Falling pregnant post-pill and other contraceptives

A range of contraceptive methods: contraceptive pills, emergency contraception, condom, IUD, vaginal ring, implant

If you’re one of the 70% of women around child-bearing age currently using some form of contraception, you may be wondering, ‘can birth control affect my future fertility?’1 The short answer is no – most methods of contraception do not have any long-term effects on your ability to fall pregnant. However, it can be helpful to understand how different types of contraception affect your body, and how to plan ahead if you are ready to start trying to conceive.

Contraceptive use and future fertility

Whether you’re using the oral contraceptive pill (commonly known as ‘the pill’) or another type of reversible contraceptive, such as contraceptive implants and intrauterine devices (IUDs), you can rest assured that your chances of having a baby in the future will not be impacted. One large analysis of approximately 14 500 women across 22 different studies found that the use of reversible contraceptives, irrespective of how long for, does not negatively impact a woman’s chances of conceiving.2 However, depending on the type of contraception you are using, your ‘return’ to fertility could slightly differ in the short term.

Below are some common types of reversible contraceptives and what you can expect to happen once you discontinue their use.

Oral contraceptive pills

Amongst Australian women, oral contraceptive pills are the most popular form of birth control, with usage rates between 28–33%.3 While oral contraceptive pills are collectively known as ‘the pill’, there are two different types. The first type is called the combined pill because it contains estrogen and progestogen, two female hormones that prevent your ovaries from releasing an egg each month. The second type is called the progestogen-only pill (POP) or mini pill. Unlike the combined pill, the mini pill only contains progestogen and helps prevent pregnancy by thickening cervical mucus, so that sperm can no longer reach an egg.

Once you stop taking the combined pill, your natural hormone levels begin to return to normal. Usually, most women can expect their regular menstrual cycle to return within 1–3 months. Depending on when ovulation begins again, you may be able to fall pregnant within a few months or even weeks after discontinuing your use of the combined pill. However, it is important to note that as soon as you stop taking the combined pill, there is always the chance of a pregnancy occurring. Similarly, it is possible to conceive as soon as you discontinue using the mini pill. As you stop taking the mini pill, the mucus in your cervix changes making it easier for sperm to reach an egg again.

Contraceptive implants

Like the pill, contraceptive implants help prevent pregnancy by slowly and steadily releasing etonogestrel (a progestin hormone). The etonogestrel contained inside the implant, which comes in the form of a small plastic rod, works in two ways. It stops your ovaries from releasing an egg each month and also thickens your cervical mucus so that it is harder for sperm to reach and fertilise an egg. Contraceptive implants are placed under the skin in your upper arm and are effective for three years. However, you can choose to have your implant removed before this time if you wish to start trying for a baby. Once you have your contraceptive implant removed, your menstrual cycle will usually return within a month. If ovulation returns quickly, it is possible to fall pregnant quite soon after implant removal.

Intrauterine devices

Intrauterine devices, commonly referred to as IUDs, prevent pregnancy by limiting the movement and survival of sperm in the uterus. IUDs are small devices that sit inside the uterus and come in two forms: the copper IUD and the progestogen IUD. Both function in a similar way. They stop sperm from fertilising an egg and also alter the endometrium (the lining inside the uterus), so that if an egg is fertilised, it does not progress to a pregnancy. If you decide you are ready to start or grow your family, you can have your IUD removed and expect a relatively quick return to your normal fertility.

The vaginal ring

Just like the pill, the vaginal ring also contains the two female hormones, estrogen and progestogen, which work by stopping ovulation. However, unlike the pill, the vaginal ring needs to be inserted for three weeks, removed, then reinserted a week later. This enables you to have a monthly bleed in-between new rings. Discontinuing its use typically leads to a quick return to your regular fertility level.

Depo Provera (hormone injection)

Depo Provera is a hormone similar to progesterone and upon injection, sends a signal to your body to stop ovulating. Because injections are given every three months and cannot be removed from your body like an implant or IUD, you will have to wait for hormone levels to decline before your fertility levels return to normal. While some women get their periods within six months of stopping Depo Provera injections, others may find that their regular menstrual cycle takes 12 months to return. However, within 12 months of discontinuation, over 50% of women fall pregnant and within two years this statistic rises to 90% of women.4

Condoms and female condoms (diaphragm)

Condom usage amongst Australian women ranges between 20–24% – a close second to the pill.3 Because condoms use a physical barrier to prevent sperm from gaining access to the egg and do not contain any hormones, your regular fertility is unaffected by this method of contraception. Unlike other contraceptive methods, condoms can also protect you from sexually transmitted infections (STIs). This is important when it comes to your fertility, as STIs can lead to inflammation of your reproductive organs and make it more difficult to conceive.

