A nurse helping a mother with Kangaroo mother care (KMC)
Kangaroo mother care (KMC) involves early continuous, and prolonged skin–to–skin contact between a mother and her newborn. The kangaroo pose consists of skin-to-skin contact (SSC) between the mother and the neonate in a vertical position, between the mother’s breasts and under her clothes. It has been proven scientifically that KMC significantly improves the survival in low birth weight (LBW) infants, reduces the risk of severe blood infections, decreases the length of hospital stay, improves breastfeeding, and leads to better physical and brain growth of the baby apart from psychological healing to the mother. Hence, KMC is now considered as the standard of care for low birth weight (LBW) and very low birth weight (VLBW) neonates in all socio-economic settings.
A father giving KMC to a low-birth-weight infant
KMC at Fernandez Hospital
In 2004 Fernandez Hospital introduced a KMC ward. It was started initially at the Boggulakunta unit and later initiated in the other units. At Fernandez Hospital, KMC commences for the VLBW neonate as early as possible, right in the NICU, once the babies are clinically stable and the mother is comfortable. In the absence of a mother, foster KMC is encouraged by other family members. Once the babies are stable, they are transferred to a dedicated KMC ward for continuous KMC. KMC wards attached to the NICUs mimic the home-like environment for the mother-infant and are, in general, low on gadgets and technology.
In the KMC ward, mothers are supported by nurses and nursing aides, but primarily the babies are taken care of by their mothers. This facilitates empowering the mother to care for her baby and allows an early discharge from the health facility. KMC also provides the best developmentally supportive care possible to the neonate and alleviates fear and anxiety in the mother and other caregivers in taking care of these tiny infants. The mothers are encouraged to continue KMC at home.
In our initial study, we looked at the feasibility of caring for stable VLBW neonates on full oral feeds in the KMC ward instead of conventional NICU. The study found that KMC ward care is safe, and neonates had similar growth patterns. It decreased the length of NICU by two weeks. Another study published by Fernandez Hospital showed that stable VLBW infants can be shifted to the KMC ward even at 1100 grams. They had better weight gain, reduced NICU, and hospital stay, with a significant cost reduction of almost 35000 INR per baby (500 USD). The effect was consistent even in extremely low birth weight babies. Around 2000 VLBW neonates have benefitted from the KMC since its inception at Fernandez Hospital.
3 Historical Women who paved the Way for Women Studying Medicine
History remembers women who reclaim the power of womanhood by breaking biases. They overcome social exclusion and obstacles of family, society, and patriarchy to actualize their potential. They create history and pave way for more such pathbreakers. On International Women’s Day, we remember three fearless women who became trailblazers for women to study medicine, which predominantly was a male domain.
Dr Kadambini Ganguly (1861-1923)
Well-behaved” women rarely make history. Dr Kadambini Ganguly is fondly remembered, to this day, as a revolutionary rebel. She dedicated her life to fighting for women’s education and rights, at a time when women were not allowed to have any other aspirations except raising a family. Dr Kadambini became the first female physician in India to be trained in western medicine and was one of the first working women. She did not let biases or societal norms prevent her from fulfilling her dreams. With the support of her husband, Dwarkanath Ganguly, who himself was a crusader of women´s emancipation and encouraged them to participate in every walk of life, she secured a seat for herself to study medicine. After obtaining her degree, she openly addressed Calcutta Medical College’s practice of not admitting female candidates, which led the university authorities to open their doors to all female students. She was also part of the first female delegation that helped secure voting rights for women. Although the journey was not easy, Dr Kadambini remained a working professional till her last breath and is still remembered for the incredible contributions she made towards this change.
Anandi Gopal Joshi (1865- 1887)
Driven by passion and purpose, Anandi Gopal Joshi, became the earliest pioneer for women’s healthcare in India. She overcame the barriers of caste and societal stigma to secure an education in medicine overseas at the tender age of 18. She wanted to change the sad truth that women, in most cases, due to the lack of female doctors, would rather die than take medical aid at the hands of a male physician. Her vision was to study medicine and set up a school of medicine in India for Indian women.
