Common Reasons Women Have Caesareans

Australia has a high rate of caesarean births, with approximately 1 in 3 babies currently being delivered by this method. This rate is also steadily increasing, so it’s important for expecting mothers to be aware of the reasons a caesarean may be recommended for their child’s birth.

A caesarean birth occurs through an incision in the abdominal wall and uterus, rather than through the vagina. There are multiple reasons why this method of delivery might be required. Some are planned due to medical complications during pregnancy, and some are needed in emergency situations after labour begins.

Let’s explore some of the most common reasons Australian women have caesareans today.

Complications during pregnancy

Some conditions can be observed during your regular pregnancy check-ups. If one of the following complications are evident during your pregnancy, your obstetrician will assess your options and recommend a birth plan.

Previous caeserean – Women who have given birth by caesarean in the past may be at greater risk of complications during pregnancy such as uterine rupture.

Placenta previa – This condition occurs when the placenta lies low in the uterus, partially or completely covering the cervix. This can cause dangerous bleeding during a vaginal birth.

Infections – HIV or active genital herpes can be passed to the baby during vaginal birth, making a caesarean the favourable delivery option.

Multiple babies – Twins can be delivered vaginally, however, this depends on their positions, estimated weights, and gestational age. Triplets or more are less likely to be delivered vaginally.

Complications during childbirth

Occasionally, a situation will occur during the birth process that makes vaginal delivery unsafe for the mother or the baby (or both). If the following situations occur, your baby may need to be born via emergency caesarean.

Failure to progress labour – If labour is long and slow, it could mean that the cervix hasn’t dilated fully, or that the baby is not in an optimal delivery position.

Distress – If your baby is becoming distressed during labour, it may be not getting enough oxygen.

Cephalopelvic disproportion – This condition is diagnosed if a baby’s head is too large to pass through the mother’s pelvis, or if the mother’s pelvis is too small to deliver the baby.

Uterine rupture – If the uterus tears during childbirth, it can lead to haemorrhaging in the mother and loss of oxygen supply for the baby.

Breech presentation – When a baby’s bottom or feet are facing down, a caesarean may be the safest method of delivery. Some babies can be turned in utero to move into a head-down position.

Cord prolapse – This situation occurs when the umbilical cord slips into the vagina before the baby. Pregnancy contractions then squeeze the cord, diminishing blood supply to the baby.

Preeclampsia – This condition involves high blood pressure during pregnancy. If preeclampsia prevents the placenta from getting adequate blood supply during labour, the baby’s oxygen decreases. This can make a long vaginal birth risky.

If no medical complications are present, vaginal delivery is still the safest way to deliver a baby. However, if a caesarean is recommended for health reasons, it doesn’t mean that you need to give up your idea of a natural birth.

Discuss your delivery options – including a Gentle Caesarean – with Dr Ljiljana Miljkovic-Petkovic at her Newcastle medical suite. Click here to make an appointment enquiry online, or alternatively call 02 4957 2743.

The Gentle Caesarean

A new option for a better birth experience

For women wanting a natural childbirth, ending up having a Caesarean can be disheartening, or even traumatic. The baby is quickly delivered and umbilical cord cut immediately and the baby handed to a midwife.

Caesareans are an incredibly common surgical procedure in Australia (and around the world). Although the majority of Australian births occur vaginally, the trend toward caesareans has been increasing over the last 10 years, with over 33% of births happening via caesearean[1] today.

Although they are often the only choice for mothers experiencing an emergency situation, or when vaginal birth is not possible, caesarean births are not without their drawbacks. They are associated with many negatives for both mothers and babies – including a longer hospital stay, weeks of recovery time, risk of infection, and delayed skin-to-skin contact after birth.

In addition to the physical impediments, caesareans can have unwelcome emotional consequences for new mothers. Women may not feel that her birth experience was what they were hoping it would be, or what the media portrays it to be for other new mums.

Fortunately, requiring a caesarean no longer means women have to give up their preferred birth experience.

Women are now opting for a new method of caesarean that can occur under controlled conditions, giving them more options in how they bring their baby into the world.

This new method is called a Gentle Caesarean.


What is a Gentle Caesarean?

