Sleep Guide for Pregnancy – by Kayla Johnson @Tuck Sleep

Original article – Pregnancy and Sleep. 

If a pregnant woman is ‘eating for two’ whenever she sits down for a meal, then it’s also true that she is ‘sleeping for two’ every time she goes to bed. Pregnancy can significantly reshape the sleep architecture of expecting mothers, often for the worse. Sleep disorders such as insomnia, sleep apnea and restless leg syndrome are somewhat commonplace. Furthermore, physical symptoms of pregnancy like cramps and nausea, as well as the general discomfort of carrying a child to term, can greatly exacerbate sleep-related conditions.

Pregnancy in measured in three stages known as trimesters, beginning with the first day of the woman’s last menstrual cycle and ending with the birth of the child roughly 40 weeks later. This guide to pregnancy and sleep will discuss the various sleep developments and concerns that arise during each individual trimester, as well as postpartum sleep issues and the sleep habits of unborn fetuses.   

First Trimester

We begin with the first trimester, which spans the first 12 weeks of a standard pregnancy. Within days of fertilization, the fertilized egg will grow into a larger cellular body known as a blastocyst and attach itself to the inner wall of the uterus.

This implantation will trigger a spike in your body’s level of progesterone, a natural hormone that regulates the various stages of your reproductive cycle. Progesterone is considered a soporific hormone, meaning that it can induce early sleep onset. As a result, higher levels of progesterone can lead to both excessive daytime sleepiness and disrupted sleep at night. These feelings of fatigue can be so strong that you may mistake them for cold or flu symptoms, and the hormonal changes may cause you to develop insomnia symptoms. Sleep onset insomnia refers to difficulty falling asleep at normal bed times, while sleep maintenance insomnia is the difficulty remaining asleep. Increased progesterone levels can lead to either type of insomnia.   

Additionally, the blastocyst will apply pressure on your uterine wall, which is located near the bladder. This pressure, along with the progesterone boost, will make you feel the need to urinate much more frequently. Nighttime bathroom visits will become part of your routine during the first trimester. Strangely enough, bladder pressure has also been linked to lucid dreams (or vivid dreams) in pregnant women. Both of these factors may impact your ability to remain asleep through the night.

The third through eighth weeks of the first trimester, known as the embryonic stage, are characterized by significant bodily changes for the mother and baby. As its major organs begin to develop, the embryo will grow to up to one inch in length. These adjustments will cause your to experience serious cramping, particularly in the pelvic region, and your breasts will begin swelling as your body prepares for nursing. These aches and pains can easily disrupt your sleep, as well. Additionally, pregnant women in their first trimester often experience excessive nausea, an affliction commonly called morning sickness.

By the ninth week, the embryo will have grown into a fetus, and the uterus will be the size of a large tomato. More cramping, swelling and discomfort typically occur in the four remaining weeks of the trimester.

Here are a few tips for reducing physical pain and getting enough sleep during your first trimester:

  • Nap frequently to counteract the effects of your rising progesterone levels during the first trimester. Experts suggest napping in the afternoon in order to maintain your nighttime sleep cycle; two catnaps, each lasting between 30 minutes and an hour, are considered more effective than one long nap.
  • Exercising in the morning can also help you maintain healthy sleep cycle.
  • Avoid consuming large amounts of fluid in the evening. This should reduce your urge to urinate in the middle of the night.
  • If you experience morning sickness, try snacking on light, salty foods like popcorn or pretzels.


Second Trimester

The second trimester is the longest, usually lasting from the 13th week to the 27th week. Your experience during the second trimester will largely depend on whether or not this your first pregnancy. First-time mothers often begin to feel the baby move at 18 to 22 weeks, but women who have already given birth may notice these sensations earlier in the trimester. At any rate, the fetus will grow considerably over the course of this trimester; by week 27, the average fetus is 10 inches in length and weighs more than a pound.

The second trimester is considered the best trimester in terms of the mother’s sleep patterns. Your body will be mostly acclimated to the rising progesterone levels, so daytime fatigue and sleep onset problems are usually less prominent. Morning sickness is also uncommon after the first trimester. This is the best time to establish a healthy sleep schedule, you’ll need it during the third trimester.

However, you may encounter some physical symptoms during the second trimester that negatively impact your sleep. Heartburn, for one, is quite common during this period, and lying down can often increase the discomfort of acid reflux. Nocturnal leg cramps can also be an issue, particularly pains in the calf muscles. Although these will probably become more pronounced during the third trimester, cramping often begins during the second. Many pregnant women experience cramping at night, which can lead to sleep disruption. If you’re prone to lucid dreams, then you can expect these to intensify during the second trimester, as well.

Another concern during the second trimester is preeclampsia, a complication characterized by high blood pressure. Preeclampsia symptoms typically begin to materialize after 20 weeks of pregnancy; these symptoms include headaches, light sensitivity, nausea, shortness of breath and decreased urination. Preeclampsia is somewhat rare, but the condition can be fatal for both the mother and the fetus.

