The best pregnancy tips from our Obstetrician for expecting parents
Donna our midwife, sits down to interview Anneleise (Obstetrician and Gynaecologist) about her top tips for expecting parents.
Here is her top tip, right off the bat.
Donna: So Anneleise, you would speak to pregnant people all the time, but what would be the best advice that you could give as soon-to-be mum?
Anneleise: I think just relax, and go with the flow. You know, we try and have a plan in place as much as possible, but sometimes babies make the decisions for us, and sometimes things don’t go according to plan. So we will be there to support you throughout the whole thing and hopefully, we can have a happy mummy and happy baby.
What to talk about in your pregnancy appointments?
Anneleise (Obstetrician and Gynaecologist) discusses what she likes to speak to parents about in her appointments. Particularly with regards to appointments which are +32 weeks.
This is great to get the perspective from clinicians about what they are looking to do for you.
Donna: Right. So getting to the gritty end. They’re coming out. And you know, a lot of women at 32 weeks have done some sort of education or they’re really looking for like, how do these babies come out? And what can I expect and what can I plan for? And so, you know, when to come in? What’s an induction? What can I read? Starts to become the first thing that everyone asks you. You’re at a BBQ. Ohh. So what are you planning with this baby? And you’re like, ohh, I don’t know, healthy baby.
Anneleise: That’s the important thing.
Donna: Yes. Or you hear some people say I’m having an induction, or I’m having a cesarean and they’re all individual choices and they shouldn’t be judged because, you know, it’s your individual need.
Anneleise: Absolutely. I think birth is a very, very individual thing. And most women have been along to antenatal classes or started to do some research and will get a feel for what things are important to them. And I think that it’s really important to discuss those things with your care provider in the last few weeks of pregnancy so that we can all be on the same page and help you to hopefully achieve the sort of birth you want. And some people might have particular concerns that mean that we do things in a certain way or they might be worried about certain things and we can address those issues as well. I really enjoy the last couple of weeks of pregnancy where we’re talking through, OK, what do you want? What can I do that will help this experience be good for you?
Should you get the whooping cough vaccination?
In this video, we discuss the pros and cons of the Whooping Cough vaccination. Donna and Anneleise discuss the impacts on the baby, who should get it and when, the cost and ability to get it.
Very sound advice for all parents.
Donna: A lot of you would have been told that from 28 weeks onward we want you to have a vaccination for whooping cough.
Anneleise: Yeah. So this is a relatively new change in obstetrics that we’ve now got some really great data to show that vaccinating women during pregnancy and towards the end of their pregnancy not only protects the mother and stops the mother from getting whooping cough as the newborn is at home and passing it on but also actually directly helps the newborn.
So the idea behind giving the whooping cough vaccination between 28 and 32 weeks means we’ve got time for placental transfer of antibodies so that they go through the placenta and then the baby is protected for the first six weeks until they can have their own vaccination. Because we know that a lot of the cases of whooping cough are actually because of the people around that baby in the first couple of weeks and so by cocooning them, vaccinating the people around them.
So we recommend vaccination of close contacts as well, which will help to protect the baby somewhat. But we can also give the baby direct protection through the placenta by giving them a vaccination at 30, well between 28 to 32 weeks. And that has actually been very effective at decreasing the rates of whooping cough, which is wonderful and helps to protect them.
Donna: This beautiful little newborn. And we do say even if you have had it before, say you went to Fiji, and you had the whooping cough booster a year before we would generally still encourage another vaccination.
Anneleise: Absolutely. So for pregnant women, it’s in every pregnancy between 28 and 32 weeks or in the third trimester if we’ve missed that time. And the reason is so that we can maximise the antibody transfer because we know that with the whooping cough vaccination that the antibody levels do wear off quite quickly. Often by about three to five years, the amount of antibodies left from your last booster are going to be very, very low. And so we’re just giving this baby the chance to get a maximum boost of antibodies to help protect it in the first couple of weeks.
Donna: Which for any new family they, with terror, think of whooping cough and all of the bugs that are out there for the baby. And this is the one thing we do want to cross through the placenta so that it can keep that little baby protected and the worst case scenario is you get a bit of a red reaction mark on your arm.
