Speaker 1: Welcome to the kick your Expert led podcast, helping you
Speaker 1: explore and learn everything about getting pregnancy, birth, and becoming
Speaker 1: a parent.
Speaker 2: On the podcast and our online pregnancy program, grow My Baby,
Speaker 2: we share my experience of helping more than four thousand
Speaker 2: babies to be born and.
Speaker 1: Our experience of running a women's health clinic and parenting
Speaker 1: for boys.
Speaker 2: We're here to help everyone to feel empowered in pregnancy
Speaker 2: and birth with real life, practical information.
Speaker 1: Welcome everyone, I'm Bridget Maloney, and today we're going right
Speaker 1: back to one of our very first episodes, what to
Speaker 1: do after you get those two lines on a p
Speaker 1: and the stick. Often it's quite a daunting time you think, gosh,
Speaker 1: what I do next? And what we've done is we've
Speaker 1: broken it up into a can you actually trust the
Speaker 1: pe on the stick tests? Are they accurate? Or do
Speaker 1: you need to go and see a GP? And then
Speaker 1: when you go and see your GP, what information should
Speaker 1: you take to that visit? And so what we've done
Speaker 1: since the very start is we've developed a downloadable checklist
Speaker 1: that is free and you can get that from our
Speaker 1: website and it's a just pregnant check list and our
Speaker 1: website is grow mybaby dot com dot au. So hopefully
Speaker 1: you've picked up this episode because you're either wanting two
Speaker 1: lines on the p on a stick or you've just
Speaker 1: found one. So if you've just found one, congratulations, listen
Speaker 1: on and hopefully you'll get lots of good tips from
Speaker 1: this episode. All right, well, let's go back, you know what,
Speaker 1: eight months to when you first find out you're pregnant. Now,
Speaker 1: we all have a love hate relationship with these pe
Speaker 1: on the stick things. You know, every woman at some
Speaker 1: stage in her life when she's trying to start a
Speaker 1: family has got the box of p on the sticks. Yeah. Anyway,
Speaker 1: so we've done our We've got two lines. And by
Speaker 1: the way, it gets asked of us a lot, doesn't it.
Speaker 1: You know, even if there's a faint second line on
Speaker 1: a pe on a stick, you're pregnant. Yeah.
Speaker 2: Read the box to make sure what a positive test
Speaker 2: is supposed to look like. But on the two line ones,
Speaker 2: even a faint second line is pregnant.
Speaker 1: Yeah.
Speaker 2: The tests are extremely accurate and very very very sensitive.
Speaker 2: So they'll pick up levels of beta hCG, which is
Speaker 2: the pregnancy hormone, when the level reaches about five and
Speaker 2: in early pregnancy the level might be fifty thousand. Yeah. Wow,
Speaker 2: So they'll turn positive as soon as that pregnancy hormone
Speaker 2: is present in the urine, which is as early as
Speaker 2: a couple of days before the miss period.
Speaker 1: Wow. So I can actually start testing just days after conception.
Speaker 2: No, yeah, well a few days before the So povulation
Speaker 2: happens in the middle of the cycle and then the
Speaker 2: little time takes for sperm to meet egg and then
Speaker 2: a little time for them to get together and come
Speaker 2: down into the uterus and implant into the wall of
Speaker 2: the uterus. But there's some bitter hCG pregnancy hormone present
Speaker 2: even before the missed periods, So even before you know
Speaker 2: you're pregnant because you're over due. Yeah.
Speaker 1: Well yeah, all right. So we talked a little bit
Speaker 1: last podcast about you know, just any generic pregnancy test,
Speaker 1: So any cheap pregnancy test will pick that up.
Speaker 2: Yeah. They're pretty simple, and I mean there's some fancy
Speaker 2: ones that try and tell you how many weeks you
Speaker 2: might be pregnant and so forth. But let's say that's
Speaker 2: a couple who are trying for a pregnancy, and they're
Speaker 2: monitoring their dates and they know precisely when to look Okay,
Speaker 2: as soon as the periods chew on one day and
Speaker 2: it's not there, then that couple will look and all
Speaker 2: you need is a yes no test. Yeah, and it
Speaker 2: doesn't have to be fancy or expensive.
Speaker 1: Yeah, well, how exciting it is. Mostly it's exciting. I
Speaker 1: know that sometimes a positive pregnancy test isn't looked or
Speaker 1: hoped for, but mostly it's exciting. So you've got your
Speaker 1: positive pregnancy test. How long do you wait before you
Speaker 1: see your GP?
Speaker 2: Well, I think think that one of the will return
Speaker 2: to this again and again, but one of the great
Speaker 2: ideas is to have already been to see local doctor
Speaker 2: before you get that positive p hon a stick test,
Speaker 2: so that a lot of the things are already sorted out.
