Prevention of Cervical Cancer (HPV Vaccine)

What is HPV ?

HPV (Human Papilloma Virus) is a common virus that is passed from one person to another through direct skin-to-skin contact during sexual activity. Most sexually active people will get HPV at some time in their lives, though most will never even know it. HPV infection is most common in late teens and early 20s.

There are many strains (types) of HPV that can infect the genital areas of men and women. Most HPV types cause no symptoms and go away on their own. But some types can cause cervical cancer in women and other less common cancers – like cancers of the anus, penis, vagina, and vulva (area around the opening of the vagina) and oropharynx (back of throat including base of tongue and tonsils). Other types of HPV can cause warts in the genital areas of men and women. These genital warts are not life-threatening. However, they can cause emotional stress and the treatment can be very uncomfortable.

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Pic courtesy:  http://www.virology.wisc.edu/virusworld/viruslist.php?virus=hpv

Why are HPV vaccines important ?

The vaccines target the HPV types that most commonly cause cervical cancer. One of the two currently available vaccines also protects against genital warts caused by HPV. Both vaccines are highly effective in preventing specific HPV types.

What is the vaccination schedule ?

The schedule is three doses of intramuscular injections, administered over a period of six months.

Who needs to get vaccinated ?

HPV vaccination is recommended for girls and women (9 to 45 years of age).

Can pregnant women take the vaccine ?

The vaccines are not recommended for pregnant women. Although studies show that HPV vaccines do not cause problems for babies born to women who received HPV vaccination when pregnant, more research is still needed. If the patient becomes pregnant in the middle of the vaccine series, then the doses should be completed after delivery. Vaccination can be given during breastfeeding.

Should girls and women be screened for cervical cancer before getting vaccinated?

Girls and women do not need to get an HPV test or Pap test to find out if they should get the vaccine. However it is important that women continue to be screened for cervical cancer, even after getting all three shots of the HPV vaccine.

How effective is the vaccination ?

It is a prophylactic vaccine. As with any vaccine, a protective immune response may not be elicited in all cases. The vaccines are less effective in preventing HPV-related disease in young women who have already been exposed to one or more HPV types. That is because the vaccines can prevent HPV only before a person is exposed to it. HPV vaccines do not treat existing HPV infections or HPV-associated diseases.

How long does the vaccine protection last ?

Research suggests that the vaccine protection is long-lasting. Current studies (with up to about seven years of follow-up data) indicate that the vaccines are effective long term, with no evidence of decreasing immunity.

Do the vaccines protect against all HPV types ?

The vaccines do not protect against all HPV types. They are ineffective in about 30% of cervical cancers. It is important, therefore, for women to continue regular screening (Pap tests) for cervical cancer.

How safe is the vaccine ?

Both vaccines have been licensed by the Food and Drug Administration (FDA) and approved by Centre for Disease Control (CDC) as safe and effective. Common mild adverse events reported during these studies include pain at the injection site, fever, dizziness and nausea.

In what other ways can women prevent cervical cancer ?

Regular cervical cancer screening and follow-up can prevent most cases of cervical cancer. The Pap test can detect cell changes in the cervix before they turn into cancer. Pap tests can also detect most, but not all, cervical cancers at an early treatable stage. There are HPV tests, which may be used with the Pap test in certain cases, to help determine the next step in cervical cancer screening. Use of condoms and limiting the number of sexual partners may lower the chances of getting HPV.

Regular cervical cancer screening and follow-up can prevent most cases of cervical cancer. The Pap test can detect cell changes in the cervix before they turn into cancer. Pap tests can also detect most, but not all, cervical cancers at an early treatable stage. There are HPV tests, which may be used with the Pap test in certain cases, to help determine the next step in cervical cancer screening. Use of condoms and limiting the number of sexual partners may lower the chances of getting HPV.

Breast Cancer – Early Detection And Prevention

Breast cancer is now becoming the most common cancer in women in India. For the year 2015, there will be an estimated 1,55,000 new cases of breast cancer and about 76,000 women in India are expected to die of the disease. The gap only seems to be widening, which means, we need to work aggressively on early detection. (Statistics of Breast Cancer in India: Global Comparison)

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Pic Courtesy: http://www.discussingbreastcancer.com/breast-cancer-prevention-and-early-detection-tips/


Tips for prevention and early diagnosis

Exercise :

Women who exercise about 30 minutes, three to four times a week, can decrease the risk of breast cancer by 26%.

Breastfeeding Your Child :

Women who breastfeed their children will have reduced risk of breast cancer.

Maintaining Weight :

Women who gained 25 kgs above what they weighed after the age of 18 have 45% risk of developing breast cancer compared to women who maintained their weight.

Weight Loss After Menopause :

Women who reduced 10 kgs after menopause compared to pre-menopause weight also reduce their risk of developing breast cancer by 45%.

