Placenta Praevia

The placenta develops at the same time as your baby and is attached to the lining of your uterus (womb) during pregnancy. It allows for oxygen and nutrients to pass from you to your baby as well as producing hormones that support your pregnancy.

Placenta praevia means the placenta has implanted at the bottom of the uterus, covering the cervix.

When a baby is ready to be born, the cervix (neck of the womb) dilates (opens) to allow the baby to move out of the uterus and into the vagina. When a woman has placenta praevia (the placenta has implanted at the bottom of the uterus, over the cervix or close by), the baby can’t be born vaginally. ‘Partial placenta praevia’ means the cervix is partly blocked, while ‘complete placenta praevia’ means the entire cervix is obstructed.

Some of the causes include scarring of the uterine lining (endometrium) and abnormalities of the placenta. Around one in every 200 pregnancies is affected.

Symptoms of Placenta Praevia

The most important symptom in placenta praevia is painless vaginal bleeding after 20 weeks. However, there are causes of vaginal bleeding other than placenta praevia. All bleeding during pregnancy should be reported to your doctor for prompt investigation and treatment.
 

Placenta Praevia Treatment

Placenta praevia is graded into 4 categories from minor to major. If you have grade 1 or 2 it may still be possible to have a vaginal birth, but grade 3 or 4 will require a caesarean section.

Any grade of placenta praevia will require you to live near or have easy access to the hospital in case you start bleeding. Heavy bleeding may mean you need to be admitted to hospital for the remainder of your pregnancy.

When you are in hospital, your blood will be taken to make sure an exact donor blood match is available in case you need a blood transfusion. You may also need to take iron tablets if you have anaemia (low blood haemoglobin level).

If you have bleeding during your pregnancy and have Rh negative blood, you will need an injection of Anti D so your baby is not affected by the bleeding.

Your baby may also be monitored with a cardiotocograph (CTG) to make sure they are not distressed. The CTG records your baby's heart rate and response to movements and contractions.

Being in hospital doesn't stop you from bleeding, but your baby can be delivered more quickly if needed. Your doctor or midwife will discuss any test results with you and what steps may be needed to ensure you and your baby's wellbeing.

Things to remember

• During pregnancy, the placenta provides the growing baby with oxygen and nutrients from the mother’s bloodstream.

• Placenta praevia means the placenta has implanted at the bottom of the uterus, over the cervix or close by, which means the baby can’t be born vaginally.

• Treatment aims to ease the symptoms and prolong the pregnancy until at least 36 weeks.

Skin & Hair Care During Pregnancy

Are you constantly confused about what is safe and what isn’t during pregnancy?
Well then have a read of the slides below to get a better understanding on what is & isn’t recommended during pregnancy.

Learn more about:

• Vitamin A

• Botox & fillers

• Oils (essential oil, bio oil etc.)

• Fake tan

• Waxing & other hair removal products

• Hair dye & Nail products/manicures

• Protein Powders

A recent question that has come up a lot from our pregnancy patients (since beauty clinics reopened after our Melbourne COVID lockdown) is in regards to Laser hair removal during pregnancy.
Although laser hair removal is generally considered a safe procedure, doctors and dermatologists usually advise women to avoid the procedure because no studies have been done to prove that it's safe for mothers and babies. In the absence of research, doctors err on the side of caution.
Also note that laser hair removal is often less effective during pregnancy. Pregnancy hormones affect the pigmentation in your skin as well as the growth of hair follicles.

Perinatal Mental Health During COVID-19

Sex & Relationships In Pregnancy

In a low risk pregnancy, sex is perfectly safe, although your levels of desire may fluctuate throughout pregnancy. Most women report that their interest in sex is the same of slightly reduced in the first trimester. In the second trimester, it varies from woman to woman and in the third trimester libido often falls.

SEX DURING PREGNANCY

During the first trimester, the hormonal changes that cause nausea, vomiting, and tiredness can naturally result in a reduced interest in sex. However, other pregnancy changes may increase your desire, such as an increased blood flow, which produces swelling in the clitoris and labia and extra vaginal secretions.
In the second trimester especially, vaginal lubrications and intensity of orgasm can increase, which may be accompanied by gentle contractions that harden the abdomen; these are normal and nothing to worry about. Many women find that their libido falls towards the end of their pregnancy as a bigger bump makes sex more awkward and uncomfortable, and they may also feel increasingly anxious about the birth.

