Dr Rahul Sen | Specialist care for birth and beyond | Sydney, Australia

Rooms : Edgecliff 02 9363 9474
Macquarie Street 02 9221 2600

All posts by Dr Rahul Sen

long-haul flight advice

Long-haul Flight Advice

Issues:

  1. Radiation: you are exposed to a small increase in the amount of exposure to background radiation
  2. Security: consider not only the customs and safety of the country you are visiting, but remember motor vehicle accidents are a leading cause of travel injury
  3. Water: drink only safe, bottled water
  4. Food: eat freshly and properly cooked food, and avoid street food and raw or under-cooked food
  5. Travel Insurance: make sure your travel insurance covers you for pregnancy complications
  6. Insect-borne infections: reduce your risk of mosquito and other infections by covering up, wearing DEET, using air-conditioning and avoiding dawn and dusk, which are common biting times
  7. Respiratory Infections: airports are hubs of infection, so consider wearing a face mask while transiting through airports
  8. Travel Letter: make sure you get a letter from me or from your GP dated within 10 days of your departure
  9. Deep Vein Thrombosis (DVT): the combination of pregnancy and long haul travel increases your risk of blood clots in legs or lungs, which can be serious

Strategies to reduce the risk of deep vein thrombosis:

Do:

Consume plenty of drinking water;

Use full length, surgical grade, stockings for the entire flight and until you are fully mobile;

Walk around the cabin or up and down the aisle every 2-3 hours;

Wiggle your toes frequently when seated.

Don’t:

Consume anything that de-hydrates you, especially caffeine or alcohol.

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pregnancy nutrition

Supplements you might be prescribed in pregnancy

This month I thought we’d focus on some other common supplements you may be prescribed in pregnancy.

Vitamin D

Many pregnant women have reduced vitamin D levels.  You are at increased risk of deficiency if you have dark skin or are veiled, but also if you use sunscreen regularly or spend little time outdoors.  It is important to ensure your vitamin D level is adequate, as vitamin D is important in the absorption of calcium, so can affect your (and your baby’s) bone strength and formation.  Your GP or Dr Sen can send you for a simple blood test to see if a supplement is required.  You may also be prescribed some ‘sun time’!  Once you start taking a vitamin D supplement you should have a follow up test in 4-6 months to check your level has risen sufficiently.  It is not uncommon for some women to need a supplement for the long term.

Vitamin B12

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) recommend that vegetarian and vegan women take a B12 supplement.  However, in practice, often supplementation is only recommended if you are showing a deficiency on blood testing.  If you are vegetarian/vegan or if you have any concerns about your B12 level you can request for Dr Sen to check your level.  It is certainly possible to obtain adequate B12 through your diet, even if you are vegetarian/vegan, although it does require more careful planning.  Low vitamin B12 levels have been associated with early pregnancy loss and increased rates of NTD and spina bifida.

Iron

In Australia, it is not recommended that all women take an iron supplement as not all women will become deficient, and excess iron can be harmful.  Women are screened several times through their pregnancy to check for iron deficiency (anaemia).  Anaemia in pregnancy can result in pre-term delivery and small for gestational age babies and will result in you feeling very fatigued.  Dr Sen will test your iron levels routinely at 26-28 weeks of pregnancy. If you are found to be deficient, one of our midwives or our dietitian will call and advise you regarding your supplementation requirements. Your levels will then be tested again later in your pregnancy, to check that they have risen to a healthy level. The amount of iron contained in a multivitamin is usually small and not sufficient if you are found to have iron deficiency.  The amount of iron required in late pregnancy is more than is possible to obtain from your diet alone.

Calcium

Ideally you will be able to obtain adequate calcium (3 serves per day or 1000mg) through your diet.  If you are unable to consume this amount of dairy or dairy equivalent, you should be taking a calcium supplement.  As is the case with iron, multivitamin preparations do not contain significant amounts of calcium, usually meaning a separate supplement is needed.

