Dr Bell would like to see you for your initial consultation quite early in pregnancy. Our reception staff will endeavour to book this visit for you to be seen at about 7-10 weeks gestation. However, if you are worried then please come in at around 6 weeks.
When you first attend our secretarial staff will collect your administrative information, previous medical history, and details of any previous pregnancies, and will explain our costs structure based upon your particular medicare and insurance status . All information is strictly confidential. If you dont want to write something down, dont worry- just wait until you see Dr Bell and tell him.
At your first visit you will meet me. I will clarify and assist with any of your particular concerns as well as performing an ultrasound in order to determine the wellbeing of your pregnancy and confirm your due date. Based on your medical history, any previous pregnancies, and any particular wishes you may have Dr Bell will develop a plan for the care of your pregnancy, organise your hospital booking in form, and order any appropriate blood tests. I will also discuss more complex screens such as the optional cell free DNA analysis (eg. GeneSyte, Harmony, etc) or an NT scan.
You will be asked to attend on a regular basis during the pregnancy. These visits are to check the well being of you and your baby. There is always scope for additional visits if required, either because Dr Bell wants to more closely monitor your pregnancy or because you have concerns. Please do not hesitate to ask if you have any concerns or queries. Do not feel you are wasting my time or that it is unimportant. I would prefer to know if you have any concerns. The best thing to do is make a list and bring this along on the day of your visit, or phone if it cannot wait. If you have any urgent problems between visits you may contact me in the rooms. After hours any of the Labour Wards would be happy to advise you and if they feel it necessary ask you to attend for evaluation. If necessary the hospital staff can contact me 24x7.
At or around 28 weeks I will give you an ante-natal card. This card will have a duplicate record of the results of your investigations and findings at each visit. Your antenatal card will assist our midwifery staff when you are eventually admitted to the Labour Ward. At or around 37 weeks any aspects of a delivery plan will be further discussed. Generally, if you do not labour spontaneously (unless there are other indications), induction at or around 41 weeks is recommended.
FEES
Unfortunately medical insurance and rebates are complex. You should be reassured that when Dr Bells secretaries quote your costs using the information you provide there are no tricks or hidden extra charges.
In particular, if your delivery is out of hours, is by caesarean, or is complex and requires extra procedures.... Dr Bell will not charge you extra.
Multiple factors influence your obstetric charge and final out of pocket costs;
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▶ Do you have medicare rights. If so medicare rebates and safety net will apply.
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▶ Do you have private health insurance, if so is obstetrics covered at the date of your delivery and is the level of your cover 'gapcover'. Although it will not affect our charges, are you covered as a private patient in a private hospital.
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▶ Which health fund are you in. In short, the more your fund pays Dr Bell, the less he charges you.
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▶ Has Dr Bell managed and delivered any of your previous pregnancies. If so, a discount will apply. The more children he has delivered for you, the greater the discount.
Because of the above, to find your actual charges and your estimated 'out of pocket' please ring the surgery. Our fees are structured so that your pregnancy care with us is both affordable and predictable. At your first antenatal visit we will explain about our fees and their payment in detail. You will know exactly how much you will be 'out of pocket' to us as our patient. You can financially plan for your pregnancy care. Dr Bell is sensitive to all the financial pressures that are present at this stage of your life.
Generally, for over 90% of patients who are privately insured and have medicare rights the charges will be;
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First Visit and Scan $185 (Government Rebate $70)
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Antenatal Visits at government rebate (ie. no out of pocket)
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A variable amount for the 'Retainer Visit' at 20 weeks.
This will be about $3,000
(You will get a Government rebate of about $500, leaving an out of pocket of about $2500).
The exact amount depends on which health fund and the table,
Basically, I try and be as fair as possible. The more I get from a fund, the less I charge you.
