Main Page

Antenatal Info

Antenatal Visits

Risks & Investigations

Screening Tests
for Down's Syndrome

Rights & Responsibilities

Hospital Bookings

Exercise and Intercourse

Diet, Alcohol, Smoking,
and Medications

The Danger of Listeriosis
Bacteria

Foods to Eliminate

Refridgerated Food

Antenatal Classes & Physiotherapy

Labour

Delivery

Cirumcision & Paediatrician

Breast Feeding Education

Postnatal

Fee Overview

Medicare

Private Health Insurance

Admin Fee

Obstetric Fee

Ultrasound

Consultations

Useful Phone Numbers

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 my main rooms at Mater Medical Centre, South Brisbane. Telephone 3844 9917. After hours emergency calls are best made to my residential
phone: 3892 1796 or mobile: 0418785765

HOSPITAL BOOKINGS

These are done through the Mater Mother's Private Hospital - Phone 3163 8847. The hospital will send you the necessary forms and costing. Bookings for childbirth education classes may also be obtained from the hospital.

ANTENATAL VISITS

Please make your appointments well in advance (at least 2 months) as this will help in reducing delays. I review you every four weeks until you are 30 weeks, fortnightly until 36 weeks and then weekly after that. Your weight and blood pressure are monitored. The baby's heart beat and the size of the uterus are checked. If there is any bleeding please notify me 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 if you are Rhesus negative 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. I will do my best to run on time.

Betty Reeder, a senior midwife at the Mater Mother's Private Hospital with more than 30 years experience has joined my practice and we can now offer an additional dimension in care and counselling. You may even encounter her during labour. I would recommend that you see Betty as an alternative to me 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 not claimable from Medicare.

There are risks involved in your 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.

RISKS AND INVESTIGATIONS

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.

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SCREENING TESTS FOR DOWN'S SYNDROME

A 12-13 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 2 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 miscarriafge).
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.

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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.

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HOSPITAL BOOKINGS

These are done through the Mater Mother's - 3840 8847. The hospital will send you the necessary forms and costing. Bookings for childbirth education classes may be obtained from the hospital.

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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 (eg. 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. Feel free to discuss any exercise concerns you have with me.

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

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DIET, ALCOHOL, SMOKING AND MEDICATIONS

A balanced diet should be the aim for all people but especially so in pregnancy. 500mcg of Folic Acid (folate) daily is recommended to reduce the risk of neural tube defects including spina bifida. Folic Acid (folate) 400mcg daily is recommended to reduce the risk of neural tube defects including spina bifida. Ideally this is started before pregnancy occurs and continue through to 12 weeks. Some authorities recommend a good Folic Acid intake through out 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.

Foods to Avoid or Reduce
· 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.
· 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!

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THE DANGER OF LISTERIOSIS BACTERIA
Listeriosis is a relative 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.

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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 sushimi (raw fish).

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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.

I do not routinely recommend vitamin or fluoride supplements but if they are required or requested I will happily discuss this matter with you. It is advisable to take iron supplements from the 20th week. Simple analgesia such as Panadol 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. Alcohol intake should be reduced to a minimum and smoking is harmful to both mother and baby. 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.

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ANTENATAL CLASSES AND PHYSIOTHERAPY

I would recommend that you go to the 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. I highly recommend antenatal classes either through the hospital that you are going to be confined in or locally through childbirth education. Parenting classes are invaluable.

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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. They will inform me of your condition no matter what time of the day or night.The number of the labour ward at the Mater Mother’s Hospital is 3840 1616. You are most welcome to ring me at anytime 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.

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DELIVERY

I try to allow everyone the opportunity for a normal vaginal delivery even though a percentage of patients will require instrumental intervention for the well being 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 I 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 my control I may miss part of the delivery but this is uncommon. If this should occur I will always come to the labour ward as quickly as I can to ensure that all is well as at all times I am fully responsible for your delivery and safety. A midwife is allocated to each labouring mother and the same midwife is usually present throughout labour (excluding meals and nature calls)

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COVER
I am frequently called at night and will need time to recover as well as be a member of my own family. I work in 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.

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. I am happy to find a Paediatrician for you. I use all the visiting Neonatal Paediatricians at the Mater Mother's Private.


CIRCUMCISION

Feel free to discuss the pro's and con's of circumcision. Ultimately it will be up to you to decide! I 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 Rd, MacGregor. Phone No: 3349 6444.

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. I am happy to find a Paediatrician for you. I regularly use several different Doctors. http://www.circumcision.com.au

If you have any problems regarding any of the above please do not hesitate to contact my rooms and to speak to my secretary.

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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 phone 07 3844 6488. You may also find the following web sites useful.
www.breastfeeding.asn.au
www.mothersdirect.com.au
www.alca.ans.au

POST NATAL

A post natal check is normally booked for 6 weeks after the birth of your baby. Please contact my office as soon as possible, after the birth of your baby to arrange a suitable time. Bleeding and discharge may continue for 4-6 weeks after the birth. If it is heavy with persistent flooding or large clots, then you will need to contact me.

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Fee Overview

This brochure is designed to provide you with information on the fees charged by this practice for obstetric management. An overview of the Australian Healthcare system has also been included.

Medicare
Medicare is a Federal Government initiative that is designed to provide financial assistance with your medical expenses. Each year the Health Insurance Commission publishes the Medical Benefits Schedule (MBS) which identifies the medical procedures eligible for a Medicare rebate, categorizes them using Item Numbers and details the Schedule Fee.

The Medicare rebate is based upon the Schedule Fee:
Treatment in rooms
Medicare Rebate = 85% Schedule Fee
Treatment in hospital
Medicare Rebate = 75% Schedule Fee.

Private Health Insurance
Private health insurance is a product purchased to provide financial security with regards to medical expenses should hospitalization be required for the management of a medical condition. In addition to providing cover for hospital related expenses private health insurance companies also contribute to the fees charged by medical practitioners for services rendered whilst the patient is in hospital. Government legislation prevents private health insurance companies from contributing to fees for services rendered in the doctor's private consulting rooms.

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ADMINSTRATION FEE
A planning, management and 24 hour 7 day a week management fee is payable after your 20th week of pregnancy. This fee is $2000.00 and is charged once under the item # 16590. The amount of rebate you will receive from Medicare depends on your Safety Net limit. Please check with Medicare to confirm your eligibility.
This Antenatal Fee is non-refundable from your private Health Fund.

For your convenience your delivery account will be billed directly to your health fund and Medicare on your behalf.

OBSTETRIC FEES

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Consultations