Newborn Services from Integra

Whether it’s your very first baby or the next addition to a growing family, Integra would be delighted to support you all the way. Newborn care is something we specialise in and there isn’t another newborn paediatric team on the island with the accreditation, training & experience that we are privileged to have.

• Only team with multiple paediatricians specifically trained & UK-accreditated in neonatal care
• All paediatricians live within 5 minutes of George Town Hospital
• Team is led by Dr Sara Watkin, formerly Neonatal Chief of Service for University College London Hospitals
• Collectively, more than 30 years experience as UK paediatric & neonatal consultants

Dr Sara Watkin, Dr Jasmina Marinova & Dr Sarah Newton represent an extremely experienced team that can support you and your child from advice antenatal, through your delivery, baby checks, early care and all the way onwards to adulthood. First class care without paying a premium and reassuringly calm and competent when nature decides to test us.

Attending Your Delivery

We, Dr Sara Watkin, Dr Sarah Newton & Dr Jasmina Marinova, would be delighted to be your (well, your child’s paediatrician) from birth, right through to a bright future as a healthy young adult. As a team, we are unique in Cayman, being the practice with three UK- or Australasian-qualified & accredited newborn (neonatal) specialists, ensuring not only the right experience if nature throws a curve ball but also, as a team, providing you with the security of knowing we are here at the right moment.

We attend all types of deliveries and work closely with every private obstetrician in Cayman. Although we are all senior specialists, with exceptional credentials, our charges for attending delivery are actually comparable to others. We’d be delighted to be there for your special time.

Delivery Types Attended

Our attendance at delivery includes:

• In normal deliveries, where the parents have decided they would like a paediatrician present (and that paediatrician to be one of us, obviously!)
  (in case of complications or for reassurance/ preference)
• In caesarean sections, where having a paediatrician present is obligatory in Cayman (because of the increased complication rate)
• Pretty much all complicated scenarios or preterm births occuring in private patients
  (Dr Watkin is the island’s primary neonatologist for private patients, also assisting the Government doctors when they want or need specialist expertise. She is joined by Dr Marinova & Dr Newton, also formally neonatal trained & accredited)

Having a paediatrician present, where not obligated, is a choice based on preference, comfort level and cost. You’ll want to talk to your obstetrician about this, and your paediatrician. We offer free antenatal appointments to discuss this from the paediatric perspective. Please just call us or complete the form below. We’d love to meet you.

See section below on the necessity for paediatricians at delivery – Jump there now

Why Us?

As a Team

There are compelling reasons to choose a team generally (as opposed to a practice with only one paediatrician) and this team specifically.

Firstly, the primary reason why most choose to have a paediatrician present at birth, and why it’s obligated at caesarean sections, is because of unexpected complications. Given nature’s tendency to decide the timing, it’s very difficult for a single paediatrician practice to know for sure they’ll be available just when needed. With Integra, you will always have your chosen paediatrician in attendance whenever humanly possible, but on the occasions they may be off island (always planned & communicated), you have the reassurance they will have comprehensively handed over to their equally competent newborn-specialising paediatric colleagues.

Secondly, given the primary role of a paediatrician at delivery is to be on hand for newborn emergencies or complications, you’ll want to ensure that your paediatrician has the right credentials. In the UK, neonatal care is rarely provided by a more general paediatrician and instead is provided by newborn specialists, called neonatologists, or by paediatricians that have a special interest in neonatal care, both needing to be formally accredited in that specialist care by the GMC (on the specialist register). Our team consists of a lead neonatologist (Dr Sara Watkin, former Chief of Service for the one of the most specialist providers of preterm & newborn emergency care in the UK), and two highly experienced Paediatricians with a Special Interest in Neonatal Medicine (Dr Jasmina Marinova & Dr Sarah Newton).

It’s a team literally without equal in neonatal care experience and formal training & accreditation.

Dr Sara Watkin

MB ChB, MRCP (paeds), FRCPCH, MD

Dr Jasmina Marinova

MRCPCH, MD

Dr Sarah Newton

MBChB, FRACP (paeds), DCH

Do You Need a Paediatrician at Birth (Delivery)?

