Dr. Charry Hemmings

Well, it's about time!

Ramadan starts next week and pregnant Mums may wonder what to do during this special time.
It seems that Islamic law states that pregnant and breast feeding women are not required to fast.
Islamic leaders tell us that pregnant women are allowed to fast if they are sure it will not harm themselves or their unborn child. This leaves the decision up to the individual woman.
We doctors strongly recommend that pregnant women who have any other medical concern should definitely NOT fast. Things like vomiting, diabetes, high blood pressure, twins, pre-eclampsia, or any infection in pregnancy should be a reason to not fast.
Click on the article for some good information for pregnant women who are healthy, feel well, and would like to fast:

Ramadan Fasting During Pregnancy: All You Need To Know Is fasting during pregnancy safe? What is the Islamic view on fasting during pregnancy? Here are some tips for pregnant women to fast safely during Ramadan.

Toddler milks are less nutritious, way more expensive, and contain heaps more sugar than cow milk.
Under 12 months, babies should have breast milk, or formula if needed. After 12 months, cow milk is best for those without cow milk allergy.

Toddler milks aren't necessary for most toddlers, and may actually have some drawbacks. The marketing of these products make it abundantly clear that they contain a range of essential nutrients. But the ads aren't providing the full picture: https://bit.ly/345Svml

Passive immunity is when baby gets immunity from Mum before birth, without the baby being vaccinated.
This is a small study, but of babies admitted to intensive care for COVID, 88% of babies had unvaccinated mothers while only 12% of babies had vaccinated mums.
Unprotected babies had 7 times the chance of needing intensive care than babies protected by Mum's immunisation.

Vaccinating Pregnant Women For COVID Seems to Give Future Protection to Their Babies If a pregnant woman catches COVID, it's very rare for the virus to be passed through the placenta to the fetus.

Here is a good guide to early baby feeding.
We recommend babies have only milk for the first 4 months, and that solids be started at 6 months.
From 4-6 months, it is OK to offer baby a small taste if baby really seems to want solids, then only a slow, small increase in the amount until 6 months.
Some babies really are interested in solids at 4 months, and others are not interested at all until 6 months.
It is important that baby's first foods are rich in iron. The article gives lots of good suggestions.

A guide to introducing your tot to new food textures If your baby doesn't like something at first, don't worry!

Supplemental feeding without baby getting used to the bottle:
Breast feeding supply lines give baby a supplemental feed during breastfeeds.
These thin tubes tape next to Mum's ni**le so baby receives milk from the breast as well as milk from the feeding tube.
If Mum has a low supply, supplementing with a bottle can make baby prefer the "easy" sucking from the bottle, causing baby to reject the breast.
The feeding lines let baby continue to suck at the breast, but get some extra milk as well.
These do not suit every breast feeding pair, but it is one more option.
More info here, which also links to the Royal Womne's Hospital info sheet on using a supply line.

https://www.abc.net.au/everyday/breastfeeding-supply-line-saved-this-mum/100802102

Belinda's breastfeeding was saved by a contraption few women know about - ABC Everyday After Belinda's newborn son was losing weight, she knew he needed more than just breastmilk. Now, thanks to a simple tube, she formula feeds and breastfeeds her son all at the same time.

Here is a long but informative piece on our normal vaginal discharge.
Many women have more mucus discharge in pregnancy, and that is normal as well.

Vaginal discharge is healthy. Unnecessary 'female hygiene' products are not Knowing what's going on inside your underwear is private, but understanding what happens down there is important for your health, and staying "fresh" is not always best.

The nasal swab RATs are more common, but the saliva tests require a saliva sample, not a sample of what you recently had in your mouth!

Updated advice for consumers with rapid antigen tests that use saliva to test for COVID-19.

It is important that you do not eat, drink, smoke, brush your teeth, or chew gum for 10-30 minutes before collecting saliva for a rapid antigen test as it may produce an incorrect result. You should refer to the instructions provided with your kit for the recommended timing.

