Babies often use their movements as a sign to alert us that something may not be right for them on the inside. You should start feeling your baby move between 18-22 weeks of your pregnancy, and by 28 weeks you will notice that your baby has developed its own pattern of movements. Every baby has a different pattern of waking and sleeping so it is helpful if you stay tuned in to your baby’s movements during waking hours.
Your baby’s pattern of movement will remain the same for your baby until birth – it is not true that babies move less as you get closer to your due date. You should feel the same pattern of movements for your baby right up until labour starts and during labour too.
Your midwife or doctor will ask you about your movements at each visit however if you feel there has been a change in the normal pattern (i.e. a change in the frequency or intensity) please contact Maternity Assessment Unit (MAU) or the Maternity Unit at the moment you are concerned, do not wait to report this change at your next appointment.
At your booking in visit your midwife will ask you if you would like an antenatal appointment with our lactation consultant. This helps to prepare you for breastfeeding and answer any questions you have regarding breastfeeding. You can also discuss antenatal expression with them and they can provide you with a kit.
Good nutrition during pregnancy is important for both you and your baby. However, as your body changes during pregnancy, you may experience some problems like morning sickness, food cravings and/or aversions, constipation or heartburn. Fortunately, there are some simple diet and lifestyle changes that can often relieve these symptoms and help you optimize the nutritional quality of your diet during this vital time.
Most women experience backache at some stage during their pregnancy. The causes include altered posture as the baby grows and hormonal changes leading to loosening of ligaments and greater water retention in the tissues. Backache is often worse at night contributing to sleeping difficulties, especially during the later stages of pregnancy.
To prevent and relieve back pain:
Pregnancy hormones can slow down the muscles in the bowel causing constipation in some women.
It will help to:
Laxatives should be avoided until discussed with your doctor or midwife. Constipation can sometimes be caused by taking iron tablets – ask your doctor if you can change to a different type.
Muscle cramps in the foot, leg or thigh are very common during pregnancy, especially at night. The cause of cramps is unclear. Results of studies have shown that calcium supplements fail to show improvement or relief of cramps.
To help relieve muscle spasm/cramp massage and stretch the affected limb or muscle during the cramp.
Some pregnant women will experience feeling faint. You’re most likely to feel faint if you get up quickly from a chair or hot bath or if you stand for too long. Lie or sit down at the first sign of faintness. In late pregnancy, lying on your back can make you feel faint; you will feel better to turn onto your side. Contact your doctor or midwife if you have frequent dizziness or fainting.
Some women experience food cravings during pregnancy. We don’t really understand the reason for this but, interestingly, the cravings are often for foods that we seem to need, such as milk (we need more calcium during pregnancy), or tomatoes and oranges (vitamin C requirements double during pregnancy). Some women may crave non-food items such as chalk or clay.
Women sometimes find that foods taste different or they ‘go off’ certain foods such as tea, coffee and meat. This usually settles down as the pregnancy progresses so if you have found it difficult to eat particular foods that are important for your diet, you may like to try them again later in the pregnancy.
In early pregnancy, frequent urination is caused by hormonal changes, but in later pregnancy it can be related to the increasing size of the baby pressing on your bladder. You may find it more difficult to empty your bladder completely in late pregnancy. In the last few weeks of pregnancy you may ‘leak’ some urine when you cough, sneeze or lift something. You can discuss pelvic floor exercises with your midwife or doctor. Any pain or scalding when you pass urine may mean you have an infection, so see your doctor.
These are swollen veins around the rectum and anus (back passage) that may itch, ache or feel sore. Piles may bleed a little and make going to the toilet uncomfortable. They can be triggered by constipation and or pressure from the baby’s head.
It may help to:
Heartburn is quite common during pregnancy and can be triggered by hormonal changes as well as the growing baby pressing on your stomach. Heartburn is a burning feeling in your chest, accompanied by a bitter taste of fluid in the mouth.
Things to try:
‘Morning sickness’ can occur at any time of the day. The cause is unknown although it has been linked to changes in the levels of various hormones during pregnancy. It usually starts at about the sixth week of pregnancy and settles by about the fourteenth week. Some women will not be affected by morning sickness, but in others it can be so bad they have to be hospitalised.