Follow these guidelines and you should sleep soundly and remain healthy during the second trimester:

  • Avoid eating and drinking certain things to ensure these second-trimester symptoms won’t be too severe. Spicy or fried food can lead to heartburn flare-ups, while soft drinks and other carbonated beverages can worsen the effects of leg cramping.
  • Try to stand or sit upright for at least four hours after eating in order to ease the digestive process and mitigate your heartburn.
  • If you experience a leg cramp in bed, try flexing your leg and/or foot muscles to relieve the temporary pain.
  • Consult your physician immediately if you begin to experience symptoms of preeclampsia, or notice a sharp rise in your blood pressure levels.


Third Trimester

Last ‘but definitely not least’ is the third trimester, which begins during the 28th week and lasts until childbirth. The average pregnancy spans 40 weeks in length, but some mothers may deliver their baby as late as week 42 or 43.

The third trimester is a period of extraordinary fetal growth. Unfortunately, these developments can cause major aches and pains for expecting mothers. The majority of pregnant women experience severe lower back pain during the third trimester due to the excess weight around their midsection, and leg cramping may become more intense. Frequent urination spells will also return as the fetus expands and eventually settles in the the lower pelvic region. All of these factors can seriously disrupt sleep routines; the vast majority pregnant women wake up between three and six times each night during their third trimesters. For this reason, the third trimester is considered a more extreme version of the first.

In addition to insomnia brought on by physical discomfort, pregnant women in their third trimester are also prone to other serious sleep disorders. Roughly 20% of pregnant women will experience restless leg syndrome (RLS), a condition characterized by painful tingling or itchy sensations beneath the skin. RLS symptoms can strike at any time, but are most commonly reported at night or after long periods of sitting. RLS has been linked to iron and folate deficiencies, so your doctor may prescribe supplements to alleviate some of the symptoms. However, there is no cure for RLS. The good news: in most cases, RLS symptoms disappear after childbirth.

Obstructive sleep apnea (OSA) is another commonly reported sleep disorder among women in their third trimester. OSA occurs when your airway is partially or completely blocked, causing shallow breathing or loss of breath during sleep. Many women snore during pregnancy due to swollen nasal passages, and snoring can quickly evolve into OSA, particularly in women who were obese prior to their pregnancy weight gain. OSA in pregnant mothers is a serious issue because the lost air supply can lead to hormonal surges powerful enough to compromise fetal health. OSA has also been linked to an increased risk for preeclampsia.

During your third trimester, it’s important to prepare for the worst sleep of your pregnancy and make yourself as comfortable as possible leading up to bedtime. Here are a few tips for making it through the third trimester with your body, and sanity, intact.

  • Reduce fluid intake in the late afternoon or evening.
  • Make sure to completely empty your bladder during your final urination of the day. Leaning completely forward while peeing can help.
  • Stay away from anything that irritates your digestive system, and consume plenty of iron-rich foods to help stave off RLS and excessive leg cramping.
  • Stretching and light exercise before bed can help you fall asleep more quickly.
  • Sleep on your left side to relieve pressure on your lower back. This will also boost your breathing circulation and help prevent apnea.
  • For maximum comfort in bed, place pillows between your knees, behind your back and beneath the underside of your stomach.


Postpartum Sleeping

The period immediately following the birth of your child is commonly referred to as the ‘fourth trimester’. The fourth trimester, like the three trimesters of pregnancy, is often characterized by sleep-related issues. However, these issues have less to do with physical changes to your body, and more to do with your newborn’s sleep schedule.

As any new parent will attest, caring for a newborn can be an exhausting task. On average, babies wake up every three to four hours, although this varies considerably from child to child; some newborns will wake up on an hourly basis. Attending to your baby’s needs can quickly take its toll on your mind, body and mood, not to mention sleep schedule. Plan on getting up throughout the night in the weeks and months after your baby is born.

Postpartum depression (PPD) is another important concern during the fourth trimester. PPD is characterized by extreme anxiety and/or depression in mothers who have recently given birth, although roughly half of women diagnosed with PPD begin experiencing symptoms during pregnancy. Crashing progesterone levels and other hormonal changes can lead to PPD, as well as genetic predisposition, stress and other environmental factors. Like any other major stressor, PPD when left untreated can lead to severe insomnia.

Here are a few final tips for getting an adequate amount of sleep during the crucial phase known as the fourth trimester.   

  • Allow your baby to sleep in a crib or bassinet near your bed. This allows you to easily tend to your baby in the middle of the night, rather than getting up and walking to a different area of your home.
  • Breastfeed if possible. Natural breastfeeding triggers a hormone called prolactin, which can induce sleepiness.
  • Alternate nighttime duties if you are raising the baby with a partner. This will allow both of you to get more sleep on a weekly basis.
  • Don’t ignore the early warning signs of postpartum depression. These include sadness, irritability, loss of appetite, inability to concentrate and sleep onset problems. Consult a physician as soon as you begin to experience these symptoms.



