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04/01/2023

Baby movements during pregnancy
An exciting landmark of pregnancy is when you first feel the sensation of your baby move. These movements are a sign that your baby is healthy and well.

Every baby is unique, it is important for you to get to know your baby’s individual movement pattern. At any point, if you are concerned about your babies movement pattern, please contact your midwife or doctor immediately. Do not wait until the next day.

When will I feel my baby moving?
You will start to feel your baby moving between 16 and 24 weeks of pregnancy. The location of your placenta will not affect this sensation. It is more common for women having their second or subsequent pregnancies to feel their baby move earlier.

If you have not felt your baby move by 24 weeks, you should contact your doctor or midwife.

What will my baby’s movement feel like?
The type of movement you feel will depend on what your baby is doing and their stage of growth and development. Each baby is different, with some more active than others.

The first sensations you feel may be a fluttering (like 'butterflies in your tummy'), swishing, rolling or tumbling sensation or a tiny kick. These early sensations are often called ‘quickening’. As your pregnancy progresses, the movements will become more distinct, and you will more easily feel their kicks, jabbing and elbowing.

How often should I feel my baby moving?
There is no set number of movements you should feel. As you start to feel your baby's movements more consistently, usually by 24 to 28 weeks of pregnancy, you will get to know what a normal pattern of movement is for you and your baby. You should then consistently feel your baby's movements right up until they are born and even during labour.

Babies tend to move more at certain times of day – they may be more active while you sleep, and sleep while you’re awake. Usually, unborn babies sleep for 20-40 minutes cycles (occasionally up to 90 minutes), and they don’t move when they’re asleep.

Should I track my baby’s movement?
There are no set number of movements a baby should have, so counting kicks or recording on a chart is no longer recommended.

It is important to make time regularly each day to notice your babies’ movements. If you are busy or not paying attention it can be easy to miss this very important signal from your baby. If you are busy or working, it may be helpful to set reminders for yourself to check in with your baby.

03/01/2023

Alcohol and pregnancy
How much alcohol is safe to drink when pregnant?
In Australia, drinking alcohol is very common. It is often linked to social and cultural activities.

Australia has guidelines to help lower the health risks from drinking alcohol. These include advice for people who are pregnant, planning a pregnancy, and breastfeeding. They can help you to make an informed decision about how much alcohol you drink.

The guidelines advise that pregnant women should not drink alcohol. This is to stop your unborn baby being harmed by alcohol.

When you drink alcohol, so does your unborn baby. Alcohol passes from your blood through the placenta and to your unborn baby. The placenta cannot stop the alcohol from reaching your baby.

When you are pregnant, there is:

no safe time to drink
no safe amount to drink
no safe type of alcohol to drink
Alcohol can harm your baby at any point during your pregnancy.

What effects does alcohol have on my unborn baby?
Drinking alcohol while pregnant can increase your chance of:

miscarriage
stillbirth
premature birth
fetal alcohol spectrum disorder (FASD)
FASD is the term used to describe the effects on the baby from drinking alcohol during pregnancy.

The effects of FASD are life-long. People with FASD often need support with:

motor skills
physical health
learning
memory
attention
communication
emotional regulations
social skills
What should I do if I drank alcohol before knowing I was pregnant?
You might have drunk alcohol before you knew you were pregnant. The risk from low level drinking before you knew you were pregnant is likely to be low.

If you are concerned, speak to your doctor or midwife. You can also call NOFASD Australia on 1800 860 613 for confidential information or support.

Once you know you are pregnant, it’s safest to stop drinking.

What if I’m planning to become pregnant?
If you’re planning to become pregnant, not drinking is the safest choice for both parents. There is still a lot we don’t know about how alcohol affects s***m.

What if I’m breastfeeding?
If you’re breastfeeding your baby, not drinking is the safest choice.

When you drink, the alcohol moves from your blood into your breastmilk. It takes about 30 to 60 minutes for this to happen.

A few factors affect how much alcohol gets into your breastmilk, including:

the alcohol you are drinking (strength and amount)
what you’ve eaten
how much you weigh
how quickly you are drinking
It takes about 2 hours for an average woman to be free of alcohol from one standard drink.

If you choose to have an occasional drink, you can plan to protect your baby. You may wish to breastfeed your baby before having an alcoholic drink.

The Australian Breastfeeding Association has a Feed Safe app to help you understand when your breastmilk is free of alcohol.

How can I avoid alcohol during my pregnancy?
It can be hard to avoid alcohol in social situations, particularly when others might not know you’re pregnant. A good alternative is to have a non-alcoholic drink.

If you don’t want people to know that you are pregnant, you might also find it helpful to say:

No thanks, I’m on a health kick and have given up alcohol.
No thanks, I have to drive.
No thanks, I have a big day tomorrow.
If you’re happy to tell people that you are pregnant you can just say:

No thanks, not while I’m pregnant.

