All women who are pregnant without complications should continue exercise as part of a healthy lifestyle during pregnancy. Carrying a baby is hard work as is labour, so remaining in good physical shape is essential. A reasonable goal should be to maintain a good fitness level throughout pregnancy without trying to reach peak fitness. It is important to stay well hydrated, wear comfortable clothing and foot wear and avoid excessive overheating. Maintaining a healthy weight will help you return to your pre-baby weight more quickly and reduce your risk of developing diabetes of pregnancy (more common in overweight mothers). RISKS OF EXERCISE There are no known adverse risks to a pregnant woman who meets the recommended guidelines of at least 150 minutes of moderate to vigorous physical activity per week. However as pregnancy progresses the body changes significantly and joints become looser. This is an important change as it allows the pelvic bones to slightly separate to allow the birth of a baby vaginally. This joint laxity can lead to pelvic and back pains. High impact running can increase the risk of pelvic instability.  A pregnant woman’s centre of gravity changes as she the pregnancy progresses, this can affect balance. Common sense must prevail, taking up a new adventure sport is not a sensible idea in pregnancy due to altered balance. You should avoid sports that put you at risk of a blow to the abdomen eg falling whilst snow boarding, martial arts. EXERCISE GUIDELINES 75-150 minutes of moderate physical activity per week. Avoid overheating; don’t exercise if you are ill or feverish, take care in hot and humid weather Stay well hydrated Avoid contact sports or activities with a risk of falling Avoid scuba diving whilst pregnant AEROBIC EXERCISE SUGGESTIONS WHILST PREGNANT

• Walking
• Swimming
• Cycling (stationary bike safer)
• Low impact aerobic exercise class
• Water aerobics
• Yoga or Pilates
• Pregnancy exercise classes

WHEN NOT TO EXERCISE WHEN PREGNANT? Stop exercising if you experience

• Abdominal pain
• Any fluid loss from the vagina
• Calf pain or swelling
• Chest pain
• Decreased baby movements
• Dizziness, light headedness, muscle weakness, blurred vision
• Shortness of breath before starting exercise
• Pelvic pain
• Excessive fatigue
• Painful uterine contractions
• Vaginal bleeding

Listen to your body! PELVIC FLOOR EXERCISES DURING PREGNANCY

• Sit and lean slightly forward with a straight back
• Squeeze and lift the muscles as if you are trying to stop urinating
• Hold the squeeze for up to 5 seconds, relax for up to 10 seconds
• Repeat up to 10 times, 3 to 4 times a day
• Keep breathing through the exercise

You can find out more here - https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-and-exercise

There is no known safe level of alcohol consumption for women who are pregnant. Consuming alcohol during pregnancy increases the risk of miscarriage, low birth weight, congenital deformities and effects on the baby’s intelligence. You can find out more information here - https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-and-diet

Whilst nausea and vomiting is an almost normal part of pregnancy, it is unpleasant and in rare cases can lead to serious complications such as dehydration. Sometimes all that is required to improve your symptoms is to make some changes to the way you eat and drink.  Sometimes medications are required, and it is important to know which ones you can safely take during pregnancy.

Hydration

The most important thing is to ensure adequate fluid intake.  You should drink at least 2000ml of fluid a day in addition to replacing fluid lost from vomiting.  Fluid tends to be best tolerated when it is cold and drunk in frequent small amounts (sips) between meals (this avoids over filling your stomach).  If you are drinking enough fluid, you will urinate normal volumes and it should be clear or yellow. If you aren’t passing much urine or if it is becoming concentrated, this is a sign you are dehydrated.  Try to increase the amount you are drinking, or use a sports drink like Powerade (it is easier for your stomach to absorb).  If this doesn’t help, or you are unable to keep fluid down, contact either the Mercy Hospital for Women Emergency Department (8458 4000) or page Dr Lenore Ellett on 9387 1000 for advice.

Controlling Nausea

Diet

Meals should be eaten slowly and in small amounts every one to two hours.  An empty stomach should be avoided, as should an over full stomach.  A snack upon waking and before getting up may help. It’s difficult to be sure what foods are best, however historically simple foods like toast and crackers are most tolerable when nausea is at its worst.  Everyone is different, so you might have to experiment.  Try avoiding spicy, odorous, high fat, acidic and very sweet foods first and replace with higher protein and salty foods like nuts.

Medications

Blackmore’s Morning Sickness This contains ginger and vit B6 and should be taken regularly (4 times a day) to suppress your nausea.  If you only take it when you have severe nausea, it probably won’t work.  If you don’t like the ginger, you could instead take vitamin B6 50mg tablets 4 times a day. If this doesn’t work by itself, take it with; Doxylamine (Restavit) This is an antihistamine that is sold over the counter at most pharmacies.  The dose is one tablet at night and ½-1 tablet in the morning and afternoon.  It is a very safe medication in pregnancy.  It is mildly sedating in some women, thus you may only be able to take ½ during the day. If these tablets together don’t work, continue to take them, and add one the following medications that require a prescription Metoclopramide (Maxolon) – Category A

• Ondansetron (Zofran) – Category B1
• Promethazine (Phenergan) – Category C
• Prochlorperazine (Stemetil) – Category C

When to seek further help If the above measures are not working and you are still troubled by significant symptoms, you should make an appointment with Lenore in her rooms, call on 8458 4022.  You should go to hospital if you are unable to tolerate any fluids or if you are not passing enough urine. Nausea and vomiting late in the pregnancy can be abnormal, and you should contact Lenore’s rooms if this occurs.

Prognosis

The vast majority of women’s symptoms resolve by about 13-15 weeks, and at the very least, you can expect symptoms to begin to subside by this stage.

Many patients ask me what is safe to eat and what is not. This is natural, we all want the best for our growing baby. A healthy balanced diet is the best plan for any pregnant woman. A healthy diet The best way to meet you and your baby’s nutritional needs is to eat a wide variety of nutritious foods and be as healthy as possible as early as possible. These foods should include a variety of:

• Bread, cereals, rice, pasta, noodles and other grain foods—mostly wholegrain and/or high fibre
• Vegetables and legumes
• Milk, yoghurt, hard cheese and dairy alternatives with added calcium—mostly reduced fat
• Meat, fish, poultry, cooked eggs, nuts, seeds and tofu

You can read more information here - http://foodauthority.nsw.gov.au/foodsafetyandyou/life-events-and-food/pregnancy/pregnancy-and-food-safety