Your last
weeks
before birth
Developed 2000
Revised July 2016
ANC Cairns Hospital
A guide
from
36 weeks
NOTES
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15
PREPARATION
NOTES
What you need
Save a lot of last minute panic by getting organised now.
Remember your Pregnancy Health Record – your record needs to be given to the Birth
Suite/Maternity staff when you are admitted to the Unit
For women:
• Your choice of comfortable clothing
• Footwear - slippers or casual shoes
• Toiletries - hairbrush, toothbrush and paste, soap
• Sanitary pads
For baby:
• Disposable nappies, baby wipes & baby bath solution.
• Baby clothes, singlets & bunny rugs
If you decide to bottle feed your baby, you are required to provide the formula,
bottles, teats and cleaning equipment of your choice.
REMINDER:
Have a baby capsule fitted into the car in the last weeks of your pregnancy
Mobile phones & other recording devices
Photography and digital recording of ‘normal’ births in birth suite is permissible
provided it does not conflict with the primary role of the support person. Any request
to cease the photography or recording in the interests of providing care to the woman
and her baby must be immediately met as patient safety needs and care remain our
primary consideration.
Members of the hospital staff should not be photographed or recorded without their
specific consent. (Under the information of Privacy Act – Qld 2009)
Other children
Sometimes your other children may not find it easy to share their parents with a new
baby, so if they are old enough to understand – preparing them in advance may be of
benefit. Small children will find it easier to cope with separation if they can visit you in
hospital.
Arrange for someone to look after the children when you go to hospital. If you don’t
have anyone to care for them, there are some community agencies that can help.
Contact the social worker on 42266345 for advice.
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GENERAL MATERNITY UNIT INFORMATION
Visiting Hours:
10am to 1pm
3pm to 8pm
Rest time:
1pm to 3pm NO VISITORS at this time
Phone calls:
Please ask relatives/friends to contact you on your mobile phone.
Landline phones are available on request. Please ask the
midwifery staff and a phone will be provided. Incoming and
outgoing calls can be made on these phones. (Phone cards
are required for outgoing calls).
Car Parking:
The multi-story car park is available for a fee and is open
between 5.30am and 11pm.
Smoking:
As smoking is detrimental to good health and also a fire
hazard, patients and visitors are asked not to smoke in the
hospital. Cairns Hospital has a smoke-free policy.
Safety:
Television:
Lounge:
Meal times:
To keep baby safe and secure in hospital, we suggest the
following:
Wash your hands before touching or cuddling baby
Wheel baby in their cot (not carried in your arms) should you
need to move around the unit for bathing etc.
Your baby will have 2 identification bands attached at all times.
Safe infant sleeping practices
There is a set available for your use at each bed. For information
regarding television hire please ask the staff.
The lounge area is available in each area for patients, family and
friends. It is an ideal area for seeing those visitors with children,
and its facilities include comfortable chairs and a TV.
Meal times are approximately:
Breakfast
7.30am
Lunch
12md
Dinner/Tea
5.30pm
IMMUNISATIONS
Influenza - The seasonal influenza vaccine, or “flu shot”, is recommended and
funded for pregnant women under the National Immunisation Program. It is can
be given at any time during pregnancy.
Women face a high risk of severe consequences if they contract influenza during
pregnancy. The flu shot is safe for pregnant women, and provides effective
protection for you and your new-born baby for the first six months of their life.
Pertussis - To protect newborn babies against whopping cough (pertussis) the
dTpa (diphtheria, tetanus, pertussis) vaccine is recommended for pregnant
women in their third trimester (from 28 weeks). Newborn babies (birth to 6
weeks) are too young to receive their first immunisation and are at greatest risk of
severe complications if they get whooping cough. By getting vaccinated against
whooping cough during pregnancy, mothers receive immunity from the vaccine,
which passes to the baby through the placenta, so when the infant is born they
already have some protection against whooping cough until they are old enough
to be routinely vaccinated at 6 weeks of age.
MMR - is a vaccination offered to mothers who have been found, during the
antenatal period, not to have immunity to Rubella. This injection is offered to
women following the birth of their baby, and prior to discharge from hospital.
Hepatitis B - The National Health and Medical Research Council of Australia
recommend that all Australian babies are vaccinated against Hepatitis B. The first
vaccination is offered before you leave hospital with your baby. A further three
doses are given from two months of age onward, using combination vaccines
when other vaccines are due. The four doses are recommended to provide long
term protection against this disease.
