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Part 1: Pregnancy, Childbirth and the Newborn  >  Pregnancy

MEDICAL CARE THROUGH PREGNANCY

Confirming The Pregnancy
See your doctor as soon as you miss your menstrual period or if you suspect you are pregnant, and have the pregnancy confirmed.

The doctor will also advise you on diet, general care and any medication you need to take.


Tests Through Pregnancy
At your first antenatal visit and at all visits thereafter, the doctor will examine you, especially for high blood pressure and anaemia. Anaemia and calcium deficiency are quite common in women of childbearing age. Iron and folic acid tablets and calcium are prescribed to combat this deficiency. One or two shots of tetanus toxoid will also be given to protect both of you against tetanus. As the pregnancy progresses, your urine may be periodically tested for the presence or absence of albumin and sugar and an increase in the number of pus cells.

Your blood will be tested to confirm your blood group and for the presence or absence of the Rh factor. These days, most hospitals also require you to be tested for HIV, sexually transmitted diseases and other infections, so that arrangements can be made at the time of delivery to reduce the chances of these being passed on to your newborn. 

If the doctor suspects a congenital disorder that may affect the baby’s brain or spinal cord, she may also do a blood test for alpha-foeto-protein.


Ultrasound Scans (Sonography)
Sonography is a useful tool to study the growth of the foetus, the size of the head, the position of the placenta, the amount of amniotic fluid surrounding the foetus, multiple pregnancies and the presence of certain congenital disorders.


Amniocentesis
This test is undertaken if the doctor strongly suspects any chromosomal or congenital abnormalities in the foetus. It must be done only by an expert under ultrasound guidance. Unfortunately, some unscrupulous doctors use it to determine the sex of the foetus and to abort if it is female.


Genetic Testing And Counselling
Parents with a child with a genetic disorder will naturally be anxious about the possible risk of the same condition in the next child. In most cities in India, facilities are now available to detect whether the unborn baby is likely to be born with the inherited disorder. A genetic counsellor will discuss the possible risk, if any, to the foetus. 

Ideally, a couple who share the same ancestors (as in a consanguineous marriage) should seek genetic counselling before marriage. The risk of inherited diseases and conditions is higher in such cases.


Antenatal Classes
Antenatal classes conducted by medical or paramedical professionals can be very helpful. At these, you and your husband will learn about pregnancy and childbirth and also get an opportunity to interact with other women in various stages of pregnancy.


KEEP YOURSELF HAPPY
Ancient Ayurvedic texts exhort that a pregnant woman be treated with as much care as that taken when carrying a pot filled to the brim with oil. Your husband’s love and affection will also play a major part in helping you deliver a happy, healthy child.

You will be advised to listen to recitations from the Holy Scriptures and to avoid thoughts that evoke anger, fear, jealousy and hatred. You will be discouraged from the use of intoxicants, asked to avoid over-strenuous work, and to refrain from travel by vehicles over uneven roads.

There is now proof that your state of mind affects your baby. It has been found that maternal anxiety in pregnancy is associated with the uterine artery resistance index, thus affecting foetal development and leading to low birth weight. 

Of course, you may not feel as happy about your pregnancy as you would like to, especially if you do not receive the care you deserve or if the pregnancy was not planned. Even the most coddled mother may suffer depression in the last month of pregnancy. Relax. Lean on the support of your husband and the people who are dear to you —this too will pass, as it did for so many other women before you.


DIET THROUGH PREGNANCY
Make sure you eat enough seasonal fruits, vegetables (especially leafy and raw— though well washed), pulses and grains. If you like milk and milk products, meat, fish and eggs, indulge yourself. However, while you need extra food, overeating is not advisable. 

If you don’t like milk or eggs, or if your older child has a history of allergy, avoid these items. Snack on fresh fruits, dry fruits and roasted channa (gram) rather than biscuits and fried foods.

Pregnant women (and nursing mothers) with a family history of allergies should avoid eating peanuts and peanut products in order to reduce the chances of allergy in the baby.

Cut down on the amount of tea and coffee you drink. The caffeine in coffee can lead to a premature delivery and lowered birth weight.


A ‘Vegetarian’ Pregnancy
A balanced vegetarian diet can meet all the requirements of a pregnant woman.

Gopalan, Puri and Sachdev, in their excellent 1993 article in Indian Pediatrics, the official journal of the Indian Academy of Pediatrics, refer to 3 categories of vegetarian diets. They are:

• Lacto-ovo-vegetarian diets, which include eggs in addition to mammalian milk (cow, buffalo and breast milk).
   
• Lacto-vegetarian diets, which include mammalian milk.
  According to Gopalan, Puri and Sachdev, such a diet — which is the one largely in practice in our country — can meet all the nutritional requirements of a pregnant mother.
   
• Vegan diets exclude the consumption of all foods of animal origin except breast milk.
  
  These diets do not include cow, buffalo or other mammalian milk.
  
  They may not provide some nutrients. Food items that could correct the deficiency in vegan diets are listed on the next page.

