Obstetric Information

*Information brochures are not designed to replace information provided by your treating doctor or health care team. If you have any questions that you would like to ask, please speak to Dr Cattanach during your consultation or contact the clinic on 07 3844 9917 during office hours.

Alcohol and smoking

Eliminate or greatly reduce your consumption of alcohol and cigarettes which are harmful to the growth of your baby and have been linked to birth defects, low birth weights, asthma and behaviour disorder problems in young children.

Smokers are more likely to have a miscarriage, stillbirth and neonatal deaths and low birth weight babies. Other complications are also more likely. Babies exposed to tobacco smoke are at a greater risk of pneumonia, bronchitis, asthma, glue ear and cot death. Recreational drugs are definitely bad for your baby and yourself.

Antenatal classes and physiotherapy

It is recommended that you go to physiotherapy classes in the antenatal period to learn back exercises and pelvic floor exercises. A physiotherapist may visit in the early post-natal period while you are in hospital. There is a charge for this so you can decide at that time whether you wish to see a physiotherapist or not.

Antenatal classes really help a couple to adjust to the new experience of pregnancy, prepare for the birth and their role as parents. Antenatal classes are highly recommended either through the hospital that you are going to attend, or locally through childbirth education. Parenting classes are invaluable.

Antenatal Information

Congratulations on your pregnancy. This is an exciting time in your life and hopefully the results will make any inconvenience worthwhile. Your pregnancy lasts about 40 weeks from the first day of your last menstrual period.

All appointments are made through our main rooms at Mater Medical Centre, South Brisbane via telephone 07 3844 9917. After hours emergency calls are best made to Dr Cattanach's residential telephone 07 3892 1796.

Antenatal Visits

Please make your appointments well in advance (at least two months) as this will help in reducing delays.

Patients are reviewed every four weeks until they are 30 weeks, fortnightly until 36 weeks and then weekly for the remainder of your pregnancy. Your weight and blood pressure are monitored, and the baby's heart beat and the size of the uterus are checked. If there is any bleeding please notify the rooms as soon as you can.

If you have the Rhesus negative blood group you will need an injection of Anti-D within 72 hours. Anti-D is administered at 28 and 34 weeks and after the birth if the baby's blood group is Rhesus positive on cord blood testing.

Antenatal visits take a variable amount of time from 10 minutes to much more and often depend on whether there are significant complications present. Delays can occur unexpectedly because of sudden events. We do our best to run on time.

Betty Reeder, a senior midwife at Mater Mothers' Private Hospital with more than 30 years' experience, has joined the practice now offering an additional dimension in care and counselling. It is recommended that you see Betty as an alternative to your obstetrician at your 16, 24, 32 and 37 week appointments. When you see Betty solely, your visits will be charged at a lower rate which is claimable from Medicare.

Breast feeding education

Many mothers wish they had been better prepared for breastfeeding in the early months of parenting prior to the birth of their baby. The Australian Breast Feeding Association holds classes that may be useful to you. For information telephone 07 3844 6488. You may also find the following web sites useful.

Circumcision

Feel free to discuss the pros and cons of circumcision. Ultimately it will be up to you to decide. We do not frequently perform this procedure and usually arrange for Dr Terry Russell to perform this in the first few weeks after the birth. His office is at 620 Kessels Road, Macgregor, telephone 07 3349 6444, alternatively there are several different doctors who can perform this; please visit www.circumcision.com.au.

If you have any problems regarding any of the above please do not hesitate to contact the office and to speak with our friendly staff.

Cover

Obstetricians are frequently called at night and will need time to recover as well as be a member of their own family. They work with a group of obstetricians who cover each other on holidays and weekends. They are all very experienced and professional and if I am unable to attend one of my colleagues will stand in for me.

Delivery

We try to allow everyone the opportunity for a normal vaginal delivery even though a percentage of patients will require instrumental intervention for the wellbeing of the baby and sometimes the mother. Forceps, vacuum cup and caesarean section may therefore be required especially if the labour is prolonged.

