Maternity A to Z

We offer several options for culturally safe maternity care from pregnancy, childbirth and beyond for Aboriginal women and their families. Services include Aboriginal Caseload Midwifery, the Aboriginal Maternal Infant Health Service (AMIHS), Aboriginal outreach clinic and other culturally sensitive services.

See Aboriginal health in Nepean Blue Mountains for further information on our services.

Information sheets

For detailed information, download these information sheets.
 

Colostrum is milk produced by the breast during pregnancy that is perfect for your baby. It is thicker and more yellow in colour than breast milk. It helps to protect your baby against infection and is high in energy. It is also easily digested and helps with baby’s first poo. Hand expressing can start after 36 weeks of pregnancy, with 3-5 minutes on each breast 2-3 times a day.

It is important to discuss antenatal hand expressing with your midwife or doctor before you start.

Antenatal expressing kits are available from your antenatal clinic or your midwife.

Information sheet

For detailed information, download the information sheet.
 

Pre-eclampsia is a medical condition that only occurs in pregnant women. It usually takes the form of high blood pressure and abnormal kidney function, but can also involve other organs, such as the liver and brain. Pre-eclampsia can occur in any pregnancy. About 3-4% of all pregnant women in Australia develop pre-eclampsia.

Your doctor or midwife can detect pre-eclampsia by measuring your blood pressure and testing your urine for protein. Once pre-eclampsia develops, it does not go away until after your baby is born.

Most women with pre-eclampsia do not have any symptoms. Pre-eclampsia is usually detected during a routine antenatal appointment. However, women with severe pre-eclampsia will have high blood pressure and may experience:

• a sudden swelling of the face, hands or feet
• a headache that does not go way with simple pain relief
• problems with vision, such as blurring, seeing flashes of light and dots
• severe pain just below the ribs
• heartburn that does not go away with antacids
• feeling very unwell

It is very important that you contact your doctor, midwife or hospital if you experience any of these symptoms.

Information sheet

For detailed information, download the information sheet.
 

One in three women having their first baby, will have an assisted vaginal birth. For subsequent births, approximately one in eight women will have an assisted vaginal birth. If you need an assisted vaginal birth, you will be asked to give consent. You can decline and your doctor will talk to you about other options.

If you do have an assisted birth, you will need to remain in hospital for at least 24 hours following the birth so we can monitor you and your baby during that period. Most babies born by assisted vaginal birth are healthy and do not have any long-term issues.

Types of assisted vaginal birth:

• ventouse birth, where a plastic vacuum cup attaches to your baby’s head using suction
• forceps birth, where smooth, curved metal instruments carefully cup around your baby’s head

In both types of assisted births your doctor will ask you to push while they pull to help you birth your baby.

Talk to your doctor, midwife or antenatal clinic for further information on assisted vaginal birth options.

Information sheet

For detailed information, download the information sheet.
 

Starting to feel your baby move is a very exciting time in your pregnancy. Most women will start to feel their baby moving when they are between 16 and 22 weeks pregnant. If this is your first baby, you may start feeling your baby move a little bit later than this.

What to expect

Some mothers report that these movements feel like “flutters”. As your baby grows and changes position, you will become more aware of different movements such as the baby’s legs and arms moving, rolling sensations and some babies get the hiccups. Every baby is unique. Some babies may be more active in the evening or the morning. It is important that you begin to take note of your baby’s specific pattern of movements. Most babies will have a pattern of movements by the third trimester (28 weeks gestation).

Movements are best felt when you are relaxed and lying or sitting down. Although every baby is different, as a general guide, most healthy babies move at least 10 times during a 2 hour period. These movements can include rolling, stretching, jabs and kicks. As you get closer to birth (after 36 weeks gestation), there is less room for your baby to move which can cause you to notice slight changes to the type of movements. Women often describe more rolling, squirming and pressing movements that are more forceful at this time, but the strength and frequency of movements should not change.

If you are concerned about how often your baby is moving or the strength of your baby’s movements, contact your healthcare provider immediately. Your midwife or doctor will need to assess you and your baby. This will involve checking your observations (vital signs) and monitoring your baby’s heart rate as well as other investigations if necessary, such as an ultrasound scan or blood tests.

Remember that you are the one who knows your baby’s movements best. It is important that you contact your healthcare provider straight away, even if you have contacted them before, to assess both you and your baby.

Information sheet

For detailed information, download the information sheet.
 

After birth, your baby may have some trouble adjusting to the outside world, processing new noises, lights, sounds and smells. As a result, it may take some time to settle or soothe them.

Babies go into a light sleep state (REM) first, and then cycle in and out of REM and deep sleep about every half an hour.

During deep sleep, a baby’s breathing is very quiet and regular, and there is no movement beneath their eyelids.

It is important to talk to your doctor or midwife about sleep and other postnatal concerns.

Information sheet

For detailed information, download the information sheet.
 

In some cases, a special catheter is used to prepare the cervix. The catheter may be used if you have had a caesarean birth previously or if there is only a small amount of fluid around your baby. This catheter is inserted through the vagina and cervix and a small balloon is then inflated to put pressure on the cervix and help it to soften and open.

The cervix takes some time to soften and open. If needed, we can use both the Cervidil and catheter to help you into labour.

You may experience some difficulty passing urine especially if you have had an epidural. A catheter may be placed in the first few hours after birth to help you with this.

It is important that you completely empty your bladder after birth to reduce the risk of long-term problems. Your midwife will give you a jug to measure the amount of urine you first pass.

