Maternity Information Package 1

Maternity Information Package Your guide to , Birth and Early Parenting

Women’s, Adolescent and Children’s Services Contact Telephone Numbers

If intrastate and urgent assistance or advice is required contact: Launceston General Hospital (03) 6777 8960 Mersey Community Hospital (Latrobe/Devonport) 1800 940 766 North West Regional Hospital (Burnie) 1800 940 747 Royal Hobart Hospital Pregnancy Assessment Clinic (03) 6166 8352 Ambulance Tasmania 000

When you should contact the Pregnancy Assessment Clinic; Birth Suite or your health provider: • If your baby stops moving or there is an obvious reduction or change in your baby’s movements at any time in your pregnancy. Please refer to page 17 for further information or https://sanda.psanz.com.au/resources/pregnancy/ or stillaware.org • Trauma to abdomen, assault, serious fall, or car accident • Sharp pains in your abdomen with or without bleeding • Vaginal bleeding at any time • Recurring and persistent headaches; • Persistent itchy skin, especially of hands and feet • Sudden onset of swelling to face, hands or feet • Blurred vision or spots before your eyes • Pain or burning when you pass urine • Labour has started and you feel it may be time to come to hospital • You are at home labouring and require advice or reassurance from a • If you are less than 36 weeks and are experiencing contractions or leaking amniotic fuid (from around the baby) • (leaking fuid from around the baby) and you are concerned about the colour/odour, or labour does not commence • You have been told your baby is NOT head down and start to labour or rupture your membranes • Booked for a caesarean birth and labour starts • If you identify any other pregnancy related concerns that you need advice for prior to your next antenatal appointment • Severe nausea and vomiting Congratulations on your pregnancy and welcome to The Tasmanian Health Service Womens Adolescent and Children’s Services (THS WACS)

The Tasmanian Health Service believe it is your right to receive care which is of a high standard in accordance with the Australian Charter of Healthcare Rights (www.safetyandquality.gov.au). Our aim is to provide safe, well planned and well communicated care through a collaborative approach where you are encouraged to be actively involved.

This booklet has been designed to provide you and your family with valuable information regarding pregnancy, birth and early parenting. You are encouraged to adopt an active role in your pregnancy and to be involved in making informed decisions about your care. Whilst this booklet is comprehensive we may not have provided all the information you feel you require and suggest that you attend our antenatal classes, talk with staff and refer to recommended resources such as The Raising Children Network (www.raisingchildren.net.au). We recognise that everyone learns differently so please use the approach that benefts you best to allow an informed pregnancy journey and transition into parenting.

Further THS WACS continually strive towards improving our services and value your feedback.

‘Nothing About You Without You’ 2 Your Rights

Your Rights Everyone has the right to feel safe and be safe Rights and responsibilities - partnership with a health professional what you should know as regarding your treatment; STOP FAMILY VIOLENCE a patient • Comply with your prescribed treatment It is a crime and help is available! or tell your health care professional of Your rights are: your intention not to do so; and Police Emergency for urgent help or reporting 000 • To receive free public hospital services • Conduct yourself in an appropriate way Court Support & Liaison Service as a public patient; so as not to interfere with the well- For victims of family violence to access and • To receive treatment on the basis of being or rights of other patients or staff. understand the legal system your health needs, regardless of your Freecall 1300 663 773 Patient medical records fnancial or health insurance status; Family Violence Response & Referral Line: • To have access to public hospital You have the right to ask to see Freecall 1800 633 937 services regardless of where you live information about you retained by Crisis Counselling: Freecall 1800 608 122 in Australia; the THS, in accordance with the Right to Information Act 2009. A fee may Court Support & Liaison Service For victims • To be treated with respect, compassion be incurred if you require copies. of family violence to access & understand and consideration of privacy which takes Confdentiality of your records is required the legal system: Freecall 1300 663 773 into account your background, needs under the Privacy Act 1988. Confdential and wishes; information including treatment details Emergency Shelters 24 hour • To participate fully in the decisions about will not be released without your consent. Services - Women & Children your care including admission, discharge Launceston and arrangements for continuing care; Open Disclosure Magnolia Place • To be given a clear explanation of the All THS hospitals respect this right, and Womens Shelter: (03) 6344 5322 proposed treatment including risk and are committed to improving the safety Karinya Young alternatives, before you decide whether and quality of care we deliver. That’s why Womens shelter: (03) 6331 0774 you will agree to the treatment; we have a policy of open disclosure for Yemaya Womens • To seek a second medical opinion; when things go wrong with the care we Support Service: (03) 6334 0305 • To give your informed consent (except provide. Open disclosure assists patients Young Mums & in exceptional circumstances) before when they are unintentionally harmed by Bubs Support (03) 63 34 8403 their health care. a procedure is carried out, including Weekdays 9am - 5pm consent to participation in under- For further information visit the Australian Launceston - Laurel House Sexual Assault graduate health professional teaching Commission on Safety and Quality in Support Service (03) 6334 2740 or medical research; Health Care website State-wide 1800 697 877 • To withdraw your consent or refuse www.safetyandquality.gov.au further treatment; North West Warawee Women’s Shelter (women and • To have access to information contained Security women with children): (03) 6425 1382 in your medical record; Any behaviour which disrupts the ability of our staff to fulfl their duty of care to Oakleigh House (men, • To expect that information about your women and families) (03) 6431 5791 hospital care will be confdential unless patients will not be tolerated. It is also our the law allows otherwise; right to be safe at work. Youth, Family and Community Connections - Burnie Youth Accommodation Services • To receive interpreter services if you are Should you, or your visitors, display (male and female 13-20 years) experiencing diffculty communicating such behaviour you/they may be (03) 6431 9230 with staff; and asked to leave. Youth, Family and Community Connections • To commend health workers, to - Youth Crisis Accommodation Service (male complain about your health care and/ Consumer Liaison Feedback and female 13-20 years): (03) 6424 7375 or to be advised of the procedure for If you are worried about anything to Wyndarra Centre Inc.: (03) 6452 1981 expressing concern about your care. do with your hospital experience please feel free to let us know. By providing us West Coast Crisis Accommodation and Your responsibilities with your valuable feedback we have the Referral Service: (03) 6471 4748 or There are a number of things that you can opportunity to continually improve the 0409 197 031 do to help health workers provide better service we provide. All calls are treated in the strictest care for you. You should: of confdence; if preferable you do not have to provide your name. • Provide information that enables Inpatient Experience Survey health care professionals to give you You can also speak with one of our The THS also provides the opportunity for Social Workers whilst accessing appropriate care and advice; feedback through an inpatient experience care at any stage. • Treat seriously any decision made in survey available at your hospital. Contents

1. Pregnancy care in 3. A healthy pregnancy your area Health advice and choices 20 North Emotional changes 20 Options of care during pregnancy 5 Braxton Hicks contractions 20 Antenatal education 6 Exercise 20 Perinatal and Infant Mental Sex during pregnancy 20 Health Service 6 Sexually transmitted 21 Pregnancy Assessment 6. Your baby is born Fasting 21 Centre (PAC) 7 Skin to skin contact Social Work Department 7 Traditional cutting / following birth 41 Maternity Unit patient accommodation 7 female circumcision 21 Arriving at the Maternity Unit Dental care 21 Your body after birth 41 for Elective Admissions 8 Venous Thromboembolism 21 Keeping your infant safe 41 Visitors 8 Natural or alternative remedies 21 Parking 8 Prevention of falls 42 Vaccination advice 21 Students 8 Sex and intimacy 42 Diet and pregnancy 22 Interpreter service 8 Look after yourself 42 Aboriginal Health liasion service 8 Food safety and hygiene 23 Feelings 43 Refugee/Migrant liasion offcer 8 Alcohol in pregnancy 24 Smoking 8 Smoking in pregnancy 24 Stress management Television 8 for parents 43 Kiosk 8 Use of drugs in pregnancy 24 Meal times 8 Physiotherapy 44 Safety - small electrical appliances 8 Neonatal paediatric Booking tests and where to go 8 intensive care unit (NPICU) 44 North West Care of your baby 45 Options of care during pregnancy 9 4. Labour and birth Getting to know your baby 45 Antenatal education 10 What you will need to bring Perinatal and Infant Mental into hospital 26 Baby’s communication 46 Health Service 10 What you will need for your Settling techniques 46 Pregnancy Assessment baby at home 26 Safe sleeping 47 Centre (PAC) 11 Labour and birth 27 Social Work Department 11 Immunisations 47 How do you know you are Maternity Unit patient accommodation 11 Plagiocephaly 47 Arriving at the Maternity Unit in labour 27 for Elective Admissions 12 Delivery of the 27 Screening tests for your baby 48 Visitors 12 Pain and labour 28 Pets and bringing baby home 48 Parking 12 External Cephalic Version Planning your discharge 48 Students 12 (ECV) 29 Interpreter service 12 Transporting baby home 48 Prolonged Pregnancy 29 Aboriginal Health liasion service 12 Extended Service Refugee/Migrant liasion offcer 12 Induction of labour 29 (EMS) 49 Smoking 12 Assisted births 31 Television 12 Vaginal birth after Breastfeeding support clinic 49 Kiosk 12 31 Child Health and Parenting Meal times 12 Birth by caesarean 32 Service (CHAPS) 49 Safety - small electrical appliances 12 Booking tests and where to go 12 After the operation 33 Gateway Services 49 Antenatal tests 13 Medical pain relief options 33 Important decision for the Unexpected outcomes care of your baby after birth 14 of pregnancy 35 7. Twins and more 47 2. Your visits Visits, tests & baby development 16 5. Infant feeding Between 7 and 10 weeks 16 Infant feeding 37 Between 10 and 14 weeks 16 Breastfeeding 37 8. General information Between 16 and 20 weeks 17 Between 24 and 32 weeks 17 10 Steps to Successful Find out more about Your Baby’s movements 17 Breastfeeding 38 birth and parenting 52 34 weeks 18 Once the milk comes in 38 Index 53 36 weeks 18 Support after birth 39 A fnal word 57 38 weeks 18 Formula feeding 39 Acknowledgements 57 40 weeks 18 Infant tooth decay 39 41 weeks 18 1

Care in Pregnancy Pregnancy Care in Your Area - NORTH 5

during your pregnancy. Where possible the Options of care TEAM will be available to care Care in for you during birth and after your baby is during pregnancy - born. However, we cannot guarantee you pregnancy will have met your birth midwife. This gives Your care would have begun with North you the chance to get to know some of the midwives who may care for you. your General Practitioner (GP), At the THS we believe it is important to by confrming your pregnancy, involve you in all aspects of your care in taking a comprehensive medical Midwifery Group Practice (MGP)

pregnancy. Statewide services do vary so NORTH You will be cared for by a primary (and and obstetric history, ordering what is available in Hobart may be different backup) midwife who you will get to know pregnancy blood tests and an in Launceston or on the North West coast. well for your pregnancy, labour, birth and obstetric ultrasound, and a referral There may be circumstances when one or postnatal needs. This model of care offers to your closest THS public hospital more of these options may not be suitable that also indicates your preferred the most continuity possible and includes for you due to medical or other reasons. model of care. Please feel free to discuss your options a shorter hospital stay of 4-6 hours after After the THS receives the referral with your midwife and/or doctor. the birth. Then you will have one on they will look at the information one visits in your home for up to 10-14 Antenatal visits will not cover all your provided to determine the model days according to your assessed needs. educational requirements for labour, birth of care that best suits your needs. The pregnancy care will occur primarily and the transition to parenting. For this For some women the model of care in community clinics with the venue reason the THS recommends Birth and may not be determined until you negotiated directly with you. Parenting Classes along with any additional have seen a doctor at the hospital classes offered that may beneft your clinic. You will then be notifed Midwives Satellite Clinics specifc needs. Further, research supports by post of your initial appointment Satellite clinics make our services the benefts of attending a tour to familarise date and time for between 12 and conveniently available to women within yourself with the environment in which 14 weeks of your pregnancy. Your their local community. To fnd out if there you will labour and commence your initial appointment is attended by transition to parenting. Whilst on the tour, is a clinic in your area ask your midwife or a midwife. you will learn valuable information like after contact Women’s Health Clinic to fnd out If your care is to be provided hours access, parking possibilities, what what is available. The clinics are run by through Midwifery Group Practice happens in hospital and length of stay. midwives and are for normal risk women. (MGP) your midwife may phone In the THS midwives work in all models These midwives give antenatal care only you and arrange an appointment of care so if you have medical or other and will not be available for your labour directly, otherwise the appointment and/or birth. will be posted to you and may be circumstances resulting in the need for you scheduled within 4-6 weeks of the to be cared for in a medical clinic you will still Medical Clinic frst contact. see midwives during your antenatal visits. Women are referred to Medical clinics Exclusion from Midwifery based care may Women sometimes request that due to health needs. These models their care be provided by female occur if there is any deviation from a normal risk pregnancy, unless you are with MGP of care encompass a team approach health professionals only. At the between the obstetric doctors and the THS most of our midwives and where collaborative care may be given between your midwife and our doctors’. clinic midwives who are both available to many of our doctors are female. complete antenatal appointments. There However, it may not always be Some women receiving Midwifery care may are varying types of medical clinics available possible for you to see a female at be required to have an appointment with thus ensuring best care depending on your appointments or upon admission one of our doctors at 36 weeks due to a circumstances. If you are required to be to the hospital. Our staff respect medical reason like a previous caesarean birth cared for in one of our Medical Clinics the concerns some women may or diet controlled gestational diabetes. have about cultural and gender this may be discussed when you frst see issues and if possible will try and TEAM Midwives you GP or at your frst appointment at the accommodate your needs. You will be cared for by a team of Womens Health Clinic. midwives, in consultation with our doctors,

Launceston General Hospital Contacts QV Outpatient Department - Clinic (03) 6777 8980 Allied Health - Social Work (03) 6777 6245 Appointments & Enquiries 1300 977 694 Allied Health - Physiotherapy (03) 6777 6216 Birthing Suite - Ward 4B 24hrs Advice (03) 6777 8960 LGH Enquiries (03) 6777 6777 Pregnancy Assessment Clinic (PAC) 1300 977 694 LGH Radiology (03) 6777 6085 Birth & Parenting Classes Educator Enquiries (03) 6777 8995 NESM Hospital - Scottsdale (03) 6778 8529 Appointments 1300 977 694 Appointments & Class Enquiries (03) 6778 8522 6 Pregnancy Care in Your Area - NORTH

There are a number of different class Your physiotherapist will support you to It is very important structures designed to suit individual needs. be as physically active as you can be during that you come to Daytime, evening and weekend times your pregnancy. slots are available. It is best to attend Talk with you Midwife or Doctor for a referral. your birth & parenting classes from 26 all your antenatal/ LGH Physiotherapy (03) 6777 6216. weeks gestation onwards & Breastfeeding pregnancy checks, workshops from 34 weeks gestation. Breastfeeding Classes to ensure the Bookings for all classes are essential Breastmilk is the most nutritious food you and can be made through the can give your baby. Breastfeeding is natural well-being of you and QVOPD reception or by phoning but a learned skill. We recommend you 1300 977 694 between 8.30am and attend antenatal breastfeeding classes, your unborn baby. 4.30pm, Monday to Friday. which are available during the day and There is no cost if you have a Medicare card. evening. If you have specifc concerns you Share care with your GP can ask to book a one on one appointment Location of Classes with a lactation consultant. Your family doctor, in consultation with hospital doctors and midwives, will care for Launceston General Hospital Class Times: you. You still need to book in at the hospital QVOPD Function Room, 3rd Floor, LGH, Breastfeeding Session Times at the LGH: and then have visits at 36 weeks, if you are Charles Street, Launceston. Workshops are two hours in duration having a VBAC (vaginal birth after caesarean) We advise you arrive 10 minutes prior to and are held Monday evenings or planned caesarean section and if you are commencement time. fortnightly; Sundays monthly & Thursdays overdue. Some situations may exclude you monthly. Partners are welcome. from GP share care, those include high BMI, Scottsdale - NEMSH Classes twins, some medical health conditions or Classes are offered three times a year on Birth and Parenting Educator previous pregnancy problems. demand. Classes run over 4 weeks and last A referral from a midwife or doctor is for 2 hours. Please contact (03) 6778 8522 Perinatal and Infant Mental required but midwives working in this area for all enquiries & bookings can assist in the following circumstances. Health Service Birth and Parenting classes • People with specifc birthing and/or Social worker services are available at the parenting issues; We recommend you enrol in a birth and LGH to assist you with further referrals. • If this is not your frst baby but you parenting class, especially if this is your Please discuss with you midwife or require an update of information in a or your partners frst child. Birth and doctor or GP. specifc area. parenting classes are facilitated by midwives. The Mental Health Service Hotline The classes cover self help skills, an • Women having twins; is also available 24hours a day freecall understanding of labour and birth, feeding, • People from culturally and linguistically 1800 332 338. unexpected outcomes, natural and medical diverse backgrounds who require one Life Line: 1300 364 566 pain relief options to help make informed to one parenting discussions with an www.panda.org.au choices. Transition to parenting can be a interpreter; and www.beyondblue.org.au busy but exciting time. We offer you some • People who would like the opportunity www.cope.org.au strategies to cope with the early days at to debrief after a diffcult birth when home and give you information regarding booking in for subsequent . follow up support in the community. Antenatal education Tours of the Maternity Unit Please read the Maternity Information The Tasmanian Health Service (THS) Package (this booklet) prior to attending Tours of the LGH maternity facilities are Women’s Adolescents and Children’s the birth and parenting classes. conducted regularly. Service’s (WACS) offers a variety of antenatal class options. Antenatal classes are designed Session Times at the LGH Enquiries to the QVOPD reception or to help you with your physical, mental and telephone 1300 977 694 between 8:30 Fortnightly Saturday 6 hour daytime am and 4:30 pm Monday to Friday. emotional preparation for pregnancy, birth, workshop. early parenting and feeding your baby. Remember you need to book for all Alternating monthly Tuesday or The sessions are relaxed and informative, education sessions. Thursday evenings which run over giving you and your support person, the opportunity to meet other families and 4 sessions for 2 hours. All THS hospitals are accredited to discuss ideas, thoughts and choices for Physiotherapy Classes Baby Friendly Hospitals birthing and parenting. It is important to Physiotherapy may be able to assist you and follow the 10 Steps to book your classes early to ensure you do further with some of the common aches Successful Breastfeeding. not miss out on the time that best suits. & pains of pregnancy (such as back or The full Breastfeeding policy Please check with your midwife for updates pelvic pain and carpel tunnel syndrome). is available on request. on sessions available. Pregnancy Care in Your Area - NORTH 7

Please note we do not have a nursery for The birthing suites well babies. Having your baby room in with you ensures you start to recognise their Remember are family focused, needs for feeding and comfort from birth and is part of the ‘Baby Friendly Hospital Social Work and designed for you Initiative’ in all THS hospitals. Department to labour, give birth Birthing Suites Birth Suites are situated on Ward 4B Provides patients with NORTH and spend time with and are designed for you to labour, give social and emotional support, birth and spend the frst few hours with practical information related your baby. your baby and partner to pregnancy and assist with If you have chosen to stay in hospital, after the birth. you will be transferred to the maternity discharge planning. The services ward when you and your baby have been are free and available to patients Maternity Unit checked and are ready to do so. and their families. Social Workers Ward Rooms assist people to make decisions patient Ward 4O provides Maternity Ward about things that are important to accommodation Accommodation at the LGH. them. Social Workers encourage Currently Ward 4O has 10 single rooms. people to be involved in their Rooming In The remaining 9 rooms are shared twin own care and to explore all The Maternity Unit has a rooming in policy, accommodation with a shared bathroom. which means, your baby is with you 24 hours Your partner cannot stay in these rooms. available choices. If you would a day. During your stay in the Maternity Unit The single rooms are generally used for like to speak to a social worker, women with specifc medical requirements you are responsible for the care, supervision please ask the staff or contact the and safety of your baby. It is your responsibility or are privately insured. Social Work Department on the not to leave your baby unattended. You will be cared for in a ward room if Tell staff if you intend to leave the ward for you are admitted antenatally, or for your number provided in the front of any reason. If you leave your room/ward postnatal care. If you are having a planned this booklet. during visiting hours ask a family member caesarean section you will be admitted to Ward 4O prior to your operation. to watch your baby. Pregnancy Assessment Clinic (PAC) The Pregnancy Assessment Clinic (PAC) is Please do not hesitate to ring PAC if you have any located within the QVOPD on Level 3 of the further concerns. LGH. It is a Monday - Friday clinic available to Limited space within this area results in lack women for care between 8:30 am & 4:30 pm. of privacy for intimate procedures. To avoid over -crowding: PAC midwives see women for assessment • Only one visitor/support person is permitted to by appointment throughout their pregnancy stay with you at the discretion of PAC midwives; if there are concerns or for treatment and • The visitor/support person is required to remain review of both mother & baby. with you behind the curtains; and • No children are allowed. You may be referred to the PAC for assessment by your Doctor or Midwife. Care before being booked in When you come to PAC, the midwives and doctor If you are pregnant but not yet booked in to access will assess the well being of you and your baby. care at the THS and experience pain or bleeding After this assessment you will either go home or be you will need to visit the Emergency Department of admitted to the Maternity Unit. your closest THS hospital. If you go home from PAC, it is important that you You may also be referred to the PAC for assessment follow the advice given and attend any follow- up by your Doctor or Midwife. appointments. 8 Pregnancy Care in Your Area - NORTH

