The midwives of the maternity unit are a magical group of individuals who bring so much experience, fun, laughter and passion to their midwifery and to the unit of the Goldfields. We believe that if women are to have safe birth options and trust in their own abilities, then the empowerment of the midwife is crucial in the delivery of care. This is our goal. Empowerment begins as we nurture our student midwives while they learn. We also need to help in the growth and development of all other midwives that come our way.

So, it is through the teaching and support provided by the midwives and the knowlegde and direction provided by the doctors that together we nurture the women to learn and to trust in their innate abilties. We are all team players and it is this team effort the makes Kalgoorlie so special and opens the way for what really makes our SECRET MIDWIVES BUSINESS.

Midwifery is founded on respect for women and on a strong belief in the value of women’s work of bearing and rearing each generation.

Midwifery considers women in pregnancy, during childbirth and early parenting to be undertaking healthy processes that are profound and precious events in each woman’s life. These events are also seen as inherently important to society as a whole.

Midwifery is emancipatory because it protects and enhances the health and social status of women, which in turn protects and enhances the health and wellbeing of society.

Midwifery is a woman centred, political, primary health care discipline founded on the relationships between women and their midwives.

Midwifery:

focuses on a woman’s health needs, her expectations and aspirations

encompasses the needs of the woman’s baby, and includes the woman’s family, her other important relationships and community, as identified and negotiated by the woman herself

is holistic in its approach and recognises each woman’s social, emotional, physical, spiritual and cultural needs, expectations and context as defined by the woman herself

recognises every woman’s right to self-determination in attaining choice, control and continuity of care from one or more known caregivers

recognises every woman’s responsibility to make informed decisions for herself, her baby and her family with assistance, when requested, from health professionals

is informed by scientific evidence, by collective and individual experience and by intuition

aims to follow each woman across the interface between institutions and the community, through pregnancy, labour and birth and the postnatal period so all women remain connected to their social support systems; the focus is on the woman, not on the institutions or the professionals involved

includes collaboration and consultation between health professionals.

She must be able to give the necessary supervision, care and advice to women during pregnancy, labour and the postpartum period, to conduct deliveries on her own responsibility and to care for the newborn and the infant. This care includes preventative measures, procurement of medical assistance and the execution of emergency measures in the absence of medical help. She has an important task in health counselling and education, not only for the woman, but also within the family and the community. The work should involve antenatal education and preparation for parenthood and extends to certain areas of gynaecology, family planning and child care. She may practice in hospitals, clinics, health units, domiciliary conditions or in any other service.

(This definition was jointly developed by the International Confederation of Midwives and the International Federation of Gynaecology and Obstetrics – later adopted by the World Health Organisation)

Midwives around the world celebrate on May 5 each year

The International Confederation of Midwives (ICM) launched the ‘International Day of the Midwife’ initiative in 1992.

The aim of the day is to celebrate midwifery and to bring awareness of the importance of midwives’ work to as many people as possible. This is achieved in many different ways according to what works best in each country.

Pre-conception check up
Your first step should be to take a trip, with your partner, to your doctor for a pre-conception visit. This will enable you to make sure that you are up to date with your regular health screenings and immunisations, to discuss any concerns about the pregnancy that you may have and to decide on any lifestyle changes that may need to be made. Your doctor will be able to get a good picture of your overall health and any aspects of your medical history and your family’s medical history that could affect your pregnancy. You should also be asked if you are taking any prescription or over-the-counter medications, as well as any herbs or supplements, as these may have to be altered before or after conception.

If you, as the prospective mother, have a pre-existing medical condition, such as diabetes, asthma, lupus or high blood pressure, it is important for both you and your baby to make sure that the condition is under control before you get pregnant. For instance, women with diabetes must ensure that they have excellent control of blood sugar levels around the time of conception as this reduces the chance of the baby having a congenital abnormality.

Contraceptive pill
If you are taking the contraceptive pill, but are planning to get pregnant in the near future, your doctor may recommend using a barrier method of contraception, such as a condom or a diaphragm, for a few months before trying to conceive. This will give your body the time it needs to re-establish your normal hormonal balance; it can take up to several months for your periods to return to a regular pattern.

Exercise
Get into the routine of doing some regular exercise: visit the gym, swim or go for long, brisk walks together with your partner. You will need to have a reasonable level of physical fitness to cope with the new demands that will be placed on your body during a pregnancy. If you are healthy, it should be safe for you to continue with your usual exercise programme when trying to conceive and into the early part of your pregnancy. If you are overweight, lose weight now, rather than after you become pregnant. Being overweight may reduce some women’s fertility.

