+ What pregnancy supplements do you recommend?

General pregnancy supplements

General pregnancy supplements such as Elevit or Blackmores pregnancy multivitamins, provided they contain folate and iodine, are recommended for pregnancy.

It is possible to achieve the dietary requirements of most essential vitamins and minerals in a normal balanced diet. Unfortunately, this is not always easy in pregnancy when nausea, vomiting or dietary preferences may interfere.

I recommend at least 400 micrograms of folate per day, ideally for one month prior to conceiving and throughout the first trimester, to prevent neural tube defects. Additionally, iodine deficiency is a significant concern for pregnant women. These are both included in sufficient doses in these supplements.

I may recommend additional iron, folic acid, calcium, magnesium or vitamin D depending on your circumstances.

Iron

Iron is used by the body to help red blood cells carry oxygen to your organs and tissues, and your body’s requirement in pregnancy doubles. A sufficient daily dose is found in most pregnancy multivitamins, but you can also eat iron-rich foods such as red meat, poultry, fish, beans and peas, iron-fortified cereals and prune juice. Iron is more easily absorbed if it is eaten with vitamin C-rich foods such as citrus fruits and tomatoes.

Calcium

Calcium is used to build your baby’s bones and teeth. It is found in milk, cheese, yoghurt, broccoli, and dark leafy greens. In some women, I will recommend a calcium supplement.

+ What beauty treatments are acceptable during pregnancy?

Manicures, pedicures and massages

Nail polish and nail polish remover are not harmful to your baby, however I recommend applying them in a well-ventilated area to minimise the inhalation of toxins. Less is known about the safety of gel manicures, so they are best avoided.

If you are having a pedicure, it is important to ensure the tubs where you soak your feet are cleaned after every use or have disposable linings. This will reduce the risk of a bacterial infection.

With respect to massages, I advise visiting only therapists who specialise in pregnancy massage. They will optimise your position during the massage to avoid strain on your back and belly, as well as knowing which pressure point triggers to avoid.

Hair colour

Although safety data on hair colouring in pregnancy is limited, the amount of hair dye absorbed through your scalp is negligible, meaning that adverse effects for your baby are extremely unlikely. I suggest avoiding unnecessary exposure during the first trimester while your baby’s organs are developing. Furthermore, if you have any breaks in your scalp avoid hair treatments until they have resolved.

Laser hair removal

I recommend avoiding laser hair removal during pregnancy, as there is no evidence to suggest that it is safe. Shaving and waxing are the preferred methods of removing unwanted hair whilst you are pregnant.

Fake tan

Fake tan contains a chemical called dihydroxyacetone (DHA). When applied to the skin directly it is not absorbed into the body and therefore cannot affect your baby. Fake tan creams and lotions are therefore safe during pregnancy. However, I suggest that you avoid spray tans as the DHA can be accidentally inhaled. If you are getting a spray tan, you should ensure that you wear a face mask during the process.

During pregnancy, your skin may be more sensitive than usual, so I recommend testing any fake tan on a small area of skin first to ensure you do not have an allergic reaction to the product.

+ How do I access childbirth education?

Frances Perry House conducts childbirth education and early parenting classes. Information will be provided by Frances Perry House when you receive your hospital registration. Fees for private classes are usually covered by your health fund although there may be some out of pocket expense. I encourage both you and your partner to attend these classes, as they will prepare you better for labour, delivery, breast feeding and early parenting. Several of these classes are available as an online program – feedback about this format has been excellent. There is still an opportunity for a hospital tour which I encourage. Please go to http://www.francesperryhouse.com.au/Maternity-Education-and-Tours/Childbirth-and-Early-Parenting-Program for more information.

+ How can I monitor my baby's movements?

Most women first feel fetal movements at 18 to 20 weeks gestation. With your first baby, this often occurs after 20 weeks, however with subsequent babies it may be as early as 16 weeks. Importantly, movements are different for every woman, and you will become aware of what is normal for your baby. Movements tend to increase in frequency until 32 weeks and then plateau. Although the type of movement may change from kicks to more subtle rolls as your pregnancy progresses, the movements should not reduce in frequency, including up until the onset of labour.

