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Caesarean Section

Most patients express a preference for a planned vaginal birth unless there are strong and compelling reasons to birth via Caesarean section. Sometimes Caesarean section is medically necessary from the outset, for example where the placenta or babies umbilical cord covers the cervix. However sometimes women elect to birth via Caesarean section as a preference. The personal reasons for this usually reflect a well thought through and considered decision. Dr Matt sees it as his responsibility to brief you on evidence-based data about the pros and cons of both approaches, then to help individualise this information so you can make a well informed decision about your preferences.

As wonderful an experience as vaginal birth can be, Dr Matt feels a Caesarean section birth need not be a cold and depersonalised experience for parents whether it be elected or required. Dr Matt Thyer has developed a sterile technique to allow parents to first see their baby delivered, and then accept baby into their arms at Caesarean section provided baby has transitioned well and there are no compelling medical reasons to do otherwise. 90% of Dr Matt’s Caesarean births are conducted in this way and Dr Matt feels it really “makes the moment” and gives mum that first touch, the skin-to-skin that is so important for bonding and breastfeeding.

Recovery can be difficult with generally more limited mobility than that after vaginal birth, however within 24 hours you will have enough mobility to toilet, shower, pick up and feed your baby. This is where post operative analgesia is key to your recovery and the perception of your experience. There is a considerable effort that goes into optimising and balancing your analgesia with your mobility after Caesarean section. However, in cases where you feel your analgesia is inadequate it is very important to get straight onto this by letting your midwife and Obstetrician know. The specialist Pain team will often review your analgesia to support you through the first week following your operation. After one week most people are down to basic analgesia.

It is well known that Caesarean section can delay the onset of milk production compared with vaginal birth. This is usually short lived and with support from Midwives is rarely a problem to establishing successful breastfeeding.

Patients need not feel concerned about their Caesarean section scar. The site of the Caesarean section wound is just above the pubic bone. Dr Matt tries to keep his scars to a very high cosmetic standard; small as is safe and possible, neat, symmetrical, horizontal, along current skin creases where present, and an attempt to try for a wound low enough to be hidden under underwear or bathers. The dressing management Dr Matt employs is designed to maximise healing and reduce scarring as much as possible.

Whichever birthing option you elect for Dr Matt Thyer Perth Private Obstetrician and Gynaecologist is there to support you and to help achieve a delivery that is safe for mother and baby. 

Private Obstetrician or Public Pregnancy Care?

Private Perth Obstetrician and Gynaecologist Dr Matt Thyer offers care at St John of God Subiaco and Mount Lawley Hospitals

Birth rates in Western Australia have hit a decade-low with 31,709 babies recorded born in 2022, with ever so slightly less babies born 10 years ago in 2012. In Western Australia there was a 7.7% drop in births overall between 2021 and 2022. Birth rate has multiple drivers, however a drop of such substantial proportions in the last year is thought to be primarily due to the escalating costs of living, housing affordability in particular.

This of course calls into question the current cost of Private health insurance, Private Pregnancy care and whether this makes cost-effective sense. People will often compare the cost of an iPhone or a new TV to the similar “out-of-pocket” cost of Specialist Obstetric pregnancy care to help put into perspective the “value-based” decision that one must make. The benefits of Private Obstetric care I have discussed below and is by no means exhaustive in detail but outlines the key benefits as I see them.

At the heart of it Private Specialist Obstetric care provides women and partner’s with a highly trained specialist Obstetrician that has trained for at least 6 years in their chosen specialty and who has experience in detecting, managing and treating complicated and life-threatening emergencies for mother and child. Patients that have been there can appreciate this benefit. The Public Hospital system is the training ground for junior doctors and other health providers, so there is no guarantee someone with specialist expertise and experience will attend to you during your pregnancy or delivery.

Obstetric Ultrasound is indispensable in detecting subtle complications to do with placenta and baby before tragedies or life-threatening emergencies occur. Specialist Obstetricians offer a detailed ultrasound review of your baby at each appointment. Unfortunately the Public hospital system simply does not have the resources to enable this level of care for the vast majority of patients.

Private patients have the choice of longer hospital admissions to allow support for breastfeeding and adequate postnatal analgesia. Your partner (or support person) can stay with you during your admission. Outside of visiting hours post delivery partners must leave the hospital. 

