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There is a boundless amount of information available on the internet. As an expectant woman, couple or extended family it can be very hard sorting the good information from the bad, or determining whether something is applicable to you and your personal circumstances. Listed here are some resources which we believe to provide fair, responsible and balanced information. However, it is impossible to give individually tailored information suited to your unique situation through a website so please be aware that all information provided is of a generic nature and may not be suitable in all circumstances - and as always if in doubt please Contact Us to arrange a consultation.

Preparing For Pregnancy

Preparing For Pregnancy

Your health and lifestyle prior to falling pregnant can in some cases significantly affect your pregnancy. At the same time there are changes you can make that can help improve the health of your pregnancy and future baby. Many drugs and medications can have an adverse affect on a pregnancy and a babies development, however to a significant degree most adverse effects can be mitigated through consulting with your doctor and your obstetrician.

RANZCOG have produced a Patient Information Resource on Planning for Pregnancy with additional information.

Here are some things to think about when preparing for pregnancy:

Folate is necessary for the healthy development of babies, particularly in the first few weeks of pregnancy when a babies growth is most rapid. Unfortunately, often women are not even aware that they are pregnant at such an early stage. Since 2009 the Australian Government has mandated that all bread making flour (excluding organic flour) is supplemented with folate as a safety net. This is because insufficient folate (folic acid) has shown to be associated with neural tube defects like spina bifida. Research undertaken by the Australian Institute of Health and Welfare suggests that the incidence of neural tube defects has decreased by about 14% since folate was mandated in bread making flour. Food Standards Australia & New Zealand has prepared some information on folic acid / folate and pregnancy.

Smoking in particular can have many serious negative impacts on pregnancy and development. While there are many 'bad' chemicals in cigarettes, nicotine and carbon monoxide in particular can reduce the supply of oxygen to the developing baby. We strongly recommend that pregnant mothers do not smoke and that family members and friends abstain from smoking around pregnant women.The Royal College of Obstetricians and Gynaecologist has produced this leaflet on Smoking and Pregnancy. There are also resources like Quitline to help with strategies to reduce or quit smoking.

Alcohol consumption in pregnancy can be a little controversial and over the last 20 years the official stance on whether low levels of alcohol consumption is safe in pregnancy has shifted a couple of times. However the official recommendation since around 2009 and our recommendation is that pregnant women should not consume alcohol. The reason for the controversy was, in part, because the linkage between very low levels of alcohol intake and harm was inconclusive. However what has been conclusively shown is that the threshold level at which harm can occur is small and, given such a small threshold before harm occurs, the most responsible recommendation is to recommend abstinence. The Royal College of Obstetricians and Gynaecologist has produced this leaflet on Alcohol and Pregnancy.

It is not possible to effectively cover prescription medications without taking into account your personal circumstances. However, in nearly all cases your prescription medication requirements can be accommodated through effective consultation with your doctor and your obstetrician. If you are considering pregnancy and are on prescription medications or other drugs we recommend you Contact Us to arrange a consultation so that your personal circumstances can be properly assessed.

There is currently no fixed, official, guideline on the amount of caffeine that can safely be consumed. Large amounts of caffeine may increase the risk of miscarriage or may make it more difficult to fall pregnant. Our advise is to restrict caffeine to around no more than 200mg per day. Due to the numerous sources of caffeine (coffee, some softdrinks, some teas or even chocolate) it can be difficult to estimate but as a general guide no more than two instant coffees or alternatively one brewed coffee per day.

The benefits of regular exercise have been well established and these benefits in general apply equally while pregnant. Benefits include feeling more energetic, improved posture and circulation, stress relief and reduced anxiety, improved sleep as well as an increased ability to handle the increased demands on your body throughout the pregnancy, during labour and with a newborn.

Before commencing a new exercise routine please consult with your health care professional to ensure that there are no medical reasons that would prevent you from exercising. If you have an existing routine your health care professional can advise if any modifications are required to your routine to accomodate the pregnancy.

RANZCOG have produced a Patient Information Resource on Exercise during Pregnancy with additional information.

Weight can be a delicate subject, however it is important to reach and maintain a healthy weight before becoming pregnant. Women who are outside of the healthy BMI range of 18.5 - 25 have an increased chance of pregnancy complications. BMI (Body Mass Index) is a comparison of your weight to your height. It can be calculated by dividing your weight in kilograms (kg) by your height in metres (m), then divide the resulting answer by your height in metres again to get your BMI.