On the other hand, the female condom (also known as a diaphragm) does not protect against STIs, as it sits inside the vagina. However, like condoms, diaphragms stop sperm from reaching an egg by serving as a barrier. Therefore, your regular fertility is also unaffected by this form of contraception.

Falling pregnant after contraceptive use

It can be frustrating and stressful when you do not fall pregnant as soon as you would have liked. When this happens, many women question whether their prior contraceptive use has had a negative impact on their fertility. It’s important to remind yourself that this is unlikely to be the case and that it’s very normal for natural conception to take some time – up to 12 months is considered normal.

If you decide you are ready to fall pregnant naturally and stop using your contraception, it can also be beneficial to make a few lifestyle changes to help boost your chances of conceiving. This can include things like:

  • Eating a healthy and balanced diet, including lots of omega-3 fatty acids
  • Enjoying caffeine in moderation
  • Sustaining from alcohol (the latest guidelines advise that there is no safe level of drinking during pregnancy)
  • Giving up cigarettes
  • Exercising three times per week, and
  • Maintaining a healthy body mass index (BMI).

It is also important to start taking a pre-conception and pregnancy multivitamin to ensure you have adequate levels of folate before conceiving. This will prevent the risk of your baby being born with a neural tube defect, like spina bifida. A supplement will also provide you with healthy levels of iodine, iron and Vitamin D, all of which are either important for your baby’s development or for helping your body cope with the physical burden of pregnancy.

When to ask for help

If you are thinking about discontinuing the use of your contraceptive, it can be useful to speak to your GP or gynaecologist first, particularly if one of the reasons you use contraception is to help manage other gynaecological conditions such as endometriosis or dysmenorrhoea. Your doctor can also manage your expectations about the return of your period and provide important advice on pre-pregnancy care. Of course, some contraceptives, like contraceptive implants and IUDs, will require a doctor to remove them for you.

If you have any queries about your fertility or are concerned about your menstrual cycle following the use of contraceptives, you can make an appointment with me by calling (03) 9418 8299 or by booking online.

References
  1. Richters J, Grulich AE, Visser RO, Smith AMA, Rissel CE. Sex in Australia: Contraceptive practices among a representative sample of women. Aust N Z J Public Health. 2003; 27(2):210–16. ↩︎
  2. Girum T, Wasie A. Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contracept Reprod Med. 2018; 3:9. ↩︎
  3. Family Planning NSW. Contraception in Australia 2005–2018. Ashfield, Sydney: FPNSW; 2020 [Accessed 7 February 2022]. ↩︎
  4. The Royal Women’s Hospital. Depo Provera. Parkville, Melbourne [Accessed 7 February 2022]. ↩︎

5 things every mum needs to tell her daughter about her reproductive health

Shot of a happy mother and daughter spending some quality time together at home

Understanding your reproductive health can be confusing at the best of times, let alone during your adolescent years. Whether you’re a mother, sister or close friend, here are five things you should tell any young woman beginning her journey to adulthood.

1. It’s important to look after your cervical health

Among Australian women between the ages of 25 and 55, cervical cancer is the fifth most common cancer.1 While this statistic is startling, the good news is that you can prevent cervical cancer by regularly having a cervical screening test and by getting vaccinated against the virus that causes it.

Cervical screening

Routinely checking for any abnormalities in the cells from your cervix is one of the most important ways to safeguard your cervical health. Cervical screening (formerly known as the ‘Pap test’) does exactly that – it is a quick and simple way of detecting any cellular anomalies early. Specifically, cervical screening looks for the human papilloma virus (HPV), a sexually transmitted infection commonly known for causing genital warts. While HPV affects both men and women, an ongoing HPV infection in a woman can lead to changes in the cells of the cervix. If left untreated, these changes can slowly (over 10–15 years) develop into cervical cancer.

