There are many formats of birth plans available on the internet eg.http://www.bubhub.com.au/info/articles/birth-labour/birth_plan_template.shtml. Some hospitals, doctors and midwives have their own forms you can fill in. Apart from for your own benefit, we are unsure how much merit the birth plan holds when you present it to your caregivers. Will it go in your file and never be looked at? Will it get lost in the system? If it is lengthy, will the important parts get through. Some women like to put a plan together, and some dont. We do however think that if there is something you need all of your labour and birth care providers to know, writing it down is a great way to communicate these wishes.
Examples of things that may be important to you:
eg- do not separate mother and baby unless one is ill
eg- do not speak to woman during the contraction
MAMA says: birth plans are a good tool for a couple to use for education, and to discuss between you what you want in certain labour and birth scenarios. We recommend keeping it as short as possible, in dot point form if you can. Print it out on a coloured piece of paper so it is easy to find!
We believe that the use of water in labour has many advantages. According to a cochrane review in 2009, there is no evidence of increased adverse effects to the fetus/neonate or woman from labouring in water or waterbirth. We provide waterbirth as an option to our clients who wish to have a homebirth, and use of the pool at home in labour for women who wish to birth in hospital. Different hospitals have different views on waterbirth; if you wish to have a waterbirth in hospital it is useful to discuss it with the hospital staff during your pregnancy.
We provide the pool and equipment for waterbirth.
Our visits during your pregnancy are adapted to suit your needs. We aim to provide the appropriate support for your circumstances. Below is a basic framework that we provide to give you some guidance as to how frequently the visits are usually scheduled. There may be times throughout your pregnancy or after the birth of your baby that you require more or less visits. Phone calls in between visits are of course always welcome.
Initial Booking Visit
Up to 28 weeks of pregnancy
Visits will usually occur once every four to six weeks.
From 28 weeks to 36 weeks of pregnancy
Visits will usually occur every two to four weeks.
From 36 weeks to 40 weeks of pregnancy
Visits will usually occur weekly. We are on call for you 24 hours a day from the payment of your booking/on call fee until six weeks after the birth of your baby.
From 40 weeks to the birth of your baby
Visits will usually occur twice weekly.
After the birth of your baby
We will visit you most days of the first week, and then visits are usually at 2 weeks, 4 weeks and 6 weeks or as required.
If you have had a tear of any sort, we recommend applying manuka honey to the tear. Manuka honey comes in different grades and has antiseptic and healing properties.
We may recommend you to apply ice to your perineum if there is swelling.
Pelvic floor exercises are essential after pregnancy and birth, as there is always a degree of pelvic floor muscle weakness. One in four women who have had babies have problems with incontinence.
Only attempt to start these exercises when you feel up to it.
Before or soon after you have your baby, your doctor or midwife will discuss Hepatitis B immunisation with you and will ask you to make a decision about whether you want your baby immunised. Hepatitis B is a serious disease that can be contracted throughout life. It is caused by a virus that affects the liver and can lead to liver cancer of liver failure later in life.
The Hepatitis B vaccine is an intramuscular injection given to babies after birth either within the first few hours or after a day or so. The baby will need three more doses of the hepatitis B vaccine to be fully immunised. These will be given at two, four and six months of age in combination with other routine childhood immunisations.
Whilst these common and perhaps transient side effects may be of little concern in an older child they are liable to be of much greater significance in a newborn baby who is already facing many challenges at this deeply important point in its life.
All women are screened for Hepatitis B antenatally so that babes of positive mothers can receive both Immunoglobulin and vaccination at birth. This has been shown to be extremely effective in managing the risk of vertical (mother to baby) transmission.
The risk factors (for contracting the disease) are IV drug use, unsafe sexual practices and certain ethnic groups who have “high” endemnicity so may have a slightly elevated risk of transmission. These being Aboriginal, Torres Strait Islander and particular Asian groups (www.health.vic.gov.au).