If you are having trouble feeling when to pass urine, your health care team may ask the physiotherapists to talk to you about a bladder diary and timed voiding, where you may need to remind yourself to pass urine every hour.

It is normal to have bleeding after giving birth. Slightly heavier bleeding is common following an assisted vaginal birth. This should gradually become moderate and then light bleeding over the next few days to weeks.

During your pregnancy and after birth you are at increased risk of having blood clots. To reduce this risk, we advise you to be as mobile as possible. Your doctor may also recommend a daily injection for a set period of time to reduce the risk of clotting if you are at higher risk.

You will need to visit your doctor or general practitioner (GP) to discuss your options for antenatal care. Your GP will also organise blood tests and give you a referral for the hospital.

We suggest that you book into hospital for your antenatal care before you are 12 weeks pregnant.

We have three hospitals that offer maternity care. Contact your nearest hospital to make an appointment for your first visit.

What to expect

Your first visit will be with a midwife. This visit is detailed and takes between 1.5 to 2 hours to complete. At this visit the midwife will take your medical, surgical and pregnancy history and will also ask you questions about your general health, past worries, experiences and current concerns.

If you are bringing your partner, support person, friends or relatives they will not be able to sit with you for some parts of the first visit.

The midwife will discuss options for your antenatal care, depending on your needs, such as midwives’ clinics, caseload midwifery, doctor’s clinic or GP shared care.

If you have particular support needs, we will ask for your consent to involve the appropriate support services.

Antenatal classes are available each of our hospitals, where information on breastfeeding and other topics are covered. Some of our hospitals also offer separate breastfeeding classes. To book your antenatal classes, contact your local hospital.

Your information

Your information will only be shared with health care professionals that are directly involved in caring for you during your pregnancy and after the birth of your baby.

It is up to you how much information you choose to tell the midwife. The more information you share, the better the care and care options we can offer you.

The information you provide will remain confidential, except where you or your children are at risk of harm.

If you have any questions about what information is collected or how the information will be used, please discuss this with the midwife at your first visit.

Information sheet

For detailed information, download the information sheet.
 

A midwife or doctor will make a hole in the bag of water that surrounds your baby. This is done during a vaginal examination with a small instrument. This can only be done once your cervix has softened and is beginning to open.

Nepean Blue Mountains Local Health District (LHD) supports women however they want to feed their baby.
 

Domperidone, also called Motilium®, is generally used to stop nausea and vomiting but can also be used to stimulate breastmilk production in mothers who may be having problems making enough breastmilk or keeping their supply.

Before considering the use of domperidone seek breastfeeding and or expressing support from:

• your child and family health nurse
• your midwife
• a feeding clinic
• an infant feeding consultant
• a lactation consultant
• the Australian Breastfeeding Association

Talk to your doctor and or midwife about your breastmilk concerns and if domperidone is relevant and safe for you.

Information sheet

For detailed information, download the information sheet.
 

A caesarean is an operation where your baby is birthed through a cut in your abdomen (above your bikini line) and womb. There are many medical reasons why a caesarean may be necessary and your doctor or midwife will discuss these reasons with you.

The caesarean takes place in an operating theatre, and you will be given an anaesthetic for pain relief. Your doctor will choose whether you need to be awake with an epidural or spinal catheter (see ‘Epidural’ under E for information) or asleep under a general anaesthetic.

Talk to your midwife or doctor about what to expect if you are having a caesarean, including pain relief, recovery, wound care and when to resume normal activities.

Elective caesareans are performed at Blue Mountains District ANZAC Memorial Hospital and Nepean Hospital.

Your support person

Due to limited space in the operating theatre, we allow one support person to stay with you during your caesarean. If you need to be asleep during surgery your support person will be asked to wait outside the operating theatre or in the Birth Unit, depending on the circumstances.

Conditions your support person needs to be aware of:

• they will need to wear theatre clothes, including a hat and shoe covers
• they may take photos, under the guidance of theatre staff, however photos or videos of the operation, staff members or other patients is not permitted
• phone calls are not allowed in the operating theatre
• support people should not touch anything below the blue drape to make sure everything remains sterile
• if they start to feel faint or dizzy, they need to let staff know

To avoid long waiting periods for friends, siblings and other family members, we recommend that they stay at home until you contact them. The best time for visitors is after the birth, when mum and baby are stable and happy to have visitors.

After your caesarean

Once your baby is born, a midwife will be available in the Recovery Unit to stay with you and your baby, where possible. This will allow you to have immediate skin-to- skin contact with your baby. Your support person will need to remain with you in the Recovery Unit and will be unable to re-enter the Unit if they leave.

The midwife is responsible for your baby in the Recovery Unit. If at any time the midwife has to leave, your support person and baby will need to leave as well.

If a midwife is not available, your support person will accompany your baby to the Postnatal Ward. If this happens, we suggest that your support person be the only one to hold your baby until you are transferred to the Postnatal Ward.

If your baby needs to be transferred to the Neonatal Intensive Care/Special Care Unit your support person and the midwife will go with the baby.

Information sheets

For detailed information, download these information sheets.
 

Cervidil® is a tape that has a hormone inside it that helps to soften and open the cervix. It is inserted into the vagina. This is done in the Women’s Acute Assessment Unit. After the Cervidil is inserted, your baby will be monitored for 30 minutes. The Cervidil® will remain in place for 24 hours. You may need more than one dose to soften and open the cervix.

You may be able to go home if the monitoring of your baby is good after you have had the Cervidil inserted, and you are not considered to be a high-risk pregnancy.

If you can go home after Cervidil, your midwife or doctor will give you instructions on what to do at home and when to come back to the hospital.

