Pregnancy, birth and baby in Southern NSW

Southern NSW LHD Maternity Services are here to help you through your pregnancy, childbirth, and after giving birth.

We suggest that women come for their initial appointment before reaching 14 weeks of pregnancy. This allows us to plan and provide the best care for you and your baby/babies. Your partner or support person, midwife, and obstetric team will also be involved in planning your pregnancy care.

How to register and book an appointment

Once we receive your online booking form, we'll email you and get in touch to arrange your pregnancy care appointments. Feel free to attach any pathology results or ultrasounds to the online booking form, or you can bring them to your first pregnancy care appointment.

Most maternity services in Southern NSW LHD follow a shared model of care with midwives and GP obstetricians. Your local Maternity Service will be happy to talk about their care model and provide more information. 

All maternity services in Southern NSW LHD are Level 3 maternity units (PDF 148.66KB) (PDF 148.66KB) with Level 2 nurseries (PDF 152.43KB) (PDF 152.43KB).

If you live in the ACT, you can give birth in a Southern NSW LHD maternity service.

Your maternity service will get in touch with you to schedule your first antenatal (before birth) visit once they receive your registration.

During this visit, your Midwife will talk to you about your overall health and ask questions about your current and past pregnancies. Please bring any recent pathology or ultrasound reports with you.

Your Midwife will start your "hand-held" pregnancy record, go over routine antenatal tests and screenings, and discuss any potential risk factors. Together with you and your partner, they'll plan your antenatal care.

If needed, your Midwife will talk about referrals to other healthcare clinicians. In case any risk factors or complications arise, additional consultations may be required, and there might be a possibility of transferring to a higher-level facility for ongoing care. However, in general, most women should be able to receive the majority of their antenatal care at their chosen Maternity Service.

In the Southern NSW we provide all women with a screening ultrasound around 18 to 22 weeks into their pregnancy. This ultrasound takes a close look at your cervix, baby, and placenta to ensure your baby's proper development.

Understanding morphology ultrasound

This screening scan checks for the following:

• the number of babies
• the position of the placenta and the umbilical cord
• the amount of fluid around the baby
• the length of your cervix and whether it is closed
• the size of your baby – the sonographer will measure the baby's organs and body parts
• structural abnormalities of the baby, such as issues with the baby's bones or internal organs.

Optional

You can inquire about your baby's gender but note it may not be 100% accurate.

Abnormalities

While most pregnancies are normal, 2 to 3% may have issues. Ultrasound is effective for major problems but not for all abnormalities, such as cerebral palsy, autism, or some heart defects.

Preparation

Wear comfortable clothing, keep your bladder comfortably full, and bring previous scans. Your partner can attend.

During the scan

• takes 30 to 60 minutes
• lie on the examination bed with a warm gel applied
• sonographer uses a flat probe on your abdomen
• they may not talk continuously as they concentrate on scanning
• a doctor might review routine scans.

Internal scans

Usually, abdominal scans are sufficient. If needed, a transvaginal scan may be offered, and you can decline or take time to decide.

Abnormal findings

Discuss with the doctor. Additional scans may be needed. More significant findings may lead to a referral to the Fetal Medicine Unit.

Results

Sent to your doctor and birthing hospital within 5 business days. Discuss results in person with your care team for clarity and questions.

Take a look at these video introductions for your local Maternity Service in Southern NSW LHD. You can contact each service directly if you have any questions or would like to come in and visit.

Queanbeyan

Virtual tour of the Queanbeyan maternity ward and antenatal clinic. 

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Batemans Bay

Virtual tour of the Batemans Bay antenatal clinic.

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Moruya

Virtual tour of the Moruya Hospital Maternity ward.

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Narooma

Virtual tour of the Narooma Community Health Centre Antenatal clinic.

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Community Midwife

Information on the Travelling Community Midwife program.

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Next steps - Batemans Bay

Advice on what you should do next if having a baby in Batemans Bay.

