I caught up with a good friend the other day, who is just entering a new stage of life. Getting engaged, planning a wedding, and thinking about starting a family. It's an exciting time - on the precipice of a transformation. She talked a little about when she'd like to start trying for a baby and wondered aloud as to whether she should be upgrading her health insurance now, in preparation.
I was surprised, because I've know her a long time and I didn't really think she would be the someone particularly drawn to private obstetric care. As the conversation continued, I realised... it wasn't that she was drawn to an obstetric care model but that she didn't really know where to start in planning. What she knew was that when she signed up to private health, she opted for a level that excluded maternity care because she didn't need it at the time (and it's crazy expensive).
I was transported to a version of myself from before I'd become a mother. The first thing I did when my husband and I had decided on a time to start trying for a baby, was upgrade my health insurance.
I didn't know whether I needed to, I just assumed I did. Marketing is clever. I wasn't totally aware that the only rebates you get on private health for maternity services are that with a private obstetrician*. And depending on your insurance, sometimes a few hundred bucks towards antenatal education. Not only that, but your antenatal and postnatal appointments attract a medicare rebate, which means they aren't covered by your private health, so depending on how much an OB charges, you can be many thousands of dollars out of pocket by the time your care has finished.
*(Possibly important to note that Defence Health [maybe others, but not to my knowledge] can provide rebates for private midwifery care now as well - worth a call to them to discuss if that's something you're interested in)
So then, in conversation we discussed the private health situation and I explained how it only covers private obstetricians, but if that's what she's after then definitely worth upgrading it in advance, to be outside the waiting periods once pregnant. She confessed she wasn't sure what kind of care she wanted, but that she understood continuity of care to be important and assumed she would need private cover for that.
We talked a bit about the different types of continuity of care that are available and the differences between obstetrician led care and midwifery led care. She, like many of us, wasn't really sure what the difference between an obstetrician and a midwife was. The best analogy I could make for this (which is not totally accurate) is that it is a bit like the difference between a psychiatrist and a psychologist. They work in the same field, but their approaches to care are different and their responsibilities are different, and they will refer to each other as needed. Midwives are the experts in 'normal' or physiological birth, while obstetricians are the experts in pathology in pregnancy and birth - things that stray from the usual order of business.
It's complicated, because somewhere along the lines, pregnancy was brought under the same umbrella as illness and injury, but in the majority of cases, it's actually as normal a physiological event for the body as a bowel motion - just with a fair bit more going on. But though it is a very complex physiological event with lots of intricate parts, it is still (for most women) a very normal biological function, compared to something like illness or injury which is a move away from normal function.
I saw a great post from Melbourne-based obstetrician Dr. Natalie Elphinstone a while ago where she explained the kind of training that obstetricians have which make them very competent at handling emergencies and complications, but not so good at standing back to allow pregnancy and birth to happen without intervening. It's worth a read as she explains how they complete at least 300 caesarean and 200 assisted deliveries over their training, but only need to witness 20 unassisted vaginal births, and how that can bias them to assume that birth rarely happens without intervention.
My point being... the model of care that you decide on for your pregnancy, birth, and postpartum will have a significant impact on your experience of this major rite of passage. And most of us go into pregnancy without even knowing the difference between those care models.
Inspired by this conversation with my friend, I've decided to write up this post as my guide to preconception - things I recommend you think about, do, and decide before falling pregnant. I've put shortcuts here for ease of reference too:
Your care provider
Choosing a model of care and/or specific care provider will require you to understand where you sit on the medical-physiological birth spectrum which will tell you what kind of care is best suited to you and your values. There was a fantastic post recently from Dr. Melanie Jackson, aka Melanie the Midwife (as she's known on her social channels) which explained a bit more about this. With permission, I've shared the image she created below, and I highly recommend checking out the caption in the original post here
However, as my friend pointed out, it can be kinda hard to know where you sit on this spectrum when you've never been through it before... She's totally right. The scenario that I would put to you to help you identify where you might sit on this spectrum is to think about getting sick with a cold: are you the kind of person that will march straight to the doctor and take any available pharmaceutical remedy, or are you someone who would rather let it run its course? Do you prefer to try alternative remedies like homeopathy, traditional chinese meditation, acupuncture, reiki? At what stage of being sick do you seek medical attention? If 'most medical' is as soon as possible when getting sick and 'least medical' is not until I'm sure I'm dying, that might help reframe the spectrum.
It's not a perfect analogy, because it's still using pathology as a reference, compared with pregnancy which is most often physiology, but it might help turn some gears.
Another way to help you identify where you sit on this spectrum is to read or watch some things and feel how you respond to them. I highly recommend the documentary BirthTime as ideal first viewing well before getting pregnant. This documentary was created in response to increasing levels of birth trauma and tackles the question "what would it take for women to emerge from their births physically well and emotionally safe?" and has won over twenty international film awards.
