Feeling tired?

A woman's body works exceptionally hard in pregnancy, growing a new little being.

It's no surprise the woman may feel tied through this process!  Virtually every body system undergoes change during pregnancy, both to help grow the baby and also to accommodate the changes that need to take place in pregnancy.  Briefly:

  • The woman's blood volume increases
  • Breasts develop
  • The uterus grows
  • The placenta develops
  • The baby grows and develops
  • Hormones are firing

So it's no surprise that pregnant women are often more tired than usual.

What can be done about tiredness in pregnancy?

The best - and most obvious - thing to do is to rest!  Get as much rest as you can, as often as you can.  Where ever possible, delegate tasks that others can do for you and structure your day so that you are not physically and mentally overwhelmed.  Get to sleep early at night and allow at least 1-2 days per week for a 'sleep-in'.  Afternoon naps may also need to be considered, especially in the first and third trimesters when energy levels are particularly low.  Daily exercise may actually increase energy levels, along with a  healthy and nutritious eating plan.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Birthing Choices

In the blog post below, I am going to go through a few scenarios or care preferences, and suggest a care option that may best suit that individual situation. I am going to assume that there are four options, even though others may be available in a woman's local area.  The options I am going to choose from are:

Private midwifery care (home or hospital birth)

This is a continuity of carer model where a woman is cared for by one chosen midwife from early pregnancy through to birth and the postnatal period until the baby is 6 weeks old.  Where the woman or baby experience complications or risk factors that require a higher level of care, the midwife involves an obstetrician or paediatrician in the care of the woman and / or baby, while the midwife remains the lead care provider and co-ordinator of care.  The midwife orders the necessary tests and scans for the woman and baby, as well as prescribing any necessary routine medications.

Private obstetric care (hospital birth)

This is a continuity of care model where the woman's pregnancy care is provided by one chosen obstetrician.  The labour is attended by hospital midwives who are not known to the woman before labour starts, and the birth is attended by the obstetrician with whom the woman has a relationship.  Postnatal care is provided by hospital midwives who are not known to the woman, with the obstetrician visiting daily and providing a final check at 6 weeks postnatal.  This model of care is available in public and private hospitals.

Shared care: either with a GP or a private midwife

This is where a woman attends a private midwife or her GP through her pregnancy (continuity of carer for pregnancy), however the birth is attended by the hospital midwives and obstetricians at the hospital at which the woman is booked, as a public patient.  Once the woman is discharged from hospital, she may again be cared for by her private midwife or GP. 

Public hospital care

In this model, a woman is cared for entirely by the staff who are employed by the woman's local public hospital.  Generally, the woman attends the antenatal clinic for her pregnancy care, where she is seen by the midwives who are on duty that day.  From one visit to the next, the woman may be seen by different midwives.  Some hospitals have a midwife clinic where it is possible for the woman to be seen by the same midwife for most of her pregnancy (antenatal) appointments.  In labour, the woman is cared for by the midwives and obstetricians who are on duty on the day.  These midwives and obstetricians will not be known to the woman ahead of time, and they work in shifts.  Once the baby is born, the woman moves to the postnatal ward where she is again cared for by midwives she has not met before, who work in shifts. This model of care is absolutely free to Medicare card holders, and in Australia, our public system delivers a very safe standard of care.

I want to build a relationship with the midwife who will be caring for me during birth.

This woman would be best to choose private midwifery care. This is the only model where all of your care is provided by one midwife.

I want to feel prepared, informed and confident as I approach my birth.

This woman would best be cared for with private midwifery care, or with private midwifery shared care.  In both models, midwives work very closely with women, through education, preparation, support and lots of time for questions and discussion.

I want basic care: just a quick check and basic education to be safe.

This woman could be cared for with private obstetric care, shared care or public hospital care.  It might be best suited to a woman who has had a normal, straightforward birth before, who just wants the basics to be safe.

I want to build a firm relationship with the obstetrician who will be present if something goes wrong.

Private obstetric care might be best here, however there are models of collaborative private midwifery / private obstetric care that might also be helpful.

