Doing it in time

Career pressures lead to late marriages, which results in couples having their first child after 35 years of age. Some parents avoid having a second child, but the first child starts demanding one after going to school. This is generally because they see the siblings of other children and start feeling lonely. Some find it embarrassing to have a second child when they cross 40 years, while some may be unable to have one, as fertility starts to decline rapidly after you are 35. However, although this is true for a lot of couples these days, a majority of the couples do have their second children in time.

So when the pregnancy test comes positive, you looking forward to having your second child. However, there are certain important things that must be kept in mind for planning a second pregnancy. If you are thinking that just because you had an easy first pregnancy, this one will be similar, think again. Most women don’t have the same symptoms as the first pregnancy.

What makes the second pregnancy different?

Every pregnancy is different for different people, sometimes even for the same person. If you are pregnant for the second time, you will have some surprises both physical as well as mental in nature.

1. Morning sickness: You are more likely to suffer from morning sickness during your second pregnancy, than your first.
2. Abdominal growth: Your abdomen will become noticeably large much earlier this time.
3. Signs of the baby: You will feel your baby move sooner. This is may just be because you are now experienced.
4. Positioning: The first pregnancy leads to stretching of the abdominal muscles, weakening them. They are unable to support the baby well in the second pregnancy, as a result you carry much lower.
5. Emotions: Handling emotions become easier when you are pregnant the second time. The experience of your first pregnancy helps in coping with general symptoms.

Is labour and delivery different too?

Yes. The second labour and delivery process can be considerably faster than your first time [where the labour typically lasts for at least 12 – 14 hours]. In most cases, the perineal cut can be avoided.

As for the delivery, if your first delivery was by caesarean section for non-recurrent cause, then the second baby can be delivered normally. If the cause was recurrent such as a contracted pelvis, then a repeat caesarean section is needed.

Post-pregnancy pains

The first 6 – 8 weeks can be the toughest. You will be under pressure to cope with both, the first child and the pregnancy. Your experience the first time will come in handy, however, the demands of looking after the first child can be challenging. If your first child is five years or older, she may be able to manage things independently. Co-operative relatives or even a good maid may be of great help here. Without proper help, you are very likely to be exhausted.

You will have to put in double the efforts getting your new-born’s schedule on track, and coping with your older child’s changed behaviour.

The good thing about the second pregnancy is that it will increase your confidence in your own abilities as a mother. Breast feeding, changing diapers, handling illness will all come back to you naturally.

How will it affect you?

Older children usually get affected emotionally and may experience a range of emotions such as jealousy, excitement or resentment. Younger children cannot verbalise their feelings and hence may show behavioural regression such as thumb sucking. Older children might misbehave, throw tantrums, or refuse to eat. These problems are usually transient, and a little preparation can go a long way.

It is a good idea to make them play the role of older sibling. There are a number of things that can help you achieve this.

• Make your older child help tidy the new baby’s room.
• Arrange special time just for you and your older child.
• Role-play or read stories to your child that will help him or her feel important.
• Prepare your child for what to expect when the baby comes home. This includes explaining that a new baby cries, sleeps, and needs diaper changes frequently.
• The arrival of a new child represents a big shift in your older child’s life. So, it is important that you plan for some time during the day to engage him or her in some outdoor activity.

Managing all this can make you physically and emotionally drained. This can also lead to depression and may sometimes make you feel very low. In such demanding and stressful situations, you may want to relax a bit or talk to a friend. Hence, it is important that you find time for yourself and your partner.

The post One more time appeared first on Complete Wellbeing.

Although pregnancy is a natural process and not a disease, a pregnant lady has to adjust to many common discomforts. The ability to cope with the challenges posed by pregnancy is determined by the physical condition, physiology of the pregnancy and the psychological state of the pregnant woman.

Some working women enjoy their work so much that they cannot think of staying away from work. Some may want to stop, but financial pressures and career prospects may force them to continue.

It is thus important to understand that work can affect pregnancy and pregnancy can affect work.

