What is Maternity?
Maternity is concerned with the care of women and babies throughout pregnancy (antenatal), labour and the first six weeks after birth (postnatal). For low risk pregnancies the provider of care (Lead Maternity Carer) is normally a midwife but this can be provided by a GP or obstetrician if they are available. If a pregnancy or birth becomes higher risk then an obstetrician may become involved in the care along with the LMC.
How does the system work?
Most midwives are community based and work as self employed practitioners. They provide care for women from the confirmation of pregnancy through to the end of the postnatal period. A woman can approach any self employed midwife to provide her care and can also change her LMC at any point if not happy with the care provided. Women receive continuity of care from their self employed midwife including labour care which is of benefit to both as a strong relationship can evolve during the pregnancy.
For women unable to locate a self employed midwife then a service is provided by the DHB. The woman will see the DHB community midwife during the antenatal and postnatal period. When in labour the woman presents to delivery suite and will receive care from the core (hospital based) staff. The DHB will try to assist most women to locate a self employed midwife so that they have the opportunity to receive continuity of care.
If a pregnancy becomes higher risk, then an obstetrician may become involved in care. The LMC will refer the woman to the Antenatal Clinic at the DHB for an appointment with the obstetric team. Dependant on the issue which has arisen with the pregnancy, ongoing care will be provided either by the LMC alone or by the LMC and Obstetrician providing joint care.
Where is maternity care available?
Maternity Care for Northland DHB is based out of the main population centres of Northland – Whangarei, Kaitaia, Kawakawa and Dargaville. Rawene is also a centre for care, but operates under a public health trust outside of the DHB.
Not sure if you’re pregnant?
If you suspect that you may be pregnant but are not sure then it is advisable to take a pregnancy test. The following places are some of the places where you can be tested:
- midwife practices
- at home – buy a home test at the pharmacy
- family planning clinic
- sexual health clinic.
Pregnancy tests are simple and do not hurt – some of your urine is placed on a test stick thatwill indicate after a couple of minutes whether the result is positive or not. If the test is carried out too soon it may give a false result so if you are still unsure repeat the test at a later date.
So you’re pregnant – now what?
Once you have a confirmed pregnancy it is important to start planning your care as soon as possible. The first thing to do is to engage the services of a Lead Maternity Carer – in Northland this would be a midwife. Details of midwives in your area can be found on the internet, phone book or following the link http://www.findyourmidwife.co.nz/ . Also the Ministry of Health can be contacted on 0800 Mum2Be (0800 686 223) to send out a list of available LMCs in your area.
If you are unable to contact a self employed midwife, then a DHB midwife can be contacted on 0800 696 439 (during office hours only) who should be able to assist you to find appropriate care.
There are various scans and tests which are available/ recommended during pregnancy. Please discuss these options with your care provider.
Consider taking folic acid and iodine supplementation in early pregnancy. Research has shown that daily doses of folic acid taken from conception until at least the end of the 12th week of pregnancy reduce the risk of your baby having neural tube defects such as spina bifida and anencephaly. For more information about supplementation in pregnancy please refer to:
Eating a balanced and nutritious diet is recommended during pregnancy. There are certain food groups to avoid while pregnant and details of these can be found at http://www.foodsmart.govt.nz/information-for/pregnant-women/. There is no specific guide to weight gain in pregnancy however if you are slim then you may gain more weight than someone who is overweight. Dieting during pregnancy is not recommended, it is more important to ensure that you are eating a healthy range of foods.
Pregnancy is an ideal time to give up smoking, drinking alcohol and taking drugs. All these things can affect the growth and development of your baby and can have lifelong effects on their health. For support with smoking cessation please contact Quitline on 0800 778778 or look at http://www.quit.org.nz/. For support with drug and alcohol issues please speak to your care provider.
During pregnancy it may be recommended that you consider vaccinations. During the flu season a flu vaccination is available free to all pregnant women. During a pertussis (whooping cough) epidemic a vaccination is available free to pregnant women between 28 and 38 weeks. This passes on immunity to your baby to cover the first few weeks of life until they can become vaccinated themselves. For further information please see http://www.fightflu.co.nz/information-for-pregnant-women/ and www.immune.org.nz.
Childbirth education is offered free through the DHB either in the form of evening classes or weekend classes. These are held at Te Puawai Ora off Maunu Road. There are also sessions targeted at young parents which are held during each school term at The Pulse. For more information regarding these classes please phone 09 430 2324 and leave a message and someone will return your call, or email .
Common complaints in pregnancy
It is common to feel uncomfortable at times during pregnancy. A feeling of nausea and sickness frequently occurs during the first trimester. However if you find that you cannot keep any food or drink down then it may be something more serious and advice should be sought from your LMC
Later in pregnancy it is not unusual to suffer from reflux/heartburn. This is due to the effect that the pregnancy hormones have on your body. Again advice should be sought from your LMC.