HOW YOUR PARTNER FEELS

Partners have a range of feelings towards sex in pregnancy. While some find their partners new, fuller shape particularly sensuous, others feel apprehensive about sexy, fearing that they may harm the baby.
Some feel a combinations of these emotions. Unless there are concerns about the pregnancy, it’s generally thought that sex won’t cause harm, as your baby is well protected by the amniotic fluid and your uterus, and the mucus plug sealing the cervix protects against infection.

WHEN TO SEEK ADVISE

Some women experience vaginal bleeding after sex in pregnancy. This is most likely harmless and is often caused by the increased blood flow to the cervix in pregnancy, which can cause it to bleed on contact with your partners penis. If this is the cause, the bleeding should settle after the birth. However as there are other possible causes, report any bleeding to your doctor.
Apart from the size of your bump causing discomfort during sex, some women experience pain during sex towards the end of the pregnancy as the baby moves further into the pelvis; or they may find that the contractions that can accompany and orgasm become increasingly uncomfortable. These symptoms are u likely to be a cause for concern, but it’s worth mentioning them to your doctor for reassurance.
There are some circumstances in late pregnancy when intercourse may not be safe. This can be the case if you’ve had a previous premature labour or risk factors for premature labour, such a weak cervix, or if you have placenta paevia, or leakage of amniotic fluid which can mean your water shave broken.

If you have any concerns, don’t be afraid to ask your doctor for advise. Being able to enjoy sex in pregnancy can help your and your partner to feel close during this time of transition.
Indeed, psychologists have found that couples who enjoy sex in pregnancy are more tender towards each other and communicate better after birth.

Vaginal Birth After a Caesarean (VBAC)

Have you had a C-section? Are you thinking about how to give birth next time?

For many years it was assumed that once a woman had a C-section all future babies would also be delivered this way. However, this is not always the case. Whether you decide to have a Vaginal Birth After a Caesarean (VBAC) or a planned C-section in your future pregnancy, either option is usually safe but also has different risks and benefits involved.

Every woman’s preferences and risk profiles will be different.

It is extremely important to discuss your birth options with your obstetrician, to ensure that you are making the most informed choice. When considering your options your obstetrician will ask you about your medical history & your previous pregnancies (unless this is the same obstetrician as your previous pregnancies, then they will know your history).

Your obstetrician will want to know about:

-       The reason for your caesarean delivery & what happened – was it an emergency?

-       The type of cut that was made in your uterus

-       How you felt about your previous birth experience? (do you have any concerns?)

-       Whether your current pregnancy has been straightforward or have there been problems or any complications? (read our previous blog on Caesarean Sections to learn more).

Your obstetrician will always respect your right to be involved in the decision-making regarding the birth of your child, and your awareness of the risks and plans for future pregnancies.

It is important that your decision involves your partner and be made earlier on in your pregnancy and of course in consultation with your obstetrician. An agreed plan will then be documented in your pregnancy file.

What are the benefits & risks of VBAC?

Benefits of a successful VBAC include:

-       A vaginal birth; which may include an assisted birth

-       A higher chance of an uncomplicated normal birth in future pregnancies

-       When repeat elective C-section is chosen, there are risks associated with any major surgery, and all future births are likely to be by C-section. As the number of previous C-section deliveries increase, so does the risk of rare but serious complications

-       A shorter recovery & shorter stay in hospital

-       Less abdominal pain after birth

-       Some may have personal satisfaction in achieving a vaginal birth

-       Babies born vaginally have a lower risk of respiratory problems.

Risks for the mother & baby when attempting a VBAC:

-       There is a chance you will need an emergency C-section during labour, which has amplified risks of bleeding and infection compared to a planned C-section

-       Uterine scar rupture. This can result in serious problems for the baby (brain injury or even death) or for you (severe bleeding, including the small risk of hysterectomy)

-       The risk of your baby dying or being brain damaged in you chose a VBAC is very small (two in 1000 women). This is low however is it slightly higher than if oyu had a repeat C-section (one in 1000).

However, this needs to be weighed up against the risks and benefits of a planned C-section.

