PHONE (do not text) for urgent care - midwifery emergencies or active labour.

If I am off call my phone is automatically answered by the on call midwife/back up. Occasionally I will put my phone into silent mode. If you are calling with an EMERGENCY or STRONG LABOUR you should call again immediately. Repeat phone calls (within 3 minutes) will break through the silent mode. Be mindful that your call will be interrupting another person in labour, much needed sleep or another appointment. It is ok to leave a message or send a text/email if your call is not urgent. See below for guidance.

Contacting your midwife in pregnancy

Contact during pregnancy can be split into 2 categories; urgent (potential emergency/potential threat to life) and non-urgent (general). For urgent matters you must PHONE me. Non-urgent queries should generally wait until your next appointment in clinic but there are some instances when a text or email would be appropriate.

Urgent Contact - Phone call required
Urgent contacts are limited to the following situations

• If you have significant vaginal bleeding. Fresh red blood, especially with abdominal cramping/pain. 
• If you notice a change in your baby's movement pattern AND you are 28 weeks or more. 
• If you develop signs of pre-eclampsia. A combination of any of the following
  • Frontal headaches - not helped by panadol, rest/sleep and hydration
  • Visual disturbances - blurring, spots or flashing lights/sparkles
  • Sudden swelling in face, hands and feet
  • Indigestion-like pain that is not associated with eating
• If your waters break (an initial gush followed by consistent/regular trickling) AND
  • You are less than 37 weeks
  • You were told at your last appointment that your baby is/may be in a breech position
  • The fluid leaking is any shade of green
• If you are in labour before 37 weeks

General Questions - self care/next appointment/email/GP
It is normal to have questions during pregnancy. Remember to use the information available via the smart start website. Many discomforts of pregnancy are normal but can be helped with a bit of self care. There are many helpful suggestions there that you can find via the information section.

Most other concerns can be addressed at your scheduled midwife appointment, however a text or email is appropriate for the following 

• Constipation (common when pregnant and/or taking iron tablets)
• Haemorrhoids (piles). Often cause pain or bleeding when passing a bowel motion (poo)
• Anaemia (low iron).  
• Thrush or other unusual vaginal discharge
• Urinary tract infection symptoms (including an increased need to pass urine with low volume).

I will generally respond between 9am and 4pm Monday to Thursday (between other appointments, visits to new mums/babies, labour care etc). Please be patient about a reply. I will only respond whilst on call and not during labour cares or other visits. If you feel unable to wait, or have concerns not mentioned, please book to see your GP for advice or treatment. 

Often emergencies require you to meet me at the hospital as soon as possible. Contact me without delay as this allows me to make the safest plan for you and your baby.

Calling in Labour

Phone once labour is established. 

If this is your first baby/labour
You are waiting for strong regular persistent contractions 

• Strong - lasting 80-90 seconds each
• Regular - a new one starts every 2-3 minutes
• Persistent - the above pattern for at least 3 hours

If you have been through labour before
Trust your instincts and your body. You will recognise labour. Think about your previous birth(s) and call when you feel certain labour is established. You can use the information opposite as a guide if you need to. 

It is not necessary to advise me of early labour after hours. A text is acceptable if you wish (text tones are turned off) but please do not phone until labour care is needed in strong active labour. Disrupted sleep increases fatigue and it is critical that we are rested enough to recognise an emergency in labour and perform life-saving cares if needed. Read information supplied about labour so you recognise the difference between early labour and active labour.
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If your waters break 
You do not need to call me after hours if your waters break (unless the fluid is green, your baby is breech or you are less than 37 weeks). Note the colour (clear, pinkish or cloudy is OK); note the time (sometimes a text can be useful in this case - I will not hear it but I will see it when I wake up); save all the pads you use. You may have irregular contractions or nothing at all. Try going back to sleep and contact me in the morning if labour doesn't establish (plans for induction and IV antibiotics may be needed). Do not have intercourse (sex) and do not have a bath (showering is OK). 

Do not present to the maternity ward in labour without calling me first

Contacting your midwife after birth

Once you are home, in the weeks following birth, you should phone me if you notice

• a significant increase in your vaginal bleeding, an offensive/rotten smell, or cramping increasing in intensity. (After pains are normal but should subside over a few days not become worse. Panadol is encouraged for afterpains)
• You develop a fever/high temperature. If over 37.5 degrees celsius, cool yourself down by removing layers, cool cloths etc. If over 38 degrees celsius take some panadol and phone me
• a hot spot or intense pain in your calf or thigh or sudden swelling of only one leg
• a hard lump in your breast which is painful to press or when feeding, it will likely feel hot and be red as well
• any signs of infection in your stitches or section wound - redness, oozing pus, or offensive smell
• any thoughts of harming yourself or your baby. You can text 1373 if you are feeling low and need support but severe depression needs the engagement of other services

If you have any concerns about your baby call PLUNKETLINE in the first instance. 0800 933 922. PLUNKETLINE is a free parent helpline, available 24 hours a day. Your call is answered by a nurse and they will offer advice or direct you to seek medical care if needed. You do not need to be registered with plunket to be able to use this service.