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.

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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.”

Childbirth Education

Childbirth is as old as the beginning of the human race. It is a natural process and yet “soon-to-be” parents tend to be anxious about coping with this new and uncertain phase in their lives. Childbirth education will help them know what to expect during pregnancy. It teaches them techniques to relieve the pain — making it easier for the mother during labour while keeping her partner informed of her developments.

Childbirth classes are not only informative, they also relieve the couple’s anxiety by providing a forum for exchanging experiences while listening to other expectant couples. They learn how to cope with the entire birthing process, making it a memorable personal experience rather than just a tense day in the Labour Room.

A childbirth instructor like Martine becomes your “third wing”.

A good instructor knows the importance of natural birthing without invasive medical procedures. She will, therefore, guide and teach you methods to make your birthing experience less uncomfortable.

Martine Cambron is a childbirth instructor from France married to an Indian. She has 20 years experience and has been associated with Fernandez Hospital since the last 15 years. Her childbirth expertise has enabled herself to give birth to nine children, all of them normal deliveries.

“Motherhood is a beautiful experience and my effort is to make this journey a special one for all mothers-to-be. Nine natural births! To be motherly is the key,” says Martine.

Mothers find the classes helpful.

A mother trained by Martine says, “When I had my first baby in the U.S. in February 2008, I had a Birth Doula who supported me throughout my labour and delivery. When I was expecting my second baby here in Hyderabad, I had no clue if there were any classes or doulas here. When I spoke to Dr. Evita Fernandez about ALL NATURAL DELIVERY, she immediately told me that I could talk to Martine about it.”

Says another happy mother: “Martine is a very nice and kindhearted human being.  Being a mother of nine, she can easily understand what a pregnant woman goes through during labour and delivery.  I had taken classes from her, though I myself got trained as a CHILD BIRTH EDUCATOR. After a long gap, it was nice to have detailed classes on diet and nutrition, understanding your pregnant body, what to anticipate, breathing techniques, labour positions, etc., including postpartum care.

The Lamaze Technique

While birthing is a painful process, these classes give pointers on how to reduce the pain. Breathing, the most important activity for the human body to function is given utmost priority to help the mother relax while in labour. The Lamaze technique, developed by French obstetrician Dr. Fernand Lamaze in the 1940’s is employed to help mothers respond positively to pain. The Lamaze philosophy stipulates that “birth is normal, natural, and healthy” and that “women have a right to give birth free from routine medical interventions.” Connecting with the baby becomes an important aspect for expectant parents. Mothers and their spouses are educated on focused breathing techniques, movement and positioning, massage, and relaxation throughout labour. The system is intended to contribute to the process of labour without the use of drugs.
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Benefits of Breathing Exercises:

Breathing is a comfort technique helping mothers ease the pain during childbirth. The benefits of learning different ways to breathe while experiencing contractions will help you enjoy the entire process of childbirth, even though it might be overwhelming.

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Inhaling gives you strength, while exhaling helps you push out the pain. Inhaling through your nose and exhaling through your mouth at a constant pace during contractions can benefit you in the following ways.

  • It helps you make the contractions work better by sending in a surge of oxygen to the uterus.
  • It aids the baby’s descent by relaxing the abdominal and genital muscles.
  • It provides another channel for you to focus on to counteract the discomfort which persists during labour. 

Q & A with Martine:

Q: What is your goal being a childbirth educator?
M: My goal is to prepare women for natural birthing and to facilitate mothers-to-be to cope with the changes in their body.

“It is a course of 6 classes with me,” says Martine.

Q: How important are these classes?
M: One big difference between people who attend classes and those who do not, is that there is no shouting during labour from those who attend. They have a calm and relaxed labour.

Mom Priyanka says : “During my labour, I did not take an epidural.  I used these breathing techniques and and had a normal delivery without any kind of medical intervention. Mrs. Martine was there with me during my labour. As I had not taken epidural, I was able to tend to my baby’s needs and feed her within the first hour of birth which is very important for her immune system development.

I would like to wholeheartedly thank Mrs. Martine for her wonderful support and compassion and hope she will change lot of women who are afraid of labour pains, to go for natural delivery.”

Movement in Pregnancy:

While at work:

Make it a point to take some time off from sitting at your desk at work and stretch your body. It helps in facilitating the hormones and blood flow through your body for you to remain much more at ease.

While Sleeping:

As the pregnancy advances, sleeping can become quite an ordeal. While sleeping, you can rest your head on a pillow comfortably cushioning the nape of your neck while you tuck a second thin pillow or a towel under your stomach. Resting your leg on a pillow or placing one between your legs can help you feel much more relaxed.

Couples Participation:

“In all our classes, it is important to have the husband with the wife,” says Martine.

Pregnancy is a joyous yet overwhelming experience for both partners. The journey is to be walked by both the parents. It is not just the mother’s responsibility to birth a healthy baby. Constant support and encouragement is highly important to get through a healthy pregnancy. Therefore, it is vital for both the parents to actively participate in child education classes. It not only nurtures a healthy bond within the family, it also takes away quite a bit of stress from the mother.

“The emotional empathy that my partner provided me during labour is what he learned from attending the classes. It helped him remain in control. The videos shown during the classes educated him much about the birthing process. I strongly recommend Lamaze for both the partners. It’s a blessing,” says Mom Apoorva.

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The partner can provide support to the mother by learning about:

  • The birthing process.
  • The breathing techniques – reminding the mother how to progress through contractions through breathing while she is in labour.
  • Nutrition required for the mother and baby.
  • What to pack while rushing to the hospital.
  • How to take care of the mother and the baby.

Parents Speak:

Parents Avinash & Nidhi:

I really have no words to explain my gratefulness. Thank you for everything. I realized everything can be controlled by the breaths we take, and being calm all the time. The breathing exercises helped boost my willpower and assured me that I can keep things in control. The pain is natural but my approach was so positive, it made me wonder if it was really me to undergo labor for so long. Thank you for being there to make the situation bright and happy.

Mom Apoorva:

I would definitely recommend Lamaze classes especially for first time mommies. I feel Lamaze provides confidence and assurance that one can have a normal, healthy and natural birth. I gained almost 25 kgs during my pregnancy and was diagnosed with gestational diabetes and hypothyroidism. I had lost all hopes of a normal delivery. To worsen it, I was swollen all over. My hands, calves and feet were swollen about twice their size. But the breathing techniques helped me focus during labour. They not only kept me well oxygenated but encouraged me to acquire a new strength and think positively about my labour.

Benefits of Prenatal Yoga

For every pregnant woman, the journey from conception to childbirth should be a wonderful experience. Fernandez Hospital is actively developing methods to make this path problem-free and smooth for mothers-to-be. A woman’s body during pregnancy is as fragile as a newborn baby, and we therefore understand the importance of fostering the well-being of the home in which a new life grows.

Yoga has been glorified through the ages for its varied benefits. With changing times, prenatal yoga has been gaining popularity to aid expectant mothers through an easy childbirth. If practiced right, under the guidance of experienced yoga instructors, prenatal yoga is a boon to pregnant women during and after childbirth.1
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