During pregnancy there is no need to "eat for two". The following table is a guide to the range of weight gain expected during pregnancy. We have also included a simple BMI calculator below to easily find your BMI if you know your height and weigth.

BMI Classification

Range of Pregnancy

weight gain

Less than 18.5 Underweight 12.5 - 18kg
18.5 - 24.9 Normal 11.5 - 16kg
25 - 29.9 Overweight 6.8 - 11.3kg
More than 30 Obese 5 - 9.1kg

Enter height:

Enter weight:

Your BMI is: ?,

RANZCOG have produced a Patient Information Resource on Why Your Weight Matters with additional information.

The purpose of antenatal care is to improve the health and wellbeing of both you and your baby before birth. Your booking appointment will ideally occur around 6 - 8 weeks. During your first appointment we will take a detailed history (medical and family), undertake a health assessment and start to better understand your personal circumstances and your needs for the pregnancy. We will also answer any questions you may have and discuss your concerns.

For an uncomplicated or low risk pregnancy you will usually have somewhere between 8 - 10 antenatal visits with us. However for a complicated or high-risk pregnancy we may require more.

RANZCOG have produced a Patient Information Resource on Antenatal Care during Pregnancy with additional information.

Cervical screening saves lives by preventing cervical cancer which is the growth of abnormal cells in the lining of the cervix. Cervical cancer may develop following persistent infection with the human papillomavirus (HPV) that causes changes in cervical cells which may lead to cervical cancer, usually after 10–20 years. HPV is acquired by genital skin-to-skin contact most commonly through sexual intercourse, but any genital contact may be sufficient. HPV infection is extremely common in men and women who have had sex and four out of five people will have HPV infection at some time in their lives and usually won’t know about it.

RANZCOG have produced a Patient Information Resource on Cervical Screening in Australia with additional information.

Many prospective parents stress about their finances. And there are lot of financial aspects and personal circumstances to consider whether it is time off work or additional costs for baby furniture. The Raising Children Network has a section on Pregnancy And Work. The Australian Securities and Investments Commission also has a section on Budgeting For You And Your Child.

First Trimester

First Trimester

The first trimester of pregnancy is the first twelve weeks. For some it is a very exciting time. For some it is a time of nervousness. If you are finding out about your pregnancy for the first time, now is a great time to review our Preparing For Pregnancy section. Oh, and by the way - congratulations!!! You will normally be having your first appointment with us somewhere around week 7 to week 10 where we will get to know you and your history as well as undertake a dating scan with our advanced ultrasound machine to confirm an expected delivery date.

Ashford Hospital is a private, not-for-profit hospital and is a proud member of the Adelaide Community Healthcare Alliance Incorporated (ACHA) in South Australia. They have a wonderful, caring, professional and friendly team dedicated to supporting you and your pregnancy needs. See the Ashford Hospital website for details on preparing for pregnancy classes or to organise a tour.

The Raising Children Network has a great section on Healthy Eating For Pregnancy. The most important point is to eat healthy - two serves of fruit and five serves of vegetables daily in particular. There are some foods to avoid, in particular foods that are prone to Listeria and Salmonella like soft cheese, raw eggs and undercooked meats.There has been a variety of advice regarding foods that can trigger allergies like peanuts, eggs and milk. The current recommendation is that pregnant women should not be avoiding foods that they are not allergic to. If you have allergies or any questions please seek advice from your doctor or your obstetrician.

Food Standards Australia also has a general section on Pregnancy and Healthy Eating for women who are planning pregnancy or who are pregnant.

The Royal College of Obstetricians and Gynaecologists have also produced two brochures  Healthy Eating and Vitamin Supplements and Why Weight Matters.

Iodine is an essential nutrient that we all need in small amounts. Iodine is stored in the thyroid however because the thyroid can only store small amounts any excess is lost through excretion. The National Health and Medical Research Council is preparing to undertake a review of Nutrient Reference Values (NRV) including iodine. The main health concern of mild iodine deficiency during pregnancy and breastfeeding is its negative effect on the brain and nervous system of unborn children and infants.

The Mater Mothers site also has an excellent discussion on Iodine Supplements in Pregnancy.