Speaker 2: And by that I mean that you've had a chat
Speaker 2: to the GP about being on some folate supplementation, that
Speaker 2: your protection against rubella has been has been checked or
Speaker 2: boosted if it was thought to be inadequate, and perhaps
Speaker 2: even had a conversation with the doc about care models,
Speaker 2: so that you know a lot about what to do
Speaker 2: when you when you when you already get that that
Speaker 2: positive test. But let's say it was a bit of
Speaker 2: a surprise and that that pre pregnancy visit hasn't happened.
Speaker 2: So the things that are important at that stage once
Speaker 2: you get that positive p test is that is that
Speaker 2: you're on some pregnancy multivitamin or at least some folate supplementation.
Speaker 2: And that's when we make a visit to go and
Speaker 2: see our GP and hopefully getting to see them at
Speaker 2: about the six weeks mark.
Speaker 1: Okay, And what is the six week mark? Is that
Speaker 1: from the first day of your last period.
Speaker 2: Yes, excellent. So that's a really important question. So let's
Speaker 2: make sure we're all on the same page about that.
Speaker 2: When we talk about six weeks pregnant, we mean six
Speaker 2: weeks from the last period, not six weeks since the
Speaker 2: ovulation or six weeks since intercourse or six weeks since
Speaker 2: we got the positive pregnancy test. We mean six weeks
Speaker 2: from the last period.
Speaker 1: Yeah.
Speaker 2: And this is an old fashioned idea of it. It dates
Speaker 2: back to the days where there were no ultrasounds and
Speaker 2: there was no great understanding of the hormonal basis of
Speaker 2: ovulation and so forth, so that all we knew were
Speaker 2: the dates. Yeah, And a woman was said to be
Speaker 2: ten weeks pregnant if there had been ten weeks since
Speaker 2: her period, because that's that's all we can know for sure.
Speaker 1: Yeah, that's right. So you go to your local doc.
Speaker 1: And we know from our experience in our practice that
Speaker 1: there are many many women who actually don't have a
Speaker 1: local doctor. You know, they've been for years. They've either
Speaker 1: moved around and they haven't sort of picked up on
Speaker 1: a GP that they go to regularly. And let's face it,
Speaker 1: so many women are just healthy and all you need
Speaker 1: to pop to the doctor for in those days is
Speaker 1: you know, maybe the treatment of the odd uti or something,
Speaker 1: and your head down to your bulk billing twenty four
Speaker 1: hour clinic and you haven't really built that rippor or
Speaker 1: that relationship with the doctor.
Speaker 2: Absolutely, and I think that's a pretty common scenario these days.
Speaker 2: So you really only need to see the local doctor
Speaker 2: that six week mark to have a talk about those
Speaker 2: big ticket things FOL eight and so forth, get some
Speaker 2: pregnancy blood tests, organized the first round of blood tests,
Speaker 2: and ideally arrange for an early scan, and that can
Speaker 2: be done through any local doctor. It's really nice if
Speaker 2: you've got an established local doctor who can go and
Speaker 2: see because building up a relationship with that person is
Speaker 2: a terrific thing to do, not only during the pregnancy,
Speaker 2: whether you're having your care as shared care with that
Speaker 2: doctor or shared care with a midwife, or shared care
Speaker 2: with a consultant obstetrician, the GP wants to see you
Speaker 2: in pregnancy and help to look after you. And then
Speaker 2: when you're got a newborn, you're never at the dock
Speaker 2: more than.
Speaker 1: Yeah, yeah, that's right. It seems like every sniffle you're
Speaker 1: down there because you really, you know, it's such unknown territory.
Speaker 2: You're nervous, and a rash and a running nose. You're
Speaker 2: at the dock a bit. And a lot of people
Speaker 2: get their vaccinations for the baby through the local dock
Speaker 2: as well. So if you're a client of an established clinic,
Speaker 2: even if it's not the same dock every time, it's
Speaker 2: at least the same practice. That's a really nice thing
Speaker 2: to be thinking about it this early stage.
Speaker 1: All right, So you've got an appointment with your local doctor.
Speaker 1: It's six weeks. What do you have to tell them?
Speaker 2: Well, what they want to know at that stage is
Speaker 2: just back to basics. Is your history? Is this your
Speaker 2: first pregnancy? Are you pleased to be pregnant? Before I
Speaker 2: was a specialist obstetrician, I was a GP for a
Speaker 2: little while many years ago, and that was the phrase
Speaker 2: that I'd worked out was a tactful way of opening
Speaker 2: the discussion. And if someone's not pleased to be pregnant,
Speaker 2: then it's a whole different discussion.
Speaker 1: Yeah, that's exactly right.
Speaker 2: So if we open with are you pleased to be pregnant?