It can be challenging to explain and comprehend the risk of complications which occur rarely, but can have severe consequences if they occur.

When it’s not suitable for a VBAC

-      You have had three or more previous C-Section deliveries

-       Your uterus has ruptured previously

-       You have a high uterine incision

-       You have had a previous surgery to your uterus (removal of fibroids)

-       You have other pregnancy complications that require a C-section delivery

Factors affecting success of VBAC

Factors favouring success include:

-       Previous vaginal birth

-       Previous successful VBAC

-       Spontaneous onset of labour

-       Uncomplicated pregnancy without other risk factors

Factors making it less likely for a successful vaginal birth include:

-       You have never had a vaginal birth

-       Need to have your labour induced

-       Have had more than one previous C-section

-       Overweight with a BMI over 30 at booking

-       Have a complicated pregnancy

-       Have had sloe progress in a past labour

What happens if you don’t go into labour?

If you do not go into labour by 41 weeks your obstetrician will discuss various options with you. Induction of labour does remain an option for you however, this reduces the success rate of achieving VBAC and increases the rate of uterine rupture.

How will your care during labour be different if you have a VBAC?

There will be continuous monitoring of your baby’s heartbeat once you are in established labour. The progress of your labour will be closely monitored, and if you are not making good progress a repeat C-section will be advised. You will be involved throughout your labour with the planning of your care.

It is very important to think about all of your options very carefully. Your obstetrician is there to discuss any questions that you may have. Regardless of how your next baby is born vaginally or by C-section, she wants your experience to be safe, rewarding & satisfying for you and your family. And most importantly that you and your baby are healthy!

All About Caesarean Sections

A CAESAREAN SECTION MAY BE SUGGESTED IF THERE IS A POTENTIAL BENEFIT TO YOUR OWN OR YOUR BABY’S HEALTH, OR SOMETIMES BOTH.

A Caesarean section is the delivery of your baby by means of a cut in the abdomen. A Caesarean rate of around 10-15 % is thought to be reasonable, although in most western countries the rate has risen above 20%. almost a 3rd of all babies in Australia are now delivered by Caesarean.

TYPES OF CAESAREAN

Caesareans are either emergency or planned procedures. The doctor assesses urgency with a grading scheme. A Grade 1 Caesarean is one that is carried out if there is an immediate threat to the baby’s or mother’s life. A Grade 2 Caesarean is one where there is concern for the baby’s or mother’s wellbeing, but no immediate threat to life. A Grade 3 Caesarean is done when there is no immediate concern for the mother or the baby, perhaps because of a condition in the mother or baby. A Grade 4 Caesarean is an elective delivery planned to suit the woman and hospital.

CONSENT

The doctor will always get your consent prior to carrying out a Caesarean. She will tell you why the procedure is being proposed, and what its benefits and risks are. Ideally, you should have plenty of time to decide whether you want the operation or not, although with an emergency Caesarean, the time to think things over may be limited.

YOUR ANAESTHETIC

The anaesthetist will make sure that you have no pain during your operation, and will help you with pain control afterwards. Most women are awake during a Caesarean. An injection of medication into the spinal fluid in you back, called a spinal block, numbs any sensation of pain. Or, if you’ve been using an epidural for pain relief in labour, this can be used for the operation. After your anaesthetic has been given, the anaesthetist will check that it is working properly. Being awake usually means that your birthing partner can stay with you and it’s also a little safer for you and for your baby than a general anaesthetic. Very occasionally a general anaesthetic is needed.

THE OPERATION

Once the anaesthetist is happy that you’re pain free, your tummy will be cleaned with an antiseptic solution and sterile drapes will be placed over you, which also stop you and your partner seeing the operations.
During the operation, a long incision will be made on the tummy wall, across the bikini line, although occasionally an up-and-down cut below the belly button is done. Your bladder will be pushed down and the front of the uterus is opened so that the doctor can assess the baby. If your waters haven’t already broken, this will be done now before the baby and placenta are delivered. The surgeon will release the head from the pelvic brim and lift the baby out. Sometimes another member of the team needs to put pressure on the uterus to assist this. You’ll be able to see your baby when the cord has been cut, and once initial checks have been done on your baby, you or your partner should be able to hold your baby and have skin-to-skin contact while the operation is complete. You’ll have an injection of syntometrine to help deliver the placenta. To finish the Caesarean, the uterus will be closed up with one or two layers of stitches, the the tummy wall will be stitched in seperate layers.

