Antenatal Care
PREGNANCY CARE
We delight in being able to provide care during this special time. All of our GPs are obstetric shared care providers in South Australia and therefore are able to provide care during your pregnancy in conjunction with major birthing units. Additionally, Dr Andrew provides intrapartum care at Mount Barker Hospital on a rostered basis. Dr Smith and Dr Andrew both hold advanced diplomas in Obstetrics and are able to manage more complex antenatal care.
ANTENATAL EDUCATION
Do you feel like you have no idea what to do when you bring baby home? You may want to get yourself prepared for parenthood while you are pregnant, and arm yourself with evidence-based information on baby-caring. Dr Rhiannon Smith and Dr Briony Andrew offer one-hour long consultations focused on educating you about feeds, sleep and sensory nourishment to make the first year of baby’s life a thoroughly enjoyable experience. Babies can be unsettled in the first 3 months, but there are many strategies you can use to help keep baby dialled down. We offer a unique approach to caring for your baby – one that is relaxed, flexible, and based in cued-care. Many parents who use a similar style report lower levels of postnatal anxiety and depression. The best time to book this appointment is in the third trimester of pregnancy.
We also offer antenatal breastfeeding education for those mothers that wish to get the best start for their breastfeeding journey, or mothers whose previous journey was troublesome. We will take the time to educate you on the Gestalt Breastfeeding Program, write a breastfeeding plan for you to take to the hospital, as well as educate about common breastfeeding problems. We can also provide education on antenatal expression of colostrum if you wish to take a supply with you to the hospital. This consult is best done in the third trimester, in an hour-long appointment.
INFORMATION ABOUT PREGNANCY COMPLICATIONS:
Pregnancy Tips and Tricks
We have summarised answers to all the common pregnancy questions we get asked.
Topics include: what to eat (and avoid), vitamins, exercise, sex, travel, management of common pregnancy complaints etc.
Gestational Diabetes
All pregnant women should be screened for gestational diabetes at around 26-28 weeks. Unfortunately, the test can be a little unpleasant – it involves fasting, having 3 sets of bloods taken over 2 hours, and drinking a very sweet, mildly fizzy drink. However, it is a very important test as many women who get diagnosed with gestational diabetes have no, or very few, risk factors for it. Importantly, it is nothing that YOU have done to cause this condition. It is entirely due to your placenta and your genetic pre-disposition to Type 2 diabetes.
If you are diagnosed with gestational diabetes, there are many things you can do to make sure your pregnancy continues to be healthy. You will be referred to see a diabetes nurse educator and dietician. The diabetes nurse educator will give you a glucometer, which is how you will measure your blood sugar levels. This will need to be done 4 times a day initially – fasting in the morning and then 2 hours after each main meal. The results need to be written in a blood sugar diary so that the doctor or diabetes educator can see your results and advise on changes.
Why Does Blood Sugar Control Matter?
With gestational diabetes, it is all about the baby. If a mother has poorly-controlled gestational diabetes, then her blood sugar levels will be consistently high. This means the baby will be getting extra sugar across the placenta which can result in a baby becoming very large, which obviously poses some issues for delivery (such as an obstructed labour, shoulder dystocia, trauma to the perineum). It can also cause excess amniotic fluid (polyhydramnios), which will make it more uncomfortable for mum, but can also result in an unstable position for the baby.
After delivery, there is a risk that the baby will develop LOW blood sugars. This is because the baby has been used to receiving the high sugars from mum, and has been compensating by producing excess insulin. When the baby is delivered, the supply from mum is instantly cut off, but the baby’s pancreas is still producing the extra insulin. The colostrum that the baby receives from breastfeeding may not be enough to keep the blood sugars up, and the baby may need to receive antenatally-expressed colostrum, formula, glucagon (an injection), glucose syrup, or intravenous dextrose. If you would like advice on how to express colostrum antenatally, make an appointment to see Dr Smith or Dr Andrew.
Diet
It is important to eat a wide variety of foods still, including carbohydrates, fats and proteins. Carbohydrate choices may need to be different in gestational diabetes. Foods that have a low Glycaemic Index (GI) will help slow the rise of blood sugar levels after eating. Carbohydrates that are brown or orange have a lower GI compared to white carbohydrates (ie brown rice/pasta, wholemeal/multigrain bread, sweet potato). It is also usually important to add in an evening snack. See below resources for food suggestions and meal plans.
Exercise
Exercise does wonders for keeping blood sugar levels even. Just a walk around the block will help enormously. If there is a particular time of day that you are struggling to keep your sugars down, a walk at this time may be useful.
Medication
If, despite good dietary changes, the blood sugar levels are still too high, medication may be needed. Often the tablet Metformin is used first. You are still able to deliver at Mt Barker Hospital if you take metformin. This tablet is taken between 1-3 times a day. It is usually well tolerated although can produce some gut upset.
If metformin doesn’t control the sugar levels, then insulin will need to be used. A referral to an Obstetric Physician at either Women’s and Children’s Hospital or Flinders Medical Centre will be needed, and this doctor will take over care of the diabetes. Often, an injection of insulin at night is all that is needed. Your baby will also need to be delivered at either of these hospitals as the risk of the baby dropping its blood sugar levels after delivery is higher and not safe to be managed at Mt Barker Hospital.
Changes in Pregnancy Care
Once diagnosed with gestational diabetes, you will need to see your doctor more frequently so they can check your blood sugar diary and make changes to your diet, exercise or medications. Due to the risk of growing a large baby, extra ultrasounds will be needed.
Depending on the level of control of the diabetes, plans for induction of labour may be advised. If your blood sugar levels have been well controlled, and the baby is of normal size with no other complications, then we do not have to intervene until 6 days overdue. Induction from 38 weeks is advised if your blood sugars have been above target, the baby is large, there is excess fluid around baby, or other obstetric complications have occurred. If the baby is believed to be below 4 kg, a vaginal delivery can be planned for. If it is in excess of 4kg, a discussion about an elective Caesarean Section should take place.
After delivery, you will need another blood sugar test at 6 hrs. The baby will need its blood sugar level tested at 1 and 4 hours of age. Generally, any medication can be ceased after delivery and no further fingerprick blood sugar testing needs to happen. A repeat Oral Glucose Tolerance Test needs to be done at 6 weeks postnatal.
Resources:
