Your first visit will generally take place at 6 to 8 weeks gestation, depending on your risk factors such as prior miscarriage or ectopic pregnancy, IVF or ovulation induction or a significant underlying medical condition. This will then be followed by routine visits at 10, 13, 17, 21, 24, 27, 30, 33 and 36 weeks gestation, then weekly until delivery. Please note that in some cases, you may need to see me more often, even weekly in cases of particularly high risk pregnancies. Your partner or another support person is very welcome to attend your antenatal visits.

It is important to use our appointments to discuss any questions you have with me and I will always make every attempt to answer them. It is often helpful to list these questions beforehand because you may forget to ask them during your antenatal visits.

I strongly endorse collaborative care and I therefore work with an exceptional team of midwives who complement and optimise my care. You will meet with midwives Charis, Michelle or Kate at 13, 30 and 37 weeks gestation to prepare for childbirth and the postnatal period. Additional visits can be arranged as required. These visits do not replace appointments with me; they enhance my care by providing invaluable support and education. Topics covered include:

• 13 weeks — establishing useful resources for the pregnancy (including books, classes and podcasts), identifying who/when to call with concerns/questions, introduction to education and advice for finding the optimal childbirth education suited to your preferences, recommended vaccines during pregnancy.

• 30 weeks — a discussion around birth, with the appointment tailored to each patient’s planned mode of birth. This may include awaiting spontaneous labour, induction of labour and caesarean section. A postpartum plan will also be established.

• 37 weeks — individualised newborn feeding appointment, with a discussion about the goals around feeding. For patients wanting to breastfeed, this may include antenatal expressing, skin to skin and breast/chest crawl, deep attachment, frequency and duration of feeds, managing supply issues and avoiding blocked ducts.

My midwives also perform fetal monitoring in our dedicated CTG room. This space allows prompt access to a thorough assessment of fetal well-being, most commonly in the setting of decreased fetal movements or fetal growth restriction.

Physiotherapist

Your pregnancy management includes an appointment with our Women’s Pelvic Health Physiotherapist at approximately 17 weeks gestation. Topics covered include assistance with pregnancy aches and pains, pelvic floor issues, preparation for birth and postpartum recovery.

Psychologist

Our patients benefit from direct access to an experienced psychologist onsite. For patients with pre-existing conditions (such as anxiety, depression, OCD and/or trauma) or those with a new antenatal or postnatal concern, input from a psychologist with perinatal experience is often vital. Our practice psychologist has a particular interest in caring for families who have experienced perinatal loss, complex pregnancies and trauma.

After birth you will have two appointments in my rooms:

• A midwife appointment within two weeks of returning home (assistance with feeding, settling advice and addressing any other concerns, as well as a check of your physical and mental health). This is available in-person or via Telehealth.

• A medical appointment with me 6 – 8 weeks following birth.

One of my friendly staff will contact you with these appointment details.

An important choice to make in early pregnancy relates to genetic testing for you and your baby. These tests are optional but need to be considered carefully. You will not be pressured to undertake any of these tests if you do not wish to do so. It is important to recognise that the choice of testing and what you do with the results, is yours. Whilst I can give you advice about the different tests available, the ultimate decision must rest with you. There are two main groups of screening tests available to you:

• Genetic carrier screening (screening of the reproductive parents)

• Aneuploidy screening, traditionally used to identify pregnancies that are high risk of Down Syndrome and other major chromosomal abnormalities (screening of the fetus)

Genetic Carrier Screening

Genetic carrier screening primarily identifies recessive conditions. Carriers of recessive conditions are completely healthy and show no signs of the condition. However, if both parents are carriers of the same condition, there is a 1 in 4 chance that their children would have the condition.

Genetic carrier screening is now offered to all reproductive couples before or very early in pregnancy to see if they are carriers of particular genetic conditions that can affect their future children. This is testing to understand the genetics of the reproductive couple, not the fetus. This screening only needs to happen once per couple (it does not need to be repeated each pregnancy, unless one of the members of the reproductive couple changes).

It is important to note that most people are carriers of one or more genetic conditions. It is also known that 90% of babies born with an inherited genetic disease have no family history of it. Therefore, genetic carrier screening is relevant regardless of your family history. If you are not a carrier of these conditions, you are at a very low risk of having a child with any of these conditions. It is important to know that the current carrier tests detect the majority of carriers, but they cannot detect every single gene change that can cause these conditions.