A Gentle Caesarean is not actually a change in the procedure itself, but rather a change in the attitudes towards caesareans. Gentle Caesareans aim to invoke an atmosphere that more closely mimics what happens during and after a vaginal childbirth.

With a Gentle Caesarean, the focus is on the mother and her baby getting a physical and emotional experience as close to a natural birth as possible.


What makes a Gentle Caesarean different?

In a traditional caesarean, the baby is quickly delivered and handed to the attending medical staff. The mother is left waiting to hold and breastfeed her child for some time as she is stitched up, and her baby is cleaned and assessed in another part of the room. She may even be unconscious, and not actually meet her baby until hours later.

But in a Gentle Caesarean, the baby’s head is delivered, and then the rest of the delivery takes place slowly, with the baby being placed on the mother’s chest directly afterward. Delayed umbilical cord cutting is performed to allow precious blood supply flow to the baby.

Additional considerations for a Gentle Caesarean include:

  • The option of selecting calming music during the procedure
  • The operating table is raised so mum can see her baby come out, while the details of the surgery are kept from her visibility via a surgical drape
  • The baby’s body remains in utero for a few minutes, allowing the pressure to help push fluid from his or her lungs

These things, while seemingly small, can make a big difference in both mum and bub’s experience of childbirth.


Is a Gentle Caesarean right for you?

A vaginal birth is the safest way to deliver a child. But if an emergency situation occurs (such as the baby is in distress or there is a danger to the mother), or if a vaginal delivery is deemed too dangerous (for example the baby is in breech or the labour isn’t progressing), a Caesarean birth may be required.

However, a Gentle Caesarean can be a safe and preferred option for mothers who are unable to deliver their child vaginally.


Where to find more information

Expecting the birth of a baby is an exciting, yet uncertain time in a woman’s life. Most women don’t realise they have the option of planning a Gentle Caesarean while creating their birth plan. That’s why Dr Ljiljana ensures all her patients understand their options when it comes to the delivery of their child.

Dr Ljiljana is the only Obstetrician in the Newcastle area that performs the Gentle Caesarean.

Making plans for a Gentle Caesarean doesn’t necessarily mean you will need a caesarean. But should a situation occur when a caesarean is necessary, having a plan in place is well worthwhile.

To discuss your options for a Gentle Caesarean, connect with Dr Ljiljana’s Newcastle gynaecology practice on 02 4957 2743 or by clicking here.


I have endometriosis. Can I still get pregnant?

If you’re living with endometriosis, you may have wondered how it will affect your fertility. You may even be trying to fall pregnant right now.

The good news is that it is possible to get pregnant with endometriosis. However, up to 50% of women with endometriosis have difficulty getting pregnant. This can be attributed to a variety of factors including your age, your partner’s fertility, and how severe your endometriosis is.


How does endometriosis affect fertility?

Although the relationship between endometriosis and fertility is not entirely clear, the condition can be attributed to several issues that can cause infertility. These include:

Scar tissue

Endometrial scar tissue can block fallopian tubes, preventing fertilization and pregnancy. Scar tissue can also cause adhesions to form on reproductive organs, stopping them from functioning normally.


The link between pelvic inflammation and infertility is not completely clear, but the two are believed to be related. Women with endometriosis generally have increased inflammation in the pelvic cavity, so it’s a possible contributing factor.

Implantation problems

While endometriosis causes tissue to grow outside the uterus, it can also affect the inner lining of the uterus. This can make it harder for an embryo to implant and develop normally.

Decreased egg viability

Embryos of women with endometriosis develop slower than average. This can result in embryos of lower quality and also affect implantation rates.


Treatment options for endometriosis-related infertility

There are a number of treatments available to assist women experiencing difficulty in conceiving. Your gynaecologist can advise a treatment plan that may include:

Surgical treatment Surgical treatment of endometriosis has been shown to increase your natural chances of conception, especially in the first six months after treatment and it should be the first line of treatment. Even though current evidence suggests that women with endometriosis are more likely to experience fertility issues, not all women with endometriosis will need help and only a small number will ever require IVF.

Fertility medications Some medications may help women with decreased egg viability produce two or three mature eggs that can increase the chance of pregnancy.

In vitro fertilization (IVF) – This involves extracting an egg and fertilising it outside the body with a partner’s collected sperm, then implanting it into the uterus. IVF is often recommended for women with moderate to severe endometriosis who haven’t responded to other treatments.