Before pregnancy

Timing matters

It is important that the pregnancy is planned properly. Crucial responsibilities that may depend upon your presence may have to be fulfilled. Imminent assessments that may lead to career progression, promotion, pay improvement and eligibility for leave should be considered, if possible.

If you are a professional with special skills, you may feel the responsibility towards your employer. You might want to find a right replacement to train somebody before becoming pregnant. It will increase your respect at work and will reduce the stress and guilt that you may feel during your absence from work.

Telling others

When the pregnancy is confirmed, when to inform the employer is often the big question.

It is advisable to wait till the first ultrasound scan [generally done at seven weeks gestation] after you miss your period and your pregnancy test comes positive. The scan confirms the location and viability of the pregnancy. This is your first opportunity to share the special news with your family, friends and colleagues.

Miscarriages [loss of pregnancy] generally happen during the first three months of pregnancy. During this time, the pregnancy is not visible and you may not want to tell anyone.

Unfortunately, morning sickness and fatigue make your pregnancy obvious to those around you. But if you can manage to hide these, then completion of 13 weeks can be your next best chance to declare your pregnancy. If you still want to keep it secret, consider sharing the news at 20 weeks [after the detailed anomaly ultrasound scan has been done]. After this time, people around you can see it anyway.

During pregnancy

Morning sickness

• Avoid triggers. Stay clear of items that trigger nausea such as certain foods or coffee.
• Consume plenty of liquids. This helps decrease your nausea and keeps you rehydrated.  Keep a bottle of water at hand at all times.
• Have frequent snacks. Stack your workplace with crackers and bland foods. It’s best to have frequent small meals that are easily digestible. Avoid eating heavy meals.
• Follow regular dinner timings. Take dinner at least two hours before going to bed. Give extra time to get out of bed in the morning, as rushing will make you physically and mentally tired and worsen your nausea.

Fatigue

• Iron deficiency anaemia is common during pregnancy and can lead to exhaustion. Eat foods rich in iron and protein such as green leafy vegetables, cereals, apricots, red meat, chicken and fish.
• Take short and frequent breaks. Take your mind off what you are doing every once in a while. Close your eyes and stretch yourself to relax your mind and body. This can be refreshing even if done for a few minutes.
• Reduce other activities. When away from work, avoid other social activities, unnecessary travelling and exertion. Make a special effort to keep weekends free for yourself.
• Take adequate physical rest. Sleep well in time at night. In later stages of pregnancy, a couple of hours rest in the afternoon is hugely beneficial.

Comfort

• The clothes you wear: This is especially important during the later stages of pregnancy.  Comfortable loose clothing [maternity clothes] makes a huge difference to your working ability.
• The commute to work: You may not be fortunate to stay close to your workplace. In that case, the travel to work will use up your energy reserves and expose you to additional physical and mental stresses. If any risk factors arise in pregnancy, your ability to continue work may be reduced. So, do all you can to keep the commute comfortable and stress-free. Listening to music while travelling helps divert your mind from the stresses of the commute. You may even want to explore the possibility of working from home.

Posture

Maintaining a proper posture is vital in making you comfortable.

• Sitting: It is essential to sit straight with proper back support. The chair you sit on should be adjustable and have a firm seat, cushions and armrests.
• Standing: Avoid standing for long hours. This can pool the blood in your legs and lead to discomfort. It is common for your feet to swell when you are pregnant, but standing can make it worse. If your job requires you to stand, wear good shoes with arch supports and small heels. You can even consider getting a footrest or a low stool to rest legs one at a time. Wearing support tights can make you comfortable.
• Lifting and bending: The changes in pregnancy lead to laxity of ligaments and joints. This increases the chances of an injury while lifting weights and bending. Look for help if you need to lift heavy objects. If you do it yourself, stand with feet shoulder width apart, bend at the knees and lift your arms and legs and not with the back.

Stress

If you’re at work, stress is inevitable. At least take care that it does not drain you of the energy that you need to look after yourself and the baby. Here are some ways to minimise stress:

• Prioritise your work. Evaluate the help available to you and delegate work.
• Share your frustration with those who care for you. Never bottle up your emotions.
• Try relaxation techniques such as good breathing exercises, meditation and yoga [performed under direct supervision] to relax the mind.

