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Obstetric Care

Pre-pregnancy

The importance of good health for both parents around the time of conception cannot be under-estimated.
Before falling pregnant a review of diet, exercise habits, weight and medications (including herbal supplements), along with iron and vitamin D levels and immunity to viral infections such as rubella and chicken pox, is of great value. There is benefit in commencing folic acid and iodine for up to 3 months prior to conception.

If you have a history of thyroid, blood pressure or mental health issues for example, seeing my team before you conceive enables us to work together to make your pregnancy as safe as possible for both you and your baby.

We would have the opportunity to discuss genetic carrier screening, to see if your future children are at risk of rare genetic conditions.

Early Pregnancy complications

Unfortunately miscarriage is common, occurring in 10-15% of diagnosed pregnancies. Ectopic pregnancy, where the pregnancy implants in the fallopian tube or rarely in other parts of the genital tract, occurs in 2% of pregnancies. Should you have bleeding or pain in early pregnancy, I can perform an ultrasound in my rooms to check if there are any issues with the pregnancy. I will then arrange further management in the event of a pregnancy loss.

Nausea, vomiting and fatigue in early pregnancy is very common and can be incredibly debilitating. At your booking appointment I will provide you with information on ways to manage this.

Antenatal Care

First visit
I would aim to see you for the first time at 8-10 weeks to perform an ultrasound to confirm your due date. I would also review the blood and urine tests performed prior with your GP, as outlined in my booking letter emailed to you. I will review your medical and surgical history and arrange any further investigations or specialist referrals that may be required in your pregnancy. If have had any mental health concerns in the past I recommend that you discuss a mental health treatment plan with your GP.
We will discuss options for screening your baby for major genetic changes including Down Syndrome.

Further Visits
Generally, repeat appointments will occur at 13, 16, 21, 24, 28, 31, 34 and 36 weeks, and then weekly until delivery. The schedule and which appointments would be suitable for telehealth will be outlined in my booking pack, emailed to you prior to your first visit.

Additional appointments can be made at any time. I will scan you at every appointment and we will review test results and discuss any concerns. I will arrange extra, more comprehensive ultrasounds at specialist women’s imaging facilities as required.

Labour and Delivery

I encourage you to consider your birth preferences from early in the pregnancy, and we can begin this discussion at your first appointment
Expectations around labour and birth are incredibly important to the birth experience and physical and emotional recovery. For this reason I encourage you to attend the antenatal classes provided by St John of God and attend a labour ward tour when they are available. Further to this, please explore your preferences, thoughts and concerns with me at any time.

It is important to be aware that situations can arise during the pregnancy and labour that may mean that there is a deviation from planned course, and my recommendations may change. I will endeavour to provide the birth experience that you seek while keeping you safe, according to my training and experience. Ultimately, I am proactive with management of pregnancy and labour, and will recommend intervention when I think it is the best option for mum and baby with the information at hand.

At this stage I can only consider a VBAC (Vaginal Birth After Caesarean Section) if your original Caesarean was done by myself.

Post-pregnancy

It takes a village to support a post-partum family! Those early days in hospital are important for establishment of breastfeeding and ensuring that both you and your baby are healthy and the midwives at St John of God are expert in helping you navigate that. The newborn period can be an incredibly challenging time, both physically and emotionally -we will check-in with you 2 weeks post-partum to check that you are coping.

We have a network of physiotherapists, lactation consultants and mental health professionals to support you– please contact the rooms at any time.

I will routinely see you at 6 weeks post-partum but extra reviews can be arranged if any concerns arise.

Gynaecological Care

Abnormal periods

Pelvic pain or vaginal bleeding that is heavy, irregular or occurs after sex should prompt a review with your General Practitioner and a pelvic ultrasound will likely be arranged. I recommend having ultrasounds performed at a specialist women’s imaging ultrasound provider if possible. These ultrasounds may identify a number of contributors to your symptoms – such as endometrial polyps, fibroids, adenomyosis, thick uterine lining, ovarian cysts or swollen tubes. These conditions may need to be managed with medication and surgery. I perform surgery at St John of God Subiaco at Bethesda Claremont. If your ultrasound is suggestive of deep endometriosis I will happily arrange for you to see a colleague of mine who is specialised in this surgery.

