Taking Care of the Expectant Mother

Published in "Panorama"



Caring for the expectant mother


Trends are changing and when women often opt for motherhood by choice rather than by chance, decide on when they wish to have a baby, pregnancy care should actually start at the pre-pregnancy stage. In a certain sense, pre-pregnancy counseling gives them an edge over mothers of yesteryears who perhaps went through the trauma of miscarriages, giving birth to abnormal babies or undergoing other problems relating to pregnancy, only because they were not “aware”. Not aware of her own health and medical status which could cause problems during pregnancy to her or the baby, not aware how their mental and emotional status could influence the rosy pictures of motherhood and other interpersonal relationships, not aware of how many of the pregnancy-related problems could be treated, managed or even prevented by adopting necessary measures by consulting relevant counselors and gynaecologists for the purpose.

Couples should actually prepare themselves to have a baby, opines Dr.Santi Medhi, Specialist Obstetrician and Gynaecology, Welcare Hospital, Dubai. “Since most couples pursue careers outside home these days, there should not only be health preparedness but also emotional and family preparedness in terms of ensuring financial capacity and space, before they plan to have a baby.”

The pre-pregnancy counseling is a very important aspect of planning for a pregnancy and this can be done by general medical practitioners or specialists. There could be medical problems which run in certain families, particularly so, when the couple are related to each other. Questions and investigations relating to these issues go a long way, either in preventing situations that can occur in the baby, or help the couples circumvent the problem when they plan the pregnancy, explains Dr.Medhi.

“For instance, the mother-to-be may have diabetes. It is very important to have normal blood sugar level before she embarks on a pregnancy, both for herself and for the baby,” reveals Dr.Medhi. “For the baby, a very high blood sugar in the mother during conception, is known to cause congenital abnormalities. One of these is that the sacral bones may not form and this is a major problem which can be avoided if the mother has a normal sugar level when she’s going into pregnancy. The mother’s sugar may become very much elevated during pregnancy because of the pregnancy hormones and sugar levels can be normalized by a changed drug regimen.”

In keeping with the motto “prevention is better than cure” medical practitioners world over, now advice screening for diseases as part of pre-pregnancy counseling, reveals Dr.Medhi. “In fact this screening should begin well before, when girls are in their adolescence. These screening tests are simple and done not only from pregnancy point of view, but for the long term health benefits of the girl. At present, a healthy girl may have a medical test only if she is taking an entrance test for a medical college, etc., because our schools and colleges may not as yet have a system of screening for a medical situation. A girl may visit a doctor only if she is having some problem with her menstrual cycle or when she becomes pregnant. Regular screening for health must start from adolescence. One very important screening at this age is done for German Measles or Rubella. This is very important because rubella infection in the mother during early pregnancy, is known to give rise to major congenital malformation in the baby. In the West, teenagers are vaccinated against rubella if they had not already been done so in childhood. Similarly one does not have to wait for girls to get pregnant to start them on calcium supplements if they are malnourished.”

Examination of the woman to see if there is any infection in the urogenital area, prior to conception, is very important because treatment of the infections may avoid problems in the pregnancy itself, reveals Dr.Medhi. “For instance, certain bacterial colonization of the urinary or genital tract can lead to miscarriages. And this can be avoided by pre-pregnancy investigation and treatment if found necessary.”

It is important to help in advising the couple on various aspects relating to healthy food, lifestyle and exercise. Advice must be given to get them to stop smoking; definitely if the mother smokes and even the father must stop smoking so that the ill effects of passive smoking may be avoided, emphasizes Dr.Medhi.

Once the pregnancy is suspected, it can be confirmed with 100% accuracy by doing a blood test. The woman will then need to be advised on diet, rest, exercise and general lifestyle along with information about the common symptoms associated with pregnancy. But if these symptoms are exaggerated and her quality of life is impaired, she should be advised to seek medical help. And these are best done as early as possible, explains Dr.Medhi. “Where a woman has had problems in previous pregnancies like early miscarriages, special advice will have to be sought early. Ultrasound will have to be done early to give her timely help so that recurrence of the event may not happen again.”

The first few weeks of pregnancy are not the best ones as one feels tired, more sleepy, etc along with morning sickness and aversion to certain smells and foods, agrees Dr.Medhi. “But one should always listen to the mind since it tells you what you need; your body will tell you what you need. So don’t force yourself to eat what you cannot eat in the first few weeks and more importantly, don’t listen to everybody trying to advise you on what you should eat, how much you should eat, et al. But don’t go hungry either. Take small feeds at frequent intervals. For example, you can keep dry biscuits in your office bag or bedside. Avoid spicy, fried, fatty food; take bland, easily digestible, fresh foods at the right time. Eat more dry sort of food like biscuits and toast because these help. Also, avoid very hot or very cold foods. Don’t keep the stomach empty too long since this can also trigger the nausea due to the production of less acid in the stomach. This can also trigger lowering of blood sugar which in turn will increase nausea and aversion for food.”

