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1. Preparation

HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consult, will be able to recommend and refer you to an obstetrician who will take care of you and your baby during your pregnancy (antenatal care), birth, and immediately afterwards (postnatal care).

You may be happy to accept the advice of your GP with regard to an obstetrician, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong – they are called ‘fellows’ of the college. These are often good organisations to turn to for information about what you can expect from your medical specialist. You can access the Royal Australian and New Zealand College of Obstetricians and Gynaecologists via their website at www.ranzcog.edu.au. The site provides an overview of obstetric services, and will allow you to search for fellows in your area.

If you are certain which hospital you wish to give birth in but have not yet chosen a doctor, the hospital should be able to provide you with a list of obstetricians accredited to work in their facility (this information is often on the hospital website).

The list of questions below may help you to better understand your care, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website)

To access a list of Obstetricians who participate in HCF’s Medicover no gap arrangement:

• Call HCF Member Services on 13 13 34
• Visit one of HCF’s customer service branches
• Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor

Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment. Some doctors who participate in the HCF medicover no gap arrangement have chosen not to be listed on the HCF website. Therefore you will need to check with your doctor.

WHAT SHOULD I ASK MY OBSTETRICIAN?

• Make sure you fully understand all aspects of your antenatal and postnatal care, as well as your baby’s birth; do not be afraid to ask questions. It is your right to know all the relevant information, as this is part of informed clinical consent.
• What are your likely out of pocket medical expenses. Your doctor should be able to give you a breakdown of all costs incurred - this is known as informed financial consent.
• Specific questions you may like to consider include:
  • What is involved in, and how often are your antenatal appointments
  • What approach does your obstetrician have to childbirth, for example do they have a preferred birthing position, or treatment regime
  • What are your obstetrician's thoughts about interventions such as induction, episiotomy, vacuum and forceps delivery – do these match your own?
  • What percentage of his/her births require assisted delivery or end as unplanned caesareans
  • What happens if your obstetrician is unavailable for the birth
  • If complications arise, is there any possibility you or your baby will need to be transferred to another hospital
  • What is the expected length of stay in your chosen hospital after the birth, and do they offer you home visits from midwives after your discharge
  • If you have any pre-existing medical conditions, how will they be catered for. Remember to ask for advice concerning any medication you are taking
  • Is there a limit on the number of support people present for the birth

HOW DO I PREPARE FOR A NORMAL DELIVERY?

ANTENATAL CARE:

Your obstetrician will see you at increasing intervals throughout your pregnancy. As these visits are done on an out-patient basis, you will not be covered under your hospital cover for any costs incurred. You will be able to claim some of your antenatal costs through Medicare, and in many cases you will reach the Medicare safety net after which your rebates will dramatically increase. Depending on your level of cover, you may be able to claim for some components of your antenatal care, such as educational classes, under your ancillary benefits. Once you have chosen a hospital (in conjunction with your obstetrician), you will need to contact them to ‘book’ your delivery. You will usually be required to pay a refundable booking fee.

LABOUR

A woman’s body begins to prepare for labour as the birth approaches. Signs that you may experience prior to labour are:

• Pink mucous discharge from the vagina (a show)
• Diarrhoea; the bowel is stimulated as the cervix changes
• Low pelvic pressure or back pain
• Some women experience a surge of energy just prior to birth
• Weight loss of up to 1kg
• Water breaks (in some cases your water can break after contractions begin) Inconsistent or unpredictable contractions of varying strength – prelabour contractions

Once conditions are right, the first stage of labour will begin. The release of a hormone called oxytocin causes the uterus to contract and is responsible for the strong, regular contractions of labour. As labour begins, the contractions come regularly and are around 20 to 30 seconds long becoming longer and stronger as labour progresses. The contractions need to be approximately 60 seconds long to dilate the cervix but can last up to 90 seconds.

WHEN SHOULD I GO TO THE HOSPITAL?

If having a normal vaginal delivery many women spend the first part of their labour at home. During this time you will normally be in phone contact with the hospital (usually the midwives in the delivery suite), who will guide and advise you of the best time to come into hospital. The midwife will usually ask to speak to the labouring woman, and will ask questions about the length, strength and time between her contractions.

You should generally contact the hospital if or when:

• Your contractions are regular and strong – typically when they are coming every 5-10 minutes, but you will be given detailed advice during your pregnancy
• Your water breaks
• You experience any vaginal bleeding or spotting
• You feel increased pelvic pressure (feeling like your baby is pushing down)
• You develop lower back pain (especially if you don’t normally experience it)

WHERE DO I GO?