Other common complaints during pregnancy are constipation, varicose veins, dizziness, backache, broken sleep, pelvic bone pain, Braxton Hicks tightenings, leg cramps and frequency of urination. It is important to always discuss these things with your LMC to see if there is any further support that can be given or any further investigations that need to be carried out.
Going into labour
If you think you are going into labour it is time to contact your LMC. It is important to contact your LMC if you think that your waters have broken even if you don’t start contracting. Your LMC will discuss the signs of labour with you so you know what to look out for.
When in early labour your LMC will advise the best place for you to be. When it is time to make your way to delivery suite the following are suggestions of things to bring with you to the hospital:
For during labour:
- support people
- own pillow
- food and drink – especially for the support people
- energy snacks or drinks for yourself
- warm socks
- something to read - magazines etc
- lip Balm
- a camera
- heat pack/wheat bag for heating up
- own clothes and toiletries
- massage oil.
For ongoing stays in hospital:
- comfortable clothes remembering that for breastfeeding it is easier with clothes that open down the front
- a good supportive maternity bra
- any pre-existing medications
- clothes for baby (woollen hat, booties, cardigan, baby grow)
- clothes for baby to go home in
- baby blanket
- baby bottles, teats and baby formula if you intend to artificially feed your baby
- car seat appropriate for newborn baby.
It is recommended that you leave all valuables at home.
Not going into labour?
If you have gone past your due date and have not gone into labour, is there anything that can/should be done? This is something which should be discussed with your LMC who may refer you to speak to an obstetrician regarding Induction of Labour (IOL). IOL occurs either for a medical/obstetric reason and the decision will be made by an obstetrician, or because the pregnancy has gone a number of days past the expected date of delivery and the woman decides in consultation with her LMC and obstetrician that she would like labour to be started.
Ongoing postnatal care
Once baby has arrived you may choose to stay in hospital or go home immediately (as long as there are no medical indications that either you or baby should stay in hospital). Care is then provided by your LMC for 4-6 weeks postnatally. From that point onwards you can choose who should provide the follow up care for your baby whether it be Plunket or some other provider.
Within the first few weeks after birth your baby should be seen by a Hearing Screener who will determine whether your baby requires any further investigations.
The lactation consultancy team are available at the hospital to see all women who require assistance with breastfeeding or who wish to discuss feeding issues. The team are also available to see women antenatally and at any point while they are breastfeeding, at free drop in clinics held at Te Puawai Ora, 3 Keays Road, Maunu. Clinic times are Tuesday and Thursday from 10am until 2pm.
In addition a free clinic is also held at Te Puawaitanga O Otangarei,175 William Jones Drive on Wednesdays from 10am until 1pm.
There is a national immunisation register that holds the immunisation details for all children born after 2005 in New Zealand, unless the parents have chosen to opt off from this register. The immunisation schedule for your baby will start at 6 weeks after birth – see your GP for more details.
With all newborn babies it is important to be aware of how to keep them safe and this is especially important when considering where they sleep. All babies should have their own sleeping space where they are free from risk – this can be in a bassinette, cot, pepipod or Wahakura. Rates of sudden unexpected death of an infant (SUDI) increase when parents smoke, take drugs and alcohol and co-sleep with their baby. If you have these risk factors, please discuss safe sleeping arrangements for your baby with your LMC prior to birth.
What if baby arrives early?
If you suspect that you are going into preterm labour, then it is important to contact your LMC and present to delivery suite to be assessed.
Whangarei hospital can provide support to babies who are born from 32 weeks onwards. If it appears that you are going into labour prior to this gestation then the decision may be made to transfer you to another unit which can support early preterm babies. In the first instance this would be Auckland, unless there is no space available in their neonatal intensive care unit.
In the event that you give birth to a preterm baby prior to 32 weeks at Whangarei, then a team would normally arrive from the neonatal intensive care unit to arrange the transfer of your baby as soon as possible.
The aim is to keep families together so where possible we will arrange for you to be transferred to Auckland for follow up care so that you can be with your baby.
Once baby is stable and it is appropriate, the plan is normally to return baby to Special Care Baby Unit (SCBU) in Whangarei for ongoing care so that you can be closer to your family.
Babies born early but after 32 weeks gestation can be admitted to the SCBU in Whangarei for care. Parents are encouraged to spend as much time as they can with their premature babies so that they can be involved in their care and aid the bonding process. This is also important to establish good lactation (milk production).
During your pregnancy or during the postnatal period there are a variety of services which can be put in place to support you and your family. There are social workers dedicated to maternity who can work with your family as required and input can also be obtained from the maternal mental health team if necessary.
Discuss with your LMC if you think that you would benefit from some input from other services.