Although she actualized her dream of securing a medical degree, Anandi (22) succumbed to tuberculosis on 26th February 1887. She could not open the women’s medical college she’d envisioned or put her hard-earned knowledge into practice for too long. Her legacy, however, lives on. The Maharashtra government offers healthcare fellowships to women in her name to keep the memory of this Braveheart alive.
Dr Mary Poonen Lukose (1886–1976)
Born on 2nd August 1886, Dr Mary Poonen Lukose was the trailblazer that set the wheels of change in motion. She championed the message that gender is no measure of potential. She is accredited with many legendary accomplishments. She was the first woman from Kerala to graduate in medicine; first lady gynecologist of Thiruvananthapuram; first lady legislator; and the first lady surgeon general (in the world) among many other firsts. Although extremely bright, she was denied admission into medicine because of her gender. She, however, did not let this prevent her from following her dreams and moved to London to secure an MBBS, an MRCOG (gynecology and obstetrics), and training in Paediatrics. As early as 1920, Dr Lukose delivered modern-day Kerala’s first C-section baby and began training professional midwives with the support of Travancore’s Maharani Sethu Bai.
In 1924, when she was promoted to head the medical department, she undertook many revolutionary steps, including the establishment of training classes for local midwives. By 1929, this led to 1.6 million residents of the state, having access to modern medicine. She was appointed Surgeon General of Travancore in 1938 and was awarded the civilian honor of Padma Shri in 1975 by the Government of India. She inspired women across the country to overcome stereotypes.
History is made by women of courage who shatter stereotypes and inspire change. Happy International Women’s Day to all the brave women out there. May your tribe grow!
A gender-equal world is possible. A world free of bias, stereotypes, and discrimination is possible. We can make it possible!
For over seven decades, Fernandez Hospital has been breaking biases by empowering women to make choices and voice their views on issues surrounding birth. This International Women’s Day, we share how Fernandez Foundation has been breaking biases by empowering women to make choices and voice their views on issues surrounding birth.
As advocates of natural birthing, we have successfully sowed the seeds of Midwifery in India. Gaining momentum with each passing day, our midwifery initiative is reducing C-section, mortality, and morbidity rates in the state of Telangana.
We’ve shattered many birth-related biases by…
Promoting and establishing midwifery-led care at Fernandez Hospital
Working with Telangana Government in establishing midwifery care in public hospitals
Preserving the rights of pregnant women
Midwives, obstetricians, and doulas working together as a team
De-medicalizing births
Doctors breaking the bias
Bias: Only doctors can help women birth
Breaking the bias by letting Professional Midwives – my trusted colleagues – help women birth naturally. Midwives provide respectful, equitable, evidence-based care to low-risk mothers and I dedicate my expertise to high-risk pregnancies.
Midwives breaking the bias
Bias: Women can only give birth lying down
Breaking the bias by helping women birth in positions of their choice. I provide the highest standards of maternity care. I strive to reduce medical interventions and help mothers have normal, physiological births.
Mothers breaking the bias
Bias: I have no say in the way I birth
Breaking the bias by ensuring I have a say in everything related to my birthing journey. I seek midwifery care that protects my voice and my rights. My midwife keeps me in charge and helps me birth the way I want.
India records 25 million births each year, out of which 2.7 million babies are stillborn, and 0.56 million babies die during the first month of their life. Thirty-five thousand women die of pregnancy-related complications. Most of these deaths occur during childbirth and are preventable with the presence of a skilled midwife. The Lancet series on Midwifery (2014) revealed, midwives trained to international standards can avert 83 per cent of all maternal deaths, stillbirths, and newborn deaths. However, India needs to train and deploy thousands of new midwives to meet its needs. This is a question of training capacity, public expenditure, and a race against time. There is an opportunity here for experienced midwives from across the world to come and help us establish this professional cadre in India.
India’s maternal mortality ratio remains high even though institutional births have increased. Today, nearly 90% of all births take place in health care institutions. An unfortunate outcome of institutional births is the strong medicalized birthing environment. This has led to an unacceptably high caesarean birth rate (21.5% of total institutional births) both in private (47.4%) and public facilities (14.3%) (NFHS 5, 2019-21). WHO considers the ideal rate for caesarean sections to be 10-15%.
