Your body will undergo many changes due to pregnancy hormones and your growing baby. Sometimes simple measures can help with these discomforts.

These minor discomforts of pregnancy may include:

• Backache and groin pain;
• Indigestion/Heartburn;
• Constipation;
• Swelling;
• Varicose Veins;
• Muscle Cramps;
• Carpal Tunnel Syndrome;
• Inability to sleep or vivid dreams;
• Shortness of breath; and
• Increased Vaginal Discharge.

Talk with your midwife, who may refer you to a physiotherapist,  or make some practical suggestions to help ease the condition. Almost all of these conditions will rapidly improve after the birth of your baby.

Please view information on travel in pregnancy at www.ranzcog.edu.au, search ‘Travelling during Pregnancy’. It is very important to know that the law requires you to wear a seatbelt at all times during your pregnancy. The lap sash should be worn around your hips but under your pregnant belly, the shoulder strap should be above your belly and between your breasts.

Along with the physical changes mentioned above some women experience emotional changes, you may feel sad and teary for what may appear to be no apparent reason.

Hormones of pregnancy are likely to be the cause of these emotional  changes, which can affect you and subsequently other members of your family. When booking into the hospital we will ask you to fill out a form that evaluates your emotional wellbeing.  This assessment is called the Edinburgh Perinatal Depression  Scale, and is completed antenatally and again after you have your baby by the Child Health and Parenting Service (CHAPS). Your score will be discussed with you at the time and depending on the EPDS score, referral may be offered to your G.P and the Perinatal and Infant Mental Health Service. It is important to discuss your  feelings during pregnancy with your partner, family, GP or other health professional.

Support  both emotionally and physically is important during your pregnancy and following the birth of your baby. Try to arrange some support well before your due date. If you require further support speak with your Midwife or contact Beyond Blue.

You could also ring Lifeline Australia on 1300 22 4636.

The transition to pregnancy, birth and early parenthood while rewarding it can also be a time of change. Depression and anxiety can happen at any time, but we know that women are more likely to be affected by depression and anxiety or stress during the perinatal period. To support our clients experiencing perinatal mental health concerns,  a referral is available to the social work  services or your GP for ongoing specialised care. Please also refer to the Beyondblue booklet ‘A guide to emotional health and wellbeing during pregnancy and early parenthood’  that can be downloaded from their website www.beyondblue.org. au.

It is also recognised that pregnancy and parenting can bring new challenges for all family members,  including dads and partners. The PANDA (Perinatal Anxiety and Depression Australia) national helpline is available 10am till 5pm eastern standard time on 1300 726 306 or there  is a lot of invaluable information  at www.panda.org.au or www.cope.org.au

These are painless and harmless tightenings of your uterus. They are not labour contractions and are common from 20 weeks onwards.

If you are experiencing lots of braxton hicks contractions things you can do to try alleviating them are; ensure you are well hydrated, change positions or lie down on your left side, and ensure you have emptied your bladder recently. If you are concerned that your contractions are more  than braxton hicks please contact your Midwife.

It is important  to remain active during your pregnancy. Activities like walking, swimming, supervised pregnancy pilates and yoga are all fne to continue whilst pregnant. Being active can help with weight management, build stamina, muscle strength, improve circulation, and assist your  body  in preparation for your labour. It is important to remember  that normal exercise should not cause pain and overheating during pregnancy can be harmful for your unborn baby. Drink plenty of water during and after exercise.

If you are experiencing a normal healthy pregnancy and you want to continue to enjoy sex there is no reason not to. It will not harm you or your baby. Talk with your midwife, doctor or Birth Suite if spotting occurs during or after intercourse (this can be normal), as any bleeding in pregnancy needs reviewing.

Sexual intercourse  is not advised in some pregnancies including if there is heavy bleeding, you’ve had previous miscarriages or your waters are broken.

It is a known  fact that some STI’s can be harmful to fertility, the unborn baby, cause premature births and infections in some newborns.  Whilst some testing is done antenatally please discuss any concerns with your doctor/midwife.

You can also access further information at www.healthdirect.gov.au

The THS WACS understand that for some clients fasting may be required  during pregnancy or whilst breastfeeding due to religious or other reasons. To help you make an informed choice about fasting, please discuss this at your  antenatal visits and ask for any further  literature  that may be available.

Your midwife or doctor  may ask you about traditional cutting/female circumcision if you are from a cultural background where this is traditional practice. If you have experienced traditional cutting/female circumcision in any form it is important you see a doctor at some time during your antenatal care to discuss any special requirements for the birth of your baby.