During your pregnancy, it is imperative for you to get enough sleep – difficult as that may be at times. You can greatly reduce the risks of insomnia and other sleep disorders by following the guidelines listed above throughout all three trimesters of your pregnancy, as well as the critical fourth trimester period. If you have a newborn or infant at home, check out our Parent’s Guide to Healthy Sleep.

Diaphragmatic Endometriosis

Endometriosis is a common condition that results from uterine lining tissue growing outside of the uterus, including on the diaphragm in rare cases. While diaphragmatic endometriosis may not cause symptoms, severe growths can cause chest, neck, and shoulder pain and can interfere with breathing.

This video shows an advanced endoscopic surgery on laparoscopic excision of diaphragmatic endometriosis.


Tips & Tricks for Laparoscopic Surgery Recovery

Recovering from laparoscopic surgery is different for everyone. Each of us heals differently. Patient expectation, extent of surgery, length of surgery, the surgeon and the facility all play a role in how someone recovers after laparoscopic surgery.

Laparoscopy is usually done under general anaesthesia. It is a “key-hole” with a small incision made near the belly button and the abdomen is filled with CO2 gas. This lifts the abdomen and gives the gynaecologist a better view into pelvic organs. The following information will help answer frequently asked questions and will help you understand some of the common experiences that may occur after your surgery.

Length of stay

Laparoscopy is usually performed as a day stay basis, but an overnight stay may be required if the surgery is complex or lengthy. If a bowel resection or partial bowel resection is performed, your hospital stay may be extended by several days. Some may take only a few days to recover from a laparoscopy, but others may take several weeks to heal completely.

Activity after surgery

There are no standard rules in regards to activity after laparoscopic procedures.  In some cases, your doctor may restrict driving for two weeks. Only begin driving when you feel strong enough to be able to stop the vehicle in an emergency, otherwise have someone drive you. Swimming and bathing will also be restricted. You can use the stairs if you feel you are able. Use common sense when starting routine exercise after surgery and gradually advance your activity.nail place

Every woman is different, hence differing degrees of recovery. You will probably be very tired and need lots of naps. You should NOT be bedridden. You will recover more quickly if you move about.

Sex activity

Intercourse should be avoided for two to four weeks, depending on your surgery. If you had a hysterectomy or surgery in the vagina, you should avoid intercourse for a minimum of six weeks to allow the top of the vagina to fully heal.


You may take a shower the day after surgery. kids nail

Wound care

Keep your wound dry and clean. No special creams or ointments are needed. Your incisions are closed with a suture underneath the skin, which will dissolve on its own. It is then covered with “derma-bond”, a surgical-glue. This protects the incision and will stay in place for two weeks or longer. The glue can be removed by using soap and water and gentle scrubbing. A small amount of bleeding at the incision sites is not uncommon.

Some patients will develop bruises at the incision sites. This is due to “the trocars”, a plastic sleeve, which can cut tiny vessels just beneath the skin. It will resolve by itself. Pain around the incision sites is not uncommon and will resolve over several days. You may feel “pins and needles” at the incision site due to the nerves being cut. These nerves will heal.

Vaginal bleeding

Vaginal spotting may last for several weeks and should resolve.  However, heavy bleeding, increasing bleeding or foul smelly discharges is not normal and you should seek medical advice.

Sore throat

Some patients will have a sore throat from the tube that is placed during anaesthesia. Throat lozenges or warm tea will help soothe the discomfort, and this will resolve within a few days.

Pain following surgery

When you come out of the anaesthesia in the recovery room, you may be in some pain. Be sure to speak up so your pain can be properly managed. Coming out from anaesthesia will also make you feel cold. Ask for more warm blankets if you’re chilly. In most cases, you will be given a prescription for pain medication to take at home. If possible, have this prescription filled prior to your discharge.

Rule of thumb“Pain should resolve over time and will get better every day”.

The first several days following surgery, take some regular paracetamol and ibuprofen at home. Prescription drugs should be used sparingly as they can cause constipation. Narcotic analgesia can sometimes help with sleep at night. Using a heat pack on the lower abdomen is safe. Coughing can be uncomfortable. Placing a pillow on the abdomen to support your abdomen while coughing can be helpful.

Shoulder pain

The carbon dioxide gas used to inflate the abdomen during the laparoscopy can irritate the phrenic nerve. This is caused by carbon dioxide gas trapped against the diaphragm (breathing muscle). This irritation is felt as pain in the lower chest and up into the shoulder area which known as “referred pain”. The pain can occur during deep breaths. This type of pain can be quite uncomfortable and may last several days. It will eventually resolve on its own but can be aided by walking and moving around. Massage, cold/heat pack and simple analgesia (such as ibuprofen or paracetamol) often bring the quickest relief.

If the pain does not resolve or becomes worse, it is important to rule out other causes of chest pain, such as heart or lung issues.

