Pregnancy Information

Your Pregnancy Explained

This very common, particularly low and on either side of the growing uterus. In late pregnancy, shooting pains in the vagina are common. If you are worried about pains, talk to me. It is often worse in second pregnancies than in the first.

You should go to the hospital if you rupture your membranes or if you are having regular contractions every 5 – 7 minutes. Contractions feel like period pains or Braxton-Hicks contractions but are stronger, more often and last longer. Do not wait at home if your membranes rupture and you are leaking fluid to see if contractions are going to start. Please ring the hospital to tell them that you are coming in or if you are uncertain if you should go in. Birth Suite numbers are 3232 7221 and 3232 7236 The hospital will notify me when you are admitted. Labour will occasionally start before term (term is 37 weeks – 42 weeks) and is then called “premature labour”. If you may be in premature labour, you should ring the hospital and make arrangements to go there immediately. Normally, there is no way of predicting when you will start labour.

If you plan to breast feed, your breasts will start to fill about three days after the birth but it will still take another 1½ days or longer to get a good milk flow. You may take 4 – 5 days to use your bowels. You may lose a large blood clot through your vagina in the first two weeks. After a caesarean delivery, you may get a few days of bright bleeding about five weeks after delivery.drome can be refined using measurements on the baby

The hospital runs antenatal classes for those who having a baby there. I would encourage you to attend especially if it is your first baby. If possible have your partner go with you. Try to book classes when you book into the hospital. This best done by a phone call to 3232 7283

Other antenatal classes and individual instruction are provided run by some other organisations and professionals. Ask friends or do an internet search.

You can expect to have discharge from your vagina for 4-7 weeks. Initially, it will be red and like a heavy period. It should change to brown and then be only a yellow discharge by about two weeks after the birth. If red discharge recurs or stays past four weeks, let me know.

If you are breast feeding, it is now recommended that you take a multivitamin for lactation for as long as you are feeding. Calcium supplements may also be beneficial to you and to baby for as long as you are breast feeding.

If you have taken iron medication during your pregnancy, it is a good idea to take it for another six months after the birth to build up your iron stores. Restart it after you go home and only when your bowels are working normally again.

A good sign that baby is thriving is regular weight gain. If your baby is not gaining weight steadily, it is usually because it is not being fed enough, although uncommonly it may have another problem. Tablets (Motilium) are available by prescription to increase your milk supply. It is helpful to get baby weighed regularly, e.g. every week at first. This can be done at a Maternal and Child Health Clinic if you may need advice on caring for baby but can also be done by most GPs and at most chemist shops. If your baby has feeding problems, advice is available from the clinics, from the midwives at The Wesley Hospital, from your GP and particularly from your paediatrician. Some pharmacies have a child-care nurse who can offer advice if needed. Often an appointment is needed for this.

Breast infections sometimes occur after you leave hospital especially if you have had a cracked nipple. You will have a tender breast with a red segment, a temperature and you will probably feel unwell. You will need to get a prescription for antibiotics as soon as possible and you should continue to feed from that breast. Milk from the infected area does not harm baby. A probiotic with a mix of bacteria may help prevent getting mastitis.

Very common, due to softer ligaments and change of posture. Lumbar support when sitting is very important. Physiotherapy can help. You cannot take anti-inflammatory drugs such as Nurafen, Voltaren, Naprogesic, Mobic.

Anything which raises your body temperature a lot may damage baby. Such things include long hot baths, saunas and prolonged jogging (more than 12 Km). Hot weather is usually not a problem although when pregnant you will feel more hot and sweaty in all weather.

Bleeding may be a sign that you are going to lose the baby although most women that have bleeding in early pregnancy go on to have a normal healthy baby.

Bright red or fresh blood means active bleeding at the time while brown loss means bleeding a few days before with no more active bleeding. The blood may be coming from your cervix or from inside your uterus from separation of a part of the membranes or placenta.