Omega 3 fatty acids

While there is growing evidence as to the important role these nutrients may play, there is currently not enough evidence to recommend they be routinely prescribed in pregnancy.

For more information about pregnancy nutrition, visit our website.

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pregnancy diet plan

Eat out safely when you are pregnant – Pregnancy diet plan

Between nausea, the worry about listeria and the need to ensure a high-quality diet lunchtime choices can be difficult!  If you usually bring your lunch to work it is likely you will need to make some changes from your usual options- but is what you are choosing now a healthy option?  Hot chips may be ‘safe’ but are they a nutritious choice? Let’s look at some of the better takeaway choices you could make and what to steer clear of most of the time!

Remember a decent lunch also makes it far less likely you’ll be reaching for that chocolate bar at 4 pm!

Toasted sandwiches/sandwiches/wraps:

Choose wholemeal, multigrain or rye bread or rolls and fill with lots of salad and some cheese, tuna or egg.   If you are toasting your sandwich, you could add chicken/ham/turkey/beef.  Make sure it is heated right through!  Salamis and other processed meats should be avoided entirely. If your sandwich is super-sized try leaving half of it for later.  Steer clear of focaccias and Turkish bread as these options are very high in energy.

Soups:

A great way of getting a whole lot of veggies in in the middle of the day!  Choose options such as lentil and sweet potato, pumpkin, chicken and corn, minestrone or barley and vegetable!  A gazpacho is a great option in summer.  Add some toast or a bread roll if you’re feeling extra hungry.  

Asian cuisine:

Skip the Laksa and deep fried items and give sushi a miss but there are still many great options to choose from- Vietnamese spring rolls, Stir-fries (add tofu/chicken/seafood/beef), a short or long or Pho noodle soup.  If you get a stir-fry ask for more veggies and less rice (or choose noodles) to ensure you are filling up on the nutritious part of the meal.

Salads:

These can be a bit tricky as it is recommended that pre-made salads are avoided when you’re pregnant.  Ultimately it is your decision as to what you choose to eat.  Some women are happy enough with the turnover rate and hygiene practices of some establishments and will consume salads.  All salads should be well washed and dried.  If you are consuming salads, then take the opportunity to add in some legumes such as chickpeas or 4 bean mix or some sweet potato or corn and skip the heavy cream dressings.

A roast:

The meat carvery can be a danger but if you skip the fatty lamb or the pork crackling and go for leaner beef or chicken (skin off!) and stock up on the roast veggies (think less potato, more onion, pumpkin, peas, etc.) you can still end up with a nutritious and satisfying lunch.  A grilled piece of fish with greens is also an excellent choice!

Still not sure what should you eat when you are pregnant?

Contact Dr Rahul Sen’s dietitian and discuss your pregnancy diet plan.

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pregnancy planning

Leg cramps during pregnancy: causes and treatment.

It’s quite common to experience leg cramps during pregnancy, particularly in the third trimester. Nearly half of all pregnant women suffer from muscle spasms in their legs, with cramping more frequent during the evening.

What causes leg cramps during pregnancy?

Leg cramps may be caused by the additional weight gain of pregnancy and changes in your circulation. Pressure from the growing baby may also be placed on the nerves and blood vessels that go to your legs. This pressure or pinching may be the cause of your leg cramps.

What can you do to treat leg cramps during pregnancy?

There are a few things that you can do to treat leg cramps or prevent them from occurring.

We listed a couple of interventions that may help you avoid leg crumbs:

  • Stretch and exercise regularly.
  • Rest with your legs up.
  • Wear supportive stockings.
  • Massage your calves and feet.
  • Apply local heat.
  • Contact your doctor if your leg cramps are severe or persistent.

If you have any questions regarding pregnancy planning, contact Dr Rahul Sen  – obstetrician from Prince of Wales Private Hospital.

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prince of wales private obstetricians

Ectopic pregnancy – treatment overview.

