Specilization»Pregnancy & Delivery

  Pregnancy Confirmation

One of the most reliable ways of determining pregnancy is missing a period.Some women continue to have periods throughout their pregnancy but this is very rare.
First morning urine will always contain the highest concentration of hCG. You can increase your chances of having enough hCG in your urine by waiting four hours after your last urination before taking the test, which will allow hCG to build up in your urine. A negative result that later turns out to be positive is usually due to the test being performed too early. A positive that later turns out to be a negative may point to a very early miscarriage.

Prepration for your first Visit

We will welcome if ladies prefer to come up with their husband during visits. On your first visit we will like to know about Gynecological health details

Pregnancy Confirmation

Those who are coming in the later stage of pregnacy should come with all previous records of consultation , investigations and medical records.

  Pregnancy Care & Visit

Ask doctor about:

Due date calculation

The doctor finds out about your last menstrual period (LMP) and will calculate the Expected Date of Delivery(EDD). Labor usually occurs + or - 2 weeks around the EDD.

General examination

This is an important part of the first visit and the findings are noted in a records to be maintained throughout the entire period of your pregnancy.

Height:Height is necessary to determine whether you would go for a normal delivery or require a Caesarian section.

Weight:You may not put on weight during this trimester as you have been vomiting for the past 2-3 months. But don't worry you will compensate in the next two trimesters.

Blood pressure: Your blood pressure is routinely recorded . Any rise in blood pressure needs medical intervention.

Antenatal visits

One should consult gynecologist as soon as periods are missed after doing a home pregnancy test.Normally schedule of Antenatal visits are like this.

   Investigations

The followings investigations will be done according to your weeks of pregnancy, preferably in the first visit Blood investigations include

1st trimester (First 3 month)

CBC Complete blood count for Hb% ,to rule out any infection
Blood Sugar  
Thyroid function test T3,T4,TSH ,to rule out thyroid in pregnancy
ELISA For HIV 1 I II
HBsAg Screening of Hepatitis B
HCV Screening of Hepatitis C
VDRL Screening of syphilis
Urine For infection ,sugar and protein
Sonography To see cardiac activity(Heart beat in baby)
Sonography 11 to 13 weeks for nuchal tranclucency
Double Marker test Done between 11 to 13 weeks

2nd trimester(4th upto 6th month)

Hb%  
Blood Sugar  
Urine routine For infection ,sugar and protein
USG Anomaly scan between 18 to 22 weeks,to rule out any congenital defect in the baby

3rd trimester(7th month onwards)

Hb%  
Blood Sugar  
Urine routine For infection ,sugar and protein
TSH  
HIV,HBsAg  
USG between 28 to 30 weeks for baby growth,amount of fluid,baby's positions and color Doppler to see the blood flow to the baby

There are some additional tests which are done if advice by the doctor

Drugs and Immunization

Generally any drugs should be avoided in first trimester as the organs of your baby develop during this period. Drugs can have harmful effects on the formation of the baby's organs and can lead to malformations.
A vitamin and mineral supplement may be a good idea to help you get all the vitamins and minerals you need.Folic acid is particularly important. A lack of this B vitamin has been linked with neural tube birth defects such as spina bifida.You may also need to take iron and calcium supplements. Your doctor will check your hemoglobin levels regularly and advise you on how much to take.
If you are already on medication, immediately consult your doctor.For any of the symptoms that occur in this period consult your doctor.

If you have not been previously immunized with Tetanus vaccine, the doctor will give you 2 shots.

  Diet During Pregnancy

     Extra Calories required during pregnancy

Even though everyone will advise you to eat for two, the average woman does not need any extra calories during the first six months of pregnancy. Your body actually becomes more efficient at extracting the required energy and nutrients from your diet when you're expecting a baby. Even in the last few months, you only need about 200 extra calories per day. You can add these additional calories to your daily diet with:

  • 2 rotis without ghee
  • One plaindosa
  • Two bananas
  • 2 eggs
Diet During Pregnancy

Your own appetite is the best indication of how much food you need to eat and you may find it fluctuating during the course of your pregnancy:

The best rule is to eat when you are hungry and to choose healthy food rather than calorie-rich dishes with little nutritive value.

