8-10 weeks, time for your first visit.
You have missed your period and the stick reads positive…Congratulations.
Regardless of how experienced or how raw, you will still be filled with an intense mixture of emotions…excitement and joy about the life you are creating, overwhelming anxiety and worry about the months and years ahead, even maybe apprehension, uncertainty and fear.
Now is the time to contact me so together we can plan for the months ahead. I will ensure you are prepared as best as possible, both physically and emotionally. You can then happily accept the unknown and enjoy the element of surprise to come.
HOW I CAN HELP YOU
I would first like to meet you and your partner around 8-10 weeks, earlier if you are having problems or have a history of miscarriage or ectopic pregnancy. This appointment will last for 45-60 minutes to allow me to thoroughly assess you and plan pregnancy management based on your specific situation, as well as provide general advice regarding common issues and concerns in early pregnancy.
A full history will be taken to highlight any potential concerns for both your physical and emotional wellbeing, which may impact on you or your pregnancy. I will then perform a physical examination, which will include blood pressure, height and weight. I will also perform an ultrasound scan to ensure your pregnancy is viable and confirm your dates.
Depending on what screening tests you have already had done and on your specific circumstance I will determine what else may be necessary and when. We will also discuss screening for chromosomal abnormalities and the options of screening or diagnostic testing available to you if you choose to have this done.
SO MANY QUESTIONS…
When should I make my first appointment?
Your first visit should be between 8-10 weeks but earlier if you are any concerns.
How often will I see Dr Carmel Cocchiaro?
- After your first visit you will have visits at 14, 20, 24, 28, 30, 32, 34, 36, 37, 38, 39 and 40 weeks.
- You will also be seen by our midwife, at around 34 weeks for a Maternity Care Plan, an extended discussion (approximately 1.5h) about your birth, planning and expectations.
What are the fees?
Please contact us for more information about my Obstetric Fees and what your out of pocket costs will be.
What tests do I need?
It is recommended that all pregnant women have antenatal screening. This includes:
- Complete blood picture.
- Blood group and antibody screen.
- Hepatitis B and C.
- Urine MC&S.
You may require additional screening tests depending on your specific circumstance, including:
- Screening for haemoglobinopathies: sickle cell or thalassemia.
- Bacterial vaginosis: as diagnosis and early treatment <20 weeks may be beneficial for women with previous PTB.
- Varicella, parvovirus, CMV, toxoplasmosis.
- Ferritin and iron studies.
- Vitamin D and folate.
- Early oral glucose tolerance test.
What do I do if I have spotting or pain in early pregnancy?
- Bleeding in early pregnancy can be very distressing but it does not always mean you are having a miscarriage.
- It is very common, affecting about one in four women, many who will go on to have a healthy pregnancy.
- If bleeding is caused by a miscarriage, there is not treatment or therapy that can stop the miscarriage from occurring.
- Ectopic pregnancy, where the pregnancy is growing outside the uterus (usually in the fallopian tube) can also cause bleeding and pain. Without treatment an ectopic pregnancy can seriously impact on your health and fertility.
- If you experience bleeding or pain in early pregnancy, please contact my rooms or the hospital where you are booked after hours or on the weekend so the appropriate investigation and treatment can be started.
Do I need to take vitamins?
- During pregnancy your body needs extra vitamins, mineral and nutrients. The best way to meet both you and your baby’s nutritional needs is to eat and wide variety of nutritious foods and be as healthy as possible as early as possible.
- In some individual groups additional supplementation may be necessary. I will let you know if you fit in to one of those groups.
- For more information see (RANZCOG Vitamin and mineral supplementation in pregnancy (C-Obs 25) Review November 2014-2.pdf)
I’m feeling sick all the time…help!
Medications may be needed to help allow you to maintain adequate oral hydration including:
- Metaclopramide (Maxolon)
- Doxylamine (Restavit)
- Promethazine theoclate (Avomine)
- Prochlorperazine (Stematil)
There are some simple things that can help make you feel better.
- Eat before or as soon as you feel hungry as an empty stomach can aggravate nausea.
- Eat small, frequent, high carbohydrate, low fat meals
- Eliminate spicy, fatty foods instead try dry, high protein foods
- Cold, clear and carbonated fluids are better tolerated (ginger ale or lemonade).
- Vitamin B6 and Ginger Powder taken regularly have both been shown to reduce nausea, dry retching and vomiting in early pregnancy.