Caution at work

• Exposure to metals such as mercury and lead are known to cause birth defects and miscarriage.
• Exposure to household cleaning agents and pesticides can lead to foetal deformity.
• Exposure to pharmaceutical agents such as chemotherapy drugs may increase the chances of miscarriage, low birth weight, and malformations.
• Exposure to infections on the job, such as hepatitis, rubella, HIV and other communicable diseases can lead to complications during pregnancy.
• Exposure to physical agents such as radiation and radioactive waste can lead to abnormal foetal development and miscarriage.
• Exposure to computer screens does not affect your pregnancy. There is enough evidence to suggest that computer screens do not emit radiation that can harm the foetus. They can cause other effects such as pain in neck, wrist, shoulder and back, though.

As the pregnancy advances, women start to wonder about when to stop working. Make this decision only as per your doctor’s advice. Also, if any risks arise during the pregnancy, you may have to stop working immediately.

If all is well, you may find it good to stop work about two weeks before your due date, as the mental and physical relaxation will prepare you better for the labour and enable a normal delivery.

The post Pregnancy: Work, baby, work appeared first on Complete Wellbeing.

Antenatal care plays an important role to achieve a successful labour and delivery process. Regular antenatal classes help in the physical and mental preparation of women and help them relax during those last months.

Role of antenatal care

To ensure maternal and foetal wellbeing:

Regular visits to the doctor during pregnancy are aimed to ensure that the health of the pregnant woman and the growing foetus is well-maintained. When all stays well and proper care is taken, the pregnancy is generally low-risk. If any abnormalities develop during pregnancy or if there are any pre-existing risk factors, then it becomes a high-risk one. The abnormalities that could develop during pregnancy include increased blood pressure, diabetes, and growth restriction in the baby to name a few. The pre-existing risk factors include previous caesarean sections, and pelvic abnormality.

To prepare for labour, delivery and the post-partum period:

Normal labour and delivery depend on good physical and mental preparation during the antenatal period. The pregnant woman is taught good breathing exercises, relaxation techniques and muscle toning exercises. Yoga is now a well established form of therapy for this purpose. In order to relieve anxiety and fear, knowledge should be given about the labour and delivery process. This includes a clear understanding of what to expect in labour, ways of monitoring the labour, options for pain relief and the modes of delivery.

Normal labour:

At about 36 weeks gestation the mode of delivery should be discussed with your doctor. If the decision is taken to proceed with normal labour and vaginal delivery, then regular visits are continued till labour starts. These weekly visits ensure that all is well and thus it is important to feel good foetal movements during this time. You will also feel contractions and pains intermittently, but these are just warm up [practice] labour pains. These help your womb muscles to get better coordinated as they are getting ready for the actual labour stage.

Onset of normal labour

The start of labour happens with one of the following:

Abdominal pains and contractions. There is backache and the contractions are typically felt coming from the back towards the lower abdomen. Initially they come every 20 – 30 minutes, but then the frequency increases. In established labour, these contractions will come every three minutes and will last up to a minute.

Leakage of clear water. You may think it to be urine, but then realise that it is coming continuously. Sometimes the bag of water around the baby breaks and the surrounding liquid starts draining.

Blood stained mucous discharge. Occasionally the mucous plus gets dislodged from the neck of the womb. This is seen as a sticky discharge with blood staining.

In any of the above events, if you are unsure, it is best to contact your doctor for guidance. You may be asked to come for a check-up. If the neck of the womb has started to open, then it indicates the start of labour. If it is very early, you may prefer to be at home and go to the hospital later.

What to do at home when labour begins?

Get ready to travel to hospital. Do not take a heavy meal as there is a risk of vomiting when pain gets strong and this will get worse if your stomach is full. Liquids are the best form of intake from now on and they are good for rehydration. You will urinate frequently; this is normal. Take as much rest as possible so that you can cope with active labour. If possible, lie down on your left side.

