General and High Risk Obstetrics
What is pre-pregnancy Counselling?
Reviewing the overall health of you and your partner before conception helps you make healthy choices for both you and your baby. All women are recommended to visit their doctor for a pre-pregnancy counselling appointment to check for possible risk factors that could affect your chances of conceiving or having a normal pregnancy. Following the counselling, you can address and resolve any medical issues that you may have before you conceive.
What can you expect during a pre-pregnancy counselling session?
At your pre-pregnancy counselling, your health care provider may discuss the following with you:
- Medical history: your past or existing medical conditions and allergies, over-the-counter and prescribed medications you are currently taking, previous surgeries and reasons for hospitalisation
- Family history: medical, congenital, genetic and ethnic-related conditions that run in your family such as diabetes, hypertension, deafness, blindness and mental retardation
- Lifestyle habits: lifestyle habits such as drinking, smoking or use of recreational drugs, stress, diet and exercise, which can influence your pregnancy
- OB/GYN history: menstrual history, sexually transmitted diseases, vaginal infections, previous pregnancies and contraceptive use
- Menstrual cycles: help determine the period during which you are most likely to get pregnant
- Home and workplace safety: exposure to X-rays, cat faeces, solvents or leads
Your doctor may also perform a physical examination, which includes assessment of your breasts, heart, abdomen, lungs, thyroid and pelvic examination. Your blood pressure will be checked and weight measured. Lab tests such as complete blood count (CBC), rubella, Pap smear, HIV and hepatitis may also be ordered.
You will be prescribed prenatal vitamins with folic acid. Your health care provider may suggest lifestyle changes based on the examination to help ensure a healthy pregnancy.
What is morning sickness?
Morning sickness refers to nausea and vomiting and affects a large population of pregnant women during their first trimester. It generally occurs from the 4th to the 12th or 14th week of pregnancy, but some women may experience it during their entire pregnancy. Morning sickness is not harmful for the unborn child, but severe cases are called hyperemesis gravidarum and may even require hospitalization.
What are the causes of morning sickness?
The cause of morning sickness is unknown, but many metabolic and physical factors have a role to play.
- Hormonal changes during pregnancy (high oestrogen levels)
- Blood pressure fluctuations (low blood pressure)
- Change in the metabolism of carbohydrates
- Chemical and physical changes
- Traveling, fatigue, emotional stress, and some foods
What are the symptoms of morning sickness?
Symptoms of morning sickness include:
- Loss of appetite
- Depression and anxiety
How is morning sickness diagnosed?
Your doctor will diagnose morning sickness based on the signs and symptoms you experience. If hyperemesis gravidarum is suspected, urine and blood tests will be suggested. An ultrasound may also be ordered to detect other underlying causes of nausea and determine the number of foetuses.
What are the treatment options?
Most cases of morning sickness do not require treatment; however, your doctor may prescribe vitamin B-6 supplements and anti-nausea medications for severe cases. Hyperemesis gravidarum may require hospitalization and treatment with anti-nausea medications and intravenous fluids.
Lifestyle and home remedies
Lifestyle and home remedies may be helpful in relieving morning sickness in some women.
- Choose your food carefully. You should eat more carbohydrate rich, easily digestible foods. Salty food or food containing ginger may be helpful at times. Snack at regular intervals throughout the day instead of having large meals. Eating a few plain sweet biscuits or dry crackers after waking up may help reduce the nauseous feeling. Avoid food that triggers nausea or makes it worst, like greasy and spicy food.
- Consume plenty of fluids. Keep sipping ginger flavoured drinks or water frequently. Sucking on ice cubes or hard candy may be beneficial.
- Take walks and try and get plenty of fresh air.
How can morning sickness be prevented?
Morning sickness can be reduced to a certain extent with prenatal vitamins taken before conception.
What is Antenatal care?
Antenatal or prenatal care is care offered throughout the course of your pregnancy. When you test positive for pregnancy, you should consult with your doctor. Your first antenatal visit will include a review of your health, previous health issues or complications, and family history of genetic diseases. Your doctor will question you about issues such as previous pregnancies and miscarriages.
