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High Risk Midwifery Team | Auckland | Te Toka Tumai | Te Whatu Ora

Midwifery Service, Maternity

Description

Formerly Auckland DHB High Risk Midwifery Team

What Does the ADHB High Risk Midwifery Team Do?

We are a team of midwives who are experts in caring for women who need extra care during pregnancy. This might be because of medical conditions, past and present pregnancy complications or fetal abnormalities.

We provide information and support throughout your pregnancy. We work business hours only. If you have questions or concerns outside these hours that are not urgent please feel free to leave us a message. If it is urgent please phone the Women's Assessment Unit on 307 4949 x 25900

We work together in a multidisciplinary team to provide care. The other members of our team include obstetricians, physicians, dietitians, physiotherapists and social workers.  We have regular meetings to review your care.

How Do You Get Referred to the ADHB High Risk Midwifery Team?

Your doctor or lead maternity carer (LMC) can refer you to our service. Once you are referred, our team will review the information we receive and either communicate with your LMC or contact you directly to arrange a clinic appointment.

How do I access this service?

Referral

Referral Expectations

This section provides information for your doctor, midwife or lead maternity carer when referring you to our team. 

The following information is required for an appointment to be made for the woman you are referring. The type of information required depends on which particular specialty you are wishing them to be seen by e.g. Diabetes, Medical (High Risk) or Fetal Medicine.

Diabetes Team Referral
Click here for a Diabetes Referral Form

Please provide the following information:

  • LMP
  • Gestation
  • Gravida/parity
  • Antenatal bloods
  • OGTT
  • Polycose
  • HbA1c
  • Previous medical history
  • Previous pregnancy history(if applicable)
  • Current antenatal record
  • Scans
  • Current contact details

Medical Team Referral

Please fill out a Maternal Medicine referral form and email to highriskservices@adhb.govt.nz. For urgent referrals, please call 09 307 4949 ext 29198. 

Please provide the following information:

  • LMP
  • Gestation
  • Gravida/parity
  • Antenatal bloods
  • Medical history
  • Previous pregnancy history
  • Scans if available
  • Current contact details

Call for advice on (09) 307 4949 extn 25357 or 25358

Fetal Medicine Referral

Please fill out a Fetal Medicine referral form and email to FetalMedicineScheduling@adhb.govt.nz. For urgent referrals, please call 09 307 4949 ext 29462.

Please provide the following information:

  • LMP
  • Gestation
  • Gravida/parity
  • Current pregnancy scans
  • Antenatal bloods
  • Contact details

Call for advice on (09) 307 4949 extn 24951

National Women's Website:
http://www.adhb.govt.nz/nwhealthinfo/

Languages Spoken

English

Birthing Facilities Midwife/s Attend

Auckland DHB Labour and Birthing Suite

Click on the following link for more information on Auckland DHB Labour and Birthing Suite.

Women attending the Maternal Fetal Medicine Clinic (High Risk) mostly deliver at Auckland City Hospital, as the specialty services required to care for them and/or their baby are here.

After consultation with the Medical Team, some women who have been referred from another part of the country can deliver their babies in their own DHB.

Birthcare

Click on the following link for more information on Birthcare.

Birthcare is also part of our postnatal care facility. Birthcare is located across the Domain, from the hospital. Most women who have experienced their pregnancy care and birth with the High Risk team will continue their postnatal care within National Women's at Auckland City Hospital.

Services Provided

Labour and Birth Care

If your midwife is self-employed, they will attend your labour and birth. In the event that they are away or busy, they will have arranged a back-up midwife to be available instead. Make sure you know who the back-up is and how to contact them. If your midwife is a hospital-based community midwife, your labour and birth care will be provided by a hospital-based midwife. Please ensure you know the correct number to call for both your community midwife and the hospital birthing suite directly. Make sure you understand the signs of labour and when to call your midwife. Every labour and birth is different and not all go according to plan. Make sure you understand what can happen and be prepared to change your birth plan. Your midwife will talk to you about what may happen and also about what strategies you can use to manage labour pain. Some midwives provide care for women who have been given an epidural by an anaesthetist, have an oxytocin drip and abnormal fetal heart trace, others do not. Please check to see if the midwife you choose offers these services. Pain Management There are no two pregnancies or labours exactly alike. Every woman's experience is unique and individual to her. Labour and birth are normal physiological processes and there are 3 stages to labour. The first stage occurs from the time regular contractions are established until your cervix is completely open and the baby can pass out of the uterus and through the cervix. The second stage is when the woman has a strong, natural urge to bear down with the contractions and push her baby out. Your baby is born! The third stage is the delivery of your placenta. Your placenta detaches from the uterine wall and is expelled through the vagina. Labour is painful but it is important to keep this experience as positive as possible. Pain is a very personal and subjective experience. Regardless of your tolerance for pain, you can learn constructive ways of coping. The pain of labour is definable - it comes with a contraction and then goes away. It is important for you to discuss your options of pain relief with your midwife before you go into labour. Please share any concerns you may have about the possible effects on you, or your baby. Keep an open mind and know your options ahead of time so that you can make an informed choice in managing your labour. Possible Medical Intervention During Labour This is discussed in antenatal classes and may also be covered by your midwife or LMC around 36 weeks when your birth plan will be talked about. The reasons why you may require any medical intervention would be in consultation with you and would usually only occur if you or your baby were considered to be needing assistance.