BCG - is a vaccination against tuberculosis (TB). This chest infection is very
common in some people and in some areas in the world. A vaccination at birth, or
within the first 6 months of life, offers protection for the Under 5 year olds.
Vaccination is offered to babies who live in high risk areas, and if you are planning
to take the baby to live in a 'high risk' area for more than a month, you should get
the baby immunised. The Department of Thoracic Medicine (Chest clinic) who
come to the Maternity Unit - Mon, Tues, Thurs and Fri offers the service. To
contact them outside these times or to make enquires please phone 42266240.
Drinks will be offered at morning and afternoon tea. Food and beverages are
available at the cafe on the ground floor of the hospital during business hours or from
vending machines in various locations around the hospital after hours.
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FORMS
Information on how to register your baby’s birth and Centrelink/Medicare form will be
given to you prior to discharge from hospital - it is your responsibility to register your
baby's birth and name.
A Personal Record Book will be given to you. This provides information of baby’s
record of birth, milestones and immunisations.
LACTATION CONSULTANT
The Lactation Consultant is a midwife with an internationally recognised qualification
to provide the latest information about breast milk and breastfeeding, and offer
practical assistance to women who are breastfeeding.
Your decision to breast or formula feed your baby is respected and you will be given
support and education to do so successfully. You can talk with, or see the Lactation
consultant during your pregnancy, following the birth of your baby, and/or after you
have gone home. Videos are available for viewing by the whole family if required.
The Cairns Hospital Maternity Unit recognises that breastfeeding provides health
benefits for mothers and their babies. If you choose to breastfeed, we are committed
to providing a high quality service that supports you to do so successfully.
EXTENDED MIDWIFERY SERVICE
After you go home, your MGP Midwife or a Midwife from the Extended Midwifery
Service (EMS) will call and arrange to visit you and your baby at home. The Home
Maternity Service bridges the gap between hospital and home, allowing new mothers
the comfort of their own home with the security of professional support. EMS offers
one-to-one with the Midwife in your own home, providing the education and help you
need with feeding and parenting your new baby.
The CH EMS service is provided for those mothers living between Gordonvale and Palm
Cove.
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CHANGES IN YOUR BODY
In the last few weeks of pregnancy, you will notice changes in your body.
These might include:
• More frequent Braxton Hicks contractions – painless tightening of the uterus as it
“practises” for birth
• ‘Lightening’ – the baby’s head moves into the pelvis 2-4 weeks before labour begins
(usually later if it is not your first baby)
• Pressure in the pelvis
• A ‘show’ – during pregnancy, the cervix (neck of the womb) is sealed with a plug of
mucous. This plug may become loose and pass out through the vagina; it may
appear in the toilet or on your underwear as pink or blood stained mucous. This is a
sign that your cervix is starting to soften.
WHEN TO GO TO HOSPITAL
Please phone the midwife in Birth Suite 42266318 or your MGP midwife anytime of the
day or night, if you are concerned about your pregnancy or if any of the following
occurs:
• Your membranes rupture or there is a constant trickle of fluid
• Bright bleeding from your vagina
• Regular painful contractions
• Decreased baby movements ( baby is not moving as much as normal)
WHERE TO COME
The Maternity Unit is located on the 2nd floor of Block C. Access is via C block lifts
between 6am and 8pm.
After these hours, access is gained through the Emergency Department, which is
located on the Ground Floor of Block C – facing the Esplanade. It is a good idea to know
where these entrances are in advance as to avoid any panic when you are in labour.
Remember to bring your pregnancy health record with you to hospital.
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WHEN DOES LABOUR BEGIN?
Labour can start from 37 weeks, or up to 2 weeks past your due date. It can start
with contractions or breaking of the waters - this can happen in any order.
Contractions
Contractions may be mild at first. Your back may ache or you may notice the sort
of aching, heavy feeling you sometimes feel with a period. These contractions
become more regular, closer together, longer and more painful. You will know
that they are the real thing and not just Braxton Hicks contractions when they
become more frequent.
Waters breaking
The bag that holds your baby (amniotic sac) may break at the beginning of labour
or when labour is established – fluid may leak or gush from your vagina when this
happens.
