what we do in dau - ministry of health

Day Assessment Unit (DAU)

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What we do in DAU


Multi-disciplinary out-patient care for pregnant women and their babies

Contents:

CTG (baby’s heart rate) monitoring

Blood Pressure Profile (BPP)

Decreased Fetal Movements (DFM)

Waters have broken (SROM)

Postdates assessment

Foley’s catheter assessment

Birth Unit 8890 6508 www.womensnewbornhealth.com


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Check Out Our Website!

Westmead hospital has a website that gives women and their families lots of useful

information. There are fact sheets to help you learn about pregnancy, birth, and what

happens after baby is born with breastfeeding and baby care. Our fact sheets are scientific

but easy to read.

Information you will find on our website:

Pregnancy:

Nausea and vomiting (morning sickness)

Diet, exercise, and vitamin advice for pregnancy and after childbirth

How much weight should I gain during my pregnancy?

What routine tests and ultrasounds do I need?

What about sex during pregnancy and afterwards?

Common pregnancy pains and aches – when should I be worried?.

Can I travel by plane while I’m pregnant?

Labour and birth:

How to create a birth plan

Natural ways to bring on labour

The role of your support person in labour

What to pack for hospital

How will I know when I’m in labour?

Next birth after caesarean – can I have a natural birth?

Complexities:

What if my baby needs neonatal intensive care (NICU) or special care nursery?

Learn about premature babies

What happens if my waters break earlier than expected?

Group B Streptococcus infection and pregnancy (GBS)

Looking after diabetes in pregnancy

Looking after anaemia (low blood count) in pregnancy

Drugs, alcohol, and smoking while pregnant

www.womensnewbornhealth.com


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CTG Monitoring

A CTG (cardiotocograph) is used to assess your baby’s heartbeat. It helps us monitor baby’s heart rate and gives a print-out of the beat-to-beat pattern. The machine also monitors any contractions you may have. Many women attending the DAU will be monitored using a CTG as this tells us whether you and your baby are well. If you are unsure why you are being monitored please ask the staff.

Pink and blue straps are used to keep the monitor in place. You will be given a button to press each time you feel your baby move. This records each movement during the CTG monitoring. Checking your baby’s movements is an important way to check on the health of your baby (see Decreased Fetal Movements). A baby’s average heart rate is called the “baseline” and is usually between 110-160 beats per minute. During monitoring you will notice your baby’s heart rate rise above the “baseline”. This is called reactivity and it is a normal and healthy pattern. We expect babies to have periods of sleep (less reactivity) and periods of being awake (more reactivity). If your baby is having a sleep period you may need to be monitored for longer. This is not something to be worried about. While being monitored your baby’s heart rate may drop significantly below the baseline. This is called a deceleration. If a deceleration is seen the DAU staff will continue to monitor you and your baby closely. If we have any concerns about your baby’s heart rate we will inform you and explain whether anything more needs to be done. Please let us know if you have any concerns or questions about your baby’s heart rate.

Before coming to the DAU make sure you:

eat and drink as usual especially if you have diabetes

bring your yellow card

While on the CTG please:

do not eat or drink without checking with our staff first

avoid distractions such as using your mobile phone

focus on your baby’s movements and press the button with every movement


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Blood Pressure Profile (BPP)

Monitoring blood pressure (BP) is an important part of routine pregnancy care. The reading tells us how hard your heart is working to push the blood around your body. For most women their blood pressure will be slightly lower during pregnancy, but high blood pressure may sometimes develop. High blood pressure, also called hypertension, is when the blood is pumped with more force than normal through your blood vessels. This increases the pressure

inside the vessels. During pregnancy high blood pressure may be managed with medication and close monitoring of you and your baby. However, in some cases a serious illness called pre-eclampsia develops. Pre-eclampsia is where the high blood pressure starts to affect different parts of your body such as the liver,

kidneys, blood cells and brain. In serious cases it can cause seizures (fits).

If your blood pressure is high, you will be asked to attend DAU for a blood pressure

profile. If you are unsure why you are having these tests please ask the staff in DAU to explain.