The World Health Organisation (WHO) classifies Australia as a “low” risk for Hepatitis B with low endemnicity of <2%, transmission rates in infancy are "rare" and "infrequent" in childhood. The WHO recommendation is for universal Hepatitis B immunisation for “high” risk groups and the recommended program is for the full course of vaccination commencing after birth with the other three doses to follow.If you are in the low risk group and would like to have your baby vaccinated against Hepatitis B consider delaying at a minimum of 24 hours post birth when your baby has stabilised or after a few days. Alternatively, if you have no risk factors and are not putting your baby into childcare within the first couple of months, consider delaying the first dose of the vaccine until your baby is two months old or later.
MAMA Says: A vaccination post birth is a huge insult to a newborn baby’s immune system. Research your risk factors and make an informed choice on if and when the best time for your baby to be vaccinated may be.
For more information, visit
You will be encouraged to get out of bed and mobilise within the first 24 hours after surgery. This will help start the healing process and get you used to moving around with your incision.
The days following the birth of your baby, can be challenging in many ways. This time can be even more challenging for a mom who has undergone a caesarean delivery. After all deliveries, women must take time to allow their body to rest and heal.
MAMA says: Focus on a well-balanced diet of fresh seasonal foods postnatally to aid in wound healing and avoid constipation.
It is normal to have bleeding after your baby’s birth, whether your baby was born vaginally or by caesarean. More often the blood loss is heavier after a vaginal birth. An average amount of blood when a women gives birth is between 200-300ml. Your body prepares in pregnancy to lose a significant amount of blood immediately after the birth, with a large increase in the blood volume. Lochia is the name given to postnatal bleeding.
Lochia is very similar to the bleeding you experience during your menstrual period; however, it is much heavier. It typically begins in the hours immediately following birth and usually continues for two or three weeks. However, in some women lochia can last for up to six weeks. In the first day or two it will be like a heavy period and it will get progressively lighter.
Lochia usually begins as a bright red discharge from the vagina. This blood typically continues to be bright red in colour for between four and ten days. After ten days, your lochia will become a pink colour, eventually changing to a clear-yellowish-white colour. This blood flow may be constant and even, or it may be expelled in intermittent gushes. Lochia may also be accompanied by numerous small blood clots, about the size of a grape (Myles, 1999).
Typically, lochia is not the result of any health complication and will end on its own when your body is ready. However, some women do experience problems with their postnatal bleeding. If you experience any of the following signs, call your health care provider or visit your nearest hospital emergency department –
Postnatal haemorrhaging is a more severe type of post-pregnancy bleeding. If you lose more than 500 ml, you are classified to have had a postnatal haemorrhage. Postnatal haemorrhaging can be a very dangerous condition and is associated with various complications including heavy blood loss and even maternal death (Myles, 1999). It usually begins in the 24 hours immediately following childbirth (primary postnatal haemorrhage); however, it can occur anytime during the six weeks following delivery (secondary postnatal haemorrhage).
What causes Postnatal Haemorrhage The most common cause of postnatal haemorrhage occurs when the uterus does not contract after birth. This allows the uterus to continue bleeding and can result in massive blood loss. Other causes include:
Every woman is at risk for developing postpartum haemorrhage. However, there are certain factors that will increase your risk although some may have a heightened risk. It is extremely important that every new mother knows how to recognize the symptoms of postnatal haemorrhage. Quick treatment is essential in order to prevent excessive blood loss. Symptoms include:
Postnatal haemorrhage is usually taken very seriously. If you are suffering from this type of bleeding, you will likely be treated in hospital with uterine massage, anti-bleeding drugs, surgery if needed, blood transfusion if needed and in some rare cases hysterectomy if they bleeding cannot be stopped.
MAMA says: Continue an iron rich diet after the baby is born! Consider an iron supplement if your iron levels are low post delivery.
For more information, call our MAMA centre and speak to a midwife.
This is the separation of the connective tissue in between the two strap like muscles that run down your abdomen (Gilleard & Brown, 1996). This often occurs during pregnancy as a result of the baby growing. The separation of this muscle usually happens to some degree in the pregnancy but for some women it may be quite severe. Left untreated post birth this can lead to posture problems, back pain or pelvic floor dysfunction.