Reduced movements may be the first sign that your baby is unwell. Each time you feel the movements are reduced, no matter how often this occurs, you should contact me immediately for advice. I will arrange for your baby’s heart beat to be monitored, and I may also organise an ultrasound scan to assess the growth and well-being of your baby. If you are at term, and experience reduced movements, I may advise that the safest thing to do is to move towards delivering your baby. Reassuringly, most women with reduced movements will have a normal pregnancy outcome.

Fish

Omega-3 fatty acids, which are found in many kinds of fish, are important in the development of the brain both before and after birth. While you are pregnant it is safe and healthy to eat two to three serves of fish per week, but the consumption of certain species needs to be limited because of the mercury content. You should limit your intake of shark (flake), marlin or swordfish to no more than one serve per fortnight with no other fish to be consumed during that fortnight. For orange roughy (also known as sea perch) and catfish you should consume no more than one serve per week with no other fish being consumed during that week. Smoked fish, sushi and sashimi should be avoided.

Caffeine

Studies on caffeine and the risk of miscarriage are inconclusive. Most obstetricians agree that consuming no more than 200mg of caffeine per day (one cup of coffee) is safe.

Food hygiene

Pregnant women are thirteen times more likely to get a bacteria called Listeria than the general population. This can lead to miscarriage, stillbirth and preterm birth. In order to prevent transmission of Listeria, I strongly advise the following:

  • Drink only pasteurised milk
  • Avoid soft cheeses (such as camembert, brie and ricotta, unless heated until piping hot) – hard cheeses, cottage cheese and processed cheeses are fine
  • Avoid soft-serve ice-cream
  • Avoid pate
  • Avoid sliced deli meat
  • Avoid uncooked ready-prepared meals (such as a deli-salad and coleslaw)
  • Avoid raw or partially cooked eggs and foods that contain them eg. mayonnaise
  • Avoid raw meat (such as a rare steak) and poultry
  • Avoid sushi, sashimi, smoked fish and raw shellfish including oysters and mussels

Toxoplasmosis is a parasitic infection that can be harmful to your pregnancy. To prevent transmission of Toxoplasmosis, I recommend that you:

  • Wash your hands before and after handling food
  • Wash all fruit and vegetables thoroughly
  • Cook meat to well-done
  • Wear a face-mask, gloves and wash hands after gardening or handling soil
  • Avoid contact with cat faeces / litter

Salmonella is a bacterial infection that although unlikely to harm your baby can cause you to have severe diarrhoea and vomiting. To prevent transmission:

  • Avoid raw or partially cooked eggs or foods that may contain them eg. mayonnaise
  • Avoid raw or partially cooked meat, especially poultry

+ Do household pets pose a risk to my pregnancy?

If you are sharing a household with pets during your pregnancy, there are a few important risk factors to keep in mind:

Cats

The main risk with cats is the parasite toxoplasmosis, which can cause significant birth defects or stillbirth. Toxoplasmosis is spread via feline faeces, so avoid touching the litter box and garden beds, and wash your hands carefully with soap and water after petting your cat. Avoid touching stray or unfamiliar cats while pregnant.

Dogs

The main advice here is to limit rough play with your dog once your bump 'pops' - this is to avoid your dog jumping on or striking your belly.

Hamsters, Guinea pigs & rodents

These animals can carry a virus called lymphocytic choriomeningitis which is an infection that can cause severe birth defects and miscarriage. While pregnant, avoid cleaning the cage and touching any bodily fluids from these animals - consider moving the cage to a room you do not have to enter on a regular basis.

Reptiles

These animals can carry salmonella - avoid touching them, and clean any surfaces they touch (outside of their enclosure).

+ How should I modify my exercise and other lifestyle routines during pregnancy?