RECOVERY

You will be encouraged by the midwives and obstetrician to get out of bed the following day, and by the day after this you may be well enough to do most things for yourself, with help.

POSSIBLE COMPLICATIONS

There are several common, but minor problems associated with Caesareans. These include bleeding during the operation, or a day or so later; needing a blood transfusion; or getting a minor infection in the bladder or in the wound. A major infection is far less common and having to have a second operation because of a life-threatening wound infection is rare.

MOST COMMON QUESTIONS AFTER CAESAREAN SECTION:

When can I drive?
6 weeks after a c-section is the recommended wait time before you can drive a car. It is important that you also speak with your car insurance to check what is stated in their T&C’s.

When can I exercise?
After a c-section you will need to wait until your 6 week check with your obstetrician before starting a strenuous program. Starting with low-impact exercises, such as walking and pilates.

When can I pick up my other child?
If your other children are 10kg + it is important that you avoid picking them up, as mentioned above in ‘When can I exercise’ you will need to wait a minimum of 6 weeks before being able to do any heavy lifting or strenuous work that can impact your abdominal muscles.

How do I take care of my Caesarean section wound?
(for all of Dr Suzana’s current pregnancy patients you can find this information in the USB we provide to you after your 10week appointment)

Your Caesarean incision may have been closed with staples which are usually removed within 3-7 days of delivery.
However the most common way that the incision is closed is with stitches, and are usually reabsorbable sutures, meaning they are absorbed by the body and do not need to be removed. Keep your wound clean and dry. Wear loose clothing and look for signs of infection (such as redness, pain, swelling of the wound or bad-smelling discharge). You will need to go see your obstetrician or midwife.
The incision will heal over the next few weeks. During this time, there may be mild cramping, light bleeding or vaginal discharge, as well as pain and numbness in the skin around the incision.
Most women will feel well by 6 weeks postpartum, but numbness around the incision and occasional aches and pains can last for several months.

Can I have a Vaginal Birth After a Caesarean (VBAC)?
ANSWER COMING IN OUR NEXT BLOG! 👉

Cytomegalovirus (CMV)

All the following information and much more is available at the CMV website. Please check it out!

What Is CMV?

Cytomegalovirus (CMV) is a common virus in the herpesvirus family. Fifty percent people have been infected by young adulthood and up to 85% by 40 years of age. Peaks of infection occur in children under 2 years age, and during adolescence.
Once a person becomes infected, the virus remains alive but usually inactive (dormant) within that person’s body for life. It is rare for a person to get symptoms after the initial infection unless their immune system is weakened by severe illness and treatments (e.g. for cancer). Reactivation can occur during pregnancy in women who have had infection previously, with a very small risk of transmission of CMV to the unborn baby.

Who Is At Risk?

If a woman is newly infected with CMV while pregnant, there is a risk that her unborn baby will also become infected (congenital CMV). Infected babies may, but not always, be born with a disability. The highest risk to the unborn baby occurs when a woman who has never had CMV before is infected with the virus for the first time during pregnancy (primary [first] CMV infection) and when infection occurs during the first half of the pregnancy.

Studies in Australia have shown that out of 1,000 live births, about 6 infants will have congenital CMV infection and 1-2 of those 6 infants (about 1 in 1000 infants overall) will have permanent disabilities of varying degree. These can include hearing loss, vision loss, small head size, cerebral palsy, developmental delay or intellectual disability, and in rare cases, death. Sometimes, the virus may reactivate while a woman is pregnant but reactivation does not usually cause problems to the woman or her unborn baby.

Transmission

Humans are the only source of CMV. The virus is found in urine, saliva, nasal mucous, breast milk, vaginal secretions and semen of infected people. The risk of transmission from children born with disability due to CMV infection is no greater than that from children who have CMV infection without symptoms. CMV is spread through:

• Close contact with a person excreting the virus in their saliva, nasal mucous, urine or other body fluid

• Handling children’s toys that have saliva or mucous on them, or handling contaminated items like dirty tissues or soiled nappies then touching the eyes, nose or mouth without first washing hands

• From mother to her unborn child as a result of maternal infection during pregnancy

• From mother to her unborn child as a result of virus reactivation during pregnancy

• Breast milk of an infected woman who is breast feeding

• Sexual contact.
  

