Joyful Motherhood – Part II

Welcome back to the second part of my blog Joyful Motherhood.
While I was practicing clinical obstetrics I used to counsel the husbands and parents on the pregnancy outcome such that all are well prepared.
Let us have a look at the frequently asked questions,

On exercise
The first three months can be a very physically tiring time for a pregnant woman due to the energy expended with changes occurring in her body and the development of a baby. There is need to listen to one`s own body and rest when one can. A brisk walk once or twice a week may be all that is needed. In the second trimester, many women tend to feel great. These women may well be able to change the exercise program during this period, and adjust to a rhythm that is comfortable for their bodies.
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During the last three months called the third trimester, women may feel more fatigued with the weight of their growing baby. This is the time for gentle walks, stretching and catching up on some rest. A pregnant woman can manage all house hold activities including scrubbing the floor during the first six months.This will give more laxity to pelvic bones and facilitate normal delivery.

On Ante natal care
This can be done by any basic doctor or a well trained midwife. Ante natal care is planned to have an idea about the health of the woman and anything that can affect the baby. Each visit should be a question answer session to build up the confidence of the patient on the doctor and vice versa. Urine and blood pressure and weight gain is checked. Weight gain should be on average 9-13 kg during the pregnancy period. An abdominal examination is also done to ascertain the position of the baby and the size of the uterus carrying the baby to rule out any small or big baby or twins. A scan is done in the second month to confirm whether the baby is inside the uterus, another in the third month to confirm singleton or multiple pregnancy. A scanning is done at fifth month to rule out neural tube defects and at 7-8th month to confirm the position of placenta.All other sophisticated tests are not required as a routine. These may be done at the instance of the Obstetrician if indicated as a special case. A blood test is done to rule out anaemia, and blood grouping in the event of the requirement of blood transfusion. Screening for Hepatitis, Rubella anti body and HIV screening are all optional.

For screening for foetal anomaly-A detailed ultrasound scan (anomaly scan) at 20 weeks. This looks for major physical abnormalities. There are however, limitations to the accuracy of the scan.

On the diet

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There is no need for any extra food in pregnancy. It is a common myth that you should eat for two. In fact most women do not need extra calories for the first 6 months of pregnancy and only require approximately 200 extra calories per day during the last 3 months.

However, because the blood sugar levels fluctuate more due to the extra demands on the body, it is important to eat regularly, including snacks between meals. Most women gain between 9 – 13 kg during pregnancy, although this can vary from woman to woman. You should never try to diet during this period as you could be depriving the baby of vital nutrients.
The best thing to do throughout pregnancy is to eat a variety of healthy foods. They should contain certain key components necessary for growth and development. These include foods containing iron (e.g. green leafy vegetables, red meat, beans and pulses although additional iron supplements may also be given to you by your doctor); calcium (e.g. dairy produce, fish with edible bones like sardines and bread) and folate (e.g. green beans, oranges, spinach, kale or broccoli).

On Vitamin, Calcium and Iron

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Folate is a B vitamin crucial in the development of baby’s nervous system. It has been shown to reduce the chance of having a baby with a neural tube defect (a disability affecting the nervous system). Folate is easily destroyed during cooking and large servings are necessary for adequate intake. The simplest way is to take a folate supplement (one 5 mg tablet daily) for the first 12 weeks of pregnancy. Folate is particularly important if one suffer from epilepsy, thalassaemia or have a family history of having relatives with a neural tube defect. One Calcium and Iron tablet each can also be consumed daily. Have enough fluids and one should also reduce the intake of tea, coffee and cola as the caffeine content of these drinks will affect the vitamins in the food, particularly Vitamin C and also Iron. Develop a habit of taking a fruit juice instead of Coffee /Tea.

On Sex
There is no reason why pregnant women cannot have a fulfilling sex life. In fact, the pregnancy hormones may make you feel more responsive. As the woman get bigger, she may want to experiment with different positions to find one that is comfortable. If she has suffered from any early bleeding, premature labour or have a low-lying placenta, it is wise to consult the doctor who may suggest a period of abstinence.

