General information

My involvement with your baby’s care may be for several reasons: the circumstances of the birth e.g. Caesarean section; your obstetrician’s wish that your baby’s care be supervised by a specialist (rather than by themselves); at your own request. I am a paediatrician with additional training in the management of newborn babies – a neonatal paediatrician.

My services include the following:

During my initial attendance, I will perform your baby’s newborn examination and document it in the Green Book.
On subsequent attendances, I will check on your baby’s progress with feeding, assess your baby for jaundice, and perform examinations to make sure that your baby hasn’t developed a heart murmur or unstable hips (after my initial visit, one of my colleagues may be covering for me but I will let you know in advance if this is the case).
If your bedside midwife is concerned about your baby at any time of day or night during your hospital stay, either myself or one of my colleagues will be available to answer their questions or to attend urgently if that were required.
After you go home, and providing your baby has a valid referral (your obstetrician’s referral lasts for the first three months of life; your GP can provide a subsequent referral), I will be available remotely to answer any questions you may have; these questions should be directed via my secretary by telephone or email. Depending on the problem, it may be necessary for you to bring your baby back to see me in my consulting rooms.

There are out of pocket costs associated with these services; more information regarding these costs can be found below the registration form in the text message you’ve been sent and on our website.

During your hospital stay

Vitamin K (Konakion) – In the first few hours after birth, and with your written consent, your baby will receive an injection of vitamin K. This injection is to prevent a rare condition called ‘vitamin K deficiency bleeding’. During pregnancy, only small amounts of vitamin K are passed across the placenta into the developing baby. In addition, breast milk contains very little vitamin K. This results in the newborn baby being deficient in vitamin K, a vitamin that is important in the function of some clotting factors in the blood. A single dose of vitamin K has been shown to be safe and very effective at preventing this rare disease.

Hepatitis B immunisation – You will also be asked to consent to your baby receiving an injection of hepatitis B vaccine. This is a very safe and effective vaccine; it is the first step of the national immunisations program which I recommend for all babies.

Feeding – Breastfeeding is the best way to feed your baby. In the first few days after birth, the midwifery staff will show you how to attach your baby to the breast. If the baby finds it difficult to attach, the midwives will show you how to express your colostrum and give it to the baby with a syringe (it is better to feed babies who are to be breastfed this way). If attachment continues to be a problem for your baby, the staff will show you how to express your breast milk with an electric pump, and how to give it from a bottle (some mothers may need to continue to express when they get home, and pumps are available for hire or purchase from pharmacies).

In most mothers, the breast milk does not ‘come in’ (i.e. the breasts do not fill with milk) until at least 48-72 hours after birth. In some babies (particularly those who are premature and/or those who weigh less than 3000g), it may be necessary to transiently supplement a mother’s breast milk with formula.

Breastfeeding is not for everyone, and some mothers choose to formula feed; this is also a safe and effective way of feeding your baby. There are many formulas available, but most babies tolerate a simple cow’s milk protein-based formula (e.g. A2, Aptamil, Bellamys Organic, Biostime, Bub’s Organic, Karicare Mumamoo, Nan, Nutura, S26). There is no benefit to swapping between these different brands for constipation, irritability etc. No benefit has been shown from using ‘Gold’ formulas except in premature infants. I do not recommend ‘AR’ (anti-reflux) formulas.

Weighing/measuring – All babies are weighed after birth but, at 48 hours of age, babies are reweighed and, if the length and head circumference were not measured after birth, these are also checked. Almost all babies lose weight in the first few days; this is quite normal and is no cause for concern unless the loss is greater than 10% of the baby’s birthweight.

Newborn screening test – Any time after 36 hours of age, the midwife looking after your baby will collect a few drops of blood onto a card for the newborn screening test. The card is sent to the Murdoch Children’s Research Institute and the blood is tested for congenital adrenal hyperplasia (an inborn error of metabolism), cystic fibrosis (a rare lung disease), hypothyroidism (an under-active thyroid gland), and phenylketonuria (PKU; another inborn error of metabolism). If the result is abnormal, a senior midwife from the hospital will contact you (sometimes there are technical problems with the specimen so a call does not mean that there is something seriously wrong with your baby). If you have heard nothing by the time your baby is five weeks old, then the results were normal.

Jaundice – All of us have a small amount of yellow pigment called bilirubin in our blood. In all babies, there is a big surge of bilirubin which results in most babies going slightly yellow (becoming jaundiced). In most cases, this is quite normal, requires no treatment, and goes away by the time a baby is two weeks old. Jaundice can make babies sleepy which may affect feeding. The midwifery staff have an instrument that estimates the bilirubin level by taking a measurement on your baby’s forehead. If your baby becomes very jaundiced, a blood test (serum bilirubin; SBR) may be organised to assess whether light treatment (phototherapy) is required.