As per the recommendations of the National Cervical Screening Program, I advise women to begin testing from 25 years of age, as there is a very low rate of cervical cancer in women younger than this. Under this new program, you will be invited to screen for HPV every five years each time your test result is negative. If you return a positive test result, a follow-up screening test will be repeated in 12 months.

Attending your cervical screening appointment can be a little daunting, especially if it’s your first time. Even though the test can sometimes be a bit uncomfortable, it only takes a few minutes and could be lifesaving.

Vaccination

Another way you can protect yourself from cervical cancer is by vaccinating against HPV. In Australia, there are two HPV vaccines available: Gardasil® 9 and Cervarix®. Both of these vaccines cover two HPV types (16 and 18) responsible for nearly 90% of all cervical cancers. Gardasil 9 also includes five other cervical cancer-causing HPV types (31, 33, 45 and 58), as well as the two HPV types (6 and 11) associated with 90% of genital warts.2

In Australia, all high-school-aged boys and girls are eligible to receive Gardasil 9 for free under the National HPV Vaccination Program. If you have not had your HPV immunisation and are over the age of 20, your doctor will be able to administer the vaccine for you at a cost.

2. Don’t put up with troublesome periods

Most girls experience their first period between the ages of 11 and 14 – a milestone that can feel like a moment of relief or anxiety for many young women. If you are beginning to menstruate, familiarising yourself with the different ways you can manage your period will make handling this time of the month a little easier.

Period products

Sanitary pads and tampons are the two main types of period products you will see on the supermarket shelf. Both of these products help absorb your menstrual blood and depending on your personal preference, you may choose to use one or the other, or both – you will have to do a little investigating first to decide what works for you.

Pads sit on the inside of your underwear (sometimes with foldable wings to help keep them in place) and absorb blood so that it doesn’t leak anywhere else. To prevent any bacterial build-up and odour from occurring, you should change your pad at least once every 6–8 hours. On days where your flow is heavier, you may need to change your pad more often.

On the other hand, tampons look like little cloth tubes and are made to sit inside your vagina where they absorb blood. You can insert a tampon using your finger or an applicator (if it comes with one), making sure you wash your hands before doing so. When it is time to remove the tampon, gently pull the string attached. Sometimes this string might disappear – don’t stress! You will always be able to remove the tampon by gently using your fingers to find the string. Like pads, you need to regularly change your tampon (every 4–6 hours) to limit the growth of bacteria and reduce your risk of toxic shock syndrome (an extremely rare complication of a bacterial infection).

Because your period can be lighter/heavier depending on the day, both pads and tampons come in various sizes and absorbency. Deciding whether to use a pad or tampon is up to you and what you are most comfortable with. If you’re a keen swimmer or sportswoman, you may also like to invest in some period underwear or swimwear, so you can carry on doing what you love without the hassle or awkwardness of sanitary products. These newer types of ‘period wear’ are also better for the environment and more and more brands (including Bonds) are offering trendy but affordable options for tweens, teens and adult women.

Dealing with period pain and problem periods

It is not uncommon to experience some discomfort and cramping around your lower abdomen during your period. To help shed its lining, your uterus contracts (squeezes in on itself tightly) which can lead to period pain. Period pain can usually be treated with simple, over-the-counter pain medication like naproxen, mefenamic acid and ibuprofen. Applying a heat pack to your lower abdomen can also help alleviate some of the discomfort.

While bleeding and discomfort are a normal part of having your period, very high levels of period pain (dysmenorrhea), heavy bleeding or bleeding in-between your periods, are not normal and can signal something more serious, such as endometriosis. It’s important to recognise that you do not have to put up with troublesome periods and seeking assistance from your GP or a gynaecologist is very appropriate. This is particularly true if period symptoms are regularly interfering with your ability to get on with normal, day-to-day activities like attending school or work, playing sports or getting a good night’s sleep. For more serious period pain, other medication such as the combined oral contraceptive pill may be considered appropriate to help you manage this time of the month better. These other options are best discussed with your doctor who can then provide a script, if appropriate.

