During Pregnancy (Antenatal)

An Introduction

Congratulations on your pregnancy

Thank you for choosing me as your obstetrician. As a father myself I know this is a truly special time in your life. I have written this as a guide to what you can expect from your pregnancy care. Of course, I look forward to discussing the important issues with you in person, as well as addressing any specific questions or concerns you may have.

My aim is to help make your pregnancy journey a safe, happy and enjoyable experience.

Dr Rahul Sen

My Team

Obstetrician: Dr Rahul Sen
Midwives: Michele Simpson, Chantelle du Boisee
Secretaries: Peta Bellanto, Breanna Goddard, Eva Cosgrove
Sonographers: Lily and Rebecca
Perinatal Mental Health Nurse Consultant: Mellanie Rollans

Please note that your medical information is confidential, and I do not discuss your details with anyone other than health staff and professionals who are involved in your care.
NB. I do not discuss results or medical care by phone, but I can to see you urgently if needed.

My background

I grew up in the UK but have lived in Australia for over 30 years. I began my medical training at the University of Sydney, Royal Prince Alfred Hospital, The Canberra Hospital and the Royal Hospital for Women, where I completed my core obstetric training. I then worked at Queen Charlotte’s & Chelsea Hospital in London, where I completed my advanced training and gained extra consultant experience, especially in diabetes and high-risk obstetrics, before returning to Sydney as a specialist.

I am experienced in both uncomplicated and high-risk obstetrics, as well as the care of pregnant women with medical disorders, such as diabetes and recurrent miscarriage. I am currently involved in the training, supervision and examination of junior doctors. I regularly teach and lecture on maternal resuscitation, as part of the Managing Obstetric Emergencies and Trauma (MOET) course that I helped to establish in Australia in 2009, and hope to take to developing countries in the near future.

What is a Doula?

A doula provides support and education during your pregnancy and labour, both at home and in the hospital. They also provide support and advice in the early days and weeks following your birth. Doula fees can vary substantially. You can ask Dr Sen or the midwives for recommendations. To find a doula see www.findadoula.com.au or www.australiandoulacollege.com.au

Pregnancy Timeline:

4 weeks: First missed menstrual period (around 2 weeks from actual conception)

8 weeks: Dating ultrasound in my rooms – you will need a “comfortably full” bladder
Referral for antenatal booking blood tests if not already done by your family doctor
Antenatal visits now every 4 weeks (1st baby) or 5-6 weeks (2nd + baby)

10 1/2 weeks: Earliest time for Non-Invasive Prenatal Test (eg Percept: vcgs.org.au/perceptNIPT)

10-11 weeks: Blood tests for the Nuchal Translucency Scan (if you are having one)

10-14 weeks: Recommended visit with a pregnancy dietitian to discuss healthy eating and weight gain in pregnancy

12-13 weeks: Nuchal Translucency Scan or Early Structural Scan (if you are having one)
Book in for antenatal classes (and maybe Calmbirth,) if booked at RHW

14 weeks: Submit Hospital booking form – paper form for RHW, online booking for POWPH

17-24 weeks: Appointment to see midwife Michele (or Chantelle) for long (1 hour) consultation

18 weeks: Book in for antenatal classes, if booked at POWPH (first baby)

19 weeks: Detailed morphology ultrasound scan (can check baby’s sex if you wish)

20 weeks: Start feeling baby’s movements (sometimes later if the placenta is at the front)

26-28 weeks: Gestational diabetes screen (Must be booked. Needs 12 hour fast. Allow 3 hours)

28-30 weeks: Anti D injection, if your blood group is Rhesus negative

Antenatal visits now every 2 weeks (1st baby) or every 3 weeks (2nd + baby)

30-33 weeks: 3D Ultrasound in Edgecliff rooms – please don’t be late, as your time slot is short

34-36 weeks: Second Anti D injection, if required

36 weeks: Growth and wellbeing ultrasound
Vaginal-perianal swab for Group B Streptococcus (GBS)
Antenatal visits now weekly (all pregnancies)

36-37 weeks: Second, shorter (30 minute) consultation with Michele (or Chantelle), if required

37 weeks: Longer consultation with me to discuss birth plan

39-40 weeks: Usual timing of elective caesarean section if you need one

40 weeks: Full term

In Emergencies

If you ever have severe pain, very heavy bleeding, shortness of breath or chest pain the safest thing to do is call an ambulance to take you to the emergency department.

Under 20 Weeks:

Please contact my rooms as soon as possible. I have emergency appointments every weekday, and will usually arrange to see you usually the same day and perform an ultrasound scan in rooms.

If you attend the emergency department you will generally have a long wait and often leave without a scan, so unless you need urgent medical attention it is probably better just to come to see me.

20 weeks and over:

Please contact the delivery suite of the hospital at which you are booked:

Prince of Wales Private Hospital: (02) 9650 4444

Royal Hospital for Women: (02) 9382 6100

Please contact the delivery suite of the hospital at which you are booked.

NB. I do not discuss results or medical care by phone, but I can to see you urgently if needed.

Choice of Hospitals

I am often asked which is my preferred hospital between the Royal Hospital for Women and Prince of Wales Private Hospital. I do not have a strong preference, however there are some differences between the Royal Hospital for Women and Prince of Wales Private Hospital. In reality both are good hospitals, and the delivery suite midwives are generally excellent. I hope the following information will help:

Royal Hospital for Women

Advantages of Royal Hospital for Women

Disadvantages of Royal Hospital for Women

Prince of Wales Private Hospital

Advantages of Prince of Wales Private Hospital

Disadvantages of Prince of Wales Private Hospital

In reality both hospitals are good and the differences between them relatively small. Please be aware that in neither hospital is a single room guaranteed from your first night. My midwifery team usually ensures that you have good support, even after discharge from hospital.

I hope that this helps with your choice of hospitals. It is something that we can discuss further at your booking visit. Parking reminder: when you come in to hospital to have your baby please remember to buy a 5 day car park pass, as this will reduce your parking cost significantly.

Hospital Antenatal Bookings

I deliver babies at both the Royal Hospital for Women and the Prince of Wales Private Hospital. If you do not already know which hospital you would prefer I shall discuss that with you at your booking visit. Both of these hospitals are on the same campus, accessed from Barker Street, Randwick. Hospital tours are conducted at both hospitals. To arrange a tour ring (02) 9382 6541 for Royal Hospital for Women and (02) 9650 4693 for Prince of Wales Private Hospital.

Women wishing to deliver at Prince of Wales Private Hospital should complete a Pre-Admission Form and return it to Level 5 at the hospital. To obtain a form or for further information ring POWPH on (02) 9650 4693. Women wishing to deliver at the Royal Hospital for Women should complete a booking form at your first visit with me. For further information ring RHW on (02) 9382 6111.

Antenatal Classes

I recommend you attend some form of childbirth education during your pregnancy, especially if this is your first pregnancy. Antenatal classes are extremely helpful and are a great way of meeting other expectant mothers and sharing common experiences.

