Frequently Asked Questions
When is my baby due?
In the days before ultrasound or IVF technologies, the only way to ‘date’ a pregnancy was by the previous menstrual period. Traditionally in women with ‘normal’ 28 day cycles, a normal length of pregnancy is 40 weeks. Hence the due date as calculated by the last normal menstrual period places the due date at 40 weeks from the first day of the last normal menstrual period (‘LNMP’). The due date may change after the first ultrasound. The way that an ultrasound ‘dates’ a pregnancy is to use an ultrasound derived measurement (usually the ‘crown-rump length’ or ‘CRL’ of the embryo in first trimester) then extrapolate from the size of the pregnancy what is the likely age of the pregnancy. The age as calculated by CRL is made by tables of the average CRL at each day of the pregnancy. For two reasons the ultrasound may not be as accurate as the dating by LNMP. Firstly, the tables of average CRL measurements are just that – averages – and therefore not absolutely accurate for every embryo. Secondly, the measurement of the CRL can be inaccurate by even a single millimetre or two, thus this may affect the due date calculation. Therefore, ultrasound itself has an inherent inaccuracy that increases as a pregnancy progresses.
Generally, for women who have a regular cycle, I will determine the due date from their LNMP unless the earlier scans (ie under 13 weeks) are more than 5-7 days different from the LNMP calculation. The earlier the scan the more accurately the ultrasound will date the pregnancy. It is very unusual to change the due date after 13 weeks (even the 19 week scan will not change the due date).
Why do doctors talk about weeks rather than months?
It is more accurate and predictable to talk about pregnancy by reference to weeks rather than months. Pregnancy is 40 weeks long, by calculation from the LNMP. Most books will refer to developmental changes according to specific weeks.
What medications can I safely take in pregnancy?
Whilst it is sensible to avoid medications in pregnancy, there are many medications that are very safe to use in pregnancy. If you are on pre-existing medication you should inform me so that I can check its safety. Medications such as asthma medication should NOT be avoided – in fact pregnancy is a time when excellent asthma control is vital and the risks of an asthma attack in pregnancy is far more dangerous than any asthma controlling medication.
You MUST NOT take aspirin in pregnancy except under specific circumstances that I will advise.
If you are unsure of the safety of any medication prescribed in pregnancy you can check with me or call the Royal Women’s Hospital Drug Information Service on 8345 2277.
Here is a list of some general medication that are SAFE to take in pregnancy:
- Panadol – For minor aches and pains
- Panadeine – For stronger pain
- Metamucil, Fybogel – For constipation
- Coloxyl (without senna) – For constipation
- Vitamin B6 – For nausea, especially first trimester
- Ventolin and Becotide/ Becloforte – For asthma
- Canesten cream – For Thrush. It is safe to insert vaginally
- Tums, Mylanta, Gaviscon – For Indigestion
- Zantac – For Indigestion
What medications can I safely take when I have a cold?
Coughs and colds are common in pregnancy. If you are asthmatic you should follow your asthma plan and contact your GP (or if severe call an ambulance or go to a major hospital emergency department). I would want to be informed of any significant asthma attack. As previously described it is very important to maintain excellent asthma control.
There are several cough and cold medications you can safely take in pregnancy but you should always consult your pharmacist before taking a commercial cough and cold treatment. Often these preparations contain multiple medications of which one or more may not be suitable in pregnancy. For a usual head cold with some chesty cough component I would simply recommend regular panadol or panadeine (for pain relief and to keep your temperature down). You should have no more than 8 panadol or panadeine tablets in a 24 hour period. Bisolvon is a good cough mixture for a mildly productive cough. Otrivine nasal spray can be used for 2-3 nights in a row for a blocked nose.
Under the following circumstances you should consult your GP as you may need more significant treatment including antibiotics (most of which are safe in pregnancy):
- symptoms persist more than 2-3 days
- you have high temperatures (over 37.5 degrees that are not reduced by panadol)
- you are coughing up yellow or green sputum
- you have other associated symptoms that are significant including headache
- you feel concerned about your level of sickness.
I would usually recommend you see your GP as the first port of call. I am, however, happy to be informed of your illness, provide guidance or reassurance as to the safety of any medication prescribed by your GP, or to provide further guidance if you are not confident in the treatment plan recommended or you feel you are deteriorating.
What foods should I avoid?
