Pregnancy Information

Labour and Birthing Suite, National Women's Hospital

Delivery takes place at the Labour and Birthing Suite, National Women’s Health, Auckland City Hospital, which is on the 9th Floor of the new Auckland City Hospital building, Park Road, Grafton.

For a virtual tour of the Labour and Birthing unit, review the online video available at http://nationalwomenshealth.adhb.govt.nz/about-us/birthing-unit-virtual-tour.

Breast feeding is best and encouraged exclusively. If you intend to bottle feed your baby, formula, bottles and teats need to be taken to hospital with you. The hospital does not provide these items.

Investigations in Pregnancy – Standard

1. Pregnancy Booking Bloods

This includes a full blood count (haemoglobin, platelets, white blood cells etc) , Blood Group (important to know if the mother is Rhesus negative), Rubella, Hepatitis Serology, HIV serology (knowing this if positive prevents 99% of cases of transmission of the virus to the fetus. Not knowing HIV status has a 30% chance of transfer).

2. Nuchal Translucency Scan

An ultrasound scan at 12-13 weeks gestation which confirms viability of pregnancy and gives a risk for Down’s Syndrome which is combined with a Blood Test at 15 Weeks to give an age adjusted risk of Down's Syndrome. Occasionally twins are diagnosed unexpectedly at this scan.

3. Maternal Serum Screening

Patients who do not wish to investigate the baby for abnormality do not need to have this test. However it can be reassuring to know everything is normal. Otherwise, it is a blood test at 15 weeks to give an age adjusted risk of Down’s Syndrome. Blood markers secreted by the placenta in pregnancy include alphafetoprotein, HCG and estradiol which are measured. It gives a 95 % confidence that the baby does not have Down’s Syndrome if the risk comes out at greater than 1/300.

If the risk is less than 1/300 amniocenteisis is recommended.

Amniocentesis Definition - A fine needle under Ultrasound guidance is passed through the maternal abdomen into the uterus under local anaesthetic. Ultrasound guides the needle position safely. Approximately 15-20 mls of amniotic fluid is removed for cell culture and analysis to check the baby has a normal number of chromosomes 46 XX (female) and 46 XY (Male).

4. The 20 week Ultrasound Scan

This is a routine scan done in all pregnancies to look carefully at the structure of the baby and the growth. Occassionally, abnormalities are identified. An abnormality occurring on its own may not be too serious. Several structural abnormalities are often associated with chromosomal abnormalities.

5. Gestational Diabetes

A screening test or ‘polycose’ is done at 28 weeks, along with other routine pregnancy bloods. This is a measure of the blood sugar after a 50 g glucose load is given. If it is more than 7.5 mmol/l then a glucose tolerance test is done. This requires a fasting blood glucose then a glucose load of 75 g and a one hour and two hour value. It is abnormal if the fasting is more than 5.8 mmol/l, the one hour more than 7.0 mmol/l and the two hour more than 9 mmol/l. Up to 10 % of women get gestational diabetes. It is important to maintain blood glucose levels before and after meals less than 5.8 mmol/l. Otherwise, complication rates of pregnancy are much higher. Treatment for diabetes in pregnancy includes modifying the diet to reduce high glycaemic index foods (sugar) and progressing to insulin lowering drugs such as metformin or insulin by injection.

Further routine bloods are done at 36 weeks of gestation.

Travel

Parents increasingly travel more in pregnancy. In general, my advice is to consider the need for travel overseas by air after 24 weeks of pregnancy, especially between 24 and 32 weeks, as this is when there is a small chance of premature labour and the baby is most vulnerable. It would also seriously inconvenience you. However, for short periods or for short flights, and Australia being 3 hours away, (I would consider it almost an extension of New Zealand), travel has less risk. The risks of a problem, particularly pre-term labour, are small (of the order of less than 1 per cent) but if it occurs, it can be serious, frightening and I cannot make a diagnosis by cell phone, particularly if the connection is not good, on the spur of the moment. If you are away and have a problem, you must seek urgent appropriate Obstetric treatment, close to where you are.

Antenatal Classes

These are attended commencing from around 28 weeks gestation. Book early either in your area through Parents Centre, Plunket or Birthcare (09 374 0800). Attending antenatal classes in your area gives you the opportunity to meet other people having a baby at the same time. Classes may vary in the nature and extent of their content, and are not usually designed from the perspective of a specialist delivery.

Transferring to Birthcare after your baby is born

If you and your baby are well then you will be required to transfer to Birthcare for your postnatal stay. If you have had a vaginal birth then the ususal length of stay at NW before transferring to Birthcare is 3-4 hours after the birth of your baby. If you have had a Caesarean Section then you may transfer to Birthcare within 24 hrs after the birth of your baby. Your LMC is not able to extend your stay at National Women's if you or your baby has no medical reason to stay. Birthcare has tours of their facility and you will find this information on their website www.birthcare.co.nz. The telephone number is 09 374 0800.

Labour Epidural Talks with an Anaesthetist

The anaesthetists at National Women's Health, Auckland city Hospital would like to give you the opportunity to learn about epidurals and their role in pain relief and labour. Labour is not the best time to burden you with this information. National Women's Health offer free hour long talks by an anaesthetist twice a month on Mondays.

Common questions that can be discussed at the talk:

Numbers are limited so bookings from 25 weeks onward is recommended. Phone Cherylyn on 307 4949, ext. 25026 during office hours. Please meet and check in at the 5th floor reception area at Auckland City Hospital, Park Road, shortly before 7.30 pm on your designated evening where you will be met by an anaesthetist.

Delivery Procedure

The ideal obstetric standard is to have a normal delivery, without an episiotomy. It is usually the clinical condition of the mother and baby that alters this, not choice. Standard Obstetric procedures include offering an epidural for pain relief which is up to the mother to agree to. Vitamin K is advised as essential to the baby at delivery to prevent a previous death rate in normal babies of 1/1,000 due to an absence of factors that coagulate the blood. Syntometrine is given to the mother to enhance uterine contractility after delivery of the baby. It reduces blood loss by up to 50%. Patients are informed and asked for their consent before these are given.

Cordbank

There is a private service for the storage of cord blood which enables ‘Banking of Umbilical Blood for Your Baby’s Future’. This is largely an insurance against possible leukaemia and other disorders which may be treatable with Stem cells harvested from the stored umbilical cord blood. It is an individual patient decision.

The website is www.cordbank.co.nz.

Copyright 2008-2018 Dr Sylvia K Rosevear - Design by Dean Heard