In most cases, an ectopic pregnancy is treated right away to avoid rupture and severe blood loss. The decision about which treatment to use depends on how early the pregnancy is detected and women’s overall condition. For an early ectopic pregnancy that is not causing bleeding, you may have a choice between using medicine or surgery to end the pregnancy.

Medicine

Using methotrexate to end an ectopic pregnancy spares you from an incision and general anaesthesia. But it does cause side effects and can take several weeks of hormone blood-level testing to make sure that treatment has worked.

Surgery

If you have an ectopic pregnancy that is causing severe symptoms, bleeding or high hCG levels, surgery is usually needed. It’s because medicine is less likely to work and a rupture becomes more likely as time passes. When possible, laparoscopic surgery that uses a small incision is done. For a ruptured ectopic pregnancy, emergency surgery is required.

Expectant management

For an early ectopic pregnancy that appears to be naturally miscarrying (aborting) on its own, you may not need treatment. Your doctor will regularly test your blood to make sure that your pregnancy hormone (hCG, or human chorionic gonadotropin) levels are dropping. This is called expectant management.

Surgery versus medicine

Methotrexate is usually the first treatment choice for ending an early ectopic pregnancy. Regular follow-up blood tests are needed for days to weeks after the medicine is injected.

There are different types of surgery for a tubal ectopic pregnancy. As long as you have one healthy fallopian tube, salpingostomy (small tubal slit) and salpingectomy (part of a tube removed) have about the same effect on your future fertility. But if your other tube is damaged, your doctor may try to do a salpingostomy. This may improve your chances of getting pregnant in the future.

Although surgery is a faster treatment, it can cause scar tissue that could cause future pregnancy problems. Tubal surgery may damage the fallopian tube, depending on where and how big the embryo is and the type of surgery needed.

Surgery may be your only treatment option if you have internal bleeding.

If you would like to find out more about ectopic pregnancy, visit our Prince of Wales Private Obstetricians website. 

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ppregnanacy planning sydney

Pregnancy Planning – Maternity Leave

If you are planning a pregnancy in the nearest future, it is important to think about your maternity leave.

Sometimes a few months could be the difference between whether or not you’re entitled to take leave or whether you are eligible for a maternity leave payment.

That’s why in today’s article we would like to help you understand your situation when it comes to maternity leave entitlement in Australia.

Here are five important maternity leave questions you should ask yourself before you decide to have a baby.

1. What are your personal circumstances?

  • Discuss your plans with your partner – make sure you both agree on plans for after the baby arrives regarding care and family income.
  • When would you like to start your leave?
  • When would you like to return to work?
  • Is your partner planning to take parental leave as well?

2. What is your financial situation?

Preparing for the baby’s arrival can cost a lot of money. Setting up a nursery might be expensive and of course there are ongoing costs as your child grows.

  • What will be the financial implications for your family?
  • Do you have savings or an emergency fund to fall back on if necessary?
  • What is your current cost of living and how will this change once the baby arrives?

3. Are you entitled to any Government assistance?

The Federal government offers various regular payments to help towards the cost of raising children, many of which are dependent upon your level of income.

  • Once the baby is born, what kind of financial compensation will you receive from the government?
  • What is the current amount of Parental Leave Pay in Australia? Are you entitled to it and over what time frame will it be paid?
  • How will the amounts of these benefits be affected if you are on paid/unpaid leave?

4. What is your employer’s maternity leave policy?

Maternity leave offered by different companies across Australia vary widely.

  • How long do you need to work for your employer before you become eligible for maternity leave?
  • How much notice are you required to give before you can start your leave?

5. Have you made any backup plan in case of unexpected changes in circumstance?

  • Consider what may happen if unforeseen circumstances should strike, for example, what would you do if your partner lost their job while you were on maternity leave?
  • Allow for your emotions and expectations to change drastically after the baby is born – you may be convinced you are happy to leave your child in daycare at the young age and return to work, but you may feel differently once he or she arrives.

