Pregnancy in Malta

 My mind is blown. It’s been two months since we’ve had our baby and let me tell you, pregnancy FLEW by even though the first trimester and the last week felt never ending.

I honestly wish I had more guidance when it came to pregnancy, especially during the first weeks. Unfortunately, it’s a period where you can’t really ask your family or friends for tips if you plan on keeping it a secret. Doctors will tell you to power through for a couple of weeks and basically hope for the best. So there’s really nothing you can do.

—For the sake of privacy, I will not be naming any names of professionals or practices—

The First Trimester

When we found out that I was pregnant, we called our gynecologist and asked what the next step would be. She told us that we’d need to go in a couple of weeks for a checkup. 

We had the first appointment at around 6 weeks. The OBGYN did a transvaginal ultrasound and found that everything was in place. She asked about my last period to calculate the estimated due date (EDD) and proceeded to book an appointment at Mater Dei and started my Blue Card. I asked her about what would happen and she just told me that “they’d open the file” and that’s it. She then told us about certain tests that were available at hospital and privately. Mater Dei does not provide the Down syndrome test for example. It’s an extra 200 EUR and it just tells you if you’re high risk or low risk, it’s not really a yes or no. We opted that we wouldn’t do it as either way we’d keep the baby.

Note: If you do not have an OBGYN, you could ask your GP to start the process at Mater Dei where they would start your Blue Card.  The Blue Card is like you ID Card, you need to carry it everywhere with you as without it you will not be checked. 

For every visit that you go to, you need to take a urine sample for the doctor to check.

After some time you will receive a letter with a date and time for the appointment at Mater Dei, you will be around 12 weeks pregnant. On the day, you need to go to the Antenatal section and take a ticket as soon as you arrive (the machine is located at the Antenatal door). It doesn’t matter if your appointment is at 8am or 10am, the ticket is the real importance (no-one told us about this, so we were a bit lost).

Once you take a ticket, you need to wait your number. Once your number is called, you go in and tell them that you have an appointment. They will ask for your blue card and give you another number. You will need to wait again until they call your name. You can stay inside the Antenatal room but your partner will need to wait outside in the corridor. There are no exceptions.

The visit is split into three parts - Meeting with a midwife, meeting with a gynecologist and blood tests (you can eat and drink normally for these tests unlike the routine ones).

First Part - You meet with a midwife alone. Your partner cannot come in with you. You will go through a set of questions about yourself and your relationship with your partner, as well if you’re taking prenatal vitamins, you will be weighed, your blood pressure will be taken, and you will be given a magazine about being pregnant as well as a list of food to avoid. You will then have to go back outside and wait again. 

Each waiting time was around 30 to 45 minutes.

Second Part - You meet with a gynecologist. Your partner can come in the room with you. They will go through the EDD, check your urine sample and will do an ultrasound checking the fetus and heartbeat. They will not tell you the gender at this point through the ultrasound. Once ready, they will tell you to go for the blood tests. They will book an appointment for that time. You will be advised whether you want to continue with Mater Dei or privately. In our case, we continued privately (big mistake, huge. More on this later). They will also book two appointments, one for the Anomaly scan and one for the 36th week.

Third part - Once you leave the Antenatal section, you need to go a few doors up on the opposite side for the blood tests. You take a ticket and wait your turn. You will have around 6 or 8 samples taken (I forgot the exact amount).

That is basically what happens in the first trimester at Mater Dei. As I said, you have the option to continue having your appointments there, but be prepared to spend at least 2 to 3 hours there each time.

Each time your visit is ready, you need to go to the Antenatal desk and book an appointment. You will be given a piece of paper with the dates of your appointment and it’s important to take it with you each time you go to Mater Dei together with your Blue Card.

The Second Trimester

During the second trimester, you will have the Anomaly scan (at around 20 weeks or so). You need to go to the Antenatal section again but wait in the corridor. There is no need to take a number as this is an appointment based.

Note: You do not need to take a urine sample for this appointment.

They will call your name and you will enter a room, your partner can join you. The doctor will scan the baby from top to bottom and here you can find the gender of the baby. My scan lasted around 20 minutes. You will be given a report of the baby and an image of the scan. 

Note: Do not search online about how long this scan should last as it solely depends on how the baby is positioned. It can take 20 minutes and it can take 30 minutes or 40 minutes. Remember that no pregnancy or baby is the same.

Your appointments will continue to be monthly based.

The Third Trimester

At the beginning of this trimester, your appointments will be still monthly based but will change to weekly based in the last month.

Here’s the issue that we found by going to a private practice by the third trimester.

