Managing the unexpected

Some babies are smaller than average but healthy while others may be smaller because the placenta is not working as well as it should. In the case of the placenta not working as well as it should, this is called fetal growth restriction (FGR).

Whether your baby is just smaller than expected or if they are growth restricted, all small babies need to be monitored and investigated.

If growth restriction is suspected:

• you may have extra ultrasounds to monitor growth
• your care team will discuss timing and type of birth
• your baby may need extra support after birth

What causes fetal growth restriction

What causes a baby to be growth restricted is complex and not fully understood. More than 50% of growth restricted babies are born to mothers with no identifiable risk factors. Some things we know that can increase the chance of a baby becoming growth restricted are:

• smoking, vaping, alcohol, or drug use during pregnancy
• poor nutrition in pregnancy
• limited physical activity during pregnancy
• having a body mass index (BMI) outside of the recommended range
• not attending regular pregnancy care appointments
• health conditions like high blood pressure or diabetes that aren’t well managed. 

There are also other factors that you can’t control or change including:

• being under 20 or over 40 during pregnancy
• having had a small baby/growth restricted baby before
• being in your first pregnancy. 
• multiple pregnancy (twins, triplets)
• medical conditions that affect the placenta
• genetic or inherited factors (eg. Fetal genetic anomalies or inherited maternal traits, family history of pre-eclampsia).

Learn more

Having a small baby | Pregnancy Birth and Baby

Most pregnancies last around 40 weeks but it’s common for babies to be born anytime between 37 and 41 weeks. Many babies are also born after their due date with only about 4–5% of babies are born on their exact due date. 

If your pregnancy goes past your due date, your care provider will:

• check your estimated due date is correct
• talk with you about what this means for you and your baby
• discuss all your options, including waiting, extra checks, or ways labour may start
• discuss the benefits and draw backs to scheduling an induction. 

If pregnancy continues beyond 41 weeks, you will usually be offered extra monitoring to check how your baby is going. This helps support informed decision making about your options.

Learn more

Let's talk timing of birth | Safer Baby - Working Together to Reduce Stillbirth

Overdue babies | Better Health Channel

Congenital anomalies are structural or genetic conditions that are present before birth. Around 1 in 30 babies are born with a congenital anomaly. These can affect the heart, brain, limbs, or internal organs 

They may be found either through screening blood tests or on ultrasound scans.

If something is found, you may be referred to a Maternal Fetal Medicine (MFM) specialist for more tests or support.

Important to know

• Many findings are minor, unclear at first, or resolve on their own.
• A referral does not always mean there is a serious problem.
• Sometimes, more tests are needed to be certain.
• Some anomalies may not be detected until birth or after.
• Some conditions detected during pregnancy or shortly after birth may not be identified until weeks, months or years later. 

Learn more

Congenital anomalies (birth defects) | Better Health Channel

During pregnancy, hormones can cause the body to handle blood sugar less effectively. When blood sugar levels rise above the ideal range, this is called gestational diabetes (GDM).

Detecting gestational diabetes is important so you can get the advice and support you need to reduce risks for your health and your baby. 

Your baby’s blood sugar may be monitored after birth for a short time to ensure they don’t need additional help to maintain their own blood sugar levels. However, this does not mean your baby will be born with diabetes.

All pregnant women are offered an oral glucose tolerance test (OGTT) at 24–28 weeks gestation as gestational diabetes can occur even without any pre-existing risk factors for diabetes.

Management and reassurance

If you are diagnosed with gestational diabetes, it is important that you are supported and know how to manage it. Health professionals such as diabetes nurse educators, your maternity care provider, a dietitian or, sometimes, a diabetes specialist (Endocrinologist) will help you understand what to do and will support you.

• Most women manage GDM with healthy eating and regular activity.
• About 10–25% need insulin to help manage their GDM.
• GDM usually goes away after birth. Your baby will not be born diabetic.
• You will be offered a follow‑up glucose test 6–12 weeks after birth.

Learn more

Gestational diabetes | Better Health Channel

Blood pressure disorders affect 5-10% of pregnancies globally and are usually detected early through routine antenatal checks of blood pressure and urine. 

In most cases, blood pressure is easily managed with the right care and support but can become more concerning in some cases. Your blood pressure should be monitored regularly. Your doctor may prescribe medication.