Professional midwifery is a multi-pronged approach to address the range of issues plaguing childbirth and maternal health in India. However there is an acute shortage of trained midwives—and just as importantly, there is a shortage of skilled and experienced trainers. This is a chicken and egg issue: unless a critical mass of clinically experienced midwives becomes available, it will be hard to find good trainers.
The PROMISE campaign
The Professional Midwifery Services (PROMISE) campaign strives to make birthing safe for Indian mothers. It embodies the promise of humanized, evidence-based, and respectful care for childbearing mothers irrespective of caste, creed, or religion. The campaign has four clear objectives:
The PROMISE campaign delivers on these objectives by focusing on training and capacity building of nurses as professional midwives.
The campaign aims to train midwives and also build up a national cohort of midwifery educators. PROMISE runs the Nurse Practitioner in Midwifery (NPM) course for nurses in the public sector. The NPM course is designed to train registered general nurses with global standards of knowledge, skills, in providing highly quality midwifery led care to mothers and neonates. It also runs a Midwifery educator’s programme to help build a national cohort of midwifery educators and trainers An excellent example of PROMISE’s outreach is its support to the 18-month Midwifery training programme run by the Indian state of Telangana. The PROMISE campaign aims to train for India, 10,000 midwives by 2032.
The Fernandez Foundation spearheads the PROMISE campaign. The Foundation runs a tertiary referral perinatal centre, the Fernandez Hospital, with 320 beds and an annual birth rate of 10,000. Based out of Hyderabad in the southern Indian state of Telangana, the Foundation is a crucial player in promoting midwifery services across India.
Work with us
There is an urgent need for midwives in India to provide women-centred, respectful, kind, and compassionate maternity care. The Foundation is looking for experienced midwives who can work with us to train and establish this new cadre of professional midwives across India.
If you are interested, do get in touch.
Write to us with a short letter of intent and a brief resume at midwifery@fernandez.foundation or WhatsApp us on +91 7995566001
Quality sleep is as crucial as proper nutrition. Babies grow and develop in their sleep and therefore a baby’s sleeping habits are a major concern for mothers around the world. While it is natural to be worried there are several ways to improve your child’s quality of sleep.
As your little human grows, their sleeping needs will change, and the hours of sleep required will gradually reduce. While newborns sleep through most of the day (14- 17 hours), they are light sleepers with their sleep divided into sleeps cycles of 4-5 hours till the age of 3 months. Babies between the ages of 3 to 6 months require 12-15 hours of sleep which spans 2-3 naps in the day and possibly a long stretch of sleep at night. From 6 months to a year, the baby’s sleeping patterns start coming closer to that of an adult. They will sleep through the night and require about 11-14 hours of sleep.
Here are 7 tips to help improve your baby’s quality of sleep:
Monitor your child’s sleep rhythm
Although it can be difficult and erratic in the beginning as your child grows, they will start to present a more consistent sleep schedule.
Respect your baby’s preferences
Adjusting to your baby’s sleep cycle might not always be ideal and can often be life-altering. But it is recommended that parents respect their baby’s sleep patterns. As your child grows older, you may gradually introduce a healthy sleep cycle.
Giving the baby time to settle down
Babies might fuss or cry before finding a comfortable position and falling asleep. Be patient and monitor them. Check on your baby, offer comforting words, and leave the room. Your reassuring presence might be all that your baby needs to fall asleep.
Soothe the baby
The baby needs to be calm to be able to fall asleep. As you acquaint yourself with your baby’s likes and dislikes, make sure to take note of the activities that your baby finds soothing to get them drowsy and ready for bed. You may start rocking the baby or sing lullabies to them.
Introduce a bedtime routine
As your baby grows, it is a good idea to introduce them to a bedtime routine. It helps the baby develop habits that prepare them for quality sleep. A positive bedtime routine involves going through a few quiet yet enjoyable activities with your baby about 20 minutes before bedtime. This could include giving them a warm bath or reading to them.
Feeding before bedtime
Make sure that you feed your baby in a dimly lit, calm environment between naps and before putting them to sleep at night. This will indicate to your baby that they have to prepare for sleep and not play.