If Dr Bell has delivered a child for you then there is a discount. The more children he has delivered for you, the bigger the discount :-) -
Delivery (The charge equals your health fund rebate. That is, there is no 'out of pocket')
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Post natal visit $75 (Government Rebate $35)
If you 'shop around', it can be hard to compare one obstetrician's fees with another. There is no point being quoted a small "retainer" payment if the antenatal visits incur large out of pocket payments per antenatal visit or 'extras' such as a caesarean section incur extra charges against you. You may wish to enquire if you will see your specialist at each visit. You will see Dr Bell at every antenatal visit.
What if I dont have Private Health Insurance?. If you are not in a health fund, but are covered by Medicare, we can still offer you an affordable package for Dr Bells services. In this case, you would usually elect to deliver at Westmead Public Hospital to reduce costs. Although in a Public Hospital, you would still be unders Dr Bells care.
I am an Overseas Visitor. If you are from overseas and are not covered by Medicare we will tailor a fee package according to your circumstances. This will also take into consideration whether you are covered by an overseas health fund.
Other Fees. When having your baby there will be accounts also from the hospital, other doctors who may be involved in your care (ultrasound doctors, paediatrician, anaesthetist, surgical assistant - if required), and pathology services. These other providors are not under Dr Bells control. Some are provided by the 'on call' service so it can sometimes be difficult to predict the out of pocket accurately.
Payment Methods. We accept for payments cash, EFTPOS, direct debit, Visa and Mastercard.
VISIT SCHEDULE
You will be asked to attend the surgery on a regular basis during the pregnancy. These visits are to check the well-being of you and your baby. You are requested to bring a urine sample from time to time (see below).
There is a set of scales in the waiting area. Please weigh yourself before the consultation and record your weight on the antenatal card (or tell Dr Bell your weight if you have not yet received your card). Weighing is not compulsory.
The frequency of visits will vary from patient to patient according to whether or not any problems are apparent. In all cases the frequency of visits increases as the pregnancy becomes more advanced. In general, visits for a first pregnancy, are every 4 weeks until 28 weeks, then every 2 weeks until 36 weeks, and then weekly thereafter. In general, second (or more) time mums have fewer visits.
First Visit- Checkup and Dating/Viability Ultrasound. Referral for blood test: Blood count, Hepatitis, HIV, Blood group, Syphillis, Rubella & Urine test.
11-14 weeks- Optional: Cell free DNA or Nuchal Translucency Scan by an outside specialist. If done, High Quality Scans-Strongly Recommended- will attract an out of pocket charge)
13-15 weeks- Optional: CVS or Amniocentesis by outside specialist
16 weeks- Visit
19 weeks- Formal Ultrasound by outside specialist- An anomaly scan. (High Quality Scans-Strongly Recommended- will attract an out of pocket charge)
20 weeks Visit
24 weeks Visit
28 weeks Visit Diabetes Screen
Whooping cough booster for mum (by GP)
Whooping cough booster for caregivers if last booster >10yrs (by GP)
Optional: Antibody Screen (If Rh Negative)
Optional: AntiD shot in Labour Ward (If Rh Negative)
30 weeks Visit
32 weeks Visit
34 weeks Visit Optional: AntiD shot in Labour Ward (If Rh Negative)
36 weeks Visit Start weekly visits. Group B Streptococcus (GBS) vaginal swab
There is flexibility to the above depending on how many pregnancies you have already had and other factors which may increase or decrease your risk of complications.
PREGNANCY TESTS
There are a routine selection of tests, which are performed in the first few months of the pregnancy. There is a blood test and a urine test. The blood test checks for your blood group and any unusual blood group antibodies, full blood count (to check for Anaemia), Rubella immunity (German Measles) and a check for Hepatitis B, C, Syphilis and HIV. Immunity to Chicken Pox and Parvovirus may be checked. The urine test is checking for bacteria in your urine.
ANEUPLOIDY SCREENING
This is the term applied to the detection of chromosomal abnormalities before birth. All of these tests are optional. Please see below.
ULTRASOUND-FOETAL MORPHOLOGY
A detailed ultrasound examination of the pregnancy is recommended at around 19 weeks gestation. The main purpose of this examination is to ensure as far as possible that your baby is developing normally. It is not possible to identify all abnormalities on ultrasound, but more than 50% of significant abnormalities will be identified.
