Wellbeing in Pregnancy

Whilst pregnancy places additional demands on your body due to your growing baby, surprisingly, your energy needs only increase slightly. So the emphasis should be on eating a wide variety of nutrient rich foods rather than increasing the quantity.

These are foods that are rich in protein, vitamins and minerals, in particular; lean meats, poultry, eggs, beans, nuts, colourful fruits and vegetables, breads and cereals and low fat dairy such as milk, cheese and yoghurt. During pregnancy your body needs more of the following vitamins: folate, iron, calcium, vitamin D, zinc and iodine.

Download this guide on some examples of foods to eat during pregnancy to ensure you are getting enough of these vital nutrients.

Whilst taking extra vitamins in pregnancy is not compulsory, most pregnant women will take a pregnancy vitamin supplement that contains iron, folic acid and iodine. Some women, who are already vitamin D deficient, who remain indoors, who veil themselves or who have dark skin, should take additional vitamin D supplementation. There is a blood test available to determine your status. Women who follow vegetarian or vegan diets may need extra vitamin B12 supplementation. Routine supplementation using other multivitamin tablets is not recommended for all pregnant women.

In particular vitamin A supplements should be avoided, as they can be toxic to your growing baby. If you aren’t sure about your nutritional status during pregnancy, if you have any concurrent medical or pregnancy-related conditions or you just want more information specific to your needs, you can see your doctor and request to have blood tests to check your vitamin status or request to see a dietician for advice. Women who have any pre-existing conditions such as diabetes, coeliac disease, Crohn’s disease, ulcerative colitis, allergies, lactose, gluten or any other intolerances or who follow certain diets such as vegetarian or vegan diets, require additional dietary support and should seek professional advice.

The latest expert advice from Australia’s peak health body, the National Health and Medical Research Council (NHMRC), is that there is no safe level of alcohol consumption during pregnancy. Drinking alcohol when you are pregnant has been linked to low IQ in babies, low birth weight, prematurity and birth defects. It also stops the absorption of folic acid and iron and reduces the calcium in your bones. There are healthy, non-alcoholic drink alternatives. If you have used alcohol as a way to relax and unwind there are many other ways to de-stress such as taking warm baths, having a massage, participating in exercise and listening to music. If you have any concerns about your consumption of alcohol, please talk to your doctor or visit the Alcohol and Other Drugs Council of Australia website using the link in the resources for this section.

If you smoke, quitting can be one of the best things you can do for yourself and your growing baby. A growing baby in the womb receives all of its nutrients and oxygen from its mother via the placenta and umbilical cord. Smoking during pregnancy exposes the baby to toxins in tobacco smoke and also damages the placenta.

When a person smokes, some of the oxygen in their blood is replaced by carbon monoxide. If a pregnant woman smokes, her blood and therefore her baby's blood will contain less oxygen than normal. Cigarettes, tobacco and other smoking substances also contain nicotine and a large number of other dangerous chemicals. Babies who are born to mothers who smoke are generally smaller than they would otherwise be. They are also at more risk of being born prematurely, dying from SIDS, and developing asthma or other respiratory illnesses. Lactating mothers who smoke do not produce as much breast milk as they could. Unfortunately nicotine replacement therapies are not recommended during pregnancy, so if you do smoke and wish to give up you can investigate other options. Visit the Quit Now site or ring the Quit Now helpline (Australia) on 13 78 48.

Soft cheese such as blue cheese, feta, brie, camembert, cottage, ricotta, Latin-American soft white cheeses and any unpasteurised milk or foods made from unpasteurised milk should be avoided during pregnancy as they may contain the bacteria called Listeria. This bacterium is very harmful to your unborn baby and must be avoided. While adults with Listeria quite often show no symptoms, it could cause life-threatening complications to the growing fetus or newborn. Listeriosis has been known to trigger miscarriage, premature births and blood poisoning. It is best to avoid this food type when pregnant and consume it only after birth.

Whether it is a rare steak, or an uncooked meat dish, raw meat has the capability to cause serious damage to your unborn baby. Raw meat should be avoided when pregnant as it can cause a parasitic disease called toxoplasmosis. This can result in a potential intrauterine fetal infection. Other dangers that may result from eating raw meat are coliform bacteria and salmonella. Raw chicken should be avoided at all times, but more so during pregnancy. Eating or coming into contact with surfaces that have had raw chicken prepared on them can transmit salmonella. Even cold chicken from the night before should be heated or cooked again to destroy any traces of salmonella. Other raw seafood that pregnant women should avoid altogether is oysters and uncooked sushi. Deli-style smallgoods such as pate, coleslaw and other cold meats are risky and consumption during pregnancy should be reduced or best avoided.