Contact me at a convenient time if you have mild or moderate bleeding without pain. If it is heavy and bright or if you have period-like pains as well, contact me at the time.

I will usually arrange to perform an ultrasound scan and check your cervix to find the cause of the bleeding and to check if the baby is healthy.

Some women have period-like pains without any bleeding in early pregnancy. Usually, this does not mean that you have any problem which will lead to you losing the baby.

With any bleeding, you should rest for a couple of days and not have sexual intercourse for 2 weeks.

Routine blood tests are recommended in every pregnancy. Previous test results will be used if possible. I need to have results for blood group and antibody screen, white blood cell and platelet count, rubella (German measles), hepatitis B and C, toxoplasmosis, syphilis, Vitamin D and urine infection. If it is your first pregnancy, liver and kidney function tests will be advised. If you have not had chicken pox, a test will be done for that as chicken pox can occasionally occur without the skin lesions. If you are a child-care worker or teacher or have young children at home, you may need tests for Parvovirus and CMV.

A blood test will be offered at around 12 – 13 weeks to make the 13-14 week scan more accurate in working out the risk of you having a baby with Down syndrome. Although the risk of this increases with age and is only “high” after the age of 34, it is still possible for it to occur in younger women. The blood test and the scan allow me to give you the risk of a Down’s baby in your present pregnancy independent of your age. If the risk is unexpectedly high (worse than 1:2700), further tests will be offered to be done on you or baby to see if Down syndrome is really present. For the majority of patients including those over the age of 35, the result of the blood test and scan together is usually reassuring. You do not have to have the test performed if you do not wish to do so. The scan and blood test may miss up a small number of Down Syndrome babies

A blood test (NIPT) can be done on the mother to detect chromosomal abnormalities such as Down syndrome. This is done from 10 weeks gestation and takes about 10 days for an answer. It costs between $400 and $700 depending on options about what is being searched for. It will detect the baby’s sex. The test misses only about 0.2% of Down babies. A “positive” result means there is a 50% chance of Down Syndrome and requires the invasive tests discussed below. I offer NIPT test to all women from age 40 but it is available to women of any age if desired.

There are two different tests which will give a definite diagnosis of chromosomal abnormalities such as Down syndrome and some other abnormalities: a chorionic villous biopsy at 10 – 11 weeks or an amniocentesis at 14-17 weeks. Both of these involve a fairly painless insertion of a needle into your uterus to obtain a sample of baby’s cells.

At about 28 weeks, another small batch of routine tests is usually requested. This includes a repeat blood count for anaemia, another blood group antibody screen, an AIDS test and a glucose test. The test will keep you in the laboratory office for about 2 ½ hours as your blood is taken before, one hour and two hours after you drink a sweet drink.

You need to book yourself into the hospital. To do that, book on line at or ring the hospital on 07 3232 7777. The hospital prefers to book you when you are around 14 weeks pregnant. Pregnancy information packs are given to you at your first antenatal visit to me. Regular open days are held to allow prospective parents to inspect the hospital. If you wish to inspect the hospital at another time, you may be able to do this by telephoning the Maternity staff on 3232 7432 or 3232 7256.
This method of delivery is used if labour is inadvisable such as if the baby is coming bottom first (“breech”), if the mother’s pelvis is too small to allow the baby to pass through or if an urgent delivery is needed. It can be performed with the mother asleep (general anaesthesia) or awake (epidural or spinal anaesthesia). Unless the operation is very urgent or other unusual circumstances exist, you will not be given a general anaesthetic. More detailed notes are found on the caesarean page. You can ask to have a caesarean delivery rather than a labour and vaginal birth with the date planned in advance (elective caesarean delivery). You cannot ask for a caesarean delivery once you are in labour due to legal problems in obtaining a valid consent.. For most caesareans, the partner may also be in the operating theatre, witness the delivery and take photographs. Your baby and partner can usually stay with you until near the end of the operation. They leave you then to have baby weighed and measured. You will be reunited with your partner and baby in the recovery unit and spend about 30 minutes there. You will then will be transferred back to your room. If you have had a caesarean delivery, when you go home, you will not be able to do any more than you have done in hospital for 1½ weeks and only light housework for the next two weeks. You may drive when baby is four weeks old if you feel alright. It will be six weeks from delivery before you can lift anything heavy, hang the washing out, push a shopping trolley or vacuum the floors and 10 weeks for heavy jobs. Lifting something heavy includes a toddler. You can start light gym work at about 4 weeks, light abdominal exercise at 6 weeks and heavy abdominal exercise at 10 weeks. If you have had a caesarean delivery and have a normal size pelvis, you may still be able to have vaginal deliveries in future pregnancies. There is no limit to the number of caesarean deliveries that you may have.