The three most common conditions which are tested for are Cystic Fibrosis (CF), Fragile X Syndrome (FXS) and Spinal Muscular Atrophy (SMA). This triple test has a complete Medicare rebate, meaning that it is available to all Medicare-eligible patients at no out-of-pocket cost. The female partner/egg provider is screened initially; if this test is positive for any of the three conditions then the male partner/sperm provider can be tested for the relevant condition(s). This too is bulk-billed for Medicare-eligible patients. For non-Medicare patients or partners the test costs $389. Results take approximately 2-4 weeks. Testing can be done by either a blood test or saliva kit.

An alternative to the above is expanded carrier screening. This can be performed to screen for over 1000 additional genes. The expanded testing makes carrier screening more relevant for people of all ethnicities and backgrounds. Testing costs up to $1500 for Medicare-eligible couples, with an additional $389 per partner tested if you do not have Medicare. These broader tests still include screening for Cystic Fibrosis, Spinal Muscular Atrophy and Fragile X Syndrome. Both biological parents are screened together and results take up to 6-8 weeks. If both partners are found to be carriers of the same genetic condition, diagnostic testing in the form of a CVS or amniocentesis will be offered.

Here is a brief description of the 3 main conditions screened for:

• Cystic Fibrosis (CF)
  Cystic fibrosis (CF) is an inherited condition affecting breathing and digestion and affects approximately 1 in 2500 babies. One in 28 Caucasians are carriers of CF. CF causes thick mucus which traps bacteria, resulting in recurrent infections that damage the lungs. Thick mucus in the gut also makes digestion of food difficult. Infants and children with CF require daily chest physiotherapy to clear mucus from their lungs, frequent courses of antibiotics, and the need to take medicine to aid digestion. Lung transplantation is a surgical option for people with CF who have advanced lung disease. Until recently many children with CF died in early childhood but now many live to be 40 years of age or more. There is no cure for cystic fibrosis but better treatments are under research and development.

• Fragile X Syndrome (FXS)
  Fragile X syndrome (FXS) is the most common cause of inherited intellectual disability affecting around 1 in 4000 babies. Approximately 1 in 150 people are carriers of FXS. People with FXS can have developmental delay, learning difficulties, anxiety, autism and epilepsy. The features of FXS vary from mild to severe with males more likely to be severely affected than females. There is no cure for FXS although some educational, behavioural and medical interventions can improve outcomes. Some females who are carriers of FXS may have early menopause and some males may develop a late onset movement disorder.

• Spinal Muscular Atrophy (SMA)
  Spinal muscular atrophy (SMA) affects approximately 1 in 6000 babies. One in 40 individuals are carriers for SMA. SMA is a condition that affects nerves in the spinal cord and causes muscles to get weaker. There are four types of SMA. SMA Type I is the most severe. Babies with SMA Type I have weak muscles from birth and usually do not live past two years of age. SMA Types II and III progress more slowly with most children unable to stand or walk without help. These children can live into early adulthood, depending on the severity of the condition. People with SMA Type IV do not develop symptoms until adulthood. There is no cure for SMA, however there are treatments and interventions available aimed at managing symptoms and improving quality of life.

Aneuploidy Screening

This is genetic screening and testing to understand the genetic health of the fetus, not the reproductive couple. This can be performed in every pregnancy and provides a risk profile for your baby being affected by a genetic disorder/disease. It is important to realise that by having aneuploidy screening performed there is no assumption that you will terminate a pregnancy should it be affected. Please be assured that if there is a serious condition detected, I will support informed decision making and perform a termination of pregnancy, if requested. There are essentially two reasons to have aneuploidy screening performed:

• If an abnormal result would lead to a request for termination of pregnancy

• If an abnormal result would give you time and resources to prepare for having a child born with a genetic abnormality.

Nowadays, the gold standard of aneuploidy screening is non-invasive prenatal testing (NIPT). NIPT is a screening test that analyses cell-free fetal DNA found in maternal blood. It aims to detect Trisomy 21 (Down Syndrome), Trisomy 18 (Edwards Syndrome), Trisomy 13 (Patau Syndrome) and sex chromosome aneuploidies. NIPT has a much greater test sensitivity and specificity compared to traditional serum screening. This means a higher detection rate with a greater than 99% accuracy as well as fewer false positive results. It is a blood test performed from 10 weeks gestation with an out-of-pocket cost of approximately $450. Results are available within 3-5 working days and I will always contact you with the result as soon as it becomes available to me. Fetal sex is also reported and I can share this news with you should you wish, or keep it a very reliable secret until the birth of your baby.

