The history of obstetrics at Sydney’s Royal Hospital for Women

Throughout its storied history the Royal Hospital for Women has been a leader in improving the health and wellbeing of the women in the country since its inception. It began its career as a health care provider established by the Benevolent Society in 1820, specifically targeted at offering obstetric, gynaecological and neonatological services to poor married women during their pregnancy, labour and after the birth of their child. 

Since then it has continued to be an innovator in the field, becoming New South Wales’ first ‘lying-in’ hospital for women in 1866, and over time became the principal teaching hospital for the University of NSW in fields related to women’s reproductive health. 

Finally, in 1992 the management of the hospital was conferred from the Benevolent Society of New South Wales to the Eastern Sydney Area Health Service, and in 1997 it officially relocated its facilities from Paddington to Randwick to occupy a new $40 million purpose built hospital in the area. 

Since then it has continued to be one of the best hospitals in Sydney for supporting women’s health, leading the way in the field of obstetrics and playing a vital role in educating the next generation of healthcare providers in Sydney.

Some of the amazing milestones that the Royal Hospital for Women has achieved over the decades in the fields of obstetrics and maternal health include:

• Being the first hospital to offer ultrasound services in Australia
• Performing the first successful fetal transfusion, fetal cardiac ultrasound, cranial ultrasound of a newborn and the first fetal muscle biopsy in the country
• Establishing the longest continuous antenatal clinic in the world
• Performing the world’s first operation in utero to save a child’s life

The Royal Hospital for Women today

Today the Royal Hospital for Women has continued to improve and grow their services for women in New South Wales. The primary areas of specialisation in the hospital include gynaecology, gynaecological oncology, maternity, maternal fetal medicine, menopause, newborn intensive care and reproductive medicine. 

The Royal Hospital of Women is dedicated to providing high quality obstetric and maternal services to women, delivering more than 4,000 babies every year, including taking care of 600 premature babies and performing more than 600 gynaecological procedures annually. This makes it one of the largest and most experienced maternal hospitals in the country.

The Royal Hospital for Women in Randwick, affectionately known as The Royal, is open to all women from across the state, providing expert support for mothers and their babies when they need it most.

The post The History of Obstetrics at Sydney’s Royal Hospital for Women appeared first on Dr Rahul Sen.

What does non-invasive prenatal testing screen for?

Non-invasive prenatal testing is a highly sensitive prenatal screening test that can help mothers understand the risk of their child developing certain genetic abnormalities during pregnancy. The test is done in the first trimester and screens for:

• Downs syndrome: a genetic disorder caused by a partial or complete copy of chromosome 21, which is associated with developmental delays and intellectual disability. 
• Edwards syndrome: a genetic disorder caused by a partial or complete copy of chromosome 18, which causes severe developmental delays that are often fatal before birth or within the first year of life.
• Patau syndrome: a genetic disorder caused by a partial or complete copy of chromosome 13, which causes severe issues with development that are often fatal within the first week of life.
• Turner syndrome: a genetic disorder caused by a female born with only one X chromosome, which is associated with short stature, delayed puberty, infertility and particular learning difficulties.

While all of these genetic abnormalities are very rare, screening for them allows the mother and their families to properly prepare for all eventualities and make informed medical decisions based on the findings of the tests.

Who should consider non-invasive prenatal testing?

Non-invasive prenatal testing is not a standard test in the first trimester, and is only offered in particular specialist clinics, however, it can be an extremely useful test for mothers who:

• Are over 35 years of age, which increases the chance of their child having a genetic abnormality. 
• Had a past pregnancy with a genetic abnormality.
• Had abnormal test results from their first trimester ultrasound or other tests and screenings.

What are the benefits of non-invasive prenatal testing?

Non-invasive prenatal testing has had such an impact on prenatal screening because of its major benefits:

• It is 99% accurate. NIPT is highly accurate at screening for Downs, Edwards, Patau and Turner syndrome, which makes it more effective than the regular ultrasound at detecting potential abnormalities. 

• It is non-invasive. Unlike some tests such chorionic villus sampling (CVS) NIPT is non-invasive, which means that it poses no risk of miscarriage. 

• It can be done as soon as 10 weeks. Because the test is available from 10 weeks, it can help parents start preparing earlier and with better certainty.

What are some considerations you should be aware of?

Non-invasive prenatal testing is highly accurate, however, it is still a screening rather than diagnostic test. This means that while it can help assess the likelihood of a baby being affected, it can not give parents a definitive answer, which will require a diagnostic test like CVS. It can however allow mothers make better informed decisions about how to prepare and whether to take a more invasive test to get a definitive diagnosis. 