3. Discharge is normal and can change during your cycle

Each day, your vagina naturally produces fluid that keeps it clean and helps prevent infections from occurring. Vaginal discharge is a normal part of being a woman and the type and amount of discharge you have will vary throughout your monthly cycle. Typically, healthy discharge appears clear or milky in colour without any strong odour. In the lead up to ovulation (mid cycle), you may notice that your discharge is thicker in consistency and more voluminous, whereas during ovulation it is thinner and more elastic in appearance.

Knowing how your discharge changes throughout the month can actually help you achieve or avoid pregnancy. That’s because the larger volume of thick discharge that occurs during the middle of your cycle is a sign that you are about to ovulate. By timing or avoiding sexual intercourse at this time of the month, you can either boost or lower your chances of falling pregnant.

On the other hand, abnormal changes to the colour, smell and texture of your vaginal discharge (not related to your cycle) can indicate that an infection is present. For example, discharge that looks yellow or grey with an obvious odour could be a sign of bacterial vaginosis. Yeast infections can also cause your vaginal discharge to change and resemble a cottage cheese-like appearance.

Getting to know your body and what is and isn’t normal for you is an important part of managing your reproductive health. If your vaginal discharge seems a bit different to how it is usually, it is important to seek the advice of your doctor to relieve any symptoms and rule out a possible infection. Left untreated, sexually transmitted diseases like gonorrhoea and chlamydia can lead to pelvic inflammatory disease, which may affect your fertility down the track.

4. There are ways you can help look after your future fertility and reproductive health while you’re young

Planning for pregnancy later on in life isn’t necessarily at the forefront of every young woman’s mind. However, taking care of your body while you are young can impact your fertility in the future. For example, smoking and excessive alcohol consumption can reduce the quality of your eggs by damaging the DNA inside them. This can make it more difficult to fall pregnant when you start trying for a baby. Women are only born with a finite number of eggs and this number naturally declines with age, so it’s important to look after them!

Other modifiable lifestyle factors like exercising regularly, eating a balanced and nutritious diet, as well as maintaining a healthy weight, will not only benefit your reproductive health but will also improve your overall health and help you cope better with the physical stress that pregnancy places on a woman’s body.

These days, it’s also not uncommon for women who think they may not try for a family until later in life (35+) to freeze some of their eggs as a safeguard against age-related fertility decline (the natural reduction in the number and quality of a woman’s eggs as she ages). Egg freezing in your 20s and early 30s enables you to collect and preserve some of your younger, higher-quality eggs. Then, if you do have difficulty falling pregnant when you are ready to do so, you can make use of these frozen eggs with the help of IVF to improve your chances of having a baby.

5. There is always someone you can talk to

It’s not always easy chatting to a parent about your reproductive health, especially if it’s a topic you find embarrassing such as contraception. However, I can assure you that no matter how awkward you think a discussion about your body is, there is always someone you can talk to in confidence.

If you feel like you can’t speak to your mum, aunty, sister or close friend, there are several other resources available for you to access, such as:

In addition, you can also speak to a gynaecologist about any of your reproductive health queries. Many women see a gynaecologist for the first time when they become sexually active. However, you can see a gynaecologist at any age and finding one you feel comfortable with earlier rather than later can help put your mind at ease. If you want to book an appointment with a gynaecologist in Australia, you need to get a referral letter from your GP first.

From arranging a cervical screening test to discussing painful periods or abnormal discharge, I can advise you on how to manage your reproductive health needs. Please feel free to book an appointment online or call my rooms on (03) 9418 8299.

References
  1. Australian Cervical Cancer Foundation. What is cervical cancer? Date unknown
    [Accessed 9 July 2021]. ↩︎
  2. Australian Cervical Cancer Foundation. Prevention. Date unknown [Accessed 9 July
    2021]. ↩︎

Coronavirus (COVID-19) and your pregnancy, including vaccination advice

Woman with face protective mask for coronavirus, COVID-19

We understand that our patients may be feeling anxious and worried at this time – and confused about the implications the coronavirus may have on their pregnancy. Please read on to understand how we are managing the risks related to the COVID-19 pandemic and what measures we are employing to prevent the spread of the infection and ensure your pregnancy is unaffected.

What effect does COVID-19 have on pregnant women?

