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Medicare Rebate


Medicare Rebate


The Federal Government sets Medicare benefits arbitrarily. Over the years the benefit level has not kept up with inflation thereby widening the gap between reasonable fees and benefits. Every medical practice incurs the cost of employing administrative staff, general running expenses such as computers and software, phone, rent, electricity, professional indemnity insurance, accounting fees and medical equipment. The practice costs must all be met entirely from the fee charged but the doctor for the medical services provided.

We encourage you to have an ongoing relationship with your family doctor (GP) and we ask that you obtain a referral from your GP prior to the consultation. If you have a current GP referral then you are able to claim a Medicare rebate. The referral will relate to a specific problem and is valid for 12 months. If you need advice about another problem as well then you are required by Medicare to obtain a separate referral.

For long-term problems and indefinite referral maybe the best option for you. Please discuss this with your GP. Referrals from other specialists are only valid for 3 months.

Mastalgia


Mastaglia


Breast pain is very common and sometimes called Mastalgia. Breasts respond to changes linked with the menstrual cycle.

Helpful Hints to relieve Breast Pain

  • You may need to try several of these ideas before finding whatworks for you. Lifestyle modifications should be tried first before medications.
  • Supportive bra at all times helps to reduce breast movement. The garments should give support without compressions. An overly tight bra will usually make pain worse, and narrow straps should be avoided.

Dietary Intake:

  • Decrease caffeine intake or stop altogether. Caffeine is found in coffee, tea, cola and chocolate.
  • Decrease salt intake.
  • Decrease fat intake.

Stress and Anxiety:

  • Stress is very commonly one of the very significant factors in causing breast pain.

Exercise:

  • Patients who are generally inactive have achieved considerable benefit from commencing a simple exercise program eg. Such as a daily brisk walk for 30 minutes.

Medications:

Evening Primrose Oil – 1000mg, 3 tablets per day available without prescription from your pharmacy, health food shop or supermarket. (Avoid if epileptic). This may be taken as a single dose or in two or three divided does. The active ingredient is GLA. There should be at least 100mg GLA per 1000mg tablet of Evening Primrose Oil. Continue on this dosage for 3 months.

After 3 months on Evening Primrose Oil:

  • If no improvement, cease and consider Vitamin B1.
  • If some, but insufficient improvement, consider adding Vitamin B1.
  • If adequate relief, try 2000mg daily and if appropriate, after a further 6 weeks try 1000mg daily.
  • Maintain whichever is the lowest dosage at which satisfactory pain relief is achieved.

Vitamin B1 –

  • 100mg daily for 6 weeks.
  • If satisfactory relief, continue.
  • If no relief, cease and get a further review by your doctor.
  • If some relief but not adequate, continue and add Evening Primrose Oil.

Nutrition for Pregnancy


Nutrition for Pregnancy


Pregnancy is a time when what you eat and drink becomes even more important. It’s no excuse to eat for two – the food and the nutrients food provides, will help with the baby’s growth and development as well as keeping you in the best possible shape. That’s why you need to focus on eating a variety of nutritious foods, particularly those that pack a strong nutritional punch!

In some instances it will be challenging to meet the nutritional demands of pregnancy without the use of supplements. This is where it is beneficial to consult a dietitian to discuss your individual needs.

Let’s have a look at the nutrients you need to focus on, the foods that you need to eat a little more of, as well as giving you a heads up on what you need a little less of to ensure (as best that we can) the health of you and
your baby.

