Looking after you, looking after your baby

No one can possibly tell you what it feels like to be pregnant, to give birth to a baby or to become a new parent. These are deeply personal experiences and are different for everyone. It is a time of great change and challenge, often bringing feelings of joy and celebration, and potentially also feelings of worry and anxiety.

Many new and expectant parents worry about how a new baby will fit into their lives, or how they will care for an infant. It’s important to remember that if you’re feeling worried and anxious during this period, you’re not alone and these are common reactions that many new parents have.

In fact, up to one in seven women who are pregnant or have recently given birth experience perinatal depression and anxiety (perinatal refers to the time from when pregnancy begins to the first year after the baby is born). Partners can experience mood problems too, so it is important that you are both well supported during this time.

When you are pregnant or have a baby, there are lots of changes going on, from physical and hormonal changes to big adjustments in your sleeping patterns and daily routine; it might feel like things are out of your control, that there is so much to learn and that sometimes it’s difficult to cope.

The good news is, there are lots of things that can be done to support yourself and/or your partner during this time in your lives.

Signs and symptoms to look out for

The signs and symptoms of perinatal depression and anxiety can vary from person to person and may include:

• Excessive worry or fear that is difficult to control. Often the worry and fears are focused on the health or wellbeing of the baby, or your abilities as a mum
• Losing interest in the things you usually enjoy
• Fear of being alone with your baby
• Feeling low most of the time, or crying for no good reason
• Physical symptoms – such as decreased energy, a change in appetite, difficulty sleeping even when you have the opportunity, increased heart/breathing rate, tight chest and feeling lightheaded
• The development of obsessive or compulsive behaviours; for example, needing to do the same task a number of times when it doesn’t need repeating
• Thoughts of death or suicide

If you feel that your worries, anxiety or low mood are interfering with your health, relationships, daily life or ability to care for yourself or your baby, then it is time to get some help and support.

Getting the right help and advice

Start early! Managing mood symptoms well during pregnancy can make a big difference to how things go when your baby is born.

Your general practitioner (GP) or maternal child health Nurse are both great sources of support. If you are unsure about talking with a doctor or health professional, reach out to a trusted friend, family member or your partner. Remember, if it is urgent, please call Lifeline on 13 11 14.

There are also many pregnancy and parenting websites, blogs and apps available. It’s important to make sure the information that you’re accessing is reliable – pick one or two sources you trust and stick with them.

One such resource is the What Were We Thinking! mobile app. It provides week-by-week information on essential topics to help mums and dads (and anyone supporting them) adjust well to the first six months of life with a baby.

Developed by Jean Hailes and Monash University, the app is adapted from the evidence-based parenting program of the same name. It is free and easy to download, and helps to build your confidence by giving you the knowledge, skills and reassurance to navigate this period.

The app helps you to develop the practical skills for settling babies, such as establishing a Feed-Play-Sleep routine as well as ideas to help you strengthen your partner relationship, such as how to best share the workload and communicate each other’s needs.

Download the What Were We Thinking! app or learn more about perinatal depression and anxiety.

Published with the permission of Jean Hailes for Women’s Health
jeanhailes.org.au
1800 JEAN HAILES (532 642)

BABY GROWTH ULTRASOUND: Growth Scans

This is one of the commonest ultrasound examinations you are likely to undergo during your pregnancy between 20-40 weeks. The main objective is to check on how well your baby is growing.

Medical reasons for this scan include the following:

1. Previous history of small baby
2. Bleeding in pregnancy or abdominal pain
3. Pregnancy with twins
4. Medical problems e.g. gestational diabetes, high blood pressure etc.
5. Reduced baby movements
6. Suspicion of baby measuring too small or too big
7. Abnormal presentations e.g. breech
8. Abnormalities of placenta e.g. location etc.
9. Variety of reasons as observed by doctors and midwives

What should you bring or do:

There are a couple of things that you need to do when coming for this examination. Firstly, bring your referral which will state the reason for the scan. Secondly, if you have any previous ultrasound reports for the current pregnancy please bring these with you for comparison as they will greatly help in the finalising of your report. Lastly, upon arrival, fill the questionnaire very carefully at reception. Remember to fill in the expected date of confinement as this will assist to date your pregnancy.

How is this scan done:

This is an abdominal scan most of the time but can be combined with a transvaginal scan to check on placenta and cervix if requested by your doctor or midwife. A moderately full but comfortable bladder is recommended but depending on age of pregnancy may not be necessary. The scan is performed while you are lying on your back. There is a possibility you may feel faint and sweaty during the scan, if this happens notify the sonographer immediately and this can be promptly managed.