What to expect during antenatal care?
You will have a thorough physical examination and a battery of tests to determine your complete health and identify any problems. Blood tests are usually ordered to rule out any deficiencies, disorders or infections. You may be screened for health problems, if you have a high risk of developing certain diseases that could affect your pregnancy. Based on these results, your doctor will instruct you on medication and other ways to manage any health problems safely, without harming your growing baby.
Throughout your pregnancy, ultrasound scanning will be performed to monitor your baby's development (heartbeat, growth and position in your womb) and detect any signs of problems at an early stage. Your urine, blood pressure and overall health will also be monitored as your pregnancy progresses. Ensure that you eat a healthy balanced diet to sustain you and your growing baby. You will be prescribed vitamin supplements. You can discuss with your doctor about safe exercises that you can follow to keep you healthy. Avoid alcohol, illicit drugs and smoking to protect the health of you and your baby.
Your prenatal visits will also prepare you for labour and care after delivery. You will be briefed about the different options of birthing (vaginal or caesarean), pain management (such as epidural or holistic methods) and breastfeeding.
Pregnancy brings about many changes in your body. These antenatal visits give you an opportunity to discuss any symptom or concern with respect to your pregnancy or any other issues concerning you. Your doctor will advise you on the best way to manage them so you can enjoy a healthy and comfortable pregnancy.
Postnatal Tips for the New Mother
The postnatal period begins after the delivery of the baby and lasts for six to eight weeks. During this time, a new mother undergoes many physical and emotional changes, and learns to care for her newborn. A new mother should also take good care of herself to restore her strength. Some tips for a new mother are as follows:
- Sleep while your baby sleeps. This helps you to gradually regain your strength.
- Go out for a walk to get some fresh air and sunshine.
- Emphasize on your nutritional intake and maintain a healthy diet. This promotes healing and recovery.
- Breastfeed your baby at appropriate times.
- Take care of your perineal area. Keep yourself clean and dry.
- Refrain from alcohol during breastfeeding.
- Contact your health care professional immediately if you notice any problem signs such as heavy bleeding, breast infection or pain in the pelvic region.
Breastfeeding provides your newborn baby with nutrients required for healthy development and growth. The yellowish sticky breast milk called colostrum, produced at the end of pregnancy, is the most recommended and perfect food for the newborn. Breastfeeding should be initiated within the first hour of birth for at least 6 months and may be continued for up to 2 years of age and beyond, along with suitable complementary foods. Because of its benefits, breastfeeding has been endorsed by many government initiatives.
What are the benefits of breast feeding?
Benefits of breastfeeding for the baby include:
- The breast milk is in the most digestible form of food and has a perfect mix of fat, proteins and vitamins that is required for the baby's growth.
- Antibodies present in the breast milk improve the baby's immunity and help fight against viruses, bacteria and allergies.
- Infants who are breastfed for 6 months have fewer ear infections, diarrhoea, respiratory illnesses and hospital visits.
- Breastfed infants may have higher IQ scores in later childhood.
- Breastfed infants may have low risk of obesity, diabetes and certain cancers, and may evade sudden infant death syndrome.
- Breastfeeding helps in building a bonding with the mother and improves the feeling of security in the child.
Benefits of breastfeeding for the mother include:
- It helps you burn extra calories and lose weight faster.
- The oxytocin hormone released helps in returning the uterus to its original size and reduces post-delivery uterine bleeding.
- It lowers your risk of osteoporosis, ovarian and breast cancer.
- It saves time and money on baby formulas, etc., and helps you build a strong bond with your infant.
What are the various breastfeeding positions?
You can follow any of the positions which will help you and you baby relax and remain comfortable during feeding. Some common positions for breastfeeding include:
Cradle position: Place you baby in such a way that the baby's head rests in the fold of your elbow while the whole body faces you. Support your baby by positioning his or her belly against your body and wrap with your free arm around to support the baby's head and neck.
Football position: Your baby's back can be placed along your forearm, while you use your palm to support the head and neck. This position is best for newborns and if you are recovering from a caesarean as it protects your stomach from excessive pressure.
