Thinking about having a baby?
So you are a forward planner and are wondering if there is anything you should know or do before you stop using contraception and see what happens! While this is a natural process that countless generations have mastered without any intervention, I am very glad you thought to check as there are indeed a few things to consider
Making a baby?
You’ll need to stop using contraception!
WHEN SHOULD I STOP CONTRACEPTION?
The combined oral contraceptive pill (COCP), NuvaRing or Implanon
There is no actual medical reason to stop the pill, NuvaRing or have the Implanon removed, before you are ready to begin trying to conceive
Despite rumours to the contrary, the hormones are out of your system very quickly
This is why for most, the period comes within days of ceasing the active pill tablets
Sometimes it’s hard to be sure exactly when you fell pregnant if it happens straight away, without another period, or if your periods are all over the place once you stop the pill/remove the Implanon, but ultrasound scans take the guesswork out of timing
However, I do recommend that you cease the pill/NuvaRing/remove Implanon six months or so in advance
The reason for stopping so far ahead is so that your natural cycle can re-establish itself and you can become familiar with the changes to your body when you ovulate
Regardless of how long you have been on the pill/using Implanon, some women have a delayed return to fertility and it can take as long as 6-12 months before you start to ovulate again
Do however keep in mind that one of the most common side effects of stopping contraception is pregnancy!
Unless it would not matter, use an alternate form of contraception
e.g. condoms, Billings (timing) or a diaphragm
Depo-Provera
The above advice also applies if you are using Depo-Provera (the injection), although consider leaving a longer gap of 9-12 months from the last injection to when you want to conceive
Intrauterine contraceptive devices or progesterone pill
If you are using an intrauterine contraceptive device (IUCD or IUD), e.g. a Copper IUD, Mirena or Kyleena, the progesterone only pill (mini-pill) or NuvaRing, you can have them removed or stop taking immediately prior to trying to conceive as these don’t stop you from ovulating
Blood tests?
Yes, there are recommended tests!
ARE THERE ANY TESTS TO CONSIDER?
Yes!
Ideally, at least two months before you would like to fall pregnant, you should have some blood tests
I recommend that you book an appointment with your GP (check with their receptionist as they may want you to book a long appointment - there is a lot to discuss!) and do consider filling out this form to take with you as a starting point - it asks a lot of questions about your health and a few about your partner’s health
It is a good idea to check your blood group as there is a potential reaction between some blood types (mum and baby) and it is important to find out if you are at risk of this
A check of your level of protection from Rubella (German Measles) is also important as, if it is low, we recommend having a vaccine at least one month before falling pregnant to boost your protection
If you are not sure if you have had Chicken Pox, a check of your status is recommended followed by immunisation (two needles 6 weeks apart) if you are not immune
Are you at risk of Chlamydia, Syphilis, Hepatitis B or C or HIV? If so, these should be checked
e.g. if you have had multiple sexual partners, have used intravenous drugs or if a current or previous partner have these risk factors or infections
Are you at a high risk of thyroid disease (family history of thyroid disorders or personal history of Coeliac disease) or over 30 years of age?
if yes, it is generally recommended to have a thyroid function test
Are you at risk of diabetes (including having a past history of gestational diabetes, family history of diabetes, BMI over 30, age over 40, previously large baby)?
if yes, you should have a test for diabetes prior to falling pregnant and again early in pregnancy
Are you at high risk of Vit D deficiency (dark skin, veiled, BMI over 30, little or no sun exposure)?
if yes, you should either be tested or simply take a supplement
Are you at risk for iron deficiency (vegan, vegetarian, past history, heavy periods and/or regular blood donor)?
if yes, you should have a check of your iron stores
There are a number of genetic conditions that can be tested for before and/or during pregnancy
some are best done beforehand, such as testing for cystic fibrosis, spinal muscular atrophy and fragile X syndrome
this is more complicated than you’d think, so more detailed information is available here
There is always something more to do!
ANYTHING ELSE?
When was your last Pap Smear or Cervical Screening test?
If the test is due, it is best to do it before you fall pregnant
changes can occur very rapidly during a pregnancy and any treatment required is best done beforehand
if it is not done before pregnancy, it is quite safe to do this test during pregnancy
When was your last dental check?
It is recommended to have your teeth checked before falling pregnant
It is recommended that both parents-to-be have a booster immunisation of Whooping Cough
This comes as a combined vaccine with tetanus and diphtheria (Boostrix or Adacel) and the cost varies, but it is about $50 - $70
Just over half of the children hospitalised during whooping cough outbreaks may get the infection from their parents and prevention is so much better than cure
Dads-to-be can have a shot anytime, although preferably before baby is born
Mums have their vaccine paid for by the government during pregnancy and this should be done every pregnancy, preferably from 20 weeks
when the vaccine is given during pregnancy, mum’s antibodies cross the placenta, meaning baby is born with protection which lasts for the first 4-6 months or so of baby’s life, significantly reducing the chance that they will end up with a severe infection
R u ok?