Over the course of the pandemic, lots of information has been gathered on the impact of COVID-19 on pregnancy.  I can now say with confidence that:

  • There is no direct effect on a baby’s physical development if his/her mother is infected with COVID-19. By this, I mean, the virus itself does not lead to an increase in fetal abnormalities.
  • There are some reports of COVID-19 causing an infection in an unborn baby, but the risk must be quite low.
  • There is an increase in premature birth if the mother is infected with COVID-19.
  • Pregnant women are not more likely to become infected with COVID-19 than non-pregnant women.
  • Pregnant women are more likely to have severe COVID-19 infections. Severe infection includes a much higher rate of hospital admission, respiratory distress syndrome, and intensive care unit admission for mechanical ventilation (breathing with a tube). This is the major contributor to the increase in preterm birth; pregnant women can be so unwell that the baby must be delivered, regardless of the gestation, in order to save the mother’s life.
  • Pregnant women are more likely to die from COVID-19 infection than non-pregnant women.

However, it is important to note that most pregnant women who have a COVID-19 infection experience a mild infection only and recover fully with no impact on the pregnancy.

If I am diagnosed with COVID-19 during my pregnancy, what effect will it have on my baby?

The major risk to your baby is that premature birth is more likely.  It does not increase the chance of abnormalities in your baby.

Can I pass coronavirus on to my baby?

It is possible, but very unlikely.

Should I be vaccinated against COVID-19 during pregnancy?

Yes.

The Pfizer COVID-19 vaccine is approved and available now for all pregnant women.

It has been approved in Australia because the safety has been very well established in studies overseas, plus there is no plausible way that the vaccine could have a harmful impact on your baby.

Pregnant women are currently being prioritised for vaccination because they are at particular risk for getting severe COVID-19. Severe COVID-19 infection can lead to premature birth of your baby.

If you would like to be vaccinated, book an appointment here.  Contact my office and we will email you a letter confirming your eligibility.

I understand that most pregnant women are worried about being vaccinated against COVID-19. We have more resources available to help you with your decision making. If you would like more information, please email [email protected] or discuss COVID-19 vaccination with me at your next appointment.

Do I need to change my birth plan because of COVID-19 risk?

There is no need to change your birth plan, regardless of how you expect the baby to be born. You can still have skin-to-skin contact with your baby and you can still breastfeed.

What should I do if I have had contact with a person with COVID-19?

Firstly, we recommend that you follow all advice from the Department of Health and Human Services. Please also contact my rooms and let us know if you are subject to any restrictions such as mandatory quarantine, so we can plan your pregnancy care accordingly. You can do this by calling (03) 9418 8299 or emailing [email protected].

What happens if I am quarantined during or before my pregnancy?

During your period of quarantine, you will be unable to attend appointments. But don’t worry, we will come up with a plan to ensure your safety, and your baby’s safety.

If you suspect you need to self-quarantine or have been told to undergo quarantine, please contact us by calling (03) 9418 8299.

Our first priority is the safety and care of your pregnancy, and we will make the required adjustments to reduce the spread of coronavirus through our community. It may be necessary to defer certain appointments or communicate by teleconference. We will decide together what’s best for your particular situation.

What happens if I go into labour while quarantined?

I always recommend that patients who think they are in labour CALL DELIVERY SUITE directly on (03) 9418 8302 24 hours a day.

The midwives will assess your symptoms and provide advice in consultation with me when required.

It is most likely that you will be advised to attend the hospital, as usual. The hospital will institute very strict infection controls. Examples could include you being isolated to your room or staff wearing protective equipment such as disposable gowns and masks.

You will not be told to stay at home from the hospital because you are quarantined, or even if you have coronavirus.

Should I still go to work while pregnant?

There is no advice from any official bodies that pregnant women should exclude themselves from work at any stage in the pregnancy. This is because pregnant women generally experience mild symptoms of coronavirus.

If your work advises that you shouldn’t attend, this is usually to reduce the spread of the virus to the community rather than to you as a pregnant woman, and that is a decision to be made by your employer.

What can I do to reduce the impact of COVID-19 on my pregnancy?

The most effective way to reduce the impact of COVID-19 on your pregnancy is to be vaccinated.

What are you doing to reduce the impact of coronavirus on my pregnancy?

The most important step I can take is to encourage you to be vaccinated.

Being a private practice, we have been able to adapt quickly to the changing circumstances, and all pregnancy appointments will proceed as usual.

