Five things you can do for your gynaecological health in 2021

Woman holding a small bouquet of yellow flowers

When you made your New Year’s resolutions this year, was your gynaecological health front-of-mind? Probably not. But if, like many of us, you let non-urgent health check-ups slide in 2020 (as the pandemic kept us all at home), it may be time to check in with your body and put a spotlight on any women’s health issues that may be troubling you. Here are five things every woman should keep her eye on ‘down there’:

Cervical screening (previously known as the ‘Pap test’)

Routine cervical screening is essential for ensuring the health of your cervix. During a cervical screening test, a scraping of cells is taken from your cervix and sent to a laboratory for analysis. Specifically, this test checks for the presence of the human papillomavirus (HPV). Persistent HPV infection can cause changes in the cells of the cervix, which can lead to the development of cervical cancer. Therefore, it’s important to keep up to date with your scheduled cervical screening.

Now I know what you’re thinking – it’s inconvenient and uncomfortable. The truth is yes, sometimes having a cervical screening test can be a bit bothersome and unpleasant. However, the good news is that the test takes just a few minutes and due to recent advances in screening, you only need to get tested every five years if your results are normal. If you missed your test in 2020, this is one health appointment you should reschedule as soon as possible.

Don’t ignore new or odd symptoms

Every woman’s body is different. When it comes to gynaecological health, knowing what’s normal and what’s not, can sometimes be tricky. If you notice any new or unusual symptoms, it’s important to see your doctor – these symptoms could be an important sign that something is wrong, in which case early detection and treatment is always better.

Symptoms to watch out for include changes in the texture, appearance and smell of any vaginal discharge, abnormal bleeding, pain upon urination and/or pain in your lower abdomen. Talking about these kinds of symptoms can feel awkward and embarrassing, but recognising changes in your body and alerting your doctor is an essential step to ensuring your gynaecological health. Be reassured that gynaecologists are trained to have these conversations; the more open you are about your symptoms and how they are affecting your day-to-day life, the easier it will be for your doctor to diagnose and treat the problem.

Consider if egg freezing is right for you

As a woman ages, the quality and number of her eggs naturally declines, which can dramatically lower her chances of falling pregnant from around the age of 36 on. Egg freezing provides a way of safeguarding a woman’s fertility by keeping some young, healthy eggs ‘on ice’. These eggs are effectively put on standby, providing women with a back-up plan if they run into problems falling pregnant later in life. If a woman knows she is unlikely to start trying for a family until she is in her mid-30s or older, egg freezing can be greatly reassuring.

So, what does egg freezing involve?

Egg freezing can be split into three steps:

  • Initially the ovaries are stimulated with self-injected hormones to produce multiple eggs. During this time, the follicles which contain the eggs are monitored via ultrasound, so we know the best time for egg collection
  • Egg collection occurs under light anaesthesia (typically this procedure takes 10–15 minutes)
  • From the eggs collected, mature eggs are identified, then frozen and stored (up to 10 years) for later use.

There are a few factors you should consider before deciding whether egg freezing is right for you. Age plays a central role in female fertility, as both the quantity and quality of a woman’s eggs affects her chances of falling pregnant. Younger women tend to have multiple, healthy eggs so women who freeze their eggs at a younger age, i.e. early 30s and younger, will have a higher chance of achieving a live birth from an egg that has been frozen than women who freeze their eggs later in life (>35). When an older women wants to freeze her eggs, she may need to undergo egg collection more than once to ensure enough eggs are collected. Ideally, a larger number of eggs will be collected. This increases the chances of having a good number of quality eggs in the mix suitable for IVF, should she need to go down this path in the future.

Another consideration to bear in mind includes the cost of the procedure and medication (hormones used to stimulate egg production), as well as the ongoing cost of storing your eggs once frozen (usually charged per 6 months’ storage). In Australia, elective egg freezing (freezing your eggs by choice and not due to a medical reason) is not covered by Medicare.

Don’t keep putting up with troublesome periods

If ‘problem periods’ are interfering with everyday life, it’s important to make an appointment with your gynaecologist. There are a number of common issues that can lead to abnormal levels of pain and/or bleeding during your menstrual cycle. The good news is that most of these issues can be well-managed and treated by gynaecologists ­– you don’t have to ‘put up’ with any unpleasant symptoms you are experiencing.

Painful periods (also known as dysmenorrhea) typically present as cramping in the lower abdomen that is much more painful than one would normally expect to experience with their period. While everyone’s pain threshold is different, any pain that is bad enough to stop you from participating in daily life and keeping up with your commitments (e.g. missing exams, repeated days off work, declining social engagements) should be investigated. This is even more true if your symptoms are causing difficulties in your relationships (including painful intercourse). Sometimes painful periods can be eased with quite simple measures, such as the right combination of pain medication and use of the oral contraceptive pill. So it’s worth finding out what your treatment options are sooner, rather than later.

Eating vagina-healthy foods

Diet and gynaecological health go hand in hand. Just like the gut, the vagina also relies on good bacteria to keep things in check. Good (probiotic) bacteria help balance the vagina’s pH, which is crucial for preventing the growth of infection-causing microorganisms. Therefore, eating foods that are rich in good bacteria like yoghurt, some cheeses, sauerkraut and pickles, can have a big impact on your vaginal health.

Consuming cranberries or concentrated cranberry juice can also help defend against unpleasant urinary tract infections. Cranberries are rich in compounds that make sticking to the bladder wall difficult for bad bacteria.1 This can help the urinary tract and bladder ward off any potential infections, so adding cranberry to your diet is a great step if you tend to suffer from repeated infections.

Make women’s health your priority

No matter the year, women should always prioritise their gynaecological health. If you have never seen a specialist gynaecologist before, consider starting this relationship in 2021. A good gynaecologist can help a woman through every stage of life – from problem periods and HPV screening through to child-bearing and menopause. To make an appointment with me, you can call my rooms on (03) 9418 8299 or book online.

References

  1. Howell AB Mol Nutr Food Res 2007;51:732­–737

COVID-19 vaccination during pregnancy, IVF or fertility treatment

Young woman with face mask getting vaccinated for coronavirus (COVID-19)

I am in full support of the COVID-19 vaccination for my fertility, gynaecology and obstetric patients. I understand that my patients have many questions relating to both fertility and pregnancy, and the safety of the COVID-19 vaccination. By answering these questions and addressing your concerns, I hope to be able to provide peace of mind. Remember, as always, specific advice from an obstetrician or fertility specialist tailored to your situation is always recommended.

Should I have the COVID-19 vaccine if I’m undergoing fertility treatment or IVF? 

Yes. Based on advice from the Australian & New Zealand Society of Reproductive Endocrinology and Infertility, I support the decision to get a COVID-19 vaccination during fertility treatment. There is no evidence that the vaccine will affect your overall fertility or current treatment, nor the pregnancy that follows.

I recommend that you avoid having the vaccine in the days leading up to your admission to the hospital for embryo transfer or egg collection. Approximately 15% of patients have a fever following vaccination. Whilst this in itself is not worrying, hospital protocols may prevent patients who have a fever from being admitted to the hospital.