Generally the baby is unaffected by morning sickness unless your symptoms are severe and prolonged. However, it is probably a good idea to see a health professional if you were not eating well before pregnancy, you have lost a lot of weight quickly, you are dehydrated or you are worried about your health and how you are feeling.
The following tips may help you:
Eighty percent of pregnant women will experience swelling of this kind. There is extra fluid in the tissues of your body during pregnancy and some of it collects in your legs, particularly at the end of the pregnancy. If you stand for long periods of time, especially in hot weather, this fluid can cause swelling in the ankles and feet. It is more noticeable towards the end of the day and usually goes down at night while you sleep.
Tell your doctor or midwife if:
To relieve swelling:
Swelling may be a symptom of high blood pressure or pre-eclampsia.
Most pregnant women experience difficulty sleeping in late pregnancy. At this stage, sleep is easily disturbed by visits to the toilet, heartburn, a kick from the baby or a feeling of discomfort lying down. Some women may experience disturbing dreams or nightmares in the last couple of months, which can be due to anxiety about approaching childbirth and parenthood.
Good sleep tips to try:
Almost all women have increased vaginal discharge during pregnancy. If the discharge smells unpleasant, causes soreness, itching or is discoloured, you may have a vaginal infection. The most common infection is thrush. It is important to see your doctor so treatment can be commenced.
Physical activity advice during pregnancy – Australian Government, Department of Health
Exercise in pregnancy – The Royal Women’s Hospital
Exercise in pregnancy – The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Pregnancy exercise – Sports Medicine Australia
Pregnancy and exercise – Continence Foundation of Australia
You Doctor and Midwife will start measuring your fundal height from around 24 weeks gestation. Fundal height is a vertical (up and down) measurement of your belly. It’s the distance from the pubic bone to the top of your womb (uterus). They continue to measure it each visit to ensure that your baby is growing adequately. If they are concerned at any stage regarding your fundal height or your babies growth they may order a growth scan to check the growth of the baby. There are some conditions that place a women at higher risk and therefore they will have these growth scans ordered regardless of the fundal height just to be safe.
The OGTT tests for diabetes which can occur during pregnancy at approx. 28 weeks or earlier if you have risk factors. The OGTT requires fasting for 12 hours beforehand and takes 2 hours to complete. If you are diagnosed with GDM, you will be referred to a South West Healthcare dietician and diabetic educator for additional care and information about diet, exercise and how to test your blood sugar levels during pregnancy.
OGTT Preparation (please note this information is specific to South West Healthcare)
Gestational diabetes fact sheet – Baker Institute
Gestational diabetes – Diabetes Australia
There are several immunisations that are recommended to be given during each pregnancy including fluvax, boostrix and COVID vaccination due to the antibodies that can pass to your baby through the placenta. For more information please see the links below
Immunisation for pregnancy – Australian Government, Department of Health and Aged Care
Having a baby – NSW Government
Pregnancy brochure from Health Translations
When you are pregnant, your body needs more vitamins and minerals. Below is a list of the vitamins and minerals you need or you need to be mindful of during pregnancy.
Calcium is needed for the development of your baby’s bones and teeth. If you calcium intake is low, calcium will be drawn from your own bones increasing your risk of osteoporosis later in life. Most calcium intakes comes from dairy products. If you cannot eat calcium products, look for calcium enriched for products in the supermarket. Fish with edible bones, such as canned salmon and sardines, are also a good source. There are small amounts of calcium in other foods, but on average about three-quarters of our calcium comes from dairy foods. If you drink soy or other milks, such as almond or rice milk, check the label and choose a brand with the same amount of calcium as cow’s milk (at least 100mg per 100ml). Low fat dairy foods are not lower in calcium than the full fat versions.
The recommended daily calcium intake for pregnant women is 1,000mg.
