Information on Antenatal Care
Below is a brief overview of our services at Women’s Heath on Strickland, what you can expect and useful information you may want to discuss further. If you have any urgent questions, please feel free to phone the practice, and either the doctor or a midwife will return your call.
The First Visit
At the first visit, you will meet one of the midwives and your doctor. The visit will usually take at least one and a half hours. The midwife will complete an antenatal card which is a summary of all information, tests and findings which are relevant to your pregnancy. There are two copies of this card, one will remain in the office and the other will be given to you. It is important for you to carry this card with you at all times and bring it with you each visit as it provides universal information to health carers should you require medical attention in an emergency. You should also take it with you when you visit a GP. When you’re in labour, you will need to take it to hospital as it will provide the midwives with a complete picture of your pregnancy. An instruction form for online registration to Calvary John James Hospital will be given to you. Once you have submitted this, you will be sent information at around week 25 on antenatal classes and, what to bring when you go to hospital. If you are delivering at another hospital, information about booking will be given to you.
After seeing the midwife, you will meet your obstetrician to go through any issues that have arisen when your card was completed, complete a brief physical examination and address any concerns you may have. There is an ultrasound machine in the rooms which allows for an early assessment of the baby if required (there will be an extra charge for this ultrasound scan.) Your doctor will also talk to you about testing that is available to detect if your baby has a chromosomal problem (eg: Down syndrome). If you haven’t had any antenatal blood tests then these will be arranged.
Soon after your pregnancy is confirmed, a number of blood tests are taken. These may be ordered by your GP or at your first visit. These include:
- A full blood count (FBC) to check that you are not anaemic and that your platelets (cells involved in clotting) are normal.
- Your blood group and antibodies. If your blood group is negative, you will be offered an injection called anti-D if you have any bleeding or an invasive procedure during pregnancy and routinely at 28 and 34 weeks. Your baby’s blood group will be checked at birth (from blood taken from the cord) and if it is positive, you will be offerred anti-D. If you have any antibodies (a rare condition) in your blood, this may affect the baby. More information will be provided if this is the case. There is a brochure available in the waiting room that contains further information on the significance of a negative blood group.
- Rubella immunity is checked as, although most teenagers are immunized, immunity is not always life long. If your immunity is low or absent, you will require re-immunization after the baby is born.
- Hepatitis B is checked as a small number of women will have had this viral infection, and do not eliminate it from their bodies (chronic carrier). If this is the case, the baby will be given an injection for further protection as well as the routine immunization at birth.
- Syphilis: Although this is quite rare, it can have major effects on the baby which is easily prevented by treatment, therefore it is a national recommendation that all pregnant women are screened.
- You may wish to have a test for Hepatitis C and HIV if this has never been checked or not checked recently. This is not universally done.
At 26-28 weeks it is recommended you undergo a Glucose Tolerance Test for Gestational Diabetes. This involves drinking a bottle of soft drink (provided by pathology) that contains a known sugar load. A blood test to measure the glucose level in your blood is then taken one hour and two hours later. You will need to set aside this time as you are asked not to move around during this time. If you would like further information about the effects and treatment, please ask at your visit. If your blood group is negative you will also have a recheck of your antibodies.
At around 36 weeks we like you to have a test for the presence of Group B Streptococcus. There is a page attached that gives you the information about Group B Strep testing.
Testing for problems with the baby
There are a number of tests available to help increase our detection rate of foetal abnormalities. Unfortunately, these tests cannot detect everything, and there will still be a small number of babies born with unexpected problems.
When you come for your first appointment you will be offered an ultrasound to check dates and confirm everything is progressing normally. This is optional and will be discussed at the time. If you would like an ultrasound I will try and provide a small picture for you.
Screening for Down Syndrome
This is an optional test that gives a risk of the baby having Down syndrome and other rarer chromosomal abnormalities. It involves an ultrasound where the thickness of the skin fold on the back of the baby’s neck is measured and blood tests are done to assess individual risk ratio. This carries no risk to the pregnancy. This ultrasound is done at one of the specialist radiology practices as they have access to specialist software to calculate the risk ratio. More information can be found in the brochure on ‘Screening for Abnormalities’. If you have an increased risk, then you may want to consider having a diagnostic amniocentesis, CVS or further blood testing.
This is general “top-to-toe” look at the baby to make sure there are no structural problems with the baby. Examples of conditions that are occasionally detected can be life threatening problems such as spina bifida and heart defects or more minor problems such as cleft palate and club feet. This is again performed at a specialist radiology practice at around 20 weeks.
Growth and Progress Scans
Sometimes if there are any concerns about the wellbeing of the baby or concern about how it is growing a growth scan is done. Most of these can be done in the office at the time of an antenatal visit and will be discussed at the time. Sometimes it is necessary to get more specialised opinions (such as if you have twins) and you will be referred externally, most commonly to the Canberra Fetal Assessment Centre.
There are 2 types of testing (invasive and non-invasive) available to detect whether your baby may have Down syndrome or some other similar problem. These are available to everyone, regardless of age. Although the risk of these problems goes up with maternal age, the actual number of babies with these problems is greater in younger women, simply because there are more of them having babies. Whether you have testing is a personal decision, and it is available to everyone.
The Harmony prenatal test is a non-invasive test that detects three primary chromosomal abnormalities – trisomy 21, 18 and 13 – from a single blood test. This non-invasive test has a 10 day turnaround time, as it is sent to America, where testing has been available since 2012. Please note this test is not rebatable from Medicare and will incur a $490.00 out of pocket fee, which has to be paid at time of testing. For further information just enquire at your visit.
Antenatal visits are scheduled every 4 weeks until 28 weeks, 3 weeks until 36 weeks and then weekly until your baby is born. If there are any complications these may be more frequent, and if all is well, they may be slightly less frequent. If you remain well, the pregnancy may go for 10 days after your due date before induction is considered.
There may be times when, for unexpected clinical reasons, an appointment will take longer than normal causing delays. If you wish to discuss non-urgent issues with your Doctor that may extend your time significantly we would be happy to make a longer appointment for you, there will however be an extra fee.
If you wish to make an appointment with one of our midwives to discuss non-urgent issues you are very welcome to do that and there is no cost.
Your Doctor will always ensure that your questions are addressed in full but they have very full appointment schedules and need to be able to see all their patients within a reasonable timeframe.
Dr Gallagher and Dr Adham work full time and are on call at all times during the week. On weekends, they share a roster with several of their obstetric colleagues. They are all qualified specialists in obstetrics and will provide you with very good care in any absence.
After your baby is born a paediatrician will check the baby while you are in hospital. The paediatricians who work at Calvary John James Hospital send their own invoice, which you can claim from Medicare and your private health fund. If your baby is admitted into the nursery for special care you will be able to claim from Medicare and your private health fund. It is important to check with your health fund that your baby will be covered after birth if admitted to the special care nursery.
If you require an anaesthetist for an epidural or other form of anaesthesia, they will also issue a separate invoice that is claimable from Medicare and your Private Health Fund.
Private Health Cover
Please ensure that you are fully covered for Calvary John James Hospital or Calvary Bruce for the birth of your baby. If your Private Health Cover is a “Single or Couples Cover” you will be covered for your admission to John James but if your baby requires medical attention in the Special Care Nursery it may not be covered and there will be an additional account from the hospital. 10-15% of babies are admitted to the Special Care Nursery for unexpected problems. Jaundice, breathing problems and low blood sugars are the most common. We suggest you discuss this with your health fund and ask specifically about cover for the baby. You may need to upgrade to family cover otherwise there may be costs involved.