Man"s role in pregnancy

                              Many a times I get patients who complain about their husband being very indifferent towards them during pregnancy . So i decided this little piece to be dedicated to the" papa to be".

                              I know that you are also apprehensive and probably has lots of queries and insecurities yourself,or may be you yourself do not know what you can do for your girl. but plz consider the fact that your girl is actually the one carrying the baby so give priorities to her problems first.If you want to talk to her about anything which is bothering you plz be very straight forward and talk to her.Hiding from problems will not lead you anywhere.instead of running to garage or your friends place be brave and face your problems and insecurities head on.
                              It really does not matter whether your wife is pregnant for the first time or the 4th, every pregnancy is different from the other so do not think that if your girl  is pregnant before she will not need the emotional and physical support this time.
                             when a woman is pregnant there are lots of changes that takes place in her body.
During 1st 3 months.:
                            This is usually the most trying time as her body is experiencing the changes for the first time.she is most of the time not feeling well and might have lost appetite or worst may be vomiting also , so please do not expect her to be in best of her mood all the time.try to be sympathetic to your girl and be less demanding both physically and emotionally.
                           You may also be bombarded with lots of baby talk as your girl might be only interested in talking about her new guest in life.It really does not signifies that she is going to love you less .remember the new person is also a part of you.Try to get involved with her during baby talk take interest in choosing the color of nursery or choosing your baby"s name.
During 4th month onwards:

Her appetite will grow so do not be annoyed if you find her in the kitchen at 2am gorging on something.Instead you can help her by preparing a meal of her taste.Remember that now she has to eat for 2 person.This is also the time when your lady will start putting on weight and her tummy might just start to show its baby bulge. her clothes will start to get tight so take her out shopping and gift the mumma to be something nice and cozy to wear.Do not forget to complement on her look. If you look closely enough you will actually notice that your girl has a radiant glow of motherhood that really make her look prettier than before.So do not hold your self back.Go ahead and complement on her look.It is also the time when she might crave for the wrong food at the wrong time.It may not be possible to fulfill all the time but try to give her whenever possible.
From 7th month onward
                       Her heart is working twice the amount it worked before .so help her in her house hold chores as she might be out of breath sometime.Also later she may start to waddle so be cautious where you leave your shoes as she might trip over.also try to remove the slippery floor whenever possible.Also go through books and web and talk to her doctor regarding the onset of labor pain and how you can know that its time to go to Hospital.
At the time of delivery
                     When you are with your girl at the delivery room . you must know that she is going through immense pain. She needs all the love and support she can get from you.talk to her ,soothe her, tell her she is doing great.
Is having sex ok during pregnancy ?
                      We do not forbid sex during pregnancy.but ask for a little precaution in the initial 3 months and last 6 weeks.Remember that your lady is running 4 times the hormones she usually has before.so plz bear with her if she does not feel or have the right mood for it.Or it might be the other way round.You may not like to have sex with a pregnant woman where as your lady might be fully charged. As i have already stated there is no harm if you avoid the periods i already stated. 
                         So i think i have said enough so go on support each other while preparing for the arrival of your little angel and best of luck

symptoms of labor pain

           The audio visual media has greatly dramatised labor pain.The woman in labor shouts with all her might  and perspire and the baby appears in no time with a vigorous cry. but reality is far from reel-lity.If you are experiencing labor for the first time your pain may drag over a period of 8 to 12 hours.In case of experienced moms the period tends to be shorter.Once you start to come closure to your THE date of expected delivery , every time you can not help but think of the slightest wince you have, to be labor pain.But till now unfortunately WE Doctors have not been able to predict with 100% accuracy on which date you will start to have labor pain.
How to calculate EDD(Expected date of delivery)
                 We calculate your EDD from the 1st day of your last menstrual period , add 9 months and 7 days to it and you get your EDD. Still confused ? say your 1st day of last menstrual period is 2nd Jan , then your EDD will be Oct the 9th. 40 weeks or 280 days if you want to know in terms of weeks and days.You should be cautious ahead of the date by 2 weeks as its an approximate not an absolute date
Symptoms of labor pain