Numbness and pain in the hand and arm especially on waking in the morning. Try to not sleep with your wrist and elbow bent as this obstructs circulation which causes the nerves to not work properly. It will usually get better after the baby is born.

You may have heard that you can catch an infection called Toxoplasmosis from cats. If you have a cat already, it is most likely either you will have had the infection already and be immune or else your cat does not have it. You should not get a new cat while you are pregnant. I usually test your immunity early in pregnancy to see if you are immune and thus at no further risk from any cat. If you are not immune to Toxoplasmosis, there is little risk from stroking your cat especially if you wash your hands afterwards. However, avoid handling kitty litter or gardening where your cat may have used the area for its toilet.

Toxoplasmosis can also be caught by handling raw meat, especially kangaroo meat. Wash your hands and the cutting board after handling raw meat and only eat meat which is fully cooked.

This is an operation with some risk to baby which was commonly performed on Australian babies from 1920 to about 1975. About one in twenty boys are now circumcised in Brisbane. The operation has risks of causing bleeding or infection with scarring or even death.

There is little reason to have baby circumcised other than cosmetic (i.e. how the parents think a penis should look). The argument that circumcision reduces the risk of cancer of the penis is not as important as practising good hygiene with or without a foreskin. A reported reduction in sexually transmitted diseases seems only related to the presence of untreated tropical ulcers in Africa, which is not a problem in Australia The only valid argument for circumcision is that the child will later be ostracised in his community such as if he is Jewish.

Consent for an operation on a child can, in Australia, only be given by a parent for a therapeutic reason, i.e. to fix a problem which is then present. This is only rarely the reason for circumcision. In other cases, legal opinion now suggests that parents cannot give permission for routine circumcision which should instead require permission from the Federal Family Court. Without this permission, especially if a complication occurs as they do in between 2% and 10% of cases, the doctor and the parents may be charged by the child, over the next 21 years, with criminal assault.

While there are both risks and benefits of circumcision to be considered, there is good evidence to suggest that your baby will be safer if not circumcised.

The Australian Society of Paediatricians has stated in 1997 that no baby should be circumcised under the age of six months unless there is a serious medical problem requiring it. Paediatricians and many obstetricians refuse to circumcise any baby. If you have a compelling reason to have your son circumcised, please discuss it with me. It is usually performed on the fifth day and local anaesthetic is now used to make it less painful for the baby. There are doctors in Brisbane willing to do circumcisions and I can give you their contact details.

We all want you to have an uneventful pregnancy with an easy delivery. Unfortunately, problems may arise in a few pregnancies. If they didn’t there would be no need for obstetricians. The aim of modern antenatal care is to discover problems early before any permanent damage is done and to fix them. Many problems require an unexpected stay in hospital so you should be prepared for this and have your household organised in case this should happen.

Some women choose to have their baby’s umbilical cord blood and part of the cord stored. This blood is drained from the placenta after the baby is born. They can be used as a source for bone marrow stem cells if your child should tragically develop leukemia or a similar cancer. The probability of needing this is around 1 in 2700. Other uses for cord blood are being developed. Storage costs are approximately $4000. Once the blood is stored it is only available to your family. Siblings have a 1 in 5 chance of being compatible if they should need a bone marrow transplant or other treatment at a later date.