When awake it is good to move around. This helps the baby’s head to push against the neck of the womb and improves the contractions. During contractions you can take support and lean forward on a steady surface [wall or bed] or be supported by your husband. Sometimes a good hot water shower is very helpful. When the contractions get stronger and frequent it will be difficult to cope and you will have to go to a hospital.

What is expected at the hospital?

If you are confirmed to be in labour on examination you will be admitted. A heart rate tracing of the baby can be reassuring at this stage. You will be encouraged to mainly take liquids. If all is well, you can continue to move around. At times, it is necessary to put an intravenous needle. Sometimes caesarean section is needed on an urgent basis. If this situation arises suddenly, anaesthesia can be given to you safely. During labour, soothing music, good aroma and massage can help you cope better.

Stages of labour

Labour has three stages. The first stage is from the onset of labour to the full dilatation of the neck of the womb. The second stage is from the full dilatation to the delivery of the baby. The third stage is from the delivery of the baby to the delivery of the placenta and membranes.

First stage

In the initial phase of the first stage [latent phase], the neck of the womb is getting ready for active labour. It is getting softer and thinner. This phase continues till3 – 4cm dilatation occurs of the neck. This phase could continue for 10 – 12 hours.

When the later phase [active labour] starts, the contractions will get stronger, more regular and frequent. If the membranes are not ruptured, your doctor may choose to break the bag of water now. If the baby has opened its bowel [meconium], then the fluid is green coloured and is a worrying sign. This phase will become very uncomfortable. It is important to breathe in and out during the contractions and relax your body muscles. You must avoid pushing as valuable energy will get wasted and the baby will get tired sooner. The regular, frequent and strong contractions will lead to full dilatation of the neck of the womb. The active phase can take about 6 – 7 hours.

Pain relief. Various options can be considered to help you cope with the labour pains. In the early stages, intramuscular pain killer injections can be considered. Gas inhalation [nitrous oxide and oxygen] can also be of help.

The most effective pain relief is with epidural analgesia [painless labour]. In this form, a catheter is put into the back through a needle. The pain-killing medicine is injected through the catheter. This is very effective and takes away the pain. In case a caesarean section becomes necessary, it can be performed with the help of the epidural catheter.

Epidural analgesia cannot be used in women with bleeding disorders or spinal cord abnormalities. The disadvantage is that labour may sometimes get prolonged and your ability to push the baby at full dilatation may get compromised. In this situation, the chances of instrumental delivery may be higher. The other disadvantage is the additional cost. This form of pain relief needs close monitoring. Sometimes the anaesthetist may stay with you till the delivery.

Monitoring. It is important to assess the progress of labour and maintain foetal wellbeing. The baby’s heart beat pattern is monitored at regular intervals. At any stage, if the mother or the baby’s wellbeing is compromised; a caesarean section delivery of the baby would be performed.

Second stage

Once the neck of the womb is fully open [about 10cm], the second stage starts. The delivery is now expected within two hours. During contractions it is important to relax and take a deep breath in and push right down. If there is any delay, this stage can be shortened by applying an instrument such as forceps [metal blades] or a suction cup [ventouse delivery] on the foetal head. A cut on the perineum is sometimes necessary to facilitate the delivery of the baby. This is repaired post-delivery and heals within few days.

Third stage

This stage extends from the delivery of the baby to the delivery of the placenta. Generally, this is completed in 15 – 20 minutes. Rarely, the placenta may not get separated. This can become a problem as bleeding may start. In this situation, you may need to be taken to the operation theatre for a manual removal of the placenta.

If approached in an ill-prepared manner, it is unlikely to be a positive experience. Hence it is important to take utmost care and proper preparation. The first labour and delivery is most challenging and the subsequent ones become relatively easier on most occasions.

The post LABOUR: How to get ready appeared first on Complete Wellbeing.

Long-term consequences of pregnancy-related complications include uterine prolapse [laxity of the pelvic floor], pelvic inflammatory disease, fistula, bladder or bowel incontinence, infertility, and pain during sexual intercourse.