Nausea and vomiting (commonly called morning sickness) is a common problem, especially during the first 12 weeks of pregnancy. However it can occur at any time of day (not just the morning) and in a small number of cases can persist through the whole pregnancy. In most cases it can be managed without medication however in some cases it can lead to weight loss and dehydration and may require treatment. Queensland Health have prepared a brochure on managing morning sickness. Additionally the Women's and Children's Health Network have a section on Morning Sickness as do RCOG on Pregnancy Sickness.

The Australian Immunisation Handbook has an excellent section on Vaccination of women who are planning pregnancy, pregnant or breastfeeding, and preterm infants. In general the Influenza vaccine and Diphtheria, Tetanus, and Pertussis containing vaccines are recommended and other vaccinations are not routinely recommended. However your personal circumstances are very important in this regard so please seek advice from your doctor or obstetrician particularly if you are planning to travel overseas.

Your body has the natural ability to recognise any germs in your bloodstream and to produce protective immune factors called antibodies. These antibodies help to destroy germs and defend you from infections. Once you develop these antibodies, your body can quickly recognise that particular germ and produce antibodies targeted against it. This process is called immunisation. Your immune system can have a similar antibody reaction if cells from a different person enter your blood stream. This process is called alloimmunisation. A woman may become alloimmunised because of a previous blood transfusion. However, it most commonly occurs because of a previous pregnancy. This is because very tiny amounts of baby’s blood may cross the placenta into the mother’s bloodstream during birth and stimulate an antibody reaction in the mother. These antibodies may then affect the next pregnancy. Approximately 85 per cent of pregnancy alloimmunisation involves the Rhesus blood group.

All pregnant women should have a blood test at their first antenatal visit to check their blood group and to look for the presence of anti-red blood cell antibodies. About one per cent of women will have anti-red blood cell antibodies detected in pregnancy and require further follow up.

Women who do not have anti-red blood cell antibodies but have a Rhesus ‘negative’ blood group will need further blood tests at 28 weeks gestation and at the time of delivery. About 15 per cent of women fall into this group.

RANZCOG have produced a Patient Information Resource on Red Blood Cell Alloimmunisation with additional information.

The Australian Red Cross Blood Service has some information on Anti-D prophylaxis but if you have any questions we strongly recommend you seek advice from your doctor or your obstetrician.

With advances in medical knowledge have come advances in the types of tests that are available to pregnant women, for example testing for genetic defects. Historically, some testing (for example an amniocentisis or chorionic villus sampling (CVS)) has been associated with an increased risk of miscarriage which can lead to difficult decisions for pregnant women. Increasingly non invasive screening is possible (commonly called Non-invasive Prenatal Test or NIPT) which eliminates some of the increased risks. However these are screening tests that advise on statistical levels of risk and further testing is sometimes necessary to provide certainty. RANZCOG have produced a Patient Information Resource for prenatal testing.

Cystic Fibrosis: To have a child with cystic fibrosis, both parents must be a carrier of the gene changes that cause cystic fibrosis. If both parents are carriers , then with each pregnancy there is a 25% risk of that child having cystic fibrosis. Cystic Fibrosis Australia has extensive information available on cystic fibrosis.

Down Syndrome: Down syndrome, or trisomy 21, is a genentic condition. The rate of Australian babies born with Down syndrome is approximately 1:1,100. Down syndrome is caused by an extra chromosome 21 (hence the name trisomy 21). Down syndrome Australia has extensive information available on Down syndrome.

Amniocentesis and Chorionic Villus Sampling: In some circumstances we may recommend additional testing. It can be a difficult decision for pregnant women to make due to research showing an increased incidence of miscarriage following these test. RANZCOG have produced Patient Information Resources on Amniocentesis and Chorionic Villus Sampling. The RCOG have produced a brochure on Amniocentesis and Chorionic Villus Sampling

Harmony Prenatal Screening Test: The Harmony Prenatal Test is a blood screening test for trisomies 21 (Down syndrome), 18, and 13 that delivers accurate results from as early as 10 weeks of pregnancy. Further information can be found on the Harmony Prenatal Test website.

The RCOG has produced an excellent brochure on Air Travel and Pregnancy. In general - for an uncomplicated pregnancy - flying is not harmful for you or your baby. However - many airlines have implemented their own policies in this regard so it is important that you careful check the terms and conditions associated with your airline carrier before making a booking. Some airlines will require you to hold a certificate from your doctor that is no more than 10 days old stating that you are "fit to fly", while others may ban you from flying from as early as 28 weeks gestation.