What nutrients you need more of:

NUTRIENT WHAT DOES IT DO? HOW MUCH? WHERE FROM?
Folate ( Folic Acid – A B group Vitamin) Healthy development of babies in the first trimester. Reduces risk of abnormalities such as Spina Bifida(where baby’s spinal cord doesn’t form properly) At least 400 micrograms daily at least 1 month before conception and 3 months following.
Ask your doctor for advice, especially if you have a family history of neural tube defects.
Green leafy vegetables (bok choy, broccoli, spinach and salad greens)
Some fruits.
Fortified cereal, fruit juice, bread.
Vitamin supplements.
Iron Helps form red blood cells that carry oxygen needed for baby to grow. Much more than when you were not pregnant –27mg.
Absorption of iron is lower in vegetarians so intakes may need to be 80% higher.
Liver, lean(particularly red)meats.
Fortified cereals.
Green leafy vegetables, legumes. (note that iron is less readily absorbed through leafy vegetables, therefore vegetarians may need to consult a dietitian to ensure adequate iron intake).
Calcium Bone mineralisation, nerve and muscle function, Blood Pressure control. 100mg per day.
At least 3 serves of calcium-rich food each day.
Milk, Cheese, Yoghurt or Soy and other non-dairy milks with added calcium.
Vitamin D Bone and Growth Development. Immune system development. 5 micrograms (200IU) per day.
Some studies are suggesting at least 35 micrograms (1400-2000 IU) per day.
Safe sun exposure. Oily Fish. Full dairy diet. Egg Yolk. Fortified foods.
Omega 3 (DHA & EPA) Baby’s brain, eye and central nervous system, development of the growing baby.
In high-risk pregnancies a higher intake of DHA has also been shown to reduce the risk of premature births (less than 34 weeks).
At least 200mg per day. 2-3 serves of oily fish weekly, apart from varieties high in mercury.

What foods should be eaten during pregnancy?


FOOD GROUP NUMBER OF SERVES EACH
DAY
SAMPLE SERVING SIZES
Bread, cereals, rice, pasta & noodles 4-6, at least half should be wholegrain 2 slices of bread
1 medium bread roll
1 cup cooked rice, pasta or noodles
1 & 1/3rd cups of breakfast cereal flakes.
Vegetables and Legumes 5-6 1 sml potato
1 cup salad vegetables
½ cup cooked vegetables
½ cup cooked legumes
Fruit 4 1 medium fresh fruit (apple, pear, orange, banana)
1 small fresh fruit (apricots, plums, kiwi fruit)
Dairy 3-4 250ml milk or yoghurt drink, 200g yoghurt, 2 Slices (40g) cheese
Meat, fish or poultry 1-2 ½ cup lean mince, 2 small chops, ½ cup legumes, 1 small fish fillet, 2 small eggs.
Extra foods 0-2 ½ 2 tbsp cream or mayonnaise, 4 plain sweet biscuits, 1 tbsp oil or margarine, 1 can soft drink.

While pregnant, try to avoid:


Too much caffeine: Caffeine takes longer to break down in the body during pregnancy, and high intakes may increase the risk of miscarriage and your baby having a low birth weight. Caffeine is found in coffee, tea, chocolate, some soft drinks, energy drinks and some medicines.
Aim for no more than:

  • 1 regular espresso style coffee; or
  • 3 cups of instant style coffee; or
  • 4 cups of tea.

Possible food poisoning: As hormone changes may weaken your immune system, avoid Listeria containing foods (mostly chilled, ready to eat foods):

  • Soft cheeses (e.g. ricotta, brie, camembert)
  • Take away chilled cooked chicken (e.g. chicken sandwiches)
  • Cold meats
  • Pre-prepared salads
  • Paté
  • Raw or smoked seafood (e.g. smoked salmon) – canned seafood is safe.
  • When eating out, avoid food served lukewarm choose hot foods only.

Foods and drinks that prevent your body absorbing iron:

  • Too much tea/coffee (especially with meals) and unprocessed bran.
  • Avoid taking iron supplement with a meal containing milk, cheese and yoghurt.

Mercury in fish: Some fish may accumulate levels or mercury that may be unsafe for your baby’s development. Food standards Australia New Zealand (FSANZ) recommends the safe fish intake for pregnant women and women planning pregnancy where 1 serve = 150g:

  • 1 serve per fortnight of shark (flake) or billfish (swordfish/broadbill and marlin) and no other fish that fortnight.
  • OR
  • 1 serve per week or orange roughy (deep sea perch) or catfish and no other fish that week.
  • OR
  • 2-3 serves per week of any other fish and seafood not listed above.

