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.

Miscarriage

The loss of a pregnancy can be a very difficult time for a woman and her family. 
Miscarriages are more common than you may think, and something that no woman should feel embarrassed or ashamed about as miscarriages affect about 1 in every 5 pregnancies.

If you require further medical advise please call our office on 9419 8333 to make an appointment to see Dr. Suzana.

What is a miscarriage?

Miscarriage is very common in the first few weeks of pregnancy.
They can occur so early in a pregnancy that a woman may not know that she was pregnant. However most occur within the first 10 weeks of gestation. Once a healthy pregnancy has reached 10 weeks, the risk of a miscarriage decreases but can still occur.

When a miscarriage occurs, eventually the pregnancy tissue will pass out of the body. Some women will feel cramps, period-like pain and in most cases there will be vaginal bleeding (you must consult with your obstetrician).

Causes of a miscarriage

The cause of a miscarriage is often unknown. Generally,  at least half of all miscarriages occur because the fetus was not developing properly. In this case, miscarriage is nature’s way of dealing with an abnormal embryo. Nothing can be done to prevent miscarriage from occurring if a pregnancy is developing abnormally.

Risk Factors

- Age (the risk increases in women older than 30 years of age, with a significant increase in women over 35; at age 40 the rate of miscarriage  increases to about 1 in every 2 pregnancies).
- Previous miscarriages
- The use of some medications (speak to your obstetrician about what you are taking)
- Use of alcohol, cigarettes and/or drugs
- Previous surgery, abnormalities or trauma to the uterus
- Fetal chromosome abnormalities
- Some medical conditions in the mother, such as poorly diabetes, fibroids or thyroid problems, can lead to miscarriage. Rare medical conditions which affect blood clotting can also cause miscarriage. Women who have three or more miscarriages in a row should be checked for these conditions.

Diagnosing Miscarriage

Women seek medical care at different stages of a miscarriage; sometimes the miscarriage has already happened and sometimes it has only just begun.

Although signs and symptoms may vary, they may include vaginal bleeding, abdominal cramps and pain, and the passing of tissue.

To confirm that you have had or are having a miscarriage your obstetrician will look at a number of things, including:

- your symptoms; such as pain and bleeding
- examination results
- ultrasound and blood test results

After an examination has been done by your obstetrician, then they can advise on what steps need to be taken next.

Preventing miscarriage

Miscarriages can happen to the healthiest of women; however, being healthy will increase your chances of a healthy pregnancy.
What you can do to limit this is to follow the advice for a healthy pregnancy:
- don’t smoke
- limit your caffeine intake
- avoid alcohol
- try to avoid contact with others who have a serious infectious illness

The Emotional Impact

There are a wide range of emotions that women may feel after having a miscarriage. A miscarriage may cause intense grief and depression, that could be for a brief or long lasting amount of time. 
It has been reported that many women feel:
- emptiness & failure
- anger & guilt
- disbelief & sadness
- disappointment & loss.

Women will often struggle with feelings of self-blame & wonder whether they could have done anything to cause or to prevent their pregnancy loss.
Grief is a normal and valid reaction for the woman and her partner. They need to allow time to grieve and come to terms with the loss. The time it takes to grieve and understand varies for each individual.

Doctors agree that a miscarriage is almost never caused by anything the woman did or failed to do. In most cases the next pregnancy will be a success.

If you feel you need to speak to someone but don't know where to turn, just visit the Beyond Blue website or call them on 1300 224 636.

After a miscarriage

- Rest for a few days
- Avoid using tampons and having sex for about 2 weeks
- Depending on your obstetricians advice you may consider becoming pregnant any time after the normal menstrual cycle has resumed.

It is normal to seek help from a physiologist or counsellor if you are finding it hard to come to terms with the loss of your pregnancy.
Please see our 'Useful Link' page for links that may help you. 

Cervical Screening Test (CST)

CST is the new pap smear and why do you need it?

If you’re female, you’re going to need numerous CST (Cervical Screening Tests) over your lifetime. But what is a CST? And are CST's necessary?

WHAT IS A CST?

The Cervical Screening Test is a simple procedure to check the health of your cervix. If you have ever had a Pap test before, the way the test is done will feel the same.

The Cervical Screening Test replaces the two-yearly Pap test for people. If you're aged 25 to 74 you should have your first Cervical Screening Test two years after your last Pap test.

The Cervical Screening Test is more accurate at detecting human papillomavirus (known as HPV). 

HPV is a common virus that can cause changes to cells in your cervix, which in rare cases can develop into cervical cancer.