There are many options available but most are very popular and book out very early so please book as soon as possible. For antenatal classes at the Prince of Wales Private Hospital please contact Carolyn Love on (02) 9650 4961. For maternity services information call (02) 9650 4693.

The antenatal and postnatal classes at the Royal Hospital for Women are held by the Physiotherapy Department and include sessions on health education, parenting and tours of the Delivery Suite. They are available to women who are booked for delivery at the Royal Hospital for Women. Classes are held one night per week for seven weeks or on two consecutive Saturdays from 9.00 am to 3.30 pm. To book call (02)) 9382 6540.

Antenatal Visits

Dr Rahul Sen ~ Long Appointments. Dr Rahul Sen details the reasons behind having long appointments with his patients – from the very first visit through to the final catch up before the birth. It’s about ensuring you have all the information and assurance you’ll need to experience a safe and rewarding birthing experience.

As your pregnancy progresses, the frequency of your visits will increase, in order to check on the wellbeing of both you and your baby. This is particularly important at the end of the pregnancy.

A pregnancy lasts 40 weeks on average, so you will have 10–12 visits with me during this time. At your second visit I shall provide you with an antenatal card. This card contains all your important pregnancy information at a glance, so please carry it with you all the time and bring it to all visits.

Please feel free to bring your partner to the visits, especially your first visit. Children are welcome, and we have toys to occupy them in the waiting room. However, if your child distracts you during a visit, you will get less benefit from the consultation, so it may be better to leave them with another carer.

Most of your visits will last 10-15 minutes, depending on your individual needs. I always try to run on time, however the very nature of obstetrics means that I can be called away suddenly, and also that I may unexpectedly need to give extra time to a patient with an unanticipated problem. I recommend that you call an hour before your appointment to confirm that I am running on time. Please remember if you run late for your appointment, you will make me run late for the rest of the day.

Your first visit

13 to 14-week visit

During this visit I shall check the results of your nuchal translucency scan and Harmony test, if you have had one.

16 to 17-week visit

I shall check that your pregnancy is progressing well, as you will probably not have started to feel movements yet, especially if this is your first pregnancy, or the placenta is at the front. I shall also arrange for your 19 week “morphology” ultrasound, if this has not already been booked. You should have your long (1 hour) appointment with Michele around this time, after your appointment with me.

20 to 21-week visit

I shall discuss the results of your 19 week ultrasound scan, and make sure you have had or booked an appointment with my midwife, Michele.

24 to 25-week visit

I shall give you a referral for your diabetes screening test, as well as your blood count and iron stores.

28 to 29-week visit

I shall discuss the results of your diabetes screen and other tests. You need to book a 3D scan. You should have a whooping cough (Pertussis) booster with your GP or family doctor at 28-32 weeks.

34 to 36-week visit

I shall repeat your blood tests to check your iron stores, if necessary

36-week visit

I shall perform a vaginal-rectal swab test, to screen for Group B Streptococcus. I also recommend a 36 week growth and well-being scan. You may wish to have a second, shorter visit with my midwife.

37-week visit

I shall review the results of your swab test. If it is positive (10-20% of women) you will need intravenous antibiotics in labour, and sometimes oral antibiotics beforehand. I shall also review the results of your 36 week growth scan. If your baby is much bigger or smaller than usual I may need to arrange further monitoring, including extra scans. I shall discuss your plans for birth at this visit.

Pregnancy Nutrition

Healthy Eating for pregnancy

Pregnancy is a time when almost all of you will think more about what you are eating. Many of you will wonder what is best for your baby and make changes to the types of food you eat. There are many aspects of diet that need consideration during pregnancy – and I just touch on a few of the most important here.

It’s quality not quantity

You do need to eat extra when you are pregnant, but the amount of extra energy (kilojoules/calories) each day is quite small i.e. equivalent to a couple of slices of bread and a glass of low fat milk only! What you do need more of are nutrients – more B vitamins, folate, vitamin C, iron, protein among others, so it can take some planning to make sure that almost everything you choose to eat is giving you something worthwhile. Don’t worry – I did say almost everything!

One of the simplest ways of achieving this is by thinking about your diet in terms of food groups. Our food groups exist because the foods within each group provide similar nutrients i.e. milk, cheese and yoghurt are all good providers of protein and calcium. There are guidelines to help you to choose the right number of serves from these groups each day.

The benefit of this approach is also that it lets you keep track of your total intake as well as the balance in your diet. It also can help draw your attention to the frequency of those ‘extra’ foods in your diet – the ones that don’t really fit into any of the groups very well. It’s these ‘extras’ that can cause trouble! High energy, low nutrition = not great for you or bub.

The following table provides a guide as to the amount of food you need for a healthy diet in pregnancy:

For more information on pregnancy nutrition, please discuss it with Dr Rahul Sen.

Healthy Diet During Pregnancy

Essential nutrients in pregnancy

There is an increased requirement for many nutrients during pregnancy. Eating a normal balanced
diet should ensure that your baby gets good nutrition.

Folate: Folate, a B vitamin, is important for your baby’s development during early pregnancy because it helps prevent birth abnormalities like spina-­bifida. The best way to make sure you get enough folate is to take a daily supplement of at least 400 micrograms one month before becoming pregnant and during the first three months of pregnancy.

Foods naturally rich in folate include green leafy vegetables such as broccoli, spinach, and salad greens, chick peas, nuts, orange juice, some fruits and dried beans and peas. See the Food Standards Australia New Zealand (FSANZ) website for more information about folate during pregnancy.

Iron: Pregnancy increases your need for iron. Good sources of iron include lean beef, duck (with the skin removed), chicken, fish, green vegetables such as broccoli, cabbage and spinach, and cooked legumes such as chick peas, lentils, kidney, and lima beans.

Calcium: Calcium is essential to keep bones healthy and strong. Dairy foods, such as milk, hard cheese, yogurt, and calcium fortified soy milk are excellent sources of calcium.

Omega 3: Omega 3 is important for the development of the central nervous system, brain growth, and eye development in your baby before and after they are born. Good Omega 3 foods include: oily fish like salmon, trout, herring, anchovies, and sardines;; chicken;; eggs;; canned tuna;; and flaxseed oil.

Iodine; Iodine is required for healthy thyroid function in both the mother and unborn baby. Insufficient iodine can lead to brain development and neurological issues in the baby. Read more in the Iodine and Pregnancy article for daily intake guides and food sources.

Zinc: Getting enough zinc is particularly important for the rapid cell growth that occurs during pregnancy.
Zinc can be found in lean meat, wholegrain cereals, milk, seafood, legumes, and nuts.

Vitamin C: The need for vitamin C is increased in pregnancy due to larger blood volume in the mother and the growth of the unborn baby. Excellent dietary sources of vitamin C include fruit and vegetables.

Fibre: Some women experience constipation especially during the later parts of pregnancy. A high fibre
intake combined with plenty of fluid is encouraged to help prevent this. High fibre foods include wholegrain breads and cereal products, legumes, nuts, vegetables, and fruit.

