The first visit is usually made at about 8 weeks :
Booking involves a thorough medical history and examination, confirmation of the expected due date for baby by ultrasound examination as required and identification of any risk factors for the pregnancy. There is also a discussion regarding antenatal screening and diagnostic tests for abnormalities of numbers of chromosomes, the most common of which is Down syndrome or Trisomy 21. Any notes from your previous medical history that may be required will be requested, and routine antenatal blood tests will be checked. After this initial assessment, the next visit is usually at 12 weeks, when the nuchal translucency scan is performed. You will have a risk assessment discussed with you immediately after the examination, so that if you fall into the high risk group, then there need be no delay arranging a diagnostic test as required.
At 16 weeks is dedicated to confirming that all is still going well with baby. Most women are not yet aware of movements, and it is very reassuring for all concerned to hear babies heart beat!
At 20 weeks it is time for the next detailed structural ultrasound; the so-called morphology scan. This is where every part of baby is scrutinised for normality, the placenta is checked by ultrasound and there is an opportunity to discover whether you are expecting a son or a daughter. 3D and 4D imaging is also done, but the quality of the pictures obtained will always depend on the position of the baby, and whether they want their photo taken that day! You will receive a CD of J-peg images of baby as well as some hard copies to enjoy on the way home.
At 24 weeks marks the start of the growth period of baby. The physicality of the pregnancy is starting to make itself felt and this can bring a new set of challenges to the expectant mother. It is also the time we routinely arrange for screening of mother for gestational diabetes and checking haemoglobin levels and iron studies for anaemia. We also check to make sure that you have addressed all the booking paperwork for the hospital.
By 28 weeks the results from the recent blood tests will be reviewed with you, and any action taken that may be necessary. Extra time is allocated at this visit for an ultrasound of baby to identify if there should be any concern clinically regarding growth and/or well-being.
At 30 weeks growth of baby is again the main thing that is assessed, this time by clinical examination and then ultrasound as required. If you are planning a caesarean section birth, booking for this with all the attendant paperwork is done at this visit.
At 32 weeks a serial growth scan is usually done to document the baby's growth velocity in comparison to previous measurements.
At 34 weeks we start getting birth ready. We are realistic at Cairns Obstetrics and Gynaecology that a birth plan is not possible - the baby is in charge, and we are all just along for the ride! Accordingly, it is very important to talk through any concerns or thoughts you have about birth, and to be ready for them. Any specific issues will be noted down, and the routine aspects of birth with measures for baby and measures for you will be addressed. We try and avoid plans as it is very rare that every point of expectation is met, which can then induce a feeling of frustration and/or failure, which are all negative emotions that should be avoided if at all possible. A positive mental attitude is always going to be part of a positive birth experience, and we are keen to help you have just that.
At 36 weeks you have your last set of routine blood tests, checking your haemoglobin, iron studes and antibodies in the blood. You are also invited to take a perineal swab looking for a bug called GBS or Group B Streptococcus?. This is present in about 15% of the population and is NOT a sexually transmitted infection (or STI). Outside the labour room, there is no need for treatment as long as there are no symptoms, however babies born through this bug can have trouble with infection. Therefore, it will be important for you to have antibiotics once your labour has established and especially once your membranes have ruptured. This will be discussed in detail with patients who are positive for GBS.
Your visits from 37 weeks through to term are taken up with continuing monitoring of maternal blood pressure, and the position of the baby and it's readiness for birth. All results are reviewed and compiled. It is also the opportunity to re-visit specific aspects of your antenatal education (whether that be through Cairns Obstetrics and Gynaecology or through your hospital) that you might feel need further attention. Term is technically anywhere between 37 and 42 weeks of pregnancy, so baby might arrive any time!
Once you reach your due date (remembering only 13% of babies arrive on their due date) care centres around the imminent birth. It is important not to rush the natural process of labour, and we don’t tend to expect baby prior to the expected date. However, this is always on a case-by-case basis, and depends on the medical situation for mother and baby.
The birth of your baby is always exciting, and we will work hard to try and ensure that it goes as smoothly as possible. The hospital that you are booked to will be the first port of call if you think labour has started, but during business hours you can also contact the rooms. Dr. Kiesey-Calding will review you at the hospital as appropriate, and then stay in close contact with the midwives caring for you there. After the happy event, most people will stay in hospital for about 5 days, again depending on their medical condition and experience with parenthood.
Your post delivery visit is usually at 6 weeks post the birth. This is where any medical issues that arose during pregnancy are reviewed and a follow-up plan made. Any repeat blood tests will be organised and a Pap smear performed if required. Wounds either from a caesarean or from a tear/episiotomy are checked for proper healing and a discussion had about contraception, with prescription as needed. We also welcome the opportunity for a little cuddling of the new arrival!