- Obstetrics Introduction
- Schedule of Visits and Pregnancy Calendar
- Tests Done in Early Pregnancy
- Vaccinations In Pregnancy
- Helpful Information
- Lower Segment Caesarean Section
- Postnatal Care
Your diet during pregnancy is extremely important for the wellbeing of your baby.
Healthy eating – “eating for two”
Now that you are “eating for two”, you will need to increase some of the foods you were eating and drinking before the pregnancy, but also take care not to put on too much weight.
A good weight gain during pregnancy is 10-12kg. The average weight gain expected during the first 3 months is 1kg, with gains of approximately 250-500gm during the remaining months. These numbers will vary depending upon your weight and height at the start of the pregnancy.
If you currently follow a sensible diet, your energy requirement will not need to increase, or minimally by about 200 calories (840kj) per day, perhaps with some additional milk or fruit, or an extra cheese sandwich, etc.
Regular physical activity is as important now, as it was before, and again after your delivery you should keep up your routine. This will ensure that you return to your original weight in good time, as well as making you feel more energetic (to cope with the new little one in the family).
Some particular needs
IRON Your blood volume increases in pregnancy, therefore additional iron is necessary. You should take an additional 30-36mg of iron daily. Most of the extra iron is used up in the second half of pregnancy, when your developing baby will begin to store its own iron.
CALCIUM Development of your baby’s skeleton means that calcium is absorbed from the mother, therefore you need to increase your intake. Calcium requirements are highest during the last 3 months of pregnancy.
For vegetarians, a Vitamin B12 supplement is also recommended. Discuss this with your doctor.
Other dietary recommendations
Alcohol should be avoided altogether, especially during the first 3 months of pregnancy.
Smoking is harmful to the developing baby and should be avoided altogether.
The bacterium LISTERIA can cause a rare form of food poisoning. It is found in soil, sewage and on many foods, and is normally harmless. However in pregnancy, extra care must be taken with hygiene. Listeriosis can be transmitted to the developing baby and may cause miscarriage, stillbirth or premature death. Listeria is destroyed by heat. Left-overs should be refrigerated, properly re-heated and used within a day. Cold food must be kept cold. In other words, use the precautions you normally use when catering for your family. For more information consult a dietitian.
Listeria can be found in foods such as listed below and these should be avoided during pregnancy:
Soft cheeses (Brie, Camembert, Fetta, Ricotta, Blue vein), soft ice creams, milkshakes, cold delicatessen meats, cold cooked chickens bought from supermarkets and take-away shops, pates, pre-prepared salads and fruit salads, raw and smoked seafood, eg oysters, sashimi, etc, unpasteurised dairy products, raw mushrooms or sprouts, any food prepared and stored in the refrigerator for more than 12 hours.
Limit the amount of fish you eat from 9 weeks prior to conception, and during your pregnancy. While fish is recognised as a healthy food, some fish contain high mercury levels which may be harmful to your baby. Current guidelines recommend that you limit your fish intake to:
- One serve of orange roughy (sea perch), catfish and no other fish that week, or
- One serve per fortnight of shark (flake), billfish (swordfish, broadbill, marlin) and then no other fish that fortnight, or
- two to three serves of any other fish per week
Fats & Oils
Saturated fats are best avoided in pregnancy. These are found in meat fat, dripping, copha, cream. Instead, use mono-unsaturated fats (found in canola margarine, olive oil, nuts & seeds, avocado) or sunflower oil, safflower oil, most vegetable oils, oily fish, nuts, polyunsaturated margarine. All types of fat provide the same amount of energy.
Saccharine and Cyclamate are artificial sweeteners which should be avoided. Safe sweeteners are Equal, NutraSweet, Sucralose (Splenda). Suitable sweeteners found in commercial foods are Sunett and Aclame.
General Pregnancy Advice
Smoking during pregnancy can endanger the healthy development, birth and wellbeing of the baby. Studies have shown that smoking during pregnancy can lead to miscarriage, poor growth of the baby, bleeding in pregnancy and stillbirth. Smoking has also been linked to Sudden Infant Death Syndrome (“cot death”). The more you smoke, the greater the risk of problems with the pregnancy and with your baby. However, if a woman stops smoking, these risks are greatly reduced. Ask your midwife or doctor for more information.
