PATIENT
INFORMATION

All airlines independently have restrictions listed on their websites.It is important that you satisfy these criteria prior to making your booking.

In general, most airlines allow women to fly until the 36th week of gestation, provided the pregnancy has been uncomplicated and the woman has had no other medical risk factors.

Some airlines may require a letter from Dr Skinner that gives an opinion whether you can undertake air travel safely. It is recommended that for any airline travel being undertaken after 28 weeks that a medical certificate be carried with you. Before booking your ticket, check the airline’s policy.

Dr Skinner recommends:

• Domestic travel – up to 36 weeks
• International travel – up to 28 weeks
• Increase fluid intake (avoid beverages containing caffeine)
• Request an aisle seat so you can carefully walk around and move your legs, feet and toes to improve circulation
• Wear well-fitted compression stockings
• Aspirin (300mg) – ½ tablet 2 days prior – ½ tablet the day of travel

Multiple pregnancies – need to consult Dr Skinner

We recommend that any air travel that is undertaken in the first six weeks postnatal is best discussed with Dr Skinner prior to booking.

Varicella Zoster

If a woman has had chicken pox in the past then they will have formed antibodies against it so their baby has immunity also to the effects of the virus.

It is more of a problem in early and late pregnancy. If you are unsure of immunity or haven’t had chicken pox – a blood test is required.

Varicella consists typically of an itchy rash of small, red bumps on face and trunk spreading to other parts of the body. Blisters over 2-4 days that crust over within 6 days of rash first appearing. Associated with the rash is fever, and runny nose and eyes in the week prior to the rash.

Varicella is infectious for 2 days before the onset of rash and until final sores have crusted over. It spreads easily from person to person by droplets (coughs and sneezes) or contact with chicken pox sore. May also be caught from shingle infections.

Varicella may later be reactivated in people to be expressed as a patch of Shingles. This is as equally infectious as the primary rash.

COLD & FLU

• Panadol and Panadiene can be taken 4 hourly to reduce temperature and alleviate other symptoms
• No aspirin or pseudoephedrine (cold and flu tablets) should be taken
• Durotuss cough medication for coughs
• Most antibiotics can be taken safely during pregnancy (please check with your obstetrician prior)
• Some nasal sprays can be used — Budesonide (Rhinocort), Oxymetazoline (Drixine otrivin)
• Old fashioned remedies — steam inhalation, salt gargles, eucalyptus inhalation
• Bed rest and fluids
• See your GP if required

Poor dental hygiene can be associated with poor pregnancy outcomes. Have your dentist or hygienist assess your needs early in pregnancy.

Your diet and body mass index is the single biggest area where you can substantially reduce the risk to you, your pregnancy, your birth and your baby.

You can have control of where your weight starts and ends during pregnancy. It is therefore in your best interests to focus on heading towards your optimal BMI by the end of your pregnancy. The lowest rates of complications such as still birth, fetal abnormalities, caesarean section, haemorrhage, induction of labour, diabetes, going overdue, high blood pressure all occur when your BMI is in the normal or mildly overweight range (BMI 23-27 at full term).

Being too underweight or too overweight both have negative effects on pregnancy and birth. Ideally before, but also during pregnancy you should endeavour to head towards a BMI of between 23-27. This is best achieved by dietary discipline as exercise will never be able to keep up with your food intake during pregnancy, as exercise is limited. When you are overweight it has been shown that weight loss during the pregnancy is not only safe but leads to improved outcomes for both mother and baby. Specific dietary advice may be required for this.

BMI = Weight (kg) / (Height in metres x Height in metres)

Example: 65kg / (1.60m x 1.60m) = BMI 25.4

This example is of a woman who weighs 65kg and is 160cm tall

Foods to avoid during pregnancy:

• High GI foods such as rice, bread, potatoes, asian sweet sauces, potato chips, rice crackers, most breakfast cereals, fruit juices, sweet drinks and pastries
• Large fish (due to mercury and lead content) eg. bluefin tuna, orange roughy, flake and sword fish
• More than two coffees per day
• Alcohol
• Foods more likely to be contaminated by Lysteria bacteria (soft cheeses, pate, cold cooked chicken and soft serve ice-cream)