What can help:


Nausea and vomiting:

  • Eat small, frequent, regular meals and have small frequent drinks between meals.
  • Avoid foods if their smell, appearance or taste makes you feel sick.
  • Food has a stronger smell when it is heated, that may make nausea worse. Prepare you food during times that you feel better, or ask others to help with the cooking.
  • Limit fried, fatty and spiced foods.
  • Eat more nutritious foods, such as dry toasts, crackers, breakfast cereals or fruit, and less sugary and fatty foods.

Reflux:

  • East small, regular meals and snacks.
  • Avoid fatty, fried or spicy foods.
  • Separate eating from drinking. Drink in between meals or snacks instead.
  • Avoid tea, coffee, cola drinks, chocolate drinks and alcohol.
  • Sit up straight whilst eating and avoid bending after meals.

Constipation:

  • Have enough fibre (from vegetables, fruit, wholegrains, nuts, seeds and legumes).
  • Keep up your fluid intake.
  • Keep physically active.

Keep weight in check:

Even though obesity negatively affects pregnancy outcomes for both mother and baby, weight loss is safer before or after pregnancy:

  • Try to minimise weight gain during pregnancy if you are overweight or obese; aim to only gain a little in the first trimester, most in the last when the baby gains most weight.
  • Depending on your pre-pregnancy weight, aim to only gain.
  • Between 10-13kg if you are in the healthy weight range.
  • No more than 10kg if your BMI greater than 30.
  • No more than 7kg if your BMI is greater than 40.

Manage your weight by:

  • Exercising throughout your pregnancy, particularly during the first two trimesters.
    Seek advice from your doctor to ensure there are no medical reasons to limit activity – but walking, swimming, low impact exercises and many other activities are safe for most pregnant women.
  • Consulting an accredited practicing dietitian, your doctor or midwife for assistance with weight management.

Keep weight in check:

It is vital to eat healthy, nutritionally – balanced food, and to look after yourself so you can provide the best care for your baby. Producing breast milk increases appetite and nutritional requirements (such as kilojoules, protein, zinc, iodine, omega 3 fatty acids and vitamin B12) for the mother.

  • Limit caffeine to 1 regular expresso style coffee, or 3 cups of instant style coffee or 4 cups of tea a day.
  • Better not to drink alcohol, at least for the first month. If you have a drink, aim for no more than 2 standard drinks a day, and drink after a breastfeed. (it can take more than 3 hours for alcohol from 2 standard drinks to be cleared from breast milk, so try to plan ahead and express some breast milk to feed your baby before you drink).
  • Keep exercising regularly: Choose something you enjoy and can combine with your busy day or with your baby: walking, an exercise DVD or resistance activities.
  • Get enough rest and if you have any problems, ask for help and advice.

Birth after Caesarian Section


Birth after Caesarian Section


50% of women will attempt a VBAC and 50% will be successful.

Factors associated with successful VBAC-a previous vaginal birth, especially previous VBAC, are associated with 87% to 90% BVAC success.

Risk factors associated with unsuccessful VBAC are:

a. Induced labour
b. No previous vaginal birth
c. BMI greater than 30
d. Previous caesarian section for dystocia

When all of these are present successful VBAC is less than 40%.

Other factors associated with a decreased likelihood of VBAC:

a. VABC at or after 41 weeks
b. Birth weight greater than 4kg
c. No epidural anesthesia
d. Previous pre-term caesarian birth
e. Cervical dilatation at admission less than 4cm
f. Less than 2 years from previous caesarian birth
g. Advanced maternal age
h. Non white ethnicity
i. Short stature
j. Male infant

Contra indication to VBAC:

a. Previous uterine rupture
b. Previous high vertical classical caesarian section, 2-9% risk of uterine rupture
c. 3 or more previous caesarian sections.

No significant difference in the rate of uterine rupture in VBAC with 2 or more previous caesars but hysterectomy rate x 3 transfusion requirements x 2.

