Blind to Bounds

Every human being deserves to be in good health, at all ages.

For women likely or planning to embark on pregnancy need to be healthy is even more. The health of a woman has bearing not only to her own future health during and after pregnancy, but also of her unborn baby developing in her.

Unplanned pregnancies are at a greater risk not only to the mother, but to the babies with preterm and low birth babies. Some medical conditions and medications can harm the developing baby.

Ideally the preparation for pregnancy should begin 3 months before getting pregnant. Some actions, such as quitting smoking, reaching a healthy weight, or adjusting medicines already in use, should start even earlier.

Steps to take before PLANNING a pregnancy:
1. All women need to take 400 to 800 micrograms of folic acid every day. It is proven that, folic acid lowers your risk of some birth defects of the brain and spine, including spina bifida. Talk to your doctor about your folic acid needs.
2. Stop smoking and drinking alcohol– it is better to start much earlier.
3. If you have any medical condition, be sure it is under control. Common conditions include: asthma, diabetes, oral health, obesity, or epilepsy.
4. For any over-the-counter and prescription medicines you are using, do inform your doctor about it. These include dietary or herbal supplements.
5. Be sure your vaccinations especially the Rubella vaccination is up to date.
6. Avoid contact with toxic substances or materials that could cause infection at work and at home. Stay away specially from chemicals and cat or rodent feces.
7. Avoid intake of fish that can be high in mercury, like shark, swordfish, king mackerel and tilefish.

If there has occurred an UNPLANNED PREGNANCY:
Start taking care of yourself right away.

• Take 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) folic acid every day.
• Stop alcohol, tobacco, and drug use. Ask help for quitting smoking.
• Make a doctor’s visit to confirm your pregnancy.
• Discuss your health and issues that could affect your pregnancy. Find out what you can do to take care of yourself and your unborn baby.

What are the different periods/trimesters of pregnancy?

Pregnancy can be divided into 3 trimesters of approximately 3 months each. They are:

What happens during prenatal visits?

During the first prenatal visit, you can expect your doctor to:

•  Ask about your health history including previous pregnancies, other diseases, operations etc.
• Calculate your due date from your last menstrual period.
• Ask about your family’s health history
• Do a complete physical exam, including a pelvic exam and Pap test
• Check your blood pressure, height, and weight
• Take your blood and urine for lab work—Blood group, Hemoglobin, check immunity to certain infectios esp Rubella, Varicella, Blood tests for infections like: hepatitis B, toxoplasmosis, syphilis, gonorrhea or chlamydia. You might also be offered a test to check for HIV, the virus that causes AIDS.
• Will order for you an Ultrasound test: To detect the location, and double check the age of the growing foetus. The doctor may also ask for certain extra blood and US tests to check for fetal abnormalities.
• Answer your questions—you must freely discuss all your concerns and fears with your doctor. Find out all you can about how to stay healthy.

Note: The purpose of first prenatal visit is to book with the doctor, get your date of delivery ascertained, check if there are any risks to the pregnancy & get basic tests done.

Following prenatal visits will probably be shorter.

• Your doctor will check on your health and make sure the baby is growing as expected. Most prenatal visits will include:
• Checking your blood pressure
• Measuring your weight gain
• Measuring your abdomen to check your baby’s growth (once you begin to show)
• Checking the baby’s heart rate—Though Ultrasound can detect the heart rate almost at any early age, but for a heart beat by a Doppler is heard only after 3 months.
• You will probably not need any internal (pelvic examination) till the later part of pregnancy.

Number and Frequency of prenatal visits:
Usually the visits are monthly till 28 weeks, then in two weeks, till 36 weeks. The purpose of the tests during the pregnancy is to ensure that the baby is growing as expected, and that the health of the mother is also normal. Regular checkups will help in finding out any deviation from normal early, and hence easy to handle.
Towards the end, after 36 weeks, the visits become weekly, just to make sure, that the growth and the position of the baby is normal enough for a normal delivery, or if not, then prepare for a surgical delivery.

Special Tests during pregnancy:
In the fifth month, the doctor shall ask you for a blood test to check Glucose tolerance. This is to rule out if you have the risk of developing high blood sugar in the pregnancy, as this can harm the growth of the baby.
Some specialist centers  may also do a ‘cardiac Ultrasound at five months ( 20 weeks) to check that baby has no heart defect.
If your Blood group is Rh negative while husband’s is positive, the doctor will ask for a Rh Antibodies test.