Here, I discuss some complications that might occur during the nine-month long journey.

First trimester [month 1 – 3]

Once you have conceived, you would probably know you are pregnant based on a variety of symptoms. These include:

• A missed period
• Heaviness and tenderness in breasts
• Tiredness throughout the day
• Feeling faint
• Increased vaginal discharge
• Nausea and vomiting
• A strong dislike for certain things such as coffee, cigarette smoke and a frequent need to pass urine.

You can confirm your suspicion using a home pregnancy testing kit using the first urine passed in the morning. The location of the pregnancy can sometimes go wrong here. An internal sonography done after seven weeks of pregnancy is able to identify the pregnancy sac and even see a heart beat. This is very reassuring as it confirms that the pregnancy is in the correct location and helps in dating the pregnancy.

Excessive vomiting: Till 13 weeks of pregnancy, vomiting is common and affects every pregnant woman though with varying degree of severity. After that, it generally settles down. Medications have a limited role to treat this condition. If vomiting becomes severe, there is a risk of dehydration. It is important to take adequate fluid intake to avoid this problem.

Bleeding and pain: These symptoms occur in ectopic pregnancy [pregnancy in the fallopian tube] and miscarriage. If there is pain in early pregnancy, the suspicion of ectopic pregnancy is high. Sometimes, bleeding accompanies pain. Unfortunately, this pregnancy cannot continue further and has to be terminated medically [with injections] or surgically [through a telescope-laparoscopy or by a cut on the tummy]. If ectopic pregnancy is not diagnosed in time, it can rupture leading to serious bleeding inside the tummy, which is an emergency situation.

If pregnancy is located within the womb, bleeding and pain could mean a possible miscarriage [loss of pregnancy]. One must take complete bed rest, stay relaxed and follow your doctor’s advice.

Supporting medications can help, but sometimes the pregnancy may be lost. There are several reasons for miscarriages to happen in the first three months. The commonest one is a developmental defect in the building blocks [chromosomes] of the foetus. Nature’s selection process prevents this abnormal pregnancy from continuing. If three or more miscarriages occur, this condition is called recurrent miscarriages. Investigations may have to be undertaken, but they do not always detect an underlying abnormality. In majority of the women, a normal pregnancy and delivery can happen in spite of previous miscarriages.

Things to avoid in early pregnancy

• Eating heavy meals: Start taking light, but more frequent meals. Avoid eating outside food, especially in the rainy season; a stomach bug may lead to loose motions and this can complicate the pregnancy unnecessarily.
• Visiting friends or relatives in hospital atmosphere: You may catch infections, which can affect the pregnancy.
• Smoking: Evidence suggests that inhaling even second-hand smoke can harm the baby, so encourage your partner to give up smoking. Smoking can cause miscarriages, growth restriction and foetal death.
• Alcohol: Excessive drinking can affect the developing baby.
• Medications: As many drugs can have harmful effects on the baby, it is important that you check with your doctor before taking any.
• Animals: Handling cats and dogs faeces can lead to infection with toxoplasma, which can cause serious harm to the baby.
• Physical and mental exertion
• Travelling on bumpy roads.

At the end of three months [12 weeks]: Frequency of urination may get better, but some women feel constipated. You may have gained about 1kg weight, but this is a very poor indicator of maternal and foetal wellbeing because at this time, the baby is only 6.5cm in length.

Checking for irregularities: A baseline blood pressure measurement should be done early in pregnancy. It is important to conduct blood and urine tests to look for low haemoglobin, abnormalities of sugar, thyroid disorders and Rh negative blood group. Routine screening for HIV, Hepatitis B and syphilis should be done. An ultrasound scan at about 11 weeks measuring the skin fold thickness on the baby’s neck is now an established way to look for Down’s syndrome. At this stage, if history, physical examination and investigations are normal, the pregnancy is classed as low risk. Presence of any abnormality increases the likelihood of complications making it a high risk pregnancy. In either case, it is important to continue regular antenatal care to identify any changes quickly.

