During pregnancy, an ultrasound scan sometimes uncovers an abnormality in the developing baby. This may have implications for the remainder of the pregnancy, the birth of the baby and his/her care in the first weeks of life. At the request of an obstetrician, we will meet with the family, explain the significance of the abnormality that has been found and make a plan for the care of the baby. These consultations take place in our consulting rooms and normally take 45-60 minutes. A detailed plan for management is then drawn up and communicated back to the referring obstetrician with a copy to the family.
Sometimes, it is necessary to have a paediatrician present for the birth of a baby. This is to ensure that a baby starts regular breathing and establishes a normal circulation immediately after their umbilical cord is cut. The need for a paediatrician to attend a birth is often clear weeks earlier but sometimes it only becomes clear just prior to birth. Common scenarios are described below:
If your baby’s birth happens without any problem, there is no need for a paediatrician to be present. Your obstetrician and midwife will make sure that the baby starts breathing regularly and establishes a normal circulation. Later that day, or in the subsequent days you are in hospital, your obstetrician may ask one of us to visit you to examine your baby and then continue his/her routine medical care. This may be because of a problem being detected with the baby, at your request, or because your obstetrician wishes for your baby’s medical care to be provided by a paediatrician.
Having attended the birth, or having seen your baby afterwards, we will continue to supervise your baby’s medical care. As well as performing and documenting your baby’s routine newborn examination, we will continue to be available 24 hours per day in the unlikely event of an emergency. Because we share the responsibility for each other’s babies in the evenings and overnight, and at the weekend, someone other than your primary paediatrician may attend at these times.
In the unlikely event that your baby becomes unwell, he/she may need to be admitted to an area where closer observation and special treatment can be provided. Common reasons include jaundice requiring phototherapy treatment, premature birth (less than 36 weeks gestation), birth weight less than 2500g, suspected infection and infants of mothers requiring insulin for diabetes. Babies in special care nursery are closely observed by specially trained midwives, and may require continuous electronic monitoring, extra oxygen, and/or intravenous fluids and antibiotics.
When a baby is born, the local council of the suburb of their parents home address is notified and a Maternal and Child Health Nurse (MCHN) in that community is assigned. Within one week of going home, the MCHN will visit you and your baby at home, check that you are well, and that your baby is feeding well and putting on weight (if this does not happen, please contact your local council). Subsequently, the MCHN will arrange a program of visits for your baby at your local Maternal and Child Health Centre.
Most babies feed well, put on weight and have no active medical problems. These healthy babies do not need to come back and see a paediatrician but all babies need a routine check at six weeks to ensure that their newborn examination has remained normal. A GP is the ideal person to perform this examination. If you don’t have a GP in your area, ask your MCHN or a friend in the area who has children for a recommendation. Every baby, infant and child should have a local GP in case they develop an illness that requires a timely review in the community.
If your nurse is concerned about your baby, she may recommend that you see either your local general practitioner (GP) or come back to see the paediatrician who saw your baby in hospital. In an emergency, she might even send you to hospital with your baby.