Avoid Alcohol :

Women who have 1 or 2 alcohol drinks a day increase their risk of breast cancer by 10%. Even moderate alcohol intake increases endogenous estrogen levels and provide a potential mechanism for breast cancer development.

Regular Screening After Age 40 :

Breast cancer, if detected early, can be cured completely. Monthly breast self-examination, yearly medical check and mammogram will detect cancer in its early stage. Monthly breast self-examination should start as early as in teens.

Eating Right :

A plant-based diet of at least two cups of a variety of vegetables or fruits is beneficial. There is evidence that minerals, vitamins, and phytochemicals in plant foods interact in different ways to boost an individual’s anticancer effects.

The top picks for cancer prevention include beans, berries, cruciferous vegetables (broccoli, cauliflower, cabbage, brussels sprouts), dark leafy green vegetables (spinach, mustard greens etc), flaxseed, garlic, grapes/grape juice, green tea, soy, tomatoes and whole grains.

Central Obesity :

Excess belly fat seems to be particularly harmful, most likely because of its effects on inflammation and its association with elevated insulin levels. So if you tend to be more “apple shaped” and carry extra weight in your belly, it is especially important to lose weight. Exercise regularly, and limit refined grains, sugar sweetened beverages, and added sugar in your diet.

How To Do Breast Self-Examination

Why Do  Breast Self-Examination

There are many good reasons for doing breast self-examination each month. It is easy to do. When you get to know how your breasts normally feel, you may be able to feel any changes. With practice, it should take about 15 minutes each month. Early detection of likely cancerous lumps is the key to successful treatment and cure.

Look for Changes

Look for changes in front of a mirror. View the front and each side in three positions. Relax arms at your sides. Look for changes in shape, colour, or any puckering, dimpling, skin changes or nipple discharge.

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Raise hands above your head. Check again for puckering, dimpling and skin changes.

Place hands on hips, press down, and bend forward. Check nipple direction and general appearance.

Palpation Technique

Use the pads of the middle three fingers of each hand to examine the breast on the opposite side. Do not use fingertips. Keep fingers together.

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Move fingers in small circles, using the three levels of pressure in each spot. Keep fingers, knuckles, and wrists straight. “Walk and slide” finger pads along so no breast tissue is missed.

Feel for Changes Lying Down

Pressure : Lumps can occur at any depth. Use three levels of pressure to examine each spot thoroughly.

Light : Use very light pressure on the first circle. The pressure should be just enough to move the skin without disturbing the tissue underneath. Pressing too hard at first could cause the lump to move out of the way.

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Medium : On the second circle, use medium pressure to feel for changes below the surface up to the mid-level of the breast tissue.

Deep : On the third circle, check for lumps deep in the breast tissue.

Pattern :  Use a vertical strip pattern to check the entire breast area. Imagine mowing a lawn with straight, vertical, overlapping rows. When you reach the end of each row, move over about one finger width and start the next row.

Once you start, do not lift fingers from the breast area. Be sure to examine the nipple with the same palpation technique you use to examine the rest of the breast tissue. The area to be examined includes sides, top and bottom of the breast. Sides include the line from the middle of the armpit (axilla), the area beyond the breast fullness, down to the bottom bra line and over to the middle of the breast bone.

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The top starts after a two finger gap above the collar bone. Two finger-widths below the bra line indicate the bottom of the breast.

Check the Lymph Nodes

Lymph nodes drain the breast tissue. The lymph nodes that drain the breast tissue are located in three spots :

  • Above your collar bone—
  • Below your collar bone
  • In the armpit you will want to know if any nodes are enlarged, movable or unmovable

Position for Examination

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Position 1 :  Spread the breast tissue evenly over the rib cage. Turn on your side with the knee bent. Lean the shoulder back towards the outside (away from your hip) and put your hand on your forehead. Place a pillow under your lower back to make it more comfortable. You are in the right position when your nipple seems to “float” at the top of the mound of your breast tissue.

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Position 2 :  When the search pattern reaches the nipple, hold fingers in place on the nipple and roll back into a position. Lie flat on your back. The arm on the side being examined should now be extended directly away from the body (at a right angle).

When to Do Breast Self-Examination?

The best time to do breast self-examination is right after your periods, when the breasts are not tender or swollen. If you do not have regular periods or sometimes skip a month, choose a day and do it the same time every month.

Remember the ABCs of Breast Health

  • A Screening mammogram
  • Breast self-examination
  • Clinical breast examination

Breast self-examination can save your life. Most breast lumps are found by women themselves or their partner. Most lumps in the breast are not cancerous. Any lump or change should be checked by a doctor.

Early detection is your best protection!

Cerclage

Cerclage is a procedure wherein a suture (stitch or tape) is placed around the cervix (neck of the womb) in a purse string manner to keep the mouth of the uterus (womb) closed and avoid miscarriage. The exact cause of premature labour or late miscarriages is not clear, but they may be caused by changes in the cervix such as shortening and opening. A cervical suture helps to keep the cervix closed.