Once you approach your EDD you might feel 

•  Dropping /lightening : you can breath properly and sleep properly.It is because your baby descends into your pelvis near EDD so the height of your tummy decreases and the pressure on your lungs somewhat lightens.
• The Minor ailments which you have faced in the early part of your pregnancy returns . such as increase frequency of micturition and constipation. The reason behind that is as the baby descends it again presses upon your bladder and rectum thereby causing those symptoms
• Braxton Hicks contraction : Uterus usually contracts infrequently throughout your pregnancy.These contractions are usually painless.As you approach labor these contractions intensifies although infrequently and might lead to discomfort.It can lead you to believe as if you are having labor pain.The differentiation points are that these are irregular and infrequent. Its intensity neither gradually increases nor leads to changes in your cervix

foods to avoid to increase your chances of getting pregnant

                          Everyone knows that there are things that must be avoided throughout a pregnancy, but most people don't realize that avoiding certain foods, before pregnancy occurs, can increase chances of becoming pregnant. Some specific foods and drinks have repeatedly shown in research studies to have a directly negative effect on chances of conception. Additionally, foods high in calories and fat can lead to weight gain, which is also known to keep women from getting pregnant. Stay away from these six below mentioned food groups, your fertility chances will increase, and your overall health will be a better environment for a baby's health and development. 

Outlaw Food #1 - Alcoholic drinks. 

                              Most women are careful to eliminate alcohol from their diets during a pregnancy because of its harmful effects on the baby. But it is just as important for women trying to conceive to eliminate alcohol completely. Alcohol disrupts hormonal balances, and can cause women to stop ovulating. Not ovulating means there is no chance of pregnancy. Often, the advice is to drink in moderation, but when getting pregnant, alcohol needs to be completely eliminated. Stay away from the booze! 

Outlaw Food #2 - Caffeine. 

                                Again, while most women decrease caffeine intake during a pregnancy, less women do the same when they are trying to conceive. Studies have shown that large amounts of caffeine can cause miscarriage. While it is likely that you don't have to eliminate all caffeine completely, it is a good idea to minimize the intake of it as much as possible. 

Cracked nipple

                                      Feeding your baby is a Divine experience.When you hold your baby for the first time in your hand and look into his tiny face , feeling of motherhood fills your soul.Its rightfully said that " with the birth of a baby a mother is also born.Before the birth of your baby you are a woman.you become a mother only after you hold your baby and feed him. Breast feeding is something which connect you to your baby both physically and emotionally.But if it becomes a horrendous time for you it might lead to lack of bonding on your part. Cracked or sore nipple usually starts bothering once you start breast feeding as both of you are new at it. But with time and patience it cures on its own

Prepare your breast for feeding


Check your breast and nipple when you are pregnant. sometimes colostrum or sebum accumulate around your nipple and make it dry as time pass by making it vulnerable to crack.Gently clean your nipple with warm water and a mild soap if that is the case.Apply moisturizer cream to keep it soft and supple.Check your nipple if they are flat.If yes then gently massage the nipple and elevate it from its base .You need to do it from 37 weeks onwards not before that as stimulating nipple may lead to premature onset of labour.

What are the symptom?

• You will feel pain ever time you baby feed on your breast
• your nipple is sore to touch
• the skin on your nipple is cracked and painful

 Why do i have cracked/sore nipple

Emergency Contraception

                 This is a contraceptive method which you use before you miss your period, to prevent pregnancy when you have unprotected sex.There are different nomenclature for this such as post coital pill , the morning after pill.They all mean basically the same.
                  These pills does not cause abortion.so if you are already pregnant these can not help .

                History : In older days women tried various harmful methods to prevent pregnancy following unprotected sex , such as They used to take

• Brews and concoctions orally
• Hot or cold vaginal douching with or without astringent
• Herbal drugs.

These methods were not only ineffective but was harm full too.Many oral preparations were toxic and vaginal douching frequently caused burns.