Stem cells can now be obtained from a patient in later life without the need to pay for storage of cord blood and tissue.

Having dental examinations and dental work such as fillings are not a problem during pregnancy. Treatment of gum and tooth problems reduces the risk of infection in your blood which could hurt baby. Having an anaesthetic injection or gas is also no problem. If your dentist gives you drugs to take at home, check with me before taking them.

Xrays are acceptable for investigating a problem but not for “routine” checks.

Many drugs and alternative “medicines” are unsafe during pregnancy. Please check with me before you take any drugs including vitamins, non-prescription drugs and those from health food shops and naturopaths.

Safe drugs include Panadol, Panadiene, Mersyndol, asthma drugs, cough suppressants (not expectorants or elixirs), Vitamin B6 (less than 120mg/day) and many blood-pressure drugs.

Unsafe drugs include Aspirin in normal doses, Vitamin A (Retinol), many herbal preparations. Very low dose Aspirin is safe and is sometimes prescribed to reduce the risk of abnormal clotting and of high blood pressure but must only be taken if advised by me. Check any multivitamin preparation with me before taking it as it may contain too much Vitamin A. Multivitamins labelled as being for pregnant women are generally safe.

You should avoid drinking alcohol while pregnant.

Avoid having your hair permed while you are pregnant as the perming lotion has chemicals which can be absorbed and which may be harmful to your baby. Dyes and foils are safe.

If possible, you will not get a cut or tear with a normal delivery although this is often not safe or possible. Unfortunately, there is nothing proven safe that you can do during pregnancy to reduce the chance of you needing stitches at delivery. A tear is less likely to heal well than an episiotomy.

It is best to stay fit during pregnancy. You may go to aerobic classes up to 4 times a week but only if you avoid prolonged strenuous exercise (more than one hour each session). Similarly, you should not jog more than 4 times a week. Excessive exercise may divert blood away from baby and stop it growing properly. Walking and swimming are good ways to exercise in pregnancy. If your baby is growing at less than the normal rate, you may be asked to limit or stop doing exercise.

Current fees are available on the fees page.

All pregnancies are bulk-billed for all visits, including the initial consultation, antenatal visits, the pregnancy management fee and ultrasound scans. Bulk billing depends on the patient having health insurance for hospital care. There are at present three funds which only pay about half of the usual amount for a delivery in hospital. Patients insured with these funds may be asked to pay an out of pocket amount to compensate for the much smaller payment by the fund. We have very few patients insured with these funds.

Patients who are not permanent residents of Australia and who have no cover by Medicare but with a general insurance company paying for their medical costs may get all of their bills paid by their insurance or may be asked to pay an amount to bring what is paid to near the level paid by Australian health insurers. We can discuss this with you once we have the details of your insurance. Most patients with this type of insurance have all of their bills paid by their insurance.

Fee structure can be complex due to government and health fund regulations which change periodically. Please discuss your fees with my receptionist. My fees may change periodically due to inflation and regulation changes and will apply immediately.

Patients with no Medicare or insurance cover will be asked to pay an amount which is approximately what would be paid for a fully insured patient.

Health funds do not reimburse “out of hospital” fees, only Medicare does that. There is a “safety net” to assist with out of hospital, out of pocket fees for which you need to register with Medicare.

Other antenatal fees may include those from pathology, physiotherapists, radiology and pharmacies.

The fees charged by the hospital are separate from the medical fees. The hospital will be able to advise you about this. Any care by an anaesthetist or paediatrician will also be extra as none of these bulk-bill. If you have a caesarean delivery, there will be a charge made to pay another doctor for assisting at the operation. Usually this does not involve a gap payment. The gap fee for an anaesthetist could be over $1,000 if after office hours.

