Obstetrics

Air travel during most stages of pregnancy is generally safe, as long as you haven't had any complications and don't have any other medical risk factors. Short flights are preferable to long-haul flights, and it is advisable to avoid international travel after 28 weeks.

In order to reduce the risk of developing deep vein thrombosis (DVT) or blood clots in your lower legs, it is very important to drink plenty of water and limit your intake of caffeine drinks. It can also be a good idea to request an aisle seat so that you can more easily get out of your seat to periodically stretch your legs, and to do simple calf, foot and toe exercises. For longer flights, well-fitted compression tights can reduce the risk of a DVT which will be increased due to both the flight and the pregnancy.

Before booking your ticket, check with the airline and travel insurance company regarding their particular policies in relation to pregnant women. Some airlines advise air travel should not be undertaken after 32 weeks' gestation while others allow women up to the 36th week. For overseas travel, you may also wish to check whether your medical insurance policy provides for air ambulance and emergency repatriation back to Australia in the event of an unexpected illness or accident.

Most of the alternative medicine (natural or herbal remedies) that is on the market has not been clinically tested to determine its safety, particularly during pregnancy and breastfeeding. Although a product may be called "natural", it may still contain ingredients that could harm you or your baby if taken. Natural or herbal preparations are not necessarily safer than other options.

Before taking any type of alternative medicine during pregnancy or breastfeeding, it is very important that you speak with your doctor, naturopath or pharmacist. Alternatively you can contact the Royal Women's Hospital drug information centre.

Chicken pox is an infectious disease that can cause serious illness in pregnant women and can also sometimes cause serious defects in an unborn baby. These can include birth defects in the brain, eyes, skin and limbs of the developing baby. Coming into contact with the virus is more of a problem in early and late pregnancy.

If you have had Chicken pox in the past you may have developed immunity to further infection. If you are immune this will protect your unborn baby. This will usually be checked as one of the routine tests in early pregnancy.

Vaccines can protect both a pregnant woman and her unborn baby from infectious diseases such as Chicken pox. Ideally, you will be up-to-date with your immunisations before you become pregnant. A booster shot is advised before becoming pregnant if you have low or no immunity.

If you come into contact with Chicken pox or shingles (which has the same virus) during pregnancy and you are not immune, you should contact your doctor who may organise for you to be treated to reduce the risks to both yourself & your baby.

It is not uncommon to come down with the common cold or a cough during pregnancy. If you do it's important to keep well hydrated with fluids and rest in bed. In addition you may take Panadol or Panadeine for a raised temperature, fever, headaches, sore throats, or aches and pains - but no more than every four to six hours. For coughs, some over the counter cough medications are safe in pregnancy. Please discuss the options with your pharmacist . Strepsils may help a sore throat.

Nasal sprays which may reduce congestion and are safe in pregnancy include Budesonide (Rhinocort) or Oxymetazoline (Drixine otrivin). It is advised not to use them for any longer than three days.

It is strongly advised not to take any Aspirin, Disprin, Ibuprufen, Voltaren or cold and flu preparations containing pseudoephedrine.

While most antibiotics can be taken safely during pregnancy, check first with your obstetrician.

Old-fashioned remedies such as steam inhalation, gargling with salt, or inhaling eucalyptus are recommended.

To protect against influenza, a Fluvax after 12 weeks of pregnancy is recommended. Please see your GP if required.

It is safe to go to the dentist in any trimester of your pregnancy. Poor oral hygiene has been associated with poor pregnancy outcomes, therefore it is really important to maintain good dental hygiene throughout your pregnancy.

It is quite common for pregnant women to experience bleeding gums, so it is advised to go to your dentist or hygienist for a check-up and let them know that you are pregnant.

If you have a dental emergency, it is safe for you to have a local anaesthetic, dental X-ray or antibiotics if required during any part of your pregnancy. However, if possible it is advisable to delay any elective dental procedure until after the birth of your baby.

A baby's healthy and normal growth during pregnancy depends on a pregnant mother's healthy and balanced diet. Such a diet comprises lean protein (well cooked meat or fish, legumes, unroasted fresh nuts), a variety of carbohydrate (potatoes, rice and grain products with a low glycaemic index, or GI) and cooked or fresh vegetables. It also includes one serve of fruit a day.