Under normal circumstances your obstetrician will be present during the delivery to manage the birth. Your partner is encouraged to be present also. However, very occasionally due to circumstances beyond our control we may miss part of the delivery, but this is uncommon. If this should occur we will always come to the labour ward as quickly as we can to ensure that all is well, as we are fully responsible for your delivery and safety at all times.

A midwife is allocated to each labouring mother and the same midwife is usually present throughout labour (excluding meals and nature calls).

Diet, Alcohol, Smoking and Medications

A balanced diet should be the aim for all people, but especially so in pregnancy. 500 mcg of folic acid (folate) daily is recommended to reduce the risk of neural tube defects including spina bifida. Ideally this is started before pregnancy occurs and continued through to 12 weeks. Some authorities recommend a good folic acid intake throughout pregnancy.

During the early months, morning sickness can be a problem. Frequent small meals of foods you find agreeable, plenty of rest, fresh air and exercise is recommended. Fefol or FGF (iron tablets) are recommended for most women from 20 weeks. Constipation can be a problem and sometimes Ferro-Gradumet is a better alternative. The dosage is one tablet with your main meal and food rich in Vitamin C.

Exercise and Intercourse

Most mild forms of exercise that do not put you at risk of injury or over-exhaustion are encouraged. Body contact sports where the abdomen could receive a blow (e.g. horse riding, water skiing) should be avoided after 12 weeks of gestation. Women who exercise vigorously should reduce the intensity of exercise during pregnancy, limiting their peak heart rate to 140 beats per minute. Weight lifting where breath holding occurs should be avoided. When lying on your back in LATE pregnancy, the uterus can compress the large aorta and especially the vena cava (large vein) reducing blood flow back to the heart, so this should be avoided.

Warming down movement and gentle exercise is important. Overheating must be avoided in pregnancy. It is important not to expose the fetus to high temperatures. Keeping cool during periods of exercise is essential. Core temperature should be below 38 degrees Celsius. Women who continue to exercise strenuously in late pregnancy may have low birth weight babies due to prematurity or reduced foetal growth. Walking and regular exercise such as swimming (water temperature less than 28 degrees Celsius) is recommended unless there are pregnancy complications. Please feel free to discuss any exercise concerns you have upon your visit.

Intercourse does not have to be restricted unless there are complications such as bleeding.

Foods to avoid or reduce

  • Avoid or limit foods high in fat or sugar like cakes, lollies and sweet snack foods.
  • Try to limit consumption of coffee, tea, cola drinks and chocolate which all contain caffeine. Promise yourself a chocolate binge after the baby is born!

Foods to eliminate

  • All processed meats, salami, liverwurst, etc.
  • Soft cheeses (blue vein, ricotta, brie, etc.)
  • Pre-packed salads, sandwiches containing cold meats, chicken, fish (tuna, salmon) and sashimi (raw fish).

Hospital Bookings

Hospital bookings are made through Mater Mothers' Private Hospital on telephone 07 3163 8847. The hospital will send you the necessary forms and costing. Bookings for childbirth education classes may also be obtained from the hospital.

Labour

When labour commences, time your contractions. When they are 10 minutes apart then it is time to ring the hospital. If your waters break, even if there are no contractions, ring and go to the hospital as soon as you can. Senior midwives are on duty at all times and will ensure your obstetrician is informed of your condition no matter what time of the day or night.

The telephone number of the labour ward at Mater Mothers' Private Hospital is 07 3840 1616. You are most welcome to ring your obstetrician at any time if you have any concerns.

The length of labour varies from each individual as does the degree of pain tolerance. Relief through breathing and relaxation is encouraged. If the pain becomes significant, an injection can be given. An epidural may be administered by an anaesthetist. Epidurals are very safe and the complication rate is very low but these may increase the chance that instrumental help will be needed at delivery. Discussion of these aspects will occur at one or more of your antenatal visits.