There is an increased risk of developing a Deep Vein Thrombosis (DVT) while flying, due to sitting for a prolonged length of time. Pregnant women also have a higher risk of developing a DVT compared with women who are not pregnant so it is important to take steps to reduce the risk of a DVT, see the RCOG brochure for more information.

RANZCOG have produced a Patient Information Resource on Travel with additional information.

Smoking in particular can have many serious negative impacts on pregnancy and development. While there are many 'bad' chemicals in cigarettes, nicotine and carbon monoxide in particular can reduce the supply of oxygen to the developing baby. We strongly recommend that pregnant mothers do not smoke and that family members and friends abstain from smoking around pregnant women.The Royal College of Obstetricians and Gynaecologist has produced this leaflet on Smoking and Pregnancy. There are also resources like Quitline to help with strategies to reduce or quit smoking.

Alcohol consumption in pregnancy can be a little controversial and over the last 20 years the official stance on whether low levels of alcohol consumption is safe in pregnancy has shifted a couple of times. However the official recommendation since around 2009 and our recommendation is that pregnant women should not consume alcohol. The reason for the controversy was, in part, because the linkage between very low levels of alcohol intake and harm was inconclusive. However what has been conclusively shown is that the threshold level at which harm can occur is small and, given such a small threshold before harm occurs, the most responsible recommendation is to recommend abstinence. The Royal College of Obstetricians and Gynaecologist has produced this leaflet on Alcohol and Pregnancy.

It is not possible to effectively cover prescription medications without taking into account your personal circumstances. However, in nearly all cases your prescription medication requirements can be accommodated through effective consultation with your doctor and your obstetrician. If you are considering pregnancy and are on prescription medications or other drugs we recommend you Contact Us to arrange a consultation so that your personal circumstances can be properly assessed.

Just as in day-to-day living it is possible to become ill, the same applies while pregnant. If you have any particular concerns we recommend you Contact Us to arrange a consultation. However the RCOG have prepared a number of information brochures that may be of assistance.

A nuchal translucency scan is a measure of the thickness of the fluid at the back of the baby's neck. The reason for taking this measurement is because research has shown that if the fluid is thicker than normal it can reflect an increased risk of Trisomy 18, Down syndrome or other complications. It is a screening test, so it is not definitive but it can show an increased risk. If you have an increased risk of genetic complications it may be strongly recommended to undertake a diagnostic test like Chorionic Villus Sampling or Amniocentesis to determine definitively if there is a concern.

In a small number of cases there are some less common complications that can occur in the first trimester. In particular, early miscarriage can be particularly traumatic especially in cases of IVF or where there is a history of difficulty conceiving. Bears Of Hope is one organisation that can provide information and support to try and help in these difficult circumstances. The RCOG have prepared a number of brochures that cover some of the less common complications:

Second Trimester

Second Trimester

The second trimester is approximately week 13 to week 27 inclusive. In this period hopefully some of the morning sickness nausea and vomiting are subsiding and in general you are feeling a little better. It is also very likely at some point in this time that you will start to feel some movements from your baby. On the other hand you may also start to notice an increase in aches and abdominal pains. We will be meeting with you approximately every four weeks and guiding you through the recommended tests and scans as well as answering any questions you may have.

Fetal movements are exciting and are a great source of reassurance that "everything is progressing". But when you feel those first movements will vary. In general most women feel the first movements of their unborn baby between week 16 and week 25. The sensation (particularly early on) can be hard to describe but is commonly described as flutters, butterflies or nervous twitches. First time mothers may not feel anything until much closer to week 25, whereas in subsequent pregnancies movement may be felt closer to week 16. At this time the movements will be infrequent, every now and then - but they will get stronger and more frequent as the pregnancy progresses. The RCOG have produced a brochure on Your baby’s movements in pregnancy.

As your belly grows and your breasts get more tender you may find your normal sleeping position becomes quite uncomfortable. In addition, sleeping on your back while pregnant can cause a decrease in blood flow around your body so we strongly recommend you sleep on your side (most commonly with one or both knees bent). It doesn't matter which side you sleep on. You may find a body pillow helps with attaining a comfortable position to get some rest.

