Whilst this may seem a lot/not a lot depending on your circumstances, bear in mind that many things can impact weight changes in pregnancy. For example, in the first 20 weeks of pregnancy, the uterus is growing, there is a big increase in blood volume in your body, the baby is growing, and the placenta is developing as is the amniotic fluid around the baby. That said, many women suffer from morning sickness in the first half of pregnancy (if not longer!) which can affect appetite and weight gain. Whilst eating a healthy, balanced diet and exercising in moderation will go a long way to achieving healthy weight gain, it isn’t enough for many women, as most women gain the target ranges above! So please speak with your midwife or obstetrician about any concerns you have in this area, and follow me on Instagram to see updates on my research as they come through!

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5. What products/resources do you recommend to your patients to prepare them for what's ahead?
I am definitely a visual person - I like to read and see in order to get new information and knowledge. My absolute favourite resources for birth preparation are books (and unsurprisingly, they are super popular in the midwife/mama world) but they are just so darn useful and comprehensive. The first one is Juju Sundin's "Birth Skills", a really practical guide with heaps of 'how-to' pics for different positions and pain relief for labour. This is so easy to flick through and pick up some ideas, and pass on to your birth support people so they know about these strategies too. Then you pack it in your birth bag, to pull out when you need some ideas in labour. You can find this book here.
The second book is Rhea Dempsey's "Birth With Confidence: Savvy Choices for Normal Birth". Rhea is world-renowned for her birth education classes and birth support, and luckily she put all of her wisdom into a book for us all (if you can't get to one of her classes). She explains in great detail the complexities of the maternity care system and how to navigate/advocate for yourself and your bub to optimise your chances of a normal birth. You can find this book here. The final resource I love is one that prepares you, gently but realistically for a baby (the first 12 months!). It's called "Baby on Board" by Sydney paediatrician Dr Howard Chiltern, so you know you are getting qualified advice. You can get this book here.

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6. Should I express milk during pregnancy for my baby?
This is a really great idea, and has become popular over the past few years as mums are keen to build a stash of breastmilk for use in the early days (or other reasons). Two things you should know about breastfeeding: 1) low milk supply is frequently wrongly blamed for many issues after birth and 2) it’s surprising how often formula/additional feeds are used in the early days after birth. However, formula use in the first few days is well known to impact on your supply and breastfeeding success[8]. Hand expressing at the end of pregnancy to build a freezer stash is a great way to avoid formula use and encourage success with lactation. If you take a few frozen syringes into hospital with you, and keep some at home, you can use them as you need without wastage.
To illustrate my point - I knew my bub would be having a NICU stay. I began expressing (with my OB's clearance) 2 weeks before she was born. I had 60mls frozen by the time she was born, and she never needed to have formula. The nurses were amazed! You may run into some negative attitudes regarding the safety of this practice, however this large randomised controlled trial showed that expressing breastmilk from 36 weeks of pregnancy is not associated with any increased risk[9]. However, if you have questions about your own individual circumstances however, definitely chat with your midwife or OB.

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7. What are the best options for birth classes, and when should I do them?

In my experience, birth classes are essential for several reasons: they expose you (and your birth partners) to things you need to know about birth, such as the signs of labour, stages of labour, birth preferences, birth positions and options for pain relief (plus skills to support you – for your partner!). You’ll also meet some other parents expecting babies around the same time as you, which is a great opportunity to build your ‘village’. Many hospitals offer birth classes, and these are a great introduction, however they are limited by hospital budgets and often only cover the essentials (including hospital policies and so on). Doing community-based or external classes is a great way to achieve a comprehensive understanding and preparation for labour and birth. Hypnobirthing or Calmbirth are two common and fantastic birth class options. If you prefer to read, I outlined my favourite books in question 5 (I highly recommend Rhea Dempsey’s Birth with Confidence book or Juju Sundin’s Birth Skills book as great preparation for labour and birth) - you can get them both here, and you can start reading them anytime. Once you’ve had your 20 week anatomy scan, you can book your birth classes for any time that suit you. However, I recommend booking them earlier rather than later so that you have time to practice your breathing and relaxation techniques for many weeks before you actually need them!
One final option is to do an online class. This can be great as you can do the videos at your own pace, in the comfort of your own environment, however you don’t get the face to face benefits of a class.
 