Chronic hypertension (pre-existing hypertension)

This describes high blood pressure that is present before pregnancy or diagnosed prior to 20 weeks gestation. It can be described as primary (essential) and secondary hypertension. 

Pregnancy induced hypertension (PIH)

New-onset high blood pressure occurring after 20 weeks, without signs of pre-eclampsia, which resolves after the baby is born. 

Pre-eclampsia

Pre‑eclampsia is a serious condition that usually starts after 20 weeks. Pre-eclampsia can also occur at the same time as pre-existing high blood pressure (primary or secondary hypertension). 

A pregnant woman with pre-eclampsia develops high blood pressure and protein in the urine. Pre-eclampsia affects about 3% of pregnancies and can also develop in the 6 weeks after birth.

There is a screening test available in pregnancy to screen for risk of developing pre-eclampsia. This test is done at 11-13 weeks, your maternity care provider can refer you for this test if your chose to have it. There are out-of-pocket costs involved. 

If your maternity care provider feels you are at a higher risk of developing pre-eclampsia, they may discuss the benefits of taking low-dose Aspirin with you. 

Learn more

Pre-eclampsia risk screening | VCGS

You are more likely to develop pre-eclampsia if you have a combination of risk factors including:

• this is your first pregnancy
• you are aged over 40
• you have high blood pressure, diabetes or kidney disease
• you are carrying more than one baby
• you have previous or family history of pre‑eclampsia.

Contact your maternity provider urgently if you experience any of the following symptoms:

• Sudden swelling of face, hands or feet
• Ongoing headaches
• Vision changes (blurred vision or flashing lights)
• Upper abdominal pain.

In some women, pre‑eclampsia can develop into a medical emergency quickly. Always tell hospital staff if you are pregnant or gave birth in the last 6 weeks.

Learn more

Pregnancy - preeclampsia | Better Health Channel

Maternal sepsis is a serious and life-threatening illness and is one of the leading causes in maternal death in Australia. Sepsis is the body having a strong reaction to an infection. 

Sepsis can occur:

• at any stage of pregnancy
• during labour or birth
• up to 6 weeks after birth, and especially in the first 2 weeks postpartum.

Sepsis can come from many places in the body including the uterus, urinary tract, respiratory system, bloodstream, skin, or surgical site infections (E.g. caesarean section scar). 

Recognising and treating sepsis early is important and can help prevent serious illness. Trust your instincts, if you feel unwell or notice a change in your health during pregnancy or after birth, seek medical advice through your maternity care provider, GP, urgent care clinic or Emergency Department.

If you are feeling unwell, or notice any of the signs and symptoms listed below, seek help immediately:

Symptoms of concern

• Fever (38°C or higher) or low body temperature (below 36°C)
• Cool, mottled or clammy skin
• Fast heart rate or breathing
• Confusion or sleepiness
• Severe stomach pain
• Breathing difficulties or cough
• Pain or burning when passing urine or needing to urinate frequently.
• Vomiting or diarrhea,
• Redness and pain in the breast
• Foul smelling vaginal discharge or discharge from any wounds
• Changes in your baby’s movements if still pregnant.

Some people may have a higher risk of developing sepsis, such as if you have experienced a recent miscarriage, feeling more unwell despite receiving medical care, or having a partner or family member say they are concerned you’re becoming more unwell.

Sepsis can develop in anyone, including people with no known risk factors. You don’t have to know if you have sepsis to seek care, if you’re feeling unwell, seek medical attention.

Learn more

Maternal health matters - Every concern deserves care | Safer Care Victoria

Sepsis Australia

Pregnancy & Childbirth | Sepsis Alliance

Sexual and Reproductive Health and Research (SRH)

Maternal Sepsis | End Sepsis

Preterm labour can start suddenly or follow signs such as:

• cramps or tightening
• back pain or pelvic pressure
• changes in vaginal discharge.

Your care team will:

• explain what’s happening
• discuss risks and treatment options
• make a care plan with you.

Babies born early may need help with feeding, breathing, warmth and oxygen.

Some babies may need to be transferred to another hospital to receive additional care. In Victoria, babies who need the highest level of care may be transferred to a Neonatal Intensive Care Unit (NICU). Every effort is made to keep mothers and babies together in hospital but this isn’t always possible.