Specific risks of VBAC:

a. Rupture rate 0.2 – 0.7%
b. No risk of rupture with ERCS, uterine rupture in an unscarred uterus is 0.005 – 0.02%

RISK’S BACV ERCS
Blood Transfusion 10.7% 1%
Endometritis 2.9% 1.8%
Hysterectomy 0.23% 0.30%
Thrombosis 0.04% 0.06%
Maternal Death 17/10 to the five 44/10 to the five

The increased risk of successful verses unsuccessful VBAC.

RISKS UNSUCESSFUL VBAC SUCESSFUL VBAC
Uterine rupture 2.31% 0.11%
Uterine dehiscence 2.0% 0.14%
Hysterectomy 0.46% 0.14%
Transfusion 3.2% 1.2%
Endometritis 7.6% 1.2%

Women considering a planned VBAC have a 2-3 out of 10,000 additional risk of birth related perinatal death when compared to ERCS. This is equivalent to a first delivery.

RISKS VBAC ERCS
Perinatal mortality 0.32% 0.13%
Still birth greater than 37 weeks 0.19% 0.08%
Delivery related perinatal death 0.04% 0.14%
Respiratory distress symptom 2-3% 3-4%

VBAC carries an 8/10,000 risk of baby developing HIE. Approximately 50% of the increased risk is caused by uterine rupture.

The risks of ERCS. There are minimal risks for a 2nd or 3rd caesarian section but risk increases with the number of caesarian sections.

a. Placenta accreta
b. Injury to bladder, bowel or ureter
c. Ileus
d. The need for post operative ventilation
e. ICU admission
f. Hysterectomy
g. Blood transfusion requiring more than 4 units
h. The duration of operative time and hospital stay

Number of previous C/S Hysterectomy Rate Placenta Accreta Accreta with Placenta Previa Bladder Injury Transfusion Requirement
1 0.65% 0.24% 3%
2 0.42% 0.13% 11% 0.3% 7.2%
3 0.9% 0.57% 40% 0.8% 7.9%
4 2.41% 2.13% 61% 14.1%
5 3.49% 2.33% 67% 2.4%
6 or more 8.99% 6.74% 67%

Healthy Pregnant or Postpartum Women


Healthy Pregnant or Postpartum Women


Is it ok to be physically active while I’m pregnant and after I have my baby?

Yes! If you are a healthy pregnant or postpartum woman, physical activity is good for your overall health. For example, moderate-intensity physical activity, such as brisk walking, keeps your heart and lungs healthy during and after pregnancy. Physical activity also helps improve your mood throughout the postpartum period. After you have your baby, exercise helps maintain a healthy weight, and when combined with eating fewer calories helps with weight loss.

Healthy women should get at least 150 minutes per week of moderate-intensity aerobic activity, such as brisk walking, during and after their pregnancy. It is best to spread this activity throughout the week.

Healthy women who already do vigorous-intensity aerobic activity, such as running, or large amounts of activity can continue doing so during and after their pregnancy provided they stay healthy and discuss with their health care provider how and when activity should be adjusted over time.

10 minutes at a time is fine. We know that 150 minutes each week sounds like a lot of time, but you don’t have to do it all at once. Not only is it best to spread your activity out during the week, but you can break it up into smaller chunks of time during the day. As long as you’re doing your activity at a moderate or vigorous effort for at least 10 minutes at a time.

Aren’t there risks involved with physical activity and pregnancy?

According to scientific evidence, the risks of moderate-intensity aerobic activity, such as brick walking, are very low for healthy pregnant women. Physical activity does not increase your chances of low-birth weight, early delivery, or early pregnancy loss. It’s also not likely that the composition or amount of your breast milk or your baby’s growth will be affected by physical activity.

What are some things to keep in mind when I do physical activity during and after my pregnancy?

Unless you have a medical reason to avoid physical activity during or after your pregnancy, you can begin or continue moderate-intensity aerobic activity. If you begin physical activity during your pregnancy, start slowly and increase your amount gradually over time. While pregnant, you should avoid doing any activity that involves lying on your back of that puts you at risk of falling or abdominal injury, such as horseback riding, soccer, or basketball.