                                             Who can use emergency contraception:

• You miscalculated your safe period . Many a times even when you have sex in your safe period you might not be well protected, as your cycles might vary.
• Ruptured condom
• Forced intercourse as in rape or incest
• For aged couple who meet very infrequently
• Unprepared sex while otherwise you use conventional methods

How does it work :The exact mode of action is not very sure.But it may act through

1. Inhibition or delay of ovulation .as no ovum to meet sperm so no pregnancy
2. Prevention of implantation in an altered endometrium(the mucosal lining of your uterus).
3. Prevention of fertilization due to quick transport of sperm or ova
4. The hormone in morning after pill also thickens the cervical mucus making it impenetrable by sperm

                                                            What are the methods:

Common ailments during pregnancy

                Hi. Today I thought I will discuss with you regarding some common ailments which you might face during your pregnancy.I get lots of phone calls every day from my patients regarding this particular subject which are bothersome to them but usually is of innocuous in nature.

                As you miss your 1st period you take your 1st step to wards your pregnancy. usually you should expect to  have the following symptom

What to expect

1. Nausea and loss of appetite:- common term as we know is morning sickness ,about which i have discussed in my previous blog.Keep in mind that it will wear off once you cross your initial 3 months and hardly stays till you complete 4 month.So nothing to worry if you are keeping yourself well hydrated.But if its bothering more your doc will give you some simple emetics which are completely safe in pregnancy and you should expect to get better in no time.
2. weakness and Easy fatiguebility- as your baby starts growing inside you there are lots of changes which takes place inside your body. so you could easily deplete your sugar reserve in your body if you skip your meal.so as i have already mentioned in my blog regarding diet in pregnancy always keep something in your bag in case you feel giddiness to pop in..But if it is bothering you more do not hesitate to talk to your doc about it as you might have some complications like anaemia too

Diet for diabetic pregnancy

                                 When a lady is pregnant and she develops Diabetes for the first time during her pregnancy its termed as Gestational Diabetes. It usually shows during pregnancy and leaves you after delivery.However if not detected and treated promptly it might cause great harm to your baby. In any kind of Diabetes whether you are pregnant or not , the first line of treatment is to follow a nutritious diet plan and regular exercise regimen...and also the diet plan should be formulated well so is to incorporate all the necessary nutrients required for a pregnant lady . The basic goal of diet control is

1.  To provide necessary nutrients for the growing baby and  the mother.
2. To control glucose level.
3. To prevent starvation Ketosis.

                             The idea is to have small, frequent meals and a lot of water. The diet should have 3 meals and 3 snacks. The food should be of high fiber and less sugar like whole grain bread , beans , fresh fruits and vegetables.all those junk foods , colas , chocolates and Candis are a big no no. as these can easily shoot up your sugar to a dangerously high level.Check food items which has added lots of extra sugar.and also watch out for those saturated fats like butter , whole milk , dairy and other animal fat.
                         But one thing always keep in mind is you can not stop intake of sugar all together as it is the absolutely necessary for energy to you and your growing baby. also fasting hypoglycemia is very common in pregnancy , more so if you are diabetic so always keep something in your bag in case you have attacks of hypoglycemia in between meal.


Here are few suggestions which you can follow

• Stay out of sugars,sweeteners and concentrated sweets.Do not have pies , pastries,cakes , cookies,jam , marmalade,soft drinks,table sugar,honey,and fruit juices with added sugar.Food containingsucrose,fructose,dextrose,honey,malasses,corn starch,corn syrup .
• Make sure to eat a very small but healthy brekfast,comprising of proteins.Do not drink juice or eat fruits and corns. Avoid eating pastas,rotis and paranthas.Instead opt for eggs,lentil broth,skinned chicken or brown bread spread with pea nut butter.
• Instead of eating large meals divide your meals into small portions and eat every 3 to 4 hours.Increase the intake of lean proteins and see that you include a rich protein source like meat(low fat),fish(skinned),eggs,cottage cheese,nuts,pea nut butter etc in each meal.
• Introduce high fibre and lots of green foods in your diet.Fresh and leafy vegetables,whole grain bread,cereals,pulses,beans and fresh should be consumed in large quantities.Ensure that you eat fruits only for lunch or dinner and do not have them for brekfast.
• Refrain from eating deep fried and fatty foods.Cooking oil should be sparingly used.possibly avoided.Instead of frying foods(even fish and meat),bake,boil or steam them.You can also eat barbequed meat and fish.Avoid meat with high fat content like pork.
• To reduce the intake of fat use only skim or low fat milk and dairy products.Thickcream,butter,cheese , mayonnaise,margarine and sour cream are to be replaced with low fat food and proteins.