Prevention

Pregnant women are recommended to take steps to reduce their risk of exposure to CMV and so reduce the risk of their developing baby becoming infected.

• Wash hands often with soap and running water for at least 15 seconds and dry them thoroughly. This should be done especially after close contact with young children, changing nappies, blowing noses, feeding a young child, and handling children’s toys, dummies/soothers.

• Do not share food, drinks, eating utensils or toothbrushes with young children.

• Avoid contact with saliva when kissing a child.

• Use simple detergent and water to clean toys, countertops and other surfaces that come into contact with children’s urine, mucous or saliva.

Child care workers who are pregnant or considering pregnancy should pay particular attention to good hand hygiene, especially after changing nappies or assisting with blowing noses or toileting.

Symptoms

Children and adults with healthy immune systems do not usually develop symptoms when infected, but may develop an illness similar to glandular fever with tiredness, sore throat, swollen glands and fever. People with a weakened immune system are more likely to develop symptoms.

Diagnosis

A person who has been infected with CMV will develop antibodies in their blood that indicate infection has occurred, either recently, or in the past. These antibodies stay in the body for the rest of that person’s life. Other tests, that detect the virus, are used to determine if a person has an active CMV infection.

Testing for CMV is not routinely recommended for all women during pregnancy or for newborn babies. CMV testing is currently recommended for pregnant women who develop an acute viral illness or when ultrasound reveals a foetal abnormality. However, pregnant women and women planning a pregnancy may wish to discuss CMV testing with their doctor, particularly if they work in high risk settings (e.g. in child care centres) or have very young children at home.

Infants born to mothers diagnosed with a primary CMV infection during pregnancy should be tested for congenital CMV infection. Babies who do not have a normal hearing screening test at birth (SWISH) can also be tested for congenital CMV, as hearing loss is the most common sign of congenital CMV. However, some infants with congenital CMV infection who appear healthy at birth develop hearing or vision loss over time; for this reason, babies known to be infected should have their hearing and vision assessed regularly.

Treatment

Currently, international research is being conducted about the best methods for treating CMV infection during pregnancy.

Pregnant women diagnosed with primary (first) CMV infection should be referred for specialist follow up and counselling in order to receive up to date information about the risks and benefits of the available treatments, which are currently experimental. Infants born with neurological disabilities due to CMV may benefit from early antiviral treatment; this should be discussed with a specialist paediatrician.

Most babies born with CMV infection grow up with normal health. Concerns about CMV infection can be discussed with a general practitioner or MotherSafe, a free telephone service that provides a comprehensive counselling service for women and their healthcare providers concerned about exposures during pregnancy and breastfeeding http://www.mothersafe.org.au/

To get involved join the STOP CMV Hand Campaign at https://www.cmv.org.au/stop-cmv-hand-photos/

*All this information is from the CMV website, all credit for this information goes to them.

Non-Invasive Perinatal Test (NIPT)

The Non-Invasive Perinatal Test (NIPT) is used to detect pregnancies that have an increased risk of a chromosome condition such as Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), Patau syndrome (trisomy 13), other rare trisomies and partial chromosome deletions and duplications.

These conditions are all related with intellectual disability and congenital malformations. The severity of intellectual disability and the risk of malformations vary with different disorders.

What is NIPT?

NIPT is an sophisticated screening test that includes an exact and accurate measure of the amount of fetal DNA in your blood before proceeding with the chromosome analysis. The NIPT uses cell-free Fetal DNA (cfDNA) located in the maternal blood to detect chromosome conditions found during pregnancy. cfDNA is released from the placenta into the maternal blood stream as part of the growth and development of the baby.

The NIPT screening is safe and poses no threat to the pregnancy as it uses a simple blood sample collected from the mother.

Accuracy 

The finding rate; this describes how good the test is at detecting a specific condition such as Down syndrome using the NIPT is >99%. What this means is that if your pregnancy is affected by Down syndrome, it will almost certainly be detected.
 

What happens if the NIPT is a high risk result?