Foods that contain raw egg such as mayonnaise, Caesar salads, eggnog, hollandaise and certain batters like those used for cookie dough can be harmful. To reduce your risk of salmonella, remember to cook your eggs well before eating them in any meal.

You should get enough of this vitamin if you consume a healthy balanced diet with a range of red, orange, yellow and dark green fruits and vegetables and dairy foods. Supplementation of vitamin A in the form of vitamin tablets, tonics, etc. during pregnancy is not advisable. Neither is the use of certain acne skin treatments that contain high levels of retinol or retinoid. This is because high levels of vitamin A taken during the first 12 weeks of pregnancy have been shown to cause birth defects in some babies. These defects involve the baby's eyes, face, brain and skeleton as well as their intellectual development.

Fish is a valuable source of protein, omega 3 oils and iodine. Yet certain fish (such as shark, marlin, southern blue fin tuna, orange roughy and swordfish) contain high amounts of mercury that is accumulated in their fatty tissue. Pregnant women should avoid eating large amounts to avoid neurologic (brain, spinal cord, nerves) damage to their growing baby. Your growing baby has a sensitive developing nervous system and while it is not clear how much seafood you would have to eat to experience harmful effects, it would be best to avoid these types of fish and seek safer alternatives. The Food Standards Australia Website contains up-to-date advice on how much and what types of fish should be eaten during pregnancy.

The current recommendation is for pregnant and breast feeding mothers to limit their caffeine intake. Caffeine passes from the mother to the baby via the placenta during pregnancy and it is also present in breast milk during breastfeeding. The safe limit for caffeine is considered to be 200mgs/day. An average cup size of filtered coffee contains around 130mgs, so even a couple of flat whites or cappuccinos a day would be too much. Two cups of weak coffee per day or 4 cups of tea is considered safe. Cola drinks need to be limited to less than 1 litre a day, preferably unsweetened, and energy drinks to less than 1 can per day as these too contain caffeine. Research has shown that large amounts of caffeine have been associated with heart defects in a small number of babies. Large amounts of caffeine have also been related to lower birth weight and an elevated risk of miscarriage. Breastfed babies of mothers who consume high amounts of caffeine sleep less and are more jittery and cranky.

When buying fruit and vegetables make sure you wash them clean of any harmful pesticides, bacteria and soil residues. Make sure most foods you eat are thoroughly washed and cooked and when choosing a recipe, be selective about what you eat to protect your baby against harmful bacteria and damage while it’s still developing. Unwashed vegetables have the potential to transmit toxoplasmosis – a parasite that contaminates the soil – that can be harmful for your growing baby. Also any mouldy fruit and vegetables should be avoided altogether.

Many foods are full of additives and preservatives so careful selection of packaged food in supermarkets is advised. Additives to avoid are MSG (monosodium glutamate) which could cause stomach upsets and headaches; artificial food colourings and sweeteners should also be avoided particularly blue 1, blue 2, green 3, red 3 and yellow 6 and saccharin. Preservatives that can cause problems include benzoates, nitrates, and sulphites. Some studies have linked food additives and preservatives with allergies and hyperactivity in children.

Regular physical activity should continue throughout pregnancy but pregnancy is not an ideal time to launch into a more vigorous exercise program. Exercise of light to moderate intensity, three times a week or less, is recommended. This may include walking, swimming, yoga, gentle stretches, certain sports, and certain exercise classes. Avoid overheating and drink plenty of fluids.

Download this Fitball Exercises for Pregnancy info sheet for some exercises you can do.

For some women, certain types of exercise may not be appropriate, especially if you have conditions such as: heart disease, threatened miscarriage, premature labour, bleeding during pregnancy, or high blood pressure that may be impacted by exercise. Seek advice from your obstetrician or a physiotherapist about what type and level of exercise is appropriate for you. You will need to modify your activity based on the stage of your pregnancy, how you are feeling and whether you have any medical or pregnancy-related conditions. Activities to avoid include scuba diving, parachuting, water skiing, martial arts, trampolining, weight lifting, horse riding, as these are more risky for pregnant women.

If you experience any of the following symptoms whilst exercising, cease the activity and contact your obstetrician or hospital: fast heart rate, dizziness or faintness, chest pain, headache, uterine contractions, vaginal bleeding, leakage of fluid, shortness of breath, back or pelvic pain, excessive weight loss, excessive fatigue, decreased movements of the baby, or sudden swelling of your eyes, face, hands or ankles.