If your midwife is self-employed, they will attend your labour and birth. In the event that they are away or busy, they will have arranged a back-up midwife to be available instead. Make sure you know who the back-up is and how to contact them.

If your midwife is a hospital-based community midwife, your labour and birth care will be provided by a hospital-based midwife. Please ensure you know the correct number to call for both your community midwife and the hospital birthing suite directly.

Make sure you understand the signs of labour and when to call your midwife. Every labour and birth is different and not all go according to plan. Make sure you understand what can happen and be prepared to change your birth plan. Your midwife will talk to you about what may happen and also about what strategies you can use to manage labour pain.

Some midwives provide care for women who have been given an epidural by an anaesthetist, have an oxytocin drip and abnormal fetal heart trace, others do not. Please check to see if the midwife you choose offers these services.

Pain Management

There are no two pregnancies or labours exactly alike. Every woman's experience is unique and individual to her.

Labour and birth are normal physiological processes and there are 3 stages to labour. 

The first stage occurs from the time regular contractions are established until your cervix is completely open and the baby can pass out of the uterus and through the cervix.

The second stage is when the woman has a strong, natural urge to bear down with the contractions and push her baby out. Your baby is born!

The third stage is the delivery of your placenta. Your placenta detaches from the uterine wall and is expelled through the vagina.

Labour is painful but it is important to keep this experience as positive as possible. Pain is a very personal and subjective experience. Regardless of your tolerance for pain, you can learn constructive ways of coping.

The pain of labour is definable - it comes with a contraction and then goes away. 

It is important for you to discuss your options of pain relief with your midwife before you go into labour. Please share any concerns you may have about the possible effects on you, or your baby. Keep an open mind and know your options ahead of time so that you can make an informed choice in managing your labour.    

 Possible Medical Intervention During Labour

This is discussed in antenatal classes and may also be covered by your midwife or LMC around 36 weeks when your birth plan will be talked about.

The reasons why you may require any medical intervention would be in consultation with you and would usually only occur if you or your baby were considered to be needing assistance. 

Pregnancy Care

Because pregnancy care is so important for your health and the health of your baby, it is free for all NZ citizens, residents and many other visa holders. Your midwife will give you advice on keeping yourself healthy in pregnancy and you will be offered regular appointments so your midwife can monitor your progress. Your midwife will be looking out for any signs that you or your baby are becoming unwell. Some conditions in pregnancy may not be obvious to the untrained eye, so attending appointments is vital. Your midwife will order blood tests and ultrasound scans as required. Please make sure you undertake these tests promptly so that any problems can be detected early. If any problems are indentified you will be referred to a hospital specialist, who will make a plan of care with you and your midwife. Your midwife will talk to you about what you want for your pregnancy and will plan your care with you. You will be asked to think about the kind of labour and birth you would like and your preferences will be recorded. It is a good idea to attend a childbirth education course, especially if this is your first baby. Pregnancy Check-ups and Tests First Trimester (0 - 14 weeks) Antenatal visits are usually once a month but may need to be more frequent, a care plan will be formulated for your needs; Ultrasound scan: pre-natal testing will be discussed with you at your booking visit. Booking visits usually take 1 hour. This includes an explanation of how the clinic runs. During your visit your medical and obstetric history is recorded. Your height, weight and blood pressure is measured and you will do a urine test. We will answer any questions or queries you may have. Second Trimester (15 - 28 weeks): Antenatal visits usually occur monthly but may need to be more frequent. At each antenatal check-up your midwife will check your blood pressure, test your urine, listen to the baby's heartbeat (12 weeks onwards) and palpate your abdomen. Ultrasound: An anatomy scan will be discussed and offered at around 18 weeks. Some women may need increased surveillance (i.e. twin pregnancies) Polycose Testing: Between 26- 28 weeks, it may be recommended earlier if diabetes is suspected. This test is free and is carried out at Labtest. Third Trimester (29 - 40 weeks): Weeks 29-35: Check ups are usually once every two weeks, but may be more frequent. Weeks 36-40: Check ups are usually once a week, but may be more frequent. Additional Tests During Pregnancy: Consult your midwife if you wish to discuss these: Chorionic villus sampling (CVS) Amniocentesis Maternal serum Sampling Development of Your Care/Birth Plans Your LMC is responsible for organising your maternity care. They may provide all your care or share the care with one other, or more, practitioners. They also provide information to assist with decision-making during pregnancy, preparation of the birth and for parenting. Topics will include a wide range of matters such as nutrition, exercise, the risks of smoking and alcohol, labour and the birth process, pain relief, breastfeeding, baby care, immunisation, community services, contraception and many more. It is important that you have a 24 hour contact number for your LMC and that back-up arrangements have been discussed with you in case your LMC is unavailable at any stage. The Maternal Fetal Medicine Clinics (High Risk) are a tertiary service. We offer a consultation service and in some cases, because of the complexities of the women and babies we care for, become their LMC.