Here is a meal plan:

Break Fast meal:   30 Gms of carbs

                                 Any amount of protein

                                    Moderate fat

Brunch Snack      :30 Gms of carbs

                                  Any amount of protein

                                     Moderate fat

Lunch Meal:           45 Gms of carbs

                                 Any amount of protein

                                    Moderate fat

Evening Snack       30 Gms of carbs

                                 Any amount of protein

                                    Moderate fat

Dinner:                     45 Gms of carbs

                                 Any amount of protein

                                    Moderate fat

Late Night Snack:  30 Gms of carbs

      If you eat more vegetables and proteins you might escape eating just a little bit more carbohydrate.Always remember to drink lots of water.

      Burn calories  by regularly going for slow walks.

Avoid stress and anxiety.

     Relax meditate and you can also try a prenatal yoga club.

So till we meet again stay healthy and live healthy,

                                 Any amount of protein

                                    Moderate fat

Natural Methods of contraception

         As the name implies these are the contraceptive practices that do not use  medication in any form to prevent conception.Now are we not interested ? well of course we are........These practices  are in vogue from the prehistoric time. But even now many of you well educated couples are practicing even if u have to face a risk of accidental pregnancy.
         If these methods r to be classified they would fall under the following category....

1. Natural family planning methods.(NFP)
2. lactational amenorrhoea method(LAM)
3. Withdrawal method
4. Minor method

1Natural family planning methods.(NFP)

      These refers to methods of planning and preventing pregnancy by observation of the naturally occurring signs and symptoms of the fertile and infertile phases of the menstrual cycle,  of course with the avoidance of intercourse during the fertile phase if pregnancy is to be avoided.
     Now let me tell u something.. during ur entire reproductive period u will shed around 300 - 400 eggs from ur ovaries, usually one in each cycle alternately. This is called ovulation.Very rarely a second ovulation occurs within 24 hours of the 1st ovulation.Ur egg is very precious , it can only be fertilized within 24 hours after it is shed. after that its gone. After ejaculation sperm gain entry into the uterine cavity within minutes and reach the outer end of ur tubes within 1 - 1 1/2 hrs(see how rest less they are ..even in their miniature form).Now these sperms can live inside vagina upto 5 days and rarely upto 7 days.But they regain the ability to fertilize ur egg for a mere 3 days. Now once u avoid intercourse this period u are a free gal...
    Now the million dollar question is how to know when u r ovulating....Usually the most fertile period of a woman is from 10th (rarely 9th ) day of her cycle to the 18th day , provided the cycle is of 28 days. To know when is ur fertile period u can try the following methods , which i will discuss one by one...

1. Rhythm method
2. Basal body temp method
3. cervical mucus method
4. Symptothermal method.

1.Rhythm Method:

This method is also called the calender method.It is based on "Ogino-Knaus theory") that ovulation takes place about 14+/_2 days before the next period. But variations are there , specially in adolescents when you are yet to come in terms with your hormones , and in pre menopausal woman when your hormones are planning to leave you. also in times of stress , travel , some medications and not to forget about is fever.as atleast 20% of you will experience abnormal cycle , a record of 1st day of menstruation (called day 1 ) should be marked on a calender for 6 months. The longest and the shortest cycle is thus noted.

                      

                       Now the tricky part...by subtracting18 days from the length of your shortest previous cycle , you will know about the day on which you will have your first fertile period. substract 11 days from the length of your longest previous cycle ,and voila ...you get the last day of your fertile period.

                         Still confused....?... OK let me explain more , say during the last six months which you had been marking laboriously on a calender...the shortest cycle you got is 28 days...do the calculation ..its 10. and now say the longest cycle you got is 32...so deduct 11 and you got is 21..   So your fertile period starts from 10th day to 21 days of your present menstrual cycle. Nd you should avoid intercourse during those days if you are to avoid being pregnant.

Diet in pregnancy

                        OK now you are pregnant........you are full of anxiety....what should you do what should you eat ??? that is the next big question..... well its time now to say bye bye to those junk foods and say hello to healthy food ,at least for the sake of your baby...although i have said like that i am pretty much sure that you are a healthy foodie....

                      now we all know what we should eat right ? everybody is conscious now a days about what type of food they should eat...if you surf the net you would probably get a load of web site which will give you the precise calorie amount the exact daily dose of carbohydrate,the percentage of fats in your diet and blah blah blah.......the point is what more can i say...probably nothing. So i decided that instead of giving you the exact amount of curbs , fats and proteins in your diet , i would rather try and give you some practical advises.