The rate of twin births in Australia is approximately 1.4% and the rate of triplet or more births is around 0.03%. It is difficult to know what to cover in a short section like this - but for starters check out the The Australian Multiple Birth Association (AMBA). They are a not-for-profit organisation consisting of multiple birth families. There are different types of multiples (Fraternal or Identical) and once you have triplets or more you can have different combinations of both.  The most important thing that you can do is to be healthy - eat healthy, lots of fluids and maintain light exercise routines. The risks associated with a multiple pregnancy do change a little and we will discuss the detail with you during consultations. Early intervention can help if there are concerns with the progress of a multiple pregnancy so we may recommend increased monitoring particularly in late pregnancy and you may deliver slightly earlier. Also, be aware that if you are planning to fly that many airlines have different terms and conditions associated with multiple pregnancies so please check the terms and conditions carefully before booking.

Gestational diabetes occurs during pregnancy when your body cannot cope with the extra demand for insulin production resulting in high blood glucose levels and occurs in around 3% to 8% of pregnant women. Most women are diagnosed using a pathology test, which requires a blood sample to be taken before and after a glucose drink. These tests are usually performed between 24 and 28 weeks and involves taking a blood test after fasting overnight. Next you have a drink containing 75 grams of glucose and blood is taken to be tested one and two hours afterwards. Gestational diabetes is managed by monitoring blood glucose levels, adopting a healthy eating plan and performing regular physical activity.

The RCOG have a great brochure on Pelvic Girdle Pain. Pelvic Girdle Pain is usually caused by the Sacroiliac joints and the Symphysis pubis joint moving unevenly. While in some circumstances it can be quite painful it is not harmful to your baby. It can be treated and we may refer you to a physiotherapist to provide the right treatment for your circumstances.

There are a small number of unlikely concerns that may arise at this stage of pregnancy. The RCOG have produced a number of brochures and we have included them here for reference even though they have a low likelihood of occurring. Please be aware however that this list is by no means exhaustive.

Third Trimester

Third Trimester

The third trimester is approximately week 28 through to delivery. Fetal movements are stronger and more frequent. At the same time, your baby is getting bigger and you may be finding it more difficult to undertake your normal day-to-day activities. We will be talking to you in more detail about your preparations for delivery and if there are any specific requests that we haven't already discussed. We will also be meeting with you more frequently to monitor your progress, fortnightly then weekly from around week 36.

A paediatrician is a medical doctor who understands about the health and development of children. Some paediatricians will specialise in neonatology which is the treatment of newborn babies. Your paediatrician will check your baby immediately after birth to check that everything is ok. They will also check your baby over the first few days to make sure that it is healthy enough to go home.

Dr Sanjay Sinhal is a Neonatologist and Paediatrician in Adelaide. He has been a consultant at the Neonatal Intensive Care Unit at Flinders Medical Centre since 2009. He also consults at Flinders Private Hospital and Ashford Hospital.

Dr Merike Perem is a specialist in General Paediatrics and cares for children from birth to 18 years old.

Somewhere between 10% and 30% of women test positive to Group B streptococcus. During labour and delivery it is possible for the infection to be transmitted to your baby which can result in early onset Group B streptococcal disease in your baby. To prevent this, if you test positive, we will recommend a course of antibiotics to minimise the risk of transfer. RANZCOG have produced some information on the Screening and Management of Maternal group B Streptococcus in Pregnancy.

A normal pregnancy is nominally 40 weeks in duration. However in some cases women can go into labour early. If you commence labour more than 3 weeks before your expected due date it is called premature labour or preterm labour. In general, premature labour can be managed quite effectively to minimise the risks associated with an early delivery and we can take some actions to reduce the likelihood of an early delivery if you do start premature labour. Some of the symptoms of premature labour include contractions more often than every ten minutes, cramping, fluid leaking from your vagina and vaginal bleeding including light bleeding.

Pre-eclampsia occurs in between 2% and 8% of pregnancies worldwide. The symptoms and effects can range from mild to very severe and can progressively develop or worsen as the pregnancy progresses. It is generally a combination of raised blood pressure (hypertension) and protein in the urine (proteinuria). Symptoms may include:

  • severe headache that doesn’t go away with simple painkillers
  • problems with vision, such as blurring or flashing before the eyes
  • severe pain just below the ribs
  • heartburn that doesn’t go away with antacids
  • rapidly increasing swelling of the face, hands or feet
  • feeling very unwell

Pre-eclampsia can be very serious in severe cases so if you have these symptoms then you should seek immediate advice from your doctor or obstetrician. Treatment will vary greatly depending on the severity of the symptoms and the progress of the pregnancy but the most effective resolution in the most severe cases is to delivery the baby which can be problematic with severe and early onset. If you start to suffer from pre-eclampsia we will discuss the implications with you in detail. The RANZCOG have produced this brochure on Pre-eclampsia.