You should be fully briefed about what to do as part of your antenatal care. Most hospitals will require you to check in briefly at the admissions desk and then go straight to the delivery suite.

WHAT DO I TAKE WITH ME TO THE HOSPITAL?

• Do not bring any valuables with you
• It’s best to leave jewellery at home, especially if having a caesarean
• Nightgowns or pajamas (front opening if breast feeding)
• Dressing gown and slippers
• Comfortable day clothes
• Nursing bras and pads (if breast feeding)
• Bring any medication that you usually take, under most circumstances you may still be able to take these
• Clothes and nappies to take baby home in
• Capsule or recognised baby restraint to transport baby home
• Remove all nail polish and do not wear any make-up if having a caesarean
• A camera
• If planning a vaginal delivery, you may wish to pack a separate “labour” bag for you and your support people. Things you may want are spare clothes for everyone, food/drinks, and CD’s or other comfort items

HOW LONG IS THE LABOUR IN A NORMAL DELIVERY?

Labour has three stages:

1. During the first stage of labour the opening of the uterus called the cervix, goes from being closed to fully open (dilated). Strong, regular contractions are what cause the cervix to open.
2. During the second stage of labour the baby moves down the birth canal and you need to push during the contractions to assist the birth of your baby.
3. The third stage of labour begins after your baby is born and ends with the birth of the placenta and afterbirth.

It is not possible to anticipate the length of labour for every woman as labour varies for each individual. In general, women expecting their first baby will take longer than women who have already given birth previously.

For the first baby, the average length of first stage labour is 12 to 14 hours, the second stage 1 to 2 hours and the third stage from 5 to 60 minutes.

Women expecting a subsequent baby can expect first stage labour to last from around 6 to 8 hours, the second stage 1 to 2 hours and the third stage from 5 to 60 minutes.

CAESAREAN SECTION:

WHAT IS A CAESAREAN?

A caesarean section is a surgical procedure where a baby is delivered through an incision made in the mother’s abdominal wall and then through the wall of the uterus. This surgery is usually performed when it is safer for the mother or the baby than a vaginal delivery.

WHY IS IT DONE?

Some medical reasons for which you may be advised to have a caesarean section include:

• The baby’s head is too large for the mother’s pelvic opening
• The baby is breech (lying with its bottom or feet first) or transverse (lying sideways)
• Dangerous conditions such as maternal high blood pressure
• The placenta is blocking the cervix
• The baby is showing signs of distress
• Multiple babies
• The first stage of labour is not progressing
• There has been an unsuccessful induction of labour

Although the majority of women will know in advance and thus have time to prepare themselves for a caesarean, an emergency caesarean is always an option if either mother or baby becomes physically distressed during labour. This possibility is worth giving a little thought to, and perhaps discussing with your doctor as many women find that unplanned surgery is easier to cope with if they are informed about what may happen.

Some women choose to have a caesarean for non-medical reasons, this is a big decision you will need to discuss with your obstetrician.

HOW LONG IS THE PROCEDURE WITH A CAESAREAN?

A caesarean section usually takes around 45 minutes but the baby is delivered within the first 5 to 10 minutes.

WHO IS INVOLVED?

The birth of your baby is usually carried out in a hospital. The people involved in the procedure are:

• Your Obstetrician
• An assistant surgeon
• Midwives will be present during the birth and will provide post natal care for you and your baby
• An anaesthetist will provide either a regional (epidural or spinal), or general anaesthetic if having a caesarian. They may also insert an epidural if required for a vaginal birth.
• A Paediatrician (specialist children’s doctor) may be called if there are any concerns over the baby’s safety
• Radiologist if any x-rays are necessary
• Pathologist if any blood tests are necessary

HOW DO I PREPARE FOR A CAESAREAN?

If your caesarean section is scheduled for the morning, you may be asked to book into hospital the night before; otherwise, you may book in first thing in the morning on the day of your procedure.

Your Obstetrician will have his/her own specific preparation requirements. These instructions should be strictly followed.

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your Obstetrician whether he will participate in HCF’s no gap arrangement for the birth so that you do not incur any out of pocket expense for your inpatient medical expenses. If your Obstetrician does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to the birth.