If you may have some difficulty in paying, please discuss this with me or my receptionist before incurring the charge.

Fees are subject to change without notice and apply to all consultations and services from that date. They are generally increased early in each calendar year.

Listeria is a bacteria which can cause infections which in pregnant women rarely can lead to complications such as miscarriage, premature labour or damage to the baby. Listeria can be present in meats bought pre-cooked and cold as well as in soft cheeses such as Camembert. The chance of an infection despite many pregnant women being exposed to Listeria is unknown but seems very small, probably less than two infections per thousand pregnancies. Other infections caught from foods such as Salmonella can also cause complications. The best advice is for you to avoid soft cheeses, soft serve ice-cream, pre-cooked meats which are cold when bought, cured meats such as leg ham and salami-type smallgoods, raw meat, sea foods eaten raw and pre-prepared salads. Cooked ham and salami are safe. Rare steak is not safe.

You should wash salad before preparing it and wash your hands as well as your cutting board whenever you have handled any of these products or raw meat. Keeping prepared food in the refrigerator does not stop Listeria from growing. Washed salads and fruit and freshly cooked foods are safe. .

Also, avoid pate and liver during pregnancy as you may get too much vitamin A.

Some seafoods should be avoided, especially larger pelagics such as Swordfish, large mackerel and also Orange Ruffy, sometimes sold as Sea Perch. These all concentrate heavy metals such as mercury.

Common, especially from 12 to 26 weeks. Keep well hydrated. Panadol and Mersyndol will help. Stronger medication is available if it is required.

It is advisable for women contemplating pregnancy to have immunity to Rubella (German measles), chicken pox and Hepatitis B. Immunisations are available for these before and after pregnancy but not during pregnancy. People who will be close to your baby in the first 8 weeks should have had a Pertussis (Whooping cough) immunisation within the last 10 years. However, Pertussis vaccine does not protect against all strains of the virus so anyone with a cough should not come near baby. Pertussis immunisation is recommended for all pregnant women after 26 weeks in every pregnancy. For other people, every 10 years is sufficient.

Labour may need to be induced if there is more risk in allowing the pregnancy to continue than in delivery. Situations for this would include high blood pressure, the placenta not working adequately and a prolonged pregnancy.

The date which you are given as being due on is not an exact date but a day in the middle of a period of about 4 weeks, from 38 to 42 weeks. You only have a 50% chance of being in labour by your “due date”. You are not “overdue” until 10-14 days past your “due date”.

Induction can be either by rupturing the membranes and giving a drug called Syntocinon via a drip or by inserting a gel containing prostaglandin into the vagina. The method used will depend on different factors in each patient.

Induction results in contractions which are the same as a natural labour although they may get stronger a bit quicker, with the labour about the same length. Induction is not more painful than if you were to go into labour naturally.gnancy to have immunity to Rubella (German measles), chicken pox and Hepatitis B. Immunisations are available for these before and after pregnancy but not during pregnancy. People who will be close to your baby in the first 8 weeks should have had a Pertussis (Whooping cough) immunisation within the last 10 years. However, Pertussis vaccine does not protect against all strains of the virus so anyone with a cough should not come near baby. Pertussis immunisation is recommended for all pregnant women after 26 weeks in every pregnancy. For other people, every 10 years is sufficient.