What is examined during this scan:

1. The baby’s heart rate and rhythm
2. Size of baby’s head, tummy and length of the thigh bone. These will help to estimate the baby’s weight.
3. Estimation of amount of fluid around the baby and other behavioural baby patterns e.g. breathing, movements etc.
4. Check blood flow patterns in the umbilical cord and in baby’s brain using Doppler techniques. This gives a clue on wellbeing of placenta.
5. Examination of location of placenta and part of baby that is likely to present at time of birth.
6. Estimate length of cervix.
7. Check for any structural anomaly that may have evolved overtime e.g. in the brain, heart, baby’s tummy, kidneys etc.
8. 3D and 4D pictures can be taken at the end.

Ultrasound Report:

This will summarise the result of the ultrasound examination. Appropriate baby growth occurs when the placenta is functioning well, leading to provision of adequate oxygen and other nutrients to the baby. The final report will show the following:

1. Baby body parts measurements compared to standardised charts.
2. Estimated baby weight which will be compared to baby growth charts that can help to detect any growth anomaly patterns.
3. Baby wellbeing parameters in umbilical cord and brain blood flow patterns.
4. Estimation of fluid around the baby and comments on baby movement patterns.
5. Location of placenta and other placental related concerns.

In summary, a growth scan is a very important ultrasound examination in pregnancy if requested by your doctor or midwife. It helps your healthcare provider in guiding them on how to manage your pregnancy.  Remember the range of normal baby growth is wide, several scans overtime may be needed to determine the trend of growth and ultimately guide management.

PAP SMEAR PROGRAM MAKEOVER

The PAP Smear Program has been around since 1991 and has served us well for the past 26 years. As from 1^st December 2017 our beloved 2 yearly routine PAP Smear will undergo a major makeover. This is a big milestone in cervical cancer screening in Australia. From 1^st December 2017, Australia will change the routine PAP Smear test to a Human Papilloma Virus (HPV) “ruling out” test based program which will detect cervical cancer promoting Human Papilloma Viruses.

This change has been found necessary and is in line with most recent scientific evidence in this area as advised by the Australian Medical Services Advisory Committee. The following recommendations will be observed in this new program:

-All sexually active women regardless of whether they have received HPV vaccination will be screened

-Screening will now start at 25years of age up to 75 years of age

-Screening interval will be 5 years instead of every 2 years

This new program is expected to result in a 30% reduction in the number of new cases of cervical cancer and deaths from the disease. The HPV test (Cervical Screening Test) looks for cancer promoting HPV in cervical specimens. If this test is negative for these viruses, research has shown that it is safe for women to get screened in 5 years’ time. If the test is found positive for these viruses, the lab will proceed with further testing of these specimens.

Women will continue receiving results from their care providers/GPs and results will be kept in the National Cancer Screening Registry. In cases where, HPV is detected and final result is categorized as high risk, a recommendation will be given by the lab. Most of women with this result will be advised to have colposcopy and possibly treatment and follow up.

Please check with your care providers for updates and watch this space carefully if you have existing abnormalities or your PAP test is due.

For more information:

National Cervical Cancer Screening Guidelines 2016 Guidelines http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/about-the-new-test

http://wiki.cancer.org.au/australia/Guidelines: Cervical_ cancer/Screening

Bladder health 101: tips to improve bladder control

We all have one. Yet the health of our bladder isn’t something many of us give much thought to – at least, not until something goes wrong with it!

It’s important to know how to take care of your bladder, and to get the right advice for your age and life stage. Throughout your life, your daily habits and practices can put you in a better position to avoid bladder leakage or loss of bladder control, also known as urinary incontinence.

Here, Jean Hailes’ own bladder guru, continence and pelvic floor physiotherapist Janetta Webb, explains how to treat your bladder well at every life stage.

For young women (and all women needing to know the basics)

Don’t go to the toilet if you don’t need to go. Many girls and young women are taught to empty their bladders before they go out, before long car trips, or when they arrive at their destination. Instead, listen to your body’s messages and pay attention to your natural urges. Your bladder works best when it can tell you when it needs to be emptied, rather than the other way around!

You can’t get an infection from a toilet seat, so please sit down. Your bladder empties itself much better when you are seated and relaxed on the toilet. If you need to, use a disposable toilet seat cover, but don’t get into the habit of hovering over the toilet.

Don’t strain to empty your bladder. When urinating, relax, take your time and let your bladder set the pace.

Any bladder leakage in young women and girls shouldn’t be ignored. If you (or your daughter) get any sort of bladder leakage – for example, when playing sport, laughing, sneezing or jumping on a trampoline – visit your GP and get it treated early.