I am planning an elective caesarean.

Probably private obstetric care will be best.  You will get to know your obstetrician well during your pregnancy, and s/he will attend your caesarean.  This is very reassuring care for women planning a caesarean.

I want to have home visits from my midwife after my baby is born.

Private midwifery care would be best for the postnatal aspect of the care.  Pregnancy and labour care may be provided through a different model, such as public hospital or private obstetric.

I am planning a waterbirth / home birth

Private midwifery care again.  Public hospitals generally don't provide homebirth services, and waterbirth rates can be quite low.  Private midwives have the highest rates of homebirth and water birth.

I am planning a VBAC

Private midwifery care will give you the best chance of a VBAC (vaginal birth following a previous caesarean).

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Energy, Food and Fluids in Labour

Eating and drinking are really important in labour.  Labour is an intense physical experience, and our bodies need fuel and fluids for this in the same way that an athlete needs fuel for their workouts.  Eating and drinking in labour will keep up your strength and provide you with energy and hydration.

How much to eat in labour?

In labour, small portions of easily-digestible food is the key.  It's also good to note that when labour is established, contractions come every 3-4 minutes and last for about a minute, therefore food that is very chewy or crunchy will not be as helpful as food that is quick and easy to eat.

Carbohydrates are usually better choices for labour instead of sugary, fatty or fried foods.  In early labour, protein will provide sustained energy for labour.  Scrambled eggs are perfect for early labour, as are omelets.

It's important to eat and drink in labour

Restricting food intake during can cause dehydration and can also cause the body to break down fat.  This can cause nausea, vomiting, lack of energy, exhaustion, a slower labour and possibly lead to fetal distress and greater pain.

Foods that I recommend for labour

  • Fruit
  • Smoothies
  • Yoghurt
  • Stewed fruit
  • Diluted fruit juice
  • Soup
  • Frozen fruit

Drinking in labour

I recommend women drink an additional one-to-two litres of fluid while they are in labour.  Dehydration can set in quickly and can be difficult to reverse without resorting to intravenous fluids (via a drip).

Partners and support people can help by offering a drink after every contraction. Bendy straws are really helpful.

Diluted fruit juice (not orange juice), water and sports drinks, are fine, but cordial and fizzy drinks should be avoided.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Bleeding in early pregnancy

Bleeding in early pregnancy can be a very worrying symptom, but it is surprisingly common.  By definition, bleeding is never normal, and should always be checked by your care provider, even if it just a quick phone call.

Bleeding early in pregnancy may be due to:

  • Hormonal changes in early pregnancy
  • Implantation bleeding (when the fertilised egg implants in the uterus)

If you see your midwife or doctor for bleeding in early pregnancy, depending on the stage of your pregnancy, they may request blood tests to determine your pregnancy hormone levels, and these may be performed a few days apart to assess the rate of change in the hormone levels.  They may also request an ultrasound scan to determine the health  and well-being of the baby and help to determine the cause of the bleeding.  Generally, ultrasounds are performed in pregnancies beyond 6-8 weeks, while blood tests would be performed in pregnancies that are less than 6-7 weeks.  In some cases, your cervix may be examined to ensure that it is closed.

Most of the time, slight bleeding in early pregnancy resolves and is harmless to the baby, however all bleeding should be checked by your midwife or doctor because sometimes bleeding can be a sign of miscarriage; when this occurs, there is usually cramping and heavy bleeding. 

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

 

Booking-in Appointment

The booking-in appointment is your first formal pregnancy care appointment, and is usually also the time of your registering for care with a particular care provider.

The booking-in appointment provides you and your midwife with valuable information that will be useful in planning your care.  The booking appointment books you in (registers you) for maternity care with your midwife.

When?

Women booking for care through this service can book-in any time from 4 weeks, ie as soon as they have a positive home pregnancy test .  Women booking with a private obstetrician typically booked between 8 and 10 weeks, while women booking-in to the public system generally do so between 12 and 20 weeks, depending on the hospital policy.