A DRAM is measured by health professionals in finger widths after birth. Usually it self resolves at around four weeks after the baby’s birth. If it does not, you may need to do some exercises to strengthen your abdominal muscles. It is best to see a Physiotherapist or healthcare practitioner who specialises in DRAM to receive appropriate treatment and follow up. Exercising too hard or with the wrong type of exercises (such as sit ups) can further extend the DRAM therefore appropriate follow up is essential.
MAMA Says: After you have had your baby ask your midwife how many finger widths your DRAM is. As a guide, anything over 3 finger widths requires follow up by a Physio.
For more information, visit
Exercise in pregnancy is essential. Exercise will help you remain active, mobile and prevent you gaining excessive weight in your pregnancy. Unless you have complications, it should be possible to enjoy some level of physical activity throughout most of your pregnancy. You may need to modify your existing exercise program or choose a suitable new one if you were not a regular exerciser pre pregnancy.
Some of the benefits of exercising regularly throughout your pregnancy include:
Women should discuss their exercise plans with their midwife or doctor. Depending on your previous exercise program, you may be able to continue this during pregnancy; however you should check this first to receive clearance.
If you have been cleared to exercise, it is recommended that you:
Activities that are generally safe during pregnancy, even for beginners, include:
There are some exercises that involve positions and movements that may be uncomfortable or harmful for pregnant women. General cautions include:
Resuming gentle exercise can be started within the first few weeks after birth, if you feel up to it. As a rule, your post birth recovery takes 4-6 weeks so after this timeframe you should be ready to resume your regular exercise routine. Remember the Relaxin hormone remains in your system for some months after birth so take care with vigorous exercise and stretching. Like in pregnancy, stay well hydrated, particularly if you are breastfeeding and gently increase your duration slowly as your fitness levels improve.
MAMA Says: Many women find themselves feeling heavy and extremely uncomfortable in late pregnancy. You don’t have to feel this way and the key is regular exercise.
For more information, visit
The Perineum is the area located between the vagina and back passage (anus) and has an amazing ability to gently stretch and give to allow the birth of our babies. Below are some methods of prevention for perineal trauma. Some points are evidence base, some are common sense, some are just comforting for the woman at the time and some just work!
Good nutrition and health equals strong elastic tissue and rapid healing after the baby is born. Focus on a well balance diet throughout your pregnancy. Eat a large variety and lots of fresh seasonal foods.
Sore, irritated, swollen perineal tissue is not likely to be as pliable, can tear easily and heals poorly. We advise to avoid perfumed soaps and sprays and sometimes panty liners can cause irritation. Comfortable cotton underwear is encouraged and prompt follow-up on yeast or other infections.
Perineal massage; anecdotally, midwives and women all over the world believe that perineal massage has helped avoid tearing and episiotomy during childbirth. The concept of stretching of the perineum by placing two thumbs into the vagina and gradually stretching the perineum open and out is thought to be beneficial. Some midwives recommend evening primrose, olive oil or unscented almond oil for this. Unfortunately, it is physically challenging in later stages of pregnancy and is generally taught as a couple’s activity. Evidence on perineal massage is shown to be effective for women having their first baby and if commenced after 34 weeks gestation (Yates, 2010).
A dilating balloon device is currently being promoted to increase vaginal elasticity antenatally. Experts are challenged to see the benefits of dilating a woman’s vagina to 10cm without actually being in labour and giving birth. The vaginal/perineal tissue does this particularly well when there is gradual dilation in labour, with sufficient expulsive urge, support and encouragement.
Management from your care provider of the second stage (the pushing part) of labour is critical to preserving the integrity of the perineum. We should observe the rest time between contractions and wait for the physiological urge to push occur. There is a significant trend towards poorer perineal outcomes when directed forceful pushing is used, with evidence that pushing on command and expulsive pushing (holding your breath, chin down on chest etc) contributes to pelvic floor damage, fetal distress, exhaustion and perineal tears.
A meta-analysis of randomised controlled trials showed that spontaneous vaginal birth reduced the incidence of perineal trauma (Yates, 2010). The absence of fear and embracing of trust of your body and the birthing process can help reduce the likelihood of tears.