Arriving at the Maternity Unit for Please discuss any interpreter needs with Safety – small electrical appliances your doctor of midwife. Elective Admissions For safety reasons patients are discouraged Patients requiring admission to the Aboriginal Health Liaison Service from bringing small electrical items (ie, computers, electronic tablets etc) into Maternity Unit between 7am and 4.30pm An Aboriginal Health Liaison Offcer THS hospitals. However, if you do bring for a planned caesarean section - Monday (AHLO) is employed by the hospital to small electrical appliances into hospital you to Friday should go to Ward 4O on Level 4 help Aboriginal and Torres Strait Islander must comply with THS policy. Further of the LGH. people access, understand and enhance details on the policy can be obtained from If you are in labour or having a planned their hospital care. The AHLO is here to ward/unit staff. induction of labour please go straight to offer you and your family support. You can Ward 4B - Birthing Suite on Level 4 of ask the staff to arrange this for you. The Prior to bringing small electrical appliances the LGH. AHLO Service is available to both patients into hospital they must be tested and and their families. tagged to ensure compliance with electrical Telephone contact for women in labour is safety standards (at your expense). The (03) 6777 8960. Refugee/Migrant Liaison Offcer THS does not accept any responsibility/ Visitors The Refugee/Migrant Liaison Offcer liability for damage or theft of appliances. is employed by the Hospital to assist The Maternity Unit security doors will be patients and their families from culturally closed at all times. Only visitors with valid and linguistically diverse backgrounds to entry reasons will be permitted access to fully access and beneft from the hospital the Maternity Unit. and support services. Staff can arrange a Booking tests Visiting Hours: 11.00am to 2.00pm referral for you too if needed. and where to go 4.00pm to 8.00pm Smoking Ultrasound Department Quiet Time: 2.00pm to 4.00pm All THS hospitals are smoke free The Ultrasound Department Parking environments for patients and visitors. This is located in the Radiology includes the hospital grounds. Department on Level 3 of the LGH. Car Parks are privately owned and operate Your scan request form will be paid parking in and around the LGH. Television given to you at booking in & you Valid tickets must be displayed at all times. Channel 110 is our free educational station can book directly at the Radiology Please ensure that you have read signage. which covers topics such as breastfeeding Department or you can phone Ticket machines are available in all car parks tips, and caring for your newborn baby. them on (03) 6777 6085. & if coins are needed there is a machine Overhead televisions (free to air channels) available near the front entrance of LGH Pathology Tests are available for hire. Please enquire about on Level 3 Charles Street entrance. and Bookings details upon admission. It is advised that you have all Students Kiosk blood tests ordered by your GP All THS hospitals are teaching hospitals of taken before your booking in the University of Tasmania, and have the 9.00am - 7.00pm, Monday - Friday & appointment, so that appropriate responsibility for teaching a wide range Saturday care can be arranged for you. of students in the health care professions. 1.00pm - 7.00pm, Sunday The diabetes in pregnancy blood We ask for your permission to involve test (POGTT or Fasting BSL) students in your care, this will help to Meal times requires you to have fasted from educate the students who will be the Approximate times are: Breakfast 8.00am, the night before. Your Midwife health care professionals of the future. Lunch 12 midday, and Dinner 5.00pm. or GP will give you a written Snack items are available in the pantry on instruction leafet. It is best to Interpreter service the ward (for mothers only). present to pathology early, and allow 2-3 hours for the completion The THS provides interpreters as required, Please advise us if you have any special of this test. to interpret medical information for patients dietary requirements. For example if you of non English speaking background. This are diabetic or vegetarian, and we will LGH Pathology is located on service is provided to ensure the best clinical advise catering services. All food and drink Level 2 and can be accessed from outcomes for the patient are achieved. placed in the pantry fridge must be the Frankland Street Entrance. Pathology parking is available The Hospital does not use family members labelled with your name and a date here also. or friends to interpret medical information, (labels provided, just ask the midwife other than in the case of emergencies. caring for you). Pregnancy Care in Your Area - NORTH WEST 9

All results will be Options of care Midwifery Group Practice (MGP) You will be cared for by a primary (and discussed with you during pregnancy - backup) midwife who you will get to know well for your pregnancy, labour, birth and at your next visit. postnatal needs. This model of care offers North West the most continuity possible and includes a shorter hospital stay of 4-12 hours If there are any At the THS we believe it is important to - involve you in all aspects of your care in after the birth. Then you will have one on abnormal results pregnancy. Statewide services do vary so one visits in your home for up to 10-14 what is available in Hobart may be different days according to your assessed needs. NORTH WEST we will contact you. in Launceston or on the North West coast. The pregnancy care will occur primarily There may be circumstances when one or in community clinics with the venue more of these options may not be suitable negotiated directly with you. for you due to medical or other reasons. Midwives Satellite Clinics Please feel free to discuss your options with Satellite clinics make our services your midwife and/or doctor. conveniently available to women within Antenatal visits will not cover all your their local community. To fnd out if there educational requirements for labour, birth is a clinic in your area ask your midwife or and the transition to parenting. For this contact Women’s Health Clinic to fnd out reason the THS recommends Birth and what is available. The clinics are run by Parenting Classes along with any additional midwives and are for normal risk women. classes offered that may beneft your These midwives give antenatal care only specifc needs. Further, research supports and will not be available for your labour the benefts of attending a tour to familarise and/or birth. yourself with the environment in which you will labour and commence your transition Medical Clinic to parenting. Whilst on the tour, you will Women are referred to Medical clinics due learn valuable information like after hours to health needs. These models of care access, parking possibilities, what happens encompass a team approach between the in hospital and length of stay. Obstetric doctors and the clinic midwives In the THS midwives work in all models who are both available to complete of care so if you have medical or other antenatal appointments. There are varying circumstances resulting in the need for you types of Medical Clinics available thus to be cared for in a medical clinic you will still ensuring best care depending on your see midwives during your antenatal visits. circumstances. If you are required to be Exclusion from Midwifery based care may cared for in one of our Medical Clinics this occur if there is any deviation from a normal may be discussed when you frst see your risk pregnancy, unless you are with MGP GP or at your frst appointment at the where collaborative care may be given Womens Health Clinic. between your midwife and our doctors’. Some women receiving Midwifery care may be required to have an appointment with one of our doctors at 34 - 36 weeks due to a medical reason like a previous caesarean birth or diet controlled gestational diabetes.

North West Integrated Care Services (THS & NWPH) North West Private Hospital Contact Numbers Maternity Unit (03) 6432 6031 Women’s Health Clinic Appointments Lactation Consultant 0409 973 547 MCH (03) 6478 5180 Interpreter Services (03) 6478 5392 NWRH (03) 6493 6353 Perinatal & Mental Health Services (03) 6478 5319 Pregnancy Assessment Clinic: Mersey 1800 940 766 Burnie 1800 940 747 10 Pregnancy Care in Your Area - NORTH WEST

is best to attend your birth and parenting Birth and Parenting Education It is very important classes from 28 weeks gestation onwards. Discuss with your midwife or doctor, as that you come to Bookings for classes will be made educators working in this area can also for you by a midwife at booking-in assist in the following circumstances. all your antenatal/ or another antenatal appointment. • People with specifc birthing and/or parenting issues; pregnancy checks, Location of Classes • If this is not your frst baby but you to ensure the Classes are conducted by Midwives require an update of information in a at the Mersey Community Hospital specifc area. and the North West Regional Hospital. well-being of you and • Women having twins; You will be sent a letter with time your unborn baby. and venue prior to the classes • People from culturally and linguistically commencing. diverse backgrounds who require one to one parenting discussions with an Perinatal and Infant Mental Birth and Parenting classes interpreter; and • People who would like the opportunity Health Service We recommend you enrol in a Birth and Parenting Class, especially if this is your to debrief after a diffcult birth when Social worker services are available at the or your partners frst child. Birth and booking in for subsequent pregnancies. MCH and NWRH to assist you with further Parenting classes are facilitated by midwives. Tours of the Maternity Unit referrals. Please discuss with you midwife or The classes cover self help skills, an doctor or GP. understanding of labour and birth, feeding, If you have not previously birthed at the The Mental Health Service Hotline unexpected outcomes, natural and medical NWPH it is important to attend a tour of is also available 24hours a day freecall pain relief options to help make informed the Maternity Unit to not only understand 1800 332 338. choices. Transition to parenting can be a the process for admission but to ensure busy but exciting time. We offer you some you are familiar with the environment Life Line: 1300 364 566 strategies to cope with the early days at during an important stage of your life. www.panda.org.au home and give you information regarding Tours can be arranged by phoning www.beyondblue.org.au follow up support in the community. (03) 6432 6000. Please read the Maternity Antenatal Information Package (this booklet) prior to attending the Birth and All THS hospitals education Parenting classes. are accredited Baby The Tasmanian Health Service (THS) Please ask your midwife for available North West Integtrated Maternity Service session times, dates and venues. Friendly Hospitals (NWIMS) offers a variety of antenatal class and follow the 10 Physiotherapy options. Antenatal classes are designed Steps to Successful to help you with your physical, mental Physiotherapy may be able to assist you and emotional preparation for pregnancy, further with some of the common aches Breastfeeding. The full birth, early parenting and feeding your & pains of pregnancy (such as back or Breastfeeding policy is baby. The sessions are relaxed and pelvic pain and carpel tunnel syndrome). informative, giving you and your support Your physiotherapist will support you to available on request. person, the opportunity to meet other be as physically active as you can be during families and to discuss ideas, thoughts and your pregnancy. choices for birthing and parenting. It is Breastfeeding important to book your classes early to ensure you do not miss out on the time Breastmilk is the most nutritious food you that best suits. Please check with your can give your baby. Breastfeeding is natural but a learned skill. If you have specifc midwife for updates on sessions available. concerns requiring further discussion you Antenatal classes are run in the evenings may book a one to on consultation. in both Mersey and NWRH and may Please ask your Midwife. sometimes be available on weekends. It Pregnancy Care in Your Area - NORTH WEST 11

with most of the medical equipment Maternity Unit discreetly concealed. A bath is available in each of the rooms for water immersion Remember patient and water birth. accommodation Most women want the company and Social Work support of someone they trust during Department Rooming In labour. Our policy is that we promote - only 2 support people (maximum) in the The Maternity Unit has a rooming in Provides patients with birthing suite. Please place mobile phones policy, which means your baby is with you social and emotional support, on silent in the birth suite. It is our practical information related NORTH WEST 24 hours a day. During your stay in the request that mobile phones are only used Maternity Unit you are responsible for the outside of the birthing suite during labour. to pregnancy and assists with care, supervision and safety of your baby. discharge planning. The services It is your responsibility not to leave your It is important to note that we are unable to accommodate additional family and are free and available to patients baby unattended. friends in our waiting lounge for the time and their families. Social Workers Tell staff if you intend to leave the ward for you are in labour, especially after 8pm. assist people to make decisions any reason. If you leave your room/ward Our waiting lounge is a small area to be about things that are important to during visiting hours ask a family member shared by many clients which makes it them. Social Workers encourage to watch your baby. unavailable to others should visitors be people to be involved in their own waiting for hours. Please note we do not have a nursery care and to explore all available for well babies. Having your baby room Children are not encouraged in the choices. If you would like to speak in with you ensures you start to recognise birthing suite. If a child is to attend the to a social worker, please ask the their needs for feeding and comfort from birth, please prepare them for this special occasion – what they may expect to see, staff or contact the Social Work birth and is part of the ‘Baby Friendly Department on the number Hospital Initiative’ at the NWPH and in all hear and experience. Also, arrange for someone other than your support person provided in the front of this booklet. THS hospitals. to look after your child during the birth. Birthing Suites Nursing staff are unable to look after children in the birthing suite. NWPH’s well-appointed and spacious There may be single rooms available birthing rooms provide a comfortable Ward Rooms for women who have specifc medical and safe atmosphere for the birth of your The NWPH maternity unit has 4 bed requirements. baby. Each birthing suite is self-contained rooms, they are shared and your partner with a TV, tea/coffee making facilities, cannot stay in these rooms.

Pregnancy Assessment Clinic (PAC) The Pregnancy Assessment Clinic is the area When you come to PAC the Midwives and that you need to contact if: Doctor will assess the wellbeing of you and • You are between 20 weeks pregnant and your baby. 10 days post birth; After this appointment you will either go • You think that you are in labour home or be transferred to the Maternity Unit. • Have a pregnancy related concern If you go home it is important you follow • If you have had a fall or an accident the advice given and attend any follow up appointments. You can contact PAC at any time if you have any concerns. You will be able to talk to a Please do not hesitate to ring PAC if you have Midwife and if needed, have a follow up visit any further concerns. to PAC. To avoid overcrowding: North West Regional Hospital 1800 940 747 • Only one visitor/support person is to stay North West Private Hospital 1800 946 766 with you at the discretion of PAC Midwives; Mersey Community Hospital 1800 946 767 • The visitor/support person is required to PAC is located in the Antenatal Clinics at both stay with you behind the curtains; and Mersey and North West regional hospitals. • No children are allowed. 12 Pregnancy Care in Your Area - NORTH WEST

Arriving at the NWPH (North Students Meal times West Private Hospital) Maternity NWPH is a teaching hospital and has Your meals will be served according to Unit for Elective Admissions the responsibility of teaching a range of your dietary needs. Please advise staff students in the health care professions. on admission of any specifc dietary Patients requiring admission for induction requirements you may have. at the NWPH should present at the time We ask for your permission to involve advised to Huon Ward on the day of students in your care, this will help to Your partner will be provided with a meal your induction. You will be provided with educate the students who will be the health while you are in labour. information on what is involved and what care professionals of the future. to expect. Safety – small electrical appliances Interpreter service Elective caesarean section patients will be For safety reasons patients are discouraged advised of admission dates and times. You North West Integrated Maternity Services from bringing small electrical items will also be given information on caesarean (NWIMS) provides interpreters as required (ie, computers, electronic tablets etc) into section when your surgery is booked. to interpret medical information for patients THS hospitals. However, if you do bring of non- English speaking backgrounds. small electrical appliances into hospital you Labour and birth This service is provided to ensure the best must comply with THS policy. Further Phoning before you leave home enables clinical outcomes are achieved. details on the policy can be obtained from ward/unit staff. the midwives to prepare for your arrival NWIMS does not use family members or and makes the admission procedure fow friends to interpret information unless in Prior to bringing small electrical appliances more smoothly. an emergency. into hospital they must be tested and Midwives are available to talk with you on tagged to ensure compliance with electrical the phone regarding concerns about your Aboriginal Health Liaison Service safety standards (at your expense). The pregnancy and whether or not you should The Social worker will provide referral to THS does not accept any responsibility/ come to hospital. appropriate services as needed. liability for damage or theft of appliances. On arrival if you are in labour, please present to Huon Ward. Multicultural and Health Diversity Offcer Telephone contact for women in labour is Booking tests 1800 940 747 or The Multicultural and Health Diversity offcer is employed to assist patients North west Private Hospital and where to go and their families from culturally and (03) 6432 6031. linguistically diverse backgrounds to fully Ultrasound Department Visitors access and beneft from the hospital The Ultrasound Department is support services. Staff can arrange a located at the Mersey Community It is important for you to get rest, referral for you if needed. Hospital ground foor or at Wenvoe particularly in the frst few days. For Street in Devonport. this reason a rest period is encouraged Smoking after lunch and visiting hours are strictly The NWRH Ultrasound department enforced. Please ask your visitors to All THS hospitals and NWIMS are smoke is located in the Medical Centre. free environments for patients and visitors. consider your needs while you are in Pathology Tests hospital. Partners and children can visit all This includes the hospital grounds. We areas in the morning. thank you in advance for your cooperation and Bookings Visiting to the ‘Special Care Nursery’ is in maintaining this policy. The diabetes in pregnancy blood test (OGTT) requires you to book restricted to members of the immediate Television family and is not an area for general visiting. an appointment and present to Please observe hand hygiene requests. All rooms at the NWPH has a remote the pathology having fasted. We recommend you book an early Visitors are asked to observe the unit and controlled television for patient use, they appointment, you will need to allow ward visiting hours below and be mindful of are required to be turned off by 9.30pm. 2-3 hours. all patients when visiting the hospital. Kiosk The pathology department is Strictly 2pm - 4.30pm & 6pm - 7.30pm The NWPH kiosk is open between 8am - located at the Mersey Community Parking 2.30pm Monday to Friday. Hospital ground foor or at Oldaker Street in Devonport. Parking is available in the NWPH car park, 24 hours a day, 7 days a week. The NWRH Pathology department A parking exemption voucher can be is located in the Medical Centre. provided for 1 vehicle on the day of your baby’s birth. Care in Pregnancy 13

packets called chromosomes. Every cell If you require information about your Antenatal tests in the human body should contain 46 options and the tests stated please ask to chromosomes, there are two copies speak with one of our doctors who will It is recommended that you have the of chromosomes numbered 1 to 22 be able to comprehensively explain what following tests during your pregnancy. (one from each parent) as well as two each test/result means. We also have a These test results will help in assessing sex chromosomes (XX girl or XY boy). handout that is used in conjunction with the well-being, of you and your baby. Trisomy means that there are 3 copies of a consultation explaining this information Your doctor or midwife can answer a certain chromosome in every cell, for further. No tests will be done without any questions you may have. example Trisomy 21 (Down Syndrome) informed consent and counseling from one Blood Tests in Early Pregnancy means three copies of chromosome of our obstetric doctors. number 21 in each cell. This obviously Blood tests are ordered by your GP and Please remember the majority of affects the way a baby develops and are to be checked for the following: pregnancies with abnormal results will have causes conditions that may affect the a normal outcome. It is also important to • Blood group, Rh factor, haemaglobin babies life. Chromosomal abnormalities note that not all abnormalities that might (iron) level, iron studies; can occur in any pregnancy but are more affect a baby can be identifed before birth. • Your immunity to Rubella common in babies of older mothers. (German measles); The frst trimester screening result Second trimester screening for • Vitamin D; measures the nuchal translucency Down Syndrome and Spina Bifda • Sexually transmitted diseases such as (thickness at the back of the fetal neck as Chlamydia, Syphilis and HIV; seen on ultrasound) and the blood test This is a blood test, that looks at your likelihood of having a baby with Down • Hepatitis B; measures the level of two hormones produced by the placenta (PAPP-A and Syndrome. It can be done between • Hepatitis C; BHCG). It is very important that you 14 and 20 weeks plus 6 days if you were • Urine test to check for ; and have both tests with the blood test frst to not able to do the frst trimester screening. • Fasting BSL or alternatively an early obtain an accurate result. It also identifes if there is an increased chance of neural tube defect that is present Glucose Tolerance Test (GTT) for some This test is specifcally designed to screen in Spina Bifda. women with higher risk of diabetes for Trisomy 21, Trisomy 13, and Trisomy in pregnancy. 18. Other genetic abnormalities however, Women who have a negative Ultrasound Scan may be revealed after further investigating blood group the test results. Remember some This is a procedure which uses sound waves abnormalities are mild but some can be All women who are Rh Negative receive to form images of your baby. There are severe in nature. injections called “anti-D” at 28 weeks and two scans routinely taken during your 34 weeks. This prevents your body from If you are unsure whether you wish to pregnancy. The frst scan is called the dating making antibodies to your baby’s red cells. have this screening test please discuss scan and it is usually organised by your GP If you have a negative blood group (Rh this with your GP or at your frst hospital for between 7 and 13 weeks plus 6 days. Negative) it is important that you understand This scan is most often used to ascertain appointment prior to 13 weeks plus 6 days. what this means for you and your baby. your baby’s due date. Understanding test results and options Please discuss it with your midwife or doctor. The second routine scan is called ‘level 2 If you do not understand your test results It is very important you have your morphology scan’ and this is done between fully please discuss this at your next recommended 26 week blood tests 18 and 20 weeks of pregnancy. This is antenatal appointment. including your blood group and red cell a very detailed scan that looks closely at antibodies checked before your 28 week As a guide when interpreting results, the your baby, the of the placenta and antenatal check. Anti D cannot be given higher the number the lower the likelihood whether your baby is growing well. The until results from this test are available. that your baby will have Trisomy 21, 18 or 13. scan takes about an hour. 1:250 or above means less chance, for Diabetes in Pregnancy Early screening for Trisomy 21 example your result may say 1:1000. It is recommended that all women have a test (Down Syndrome), Trisomy 18 1:250 or numbers lower than this are for diabetes in pregnancy (POGTT) attended and 13 classed as a higher likelihood of baby having at 26 weeks, this includes women who a chromosomal abnormality, for example may have had this test early in pregnancy. This test is available to you between 11 and 1:50. Options then include: Undiagnosed or uncontrolled diabetes 13.6 weeks gestation. It is a combined test • Chorionic Villus Sampling (CVS) or may lead to: that consists of a blood test done by 13.4 for a more defnitive weeks gestation and a scan of your baby that • Bigger or smaller babies due to the diagnosis; shows your possible chance of having a baby placenta not functioning properly with Down Syndrome, trisomy 13 or 18. • non-invasive (NIPT); • High blood sugar levels at birth for baby • detailed ultrasound at 16-20 weeks; Genetic Material (DNA) and sometimes breathing diffculties • no action - parents may choose to accept • Higher risk of baby developing obesity DNA is arranged in the human body in the results with no further investigation. or diabetes as an adult 14 Care in Pregnancy

