Whenever you as a woman are concerned. No one knows your body like you! Your GP will also refer you if you have an abnormal pap smear, abnormal uterine bleeding (both pre-, peri- and post-menopausal bleeding), pelvic pain not responding to simple measures, ovarian cysts, abnormalities on pelvic ultrasound, concerns with urinary incontinence or prolapse. These are a few of the issues that may cause concern, but I welcome any gynaecological challenges!
Pap test screening is recommended every two years for women who have ever had intercourse and have an intact cervix, commencing from age 18–20 years (or up to two years after first having sexual intercourse, whichever is later). These recommendations are under review because evidence is challenging some of these current ideas and may change practice as early as 2016. 85% of women in Australia who develop cervical cancer have either not had a Pap test or been inadequately screened in the past 10 years. The introduction of the HPV vaccine as part of the National Immunisation Program (NIP) 2007 may reduce the future incidence of cervical cancer, but everyone should still continue to have their routine pap testing. It is recommended you continue to have Pap smears until 69 years of age.
All forms are safe after individual discussion with a health practitioner. The oral contraceptive pill has many advantages including reducing ovarian cysts, certain types of gynaecological cancer over time and control of menstrual bleeding. Certain reasons why you should not use the pill are varied and need discussion with a doctor, but include hypertension, increased BMI, the combination of being over 35 and smoking, blood clotting disorders and migraines or liver disease. The Mirena is becoming more popular and is a very effective form of contraception in addition to helping with abnormal uterine bleeding in many cases. Progestorone injections and the Implanon are other options. The only method which prevents against STIs and pregnancy are condoms and this is essential to consider.
Ideally, you need to feel as comfortable as you can with seeing someone for a gynaecology appointment. A referral from your GP is essential and you should bring results of any bloods tests or ultrasounds which are relevant. The most important thing though is to come to your appointment with any questions you want to ask and an open mind. Usually, a detailed history is taken and a physical examination is often required.
I have a discharge/it hurts during sex/my vagina looks different….Don’t worry, I have heard it all. Working in this area for ten years means there is very little I have not come across. It can be embarrassing talking to someone about intimate details of your life however it is an important part of your health and you should find someone you feel comfortable with. I am very happy to discuss all issues around gynaecology and look forward to developing an individualized plan with you.
Sexual health is a vital part of every woman’s health. Many disorders of sex are related to gynecological issues that require addressing. Bleeding after intercourse can be an early sign of cervical pre-cancerous or cancerous change, pain during sex can sometimes be related to some conditions eg endometriosis and prolapse/vaginal dryness after menopause can seriously affect your intimacy. I am very happy to discuss issues around sex and feel this is an important part of any woman’s general health and happiness!
Generally, it is recommended you seek assistance after 12 months of unprotected intercourse if you have not managed to conceive. If you are over 35 years, after six months of unprotected intercourse it is advised that you see your doctor. As your first step, you should see your GP, who will then refer you to a gynaecologist for basic investigations and management. If this is unsuccessful, IVF may be recommended. Of course, during any attempt to fall pregnant, I would advise optimisation of both your and your partner’s health, including avoidance of alcohol and recreational drugs, ensuring you are up to date with your vaccinations and adherence to a healthy diet and exercise. It is essential to make sure any medical condition you have is under control. I am happy to consult for pre-pregnancy advice.
A normal pregnancy lasts on average for 40 weeks – two weeks before and two weeks after is completely normal. It is more accurate to discuss milestones in weeks rather than months (this actually means that the normal human gestation lasts for unfortunately ten months rather than the more popular thought of nine months).
There are many medications that are not advised to be taken in pregnancy. This makes it vital to discuss any medications you are taking about their safety in the antenatal period and often in the time before you conceive. On the other hand, many medications are well studied and safe and many are required in order to stabilize a medical condition in pregnancy. I urge anyone with a medical condition who is considering having a baby to have a discussion with their obstetrician prior to embarking on pregnancy. The early weeks are often the most important to a baby’s development. Medications which are well established to be safe in pregnancy include:
Anti-inflammatories are generally not considered safe in pregnancy however aspirin may be used for certain pregnancy-related conditions under the advisement of an obstetrician.
Ensure all foods derived from animals are prepared and cooked thoroughly. Most of the hype around foods and pregnancy comes from the risk of Listeriosis which is a serious condition and can cause miscarriage, stillbirth and preterm delivery. It is advised that you avoid sushi/ sashimi, smoked fish/seafood, pate and deli meats. Anything kept out of the fridge for a while like salads and leftovers, is also best avoided. I have a dietician on site who is available and happy to consult with you about recommended foods in pregnancy. Please also refer to the website www.foodstandards.gov.au for further information.