Keep distractions away
Babies are easily amused. It is a good idea to provide them with an environment that free from distractions to improve their quality of sleep. Avoid using mobiles or TVs especially, one hour before bedtime.
As your newborn grows, their ability to sleep soundly will improve. Good quality sleep plays a key role in your child’s physical and mental development. If you notice that your child is sleeping too little or too much, it is recommended, that you consult a paediatrician as sleeping issues could indicate underlying medical issues.
To book an appointment with our expert Paediatricians, call: 1800 419 1397
Every mother-to-be needs to be aware of certain conditions that might affect her baby. One of those is the risk of birth defects. 1.7 million babies are born with birth defects every year in our country as per UNICEF, India.
Not all birth defects can be prevented, but you can reduce the risks by taking certain precautions.
Here are 4 measures you can take to help you prevent birth defects:
Commit to a Healthy Lifestyle– Leading a healthy lifestyle is all about making healthy choices. Various studies show that an obese woman having a BMI of more than 30 is at a higher risk of complications during pregnancy. Some serious birth defects can be prevented if one maintains healthy weight before and during pregnancy.
What can you do?
Exercise regularly (consult your obstetrician about the best course of action)
Consult your nutritionist for a personalized diet plan and eat healthy meals
For light exercise, you can go for short regular walks
Attend prenatal yoga sessions, which will help calm your senses.
Try to maintain a healthy weight.
In case, you are an expectant mother and have diabetes, you need to take precautions advised by your obstetrician. If left unchecked gestational diabetes can cause serious complications for the unborn baby. You can prevent birth defects and other problems by keeping your blood glucose levels in control. Consult your nutritionist for a healthy diet plan and get ample exercise.
Keep away from Alcohol and Cigarettes
Drinking and smoking are a BIG NO during pregnancy. The alcohol passes through your bloodstream and the placenta to your baby. As your baby is still developing in the womb, be mindful that the liver is the last organ that develops.
It is important to abstain from alcohol and all other harmful substances. Drinking alcohol during the first three months of pregnancy can result in miscarriage or preterm birth. Even after the first three months, drinking may result in the baby being born with birth defects.
What can you do?
opt for a healthy lifestyle and consume healthy drinks like fresh juices
Meditate – Meditation helps you to take control of your mind and body
Include Folic Acid in your diet
If you are planning to embrace motherhood or are pregnant, Folic acid is a diet essential. WHO advises pregnant women to take 400 micrograms of folic acid daily. Folic acid is a B vitamin that helps create new cells in our body.
Why Folic acid?
It helps form the neural tube
Prevents major defects at birth
Helps prevent defects in the baby’s brain and spine.
What can you do?
You must take 400 mcg of folic acid every day during pregnancy
Include folate-rich foods in your diet each day, all through your pregnancy.
Avoid Self-medication
Most women self-diagnose medical issues and take certain medicines without consulting their doctors. From menstrual problems, abortion to back pain and other issues. On an average, nearly one-third of pregnant women practice self-medication using herbal and/or conventional medicine.
Effects of self-medication:
Impacts foetal health
The medicinal product or chemical agent can cause morphologic or physiological abnormalities in the baby.
Can cause developmental delays in the baby .
What can you do?
You must consult your doctor before taking any medicine/drugs
Be aware of all the medicines you take
Rely on the doctor’s advice.
All in all, the risk of birth defects can be reduced to a large extent if mothers adhere to prenatal care. At Fernandez Hospital, we have an experienced team of obstetricians, nutritionists, and childbirth educators who can help you have a healthy pregnancy.
With pregnancy, comes unparalleled joy. But one thing that follows is the dreaded stretch marks.
Stretch marks occur on the skin when it stretches beyond capacity. With the growing baby, the skin stretches beyond the bounds. Thus, stretch marks appear. Skin is elastic, but it is bound to leave marks when stretched. Though the stretch marks are painless, some women feel distressed when they appear.
Usually, they appear on the areas accumulating fat such as the belly, breasts, thighs, or hips. Before birthing, one might encounter purple reddish stretch marks that turn white. They might fade off after birthing the baby.
