Dr Karuna Raja

Preparing for your baby

Dr. Raja is here for any of your obstetric needs and throughout your pregnancy she will guide you through any and all recommended test that you choose to take.

Recommended Antenatal Classes

RPAH Women and babies Parent Education Centre, 95155284

  • 2 hours a week, for 7 weeks - weekday classes are free, evening classes are chargeable.
  • 2 hour baby care class - free of charge, conducted monthly during day time.
  • 2 hour breast feeding class - free of charge, conducted monthly during day time.
  • Hospital Tours - free of charge, conducted mornings and evenings.
  • 4 hour a week, for 2 weeks - labour intensive.

Birth Matters (Summer Hill and Padstow)

  • 2 hours a week, for 8 week series, refresher and private classes.

Contact Lyn Wallace at 97641319

Birth and Parenthood (Inner West)

  • Private Classes
  • Birth Support
  • Postnatal Care at Home.

Contact Russell Menzies at 97984610(H) or 0425276113(M)

Breast-feeding - NSW breast-feeding helpline (02) 96398686, www.breastfeeding.asn.au

Physiotherapy Centre for Pregnancy and Postnatal Care (Camperdown)

  • 2 hours a week, for 7 weeks - refresher classes

Call Julia Schwarz at 95162612(H) or 0419405290(M)

Birth Connection Childbirth Education (Glebe)

  • 7 week series, refreshers and private sessions. Postnatal home visits and pregnancy massages.

Contact Claire Cleaver at 96608795 or send a fax to 95526685

These are all educational options that you can choose. All of these classes are recommended by this practice. The Childbirth Education Association of NSW can be contacted at 95397188, if you require service out of the area.

If you have difficulty finding a service that suits you, please speak to our staff and we will help you find alternative options. We would be very interested to hear any feedback you may have about the quality of the class you attend.


How to Perform Pelvic Floor Exercises

Relax your thighs, buttocks and tummy muscles, visualize that you are trying to stop a flow of urine. This should be an upward to inward feeling. Do not hold your breath as you do this, but instead gently breath out. You can give yourself feedback about this exercise by inserting your finger in your vagina and feeling the contractions.

Try to hold the contraction for five seconds and then rest for two seconds. Repeat this until you feel the contractions are getting weaker, or fatiguing, to determine the number of repetitions that suits you. With practice you can aim to do 6-8 contractions in each set. Repeat the set 3 to 10 times a day. Learn it now and practice it for the rest of your life. Pregnancy and childbirth may be beginning of pelvic floor weakness and associated problems. Make pelvic floor exercises a part of your daily routine. It’s never too late to start.


Perineal Massage

Massaging the perineal area during the last 3-4 weeks of pregnancy will increase the elasticity of the tissue in this area and get you accustomed to the stretching sensations of the second stage as the baby’s head emerges. Perineal massages will not necessarily prevent a tear or the need for episiotomy, but it does however improve the “stretchiness” of the perineum and desensitize the area to pressure and stretching.

Lie on your back and use a mirror to locate the vagina and the perineum (area between the vaginal opening and the anus) using vegetable oil on your thumbs, insert them 3-4 cm inside the vagina and press on the perineum towards the rectum (back passage) and sides. Gently stretch the opening until you feel a slight burning or tingling sensation. Maintain pressure for 2 minutes until the area becomes a little numb. Then slowly massages in the oil maintaining the stretch and pressure.

Massage for 3 to 4 minutes, concentrating on any previous episiotomy scares which are usually very inelastic.

The massage can also be done with a sweeping motion from side to side with the fingers either moving together in one direction or in opposite directions, according to your preference. Do this massage once a day during the last 3 to 4 weeks of your pregnancy.


Flying/Traveling During the Pregnancy

There are some risks involved in traveling during pregnancy. you should be aware of the risks associated with food and water consumption, air travel, hight altitudes and overseas travel especially to tropical regions in developing countries. Medical facilities are limited in remote areas and it may be difficult to get any treatment - even for minor problems.

Traveling during the last 6 weeks of pregnancy should be avoided. Most airlines allow women to fly until 36 weeks of gestation, however, before booking your ticket, check the airline’s policy. Relatively low pressure in the cabin may produce problems of reduced oxygenation in the blood of the mother and baby. Shorter flights of less than 2 hours are preferred to longer flights. There is some concern about increased risk of miscarriage due to flying early in pregnancy.

Problems associated with flying are passenger air crafts are not equipped to deal with obstetric emergencies such as premature labour or delivery. There is also a risk of developing deep vein thrombosis (DVT) due to immobilization, dehydration, low humidity in the aircraft and excessive alcohol consumption. A pregnant women has an increased risk of DVT due to the pregnancy itself.

