12 Jan 2018

Weekend Cover Changes

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Dr Natalie Shaw and I have pretty much covered each other’s weekends, study leave and holidays on a one in two roster (12 days on and two days off) now for ten years.

This is an unusually onerous out of hours roster (many obstetricians work in groups of up to four or five doctors) although working in this way has enabled us to provide our patients with a very personalised service. Unfortunately we aren’t getting any younger and we both face a number of challenges including ageing parents and – in my case – a wife that works in Melbourne.

Anyway we have taken the step of gradually including a third obstetrician into our weekend roster over the course of this year. This is not a step we have taken lightly and indeed we have waited until a suitably qualified, experienced obstetrician could help us out. This doctor is Justin Tucker who has trained in Melbourne and Sydney at RPA Hospital. Justin is also a Fertility Specialist working at Monash IVF next door to my office. Justin will be seeing patients in my rooms so – as with Natalie – you will have a chance to meet him before the birth of your baby to continue with our “no strangers” policy.

I know this is a big change. I spent the first 5 years of my private practice life pretty much doing all of my weekends prior to Natalie and I getting together (professionally, that is) and then we have covered each other for the last ten but to be truthful doing so has become exhausting even though both of us have smaller practices than many other obstetricians.

Keep an eye on the Whiteboard in my office for our weekend and leave roster and remember I always strive to continue to provide the highest standards of care

Rob

07 Dec 2017

MY FEES

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I know that seeing a private obstetrician is expensive, I really do. I’m also aware there is a sizeable out of pocket component to these fees that is driven by relatively low Medicare and Health Fund rebates for maternity care. I have not increased my fees for a number of years but I am now faced with increasing medical indemnity costs along with significant operating costs (rent, parking etc). However I have not increased my fees but am adopting a “no discount” policy. In the past I used to discount my fees for returning patients, medical colleagues and various others. I can simply no longer afford to do this and have taken this step to try not to increase the already significant financial burden of private maternity care. Please check out my fee schedule in the “Services” section of my website.

Rob

09 Apr 2016

Former Patients Only

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Things are really ramping up with Aquamamma. We have signed manufacturing, distribution and marketing deals for the world with a couple of companies – unfortunately for tiny royalties not millions of dollars! While this is very exciting Aquamamma is taking up more of my time than it has done previously – over the past three years it has just been something to fill my spare time (Ha Ha).

 

Anyway unfortunately I need to further cut down my private obstetric work such that for the remainder of 2016 I will only be able to accept former patients of mine for obstetric care. I hope this will only be a temporary change and hopefully you will understand my wish to maintain the quality of my care.

 

In the Eastern Suburbs I highly recommend my weekend and holiday partner (if you know what I mean) Dr Natalie Shaw and also Drs Rahul Sen, Bobby Teoh, Steve Coogan, Wendy Hawke and Jan Dudley.

 

Of course if nobody buys Aquamamma in the next six months I will be back to my usual booking numbers after Christmas!

 

Rob

05 Feb 2016

Of Salads & Salmonella

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Of Salads and Salmonella

As you no doubt know there is an issue with respect to Salmonella infections in pre-prepared salads that can be purchased in plastic bags, usually from supermarkets. A couple of patients have already contacted me having consumed such salads.

Now first things first. Salmonella is an extremely unpleasant infection and well worth avoiding but it does NOT specifically cross the placenta and target babies (unlike Listeria, CMV, Parvo – “slapped cheek” –  and Toxoplasma). Babies can only come to harm if their mothers become dehydrated from the infection. This means that if you have no symptoms your baby is fine.

Secondly however – and I thought I did tell people this at their first visit – I would NEVER consume a pre-prepared salad in pregnancy anyway because of the risk of Listeria infection. (Actually I’m not pregnant and I would never eat a pre-prepared supermarket salad myself). A salad made the same day in a restaurant, café or salad bar should be ok.

 

So the food rules are simple:

  • Anything that is fully cooked through and served hot is fine
  • Food that has been cooked OR pre-prepared IN ANY WAY, refrigerated and served cold is NOT ok.

 

Have a safe weekend

Rob

03 Feb 2016

The Zika Virus

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The Zika Virus

 

You cannot have missed the media coverage of the Zika virus outbreak in latin America along with the very disturbing news that this infection appears to cause birth defects.

There appears to be a link between maternal infection with Zika and babies suffering from microcephaly. Microcephaly literally means “small head” and the small head in these cases is due to abnormalities in brain development. This means that babies with microcephaly have a very high likelihood of suffering significant developmental delay. The earlier in pregnancy the infection occurs, the greater the likelihood of microcephaly occurring.

Zika virus infection appears to cause no symptoms so people are not aware they have caught it. There is no vaccine for the virus.