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Next steps - Moruya

Advice on what you should do next if having a baby in Moruya.

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You should contact us immediately if you are experiencing the following in pregnancy:

• your baby stops moving or you are experiencing reduced movements
• trauma to the abdomen, assault, serious fall or car accident
• vaginal bleeding at any time
• sharp pains in the abdomen with or without vaginal bleeding
• your waters break or if you have a constant clear watery vaginal discharge
• fever or chills, temperature over 37.8 degrees
• severe nausea and persistent vomiting
• recurring and persistent headaches
• blurred vision or spots before your eyes
• pain or burning on passing urine
• contractions at any time before 37 weeks
• sudden swelling of the face, hands or feet
• persistently itchy skin, especially hands and feet
• labour has started and you feel it is time to come to hospital
• booked Caesarean birth and labour commences.

Have you ever experienced severe morning sickness during pregnancy?

Hyperemesis gravidarum (intense nausea and vomiting), can make it difficult for pregnant women to eat, drink, and manage daily tasks. Without treatment, it can lead to dehydration, weight loss, anxiety, depression, and other serious complications. It's more than typical morning sickness. Did you know it's the most common reason pregnant women are hospitalised early in pregnancy? Many are unaware of its impact on pregnant women, their babies, and families. It can be debilitating, isolating, and frightening.

You're not alone. We're here to help.

If you have questions or need more information, ask at your next pregnancy visit. We aim to provide consistent, integrated, and continuous care that's culturally appropriate, supportive, and respectful.

Learn more about hyperemesis gravidarum.

For mother

• antenatal card
• loose comfortable clothing
• maternity pads
• toiletries
• heat pack
• phone charger
• snacks for labour.

For baby

• nappies
• clothing
• baby wraps
• formula, bottles, teats and sterilisation equipment if you are choosing to formula feed.

Hand hygiene

Help us prevent infection by following the hand hygiene rules:

• sanitise hands upon entering hospital
• sanitise hands upon entering rooms
• sanitise hands upon exiting rooms.

Safe environment

Ensuring a safe and friendly space for our patients, visitors, and staff is our top priority. We do not tolerate any actions that put the safety and well-being of mothers, babies, or staff at risk.

Understanding induction of labour

Labour usually starts naturally between 37 and 42 weeks of pregnancy when the uterus has regular strong contractions that open the cervix, letting the baby pass down the vagina for birth. Sometimes, this doesn't happen, or there's a need to bring on labour before it starts naturally, called Induction of Labour.

Inducing labour often involves using medication (oxytocin in an Intravenous drip) along with breaking the waters in front of the baby's head (artificial rupture of membranes or ARM). This happens in the Maternity Unit birth suite.

If your cervix is ready for birth, ARM/oxytocin might be enough to start labour.

However, in many cases, there's a need for treatment the day before the induction to soften and open the cervix. This process, known as Cervical Ripening, makes the induction more successful and shortens the labour.

The usual way to ripen the cervix is by inserting a small, soft Foley catheter balloon into your cervix, causing the release of a natural hormone called prostaglandin.

Another option is to use a synthetic prostaglandin like Prostin Gel or a prostaglandin pessary (Cervadil) inserted into your vagina. Your GP, Obstetrician, and Midwife will discuss with you which method is better for you and your baby.

Monitoring your baby

Before and after inserting the balloon catheter or Prostin Gel/pessary, we'll check your baby's heartbeat with a cardiotocograph (CTG) to ensure everything is okay.

Once oxytocin is started with an intravenous drip, your baby's heartbeat will be continuously monitored during labour with a CTG.

We have wireless CTG monitoring, allowing you to be upright and mobile during labour if you choose.

For more information on Induction of Labour, please speak to your Midwife and GP Obstetrician.