Bowel health affects bladder health. Being constipated is a common cause of urinary incontinence in girls and young women. Keep your bowels in check by staying hydrated, eating a diet rich in fibre and whole foods (such as fruits, vegetables and wholegrains) and exercising regularly.

How much water should you be drinking? Unless instructed otherwise by your doctor, aim to drink 1.5-2 litres of fluids every day. This includes everything that you drink, not just water. There is no evidence to support that drinking more than this is healthier. If leakage is an issue, switch to decaffeinated coffee and tea.

For pregnant women

Up to half of pregnant women experience urinary incontinence, so special attention needs to be given to your bladder (and urinary system) during this time.

Dedicate a daily session to your pelvic floor. To avoid incontinence in pregnancy, learn how to correctly exercise your pelvic floor muscles (the ‘sling’ of muscles that support the bladder, bowel and womb). Set aside a dedicated time to do your pelvic floor exercises every day, while doing nothing else.

Squeeze at pressure points. Additionally, get into the habit of squeezing your pelvic floor muscles while doing activities that put more pressure on your bladder; for example coughing, sneezing, bending or lifting.

Change is normal. It’s normal for pregnant women to urinate more frequently and to need to use the toilet during the night. But watch out for constipation, which is common during pregnancy (see tips above regarding bowel health and fluid intake).

Don’t ignore pain. Lower back pain or pelvic joint pain during pregnancy can impact your pelvic floor. Seek a referral to a physiotherapist who specifically treats these conditions – find one by visiting the Australian Physiotherapy Association website.

Keeping fit is key. However, make sure it’s pregnancy-appropriate exercise.

For postpartum women

The first few days and weeks after birth are a crucial time for your pelvic floor. While you’re in hospital after the birth, lie down and rest as much as possible. Start your pelvic floor exercises as soon as you can do so comfortably, without any pain.

Get some extra support. Postnatal compression garments give extra support. Additionally, when first using your bowels after giving birth, and in the first few weeks after, support your perineum with your hand.

Exercise caution with heavy loads. Try to avoid lifting anything heavier than your baby in the first six weeks after birth.

Return to a healthy fitness as soon as you are comfortable. One of the best exercises is walking. But if you experience bladder leakage with any exercise (such as jogging or gym workouts), it’s your body telling you that you are not yet ready for that particular form of exercise. Again, seek treatment for leakage early.

A note for breastfeeding mums. Breastfeeding keeps your levels of the hormone oestrogen low. As oestrogen supports bladder control, you will therefore rely even more on good pelvic floor strength.

For menopausal & postmenopausal women

Incontinence issues often arise in menopause. This is due to the falling levels of oestrogen, which can impact bladder control. Incontinence is also more common after gynaecological surgery.

Night-time bladder habits. If you wake during the night because of insomnia or night sweats, don’t just go to the toilet for ‘something to do’, or to help you get back to sleep. Empty your bladder only when needed.

Urinary tract infections are more common in midlife women. This is because of the reduction of oestrogen. Seek advice from your GP.

Tips for healthy ageing

Maintain your levels of fitness. The fitter you are, the better your flexibility, strength and endurance will be. This not only means you’ll be more able to maintain pelvic floor strength, but also helps with the practicalities of making it to the toilet in time.

Get back pain and hip pain treated. Don’t allow pain to limit your mobility.

Learn more about bladder health and urinary continence by visiting the Jean Hailes Bladder & bowel webpages.

Published with the permission of Jean Hailes for Women’s Health
jeanhailes.org.au
1800 JEAN HAILES (532 642)

Just a gentle reminder to our Mothers-to-be, this week is World Breast Feeding Week. It marks the 25^th anniversary of this event. The World Alliance for Breastfeeding Action (WABA) has declared this year’s theme as Sustainable Partnership and the Rule of Law. This event will be held and celebrated in most health facilities that look after pregnant women.

At the start of pregnancy, 9 months or 40 weeks seems like a long time. However, with the dynamics that come and go with pregnancy it passes very quickly and soon the baby arrives with all it’s needs, demands and “attitudes”. Feeding is one of the top needs that a baby comes along with.

