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Caesarean section changes during my time as an obstetrician

Caesarean section changes during my time as an obstetrician

When I started my training as obstetrician Caesarean section deliveries were done much less frequently than today. There were various reasons for this including… Caesarean sections were considered more dangerous for the mother than vaginal deliveries and so vaginal...

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Another reason why not to go public for pregnancy care

Another reason why not to go public for pregnancy care

Wendy had her first baby at a major public hospital as a public patient. She needed an emergency Caesarean section. She said the operation was done by a young female doctor who she had never met. She never saw this doctor again after the operation. Wendy said she had...

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Caesarean section by choice

Caesarean section by choice

When asked: “Can I have a Caesarean section?” I always answer: “YES”. There is an increasing number of women who choose to have an elective Caesarean section as the mode of delivery, rather than a vaginal delivery. The request is usually made at the first antenatal...

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History of Caesarean section delivery

History of Caesarean section delivery

There are references to Caesarean section operations in ancient Hindu, Egyptian, Greek, Roman, Chinese and European stories, photos and ancient historical records. While it is commonly believed the name ‘Caesarean’ is from the surgical birth of Julius Caesar, this is...

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Planning is important

Planning is important

Pregnancy and childbirth complications can happen irrespective of who is managing your pregnancy. But with considerable professional clinical experience that is consequence of having managed many thousands of pregnant women and with personalised patient care the...

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Epidural and spinal anaesthetics

Epidural and spinal anaesthetics

I am often asked questions about epidural and spinal anaesthetics. I have compiled the information below with these questions in mind. An epidural anaesthetic is a regional (not general) anaesthetic whether local anaesthetic medication is injected into the epidural...

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Do Epidurals Prolong Labour?

Do Epidurals Prolong Labour?

This popular question does not have a simple answer as there are different circumstances that need to be considered. First stage labour There is no reason an epidural block should prolong first stage labour. To the contrary epidural can result in a shorter first stage...

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When Less is Better than More

When Less is Better than More

It was Louise’s second pregnancy. In her first pregnancy, she went into spontaneous labour at 40 weeks and 6 days. She had a spontaneous vaginal delivery of a baby girl weighing 3662gms. This second pregnancy was progressing well except her baby started measuring...

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Caesarean section delivery needed in second stage labour

Caesarean section delivery needed in second stage labour

  The first time I met Fozia was at 12 weeks gestation in her second pregnancy. She told me she delivered her first baby in 2006. She told me she went into spontaneous labour at 40 weeks gestation and after 17-hr labour had a spontaneous vaginal delivery of a...

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Her uterus was adherent to her anterior abdominal wall!

Her uterus was adherent to her anterior abdominal wall!

A new patient saw me for management of her third pregnancy. Her first delivery had been in Pakistan. It was an emergency Caesarean section at 36 weeks because of foetal distress. Her second delivery was in the United Kingdom. It was an emergency Caesarean section at...

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Foetal distress in first stage labour

Foetal distress in first stage labour

I have had two patients recently where despite foetal distress in first stage pregnancy were able to have vaginal deliveries. The first patient was in her second pregnancy with the first pregnancy ending as a miscarriage because of the baby having a chromosomal...

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Management of an occipito-posterior positioned baby

Management of an occipito-posterior positioned baby

It was Shannon’s third pregnancy. Her first was in 2015. That pregnancy had been uneventful. She ruptured her membranes at 40 weeks. As she did not go into labour a Syntocinon infusion was commenced. She had a vaginal delivery of a healthy girl weighing 3.1Kg. Her...

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Just in time

Just in time

Vanessa saw me for her first antenatal visit of her second pregnancy when she was 8 weeks pregnant. She told me her first pregnancy was uneventful. She went into spontaneous labour at 37 weeks. Labour lasted about 15 hours. There was a lack of progress in the second...

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Repeat Caesarean section had unexpected surprises

Repeat Caesarean section had unexpected surprises

A patient said to me at her first antenatal visit of her second pregnancy that she wanted an attempt at a VBAC (Vaginal Birth After Caesarean section). She was ten weeks pregnant at the time. I had not met her prior and I was not the obstetrician for her first...

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Pregnancy and young drivers

Pregnancy and young drivers

On December 1st 2016 driving rules in NSW changed for learner, P1 and P2 licence holders. Learner, P1 and P2 licence holders are now not permitted to use a mobile phone at all while driving. “These laws encourage learner and provisional drivers and riders to...

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Face presentation

Face presentation

I was woken by the midwife at 12.30am. A patient had arrived in labour at 6cm cervical dilatation. She was 39 weeks’ gestation and she had had two uncomplicated vaginal deliveries. She still had intact membranes. The midwife asked me to come as she was starting to get...

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Two recent cases of placenta praevia

Two recent cases of placenta praevia

Two recent cases of placenta praevia It was a Thursday afternoon. I took a patient to theatre for a Caesarean section delivery because of placenta praevia. Placenta praevia is when the placenta develops in the lower aspect of the uterus and in close relation to the...

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Fully dilated and baby’s head not engaged

Fully dilated and baby’s head not engaged

I was woken at about 12.30am by a midwife working in the Birth Unit. A patient had arrived in spontaneous labour and her cervix was now fully dilated. But the baby’s head was very high. The midwife told me the head was still at the level the brim of the pelvis....

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How to avoid tearing with delivery.

How to avoid tearing with delivery.

