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Dr. Evita Fernandez’s response on the article – “Can We Please Stop Telling Pregnant Women This?

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Original Article – “Can We Please Stop Telling Pregnant Women This?”

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I’m currently 29 weeks pregnant and have already lost track of the amount of times I’ve been told by people that ‘everything will be fine.’

Read complete article at:

Can We Please Stop Telling Pregnant Women This? | The Huffington Post

Dr.EvitaDr. Evita Fernandez’s response on the article – “Can We Please Stop Telling Pregnant Women This?”
When I was a young obstetrician and not as wise as I am today, I often spoke these lines “don’t worry- everything will be fine” believing at the time that it was. Indeed the truth.

Today, I LISTEN very very carefully to the unspoken words of the young mother before me. I do my best to understand her fears and help her work through it all. I have learnt to believe in maternal instincts; learnt to listen to women when they express a fear repeatedly. I also know that a pregnancy can go horribly wrong. Sometimes there are tell-tale signs to warn and prepare both sides. Sometimes, one does not get the luxury of time to prepare for a loss or morbidity affecting the mother or her newborn.

It is important for us obstetricians to give women the freedom to ask questions, to clarify doubts no matter how small they may appear and more importantly, to LISTEN and become aware of the unspoken fears.

May this article help us understand a different perspective. May it induce us to reflect and initiate change wherever necessary.

Blood Pressure During Pregnancy

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Carrying a baby in the womb and giving birth is a beautiful feeling that women get to experience. During pregnancy, it is quite natural that the blood pressure of women may fluctuate.

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Blood Pressure

The pressure at which blood is pumped throughout the body is known as blood pressure. Usually, blood pressure is measured in terms of the maximum pressure over the minimum pressure. In an adult, the normal resting blood pressure is 120/80 mm Hg (millimetres of Mercury) approximately.

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Pregnancy and Blood Pressure

When a woman conceives, there are changes in her body due to hormonal influence. Due to this, the blood pressure of the pregnant woman fluctuates. During the first and second trimester of pregnancy, blood pressure may be lower than normal.  And in some cases, blood pressure becomes higher than normal. And as time progresses, after delivery, blood pressure may return to normal.

So, it is very necessary that special attention should be given if you are suffering from high or low blood pressure during pregnancy.

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Types of High Blood Pressure During Pregnancy

  • Gestational Hypertension: When a pregnant woman develops hypertension after 20 weeks of pregnancy, and no other organs are affected, it is referred to as gestational hypertension.
  • Chronic Hypertension: When a woman has blood pressure before being pregnant or before the 20th week of pregnancy, then it is known as chronic hypertension (Pre-existing Hypertension).
  • Preeclampsia: Sometimes, gestational hypertension or chronic hypertension can lead to preeclampsia. Preeclampsia is a serious medical condition during pregnancy which is also known as toxaemia. It occurs after the 20th week of pregnancy which is characterized by high blood pressure along with signs of other organ system damage. Preeclampsia when left untreated may cause severe complications including death of the foetus.

Problems Caused Due to High Blood Pressure

High blood pressure during pregnancy, causes different types of health problems, including :

  • Fetal Growth Restriction: High blood pressure may result in slow growth of the baby, leading to low birth weight.
  • Premature Delivery: In order to prevent further complications due to high blood pressure, premature delivery may be necessitated.
  • Separation of Placenta: Due to preeclampsia, the placenta may get separated from the uterus before the baby is born. And when the placenta prematurely separates from the uterus heavy bleeding may occur which may be seen coming through the vagina. In some cases, separation of the placenta from the uterine wall may be life threatening for both the mother and the baby.
  • Eclampsia : Preeclampsia can lead to mother having seizures (fits / convulsions) that is called Eclampsia. This is life threatening for both the mother and the baby.
  • Multi-Organ Damage: Preeclampsia can affect all the organs of the mother – leading to multi-organ damage. Sometimes, any one organ like the kidney, liver or blood cell may be affected, and this may lead to premature delivery. The mother is also at risk of developing HELLP Syndrome (Hemolysis, Elevated Liver Enzymes, Low platelets).


