• Preparing your body

    Preparing for pregnancy physically makes lots of sense. As your baby grows, there are increased demands on your body - both energy and physical ones. Being fit and strong before you become pregnant is a great way to help your body prepare for these extra challenges that come with pregnancy.

    Areas that are particularly challenged during pregnancy are pelvic floor muscles, abdominal (stomach) muscles, upper back muscles, pelvic joints and lower back. All of these areas cope with these challenges much better, and recover after pregnancy quicker if they are in good shape prior to becoming pregnant.

    Why exercise is important

    The extra energy demands of pregnancy can lead to fatigue, however the fatigue levels of an unfit person will be higher than a fit person, so getting fit for pregnancy is great planning. You do not need to be capable of running a marathon, but if your idea of exercise is reaching for the remote, then starting a fitness program can smooth your way through the challenges ahead!

    “Pelvic Floor” is an area you don’t hear much about until you are pregnant. It is the name given to a collection of muscles that run from your pubic bone at the front, to your tail bone (coccyx) at the back, and literally forms a “floor” to your pelvis. These muscles are responsible for supporting your bladder, bowel and uterus, and when you are pregnant, the weight of your baby as well. Your pelvic floor muscles also help maintain control of your bladder and bowel, so that when you sneeze, laugh cough, jump or run you don’t leak.

    Pregnancy adds a much bigger workload to these muscles, so it is very important to ensure that you are exercising these muscles correctly in preparation for pregnancy, during pregnancy, and after your baby has arrived. It can be difficult to know if you are exercising these muscles correctly, and it is common for women to have the incorrect action even though they think they are doing the right thing. If you are unsure, an assessment with a Women’s Health Physiotherapist is the best way to make sure you are on the right track.

    What exercise should you do to prepare for pregnancy?

    Exercise for your core

    Well supervised clinical pilates is an excellent way to prepare your body for the demands of pregnancy. All the muscle groups that you need to be strong and functioning well, such as your pelvic floor, deep abdominal muscles, upper back muscle amongst others, can be directly targeted with this form of exercise. This form of exercise can be modified to enable you to continue it right through to 40 weeks of pregnancy. It is vital that you ensure you are contracting your pelvic floor correctly before you commence Pilates, so visit your Women’s Health Physiotherapist or visit the Australian Physiotherapy Association to locate a physiotherapist near you prior to starting to ensure you get the right benefit from this exercise.

    Cardio exercise

    Remaining or getting fit prior to becoming pregnant should be a priority. There is good research to show that fitter women have less trouble with the “minor discomforts of pregnancy” – really only minor if you don’t have them! These include back pain, rib pain, fatigue, nausea (usually worse if fatigued) and swelling. Pre-eclampsia has also been shown to have a lower incidence amongst fitter, healthier women. Walking, running, swimming and cycling are all good examples of exercise that improves your cardio fitness. Interval training can be a good way of improving your fitness when you are time poor, prior to becoming pregnant.

    For advice regarding exercise when planning for pregnancy, visit Fitwise Physiotherapy.

    Pelvic floor exercise

    Before pregnancy it is good to start a pelvic floor exercise habit, to ensure your pelvic floor is in great shape for pregnancy. When you contract your pelvic floor muscles, you should feel a squeeze and a lift inside, as if you were trying to stop the flow of urine, or grip onto a tampon in the vagina. You should aim to do this at maximum strength for 10 seconds, and repeat 10 times consecutively. It is important that you keep breathing while you are holding. Try and do this routine twice a day.

    If you have difficulty with these exercises, or are not sure if your technique is correct, then contact your women’s health physiotherapist to help you. Remember, it is never normal to leak, and there is always something that can be done about it. If you have concerns regarding your bladder and / or bowel control, then contact your Women’s Health Physiotherapist, or the Continence Foundation of Australia.

    Visit your GP

    It is important that you see your doctor for a health check before you become pregnant. The aim of the visit is to identify any potential problem that could affect your chances of getting pregnant or baby’s growth and development. Therefore you can correct the problem to improve your chances of having the best outcome.

    Health check includes assessment of your current health, medical history, family history, examination, blood tests and other tests based on individual assessment.

    If you have any existing medical conditions you may not be aware that they can affect your pregnancy. It is advised to discuss any medical condition with your doctor several months before falling pregnant to plan for any medication change or dose adjustment as appropriate. You also may need specialist support during the pregnancy.