Alcohol passes through your bloodstream and into your baby. It is known that alcohol can harm a growing baby, but it is not known what level of drinking causes this harm. Even small amounts of alcohol taken regularly may cause problems. Effects on baby can include poor growth, learning difficulties or poor co-ordination. In Australia, the National Health and Medical Research Council advises women not to drink during pregnancy.
Caffeine is an addictive drug, and is contained in tea, coffee, coke and cola, cocoa and hot chocolate. More than 2 cups of instant coffee or 1 cappuccino should be the upper limit of your caffeine intake. More than this, or 4-6 cups of tea / hot chocolate per day could be harmful and addictive for you and your baby. It is best to try and replace these foods and drinks with caffeine-free alternatives where possible.
It is very important to maintain fitness and flexibility which increases your energy and sense of wellbeing, and often helps you to cope better during and after childbirth. If you were active before pregnancy, it is usually fine to continue the same activity – check with your midwife or doctor regarding the particular sport or activity.
If you have not exercised regularly before pregnancy, do not launch into a new fitness regime too quickly. 12 weeks (3 months) is a good time to start a gentle exercise program suitable for pregnancy. Exercise is safe as long as you take things easy, stop when you feel tired and do not overheat yourself. Walking, swimming and yoga are very good for pregnant women.
Pelvic Floor exercises
Your pelvic floor contains the muscles forming a base supporting your bladder, uterus and bowel. Like other muscles, these can weaken and sag during pregnancy. This can cause accidental loss of urine (incontinence), the need to pass urine more frequently, prolapse or sagging of the uterus, bladder and bowel, and sexual dysfunction.
To exercise the pelvic floor
Pull up the muscles inside your vagina as though you are stopping yourself passing urine or wind, without tensing your thighs or buttocks. Hold this for a few seconds and relax. Repeat this exercise regularly and frequently every day.
Most airlines allow women to travel until the 34th week of pregnancy, provided the pregnancy has been uncomplicated and the woman has no other medical risk factors. Short flights (less than 2 hours) are preferred to longer flights. Before booking your ticket, check the airline’s policy.
Problems associated with air travel are:
In the event of premature labour, adequate facilities for birth or a medical emergency will typically not be available on the aircraft.
Deep vein thrombosis (DVT) is a medical condition in which one or more blood clots form in the large deep veins of the legs. In some cases, DVT can be life threatening. Sitting in one position for a long time, dehydration, low humidity in the aircraft and excess alcohol consumption are some of the risk factors for DVT. It is often called “travellers’ thrombosis” or “economy class syndrome”.
A pregnant woman has an increased risk of DVT due to the pregnancy itself, and flying adds to that risk. Pregnancy-associated risks last for 6 weeks after the baby is born. The risk of DVT may be reduced by:
- requesting an aisle seat so you can carefully walk around and move your legs, feet and toes to improve blood circulation;
- drinking plenty of water and little or no alcohol or beverages containing caffeine;
- wearing well-fitted compression stockings
As many vaccines are available, pregnant women should seek advice from their general practitioner about which vaccines are recommended for the region they intend to visit. Avoid vaccines in the first 3 months of pregnancy, and avoid “live” vaccines (which carry a small risk of transmitting the disease to the foetus) throughout the pregnancy. Live vaccines include measles, rubella, BCG (tuberculosis) and polio (oral route).
Some of the safe vaccines after the first 3 months are Hepatitis A, Hepatitis B, meningococcal meningitis, rabies and thphoid fever (thphium Vi). Vaccines should be used only when the benefits outweigh the risks that vaccines may cause to the mother and the foetus.
Unless your job involves heavy physical work or occupational hazards harmful to the baby, there is no reason why you cannot continue to work for as long as you feel comfortable.
It is important to have your allocated rest breaks, take care of your posture, and maintain a healthy diet with your meals and snacks at work.
- Avoid lifting heavy objects and lift correctly (i.e. with knees bent and back straight).
- Wear support stockings. This may help to relieve tired legs if you have to stand for long periods.