Water: Drink eight glasses of fluid a day – and remember that juice, milk, coffee (caffeinated or decaffeinated), and other drinks count toward your fluid intake, so you don’t need 8 glasses of water on top of everything else you drink – though plain water in the best.

If you think you are not getting enough vitamins or nutrients please contact your health practitioner.

Foods to take care with in pregnancy

The golden rules of food safety:

Other food risks in pregnancy

Mercury in fish

Alcohol in pregnancy

Smoking when pregnant

The evidence against smoking during pregnancy is overwhelming and giving up is the best thing that you can do for both you and your child.

Smoking during pregnancy has been linked to a number of problems, including increased risk of miscarriage, premature birth, developmental problems, asthma and SIDS, as well as an increased risk of a number of other diseases in adult life, such as heart disease and diabetes. For assistance with quitting smoking, call the Quit line on 131 848.

FORUM: Find non-judgement support in the Support for quitting smoking forum section

Medicines in pregnancy

Medications that you take can pass to your unborn baby through the placenta. Be very careful with any remedies that you take – including herbal remedies, over-the-counter medications, and vitamin supplements. Check with your pharmacist for non-prescription items or doctor/obstetrician before starting any form of medication.

You can also contact the Medicines Line on 1300 633 424 (1300 MEDICINE). NPS collaborates with healthdirect Australia to deliver Medicines Line, a telephone service providing consumers with information on prescription, over-the-counter, and complementary (herbal/’natural’/vitamin/mineral) medicines.

There is an additional service for residents of NSW called Mothersafe that you can call on (02) 9382 6539 (Sydney) or Tollfree 1800 647 848 (outside Sydney metro and state wide). Mothersafe is a telephone service based at the Royal Hospital for Women that is for pregnant and lactating mothers to call and check on any concerns they have about taking medications during this time (e.g. vitamins, over-ˇthe-ˇcounter medications, use of pesticides, exposure to radiation via mammograms, xrays & dental xrays, medications for other health reasons, prescription drugs from your doctor).

Illicit drugs in pregnancy

It is strongly recommended that you do not take any form of recreational drugs during pregnancy.

NOTE: This information is not intended to replace actual medical advice. If you have any concerns about your health or nutrition during pregnancy, seek advice from your health care practitioner.

– This article was kindly supplied by the NSW Food Authority.

Further Reading:

Download the NSW Health Listeriosis Fact Sheet as a PDF file to view or print – by clicking HERE.

Weight Gain During Pregnancy

Healthy Weight Gain in Pregnancy

Most women should gain between 10 and 15 kg during the pregnancy. About half of that is from the baby, the amniotic fluid, the placenta and the womb. The other half is extra fat stores, blood and other fluids and breast development. If you gain too much or too little weight it may affect the pregnancy. If you gain more than 15 kg it may be difficult to lose the weight afterwards.

Your ideal weight gain depends on your starting weight or body mass index (BMI), which is your weight in kilograms, divided by your height in metres multiplied by itself (weight/height2):

Watch your weight gain

Everyone is different and weight gain will always vary between women but it is important to keep an eye on it. A higher weight gain can lead to complications that are potentially avoidable. In the women I regularly see who have gained an excess amount of weight, a diet history usually reveals the culprits are high calorie snacks and bigger portions at meals. Portion size is a vital part of weight management.

If you are hungrier and are already eating the recommended amounts of protein/starch already then the best way you can bulk out a meal is by adding vegetables – while the other meal components may be nutritious, if you’re overdoing it you’re more likely to put on too much weight. A quick way to think about it is by using the ‘plate’ model. Half your plate should be salad or cooked vegetables, then a quarter lean protein (meat/chicken/fish/tofu/eggs), and a quarter starch (bread/rice/pasta/quinoa or noodles).

My five top tips

It’s all in the planning

If you are feeling sick often the last thing you feel like doing is thinking or talking about food but spending a short time focusing on your shopping list and planning ahead will help a lot in managing your diet. Ensuring you have nutritious snacks on hand and a list of options for work lunches as well as perhaps some weekend cooking to enable quick but healthy dinners through the week will save you from the trap of banana bread, giant sandwiches and late night laksas!

It isn’t always easy but it is worthwhile

The potential changes to your appetite, nausea plus cravings and food aversions along with early fatigue make it a trying time for you – not to mention the food safety restrictions and conflicting information you might read.

I look forward to seeing all of you early on in your pregnancy, to work with you to answer any queries you may have. I aim to provide some practical help in managing any of the above considerations, as well as looking at the adequacy and balance of your diet. We can also focus on any planning, shopping, label reading and cooking issues you may have!

From Dr Rahul Sen…

I check your weight at your booking visit and then each month during the pregnancy.

I calculate your Body Mass Index (BMI) at booking. BMI is your weight in kg divided by your height in metres divided by your height in metres again. A normal BMI is 19-25

If your BMI is very low, your baby may not put on enough weight, so we may need to monitor the baby’s growth.

If your BMI is very high it is difficult to assess growth during pregnancy and fetal wellbeing during labour. You may need extra ultrasound scans and extra monitoring during pregnancy.

Most women gain 10-14 kg during the pregnancy. If you gain a lot more than that then there is an increase in risk of diabetes in pregnancy. It is also much harder to lose the weight after the baby is born.

If your BMI is above 25 you should aim to restrict your weight gain as per the BMI table above:

The best way to control your weight in pregnancy is a regular, balanced diet, high in complex carbohydrates, fibre and protein, and low in sugars and fats, high volumes of water, and 20-30 minutes of planned, physical exercise per day, of at least moderate intensity.

If beneficial, I shall refer you to a dietitian during pregnancy.

Pregnancy Education and Information

Diet and Exercise

I recommended that you take a pregnancy specific supplement during your pregnancy, which includes Iron and Folic Acid, such as Elevit, InNatal with iron, Eagle Brand, or Blackmore’s Pregnancy and Breastfeeding Gold. Elevit has more iron, but is larger and harder to swallow in the first trimester.

Iron deficiency is very common in pregnancy. The symptoms include tiredness and lack of energy. Iron deficiency may affect your recovery from birth and your milk supply. I shall check your iron stores at times during the pregnancy and will recommend a supplement if you are deficient. The highest dose supplement is Ferro Grad C, however it can be quite constipating, in which case Maltofer may be better, or the liquid Spatone may be a better option, although it gives you a much lower dose of iron. Do not take Iron at the same time as tea, coffee, Calcium or dairy, which inhibit iron absorption.

If you are severely iron deficient or do not tolerate or respond to oral supplements then I can arrange an iron injection, known as Ferinject. It is given intravenously, and takes about an hour. It has recently been PBS listed, so it costs only $40 with Medicare, unless you have to pay a hospital excess fee. Iron infusions can also be performed in the infusion clinic, or in some GP surgeries.

Vitamin D deficiency is common. I recommend you have 15 minutes of sunlight every day, preferably early morning or late afternoon, and you may need a Vitamin D supplement, such as Ostelin. Iodine deficiency is also surprisingly common in Australia and there are usually no symptoms. It is recommended that all women who are currently pregnant or planning a pregnancy take a supplement, containing 150mg iodine, throughout pregnancy and while breastfeeding.