Talking to your partner, family, obstetrician or other health professional such as your GP or Local Community Health Centre, about your feelings can help you to see things differently. Taking a nap, going for a walk or socialising with friends can also help you feel better. If you cannot seem to shake off negative feelings or they worsen over time, you might need to seek professional help. About 1 to 2 in 10 women may experience depression during pregnancy.

Signs to be concerned about and to seek professional advice for include:

No matter what the apparent cause of these symptoms may seem to be, if you feel they are out of control please talk to your obstetrician and/or hospital about getting advice and the support you need. Pregnancy and childbirth are times when depression, anxiety or more serious mental illness may first manifest. These conditions are very treatable and recovery is common. It can be difficult to seek help at a time when everyone expects you to be happy, but early intervention is associated with better outcomes for you and your family and many organisations now have websites and help lines offering immediate support and advice. One of our Ramsay Health Care hospitals offers an Emotional Wellbeing Program.

Your partner may be feeling very excited about the new baby, but they might also be feeling a bit confused about your feelings and the changes that are happening to you. Try to talk to your partner about what you are experiencing. This can help both of you to adjust to the changes happening in your life.

In addition to discussing your feelings, your partner can also become more involved in your pregnancy by:

The incidence of domestic violence within relationships is thought to be vastly under-reported. Pregnancy is a time when it can first manifest and peak, especially when the baby has not been planned, when parents are young and unsupported or there are additional stressors. Unemployment, homelessness, drug and alcohol abuse can all make violence worse but it occurs in all ages and socio-economic groups.

If you, your unborn baby or other children experience verbal, emotional, sexual, financial, spiritual or physical violence or abuse, please seek advice from your doctor. Alternatively, your local white pages have a range of contact services in your area and State and some of these are listed in the Resources. Safe houses are usually available in cities and towns for women and children who are at risk. Think about developing a safety plan and establishing a safety network of trusted people who can help you if you need it.

Feeling your baby move gives you reassurance of his or her wellbeing. Your perception of baby’s movements will vary depending on how far your pregnancy has progressed, how many babies you are carrying, whether you are a first time mother, the position of the placenta and baby within your womb, how much amniotic fluid surrounds your baby, your own activity and your weight.

In general, mothers first become aware of their baby’s movements at around 18 to 20 weeks. First time mothers may feel baby’s movements later and if you have already had a baby you may feel movements earlier than these dates.

Baby’s movements are often felt as a discrete kick, flutter, swish, or roll. Movements are best felt when you are lying on your left side compared to when you are standing or otherwise active.

Your baby’s movement patterns will change as it develops. Afternoon and evening periods are often times of increased activity for your baby. During both day and night, your baby has sleep periods for between 20 and 40 minutes, but rarely longer than 90 minutes. Your baby will usually not move during these sleep periods. The number of movements tends to increase until 32 weeks of pregnancy and then stay about the same, although the type of movement may change as you get nearer to your due date. You should continue to feel your baby move right up to the time you go into labour. It is a myth that they slow down as labour and birth approach.

Your baby should move during labour too. If you are busy, you may not notice all of these movements, but if you notice a change in movements, you should contact your obstetrician or midwife and arrange to be assessed.

If you notice your baby is moving less or more than usual or if you have noticed a change in the pattern of movements, it may be a sign that your baby is unwell. In this case you must contact your obstetrician and hospital immediately so that your baby’s wellbeing can be assessed. Please do not delay seeking advice and assistance even if you have been recently seen or checked.

Depending on the stage of your pregnancy and your individual circumstances, your baby’s heartbeat and/or movements will be checked using a variety of methods, such as with a Doppler listening device or a heart rate monitor called a cardiotocograph (CTG machine) or real-time ultrasound scan. You may also have a physical examination to check the size of your uterus, a blood pressure check, and urine or blood tests as indicated.

Your obstetrician will guide your individual antenatal care and any tests recommended during your pregnancy. Generally, if you are healthy and have a normal pregnancy, depending on your individual needs, a schedule of anywhere from 7 to 14 appointments will be adequate. Please discuss this with your obstetrician if you experience any pregnancy complication or feel you need to change your schedule to better meet your needs.

A typical first visit will include asking information about your past medical and obstetric history and various examinations and tests. All of this information will assist your obstetrician to plan your care and prepare you for childbirth and parenting. At successive visits your obstetrician will provide you with general and specific advice about the ongoing management of your pregnancy and other aspects of your antenatal care such as how to keep yourself and your baby well throughout pregnancy, the hospital you plan to have your baby and related costs for antenatal and birthing care. During early pregnancy the appointments may require a longer time for you to discuss matters with your obstetrician.