Find out more:
https://www.tga.gov.au/covid-19-rapid-antigen-self-tests-home-use

Nausea When Breastfeeding
One of our new Mums gets nausea when breastfeeding.
This is not common, but is most likely a result of the hormone oxytocin released during the feed, that allows the milk to "let down".
The nausea usually settles down well before the 6-week postnatal check.
This helpful link gives more information: https://www.todaysparent.com/baby/breastfeeding/what-causes-nausea-while-breastfeeding-and-how-to-treat-it/

What causes nausea while breastfeeding—and how to treat it Nobody said that nursing would be easy, but what if you’re feeling downright sick? We’ve got some expert advice on how to deal with breastfeeding nausea.

How to do a RAT test
Some of you will be swabbing your children for school. The swab will be uncomfortable, but not at all painful if done correctly.
Both the pathology PCR tests and the home RAT tests should be swabbed the same way.
Aim straight BACK , not UP the nose.
Go in slowly, about 2 cm, twirling to get a good sample of snot and nasal mucus.
Click on the link for Dr Levi's video.

Dr Eric Levi on Twitter “How do you do a Rapid Antigen Test on a child? Here you go! (Quick vid due to time) Wash hands, blow nose. Kid’s head on arm/pillow. Swab hand resting on chin or cheek in case sudden moves. GO LOW, GO SLOW. Gentle twirl 1-2cm for 10-15 seconds. Do other side. Take care! https://t.co/zfnGFlHlTp....

Accidental Home Birth.
Casey has an excellent home birth program with our Casey Hospital midwives, but some patients with planned hospital births do not make it in time..
This is more common with second and third deliveries.
Think of all the stories you have heard about babies being born in the car or accidentally at home. The babies are always well, aren't they? Unwell babies tend to have a slower labor, so most unwell babies are born in the hospital. If your labor is super quick, then most likely baby is well and healthy.
If you have to push with contractions, don't get in the car. Call 000 and the person on the end of the phone will stay on the line with you and give you instructions until the ambulance arrives.
Baby is wet once she arrives, so pop baby on Mum's tummy and cover them both with a towel or sheet to keep baby warm.
Leave the cord and the placenta alone. The ambulance folk will deal with it once they arrive.
The link has more info:

'I can see the head': Meet a couple who had an accidental home birth - ABC Everyday When it's plainly obvious that the baby is coming, help isn't going to arrive and you're not going to make it to the hospital, you might need a crash course in midwifery.

We girls can make a big difference here.
Menstrual cups instead of tampons, period underwear with washable pads instead of throw-away pads, and some cloth nappies replacing some disposable nappies.

The war on single-use and plastic products is in motion. Many companies are answering the call to arms with reusable household products that claim they are better for the environment because they can help you reduce waste.

We've listed down some alternative materials and their pros and cons here: https://bit.ly/3AaORTL

Check the fridge for these.

Saputo Dairy Australia is conducting a recall of various butter and spreadable butter blend products sold under Devondale and Woolworths brands. Anyone who has consumed this product and is concerned about their health should seek medical advice. Otherwise, return it to the place of purchase for a full refund.

Recall notice: https://bit.ly/3qHF8Ba
More details: https://bit.ly/3nIOISC

Getting a COVID Vaccine After COVID Infection
Some folk have had COVID in between scheduled COVID vaccines.
As our knowledge of COVID increases, our recommendations change as well. Science works like that. As COVID is still "new" and is changing, we should not be surprised that our recommendations change, and often we don't know what is exactly the best scientific recommendation.
I have condensed what we know into these points:
1 ---- All countries and scientists agree we should NOT have the vaccine during an illness. Your vaccine or booster should definitely be put off until you are feeling well.
2 ---- The UK / England recommends waiting for 28 days after COVID diagnosis to have the next dose or the booster.
3 ---- Most states in the USA recommend having the next scheduled dose 30 - 60 days after COVID infection. (depending on the state)
4 ---- Evidence shows we are likely to be at least partially protected from another COVID infection for 6 months after a COVID infection.
5 ---- Our own Australian Technical Advisory Group on Immunisations recommends that one should have their scheduled COVID vaccine as soon as they are fully-recovered from a COVID infection. They advise that once recovered, it is safe to have a COVID vaccine immediately, and this should be done not more than 6 months of the infection being diagnosed.
Lots more info here:

So you've had COVID. When should you get a booster or vaccine? As Omicron cases soar, many people are faced with having to re-book their vaccination appointments. Here are some principles to help you decide when to lock it in, writes Margie Danchin.

