Dr Keith Figueiredo is a GP Obstetrician/Anaesthetist and principal at the Panaceum Group.
There are about 700 deliveries per year in Geraldton. Geraldton is fortunate to have one of only two private hospitals in Western Australia outside of Perth, so women have the choice of delivering at the public hospital (the Geraldton Regional Hospital), or at the private hospital (St John of God).
Deliveries at the public hospital are based on a shared care model. General Practitioners (GPs) who are skilled in obstetric care carry out antenatal care in their surgery, as well as the Geraldton Aboriginal Medical Service (GRAMS). The GP Obstetricians are the point of first contact. They look at the whole picture, including the pregnant mum’s family history, psychological state, medical history, medication usage, and social issues. They organise the routine checks in pregnancy (see below) and manage antenatal problems such as vaginal bleeding in pregnancy, ruptured membranes, preterm labour, raised blood pressure, abdominal pain or decreased baby movements.
When public patients go into labour, they are usually looked after by their obstetric GP (or their nominee) if they come in in-hours, or the doctor on call after-hours. Highly trained midwives are available at both hospitals, and they do most of the deliveries. The doctor’s role in labour is to manage the emergencies, such as pain relief, the labour not progressing, the baby getting stuck or becoming distressed for whatever reason, the baby needing acute resuscitation when it is born, or managing a mother’s haemorrhaging after the baby is born. These emergencies can happen anytime and often can be completely unexpected.
Private patients are looked after by their GP obstetrician of their choice whenever they go into labour, or if they have any severe complications in their pregnancy. If that doctor is unavailable, a nominated private doctor will be called.
Geraldton has two specialist obstetricians who provide invaluable support to the GPs for the complicated pregnancies, as well as an anaesthetic team who provide pain relief in labour. There are also rostered paediatricians to look after sick newborn babies.
There are some important principles in pregnancy. Stay fit during pregnancy, as labour can be hard work! Your doctor can point out dietary and exercise classes run for pregnant women. Women who weight too much may need to have their baby in Perth (if their booking BMI is >40 or if they are otherwise high risk). Consider folate supplements in the first 3 months of pregnancy (and prior to pregnancy if it is a planned pregnancy), avoid smoking, avoid alcohol, and avoid foods that may contain listeria.
There are some routine tests in pregnancy. At the initial consult, your blood may be checked for viruses, rubella immunity, as well your blood group. A dating scan may be ordered if there is uncertainty as to when you are due. Around 12 weeks a scan may be ordered for Down Syndrome screening (this depends on parental preference). At 18 to 20 weeks, a fetal anatomy scan is done. A booking letter is then done to the hospital of your choice. The hospital will inform you about the various antenatal classes and parenting classes they run. Around 26 weeks, a test is done for diabetes, and at 36 weeks a vaginal swab is checked for bacteria called Group B strep.
Antenatal visits are usually monthly to 32 weeks, then 2 weekly till 36 weeks, then weekly thereafter. This is to make sure you get your tests done at the right time, and to pick up such problems as the baby not growing adequately, the baby being in the wrong position, or the many other other complications of pregnancy.
So if you are pregnant, talk to your GP about the local obstetric services… it’s a great place to start!