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:
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.
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.
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.
|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:
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.
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.
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!
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.
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.
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.
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.
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.
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:
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.
Head Office: 9885 0855
Breastfeeding Helpline: 9885 0653
Telephone: 9513 1383
Telephone: 9836 7382
Support Line: 9836 7677
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.
ABOUT 1 TABLESPOON
Raw is best
Have a citrus fruit daily
AT LEAST 3 SERVES
Raw or lightly cooked and a variety of colours.
AT LEAST 2 CUPS
See the hospital dietician for special advice.
MILK: SKIM OR LOW FAT
Drink or use in junkets, cooking etc. One cup of milk is the same as:
AT LEAST 3 CUPS
WHOLEMEAL KINDS ARE BEST:
AT LEAST 4 SERVES
AT LEAST 6 GLASSES
Cut off the fat first
MINIMUM 100-200 G (3-6 oz)
Also 3 eggs per week
TO HELP YOURSELF:
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:
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
If you are prescribed extra Iron:
Iron can make your bowel actions black. THIS IS NOT HARMFUL. If constipation occurs, follow the advice in the pamphlet.
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:
IF YOU DON’T TAKE DAIRY PRODUCTS, PLEASE TELL YOUR DOCTOR OR MIDWIFE
Takeaways and frozen dinners are often:
Because your still growing, you need EXTRA nourishment, for YOUR growth AND that of your baby. Be very sure that you choose good foods.
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.
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!
For this very common problem:
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:
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.