Cerclage

Pic courtesy: https://alittlebitofcancer.wordpress.com/tag/transabdominal-cerclage/

 

Types

Cerclage may be done using a suture or a tape.

  • Vaginal route – McDonald or Shirodkar
  • Abdominal route – open or laparoscopy

Shirodkar or abdominal cerclage may be advised in women who had a previously failed McDonald cerclage.

Indications

Planned (Elective): Women with previous second trimester pregnancy losses or prior cervical surgeries such as conisation/LLETZ (history-indicated) or short cervix on ultrasound examination (USG-indicated).

Rescue (Emergency): When the cervix is found to be open incidentally and the bag of membranes is exposed to the vagina.

Timing

  • It is usually done after 3rd month scan (NT scan) between 12 to 16 weeks of pregnancy.
  • It can be done laparoscopically in the interval period between pregnancies.

Hospital Stay

It can be done under regional (epidural or spinal) or general anaesthesia. The hospital stay may be 12 to 24 hours for vaginal cerclage and up to 3 days following open abdominal cerclage.

Complications

During Procedure

  • Bleeding
  • Bladder injury
  • Rupture of membranes and fluid leak

Post Procedure

  • Risk of miscarriage/premature labour
  • Infection (more for rescue cerclage)

Post Cerclage Care

Bleeding can be expected for a few days after the procedure. Physical strain and sexual intercourse must be avoided in the initial few days of recovery. Complete bed rest is not recommended. Routine antenatal care should be continued as advised.

Removal

For Vaginal Cerclage:

The suture has to be removed at 36-37 weeks of pregnancy and vaginal delivery can be allowed.

For Abdominal Cerclage:

Delivery is by planned Caesarean section at 38 weeks and the tape may be left in situ for future pregnancies. Removal of the tape may be advised in cases of premature labour, leaking/bleeding per vaginum or fetal demise, which would require additional procedures under anaesthesia.

STEM CELLS – Frequently Asked Questions

Q. What are stem cells?
A. Stem cells are the master cells of our body from which all the other 250 types of cells are formed. The umbilical cord blood mainly contains hematopoietic or blood cell forming stem cells i.e., stem cells that form Red Blood Cells, White Blood Cells and platelets.
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Pic courtesy:  http://nas-sites.org/stemcells/stem-cell-basics/download-stem-cell-figures/

Q. In what conditions can stem cells be used?
A. As of now, stem cells have been used to treat almost 70 blood related diseases. Some of them are blood cancers like Leukemia and Myelo-proliferative disorders, Inherited Red Cell abnormality like Thalassemia, Immune-deficiency disorders and inherited metabolic disorders.

Q. What is the difference between Public Cord Blood Banking and Private Cord Blood Banking?
A. In public cord blood banking, there is no cost to the family concerned. The family donates their baby’s cord blood to the bank for future use by any Indian, subject to HLA compatibility or for research purposes. The cells belong to the bank and the family has no claims on the cells.

In private cord blood banking, the family pays a fee for storing their baby’s cord blood ONLY for their future use. The cells belong to the family.

Q. What is the rationale for public banking?
A. When the stem cells are donated, these cells can be made available to anyone across the world who is a perfect HLA match. Hence the likelihood of usage is much more, especially for Indians in any part of the globe as these HLA proteins are similar in people of the same ethnic origins.

Q. Does collecting cord blood affect the baby?
A. No. Cord blood is collected only after the birth of the baby and after clamping of the umbilical cord. The baby is in no way deprived of blood as the routine process of delivery is not interfered with in any way.

Q. Does the cord blood collection harm the mother?
A. No, it does not harm the mother in any way. It is a completely safe, harmless and painless procedure.

Q. Can all pregnant women donate cord blood?
A. Every healthy pregnant woman who has a normal pregnancy and a healthy foetus can opt to donate the cord blood of her baby.

Q. Will a blood sample be collected from the mother?
A. Yes, a sample from the mother will be collected at the time of onset of labour.

Q. What is HLA testing?
A. HLA or Human Leukocyte Antigen testing is the test for specific proteins that are present on the surface of the leukocyte (white blood cell). If stem cells from one individual have to be used for another person, the HLA types of the donor and recipient need to match.
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Pic courtesy: http://www.stemcellclinic.com/scientists-learned-how-to-expand-successfully-cord-blood-stem-cells/?lang=en

Q. How do I benefit from donating my baby’s cord blood?
A. Your cord blood donation will help the public cord blood bank to create a large inventory of tested stem cell units ready for transplant and thus increase the chances of finding a match. In the unforeseen event of any of your children needing a unit of stem cells for treatment of any haematological diseases, the public cord blood bank will make all efforts to find a best match available. In such an instance, you will only have to pay any additional testing charges and cost of transportation of the unit to the place of treatment.

Q. What are the chances that any one of us may need stem cells?
A. For a family to make use of the cells banked for itself, the likelihood varies from 1 in 400 to 1 in 200,000, as the usefulness is limited to the close family alone. Most of the childhood illnesses and cancers have a genetic basis and as the stem cells will carry signs of any genetic illness, the likelihood of the child using its own stored cells is also very remote.

