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.


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

25 May 2014

Fees Increase – just kidding!

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I usually increase my fees each year in order to reflect my increasing cost base. However I realise private obstetric services are expensive so this year we will absorb those costs and not alter my basic fee structure.

We will however now have to charge for giving iron infusions and for performing fetal heart beat tracings. While my midwifery colleagues do much of this work I pop the IV in for the iron and I read and report the heart tracings. These episodes will cost $160 although you should get more back from Medicare than for a usual visit because of the complexity of these visits (Rebekah can tell you exactly how much). All other midwifery visits will remain free and I urge you to see the Amanda and Caroline from time to time during your pregnancy and they offer great support after the birth of your baby.


I will be renewing my lease with Westfield later next year and I have heard a significant rent increase is on the way so I may need to increase my fees from 1 July 2015 but let’s wait and see.



01 Oct 2013

Aqua Mamma is here!

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For some time now I have been thinking about healthy hydration in pregnancy. I have watched as my patients have struggled to have their hydration needs met throughout pregnancy. In the first trimester a lot of my patients find water makes them more nauseated than usual so they struggle to keep their fluid intake up. In the second trimester some women are affected by the low blood pressure (and fainting as a result) that usually goes with a healthy pregnancy.  Then in the third trimester women need to keep their fluid intake up without taking in too much sugar. Finally I see women bring all sorts of – usually sugary – drinks in with them for hydration in labour.


So in my spare time (Ha Ha) I have come up with Aqua Mamma.


Currently there are very few healthy hydration options available to pregnant women (and middle aged obstetricians, for that matter). Purists will argue that our hydration and electrolyte needs are best met by drinking one to two litres of water per day and eating a banana. However some people – and pregnant women in particular – struggle to drink lots of plain water. Indeed I find it hard to drink lots of plain water after I have been for a run.


The problem is all of the other drinks out there are inappropriate for pregnancy , contain artificial sweeteners, caffeine, or – worst of all – FAR too much sugar. Some examples of sugar contents are:

  • ·         Cola drinks – 10.6 grams sugar per 100 ml
  • ·         Apple Juice – 10.9 grams sugar per 100 ml
  • ·         Orange juice – 7.8 grams per 100 ml
  • ·         Sports drinks – 5.7 grams per 100 ml
  • ·         Coconut Water – 5 grams per 100 ml
  • ·         Low Calorie Vitamin Water – 4.3 grams per 100 ml.


Aqua Mamma contains 2.5 grams of sugar per 100 ml along with an appropriate amount of electrolytes.


The product in the above list that upsets me the most is apple juice. Apple juice (along with many other fruit juices) is marketed as being healthy because it is pure and natural yet such marketing overlooks the high sugar content 13 grams of sugar per 100 ml! There is less sugar in most soft drinks!


Remember also that many juice bars use apple juice as the basis of many of their drinks and smoothies. Take a look at the energy and sugar contents of drinks that are marketed as being healthy and natural – you may be in for a surprise.


Coconut water is marketed as being very healthy hydration yet it contains twice as much sugar as Aqua Mamma. When it comes to coconut water as with most things, due to its popularity – an increase in quantity leads to a decrease in quality. The stuff right out of the coconut might be great for you, but the stuff on store shelves is a far cry. In fact, there’s a lot not to love about coconut water. Here are a few not-so-fun facts about “nature’s sports drink”:

  • To prevent Thai coconuts from spoiling on their way to the U.S., they’re coated with formaldehyde.
  • Several independent studies reveal that most processed coconut water does not have the level of electrolytes they claim. Big manufacturers O.N.E and Vitacoco are currently involved in class action lawsuits because of this false advertising.
  • Fresh, raw coconut water has enzymes that detoxify and repair the body, helping it to easily absorb all its electrolytes. But the stuff you find in stores has been pasteurized, which kills those healthful enzymes.
  • If natural is your priority, raw, organic coconut water is still a better choice than sports drinks after a heavy sweat session (and by heavy, I mean hot yoga-heavy, or outdoor-run-in-95-degree-heat-with-100-percent-humidity-heavy) or to rehydrate during a stomach bug, but in general the sugar content (11-14 grams per serving) makes it a poor choice in large quantities.

Anyway with all of these concerns in my mind I went into partnership with Rob Bates (my website guy – Tasman Multimedia – who is the healthiest person on the planet) and Victor Manauzzi (my wonderful accountant and Principal of Platinum Associates) to start making a healthy uncomplicated drink that is appropriate for pregnant women (and everyone else for that matter). Aqua Mamma is the result.


Aqua Mamma is pale pink (of course!) and it has a pleasant mild Cranberry / Raspberry flavour.