Side-lying position: This is the best position for feeding during nights or during an episiotomy recovery (vaginal incision during delivery). You can lift your breast and place the nipple into your baby's mouth by using your free hand. After proper latching, you can support your baby's neck and head to avoid twisting or straining during feeding.
Process to ‘latch on'
Your baby should be latched on properly to your nipple before feeding. This helps avoid sore nipples. The process to help your baby latch on includes:
- Place your baby in a comfortable position facing you so that he/she does not have to twist their neck to breastfeed.
- Gently stroke the baby's lower lip with your nipple. Your baby will instinctively open the mouth wide.
- Bring the baby's mouth closer to your nipple and centre the nipple above the baby's tongue.
- The baby's lips should cover the nipple and a part of the areola (darker skin around your nipple) as well to ensure correct latching. You may feel slight painless tingling sensation during breastfeeding.
- If the baby hasn't latched on correctly, release the suction by placing your finger in the baby's mouth, remove the nipple and try again.
What are the challenges you may face while breastfeeding?
Several challenges that breastfeeding mothers face include:
- Sore nipples: If you experience nipple soreness, ensure that your baby latches on correctly. You will have to empty the milk ducts to avoid swelling, pain and hardness of the breasts.
- Dry, cracked nipples: Avoid cosmetics containing alcohol that can make the nipples dry and cracked. Applying lanolin after breastfeeding may also help. Changing bra pads often will help keep the nipples dry.
- Blocked ducts: Blockage of ducts may cause a sore spot on your breast. This can be relieved with a warm compress, frequent nursing and massage.
- Breast infection (mastitis): This is a bacterial infection which results in flu, fever and fatigue. Your doctor may prescribe antibiotics to treat the infection, and you may continue to breastfeed your infant.
- Pumping and storing milk: If you are going back to work, you can express milk by hand or with a breast pump and refrigerate it. Refrigerated milk should not be thawed in a microwave, but in a bowl of warm water. You can start experimenting with bottle-feeding early, since the baby will take a few weeks to get adjusted.
- Stress: Being stressed can interfere with the release of milk into the milk ducts. It is advised to be calm and relaxed during nursing to allow easy flow of milk.
- Producing sufficient milk: Many women worry that they are not producing enough milk. A general rule is that a baby wetting six to eight diapers in a day is getting sufficient milk. Your body will produce a constant supply if you breastfeed your baby frequently and regularly, even if you have small breasts. Milk production will also depend on good nutrition, plenty of water and ample amount of rest.
Breastfeeding can harm the baby in few situations. Breastfeeding is contraindicated if you are:
- HIV positive
- Receiving chemotherapy
- Using illegal drugs
- Taking prescription medicines for migraine, headache, arthritis or Parkinson's disease
- Your baby has galactosemia (inability to tolerate galactose in the breast milk)
Talk to your doctor regarding breastfeeding if you are on any medication. It is important to note that having flu or cold should not stop you from feeding, as your child will gain immunity against the infection.
ABC of breastfeeding
A=Awareness: You should watch out for the signs of hunger and breastfeed when your baby is hungry. Avoid waiting till your baby gets cranky or shows signs of frustration when he/she is too hungry. In the first few weeks, you would be nursing your new born 8-12 times in a day.
B=Being patient: Avoid hurrying your baby while breastfeeding. Be patient and take as long as your infant wants to be nursed. Typically, infants nurse on each breast for about 10-20 minutes.
C=Comfort: You should be comfortable while you breastfeed to allow easy flow of the milk. Use pillows to support your head, neck, arms and foot before you start to feed your infant.
What is anaemia?
Anaemia, characterized by low oxygen-carrying capacity of the blood, can occur during pregnancy. During pregnancy, the blood production in the body increases to support your baby's growth, but sometimes, insufficient iron or other nutrient intake hampers the body's ability to produce sufficient red blood cells, which carry oxygen to the tissues. The three major types of anaemia that develops during pregnancy are iron-deficiency anaemia (most common), vitamin B12 deficiency and folate-deficiency anaemia.
