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Antenatal Care

The Obstetricians at Alana Healthcare are an all female group who share a common philosophy on pregnancy care. Dr Erin Nesbitt-Hawes, Dr Minke Burke and Dr Neetika Mishra work as a team in Sydney’s first all-female group obstetrics practice to provide you with 24-hour specialist care, expertise and support during your pregnancy.

Congratulations on your pregnancy and welcome to Alana Obstetrics!

Continuity of care is important to us, as is sharing our knowledge and expertise. By booking your pregnancy with the Alana Obstetricians, you will be cared for by not one, but a group of four specialist obstetricians, with their combined experiene, regular case conferences and reviews for women with high risk or more complex pregnancies.

The Alana Obstetricians work on a roster system which means that the Obstetrician on call will manage all deliveries and emergencies during that 24 hour period.  This means that the familiar face that greets you in the delivery suite will also be fresh and rested!

You can download our Obstetric Fee Disclosure on our fees page.

Booking your Antenatal Care with Alana Obstetrics

Please call us on 02 9009 5255 or use our Contact Form to arrange your first appointment.  Ideally, your first appointment should take place when you are 8-12 weeks pregnant, but we are happy to accommodate your needs.  As our doctors have a limited number of patients who they can deliver each month it is important to schedule your first appointment as soon as possible.

When calling Alana Healthcare, having the following information will assist with making your appointment:

  • Date of last menstrual period (LMP) or expected date of confinement (EDC) or due date from dating scan
  • Medicare number
  • GP referral

Calculating your dates

Your estimated date of delivery is calculated using either the first day your last menstrual period or a first trimester ultrasound for dating.  A normal pregnancy can last anywhere from 37-42 weeks duration, with only 5% of women delivering their baby on their due date.

A dating calculator can be used to estimate your due date if you know the date of your last menstrual period.

If you are uncertain of your dates, or you have an irregular period, the most accurate way to assess your due date is a first trimester ultrasound scan.  If you have not already had a scan, your Alana Obstetrician will perform one on your first visit to help confirm your due date.

Routine Pregnancy Blood Tests

During your pregnancy, you will have a number of routine tests to ensure that the pregnancy is progressing well with no complications.

Antenatal screening blood tests: Ideally, these blood tests are performed prior to pregnancy to identify any potential issues and things that can be remedied (e.g. rubella vaccination for women with low immunity). If your GP has not already organised for you to have antenatal blood tests, these will be arranged at your first visit.  These blood tests include screening for infections such as HIV, hepatitis B and C, syphilis, rubella, as well as your blood group and blood count.

Glucose challenge test (GCT) and glucose tolerance test (GTT):  These blood tests are performed to determine whether you are developing gestational diabetes in the pregnancy. Usually performed at 26-28 weeks gestation, it requires you to drink a sugary liquid and wait at the pathology centre for an hour or two to measure your body’s response. This blood test usually requires an appointment. Be sure to take a good book or magazine!

Certain women have a higher risk of gestational diabetes in their pregnancy and may be recommended to have this test earlier, or on more than one occasion during your pregnancy.

Blood count and antibody screen:  This is performed at the start of the pregnancy and again at 28 and 36 weeks gestation to look for anaemia (low iron levels).  The antibody screen is particularly important for women who have a negative blood type and are at risk of rhesus isoimmunisation.

Delivering your baby with Alana Obstetrics

Our patients are delivered in Randwick at either the Prince of Wales Private Hospital or the Royal Hospital for Women.  Please check with your private health insurer to make sure that you have the required level of cover and have completed any waiting requirements.  If you have any questions, our staff will be happy to assist you.

The Alana Obstetricians believe in choices when it comes to delivering your baby. During your pregnancy care, we are more than happy to discuss all of the options available to you.

Vaginal delivery:  Most women will have a vaginal delivery without requiring assistance from their Obstetrician.

Sometimes assisted delivery with the ventouse (vacuum) or forceps is required to ensure a safe delivery for you and your baby. Circumstances where this may be recommended include exhaustion, when the baby is coming down the birth canal in an awkward position, or if there is fetal distress while pushing.

Caesarean delivery (caesarean section):  Some women will require a caesarean to deliver their baby. This may be elective and booked prior to going into labour (for placenta praevia, breech presentation, some types of twins, previous caesarean delivery), or may be an emergency caesarean after going into labour.

If you require a caesarean delivery they are most commonly performed under a spinal or epidural block so you can be awake and meet your baby. Your partner is also welcome in the operating theatre to support you.

Frequently Asked Questions

How much does antenatal care at Alana cost?
For Medicare eligible, privately insured patients, you can read our Obstetric Fee Disclosure located on our fees page. If you are Medicare ineligible and/or don’t have private health insurance, please telephone us on 02 9009 5255 and we can provide you with the relevant fee information.
Why do I need to have an ultrasound during my pregnancy?