First Antenatal Visit


First Antenatal Visit


This is usually the longest consultation that takes place during the pregnancy. Many women will come along with their partner, making this a nice introduction to the start if a 9 month relationship.

Your history is initially taken. Details such as the date of the last period, whether the periods are regular, the number of pregnancies previously etc. are obtained. Any previous obstetric history is discussed and a note is taken of risk factors i.e. previous presence of hypertension or caesarian section. A full medical and family history is also taken, along with smoking, drinking and allergy history.

Obviously this is the time to discuss any present issues with the pregnancy eg. Nausea ore recent bleeding. The first pregnancy especially is a very worrying time and often some fears can be allayed at this stage.

You would then be examined. This usually involved a blood pressure check and cardio vascular examination. A vaginal examination and pap smear will be done if this is necessary and the pregnancy is still early. I then perform an ultrasound either transabdominally or transvaginally to assess the pregnancy, but at this early stage I am only expecting to see a “jelly bean” with a heart beat.

This first consultation takes place between 8-10 weeks, although I will see women earlier if there have been previous medical or fertility issues, or bleeding during this pregnancy.

There are then routine investigations that are organised. Sometimes these have already been organised by the referring GP. The investigations that I like to have performed are:

1 Blood Group and Antibodies. There are a number of different blood groups. Once of these is Rhesus Negative. If you are Rhesus Negative and your baby has Rhesus Positive blood, you may be at a small risk of developing antibodies in your blood, either during the pregnancy or the birth of this baby. This can have potentially damaging outcomes for future pregnancies.

There is an injection that can be given in the event of any bleeding or after birth to help prevent the development of these antibodies. These injections are provided also at 28 and 34 weeks to women who are Rhesus Negative.

2.Full Blood Examination. This is a test to see if you are anemic. Anemia can make you feel very tired. It is often seen in women who are vegetarians, have a poor diet, or have had heavy periods in the past. It does not effect the baby. It is treatable by taking iron supplements.

3.Mid-Stream Urine (MSU). A Urinary Tract Infection does not always need to have symptoms. Infections can produce bladder infections and cause kidney infections and are associated with Anemia and preterm labour. Obviously any symptoms of UTI need to be mentioned during the pregnancy.

4.Serum Folate and B12. Folic acid deficiency is associated with an increased risk of Spina Bifida abnormalities but is very uncommon as most women will take vitamin supplements before conception.

Vitamin B12 deficiency is seen in women with pernicious anemia or malabsorption problems, or in Vegan’s. Vitamin B 12 deficiency can produce neurological problems in the baby and it is also important that it be corrected during the pregnancy.

Vitamin B12 can be provided in tablet form or by injection and is very rarely a problem.

5.Syphilis. Risk of Syphilis a Syphilis infection is very rare but it can have side effects for you and the baby and is treatable by antibiotics.

6.Hepatitis B. Hepatitis B is a virus that can cause liver disease and can be passed onto the baby. The baby is not infected during the pregnancy but can be infected during birth. If it is known that you are a Hepatitis B carrier, the baby can be protected by immunisation soon after birth.

Your Hepatitis B status is also important because it is a blood born infection and can be spread during examinations or delivery.

7.HIV. This is now a routine test for all pregnant women to enable appropriate treatment to the mother and baby during pregnancy and delivery.

8.Varicella (Chicken Pox) Serology. If you do not have immunity to Chicken Pox and are exposed to active disease it is possible to treat you safely by immunoglobulin or acyclovir. This disease is more harmful to the mother and rarely effects the baby.

9.Parvovirus. This is a virus infection that can cause miscarriages and fetal loss in the middle part of the pregnancy. There is no vaccination available but if you do not have immunity, blood tests are repeated monthly until 30 weeks, and appropriate treatment to the baby can be applied if necessary. The overall risk is small.

10.Thyroid Function Test. Thyroid deficiency can produce neurological problems in the baby and need to be treated. An overactive Thyroid may be treated during the pregnancy but uncommonly will affect the fetal development.

11.Serum Screening for Down Syndrome. This is preferably performed at 10 weeks gestation. A simple blood test is taken and checks for 2 pregnancy related hormones.