It is unlikely that one can get rid of stretch marks completely. However, they can be made less noticeable.
Here are 5 ways to reduce stretch marks:
Exercise
As surprising as it may sound, exercise can help in the lightening of the stretch marks. Exercise helps tighten the tissues, which makes the stretch marks look like fine lines, matching the skin tone of the person.
Home Remedies
Home remedies such as egg white, shea butter, olive oil, honey work to a certain extent to make the skin soft and supple. This prevents and controls the stretch marks.
Creams with Hyaluronic acid or Tretinoin
Applying gels containing hyaluronic acid or creams with tretinoin can help in the lightening of the stretch marks. Provided the creams must be applied every day to the affected area. However, it is advisable that you consult a skin specialist before applying any medicated cream on your body.
Hydration
Keeping yourself well hydrated is essential for good skin health. Dehydrated skin will lack moisture and is prone to developing stretch marks more easily, as compared to the hydrated ones.
Oil treatments
You can apply any oil of your choice to the affected areas, keep it for 30 minutes, and follow it up by a warm bath. Doing this regularly can show results, albeit at a slow pace.
Take a Vitamin E capsule. Break it open and mix with the oil of your choice. Massage and rinse it off later.
Or add Vitamin E oil to your moisturising cream, apply on the affected area.
Stretch marks shouldn’t make you feel embarrassed. They’re signs of the changes your body has gone through in your journey towards motherhood. Stretch marks are as natural as they can be and stressing about it will only take away your joy as a mother.
Gestational Diabetes, unlike other forms of diabetes, is temporary. Hormonal shifts during pregnancy can cause insulin resistance, which means glucose levels stay high in the blood instead of being taken to the cells for energy, causing a spike in blood sugar levels. These imbalances occur through the course of some pregnancies and usually disappear after childbirth. The good news is that a healthy pregnancy is possible with appropriate management. You can keep your blood sugar levels in check through proper nutrition, physical activity and working closely with your doctor.
Step 1: Identifying the Symptoms
The symptoms of Gestational diabetes can be tough to identify on your own. However, through routine pregnancy screening tests, your obstetrician will be able to identify high blood sugar levels.
Imbalance in blood sugar causes symptoms like:
• Increased thirst
• Frequent urination
• Fatigue
• Dry mouth
Step 2: Diagnosis
The primary method to diagnose gestational diabetes is blood testing. Your obstetrician may advise a glucose screening test, oral glucose tolerance test or both.
Glucose screening test:
This test may require fasting. Your obstetrician will take a blood sample one hour after prescribing you a liquid containing glucose. If your blood sample indicates high glucose levels i.e., 140 mg/dL or more, your doctor may request you to go for a glucose tolerance test.
Oral Glucose Tolerance Test (OGTT):
OGTT is typically done between 24 – 28 weeks of the pregnancy. You will be required to fast for at least 8 to 10 hours before this test. Two blood samples will be collected, one on arrival and the other after you have consumed a prescribed drink containing 75 grams of glucose in 200 ml of water. Further, your blood sample is collected one or two hours after.
1 hour after drinking glucose- 180 mg/dL (10.0 mmol/L) or lower.
2 hours after drinking glucose- 153 mg/dL (8.6 mmol/L) or lower.
Abnormal values would indicate Gestational diabetes.
Step 3: Treatment and Prevention of Gestational Diabetes:
You can reduce your risk of gestational diabetes by staying healthy before and during your pregnancy. Eat a balanced diet and get regular exercise.
Treatment for gestational diabetes primarily involves maintaining and monitoring blood sugar levels with frequent checkups throughout your pregnancy. Your healthcare provider will closely monitor the health of your baby and check your blood sugar levels. You may need to monitor your blood sugar at home with a glucometer.
Some women need medication to manage gestational diabetes, but most women can keep their blood sugar levels under control with diet and exercise.
If the sugar levels continue to fluctuate, your obstetrician may start you on insulin treatment.
Step 4: Management
The good news is that a healthy pregnancy is possible even with gestational diabetes with the help of the correct precautionary measures and medical nutrition therapy. The four primary factors in managing gestational diabetes are:
Meal timings
Apart from having a dedicated meal plan, it is crucial to adhere to fixed meal timings. Skipping or delaying meals can cause high/low blood sugar.