Listeriosis: This is a bacterial infection picked up through infected food. It can be serious in pregnancy because it can result in placental infection. Foods that can transmit listeria include uncooked meat – sushi/ sashimi, smoked fish/ seafood, pate and deli meats. It is also found in soft cheeses (camembert, brie, ricotta), poorly washed salads and vegetables, leftovers and reheated food and pre-prepared salads such as coleslaw. You should avoid all these foods. Infection with listeria will usually be suggested by significant illness associated with high fevers, back pains and sometimes gastrointestinal symptoms. It does not usually present with just ‘gastro’ symptoms. My general rule of thumb for pregnant women to follow is: “all animal products should be cooked all the way through and eaten hot”.
A good reference for foods that should be avoided can be found at the Food Standards website below.
Please visit – www.foodstandards.gov.au
What Vitamin Supplements should I be taking?
Folic acid: 0.5mg daily. Should ideally be taken for 3 months preconception and until 14-16 weeks of pregnancy. Folic acid supplementation reduces the chance of neural tube defects (‘spina bifida’ -ie abnormalities of the spine and brain) by up to 70%. It is fine to take folic acid until you have your baby but its real benefit is in the first trimester. For some women we recommend 10 times this dose: 5mg.
Iron: most pregnant women need to take some supplemental iron – especially vegetarians or those who do not each much red meat. Iron is usually present in the commercially available pregnancy multivitamins but I may still recommend additional iron depending on your blood levels.
Calcium: this is especially important in the second and third trimesters when the baby’s bones are forming. You will also need calcium for breastfeeding.
Iodine: many women have low iodine levels. You may need to make sure it is present in your multivitamin.In addition you may need to use iodised salt and an iodine supplement, such as Blackmores I-folic (you may use a kelp supplement but the mercury content may not be well controlled. I would rather you avoid kelp supplements unless it is manufactured in Australia by a reputable company). I will advise you of your iodine levels.
Supplements can be obtained through your local pharmacy – just ask your pharmacist. There are now many multivitamins commercially designed for pregnant women.
What exercise can I do?
In most cases it is safe to continue to exercise during pregnancy. The basic rules are to keep the exercise low impact, keep your heart rate below 140 beats per minute and to avoid contact sports after the first trimester (this includes any sport where you are at risk of a direct blow to the abdomen). There are many exercise classes available including ‘Preggy Bellies’ that are specifically designed for pregnant women. Activities such as walking and swimming are fine all the way through pregnancy. Pilates and yoga are the best forms of formal exercise for pregnant women in my opinion.
What about travel?
My general rule of thumb for flying in pregnancy is that you should not travel internationally after 26 weeks of pregnancy and should not travel domestically after 34 weeks. This is a guideline, however, and for certain individuals these may be too generous. The issue with air travel in pregnancy is really not the actual plane trip itself but the fact that you are going to be remote from home. I am quite conservative about travel. For women with uncomplicated pregnancies I think these guidelines are OK but before you book your flight you should consider the following: have you had any complications in the pregnancy, can you get travel insurance (it is almost impossible to obtain insurance for pregnancy related issues including premature birth after 24 weeks even in an uncomplicated pregnancy), how close will you be to medical care/ hospital, how remote is your destination? In pregnancy complications can occur without warning. If you are a long way from medical care or obstetric care then complications may have serious implications. Even if you are close to high quality medical care you may not be insured for medical care. For example a premature birth can result in intensive medical care for a premature baby that may need a prolonged hospital stay in another country. This may result in a very large bill – possibly into the tens or even hundreds of thousands of dollars.
For those patients returning overseas to a ‘home country’, to a system they know and to which they have medical access, then international travel is not such an issue. For Australian residents it is worth asking me about your individual situation before booking overseas travel or remote travel in Australia.
Can I sleep on my back?
This is the most commonly asked question of all pregnancy related questions. Generally the answer is yes – until about 34 weeks. The physiological reason why sleeping on your back is said to be unsafe is because the weight of the pregnant uterus can compress the large vein (called the ‘inferior vena cava’) that runs along your spine as you lay on your back in late pregnancy. The effect of this compression can reduce the blood flow back to your heart and hence the blood flow forward towards your uterus and placenta. The good news is that it is very unlikely that this will occur under 34 weeks gestation. Even if it does, you will feel faint and unwell and therefore naturally change your position (to lie on your side). Hence, even if the blood pressure drops, you will know about it and move. Some women are more susceptible to this effect – especially women who are pregnant with twins. The effect is transient, does not harm your baby and simply changing your position will alleviate the problem. Certainly don’t worry if you wake up on your back. Even while sleeping, your body will be alerted to a drop in blood pressure and you will move in your sleep or wake feeling unwell and move.
