Maternity (Obstetric) Care

Ben

Please Note: Anyone who has recently become pregnant (or is planning to), should start taking Folic Acid 5mg IMMEDIATELY
It has been shown that 0.8mg reduces Spina bifida risk by about 80%, while 5mg [funded], if taken early enough, reduces spina bifida risk close to zero and reduces cleft palate and hare lip risk. I don't recommend other supplements, you are best to ensure an adequate diet.
You are also advised to stop smoking cigarettes or Marijuana, drinking alcohol or using any other recreational drug (don't wait till your first visit)!

The large Dunedin prospective study has also shown that stress in pregnancy is a large determinant for adverse outcomes in children. Stress is our body's response to danger and uncertainty (the "fight or flight" response) so my advice is 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 not just no point in getting frustrated and stressing over things one has no control over, it has been shown to create a demanding, fretful baby, a selfish child, a delinquent youth and often a criminal adult, so accept what you can't change (or get help from someone who can change it) to avoid putting your child's personality at risk!

Until recently, 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, the Practice can NO LONGER offer:
  • 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.

  • U/S scanAntenatal Screening. 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.

The Practice currently continues to offer:
  • U/S scanPre-pregnancy Screening and advice (not covered by maternity funding). We can refer for genetic screening (if at increased risk) or genetic counselling. Some women may be at particular risk from diseases such as toxoplasmosis and may wish to screen for immunity but in most cases standard antenatal blood testing isn't required. Far more importantly, it is sensible to stop all smoking, drinking and recreational drug use and have a chat about any regular medication you are taking to see if it is safe or even necessary in pregnancy. Starting Folic Acid before conception provides much higher protection.

  • Vaccinations of my 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 as Boostrix during the second or third trimester (aim about 30 weeks) in order to provide protection to the baby until the 6 week vaccination. -strongly recommended
    • Free antenatal Influenza vaccination at any stage of the pregnancy (recommended, probably best given when having the Pertussis shot)

  • Six week baby check and vaccination of my patients -who have been delivered under a hospital team or by a LMC (Independent Midwife or Obstetrician).

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