Speaker 2: Then yes, of course, we've been trying to get pregnant
Speaker 2: for three or four months and tracking our povulation and
Speaker 2: we're thrilled. Then there'll be some early questions about the
Speaker 2: women's medical history and also histories for the partner family history,
Speaker 2: whether there's any body in the extended family here any
Speaker 2: unhealthy or unusual babies, whether the woman or her partner
Speaker 2: have any issues with drugs and alcohol. I think these
Speaker 2: days it's very important that we get in early and
Speaker 2: ask people about things like family violence. Family violence is
Speaker 2: a problem that gets worse in pregnancy, and.
Speaker 1: Then that might be kind of quite confronting for someone
Speaker 1: that's just come in with really happy news that they're pregnant.
Speaker 1: Why do you actually ask them?
Speaker 2: Well, we don't have to go You don't have to
Speaker 2: ask that up front, right, Okay, So what I say
Speaker 2: to my students is, don't forget to say congratulations, yeah,
Speaker 2: oh my god, and be happy, be happy for the patient.
Speaker 2: But at some point we do need to ask about
Speaker 2: those those serious things, those negative things. That's part of pregnancy.
Speaker 1: Care, right, I would imagine too. Another thing that you'd
Speaker 1: be asking about is their mental health.
Speaker 2: Absolutely, so people with a hit. Let's let's use that
Speaker 2: as a great example. A one with a history of
Speaker 2: depression anxiety, for example, which is common. She might be
Speaker 2: on a medication at that time, which is okay for
Speaker 2: her to be on in the first few weeks of pregnancy,
Speaker 2: but may not be an ideal thing to be on
Speaker 2: for the whole pregnancy. So we like to see her
Speaker 2: at the start, so we can say, fine, let's change
Speaker 2: it from drug X to drug why that's got a
Speaker 2: better pregnancy safety profile. We also know that pregnancy can
Speaker 2: be a challenging time for people, for anybody, but also
Speaker 2: for a woman with a history of depression and anxiety,
Speaker 2: So we would say, how are you coping? Are you pleased?
Speaker 2: Is your family pleased?
Speaker 1: Have you got any sort of support mechanisms? Absolutely?
Speaker 2: And then if the let's say that woman, she's been fine,
Speaker 2: she's been totally fine. Mental health for a couple of years,
Speaker 2: but before that she'd had some issues. Well, this might
Speaker 2: be the perfect time to reconnect with her psychologist, go
Speaker 2: back over the principles of the cognitive behavior therapy. Happy
Speaker 2: thoughts lead to happiness, not to go down negative thought spirals.
Speaker 2: And because the pregnancy itself, it's a funny time hormonally,
Speaker 2: it's a time of great change in flux, and you know,
Speaker 2: it's a time when mental health problems be really triggered.
Speaker 1: I could imagine you know it is you question everything
Speaker 1: and you're so anxious about you know, right now, but
Speaker 1: also the future. Like there's a lot coming onto your plate,
Speaker 1: isn't it. It's not just that you're growing a baby.
Speaker 1: It's like, you know, you're lifestyle is going to change,
Speaker 1: your relationship with your partner may or may not change,
Speaker 1: And all of those things seem to sort of just
Speaker 1: come in not a person.
Speaker 2: Yeah, and that's not those aren't things that are going
Speaker 2: to change for someone with a history of mental health problem.
Speaker 2: That's going to change everyone.
Speaker 1: Everybody, that's right, Yeah, all right. What other sort of
Speaker 1: medical history is your GP interested.
Speaker 2: In any health problems you've had in the past, be
Speaker 2: they medical, law, surgical, asthma, epilepsy, diabetes, thyroid, history of operations, tonsils,
Speaker 2: gall bladder.
Speaker 1: Really what would tonsils and gallbladder have.
Speaker 2: To do with Well, let's say, for example, I had
Speaker 2: my person has a history, I had my gall bladder
Speaker 2: out and I had a severe anesthetic compemation. We need
Speaker 2: we want to know that. We want to know what
Speaker 2: that was and how did you go? And let's say
Speaker 2: cut forward eight and a half months you have a
Speaker 2: cesarian section. I want to know what the anesthetic problem was.
Speaker 2: So everything's relevant. It might not seem so, but everything
Speaker 2: we're going to ask at that early stage is relevant
Speaker 2: and there will be a reason method in that madness.
Speaker 2: So absolutely, medical and surgical history, mental health history, lifestyle issues, drugs, alcohol,
Speaker 2: and it's all part about building a picture which even
Speaker 2: as early as that first visit and what's going on
Speaker 2: in your caregiver's mind is stratifying the risk. Is this
Speaker 2: a person with a complex medical history where the pregnancy
Speaker 2: is going to make a difference to the medical problems
Speaker 2: they've already got, Plus the medical problem is going to
Speaker 2: make a difference to the pregnancy. And that's a complex person.