If you are well and your pregnancy is progressing normally, there is no reason why you cannot continue with your usual sexual activity. For some couples, it is not unusual to lose interest in sex at some stage during the pregnancy. At other times, enjoyment of sex may be unchanged or even increased. It is important to feel comfortable about the decisions you make together about love-making.
Feeling baby move
Most women become aware of baby’s movements as “flutters” in the lower abdomen at about 18-20 weeks. The baby will move more frequently throughout the day, but is often more noticeable when you are resting. Once you start to feel baby move, you should feel more than 10 movements per day – this is a sign of baby’s wellbeing.
Your baby may get hiccups; this is quite normal. Toward the end of pregnancy, the baby’s movements may seem less strong as the baby has less room to move inside the uterus. However the baby should still move as many separate times each day as before.
Baby’s movements do not slow down or stop just before labour starts. Do not hesitate to contact the hospital if you notice any significant decrease or change in your baby’s movements. It is recommended that if this happens, you should go straight to the hospital and have the baby’s wellbeing checked thoroughly.
Breast Care during Pregnancy
During pregnancy, wash breasts daily as normal in the bath or shower. The dark area surrounding the nipple is called the areola. This produces its own oils/lubricants to prevent the areola from drying. There is no need to apply extra lotion or creams on your nipples or areolas.
As early as 16 weeks you may notice a yellowish fluid leaking from your nipples. This is colostrum and it is the beginning of your supply of milk for the baby. Some women may not notice it until the baby is born; either is normal. Colostrum is thick and provides all the nourishment your baby needs in the first few days of life, as well as providing a high level of protection against disease.
DISCOMFORTS OF PREGNANCY
During pregnancy, hormonal changes contribute to increased laxity of joints. As the baby grows, your posture needs to adapt to the changing shape of the abdomen. This can result in backache and/or pelvic pain.
To prevent backache
- maintain good posture
- bend the knees when lifting.
- wear low-heeled supportive shoes.
- daily exercise (walking, swimming and/or yoga).
- back exercises which strengthen your back and abdominal muscles
- sit with a rolled-up hand towel at the base of your spine for support and comfort.
If you have backache
- apply heat (eg wheat pack)
- gentle massage
- avoid heavy lifting, vacuuming, sweeping
- check with your midwife or doctor – referral to a physiotherapist may be necessary
The need to pass urine frequently is common throughout pregnancy as the growing uterus presses on the bladder. However, if you notice pain, stinging or burning when you pass urine it may mean that you have a urinary infection and this needs to be treated. Please contact your midwife or doctor.
A daily glass of cranberry juice and increasing your daily intake of water may reduce the likelihood of a urinary infection.
Bowel – constipation
During pregnancy, hormonal changes slow the movement of food through the bowel.
What can help?
- Increase the amount of water you drink daily.
- Eat plenty of fibre-rich foods every day, eg cereals, vegetables, fruit, wholegrains, prunes.
- Mild laxatives recommended by your doctor or midwife are safe to take, but try to avoid strong laxatives.
- Constipation may also be caused by iron tablets, so if you need to take these, increase your fluid and fibre intake.
- Walking can help as this increases peristalsis of the bowel.
- You may safely take Metamucil or Fybogel.
These are varicose veins which appear as small swellings outside your rectal area. They may become itchy, painful and sometimes bleed slightly.
To prevent or relieve haemorrhoids:
- Avoid constipation
- Avoid straining when going to the toilet – placing a stool or cushion under your feet while sitting on the toilet may help
- Pelvic floor exercises may help to control haemorrhoids
- Sitting in a warm bath using an ice pack may bring relief
- Haemorrhoid preparations with local anaesthetic – available you’re your pharmacy
- Safe to take are Proctosedyl and Rectinol
- If you cannot get relief, or if the haemorrhoids bleed, seek medical advice.
This discomfort is often a problem during pregnancy. It is caused by hormones which relax the stomach muscles, and also by the growing baby pushing on the stomach. This forces food and stomach acids upwards causing a burning feeling in the chest and throat.