Awareness of the circumstances before your baby’s birth is very important  as it allows discussion of any needs and postnatal expectations.

The hormonal  changes that occur during pregnancy can lead to dental problems such as tooth  decay and gingivitis (where gums become red and bleed easily). Twice daily dental care is important whilst pregnant. If you make a dental appointment during pregnancy, x-rays or local anaesthetic may be required, so be sure to let your dentist know that you are pregnant. The increased incidence of gum disease or bacterial infection of the gums has been shown to be associated with low birth weight and premature infants.

VTE is defned  as a condition in which a blood clot develops within the deep veins of the leg. VTE may lead to the blood clot breaking free and entering the blood circulation causing potential blood  vessel obstruction to important organs such as the lungs. As blood clots can restrict blood fow, they can potentially lead to lifelong complications or fatality. Fortunately VTE can be prevented  and if diagnosed effective treatment can be implemented.

Symptoms may include:

• Redness or warmth in one spot on the leg
• Pain and swelling in one leg
• If the clot has reached the lungs, shortness of breath or chest pain may occur

VTE does not always have symptoms, which is why it is important to understand the risk factors. Due to the hormonal changes pregnancy places women  at an increased risk of developing a VTE. This combined with other conditions like obesity, elevated blood pressure, smoking or caesarean birth may further increase the risk of VTE.

The THS WACS have implemented into the booking in visit a screening tool to help determine  if you are at risk of a VTE and to allow for appropriate management if the risk is identifed.  We ask all pregnant women to be mindful of the symptoms and report to staff if concerned. For more information go to www.healthdirect.gov.au/deep-vein-thrombosis.

If you are intending on travelling within Australia and to foreign countries you should consult your doctor or midwife for advice about continuing pregnancy care and travel health. See also advice on VTE within this booklet.

RANZCOG have advice for Travelling when Pregnant Booklet

Natural or alternative remedies may also be drugs. To safeguard you and your baby, both through your pregnancy and afterwards, do not take any alternative remedies unless directed by your doctor or an accredited therapist. Midwives do not have the expertise to endorse or educate you in these matters.

Infuenza (Flu)

Under the National Immunisation Program all pregnant women  are eligible to receive a free fu vaccine every year. It is safe to have the flu vaccine at any stage during pregnancy or when breastfeeding.

Infuenza vaccination in pregnant women may protect them, and their unborn child, from  the risk of severe illness and hospitalisation resulting from some strains of the flu.

Whooping Cough (Pertussis)

Whooping  cough is an extremely contagious respiratory infection caused by the bacteria Bordetella pertussis which gives violent  coughing spasms up to 100 days or more.  This can cause sleep disturbances, vomiting, rib fractures, pneumonia and in rare cases fatality in adults. For the first six weeks of a newborns  life they have no immunity against whooping cough which if contracted can cause serious complications like pneumonia  and fatality for babies under twelve months of age.

The recommendation is that it is safe for pregnant women to receive the Pertussis Vaccine in every pregnancy after 28 weeks gestation and if given prior to 32 weeks full benefit to the unborn  baby is more likely. Please check the recommendations for other family members on the website below.

For more information on immunisations against childhood diseases, visit your local doctor or immunisation provider or go to www.immunise.health.gov.au

Diet and pregnancy

Pregnancy brings with it enormous changes in your body and because of the growing baby you need to eat a healthy diet. Healthy weight gain is important  and a guide to this is given in the box below.

Women who do not gain enough weight have a risk of premature birth. Women  who are overweight or gain too much weight during pregnancy have a higher risk of:

• high blood pressure;
• gestational diabetes;
• caesarean birth; and
• diffculty loosing weight after the birth.

The THS WACS strongly believe in open disclosure and your right to be fully informed. To ensure this woman with a BMI above 35 will additionally be provided with (or upon request) the RANZCOG

‘Weight Management during Pregnancy’ guide which provides further information relevant to BMI.

Five food groups

Eat a variety of different foods from the essential food groups every day to get all the vitamins and minerals you and your baby need. The essential food groups for your health and baby’s growth and development are:

1. Vegetables, legumes, and some fruit;
2. Grains;
3. Milk, yoghurt, cheese and dairy alternatives;
4. Lean meat, poultry, fsh, eggs, nuts and seeds;
5. Healthy fats, herbs and spices.

Water intake of more than two litres daily is recommended. Limit salt and sugar whilst pregnant and breastfeeding to allow for steady baby growth  and development.