• Mother has higher risk of developing share with your baby. pre-eclampsia or hypertension Information on caring for your newborn Please note this is a fasting test for pregnant and SIDS is further discussed more later in Remember women which means no food including this booklet. Hepatitis B Vaccination chewing gum and cigarettes for at least for the Newborn 8 hours prior and plain water only during Hepatitis B Vaccination for the fasting period. the newborn The National Health and Medical www.diabetesaustralia.com.au/ Research Council recommend that Hepatitis B is a virus that can cause acute all babies be immunised against gestationaldiabetes or chronic liver disease. If a baby contracts Hepatitis B. This involves a course this disease, symptoms fortunately may be Blood tests at 26-28 weeks mild for your baby. However, most babies of vaccinations beginning at birth. We require your verbal consent to At 26-28 weeks bloods are taken for will go on to be chronic carriers which can give your baby this vaccine. diabetes (POGTT), haemaglobin and red cause liver cancer later in life and also pass cell antibodies and iron studies. the virus onto others or their own children. Hepatitis B is spread easily through body The results of these tests will be discussed recommend that all babies be given the fuid secretion including blood (cuts or with you at your 28 week visit and any Vitamin K injection to prevent a now sores, body piercing, sharing toothbrushes, rare bleeding disorder called Vitamin K recommendations/follow up made. It is razors), saliva (kissing, baby dribbling), Defciency Bleeding (VKDB). Prior to therefore very important that you ensure semen, vaginal secretions and breast milk. the implementation of routine injection these tests have been completed prior to of Vitamin K, some untreated babies your 28 week antenatal appointment. Immunisation is considered the most effective way of preventing hepatitis B and who suffered from VKDB sustained brain Group B Streptococcus if given at birth is more likely to provide life damage or even died. long immunity. The injection is the most reliable way to At 36 weeks you will be weighed and provide enough Vitamin K to protect your asked to provide a specimen of urine. The THS offers vaccination to your baby prior to leaving the hospital. Your baby will baby for months until he/she can produce The midwife will also ask you to collect a need a further three more doses of the it themselves. vaginal swab. The swab is used to detect hepatitis B vaccine to be fully immunised. a bacteria called Group B Streptococcus Alternatively Vitamin K can be given to These three doses are given at six weeks, (GBS). 15%-25% of the normal population babies orally. Because Vitamin K is not four and six months of age in a combination absorbed as well when given by mouth, carries this bacteria which is not harmful with other routine infant immunisations. to you. However in 1%-2% of cases it your baby must have three doses over the can be passed onto the baby during the The vaccine is considered safe to give to course of four weeks. If your baby vomits birth process, which can cause the baby to your baby after birth. It is well tolerated within an hour of swallowing the Vitamin K, become ill with symptoms of sepsis. and minor side effects may include local the baby will need to repeat the dose. swelling and redness at injection site, mild Limitations around giving vitamin K orally THS policy recommends that you be fever and occasionally irritability or refusal include premature or sick babies; mother’s treated with antibiotics (given into your of feeds for a short time. These symptoms who have a history of blood clots, epilepsy vein) during labour if GBS is detected. This are short lived. or tuberculosis. will help protect your baby from infection and reduce their risk to around 0.1%. Premature babies less than 32 weeks Within Australia, Vitamin K has been gestation may have a lower immune All babies whose mothers are GBS positive administered to babies for over 50 years response to hepatitis B vaccine and may are closely observed for signs of illness, with no documented problems. Earlier need a hepatitis B booster at 12 months particularly in the frst 12 - 24 hours after studies suggested that injections of of age. The vaccination should only be birth. In some cases where antibiotics were Vitamin K may be linked with childhood delayed if your baby is very unwell or has cancer. The National Health and Medical not given in labour those babies will need a high fever. Antibiotic treatment is not a to be observed for 48 hours. Research Council conclude from more reason to delay hepatitis B vaccination. recent studies that Vitamin K is not For further information visit Immunise associated with childhood cancer, whether Important decisions Australia www.immunise.health.gov.au it is given by injection or by mouth. Vitamin K In order to prevent the rare but potentially for the care of your fatal disease (Vitamin K Defciency baby after birth Vitamin K helps blood to clot. It is Bleeding), medical authorities strongly produced by the body and is essential to recommend that all babies be given Some consideration needs to be made prevent rare but serious bleeding in the Vitamin K. This includes babies who are antenatally about care options for your newborn. Some babies do not produce premature or sick, and babies having any baby when it is born. This involves some enough Vitamin K until they are a few surgery (including circumcision). injections and tests as well as safe sleeping months old. They do not get enough We require your verbal consent to allow and safe care. Vitamin K from their mothers during pregnancy and there is not suffcient administration of Vitamin K. If you decline It is important you read information about Vitamin K for their needs Vitamin K for your baby a paediatrician will Sudden Infant Death Syndrome (SIDS) and in breastmilk or formula. see you in the postnatal period to ensure bed sharing. Because of the risk involved you are making an informed choice for The Royal College of Paediatricians the THS recommends that you do not bed your baby. 2

Your visits 16 Your Visits Visits, tests and baby development Between Between 7 and 10 10 and 14 weeks weeks Usually attended by GP Attend frst Midwife appointment

GP to provide referral to THS for Discuss ultrasound and blood results pregnancy care. Chlamydia Screening – 25 yrs & under. Recommended tests for discussion: Early Glucose Test if indicated. • Blood Group, antibody screen; Complete any unfnished tests. • Full Blood Examination (FBE); Book 18 -20 week ultra sound to look • Ferritin levels at fetal development and wellness. • Rubella; Measure blood pressure (B/P), weight, • HIV; check uterine size. • Syphilis; Given a copy of the Maternity Information Package (this book) of • Hep B and C; which it is important to start reading • Vitamin D; as education is a continual process throughout your pregnancy. • early POGTT or blood test to check for diabetes in pregnancy Orange folder provided to hold if indicated; and information obtained from visits and At 12 weeks the forms for all tests required in pregnancy • Urine test (MSU) for asymptomatic including ultrasounds and blood tests. bacteriuria. fetus is fully formed, Offer to complete Edinburgh Perinatal from now on it has Tests to be offered/discussed at Depression Screening (EPDS). this Visit: Models of care and antenatal education to grow and mature. • Serum screening (Down Syndrome options discussed. Test) and scan; Screening assessment done for Venous • Dating scan and discuss 18 -20 Thromboembolism (VTE) risk category Please bring this ultrasound scan that looks at fetal Discuss Fluvax and Pertussis booster. development and wellness; book with you to • Height, weight to determine BMI. your appointments Baby development and pack in your At 12 weeks the fetus is fully formed, Baby development from now on it has to grow and mature. The baby is already moving hospital bag. At 7 weeks the embryo has grown about but the movements cannot to about 10mm long from head to be felt yet. By 20 weeks the face is bottom. By 8 -9 weeks, your baby has Please note the schedule of beginning to look more human and visits outlined is in line with grown to 22mm, a face is forming, hair is starting to grow as well as Australian standards but and the eyes are obvious. There are eyebrows and eyelashes. Between may vary depending on the beginnings of hands and feet. The 16 -20 weeks you will feel your baby your assessed needs during major internal organs are all developing move for the frst time, it will feel like your pregnancy. -heart, brain, kidneys, liver and gut. futtering or bubbling. Your Visits 17 Between At 16 and 20 24 and 28 weeks weeks

Discuss ultrasound and blood results. Check and discuss any results. Attend ultrasound appointment. Measure B/P, weight, check fetal Measure B/P, weight, check heart beat, fetal movements, uterine size. size and position of baby via abdominal palpation. 32 weeks Listen for fetal heart and check for fetal movements. Discuss healthy lifestyle, emotional and social well -being Discuss fetal movements (pattern, Measure B/P, weight, check fetal strength,frequency & intuition) If 28 weeks and Rh -Negative review heart beat, fetal movements, the antibody screening blood test size and position of baby via Discuss the Glucose screening test, results and give Anti -D injection. abdominal palpation. used to detect diabetes of pregnancy. Safe Sleeping and active third stage Discuss healthy lifestyle, emotional If not already done book Glucose (delivery of placenta) to be discussed. Tolerance Test for around 26 weeks. and social well -being. Commence breastfeeding education Ensure you have blood forms for Reminder of importance of fetal pathology for FBE, antibodies, Reminder about seasonal fuvax and movements and use of PAC. Glucose Tolerence Test (POGTT), getting Pertussis vaccination/booster Considerations for birth, postnatal due before 28 week visit. between 28 and 32 weeks. care and breastfeeding discussed. Discuss Anti --D for Rh Negative Discuss Mum settling to sleep on her mothers for next visit. side from 28 weeks. “Side to sleep for Mum & back to sleep for baby”. Book birth and parenting, and breastfeeding classes. Baby development The baby is now moving about vigorously and responds to touch and to Sometimes the baby may get hiccups, Baby development sound. A loud noise may make it jump and you may feel the jerk of each and kick. It also swallows small amounts At about 22 weeks the baby hiccup. The baby may also begin of the amniotic fuid and passes tiny becomes covered in a fne hair to follow a pattern for waking and amounts of urine back into the fuid. At called ‘lanugo’, which usually sleeping. At 24 weeks your baby is 26 weeks the eyelids open for the frst disappears before birth. about 33cms long and is covered in a time. Your midwife/Dr can hear the substance called vernix. baby’s heartbeat through a sonicade.

Your baby’s movements Usually, an active baby is a healthy baby. Most women will healthy baby through both pregnancy and labour. Babies start to feel their baby move between 16 - 22 weeks of do not move all the time, even when perfectly healthy their pregnancy. It is important that you get to know your they do have short periods of sleep and quiet times - you baby’s routine, pattern and frequency of movements. Early will get to know your baby’s pattern of movement. A movements will feel like a futter or a tickle, only mum can reduction or a sudden increase in a baby’s movements feel these. As the baby gets bigger so do the movements. can sometimes by an important warning sign that a Between 20 - 35 weeks baby is getting stronger and baby is unwell. If you feel something has changed or you you will feel kicks and punches. As baby grows there is have a bad feeling then contact your doctor, midwife or less room but baby won’t slow down, rather the type of maternity ward. movement will differ, but regularity shouldn’t change. You A good habit during pregnancy is to spend some quiet time may feel rolls or sweeping movements. You may see a each day being aware of your baby’s movements, learning hand or foot. If anything feels different to normal, let your your baby’s routine, pattern & frequency of movement doctor, midwife or maternity ward know. so you know what is normal for YOUR baby. For further Always remember that normal movements are a sign of a information go to www.stillaware.org 18 Your Visits 34 weeks 38 weeks

Measure B/P, weight, check fetal Check Group B Streptococus (GBS) heart beat, fetal movements, result and discuss possibility of size and position of baby via having intravenous (IV) antibiotics in abdominal palpation. labour if the result is positive. Discuss healthy lifestyle, emotional Discuss healthy lifestyle, emotional and social well -being. breast and social well -being. nipple Discuss Group B Streptococus areola (GBS) screening. Measure B/P, weight, check fetal heart beat, fetal movements, If Rh -negative discuss and give size and position of baby via Anti -D injection. abdominal palpation. Consider options for birth and Discuss signs of labour. coping with pain. placenta Continue breastfeeding education. Continue breastfeeding education. uterus baby Baby development Your baby is gaining weight so the skin that was quite wrinkled before is now smoother. Both the lanugo cervix and the vernix begin to disappear. By 32 weeks your baby is usually bladder lying head down. 40 weeks vagina

Measure B/P, weight, check fetal 40 weeks heart beat, fetal movements 36 weeks size and position of baby via abdominal palpation. Group B Streptococus (GBS) screening swab collected, mid Discuss healthy lifestyle, emotional stream urine (MSU) collection and and social well -being, you will be weighed & have a blood Possible vaginal examination and test for Hb and Ferritin. cervical sweep. Discuss healthy lifestyle, emotional Discuss fetal monitoring, baby and social well -being, & have a blood movements and CTG (monitoring test for Hb and Ferritin. baby’s heart beat) requirement at Active management of the 3rd stage next appointment. 41 weeks of labour should be discussed and your preference documented. Discuss induction of labour. Importance of Safe Sleeping discussed. Continue breastfeeding education. Measure B/P, weight, check fetal Measure B/P, check fetal heart beat, heart beat, fetal movements, fetal movements, size and position of size and position of baby via baby via abdominal palpation. abdominal palpation. Discuss consent for Hepatitis B and Post Term Discuss healthy lifestyle, emotional Vitamin K immunisation. and social well-being. Continue breastfeeding education. Some women do not go into labour Offer a vaginal examination, cervical by themselves. It is safe to go over sweep and gain indication of your due date providing you and requirements for induction of labour. Baby development your baby’s health are fne. You may CTG attended. be required to have more hospital At 36 weeks your baby may start to Induction of labour booking made move down into the pelvis and may visits to ensure this and be offered an and discussed (usually for around be in the ‘engaged’ position. induction of labour. 41 weeks plus 2 days). 3

A healthy pregnancy 20 A healthy pregnancy

depending on the EPDS score, referral may Health advice and be offered to your G.P and the Perinatal Why attend and Infant Mental Health Service. It is choices important to discuss your feelings during scheduled Antenatal Yo ur body will undergo many changes due pregnancy with your partner, family, GP or visits if I feel well? to pregnancy hormones and your growing other health professional. baby. Sometimes simple measures can help Antenatal care allows us to monitor Support both emotionally and physically with these discomforts. your health and emotional well is important during your pregnancy and being and the baby’s health These minor discomforts of pregnancy following the birth of your baby. Try to and growth. Most pregnancies may include: arrange some support well before your progress well but some problems • Backache and groin pain; due date. If you require further support are symptom -less and not easily • Indigestion/Heartburn; speak with your Midwife or contact recognised by the pregnant women. • Constipation; Beyond Blue at: www.beyondblue.org.au This may include a slowing in the • Swelling; You could also ring Lifeline Australia on baby’s growth or a rise in your 1300 22 4636. blood pressure. • Varicose Veins; • Muscle Cramps; The transition to pregnancy, birth and We would prefer you do not • Carpal Tunnel Syndrome; early parenthood while rewarding it can worry unnecessarily. One way also be a time of change. Depression and • Inability to sleep or vivid dreams; to ensure this is possible and anxiety can happen at any time, but we you enjoy your pregnancy is to • Shortness of breath; and know that women are more likely to be attend all scheduled appointments • Increased Vaginal Discharge. affected by depression and anxiety or stress and available education sessions Talk with your midwife, who may refer during the perinatal period. To support our according to your needs. you to a physiotherapist, or make some clients experiencing perinatal mental health practical suggestions to help ease the concerns, a referral is available to the social condition. Almost all of these conditions will work services or your GP for ongoing Exercise rapidly improve after the birth of your baby. specialised care. Please also refer to the It is important to remain active during your Beyondblue booklet ‘A guide to emotional Please view information on travel in pregnancy. Activities like walking, swimming, health and wellbeing during pregnancy and pregnancy at www.ranzcog.edu.au, supervised pregnancy pilates and yoga are early parenthood’ that can be downloaded search ‘Travelling during Pregnancy’. all fne to continue whilst pregnant. Being from their website www.beyondblue.org. It is very important to know that the active can help with weight management, au. It is also recognised that pregnancy law requires you to wear a seatbelt at build stamina, muscle strength, improve and parenting can bring new challenges all times during your pregnancy. The circulation, and assist your body in for all family members, including dads and lap sash should be worn around your preparation for your labour. It is important partners. The PANDA (Perinatal Anxiety hips but under your pregnant belly, to remember that normal exercise should the shoulder strap should be above and Depression Australia) national helpline not cause pain and overheating during is available 10am till 5pm eastern standard your belly and between your breasts. pregnancy can be harmful for your unborn time on 1300 726 306 or there is a lot baby. Drink plenty of water during and Emotional changes during of invaluable information at after exercise. pregnancy www.panda.org.au Along with the physical changes mentioned or www.cope.org.au Sex during pregnancy above some women experience emotional If you are experiencing a normal healthy changes, you may feel sad and teary for Braxton Hicks Contractions pregnancy and you want to continue to what may appear to be no apparent reason. These are painless and harmless enjoy sex there is no reason not to. It will tightenings of your uterus. They are not Hormones of pregnancy are likely to be not harm you or your baby. Talk with your labour contractions and are common the cause of these emotional changes, midwife, doctor or Birth Suite if spotting from 20 weeks onwards. which can affect you and subsequently occurs during or after intercourse (this can other members of your family. When If you are experiencing lots of braxton be normal), as any bleeding in pregnancy booking into the hospital we will ask you to hicks contractions things you can do to try needs reviewing. fll out a form that evaluates your emotional alleviating them are; ensure you are well wellbeing. This assessment is called the hydrated, change positions or lie down Sexual intercourse is not advised in some Edinburgh Perinatal Depression Scale, and on your left side, and ensure you have pregnancies including if there is heavy is completed antenatally and again after emptied your bladder recently. If you are bleeding, you’ve had previous miscarriages you have your baby by the Child Health concerned that your contractions are or your waters are broken. and Parenting Service (CHAPS). Your score more than braxton hicks please contact will be discussed with you at the time and your Midwife. A healthy pregnancy 21