Ideally, your booking-in appointment should take place as soon as possible, 1) so that you can be assured of a booking and relax into your chosen model of care, and 2) so that you can work with your midwife on preventative measures to keep your pregnancy and baby healthy.  Early pregnancy is a time of laying the foundations of a healthy pregnancy and baby, leading to a healthy and normal birth.

What to expect?

The date of your last period and the length of your cycles. This will help your midwife work out your due date.  Don’t be surprised to find that the estimated due date that your midwife gives you, is different to the one you might have found online: this is because your midwife will be taking into account many more factors than just the date of your past period.  Your midwife may also offer you a dating scan, even if you’re certain of the date of your past period.  Research has shown that when we use a due date generated by an early pregnancy scan, we tend to see fewer inductions for pregnancies that have progressed beyond 41 weeks, compared to if we used menstrual dating.

Previous miscarriages, terminations and births. This is to establish your obstetric history and plan your ongoing care.

Your health history.  This is to help your midwife to identify any health issues that may cause a problem in your pregnancy, or any health issues that your pregnancy may impact.

Your family history. This is because certain screening tests are available for genetic conditions and you may wish to avail yourself of these.

Personal questions.  Your midwife will be interested in you holistically, and this includes emotional and psychological health issues.  Your midwife will ask you about a history of abuse, previous negative medical / hospital experienced, depression, anxiety and so on.  She will also ask if there is any history of domestic violence.

Your occupation: your midwife will ask what type of work you do in order to identify any work factors that may create a risk in your pregnancy.

Where you want to have your baby: private midwives generally offer a choice of birth place, including home and hospital.  It’s perfectly ok to be undecided in the booking appointment.

Tests: your midwife will arrange for you to have some blood tests at the start of your pregnancy to test for rubella, your blood group, hepatitis B, full blood count, a urine test, syphilis and perhaps some other tests if they are needed.  Your midwife will explain each test to you and seek your consent before ordering them.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Heartburn in Pregnancy

Heartburn and indigestion are common in pregnancy, occurring usually in the third trimester.  The hormones of pregnancy that facilitate birth are mainly responsible for heartburn and indigestion, as they tend to relax the oesophagus and allow stomach acid to move upwards towards the oesophagus.  This causes a burning sensation that is experienced as heartburn.

How to minimise heartburn

  • Small, frequent meals can prevent your stomach from becoming too full and potentially regurgitating.
  • Sitting upright for up to an hour after meals: this can assist the food to stay down.
  • Drinking milk: small amounts sipped through the day.
  • Almonds
  • Avoiding spicy, hot foods
  • Avoiding having a large meal in the hours before bedtime: make breakfast and lunch your largest meals.
  • Drinking water throughout the day
  • Avoiding coffee and sugar
  • Peppermint tea
  • Avoiding fizzy drinks

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Private Midwifery Antenatal Shared care

The Private Midwifery Antenatal Shared Care Program has been running now for over two years, providing pregnant women with even more options for their pregnancy care.  Antenatal Shared Care enables women to have their antenatal care with a private midwife.  Private midwifery shared care is provided at no cost to Medicare card holders through this practice. 

The main benefits of private midwifery shared care are:

  • Personalised, comprehensive care
  • Continuity of care means you are seen by one midwife who knows you well
  • On-time appointments: there is no waiting time: we run on time
  • A comprehensive information pack and education program will support you through your pregnancy and new parenting experience

To arrange private midwifery antenatal shared care

Email me to arrange a time for your booking-in appointment. 

What is the cost?

Women accessing shared care through this service must have a Medicare card.  With a Medicare card, this service will result in no cost to you.  Simply make payment at the time of your appointment, and receive the FULL amount back at the Medicare office.

Birth care

Private midwifery antenatal shared care provides pregnancy care.  It does not provide a service for birthing.  Birth care is provided by the skilled and experienced Birth Unit midwives and obstetricians at the hospital where you will give birth.

When will my appointments be held?