Anneleise: Absolutely. Most women do tolerate it very well and it’s government-funded for pregnant women so it doesn’t cost anything to have it done (in Australia). Partners and close contacts do have to pay for their vaccination privately, but we do recommend that all close contacts should be vaccinated every five years if they’re in contact with the baby.
Donna: And I think it’s about $45.00 (AUD) so it’s not hugely expensive and in South Australia especially our councils do a lot of our vaccinations or your GP. So your obstetrician and midwife aren’t going to provide that vaccination. We encourage you to go out and get it in the community or with your GP.
Tips for monitoring your baby's movements during pregnancy
This is a often discussed subject for pregnant mums. There is a lot of information and disinformation about what it means to be tracking your baby’s movements during pregnancy.
In this video, our clinicians discuss what to look for, how to do it, when to be worried and what to do when you are worried.
This is a must-watch for all expecting mums. If you want an in-depth look at ways to prevent stillbirth, click the link to read our blog.
Donna: So baby movements. So we talk a lot about how much should it move. And is it OK if it moves that much? There’s a lot of media on movements which can be so confusing for a mum.
Anneleise: And I think this is something else that’s been changing over the last few years as well. So you know, baby movements are really variable. Some babies will move a lot, some babies don’t move very much, but each baby will have its own pattern. What we know is that changes in that pattern, particularly a reduction in the amount of movements for a baby, can actually give us really valuable clues as to something going on with that baby.
So it is good for all pregnant women to get a feel for what their baby would usually move like. So the types of movements might change throughout the course of the pregnancy as it gets a little bit cramped and stuck in space, but it should still be moving just as often.
So usually the movements will increase to around about 32 weeks and then stabilise after that. But babies do actually move the whole way through. They don’t slow down before labour. It’s not normal for a baby to get very quiet toward the end of pregnancy.
So what we want women to do is, not necessarily count the exact number of movements because they’re all different, but to have a feel for what you would expect for your baby and if you feel that there is a significant decrease in the movements for your baby to contact your healthcare provider that day, doesn’t matter what time of day or night it is, we’re always got someone around in labour ward.
They’ll bring you in and we do a monitor and check the baby and get some more information. A lot of people these days think that having a handheld Doppler at home or something to monitor the baby’s heartbeat is enough. But the problem is that just knowing that your baby has a heartbeat is not necessarily going to reassure us that your baby is well, we still want to be able to check your baby over.
So if you’re worried, if you think that the movements are less compared to usual, most of the time it will be fine. But we would much rather just check everything and have you come in. And it doesn’t matter if you have to come in once or ten times, the idea is that you’re the one that’s looking out for your baby. And if you’re worried, you should come in and get checked and we will always be glad that you did.
Donna: Yes, you’re never a bother. And whichever organisation you’re having your baby in, they’re set up to do a fetal well-being check which will be a trace for a short period of time, and then if you’re a private patient, will contact your obstetrician to get that all checked up.
And we don’t want you to wait until the next day, for the next morning or later that day. If you’re worried we want you to contact us at that time and if there has been a change you’ve probably already been monitoring for some time so don’t feel like you’re putting everyone out.
Because it is quite important to know that little babies don’t just have sleep days. I’ve heard that a lot there. ‘Oh it’s just having a sleepy day and it hasn’t moved at all’. That’s not normal! Babies don’t have a sleepy day. Maybe you’ve had a super busy day and you haven’t felt the baby move because you’re moving. And so when you sit down and rest or it’s a normal moving time and you feel that baby move, that’s reassuring. But if that baby hasn’t moved at it’s normal moving time, then that’s something that we want you to contact us about.
Who to speak to and when?
There are so many clinicians involved in your pregnancy journey. Sometimes it can be difficult to keep track of all of them and their different roles.
In this video, Donna and Anneleise discuss what the different roles are for midwives and obstetricians and who does what.
Very helpful to know when you are looking to advocate for your wants in the healthcare system.
For a more detailed look at all the different roles of clinicians during labour, click the link to read our blog post.
Donna: So say your waters have broken at 2:00 o’clock in the morning, beautiful light pink. You’ve come in, I’ve assessed you and said we’re all good, you’re 4 centimetres and so Annelesie is your doctor and so are you going to come in?