Sexually Transmitted Infections Venous Thromboembolism Natural or alternative remedies (STI) (VTE) Natural or alternative remedies may also It is a known fact that some STI’s can be VTE is defned as a condition in which a be drugs. To safeguard you and your harmful to fertility, the unborn baby, cause blood clot develops within the deep veins baby, both through your pregnancy and premature births and infections in some of the leg. VTE may lead to the blood afterwards, do not take any alternative newborns. Whilst some testing is done clot breaking free and entering the blood remedies unless directed by your doctor or antenatally please discuss any concerns with circulation causing potential blood vessel an accredited therapist. Midwives do not your doctor/midwife. obstruction to important organs such as have the expertise to endorse or educate You can also access further information at the lungs. As blood clots can restrict blood you in these matters. www.healthdirect.gov.au fow, they can potentially lead to lifelong Vaccination Advice complications or fatality. Fortunately VTE Fasting can be prevented and if diagnosed effective Infuenza (Flu) The THS WACS understand that for some treatment can be implemented. Under the National Immunisation Program clients fasting may be required during Symptoms may include: all pregnant women are eligible to receive pregnancy or whilst breastfeeding due to a free fu vaccine every year. It is safe to religious or other reasons. To help you • Redness or warmth in one spot on the leg have the fu vaccine at any stage during make an informed choice about fasting, • Pain and swelling in one leg pregnancy or when breastfeeding. please discuss this at your antenatal visits Infuenza vaccination in pregnant women and ask for any further literature that may • If the clot has reached the lungs, shortness may protect them, and their unborn be available. of breath or chest pain may occur child, from the risk of severe illness and VTE does not always have symptoms, which Traditional Cutting/Female hospitalisation resulting from some strains is why it is important to understand the risk of the fu. Circumcision factors. Due to the hormonal changes Whooping Cough (Pertussis) Your midwife or doctor may ask you about pregnancy places women at an increased Whooping cough is an extremely traditional cutting/female circumcision if risk of developing a VTE. This combined contagious respiratory infection caused you are from a cultural background where with other conditions like obesity, elevated by the bacteria Bordetella pertussis which this is traditional practice. If you have blood pressure, smoking or caesarean birth gives violent coughing spasms up to experienced traditional cutting/female may further increase the risk of VTE. 100 days or more. This can cause sleep circumcision in any form it is important The THS WACS have implemented into disturbances, vomiting, rib fractures, you see a doctor at some time during the booking in visit a screening tool to help pneumonia and in rare cases fatality your antenatal care to discuss any special determine if you are at risk of a VTE and in adults. For the frst six weeks of a requirements for the birth of your baby. newborns life they have no immunity to allow for appropriate management if against whooping cough which if contracted Awareness of the circumstances before the risk is identifed. We ask all pregnant your baby’s birth is very important as can cause serious complications like women to be mindful of the symptoms it allows discussion of any needs and pneumonia and fatality for babies under and report to staff if concerned. For more postnatal expectations. twelve months of age. information go to www.healthdirect.gov.au/ The recommendation is that it is safe for Dental care deep-vein-thrombosis. pregnant women to receive the Pertussis Vaccine in every pregnancy after 28 weeks The hormonal changes that occur during Travel Advice gestation and if given prior to 32 weeks pregnancy can lead to dental problems If you are intending on travelling within full beneft to the unborn baby is more such as tooth decay and gingivitis (where likely. Please check the recommendations gums become red and bleed easily). Australia and to foreign countries you should consult your doctor or midwife for for other family members on the website Twice daily dental care is important below. whilst pregnant. If you make a dental advice about continuing pregnancy care For more information on immunisations appointment during pregnancy, x-rays or and travel health. See also advice on VTE against childhood diseases, visit your local local anaesthetic may be required, so be within this booklet. doctor or immunisation provider or go to sure to let your dentist know that you are RANZCOG have advice for Travelling www.immunise.health.gov.au pregnant. The increased incidence of gum when Pregnant Booklet disease or bacterial infection of the gums has been shown to be associated with low and premature infants. 22 A healthy pregnancy

The THS WACS strongly believe in of 400 micrograms per day at least open disclosure and your right to be fully one month before pregnancy and 600 informed. To ensure this woman with a micrograms plus for three months after BMI above 35 will additionally be provided becoming pregnant to reduce the risk of with (or upon request) the RANZCOG their baby having a neural tube defect such ‘Weight Management during Pregnancy’ as spina bifda. guide which provides further information relevant to BMI. Vitamin D Five food groups Vitamin D helps the body to absorb calcium from food to provide you with Eat a variety of different foods from the healthy bones and muscles. Your body essential food groups every day to get all the will produce vitamin D when your skin is vitamins and minerals you and your baby need. exposed to the UV light in sunlight. The The essential food groups for your health and amount of vitamin D your body makes baby’s growth and development are: depends on skin type, exposure time, 1. Vegatables, legumes, and some fruit; amount of skin exposed, UV levels, lifestyle 2. Grains; and health. It is good to spend time in the 3. Milk, yoghurt, cheese and dairy alternatives; sun and sensible sun protection (sunscreen, hat and glasses) does not put people at risk 4. Lean meat, poultry, fsh, eggs, nuts and seeds; of vitamin D defciency. Women more at 5. Healthy fats, herbs and spices. risk of Vitamin D defciency: Water intake of more than two litres daily • Have dark skin; is recommended. Limit salt and sugar whilst • Cover most of their body with clothing; and pregnant and breastfeeding to allow for steady baby growth and development. • Spend most of their time indoors. Diet and pregnancy For more information regarding maternity Speak to your doctor if you have any concerns or for further information on Pregnancy brings with it enormous changes patient dietary requirements and portion sizes visit www.nutritionaustralia.org Vitamin D in Tasmania go to in your body and because of the growing or www.nhmrc.gov.au/guidelines- www.dhhs.tas.gov.au and search this topic. baby you need to eat a healthy diet. publications/n55 (healthy eating during Healthy weight gain is important and a It is safe to take vitamin D supplements your pregnancy pdf). during pregnancy and breastfeeding. guide to this is given in the box below. Women who do not gain enough weight Folate (or folic acid) Calcium have a risk of premature birth. Women who Folate is needed for the growth and Have four serves of calcium rich food every are overweight or gain too much weight development of your baby. A good source day to help your baby grow strong bones during pregnancy have a higher risk of: of folate can be found in green leafy and teeth. Dairy foods or calcium fortifed • high blood pressure; vegetables, broccoli, oranges and fortifed dairy alternatives, e.g. soy or rice milk and • gestational diabetes; fruit juice, bread and breakfast cereal. tinned fsh are the best sources of calcium. • caesarean birth; and It is recommended that women planning If you don’t eat these foods you may need • diffculty loosing weight after the birth. pregnancy take a folic acid supplement a calcium supplement.

BMI and recommended weight gain for single pregnancy * RANZCOG Guidelines First trimester (3 months) One to two kilograms in the frst three months of pregnancy. Recommended weight gain Second and third trimesters for twins or triplet pregnancy

If your pre -pregnancy You should gain: Recommended If your pre -pregnancy BMI Recommended total gain range BMI was: total gain range (kg) was: (kg) Less than 18.5kg/m² 500g/week 12.5-18 Less than 18.5kg/m² Discuss with Obstetrician/Dietitian 18.5 to 24.9kg/m² 400g/week 11.5 -16 18.5 to 24.9kg/m² 16-24 25 to 29.9kg/m² Less than 300g/week 7-11.5 25 to 29.9kg/m² 14-23 Above 30kg/m² Less than 300g/week 5-9 Above 30kg/m² 11-19 A healthy pregnancy 23

Iron Food safety and hygiene • Ideally, eat only freshly cooked food and Iron is needed to form red blood cells for well-washed freshly prepared fruit and Toxoplasmosis you and your baby. It helps carry oxygen vegetables. However, leftovers can be in your blood and is needed for your baby Humans can be infected with eaten if they are refrigerated promptly and kept no longer than a day. It is to grow. toxoplasmosis through being in contact with the faeces of infected animals important you do not eat food if there is During pregnancy your iron requirements (commonly cats), eating undercooked or any doubt about its hygienic preparation are increased. A lack of iron can often leave raw meat, consuming unpasturised milk or storage. you anaemic, tired and less able to fght and contaminated vegetables. off infection. The best sources of iron are Cytomegalovirus (CMV) lean meats, green leafy vegetables, legumes Toxoplasmosis can reach the baby of an A pregnant woman infected with CMV and fortifed cereals. Citrus fruits and other infected mother through the placenta and can pass the virus to her baby during foods high in Vitamin C will help the iron cause them to become very unwell. pregnancy. from your food to be well absorbed. For further information search Most babies born with CMV infection toxoplasmosis at better health vic. Your iron levels may be tested in your will be fne, however some may develop pregnancy especially if your hemoglobin To reduce the risk of Toxoplasmosis: health problems. is found to be low. It is safe to take iron • Wash hands well after gardening or CMV is transmitted through urine & saliva. supplements during pregnancy and handling pets; If you’re pregnant, the best way to protect breastfeeding. Talk to your midwife or • Wash salad and vegetables well; your baby from CMV is to protect yourself. doctor to discuss the best supplements • Cook meat well; • Wash your hands often with soap and for you. • Wear gloves when disposing of cat water especially after changing a nappy; feeding, wiping a child’s nose or mouth, Eating fsh during pregnancy litter, avoid contact with animal faeces where possible. and touching their toys, pacifer, or Fish is a safe and important part of healthy other objects. eating. It is important to eat fsh when you Listeria • Don’t share food, drinks, eating utensils, are pregnant but you need to be careful Is a bacteria that is not common but can or a toothbrush with a child. about the fsh you choose. Some fsh may cause a serious illness called listeriosis in some • Do not put a child’s pacifer in your mouth. accumulate mercury which may be harmful people. Pregnant women, their unborn • Use soap and water or a disinfectant to your baby’s developing nervous system. and newborn children are at a higher risk of to clean toys, counter-tops, and other For more information regarding Mercury becoming unwell if they get listeriosis. surfaces that may have a child’s saliva or levels in fsh go to: It can cause miscarriage, premature labour, urine on them. www.foodstandards.gov.au/ babies being signifcantly unwell at birth and • Avoid contact with saliva when kissing consumerinformation/mercuryinfsh.cfm stillbirths. Some foods are more prone to or snuggling. Iodine for pregnancy and breastfeeding contamination. Listeriosis can be treated For more information see www.cmv.org.au with antibiotics but prevention is best. For Adequate Iodine in pregnancy and further information please search listeria on breastfeeding is essential for the normal www.foodstandards.gov.au Eating nutritious meals development of baby’s brain and nervous system. It is recommended that all To reduce the risk of Listeria is one of the best women who are pregnant, breastfeeding • Thoroughly wash your hands, cooking things you can do for or considering pregnancy take an iodine utensils and chopping boards. supplement of 150 micrograms each • Make sure hot foods are hot your baby’s health day. You need to include good sources (above 60 degrees) and cold foods are of iodine in addition to this supplement. cold ( below 5 degrees) both at home whilst pregnant. These include: seafood, eggs, iodised salt and when eating out. and bread with added iodine. Women • Cook all meat, chicken, fsh and For further with pre-existing thyroid conditions should eggs thoroughly. seek advice from their medical practitioners information go to: prior to taking a supplement. • Avoid certain high risk foods, e.g. soft cheeses, cold cooked chicken, cold www.pregnancy Ask your midwife or obstetrician for sliced meats, uncooked or smoked more information regarding iodine. or go seafood, pre-prepared salads such as birthbaby.org.au/ to www.nhmrc.gov.au/guidelines- coleslaw, pate and soft serve ice cream. publications/new45 or healthy-diet-during- • Wash raw vegetables and fruit well www.foodstandards.gov.au before consuming. pregnancy 24 A healthy pregnancy

Frequently asked questions about Talk to your doctor or midwife for a alcohol in pregnancy referral to the Smoking Cessation Service. Alternatively visit www.quittas.org.au Alcohol in • Can Fetal Alcohol Spectrum or telephone 13 QUIT (13 78 48) for Pregnancy Disorders (FASD) be cured? further details. The brain damage caused by alcohol is Use of drugs in pregnancy Drinking alcohol during permanent and lifelong. pregnancy can harm the There is no safe level of illicit drug use in • Will a little bit of alcohol be a risk? pregnancy and some prescribed and legal brain and body of an unborn Yes. It is therefore wise to have no alcohol if medications can also be harmful to the child and increase the risk of you are planning a pregnancy or are pregnant. unborn or breastfeeding baby including miscarriage, low birth weight complimentary medicines. Many drugs can • What if I drank alcohol before I knew cross the placenta and harm your child. or premature birth. This can I was pregnant? In Australia medications are classifed into also mean underdeveloped Many women are unaware they are pregnant risk categories so it is important that you organs within your baby. until the 5th or 6th week. If alcohol was tell medical or midwifery staff if you are used at this time, don’t panic. taking any kind of drugs (including over the Fetal Alcohol Spectrum counter) drinking alcohol or smoking. The best action is to stop drinking. Disorder (FASD) is a term It can also be dangerous if a woman who For more information telephone the used to describe conditions needs medication stops taking it so get Drug Education Network Inc. local call: advice prior to any changes. caused by harmful effects of 1300 369 319 or www.den.org.au alcohol exposure on the Babies whose mothers use drugs and Alcohol and Other Drug Information alcohol during their pregnancy may unborn child. Most children Service: 1800 811 994 have lower intelligence and behavioural with FASD do not look problems. These babies often go through Smoking in pregnancy different but may have withdrawal symptoms and may need to varying levels of brain There are many health risks associated go to the Neonatal Paediatric Intensive with tobacco for both you and your baby. Care Unit or Special Care Unit. There is damage, emotional and Smoking increases your risk of having also a risk of stillbirth or premature birth. physical development a miscarriage, a premature birth or a A premature birth means your baby may delays, learning problems stillbirth. Babies whose mothers smoke not be well developed and have a low birth tend to be small for their age which can weight which tends to lead to them being and behavioral disorders more prone to childhood illnesses. For such as Attention Defcit also mean poorly developed organs and frequently have breathing problems. help/information contact: Hyperactive Disorder Your midwife will ask you about your • Quit line – 13 78 48 (ADHD). www.quittas.org.au smoking and alcohol use with each of your visits & can help with strategies to cut • Alcohol & Drug Service – down & stop. 1300 139 641 or www.den.org.au (24hr Help 1800 811 994) 4

Labour and birth 26 Labour and birth

What you will need to bring into hospital Remember

Baby grows very quickly so it is good advice not For mother For baby to buy too many very • Loose and lightweight clothing • 4 - 6 grow suits, either size small items of clothing. for labour; 0000 or 000; • Comfortable day clothes and • 4 - 6 singlets; footwear; • 4 - 6 light weight wraps; • Comfortable sleepwear; • Nappies, pack of 32, newborn size; When buying nursery • Nursing bras and pads; • Sanitary pads; • 2 Light weight blankets; equipment look • Medicare Card and Private Health • Socks/Mittens; Insurance Card; • Hat for discharge; for the Australian • Hand held record (orange folder); • Nappy changing gear - face washers, • Energy rich food for labour like bananas, baby wipes, cotton balls; Standards Logo. grapes, barley sugar, cheese, yoghurt; • Cloth nappies or hand towel for ‘spill’ • Tea, coffee if required between meals; cloth; and Check the web site • Massage Oil with no added scents; • Tin of formula if artifcially feeding. • Watch or clock; www.kidsafe.com.au • Music in CD or iDOC form for labour; • battery charged ‘tea light’ candles are for information on permitted only: • Camera; and safety features for • Mobile phones but should not be used in areas where they might interfere children’s equipment. with electronic equipment, if unsure please ask the staff. Mobile phone use should be restricted in double rooms – turn off overnight. Partners need to bring what they may require over 24 - 48 hours including all snacks (meals not provided for partners). Please pack this book Do not bring large amounts of money or valuables. (You may be asked to complete a valuables disclaimer when you present to the hospital). What you will need for your baby at home At minimum you will require a safe sleep make sure they are safe for baby, with environment for baby (cot or bassinet), recommended 5 point harness for car approved rearward facing car seat and seats, prams and high chairs. For further possibly a pram. Optionally you may like information on Australian standards go to purchase a baby bath and some type of to www.productsafety.gov.au/products/ baby rocker or play mat. Remember the babies-kids only unsupervised safe sleep environment If you are formula feeding your baby, you for baby is their cot/bassinet. will need sterilising equipment, bottles, When buying second hand equipment caps and teats. Labour and birth 27

• Second stage is when the cervix is fully which are all normal signs of early labour. Labour and birth open until your baby is born. This is Remember though you do not have to Your birthing preferences commonly called the pushing stage, have ruptured membranes to be in labour, although not all women feel the urge to this can happen at any stage. Preparation for your birth is important and push. If you do not feel the urge your Once the contractions become stronger, some women decide to write down their body will usually do it involuntarily with more regular and painful you are in a more birthing preferences which allows them contractions anyway. Women usually active part of your labour. This is still a part the opportunity to share thoughts and feel bowel pressure and a burning and of the frst stage of labour, your cervix is special needs with the midwife/doctor and stinging sensation around their vagina dilating from 4 to 8cm, the contractions are support people. It is important that you during this stage. This is normal and around 3 to 7 minutes apart and lasting up provide your midwife/doctor with a copy means your baby will be born soon; and of your birth plan prior to your labour to to 60 seconds. This active phase may take • Third stage is from the birth of your allow an informed discussion to take place. around 3-5 hours. Many women present baby until the birth of the placenta. The midwives will always try to fulfl your to hospital during this part of labour. wishes provided that it is safe for you and How long is labour and how might During this phase your feelings need all your baby. I feel? your attention. Remember in between Some things to think about during your each contraction your body is able to relax Labour and birth is unique for every and regain focus. pregnancy, and possibly discuss with your woman. This can mean lots of variation in midwife and doctor are: the length of each labour and feelings you Transition is part of frst stage of labour • Your chosen support team may experience. where your body is working really hard for approximately 1-2 hours. Contractions (2 people only); In the weeks leading up to your labour, may be 2-3 minutes apart lasting 60 to 90 • Positions for labour and birthing; it is very normal to experience varying seconds and your cervix dilates to 10 cm. emotions and body changes including • What you will bring with you to Common feelings include pressure in personalise your environment; increased vaginal discharge, increased Braxton hicks, feelings of anxiousness or the bowels, nausea, irritability or panicky, • Your chosen methods of pain relief; and excitement and other common discomforts a heavy vaginal show (thick mucous • You preferences if there are like back or hip pain or the occasional sharp combined with blood) and spontaneous complications. pain within the cervix region, as the body rupture of membranes if this has not and mind prepare for labour. occurred earlier. These feelings are a good Labour has three stages: sign your body is progressing well towards The early phase of your frst stage is when meeting your baby. Labour is simply the muscles of your uterus the contractions are often irregular around contracting to thin and open your cervix 5 to 20 minutes apart lasting 20 to 40 Stage two, the pushing phase to the birth (the lower part of the uterine muscle) and seconds and may range from approximately of your baby, begins when your cervix is to help move baby down further into the 8 to 16 hours. During this time your cervix 10cm and fully thinned out, plus the baby pelvis. Oxytocin is your natural hormone is starting to change, thinning out and dilating has moved further down into your pelvis. that works to allow this to happen. to 3-4 cm. You may also notice a mucous Pushing for some women may only take • First stage is from the beginning of plug referred to as a show (clear or white 15 minutes but for other women it regular contractions until the cervix is thick mucous often streaked with blood) or could be up to 2 hours. Strong, regular fully open (10cm); your ‘waters’ break; backache or diarrhea contractions continue during this phase. Please remember this is only a guide, each labour is different. For more information How do you know you are in labour? please refer to www.raisingchildren.net.au pregnancy information or consider attending You are unlikely to mistake the signs of labour when the time really one of our antenatal education sessions. comes, but if you’re in any doubt don’t hesitate to contact your Midwife, PAC or Birth Suite and ask for advice. Labour patterns are Delivery of the Placenta (third stage) different for all women. You are likely to be in labour when your During the delivery of the placenta and contractions are regular (between 3 -7 minutes apart) and cause strong soon after, new mothers are at their period like pain or back ache and last more than 45 seconds. greatest risk of abnormal heavy bleeding (known as haemorrhage). With modern You time from the start of one contraction to the start of the next medicine the incidence of haemorrhage contraction and they do need to be strong, regular and painful. can be prevented or treated using oxytocin Remember normal labour is painful but many women cope well. drugs to help the uterus (womb) contract You do not have to have ruptured membranes (waters) to be in labour. and stop the bleeding, thereby reducing the risk of heavy bleeding. 28 Labour and birth