A suction cup called a Ventouse or Vacuum cup is applied to the baby’s head which can be used to make the mother’s pushes more effective. Sometimes the baby’s head is too pointed to allow the cup to stick to it. Forceps may then have to be used. Forceps are metal “tongs” which are used to ease the baby out of the vagina. Ventouse cups and forceps are used when mother is unable to push strongly enough to push the baby out or when the baby is distressed and there is not time to allow the baby to be pushed out naturally. Normally, the forceps and the cups do not cause any damage to mother or baby but very occasionally there may be some from either. In a first delivery, it usually takes between 15 and 90 minutes to push the baby out without instrumental assistance. I normally aim to help have a baby pushed without the need for the vacuum cup of forceps.
Some consumer groups condemn the current level of intervention in pregnancy without acknowledging the advancements made in reducing problems with the baby and mother by these interventions, such as caesarean delivery, induction of labour or monitoring of the baby’s heart rate in labour. I believe that intervention should require a sound reason for its use and that the least intervention compatible with safety is best. Any interventions planned will be discussed with you first. While women have been having babies “naturally” for millions of years, they and their babies have been dying and damaged for the same time due to lack of surveillance and intervention as they still are in third world countries today.
We all want a normal healthy baby and for most, this is the case. Unfortunately, some babies have problems which may be serious or even fatal. One in 80 babies has a “major” abnormality such as cleft palate or mental retardation. One in 20 babies has a “minor” abnormality such as a birth mark. Ultrasound scans will pick up some abnormalities before birth but many are unexpectedly found at birth. This is a risk which you have to take to have a baby. Every effort will be made to help ensure your baby has no problems. If you have any particular fears, please talk to us about them. All babies have a small risk of developing “Haemorrhagic Disease Of the Newborn” in which unexpected serious bleeding can occur inside parts of the body such as the joints or brain. To prevent this, babies are routinely given an injection of Vitamin K at birth. The Vitamin K is not thought to have any risk to baby. If you wish that your baby not have this treatment, please discuss it with me before the birth otherwise it may be automatically given. Many babies become jaundiced (yellow) after birth and if severe, can be damaged by it. Most babies cure themselves after a few days. If a blood test shows that the jaundice might become a problem to baby, a bright light (phototherapy) is used to destroy the yellow pigment in the baby’s skin before it reaches a dangerous level. This may result in your baby having to stay in hospital longer than you. If your baby turns yellow after discharge from hospital, ring your paediatrician.
Within safe limits, you can do anything you like in labour and be in any position. You can walk, squat, sit, shower or lie flat. In established labour, despite what some women say, many women prefer to lie flat on the bed. This is because labour is usually tiring and many wish to have the most rest possible between contractions. Sitting and other positions do not particularly help your labour progress but may be much more comfortable. Your midwife will help you to be in any position that you wish to try. You may wish to write out a “Birth Plan” detailing how you would like your labour to be managed and what you would like to be able to do in labour. If you do, please remain flexible in your plans as you may feel different when actually in labour. Labour is usually slow enough to give you time to make decisions and requests on the day. Knowing your options is more important than writing a birth plan. If you have a birth plan, please discuss it with me before you go into labour. Some birth positions reduce safety for you and your baby. If you wish to deliver in a particular position, please discuss it with me before you start labour. I will ask you not to have any food to eat or drink after labour is fully established other than sips of plain water. Very little is absorbed from your stomach in labour so it does you little good and may be dangerous if you have to unexpectedly have an anaesthetic for any reason. Please encourage your partner to be with you in labour for your support and his enjoyment. You may also have a close friend or relative with you as well if you wish. Make sure that your camera or phone has plenty of memory spare and that the batteries are charged. If possible, bring both spare memory and a spare battery. I aim to be present at every delivery and will usually see you at other times during your labour.

Vaginal delivery: 5 days
Caesarean delivery: 6 days

These times are only guidelines and can be varied depending on your circumstances. They are largely dictated by how long the health funds will pay for you to stay in hospital.