Many things can make your menstrual cycle change.
Changing jobs, moving house, and going on holidays can all make a normal, healthy woman's period up to a week late with no harmful consequences.
Having a vaccine can also make your period a few days late.
The average change after the first COVID vaccine is for your period to be half a day late, while after the second COVID vaccine the average was almost a day late. This means that some women will have their periods right on time after a vaccine, while others will be up to a week late.
Don't panic and go out to buy a pregnancy test - give your body a week to settle!

Don't Freak Out if a COVID Vaccine Slightly Changes Your Period Cycle, Says Study Women vaccinated against COVID-19 saw a slight delay in their period of almost a day compared to those who were unvaccinated, a US government-funded study said Thursday.

Headaches are Common.
There are many kinds of headaches.
Most headaches, even those in pregnancy, are not serious.
Severe headaches, worse than you have ever had, should be assessed in Emergency immediately.
Here is more info on headaches:
https://theconversation.com/when-should-you-go-to-hospital-for-a-headache-a-doctor-explains-how-to-tell-if-its-an-emergency-161276?utm_medium=email&utm_campaign=Latest%20from%20The%20Conversation%20for%20December%2029%202021%20-%202162221409&utm_content=Latest%20from%20The%20Conversation%20for%20December%2029%202021%20-%202162221409+CID_446021d53061c8070e2cb1cde6af4a4d&utm_source=campaign_monitor&utm_term=When%20should%20you%20go%20to%20hospital%20for%20a%20headache%20A%20doctor%20explains%20how%20to%20tell%20if%20its%20an%20emergency

When should you go to hospital for a headache? A doctor explains how to tell if it's an emergency As a GP, bad headaches are among the most common topics I’m asked about. Here’s how you can assess whether to stay home, see a doctor — or head straight to emergency.

I had few toys as did my sons.
If your children have too many, then rotating them is a great idea.
It is better to have a few "good" toys of wood or metal, than have heaps of plastic ones.
The article has great information:

Why kids should not have lots of toys — and what to do if yours have too many Apart from environmental concerns, having lots of toys can negatively impact children as well as parents and carers. Here are some ideas for dealing with existing toys, as well as the upcoming influx of new ones, write Louise Grimmer and Martin Grimmer.

The transition from being a couple ( or a single ) to becoming a family with a tiny baby can come as a shock.
Baby Steps is a site for both new parents. It gives tips and recommendations to help with the big adjustment to parenting.
You have to sign in and create a password to access the info, but it is worth it to see what they have to offer.
Click to get to the website:

Baby Steps Most websites and services are mainly for mums but the adjustment is just as big for dads as it is for mums. Baby Steps is relevant for both parents.

Most add-on IVF services do not increase the chance of having a healthy baby.
This article has more info:

Testing embryos before IVF doesn’t increase the chance of a baby Genetic testing of embryos during IVF doesn’t increase the odds of having a baby. But there are a number of downsides, including cost.

Talking to your baby is important.
Tell baby what you are doing, what you want baby to do, and tell baby how very cute he/she is.
It doesn't really matter what you say, as long as baby hears your voice and hears how your language is put together.
Lots more here:
https://www.popsci.com/science/baby-talk-language-development/?utm_campaign=trueanthem_AI&utm_medium=social&utm_source=facebook&fbclid=IwAR3zXk3n_i-N00QcgZpmXBtKMHyyExPTrz_3JPZKP8MqSoWf-ymGwV_7r9A

Baby talk isn't just cute—it's critical for kids' vocabularies The high-pitched gibberish that constitutes baby talk plays an important role in language development for kids—and other young animals.

Cars Get Very Hot
We sometimes forget this in the winter.
Never leave your valuables in your car. You know, like your pets, your grandparents, or your children.
The fire brigade tells us a few tips to help avoid a disaster. Importantly, ALWAYS keep your car keys with you when getting children in or out of the car. If they lock themselves in the car along with the keys, it can be quite tricky to get them out.

With hotter days ahead, we'd like to remind parents and caregivers about the dangers of leaving children in the car.

We know that accidents do happen, so here's some tips to keep your kids safe.

Keep your keys on you at all times when getting children in and out of the car.