    Some of the most common conditions include:

    • Diabetes – if you are diabetic, it is really important you try to get your diabetes under control before you fall pregnant. Pregnancy also increases the chances of diabetes, and it may lead to complications during pregnancy, during birth and in the post-partum period
    • High blood pressure – if you have high blood pressure before pregnancy, you may need to take special medication that is safe for pregnancy and be closely monitored. High blood pressure may lead to pre-ecplampsia which is a life threatening condition for both the mother and the baby
    • Anaemia – a complete blood count (CBC) can measure your haemoglobin, red & white blood cell count, and the appearance of your platelets. Anaemia can cause weakness and fatigue during pregnancy. Anaemia and low iron can cause weakness and fatigue during pregnancy and affect baby’s growth
    • Thyroid problems – Hyperthyroidism or overactive thyroid as well as Hypothyroidism or underactive thyroid can lead to infertility or pregnancy complications when not treated properly

    Some of the tests that are common during a preconception health check up are:

    • Pap smear – a screening test for early changes that could lead to cervical cancer if left untreated
    • Breast exam – it is important to diagnose any existing lumps before getting pregnant
    • STIs (sexually transmitted infections)– it is best to know if you have any STI's before getting pregnant, since some STIs can cause infertility or pregnancy complications. For example, if chlamydia is left untreated, it can lead to cervicitis, blocked fallopian tubes, and Pelvic Inflammatory Disease (PID) which can cause infertility or ectopic pregnancy
    • Blood type and antibodies - if you have negative blood type you could have antibodies that could affect the baby
    • Immunity to rubella (measles) and varicella (chicken pox) – it is recommended that all women be tested for immunity before they become pregnant and that they consider being vaccinated if they are not immune. The Centres for Disease Control and Prevention (CDC) recommends that a woman waits at least 4 weeks after receiving the vaccination before trying to conceive
  • Preparing your finances

    Budget and income

    View parental leave pay details for parental leave and government payments.

    Obstetrician fees

    This is a Medicare subsidised cost and the charge varies between obstetricians. You will need to investigate the costs of the obstetrician by calling the rooms and requesting a fee schedule.

    Hospital fees

    The hospital stay is covered by your private health fund. Additional charges relate to:

    • your excess and / or co-payments
    • queen bed and partners over night stay charges
    • additional meals
    • STD / mobile phone calls
    • sundries

    Out of pocket expenses

    These include but are not limited to:

    • obstetricians fees that are not covered by Medicare and or your private health insurance
    • blood tests (costs are not entirely covered by Medicare)
    • ultrasounds (costs are not entirely covered by Medicare)specialist costs- anaesthetists, paediatricians and others.

    Self insured

    Self insured patients are those patients that do not have private health insurance however choose to pay to have their baby in a private hospital. They are also those patients who have overseas private health insurance.

    Self insured patients will need to pay $6,300 for vaginal delivery (3 nights)  or $7,650 for c-section delivery (4 nights) at least two months before their expected due date. This will cover accommodation, birth suite and or theatre fees. It will not cover special care nursery should your baby require admissions. Special Care Nursery is $1,240.00 per day.  

    Patients that have overseas health insurance cover will be issued with a receipt upon discharge from hospital that they can then forward to their overseas insurers for re-imbursement.  

    Please call the maternity liaison officer on (03) 9418 8300 if you have any questions regarding self insured fees.

    Insured

    It is recommended that you contact your private health insurer and ask them:

    • am I covered for obstetrics?
    • what is my excess?
    • do I have copayments ?
    • will I have any other out of pocket expenses?
    • do I have family cover, is my baby covered for special care nursery?

    Please do not assume that because you have private health insurance that it includes waiting periods. You will need to contact your private health fund. Normally you would need to have been insured for at least one full year before your due date.

  • Getting started

    How long might it take to conceive?

    There are a number of factors which can influence how long it takes to conceive, for example:

    • your ovulation cycle
    • your age and your partner's age
    • the state of your health
    • your lifestyle
    • frequency of intercourse. Having sex every few days ensures there will always be a supply of sperm in the right place whenever you ovulate. Once released, an egg usually lasts around 24 hours. On the other hand, sperm can survive for around 2-4 days inside a woman, depending on conditions
    • smokers - women who smoke can take twice as long to conceive
    • the level of alcohol consumption
    • contraception previously used eg it can take up to six months for ovulation to resume after stopping the pill
    • intercourse 3-4 times a week at ovulation time maximises the chance of conception

    Coming off the pill

    Please remember that when you decide to come off the pill, you may take up to 6-12 months to conceive.

    It is important to ensure your private health insurance covers obstetrics etc. before you stop taking the contraceptive pill.

    Over 35 years old

    Women over 35 can take longer to conceive because age is directly proportionate to the amount and quality of eggs that are produced.