Information sheet

For detailed information, download the information sheet.
 

Our experienced Midwives run classes to assist parents with making informed choices. Classes cover pregnancy, birth and the early months of parenting.

They are inclusive of singles, couples, LGBTQIA+, teenagers and parents expecting again.

The sessions cover topics such as:

• the role of the midwife in Birthing Unit
• what to expect during the birth process; how to minimise complications
• natural methods of managing anxiety, discomfort and pain
• medications, induction of labour, vacuum extraction, forceps and caesarean section
• benefits and risks of interventions – making informed choices
• being a more confident support person
• how to breastfeed; avoiding and managing problems; support from partners
• understanding and responding to your newborn’s cues
• helping your newborn learn the skills of settling and sleeping
• reducing the risk of Sudden Unexpected Death in Infancy (SUDI)

They also provide information about ongoing support services such as:

• Midwifery@Home Program 
• Tresillian Family Care Centre
• Australian Breastfeeding Association
• NSW Child and Family Health Services

The cost of the classes is a one-off low fee – no one will be disadvantaged.

Classes are currently held live online. It's best to book before you are 24 weeks pregnant. 

For more information and to book a class, contact your local antenatal clinic. They are available 8:30am-3:30pm, Monday to Friday. 

• Nepean Hospital Antenatal Clinic 02 4734 2373
• Blue Mountains ANZAC Memorial Hospital Maternity Unit 02 4784 6573

Information sheet

For detailed information, download the information sheet.
 

Some women who are pregnant may be at greater risk of complications from COVID-19 and may require closer observation. It is important that if you do test positive to COVID-19 while you are pregnant, that you notify your maternity care provider to make sure you receive the most appropriate care. This may be your doctor, midwife, obstetrician or local maternity service.

Most pregnant women will be able to safely stay at home while they have COVID-19. During this time, it is important to:

• have plenty of fluids, like you would with a regular cold or flu
• if you feel unwell, paracetamol can also be taken to help with symptoms. Ibuprofen is not recommended to take while you are pregnant
• move around regularly to reduce your risk of developing blood clots
• keep a close eye on your baby’s movements

Call your maternity care provider immediately if your baby’s movements change or if you have:

• vaginal bleeding
• abdominal pain
• constant clear watery vaginal discharge
• contractions any time before 37 weeks
• persistent fever
• headaches
• sudden swelling of your face and hands
• started labouring
• any serious concerns about your pregnancy

Call 000 if you develop chest pressure or pain, have severe headaches or dizziness, or have difficulty breathing. Tell them you are pregnant and have COVID-19.

COVID-19 vaccines, such as Pfizer and Moderna, are safe if you’re pregnant, breastfeeding or trying for a baby. See COVID-19 vaccines – your questions answered for more information.

Information sheet

For detailed information, download the information sheet.
 

The Ruby Clinic is a midwifery-led clinic that aims to support women who are drug and alcohol dependent and pregnant.  

The Clinic is run by the Antenatal Clinic at Nepean Hospital’s Women & Children’s Outpatient Department. It is suitable for low-risk obstetric patients.

Women attending the Ruby Clinic have access to: 

• Midwifery-led care 
• Education on drug and alcohol use in pregnancy 
• Drug and alcohol doctors 
• Obstetric care
• Breastfeeding consultations
• Social work support 

Our team will work with you during your pregnancy to help you reduce and even quit drug and alcohol use. Our aim is to improve both the mother and baby’s health outcomes. 

More information

File

Labour and birth are different from person to person and from pregnancy to pregnancy. No two labours or births will be exactly the same.

Early labour means your body is getting ready. Your uterus is working to help make your cervix shorter and thinner.

During an early labour you may experience:

• contractions that may be short and or irregularly spaced. they may feel like period type cramps
• you may have a persistent dull lower backache
• you may have inner thigh pain that may run down your legs
• you may have had a ‘show’, blood stained or pink coloured mucous, discharge from your vagina, hours and or days before contractions start

Some women experience symptoms of early labour for up to a week before their labour establishes. This is normal and is not cause for concern.

Trust your body and listen to your instincts, ensuring you rest when you need to. Early labour can take time so be patient.

If you enter early labour it is important to stay calm. You can carry on with your normal day to day activities, but no heavy lifting. It is best to stay at home, making sure you have access to your support person and transport. While going through early labour you can:

• eat and drink normally unless you have been advised by your doctor or midwife not to
• go for a walk, have a bath or shower, use heat, aromatherapy or other things that make you feel comfortable
• contact your hospital’s Birth Unit or your midwife for advice if you are concerned

Babies are still active when you are in early labour and established labour. It is normal for babies to have a wake and sleep cycle during this time. Please contact your hospital or midwife if you are concerned about your baby’s movements.

When it’s time to go to the Birth Unit

Your doctor and or midwife will guide you on when it is time to come into the Birth Unit, however if you are concerned, please come in and we will assess your progress. Some signs to look out for that you are ready to come in are:

• if your waters break (ruptured membranes), this fluid is usually yellow or a straw colour
• if your contractions are getting stronger, longer, closer together and have a pattern
• if you have any bright blood stained fluid from the vagina
• if you are in pain and do not feel comfortable to stay home
• if you are concerned about your baby’s movements

Please let us know you are coming into the Birth Unit so we can prepare for your arrival and manage your care.

Information sheet

For detailed information, download the information sheet.
 

Most women use a variety of ways to cope with labour pain. Each labour experience is unique and it is a good idea to have an open mind and be flexible.

Epidurals and spinals are the most specialised and effective methods of pain relief during labour. They are carried out by an Anaesthetist who is a doctor that is specifically trained to provide pain relief.