8. What can I do to reduce the chance of having a C-Section?
Globally, we are dealing with rates of C-Sections that are way above the World Health Organisation’s recommended rate of 10-15%. Many women wish to avoid caesarean sections because of the increased risks of a C-Section compared with a vaginal birth. There are many things you can do to improve your chances of having a natural birth. Firstly – the maternity care and birth place you choose will have a huge impact. Especially for low-risk pregnancies, continuity of care with a midwife consistently shows the best outcomes, including for natural births, for mums and babies[10, 12]. Birthing at a public hospital, birth centre or at home versus a private hospital is also associated with higher rates of normal birth[11]. The type of support you have in labour is also crucial – continuous support from a partner, midwife and/or doula is linked with less caesarean sections[12]. Finally, the more you can avoid medical interventions during your labour and birth, especially if they are unnecessary (e.g. synthetic hormones to ‘speed up’ labour when it is progressing at a normal rate), the more likely it is that a caesarean birth can be avoided[11]. For more about this – I recommend reading up on the ‘cascade of intervention’ in labour and birth.
 

9. How will I know if labour has started?
This is a question I’m asked by many first-time mums, but rarely mums who’ve given birth before, unless they were induced (they will overwhelmingly tell you “oh, YOU’LL KNOW” with a raised eyebrow and a wry smile). But reality is, sometimes we get mixed signals from our body! And every so often on the news you’ll see a baby has been born en route to hospital, and we wonder whether the mother didn’t realise she was in labour in time to make it to hospital (FYI, these babies tend to be the typical 2nd baby, very quick births! They take their mums by surprise after the first birth was a much longer labour). Labour is made up of several stages. The first stage involves your cervix dilating from closed to fully open; the second stage involves the birth of the baby and the third stage involves the birth of the placenta. The first stage is usually the longest stage, and can be split into two parts: latent first stage and active first stage. Latent first stage is characterised by irregular, unpredictable tightenings or contractions (usually lasting less than a minute), and they may start and stop over days or even weeks. They are actually doing a very important job (softening and thinning out your cervix up until around 4cm dilation), and generally this stage is best spent at home. You might feel excited, apprehensive and uncomfortable, but you should still be able to talk through your contractions and rest a bit. Somewhere between 4cm and 6cm (generally speaking) is when you’ll hit active labour – and those irregular cramps will be characteristically regular, and occurring 3 or 4 times in a 10 minute period, and lasting around a minute. This is when labour lives up to its name and becomes hard work – you mightn’t be able to speak during contractions as you need to focus on breathing through each one. You should be in contact with your midwife or obstetrician through this time so they can continue guiding your care appropriately.
 

10. I really want to breastfeed but I’ve heard it can be really hard – is there anything I can do to make breastfeeding easier or more successful?
Breastfeeding has a wealth of benefits for both mum and bub, but unfortunately many mums (for a variety of reasons) aren’t able to continue their breastfeeding journey as long as they’d like. One of the most common reasons mums give up breastfeeding is a (often incorrect) perception that they’re not making enough milk. See, low milk supply is an easy scapegoat for many things early on: Not enough weight gain? Mustn't be enough milk. Constipated? Not enough milk. Mum's tired? Trying too hard to make not enough milk. Baby fed 15 minutes ago and hungry again? Not enough milk. Baby only slept 20 minutes? Not enough milk. Baby has jaundice? Not enough milk. Baby is cold? Not enough milk. Mum's boobs are soft and comfortable? Oh - must be empty! Baby is unsettled at the breast? It's because there's not enough milk. But all of these things can occur even if the milk supply is plentiful! I highly recommend reading up on what will impact on the establishing of lactation and your milk supply in the early days, so you are well prepared for success before your bub arrives!
Another thing that contributes to breastfeeding problems is the technique (or positioning and attachment). This is crucial for ensuring that the milk you are producing is transferred to the baby. And, breastfeeding is a learned behaviour, which unfortunately in our society is often done behind closed doors – meaning by the time we come to breastfeed our first baby, we have not acquired this learned skill.
So, my tips for success (in addition to question 6 – expressing colostrum in late pregnancy!) are two-fold: equip yourself with knowledge about establishing breastfeeding and your milk supply, and try to avoid things (or people!) that might lower your supply (but don’t automatically blame your supply if you have any issues!). Secondly, observe as much breastfeeding as you can – whether that’s friends or relatives that are happy for you to be present as they feed their babes, YouTube videos, breastfeeding classes and so on. My "Breastfeeding 101" article is really detailed and has  a tonne of images that show good versus bad positioning and attachment, plus a lot of other helpful breastfeeding stuff (click here to read). Another helpful tip - find a lactation consultant (someone who’s done extra qualifications to be a breastfeeding specialist) near you, so that you have a contact to assist you at the first sign of an issue in your breastfeeding journey. Finally, lactation cookies are a healthy, delicious snack option proven to increase your milk supply. I kept a tin of these ones in my pantry after birth, and used them anytime I  felt my supply needed a boost (or if I just wanted a really yummy snack!).

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