Q. What happens if I donate to the public bank and then I need the stem cells myself?
A. If the cells you have donated are required for anyone else, the public bank shall issue these cells and keep you informed. If the cells are still with the bank, they will make them available to you at a concessional cost. This cost is for any additional testing and transport of the cells to the transplant site.

Q. What if there are twins?
A. Ideally, 70 ml or more cord blood is required to get adequate numbers of stem cells for transplant. In twin pregnancies, the volume of cord blood collected from each twin is appreciably less, as the weight of each twin is also less than an average weight of a newborn. Hence only in rare instances is cord blood collection in twin pregnancies encouraged.

Healthy Habits for Women to Start

Today’s women have become career achievers and also manage to cope with family responsibilities efficiently. However, they neglect health issues and seek help only when they have complications and medical conditions which are difficult to treat. Incidences of obesity, diabetes, hypertension, vitamin D deficiency, thyroid disorders, heart diseases and cancers have increased tremendously. Sedentary lifestyle, increasing stress and fewer children have contributed to rising health problems in women.

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Pic courtesy:  https://www.focusforhealth.org/stay-informed-stay-healthy/

Obesity

In the National Family Health Survey in 2007, Punjab ranked first in order of percentage of obese / overweight women with an incidence of 37.5% followed by Kerala at 34% and the erstwhile Andhra Pradesh at 22.7%.

Diabetes

Incidence of diabetes in Indian women is rising alarmingly. Approximately 29 million women are affected by high blood sugar. Women with diabetes still play a ‘caretaker role’ in the family and prioritise the health of others above their own. At a disadvantage compared to men, women have unequal access to resources preventing early diagnosis of the disease.

Hypertension

Since hypertension is easy to diagnose but not easy to treat, a few blood pressure recordings can confirm the disease and the treatment can be initiated early to prevent complications. The number of women affected by high blood pressure is very high – 17% as per one study in India and 22.6% in a WHO report on Indian women.

Vitamin D Deficiency

Vitamin D deficiency and reduced bone mineral density is widespread. Vitamin D deficiency is a common problem in India due to several factors:

  • Changing food fads and habits contribute to low dietary calcium and vitamin D intake.
  • With modernization, the number of hours spent indoors has increased thereby preventing adequate exposure to sun. This is particularly true in urban Indians.
  • Increased pollution can hamper the ultraviolet rays to adequately synthesize vitamin D in the skin.
  • Cultural and traditional habits prevalent in certain religions like “burqa” and the “pardah” have been well known to be associated with vitamin D deficiency.
  • Repeated and unplanned, and unspaced pregnancies in dietary deficient patients can aggravate vitamin D deficiency in the mother and the fetus.

Thirty minutes exposure of the skin on the arms and face to sunlight, without application of sunscreen, preferably between 10 am and 2 pm daily (as maximum ultraviolet B rays are transmitted during this time) is adequate to avoid vitamin D deficiency. An Indian study looked at 25-hydroxy Vitamin D and BMD in women of reproductive age group and post menopausal women in South India. They have reported vitamin D deficiency in 76% women of reproductive age, 70% in post menopausal women, and insufficiency in 16.5% in women of reproductive age and 23% in post menopausal women.

Thyroid Disease

Thyroid disease prevalence in women is high and the disorder mostly affects older women, especially the ones with hormonal imbalances, such as the one occurring around menopause, or during pregnancy etc. But in recent times, however, the incidence of thyroid disorders among urban women in their early 30s, has increased and is on the rise. Almost 30% – 35% of women belonging to this age group are affected.

According to clinical data, the current trend of abnormal thyroid status in younger women is because urban young women though highly educated, in an attempt to enhance their career or in order to follow the modern lifestyle, tend to neglect their health to a critical extent. Not only their diet is improper with deficiency in iodine, it is also unbalanced from the perspective of adequate and accurate nutrition. They also lack the required physical activity appropriate for their age.

While they are in hot pursuit of their career, leading to a stressful lifestyle, there sets in a scenario where these women tend to turn a blind eye to symptoms such as obesity, failure to lose weight, tiredness, bodyache, mood swings, excessive hairfall, balding scalp, irritability, menstrual disorders, difficulty in conception, repeated miscarriages etc., which typically point towards medical disorders, of which thyroid related ailments are the most common presenting with such symptomatology.

Diabetic women are more prone to a disturbed thyroid profile. Also, over-burden of toxins (endocrine disrupting toxins) caused by pollution through air, water, and food add to complications. An early diagnosis goes a long way in preventing these serious health disorders.

A change in lifestyle like a healthy diet, exercise, proper nutrition and stress reduction can help minimise the chance of developing thyroid disease. Sea kelp, selenium, flaxseed oil, zinc, multi-vitamins, etc can help in hypothyroid cases.