What are the Symptoms of Preeclampsia

Preeclampsia, many times, may occur without any warning symptoms. It may be detected by your doctor during routine check-ups.

The symptoms of severe preeclampsia include:

  • Severe headache that doesn’t go away with simple painkillers
  • Problems with vision, such as blurring or flashing before the eyes
  • Severe pain just below the ribs
  • Heartburn that doesn’t go away with antacids
  • Rapidly increasing swelling of the face, hands or feet
  • Feeling very unwell.

Who is Likely to Get Preeclampsia? How to Prevent High Blood Pressure During Pregnancy:

Preeclampsia can occur in any pregnancy but you are at higher risk if:

  • Your blood pressure was high before you became pregnant
  • Your blood pressure was high in a previous pregnancy
  • You have a medical problem such as kidney problems or diabetes or a condition that affects the immune system, such as lupus.

If any of these apply to you, you should be advised to take low-dose aspirin (75 mg) once a day in pregnancy, to reduce your risk.

The importance of other factors is less clear-cut, but you are more likely to develop pre-eclampsia if more than one of the following applies:

  • This is your first pregnancy
  • You are aged 40 or over
  • Your last pregnancy was more than 10 years ago
  • You are very overweight – a BMI (body mass index) of 35 or more
  • Your mother or sister had preeclampsia during pregnancy
  • You are carrying more than one baby.

If you have more than one of these risk factors, you may also be advised to take low-dose aspirin once a day in pregnancy.

Treatment for High Blood Pressure During Pregnancy

If you are pregnant and suffering from high blood pressure, it is very necessary to seek your doctor’s advice.  Normally, a doctor may suggest the following in order to make your blood pressure normal and keep you and your baby safe.

  • Advise admission
  • Medications to lower high blood pressure
  • Offer frequent tests of your blood and urine
  • Monitor the health of the baby

So, it becomes very necessary to have regular check-ups during the gestation period. It will help you to know your health status and that of your baby. And if you are suffering from high blood pressure, your doctor will recommend certain things that you need to do.

Check-Ups and Tests to Get During Pregnancy

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It is very important for women who are pregnant to have regular check-ups either with a doctor or a midwife. There are certain types of tests and scans which are needed to be done during pregnancy. All these help in keeping track of your baby whether it is developing in a healthy way or not. Moreover, you also get to know about your health.

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For some women, pregnancy turns out to be well with no complications. But that doesn’t mean that you can skip those check-ups and tests. These procedures are not to be missed during pregnancy.

These are some of the prenatal tests and check-ups :

  • Routine Check-ups: During pregnancy, you have to visit your doctor many times for routine check-ups where certain types of urine and blood tests will be done. Your blood pressure will be checked and it will be determined through the blood and urine tests if you are suffering from gestational diabetes. All these tests are done to see if there are any problems which may create complications during pregnancy or during labour and to check the health of the baby, as well.

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  • Ultrasound: Every pregnant woman needs to do an ultrasound between 18 weeks and 21 weeks of pregnancy. This scan is known as Anomaly Scan which lets the doctor know if there is any structural deformity in the foetus. Ultrasound also helps in detecting :
  • If you are carrying a single baby or twins or more
  • The size of the baby
  • The health status of the baby
  • Position of the baby
  • Neural tube defects
  • Amniocentesis: It is a specialised procedure in which a small amount of amniotic fluid is taken from the mother’s womb. Normally, it is done between the 15th and 20th week of pregnancy and is performed on those women who have the risk of genetic disorders. It helps in assessing whether your baby has any chances of developing any birth defects or  has already developed some.

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  • Down’s Syndrome Screening: This test helps in assessing whether your baby has the risk of suffering from Down’s Syndrome.
  • CVS or Chorionic Villus Sampling: This is done for those pregnancies where the risk of the baby suffering from serious inherited disorders is higher. It is an alternative test to Amniocentesis and is done by taking a sample of cells from the placenta.

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Exercising for a Healthy Pregnancy

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Introduction:

As one of the most fulfilling phases in a woman’s life, being pregnant doesn’t mean that you have to sit and relax throughout the whole pregnancy period. Yes, during your pregnancy, you may feel more tired than before. You may have backache and swollen ankles. But it is very essential for pregnant women to keep active. Exercising during pregnancy will not only help you to stay in shape but also prepare you for labour and delivery. It allows you to return to your pre-pregnancy shape faster.