Should I have the COVID-19 vaccine if I am pregnant? 

Yes. The Pfizer vaccine is now recommended for all women who are pregnant. There has been extensive use of this vaccine in the US and UK with no specific pregnancy complications and no increase in overall complications compared to non-pregnant recipients. What has been seen with vaccine administration is a reduction in the chance of the pregnant woman getting COVID-19 and therefore a reduction in transmission to family members and close contacts.

Does the COVID-19 vaccine cause miscarriage?

No. There is no evidence of an increased risk of miscarriage or abnormalities in the physical development of your baby.

Should I have the COVID-19 vaccine if I am breastfeeding?

Yes. COVID-19 vaccines are thought to be safe and not considered to be a risk to your child.

How does the COVID-19 vaccine work?

The vaccine protects you from COVID-19 by fooling your immune system into making an immune response to small proteins that are associated with the SARS-CoV-2 virus (the virus causing the disease COVID-19). Your body will then have pre-built immunity should you ever be exposed to the real virus and you will be protected. For an adequate response, it is recommended that you receive the vaccine twice, several weeks apart.

What are the side effects of the COVID-19 vaccine?

There are minimal side effects that remain uncommon. These include a sore injection site, headache, fatigue, temperature rise and muscle weakness. These symptoms are not from you having ‘mild COVID-19’. They are as a result of the immune response that your body mounts in response to the vaccine.

What should I do if I am newly pregnant? 

Get the vaccine as soon as possible! As above, the Pfizer vaccine has been determined safe for use in pregnancy in Australia.

How to manage mastitis

Young Mother Breastfeeding Baby Baby at Home

This post was contributed by Registered Nurse/Midwife and Gestational Diabetes Educator, Jenny van Gemert MNurs GDipMid GDipEd. (Insta)

What is mastitis?

Mastitis refers to inflammation, and sometimes infection, of the breast tissue. It starts with a blocked milk duct that creates a build-up of breast milk, which can then spread into breast tissue, causing inflammation. Mastitis affects anywhere between 5 and 20% of women in the postnatal period, and is more common in the first six weeks. It almost always affects one breast at a time.

How do I know if I have mastitis?

The onset of symptoms is usually quite sudden and includes a red breast that is hot and painful to touch. If an infection develops, symptoms often mimic a flu, with a temperature (above 37.5 degrees), exhaustion, shivers, and aches and pains. Patients often describe the feeling as being like a sudden-onset flu. However, if the infection is caught and treated early enough, many of these symptoms can be avoided.

How can I avoid mastitis?

There are a few things you can do to reduce your risk of mastitis. Avoid letting your breasts fill up too much by ensuring that your baby feeds, or that you pump, at regular intervals. If you do notice a blocked duct (it will feel firm), attempt to unblock it using massage, applying heat and encouraging your baby to feed from the affected breast. I suggest that women massage their breast in the shower, while applying warm or hot water to it. If it’s painful to feed or pump, you can hand express for comfort, too.

What do I do if I think I have mastitis?

If you are showing signs of an infection, the first and most important thing is to seek antibiotics. If your baby is six weeks or younger and you are still under the care of Dr Chris Russell, he can write a script to be faxed to your nearest pharmacy. Give the rooms a call on (03) 9418 8299 to arrange this.

If your baby is older than six weeks, please make an urgent appointment to see your GP. Be sure to explain the situation to reception staff as you will need to commence treatment immediately. If it’s the weekend, or you’re unable to get to your GP, please consider calling 13SICK and a bulk-billed GP can visit you at home.

Be sure to take the full course of antibiotics and to check for persistent symptoms (as described above), as you may need further follow-up from a breast specialist (although this is only required in rare, unresolved cases).

During treatment, I recommend:

  • Resting as much as possible
  • Applying a warm pack prior to feeding or expressing
  • Applying a cold pack afterwards, for comfort and relief
  • Continuing to empty the affected breast.

Should I keep feeding my baby?

If you feel able to, I recommend you keep feeding your baby. It is perfectly safe to do so and it will not only help your recovery, but will continue to establish a feeding routine. If it’s too painful to feed, don’t push through the pain as this could result in a negative association for both you and baby. Instead, you could consider pumping from the affected breast.

And finally

It can be very helpful to see a Lactation Consultant during this time. They can help you make a feeding plan and proceed with feeding, if this is your goal. Don’t be disheartened; there is no reason you can’t continue breastfeeding.

When should you start your baby on solids?

Happy toddler eating a meal

This post was contributed by Registered Nurse/Midwife and Gestational Diabetes Educator, Jenny van Gemert MNurs GDipMid GDipEd. (Insta)

In this blog post, we will be discussing the more traditional introduction of solid food, as opposed to other feeding styles such as baby-led weaning. Should you be more interested in an alternative method, be sure to approach your care provider for more information.

How to know when your baby is ready

It’s important to introduce solids at the right time in order to ensure your baby’s increasing nutritional needs are met as they grow and develop, but to also help your little one learn essential skills for eating (like chewing). Solids should start at around 4–6 months of age once your baby can sit up and support their own head. Before 4–6 months, your baby will be using stores of iron from their time in the womb while also receiving nutrients from breastmilk and/or formula – solid food is not required in these first few months, and can even be dangerous.

When your baby begins to show an interest in food, they are telling you that they are ready for something other than milk. Some of the behavioural signs to look out for include reaching for your food, staring at your mouth as you eat, and opening their mouth when they see you eat. Babies at this stage might even pick up and try to eat food they find around the house – so don’t underestimate what a little person could find under a couch cushion! If your baby is older than six months and not yet expressing any interest in food, you should seek advice from your Maternal Child Health Nurse (MCHN) or GP.

Initially, you should continue to feed your baby breast milk or formula alongside any solid food. You may find that your baby starts to require these feeds less, as solids begin to fill them up and provide more of their nutritional requirements. To start with, it’s a good idea to try solid food soon after a liquid feed. This will ensure that hunger doesn’t distract your baby from trying out their new eating skills.

How to make the change

Begin with smooth purees before moving on to mashed foods and small, soft pieces of food. A good starting point can be a rice cereal from the chemist or supermarket, made into a thin paste. You can use breastmilk or formula to thin out the paste. It’s best to start with foods with a thinner consistency and then slowly move onto minced or chopped food.

There’s no need to prepare different food for your family and your baby – you can simply adjust the consistency of the same dish. It’s also unnecessary to introduce your baby to only one type of food at a time. Mixing is encouraged, unless you are trying to test if your baby is allergic to a particular ingredient.

Use clean, plastic plates, bowls and cutlery – nothing sharp or breakable, as these items will inevitably end up on the floor. There is no need to sterilise tableware; simply wash with hot soapy water and be sure to rinse before drying.

Solid foods to feed your baby

You can start by feeding your baby what the rest of your family likes to eat – this will make life easier!

