Vitamin K is a vitamin that naturally occurs in our bodies, which helps to clot the blood. After a baby is born it takes a few months for their liver to make enough Vitamin K to ensure their blood can clot properly. By giving your baby Vitamin K it makes sure they will have enough to clot their blood and can prevent a rare disorder, known as, haemorrhagic disease of the newborn (HDN). HDN can cause bleeding into the brain and could result in brain damage or, in extreme cases, even death.
Vitamin K can be given to your baby by injection or orally. Only one injection is required, however, oral dosage is more complicated. To give your baby Vitamin K orally you will need to make sure your baby has one dose at birth, one dose between three and five days after birth and another one in their fourth week of life. There are a few reasons babies may not be able to have Vitamin K orally, including if they are ill, if they are born prematurely or if you have had medication during your pregnancy for epilepsy, blood clots or tuberculosis.
One Vitamin K injection is enough to last your baby for months. They will only need one injection or one course of oral treatment. Vitamin K has been used in Australia for more than 25 years without any apparent side effects and has eradicated HDN. There was one study that suggested there could be a link between Vitamin K and childhood cancer, but this study has since been discredited.
It is your choice whether or not your baby is given Vitamin K. However, medical experts in Australia agree that babies should be given Vitamin K to prevent the very serious disease of HDN. Your baby will be given a Vitamin K within an hour or two after birth. If you would prefer your baby to have Vitamin K orally, please speak to me, and let your midwife know at the birth.
Your breasts will grow throughout the pregnancy but mostly in the first 26 weeks and in the last few weeks of your pregnancy. It’s normal for your breasts to increase by at least a cup size so it is important to wear a comfortable (non maternity) bra at this time, sports bras may be an appropriate choice.
Underwire bras are not recommended as they can sometimes make your breasts feel uncomfortable and affect the way the milk ducts form. It’s a good idea to get a proper feeding bra fitted professionally around 36 weeks, The bras are generally bigger than normal allowing room for breast growth which will occur after your baby’s birth. Having a few inexpensive breastfeeding crop tops or singlets on hand may get you through the first few weeks after baby’s birth.
Many women have an oversupply of breastmilk that may last up to 6 weeks. Your breasts will then decrease in size yet still containing enough milk for your baby. Your breasts should generally remain that size for the duration of your breastfeeding time. 6-8 weeks postnatally may also be a good time to have a bra professionally fitted, particularly if you are getting upper back or neck pain.
There is increasing evidence that the use of probiotics may help both you and the baby. Benefits for you include reduced risk of mastitis and improved bowel health, especially if you need antibiotics There may also benefits for your baby, especially if he or she is born early or if you need antibiotics.
The most promising probiotics for pregnant and breastfeeding women appear to be either Qiara or VSL. Qiara is available from selected pharmacies. VSL is only available online at this stage.
I shall visit you regularly in hospital after the birth until you go home. On average you stay 3-4 nights following a vaginal birth and 4-5 nights following a caesarean section.
I want to ensure you have adequate pain relief during your recovery. Usually I prescribe pain medication to be brought to you by midwives on request, but I want to make sure your individual needs are met. I also want you to be able to move about freely, even if that means extra pain medication. If you have had a caesarean section you will have a Prolene (non-dissolving) suture, tied in a loop in front of the scar, that must to be removed by the midwife before you go home.
It is normal to experience swelling of the feet after the birth, even if there was none during the pregnancy. This will settle on its own, usually within one week. Your bowels will usually not open for 2-3 days after the birth. Drinking plenty of water and eating fibre, such as pears and prunes, will help. You may need Normacol granules to help prevent you from needing to strain at stool.
If you are booked at the Royal Hospital for Women you have the option of early discharge on the Midwifery Support Programme (MSP). Under this programme if you leave the hospital within 48 hours of a vaginal birth or within 72 hours of a caesarean birth the hospital post-natal midwife team will follow you up with visits to your home. If you live out of the area then a cross-referral needs to be made to your local maternity MSP midwifery team.
If you are booked at Prince of Wales Private Hospital you have the option of staying at the Crowne Plaza in Coogee, as part of the Little Luxuries programme. Under this programme you spend half your post-natal stay in the hospital and the other half at the Crowne Plaza. There is a midwife stationed there 24 hours a day, to give you help and support if you need it, with parenting and feeding. There is no night nursery at the Crowne Plaza and the doctors generally do not do rounds there, but it is an excellent transition to home if you and your baby are well, and largely self-caring. It is essential to ensure that any feeding issues are resolved before going to the Crowne Plaza.