It is important to contact the Birth Suite as soon as your waters break.
First stage of labour – onset of regular contractions to full dilatation of the cervix
This is the longest part of labour. The average length of the first stage is about 10 14 hours for a first baby and about 8 hours for subsequent babies. During this
time, contractions gradually open up the cervix until it is about 10cm wide (fully
dilated).
The contractions will gradually get stronger and closer together. You may want to
come to hospital when they are demanding all of your attention, and you would
like the support of a Midwife.
During the first stage the progress of your labour will be monitored by:
• Midwife/Doctor may do internal examinations to see how far your cervix has
opened.
• Your baby’s heartbeat will be monitored frequently; this may be done with a
Doppler. If continuous observation is required, an electronic monitor (CTG
machine) may be used. This involves 2 belts being attached to your abdomen
which hold in place the machine attachments – this gives a printout of your
baby’s heartbeat and your contractions.
• Your ‘vital signs’ will also be monitored frequently to see how you are coping
with the progress of your labour.
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AFTER BIRTH – YOUR BABY
Identification bands are placed on your baby's arm and leg at birth. If labour and
birth have happened without any problems and you and your baby are well, you
may choose to go home when your baby is 6 hours old. Your baby remains with you
throughout your stay in hospital. You will be assisted with feeding and shown how
to bath your baby, change nappies and how to keep your baby’s belly button clean
and dry.
Sometimes there are times following birth, when the baby may require special care
and attention in the nursery, whereas, you are well. In times such as these, you can
go home and receive continuing care from a midwife, while the baby remains in
hospital.
Parents are encouraged to attend the nursery at any time.
Vitamin K for the Newborn
Vitamin K deficiency bleeding in infancy is a condition that occurs due to
immaturity in the baby's blood clotting mechanisms. In untreated babies bleeding
occurs in approximately 1 in every 200 births. If this bleeding occurs within the
brain it can be life threatening.
Should you feel that an injection of vitamin K is inappropriate for your child, vitamin
K may be administered by mouth. The oral route should consist of many doses of
Vitamin K from birth, and continues weekly while the baby is breastfed. If you feel
that either form of prophylaxis is inappropriate for your child we would welcome
the opportunity to discuss this further.
Screening newborn babies
Some rare medical disorders in apparently healthy babies can be detected by blood
tests before the babies become ill. Early diagnosis means that treatment can be
started immediately and serious mental and/or physical disability prevented. After
72 hours of age, a few drops of blood are taken from the heel, collected on treated
blotting paper, and sent to the Queensland Health Laboratory in Brisbane. Parents
are not notified of normal test results. All babies in Australia are screened for:
Phenylketonuria; Hypothyroidism; Cystic Fibrosis and Galactosemia
Healthy Hearing Screen
The Healthy hearing screen aims to identify babies born with a hearing loss. Early
diagnosis and treatment means that children develop language skills earlier and
schooling is less likely to be affected. This screen will not harm your baby and will
be offered before you leave hospital. You will be notified of the results of the
screen straight after it is performed.
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PROLONGED PREGNANCY
Second stage of labour – birth of the baby
If your pregnancy has gone more than one week overdue (on accurate dates) it is
considered to be prolonged
This is much shorter, usually about 45 minutes – 2-3 hours for a first baby and between
15 – 60 minutes for subsequent babies.
Around the world, there is no general agreement among obstetricians as to the
best advice to give women whose pregnancies are prolonged.
Indications that the baby will be born soon are:
Contractions are coming every 2 – 3 minutes and lasting 60 – 90 seconds
Heavy ‘show’
The urge to push
We know that there are very small extra risks to the baby in pregnancies that are
prolonged.
We know that there is no perfect way to monitor the well being of every baby that
is overdue.
We also know that induction of labour has occasional complications, although
overall there is no increase in Caesarean Section rate.
After your baby is born, the Midwife will place your baby on your abdomen – your
partner may want to cut the ‘cord’.
Cairns Hospital Policy
Third stage of labour – birth of the placenta
If your pregnancy is normal but is clearly overdue by 7 – 10 days AND you wish to
have your labour induced, the doctor will perform a vaginal examination to assess
the condition of your cervix (neck of the womb).
• Active management:
Research shows that women bleed less and the 3rd stage is completed sooner if you are
administered intramuscularly with a synthetic oxytocic drug, called Syntocinon.