NORMAL DELIVERY ADMISSIONS

For your information, the average charges for claims paid for Normal Delivery admissions for the financial year 06/07 are provided below:

Points to Note:

• Charges are based on HCF claims for a sample size of 3,699 overnight admissions with an average length of stay of 4.3 days in participating private hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 16519.
• As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation and hospital related services).
• These charges are for comprehensive product and family equivalent only. Check the level of your benefit under your hospital product.

¹ These medical services are in-patient services only.

² The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. specialist consultations. Therefore, the total average medical service charge ($1,567) differs from the sum of the individual average charges as shown.

³ Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

⁴ Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

⁵ This percentage indicates the total coverage of hospital and medical services for all normal delivery admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

CAESARIAN SECTION DELIVERY ADMISSIONS

For your information, the average charges for claims paid for Caesarian Section Delivery admissions for the financial year 06/07 are provided below:

Points to Note:

• Charges are based on HCF claims for a sample size of 2,522 overnight admissions with an average length of stay of 5.4 days in participating private hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare items 16519 and 16520.
• As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
• These charges are for comprehensive product and family equivalent only. Check the level of your benefit under your hospital product.

¹ These medical services are in-patient services only.

² The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. specialist consultations. Therefore, the total average medical service charge ($2,497) differs from the sum of the individual average charges as shown.

³ Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

⁴ Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

⁵ This percentage indicates the total coverage of hospital and medical services for all caesarian section delivery admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

2. Day of admission

WHAT HAPPENS TO ME AT THE HOSPITAL?

When you arrive, the receptionist will do all the paperwork necessary for your stay. Please ensure that you let the staff know of any medication you are taking and any allergies that you may have.

NORMAL DELIVERY:

Usually you will be directed to the delivery suite or birthing centre on arrival. A midwife will assess you and your baby to ensure everything is progressing well, and communicate with your obstetrician to determine when he or she should attend. You can expect the midwife to monitor your blood pressure, pulse and temperature, and to perform a vaginal exam(s) to check the dilation of your cervix. He or she will monitor the baby’s heart rate, usually with a hand-held ultrasound machine, or with a CTG (Cardio Toco Graphic - continuous fetal monitoring) machine.

Because labour and childbirth can cause significant pain, it is important that you know your options for pain relief. Some non-medical methods may include:

• Reduce pain by changing position, moving or applying firm counter-pressure for back pain
• Hot and cold packs, touch and massage can all help to relieve pain by activating other nerves that alter the way your mind perceives your labour pain. Your hospital may also provide a TENS (Transcutaneous Electrical Nerve Stimulation) machine that helps relieve pain in the same way – check with your care provider
• Having a warm bath or shower
• Using distractions such as music or attention focus

Medical methods include:

• Gas (nitrous oxide mixed with oxygen) given by mask or mouthpiece
• Pethidine injection, usually given into a muscle in either your leg or bottom
• Epidural or spinal injection into the back to reduce sensation from the top of the uterus down

Although most women and health professionals aim to deliver the baby as naturally as possible, sometimes assistance is required. This could be in the form of induction or augmentation of labour (either with locally applied gel or a intra-venous drip), an episiotomy, forceps delivery, or vacuum (ventouse) assisted delivery. You should explore and discuss these options prior to labour, so you are as prepared as possible if a situation for their use should arise.

CAESAREAN SECTION:

Once the admission procedure is completed, the anaesthetist will discuss anaesthetic options with you. Most elective caesareans are performed under either spinal or epidural anaesthetic (where medication is injected into the area surrounding the spinal cord), or a combination of the two. If you have a spinal or epidural anaesthetic you will be awake during the procedure but will not be able to feel pain or move the lower half of your body. In some cases, you may require general anaesthesia during the caesarian, which means you will not be conscious during the birth. If your caesarean is planned you should familiarise yourself with these options, and use this discussion to ensure you understand and are comfortable with your anaesthetic choices.

WHAT CAN I EXPECT DURING THE DELIVERY?

NORMAL DELIVERY:

The second stage of labour begins when your cervix is fully dilated. At this time you will usually get the strong urge to push. This is due to the pressure your baby is placing on your pelvic area.

As your baby’s head descends, your perineum, the area between your vagina and anus, begins to stretch and you often feel a burning sensation. This happens when your baby’s head is crowning (the stage of childbirth when the top of the baby’s head is visible at the vaginal opening). In some cases the perineum will tear as the baby is being born so your doctor may discuss with you the option of having an Episiotomy. An Episiotomy is a surgical cut of the muscular area between the vagina and anus to enlarge the vaginal opening.

