I'm Thinking of Having a Baby

The Must-Do's Before Pregnancy: GP Edit

• Hannah Eriksen • Season 1 • Episode 13

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What are the things you MUST have your general practitioner (doctor) check for you before you get pregnant?

In this episode of the I'm Thinking of Having a Baby podcast, I talk to Dr Kris. With 33 years of experience in general practice and special training in maternal care, she goes into detail about what kinds of preparation she will do with her patients who are planning a pregnancy.

It's quite a list, so make sure you grab your very own Blood Test Checklist here.

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🤰🏽Preparing for Pregnancy Pack - The 3 Essentials for Pregnancy Success

🥰 10 Ways to Feel Wildly More Supported on Your Fertility Journey

👌🏼25 Simple Things to Curb Your Cravings with PCOS

💃 Beat Your Endo Belly


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Oh Goodness! Nutrition is an evidence-based dietitian practice. However, given the general nature of the content presented on this podcast, it can not replace individualised medical advice. Get yo'self a professional (psst, lik...

Hannah Eriksen:

You're listening to the I'm thinking of having a baby podcast. I'm Hannah Eriksen, New Zealand, registered dietitian and owner of Oh Goodness Nutrition, an online consultancy, taking the confusion out of eating well for conception, pregnancy and post baby.

Hannah:

Today on the show we have Dr. Kris. She is a GP with 33 years experience. So Kris, welcome.

Kris:

Thank you.

Hannah:

Very good to have you here. Shall I just launch into the questions?

Kris:

I think so. Yeah. Let's go.

Hannah:

In New Zealand, we know that about 50% of pregnancies are planned. So when should a man or a woman who's planning a pregnancy, reach out to their GP?

Kris:

Well I've yet to have a man reach out to talk to me about planning a pregnancy. I might mention something in passing, but, women generally, they should mention it at least three months beforehand so we've got time to do some planning. 12 months is better, especially if you've got somebody who already has some issues. So those are the patients that are already, on regular medications for something, or if, you know, have a medical issue that they've grown up with. So folks with diabetes or epilepsy, most of those will know, we will have said to them, now you must talk to us before you plan a pregnancy, because there are some things that we would like to do, but for somebody who's not in those circumstances three months is good. Quite often a woman will be having a smear or coming in for contraception. And she'll say, oh, this might be the last prescription I get from you... then that's my opening to say, okay, well, let's have a talk about that or book another time to talk about it.

Hannah:

What is the benefit of someone coming to see you around three months before they're thinking of having a baby?

Kris:

Well, I think one of the first things is that we can then say, look, it's normal to take 12 months, but you might get pregnant in the first month. There's no predicting it. So, don't stop your contraception until you're ready to have a baby. Don't come and tell me it came too soon. And don't worry about not getting pregnant. Particularly if you are young until you've gone 12 months. Although I would normally see people sooner about that, but just that reassurance that, you know, it is a bit of a Russian roulette getting pregnant and it is normal to take longer. I think that's just to try and alleviate any stress before it starts is, is a good thing.

Hannah:

It something that you think will happen immediately. Mm, and then it, it doesn't and you think something's wrong with you? So for you to say, look, it's normal for it to take 12 months. That's awesome.

Kris:

I think because you spend, you know, the preceding years, months trying not to get pregnant. Suddenly you want to and it doesn't happen as quickly. And it is their unpredictability, isn't it, you know, people who are really planning want to make sure that they're pregnant through the winter and have a summer baby or they don't wanna be pregnant through the summer and have a winter baby.

Hannah:

So what kind of testing would you do for someone who's come to see you.

Kris:

You wanna get some baseline information. The most important thing that always sticks in my mind is to make sure that they're immune to rubella, to German measles because getting rubella in pregnancy is fraught. In the past, there have been lots and lots of disability related to that. And we don't see very much of that anymore, but we also don't want to forget about it. The idea of doing the Rubella is that we can then offer a vaccination before they conceive rather than test an early pregnancy, find out they're not immune, worry a little bit all through the pregnancy that they might get it, be nervous every time they get a little bit of something. So it's better to do it beforehand and you shouldn't conceive for one month... you want to do height and weight and work up with their BMI is. We know that it's easier to get pregnant if you're not too heavy or you're not too thin. You wanna check their blood pressure because blood pressure and pregnancy can be a problem. And you wanna check their general health and make sure they're in a good place, in a safe relationship, which, you know, you would assume if somebody was planning a pregnancy. But those are not always a given. And then you would want to start them at least on folic acid, cuz we like them to be taking that at least four weeks before pregnancy. But there's quite a range of things I like to do in the bloods. I mean the, the German measles slash Rubella is probably the most important, but I tend to do all of the standard initial antenatal bloods. You're looking for things like anemia. So you'll check the iron. Particularly with vegetarians and vegans, you're checking B12 as well. I'm checking for diabetes and I'm checking their thyroid function. And then the rest is part of the STI screening, there's a blood test for syphilis and Hep B and Hep C and again, with permission HIV, cause we are seeing less and less of that, but we still always want to pick that up before pregnancy.

Hannah:

We've talked about when you're thinking about having a baby just before you start trying, you're still on contraception. But what about when getting pregnant takes a bit longer than you think?