Some of the foods you can try include:

  • Easy-to-chew root vegetables including sweet potato, pumpkin and carrots
  • Corn
  • Avocados
  • Softer fruit including apples, pears and bananas
  • Avocado
  • Pureed meats and cooked egg.

Some parents like to add sweeter fruit purees to savoury foods in order to make them more appealing. Although this does work, it can be hard to wean a baby off the sweet addition once they are older. Instead, try feeding the savoury food on its own first. If this doesn’t work, alternate each teaspoon: one with the fruit, one without, and so on.

Solids to avoid

You should avoid the following foods until your baby is at least 12 months old:

  • Honey
  • Raw or runny egg.

While babies can have cow’s milk when eating cereal and cooked foods like mashed potato, it should not be your baby’s main milk source until they are older than 12 months. Full cream dairy is recommended until your child is two years old, after which reduced-fat dairy can be introduced. Unpasteurised milk should always be avoided.

Alternative milks such as soy, goat or almond are also not recommended before your baby is two years old. We always recommend you ask your MCHN, GP or paediatrician before commencing a non-dairy milk.

Bread, pasta, cheese and other foods that require more chewing are best introduced when your baby is older – and wait until your child is at least five years old before feeding them whole nuts, grapes or other choking hazards.

Managing allergies

When you introduce solids, you should be mindful, but not anxious, about any potential allergies your child may have. Babies with eczema or who have siblings or parents with an allergy are more likely to also have an allergy. If you are concerned that your baby may have an allergy, introduce foods one at a time and check for a reaction.

If your baby has a reaction to a particular food (e.g. rash), don’t feed it to them again until first seeking the advice of your MCHN or GP. It can be helpful to take a photo of the allergic response in case it reduces in severity before your doctor can see it. If your baby has a more severe reaction (face, lip or neck swelling), visit your closest emergency department (preferably one with a paediatric ward).

If your baby has any difficulty breathing whatsoever, dial 000 and ask for an ambulance. While you wait, remove any food left on your child’s face or mouth and follow the advice of the phone operator.

Should you feed your baby sugary foods?

Babies don’t need sugar added to their food. This includes fruit juices, cordials and all soft drinks. Soft drinks in particular provide no nutritional value.

Sugar in a baby’s diet can lead to dental health problems, poor oral hygiene and unnecessary weight (which comes with its own health risks). Most importantly, too much sugar early in life can be the start of an unhealthy relationship with food. Once your baby tastes that first yummy ice-cream, there’s no going back – pureed carrot just won’t cut it.

Your child will get the chance to try out cakes, biscuits and other sweet treats in the coming years. Once they are older, you can teach them about balance and the difference between a ‘sometimes’ food and an everyday snack.

Have fun with it

Introducing your baby to the world of food is a wonderful and exciting time. For many parents, it feels like the end of the tiny baby stage. Once your child is on solids, they can enjoy eating with the rest of the family. So if you don’t have one already, invest in a high-chair so your baby can join you at the table. It doesn’t need to be expensive – try IKEA, Kmart and second-hand listings on Facebook or Gumtree. If you all eat together, everyone can have a great time watching the many delighted (and not so impressed) faces your baby makes as they try new foods for the first time.

What to do if you need help

To avoid confusion, we recommend sticking to reputable sources of information, including websites such as VicHealth, Raising Children and the World Health Organisation (WHO). Your MCHN is also an incredibly valuable source of up-to-date, evidence-based information.

If you are unsure about the introduction of solids to your baby’s diet, you can also make a 45-minute appointment with me, Jenny Van Gemert. As a registered nurse and midwife, I can assist you with the process of introducing solids and can provide personalised guidance. These appointments cost $90 and can be arranged by calling 03 9418 8299.

Caesarean versus natural birth – how does it affect my baby?

Mum and baby after caesarean section

A caesarean section is an operation in which your baby is delivered through a cut made in your lower abdomen and womb (uterus). It’s a common procedure – most of us would know someone who has been born via caesarean section or know a mother who has had a caesarean section. Furthermore, the proportion of women giving birth via caesarean section has increased over the years. In 2019, 38% of mothers who gave birth at the Mercy Hospital for Women in Melbourne had a caesarean section, compared to 29% in 2010.1

When might a caesarean section be required?

Caesarean sections may be planned, meaning that the decision to perform a caesarean section is made before you go into labour. This is usually due to medical reasons that preclude a vaginal delivery, such as:

  • Malpresentation: Ideally, your baby’s head should be down prior to the beginning of labour. If your baby is positioned bottom or feet first (breech) or lying sideways (transverse), a caesarean section may be preferred to attempting to turn the baby.
  • Placenta praevia: This is a condition where the placenta — which provides your baby with oxygen and nutrients — lies close to or crosses the cervix (the opening of the uterus through which the baby exits). Placenta praevia can cause a massive bleed during labour, so a vaginal delivery is usually too risky.
  • Multiple pregnancy: Twins can sometimes be delivered via vaginal birth – however, if the first baby is positioned feet or bottom first (breech), or if other complications have developed, a caesarean section will be required. If there are three or more babies, a caesarean section will be necessary.
  • Past history of caesarean section: If you’ve previously had a caesarean section, you may still be able to have a vaginal birth for future pregnancies. However, a VBAC (vaginal birth after caesarean) does carry more risk than a standard vaginal birth – and the more caesarean sections you have had, the greater the risk. Depending on your individual circumstances, a previous caesarean section may be sufficient reason to have another.

Caesarean sections are sometimes necessary in emergency situations. This happens if you have already gone into labour, but your baby must be delivered quickly due to complications that have arisen. These complications may include:

  • Inadequate progress during labour or obstructed labour: If your labour is progressing very slowly, or not progressing at all, a caesarean section may be required to safely deliver your baby. This decision will be based on how tired you and your baby are during the labour.
  • Distress of the baby: If your baby shows signs of distress late in your pregnancy (e.g. reduced movements), or at any time during your labour (e.g. increased or decreased heart rate), you may need a caesarean section to deliver your baby quickly.
  • Chorioamnionitis: Chorioamnionitis is an infection of the fluid and sac surrounding your baby. It is a medical emergency and requires prompt delivery. Therefore, a caesarean section will be necessary.
  • Severe bleeding: If you have a severe bleed while you are pregnant, or at any time during your labour, a caesarean section can be lifesaving – for both you and your baby.
  • Cord prolapse: Sometimes the umbilical cord (which transports vital oxygen and nutrients from your body to your baby) can slip out of the uterus before your baby does – this is known as a cord prolapse. When this happens, your baby may compress the cord as it moves down the birth canal. This prevents oxygen from reaching your baby, which can be fatal for the baby. In this situation, an immediate caesarean section will be required.
  • Placental abruption: Placental abruption is the separation of the placenta from the uterus. This cuts off your baby’s supply of oxygen and can be life-threatening to the baby. It can also put you in significant danger, due to the risk of a massive bleed. Therefore, it necessitates prompt delivery via caesarean section.

Lastly, a caesarean section may be ‘elective’. This is when a woman chooses to have a caesarean section. Women often make this decision when they want to avoid the complications that can occur during a vaginal delivery or they deem it to be the safest option for their baby.