12.Combined Screening for Down Syndrome. It is usual today to have a blood test taken at 10 weeks gestation checking 2 pregnancy hormones and an ultrasound performed at 12 weeks to assess the nuchal thickness which is the skin fold at the back of the neck. The combination of these results in conjunction with the maternal age, will help predict the risk of having a baby with Down Syndrome and several other chromosome abnormalities. A risk of 1/300 is regarded as high and women who have a higher risk will be offered further testing, after a prolonged discussion.

13.Vitamin D Deficiency. Vitamin D deficiency is very common. The Vitamin is important in the development of strong bones in the baby, and therefore if a mother is Vitamin D deficient she will be recommended to take supplementation. This supplementation is recommened during the breast feeding phase as well. An iron deficiency will cause Anemia. Many women have an inadequate intake of meat and are iron deficient and need supplementation during pregnancy. If this does not occur they can feel very tired and obviously an adequate haemoglobin or blood count is preferable to cope with the blood loss at delivery.

Other tests that will be offered during the pregnancy include:

1.An ultrasound at 19-20 weeks. This is a structural scan and the baby is assessed from head to toe for abnormalities. Sex of the baby may be detected at this ultrasound. I only recommend the use of obstetric ultrasongrapher’s who improve the reliability, but even so can not absolutely guarantee that all fetal problems are detected.

Other factors detected here include the position of the baby, and the position
of the placenta which is obviously crucial if a placenta is low lying.

2.Blood Testa at 26 weeks. At 26 weeks gestation, all women will have further blood tests. These consist of repeating the full blood count, iron studies and may require retesting of Vitamin D, Thyroid function and Parvovirus.

At this stage a Glucose Challenge test will be performed. This blood test measures the amount of sugar in your blood. You will be given a sweet drink and have the blood test taken 1 hour later. You do not need to fast for this blood test. If this blood test in abnormal a longer Glucose Tolerance Test, which takes 3 hours and involves fasting overnight will be necessary. In most cases women who are diagnosed with Diabetes of pregnancy, have minor dietary adjustments and there are no consequences to the mother or baby. Occasionally women will need oral medication of Insulin.

3.36 Week Vaginal Swab. At 36 weeks gestation you will have screening for GBS. This is a common organism found in the vagina which will not harm the mother but can cause health problems in the new born baby. The swab is taken from the lower vagina. If the swab is positive, that is you grow the germ, antibiotics will be provided during labour. Antibiotics are not required before labour starts.

There may be other investigations required during pregnancy, for example, more ultrasounds, more blood tests if you have Hypertension of Diabetes, or if other medical or obstetric problems arise.

Follow up during the pregnancy.

During a first pregnancy the consultations are usually monthly until 28 weeks gestation, fortnightly until 36 weeks gestation and then weekly until the baby is delivered.

A discussion about your expectations of labour will occur between 34 – 36 weeks gestation, although many of these aspects have been discussed prior to this stage. I have a midwife, Maryann, who will discuss labour and breast feeding from a Midwife’s perspective to the management.

Whoping Cough Vaccination

Why should parents have the vaccine?

The number of babies under six months old catching whooping cough has increased dramatically in Victoria over the last 5 years.

Around one in every 200 babies under six months of age who catch Whooping Cough will die. Some babies will suffer permanent disability from brain and lung damage.

Parents and family members are the main source of Whooping Cough infections in babies. Vaccination protects you from catching and passing on the infection to your baby.

Even if you were vaccinated as a child, you may no longer be protected; immunity provided by the vaccine fades after 6 to 10 years.

Partners of pregnant women should get the vaccine before the birth of the baby. Pregnant women should be the vaccination as soon as possible after the birth of the baby.

The vaccin is safe for adults and children including:

  • Breastfeeding mothers
  • People who have had a recent tetanus booster.

What is Whooping Cough?

Whooping Cough, also known as Pertussis, is a highly infectious disease causing a severe, persistent cough. In young babies the cough is often followed by breathing problems and vomiting. Whooping Cough is spread by coughs and sneezes from an infected person.