Speaker 2: And we might say to that person, well, this is
Speaker 2: all looking a bit tricky. Perhaps we'll get you off
Speaker 2: to consultation with an obstrition straight away, because you've got
Speaker 2: a lot going on versus somebody who's totally fine, regular cycles,
Speaker 2: history of perfectly good health, normal childhood vaccinations, who's got
Speaker 2: noash's door. And you might say to that person, congratulations, fantastic.
Speaker 2: Let's organize a dating scan and you can go and
Speaker 2: book in at the public anti natal clinic in whenever
Speaker 2: they'll see you, yep. And if that's not till fifteen weeks,
Speaker 2: don't matter, okay, yep. So we're trying to work out
Speaker 2: the appropriate place to send people and the appropriate timeframe
Speaker 2: to send them there.
Speaker 1: So when you know, you often think that you have
Speaker 1: to go to the doctor because you need a blood
Speaker 1: test to confirm the pregnancy.
Speaker 2: Is that the case, Yeah, you don't. You don't need
Speaker 2: a blood test to confirm a pregnancy. So the urine
Speaker 2: test is extremely accurate. And if it says you're pregnant,
Speaker 2: you're pregnant. It doesn't say that you're not going to miscarry,
Speaker 2: or even that it's not a neck topic pregnancy that's
Speaker 2: stuck in the tube rather than the uterus, but does
Speaker 2: say you're pregnant. So the blood tests are not just
Speaker 2: to confirm that a healthy person with a normal pregnancy
Speaker 2: is pregnant. We already know that from the positive urine test,
Speaker 2: and an ultrasound at six weeks will show us that
Speaker 2: the pregnancy is in the uterus. My heart's beating, So
Speaker 2: that person certainly doesn't need a blood test that counts
Speaker 2: up the amount of pregnancy hormone. That's called a quantitative
Speaker 2: beta hCG, and that gives you a number like the
Speaker 2: number might be one thousand or twenty thousand. Those blood
Speaker 2: tests are for where the situation is not clear. So
Speaker 2: for example, we do an ultrasound at six weeks and
Speaker 2: the woman's pregnant, the uters is empty, and we think, okay,
Speaker 2: what are possibilities. It might be an ectopic pregnancy, might
Speaker 2: be somewhere else. It might be an early miscarriage, or
Speaker 2: it might be that we're earlier than we think and
Speaker 2: that just hasn't had a chance to show up in
Speaker 2: the uterus yet. Well, if we get a pregnancy hormone level,
Speaker 2: that will help us answer that question.
Speaker 1: Yeah, right, so that's that beta hCG.
Speaker 2: Yeah, and that might do two of those in a row.
Speaker 2: And if we do it on a Wednesday and it's
Speaker 2: a thousand, and we do it on a Friday and
Speaker 2: it's two thousand, then that's doubling normally every forty eight hours,
Speaker 2: and that's a sign of healthy. If it was falling
Speaker 2: over that forty eight hours, probably a miscarriage. Yeah, staying
Speaker 2: about the same over that forty eight hours might be
Speaker 2: a topic. So that's what those numbers are for. But
Speaker 2: they're not really to confirm a normal pregnancy, and they're
Speaker 2: not very useful to conform a normal pregnancy, because if
Speaker 2: you're ten weeks pregnant, the normal range of quantitative beta
Speaker 2: hCG might be five thousand, it might be might be
Speaker 2: twenty thousand.
Speaker 1: And it's different for every woman, isn't it. So there's
Speaker 1: no point in comparing yourself to anybody else.
Speaker 2: No, And it doesn't predict outcomes like that.
Speaker 1: Right, hCG, what does it stand for? What's that acronym?
Speaker 2: Oh B is for beta. That's just like the Greek alphabet.
Speaker 2: There's an alphab hCG and a beta HG and H
Speaker 2: is human, c is choreonic and choonic means is part
Speaker 2: of the early pregnancy. The cooreon is the outer sack
Speaker 2: and the G is something called going out a trophy,
Speaker 2: and that's just what the hormone's called.
Speaker 1: Right, Okay, good, because people do talk a lot about
Speaker 1: hCG and they sort of tend to, well, they're at
Speaker 1: that point where they're anxious about a miscarriage and they
Speaker 1: start talking about hCG and you know the levels of hCG.
Speaker 1: But the big thing that I'm getting from you right
Speaker 1: now is that it's just if it's doubling, and don't
Speaker 1: compare yourself to somebody else's hCG level.
Speaker 2: Absolutely so. In twenty nineteen, the management of what's called
Speaker 2: the uncited pregnancy, so we know the woman's pregnant, but
Speaker 2: we're not sure whether it's in the uterus where it belongs,
Speaker 2: miscarrying or a topic. The management of that is based
Speaker 2: on ultrasounds and interpretation of serial beta hCG, so having
Speaker 2: a few in a row and that's how the diagnosis
Speaker 2: is made. But if we're in this territory under an
Speaker 2: expert help.