There is very clear evidence to suggest folic acid taken pre- and post-conceptually helps reduce the incidence of neural tube defects. These are the defects associated with conditions like spina bifida. I advise that you take 500 mcg of folic acid for at least a month prior to conception and or the first 12 weeks of your pregnancy. There are some conditions eg women with diabetes, epilepsy or those with a child previously affected, who I would recommend be on a higher dose of 5mg.
Pregnancy vitamins are readily available at your pharmacy. All have adequate doses of iron, calcium and Blackmores include iodine. If you are unsure, please feel free to discuss with your obstetrician. Some women may need certain additional supplementation.
Being as fit as possible is essential for health in pregnancy, labour and caring for a newborn. Generally, if you have been doing exercise prior to the pregnancy, then it is safe to continue to do so, with a few exceptions. Ideally, it is recommended to keep your heart rate at <140 bpm and avoid becoming very overheated. Certainly, saunas and hot spas are not a good idea. Contact sport after the first trimester is best avoided in order to minimize the risk of abdominal trauma. Low impact sports eg swimming, gentle walking, are useful throughout the whole pregnancy, and can keep you cool in summer. There are certain classes specifically designed for pregnant and postnatal women and yoga and pilates are specific examples of the types of classes available.
Travel is best done in the middle of your pregnancy in order to avoid the risk of miscarriage and risk of preterm labour. Individual airlines have rules about pregnant women flying and you need to check with them to avoid problems on the day however usually women can fly internationally up to 32 weeks and up to 36 weeks for domestic trips. Some airlines require a letter from your doctor to confirm your due date and ensure you have no medical issues.
During the later stages of pregnancy, when the uterus reaches a certain size (from about 28 weeks in most cases), lying flat on your back may compromise the blood supply in the main vessel travelling back to your heart. This means that lying flat on your back can make you feel nauseous, faint, or dizzy. It is worse with multiple pregnancies. Most of the time you will realise that this is an unpleasant sensation and thus move off your back. Ideally, towards the end of pregnancy, lying on your side is the most comfortable and best position. It is not a worry if you have woken up on your back though – we have an innate sense to move, even in our sleep. Certain pillows can be lifesavers during this uncomfortable time!
Yes. Some pregnant women prefer to use foils rather than colour directly onto their scalp to minimize the risk of absorption through their scalp.
Generally this is best avoided however, once or twice for a special occasion will not do any harm. Solariums/tanning beds are definitely not to be used. The skin absorbs any chemicals or solutions applied to it and in pregnancy, if substances are not well studied, they are probably best avoided.
Yes! Dental hygiene becomes even more important during pregnancy. There are clear associations between periodontal (gum) disease and preterm labour. Notify your dentist that you are pregnant (even if you are not showing yet) and they may hold off on any non-essential Xrays, major work or treatments until after the baby is born. Any cosmetic treatment eg teeth whitening, is best avoided until after the pregnancy. Most other treatments used by a dentist, eg pain relief and antibiotics, are safe throughout pregnancy as well.
Generally yes, if you want to. There are some conditions in pregnancy (eg low lying placenta) or recurrent bleeding, where under the advice of a doctor it is recommended that you don’t have intercourse however these are rare. Pregnancy hormones play havoc with a women’s libido – some feel they want more intimacy and others feel they want less. Either is very normal. It is also important to remember that women can feel sick, uncomfortable, tired or unattractive at all stages of pregnancy and this may be a deterrent from engaging in sexual activities.
Average weight gain is about 11-14kg, however there is a wide range of 5-20kg. We no longer weigh women at every visit, however being a healthy weight at the start of the pregnancy improves your chances of a healthy outcome. Women should be encouraged to eat a healthy and nutritious diet and continue a comfortable level of activity and exercise. We would never ask someone to strictly diet or control their calories while pregnant but talking to your doctor about any concerns is important. Sometimes rapid weight gain can be due to other health issues related to the pregnancy.
This is up to you in most cases. It is often a balance between financial incentives and wanting time off with the baby after the birth. Each case is individualised and dependent on many factors, including what type of work you do, how well your pregnancy is and what your family and financial situation involves. There will be times that stopping work earlier than anticipated is recommended. However, generally pregnancy is not an illness and many women choose to work until close to giving birth.
This is different for every different pregnancy. A number of factors contribute. A woman having her first baby will often be 18-22 weeks before she feels definite movement, whereas a women in a subsequent pregnancy, may start to feel movements as early as 14 weeks. Generally, those first movements feel like bowel gas, flutters or little butterflies. The position of your placenta can also delay the first perception of movement, especially if it is on the front wall. A woman’s weight also has an effect, as women who have a larger body mass index (BMI), may be later in feeling their baby’s first movements.
The most important thing to remember about movements is that if you detect a change in your baby’s pattern of movements that you discuss this with your doctor as soon as possible.