You should avoid all alcohol, fried foods, drinks and lollies with a high sugar content, as well as highly processed energy food which is high in fat and sugar. Some "health foods" have a high sugar content so check the labels.

You should also avoid altogether soft cheeses (including uncooked ricotta), pate, unwashed vegetables, pre-prepared salads, uncooked processed meats, raw fish/seafood and soft-serve ice-cream. This is due to the risk of the bacteria, Listeria. Eating under-cooked meat, unwashed vegetables from the garden or handling soil also present a risk of Toxoplasmosis.

In order to meet your daily requirements of both vitamins and folate, it is advised that you take a standard pregnancy multivitamin which also contains the recommended amount of folate of 500 micrograms per day. Folate is especially important before conception and during the first trimester - to help prevent neural tube defects in the developing baby.

Iodine is a mineral that is an essential nutrient in everyone's diet. While it is only required in very small quantities, many Australians nevertheless have an iodine deficiency. Iodine is present in seafood, as well as vegetables and milk but the quantity varies according to where and how the product is grown. Iodine is needed by the thyroid gland to produce hormones which are vital for normal brain and nervous system development in the unborn baby. If a pregnant or breastfeeding woman doesn't get enough iodine, even a mild deficiency of this mineral can cause learning difficulties, as well as hinder physical development and hearing ability in the baby.

The National Health and Medical Research Council (NHMRC) recommends that all women who are pregnant, breastfeeding or considering pregnancy take an iodine supplement of 150 micrograms a day. However, if you have a pre-existing thyroid condition, first consult your endocrinologist.

Some studies show a possible link between high levels of caffeine intake and miscarriage or the impaired growth of the foetus. It is therefore advisable to limit your consumption of caffeine (found in coffee, tea, cola, chocolate and certain energy drinks) to less than 200mg per day - which is equivalent to 2 cups of ground coffee, or 4 cups of medium-strength tea, hot chocolate or cola per day.

Fish and seafood are both a very good source of omega-3 fatty acids as well as protein and should be a regular part of your diet - roughly 2-3 times a week. However because mercury is a naturally occurring element that is found in water and food, it is advisable to eat smaller fish, and not shark, swordfish, barramundi, gemfish or southern blue-fin tuna. (High levels of mercury are dangerous to humans.) Consuming tinned tuna (which comes from smaller tuna) is safer, and there are no restrictions on salmon - fresh or canned.

Reference: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Pregnancy_and_diet?open

Exercise may help to relieve some discomforts during pregnancy, including tiredness, constipation, leg cramps and excessive weight gain. A program of back-strengthening exercises may help women who develop backache. This can include simple yoga and swimming.

Regular exercise (about three times a week) is recommended. Preferably keep the intensity of exercise low enough that your heart rate does not exceed 140 beats per minute. It is also advised not to start an exercise regime requiring extreme exertion (eg marathon running). Ask your doctor if you have not been following an exercise routine before becoming pregnant. Low impact activities such as walking, swimming, water aerobics and using an exercise bike are all considered safe forms of exercise throughout a pregnancy. If you play a team sport, be sure to rest and substitute frequently.

Pelvic-floor exercises are very useful to strengthen the muscles which support the bladder, the uterus and the bowel area.

Expect that you may experience occasional dizziness or light-headedness during your pregnancy.

Normal changes in your blood circulation happen early on in pregnancy which may leave you feeling faint or dizzy. There are hormonal changes and an increase in blood volume. Then in later pregnancy your blood pressure can change as your uterus expands to accommodate the growing baby.

To prevent mild, occasional dizziness, avoid prolonged standing and get up slowly after sitting or lying down. Safely stop driving if you start to feel dizzy. If you are standing when you begin feeling dizzy or light-headed, sit or lie down. Drink a lot of water - at least two litres of fluid each day. You may also find that it's also more comfortable to dress in layers to prevent overheating.

Stress or fatigue or even feeling hungry may also play a role in feelings of light-headedness. Low blood sugar levels can cause dizziness, so eating more frequently and smaller meals or snacking on good food can help. As well, it has been found that eating some protein at every meal helps stabilise blood sugar levels.