Abdominal discomfort/ bloating

Some degree of abdominal distension (swelling) is to be expected after surgery. This is due to distension of the intestines and resolves over time. Intraperitoneal gas pains are caused by gas trapped outside of the intestines, but inside the abdominal cavity.

Manipulation of bowels during laparoscopic surgery can leave the bowels ‘stunned’. General anaesthesia can slow down the bowels, preventing the passage of gas and stool. Walking encourages the peristaltic movement of the bowels, relieving gas and constipation. A heat pack may also provide relief. If you are allowed to drink, hot peppermint tea is a great remedy to help gastrointestinal motility and relieve painful gas pains.

Post-op blues

You may experience a period of emotional ups and downs following surgery such as crying easily, or feeling anxious, agitated, frightened or suspicious. It can remain for several weeks and it is not unusual. All of this will pass in time and you will begin to feel in control again.


Nausea after laparoscopy is very common. Anaesthesia drugs are the main cause for nausea immediately after surgery. After the first 24 hours, nausea is likely related to pain medication or antibiotics.  Many medications exist to help. Some can be taken before surgery, during or after surgery. Talk to your gynaecologist and/ or anaesthetist about the ways to minimise nausea. Ginger tea may help.

Loose clothing following surgery

Wear loose-fitting, comfortable clothes during the first few weeks after laparoscopy. The incision site will be tender and the abdomen swollen so try not to aggravate it with tight clothing.

Things to watch following surgery

  • Fever higher than 38 degrees
  • Shortness of breath
  • Dizziness
  • Heavy vaginal bleeding
  • Severe pain not relieved with pain medication
  • Persistent nausea or vomiting
  • Increased pain, redness, or swelling at the incision
  • Severe diarrhoea, bloody diarrhoea, or diarrhoea is accompanied by fever or worsening pain
  • Inability to pass urine

Always go to your nearest hospital if an emergency visit is necessary post-operatively.

For more details contact:

Dr Donald Angstetra

Obstetrician/Gynaecologist/Advanced Endoscopic Surgeon

Suite 18, Level 1, Gold Coast Private Hospital

(07) 5594 9496



FAQ on recent HPV test replacing pap smear test

The new cervical screening known as HPV test, promises to save more lives than outgoing Pap smear



What do you need to know about changes to the Pap smear?

As of 1st December 2017, Pap smear examinations were favourably replaced with the HPV test in order to improve early detection of cervical cancer and ultimately save lives. We now know that the vast majority of cervical cancers are caused by a virus – the human papillomavirus, or HPV – and in the absence of this virus, cervical cancer is extremely rare.  The HPV test looks for the presence of the virus that is known to cause cervical cancer. If any of these cancer-causing subtypes are found, further testing is done on the same sample to look for evidence of the abnormal cells that can be a precursor to cervical cancer.

This is done in the same way that a Pap smear used to be analysed, although the technology has changed.

What does this mean for you?

Women will now be tested every five years, instead of every two, commencing at the age of 25 (instead of 18) and will continue until she is 74 years old (instead of 69).

If HPV subtypes are found (which are responsible for around 70 percent of cervical cancers), then the woman is automatically referred for a colposcopy. This involves examining the cervix directly with a special microscope to look for those same abnormalities.

If there is no sign of abnormal cells, these women will most likely to be asked to return for another test in 12 months.

But if no evidence of HPV infection is found, then the woman has another five years before she needs to have another HPV test.

There is an option of self-collection for certain women who for some reason or another, don’t want someone else to perform the swab.  It will still be done in a health-care setting, perhaps under the supervision of a nurse.

What is HPV?

– HPV stands for Human Papillomavirus

– It is a cancer-causing virus; however, not everyone infected with HPV develops cancer

– HPV is a very common sexually transmitted infection with up to 80% of adults will be infected at some point

– Many adults do not know they are infected and goes away by itself

– There are more than 120 types of HPV viruses

– Some HPV types cause warts — such as genitalia warts; others cause cervical, penile, anal, vulva and vaginal cancers.

– HPV16 or HPV18 causes the most cancer cases.

Is the new HPV test actually better than the Pap smear?

New research has found that DNA screening for the HPV virus is more effective than a Pap smear for detecting pre-cancerous cells.  The HPV virus causes about 99% of cervical cancer cases.  It is a more accurate test and can detect potential problems earlier. The health modelling had shown HPV testing would reduce cervical cancer deaths by up to 30%.

Do you still require the test if you have been HPV vaccinated?

Yes. The HPV vaccine does not protect against all the types of HPV that cause cervical cancer. Even if you’ve had the HPV vaccine, you should be tested.

Will you definitely get cervical cancer if you test positive for HPV?

No. In fact, four out of five people have at least one type of HPV at some time in their lives without realising.

HPV is a very common sexually transmitted infection which usually causes no symptoms or signs, and goes away by itself.

So, what happens if you test positive?

If the new test detects HPV infection, the lab will look for abnormal cell changes, called a reflex liquid-based cytology (LBC).

The combined results of the HPV test and the LBC test (if performed) will determine a woman’s risk of developing cervical cancer and her clinical management.