Improving your likelihood of conceiving with endometriosis

While there’s no ‘magic bullet’ treatment or medication that guarantees pregnancy, there are some practical ways you can increase your chances of conceiving when you have endometriosis.

Steps you can take include:

  • Maintaining a healthy weight
  • Exercising at least 4 times a week for 40 minutes or more
  • Eating a diet rich in vegetables, whole grains, and lean proteins
  • Not smoking, and limiting your alcohol intake


When to see a specialist

If you’ve been diagnosed with endometriosis and are planning to become pregnant, and have symptoms suggestive of endometriosis you may want to see a gynaecologist when deciding about treatments. They can work with your doctor to ensure your treatment is aligned with your future goals of having a family.

If you’ve been trying to conceive for six months or more, there may be an underlying fertility issue that needs to be addressed.

Talk to your family doctor for a referral to Dr Ljiljana Miljkovic-Petkovic at her Newcastle medical suite. Click here to make an appointment enquiry online, or alternatively call 02 4957 2743.

Cervical Screening Changes


Advances in medical technology mean that the way pap smears are conducted is changing. A National Cervical Screening Program will replace the pap smear program, which is currently administered by individual states. The new program will begin on December 1, 2017.

Early detection is vital in the fight against cervical cancer, so it’s important to undergo the cervical screening test. Dr Ljiljana can answer any questions you might have about the changes to cervical screening.

What is the Cervical Screening Test?

The Cervical Screening Test replaces the pap smear and Medicare will now fund the new test rather than the pap smear. While the pap smear checked for abnormal cells that could become cancerous, the new test checks for the human papilloma virus.

What is the Purpose of the Cervical Screening Test?

The cervical screening test detects the presence of the human papilloma virus (HPV). There are many highly oncogenes types of HPV virus, but types 16 and 18 are the commonest. In most cases, HPV infections clear up on their own, but persistent infections can sometimes cause cervical abnormalities that can lead to cancer of the cervix.

Who Is Eligible for the Cervical Screening Test?

Women between the ages of 25 and 74 who have not participated in screening will receive an invitation to undergo the test.

Women under 25 who are in a higher risk category will also be eligible for the test.

The National Screening Register will send an invitation to women who are overdue for cervical screening.

When Should the Test Take Place?

If your pap smear falls due before the new program begins, all you need to do is have your pap smear as usual with your GP. The new test will take place the next time your pap smear would have been due.

Does the HPV Vaccination Mean You Don’t Need the Test?

Even if you have had a vaccination against HPV you should still have the test. The vaccination doesn’t cover all types of HPV or completely eliminate the risk of cancer.

How Is the Test Conducted?

The cervical screening test involves collecting a small sample of cells from the cervix (the same procedure as a pap smear). The sample is sent to a pathology laboratory for analysis.

How Does the Screening Program work?

Women are eligible to take the new test two years after their last pap smear. If the test comes back negative for HPV, the next test will be due in five years’ time.

Each woman who undergoes the test will be assigned a risk category of low, medium or high. For those in a higher risk category, screening may take place more frequently or additional tests may be necessary. Some of the risk factors include:

• A positive HPV test
• Unexplained bleeding in post-menopausal women
• Unexplained pain or bleeding after sex

What to Expect After a Positive Result

If you have a positive result for HPV, Dr Ljiljana may offer an additional test for greater accuracy (2). She may also recommend that you undergo a colposcopy procedure, where she will examine your cervix for abnormalities and may take a small sample of tissue for testing.

If you would like to know more about the National Cervical Screening Program or have questions about the new test, please call us or use the contact form in our Contact Us section. Dr Ljiljana can answer your questions or discuss any concerns you have.

What to pack for hospital

Pregnant Woman Packing Suitcase For Trip To Hospital

As the exciting arrival of your baby starts to get ever closer, it’s important to start getting prepared for your stay at either John Hunter Hospital or Newcastle Private Hospital.

Most pregnant women begin to pack their hospital bag at around 33-36 weeks and keep it in their car or at the front door.

If you’re wondering what to pack, this is the only list you’ll need.