Paediatrician

If a caesarean section is performed, and also with some instrumental deliveries, a paediatrician is present. For normal deliveries a paediatrician of your choice will examine the baby during your hospital stay and six weeks later if you wish. There is a fee involved. We are happy to recommend a paediatrician for you. We use all the visiting neonatal paediatricians at Mater Mothers' Private Hospital.

Postnatal

A postnatal check is normally booked for six weeks after the birth of your baby. Please contact the office as soon as possible after the birth of your baby to arrange a suitable time. Bleeding and discharge may continue for four to six weeks after the birth. If it is heavy with persistent flooding or large clots, then please contact the office.

Refrigerated foods

Do not consume leftovers after 24 hours unless thoroughly cooked.

Calcium supplementation appears to be very beneficial, low fat high calcium milk maybe a good alternative. Vitamin or Fluoride supplements may be useful but dosages and expense are often considerations.

Rights and Responsibilities

The pregnant woman and her family have the right to be treated with respect and informed in an understandable and culturally sensitive way; to participate in the decision-making process; to exercise choice including refusal of treatment; to express concerns; to seek further opinion; to be given appropriate privacy for herself and to know her medical records are being handled confidentially.

The obstetrician has the right to be provided with full and accurate information; to expect communication and cooperation; to be advised of preferences, needs and expectations; to refuse to carry out treatment if he/she believes this to be dangerous or unethical; to have periods of leave (while providing appropriate cover).

Responsibilities of the pregnant woman include looking after her health; to plan for birth needs; to be cooperative, realistic and capable of modifying her plans if necessary.

Risks and Investigations

There are risks involved in pregnancy and childbirth. When miscarriages occur, usually in the first 13 weeks, there is usually nothing which you could have done that would have avoided this consequence. The details will be carefully reviewed if any tragic events were to occur.

Both mother and baby risk has reduced dramatically over the last 50 years due to many factors both social and medical. Childbirth management has altered considerably and this has been influenced by advances in knowledge and technology. As a result parents have an increasing expectation of normal outcome.

Realistic expectations of pregnancy and childbirth are important. There are various tests available to detect abnormalities but these of course have some limitations and may not be appropriate to carry out. There are false negative and false positive results in some instances. Chorionic villus sampling (CVS) and amniocentesis are available to all but in view of the risk of pregnancy loss and the low risk of chromosomal abnormalities in under 35 year old women these are not routinely ordered.

Screening Tests for Down’s Syndrome

A 12 to 13 week ultrasound looking at the oedema of the neck can help determine the risk that a baby has Down syndrome. It is now combined with two serum blood tests to give risk assessment and is frequently used to help mothers over 35 years decide whether or not to have amniocentesis or Chorionic villus sampling (invasive tests which have a very small risk of miscarriage).

Alternatively the triple test is a blood screening test done at 15 weeks for Down syndrome and spina bifida. This can help the mother-to-be decide whether to have an amniocentesis. The result is given as a risk level (high or low). There are many false positive (high) results and some false negative results so as a rule I do not recommend this test in younger women. However, you may have a triple test at any age if you so desire.

Please feel free to discuss this option further with me. The 18 week ultrasound scan is very useful in that it may identify major foetal abnormalities. The results of the scan can be very reassuring but not all abnormalities can be routinely detected on scan.

Supplements and medications

Vitamin or fluoride supplements are not routinely recommended but if they are required or requested we are happy to discuss this matter with you. It is advisable to take iron supplements from the 20th week.

Simple analgesia such as paracetamol and some antibiotics are quite safe during pregnancy. For minor illnesses your GP will be aware of the safe medications. Mylanta and peppermints can help the heartburn.

The danger of listeriosis bacteria

Listeriosis is a relatively uncommon disease that may result from eating food contaminated with bacteria known as listeria monocytogenes. The listeria bacterium is not affected by refrigeration and is life-threatening to babies in the womb.

Useful Obstetrics links

Listed below are a number of websites that you may find helpful in finding answers to your questions regarding your pregnancy or becoming pregnant.

Dr Stephen Cattanach