The scientific community has clear and conclusive evidence that breastfeeding is the best nutrition for the newborn with lots of benefits to both mother and baby as well as to the economy and environment. For the newborn to maximally benefit from breastfeeding, it should start immediately following birth and continue exclusively till around six months. Introduction of solids can be started between 4 to 6 months of age when the baby is developmentally ready. Let us remind ourselves of the benefits of breastfeeding to both mother and baby:

Advantages of Breastfeeding to Mother:

1. Skin to skin (kangaroo care) promotes bonding/mother-baby attachment, breastfeeding behaviour and latching. Breastfeeding puts the mother in control of nutritional needs of their newborn.
2. Breastfeeding stimulates the release of hormones which promote contraction of the womb, hence less blood loss following delivery. Some of the hormones lead to relaxation and calmness to the mother.
3. Exclusive breastfeeding leads to cessation of periods on average 6 – 8 months offering temporary contraception, however back up methods are recommended as well.
4. Mother has less time off work due to infant illness when she resumes work.
5. Breastfeeding is cheap and convenient.
6. In the long term, the mother has less risk of breast cancer, ovarian cancer, endometrial cancer, coronary heart disease, osteoporosis and obesity.

Advantages of Breastfeeding to Newborn:

1. Breastmilk offers complete,sterile nutrition for the baby. Colostrum has good proteins that are easily digested and absorbed by the body and brain. It helps gut maturation and confers passive immunity to the newborn.
2. Mother’s milk has saturated, unsaturated fats and cholesterol which are easily digested and valuable for brain and nerve development resulting in good cognitive development.
3. Breastfeeding confers protection against various infections such as ear infections, urinary tract infections, gastroenteritis and respiratory infections.
4. It reduces the risk of Sudden Infant Death Syndrome (SIDS) by almost half.
5. It reduces the risk of Type 1 and 2 Diabetes, Coeliac disease, Crohn’s disease and childhood cancers as well as the risk of mental health issues later in life.
6. Breastfeeding can reduce the incidence of allergic disorders and risk of obesity as well.
7. Breastfed babies respond better to vaccines; they also experience less nappy rash, thrush, stomach upsets and constipation.
8. Breastfeeding promotes proper development of jaws and teeth with less cavities.

For those who are politically inclined, breastfeeding is good for the economy as it saves billions of dollars and is good for the environment as there is no waste nor green house gases.

As we celebrate this event, let us remember this sacred activity at the centre of development and growth of humankind. As you go through your pregnancy, if you have any concerns in this area please ask for advice from the midwives and doctors taking care of you. Most facilities have antenatal and postnatal breastfeeding advice and assistance programs in place which are ready to offer help. Dr Anwar Fazal, Chairperson and Director of WABA has put this world initiative very nicely in these words, “world breastfeeding week is a vibrant global movement for action to promote, protect and support breastfeeding by anyone, anywhere and at any time. It expands and connects the power of one with the power of many. Only by working together can we make the change we need”.

Please allow me to kindly remind you to present for your ultrasound examination with a “full bladder” thanks.

This is a common phrase from the receptionist whenever one books for a pregnancy or gynaecological ultrasound examination. What is the medical science behind this simple but sometimes uncomfortable request?

How ultrasound machines function:

Ultrasound equipment generates and receives sound waves. Ultrasound waves are at very high frequency that can’t be heard by the human ear.

Once the ultrasound probe is placed on or in your body, it transmits sound waves through your body. The sound waves travel through your body to organs and structures along their path of transmission. Sound energy and light energy have lots of similarities. Both can be reflected and in the case of sound, giving an echo as a result or it can be refracted leading to a change in transmission path.

Sound waves which are reflected or bounced back (echo) are very important in ultrasound examinations. We rely on the echo to make a diagnosis. The ultrasound machine can amplify and process these echoes and by using a special computer can generate an image of the body part that is getting scanned on a video screen which can be saved e.g. baby parts, uterus, ovaries etc. Once the computer has assessed these echoes it is possible to determine the distance, size, shape and consistency of the target organ.

In summary, an ultrasound machine functions in this cycle of: sound transmission, reception of echoes, analysing and processing of echoes and image display.

What is the Advantage of a Full Bladder:

The primary objective of every examination is to transmit as much sound energy as one can, so that we receive a good echo which may lead to better images. The use of ultrasound gel helps to maximise transmission of sound. Body tissues or organs have their own different inherent tendencies to sound transmission. Fluid filled body cavities have good transmission of sound whereas gas filled organs e.g. bowel and lungs have poor transmission of sound. In fluid filled cavities, there is better transmission and good echoes and in gas filled organs there is poor transmission and weak echoes.