I have even partnered with them to be able to give you 20% off streaming because I genuinely wish all women could see this documentary before they fall pregnant. Use this link to check it out, and make sure to enter the code CICADA20 at check out for your discount. Other ways you can view is to catch it at a DemandFilm screening (you can even set one up to host yourself!)
Once you have identified where you sit on the medical-physiological birth spectrum, you can think about what kind of care you would like. I've done a write up on maternity care options (specific to Western Sydney/Blue Mountains, but plenty of general information in there as well), which you can read here.
I'd highly recommend trying to choose your care provider before falling pregnant, even interviewing some, so that if they are in high demand, you can book them in as soon as you get a positive test.
Your physical health
Pregnancy is incredibly demanding on the body. There are some women who breeze through it, never feeling better, but more commonly, women battle fatigue, nausea, and body aches among other symptoms throughout.
Not only are you building an entire person from scratch inside you, but you will be carrying an increasing load while doing it. Being in good physical health can go a long way to making pregnancy, and even labour, an easier time for you. It's worth checking in with a doctor, or even dietitian, nutritionist and/or naturopath if you prefer, to make sure your body is ready for the challenge of pregnancy and birth - in particular, things like iron, folate and iodine can be important to check.
It's also a good time to develop good exercise habits, if you don't already. Pregnancy is not a great time to be trying new workouts or activities, but you are encouraged to continue the exercise your body is used to. If you know you have a while before trying to get pregnant and want to maximise your strength and energy levels, getting into an exercise regime can be a great way to do so. It's not just for pregnancy, but also for labour - having the physical strength to remain upright for a long time and flexibility to hold a squat can be of a huge benefit in labour in giving you more stamina and ability to meet your body's instinctive needs.
Good nutrition as important leading up to pregnancy as it is throughout. The three months prior to conception are critical to how healthy the egg is at the time. There's a great podcast episode on "Welcome to the Womb" that discusses this - well worth a listen!
Your mental and emotional health
Not only is pregnancy a strain on the body, but it can also be a real strain on the mind.
How you feel throughout your menstrual cycle can give you some great clues about how you will feel at different stages of pregnancy, and throughout labour, birth and postpartum. This is because a pregnancy is a cycle, so is labour, in the same way that our menstrual cycles are. At different times throughout each, we will have varying levels of progesterone, oestrogen, testosterone, oxytocin and other hormones... and these can have different effects on us. Understanding what hormones are at play at each stage of your cycle, and then knowing when to expect those hormones to be leading the charge during pregnancy can prepare you for how you might feel emotionally, and what strategies and plans you might need to manage at that time. If you want to learn more about this, I definitely recommend Dr. Rachel Reed's "Reclaiming Childbirth as a Rite of Passage", in particular, the Blood Mysteries chapter. You can buy the physical book, or it's also available as an e-book or audio book, making it brilliantly accessible.
Women who have a history of mental illness can be at greater risk of perinatal and postnatal disorders like PND and PNA, among others. It might be a good idea for women who know this about themselves to have a discussion with their care provider about what signs to look out for and develop a plan for managing mental illness if symptoms arise. It can also be helpful to have a similar conversation with your partner or those close to you so that they might be able to gently prompt if they notice you straying into unwell territory, as it can often be difficult to be aware of it yourself in the early stages.
If you are someone who has a history of trauma, it can also be worthwhile to check in with yourself and ready your coping strategies. It is also a good time to consider what is going to be important for you to feel safe throughout pregnancy and add it to a list of non-negotiables that you need from a care provider and you can mention in an interview phase. You feeling safe is paramount throughout pregnancy and birth, so if you interview a care provider who is clearly uncomfortable at the thought of not being given consent for four-hourly vaginal exams in labour, consider it a red flag that they are not the care provider for you.
Your relationship
I fully acknowledge that parents come in all forms, including those without a partner, and for single people opting to have a child, this section may not be relevant (unless you are planning on co-parenting with someone else). If this is the case, feel free to skip ahead to the next section.
How are you and your partner's communication skills? Do you find it easy enough to have difficult conversations? How do each of you manage and respond when the other is stressed or exhausted and maybe a little short-fused? Are you on the same page when it comes to what you want from birth and how you want to parent?
All really important discussions worth having before falling pregnant. Pregnancy can have you feeling irascible and irritable, but that doesn't necessarily let up once baby is here when you are touched out and sleep deprived (and your partner may also be). It's good to have a solid foundation for communication in place that can withstand the inevitable moments of fatigue-induced frustrations that will come. Pregnancy and postpartum also impact our hormones which can in turn, impact our libido. This is another important discussion point for you and your partner - it might be a long time before you feel like having sex after having a baby, possibly even after getting pregnant. Talk about it, and how you will approach this if it is something that happens to you.