Food to be avoided during pregnancy

There are some foods that could be unsafe for your baby:

Supplements to be taken during pregnancy

Morning sickness or food aversions may make it hard to eat well during pregnancy. A vitamin and mineral supplement may be a good idea to help you get all the vitamins and minerals you need.

Folic acid is particularly important. A lack of this B vitamin has been linked with neural tube birth defects such as spina bifida.

You may also need to take iron and calcium supplements. Your doctor will check your hemoglobin levels regularly and advise you on how much to take.

Dieting during pregnancy

Dieting during pregnancy could harm you and your baby. Some diets can leave you low on iron, folic acid or other important vitamins and minerals. Weight gain is one of the most positive signs of a healthy pregnancy. Women who eat well and gain the appropriate amount of weight are more likely to have healthy babies.

Weight gain in pregnancy

The average weight gain during pregnancy is between 8 kgs and 15 kgs. Concentrate on eating well rather than worrying about weight gain. Eat plenty of carbohydrates, lots of fruits and vegetables, reasonable amounts of protein, and just a little in the way of fats and sugars. If you are over 90 kgs or under 50 kgs, your doctor may advise a special diet.

Frequency of meals during pregnancy

Even if you're not hungry, chances are your baby is, so try to eat every four hours. Sometimes morning (or all-day) sickness, food aversions, acidity, or indigestion make eating difficult. Try eating five or six small meals each day, instead of three large ones. Your baby needs regular sustenance, and you need to keep up your energy levels, so try not to miss meals.

Food cravings during pregnancy

You don't have to give up all your favourite foods just because you're pregnant. But processed or heavily fried foods and snacks and sugar-packed desserts shouldn't be the mainstay of your diet, either..!

  Exercise

Always talk to your doctor before beginning any exercise program.Once you're ready to get goning:

  • Start gradually.Even 5 minutes a day is a good start if you've been inactive.Add 5 minutes each week until you reach 30 minutes.
  • Dress comfortably in lose-fitting clothes and wear a supportive bra to protect your breast.
  • Drink plenty of water to avoid overheating and dehydration.Skip your exercise if you are ill.
  • Opt for a walk in air-conditioned mall on hot,humid days.
    

PRE NATAL EXCERCISES

Pelvic Tilt

This important movement lengthens muscles of lower back and helps keep abdominal muscles strong enough to take weight of growing baby.Start against a wall so you can not cheat by moving top half as well.Feet should be slightly apart and away from wall and knees slightly bent.Feel back of the head,shoulder blades and spine resting against wall and breathe in.As you breath out press back of the waist into wall so that bottoms moves away from it a little.This is a small movement repeat several times slowly with correct breathing.

    

Sideways Pelvic Tilt

Standing with the feet apart, lift left hip towards left ribs and then the right hip towards the right ribs. Repeat several times, transferring smoothly from side to side with a good rhythm, and then try it with knees bent.

    

Breathing

Sit in any comfortable position where the spine is lengthened and ribs are free and concentrate on taking each breath down to the baby and then letting each breath out completely. Think about your baby as you do this. stroking and circular movements with palms over the bump will be comforting for you both too. Breathe down to the baby at back to the body as well.

    

Pelvic Floor

To locate your pelvic floor muscles, test them out while you are passing water (not on an extremely full bladder through, such as first thing in the morning) by stopping flow of urine mid-stream. You should be able to stop it completely with no drips. If you can't pelvic floor muscles need working on. Lift them up a little (as though stopping urine flow mid-stream), then squeeze upwards as much as you can. Hold for a slow count of and then lower in three stages as before. Don't worry if you can't get all stages up or down at first you will become more precise with practice. Try to do this atleast 5 times a day. Left and squeeze pelvic floor in one quick movement too repeat several times daily. When you are familiar with exercise, try combining it with pelvic tilt.

