Description of Antenatal Care

It is essential that every patient and her partner read the following notes in order to provide a happy antenatal period and safe delivery of your baby or sometimes babies.

Congratulations on your pregnancy and welcome to my practice. These notes have been prepared to answer the common queries about arrangements for out antenatal care. There are plenty of other questions and issues to be discussed as your pregnancy progresses, and please feel free to discuss any concerns you may have. Any tests ordered or problems that may develop will be discussed and carefully explained. All decisions concerning the management of you and your baby will be made jointly with you.

Following your first antenatal visit, subsequent visits will be scheduled at approximately six weekly intervals until 28 weeks, two weekly until 36 weeks, then weekly until delivery. Should problems arise then there may be a need for more frequent visits. Feel free to bring your partner to any of these visits. A postnatal visit will be approximately six weeks after delivery.

Like you I hate waiting and every attempt will be made to see you at your appointed times. However an obstetrician’s life is never predictable and babies are often born at the most inconvenient times. We also have to tend to other medical emergencies which would further delay our day. On occasions this may lead to a longer than acceptable wait. In normal events we would attempt to phone you prior to the appointment to warn you if we are running late but sometimes we either cannot contact you or there is insufficient time to contact you and you will be faced with either a wait or rescheduling your appointment. I apologize in advance if this happens to any patient.

Please book in to your hospital at 12-15 weeks gestation, by phoning the Midwifery Department at Peninsula Private Hospital to make an appointment.. Antenatal education classes will be organised by your hospital and these classes cover a range of practical topics related to your pregnancy. The classes may be supplemented by reading from the list of recommended books which is included. The Midwifery Department also carry pamphlets and information sheets on many topics related to pregnancy including nutrition, exercises, relaxation, preparation for breast feeding, danger signs in pregnancy, drugs in labour, smoking in pregnancy etc.

Routine screening blood tests will be ordered at your first visit and these include a determination of your immunity to Rubella, blood group, blood counts as well as hepatitis and HIV testing. Results of these tests will be discussed at your next antenatal visit. The need for iron tablets or calcium supplementation will be advised. A ‘combined screening test’ for Down’s Syndrome and other abnormalities is also often performed. This consists of blood tests at 10 weeks and an ultrasound at 12 weeks or you may choose to have the NIPT HARMONY TEST for Down syndrome. An ultrasound scan is performed at 18-20 weeks of pregnancy and this will help determine your due date and assess the development of your baby’s bodily organ systems.

During your pregnancy you will experience many and varied symptoms. The vast majority are quite normal although some may cause you inconvenience, but please be sure to report any of the following immediately:

• Vaginal bleeding
• Severe abdominal pain
• If the baby’s movements have slowed right down or the baby is not moving at all. This is a very important sign of your baby’s health we encourage you to report this early.

Certain serious medical conditions or premature labour may mean that you and or your baby will require specialized facilities not available at Peninsula Private. Prior to 24 weeks of pregnancy, you will generally be transferred to a hospital in Melbourne where there are neonatal intensive care facilities. These 3 hospitals are Monash Medical Centre, Royal Woman’s Hospital and The Mercy Hospital. There is no real choice of hospital as the hospital to which you will be transferred will be dependant on the availability of neonatal intensive care beds. At these hospitals we will endeavour to transfer your care to a private obstetrician who works at those 3 units.

Obstetrician’s availability

It is my wish to be present for the labour and delivery of all my obstetric patients. However there are factors which may prevent me from doing this and this would affect approximately 5% of patients.

Safe working hours

As with driving a car, fatigue has been noted to be a major cause of medical accidents. It is now essential that obstetrician’s ensure that they have adequate down time in order to prevent fatigue. To do this groups of like minded obstetricians have joined forces to provide safe, predictable and like care for all their patients. This means that there will be times when an associate will provide care.

Leave

We endeavour to pre-plan our leave 1 year in advance so that we can warn patients at the time of booking that we may be on leave. Patients may either choose to continue under our antenatal care and be transferred to an obstetrician of their choice.

In the event of another doctor taking over your care during labour there will be no added cost to yourself and the doctor would generally send the bill to me and I would fully reimburse him for your fees that have already been paid.