What are the pros and cons of having a caesarean section?

The main advantage of a caesarean section is that when a vaginal delivery is too risky for medical reasons, a caesarean section allows you to safely give birth to your baby. In the end, this is what’s most important.

Caesarean sections are also associated with a reduced risk of later incontinence and pelvic organ prolapse. This is because a caesarean avoids the need for a forceps delivery. This kind of instrumental delivery can place significant stress on a woman’s pelvic floor. It also usually requires a surgical cut to be made at the opening of the vagina (called an ‘episiotomy’).

Many women assume that their recovery from a caesarean will be harder and longer than a vaginal delivery. In fact, whilst the immediate recovery from a caesarean is more painful over the first few days, it is frequently a quicker overall recovery than a vaginal delivery, especially when compared to a complicated vaginal delivery. In general, the time it will take you to recover from childbirth will depend on your age, how fit you are, your pain tolerance, and the number and mode of any previous deliveries. A woman’s first vaginal delivery usually takes the longest to recover from, with recovery becoming increasingly faster and easier with each subsequent vaginal delivery. In comparison, recovery from a caesarean sits somewhere in the middle – it’s not as hard and long as a woman’s first vaginal delivery but not as quick or easy as her second.

For some patients, the certainty that comes with a planned caesarean – e.g. known delivery date, optimal timing of delivery, reassurance that the pregnancy won’t go past the due date and expose the baby to post-maturity complications – is a real benefit. Other women prefer a planned caesarean because it means they can avoid going into labour and the pain associated with it.

Lastly, women who have an elective caesarean also have the option of undergoing other surgical procedures straight after the caesarean – most commonly, tubal ligation (‘tube-tying’) to provide permanent contraception.

On the other side of the coin, there are some risks involved with a caesarean section. Similar to any surgical procedure, there is always a risk of bleeding, infection and damage to other organs close to the womb (e.g. the bowel and bladder). But, overall, the danger posed by these risks is low. Infection occurs following approximately 3–4% of caesareans. The other complications mentioned are rare.

Prior to a caesarean section, you will also have a spinal anaesthetic. This anaesthetic is injected via a needle between the bones of your spine. While this blocks pain from your chest down, you will usually still feel some tugging and pulling during the caesarean section. However, the anaesthetic can cause nausea, low blood pressure or a headache. Rarely, it may lead to temporary nerve damage, resulting in a loss or change of sensation to your lower body. However, this normally resolves.

In both the public and private setting, you will typically stay in hospital for four nights following a caesarean section. This is the same length of a time a woman will stay in a private hospital if she has had a vaginal delivery – even if the delivery was uncomplicated. In the public hospital setting, women who have had an uncomplicated vaginal delivery will usually go home after one night.

Lastly, due to the scar in your uterus after a caesarean section, there is a slightly higher risk of complications for future pregnancies if you end up having multiple, repeat caesarean deliveries.

Will a caesarean section affect my baby?

Following a caesarean section, your baby has a higher chance of having temporary breathing difficulties. This occurs because the natural labour process clears fluid from your baby’s lungs, by physically ‘squeezing out’ the fluid as your baby goes through the birth canal. The risk of this temporary breathing difficulty is lower with longer pregnancies (i.e. there is a smaller risk of it occurring at 39 weeks’ gestation compared with 37 weeks’ gestation). Therefore, I usually aim to schedule caesarean sections at around 39 weeks’ gestation, if an earlier delivery is not required for other reasons. Rates of breathing difficulty at 39 weeks are similar (about 1%) when babies born by caesarean versus vaginal delivery are compared.

There used to be a concern that caesarean delivery upsets the baby’s microbiome (bacterial colonisation of the gut), potentially leading to allergies in the future. However, this has been debunked by recent research showing that babies born vaginally and by caesarean have identical gut flora by Day 3. More important factors that can adversely affect a baby’s microbiome are the use of formula (versus breast milk) and extremely low fat intake during pregnancy!

Finally, if instruments (forceps or vacuum) are used to assist the delivery of your baby during a caesarean section, this can bruise your baby’s head. However, this type of bruising can also occur (and is actually more common) when these instruments are used during a vaginal delivery. In either case, bruising generally resolves rapidly over a few days.

Want to discuss your options for birth?

Deciding between a caesarean section and vaginal delivery is highly individual and requires consideration of your specific circumstances. As an obstetrician, I will work with you to determine what’s best for you – to ultimately ensure that you have a healthy baby at the end of your pregnancy. If you would like to make an appointment, please call (03) 9418 8299 or book online.

  1. Dr Michael Rasmussen. Internal Audit, Mercy Hospital for Women, Heidelberg, Victoria. Data on file, April 2020. ↩︎

When female hormones go astray – common signs of an imbalance

Female stressed at work

Feeling irritable, bloated, or just not yourself? If so, a hormonal imbalance may be to blame. Hormones are chemical messengers that are secreted into the blood to regulate a variety of important bodily functions and processes. If hormones become imbalanced, they can have a huge effect on our bodies and how we feel. Here, we explore why they’re so important and what happens when things go wrong.

Meet your hormones

What springs to mind when you hear the word ‘hormones’? The emotional roller-coaster of puberty? The competitive spirit of testosterone? Perhaps the night sweats of menopause? While fluctuating hormones can certainly be the cause of symptoms like mood swings and hot flushes, hormones also do us a lot of good.

Our bodies produce over 50 hormones, which are involved in the control of entire organs and systems. These hormones act like tiny messengers, transmitting signals that tell the cells in our body to take on specific actions. When hormones are working well, our bodies and minds flourish, but an imbalance can cause a spectrum of health problems.

So, what are ‘female’ hormones?

Interestingly, men and women have both ‘male’ and ‘female’ sex hormones, just in different amounts. These hormones play a profound role in male and female biology, kicking in during puberty and promoting gender-specific characteristics, such as breasts in women and facial hair in men. The female sex hormones, oestrogen and progesterone, are well known for their impact on a woman’s reproductive health but also play a big part in how a woman thinks, feels and looks.1

Oestrogen is produced by a woman’s ovaries, fat cells, adrenal glands, and the placenta during pregnancy. It plays a more important role in women than in men because it is involved in the development and regulation of the female reproductive system, so oestrogen affects puberty, menstruation, pregnancy and menopause.2

Also referred to as the ‘pregnancy hormone’, progesterone is a steroid hormone produced by the ovaries after ovulation and by the placenta during pregnancy. It plays a crucial role in the menstrual cycle, preparing a woman’s body for pregnancy by causing the lining of the womb to thicken and suppressing oestrogen production after ovulation.2

It’s natural for these hormones to fluctuate

Fluctuations in your sex hormones – throughout the month and at different stages of life – are normal and expected, but these highs and lows can lead to changes in the way you look and feel. For example, it’s common for women to experience headaches right before their period when oestrogen and progesterone levels drop.3 On the other hand, hormonal changes during pregnancy, including significant increases in progesterone and oestrogen, can affect mood, create the much-talked about pregnancy “glow”, and change how your body responds to exercise (you get hotter and puffed a lot faster!).4 During perimenopause and menopause, hormone production in the ovaries begins to decrease, leading to a whole other range of symptoms including hot flushes, night sweats, reduced libido and irregular periods.