Annelesie: Ohh, look, if everything is fine at 4:00 AM in the middle of the night, not usually. Often hospitals will have the ability to remotely monitor a baby. So at the hospital, I work at we have that option and I can just log in and have a quick look and check that I’m happy with the baby as well. But otherwise, we have our fabulous midwives who are able to interpret what they’re seeing with a CTG trace and let us know if things are completely normal, we would expect it to take some time and we wait and let things happen.
If there are any concerns with the baby, the baby is not coping, or if the midwife is not sure about something, then we would absolutely come in and assess the situation. But if it’s all normal, we wait and let things happen.
Donna: And I guess it’s realizing everybody’s role. So, you know, a midwife’s role normally is with ‘normal’. We’re very good at normal. We understand normal. We can assess abnormal, but we’re not the managers of ‘abnormal’. That’s why we work as a team. So if everything’s going very well, even if you’re a private patient, we’re going to say to the doctor this is what’s happening. She’s going to say, that’s great. Let me know if anything changes.
But you may not see that doctor for a few hours because they can check. We might communicate with them, but they’ll generally come at the end and steal the glory. Coming in and safely transitioning that baby into the world. And we’d say, ‘oh look, it’s time to come in now’.
Annelesie: So the midwife is very much there for supporting you through the labour. They’ll be able to make suggestions on things that you can try, different positions, different things that you can do to try and help move the baby into a better position. They’re great, all those things and they’ll stay with you the whole time and give you lots of support and advice throughout the labour. And then obviously we come in and we deliver the baby because we’ve looked after them for nine months and want to be there.
Donna: And that’s a part of your relationship, you’ve got to know the doctor throughout. And so it’s lovely to see it at the end. But if you’re in a public hospital, in a public setting, a midwife is educated and trained to do the whole shebang if everything’s nice and normal. So if all is very good, you might actually not see a doctor at all. You might have a midwife that does everything.
And so that doesn’t mean that you’re not being monitored or if anything changes that you wouldn’t get that support, but it’s knowing that. That a midwife is trained to do all of that to deliver babies and in a lot of cases to do suturing, put Jelcos in, and do newborn checks.
So if everything is all very normal you might have me the whole time and think when’s the doctor coming? Now the doctor in a public setting is there for the abnormal and it’s generally a doctor that you have never met anyway. And so if I was worried I would say, ‘hey Brenda in room 3 I’m a little bit concerned about’. And then they would come in and offer some opinion and some treatment for that because things have moved from normal to abnormal.
And so as the patient, you don’t need to manage that. Your job is just to do what you’re doing. And that’s why you have health professionals that sit around you to help, to know how things are going.
What to expect and see when your waters break?
When you water’s break, its a very good indication that labour is imminent. But should we call the hospital straight away? And how do you know when your waters have broken?
Anneliese talks about what it looks like when your waters break. (Hint: it’s not always what it looks like in the movies.) What colours your waters should be? And what colours are the reasons for concern? And should you call the hospital, as soon as your waters break?
Donna: We talked about waters breaking and there is a lot of pressure on the cervix in the third trimester. But they’re like, ‘oh, I think pee’d, my pants or my waters broke’ and starting to think, well in some cases, a small amount of cases that can happen a bit earlier, but what colour would we expect the water to be?
Anneliese: Generally the most common report would be either pink or clear. But it can be quite variable. There are some colours that we’re concerned about.
So I guess with ruptured membranes, probably the first thing is that sometimes it’s like the movies and there is a big gush everywhere and it’s very obvious, but sometimes it’s not. And so if you’re experiencing a continued trickle of fluid. You know, if you put a pad on and it’s continuing to come out, then that would make us more concerned with ruptured membranes.
And if in doubt, again, just get checked by your care provider and they’ll be able to assess things for you. But most commonly? The fluid is either a straw colour or clear colour or a pink colour and they’re all normal variations and that’s fine.
The colour that we worry about a little bit more is if the fluid is green or brown, which might be an indication that the baby has passed meconium in utero. So that might be a sign of the baby being concerned or fetal distress. And so we do like to check those situations more closely and more quickly and continue to monitor those babies during labour as well.
Obviously, if it’s bright red, like blood, then we would be concerned about bleeding from either the cervix or the placenta. And so again, that would be a reason we would come in sooner than later and we can check things over.