ULTRASOUND-EXTRA SCANS
The above two ultrasound examinations are the only ones that are routinely offered. Sometimes indications arise to perform additional ultrasounds; this will be fully explained if required.
DIABETES OF PREGNANCY
It is recommended that all pregnant women be checked for pregnancy (Gestational) Diabetes. This usually does not have any symptoms. A blood test is performed at about 28 weeks gestation. Fasting is not required for this test. The pathology staff will give you a drink which contains a standardized amount of glucose (it is sweet!). Your blood test is then performed 1 hour after this drink. You will be contacted if this test is elevated, as you will require a further 2-hour test.
PAP SMEAR
If your Pap smear is due it will usually be performed at the time of the 6-week postnatal check up. It is sometimes performed during the first half of pregnancy if there is a specific reason to do so.
URINE TESTING
Urine testing used to be performed on all pregnant women at each checkup. Recent studies have demonstrated this to be unnecessary for the majority of women. The purpose of testing urine is to check for changes, which may occur in association with a pregnancy disorder called pre-eclampsia. Under some circumstances, testing of urine is necessary; you will be advised if this applies to your pregnancy.
DOWN SYNDROME AND OTHER ANEUPLOIDY SCREENING
Downs Syndrome (Trisomy 21) is a condition in which a baby carries an extra chromosome. Chromosomes contain the genetic blueprint that regulate growth and development. Babies with Down’s Syndrome have an extra chromosome and this various problems. Children with Downs syndrome are at increased risk of abnormalities of the heart, bowel, hearing, and breathing. They are also at increased risk of developing diabetes and dementia, and intellectual disability of varying degrees. The degree of learning disability cannot be determined prior to birth. It may be profound (10%), severe (70%), or mild (20%). About 45% will survive to the age of 60.
The risk of having a baby with Down’s Syndrome increases with advancing maternal age but women at ANY age can have conceive a baby with Down’s Syndrome. The approximate risk of having a baby with Downs Syndrome is age dependent, set out in the table below;
Age Risk Of Down Syndrome
At Birth At 12 weeks
20 1:1500 1:1000
25 1:1350 1:900
30 1:900 1:600
32 1:660 1:440
34 1:440 1:300
35 1:350 1:240
36 1:280 1:190
37 1:200 1:150
38 1:170 1:110
40 1:100 1:65
42 1:55 1:35
44 1:30 1:20
The risk of having a baby with Downs Syndrome at birth is less than the risk at 12 weeks. This is because a percentage of babies with Downs Syndrome will not make it through the pregnancy. That is, in the absence of a termination, the mother would experience a miscarriage or stillbirth.
Testing may be performed (see below for the options). There would be out of pocket expenses, the amount depending on the test. A few general comments about testing;
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There are lots of conditions (eg. Autism) where, at the moment, test results will be normal. That is, we cant check for a "normal" baby, but can check for some chromosome problems.
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Testing will not pick up 100% of cases of Down Syndrome. That is, it may suggest that a baby does not have Down’s Syndrome even though the baby does. This is called a false negative finding.
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There is a small chance that the test will suggest that your baby has Down syndrome even though it does not. This is called a false positive finding. The NT+ has about a 5% false positive rate, while the cfDNA rate is about 0.1%
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If you have a NT+ or cfDNA study that suggests a chromosome problem, then a CVS or amniocentesis will be offered to decide if the result was a true positive (baby has Down Syndrome) or false positive (baby has normal chromosomes). A CVS or amniocentesis (performed at 13-16) weeks has a risk of causing a miscarriage of about 0.5% (1:200).
Whether or not you have testing depends, in the main, on whether you would consider termination if the baby was affected. What do I think?. As long as you are prepared to accept that the tests (NT or cfDNA) study have false positive and false negative findings, I am more than happy to order the test.