For Baby:

  • Baby clothes including hats, mittens, booties, socks, etc.
  • Swaddles/wraps (one for each day – they may not get dirty, but it’s always good to have a spare in case of leaks and spills.)
  • Baby blankets.
  • Car seats (this needs to be organised prior to discharge).
  • Bottles – if you’re planning on bottle-feeding, you may wish to bring your own bottles so that baby gets used to what you have.
  • Nappies and wipes are usually supplied, but if you choose to use cloth nappies and reusable wipes, please feel free to bring your own.

For You: 

  • Medicare card and private health insurance details.
  • Any medication you may be taking.
  • Your personal birth plan (if you have one) – remember to keep this short and be flexible as babies don’t always follow your plan.
  • An old nightdress or large shirt to wear during labour (something you don’t mind throwing away afterwards).
  • Your own toiletries – this includes body wash, shampoo, conditioner, face wash, toothpaste and toothbrush, shaver and make-up. We recommend that deodorant is not used within the first 24 hours after birth so that your baby can get used to your unique smell.
  • Hair products – hairband, hair clips, brush, etc.
  • Clothes, front opening pyjamas (if you intend on breastfeeding) and dressing gown.
  • Slippers and non-slip socks.
  • Glasses or contact lenses, if you wear them.
  • Things to help you relax such as massage oil, music, oil burners, books/magazines.
  • Snacks to have during labour.
  • Nursing bras, breast pads and nipple cream. Even if you’re not planning on breastfeeding, it’s still best to avoid underwire bras as they can become uncomfortable and block your milk ducts.
  • Maternity pads (3-4 packs). Tampons should not be used as they can increase risk of infection after you’ve given birth.
  • Comfortable dark cotton underwear – please bear in mind that you will need to have full briefs to securely hold your maternity pads as G-strings are not suitable for this purpose. Two per day should be more than sufficient.
  • Phone and charger.
  • An outfit to go home in.

You may wish to have a smaller bag for the day of the labour and have additional supplies packed in a bag that your partner can bring after the birth, instead of trying to take a heavy bag with you while you’re in labour.

If You’re Having a Caesarean Section:

  • Comfortable underwear that won’t sit on your wound.
  • Loose pants or dresses that won’t irritate your wound.
  • Stool softeners to assist your first bowel movement.
  • Mouthwash to freshen up your mouth if you can’t get out of bed.

For Your Birth Partner:

  • Comfortable clothes and shoes.
  • A change of clothes.
  • Swimmers for assisting you in the shower.
  • Toiletries (toothpaste and toothbrush).
  • Copy of your birth plan.
  • Camera, phone, ipod – make sure it’s fully charged.
  • Snacks and drinks.
  • Cash and change for the canteen and parking.

How to beat the heat

Summer is here and whether you’re pregnant or have a newborn, it’s important to have a few tricks up your sleeve for staying cool and feeling comfortable during the hotter months.

Keeping Your Baby Bump Cool:

Keep drinking that water!
Regardless of the weather, it is important to stay hydrated during pregnancy, but it’s especially vital during the hot summer months to drink the amount you’ll be sweating out. Dehydration can worsen pregnancy aches, swelling and even trigger contractions.
Since you’ll be constantly sipping away, we suggest making it a little more interesting by adding a slice of lemon, lime, orange or even a sprig of mint to your water.
You could even opt for a fruity mocktail which will not only keep you hydrated, but will boost your vitamin C at the same time.

  • Get wet
    Water is your new best friend and it’s not just for drinking. When you’re on the go and need to keep your cool carry around a water-filled spritz bottle and spray yourself whenever you need to. Alternatively, you could use a cool facecloth on the back of your neck.
    A dip in the pool will also most certainly do the trick! It’s a great way to cool you off, ease the stress of your squished organs, support the growth of your baby and get a low-impact workout all at once.
  • Put your feet up
    Believe it or not, those chores can wait, or your partner can do them. Oedema can be worse in summer causing your calves, ankles and feet to swell and become extremely uncomfortable. Elevate your legs whenever you can and for added relief, when your partner is around, get them to massage your feet for you.
    If the urge to do chores is still too overwhelming, ensure you do them early in the day or late in the evening and where possible blast that aircon!
  • Wear light clothing
    Remember to wear breathable, lightweight, comfortable maternity wear. This will prevent you from overheating and allow sweat to evaporate – helping you avoid rashes and chafing.
  • Road trips
    If you’re planning on hitting the road for your summer holiday, make sure you stop frequently (every hour or two) to stretch your legs and get the circulation flowing. (If flying – walk up and down the aisle and flex/extend your ankles while seated)
    Don’t forget to pack snacks, water and a pillow!
  • Be sun smart
    Pregnant women are more prone to sunburn and dark pigmentation, so slather on the sunscreen and avoid the afternoon sun.