Heart Disease

Diagnosis of heart attacks in women is late because classic heart attack symptoms as in men are absent, but many experience vague or even “silent” symptoms which they will miss. There are six symptoms which are common in women –

  1. Chest pain or discomfort which may feel like a squeezing or fullness
  2. Pain in your arm(s), back, neck, or jaw
  3. Stomach pain
  4. Shortness of breath, nausea, or lightheadedness
  5. Sweating
  6. Fatigue

Heart disease is now the leading cause of death in women. There is a lack of information about the prevention and management of atherosclerotic heart disease in women from a range of communities that comprise the extremely diverse population of India. Westernization of Indian women has lead to smoking and alcohol addiction and this is also contributing to high cardiovascular disease in women.

Women and Cancer

Last, but not the least, incidence of cancer in women is on rise, and Indian women top the world with the highest number of cervical cancer deaths. Pap smear examination and knowledge about its value in detection of cervical cancer at the earliest is lacking. Experts say that now women marry late and give birth to fewer children, all of which leads to a dip in cervical cancer but rise in breast cancer.

Breast cancer is now more prevalent than cervical cancer. Educated as well as uneducated women lack knowledge about self breast examination and the awareness to seek help. Late marriages, fewer children, use of oral contraceptive pills, obesity, sedentary lifestyle and unhealthy eating habits are fuelling cancer growth in women.

Cervical cancer vaccine and Hepatitis B vaccine prevent cancers. Ask your doctor for vaccinations to prevent these cancers.

Now let us look at what every woman should do to look after themselves:

  • Weight should be checked every week. Maintaining body mass index of 23 is essential.
  • Exercise daily for 30 minutes. Household work is accustomed exercise and will not burn your calories.
  • Eat healthy; avoid high calorie carbohydrates, saturated fats. Increase vegetable intake and fruits in daily diet.
  • Check for thyroid swelling in the neck every day when you look into the mirror.
  • After the age of 30, get sugar, BP and thyroid tests done.
  • Every woman should get a Pap smear done 1 – 2 years after starting active sexual life. Getting cervical cancer vaccine before starting sexual activity is a very wise decision.
  • Self breast examination should be taught to every girl after attaining menarche (first menstrual period) and it should be done every month after bleeding stops.
  • Get your thyroids checked and diabetes risk checked before planning pregnancy.
  • Daily sun exposure for 30 minutes from 10 am to 2 pm will keep bones healthy. Drinking milk and taking calcium rich diet protects you from osteoporosis.
  • Yearly health checks and doctors consultation will go a long way in keeping healthy.

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Pic courtesy: http://phmastersjobs.com/masters-public-health/

A Healthy Woman Brings Up A Healthy Family!

MULTIPLE PREGNANCIES

The phenomenon where more than one fetus results from a single pregnancy is termed as Twin Pregnancy or Multiple Pregnancy. It is caused due to the spontaneous competition between the sperms. These types of pregnancies are either natural or due to infertility treatments.

The chances of multiple pregnancies increase:

  • Through fertility treatments.
  • When the age of the mother is above 30.
  • With a personal or family history of fraternal (non-identical) twins.

How can complications be addressed?

Various complications occur during twin or multiple pregnancies due to high competition between the embryos. The most common one is ‘Pre-term Labour’. Apart from this, other complications that may arise are Anemia, Miscarriage and Vanishing twin, Preeclampsia, Intrauterine growth restriction (IUGR), Gestational diabetes and Post-partum hemorrhage. However, the good news is that twin or multiple pregnancies can lead to successful outcomes by ensuring Frequent antenatal visits, Frequent fetal assessment, Attention to nutritional needs, Assessment of cervix, Restricted physical activity and Neonatal care.

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Nutrition 

The mother has to pay close attention to her nutrition levels when expecting twins or multiples. A diet rich in good quality protein, iron, folic acid and calcium with optimum calories is recommended for better pregnancy outcomes.

Including wholesome nutritious foods like whole grains, fruits, milk and sprouts to the diet, rather than processed food, helps in giving the mother a balanced diet.

Special Clinics

Special clinics are dedicated to mothers experiencing multiple pregnancies. It helps them keep a track of the fetal growth by offering close monitoring and counseling thereby reducing complications or risks that may arise. Visiting these clinics is beneficial to parents and babies.

Fernandez Hospital started a specialized Twins Clinic in 2006, the only one of its kind in Telangana and Andhra Pradesh. This is a fully functional, multidisciplinary clinic comprising a dedicated obstetrician, fetal medicine specialist, nutritionist, lactation consultant and an excellent neonatal team that provides round the clock service. The Clinic deals with about 250 twin and 10 triplet pregnancies per year.

Mothers monitored by specialized clinics tend to give birth closer to term, reducing the risk of pre-term labour. More importantly, these clinics give an opportunity for parents in similar situations to meet, discuss and feel more at ease.