02/01/2023

Birthmarks
Birthmarks are coloured marks that are visible on the skin. They are often present at birth or develop soon afterwards.

There are several different types of birthmark and some of them are very common.

The 2 main types of birthmark are vascular birthmarks (often red, pink, purple or blue) caused by abnormal blood vessels in or under the skin and pigmented birthmarks (usually brown or tan coloured) caused by clusters of pigment cells.

Vascular birthmarks usually occur in the head and neck area, mainly on the face. However, both types of birthmark can appear anywhere, including inside the body.

Vascular birthmarks
Some of the most common types of vascular birthmarks are described below.

Salmon patch (stork mark) — red or pink flat patches that can appear on a baby's eyelids, neck or forehead at birth. They are the most common type of vascular birthmark and occur in around half of all babies. Most will fade away within a few months but salmon patches on the forehead may take up to 4 or more years to disappear. Patches on the back of the neck often last. They are often more noticeable when a baby cries.
Infantile haemangioma — a raised mark on the skin that is usually red and can appear anywhere on the body. These are also known as 'strawberry birthmarks'. Sometimes they are deeper in the skin, in which case the skin can look blue or purple. Haemangiomas are also common, especially in girls, and affect every 2 to 4 in 100 babies by 6 weeks of age. They increase in size rapidly for the first 6 months but will eventually shrink and usually disappear by around 4 or 5 years of age. Very bulky haemangiomas, those that rapidly increase in size and those that get in the way of vision, breathing or feeding, may need treatment.
Port wine stain — red or purple flat marks that affect around 3 in 1000 newborn babies. They can vary in size, from a few millimetres to several centimetres in diameter. Port wine stains often occur on one side of the body and usually appear on the face, chest and back, although they can appear anywhere. Port wine stains tend to be sensitive to hormones and may become more noticeable around puberty, pregnancy and menopause. Most are permanent and may deepen in colour over time.
Pigmented birthmarks
Some of the most common types of pigmented birthmarks are described below.

Café-au-lait spots — coffee-coloured skin patches. Many children have 1 or 2 of these, but if more than 6 have developed by the time the child is 5, see your doctor as it could be a sign of neurofibromatosis.
Mongolian spots — blue-grey or bruised-looking birthmarks which are present at birth. They are more commonly seen in darker skinned people and usually appear over the lower back or buttocks, but can also appear elsewhere on the body or limbs. They may last for months or years, but usually disappear by the age of 4. They are completely harmless and do not need treatment. They may be mistaken for a bruise.
Congenital melanocytic naevi (CMN) — also known as 'congenital moles'. These are relatively large brown or black moles that are present at birth. They are fairly common and are caused by an overgrowth of pigment cells in the skin. Most CMN become proportionally smaller and less obvious with time, although they may darken during puberty or become bumpy or hairy. They can range in size from less than 1.5cm to more than 20cm in diameter. The risk of CMN developing into skin cancer is low, but this risk increases with the size of the CMN.
What causes birthmarks?
It is not understood exactly why birthmarks occur, but they are not usually inherited. Vascular birthmarks are caused by abnormal blood vessels in or under the skin, while pigmented birthmarks are caused by clusters of pigment cells.

It is thought that port wine stains occur because the nerves that control the widening or narrowing of the capillaries (tiny blood vessels) do not function properly, or there are not enough of them. This means that blood is constantly supplied to the skin in that area, which makes it permanently red or purple in colour.

Port wine stains are sometimes related to other conditions, such as Sturge-Weber syndrome and Klippel-Trenaunay syndrome.

Is treatment needed for birthmarks?
Most birthmarks are harmless and do not need to be treated for medical reasons although some people seek treatment for cosmetic reasons. Some types of birthmark will fade over time whereas other types, such as port wine stains, are permanent if they are not treated. In some cases, a birthmark will need to be treated for medical reasons, for example if a haemangioma blocks the airways, affects vision or feeding or becomes ulcerated.

Laser therapy is the best available treatment available for port wine stains. It destroys the blood vessels that make up the birthmark without injuring the skin on top.

01/01/2023

Breastfeeding and cancer treatment
Cancer treatments can affect many areas of your life. If you are pregnant or a mother of young children, there are extra challenges. For example, cancer treatment can affect your ability to breastfeed safely and effectively. However, your medical team will be able to support and advise you at this time.

How can cancer treatment affect breastfeeding?
Cancer treatment can affect breastfeeding in several ways. You may need to have radiation therapy or take strong medicines — including chemotherapy — which can cross into your breast milk and are harmful to babies. If you have breast cancer, you may need surgery on one or both breasts, which can affect their ability to produce milk.

You might only need to take medicines for a short time —for example, before certain scans or during surgery — but the medicines can also be passed on to your baby through your breast milk.

