Congratulations on your pregnancy! At the Cove Medical Group, we provide clinical expertise for those women with a normal, healthy pregnancy, as well as those who have either an underlying medical issue or a pregnancy with complications. We are experienced, up-to-date and knowledgeable in all aspects of maternity care. We are comfortable with a wide range of birthing options including drug-free vaginal births, Caesareans and vaginal birth after Caesarean (VBAC). Between us, Drs Clarke and Gunnell are available 24 hours a day and are able to provide you with safe and reliable service.
Your first appointment is generally around 12 weeks' gestation. We recommend you ring to book this appointment as soon as you know you are pregnant. You will need to visit your GP to arrange a referral and he/she will also provide referrals for appropriate blood tests and an ultrasound. Occasionally, if you have a high risk situation, you may require an earlier initial appointment. Please discuss this with the reception staff. PLEASE remember to bring your GP referral and try to arrive 10 minutes early.
The first appointment will take up to 1/2 hour. Your obstetrician will take a detailed history and perform a basic examination (no need for a vaginal examination). He will check all your results and arrange any other necessary tests. There will be plenty of time for you to ask questions. You partner is very welcome to attend this and subsequent visits.
First Trimester Screening
Down Syndrome screening is offered to all women. The current recommended test is called 'First Trimester Screening' or FTS. This involves having blood taken for several hormone levels at around 10 weeks together with an ultrasound to measure the thickness of the babies neck at 11-13 weeks.
Your GP will discuss this test with you in more detail and arrange the appropriate referrals. We would recommend you have your Ultrasound done at one of these Specialist Ultrasound practices.
NIPT (Non Invasive Prenatal Testing) is a new blood test available which is more accurate than FTS. This can be done from 10 weeks.
Visits during pregnancy
Your second antenatal visit is usually scheduled for soon after the Anatomy scan. Subsequent visits are around 4 weekly until 32 weeks, then fortnightly to 36 weeks. We generally see you weekly from 36 weeks until delivery. You can book these visits as far in advance as you wish. It is an easy matter to ring and change your appointment at short notice if necessary. Most of these visits will take around 10 minutes.
Both Obstetricians try very hard to stay on time. It is therefore important that you help us by arriving for your appointment at the scheduled time. Sometimes, however, we get called away at short notice. Our reception staff will do their best to contact you to reschedule.
Routine tests for early pregnancy
There are several recommended tests that should be performed early on in every pregnancy. Your GP will provide you with a referral to have them done. These tests include:
Blood group and antibody screen
Full blood count (to check for anaemia)
Hepatitis B & C, HIV
Urine testing for various infections
Other tests your GP may recommend include:
Vitamin D levels
Other routine tests in pregnancy
Once you have seen your Obstetrician, he will arrange all further routine and necessary tests.
You will be given a referral for the Anatomy ultrasound which is done at 19 - 20 weeks. You will generally be able to find out the gender of your baby at this scan (if you wish).
At around 28 weeks you will have a screening test for gestational diabetes and an iron level.
If you are planning a vaginal birth, we will recommend a vaginal swab to check for a bacteria called Group B Strep.
Problems or questions during pregnancy?
There is always plenty of opportunity for you to ask questions at your antenatal visits so we suggest you write them down (to get around the 'pregnancy brain' problem).
If you have a question or problem between appointments, don't hesitate to ring. One of our friendly receptionists will either put you through to your Obstetrician or leave a message and he will call you back as soon as possible.
If there is a problem after hours, ring St Mary's Ward at St John of God Hospital (Murdoch) on 9438 9700 and speak to a midwife. There is someone for you at the end of the phone 24 hours a day, 7 days a week. The midwife will assess the situation over the phone and either ask you to come into hospital or call your Obstetrician.
Antenatal classes are arranged through St John of God Hospital and cover all the important aspects of pregnancy, birthing (both vaginally or by Caesarean), breastfeeding and care of your newborn baby. They are highly recommended for 1st time parents. You will receive information early on in the pregnancy regarding the booking process. It is generally recommended you complete the classes by around 34 weeks.
Dr Gunnell intermittently holds "Secret Men's Business" classes for 1st time fathers to be. These are generally held towards the end of the pregnancy and are for men only. He will send an invitation to the partners of his patients.
During the course of your pregnancy there will be extensive discussion regarding your birth. We believe in women making an informed decision concerning the method of birthing their baby. In general, we understand that most women hope and expect to have a vaginal brith and we are keen to support your expectation in an holistic way. Unfortunately things do not always go to plan, and complications or difficulties may arise necessitating the need for intervention and/or a Caesarean. No decision is made without your consultation and full discussion.
If you prefer to have an elective Caesarean, this will also be fully discussed so that you are able to make an informed decision based on the pros and cons of the surgery.
What to bring into Hospital
All you really need is comfortable clothing for yourself and your newborn baby, and personal toiletries. Disposable nappies, maternity pads, linen/towels, etc are all supplied by the hospital. If you are not planning to breastfeed, you will also require some formula.
Of course, you are most welcome to bring whatever else you think will make your stay more comfortable, particularly during the time you are in labour. You are welcome to bring your electronic equipment including a laptop/ipad/etc and the hospital has Wifi access (for a small fee). Don't forget your camera!