Last night a patient had an intact perineum after a spontaneous vaginal delivery. It was her first baby. There was some minor vaginal tearing only. I said to her she can expect to have a much better recovery because her perineum was intact. I often get asked by...

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Baby’s hand below head in labour

Baby’s hand below head in labour

Towards the end of her third pregnancy, a patient asked me if her labour could be induced. She had requested the same in the previous two pregnancies. In her first pregnancy delivery took place at 39 weeks gestation and in the second at 38 weeks gestation. All worked...

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Time was of the essence

Time was of the essence

It was Monday morning. Amie’s husband Mitch had gone to work. Amie woke at 7am and “spent the morning lying in bed practising my calm birth breathing from the calm birth course we did two weeks earlier”. Amie was 33 weeks pregnant in her first pregnancy. Her pregnancy...

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Saturday afternoon had unexpected developments

Saturday afternoon had unexpected developments

Saturday afternoon had unexpected developments. After a busy morning of visiting postnatal patients in hospital and then seeing antenatal patients for consultations in my office, I returned home. My wife and I had a major appliance at home that needed to be replaced....

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How can I get myself into labour?

How can I get myself into labour?

How can I get myself into labour? This is a common question asked by a patient when she approaches her expected date of confinement (EDC), and especially if she goes past her EDC. EDC and onset of labour The first point to understand is that an EDC is an artificial...

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VBAC attempt went horribly wrong

VBAC attempt went horribly wrong

A 23-year-old woman saw me for a gynaecology consultation in the hope I could explain to her what went wrong with her last delivery eight months earlier when she had a ruptured uterus. Also, she wanted my management of abdominal pain she has had since then. I was very...

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A better delivery experience

A better delivery experience

I recently delivered the third baby of a patient who is a Pacific Islander and is a resident of her home country. She flew to Australia to meet me for the first time when she was 27-weeks' pregnant. She told me about the very traumatic delivery of her second baby at...

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Last childbirth experience

Last childbirth experience

A new patient saw me this week to talk through her last childbirth experience. She also wanted to discuss having another baby. She had been managed as public patient in her last pregnancy. It was her first pregnancy. There were no pregnancy problems except for...

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Childbirth positions

Childbirth positions

I recently had two patients who wanted to deliver on “all fours” as it was a more comfortable position. One baby’s heart rate slowed every time the mother adopted the “all fours” position but was normal when she was in another position. As a consequence, we had to...

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“Please don’t let me die”

“Please don’t let me die”

It was S’s first pregnancy. S and her husband are a delightful couple who were very excited about the pregnancy. The pregnancy was uneventful. At 39 weeks, S was admitted to hospital with spontaneous rupture of membranes. After hours of waiting for spontaneous labour...

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“inductions are better than people make out”

“inductions are better than people make out”

A patient asked me to do a blog titled “inductions are better than people make out”. This patient delivered two days ago. It was this patient’s third pregnancy. Because of developments with the second delivery, we agreed that induction of labour was a safer option...

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Mothers Day

Mothers Day

It was Mother’s Day. The plan was to have a celebration breakfast wife my wife Robyn, give Robyn her Mothers Days gifts, then go to church with Robyn, then lunch and then take Robyn to our daughter’s home for a Mothers Day celebration afternoon tea with all the...

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Sunday had its own surprises

Sunday had its own surprises

On Sunday I planned to attend my wife Robyn’s great nephew’s christening. Robyn was overseas. I had not gone overseas with her as the trip had been organised at short notice and I had too many patients due. So, at the christening I was also representing Robyn. The...

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Avoiding tearing with childbirth

Avoiding tearing with childbirth

On Sunday morning at about 1.00am a patient delivered a beautiful baby girl weighing 3512gms. It was her first baby and she delivered her baby without even a graze of trauma to her vagina or perineum. She adopted the position of being on ’all fours’ to push and...

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A patient’s birth plan – an elective Caesarean section

A patient’s birth plan – an elective Caesarean section

A patient who is 29 weeks pregnant in her second pregnancy saw me yesterday for a scheduled antenatal visit. She said she had decided on her ‘birth plan’ and wanted to discuss it with me. In her first pregnancy she was managed as a public patient as a major Sydney...

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An episiotomy that went wrong

An episiotomy that went wrong

I recently saw a new patient eight days after her confinement. She had been managed in her recent and first pregnancy as a public patient in a local large teaching hospital through its midwives clinic. She wanted a water birth. Thirteen days overdue her labour was...

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VBAC vs elective Caesarean section

VBAC vs elective Caesarean section

A question and my answer on a health matter advise website where I am a Heath Professional 'expert contributor'. Question to the health advise website from an anonymous person (not my patient) who I don't know and who lives somewhere in Australia: "I have had 2...

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Expect the unexpected with childbirth

Expect the unexpected with childbirth

Today I induced the labour of a patient who was 39 weeks pregnant because it was her personal request. It had been an uncomplicated pregnancy. It was her second pregnancy. With her first pregnancy her labour had been induced at 39 weeks by me at her personal request....

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Caesarean section closure

Caesarean section closure

A patient at her postnatal visit today complimented me on how much better her Caesarean section delivery experience had been with me. I had not looked after her in her previous pregnancy. She also said she had much less postoperative pain, needed fewer painkillers,...

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Caesarean section closure technique

Caesarean section closure technique

My goal is not only for you to have an enjoyable Caesarean section delivery experience but also for you to have the least postoperative discomfort possible and an excellent long to recovery with excellent healing. While there are many variables that can account for...

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