Dr. Kiesey-Calding is an accredited fertility specialist, working with Queensland Fertility Group (QFG). Your first fertility appointment allows time for a full and thorough assessment of both yourself and your partner. Indeed, because fertility if a “team” event, we will need your partner formally referred to Dr. Natalie as well as yourself, to allow consultation for both of you. After your initial work-up, a plan of management will be instigated working with you both to achieve pregnancy with the least intervention possible. Systematically excluding reversible forms of subfertility, Dr. Natalie will continue to work with you to achieve a pregnancy. This may include testing the patency of the fallopian tubes (checking that the tubes “work”) with a special ultrasound called a HyCoSy done on-site at the rooms on Martyn Street. If needed, Dr. Kiesey-Calding will elevate your journey to parenthood and access the newest artificial reproductive technologies to enable you to achieve your family goals via IVF.
This is done under ultrasound guidance and usually takes about 30 minutes from the start of the consultation to finish. Full written information is provided and any questions answered. Then the actual procedure is carried out and the amniotic fluid obtained sent to the laboratory in Brisbane for testing. A FISH (DNA probe test) result is available within 48 hours in most cases with full culture back usually by 10 days, although this can take up to three weeks. Written advice on what to do and what NOT to do pre and post procedure is given, as well as any sick notes that may be required.
There will be a small out of pocket cost associated with these technically very difficult tests. This is solely at the discretion of the laboratory and not under the control of Cairns Obstetrics and Gynaecology. Please contact our administrative staff for more information on this and contact numbers for the laboratories if required.
This is an invasive procedure, and as such, should be taken seriously. Miscarriage rates are quoted as 1 every 200 times, and to minimise this, Dr. Kiesey-Calding would like you to arrange the day of the procedure and the following day off work.
For the week following the procedure, you should operate at "low activity" and take things very easy. You should not exercise, but gentle walking is okay. If you have a sedentary job, then going back to work should be okay after a couple of days, but not if you have an active job. Travelling should be curtailed for the week following the procedure.
You should not have intercourse for about a week after the procedure. Please arrange for someone to bring you to the rooms for the procedure, and then to take you home afterwards.
If you are a Rhesus negative blood group, you will have an injection of Anti-D at the time of your amniocentesis. This will cover you for the next week or two, but if you have any vaginal bleeding or any trauma to the abdomen, please contact the rooms to discuss the need for a further dose.
After the procedure, you will need to rest for about half an hour at the rooms for observation. You will be encouraged to eat and drink whilst you are here.
Please click here to access a patient information pamphlet
This is a special facility for patients of Dr. Kiesey-Calding. Staffed by our midwife, women with a need for increased monitoring (eg for increased blood pressure, CTG's (see below) etc, are able to attend outside their scheduled visits. Our experienced midwife is available to you during Tuesday to Thursday to give you unparalled access to a midwife who is both familiar to you and has been involved in your care from the beginning of your pregnancy. With close liason with Dr. Kiesey-Calding, a full assessment can be made in a timely fashion, and appropriate action taken. As this is all done on site, there is no loss of time in attending different places for care (for example, to get an ultrasound done, or CTG monitoring done at the hospital). So if everything is okay, you are in, checked and then good to go.
CTG monitoring is done to measure baby's overall activity and cardiac reserves. It is similar to an ECG done on adults to examine the heart, and uses a microphone strapped against a pregnant abdomen to pick up the fetal heart rate. This is then recorded on graph paper over about 30 minutes. As well as the fetal heart rate, any uterine activity ("tightenings" or contractions) will also be recorded, ensuring a full data set for intepretation. This is usually done in our day pregnancy unit, in an armchair for your comfort and privacy.
Testing of your pregnancy can start even prior to conception as well as in the first trimester of pregnancy (between 10 weeks and 13 weeks + 6 days of pregnancy).
Then at around 20 weeks of pregnancy, the anatomy of the baby becomes more clearly visible and can be assessed on ultrasound – the “morphology” or “anatomy” scan.
