Frequently Asked Questions

No, your referral to doctors will cover your visits with the midwives.

During your first visit we like to discuss your medical and obstetric history, as well as the progress of your current pregnancy. We will also discuss what to expect antenatally, as well as with labour and delivery. We will also organise any routine as well as unexpected investigations, as needed.

Please contact our office to ask any questions about fees. Otherwise, prior to your first visit we will email the costs of that visit. Full antenatal care fees will be provided before your visit.

Our doctors see uninsured patients at no cost through the public Gynaecology Clinic, located within the Orange Health Service.

A common reason for women to experience prolonged, painful labours is due to the way the baby is facing in labour. ‘Occiput posterior’ or ‘OP’ (sometimes called ‘back labour’) position relates to the way the baby is facing. Imagine a pregnant woman lying on her back. The baby is in the head-first (or cephalic) position. Most commonly, the baby is facing the floor (‘Occiput anterior’ or ‘OA’ position), but in about 15% of women the baby is facing the ceiling and in the OP position. Unfortunately, as the baby descends during labour in the OP position, the neck extends and there is a larger diameter that must fit through the pelvis. This can lead to longer and more painful labours.

Most of the time, nature intervenes, and the baby will turn to an OA position during the labour. However, if this doesn’t happen it’s important to try to do things to help nature along. We have found that several things can help to turn the baby back to the OA position. They are:

• Mobilising in labour
• Strong contractions (possibly augmented with Oxytocin)
• Epidural block (which then precludes mobilising in labour)

In some instances, none of this will work and we can discuss other options including an instrumental delivery or a caesarean delivery. Alternatively, some women will go on to push out their baby in the OP position. Whatever your choices in labour, rest assured that our goal is to support you and your baby with a safe, healthy birth that takes your desires into account.

At Highlands Healthcare we focus on improving the long-term health of our patients. We want the absolute best outcomes and experience for you and your family, and we recognise that pregnancy can be an exciting and anxiety provoking time. We’re excited too! It’s ok and normal to feel that way. We strongly believe in patient choice and autonomy. So, we like to fully inform patients about options and risks and help guide you to a decision that respects your lived experience. Delivery can be particularly nerve wracking, so we want to give you as much information as possible to best prepare you for the day.

VBAC (vaginal birth after caesarean section) is a safe option for most women. However, like anything in life there are some risks to consider when comparing VBAC to an elective caesarean. In general, the safest option for you and your baby is to try for vaginal delivery, but we will discuss this with you further while considering your medical history and desires.

Our main concern is an uncommon, but important condition called ‘uterine rupture’. ‘Uterine rupture’ or ‘dehiscence’ is when a hole opens in the uterus most commonly around the old incision. This can happen before, or more commonly, during labour. The risk is somewhere in the vicinity of 1 in 50 to 1 in 200. Usually when uterine rupture occurs, both mum and baby are fine. However, poor outcomes are possible with an increased risk of serious perinatal outcomes when compared to elective caesarean section.

If opting for a VBAC, we monitor the labour very carefully and recommend continuous fetal heart rate monitoring. You can choose to have an induction of labour, even if you are trying for a VBAC. You can have any type of analgesia as per normal labour including nitrous gas, morphine, and epidural block.

Should you choose to, it will be our pleasure to support your decision for a VBAC.

Please feel free to ask if you have any questions about the above.

Broadly pelvic floor dysfunction can be categorised into pelvic organ prolapse and incontinence. Pelvic organ prolapse can be experienced by a feeling of vaginal bludge, fullness, or by feeling a lump. We categorise pelvic organ prolapse further into three parts:

• • Apical, or ‘top of vagina’ prolapse
  • Anterior compartment or ‘bladder’ prolapse
  • Posterior compartment or ‘rectal’ prolapse

Incontinence on the other hand can be from the bladder or bowel. For bladder incontinence, there are three subtypes:

• • Stress urinary incontinence (leaking urine while coughing, laughing, jumping, sneezing)
  • Urge urinary incontinence (leaking with a feeling of the bladder being full)
  • Mixed urinary incontinence from both stress and urge incontinence

There is significant overlap in treatments for prolapse and incontinence, and can include:

• • Pelvic floor muscle exercises (through a physiotherapist or online)
  • Weight loss (if relevant)
  • Smoking cessation (if relevant)
  • Bladder retraining
  • Vaginal pessaries
  • Medications
  • Surgery

At Highlands Healthcare we want you to know that after discussing your history and examining you, we will undertake a process that attempts to determine the cause or causes for your pelvic pain and treat that condition or conditions appropriately.

Common causes for pelvic pain can include:

• Infection
  • Uterus, tubes, pelvic cavity, bladder
• Bleeding
  • Spontaneous or post-operative
• Adenomyosis
  • Lining of the uterus in the muscular wall of the uterus
• Endometriosis
  • Lining of the uterus in the abdominal or pelvic cavity
• Pelvic floor muscle dysfunction
  • A chronic muscular contraction in response to pelvic pain
• Interstitial cystitis
  • Inflammation of the bladder
• Fibroids
  • Non-cancerous (occasionally cancerous) growths in the muscular wall of the uterus
• Ovarian cysts
  • Non-cancerous (occasionally cancerous) cysts in on or both ovaries
• Bowel disease
  • Irritable bowel syndrome or constipation

Due to the multi-factorial nature of pelvic pain, your treatment plan may include multiple aspects, as we try to treat all underlying causes for pelvic pain.

Treatments may include:

• Simple to complex analgesia
  • For example, Paracetamol, Ibuprofen, Opiates, Neuromodulators
  • As we move from simple to more complex options, risks increase such as sedation, constipation, and dependence
• Hormonal options
  • The pill, Implanon, Depot, Mirena
• Surgical options
  • To target and remove any pain causing structures
  • As we move to more invasive options, risks increase and may include loss of fertility
• Referral to other specialists
  • Bowel surgeons, gastroenterology, chronic-pain specialists, neurologists, urologists, psychologists
• Physiotherapy
  • To target chronic pelvic floor contraction
• Antibiotics