Important Nutrients Lacking In A Diet Devoid Of All Mammalian Milk

* Deficiency of Vitamin B12 can cause anaemia and brain and nerve damage. I have seen severe effects on the mental faculties of 2 breastfed infants whose mothers were on vegan diets. Kavita Mukhi, a reputed Mumbai nutritionist, believes that spirulina — can meet some of the normal requirement of Vitamin B12. Vegetarians may also obtain some Vitamin B12 by consuming legumes and nodules of root vegetables in which Vitamin B12 is synthesised by microorganisms. However, I recommend that those on a vegan diet take a daily supplement of Vitamin B12.


Calcium Rich Foods:

• Leafy vegetables: curry leaves, choolai, leaves of shalgam, arbi (black variety) and mooli, methi, pudina, augusti.
   
• Grains and pulses: ragi, soyabean, rajma, black gram 
   
• Animal source: small fish, cow milk, buffalo milk, curds, rohu fish

TIPS FOR A HEALTHY PREGNANCY
Most women are highly motivated during pregnancy to remain as healthy and happy as possible in order to give their baby the best start in life. Pregnancy is, in fact, an excellent time and opportunity to develop healthy habits for life. 

Educate yourself on pregnancy: Learn as much as you can about the wonderful ways in which your body is changing and about how your baby is growing. Talk to your mother, your friends and other women about pregnancy, labour and birth. Attend antenatal classes, read relevant books and literature, and watch videos about normal pregnancy and childbirth. Being well informed is the best way of retaining control over your own pregnancy— especially if you are unfortunate enough to hear other women’s horror stories and your doctor is too busy to address all your concerns. The Internet is an informative resource as well. 


Eat a well-balanced diet and drink enough water. 
Avoid substances that may be dangerous to you and your baby, such as cigarettes, gutkha, alcohol and hard drugs. Avoiding these (at least for the 9 months of pregnancy) reduces the risk to your foetus. It has been shown that babies born to women who quit smoking early in their pregnancies had birth weights that were almost 300 grams higher than those who did not. Intermediate improvement in birth weights was seen for those who cut down on their smoking but were not able to eliminate it. It has also been seen that maternal smoking during pregnancy increases the risk of idiopathic mental retardation.

Do NOT take any medication — even over-the-counter drugs — without discussing them with your doctor and getting her approval. On the other hand, DO take the medication that your doctor allows you — many medicines these days are formulated to be safe for your baby. DO inform your doctor if you are on ongoing medication — as for epilepsy — so that she can work out the effects it may have on your baby, and substitute it with another version that will not affect your pregnancy.

Remain active. If you were following an exercise programme before you became pregnant, continue it after consultation with and modification by your doctor. If you were not exercising at all before you became pregnant, this is the time to start walking or swimming Start with short periods of exercise and gradually increase the amounts of time. Regular and monitored exercise will reward you with better posture, less back pain, less stress, anxiety, depression and constipation, better digestion and more energy.

Once you are in labour, the rewards of exercise will be apparent in the form of increased strength, flexibility and stamina. Fit women typically enjoy faster postpartum recovery too. 

However, do not exercise in hot, humid weather or wear excessive clothing, as overheating can be harmful for your baby. To prevent dehydration, drink plenty of water, before, during and after exercise. Monitor your fluid intake by checking the colour of your urine; if it is clear, you are drinking sufficient liquid.

DO NOT exercise however if you have any of the following medical conditions: Pregnancy-induced hypertension, pre-term rupture of membrane, pre-term labour during the current or prior pregnancy, incompetent cervix, persistent second or third trimester bleeding and intrauterine growth retardation.

Get plenty of rest. Listen to your body— it will tell you how many hours of sleep you need at night, and when you need to take short breaks during the day as well. 

Talk to your baby. Enjoy your growing bond with her. Research shows that a foetus as young as just 10 weeks can react to the sense of touch. Later, she will respond to light, your voice, music and other sounds. 

Involve your husband. He can be your best friend and help mate, and pregnancy and childbirth is a great opportunity to cement your bonds. Most important, do not shut him out of the whole experience; it is his baby too!

Sex is possible. Lovemaking does not ordinarily harm your baby and most women can safely continue to have sex during pregnancy. During the third trimester, you will need to use your imagination to find positions comfortable for you. Avoid sex however in these medical situations: Recent vaginal bleeding, pre-term labour, ruptured membranes (broken water bag), and placenta previa (a condition in which the placenta covers the inside of the cervix).

Destress with techniques like slow and deep breathing, yoga and relaxation of the various muscle groups.

Enjoy this special time of your life. Accept the support of your husband, family and friends in this wonderful transitional period. Have confidence in your body’s ability to grow and nourish and give birth to your baby. 


Your Vegetarian Baby
US scientists at the Monell Chemical Senses Center, Philadelphia, have found that babies whose mothers preferred vegetables during their pregnancies and while breastfeeding were more enthusiastic about adopting the same diet.