Kris:

Yeah. And the recommendation for referral, if you need some help is 12 months or at six months if they're older over 35, because really the process of getting some help can be long. And you, you do need to get on with it. I think public fertility services don't help you after 37. Because let's face it. Women are most fertile in their twenties. And, you know, with us wanting to work and have careers and trying to, get that balance it does put a bit of a strain on the system and you do see some women who, have no trouble having their first at 33 and two years later, difficult, unable to conceive. But I usually say if you've really been trying and, you know, sometimes they travel for work or he travels for work, or when they've missed that window, I say, come back and see me in six months. Cause I do go through and check that they had a regular cycle and I get them to record their cycles. So if, if it looks like they really have been hitting the window of, conception and not conceiving, then I just do a few simple tests. I get the bloke involved and we just check his semen. Cause there's no point in putting a woman through a whole lot of stress if he hasn't got enough swimmers. So, that's probably one of the first things I do. And the second thing I do is prove that she's ovulating. So I do a progesterone at about day 20, but I adjust that depending on her cycle length. I might get her to do two or three bloods, two days apart to pick it. And I get really excited when I've picked the ovulation and then they conceive on that cycle which has been known to happen. So it's, it's wonderful. I ring them and you ovulated. Yes, but I haven't had my period yet. I noticed on the information that on Health Pathways, which is our sort of guidance documents that the DHBs produced is that they suggest intercourse three times a week, right through the cycle. Um, I don't

Hannah:

yeah. Comment on that.

Kris:

Well, my sense is that sometimes you know, the store of sperm isn't endless. And I always say, look, the egg lasts about 12 hours. What you want is you want to have sperm in there ready and waiting. So if you've got a standard 28 day cycle and you're therefore you're ovulating on day 14, then you wanna have intercourse day 11 or 12, and about day 13 and 14. And as often as you want after that, but I wouldn't be having intercourse every day from the end of your period, leading up to ovulation because by the time you get to day 12 or 13 or 14, the stores might be a little bit depleted.

Hannah:

Plus you'll be exhausted.

Kris:

yeah. And that too. And that too. Yeah. So I was a bit surprised when I read that. But I do think timing intercourse, two or three days before you expect ovulation, and then again, a roundabout ovulation. Not quite like in those movies where somebody tests with an ovulation kit and drags their husband partner home from work. And fortunately, there are kits where you can check ovulation and stuff, but, but that's a very general timing. If you've got a regular cycle, even if it's 30 days long or 35 days long, you can work out when ovulation is cause it's two weeks before your period comes.

Hannah:

I dunno if this is too much information for my listeners, but, I'll tell it anyway, my partner and I I think we had sex every couple of days or something for months. It ended up being like the first couple of weeks of your cycle, right before ovulation we'd have sex. And then afterwards I was like, don't touch me. I'm just not interested at all because it just, it loses it's fun. It just becomes perfunctory. So trying to avoid the task ness of it and just really focusing on your time of ovulation having some sperm ready to go. I think that's excellent advice.

Kris:

And then we all know how much stress has a part to play here. The more you worry and the more anxious you are and the less fun it is, you get the sense that the less likely it is to happen. You really just need to do the things that we know that help manage stress. So you want to get as much sleep as you can. You wanna have regular exercise, you wanna have a good diet. You wanna feel good about yourself? Yeah. And about your future and about your relationship.

Hannah:

Do you find that your patients are pretty willing to tell you that they're thinking of having a baby?

Kris:

Uh, yes absolutely.

Hannah:

Reach out to you at what point?

Kris:

So they would more often reach out because they weren't having any success. Yeah. But as I say often if they're coming in for contraception, then they'll let me know that that might be their last prescription and we can talk about it then. You know, when we're doing a smear or something like that. So incidentally, they're very happy to share it. Some would book an appointment, especially, but that would be the minority, but obviously it would be a very good idea. So hence your podcast. If you can get more women going to their GP ahead of time. It also helps set up that caring relationship and it makes it more exciting when they get pregnant. Because sometimes when a woman announces a pregnancy to me, the first thing I have to do is be very careful. And how I react and definitely make sure that this was planned and wanted. So when I know they're trying I can be overly excited.

Hannah:

And that would be really special for the woman as well.

Kris:

Yeah, it's lovely. It really helps cement the relationship.

Hannah:

I'm just gonna do a shameless plug, I suppose, from the diet perspective. I know how tricky it can be to implement what we know to be good or even just to double check that what you are doing is spot on. So, don't hesitate to reach out to your GP to talk about it. They can always refer you on to a dietician. Your GPs are there to help and they know all the people to put you in contact with as well.

Kris:

Very wise words. I've just had a quick crib at my notes.

Hannah:

Yeah, definitely. I love it.

Kris:

So we didn't mention the obvious things. I didn't mention the obvious things of stopping smoking if you are smoking. And at least reducing alcohol. I mean, my feeling is definitely no binge drinking and try not to drink when you're trying to conceive.

Hannah:

That has such massive impacts on the quality of the sperm, and the egg health as well.

Kris:

So that's something for the boys to think about too, isn't it?

Hannah:

A very special thanks to Kris for sharing her expertise with us. Now I imagine that many of you didn't have the chance to scribble down notes as you were listening. Don't worry I have made a checklist for you and you can download that in the show notes today and get ticking if you're planning your very own pregnancy.

And just so you lovely people are in the know that I'm thinking of having a baby podcast is taking a wee break and we'll be back with season two before you know it. We've got some big changes planned which I can't wait to share with you. If you'd like to get in touch, you can email me hannah@ognutrition.co.nz. I would love to hear from you. Speak soon.