In its early stages, anaemia may not show any symptoms or the symptoms may be common to those experienced during pregnancy without anaemia.
What are the symptoms of anaemia during pregnancy?
Anaemia during pregnancy can make you feel tired and weak, dizzy and make cause shortness of breath, increased heartbeat, problems in concentration, and paleness of the lips, skin and nails. If left untreated, it may increase the risk of preterm (premature) delivery.
How is anaemia diagnosed?
Routine blood tests are important to detect anaemia at its early stages. Your doctor will suggest a blood test during the first prenatal appointment. Lower levels of haemoglobin and red blood cells in the haematocrit test may indicate anaemia. The tests are repeated during the second or third trimester.
What are the treatment options?
Anaemia during pregnancy can be treated with iron and folic acid supplements. Your doctor will advise you to include foods rich in iron and folic acid in your diet. You can prevent anaemia by including eggs, poultry, fish, lean red meat, dark green and leafy vegetables, iron-rich cereals, and nuts in your diet. You can also include high vitamin C rich foods like citrus fruits, tomatoes, bell peppers and strawberries, so that more iron can be absorbed in your body. Vegetarians and vegans should consult their doctor regarding taking vitamin B12 supplements during pregnancy and breastfeeding.
Pregnancy Complicated by High Blood Pressure or Gestational diabetes
Pregnancy is an exciting time for any women, but complications may develop sometimes even in healthy women. Most pregnancy complications can easily be detected and prevented during regular prenatal visits. The two most common complications that arise during pregnancy are high blood pressure and gestational diabetes.
Complications of Pregnancy Induced by High Blood Pressure
Pregnancy Induced Hypertension (PIH), also called preeclampsia is a pregnancy complication that usually starts after the 20th week of pregnancy. It is one of the main causes of concern in pregnant women as this severe form of hypertension may induce labour very early. Pregnancy induced hypertension might present as high blood pressure alone or accompanied with other conditions such as protein in the urine, swelling and even convulsions. The condition can be detected during antenatal visits and should be treated and monitored appropriately. If left untreated, this condition can cause serious problems for both the mother and the baby. In the mother PIH can cause placental abruption (premature detachment of the placenta from the uterus) and seizures. Pregnancy induced hypertension also causes less blood flow to the placenta. Complications in the baby include premature birth, low birth weight, stillbirth, or growth restriction. You should watch for signs such as rapid weight gain of 4-5 lbs in a week, severe headache, blurred vision, severe pain in the stomach under the ribs and consult your doctor immediately. During a routine check-up, your doctor will check your blood pressure, urine levels, and may order blood tests which can show if you have preeclampsia. There are treatment options which include medications, dietary modifications, mild exercise and activity along with sufficient rest. In severe cases, your doctor may want your baby to be delivered. It is important to remember that hypertension during pregnancy is a serious condition and should be taken care of to prevent further complications.
Complications in pregnancy induced by Gestational Diabetes
Gestational diabetes is a condition in which the level of sugar in your blood becomes higher than normal. This condition usually develops in the second trimester and most often returns to normal soon after delivery. High blood sugar levels can affect both the mother and development and growth of the baby. Normally there will not be any symptoms except for extreme thirst, hunger or tiredness that may be experienced occasionally. The screening test for diabetes is done in the 28th week of pregnancy. Your doctor checks your blood glucose level using a test called a fasting blood glucose test. Other tests such as screening glucose challenge test and oral glucose tolerance test may be needed to confirm the diagnosis. Pregnancy induced diabetes can usually be controlled by certain dietary changes, regular exercise, and frequent blood tests as suggested by your doctor. Some cases might also require use of insulin to keep blood sugar levels under control. Poorly controlled or uncontrolled gestational diabetes increases the risk of preeclampsia, preterm delivery, large-sized baby, caesarean section, newborn with low blood sugar, breathing difficulties and jaundice. Even if gestational diabetes goes away after your baby is born, it increases your risk for diabetes later in your life. Therefore, it is important to exercise, eat a healthy diet and maintain a healthy weight after pregnancy.