Planned caesarean – meeting with the anaesthetist before the operation

If your baby is going to be born through a planned caesarean section, you'll have an appointment to visit the hospital and talk to an anaesthetist. This usually happens a week or two before the operation, and the anaesthetist will discuss the choices for your anaesthetic.

During this visit, you can ask questions about the operation, your hospital care, and receive instructions on when to stop eating and drinking before the procedure.

For a planned caesarean, you'll be admitted to the hospital on the day of your operation, specifically to the Maternity Unit, where you'll get ready to go to the Operating Theatre.

Anaesthetic options for a planned caesarean

In the operating room, before the surgery begins, an intravenous drip will be placed in your arm if you don't already have one.

Epidural or spinal anaesthetic

This is a local anaesthetic inserted into your lower back to numb the pain during surgery, allowing you to be awake. It's the most common and generally the safest option. With this choice, one person (your partner or support person) can accompany you into the operating theatre.

General anaesthetic

General anaesthetic involves being in a deep sleep throughout the procedure. While less common for a caesarean, it might be the better option in some cases. For safety reasons, your partner or support person is not allowed in the operating room. Your baby will be taken to your partner, and your midwife will stay with them until you wake up to see your baby.

When baby is born with epidural or spinal anaesthetic

Once everything is ready, the obstetrician will start the operation. If you're awake, you might feel some mild pressure as your baby is lifted out of your uterus. Your baby will be dried off and usually brought to you. Occasionally, some babies may need a bit of help getting used to breathing in air, which could delay contact with you for a few minutes.

With a planned caesarean, we aim to keep you and your baby together during the rest of the operation and in the theatre recovery room afterward. This allows for skin-to-skin contact and, if you've chosen to breastfeed, the possibility of the first breastfeed soon after birth.

Your midwife will stay with you and your baby in the operating theatre and recovery room to assist with care and breastfeeding.

After the operation, you'll spend a brief time in the recovery room before returning to your room in Maternity.

If an emergency caesarean section is needed

In most cases of an unplanned or emergency caesarean section, it will still be done under an epidural or spinal anaesthetic, and your partner will be present in the operating theatre. Additional doctors may be present based on the reason for the emergency caesarean. Efforts will be made to keep you and your baby together, but if additional care is needed, your partner will be encouraged to stay with your baby in such situations.

At Southern NSW LHD, you can decide to go through labour and give birth in water if it's deemed safe for both you and your baby. Use the details below to chat with your midwife or doctor, aiming for a positive experience.

Benefits of water immersion

Using water during labour and birth can offer you added comfort, mobility, and privacy. Evidence suggests that in uncomplicated labours:

• less need for pain-relief drugs, especially epidural analgesia
• increased relaxation and lower perceived pain levels
• fewer medical interventions for slow progress in the first stage of labour
• greater sense of control during labour.

If you have questions or want to understand our procedure for water immersion during labour and birth, talk to your midwife or doctor.

We have water immersion at certain times

Maternity services in Southern NSW LHD consider the following criteria before offering water immersion during labour:

• healthy with no pregnancy complications
• only one baby in a head-down position (not twins)
• at least 37 weeks pregnant
• no infections that may affect your baby
• able to enter and leave the bath with minimal assistance
• no use of injected pain relief in the previous four hours
• pre-pregnancy Body mass index (BMI) less than 40 for safety reasons.

It's not advisable to have water immersion in certain situations

Your midwife or doctor may advise you to leave the bath during labour in certain circumstances, including:

• concerns for your well-being (bleeding, high temperature, feeling faint or unwell)
• concerns for your baby's well-being (changes to heart rate, meconium, or blood-stained amniotic fluid when waters break)
• abnormal progress in labour; a period out of the water with walking may help contractions strengthen and progress.

Considerations when choosing water

• have support with you at all times, and assistance when entering and leaving the bath to prevent injury
• bathwater should be free from additives like oils, gels, and soap
• water temperature can be adjusted for your comfort
• stay hydrated during labour
• ensure the water level is deep enough for your body to be fully submerged at breast level when seated or kneeling
• nitrous oxide gas can be used in the bath if you choose
• gently guide your baby to the water's surface
• you can leave the bath at any time.

