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Pregnancy and Birth Care Options

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Exercise in Pregnancy

Pregnancy Loss

Maintaining a well-balanced diet during pregnancy is important for healthy mother and baby - see Nutrition & Food Safety in Pregnancy

Food contamination - Some types of food poisoning organisms (e.g listeria, salmonella, can cause problems during pregnancy. The risk can be minimised by good hygiene and food handling practices and avoiding high risk foods. Please refer to this resource from NSW Food Authority for details. You can also find more information regarding food safety can be found here (Royal Women Hospital).

Vitamin A - Limit liver to very small amounts, no more than 50 grams a week, as it contains high levels of a form of vitamin A called retinol which may be harmful to the developing baby.

Caffeine - It is recommended to limit your caffeine intake to 200mg a day or less. A high caffeine intake has been linked to slightly increased risk of miscarriage and low birth weight.

Alcohol - There is no known safe level of alcohol use in pregnancy, and it is advised to avoid alcohol altogether during pregnancy

Having a baby is one of life’s most exciting and challenging experiences. It is so important as parents to look after your own physical and emotional wellbeing throughout this life stage.

It is a huge transition for a family to welcome a new member, and can be a huge emotional rollercoaster of both positive and negative emotions.

It is normal to need time to adjust to the arrival of a new family member. If you find negative emotions or feelings are lasting longer than a few weeks, or start to impact daily life, it is important to seek help.

Perinatal mental health issues affect both men and women, with 1 in 5 mothers and 1 in 10 fathers experiencing perinatal depression or anxiety.

The Centre of Perinatal Excellence (COPE) has an excellent newsletter you can sign up to that encourages you to check in with your emotional wellbeing at different intervals during your pregnancy and parenthood journey.

There is also a wealth of mental health support for families via Perinatal Anxiety & Depression Australia (PANDA).

If you are struggling, please don’t feel alone. I am here to support you, and can refer you on if needed to psychologists both face-to-face or remotely. Telehealth psychology is available at short notice through Gidget Foundation Australia, and more.

Vaccinations during pregnancy are recommended to protect expectant mothers and their babies against serious infection and adverse health outcomes.

It is routinely recommended to consider the following vaccines:

• Pertussis (whopping cough) - between 20 to 32 weeks gestational age

• Influenza - at any time during pregnancy

• COVID-19 - at any time during pregnancy

For more detailed information, visit NCIRS Vaccinations during pregnancy fact sheet.

It is advised to avoid drugs during pregnancy and breastfeeding as any medication, whether prescription or over the counter, herbal medicines or supplements can impact your baby’s growth and development.

The following over-the-counter medications are considered safe during pregnancy:

• For pain or fever: paracetamol

• Vaginal thrush: internal treatments, e.g. vaginal cream or tablets

• Heartburn: atacids (mylanta, gaviscon, quickeze)

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are NOT safe during pregnancy. Medications that are safe during pregnancy may not be safe whilst breastfeeding.

Please advise me if you are taking any complementary or over the counter medications.

If you are unsure, or have a particular question about a medication, please contact the Medicines Information Service, at (03) 8345 3190,

Coping with nausea and vomiting

Heartburn

Coughs and Colds

Hayfever

Cytomegalovirus

The most common infection that can affect the baby is cytomegalovirus (CMV). CMV affects fewer than 1% of pregnancies, but when it does, it an cause developmental delays in the baby, as well as hearing loss. When an adult has CMV, there are often no symptoms. If symptoms do occur, they are usually mild and include fevers, fatigue and headache. CMV does not cause common cold symptoms like cough or runny nose.

Young children are at high risk of contracting CMV, especially in contact with other children at daycare or schools. There is currently no treatment or vaccine available. If you think you have symptoms of CMV during pregnancy, please book an appointment as soon as you can to discuss this.

The risk of CMV to baby varies:

• If a person has never had CMV and catches it while they are pregnant, there is a 30% risk of the baby also being infected. Long term effects are seen in approximately 15% of cases where baby is infected. Overall risk is 45 in 1000 (4.5%)

• If a person has had CMV previously, they have a very low risk of infection during pregnancy. If a virus reactivates, there is a 1% risk of transmitting it to the baby, and of those who are infected, fewer than 10% will have long-term effects. Overall risk is 1 in 1000 (1%)

The best way to prevent CMV and other infections is through basic hygiene measures.