If you have a complicated or long labour, your midwife or obstetrician may suggest that you have an epidural as it may help you and your baby.

Epidural

An epidural is the pain relief option that will have the least effects on your baby. It should not make you feel drowsy and can usually be topped up to provide pain relief if you need to have a ventouse (application of suction cap on baby’s head), a forceps birth or a caesarean (c-section).

An anaesthetist will assess you to make sure an epidural is a suitable option for you.

It is a good idea to decide on having an epidural early, while your pain is tolerable and you are able to move yourself into position for the epidural.

Spinal

Painkillers are given directly into the spinal fluid surrounding the nerves in your back. A spinal works much faster than an epidural.

Combined Spinal Epidural (CSE)

This is a combination of the above two techniques, where an epidural catheter (a thin plastic tube about the size of a fishing line) is inserted at the same time as the spinal.

For further information on pain relief during labour, talk with your midwife or obstetrician.

When you are giving birth, the opening of the vagina and perineum (the skin between the vagina and anus) stretches to allow the baby to be born.

An episiotomy is a small diagonal cut made with scissors through the perineum by a midwife or doctor that may reduce the chance of having a deep tear into your anus called ‘obstetric anal sphincter injuries’. These tears are repaired with dissolvable stitches which dissolve over 3 to 4 weeks. Your midwife or doctor will discuss this with you during the birth if they think it may be of benefit.

An episiotomy might be recommended if:

• your baby is showing signs of fetal distress because of an abnormal heart rate pattern and needs to be born quickly
• there are signs that you may sustain a more severe tear involving the anal sphincter
• you are going to have an assisted birth with a ventouse (vacuum) or forceps
• you have a serious health condition and it has been recommended to shorten the duration of second stage or 'pushing'

Third and fourth degree tears (involving the muscle and wall of the anus or rectum) are not common (3% in vaginal birth, 4% in ventouse birth and 8-12% with forceps birth). If this does happen, you will need to stay in hospital for 24 to 48 hours for antibiotics.

We will arrange a follow-up appointment for you when your baby is six weeks old to check the healing and function of your muscles around the anus.

The tenderness over the healing wound should improve when you go home and after the first week. If you notice an abnormal discharge or increased pain, please see your midwife or doctor.

For any type of tearing, we advise you to:

• keep the area clean and dry
• after a bowel movement (stool) wash the area thoroughly with water only and pat dry
• drink at least 2-3 litres of water every day and eat a healthy balanced diet with plenty of fruit and vegetables to prevent you from becoming constipated
• if you become constipated, discuss options with your midwife or doctor
• place an ice pack wrapped in a towel or cloth onto the area to relieve pain and swelling for ten minutes at a time
• avoid sitting for long periods of time, you may find it helpful to lie on your side when feeding your baby or sitting on a pillow
• start pelvic floor muscle exercises as soon as you can to increase blood circulation to the area and help with the healing process

For further information talk with your midwife or doctor.

Information sheet

For detailed information, download the information sheet.
 

Exercise is good for everyone including pregnant women and women who have given birth. Always check with your midwife or doctor for advice on when to start and what kind of activities are right for you.
 
Some general guidelines for pregnant women are:

• start gently, stop if any undue pain or discomfort occurs and consult a professional
• exercise for about 30 minutes on most days
• walking, swimming, a stationary bike or low impact exercise classes are also examples of suitable exercise
• wear cool, comfortable clothing and good supporting shoes and take water with you
• always warm up and cool down
• exercise at a moderate intensity so that you feel puffed but are still able to hold a conversation
• use caution when participating in sports, especially if there is a risk of falling, it is better to avoid contact sport

Some general guidelines for women after the birth of their baby:

• resume your normal level of exercise slowly and progress gradually at your own pace within 
• limits of comfort and fatigue
• try to attend a postnatal class if one is available or see your physiotherapist
• walking is an ideal exercise in the early postnatal time
• exercise in water may begin after stitches have healed and vaginal discharge has finished (often about 6 weeks)
• stronger exercise such as low impact exercise classes can usually be started after about 6 weeks (sometimes longer after caesarean birth)
• aim for 30 minutes of moderate intensity exercise on most days
• always warm up and cool down and don’t forget to take water with you
• avoid exercise that causes pain or strains muscles and joints
• only start high impact exercise such as jogging and netball when your back and pelvic floor feel strong again, this may take several months

Talk to your doctor, midwife or physiotherapist about returning to exercise. 

You can also ask your midwife or physiotherapist for the Nepean Blue Mountains LHD Physiotherapy booklet ‘Exercises before and after birth’, which contains examples of exercises that are safe to do throughout the pregnancy and after birth.

Information sheet

For detailed information, download the information sheet.
 

Gestational Diabetes Mellitus (GDM) is diabetes that develops only in pregnancy. Typically, women with gestational diabetes have no symptoms. Most women are diagnosed after routine tests during pregnancy.

When you are pregnant, your placenta produces hormones to help the baby grow. These hormones also block the action of insulin in your body (called insulin resistance). Women need 2 to 3 times more insulin when they are pregnant. If you already have insulin resistance, your body may not be able to cope with this extra demand for insulin. That will lead to blood glucose levels being too high and result in GDM.

Diabetes that is found during pregnancy usually goes away within 24 hours of your baby being born. Your baby will not have diabetes, but we will monitor or your baby’s sugars for the first 24 hours after birth.

Testing for GDM and what to expect

At 24 to 28 weeks, we will arrange for you to have a glucose tolerance test. The test will take two hours.