Nutrition
It’s obvious that the food you will be eating when you are pregnant will be nourishing your growing baby, but recent research has shown just how crucial an adequate food supply is to your baby during its first few weeks of development — which means that you must establish healthy eating habits before getting pregnant. You should try to eat more vegetables, fruits, grains, dairy products and foods rich in protein, and fewer artificial sweeteners and ‘empty’ calories (foods and drinks that are high in calories but don’t contain useful nutrients).

Folate
Pregnant women need to increase their intake of dietary folate to cover their own needs and those of the baby. Folate is found in many fresh fruits and vegetables (especially green leafy vegetables such as broccoli and spinach), as well as nuts, chickpeas and dried beans. In addition to consuming food folate from a varied diet, it is also recommended that women begin taking a supplement of 0.4 mg per day of folic acid for one month before conceiving and during the first 3 months of pregnancy to reduce the risk of having a baby with a neural tube defect, such as spina bifida.

It is important to take folate while you are trying to get pregnant because the baby needs adequate amounts of folate in the first weeks of life — when you may not know you have conceived — for normal neurological development. If you are having trouble eating during the early stages of pregnancy due to morning sickness, your doctor may advise you to take a daily supplement containing 0.6 mg of folate.

Iodine
Keep your iodine levels up as well, as this will reduce the risk of thyroid disease in both you and your baby. Iodine is found in seafood, vegetables grown in iodine-rich soil, and iodised table salt. There is a risk of mental retardation in children born to women who are iodine deficient.

Multivitamin and mineral supplements
It can sometimes be difficult to eat a balanced diet when you are pregnant, especially if you have morning sickness. Look for supplements that are specifically designed for women who are pregnant or trying to conceive, with adequate amounts of all the things you need and without too much vitamin A, as this may harm the baby. Also, consult your pharmacist about whether the formula design is adequate. In 2006, the Australian National Health and Medical Research Council revised its recommended daily nutrient intakes for pregnant women, and older formulations may not have been updated.

Vitamin and mineral supplements can help you get:

the essential nutrients you and your baby will need, including adequate amounts of folate and iodine (as mentioned above) as well as iron;

nutrients that can help reduce the risk of problems (for example calcium may help reduce the risk of a serious pregnancy-related condition called pre-eclampsia); and

other nutrients that may help your health and the baby’s growth and development, such as omega-3 fatty acids.

Caffeine
Try to cut down on your caffeine intake as it is not certain what level of caffeine is considered safe during pregnancy. Some researchers have found a connection between high caffeine intake and miscarriage, stillbirth and low-weight birth in babies.

Alcohol
Most doctors also recommend that you totally avoid alcohol during a pregnancy because it is not possible to identify what level of drinking is safe for pregnant women. Prenatal exposure to alcohol can have serious long-term health consequences for your baby, including learning disabilities, mental retardation, behavioural problems and slower growth. The risk of stillbirth and miscarriage is also increased by excessive drinking. Additionally, alcohol can reduce the fertility of both males and females.

Smoking
Put simply, there is no safe level of smoking during pregnancy. The more you smoke, the more risks for you and your baby. Smokers are less fertile than non-smokers, and have a higher incidence of miscarriage and stillbirth. Smoking while pregnant interferes with the baby’s blood supply, which tends to result in low birth weight babies and babies with developmental problems. Babies born to mothers who smoke also have a greater chance of Sudden Infant Death Syndrome (SIDS). Your partner should also kick the habit: exposure to second-hand tobacco smoke can increase the risk of problems such as SIDS and having a low birth weight baby.

Rubella (German measles) vaccination
This viral illness can severely affected the baby if the mother contracts it while she is pregnant. Among other things, it can cause blindness and severe mental retardation. Fortunately, the disease can be prevented with a vaccine; unfortunately, the vaccine cannot be given if you are already pregnant. Most women will have been vaccinated as children or teenagers, however, their immunity may have waned by the time they are ready to start a family. Consequently, it is important to have a simple blood test before you become pregnant to find out whether you need a booster shot.

Unlike other pregnancy tests such as ultrasound, CVS isn’t a general check of the baby’s health but a specific test for particular abnormalities, such as Down syndrome or cystic fibrosis. The risk of miscarriage following CVS is one in 100, so it is important to thoroughly understand the benefits, risks and complications before agreeing to take the test. Generally, CVS is offered between 10 and 19 weeks gestation.

A range of potential patients
The range of patients offered chorionic villus sampling could include women:

With a family history of an inherited disorder, either on her side of the family or on her partner’s side.