If you want to have aneuplody screening, the next step is to decide whether to have an NT+ study or a cfDNA study (there is some controversy as to whether to always have an NT+ as well if you are going to have a cfDNA, but I am not of that view). The quick summary is;
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Nuchal Translucency (NT). Zero risk. An ultrasound at 12-14 weeks can be performed by certain specialised ultrasound practices and measures an area of the fluid at the babies neck called the Nuchal Translucency (NT). A thicker than normal NT in combination with an abnormal protein in your blood (PAPP-A) is associated with an increased risk of chromosome problems. In combination with a blood test the NT+ scan can detect 80-90% of cases of Downs Syndrome. It returns a risk ratio. Can vary from 1:2 to about 1:20,000. A positive NT+ study is considered to be either more than 1:300, or at a risk that you judge merits further testing.
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Cell free DNA (cfDNA), Fetal free DNA (ffDNA), or Non invasive prenatal testing (NIPT). Zero risk. During pregnancy some of the fetal DNA is released into the mothers circulation. To say that the reliable detetion and analysis of this DNA is complex is a gross understatement. On the one hand it consists of a simple maternal blood test (zero risk), on the other this is an emerging technology. There are a number technologies at the moment; ▶Genesyte (Genea), ▶Materni21 (Healthscope Pathology), ▶Harmony Verify (Douglass Pathology), ▶iGeneScreen (Laverty Pathology). These are changing technologies. Please click on each link above if you may proceed with cfDNA and want to know more about the technology. It involves a maternal blood test at about 10-13w and is about $100 more expensive than the NT+. Takes one week to process. Generally returns either a positive result (about 1:3 chance of Down syndrome) or a negative result (depending on maternal age that ranges from 1:10,000 to 1:150,000).
If you have a positive NT+ study, then either a cfDNA test (for moderate risk) or a CVS-Amniocentesis will be offered.
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cfDNA. See above
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CVS. Invasive. Performed at 13-14w. 1:200 risk of miscarriage. Rarely needs an amniocentesis if fails. If a termination is decided upon, can be done in theatre.
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Amniocentesis. Invasive. Performed at 15w. 1:200 risk of miscarriage. If termination decided upon, usually requires a labour.
CVS and Amniocentesis are invasive procedures, which enable the chromosomes or genetic material of your baby to be examined. These tests have a small risk (about 1:200) of causing miscarriage and will therefore are usually only offered in pregnancies where there appears to be an increased risk of chromosome or genetic abnormalities.
Group B Strep (GBS)
This is a bacteria, which commonly occurs in the vagina. It occasionally causes serious infection in the newborn. One of the recommended approaches to prevent this is to identify pregnancies that are at risk and to treat the mother with antibiotics during labour. There are a number of factors, which identify at risk pregnancies. Some practitioners perform a swab on all pregnant women in late pregnancy. This is an alternative approach. Both approaches are considered acceptable strategies in the prevention of GBS infection in newborns.
Dr Bell prefers that a swab be collected at 36 weeks for DNA analysis to see if you are carrying the GBS bacteria in the vagina.
GBS is the most common cause of life-threatening infections in newborns. GBS is the most common cause of sepsis (blood infection) and meningitis (infection of the fluid and lining surrounding the brain) in newborns. GBS is a frequent cause of newborn pneumonia
Many people carry GBS in their bodies but do not become ill. These people are considered to be "carriers." Adults can carry GBS in the bowel, vagina, bladder, or throat. One of every four or five pregnant women carries GBS in the rectum or vagina. A fetus may come in contact with GBS during birth if the mother carries GBS. People who carry GBS typically do so temporarily -- that is, they do not become lifelong carriers of the bacteria.
Approximately one of every 100-200 babies whose mothers carry GBS develop signs and symptoms of GBS disease. Three-fourths of the cases of GBS disease among newborns occur in the first week of life ("early-onset disease"), and most of these cases are apparent a few hours after birth. Sepsis, pneumonia, and meningitis are the most common problems. Premature babies are more susceptible to GBS infection than full-term babies, but most (75%) babies who get GBS disease are full term.