I shall provide you with a booklet that gives you details about foods to choose and foods to avoid in pregnancy. And although you are eating for two during pregnancy, this does not mean twice as much! On average you should expect to gain 10-15 kg in weight during the pregnancy. In pregnancy you have increased insulin resistance, so it is preferable to choose low glycaemic index (GI) foods, and reduce your intake of saturated fats, processed foods and white sugar, white flour and white rice.

You should aim to have three meals per day, each with some lean protein, starchy carbohydrate and green vegetables. You should also have three snacks per day in between meals. All meat and seafood should be cooked through. Soft cheeses, patés, and smoked or cured meats should be avoided, unless they are then cooked, in which case they are fine. All dairy should be pasteurised. Caffeine should be restricted during pregnancy. One coffee per day, however, is reasonable.

The current recommendation on alcohol is to avoid it entirely during pregnancy. That is because heavy or frequent alcohol consumption in pregnancy has been associated with a range of problems with babies including birth defects and a risk of alcohol dependence in later life. The official advice used to be only one alcoholic drink per day, but this has been reduced to none, because we do not have good evidence on what the safe threshold is. If you are going to drink alcohol during pregnancy then my advice is to limit it to a single standard drink, no more than one or two times per week.

Cigarette smoking during pregnancy has been shown to cause a variety of problems for both you and your baby. For that reason I urge you to cut down or, preferably, quit smoking as soon as you find out that you are pregnant, even if you need to use Nicotine patches to help you through the pregnancy. You should encourage your partner not to smoke, as it is then easier for you not to smoke, and smoking in the home increases the risk of SIDS and childhood respiratory diseases, including asthma.

You should try to remain active during the pregnancy. Most exercises are fine, including brisk walking or even light running and upper body exercises. Swimming and aquarobics, in particular, are great. Core strength and breathing exercises, such as pregnancy yoga and Pilates are also excellent, as are classes that develop your breathing and stretching techniques.

You should avoid sit-ups, crunches and exercises that increase abdominal pressure or separation of the abdominal muscles. And it is important you keep your heart rate under 140-160, depending on your level of fitness, and, above all, not to over-heat. Remember the baby takes up a lot of your heart and lung reserve, so please do not to push yourself too hard in pregnancy. Please make sure that you drink plenty of water before, during and after exercise, especially in summer.

Good Bowel and Bladder Habits

Keeping Fit and Healthy

It is important to maintain your fitness with regular, gentle exercise throughout your pregnancy. Exercise programs that include walking or aqua-aerobics are ideal. Utilise the pelvic floor “bracing” technique to protect your body throughout each exercise session.

You are free to continue with your regular non-contact sports for as long as you are comfortable doing so. However, if you experience any pain or discomfort during any exercise activity, be sure to stop the activity and seek professional advice. Starting new sports or participating in vigorous exercise should be avoided while you are pregnant. Contact sports especially should be avoided, particularly after you are 13 weeks (4 months) pregnant.

Preparing Guidelines for Exercising Safely

Things to Avoid:

Seek further help if you experience any of the following:

Advice on Pregnancy Sickness

Introduction

Many women experience nausea in early pregnancy and some women experience vomiting. Although often referred to as morning sickness the feeling of queasiness can last all day.

The symptoms occur in part because of your levels of pregnancy hormone, which is why they may be stronger with twins, but can also be affected by your background mood and feelings towards your pregnancy.

In general the symptoms get worse until around 8-10 weeks then level off, and usually improve from around 12-13 weeks. Some women experience nausea symptoms throughout pregnancy and even when the nausea settles there may be days on which the nausea symptoms return.

Nausea in general is associated with good pregnancy outcomes, although some women may have nausea of pregnancy even when the pregnancy is not progressing and some women may have a normally progressing pregnancy with no nausea symptoms. That is why having a dating scan at around 8 weeks is generally a good idea.

How to Manage Nausea Symptoms:

Further information: Mothersafe: https://www.mothersafe.org.au
Royal College of O&G: https://www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg69-hyperemesis.pdf

Further Information

Swine Flu (H1N1) During Pregnancy

Travel During pregnancy

Issues:

Strategies to reduce the risk of deep vein thrombosis:

Pelvic Floor Exercises

The pelvic floor is made up of a sling of muscles and connective tissue. They stretch like a hammock from the pubic bone at the front to the tailbone at the back. The three openings (urethra, vagina and rectum) pass through the pelvic floor muscles. Strong pelvic floor muscles prevent leaking of urine, wind and faeces. They also play a part in sexual function and stability of the spine.

One in three women who have had a baby will experience some leakage of urine after the birth.  This may be prevented by strengthening the pelvic floor both before and during pregnancy, and after your baby is born.  By practising strengthening exercises regularly you can help ensure these muscles stay strong.  All women should continue doing pelvic floor strengthening exercises daily in order to prevent pelvic floor weakness in later life.

To activate and strengthen your pelvic floor muscles, position yourself by either sitting up tall or lying on your side. You should feel comfortable in whichever position you choose, with your back in a “neutral” curve and your tummy, buttocks and thighs fully relaxed. Gently draw your pelvic floor muscles up in a “squeeze and lift” action by imagining you are stopping the flow of urine. At the same time continue to breathe easily. This will close off and draw up the muscles around your front passage, vagina and back passage.

Aim to hold this contraction for up 5-10 seconds, then relax for 5 seconds. Make sure you are not squeezing your buttocks or bearing down or straining in any way. Repeat this action up to 10 times. You can further progress to performing 10 short, fast, and strong contractions

Performing this set of exercises at least four to five times daily will help you to maintain good bladder control, or help improve your control of your bladder if you find urgency or frequency is a problem. It is a good idea to “brace” with these muscles before you lift, move, cough, laugh or sneeze.

If you find you cannot activate these muscles, are holding your breathe or seem to be straining, stop performing the exercise and talk to your physiotherapist.  Regular pelvic floor exercise is important in pregnancy, but you need to make sure your technique is correct.  Additionally, it’s important to not stop the flow of urine mid stream repeatedly as an exercise, as this is not good for your bladder.

Fetal Wellbeing During pregnancy

Most of the tests and visits in pregnancy are designed to ensure that your pregnancy is progressing normally and that your baby is well. The most important form of reassurance that your baby is fine is when you are feeling good fetal movements. Most babies have spurts of movement every few hours during the day, which is very reassuring. In late pregnancy babies often squirm instead of kicking.

In the third trimester (after 28 weeks) there should be a 2-hour window every day during which you feel the baby move at least ten times. If you do not then you may need extra monitoring, and possibly even a planned delivery. I am very concerned about a reduction in the number of movements. If this occurs you should contact the Delivery Suite of your maternity hospital the same day.

The other thing I am concerned about is the development of itch in the third trimester of pregnancy, especially itch without rash or itch on the palms of the hands and/or soles of the feet. If you develop itch during late pregnancy then please contact my rooms immediately and arrange to see me as soon as possible, or after hours ring the delivery suite of the hospital at which you are booked.

