Obstetrics

Importance Of Your Pelvic Floor Muscles

What do my pelvic floor muscles do? 

The pelvic floor is the base of the group of muscles referred to as your ‘core’. These muscles work with your tummy (deep abdominal) and deep back muscles and diaphragm to stabilise and support the spine. They also assist in controlling the pressure inside your abdomen to deal with the pushing force when you lift or strain, for example when you are exercising.

Pelvic floor muscles support the bladder, bowel and uterus in women (and the bladder and bowel in men).

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What causes my pelvic floor muscles to weaken? 

Pelvic floor problems can occur when the pelvic floor muscles are stretched, weakened or too tight. Some people have weak pelvic floor muscles from an early age, whilst others notice problems after certain life stages such as: 

·      Childbirth (predominantly resulting in the delivery of a large baby or prolonged pushing during delivery)

·      Being pregnant

·      Being overweight

·      Heavy lifting (e.g. at work or the gym)

·      Chronic cough or sneezing (asthma, heavy smokers & hayfever)

·      Changes in hormonal levels (menopause)

·      Constipation (excessive straining to empty your bowel)

·      A history of back pain

·      Growing older.

 

How do you strengthen your pelvic floor muscles?

Your pelvic floor muscles can be consciously controlled and therefore trained. Strengthening your pelvic floor muscles will help you to support your bladder and bowel. What this does in improve your bladder and bowel control and helps reduce the possibility of accidentally leaking from your bladder and bowel. With a regular strengthening exercise program your pelvic floor muscles will become stronger. This is very important for both women and men.

·      If you have mastered the art of contracting your pelvic floor muscles correctly, you can try holding the inward squeeze for longer (up to 10 seconds) before relaxing. Make sure you can breathe easily while you squeeze. If you can do this exercise, repeat it up to 10 times, but only as long as you can do it with perfect technique while breathing quietly and keeping everything above the belly button relaxed. This can be done more often during the day to improve control. If you need help identifying your pelvic floor muscles then visit the Pelvic Floor First website.

·      Pilates are another great way to strengthen your pelvic floor muscles as these muscles require slow exercises as well as fast exercises. Check out the Poise website for some great pilates workout examples. (Consult your physician if you have any questions or are hesitant whether or not pilates is ok and safe for you, especially if you are pregnant).

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How do I prevent damage to my pelvic floor muscles?

You need to avoid the following:

·      Straining with a bowel motion

·      Persistent heavy lifting

·      Repetitive coughing

·      Putting on too much weight.

Like all exercises, pelvic floor exercises are most effective when individually tailored and monitored. The exercises described are only a guide and may not help if done incorrectly or if the training is inappropriate.

Weight Gain During Pregnancy

It's normal for women to gain some weight during pregnancy due to the growth of the fetus, placenta and amniotic fluid.

Eating for two is the term we seem to hear a lot when you’re pregnant, however you have to remember that that second being growing inside of you is not the same size as you!

This is what many women seem to forget once they fall pregnant. They forget to watch their weight and constantly say to themselves “I am eating for two”.
Yes that is correct, yes it’s ok to put on weight during your pregnancy! However you must remember there is healthy weight gain and then there is unhealthy weight gain during your pregnancy.

Once again every woman’s pregnancy journey is different and no two women have the same body, therefore weight gain needs to be assessed by your obstetrician to ensure you and your baby are healthy and growing well.


What is considered ‘healthy’ & ‘unhealthy’ weight gain during pregnancy?

The amount of weight that a woman can expect to gain during pregnancy varies depending on the woman’s existing weight and height.
The table below shows recommendations for total and average rate of weight gain during pregnancy, by pre-pregnancy BMI.

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Eating for ‘two’

When eating in general it is important to keep in mind what you eat and the nutritional value of the food.

Tip: Eat to fuel your body.

This is vital especially when you are pregnant.