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Exercising during pregnancy doesn’t mean that you have to do complicated workouts. Simple exercises daily are enough to keep you fit and active. So, in order to have a healthy pregnancy, you should consult your doctor or an experienced trainer or join classes on pregnancy exercises.

Exercising and Pregnancy:

Exercising 20-30 minutes 3 or 4 days a week can help you maintain a healthy pregnancy. Walking is one the best exercises which provides a moderate aerobic conditioning without much stress. Swimming, pedalling on stationary cycle, light aerobics and yoga are some of the good exercise choices during pregnancy.

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While exercising, it is very essential to stay hydrated. Have plenty of fluids and don’t be overheated. Exercise to the limit you are comfortable and as per your health trainer’s suggestions.

Benefits of exercising during pregnancy: 

  • Relieves backache and other discomforts
  • Increases your stamina and energy level
  • Prevents you from gaining excess weight
  • Helps you to sleep better
  • Gives a boost to your mood
  • Reduces the risk of gestational diabetes
  • Reduces constipation
  • Helps proper blood circulation
  • Gives a healthy glow to your face
  • Controls pregnancy related high blood pressure
  • Reduces the symptoms of postpartum depression


It is better not to exercise during pregnancy if you have the following problems:

  • Cervical problems
  • Heart or lung related disease
  • Vaginal bleeding
  • Previous pre-term labour
  • Threatened miscarriage


Do’s while exercising:

  • Wear comfortable and loose fitting clothes along with a supportive bra
  • Wear well-fitting sports shoes
  • Exercise on flat surface to prevent injury
  • Choose healthy food and eat at least an hour before exercise
  • Drink lots of water before, during and after exercising
  • If you are doing floor exercises, get up slowly


Don’ts while exercising:

  • Avoid exercises involving extensive hopping, bouncing, skipping and jumping
  • Avoid exercises which have chances of you falling down
  • Avoid waist twisting movements
  • Avoid exercising in hot and humid conditions
  • Don’t  hold your breath for a long time
  • Don’t do extensive exercises for long periods of time


Conclusion:

So, if you are pregnant, do moderate exercises to stay fit and healthy. Not only you, but your baby also will greatly benefit by the exercises.

Exercise daily and have a healthy pregnancy.

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Stork Delivers the First Baby

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Dr.Evita.jpgLast night I stood silently by the side of a young mother who asked me to be present at the birth of her second baby. I re-entered a birthing room after several years. It was a privilege, to be a part of that very special, intimate circle. She chose to have the chants of the Vipassana meditation which added a spiritual dimension and left her calm.

I continue to be in awe of the mystery of birth. I never cease to be amazed by the quiet inner strength and determination of a woman, to birth. The sheer unadulterated joy she displays when she holds her baby only reiterates the power of a mother’s love.

Thank you my young mother, for drawing me back into that special spot last night.

A successful vaginal birth, following a previous Cesarean section, is a reason to celebrate. You have only reinforced my belief in women and their understanding of their own bodies.

Our first birth in Stork Home – a good beginning indeed.

– Dr. Evita Fernandez

Diabetes Before Pregnancy

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Introduction:

When a woman gets pregnant, it is very essential that she is healthy and free of disease. This is one of the main factors in giving birth to a healthy baby. And, if you have diabetes before getting pregnant, then special care should be taken to control it. You should consult your doctor before getting pregnant. Otherwise, there is a possibility of the baby being born with health defects.

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Complications of diabetes before pregnancy:

Due to poor control of diabetes, some women even have miscarriages or lose their baby during childbirth. In order to prevent these complications, there is need for proper treatment to control diabetes before you get pregnant.  High glucose levels and Ketones, which are very dangerous, present in the mother pass through the baby’s placenta leading to various type of complications.