Evidence from clinical studies demonstrates Care of stitches that active management (administration • Ensure that you take some pain relief; What to do if you of oxytocin drug) of third stage is more are in labour effective than natural (physiological) • Stool softeners may be required to management in reducing the risk of heavy decrease pressure on the stitches when Telephone your Midwife, PAC or bleeding immediately after birth. For this opening your bowels; Birthing Suite out of hours anytime reason, active management is considered • Keep the area clean and dry; about your labour. The midwife the best and safest practice around the • Apply ice pack supplied by the hospital will ask you questions about: world and is routinely practised in hospitals every three hours for 20 - 30 minutes within Australia. • When your baby is due; in the frst 24 hours, this helps with All THS services have a policy to actively swelling and pain; • The timing and strength of your manage third stage with your consent. contractions; and With consent (obtained during your • If you have problems with wound antenatal visits) you will be given oxytocin healing or infection after giving birth talk • Whether your membranes have with the birth of your baby, a drug similar with your midwife or see your GP; and ruptured (waters broken). Please to the body’s natural hormone, which • For women who have sustained put a pad on if you suspect this causes the uterus to contract and separate a 3rd or 4th degree tear to their so the midwife can check it. It the placenta from the uterus soon after the perineum, a physiotherapist will see should be clear or slightly pinkish. birth of your baby. Following the injection you following the birth and you will also of oxytocin, the is usually have an appointment to return to the clamped within 2-3 minutes and to assist Gynaecology Clinic in about 6 weeks be considered at an increased risk. Please the placenta to be delivered, the midwife from the birth. discuss this in your antenatal visits. If your or doctor will create tension on the labour is classifed as higher risk the THS cord whilst also applying gentle pressure Monitoring your baby during labour WACS recommends continuous fetal on your stomach just above your pubic When you come to the hospital in labour monitoring and increased observations of bone. Side effects such as mild nausea there are some routine checks that the the mother be implemented during labour. or a temporary increased blood pressure midwife or doctor will usually do. from the oxytocin drug are minimal when These may include: considering the risk of haemorrhage is Pain and labour signifcantly reduced. • Regular check of your blood pressure, It is normal for women to feel pain in Please understand that if you choose to temperature and pulse; labour and everyone experiences this pain have a physiological third stage (i.e. no • Check of your baby’s heart rate; differently. Some women say they have injection of oxytocin unless heavy bleeding • Palpation of your abdomen to feel the very little pain whilst others say it is the occurs), the THS will respect your decision position of your baby; but recommend that you discuss this at an strongest they have ever felt. antenatal visit to ensure your decision is • On admission a monitor (CTG) may You will feel each contraction reach a peak fully informed. be used to record your baby’s heart (like a hill or wave) but then it will recede rate and your contractions, and in or lessen and there will be no pain until the Tear/ and Stitches certain circumstances may be required next contraction. During your baby’s birth a tear to the continuously throughout the labour Each woman labours differently and how vaginal opening (perineum) sometimes process. In some circumstances when you cope with labour depends upon a lot happens. The doctor/midwife will repair the quality of the external monitoring the area with stitches within an hour after is poor, internal monitoring may be of different factors. It is important not to the birth. Local anaesthetic is used to help required. This involves attachment of a compare yourself and how you labour to numb the area so it doesn’t hurt. small probe via the vaginal passage and other women. The most important thing is on to your baby’s head; and how you feel. Episiotomy is a cut in the side of the vaginal opening - usually the right side. It is not • An ‘internal’ or vaginal examination will What you can do for yourself routinely done but may be necessary need to be done at regular intervals to Research indicates that many women cope depending on the circumstances to assit in check the progress of your labour. This with labour by having a good understanding the birth of your baby. After the birth the is to feel how open and thin your cervix vaginal trauma will be assessed and sutured is and the position of your baby in the of the process and feeling well supported. as required. Local anaesthetic is used in the pelvis. A vaginal examination is the only Various hormones and beta-endorphins in area if suturing is needed. way we are able to accurately determine your body are superbly designed to help your progress through labour. you during labour and birth. To allow your Both tears and usually heal body the best chance possible of labouring quickly and the stitches will dissolve. For women with a high Body Mass Index effectively and releasing natural pain relief (BMI) score your labour and birth may Labour and birth 29

External Cephalic Remember Version (ECV) Induction of labour In the last few weeks of pregnancy, most babies are head down in their mother’s Sometimes labour needs uterus and this is the easiest and safest to be started artifcially. This is position for birth. ECV is a procedure called induction. This is only done if performed by an Obstetrician which the the health of the mother and baby is THS WACS may be able to offer to turn of concern or you are overdue. a baby from a breech (bottom/foot frst) to a cephalic (head frst) presentation. The obstetrician will discuss the procedure with of labour to be done at a time of around you and will need to obtain your consent 10+ days overdue. ‘Ripe’ means that your to perform. For more information go to cervix has opened and thinned enough to to it’s full potential it is important that you www.ranzcog.edu.au and search for the allow an artifcial rupture of membranes to trust your body and try to create a calm, patient information pamphlet ‘Breech be easily performed. You will be given a date undisturbed environment. Simple and Presentation at the End of your Pregnancy’. and time to present to the Maternity Unit. effective ways of helping you include: If on examination at your 41 week • Understanding what is happening to Prolonged pregnancy consultation your cervix is not favourable your body; be positive and ask questions Most women will go into labour naturally or “unripe” and your labour needs to be if you feel “out of control”; between 37 and 42 weeks. induced you may still be offered a stretch • Knowing that you are in a safe and sweep but arrangements will be If your pregnancy has gone more than environment and the staff will respect made for your admission to hospital for one week overdue it is considered to your needs and support you; the evening prior to commencement of be prolonged. Approximately 10% of all • Having a support person with you your labour at 9+ days overdue. This is pregnancies are prolonged, the majority to allow procedures to be put in place that with whom you feel comfortable of these being ‘frst time’ expecting encourage cervical ripening. After any of and confdent; mothers. We know from the research these procedures a monitoring trace • Relaxation and slow breathing that that spontaneous labour allows for the (CTG) will be taken of baby’s heart rate. concentrates on the ‘out’ breath; best possible outcome emotionally and If you are 10-12 days overdue and do not physically for the woman, her family and • Heat packs (are provided by the wish to be induced, we recommend the hospital, wheat packs or hot water her baby. However, we need to balance following: bottles are not allowed in hospital); this with the understanding that closer to the 42 weeks gestation, a very small • Fetal heart monitoring three times a • Choosing to make a noise or be silent; percentage of prolonged pregnancies may week; and • Massage; lead to potential risk to the wellbeing of • An ultrasound scan to measure the • Moving and varying positions, fnd the the baby. The THS policy is that if your amount of amniotic fuid around the baby. position that is comfortable for you; pregnancy is normal but is clearly overdue If any tests suggest a medical reason to • Music or an object to help you focus by 6-8 days AND you wish to have labour deliver your baby it will be fully explained to your mind; and induced, the doctor or midwife may, with you so an informed decision can be made. consent, perform a vaginal examination to • Showers/baths. assess the condition of your cervix (neck It is important to have an idea of what you of the uterus). Induction of labour will not Induction of labour think may work for you when establishing occur at the 41 week consultation, but Sometimes labour needs to be started your labour at home. The suggestions preparation and planning will however take artifcially. This is called induction (IOL). provided can be useful at home and in place for IOL at 40 weeks +10 days. Prior This is only done if the health of the hospital. Remember normal labour is painful to 40 weeks +10 days the THS WACS mother and baby is of concern. but many women do fnd coping strategies support the benefts of spontaneous labour that help them through the pain and reduce and will only induce women for medical Some reasons for having an induction the need for medical pain relief options. reasons in relation to the mother or baby. may be: • Being overdue (usually 10 days); Please Note: You cannot bring fammable At 41 weeks if on vaginal examination your items such as incense burners or candles cervix is “ripe” or favourable, you may be • Having a medical problem, eg. high into THS hospitals. offered a stretch and sweep of the cervix blood pressure, diabetes, bleeding; and and arrangements will be made for induction • Baby is stressed or not growing well. 30 Labour and birth

IOL may progress differently to spontaneous Cervical ripening can be encouraged by What will happen when I arrive at labour. These changes can include: placing a hormone called prostaglandin near the hospital? • Preparing the cervix for labour may the cervix during an internal examination, You will be directed by your Doctor or given in the form of a slow release pessary take some time, even a few days, to be Midwife as to when & where to present. or a gel to help soften the cervix. The effective. For this reason the decision for You will initially be admitted into a shared prostaglandin pessary is left in place for caesarean birth may occur if mother or room until labour has begun. This means 12 hours; the prostaglandin gel is absorbed baby are not well enough for IOL. that your partner will not be able to slowly into the area and may require 2-3 stay with you overnight. When labour • Once the waters are broken labour doses over a day or two before induction is establishing and you are moved to may take some time to begin or may is possible. a birthing room your partner/ support not establish. Another way to encourage cervical ripening people will be able to remain with you • There is a slightly higher risk that your is by placing pressure on the cervix. A thin until your baby is born. baby may show signs of distress and rubber tube called a balloon catheter is If labour begins to establish during the require an assisted birth or caesarean inserted through the cervix. The catheter night, we will contact your support person section to be born safely. has two balloons at the tip that can be flled and ask them to return to the hospital. with water. When infated these balloons • Intermittent monitoring whilst preparing An intravenous cannula (IV) may be placed the cervix and then continuous electronic put pressure on the cervix stretching into your hand or arm and a blood test monitoring (CTG) of baby is required it and encouraging it to release natural will be taken to check your haemoglobin once in established labour to ensure your prostaglandin which leads to softening (iron) levels, this is part of routine care for and shortening. baby is coping well with the changing women having an induction of labour to ensure safe care is provided. environment. Balloon catheter in place • You may require pain relief to help you When medical staff are available, the prostaglandin or balloon procedure will manage labour. take place, and your baby’s heart rate will There are other reasons why labour may be monitored for a short time to make need to be induced, and your doctor or sure you are both well. midwife will explain these to you so you You will need to remain in hospital, but are can participate in the decision. encouraged to walk around to assist labour There are several methods used to induce to begin. Even though you are experiencing or begin a labour. The choice of this depends an induction of labour remember an active on a medical assessment by the doctor labour has been shown to improve time or midwife. frames and reduce pain levels and further intervention. Your cervix will be re-assessed Induction of labour often needs to be carried later depending on which method of out in two phases. The frst phase is called Cervical ripening methods may take several induction has been chosen. If your cervix cervical ripening, where the cervix (neck of has not changed enough to allow your days to be fully effective, and in some cases the uterus) is encouraged to soften, shorten waters to be broken, more gel or another more than one method is used. and open slowly to prepare for labour. balloon may be required. The second phase occurs after the cervix This is called effacement of the cervix. Your midwife will check on you and your has softened and is the labour phase. baby regularly over this time. Labour may have commenced with the use of the prostaglandin hormone which may Our aim is to start your induction in a bring on contractions or by breaking the timely manner. The Maternity Unit is a busy workplace with unexpected admissions forewaters (artifcial rupture of membranes and fuctuations in the number of women or ARM) which typically occurs the presenting in spontaneous labour. following morning once the cervix is ripe. Unfortunately sometimes we may need to If you do not begin to have strong, delay or postpone your induction to ensure regular contractions (3-4 contractions all our women are cared for in a safe in 10 minutes, lasting 45-60 seconds), environment. If you have any questions an oxytocin infusion (hormone drip) will or concerns please contact the clinic or be started to encourage contractions to Maternity Unit on phone numbers provided Mucus plug begin. The oxytocin infusion often needs in the front of this booklet.If you have any Cervix to continue throughout labour and birth to questions or concerns after admission, Vagina allow for the contractions to continue. please ask your midwife or doctor. Not effaced Effaced Labour and birth 31

• less risk of the baby having breathing Assisted births Vaginal birth after problems and being admitted into the In some births assistance may be required caesarean section nursery; to allow your baby to be born vaginally. • reduced complications associated with Whether you have a Ventouse or obstetric (VBAC) major abdominal surgery; forceps depends on the circumstances of • improved chance of early physical contact your labour and the individual needs of For many women it is safe practice to have the labouring woman. a vaginal birth after having had a previous with baby and initiating breast feeding; caesarean birth. It is important you discuss • enhanced ability to care for baby more Ventouse (suction cup) your options and wishes with your doctor effectively after delivery; This may be used to assist in the birth of or midwife as this information does not • some women experience a high level of your baby if labour is not progressing with cover all the known facts about VBAC or satisfaction after a vaginal birth; and pushing. Reasons may include that the all rare but possible complications that • reduced risk of future placental problems mother is too exhausted to push effectively, can occur as a result of VBAC. Everyone from repeat caesarean section. or if your baby is showing signs of fatigue has different circumstances and personal and needs to be born quickly. The cup is requirements that need to be considered. When all the risks of labour are considered made of plastic and has a hand pump. It Many women who have had a caesarean VBAC results in fewer complications is carefully positioned by the doctor and section can have a vaginal birth in for most women than routine, repeat placed onto your baby’s head; the suction subsequent pregnancies. There is a small caesarean sections. is applied, which allows for gentle traction risk of problems with previous caesarean when the mother is pushing. Your baby will scars and you will therefore be monitored When is a VBAC not advisable? have a swelling on the head immediately closely. Your doctor and/or midwife will • After a previous vertical/classical after birth which will begin to reduce over discuss which conditions or precautions are caesarean section birth where the the following 24 hours. necessary for you. uterine incision has involved the upper Sometimes there is bruising on the head In some cases a repeat caesarean section segment of the uterus. which will recede within about 10 days will be recommended for certain medical • After some uterine surgery. following the birth. An episiotomy is not or obstetric reasons. • After a previous uterine tear or rupture. always necessary with a birth assisted with It is important that you discuss all your options • Because of a maternal or fetal reason for a Ventouse however the decision to use with your health care team. Write down an elective caesarean section. episiotomy to assist the birth is decided any questions you have and your doctor/ following evaluation of each individual midwife will be pleased to answer them. • If the baby remains in a breech woman. presentation. What does the research say? Forceps • If you have a multiple pregnancy, even Caesarean section is a common operation if you have had a previous successful Forceps are special instruments placed with reported rates varying across the world. VBAC. around your baby’s head inside the vagina Australia’s reported rate is 23% of all births. to help guide your baby out during the • Two or more previous caesarean Women considering their birthing options pushing or second stage. They are used deliveries. should understand that, overall the chances if there is delay in the second stage, your of a successful planned VBAC are 60-80% Risks associated with VBAC baby is in a diffcult position, or there are (RANZCOG, 2010) and 90% for those concerns for your baby’s well-being. An A previous caesarean section leaves a scar who have had a subsequent normal vaginal episiotomy (small cut) in the perineum on your uterus. This scar is a potentially delivery following a caesarean section may be required to assist the birth of your weakened area that has a small associated (RANZCOG, 2007). baby’s head. risk of rupture or tear during labour Benefts of a successful VBAC include: because of the forceful contractions. • reduced blood loss; The reported risk of uterine rupture is • less likelihood of infection; 1 per 200 births. This is a rare but serious complication for the mother and unborn • shorter recovery time and hospital stay; infant. To reduce the risk of a tear or • reduced chance of readmission after rupture, spontaneous labour is preferred giving birth; but labour may need to be induced for • less need for strong pain relief medications; some women. • reduced risk of complications in future A repeat caesarean section may be pregnancies; required if labour does not progress. 32 Labour and birth

Factors which improve your chance of a successful VBAC include: Birth by caesarean • waiting at least 18 months after a A caesarean is usually performed under caesarean section before becoming spinal or epidural anaesthetic so that you are pregnant again; able to be awake for the birth of your baby. • no complications such as medical You do not watch your own operation as a problems; screen is placed over your chest. A general anaesthetic is not a common choice but • healthy weight range Body Mass Index (BMI) of less than 30 and eating low GI may sometimes be necessary. foods; A caesarean birth may be elective/planned • going into labour naturally before 41 or it may be an emergency/unplanned. completed weeks of pregnancy with There are many reasons why women baby lying head down in an anterior have a caesarean birth, and position; these may include: • baby’s estimated weight less than 4000 • Problems with mother – e.g. small grams; and pelvis, high blood pressure, bleeding, no progress in labour; and Expectations • continuity of midwifery care. • Problems with baby – e.g. wrong • F or planned/elective caesarean, do not Factors which reduce your chance of position, breech, too big or too small eat for 12 hours prior to admission. a successful VBAC can include: or distressed baby. • The abdomen and pubic hair may be • induction of labour; clipped. Preparation for a caesarean birth • being overweight ie BMI of more than 35; • A urinary catheter will be inserted into If the plan is for you to have an elective • no previous vaginal birth or labour; your bladder to keep it empty. or planned cesarean section you will • previous caesarean section for failure to be given an admission time & date with • A dose of antacid or citrate preparation progress; and your Doctors appointment, where the is given to neutralise stomach acid. • large baby (over 4000 grams). operation will be discussed & a consent • You may be in the operating theatre for obtained. You will also be given instructions more than an hour. Labour for blood tests & when to fast prior to • Your support person/partner may • Phone the hospital to discuss when to your operation, as well as exercise advice come into the operating theatre come in if: you are experiencing regular & what activities are limited after your with you unless you are having a painful contractions; operation. You may also be asked to have general anaesthetic. a pre-admission clinic appointment to see • your membranes (waters) have broken; • You may take still photos of your baby at an anesthetist. • you are bleeding; and/or birth, but THS hospital policy does not For emergency caesarean births you will allow videoing of procedures. • you have constant pain. be prepared on the Maternity Unit and • Your hospital stay will be 2-3 days post transported to theatre from there. On admission, it is advisable that an intra- birth as required. venous cannula (IV) be inserted into your Skin to skin contact is advised as soon as • You will only be separated from your arm in case of bleeding due to possible possible after birth. scar problems. baby if; • However you feed your baby skin to • Y ou need a more prolonged stay in It is advisable to monitor the baby’s heart skin will be encouraged for at least one the recovery room; rate continuously by the cardio-toco hour, even if baby feeds early. graph (CTG) machine once you are in • Y ou require a general anaesthetic; • Following a caesarean, if both mother established labour as fetal heart rate issues • B aby needs to go to the Special Care will often precede potential scar problems. and baby are well, baby will be placed Nursery (SCN); and To remain active in labour, you can request on the mother’s chest whilst on the telemetry CTG monitoring which enables theatre table. • I f your baby is well but you require you to walk around without being attached attention, then your partner or • If the above is not possible, your baby to the machine. support person is encouraged to will have skin to skin within 10 minutes have contact and bond with your The progress of your labour will be of arrival in the recovery room. baby, on the Maternity Unit. monitored closely, your doctor or midwife will assess the strength and timing of • If you have a general anaesthetic skin to contractions along with fetal wellbeing. skin will be within 10 minutes of being able to respond to baby. Labour and birth 33

You and your baby after a When getting out of bed for the frst time caesarean birth ensure a staff member is present. Whilst you may feel normal when in bed you may Remember Whilst still in the operating theatre, your fnd your legs are weak or you become baby will be checked to ensure he/she is dizzy the frst time you try to stand. You Feelings well. Your birth partner and you will be may also fnd the wound pain increases. able to cuddle your baby. We will assist When a baby has been It is safer to be accompanied until you are you to begin skin to skin contact with your born by a caesarean birth the sure any risk of falling has been assessed. baby as soon as possible after the birth. If mother or the baby may have been you have chosen to breastfeed you should Wound ill. A woman may sometimes begin feeding as soon as your baby is The incision will be located below your be disappointed if she does not showing signs of wanting to do so. bikini line. The type of wound dressing experience the expected surge of If your baby is premature, has medical used changes from time to time. Often the maternal love. These feelings are reasons or is having problems with wound will be covered with a clear dressing quite natural but it is important to breathing, he/she may need to go to the that should remain intact for 7-10 days. remember that despite the diffculties Special Care Nursery (SCN) for observation. You can remove it yourself in the shower. experienced, it is expected that If this is the case, staff will take you and your Generally you do not need to have your mother and baby should soon be partner to see your baby as soon as possible. stitches removed. Sometimes staples are relating to each other normally. You will need to express breastmilk if your used which need to be removed, this can baby is unable to feed from the breast, be done by the Extended Midwife Service starting as soon as you can after birth. (EMS) or by your GP. Pain relief and baby After the operation If there is any redness or discharge from your If you are taking regular medication wound notify midwifery/medical staff or when Pain relief for pain you should be aware of the you get home see your family doctor. It is important in the frst 2 days after the possibility of becoming drowsy when operation to ensure you have adequate Vaginal discharge you are feeding or cuddling your baby. Ask for help to place your baby back and regular pain relief so that you can move There will be some bleeding after the in the cot or have your bed rails up around freely. Support your wound by operation and this usually decreases over during this time. applying frm pressure with the help of a the next few days. If it increases tell your rolled towel or a small pillow. Your need for doctor or midwife. See page 41 for pain relief should decrease with each day. further information. The Anaesthetic Service will visit you on the Intravenous cannula (drip) day after your caesarean birth to discuss A caesarean birth is your pain relief. You are usually confned and urinary catheter to bed for 12-24 hours after the birth. • You will be encouraged to sip fuids soon a major operation When confned to bed there is a risk that after the operation and eat a light meal you can develop clots in your legs (deep when you feel ready. Once you are able where the baby is vein thrombosis). A drug is given as a small to tolerate fuids the intravenous drip is injection into the fatty tissue just under the usually removed. born through an skin, to help prevent deep vein thrombosis. • The day after your operation the incision or cut in your Moving – getting out of bed urinary catheter is usually removed. For most women it is quite safe to be out This enables you to move freely, get up, abdomen and uterus. of bed the day after their caesarean birth. shower and care for your baby. Circulation and deep breathing exercises Some people fnd diffculty with passing The incision is usually are important to do regularly while resting urine following removal of the catheter, in bed, until you are moving freely around the midwife caring for you will instruct you just below the ‘bikini the ward. These exercises and walking on on how to measure the amount passed the ward are encouraged to help prevent the frst few times. Passing urine may line’ so after healing post-operative chest infection and deep vein also sting, if this happens tell the midwife, thrombosis (DVT). When you return from is often hidden or who can give you some medication to theatre you may have pressure devices on your legs called SCUDS and special stockings help neutralise the urine acidity. If stinging less noticeable. called TEDS. This helps with the circulation continues a specimen may be sent to until you are able to ambulate freely. pathology to rule out an infection. 34 Labour and birth