To put this into perspective eating 100gr of M&M’s chocolate with a nutritional value of 30gr Sugar (refined sugar) & 10gr Fat, as you can see there isn’t really anything good about having this ‘snack’ apart from stopping a sugar craving. Where as when you compare this to a 100gr of a red delicious apple the nutritional value is only 10.4gr of sugar and NO fat; keep in mind this natural sugar and there is also plenty of vitamin C and fiber in that apple.
Now I’m not saying that you shouldn’t have any sweets or treats at all, but what I am saying is to be mindful about what you eat on a DAILY bases.

As stated above depending on our weight pre-pregnancy this will determine how much weight you should/can put on during each trimester.
Naturally you will put on weight as your baby, placenta and amniotic fluid grow.

Have your chocolate or piece of cake but don’t forget it might be a good idea to go for a walk afterwards, or limit how many ‘treats’ you have each week.
(For exercise tips see my previous blog 'Exercising During Pregnancy').

Remember you aren’t just eating that apple for you, but for your growing baby as well. Your baby definitely doesn’t need a packet of chips or slice of cake every day.

So be mindful and be smart with what you choose to fuel your body and baby with.

As to what you can and cannot eat whilst pregnant this is discussed at your first appointment with Dr Suzana and all information is included on your USB we provide our patients with.

Exercising During Pregnancy

All women who are pregnant without complications are encouraged to participate in aerobic and strength-conditioning exercises as part of a healthy lifestyle during their pregnancy.

There are many benefits from exercising regularly during pregnancy. These include physical benefits and the prevention of excessive weight gain, as well as benefits for psychological wellbeing.

Before you start any exercise program you must speak to your obstetrician to make sure that you do not have any health issues that may stop you from participating in regular exercise during your pregnancy.

For those women that may be worried there is no actual evidence to suggest that regular exercise during a healthy pregnancy is harmful to the woman or her baby, therefore you are encouraged throughout your pregnancy to participate in regular aerobic and strengthening exercises.


Suggested exercise activities during your pregnancy

It is recommended that you are active most days if not every day. However, if you are currently inactive or overweight, you should start with 3-4 days per week on non-consecutive days.

There are two types of exercises that you are encouraged to do whilst pregnant, aerobic and strengthening exercises.

Aerobic exercises involve continuous activities that use large muscle groups and raise the heart and breathing rates.
Some examples of aerobic exercises include:

·      Brisk walking
·      Stationary cycling
·      Swimming and other water based activities like aquarobics (avoid heated spas & hydro pools)

Strengthening exercises suggest being performed 2 times per week, on non-consecutive days, this covers the main muscle groups of the body.

You can use light weights, body weight or elasticised resistance- bands.
Some examples of Strengthening exercises include:
·      Pelvic floor exercises
·      Yoga, stretching & other floor exercises
·      Pilates
·      Pregnancy exercise classes

Important tip: pelvic floor exercises are vital to begin conditioning the pelvic floor muscles from the start of your pregnancy as these muscles are weakened during your pregnancy and during vaginal birth.

It is important to continue with these throughout your pregnancy and resume as soon as you are comfortable after birth (consult with your obstetrician).


Exercises to Avoid

A list of exercises you should avoid include:
·      Abdominal trauma or pressure activities such as weightlifting or heavy lifting
·      Contact or collision sports such as martial arts, soccer, basketball (other similar sports)
·      Hard projectile object such as hockey & cricket
·      Falling such as skiing & horse riding
·      Extreme balance such as gymnastics
·      Major changes to pressure such as scuba diving
·      High-altitude training over 2000m
·      After your first trimester you should not perform any exercises lying flat on your back
·      It is also recommended to avoid walking lunges & wide squats as they can cause injury to the pelvic connective tissue.

If you are not sure whether a certain activity is safe during your pregnancy, you must check with
your obstetrician at your antenatal appointments.
 

Warning signs when exercising during pregnancy

If you experience any of the following during or after physical activity, stop what you are doing and contact or obstetrician or GP, or in an emergency go straight to your booked hospital.