Choosing a care giver who allows you to adopt your birth position instinctively is important with the avoidance of Lithotomy (legs up in stirrups) which is the worst position for pain and tearing. The avoidance of forceps or vaccum deliveries and epidural or local anaesthesia that will numb the area all play a part in preventing trauma.
Placing warm packs over the perineum to help relieve the burning sensation during crowning can be most comforting.
A trusting relationship with your birthing carer will allow you to work with your body and your baby during the process. Humour can help women to relax and a close interaction between midwife and the woman throughout with gentle coaxing and quiet, peaceful talking to encourage slow birth of the head after crowning. The most effective preventative for perineal trauma in our experience is the trusting relationship between mother and midwife developed through pregnancy. Discussion occurs about what happens in the second stage and how the midwife will provide encouragement and support to get through this overwhelming experience.
Below are our recommendations in dealing with perineal soreness, care after birth and how to care for stiches.
MAMA Says: MAMA believes a loose open jaw may help to have a loose open vagina. The energy in the room and the space held for the woman may also greatly help reduce the chance of perineal tears.
For more information, visit http://www.ranzcog.edu.au/publications/o-g_pdfs/O&G-Winter-2010/Perineal_tears_Yates.pdf
Cytomegalovirus (CMV) is a common viral infection and a member of the herpes family. Related viruses include Epstein-Barr (causes glandular fever), varicella-zoster (causes chicken pox) and herpes simplex (causes cold sores). This viral infection can be spread through coughing, contact with blood, urine or faeces, or via the mucous membranes such as the mouth and genitals.
In healthy people, CMV infection causes nothing more than a flu-like illness that lasts a few days. In certain people, however, including transplant patients and pregnant women, the effects can be much more serious. Once a person has contracted CMV, they will carry it for life. This is because the virus lies dormant inside the body and may or may not reactivate itself at any time. Women can catch CMV during pregnancy and pass it on to the baby – this is called congenital CMV. Around one in ten infected babies will have lasting problems. These can include deafness, poor eyesight, intellectual disability and an enlarged liver or spleen. Pregnant women should wash their hands after handling bodily secretions from babies or children, for example after changing nappies or wiping noses. Treatment depends on the severity of the condition. In a healthy person, bed rest, drinking plenty of fluids and medical supervision are all that is generally required. Pregnant women and patients with suppressed immunity need careful medical monitoring and frequent testing, including blood, sputum and urine tests. Antiviral medication may be prescribed.
MAMA Says: Remember good hand hygiene and consult medical advice if you are concerned regarding exposure.
For more information, visithttp://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Cytomegalovirus
Listeria is an illness usually caused by eating foods contaminated with the bacteria known as Listeria monocytogenes. Other less common forms of transmission are indirect contact with contaminated soil, water or sewage. Listeriosis is a serious disease in pregnant women and their babies, newborns, the elderly and people with weakened immune systems.
The incubation period (between infection and symptoms) can vary but on average is about three weeks. Symptoms include: fever, muscle aches, and sometimes gastrointestinal symptoms such as nausea and diarrhoea. In the more severe form, symptoms also include collapse and shock. Infection during pregnancy can lead to miscarriage, stillbirth and infection of the newborn.
Listeria is widespread throughout nature, being commonly carried by many species of both domestic and wild animals. Outbreaks of illness have been associated with raw or contaminated milk, soft cheeses, prepared salads (for example, from salad bars), unwashed raw vegetables and ready to eat meat such as paté. People who are at risk can contract listeriosis through eating food contaminated with the Listeria bacteria. Babies can be born with listeriosis if their mothers eat contaminated food during the pregnancy.
The diagnosis of listeriosis can be confirmed by a blood or other tests. Treatment involves antibiotics and supportive therapy. When infection occurs during pregnancy, antibiotics can often prevent infection of the foetus or newborn.
MAMA Says: Unlike most other food-contaminating bacteria, Listeria can grow in the refrigerator. However, Listeria bacteria are readily killed during cooking. So, think freshly prepared foods, served hot and if re-heating left-over foods the next day heat until piping hot.