Some women will need to be tested early in pregnancy and this will be determined at your first booked visit to the hospital.

To take the test you must not eat or drink anything from midnight before the day of your test until the test is finished. When you arrive at the Women and Children’s Outpatients Clinic you will have a blood sample taken and be given a sweet drink which you must drink within 10 minutes. Blood tests will then be taken at one hour and two-hour intervals. After the last blood test, you can eat and drink normally.

If your test is abnormal, you will either attend a special clinic or stay at the clinic, for follow up appointments with the diabetic team, which includes an obstetrician, endocrinologist, diabetic educator or dietitian and in some cases your midwife.

We will only contact you if your tests are abnormal.

Information sheet

For detailed information, download the information sheet.
 

If you or your baby experience any of the below symptoms seek help right away by contacting your midwife or doctor. In an emergency go directly to the nearest hospital emergency department or call an ambulance on 000.

Seek help if you:

• are passing blood clots, or experience a heavier blood loss
• have fevers, faintness or dizziness
• your leg is painful, red, hot and or swollen
• have severe headaches
• have pain, discharge, or redness from your caesarean wound
• have pain, discharge and a large amount of swelling around your vagina, following a vaginal birth
• have burning, or difficulty passing urine
• have painful breasts with a reddened area
• are generally feeling unwell

Seek help if your baby:

• seems tense and irritable
• seems too floppy or very sleepy
• has any change in their skin colour
• has blood in their nappy
• has nappies that are less wet or dirty than previously
• is not feeding enough
• has anything that you may be concerned about

High blood pressure happens in about 10% of all pregnancies. Many women will not be aware that their blood pressure is high.

This may be the first sign of other changes throughout your body that can affect the wellbeing of both you and your baby.

Some women will have high blood pressure even before pregnancy. This is called chronic hypertension.

Other women may develop high blood pressure during their pregnancy and not show any signs or symptoms of other problems that can occur with high blood pressure.
This is called gestational hypertension.

Pre-eclampsia may also occur during pregnancy, this can cause high blood pressure combined with signs and symptoms such as headaches or eye sight problems, protein in the urine or abnormal test results. See ‘Pre-eclampsia’ under P for further information.

Information sheet

For detailed information, download the information sheet.
 

HG is a severe form of nausea and vomiting during pregnancy affecting about 1 in 100 women. It can lead to dehydration, weight loss and vitamin deficiencies.

The condition can have a big impact on women’s emotional, mental and physical health. Women are often so sick they cannot go to work, care for themselves or anyone else, and have great difficulty participating in normal daily activities.

HG can make women feel very unwell and needs to be taken seriously by their health care provider, families and support people and employers.

More resources

MotherSafe NSW can support women experiencing HG. Contact 1800 647 848, Monday to Friday, 9am to 9pm for free counselling and medication advice.

Download the hyperemesis gravidarum information sheet

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An induction of labour is a process to start labour. It may include one or more of the following processes or medications: membrane sweeping, Cervidil® inserted into the vagina, a balloon catheter, breaking your membranes and/or a Syntocinon® drip.

You may be offered Induction of labour because continuing with your pregnancy may cause risks to you or your baby’s health. Some of the common reasons why induction may be offered to you include:

• your waters have broken before labour starts on its own
• you have diabetes in pregnancy
• you are overdue (more than 41 weeks)
• your baby is not growing well or is small for your due date
• you have high blood pressure in pregnancy
• you have had serious bleeding in pregnancy
• there are concerns about your baby (low fluid around the baby, fewer fetal movements)
• your age (40 years and over)

Softening and opening of the cervix can take time, it may take three or more days before you are in active labour.

Your doctor and midwife will discuss the risks and benefits of induction with you. After this discussion a plan for your care will be made and clearly documented in your medical record.

Home during the induction process

Some women will go into labour after the first stage of the induction process and will come back into the Birth Unit during the afternoon or night.

When you return to the hospital at the time your midwife advised, you will be assessed for the next stage of the induction process.

If you are at home and become distressed or upset at any time, please contact the midwife or return to the hospital as soon as possible. Midwives are on duty 24 hours a day 7 days a week.

Information sheets

For detailed information, download these information sheets.
 

A free and comprehensive counselling service for women concerned about exposures during pregnancy and breastfeeding provided through MotherSafe NSW.

Service covers:

• prescription drugs
• Over-the-counter medications
• Street drugs
• Infections 
• Radiation
• Occupational exposures
• Hyperemesis Gravidarum

Call 1800 647 848, Monday to Friday, 9am to 9pm

During a vaginal examination your midwife or doctor places a finger just inside your cervix and makes a circular, sweeping movement to separate the membranes from the cervix. This has been shown to increase the chances of labour starting naturally within the next 48 hours and can reduce the need for other methods of induction of labour.

Information sheet

For detailed information, download the information sheet.
 

Mental health support during and after pregnancy is available through our Safe Start program.

Our Safe Start team is made up of midwives, social workers, drug and alcohol and mental health clinicians, a member of our Aboriginal Health Unit and community health child and family nurses.

If you or your midwife feel that you may benefit from some extra help, your midwife will ask for your consent to refer you to the Safe Start program.

During pregnancy, after the birth and in the early years of a child’s life, known as the perinatal period, many families need support. The support needed will vary from family to family and may include:

• assistance accessing parenting advice
• support with feeding, sleeping and settling, behaviour issues
• help in managing other children
• information about meeting other parents or support services in your area
• disability assistance if you find this is affecting your parenting
• services for young parents
• advice regarding child development
• support with housing and financial issues
• supportive counselling around respectful relationships or family issues
• grief and loss counselling
• help with drug and alcohol, mental health and domestic violence issues
• having someone to talk to if you are feeling sad, lonely or having trouble coping

The support offered might be for a short time or ongoing through your pregnancy and after your baby is born. You will be contacted by a team member to discuss extra support services.

All services are provided free of charge.

Free mental health support is also available to women and parents through various programs in NSW, see 'Mental health help' under Useful links for further details.

See also 'Social work support in hospital' below.

Midwifery@Home is a follow up support service provided by Nepean Hospital for you and your baby for up to the first 2 weeks after the birth. The number of visits you receive will depend on the needs of you and your baby.

Most women who have had their baby at Nepean Hospital are eligible. If you live outside the Nepean Blue Mountains LHD you may be referred to a hospital closer to your own home, within your own local health district.

The Service operates 7 days a week. It may include follow up by phone or a visit to your home. The visit will occur sometime between 9:00 am and 4:00 pm and generally lasts 30 to 45 minutes, depending on your needs.

The service is free for Medicare card holders. If you do not have a Medicare card you will need to pay in advance. Proof of payment must be shown at the time of the visit.

At the visit the midwife will:

• support you with feeding your baby
• educate you about helping your baby to sleep and settle
• weigh your baby
• perform necessary blood tests for your baby (including the newborn blood spot screening test)
• attend to your postnatal check-ups
• provide you with support and reassurance
• put you in contact with your local Child and Family Health Centre and any other support services you may need

Ask your midwife about arranging your first appointment.

If you are concerned about yourself or your baby and need help sooner, please contact your midwife or doctor. In an emergency go directly to the nearest hospital emergency department or call an ambulance on 000.

Our midwives are unable to remove their shoes when visiting your home due to work, health and safety regulations. If this is not suitable due to cultural or religious reasons, alternative arrangements can be made, such as visiting you and your baby outside of your home or an appointment can be made for you to visit the hospital.

Information sheet

For detailed information, download the information sheet.
 

If you are pregnant and have had a caesarean, you will need to think about your next birth. There are two options to choose from, Vaginal Birth After Caesarean (VBAC) or a repeat elective caesarean (c-section).

VBAC is safe for most women. National and international research shows that the majority of women (63 to 94%) succeed in having a vaginal birth after a caesarean. There are several factors that can mean a VBAC is successful, including the reason for the previous caesarean. Each individual situation is different.

You will need to discuss your plan of care with your midwife and doctor at your antenatal clinic visit. How you choose to give birth to your baby is your choice.

Read the NSW Health booklet Your Next Birth after caesarean section for further information and advice.

Information sheet

For detailed information, download the information sheet.
 

Most women experience pain and discomfort after giving birth. We will offer you pain relief immediately after birth. After you go home, you may take paracetamol or ibuprofen. Always check with your doctor or midwife for pain relief advice.

If you experience any of the concern or symptoms described in ‘Help - when to get help after birth’, seek help right away by contacting your midwife or doctor. In an emergency go directly to the nearest hospital emergency department or call an ambulance on 000.

When you are giving birth, the opening of the vagina and perineum (the skin between the vagina and anus) stretches to allow the baby to be born. During birth you may have had an episiotomy, which is a small diagonal cut made with scissors through the perineum by a midwife or doctor. 

After birth, good perineal care can help reduce pain and the risk of infection. Follow the advice below for help with recovery.

Pain management

• apply cold packs for 10 to 20 minutes for the first 1 to 3 days, as needed
• take pain relief medication such as paracetamol or ibuprofen, as needed

Hygiene and healing

• wash and pat dry your perineal area after using the toilet
• change your perineal pad frequently
• regularly inspect your perineal injury by lying on your back, separating your labia and use a handheld mirror to look for signs of infection (increased swelling, yellow or green discharge, separation of sutures
• try to support the perineal wound when coughing and passing a bowel motion (avoid straining)

Positioning and movement

To reduce swelling and bruising in the first 48 hours, we recommend you:

• lie on your side when resting and breastfeeding
• lift your body when repositioning rather than dragging
• place a pillow between your thighs when lying on your side
• avoid sitting in the same position for too long
• avoid lifting heavy objects or straining
• avoid high impact exercise or sit-ups for 6 to 12 weeks after you have your baby

Pelvic floor muscle exercises

• begin exercises 2 to 3 days after you have your baby, or when you feel comfortable
• if you have had 3rd or 4th degree tears you will need to consult with a physiotherapist and a specialist doctor at 4 to 6 weeks after you have your baby

Diet

• a healthy diet high in fibre will help to avoid constipation
• drink a minimum of 2 litres of water a day

Lifestyle

• sexual activity can begin when you feel comfortable, we suggest using a water-based lubricant
• to avoid infection return to swimming when your bleeding has stopped and your sutures have healed

Information sheet

For detailed information, download the information sheet.
 

Pre-eclampsia is high blood pressure combined with signs and symptoms such as headaches or eyesight problems, protein in the urine or abnormal test results. It affects women only during pregnancy.

It may temporarily affect the functioning of other parts of your body such as the kidneys, liver, the way your blood is able to clot or your placenta (which feeds your baby).

We will carry out a blood pressure profile assessment if your pregnancy is greater than 20 weeks and you:

• have a blood pressure reading above 140/90 or significantly higher than a previously high recording
• show symptoms of having elevated blood pressure, such as feeling dizzy, have blurred vision, headaches and/or visual disturbances
• have protein in your urine

The assessments are usually conducted in the Fetal Maternal Assessment Unit (FMAU). At the assessment a midwife will take your blood pressure once an hour for a total of 4 hours, a urine sample, and CTG (electronic monitoring) will be conducted to check the welfare of your baby. A doctor will review the results from your assessment and make an appropriate care plan with you.