Good foods to be eaten during pregnancy

• Low GI foods eg, all coloured vegetables, especially green ones such as broccoli, beans and cauliflower, mushrooms, onions, eggplant, asparagus and tomatoes
• Apples, pears, berries and apricots
• Nuts and pulses such as lentils, baked beans and chickpeas
• Essential proteins, eg. chicken, oily fish (salmon, sardines and herrings) whitefish up to 500gm per week, red meat, eggs, lentils, tofu, full fat Greek yoghurt and tinned tuna
• Essential oils eg olive oil, butter, avocado and coconut oil
• Drinks eg water (1-2ltr per day, a few cups of tea, common herbal teas and milk)

Most patients who modify their diet to the above low GI diet, after being diagnosed with gestational diabetes at the end of the second trimester, safely lose 3-7kg in the third trimester. Moderating portion size and eating healthy, low GI, clean food diet delivers more than adequate nutrition whilst not causing excessive fat deposition that complicates pregnancy and birth.

Whilst many expensive and artificial vitamin and mineral supplements are consumed, the best nutrients are found in their natural state in a clean food diet. I most commonly see iron deficiency anaemia and bone stress fractures in reproductive years. These can be avoided by orientating the diet away from overly refined foods back to basic essentials.

• Aids physical and psychological wellbeing but does not overall assist your baby’s development.
• Naturally expect a drop in performance targets as your body changes in the first trimester.
• Preferably keep intensity low enough that your heart rate does not exceed 150 beats per minute.
• Keep sessions to 20 to 40 minutes maximum, three times per week.
• Your dietary input will have a much greater role in minimising excessive weight gain in pregnancy.

Dizziness and lightheadedness is fairly common during pregnancy for a number of reasons:

• First trimester – hormonal influences before an increase in blood volume resulting in an inadequate blood supply to fill the rapidly expanding circulatory system
• Second and third trimester – changes in blood pressure and pressure of an expanding uterus on the mother’s blood vessels

Tips:

• Avoid long periods of standing
• Avoid getting up in hurry from sitting or lying down, dizziness is caused by a sudden shifting of blood away from the brain as you change positions
• Be quick to sit or lie down if feeling lightheaded or dizzy
• You may feel dizzy when your blood sugar levels are low. Eat more frequent, smaller meals or snacking between your usual mealtimes and eating some protein at every meal helps stabilise your blood sugar levels.
• Ensure you are consuming adequate amounts of fluids to avoid becoming dehydrated.Drink at least 2 litres (8 cups) of fluid each day
• Avoid lying flat on your back late in pregnancy

If fainting reoccurs please contact Dr Skinner for advice.

As a private patient the fees for the duration of your pregnancy are not covered by your private health fund. These fees are an out of pocket expense, with some payments partly claimable for a Medicare rebate (this amount may vary according to individual circumstances).

The charge for your delivery and hospital accommodation is an additional and separate expense to this account and is largely covered by your private health fund depending upon your level of cover. Charges for pathology, ultrasound, or other specialists e.g. epidural or specialist paediatric care that could be necessary during the birth of your baby, will be an additional cost.

Your total out-of-pocket expenses will also vary according to which maternity program you proceed with.

For overseas and international patients, costs will vary depending on your Medicare eligibility and overseas insurance funds. Our practice staff will endeavour to answer any questions you have specific to your situation.

Availability: There may be times when Guy is unavailable, including weekends, holidays, conference leave or illness. At these times one of his colleagues will be available for your care. He will advise you the dates and name of the relieving obstetrician for annual leave as soon as these are finalised.

• Occurs in about 8% of pregnancies
• Can usually be controlled by healthy eating and exercise
• Generally goes away once your baby is born
• Does not cause your baby to develop diabetes

A Glucose Challenge Test is a screening test for gestational diabetes done at around 26 weeks gestation.

You may eat and drink as usual before test avoiding sugary sweet foods such as fruit juice, jam, cake and soft drink etc. Do not eat after the drink.

The test involves consuming a glucose drink within 5 minutes and having a blood test one hour after consuming the drink

If the test is positive you will be notified by the rooms and asked to return to pathology in the next week for a full fasting Glucose Tolerance Test (GTT). This test can take 2 hours.