Prevention or relief:
- small sips of milk, fruit juice, soda water or plain water
- sit up, raise the arms above the head
- avoid greasy or spicy foods, tea, coffee, cigarettes, alcohol
- eat small, frequent meals
- drink plenty of fluids separate from your meals
- sleep with your back elevated
- you may safely take Mylanta, Gaviscon, Rennie – follow the manufacturers’ instructions.
Nausea & Vomiting
These are two of the most common discomforts of pregnancy. A poor diet, stress, drugs and lack of sleep can make them worse, so try to eliminate these factors.
Prevention or relief:
- Replace large meals with small frequent meals.
- Avoid fatty and spicy foods.
- Avoid alcohol, tea, coffee.
- Eat plenty of fresh fruit, and vegetables rich in Vitamin B.
- Eat something (eg a dry biscuit) before getting out of bed.
- Ensure an adequate fluid intake – at least 6-8 cups of water per day, more if you have been vomiting.
- If vomiting becomes too frequent, seek medical advice.
- Ginger products may help, eg ginger beer, ginger biscuits, ginger tea, grated ginger in hot water.
Muscle cramps of the feet, lets and thighs can occur in late pregnancy, usually at night.
- Exercise will help to improve circulation in your legs.
- A warm bath and gentle leg massage before bed may also help.
- Wear socks to bed.
- If you get a sudden spasm or cramp, massage the cramped muscles upwards towards the heart, and pull your foot toward the knee. Get up and walk around to warm the cramped area.
- Try not to point your toes while in bed.
These occur in pregnancy due to the increased blood supply of the nasal lining. If bleeding occurs, apply an ice pack to the nose until bleeding is controlled. It should last for only a few minutes. If it is very heavy or frequent, seek medical advice.
It is normal to have some swelling in the hands, face or feet, particularly towards the end of pregnancy. It tends to be worse in hot weather, or when standing or sitting for long periods. Swelling should ease after resting. If swelling is accompanied by high blood pressure and/or protein in the urine, you must consult your doctor.
Prevention or relief:
- Avoid highly-salted foods.
- Ensure plenty of rest with feet elevated.
- Regular exercise and/or massage.
- Increase fruit and vegetable (anti-oxidants) intake.
Cold or Flu
These common respiratory infections do not pose any problems for your pregnancy. If you have a fever you should treat it with Paracetamol as directed and drink plenty of fluids. If fever persists for more than 48 hours, see your GP. Symptom relief is usually all that is required. To relieve coughing, you may safely take Benadryl or Duratuss.
Ligaments and muscles soften during pregnancy due to hormonal action and this makes them prone to strain and injury. It is therefore important to exercise with care. Discomfort can also be felt from ligaments stretching with the growth of the uterus which occurs throughout the pregnancy. Pain can be relieved by using wheat packs or Paracetamol. If pain is severe or constant, check with your midwife or doctor.
This occurs due to increased blood supply to the mouth and softening of the gums. It can occur spontaneously or after brushing your teeth. Good dental care and nutrition prior to and during pregnancy is very important. If your gums are bleeding it may help to rinse you mouth with cool water containing salt or lemon juice. Change your toothbrush to a softer type and floss daily.
Vaginal thrush is a common problem in pregnancy. It causes a vaginal/vulval itch and sometimes a white/yellowish discharge. It is safe to treat it with any of the over-the-counter preparations available from your pharmacy. Either vaginal cream or pessaries are satisfactory. If using a cream apply it with an applicator, otherwise the treatment may not be effective.
|NB||Your partner may also need treatment as thrush can be passed on to each other via sexual intercourse. Anti-fungal creams are available at the pharmacy.|
Your may find you become short of breath whenever you are moderately active in the last few months of pregnancy – this is normal and is due to the size of your growing baby. Gentle exercise and sleeping on two pillows may help. However, if you are breathless on even mild exertion, or have a cough or chest pain, it is important to get medical advice.
These happen as your skin stretches and changes. Again, hormones have an effect. Stretch marks most commonly appear on the abdomen, breasts and thighs. They usually fade after pregnancy, but they do not disappear entirely. It is difficult to prevent stretch marks completely, but there are some things which can help:
- a balanced diet with plenty of fluids
- regular exercise
- daily massage with a moisturiser, eg. Aloe Vera
These are painless contractions (or uterine tightenings) which occur throughout the pregnancy. They become more noticeable as the baby grows and often become more uncomfortable towards the end of the pregnancy. They are a normal part of pregnancy and prepare the uterus for labour.