The following strategies have been instituted:

  • Pregnant patients attend as usual in person
  • Gaps have been placed in our consulting schedule to avoid a build-up of waiting patients
  • Non-pregnant patients where possible are having virtual appointments by video conference and therefore will not be in the waiting room
  • All patients disinfect their hands on arrival
  • If you have cold and flu symptoms, your appointment will be delayed until you have a negative COVID-19 swab.
  • We will not shake your hand. Sorry…

I’m still worried, what can I do?

There are always worries associated with pregnancy. We always encourage patients to seek help from us when needed, and the coronavirus pandemic is no exception.

Call (03) 9418 8299 to speak to our staff or email [email protected] if you have concerns.

Is genetic carrier screening right for me?

Female speaking to doctor

In the same way that physical traits, such as blue eyes or blonde hair, are passed down from parent to child, so too are some medical conditions. Children may inherit a rare disease, even if their parents are both healthy and have no family history of the condition.

Genetic carrier screening enables you to understand your risk of passing on a particular condition to your children and to then make reproductive choices in line with your personal wishes and values. To understand what’s involved in this type of testing and whether it’s the right choice for you and your partner, please take the time to read through the following information.

What is genetic carrier screening?

Carrier screening is used to determine whether a healthy individual or couple are carriers for certain rare hereditary diseases, such as cystic fibrosis (CF), fragile X syndrome (FXS) and spinal muscular atrophy (SMA). It involves a simple mouth swab or blood test, and allows a woman or couple to understand their risk of passing an inherited condition on to their children. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) now recommends that genetic carrier screening be offered to all women planning a pregnancy or in the first trimester of pregnancy.1

What does it mean to be a carrier of a disease?

A carrier is someone that does not show any symptoms of a condition, despite having a copy of the faulty gene known to cause that condition. In isolation, this gene does not cause a problem. It is only when this faulty gene is passed on to an unborn child that an issue may arise. Conditions are generally passed on in one of two ways:

Autosomal recessive inheritance

The child has the condition because it has inherited two copies of the same faulty gene – one passed on from it’s mother, the other passed on from it’s father, i.e. both parents carry the faulty gene.2 When both parents are carriers, there is a one in four (25%) chance of having an affected child with each pregnancy.

X-linked recessive inheritance

These conditions occur when the faulty gene is located on the X chromosome.2 Because males inherit only one X chromosome (from their mother), they only need to inherit one faulty gene in order to have the condition.3 Females, on the other hand, inherit two X chromosomes, one from each parent. In order to be affected, they need to inherit two faulty genes – one from their mother and one from their father. As such, women are much more likely to be carriers of these types of conditions and have a one in two (50%) chance of passing on the faulty gene with each pregnancy.

inheritance patterns
Source: The Royal Australian College of General Practitioners. Beware the rare: Carrier screening. East Melbourne, Vic: RACGP, 2020 [Accessed 14 August 2020].4

What carrier screening tests are available?

If you and/or your partner opt to undergo carrier screening, you can choose to be tested for just one condition, a few conditions, or hundreds of conditions. The most appropriate option for you will depend on your family history and ethnic background, as well as your personal wishes and values.

Single-condition screening

Single-condition, or ‘targeted’ screening, is designed to identify specific changes in one particular gene. These tests are generally offered to women and couples with a known family history of a particular condition, or from a particular ethnic background that is known to be at higher risk of inheriting a particular condition, e.g. Tay-Sachs disease which is seen at higher rates in Jewish communities, and cystic fibrosis which is more common in people with Celtic origins.4

Three-condition screening

One of the most widely used genetic tests performed in Australia, this screening panel detects faulty genes linked to three of the most common and severe inherited disorders – cystic fibrosis (CF), fragile X syndrome (FXS) and spinal muscular atrophy (SMA).4

Victorian Clinical Genetics Services (VCGS) offers a highly sensitive, three-condition screening panel called prepairTM. I generally recommend this test for women and couples who are planning or are in early pregnancy, irrespective of ethnic background or family history.

Expanded carrier screening

Expanded carrier screening enables women and couples to be screened for hundreds of rare hereditary diseases at once. It is recommended for individuals (of any ethnicity) who want to explore their level of risk beyond the three-condition screen.4

The list of genes tested for varies significantly between providers, but usually include conditions that significantly impact quality of life. For example, VCGS offers expanded carrier screening for more than 250 severe inherited disorders.5

Do both partners need to be screened?