There are other, uncommon, concerns that can occur at this stage of your pregnancy. The RCOG have produced some brochures that cover some of these:.

Delivery / Post Delivery

Delivery

It is time for the BIG DAY! For some the preceding weeks have rocketed past with a combination of nerves, trepidation and excitement. Others may be feeling the constant pressure of carrying a fully grown baby with you every where you go. Regardless, hopefully you have had a chance to bask in the beauty and wonder that is pregnancy because now is the time that you are going to meet the newest member of your family and a whole new set of experiences and challenges begin.

Childbirth through labouring and vaginal delivery is divided into stages.

The First Stage (the "onset of labour") is generally considered to have commenced when you start having regular uterine contractions (as opposed to Braxton Hicks contractions or "false labour") less than 10 minutes apart. The purpose of this stage is for your body to prepare itself for the actual birth. Primarily, the cervix (which is the opening into the uterus) will progressively thin, stretch and widen which is called cervical dilation. During this stage you should not try to "push" or "bear down". The first stage of labour can last many hours, however it tends to be shorter or quicker in subsequent deliveries.

The Second Stage of labour commences when the cervix is fully dilated and the babies head is fully engaged in the pelvis. This stage can last from 20 minutes up to 2 hours and will culminate in the physical delivery of your baby. Provided there are no complications and your baby is in good health you will immediately be given your baby to cuddle including skin-to-skin contact to help with bonding. In some cases your paediatrician may need to help your baby to establish breathing or to clear some mucus from the nose and mouth. The umbilical cord will be clamped and, if you wish, your partner may cut the umbilical cord.

The Third Stage of labour is delivery of the placenta.

RANZCOG have produced a Patient Information Resource on labour and birth with additional information.

It is possible to create a continuous record of the unborn baby’s heartbeat using Doppler ultrasound. The woman wears two plastic discs containing sensors on her abdomen, held by a belt around her waist. One sensor picks up the baby’s heartbeat and the other detects contractions. The continuous, combined recording of the baby’s heartbeat and contractions is called the ‘cardiotocograph’ (CTG).

The RANZCOG have produced a Patient Information Resource on Monitoring the Baby's Heart Rate in Labour.

Childbirth can, at times, be painful. Fortunately there are a range of pain relief options available. It is important to note that in some cases the pain associated with childbirth can be overwhelming or much greater than anticipated. If, during labour, you find that the pain becomes too much then please do not hesitate to speak up and let us know.

Medical pain relief includes:

  • Epidural: An anaesthetist will inject a pain killing medication into the epidural space of the spinal cord which can block sensation and pain sensation by blocking signals through the nerve fibers in or near the spinal cord. An epidural usually provides rapid and very effective pain relief and is generally quite safe. However there can be some increased risks - which we will discuss with you - including potential for fetal distress so usually increased monitoring of your baby is also required.

  • Pethidine: Is usually administered via an injection and will last for two - four hours. Side effects can include nausea and dizziness in the mother. The baby is also exposed to the pethodine via the umbilical cord which in some cases can cause respiratory depression at birth.

  • Nitrous Oxide: Also known as "happy gas" or "laughing gas" it is also commonly used with dental procedures. It is usually administered via breathing through a mouthpiece held in the mouth during contractions. Unfortunately, in around one third of people nitrous oxide only provides limited or no pain relief. Side effects can include nausea.

Non-medical pain relief includes:

  • Heat Packs / Cool Packs: Or alternatively warm / cold washers or a warm shower.

  • Controlled Breathing: focusing on slow, gentle, controlled breaths.

  • Meditation / Relaxation: such as the techniques of Hypnobirthing, Calm Birthing, or JuJu Sundin Birth Skills.

RANZCOG have produced a Patient Information Resource on pain relief.