More information

For more details or to review our procedure for water immersion during labour and birth, talk to your midwife or doctor.

Information about epidurals to help you decide if you want one for the birth of your baby

You don't have to make a decision now. When you're admitted to the hospital, a midwife or anaesthetist will be available if you want to discuss it further.

Pain relief in labour

Every labour and birth is unique, and everyone experiences pain differently. Until you're in the midst of childbirth, you may not know how you'll cope or what will work best for you.

Your 'Having a Baby' book, especially pages 70 to 83, contains helpful information about labour and birth, given to you by your midwife. We suggest reading it to prepare for the birth and discussing any questions with your midwife or doctor.

Various methods can help you cope with pain in labour, including staying active, changing positions, breathing techniques, water immersion (bath or shower), complementary therapies like hypnotherapy, reflexology, massage, and aromatherapy, subcutaneous sterile water injections, TENS (transcutaneous electrical nerve stimulation), Nitrous Oxide (gas and air), opioid analgesia (morphine), and epidural analgesia.

This information focuses on epidural analgesia.

More information

If you have questions, talk to your midwife or doctor, who can arrange for you to speak with an anaesthetist. You can also request to talk to the Maternity Unit Manager at your birthing hospital. You have the right to an interpreter; please ask staff to arrange this service for you.

Frequently asked questions

What is an epidural?

Epidurals are a common way to relieve pain during childbirth. They're administered by an anaesthetist, a doctor trained to manage pain and care for patients during surgery, including caesarean sections.

Facts about epidurals

Epidurals are the most effective pain relief during childbirth. The anaesthetist inserts a small plastic tube (epidural catheter) in your lower back near spine nerves, staying in place for continuous pain medication. This can include local anaesthetic to numb nerves, small opioid doses, or a mix.

An epidural shouldn't make you feel drowsy or sick. However, it increases the chance of needing tools like a ventouse or forceps during birth, raising the risk of perineal damage for the mother and injury for the baby.

You can top up an epidural for added pain relief during procedures like ventouse, forceps, or a caesarean section. If a caesarean is needed and you don't have an epidural, the anaesthetist typically uses a spinal anaesthetic, similar to an epidural feeling.

Can everyone have an epidural?

Most people can get an epidural, but some health issues (like spina bifida, prior back surgery, or clotting problems) may make it unsuitable. It's best to know this before labour. If your labour is complicated, your midwife or obstetrician might suggest an epidural for you or your baby's benefit.

If you're overweight, placing an epidural may be trickier and take longer.

Epidurals don't harm your baby or increase the chance of emergency caesarean section.

For pain relief during labour and birth, epidurals are more effective than tablets, Nitrous Oxide gas, or injections.

What is the procedure for putting in an epidural?

First, a plastic tube (cannula) goes into a vein in your hand or arm, and a 'drip' (intravenous fluid) usually runs. During labour, you might have a drip for medication or if you're feeling sick.

Your midwife will guide you to lie on your side or sit bending forward. The anaesthetist will clean your back with an antiseptic.

Local anaesthetic is injected into your skin to numb it before placing the epidural catheter near your spine nerves. The anaesthetist must be cautious to avoid piercing the fluid bag around your spinal cord to prevent headaches.

Stay still while the anaesthetist inserts the epidural, but after securing the catheter with tape, you can move freely.

Once the catheter is in place, medication is delivered through a pump from a fluid bag. You might receive a handset to request additional doses, giving you control over pain relief with a safety lockout to prevent accidental overuse.

How long does it usually take for an epidural to work?

Setting up the epidural typically takes around 20 minutes, and it provides pain relief after another 20 minutes.