Speaker 1: Yeah, a medical expert, and we should just sort of
Speaker 1: know that they've got that. Yeah, all right, So does
Speaker 1: every woman need or have a dating scan?
Speaker 2: It's a good question. You don't absolutely need a dating scan.
Speaker 2: If you're pregnant and there's no sign that anything's wrong,
Speaker 2: like you've got consistent pregnancy symptoms, there's no early pregnancy bleeding,
Speaker 2: then it is safe to assume that things are fine,
Speaker 2: and we probably tend to get a dating scan done.
Speaker 2: The dating scan probably doesn't tend to get done until
Speaker 2: it's done, for example, as part of down syndrome screen,
Speaker 2: which depending on what we're doing, might be ten or
Speaker 2: twelve weeks, and that might be the woman's first scan,
Speaker 2: and that's fine. But if if she wants a dating scan,
Speaker 2: or if one's thought to be necessary because there's some
Speaker 2: confusion about exactly what's going on, then from about six
Speaker 2: and a half weeks, you can see you can see
Speaker 2: the what's called the fiddle pole, which is a start
Speaker 2: of the baby and the heart beating.
Speaker 1: Oh, you can actually see the heart beating.
Speaker 2: Baby looks like a tony little jelly bean, and in
Speaker 2: the middle that's a beating heart.
Speaker 1: Yeap, oh cool, and not.
Speaker 2: Thing's only a few millimeters long, but you can quite
Speaker 2: clearly see that going on.
Speaker 1: And you have to go to an ultrasound clinic for that.
Speaker 2: Yep. So the GP will send you off to an
Speaker 2: ultrasound clinic, and a lot of obstetrician gynecologists like myself.
Speaker 2: I've got an ultrasound machine ourselves, and I might see
Speaker 2: people in very early pregnancy if they're worried, and scan
Speaker 2: them myself.
Speaker 1: And do you know whether that is bulk build or
Speaker 1: whether you can have a bulk build early dating scan.
Speaker 2: Yeah, so there are some ultrasound clinics that offer bulk
Speaker 2: billing and an early scan is not rocket science for
Speaker 2: them to do. So when your GP sends you for
Speaker 2: a scan, like anything else, you ring up to make
Speaker 2: the appointment and you ask very clearly how much it costs,
Speaker 2: and don't hesitate to shop around a little bit.
Speaker 1: Yeah. Yeah, that's right because there are lots of providers
Speaker 1: out there, isn't there certainly. Yeah.
Speaker 2: In the ultrasound world, there's big variation between For example,
Speaker 2: the ultrasound department of a public hospital, which is free
Speaker 2: to go to it has it might not have as
Speaker 2: many appointments for people because it's a busy public hospital
Speaker 2: clinic that's looking after the patients of that hospital, the
Speaker 2: inpatients of that hospital, but it's available to people for
Speaker 2: people to use as an ultrasound clinic. It's usually free.
Speaker 2: It might not have as many bells and whistles as
Speaker 2: a private clinic, but that's fine. Right up to the
Speaker 2: full service private clinical at the end of your street
Speaker 2: that we'll charge you in out of pocket costs, but
Speaker 2: they'll give you they'll give you photos and a video
Speaker 2: and a DVD and a USB with the pictures and everything.
Speaker 1: So pad, how do we even know like when our
Speaker 1: babies a jew Like, how do we have a date
Speaker 1: in mind for that?
Speaker 2: Yeah? So good question. This is about something called an
Speaker 2: ed D or an e d C, and an e
Speaker 2: d D is estimated date of delivery, So basically when
Speaker 2: the baby's due, and an e d C is a
Speaker 2: beautiful old fashioned term. That's an estimated date of confinement.
Speaker 1: Well confine, my gosh, I haven't heard that for you.
Speaker 2: Some of my senior colleagues in of cetric still say confinement.
Speaker 2: So that's back in the day when the pregnancy was
Speaker 2: shrouded in mystery.
Speaker 1: And you had to hide at home and never let
Speaker 1: your belly be shown.
Speaker 2: Yeah, so the woman would be confined to her house
Speaker 2: for presumably weeks before delivery and to hangover from those days.
Speaker 2: So basically the JEW date. There's two important ways to
Speaker 2: calculate that. One is based on the period dates, and
Speaker 2: that's extremely accurate if the woman had a nice, regular
Speaker 2: cycle leading up to conceiving, and it's very reliable that
Speaker 2: the baby's due forty weeks after the woman's last period. Again,
Speaker 2: when she not the date of sex and not the
Speaker 2: date of population, but the date of the period in
Speaker 2: the pre ultrasound the era, that's all on you. So
Speaker 2: you can just calculate, and you've seen your local doctor's
Speaker 2: got one of those wheels where you turn the wheel
Speaker 2: around to the known date of the first day of
Speaker 2: the last period, and then the error on the other
Speaker 2: side will indicate the date that the baby's jew. Yeah,
Speaker 2: it's important to have an answer because a lot of
Speaker 2: the tests during pregnancy at times, so we need to
Speaker 2: know when someone is twenty eight weeks and when they
Speaker 2: are thirty six weeks. But it's particularly important at the
Speaker 2: other end when if we're going to interfere in the
Speaker 2: pregnancy because we think the woman's overdue, then we need
Speaker 2: to know she really is. The other way to calculate
Speaker 2: the estimated your d is off a dating scan and
Speaker 2: first trimester dating scanning done trans vaginally is very accurate.