The Evidence

Br Med J (Clin Res Ed). 1984 Jul 7;289(6436):16-8.
Which deliveries require paediatricians in attendance?
Primhak RA, Herber SM, Whincup G, Milner RD.

The mode of delivery and one minute Apgar score were taken from the neonatal records of 2086 full term infants born at one obstetric unit over 12 months. There were 1554 spontaneous vaginal vertex deliveries, 26 vaginal breech deliveries, and 506 operative or instrumental deliveries. The obstetric records of the operative deliveries were reviewed to determine whether fetal distress had been an indication for intervention, and the obstetric records of the spontaneous vaginal vertex deliveries were also reviewed for fetal distress detected antenatally. When fetal distress was present antenatally in spontaneous vaginal vertex deliveries the frequency of a one minute Apgar score below 7 was 10.2%. In operative and instrumental deliveries where fetal distress was the indication for intervention, the frequency of one-minute Apgar score below 7 was 15.6% after non-rotational forceps delivery, 13.9% after rotational forceps delivery, and 45.8% after caesarean section. In the absence of fetal distress, the frequency of an Apgar score below 7 was 2.4% after spontaneous deliveries, 7.1% after non-rotational forceps delivery, 13.2% after caesarean section, and 18.4% after rotational forceps delivery. The presence of fetal distress considerably increased the frequency of an Apgar score below 7 in each category except rotational forceps deliveries. Paediatric services to an obstetric unit may be organised rationally in the light of local staffing conditions with the help of these findings.

The Interpretation

What this shows is the following:

• If the spontaneous delivery went as planned, the need for medical intervention was present in only 2.4% or roughly 1 in 40 deliveries – a comparatively low rate
• If the baby required delivery assistance using forceps, medical intervention was necessary for between 7.1% and 18.4% of deliveries depending on whether the baby needed rotating
• After caesarean, medical intervention was needed in 13.9% of cases

All of the above are ‘in the absence of fetal distress’. In the presence of fetal distress before birth i.e. pre-existing fetal distress, the rate was 10.2% or 1 in 10 deliveries, a much higher rate of complication and not dissimilar to the rate after uncomplicated caesarean section, which definitely requires a paediatrician to be present (an obligation in Cayman). So why the uncertainty?

Fetal distress also occurs during delivery, influenced by things such as the length of labour. Whereas your obstetrician will almost certainly know about pre-existing fetal distress and will plan accordingly, there is a proportion of births where it occurs during labour and delivery. The problem is always that you don’t necessarily know going in!

In the UK, normal deliveries don’t normally require a paediatrician and because it is a national health system, if you don’t officially ‘need’ it then you don’t get it unless you go private. In part, that’s also because for every delivery team there’s a neonatal team hovering close by, generally with 24-7 doctors on the rota. The point is that help is quickly on hand when required.

In Cayman, us paediatricians do liaise very closely with our obstetric colleagues and delivery suite. We are generally aware of who is delivering imminently. If I am going to do something like snorkelling, I tend to phone delivery suite to ask for any updates or alerts. In many cases, parents have requested a paediatrician anyway. Generally, we are also not that far away. For instance, when I get calls in the night, with my skates on I can be at the hospital within around 10 minutes from getting the call. For all paediatricians, the greater challenge comes at the busy times – when the Christmas lights on South Church Street cause a complete blockage, or Esterley Tibbetts is at a standstill in rush hour, or your paediatrician is enjoying Sunday brunch in Tukka’s out at East End. These are the points when the combination of urgency, timing and traffic work against everybody.

You can probably see there is no absolutely right answer. These are issues to discuss with your obstetrician and your paediatrician. They can help you come to a choice that you are comfortable with that balances risk, medical necessaity and cost too, of course. In my experience, none of the paediatricians will over-encourage you to engage them and so you can feel comfortable openly discussing your circumstances. I am certainly happy to talk through the issues and advise accordingly.

BOOK A FREE ANTENATAL APPOINTMENT

We would be delighted to meet you at any point during your pregnancy and you can arrange this by simply completing the form below.