Because pregnancy care is so important for your health and the health of your baby, it is free for all NZ citizens, residents and many other visa holders. Your midwife will give you advice on keeping yourself healthy in pregnancy and you will be offered regular appointments so your midwife can monitor your progress. Your midwife will be looking out for any signs that you or your baby are becoming unwell. Some conditions in pregnancy may not be obvious to the untrained eye, so attending appointments is vital. Your midwife will order blood tests and ultrasound scans as required. Please make sure you undertake these tests promptly so that any problems can be detected early. If any problems are indentified you will be referred to a hospital specialist, who will make a plan of care with you and your midwife.

Your midwife will talk to you about what you want for your pregnancy and will plan your care with you. You will be asked to think about the kind of labour and birth you would like and your preferences will be recorded. It is a good idea to attend a childbirth education course, especially if this is your first baby. 

Pregnancy Check-ups and Tests

First Trimester (0 - 14 weeks)

  • Antenatal visits are usually once a month but may need to be more frequent, a care plan will be formulated for your needs; 
  • Ultrasound scan: pre-natal testing will be discussed with you at your booking visit.
  • Booking visits usually take 1 hour. This includes an explanation of how the clinic runs. During your visit your medical and obstetric history is recorded. Your height, weight and blood pressure is measured and you will do a urine test. We will answer any questions or queries you may have.

Second Trimester (15 - 28 weeks):

  • Antenatal visits usually occur monthly but may need to be more frequent. At each antenatal check-up your midwife will check your blood pressure, test your urine, listen to the baby's heartbeat (12 weeks onwards) and palpate your abdomen. 
  • Ultrasound: An anatomy scan will be discussed and offered at around 18 weeks. Some women may need increased surveillance (i.e. twin pregnancies)
  • Polycose Testing: Between 26- 28 weeks, it may be recommended earlier if diabetes is suspected. This test is free and is carried out at Labtest.

Third Trimester (29 - 40 weeks):

  • Weeks 29-35: Check ups are usually once every two weeks, but may be more frequent.
  • Weeks 36-40: Check ups are usually once a week, but may be more frequent.

Additional Tests During Pregnancy:

Consult your midwife if you wish to discuss these:

  • Chorionic villus sampling (CVS)
  • Amniocentesis
  • Maternal serum Sampling

 Development of Your Care/Birth Plans

Your LMC is responsible for organising your maternity care. They may provide all your care or share the care with one other, or more, practitioners. They also provide information to assist with decision-making during pregnancy, preparation of the birth and for parenting.

Topics will include a wide range of matters such as nutrition, exercise, the risks of smoking and alcohol, labour and the birth process, pain relief, breastfeeding, baby care, immunisation, community services, contraception and many more.

It is important that you have a 24 hour contact number for your LMC and that back-up arrangements have been discussed with you in case your LMC is unavailable at any stage.

The Maternal Fetal Medicine Clinics (High Risk) are a tertiary service. We offer a consultation service and in some cases, because of the complexities of the women and babies we care for, become their LMC.

Staying in Hospital/Birth Centre After the Birth

After the birth you will be tired and busy getting to know your new baby. Most women who have had a normal birth stay in the hospital or birth centre for 48 hours. If you have had a caesarean section, the usual hospital stay is 3-5 days. There may be an option to have your postnatal stay in a primary unit if you have given birth at hospital. Some women choose to go straight home after birth, this is called a planned early discharge. Talk to your midwife about your postnatal stay and make sure your family know what your plan is. Following the birth of your baby you will most likely stay on our postnatal Ward 96/98 (sometimes this may include Tamaki Ward). The length of postnatal stay will vary between women. The length of your stay will be influenced by factors including the reason for your pregnancy being considered high risk, the type of birth experienced and/or any other concerns. Midwives on the wards will assist you in caring for yourself and your baby, preparing you for the transition to going home.