Find out more about pregnancy planning here:

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Pregnancy nutrition eating seafood

Pregnancy nutrition – Eating seafood

Unless you are vegetarian, it’s ideal to have seafood feature in your diet regularly!  This may include white fish, pink/oily fish and shellfish such as prawns, lobster, bugs as well as scallops and mussels.

Seafood gives you a valuable source of protein, B vitamins, iron, zinc and especially iodine and omega-3 fatty acids.  The iodine and fatty acids are particularly important for your baby’s growing brain, which is actually made up of around 70% fat.  Studies are ongoing about the many important benefits both iodine and fatty acids may provide-especially surrounding neural development and future intellect.

Many women are confused about the guidelines for including seafood in their diet due to concerns regarding food safety.  The main issue is surrounding mercury, which is a heavy metal that can build up in the tissues of bigger fish when they eat the smaller fish.  In Australia however there are very few fish that present this concern.  Tinned fish is also considered safe, and often a very convenient way of getting your intake up!

Below is a table from our national Food Authority (FSANZ) that outlines the guidelines for you in pregnancy:

Safe levels of fish/seafood consumption in pregnancy (1 serve = 150g)

2-3 serves per week of any fish/ seafood (this includes canned fish) not listed below

OR

1 serve per week of Sea Perch (Orange Roughy) or Catfish AND no other fish that week

OR

1 serve per fortnight of Shark (Flake) or Swordfish/Broadbill/Marlin AND no other fish that fortnight

Keep in mind a small tin of salmon, sardines or tuna may only provide just over half of this serving size, so having tuna most days of the week as a lunch option is not a concern-though variety is always advised!

It is preferable to include seafood in your diet several times a week rather than taking fish oil supplements.

It is important that when you consume seafood in pregnancy that you ensure it is well cooked-that means no sashimi but also items such as chilled prawns (even though they are pre-cooked) should be avoided.  Hot prawns or shellfish are safe as part of a hot dish.  I advise women to avoid all oysters in pregnancy, just in case of hepatitis infection.

If you have further queries regarding your pregnancy nutrition please make an appointment to discuss further with Natasha, Dr Sen’s dietitian.

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iron pregnancy nutrition

Pregnancy nutrition – Iron needs in pregnancy

What is iron and why do I need it?

Iron is a mineral that is involved in making red blood cells, carrying oxygen and producing energy.  It is therefore important to ensure you’re eating enough of it!

What is different in pregnancy nutrition?

In pregnancy your iron requirements rise greatly so you can provide for your baby’s blood supply and build up their stores.   If you eat meat you should aim to include red meat at least 3 times per week as well as choosing white meats, eggs, wholegrain breads and fortified cereals, legumes and vegetables regularly.  Vegetarian women will need to rely more heavily on plant sources of iron, which aren’t as well absorbed by the body.

Why does my iron level matter?

Iron deficiency can lead to complications for you and your baby.  Women who are low in iron have a higher risk of small for gestational age babies as well as premature delivery.  Women themselves usually feel quite fatigued and may become short of breath.

How do I know if I’m getting enough iron?

Even if you do eat red meat it is often difficult to consume the amount of iron that is needed in the last trimester of pregnancy.  However, not all women will become iron deficient (anaemic), even those that follow vegetarian diets.  It will depend in part on how well you absorb iron and on your body’s initial store.

Dr Sen will check your ferritin (body store) level, usually when you are around 26-28 weeks.  Your haemoglobin level (amount of iron in your blood) is also checked but as your blood supply doubles during your pregnancy this level drops due to a ‘dilution’ effect and therefore isn’t reliable as a measure of iron deficiency.

Pregnancy nutrition – Supplements

If your ferritin level is low increasing your intake of red meat will not be enough to increase your stores.  You will need to begin taking a high dose iron supplement formula (usually FerroGrad + C or Maltofer or Ferrotabs) 1-2/day depending on your result.  Iron supplements may cause tummy upset including constipation or diarrhoea, especially in higher doses.  If you suffer any discomfort, try taking it every 2nd day rather than stopping it all together.  Low dose iron or the iron in your multivitamin (if you’re taking) is not sufficient. It is normal that your stool colour can change to very dark/black.  This is not dangerous.  Dr Sen may also discuss the possibility of an iron infusion with you.