How to avoid complications

• Diet: Eat fresh food. Most women require taking iron and calcium supplements. You may discontinue folic acid supplements.
• Exercise: Performing antenatal exercises under supervision is recommended. Yoga helps staying physically and mentally fit during pregnancy, delivery and the postnatal period. Familiarise yourself with the care providers and hospital facilities to prepare yourself mentally.
• Posture: Wear low-heeled shoes and hold yourself well to avoid back injury. Avoid bending in your back. If you need to bend, say to pick up something from the floor, go down on your knees. When getting up from the bed, turn to one side and then rise slowly. Standing suddenly can cause giddiness.

At the end of 16 weeks: Undergo blood tests to detect abnormalities such as Downs’s syndrome and neural tube defects in the baby. A detailed sonography is performed from 16 to 20 weeks to detect any abnormality in the baby. This is called an anomaly scan and checks the baby from head to toe. A normal scan at this stage almost completes the investigative process to detect an abnormally developed baby.

Common pregnancy complications

You may start to bleed, which could indicate a miscarriage. Bleeding at this stage of pregnancy happens if the neck of the womb [cervix] is weak. If you bleed, you may need complete bed rest and a stitch to tighten the neck of the womb. Rarely, the screening blood tests and the detailed anomaly scan suggest abnormalities in the baby. If that happens, more reliable tests such as amniocentesis [aspiration of fluid from the pregnancy sac] may become necessary.

Third trimester [month 7 – 9]

At the end of 28 weeks: Make sure to get enough rest in the day. If you have difficulty sleeping, try sleeping on your side with one leg bent and supported on a pillow. You may have gained another 5kg weight. If you are still at work, inform your employer about when you intend to stop working. Sometimes, it becomes necessary to check your haemoglobin and blood sugar levels at this stage. From now on, you will be checked every two weeks.

At 30, 32 and 34 weeks: Keep a count of the foetal movements. You should feel at least 10 movements in a day. Keep your feet up for an hour or two. You may notice swelling of your feet that worsens at the end of the day. Pelvic floor exercises become very important especially if you are suffering from leaking urine.

From 36 weeks onwards: False labour contractions start from now.

Week 40 onwards: If all is well, there is no need to panic. You could deliver anytime from two weeks before the due date to even two weeks after. Generally, most people prefer to start labour 8 to 10 days after the due date. A baby’s heart beat recording [non-stress test] may become necessary to ensure its well-being. Doppler blood flow studies of the baby also help in understanding the foetal well-being.

Possible complications in the last three months

Growth restriction: It is important to monitor the growth of the baby, mainly during the last three months. If the growth slows, additional tests such as blood flow to the baby [Doppler test] may be necessary. If there are abnormalities in the scans, Doppler or the baby’s heart beat recording, the baby may have to be delivered. It is important to look out for the baby’s movements. Decreased movements may indicate reduced oxygen supply to the baby. Resting in the left lateral position and a good diet are helpful.

Preterm labour: The baby becomes fully mature at 37 weeks gestation. Sometimes labour may start before this time. This is generally due to infection, mainly urinary infection. In such situations, it is important to be cared for in a hospital that has neonatal intensive facilities.

Medical disorders in pregnancy: In some patients, either the blood pressure, or the blood sugar rise. Careful monitoring coupled with timely tests can diagnose these disorders early and keep them under control.

Low placenta and abruption: These conditions lead to bleeding in pregnancy. Emergency situations may arise and delivery may become necessary. Low lying placenta warrants complete rest and delivery may have to be by caesarean section. Abruption means sudden separation of the placenta.

Abnormal lie: Occasionally, the baby may be in an abnormal position. This could be breech [presentation by legs], oblique or transverse lie. In such situations, a caesarean section becomes necessary.

If all is well, labour can start anytime after 37 weeks gestation. It is important to monitor labour closely and ensure that proper a assessment is done and in time. Systematic efforts by you and your doctor can ensure that your pregnancy is both, safe and happy.

The post Prevent pregnancy complications appeared first on Complete Wellbeing.