A high risk result doesn’t necessarily mean that your pregnancy is definitely affected by a specific condition, what it means is that that may be an increased chance. When this happens a genetic counsellor will contact your obstetrician to discuss other testing options, such as diagnostic testing. Diagnostic testing will not give you a definitive yes or no answer, however it is the only way to verify the presence of a condition or assure you you’re your pregnancy will not be affected.

When can I do the test?

Screening can be done any time from 10 weeks of your pregnancy. Once the test has been undertaken it then takes 3-8 business days to receive the results. Your results are investigated by certified medical scientists who are trained specialists in prenatal screening and diagnosis. 

For more information please speak to Dr Suzana at your next appointment or visit:

https://www.sonicgenetics.com.au/nipt/patients/what-is-nipt/

https://www.vcgs.org.au/tests/perceptnipt

Importance Of Your Pelvic Floor Muscles

What do my pelvic floor muscles do? 

The pelvic floor is the base of the group of muscles referred to as your ‘core’. These muscles work with your tummy (deep abdominal) and deep back muscles and diaphragm to stabilise and support the spine. They also assist in controlling the pressure inside your abdomen to deal with the pushing force when you lift or strain, for example when you are exercising.

Pelvic floor muscles support the bladder, bowel and uterus in women (and the bladder and bowel in men).

What causes my pelvic floor muscles to weaken? 

Pelvic floor problems can occur when the pelvic floor muscles are stretched, weakened or too tight. Some people have weak pelvic floor muscles from an early age, whilst others notice problems after certain life stages such as: 

·      Childbirth (predominantly resulting in the delivery of a large baby or prolonged pushing during delivery)

·      Being pregnant

·      Being overweight

·      Heavy lifting (e.g. at work or the gym)

·      Chronic cough or sneezing (asthma, heavy smokers & hayfever)

·      Changes in hormonal levels (menopause)

·      Constipation (excessive straining to empty your bowel)

·      A history of back pain

·      Growing older.

How do you strengthen your pelvic floor muscles?

Your pelvic floor muscles can be consciously controlled and therefore trained. Strengthening your pelvic floor muscles will help you to support your bladder and bowel. What this does in improve your bladder and bowel control and helps reduce the possibility of accidentally leaking from your bladder and bowel. With a regular strengthening exercise program your pelvic floor muscles will become stronger. This is very important for both women and men.

·      If you have mastered the art of contracting your pelvic floor muscles correctly, you can try holding the inward squeeze for longer (up to 10 seconds) before relaxing. Make sure you can breathe easily while you squeeze. If you can do this exercise, repeat it up to 10 times, but only as long as you can do it with perfect technique while breathing quietly and keeping everything above the belly button relaxed. This can be done more often during the day to improve control. If you need help identifying your pelvic floor muscles then visit the Pelvic Floor First website.

·      Pilates are another great way to strengthen your pelvic floor muscles as these muscles require slow exercises as well as fast exercises. Check out the Poise website for some great pilates workout examples. (Consult your physician if you have any questions or are hesitant whether or not pilates is ok and safe for you, especially if you are pregnant).

How do I prevent damage to my pelvic floor muscles?

You need to avoid the following:

·      Straining with a bowel motion

·      Persistent heavy lifting

·      Repetitive coughing

·      Putting on too much weight.

Like all exercises, pelvic floor exercises are most effective when individually tailored and monitored. The exercises described are only a guide and may not help if done incorrectly or if the training is inappropriate.

Weight Gain During Pregnancy

It's normal for women to gain some weight during pregnancy due to the growth of the fetus, placenta and amniotic fluid.

Eating for two is the term we seem to hear a lot when you’re pregnant, however you have to remember that that second being growing inside of you is not the same size as you!

This is what many women seem to forget once they fall pregnant. They forget to watch their weight and constantly say to themselves “I am eating for two”.
Yes that is correct, yes it’s ok to put on weight during your pregnancy! However you must remember there is healthy weight gain and then there is unhealthy weight gain during your pregnancy.

Once again every woman’s pregnancy journey is different and no two women have the same body, therefore weight gain needs to be assessed by your obstetrician to ensure you and your baby are healthy and growing well.

What is considered ‘healthy’ & ‘unhealthy’ weight gain during pregnancy?