A hormone imbalance is not normal

A hormone imbalance is not a temporary fluctuation in hormone levels – it occurs when there’s consistently too little or too much of a certain hormone. The effects can range from irritating or distressing to even life-threatening. A hormonal imbalance is often the sign of an underlying medical condition like thyroid disease or polycystic ovarian syndrome (PCOS). However, our lifestyle and eating habits can also lead to hormone imbalances.

For example, carrying excess body weight is an increasingly common reason for women’s hormones to ‘play up’. This is because excess fat promotes the production of certain hormones. Unfortunately, too much of a good thing can have a range of deleterious effects, including a rise in blood pressure, increased insulin resistance, inflammation, sexual dysfunction, and an increased risk of certain cancers.5

Excess fat can also lead to decreased levels of sex hormone-binding globulin (SHBG), a substance involved in regulating the sex hormones. This can alter the level of a woman’s sex hormones causing irregular periods, which in turn, may affect her ability to fall pregnant. Indeed, research has shown that in overweight women, even a modest weight loss of 5% can improve fertility and the chance of conceiving.6

Not feeling quite right and think your hormones may be to blame?

If you are experiencing a range of vague or unsettling symptoms, including issues with menstruation and/or fertility, and suspect that a hormonal imbalance may be the cause, the first step is to speak to your GP or a women’s health specialist. You can make an appointment with me by calling (03) 9418 8299 or by booking online.

  1. Tata JR. EMBO Rep. 2005; 6(6):490–496. ↩︎

  2. DeMayo FJ et al. Ann N Y Acad Sci. 2002; 59:396–406. ↩︎

  3. Chai NC et al. Curr Opin Neurol. 2014; 27(3):315–324. ↩︎

  4. Kumar P et al. Niger Med J. 2012; 53(4):179–183. ↩︎

  5. Lovejoy JC et al. Int J Obes (Lond). 2008; 32(6):949–958. ↩︎

  6. Clark AM et al. Human Reprod. 1995; 10(10):2705–2712. ↩︎

Can losing weight really help me fall pregnant?

Young woman trying to choose between apple and donut

This post was contributed by Registered Nurse/Midwife and Gestational Diabetes Educator, Jenny van Gemert MNurs GDipMid GDipEd (Insta).

It may be difficult (and frustrating) to hear but did you know that weight loss may represent one of the best ways to improve your chances of having a baby? While weight gain is considered a good sign during pregnancy, carrying excess weight before you are pregnant can actually make you less fertile. That’s because extra weight can disrupt the balance of insulin and other hormones in your body, leading to ovulatory issues (your ability to release an egg from your ovaries each month).

Interestingly, weight loss doesn’t always have to be drastic in order to improve fertility. Research has shown that even a 5% drop in body weight can greatly increase a woman’s chances of falling pregnant.1 That’s not to mention the many other benefits linked to losing weight, such as a reduced risk of conditions like diabetes and heart disease, and a lower rate of complications once you do become pregnant.2

However, when you are having difficulty conceiving, attempting to lose weight on top of this may seem like an impossible task. You may also be confused about the best way to go about losing weight and be worried about how long it could take you to achieve the weight loss your doctor recommends. The first thing to remember is that you are not alone in this – many women struggle with both their fertility and weight.3 The good news is that a little persistence and determination can go a long way in helping you achieve your goals. Being aware of how important weight loss is for improving your chances of having a baby may well be all the motivation you need to finally shed some of those extra kilos.

Where to start?

The best place to start is to understand that the key to weight loss is to lower your calorie intake (decrease the amount of energy you take in through food and drink) while increasing your physical activity levels (so that you burn off more energy). To achieve weight loss, ‘energy in’ must be less than ‘energy out’. We discuss some strategies for achieving this below.

Change the way you eat

For many years, the low-fat diet was the most widely-accepted and recommended weight loss method. However, recent studies have raised some questions around the long-term effectiveness of this diet, shining light on the low-carb diet as a better option for weight loss.4,5,6

As the name implies, a low-carbohydrate or ‘low-carb’ diet involves eating fewer carbohydrates, such as those found in starchy vegetables, fruits and grains. Lowering your carbohydrate intake decreases the amount of insulin your body releases in response to food. This prompts your body to burn through its fat stores for energy, resulting in weight loss.

Eating low-carb doesn’t mean eating no carbs – it’s all about moderation and making better choices, e.g. choosing to have a slice of grainy bread, rather than a large white roll. In general, a low-carb diet involves eating foods that are protein-rich (chicken, salmon), high in ‘good’ fats (like nuts and avocado) and low in starch (cauliflower versus potato). Unlike many fad diets, a low-carb diet can be much easier to stick to because it allows you to eat a variety of foods. After a while, you may even find that it just becomes the way you eat rather than a diet per se, making it easier to sustain a healthy weight over the long-run (including during and after a pregnancy!).

When you choose a low-carb diet, you’ll naturally avoid foods and drinks that are high in sugar, including fruit juice, soft drinks, lollies, cakes and biscuits. You’ll also tend to eat much smaller portions of starchy vegetables like potatoes, pumpkin and corn. Avoiding sneaky ‘side carbs’ like naan bread, bread rolls, corn chips and garlic bread can also be very helpful for triggering weight loss. If you’re serving rice and pasta dishes, a good tip is to put more of the sauce (filled with meat and vegetables) on your plate rather than the carbohydrate.

The more familiar you become with a low-carb diet, the more you’ll learn about tasty, low-carbohydrate alternatives (e.g. cakes made from almond or hazelnut meal rather than flour). Over the longer term, you may even find that you prefer these options. But when you’re just starting out, avoid temptation by being extra careful with what you put in your shopping trolley and by avoiding supermarket runs on an empty stomach! And remember that home-cooked meals are often better than shop-bought, packaged foods, which tend to be higher in sugar and other chemicals.

What else can you do to trigger weight loss and improve your fertility?

  • Increase your level of physical activity – resistance exercise and cardio are great but also try to work coincidental exercise in whenever you can, e.g. taking the stairs, parking further from your destination so you walk more, doing squats every time you visit the toilet. Be mindful that high-intensity exercise can affect your menstrual cycle.
  • Get enough sleep – studies show that poor sleep is one of the strongest factors affecting weight gain because sleep deprivation impacts the daily fluctuations in appetite hormones.7
  • Fast intermittently – intermittent fasting involves interchangeable periods of fasting and eating. It has been linked to weight loss and numerous other health benefits.8
  • Eat more fibre – foods high in fibre may help with weight loss by delaying stomach emptying and increasing feelings of fullness.9
  • Practise mindful eating – this involves making conscious food choices while developing a greater awareness of your feelings of fullness and hunger. It has been shown to help with weight loss, particularly if you tend to binge or engage in emotional eating.10
  • Choose foods that are good for fertility – these include vegetables, protein and healthy fats.

