It is quite common to have occasional abdominal pains due to stretching of ligaments etc. Panadol can be taken quite safely for these and also for headaches, which are also common in pregnancy. Nose bleeds, dizziness, fainting and pressure in the vagina can also be common but please let me know if the symptoms persist or if you are concerned.
Current guidelines recommend no alcohol consumption in pregnancy and certainly binge drinking is to be avoided at all costs. However, there is no evidence that a celebratory glass or two on random occasions is dangerous to a developing baby, so enjoy your birthday or anniversary as it arises!
Smoking is harmful throughout the entirety of the pregnancy and is best avoided. Effects on foetal growth and placental function, including the risk of miscarriage and prematurity are just some of the potential consequences. I will help you to wean (still useful) and/or quit (ideal) and recognise that it may be difficult. Support services in the form of the QUIT Line, amongst others, plus the use of aids such as nicotine gum/patches etc. can be relatively safely used to aid in the process.
Antenatal classes covering a number of topics including labour and birth and post-natal and early parenting are conducted by Frances Perry House and I encourage both you and your partner to attend.
A small show of mucous and blood is normal in late pregnancy and should not alarm you. If the bleeding is more than a teaspoonful, or if it occurs in the early stage of pregnancy, please contact me.
Can I dye my hair? (yes), can I paint a room? (yes), can I use spray tan? (no evidence currently to say it is unsafe), are mobile phones safe near my abdomen? (do we really know?!) and other miscellaneous questions will often arise. Please do not hesitate to ask me at your antenatal appointment or call as per the urgency.
Exercise in pregnancy is safe, although it is recommended that you keep the intensity down to a moderate level and certainly stop if the heart rate remains persistently above 140b/min for a prolonged period time or if you are becoming concernedly short of breath. Always drink plenty of water and avoid potential contact sports such as Netball. Good choices of exercise include walking, swimming, cycling (particularly spinning), pregnancy aerobics, yoga and Pilates.
Day to day assessment of your baby’s wellbeing is helped by your impression of foetal movements. If you are concerned about change with your baby’s movements or lack of movement, particularly after the 28th week contact either the rooms or the hospital delivery suite. You may need to attend for a foetal heart monitor (CTG) to ensure all is well.
Folate is recommended in the first 12 weeks of your pregnancy to help reduce the incidence of spinal defects in your baby. Iron tablets are often required in pregnancy as are multivitamins but I will discuss this with you depending on the results of your blood count and your dietary intake.
There are a number of tests available to assess your baby’s genetic wellbeing and all will be discussed at your first visit. CVS (chorion villous sampling) and Amniocentesis are both invasive options which are almost always reserved for high risk pregnancies.
A hormonal blood test between 9-11 weeks (first trimester maternal serum screen) in conjunction with an ultrasound at approximately 12-13 weeks, focusing specifically on the baby’s neck (the nuchal translucency), has 92% predictive sensitivity in assessing for, amongst other things, Down Syndrome. A cell free DNA blood test after 10 weeks (NIPTS) is in itself, along with the aforementioned 12-week ultrasound, approximately 99.5% accurate in assessing for Downs Syndrome, but accordingly, due to its higher degree of accuracy, is a few hundred dollars more expensive.
Further tests for Cystic Fibrosis, Fragile X syndrome, SMA (spinal muscular atrophy) and some rarer conditions seen in certain populations such as the Jewish community are also available and will be discussed.
Dr. Salwyn Al Salihi, Dr. Faris Al Shammaa and Associate Professor Vinay Rane are Obstetricians and Gynaecologists with many years of experience and are very capable of providing safe medical care for those occasional times when I am unavailable.
Whilst practicing as individual providers, they each partake in a weekend roster arrangement allowing us to have a couple of invaluable days off per month to recover from the on-call demands of the profession.
My holidays are booked 12 months in advance and will be covered by the same doctors with notification of my holidays provided for all patients who are due on or within a week of the planned holiday. Pleasingly over 15 years of data collection relating to my availability, I have been able to attend in excess of 95% of all patient’s deliveries (as a testament to my endurance and general availability).
Certain foods may be infected by a germ call Listeria. This infection can cause serious problems in pregnancy and it is therefore recommended that certain foods be avoided. Brochures and websites on the subject are available but should you have an episode of food poisoning or gastroenteritis, be assured that this is the least likely cause with other more typical causes usually of no concern to the baby unless you became profoundly dehydrated.
Most HR requirements are that you are entitled to maternity leave from 34 weeks in the pregnancy (6 weeks prior to your due date) this can be altered as per the nature of the pregnancy, with some women finding the physicality of the pregnancy hard to manage in the third trimester requiring more time off presumably through negotiated sick leave, or alternatively, feeling well enough to continue, wishing to work right up until your due date. I am happy to guide you in this regard but please remember once the baby is delivered there are very few days off!