Over 37 years, since the babies of older mothers are at increased risk of abnormalities.

Who have already had a baby with chromosomal or other abnormalities.

Whose ultrasound test results showed a possible abnormality.

Who are particularly anxious about the possibility of abnormalities.

Medical issues to consider
Medical issues to consider may include:

CVS doesn’t check for spina bifida.

The risk of miscarriage following chorionic villus sampling is around one in 100.

Genetic counselling can help you decide whether or not you want to take the test. Issues discussed include the benefits, risks and complications of CVS, and information about the particular inherited disorder and associated birth defects.

If you decide to undergo CVS, your doctor will need to know your blood group and Rh status, so you may require a blood test beforehand.

The procedure
The CVS procedure includes:

You need to have a moderately full bladder.

You are dressed in a cotton hospital gown, and asked to lie on an examination table on your back. Sedative drugs such as nitrous oxide are available if you wish.

Your baby is checked first via ultrasound scan.

Your abdomen is swabbed with antiseptic solution.

The site is injected with local anaesthetic.

A slender needle, guided by ultrasound, is inserted through your abdomen wall until it reaches the edge of the placenta. The needle is nowhere near the amniotic sac or the baby at any stage.

A finer needle is threaded through the first needle, and a syringe is used to ‘vacuum’ a small sample of placental tissue. This takes about two minutes or so.

You may feel a strange dragging or drawing sensation in your pelvis or legs - this is normal, and no cause for alarm.

It may be necessary to take a second sample.

Once the sample is taken, the needles are removed.

The baby is checked using the ultrasound scan.

You are then free to get dressed.

Generally, you can expect to be at the clinic for up to 90 minutes.

Immediately after the test
You may be asked to wait half an hour or so before leaving the clinic, just to make sure that both you and your baby are all right. It may be best if someone else drives you home, especially if you were given drugs during the test. The placental sample is sent to a laboratory and cultured. When enough cells have grown, the chromosomes are individually tested to make sure the number, appearance and size are correct. The results are usually sent to your doctor within a few weeks, so make sure you arrange for a follow-up appointment.

Possible complications
Some of the side effects, risks and possible complications of CVS include:

Light-headedness

Abdominal discomfort

Pains that feel similar to menstrual cramps

Haemorrhage

Infection

Ruptured amniotic sac

Miscarriage, estimated at one in 100

Increased risk of limb defects if the test was performed at nine weeks’ gestation or earlier

Inaccurate or unclear test results, estimated at one per cent.

Taking care of yourself at home
Be guided by your doctor, but general suggestions include:

Get plenty of rest for the remainder of the day.

Avoid hard physical activity, such as lifting heavy objects.

You should be able to go about your normal business in the next day or so.

See your doctor immediately if you notice any unusual vaginal discharge, such as bright red blood or watery fluid.

Long term outlook
If CVS shows that your baby has an abnormality, you can undergo counselling if you need help to make a decision. Terminating the pregnancy in the first trimester involves a straightforward dilatation and curette (D&C). The cervix is dilated and the contents of the uterus removed.

Other types of pregnancy tests
Other types of pregnancy tests that check for foetal genetic abnormalities include:

Vaginal CVS - a small needle is pushed through the cervix and into the side of the placenta, guided by ultrasound. Vaginal CVS carries a slightly higher risk of complications than transabdominal CVS.

Amniocentesis - a small amount of amniotic fluid is removed using a slender needle inserted through the abdomen. The needle is guided with the help of ultrasound. The fluid sample contains cells, which are then examined for chromosomal abnormalities. The risk of miscarriage following amniocentesis is around one in 250. Amniocentesis may be offered if your CVS test results were unclear.

Where to get help

Your doctor

Things to remember

Chorionic villus sampling (CVS) is a pregnancy test that checks the baby for genetic or biochemical abnormalities.

A small sample of the placenta is taken using a slender needle inserted through the abdomen, and the sample is then examined in a laboratory.

The risk of miscarriage following CVS is one in 100.

These include congenital hypothyroidism, phenylketonuria (PKU), cystic fibrosis (CF), galactosaemia, and several conditions affecting the breakdown of fats (fatty acid oxidation defects) and proteins (amino acid metabolism disorders). Many of these conditions are genetic, and inherited from two healthy parents each carrying the abnormal gene.

Babies born with any of these health problems generally appear healthy and well at birth. Signs that something is wrong often cannot be recognised until the baby is several weeks or months old. Undiagnosed and untreated babies become seriously sick and may die. Early treatment greatly reduces, and often prevents, the effects of serious problems for the rest of the baby’s life. The objective of the screening program is to detect those babies whose tests suggest a high risk of any of these conditions. Follow up diagnostic testing will confirm whether the baby has the specific condition.