You may have high blood

pressure if you notice:

severe headaches

blurred vision or flashing lights

in front of the eyes that last

more than a few seconds

severe pain under your ribs

(that is not due to baby’s

position)

sudden swelling of your face

or hands

feeling very unwell

What makes pre –eclampsia more likely to happen?

first pregnancy or pregnancy with a new partner

age over 40 years

being overweight

having a mother or sister who had pre-eclampsia

carrying twins or more

having high blood pressure before this pregnancy

having high blood pressure or pre-eclampsia in a previous pregnancy

having diabetes, kidney or immune problems


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What will we check?

Urine: Urine tests help us check how healthy your kidneys are. The kidneys clean your blood by getting rid of waste and passing it into the urine. Sometimes during pregnancy, particularly if you have pre-eclampsia, your kidneys pass lots of protein into the urine. This is not normal. We can look for it with a urine a dip-stick test or send the urine to the laboratory for further testing. The dip-stick test quickly tells us how much protein is in the urine. The result of laboratory urine test can take a few hours, but is more accurate (reliable) than the dipstick test. Blood: These tests check your kidneys, liver, and look at the different cells in your blood. The results take a few hours and it is important for you to stay at the hospital until they are checked and discussed with you.

Blood Pressure: Before checking your blood pressure we will ask you to sit quietly for 10 minutes. Your blood pressure will be taken three times with a five-minute break between checks. This helps us decide what your average blood pressure is. An hour and a quarter after your first blood pressure reading we will repeat the check two more times. CTG: If needed, your baby’s heartbeat will be monitored using a CTG (For more information on this please read, “CTG monitoring”). Medical Review: Once the blood pressure profile (check) is finished, a doctor will review your urine and blood tests as well as the BP readings and CTG monitoring. The results will be discussed and a plan will be made with you about your ongoing care. Some women with high blood pressure will have more than one blood pressure profile during their pregnancy. Comparing these profiles helps us decide if you are developing (getting) pre-eclampsia.

A High blood pressure (hypertension) in pregnancy factsheet is available on our website: www.womensnewbornhealth.com.

Urine test:

Dip stick test

Formal urine test Blood test:

Full blood count

EUC (kidney test)

Uric Acid (kidney test)

LFT’s (liver test)

BP check x3 +/- CTG monitoring BP check x2 Medical review and plan


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Decreased Fetal Movements Your baby’s movements are the best way to tell that your baby is healthy. You will start to feel

baby move around 16 – 24 weeks of pregnancy. In the third trimester, around 28 weeks, baby

will start to develop a pattern of movements. Each baby’s pattern is different and it’s important

to get to know your baby’s movements and what is normal for them.

Fetal movements can feel like a single kick, a flutter, a swish or roll

You should feel your baby’s movements all the way up until they are born. Decreased, changed,

or absent movements are not normal in pregnancy.

Common myths about baby’s movements:

It is not true that babies move less towards the end of pregnancy.

It is not true that the placenta stops you from feeling movements.

Movements Matter!

Do NOT wait until the next day or your next appointment to tell us you are worried about

your baby’s movements. Never feel silly coming into the hospital. Never feel that you are

over-reacting. If you are worried about baby’s movements call birth unit as soon as possible.

Do NOT compare your current pregnancy and baby’s movements to past pregnancies or

other people’s descriptions of a baby’s movements. Each baby is an individual and has their

own pattern.

Do NOT use home Doppler scanners. This is a medical device that needs training to use properly. While you may hear a heartbeat it does not mean that baby is well. Home Doppler scanners can falsely make you believe everything is okay and therefore can increase the risk of stillbirth.

What we do when you are concerned:

Fetal movements are a priority (very important) for us in DAU and we will have you assessed as soon as we are able. Heart rate monitoring: Your baby’s heartbeat will be monitored using a Doppler or CTG (see CTG monitoring information) depending on how many weeks pregnant you are. If you are still concerned about baby’s movements please tell us before we stop the CTG monitoring. It is important that you feel reassured.


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What if decreased movements continue to worry you?