Mental health is always important, but changes during pregnancy and the newborn period increases the risk of a new mental health condition AND/OR deterioration in a pre-existing condition for both parents
Do you have a support team close by/ready to go?
There are great online resources such as the Centre of Perinatal Excellence - COPE and Pregnancy, Birth & Baby
R u safe?
Unfortunately, not only is pregnancy not protective against family and domestic violence, it can actually get worse or appear for the first time during a pregnancy
please do not assume that, if your relationship is already under strain, it will get better if you fall pregnant
please, if you are not safe, get help early e.g. https://www.1800respect.org.au
Are you planning to be looked after privately or publicly?
This gets complicated, but long story short, if you want private care, check your insurance - Australians will need to hold a Gold policy for 12 months BEFORE baby is born to have private maternity cover
Do you want to have private obstetric or midwifery care?
even with a Gold policy, you can be thousands of dollars out of pocket, but without it, you will usually be much more than $10 000 out of pocket!
If you want to compare policies, I recommend this government site
Do you know what models of care your local public hospital offers?
many hospitals have information on their website and it is well worth being informed about the options available to you
there is no waiting list for public maternity care!
Are you taking any prescription, over-the-counter, supplements or herbal medications?
Please check with your GP or pharmacist if they are safe in pregnancy
it is always a balance between the effect and the side effects and sometimes the risk of NOT BEING on the medication is greater than the risk of BEING on the medication
more advice on this important topic is available here
Are you entitled to maternity (or paternity) leave?
If so, are there conditions?
Food
You know we want you eating healthy food!
SHOULD YOU CHANGE YOUR DIET?
You do not have to "eat for two" from a calorie point of view, but you will have different nutritional requirements. In particular, your iron, calcium, protein and folic acid requirements are increased
The first three are best addressed by dietary changes such as regular red meat (beef or lamb) and dairy foods
It is always a good idea to eat plenty of fresh fruit and vegetables, which also provide us with various vitamins and minerals
Folic acid, however, is another story. It has been well demonstrated that boosting our intake of folic acid can reduce the risk of neural tube defects such as spina bifida by as much as 60%
spina bifida can be anything from a mild variation causing no trouble to a severely disabling condition
Folic acid is best taken as a supplement, with the recommended dose 0.5 mg daily for those with no history and 5 mg daily for those at a higher risk (a personal or family history of spina bifida or neural tube defects, those taking certain epilepsy medications, who have diabetes or whose BMI is greater than 30)
these tablets are available at low cost from your chemist and should be commenced at least one month before conceiving and taken for the first three months of the pregnancy
Australia has seen an increase in Iodine deficiency so an Iodine supplement of 150 mcg a day is recommended for everyone planning a pregnancy, pregnant or breastfeeding. Alternatively choose a pregnancy supplement that contains Iodine and Folic Acid (all of the major brands contain both) or products such as I-Folate, which is a cheaper alternative to the multivitamin and quite suitable for those with a good, varied diet
Research is underway into the link between Omega 3 and preterm births, with sufficient evidence to recommend supplementation in those with low levels, however it is unclear how best to measure this nor is it funded outside of South Australia. For now, 2 fish meals a week (tinned, frozen or fresh) should see levels sufficient to cover the recommendations. Watch this space! More information is available here
For more detailed advice about nutrition and food safety, click here
Please quit
WHAT ABOUT SMOKING?
Still smoking? QUIT.
Dad -to-be still smoking? QUIT.
Friends/family still smoking? QUIT, or smoke outside the house
There is a lot of advice/support about quitting smoking, including some I’ve put together here
Taking illicit drugs? QUIT. I know this is easier to say than it is to do, so please, reach out for support
WHAT ABOUT ALCOHOL?
In pregnancy, please don't drink. It kills brain cells, crosses the placenta and can harm baby for life. It helps if dad is not drinking or drinking lightly before conception and not too heavy afterwards!
If you want to know more about the effects of alcohol during pregnancy, start with the resources here
RIGHT, ANY LAST POINTS?
Yes. Despite the ease with which most of us conceive, timing is everything. We are only fertile when we ovulate and if you wish to conceive ASAP, you should have sex in the week leading up to and the day of ovulation. So, get to know your cycles and your signals (low pelvic pain, mucus changes) and communicate with your partner. I have another post with information about making babies here
And last, but not least, relax and enjoy! Making babies is supposed to be fun! Don't be disappointed if it doesn't happen first try--it may not happen overnight, but for most of us, it will happen
If despite doing all of the above you are not pregnant after 6-12 months, do talk to your GP--it may be something simple, or it may be time to get specialist advice
Things don’t always go to plan
sometimes, assistance is needed along the journey
Disclaimer: The information on this website is of a general nature only & is not individual clinical advice. For specific advice, please consult your midwife, doctor or other appropriate healthcare professional