We remind you that our aim is to deliver a healthy baby in as safe and happy an environment as can be provided. The best person to do this is an obstetrician who is not worried about having to be elsewhere and is not exhausted.

The fee for your initial consultation is $163.00 and is due on the day. The Medicare rebate for this visit is $72.75.

Your additional out of pocket costs for pregnancy care will be approximately $4000 .00 depending on your private health fund cover, these fees are payable in full by 36 weeks.

Two thirds of this gap is due after 20 weeks and you will receive a capped rebate from Medicare.

The remaining third of your gap is billed at thirty weeks and is due for payment by 36 weeks. This amount is not claimable from Medicare or your health fund. This covers the remaining out of pocket costs for you pregnancy.

Initial Consultation	$163.00
Your 20 week fee	$2200.00(This may be paid off in instalments prior to 28 weeks)
Your 30 week fee	$1100.00(This due for payment by 36 weeks)
Total Out of Pocket Costs	$3300.00

Your antenatal appointments fee will be bulk billed at each appointment, please bring your Medicare card to every appointment.

These visits will often be combined visits with Mary Jay the midwife who works within our antenatal section of the practice. Her input is invaluable to your care.

If there are questions or problems between visits please contact us as follows:

• Urgent during office hours ph: 9785 6816
• Urgent after hours contact the Maternity ward of the hospital you are booked into for your delivery.
• Routine questions can be dealt with by phoning Mary on ph: 9785 6816 on Monday between 1.30pm until 5pm and Wednesday between 9am until 12pm.

Therefore for most health insurance funds, your out of pocket expenses for the pregnancy will be limited to a maximum of $4000 if paid by the specified times. Some funds do not cover you as well as others and your out of pocket costs will vary. My fee for your pregnancy care covers my on-call commitment and your labour, delivery and postnatal care in hospital . This includes the entire service regardless of complexity, including complicated pregnancies, Caesarean Section, emergencies etc. To minimize your out of pocket costs, I use the “gap cover” facilities provided by the various health funds.

If you are not covered by health insurance, please discuss this with my secretary, as there will be additional costs. If you have any questions about the fees, or if you have any sudden financial difficulties, please do not hesitate to discuss these with my secretary or myself.

I hope these notes are of help and please feel free to discuss any questions or problems at any time. I look forward to caring for you and your baby.

Here is a cutting edge introduction to, and preparation for parenthood from the Internet! ENJOY!

“Preparation for parenthood is not just a matter of reading books and decorating the nursery”. Here are 12 simple tests for expectant parents to take to prepare themselves for the real-life experience of being a mother or father.

1. Women: to prepare for maternity, put on a dressing gown and stick a beanbag down the front. Leave it there for 9 months. After 9 months, take out 10% of the beans. Men: to prepare for paternity, go to the local drug store, tip the contents of your wallet on the counter, and tell the pharmacist to help himself. The go to the supermarket. Arrange to have your salary paid directly to their head office. Go home. Pick up the paper. Read it for the last time.
2. Before you finally go ahead and have children, find a couple who are already parents and berate them about their methods of discipline, lack of patience, appallingly low tolerance levels, and how they have allowed their children to run riot. Suggest ways in which they might improve their childs sleeping habits, toilet training, table manners and overall behaviour. Enjoy! – it’ll be the last time in your life that you will have all the answers.
3. To discover how the nights will feel, walk around the living room from 5pm to 10pm carrying a wet bag weighing 8-12 Ibs.

   At 10pm put the bag down, set the alarm for midnight and go to sleep. Get up at 12 and walk around the living room again, with the bag until 1am. Put the alarm on for 3am. As you can’t get back to sleep, get up at 2am and make a drink. Go to bed at 2.45am.

   Get up again at 3am when the alarm goes off.

   Sing songs in the dark till 4am. Put the alarm on for 5am. Get up. Make breakfast. Keep this up for 5 years. Look cheerful.