Prior to conception, it is possible to test you (and your partner as necessary) to see if you carry the genes for the 3 most common genetic diseases in our community:
This is only a problem if you both carry the gene(s) and then, only a problem in 25% of resulting pregnancies. If it is found that you both carry the genes for one or more of these conditions, then you will have time to consider your options for testing in your pregnancy. Dr. Natalie offers a comprehensive counselling service around all results.
For those families who choose to test their pregnancy for abnormality, Cairns Obstetrics and Gynaecology are proud to be able to offer testing using the very latest techniques, which are non-invasive and low risk.
These comprise the Nuchal Translucency Screen (NTS) as well as the Non-Invasive Prenatal Testing (NIPT). Dr. Kiesey-Calding is the only obstetrician in Cairns to be accredited to perform her own nuchal translucency ultrasound. After a comprehensive discussion about tests available, blood tests will be booked around your ultrasound so that results can be discussed in “real time” and all concerns answered at the time of the scan instead of having to wait for a report. In the event that further testing becomes necessary, this can then be arranged seamlessly and quickly, to support you the very best way we can.
The NIPT test has lots of different trade names, but they are all looking at fetal DNA in mother’s blood. It aims to identify if there is any extra genetic material for chromosomes 13, 18, 21 and the sex chromosomes. This doesn’t mean that you have to find out the sex of your baby, just that Dr. Kiesey-Calding will be able to reassure you that the baby has a normal number of sex chromosomes – the X and Y chromsomes. This test is approximately 99% sensitive, but as it is not 100%, it is still seen as a screening test. Any concerning reports would need to be confirmed with a diagnostic test before any therapeutic action was taken. Diagnostic tests are Chorionic Villus Sampling (CVS) and Amniocentesis and carry with them the risk of miscarriage – which is why the screening tests are able to avoid the need in most cases to have these tests at all.
The NTS is still an important part of screening, however, if you are having a NIPT test, this is a much more sensitive test to give you information about your baby’s chromosomes. The NTS will give you:
So the NIPT and the NTS work very much “hand in hand” rather than “either/or”.
When you book for your pregnancy, you will be given detailed information as well as the opportunity to discuss any questions you might have about the testing available.
As knowledge is power, please feel free to access the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) by clicking here, to read through patient information pamplets on the common obstetric and gynaecological conditions/procedures.
Questions about immunisations? Access excellent, evidence based information by clicking here to access the SARAH project from the NCIRS (National Centre for Immunisation Research and Surveillance) to help parents feel confident about immunisation.
The day before your appointment, a text is sent to your mobile to ensure that it is still convenient for you to attend. A simple "yes" or "no" is all that's required to text in return. If "no" our staff will contact you to arrange a re-schedule if required.
These are located within the rooms themselves; big enough to accommodate a pram, this means that toilet stops with toddlers hopefully become a little easier!
There are three off street dedicated parking spaces for the practice and ample street parking available on both Martyn Street and on Draper Street, with the driveway running through from Martyn Street to Draper Street in a "one way" arrangement.
Self explanatory: and it's really great coffee!
Post the delivery of your baby, the biggest challenge of all is often successfully breast feeding your infant. Cairns Obstetrics and Gynaecology offers a private environment, with a midwife that you have already met and feel comfortable with during the course of your pregnancy to help you with these challenges in those first few weeks following birth.
We acknowledge that your time is as valuable as ours, and for the convenience it offers we have the facility to take any blood tests that you may require for your clinical care, excepting screening for diabetes of pregnancy. Done by our friendly (and gentle!) midwife, this service is an exclusive feature to smooth the journey of your pregnancy. Likewise urine testing or microbiological swabs can also be collected and sent via courier to the laboratory. For testing for diabetes of pregnancy, this requires specific timing, and is done at the collection centre for the laboratory. QML has a collection point located just behind the rooms, open every morning until noon.