GBS carriage can be detected during pregnancy by taking a swab of the vagina for special culture. Culture for GBS carriage should be done late in pregnancy (35-37wks gestation); cultures collected earlier do not accurately predict whether a mother will have GBS at delivery. A positive culture result means that the mother carries GBS -- not that she or her baby will definitely become ill. Women who carry GBS should not be given antibiotics before labour because antibiotic treatment at this time does not prevent GBS disease in newborns. Antibiotics (thru the vein) given during labour are effective in preventing the spread of GBS from mother to baby.
A GBS carrier without other risk factors (eg. High fever, long duration of ruptured membranes) has the following risks:
▶1 in 200 chance of delivering a baby with GBS disease if antibiotics are not given versus a 1:4000 chance of delivering a baby with GBS disease if antibiotics are given
▶1 in 10 chance, or lower, of mother experiencing a mild allergic reaction to penicillin (such as rash)
▶1 in 10, 000 chance of the mother developing a severe allergic reaction--anaphylaxis--to penicillin. Anaphylaxis requires emergency treatment and can be life-threatening.
MEDICATIONS IN PREGNANCY
The following are considered safe
Pain relief: Paracetamol +/- codeine e.g. Panadol or Panadeine or equivalent
Cough suppressant Benadryl or Duratuss
Constipation: all laxatives safe. Try Metamucil or Fybogel first
Heartburn: all antacids safe e.g. Mylanta, Gaviscon, Rennie
Vaginal thrush: vaginal creams and pessaries all safe e.g. Canestan, Nilstat, Monistat
Haemorrhoids: all creams safe e.g. Proctocedyl, Rectinol
Antihistamines: older ones are known to be safe e.g. Polaramine, Phenergan
Throat lozenges: all safe e.g. Strepsils, Difflam
Iron tablets: all safe but may cause constipation
Vitamin supplements: Elevit or Blackmores pregnancy & breastfeeding
Antibiotics: Amoxil, Keflex commonly prescribed and are safe.
Nasal sprays: temporary relief of congestion e.g. Saline, Sinex, Drixine
Dermatitis/skin rashes hydrocortisone cream e.g. Sigmacort
Dental local anaesthetic is safe
Other medications: if in doubt or concerned phone us to check
Mothersafe (www.mothersafe.org.au/) is a free telephone service (9382 6539) in NSW for women concerned about exposure to medications and other toxins during pregnancy and breastfeeding. This includes, prescribed medication or over the counter medicines. They are available Monday to Friday 9am to 5pm.
NUTRITION, VITAMINS, WEIGHT GAIN, ROUTINE WEIGHING, & EXERCISE
I encourage you to have a very sensible diet. Meat, vegetables, fruit and dairy products in moderation are desirable. Restrict carbohydrates and sugar foods to a reasonable extent. Excess sugar (either as the obvious, or thru sweet fruits) may cause the baby to be larger than otherwise.
Some foods contain significant iron but the body is unable to absorb it. Beef, lamb, fresh and tinned fish, pork, and chicken are good sources of absorbable iron. Iron (food or tablets) is best absorbed if taken with vitamin C (eg. Orange juice). If you require an Iron supplement, I recommend FGF (a number of supplements have too low a level of iron).
Shape, Lite White and skim milk are preferable to full cream milk. Restrict your alcohol to a minimum and try to discontinue smoking if possible. If you can’t stop, at least aim for less than 5 cigarettes per day.
If you wish to read more, please see general purpose information on healthy eating.
Fish & Seafood. Fish are rich in protein, minerals, and important fatty acids. However, some fish contain mercury levels that may be harmful to baby. A serve for an adult is 150gms, for a child up to 6 years it is 75gms. The following fish should be limited to no more than one serve per fortnight; Organge Roughy (Sea Perch), Catfish, Shark (Flake), or Billfish (Swordfish, Broadbill, or Marlin). Any other fish may be eaten 2-3 times per week.