Please note NIB does not allow you to go to the Crowne Plaza. You can ring another fund, such as BUPA, and change your cover with no waiting period. In most cases you can do this even after you have had the baby, and still go to the Crowne Plaza.
You will have a final check-up in my rooms at 6-8 weeks after the birth. At this visit I check that everything is back to normal, and that any stitches have healed properly. I will also do a Pap smear if it is due, and discuss your contraceptive needs. Please call to make an appointment for your 6-8 week check after you are discharged from hospital.
The hospital does not accept any responsibility for the loss of valuables, credit cards or money whilst in the hospital. It is better not to bring these with you. Please ensure that you have someone available to take you home from hospital.
Time of discharge is generally around 10 am for both hospitals.
Many women experience lower back and hip pain during pregnancy. In addition to physiotherapy, you may well benefit from additional support wear. If you have private health insurance your health fund may provide a rebate for some of the costs of special support wear. Chiropractic, osteopathy or massage may also help. The following sites provide to supportive clothing that may be of help:
SRC recovery shorts: https://www.recoveryshorts.com/
Wraps and support belts: https://www.duesoon.com.au/
These may best be fitted after consultation with a physio, chiro or osteopath. You may be eligible for a health fund rebate.
If you are experiencing great difficulty in finding a position in which you can sleep comfortably, you may like to look into the Belly Bed – Tel: 1300 961 110 or www.thebellybed.com.au
Breastfeeding gives your child the very best start in life, but it is not always easy, especially when you are doing it for the first time. It is often the case that breast-feeding represents a greater challenge to new mothers than the birth itself. Attachment and settling are the main problems. The midwives looking after you will help you with attachment and feeding. You often receive quite contradictory advice on techniques and strategy. That simply reflects the fact that there are many different ways of doing things. My advice is to try everything and see what works for you.
Remember that Lansinoh and nipple shields can be a lifesaver for some women. I can prescribe Motilium for you if your milk supply needs to be increased. Some women experience vasospasm of the nipple when feeding, which can be very painful. Nifedipine and complementary therapies can be very effective treatments.
If you are breast feeding for the second time you may well experience intense cramping “after pains” with feeding that you did not have the first time. These will usually settle after about one week. Taking pain relief tablets, such as Panadol and Voltaren, just before feeds, can be of real help for the first few days
I am also mindful that not all mothers are able to or want to breast feed, so if you have had a bad experience with feeding previously or you do not want to breast feed then please let me know. I can prescribe Dostinex to suppress your milk supply if necessary.
My midwife, Michele, will contact you after your return home. She will usually arrange to visit you at home. Please do not hesitate to contact Michele by email, phone, or text message if you need her help. Michele provides an exceptional service, that has been of tremendous benefit to many women, especially those who have experienced difficulty with feeding or settling. Please remember that Michele can only provide a single home visit, and is not contactable on some days, and cannot provide an emergency service.
In addition to the support from Michele you may need assistance from a lactation consultant or mothercraft nurse. There are drop-in classes available at the hospital, but for extra support at home I recommend the following:
Breastfeeding and breastmilk is very important. It benefits the health and well-being of mothers and babies, their families, society and the environment. Not breastfeeding increases the risk of a number of illnesses and health conditions. Breastmilk alone is perfectly suited for babies for the first six months after which appropriate family foods are introduced. Breastmilk continues to be the main food for the first twelve months. Cow’s milk is suitable from twelve months of age. Mothers will slowly stop breastfeeding when they are ready, many continue well into baby’s second year.
Reference: www.seslhd.nsw.gov.au
You will be given the phone number of your local Early Childhood Centre and advised to call and make an appointment for a visit for your child with the family health nurse. Generally first visits are either done in your home or at the centre a few weeks after your baby’s birth. There is often a long wait, so please ring to book your visit as soon as possible after the birth.
After that all visits are in the early childhood centre. The nurse will be able to advise you regarding all aspects of care of your baby. They will also provide comprehensive assessments of your child’s growth and development and offer support to parents who are experiencing difficulties with parenting. The nurse will encourage you to attend the centre regularly, so you can access the information sessions and the parents groups (mothers groups).
Remember to take your baby’s blue book, so that your baby’s weight and progress can be recorded.
Learning how to self-settle and go to sleep is a skill babies usually gain during the first year of life.