A trained midwife performs the Newborn Screening Test when the baby is about two days old (after 48hours). If mother and baby are discharged early, the mother and baby are asked to return to the hospital when the child is over 48hours old. For the test, a few drops of blood are taken from the baby’s heel and collected onto three small spots on a specially prepared absorbent paper card. The blood spots are allowed to dry and the card is sent to the Princess Margaret Hospital.

The results of the tests are sent back to the hospital within two weeks. If there is a suggestion that the baby may have a problem, the parents are notified immediately and arrangements are made for further tests to confirm or exclude the disorder. Parents are not notified of normal test results.

Each of these health problems are rare, but added together, they occur about 1 in every 800 babies.

Congenital hypothyroidism
The thyroid gland (in the neck) of babies with this condition does not produce enough thyroid hormone. An insufficient amount of this hormone slows brain development and growth. Early detection and treatment with thyroid hormone tablets allows children with this condition to grow and develop normally.

Phenylketonuria (PKU) and other amino acid metabolism disorders
PKU is the most common amino acid metabolism disorder where the baby cannot break down one of the amino acids (building blocks of proteins) called phenylalanine. This results in the build up of phenylalanine and other chemicals which cause brain damage if the baby is not treated. Feeding a special diet soon after birth allows these babies to develop normally. In addition to PKU the Neonatal Screening Test also detects other rare disorders of amino acid metabolism.

Cystic fibrosis (CF)
In CF the mucus produced in the intestine and lung is sticky and thicker than normal. Affected individuals are prone to serious chest infections and have difficulties in digesting food properly. The Newborn Screening Test for CF detects 96% of babies with it. Early diagnosis and treatment is important as recent medical advances have improved the life of children, although it does not prevent all the problems.

Galactosaemia
Babies with galactosaemia cannot break down one of the sugars (galactose) in milk and accumulate high levels of this sugar in blood. If untreated, this leads to severe health problems including cataracts, brain and liver damage or death. Feeding babies a special diet which does not contain galactose can prevent these health problems.

Fatty acid oxidation defects (FAOD)
Babies with a FAOD cannot use their stored fat to provide energy during a time of stress, causing the body to use all of its blood sugar for energy. This results in low blood sugar levels that can be fatal if not treated. Children with a FAOD are generally well unless they have a viral infection (cold or flu) or go for longer than usual between meals, when they may develop a severe problem. Treatment for this group of disorders involves careful monitoring of food intake and avoiding prolonged periods of fasting.

Problems detected by amniocentesis
Amniocentesis can detect a number of disorders that will affect babies, while they are still a small foetus in the uterus. These conditions include:

Down’s syndrome.

Neural tube defects, such as spina bifida.

Cystic fibrosis.

Genetic disorders - amniotic fluid samples can be DNA tested to identify a wide range of genetic disorders, including Fragile X syndrome, phenylketonuria, Tay-Sachs disease and sickle cell disease.

Medical issues to consider
As a woman grows older, the risk of having a child with Down’s syndrome begins to increase significantly - from about one in 2,000 (at age 20 years) to one in 100 (at 40 years). Pregnant women who may be candidates for amniocentesis include:

Women over the age of 40 years (Victorian women aged 37 years and over are routinely offered this test).

Women with a family history of chromosomal abnormalities, such as Down’s syndrome.

Women who have already had children with chromosomal abnormalities.

Women known to be carriers of genetic diseases.

Women with partners who have a family history of a genetic disorder or chromosomal abnormality.

Women who return an abnormal ’serum screen’ blood test or ultrasound examination result.

The procedure
Before having amniocentesis, it is usual for the woman and her partner to be counselled on the risks of the procedure. Amniocentesis is performed between 16 and 20 weeks into the pregnancy. The woman lies down, and the position of the foetus and the placenta are determined by an ultrasound scan. When the doctor is sure of a safe spot, they swab the woman’s belly with antiseptic and inject a local anaesthetic into the skin. Using a long, thin needle, the doctor extracts about 15 to 20ml (approximately three teaspoons) of amniotic fluid. This takes about 30 seconds or so. The foetus is checked afterwards to make sure all is well. The entire procedure can take around 90 minutes.

Immediately after the procedure
You may need to wait in the surgery for around 20 minutes before leaving for home. Most patients find amniocentesis to be painless, although it is recommended to continue resting for an hour or so afterwards. The doctor will advise when the results are expected. In some cases, the results may take up to three weeks. Side effects of the procedure may include:

Mild discomfort

Slight bruising at the injection site.