If you are over 28 weeks pregnant and remain worried about their baby’s movements even after being monitored; staff will do further investigations (tests) to check for any problems that could be causing this.

Blood test: In some cases a blood test called a FMHQ (Fetal Maternal Haemorrhage Quantitation) will be done. This test checks if baby’s blood has mixed into your blood. If the test is positive it could mean your baby is unwell and that we need to do further tests.

Bedside ultrasound: Our doctors may want to look at your baby with our bedside ultrasound machine. This helps us check the waters around your baby as well as baby’s position.

Formal ultrasound: In some cases, a more detailed ultrasound will be required to check the welfare (health) of your baby. This ultrasound is performed outside the hospital and should be done within 24 hours. The report is then collected by you and faxed to the hospital to be looked at by one of our doctors.

If you have any other questions or concerns

about your baby’s movements please tell a staff member in the DAU.


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Waters Have Broken

From the beginning of pregnancy baby is surrounded by a bag of water called the amniotic fluid. This fluid should be clear in colour and it helps keep baby warm and protected. Around the fluid are two layers of membrane that look a bit like cling wrap. These membranes can break (tear open) before, or during labour or birth, releasing the amniotic fluid. You may feel this as a small constant drip of fluid or a large gush of water.

If you think your waters have broken and you aren’t in the hospital please put on a sanitary pad and call birth unit on: 8890 6663. (This number is also on your yellow card). When you arrive at DAU we will check:

What time your waters broke

That baby is lying head down

Whether baby is moving as normal

Baby’s heart beat using a CTG

Your temperature, pulse and blood pressure to make sure

you don’t have an infection.

Whether your waters have broken by checking your pad or by looking with a speculum. This helps us see the cervix and decide if there is amniotic fluid, mucus, urine or vaginal discharge present.

GBS Swab: If your waters have broken, we will take a swab (sample) from your lower vagina and anus to check for bacteria called Group B Streptococcus (GBS) which is:

A common bacteria found in the vagina and bowel

Generally harmless

Rarely, about 1% of the time, causes a serious infection in babies

Not a sexually transmitted infection

The swab result is usually available within 3 hours.

Going home: If you and baby are well, you may return home to wait for labour to start naturally. Most women will go into labour within 24 hours of their membranes rupturing. We will book a time for an induction of labour (starting labour going) for you. Usually this is within 24 hours after your waters break. We will give you a thermometer, an information sheet, and a sheet to record your temperature every four hours. You will also need to check the colour, smell, and amount of the fluid.

When your waters break after 37 weeks – Term PROM and Group B Streptococcus in pregnancy factsheet is available on our website: www.womensnewbornhealth.com.

It is very important to tell

us if:

The waters are brown or green

in colour

The waters smell bad

Baby isn’t moving as normal

You have a fever or feel unwell

You know you had a positive

Group B Strep (GBS) test this

pregnancy


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Postdates Assessment

Labour usually starts naturally between 37 and 42 weeks of pregnancy. However sometimes this does not happen and it becomes necessary to bring on labour – this is called induction of labour. Ideally we would like you to have your baby by 42 weeks as inductions after this increase the risks for both you and baby. At 41 weeks a postdates assessment will be booked in the DAU to make sure you and your baby are well. We will discuss management options and how you would like to manage your pregnancy care after 41 weeks.

If you have not received your Pregnancy Beyond 41 Weeks brochure, please ask our DAU staff

What we do in DAU

Your midwife or doctor will ask you to come to DAU on the day you turn 41 weeks pregnant for a post-dates assessment. The aim of this assessment is to check whether:

You are well

Baby is well

The placenta is still working well

Your cervix is ready for induction of labour Urine test: We will ask you for a sample of urine to do a dip-stick test in DAU. This gives us some information about your health including your kidney function. Observations: Your pulse, blood pressure, temperature and breathing rate will be checked. Bedside ultrasound: Our doctor will perform an ultrasound with our small portable ultrasound machine. This will measure the amniotic fluid around baby, a measurement called the Amniotic Fluid Index (AFI). The amount of amniotic fluid (AFI) around baby gives us valuable information about the health of baby and the placenta. CTG: A CTG will be used to check your baby’s heart rate patterns. This helps us to assess how your baby is doing. (Please see CTG information page) Vaginal examination: To induce labour your waters need to be artificially broken prior to starting your labour. To break the waters your cervix needs to be slightly open (this is called dilation). A vaginal examination is how we check whether your cervix is open enough. During the examination the midwife or doctor will feel the position of your cervix, how thick and soft it is, and if it is dilated. Usually we can also feel where baby’s head is.