Like most skills, it takes time and occurs at an individual rate. In the early months of life a baby has a need to be physically connected to their parents. They are in a normal state of adjustment where erratic feeding and sleeping patterns, periods of crying and unsettled behaviour are common. During this period there is a gradual development of a routine as babies adapt to their environment and develop their own rhythms.
Tired signs are the individual signals your baby gives to let you know they are getting tired and need to sleep. These may include: facial grimacing, yawning, grizzling, frowning, sucking, staring, minimal movement or activity, turning head away, jerky movements or becoming more active, clenching fists, rubbing eyes, squirming crying/ fussiness
Responding quickly to your baby’s tired signs can stop your baby becoming overtired and distressed. This quick response helps your baby learn to self settle and prevents your baby getting into a state of distress that requires lots of effort to calm.
All babies are different which means that some babies will sleep more and some will sleep less. Most newborns 0-6 weeks will become tired after 1 hour of up time they should ideally sleep for 1½ -3 hours.
By the end of the first month the infant sleeps approximately 13-14 hours per day spread across day and night. As your baby matures the sleep requirement of 13-14 hours remains much the same with the length of time your baby sleeps at night increasing. During the day your baby will have longer wake times and up to 2-3 day sleeps. If your baby wakes up happy your baby probably has had enough sleep.
Babies are not born with a day/night rhythm. It takes time to develop their 24 hour internal clock that controls the sleep-wake cycle. The sleep-wake cycle, is the time spent going through both deep (quiet) and light (active) stages of sleep. From birth a sleep cycle is about 40 – 60 minutes with 20 – 30 minutes deep sleep within the cycle. The periods of deep sleep in each cycle, and the time to move to deep sleep, increases with age. Between each sleep –wake cycle, babies rouse/wake briefly then resettle to sleep – sometimes you may need to help your baby to resettle, this need for assistance should decrease as your baby becomes older.
ROUTINES are generally structured around three main activities: feed, play and sleep. These are regular events that occur throughout the day.
After a feed and /or play (depending on day or night) you may use a range of activities that signal to your baby that bedtime is approaching, helping your baby move to a calm state in preparation for sleep. These activities may include a quiet story, a particular song, cuddles, certain verbal phrases, bath-time and a goodnight kiss.
Most babies will take time to settle and consistency with your choice of options is important in helping your baby establish good sleep habits. Remember babies may protest as they learn a new way of settling.
Hold your baby in your arms until they fall asleep. You can use gentle rhythmic patting, rocking, stroking, talking, or softly singing prior to putting your baby into the cot. If your baby wakes after a sleep cycle you may need to resettle (as above) to ensure adequate sleep.
When you see your baby’s tired signs (cues), prepare your baby for sleep
The length of time it takes to calm your baby will lesson as your baby learns to self settle.
Comfort settling provides your baby with reassurance and support while also providing an opportunity for your baby to discover their own way of going to sleep.
Use the first 5 steps above (Hands on Settling)
As your baby calms, move away from the cot or leave the room
You may prefer this option if your baby is over 6 months of age and has not been separated from you at sleep time.
Crying is part of normal behaviour (your baby’s way of communicating) and can be due to:
Your baby may have unsettled periods where they are fussing and crying for no apparent reason. If your baby is otherwise well you can consider other options. For example: offer a ‘top up’ breastfeed within 30 minutes of the last feed (babies up to 3 months); cuddle; rhythmical movement, walk using pram, sling; play some music; offer dummy; offer cooled boiled water (babies over 6 months) baby massage; or deep relaxation bath.
If your baby still finds it hard to settle a wrap may help. It is thought a wrap lessens baby’s involuntary movements giving a sense of security and promoting a state of calm. Use a light material [usually cotton] ensuring arms are above waist level and hip movement is not restricted. It is important to choose options that are safe and suit you and your baby. If your baby does not calm [during the day] after an attempt to settle and becomes too distressed, get your baby up and continue your daily routine. If your baby remains unsettled ask for help from family, friends, the Child and Family Health Nurse or local doctor.
For safety ensure the cot sides are completely raised whenever the baby is left unattended in it
There are three main ways to reduce the risk of SIDS:
More information on how to reduce the risk of SIDS and sleeping your baby safely can be obtained from the SIDS and Kids website or by contacting SIDS and Kids by telephone on 1300 308 307.
© Tresillian 2000–2013
If you have a son and would like him to be circumcised then this can easily be arranged. It is now no longer done immediately after birth, but can be done soon after discharge from hospital. Circumcision was very popular, then largely went out of fashion, but it is becoming more popular again, although most Australian boys are not circumcised. From a medical perspective the risks and benefits of circumcision are evenly balanced in Australia, although in countries with very high rates of HIV circumcision appears to reduce HIV transmission to males.