You may book-in any time after you have a positive home pregnancy test.  All routine tests and scans can be arranged through this practice.  Many women choose to book-in as soon as they find out they are pregnant - we can even confirm your pregnancy for you.

Following booking-in, we meet every 4 weeks until you are 28 weeks pregnant, then 2-weekly until you are 36 weeks pregnant, and then weekly until birth.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Thrush in pregnancy

Thrush is a very irritating fungal infection that affects the vulva and vagina.  It is very common in pregnancy due to the hormonal changes of pregnancy, and occurs in many pregnant women.  While there are a few things that women can do to minimise or prevent it, once a woman has it, it can be difficult to treat without medication.

Some suggestions for preventing thrush include:

  • Wearing cotton, breatheable underwear
  • Minimising your intake of sugar and sweet foods, including limiting fruit to two pieces per day
  • Avoiding soap and washing with water
  • Avoiding wearing tight jeans
  • Wiping from front to back after using the toilet
  • Eating natural yoghurt

If thrush is a concern, treatment is available over-the-counter from the chemist.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Nausea in pregnancy

Morning sickness (all day sickness ...) is one of the most common symptoms in pregnancy.  It usually begins at around week 6 and resolves by about week 12-14, however for a few women, it remains for the whole pregnancy (and improves after the baby is born, thankfully!)

There is a lot that women can do to relieve morning sickness, and if all else fails, there are some effective and safe medications that can be prescribed by your midwife or doctor.

Some women experience nausea only, while others experience vomiting, too.  Sometimes this is only once or twice a day, however other women have a complication called hyperemesis gravidarum, which is a more severe form of vomiting that often requires hospitalisation for fluids and medications to treat the vomiting and prevent dehydration and electrolyte imbalances.

Nausea in pregnancy is actually a really positive sign, as it indicates high levels of pregnancy hormones that help to sustain and develop a healthy pregnancy.  That said, if you are fortunate to experience no morning sickness, please don't take that to be a bad sign: you probably have other pregnancy symptoms such as bloating, breast and nipple tenderness and tiredness.

Managing morning sickness day-to-day

Morning sickness can be difficult to cope with day-to-day, but there are many things that you can do to make things easier.  Most commonly, extra rest and more frequent, carbohydrate-rich snacks will be very helpful in keeping nausea and vomiting at bay.

Spicy, hot foods will make morning sickness worse, as will large, heavy meals.  Many women cannot eat protein-based foods without an increase in morning sickness, and instead prefer carbohydrate-based foods.  Go with what your body needs.

Vitamin B6 and ginger supplements can also be helpful, as can peppermint tea, homeopathic remedies, acupressure, reflexology and acupuncture.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Carpal tunnel in pregnancy

Carpal tunnel syndrome is a tingly, numb and painful sensation in the wrists and hands that develops usually in the third trimester (28+ weeks).  It is common in pregnancy and occurs when there is swelling around the nerves in the wrist.  Usually, women who have carpal tunnel syndrome will have swelling in their lower legs and feet as well.

Carpal tunnel gets better within 6-12 weeks after the birth of the baby, along with other body swelling. 

If you have carpal tunnel, you may find it difficult to grip things and do anything which requires fine movements of your hands and fingers.  You may find that you drop things easily and that you have lost the strength in your hands and wrists.

I usually recommend that women with carpal tunnel see a chiropractor or osteopath as there is sometimes an underlying skeletal issue that makes the carpal tunnel worsen, and relief can be almost instantaneous with chiropractic or osteopathic care.

There are also exercises that women can do to relieve the sensations.  These include squeezing a small ball, massage of the hands and wrists, and making circular movements of the hands.  These exercises encourage fluid to move away from the hands and wrists. Stretching exercises can also be helpful.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

 

About due dates

Due dates can be calculated using the last normal menstrual period or through ultrasound.  If the last normal menstrual period is being used to calculate the due date, there are a few conditions that must be met for this to be considered an accurate input to the due date:

  1. The last period needs to have been a normal period
  2. The women must have had three normal cycles since ceasing breastfeeding or the oral contraceptive Pill
  3. The last three cycles must have been regular

If these conditions are not met, the date cannot be calculated using the last normal menstrual period, and so the due date would then be based on an early pregnancy scan.

When should an early pregnancy scan be attended?

The earlier the scan, the more accurate the estimate of the due date.  I usually refer women for dating scans at 7 weeks of pregnancy, however they can be performed any time between 7 and 12 weeks for the purposes of dating.  The earlier in pregnancy,  the more accurate the date.  There is very little to be gained from doing a scan prior to seven weeks as there is less chance of the baby having a heart beat, and so a good chance that the scan will need to be repeated.

An early pregnancy scan can be reassuring and exciting for parents.  Studies suggest that when the due date is taken from a good-quality, early pregnancy scan, there are fewer inductions for women going overdue.  In other words, due dates that are derived from dating scans tend to push back the due date when compared with pregnancies that are dating from the last menstrual period.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Your skin during pregnancy

There are many changes that can occur in a woman's skin during pregnancy.  These can include stretch marks, pigmentation of the skin, a brown line on the abdomen and sensitive skin.  We think this is related to the hormonal changes that occur during pregnancy, and hence, most of the changes that occur during pregnancy disappear after the baby is born.

Some skin changes, such as stretch marks and pigmentation, are thought to run in families.  While there are numerous good products on the market for stretch marks, there is a good chance that you will develop stretch marks - despite using these products - if your Mum or sisters had them. 

Nutrition, exercise and good health prior to pregnancy are thought to increase elasticity of the skin during pregnancy and reduce stretch marks.

Chloasma

Chloasma is dark, patchiness of the skin.  It is caused extra melanin in the skin during pregnancy.  Sunblock is recommended to protect your skin.  Chloasma usually resolves 6 weeks - 3 months after the birth of the baby. 

Linea Nigra

Linea nigra is a verical line that appears down the centre of your abdomen, crossing your belly button.  It is a darkened area that occurs due to the hormonal changes in pregnancy, and again, it resolves after the birth of the baby. 

Stretch marks

Stretch marks can appear during pregnancy at any stage, but usually they develop in the third trimester.  The third trimester (28-40 weeks and beyond) is usually the period of time where there is rapid and large weight gain, and so the skin sometimes doesn't have sufficient time to stretch without causing stretch marks.  Normal weight gain in pregnancy is 10 - 14 kg, and the bulk of this weight gain occurs in the third trimester, so you can appreciate that this causes the skin to stretch rapidly.

There is very little that can be done to prevent stretch marks, as they are largely a function of genetics and weight gain in pregnancy.

Women who lead a healthy, active life leading up to pregnancy (ie, good nutrition, exercise and healthy weight) generally have fewer stretch marks.  Limiting weight gain in pregnancy to no more than 10-14kg can also minimise stretch marks.

Good nutrition and sensible exercise during pregnancy, as well as a high-quality stretch mark cream can help to minimise stretch marks.

Sensitive skin

Many women experience sensitive skin during pregnancy, and this can be made worse by using soap.  Some women find that pre-existing skin conditions worsen during pregnancy, while other women experience an improvement in skin conditions in pregnancy.  To minimise sensitive skin, find a soap that does not cause sensitivity and use  good-quality moisturiser after every bath or shower and after washing your hands.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Prenatal Testing

Many women are now choosing the 10-week blood test rather than the 12-week nuchal translucency scan. The 10-week blood test is a new blood test that is a more accurate screening test for chromosomal abnormalities than the NT scan. It is so new that the blood is actually processed overseas …. in the US! The test does not carry a Medicare benefit, so parents are out-of-pocket for the full cost of the test, which is around $500-$600. The results are 99% accurate.

The new blood test reduces the need for amniocentesis / CVS which carry a small risk of miscarriage. The test may be used in place of the NT scan or to confirm a high-risk NT result (without needing an amnio). Additionally, it can be performed from 10 weeks. If the blood test comes back positive, the woman would still be advised to have an amnio as the blood result is not 100% (it is 99%+), but the blood test does reduce the number of amnios needing to be performed. Many women coming through this practice are now opting for this test. 

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Fish in pregnancy

Fish is a really healthy food to eat. It is rich in protein, healthy fat and minerals. It contains the sort of fat that can help to lower bad cholesterol, and increase good cholesterol.

It also contains omega-3 fatty acids which are important for the development of the baby's central nervous system.  Some women have commented that they don't like fish, and have asked if a fish oil supplement is a reasonable alternative.  I think that if it's a supplement or nothing, then a supplement is good, but there's no substitute for the real thing, so where possible, eat fish and avoid the supplements.

Although fish is a great food source, you need to be careful about which fish you choose. Bigger fish, such as shark, eat smaller fish.  They also live longer than smaller fish.  Therefore, over their lifetime, they accumulate more mercury than what a smaller fish would accumulate, and this can be harmful for the developing baby when we eat bigger fish.

Small amounts of salmon or sardines every day is very beneficial to your developing baby.  It does not need to be a large serve; the important thing is to have a steady stream of nutrients and fatty acids to your baby.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Independent childbirth education classes: a midwife's perspective

Women who book with me for care will know that I am a firm advocate of independent childbirth education classes.  Why do I feel that these classes are so important?  It’s not that I believe that women need to be taught how to give birth, because I know that women's bodies are designed to birth babies, and for the most part, women birth their babies without any help from anyone else.  Yet I still believe these classes are important ... vital, even. This is because all pregnancies and births involve choice.

And to exercise our choices responsibly, we need to have knowledge.

It is that simple.

If we do not know what choices we have, we do not have any.

If we are aware of our choices but lack any information about the implications of each path, we may not make responsible choices that lead us to a healthy birth and baby.

We have choices around care providers, place of birth, testing in pregnancy, interventions in birth, type of birth, methods of feeding a baby, postnatal care issues and early parenting choices.

Labour and birth and early parenting are not the times to be learning new information for the very first time: these are times in our lives when we are not in a state to take in new information and assimilate it.  This learning is best done in pregnancy, so that the time we get to labour, birth and baby, we are already aware of our options and our preferred choice.

Independent childbirth education classes cover more than basic hospital classes, in my opinion.  They will teach you everything from late in pregnancy to labour, birth and caring for your new baby.  They will provide all of the content of hospital-based classes and much more: more time, more resources and more attention.

The couples I have worked with over the years have been delighted with the classes they have attended, coming away feeling relaxed and calm, confident and knowledgeable.  They have helped enormously with birth planning and preparing for birth and baby, and with choices and decision-making.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Top tips for a healthy pregnancy

Folate Folate is a B vitamin that is found in food.  Folate helps to produce and maintain new cells - especially important during early pregnancy when the baby is developing.  Folate is found in green, leafy vegetables, citrus fruit, beans and peas.  As well as dietary sources of folate, it is recommended that women take an additional supplement of folate in the form of folic acid.  500 mcg daily is recommended for women from 3 months prior to pregnancy, until three months into the pregnancy.

Alcohol and smoking

Both are best avoided in pregnancy,  Alcohol crosses the placenta and directly affects the baby.  Alcohol can cause miscarriage, premature birth, stillbirth, a small baby and fetal alcohol syndrome.  Smoking reduces the amount of oxygen that is available to your baby, and can cause low birth weight.  As well as this, there are many chemicals present in cigarette smoke that can be harmful to a growing and developing baby.  Smoking can increase the chance of a miscarriage and preterm birth.

Sleep

Rest and sleep are really important in pregnancy.  Early pregnancy, especially, is often a time of tiredness and fatigue, and in general, the first trimester is easier when you are well-rested.  Some women will need an afternoon nap or sleep-ins on the weekend to get through the first trimester.  Likewise, the third trimester is also a time when some extra ZZZZZs are need.

Exercise

Exercise is great during pregnancy!  Any exercise that you have been doing consistently prior to pregnancy is safe during pregnancy, but it is a good idea to run this past your care provider.  Contact sports, high impact exercise and vigorous sports may need to be avoided.  The best exercises are walking and swimming, and some women also like to do pregnancy yoga and pregnancy pilates.  These are both very gentle.

Exercise has numerous benefits to you and to your baby:

  • Maintenance of a healthy weight
  • Reduction in the risk of gestational diabetes and high blood pressure
  • Promotes more restful sleep
  • Stress management
  • Improved sleep
  • More energy to get through your day
  • A shorter labour, perhaps with fewer interventions

Healthy diet

A healthy diet is the foundation of a healthy pregnancy.  A healthy diet can help to prevent gestational diabetes, high blood pressure and obesity.  Every mouthful of food helps to grow a healthy baby.  You want to give your body the best nutrients, frequently throughout the day (ie, several small meals throughout the day), to allow your baby to develop healthily.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Midwifery care after baby arrives

The focus of midwifery care is often thought to be about birth, however, after the birth, the focus rapidly shifts to the brand new baby who has joined the family.   I wanted to share some insights into postnatal midwifery care as an important (and perhaps under-valued) aspect of the care of a woman and her family.

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Once a baby is born, new parents can be thrown into an enormous sense of responsibility, combined with a very steep learning curve. A midwife helps the mother and family make this transition to parenthood. A midwife is there to help with breastfeeding, teach practical baby care and also to provide the necessary checks of mum and baby to ensure that the normal recovery process is underway.

I provide my clients with extensive postnatal care because I know it can be a challenging time for a new family. I visit the new baby and mother at home every day for the first week. After that time, families can choose to see me in my rooms or I visit them in their home. There are two visits in the second week, and then week 3, 4 and finally discharge at week 6.

We do all sorts of things: I attend the baby's newborn screening test (Blood spot test), I check the mother and baby to ensure that they are both recovering, we talk about breastfeeding and ensure that the baby is feeding well, we monitor the baby's output to be sure that the baby is getting sufficient milk for his/her needs, I attend the Vitamin K drops for families who choose to give their babies Vitamin K drops, and we do lots of education about postnatal care, postnatal depression, what to expect with a new baby in the first few weeks, expressing milk, safe sleeping, adjusting to parenthood and so on.

Over time, I have increased the care that I provide to my clients and the feedback from my clients has been that the current visiting schedule has enabled them to feel confident, safe and secure with their new baby. Much of this stems from the extensive preparation that my clients do in their pregnancy, and that most have a drug-free, natural birth. This seems to help with the baby's adaptation to newborn life.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Home birth: how messy is it?

Homebirth generally isn’t messy at all.  Many women birth in a birth pool and any bodily fluids are easily contained.  Towels and plastic sheeting come in handy and are strategically placed to catch any mess.  And midwives are very good at leaving the house as it was found.  Plastic bags collect any garbage, the placenta is collected in a bowl or container, and sheets and towels can be washed.  All in all, a homebirth is nowhere near as messy as people think.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Birth positions

The best positions for birth are usually the positions that are the most comfortable for the woman at the time.  These are usually also the positions that will assist the baby into a good position to be born.  The positions you use will have an effect on your sense of control and how you experience your labour.  Generally, women who are able to move around as they need to, will experience labour more positively and as less painful, than women who are confined to the bed.

Women usually need to move through labour, and from a physiological perspective, this makes sense as the baby needs to make several movements through the mother's pelvis to be born.  So in this way, the mother's movements through labour and birth assist the baby to descend though the pelvis and be born.

There are many positions that women will naturally adopt in labour, such as:

  • Standing
  • Leaning over a bench or couch
  • All fours positions
  • Kneeling positions
  • Walking
  • Lying on your side

Because gravity helps the baby’s head to descend deeply into the pelvis, upright positions are generally better for aiding progress in labour while also reducing pain. This is because upright positions work with the body in labour, rather than against it.

Many women choose to birth in the water because the sensation of being in water combined with the lack of gravity makes them feel more mobile and able to position in the best way possible to help the baby move through the pelvis.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.