By the 33rd week of my pregnancy my OBGYN found that our baby’s stomach was a week behind than the rest of her body. She did an ultrasound and was concerned about it that she booked us an appointment at Mater Dei. I asked her what the issue was and what that meant and she basically was avoiding my question. I assume that she did not want to take any responsibility but I expected that she’d tell us what was happening with our baby. Especially since the visit was not free but a good whooping 50 EUR. So basically, if there is an issue with anything, you still need to go to Mater Dei. Private practices are only good for not spending a lot of time in the queue. That’s it. We got better service from Mater Dei (more on this soon).

We went to Mater Dei and was checked by one of their doctors. She booked me an ultrasound appointment. Now, if you have an ultrasound, you need to go to the reception outside before entering the Antenatal section. We booked an appointment for that time, went to the Antenatal section again to tell them that we had an ultrasound appointment and waited our turn.

They asked me for the report to compare the measurements of the baby but my OBGYN never gave me anything of this sort. They proceeded to measure the baby anyway and told us that everything seemed to be fine. We then went to the doctor again and she told us to follow up at Mater Dei again on our 36th week visit so we could determine if there were any issues.

Note: I talked to one of friends about the issue we had and how we never received a report in every visit that we went privately. She told me that her OBGYN (private) always gave her a report about the baby. So for me that was a red flag. The ultrasound technology that Mater Dei have are a thousand times better than what my OBGYN had and they could open up your file and see the history. Unlike my OBGYN, who just wrote on my blue card and that’s it.

Due to this issue, we decided to continue with the services at Mater Dei.

On the 36th week, you will have an ultrasound which will probably be the last ultrasound (since the baby will have gotten big at this point and it will be more difficult to see the baby from all sides). The doctor will book you an induce date which will be a few days after the EDD.

At the 37th week appointment, they will check your belly and heartbeat of the baby (not by ultrasound). They will advise about a  membrane sweep for the next appointment (you can opt out of this if you do not want it). During this visit, you will be given a test and swab down there to check for a particular presence. If you test positive (in my case it was negative), you would need to be administered antibiotics (this is to protect the baby from contracting it during birth). You would need to go to the toilet and do the swab. For me, I had to squat and do the swab as I couldn’t manage otherwise. If there is some spotting, that’s fine according to the nurse. You would then need to take the swab to the laboratory yourself.

By the 38th week, you will have received the result of the swab (this can be found on myhealth). The doctor will perform a membrane sweep if you agree to it. I will be honest with you, it hurts like hell. To me, it hurt more than birth itself. It was an awfully uncomfortable experience for me and my husband could see the pain on my face. You will be advised that you may have contractions and your water may break with this. It’s not always the case though, so don’t get your hopes up. By doing the sweep, you will also find out how dilated you are. If the sweep does not work and you do not give birth, you will have another sweep the next visit you go to.

I am not sure what happens post 38 weeks at Mater Dei as I gave birth at 39 weeks pregnant. But I will tell you what happened in my case.

For me, the sweep at the 38th week had helped me to start having contractions. Just as we left the hospital, I started having some cramping. They felt like period cramps but went away after some time. The day went by, we slept and woke up the next. My contractions started to get worse. I also found what I thought was the mucus plug (still not sure till this day lol). They were around 5 minutes apart but started to come and go after some time. We got our hopes up but quickly vanished. I had napped and everything went away, however, I started getting sever pain again. 

My husband and I decided to go to the hospital because we were a bit concerned about this given that it was our first baby. We went to the birth section and the midwife told us that these were not birth contractions but rather Braxton hicks (to be honest, I did not agree with her lol). She then told me that they had to check me before discharging me as since I was close to birth it was best to check.

I entered a birthing suite and the midwife hooked me to a machine that measured my heart rate and strength of each contraction and took my blood pressure. She told me that my contractions had to be double in strength in order to be birth contractions. I don’t know though because the amount of pain that I was in was the same as when I was about to give birth. Anyway, she then did another sweep like motion (two sweeps in a row were too much) and told me that I was 1cm more dilated than the day before. They kept monitoring me for an hour or so. The midwife then told me that the doctor needed to check me before I could get discharged.

Once the doctor checked me, I was given the option to stay there for four hours and have another sweep like thing to see how much I was dilated or go home and wait for the contractions to be 3 minutes apart. We chose the latter. It was pure torture to go home and wait but there wasn’t much to do at that stage.

Once your contractions are 3 minutes apart, it is go time my friend.

I hope that this will help give you an idea on what to expect locally. I will tackle the birth process in another blog post.