    • women are born with a finite number of eggs (typically over one million eggs), and these are all the eggs that she will ever have
    • by the time a woman reaches puberty, these one million eggs are now just a mere 300,000
    • of these 300,000 only a miniscule number (about 300) will ever become mature and subsequently released during ovulation
    • as a woman ages, the amount of cervical fluid that her body produces decreases, which can also impact fertility
    • libido also decreases with age thereby decreasing the frequency that a couple engages in sex

    Six things over 35 year olds can do to aid in the conception process:

    • be patient. The amount of time it takes for a woman over 35 to conceive is much longer than that of a woman in her 20s. It is estimated that it can take one to two years to conceive. So it is important to be patient and to stay positive
    • consult with your doctor. Schedule a pre-conception appointment with your doctor so that you can discuss your medical history, current medications, lifestyle, diet, and menstrual cycles to determine what problems you may be facing and any changes that need to be made to help you become pregnant
    • avoid lubricants during sexual intercourse
    • keep track of when you will be ovulating and plan to have sex during those times
    • live a healthy life. Eating a well balanced diet, exercising regularly, and avoiding risky substances such as alcohol and recreational drugs are all great ways to boost your fertility
    • have sex every day. Sperm can live inside a woman for 24–48 hours so the more often you engage in sexual intercourse, the more sperm you will have in your body waiting to fertilize an egg

    When to start worrying?

    See your GP if any of the following factors might be contributing to a difficulty conceiving:

    • smoking
    • take medications (such as some steroids or antidepressants)
    • are more than 25 per cent overweight or underweight
    • history of pelvic inflammatory disease
    • fibroids
    • endometriosis
    • sexually transmitted infection, such as chlamydia or gonorrhoea
    • irregular periods
    • surgery on your reproductive organs or intestines
    • chronic illness such as diabetes, cancer, thyroid disease, asthma, or depression

    Most GPs won’t start testing for fertility problems until you have been having frequent unprotected sex for at least a year if you're under 35 or six months if you're 35 or older.

    IVF

    In Vitro Fertilisation (IVF) is a fertility treatment used to conceive a child outside the body.  It involves artificially stimulating the ovaries to increase the number of eggs produced.  The eggs are collected from the woman’s ovary and then placed with the sperm in a plastic dish for fertilisation in a laboratory.  After fertilisation the embryos are transferred to the woman’s uterus in the hope that a successful pregnancy occurs.

    View an interactive online fertility charting system or for more information visit Melbourne IVF or Monash IVF.

  • Genetic counselling

    Genetic counsellors can provide information and support to couples identified as having an increased risk.

    Once you are pregnant, genetic counselling can assist you to make decisions about having screening for down syndrome and associated diagnostic tests during pregnancy. If the results from these tests do not provide reassurance, genetic counsellors also offer information and support to assist with decisions about how to proceed with the pregnancy.

    Genetic counselling is available through genetic clinics at major public hospitals in Victoria.

    Understanding genetics

    Our understanding of genetics is expanding rapidly. This is, in part, due to the human genome project, which has mapped (and aims to analyse) every human gene.  As a result, the complexity and the number of genetic tests is growing. There are already many single gene conditions (e.g. Cystic Fibrosis) and chromosome conditions (e.g. Down Syndrome) that can be diagnosed before birth. For some single gene conditions, it is possible to find out the risk for a future pregnancy before you are pregnant.

    Genetic counselling provides information and support to families and individuals who have concerns about genetic conditions. Genetic counsellors can explain the different tests that are available, whether they are available before or during pregnancy, and facilitate decision making around them. These decisions may involve difficult choices and evoke a range of emotional responses. Genetic counsellors support couples through these difficult decisions.

    Genetic conditions in the family 

    Identifying the risk for a future pregnancy includes taking a family history and may include parental genetic testing before pregnancy.  There are several options for couples identified as being at an increased risk for a genetic condition in a future pregnancy. These can be discussed with your doctor or a genetic counsellor.

    Screening and genetic testing

    Once you are pregnant, your GP or obstetrician will offer you a screening test for Down Syndrome and Edward Syndrome. Although older women are at increased risk for these conditions compared with younger women, the screening test offered in the first trimester of pregnancy gives a more accurate and individual risk determination. Most women will receive reassuring results, but some will learn they are at high risk for their baby having Down Syndrome or Edward Syndrome. There are further tests that are offered if this occurs. Deciding whether to have further testing and which test to have can be a difficult decision. Genetic counselling provides the opportunity to discuss your concerns with a health professional trained in counselling, who also understands genetic testing options.

    The Genetic Support Network of Victoria provides a point of contact for individuals, couples, and families seeking information and support around genetic conditions and genetic testing.

    They can assist with:

    • accurate and balanced information
    • referrals to support groups and other community services
    • referrals to clinical services
    • peer support
    • establishment of new support groups and the expansion of existing groups
    • provision of educational workshops, seminars, patient information sessions and peer support training