In addition to the information provided on my website, all of my antenatal patients are given an Antenatal Pack containing additional information.

It is quite common to have some degree of nausea during the first trimester. This will generally begin at around six weeks, peak at around nine to ten weeks and gradually resolve between 12 and 14 weeks. Sometimes the nausea may be severe and persistent and occasionally associated with excessive vomiting.

This is termed hyperemesis gravidarum (commonly known as ‘morning sickness’, although it can occur at any time throughout the day.) It is the normal increase in pregnancy hormones that causes these symptoms. Rarely, there may be an underlying cause to make the symptoms more severe. These situations may include a urinary tract infection, an overactive thyroid gland or a multiple pregnancy.

At its most extreme, vomiting can be so severe that hospitalisation is required and strong medication is necessary to prevent more serious complications. This is extremely unusual. If you are at the stage where you are vomiting more than twice a day, you should not hesitate to contact me, so you can avoid getting into this more serious situation.

There are many options to control the symptoms but there is virtually no treatment that will eliminate them completely. Treatment involves a combination of rest, dietary modification, vitamins, complementary therapies, conventional medicine and occasionally intravenous fluids.

One of the difficult issues to face in early pregnancy is the option for prenatal testing. In recent years, several new tests have become available primarily aimed at testing for Down syndrome.  These tests are offered in addition to the usual blood and urine tests in early pregnancy, and are also additional to the detailed ultrasound examination at around 20 weeks. These tests are looking for various genetic conditions in your baby. They are optional but need to be considered carefully.

This information sheet provides a summary of the tests available and is intended to be a reminder of the issues that need to be considered. You should not feel 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. I will give you advice on the different types of tests and options available but the ultimate decisions must rest with you.

I have provided you with some information about the different tests available, and what they are looking for.

There are two main groups of screening tests available to you:

• Genetic tests performed before or very early in pregnancy
• Prenatal tests performed at various stages throughout pregnancy

When you commence having contractions, or if your membranes rupture (waters break), please telephone the Delivery Suite directly on 9344 5100. The midwife in Delivery Suite will advise you about the appropriate time to come into hospital. After you have been admitted, the midwife will phone me with a progress report and I will usually come to see you shortly afterwards. It is normal to have a small “show” of blood prior to the onset of labour. If the bleeding is more than a teaspoon full, or occurs before you are 34 weeks pregnant then you should contact me immediately.

In labour you will have a range of pain relief available to you. This will include gas, morphine, TENS and an epidural if necessary. Nothing will be given without your permission and pain relief will always be discussed with you before a decision is made. You have the choice to have an enema on admission to labour ward, although this is by no means a necessity.

Provided there are no medical complications, you may deliver in whatever position you find comfortable at the time. I do not routinely cut episiotomies unless it is necessary to prevent a large tear. Following delivery, you will then have an injection to help deliver the placenta more quickly in order to prevent excessive bleeding. I recommend strongly that your baby has an injection of Vitamin K (rather than the oral form) in order to prevent internal bleeding complications that affects approximately one in 1000 babies. If this injection is given, the complication is never seen.