Carpal Tunnel syndrome
During pregnancy, the increased fluid in your hands and feet can lead to swelling (oedema). Sometimes this can put pressure on the nerves in your wrists (the carpal tunnel). This causes numbness, tingling or pain in the hands and fingers. This usually improves after pregnancy. Gentle massage and exercise can help to relieve some swelling, but check with your midwife or doctor. If pain persists you may need referral to an occupational therapist.
During pregnancy, hormones affect the vein walls, including the veins in the legs. Also, the growing uterus slows blood flow to the legs. This is made worse by standing still for long periods. Varicose veins can be noticed in the legs, the vulva or anus. They can also be the cause of swollen ankles.
Prevention or relief:
- Avoid tight underwear.
- If standing, move around from foot to foot, wriggle your toes.
- Avoid heat directly on legs, eg. a hot bath or hot leg wax.
- Do not massage varicose veins as you may disturb the circulation.
- Take regular exercise, especially swimming or walking.
- Support stockings or pantyhose can help relieve the ache in your legs.
- Resting with legs elevated will help reduce swelling and ease the ache by aiding circulation.
It is not uncommon to experience rapid changes of mood throughout your pregnancy. You may find you laugh and/or cry more, become angry and generally feel less in control of you than before. This is quite normal, but if you are finding it difficult to cope with these changes in mood, discuss it with your midwife or doctor
Some Complications in Pregnancy
Anaemia is a disorder caused by a deficiency in the blood. The most common is a lack of iron or folic acid. During pregnancy the blood has to supply the baby’s placenta with oxygen as well as maintaining your own supply. Oxygen is carried by haemoglobin in the red cells. This is why your haemoglobin is checked during pregnancy. Some types of anaemia are inherited.
Signs of anaemia are: tiredness, lack of energy, shortness of breath, heart palpitations. dizziness, loss of appetite.
Prevention of anaemia:
- an iron-rich diet (see section on Diet). The best source of iron is red meat.
- foods and juices containing Vitamin C, which helps the body absorb iron.
- avoid tea and coffee as they can reduce absorption of iron.
Treatment of anaemia
Iron or Folate-deficiency anaemia is usually a simple matter to treat with supplements available from the chemist. Your midwife or doctor will advise you when this is necessary.
If the bleeding is heavier than a period you should seek advice. If you are less than 20 weeks pregnant, contact your obstetrician and ask for an immediate appointment. If more than 20 weeks, contact the maternity unit of the hospital where you will be delivered. Lighter amounts of bleeding, if there is no pain, should be reviewed as soon as possible. If there is pain, contact either your obstetrician or the maternity unit.
Some women may develop a temporary elevation of the blood sugar level. This is called “gestational diabetes” as the blood sugar level usually returns to normal after the baby’s birth. It is advisable for all pregnant women to be tested between 24 and 28 weeks of pregnancy. The laboratory takes a fasting blood sugar level following by a sweet sugar drink and then a blood test at 1 and 2 hours post drink. The test itself takes about 2½ hours. If diabetes does occur during pregnancy, it is extremely important to control your blood sugar levels in the normal range. This can be achieved by diet and exercise. In some cases, Insulin injections are needed until after the baby’s birth.
Pre-eclampsia is a potentially serious complication of pregnancy. It involves high blood pressure and/or increased protein in the urine (it is normal to find a trace of protein in the urine samples of pregnant women).
Other symptoms can include headaches, blurred vision, nausea and abdominal pain. If you have any of these symptoms, contact your doctor or hospital.
This refers to labour which begins before the 37th week of pregnancy. Signs of pre-term labour can be vague but include backache which comes and goes, period-like pain or cramps, a “show” (a blood-stained mucous plug) or actual uterine contractions. If any of these are happening, contact the Maternity Unit at your hospital.
Premature rupture of membranes
This means that your sac or bag of waters surrounding the baby breaks before the 37th week. This can happen even if the labour has not yet started.