These are ‘practice’ contractions which help your uterus prepare for the big birth day. They are defined as being painless tightenings, where your uterus will tighten but not be uncomfortable. I (Dr Skilbeck) have experienced Braxton - Hicks in my time, and found them quite painful! They should not become regular and should not be associated with vaginal loss, leaking fluid or change in movements. They can start reasonably early in the pregnancy, yet some women never report them as an issue. Any concerns about what is normal or abnormal, should be addressed by a midwife or doctor.
Congratulations- you’re pregnant!
Finding out you are pregnant is an exciting and emotional time, but amidst the celebrations there’s some important decisions to be made. One such decision is how you’d like to be cared for throughout your pregnancy.
Public or private care?
It’s important to research as thoroughly as you can as no two mothers and no two births are the same. Choosing where to have your baby can be a difficult decision. You may have picked a hospital based on where you live, where your family and friends gave birth, or where your GP recommended. Similarly, your decision to go with a private obstetrician or through the public system may have been based on whether you have private health insurance, who you believe will give you and your baby the best care, or if you’ll have a room all to yourself following the birth.
Giving birth is unpredictable and decisions are made for the health and well-being of you and your baby, however one of the single best ways to aim for the birth you want, whether you go public or private, is to communicate with your caregiver. Write a birth plan and discuss it before your due date as we each have our own beliefs and values- talk about your ideas, questions and any concerns you may have. Your caregiver can provide you will all the information you need to be well prepared and as informed about birth as possible.
So how do you decide?
In Australia, we’re fortunate enough to have a high standard of healthcare and a wide range of options for expectant mums.
When you are making a decision, it’s important to consider what’s best for you, your baby and your partner. A few important considerations are:
* Where you live (some options may not be available in your area)
* Your health, cultural and life experiences
* Your previous experiences of pregnancy or birth
* Who you’d like to care for you e.g a midwife, your doctor, obstetrician or mixed?
* Affordability, or whether you are a public or privately insured patient
* Access to medical intervention
* Access to all pain relief
Public maternity hospitals in Australia generally provide very good quality care for women during pregnancy, birth and the postnatal period, as well as caring for babies. Women with healthy pregnancies who want to be cared for as a public patient are usually advised to book in at their closest maternity hospital.
It’s handy to know that different models of care are usually available within the hospital such as the Midwife Group Practice (MGP).
If you choose to have your care at a public hospital, fees and expenses are very low if you have a Medicare card. You can choose to have care with very little intervention but will still have access to medical backup if it is needed. You also have access to allied services including dieticians, social workers and physiotherapists. Out-of-hours clinics are often available and many public hospitals generally have facilities for high-risk pregnancies, premature & very sick babies.
It’s important to note that you won’t always see the same doctor or midwife each visit. The doctors or midwives you see when you are pregnant will often not be present at your birth, except in the case of Midwife Group Practice and your choice of a male or female practitioner may not always be available. Public hospitals generally offer shared rooms with 2-4 other women and at peak times, there’s potential overcrowding and women tend to be discharged earlier from a public hospital.
You may choose to be cared for privately by an obstetrician, usually as a private patient you will have your baby in a private hospital but you can also choose to be a private patient in a public hospital- with some exceptions.
Private health funds usually require membership for at least one year before they will cover you for maternity services (alternatively, you can be a self-funded private patient).
If you choose to have your care by an obstetrician in a private hospital, Medicare will cover part of the costs. Charges for a stay in a private hospital are usually covered in part, if not in full, by private health insurance. There’s usually out of pocket fees relating to the planning and management of your pregnancy from your obstetrician and costs for diagnostics, an anaesthetist and paediatrician (if required when in hospital).
There can be exclusion criteria (in relation to pregnancy and labour) for private hospitals such as gestation of your baby. For some it’s before 34-36 weeks and others it’s 32 weeks or a minimum weight. Labouring women, or their babies born before these gestations will usually always be admitted to/transferred out to larger, tertiary level hospitals to continue their care.
Whilst out of pocket costs are usually considered the main disadvantage when choosing private care, your money is generally considered well spent as private hospitals offer private rooms; boutique hotel style accommodation with ensuites, tasty food, Pay TV, bedding for partners to stay, around the clock lactation consultants and near-by parking. Many private hospitals also offer complimentary morning and afternoon tea for family and friends, information sessions such as Meet the Midwives, grandparents course, physiotherapy sessions and ward tours. By opting for private care, you are also able to choose your own obstetrician who ‘fits’ with you and will provide your care throughout your pregnancy, labour and the postnatal period. A private hospital stay is also usually longer than that of a public hospital stay.
Either way, there are lots of reasons people have a preference for one system over the other- whatever they may be. The great thing is that people do have the choice so everyone is catered for.
We wish you all the very best throughout your pregnancy journey!