Each antenatal appointment will generally follow a particular topic or theme related to your pregnancy and your individual needs. You will likely receive an Antenatal Card or Summary when you book with your obstetrician. It is a record of yours and your baby’s health and wellbeing throughout your pregnancy. Please keep it with you at all times in case you need urgent medical or maternity attention outside your usual antenatal visit times. If you require admission to hospital your Antenatal Card or Summary will be an important reference for your midwives to guide your care.

In general, your obstetrician will conduct a physical examination, check your blood pressure, weight (and possibly height) and you may need to have a Pap smear if you have not had one in the last 2 years. She or he will examine you to check how well your baby is growing, to listen to their heartbeat and they may offer an ultrasound scan. Other examinations of your heart, chest and breasts may be done if indicated. You will need to have some blood taken for various tests such as haemoglobin, blood group (A,B,O), Rhesus factor (positive or negative), rubella immunity, varicella, hepatitis B and C, syphilis, HIV.

Other screening tests, such as for Down Syndrome and for Anti-D antibodies, urine testing and swabs for Group B Streptococcus, and a glucose challenge test (test for diabetes), will be offered to you at successive visits. If you have any existing medical conditions your obstetrician may order additional specific examinations or tests related to your particular circumstances or repeat earlier tests if indicated. Please discuss any tests you wish to know about with your obstetrician.

Discussing the risks and benefits of health care, in the topic Preparing for Labour and Birth provides a general guide on how to approach this discussion.

Your obstetrician will need to know:

You may also be asked about possible signs of depression, stresses that you might have and social supports (your family and friends).

Your obstetrician will want to know the following:

All of this information is kept private and confidential. If you do not want some information written on the Antenatal Card that you carry with you, tell the obstetrician that you want this kept separately.

If you have a regular menstrual cycle of 28 days and you know the date your last period started this can be used to work out when your baby is due.

Your due date is known as your EDD (Estimated Date of Delivery) or EDC (Estimated Date of Confinement) and is usually around 40 weeks after the beginning of your last period. You can calculate your due date by adding 7 days and 40 weeks to the date of your last menstrual period.

Ultrasound scans use sound waves to produce images of the growing baby, placenta, umbilical cord and the water surrounding the baby (amniotic fluid). Most women in Australia have at least one scan during pregnancy at around 18-20 weeks, and others might have more depending on individual circumstances and how their pregnancy is progressing. You can discuss the risks and benefits of ultrasound scans and what information you would like to know with your obstetrician in accordance with what is appropriate for your particular circumstances.

Please check with your obstetrician or GP that your immunisations are up to date. These include: measles, mumps, rubella, chickenpox, diphtheria, tetanus and whooping cough. The doctor can order a blood test to check your level of immunity.

You can also reduce your risk of exposure to infectious diseases during pregnancy by regular hand washing for yourself and others who handle your baby, changing travel plans, using gloves when gardening, not handling cat litter, avoiding high-risk behaviours and avoiding social or occupational exposures to infections. 80% of common infectious diseases are spread by hand. Washing your hands regularly can significantly reduce your risk of catching flu for example.

Members of your family and social circle are also encouraged to use regular hand washing when in close contact with you and your baby and avoid contact with you and your baby if they are unwell so they do not expose you or your baby to infectious diseases. Dental care is especially important during pregnancy. Keeping your teeth and gums healthy during pregnancy may prevent gum disease that may lead to premature birth and it may also stop the transfer of decay causing bacteria from you to your baby.

During pregnancy, the symptoms of influenza (e.g. fever, chills, coughing, headache, muscle aches) may be harmful for you and your baby. Influenza vaccine should be given before or during pregnancy, especially if you are pregnant in the flu season. The Australian Government offers it free through your doctor. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) strongly recommend routine vaccination of pregnant women. Influenza vaccine given during pregnancy can protect you during pregnancy and provide ongoing protection to your newborn baby during the first few months of life.

Pneumococcal vaccine is recommended for women with risk factors, including smokers, when planning pregnancy, i.e. before pregnancy

Immunity to whooping cough lessens over time and therefore whooping cough vaccine is recommended for couples planning a pregnancy or as soon as possible after the baby is born. Several studies of infants with whooping cough show that parents were the main source of infection. Newborns don’t have enough immunity to whooping cough until they have their second dose at age 4 months, so it is vital that they aren’t exposed during that time.

Most women who reach childbearing age are immune to common infections through either experiencing the illness as a child and developing natural immunity, or by being vaccinated. However, if a pregnant woman does not have adequate immunity and becomes infected with an infectious disease, some of these can potentially harm her, or her unborn or newborn child. Some infections that carry greater risk for pregnant women include: