Care in the early stages of pregnancy
Q: My partner and I are thrilled to find out we are having a baby. I am about 6 weeks pregnant, and would love to know if there is anything special I need to do at this stage? – Candice, 28.
A: The first 12 weeks of pregnancy (counting from the first day of your last period) are known as the first trimester. This is a really important time, as although most people won’t know you are pregnant, and you won’t begin to ‘‘show’’ for a few more weeks, your baby is already growing and developing at a huge rate each day. There are a few things that you should do during this stage – but most importantly, I think it is important to keep in mind that women have been getting pregnant since time began: pregnancy is a natural state to be in, so try not to get too hung up on the ‘‘do’s and don’t’s’’, and enjoy it if you can.
Having said that, the first three months can be a time when you feel really exhausted, and for some unlucky women, quite sick – so make sure you get plenty of rest, pull back on work and other commitments if you can, and don’t expect too much from yourself.
Probably the most important practical thing to do during this stage is to work out who your ‘‘lead maternity carer’’ (LMC) is going to be for your pregnancy. This is the person who will not only look after you over the next eight months, but will assist with the delivery of your baby, and keep an eye on you both after your baby is born.
In New Zealand, most people choose a midwife as their LMC – this is either done through your local hospital, or through an independent midwife (a midwife who is working outside the hospital system, but is still able to access hospital services as needed).
I am a strong advocate for choosing midwifery care, especially in uncomplicated pregnancies, without any risk factors – a good, reputable, experienced midwife will provide you with not only wonderful, holistic care for your pregnancy, but will also know when to involve a specialist if things are going a little awry at any stage. If you visit the website findyourmidwife.co.nz you will be able to search for midwives in your area, but first I would talk to either your GP or local friends who may be able to recommend a good one.
If you don’t want a midwife as your LMC, or you have any risk factors at all, your GP will be able to suggest a private obstetrician who you could use instead.
Once you have chosen your LMC, they will arrange their ‘‘booking’’ or introduction appointment for you. This should be in the first trimester, and ideally you will have seen your GP to organise your basic blood tests and perhaps an ultrasound scan prior to this.
Blood tests are essential for everyone – they check out basic things like your blood group and rhesus status, but also make sure you don’t have any latent infections (such as hepatitis, syphilis or HIV) that could be passed to your baby.
At your booking visit, you will get basic checks done including your height, weight, blood pressure, a urine test, as well as answering questions about your past health history to make sure there aren’t any special risks for your pregnancy.
Your LMC will organise your first ultrasound scan (usually at around 12 weeks) if you haven’t already had one, and will be able to talk you and your partner through special ‘‘screening’’ options, such as the combined test for Down’s syndrome, if you’d like to consider having those.
Whilst you are awaiting your first appointment with your LMC, there are a few other things you should be doing: ❚ Folic acid and iodine – ideally before you conceive, but certainly as soon as you know you are pregnant, it is important to take folic acid and iodine tablets. These help the baby’s brain and spinal cord develop normally. Your GP will be able to prescribe these, but you can also buy them over the counter at the chemist. Unless you have any particular nutritional deficiencies, you shouldn’t routinely need any other supplements at this stage of pregnancy. ❚ Diet – try to eat a balanced healthy diet, and avoid raw meats, eggs or seafood; unpasteurised cheeses; liver or pate. Be scrupulous about food hygiene as any food poisoning can pose a risk to your baby. Minimise caffeine. ❚ Physical activity – other than contact sports, you can continue with your usual level of physical activity. Being fit and feeling healthy is really important for both you and your baby. ❚ Medication – paracetamol is safe during pregnancy, as are asthma inhalers, but I would recommend checking with your GP about any other medicine you are thinking of taking. ❚ Smoking and alcohol – if you do smoke, it is essential you stop during the pregnancy, and current advice is also to cut out any alcohol, especially during the first trimester when the baby’s brain is at a crucial stage of development. ❚ Dr Cathy Stephenson is a GP and forensic medical examiner.