Ultrasound can take high quality images of many parts of your body, which makes it an excellent diagnostic tool. During pregnancy, an ultrasound is recommended for a number of reasons:

  • For confirming the age of the baby and to predict the due date;
  • To look at the baby as it develops throughout the various stages of pregnancy;
  • To screen for chromosomal and other abnormalities (such as Down syndrome).
Ultrasound during pregnancy is safe and does not harm you or your baby.  You can read our blog on this topic here.
Is having an ultrasound safe for my baby?
Ultrasound has been used in obstetrics for over 50 years. Ultrasound services provided to you in the context of your pregnancy care follow the ALARA (as low as reasonably possible) principle and the recommendations of The Australian Society for Ultrasound in Medicine. This means that we will only perform an ultrasound when indicated, and minimise the exposure time and intensity. We have written more about the use of ultrasound in pregnancy in our blog .
What are my chances of falling pregnant after an ectopic pregnancy?
It depends.  Some ectopic pregnancies are caused by certain conditions like endometriosis or as a result of previous pelvic inflammatory disease (PID) commonly caused by Chlamydia infection.  In these conditions the remaining fallopian tube may be scarred and increase the likelihood of another ectopic pregnancy.  In general, the risk of recurrence is up to 8-10% after one ectopic pregnancy.  The recurrence risk is of course dependent on whether or not you have any underlying conditions.  Many women (and doctors) think that the ovaries are taking turns in releasing an egg (left than right etc.) but this is not true.  The other commonly held belief is that, for example, the right fallopian tube only can pick up the egg released from the right ovary, which is not true either.  We know that in reality the ovaries are located rather close to each other (not like in the anatomy pictures), and ovulation occurs more “randomly” from each ovary (sometimes at the same time!) and that the fallopian tubes can pick up the egg from the ovary on the other side.  This is because of a complex process attracting the fallopian tube to move towards the ovary where the ovulation (release of the egg) has occurred. Therefore a previous ectopic pregnancy doesn’t half your chances of a next pregnancy.  Research has shown that around 65% of women with a previous ectopic pregnancy have an intrauterine pregnancy within 18 months.  This figure may go up to as high as 80% in two years, so that is promising.  If you do fall pregnant it is important to have an early pregnancy scan determining the location of the pregnancy, making sure it is inside the uterus. If you have trouble falling pregnant than depending of your age and underlying conditions we would recommend you to see one of our Alana specialists as the other fallopian tube may be scarred and preventing you from conceiving naturally. There is an ultrasound test called a HyCoSy (“Hysterosalpingo Contrast Sonography”) which can determine whether your other fallopian tube is functioning normally.  During this ultrasound investigation a speculum is inserted to allow a thin plastic tube to be placed inside the uterus.  Through this tube a mixture of air and normal saline is injected and this shows up on the ultrasound scan.  You can see if the fallopian tube is open (“patent”) as there is spill seen around the end of the fallopian tube and ovary.  This test may reassure you if normal.  If the fallopian tube is blocked it is worthwhile seeing one of our fertility specialists at Alana who will discuss alternative ways for a pregnancy to occur (like IVF).
How long do I have to wait after my miscarriage to try to conceive again?
We recommend you have at least one normal period after your miscarriage.  If the first bleed is not quiet as normal than wait until you have a normal menstrual period in your next cycle as it takes time for your body to clear the pregnancy hormone.  When you have had a normal period we know your cycle has returned to normal, the pregnancy hormone is out of your system and that your body is ready for a new pregnancy.  Record the first day of your menstrual period (LMP) as this is important in dating your next pregnancy. Physically you do not need more than one period but allow yourself enough time to emotionally be ready as well.  Some time is also necessary to allow yourself to grieve about your pregnancy loss. We find that most women after a miscarriage are a little more anxious in their next pregnancy.  Your GP can refer you to the Alana Obstetricians for an early pregnancy scan and we recommend it to be done at around 8 weeks from your LMP as at this stage you should really be able to see your baby’s heartbeat.
I thought I was 7 weeks pregnant but the scan says I’m only 5 weeks and no heartbeat is seen, how is this possible?
To answer this question we firstly go back to basics to understand your cycle. The pregnancy is calculated based on the average menstrual cycle which is 28 days.  The first day of menstrual bleeding marks the first day of the menstrual cycle.  This is called your LMP (or “last menstrual period”).  Right in the middle of this picture perfect 28 day cycle is when ovulation occurs (day 14 of the cycle) and roughly 2 days before and after is when you are most fertile.  In real life not everyone has this picture perfect 28 day cycle, it may be longer or shorter, but we know that ovulation occurs roughly 14 day before your next period.  This is why many fertility doctors recommend to have intercourse every 3 days if you really are trying to have a baby because the ovulation may occur a little earlier or later than you may think. When calculating the weeks of pregnancy we include those two weeks from the first day of the LMP as this is the easiest part of the cycle to notice and to record.  We also will enquire about the length of your cycle and whether it is regular or irregular.  All of this is helpful in trying to establish the gestation.  For example, if your cycle is regular and 33 days long we would expect your ovulation to have occurred later (5 days) and an early pregnancy scan will most likely show a baby that measures 5 days less than you were expecting. Now to answer your question, it may be that you ovulated later in the cycle or have a longer cycle.  The pregnancy is truly only 5 weeks, a follow up ultrasound in 10-14 days is likely to show your baby’s heartbeat and all is well.  The other possibility is that unfortunately the pregnancy is not developing as expected at 7 weeks gestation and a follow up scan may reveal a miscarriage.  We understand that this is an anxious time and to have to wait for 10 -14 days seems very long but it is important to have this time in between scans to determine accurately what is taking place.