For more information, visit http://www.health.vic.gov.au/ideas/bluebook/listeriosis
Toxoplasmosis is caused by a parasite, Toxoplasma gondii. This infection is not serious for you but can be for your developing baby. Although mostly exposure carries no symptoms, the most common sign in symptomatic patients is enlarged lymph nodes, especially around the neck or muscular pain and fever. Should exposure to this parasite occur to a woman during pregnancy, it can affect the unborn baby with varying degrees of severity. Depending on the time of exposure during pregnancy and fetal development, symptoms can vary from mild to eye disorders, liver or brain damage.
A women can acquire Toxoplasmosis from contact with infected cat faeces (directly or indirectly through soil), eating raw or uncooked food that is contaminated, not washing hands thoroughly after handling raw meat, gardening with direct contact in soil, from contaminated raw vegetables or fruits or drinking unpasteurised milk.
Women are not routinely screened for this antenatally, but you can have a blood test to check your immunity. If there is concern of exposure during pregnancy, Amniocentesis can be performed to detect infection, but this cannot reveal the severity of exposure. Babies can also be tested after birth.
There are several steps you can take to avoid infection: • Always wash your hands before preparing or handling food. • Make sure that all meat and chilled ready-meals are thoroughly cooked before you eat them. • When you have handled raw meat, remember to wash your hands, cooking utensils and surfaces thoroughly afterwards. • Don’t eat cold processed meats, such as ham or salami. • Avoid unpasteurised milk and products made from it. • Always wash fruit and vegetables thoroughly. • If you’re gardening or handling soil or sand, wear gloves and wash your hands afterwards in case you have come into contact with cat faeces in the soil. • Wash your hands thoroughly after contact with sheep at farms and outdoor play centres with animals, and avoid handling newborn lambs. • If you have a cat, use gloves when emptying the litter tray and wash your hands afterwards. Empty the litter tray daily.
MAMA Says: If you have a cat, maybe ask someone else to deal with the litter tray while you’re pregnant.
For more information, visit http://www.health.vic.gov.au/ideas/bluebook/toxoplasmosis
Although Morning sickness is a common pregnancy ‘side effect’, it does not make it any easier for the two thirds of pregnant women who will experience morning sickness to some extent. It most commonly occurs in the first trimester (usually between weeks four and twelve), however some women may have it for the entire duration of their pregnancy. It usually occurs in the morning, hence its name, however it can happen at any time of the day (Fraser & Copper, 2003). The symptoms of morning sickness include nausea and vomiting, decreased appetite and in some cases may lead to anxiety and depression. In most cases, morning sickness does not have any long term health effects for the mother or unborn child. However, for some women, morning sickness can make them extremely ill, requiring hospitalisation for weight loss and dehydration. This severe form of morning sickness is known as hyperemesis gravidarum (Fraser & Cooper, 2003). In this case, if left untreated, the baby can also suffer from lack of nutrients.
For more information, visithttp://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/morning_sickness?open
Postnatal depression (PND) can be a devastating and debilitating illness that can persist and affect not just a new mother but everyone around her (PANDA, 2011). PND can be mild, moderate or severe and symptoms can begin suddenly after birth or appear gradually in the weeks or months during the first year after birth. PND can occur after miscarriage or stillbirth, normal or traumatic delivery, or caesarean delivery. PND happens not only after a first baby. It can occur after a third or fifth baby. Sometimes it happens after a first baby only. Sometimes it happens with a third baby, but not with the first two. Sometimes it happens after each pregnancy. A woman who has had PND has an increased chance of recurrence with a subsequent pregnancy (PANDA, 2011).
Like with other forms of depression, the severity of PND depends on the number of symptoms, their intensity and the extent to which they interfere with activities of daily living. The combination and severity of symptoms will be different for every woman, resulting in many different appearances of PND.
PND is a multi-factorial condition with biological, psychological and social factors all playing varying levels of involvement. This is why all women who suffer from PND will have their own unique symptoms and experience.
It is essential to seek professional advice should any of the above symptoms exist in your life after you baby is born. Seeking professional help as early as possible will allow a prompt treatment plan to be developed.
MAMA says: The best person to detect any form of PND is your partner. Keep communication channels open after delivery and talk through your feelings and any worries you may have.