Speaker 1: Okay, hang on a minute. What is trans vaginally?
Speaker 2: Well, that's that glamorous procedure where the ultrasound is done internally, so.
Speaker 1: That you got Yes, I've had quite a few of those.
Speaker 1: That's the probe.
Speaker 2: Yeah, So the probe with the cover over that goes
Speaker 2: up the vagina and it puts the source of the
Speaker 2: ultrasound but in which is the wand right up close
Speaker 2: to the pregnancy, and the pitches are much better. And
Speaker 2: if you've got a good view in early pregnancy, then
Speaker 2: everybody's everybody's sick week fetus is the same length. Genetic
Speaker 2: differences haven't come into it yet, so if you're an
Speaker 2: African or an Eskima, it doesn't matter that it's going
Speaker 2: to be about the same length. And so we can
Speaker 2: say very confidently that if the early pregnancy is so
Speaker 2: many millimeters long, then it must be so many days
Speaker 2: and weeks old.
Speaker 1: And how often is that different from somebody's estimated sort
Speaker 1: of last day of their period and what they think they're,
Speaker 1: how pregnant they think they are.
Speaker 2: Yeah, it can be. So if you've got any irregular cycle,
Speaker 2: you can be more or less pregnant than you think
Speaker 2: you are. If you had an episode of bleeding in
Speaker 2: early pregnancy that happened about four weeks in and you
Speaker 2: thought that was a period, but it was in fact
Speaker 2: a bleed at four weeks, then you're four weeks more
Speaker 2: pregnant than you thought you were. Yeah, and if there's
Speaker 2: a significant discrepancy, the period dates are more likely to
Speaker 2: be wrong than the ultrasound.
Speaker 1: A little off topic, a little down the way, but
Speaker 1: it's of interest. So it's always puzzled me why women
Speaker 1: might get to that point and they find out suddenly
Speaker 1: that they're twenty weeks pregnant, Like, how does that suddenly happen?
Speaker 1: You know, I knew the minute I've been pregnant every
Speaker 1: four all four times. Well it happened.
Speaker 2: It happens. I mean, some people just don't know. So
Speaker 2: you could have no pregnancy symptoms at all. You might
Speaker 2: be somebody who only menstrates twice a year anyway, so
Speaker 2: you don't notice the absent period. Some women continue to
Speaker 2: bleed a little bit, even in a regular basis in
Speaker 2: the pregnancy and think that they're just having periods, So
Speaker 2: it happens.
Speaker 1: Okay, sorry that was off topic anyway, back to it.
Speaker 1: All right, So we've covered taking of the medical history,
Speaker 1: a dating scan. What what are the other bloods for?
Speaker 1: What do you need a blood test for?
Speaker 2: Well, the blood tests in early pregnancy are mostly an
Speaker 2: infectious diseases screen. Oh yeah, So historically some of the
Speaker 2: major problems in pregnancy were related to infectious diseases, and
Speaker 2: we don't see tons of those these days because of
Speaker 2: vaccination and because of improved living standards and nutrition. But
Speaker 2: we still check for those things because some of them
Speaker 2: can have a devastating impact on pregnancy. So what are
Speaker 2: we talking there, Well, we still checked for syphilis. I've
Speaker 2: never seen Yeah, I've never seen a positive syphlis test
Speaker 2: in pregnancy in all of the time I've been doing obstetrics.
Speaker 2: But it's still checked four because there is a little
Speaker 2: bit of syphilis around in our country and certainly globally
Speaker 2: it's still around, and a syphless infection in pregnancy is catastrophic.
Speaker 2: There's causes dreadfully severe fetal abnormalities. So that's still checked four.
Speaker 2: In twenty nineteen, probably of more relevance, there's a check
Speaker 2: for hepatitis. That's because we now know the way to
Speaker 2: use what's called vertical transmission. So if the mother's got
Speaker 2: hepatitis BC or HIV, we can stop that being passed
Speaker 2: down to the vetus in pregnancy. And so we can't
Speaker 2: do that unless we know who's got it, So that's
Speaker 2: what those tests are for. There's a urine a urine
Speaker 2: test as part of the first lot, which is about
Speaker 2: finding women who've got what's called subclinical utili so's they've
Speaker 2: got bacteria in the urine, but they feel fine, and
Speaker 2: we know that those women, if the if that's not
Speaker 2: picked up, may carry that bacterial infection through pregnancy and
Speaker 2: that can be involved in things like premature labor and delivery.