The amount of weight that a woman can expect to gain during pregnancy varies depending on the woman’s existing weight and height.
The table below shows recommendations for total and average rate of weight gain during pregnancy, by pre-pregnancy BMI.

Eating for ‘two’

When eating in general it is important to keep in mind what you eat and the nutritional value of the food.

Tip: Eat to fuel your body.

This is vital especially when you are pregnant.

To put this into perspective eating 100gr of M&M’s chocolate with a nutritional value of 30gr Sugar (refined sugar) & 10gr Fat, as you can see there isn’t really anything good about having this ‘snack’ apart from stopping a sugar craving. Where as when you compare this to a 100gr of a red delicious apple the nutritional value is only 10.4gr of sugar and NO fat; keep in mind this natural sugar and there is also plenty of vitamin C and fiber in that apple.
Now I’m not saying that you shouldn’t have any sweets or treats at all, but what I am saying is to be mindful about what you eat on a DAILY bases.

As stated above depending on our weight pre-pregnancy this will determine how much weight you should/can put on during each trimester.
Naturally you will put on weight as your baby, placenta and amniotic fluid grow.

Have your chocolate or piece of cake but don’t forget it might be a good idea to go for a walk afterwards, or limit how many ‘treats’ you have each week.
(For exercise tips see my previous blog 'Exercising During Pregnancy').

Remember you aren’t just eating that apple for you, but for your growing baby as well. Your baby definitely doesn’t need a packet of chips or slice of cake every day.

So be mindful and be smart with what you choose to fuel your body and baby with.

As to what you can and cannot eat whilst pregnant this is discussed at your first appointment with Dr Suzana and all information is included on your USB we provide our patients with.

Exercising During Pregnancy

All women who are pregnant without complications are encouraged to participate in aerobic and strength-conditioning exercises as part of a healthy lifestyle during their pregnancy.

There are many benefits from exercising regularly during pregnancy. These include physical benefits and the prevention of excessive weight gain, as well as benefits for psychological wellbeing.

Before you start any exercise program you must speak to your obstetrician to make sure that you do not have any health issues that may stop you from participating in regular exercise during your pregnancy.

For those women that may be worried there is no actual evidence to suggest that regular exercise during a healthy pregnancy is harmful to the woman or her baby, therefore you are encouraged throughout your pregnancy to participate in regular aerobic and strengthening exercises.

Suggested exercise activities during your pregnancy

It is recommended that you are active most days if not every day. However, if you are currently inactive or overweight, you should start with 3-4 days per week on non-consecutive days.

There are two types of exercises that you are encouraged to do whilst pregnant, aerobic and strengthening exercises.

Aerobic exercises involve continuous activities that use large muscle groups and raise the heart and breathing rates.
Some examples of aerobic exercises include:

·      Brisk walking
·      Stationary cycling
·      Swimming and other water based activities like aquarobics (avoid heated spas & hydro pools)

Strengthening exercises suggest being performed 2 times per week, on non-consecutive days, this covers the main muscle groups of the body.

You can use light weights, body weight or elasticised resistance- bands.
Some examples of Strengthening exercises include:
·      Pelvic floor exercises
·      Yoga, stretching & other floor exercises
·      Pilates
·      Pregnancy exercise classes

Important tip: pelvic floor exercises are vital to begin conditioning the pelvic floor muscles from the start of your pregnancy as these muscles are weakened during your pregnancy and during vaginal birth.

It is important to continue with these throughout your pregnancy and resume as soon as you are comfortable after birth (consult with your obstetrician).

Exercising and changes associated with pregnancy

Your body will undergo many changes during pregnancy. Some will affect your ability to exercise, or require you to modify your exercise routine, including:

• Hormones such as relaxin loosen ligaments, which could increase your risk of joint injuries (such as sprains).

• As pregnancy progresses, your weight will increase and you will experience changes in weight distribution and body shape. This results in the body’s centre of gravity moving forward, which can alter your balance and coordination.

• Pregnancy increases your resting heart rate, so don’t use your target heart rate to work out the intensity of your exercise. In healthy pregnant women, exercise intensity can be monitored using a method known as Borg’s Rating of Perceived Exertion (RPE) scale. This measures how hard you feel (perceive) your body is working.

• Your blood pressure drops in the second trimester, so it is important to avoid rapid changes of position – from lying to standing and vice versa – so as not to experience dizzy spells.