Exercise

Moderate exercise is safe during pregnancy and I recommend that you do at least 150 minutes of moderate-intensity exercise every week. The benefits of exercise during pregnancy include:

  • Reduced back pain
  • Decreased constipation
  • Promotion of healthy weight gain in pregnancy
  • Improved overall general fitness and improved mental heath
  • Possibly shorter and less complicated labour
  • Easier loss of baby weight after the baby is born

Good options include:

  • Walking
  • Swimming and water workouts – avoid prolonged immersion in heated spas and hydrotherapy pools
  • Stationary bicycling
  • Modified yoga and modified Pilates

Avoid:

  • Strenuous exercise, especially if repeated or prolonged, as this may affect fetal growth
  • Contact sports
  • Vigorous racquet sports that may involve the risk of abdominal trauma
  • Activities that may result in a fall, such as snow skiing and water skiing
  • Scuba diving
  • Skydiving, bungee jumping and parachuting
  • “Hot yoga” or “hot Pilates”
  • Heavy weight-lifting
  • Sit-ups after the first trimester

When exercising, ensure that you drink plenty of water and avoid becoming overheated. You should wear a sports bra that gives adequate support.

If you experience any of the following symptoms, you should stop exercise and seek medical attention immediately:

  • Chest pain or shortness of breath
  • Faintness or dizziness
  • Uterine contractions or abdominopelvic pain
  • Decreased fetal movements
  • Calf pain, swelling or redness
  • Vaginal bleeding or amniotic fluid loss

Alcohol

There is no safe amount of alcohol consumption during pregnancy. Alcohol is best avoided whilst trying to conceive and throughout pregnancy.

Smoking

Cigarette smoking is associated with a number of pregnancy complications including miscarriage, fetal growth restriction and stillbirth, as well as being detrimental to your health. I recommend that you stop smoking during pregnancy.

Sexual activity

Sexual activity and female orgasm are safe during pregnancy. It is not unusual to have a small amount of bleeding after sexual intercourse. This is not cause for concern unless the bleeding is either heavy or recurrent. If you have a history of miscarriage you may prefer to abstain in the first trimester. You should avoid penetrative intercourse if you have a condition called placenta praevia, where your placenta lies low down in your uterus (near the cervix).

Sleeping positions

There are many myths about sleeping positions for pregnancy. You may sleep on either your left or right side at all stages of pregnancy. It is best to avoid lying on your stomach from 12 weeks to avoid “squashing” your baby although the actual risk is very small. It is best to avoid lying on your back from 20 weeks so that you avoid compressing the major blood vessels in your abdomen. This can lead to low blood pressure and fainting.

In practice, the risks to your baby are very small. If you wake up and find that you have been lying on your stomach or back do not panic. You will have done no harm; your body has done exactly what it should have and woken you to allow a position change.

+ What medications are safe to take?

It is important to understand how drugs are classified according to their safety in pregnancy. In Australia drugs are categorised as A, B, C, D or X according to their safety in pregnancy:

  • Category A drugs have been taken by a large number of pregnant women for many years with no evidence of any adverse effects on the fetus ever having been reported.
  • Category B drugs, likewise, have never been shown to have any adverse effects but have only been taken by a limited number of pregnant women.
  • Category C drugs have been known to have effects on the fetus but these are not necessarily effects that may be harmful nor particularly relevant during the first trimester. For instance, it is best to avoid sleeping tablets late in the third trimester but they have no effects in the first trimester and therefore are safe to take.
  • Category D and Category X drugs are known to cause fetal malformations and must never be taken in pregnancy.

You can be assured that if I ever prescribe a drug for the treatment of any condition in pregnancy that I am perfectly comfortable with its safety. I will never prescribe a category D or X medication; almost always I will prescribe Category A and sometimes Category B drugs. If I ever prescribe a Category C drug I will explain why it is safe for you to use at that time but not safe to use later in pregnancy. Nevertheless, I understand that there is a great reluctance for many women to take any medication in pregnancy and this is completely understandable. However, there are times when the benefits of taking medication outweigh any potential risk, but it is always up to you.