Folic acid (also called folate) is essential for blood formation and for the building of body cells. It is especially important around the time of conception and in the first trimester to help prevent some types of birth defects. Taking enough folate substantially reduces the risk of neural tube defects (e.g. spina bifida) in your baby. It is difficult to get enough folic acid from food alone; start a daily supplement of 400 micrograms (mcg or μg) when planning a pregnancy and continue it for the first three months of your pregnancy.
Folate is important throughout pregnancy for the normal development of your baby so eat foods rich in folate such as; green leafy vegetables, salad greens, fruit, wholegrain breads and cereals, fortified breakfast cereals, legumes and nuts.
Iodine is needed for normal brain development in the baby. The need for iodine increases during pregnancy, but it can be difficult to get enough as most foods in Australia are fairly low in this mineral. Seafood, dairy foods, iodized salt and iodine added to bread flour help meet the needs of most of the population but this may still not be enough for pregnant women. A
daily supplement which contains 150mcg of iodine is recommended. Most pregnancy multivitamins contain this dose. Supplements are also available that contain both iodine and folic acid. Kelp tablets are not recommended as they may contain too much iodine which can be harmful.
Iron is needed to make red blood cells for you and your baby. During pregnancy your blood volume increases and the baby’s blood tissue is also being formed, so your requirement for iron increases. Lack of iron can lead to low iron stores, tiredness and eventually anaemia. The doctor will check your iron levels (FBE and Ferritin) when you first initially have bloods. Again at 28 weeks and 36 weeks and again at other times if there are concerns that your levels are low. A full blood count checks for general health and can indicate the presence of anaemia. Making the extra blood cells during your pregnancy requires plenty of iron, vitamin B12 and folate to make all the extra haemoglobin needed. Your iron (ferritin) levels will also be checked and supplements recommended if necessary.
The best sources of iron are lean red meat, chicken and fish. Other sources include legumes, wholegrain breads and cereals, dark green leafy vegetable, nuts and eggs.
If your levels are low your doctor will suggest commencing an additional iron supplement.
Iron in pregnancy – The Royal Women’s Hospital
Omega 3 fatty acids are needed for development of the baby’s brain and nervous tissue. Oily fish (E.g. salmon, sardines and tuna are a good source. Having 2-3 services of finish is recommended per week.
Limit certain types of fish (shark/flake or swordfish/broadbill/marlin and orange roughly/deep sea perch) due to their possibility of higher mercury levels.
Smaller amounts of these fatty acids are also found in walnuts, spinach, soybeans, linseeds and canola.
Protein requirements are higher during pregnancy. Most women in Australia eat generous amounts of protein so don’t need to increase their intake if they are eating meat and dairy (or their alternatives) regularly.
Large amount of vitamin A can be harmful to your developing baby. Liver is a rich source of iron, but it is also very high in vitamin A.
If you eat liver, limit is to a small amount (50g per week).
Vitamin B12 is needed for blood cell, nerve and the brain development of the baby. It is found in all animal products including milk and eggs. Plants do not contain this vitamin. Pregnancy and breastfeeding can rapidly deplete body stores. Women at risk should have their level checked and may need to take a supplement. If you are concerned please discuss this with your dietitian or doctor. As this vitamin is naturally present only in foods of animal origin, vegans and vegetarians who eat few dairy foods or eggs are particularly at risk of vitamin B12 deficiency. Certain brands of soy milk and meat substitutes have added-B12 but the amount may not be enough if few other sources of B12 are eaten.
Vitamin D helps the body absorb and use calcium. It is needed for strong bones, muscles and overall health. It is mostly made in the skin by the action of sunlight, but a small amount comes from food (oily fish, egg yolks, margarine, vitamin D-fortified milk). If you have darker skin, cover most of your body in clothing or spend most of your time indoors, you are at risk of vitamin D deficiency.
In Australia, it is advised that all women, regardless of their skin colour, sun exposure and any other risk factors for vitamin D deficiency, to take at least 400units of vitamin D daily during pregnancy and continued for at least 6 weeks after baby is born.
Vitamin D deficiency can cause bone weakness and muscle pain in women and if severe, skeletal abnormalities (called rickets) in their babies.
Most newborns do not receive enough Vitamin D from their mothers during pregnancy, from sunlight or through their diet. Therefore, it is recommended that all babies are given a vitamin D supplement.