Never give keys to a child to play with while you’re getting them in or out of the car.

Always lock the car when it’s not in use, and don’t leave keys where children can reach them to prevent them gaining access to the car without an adult knowing.

Children have been forgotten in cars, particularly with rear-facing seats and where routines have changed. While it may seem like something that would “never happen to you”, it’s a good idea to keep your bag or phone next to the car seat as a reminder.

Even on a mild day, it only takes 5 minutes for the temperature inside a car to double. A child left in a car on a 30°C day could be suffering in 60°C heat and is at risk of life-threatening dehydration, heatstroke, brain injury, heart and lung failure, and death.

To avoid potentially tragic consequences, never leave your child in a car.

The same applies to pets the aged or infirm

Circumcision
Some of you wonder about circumcision for your son. It is not done for newborns in the hospital as it is not considered essential. The procedure is done privately in the doctor's office.
If you plan on circumcision for your son, be aware that it should be done in the first two months, preferably when baby is 3 weeks old or less. For premature babies, count from their pregnancy due date, not from their premature birthday.
Baby needs to have the routine vitamin K given in hospital to decrease the chance of bleeding.
You should chose someone who has much experience and does frequent circumcisions.
There are many doctors that perform circumcisions.
The two doctors that most of my patients use and who I know have excellent results are:
Dr. Hershel Goldman in Noble Park:
https://www.circumcisioncentre.com.au/index.htm
and Dr. Nick Demediuk in Keysborough "Dr Snip" : https://pmc.net.au/consultants-staff/doctors/

You should probably seriously consider circumcision if there is a boy in the family who had to have it done because of a tight fo****in. Doing a circumcision on an older boy who is having problems is much more painful, has more side effects, is riskier, and bleeds more than circumcision on a baby.
Heaps of info on circumcision here:
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/circumcision -deciding-on-circumcision

Circumcision Centre Melbourne Parents are faced with many important decisions throughout their child’s life on how best to establish the building blocks of optimum health, self-esteem and quality of life. A decision that is best considered early on in your son’s life is whether or not to circumcise. As parents have the legal...

Yes, parenting is tiring and difficult.
And it will make you smile and laugh like never before.
https://www.abc.net.au/everyday/nothing-prepares-you-for-how-much-your-kids-will-make-you-laugh/100647492

I was warned about sleep and nappies, but I hadn't prepared for this as a parent - ABC Everyday I was warned about sleep and nappies. But there’s one part of parenthood that nobody can prepare you for.

If you have asthma or if you were affected the last time we had a thunderstorm asthma epidemic, be sure to keep your reliever (Ventolin) handy, and don't forget your preventer.

A high-risk of epidemic thunderstorm asthma is forecast in Central Victoria today, including Melbourne. There is also a moderate risk across much of the state.

It’s important that you:
▪️ Monitor the VicEmergency app for information and warnings.
▪️ Carry your asthma medications at all times.
▪️ Go inside during the storm, and avoid the winds that come before it.
▪️ If you are experiencing mild asthma symptoms, contact NURSE-ON-CALL on 1300 60 60 24 for expert medical advice.
▪️ If your condition is urgent, not improving or getting worse, call Triple Zero (000). Call Triple Zero (000) if someone is not breathing.

More information:
https://www.health.vic.gov.au/environmental-health/epidemic-thunderstorm-asthma-risk-forecast

Hep B and Vitamin K Injections for Newborns.
Before you leave hospital or the next day for home births, you will be offered two routine injections for baby, Hep B vaccination and Vitamin K injection.
Hepatitis B is a common liver infection. If a baby gets Hepatitis B, it usually becomes chronic and lasts a lifetime. Hepatitis B infection is a common cause of cancer of the liver.
Vitamin K is needed to help the blood clot normally. It prevents hemorrhagic disease of the newborn which is rare, but causes severe bleeding and can be fatal.
More info from the Royal Women's Hospital here:
https://www.thewomens.org.au/health-information/pregnancy-and-birth/after-your-baby-is-born/tests-and-medicines-for-newborn-babies

How do you plan on getting to hospital in labor?
None of my patients have gone by bicycle so far.
https://edition.cnn.com/2021/11/28/asia/new-zealand-politician-labor-cycle-intl-hnk/index.html

New Zealand politician cycles to hospital in labor, gives birth New Zealand Member of Parliament Julie Anne Genter got on her bicycle early on Sunday and headed to the hospital. She was already in labor, and she gave birth an hour later.