4. To find out what mess children make: smear peanut butter onto the sofa and jam onto the curtains. Hide a fish stick behind the stereo and leave it there all summer. Stick your fingers in the flower beds then rub them on the clean walls. Cover the stains with crayons. How does that look?
5. Dressing small children is not as easy as it seems. First buy an octopus and a string bag. Attempt to put the octopus into the string bag so that none of the arms hang out. Time allowed for this – all morning.
6. Take an egg carton. Using a pair of scissors and a pot of paint, turn it into an alligator. Now take a toilet roll. Using only scotch tape and a piece of foil, turn it into a Christmas cracker. Last, take a milk container, a ping pong ball, and an empty packet of Coco Pops and make an exact replica of the Eiffel Tower. Congratulations. You have just qualified for a place on the playgroup committee.
7. Forget the BMW and buy a Hyundai. And don’t think you can leave it out in the driveway spotless and shining. Family cars don’t look like that. Buy a chocolate ice cream bar and put it in the glove compartment. Leave it there. Get a coin, stick it in the cassette player. Take a family size packet of chocolate biscuits, mash them down the back seats. Run a garden rake along both sides of the car. There. Perfect.
8. Get ready to go out. Wait outside the toilet for half an hour. Go out the front door. Come in again. Go out. Come back in. Go out again. Walk down the front path. Walk back up it. Walk down it again. Walk very slowly down the road for 5 minutes. Stop to inspect minutely every cigarette end, piece of used chewing gum, dirty tissue, and dead insect along the way. Retrace your steps. Scream that you’ve had as much as you can stand, until the neighbours come out and stare at you. Give up and go back into the house. You are now just about ready to try taking a small child for a walk.
9. Always repeat everything you say at least five times.
10. Go to your local supermarket. Take with you the nearest thing you can find to a pre-school child – a fully grown goat is excellent. If you intend to have more than one child, take more than one goat. Buy your weeks groceries without letting the goats out of your sight. Pay for everything the goats eat or destroy. Until you can easily accomplish this do not even contemplate having children.
11. Hollow out a melon. Make a small hole in the side. Suspend it from the ceiling and swing it from side to side. Now get a bowl of soggy oatmeal and attempt to spoon it into the swaying melon by pretending to be an aeroplane. Continue until half the oatmeal is gone. Tip the rest into your lap, making sure that a lot of it falls on the floor. You are now ready to feed a 12 month old baby.
12. Learn the names of every character from Sesame Street, Mr Rogers Neighbourhood and available Disney movie. When you find yourself singing “lion King” songs at work, you finally qualify as a parent.”

Antenatal care is just not something you receive from your doctor every few weeks. It is what you should give yourself every day. The following are some of the main components of self-care. Be good to yourself and you baby!

Nutrition

Eat from the five basic food groups daily.

Take supplements that I know I need.

Drink at least 6 – 8 glasses of water, juice etc per day.

Pay attention to my inner voice of hunger and respond accordingly.

Treat myself to something I know is especially good for myself and the baby.

Exercise

Take fresh air and (if available) sunshine every day.

Do something to increase my heartbeat each day eg. Brisk walking, swimming etc.

Do exercises specific to pregnancy several times a week.

Dance, move rhythmically and freely to music.

Do pelvic floor exercises – DAILY.

Relaxation

Completely let go at least once every day.

Have my partner (or someone else) massage me at least once weekly.

Deliberately release areas where I know I hold tension, several times daily.

Allow myself the necessary comforts to curl up and take it easy before bed.

Emotional Wellbeing

Let myself cry whenever I feel like it.

Vent my frustrations before they become explosive.

Feel free to be tender and loving with partner, day-by-day.

Ask for support, acknowledgement, touch and sex from my partner whenever I need it.

Give myself time alone and find new ways to enjoy it.

Intellectual Preparation

Read something on pregnancy several times a week.

Formulate and ask questions.

Take stock of my status in pregnancy by reviewing my daily or weekly activities and looking for areas that need improvement.

Discuss technical aspects of pregnancy, birth and parenting with my partner on a regular basis.

Work on developing my birth plan by noting ideas and preferences at they arise.

Attend information sessions or film series on birth whenever possible.

Social Preparation

Meet with other pregnant women often.

Talk to mothers of infants.

Observe infant behaviour and family interaction whenever possible.

Ask for concrete support from friends and relatives for needs in pregnancy and after the baby is born.

Think about the changes having a baby will bring and formulate ways to adapt.

