Preparing for Pregnancy

I'm in my early 30s so have lots of friends and family who are starting or expanding their families with babies. It's an exciting time in life and so lovely when we get to meet the bubs and watch them grow into little people. There are so many things to consider when having a child. I thought I'd focus on some of the things you can do to best medically prepare yourself and your body for pregnancy.

Firstly, it's a good idea to see your family doctor for a medical check-up. This is particularly important if you are taking any medications as they can cross the placenta into the baby. Some medications are safe, some should be used with caution and some should not be taken at all during pregnancy. By discussing your medications with your doctor before you start trying to become pregnant, you can weigh up the risks and perhaps even change to a medication known to be safe with plenty of time. Don't forget to mention over-the-counter medications and herbal or complementary medicines as these can also affect your baby.

You should also discuss immunisations with your doctor. If you are unsure about what immunisations you have had, you can organise blood tests to check your immunity status. It is important that you are fully immunised against chicken pox, influenza, measles, mumps, rubella, diphtheria, tetanus and whooping cough. If you require any 'live' vaccines such as measles, mumps, rubella or chicken pox, you should wait one month before trying to become pregnant. It is also a good time for any other people who live with you to update their immunisations too as this will reduce the risk of these diseases being passed on to your baby.

It is recommended that women who are intending to become pregnant take 0.5mg of folic acid for one month before pregnancy and at least the first three months during pregnancy. Folic acid has been proven to reduce to risk of neural tube defects such as spina bifida. Some women, such as those with a family history of spina bifida or cleft palate or are taking medication for epilepsy, are recommended to take higher doses. Once again, speak to your doctor.

Some women choose to take a multivitamin either before and/or during pregnancy. Discuss this with one of our pharmacists at Berwick Pharmacy as excess amounts of certain vitamins such as Vitamin A can actually be harmful to your baby.

Iodine is a mineral which helps with the development of the thyroid hormone. Iodine is found is most breads as well as eggs, meat, dairy and seafood. It is also in some pregnancy multivitamins. Women who are pregnant should switch to iodised salt (rather than uniodised salt) when cooking.

No completely safe level of alcohol consumption has been determined for pregnant women. Many women choose to abstain from alcohol completely and some will allow the occasional drink. Keep in mind that there is a higher risk if alcohol is consumed early in the pregnancy, including the time prior to the first missed period. Speak to your family doctor or obstetrician with any concerns.

If you are a smoker, it's the perfect time to quit. Smoking can increase your risk of miscarriage and stillbirth and babies of mothers who smoke are at a higher risk of low birth weight, being born prematurely and Sudden Infant Death Syndrome (SIDS). Our pharmacists at Berwick Pharmacy can discuss options with you to help you to quit.

It's wise to limit your caffeine intake if you are trying to become pregnant as there is evidence that it can decrease fertility. Don't forget that caffeine is also present in some soft drinks and energy drinks. Guarana, an ingredient also often in energy drinks, is not recommended during pregnancy.

If you are pregnant, you also need to be aware of the potential risk of Listeria and Salmonella infection. The risk of catching these bacteria is small, but it can be dangerous if it passes to your baby. Always practice good food handling hygiene and if you are eating reheated food such as leftovers, make sure it is piping hot. Avoid foods such as soft cheeses, cold cooked chicken or deli meats, whole egg, pate, soft serve ice-cream and raw seafood.

It's also worth having a dental check-up prior to becoming pregnant as generally, procedures such as x-rays aren't recommended during pregnancy. If you are planning on having your baby in a private hospital, you should also check your level of health insurance and make sure you are aware of any waiting periods.

So yes, there's lots to think about, but by doing some groundwork in advance, you're giving yourself, and your baby, the best start to life. Pop into Berwick Pharmacy anytime for advice on pregnancy or any other

health issues. We even sell home pregnancy tests for when the time comes.

Here's a cute cartoon I found...

References and further reading

• Immunisation and Pregnancy Fact Sheet, Better Health Channel, published July 2011 (accessed online 22 March 2012)
• Pregnancy and Drugs Fact Sheet, Better Health Channel, published March 2010 (accessed online 22 March 2012)
• Preparing for Pregnancy - Your Health Fact Sheet, Royal Women's Hospital, published January 2008 (accessed online 22 March 2012)
• Food Safety During Pregnancy Fact Sheet, Royal Women's Hospital, published January 2012 (accessed online 22 March 2012)

Nappy Rash

Babies. Such a little word. Such little beings.

Someone wise once said to me that when you have children, you’ll never know a life without worry ever again, not even when they’re all grown up with children of their own. And now I know that’s true. There’s always something – they’re teething, they’re not eating, they never stop eating, they’re not sleeping, they’re sleeping too much, they’re unwell. And that’s before they hit puberty and bring a whole new barrel of issues with them!

I thought I’d start with a post on a condition that is really common in babies – nappy rash. This is one of those issues that suddenly becomes very important when you have a baby or you’re caring for one who is affected by it. Luckily, it’s relatively easy to treat.

