Maternity (Obstetric) Care

Please Note: Anyone planning a pregnancy (or is pregnant), should START taking Folic Acid and STOP alcohol IMMEDIATELY The 0.4mg (400mcg) folate dose found in some multivitamins reduces Spina Bifida risk by about 75%, the recommended 0.8mg (800mcg) Folic Acid dose reduces Spina Bifida risk by about 80%, while the 5mg taken pre-conception, reduces incidence close to zero AND also reduces Cleft Palate and Hare Lip risk. Recent concerns about doses over 1mg (1,000mcg) having possible small development effects in childhood means the 5mg dose is probably best restricted to those with a history of congenital defects (like a previous Spina Bifida child). Low dose Iodine (eg Neurotab 150mcg) should be prescribed by your Lead Maternty Carer (see LMC below) from confirmation a pregnancy until discontuation of breast-feeding (Ministry of Health recommendation) to prevent low iodine levels affecting thyroid function and normal brain development.

There are no known harmful effects on the development of the baby from taking 0.8mg folate (folic acid) or 100mcg iodine but there are a number of recent studies and reports showing taking other supplements (especially anything containing Vitamin A) increases abnormalities when compared to a healthy and balanced diet so I do NOT recommend other supplements, including Elevit. Your money is better spent on fruit, vegetables, mixed nuts, eggs etc. Eating cooked locally caught fish is fine but it is advised to avoid "top of the food chain" marlin, swordfish, tuna and shark (mercury risk). See Pregnancy and healthy eating (Food Standards) and Pregnancy nutrition (Plunket) where there is evidence based advice on best nutrition and which foods to avoid. New Zealand has a real problem with Fetal Alcohol Syndrome and other drug related developmental disorders so women are strongly advised to immediately STOP using alcohol, cigarettes, marijuana or any other recreational drug when planning a pregnancy or if they find they are pregnant. It is also very important if you are on any regular medication, please contact the surgery as soon as possible for advice if this is safe or necessary to continue or change (may need GP appointment). This is particularly important for medications that affect blood pressure (especially ACE-inhibitors), brain (anti-seizure, anti-anxiety, lithium and some anti-depressants) as well as anit-inflammatory, anti-biotic and decongestant treatments. The large Dunedin prospective study has also shown that stress in pregnancy is a large determinant for adverse medical and social outcomes in children. Stress is our body's response to danger and uncertainty (the "fight or flight" response) so my advice is to minimise your stress by sorting out your response to potential "stressors". Work on ways to deal with issues, how you will plan for the arrival of a baby in your life, how you and your partner will manage differences and uncertanties and most importantly, learn to accept things you cannot change. There is just no point in getting frustrated and stressing over things one has no control over, in fact it has been shown to create a demanding, fretful baby, a selfish child, a delinquent youth and often a criminal adult! Particularly in pregnancy, "stress" is not "cured" by drugs (prescribed or not), including alcohol and nicotene, so if you need help a Pyschologist and/or Cognitive Behaviour Therapist are you best resources.

Until 2018, I remained one of the only GPs in New Zealand providing full maternity services including emergency back-up to local Independent Midwives. However, for legal and self-preservation reasons, I can NO LONGER offer funded maternity services, in particular: ❌ Full antenatal and labour care Please contact the surgery for a list of available Lead Maternity Carers (LMCs) if you have any doubts. In general we recommend a specialist obstetrician or an Independent Midwife who is also a Registered Nurse. ❌ Partial antenatal care You will need to have all care from your LMC and any specialist providers they refer to. ❌ Emergency Obstetric support to local Independent Midwives. Your LMCs will need to arrange timely transfer to Base for any labour complications that cannot or should not be managed in Hawera. ❌ Antenatal Screening (in pregnancy). Your LMC will generally refer you for a 12 week MSS1 (including a "Nuchal Translucency" scan to determine the risk for trisomy, which includes Down Syndrome) and a 20 week morphology Ultrasound screen is also usually offered. ❌ Stem Cell collection for banking. HOWEVER, our Practice currently continues to offer: ✅ Pre-pregnancy Screening and advice (not covered by maternity funding). Screening women for immunity who are at risk of toxoplasmosis exposure (such as vets). Review of current medication to ensure it is needed and safe and if not what are your alternatives? Even more importantly, it is sensible to stop all smoking, drinking and recreational drug use, as well as starting Folic Acid before conception order to achieve much higher protection than waiting until pregnant. ✅ Pregnancy related Vaccinations of our patients (usually with the Practice Nurse) ✅ Free pre-natal Rubella vaccinations for anyone not protected (eg a negative Rubella screen in a previous pregnancy) -strongly recommended; ✅ Free antenatal Pertussis (Whooping Cough) vaccination around 30 weeks (provides vunerable newborn protection to 6 weeks) -strongly recommended; ✅ Free antenatal Influenza vaccination at any stage of the pregnancy (also recommended, probably best given when having the Pertussis shot); ✅ Six week baby check and vaccination of my patients -whether delivered by hospital team or LMC (Independent Midwife or Obstetrician).