Returning to normal activities Labour TENS machines can be hired Help at home is necessary over the frst privately through local medical companies Morphine and Pethidine and online. Operating instructions come few weeks caring for your baby. These are strong pain relievers given with the machines. Initially you should only lift things around by injection. At all times prior to the the weight of your baby but increase this For further information or hire call the administration of these narcotics or any activity as you feel able. Better Life Company on 6234 5144 or other drugs, the midwife or doctor will visit them at 83 Brisbane Street Hobart. need to assess the progress of your Ensure you do not put yourself or your Alternatively search Australian companies labour. They take between 5 to 30 baby at risk by taking on too much too online for TENS hire. minutes to work depending on the way soon. Be aware that it will take time to the drug is given. heal and stay safe. Water Injections Check with your insurance company It has been suggested that injections of small before you begin to drive – some may amounts of sterile water into, or just under, not cover you in the frst 6 weeks the skin of the lower back might be able to Epidural Anaesthesia relieve some types of labour pain, especially post operatively. Epidural Anaesthesia is an effective means the pain felt in the back. There are no Will a caesarean birth be necessary in of pain relief and involves the injection of known side effects for mother or baby. local anaesthetic and other pain relieving the future? Nitrous Oxide (Gas) medication into the epidural space. This If a woman has had a lower uterine is the only pain relief that has the ability segment caesarean birth and there is not This is a mixture of nitrous oxide and to take the pain of labour away almost a recurrence of the problem that led to oxygen sometimes called ‘laughing gas’. It completely. the frst caesarean, then she may be able is a very safe option for pain relief in labour. to have a vaginal birth next time. Factors Some women fnd the gas helps by taking You will always have an intravenous infusion such as the size and position of your baby the “edge” off the pain of the contraction, inserted, a monitoring machine (CTG) to can affect whether your next baby is born others fnd it is a good focal point to help measure baby’s heart rate and to measure vaginally or by caesarean. Discuss this with slow down breathing during contractions. your contractions. A urinary bladder your doctor/midwife. The midwife will instruct you on how to catheter is always needed. Caesarean birth is a safe method for use it during labour. You may experience Only a specialist doctor called an anaesthetist the birth of your baby but it is a major nausea, light headedness and a dry mouth can give an epidural anaesthetic. You will operation, and therefore the decision to for a short time. There are no after effects be given a local anaesthetic into the skin of have a caesarean is made carefully. for you or your baby. This is a great option your back before the epidural is inserted. if wanting minimal intervention. After this you should only feel a dull pushing If further information is required please sensation on your back. A thin fexible request the RANZCOG leafet on Morphine and Pethidine plastic catheter is inserted into the epidural Caesarean Section or Vaginal Birth After Narcotic medication given as a single space and this will stay taped in place until Caesarean Section. dose injection either under the skin, into after the birth when it will be removed. a muscle or via an intravenous cannula. It Anaesthetic drugs are given continuously Medical pain relief helps take the edge off contraction pains through this catheter via a pump to provide through a sedative effect but will not take all pain relief through the labour, pushing and options the pain away. Further doses can be given any suturing that may be required. There is after around 2 hours. This medication does also an option to have Patient Controlled Everyone manages labour differently and cross the placenta to the baby. It can make Epidural Analgesia (PCEA) where you are there are many pain relief options available you and your baby sleepy, and this may given a smaller continual does but can to assist you. reduce respiratory effort in your baby if push a button to provide extra pain relief TENS Machine (Transcutaneous given close to birth. Research indicates that as needed. Management and care are the Electrical Nerve Stimulation) these drugs when given in labour can reduce same for standard epidurals and PCEA. your baby’s sucking refex, which may The TENS machine is a small, hand-held, If you have an epidural for pain relief affect initiation of breastfeeding in the frst battery operated unit, with wires and in labour it will be turned off once any 12 to 48 hours. After this time your baby self-adhesive pads attached. The pads are suturing has occurred after the birth of your will become less sleepy and breastfeeding placed on 4 points on your back. These placenta. Generally it will take 1-2 hours to should improve. Morphine is more rapidly pads produce an electrical pulse with a feel full sensation and strength in your legs eliminated than Pethidine so the effects to tingling sensation, that helps block the again. When you stand for the frst time baby may resolve quicker. Please note these sensation of pain interpreted by the brain after having an epidural removed please which occurs with contractions. It can work side effects are not seen in all babies whose ensure you are not at risk of falling by well for pain during any phase of labour, mums have had narcotics during labour. having a staff member with you to assess but it seems to work best for back pain. the situation. Labour and birth 35

Advantages of Epidural Anaesthesia • Rarely, an allergic reaction to an • It can allow you to rest during a long or anaesthetic agent may occur. painful labour. • Occasionally, the anaesthetic service Remember • It is the only form of pain relief that is unavailable or delayed because the Pain relief options causes little or no drowsiness to you anaesthetist may be tending to other in labour or your baby. urgent responsibilities. It is important that you • If a forceps, caesarean birth or other discuss medication options intervention is needed to deliver your Rare complications of Epidural with your Midwife or Doctor. baby, a stronger epidural may be Anaesthesia This will ensure you have a complete used to help to relieve the pain of • The site of the epidural may become understanding of the drug, its use these procedures. infected and you will require antibiotics. and effects on you and your baby. An epidural does not necessarily lead to Very rarely this may lead to meningitis A good time for this type of an increased risk of a caesarean birth. or an epidural abscess. discussion is during the antenatal However there is a slightly higher chance • The local anaesthetic may be accidentally period and your preferences can then of a ventouse/forceps birth as the urge to injected into a blood vessel causing be recorded prior to your labour. push may not be felt. dizziness, a metallic taste in the mouth, Anaesthetic and pain-relieving procedures and in extreme cases, convulsions and are typically reliable and safe but do have signifcant heart problems. some risks. Despite the high standards of • Temporary damage to spinal nerves medical practice, complications can occur. outside the spinal column may occur. Virtually all of these cases recover Possible complications of within a few weeks or months. Every journey is Epidural Anaesthesia • Permanent but rare damage may occur • Your blood pressure may fall and this important to us. ranging from nerve damage to paralysis may affect your baby. To prevent this, in one in 20,000 to 200,000 women an intravenous drip line is inserted undergoing an epidural anaesthetic beforehand so fuid and medications depending on the severity and type of can be given quickly. the damage. • Walking around is not possible due to heaviness and numbness in the legs but you can usually move freely in the bed. Unexpected • Irregular or ineffective pain relief can outcomes of sometimes occur if the anaesthetic agent does not spread evenly. A top-up pregnancy may be necessary or a repositioning or replacement of the epidural may occur. If unexpected complications occur with your pregnancy, the hospital has staff and • A leak of spinal fuid can cause a severe services available to support and assist you. headache. A number of leaks heal on Any concerns can be discussed with the their own while others may require a midwives and doctors. further epidural injection. The risk of this is about one in one hundred. Loss and grief are not usually associated with pregnancy, but not all pregnancies • Local tenderness and bruising can occur progress smoothly. Unfortunately, around the site of the epidural but miscarriages do occur, as do stillbirths, and usually resolves within 7-10 days. some babies are diagnosed with medical • Shivering, nausea and vomiting may problems. We are able to call on resources occur but this frequently occurs in a in the hospital and community that can normal labour as well. support you during your time of need. • Intense itching with some types of medication can sometimes occur. 5

Infant feeding Infant feeding 37

during your pregnancy due to hormonal ovarian cancer and osteoporosis; Infant feeding infuences, with most of the growth • It is also VERY good for the environment occurring in the frst 20 weeks or in the last - no packaging, transport or factory costs; All THS hospitals are Baby Friendly few weeks. Accredited providing a supportive and environment for women regardless of Avoid using soaps and perfumed creams or body lotions on your breasts, expecially in • One important aspect for prevention their feeding choice. the last few weeks of pregnancy. This helps of SIDS. Our policies support the establishment preserve the action of the natural lubricant and maintenance of breastfeeding. Should secreted by pores on the areola. Baby’s behaviour before the you wish to see a copy of the complete frst breastfeed breastfeeding policy, ask your midwife. Exclusive breastfeeding If left skin to skin on your abdomen after If you are unsure about how to feed • Breastmilk alone is the only food birth your baby will gradually crawl toward or drink a baby needs for the frst your baby, feel free to discuss with your your breast. midwife or doctor so an informed decision 6 months of life. Your baby will start mouthing; hand to mouth can be made. We also have further • Breastfeeding continues to be important movements; licking fngers and touching your literature we can give you to support after 6 months when other food is nipple which makes it erect and easier to your decision. introduced. attach to. If you did not breastfeed last time or had • The World Health Organisation (WHO) recommends breastfeeding for As your breast brushes baby’s cheek, baby issues it can be good to talk this over with 2 years and beyond. will turn his/her head towards your breast: your midwife, attend a breastfeeding class open the mouth wide and protrude his/her or see a lactation consultant. • Offering your baby bottles or a dummy can lead to less frequent breastfeeds and tongue over the bottom lip to lick your nipple. you may not make enough milk. When ready, baby will attach to your breast Breastfeeding Breastfeeding is a learnt skill and like and begin to suck. This usually occurs within Antenatal education many other skills, it takes time, patience the frst hour of birth. and practice. Research indicates the importance of Babies breastfeed they don’t nipple feed. learning about breastfeeding during your Why is breastfeeding better It is essential baby takes a good mouthful of your breast not just your nipple. Encourage pregnancy. We suggest you include your for your baby? partner in your education as they then your baby to self attach for the frst feed. understand better what to expect in • A healthier baby - helps protect against If possible, baby should be kept skin to skin gastroenteritis (tummy upsets), ear regards to labour and breastfeeding. The with you for an hour even if they infections, allergies, chest and urinary hospital runs breastfeeding education feed earlier. tract infections and juvenile diabetes. opportunities regularly. To fnd out more information, ask your midwife. You • Longer term, breastfeeding helps The frst few days protect against childhood cancers, need to book early as these sessions are This is a good time to learn and practice obesity and heart disease. very popular. If you have any specifc getting your baby on the breast (attachment). breastfeeding concerns you can also book • Perfect food - helps baby grow, develop All midwives on the Maternity Unit are able an antenatal appointment with one of our and learn. to assist you to achieve good attachment. accredited lactation consultants through • Breastfed babies have improved speech, Babies need to take a good amount of your midwife. sight, muscle development, reduced breast tissue into their mouth for this to tooth decay and gum disease. Please cancel if you are unable to attend as occur and to try and ensure feeding is sometimes there is a waiting list. • Perfect way to bond and feel close comfortable for you. Getting it right in the to mother. frst few days can make the transition at There is no special preparation required Breastfeeding is best for you because: home easier. for breastfeeding however it can be Your breasts are soft in the frst few days helpful to learn a little more before the • Saves money – bottle feeding with infant before your breastmilk changes from the baby comes. Mums do best if they have formula can cost up to $3000 per year; highly nutritious colostrum to mature milk. read all the available information about • With fewer trips to the doctor, medical It is important during these days that your feeding, watched a baby being breastfed, expenses will be less; gone to a breastfeeding class or sorted • Saves time – breastfeeding is quick, baby is offered breastfeeds frequently. out any concerns before baby comes. effcient and hygienic - more time to A baby that appears sleepy may need Doing these things can help you be relax and enjoy your baby; stimulating to feed more often after the more prepared and you may fnd the • Helps you return to your pre pregnant initial settling in period (around the frst establishment of breastfeeding easier. weight more quickly; 24 hours). Usually your breasts will increase in size • Helps protect against against breast and 38 Infant feeding

Hints to achieve and recognise breastmilk in your baby’s Personal Health good positioning and attachment Record book (given to you after your birth). Support from your Child Health • Have baby’s body facing you and held & Parenting Service (CHAPS) and the close to your body, with their mouth Australian Breastfeeding Association (ABA) next to your nipple. is invaluable 1800 MUM 2 MUM or • Point your nipple towards baby’s nose 1800 686 268 and tickle their bottom lip with the edge Thaw breastmilk in cold water or it can of the areola until their mouth is wide open, then bring baby into your breast be thawed in the fridge overnight. Warm with your hand behind their shoulders. in a jug of hot water when ready to use. Microwaves should not be used. Once • When attached well, baby’s lips should heated it cannot be reheated and used be turned outwards and their chin again so only thaw what you need to should be well into your breast, leaving Ten Steps to Successful their nose clear. feed baby. Breastfeeding • It is normal to feel some tenderness for Avoiding teats, dummies and The following 10 Steps to Successful the frst 6-8 sucks while baby stretches complementary feeds breastfeeding have been established your nipple to the back of their mouth, • Your new baby is learning to breastfeed by the World Health Organisation then the feed should feel comfortable – and can become confused if offered a and the United Nation’s Children’s not painful. teat or dummy before he has learnt to Fund for all facilities providing • Your baby should have rhythmic sucking breastfeed well. maternal and newborn care. The with well rounded cheeks and you THS has adopted these steps as should hear swallowing. • Offering fuid other than breastmilk will a summary of their Breastfeeding • Your nipple may be elongated at the end decrease the time he breastfeeds, and Policy - the full policy may be of a feed but will still be a good shape reduce your milk supply. viewed on request. and colour. • Frequent unrestricted sucking at the 1. Have a written breastfeeding policy • Any problem with this – ask your breast will satisfy your baby. midwife to review a feed with you. that is routinely communicated to all Feeding cues (signs that your health care staff. Demand feeding 2. Train all health care staff in the skills baby is ready to feed) necessary to implement the policy. • Is feeding your baby according to their • Hands up to mouth. needs – the more often you feed the 3. Inform all pregnant women about more milk you will make. This is called • Sucking movements. the benefts and management of supply = demand. • Soft cooing, sighing sounds. breastfeeding. • In the early days it is normal for your • Head movements and stretching. 4. Place babies in skin-to-skin contact baby to feed a minimum of 6-8 times with their mothers immediately • Crying is a late sign of hunger – and up to 12 times in 24 hours to help following birth for at least an hour and don’t wait until then! your breastmilk supply to establish. encourage mothers to recognise when their babies are ready to breastfeed • Rooming in (keeping your baby in your offering help when needed. room) allows you to recognise hunger Once the milk 5. Show mothers how to breastfeed, cues and provides the right environment and how to maintain lactation even if for demand feeding See page 7,11 or comes in 41 for further information on rooming in. they are separated from their infants. Breastmilk, once established, looks a little 6. Give newborn infants no food or The only time a newborn needs fuids like skim milk, whitish blue in colour, and drink other than breast milk, unless other than breastmilk is when there is a thin. It is not “too weak”, it always has the medically indicated. medical reason. right amount and type of nutrients, perfect 7. Practise rooming-in - allow mothers Expressing and storage of for your baby. and babies to remain together 24 hours a day. breastmilk Is my baby getting enough milk? 8. Encourage breastfeeding on demand. Some mothers fnd it necessary to express • Baby will have some settled periods. milk from the breast to give to the baby 9. Give no artifcial teats or dummies • You will be reassured when you can later. If you plan to express on a long term hear swallowing sounds with feeds. to breastfeeding infants. basis, you need good skills to keep your 10. Foster the establishment of milk supply. You should talk about this with • Baby’s wet nappies will increase in breastfeeding support and refer your midwife or lactation consultant before number after the milk comes in – at least mothers on discharge from the facility. the birth. 5 heavy disposable nappies in 24 hours. You will fnd information on how to store • During the frst few days your baby’s Infant feeding 39

bowel actions change from black Parent Helpline sleeps in the same room as you in its own safe sleep environment. meconium to a soft mustard yellow 24 hour telephone 1300 808 178 for in appearance. Most babies will have advice and support for any stressful When formula feeding always hold your 1-3 bowel actions per day in the frst feeding or parenting issues that need baby during the feed as this offers your 3 months of life. immediate attention. baby visual stimulation and close physical contact with you. It is not a recommended • Your baby starts to gain weight after an Your Doctor safe practice to prop feed your baby as initial loss of 5-10 % and will regain there is a danger of choking. birth weight by 10 days to 2 weeks. Your family doctor or obstetrician if the symptoms are not getting better in 8-12 Further literature to support your choice of There should be an average gain of hours, or immediately if you feel very unwell. feeding is available on request. Help after 150 gms per week. discharge with formula feeding issues can If breastmilk supply is a problem, talk to a be obtained from your midwife at home midwife, lactation consultant or CHAPS Formula feeding visits, child health nurse or doctor. nurse about the many things you can do Some mothers who plan to formula feed to improve your supply. give their baby the frst feed at the breast, so the baby gets a very precious feed Infant tooth decay Breastfeeding and returning of colostrum (mothers frst milk). If you The following may increase the risk of to work don’t want to do that, you could consider infant tooth decay: expressing some and giving it to your baby. • It is possible to work and breastfeed, • Honey or sweetener on the dummy; If you have chosen to formula feed prior to many mothers express at work for their • Infrequent tooth brushing or not your baby’s birth we strongly recommend cleaning after the frst tooth appears; baby’s feeds. skin to skin contact immediately following • Prolonged and frequent bottle feeding • Discuss with your midwife, lactation the birth for at least one hour. This frst when teeth are present; consultant or CHAPS nurse. contact is important for all babies regardless of method of feeding. • Adding any sweeteners to the bottle; and Remember to bring a tin of formula suitable • If your baby has a bottle or dummy Support after birth for a newborn baby under 6 months to which has been in the mother’s mouth hospital with you. Your midwife will show bacteria will be transferred which Lactation consultant you how to make up the formula and may cause decay or infection in your discuss how to sterilise the bottles, teats, baby’s mouth. telephone advice and caps when you are in the maternity Available from 8.30am-4.00 pm, ward. You don’t need to bring your own Monday to Friday. teats or bottles as these are provided. Baby is often alert, LGH: (03) 6777 8934 Refer to the formula tin for appropriate amounts per feed. The amount will awake and responsive North West: 0409 973 547 increase as baby grows. Ask the Child Health & Parenting Service for advice. in the frst hour after Australian Breastfeeding If you plan to use infant formula, remember Association (ABA) to offer skin to skin contact on a regular birth - making it the basis. As formula fed babies sleep heavily it Telephone 1800 686 268 is recommended by Red Nose (previously perfect time for the (1800 MUM 2 MUM) for Breastfeeding known as Sids and Kids) in accordance with Helpline, local group contacts and enquiries the safe sleeping guidelines that your baby www.breastfeeding.asn.au frst breastfeed. Child Health and Parenting Services (CHAPS): incorporates Parenting Centre Telephone CHAPS North & NW 1300 064 544. Tasmanian Multiple Birth Association Telephone 0420 588 805 or go to www.tasmba.org.au/ for enquiries. 6