On Drugs
Avoid intake of any drugs from any system of medicine from 28th day of conception to sixtieth day unless and until they are absolutely indicated.The date of conception will normally be between 10th to 15th day of last menstrual period. This period is very crucial as organogenesis occurs during this period. A ball like fertilized egg called Zygote turns into a foetus during this period. Unnecessary drug intake can result in the defect in the organ that is likely to develop during the dates when the drugs are taken.

The Warning Symptoms Of Adverse Events In Pregnancy
In early pregnancy light spotting or bleeding is due to implantation which occurs when the embryo is attached to the womb. This is a normal phenomenon. However continued bleeding requires clinical examination. Similarly light bleeding with blood-stained mucus in the month before the baby is due could be a ‘show’ — a sign that the woman may go into labour within the next few days or week. However painless heavy bleeding and any amount of bleeding with severe pain also warrants clinical examination. Another warning symptom is feeling dizzy with , nausea and vomiting, blurred or double vision which often herald hypertensive disorders from pregnancy. This requires continued monitoring of blood pressure and albumin in the urine and swelling over the legs.

Babies are most active when the woman is at rest. This is because she is now more aware of their movements. Hence she will notice frequent movements in the evening or at bedtime. There should be at least 10 “kicks” over a 12-hour period. Conversely an active baby is reassuring and excessive movements are not cause for worry. If the kicks become lesser a scanning may be required.

Normally the water-bag where the baby floats in t he uterus is ruptured (either spontaneously or by the obstetrician) when labour begins. Rupture of the water-bag before the onset of labour is associated with increased risk to the baby. Complications include infection or prolapsed of the umbilical cord through the cervix. If she feel a sudden gush or continuous flow of clear fluid from the vagina, an obstetrician should be consulted.
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I am sure if the woman is under the care of a trained doctor/midwife they can easily pick out these problems and initiate required management processes.

Remember always that 60% of pregnancies can occur without any help, only 40% require some assistance and only 15% require surgical interventions. This doesn’t mean that 60% need not have any help. The main issue is that only after the delivery will one know in which group they belonged?

Labour -the process of child birth begins with regular, painful uterine contractions or tightening of the abdomen, ‘bloody show’ (blood-stained mucus) or ‘breaking of her waters’ (rupture of your membranes). This usually occurs at term, after 37 weeks of pregnancy. Preterm labour occurs when these signs are present before 37 weeks.

The idea behind this article is awareness generation on Safe delivery and for avoiding undue tension and stress during pregnancy. I have included only some of the danger signs in Pregnancy and Child birth. My intension is not to load one with lot of materials that may not be much relevance .

Be under the care of a well trained midwife who is very patient or a well trained family doctor. Forget all the tension and stress. Pregnancy problem are always individualistic and not much attention need be given to what the print and visual media churns out. Remember that media are more interested in circulation and number of viewers their product can attract.
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The estimated date of delivery is often calculated by adding 9 months and 7 days to the first day of the last menstrual period. These dates are all calculated assuming that you have a standard 28 day cycle and the number of weeks also includes the first 2 weeks of your menstrual cycle, when you are technically not pregnant. If your cycle varies from this and you know when you ovulated (mid period with signs like lower abdominal pain and increased discharge of thick vaginal mucus), just work back 2 weeks from this date to find your last menstrual cycle date (LMP). Knowing when you are due can help you plan your important appointments for your antenatal care and lots more. Just remember, it’s not mandatory that the woman will be delivering on the estimated day. Baby will come  when it is ready. The majority of babies are born within 2 weeks either side of their EDD.

Have a safe and Joyful pregnancy

An alumnus of Trivandrum Medical College (1965-70) Dr N S Iyer is a senior Obstetrician and Gynecologist and retired Deputy Director of Kerala Government Health Services. Post retirement he became the Project officer in UNICEF, Chennai office, in charge of the Maternal and Child Health Programme in Tamil Nadu and Kerala.

If you have any pregnancy related queries for Dr.Iyer  write to us at marketing@pmsind.com