Severe complications such as Pneumonia, bleeding, convulsions, coma and permanent brain and lung damage can occur.

Why do babies need extra protection against whooping cough?
Babies under six months of age are particularly at risk, as they are not protected against Whooping Cough until their six months vaccination schedule is complete. Infected babies often require admission to hospital. A mother does not pass any protection against Whooping Cough onto her baby whilst pregnant or breastfeeding.

How do I obtain the free vaccine?

Ask your health care provider about getting the free Whooping Cough vaccine called Boostrix, which also contains protection against Diptheria and Tetanus. Some councils may also provide the vaccine. Contact your local council directly or ask you maternal and child health nurse.

Who can receive the vaccine for free?

The vaccine is available free until 30 June 2011 to parents, adoptive parents and foster parents of newborn babies. It is also available free to partners of pregnant women.

Other ways to protect your baby from Whooping Cough.

  • Vaccinate your baby on time.
  • Make sure all your children are up-to-date with Whooping Cough vaccines. Booster doses are required at 4 and 15 years of age.
  • Anyone regularly in contact with your baby (grandparents, childcare and healthcare workers) should be vaccinated.

Where can I get further information about Whooping Cough?

More information is available from:

Pre Conception check


Pre Conception check


Before attempting to conceive it is desirable that all women have a pre-conception check to ensure that cautions are taken to improve the chances for a successful outcome of pregnancy. Usually 3 months before attempting to conceive is adequate, but women with PCOS or endometriosis may need to increase this time because help may be required in achieving a pregnancy.

Either a GP who is interested in women’s health or an Obstetrician Gynaecologist can perform the assessment at this stage.

The rationale behind this consultation is to discuss lifestyle factors that can have an impact on the pregnancy and also ensure that the appropriate pre-pregnancy investigations have been performed.

Smoking

Smoking should definitely be discontinued before a pregnancy. Smoking is associated with an increased risk of fetal mortality, pre-term labour and small growth retarded babies. It also increases the risk of infertility, placental separation, premature rupture of membranes and placenta previa. Of course there are the long term maternal risks such as heart disease, lung disease and an increase in numerous cancers.

It is also known that children who inhale smoke have a higher incidence of SIDS, chronic respiratory conditions, including asthma, Atherosclerosis and middle ear disease. Essentially they grow into unhealthy adults.

Nicotine patches are not recommended during pregnancy but are probably safer than smoking during pregnancy. Ideally smoking should be ceased before the pregnancy is conceived.

Alcohol

It is known that excessive alcohol intake can produce fetal abnormalities, but the exact safe level of alcohol intake during pregnancy has not been determined. Binge drinking has a higher risk than a small amount of alcohol on a regular basis. It is important that women, once they start attempting to conceive, avoid the possibility of binge drinking, especially over the Christmas period, when this seems most likely to happen.

The occasional glass of alcohol, however, is unlikely to cause any problems to the baby, but this can not be guaranteed. I will add that 1 standard drink is 100mls of wine.

There is no exact dose response relationship between the amount of alcohol consumed during the prenatal period and the extent of damage caused by the alcohol and the infant, abstinence is recommended.

Diet

Obviously a healthy diet will help grow a healthy baby. It is recommended that women taken pregnancy vitamins for 3 months prior to conception. There are a range of these on the market and it is important to choose 1 with Iodine. For example: Elevit with Iodine, Blackmores Gold with Iodine, Pregnacare with Iodine.

Folic acid deficiency has been shown to increase the risk of Spina Bifida and related abnormalities, and the addition of folic acid either by folic acid tablets alone or in the multi vitamins, can significantly reduce this risk.

The makers of Elevit claim a reduced risk of miscarriage.

Another issue to be concerned about is ones BMI.

Underweight women who have a BMI of less than 18.5 have an increased risk of spontaneous preterm birth. Small babies (less than 2500 grams), and have increased risk of perineal tearing during labour. Women who have a raised BMI, however, have an increased risk of gestational diabetes, hypertension during pregnancy, the need for induction of labour, caesarian section and large babies. There is also an increased risk of fertility issues, often because a raised BMI is associated with the presence of PCOS.