Once you have given birth, your doctor or midwife may then place your baby on your abdomen so you can enjoy your first cuddle. At this time, your baby’s umbilical cord will need to be cut.

The third stage of labour, the separation of the placenta (afterbirth) begins after the birth of your baby. At this time, you may be given an injection to help your placenta separate from your uterus and control any bleeding.

CAESAREAN SECTION:

You will be transported from the antenatal ward to theatre on a bed or trolley.

The area will be surrounded with sterile drapes to ensure you and your support person cannot view the procedure. Your pubic hair is shaved and the area cleansed. An antiseptic wash will then be painted onto your abdomen. A catheter is passed into the bladder to keep it empty and an intravenous drip line will be set up into the back of your hand or arm. A blood pressure cuff on your arm, heart monitor on your chest and oxygen saturation probe on your finger will give continuous readings throughout the procedure. You will usually have a small wedge pillow placed under your right side to slightly tip your uterus away from major blood vessels, thus ensuring optimal blood flow for you and your baby.

When anaesthesia is complete an incision is made through the lower abdominal wall and the lower end of the uterus. Most incisions are horizontal, allowing the muscles in the uterus to safely stretch for future childbirth. Many women give birth through the birth canal after a previous caesarean section.

The baby’s head is delivered through the incision and the baby is lifted free of the uterus. Sometimes forceps are used if the head is tightly wedged in the pelvic cavity. The placenta is then removed and the wound stapled or stitched closed.

3. Aftercare

WHAT HAPPENS AFTER THE BIRTH?

NORMAL DELIVERY:

After the birth, your baby will be examined, weighed and bathed. If you and your baby are warm and well, you will both be transferred to the postnatal ward.

Whether you are having a normal delivery or caesarean section, it is usual for your baby to stay with you in your room at all times.

During your stay, hospital staff and midwives will provide you with information and support in caring for your baby. This will include showing you how to breast or bottle feed, bath, change, burp and settle your baby.

The length of your hospital stay will vary, but on average will be between 2-5 days.

CAESAREAN SECTION:

You will be transferred from the operating room to recovery where nursing staff will check your pulse, blood pressure, dressings, abdomen and urine output (if you have a catheter inserted). The observations continue every 10 minutes for a period of about half an hour. All being well you will be taken back to the obstetric ward for the rest of your recovery.

When you have a caesarean section you usually have an intravenous drip for the first 24 hours or so. This helps to replace any fluid lost in theatre, and keeps you hydrated until you are able to eat and drink normally. You may also have a tube to drain fluid from the wound which will be removed after a day or so. If you had an epidural for the operation this may be left in place to help with initial pain, or you may be offered injections of strong narcotic medication. If possible, you should discuss your pain relief options with your anaesthetist prior to the procedure. You will need some extra help from staff and family to assist with caring for your baby until you are feeling physically stronger, and it may be helpful to plan your strategies before the birth.

Your wound will usually be stitched with internal, dissolvable sutures, so you should have a neat scar. The midwives will check your wound and apply a dressing if needed whilst in hospital, and will advise you of any care required after your discharge.

The length of your hospital stay will vary, but on average will be between 5–7 days. Once home, it is important to get as much rest as you can for the first few days so if at all possible, it is a good idea to have the help of family or friends.

Some general self-care suggestions include:

• When you feel up to it, take a gentle walk every day
• Eat a healthy diet and drink plenty of water to avoid constipation
• Try to avoid (or at least minimise) heavy lifting
• Try to remember your pelvic floor exercises
• Check with your doctor and your insurance company before driving a car within six weeks

WHAT HAPPENS AFTER DISCHARGE?

Depending on the hospital, you may be eligible to receive some home visits from the midwives to help you adjust to life at home with your baby. It is usual for your obstetrician to see you after about six weeks to check you are recovering well, both physically and emotionally, from the birth. He/she will normally refer your baby to a paediatrician who will see your baby around the same time and check their health and development; if all is well, this may be your only visit. You should be advised of support services in your area, including your local Early Childhood Health Clinic. If you haven’t already got a regular GP, now is a good time to find a General/Family Practitioner you trust to provide primary health care for the whole family in the future.

1. Preparation

HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consult, will be able to recommend and refer you to an obstetrician who will take care of you and your baby during your pregnancy (antenatal care), birth, and immediately afterwards (postnatal care).