Vaccinations During Pregnancy

Vaccinations are not generally recommended in pregnancy with the exception of the influenza or “flu” vaccine, which is the one vaccine that is recommended by the National Health and Medical Research Council of Australia

Each year the dominant strains of flu are incorporated into a vaccine that is given to people at risk, including pregnant women.

I strongly recommend the flu vaccine if you will be in the second or third trimester of pregnancy between May and October.

Complications During Pregnancy

My rooms are 20 minutes from the hospital, and I live nearby if I need to attend urgently after hours.

Tests During Pregnancy

Medications During Pregnancy and Lactation

While many medications can safely be taken during pregnancy and breastfeeding, it always helps to ensure that you are on the safest medication and at the correct dose. Mothersafe provides an excellent, free counselling service for women of NSW. Mothersafe also provides fact sheets on safe medications and self help for common pregnancy complaints, such as nausea, haemorrhoids, constipation, and management of cold and flu. Most cold and flu preparations are safe in pregnancy.

Mothersafe, Royal Hospital for Women: www.mothersafe.org.au 9382 6539

Ultrasound Scans

Your pregnancy is dated from the first day of your last menstrual period (LMP), which is around two weeks before actual conception. I shall confirm this with a dating scan at around 8 weeks. Early (8-10 week) ultrasound scans are generally more accurate for dating your pregnancy than later scans.

At 12-13 weeks you may wish to have a screening test for Down Syndrome (Trisomy 21) if you have not had the Harmony test, known as the Nuchal Translucency Test. This involves an ultrasound of the baby’s neck and nasal bone, The test is best performed in specialised obstetric ultrasound centres and should be performed in conjunction with a special blood test, done at 10-12 weeks. If these tests show a high likelihood of a problem I shall discuss further testing with you, including Chorionic Villus Sampling (CVS) or Amniocentesis.

I shall arrange for you to have a specialised ultrasound scan at 18-20 weeks, known as the morphology scan or fetal anomaly scan. At this scan a detailed review of your baby’s anatomy is performed, to make sure that there is no major abnormality. The majority of major malformations can be detected in this way, as well as some other problems, but please be aware that the background rate of abnormalities is around 3%, and that no single test can detect 100% of problems. It is also important to remember that while we are quite good at checking fetal anatomy, it is almost impossible to check on fetal function prior to birth.

I usually scan your baby at each of your visits, however I usually recommend an external scan at 36 weeks to recheck the baby’s anatomy and to check on the baby’s growth and placental function. I may also discuss further growth scans in the last trimester of pregnancy if I am concerned about the growth or wellbeing of your baby, or if you have high blood pressure or diabetes. If the placenta is low-lying at your 19 weeks scan then this will be rechecked with a further ultrasound at 32-36 weeks.

3D scans can provide great views of the baby’s face. The best time to perform a 3D scan is at 30-33 weeks. This is a fun scan and is not medically necessary. I have organised for an experienced sonographer, Lily, to perform 3D scans at around 29-30 weeks in my Edgecliff rooms. Please book in for this scan at your 24-28 week consultation.

Planning for Birth

Birth plans can be a great way of making sure your key wishes and expectations for childbirth are met. The key thing about a birth plan is to keep it simple. Remember most things are determined by the baby so try to adopt a flexible and ‘go with the flow’ approach. I suggest watching this video and then read the specific information below…

Dr Rahul Sen ~ Your Birth Plan. Creating a birth plan towards the end of your pregnancy is a vital step. In this video Dr Sen talks about how he will meet with you to discuss all the birth details including, the Vitamin K injection for your baby after birth and even your cord blood banking options. Having a plan can increase your confidence during this very important and special time for your family.

Birth Education

If this is your first pregnancy I strongly recommend that you and your partner attend childbirth education. There are many options available, but most are very popular so please book well in advance. Classes include sessions on health education, birth preparation and parenting, and most include a tour of delivery suite. Many classes attract a health fund rebate, depending on your fund.

At Prince of Wales Private please email: POWPrivate.Prenatal@healthscope.com.au for details of antenatal classes. You should book at around 18 weeks, although the classes are at 32-36 weeks.
The antenatal and postnatal classes at the Royal Hospital for Women are available to women who are booked at the RHW. Classes are held one night per week for seven weeks or on two consecutive Saturdays from 9.00 am to 3.30 pm.

RHW also offers 4-hour Birth Intensive and Baby Intensive courses at weekends, as well as Calmbirth classes, and also Twin Birth classes, if you are expecting twins. To book visit the RHW website at https://www.seslhd.health.nsw.gov.au/RHW/Health_Education/ and book online. Please book early.

If you are anxious about birth or interested in a natural, drug-free approach to childbirth you may wish to consider Calmbirth, or Hypnobirth. These courses aim to reduce the fear and anxiety associated with labour, which can cause physical tension and reduce the effectiveness of labour contractions. They are very helpful for most women, but they do not suit everyone, and birth experiences can be quite different. They tend to have a rather strong emphasis on pre-formulated birth plans.

Birth Preparation Classes

Carolyn Love, Prince of Wales Private Hospital: POWMaternity@healthscope.com.au

Health Education Centre, RHW: https://www.seslhd.health.nsw.gov.au/RHW/Health_Education/

Calmbirth, RHW: https://www.trybooking.com/195086

Lynne Hall, Better Beginnings Birth Education Classes (02) 9664 4315
and Lactation Consultant www.betterbeginnings.com.au 0419 245 966.

Michelle Eveleigh. Midwife Antenatal Classes and Aquanatal Teacher 0451 957 713.

Jane Simons, Physiotherapy Exercise Classes (02) 9327 4294.

Calmbirth, Karen Mclay, Bowral www.calmbirth.com.au (02) 4871 1806.

Shebirths, Nadine Richardson – shebirths.com.au (02) 8060 2212.

Transition into parenthood/calmbirth, www.Julieclarke.com.au or www.bluemountainscalmbirth.com.au

Parenting for Life, RHW: https://www.trybooking.com/195174

For Dads:
Beer and Bubs – 1 night session, www.beerandbubs.com.au (02) 9440 9999

The Baby Shed – a hands on workshop for new Dads. Contact familysupport@senc.org.au or www.facebook.com/thebabyshed

Dadvice – www.Dadvice.org

Midwife Support:

Michele Simpson (or Chantelle du Boisee). Tel 0417 821 438
Email: michele@rahulsen.com.au

Please contact Michele if you need any advice during your pregnancy or help in the postnatal period eg: postnatal recovery, breastfeeding or settling advice, or for any difficulties you may be experiencing as new parents. Michele will make one visit to your home to provide practical advice, help and reassurance after you have had your baby.

You can communicate with Michele by phone, text, or email, preferably between the hours of 8am and 9pm most days. Please note that Michele has a busy hospital schedule, and also has a family, so reason she may not be contactable on some days, overnight or some weekends. The cost of the care and advice that Michele provides, including one home visit, is incorporated in your planning and management of pregnancy fee.