Why do I have spotting or mild bleeding in early pregnancy?
It is common to have some bleeding in early pregnancy.  It may occur in 20% (or one out of five) mums to be, and it is unlikely to be harmful to your baby.  It usually happens at about the same time that your period would have been due, and may last for a couple of days.  The bleeding is usually light (no large clots) and is not accompanied by strong period pains. There are many different causes for bleeding in pregnancy, and in the first trimester the bleeding may be caused by:
  • Breakthrough bleeding: which happens as the pregnancy hormones interfere with the hormones of your normal menstrual cycle.  This causes some the endometrial lining to be shed.  Spotting or light bleeding may come and go for several days.
  • Implantation bleeding:  which happens when the fertilised egg implants in the endometrial lining of the uterus. The endometrial lining has been prepared for the nestling of the fertilised egg during the menstrual cycle and has now got a very good blood supply.  The implantation may therefore be associated with some light bleeding.
  • Other causes:  which may include changes to your cervix by the pregnancy hormones; it softens the cervix and causes an area of cells covering the cervix to move towards the outside of the cervix.  These cells are more prone to bleeding, especially when touched during intercourse.  It is important to be up to date with your Pap smear screening tests as bleeding may also be caused by abnormal cells.  Bleeding can also be linked to vaginal or cervical infection which would require further investigation with a vaginal swab and may need treatment.  A harmless growth on the cervix called a polyp may also cause bleeding at any stage in the pregnancy.  A speculum examination (as is done with the Pap smear) will reveal this polyp, and usually nothing needs to be done about it during your pregnancy.
Bleeding in early pregnancy is common but it’s important to tell your doctor about it.  At Alana we will perform a physical examination which may include a speculum examination to see if the cervix is open or not and what the cervix looks like in general.  Depending on other symptoms we may take a vaginal swab if we think there is an infection.  We may also perform an (internal) ultrasound to measure the gestation and to determine where the pregnancy is located. We would recommend testing your pregnancy hormone level (“quantitated HCG”) which also helps in dating the pregnancy, and we would test your blood group. In general if the bleeding is light and settles down, and is not accompanied by bad period type pains, there is a good chance that all is well and that your baby is fine.
When should I book in to see my obstetrician?
We usually see you for your first antenatal visit between 8-10 weeks of the pregnancy, but in some circumstances you may need to come in earlier. If you are experiencing severe early pregnancy symptoms, have bleeding or pain, or are uncertain of how far through the pregnancy you are we can see you as early as required.  Alternatively, if you find out that you are unexpectedly further along in a pregnancy you can book in as soon as possible.
Do I need to have an ultrasound before I attend the clinic?
No, an ultrasound will be performed at your first visit to confirm the dates while you are seeing your obstetrician. If there are any concerns, we may refer you for a formal ultrasound.
What do I need to bring to my first antenatal appointment?
Your referral letter from your General Practitioner plus any antenatal screening bloods and/or scans that you have had performed, as well as any relevant medical history including medications. You should also bring your Medicare card and private health insurance details.
Where will my baby be delivered?
The Alana Obstetricians deliver at both the Prince of Wales Private Hospital and the Royal Hospital for Women, both located in Randwick, in the Eastern Suburbs of Sydney.  For more information about Prince of Wales Private Hospital Maternity Services, please click here.  For information about Royal Hospital for Women Maternity Services please click here.
Who will attend my delivery?
A familiar face!  The Alana Obstetrician on call will attend your delivery.  While this may be your primary Obstetrician who has cared for you throughout your pregnancy, it may also be one of the other Alana Obstetricians who you will meet at planned visits throughout the course of your antenatal care.  This means that you will never have a stranger attending you when you go in to hospital.
What is the cost of private antenatal care at Alana Healthcare?
Our full fee disclosure is available here.
What should I do if I need medical assistance during my pregnancy?
Once you have booked your antenatal care with us, you have access to medical assistance 24 hours a day, 7 days a week. If at any stage you feel something is not right, telephone us at any time of the day or night on our emergency number 0499 525 000. If you are beyond 24 weeks gestation telephone either us or the Prince of Wales Private Delivery Suite on 02 9650 4444.
How long will I be in hospital for when I deliver my baby?
If you give birth via vaginal delivery, your hospital stay will generally be 4 nights/5 days.  If you give birth via caesarean delivery, your hospital stay will generally be 5 nights/6 days.  If you are admitted after midnight that counts as day 1 not as night 1!
What do I do if I am experiencing hand/wrist pain during my pregnancy or after the birth?
Correct diagnosis of a hand or wrist condition is important when considering appropriate management.  An early diagnosis allows for early intervention, which will favour promising outcomes. The Alana Physiotherapists are trained to identify the cause of your hand and wrist pain, and to assist each woman throughout her recovery. An appointment can be made with the reception staff and does not require a doctor’s referral.
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