Antenatal care is the care you receive while you are pregnant. It monitors your health and your baby's health through regular appointments, from early in the pregnancy until birth. It combines regular check-ups, information and support, and screening to pick up any concerns early so they can be managed.

At each visit, your care covers three things:

• checking your health and your baby's growth and wellbeing
• giving you information so you can make choices about your pregnancy and birth
• screening for conditions that are easier to manage when found early

Starting antenatal care in the first trimester is recommended. In Australia, the first antenatal visit is best held within the first 10 weeks of pregnancy, as there is a lot to cover early on and some tests work best when done early.

See your GP as soon as you think you are pregnant. Your GP arranges the standard blood tests and an early ultrasound to confirm the pregnancy, and can give you a referral to a private obstetrician. Once that is done, your first consultation with Dr Mahadik usually happens at around 10 weeks.

Your first consultation is a long appointment. It covers:

• Your pregnancy. Anything about this pregnancy that may need extra care, such as a twin pregnancy, and your pregnancy history, including any past complications like a small baby or an early birth.
• Your health. Any medical conditions that may need closer attention in pregnancy, such as diabetes, high blood pressure, thyroid, kidney or heart conditions.
• How you are feeling. Questions about your life, your mood and how the pregnancy is affecting you, so we can arrange support if you need it.

Together you then set out an antenatal care plan, looking ahead to the tests and check-ups at each stage. You are welcome to bring a support person to any appointment.

• Your GP referral
• Your blood, urine and ultrasound results
• Your Medicare card
• Your private health fund card, if you have one

Pregnancy is divided into three trimesters, and the focus of your care changes as your pregnancy progresses.

Your care focuses on your health and your baby's early development, and you begin making choices about the care you want for the rest of your pregnancy. This is an important window for screening, including for:

• pre-eclampsia (raised blood pressure in pregnancy)
• gestational diabetes (diabetes that develops in pregnancy)
• chromosomal and genetic conditions
• infections

Your care focuses on monitoring your baby's growth and checking on your wellbeing.

Most babies are born between 40 and 42 weeks. In this stage you have more frequent visits and closer monitoring of your baby’s growth, and your care turns towards preparing for birth and the first weeks afterwards. Antenatal classes are encouraged. Your care during labour and birth is covered on the delivery options page, and the care you receive after birth on the postnatal care page.

Your appointments are spaced to fit the routine tests and check-ups recommended at each stage. As a general guide, you would be seen every 4 to 6 weeks until 28 weeks, then every 2 weeks, and then weekly from 36 weeks until your baby is born. A first, uncomplicated pregnancy usually involves around 10 visits; a later uncomplicated pregnancy around 7. Your own schedule is tailored to you, and you will be seen more often if anything needs closer monitoring.

A typical schedule looks like this:

• 9-10 weeks — first consultation. Your care plan is set out and genetic carrier screening is discussed, with referrals provided.
• 10–12 weeks — first-trimester screening. Non-invasive prenatal testing (NIPT) and a 12-week ultrasound, which screens for early fetal development, pre-eclampsia risk and nuchal translucency.
• 18–20 weeks — morphology scan. A detailed ultrasound that checks your baby’s development.
• 26–28 weeks — blood tests and diabetes screening. Iron and thyroid checks, and screening for gestational diabetes.
• 28 weeks — vaccinations. Whooping cough (Boostrix) and RSV are usually given around now. The flu vaccine can be given at any stage of pregnancy.
• 28 weeks — antenatal class.
• 36 weeks — group B strep swab. A vaginal swab plus an iron check.
• 36–37 weeks — antenatal class. A discussion of labour and pain relief options.
• 40–41 weeks — review. An assessment and discussion about inducing labour if your baby has not arrived.

Small, everyday healthy choices support a healthy pregnancy. Your care includes practical guidance on the areas below.

Eat a varied, balanced diet across the five food groups, and drink plenty of water. Some foods carry a risk of infections like listeria, which can cause serious harm in pregnancy, so it is best to avoid:

• unpasteurised milk and soft cheeses
• cold processed and deli meats, and pâté
• pre-cut fruit, pre-packed salads
• raw and cold-smoked seafood

Wash raw fruit and vegetables well, and cook meat, poultry and eggs right through. To lower the risk of toxoplasmosis, avoid raw or undercooked meat and avoid emptying cat litter trays.

• Folic acid: 0.5 mg (500 micrograms) a day, ideally starting at least one month before conception and through the first three months, to lower the risk of neural tube defects. Some women need a higher 5 mg dose. This may apply if you have had a baby with a neural tube defect before, if you have diabetes, if you take certain medicines, or if your BMI is higher. Dr Mahadik will tell you if this applies to you.
• Iodine: 150 micrograms a day before and during pregnancy and while breastfeeding, to support your baby’s brain development. If you have a thyroid condition, check with your doctor first.
• Iron and vitamin D: You may need these depending on your blood test results. They are recommended for some women, not for everyone.

Start folic acid and iodine as soon as you know you are pregnant if you have not already — it is not too late.

Limit caffeine to no more than 200 mg a day (roughly two cups of coffee) and avoid energy drinks. There is no known safe level of alcohol in pregnancy, so it is safest to avoid it. Quit smoking and avoid second-hand smoke.

Regular, low-intensity exercise most days is encouraged — a mix of activities like walking, swimming or stationary cycling with some light strengthening. Exercise supports your wellbeing, helps manage weight gain and is especially helpful if you have gestational diabetes. Pelvic floor exercises are worth doing through pregnancy and after birth.

How much weight to gain in pregnancy depends on your body mass index (BMI) before pregnancy. As a guide, this is around 11.5–16 kg for a healthy BMI, 7–11 kg if you are overweight, and 5–9 kg with a BMI over 30. Your own target is discussed with you at your visits.

Nausea and vomiting (morning sickness) is common in the first trimester and usually eases after that. It can often be helped with smaller, more frequent meals, less spicy and oily food, and rest; there is some evidence ginger can help. If it is more troublesome, anti-nausea medicines that are safe in pregnancy can be prescribed. Always check any medicine — including anything over the counter — with your doctor or pharmacist, and do not start or stop a prescribed medicine without medical advice. In NSW you can also call MotherSafe on (02) 9382 6539 for advice on medicines in pregnancy.

Whether or not to breastfeed is your choice, and your choice is respected. It comes up in your antenatal classes and consultations, and antenatal expression of breast milk is sometimes discussed later in pregnancy. Feeding support and the benefits of breastfeeding are covered in full on the postnatal care page.

Some vaccines are recommended in pregnancy to protect you and your baby, including in your baby's first months of life before they can be vaccinated themselves. Dr Mahadik discusses these with you and your GP can also help arrange them.

• Whooping cough (dTpa): recommended between 20 and 32 weeks, in every pregnancy. It can be given up to the time of birth if missed.
• Influenza (flu): recommended at any stage of pregnancy, each year.
• RSV (respiratory syncytial virus): recommended between 28 and 36 weeks to protect your newborn. It is funded under the National Immunisation Program.
• COVID-19: the vaccine is safe in pregnancy. If you have not been vaccinated, a course is recommended. If you have already been vaccinated, talk with your doctor about whether another dose is right for you.

The flu, whooping cough and RSV vaccines are free for people eligible for Medicare, and COVID-19 vaccines are free for everyone in Australia. A consultation fee may still apply.