Gestational diabetes occurs when elevated blood sugar (glucose) levels are detected in pregnancy. This type of diabetes occurs in 5 - 8% of pregnant women. It happens because of changes to a pregnant woman's hormone levels and how their body then uses insulin. The condition can generally be controlled by healthy eating and moderate-intensity exercise (at least 30 minutes of physical activity on most days). Exercise and healthy eating also help to maintain a healthy weight gain in pregnancy.

If you are advised that you have gestational diabetes, you will be referred to a diabetic educator who specialises in talking to and monitoring pregnant women with diabetes. The diabetic educator will discuss how to try and keep your sugar levels in the healthy low range.

For all pregnant women a healthy diet includes carbohydrate foods which are spread over the day. Carbohydrate foods are broken down by the body into glucose to release energy. For staggered energy release, it is advised to have three small meals plus 2-3 snacks each day containing nutritious carbohydrates. These are best consumed as low carbohydrate vegetables and fruit, legumes, grainy breads, rice and low-fat yoghurt. It is best to avoid high-sugar carbohydrates, with little nutritional value, such as sweet biscuits, cakes, lollies, cordials and soft drink. The rest of the diet needs to be balanced with protein, iron, low-fat calcium and unsaturated fats. For fluids, it is advised to drink tap water.

Diabetes in pregnancy, or gestational diabetes, will usually go away after the baby is born. While it does not cause your baby to develop diabetes, it does increase the likelihood of the mother getting Type 2 diabetes later in life.

A screening test for gestational diabetes is available. It is called the Glucose Tolerance Test (GTT). This test requires that you fast. You will then have 3 blood tests over a two hour period. Depending on your family or personal history it may be recommended that you have an early GTT before 18 weeks of pregnancy. If an early GTT is not indicated, then all women will be advised to have the GTT at around the 26th week.

The symptom of heartburn is due to reflux of swallowed food back up the oesophagus or food pipe, along with stomach acid. It creates a burning sensation in the lower part of the chest & throat. Heartburn is common throughout pregnancy but may be exacerbated in the final 2-3 months of pregnancy because of hormonal changes as well as the growth of the baby which presses on the mother's stomach that can push up acid contents.

To try to prevent heartburn, avoid spicy, acidic, fatty and greasy foods; also avoid coffee as this can further irritate the stomach; eat small meals more frequently, eat slowly and chew thoroughly; rather than drinking with meals, drink plenty of fluids in between meals; drinking a little warm milk before bed can help, as can sleeping with your head higher than your stomach supported by a lot of pillows. Some over-the-counter antacids can relieve symptoms - such as Mylanta, Zantac, Gaviscon and Quick Ease. Different preparations work for different women. You should not take Alka Seltzer or Bicarb of Soda as they can upset acid/alkaline balance in the gut.

For many women nausea and vomiting are a normal part of early pregnancy (between 5-20 weeks). It often peaks at around 9-12 weeks. Morning sickness appears to be related to the high hormone levels in a pregnant woman's blood. The slowing down in the speed of digestion may also contribute. Nausea or vomiting seems to occur more often on an empty stomach and when blood sugar levels are low.

Morning sickness is not harmful to you or the unborn baby. Please be aware that nausea and vomiting may sometimes be related to another medical problem. Symptoms of morning sickness can occur right up until birth for a small number of women. Studies show that the rate of miscarriage and stillbirth is lower for women who experience feelings of nausea and vomiting during pregnancy, which can be good news!

There are a number of things you can try to relieve the symptoms and reduce dehydration:

• Eat small meals which are high in protein or carbohydrates and are low in fat, as well as frequent nutritious snacks - rather than three large meals each day. This will help to keep your sugar levels constant. For example, eating salty chips or drinking bland broth can help settle a stomach
• Avoid an empty stomach - keep some dry biscuits by your bedside to eat in the morning, about 15 minutes before you get up
• Keep up a regular intake of fluids, sipping on small amounts throughout the day, about every 10 - 15 minutes
• Sip cold clear fluids such as plain water, mineral or soda water, ginger ale or lemonade - removing the lid to reduce the carbonation before drinking fizzy drinks
• Also try putting a sliced gingerroot into warm water or weak black tea, or take over the counter ginger tablet preparations, which may include Vitamin B 6
• Sipping peppermint tea, or hot or cold water with slices of lemon, can also be helpful.
• Get plenty of rest, get up slowly and do not lie down right after eating.
• Avoid things which may trigger nausea and vomiting - such as greasy, spicy or fatty foods, unventilated rooms or strong odours (eg food, perfume, smoke, chemicals, or even coffee), noise, and visual or physical motion (eg flickering lights, driving).
• Vitamin B6 (Pyridoxine), an over-the-counter supplement, can help with nausea - 25mg tablets, up to three a day eg Blackmores morning sickness formula. (Green leafy vegetables, bananas, tuna and chicken are natural food sources of Vitamin B6.)
• If pregnancy multivitamins or iron supplements make your symptoms worse, try taking them at night, or stop taking them temporarily.
• Please contact our rooms if you are not able to keep down any food or fluids. Maxalon or Zofran medication may be prescribed if necessary.