Dr.Medhi continues, “It is very important to try and relax the mind, to keep it from always thinking about the pregnancy state and its undesirable symptoms. Don’t lie down immediately after food because pregnancy makes one lazy and you feel like sleeping whenever you find time. Simply sit up for a while after eating or walk for a while within the house. This will help the stomach to settle with the food so that it doesn’t regurgitate and you wont feel the fullness in the stomach. Also, avoid eating heavy.”

It is important to exercise appropriately during pregnancy, cautions Dr.Medhi. “Each one is used to doing certain exercises. One doesn’t have to give it up because of pregnancy, unless otherwise indicated. But if it is a vigorous sort of thumping, aerobic exercise, that has to be scaled down to a mild form. If one is used to swimming or walking, there is no need to give these up during pregnancy. The thumb rule is, while you may continue with exercises which are mild, don’t start anything new during pregnancy because of the risk of miscarriage which is maximum till about 10, or even 13 weeks. Till then, one should be careful and avoid lifting heavy weights, running around, rushing about. “

“Since one becomes heavier in later pregnancy, it is always advisable to start exercise early, rather than late and continue it through the pregnancy, so that the body copes, the heart will cope better during the latter part of the pregnancy and during the delivery itself,” advises Dr.Medhi. “Some breathlessness is normal during pregnancy; one should not be worried if similar breathlessness remains after some exercise. However, if it is more than usual, seek medical help.”

Continuing on the exercise regimen, Dr.Medhi reveals, “Later pregnancy has different exercises to help cope with the delivery. Keep your posture nice and as erect as possible. For people who are into yoga, they should continue it throughout pregnancy. In fact, there are certain postures in yoga which help to ease nausea, vomiting in pregnancy, in maintaining the posture during mid part of the pregnancy and in the latter part, to help ease the pelvic joints and bones. But these must be done under a yogic instructor, not buying a book and trying to follow it.”

Monthly checkups are advised in the first two trimesters; fortnightly between the 28th and 36th weeks, followed by weekly checkups till the completion of pregnancy at 40 weeks. Most of the routine blood tests to identify blood group etc, are done in the first few weeks of pregnancy. “Ultrasound as a screening test is done to detect any abnormality in the foetus, reveals Dr.Medhi.

In high risk pregnancies specific blood tests and specialized ultrasound tests are done to know if the baby is having any abnormality. By high risk pregnancies we would mean, the lady is more than 35 years of age, she may have given birth to abnormal babies earlier, she may have had repetitive miscarriages, or has had a malformed baby, she may have a family history where a brother or sister was born with congenital problems, or, these members may have borne congenitally abnormal child/children, or in the case of cousin marriages, explains Dr.Medhi. “This is not to say that an 18 or 20 year old girl cannot have an abnormal baby; the risk definitely goes up with age and family situations.”

The 2nd trimester of pregnancy, between the 4th and 7th months, are pretty easy going with routine, urine, ultrasound tests, checking blood pressure and weight. “These will do if all goes well. Late in the 2nd trimester, towards the 28th or 30th week, we do another blood test, giving a sugar challenge to see if the mother is going to develop gestational diabetes,” explains Dr.Medhi. “This test is done in most hospitals today as routine antenatal care. “

A couple of weeks later, even if the woman is not symptomatic, a swab from the vagina is taken to look for the presence of Group B Haemolytic Streptococcus, a certain bacteria which if present in the lower genital tract and goes untreated, can infect the baby during delivery. This is again a preventive health check for the baby’s sake because the baby can have lots of problems if it catches this bacteria from the mother during childbirth. The mother can be appropriately treated if she is found to have this bacteria explains Dr.Medhi.

The last four weeks of the last trimester are spent mainly on discussions about the delivery and pain relief, reveals Dr.Medhi. “During this time, we also give the couple an idea about the expected mode of delivery. Most of the times, consultants do get an idea whether the baby is bigger than the average size, if the lady’s pelvis looks clinically very for a normal delivery possible and whether a Caesarian section is indicated.”

Pregnancy is a time when you will have lots of mental and bodily changes. Register these changes, enjoy the ones you can, that is, by acquiring accurate information about them. And make sure that the information you gather are from genuine sources, emphasizes Dr.Medhi.

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