Warm clear fluid can leak slowly out of the vagina or come out in a sudden gush. If it is coming out slowly, you may think it is urine, but it smells different and it should be clear. The bag of waters protects the baby from the outside world. If you think your bag of waters has broken (your membranes have ruptured), it is essential to contact the Maternity Unit.
Urinary tract infection
During pregnancy, there is more fluid flowing through your system. This means that your kidneys have to work harder and there is a greater chance of getting an infection of the bladder, kidneys or urinary tract.
The frequent urge to pass urine, a burning sensation when passing urine, lower backache, groin-ache and sometimes cramps in the lower abdomen are all signs of a possible urinary infection. If you develop any of these signs, contact your doctor or midwife so that treatment can be started before the infection becomes more severe.
Prevention of Haemolytic Disease of the Newborn / Rhesus disease
Haemolytic Disease of the Newborn (HDN) only occurs if the mother is Rhesus (Rh) negative and the baby is Rhesus positive. Foetal blood cells can cross the placenta and enter the mother’s circulation. This can happen in a normal pregnancy or in certain situations such as when amnioscentesis is performed, a miscarriage or an event such as a motor accident or a major blow to the abdomen. As a result of the baby’s red cells entering the mother’s circulation, she can develop abnormal antibodies which can subsequently affect future pregnancies.
To reduce the risk of HDN, the Health Department has recommended that Rhesus negative women should have Rhesus immunoglobulin injections at 26 – 28 and 32-34 weeks, as well as at delivery. It is also recommended following sensitising events such as miscarriage, termination of pregnancy, amnioscentesis or abdominal trauma.
Where does Rhesus (D) immunoglobulin come from?
Injections of Rhesus (D) are made from plasma of carefully selected blood donors. In Australia to date, there has never been a confirmed case of transmission of Hepatitis B or C or HIV from Rhesus (D) immunoglobulin products supplied in Australia. The risk or viral or other infective agents’ activity, however, cannot be totally eliminated.
Most pregnancies run smoothly. Occasionally, medical problems occur resulting in early or late miscarriage, the birth of a baby who is sick and/or premature (less than 37 weeks gestation), or more rarely a stillbirth.
There are times when an admission to hospital is needed during pregnancy to monitor you and/or your baby. If the baby is born prematurely or sick, he/she may need to spend time in the Special Care Nursery or the Neonatal Intensive Care Unit.
If any of these situations develop, social workers play an important role in providing practical assistance, information, support and follow-up counselling.
Medication during pregnancy
All medication, whether prescribed or available over the counter, may pass through the placenta to your growing baby. Always check with your midwife, doctor or pharmacist before taking or applying anything.
Pain relief: Paracetamol +/- Codeine, eg. Panadol, Panadeine or equivalent
Cough suppressant: Benadryl or Duratuss
Constipation: All laxatives are safe, eg Metamucil, Fybogel
Heartburn: All antacids are safe, eg. Mylanta, Gaviscon, Rennie
Vaginal thrush: Vaginal creams & pessaries, eg. Canesten, Nilstat, Monistat
Haemorrhoids: All creams are safe, Proctosedyl, Rectinol
Anti-histamines: Older ones are known to be safe, eg. Polaramine, Phenergen
Throat lozenges: All are safe, eg. Strepsile, Difflam
Iron tablets: All are safe but may cause constipation
Vitamin supplements: Elevit or Blackmore’s pregnancy and breastfeeding tablets
Antibiotics: Amoxil and Keflex are commonly prescribed and are safe
Nasal sprays: Temporary relief of congestion, eg. Saline, Sinex, Drixine
Dermatitis/skin rash: Hydrocortisone cream, eg Sigmacort
Dental / minor surgical procedures: Local anaesthetics are safe
Other medications: If in doubt, telephone the doctor to check
Mothersafe is a free telephone service in NSW for women concerned about exposure to medications and other toxins during pregnancy and breastfeeding. This includes, prescribed medication or over the counter medicines. They are available Monday to Friday 9am to 5pm.
Call 9382 6539
Marijuana, heroin, cocaine, amphetamines (“speed”), LSC, ecstasy and sedatives are all addictive drugs, and dangerous to you and your baby.