Patient and Pregnancy

While pregnancy is a journey unique to every woman, most mothers-to-be share similar questions and concerns. It’s completely natural to worry about your baby and your body. A/Prof Fiona Brownfoot, a private obstetrician at the Epworth Freemasons Hospital in East Melbourne, has compiled some of the most common pregnancy questions, pregnancy symptoms and pregnancy resources for you to make the journey that little bit easier.

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Very common questions and answers

What is my due date?

Your due date is generally 40 weeks from the first day of bleeding from your last menstrual period. Sometimes your due date will change after you have an ultrasound as it can be more accurate. We have an excellent due date calculator at CLICK HERE.

What vitamins should I be on?

Folate and iodine are important vitamins for the healthy development of the baby’s brain and nervous system. We recommend taking 500mcg of folate and 150mcg of iodine for 3 months before you become pregnant and continuing these until 12 weeks and throughout your pregnancy respectively. You may need extra supplements such as iron, vitamin D or calcium and Fiona will advise you about this at your appointment. Find out more HERE.

What exercise can I do?

It is really important to stay healthy during your pregnancy and exercising is generally encouraged. Low impact, non-contact exercise is generally safe to continue in pregnancy. High impact exercise or extreme exercise however should be avoided. There are antenatal exercise classes that patients enjoy such as ‘Preggy Bellies’. If your pregnancy is complicated Fiona may advise that you stop exercising. To find out more HERE

Can I fly on plane?

Yes, flying is not known to cause any harmful effects to your baby. If your pregnancy is uncomplicated then generally I think it is okay to travel internationally up to 26-28 weeks and interstate up to 34-36 weeks of pregnancy. Before you book your flights just double check the airline policy on flying and make sure you have adequate insurance. You are at increased risk of clots in your legs so keep your fluids up, walk around and use compression stockings. for more information CLICK HERE.

What should I consider if I want to travel?

If you have a pregnancy complication would the country and location you are in be able to offer you adequate care? If a complication arose you may be stuck in a location far from family and friends. Furthermore it can get very expensive, in the hundreds of thousands of dollars. It is also important to avoid travel to countries with Zika. These can be found at: HERE.

Can I dye my hair and can I have a spray tan?

Yes you can dye or bleach your hair and use tanning products as they have not been shown to cause problems in pregnancy. It is however best to avoid the fumes from a spray tan so if you did want to have a fake tan once or twice in pregnancy perhaps the lotions would be best.

Can I have a bath, spa or sauna?

You can have a bath or a spa when you are pregnant however it is important that you don’t get too hot. If you feel like you are sweating then the temperature needs to be reduced. Saunas are too hot and not safe to have while you are pregnant.

Can I see a dentist?

It is important to have good oral hygiene in pregnancy and seeing your dentist is definitely recommended. It is important to have emergency dental work and local anaesthetic and antibiotics have not been shown to cause harm. Perhaps delay any elective dental procedures until you have had your baby.

Information Overload?

Being pregnant can be overwhelming, with so much information, and the pressure of doing the right thing for your baby. One of the fantastic things about having a dedicated private obstetrician like Fiona looking after your pregnancy and baby is that she will make sure you know what you need to know and when you need to be aware of it. You are welcome to ask Fiona any questions you have. Fiona also provides all her mothers to be with a pack of useful info about pregnancy at your first visit and then a second pack at 28 weeks detailing labour, birth and beyond. You will be in safe hands.

Most common Pregnancy Symptoms FAQ’s

Nausea and vomiting is really common in early pregnancy. By around 14 weeks the nausea and vomiting tends to subside however in a small number of patients it can continue up to delivery.

There are a few things you can do to reduce your symptoms to make you feel better. These include eating small but frequent meals, avoiding foods that make the nausea worse such as spicy or greasy foods and ensuring you are drinking plenty of fluids including water or mineral water and lemonade or dry ginger ale can also help.

It is a good idea to start taking a pregnancy multivitamin as you may not be able to eat a balanced diet. If your symptoms are not improving with these simple measures patients find vitamin B6 (pyridoxine) is helpful. If your nausea continues to persist there are many safe anti-nausea medications that we can start. If you are not able to keep any food or fluids down then please contact Fiona as you may need to be admitted to hospital.

Constipation is really common in pregnancy.

There are some simple measures that you can take to reduce this including increasing the amount of fibre in your diet by eating things such as all bran breakfast cereals and by increasing your fluid intake.

There are also a number of medications that help with constipation that are safe in pregnancy and these include: Metamucil, fybrogel or lactulose. Make sure you also keep up some exercise as this can also help.

