Obstetrics

Introduction to obstetrics

Most pregnancies happily need care, attention and support only. The role of a midwife and obstetrician is to guide through the routine and normal parts of pregnancy, labour and postnatal care. Also importantly to recognise when intervention is required, when normal has become or is becoming abnormal.

Simon McDowell and Nick Bedford provide care for woman opting for an planned elective caesarean section. For those without an indication for an elective caesarean section they encourage and recommend a planned vaginal delivery.

Caesarean section

Aceso offers private obstetric services for those women having a planned elective caesarean section. This may be because the woman has had a previous caesarean section, or there are other medical issues necessitating caesarean section.

Dr Simon McDowell and Dr Nick Bedford offer this service as a shared service. Women and couples will see them alternately. These appointments generally occur at Wakefield Specialist Centre. Delivery occurs at 39 weeks gestation at Wellington Public Hospital.

Nick and Simon utilise the Wellington Hospital community midwifery team for midwifery obstetric services. The midwife sees patients at 18 weeks, 34 weeks then for postnatal care.

Routine schedule of visits is as follows:

Date Specialist
Booking visit Obstetrician
13 weeks Obstetrician
18 weeks Midwife
20 weeks Obstetrician
24 weeks Obstetrician
28 weeks Obstetrician
32 weeks Obstetrician
34 weeks Midwife
36 weeks Obstetrician
37 weeks Obstetrician
38 weeks Obstetrician
39 weeks Caesarean section

Down syndrome screening

Down syndrome is the most common chromosomal abnormality affecting children. The chances of having a child with Down syndrome increases as the age of a woman increases.

There are 2 options for Down syndrome screening in New Zealand:

Standard screening

This gives an updated risk analysis of having a child with Down syndrome. It takes information from 2 sources:

  • A blood test from the mother at 9-13 weeks, looking a 4 different markers
  • An ultrasound scan performed at 12-14 weeks where the skin fold on the back of the baby's neck is measured

Both of these pieces of information are sent for an updated analysis. For example, a 35-year women pre-testing has a 1 in 900 chance of having a child with Down syndrome. Analysis of the test results may indicate the actual risk is 1 in 10,000, and in this situation no further action is generally taken.

If a 'high-risk' result eventuates (higher chance than 1 in 300), a diagnostic test may be offered. This is an amniocentesis (a small amount of amniotic fluid is aspirated), or chorionic villus sampling (CVS), where a small amount of placenta is taken for analysis.

There is no cost for standard screening in NZ.

Non-invasive prenatal screening test for Down Syndrome (NIPT testing)

This test involves only a blood test of the mother, taken after 10 weeks. Foetal DNA is extracted from the maternal bloodstream, and the chromosomes very accurately analysed. The test gives 99% accuracy of the chromosomes.

A result is generally back within 1-2 weeks. Foetal sex can also be determined if a patient wishes.

The test is not funded in NZ, and entails a private fee ($600-800). Aceso Health refers patients to Dr Jay Marlow, who has a consultation with the parent(s), takes the sample, and arranges followup and communication of the result.

Further reading

Vaccination(s) during pregnancy

All pregnant women are advised to have a flu vaccination during pregnancy. This can be obtained free of charge at your GP. A flu vaccination can be performed at any time during the pregnancy.

Vaccination in pregnancy protects a newborn baby from pertussis (whooping cough). It is free of charge, and can be administered at your local GP. It is recommended that you have this vaccination between 28 and 38 weeks of pregnancy.

Further reading

Ultrasound scanning

Aceso Health uses specialist obstetric scanning for all imaging required during pregnancy. We recommend Wellington Ultrasound who provide high quality specialist service.

Further reading

Foods in pregnancy

Many woman are unsure what foods they should not eat during pregnancy. The Ministry for Primary Industries (MPI) website details safe foods to eat during pregnancy and also safe food preparation.

Further reading

Exercise and weight gain during pregnancy

It is important to stay active during pregnancy. Many patients worry about what level of exercise is safe. The link from the Ministry of Health (below) provides some guidance.

The body becomes extremely efficient obtaining nutrients during pregnancy. Some women feel they need to 'eat for two', but in fact an extra 'slice of bread' per day is all that is required. The Ministry of Health link (below) also discusses healthy weight gain in pregnancy.

Further reading

Further information

Symptoms

Break-through bleeding

This is spotting or bleeding that occurs between periods while on hormonal contraception, or whilst pregnant. It is more common when you've missed a pill, or have vomiting or diarrhoea. It is relatively common in the first six months after a mirena is placed, or with a copper IUD. Other causes include genital tract infections, cervical ectropion, or as part of early pregnancy. Find out more

Irregular or unscheduled bleeding

There are a number of causes of irregular bleeding, and our investigations will depend a bit on your age and fertility plans. Common causes can include endometriosis, infection, instability of the lining of the womb, ovarian cysts, perimenopause, polycystic ovarian syndrome, polyps, and early pregnancy. Find out more

Conditions

Pregnancy

Most pregnancies happily need care, attention and support only. The role of a midwife and obstetrician is to guide through the routine and normal parts of pregnancy, labour and postnatal care. Also importantly to recognise when intervention is required, when normal has become or is becoming abnormal. Find out more