Partners suffer from PND too; be aware of each other’s mood around this time and seek help if you need to!
For more information, visithttp://www.panda.org.au/, or for help call PANDA on 1300726306 or your MAMA midwife.
There are many tests and investigations offered to you during pregnancy. Most tests are done quite early in pregnancy, usually at your first visit with your Midwife. These tests may include such things as blood tests, ultrasounds, urine tests and vaginal swabs. Here is a simple breakdown of what to expect week by week.
Please discuss any tests/investigations with your MAMA midwife that you do not feel comfortable with.
Download: Tests offered in pregnancy
After birth, most hospitals’ policy is for all babies to be offered vitamin K, either orally or by intramuscular injection. This has been an option in most areas for over thirty years and it is thought by the medical profession to be an important prophylactic measure in preventing haemorrhagic disease of the newborn. The medical information regarding this is that it is perceived all babies are born with low levels of vitamin K. Babies need vitamin K to prevent haemorrhagic disease (HDN), which can cause serious complications.
Breast milk is known to carry ‘low’ levels of vitamin K, which are not high enough to prevent HDN.
The babies most at risk from HDN are those who have traumatic births (clinically, this might include babies who are delivered by forceps, ventouse or emergency caesarean section, or babies who show bruising). The risk of a baby who is not given vitamin K developing HDN is between 1 in 10,000 and 1 in 25,000 (Wickham, 2001). Babies, who are born vaginally or without undue trauma, are at the very lowest risk of developing HDN.However, there is still a risk that a baby who is born vaginally will develop HDN.
Some studies have found a possible link between intramuscular vitamin K and childhood cancer. This is not conclusive evidence (Wickham, 2001), and The National Health and Medical Research Council has looked carefully at these studies and other evidence, and has concluded that vitamin K is not associated with childhood cancer, whether it is given by injection or by mouth.
MAMA Says: In general, babies are born with pretty much everything they need. However, as we are unsure as to why some babies born without ‘risk factors’ still develop HDN, giving vitamin K to your newborn baby is a simple way of preventing a very serious disease
For more information:
Iron is an essential element that your body uses to produce red blood cells. One of the primary functions of red blood cells is to carry oxygen around your body. Haemoglobin is the protein in the red blood cells that carries oxygen. When health professionals test your haemoglobin level, it gives them ‘a gauge of the oxygen carrying capacity of the Red Blood Cells’ (Frye, 2006, p.580). When you iron level is low, it in turn affects your oxygen carrying capacity, which can make you feel lethargic.
The mother’s blood volume expands by 50%-60% in pregnancy (with peak volume at around 30 weeks) (Frye, 2006). This is to ensure a good blood supply to the most important organ of pregnancy; the placenta. It also allows for a significant amount of blood loss after birth. However, it is the blood volume (also called plasma) not the red blood cells that increase, meaning that the red blood cells actually become diluted. Just like cordial. This means that in the first trimester of pregnancy, your haemoglobin level will drop, and will increase again (after the volume expansion plateaus around the 30th week) towards the end of pregnancy. In other words, it is normal for haemaglobin to drop in the first trimester of pregnancy due to the dilution of the blood (hence why most women are tired in this period), and it should be back up to the pre-pregnancy level at around 30 weeks. The World Health Organization defines anaemia (another word for iron deficiency) in pregnancy as a haemaglobin below 110g/L. Bryant & Larsen (2009) state that women with a ferritin of less than 10-15ng/ml are iron deficient.
During pregnancy, your iron demands increase to account for the increased volume of blood circulating around your body, which is to ensure your baby gets enough nutrition through the placenta.
(Bryant & Larsen, 2009, p.17).
You may be:
Blood tests are definitive; your health care provider may decide to do a Full Blood Examination (FBE) to test your Haemoglobin (Hb), and Iron stores (ferritin).
An ‘acidic’ environment in the gut improves iron absorption. For this reason, antacid medications should be avoided taken at the same time as iron rich foods or supplements. Tannin also decreases the absorption of iron; tannin is in tea so avoid a cuppa with your iron intake. On the other hand, vitamin C may increase acidity and in turn absorption, so have vitamin C rich foods (such as red capsicum) with your iron intake. The best way to increase your iron in pregnancy is through your diet. If this is not sufficient, you may be advised to take an iron supplement. Most iron supplements cause constipation, so if this is something you are prone to, ask your health professional for a brand that minimises this.