The main benefit for performing circumcision, therefore, is for religious or cultural reasons. Most little boys would like to look and be like their dads and brothers, but on the other hand they may feel self-conscious if they look different from other boys at school. This remains a highly controversial topic, both on medical grounds and legal grounds, with passionate advocates for and against circumcision. You might like to read the American Academy of Pediatrics’ recent statement and the discussion that follows HERE.
If you are planning circumcision purely as a medical procedure I can recommend two excellent paediatric surgeons, who will perform the procedure either soon after the birth under local anaesthetic, or after 12 months of age under general anaesthetic:
Dr Vincent Varjavandi, Tower 2, 101 Grafton Street, Bondi Junction. Tel: 02 9389 1049 – also at 103 Botany Street, Randwick. Tel: 02 9326 6826
Dr Anthony Dilley, 352 President Avenue, Gymea 2227. Tel: 02 9540 4409
If you would like to have your son circumcised as part of the Bris then you may have your own Mahel, but alternatively you can contact Dr David Robinson, (02) 9387 8700, who is an ophthalmic surgeon with special interest and expertise in newborn male circumcision.
The two vaccinations that are recommended in pregnancy are the Influenza vaccine and Pertussis (whooping cough) booster. I strongly recommend the Flu vaccine if you will be pregnant during winter. The seasonal vaccine is available in March each year and covers the latest Influenza strains. It is supplied free to pregnant women by the government, and is available through your GP. It can be given safely in any trimester of pregnancy. You should consider it if travelling overseas in summer.
I also recommend vaccination against Pertussis (whooping cough) for you, your partner and all the baby’s close contacts, especially grandparents. Whooping cough is not usually a problem during pregnancy, however it can be a very serious infection for newborn babies and infants. It is given together with Tetanus and Diphtheria. You can have the booster with your GP in the third trimester or soon after the birth, before leaving hospital, but during pregnancy is far better, as the baby receives passive immunity. I recommend having the booster at 28-32 weeks in every pregnancy.
Tel: 02 8853 4999 or 1800 686 268 or breastfeeding.asn.au
ABA is a free 24/7 telephone service run by trained volunteers who all have experience at breastfeeding. They can give practical advice regarding any aspect of breastfeeding. You can join the Association to receive updated information on breastfeeding and baby products. They also have regular get-togethers and welcome new mums.
Breastfeeding help & advice from lactation consultants. For new mums who have birthed at POWPH.
Monday–Friday 12.30–2pm. Appointment preferable – call 9650 4443
Prince of Wales Private Hospital – Antenatal & postnatal breastfeeding talks
Mon, Wed, & Fri 10.30–12pm drop in – no appointment needed.
For women who have birthed at RHW and are experiencing breastfeeding difficulties. The Unit is staffed by lactation consultants, who can make an appointment to see you.
Monday–Friday BY APPOINTMENT ONLY call switch on 9382 6111 or call direct on 9382 6341.
All Drop-in – no appointment needed.
Eastgardens early childhood centre breastfeeding Drop-in
Mondays 9-11am; 9382 0933.
Eastgardens Suite 510, Level 4, Westfield, Pagewood
Waverley early childhood centre breastfeeding Drop-in
Thursdays 9-11am; 9387 1981.
59 Newland Street, Bondi Junction
Karitane lactation support clinic: 9399 6999
146 Avoca Street, Randwick – by referral only
Kings Cross early childhood centre breastfeeding Drop-in
Wednesdays 9-11am: Tel 9357 1655
50-58 Macleay Street, Potts Point NSW 2011
Mothersafe A free telephone service for medication use in pregnancy and
breastfeeding 02 9382 6539 mothersafe.org.au
Australian Breastfeeding Association call Michele 0413 441 156 or Katie 0404 014 558
Comino Chemist, 149 Avoca Street, Randwick. Tel: 02 9399 3025
Online: Breastpumphire.com.au or Medirent.com
Mums and Bubs Yoga at Royal Hospital for Women
A great opportunity to connect with other new Mums whilst improving your fitness, rebuilding core and pelvic floor strength and gaining more energy and vitality. Learn invaluable breathing & relaxation techniques to stay more centered & grounded in early parenting..