Iron supplements should be continued until 6 weeks after delivery, though if you’ve been taking more than 1/day you can decrease to just 1/day from when you have your baby.  Iron supplements are best consumed away from dairy products or calcium supplements.

It is not advised that women take a high dose iron supplement unless they have been shown to have iron deficiency.

For more information about pregnancy nutrition, contact our dietician services in Sydney

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preganacy diet plan gestational diabetes

Pregnancy diet – What is gestational diabetes?

Gestational diabetes is the type of diabetes that can happen during pregnancy. Treating gestational diabetes helps reduce the risk of complications during pregnancy and improve your baby’s health in the future.

What causes gestational diabetes?

Gestational diabetes is a condition affecting around 15% of pregnant women.  It causes a woman’s blood glucose to be high. The placenta produces hormones to help the unborn baby develop and grow and these hormones stop insulin hormone working so well.  Insulin is the hormone needed to keep blood glucose normal.  If a woman can’t meet the demand for extra insulin her blood glucose will rise.

How can gestational diabetes be avoided?

The best way to reduce the risk of gestational diabetes is to be fit and healthy before becoming pregnant. Being overweight will increase your risk, as does having a baby after 30 years of age. Gestational diabetes can still occur in healthy people – risk factors you can’t change include your family history of type 2 diabetes, gestational diabetes in a previous pregnancy and being certain ethnic backgrounds (diabetes is much more common in women of an Asian, indigenous, Islander, Mediterranean or Middle Eastern background).

Symptoms of gestational diabetes:

Gestational diabetes usually has no obvious symptoms. If symptoms do occur, they can include:

  • Excessive urination
  • Unusual thirst
  • Extreme tiredness
  • Frequent yeast infections

Unfortunately, these are often common symptoms of pregnancy, so generally, gestational diabetes is picked up when you have a routine blood glucose test between the 24th and 28th week of your pregnancy.

Dr Rahul Sen team can create a personalised pregnancy diet plan just for your needs.

Visit our dietician page to find out more.

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best obstetrician in sydney morning sickness

Obstetrician’s advice on morning sickness

Morning sickness is a common symptom of early pregnancy and in many cases, goes away by the end of the first trimester. It is caused in part by changes in hormones during pregnancy and may make eating difficult.  

Although it is called ‘morning sickness’, nausea can happen at any time of the day.

Morning sickness does not usually cause any problems for the unborn baby. However, if a pregnant woman experiences severe ongoing vomiting, she should see a doctor.

Please have a look at some food and eating suggestions that may help manage symptoms of morning sickness.

  • Eat smaller meals more often. Missing meals can make nausea worse.
  • Avoid large drinks. Have frequent small drinks between meals.
  • Cut down on fatty, fried or spicy food.
  • Try eating a dry biscuit before you get out of bed in the morning.
  • Eat a healthy snack before you go to sleep at night. This might include fruit or yoghurt.
  • Avoid foods if their taste, smell or appearance makes you feel sick.

 

If you vomit, it is important to not become dehydrated. It may be easier to have lots of small drinks rather than drinking a large amount in one go and Hydralyte drinks/ice blocks (or similar products) may be easier to manage.

Please be mindful that the stomach acids in vomiting can soften tooth enamel. It is best not to use a toothbrush to clean the teeth straight after vomiting as this may damage them. Have a drink of water to rinse your mouth.
If the nausea is affecting your life or your diet a lot there are several medications you can take to help- you should discuss this with your doctor.  There are also some suggestions regarding nausea management:

 http://mothersafe.org.au/

For all other enquiries visit our website:

Dr Rahul Sen the best obstetrician in Sydney

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