Nettle Leaf (comes in tea form), dark green vegetables such as spinach, prunes, grape juice, kidney, oysters and scallops (Frye, 2006). Please note: whilst seafood is a great source of iron, seafood should be cooked before eating in pregnancy due to the risk of listeriosis.
For more detailed information on iron-rich foods, visithttp://www.ourmidwife.com.au/articles/iron.html
There are many different tablets and liquids available to increase your iron. Only take supplementary iron if this is recommended by a health care professional.
Bryant & Larsen state that ‘only approximately ten per cent of oral iron is absorbed’ (2009, p.18). This means that from a tablet containing 100mg of elemental iron, 10mg will be absorbed.
MAMA says: if you are suffering from nausea and vomiting in the first trimester eat whatever you can; this is not the time to try to increase your iron! Hopefully you can concentrate on this in the second trimester.
The pelvic floor is a hammock of muscles which run from the pubic bone all the way back to the tailbone (coccyx) and support the uterus, bladder, vagina and bowel. The urethra, vagina and anus all have sphincters which pass through the pelvic floor. Pelvic floor exercises are most important for all women and these are also known as keigel’s exercises. Under the influence of relaxin, all of the tissues in the body relax. The exercising of the pelvic floor muscles during pregnancy and after the birth prevents things like vaginal prolapse and incontinence. Pelvic floor exercises are designed to improve muscle tone and integrity and can prevent the need for corrective surgery after birth or later in life.
If the muscles are weakened, the internal organs are no longer fully supported and you may not be able to control your urine, wind or bowels. If you have symptoms including difficulty holding onto urine, wind or bowels this can be a sign that your pelvic floor muscles are weak.
The pelvic floor can be weakened in many ways, including:
In order to strengthen your pelvic floor you must know how to correctly perform the exercises. Squeeze the sphincters from the vagina, urethra, and back passage as if you were tightening the vagina, stopping the flow of urine and holding back wind.
You can perform these exercises lying down, sitting or standing. Ideally, women should perform these daily but even up to three times a day is preferable. Before you start, focus your attention to your pelvic floor muscles. Avoid contracting your abdominal muscles and try not to bear down or hold your breath. Gradually squeeze all three sphincters and increase the tension until you have contracted the muscles as hard as you can. Release gently and slowly. Then perform the exercises, which include:
MAMA Says: Remember to do such things as squeeze the pelvic floor muscles whenever you clear your throat or cough. We all have a vested interest in preserving our pelvic floor so incorporate the above exercises into your daily routine.
For more information, visithttp://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Pelvic_floor
Preconception is the period of time before pregnancy begins. It is the term used when people begin to consider pregnancy, usually a planned pregnancy, and may choose to take a look at their health status. Most people talk about preconception as ‘life style’ and ‘check ups’. MAMA midwives agree that these things can be important. However, we challenge you to prepare yourself to welcome a baby, to think about how I/We want a baby, and if I/We get pregnant what then?.
the ‘decision’ to become pregnant may be a result of a chronological journey through a traditional life pathway; a show of your relationship commitment, a holiday romance, a result of vomiting up the pill or AI between friends, to IVF in all of its struggles and possibilities, or in this day and age surrogacy. No matter how the pregnancy comes about, the focus of the pregnancy or wanting a child should be a wanting the person. MAMA encourages you to acknowledge the human baby, be joyous and ready to welcome and embrace its needs. We have included the traditional prepregnancy counseling literature below, but encourage talking between you and your family and usual support groups to decide what is important to you in this time.