The bottom line

Research shows that weight loss can have a dramatic impact on a woman’s ability to fall pregnant. A healthy weight will also set you up for a healthy pregnancy and ensure you give your baby’s health the best start in life. If you have concerns about your fertility or the role your weight or other factors may be playing in your ability to conceive, you can make an appointment with me by calling (03) 9418 8299 or by booking online.

  1. Balen AH et al. Hum Fertil. 2007;10:195–206. ↩︎
  2. Ma C et al. BMJ. 2017;359: j4849. ↩︎
  3. Australian Bureau of Statistics. National Health Survey: First Results, 2017–18. ↩︎
  4. McClemon FJ et al. Obesity. 2007;15:182–187. ↩︎
  5. Tobias DJ et al. Lancet Diabetes Endocrinol. 2015;12:968–979. ↩︎
  6. Foster GD et al. N Engl J Med. 2003;348:2082–2090. ↩︎
  7. Nedeltcheva MD et al. Ann Intern Med; 2010;153:435–441. ↩︎
  8. Alirezaei M et al. Autophagy. 2010;6:702–710. ↩︎
  9. Rebello CJ et al. Nutr J. 2014;28:49. ↩︎
  10. Katterman SN et al. Eat Behav. 2014;15:197–204. ↩︎

Chris’ Christmas gift guide for all the women in your life

Mother with baby during Christmas decorating with fairy lights, wearing Father Christmas hat and antlers.

Without doubt, Christmas is my favourite time of year. To make things even more special, this year will be my son’s first Christmas. With both the birth of my son and Newlife IVF in 2019, it’s been a pretty hectic year on all fronts for my family. I’ll be sure to give my wife and two girls something a little extra special this year to thank them for all their love and support during these busy times.

It’s probably no surprise to you that as an obstetrician, gynaecologist and fertility specialist, I get to meet a lot of different women from every stage of life. I have the privilege of watching these women deal with a range of challenges unique to women’s health, infertility and motherhood. Observing how they get on with life while managing their way through and over these hurdles is what inspired me to put the following list of gift ideas together.

I’ve tried to only recommend products that you can source locally, that are sustainable and crap-free. And yes, I admit it, a few good women may have helped me with some (or all!) of these ideas.

For first-time mums

Many a patient has told me that when you spend your days changing nappies and dodging drool, the simple things in life (like taking a shower) can become a real luxury. For these women, I reckon that an amazing hand cream is the go. My sources tell me that the Empire Australia range is a beautiful brand, designed and produced right here in Melbourne.

I also have it on good authority that new mums sometimes need a hand to swap out their professional workwear for more casual wear. If the woman you are buying for needs some help turning her wardrobe from ‘office chic’  to ‘mumsy chic’, my suggestion is a pair of Bared’s ‘Weaver’ sneakers. A little birdie tells me that paired with some jeans and a long sleeve tee, these minimalist sneakers will do the trick in dressing down any old work blazer. And all men know that shoes are the way to a woman’s heart, right? You can find these particular beauties in-store (CBD or Armadale) or online.

For mums who have just popped out Baby #2 or 3 or 4 …

There’s busy, then there’s super-busy. I’m thinking that what these mums really need is an extra pair of hands. I’m not a plastic surgeon, so the next best thing is to help them be hands-free, which is where this Hoopla crossbody box bag comes in (did you like how that just rolled off my tongue?). I’m told that this bag is a busy mum’s perfect companion because it’s small enough to wear while playing at the park, doing the shopping, etc., but also big enough to hold all the essentials (phone, purse, lip balm, sultanas, baby wipes, tissues, random Thomas train …). I’m also told that they come in a great range of colours! You can find them at Coconut Home & Co, a boutique retail store based in Surrey Hills, Melbourne (visit them in store or order online).

For mums-to-be

For mums-to-be, we’re loving this modern take on a baby memory book from Peachly, a husband and wife duo based on the Sunshine Coast. Billed as ‘the baby book you’ll actually complete’, it’s easy to fill out and is also designed to suit every type of family, so it’s LGBTQ and adoptive-family friendly. For example, instead of saying ‘Mummy and Daddy’s reactions to seeing you for the first time’, the book says: ‘Our reactions to seeing you for the first time’. And if memory books aren’t your thing, Peachly also has a great range of bamboo swaddles – all original designs, so you can be sure your present won’t be a double-up!

For women trying to conceive

Christmas can be an awkward time of year for women trying to get pregnant, especially if they are undergoing fertility treatment. You’ll need to use your judgment to decide what type of gift will be most appreciated.

Women dealing with infertility are often meticulously tracking dates, so a beautifully designed yearly diary or planner can make a nice gift without screaming ‘I know you’re trying to get pregnant’. Try these designs from Bespoke Press.

If your friend is undergoing IVF and is open with you about their experiences, you may like to go for a gift that helps them to be mindful rather than mind-full throughout their IVF journey, like a set of affirmation cards. Robyn Birkin, a Perth-based mum who hosts the award-winning Fertility Warriors podcast (inspired by her own fertility journey), gives some great suggestions for these and other gift ideas here.

Alternatively, I think these watercolour art prints of IVF embryos are amazing and they can be custom designed. While these prints are not Australian made, they are created by a fellow IVF mum, Pamela Gallegos, who lives in Florida.

For working mums

All kudos to these mums who are just trying to fit it all in. There are a few ways you can go here:

  1. Help them fit more in to their day, e.g. buy them a subscription for Les Mills On-Demand so they can stream video work-outs at-home anytime. And because it’s Les Mills, it has a huge variety of programs (e.g. HIITs, Cardio, Core, BARRE, BODYPUMP, Yoga, Body Balance) so they can choose the work-out style they enjoy most. Classes also come in all kinds of formats so if they only have 15 minutes spare, they’ve still got time to squeeze in one of the super-quick short programs.
  2. Give them some down time, e.g. tee them up for a massage or facial. Just make sure you choose somewhere local, so they can get there easily.
  3. Make the everyday a little less ho-hum, e.g. buy her a crazy cool workbag (like this Melbourne tote from Australian brand bellroy) that makes her feel ‘put together’ even as she struggles to clean baby food off her blouse while getting a pram in the door of an already-full train during rush-hour as her child cries because Bluey the soft toy has just fallen into the clutches of a scary-looking … you get the picture.

 

For single women and same-sex lesbian couples wanting to have children of their own

What these women want most in the world is donor sperm to help them start or build their own family. Victorian legislation means that single women and same-sex couples can now legally access assisted conception techniques like intra-uterine insemination (IUI) and IVF to do so. However, a shortage of donor sperm means that these women often have a very short list of donors to choose from. This can present a real problem if they are looking for a specific nationality or culture to align with their own background. In many cases, these women have to import sperm from an international sperm bank, which can be a much more expensive process.