While it's taking effect, your midwife will regularly check your blood pressure. The anaesthetist ensures the medication works on the right nerves by applying ice to your tummy and legs, asking you about the cold sensation.

In some cases (about 10 to 15%), the epidural might not work well, and adjustments or reinsertion of the catheter by the anaesthetist may be necessary.

Are there any problems associated with having an epidural?

Your blood pressure may drop, making you feel light-headed or nauseated. We'll monitor your blood pressure regularly.

You might need to stay in bed as your legs could feel heavy and numb. The epidural may also remove the urge to urinate, and a catheter will be used.

You may experience shivering, fever, or itching.

The epidural may not always fully relieve pain. If uncomfortable, the anaesthetist might use more local anaesthetic, and occasionally, the epidural may need replacement.

In rare cases (less than 1 in 100), severe headaches may follow an epidural, but they can be treated.

What are the risks of an epidural?

How could an epidural be used to keep me comfortable during a caesarean section?

If you require a caesarean section, an epidural is often chosen over a general anaesthetic.

A potent local anaesthetic is injected into the epidural catheter, numbing the lower half of your body for the operation. This is safer for you and your baby compared to a general anaesthetic.

In rare cases (1 in 20 people), the epidural may not work sufficiently for a caesarean section. In such instances, another anaesthetic like a spinal or general anaesthetic may be necessary.

Consent for an epidural

NSW Health requires written consent before inserting an epidural. Understanding your pain relief choices, weighing the benefits and risks of an epidural is crucial. Please read this information and ask questions early.

While there are occasions when an obstetrician may recommend an epidural, each woman can make her own decision. If you choose an epidural, you'll sign a consent form before having it. As you may be focused on labour, in pain, or have taken pain-relieving drugs, sign and date below to confirm you received and read this info.

The anaesthetist will repeat this information verbally if you opt for an epidural during labour. Remember, the anaesthetist can answer any remaining questions during consent, but you might be distracted by pain or sedating drugs.

If you need an interpreter

Professional interpreters are available if you need help to communicate with staff. Please ask our team who can make this booking for you. The service is free and confidential. 

Severe complications following an epidural or spinal anaesthetic are extremely rare and include infection or blood clot at the site of the injection. Problems associated with them can be avoided when detected early

If you have any of the following symptoms contact the hospital as soon as possible

Contact the hospital if your headache:

• Does not go away after you have rested, taken fluids or mild pain relievers, such as paracetamol
• Gets worse while you are sitting or standing but feels better when you are lying down
• Comes with other symptoms like neck stiffness or hearing changes (such as ringing, or a blocked sensation) or problems with your eyes or fever or chills

Contact the hospital if you have pain in your back where you had the epidural or spinal injection, especially if

• the pain is new or getting worse (for example, if the pain travels up the spine or down into the buttocks and legs)
• the area where the needle was inserted becomes inflamed (if the area is red, oozing or weeping)
• you are experiencing a fever or chills.

After birth, numb patches are relatively common and are usually caused by direct pressure of the baby on the nerves in the pelvis during labour and delivery.  Very occasionally it may be related to the anaesthetic and this usually resolves within weeks.

Contact the hospital if you feel any persistent or new changes in your buttocks or legs such as:

• weakness
• numbness
• pins and needles
• new problems with bladder or bowels

Telephone the maternity service on the number below and tell staff that you are concerned about your recent epidural or spinal anaesthetic and ask for referral to the duty Anaesthetist.

Cooma Hospital – (02) 6455 3230

Goulburn Hospital – (02) 4825 4560

Moruya Hospital – (02) 4474 1521

Queanbeyan Hospital – (02) 6150 7190

South East Regional Hospital (Bega) – (02) 6491 9970

This information is for women who choose to go home after assessment, especially when their waters break before labour, and they don't want or need to stay in the hospital.

About 70% of women will start labour within 24 hours after their waters break.

Before you go home and wait for labour, we need to make sure:

• your baby is positioned head down
• you show no signs of infection
• you have a reliable way to get back to the hospital quickly if needed.