                    The need of your body changes as you advance through your pregnancy, as your baby grows so does your appetite.As long as you are gaining in your weight the food you are taking is probably sufficient, provided

1.  you have a normal pregnancy
2. You don't have Diabetes/hypertension(high blood pressure).
3. you are not obese
4. you don't literally live on junk foo

                    Presuming you have none,and presuming you know that healthy food does not mean junk food , i will take our discussion further and try to give you a fair scenario of your dietary picture  Initially when you begin your journey through the first few months you are usually much bugged by morning sickness. some even has tendency to vomit at the site or smell of food , and its quite natural that you loose few kgs initially(1 to 2 kgs).

Heterotopic pregnancy

        Today i did a laparotomy ( any operation for which you need to open up the abdomen is termed laparotomy ) the indication is .........yes you are right (no prize for guessing )....Heterotypic pregnancy...........

       Heterotypic pregnancy is actually a twin pregnancy , one inside uterus and the other being outside uterus...most commonest site being the tubes. it is actually a very rare condition........if you want the statistic its 1 in 30,000.........pretty rare huh.....thank god for it being rare.......but as always we being the spoil sport are making it happen more often . as we are trying to gift babies to infertile couples we are also increasing its incidence. it can be as common as 1 in 900 in case of ovulation induction.

         in my patient though it was nothing of that sort.she had an abnormality of the uterus.....she had bicornuate uterus....if i am successful it putting a picture in this blog than you can see that a normal uterus has a single cavity.but in this particular patient she had two cavities in her uterus. she had a normal pregnancy in her right uterine cornu and a left sided ectopic pregnancy. she also has a child of 3 years which she had delivered normally.

       this type of condition is particularly confusing with ruptured corpus luteal cyst of pregnancy (about which i will discuss some other time ). it can only be differentiated properly by Histopathological examination of the dissected tissue.

         to diagnose it ...a high degree of suspicion is necessary .the lady usually presents with a short period of amenorrhea , followed by symptoms of ectopic pregnancy......such as bleeding vaginally severe pain abdomen as the ectopic pregnancy ruptures and fainting as severe intra abdominal bleeding ensues. the bleeding can be very severe at times so as to endanger ones life.the uterine pregnancy usually does not give rise to any problem but most of the time ends as missed abortion.

       one diagnostic tool which comes in handy is ultrasonography as it can visualize both pregnancies properly(in case of my patient both the pregnancies was alive even when the tubes had ruptured . the placenta got hold of near by organs and was feeding from them)

      regarding management of this condition its nothing but laparotomy . the ectopic pregnancy has to be removed and bleeding has to be stopped.

     pregnancy is the most natural phenomenon that can happen to a lady...but when there is deviation the result can be devastating. the only way to diagnose it before catastrophe strikes is to do an ultrasonography before you miss the second period.

    i think i have written enough on heterotypic pregnancy....till i blog again stay well and be healthy.



    

      

post partum depression

                           Post partum depression is a highly under reported condition that affects many women across the world. Who have undergone childbirth. post refers to after and partum refers to a latin word that means birth. “during the 1st week after childbirth,many women(upto 85%)experiences a brief period of mood symptoms and anxiety mostly due to exertion,loss of sleep. about 10 to 15% of women however experiences more significant mood symptoms in the post partum period , called post partum depression.


        Signs and symptoms:   Post natal depression is by far the most widely discussed perinatal mood disorder. Defining as arising in or persisting into, the first postnatal year.it presents similarly to depression at other times. while most mothers suffer from being is emotionally low after childbirth. Extended periods of depression should be looked into.The depression can begin at any time between delivery and six months or even a year. In more severe forms the women may express suicidal thoughts.It is usually  characterized by

• low mood,
• tearfulness,
• emotional lability,
• fatigue,
• excessive anxiety,
• attachment difficulties and
• withdrawal from social events

 .    Main reasons: Although the precise cause of post partum depression is unclear many scientifical studies point that it is linked to the hormonal fluctuation that a woman experiences after childbirth. number one is

.blame it on your hormones:     During pregnancy the levels of female hormones estrogen and progesterone increase upto 10 folds.within the 1st 48 hours after delivery this hormone level decline dramatically. Research suggest a connection between rapidly declining hormone levels and the appearencec of symptoms of PPD.other hormones such as prolactin (levels of which are lower at the time of delivery but begin to raise sharply in the 1st week following delivery) and changes in blood levels of cortisol and aldosterone have also been implicated in PPD.

