Obstetrics

General health advice

Diet and exercise

During pregnancy maintaining a healthy diet and continuing to get regular exercise are important to maintain a healthy weight and fitness level for you and a healthy weight for baby.

If you exercised regularly before pregnancy most activities will be okay in the first part of pregnancy but some of them will become more difficult as your pregnancy progresses and a few may increase your chances of injury to yourself or your baby. In general low impact exercise is good throughout and high impact exercise should probably stop once you know you are pregnant until you have recovered from the birth as it places strain on your muscles and joints and rarely if you have an accident you can cause problems with the placenta. So walking and swimming are great, Mountain biking, Kickboxing not so much.

Food wise, being sensible is probably my best advice. While it is normal to gain some weight in pregnancy keeping it within the normal range of 10-15 kg means it will be easier to get back to your normal weight after baby is born. This level of weight gain makes it likely your baby will be a more healthy weight Large weight gains in Mum are associated not surprisingly with large birth weights in babies.

Foods to avoid include alcohol, high intake of caffeine so tea, coffee and Coke, foods which might contain harmful bacteria. The most significant of these is Listeria which grows in soil and plants and can be transmitted in food and in mother causes a vague fairly mild illness with fever and symptoms like flu. That’s not so bad, but the trouble is, it crosses the placenta to baby and there it can cause much more trouble for example miscarriage, preterm birth and babies to die in the uterus. It is a pretty resilient bug and can survive in food in the fridge which is why you are advised to be cautious around food which might have sat in the fridge for a while for example cold meats, pre-prepared salads, soft cheeses, undercooked meat. If you can, cook food well before you eat it, avoid soft cheeses, cold meats which may have been sitting around for a while in the fridge, cold chicken, chilled seafood, pate, soft serve ice cream and unpasteurized dairy products.

Dentist

In general most of the activity a dentist might have planned for you will be safe in pregnancy. It is okay to have local anaesthetic for any fillings and I would encourage you to have any toothache investigated as infections in the mouth have been shown to be a risk factor for premature birth. Ensure your Dentist knows you are pregnant and they will advise you about anything which can or should wait until after your baby is born.

Vitamins

There are a range of pregnancy vitamins available. A supplement which includes folic acid (also called folate) 0.4mg a day and iodine 150µg daily (as long as you have no thyroid disorder) is recommended.

Iron

Routine iron supplementation above that which is in a pregnancy vitamin is not recommended but if you become anaemic I will prescribe a tablet for you. Iron is absorbed better when Vitamin C is around so I will give you a tablet which combines both and this is safe to take in pregnancy but will affect your bowels. Your bowel motion can go black and sometimes they cause diarrhoea but more often constipation so you may need to increase the roughage and water in your diet and add in some Metamucil.

Vitamin D

In Australia the trend to avoid skin cancer and so the sun has resulted in a tendency for people to now suffer from Vitamin D deficiency. Some sun is beneficial. The trick is getting the balance right. About 20 mins with your arms in the sun each day is considered to be about right. If you are vitamin D deficient, supplementation with Ostelin might be recommended and is considered safe to use. The dose is usually 1000 to 2000 IU daily (2 tablets) unless your levels are very low.

What about sex?

Most of the time continuing an active sex life is fine in pregnancy. There are a few rare situations where things going in the vagina might lead to a problem. If your placenta is low down across the cervix it might cause bleeding and I would advise you to avoid it in that case. Also if you have a risk of preterm birth and in particular have ruptured the waters around the baby it is best avoided. There is otherwise no stage of pregnancy where it must cease although safe sex (if at risk of infection) and consensual sex is still important.

Can I fly?

For the most part flying is okay in early pregnancy up to 32 weeks anywhere. Consider that pregnancy can be unpredictable though and things sometimes happen which mean you are then stuck somewhere away from friends and family in hospital for what can on occasion be an uncertain length of time.

Domestic travel up to 36 weeks is usually acceptable to airlines provided you have a low risk pregnancy. They don’t want a baby making an appearance on a plane any more than you do and hence the cut off just before full term.

International travel is a little more risky depending on where you are going. Long flights increase your risk of blood clots developing in your legs or lungs and unless you are lucky enough to be flying first class being cooped up in a small space for a long time in advanced pregnancy is pretty taxing. Most airlines have a policy which limits flying overseas to women with pregnancies under 32 weeks and a medical certificate stating how pregnant you are and confirming you are at low risk of something going wrong is required. If you do go overseas make sure you have adequate health insurance which includes pregnancy. I may discuss with you additional strategies to reduce your chance of blood clots depending on when and where you are going. Don’t forget immunisations if going somewhere these are recommended and you would be best to get advice on this from a knowledgeable travel doctor before you book your tickets.