The risk of DVT may be reduced by walking around and moving your legs and feet to improve circulation and keep your fluids up. Avoid alcohol. Compression stalkings (TEDs) also help reduce the risk of DVT.

Follow general advice bout food and drinks in pregnancy while traveling, avoid dehydration and be careful not to eat contaminated food. Also check the requirements for vaccinations and malaria prophylaxis. Avoid activities at high altitudes such as trekking and skiing. Avoid scuba diving. Avoid long land journeys. Make frequent stops and make sure to drink plenty of water. Sea travel may cause increased nausea and vomiting. Always wear a seatbelt going across the lap, beneath the tummy and across your hips with your shoulder strap between your breasts and across the shoulders.


Exercise During Pregnancy

Regular exercise during pregnancy improves muscle tone and promotes well-being. The body undergoes many changes during pregnancy; increased weight and change of body shape can alter a woman’s sense of balance and co-ordination, so it is important to avoid activities that increase the risk of falls or injury to the abdomen. Concat sports, skiing and horseback riding are best to be avoided - particularly after 28 weeks.

A hormone called relaxin which the body releases during pregnancy softens the ligaments to prepare for pelvic birth. However, it also makes all joints less stable and the risk of injury to the joints increases. There is also increased blood circulation, which in turn increases resting and exercising heart rates. As pregnancy advances, the enlarging uterus pushes the diaphragm upwards, crowding the chest and potentially making it difficult to breath. More frequent water and food intake may be necessary when exercising in pregnancy. Pregnancy increases body temperature by about 1 degree centigrade. Prolonged and excessive heating can be harmful to the featus.

Before any vigorous exercise it is important to do warm-up stretches and exercises, followed by a gradual cool down period. Avoid over-stretching and do not over exert. Wear loose cotton clothes and a well fitting bra. Exercise in a well ventilated area. Avoid high temperature areas such as spas or saunas. Avoid exercising lying flat on your back after 20 weeks, as the enlarged uterus can put pressure on major blood vessels in your abdomen thus interfering with the blood flow to the heart and uterus, causing you to fee faint. Avoid high impact exercise such as jumping and contact sports. Do regular pelvic floor exercises.

There are certain conditions such as preterm labour, placenta praevia and others where exercise may be contraindicated. Please discuss this with me so we can go over the best exercise options for you individually.


Foetal Movements

Normal foetal movement during pregnancy indicates foetal well being. Babies usually move more than 10 times in a 12 hour period. If you think your baby has reduced movement or has not moved at all in 12 hours you should contact the myself or the delivery suite.


Suggested Reading List

  • ‘The New Active Birth’ by Janet Balaskas
  • ‘Brestfeeding’ by M. Renfrew, C. Fisher, S. Arms
  • ‘Baby Love’ by Robyn Barker
  • ‘What to Expect When You’re Expecting’ by A. Eisenberg, H. Eisenberg Murkoff and S. Eisenberg Hathaway
  • ‘Life Before Birth’ by Ashley Montagu
  • ‘Touching’ by Ashley Montagu
  • ‘New Pregnancy and Childbirth’ by Sheila Kitzinger
  • ‘Face to Face with Childbirth’ by Julia Sundid
  • ‘Conception, Pregnancy & Birth’ by Dr. Miriam Stoppard
  • ‘Twins and Multiple Births’ by Dr Carol Cooper
  • ‘Breastfeeding... Naturally’ by Nursing Mothers Association of Australia
  • ‘The Experience of Breastfeeding’ by Sheila Kitzinger
  • ‘Birth - Through the Child’s Eyes’ by Sandra Van Dam Anderson and Penny Simkin
  • ‘Children at Birth’ by M & J Hathaway
  • ‘The Baby Book’ by Karitane Mothercraft Society
  • ‘How to Stay Sane in Your Baby’s First Year’ by Tresillian Family Care Centre
  • ‘Babies’ by Karitane Mothercraft Society
  • ‘What to Expect in Baby’s First Year’ by A. Eisenberg, H. Eisenberg Murkoff and S. Eisenberg Hathaway
  • ‘Raising Boys’ by Steve Biddulph
  • ‘Manhood’ by Steve Biddulph
  • ‘So You’re Going to be a Dad’ by Peter Downey
  • ‘Sounds for Silence, Babies Settling and Health Guide and a CD-ROM by Harry Zhenwirth

The first three books are particularly recommended for the subjects of Labour, Birth, Breastfeeding, Parenting and Baby Care. The remainder may be useful as a supplement.