Please contact Fiona if you have bleeding in pregnancy so she can see you and organise your care.

In general however a small amount of bleeding in early pregnancy is quite common and usually nothing to worry about. If you have persistent heavy bleeding contact Fiona immediately or come in to hospital.

Bleeding later in pregnancy is not common and it might be a sign that there is a complication with your pregnancy. It is really important that you call Fiona as soon as possible if this happens.

It is really common to experience some cramping in early pregnancy. If the cramping is persistent or if it is associated with bleeding it might be a sign of miscarriage so please contact Fiona.

Some women experience pain on either side of their abdomen at around 16 weeks of pregnancy. This is very common and most likely due to stretching of the ligament (round ligament) that attaches the sides of the uterus to the abdominal wall. Generally these pains will subside over days. Placing a heat pack over the area can be helpful.

Later in pregnancy you may notice pain at the front of your pelvis or around your pelvic girdle that is worse with movement and on walking. This is really common and called pubic symphysitis. It occurs due to the hormones of pregnancy relaxing the ligaments of the pelvis. Generally as your pregnancy grows and becomes heavier the pain worsens. Once you have your baby the pain generally improves. Make sure you avoid activities that exacerbate the pain and ensure you are wearing flat shoes. Often keeping your legs together helps so sitting down to put your pants on, using a plastic bag on a chair such as in the car so you can swivel around can really help. A physiotherapist can also help by giving you different exercises to strengthen your abdominal muscles, pelvic muscles and back. Sometimes a hip brace can help and the physiotherapist can fit you with this. When the pain is extreme some women need crutches.

Some women find they have shooting pain down either leg in later pregnancy and this is called sciatica. It usually occurs due to compression of the sciatic nerve by the growing uterus. Usually moving or rolling over onto your other side can help reduce the pain. This pain usually resolves once you have your baby.

It is really important to stay healthy in pregnancy and eat a well balanced diet. There are a few dietary restrictions recommended to reduce the chance that you could pass any harmful infections on to your baby. The main infections that can be passed on through food that we want to prevent are listeria, toxoplasmosis and a condition called gastroenteritis. Also some fish contain high levels of mercury so it is recommended to limit your intake of these. It is also really important to avoid alcohol intake and smoking during pregnancy.

Listeria is a bacteria commonly found in the environment and can be present in unpasteurized milk products, raw vegetables, raw meat and seafoods. It is killed by thoroughly cooking foods. It is therefore best to avoid unpasteurized dairy products, soft cheeses and soft serve ice cream, per-prepared cold salads, raw or partially cooked meets or seafood or cold cooked meats, processed meats or seafood and reheated foods.

Toxoplasmosis is a parasite that can be found in the soil due to the presence of animal faeces (mainly cat). It is really important to wash fruits and vegetables thoroughly, ensure meats are cooked all the way through, wear gloves whilst gardening, ensure you wash your hands after patting animals and get someone else to change the cat litter.

Gastroenteritis is caused by an infection or toxin in the digestive system. Symptoms include abdominal cramps, vomiting and diarrhoea. To avoid gastroenteritis ensure you thoroughly cook raw animal products including eggs, ensure re-heated food is steaming hot throughout and make sure you wash your hands prior to eating. If you develop gastroenteritis in pregnancy make sure you keep your fluids up with water and other clear fluids such as apple juice, cordial or lemonade and use rehydration sachets. If you are not able to keep any fluid or foods down or have abdominal cramps then please contact Fiona.

It is also important to restrict your intake of certain fish as they contain high amounts of mercury, which can be harmful to the baby’s developing nervous system. Fish that can contain mercury include shark (Flake) or billfish (swordfish, marlin) and you should limit your intake to 1 serve per week and catfish or orange roughy (deep sea perch) and you should limit your intake to 1 serve per fortnight. Salmon, prawns and shellfish are fine to eat up to 2 – 3 times per week.

For more information on safe foods in pregnancy please see Healthy Eating During Pregnancy OR Foods to eat or avoid when pregnant

Heartburn, also known as reflux, is really common in pregnancy. This is because the hormones of pregnancy cause the muscle around the esophagus to relax. Also as your uterus and pregnancy grows there is increasing pressure in your abdomen predisposing you to reflux.

Eating small frequent meals, avoiding rich or spicy meals, chocolate, citrus, tomato and coffee can reduce reflux. Also avoid lying down straight after you have eaten. Antacids such as mylanta and gaviscon are safe and can really help to ease reflux. If it persists then it is a great idea to start a preventer such as ranitidine or esomeprazole.

