I’m now going to invite Ms Elizabeth Kleinig come here. As most of you guys know, she is
the clinical manager of maternity at Calvary North Adelaide for some ten years. And Liz
became an RN at Royal Adelaide Hospital and has over 30 years of midwifery experience
in Scotland, Alice Springs and Calvary North Adelaide and so has an extensive personal
experience of the changes in perinatal care, particularly outside the public hospital system.
Thank you Liz.
One finds it very difficult to say no to Brian Wheatley, so I find myself standing here.
I’ve worked in midwifery for 30 years and over that period of time I’ve seen quite
a marked difference in the way we do things and the age of women who present to have their
babies – first babies, second babies. Just anecdotally, my mother had me when she was
42, but I was number five. So that’s a slightly different perspective to now where people
are perhaps having their first children at this later age in life. So anyhow, I thought
I’d just have a look at some of the stuff that’s out there. I saw Tamara, she was
47, she’s a teacher. I figured she’d have pretty good access to the internet and that
she basically would be doing a little bit of research, maybe at school or after-hours,
and there was a huge amount of stuff that she could come across telling her about what
could be expected at 47. She has an advantage – she’s had a baby before – but there’s
all sorts of information. Whether the information she gets from the internet or from any of
these websites, older mothers, mothers over 40, Amazon book store, mothers 35+ - whether
that’s all relevant for her is another question. But I suspect she’s been there and read
that and had a look and wonders why perhaps things aren’t happening the way she might
have thought. Anyhow, Tamara – she comes in labour and she’s had her baby. And, as
has been alluded to by the previous speakers, she has some medical issues. So I’m looking
at this mainly from a post-natal sort of perspective. But we’d be really concerned for this woman
because she’s not only got essential hypertension, but she’s been showing signs of pre-eclampsia
as well. So once she’s had her child, I think we’d really need to look at her very
closely, watching her blood pressure, need regular checking, look at the other sorts
of aspects – headache, her visual disturbances, whether she’s got any epigastric pain, the
basic midwifery stuff that we do looking after her. And then just general observations – her
loss, will she be at a greater risk of post-partum haemorrhage because of the myometrium. So
I would be looking at that as well to make sure that all those things are covered in
her initial post-partum period and also in the next couple of days.
The other thing that came to mind when we were just looking at this case was she’s
got a pre-term infant, and Chris has already alluded to some of this stuff that I’m going
to look at. Size and gestation of this baby; how long will the baby be in special care;
will she have to go home before the baby is ready to come out of special care and then
come back to room-in or whatever? Then the separation issues that go along with that.
But maybe she’s got some issues around has my age caused this to happen, and I think
we’d maybe need to look at that very carefully and help her around those sorts of issues
as well because even though she’s spontaneously pregnant, she may have thought that this may
have had some impact on the fact that she’s got a pre-term birth, maybe feel a bit guilty
there. A lot of work will go around lactation, assuming that she wants to breastfeed, assuming
that she will want to breastfeed, but she will most probably want the best for her child.
Has she successfully fed her first child? Does she remember what it’s like? Does she
know what will happen? Does she remember the lactation process? Will it be possibly impeded
by medical issues or tiredness or medication? How is the baby being fed in the nursery?
Is it going to be gavage fed or whatever? Is the concept of skin-to-skin new to her?
She had her first baby 19 years ago. Well, that was most probably not heard of or not
done very frequently. But nowadays putting the baby onto the skin-to-skin to help may
have some impact for her. She may not like it, but it’s been shown to be beneficial.
And to encourage and to commence expressing to give the best start for this baby. All
this while she’s thinking about I’ve had the baby, I’m tired, I’ve got all these
other things that I’ve got to do and there’s a lot to go on there.
And then the other considerations we looked at, which I’ve sort of touched on, how has
the care changed over the time difference between her first child 20 years ago? Will
she adapt to that change? I suspect so, but there’s lots of things that she may have
to look at. Perhaps the less rigorous approach to perhaps four hourly feeding, which was
perhaps more common then, and it’s certainly more promotion of demand feeding, but making
sure that baby still gets the right amount of feeding. How has mum changed in that period
of time? She’s obviously changed a lot. What sort of education do we need to do with
this mum around breastfeeding? Does she actually know about the new sorts of things re safe
sleeping? So there’s a whole thing to look at there. She may have well put her first
child to sleep on its tummy on a sheepskin 20 years ago. Well, that’s certainly not
going to happen now, so we have to relook at that. She’s going to be putting the baby
on its back, not overly wrapped – all that sort of thing. So there’s a whole aspect
of education there. Has she handled a small baby recently? Does she remember how to bath
a small baby? So there’s those little things about teaching her to look at how to handle
a baby, how to bath a baby, how to change a baby. How do her family view her with a
new baby? Is the 19 year old really excited or is the 19 year old a bit, you know, “my
mum’s had a baby, that’s 19 years ago, she’s actually had sex with...” You know,
how does all that impact on the care that’s going to happen? She’s likely to be extremely
tired. Everybody is tired when they have a baby. It’s hard work. Even more-so when
you’re 47. What sort of support does she have? And as somebody alluded to before, her
parents are likely to be quite elderly. Are they physically able to support or are they
even alive to support? So there’s those sorts of things that she may have to think
about. And how does she think she’s going to manage when she goes home? What sort of
things are going to happen? It’s a total lifestyle change. So all those sorts of things
we try to address in the first couple of days in hospital.
This is a really brief overview, and a lot of you out there have got a lot more experience,
or as much experience, as I have. So if you’ve got any other comments to say, I’d really
appreciate them. And then I just thought I’d quickly look at some very famous, or perhaps
not so famous, older women. As you can see, there’s Cherie Blair and there’s just
some odd pictures around about. And just to end up, we have alluded to the
fact that some of what we’re thinking is not suitable for older parents, and I did
like this one.