These include:

• Do not share food, drinks or utensils used by young children

• Do not put a child’s dummy in your mouth

• Avoid contact with saliva when kissing a child

• Thorougly wash hands with soap and water for 15 to 20 seconds after changing nappies, feeding a young child or wiping their nose or mouth

• Clean toys, wipe counters and other surfaces that come into contact with children’s urine or saliva

• Do not share a toothbrush with a young child

Parvovirus / Slapped Cheek / Fifth Disease

Parvovirus is a common infectious illness of childhood. It usually presents as a mild fever and classic red rash of the cheeks. Adults who are infected may experience fever and joint pains, however they generally do not get a rash. Due to the mild nature of this illness’ symptoms, many people are not formally diagnosed.

While parvovirus is a mild illness in children, it can have a significant effect on the fetus. If you come into contact with parvovirus, please book an appointment as soon as you can to discuss next steps. It usually involves a blood test to check your immunity to the disease.

Toxoplasmosis

Toxoplasmosis is a parasitic infection that infects birds and mammals. Cats are most commonly a host for these parasites, and touching or eating raw or undercooked lamb or pork.

If a women becomes infected with toxoplasmosis for the first time when pregnant, the unborn baby may also become infected via the placenta. If this occurs, long term antibiotics can be used to treat the infection.

This is a rare condition and prevention is key.

You can prevent it by:

• Taking precaution with food hygiene

  • Wash hands before eating or after handling raw meat

  • Cook meat thoroughly until juices run clear

  • Don’t eat with dishes that have raw or undercooked meat in them

  • Wash vegetables to remove all traces of soil

  • Wash cutting boards, knives or other implements used in preparation of meat after use

• Wear gloves when gardening

• Safety with Cats

  • Owning a cat is generally safe for pregnant women.

  • Reduce the risk further by asking someone else to clean the litter tray daily

  • Keep your cat indoors.

  • Try to prevent your cat from hunting or eating birds or other wildlife

  • Feed your cat tinned foods and not raw meat

• Safety with sandpits

  • Parasite eggs of toxoplasmosis can live for 12 months in soil, sand or water

  • Precautions should be taken with young children and sand pits

  • Cover sand pits to prevent stray cats from using them as litter trays

  • Always wash hands after playing in the sand pit and before eating

Gestational Diabetes

Gestational diabetes mellitus (GDM) is a type of diabetes that can occur during pregnancy and usually resolves after pregnancy.

The glucose tolerance test (GTT) tests for gestational diabetes. The test involves fasting from 10pm the night before the test (no food or drink water only) and having blood samples taken before and after drinking a glucose drink. If your blood sugar level is higher than they should be, gestational diabetes is diagnosed.

You normally will need to make an appointment for your Glucose Tolerance Test at a pathology collection centre.

Group B Streptococcus (GBS)

Group B Streptococcus (GBS) is one of the many bacteria that live on the body, particularly the bowel and vagina. In late pregnancy, about 10-15% of women will have GBS. It is usually harmless, and women experience no symptoms at all

A woman can pass on GBS to her baby during labour and delivery. Most babies who get GBS do not have any problems, however, rarely a baby who has contracted GBS can suffer a serious infection, e.g. pneumonia, or meningitis, which results in long-term disabilities, or may even be life threatening.

Between 34-36 weeks of pregnancy, you will be a recommended to do a screening test for GBS by having a low vaginal swab.

If you test positive to GBS, antibiotics are usually recommended during labour, or after the membranes rupture.