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THE IMPORTANCE OF BREASTFEEDING

Breastfeeding is a natural, safe and healthy way to provide nutrition for your baby. The overall composition, temperature and cleanliness of breast milk makes it an ideal food source for a newborn. Breastfeeding is beneficial not only to the baby but to the mother as well. All healthy newborns should receive exclusive breastfeeds for the first six months and mothers should continue to breastfeed their infants for two years or beyond.

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The benefits of breastfeeding:

  • It strengthens the bond between the mother and the newborn.
  • It supplies the required nutrients for the appropriate growth of the baby and builds the baby’s immune system.
  • It protects the baby from diseases like obesity and cancer.
  • It keeps common allergies, infections and sickness at bay.
  • It is easily digested, avoiding constipation, diarrhea or an upset stomach.

Breastfeeding Counseling at Fernandez Hospital

Fernandez Hospital provides counseling on breastfeeding to expectant mothers before delivery. This includes a general discussion about pregnancy and breastfeeding counseling sessions by our in-house Neonatologist, Dr. Hemashree.

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Dr. Hemashree

 Dr. Hemashree has been associated with Fernandez Hospital since 2011. In every counseling session, she highlights the advantages of breastfeeding to the mother and baby. Some of the common topics covered in the sessions include composition of breast milk, correct position of the baby, latching onto the breast, common breast and nipple problems, storage of the milk and the role of mother’s diet in breastfeeding.

According to Dr. Hemashree, “Breastfeeding is not given importance in this modern era.” She stresses on this natural phenomenon, recommending exclusive breastfeeding for all newborns for the first six months and to continue breastfeeding with complementary nutrition after six months till two years and beyond. The mother should use every opportunity to ensure skin to skin contact immediately after birth (breast crawl) and provide colostrum (first milk) to her newborn.

Your questions answered

Q: How often should a mother breastfeed?

Dr. Hema:  Breastfeeding should be on demand. Watch for hunger cues. Crying is a late sign of hunger. On an average the newborn feeds 8 to 10 times a day.

Q: How do we know when the baby is hungry?

Dr. Hema: When the baby cries, it is its last signal of hunger and should be breastfed immediately. The early clues to a baby’s hunger are moving its head from side to side, mouthing movements, sucking movements, puckering of lips and rooting for any object nearby.

Q: Is it safe if the mother continues to feed the baby when she has flu or cold?

Dr. Hema: Yes, it is safe and the mother must continue to feed the baby. In fact breastfeeding at this time will boost the baby’s immunity.

Q: How can a mother increase her milk supply?

Dr. Hema: The more frequently the baby suckles from the mother’s breast the more will be the milk supply. Emptying of the breasts by the baby is the best stimulus for more milk.

Q: Is there any special diet for feeding mothers?

Dr. Hema: They need to maintain a balanced diet. Concentrating more on small meals and keeping themselves hydrated with water and juices will improve lactation.  Natural galactagogues (substances that promote lactation) such as garlic and methi seeds may be used.

Q: How will we know if the baby is getting adequate milk or not?

Dr. Hema: Weight gain is the best way to know that the baby is receiving adequate milk. 6 to 8 wet diapers per day, sleep for 45 minutes to 1 hour after a feed are the other indications of adequate milk.

Q: What is the progressive weight of the baby?

Dr. Hema: The baby might lose weight initially, but it should regain birthweight by two weeks after birth. After that a newborn puts on nearly 800 grams per month in the first six months of life.

Breastfeeding for the Working Mother

Though difficult, it is possible to nurse your baby while working. If you live near work or have a day care within the premises, you can always take short breaks to feed your baby.

Your milk supply can be kept at an optimum by using a high-quality electric breast pump to express milk during workdays. The babysitter can feed your baby this expressed milk. Expressed milk can be stored at room temperature for 4 to 6 hours and in the refrigerator for 24 to 48 hours.

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Even with alternatives available, make sure to nurse your baby in the mornings and at night. Remember that if you do not nurse or pump during the day, your milk supply will decline.

Even with alternatives available, make sure to nurse your baby in the mornings and at night. Remember that if you do not nurse or pump during the day, your milk supply will decline.

Milk Bank

The Milk Bank is used to store donor mother’s milk which is pasteurized and made available to fragile infants when their birth mother is unable to produce enough milk. It helps the baby receive enough calories and nutrients for its development.

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The myth that donor milk causes unknown infections is not true.

By donating milk to the milk bank, donors have satisfaction of helping sick and premature babies to survive; it is a service to humanity.

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Mothers Speak

Michelle Valdez, who delivered her baby at Fernandez Hospital, states: “Donor milk meant the difference between life and death for my baby.”

Another mother, Mary Jane Pfuetze shares, “My child might not have lived if it were not for breast milk donations. She is adopted and I could not provide her with mother’s milk. People do not realize that some children cannot survive on formula and some mothers cannot provide their own breast milk.