                                                 Why does postnatal depression matter ?

 Its effects on mother

 1. psychiatric illness was the most common cause of indirect deaths and the largest cause of maternal deaths overall in the last CEMACH report(why mothers die 2000—2002)

2. it is reasonable to speculate that a tremendous amount of damage was also present in families where the woman did not die,but made a failed attempt at suicide.

3. although symptoms of depression may remit spontaneously,or respond to counselling ,about 1/3 rd of women will remain depressed and need further treatment.

4. untreated depression may contribute to the development of a chronic refractory mood disorder in the mother, a potentially negative influence on the marital relationship with the possibility of contributing to raised rates of separation in couples. This will also have a negative impact on the baby or othe siblings.

5. difficulties are often concealed.this may be due to cultural attitudes to mental health problems.women fear the label and what they perceive as the stigma:they are afraid that they will be seen as a bad mother and the baby will be taken away. The disease process itself makes people feel isolated and not want to relate to anyone including health professionals.

 Impact on the child

                         This is one area of research in which there is good evidence that postnatal depression particularly if moderate or severe can have long lasting negative effects on any children in the family,with new infant being particularly at risk. There appear to be both short and long term effect.

 Short term

1. Infants are often reported as being of more difficult temperament by their mothers(although this may be because the mothers are themselves not coping well and giving poor feedback emotionally to the children,who then behave in a more difficult fashion in order to gain attention.

2. less sensitive mother-infant interactions are seen,leading to insecure attachment pattern

3. one study has even reported PPD to be a risk factor of sudden death syndrome(SIDS)

 Long term

1. A number of researchers have found adverse effects persisting for sometime,and this effect appears to be more marked for boys.

2. Sinclair and murray found PPD to be associated with significantly raised levels of child disturbance at the age of 5 years ,specially in boys.

3. another group of researchers has been following a cohort of 149 women recruited at 3 months post partum. 132 of their chidren was followed upto the age of 11 years.children of women depressed at 3 months were found to have significantly lower IQ scores, more attention problems and difficulties in mathematical reasoning and were more likely to have special educational needs. Boys were more severely affected than girls.

4. finally a meta analysis conducted by Beck concluded that post partum depression had a small but significant effect on children’s cognitive and emotional development.for all these reasons identification and active treatment of women experiencing post natal depression is important.

 Management :


              Treating it right: “ the 1st step is medical evaluation by a physician or psychiatrist to rule out presence of other illnesses”. counselling and psychotherapy can help women identify factors that may be causing depression. Counselling along with participation in a support group is recommended.however care should be exercised before putting breast feeding mothers on medication.the most commonly used treatments for depression are antidepressants ,psychotherapy or a combination of two.which of these is the right treatment for an individual depends on the nature and severity of the case.

back ache in pregnancy

            Oops my back hurts…..how many of us have used these words in our life ? Probably many times….well it hurts and worries you most , specially when you are pregnant. Coz many a times you can not pop those pain killers like you used to do before.


Regardless of whether you are pregnant or not the lifetime incidence of low backache ranges from 50 to 70%.All the structures of the lower spine and pelvis i.e. the muscles ,ligaments, joints,intervertebral discs and nerve root can cause back ache.

As if that was not enough, back ache is very common during pregnancy. You will be surprised to know that 50 to 80% of pregnant ladies will admit to the fact that they have some degrees of back pain while they are pregnant. Of which a very few reported it to their doc. The pain may be associated with certain activities only, or it may be so severe that you would have restricted mobility.( I hope I have not scared you ).

Back pain usually starts to bother you between 5th to 7th month(i.e.20 to 28 weeks of pregnancy). But if you have had back pain before , it might come even earlier.

There are two commonest types of back pain