Q&A with Obstetrician Suzana Kotevska
Today, I am chatting to Melbourne Obstetrician Suzana Kotevska who answers some of the most important questions mamas need to know.
Dr. Suzana Kotevska is a highly experienced & passionate Obstetrician and Gynaecologist in the heart of East Melbourne. She offers a range of personalised services tailored to every woman’s needs. With decades of experiences, ensuring the best care whilst providing the utmost professional and personable assistance for women and baby”
Q&A with Melbourne Obstetrician Suzana Kotevska
Question 1: Does a fast first labour mean second time will be faster?
Answer: I wish I had a crystal ball to be able to prepare my mums to be 100% for the type of labour and delivery they will have, however this isn’t always possible.
Generally speaking , the first labour can be a good prediction for the subsequent delivery, but then on the other hand it could be completely different, meaning a longer labour than your first (if bigger baby for example second time)
It would be helpful to see your birthing chart, to see what was the time of active labour e.g. 3cm to 10cm. The size of the baby can contribute to the labour length. Plus many other factors.
Delivery is individual to every woman’s previous labour and current pregnancy situation.
Question 2: How do I avoid posterior labour?
Answer: The baby is in posterior position in about 5-8 % in the first time mums, and when labour begins, the uterine contractions make the baby`s head turn clockwise or anticlockwise. We can not “make” baby move the direction we want.
Normally, when we have “posterior” labour, it may be longer, more back pain, presenting part may be higher for longer and many women opt to have epidural for analgesia.
Sometimes we try and change the woman’s position (midwifes in delivery suite are very good in assisting with this). Sometimes baby does rotate as the woman is in second stage when the baby fits well the birthing canal and outlet.
However sometimes we need to help to rotate the baby`s head, sometimes by a simple manual rotation or sometimes we may use a Vacuum or forceps.
Some women may need to end with an Emergency Caesarean section if the presenting part is too high or not deliverable vaginally.
Question 3: What are some tips for recovering my c-section wound?
Answer: Keep your wound clean and dry. Wear loose clothing and look for signs of infection (such as redness, pain, swelling of the wound or bad-smelling discharge).
You will need to go see your obstetrician or midwife.
The incision will heal over the next few weeks. During this time, there may be mild cramping, light bleeding or vaginal discharge (normal up to 6 weeks), as well as pain and numbness in the skin around the incision.
Most women will feel well by 6 weeks postpartum, but numbness around the incision and occasional aches and pains can last for several months.
Question 4: What is covered at the six week Doctor appointment check up postpartum?
Answer: For my patients I cover everything from going over their birth, assessing their mental health (this is very important and compulsory), checking any wounds, pelvic strength, contraception or their next pregnancy plans and answering any of their concerns… plus a CST if they’re due for one. I also discuss contraception and/or plans for future pregnancy etc.
It’s not a quick ‘in & out’ appointment, I want to make sure all of my mums are more than just OK!
Question 5: How to prepare to attempt vaginal birth after 1st was 3x tear & PPH?
Answer: I usually go through the first birth, see what was the size of the baby`s head, what was the delivery type, how did she recover ( is there any residual issues, like faecal incontinence etc.) Sometimes the woman has already seen a colorectal surgeon and he or she has given already their advise. Sometimes the advise may be that they need to have planned CS.
However I always discuss their fears and expectations and what we historically always did is plan vaginal birth and prepare the woman to have episiotomy when the baby`s head is at the perineum to avoid the tear through the previous scar. Normally, at the next labour the perineum is more stretchy and usually they end up with nice vaginal delivery.
Question 6: Is it safe to push through pelvic discomfort while running 12 weeks postpartum?
Answer: If she has severe pelvic discomfort then I would not advise that she runs. There are other safe and pleasant exercises and the woman can still be active and avoid the discomfort.
Such as the exercises that Kerryn at PregActive has crafted. If you are still unsure please consult your health care professional.
Question 7: When do we need to start sleeping only our left side in pregnancy?
Answer: If your BMI is higher you will need to stop sleeping on your back sooner than someone with a lower BMI.
However generally my recommendation is to start sleeping on your side from 20 weeks gestation (either side).
If for example you find yourself on your back, just turn onto your side, do not panic and just continue to sleep.
Question 8: Can blood tests tell if you’re pregnant with twins?
Answer: When a woman is carrying a twin pregnancy, she will generally have a higher Beta HCG result than a woman whom is pregnant with one baby. However this isn’t a guarantee, as hCG levels vary for every woman. Only an ultrasound can confirm a twin or multiple pregnancy.
There are certain conditions that can be associated with very high levels of Beta HCG, like for example Hydatidiform mole.
Question 9: What are the best ways to minimise tearing?
Answer: To reduce the risk of having a 3rd or 4th degree tear, you will be offered the following during birth:
1. a warm cloth applied to your perineum when your baby’s head starts to show (softens the skin).
2. help with breathing techniques to have a slow, controlled birth.
3. the doctor or midwife will gently support your perineum with their hands during the birth of your baby’s head.
4. you may require an episiotomy.
Another way to potentially reduce the chance of tearing during birth is doing perineal massages starting from around 34 weeks gestation (rub a pregnancy safe oil into the skin between your vagina and anus once or twice a day). Make sure you consult your health care professional about this.
Question 10: How long does it usually take to conceive if trying for a baby?
Answer: Just 20% of couples actively trying to conceive become pregnant in the any month cycle. For 80% of couples it takes up to a year to conceive. So be patient and try not to stress if you don’t conceive straight away.
Question 11: Can I get the whooping cough vaccine now for a family baby and get it again when I’m pregnant?
Answer: Pregnant women are ideally vaccinated between 20-32 weeks gestation of every pregnancy, regardless of the time between pregnancies. This provides the best protection for your baby.
Generally the answer is yes, you will need a booster once you are pregnant even though you had one pre-conception. However every patients situation is monitored individually.
This is general advice only. Please consult your doctor for personal advice to your specific situation.