When you're home, take some basic precautions and know when to call and come in:

• check your temperature every 4 hours during the day
• if your temperature is 37.5 degrees or higher, contact your midwife or maternity ward
• use a sanitary pad and change it at least every 4 hours during the day
• normally, the colour of the water (amniotic fluid) is clear. If it changes to green, yellow, or blood-stained, contact your midwife or maternity ward
• if your baby moves less than usual, contact your midwife or maternity ward
• if you have regular, painful contractions, contact your midwife or maternity ward
• if you feel concerned for any reason or unwell, contact your midwife or maternity ward.

In case any of these things happen, you'll be asked to come to the hospital for review.

How you can reduce the chance of infection and help your body prepare for labour

• rest, eat, and drink normally
• take a bath or shower if you want to
• wash your hands carefully before and after using the toilet or changing your pad
• change your pad regularly
• avoid sexual intercourse
• don't go swimming
• avoid using tampons.

The Southern NSW LHD recommends inducing your labour if it hasn't started within 24 hours of your waters breaking.

More information

If you're concerned or have questions at any time, please contact your midwife or maternity ward.

Southern NSW LHD supports your decision to hire a doula for emotional and physical support during labour.

A doula is an experienced companion who understands the needs of a woman and her family during pregnancy, birth, and the postnatal period. They provide continuous, non-medical support.

Doulas are not regulated or registered health professionals. Anyone can use the title "doula".

Some doulas undergo a doula course. You can ask about their education and experience. Your doula should share their background, abilities, education, and feedback from previous families.

It's important to clarify the roles of midwives and doulas, especially if the doula has midwifery qualifications. However, a doula cannot act as a midwife, providing clinical advice or tasks.

To avoid confusion:

• bring your doula to antenatal care appointments for information sharing
• develop your birth plan with your midwife or doctor by 36 weeks
• call the hospital or midwife if you think you're in labour.

Your doula is one of your support people in labour but cannot speak for you or make decisions with your doctor or midwife. If you can't communicate in labour, the midwife or doctor will discuss your wishes with your partner or next of kin.

Your doula cannot provide clinical care or advice. For clinical concerns, talk to your midwife or doctor.

If you need a caesarean, only one person can be with you in the operating theatre. Decide beforehand who that person will be.

Your doula, like other visitors, may be asked to leave if the focus is on your safety.

• NSW Health - Having a baby
• NSW Health - Pregnancy screening for Group B Streptococcus (GBS)
• NSW Health - Pregnancy beyond 41 weeks
• NSW Health - Next birth after caesarean
• NSW Health - Breech baby at term
• Get Healthy in Pregnancy Service
• RANZCOG Pregnancy information pamphlets
• Non-Invasive Prenatal Testing (NIPT) fact sheet
• Royal Women’s Hospital - Pregnancy, labour and birth
• Royal Hospital for Women - MotherSafe fact sheets
• Information sheet - Movements matter
• Baby's Movements Matter website
• Third and fourth degree perineal tears
• NSW Health - Labour and birth fact sheets
• NSW Health - Breastfeeding and newborn care fact sheets

• Perinatal Anxiety and Depression Australia (PANDA)
• Beyond Blue - pregnancy and new parents
• Information on perinatal depression and anxiety

• National Immunisation Program
• Immunisation for mums and babies
• COVID-19 vaccine information for women who are pregnant, breastfeeding or planning pregnancy

• NSW Health - Hepatitis B Immunisation for your baby
• Vitamin K information for parents
• NSW Health - Newborn Bloodspot Screening - Information for parents
• Raising children - Newborns
• Jaundice and your newborn baby
• Neonatal Hypoglycaemia Newborn Care Guidelines (PDF 197.55KB) 

• NSW Health - Smoking and pregnancy fact sheet
• NSW Health - Smoking and pregnancy information and resources