The post What is Non-Invasive Prenatal Testing? appeared first on Dr Rahul Sen.

Make sure you plan for the heat

Most mothers will attest to the fact that being pregnant will also often come with generally feeling hotter throughout the day than they normally would. Combine this with the already overwhelming heat of peak summer days and you could begin to feel very uncomfortable. A good way to stay on top of this is to be aware of heat alerts and plan accordingly. If you know it is going to be a hot day, plan to do something cool or indoors such as shopping, going to the pool or watching a movie.

Continue to exercise

While it might be the last thing you want to do, it is important to continue some kind of exercise regime even in summer. The highest priority however is to stay safe so make sure that you exercise either outside of peak heat hours, such as taking a walk in the morning or evening when it is cooler, or finding a cool place to stay fit such as a gym or Pilates studio. This will help keep you healthy and active, however, make sure you avoid any kind of overheating or exhaustion, with low impact exercises a good choice.

Follow heat safety guidelines

Diligently following heat guidelines should be a top priority. These include sun safety recommendations such as putting on sunscreen, wearing protective clothing, wearing a hat and seeking shade where you can. It also means that you should hydrate regularly, which helps keep the body cool and decreases water retention, which can make Sydney summer days more bearable.

Take precautions against bushfire smoke

Bushfires are a real health risk in summer and can cause serious issues such as difficulty breathing and asthma attacks, as well as milder symptoms such as burning eyes or throat irritation. Some of the best ways to protect yourself are:

• Stay indoors, preferably in an air-conditioned building where the air is building filtered of smoke and particles.
• Consider buying a portable air filter for your home to remove hazardous particulates from the air.
• Avoid exposing yourself to smoke by doing physical activity outside.
• Buy a P1 or P2 mask from the hardware store if you have to go outside. These masks, when worn properly, can minimise the effect of smoke, however do not provide perfect protection, so should be used alongside other precautions.
• Leave the smoke affected area if you have a chance, such as staying with a friend outside of the bushfire affected areas or taking that relaxing holiday you’ve been planning but haven’t quite had the chance to go on yet.

The post Pregnancy care tips for a Sydney summer and bush-fire season appeared first on Dr Rahul Sen.

Amongst the options of obstetrics and maternity services in Sydney, the Prince of Wales Private Hospital is the standout choice, providing modern, private hospital care, a step above the other options in the city. Some of the reasons why the Prince of Wales Private Hospital is one of Sydney’s leaders in obstetrics is:

Focus on private patient care

Perhaps the most important factor in choosing the Prince of Wales Private Hospital is their focus on private maternity care for their patients. While most other hospitals offer some form of private care the Prince of Wales is entirely centred on providing a personalised experienced that fulfils your needs and expectations.  From an experienced maternity team to modern, cutting edge facilities there isn’t a better private obstetrics program in Sydney.

A variety of birthing equipment

Most mothers would prefer to have some kind of control over the birthing process, and that is where the Prince of Wales Hospital shines, providing a variety of birthing equipment to help facilitate your labour preferences. These include a host of resources including water immersion, birth balls, mats and stools.

More operating theatres

Another massive advantage for the Prince of Wales obstetrics program is the amount of operating theatres they have available if there are complications during the birth. Outfitted with the best equipment the hospital is ready to support emergency caesarean sections if needed and are happy to provide elective caesarean sections if the mother chooses to undergo the operation.

Support 24 hours a day

The hospital offers 24-hour support for mothers before and after birth, including a night nursery where the newborn can be taken care of at night while the mother rests and gets some much needed sleep.

Little Luxuries program

Opening again in late 2020 is the option of the Little Luxuries program. Which is a 4.5 star private hotel on Coogee Beach which offers post-natal support for mothers who gave birth in the Prince of Wales Private Hospital. Along with the beachfront views and 24-hour medical support, the Little Luxuries program is also covered by most private health insurance schemes.

Access for partners and overnight stay

One of the best parts of choosing the Prince of Wales Private Hospital for your obstetric needs is the fact that they are very accommodating to partners. Partners are welcome to stay overnight at the hospital and are provided with either a double bed or sofa bed in the room so that they can be a part of the experience.

Postnatal care

Postnatal care is a big focus for the Prince of Wales Hospital with spacious postnatal accommodation including freshly cooked meals, air-conditioning, a bar fridge, television, Wi-Fi, ensuite bathroom and a lounge area for the ward. Nursing assistance is available on-call, providing support whenever it is needed.