CLARIFICATION FOR A FRAUD VIDEO OF A BULGARIAN WORK NURSE BEATING A CHILD WHICH IS BEING CIRCULATED TO FALSELY PORTRAY THAT THE INCIDENT OCCURRED IN FERNANDEZ HOSPITALS

CLARIFICATION FOR A FRAUD VIDEO OF A BULGARIAN WORK NURSE BEATING A CHILD WHICH IS BEING CIRCULATED TO FALSELY PORTRAY THAT THE INCIDENT OCCURRED IN FERNANDEZ HOSPITALS

Please note that there is a video of a work nurse, by the name of Emiliya Kovacheva, from Sofiamed Hospital in Bulgaria, in which she is seen beating a 4-day old girl child. The brutal attack took place the morning of April 18, 2015, and the work nurse is now under arrest.

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See this video below: https://www.youtube.com/watch?v=Ipmzp_9G5Es

Some person, or persons, with a mischievous intent to malign, is / are circulating the video – which has gone viral globally – of the work nurse from Bulgaria beating the 4-day old girl child, stating that the incident occurred in Fernandez Hospital.

Fernandez Hospital very clearly and emphatically states that this child-beating incident did not occur on its premises, but in actual fact occurred, as stated above, in a hospital in Bulgaria.

 

GESTATIONAL DIABETES

WHAT IS THIS?

Gestational diabetes is a condition caused by a rise in blood sugar levels which can possibly develop in pregnant women around the 24th week of gestation. “It is a common medical problem – Hypertension being the first while gestational diabetes comes second,” says Dr. Tarakeswari, our specialist in gestational diabetes.

HOW IS IT CAUSED?

Hormones from the placenta, which connect the baby and the mother, help in the baby’s development. These hormones also block the action of the mother’s insulin in her body. Insulin aids the process of converting glucose in the blood to energy. During pregnancy, the mother’s body uses at least three times the regular amount of insulin. When the body is not able to produce the optimum levels of insulin it requires during pregnancy, it leads to Gestational Diabetes.

PREVENTION

There is no guaranteed method to prevent the onset of gestational diabetes. However, adopting healthier choices earlier in life and during pregnancy are helpful in keeping it under control. If you have had gestational diabetes previously, then following a healthy lifestyle reduces the risk of having it in future pregnancies or developing Type 2 diabetes consequently. Here are some of the healthy choices women can make:

Eat Healthy Foods:

  • Choose to eat foods with high fibre content and low in fat and calories.
  • Add ample fresh fruits and vegetables to your diet.
  • Strive to balance your protein and carbohydrate content while making sure you gain enough nutrients from your daily food intake.
  • Watch your portion sizes.

Exercise:

  • Be sure to add a cardio workout for at least 30 minutes to your day. It could be brisk walking, light jogging, cycling or swimming.
  • Stay moderately active every day.

Losing Excessive Pounds:

  • It is not recommended to lose weight during pregnancy. Hence shedding excess weight before conceiving helps you have a healthier pregnancy.

MYTHS

There are an umpteen number of myths about gestational diabetes which have been addressed time and again. These myths paint a false picture in people’s minds creating a stigma around this disease. Two of the most common and important myths are addressed below.

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However, diabetic pregnancies require extra care and excellent blood sugar control, before and during the pregnancy. If you have diabetes and are trying to conceive, it is vital to talk with your doctor.

Myth 2: Gestational diabetes does not need to be taken seriously.

Although gestational diabetes usually disappears after childbirth, it needs to be monitored. Ignoring it not only leads to complications in pregnancy, it is also a health hazard to the mother and baby. Our specialist Dr. Tarakeswari says, “There are two complications which may arise if the blood sugar levels are not controlled. Firstly, the baby is born overweight, leading to difficulty in delivering the shoulder, causing shoulder damage. The second one could be an increase in the need for a C-section to deliver the baby.”

If precautionary measures are not taken in time, there are high chances that the mother and the baby will develop Type 2 diabetes later in life. This makes it vital for the mother to keep her blood sugar levels in check.

HIGH AND LOW RISK FACTORS:

These factors determine the likelihood of developing gestational diabetes.

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OUR SPECIALIST

Dr. Tarakeswari is the Head of Obstetric Medicine Unit at Fernandez Hospital. Her professional interests include Medical Disorders Complicating Pregnancy, Recurrent Pregnancy Loss and High Risk Pregnancy. Dr. Tarakeswari, our specialist in the care of Gestational Diabetic mothers, has been associated with Fernandez Hospital for 20 years. Since joining in March 1995, she has supported, counseled and guided mothers with gestational diabetes through their pregnancies.

Dr. Tarakeswari
Dr. Tarakeswari

YOUR QUESTIONS ANSWERED

Q: Tell us how Fernandez Hospital acts a referral center for Gestational Diabetes? 