If you test positive for HPV, you will need to be monitored closely for potential cell changes.

Will problems be missed by only testing every five years?

The new evidence about cervical screening has demonstrated that screening for HPV every five years is more effective, and just as safe as, screening with a Pap test every two years

Screening for the presence of HPV virus has advantage as it detects a potential problem much earlier The HPV infected cells which can lead to cervical cancer, are often take more than 10 years, nail place

The participation rate is likely to increase with this new program as women will only be invited for cervical screening on a five-yearly basis, rather than every two years.

However, if you have an unusual bleeding or abnormal discharge at any time, you should see your gynaecologist.



Exercise During Pregnancy – Dr Donald Angstetra, Obstetrician & Gynaecologist


How to stay fit and healthy? – A Guide to Pregnant Women


The benefits of exercise during pregnancy

Exercise during pregnancy lifts your well-being and prepares you for labour and childbirth. According to the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), a routine sensible exercise is safe and beneficial during pregnancy. Exercise can help to relieve some aches and pains and also pregnancy-related symptoms such as tiredness, leg cramps, constipation and weight gain.  Exercise during pregnancy boosts mood and improves sleep. It also prepares you for childbirth by strengthening muscles and building endurance, making easier to get back in shape after you give birth. Research suggests that prenatal exercise may also lower the risk of developing gestational diabetes and preeclampsia. If you have been diagnosed with gestational diabetes, exercise can help you manage to control your sugar levels.


Changes during pregnancy

The body undergoes some physical changes during pregnancy which may affect the response to physical activity such as

•  Pregnancy increases weight and change in body shape; hence it alters body balance and co-ordination.

•   During pregnancy, the body releases hormones called Progesterone and Relaxin. It softens the ligaments, allowing the pelvis to expand in preparation for childbirth. All joints become less stable hence the risk of injury increases

•   Pregnancy increases demands on cardiovascular system. The heart has to pump more blood and the heart rates increases in order to adequately supply Oxygen to the baby.

•   Pregnancy hormones and gravid uterus that pushes the diaphragm (muscle between chest wall and abdomen) upwards can make breathing more difficult.

•   Core temperature rises about 1oC during pregnancy. Coupled with an increased in core temperature during exercise, means pregnant lady must be careful not to overheat as prolonged overheating can be harmful to the baby.


Exercise activities that are safe for expectant mother

•   Walking : Routine walking will keep you fit. It is safe to do throughout pregnancy.

•   Swimming : Swimming is the best and safest exercise for pregnant women. Swimming is ideal because it exercises both arms and legs, provides cardiovascular benefits, reduces swelling and allows you to feel weightless despite all the extra pounds you’re carrying. It can be helpful for low back pain.

•   Aerobics : Aerobic exercise strengthens your heart and tones your body. Many centers offer aerobics classes designed specifically for pregnant women and have instructors who can offer expert guidance on safe exercise.

•   Dancing : Get your heart pumping by dancing to your favourite music. Avoid routines that call for leaps, jumps or twirls.

•   Running : Going for a jog is an excellent way to exercise your heart and build endurance during pregnancy. It is better to start at a slow pace on shorter routes before gradually building up to 30-minute runs.

•   Yoga : Yoga can maintain muscle tone and keep you flexible with minimal impact on your joints. Yoga gives your heart a workout. Prenatal yoga can help to stay in shape and practice important breathing techniques for labour and birth.

•   Cycling : Cycling early in your pregnancy is safe if you are already comfortable on a bike. However, it is probably best to stick to stationary bikes later in pregnancy.

•   Stretching : Stretching is a great way to keep your body relaxed and prevent muscle strain. Add stretching to your cardiovascular exercises to get a complete workout.


Things you should NOT DO…

1.      Lie on your back

 As your pregnancy advanced, the weight of your uterus puts pressure on a major vein called inferior vena cava. It can reduce blood flow to your heart and may reduce blood flow to your brain and uterus. This can make you dizzy or short of breath. You can avoid this by putting pillows or a foam wedge behind your back to lift your body while you exercise.

2.      Overdo it

You should feel like you are working with your body, not punishing it. If you feel completely drained instead of invigorated after a workout, you are probably overdoing it. Don’t exercise until you are exhausted. In general, the best guideline is to listen to your body. Always stop if something hurts.

3.      Exercise in high heat or humidity

Avoid exercising in hot or humid conditions during pregnancy. Avoid activities such as doing Bikram yoga or “hot Pilates”.  Increased blood flow and a higher metabolic rate during pregnancy can make your body harder to regulate the core temperature. As a result, you may get overheated much faster than you normally would.

It is important to watch symptoms such as excessive sweating, feel uncomfortably warm, nauseated, dizziness or short of breath. To cool off quickly, stop exercising, take off layers and go someplace with air-conditioning or step into a cool shower. Hydrating is important so drink plenty water.