Support my partner in talking to other new fathers, reading about parenting or discussing the baby with me.

During your pregnancy, or as you come into labour, there may be times when you are unsure as to whether you should contact me or the midwives at the hospital. However it is imperative that you do when there is:

Vaginal Bleeding

In the first trimester this can indicate threatened miscarriage. However if spotting or bleeding occurs at any time in pregnancy, please notify the midwives or myself.

Leak or gush of fluid from the vagina

Observe colour of the fluid (liquor), wear a sanitary pad and notify. This may indicate premature labour in second or third trimesters.

Swelling of hands and face

Particularly if the face looks very puffy, notify. This could be a sign of pre-eclampsia.

Regular strengthening, painful contractions

If these are occurring for more than an hour if before 37 weeks, premature birth may be impending.

Decreasing or loss of foetal movements

If you notice decreasing movements over 3-4 days or no movements in a day, please contact the midwives and attend the Hospital for a foetal heart recording.

Severe pelvic or abdominal pain

Particularly if pain is associated with vaginal bleeding, this should be notified urgently.

• The new Pregnancy and Childbirth – Sheila Kitzinger
• Up The Duff – Kaz Cooke
• “Mother and Baby – A Survival Guide for the Firth 12 Months and Beyond” – Margaret Geddes
• “Baby and Child” – Penelope Leach
• “The Crying Baby” – Sheila Kitzinger
• “Easy Parenting” – Judith Paphazy
• “Breast Feeding” – N.M.A.A. Booklets
• “The Baby Book” – William & Martha Sears
• “Breastfeeding” – Mary Renfrew, Chloe Fisher & Suzanne Arms
• “Nighttime Parenting” – William Sears
• “Every Parent” – Matthew R Sanders

Australian Breast Feeding Association

Head Office: 9885 0855

Breastfeeding Helpline: 9885 0653

Australian Multiple Birth Association Vic Branch Inc.

Telephone: 9513 1383

P.A.N.D.A (Post and Ante Natal Depression Association)

Telephone: 9836 7382

Support Line: 9836 7677

SANDS
Miscarriage, Stillbirth and Newborn Death Support

Telephone: 9899 0217

Support Line: 9899 0218

Eating a variety of foods helps your baby to develop and you to stay well. Every day choose foods from all these groups.

FATS

• Butter
• Cooking Oil
• Margarine

ABOUT 1 TABLESPOON

FRUIT

Raw is best

Also

• Cooked
• Tinned
• Juices

Have a citrus fruit daily

AT LEAST 3 SERVES

VEGETABLES

Raw or lightly cooked and a variety of colours.

AT LEAST 2 CUPS

VEGETARIANS

See the hospital dietician for special advice.

DAIRY

MILK: SKIM OR LOW FAT

Drink or use in junkets, cooking etc. One cup of milk is the same as:

• 2 thin cheese slices
• 200g yoghurt
• 250g cottage cheese

AT LEAST 3 CUPS

CEREALS

WHOLEMEAL KINDS ARE BEST:

• Bread
• Rice/Barely etc.
• Pastry
• Pasta
• Breakfast cereal
• Oatmeal
• Crispbread

AT LEAST 4 SERVES

DRINKS

• Skim or low fat milk
• Fruit juice
• Mineral Water
• Plain water
• Soup

AT LEAST 6 GLASSES

PROTEIN

• Red meat
• Poultry
• Fish

Cut off the fat first

MINIMUM 100-200 G (3-6 oz)

Also 3 eggs per week

OH THIS MORNING SICKNESS!

TO HELP YOURSELF:

• Eat a small snack of dry biscuits, toast or fruit juice before rising.
• Take small, frequent and light meals rather than 3 large ones
• Avoid drinking with meals. Drink in between meals.
• At meal times TRY to relax.
• Avoid foods that are fatty, fried or very spicy, plus any food that upsets you.
• Try COLD foods e.g. meal, salad and TART foods to help nausea
• Sips of cold, flat ginger ale or lemonade may help
• Grated apple (with skin on) and apple juice are old remedies
• If cooking odours bother you, choose uncooked meals or ask someone else to cook.

A WORD ABOUT IRON

Pregnant women and new mothers need more iron than usual. Iron is needed to make blood and tissues- yours AND baby’s.