Speaker 2: So that's what the urine culture is for. And then
Speaker 2: we look for the blood group. It's very very important.
Speaker 2: Women who are a negative blood group have some special
Speaker 2: potential complications of pregnancy, which will cover in a future
Speaker 2: episode of The Kick. And so we want to know
Speaker 2: whether the woman, what the woman's blood group is, and
Speaker 2: whether she's got any abnormal blood antibodies. And then lastly,
Speaker 2: you know the hemoglobin, just hemoglobin and nine levels to
Speaker 2: make sure that they're adequate for nice, healthy early pregnancy.
Speaker 1: Yeah great, all right, So is there any other things
Speaker 1: that would happen at your first GP visit.
Speaker 2: Well, I think the other thing that would commonly happen
Speaker 2: is the GP would ask you, right, yo, where do
Speaker 2: you want to have your care? And we're lucky in Australia.
Speaker 1: We've got options, so many options, so many options that
Speaker 1: sometimes it's a little confusing.
Speaker 2: Yep, it certainly, it certainly can be confusing, but I
Speaker 2: think we can help people, you know, sort of clear
Speaker 2: some of that confusion a little bit. And that first
Speaker 2: visit with the local doc is a great idea to
Speaker 2: get the local doc's view on that and the options
Speaker 2: that are available to you in your local area. The
Speaker 2: pregnancy care in Australia is typically provided by a number
Speaker 2: of different practitioners, from midwives from gps, from independent midwives
Speaker 2: out of a hospital up to consultant obstetrician and there's
Speaker 2: a choice available to people which is terrify. So the
Speaker 2: GP can help you find your way through that mace.
Speaker 2: It's good idea in the first trimester to make a
Speaker 2: decision about where that care will happen. The Ancinata clinic
Speaker 2: of your local public hospital. You might go there at
Speaker 2: ten or twelve weeks and be assessed again as to
Speaker 2: whether you need you've got high risk issues that need
Speaker 2: to see the doctors and obstetricians every time, or whether
Speaker 2: you've got lower risk issues and can go through the
Speaker 2: Midwiffree clinic, see midwife each time and be booted out
Speaker 2: back to the high risk clinic if you develop some abnormality,
Speaker 2: or you might be able to see a midwife practicing
Speaker 2: outside the hospital who does lower risk et ceterac here
Speaker 2: in the same way. And then a lot of people
Speaker 2: can have care through private obstetrician, which is what I
Speaker 2: do for a living. It's a very very rewarding relationship
Speaker 2: I think where people get to see the same person
Speaker 2: i e. The obstetric right through the pregnancy for each
Speaker 2: of the visits and also have that person attend the
Speaker 2: birth to support the woman in birth and deal with
Speaker 2: any complications that could arise.
Speaker 1: Yeah.
Speaker 2: And then and then lastly, there's a thing called shared
Speaker 2: care where you can have your pregnancy visits with your
Speaker 2: GP if they're a GP with an interest in pregnancy care,
Speaker 2: and then from time to time a visit at the hospital.
Speaker 1: And it really you know, your decision might be based
Speaker 1: around whether you have private health insurance or not, and
Speaker 1: we do see it in the practice where people want
Speaker 1: to come and see you, but perhaps they haven't had
Speaker 1: their private health insurance for long enough. So you know,
Speaker 1: in the it's another thing to put into your pre
Speaker 1: planning stage and phase.
Speaker 2: I think it's on our list, isn't it.
Speaker 1: Yeah.
Speaker 2: Yeah, yeah. If you're thinking of having a baby and
Speaker 2: you're thinking that when you are pregnant you might go
Speaker 2: through a private obstetution and in particular to give birth
Speaker 2: to private hospital, then you need to have you ducks
Speaker 2: in a row with insurance in advance.
Speaker 1: At least nine months in advance.
Speaker 2: Yeah, well, most of with most of the health funds,
Speaker 2: if you increase your cover to cover pregnancy, then they
Speaker 2: won't cover you for a year. Now, the year includes
Speaker 2: the nine months of the pregnancy. So then if you
Speaker 2: once you've increased your cover, probably not if avoidable not
Speaker 2: to get pregnant that first three months, and then by
Speaker 2: the time the pregnancy is run its course, your year
Speaker 2: will be up. You should be fine, Yeah, because the
Speaker 2: bit the funder paying for is the delivery and the
Speaker 2: private hospital state at the end. Yes, so the nine
Speaker 2: months of the pregnancy are going to count in that year.
Speaker 1: So Let's say you don't have private health insurance and
Speaker 1: you go to your public hospital and you're in the
Speaker 1: antenatal clinic. You mentioned that they may not see you
Speaker 1: if you're considered low risk until about fifteen weeks. So
Speaker 1: is this something that your doctor will discuss with you
Speaker 1: what happens between their visit at six weeks and when
Speaker 1: you see someone at the anteen eighty climate.