Michele is not able to provide an emergency service. In an emergency please contact the Delivery Suite of your hospital.

Preparation for Birth

As we approach your due date I like to have a longer discussion with you and your partner, to discuss your birth plan. You do not need to have a written document, it is good to be informed, and to have an idea of how you would like the birth to go, but it is essential to be flexible, as babies do not always behave as you expect or want them to, both during the birth and afterwards.

My aim is to help you achieve the birth experience you would like. If you are wanting a natural birth then being in the best physical and mental shape you can be for labour is important. Courses like Calm Birth can be very helpful in reducing anxiety, reducing physical tension, and giving you the confidence to try and trust in yourself and to trust your body.

It is important to remember what the ultimate goal is i.e. healthy mother and healthy baby. If it takes an epidural or forceps or caesarean section to achieve that then you should not feel disappointed that your original birth plan did not come about. As much as I want you to stay confident and positive it is important to consider some of the variations that happen in labour, as they are common.

The first is epidural. Four out of five women who have private obstetric care choose to have an epidural. Your likelihood of asking for an epidural is reduced if you are highly motivated, or if you have a single support person with you throughout labour, and if you have attended a Calm Birth course or similar. It is increased if labour is induced

If you are keen to avoid an epidural, and you are coping well with labour then there is absolutely no reason to have one. You get a natural high from the adrenalin and endorphins after birth, you can quite rightly feel a strong sense of accomplishment after successful vaginal birth, particularly if you have done it drug free.

On the other hand there is no shame in having an epidural, many women know in advance that they want one. An epidural may well be of help if your labour is progressing slowly, and this commonly occurs if the baby is in a posterior position, i.e. head down but gazing up to the sky.
I will generally recommend an epidural if I need to do a forceps delivery, and sometimes if I need to do a vacuum or ventouse delivery.

Episiotomy:

Episiotomy is a cut with the scissors, usually from the lowest part, or “V” of the vagina, angled to the right. Many years ago an episiotomy used to be standard for all births. I do not perform episiotomy routinely, but sometimes they are necessary. I perform them always with forceps, sometimes with vacuum, and sometimes for other vaginal birth, especially when the perineum starts to tear early, or becomes very swollen, in which case it loses its natural stretch. If you do not have an epidural I will inject local anaesthetic into the perineum before doing an episiotomy where possible.

Ventouse:

A ventouse or vacuum delivery is required if we need to speed up delivery, either because you have been pushing for a long time, or baby is becoming distressed, or if baby is stuck in an awkward position. To do a vacuum delivery you need to have adequate pain relief, the cervix needs to be fully dilated, you need to be able to move the baby’s head and with pushing and there needs to be enough space in the pelvis, all of which I assess on vaginal examination, sometimes with the assistance of ultrasound.

It is important for you to know that successful delivery with a vacuum is not always guaranteed.
If I think there is a low likelihood of delivery then I might recommend forceps delivery, a caesarean section, or a trial of vacuum delivery in the Operating Theatres, with the option of proceeding to caesarean section if we are not successful. When the vacuum is applied there is a maximum amount of time when the vacuum can safely stay on for, and there needs to be some degree of success with each pull, whether it is rotation or decent of the head.

If the head does not move at all with the vacuum then I will generally need to do a caesarean section, if there is some descent with each pull then I will generally do up to three pulls, and a maximum of four, and then stop unless the head is by now partly out.

It is generally safer for your baby if I use just one instrument, so if I do not think that vacuum is likely to be successful I will recommend forceps. This is likely to be the case if the head is not very low in the pelvis, if there is a lot of swelling on the back of the baby’s head, so the suction cap is likely to fall off, or if the baby’s head does not move with pushing. If I do not think either can be tried safely I will recommend caesarean section.

Following ventouse delivery your baby will have a small round “bun” on the back of their head, in addition to the swelling that occurs naturally from being upside down in the pelvis. This usually settles within a few days. There is often a dark purple disc which can persist for around a week. Sometimes there is soft swelling under the scalp, which generally settles down after a few days. Occasionally this causes the baby some irritation, and your Paediatrician may prescribe baby Panadol.

Severe complications as a result of ventouse are rare, especially if we limit the number of pulls and the amount of pressure applied.

If your baby becomes stuck in labour or distressed before the cervix is fully dilated I will need to perform a caesarean section.

Forceps:

You require good pain relief for forceps delivery. Generally this means epidural. Sometimes I can perform what is known as a pudendal block, which is local anaesthetic injected inside the vagina. This is usually very effective.

I routinely perform episiotomy with forceps. This is to reduce the chance of a tear in the midline extending down into the sphincter muscle. The importance of such a tear, known as a third or fourth degree tear, is that if it occurs it can leave you with a greater chance of having little control over wind, liquids, and sometimes even solids from your bowel. Needless to say this is personally distressing and socially awkward, but fortunately it is rare. Even when it does occur it often improves and sometimes resolves completely with time.

Bladder function is often worse after birth. Many women report loss of bladder sensation, and loss of bladder control after birth, even after caesarean birth. The chance of reduced bladder control is greater if you have had long labour, big baby, ventouse delivery, and especially, forceps delivery.

Perineal Repair:

If you have a cut or a tear then I will suture or stitch the perineum with a dissolving stitch. This is usually a suture material known as Vicryl. In the deep layers the Vicryl is slowly dissolving, and takes two to three months to dissolve. In the skin layer the Vicryl dissolves after two or three weeks.

Because of the proximity of the perineum to the anus, and the multiple bacteria that live in the area it is very easy for the perineum to become infected. For that reason I wash the perineum extensively, before, after and during the repair, and I advise you to keep the perineum as clean and dry as you can after the birth

At the first sign of infection it is important to start antibiotics to prevent breakdown of the perineal repair. Early signs of infection are worsening pain, increasing tenderness, an unusual smell, and increasing redness of the perineum. Starting antibiotics promptly will generally prevent the perineum from becoming truly infected and the wound breaking down. If it does break down it will still heal, but healing will take longer.

The two issues I would like you to consider are issues after the baby is born. In a sense the birth is the easy bit if all goes well you push the baby out. If necessary I will do a vacuum or forceps delivery. If the baby gets distressed or baby gets stuck then I shall do a caesarean. Then the fun begins.

For most first time mums feeding and settling is a challenge. Most babies do not naturally attach to the breast. They often attach to the nipple and if that is not corrected then they will cause nipple damage which can be very painful, and take a while to heal. It is important, therefore, for both you and the baby to learn good technique from the outset.

Please take advantage of the expertise and support offered by the midwives on the ward. If necessary you can be referred to a Lactation Consultant. There are daily drop in classes, lactation consultant sessions and one on one sessions during the week, and sometimes even at weekends, depending which hospital you are booked at.

Your milk generally comes in on day three or day four. When it comes in you are often very tearful. Most babies lose between 5 and 10% of their birth weight in the first few days. If your baby loses much more than 10%, then you may need to supplement the breast milk with some formula, especially if your baby is jaundiced, or low birth weight to start with. This is something that you will be given advice on by your Paediatrician, in conjunction with the Midwife or Lactation Consultant.

