It may sound obvious to say that pregnancy is a normal part of life because if it wasn’t none of us would be here but these days there is certainly a role for medical science to help that process along.
We have pregnancy relatively down pat these days. There are still some bumps in the road but fortunately not too many for most women and there are some fairly standard procedures that you’ll go through when you are pregnant.
Now for most women the first sign of pregnancy is that their period is late and these days by the time people come to see me in the practice they’ve often already done a home pregnancy test, so it’s not a necessity to go to the doctor to be told you are pregnant. Most of the time I am finding that women already know that. We can confirm that with a blood test but it’s fair to say the urine home tests are reasonably accurate. If anything it’s more likely it may show up negative and you are pregnant rather than it show up positive and you’re not, so they are fairly useful.
So what happens now? It’s useful to remember that pregnancy has been going on since the year dot. As I said at the top of the video if it didn’t exist then none of us would be here. It predates doctors and it predates hospitals but we have been able to improve things a little bit. We notice that a bit in the significant decline in perinatal death; that’s the death of a baby at or around the time of birth, and also maternal deaths. They are not down to zero, you can’t absolutely stop nature but they have been reduced significantly. The risks and dangers in pregnancy have dropped dramatically over the last 100 years.
So what can you expect? Generally first up at 6 weeks, which is often when women come along to the doctor because they are a week or two over with their period, there will be a check of your the blood pressure and a chat about if you are on certain medication that they may need to be changed or stopped. Again that will depend on the individual circumstances. Usually at that point it’s about thinking where do you want to go for delivery and that will depend upon where you live and what sort of insurance you may or may not have. In Australia, regardless of whether you are in the public or private system, it is relatively straight forward. Most of the time by about week 9 there will be an ultrasound done which is a fetal development scan and that’s really just to assess how is baby going in that very early time. Often around that time also there will be some blood tests done for a routine antenatal screen.
I won’t list all the tests because we will be here for quite a while but there’s about a dozen that all get done on a blood test and urine test as well. Now the next check at around about week 11 or 12 is a screening test for Down’s Syndrome and conditions of the spinal cord called Neural Tube Defects and that’s a combination of a blood test and a scan. From that you get a risk factor number and it is a statistical number, not an absolute result, which tells you that the pregnancy is high, low or average risks for some common malfunctions. Again, depending on the results of that, further tests may be done and that is something you discuss with your doctor.
Normally about week 14–15 might be the first time you see your obstetrician and again, things like your blood pressure will be checked, your weight is checked each time you go along and a urine sample is done as well. Normal routine antenatal visits should be fairly simple; there is not a lot that needs to be done and what you really want is for it to be quite boring. You go in, have a couple of checks, the doctor says, “yes, it’s all good” and away you go. It’s not really a time when you’re hoping to get your money’s worth and be in there for half an hour. You want to be moving along because everything is actually going well and there’s not a lot to do. The aim of good antenatal management is to be able to act if necessary but hopefully it isn’t but if it is things can be done. In terms of routine tests there is an anatomy scan done at about 19 weeks or so and that is an ultrasound scan to have a look at how the development of the baby is going because by that stage baby is fully formed. Obviously baby is not fully grown, but is fully formed.
The next step after that will be around 26–27 weeks there will be a diabetes test done for gestational diabetes and in amongst all this time, roughly every 4 weeks, you’ll go along to the doctor for a bit of a check. At 36 weeks it goes to a weekly check because at that point baby may be ready to come out so have your bags packed from about 36 weeks or so. For women who have been through one pregnancy they know the ropes and whilst each pregnancy is different there are obviously some things that are quite the same.
So to sum up, routine monitoring in pregnancy is pretty straight forward. It’s not about doing lots of stuff for the sake of it. It’s about monitoring and checking for problems which most of the time will not be there. If anything is detected, for example, your blood pressure is up or something shows up on your urine test then that can be acted on and problems averted. It’s fairly smooth sailing in most, but unfortunately not all, but in the vast majority of instances. Certainly a very well worn path and certainly nothing to be anxious about.