Appointments

Every attempt will be made to see you at your appointed time, although occasionally there may be a delay. This usually occurs because another patient needs to be delivered during a consulting session. If this happens you will be offered another appointment, although you are welcome to wait until I return.  Children are welcome, but we have found that they may be intolerant if there are long delays.  It is always wise not to commit yourself immediately following  your appointment.

Your first visit will generally be at 10 weeks gestation followed by 16, 20, 24, 28, 31, 34, 36, 38 weeks then weekly till delivery. Your postnatal visit will be 6 weeks after delivery and you should ring my rooms to arrange this soon after you leave hospital.  Your partner is very welcome to attend your antenatal visits and will be most welcome at the birth of your baby. Please note that in some cases, you may need to see me more often, especially if your pregnancy is high risk.

It is important to discuss any questions with me and I will always make every attempt to answer them. It is often helpful to list these questions because you may forget to ask them during your antenatal visits.

At your second visit you will receive your Pregnancy Summary.  This contains important medical information, including your blood group, and you will be given an updated version at each visit.  You should bring this summary to hospital when you are admitted.

At around 24 weeks you will have a test for diabetes and a check on your blood count.  At approximately 36 weeks I take a vaginal swab to test that you are not a carrier of Group B Streptococcus, a potentially dangerous bacteria found in one in seven women.  If your test is positive both you and your baby will receive antibiotics during labour and delivery.  With this treatment, no baby should be severely affected by Group B Streptococcus. For more information on prenatal testing, please see below.

 

Holiday Cover

My holidays vary annually - if you wish to know what the dates I am away, please contact reception.

My weekend and holiday cover will be primarily shared with Dr Tom Cade however, sometimes there will be another Obstetrician covering.

Tom is an Obstetrician on the staff of the Royal Women’s Hospital and delivers at Frances Perry House. He has experience in the management of normal and complicated pregnancies including multiple pregnancies. More details about Tom can be found in the 'My Practice' tab.

My weekends off extend from Friday afternoon until Monday morning. In my absence there will be 24 hour cover by one of the covering Obstetricians and you should feel free to contact them as you would contact myself. They can be contacted via the Call Service on 9387 1000.

Labour

When you commence having contractions, or if your membranes rupture (waters break), please telephone the Delivery Suite directly on 9344 5100.  The midwife in Delivery Suite will advise you about the appropriate time to come into hospital.  After you have been admitted, the midwife will phone me with a progress report and I will usually come to see you shortly afterwards.  It is normal to have a small "show" of blood prior to the onset of labour.  If the bleeding is more than a teaspoon full, or occurs before you are 34 weeks pregnant then you should contact me immediately.

In labour you will have a range of pain relief available to you.  This will include gas, morphine, TENS and an epidural if necessary.  Nothing will be given without your permission and pain relief will always be discussed with you before a decision is made.  You have the choice to have an enema on admission to labour ward, although this is by no means a necessity.

Provided there are no medical complications, you may deliver in whatever position you find comfortable at the time.  I do not routinely cut episiotomies unless it is necessary to prevent a large tear.  Following delivery, you will then have an injection to help deliver the placenta more quickly in order to prevent excessive bleeding.  I recommend strongly that your baby has an injection of Vitamin K (rather than the oral form) in order to prevent internal bleeding complications that affects approximately one in 1000 babies.  If this injection is given, the complication is never seen.

Childbirth Education

Frances Perry House conducts childbirth education and early parenting classes.  Information will be provided by Frances Perry House when you receive your hospital registration.  Fees for private classes are usually covered by your health fund although there may be some out of pocket expense. I encourage both you and your partner to attend these classes, as they will prepare you better for labour, delivery, breast feeding and early parenting.

Several of these classes are available as an online program. Feedback from many of my patients has been very favourable for this format. There is still an opportunity for a hospital tour which I encourage.