You may be happy to accept the advice of your GP with regard to an obstetrician, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong – they are called ‘fellows’ of the college. These are often good organisations to turn to for information about what you can expect from your medical specialist. You can access the Royal Australian and New Zealand College of Obstetricians and Gynaecologists via their website at www.ranzcog.edu.au. The site provides an overview of obstetric services, and will allow you to search for fellows in your area.

If you are certain which hospital you wish to give birth in but have not yet chosen a doctor, the hospital should be able to provide you with a list of obstetricians accredited to work in their facility (this information is often on the hospital website).

The list of questions below may help you to better understand your care, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website)

To access a list of Obstetricians who participate in HCF’s Medicover no gap arrangement:

• Call HCF Member Services on 13 13 34
• Visit one of HCF’s customer service branches
• Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor

Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment. Some doctors who participate in the HCF medicover no gap arrangement have chosen not to be listed on the HCF website. Therefore you will need to check with your doctor.

WHAT SHOULD I ASK MY OBSTETRICIAN?

• Make sure you fully understand all aspects of your antenatal and postnatal care, as well as your baby’s birth; do not be afraid to ask questions. It is your right to know all the relevant information, as this is part of informed clinical consent.
• What are your likely out of pocket medical expenses. Your doctor should be able to give you a breakdown of all costs incurred - this is known as informed financial consent.
• Specific questions you may like to consider include:
  • What is involved in, and how often are your antenatal appointments
  • What approach does your obstetrician have to childbirth, for example do they have a preferred birthing position, or treatment regime
  • What are your obstetrician's thoughts about interventions such as induction, episiotomy, vacuum and forceps delivery – do these match your own?
  • What percentage of his/her births require assisted delivery or end as unplanned caesareans
  • What happens if your obstetrician is unavailable for the birth
  • If complications arise, is there any possibility you or your baby will need to be transferred to another hospital
  • What is the expected length of stay in your chosen hospital after the birth, and do they offer you home visits from midwives after your discharge
  • If you have any pre-existing medical conditions, how will they be catered for. Remember to ask for advice concerning any medication you are taking
  • Is there a limit on the number of support people present for the birth

HOW DO I PREPARE FOR A NORMAL DELIVERY?

ANTENATAL CARE:

Your obstetrician will see you at increasing intervals throughout your pregnancy. As these visits are done on an out-patient basis, you will not be covered under your hospital cover for any costs incurred. You will be able to claim some of your antenatal costs through Medicare, and in many cases you will reach the Medicare safety net after which your rebates will dramatically increase. Depending on your level of cover, you may be able to claim for some components of your antenatal care, such as educational classes, under your ancillary benefits. Once you have chosen a hospital (in conjunction with your obstetrician), you will need to contact them to ‘book’ your delivery. You will usually be required to pay a refundable booking fee.

LABOUR

A woman’s body begins to prepare for labour as the birth approaches. Signs that you may experience prior to labour are:

• Pink mucous discharge from the vagina (a show)
• Diarrhoea; the bowel is stimulated as the cervix changes
• Low pelvic pressure or back pain
• Some women experience a surge of energy just prior to birth
• Weight loss of up to 1kg
• Water breaks (in some cases your water can break after contractions begin) Inconsistent or unpredictable contractions of varying strength – prelabour contractions

Once conditions are right, the first stage of labour will begin. The release of a hormone called oxytocin causes the uterus to contract and is responsible for the strong, regular contractions of labour. As labour begins, the contractions come regularly and are around 20 to 30 seconds long becoming longer and stronger as labour progresses. The contractions need to be approximately 60 seconds long to dilate the cervix but can last up to 90 seconds.

WHEN SHOULD I GO TO THE HOSPITAL?

If having a normal vaginal delivery many women spend the first part of their labour at home. During this time you will normally be in phone contact with the hospital (usually the midwives in the delivery suite), who will guide and advise you of the best time to come into hospital. The midwife will usually ask to speak to the labouring woman, and will ask questions about the length, strength and time between her contractions.

You should generally contact the hospital if or when:

• Your contractions are regular and strong – typically when they are coming every 5-10 minutes, but you will be given detailed advice during your pregnancy
• Your water breaks
• You experience any vaginal bleeding or spotting
• You feel increased pelvic pressure (feeling like your baby is pushing down)
• You develop lower back pain (especially if you don’t normally experience it)

WHERE DO I GO?

