Antenatal Care


Your First Appointment

Your first appointment with Dr Metawa is generally 10 weeks into the pregnancy. A home pregnancy test is sufficient to confirm a pregnancy and to make an appointment with Dr Metawa.

An earlier appointment within 10 weeks of pregnancy may be necessary if you are unsure of your date of conception or estimated due date, have previous experienced a miscarriage, or are experiencing bleeding or other symptoms that are concerning you. Please contact us if you are concerned about any of these aspects.

Your first appointment at 10 weeks will go for 30 minutes and will involve:

  • An ultrasound examination – you will need to have a full bladder if you are less than 10wks pregnant.
  • An accurate due date of delivery
  • Review of previous tests & investigations prior to this appointment – for example blood tests
  • Discuss chromosal testing and options
  • Address any concerns or questions you may have

Preparing For Your First Appointment

A referral from your GP for your first appointment enables you to claim a Medicare rebate – this is highly advisable.

To your first consultation, remember to bring:

  • All previous blood results or ultrasounds that you have performed for this pregnancy
  • Any questions that you may have. It is a good idea to write questions down before you see Dr Metawa. This ensures that all your questions and concerns are addressed in your consultation

Dr Metawa welcomes you and your partner to be involved in each decision surrounding your pregnancy and birth.

Dr Metawa will help accommodate your pregnancy desires and expectations through your pregnancy. So please share your ideal pregnancy journey and delivery with him.

Follow-Up Appointments

All follow up appointments will be 15 minutes and are recommended at the following times:
10 weeks (first) 16 weeks 20 week 24 week 28 weeks 30 weeks
32 weeks 34 weeks 36 weeks 37 weeks (and weekly until your delivery)

Tests and Procedures

Anti-D Injections- Dr Metawa will recommend that you have an Anti-D injection at 28 and 34 weeks if your blood group is RH negative. You will also need an Anti-D injection if you have a episode of any sort of uterine bleeding during your pregnancy. Dr Metawa will organise the injection for you.

Ultrasound – The two main ultrasounds are performed at 11-14 and 18-20 weeks of pregnancy. At 11-14 weeks the nuchal transluscency (neck thickness) ultrasound screens for down’s syndrome and other chromosomal abnormalities. If the result is considered high risk then further investigations may be required ( such as CVS and amniocentesis).

The 18-20 week (or morphology) ultrasound assesses the anatomy of the baby as well as the position of the placenta in relation to the cervix. This is a more detailed ultrasound and some couples will have the opportunity to discover the gender of their baby if desired.

Chorionic Villus Sampling (CVS) – This procedure is performed between 11 and 14 weeks and involves sampling the placental bed to screen for chromosomal abnormalities. It is performed on women who have a higher risk of chromosomal abnormalities (women over 35, or women who return a high risk result on nuchal translucency screening).

CVS carries approximately a 0.5% risk of miscarriage.

Amniocentesis – Is usually performed at 16 weeks of pregnancy. The procedure involves drawing a sample of amniotic fluid to detect any chromosomal abnormalities. The risk of miscarriage after amniocentesis is approximately .25%.

Managing Early Pregnancy

Every woman will have a unique experience through her pregnancy. Here are a few tips and recommendations from Dr Metawa on managing this time.


Nausea is a normal side effect of pregnancy. Try eating small amounts of food regularly – salty crackers, ginger biscuits/drinks/tablets can make you feel better, sweet biscuits are not advised.

If you are having trouble functioning with increased nausea or cannot hold anything down (including water) please call Dr Metawa’s rooms.


Some slight bleeding or ‘spotting’ during early pregnancy can be a common and normal experience.
If you have any concerns or have any pregnancy related concerns before your first appointment, please contact us. We are available in the practice during business hours, alternatively you can call your hospital delivery suite after hours.
After hours delivery suite numbers;

  • North Gosford delivery suite 43238169, if you have Private Health Insurance
  • Gosford District Hospital delivery suite 43203439


Dr Metawa generally recommends that you take a pregnancy vitamin supplement such as Elevit or Blackmores Pregnancy Gold.