For more information regarding maternity patient dietary requirements and portion sizes visit www.nutritionaustralia.org or www.nhmrc.gov.au/guidelines- publications/n55 (healthy eating during your pregnancy pdf).

Folate (or folic acid)

Folate is needed for the growth  and development of your baby. A good source of folate can be found in green leafy vegetables, broccoli, oranges and fortifed fruit juice, bread and breakfast cereal.

It is recommended that women planning pregnancy take a folic acid supplement of 400 micrograms per day at least one month before pregnancy and 600 micrograms plus for three months after becoming pregnant to reduce the risk of their baby having a neural tube defect such as spina bifida.

Vitamin D

Vitamin D helps the body to absorb calcium from food to provide you with healthy bones and muscles. Your body will produce vitamin D when your skin is exposed to the UV light in sunlight. The amount of vitamin D your body makes depends on skin type, exposure time, amount of skin exposed, UV levels, lifestyle and health. It is good to spend time in the sun and sensible sun protection (sunscreen, hat and glasses) does not put people at risk of vitamin D defciency. Women more at risk of Vitamin D defciency:

• Have dark skin;
• Cover most of their body with clothing; and
• Spend most of their time indoors.

Speak to your doctor if you have any concerns or for further information on Vitamin D in Tasmania go to www.dhhs.tas.gov.au and search this topic.

It is safe to take vitamin D supplements during pregnancy and breastfeeding.

Calcium

Have four serves of calcium rich food every day to help your baby grow strong bones and teeth. Dairy foods or calcium fortified dairy alternatives, e.g. soy or rice milk and tinned fish are the best sources of calcium.

If you don’t eat these foods you may need a calcium supplement.

Iron

Iron is needed to form red blood cells for you and your baby. It helps carry oxygen in your blood and is needed for your baby to grow.

During pregnancy your iron requirements are increased. A lack of iron can often leave you anaemic, tired  and less able to fight off infection. The best sources of iron are lean meats, green leafy vegetables, legumes and fortified  cereals. Citrus fruits and other foods high in Vitamin C will help the iron from your food to be well absorbed.

Your iron levels may be tested in your pregnancy especially if your haemoglobin is found  to be low. It is safe to take iron supplements during pregnancy and breastfeeding. Talk to your midwife or doctor to discuss the best supplements for you.

Eating fish during pregnancy

Fish is a safe and important part of healthy eating. It is important to eat fish when you are pregnant but you need to be careful about the fish you choose. Some fish may accumulate mercury which may be harmful to your baby’s developing nervous system.

For more information regarding Mercury levels in fish go to: www.foodstandards.gov.au/ consumerinformation/mercuryinfish.cfm

Iodine for pregnancy and breastfeeding

Adequate Iodine in pregnancy and breastfeeding is essential for the normal development  of baby’s brain and nervous system. It is recommended that all women who are pregnant, breastfeeding or considering pregnancy take an iodine supplement of 150 micrograms each day. You need to include good sources of iodine in addition to this supplement. These include: seafood, eggs, iodised salt and bread with added iodine. Women with pre-existing thyroid conditions should seek advice from their medical practitioners prior to taking a supplement.

Ask your midwife or obstetrician for more information regarding iodine. or go to www.nhmrc.gov.au/guidelines- publications/new45 or www.foodstandards.gov.au

RANZCOG Guidelines - BMI and recommended weight gain for single pregnancy

First trimester (3 months) - One to two kilograms in the first three months of pregnancy

Second and third trimesters

RANZCOG Guidelines - Recommended weight gain for twins or triplet pregnancy

Toxoplasmosis

Humans can be infected with toxoplasmosis through being in contact with  the faeces of infected animals (commonly  cats), eating undercooked  or raw meat, consuming unpasturised milk and contaminated vegetables.

Toxoplasmosis can reach the baby of an infected mother  through the placenta and cause them to become very unwell.

For further information search toxoplasmosis at better health vic.

To reduce the risk of Toxoplasmosis:

• Wash hands well after gardening or handling pets;
• Wash salad and vegetables well;
• Cook meat well;
• Wear gloves when disposing of cat litter, avoid contact with animal faeces where possible.

Listeria

Is a bacteria that is not common but can cause a serious illness called listeriosis in some people. Pregnant women,  their unborn and newborn  children are at a higher risk of becoming unwell if they get listeriosis.