Heartburn is usually worst in the last 12 weeks of pregnancy because:

• Hormones relax smooth muscle which can lead to regurgitation of stomach contents creating burning in the lower part of the oesophagus.
• As the baby and uterus grow, they press on the stomach and displace it pushing the acid contents out into the oesophagus creating heartburn.

Tips:

• Avoid the foods you identify that give you heartburn
• Avoid spicy, greasy foods
• Avoid coffee as it can irritate the stomach making heartburn worse
• Eat small frequent meals rather than 3 large ones and eat slowly, chewing food thoroughly.
• Drink plenty of fluids between meals rather than with them
• Drink some milk (may be warmed) before going to bed at night
• Sleep partially sitting up, well supported by lots of pillows.
• Antacids can help e.g. Mylanta, Zantac(150mg), Gaviscon and Quick Ease
• Do not take Alka Seltzer or Bicarb Soda as they can upset acid/alkaline balance

Try several of these suggestions, as different things work for different people.

Nausea and vomiting seem to occur most often on an empty stomach and when blood sugar levels are low. The symptoms usually go away after the first 12 – 16 weeks of pregnancy.

Tips:

• Eat 4 – 6 small nutritious meals rather than 3 big meals each day to keep sugar levels constant
• Vitamin B6 (Pyridoxine) supplements can help – 25mg tablets, take up to 75mgs per day maximum (Blackmores morning sickness formula)
• Sip soda water or lemonade – remove lid and allow ‘fizz’ to reduce before drinking
• Ginger – drink some dry ginger ale or sliced root ginger to weak black tea and sip when nauseated or take 3 – 4 ginger tablets / capsules in the morning (500mg)
• Have some dry biscuits by the bed to eat in the morning, then wait 10 minutes before getting up
• Concentrate on fluids and take sips of fluids every 10 – 15 minutes
• Maxalon or Zofran medication may be ordered if necessary

Resolution of morning sickness should occur around 12 – 16 weeks.

If unable to keep down clear fluids and vomiting persists please contact the rooms on (03) 9417 0147.

• Have to have had close contact with child with slap cheek
• Takes 6 weeks to manifest an effect on the baby
• If close contact has occurred then a blood test is needed
• Blood test need to be taken 2 weeks after initial contact
• There is no specific vaccine for parvovirus, and the virus causes anaemia in the baby which can be treated whilst in utero

There are many things that can assist mothers to prepare for the birth of their child, but like pregnancy, birth and babies themselves, all are different and so it is important to remember that what may suit one person may not suit someone else. This is why good quality education and information resources can be a key in determining the best options for impending births.

As an obstetrician, the most important goal of birth is for a healthy baby and healthy mother. Following that, I see there are two main areas to consider when preparing for birth and they are the physical and psychological, both are equally important.

Physical

• Optimum weight management. Aim for a BMI in the normal range. There is strong evidence that BMI at the end of pregnancy is a major influence on mother and baby’s health and complications occuring during birth, including death rates. This is also a major determinant in the mode of birth. Obesity nearly triples your risk of obstructed labour (which can result in caesarean section).
• Physical fitness doesn’t have a big impact on birth, but avoid excessive exercise as this has a detrimental role on placental function and fetal growth.
• Commonly held beliefs in varying methods of self-induction rarely have great value and nature should be left alone. The need for a sense of control over the time of birth should also be avoided.

Psychological

• Seek education to alay fears and have a positive expectant view.
• Understand natural stages and changes’.
• Relinquish the need for control, “it happens to you, you don’t happen to it.”
• Patience, patience, patience.
• Don’t look for labour, play it down.
• Be surrounded by confident, positive people.
• Admit to anxious feelings early and seek help.
• Your happiness at achieving your desired birth is determined more by expectations, than outcomes.

Medicines and pregnancy
www.thewomens.org.au/askapharmacist

Lactation Consultants of Australia and New Zealnad
www.lcanz.org

Having a baby in Victoria
www.health.vic.gov.au/maternity

Gestational diabetes
www.diabetesaustralia.com.au

Parentline Victoria
www.parentline.vic.gov.au

Maternal and child healthline
www.betterhealth.vic.gov.au

Multiple births
www.amba.org.au

Post and antenatal depression association
www.panda.org.au

Paid parental leave
www.familyassist.gov.au

St Vincent’s Private Hospital
www.svpm.org.au

Epworth Freemasons Hospital
www.epworth.org.au