The assessment usually takes between 4.5 to 5 hours. You will need to remain seated in the FMAU until the assessment is finished to ensure the most accurate results.

There are some routine tests you will need during pregnancy. Extra tests may be offered if any risks arise. The tests will take place at the following intervals in your pregnancy:

• 11 to 13 weeks: Nuchal Translucency ultrasound (also known as the scan that screens for Down Syndrome)
• 18 to 20 weeks: Morphology ultrasound (Anatomy screen where you can choose to find out the sex of your baby)
• 24 to 28 weeks: Glucose Tolerance Test (2hr fasting blood test. We also check your iron levels at this time).
• 28 weeks (approx.): Free whooping cough vaccine for you at the hospital. Please see your doctor or pharmacist at anytime for your flu vaccine
• 28 to 34 weeks: Growth ultrasound
• 36 weeks: Vaginal swab for Group B Strep (GBS)

Hospital social workers can provide assessment and counselling for social, emotional and psychological issues for women and their families in the antenatal clinic and postnatal wards.

Social workers can help you with safety issues, offer advocacy and information on the health system, services and resources in the local community. They can make referrals to other services and provide education and parenting support. Our services are free and confidential.

Social workers that work in maternity can help you prepare for the birth of your baby by: 

• linking you with charitable organisations that can provide you with the things you need such as cots, prams and car seats
• help you develop a birth plan and make decisions ahead of time about who you would like to support you through the birth of your baby
• provide counselling services if you need extra support during your pregnancy

Our social workers can also link you with services such as:

• a perinatal mental health midwife who can provide mental health support and access to a clinical psychiatrist if a medication review is needed
• a psychologist for counselling support about your pregnancy
• drug and alcohol support services
• non-government organisations that provide parenting education, mums and bubs groups and or family counselling

Ask your doctor or midwife to refer you to a social worker. 

See also 'Mental health support' above.

Information sheet

For detailed information, download the information sheet.
 

Sterile water injections are a form of natural pain relief for women experiencing back pain during labour.

The procedure involves a small amount of sterile water being injected just under the skin at four spots on your lower back. Two midwives will complete two of the injections at the same time. The injections may cause a brief stinging sensation as they go in.

The advantages of sterile water injections are:

• they often have an immediate effect
• there is no effect on your baby
• you can still walk around and be active in labour

Sterile water injections work for 90% of women and can last for up to two hours.

The injections can be repeated several times if you find they are working.

Information sheet

For detailed information, download the information sheet.
 

A birth rope also known as a Rebozo is a long piece of woven material hung from support, usually the ceiling, to help with active labouring and birthing positions.

Staying active and using upright positions may help your labour to progress and improve a vaginal birth. This is because gravity helps move your baby down and relaxes your muscles, so your baby can move through the birth canal more easily.

You might like to use a birth rope to help you achieve active labour and assist with your comfort. The birth rope can be used during labour and birthing to provide a squatting, kneeling or standing position while also supporting you for rest.

The birth rope can be used to ‘pull down’ on, or it can be wrapped around your hands or arms for support whilst bearing down. It can also be used on its own or with other items, such as a peanut ball, birthing (gym) ball, pillows, floor mat or a chair. Using these items in labour can help you find comfortable positions.

There are many different techniques that can be used with a birth rope and your midwife can help you find what is most comfortable for you during your labour and birth.

Nepean Hospital can provide the birth rope for your use. Please speak to your midwife if you would like to use one.

Information sheet

For detailed information, download the information sheet.
 

Your labour and the birth of your baby is a very personal and special time for you.
Research has shown that women who have continuous emotional and physical support during labour are less likely to need pain relief and will have a shorter labour and better birth outcomes.

Although you will be supported by a midwife throughout your labour, it is important to have another support person with you, usually your partner or another person you are close to. One to three people is an optimal number.

Choose support people who you will feel comfortable with and who will help you rather than distract you during the different stages of labour. If you have too many people with you, it may affect your ability to cope with the progress of your labour.

We encourage your support people to stay with you during your labour and the birth of your baby to provide continuous support.

Talk to your midwife about the role of your support person and what they can do to assist you.

Information sheets

For detailed information, download these information sheets.
 

Once your waters have been broken, your midwife will start a drip which has a medication called Syntocinon® in it. Syntocinon is a man-made hormone that will make your uterus contract and cause labour to begin.

The third stage of labour is the time from the birth of your baby to the birth of the placenta and membranes.

There are two types of care for the third stage, active and physiological management. 

Active management is recommended for women with antenatal risk factors or a previous complex pregnancy and birth. 

In active management:

• after your baby is born the midwife will give you an injection of syntocinon®, this medication will help the uterus to contract and your placenta to separate
• the cord is clamped and cut and the midwife will gently pull on the cord while placing a hand on your stomach to help birth the placenta and membrane

Approximately 1 in 10 women experience nausea and vomiting with active management, 13 in 1000 women experience severe bleeding (more than 1 litre) and approximately 14 in 1000 women will require a blood transfusion.

In physiological management no medicine is given, and you may need to push with some effort to birth your placenta. Approximately 5 in 100 women experience nausea and vomiting with physiological management, 29 in 1000 women experience severe bleeding (more than 1 litre) and approximately 4 in 100 women require a blood transfusion.

Nepean Blue Mountains LHD recommends active management of the third stage to reduce the risk of bleeding.

