You've got a positive test and no real idea who to ring. Or when. Or whether it's too early to be bothering anyone.

Here's the short version.

Book an appointment with a GP or a midwife. You don't need a referral to see a midwife in NSW, and you don't need to wait for anything. Aim to be seen in the first ten weeks. Everything else can be worked out from there.

Do I see a GP or a midwife first?

In Australia, the GP has traditionally been the first stop. That's still an option, and for plenty of women it's the right one.

It's worth knowing that this is largely a Medicare artefact rather than a clinical rule. The system developed that way.

An Endorsed Midwife can look after you from the moment you find out until your baby is around six weeks old, and often a little beyond. That includes confirming your pregnancy, ordering your blood tests, ordering your ultrasounds, and talking you through your options for early screening.

From there, one of a few things happens.

Your midwife can continue your care through your pregnancy, or can refer you on. That might be to your local public hospital service, a publicly funded homebirth program, a midwifery group practice, or a specialty clinic if you're having twins or your pregnancy needs extra attention. Or to a private obstetrician, if that's the direction you want to go.

Medicare recognises referrals from Endorsed Midwives to obstetricians and paediatricians. You don't need to go back to a GP for a second referral to the same specialist. Appointments with an Endorsed Midwife also attract Medicare rebates, as do the tests and ultrasounds that Medicare normally covers in pregnancy.

And once you've been referred on, you can come back. Being under someone else's care for your birth doesn't close the door on midwifery support in the weeks around it.

Do I need a referral to see a midwife in NSW?

No.

Midwives are primary care providers. There's no referral barrier. You can pick up the phone and make an appointment, and a midwife can refer you onward where that's needed.

Midwifery covers pregnancy, labour, the postnatal weeks and the newborn. That includes recognising complexity and managing an emergency, and it includes knowing when another set of hands is needed. Knowing what's normal is precisely what makes it possible to recognise when something isn't.

Every woman needs a midwife. Some women need a doctor as well.

Midwives know birth. You know your body and your life. Care tends to work best where those two meet.

When should I book my first pregnancy appointment?

Honestly, there isn't strong evidence pointing to one particular week.

What there is, is consensus. The Australian pregnancy care guidelines say your first proper visit should happen within the first ten weeks, and that it needs a long appointment rather than a quick one.

Ten weeks counted from the first day of your last period, not from conception. If that's still confusing, start with How many weeks pregnant am I?

Seeing someone early gives you both time. Time to talk about any health concerns you're carrying in, time to sort out what's recommended for your particular situation, and time to get help with symptoms if you need it.

How early is too early?

It's never too early.

If you need help, ask for it. You can do that from the minute you look at a test, and home tests are accurate enough now that some women know before their period is even due.

There's one thing worth knowing before you book a scan, though.

The earliest an ultrasound can accurately estimate how far along you are is around six weeks, and seven or eight is usually the sweet spot. Part of the reason is that a baby's heartbeat doesn't become visible until about five weeks and five days, which is three weeks and five days after conception.

Which is remarkable when you sit with it. One day there's no heartbeat, and then there is.

The practical consequence is that if you go in for a dating scan thinking you're further along than you are, you might not see the things you went looking for. And then you wait a fortnight and go again, with all the worry that comes with that.

So seek support whenever you want it. Just know that waiting is, more or less, the first thing you learn to do as a parent.

What is a booking-in appointment?

It's the name given to your first comprehensive appointment with the service you'll birth with. If you've had friends have babies, you'll have heard the phrase.

It's usually long, and it usually happens somewhere between twelve and sixteen weeks.

It is often not your first appointment of the pregnancy. By the time you get there you may have already been seen several times, had bloods, had a scan, and made decisions about genetic screening.

Here's the part worth underlining: you don't have to be booked in anywhere to get care.

You shouldn't have to wait until you're sixteen weeks pregnant to get information and support. You're nearly halfway by then.

And there's a circularity in it. How are you supposed to choose where and with whom to have your baby if nobody has told you what the options are?

Early pregnancy care should give you time and information about all of your options, early enough to actually use them. For what those options are, see Where can I give birth in Sydney?

What happens at your first antenatal appointment?

Everything in this section is optional. What follows is what usually happens, not what must.

A health and lifestyle review. General health, previous pregnancies, how work is, how home is.

A detailed medical history. For a lot of women this is the most thorough health assessment they've ever had. It's not box-ticking. It's how anything that might affect you or the pregnancy gets picked up early.

Family and genetic history, yours and your baby's other parent's.

A conversation about how you're actually doing. Your emotional wellbeing should be part of this appointment, not a footnote at the end of it. What's a normal shift in early pregnancy, what isn't, and when it's worth getting some support.

Physical checks. Usually weight, which moves in and out of clinical fashion and has a genuinely mixed evidence base. If being weighed is difficult for you, it is completely reasonable to decline, and reasonable to ask why it's being done. Blood pressure is usually checked at least once in the first twelve weeks, mostly to establish what's normal for you before anything changes.

Your care options. This should be discussed here, if it hasn't been already. What your choices are for pregnancy care and for birth, and what the next few months usually look like.

Early screening and testing. What's available, what each test looks for, and time to think about what you'd do with the information. More in What tests will I be offered in early pregnancy?

Reviewing anything you've already had done, and planning what's coming.

In practice there is far too much here for one appointment. I usually spread it over a few. These are decisions worth chewing on rather than making on the spot.

This appointment can be in person or by telehealth. I do a lot of them by telehealth. Some women don't feel well enough to leave the house. For others it's simply easier to have both of you in the same room at a time that suits.

How many appointments will I have?

It varies, by woman, by pregnancy, and by care provider.

First-time mothers and more complex pregnancies usually mean more appointments, and sometimes appointments with more than one provider. With twins you might see a midwife, a sonographer and an obstetrician, ideally on the same day, though it doesn't always fall that way.

The national guideline says ten visits is adequate for a first uncomplicated pregnancy, and seven for later ones. That's the baseline, not a ceiling.

If you go looking online you'll find twenty different schedules, which mostly tells you there isn't a rule. Women aren't the same, babies aren't the same, and pregnancies aren't the same.

For a rough shape, I'd usually want to see someone around eight weeks, then twelve, then sixteen. After that the rhythm tends to be twenty, twenty-four, twenty-eight, thirty-one, thirty-four, thirty-six, thirty-eight, thirty-nine, forty, forty-one, and beyond if you stay pregnant.

What should I bring, and what will they ask?

Anything about your health that might be relevant. If you see a doctor regularly, or take regular medication, bring the details.

Anything from this pregnancy already. Blood tests, ultrasounds, results.

Family and genetic history, if you have it.

You'll be asked about your health, your wellbeing and your family. It's fine not to know. Plenty of people don't have a clear picture of their family's genetic history, which is part of why screening tests exist. You can always go back and ask, and bring it next time.

Some of the appointment is getting to know you. The rest is ordinary pregnancy care, which is designed to pick up the things that need more attention.

One thing worth doing

Make the appointment. Don't wait to feel more certain, or more pregnant, or less silly about it.

If you're not sure who to call, a midwife is a reasonable first phone call, and you don't need anyone's permission to make it.

This is general information about pregnancy, not advice about you. It doesn't replace the care of your own midwife, GP or maternity service, and it can't account for what's particular about your pregnancy.

If you're worried about yourself or your baby, contact your maternity service or go to your nearest emergency department. Don't wait to be sure.

I just found out I'm pregnant. What do I do first?