The post What makes the Prince of Wales Private Hospital one of Sydney’s leaders in Obstetrics appeared first on Dr Rahul Sen.

What is the difference between 2D and 3D ultrasounds?

Many people have undergone an ultrasound sometime in their lives, and this is particularly true of women who have passed their 8^th week of pregnancy. A 2D ultrasound can be performed in most practitioner’s offices or at the local hospital and provides an exciting first glimpse of your child.

When you are undergoing a 2D ultrasound you will be asked to lie on your back and expose your belly. The practitioner will then rub a gel on your abdomen to help the transmission of sound waves into your body. Once the gel is applied they will use a hand held device called a transducer and rub it against your belly, allowing sound waves from the device to enter your body and bounce off the various structures inside, including your growing child! These sounds are then converted into electrical signals and translated to pictures on a screen.

If the ultrasound is very early on in your pregnancy then an abdominal ultrasound may not be possible. In that case it would be performed by a vaginal probe, rather than hand held transducer.

A 3D ultrasound is similar to a 2D ultrasound, except multiple two-dimensional images are taken at different angles, and then pieced together to provide a three-dimensional image of the child.

What are 2D and 3D ultrasounds used for during pregnancy?

2D ultrasounds are a regular part of the prenatal tests performed during pregnancy. They are normally performed once in the first and once in the second trimester. The first trimester ultrasound is used to pick up the heart rate and see the umbilical cord, size and placenta. The second trimester ultrasound is used to observe the placenta and different features of the foetus including the head, face, spine heart and abdomen. The main reason for these tests is to look for physical abnormalities in the development of the child.

3D ultrasounds are only recommended by the doctor if they suspect a foetal abnormality such as a cleft lip and are not a regular part of prenatal exams. Parents on the other hand sometimes wish to perform a 3D ultrasound for the sake of creating a keepsake of their child, a 3D image that they can show to their friends.

Are 3D ultrasounds safe for the mother and child during pregnancy?

There are many ‘prenatal portrait centres’ that offer 3D ultrasound pictures of your child, however, the safety of these sessions is uncertain. It is recommended by doctors that while ultrasound technology for the most part is considered safe, it should only be used by a trained practitioner and only if it is medically necessary, such as to examine foetal abnormalities.

3D ultrasounds use sound waves which can warm up the tissue a little, which can sometimes create pockets of gas. While there are no known risks with ultrasound technology, the long term consequence of this effect are unknown, so it is always best to be safe.

Therefore, experts discourage the idea of using 3D ultrasounds for creating a keepsake or just to have a portrait of the child. Instead they counsel that they be used only for medical purposes, by a trained professional and only if it is recommended by trained medical staff.

The post Is a 3D Ultrasound Safe for Baby and Mother? appeared first on Dr Rahul Sen.

However, because people only really encounter an obstetrician when they are looking to have a child many might still be confused by what exactly it is that they do and what their qualifications are for such an important job in the medical field.

What is the role of an obstetrician?

As mentioned earlier the role of an obstetrician is to provide medical advice and care from pregnancy to childbirth. This involves:

• Antenatal care. Antenatal care is the medical support provided for you and your baby during pregnancy. At this stage the role of the obstetrician and their team is to provide you with:
  • Regular checkups to monitor the health of the baby and mother.
  • Examinations to identify the stages of pregnancy and sex of the baby.
  • Advice for how to take care of yourself and your baby during pregnancy.
  • Medical care for any issues that might arise during the pregnancy.
• The main role of the obstetrician during childbirth is to ensure that the birth is going smoothly and provide any medical assistance that might be necessary to ensure the safety of the mother and child. If the pregnancy is considered high risk it is the obstetrician who provides the medical support required, including performing the caesarean procedure if it is needed.
• Postnatal care. After birth it is the job of the obstetrician to perform a postnatal check-up to examine the overall physical and mental health of the mother and child. In this check up the obstetrician also talks about the pregnancy and any considerations should the mother wish to have more children.

At these three stages of the birth cycle an obstetrician must perform a variety of roles including prescribing medication, determining the need for surgery, monitoring the health of the mother and child, treating complications, providing advice on family planning, and providing advice on nutrition and a healthy lifestyle.

What are the qualifications of an obstetrician?