Keeping Your Newborn Cool:

Hot weather can be dangerous for babies especially newborns, as they don’t have well developed thermostats, so they can easily overheat quickly. They need to drink regularly, wear light breathable clothing and keep cool.

  • Keep the nursery cool
    During the day, keep blinds or curtains closed. You can also use a fan to circulate the air in the room making sure the fan is not directly blowing on your baby. A thermometer will help you monitor the temperature in the room to ensure it’s a comfortable temperature for your baby to sleep.
  • Keep clothing and bedding to a minimum
    A nappy and singlet or summer weight sleeping bag is all your baby needs to go to sleep in. On very hot days, a cool bath before bedtime will also be beneficial.
  • Car trips
    If you need to travel by car, try to make the trip during the cooler part of the day (early morning), keeping the car cool with the air conditioner or opening the windows. Make sure that baby is kept shaded. And remember, NEVER leave your baby in the car alone!
  • Keep them well hydrated
    Like adults, babies need plenty of fluids to stay hydrated in hotter weather. If you’re breastfeeding, your baby may want to feed more than usual, there is no need to give them water. Bottle fed babies may be given cooled boiled water throughout the day on top of their usual formula feeds.
  • Protect them from the sun
    Newborns should be kept out of direct sunlight, they can overheat and develop a heat-related illness. If you need to go out in the sun, keep baby shaded using a wide brimmed hat, sunshade on your pram or a parasol. You can also get baby sunglasses to protect their sensitive eyes. Even though they’re shaded, it is also recommended to apply sunscreen to your baby’s skin – there are many brands that produce sunscreen specifically for babies.

What to look out for:

Prickly Heat
This is an itchy rash of small, raised red spots that babies are at risk of getting as their sweat glands are not fully developed. It commonly affects areas of the skin that stay moist such as in the nappy area or under the chin – try using zinc or barrier cream to protect the skin. Frequent clothing changes and tepid baths can also help prevent prickly heat.

Heatstroke occurs when the core body temperature rises above 40 degrees and parts of the body begin to stop working. Heatstroke can cause organ failure, brain damage and can even be fatal.

Symptoms include:

  • Temperature of 40 degrees or higher
  • Extreme sweating that suddenly stops (the body is unable to produce more sweat and is dehydrated)
  • Increased thirst, but as baby gets weaker they may drink less
  • Pale, clammy skin
  • Rapid heartbeat
  • Sunken fontanelle
  • Fewer wet nappies and/or dark coloured urine
  • Dry mouth and eyes
  • Headache and muscle cramps
  • Baby becomes floppy and/or sleepy
  • Confusion, shortness of breath and vomiting
  • Coma

If your baby is showing any of these signs, they need urgent treatment! Call an ambulance or take baby to the emergency room.
Keep baby as cool as possible, removing excess clothing, placing them on a damp facecloth and fanning them. If your baby is conscious, keep trying to give them cool water to drink.

If you have any questions about having a comfortable pregnancy during the summer months or looking after your newborn, please don’t hesitate to give Dr Ljiljana a call for advice.

Can I Eat That Christmas Ham?

Pregnancy is filled with many joys and tribulations, and one such challenge is knowing what you can and can’t eat over the festive season.

There are a few different kinds of bacteria that can live in your favourite Christmas treats, so we thought we’d compile a short list to help you avoid them and make your life easier.

Snacks and nibbles:

The NSW Food Authority advises pregnant women to approach any cheese and fruit platters with caution. Ensure that all fruit is thoroughly washed and if in doubt either avoid it altogether or wash it yourself.

Soft cheeses such as brie, camembert, ricotta, fetta and blue cheese can carry listeriosis bacteria and should be avoided. Instead opt for harder cheeses such as cheddar, halloumi, Swiss or tasty. You can also still enjoy the likes of cottage and cream cheese, bocconcini and mozzarella. A listeriosis infection can be very dangerous as it can affect your immune system and be passed on to your baby.