Leg Swings

These will get circulation moving in the hips and legs. Try them forwards and back and across and out away from the body, holding lightly onto the back of a chair for support.

Side Stretch

Sitting cross-legged, breathe in and stretch one arm up and over head. Reach over to opposite side enjoying stretch and breathing out. Breathe in as you return to center and then change arms stretch to other side Repeat several times.

Twist

Sitting Cross-legged, place one hand on opposite knee and press the other into floor behind you to help lift spine as you take a good breathe in. As you breathe out, twist gently round towards arm at back and look round gently too. Think of spiralling round on a well-liftes spine as you do this. Hold for a few moments, breathing normally, then repeat to other side.

Warning signs or symptom requiring urgent consultation

Your body is changing so rapidly that it's hard to know whether what you're experiencing is "normal." If you're not sure whether a symptom is serious, you don't feel like yourself, or you're uneasy, trust your instincts and make the call.

 

  Preparation for Labor & Delivery

After months of anticipation, your baby's due date is near.
Start preparation, whenever you come to hospital for delivery do not forget to bring

Signs of Labor

No one can predict with certainty when labor will begin -- the due date your doctor gives you is merely a point of reference. It is normal for labor to start as early as three weeks before that date or as late as two weeks after it. The following are signs that labor is probably not far away:

Stages of Labor

Labor is typically divided into three stages:
Stage 1:-This stage has three phases:

I Stage of Labor Latent Active Transition
Contraction More frequent Intense pain , pressure in back and abdomen Very strong painful and frequent
Cervix Dilataion 3-4 cm , effaced or thin out 4-7 cm cervix effaced completely Dilated copmpletely 10cm
Instruction for patient This is the longest period have patience . Discomfort is minimal. You may feel urge but do not bear down Once cervix dilates fully doctor will ask you to bear down

Stage 2:-

Stage 2 begins when the cervix is completely opened. At this point, your doctor will give you the OK to push. Your pushing, along with the force of your contractions, will propel your baby through the birth canal.

As soon as your baby's head comes out, your doctor will suction amniotic fluid, blood, and mucus from his or her nose and mouth. You will continue to push to help deliver the baby's shoulders and body. Once your baby is delivered, doctor clamps and cuts the umbilical cord.

Stage 3:- After your baby is delivered, you enter the final stage of labor. In this stage, you deliver the placenta, the organ that nourished your baby inside the womb.

Remember for each woman labor is different. The amount of time spent in each stage of delivery will vary. If this is your first pregnancy, labor and delivery usually lasts about 12 to 14 hours. The process is usually shorter for subsequent pregnancies.

Pain Treatments

Just as the amount of time in labor varies, the amount of pain women experience is different, too.

The position and size of your baby and strength of your contractions can influence pain, as well. Although some women can manage their pain with breathing and relaxation techniques learned in childbirth classes, others will need other methods to control their pain.

Some of the more commonly used pain-relief methods include:
Medications:- Several drugs are used to help ease the pain of labor and delivery. Although these drugs are generally safe for the mother and baby, as with any drugs, they have the potential for side effects.

An epidural block continuously administers pain medication to the area around your spinal cord and spinal nerves through a catheter inserted into the epidural space. Possible risks of both include decreased blood pressure, which can slow the baby's heart rate, and headache.

Non-Drug Options:- Non-drug methods for relieving pain include acupuncture, relaxation techniques, and changing position frequently during labor.

Cesarean section

Cesarean delivery - also known as a C-section-is a surgical procedure used to deliver a baby through an incision in the mother's abdomen and a second incision in the mother's uterus.

A C-section might be planned if you develop pregnancy complications. Often, however, the need for a first-time C-section doesn't become obvious until labor is under way.
 