Speaker 2: Yeah, that's a terrific question and something that I'm quite
Speaker 2: passionate about because in that gap there's a couple of
Speaker 2: things that need to be done, and the big ticket
Speaker 2: one is down syndrome screening. So if the couple want
Speaker 2: down syndrome screening, that needs to be organized through the
Speaker 2: local dock because the window to get that done is
Speaker 2: going to have expired by the time the couple get
Speaker 2: to the public antenatal clinic, if that's where they're going,
Speaker 2: if they're going to a private obstetrition I see patients
Speaker 2: who are referred to me at ten weeks, so that
Speaker 2: I can organize the down syndrome screening because I've got
Speaker 2: my people who do it well and so forth. But
Speaker 2: a patient on their way to the public clinic that's
Speaker 2: going to have to be sorted out first.
Speaker 1: Yeah, and we'll do a whole other kick episode about
Speaker 1: down syndrome screening and the NIPS test. But I think
Speaker 1: you know, it's just important for women to talk to
Speaker 1: their GP at their six week visit, yes, about what
Speaker 1: their plan might be for their down syndrome screening, whether
Speaker 1: they have it or not, that's choice.
Speaker 2: Oh yeah, that one's optional. You don't have to have it,
Speaker 2: but if you do want it, it's very important and
Speaker 2: dear in my heart that it's offered to you at
Speaker 2: the right time so that we don't have people turning
Speaker 2: up in more advanced pregnancy who haven't been screened.
Speaker 1: And this is all about having the knowledge to be
Speaker 1: premed with the facts. You know, we have seen it before,
Speaker 1: haven't we, Where somebody's come to our practice and they've
Speaker 1: come later they might have swapped out of the antenatal
Speaker 1: care into private care or whatever it might be, and
Speaker 1: that window is passed. So you know, that's a point
Speaker 1: of great sort of confusion and frustration.
Speaker 2: Yes, this is our part of our knowledge is power mantra.
Speaker 2: We really want to see an educated group of young
Speaker 2: women who know the basic facts about these things so
Speaker 2: that they can take personal power and responsibility for making
Speaker 2: sure that some of the stuff gets done properly and
Speaker 2: that they can take full advantage of all of the
Speaker 2: technology that's available. And I guess our ideal patient out there,
Speaker 2: our ideal young pregnant woman is someone who is literate
Speaker 2: pregnancy literate, knows about these things and says, Okay, I
Speaker 2: already know what I need, and I'm interested in the
Speaker 2: doctor's expertise, but I've also learned a lot myself.
Speaker 1: All right, So what are we doing? Is everything at
Speaker 1: the GPS. You know there's a lot to cover in
Speaker 1: twenty minute appointment.
Speaker 2: Well, that's a good point. You should book a long appointment.
Speaker 2: It's an awfully long time ago. But I was a
Speaker 2: GP once upon a time, and you book a long appointment,
Speaker 2: especially if there's something to discuss.
Speaker 1: So you're ringing up the receptionist and you're saying, I
Speaker 1: need a long appointment.
Speaker 2: Yeah, yeah, yeah, And I'm sure the GP i'd love
Speaker 2: you booked that in advance, especially if there's a lot
Speaker 2: to discuss. Yeah, if you think it's going to be
Speaker 2: the GP goes congratulations. Here's some blood tests. He's an
Speaker 2: ultrasound and he's a referral to doctor Maloney. Then great,
Speaker 2: ten minutes, it's done. But you know, if this is
Speaker 2: your first pregnancy after a period of infertility, and you've
Speaker 2: got a history of type one diabetes and hyper thyroidism
Speaker 2: and a strong family history of cystic fibrosis, then okay
Speaker 2: to do.
Speaker 1: Yeah, yeah, that's right. Thank you everyone for listening to
Speaker 1: our episode. I hope you are now the full bottle
Speaker 1: on what to do next now that you've got your
Speaker 1: p on the stick. As we always say, if you
Speaker 1: find our information useful, then share it with a friend,
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Speaker 1: other people, and that really helps our message get out
Speaker 1: to all those people that are probably floundering with some
Speaker 1: information on pregnancy that they need. All right, until next week,
Speaker 1: we'll be back in your ears. Then keep growing those
Speaker 1: babies by fore an our Hey, even though doctor Pat
Speaker 1: is well a doctor and we get lots of other
Speaker 1: doctors and other experts on our podcast, just need to
Speaker 1: remind you that this podcast is for informational purposes only.
Speaker 1: We share lots of medical insights and experience, but everything
Speaker 1: we talk about is general in nature and may not
Speaker 1: apply to your specific situation. Please always consult with your
Speaker 1: own healthcare provider for your individual medical advice. When you
Speaker 1: grow your baby,