Zika virus is spread by the Aedes aegypti mosquito. This mosquito is found in latin America (ie all of America south of the USA and the Caribbean), the Pacific Islands and North Queensland. I know that Health Authorities in Australia are being very reassuring we need to consider the possibility that this mosquito – and the Zika virus – may become more prevalent in Australia.

My strong advice is for pregnant women – or those even considering pregnancy – NOT to travel to countries in which there is a Zika virus outbreak. Currently that means the entirety of latin America, the Caribbean and some Pacific Islands including Samoa and Tonga although I expect that list to increase with time.

Whenever you are in the tropics be meticulous about mosquitoes – use repellent (yes, it’s safe), long sleeves if possible, insect screens or nets.

 

So while Peter Allen said “When my baby smiles at me I go to Rio” right now I wouldn’t.

18 Jan 2016

Email issues

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I’m now receiving quite a few e mails from patients about urgent clinical concerns.

I’m really uncomfortable about this as my e mail goes down from time to time and on occasions it has been down for a few days.

PLEASE text me if you have an urgent concern about yourself or your baby – do not e mail me.

Rob

17 Nov 2015

New Patient Booking Procedure

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New Patient Booking Procedure

It’s a bit of a first world problem – and one I definitely do not take for granted – but we’re struggling to keep a lid on our numbers of births per month. In order to retain what I hope are high standards of pregnancy care it is necessary for me to continue to limit the number of pregnancies I take on per month. I am resisting the temptation to increase my fees to try and mange my numbers as truthfully I think I am expensive enough. With this in mind we are instituting a new booking in procedure for new pregnant patients at Rob Buist Obstetrics:

If you are pregnant and wish to seek my services please e mail me at rob@robbuist.com letting me know:

  • The date of the first day of your last period OR your due date if you have undergone a dating ultrasound scan
  • The name of your GP or referring doctor
  • Any complex medical reproductive or pregnancy history that may be relevant (this information is treated with the utmost confidentiality)

Priority will be given to women who:

  • Are previous patients of mine – I value loyalty above all else,
  • Are patients of the GPs and referring doctors who have supported my practice over the past decade (they know who they are),
  • Have significant medical problems or who have experienced previous reproductive or pregnancy problems

In the absence of a reason for a very early visit most first visits will occur at 8 to 9 weeks gestation  and will include an ultrasound scan of your baby

The required documentation for your first visit is:

  • A valid referral from your GP or referring doctor
  • A full set of Pregnancy Booking Bloods (Bloods Group, Rubella etc). Your referring doctor will know what these are.
  • I’m sorry but you will not be seen if you do not provide this documentation and it is your responsibility to do so.

Rob

09 Feb 2015

Nurse Surgical Assistant at Prince of Wales Private Hospital

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As most of you know it is common practice in Australia to have a doctor assist the obstetrician at caesarean sections. Indeed this practice is generally viewed as compulsory (although in the UK and NZ I often found myself performing a Caesar assisted only by the scrub nurse) and there are times when another pair of experienced hands can be very useful.

You will also be aware that surgical assistants at Prince of Wales Private Hospital will send you a bill for their services. Depending upon the time of day (or night) these doctors can charge anywhere from around $600 up to $1,000 (or occasionally more) to assist at your caesarean and you will usually get around $150 back from your Medicare and your Health Fund.

There is now a nursing surgical assistant at Prince of Wales Private Hospital called Cynthia Labi. Cynthia is an extremely capable assistant and I use her frequently. If Cynthia assists at your caesarean she will bill you a flat rate of $300. Because she is a nurse you will not be able to claim for her fee from either Medicare or your Health Fund but please note that you will be financially better off than if we used a doctor assistant – your out of pocket expense will be less than if a doctor assisted.

Rob

04 Dec 2014

Group B Strep

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Group B Streptococcus (Group B Strep)

Our mouths, our bottoms and our vaginas contain many bacteria. The overwhelming majority of these bacteria are harmless to our health. Group B Strep is a bacterium that lives in the vagina of 12-15% of Australian women. It is not a sexually transmitted disease (which means it is not the type of infection your mother warned you about when you were a teenager). Group B Strep does not usually cause any symptoms, and it is not harmful to women. However, if it is passed to a baby during a vaginal birth, it can rarely – extremely rarely – cause a serious infection in the newborn baby.

What does this mean for my baby?

Many babies will come into contact with Group B Strep during labour and birth and only a very small number of babies will become infected. Approximately 1% of babies exposed to Group B Strep at birth will develop an infection. It is therefore VERY rare. The majority of babies who come into contact with Group B Strep are not harmed. Of the babies that develop Group B Strep, a very small number of these babies will develop a serious infection such as pneumonia or meningitis.

Is there a test to see if my baby is at risk of contracting Group B Strep?

Yes. At around 35 weeks of pregnancy, you will be offered a vaginal bacteriology swab. This is a really simple test you can perform yourself – we just ask you to put a cotton bud just inside the entrance to your vagina. We will call you with your results within a few days.