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We use all this information to assess the cervix and give it a ‘score’ called a Bishop’s score. The score tells us whether we can break your waters. A score of less than seven means the cervix is not ready to have your waters broken. In this case we will discuss booking you in to have a “Foleys Catheter Assessment”. This is discussed in the Foley Catheter Assessment part of this package. If your bishop’s score is over seven you will be booked for an induction of labour. Medical Review: If you and your baby are well, an induction will usually be booked for around 41 weeks and 3 days of pregnancy (41+3). This will depend on your preference and availability of dates.

Day of the Induction:

On the day of your induction you will need to call Birth Unit at 5am in the morning. They will guide you as to what time to come to hospital.

Call birth unit if:

you are concerned about a change in your baby’s movements

you think you have broken your waters

you are having vaginal bleeding


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Foley’s Catheter Assessment

An induction of labour involves a medication (oxytocin) and the breaking of your waters. This is called artificial rupture of membranes. To do this the cervix needs to be slightly open and soft. If your cervix is not open enough you will be asked to attend a ‘Foleys catheter assessment’.

Foley’s catheter assessments will take between 2 – 3 hours so it is important for you to arrive on time for your appointment.

What we do in DAU

The catheter is used to open and soften your cervix, also called dilating the cervix. This will be done in the DAU on the day before your induction.

Observations: Your pulse, blood pressure, temperature and breathing rate will be checked. CTG: A CTG will check your baby’s heart rate patterns. This tells how your baby is doing. (Please see CTG information page) The CTG will run for at least 30 minutes. Vaginal examination: A midwife or doctor will feel the position of your cervix as well as how thick, soft and open it is, indicating whether your cervix has changed since your last examination. They can usually feel where baby’s head is too. Foley’s catheter insertion: Is done with the help of a speculum, the metal or plastic

instrument that helps us to see your cervix, like when you have a pap-smear. A thin soft tube is inserted into your cervix and a balloon at the end of the tube is filled with a small amount of water. This balloon will put pressure on your cervix that helps the cervix to soften and open so that your waters can be broken on the day of your induction. The tubing will be taped to your leg to keep it in place and prevent the balloon from moving. Second CTG: A second CTG will then be done for at least 60 minutes to tell us that both you and baby are well.

Change of plan: In case plans change and we would like you to stay overnight, or bring your induction forward to the day of the catheter assessment, please bring your packed bags and leave them in the car.


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What happens when the catheter falls out?

The catheter usually falls out within 12 hours of being put in. This is a good thing as it means that your cervix has opened and softened. When it falls out you can throw the catheter away. If you are worried about

Vaginal bleeding

Abdominal pain

Decreased or changed fetal movements

Your waters having broken Call Birth Unit straight away! Otherwise, ring birth unit at 5am the next day.

Call birth unit if:

baby is not moving or moving less than normal

you think your waters have broken

you have vaginal bleeding

you feel severe abdominal pain

Please note:

Vaginal bleeding – It is common to

have small amount of bleeding

after insertion of the catheter but

if it continues please tell us.

You think your waters have

broken – this may happen after

the catheter insertion. Please tell

staff in the DAU if you believe this

is the case.

Decreased or changed fetal

movements – Please let staff in

the DAU know if you notice

decreased or changed fetal

movements.

Uterine activity – It is very

common to feel cramps or period

like pain after catheter insertion.

This will usually settle before you

go home but if the pain is getting

worse please tell staff in the DAU.

what we do in dau - ministry of health

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