4.      Dangerous sports

Avoid contact sports or some other activities that might throw you off balance and cause a fall (such horse riding, surfing or skiing). All pregnant women should avoid scuba diving – babies in the womb aren’t protected from the effects of pressure changes.


Things you should DO…

1.      Eat enough calories

Exercise burns calories, so be sure to eat well to nourish and strengthen your body. When you are pregnant, you naturally gain weight as your baby grows. The amount you need to gain varies based on your pre-pregnancy weight.

If your body mass index (BMI) is in a healthy range (20-25), you will need to eat about 340 calories/day more in the second trimester than before you were pregnant and 450 calories/day more in the third trimester. If you’re underweight or overweight, you may need to gain a little more or less than someone with a healthy BMI and adjust your calorie intake accordingly.

2.      Wear the right clothes

Wear loose-fitting, breathable clothing. Make sure your maternity bra is supportive enough and choose athletic shoes that fit properly. You may need to get a new pair as your feet have changed because of mild swelling.

3.       Warm up

Warming up prepares your muscles and joints for exercise and increases your heart rate slowly. If you skip the warm-up and jump into strenuous activity before your body is ready, you could strain your muscles and ligaments and have more aches and pains after your workout.

A good way to warm up is to go slowly with your chosen activity and gradually increase its intensity after the first five to eight minutes. This prepares the muscles you will be using for more vigorous movement.

4.       Drink plenty of water

Drink water before, during, and after exercise to prevent dehydration. Dehydration can reduce blood flow reaching the placenta. Dehydration can also increase your risk of overheating or even trigger contractions.

There is no guideline on how much water pregnant women should drink while exercising, but many experts recommend a simple technique by checking the colour of urine to determine you are well hydrated. Dark yellow urine is a sign of dehydration.

5.      Get up from the floor slowly

Your centre of gravity shifts as your belly grows. It is important to take extra care when you change positions. Getting up too quickly can make you dizzy and may cause you to lose your balance.

6.       Make it a habit

Make a commitment to exercise regularly. Keeping up a routine is easier on your body than long periods of inertia interrupted by spurts of activity.


It is important to be cautious throughout your exercise. You should learn which activities to avoid during your pregnancy so that it can keep you – and your baby – healthy and safe.

Always check with your obstetrician, GP or midwife about your exercise routine to make sure your activities don’t put you or your baby at risk. If you exercised regularly before getting pregnant and your pregnancy is uncomplicated, you can probably continue with a few modifications.


Iron for Pregnant Women – Dr Donald Angstetra, Obstetrician & Gynaecologist


Studies show that 50 percent of pregnant women do not have enough iron in their body. The iron demands during pregnancy and breast feeding are particularly evident due to the expanded red blood cell volume, demands of the developing baby and placenta and blood loss around the time of delivery.

The recommended daily intake (RDI) of iron for women aged 19 to 50 years is 18mg per day.  For pregnant women, this RDI increases to 27mg per day; whilst for breastfeeding women, the RDI decreases to 9mg. This is thought to be due to the fact that the lactating mother cannot increase the iron levels in her milk by eating iron rich foods or taking supplements. Also menstruation does not normally resume until after 6 months of exclusive breastfeeding.

What is the role of iron in the body?

Iron is found in haemoglobin, a substance in the red blood cells that carries oxygen in the body.

Your body makes more blood when you are pregnant due to the demand from baby. It needs iron to make healthy blood.

A blood test that looks at haemoglobin (Hb) level is usually offered at the first antenatal visit and again at 26-28 weeks’ gestation.

Having low iron levels may result in anaemia. Any anaemia should be investigated and treated. Low iron will make you feel tired, have poor concentration and an increased risk of infection. Very low iron levels may cause low birth weight of the baby.

iron in food

There are two forms of dietary iron: Iron from animal foods (called haem iron) and iron from plant foods (called non-haem iron). Haem iron is absorbed 10 times better than non-haem iron. It is found in animal foods that originally contained haemoglobin such as red meats, fish and poultry. Red meats are the best source of iron; the redder the meat, the higher the contents of iron.

This means beef, kangaroo and lamb are higher in iron than pork, chicken or fish. Red fleshed fish, such as tuna and salmon, are higher in iron than white fleshed fish.

Most non-haem iron is from plant sources:

  • Wholegrain, iron-enriched breads and cereal foods.
  • legumes (such as lentils, beans, chickpeas) and nuts
  • green leafy vegetables (such as spinach, broccoli)

Our bodies are less efficient at absorbing non-haem iron than haem iron from animal foods. You will need to eat more of these foods if they are your only iron source.

To help your body absorb more iron from plant foods, eat it along with foods that have a high vitamin C content (fruits and vegetables).

For a detailed look at animal and plant-based iron-rich foods, head to the Nutrition Australia website:

How can I improve my iron intake?

While some foods can help our bodies absorb iron, others can prevent it. Tea, coffee, unprocessed bran and various mineral, herbal and other medications can block iron being taken up by the body.