You will generally start to feel your baby moving by around 16-22 weeks of pregnancy. Usually the first movements you feel will be flutters, swishes or kicks. At first your baby won’t seem to move very much however the movements will increase over the course of your pregnancy. By 24-28 weeks of pregnancy your baby will be moving regularly and it is really important that you take note of this. If you think your baby’s movements have reduced it is really important to have a drink of water and something to eat and sit or lie quietly for 1 – 2 hours and monitor your baby’s movements. If you have less than 10 movements in 2 hours or still feel like they are reduced compared to your baby’s usual movement pattern then come in to emergency at the Mercy or contact Fiona and she will organize your care.

The amount of weight to gain in pregnancy differs based on your body mass index (BMI) and other pregnancy factors such as if you are expecting twins. For average weight women with a single baby you would expect to put on 11.5-16kg over the course of pregnancy. If you are underweight then you should put on more weight than this and if you are overweight you should put less weight on than this. Please see Mercy Perinatal website for a more detailed overview

Gestational weight gain singletons

If you have a medical condition and are on medications let your GP and/or specialist know you are pregnant and also please inform Fiona. Common conditions and safe medications to use include:

Aches and pains: paracetemol is safe. You must not take non-steroidal anti-inflammatory medications such as voltaren, or ibuprofen.

Infections: antibiotics including amoxicillin, erythromycin, Keflex are all safe.

Allergies: antihistamines including polaramine and restivit are safe.

Constipation: metamucil, fybogel and lactulose are safe

Nausea and vomiting: vitamin B6 (pyridoxine) and ginger are safe.

Thrush: canestan vaginal cream Reflux or heart burn: Mylanta or gaviscon.

Advise Fiona at your appointment and she can recommend or prescribe other medications.

Hemorrhoids are really common in pregnancy due to the increasing abdominal pressure from your growing uterus and baby and also due to constipation. They will generally get worse over the course of your pregnancy and subside once you have your baby. Try to avoid constipation to reduce these symptoms. If they are painful you can safely use topical treatments such as rectinol ointment.

Thrush is really common in pregnancy and can be treated with canestan cream. It is generally safe to apply the canestan cream vaginally.

Yes, you can have sex while pregnant so long as your pregnancy is progressing normally. There are a few conditions in pregnancy when sex is not advised such as if you are diagnosed with a placenta praevia. This is where the placenta lies over the cervix. We generally identify this at your 20-week ultrasound. I will let you know after this scan and advise you to stop having intercourse.

After you have had your baby you can generally start having sexual intercourse again once you stop bleeding vaginally. If you have intercourse earlier it can increase your risk of infection. Breast-feeding generally reduces your fertility although isn’t a very reliable form of contraception and I would advise you to use another form of contraception when you are ready to have intercourse.

After around 20 weeks of pregnancy it is best to lie on your side to sleep. This is because the uterus is getting bigger at this point and can compress the large vessel (the inferior vena cava) that takes blood from your lower body up to your heart and can potentially compromise blood flow to you and your uterus, placenta and baby. A number of recent studies have found that falling to sleep on your side is associated with a lower risk of stillbirth. If you happen to wake up and you are on your back, please don’t panic, just roll over onto your side again. Placing a pillow behind your back can help to keep you on your side whilst sleeping.

If you have an uncomplicated pregnancy I would advise you to finish work when you are around 34-36 weeks pregnant. If you have a physical job or your pregnancy is complicated I might advise you to finish work earlier. It is great if you can take some time to enjoy yourself prior to having your baby. Go out with your friends, have dinner and a movie with your partner and enjoy a massage. Make sure you rest. Your life is about to really change. There will likely be sleepless nights and settling challenges however the joy and happiness a baby brings far outweighs the negatives.

There are out of pocket fees associated with private care. The main reason for these are to ensure you have comprehensive 24-hour on-call care by a specialist obstetrician every day of the year. The second reason is to cover the costs of large insurance premiums that are in the tens of thousands of dollars. There are also significant fees associated with running a practice and rooms. The out of pocket fee for obstetric care has been calculated carefully taking all of these factors into account and agreed upon by a group of specialist obstetricians at the Mercy. My receptionist can outline these to you over the phone and I will discuss these with you at your first visit. It is really important to tell you that your private health insurance covers the cost of your care while you are an inpatient in hospital during delivery and after you have your baby in hospital however it doesn’t cover your clinic visits.

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