Make sure you have a suitable car seat to take your baby home.
When to come into Hospital
This really depends on many factors including whether this is your first or subsequent baby, the distance you live from the hospital and whether there have been an problems during the pregnancy. In general, if you think you may be in labour, your waters have broken or you have any concerns about anything, it is always safest to ring and speak to a midwife on St Mary's Ward on 9438 9700. There is always someone available to give you advice (even at 3 o'clock in the morning).
Once you arrive at the hospital, you and your baby will be checked out by a midwife. This will include a short period of monitoring of the baby's heart by a machine called a CTG. You may need to have an internal (vaginal) examination to decide if you are in labour or whether your waters have broken. Once the midwife has the necessary information, she will call your Obstetrician.
We aim to keep labour as intervention free as possible. We encourage you to keep mobile and do whatever you can to stay comfortable. As long as everything remains normal, minimal interference is required. A midwife will be present to support you during your labour and she will monitor both you and your baby's health. Your progress in labour will be assessed every few hours by an internal examination.
Sometimes things do not go according to plan. If there are any concerns regarding the progress of labour or the health of you or your baby, increased monitoring will be required. Further interventions may become necessary but everything will be discussed with you in detail by both your midwife and Obstetrician and you will be calmly guided through the process. Occasionally, something serious and unexpected can occur. Your Obstetrician is fully qualified to deal with any complication that may arise and you need to trust his decision in the case of an emergency. If this happens, a full 'debriefing' will occur in the subsequent few days.
Caesarean births have become increasingly common over the last few decades. There are many complicated reasons for this trend. Some women will choose to have a Caesarean, some will have no choice and some will want to do everything possible to avoid one. It is important that you discuss your preferences during the course of the pregnancy.
There are many possible reasons that you may need to have a booked or emergency Caesarean.
There are many ways we try to make your Caesarean a positive experience and encourage bonding. Your baby is generally in your sight once birthed in the operating theatre and you can usually have close physical skin-to-skin contact within a few minutes. Breastfeeding is too difficult on the operating table but can be achieved as soon as you return to your room within about 1/2 hour.
It is important that you research the various options for pain relief during the course of your pregnancy. This topic is generally well covered in the antenatal classes. Research has demonstrated the importance of water during labour so feel free to utilize the shower or bath facilities in the Birthing Suite. Entonox (nitrous oxide or 'laughing gas' and air) is readily available. If you would like to use a TENS machine, this will need to be hired well in advance from a Physiotherapist or Pharmacy.
Many women choose to have an epidural during labour. This is very effective pain relief. If you decide to have an epidural, you just need to inform your midwife at the time who can then arrange for an Anaesthetist to attend for the procedure. Sometimes, particularly at night, there can be a delay in finding an available Anaesthetist so it's important you give the midwife plenty of warning.
Postnatal feelings and emotions
Having a baby is life-changing! All women feel a range of emotions ranging from intense love to feelings of frustration and helplessness. It takes time to recover from birth and learn the skills required to look after a new life that is totally dependent on you. About 80% of women will experience 'baby blues' in the first week or so after having their baby. They may feel teary, anxious, depressed or have mood swings. Many will feel overwhelmed and unable to cope. This lasts a few days and requires no treatment. It is normal! The support provided by your partner, family/friends and the midwives will help you get through this short-term issue.
Postnatal depression is much less common and affects around 10-20% of women (and a small percentage of men). It often starts insidiously within the first 6 weeks and can be difficult to diagnose. PND varies in severity. Many women will recover with practical support and counselling; others will require medication. It is important to seek help from your GP, Obstetrician or a Clinical Psychologist. We are fortunate to have a Psychologist working here at the Cove Medical Group. Jenny Vulin has many years of experience working with postnatal depression and would be happy to receive a referral from your GP if you are in need of counselling.
Most women stay in hospital for 3 nights following a vaginal birth and 4 nights after Caesarean. You may prefer to be discharged earlier than this if you have good support at home from family and friends.
This time is your opportunity to rest after the birth and start to learn to care for your newborn baby. The midwives will guide and support you if you wish to breastfeed. St John of God Hospital has several specialized Lactation Consultants who are available to assist if there are difficulties. You will also be given education on changing nappies, bathing your baby and other important practical tips.
Your family and friends will be very excited and keen to visit. We suggest you try to limit visitors for the first few days to give you plenty of time alone with your baby and partner, and maximize the opportunity to learn from the midwives.
Your Obstetrician will see you for a postnatal visit around 6 weeks after the birth of your baby. This is a great time for you to raise any questions regarding the birth and postnatal period, and an opportunity to 'debrief'.
You will have a quick examination to ensure you have healed from either the Caesarean or vaginal birth and a Pap smear can be done if it is due. Your Obstetrician will not check the baby (this is for your Paediatrician or GP to do), however you are very welcome to bring him/her alone for a cuddle or photo opportunity.
There will be discussion regarding contraception and any other relevant issues. This is also a good time to discuss any concerning psychological symptoms in case you are developing postnatal depression.