But generally speaking, if you think you may have broken your waters, we do encourage you to phone the hospital and the advice will be to come in for a check and assess the situation. And depending on the situation, it may be appropriate for you to go back home and wait for things to happen or it may be more appropriate for the labour to be started. But at least that way we can assess things and give you some advice and you know what’s going on
Donna: Because obviously don’t want those waters to be broken for days on end. We’re kind of on a bit of a timeline as well. So we like to you know make sure the baby’s happy and then see some progress from that point forward. But that pressure on the cervix sometimes does release quite a lot of vaginal mucus which is quite watery. And so in some cases, it might not have been that your water’s broke, but either way, we would like to assess and if in doubt, we just we’re going to check.
You’re not being a bother, but obviously green or red are things that we don’t want you to have a good old think about for, you know, four or five hours. We’d like to have some insight into what’s happening, but the pink and the clear or the straw colour are all very normal.
And yes, it’s very rarely like the movies with that torrent of fluid, because the head is normally sitting quite low and acting like a plug. So there’s fluid with the body, but that will come out when the baby is born.
CPR for newborns
This could save some ones life – so you should definitely know how to give CPR to an infant. In fact, there is no point owning a baby monitor unless you know how to revive a new-born.
Laura a first aid instructor from St John’s goes through everything you need to know as a parent about giving CPR to a baby. Hopefully you never need to use it, but better to know and not use it then the alternative.
Donna: The last thing is resources. So there are lots of courses, and books on normal birth and choices.
Anneliese: Yeah, there are a lot of resources for information out there and I think one of the ones that I like to recommend to women who are particularly keen to avoid intervention or epidurals and those sorts of things is a book actually written by an Australian midwife. So it’s called Birth Skills by Juju Sundin. She’s I think in Sydney and she has a wonderful book that talks through all of the different things that you might be able to draw on to help you get through the labour and to prepare and to know what your options are going to be and how you can try and manage things. I think that’s a really, really good resource for anybody who is hoping to avoid an epidural. Or even for women who just want to be able to have the tools in place to be able to help them cope with whatever happens during their labour, regardless of how things go.
Donna: Yes, and knowledge is power, as they say. And sometimes if you’ve been an engineer or a lawyer, should you understand what the body does in labour? Should you just know that? Or is it something maybe that you need to get a little bit more information on to help you to feel comfortable? You don’t have to understand it like we do but just to have an understanding of how all of these things change and why might I feel something.
And there’s another new book by Millie Hill, which is The Positive Birth Book. And we’ll have information again for you to have a look at. And a lot of these resources are about supporting you to understand what’s happening and what can I do about it or what might be helpful rather than a prescriptive process of doing this and then this happens.
Anneliese: Because we just don’t want people to go into a blind. It’s good to have information to know what you can do and the midwives will try and give you as much information as possible while you’re there. But knowing beforehand, OK, these are the things that might work for me, this is what I can ask for, can sometimes be really useful.
Donna: And it’s certainly a different area. And for a lot of people, they may have been healthy and fit their whole life to go into hospital and have monitoring and things happen to them. Is so far from what they’ve experienced that sometimes they might be better prepared if they’ve done some reading. Or they think ‘ohh, Look, I trust Annalise. She knows what she’s doing. So I’m just going to go with that.’
Anneliese: Some people choose to do things that way. That’s fine, but everyone’s different and it’s good to have that information if you need it.
Donna: Absolutely. Ohh, well that was a lot to talk about, wasn’t it?
Anneliese: There’s a lot to do in pregnancy
Donna: There is and just to know those little tidbits of information at this point in your pregnancy so that hopefully this next few months and that birth can be a lot easier and you know where your choices sit and what’s normal as well is important. But thank you Annalise for coming along. That was really helpful. Thank you
Top tips for looking after your baby?
We are glad you asked, because this is exactly what we do. Goldilocks is a next generation baby monitor that tracks your baby’s feeding, sleep, breathing, skin and core temperature.
But we don’t just track, we also provide insights and advice from clinicians (just like those you have seen above) right when you need them.
Click the link to find out more about Goldilocks.
Disclaimer: This article is for general information only and not intended as a substitute for medical advice. All information provided on this website is not intended to diagnose or prescribe. In all health-related matters we recommend consulting with your local healthcare professional