The expected positioning of your baby for delivery is with their head down so that it can engage with your pelvis during delivery. If your babies head is up (bottom or feet down) immediately prior to delivery then your baby is considered to be in the breech position. The risk of complications occuring during delivery if your baby is in the breech position is significantly higher. We will always discuss your individual circumstances with you first, but we are likely to recommend a Caesarean Section in these situations. The RANZCOG have produced a Patient Information Resource on Breech Presentation at the End of your Pregnancy.

Sometimes it is possible for a baby in the breech position to be rotated by a procedure called an External Cephalic Version (ECV) to enable a normal vaginal delivery to be planned, however the success rate may only be around 50%. We would discuss the risks and benefits in the context of your individual circumstances with you first. The RCOG have produced a brochure on ECV "External Cephalic Version"

Induction of labour is where the commencement of the first stage of labour is triggered artificially through the use of medications. It is commonly associated with pregnancies where labour has not commenced naturally within 1 - 2 weeks after term due to the risks of an adverse outcome increasing significantly from 42 weeks gestation onwards. However it may be recommended in many other circumstances, for example to assist with the management of various complications like pre-eclampsia or if the pregnancy was achieved through IVF.

The RANZCOG have produced a Patient Information Resource on Induction of Labour.

There are many reasons why an assisted delivery through the use of ventouse or forceps may be required, including if there are concerns for your baby's health during delivery or if the delivery is not progressing as expected. A ventouse is a vacuum extraction cup that is attached to the top of your baby's head that is used to help pull your baby during delivery. Often multiple pulls may be required. Forceps are best described as a pair of spoons or tongs that are curved to fit around your baby's head. Again, often multiple pulls may be required.

The RANZCOG have produced a Patient Information Resource on Assisted Birthing.

A Caesarean Section or C-Section is the delivery of your baby using surgical means during an operation. Typically we will deliver your baby through an incision across the lower segment although in some cases a more classical longitudinal incision will be used. Caesarean Sections are often categorised by urgency. A planned Caesarean Section may be recommended for a variety of reasons including unfavourable positioning for a vaginal delivery, twins / triplets, or for the management of a variety of complications. An emergency Caesarean Section may be required due to an obstructed vaginal delivery, foetal distress or due to other emergency complications.

The RANZCOG have produced a Patient Information Resource on Caesarean Section.

A vaginal birth after caesarean section (VBAC) has some specific risks that need to be considered. For example the reason that you needed a previous caesarean section for may still exist. There is also a small chance that the previous scar may rupture which despite having a low chance of occurring is a very serious complication.

A recommendation for a VBAC can only be done on a case-by-case basis after understanding your particular circumstances. However in general we do not recommend a VBAC where:

  • You have had more than one previous caesarean section.

  • You have an increased risk of obstructed labour.

The RANZCOG have produced a Patient Information Resource on Vaginal Birth after Caesarean Section.

Cord blood is blood left behind in the umbilical cord and placenta after delivery and has a significant percentage of stem cells. In particular it can be donated to patients who need a bone marrow transplant. Increasingly, there are claims that cord blood can prevent and / or cure a whole range of diseases however the reality is that this is still an emerging science. Research is ongoing around the world and it has the potential for some very interesting developments. There are a number of organisations involved in this field that you can contact for further information:

RANZCOG have produced a Patient Information Resource on Umbilical Cord Blood Banking with additional information.

There are a number of unlikely concerns that may arise during delivery. The RCOG have produced a number of brochures and we have included them here for reference even though they have a low likelihood of occurring. Please be aware however that this list is by no means exhaustive.

In a small number of cases additional intervention may be required following the delivery of your baby.

  • Third or Fourth degree vaginal tears: Can occur during later stages of labour and are tears of the perineum (the area between the vagina and the anus) which, if severe enough, may require stitches to repair. A third degree tear extends to the anal sphincter and a fourth degree tear extends to the anus. In some cases we undertake a surgical cut called an episiotomy to try and control the amount of tearing and to enable more effective repair post delivery. The RCOG have prepared a brochure on Third and Fourth degree vaginal tears

  • Postpartum Haemorrhage: is excessive bleeding following delivery. It is usual for there to be some bleeding following delivery but usually the body is well able to handle the blood loss. However in around 6% of cases the bleeding can be excessively heavy and may require intervention. The RCOG have prepared a brochure on Postpartum Haemorrhage. In some cases a Blood transfusion may be required.