Your baby is born Your baby is born 41

Skin to skin contact Some mothers experience ‘after pains’ for the frst few days. They may be mild or Keeping your infant following birth severe contractions and often get worse during breastfeeding. Breastfeeding makes safe in hospital After birth your baby is usually alert and the uterus shrink back to its normal size • All hospital staff are identifed by ready to get to know you. more quickly. authorised THS identifcation tags. Uninterrupted skin to skin contact is Lochia is the word used to describe the important for all mothers and babies for at • Baby should not be taken outside blood loss you have vaginally after birth. Maternity Unit until you are least the frst hour because it helps: To begin with it will be red, just like a heavy discharged. When taking your • Baby feel more secure; period, but within a few days your vaginal baby out of your room put the • Baby maintain body temperature and loss will be less in amount and much infant in the cot and push the cot. blood sugar; lighter in colour. It may increase during Do not carry your infant in your breastfeeding as your uterus contracts. arms outside the room or allow • Improve oxygen levels for baby; others to either unless you have Over the next six weeks the loss becomes • Baby breathe more regularly; and been discharged. lighter and stops. If your loss becomes • Baby gets bugs from your skin, which • Your baby will wear two bright red again and gets heavier or smelly protects him from infection. identifcation name bands after going home you should let your throughout his/her stay in doctor know. Skin to skin contact until your hospital. If your baby’s name baby’s frst breastfeed is If you have problems in the frst few band is loose or has come off, important because it: days with: please tell your midwife. • Sensing the urge to void (pass urine); • The Maternity Unit has a • Keeps baby warm and cries less; rooming -in policy, which means • A slow or hesitant fow of urine; • Helps baby use instincts to fnd the having your baby with you all the • Pain on passing urine; nipple and attach correctly; time. It is your responsibility not • A feeling that you are not emptying your to leave your baby unattended. • Helps baby learn to breastfeed; bladder properly; If you leave your room/ward • Promotes a feeling of closeness during visiting hours, ask a family • Frequent leakage of urine; and between you and your baby; and member to watch your baby. • Passing urine more frequently than • Helps ensure you have enough milk every 2 hours. and fewer breastfeeding problems. Let your midwife, doctor or physiotherapist During this special time, the midwife will make sure you and your baby are well. know. Everyone loves to Once your baby has had at least an hour of It is important to have regular bowel skin to skin and has had the frst breastfeed motions after birth. Drink plenty of fuids welcome a new then your partner or support person may and eat a diet that is high in fbre. The like to cuddle or even skin to skin cuddle midwives caring for you can offer you baby, but your rest is baby. If you are choosing to bottle feed, we medication that can help to soften you encourage you to continue skin to skin for bowel motion if needed. important especially at least an hour. You can give a feed whilst If you have any problems with your bowel cuddling your baby. in the frst few days or bladder in hospital please talk with your midwife or doctor. A Continence & after the birth. It may Your body after birth Womens Health Physiotherapy may be Straight after birth the fundus or top of available via outpatients - if you have any be hard for you to say your uterus can be felt like a ‘cricket ball’ questions ask your midwife to refer you. just below your navel. Your midwife will All women are seen on a priority basis. no to well meaning check to see if your uterus is shrinking each Any sutures in your perineum are day. By six weeks it should be back to its dissolvable. Please see page 28 for further friends and relatives. pre-pregnant size. care of stitches information. 42 Your baby is born

• When using the bathroom facilities, use Use a lubricant, go gently, relax and don’t the shower chair and rails provided. If forget to use contraception! Remember you feel unsafe, remain seated and call staff for assistance. Contraception Look after yourself • Placing baby on his/her back in the cot if There is a chance that you could become pregnant before your six week check so Save energy by trying to you are feeling sleepy. we recommend that if you are sexually have a rest during the day so • Wear non-slip footwear. active, and you don’t want to get pregnant, you can cope with evening • Turn the light on when getting out of that you use some form of contraception, tiredness. Sleep when your bed or attending to your baby during eg condoms. Some women choose baby sleeps. the night. to have the implant called “Implanon” To keep your baby safe from falling: and this medication can be given to you prior to you leaving hospital. There are • Addressing any safety issues when other options available that may be more changing nappies or at bath time. appropriate for you and your lifestyle. Your • Change the nappy in the cot rather than midwife and doctor are available to discuss on the bed. your contraceptive options. • Never leave the baby unattended on For more information visit any raised surface without supervision. Alliance Australia • Don’t carry your baby in your arms www.familyplanningallianceaustralia.org.au/ while you are walking around the unit. resources/ Use the cot when you are walking Family Planning Tasmania around the maternity unit. www.fpt.asn.au/advice/contraception

Sex and intimacy Look after yourself After you have given birth to your baby, • Learn to ask for help. you may feel a variety of emotions about • Develop a practical support system. your body. It has created another living • Take time out just for you – do being and you should feel proud of it. something you really enjoy. However, so often women feel impatient • Try to allow some time for exercise. because it may take time for their body to It increases health, makes you less tired, Prevention of falls return to its pre-pregnant shape. helps to regain your fgure, and Your vagina may be tender, especially increases self esteem. Mothers and newborns can be at risk of falls. if you have had stitches. If your baby is After you have had your baby, you may be • Don’t feel guilty ignoring the phone or feeding frequently, you may feel tired of very tired and drowsy because of lack of doorbell, especially at bath time, during sleep, blood loss or pain-relief medication physical contact. meals, feeding and rest times. and it is important that you take steps such Share these normal feelings with your • Put time aside for meals, especially with as the following to reduce this risk of falls: partner. Let your partner know that you your family. Sit down and take your time • Obtaining help when you frst get out do care, that you do enjoy cuddling and to eat. Try not to miss meals. touching, but that you may not be feeling of bed after having your baby. Later on, • Seek out new mothers so you don’t feel up to sexual intercourse for a few weeks. take your time when getting in or out lonely or isolated. of bed. You can be sexually intimate without penetration occurring. Be imaginative • A GP check is recommended 6 weeks • Ensuring that the area around your after birth to ensure that mothers are bed is free from obstacles such as extra but always be sensitive to one another’s feelings. While you are breastfeeding, there recovering from her pregnancy and chairs, presents, surplus blankets, clothes delivery, and are coping with baby’s is a change of hormones in your body. and footwear left lying on the foor. demands. This will mean that your vagina may be • Placing frequently used items within easy drier than usual and that you may need a • Follow up might include - breast exam; reach. lubricant. If dryness is a major problem, urine; perineum check; blood pressure; • Asking for assistance if you feel unsteady please talk to your doctor. pap smears and contraception advice if or when moving your baby into or from this has not already been attended at Also during sex, your breasts may leak, the cot. 2 week check or prior to discharge. so don’t be surprised! Your baby is born 43

• A stressful pregnancy; Remember • Experiencing severe ‘baby blues’; Stress management • Sleep deprivation; for parents Baby blues • Prolonged labour and/or delivery complications; It is normal for parents to have Remember…. It is • A lack of practical, fnancial and/or times when they feel angry, normal for all mothers to emotional support; frustrated and helpless. experience times of emotional • Past history of abuse; The responsibility of parenting and physical exhaustion. If your • Unrealistic expectations about can weigh heavily, especially depression or anxiety lasts more motherhood; and when you are unable to feel in than two weeks, seek help. • Moving house. control of a situation you are responsible for (an example can Signs resulting in you getting support be when your baby is crying for immediately may be: no apparent reason). If you have • Feeling like life isn’t worth living; tried all the settling techniques • Having thoughts about hurting and nothing is working and you yourself; and are feeling fed up… • Worrying about hurting your baby. Although some women get depressed STOP straight after , some women • Put your baby down in a safe may not feel ‘down’ until several weeks or place - in the cot with the cot months later. Depression that occurs within side up. 6 months of childbirth may be Postnatal Depression (PND). • Leave the room – no baby has died from being left to cry for Your family or partner may notice that you 5 -10 minutes but some have died are depressed before you do. They should from brain damage from being encourage you to seek help, if they suspect shaken by an angry parent. you are suffering from depression. If you think you have PND there are • Consider why am I (or was I) Feelings several people you can contact: angry? Where does it stem from? • Family GP • Take 10 slow deep breaths – Baby blues • Child Health Parenting Service concentrating on making the out Some women experience mood swings breath slow. • Family and friends about 3-4 days after the birth of their baby. • CHAPS North & NW 1300 064 544 • Take action: Talk to someone if One moment they are happy and the you are still feeling angry. next they may be crying. These ‘blues’ are You can visit these websites: normal and usually go away within www.beyondblue.org.au Lifeline telephone 131 114 10 days. They are like an emotional release www.panda.org.au/images/resources/ Tasmanian Parent Line telephone after the pregnancy and birth and are often Resources-factsheets/Anxiety-And- 1300 808 178 hormonally induced. depression-in early parenthood-And- pregnancy.pdf Beyondblue During your hospital stay we are able to www.cope.org.au telephone 1300 224 636, provide counselling services if you begin www.beyondblue.org.au to feel overwhelmed. • If you attended appointments with Pregnancy Birth & Baby helpline Some signs and what may cause the Perinatal and Infant Mental Health Service antenatally you can also contact 1800 882 436 Postnatal Depression? them on the numbers provided in the • Nothing is too awful that it can’t Postnatal Depression (PND) affects almost front of this booklet. be talked about. 16 per cent of new mothers in Australia, • Mental Health Service hotline freecall • Everyone has a right to feel safe – it doesn’t have one defnite cause, but 1800 332 388. is likely to result from a combination of including your baby. It is normal for all mothers to experience factors, including: • ANGER, if not given thoughtful times of emotional and physical exhaustion. direction, will fnd its own target. • A past history of depression and/or If your depression or anxiety lasts more anxiety; than two weeks, seek help. 44 Your baby is born

Unit, 3rd foor, D Block. The Unit has Postnatal VTE highly trained medical and nursing staff, and Remember offers the latest in technological care for prevention sick and premature babies. To take time out if you are feeling angry, stressed After giving birth to reduce the risk of a If it is anticipated that your baby may need or frustrated with your baby. VTE all women are encouraged to:- to go to NPICU or SCN after birth, we will arrange for you to have a tour of the A couple of minutes time out • Resume walking after your baby is born unit in your area. In the North & NW of and a breath of fresh air can make if safe to do so. all the difference. the state women will be transferred to the • Avoid becoming dehydrated, especially RHH if it is thought they may be in labour during the warmer months. or require delivery and are under 30 weeks pregnant. Sometimes babies who • Wear elastic compression stockings if you are born prematurely at the LGH may also have been advised to do so, especially if need to be transferred so they can receive you have had a caesarean birth. Physiotherapy specialised care and treatment. Women who have been assessed as having Physiotherapy may be able to assist you Visiting hours are unrestricted for parents. a high risk of developing a VTE will be further with some of the common aches The only children allowed into the unit prescribed medicine called anti-coagulation and pains of pregnancy (such as back or are siblings. (injections) to prevent blood clots forming pelvic pain and carpal tunnel syndrome). during the pregnancy and after the baby is Parents are actively encouraged to Community Physiotherapy and THS born. These medications plus the above participate in the care of their baby while Physiotherapy offer individual appointments steps should prevent the development of in NPICU and SCN, including cuddling, to help you – please discuss your problems bathing and feeding. You may also receive a VTE. These medications are safe to use with your midwife or doctor. support while your baby is NPICU and if you are breastfeeding. SCN from a physiotherapist, occupational After your baby is born therapist or speech pathologist. This is to A Continence & Women’s Health Neonatal Paediatric assist with your baby’s development. Physiotherapist may be available on the If baby is in NPICU or SCN for a long time, maternity ward – if you have any questions Intensive Care it is likely mum will be discharged before or concerns ask your midwife to refer you. baby, this can be very diffcult. Chat to staff All women are seen on a priority basis. Unit (NPICU) for support as our midwives and social workers may be able to assist with Pelvic Floor Muscle Exercise and Special Care accommodation choices and provide Our pelvic foor muscles help with Nursery (SCN) ongoing assistance. control of our bladder and bowel and are important for sexual function. All women Sometimes all does not go as planned in a pregnancy, labour or birth. Some babies need to strengthen these muscles after are born in need of special care and being pregnant. However, over one third observation, and may need to go to of women will do the exercise incorrectly. the NPICU or SCN. If you experience diffculties performing Sometimes they may even need intensive the exercise, poor control over your care treatment, though this is most unusual bladder or bowel, or symptoms of unless your baby is premature or has a prolapse you are invited to seek referral medical condition. to the Continence & Women’s Health The RHH NPICU unit in Hobart is the Physiotherapist for assessment and Tasmanian referral centre for premature treatment. babies under 30 weeks in singleton Referrals are accepted from your doctor, pregnancies and under 32 weeks for twin midwife or allied health profession and you or higher multiple pregnancies and sick will receive a letter to let you know you are babies, from the LGH and by negotiation on the wait list and will be phoned with an with the NW under 32- 34weeks, as Launceston may also be the referral appointment. centre in some cases. The RHH NPICU is situated on the same foor as the Maternity Your baby is born 45

• Keep the nappy away from the cord. Care of your baby • It is not normal if the tummy area During your hospital stay the midwives will around the cord looks red or infamed, Remember assist you in many aspects of baby care. if this happens it is very important to Best of all try to sleep Please feel free to ask your midwives have it checked by your visiting when your baby sleeps. questions as they are trained to give the midwife, doctor, or Child Health and There will be a time when your appropriate information. Parenting nurse. family routine will be normal again. Sleep Nappy area It is important to understand that baby is With baby boys the foreskin is attached to born with a sleep/wake pattern already the head of the penis up until about three in place; we call it the baby’s ‘natural years of age. Therefore it is important the odd bit of laundry or vacuuming, an biorhythms’. Therefore if you have a baby not to attempt to retract the foreskin as it occasional meal things are twice as helpful that is active in the uterus when you are in may cause damage. Nature has designed as minding the baby because they give you bed at night then chances are you will have it like that to protect the sensitive penis more time to rest, to take time out with an awake and alert baby at night when from faeces and urine. Normal cleaning your partner, and for both of you to spend they are born. It can take up to 6 weeks as your baby is bathed and normal nappy time with your baby. Learn to accept the or longer for this natural sleep pattern to care is enough to clean the penis. Infant offer of help. turn around. male circumcision is not performed at any THS hospital in any circumstance including Tasmanian Personal Health Record Best of all try to sleep when your baby sleeps. religious and cultural reasons. (Blue Book) Be patient as there will be a time when your family routine will be normal again. With baby girls the labia are often swollen After the birth of your baby you will receive and red and sometimes there is sticky a Personal Health Record, a blue book, First bath mucus which appears around the vaginal in which you may record all details about Usually babies frst bath is delayed until they area and on occasions some light bleeding. your child’s growth, development and are a day old so they don’t get too cold. This is caused by the mother’s hormones health for the next four years. The book and will disappear soon. If you are should be taken with you when visiting Ask your midwife questions, there are concerned ask your midwife. with a health professional, Child Health many things to learn about your baby at & Parenting Services (CHAPS) nurse, A light orange/pinkish stain is sometimes this time. doctor, or dentist. noted in the nappy and mistaken for blood. Baby’s fngernails are sometimes long and This is caused by a reaction between can cause scratches to their face. Be careful chemicals in the babies urine called urates as the nails are adhered to the ends of Getting to know and chemicals in the nappy fbres. If you are fngers until baby is about three months at all concerned please seek advice. your baby old, so cutting them with scissors or clippers before this time may cut Unwell baby During your stay in hospital we will help baby’s skin. Gently peel the nails back after you and your new baby get to know each Sometimes without prior warning a full a bath. other. To assist this we encourage term baby becomes sick or requires special • Baby skin is new and very sensitive. “rooming in” which means having your monitoring and may need to spend time in baby with you all the time. See pages Try to restrict the amount of products Neonatal Paediatric Intensive Care Unit or used on baby. 7,11,41 for further information on rooming Special Care Nursery. If this period extends in. A midwife will care for you, and assist • The more natural the better it is beyond the normal length of stay for the and support you with the practical aspects for baby’s skin ie there is nothing mother then she is often discharged before of caring for your baby. This is a learning wrong with using water to clean the baby. This can be diffcult and hard for time so ask lots of questions! the nappy area. the parents to deal with. It is important to discuss your feelings with the staff caring for Take notice of your baby after birth and Cord care you and your baby. understand their cues. Your baby is capable of eye contact with you (for short moments), The cord and clamp will be still attached Please see information on NPICU and they know your voice and this can be when you go home. The cord takes from SCN in this booklet. reassuring for them. Your baby will respond 5-10 days to fall off. It is important to keep to light, sound, facial expressions and be the cord area clean and as dry as possible. Accepting help capable of visual tracking with certain objects. • Clean the cord with cotton buds or If friends and relatives offer help, they will They learn very early to protect their sleep cotton wool and tap water. often take it as a compliment if you accept. in known environments where they feel Suggested helpful things for them to do • Keep it as dry as possible. safe. A baby communicates through their may include household chores, especially behaviour, watch for these cues. 46 Your baby is born

For further information on crying babies, Baby’s see your Tasmanian Personal Health Record book (blue book), your Child Remember communication Health & Parenting Service or doctor, or Babies communicate in many ways. Crying contact the Tasmanian Parent Helpline, Back to sleep is just one way of communicating with you. telephone 1300 808 178. There is also good information found at Tummy to play (supervised) Other ways include; eye rubbing, jerky www.raisingchildren.net.au Sit up to watch the world movements, yawning, rooting or sucking if hungry, not holding your gaze, grizzling. Settling techniques Is your baby? There are many ways of settling and Hungry… comforting your baby, and during your stay on the postnatal ward your midwife Your baby has “growth spurts” regularly, will help you to learn and practice some so may want to feed more often to satisfy of these. They include: hunger. If you are breastfeeding this frequent feeding will also build up your milk supply. • Rhythmic patting; Crying is the last sign of hunger, baby will • Rocking/cradling; mouth about and try to suck on their hand • Walking: with a pram or cuddling baby; or something else frst. • Carry baby in a sling against your body; Lonely… • Baby massage; Your baby needs to have the warmth and • Swaddling or wrapping in a bunny rug reassurance of your presence. or sheet; Lots of cuddles is a good thing, you can’t • Relaxation bath; spoil a child with love. • Sucking; Uncomfortable… • Positioning baby over your knee, or arm or shoulder; Maybe your baby is too hot or too cold, or • Nappy change; has a wet or dirty nappy, or is wrapped too tightly, been in the same position too long. • Soothing and rhythmic sounds, eg lullaby, music, vacuum cleaner, washing In pain… machine, singing or talking to your baby; Baby may show this by screaming, drawing • Baby sling or hammock; and their knees up and/or generally fussing. • Allowing someone else to hold baby. Tired… Take time out if you are feeling angry, Avoid over stimulation and excitement. stressed or frustrated with your baby. Gentle rocking before settling will help. A couple of minutes time out and a breath Babies communicate Recognise the three key tired signs: of fresh air can make all the difference. in many ways. • Grizzly; It is important to understand that you may • Jerky movements; and try all of the above suggestions and still not settle your baby. Try to stay calm and not • Facial grimacing. Spend time each day take it personally. It’s never OK to shake When your baby is showing these signs, it babies, owning our feelings and taking observing your baby’s may help to swaddle them gently and put steps to prevent irreversible harm are them straight to bed. Some babies need very important. non-verbal cues. help settling, refer to the section on Settling techniques. https://www.napcan.org.au/wp-content/ uploads/2018/07/NAPCAN-Its-Not-Ok- Overstimulated... DL- 6pp.pdf Babies are learning a lot and very quickly If you need support or advice at home, so can get overwhelmed and need quiet telephone CHAPS North & NW during time to calm down. Signs of overstimulation business hours on 1300 064 544 or include; not interested in playing, turning Tasmanian Parent Helpline on 1300 808 178. head away or not meeting your gaze, yawning. If you recognize these signs give You may also fnd information and videos your baby even a few minutes of time and on www.raisingchildren.net.au to be space, watch for a happy and alert baby benefcial. before resuming interactions. Your baby is born 47

by the position of your baby in the uterus Safe sleeping Immunisations during pregnancy, or can happen during birth. Your baby’s head should go back to It is important to be familiar with Immunisation is a simple yet safe and highly normal shape within about 6 weeks after effective way of protecting both adults and information on how to safely sleep your birth. Flattening of the head in one area may children from some harmful and contagious baby and ways to reduce the risk of happen if a baby lies with its head repeatedly diseases before contact occurs. It has Sudden Unexpected Death in Infancy in the same position for a long time. been estimated that through vaccination (SUDI) including Sudden Infant Death Sometimes a fat spot develops when a baby programmes up to 3 million lives are saved has limited neck movement and prefers Syndrome (SIDS). It is important that you per year worldwide. understand this information before your resting their head in one particular position. Vaccinations use the body’s natural defence baby is born, so you can be prepared and mechanisms to help build resistance to Prevention of misshapen head get your baby’s cot/bassinet ready. targeted viruses. This means if you are For information on Australian standards for exposed to that virus in the future your Sleep position infant cots go to www.kidsafe.com.au body’s immune system is able to respond Place baby at alternate ends of the cot to When purchasing a cot the code you and prevent you from developing that sleep, or change the position of the cot in need to see is AS2172 to meet Australian disease or in some cases ensure only a the room. Babies look at fxed objects like milder strain occurs. windows, by changing their cot position standards. Immunising your child not only gives you will encourage them to look at It is THS Policy not to have your baby sleep them protection but means there is a different angles. in your bed with you. lower chance that your child will pass on Tummy time and play time For further information on these viruses to vulnerable children and safe sleeping please go to adults who cannot be fully immunised. Place your baby on their tummy or side to play when awake and always supervise. www.rednose.com.au Fortunately modern advances mean vaccinations today are very safe and Change the position of toys they like to serious reactions are rare. Please go to look at. Tummy time also helps with baby’s www.immunise.health.gov.au for muscle and eye development. Prevention of sleep accidents further information. From as early as one or two weeks of age Although the causes of SIDS have not Your baby will be offered Hepatitis B you can place toys or faces in different yet been found, research has identifed vaccine at birth. Please refer to page 14 positions to encourage your baby to turn factors that will reduce the risks of for comprehensive information on their head both ways. Your baby can follow SIDS (cot death) and unexpected Hepatitis B vaccination. your voice and maintain eye contact, and sleep accidents. In you babies Personal Health Record turn their head themselves each way if you support their head in your hands while they • Sleep baby on their back. book (given to you after your baby’s birth) you will fnd the immunisation schedule are awake and alert. • Keep your baby in a smoke free recommended from birth to 4 years. environment during pregnancy Carrying your baby We strongly recommend you immunise and beyond. you child. For further discussion on Carry your baby in different positions • Avoid letting your baby get too hot. childhood immunisations please see your varying the way you hold them. Speak to your Midwife if you are unsure about safe • Breastfeed your baby, if possible. GP or Child Health Nurse. ways to carry your baby. • Use light bedclothes. No doonas, pillows or cot bumpers. Plagiocephaly Talk to your Child Health & • Use frm well ftting mattress. Parenting Service Nurse or GP (misshapen head) if you are worried about your • Tuck bedclothes in securely. babies head shape. • Make sure baby’s head and face It is common for a newborn baby to have is uncovered. an unusual head shape. This can be caused • Place baby’s feet at the bottom of the cot. • Place baby in a safe cot in their parents room for six to 12 months. • Provide a safe sleep environment day and night. www.rednose.com.au 48 Your baby is born