Drug (generic name)

Drug (brand name)

Category

Notes

Medications used for nausea and vomiting

Doxylamine

Restavit

Category A

Safe

Metoclopramide

Maxalon, Pramin

Category A

Safe

Ondansetron

Zofran

Category B

Safe, but expensive. Can buy as wafers which are absorbed even if vomiting

Prednisolone

Category A

Safe. Used only for severe cases

Prochlorperazine

Stemetil

Category C

Safe. Category C during third trimester when it can cause withdrawal and irritability in the baby after delivery

Promethazine

Phenergan

Category C

Safe. Limit use in late pregnancy (within two weeks of birth) to minimise the effects on the newborn

Medications used for pain relief

Paracetamol

Panadol

Category A

Safe

Codeine

Panadeine, panadeine forte (in combination with paracetamol)

Category A

Safe in pregnancy. Consider alternative during breastfeeding

Anti-inflammatories – ibuprofen, diclofenac

Nurofen, voltaren

Category C

Do not use at any stage in pregnancy. If you have inadvertently taken these, please call me

Oxycodone

Endone, Oxynorm

Category C

Safe to use lowest effective dose for the shortest duration possible. Use with caution in third trimester to minimise neonatal effects

Tramadol

Tramal

Category C

Possible increase in risk of fetal loss in early pregnancy. Consider alternative in first trimester. Occasional doses are safe to use during the second and third trimester.

Medications used for allergies and itch

Loratadine

Claratyne

Category B

Safe. Of these medications, loratadine is the preferred option

Cetirizine

Zyrtec

Category B

Fexofenadine

Telfast

Category B

Dexchlorpheniramine

Polaramine

Category A

Safe

Medications used to treat high blood pressure

Labetalol

Presolol

Category C

Safe. Monitor fetal growth and monitor baby’s sugars after birth

Methyldopa

Aldomet

Category A

Safe

Nifedipine

Adefin

Category C

Safe. Avoid dropping blood pressure too much to avoid effects on fetal growth

Medications used to treat headaches

Cyproheptadine

Periactin

Category A

Safe in pregnancy. Consider an alternative during breastfeeding

Chlorpromazine

Largactil

Category C

Safe. Use in late pregnancy associated with neonatal withdrawal symptoms and neurological symptoms

Drugs used to treat depression and bipolar disorder

Citalopram

Cipramil

Category C

Newborns exposed to SSRI, especially in late pregnancy, have experienced self-limiting neonatal withdrawal symptoms. If you have been prescribed either of these medications, please do not stop taking it. It is very effective and the benefits throughout pregnancy and breast-feeding outweigh the risks. Please remember to advise me or your anaesthetist if you are taking these medications as they can interact with one particular pain-killer.

Sertraline

Zoloft

Category C

Venlafaxine

Efexor

Category B

Neonatal withdrawal symptoms can occur. Use the lowest effective dose

Lithium

Category D

Lithium use during the first trimester may be associated with an increased risk of congenital heart defects and other adverse effects

Medications used to treat heartburn and reflux

Antacids

Gaviscon, Mylanta

Category A

Safe

Ranitidine

Zantac

Category B

Safe

Omeprazole

Losec

Category B

If one of these medications is required, omeprazole is the medicine of choice

Esomeprazole

Nexium

Category B

Pantoprazole

Soman

Category B

Antibiotics

Amoxicillin

Amoxil

Category A

Safe

Cephalexin

Keflex

Category A

Safe

Metronidazole

Flagyl

Category B

Safe

Erythromycin

Eryc

Category A

Safe

Aciclovir

Zovirax

Category B

Safe

Oseltamivir

Tamiflu

Category B

Safe

+ Do you recommend neonatal vitamin K?

Newborn infants have a relative vitamin K deficiency at birth. I recommend that all newborn infants should receive vitamin K prophylaxis at birth. This is usually given as a single injection just after your baby is born, however it can be given orally to full term babies who then require three doses. These are given at birth, on day 3-5 and again in the fourth week of life (this dose can be omitted in predominantly formula-fed infants).