On a side note, this is as good a time as any to send out a massive thank you to everyone who helps care for and raise children, especially grandparents. I know we would be in serious trouble without The Munchkin’s four wonderful and doting grandparents! Not just for their help looking after The Munchkin (allowing us to work and even the occasional date night out), but also for all their advice and support since she was born.

Back to nappy rash. Nappy rash is caused by irritation to the skin, usually as a result of contact with baby’s urine and faeces, and especially when it’s prolonger contact. Chemicals such as soaps, detergents and nappy creams can also lead to or exacerbate the rash. If your baby has sensitive skin or a skin condition such as eczema or psoriasis, they are more likely to get nappy rash. Some babies are prone to nappy rash when teething or unwell.

Basic nappy rash shows up as red, swollen and sore-looking skin in the nappy area. Usually the folds of the skin (and who doesn’t love a baby with rolls on their legs?) remain unaffected as the moisture doesn’t get in. It can be painful for baby and they may be very unsettled as a result, especially in the bath or overnight (as if there wasn’t already enough things to blame for sleep problems!).

If the rash is shiny with a sharply defined edge and little white spots surrounding it, it is likely it is infected with a fungus called candida (thrush). This may also spread to the creases, bottom, thighs and tummy and may be accompanied by a thrush in the mouth (oral thrush). In this case, speak to your pharmacist about an appropriate antifungal treatment for any affected areas, both in the nappy area and in the mouth.

If the rash is weeping or has yellow crusts and is accompanied by a fever, it’s probably infected with bacteria and you’ll need to consult your doctor for antibiotics.

Some babies get nappy rash no matter how well they are cared for, and some babies never seem to be affected by it. If your baby does get nappy rash, it is a relatively simple condition to treat and will generally clear up within 2-3 days of treatment. It makes sense that since moisture causes nappy rash, we need to keep the area as clean and dry as possible in order to treat and avoid it.

Important points to remember:

• Check baby’s nappy often and change it immediately if baby has done a wee or poo
• Gently clean the area with water or a specialised mild baby cleanser (chat to your pharmacist). I keep a spray bottle (the types hairdressers use which can be bought for about $1) filled with water on the change table. We also found using cooled chamomile tea was really soothing and gentle when The Munchkin was younger and had a bad flare-up.
• Pat skin dry, rather than rubbing it which can further irritate the skin. Try and avoid disposable wipes at these times as they can irritate the area further.
• You can use a baby powder (ones specifically for the nappy area, not talcum powder) to help keep the area dry.
• Apply a barrier cream all over the area, concentrating on the red spots. Your pharmacist can help you choose an appropriate one.
• Try and give baby some nappy-free time during the day. I used to pop The Munchkin on a towel on her change mat on the floor. Expect the occasional wee or poo accident. This got more challenging when she started rolling and then crawling, but her skin cleared up by then so didn’t need as much nappy-free time.
• Use non-soap bath lotions and oils in the bath to help soothe baby’s skin. Your pharmacist can help with selection. This is also important for babies with eczema or psoriasis. 

What about cloth nappies? Well, I’m proud to say that we’ve used cloth nappies on The Munchkin since birth (although she now has eco-disposables at night) and the evidence says that due to the very clever materials which absorb moisture whilst still allowing the skin to breathe, they have a lower incidence of nappy rash than disposables. Some babies are actually sensitive to the chemicals in disposables. If your baby does get nappy rash with cloth nappies:

• Wash at least every two days.
• Make sure they are thoroughly rinsed and dry before using.
• Allow them to dry in fresh air and sunlight as often as possible. The UV in the sunlight helps kill any bacteria.
• Avoid waterproof covers as these can make the area hot and sweaty.
• If using barrier creams with cloth nappies, use a liner (washable or flushable) as the creams can accumulate in the nappy and reduce the absorbency.

   

Consult your doctor if:

• The rash spreads outside the nappy area.
• The rash has not improved after five days of treatment.
• The skin is broken and the rash is severe.
• Signs of a bacterial infection are present (e.g. weeping, pus, yellow crusts, blisters).
• Baby has a fever, is very unsettled or is not feeding as well as usual.

If you’re in the area, please pop in and have a chat with the pharmacists at Terry White Chemists Berwick about all your health, and especially baby needs. The four owners are all pharmacists (and have 7.5 kids between them, ranging in age from their mid-twenties to one due in September!) and two of the other pharmacists are also mums. All our pharmacists would be pleased to help you choose the right products to help clear up and prevent nappy rash. And don’t forget to ask for a free Self Care Card to take home. They contain helpful information and tips and are available on a range of health topics, including nappy rash.

References and further reading

• Nappy Rash Self Care Card, Pharmaceutical Society of Australia, published February 2011
• Nappy Rash Fact Sheet, Better Health Channel, published 2011 (accessed online 26 July 2011)
• Nappy Rash article, Professor Frank Oberklaid and Dr Leah Kaminsky, Raising Children Network (accessed online 26 July 2011)
• Rash Decisions - Why Does Using Cloth Nappies Help Prevent Nappy Rash?, My Green Nappy (accessed online 26 July 2011)