As we can see the role of an obstetrician is extremely important and requires a high degree of training to perform the vital function of providing medical care before, during and after pregnancy. In order to become an obstetrician one must:

• Complete a Medical Degree. In Australia medical degrees take between 4 to 6 years to complete.
• Complete an Internship. An internship takes an additional year and provides experience in different departments of a hospital.
• Complete a Residency. A residency takes at least another year of rotations in a hospital in order to accumulating sufficient experience to enter into a vocational program.
• Vocational training. Finally, a doctor looking to become an obstetrician needs to complete vocational training which currently takes 6 years with the Fellowship of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

These are the four key qualifications that an obstetrician must undergo, and in addition needs to be registered as a doctor in Australia and continue to undergo training and development throughout their entire career to stay up to date with the newest developments in the field.

The post What qualifications does an Obstetrician have? appeared first on Dr Rahul Sen.

What are scans used for during pregnancy?

Some of the reasons why scans might be performed during pregnancy include:

• To confirm that you are pregnant and review how many foetuses are present to identify twins or triplets.
• To confirm that the pregnancy is taking place in the uterus, that it is developing as expected and the presence of a heartbeat.
• To calculate the estimated due date of the baby.
• To examine the likelihood of any abnormalities in the foetus as it grows and its overall physical development.
• To determine the amount of amniotic fluid present around the baby and the position of the baby and placenta before birth.

What are the regular scans recommended during pregnancy?

There are several scans that are generally recommended during the pregnancy period:

• A Dating Scan: Dating scans can be performed as early as six weeks into the pregnancy and provide information on when the conception took place and when the expected arrival date of the baby might be.
• A first trimester pregnancy screening scan: Also known as a nuchal translucency scan this ultrasound scan is normally performed within the first 11 to 13 weeks of pregnancy. This test is performed to screen for specific chromosomal abnormalities such as Down Syndrome and normally takes place alongside other tests such as blood screening.
• A second trimester pregnancy screening scan: This scan is normally performed in the 18 to 20 week period of the pregnancy and its major purpose is to screen for any anatomical abnormalities such as problems with the heart or internal organs. If the genitals can be easily seen the doctor might also be able to confirm the sex of the baby at this stage.

While these are the regular tests performed throughout the pregnancy if the pregnancy is high risk or involves multiple births such as twins then other scans might be recommended.

What to expect when ultrasound scans are performed

Ultrasound scans are a simple and safe procedure that is used to visualise internal structures within the body. When having your ultrasound scan during pregnancy the doctor or medical professional will apply a gel to the stomach and then use a device that produces soundwaves to reflect off the baby and provide a picture of what is going on inside your body. In some cases very early on in the pregnancy if there is a need to do an ultrasound scan it might be necessary to do it transvaginally, which means that the ultrasound device is gently inserted into the vagina to provide images rather than over the abdomen. It is completely painless and safe for the baby in addition to being extremely useful for understanding how the pregnancy is developing.

The post The importance of regular scans during pregnancy appeared first on Dr Rahul Sen.

In short obstetrics deals with the care of women and their baby during pregnancy, birth and the immediate days or weeks after their child is born. Gynaecology on the other hand specialises in understanding and treating women’s reproductive systems. This article will attempt to clarify what both of these professions do and how to decide which one is the right doctor for your needs.

What is an obstetrician?

Diabetes – pregnancy diet plan

As mentioned above obstetricians are specialists in the field of medicine which are concerned with the care of women during pregnancy, labour and birth. Their primary function is to ensure the wellbeing of women and their children during this critical period in their lives.

• During pregnancy: During pregnancy an obstetrician is responsible for monitoring the health of a woman and her child. This is called antenatal care and involves performing tests to monitor the stages of a baby’s growth, examining the physical and mental health of the baby and their mother and providing advice on care and nutrition.
• During childbirth: When the baby is ready to be born an obstetrician plays a vital role in recommending the proper care during the birthing process and advising on the delivery of the child. If there are complications an obstetrician will be involved in taking the necessary steps to ensure the health and wellbeing of the mother and child.
• After childbirth: An obstetrician will do a postnatal check-up after birth and help guide you to the care and support you need in the first stages of your life with your child.

What is a gynaecologist?

While it is very common that an obstetrician is also a gynaecologist, gynaecology is a field of medicine that focuses on a different side of women’s health and these professionals are involved for a much longer period of a woman’s life, which ranges from puberty all the way through to menopause.

Gynaecologists focus on the health of a woman’s reproductive health which can include the reproductive system such as the uterus, fallopian tubes and ovaries as well as their genitals and breasts. Gynaecologists perform routine checks such as Pap tests and examinations for sexually transmitted diseases, and can provide medical treatment for issues such as infections, diseases or other irregularities. They may also perform or advise on particular surgical procedures such as hysterectomies or the removal of precancerous cells within a woman’s reproductive system.