Every case of cancer is treated differently, but your doctor will support and advise you on whether it is safe to start or continue breastfeeding.

Can I breastfeed safely if I need to have surgery for cancer?
If you have surgery while you are breastfeeding, you may need to have an anaesthetics or other medicines. If you are breastfeeding, your doctor might be able to choose a different medicine from the one normally used — so long as the alternative medicine is safer for your baby. You can usually continue to breastfeed as soon as you wake after surgery, but you should check with your doctor before you return to breastfeeding, just to be sure.

You could also consider expressing breast milk before your surgery. Just make sure the hospital is prepared and that the milk is safely stored.

Can I breastfeed safely while receiving ongoing cancer treatment?
Many people who have cancer need treatment with x-rays (known as radiotherapy) or strong medicines (chemotherapy) which kill fast-growing cells, such as cancer cells. These treatments can stay in your blood for some time after you take them and they can also cross into your breast milk. Since these medicines are very strong, they can be harmful for babies even in small amounts. Your doctor may advise you not to breastfeed while you are taking them.

Can I breastfeed safely if I am being treated for breast cancer?
If you have breast cancer, the type of treatment you need will affect whether you can breastfeed safely. Some women need only minor breast surgery to remove the cancer, an operation known as a lumpectomy. If this applies to you, you will most likely be able to start or continue breastfeeding — check with your doctor first though.

Other women who need to have a breast partially or completely removed due to cancer may find it harder to produce enough milk to breastfeed exclusively, though many women successfully breastfeed using only one breast.

If you need to have radiotherapy, chemotherapy or treatment with other anti-cancer medicines following surgery, it is unlikely you will be able to breastfeed safely. However, you should discuss your options with your doctor.

How can I feed my baby if I am unable to breastfeed?
While breast milk is the best option for babies, there are many good alternatives available. You can be confident that all infant formulas sold in Australia will meet your baby’s nutritional needs. If your baby has specific nutritional needs due to a medical condition — such as being born prematurely — you might like to discuss the options with their paediatrician.

Many Australian hospitals follow the ‘Baby Friendly Hospital Initiative’ and so may not provide baby formula in the hospital. If you know you will need to start bottle feeding straight after your baby is born, you may wish to bring your own supplies to the hospital with you.

I feel disappointed that I am unable to breastfeed my baby. What can I do?
It is natural to feel a sense of loss and disappointment if you had planned to breastfeed your baby. Managing these feelings can be even more challenging when you are already coping with the ups and downs of cancer treatment. Discussing how you feel with people you trust can help you work through these emotions. There are also many other ways you can develop a strong bond with your baby — even if you cannot breastfeed.

If your feelings of disappointment do not improve over time, or they interfere with your daily life and your relationship with your baby, you may wish to discuss them with your doctor or a mental health professional.

31/12/2022

Birth injury (to the baby)
What is birth injury?
Having a baby in Australia is very safe, although it’s estimated that more than 1,000 babies are injured during childbirth each year. It can be very upsetting if your baby has been injured, but most birth injuries are only temporary.

Also called 'neonatal birth trauma', birth injury to a newborn baby can include many things, from bruising to nerve damage to a broken bone. Sometimes an injury occurs as a result of life-saving procedures.

About 49 in every 10,000 babies born in Australian hospitals suffer a birth injury. Here are some of the types of birth injury affecting babies.

Bruises and swelling of the scalp
Sometimes a baby can be born with minor, temporary injuries to their head or face. These include bruises, swelling (sometimes called a chignon), lumps caused by fluid under the skin (caput succedaneum) or bleeding under the skin (cephalohematomas), and blood inside the eye (subconjunctival haemorrhage).

Fractures
Fractures (breaks) can occur when there is difficulty getting a baby through the birth canal. The bone that most often breaks is the collarbone (clavicle), and this can happen when the baby's shoulder gets stuck (shoulder dystocia), or if the baby is born breech (bottom first).

Nerve damage
Nerves can be damaged during childbirth, particularly in the baby's face (which can lead to facial paralysis) and the shoulder (which can lead to brachial palsy — loss of arm movement). Usually, nerve damage in a newborn is only temporary.

Brain injury
In very rare cases, a baby can suffer a brain injury during childbirth. If the baby doesn’t get enough oxygen for a long time during labour (perinatal asphyxia), they can experience brain damage. Cerebral palsy is a type of brain damage, but only a very small percentage of cerebral palsy cases is due to complications at birth.

Bleeding on the brain
In rare cases, a baby can suffer bleeding in or around the brain during childbirth. This is more common among very premature babies, and most infants with bleeding don't have symptoms. Others may be lethargic, have difficulty feeding and/or have seizures.

