Common Queries Regarding Obstetrics
Individual circumstances may vary depending on individual conditions.
Generally, one should be as healthy as one can possibly be. That means a healthy balanced diet, regular physical exercises and no vices (such as smoking, minimal alcohol and definitely no recreational drugs). There is no reason one cannot have a balanced diet being a vegetarian (see Medical Journal of Australia, 4th Jun 2012). However, it obviously requires more planning.
Regular exercises does not necessarily mean one should join a gym, but simple exercises such as 30 to 40 minutes of brisk walking 3 to 4 times a week would constitute very healthy exercises.
Additionally, women are recommended to take Folic Acid at 0.5mg daily prior to getting pregnant. The recommendation is that ideally, one has taken Folic Acid for at least 3 months prior to getting pregnant. The benefit is to reduce the likelihood of “spinal cord abnormalities” in babies.
Iodine supplementation (150µg per day) is also recommended as there is some evidence of improved brain functioning in children with maternal iodine supplementation. Women with thyroid disorders should check with their doctors before taking iodine.
Women should check immunisation status regarding Rubella and Herpes Zoster (Chicken Pox) and be immunised PRIOR to getting pregnant.
For those with pre-existing medical conditions such as hypertension, diabetes, thyroid disorders or asthma (these are the common ones), the general principle is that whatever the condition, it needs to be very well controlled and very stable prior to attempting pregnancies.
The NSW Dept. of Health provides very comprehensive advice on food safety for the pregnant woman (www.foodauthority.nsw.gov.au/consumers/life-events-and-food/pregnancy).
A simplified summary can be described as follows:
Foods to avoid:
The main concern is “Listeria”. It is a bacteria that can affect an unborn baby. “Toxoplasmosis” is a less common infection that can also affect the unborn baby.
What should be avoided are “soft cheeses” (such as camembert and brie) and uncooked meat (including sandwich ham, sashimi and sashimi used in sushi). Cooked cheese (such as on the pizza) and cooked ham (as used in fried rice sometimes) are fine.
Apart from these absolute restrictions, one should follow general principles regarding food handling, preparation and storage. For example, salads, fruits and vegetables should be fresh and properly cleaned; leftover meat should also be stored and re-heated properly (to steaming hot) before eating. These principles should apply at any time, not just in pregnancy. Similarly, one should always be careful of hand hygiene dealing with pet litter or children’s nappies. Food poisoning does not usually affect the pregnancy except in extreme circumstances.
Foods to eat more of:
There is no such thing as foods to eat more of during pregnancy. A healthy balanced diet is the key, even for vegetarians and the other important principle is: eat for one, NOT for two.
For those who normally exercise, it is good policy to keep it up at about 50-80% of what they normally do.
For those who do no regular exercises, it is good policy to do some gentle to moderate exercises 3 to 4 times a week for 30 to 40 minutes at a time.
The idea is the exercise should make one slightly sweaty.
These are general principles, individual circumstances may alter these recommendations. For example, women with “pregnancy induced hypertension” are not advised to exercise.
Dr. Wang has always maintained a willingness to carry out elective “C-sections” for patients if they have considered their situations carefully before deciding on an elective “C-section”. However, the benefit of many years of clinical practice is the accumulation of experience not provided by medical textbooks. It is Dr. Wang’s experience that the majority of women request elective C-sections for two reasons: “the fear of the unknown” and /or “the need to be in control”. Sometimes patients return for their subsequent pregnancies having regrets about the decision for an “elective C-section” they made the first time. Unfortunately, it is harder to achieve a successful vaginal delivery after a previous C-section (see below).
Whilst doctors do not have a magical pill to correct these genuine emotional concerns, Dr. Wang would always have a detailed discussion with those making the request regarding the pros and cons. Most importantly, the patient’s final decision will be respected.
The uterus needs to be trained into action! Most first labours are fraught with the problem of in-coordinate contractions. That is why first labours are often longer, requiring more “inductions” or “augmentations” with “drugs”. Once the uterus has undergone “training” with the first labour, it retains the “memory” of what to do and as a result, the second and third labour are characterised by more synchronised (thus more painful but better) contractions and therefore quicker labour. When a woman had a “C-section” for her first pregnancy, especially an elective “C-section”, the uterus did not get into labour and lacked “training”. Additionally, the uterus has a scar and is therefore weaker. Doctors are therefore reluctant to give these women “drugs” to make the uterus contract better. As a result, the chance of a successful vaginal birth is lower (but still possible).
It also needs to be said that most women have Cesarean sections for medical reasons: breech presentation, placenta praevia are examples. It is generally felt that the chance of vaginal birth is higher if the previous “C-section” was done for “non-recurring” causes; for example, breech. It is unlikely the second pregnancy is also breech. However, if the previous “C-section” was done for a “recurring cause”, the chance of a successful vaginal delivery is lower; for example, big baby (CPD: cephalopelvic disproportion). This is because we tend to produce similar sized children (genetics!).