Your private Obstetrician will see you early in pregnancy to help set you up for success including ensuring your baby is in the right location and healthy from the beginning. Occasionally pregnancies get stuck in the fallopian tubes (2% of pregnancies) and a substantial proportion will be non-viable or silently miscarry . It is better to detect these complications early so a plan can be made to optimise care and keep you safe from life-threatening emergencies. Dr Matt Thyer prefers to see his patients for the first time just after 6 weeks gestation for this reason.  In the public hospital system patients will be reviewed for the first time by a caregiver after 20 weeks gestation.

Your private Obstetrician will see you at every appointment through to delivery and post birth. Public hospitals cannot provide this continuity of care and opinions and plans can often change from one health provider to the next causing confusion and a lack of confidence in care. 

There is more flexibility around your antenatal appointments with your Private Obstetrician rather than at a public antenatal clinic. It’s much easier to make appointments to suit you and your partner with your private Obstetrician such as early morning or late evenings and where emergencies arise your private Obstetrician will always find a spot for you. Care is more personalised in this way.

Your Private Obstetrician will help individualise your plan for a safe and successful birth. A significant amount of time is invested into discussions around your circumstances and how these may affect your expectations around pregnancy and birth. There are simply not the resources available in the Public system to accommodate or incorporate your desires and wishes to such a degree.

Underlying the quality of service offered by your private Obstetrician is that they are working for you, being paid by you and in this sense responsible to you. This belies a very strong motivation to provide the best possible service to patients.

More important than any other benefit I believe is the trust that develops between a patient and their private Obstetrician over the course of a pregnancy (moreso after subsequent pregnancies). Circumstances can change so quickly in pregnancy and especially during birth, so it is reassuring that you have the private Obstetrician you have come to know and trust in your corner who will genuinely support your interests, fight for your wellbeing and that of your child, and stick with you through the good and difficult times.

Dr Matt Thyer Private Perth Obstetrician and Gynaecologist strives to provide high-value affordable private Obstetric care of a high standard at Subiaco and Mount Lawley St John of God Hospitals in Perth Western Australia. Please feel welcome to enquire as to how Dr Matt may help you through your pregnancy journey.

Sexual Dysfunction after Childbirth

Private Perth Gynaecologist Dr Matt Thyer offers care at St John of God Subiaco and Mount Lawley Hospitals

Not uncommonly women may site concern about sexual dysfunction following vaginal birth. Concerns such as a lack of sexual interest (libido), pain at the entrance of the vagina, occasionally urinary or flatus incontinence, excessive laxity, reduction in sensation and pleasure. This can lead to reduced confidence with intimacy and lowered self esteem. Particularly where breast feeding is involved there is a significant reduction in natural ovarian oestrogen’s that are produced compounding vaginal tissue sensitivity, dryness and atrophy. Sleep deprivation due to parenting demands will commonly reduce libido.

Generally your Gynaecologist will recommend at least 6 months of observation, disciplined pelvic floor exercises and expectant management following childbirth to see if these problems self-resolve. A Women’s health Physiotherapist can guide your recovery in this way. Occasionally vulval or vaginal oestrogen’s may be of benefit, however caution is required in the context of ongoing breast feeding. 

However despite disciplined exercises sexual function may be sub-optimal. This is because much of the pelvic floor and fascial/connective tissue damage occurs away from the obvious site of injury at the perineum and remains hidden underneath intact skin in other areas of the lower genital tract, commonly between the bowel, bladder, bladder neck and vagina. Perineal tissue melding may be also sub-optimal resulting in long term problems such as inadequate perineal support, a capacious opening of the vaginal entrance, scarring and hardening of tissues that can result in excessive sensitivity and pain.

Where conservative measures prove ineffective or suboptimal, surgery is a reasonable choice of treatment with either scar revision, perineal rebuilding, bladder neck/urethral reconstruction or vaginal repair. The primary consideration here is about further childbearing, as subsequent vaginal delivery may result in repeated or worsened damage. Some women decide to delay surgery until childbearing is completed, while others will elect for repair and consider any future birthing via Caesarean section. 

There are costs and benefits to both approaches. The primary cost to waiting until childbearing is completed is the length of time taken be relieved of symptoms. There is also the argument that delivering further children vaginally will worsen lower genital tract symptoms. Conversely, recovery from pelvic floor surgery is a long process and women need plenty of support especially where parenting demands are often at their peak.