What causes birth injury?
Birth injuries can occur simply because of the pressure and resistance involved in giving birth vaginally. When the baby moves through the birth canal, there's pressure on its skull and body from the mother's pelvic bones.

Large birth weight (more than 4kg) can increase the risk of injury during childbirth. There is also a greater risk if the baby is in a difficult position for labour and birth (such as the breech position). Premature babies born before 37 weeks are typically more fragile and may be injured more easily.

Other causes of birth injury to a baby include a difficult or prolonged labour, the shoulder becoming stuck in the birth canal and cephalopelvic disproportion (if the mother's pelvis isn't large enough or shaped in a way that allows for a vaginal birth).

Babies born with the assistance of forceps or ventouse (vacuum) are at higher risk of bruising, marks or swelling on the baby's head or face.

Lack of oxygen to the baby during birth could be caused by a number of things, such as problems with the umbilical cord, serious events in the mother such as haemorrhage or fever during labour, uterine rupture or abruption of the placenta (when it comes away from the uterus prematurely).

How are birth injury in babies treated?
Most birth injuries in babies are temporary. If the injury was to the soft tissue, then no treatment is normally needed — the medical team will just monitor the baby and may run tests to check for other injuries.

If there has been a fracture, your baby may need an x-ray or other imaging. The limb may need to be immobilised and some babies may need surgery.

If your baby has damaged nerves, the medical team will monitor them closely and recovery can take a few weeks. For more serious nerve damage, your baby may need special care.

31/12/2022

Breastfeeding while pregnant
You can carry on breastfeeding while you’re pregnant with your next child, without causing any harm to your toddler or your unborn baby. Here’s what you need to know if you decide to breastfeed while pregnant.
Is it safe to breastfeed while pregnant?
You might choose to breastfeed through your next pregnancy for several reasons. For example, you might unexpectedly fall pregnant while your first baby is still young (it is possible to fall pregnant while breastfeeding, even if your periods haven’t come back). Or you might not be ready to wean your toddler yet (weaning usually happens any time between birth and age 3).

Whatever the reason, it is usually perfectly safe to breastfeed while pregnant. Your body will carry on producing enough milk to nourish your older child, while your unborn baby will get all the nutrients they need from your body.

Breastfeeding does trigger mild contractions. These are safe in uncomplicated pregnancies, but if you are at risk of preterm labour — for example, if you are expecting twins or more, or if you have had a miscarriage or preterm birth in the past — then seek advice from your doctor or midwife.

Looking after your first child
Your breastmilk will still provide your first child with the nutrients they need. However, you are likely to produce less milk as your pregnancy progresses. Also, the content of your milk will change as you start to produce colostrum, and it might taste different. These changes might lead your older child to wean themselves at some point during your pregnancy. This often happens around the 5-month mark.

Colostrum is a natural laxative, so your older child’s poo might be more liquid than normal. This is nothing to worry about.

If your older child is less than 1 year of age when you fall pregnant, keep a close watch to make sure they’re putting on enough weight after your milk changes. You may need to introduce extra feeds if they are still relying on breastmilk for their nutrition. Talk to your maternal child health nurse for advice.

How to look after yourself
Breastfeeding while pregnant can make your breasts sore and your ni***es tender. You might find you are even more tired or experience worse morning sickness than you normally would during pregnancy.

These side effects are due to your pregnancy hormones. They may clear up after the first trimester, but for some women they last the entire pregnancy. It can help if you make sure your older child is attached well, or change your position while breastfeeding.

You can look after yourself by eating well, making sure you are well hydrated, and getting plenty of rest. You don’t need to take lots of vitamin or mineral supplements — your body will adjust to making breastmilk and nourishing your unborn baby at the same time.

After the baby is born
You can keep feeding your older child after the baby is born. This is called tandem feeding. Your newborn will still get all the colostrum they need. You don’t have to limit your older child to one side.

There are different ways of tandem feeding. You could feed both children at the same time (you might need some cushions to prop you up or you might find it easier lying down). Or you could feed the newborn first and then your older child.

You might find your older child wants to feed all the time because you have a lot of milk. If you like, you can limit their feeds. You might also find that your newborn has trouble coping with your let down reflex because you are producing so much milk. You could try feeding your older child first then attaching the newborn to the other breast after the milk has started to flow.

How to wean your older child
If you decide to wean your older child, it’s a good idea to do this while you’re still pregnant so they don’t have to cope with so many adjustments after the baby is born.

If you would like to encourage your older child to wean while you are pregnant, you could try weaning them slowly by delaying feeds or encouraging shorter feeds. If your child is old enough, explain to them that your breasts feel sore.

29/11/2022

Fertility Drugs: Functions and side effects
It is the process of this paper to critically evaluate the functions and side effects of fertility enhancing drugs with a view to demonstrate that their benefits outweigh social and health costs.

dr_uzma_gynaecologist

04/01/2023

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