Nausea and vomiting are some of the earliest symptoms of pregnancy and can affect up to half of all pregnant women.
Sometimes your nausea and vomiting can be so severe that you are unable to keep anything down and need admission to hospital for IV re-hydration and IV medications.
What food do I need to avoid?
During pregnancy your hormonal changes lower your immune system, which makes it harder to fight off illness and infection. There are some food borne infections that can seriously affect your pregnancy and for that reason some extra care needs to be taken.
You can reduce your risk by:
Avoiding high risk foods
- Unpasteurised milk or food made from raw milk
- Pate, dips and soft cheese
- Raw eggs in food: mayonnaise, mousse, batter
- Raw or precooked meats or poultry
- Uncooked, smoked or chilled pre-cooked seafood
- Pre-prepared salads and coleslaws
Use safe food handling practices
- Keep it cold
- Keep it clean
- Keep it hot
- Check the label
Why aren’t all babies perfect?
- Most of the time your journey thought pregnancy will be smooth and problem free but occasionally things will go wrong. This can cause intense anxiety and distress.
- 2-3 per 100 babies born in Australia and NZ have some kind of significant birth defect and an additional 2-3 per 100 have a minor defect.
What testing is available?
Most babies are born healthy but there is always risk something can go wrong. The risk may be greater for some couples depending on age, lifestyle factors, medical history or a history of a problem before.
Testing is available to identify fetuses with increased likelihood of having certain chromosomal abnormalities, such as trisomy 21 and trisomy 18 and some structural anomalies such as neural tube defects.
There are two kinds of test that can be done in pregnancy:
- Screening tests: Can tell if you are at risk of a baby having a birth defect but will not give definite information about your fetus.
- Diagnostic tests: can tell you if your fetus has a problem.
- First trimester combined screening: For T21 and T18
- This includes a blood test done from 9-13+6 combined with ultrasound measurement of fetal nuchal translucency between 11-13+6
- Second trimester screening: For T21, T18 and NTD
- Blood from 14-20 weeks
- Free fetal DNA: For T21, T18, T13, X and Y
- Blood test from 10 weeks
How much weight will I put on?
- No matter our body shape or size, pregnancy will challenge the way you feel about yourself and how you look.
- Weight gain during pregnancy varies but the average weight gain is between 11.5 and 16kg.
- The usual pattern is 1-2 kg during the first three months, followed by 0.4kg per week or 1-2kg per month during the final 6 months but not everyone follows this pattern.
- Your optimal weight gain during pregnancy will be different depending on your pre-pregnancy weight, if you are underweight at the start of pregnancy you can afford to put on more than the average, if your are overweight you weight gain may need to be less than average.
WHAT TO DO NOW
Here are some dos and don’ts to help try and achieve the best outcome possible and a list of things to bring when you come and see me for the first time.
Book your appointment...
Book your appointment to see me at about 8-10 weeks.
See your GP...
See your GP to obtain a referral and ensure your routine antenatal screening has been done.
Consult your health fund...
Consult your health fund to work out private costs, what your are covered for and what is out of pocket.
Find out the maternity leave...
Find out the maternity leave and payment policy at your work and find out about paternity leave arrangements.
Continue eating a variety of good food...
- Eat a balanced diet with a mixture of fruit and vegetables to ensure you are have adequate vitamin and anti-oxidant levels.
- Prenatal vitamins will help to ensure this.
Maintain a good level of activity...
Pregnancy is physically demanding. You can help manage your changing body shape as well as the demands of pregnancy, birth and early parenting by having a good level of fitness.
Look after yourself...
Try and rest whenever you can, get enough sleep, reduce stress in your work and family life if you can and if possible, try and find time for yourself.
WHAT TO TRY AND AVOID
Stop drinking alcohol
- There is no safe level of alcohol in pregnancy so you should stop drinking now.
- Excessive alcohol consumption may reduce sperm mobility so it is important for your partner as well.
Avoid multivitamins containing retinol
- This is a type of vitamin A that can be harmful in large amounts.
- Tea, coffee and cola drinks all contain caffeine. Large amounts of caffeine may increase your risk of miscarriage. You should try and limit your intake to three cups of coffee per day.
WHAT TO BRING
A list of what to bring
- A referral letter from your GP
- Any recent blood test or ultrasound results
- Record of recent vaccinations if available
- A list of your current medications and doses
- Any letters or referrals from other specialist