Dr. Tarakeswari: As we have a nutritionist, an endocrinologist and an expert fetal medicine team under the same roof, a lot of pregnant women diagnosed with Gestational Diabetes come in for a second opinion. We make sure we know complete details about the patient’s previous pregnancy history; it could be either diabetes or any other condition. Firstly, the nutritionist and the endocrinologist review the patient together. The nutritionist suggests the mother a diet plan and the endocrinologist checks her current diet and starts her on insulin. Once this process begins, the fetal medicine team keeps a constant check on the health of the baby. As everything is done under one roof, it becomes easy for the patient to keep herself and her baby healthy.

Group Photo

A picture of the team

Happy mother Ms. Sandhya gupta shares her experience with Fernandez hospital:What really stuck us about FH from the very beginning – over and above their medical expertise – is their thoroughness and personal care. Despite packed schedule, Doctors would specifically ask us multiple times if we had any questions. And we had a lot of them! Doctor would listen to one and all and reply with full patience. Follow ups for tests/appointments were another hallmark. 3 months into pregnancy, and it was discovered I’m gestational diabetic and we went into panic mode, again! We had read/heard about stories of complications due to diabetes: high risk pregnancy, baby weight, C-section. FH staff also went into overdrive. We were given special appointments, all scenarios were explained, and assured that with proper advice and care it can be managed. Regular appointments with Dr. Santosh (Endocrinologist), dietician consultations, regular-and-frequent sugar level test records, and all these being discussed with Dr. Tara – led to keeping sugar level in control over the months. Towards the last weeks, doctor paid special attention to glucose levels and baby weights and advised induced labour a little before full-term. Sure enough, we have a healthy baby boy with 3 kg weight at birth from NORMAL DELIVERY! This requires another special mention – while we had a notion that doctors every-where jump to C-section at first chance, at FH, Hyderguda, it was just the opposite! Most beautiful reward we got for sure. Thanks FH (doctors/nursing staff/others) for the beautiful gift and amazing experience. We’ll cherish the experience and be in your gratitude forever!”

 

 

Q: Does gestational diabetes go away after delivery?

Dr. Tarakeswari: We do a follow up after 6 weeks of delivery. If the blood sugar levels are high, we advise the patient to continue the diet. There are cases where the blood sugar level returns to normal while in some cases, they might develop Type 2 diabetes after delivery. If one develops diabetes during pregnancy, there are high chances of it transforming into Type 2 diabetes in the future.

Q: How much does gestational diabetes counseling help the pregnant women?

Dr. Tarakeswari: Counseling helps a lot during pregnancy. There are women who come to us before planning their pregnancy. We tell them to check their blood sugar before they conceive because they might have a family history of diabetes.

Counseling gives you information on the body health conditions. Information is provided to pregnant women before signing them for blood sugar levels check. They need to be kept calm as panicking can only cause distress. Before ordering the test, we tell them why it is important. Usually we do the test at 24 to 28 weeks as that is the time when gestational diabetes is detected. But for those with a family history of diabetes, it is done around the 16th week.

Q: Are there specific doubts that pregnant women have during pregnancy?

Dr. Tarakeswari: They do have questions like —

What happens to my baby if I have gestational diabetes?

Will the baby have diabetes?

Will I have a normal delivery?

We assure them that nothing will happen to their baby and if they are well in control of their diet, and exercise on a regular basis, they can have a normal delivery. But if the sugar level is high, we make sure to tell the patient to admit themselves a week before their due date.

 

Q: Is it compulsory to take the test at 26 weeks or does it depend on certain factors?

Dr. Tarakeswari: We take a combination of both into consideration. If somebody is treated for infertility and her BMI is 30, we test them before 16 weeks itself. If she has a BMI of 24 and she conceives with no family history of diabetes, then we test her at 24 weeks.

Happy Parents Ms. Richa and Mr. Anilesh share their experience with Fernandez hospital:

”When my wife conceived after two early miscarriages, it came as a beautiful surprise which was later shattered by the detection of Rubela/Herpes & MMR virus through torch test. To top up, the mother was also detected with Gestational Diabetes. Hope showed up with someone suggesting Fernandez Hospital as the best place for all such otherwise difficult cases. And the journey started with first visit at Hyderguda Branch. The consulting Doctor’s serious intervention along with much care and concern brought us to the last leg of our journey. Not even a single detail went unnoticed and at all steps taken by them stood by us and here we are, with a cute little girl delivered normally. Yes! Surprising but true, that even mothers with gestational diabetes can deliver normally and we are a true witness to this.

We take pride and pleasure together to thank the whole team at Fernandez Hospital, Dr. Tarakeswari and other senior doctors who stood with us all through. We also thank the Nutrifit team led by Dr. P. Janaki for their dietary planning and assistance. Not to forget the ever smiling team at the OP helpdesk to always accommodate us even in the 11th hour. But on top of all, we are humbled by patient intervention and concerning attitude of the labour room team who persisted despite all odds to help us deliver a health born baby. We fall short of words to describe our sincere gratitude towards all of them (as one team) for everything. It sure has been a life changing and heartwarming experience that God gave us through bringing us to Fernandez Hospital.”