To better determine the risk of having a child with an X-linked or autosomal recessive condition, both partners should be screened. This may be done sequentially or simultaneously.

With sequential screening, the female partner is screened first (to detect X-linked conditions). The male partner then only undergoes testing if the woman is found to be a carrier for an autosomal recessive condition.1 I often recommend sequential screening for couples who have opted for single- or three-condition screening and plan to undergo testing prior to pregnancy.

Simultaneous screening involves testing both partners at the same time. Couples are given a combined ‘high probability’ result if both partners are carriers for the same autosomal recessive disorder, or the woman is a carrier for an X-linked disorder. Simultaneous screening is usually recommended if the couple is undergoing screening during the first trimester (when the time window for receiving results and making decisions is limited), or if the couple has opted for expanded screening due to the relatively high risk of each person being a carrier for at least one condition.

If I am identified as a carrier, what are my options?

Several options are available to women and couples who are identified as carriers. When carrier status is determined before pregnancy, women and couples have access to the full range of options. They may choose to continue on to a natural pregnancy with or without prenatal diagnostic tests to check whether the fetus has the condition. Alternatively, they may choose to undergo in vitro fertilisation (IVF) with preimplantation genetic testing (PGT) to detect affected embryos prior to transfer. They may also choose to adopt or not have children.

Unfortunately, reproductive choices are more limited for women and couples who are identified as carriers during the first trimester of pregnancy. However, in this case, they do still have the option to undergo prenatal diagnostic tests (via amniocentesis or chorionic villus sampling) to check whether the fetus has the condition. This may lead them to consider termination of the pregnancy for medical reasons or to prepare themselves for having a child with a known medical condition.

Genetic counselling

Genetic counsellors and clinical geneticists are health professionals who are specially trained to counsel women and couples who are considering or have had carrier screening.

Before screening, genetic counselling allows women and couples the opportunity to have a more detailed discussion about the different screening options available and the medical conditions that can be tested for. Genetic counsellors can also provide further information about the benefits, limitations (e.g. accuracy) and implications of each type of screening.

If, following screening, one or both partners have been identified as carriers, genetic counselling ensures the couple fully understands their reproductive options and can access the support they need when making decisions. Since carrier status can impact not only the individuals but also their families, genetic counsellors also provide advice on ways to communicate results with family members.

Additional information

Please be advised that neither Medicare nor private health insurers currently offer rebates for genetic carrier screening, and out of pocket costs do vary between tests and providers. In general, single-condition screening costs around $100–$200, three-condition screening $350–$400 and expanded carrier screening $580–$900.

It’s also important to note that genetic carrier screening is not the same as other prenatal genetic tests routinely offered to pregnant women. Non-invasive prenatal testing (NIPT) and combined first trimester screening (CFTS) are still both recommended in addition to carrier screening, as these tests screen for chromosomal disorders, such as Down syndrome (which are different to genetic conditions).4,5

Is genetic carrier screening right for me?

Ultimately, only you and your partner can decide if carrier screening is right for you. These tests can raise complex ethical and moral dilemmas for a couple and will not be the right choice for everyone.

If you’re planning a pregnancy or are in the first trimester and would like additional advice and information about genetic carrier screening, you can make an appointment with me by calling (03) 9418 8299 or by booking online.

References
  1. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Genetic carrier screening. East Melbourne, Vic: RANZCOG, 2019 [Accessed 14 August 2020]. ↩︎
  2. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Reproductive Carrier Screening. East Melbourne, Vic: RANZCOG, 2019 [Accessed 14 August 2020]. ↩︎
  3. Genetics Home Reference. What are the different ways in which a genetic condition can be inherited? Maryland, USA: NIH, 2020 [Accessed 17 August 2020]. ↩︎
  4. The Royal Australian College of General Practitioners. Beware the rare: Carrier screening. East Melbourne, Vic: RACGP, 2020 [Accessed 14 August 2020]. ↩︎
  5. Victorian Clinical Genetics Services. Expanded carrier screening. Parkville, Vic: VCGS, date unknown [Accessed 14 August 2020]. ↩︎

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

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. ↩︎