+ Can I still travel while pregnant?

Car travel

Always wear a three-point seatbelt above and below your pregnant belly, not over it. Make frequent breaks to stretch your legs and visit the toilet. Keep a water bottle filled with cool water in your car.

Flying

There is no evidence that air travel has a harmful effect on you or your baby, with no increased risk of miscarriage, preterm labour or rupture of the membranes. The primary concern I have for pregnant women who wish to travel is that, if you deliver away from Melbourne, the risks to you and your baby are greater:

  • You will need to find a new hospital and a new doctor, neither of whom will have a record of your history
  • If you deliver even slightly prematurely, you are not permitted to travel until the newborn is the equivalent of 40 weeks gestation
  • It is very difficult to get travel insurance to cover you for pregnancy after around 24 to 26 weeks internationally, or 34 to 36 weeks domestically
  • The costs for an international delivery can be as high as one million dollars, and are rarely covered by insurance. It is for these reasons that I do not recommend pregnant women fly internationally from around 24 weeks, and domestically after around 34 weeks. If you do need to fly, the airlines will require a letter from me authorising you to fly (either internationally or interstate) after 20 weeks gestation. Please contact me to discuss this.

When flying, I suggest that you do the following to reduce the risk of deep vein thrombosis:

  • Wear your seatbelt at all times – it should be belted below your belly
  • Wear compression stockings
  • Wear loose clothing and comfortable shoes
  • Try to get an aisle seat
  • Take regular walks around the plane
  • Do in-seat exercises every 30 minutes or so
  • Have cups of water at regular intervals throughout the flight
  • Cut down on drinks that have alcohol or caffeine

Travel and illness

In some countries, hygiene standards may not be as stringent as they are in Australia, and the risk of infection (and thus complications) is substantially higher. When travelling, avoid salads, ice, water (including bottled water unless you can be certain you are the one who broke the seal) or anything else that may have been rinsed in tap water. Also, try not to eat food of which you cannot guarantee the safety.

Zika virus

Zika virus can potentially pose serious risks to your baby, including:

  • Microcephaly (an abnormally small head) – this can cause long-term problems such as seizures, feeding problems, hearing problems, visual problems and learning difficulties
  • Other brain abnormalities

Zika virus is spread via the following methods:

  • Mosquito bites
  • From a pregnant woman to her fetus
  • During sex

Unfortunately there is no vaccine, and avoiding infection is therefore best. My recommendations for pregnant women are as follows:

  • Avoid countries that are high or moderate risk for Zika virus (to see the list of the countries go to http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-zika-countries.htm)
  • If you travel to a high or moderate risk country, avoid mosquito bites – use pregnancy-safe bug sprays, wear long-sleeved shirts and long pants, wear clothing that has been treated with permethrin and stay in air-conditioned or screened-in areas
  • Avoid unprotected sex with a male partner who has been to a high or moderate risk country for the duration of the pregnancy or for 6 months, whichever is longer
  • Avoid unprotected sex with a female partner who has been to a high or moderate risk country for 8 weeks

I recommend Zika virus testing in pregnant women with Zika virus exposure whether or not you have symptoms of infection. Symptoms of infection are usually mild and include fever, rash, joint pain and itchy red eyes. Usually, two blood tests will be taken, with the second blood test at least 2 weeks after the first sample and at least 4 weeks after your last potential exposure to Zika virus.

If you are not yet pregnant, and have been to a high or moderate risk Zika-affected country, you should avoid pregnancy and unprotected sex for at least 8 weeks. If your male partner has also been potentially exposed to the Zika virus, pregnancy and unprotected sex should be avoided for 6 months. If you are unable to wait 6 months, I can arrange a blood test for your male partner 4 weeks after the last potential exposure to exclude infection.

+ What vaccinations should I have?