Quantity of food
Observe control on serving size, as a greater quantity of food intake can raise blood sugar.
Quality of food
Balanced diet of healthy foods with a low glycemic index (GI).
Follow a split meal pattern of eating that will control your blood sugar levels while you’re pregnant.
Physical activity
A health-conscious diet is paramount, but it is also important to get 45 minutes of daily physical activity.
Your dietician will keep track and plan a healthy and nutritious diet according to your needs during pregnancy to keep your blood sugar levels on track. A healthy and safe birth experience is possible even with gestational diabetes. Please consult with your obstetrician at the earliest to construct a Gestational Diabetes management plan best suited to your personal needs
Dr. Nuzhat Aziz, Consultant Obstetrician, Fernandez Hospitals, Hyderabad, talks about the totally unacceptable stigma and shame heaped on women post pregnancy failure and wishes to clear misconceptions surrounding miscarriage.
It is noticed that like many western countries, India too, is beginning to observe Pregnancy and Infant Loss Remembrance Day on October 15? What is the significance of the Day?
In the year 2002, Robyn Bear, Lisa Brown, and Tammy Novak campaigned for a movement to declare October 15 as an awareness day for pregnancy and infant loss in USA. The aim was to create awareness, to allow people to join in reflection, support and honour those who have suffered a pregnancy loss or infant death. Pregnancy loss may be a miscarriage, stillbirth, an ectopic pregnancy or sudden infant death syndrome. Loss of a baby is devastating to the woman, to her family and all connected with her. The grief they experience is very different and still not acknowledged as other forms of bereavement. Pregnancy loss and stillbirths are still a taboo in many cultures, we struggle to talk about it. Grieving is a part of healing and acknowledging a person’s grief helps them to recover. The concept of observing October 15th as a Pregnancy and Infant Loss day is to create public awareness on this very important social issue. A parallel concept of lighting candles, all monuments lit up at 7 pm was added as the Wave of Light in the year 2004, allowing every individual to take part and join in promoting the campaign.
What is the most common cause of loss of pregnancy?
The most common causes of pregnancy loss differs with the phase of pregnancy. Early miscarriages have genetic abnormalities as a major cause but late pregnancy losses are due to hypertensive disorders, diabetes, fetal growth restriction as major reasons. Neonatal deaths have decreased significantly in the past few years. In developing countries, we still find labour related causes, infection as the main cause of neonatal death.
What are the main causes of Sudden Infant Death Syndrome (SIDS)?
Sudden Infant Death Syndrome is a sudden, unexplained death of a baby. Limited to less than a year of age. The causes are not known, for it happens suddenly in a healthy baby. Few conditions that are found to be associated are baby sleeping on tummy face down position, too soft mattress or fluffy toys, overheating during feeding, previous history of SIDS, mothers who smoke. It is important for mothers to know the best sleeping position, in a place where they can keep a watch on the baby, not feed the baby lying down in bed (when the mother might fall asleep).
What is the rate of miscarriage in India?
The reported incidence in literature stands between 10 to 30% but 15% is the accepted miscarriage rates across the world.
What is the psychological and emotional impact of pregnancy loss, particularly faced by women?
Women are scarred for life by a pregnancy loss. The hope of a baby playing in her arms builds-up with a positive pregnancy test. Pregnancy failure at any point of pregnancy shatters that hope and they experience the worst emotional trauma of a baby’s death. This grief lasts for a long time, and depends on multiple factors and on the emotional support she receives.
There is plenty of shame, stigma and self-blame linked to failed pregnancy. To what extent is a woman responsible?
There is no way a woman can ever be responsible for pregnancy failure. Women blame themselves when a loss occurs- especially in the early weeks of pregnancy. They seem to link intercourse, work or travel as a cause of the miscarriage. It is the responsibility of healthcare workers, her family to negate these feelings. We need to keep reinforcing at every visit that it was NOT her fault.
What is the best way to manage negative symptoms surrounding a miscarriage?