Routine iron supplementation is not recommended in every pregnancy. Iron supplementation will generally be recommended for women at particular risk of iron deficiency. This includes when a blood test has confirmed that your levels are low, vegetarians or women with a multiple pregnancy.

Women with iron deficiency anaemia will need additional iron supplementation, containing at least 60mg of iron daily.

Women commonly experience constipation from taking iron tablets. You can manage constipation naturally by:

  • eating more fruits, vegetables, wholegrains, legumes
  • drinking more water
  • remaining physically active

For more information on the recommended daily intake for iron requirement in pregnancy, head to the National Health and Medical Research Council – Nutrient Reference Values for Australia and New Zealand website:

Ways to improve your diet for adequate iron intake:

  • Check that you are regularly eating animal sources of iron — the redder the better.
  • Include wholegrain and iron fortified foods (e.g. cereals or wholemeal toast).
  • Include vitamin C containing foods at meals (e.g. orange juice).
  • Check to make sure you limit the iron blockers.
  • Talk to your GP, midwife or obstetrician about taking iron tablets.

What to do if your iron levels are still low:

You should talk to your doctors or midwife to have your Haemoglobin (Hb) level checked during antenatal visit and any anaemia should be investigated and treated. Your doctor should consider iron studies if the haemoglobin is 105 g/L or less or red blood cells are microcytic (small); B12/folate levels if the red blood cells are macrocytic (big). Testing for Thalassaemia (haemoglobin electrophoresis) should also be considered where appropriate.


Chinese Confinement Practice – Dr Donald Angstetra, Obstetrician & Gynaecologist



Doing the Month – Culture Behind the door of Chinese Postnatal Confinement

Chinese postnatal confinement, known as 坐月(zuò yuè, “sitting the month”), with its many strict traditional rules prompts many debates and online discussions. New mothers are often experience conflicts between the cultural traditions of their parents and the western ideas. On occasion, this can even lead to tension between pregnant women and their mothers or even mothers-in-law.

Dr Donald Angstetra, a leading Gold Coast Obstetrician of Chinese descent has extensive first-hand experience helping parents though this clash of cultures and norms. “An appreciation and understanding of the different approaches and ideas is invaluable in helping both the women and their care providers through this very special and important time in their families’ life” Dr Angstetra said. “Learning about our past and the rationale for practices can help us to plan better for this time and smooth the transition to motherhood.”

The culture of Chinese postnatal confinement dates back 2000 years to the Han Dynasty. In the past two centuries, westernised women with Asian descent have abandoned these traditions due to disbelief as they are irrelevant to the so-called modern world. Yet somehow, this specific traditional belief stubbornly survives.

Zuo yue – ‘Sitting the month’

Chinese believe that confinement includes a strict post-natal period whereby mother and baby are “quarantined” at home for a month. It is practised in various Asian cultures across mainland China, Taiwan and South-East Asia. It helps new mothers recover from the rigorous pregnancy and child birth. It is believed that women who do not have a good recovery often suffer postnatal issues like severe fatigue, lower back pain, insomnia, and hair loss. These symptoms can often last for months or even years after the pregnancy.

Help during Confinement

Traditionally, a women’s mother or mother in law will take care of her during the confinement period, some women even return to their childhood home. Other new mothers will hire a confinement nanny (pui yuet), who will help them and their baby during this period. It is also common that husband and wife are separated for the month.

Confinement taboos and restrictions

While some women consider confinement practices to be old fashioned and opt to not follow the more restrictive practices, many others do welcome the enforced rest built into this tradition.

Chinese confinement restrictions include:

Chinese confinement diet. These include ginger and a traditional tonic brewed with herbs. They are believed to promote better blood circulation and strengthen the joints.

No washing your hair for the entire confinement period. Avoiding exposure to “cool” elements such as cold water or air-conditioner. Chinese believes that women who have just given birth are more susceptible to cold air, so it’s not uncommon for mothers to refrain even from washing themselves.

Bathing only in specially prepared warm water that is infused with herbs.

Mothers are not meant to leave the home or show off their baby until after their one-month confinement period. Visitors are not welcome.


The clash of two cultures is most pronounced over this confinement practice, and can lead to a turbulent transition in life for new mothers. In deciding upon your approach to this period in your life, Dr Angstetra explains that “Those who grew up in families with strong Chinese heritage sometimes suddenly realise that the information about confinement they were given growing up  was unclear, and often confusing. You should do some research yourself, think about what you would like, and whatever your options, do what is comfortable and makes sense to you”.


Nutrients of importance during pregnancy – Fiona Brown, dietitian


Folate (or folic acid) is needed for the growth and development of your baby, even before you know you are pregnant. It is especially important you take a vitamin supplement containing 500mg folic acid for at least one month before you fall pregnant and for the first trimester (three months) of pregnancy. Studies show that a good intake of folate can help to significantly reduce the risks of neural tube defects (such as spina bifida) in babies, as well as help, prevent preterm birth. Dietary sources high in folate include green leafy vegetables such as broccoli, spinach, bok-choy and salad greens. Also be on the lookout for breads and cereals with added folate and include these as part of a healthy diet.