Main things to consider if planning travel while pregnant are:

• Destination - local or overseas

• Risk of injury or infection

• Number of weeks you are pregnancy

• Travel insurance

Documentation

• If you have a normal, low risk pregnancy, travel within Australia is usually straightforward

• Some airlines require you carry certain documentation - it is recommended to look into this well before you plan to travel

• If you require any documents for travel, please kindly book in an appointment to discuss this

Insurance

• If you are planning travel overseas, consider what will happen if you become ill, have an accident, or need to deliver your baby

• Some insurers cover pregnancy until a certain gestation but may not cover the baby after birth

• Most airlines require you to return before 34 weeks’ gestation

Vaccinations

• It is recommended to make an appointment at least 6-8 weeks prior to travel to review and discuss any potential vaccination, or medications you may require to protect against infections and common ailments

Flying

• In the first trimester, flying can make pregnancy nausea worse

• Prolonged sitting increases risk of deep vein thrombosis (DVT) or pulmonary embolism (clot travelling to the lung). To reduce risks:

  • Keep hydrated

  • Move as much as possible

  • Do leg exercises to keep blood circulating

  • Wear well-fitting compression socks

  • If you notice calf swelling, shortness of breath or chest pain after travel, seek urgent medical advice

Side Sleeping

Research shows that going to sleep on your side from 28 weeks of pregnancy can halve your risk of stillbirth, compared to going to sleep on your back.

After 28 weeks of pregnancy, lying on your back presses on major blood vessels which can reduce blood flow to your uterus and the oxygen supply to your baby.

Either side is fine.

The important thing is to start each sleep lying on your side.

If you wake up on your back, don’t worry, just roll over on your side.

For more information, visit #SleepOnSide

Baby movements are so important! Your baby's movements are one of the signs that your baby can give you that they are well.

As baby’s mum, you know your baby the best. If you are worried, I am worried. If you are concerned at any point about baby’s movements - call the birth suite at hospital that you are giving birth at without delay at any time of the day.

Being aware of your baby’s movements during pregnancy is one of the simplest things you can do to help keep your baby safe and healthy. Regular and healthy movements are a good sign of wellbeing. It is a myth that babies’ movements slow down or become weaker towards the end of pregnancy.

You will start to feel your baby move between weeks 16 and 24 of pregnancy, regardless of where your placenta lies, and you should feel your baby's movements right up until they are born, even during labour.

For more information, visit #MovementsMatter

Rhesus D negative in pregnancy

Labour and birth information

Assisted Delivery

Instrumental vaginal birth information

Healthy parents means healthy bubs and children, and better health outcomes for the whole family. It is so important for you to look after yourself, your body and emotional wellbeing during and after pregnancy.

It is common to experience aches and pains, pelvic floor discomfort after birth. Just as it takes 9 months to grow a baby, it means 9 months of body changes and may mean up to a year (or more) after birth for you to feel yourself again.

Take time to check in with your pelvic floor - Looking after your pelvic floor - and your body - Caring for your body after pregnancy.

The same goes for our emotional wellbeing and mental health too. It is a huge transition for a family to welcome a new member, and can bring various emotions out too - excitement, overwhelm, anticipation to name a few, and can be a big adjustment for the whole family.

The Centre of Perinatal Excellence (COPE) has an excellent newsletter you can sign up to that encourages you to check in with your emotional wellbeing at different intervals during your pregnancy.

There is also a wealth of mental health support for families via Perinatal Anxiety & Depression Australia (PANDA)

Breastfeeding has immense benefits for both mother and baby - from protection against short-term illnesses like ear infections and stomach bugs, to reduced risk of asthma, obesity, diabetes, and sudden infant death syndrome (SIDS) in breastfed infants. Breastfeeding can also reduce the mother’s risk of breast and ovarian cancer, type 2 diabetes, and high blood pressure.

That being said, everyone’s breastfeeding experience is different. For some people, establishing breastfeeding after birth may be quite difficult. If this is you, please don’t feel alone.

Luckily, breastfeeding support is very plentiful nowadays, and we are fortunate to have many International Board Certified Lactation Consultants (IBCLCs) available to help. If you are planning to and wish to breastfeed, it is worthwhile to explore some of the resources below. If you have just given birth and needing help, please talk to me early in your breastfeeding journey.

Here are some resources:

• Australian Breastfeeding Association (ABA)

Helpline available 24 hours per day, every day of the year
Accessible to any parent with a breastfeeding or infant feeding related question
Phone number: 1800 mum 2 mum | 1800 686 268

• Kellymom Breastfeeding

• Royal Women Hospital Breastfeeding Fact Sheets

• The First Droplets

• Antenatal expression of colostrum

BASIS - Baby Sleep Information Services

Safe Sleep Seven

Newborn Sleep

Can you spoil a baby?