• Physiological management:
The alternative way of birthing your placenta, is to wait until you start contacting again.
A contraction may be stimulated naturally by breastfeeding the baby. You will feel the
need to push the placenta out, with guidance from your midwife.
If the cervix is ‘ripe’, the cervix will be stretched and arrangements will be made
for induction of labour at a mutually convenient time, at 7-10 days past your due
date. Induction usually involves an internal examination to break your waters and,
if necessary, the use of a ‘drip’ containing the hormone called Syntocinon.
You may choose to stand, squat, kneel on all fours or use a birthing stool – it is
important to find the best position for you.
You need to discuss your plans for birth with your midwife.
If the cervix is ‘unripe’ and if you still want to be induced, arrangements will be
made for your admission to hospital at a mutually convenient time, at 7-10 days
past your due date. A drug called Prostin, given in the form of a jelly, is placed in
the upper vagina to ‘ripen’ the cervix. This may require several doses over a day or
two, before induction is possible.
If you do not wish to be induced, we recommend the following:
Electronic fetal heart rate monitoring in the clinic three times a week, and
an ultrasound scan to assess the amount of fluid around the baby.
These tests may suggest a medical reason to deliver your baby and, if this is the
case, it will be fully explained to you.
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PAIN RELIEF IN LABOUR
As labour progresses, the contractions usually become more painful. During
pregnancy you need to think about how you will cope with this.
You will feel much more relaxed if you understand what is happening to you.
Being anxious makes muscles tense and can increase pain. Don’t hesitate to ask
questions during your labour if there is something you don’t understand.
Relaxation
Labour is the time to put relaxation techniques to good use. Some women find
soothing music helps them to relax.
Heat and water
A hot bath or shower may help to ease backache in labour; a hot pack can feel
good too.
Massage
Massage can reduce muscle tightness during labour. Ask your partner or support
person to practise massage techniques with you during pregnancy.
Staying Active
Walking around when you are in labour can help with pain, it can distract you.
Staying upright also helps the forces of gravity aiding baby to move down the birth
canal and stimulating the uterus to contract.
Changing positions
Staying in the same position for too long can become uncomfortable. Although
you may not feel like you want to move, changing position frequently can help
you cope better with the contractions and encourage baby to adopt a good
position as well.
Support person
It is best to limit support people to persons you can talk to and can give you moral
support. This is a big help in labour and there are practical things they can do as
well:
wipe your face, rub your back, give you sips of water, help change position
remind you to use relaxation techniques
support your decisions and tell you how well you are coping
DRUGS IN LABOUR
If you have spent your pregnancy talking about a drug free labour and find that you do
need pain relief from drugs, it does not mean that you have failed.
Labour can be unpredictable and it is impossible to know how much pain there will be
and how it will affect you. The length of your labour and the time of day that it starts
can also affect how you will feel the pain and your need for pain relief.
Gas
Gas is a mixture of nitrous oxide and oxygen which takes the edge off pain but does not
remove it altogether. You breathe through a mask or mouth piece which you hold
yourself. Its advantage is that it doesn’t accumulate in your body to affect you or your
baby. Sometimes it can make you feel nauseated or drowsy.
Pethidine/Morphine
Pethidine/Morphine is a narcotic given by injection. It lessens the pain for 2 to 4 hours,
sometimes longer. The disadvantage is that it can make you feel drowsy, dizzy,
nauseated or make you vomit. Pethidine & Morphine cross the placenta, so depending
on the stage of labour that it is given to you, at delivery your baby may be sleepy and
slow to breathe; these effects can be reversed quickly with treatment.
Epidural
Epidural is an injection of local anaesthetic into the spinal cord by an anaesthetist. It
blocks pain quickly and safely; although sometimes it doesn’t work completely for
some women.
Its advantage is that it gives you excellent pain relief and you stay alert and can be
helpful in long labours.
Sometimes if your labour is long, the effects of the local anaesthetic become more
pronounced, so your legs may feel weaker and you may not be able to walk around.
Sensation becomes less and you may not feel the urge to push.
You can request an epidural at anytime once labour has been established.
Sterile Water Injections
These injections can be helpful if you are experiencing severe back pain in labour.
Your midwife will inject a small amount of sterile water into certain points in the
lower back to block nerve pathways to help alleviate the pain.
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