At MAMA we provide holistic preconception conversations and referral to other practitioners of your choice; eg. obstetricians, IVF specialists, naturopaths. This visit is unfortunately not medicare rebatable. At this visit we can help you understand any health conditions or risk factors that can affect you or your baby during your pregnancy. We will also discuss fertility awareness and choices you have once you are pregnant.For those who like to be organised and plan everything, preconception care can be a wonderful activity for you. For anyone, preconception care can make a very positive difference for the health of mother and child, and can also increase the likelihood of getting pregnant. The focus of preconception care differs amongst people based on their diet, nutrition, bad habits and emotional health. Many different health care professionals can offer preconception care; midwives, naturopaths, homeopaths, traditional chinese medicine, etc. These practitioners will offer you more in depth and individualised advice for prepregnancy care. Some studies suggest that prepregnancy care should commence for the mother and father for at least four months prior to falling pregnant (Naish & Roberts, 1998). However many women find themselves pregnant without considering preconception care; this usually means you are in a relatively healthy state to get pregnant in the first place! Read on for the basics in pre-conception health.
Ideal body weight is spoken about a lot in our society. Some people who are very over or under weight get pregnant easily. However the literature supports that these people often have more challenges getting pregnant. In this case, it is advisable to try to increase or decrease your weight as part of preconception care. The BMI (Body Mass Index) is often used as a tool to calculate a health weight range. A health range for BMI is considered to be 20-25. BMI is calculated by weight in kilograms divided by height in metres squared. Some conception problems and many birth choices are affected by a person’s BMI being out of the normal range. For example, people with a high or low BMI are not considered ‘low risk’ and are therefore recommended to have obstetric involvement in their care. Choice of place of birth is also affected by extremely high or low BMI. Think about what you would like your pregnancy and birth care to involve, and you may need to work towards a normal BMI in your preconception care. MAMA midwives are happy to have a conversation with you about this and refer you to the appropriate care.
Folic acid is proven to decrease the chances of Neural Tube Defects (NTD’s) such as spina bifida in the baby (Fraser & Cooper, 2003). This is particularly important to take prior to pregnancy and in the first trimester of pregnancy. Research shows that in this time, a 400mcg supplement is enough to prevent NTD’s. These supplements should be in addition to the folic acid that you can get out of foods, which should add an additional 200mcg’s to your folic acid intake. Foods that contain folic acid include;
MAMA Note: cooking foods begins to decrease the folic acid content, so try to minimize cooking time of foods that it is safe to do so. Also read labels at the supermarket for folic acid content – you may be getting more than you think!
Even in moderation, alcohol has been found to reduce the chances of falling pregnant. There is also no known safe amount of alcohol in pregnancy. This is a good one to avoid in large amounts in preconception, pregnancy and breastfeeding.
Try to avoid chemicals; you can use green cleaning products, avoid passive smoking etc.
Only take medication that is recommended by a health professional. Even if you can get it over the counter, it does not mean it is safe.
Toxoplasmosis is a known cause of miscarriage and is found in cat faeces and some undercooked foods. See our toxoplasmosis factsheet for more information.
A well planned vegetarian or vegan diet provides more than adequate food for mother and baby. It is a myth that you have to start eating meat in your pregnancy. Improving your diet in the prepregnancy period will set you up for a health pregnancy and birth.
If you do not exercise, try to start a regular exercise routine – this has great long term health benefits for the mother and baby (see our factsheet on exercise in pregnancy).
In the last decade have really started to focus on their involvement when in comes to preconception care. It is a wonderful change. Just as diet and lifestyle affects the woman’s body, it also affects the man’s sperm production and health. New research shows that 86% of men want to be more to be proactive in pregnancy care. We also recommend simple health and lifestyle changes for men in the preconception and conception periods. For more information visit www.femail.com.au
Visit a health care practitioner such as MAMA midwives who specialise in preconception care.
For more information on preconception care, visit http://www.pregnancy.com.au/resources/topics-of-interest/preconception/planning-for-pregnancy-preconception-care.shtml
TENS is a very effective pain relief option during labour. Using electric pulse, it is a drug free pain management method which helps you to remain calm and manage contractions.
TENS machines are available for hire at MAMA.
You can pick them up at our Caulfield or Kensington centre.
Please contact should you wish to reserve a machine.
38 Gatehouse Drive
Kensington VIC 3031.
Ph: 03 9376 7474
722 Glenhuntly Road,
Caulfield South VIC
Ph: 03 9013 0577
Ph: 03 9376 7474