Mondays 1.30 – 2.30pm, (except Public Holidays), in Seminar Rooms 1&2
Booking essential: karmamama.com.au Cost: $18 per session. Please check in 15 mins prior. https://www.trybooking.com/195115
This is a special informal group for women born overseas who would like to come and learn about health issues and also meet other women who live locally. This group is held on the third Monday of every month in Seminar Rooms 1 and 2 from 10.30am – 12.30pm. at Royal Hospital for Women.
No booking required. Cost: Free
Karitane 1300 CARING (1300 227 464) TTY 02 9794 1848 or www.karitane.com.au
A free 24/7 advice line for parents and carers. Information regarding all aspects of parenting babies, toddlers and under 5’s, can be accessed, including breastfeeding, sleep and settling.
Parent baby day unit, 9399 6999 Karitane Family Care Cottage, 146 Avoca Street, Randwick
Parents can spend the day at the cottage and receive support and expert advice on sleep, settling breastfeeding and parenting. Referral from healthcare professional required.
Tresillian Family Care Centres & Parenting Line 1800 637 357 or 9787 0855 www.tresillian.net
A similar set up to Karitane. A 24/7 advice line with residential and outreach programmes. Parents are referred to Tresillian whose babies have settling difficulties or parents who have postnatal depression. Referral from healthcare professional required.
Health Direct, 24/7 medical advice line: 1800 022 222
Pregnancy, birth & baby helpline: 1800 882 436 or www.healthdirect.gov.au
Dr Howard Chilton, Paediatrician and author of Baby on Board, presents a free and informative talk on understanding babies at Royal Hospital for Women, level 3, each Thursday 10.15am
Helpful websites: www.raisingchildren.net.au, www.Tresillian.net,
www.Karitane.com.au and www.Australianbreastfeedingassociation.com.au
websites have great information and factsheets on babies and breastfeeding.
www.Bottlebabies.org has great info on formula feeding
Sleep/settling advice app: rockabub
Outline of baby’s development and milestones apps:
Contraception information: www.fpnsw.org.au/
Domestic Violence hotline 1800 65 64 63
If you or your partner is feeling depressed or anxious there is a lot of support for you, including Dr Mellanie Rollans. Please discuss your concerns and feelings with any or all of the following health professionals who can refer you to a counsellor if necessary: GP, Early childhood nurse, Tresillian, Karitane, Obstetrician, Midwife, local maternity hospital.
Emergency departments at public hospitals, such as Prince of Wales Hospital, provide assessment and support for anyone experiencing acute anxiety, depression or psychosis, especially if you or your partner have any thoughts of harming yourself or harming your baby.
Alternatively urgent assistance or advice can be obtained by contacting the Crisis or Acute Care team on 1800 011 511.
Perinatal depression line 1300 726 306 or www.panda.org.au
Mum for Mum is a service for new mothers having difficulty coping with motherhood, who don’t have their mums around. Support is given free of charge by older women in your home. contact@mumformum.org.au or 9363 0257
The immunisation schedule is on the back pages of your baby’s blue book. Your GP provides immunisation commencing when your baby is 2 months. It’s important to find a GP you feel comfortable with. Feeding or at least cuddling your baby during immunisation will provide comfort for your baby. Some parents apply EMLA cream onto the baby’s thigh to numb the injection site an hour prior to immunisation (ask your chemist). It may be wise to have baby Panadol on hand in case of common reactions like pain and fever. Again don’t forget to take your baby’s blue book.
MUMSENSE at Royal Hospital for Women. A weekly parenting group for all new parents who have babies aged 0-4 months:
No need to book – Every Thursday 10.30–12.30. Call 9362 6700 for more information
Early childhood centres run their own groups: www.sch.edu.au/departments/child_family_health
Australian Breastfeeding Association have regular meetings and welcome new parents
Movie sessions especially for parents with babies and children under age of 4 –
Participating cinemas: Randwick Ritz, Greater Union and Hoyts
PLAYGROUP: look up playgroupassociation to find your local playgroup. All parents and children under 5yrs welcome.
Your local council website lists all children’s services (including childcare) available in your local area.
Childcare information: www.mychild.gov.au
Mensline: 1300 78 99 78 – A 24/7 counselling line for men, or visit www.mensline.org.au a great website with on line forums and helpful information
South east local neighbourhood centre runs Mens Shed – A fathers’ group for dads and babies: familysupport@senc.org.au or www.facebook.com/thebabyshed
Cheers to Childbirth by Lucy Perry – A dads’ guide to childbirth support
“Being Dad” 1 (pregnancy and birth) & 2 (surviving with a baby) – DVDs available from Big W.