After the birth you will be tired and busy getting to know your new baby. Most women who have had a normal birth stay in the hospital or birth centre for 48 hours. If you have had a caesarean section, the usual hospital stay is 3-5 days. There may be an option to have your postnatal stay in a primary unit if you have given birth at hospital. Some women choose to go straight home after birth, this is called a planned early discharge. Talk to your midwife about your postnatal stay and make sure your family know what your plan is.

Following the birth of your baby you will most likely stay on our postnatal Ward 96/98 (sometimes this may include Tamaki Ward). The length of postnatal stay will vary between women. The length of your stay will be influenced by factors including the reason for your pregnancy being considered high risk, the type of birth experienced and/or any other concerns. Midwives on the wards will assist you in caring for yourself and your baby, preparing you for the transition to going home.

Home Visits From a Midwife (From Birth to 4 - 6 Weeks)

Home visits provide an opportunity for you to discuss any concerns you have about your health or the health of your baby. Your midwife will assist you with breastfeeding and will monitor your baby's growth and development. Your midwife will visit you the day after you get home. You will then receive between 5 and 10 visits until your baby is around 4-6 weeks old. It is important to let your midwife know where you are, if you are planning to stay at another address after the birth. Once discharged from hospital your midwife that you met antenatally, will visit you at home 5-6 times (visits are tailored to meet your needs). If your midwife is on annual leave or sick, then one of her team colleagues will visit you. Your midwife will liaise with you to determine a mutually convenient time to visit you and your baby. It is important that you ensure your midwife has the correct address of where you will be with your baby and your telephone details.

Home visits provide an opportunity for you to discuss any concerns you have about your health or the health of your baby. Your midwife will assist you with breastfeeding and will monitor your baby's growth and development. Your midwife will visit you the day after you get home. You will then receive between 5 and 10 visits until your baby is around 4-6 weeks old. It is important to let your midwife know where you are, if you are planning to stay at another address after the birth.

Once discharged from hospital your midwife that you met antenatally, will visit you at home 5-6 times (visits are tailored to meet your needs). If your midwife is on annual leave or sick, then one of her team colleagues will visit you.     

Your midwife will liaise with you to determine a mutually convenient time to visit you and your baby. It is important that you ensure your midwife has the correct address of where you will be with your baby and your telephone details.

Ongoing Care for You and Your Baby

Your midwife will transfer the care of your baby to a Well Child / Tamariki Ora Service before your baby is 6 weeks old. Well Child / Tamariki Ora Health providers work with families to provide support, advice and care for all children under 5 years old. The most common Well Child / Tamariki Ora provider is Plunket but there are others in your region, ask your midwife for information about this service. All babies born in New Zealand are registered with the National Immunisation Register. To find out more about the NIR click here. It is important that you register with a local GP. If you do not have a GP or a GP for your baby, it is important to do this when you are pregnant.

Your midwife will transfer the care of your baby to a Well Child / Tamariki Ora Service before your baby is 6 weeks old. Well Child / Tamariki Ora Health providers work with families to provide support, advice and care for all children under 5 years old. The most common Well Child / Tamariki Ora provider is Plunket but there are others in your region, ask your midwife for information about this service.

All babies born in New Zealand are registered with the National Immunisation Register. To find out more about the NIR click here.

It is important that you register with a local GP. If you do not have a GP or a GP for your baby, it is important to do this when you are pregnant.

Disability Assistance

Wheelchair access

Parking

  • Parking charges apply if you park in the hospital grounds
  • Pay parking for visitors and patients is available in the Visitors' Carpark - Carpark A   (use the Park Road entrance and follow the signs)
  • A 5-minute drop off area is located outside the Main Entrance
    • 0 - 30 Min: $4.00
    • 30 Min - 1 Hour: $4.00
    • 1 - 2 Hours: $6.00
    • 2 - 3 Hours: $7.00
    • 3 - 4 Hours: $8.00
    • 4 - 5 Hours: $9.00
    • 5 - 6 Hours: $10.00
    • 6 - 7 Hours: $18.00
    • 7 - 8 Hours: $18.00
    • Lost Ticket: $20.00

Contact Details

Auckland City Hospital

Central Auckland

Clinic Reception extn. 25920
Fetal Medicine Scheduler: 24951
Maternal and Diabetes Scheduler: 25357/25358

National Women's Health
Newborn and Maternity Outpatients
Level 9
Support Building
Auckland City Hospital

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Street Address

National Women's Health
Newborn and Maternity Outpatients
Level 9
Support Building
Auckland City Hospital

Postal Address

National Women's Health
Auckland City Hospital
Park Road
Grafton

This page was last updated at 11:07AM on November 27, 2023. This information is reviewed and edited by High Risk Midwifery Team | Auckland | Te Toka Tumai | Te Whatu Ora.