Sleep:

By far the most difficult challenge facing new mums is coping with sleep deprivation. Before the birth please take some time to consider how you personally will cope with sleep deprivation. Most new mums are not prepared for just how difficult it can be to adjust to having a newborn, who, while delightful and engaging in every other way, wants to stay awake all night, and feed, cry, or play, or all of the above.

Most babies sleep in patches during the day so please take advantage of every opportunity during daylight hours when your baby goes down to have a rest as well. If partners or family are around then they can often take the baby for walks during the day while you rest.

I recommend you limit visitors to family and close friends. Visitors are well meaning, but often draining at a time when you need all your energy and resources. Take advantage of every offer of help from practical things such as shopping, cooking and cleaning, and offload peripheral responsibilities.

The good news is that there is light at the end of the tunnel. For a while you may feel like there is a heavy fog hanging over you preventing you from functioning normally and making rational decisions. Over time you become accustomed to broken sleep, and learn to take advantage of the sleep opportunities you have.

Above all else I think it is important not to torture yourself trying to do things perfectly. Most first time mums especially want to do everything perfectly, and if it works then that is fantastic, but please have a plan B. Sometimes you will need to give your baby formula top ups and that is no crime. Sometimes it is necessary to preserve your sanity, and your baby will still love you just the same.

I look forward to finishing this journey, and remember it will all be worthwhile when you are holding the little one in your arms.

Preparing for Labour

Birth in most cases occurs between 37 and 41 weeks of pregnancy.

Here are a few suggestions to prepare your mind and body for labour from Michele Simpson:

Mind Preparation

Connecting your mind with your baby may help both the baby and your body to release the hormones that will initiate labour. Talking to your baby, being aware of baby’s movements and imagining what life with your baby will be like as you go through your day to day activities eg: shopping, driving, may help you to connect and prepare you better for the reality of being a mum. Yoga, relaxation, hypnobirthing sessions, meditation, visualization and prenatal classes may also help.

Body Preparation

Helping your baby to adopt a head-down, anterior (back facing the front) position will optimize your chances of having a normal labour and birth. Leaning forward over the kitchen bench and rocking your pelvis for a few minutes several times each day in the last few weeks of pregnancy may help. Avoid leaning back in lounge chairs, instead adopting a leaning forward position when sitting may also help. Remember not to sleep on your back as it may decrease the blood flow that you and your baby receive. It is best to lie on either side to sleep, and not flat on your back.

Acupuncture

It is recommended to start acupuncture for birth preparation from week 37. Acupuncture at this time is designed to help you achieve the best balance possible – improving energy levels, finding a sense of calm, whilst working to optimise positioning of baby, ripen the cervix. We help get your body and mind as ready as possible for this incredible life transition. Enquire at reception for appointments with Naomi Abeshouse from the Red Tent Health Centre in Edgecliff and Bondi Junction.

Perineal Massage

Perineal massage has been used in different countries and cultures throughout much of human history. It is a method of preparing the outlet of the birth passage, particularly the perineum, for the stretching and pressure sensations during the birth of your baby.

The aim is to avoid trauma to that area – either a tear or an episiotomy (a cut made in the perineum to enlarge the outlet). It has been shown that women experiencing their first vaginal birth, who practise perineal massage from 34 weeks onwards, have a lower risk of serious tearing or episiotomy.

Massage can be done internally or externally before your baby is born by you or your partner depending on how comfortable you both are with the procedure. To aid relaxation prior to the massage, a warm bath or warm small towels placed on the perineum before starting the massage can help to relax the area. A low-irritant oil or cream e.g. vitamin E, or olive oil can be used as a lubricant if desired. Perineal massage can be performed from 34 weeks onward, just 3 times per week for about 5-8 minutes per day. You will notice that the stretchiness and flexibility of your perineum will increase.

First wash your hands, then obtain a mirror and prop yourself up with pillows. Look at your perineum with the aid of the mirror and become familiar with the whole area involved.

If you use a lubricant, put it on your thumbs and place your thumbs three to four centimetres inside your vagina and press the inside of the perineum toward the rectum and to the sides. You will feel a slight tingling or burning as you gently press down and stretch the opening.

Maintain this stretching and pressure for about one minute. The area will become a little numb. Work the lubricant in, slowly and gently, maintaining the pressure and pulling the perineum forward a little; this is what your baby’s head will do as it is being born. The massage can be in one direction at a time i.e. from side to side, or the fingers can be swept in the opposite direction. Try different ways until you find which is more comfortable for you. This massage should not be painful.

If your partner does this massage, the perineum and sides are pressed by using his two index fingers. He massages with his index fingers inside and his thumbs outside. This is a very intimate and private area and sensitivity within the relationship with your partner is essential.

Perineal massage will make you more aware of this area and will assist you to relax and open up for your baby’s birth. During the bearing down stage of labour it is common to tense and try to hold back. Women who have consistently done perineal massage do not report the extremes of stinging and burning that often accompany the birth of the baby’s head. It is hoped that because the stinging and uncomfortable burning sensations are reduced, you will be able to relax more and allow your baby’s head to slip over an intact perineum. Be prepared to have a slow, controlled birthing of your baby’s head. Pant/blow to overcome pushing sensations as the head emerges.

Pelvic floor exercises should be practised daily throughout pregnancy. This practice will help you to be able to consciously relax the muscles of the pelvic floor, which is exactly what you will do to assist in the birth of your baby. Pelvic floor exercises after birth will help you to re-tone your stretched muscles and tissues.

Epi-No

The Epi-No device is a device for perineal stretching. It is a relatively new invention (15 years) and the evidence supporting its use is still somewhat conflicting. It may, however, reduce the likelihood of having a major perineal tear. It costs around $280, and can be purchased from the hospital Foyer Pharmacy, and can be used as an alternative or in addition to perineal massage.

Ripening of the Cervix

(things to do if you are 37 weeks or more)

Nipple Stimulation:

Oxytocin, a hormone that initiates labour, is released when nipples are stimulated and breasts are expressed. Roll one nipple at a time between finger and thumb alternating positions of fingers as breasts may be tender. You may want to express your breasts (squeeze breasts in a pumping action for 10 minutes at a time as often as you like at least 3 times per day (ask us to show you how). You may notice some colostrum (milk) coming out. In many cases, expressing at the end of pregnancy can increase the amount of breast milk you will have for your baby (only to be done after 36 weeks).

Membrane sweeping & stretching:

This should only be done by a midwife or doctor and involves a vaginal examination, stretching of the cervix, and separation of the membranes from the cervix. It is generally very safe, when there are no complications. Often the procedure can cause discomfort and bleeding (a “show”) and sometimes, irregular contractions. It may however help you to go into spontaneous labour earlier than otherwise.

Acupuncture:

Regular acupuncture sessions have been shown to decrease stress and increase energy levels, helping you to cope with the final weeks of pregnancy and labour. Some studies suggest it may assist with the initiation of labour, although the evidence is not strong, just like with eating dates.

