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.
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.
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.
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.
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.
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.
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.
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.
Please let me know if any of the following occur:
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.