A full bladder helps the sonographer in several ways:

1. Sound transmitted through the bladder results in more sound energy at the target organs e.g. baby, cervix, uterus ovaries etc. This results in good echoes and better, more crisp images on display as the round trip of sound energy has little resistance to transmission.
2. Air is a very strong ultrasound beam reflector. Bowel tends to fill up with intestinal contents and gas. This makes it almost impossible to get good transmission of sound to target organs if bowel is along the pathway as almost all the sound will get reflected before reaching the region of interest. A full bladder helps by pushing bowel out of the pelvis allowing transmission of ultrasound to target organs.
3. Most women have an anteverted (tilted forwards) womb which unfortunately in some cases doesn’t present the ideal angle to the sound transmission pathway. A full bladder tilts the womb backwards hence presenting a more favourable angle to the transmitted sound energy which results in better images.

How much fluid should one take:

Bladder capacity and behaviour varies with individuals. Ideally, drink as much fluid to make your bladder comfortably full. If your bladder is not adequately full or is very full and causing great discomfort, both may impact negatively on the examination.

Depending on the service provider you may not need a full bladder for all examinations. Most early pregnancy ultrasound scans and up to 22-24 weeks will need a full bladder but thereafter possibly not. Gynaecological scans performed using the vaginal approach generally don’t need a full bladder as the ultrasound probe is much closer to the region of interest. When booking for an ultrasound scan, the reception staff will advise you accordingly depending on the indication for the scan on your referral.

At Specialist Ultrasound for Women Blacktown, the care of our patients is very important to us.  That care includes providing excellent patient education, so that you know what is happening at every step of the way.  In addition, we make it as easy as possible to book your scans as well as offering a full range of services, so no need to go elsewhere for more specialised tests.

With your care as our aim, we developed a user-friendly website that you can access via your desktop computer, your iPad or your mobile phone.

Our new website contains information on health conditions and types of scans and tests relating to being pregnant and for women’s gynaecology needs.  This information is easy to understand and to be used as a guide only, it doesn’t replace your doctor’s advice.

In addition, we have created a nifty Pregnancy Calendar to work out the estimated date of when your baby will be due as well as a Scan Calculator, to assist you with dates of when you should have your ultrasound scans during your pregnancy.

There are also a range of 3d and 4d scans of babies in our Scan Gallery.

We hope you will enjoy what our website has to offer.  We look forward to meeting you and assisting you with any of the services we offer, including:

Pregnancy ultrasounds

• 7 week ultrasound
• 1st, 2nd and 3rd trimester ultrasounds
• Pregnancy complications scans
• 3D and 4D imaging

Gynaecology Ultrasounds

• Pelvic Scans
• Infertility tests
• Ectopic pregnancy/miscarriage

Specialised tests

• First trimester screening for aneuploidy followed by counselling of results
• Detailed 18-20 week morphology scan
• Foetal heart echocardiography, Foetal Growth scans and follow up, Foetal Doppler studies
• HYCOSY for Fallopian tube patency and Antral follicle counting
• Sonohysterogram for endometrial cavity pathology
• Chorionic villus sampling and amniocentesis
• Ovarian cancer screening

If you think you may be about to experience ‘double the trouble and twice the pleasure’ then it may be a good idea to learn more about having twins.

The incidence (rate) of multiple pregnancy is rising.  Twin birth rate increased from 19 per 1000 live births in 1980 to 32 per 1000 births in 2006 (ISOUG Guideline 2016). In Australia, twin pregnancies represent 1.4% of all births (Australia Bureau of Statistics, 2013).

Twins are two offspring produced by the same pregnancy. Twins can either be:

• Identical (monozygotic): these comprise one third of twins and the majority (80%) are monochorionic diamniotic (MCDA); these share the same placenta but have different amniotic sacs. Very very few are monochorionic monoamniotic (MCMA); these share a placenta and amniotic sac.
• Non-identical (dizygotic): these comprise two thirds of twins and are referred to as dichorionic diamniotic (DCDA). Non-identical twins carry less risk compared to the identical type.

There are some additional risks to having twins, so it is important to follow your doctor’s instructions for the safe management of your pregnancy, such as:

• Twin pregnancies should have a dating scan between 11 and 13 weeks 6 days of gestation.

• DCDA (non -identical twins): require first trimester screening for chromosomal problems; detailed 18-20 week scan and thereafter scans every 4 weeks.

• MCDA/ (MCMA) – (Identical twins): require first trimester screening for chromosomal problems and then should be scanned every 2 weeks after 16 weeks to detect possible complications.
• Screening for chromosomal problems in twins e.g. Downs Syndrome can be done in the first trimester using maternal age, nuchal translucency (NT) and hormonal blood results.

• Structural anomaly scan should be done at 18-21 weeks.

It can be challenging for parents as more medical investigations are necessary than when you are having one baby.  By listening to advise from midwives and obstetricians and being sure to attend all medical appointments, you may lessen any risks and have a good health outcome, or two healthy outcomes that is!