A sensible eating plan should be commenced before conceiving and should be incorporated with exercise. It is possible, of course, to continue this eating program during a pregnancy to help minimise the risks.

Medical Conditions

Medical conditions such as Thyroid Disease, Auto Immune Diseases, Hypertension and Heart Disease need to be discussed and medications evaluated before conception occurs. It is vital to ensure that these drugs are safe during pregnancy and, if the preconception assessment occurs in time, there is time to change to safer medications if necessary.

Some blood tests are best performed before pregnancy. These include Rubella (German Measles) and Varicella (Chicken Pox). An infection with German Measles during the first 12 weeks of pregnancy can produce significant fetal abnormalities including deafness and blindness. A Chicken Pox infection during pregnancy can cause the mother to become very unwell with the risk to the baby being significantly less.

There are vaccinations for both of these viral infections but they need to be given 3 months before conception occurs.

Blood Group

It is also good to know your blood group before conceiving in the event of an early miscarriage. If the woman is rhesus negative she may require an Anti-D injection to protect against future pregnancy problems.
Cystic Fibrosis

Another test that we are now doing is for Cystic Fibrosis. Cystic Fibrosis is a genetic condition that occurs in approximately 1/25 people in the community who are carriers of the abnormal gene. There is a 1/625 chance of 2 carriers conceiving together and that couple has a ¼ chance of having an infected baby.

Cystic Fibrosis causes major lung problems, malabsorption and pancreatic damage and is often associated with a shortened life span.

There is a test available to check the presence of the carrier state so that appropriate advice can be provided if necessary. This is a test that only needs to be performed on the mother in one pregnancy in most circumstances.

Pap Smear

It is always advisable to check on a pap smear during a preconception check. If a pap smear is taken during pregnancy it often shows low grade changes that can be worrying but are usually not significant and therefore it is desirable to avoid taking a pap smear when pregnant.

The preconception check is also a time to discuss period regularity, whether there are signs of ovulation, period pain or other symptoms that could suggest that there may be factors that could hinder conception. A preconception check is one way of making sure that everything is in order before a baby is conceived.

Baby Information


Baby Information


Baby’s skin

Welcoming a baby into the world is an exhilarating and exciting time filled with the first experiences for parents and baby alike – the first bath, first outing and that first magical smile. Another first, the amount of washing – becoming an almost daily routine.

Dress for comfort.

When washing clothes and linen ensure that a reputable washing powder is used to give the best protection for baby’s delicate skin.

New baby clothes often retain the chemicals left over from the manufacturing process, so it is recommended to wash all new baby clothes and linens before use to remove any of these potentially irritating dyes and chemicals.

As baby’s skin is so delicate, avoid dressing your baby in fabrics that could irritate skin, such as wool or nylon. Avoid clothing with tight cuffs, elastic that goes all the way around arms or legs and exposed zippers close to your baby’s neck.

Soft and safe.

Soft toys become a part of family life from the day you bring your baby home, right up until school. More will arrive for birthday’s and Christmas, or even just from a weekly visit from grandma! These toys make wonderful friends, playmates and comforters for young children, but without proper care, they can also put your child’s health at risk, as the dust mites they carry can be potential asthma triggers.

Regular laundering of washable toys is an effective, yet simple and inexpensive method of helping to remove common triggers such as allergens from dust mites and pets.

Regular laundering of washable toys is an effective, yet simple and inexpensive method of helping to remove common triggers such as allergens from dust mites and pets.

Loving touch

Experts recommend skin-on-skin contact as a way to soothe upset or stressed babies. Bath time is a wonderful chance for parents to give their child close one-on-one contact. After bath time, gently pat dry with a very soft towel. Sometimes giving your baby a massage with a gentle cream that is recommended for baby use, can also give that wonderful one-on-one contact between parent and baby. It’s a good idea to dry your baby’s towel in a clothes dryer if possible, as this leaves the towel softer than if it was dried on the washing line.