  • Retained Placenta: sometimes all or part of the placenta fails to detach completely which can cause painful cramping, fever, foul discharge or heavy bleeding (postpartum haaemorrhage). Often you will be given oxytocin to cause the uterus to contract which helps the placenta be expelled to minimise the likelihood of retention. In some cases manual removal or a Dilation & Curettage may be required.

  • Venous Thrombosis: pregnancy increases the risk of venous thrombosis with the highest risk being shortly after delivery. There is a risk that if part of the blood clot breaks off, travels around the body, and gets lodged in the lung it can cause a pulmonary embolism. Symptoms of a pulmonary embolism can include collapsing, tightness in the chest and sudden difficulty breathing. The RCOG have prepared a brochure on Reducing the risk of venous thrombosis

Babies do not get enough vitamin K from their mothers during pregnancy, or when they are breast feeding. Without vitamin K, they are at risk of getting a rare disorder called Vitamin K Deficiency Bleeding which in rare cases can cause bleeding into the brain, brain damage, or even death. A single injection immediately after birth can provide protection for several months. After about 6 months babies will have built up their own supply. Additional information on vitamin k at birth can be found at HealthDirect.

The first few weeks after having a baby are a time of great change. Regardless of the type of birth you have had, your body will go through many changes as it adjusts to not being pregnant and recovers. These changes are different for every woman.

The RANZCOG have produced a Patient Information Resource on The First Few Weeks Following Birth.

Newborn

Newborn

Congratulations! Your family is now just a little bit larger. Some might say all the hard work is behind you, some might say all the hard work is just starting, either way at the very least you are probably going to be getting a little less sleep than you used to. At the same time you can now hold and cuddle your baby in your arms and start to really get to know them.

Breastfeeding is the most natural way to feed your newborn. However it does not always come naturally and you may need to persist to find a technique that works for you. There is too much to try and cover everything here but the following are a couple of points that we feel are important:

  • For the first few days your body will produce colostrum which is a nutrient rich pre-milk.
  • After 3-4 days your milk supply will increase and change from colostrum to breast milk. This is often referred to as your milk "coming in".
  • It is best to avoid pacifiers (dummys) or bottles until your baby has learnt to feed well to avoid "nipple confusion".
  • There are multiple different holds, you need to find the one that works best for you and your baby.
  • Don't be afraid to ask questions or seek help, there are lots of support groups and sites with information, see below for a couple.

The Australian Breastfeeding Association (ABA) is Australia's leading source of breastfeeding information and support. Through a range of services, the Association supports and encourages women who wish to breastfeed their babies, and advocates to raise community awareness of the importance of breastfeeding and human milk to child and maternal health.

Lactation Consultants of Australia and New Zealand (LCANZ) is the professional organisation for International Board Certified Lactation Consultant's (IBCLCs) and others who have an interest in lactation and breastfeeding. Their core business is to provide members with information and educational opportunities.

International Lactation Consultant Association, World health transformed through breastfeeding and skilled lactation care.

In Australia, postnatal depression affects approximately 1 in 7 women. Many women may experience the 'baby blues' which usually only last for 2-3 days where you may feel anxious or teary. When these feelings last for more than the first few days it may be a sign of developing postnatal depression. Some of the more common signs of postnatal depression include:

  • feeling sad and teary.
  • feeling panicked.
  • feeling ashamed, worthless or inadequete.
  • feeling scared or afraid of being alone.
  • difficulty sleeping.

Beyond Blue provides information and support to help everyone in Australia achieve their best possible mental health, whatever their age and wherever they live.

RANZCOG have produced a Patient Information Resource on depression and anxiety following birth.

Many pets are quite tolerant of small children however it is important to be aware of the potential dangers. It is important to keep pets out of the room where your baby sleeps, cats may not get jealous of your baby but they may be attracted to the warmth of the baby and its cot. Dogs always need supervision, even a tolerant pet can lose patience if it gets poked in the eye or its tail pulled. Consider the use of safety gates or fencing to keep your pets and baby in separate areas.

Once your baby is crawling you may need to check that a cat flap / pet flap cannot be used by your baby to escape.

The RSPCA has a number of resources available that may be useful:

General

General

The following are some resources that provide advice and assistance across all stages of pregnancy. In some cases where possible we have linked directly to relevant content under the other menu headings so if you are looking for something specific you may find it more quickly and easily under the appropriate menu heading.

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