Can I dye my hair?
Can I use fake/ spray-on tan?
Once or twice is OK but I would prefer you not use spray-on tans, self tanning creams or solariums while you are pregnant. A small amount of fake tan on your legs during Summer is OK.
Can I have a bath/ sauna/ spa?
Yes, but make sure the temperature is warm, not hot. If you find the bath or spa causes you to feel quite hot and sweaty it is too hot for you. Saunas are NOT safe for pregnant women.
Can I go to the dentist?
Yes. Good dental hygiene is important in pregnancy. Gum inflammation has been associated with an increased risk of premature labour. Having a routine teeth cleaning is fine. I would, however, defer any non-essential dental work until after pregnancy. Sometimes it may become necessary to have some dental work done and it may be more important to do this than end up with a severe infection. Always let your dentist know that you are pregnant. Sometimes you may need antibiotics to cover you for potential infection. Your dentist should know if this is necessary but I am always happy to be contacted by your dentist or yourself if you wish to clarify the safety of the treatment or antibiotics.
Can I have sex while I am pregnant?
Generally the answer is yes in most pregnancies. There are some specific medical conditions in pregnancy that mean that intercourse is not safe. The most common of these is a low lying placenta or ‘placenta praevia’. This will be diagnosed after your ultrasound at 19-20 weeks. I will advise you if you have a low lying placenta and should not engage in intercourse. Also if you have any bleeding that occurs in pregnancy, even if you do not have a low lying placenta, I will recommend that you do not have sexual intercourse for at least a few days.
How much weight will I put on?
The average weight gain in pregnancy is 12-14 kg. This will depend on your starting weight and other factors. The healthy weight gain spectrum is from 5-20kg. It is important to look at the overall trend in weight gain rather than short term week by week losses or gains. Some women with healthy pregnancies may lose weight in first trimester whilst others will quickly put on 5kg. If you are concerned about too much or too little weight gain then speak to me about it.
When should I finish work?
Having had 4 children myself, this is a subject about which I have given a great deal of thought. Medical complications will obviously affect my recommendations about when you should stop work. In my opinion, for your first baby I think the ideal time to finish work is about 34 weeks; certainly no later than 36 weeks. Many women will think this seems early and want to save all their maternity leave for after the baby, so try to work as late as possible. Also, many women will feel great at 24 weeks and wonder why I would advise finishing early. There are several issues to addresss. Firstly, your body changes so much between 20 and 28 weeks that you will find it hard to believe. Even the most healthy, fit and motivated women will struggle to get out of bed every day after 32 weeks. Sometimes it is not until you have stopped that you will realise how much you have been pushing yourself. Secondly, the best way to approach the birth of a baby is to be rested, psychologically focussed on the birth and baby (not work) and even a little bored! Thirdly, you will not appreciate how much your life will change (for the better) and a little last minute indulgence to go out for lunch with friends, have a spa treatment or go shopping is a luxury that will soon be a distant memory. Things change with a baby such that there are some individual activities you will not be able to do for a long time (even years). This may depend on your level of family support. Trust me, a week or two of ‘indulgence’ will pay itself back in spades. You need to start life with baby completely ready for a change from your old life into a new and different one. People are often more than willing to tell you how hard things will be with a baby. Yes, it will be new, sometimes difficult and occasionally upsetting but the new experiences, pleasures, love and excitement ahead of you will be worth every bit of effort. It will just be different. So I recommend that, unless money or time off after baby is extremely crucial, finish work and put it behind you, indulge a little, get as much sleep as you can and get physically and psychologically ready for the single most life changing event of your entire life.
When will I feel my baby move?
Women having their first baby willl usually feel small movements from 16-20 weeks. Women having their second baby or more will feel movements by 14-18 weeks. At first the movements will be very subtle – like little flutters or taps. With every week that goes by the movements will feel more obvious. If you are working or otherwise busy you may not feel movements at all, especially in second trimester. By third trimester the movements are more vigourous and will distract you from any activity you are doing. If at any time you are concerned that your baby’s movements have reduced significantly I would recommend that you sit or lie quietly for an hour or two, have something to eat and drink and monitor the movements. If you still feel no movements or very little movements in comparison to your usual amount of movements then call delivery suite at your booked hospital. The midwife will give you further directions that may involve coming in for assessment. The midwife will let me know. During the day you are welcome to call my office and I will give you instructions that also may involve coming in to see me.