Large amounts of iron are essential to form the red blood cells for you and your baby. It helps to carry oxygen in your blood and is needed for your baby to grow. During pregnancy, you need a lot more iron that when you are not pregnant and it is best to get the iron you need from your diet. Iron from animal food sources is absorbed more easily than iron from plant foods. The best sources of iron are lean meats (especially red meat), some vegetables (especially leafy greens), legumes and cereals with added iron. If you are vegetarian or vegan then talk to your dietitian to make sure you are getting enough iron from your diet. Eating foods rich in vitamin C at the same time as iron-rich foods will help to increase the absorption of the mineral by your body. For many women, getting enough iron is difficult during pregnancy so you may require a daily iron supplement. To enhance the absorption of the iron supplement, take in between meals with a fruit juice that is rich in vitamin C. Some foods and fluids may reduce the absorption of iron from your supplement or your diet. These include tea/coffee with meals, taking your iron supplement with a meal that includes milk, cheese or yoghurt and/or foods high in fibre (e.g. two tablespoons of unprocessed bran) and a high intake of antacids can all limit or reduce the absorption of iron.


Adequate iodine intake during pregnancy is essential for your baby’s growth and brain development. It is recommended that all pregnant women should take a supplement containing 150mcg of iodine and also increase their intake of iodine-rich foods. These foods include fruits and vegetables, bread with added iodine, seafood, eggs and iodised salt.


Fish is a safe and important part of a healthy diet during pregnancy. It not only provides protein but it’s low in saturated fat, high in omega 3 fish oils and is a good source of iodine. Omega 3 oils are important for the growth of your baby’s brain and eye development. It is very important to eat fish when you are pregnant but you need to be careful about the fish you choose. Some fish may accumulate mercury, which may be harmful to your baby’s developing nervous system

The Food Standards Australia New Zealand have set the following recommendations for safe fish intake:

Pregnant women (one serve = 150grams):

Limit of one serve per fortnight of shark (flake) or billfish (swordfish/broadbill/marlin) and NO other fish that fortnight.


Limit of one serve per week of orange roughy (deep sea perch) or catfish and NO other fish that week.


Two-three serves per week of any other fish and seafood not listed about.

(Information obtained from a consensus document developed by Queensland

Healthy Eating During Pregnancy – Fiona Brown, dietitian

Healthy eating during all stages of life is important, especially during pregnancy.  The choices you make regarding what to eat and drink at this time can affect your health and the health of your baby.

Whilst you are “eating for two”, there is only a small increase in the amount of food you need to eat while you are pregnant.  It is more important to focus on making good food choices for a healthy nutritious diet that provides you and your baby with the essential nutrients required to promote healthy growth and a healthy pregnancy.

Your daily food requirements during pregnancy are outlined in the table below:

Food Group Number of serves per day 1 serve equals…
Vegetables, legumes and beans 5 ½ cup cooked green or orange vegetables (e.g. broccoli, carrot, pumpkin or spinach)½ cup cooked, dried or canned beans, chickpeas or lentils (no added salt)1 cup raw leafy green vegetables½ medium potato, or other starchy vegetable (sweet potato, taro, or cassava)½ cup sweet corn

75g other vegetables e.g. one small-medium tomato

Fruit 2 1 piece medium sized fruit (e.g. apple, banana, orange, pear)2 pieces smaller fruit (e.g. apricot, kiwi fruit, plums)1 cup diced, cooked or canned fruit½ cup 100% juice30g dried fruit (e.g. 1½ tbsp sultanas, 4 dried apricot halves)
Grains (mostly wholegrain) 1 slice of bread½ medium bread roll or flat bread½ cup cooked rice, pasta, noodles, polenta, quinoa, barley, porridge, buckwheat, semolina, cornmeal⅔ cup breakfast cereal flakes¼ cup muesli

3 crisp breads

1 crumpet or 1 small English muffin or scone

Lean meat and poultry, fish, eggs, nuts, seeds, legumes and beans 65g cooked lean red meats (e.g. beef, lamb, pork, venison or kangaroo) or ½ cup lean mince, 2 small chops, 2 slices roast meat80 g cooked poultry (e.g. chicken, turkey)100 g cooked fish fillet or 1 small can fish, no added salt, not in brine2 large eggs (120g)1 cup (170g) cooked dried beans, lentils, chickpeas, split peas, canned beans

170g tofu

1/3 cup (30g) unsalted nuts, seeds or paste, no added salt

Milk, yogurt, cheese and/or alternatives (mostly reduced fat) 1 cup (250 ml) milk40g (2 slices) hard cheese (e.g. cheddar)120g ricotta cheese200g yoghurt
Additional serves for taller or more active women 0–2½ Additional serves from the five food groups or 3–4 sweet biscuits30 g potato crisps2 scoops ice cream1 Tbsp (20 g) oil


(Information obtained from a consensus document developed by Queensland Dietitians