Aside from medical conditions, gynaecologists also concern themselves with a woman’s fertility and can advise on fertility treatments, advice on conception and the proper use of contraception.

The post What is the Difference Between an Obstetrician and a Gynaecologist? appeared first on Dr Rahul Sen.

That’s why a good prenatal doctor is vital to the process. An obstetrician can be there to answer questions, perform routine checks and ensure that the mother and baby remain healthy throughout the pregnancy and birth.

Complications do happen however, and when they do having an obstetrician on your side can make a significant difference. An obstetrician is a highly qualified medical professional, trained in helping women through complicated pregnancies and experts in facilitating successful births.

What is a complicated pregnancy?

A complicated or high-risk pregnancy is a complication during the nine month period that might affect the health of the mother or child. High risk pregnancies can develop for a number of reasons including:

• Pre-existing medical conditions: Pre-existing medical conditions such as high blood pressure, obesity, autoimmune disease or diabetes can all be at the root of complications during pregnancy.
• Medical history: Medical history might involve genetic disorders, history of miscarriage or complications in previous pregnancies.
• Lifestyle factors: Lifestyle factors such as smoking, drinking or use of drugs can cause complications for the child.
• Pregnancy complications: Issues in the uterus, placenta or cervix can all contribute to a more complicated pregnancy and require special medical attention.

The good news is that a complicated pregnancy doesn’t necessarily have to be more difficult than a pregnancy that is low-risk and in a lot of cases can be managed successfully through a combination of the right prenatal care and the attention of an obstetrician.

What is an obstetrician?

An obstetrician is a medical professional that provides expert care and advice before, during and after birth. They perform a number of important functions including:

• Antenatal care checkups to examine overall mental and physical health.
• Ultrasound scans to monitor to development of the baby.
• Nutritional advice to ensure that the child and mother have the sustenance they need for a healthy birth.
• Support during childbirth and high risk pregnancies.

What is the role of an obstetrician during complicated pregnancies?

There are a number of factors that make an obstetrician important during high risk pregnancies.

First and foremost they are the health care provider that has been there with the mother and baby since the beginning of the journey. They understand the medical history of the mother and how the child has developed over the nine months. This makes them uniquely qualified to know what treatments and procedures are best to ensure a successful birth.

As an expert in their field they will play a vital role in adjusting prenatal (pre-birth) care and will have an active role in the delivery of the child. They will be able to advise on whether a natural birth or c-section and help facilitate a healthy birth.

The post The Importance of Obstetricians for Complicated Pregnancies appeared first on Dr Rahul Sen.

Midwives are trained and authorised to provide medical care under their own authority, meaning that they only need to refer to doctors when necessary or there are complications in the pregnancy or birthing process. They often work in conjunction with an obstetrician to ensure that you have the care and support you need to give birth to a happy and healthy child.

What do midwives do?

While most people assume that midwives only provide care during the birth of the child, to be most effective it is recommended that a midwife is present before and after the pregnancy as well. This is called continuity of care and means that you will have someone present to give you advice when you need it and be aware of the details and peculiarities of your case, a role which is vital to the success of your pregnancy and labour.

Midwife care during pregnancy

Midwife care during pregnancy and before the birth is focused on monitoring the health of you and your baby and helping guide you in your physical health and psychological needs. A midwife’s role might include:

• Providing family planning and conception advice
• Conducting pre-birth scans and tests
• Monitoring your wellbeing and psychological state
• Providing advice about nutrition and exercise
• Educating you and your family on the birthing process and caring for your child

Midwife care during and after labour

If your pregnancy is expected to be natural and without complications then a midwife might be the only support you need, however, if there are complications in the birth then they should be working closely with an obstetrician to provide the medical care necessary for you to have a successful delivery.

During labour a midwife will:

• Provide you with emotional and practical support through information and encouragement
• Monitor you and your child’s health
• Provide you with pain relief directly or facilitate access to it
• Act as a line of communication to doctors if necessary

After your baby is born your midwife will:

• Assist you with breastfeeding
• Educate you on how to take care of your newborn including bathing, settling and changing their nappies
• Provide you with pain relief and offer medical care if necessary
• Perform medical checks on you and your child to ensure the continued good health

Midwives work in a variety of settings from hospitals to birthing centres and obstetrician clinics. They are often able to visit you at home and play a key role in providing you with advice and care on an ongoing basis from conception to around 6 weeks after birth, meaning that if you don’t already have one you should contact a clinic today.

The post What is a Midwife and What do they do? appeared first on Dr Rahul Sen.