There already is an age limit. You can’t treat anyone beyond the average age of menopause
in this state, so 51 is the cut off.
The women in their 50’s that I’ve seen have all been overseas for donor eggs.
Yeah, but that’s an arbitrary cut off that the government have made, I mean, why it makes
biological sense that at 52 you’re incapable of parenting and at 50 you are, I don’t
know.
So I just wanted to ask a question, it seems quite clear that older is not better and it
might be even worse, and we are making women aware that there are treatments available
with IVF and other things, but it seems to be like a really big public health issue.
Are we as a medical community, actually doing something to make women aware that this is
actually a problem because the women might actually change their mind.
I might answer that one. Eleven years I ago I came up with the egg timer test which is
the AMH test that I wanted to increase women’s awareness of running out of eggs and such
and I went on Kerri-Anne Kennerley’s TV show and did a lot of interviews. In some
respects I was attacked for that because I had female reporters saying I was trying to
keep women barefoot and pregnant in the kitchen and such and so forth. So I think there’s
a bit of resistance there in some parts of the community to hear this message. I think
we are trying to get it out there, but it’s just not getting through and I think it’s
because of that natural human tendency to think ‘It won’t happen to me because my
mum had three kids’ or ‘I go to the gym regularly.’ I think we are trying, the Fertility
Society of Australia had a public campaign about this a few years ago, but it’s just
not remaining the forefront of the public’s mind.
I think to a certain extent it’s also viewed as a woman’s problem and - I think it’s not just women that should
be hearing this message, it is a society message, you know, blokes are part of a couple and
at some stage they also have to be on board with the whole baby idea. I think also the
idea that there is never a good time to have a child, there is never a time when it won’t
interrupt your career needs to probably be made plainer to girls in high school. I think
by the time they’re out with a few years of work under their belt and have got into
the swing of disposable income and few commitments and on the career trajectory, suddenly there’s
an awful lot to have to give up whereas if they’d started their plan at the beginning
of that, they might have been able to factor it in.
Being a primary care practitioner, I think that one of the really important things is
that we have an opportunity when we see young women, especially those in their late 20’s,
early 30’s when we’re doing their regular checks, to actually bring up the whole issue
of what were their thoughts, you know, are they planning a family; when are they thinking
of planning a family, and that’s an opportunity for us to educate, but of course that takes
time as well, and knowledge for the practitioner but I think that’s a very important time
to do it as well.
Hi, this is a question about gestational diabetes. I haven’t been a midwife for very long,
but even I’ve noticed that there seems to be an increase in the amount of women who
have it. I was wondering has the rate been lowered, like the test, the number?
To answer your question, yes sort of. The new criteria for diagnosing gestational diabetes
has been argued over for the last three years, but we are moving towards a formal acceptance
of the lower fasting target and the slightly higher two hour target in South Australia.
All the public hospitals have signed up to it. But even before that came in, we’ve
seen an increase in the rates of type 2 diabetes within our community and the rates of gestational
diabetes in the antenatal clinics have paralleled that increase, so it has been increasing,
predominantly because people are getting heavier and a bit more sedentary. When I first started
practice, people would tell me that their grandparents had diabetes, now it’s their
parents, their siblings and a lot more Caucasian women are coming into pregnancy already with
type 2 diabetes.
Thank you.
Erin also about diabetes, those increased rates in Vietnamese and South East Asian women,
were they women in Australia, resident in Australia or they were…
And do they have similar rates in their own, original countries?
It’s a little difficult to say, partly because the screening program may not be as extensive
and partly because these are women who are born somewhere else, but have moved to Australia
and they might not have had pregnancies in those countries, but I think there’s probably
a higher nutritional level in Australia and we do see probably more gestational diabetes
because we look for more, so there’s those two factors. That probably didn’t answer
your question.
Oh no it does. I wondered whether it was a factor of them not being adapted to our diet,
having a different diet from their…
I’m not sure that anyone is adapted to our diet. [laughter]
That’s true.
So Tamara, Tamara will see Doctor Clark again and be put on medication. Pregnancy progresses
well, normal morphology ultrasound, her blood pressure remains 135-150/85-95 and she’s
now on triple anti-hypertensive therapy. Routine growth scan, ultrasound scans have been normal.
She comes into clinic at 36 weeks and says that she’s really feeling unwell, has headaches,
visual disturbances and her blood pressure at that stage is 160/110. Under examination
there’s a cephalic presentation, the symphysio-fundal height is 36cm which is the normal size. She
will have some bloods and investigations done, and her urine protein:creatinine ratio is
45, so she has some proteinuria. Her creatinine is 71, just slightly in the higher range.
Urate rate is 0.42 which is high and the remainder is normal. She will be admitted to the ward
for observation but her blood pressure remains quite high and is very difficult to control,
and hence the decision for induction of labour. Now I’m going to invite Professor Robert
Bryce to come up now and until recently Professor Bryce was Clinical Director in Obstetrics
and Gynaecology at Flinders Medical Centre. He has had a broad interest in obstetric outcomes
over many years and in particular has reviewed and published the impact of age on first-time
mothers, birthing and experience based on local data. Professor Bryce.