In the wider population, a healthy balanced diet should largely reduce the need for vitamin and mineral supplementation. However, during pregnancy and lactation there are extra nutritional demands on the body that can make supplementation advisable.


Antenatal Classes

From first time mothers to experienced parents, there are classes are available for everyone. Both North Gosford Private Hospital and Gosford District Hospital offer classes.

Later in Pregnancy

Fetal movements

By 20 weeks gestation most women are aware of the baby moving. There will be times throughout the day where you will not feel the baby move, this is usually because the baby is asleep.

You should feel at least 10 movements within a 12 hour period. If you are concerned that your baby has not moved or that the movements are decreased please do not hesitate to either call the rooms on 43236140 or;
After hours delivery suite numbers;

  • North Gosford delivery suite 43238169, if you have Private Health Insurance
  • Gosford District Hospital delivery suite 43203439

Braxton Hicks contractions

These are painless irregular uterine (not labour contractions), contractions which usually start at about 20 weeks increasing in regularity after the 35th week of pregnancy. The tightenings are very normal and can be quite uncomfortable at times.

Body changes and discomforts during pregnancy

Body aches: You may feel aches and pain in the back, abdomen, groin area and thighs. 

Breast changes: As the due date approaches, hormone changes will cause your breasts to get bigger to prepare for breastfeeding; your breasts may feel full, heavy or tender.

Constipation: Constipation can occur at any time during pregnancy. This is often the result of an increased level of progesterone acting on the intestine, or other causes such as iron supplements. Higher levels of hormones slow down digestion and relax muscles in the bowels; signs of constipation include having hard, painful, dry stools – fewer than three bowel movements per week. Mild laxatives may be necessary such as Movicol, Normacol, and  Duphalac can be safely used during pregnancy. Increasing your fluid and fibre intake during pregnancy will also help.

Fatigue/Sleep problems: Many women find they’re exhausted in the first trimester. In the second trimester tiredness is usually replaced with a feeling of well being and energy,but in the third trimester exhaustion often sets in again; as you get bigger, sleeping becomes more difficult as well as lack of sleep from babies movements, bathroom runs, leg cramps and an increase in the body’s metabolism.

Hemorrhoids: Up to 50 percent of pregnant women get hemorrhoids; they can cause itching, pain and bleeding. Hemorrhoids usually improve after delivery. 

Numb or tingling hands: Swelling, tingling and numbness in fingers and hands is called carpal tunnel syndrome; these symptoms are due to swelling of tissues in the narrow passages in your wrists.

Swelling: Many women may develop mild swelling in the face, hands or ankles.

Urine frequency and leaking: Your baby pushes down on the bladder, urethra and pelvic floor muscles; this pressure can lead to more frequent need to urinate, as well as leaking urine when coughing, sneezing or laughing.

Heartburn and indigestion: Reflux and heartburn are common later in pregnancy as the baby grows. Hormones and the pressure of the growing uterus can cause heartburn and indigestion; food tends to move more slowly and digestion is sluggish causing many women to feel bloated. Smaller more frequent meals and the avoidance of fatty, rich or spicy foods will all help to minimise the effect of heartburn. Many women will require antacids such as Mylanta or Rennie tablets to help ease the discomfort and occasionally prescription medications may be necessary.

Stretch marks and skin changes: Stretch marks are red, pink or brown streaks on the skin; most often they appear on the thighs, buttocks, abdomen and breasts – this is caused from stretching of the skin. 

Back pain

During pregnancy back pain may develop as the uterus enlarges this puts a greater strain on the lower back. Ligaments become softened and lax due to increased hormone production. Sciatica and pelvic instability may also develop.

Treatment can include:

  • sleeping on your side with a pillow between the legs with your knees slightly bent
  • hot packs
  • forward tilting exercises of the pelvis
  • always maintain good lumbar support when sitting
  • physiotherapy

Any surgical or invasive procedure carries risks.
Before proceeding, you should seek  a second opinion from an appropriately qualified health practitioner.