Often the best advice is to avoid all medicines and herbal therapies. There are certainly a number of medications which can generally be used fairly safely in pregnancy but where you may have concerns about medications, be it over the counter or prescribed by another practitioner, please don’t hesitate to check with me or call The Royal Women’s Hospital on 8345 2000 and ask for the drug information line.
Generally safe drugs include: Paracetamol, constipation agents such as Metamucil, Lactulose etc, asthma agents such as Ventolin and other inhaled steroids, antifungal cream such as Canestan for thrush (including the appropriate insertion of the applicator), anti-heartburn agents such as Mylanta, Gaviscon and Zantac, Maxolon and Vitamin B6 and Ginger tablets for nausea and vomiting and haemorrhoidal agent such as Rectinol and Antihistamines such as Polaramine for hayfever. The list is by no means comprehensive, so please don’t hesitate to check where need be.
Both nausea and associated vomiting in pregnancy are common and whilst often referred to as ‘morning sickness’, they can occur throughout the day. In most pregnancies, the symptoms will abate by the 14-week mark, but occasionally can continue through to the end. The severity can vary between individuals and from pregnancy to pregnancy, and in its severest form, known as hyperemesis gravidarum, hospitalisation for hydration support, medication and dietary management may be required. Thankfully this is rare.
Often, the simple use of vitamins, rest and dietary adjustments will tide you over, with the addition of medically appropriate medication as necessary. I am happy to be contacted or see you to discuss and manage this.
Parvovirus, Slapped Cheek and Varicella can cause problems in pregnancy but there are tests and treatments which can be offered and pleasingly a substantial proportion of the population is already immune. It is best not to worry about these but do not hesitate to call if you have any questions or concerns about them and always exercise good hygiene around potentially sick individuals.
Eventually it will become difficult to sleep on the flat of your abdomen but where you do, it is highly unlikely you will ‘squash’ the baby. Sleeping on either your left or right side at any stage is fine, and log pillows can help in this. Avoiding lying on the flat of your back, particularly from the third trimester on is ideal to avoid potentially compressing the vessels to your womb and to reduce the chances of low blood pressure and feeling faint. Don’t panic if you wake up on your back as it is highly unlikely you will have caused any harm to your baby.
Sexual activity in pregnancy is usually safe. Occasionally, a small amount of bleeding can occur and whilst this is normally of no concern to the baby, I am happy to advise as needed.
Baths and spas are generally safe (your baby is in its own 37-degree bath!) but avoid prolonged exposure to overly hot water and watch the jets in a spa, particularly to avoid water squirting into the vagina.
Swollen ankles are also commonplace in pregnancy and are usually of no concern. Leg cramps also occur frequently and may improve by taking a Calcium/Magnesium supplement each day.
Toxoplasmosis is a germ that can be contracted from cats. Cats need not to be removed from the house but good hygiene including thorough washing of your hands after exposure and avoiding the kitty litter is recommended.
Interstate travel is generally safe up until 34-36 weeks and overseas travel up to 32 weeks’ gestation. For extraneous circumstances these gestational limits can be extended but I urge caution, as complications arising away from home may preclude a return trip.
Generally, for third trimester travel, as you will be clearly showing, you will usually require a letter from me to take to the airport and I am happy to provide this for you as necessary.
The current recommendation is that a Flu vaccine should be administered to all pregnant patients when it becomes available. Whooping Cough vaccination is also recommended in the 3rd trimester of every pregnancy ideally between 28-32 weeks and partners and grandparents with presumed high visitation are also recommended to be vaccinated but only every 10 years.
There is variable information on this and genetics may have a large component to play but certainly good food choices can impact. Whilst the average weight gain for pregnancy would be between 8-14kg evidence points towards women often retaining approximately 5kg from their pre-birth weight once the baby is delivered and they are several months down the track.
Whilst a large proportion of weight gain will be fluid retention and blood volume increases, as well as the baby’s weight and placental weight other weight may be able to be controlled by sensible food choices. If you start the pregnancy worrisomely overweight it is actually safe to have no weight gain or even some weight loss in pregnancy.
The MBS dictates how much the government and the health insurer will pay for medical services. The current recommendation is unfortunately inadequate to cover the operating costs of a practice inclusive of renting and running the rooms, the secretaries and the current large indemnity insurance fee paid by Obstetricians to look after pregnant women.
To cover these operating costs but to also have Dr. Jurcevic available on call 24 hours a day, 365 days of the year in case you have an emergency or if you go into labour, regardless of the day of the week of the time the day, the out of pocket fee has been set and carefully calculated to compensate for providing this intensive cover.