Because of Listeria (see below), raw seafood such as oysters, sashimi, smoked salmon should be avoided (canned oysters are safe).
Should I restrict my activity? Normally there is no restriction except that you should avoid potentially dangerous contact sports. Antenatal classes are available through the hospital. You can enquire about these classes when you book in.
Normally I do not insist that you give up work during pregnancy. If you are coping there is no reason why you can not continue working until the end.
You will need to accept that your exercise tolerance level will fall and tiredness will increase as the pregnancy advances. I will let you know of any special consideration that may apply to your work or physical activity. There are usually no restrictions on sexual intercourse during pregnancy.
Nutrition... Folate, Iodine, and Vitamin D. Folate is a B vitamin needed for healthy growth and development. A baby's growth is most rapid in the first weeks of life - often before you even know you are pregnant. Folate is especially important for women at least one month before pregnancy and for the first three months of pregnancy to help prevent birth abnormalities like Spina-Bifida in babies.
It is recommended that all pregnant women ensure adequate iodine intake throughout the duration of pregnancy and especially in the first trimester. Iodised table salt is a good source of iodine. There are also a number of vitamin supplements that contain iodine.
Maternal Weight Gain. Weight gain in the pregnancy, if excessive may impact on your comfort and mobility in later pregnancy as well as your longer-term health. Assessment of ideal weight gain in pregnancy is best based on a woman's pre-pregnancy body mass index (BMI, a measure of height in relation to weight). In general, leaner women are advised to gain more pregnancy related weight, and heavier women are advised to gain less.
Routine weighing of pregnant women at each visit has not been shown to be of benefit in relation to pregnancy outcomes and is therefore not a necessary part of your pregnancy care. We are happy to record your weight at each visit if you wish and provide advice on ideal target BMI weight gain if desired.
LISTERIA
Listeria monocytogenes is a type of bacteria, which can be found in some foods. It causes few or no symptoms in healthy people, but can be very dangerous to pregnant women and babies. Hormonal changes during pregnancy have an effect on the mother's immune system that makes the mother more vulnerable to Listeria. Listeria, although rare, can be transmitted to an unborn baby, and may lead to miscarriage, stillbirth, or premature birth. About 22% of cases with perinatal Listeriosis result in stillbirth or neonatal death. Early treatment may prevent fetal infection and fetal death.
Listeria has been found in uncooked meats, uncooked vegetables, unpasteurised milk, foods from unpasteurised milk and processed foods. Listeria is destroyed by pasteurisation and conventional cooking (if at a high enough temperature), but can grow in refrigerated food. Ideally, eat only freshly cooked food and well-washed freshly prepared fruit and vegetables. Leftovers can be eaten if they are refrigerated promptly and kept no longer than a day. It is important not to eat food if there is any doubt about its hygienic preparation or storage. There is a chance that contamination may occur in ready-to-eat foods such as hot dogs and deli meats because contamination may occur after cooking and before packaging.
Symptoms of Listeriosis may show up 2-30 days after exposure. Symptoms in pregnant women include mild flu like symptoms, headaches, muscle aches, fever, nausea and vomiting. If the infection spreads to the nervous system it can cause stiff neck, disorientation or convulsions. Infection can occur at any time during pregnancy, but it is most common during the third trimester when your immune system is somewhat suppressed.
Listeriosis is treated with antibiotics during pregnancy. These antibiotics, in most cases, will prevent infection to the fetus and newborn. These same antibiotics are also given to newborns with Listeriosis.
Following these guidelines can greatly reduce your chances of contracting Listeriosis.
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Eat hard cheeses instead of soft cheeses. Hard cheeses such as cheddar and semi-soft cheeses such as mozzarella are safe to consume. Pasteurized processed cheese slices and spreads such as cream cheese and cottage cheese can also be safely consumed. The most important thing to do is to read the labels!Pregnant women should avoid soft cheeses such as feta, Brie, Ricotta, Camembert, blue-veined cheeses and Mexican style cheeses.