It can cause miscarriage, premature  labour, babies being significantly unwell at birth and stillbirths. Some foods are more prone to contamination. Listeriosis can be treated with antibiotics but prevention is best. For further information  please search listeria on www.foodstandards.gov.au

To reduce the risk of Listeria

• Thoroughly wash your hands, cooking utensils and chopping boards.
• Make sure hot foods are hot (above 60 degrees) and cold foods are cold ( below 5 degrees) both at home and when eating out.
• Cook all meat, chicken, fish and eggs thoroughly.
• Avoid certain high risk foods, e.g. soft cheeses, cold cooked chicken, cold sliced meats, uncooked or smoked seafood, pre-prepared salads such as coleslaw, pate and soft serve ice cream.
• Wash raw vegetables and fruit well before consuming.
• Ideally, eat only freshly cooked food and well-washed freshly prepared fruit and vegetables. However,  leftovers can be eaten if they are refrigerated promptly and kept no longer than a day. It is important you do not eat food if there is any doubt about its hygienic preparation or storage.

Cytomegalovirus (CMV)

A pregnant woman infected with CMV can pass the virus to her baby during pregnancy.

Most babies born with CMV infection will be fine, however some may develop health problems.

CMV is transmitted through urine & saliva. If you’re pregnant, the best way to protect your baby from CMV is to protect yourself.

• Wash your hands often with soap and water  especially after changing a nappy; feeding, wiping a child’s nose or mouth, and touching their toys, pacifier, or other objects.
• Don’t  share food, drinks, eating utensils, or a toothbrush with a child.
• Do not put a child’s pacifier  in your mouth.
• Use soap and water or a disinfectant to clean toys, counter-tops,  and other surfaces that may have a child’s saliva or urine on them.
• Avoid  contact  with  saliva when  kissing or snuggling.

For more information see www.cmv.org.au

Alcohol in Pregnancy

Drinking alcohol during pregnancy can harm the brain and body of an unborn child and increase the risk of miscarriage, low birth weight or premature birth. This can also mean underdeveloped organs within your baby.

Fetal Alcohol Spectrum Disorder (FASD) is a term used to describe conditions caused by harmful effects of alcohol exposure on the unborn child. Most children with FASD do not look different but may have varying levels of brain damage, emotional and physical development delays, learning problems and behavioural disorders such as Attention Deficit Hyperactive Disorder (ADHD).

Frequently asked questions about alcohol in pregnancy

• Can Fetal Alcohol Spectrum Disorders  (FASD) be cured?
  The brain damage caused by alcohol is permanent and lifelong.
• Will a little bit of alcohol be a risk?
  Yes. It is therefore wise to have no alcohol if you are planning a pregnancy or are pregnant.
• What if I drank alcohol before I knew I was pregnant?
  Many women are unaware they are pregnant until the 5th or 6th week. If alcohol was used at this time, don’t panic.

The best action is to stop drinking. For more information telephone the Drug Education Network  Inc. local call: 1300 369 319 or www.den.org.au

Alcohol and Other Drug Information Service: 1800 811 994

There  are many health risks associated with tobacco for both you and your baby. Smoking increases your risk of having a miscarriage, a premature  birth or a stillbirth. Babies whose mothers  smoke tend to be small for their age which can also mean poorly  developed organs and frequently have breathing problems.

Your midwife  will ask you about your smoking and alcohol use with each of your visits & can help with strategies to cut down & stop.

Talk to your doctor or midwife for a referral to the Smoking Cessation Service. Alternatively visit www.quittas.org.au or telephone 13 QUIT (13 78 48) for further details.  An Aboriginal Quitline Counsellor is also available

There  is no safe level of illicit drug use in pregnancy and some prescribed and legal medications can also be harmful to the unborn or breastfeeding baby including complimentary  medicines. Many drugs can cross the placenta and harm your child.

In Australia medications are classified into risk categories so it is important that you tell medical or midwifery staff if you are taking any kind of drugs (including over the counter) drinking alcohol or smoking.

It can also be dangerous if a woman  who needs medication stops taking it so get advice prior to any changes.

Babies whose mothers use drugs and alcohol during their pregnancy may have lower intelligence and behavioural problems. These babies often go through withdrawal symptoms and may need to go to the Neonatal Paediatric Intensive Care Unit or Special Care Unit. There is also a risk of stillbirth or premature birth. A premature birth means your baby may not be well developed and have a low birth weight which tends to lead to them being more prone to childhood illnesses. For help/information contact:

• Quitline – 13 78 48 www.quittas.org.au
• Alcohol & Drug Service – 1300 139 641 or www.den.org.au (24hr Help 1800 811 994)