor or a hospital doctor, depending on what type of obstetric care you have chosen. If your baby needs specialist care, a paediatrician can be involved.
A postnatal visit at six weeks after delivery is usually arranged, to check on the health of the mother and baby.
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