Vitamin D in Pregnancy – The Royal Women’s Hospital
Ideally the best way to meet the increased nutrient requirements of pregnancy is with a balanced diet, however if you are unable to eat well, a pregnancy multivitamin supplement can be beneficial. A multivitamin supplement can also be a convenient way of getting enough folic acid and iodine if you are not taking these supplements.
Check that any supplements you are taking are suitable for pregnancy. Ask your pharmacist, doctor or dietitian for advice.
Eating well during pregnancy is important for you and your baby. Pregnancy increases you need for many nutrients such as protein, calcium, iron and certain vitamins. Only a small rise in additional calories is needed. It is therefore important to look at the quality of the food you eat and serving sizes.
Planning regular meals by using a food group guide will ensure variety and help you to meet most of your nutritional requirements. If you often skip meals you may find it difficult to eat well and get enough nutrients.
Eating well during pregnancy for your baby’s health and development – Australian Government, Department of Health
Healthy eating when you’re pregnant or breastfeeding – eatforhealth.gov.au Australian Government, Department of Health
Food safety during pregnancy – The Royal Women’s Hospital
Healthy eating when you’re pregnant – The Royal Women’s Hospital
Healthy eating when you’re pregnant: Information for vegetarians and vegans – The Royal Women’s Hospital
Healthy eating when you’re pregnant with twins – The Royal Women’s Hospital
Not drinking alcohol is the safest option.
Tea and coffee contain caffeine. These are safe to drink in moderation, for example, one to three coffees (depending on strength) or up to five cups of tea per day. Energy drinks can contain large amounts or caffeine or guarana (source of caffeine) so should be limited.
Fish is a good source of omega 3 fatty acids which are needed for brain and nervous tissue development in the baby. One to three serves a week are recommended. However, some fish may contain high levels of mercury so intake of these fish should be limited. Limit shark (flake), marlin, broadbill or swordfish to no more than one serve per fortnight and orange roughy (deep sea perch) or catfish to one serve per week and eat no other fish that week.
Pregnant women should avoid foods that may contain listeria bacteria such as sandwich meats, soft cheeses (brie, camembert, ricotta, feta and blue cheese), soft serve ice-cream, pate, pre-prepared salads, smoked salmon, uncooked seafood and pre-cooked prawns. Freshly cooked seafood is safe. Listeria is killed by cooking food to boiling point, so, when reheating foods, make sure they are steaming hot.
Limit liver to 50g a week as it can contain more than the recommended levels of vitamin A (retinol) for pregnant women.
Raw meat and cats’ faeces can carry toxoplasmosis infection. Thoroughly cook meat, wear rubber gloves if handling cat litter and wash hands after gardening or handling pets. Avoid undercooked eggs and meat to limit risk of salmonella food poisoning, which in rare cases can affect the baby.
There are things we can do to help encourage your baby to go into the ideal position for birth before labour begins. The ‘occiput anterior’ position with the babies head down, facing your back allows for easier descent and rotation through the pelvis during birth. The link below provides information on positions you can do to help make space in your pelvis for your baby to get in this ideal position.
A woman’s pelvic floor muscles support the bladder, bowel and uterus (womb). The urethra (urine tube), anus (back passage) and vagina all pass through the pelvic floor muscles.
Expecting a baby – National Continence Program
Pelvic floor muscle exercises for women – National Continence Program
We encourage and support women who are planning to have a vaginal birth to commence perineal massage from 35 weeks of pregnancy.
Please do not perform perineal massage if you have any of the following conditions:
If you have not experienced any of these conditions you may perform perineal massage from 35 weeks of pregnancy.
What is perineal massage? – Youtube video
Please note: Although this video states perineal massage may be performed from 32 weeks, current research states that it is not necessary to perform perineal massage at this gestation and that optimal benefit is obtained if commenced at 35 weeks of pregnancy.
Perineal tears: What you need to know during pregnancy – Australian Commission on Safety and Quality in Health Care
Third and fourth degree perineal tears – Australian Commission on Safety and Quality in Health Care
Perineal tears: How to reduce the risk – Australian Commission on Safety and Quality in Health Care
Perineal tears: How to get better – Australian Commission on Safety and Quality in Health Care
If you smoke, the best thing you can do is to stop.