Sometimes a C-section is safer for you or your baby than is a vaginal delivery. doctor might recommend a C-section if:

It's also important to know when to contact your health care provider. Make the call if you experience:

Postpartum depression - which can cause severe mood swings, loss of appetite, overwhelming fatigue and lack of joy in life - is sometimes a concern as well. Contact your health care provider if you suspect that you're depressed. It's especially important to seek help if your signs and symptoms don't fade on their own, you have trouble caring for your baby or completing daily tasks, or you have thoughts of harming yourself or your baby.

 

What to Expect After Delivery

Just as your body went through many changes before birth, it will go through transitions as you recover from childbirth.
Physically you may experience the following:

Emotionally you may experience irritability, sadness, or crying, commonly referred to as the "baby blues," in the days or weeks after delivery. These symptoms occur in up to 80% of new mothers and may be related to physical changes (including hormone changes and exhaustion) and your emotional adjustment to the responsibilities of caring for a newborn.

If these problems persist, inform your doctor or other health professional; you could be experiencing postpartum depression, a more serious problem that affects between 10% and 25% of new mothers.

  Breast Feeding

Starting breastfeeding

The first time you hold your newborn is a right time to start breastfeeding. Initially your body produces small amounts of a thick yellowish milk called colostrum that will help protect your baby from infection.
Turn your baby's whole body toward you, chest to chest. Touch her upper lip with your nipple, and, when she opens her mouth wide, pull her onto your breast, holding your breast for support. Her mouth should cover not just the nipple but as much of the areola (the darker part surrounding it) as possible. Breastfeeding requires patience and lots of practice. Don't hesitate to ask a nurse to show you what to do.

Breast Feeding

How frequently you should feed

The more you nurse, the more milk you'll produce. feeding eight to 12 times every 24 hours is usually adequate.

Feed on demand: According to guidelines from the American Academy of Pediatrics (AAP), rather than nursing according to a rigid schedule, you should nurse your newborn whenever she shows early signs of hunger, such as increased alertness or activity, mouthing, or rooting around for your nipple. Crying is a late sign of hunger – ideally, you should start feeding your baby before she starts crying.During the first few days, you may have to gently wake your baby to begin feeding, and she may fall asleep again mid-feeding. (To keep her awake during feedings, you may want to tap her on sole or remove a layer of clothing.) To make sure your baby's eating often enough, wake her up if it's been four hours since your last nursing session.

Best position for feeding

Since feedings can take up to 40 minutes, especially in the newborn months, choose a comfortable place. Hold your baby in a position that won't leave your arms and back sore. It works well to support the back of your baby's head with your hand, but the position you choose really depends on what's comfortable for you.

If you're sitting, a nursing pillow can be a big help in supporting your baby. Whether you're sitting or lying down, don't start the feeding until you and your baby are comfortable because you'll be in that position for a while.

Dietary advise

A normal healthy diet is all you need while you're nursing. Although you can produce milk for your baby even if your nutrition isn't up to par, eating a well-balanced diet will ensure that the quantity and quality of your milk is all it can be and will help you feel your best. Follow your hunger rather than counting calories, and drink fluids throughout the day to stay well hydrated.

Problems you may encounter

Some women adjust to breastfeeding easily, encountering no major physical or emotional hurdles. But many new moms find it hard to learn. If you're tensed, you're not the only one.
It's normal to feel overwhelmed by your baby's constant demands and exhausted from lack of sleep. And you may have questions: Is my baby getting enough milk? Should I have sore nipples? How long should my baby nurse? Should I wake her if she falls asleep nursing?
Although women have nursed their babies for centuries, breastfeeding doesn't always come easily. Many women face difficulties early on. Some of the most common breastfeeding problems you may encounter in the first six weeks include:

Calcium requirement during pregnancy
Pregnancy is a critical time for a woman to consume more calcium. Even if no problems develop during pregnancy, an inadequate supply of calcium at this time can diminish bone strength and increase your risk for osteoporosis later in life.

The following guidelines will help ensure that you are consuming enough calcium throughout your pregnancy:

Best Sources of Iron