Hormones – PCOS to Menopause

In my Fertility and Reproductive Endocrinology fellowship I undertook additional training in the hormonal aspect of gynaecological health, including paediatric and adolescent gynaecology, premature menopause and menopause after cancer.

In the teen years, periods can be problematic and interrupt important daily activities. Consideration of growth and maturity is required when determining the most appropriate management option.

PCOS in an area of interest of mine, particularly around management of its fertility implications and associated conditions. I have participated in a PCOS in General Practice Advisory Committee aimed to translate current evidence into practice since the release of the 2018 International PCOS Guideline. I am passionate about educating patients about their condition and how to best manage it.

Menopause symptoms and complications can vary significantly between individuals and options for treatment need to be compatible with past medical history. Women with premature menopause may still be able to conceive and need contraception. The impact of early menopause on bone, brain and cardiovascular health needs to be identified and managed appropriately. I would tailor the treatment of your menopause symptoms to what is effective but also safe for you.

Abnormal cervical screening test

Your risk of developing cancer of the cervix (opening of the uterus/womb) can be almost eliminated by

  • Having cervical screening every 5 years between the ages of 25 and 75
  • Having screening more frequently or a detailed assessment of your cervix (colposcopy) in the event of an abnormal result
  • Treating any pre-cancerous change

Routine cervical screening is performed by your GP. If there are any difficulties or abnormal results, they may refer you for colposcopy +/- treatment.

Self-collect cervical screening is now an option for all women – this may be an option if you find it particularly difficult to have your screening performed by the traditional method (speculum examination). If a self-collect sample detects presence of Human Papilloma Virus (HPV), a traditional collection is recommended to check for pre-cancerous/ cancerous cells in the cervix.

If you need any pre-cancerous change surgically treated, I can complete that for you.

Vulval problems

Vulval skin is prone to infection, itch and inflammation for a number of reasons, including concurrent urinary incontinence or vaginal infections.

It can also be affected by systemic conditions such as Crohn’s disease and psoriasis, and rarely it can be cancerous or pre-cancerous. These conditions It can lead to significant pain, irritation and sexual dysfunction.

Along with my network of physiotherapists and dermatologists I will endeavour to accurately diagnose and treat vulval pathology. A movement to appreciate vulval diversity has arisen out of rising requests for cosmetic vulval surgery. Some great resources on healthy variation in vulval appearance can be found on the website of the Australia and New Zealand Vulvovaginal Society.

Fertility

I provide fertility consulting and assisted reproductive treatment, including IVF, at City Fertility rooms in Bethesda Claremont (Fertility Specialists of WA). If you and your partner are unable to conceive or have an identified cause of couple infertility I can receive referrals through these rooms.

Infertility is a couple issue; only rarely an individual issue. Women often feel that difficulties with conceiving or suffering miscarriage is an issue with them, and it often isn’t! Male partners need to be equally engaged and receptive to treatment to have best fertility and pregnancy outcomes.

Once I have seen you through fertility treatment I would love to care for you in your pregnancy. This continuity enables me to appreciate the context of your pregnancy, your whole journey, and the things that are most important to you.

Women are increasingly older when they start their families for several positive reasons. It does however lead to concerns around fertility – both egg quality and quantity. I am very happy to arrange some tests and discuss this with you.

IVF is sometimes seen as treatment to overcome all fertility obstacles, including maternal age. Unfortunately this is not necessarily the case, but other fertility assistance options may work well for you. Your IVF Success is a great tool to provide an indication of your chances of conception with IVF treatment, taking into account previous treatment, age, obstetric history and cause of infertility.

The importance of good health for both parents around the time of conception cannot be under-estimated. Get in touch to ensure the best care right from the start.

Suite 209, 25 McCourt Street, Subiaco WA 6008
Ph: (08) 9200 1871 | Fax: (08) 9200 1857
Email: admin@dralishamccreery.com.au
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