If while you are pregnant, you develop an illness for which you would normally see your general practitioner, please still see him or her. Examples would include a virus, asthma or dermatitis. However, if drugs are prescribed, please check with me before taking them.
All caesarean deliveries have a paediatrician in attendance who will then look after the baby until discharge from the hospital. They then offer to do a six week check on baby. For vaginal deliveries, a paediatrician will also look after your baby but may not see it immediately. I normally use the paediatricians who work at The Wesley Hospital, depending on who is on duty that day. If you wish to have another paediatrician of your choice attend, please tell me.
Most labours are uncomfortable or painful. You do not have to have any drugs for the pain if you do not wish to do so. The shower is helpful in reducing discomfort. Back massage can help. You may then be offered Nitrous Oxide (“gas”). If these are not sufficient or you do not like them, you would then be offered an injection of Pethidine and/or an epidural anaesthetic. Pethidine will usually give you quicker relief but may make you a little drowsy and after several doses, slow the baby’s initial attempts to breath. Fortunately, the effect on baby’s breathing can be quickly reversed by an injection. To reduce the amount of Pethidine needed to give you good pain relief, another drug named Droperidol which increases the pain relieving effect of Pethidine without affecting baby’s breathing and also reduces the chance of you feeling nauseated is usually given with the Pethidine. An epidural may take a little longer to arrange but should stop your pain almost completely. The drugs used do cross the placenta but do not cause problems in the baby. It also increases the chance of you needing an instrumental delivery and perhaps of having a larger episiotomy with more stitches. There may be a delay in getting an anaesthetist to insert the epidural.
All paints and glues contain solvents which can be absorbed through your lungs or skin. There is evidence that oil based paints, glues and oven cleaners can cause defects in a few babies if either mother or father are exposed before or around conception. The risks continue for pregnant women including from exposure at their place of employment. It is advisable for you to not paint inside while you are pregnant. If your house must be painted, if possible spend a couple of days staying with family or friends to avoid the worst of the fumes. If you must paint yourself, do not use oil based or epoxy paints and make sure that there is plenty of ventilation.
Morning sickness usually lasts up to about 13 weeks but may recur or even last for most of the pregnancy. Being hungry and eating spicy or fatty food may make it worse. Eat small meals often. Carry some food with you in case you get hungry. Have a dry biscuit by your bed to have if you get hungry during the night. Avoid spicy food and anything which seems to make you feel sick. Treatments with safe drugs are available. Ask my rooms for an instruction sheet about using Vitamin B6 plus Restavit. Other drugs are available by prescription which are very effective. If you have been given metoclopramide (Maxalon or Pramin), you may find it is not effective. Ask me for further help.

Medical researchers have identified safe working hours as being crucial to providing safe working practices. Dr Howland is committed to safe working hours to give his patients the best and safest care possible. For this reason, he participates in a weekend roster with his colleagues at The Wesley Hospital. Most of the obstetricians at The Wesley participate in providing safe working hours.

During the week, Dr Howland sometimes shares nights with Drs Tronc. This means that if you deliver through the day (from 6am) or are admitted before about 4:30pm in labour, Dr Howland will deliver you. If you are admitted after about 4:30pm in labour and give birth before 6am on a night when Dr Howland is not on call, you will have your labour supervised and the delivery conducted by the night on-call doctor. If you are admitted before 4:30pm in labour, Dr Howland will look after you for the entire labour and delivery even if that takes all night.

On weekends, Dr Howland shares call with Dr Tronc.

When Dr Howland is away on holiday, his patients are looked after by the same doctors as on the weekday and weekend rosters.

If you need advice or assistance after hours, please ring my rooms number. An answering machine will give you the name and phone number of whoever is on call for my patients at that time. That person may be me.

A scan is usually performed at your first visit. If this is the first scan in your pregnancy, I will check that you have a live baby, count them, check size against dates and look for abnormalities. Sometimes, a serious problem is found at a scan with no prior warning.

You will be offered a scan at 13 to 14 weeks to look at the structure of your baby, to measure your baby and to assess the risk of abnormalities. Down Syndrome is the abnormality that most people think of but others which are less common but much worse may be seen. If the scan suggests that you have a high risk of having an abnormal baby, further testing will be offered.

A more detailed scan looking at the structure of your baby will be done at around 20 to 22 weeks. Baby’s sex may be seen at this scan although sometimes the apparent sex is wrong (about 2%). If you want to know your baby’s sex and we can see it, we will tell you. If you do not want to know, we will hide it.