So, the best Christmas gift you can give these women is a well-stocked local sperm bank that gives them lots of home-grown, Victorian men to choose from. If you know a man who would make a great donor, ask him to consider giving the gift of life this Christmas. Our sperm collection centre in Box Hill makes donating a really simple and seamless process. For all the deets, get your favourite male specimen to check out the Newlife IVF website.

For mums who have ‘lost their mojo’

There is only one way to go here and that’s to buy something fun, frivolous and carefree. My little birdie tells me that a cracker pick-me-up is a bright and cheerful nail polish – like Essie’s ‘play date‘, which judging by its name, aims to put the fun back into play dates! Or if the woman in your life is a lover of all things royal, try Essie’s ‘ballet slippers’ instead, which is the nail colour Meghan Markle supposedly wore on her wedding day (dropping that fun fact is also sure to earn you some extra Brownie points!).

For breastfeeding mums

These mums are living in an alternate universe right now: day becomes night, night becomes day, then all their days and nights seem to meld into one. What I think these women would really appreciate is some super-comfy, super-groovy lounge wear that takes them from day to night to day, and back again. You know, an outfit they can sleep in but, if necessary, also do the school run in. For an ethical, sustainable, organic brand with a great range, try Organic Crew available online or from their store in Malvern.

For every other woman on your list

Okay, so for all the other women in your life, here are a few other suggestions that might tickle your fancy (and theirs):

Right, now that we’ve got the Christmas shopping sorted, I’d say it’s time for a refreshing mojito mocktail – it’s low-carb and alcohol free, so suitable for women who are pregnant or trying to conceive. Cheers!

Disclaimer: I fully admit that I had an extreme amount of help in putting this article together. As the old adage goes, a woman knows what a woman wants – and I’m not one to argue with that. That said, I hope you enjoyed it!

When breastfeeding hurts

a smiling mother breastfeeding her baby

This post was contributed by Dr Candice O’Sullivan. Previously a medical practitioner, Candice now owns a healthcare communications agency, helping doctors and other healthcare providers to produce high-quality patient information.

My breastfeeding story

When I was pregnant with my first child, I assumed that breastfeeding would come naturally and just work. Even so, I still did a lot of reading on the topic, so by my third trimester, I felt well-educated and well-prepared.

Then four weeks before my due date, my waters broke unexpectedly, and I ended up having an emergency caesarean in the middle of the night. My little boy came out ‘borderline small’, meaning he wasn’t quite small enough for the special care nursery, so we stayed on an ordinary maternity ward. And therein began my very long, lonely, painful battle to breastfeed a tiny baby with a tiny mouth who couldn’t latch properly.

I won’t go into the ins and outs of what happened next and all the different things we tried but suffice to say, it would take months before latching on became a seamless process for him, and breastfeeding became ‘natural’ for us both. I distinctly remember giving my son a bedtime feed when he was around 9 months old and feeling amazed at how easy and ‘natural’ breastfeeding had finally become. In the end, I breastfed my first son for a little over 13 months. This was a massive achievement given where we had started.

When I was pregnant with my second son, yet again I assumed that breastfeeding would come easily. What I didn’t take into consideration was the possibility that I could come up against a whole other range of breastfeeding issues. You see, my second son could latch brilliantly, but by about Week 3, breastfeeding not only hurt – it was pure agony. I couldn’t understand why until I was diagnosed with thrush, which not only affected my nipples but also the milk ducts inside my breasts. This led to an 18-month battle with recurrent thrush. I ended up on some heavy-duty medication, taking it for weeks and sometimes months at a time, to try and keep the infection under control. It wasn’t pleasant but when the infection was at bay, breastfeeding was easy and painless, so I kept going even though I had to deal with recurrent flares. This time round, I ended up breastfeeding even longer, for around 22 months.

The ‘moral’ of my experiences is that breastfeeding doesn’t always come easy. It can be really hard work but it can become second nature if you receive the right information and support. So if, like me, you want to persist with breastfeeding despite any challenges you may be facing – and you have the energy and ‘mental space’ to keep trying for a little while longer – there are people who can help you and your baby to figure it all out. Or to at least give it a good old try.

Common causes of pain with breastfeeding

Some of the most common causes of pain during breastfeeding include:

Poor latch: Latch problems are the most common cause of breastfeeding pain. They usually involve a latch that is too shallow, meaning that your baby’s tongue rubs against your nipple when feeding rather than your breast. Milk engorgement can make latching difficult, so sometimes it can help to express some milk before putting baby on your breast. Other times, a small change in positioning can make a huge difference.

Thrush (yeast infection): An overgrowth of yeast can lead to thrush around your nipples and/or in your milk ducts. This is often described as a burning pain, or sharp and stabbing, and is usually accompanied by a rash. The skin over your breast may also look smooth and shiny.

Tongue-tie: When you look inside baby’s mouth, you see that the thong of skin under baby’s tongue (the frenulum) is tight or short, and the baby isn’t able to stick his tongue out or lift it up. That means he can’t bring it forward or cup the breast as he needs to, and his tongue rubs against the end of the nipple, causing pain.

Vasospasm: This is when blood vessels in the nipple tighten and go into spasm, so that blood does not flow normally. You will usually feel sharp pain, burning or stinging in the nipple. It is typically accompanied by sudden whitening of the nipple, followed by a colour change from red to blue.

Plugged duct: This is a sore, tender area in the breast. It may feel like a lump under the skin and the skin may look red. This usually indicates that a milk duct has become blocked. The milk backs up and creates pressure behind the plug.

Mastitis: You will have a hot, red, very tender area on your breast. You will also usually have a fever and feel unwell. Mastitis may develop suddenly or may follow an unresolved plugged duct. When a plugged duct stops the milk from flowing, bacteria may grow in the milk leading to an infection and inflammation. Sometimes cracked nipples may also allow bacteria to enter the breast. If you suspect you have mastitis, call Chris on (03) 9418 8299 for advice.

Where to seek help

Your local lactation consultant or clinic: the hospital you gave birth in will usually have a specialist lactation nurse or clinic who can assess and diagnose your breastfeeding issues. If Chris delivered your baby at Epworth Freemasons, you can contact the Freemasons Lactation Clinic on (03) 9418 8310. You can book a face-to-face consultation or the lactation consultants may be able to provide all the help you need just by talking things through with you over the phone. If you delivered elsewhere, call Chris’ rooms on (03) 9418 8299 for a list of lactation consultants he recommends in your area;

Your maternal child health nurse: you’ll have appointments with a maternal child health nurse at Weeks 1 (home), 2, 4 and 8. This is a great time to ask questions and find out where you may be going wrong with your feeds;

The Australian Breastfeeding Association (ABA): this website has lots of useful information for women at every stage of breastfeeding;

The sisterhood: mums, mums-in-laws, sisters, etc. can relay their own experiences, but they can also just be there to make you a cup of tea or hold baby while you take some time for yourself;

Online baby and motherhood forums: while you do need to fact-check the advice of non-professionals, peer-to-peer support can reassure you that you are not the only person facing these types of issues. They can also help pinpoint the source of your problem and guide you in the direction of where to seek help;

Your mother’s group: these women can be a great source of useful tips and hints, as you all muddle through this new experience together.