How can my baby be protected from developing an infection?

If you have tested positive to Group B Strep on your vaginal swab at any time in pregnancy you will be offered antibiotics during your labour. These are administered into a plug in a vein in your arm, and do not prevent you moving around, or hopping into the shower or bath during labour. The usual antibiotic given for Group B Strep is penicillin; other antibiotics can be given if you are allergic to penicillin. You will also be offered antibiotics in labour if:

  • You have Group B Strep found in a urine sample
  • You have had a previous pregnancy affected by Group B Strep
  • You develop a temperature/fever during labour
  • Your waters have been broken for over 18 hours.
  • Your labour starts before 37 weeks gestation.

 

 

Are there risks with having antibiotics?

Side effects are extremely rare with intravenous antibiotics. Allergic reactions to antibiotics are vanishingly rare in women with no previous history of such allergies. In the extremely unlikely event of an allergic reaction occurring we are able to give you appropriate medication to treat the allergy. We believe that if you are positive for Group B Strep the risk of you suffering an allergic reaction to antibiotics is much, much less than the risk of your baby being harmed by Group B Strep.

Why don’t you give me antibiotics when we find out I am carrying Group B Strep, rather than waiting until I am in labour?

Good question. Logic would suggest that we should treat you and get rid of the Group B Strep once we find out about it. Unfortunately this approach does not work because the Group B Strep usually returns once you have been treated for it. This is why we only give you the antibiotics once you are in labour.

What if I come into hospital and give birth before the antibiotics can be administered?

Some babies can arrive very quickly. Whilst we recommend antibiotics in order to prevent a Group B Strep infection, it is important to remember that such infections are rare. If your baby is born before we can give you antibiotics we usually keep an extra close eye on your baby for signs of infection for the first 48 hours after birth. If there are other risk factors for infection (such as you having a fever in labour), we may give your baby one dose of antibiotics shortly after it is born.

 

Does being positive for Group B Strep affect my labour?

Not really. However, we prefer your baby to be born within 24 hours of your waters breaking if you have Group B Strep. (Once your waters have broken, the protective bag around your baby is broken and bacteria in your vagina can start migrating into the uterus). Accordingly, if you have Group B Strep and your waters have broken, but you are not in labour, we will usually recommend either inducing your labour contractions or starting you on antibiotics while we wait for labour to begin.

 

Do I need antibiotics for Group B Strep if I am having an elective Caesarean?

No. Some people call a Caesarean section a vaginal bypass procedure. A Caesarean performed before labour completely bypasses the vagina – and its bacteria!

 

This information sheet was adapted from The Royal Hospital for Women Group B Strep information sheet by our midwife Amanda Bartlett. As usual I take full responsibility for any errors or omissions. Rob

18 Jun 2014

Non Invasive Prenatal Testing

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Non Invasive Prenatal Testing

 

I’d like to teach the world to sing (in perfect harmony)

–        The New Seekers*

New things come along very rarely in my business. Childbirth itself defines human existence and is of course described in the most ancient of texts. The techniques we use to manage abnormal labour and birth – the ventouse, the forceps and caesarean section – have all been around for more than a century and have changed little over time. We still don’t know the exact cause of preeclampsia (high blood pressure in pregnancy) and the cure remains simply delivering the baby. Ultrasound and epidurals were discovered in the 1960s although they have improved greatly over the last decade or so. We have been sticking needles into the pregnant uterus for more than fifty years and these invasive techniques have been the mainstay of the prenatal diagnosis of fetal chromosomal abnormalities for at least as long as I have been involved in obstetrics.

Unfortunately there is a problem (as Jeremy Clarkson might say on Top Gear) with amniocentesis and chorionic villus sampling (CVS) for chromosomal abnormalities: the – admittedly very rare – risk of a miscarriage being caused by the procedure. This risk is the reason why we usually begin the prenatal testing process with a screening test that carries no risk – the Nuchal translucency (NT) test. This test was discovered in the early 1990s and is based on some very simple observations; namely that fetuses with Down syndrome – as well as those with the other common significant chromosomal abnormalities, Trisomy 18 and Trisomy 13 – have some changes that can be seen on ultrasound at around twelve weeks gestation. These changes are a thicker neck (the nuchal translucency) and an underdeveloped nose bone. When combined with some placental hormonal blood tests this ultrasound detects around 96 percent of fetuses with Down syndrome. Until recently a “high risk” NT test meant that a woman had to consider one of the invasive needle tests in order to confirm or deny whether the fetus indeed had a major chromosomal abnormality (with, of course, the attendant very small risk of a miscarriage being the result).

So we have been using the NT test along with – if necessary – the needle tests as the basis for our prenatal testing for fetal abnormalities for at least twenty years now.

And then…

…the Non Invasive Prenatal Test (NIPT) came along this year. This test is marketed by an American company as the Harmony test (hence the musical reference above*). Read more