This video shows and explains what your baby is doing at about the time you have your routine 12-13 week ultrasound:
https://www.youtube.com/watch?v=sivegxcp2Bk

Inside Pregnancy: Weeks 10 - 14 | BabyCenter Fingerprints and nails are forming, and eyes and ears move into place so your baby can squint and grimace.https://www.babycenter.com/pregnancy-week-by-week |...

Here are some things you may not know about added sugar, including the way your favourite products may mislead you, and where the sweet stuff might be lurking. https://bit.ly/3CduG7f

At Monash, we are on the cutting edge of medical research.
Monash is trialing using baby's own cord stem cells to improve the outcome for very premature babies.

In Australia, around 10% of babies are born preterm.

But for these little ones, who can be born as early as 24 weeks, the danger doesn’t stop there. For those who survive:

⚠️ 30-50% are at risk of long-term lung and brain complications
⚠️ 22% will have a moderate to severe disability
⚠️ 10% will develop cerebral palsy

Associate Professor Atul Malhotra, Consultant Neonatologist and Head of Early Neurodevelopment Clinic at Monash Children’s Hospital, said he is currently leading a ground-breaking program to use cell therapy in newborns.

“We are trialing cell therapy to treat respiratory and neurological conditions in preterm newborns,” he said.

“One such therapy is to take the baby’s own cells that can be taken from their umbilical cord after birth, which are then processed and given back to the baby to support their development.

“To develop these therapies and treat more babies, we need investment to establish the best cell therapy centre in Australia for the treatment of newborns.”

To help give preterm babies the best chance at life, and help fund ground-breaking treatments like cell therapy, please consider donating at https://monashhealthfoundation.org/2021christmas/

Some Stillbirths are Preventable.
Victoria has seen our stillbirth rate decrease by over 21%.
Our three Monash Women's hospitals at Clayton, Dandenong, and Casey have been leaders in making this happen.
Five interventions have made the difference:
-- Stop smoking advice and support
-- More ultrasound monitoring of small babies.
-- Educating Mums about monitoring baby's movements from 28 weeks
-- Encouraging side-sleeping from the third trimester
-- Recommending induction of labor for babies who are not growing well, are not moving well, or are very overdue.

https://www.abc.net.au/news/2021-11-10/simple-interventions-see-victoria-s-stillbirth-rate-decline-for-/100603472

These simple interventions saved 20 families from the tragedy of stillbirth, say experts Victorian maternity services using the Safer Baby Bundle program see a 21 per cent drop in stillbirths, with experts predicting it will save hundreds of babies every year once it is rolled out nationally.

Here is a post from Dec 2019 about placenta previa.

Placenta previa describes a placenta that has implanted low down in the uterus so the placenta covers the cervix.
This requires a caesarean delivery as labor will open the cervix so the placenta is not attached and bleeds.
Lots.
Low-lying placentas nearly always end up high enough to be out of the way and do not require a caesarean delivery.
We identify the placenta position at the 21 week scan. If the placenta is not 2 cm or more away from the cervix, we re-scan at 34 weeks to check if it is out of the way by then.
We cannot prevent placenta previa, but we know it is more common if the mother has had any uterine surgery, especially if she has had a previous caesarean birth.
Older mothers also have an increased chance of placenta previa.
More info here:
https://www.pregnancybirthbaby.org.au/placenta-praevia

"A sugar bomb dressed up as a healthy snack" is how Choice describes these lollies.
The label says it is made with "real fruit" but it is really made with concentrated fruit sugars.
The article explains that these contain more sugar than many lollies!
Read more here:
https://www.choice.com.au/shonky-awards/hall-of-shame/shonkys-2021/kiddylicious-strawberry-fruit-wriggles?utm_source=facebook&utm_medium=social&utm_campaign=shonkys21&fbclid=IwAR2QuHBjDbEEphi1DK-PvpnJlLUfCjyi9o0FiBUC3HLoAIi0odl7tWBHXsM

Kiddylicious Strawberry Fruit Wriggles – 2021 Shonky Awards | CHOICE We’ve called out a lot of sugary kids’ stuff over the years, but the Kiddylicious Strawberry Fruit Wriggles truly take the biscuit.