Ultrasound scans during pregnancy:

• In the first 10 weeks of pregnancy the best way to scan is by inserting a small probe into the vagina. The examination is similar to an internal pelvic examination. Embryos as small as a few millimeters long will be visible on the TV monitor. The procedure my be a little uncomfortable for some, but it is not painful at all.
• In later stages of the pregnancy, the scanning will be done via the surface of the abdomen. Ultrasound gel will be spread on the skin, then the scanner is passed over the uterus until the fetus and the placenta are found. Usually, the pregnant woman and her partner can watch the scan on the monitor.
• In the first stage of the pregnancy, usually before 14 weeks, ultrasound scanning is used to check whether the fetus is alive and whether it is alone or one of twins or triplets.
• By measuring the length of the fetus it is also possible to accurately determine when the baby will be due.Some major abnormalities can also be detected at this stage.
• At 11 to 14 weeks, measurement of the thickness of the skin at the back of the neck (known as nuchal translucency measurement) can be used to calculate the risk of the fetus having a chromosome abnormality.
• From 18 weeks onward  it is possible to examine the fetus in more detail. Most organ systems can be examined to ensure that the fetus appears to be developing normally. The spine, skull, brain, heart, lungs, kidneys, arms and legs can all be seen. If the mother is overweight, then the quality of the examination may be poor.
• From 30 weeks onward  ultrasound is often used to estimate how well the baby appears to be growing. It is difficult to be precise about this but it is often useful if the woman has had a small baby in the past or has a condition that may affect the baby’s growth, such as preeclampsia.
• The bloodstream in the umbilical cord is also examined to see if it is functioning well enough to transport sufficient oxygen and nutrition to the fetus.
• It is also possible to check the position of the placenta to see whether it is lying normally or if the placenta is lying abnormally close to the inside of the cervix (a condition known as placenta praevia).
• There is no scientific evidence to support the concern of harm caused by repeated US scan.

Last weeks of pregnancy:

• After 36 weeks till 40 weeks you will be asked to visit every week.
• Apart from the usual weight and blood pressure, the doctor will lay more emphasis on the abdominal and pelvic examination to assess the position of the baby and its possibility of a normal birth through vaginal delivery.
• If the baby is with head down, you are good to go with normal delivery.
• If the baby is positioned otherwise i.e. rump or legs first( breech) the doctor might try to over the abdomen to turn the baby to head down. This is called as external cephalic version.
• If it still remains so, then you might need Cesaerian section.
• In the last visits, do ask doctor about any questions that arise in your mind, pertaining to the child birth, like sexual intercourse in the last weeks, or about the preparation of the new arrival, like Breast feeding the baby, and other concerns. This is also the right time to discuss, what are the different methods of birth control, in order to space the next child.

Role of the Dads to be:
You know it takes two to make a baby. She’s not the only one who’s expecting, you too are. Hence the responsibility does not stop there. Nor does it stay limited to driving a screaming partner to the hospital for child birth and then pacing in the corridor to hear if it’s a girl or a boy.

Research has shown, the Dads who take part in the pregnancy have less infant mortality rates. And there needs to be a relationship built with the baby while the baby is in the mothers womb.

Some of the things fathers-to-be need to do:

• Create a birth plan together-the doctor to be seen, the place of birth, the method of birth, even about the time baby arrives.
• Read up together with the Mom to be about pregnancy from the net, books, hospital brochures etc.
• Accompany her to her prenatal visits, her tests and Ultrasound scans. Also know what is being done and why?
• Nurture the Mom to be—understand her condition, her anxieties, help her in the daily chores, make her rest, and most of all pamper her, after all she is carrying your baby.
• Build a relationship with the baby. Studies show that babies in the womb can hear outside noises (and voices) as early as the fourteenth week. By talking to your baby he/she will be familiar with your voice even when still in the womb and this will help develop a closer bond with your tot before he/she enters the real world.
• Lastly, enjoy your new role, don’t take it as a challenge or burden.

Dr. Bradley said (in his path-breaking book “Husband-Coached Childbirth”), “You can’t beat a husband as a companion in labour!”

Childbirth:

From 36 weeks to 40 weeks , it is normal time for childbirth. If no onset of labor  pregnancy can be allowed to go on till 42 weeks, but there is close watch at the baby with weekly checkups.

Majority i.e. 85% or more have normal childbirth, while 15% or less may need a Caesaerian section.

There are many details, and information an expectant couple would like to learn, about child birth. The are many details you need to know, and hence I suggest you to read, and understand about Sign of labor  types of delivery  episiotomy, epidural anaesthesia etc and know terms like Labor Pains, cervical effacement, breaking water, episiotomy etc. This link answer many of your queries.

“A mother’s joy begins when new life is stirring inside… when a tiny heartbeat is heard for the very first time, and a playful kick reminds her that she is never alone“