You should be fully briefed about what to do as part of your antenatal care. Most hospitals will require you to check in briefly at the admissions desk and then go straight to the delivery suite.

WHAT DO I TAKE WITH ME TO THE HOSPITAL?

• Do not bring any valuables with you
• It’s best to leave jewellery at home, especially if having a caesarean
• Nightgowns or pajamas (front opening if breast feeding)
• Dressing gown and slippers
• Comfortable day clothes
• Nursing bras and pads (if breast feeding)
• Bring any medication that you usually take, under most circumstances you may still be able to take these
• Clothes and nappies to take baby home in
• Capsule or recognised baby restraint to transport baby home
• Remove all nail polish and do not wear any make-up if having a caesarean
• A camera
• If planning a vaginal delivery, you may wish to pack a separate “labour” bag for you and your support people. Things you may want are spare clothes for everyone, food/drinks, and CD’s or other comfort items

HOW LONG IS THE LABOUR IN A NORMAL DELIVERY?

Labour has three stages:

1. During the first stage of labour the opening of the uterus called the cervix, goes from being closed to fully open (dilated). Strong, regular contractions are what cause the cervix to open.
2. During the second stage of labour the baby moves down the birth canal and you need to push during the contractions to assist the birth of your baby.
3. The third stage of labour begins after your baby is born and ends with the birth of the placenta and afterbirth.

It is not possible to anticipate the length of labour for every woman as labour varies for each individual. In general, women expecting their first baby will take longer than women who have already given birth previously.

For the first baby, the average length of first stage labour is 12 to 14 hours, the second stage 1 to 2 hours and the third stage from 5 to 60 minutes.

Women expecting a subsequent baby can expect first stage labour to last from around 6 to 8 hours, the second stage 1 to 2 hours and the third stage from 5 to 60 minutes.

CAESAREAN SECTION:

WHAT IS A CAESAREAN?

A caesarean section is a surgical procedure where a baby is delivered through an incision made in the mother’s abdominal wall and then through the wall of the uterus. This surgery is usually performed when it is safer for the mother or the baby than a vaginal delivery.

WHY IS IT DONE?

Some medical reasons for which you may be advised to have a caesarean section include:

• The baby’s head is too large for the mother’s pelvic opening
• The baby is breech (lying with its bottom or feet first) or transverse (lying sideways)
• Dangerous conditions such as maternal high blood pressure
• The placenta is blocking the cervix
• The baby is showing signs of distress
• Multiple babies
• The first stage of labour is not progressing
• There has been an unsuccessful induction of labour

Although the majority of women will know in advance and thus have time to prepare themselves for a caesarean, an emergency caesarean is always an option if either mother or baby becomes physically distressed during labour. This possibility is worth giving a little thought to, and perhaps discussing with your doctor as many women find that unplanned surgery is easier to cope with if they are informed about what may happen.

Some women choose to have a caesarean for non-medical reasons, this is a big decision you will need to discuss with your obstetrician.

HOW LONG IS THE PROCEDURE WITH A CAESAREAN?

A caesarean section usually takes around 45 minutes but the baby is delivered within the first 5 to 10 minutes.

WHO IS INVOLVED?

The birth of your baby is usually carried out in a hospital. The people involved in the procedure are:

• Your Obstetrician
• An assistant surgeon
• Midwives will be present during the birth and will provide post natal care for you and your baby
• An anaesthetist will provide either a regional (epidural or spinal), or general anaesthetic if having a caesarian. They may also insert an epidural if required for a vaginal birth.
• A Paediatrician (specialist children’s doctor) may be called if there are any concerns over the baby’s safety
• Radiologist if any x-rays are necessary
• Pathologist if any blood tests are necessary

HOW DO I PREPARE FOR A CAESAREAN?

If your caesarean section is scheduled for the morning, you may be asked to book into hospital the night before; otherwise, you may book in first thing in the morning on the day of your procedure.

Your Obstetrician will have his/her own specific preparation requirements. These instructions should be strictly followed.

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your Obstetrician whether he will participate in HCF’s no gap arrangement for the birth so that you do not incur any out of pocket expense for your inpatient medical expenses. If your Obstetrician does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to the birth.

NORMAL DELIVERY ADMISSIONS

For your information, the average charges for claims paid for Normal Delivery admissions for the financial year 06/07 are provided below: