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Why do doctors talk about 'weeks' instead of months?

A pregnancy is medically calculated to end at 40 weeks after the first day of the last normal menstrual period, although anywhere from 37 to 42 weeks is usually considered normal. Obviously 40 weeks is actually 10 months, but usually works out to about 9 calendar months and one week. When we talk about months, there can be confusion between 5 months (20 weeks) and 5 months (January to May, 17 — 21 weeks). To make sure we all mean the same thing, we stick to weeks. On the same subject, many people say ‘but I actually conceived two weeks after my period, so shouldn’t I be 2 weeks less than you say?’ — we take your point, but medical convention dates a pregnancy from the last period, and that’s just how it is! If you conceived with IVF, we say that 38 weeks from the date of your embryo transfer is your expected due date.

Why did you change my due date after my ultrasound scan?

As the baby develops in the early stages of pregnancy, they are all pretty much the same size. Ultrasound experts have measured many thousands of pregnancies, and have accurate charts which can tell the due date from the length of the baby. When the date given by the ultrasound matches (within a few days or so) the date we worked out from your period, we say that the due date is confirmed. When the date given by the ultrasound varies quite a bit, we usually think that the scan date is probably the correct one. This is because in early pregnancy it is easy for the ultrasonographer to be very accurate. The reason your dates might be wrong can be that bleeding you thought was a period was actually bleeding in the pregnancy, or that for some reason you ovulated at an unusual time in the month. These things don’t usually matter as long as your baby is fine, and remember that babies hardly ever come exactly when they are supposed to, anyway!

How will I know when I am in labour?

Sometimes the onset of labour is preceded by a ‘show’ of old blood mixed with mucous. At first it can be hard to tell the difference between labour pains and Braxton Hicks contractions (‘practice’ contractions which are short and mild and occur periodically from about 32 weeks). Usually labour pains will get stronger, longer and more frequent, although the early phase can take many hours. If you are in doubt it is often helpful to ring your hospital and discuss your pains with a midwife, who will advise you when to go in to the hospital. If you break your waters, with or without contractions, you should ring the hospital and let them know you are coming in to the hospital. You do not need to let me know at this stage — the midwives will do so. le will provide you with more information about this later.

What exercise is safe in pregnancy?

Walking, swimming and special pregnancy ‘aerobics’ and yoga classes are all good exercise. ‘Harder’ exercise such as aerobics, running, tennis, gym etc. may be done with a few provisos – keep the exercise to a ‘moderate’ level only, stop if you are puffed out, have plenty to drink. It is probably wise to avoid sports where you are at risk of a heavy thump to the abdomen – for example volley ball.

Can I dye my hair?

Yes!! Lots of people ask this question!

Can I have a sauna or spa?

Having a sauna can make your inner temperature very high – it is best avoided. A spa is safe, but do not stay in too long or the hot water may make you feel faint and sick.

Is it safe to have sex when I am pregnant?

Yes, although you may feel too tired or uncomfortable to want to. There are a few medical conditions where sex in pregnancy is not advised – I would tell you specifically if this was the case.

When will the baby start kicking?

The baby is probably already kicking, you just can’t feel it! If you are having your first baby you will usually feel it sometime between 18-24 weeks. You will probably feel it earlier if you have had a baby before. It may be one to two months later before your partner can feel the kicks from the outside.

How much weight will I gain?

This is highly variable, and probably has more to do with genetics than how much you are eating. Some women gain very little, most people gain 10-14 kg and a few seem to gain as much as 20-25 kg. Generally, you should aim to follow a normal healthy diet, with plenty of fruit and veggies and grainy foods, some dairy, fish/meat/lentils/beans and eggs, and lesser amounts of fats and goodies. You do not need to eat ‘for two’. If you are very overweight, it is safe to aim for no weight gain, or even a small weight loss.

What supplements should I take in pregnancy?

All pregnant women should take folate (folic acid) in the first half of their pregnancy, regardless of whether they have a high folate diet or not. If your blood tests show you are low in iron or other nutrients, supplements will be advised. Other supplements are only required if your diet is inadequate. Most women who are eating a good diet, as outlined above, do not need a supplement. Some women worry that they are not getting enough vitamins etc. If you are particularly concerned about this, then it is safe to take a supplement such as Blackmore’s pregnancy formula or Elevit.

What medications are safe to take in pregnancy?

In general it is best to avoid all medicines and herbal remedies. There are some medications which are safe for certain conditions, listed in the table below. If you have any concerns about medicines you should not take them before checking with me, or calling the Royal Women’s Hospital on 8345-2000 and asking for the drug information service. Drugs which are safe and that you do not need to check with me first include:

Minor aches and pains, headache etc Panadol
Nausea and vomiting Vitamin B6 (pyridoxine) and ginger, others we may advise you.
Haemorrhoids Ointment such as Rectinol
Constipation Metamucil, fybogel, others we may advise you.
Asthma Ventolin and becotide puffers.
Thrush Canesten cream
Heartburn and indigestion Mylanta, Gaviscon, etc. Others we may advise you.

Of course, if any of the problems seem serious you should report them rather than just treating yourself:

Are there any books about pregnancy you recommend?

There are many good books and websites. A couple I recommend are: Dr Derrick Thompson – ‘The Australian Pregnant Book’ Dr Miriam Stoppard – ‘Conception, Pregnancy and Birth’ Kaz Cooke – ‘Up the Duff’ Robin Barker – ‘Baby Love’

Why is there such a large out of pocket fee for obstetric care?

The Medicare Benefits Schedule (MBS) dictates how much the government and the health insurer will pay for a medical service. These fees were set many years ago, and generally have only increased in line with inflation. They do not take into account the service provided by obstetricians. There is no fee to pay for your obstetrician or her partners to be on call 24 hours a day, every single day of the year, just in case you have an emergency, or go into labour at night or on the weekend. Many surgical operations which take place on planned operating lists during daytime and weekday hours and where the patient goes home the same day have fees well into the thousands, and unfortunately the government has never seen fit to address this imbalance. The second reason there is a large out of pocket fee for obstetric care relates to the indemnity insurance paid by obstetricians. This year it is between $50,000 and $90,000. The out of pocket charge for obstetric care has been calculated carefully to cover our insurance payments, and to compensate us for providing such intensive cover. We hope you think it is good value.