Possible complications
While amniocentesis is generally considered a safe procedure, possible complications may include:

Infection - symptoms of which include high fever. Contact your doctor immediately.

Vaginal leakage - amniotic fluid may leak from the vagina in about one per cent of cases. Contact your doctor for reassurance. In most cases, the leakage slows and stops within two days or so.

Spontaneous abortion - can occur in less than one per cent of women undergoing this test. Exact figures are hard to calculate, since some miscarriages would have happened anyway - with or without the amniocentesis.

Injury to the baby - very rarely, the needle used during the procedure may accidentally touch some part of the baby’s body.

Taking care of yourself at home
Most women feel fine after the procedure, and no alteration to normal routine is necessary. However, it is generally advised to take it easy for the next couple of days.

Long term outlook
Amniocentesis rarely causes harm to either the mother or her baby in the long term. Complications following amniocentesis are very rare, but if you experience unusual symptoms, such as losing blood vaginally, seek medical attention promptly.

Where to get help

Your doctor

Gynaecologist.

Things to remember

Amniocentesis is a medical procedure performed on a pregnant woman to withdraw a small amount of amniotic fluid from the sac surrounding the foetus.

The goal of amniocentesis is to examine a tiny amount of this fluid to obtain information about the baby, including its sex, and to detect physical abnormalities such as Down’s syndrome or spina bifida.

Amniocentesis is only performed on women thought to be at higher risk of delivering a child with a birth defect.

While many women over 35 years have normal pregnancies, those over 35 do have special considerations for pregnancy. Making the right choices early on and working with your doctor or obstetrician can help your pregnancy be trouble-free.

Making the right choices
What’s healthy for you is often healthy for your baby. What’s harmful to you may harm your baby even more. Before and after you become pregnant:

do not use recreational or illicit drugs;

do not drink alcohol; and

do not smoke.

Keeping you and your baby healthy
Diet and exercise before and during pregnancy play a big role in your health. To help you and your baby remain healthy:

take a daily vitamin supplement that contains folic acid (a vitamin that reduces the chance of some birth defects), calcium, iodine and iron, but does not have a high level of vitamin A (check with your doctor or pharmacist that the formulation is appropriate);

eat a high fibre, well balanced diet rich in fruits and vegetables;

stay physically active; and

keep to a healthy bodyweight, but do not diet to lose weight during pregnancy.

Work closely with your doctor or obstetrician to get answers to the questions you may have. You may need extra care during pregnancy if you have any of the following:

a sexually transmitted disease (STD);

diabetes;

high blood pressure; or

other chronic health problems (illnesses requiring long term treatment), especially heart or lung disease.

Special health care
Your doctor or obstetrician can give you more details about the care you will need. Women aged 35 years and older may need special care before and during pregnancy. You may want to learn more about the following issues.

Fertility counselling
As women and men age, their fertility decreases and getting pregnant can become difficult for women. Ask your doctor how long you should try to get pregnant before seeking help regarding infertility. If necessary, you and your partner can work with a specialist towards achieving conception.

Genetic counselling
Genetic counselling studies the risk of birth defects for your baby. As you get older, the risk of having a baby with a chromosomal abnormality gradually increases. You should ask your doctor for details. You will be asked detailed questions about your family health history. The information gained can help you and your doctor learn whether the fetus has a risk of health problems.

Amniocentesis
This test studies amniotic fluid (liquid that surrounds the fetus in the womb). Amniocentesis can help diagnose birth defects and other medical problems. Women aged 35 years and older often have this test, which is usually done at about 15 weeks.

Chorionic villus sampling
This test studies cells from the placenta, and can help diagnose birth defects and other medical problems. Women aged 35 years and older often have this test, which can be done as early as 10 to 12 weeks.

Other things to consider
Most women aged 35 years or older have normal pregnancies, but there are some particular things you need to think about before becoming pregnant. Once a woman reaches 35 years she has a greater chance of the following:

having fertility problems;

having a miscarriage or fetal loss in the second or third trimesters;

developing diabetes or high blood pressure while pregnant;

being constantly tired when pregnant;

giving birth by Caesarean section (surgery needed to deliver a baby);

having babies with chromosomal problems such as Down syndrome; or

having multiple births.

This is a great time for you to become a mum, with many women over 35 years having first babies. By working with your doctor and obstetrician and getting regular antenatal care, you will help to ensure a healthy and rewarding pregnancy.