What to remember in the middle of the night

Everything always seems worse in the middle of the night, especially when you are sleep deprived. This is when you need to tell yourself that this moment in time will pass and that you will look back one day and think: ‘I can’t believe I got through that’. But for now, while you are caught up in the midst of it all, just breathe, then keep doing what only you can do best: love your baby and love yourself. If you can just keep doing that, you will find a way to get through. It may not always be pretty or graceful or elegant. In fact, it will probably be downright messy, particularly if you throw in another kid or two and a needy husband, but you will get there.

And if you really do need a laugh, imagine what the lovely Kate Middleton might look like if she didn’t have people to do her hair, organise her outfits, take care of her children, cook all her meals, and give her time to exercise. Blimey, it would be a bloody shambles!

Jokes aside, it’s also important to be able to recognise the possible signs of postnatal depression and anxiety. If you think the sleep deprivation and stress of breastfeeding are catching up with you, don’t be afraid to reach out for help. After all, we’re all in this together.

Lastly, don’t forget your 6-week post-partum visit with Chris

Every new mum should have an appointment with their obstetrician 6-weeks post-partum. This booking will usually be made before you leave hospital. If you need to contact Chris before this time, please call (03) 9418 8299 or simply book online.

Managing labour pain – what are your options?

pregnant woman managing labour pain by sitting on an exercise ball holding her belly with eyes closed

Labour can be painful, but there are many options available that can help you manage the pain. It’s good to learn about what these are before you go into labour.

You’re having a baby! You may be feeling excited, a little nervous and likely wondering how much labour will hurt and how you are going to cope with the pain. Fortunately, there are many different methods to help ease the pain of labour, including a variety of medicines and natural pain relief options that have been tried and tested over the years.

Pain is a normal part of labour and is experienced differently by every woman. It is often described as a unique feeling, and of course it is associated with a wonderful and meaningful life event – the birth of a new baby. You can help prepare yourself for labour pain by gaining a better understanding of your options for pain relief, how they work, and the effect they will have on you and your baby.

Just like the experience of labour itself, your pain management choices are very personal and should be based on your physical and emotional needs. You may already have a very clear idea of the pain relief you want or don’t want, but it can be helpful to keep an open mind – depending on how your labour progresses, you may choose to change your pain management plan or use a combination of methods. Whatever happens on the day, your midwife and/or doctor will be on-hand to support you with what is best for you and your baby at the time.

Here are some of the most common options for managing labour pain:

Natural relief for labour pain

1. Active birth

Thanks to what we often see on TV and in movies, many women still expect to spend labour reclined in a hospital bed. But studies have shown that actively moving around by walking, changing positions, rolling on a birthing ball or swaying can help ease pain.1 Being in an upright position can help support the baby’s movement as it moves through the birth canal, while gently rocking your pelvis can ease the discomfort of contractions. These movements can be done almost anywhere and can be used with other complementary therapies. However, movement alone is unlikely to completely relieve you of pain.2

2. Massage

Massage and touch can be calming, can help ease tension and may act as a distraction from labour pain. In a recent study, women who received massage from a physiotherapist during labour reported significantly less pain than those who didn’t, although massage did not change the characteristics of the pain.3

If your partner is likely to be there during childbirth, you can practise being massaged before the birth to discover what feels most comfortable. During some stages of labour, you may find that massage feels good, while at other times it may be distracting or even annoying.

3. Relaxation and breathing

One of the most important parts of your body to relax during labour is your mind. If you’re calm and less anxious, you will be more physically relaxed, which can help reduce the pain. Deep breathing and concentrating inward often come as natural responses for women during contractions. Breathing in through the nose and out through the mouth can help you get into a relaxed state and help you cope better with labour.4 You can find out more about this in antenatal classes, which often cover breathing and relaxation techniques. Your midwife will also help you with these techniques during labour.

Medical relief for labour pain

1. Epidural

This is the most common and effective type of pain relief used in labour.5 If you choose to have an epidural, an anaesthetist will insert a needle and a tiny tube, called a catheter, in the lower part of your back. An anaesthetic will then be administered via this tube, which usually numbs only the lower section of your body. The aim of an epidural is to make you completely pain free during labour and delivery.

There are a few possible side-effects of epidural anaesthesia to be aware of, including temporary muscle weakness or numbness from the waist down, a lengthened second stage of labour, and tenderness around the injection site. However, epidurals are considered very safe, with serious complications being rare.6 An epidural does not increase your chances of needing a caesarean. However, an epidural may increase the chances of forceps being used to help deliver your baby.

2. Opioids

If you’re interested in a form of pain relief that doesn’t cause a total loss of sensation in part of your body or increase your chances of needing assisted delivery, you may want to consider opioids. An opioid, such as morphine, is usually injected into your thigh or buttock – it relieves pain by having an analgesic effect, which means it dulls your feelings of pain but doesn’t have a deep-numbing effect. Opioids normally take about 20 minutes to work after the injection and can last between 2 and 4 hours.

Opioids can sometimes make you feel disorientated or sick, so anti-nausea treatment is often given at the same time. Opioids cross the placenta, which can affect the baby’s breathing, but this can be reversed by another drug should this become a problem.7 Morphine can take the edge off your pain, but it won’t take the pain away completely.

3. Nitrous oxide

Nitrous oxide gas, often referred to as ‘laughing gas’, acts quickly and doesn’t affect contractions or stay in the baby or mother’s body. Many women like this option because it’s easy to use and self-controlled – you simply hold the mask and take deep breaths whenever necessary.

On the whole, nitrous oxide is considered a safe pain management option during labour. It won’t remove all the pain but can take the ‘edge’ off it and make it more bearable.

Alternative methods of pain relief

There are various alternative options that may be of interest to you. These include reflexology, hypnosis, massage, aromatherapy, TENS and acupuncture. It’s worth bearing in mind that there is little research proving the effectiveness of some of these treatments, but some women do find them helpful.

Talk through your options with your obstetrician

Childbirth can be an amazing experience, and there are many options for managing the pain associated with it. Although you can’t predict how much pain you will have during labour and delivery, you can prepare yourself for it by discussing the options available to you with your obstetrician beforehand. My patients are welcome to chat to me about this at any of their appointments. To make an appointment, call (03) 9418 8299 or book online.

References

  1. Shilling T et al. J Perinat Educ 2007;16:21–24. ↩︎
  2. Ondeck M et al. J Perinat Educ 2014;23:188–193. ↩︎
  3. Gallo et al. Journal of Physio 2013;59:109–116. ↩︎
  4. Smith CA et al. Cochrane Database Syst Rev 2018;3:CD009514. ↩︎
  5. Anim-Somuah M et al. Cochrane Database Syst Rev 2011;12:CD000331. ↩︎
  6. Benzon HT et al. JAMA 2015;313:1713–1714. ↩︎
  7. Smith LA et al. Cochrane Database Syst Rev 2018;6:CD007396. ↩︎