·      Headache
·      Dizziness or feeling faint
·      Heart palpitations
·      Chest pain
·      Swelling of the face, hands or feet
·      Calf pain or swelling
·      Vaginal bleeding
·      Contractions
·      Deep back, pubic or pelvic pain
·      Cramping in the lower abdomen
·      Walking difficulties
·      An unusual change in your baby’s movements
·      Amniotic fluid leakage
·      Unusual shortness of breath
·      Excessive fatigue
·      Excessive muscle weakness.

For any further questions please speak to your obstetrician at your antenatal appointments.

Miscarriage

The loss of a pregnancy can be a very difficult time for a woman and her family. 
Miscarriages are more common than you may think, and something that no woman should feel embarrassed or ashamed about as miscarriages affect about 1 in every 5 pregnancies.

What is a miscarriage?

Miscarriage is very common in the first few weeks of pregnancy.
They can occur so early in a pregnancy that a woman may not know that she was pregnant. However most occur within the first 10 weeks of gestation. Once a healthy pregnancy has reached 10 weeks, the risk of a miscarriage decreases but can still occur.

When a miscarriage occurs, eventually the pregnancy tissue will pass out of the body. Some women will feel cramps, period-like pain and in most cases there will be vaginal bleeding (you must consult with your obstetrician).

Causes of a miscarriage

The cause of a miscarriage is often unknown. Generally,  at least half of all miscarriages occur because the fetus was not developing properly. In this case, miscarriage is nature’s way of dealing with an abnormal embryo. Nothing can be done to prevent miscarriage from occurring if a pregnancy is developing abnormally.

Risk Factors

- Age (the risk increases in women older than 30 years of age, with a significant increase in women over 35; at age 40 the rate of miscarriage  increases to about 1 in every 2 pregnancies).
- Previous miscarriages
- The use of some medications (speak to your obstetrician about what you are taking)
- Use of alcohol, cigarettes and/or drugs
- Previous surgery, abnormalities or trauma to the uterus
- Fetal chromosome abnormalities
- Some medical conditions in the mother, such as poorly diabetes, fibroids or thyroid problems, can lead to miscarriage. Rare medical conditions which affect blood clotting can also cause miscarriage. Women who have three or more miscarriages in a row should be checked for these conditions.

Diagnosing Miscarriage

Women seek medical care at different stages of a miscarriage; sometimes the miscarriage has already happened and sometimes it has only just begun.

Although signs and symptoms may vary, they may include vaginal bleeding, abdominal cramps and pain, and the passing of tissue.

To confirm that you have had or are having a miscarriage your obstetrician will look at a number of things, including:

- your symptoms; such as pain and bleeding
- examination results
- ultrasound and blood test results

After an examination has been done by your obstetrician, then they can advise on what steps need to be taken next.

Preventing miscarriage

Miscarriages can happen to the healthiest of women; however, being healthy will increase your chances of a healthy pregnancy.
What you can do to limit this is to follow the advice for a healthy pregnancy:
- don’t smoke
- limit your caffeine intake
- avoid alcohol
- try to avoid contact with others who have a serious infectious illness

The Emotional Impact

There are a wide range of emotions that women may feel after having a miscarriage. A miscarriage may cause intense grief and depression, that could be for a brief or long lasting amount of time. 
It has been reported that many women feel:
- emptiness & failure
- anger & guilt
- disbelief & sadness
- disappointment & loss.

Women will often struggle with feelings of self-blame & wonder whether they could have done anything to cause or to prevent their pregnancy loss.
Grief is a normal and valid reaction for the woman and her partner. They need to allow time to grieve and come to terms with the loss. The time it takes to grieve and understand varies for each individual.

Doctors agree that a miscarriage is almost never caused by anything the woman did or failed to do. In most cases the next pregnancy will be a success.

If you feel you need to speak to someone but don't know where to turn, just visit the Beyond Blue website or call them on 1300 224 636.

After a miscarriage

- Rest for a few days
- Avoid using tampons and having sex for about 2 weeks
- Depending on your obstetricians advice you may consider becoming pregnant any time after the normal menstrual cycle has resumed.

It is normal to seek help from a physiologist or counsellor if you are finding it hard to come to terms with the loss of your pregnancy.
Please see our 'Useful Link' page for links that may help you. 