Stopping at any time in pregnancy will help, though the sooner the better. SWH offers lots of support to help women stop smoking in pregnancy – your midwife, GP or pharmacist can advise you. Passive smoking (breathing in smoke from other people’s cigarettes) is also harmful in pregnancy, so avoid being around people who are smoking if you can. If your partner or someone else in your household smokes, they can contact Quitline services for support in quitting.
South West Healthcare Smoking Cessation Clinic
Visit the clinic at Warrnambool Community Health, Koroit Street
Phone: 5563 4000 Fax: 5563 1699
Monday 12:30 – 5.00pm
Wednesday 10.00am – 1.45pm
Thursday: 8.30am – 1.00pm
There is no cost to attend the Smoking Cessation Clinic.
Quit for you – Quit for two (Phone App)
The app is FREE and can be downloaded from either iTunes App Store or Google Play.
It is also recommended that from 28 weeks, women should sleep on their side for optimal blood flow to their baby. Please see links below for more info
Research shows that going to sleep on your side from 28 weeks of pregnancy halves your risk of stillbirth (The Royal and Australian College of Obstetrics and Gynaecology, [RANZCOG], 2019)
Women are advised to settle to sleep on their side for any episode of sleep, including:
Please let your midwife or doctor know if you are concerned about your sleep position.
If you are pregnant and wish to travel, you must consult with your doctor( either your GP or Obstetrician) to check there are no medical reasons to prevent you from flying and what vaccinations are required. This is especially important if your pregnancy is high risk or you have an increased risk of developing clots in the legs, also known as deep vein thrombosis (DVT). In general, the best time to travel in pregnancy is during the second trimester, between 14 and 28 weeks of pregnancy.
Important considerations before you travel
My last birth was a caesarean – What are my options? – The Royal Women’s Hospital
Venous thromboembolism (VTE) is when blood clot forms in a vein, most commonly in the deep veins of the legs or pelvis. These blood clots may break loose and then block the pulmonary artery in the lung or one of the lung’s branches.
In pregnancy and the postpartum period, VTE is uncommon (1-2 per 1000) but important for us to monitor, as it is the most common cause of maternal mortality in Australia. Several factors may also increase a pregnant woman’s risk for a blood clot:
Every woman’s VTE risk status is assessed during the antenatal period and updated postnatally as required.
Know the signs and symptoms of blood clots
A blood clot occurring in the legs, arms or pelvis is called deep vein thrombosis (DVT). Signs and symptoms of a DVT include
A blood clot in the legs or arms can break off and travel to the lungs. This is called a pulmonary embolism (PE), and can be life threatening. Signs and symptoms of a PE include
Seek immediate medical attention if you experience any of these signs or symptoms.
Preventing Venous Thromoboembolism (VTE)
Non- pharmacological prevention:
Why your weight matters during pregnancy – The Royal Australian and New Zealand College of Obstetricians and Gynaecologist
Pregnancy is a time to focus on the health and wellbeing of you and your developing baby. Looking after yourself both physically and emotionally is very important. Spending time reading information may help you to make healthy choices and increase your chances of a healthy pregnancy.
There are some things you can do to take care of yourself and your baby during pregnancy:
There is no reason why you can’t keep working if your pregnancy is straightforward with no complications. You need to consider the type of work you do, and speak to your doctor if you are concerned that it may impact on your health or the health of your baby. Your doctor may need to provide advice in writing for your employer regarding the type of work you are required to do. If your employer is concerned about your health they may request a ‘fit for work’ medical certificate.
Many women prefer to keep the pregnancy private until around 12-14 weeks. It is a good idea to tell your employer that you are pregnant before he/she starts to guess or hears it from someone else, but you have no legal requirement to inform them unless your employment contract requires this. Your employer however cannot asses the health and safety risks for your pregnancy unless they have been informed of the pregnancy. If you intend to take maternity leave, you are required to give ten weeks’ notice.