If this is not done in hospital the screener Screening tests will contact you for an outpatient Planning your for your baby appointment. discharge For further information please request the Newborn Screening Test (NST) Audiology Service pamphlet ‘Your baby’s Your expected length of stay is 1-2 days for The Newborn Screening Test is a routine hearing check’. a vaginal birth and approximately 2-4 days for a caesarean birth. Discharge can also procedure to screen for several rare Jaundice disorders. Early diagnosis and appropriate occur before these times with a minimum treatment can prevent or greatly reduce Jaundice is a yellow discolouration of length of stay of four hours for a vaginal the baby’s skin due to a build up of a the effects of these disorders. A pamphlet birth. If your wish is to discharge against pigment called bilirubin. This pigment is a explaining these rare disorders will be given medical advice you will be required to to you before the procedure is performed product of the breakdown of excess red sign a form. You will need to discuss your on your baby. blood cells. The breakdown of cells is a normal occurrence in all newborn babies. discharge with the midwife caring for you. It needs to be between 36-56 hours Babies that get jaundiced are not ill, but after your baby’s frst feed when the test they sometimes need help to reduce the is taken. A few drops of blood are taken amount of pigment as may become ill if Transporting baby from baby’s heel, collected on a special this continues to increase. blotting paper, and sent to a laboratory on home If your baby becomes very jaundiced, a the Mainland for testing. The blood can be test to measure the level of bilirubin will taken in hospital or at home. You only It is a legal requirement that baby travels be taken, and your baby may need to hear about the results if a potential disorder in an approved baby car seat which should be placed under special phototherapy is detected. be properly ftted. lights. These lights help to break down the To prevent discomfort for your baby during bilirubin causing the jaundice to gradually For further assistance the RACT can also this procedure we advise you to feed subside. be contacted on 132 722 or information your baby. We can also offer baby some Your baby will continue to room in with viewed at www.ract.com.au/child- sucrose according to the hospital ‘pain relief you during phototherapy so you are still restraints-faq. guidelines for babies’. able to feed, change and cuddle your baby. Hearing Test (National Screening) Usually the jaundice subsides quickly over Most children hear and listen from birth. 24-48 hours with this treatment. Please ask your midwife and the doctor any questions They learn to talk by copying the sounds you might have, if your baby has jaundice. around them and the voices of their families. But that’s not true for all children. In fact, two out of every 1,000 children are born with a hearing loss. Many of Pets and bringing these babies are healthy and have no family baby home history of hearing loss. Hearing loss can be easily overlooked because babies and Research has found that most animal toddlers cannot tell us they are unable accidents involving young children occur to hear. The frst few months and years in the home from the family dog or cat. are the most important time for learning Children from ages 1 to 4 years are most speech and language. Hearing-impaired at risk. If you have a family pet try to get the babies who receive help early have much animal used to being in its own bed space, better chance of learning to talk and before you bring your new baby home. understand what people are saying than Don’t leave a young child alone with a dog children who are not diagnosed until they or cat no matter how safe you feel the are older. animal is. Some owners have their animals sleeping in/on the bed up until their baby For this reason, the THS offers a trained comes home and the animals are suddenly hearing screener to test your baby’s put outside when the baby arrives home. hearing while your baby is asleep or Think about this while you are pregnant, resting quietly. The screen takes about and gradually get your pet into better habits 10-20 minutes with results discussed at before your new baby is brought home. the end of the test and recorded in your baby’s Personal Health Record book. www.pets.dpi.vic.gov.au Your baby is born 49

Extended Midwifery Child Health and Wetaway program For children over 5 years who want to Service (EMS) Parenting Service overcome bed wetting call 1300 064 544. Most women go home soon after the birth The Child Health and Parenting Service Parent Line 1300 808 178 of their baby, that is between 2-3 days. (CHAPS) is a community-based health A 24 hour statewide telephone service Midwives are available to visit you at home service that is available for children aged that provides parents and carers support to check that you and your baby are well 0 -5 and their families and follows on from and information. NB: cost for local call or and happy, and to answer any questions hospital care after the birth of your baby. mobiles charges apply. you may have, just as if you were in hospital. This excellent service is available Child and Family Health To fnd out the location of your to those who live approximately within a Nurses offer families the nearest service telephone: 30 minute drive of the hospital. If you have following services: 1300 064 544 or go to received your care through MGP your www.dhhs.tas.gov.au/children/child_ midwife will provide this service postnatally. • Home visit families with new babies health where you will also fnd further within 2 weeks of leaving maternity LGH: (03) 6777 8994 or information on recommended schedule of services; 0419 882 039 visits, centre locations and opening hours. • Child Health Assessments; North West: 0409 973 547 • Healthy kids check; Gateway Services This is the single entry point for referral • Parenting information – infant feeding, Breastfeeding to further family and disability services sleep and settling and other concerns; throughout Tasmania. support and Referral through the Gateway Service can LGH • Referral to other early intervension provide access to parenting programs, Run by Lactation Consultants Monday services when necessary. intensive family support and help build - Friday within the frst 2 weeks after better outcomes for families. Other CHAPS activities and discharge for anyone having problems Contact: 1800 171 233 with their feeding. For an appointment programs available to families call (03) 6777 8934. Parenting centre North West Daytime centre-based and outreach Women can contact the lactation services for families needing more consultant on 0409 973 547 or intensive support for concerns related (03) 6478 5392 anytime during their to parenting babies and young children breastfeeding experience. e.g. sleep and settling, breastfeeding, postnatal depression, toddler behaviours CHAPS on 1300 064 544. and relationships.

CU@home A home visiting program for young frst time parents (15-19 years of age). The cu@home program is via referral only and starts at 28 weeks gestation and continues until the infant is 2 years old. This program is a part of the Child Health and Parenting Service (CHAPS) and is designed to support young parents in their transition to parenting and promote good health outcomes for their babies. For further information visit www.dhhs.tas.gov.au and search cu@home. 7

Twins and more Twins and more 51

If your babies are born prior to 36 weeks coping please ask your midwife, GP or Multiple birth they are considered premature and may Child Health Nurse as there is a lot of Being a parent of twins or a further be cared for in the Neonatal and Paediatric support you can access antenatally or in the multiple is a unique and very special Intensive Care Unit (NPICU) or Special community once your babies are born. experience. Our aim is for you and your Care Nursery (SCN). A multiple pregnancy Purchasing double the equipment can be family to enjoy the experience through an has a greater possibility of not reaching expensive. Your local multiple birth group informed journey including offering links to 37-38 weeks gestation due to the uterus will be happy to share information about community support networks. carrying more than one baby, along with various types of equipment they have the extra physical demands this brings to If you are a frst time parent, it is benefcial found satisfactory. Please ensure equipment the pregnant woman. Most Obstetricians that you attend a birth and parenting especially if purchased second hand meets prefer twin pregnancies to deliver by 38 class prior to the multiple births sessions Australian safety standards if required. weeks for the wellbeing of both mother to ensure you have comprehensive For further information on these and babies. understanding of the process of labour standards go to and birth. Whilst in hospital you may be offered www.productsafety.gov.au or support from a Lactation Consultant as www.raisingchildren.net.au For further parenting support the feeding more than one baby can offer Tasmanian Multiple Birth Association different challenges than feeding just one Practical tips can be contacted on 0420 588 805 baby. How your babies initially feed will • Always have your nappy bag restocked or website www.tasmba.org.au often depend on the gestation they are and ready for outings In the early weeks of any pregnancy born. If they are not able to breastfeed • Shop online or have groceries delivered hormone levels increase and can produce initially you will be assisted to commence • Accept help with daily routines from symptoms such as nausea and swinging expressing your breast milk as soon family/friends emotions. These symptoms can be more as possible. severe in a multiple pregnancy due to the • Prioritise housework If your babies are born closer to term added hormone levels. The hormone (after 36 weeks) and are a good weight • Freezer, microwave and dishwasher are relaxin which helps to prepare your pelvis and feeding well you may be home within great time savers if this is in the budget for birth may also cause problems with 3 to 5 days after the birth. Support on • Limit visitors but accept help, you don’t lower back pain, you may also notice discharge from the Maternity Unit as with want to have to entertain in the early days discomfort from extra weight, an increase all parents is our Extended Midwifery in lower abdominal and pelvic pressure and • Connect with other families of multiples, Service and the Child Health and Parenting tiredness as the pregnancy progresses, all of not only will they show you that life is Service. If your babies are in SCN they will which can occur in any pregnancy but may do-able, they can give you solid advice have additional follow up appointments be greater in a multiple pregnancy. on how to cope. made on discharge. It is important to note that women with • Sleep when babies sleep, it is a precious There is no doubt that parents of multiples a multiple pregnancy can be well during commodity may require more assistance in the early this experience. Of consideration though days of parenting. It is therefore important • Routines are good, but keep it a bit is that women expecting more than one to utilize practical support offered from fexible, what works for one baby may baby are twice as likely to experience family and friends. If support is limited not work for the other gestational diabetes due to the increased consider outsourcing such as childcare hormones interfering with the body’s ability when the babies are a little older, a baby to process insulin. High blood pressure and sitter for occasional outings or a house a condition called pre-eclampsia can also cleaner if fnancially viable. This will allow occur more often in a multiple pregnancy. Savour the special moments, you to rest and care for yourself, time to cuddles, giggles and smiles. On top of the normal schedule of visits spend with older children, and also more and tests, your care will encompass an time to spend with your babies instead of They grow up fast! early blood test for gestational diabetes, on household chores. For information on additional antenatal visits, further siblings adjusting to new babies in the house appointments for ultrasounds for fetal got to www.raisingchildren.net.au growth and wellbeing and fetal heart Gentle exercise and a good diet will help monitoring. you feel well. If you feel you are not 52

All THS hospitals are Find out more about birth and teaching hospitals parenting of the University of Some ways to fnd out more information about birth and parenting are: Tasmania, and have • Book-in and attend Antenatal Classes. the responsibility • Ask questions at your antenatal visits. for teaching a wide • Browse book shops and libraries for childbirth/parenting range of students books that interest you. Parenting websites: in the health care www.raisingchildren.net.au professions. www.pregnancybirthbaby.org.au Index 53 Index Contents 3 A Continence support 41 Contraception 42 Aboriginal Health Liaison 8 Coping in labour 28, 29 Active management third stage Cord care 45 (placenta) 27, 28 Cost for classes 6, 10 Admission for Induction of Labour 8, 12 Crying baby 46 After caesarean birth 33 CU@Home 49 24 Cytomegalovirus (CMV) 23 Alternative remedies 21 Antenatal Education 6, 10, 52 Antenatal Tests 8,12, 13, 14 D Antenatal Visit Schedule 16, 17, 18 Delivery of Placenta 27, 28 Anti D 13 Demand feeding 38 Artifcial feeding 39 Dental Care 21 Assisted births 31 13, 14 Attendance at antenatal visits 20 Diet 22, 23 G Discharge 48 Gas (Nitrous Oxide) 34 DNA (Genetic material) 13 B Gateway Services 49 Domestic Violence Support 2 Genetic Material (DNA) 13 Baby blues 43 Down syndrome 13 Baby development 16, 17, 18 Drugs and pregnancy 24 Getting to know your baby 45, 46 Baby’s communication 46 Group B Streptococcus 14 Baby’s movements 17 E Balloon catheter 30 H Benefts of Vaginal Birth after Early Screening tests 13 Caesarean (VBAC) 31, 32 Eating Fish 22 Health Advice and Choices 20 Birth and Parenting Classes 6, 10 Effacement 30 Hearing Test 48 Birth and Parenting Educator 6, 10 Elective admissions 8, 12 Hepatitis B Vaccination for newborn 14 Birthing preferences 27 Electrical appliances 8, 12 High BMI considerations 22, 28 Birthing Suites 7, 11 Emotional changes and support 20 Blood tests 8, 12, 13, 14 Epidural 34, 35 Body Mass Index ( BMI) 22 Episiotomy 28 I Booking tests and where to go 8, 12 Equipment for baby 26 Braxton Hicks Contractions 20 Immunisations 21, 47 Established labour 27 Breastfeeding 37, 38 Induction of Labour 29, 30 Exercise 20 Breastfeeding benefts 38 Infant feeding 37 Expressing and storage of breastmilk 38 Breastfeeding Classes 6 Infant safety 41, 42, 43 Extended Midwifery Service (EMS) 49 Breastfeeding support 39, 49 Infant tooth decay 39 External Cephalic Version (ECV) 29 Infuenza (fu) 21 Interpreter service 8, 12 C F Intravenous cannula 30, 33 Caesarean birth 32, 33, 34 Iodine 23 Falls prevention 33, 35, 42 Calcium 22 Iron 23 Fasting in pregnancy 21 Cardiotoco Graph (CTG) 18, 28, 29 Feeding cues 37, 38 Care in Pregnancy 5 Feelings 20, 27, 33, 43 J Care of your baby after birth 45 Female circumcision (of mother) 21 Cervical ripening 30 Fetal Alcohol Spectrum Disorder (FASD) 24 Jaundice 48 Child Health and Parenting Service Fish 22 (CHAPS) 49 Flu (Infuenza) 21 Circumcision (of baby) 45 K Folate (folic acid) 22 Class bookings and session times 6, 10 Food groups 22, 23 Community Support 49 Kiosk 8, 12 Food safety and hygiene 23 Consumer Liaison Feedback 1, 2, 57 Konakion (VitaminK) 14 Forceps 31 54 Index

Perinatal and Infant Mental Sudden Unexpected Death L Health Service 6, 10 in Infancy 14, 47 Perineum 28 Labour and Birth 27 Pertussis (Whooping Cough) 21 Labour and VBAC 31, 32 T Labour pain 28, 29 Pethidine 34 Lactation Consultant 39 Pets 48 Team 5 Tear 27 Length of Labour 27 Physiological Third Stage 27, 28 Television hire 8, 12 Listeria 23 Physiotherapy 44 Ten Steps to Successful Breastfeeding 38 Location of classes 6, 10 Placenta 27, 28 Plagiocephaly 47 TENS machine 34 Positioning and Attachment – Tests 8, 12, 13, 14 M Breastfeeding 38 Tour of Maternity Ward 6,10 Postnatal Care after Caesarean 33 Toxoplasmosis 23 Meal times 8, 12 Postnatal Depression 43 Traditional Cutting Medical Clinics 5, 9 (Female circumcision of mother) 21 Postnatal Recovery 41, 42 Medical pain relief options 34, 35 Transport baby home 48 Preadmission Clinic 32 Midwife Satellite Clinics 5, 9 Twins and multiples 51 Midwifery Group Practice (MGP) 5, 9 Pregnancy Assessment Centre (PAC) 7, 11 Migrant Liaison 8, 12 Pregnancy Tests 8, 12, 13, 14 Misshapen head 47 U Monitoring baby in labour 28 Preparation for Caesarean 32 Ultrasound department 8, 12 Morphine 34 Prevention of Falls 33, 35, 42 Ultrasound Scan 8, 12 Movements – baby 17 Prevention of Sleep Accidents 47 Multiple birth 51 Prolonged Pregnancy 18, 29 Understanding Screening 13 Prostaglandin 30 Unexpected Outcomes of Pregnancy 35 N Urinary Catheter 33 R Nappy area 45 Refugee Liaison 8, 12 V Natural Remedies 21 Repeat caesarean for future births 34 Negative blood group 13 Vaccination Advice 21, 47 Risks associated with VBAC 31, 32 Neonatal and Paediatric Intensive Vaginal discharge 33 Care Unit (NPICU) 44 Rooming-in 7, 11, 41 Vaginal examination 18, 28 Newborn Screening Test (NST) 48 Venous Thromboembolism Nitrous Oxide (Gas) 34 S (VTE) 21, 33, 44 Normal activities post caesarean 34 Visitors 8, 12 Notes 55, 56 Safe Sleeping and environment Visits (antenatal) 16, 17, 18 Nutritious eating 22 for baby 14, 47 Vitamin D 22 Screening tests for baby after birth 48 Vitamin K 14 Second trimester screening 13 O Security 2 Open Disclosure 2 Settling techniques 46 W Sex and intimacy 20, 42 Options for screening test results 13 Ward Rooms 7, 11 Sexually Transmitted Infections (STI) 21 Options of care in Pregnancy 5, 9 Water for injection 34 Overdue 18, 29 Shared Care (S/C) with your GP 6 Skin to Skin Contact 41 Weight gain 22 Sleep patterns 45, 46 Welcome 1 P Smoking 8, 12, 24 Wetaway Program 49 Pain and Labour 28, 29 Social Work Department 2, 6, 10 What to bring to hospital 26 Pain Relief Options for Special Care Nursery 44 When to contact the hospital Labour 28, 29, 34, 35 Spina bifda 13 (PAC) 7, 11 Pain Relief post caesarean 33 Spinal Anaesthetic 32 Whooping Cough 21 Parent Helpline 49 Stages of labour 27, 28 Wound Care 33 Parenting Classes 6, 10 Stitches 28 Parking 8, 12 Stop family violence 2 Pathology tests and bookings 8, 12 Stress management 43 Y Patient Accommodation (inpatient) 7, 11 Students 52 Your Responsibilities 2 Patient Controlled Analgesia (PCA) 34 Suction Cup (Ventouse) 31 Patient Medical Records 2 Sudden Infant Death Syndrome Your Rights 2 Pelvic Floor Muscles 44 (SIDS) 14, 47 Notes 55

Notes 56 Notes

Notes A fnal word

We at THS Maternity Services wish your family all the best for a healthy future. If you have any questions, or suggestions for improving the services we provide, including this booklet, please discuss with your Midwife. You are invited to also complete a feedback form, which can be provided for you in your area.

Acknowledgements

Medical and Maternity staff at the Royal Hobart Hospital, Policy and Procedure Manuals at the Royal Hobart Hospital.

Launceston General Hospital and North West Integrated Maternity Services (THS and NWPH)

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Thank you to our Tasmanian families who have shared their beautiful photos with us.

Thank you to our wonderful parents for allowing the THS to share part of their journey to parenthood.

Updated for North & North West November 2018 for review November 2019. If urgent assistance or advice is required contact 24 hours : Launceston General Hospital (03) 6777 8960 Mersey Community Hospital (Latrobe/Devonport) 1800 940 766 North West Regional Hospital (Burnie) 1800 940 747 Royal Hobart Hospital Pregnancy Assessment Clinic (03) 6166 8352 Ambulance Tasmania 000

Please bring this book with you to your appointments and pack in your hospital bag.