 

What is an Obstetrician?

Choosing an obstetrician can be one of the most difficult decisions for a woman to make. It is essential that a woman chooses an obstetrician that aligns with her individual preferences. Before choosing an obstetrician, there are a number of questions you need to ask. So let’s start with the basics.

WHAT IS AN OBSTETRICIAN?

An obstetrician is a doctor who specialises in pregnancy, childbirth and a woman’s reproductive system. Obstetricians specialise in taking care of women from conception through to delivery, covering all aspects of the pregnancy journey.

It must be noted that obstetricians provide a number of services for women during pregnancy, which include:

  • Monitoring the health of your child by conducting regular tests
  • Regularly assessing patients for health conditions that may cause problems during pregnancy, which include high blood pressure, diabetes and any other genetic disorders
  • Providing diet, exercise and medical advice for patients to ensure they remain healthy during pregnancy
  • Providing care for common symptoms of pregnancy which include morning sickness, stomach pains and other common complaints

HOW TO CHOOSE AN OBSTETRICIAN

As mentioned, it is pivotal that women choose a doctor who aligns with their individual preferences. You may need to ask yourself questions such as:

  • Will I be more comfortable with a male or female doctor?
  • How much can I afford to spend for treatment?
  • Will my doctor support my desire to aim for a drug free birth?
  • Will my doctor support my birthing preference (e.g. hypnobirthing)?

It is essential that you ask yourself necessary questions such as these before choosing an obstetrician to support you during your pregnancy journey.

WHEN SHOULD I FIRST VISIT AN OBSTETRICIAN?

Well it’s simple, as soon as you believe you may be pregnant! Here it is recommended that women undergo an initial physical examination to ensure you receive the care you require. Traditionally, most doctors won’t schedule a visit until around the two month mark of your pregnancy journey, although it is recommended that you schedule an appointment to visit your doctor immediately if you are experiencing symptoms such as vaginal bleeding, abdominal pain, or severe nausea and vomiting.

The sooner you schedule an appointment with your obstetrician, the smoother your pregnancy journey will be, as they will assist you in determining the most effective treatment plan for you.

Early pregnancy indications

Missing a period

One of the earliest indications that a woman is pregnant is missing a period. However, there could be other reasons for menstruation to be delayed, such as stress, illness, excessive weight gain or anorexia, or coming off of an oral contraception pill. In some women polycystic ovarian syndrome can be a condition that causes irregular periods and sometimes very infrequent periods.

Breast tenderness

Some women, especially multi-gravidas, know that they are pregnant just by the give away sign of breast tenderness. As early as a few days after conception the breasts begin to enlarge in order to get ready for breastfeeding. They feel heavier and sore, especially on touch. There is sometimes a tingling sensation and this disappears several weeks later.

Morning sickness, nausea and vomiting

Feeling nauseous is a quite common complaint in early pregnancy and is experienced by the majority of women in early pregnancy, especially around five to six weeks. For most women this symptom disappears at around 14 to 16 weeks of pregnancy. However, there are a small number of women who have hyperemesis throughout the pregnancy.

Tiredness

Many women feel very tired during pregnancy, especially at the beginning. They find that they need much more rest and they need to take a nap several times during the day. However, the frequency of napping lessens after 14 weeks.

Changes in taste and smell

Certain foods can cause sudden queasiness or you may start to crave particular foods. Sometimes women may have a metallic taste in their mouths.

Constipation

Constipation is a common symptom in early pregnancy. However, this can be a continuing symptom throughout the pregnancy. This is caused by the high levels of progesterone which relaxes the bowel and slows the digestion.

Mood swings

Pregnant women can be overtly emotional. This is a secondary effect from a flood of pregnancy hormones.

Frequent urination

Early in the pregnancy there is pressure from the enlarging uterus onto the bladder and this is literally reducing the capacity of the woman’s bladder. At about 14 weeks the uterus rises up into the abdomen and most women start having the urge to urinate frequently which can be annoying. This is a very good time for you to start doing your pelvic floor exercises if you haven’t already started.