Nuts are an excellent source of nutrients such as omega -3 and -6 fatty acids and are considered safe for pregnant women, unless of course, you’re allergic or a health professional has told you not to eat them for any reason. So, feel free to snack away.


Whether you’re serving turkey, ham, or beef, home cooked meats are perfectly fine to eat on condition they are cooked through and eaten while hot. If you’re a fan of stuffing, it should be cooked separately from the poultry and eaten hot.

Avoid fish with high levels of mercury such as Flake (shark) or swordfish as it can harm a child’s developing nervous system. It’s also best to avoid shellfish including oysters, prawns and mussels as they can cause food poisoning, unless served piping hot.

It’s also advisable to avoid cold meats such as parma ham and salami as they can cause toxoplasmosis, which can adversely affect the development of your baby.

Leafy green salads are fine too if they have been washed properly and don’t contain any bean sprouts. Mind the dressings as you don’t want to be eating anything that contains raw eggs such as mayonnaise or aioli, which can cause salmonella poisoning. Coleslaw should also be avoided as it can contain listeria.

The NSW Food Authority also advises to avoid pre-packaged salads and fruit, salad bars, smorgasbords and delis.


As far as dessert goes, you can enjoy most of those guilty pleasures as long as the ice-cream or custard you pair it with is store bought and not home-made. And of course, avoid anything made with raw eggs, e.g. egg nog or home-made chocolate mousse.


The best thing about the festive feast is that it goes on for a few days in the form of leftovers. Just make sure that any leftovers are refrigerated and eaten within a day to avoid any unwanted food poisoning or nasty bacteria.

Remember the food safety rules of keep it cold, keep it clean, eat it hot and check the label and you’ll have a safe and healthy pregnancy where food is concerned.

Consult with Dr Ljiljana for more information about what not to eat during pregnancy.

Gynaecology for the Modern Woman

Dr Ljiljana Miljkovic-Petkovic prides herself on staying abreast of advancements in her field, and this includes attending the latest conferences focused on new technologies and approaches to gynaecology and obstetrics in Australia.

The Australian Gynaecological Endoscopy and Surgery XXVI Annual Scientific Meeting (AGES XXVI ASM) was held in Brisbane this year from 3rd to 5th March and discussed the evolving needs of the modern woman in regards to health. Dr Ljiljana attended this ground-breaking conference, aptly named Modern Woman, which addressed new surgeries, technologies and approaches to gynaecological health in the 21st century.

As women’s roles change and evolve in society, so too must the way we address our unique health concerns. With an ageing population, there are new health problems that must be acknowledged which simply weren’t a concern before, as well as the continually changing role of women in society. Often guilty of neglecting our own needs and health at the expense of others, the modern woman requires a different approach to gynaecological health. If the need for a procedure is identified, something non-invasive and with little down time is the preferred option, allowing women to continue on with their busy schedules.

During the conference, Dr Ljiljana was honoured to meet with Professor Stefano Salvatore, current president of the European Urogynaecological Association and Professor of Urogynaecology at the San Raffaele Hospital, University of Milan. As one of the invited speakers, Professor Salvatore discussed his revolutionary vaginal laser procedure, the MonaLisa Touch, which works at treating the vaginal atrophy that affects over 60% of post-menopausal women. Dr Salvatore updated the conference attendees on the amazing results they had seen with the MonaLisa Touch thus far, with over half a million women receiving treatment with excellent results.

Dr Ljiljana Miljkovic-Petkovic is proud to be the first and only gynaecological practice to offer the MonaLisa Touch treatment in Newcastle, and she was thrilled to discuss tips and finesses of this revolutionary treatment with Dr Salvatore himself at the conference.

Another talking point during the AGES Modern Woman conference was the use of robotic surgery for gynaecological treatments. Although not yet available in Newcastle, robotic gynaecological surgery is currently utilised by gynaecological oncologists in major cities on a smaller scale. This sophisticated approach to surgery will hopefully become more commonplace in Australian clinics as the technology advances and gains more popularity.

For any and all enquiries regarding gynaecological and obstetrical services, including the revolutionary MonaLisa Touch procedure, contact Dr Ljiljana today on 02 4957 2743 for a confidential discussion.