Pelvic floor exercises and pregnancy

Your pelvic floor muscles are weakened during pregnancy and during birth (vaginal delivery), so it is extremely important to begin conditioning the pelvic floor muscles from the start of your pregnancy.

Appropriate exercises can be prescribed by a physiotherapist. It is important to continue with these throughout your pregnancy and resume as soon as is comfortable after the birth.

Exercises to take caution in or avoid

A list of exercises you should take caution in or avoid, include:

·      Weightlifting/heavy lifting is recommended that it is avoided during pregnancy, especially if you were not weightlifting prior to becoming pregnant. It’s important that your personal trainer is educated on exercise in pregnancy and always inform your obstetrician if you are planning on weightlifting. Try to choose low weights and medium to high repetitions – avoid lifting heavy weights altogether.
·      Avoid abdominal trauma or pressure activities such as situp/crunches
·      Avoid contact or collision sports such as martial arts, soccer, basketball (other similar sports)
·      Avoid hard projectile object such as hockey & cricket
·      Avoid falling such as skiing & horse riding
·      Avoid extreme balance such as gymnastics
·      Take caution with major changes to pressure such as scuba diving. It’s best that this is avoided.
·      Avoid high-altitude training over 2000m
·      After your first trimester you should not perform any exercises lying flat on your back
·      It is also recommended to take extreme caution with walking lunges & wide squats as they can cause injury to the pelvic connective tissue.

If you are not sure whether a certain activity is safe during your pregnancy, you must check with
your obstetrician at your antenatal appointments.
 

Warning signs when exercising during pregnancy

If you experience any of the following during or after physical activity, stop what you are doing and contact or obstetrician or GP, or in an emergency go straight to your booked hospital.

·      Headache
·      Dizziness or feeling faint
·      Heart palpitations
·      Chest pain
·      Swelling of the face, hands or feet
·      Calf pain or swelling
·      Vaginal bleeding
·      Contractions
·      Deep back, pubic or pelvic pain
·      Cramping in the lower abdomen
·      Walking difficulties
·      An unusual change in your baby’s movements
·      Amniotic fluid leakage
·      Unusual shortness of breath
·      Excessive fatigue
·      Excessive muscle weakness.

For any further questions please speak to your obstetrician at your antenatal appointments.

Early pregnancy indications

Missing a period

One of the earliest indications that a woman is pregnant is missing a period. However, there could be other reasons for menstruation to be delayed, such as stress, illness, excessive weight gain or anorexia, or coming off of an oral contraception pill. In some women polycystic ovarian syndrome can be a condition that causes irregular periods and sometimes very infrequent periods.

Breast tenderness

Some women, especially multi-gravidas, know that they are pregnant just by the give away sign of breast tenderness. As early as a few days after conception the breasts begin to enlarge in order to get ready for breastfeeding. They feel heavier and sore, especially on touch. There is sometimes a tingling sensation and this disappears several weeks later.

Morning sickness, nausea and vomiting

Feeling nauseous is a quite common complaint in early pregnancy and is experienced by the majority of women in early pregnancy, especially around five to six weeks. For most women this symptom disappears at around 14 to 16 weeks of pregnancy. However, there are a small number of women who have hyperemesis throughout the pregnancy.

Tiredness

Many women feel very tired during pregnancy, especially at the beginning. They find that they need much more rest and they need to take a nap several times during the day. However, the frequency of napping lessens after 14 weeks.

Changes in taste and smell

Certain foods can cause sudden queasiness or you may start to crave particular foods. Sometimes women may have a metallic taste in their mouths.

Constipation

Constipation is a common symptom in early pregnancy. However, this can be a continuing symptom throughout the pregnancy. This is caused by the high levels of progesterone which relaxes the bowel and slows the digestion.

Mood swings

Pregnant women can be overtly emotional. This is a secondary effect from a flood of pregnancy hormones.

Frequent urination

Early in the pregnancy there is pressure from the enlarging uterus onto the bladder and this is literally reducing the capacity of the woman’s bladder. At about 14 weeks the uterus rises up into the abdomen and most women start having the urge to urinate frequently which can be annoying. This is a very good time for you to start doing your pelvic floor exercises if you haven’t already started.