High glucose level before pregnancy, if not controlled, may result in the following complications during childbirth :

  • Miscarriage
  • Health risks to the baby
  • Premature delivery
  • Different types of birth defects
  • Low glucose level at the time of birth
  • Prolonged jaundice in the baby
  • Respiratory problems in the baby
  • Difficulty during delivery necessitating caesarean section
  • Infections in the vaginal area and urinary bladder
  • Kidney problems
  • Eye problems

How to prevent and control blood sugar level?

Babies born to mothers having diabetes are at the risk of having diabetes in later stages. The complete organs of a baby are formed within a period of 7 weeks from the date of your last menstrual period. And when you realise that you have conceived, it becomes too late to control diabetes. Since the early weeks play a crucial part in the development of the baby, controlling your blood sugar level is very important. So, it is better to get your glucose level lowered if you are planning a baby.

Proper treatment and regular check-ups reduce the risk of complications during pregnancy and after childbirth. When a woman conceives, the level of blood sugar automatically goes up.  Doing exercises, light work, taking meals and medications as prescribed by your doctor will help you balance your blood sugar levels.

Tips for women suffering with diabetes before pregnancy:

  • Plan your pregnancy
  • Control the level of blood sugar before and during pregnancy
  • Follow a proper diet chart recommended by your doctor
  • Exercise
  • Control your weight
  • Do urine and blood tests frequently
  • Avoid smoking and alcohol

Conclusion:

Treating diabetes before getting pregnant will let you and your baby enjoy good health. Make your pregnancy safe and enjoy this beautiful phase of life rather than being tense with complications.

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Managing food allergies and intolerances in babies

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Food allergies and intolerances in babies have become quite common and almost 1 in 12 babies suffer from them. So, it is very essential for mothers to take proper care of their babies regarding food. Your baby can have food allergies if you have a family history of food allergy, hay fever, asthma or eczema.

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What is food allergy?

Food allergies in babies occur when their immune system has an adverse reaction to harmless proteins in food and produces antibodies. The immune system responds to the food as toxic. It occurs immediately or after some time of having food.

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Symptoms of food allergy:

  • Redness on skin and dermatitis
  • Nasal congestion
  • Itchy eyes and mouth
  • Vomiting, diarrhoea and stomach cramps
  • Swollen face and eyelids
  • Swollen tongue and lips
  • Frequent crying and distress
  • Persistent cough, difficulty in swallowing, wheezing, shortness of breath and hoarse voice is called anaphylaxis, a severe and life-threatening food allergy

The most common foods that causes allergy in babies are:

  • Milk
  • Egg
  • Peanut

What is food intolerance?

Food intolerance in babies is caused by some substance present in the food they eat. It is not caused by the immune system responding to the food. Often, food intolerance occurs after two days of having the intolerance prone substance in food.

Symptoms of food intolerance:

  • Skin redness and dermatitis
  • Constipation
  • Diarrhoea
  • Stomach pain
  • Vomiting

The most common form of food intolerance that occurs in babies are:

  • Milk or lactose intolerance
  • Some react to strawberries
  • Tomato can also cause food intolerance

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Food allergies and intolerances in babies can be controlled in the following ways:

  • Avoid the food: It is very important to avoid the food that causes allergies and intolerance in your baby. So, you should be aware of these foods. Carefully read the food labels and see if words like ‘whey’, ‘casein’ etc. are there. Presence of such words means, having the product can lead to allergies.
  • Have an emergency plan: Parents should speak to their doctor to give them an emergency plan which will help them to recognise allergies and intolerances and if medical attention is needed or no

Diagnosing food allergies or intolerances

If you find that your baby is having a food allergy or intolerance and not getting better, you should always consult your doctor. If the allergies and intolerances are not mild, they will be cured by taking the prescribed medicines. Some tests may need to be done, as well. As mothers breastfeed their babies, they should not eat the foods that causes allergies and intolerances during the pregnancy and breasting period.

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Back pain during pregnancy — How to overcome it

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Back pain is one of the common problems that occur during pregnancy. Most pregnant women suffer from back pain mainly due to weight gain. But this doesn’t mean you have to suffer throughout the pregnancy. Besides consulting your doctor, there are several ways (read further below) you can overcome back pain during pregnancy.