FOODS RICH IN IRON ARE:

• Red meat
• Liver
• Kidney
• Egg yolks

PLANT IRON:

• Wholegrains and flours
• Soybeans and soyflour
• Wheatgerm (raw)
• Prunes and prune juice
• Dried apricots and figs
• Parsley
• Silver beet
• Spinach
• Brewers yeast
• Blackstrap molasses
• Liquorice

The iron in “plant iron” foods is poorly absorbed. Eating “meat iron” foods at the same meal helps your body to get the iron it needs.

VITAMIN C HELPS THE BODY TO USE IRON

You can get it in

• Citrus juice
• Kiwi fruit
• (Juices too)
• Tomatoes
• Pineapple
• Vitamin C tablets

IRON TABLETS

If you are prescribed extra Iron:

• Take tablets WHOLE, after eating
• Swallow with fruit juice (vitamin C) or water
• Do NOT take HEARTBURN MEDICINE (antacids) 1 hour before, or after taking your iron tablets.
• Do NOT stop taking iron tablets before talking to your doctor or midwife.

Iron can make your bowel actions black. THIS IS NOT HARMFUL. If constipation occurs, follow the advice in the pamphlet.

CALCIUM

Pregnant women need more calcium than is needed to make and maintain bones and teeth in both you and your baby.

FOODS RICH IN CALCIUM ARE:

• Milk and its products eg.
• Yoghurt, and cheese
• Soy bean curd (Tofu) and milk
• Sesame Seeds
• Almonds
• Parsley
• Seafood

IF YOU DON’T TAKE DAIRY PRODUCTS, PLEASE TELL YOUR DOCTOR OR MIDWIFE

CONVENIENCE FOOD

Takeaways and frozen dinners are often:

• Fatty
• Very salty
• Poor food value for you and your baby
• VERY EXPENSIVE
• HAMBURGERS: Grill one at home and serve a wholemeal bun with salad
• CHICKEN: Have with a salad
• FISH ‘N’ CHIPS: Take the batter off the fish or ask to have it grilled instead and add a baked potato and salad instead of chips
• TINNED FOOD: Baked beans on wholemeal toast!
• SOFT DRINKS: Mineral water add fruit juice and make it fizzy. Adding a banana to milk and whizzing it in the blender makes a great milkshake and you can add vanilla essense and/or sprinkle nutmeg if you like.
• A WHOLEMEAL SALAD SANDWHICH: Is quick and easy

Because your still growing, you need EXTRA nourishment, for YOUR growth AND that of your baby. Be very sure that you choose good foods.

WEIGHT GAIN:

• Gaining weight is necessary in pregnancy, and your total for the whole pregnancy should be about 9kilograms.
• During the first 20 weeks, total weight gain is about 3.5kg
• Thereafter gain of ½ kg per week on average is usual.
• Your need for extra calories during pregnancy is small, so the old saying about eating for two is not true!
• If you do have a weight problem, severe dieting should not be attempted in pregnancy. Speak to your dietitian, doctor or midwife if you are concerned about your weight.
• The following foods should be avoided, as they are HIGH IN CALORIES and provide LITTLE that is good for you and your baby.

OIL

• Rich sauces
• Cream
• Salad dressing

SUGAR

• Honey
• Jam
• Glucose
• Sweets
• Syrups
• Toppings
• Chocolates

SOFT DRINKS

• Cordial
• Alcohol

SNACK FOODS

• Cake
• Pastries
• Biscuits

FATTY MEATS

• Sausages
• Salami
• Bacon

FRIED FOODS

Take away

ALCOHOL

Alcohol is dangerous and damaging to the unborn baby. It is best not to drink any alcohol, but at most NO MORE THAN 2 standard drinks per day.

NEED A NIBBLY

Fruit, salad, vegetables, small amounts of dried fruit and nuts, dry biscuits and tomato, skim milkshakes: (put skim milk in the blender and add eg: banana, pineapple, peaches or strawberries and ice cubes: watch it froth!)

Try frozen grapes – very refreshing!