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Neonatal Intensive Care Units in Victoria | Better Health Channel

Pregnancy - premature labour | Better Health Channel

Premature babies | Better Health Channel

There is no set time your waters will break. It can happen before or after contractions start and, in some cases, it can happen before your pregnancy is near your due date.

Your waters don’t always break suddenly like in movies. You might feel a big gush of fluid, a steady trickle, unexplained wet underwear or you may be unsure if your waters have broken at all.

If you think your waters have broken, it’s important to contact your maternity care provider as soon as you can. They are trained to assess if your waters have broken. 

When waters break early, there is a higher risk of infection for both you and your baby, so early advice and care are important.

What to do

If you think your waters have broken, contact your maternity care provider or maternity assessment unit straight away. It can be helpful to put on a pad so the maternity care provider can assess the colour but don’t delay calling. 

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Waters breaking early (preterm prelabour rupture of membranes | Pregnancy Birth and Baby

Giving birth - waters breaking | Pregnancy Birth and Baby

The cervix usually stays long and closed until just before labour starts. A shorter cervix can increase the chance of preterm birth. This is detected on ultrasound, usually through the vagina or abdominally.

If you have risk factors, you may be offered extra scans. Finding a short cervix does not mean early birth will happen but it allows your maternity care team to take steps to reduce risk. These may include:

• closer monitoring 
• medication
• a cervical stitch (cerclage) in some cases.

Your maternity care provider will recommend care based on your individual circumstances.

Learn more

Short cervix in pregnancy | Pregnancy Birth and Baby

Most babies are positioned head down in the uterus by the end of pregnancy. About 3–4% are positioned bottom‑down or feet-first (breech).

During antenatal appointments towards the end of your pregnancy, your maternity care provider will confirm your baby’s position by feeling your stomach or doing a scan, and talk through your options, which may include:

• external cephalic version (ECV) – trying to turn the baby into head down position
• planned caesarean birth
• vaginal breech birth following discussion with your maternity care provider.

Alternative therapies (such as acupuncture or exercises) have limited evidence and should not replace evidence-based medical care and advice from your maternity care team.

If your baby was born in breech position at term, your maternity care provider will check their hips closely after 24 hours and a hip ultrasound should be scheduled.

Learn more

Breech pregnancy | Pregnancy Birth and Baby

During pregnancy, your placenta provides your growing baby with oxygen and nutrients from your bloodstream. In most pregnancies, the placenta implants and grows on the uterine wall, away from the cervix. Your placenta is delivered after the birth of your baby and is known as the third stage of labour, this is a normal part of the birth process. 

In rare cases, the placenta implants too deeply to the uterus. How deeply the placenta implants determines what it is called and how it is managed. All forms of abnormal placental implantation are diagnosed by ultrasound and require specialist care to ensure your safety. Sometimes an MRI may be recommended to determine to diagnose the type of abnormal placental implantation, this is considered safe in pregnancy. 

Management options vary depending on your individual situation, you can discuss your options with your maternity care team. 

If you are diagnosed with abnormal placental implantation:

• your pregnancy will be closely monitored
• you should report any bleeding from the vagina immediately – if bleeding is heavy call Triple Zero (000) 
• you may need extra scans and appointments
• if you experience bleeding, you may be admitted to the hospital until the bleeding stops.

Low-lying placenta (LLP)

When the placenta implants too close to the cervix, this is called a LLP. A LLP is usually identified during the 20-week morphology ultrasound. In most cases, the placenta moves further away from the cervix as the uterus grows. You will usually be offered a repeat ultrasound between 32 and 36 week to check if the placenta has moved away from the cervix. 

If the placenta remains low, your maternity care provider will discuss birth options with you. A planned caesarean may be recommended.

Placenta previa

Placenta previa is when the placenta has implanted at the bottom of the uterus, over the cervix or close by.  which means that your baby cannot be born vaginally as the placenta is directly in the way of the baby. Your maternity care provider will recommend a planned caesarean birth and work with you to plan the birth in a way that feels as safe, informed, and supported as possible

There may be no signs that you have placenta previa or you may have painless bleeding from the vagina. 

Your maternity care provider will recommend a planned caesarean birth and work with you to plan the birth in a way that feels as safe, informed, and supported as possible.

Learn more

Placenta praevia | Better Health Channel

Placenta praevia | healthdirect