If you have a high risk or positive result, you will need a diagnostic test to confirm whether the baby is truly affected. There are two types of diagnostic tests available:

• Chorionic villus sampling (CVS)
  This involves passing a needle into the placenta between 11 and 13 weeks gestation. A small amount of placental tissue is taken for chromosomal analysis. The risk of miscarriage from the procedure itself is approximately 1:200 to 1:450.

• Amniocentesis
  This involves taking a small sample of amniotic fluid from around the developing baby after 15-16 weeks gestation. Only a small amount of fluid is taken but this is enough for a full chromosomal analysis to be performed. The risk of miscarriage from the procedure itself is approximately 1:200 to 1:900.

Full results from each of these tests take approximately 2 weeks to become available. FISH testing is a more rapid test on the sampled tissue that detects a smaller number of conditions, including trisomies 21, 18 and 13, and the results of this are available within 2 working days.

I recommend that you have the following ultrasounds during your pregnancy:

• Dating Scan
  This is ideally performed between 6-9 weeks gestation to determine your due date and the plurality of the pregnancy. I will perform this in my rooms at your first appointment, however you may choose to have one done externally prior to seeing me. If this is the case, please ensure the report is sent to me.

• 12–13 Week Ultrasound
  At this gestation, all the major organs and structures have been formed in the fetus making this a good time for the first detailed assessment of fetal anatomy. Some major structural abnormalities may be detected at this time. Nuchal translucency is also measured and this contributes to an overall risk assessment for Down Syndrome and other chromosomal abnormalities.

• 20–22 Week Ultrasound
  The detailed mid-trimester scan is the single most important scan in pregnancy. This is the optimal time to detect fetal abnormalities. Other factors such as the location of your placenta, the length of your cervix and fetal growth will also be assessed.

• 32-34 Week Ultrasound
  This scan allows a final review of the fetal anatomy, as well as reliable detection of growth deviation.

I have additional training in obstetric ultrasound and I will perform a detailed scan at every one of your antenatal appointments. Not only does this allow me to assess the wellbeing of your pregnancy, it is also a fantastic opportunity for you to bond with your baby before birth. Importantly, medical ultrasound is completely safe and routine scanning during pregnancy is not contraindicated. There are no known adverse biological effects associated with obstetric ultrasound.

Gestational diabetes mellitus (GDM) is a common type of diabetes related to pregnancy, affecting up to 5–10% of pregnant women. It occurs due to hormonal changes causing insulin resistance — the body is then unable to produce enough extra insulin to meet its increased needs in pregnancy.

I recommend that all my patients are tested with an oral glucose tolerance test (GTT) at 24–28 weeks gestation. This is a fasting blood test — please ensure you have had nothing to eat or drink (other than plain water) overnight for 8–12 hours prior to having your test. Water is allowed anytime overnight, and I suggest that you maintain adequate water consumption to ensure good hydration. After the initial blood test, you will be given a glucose drink, and further blood tests will be performed at 1 hour and then 2 hours after the drink to check your blood sugar level. You will therefore need to stay at the collection centre for 2 hours and 15 minutes from the time you are first attended to. If you are at particularly high risk of having diabetes, I will also test you earlier in your pregnancy (usually at approximately 16 weeks gestation) with a GTT. If the result is normal, you will need to repeat the GTT at 26–28 weeks.

I recommend that all of my patients planning on having a vaginal birth have a GBS swab test performed at 35 to 37 weeks gestation. GBS is a common bacterium found in the vagina and bowel of about 15-25% of women. It causes no harm to you. However, if GBS is passed from you to your baby around the time of a vaginal birth, there is a small chance your baby will develop an infection and become seriously ill.

Your baby is more likely to become infected if:

• It is born prematurely

• You have previously had a baby who developed GBS infection

• You have a temperature of 38 degrees or higher during labour

• Your waters break more than 18 hours before your baby is born

To reduce the risk:

• If you are GBS positive you will be given antibiotics in labour. The antibiotic of choice is penicillin. If you are allergic to penicillin I will arrange an alternative antibiotic such as Clindamycin. If you have a urinary tract infection caused by GBS it should be treated, and you should be given antibiotics in labour

• If you have previously had a baby with GBS infection you will be given antibiotics in labour

• If you are GBS positive at term (after 37 weeks) and your waters break before you go into labour, you will be advised to have your labour induced as soon as possible

It is safe to breastfeed if you are GBS positive.