During pregnancy, I will recommend that you are vaccinated against influenza and pertussis (whooping cough). If you are not immune to rubella and chickenpox, I will organise a postnatal vaccination for you, but please do not have these vaccinations while you are pregnant. If you are inadvertently vaccinated against rubella or chickenpox in pregnancy (or within 28 days of becoming pregnant), please do not panic as no adverse reactions have ever been reported.

Influenza

Influenza, or the “flu” is a serious illness caused by the influenza virus. As there are multiple strains of this virus that change annually, it is necessary to have an influenza vaccination on an annual basis. Pregnant women are particularly susceptible to influenza infection. It is a very serious illness that can cause severe pneumonia in the pregnant woman and, rarely, the early delivery or loss of your unborn baby.

Influenza vaccination is:

  • Recommended for every pregnant woman at all stages of pregnancy including the first trimester
  • Essential if you have any other chronic illnesses such as diabetes, kidney or lung disease
  • Free for pregnant woman and available at your General Practitioner (GP)
  • The best way you can protect yourself and your unborn baby against influenza

Important facts about influenza vaccination:

  • The influenza vaccination does not give you influenza
  • The influenza vaccination will protect you for 12 months
  • An influenza vaccination during pregnancy will also protect your baby from influenza for the first six months of life

Please disregard the negative myths and misconceptions regarding this vaccine that you may hear from friends, relatives or on the internet. Most of this advice regarding influenza vaccination is simply incorrect. If you have any questions about the vaccination please do not hesitate to ask me.

Whooping cough (pertussis)

Whooping cough, or pertussis, is a highly contagious disease caused by the bacteria Bordetella pertussis and is spread by droplets from coughing and sneezing. Susceptible people are those who are either unvaccinated or have waning immunity since childhood vaccines. Whooping cough is particularly serious in infants under 12 months of age, while older children and adults usually have a milder disease.

Symptoms may vary for different ages but first symptoms are usually similar to a cold. Severe cases develop sudden attacks of repetitive coughing and often a characteristic ‘whoop’ as the person gasps for breath. Not all cases get the ‘whoop’. Babies may have pauses in breathing (apnoea). Vomiting often follows a coughing spasm. A person with whooping cough is infectious for up to three weeks after they start coughing. The cough may last for months. Whooping cough has tragically resulted in the deaths of several babies in Victoria in recent years.

Adult pertussis booster vaccines (combined with diphtheria and tetanus) are recommended for all women in the third trimester of each pregnancy, regardless of when their last vaccine was administered. The optimal time for vaccination is between 28 and 32 weeks. This allows protection of the newborn by transfer of high levels of antibodies across the placenta from the vaccinated woman to the fetus. In addition, pertussis vaccination is offered as part of the government funded immunisation program for children at two months, four months, six months and four years of age, and in year 10 of secondary school (or 15 years of age).

Protection is not life-long and begins to fade after 6-10 years. I therefore recommend that partners, family and anyone else who will have contact with your baby should have a booster every ten years. Boostrix® is the recommended vaccine and is provided free to parents of new babies. Whilst pertussis booster vaccine is strongly recommended for the other groups outlined, it is not funded. Boostrix® is completely safe when administered in pregnancy.

+ What is vaginal seeding?

Vaginal seeding is a recent practice that can be undertaken by women whose babies have been born by caesarean section. A gauze swab is used to transfer maternal vaginal fluid, and hence vaginal microbiota, to the baby’s mouth, face and body shortly after birth.

The theory behind this is that vaginal birth exposes the baby to vaginal microbiota, which reduces the risk of autoimmune diseases, asthma, and allergic diseases seen in children delivered by caesarean section in women who did not have a labour.

However, newborns may develop severe infections from exposure to vaginal bacteria and viruses, which could also be transferred on a vaginal swab. This includes group B streptococcus, chlamydia, gonorrhoea and herpes.

In the absence of proven benefit or safety, vaginal seeding cannot be recommended. However, as long as you are fully informed about the theoretical risks, I will respect your decision to perform vaginal seeding should you choose to do so.