Nosebleeds in Pregnancy.
Nosebleeds are quite common, with about 1 in 5 women having a pregnancy nosebleed.
The hormone changes of pregnancy make blood vessels enlarge, even those inside your nose.
The enlarged blood vessels are prone to breaking, causing a nose bleed. These bleeds are usually short, less than 10 minutes, and are not dangerous.
The link explains what to do, and when you should see a doctor:
https://www.healthline.com/health/pregnancy/nosebleeds-while-pregnant

Nosebleeds While Pregnant: Causes, Treatment, Prevention Nosebleeds while pregnant are pretty common. We'll tell you why, and how you can treat and prevent them.

Miscarriage is Common
Sadly, about one in four pregnancies ends in miscarriage.
Although each couple experiences miscarriage differently, the emotional trauma of the loss of a baby does not settle quickly, and the painful memories last forever.
The link has an interview with two doctors who experienced multiple miscarriages, and there is a link to their podcasts that discuss miscarriage and stillbirth and the pain they cause.
https://www.abc.net.au/news/2021-10-15/podcast-pregnancy-uncut-breaks-silence-miscarriage-stillbirth/100532648

One in four pregnancies end in miscarriage. But do we know what that really feels like? "It's a loss of a little life, but it's not a little loss": These doctors have created a "soft place for the hard conversations" about pregnancies that haven't gone to plan.

Hip Dysplasia
This occurs when baby's hip joint is not firm and tight, so there is a risk of the hip joint becoming dislocated.
We have yet another baby with hip dysplasia in the clinic.
At baby's 6-week neonatal check we assess baby's hips to be sure the leg bone is firmly held in the hip socket.
All babies with uneven leg creases, all babies who were breech in pregnancy, and all babies who have a relative with hip dysplasia should have a hip ultrasound booked.
Hip dysplasia does not cause pain to baby, but if not treated, baby will have hip and leg and walking problems once she starts to walk.
Treatment as a baby usually involves a harness that improves the dysplasia in a few weeks. Occasionally with more severe dysplasia, a solid plaster cast is needed. Only rarely do little babies need an operation to fix this, but if left untreated, older children may need an operation.
Which of the babies in the photo is swaddled correctly?
More info here:
https://www.healthyhipsaustralia.org.au/services/useful-information/faqs/

FAQs About Hip Dysplasia - Healthy Hips Australia Questions are common after a diagnosis of hip dysplasia. What is hip dysplasia and how do I prevent it are frequently asked.

Safe Swaddling
Some new babies fall asleep faster and sleep better when they are swaddled; when their arms are wrapped up so they don't startle themselves awake, or hit themselves in the face while sleeping.
Wrapping baby's arms seems to re-create the comforting feeling of being tight in the womb again.
It is important that baby's legs need to be free to bend and flex, so babies should not be swaddled lower than the waist.
Wrapping baby's legs down straight puts pressure on the hip joint that can cause hip abnormalities and even hip dislocation.
The link below has more info, and a video on safe swaddling.
Important points are:
-Swaddle arms, not legs
-Baby needs to be on back, never on tummy when swaddled
-No swaddling once baby can roll over
-Sleep bags need to be roomy in the leg area so baby can spread legs apart.
-Use thin/light blankets to swaddle. Don't overheat baby.
Here is heaps more info and a video on safe swaddling:

https://www.healthyhipsaustralia.org.au/safe-swaddling-guidelines/

Safe Swaddling Safe swaddling guidelines to ensure healthy hip development for babies whilst swaddled.

I posted Choice magazine period knicker reveiw a week ago.
Now Kmart has its own brand, rated here:
https://www.choice.com.au/health-and-body/reproductive-health/womens-health/articles/kmart-period-briefs-review?utm_source=facebook&utm_medium=social&utm_campaign=kmartperiodreviews&fbclid=IwAR1E7auBdNn7hAuGHziDLCwHTCcfpQZU9xMJ0vT282QjfCN-bMB2FU6hiDs

Kmart period briefs review | CHOICE We trial Kmart's period bikini briefs and period full briefs to assess comfort and how well they work.