The optimal approach depends on your individual circumstances and desires. However in determining the correct approach for you it is important for you to seek professional advice, individualised to your circumstances that is truly aimed at your medium to long term benefit.

Dr Matt Thyer Private Perth Obstetrician and Gynaecologist has expertise in addressing sexual dysfunction following childbirth and regularly performs pelvic floor and vaginal surgeries to repair birth related trauma. Feel free to contact Dr Matt Thyer to help you navigate any concerns you may have following childbirth.

Vaccinations

Pre-pregnancy vaccinations:

Prior to pregnancy you may need to consider vaccinations that protect you and your baby during the pregnancy period. These include the measles, mumps and rubella (MMR) vaccine, the chicken pox vaccine and hepatitis A/B vaccine. If you have had chicken pox in the past, you will be protected. However, if you have had a vaccination in the past for the above viruses, your immunity status should be checked, and a vaccination recommended if this is sub-optimal.

There are other vaccines important for your general health that should not be administered during pregnancy, but may be considered prior to pregnancy, including the meningococcal vaccine, and the HPV vaccine. A recently released vaccine protects you against nine of the most common HPV viruses that cause 90% of cervical cancers and genital warts. Your GP can advise you of your suitability for these vaccines.

Whooping cough and influenza vaccinations:

It is recommended to be vaccinated every pregnancy for whooping cough and influenza, unless you have an allergy to these preparations.

Whooping cough is relatively common infection in the community, across all ages, and it is easily passed by droplet spread from infected individuals. It can cause a nasty respiratory infection to your newborn requiring hospitalization, and cause long-term lung disease in your child. In severe cases a newborn may not survive the infection.

The good news is that your newborn can be protected by having a whooping cough vaccination, optimally given between 28-32 weeks of pregnancy. The antibodies you produce against this vaccine cross the placenta, enter the babies circulation and protect your baby for the first 3-4 critical months until your child has begun its own vaccinations (the DTTP vaccine). Your partner and any other close contacts with your newborn are also encouraged to have a booster every 5 years in order to create “herd immunity” around your child.

The “flu” is a particularly nasty infection to acquire during pregnancy and pregnant women are considered high risk. Pregnant women have an altered immune system and later in pregnancy have compromised respiratory capacity. If you are pregnant, you should take the “flu” very seriously and check in with your GP or obstetrician.

Fortunately, the flu vaccine is available in Autumn every year and is recommended by Australian medical authorities. Pregnant women may consider receiving the flu vaccine at any gestation during their pregnancy and it bears no harm to you or your baby as it only contains the “dead” influenza virus. Like the whooping cough vaccine, the antibodies you produce against the influenza viral strains will cross the placenta and protect your baby at birth.

Other important precautions that you can take to reduce the risk of acquiring a nasty respiratory infection are regular washing of hands before touching your own, or your child’s, face. Others who clearly have signs of the flu or a respiratory tract infection should ideally not handle the child.

COVID 19 Vaccination and Boosters

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommend women to consider vaccination for Covid-19 (Pfizer preferred) and a booster if it has been 6 months since your previous vaccination. This can be considered prior to and during pregnancy should you meet the requirements and conditions. The evidence appears to weight in favour of vaccination with the benefits to mother and baby outweighing the risks. You should consult your doctor for individualised advice about this vaccine.

Gratitude to Mr James Harrison for his life-saving plasma donations

81 year old Mr James Harrison retired from plasma donation last week after six decades of selfless, life-saving contributions.

James Harrison became a donor after he underwent chest surgery and received donated blood — he felt that he needed to pay it forward. His donations were critical to the success of millions of pregnancies and the lives of millions of babies as they contained antibodies that could be purified into anti-D.

If your blood type is rhesus negative you may need to have anti-D protection during pregnancy. Anti-D is a purified antibody harvested from human blood donors like James Harrison. It may be required when there are risks of blood mixing between you and your baby. For example, as a result of abdominal trauma, bleeding in pregnancy, amniocentesis and after delivery of your baby. It may also be given as a preventative medication at 28 and 34 weeks of pregnancy for further protection. There are some circumstances in which anti-D may not be recommended for a rhesus negative woman, however these exceptions are best discussed with your medical practitioner.

We are deeply grateful to donors like James Harrison, who have enabled safer pregnancies and healthy babies.

Thank you James!