Society has a huge role to play along with her family as she grieves through this loss. Training in bereavement counselling allows healthcare teams to be sensitive, to use appropriate words. Every woman, couple grieves differently. Giving them time, listening to them allows one to look for a need for specialist help. Some may require psychological support and may benefit from referral to psychologist or psychiatrist.
Why is it important to talk and have an open expression about pregnancy loss and miscarriage?
We humans need support, we recover faster when we have family and society support. Death of an adult is followed by emotional support from everyone around us. But when a stillbirth or a miscarriage occurs, its taboo, its hidden and not disclosed. I know several women who left their hometown to escape questions about pregnancy after a baby loss. We hope that having a day of remembrance on October 15 will open these issues, allow couples to talk about their pregnancy loss, educate all on how to acknowledge this grief and facilitate healing.
Why do you think women are not adequately informed and supported by health care professionals following pregnancy and infant loss?
During our training we were not taught how to help individuals who experience any form of loss. As a young obstetrician I know I was not sensitive to the emotions of women and couples as I am today. At Fernandez we invest in “bereavement counselling” and train our residents, nurses and midwives on how to work with mothers who experience loss. Many of us need to learn about silence too. Some women need that space before they start sharing. We need to learn the cues on when to talk and not plug the silence. We simply need to raise awareness on this – among the women and in our own fraternity.
Do you think psychiatric issues following a prenatal loss can be resolved with the birth of a subsequent healthy child?
Each woman grieves differently, has different coping mechanisms. Many have anxiety, depression for varied periods of time. Couples find it difficult to go through the next pregnancy. Many triggers keep stimulating these emotions. Grieving women experience flashbacks as they visit the hospitals again, or every time the fetal heartbeat in a subsequent pregnancy is heard. When they have a subsequent healthy baby, they do become occupied with baby care. The psychological trauma is lifelong. I remember my friend, who first visited us for a second pregnancy after a first stillbirth. She had a subsequent healthy baby. I can never forget her words. She said every time she sees a 4 year old baby she keeps thinking her baby would have been playing this way (she had a loss 4 years ago). “I always say I have two kids, one is with God” Hence all preventable pregnancy losses should be prevented, to create better families, better society.
How long is recommended a woman should wait following miscarriage before conceiving again?
We would advise women to plan after evaluating all preventable causes of miscarriage, when she feels she can go through another pregnancy. We suggest after two to three menstrual cycles, but it is absolutely fine if they conceive sooner. There is no scientifically proven time period that is said to be the most appropriate interval.
What are the chances of losing a baby after miscarriage?
After one miscarriage, the chances of a miscarriage do not increase. The risk increases if a woman has recurrent miscarriages (three consecutive pregnancy losses).
Could stress and lifestyle choices contribute to miscarriage and pregnancy loss?
Many times, stress is unavoidable. It is important we do not use this as a reason for pregnancy loss because women will experience incredible guilt. Lifestyle choices yes can have an impact; smoking, alcohol, risk behaviour can be modified. Obesity is one important association that can be modified through lifestyle change.
Is there any link of preventing miscarriage to pre-conception planning? In what cases is pre-conception planning advised?
Preconception counseling or consultation is very important. I would suggest all women to have pre-pregnancy counseling. It allows for a review of her medical history, to optimize medical conditions like thyroid or diabetes or hypertension, to change to safe medications if necessary. It is also used to screen for common medical conditions, and start preconception vitamin folic acid supplements. Folic acid deficiency is known to cause birth defects. We check for vaccination status like Rubella, Covid these days, as it’s always better to plan pregnancy after vaccination. All miscarriages may not be preventable, but those due to preventable factors can be.
What are 5 warning signs of a possible problem during pregnancy?
1.Bleeding in early pregnancy
2.Abdominal cramps which are rhythmic and regular
3.Decreased fetal movements
4. Hypertension
5. Diabetes.
Disclaimer: This is a reposted article, originally published in *PatientsEngage, on 13th October 2021
Pregnancy can be a roller coaster ride, especially when managing nutrition with essential fat intake, antioxidants, proteins and keeping food cravings in check. More so if you have been diagnosed with gestational diabetes. However, the good news is that you can sustain a healthy pregnancy by keeping your blood sugar levels in check through proper nutrition, daily physical activity and working closely with your doctors (obstetrician endocrinologist and dietitian). The objective is to follow a meal plan that is easy, manageable, keep your blood sugar low, and leaves you stress-free.