Some women have to have scans later in the pregnancy for various reasons including checking the position or the function of the placenta and the growth rate of your baby. The timing of scans is explained in the scan page.

You need to be aware that while abnormalities are searched for, it is sometimes impossible to see them. If you are told the sex of your baby from the scan findings, there is a small chance that it may be wrong.

Occasionally, problems arise in which there are no simple solutions or in which opinion varies markedly. If you have any doubt about any aspect of your treatment by me, please discuss it with me. If you wish, you can be referred for a second opinion by another obstetrician. You may find it useful to discuss such matters with your referring GP.

Hopefully, you will be happy with your management and outcome. Having happy and satisfied patients is the best way a Specialist can advertise.

During Pregnancy: If you do not have any problems such as bleeding, intercourse is usually safe. I will advise you if you have any condition which may make it unsafe. However, changes to your vagina which prepare for the birth may make intercourse too uncomfortable especially in the second half of your pregnancy. After Delivery: You should wait for any discharge to stop and for any suturing to heal. This will usually take at least 5 weeks. Even after a delivery which did not need stitches, your vagina may feel tender for 5-10 weeks. If you are comfortable, you may have intercourse before I check you six weeks after the birth. Sex drive is often very low for a while after having a baby as nature conserves energy to assist healing and to cope with less sleep. The first area that loses “non-essential” energy is sex drive.
Safe pyrethrum-type sprays are available in cans or for use by pest control firms. The stronger sprays sometimes used by pest control firms (usually “anti-cholinesterases”) should be avoided as they may be absorbed by you and put baby at risk. You will need to tell the firm to only use pyrethrum-type chemicals.

Common in late pregnancy. It is not a sign of impending high blood pressure. It is often associated with good placental function. It sometimes gets worse a few days after delivery and may then last for a few weeks. Support stockings may help.

If you have no risk factors such as a low placenta or a previous early delivery, domestic travel (within Australia) including by air is usually safe until 36 weeks, which is about four weeks before you are due. It is always sensible when pregnant not to go to places where help may not be easily available within a reasonable time such as an offshore island. International travel is usually safe until about 32 weeks if you have no risk factors and your destination can provide adequate medical services. You should not travel to any area for which malaria is a risk as malaria prophylactic tablets and treatment of malaria can all damage your baby as well as make you very ill. Travel agents frequently make the risk seem much less than it really is in order to make a sale. The only sensible advice for a pregnant woman is to not go to a malarious area. Please check with me before you book any travel overseas and always arrange medical insurance for your trip which includes complications of pregnancy. Insurance companies vary a lot in how late they will cover complications of pregnancy. At present, Columbus Direct appears to be the only company which will cover both you and your baby up to 32 weeks. Good current advice about the risks of overseas destinations can be found at

Please let me know if any of the following occur:

  1. Any red bleeding from the vagina
  2. Leakage of the fluid around baby (clear or bloody fluid from the vagina which keeps coming) before 36 weeks
  3. Any pain which is persistent and which is not relieved by Panadol.
  4. After 35 weeks, if the baby has not moved for 12 hours
  5. Any problem which worries you.

It is normal to gain 8-15 kilograms during a pregnancy. You will lose about 8 kilograms within 2-3 days of delivery. It is better to put on a bit too much than too little, but either does not necessarily indicate a problem in you or your baby. However, large weight gain does increase the chance of your baby developing diabetes in later life.

Please feel free to ask any questions during your pregnancy. If you have trouble remembering them, write them down and bring the list with you on routine visits. You can ask me either at visits, by email or by telephone. Bring your partner to antenatal visits to remind you and to give you support. Be careful about taking advice from friends or relatives and check with us if anyone says anything which worries you. If you look up information on the internet, only take notice of sites run by governments, medical journals or hospitals rather than the opinion of individuals or pregnancy help sites and forums. The staff will tell me about any calls received and about any advice that they have given.