Vitamin D deficiency – Breastfeeding babies are at risk of becoming vitamin D deficient. This is because vitamin D doesn’t cross the placenta, and there is very little in breastmilk. Vitamin D deficiency increases the risk of severe allergy in infants including to egg and nut. If you are breastfeeding, even if you are also giving formula, your baby should receive a vitamin D supplement. Please buy OsteVit-D3 Oral Drops from a pharmacy (a prescription is not required) and, once you leave hospital, give your baby two drops once each day until the age of six months. If your baby is only receiving formula, supplemental vitamin D is not required.

Admission to Special Care Nursery (SCN) – Some babies require admission to SCN rather than being nursed on the ward with their mothers. Common reasons include prematurity (birth prior to 37 weeks of pregnancy), birthweight less than 2500g, breathing difficulty, suspected infection, and infants of diabetic mothers.

Transfer to the Park Hyatt Hotel – If you and your baby are well, you may be eligible to be transferred to the Park Hyatt Hotel. Your baby will be closely monitored by the midwives there who will notify me if there are any concerns. I do not routinely see babies transferred to the hotel unless specifically asked to do so by the staff.

After you go home

Maternal & Child Health Nurse (MCHN) – When you go home from hospital, a Maternal and Child Health Nurse from your local council will be informed. She will come and visit you at home in the first week after discharge to check on your baby (if this does not happen you should contact the local council). Subsequently, she will arrange regular checks until the age of four years.

Billing – My secretary will email you an invoice for my services the week after you go home. This email will also include a copy of the discharge summary I have sent your obstetrician (your GP will also receive a copy if you have provided their details).

Ultrasounds & blood tests – Your baby may need an ultrasound of the hips, kidneys or brain; if this is required, I will have let you know, and my secretary will make the appointment and email you a request form and details of the appointment. Finally, your baby may also need a follow-up blood test; my secretary will email you a form to print out and take to your local pathology collection centre (the form will be a St Vincent’s Pathology form but any laboratory will accept it); please ring the collection centre the day before you attend to warn them you’re bringing in a newborn baby (so they can have a staff member available who knows how to do a heel prick).

Follow-up – I do not need to see most babies again after they go home from hospital. All babies need a check at six to eight weeks of age, but this can easily be done by your local general practitioner (it is also a good opportunity for you to introduce your baby to your GP). Your baby may need to see me again, but I will let you know if this is the case. If you do need to bring your baby to see me, please ring to make the appointment as soon as possible after going home.

Whooping cough (Pertussis) – This is a very serious illness in infancy. Most babies who develop it, catch it from one of their parents, or another adult carer. Both parents, and any adult looking after a baby regularly (e.g. a grandparent), should be immunised with the Boostrix vaccine by a local GP (the vaccine lasts for 10 years but women receive a repeat dose each pregnancy).

Costs

Doctors who work in private hospitals are not paid a salary; rather they charge fees for their services. After you go home, my secretary will send you an account for my care of your baby. My fees are higher than the amount you receive back from Medicare (the Medicare ‘rebate’) because they reflect both the requirement to be available at all times of day and night in case your baby becomes unwell while you are in hospital, as well as the remote support I provide once you have gone home. The extra amount (or ‘gap payment’) varies depending on the circumstances of the service provided e.g. being called in from home at 4AM on a public holiday for an emergency Caesarean section is associated with a much higher gap payment than coming to see your baby during normal working hours for a non-urgent consultation. Specific details about the gap payment are provided on our website under each doctor’s profile. Unless otherwise agreed, I will come and see your baby each day while you are in hospital.

Most babies remain well after birth, stay with their mother in the room, and are not admitted to the Special Care Nursery. If this is the case for your baby, your health fund considers that the baby is being cared for by you and is not a ‘patient’ of the hospital. Because of this, your health fund will not contribute towards my gap payment. However, Medicare will contribute the rebate amount for each service provided and, if you qualify for the Medicare Safety Net (as most mothers do by the second half of the calendar year), up to 80% of my gap payment may be claimed (also from Medicare).

If your baby is admitted to the Special Care Nursery (or receives phototherapy in your room), then he/ she is a patient of the hospital. In this case, my gap payment will also be partly covered by your health fund. Medicare will also pay the rebate for each service (sometimes your health fund pays me the rebate and claims it back from Medicare for you). The Safety Net does not apply for babies who are patients of the hospital. If a baby will likely require a prolonged admission to the Special Care Nursery, a separate billing system is used called Eclipse. If this is the case, you will be notified and different billing paperwork will be provided.

If one of my colleagues sees your baby in my absence, you will receive a separate account from them.