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Do not consume unpasteurized dairy products (eg. Raw goats milk)
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Avoid cold meats. Either ready to eat from deli counters and sandwich bars, or packaged sliced ready to eat cold meats. Do not eat hot dogs, luncheon meats or deli meats unless they are properly reheated: Eating out at certain restaurants that provide deli meat sandwiches such as Subway is not recommended for pregnant women since they do not reheat their deli meats.
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Do not eat cold cooked chicken.
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Do not eat refrigerated pates or meat spreads.
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Do not eat pre-prepared or pre-packaged salads (eg. Salad bars or smorgasbords)
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Do not eat smoked seafood unless it is contained in a cooked dish, such as a casserole.
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Do not eat chilled seafood. This includes raw (oysters, sashimi, sushi), smoked, or ready to eat prawns (includes prawn cocktails, sandwich fillings, and prawn cocktails).
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Practice safe food handling:
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Wash all fruits and vegetables
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Keep everything clean including your hands and surfaces
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Keep your refrigerator thermometer at 40 degrees or below
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Clean your refrigerator often
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Avoid cross contamination between raw and uncooked foods (this includes hot dog juices)
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Cook foods at proper temperatures (360 degrees is the recommended temperature for most food items and you can use a food thermometer to read the temperature)
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Refrigerate or freeze promptly
For more information on food safety and prevention of food borne illnesses refer to foodstandards or NSW health or the Center for Disease Control and Prevention Or NSW food authority.
EMOTIONAL HEALTH
Pregnancy, birth and early motherhood for most women is a very positive experience. However, it may not be totally what you expected. This is a time of transition for you and your partner and it may be difficult to adjust. Depression may affect up to one in seven women, either during the pregnancy or after birth. There is help available and I have listed some contact numbers for you.
Emergency Telephone Support
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Dona Maria Support Line. 1300 555 578
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Lifeline. 13 11 14
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Karitane. 1800 677 961
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Tresillian. 9596 5733
Depression
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Beyond Blue. www.beyondblue.org.au
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Depression. www.depressionnet.com.au
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Karitane Jade House
Mothercraft advice
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Local Community Womens Health Centres
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(Hills Community Health Care) 8853-4500
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Karitane Cottages 9399 6999
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Karitane Residential Unit 9794 1800
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Tresillian Residential Unit 9569 5773
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Parent Support Line 9832 8081
Self Help
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Parent Line 13 20 55
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Home Start Program 9310 5885
Specialist Psychologists
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Australian Psychological Society 1800 333 497
Perinatal Mental Health Services
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RHW (Randwick) 9382 2796
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King George V (Camperdown) 9515 8165
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Liverpool Hospital 9827 8070
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Nepean Hospital 4724 2585
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St John of God (Burwood) 9747 5611
Family Services
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Relationships Australia 1300 364 277
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Domestic Violence 9382 6539
HOW LONG WILL MY PREGNANCY BE?
The average length of pregnancy is 40 weeks from the first day of your last normal period, but this varies considerably from one pregnancy to another. We will always describe any particular stage of pregnancy as so many weeks as opposed to months. This avoids confusion between calendar months and groups of four weeks. All other factors being equal it is safe to let a pregnancy go to about 41½ weeks before induction is necessary.
WHAT SHOULD I DO WHEN LABOUR STARTS?
If you think that your are in labour, that your waters have broken or if you have had a "show" then telephone Labour Ward directly and the midwife will tell you what to do. The midwife will inform me of your admission and keep me informed of your progress in labour.
While it is not possible for me to be present during the whole of your labour, I am personally responsible for the care and well-being of you and your baby. That is, the midwives will keep me informed throughout your labor and I will respond with appropriate instructions and/or attend personally.
I will come to Labour Ward immediately if there is a significant problem or when delivery is close. If in the unlikely event that I am unavailable when you are ready to deliver (eg. Attending a conference or attending an emergency) then a trusted specialist colleague will attend you (you will not be charged by that specialist, I will take care of his payment).
SHAVES, ENEMAS, LABOUR POSITION?