HEARTBURN

• Avoid foods which bother you (often greasy, fried or spicy), coffee and cigarettes
• Eat small frequent meals rather than 3 large ones
• Avoid drinking for 1 hour before or after eating
• Stay upright as much as possible, even in bed
• Sipping mild or soda during an attack may help
• Stop eating and drinking several hours before bed

CONSTIPATION

For this very common problem:

• Increase the fibre in your diet:
  • Fresh fruit, leaving skin on if possible
  • Dried fruit
  • Raw/lightly cooked vegetables. Scrub, rather than peel
  • Wholemeal bread, flour and cereal, e.g. porridge, allbran
  • Brown rice
  • Add 1-2 tablespoons of unprocessed wheat or rice bran to food over the day. Mix it with soup, cooked fruit, cereal, gravy.
• Drink plenty
  • At least 6 glasses of water each day, extra to milk
• Exercise Daily

DO NOT TAKE LAXATIVES WITHOUT MEDICAL ADVICE

Recent research now suggests 4% to 15% of pregnant women will suffer depression in pregnancy and are at risk of developing postnatal depression. Antenatal depression is often misunderstood or hidden because of shame. Frequently it is put down to hormonal changes, tiredness or stress. However, pregnancy for some women isn’t an enjoyable experience and they may feel ashamed in discussing this for fear of being judged. Seeking treatment early is a way of preventing chronic postnatal depression.

Symptoms of Depression:

When a woman is suffering antenatal depression their mood is low most of the day, nearly every day for longer than a two week period. Some of the signs and symptoms of depression listed below can be confused with the normal issues associated with pregnancy, however the difference is that they tend to be overwhelming and debilitating for the mother-to-be and greatly interfere with her daily functioning.

Physical Symptoms	Psychological Symptoms
Insomnia, waking or excessive sleep	Low mood and tearfulness
Difficulty concentrating and poor memory	Feeling worthless or having inappropriate guilt
Loss of appetite or over eating	Thoughts of suicide or self harm
Lack of energy and motivation	Lack of interest in once pleasurable activities
Loss of libido	Withdrawing socially
Little interest in self-care	Difficulty making decisions
	Pessimistic view of self and the future

Cause of Depression:

There are many reasons why some women suffer depression in pregnancy. Below is a list of some possible triggers:

• Past history of depression or family history of depression
• A difficult pregnancy, including health difficulties for mother or baby
• Anxiety surrounding financial problems, medical procedures or concerns for thein unborn baby
• Relationship difficulties
• Lack of family or social support
• Being unsure of the pregnancy and ability to cope with a newborn
• Concern about older children
• Issues with body image, adjusting to being pregnant and gaining weight

Antenatal depression needs professional treatment. If you are concerned that you are suffering antenatal depression speak to your GP or obstetrician about a referral to a Psychologist or Psychiatrist who specialises in this area.

During your hospital stay there may be need for a paediatrician to be involved in the care of your baby. This may involve attendance at your delivery for potential problems during labour (eg. Caesarean section, forceps delivery), or if there is some concern about your baby after birth.

There are 4 paediatricians who make up an ‘on call’ roster to provide cover to the private hospitals. After hours and on weekends, your usual paediatrician may not be available to attend to your baby if advice or help is needed. In this situation the on call paediatrician is called for consultation, and your usual paediatrician may take over when he/she is next available.

Please note that fees for the attendance of a paediatrician are NOT included in the obstetrician fees, or the hospital fees. Each paediatrician will have a slightly different fee structure, as federal legislation prevents doctors from comparing fees or charging the same fees.

Your private insurance fund will only contribute to the fee for the paediatric services if you have family cover, and if your baby has a medical problem that requires him/her to be admitted in his/her own right.

The private insurance companies regard babies rooming in with their mothers as boarders, not as inpatients, and will not contribute to expenses associated with the baby.

Indicative fees for paediatric attendance:

At Caesarean Sections and other deliveries	up to $450.00
Prolonged consultations	up to $250.00 per hour
Initial consultation with newborn infant	up to $250.00
Review visits	up to $100.00
After hours/overnight call out	up to $100.00

If you have any queries, please address these with the hospital administration, or with the paediatrician directly.

When you book into the hospital before delivery you will be required to sign a copy of this document, thereby acknowledging that you have read this information, and are providing informed consent to its terms.