Pregnancy screening and birth choices

If you need help now: Pregnancy and early parenthood can be emotionally hard, and that’s nothing to be ashamed of. In an emergency call 000. For support, call Lifeline on 13 11 14, Beyond Blue on 1300 22 4636, or PANDA (Perinatal Anxiety & Depression Australia) on 1300 726 306. You don’t have to be at your lowest to reach out.

A run of real decisions, close together

Pregnancy has a way of stacking decisions into a short window: which screening test, how to give birth this time, how to feed your baby, what to do about a medicine you take. Each one can feel weighty, and well-meaning advice from every direction can make it harder, not easier. The steadying thing to know is that most of these don’t have one universal right answer — they have your answer, found by weighing real trade-offs with your maternity team.

This guide walks through four of the big ones so you can take clear questions to your GP, midwife or obstetrician. None of it is personal advice, and none of it tells you to start, stop or change a medicine.

Prenatal screening: NIPT versus combined first-trimester screening

The first fork for many is which screening test to have for the common chromosomal conditions like Down syndrome. Both options are screening tests — they estimate a chance, they don’t diagnose, as Pregnancy Birth and Baby explains.

• NIPT (non-invasive prenatal testing) analyses the baby’s DNA in a sample of your blood. It’s more accurate, with fewer false alarms for the common trisomies — but it’s generally not Medicare-rebated, so it carries an out-of-pocket cost, per Pregnancy Birth and Baby.
• Combined first-trimester screening (CFTS) pairs a blood test with the nuchal-translucency ultrasound. It’s partly Medicare-covered, and the scan also gives early structural information, as the screening overview describes.

The crucial point with either: a higher-chance result needs a diagnostic test (CVS or amniocentesis) to confirm. Part of the decision is also thinking ahead about what you’d do with the result. The prenatal screening decision aid below helps you weigh accuracy, cost and meaning — it doesn’t choose for you.

Birth after a caesarean: VBAC or planned repeat

If you’ve had a caesarean before, this time brings a genuine choice. For many women with one previous lower-segment caesarean, a planned vaginal birth after caesarean (VBAC) is a reasonable and safe option, per RANZCOG and Pregnancy Birth and Baby. The main specific risk is a tear in the uterine scar (uterine rupture) — uncommon, but potentially serious — which is why VBAC is planned in a hospital able to perform an emergency caesarean if needed.

The alternative, a planned repeat caesarean, avoids that particular risk but is major surgery with its own recovery, as Pregnancy Birth and Baby sets out. Neither is universally right; the balance depends on your history, this pregnancy and your own priorities. The VBAC decision aid below helps you frame that conversation with your maternity team.

Feeding your baby: breastfeeding and formula

Few topics carry more pressure than infant feeding, so it helps to hold two truths at once. Australian guidance recommends breastfeeding — ideally exclusively until around six months, continuing alongside other foods after that — for its benefits to babies and mothers, per the NHMRC Infant Feeding Guidelines and the Australian Breastfeeding Association.

And, equally importantly: where breastfeeding isn’t possible or chosen, infant formula is a safe, nutritionally complete alternative, as Pregnancy Birth and Baby makes clear. Feeding is not a test you pass or fail. If it’s hard at first — and it often is — that’s a reason to get support, not to feel you’ve failed. The infant feeding decision aid below is built to help, without judgement.

Medicines in pregnancy — and why valproate needs special care

If you take a regular medicine, one of the most important things to sort out — ideally before pregnancy — is whether it’s safe to continue. Some medicines are fine, some need switching, and a few carry real risk; Australia classifies them in pregnancy categories to guide this, per the TGA. The overriding principle is to never stop a medicine on your own, because for many conditions stopping suddenly is more dangerous than the medicine itself.

Sodium valproate (used for epilepsy and bipolar disorder) is the clearest example of why this needs planning. It carries a high risk of birth defects and of effects on a child’s development if taken in pregnancy, and the risk rises with the dose, as Australian Prescriber and the TGA valproate safety alert set out. Because of that, regulators advise it should not be used in women who could become pregnant unless there’s no suitable alternative and pregnancy-prevention planning is in place.

But valproate must never be stopped abruptly — doing so can trigger seizures or a relapse of bipolar disorder. The safe path is a planned, specialist-led review, ideally before pregnancy, co-ordinated between your GP and your neurologist or psychiatrist. The valproate decision aid below is built to help you prepare that exact conversation. It does not tell you to change anything — that is for you and your treating doctors. And if your mental health is suffering at any point, please use the support lines at the top of this page.

The questions worth taking in

• Given my situation, what are the trade-offs between NIPT and combined screening — accuracy, cost, and what I’d do with the result?
• Is VBAC a reasonable option for me this time, and where would I birth to do it safely?
• What feeding support is available to me, whichever way things go?
• Which of my medicines need reviewing for pregnancy, and can we plan that before I conceive?

These are questions, not conclusions. The aim is to decide with your maternity team and GP.

What this is, and is not

This is general information to help you prepare for your GP — not a diagnosis, and not personal medical advice. It doesn’t tell you which test to have, how to give birth, how to feed, or to start, stop or change any medicine; those decisions are made with your own doctors. For trustworthy Australian background, see Pregnancy Birth and Baby and the NHMRC.

And again, if things are hard right now: 000 in an emergency, Lifeline 13 11 14, Beyond Blue 1300 22 4636, or PANDA 1300 726 306. Reaching out is a strong move.

Related on this site: the gestational diabetes explainer and the perinatal mental health explainer cover two common parts of the pregnancy picture, and the fertility and family-planning decision aid covers the decisions that come just before.

If you want a thorough, unhurried discussion of your own pregnancy-planning picture, you can work with Dr Lo.

Author: Dr Hoe Bing Lo — AHPRA MED0001212640 · FACRRM. Fun Doctors Pty Ltd · ABN 83 404 436 330.