I do not insist that you have a shave or an enema, however you can if you prefer. I try to keep delivery as natural as possible. If all is well I do not have strict views about the birthing position and do not insist on the use of drapes. I encourage you to adopt the most efficient position during the second stage of labour and this will vary from one labour to the next.
EPISIOTOMIES?
I do not routinely perform episiotomies (cutting the vagina prior to delivery) and will only perform one if I judge that overall any perineal tear will be smaller if I do one. Obviously I prefer you to have no tear or a small one.
PAIN RELIEF?
Pain varies enormously from person to person. All popular modern methods of pain relief are available in the hospital. This includes gas (nitrous oxide and oxygen mix), Pethidine injection, and epidural block. Most people will wait until labour starts before stating their preference. Some labours will generate intense pain signals, others will not. For some patients their cervix will dilate very quickly, others will not. Keep an open mind. If you have questions please ask.
EPIDURAL BLOCK?
An epidural may be required for pain relief in labour, to allow comfortable delivery by forceps, for an elective or emergency caesarean, or sometimes to aid control of blood pressure in labour for pre-eclampsia.
An epidural is an injection of local anaesthetic into the epidural space deep inside the back. Initially a needle is inserted but then a fine catheter is threaded through the needle and the needle withdrawn. The soft catheter stays in place so that further injections may be given as the first dose begins to wear off.
All procedures carry risks, just as getting in your car carries a risk, however you can be assured that there is no safer place in the world to have an anaesthetic than Australia. Major complications are very rare. Common side effects are an initial fall in blood pressure, shivering, temporary loss of bladder sensation (requiring a catheter to empty the bladder), or a headache which lasts some days. The chance of long term back problems from the epidural is either zero or very small. Your anaesthetist will be able to provide further information and/or clarification.
Cost of an epidural?. Your anaesthetist is an independent specialist. He or she will charge according to the type of procedure, time taken, out of hours, etc. I am unable to state what the ‘out of pocket’ will be if you have an anaesthetic in labour and/or for delivery.
BREAST PREPARATION
Breast feeding is preferable to bottle feeding. To prepare for this we suggest that whilst in the shower or bath that you pluck the nipples with a slightly soapy thumb and first two fingers five times. Then rub with a soft towel. Finally rub with a moisturising cream (eg. Wool at, Lanolin, or Ego skin cream).
DELIVERY?
My aim is that you should experience a natural birth. However, if circumstances arise that place you or your baby in jeopardy then forceps or caesarean section delivery may be required. If that is the case, I will of course be discussing that in more detail with you and your partner.
After delivery I will place your baby on your abdomen. If you wish you can put your baby to the breast as soon as delivery is completed. I encourage you to breast feed.
Your partner is encouraged to stay with you during the labour and the delivery. This includes the situation where forceps are needed. I will try and keep your partner involved. I have no objections to other support staff being present, but you should discuss this with the labour ward midwives beforehand.
BREAST FEEDING. See below
PAEDIATRICIAN?
The hospital will routinely arrange for your baby to be checked and cared for by a Specialist Paediatrician. If you have a special request for a particular paediatrician then please let me know.
BREAST FEEDING
Breast feeding is preferable to bottle feeding. To prepare for this we suggest that whilst in the shower or bath that you pluck the nipples with a slightly soapy thumb and first two fingers five times. Then rub with a soft towel. Finally rub with a moisturising cream (eg. Wool at, Lanolin, or Ego skin cream).
It is important to make sure that your baby attaches properly. If the baby is feeding and it is uncomfortable then break the suction and call the nursing staff to show you how to attach the baby to feed comfortably. Most mothers do not get milk for 3-4 days and it can take up to 4-6 weeks for lactation to settle.
I won’t go into all the details of breast feeding. It is one of the major tasks of the nurses on the post natal ward to assist you in establishing comfortable effective breast feeding. Continued support after discharge from hospital is available.
Good luck with breast feeding – it is not for everyone. If you cannot do it you are not a failure.