Discuss your preferences with your midwife and or doctor. Your choice will also be documented in your medical record.

After the birth of your baby, we may give you advice to change from physiological management to active management third stage labour. This may be the case if there is bleeding and the placenta has not been birthed after one hour, or where you want to shorten the time in third stage labour.

Information sheet

For detailed information, download the information sheet.
 

A vaginal examination (internal exam) is a procedure that a midwife or doctor performs to check the cervix (opening to the uterus).

This may be done to check and see if your cervix is ripe (ready to labour) or once you start having contractions to check on the progress of your labour. An internal exam is commonly done at the end of your pregnancy.

The exam may not be carried out if you are early or mid-pregnancy, if you have a low lying placenta, or if you have experienced any heavy bleeding in pregnancy.

If your waters have already broken, an internal exam can still be performed, but not too frequently, as it can increase the risk of infection to you and or your baby.

An internal exam can be uncomfortable. The midwife or doctor will use some lubricating gel to help reduce the discomfort and, in most cases, the exam itself may only take a minute or two. You may experience some tightening or contractions afterwards, using a heat pack or warm shower can help.

What to expect:

1. the midwife or doctor will explain the procedure to you
2. you will be asked to lie on a couch or bed, remove your underwear and they will make sure you are comfortable
3. they will examine which way your baby is lying by feeling your tummy and they will also check your baby’s heartbeat
4. they will examine you internally, using their fingers to feel your cervix
5. you will then be able to sit up and get dressed
6. the findings of the exam will be explained to you

The exam is usually performed either in the Birth Unit, Fetal Maternal Assessment Unit (FMAU) or in the antenatal clinic. You do not need to do anything to prepare for it.

In some cases, it may be necessary for you to be admitted to hospital overnight, or you may be able to go home and wait for your labour to start.

After the exam you may experience some slight vaginal bleeding or discharge, this is called a ‘show’ and is common. A ‘show’ is a mucousy discharge from the vagina which may contain some blood. If you have any fresh bleeding from your vagina please contact the Birth Unit and speak with a midwife.

Please tell us know if you prefer a female carer and we will do our best to make this happen.

Information sheet

For detailed information, download the information sheet.
 

Water immersion and waterbirth are forms of comfort and pain relief during labour and birth. Immersion can reduce the length of labour and reduce the need for alternate pain relief for some women.

Waterbirths are offered at Nepean and Blue Mountains Hospitals. Water immersion is available Lithgow Hospital but you will need to leave the bath when the time comes to begin the birth of your baby.

In a waterbirth your baby is born under the water and then brought to the surface of the water, you will then leave the bath to birth the placenta.

A waterbirth can be an option if:

• you always have a support person with you
• you weigh less than 100kg
• you or your baby have no underlying medical conditions
• you have not had an injection of morphine
• you do not have an epidural
• your baby does not require continuous monitoring
• your baby is not showing signs of distress
• the fluid around the baby is not meconium stained
• you have not had a large blood loss after previous births

All healthy women with uncomplicated pregnancies at term are given the option of water immersion and waterbirth. There are exceptions to water immersion and waterbirth and these will be explained to you by your doctor or midwife.

Information sheet

For detailed information, download the information sheet.
 

We recommend having a bag packed at least a month before your baby is due. We suggest the bag contains the following items for yourself, your support person (or people) and for your baby.

For you:

• comfortable clothes
• comfortable clothes for labour, such as a large t-shirt or nightie
• underwear and maternity bras
• toiletries such as toothbrush, soap, shampoo
• hair bands and or headbands
• lip balm or chap stick
• maternity pads (at least 2 packs), breast pads
• warm socks, shoes
• any medications you are currently taking
• phone, phone charger, camera
• things that may help you in labour, such as music, massage oils, pillows

For your support person:

• healthy snacks, drinks, lollies (if you are in labour at night the hospital food outlets are closed)
• a change of clothes and some toiletries to freshen up

For baby:

• nappies (1 to 2 newborn size packets)
• wipes
• clothes (hospital gowns are provided for use in hospital but you can choose to use your own clothes)
• wraps and blanket
• if you are planning to bottle feed you will need to bring your own formula, bottles and teats

We suggest you label your bag and leave your valuables at home.

Information sheet

For detailed information, download the information sheet.
 

Broken waters (also known as amniotic fluid or liquor) occur in 6 to 19% of women at the end of their pregnancy. Most of these women go into labour by themselves, approximately 70% of these women will give birth within 24 hours of their waters breaking and almost 90% will give birth within 48 hours.

If your waters have broken and you are not in labour yet. We will check to see if the swab taken late in your pregnancy for Group B strep is negative. If negative, we will recommend you go home and wait for labour to commence. 

Most women will labour naturally within the next two days. While you wait, we advise that you:

• continue with your normal routine
• monitor your temperature, take your temperature every four hours when you are awake and if you feel hot or unwell
• come to the hospital daily so we can assess you and your baby
• change your pads regularly, do not use tampons

If you experience any of the following contact your birth unit and speak to a midwife (available 24 hours a day):

• your water smell becomes unpleasant, it will usually have a sweet smell
• your water changes to green or brown, it should be clear or pinkish in colour
• you have a bright vaginal blood loss
• your temperature is over 37.4°C
• you feel unwell or have flu like symptoms
• you notice any change or decrease in your baby’s movements
• you are having regular painful contractions or constant abdominal pain
• you need pain relief regardless of frequency of contractions 

When your waters have broken we recommend not to have sexual intercourse and to avoid pools, baths or spas. These activities may increase the risk of infection.

Information sheet

For detailed information, download the information sheet.