What is Gestational Diabetes?
Gestational diabetes is a condition that occurs during pregnancy and in most cases, disappears after childbirth. In this condition, the mother experiences high blood sugar levels. Hormonal shifts during pregnancy can reduce insulin effectiveness, meaning glucose levels stay high in the blood instead of being taken to the cells for energy. Approximately 4 to 14 out of 100 pregnant women develop gestational diabetes. The risks of gestational diabetes can include complications for mom and baby – a large baby can increase the risk of needing a cesarean section, and uncontrolled blood sugar may put the mother at higher risk of high blood pressure. Medical Nutrition Therapy is the first step in the management of this condition. A balanced diet with optimum calories is essential. The goal is to gain weight according to prenatal BMI, avoid excessive weight gain, and control blood sugar levels.
Here are 7 must-eats to include in your Gestational Diabetes Meal Plan…
High-fibre foods/Complex Carbs
Include whole grains, fruits, and vegetables in your daily diet to ensure adequate fibre intake. Include one serving of whole beans and legumes like moong, moth, chana, rajma, lobia, green peas etc.
A variety of cereals and millets with high-fibre content are recommended. You may prefer brown rice, whole wheat, and millets like jowar, bajra, foxtail etc.
Take a blend of wheat flour and soya bean flour OR wheat flour and roasted channa flour in the ratio of 4:1 to improve the protein quality. Avoid all refined, processed grain, maida products and bakery products.
You may enhance the fibre content by blending cereals and millets or by adding vegetables in cereals and millets as in the preparation of vegetable – rotis, rice and porridge.
Protein-rich food
Vegetarians may prefer milk, yoghurt, cheese, beans, pulses, soya nuggets, tofu, and paneer. Non-vegetarians can include eggs, fish, and chicken. It is preferable to use low-fat milk-toned (3% fat) or double toned (1.5% fat).
Vegetables
Vegetable salads must be a part of your daily diet. Your diet must include green leafy vegetables, cucumber, tomatoes, carrot, peppers, lettuce, spinach, cabbage, cauliflower, brinjal, capsicum, bottle gourd, ridge gourd. Avoid potatoes, sweet potatoes, colocasia, beetroot and yam.
Fruits
Fruits offer a great variety of vitamins, nutrients and fibre and can be consumed daily as a snack. The options are endless: sweet limes, oranges, guava, musk melon, apples, papaya, kiwi, watermelon, etc.
However, they must be consumed in quantities as prescribed by a nutritionist and must be consumed as whole fruits and not fruit juices
Nuts & Oil seeds
Nuts and oil seeds like flax seeds, almonds, walnuts, and groundnuts can be a part of your diet in quantities prescribed by the nutritionist. Avoid coconut or groundnut chutneys.
Cooking oil
Make sure to use oil in limited quantities – 2 tablespoons or 30ml of oil per day is recommended.
Preferably use groundnut, rice bran, til or soya bean oil. Limit saturated fats like full-cream milk, dairy cream, ghee, salad dressing, red meat etc.
Fluids
Take fluids in plenty and do so frequently. The minimum intake should be 2-3 litres per day. Tea and coffee consumption must be in moderation.
Gestational diabetes is manageable with timely intervention and medical nutrition therapy. Apart from having a dedicated meal plan, it is important to adhere to scheduled meal timings. It is recommended to eat small frequent meals every 3 hours. Avoid all types of sweeteners even honey, jaggery and sweets and desserts and all high fats, salts, and sugars (HFSS). Observe control on serving size, as a greater quantity of food intake can raise blood sugar. 45-minutes of daily physical activity is a must. You may do so with small breaks and break it up into 10–15-minute sessions half an hour after every meal.
To summarize, the four key factors in the management of blood sugar are meal timings, the quantity of food, quality of food and physical activity. A healthy and safe birth experience is possible even with gestational diabetes.
Please consult with your nutritionist to develop a diet plan that is customized to your nutritional needs.