WHY HAS SCREENING CHANGED FROM 2 TO 5 YEARS?

The Cervical Screening Test is more accurate at detecting HPV. The Pap test used to look for cell changes in the cervix, whereas the new Cervical Screening Test looks for the HPV which can lead to cell changes in the cervix. 

Because of this, it is safe for you if your test does not indicate (show) you have a HPV infection to wait five years between tests. Even if your test shows you have HPV it usually takes 10 or more years for HPV to develop into cervical cancer and cervical cancer is a rare outcome of a HPV infection. 

WHEN WILL I GET THE RESULTS OF MY PAP SMEAR?

The results of your CST will generally be returned within two weeks.

HOW OFTEN DO I NEED TO HAVE A CST?

Once you have had your first Cervical Screening Test, you will only need to have one every five years instead of every two, if your results are normal.

DO CST HURT?

While the process certainly isn’t overly comfortable, your CST should not be painful. The whole process is over very quickly and you’ll be able to re-commence your day’s activities.

I’M TOO SCARED TO GET A CST

While a CST can sound a little scary, it’s truly not that bad, and will be over before you know it. If you’re really nervous about it though, don’t be shy to speak to the friendly and compassionate staff at Stela Obstetrics and Gynaecology about the process and how they can help you. It’s such an important part of monitoring the health of every woman. There’s also no need to be embarrassed about getting a CST Dr Suzana is highly experienced at taking CST's; it’s a very normal part of her job and she will help you to feel comfortable and relaxed.

WHERE TO GET YOUR CST IN MELBOURNE

Dr Suzana Kotevska is a highly experience obstetrician and gynaecologist, and she strives to ensure all her patients feel completely at ease and relaxed at their consultation. Apart from English, Dr Kotevska also speaks Macedonian, Serbian, Bulgarian, Bosnian and Croatian which allows her to provide excellent and personalised care to women of many backgrounds.

Contraception

Dr. Suzana is committed to helping women manage their fertility with a range of different contraception options. There are many different types of contraception that Dr. Suzana will explain to her patients during their consultation.
A number of factors will impact a woman’s decision to use contraceptives, and Dr. Suzana is discreet and understanding about all of these factors.

When it comes to contraceptive methods, it is essential that Dr. Suzana understands the reason why you are choosing to manage your fertility. Whether it’s to manage hormonal factors, health factors or lifestyle factors, Dr. Suzana will work with you to find the right treatment for you.

We offer non-hormonal, hormonal, and permanent contraception options, so you can rest assured that you have access to a full spectrum of contraceptive choices. Dr. Suzana also works with long-term reversible contraception, such as Mirena and Implanon.
Patients can undergo these long-term contraception options in Dr. Suzana's practice rooms, however some selected patients may need to be admitted into day surgery for light anaesthetic.

Menopause Treatment

All women experience menopause differently. While some are relatively unaffected by symptoms, others may experience minor changes, or even very noticeable changes that can interrupt their life. Menopause represents the relative end of a woman’s reproductive capacity, and as this change begins a woman’s hormone levels will also change, with a wide range of symptoms.

The symptoms of menopause and hormonal changes can be extremely varied from woman to woman. Some of these symptoms can last for years, which is why Dr. Suzana provides a range of treatment options and menopause counselling.

Some menopause symptoms include:
- Hot flushes
- Muscle and joint pain
- Increased sweating
- Fatigue
- Anxiety and depression
- Loss of energy and concentration
- Insomnia
- Vaginal dryness

If you are experiencing these symptoms and believe it may be caused by entering menopause, Dr. Suzana can formulate a treatment plan that suits you.

Pelvic Pain Management

Many women experience chronic pelvic pain, which can be caused by a number of different factors.
Some concerns that can cause pelvis pain include:
- Endometriosis
- Adenomyosis
- Infection

Unfortunately ongoing pelvic pain can impact a woman’s physical health, in addition to their emotional health. The symptoms of pelvic pain are not limited to just the pelvic area. Many women can experience pain passing urine, during intercourse, when opening the bowels, a shooting pain in the back or legs and more.

Many women experience pelvic pain without diagnosis for many years. Dr. Suzana is highly trained in the diagnosis of pelvic pain and other gynaecological issues, so you can rest assured you will receive skilled and accurate care. The assessment of pelvic pain may ensue over a number of consultations and may involve a number of different diagnostic techniques.

Acute pelvic pain can develop over a long period of time and thus treatment can often be a long-term process. Some treatment options that Dr. Suzana can perform include surgery or medical therapy, however during your consultations Dr. Suzana will work with you to tailor a treatment plan that best suits your concerns.

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.