Acupressure:

(Only to be used after 37 weeks to help initiate labour)

Stimulating points on the feet and hands can stimulate other parts of your body ie: uterus and help labour hormones to be released. Locate the points illustrated in the pictures below, ie SP6 is 4 fingers up from the top of the ankle bone. The points may be tender when you press them. Press firmly with your thumb for about 5 minutes each 1-2 hours. It’s normal that your baby may move during acupressure. Feeling hot, flushed, teary or experiencing a contraction during the point stimulation is also normal, and will show that the treatment is effective.

Intercourse:

Semen contains prostaglandins, which are hormone-like substances that help soften the cervix, so it may start to dilate. The cervix responds to intercourse only at the end of your pregnancy, and it is generally safe to have sex throughout your pregnancy, unless you have been advised not to. It is common for many women to find it uncomfortable toward the end of pregnancy, so trying the above alternatives instead may be just as beneficial in terms of preparing for labour.

When to Contact the Hospital

It is very important that you ring the Delivery Suite before leaving home. The Midwife will ask you some questions about your labour and answer any questions you may have.

Contact Numbers:

Women expecting their first baby

Women who have given birth before

Other reasons to call the hospital at any time during your pregnancy:

Baby Emergencies:

You may wish to learn Baby and Child CPR and First Aid with a 6 hour course:
Website: www.cprkids.com.au or email: hello@cprkids.com.au or Tel: 1300 543 727
Sydney Children’s Hospital also provides excellent emergency care for babies.
Emergency First Aid for Baby: www.littlelives.com.au

What to Bring to Hospital

Below is a list of suggestions of what to bring to hospital for the birth of your baby. NOTE: Further down the page we also include a suggested list of items for your newborn at home. We hope this helps you.

For the car – put this in the car after 24 weeks:

For Labour and Birth:

For partners or support people:

For your post-natal stay:

For baby:

Please remember to bring your antenatal card

Parking reminder: when you come in to either hospital to have your baby please remember to buy a 5 day car park pass, as this can reduce your parking costs significantly.

Birth Photography – Shirin Town:

If you are looking for a great photographer with a special interest in birth, I recommend Shirin Town. Email: shirin@shirintown.com Telephone: 0404 063 441

Baby Emergencies:

Sydney Children’s Hospital also provides excellent emergency care for babies.
Emergency First Aid for Baby: www.littlelives.com.au

Suggested List of Items for your Newborn:

Items must comply with Australian Safety Standards. For further information ring Standards Australia 1300 308 989 or visit their website www.standards.org.au

Important: Warning about Cytomegalovirus (CMV)

The Birth

Dr Rahul Sen ~ Being at the Birth. Dr Rahul Sen explains how committed he is to being at the birth of your baby – from travelling by ferry in the moonlight to driving from the Blue Mountains in the middle of the night to reach the birth on time. Dr Sen also highlights the specialist team of obstetricians he works with who are on-call for you when Dr Sen can’t be.

Timing of Birth

It is generally better for you (and your baby) if your labour starts spontaneously, however if this does not occur then I would normally plan to induce your labour up to 10 days after your due date. The reason for inducing labour, and for most interventions regarding timing of birth, is to minimise the risk of stillbirth. Reassuringly the risk of this is extremely low.

Women with complications in pregnancy, such as high blood pressure or diabetes, may need to be induced earlier. The main disadvantage of inducing labour is that it can make your labour more intense. If we are planning delivery by elective caesarean section I will generally perform this between 39 and 40 weeks, as this time has been shown to be safest for your baby.

Labour

Labour can start gradually or all at once. You may experience some “practice” contractions before true labour starts. Contractions become more frequent and more intense as labour establishes.

You will often make better progress in labour in your home environment, however if you need pain relief or feel you may be progressing rapidly then you should ring the Delivery Suite and come into hospital. When you are having regular, painful contractions that are five minutes apart, or your waters have broken, it is time to contact the Delivery Suite at your booked hospital.

It’s important to ring the Delivery Suite at your hospital before you leave and please remember to bring your antenatal card. If you are unsure whether you should go to the hospital please ring the Delivery Suite and one of our midwives will give you advice over the phone.

On arrival at the Delivery Suite a midwife will assess you and your baby and then notify me of your admission and progress. During your labour you and your baby will be assessed regularly. Provided the labour is progressing normally you may not see me until close to the delivery time, however I shall be in close telephone contact with the midwife looking after you, and readily available should I be needed.

If you are having a planned caesarean section and you start to go into labour or your waters break before the planned date, please notify the Delivery Suite immediately. There is no need to panic, but you will need to come into hospital immediately for assessment. Please do not have anything to eat or drink, in case your caesarean needs to be performed urgently.

Pain Relief

Not all women want or need pain relief in labour. During labour your body naturally produces Adrenaline and natural forms of Morphine, which allow you to cope with labour pains. Also many women find it very comforting in labour to be under the shower, or immersed in a bath of warm water. Other things that can help are massage, a TENS machine and nitrous oxide gas.

If you do want stronger pain relief then there is a range of options available to you, including injections of Morphine or an epidural anaesthetic. If you want or need an epidural you can have one, and it does not need to be booked in advance, unless you want a specific anaesthetist. There is a consultant anaesthetist on call 24 hours a day in both hospitals. Both hospitals have recently started a patient controlled epidural service, which provides good pain relief with some degree of mobility.

Perineum and Pelvic Floor

The perineum is the area between the anus and the vagina. The pelvic floor is a sling of tissue, mainly muscle, that supports and controls your bladder and bowel function, and through which your baby passes when coming through the birth canal. I usually perform an assessment of your perineum at your first visit and teach you how to perform a pelvic floor squeeze correctly. Once you have learned how to do a pelvic squeeze correctly I recommend that you practise regularly during the pregnancy and post-natally, to reduce the risk of bladder leakage and prolapse in later life.

At the birth one of my priorities is to protect your perineum from avoidable tearing. I do not routinely do an episiotomy (cut with scissors), and a small tear is generally better than a cut, however major tears can leave you with lasting pain and problems with lack of bowel control, so there are times when an episiotomy is better. That is particularly the case when forceps or vacuum is required for delivery. You can reduce the risk of tearing by doing perineal massage or by the use of the Epi-No device.

Cutting the Cord

I usually encourage your partner to cut the cord after I have clamped it. Traditionally the cord is clamped and cut immediately after the birth, however there is now a trend towards delayed clamping. Delayed clamping allows more cord blood to flow to the baby and is thought to be beneficial for pre-term babies (under 37 weeks).

For babies 37 weeks and older the benefit is less clear – it does give them a higher blood count, but it also gives them higher rates of jaundice, requiring phototherapy, and may result in the baby being separated from you for admission to the special care nursery for treatment.

I usually compromise and cut the cord at around 1-3 minutes. This still gives the baby a little extra cord blood, does not appear to be associated with higher levels of jaundice, and still allows me to collect the cord blood, either for donation or for private storage.