Nausea and Vomiting

 

It is quite common to have some degree of nausea during the first trimester.  This will generally begin at around six weeks, peak at around nine to ten weeks and gradually resolve between 12 and 14 weeks.  Sometimes the nausea may be severe and persistent and occasionally associated with excessive vomiting.  This is termed hyperemesis gravidarum (commonly known as 'morning sickness', although it can occur at any time throughout the day.) It is the normal increase in pregnancy hormones that causes these symptoms. Rarely, there may be an underlying cause to make the symptoms more severe. These situations may include a urinary tract infection, an overactive thyroid gland or a multiple pregnancy.

At its most extreme, vomiting can be so severe that hospitalisation is required and strong medication is necessary to prevent more serious complications.  This is extremely unusual.  If you are at the stage where you are vomiting more than twice a day, you should not hesitate to contact me, so you can avoid getting into this more serious situation.

There are many options to control the symptoms but there is virtually no treatment that will eliminate them completely.  Treatment involves a combination of rest, dietary modification, vitamins, complementary therapies, conventional medicine and occasionally intravenous fluids.

 

Treatment Options

Rest

Diet

Vitamins

Complementary therapies

Conventional Medicine

Safety Categorisations

Metoclopramide (category A)

Prochloroperazine (category C)

Antihistamines (category A, B, C)

Ondansetron (category B)

Prednisolone (category A)

Hospitalisation and Intravenous Fluid Therapy

Prenatal Testing

One of the difficult issues to face in early pregnancy is the option for prenatal testing. In recent years, several new tests have become available primarily aimed at testing for Down syndrome.  These tests are in addition to the usual blood and urine tests in early pregnancy and are also additional to the detailed ultrasound examination usually undertaken at 20 weeks.  This information sheet provides a summary of the tests available and is intended to be a reminder of the issues that need to be considered.  Do not hesitate to clarify any of these issues with me if they are unclear.

What conditions are detectable?

Down syndrome

Edward syndrome

Neural Tube Defects

Cystic Fibrosis

Fragile X Syndrome

Spinal Muscular Atrophy

How reliable are these tests?

Sensitivity: the reliability of a test depends on its ability to detect a problem if it is there: this is known as the sensitivity of the test. This means that a test with 100% sensitivity will detect a problem every single time it is there, but if the sensitivity is 70% only 7 out of 10 babies who have this problem will be detected by this test.

False positives: the other important factor to consider in assessing the reliability of the test is the false positive rate. A test is considered to give a false positive result if it suggests there is a problem with the baby that is subsequently shown not to be there at all. Ideally a test would have a 0% false positive rate but, in practice, some positive results are incorrect.

Options for Prenatal Testing

1. No testing

2. Nuchal translucency (NT) scan

3. Combined first trimester test

4. Non-invasive prenatal testing (NIPT)

5. Maternal serum screening (MSS)

6. Chorionic villus sampling

7. Amniocentesis

8. Genetic Carrier Screening

 

Summary of Prenatal Testing for Down Syndrome

There is now a bewildering array of tests available for prenatal testing. You should not feel pressured to undertake any of these tests if you do not wish to do so. It is important to recognise that the choice of testing is yours. I will give you advice on the different types of tests available but the ultimate decision must rest with you.

It is important to realise that by having any of these tests there is no implication that you would necessarily wish to terminate a pregnancy should it be affected.

This table summaries the sensitivity, false positive rates and risk of each test.

Test Weeks pregnant Detection of Down Syndrome False positive rate Risk from the test
No test N/A 0% 0% 0%
NT test 12 to 13 70% 5% 0%
NIPT 10 to 12 99.9% 0% 0%
Combined first

trimester test

12 to 13 90% 5% 0%
MSS 14 to 19 80% 5% 0%
CVS 10 to 13 100% 0% 0.5% to 1.0%
Aminocentesis 15 to 19 100% 0% 0.5%

General Advice and Precautions

Using Baths and Spas
Exercise
Nutritional Supplements
Sexual Intercourse
Sleeping Positions

Vaccinations and Infections

Influenza ('The Flu')
Toxoplasmosis
Whooping Cough (Pertussis)