Aqua Mamma is low sugar, low calorie and it contains no artificial colours or flavours. We have added some sodium (not too much) and potassium in order to assist with your electrolyte needs. We have made certain the drink contains nothing genetically modified and our recyclable PET bottle is BPA free (I recently read a study in which BPA – commonly found in many plastic containers – can be found in the urine of some pregnant women). We tried to add folic acid, iodine and many other goodies to our drink but we found that these adversely affected the taste and texture of the drink and we simply could not add therapeutic amounts of these substances to the drink so we have stuck to a purely hydration and electrolyte product (and all the pregnant women I know are taking an appropriate pregnancy multivitamin anyway).


While we are promoting Aqua Mamma for pregnant women it is just as good for women planning to become pregnant and those who have given birth. In fact it is better and healthier than most hydration options for everyone which is why I drink a bottle after going for a run and always keep one in my car.


And so we have manufactured our first 5,000 bottles of Aqua Mamma (or AM, as we call it). We have a little more work to do on the labels but we are 100 percent happy with the drink and all of our early feedback from pregnant women has been favourable.


At the moment we are giving bottles of Aqua Mamma away for free from my office and from Women in Focus Physiotherapy (www.womeninfocusphysio.com.au) on level 17 of my building (OK, its Frank Lowy’s building but you know what I mean) so please come in and try it (it doesn’t matter if you aren’t one of my patients). Rebekah in my office will sell you  a six pack for $20 if you wish – and one of our first three paying customers was the health conscious husband of one of my patients.


We are very excited about having three paying customers.


A couple of intrepid outlets – Windscreens Café at The Royal Hospital for Women and Clodeli Café in Clovelly Rd – are also stocking Aqua Mamma. I don’t think they have sold any bottles yet but hope springs eternal.


And in the meantime we are working on a healthy hydration drink for everyone.


Then we are going to take over the whole world…




30 Apr 2013

Hydration for Pregnancy, Labour and Birth

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I have been thinking about drinks and hydration in pregnancy lately. There don’t seem to be many healthy options out there for pregnant women so in my spare time (ha ha) I have been working on a healthy hydration drink for pregnant women. It is called Aqua Mamma and its coming very soon – watch this space!

30 Apr 2013


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I’m well aware that having a baby in the private system is an expensive exercise, even with Medicare and Health Insurance. As I have explained previously neither organisation contributes a great deal to doctors’ fees in maternity (and given the prospective size of the Federal Budget Deficit I wouldn’t hold out any hope of an improvement).

A few patients have been surprised and disappointed to receive an invoice from a surgical assistant if they have a caesarean at Prince of Wales Private Hospital. Unfortunately it is compulsory for me to contract a surgical assistant when you have a Caesar at Prince of Wales and unfortunately they do send you a bill and your Health Fund doesn’t cover a great deal  of it.  You can avoid this expense by having your baby at The royal Hospital for Women. If you have a Caesar there I press gang one of the junior doctors to assist and they cannot bill you (I bought a plasma TV and a couch for the junior doctors lounge at The Royal in recognition of their ongoing support).

31 Jan 2013

Your Baby’s movements

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I have had a couple of women ring the office asking Rebekah to move their appointments forward because of a reduction in their baby’s movements.

I cannot emphasise strongly enough that a reduction in your baby’s movements is a potential emergency and that you must call or text me on my mobile phone if you are concerned – and that you must not go to bed worried about your baby’s movements.

Please read Your Baby’s Movements on my website. This information is also found in the booklet I gave you at your booking visits.

19 Dec 2012

Watch out – Listeria is about

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I was reading my usual source of up to date medical information this morning – The Sydney Morning Herald – and I came across a piece about a listeria outbreak in Melbourne. The source of the infections appear to have been Australian – made soft cheeses (Brie and Camembert). This just highlighted the need to be very careful about potential sources of listeria when you are pregnant as the infection can be very harmful to unborn babies.

For more information about food and Listeria you can check out www.foodauthority.nsw.gov.au/consumers/life-events-and-food/pregnancy/

(And before many of you ask the Christmas Ham is NOT safe unless it is freshly cooked and served hot – so throw some on the barbie and cook the crap out of it if you are desperate)

05 Oct 2012

Next Year’s Break

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This year is passing by so quickly – I just can’t believe it. Of course the nature of my business is such that I need to organise study leave and holidays 8 months or so in advance so that you are fully informed of my availability (or lack thereof). Accordingly I will be off on study leave and holiday for the first three weeks of June 2013, returning to work on Monday 24th June. I know my partner Dr Natalie Shaw is then having three weeks off for the same reason (through to mid July).

Both Natalie and I have decided to engage a locum to cover our respective practices over June and July (the last time I was away for two weeks poor Natalie delivered the babies of seven of my patients as well as looking after her own patients!). The locum will be Dr Lynn Townsend. Both Natalie and I have worked with Lynn for many years at the Royal Hospital and regard her very much as an assiduous, caring, safe obstetrician – so we think she fits in very well with the way we practice. Lynn’s other job is in Obstetric ultrasound – she works at Ultrasound Care so some of you may meet her when you have your routine ultrasound scans (such as the Nuchal Translucency).