It's also great to be on the same page around birth and parenting philosophies before falling pregnant, but parenting philosophies may bend and change once you've actually got a tiny human in front of you as well.
Your finances and leave allowances
This one is particularly important as we find ourselves dealing with increasing costs of living.
By now you've hopefully heeded my advice and figured out what sort of care you want in pregnancy, but now you might also need to consider what that kind of care you will cost. Maybe it's going through the public system which won't cost a thing. Maybe it's a private midwife, plus a doula for birth and postpartum support, and an IBCLC lined up if needed. Or a private obstetrician, using private health cover. Cost it out and come up with a plan for paying for it. If you need private health cover, make sure to arrange it early enough to account for the waiting periods.
Aside from your care team, think about what other services you might need throughout pregnancy. Physio, chiro, nutritionist, naturopath, acupuncture, and independent birth education are just some of the services that pregnant women might use throughout pregnancy, and usually at a cost.
The costs can start to add up quickly and seem quite overwhelming, but try to remember that it is but a season in your life. Not only that, but it is one of the most significant events you will experience and investing in the right care for you can have a profound impact on your experience of pregnancy and birth and set you up for confident and strong motherhood. People take out personal loans and spend tens of thousands (sometimes more) money on their wedding days - imagine if we invested that same money into our pregnancy, birth, and postpartum...
You do also need to budget for the actual baby and the things you might need. Honestly, you can get so much stuff second hand if that appeals to you, because babies use things for such a short period of time that there is plenty of stuff being passed from person to person. However, for safety reasons, car seats and cot/bassinet mattresses should always be purchased new.
If you have a job that provides paid maternity or parental leave, be sure to have a read over the policy and understand how it works and if there are any conditions. For example, some jobs will require you to have been employed a certain time period before you qualify for parental leave.
The Australian government also has a paid parental leave available through Centrelink which is worth investigating to understand the terms and conditions and how you can receive it. There is an income test and work/activities test involved to check if you qualify. Often, people can qualify for both the leave from their employer and the government paid parental leave scheme. It's useful to investigate in advance and can then hep you determine how long you can budget for taking off work after having a baby.
Your village
This is a less urgent one, as much of it can be planned throughout pregnancy, but if you find yourself with the brain space to spare, thinking ahead to your village and the support you have around you can help you in planning for pregnancy, as well as postpartum and parenting.
Do you want someone to plan you a baby shower or a mother blessing? Do you have people to help you stock the freezer in preparation for baby's arrival? Do you have people who will bring meals around once you and baby are settled at home? Who will be around to help when your partner has to go back to work? Do you have someone you can call in the middle of the night if you're feeling too overwhelmed? Does your village understand and respect your needs in labour, birth and postpartum? Who do you want with you during labour? It might be someone different to you partner, or in addition to them. Or it might be someone you only want around in parts of labour, maybe early to keep you busy and help you with last-minute tasks, or as things start to get tougher to give you emotional and physical support.
Do you have people around you who are going to build you up in pregnancy or people who might pull you down with their own fears or trauma? Figure out who is going to be helpful to you in this time and those you might need to distance yourself from - even temporarily. For example, someone planning a homebirth might choose not to share that information with friends or family that have very medical philosophies or had traumatic birth experiences, until after the baby is born. On the other hand, someone planning a caesarean might choose not to share that with more physiology-minded friends and family. Ideally, our village will respect that our choices are our own to make, but sometimes they bring their fears, values and biases into our space and it can be unhelpful. It's perfectly okay to keep some information to yourself if you suspect some of your people might have this tendency.
In Summary
There is much you can do to prepare in advance of planning a pregnancy, but remember that plenty of people get no prep time at all and manage just fine. If you know you have the time to prepare, that's great! But if you're already pregnant and find yourself panicking after reading this, try not to worry - just prioritise what you feel is most important and take things one step at a time.
Happy planning!
My name is Katelyn Commerford and I am a doula and next birth after caesarean guide who has completed comprehensive doula education at Vicki Hobbs’ Doula Academy. If you want to know more about what I do and how I can help you, please visit my website where you can get your free cheat sheet of my favourite VBAC resources, or find me on instagram @thenbacguide where I answer commonly asked questions about planning the next birth after caesarean and share loads pregnancy, birth, postpartum and parenting content.
Katelyn Commerford – Doula and NBAC Guide
Phone: 0431 369 352
Email: hello@katelynthedoula.com.au
Instagram: https://www.instagram.com/thenbacguide/
Website: www.katelynthedoula.com.au
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