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Factors causing back pain during pregnancy:

  • Weight gain: Gaining weight during pregnancy is quite a normal phenomenon. But some women tend to gain more weight than required. The extra weight  puts a load on your spine resulting in lower backache and other complications. Moreover, the weight of the developing baby and the uterus puts pressure on the nerves and blood vessels of the pelvis and back.
  • Hormonal changes: This is another factor causing back pain in pregnant women. Due to the hormone called Relaxin, the ligaments in the pelvic area tend to relax and the joints loosen. It also loosens the ligaments supporting the spine that causes instability causing back pain.
  • Changes in posture: As you gain weight during pregnancy, the centre of gravity also changes. So, in order to be comfortable, you change your sitting postures, the way you walk etc. These changes in posture give rise to back pain.
  • Muscle separation: As time passes, the uterus starts expanding more and more. In the process, the two parallel stretches of muscle between the rib cage and pubic bone get separated along the centre seam. This process worsens backache if you are already suffering from it.
  • Emotional stress: During pregnancy, emotional stress causes tension in the back muscles which may result in back pain.

Back pain during pregnancy can lead to following:

  • Difficulty in getting up from a sitting posture
  • You may find it difficult to change positions on the bed
  • Uneasiness while walking for a longer period of time
  • Dressing and undressing may become a problem
  • Difficulty while taking a bath
  • Doing work with back pain becomes very painful

How to ease back pain during pregnancy?

Following these points can help you get rid of your back pain to a great extent:

  • Exercise: Exercising is one of the best ways to ease backache in pregnant women. Walking, cycling on stationary cycle and swimming are some of the safe exercises which you can do while pregnant. Exercising for at least 30 minutes five times a week will not only help you strengthen your body muscles but also increase your flexibility. Staying active by doing exercises and light work is the key to reducing back pain during pregnancy.

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  • Posture: Improving your posture helps in getting relief from backache. You should avoid staying in the same posture for a long period of time. While sitting you can use a cushion at the back and rest your feet on a stool. Using maternity pillows while sleeping also help to reduce backache.
  • Acupuncture: Acupuncture helps you to get rid of back pain. But it is very necessary to get it done by experienced professionals.
  • Heat and cold: To get relief from pain, you may apply cold packs or hot water bag according to your convenience. Even a warm bath can be helpful to reduce back pain.

 

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Staying Hydrated During Pregnancy

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Everyone needs to stay hydrated for healthy living. For the body and vital organs to function properly, you need to have lots of water. And if you are pregnant, the amount of water to be taken increases to a great extent.

During pregnancy, your body needs more water to meet the demanding needs of your changing body. So, it becomes very essential for the mom-to-be to remain adequately hydrated. Moreover, water is one of the key components for breast milk and essential for proper lactation.

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How much water do you need during pregnancy?

A pregnant woman is required to have approximately three litres of fluid every day. Fluids include water, milk, fruit and vegetable juices, and other non-alcoholic refreshments. Apart from having water directly, your body receives water indirectly from fruits, vegetables, yogurt etc. So, you can have water according to the intake of other fluids, fruits and vegetables.

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Benefits of water during pregnancy:

  • As water is one of the main sources for carrying nutrients and oxygen to your organs, cells and tissues, staying hydrated during pregnancy ensures that your baby is receiving the required nutrients for proper growth.
  • It helps in preserving the required amount of amniotic fluid and helps in the kidney function of the foetus by facilitating the waste your baby’s kidney filters.
  • Drinking enough water lets you keep hydrated as dehydration during pregnancy leads to headaches, dizziness, cramps and nausea.
  • Water can help prevent constipation and haemorrhoids.
  • Drinking adequate water helps in preventing morning sickness, indigestion, acidity and heartburn.
  • Keeping hydrated means it keeps your urine diluted which not only helps in keeping all things in order but also keeps Urinary Tract Infections (UTIs) at bay.
  • During the third trimester, hydration becomes especially important as dehydration can cause contractions leading to preterm labour.

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How to know that you are hydrated?

During pregnancy, the best way to know that you are hydrated is to check the colour of your urine. If the colour is pale or straw-coloured, then you are adequately hydrated. But if it is dark, it means you need to have more water. So, keep a water bottle handy which will remind you to keep hydrated.

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