Parvovirus is a virus that causes fever and a rash (often red cheeks) in children. The condition is also known as Slapped Cheek. The person with slapped cheek is infectious two weeks before the the rash appears. Once there is a rash on the face, the child with the rash is not infectious and cannot spread the infection to others. In adults most infections do not have any symptoms. Six out of ten people have had the virus by the time they are adults. If a pregnant woman has never had parvovirus before, then she has no immunity to parvovirus.

If you are pregnant and exposed to someone with slapped cheek, a simple blood test can determine if you have had parvovirus in the past. Sometimes this blood test is run as part of the antenatal screening bloods. Therefore your obstetrician may already know if you have immunity. If you have already had parvovirus then there are no concerns for your unborn baby.

If you believe you have had close contact with a person, usually a child, with Slapped Cheek, and you don't know if you are immune, then you need to have a simple blood test to confirm if you have or haven't had parvovirus before. If you haven't had it before then you will also need a further blood test two weeks after that contact to determine whether or not you caught the infection. Many adults will have no symptoms of a parvovirus infection. If you caught Parvovirus then your unborn baby can get a type of aneamia (low levels of red blood cells in the blood). This is rarely serious and usually resolves by itself. Your obstetrician will organise to closely monitor your baby if you do catch Parvovirus. Parvovirus can take up to six weeks to show any effect on an unborn baby. The virus does not cause any other problems for the baby.

There is no vaccine available to prevent unborn babies contracting the virus. If your baby develops severe anaemia, the baby can be safely treated for this whilst still in utero.

If a pregnant woman is overweight or obese this can put the health of both mother and baby at greater risk and increase the likelihood of complications during pregnancy and delivery.

Excess weight increases the risk of early miscarriage, stillbirth, high blood pressure, gestational diabetes, pre-eclampsia (sudden swelling, headaches and shortness of breath accompanying rapid weight gain) and blood clots in the legs or lungs. Excess weight can also lead to difficulty in monitoring the health of the foetus, a slow and difficult labour that requires intervention, complications related to a spinal epidural, and a greater need for a caesarean section delivery which can carry risks of blood loss and infection.

The increased risks to the baby of a pregnant woman carrying too much weight include a higher risk of birth defects and developmental abnormalities, premature delivery and associated problems, and a greater likelihood of the baby becoming obese and developing diabetes in childhood. Excessive maternal weight gain during pregnancy affects the baby's metabolism forever.

After giving birth, an obese or overweight mother experiences greater difficulty in shedding the weight gained during pregnancy, higher risks of post-natal depression or a deep-vein blood clot, and greater difficulty with breastfeeding.

A baby's healthy and normal growth during pregnancy depends on a pregnant woman's healthy and balanced diet. Such a diet comprises lean protein (meat, fish, legumes, unroasted fresh nuts), a variety of carbohydrate (potatoes, rice and grain products with a low glycaemic index, or GI) and cooked or fresh vegetables. It also includes one serve of fruit a day. You should avoid all alcohol, fried foods, drinks and lollies with a high sugar content, and highly processed energy food which is high in fat and sugar - such as toasted muesli, coated nuts, chocolates, savoury crackers and health food bars.

A pregnant woman should also try to do 20-30 minutes of physical exercise each day. An important part of this is to slowly warm up and cool down on either side of the exercise session. Make sure you also drink plenty of water before, during and after physical activity. Check with your doctor first, but appropriate activities can include swimming, walking, gardening, and specially designed aerobic and mild stretching exercises (low impact and not too strenuous). After the first 16 weeks of pregnancy, you should not lie flat on your back because the baby's weight can press on major blood vessels and cause faintness.