A 30 year old lady pregnant for the second time was following up with me. She had a traumatic experience in her first labour as she had an instrumental delivery followed by heavy bleeding and a deep episiotomy which took more than a month to heal.

She was apprehensive about the painful experience of labor and post-delivery discomfort. Pain relief methods in labor were discussed with her and she did not want any medical intervention like epidural analgesia.

She was offered the option of laboring under water. Since this form of delivery is not usual in India she was initially apprehensive about it. She was explained about the benefits of water birth which included faster labour, lesser pain, improved relaxation, decreased anxiety and lesser need of episiotomy.

Since she fulfilled all the selection criteria for water birth she was encouraged to go for the same.

She came to the hospital with spontaneous rupture of membranes at term and was having regular contractions. She entered the pool once in active labor and delivered within an hour without the need of an episiotomy comfortably. She was grateful for her wonderful experience.

About Dr Astha Dayal

Dr Astha Dayal is a renowned Gynaecologist working as a Senior Consultant in CK Birla Hospital for Women, Gurgaon, specializing in medical and surgical management of women’s health. She has a special interest in managing high-risk pregnancy. She is a highly progressive and well-read and has published extensively in national and international indexed journals.

She has worked previously in Medanta Medcity, Artemis, MAMC, over the past 20 years of her illustrious career and has many publications in national and international medical journals to her name

Dr. Astha has completed her MD/MBBS from Maulana Azad Medical College, New Delhi with multiple distinctions. She won the CL Jhaveri Award for best presentation in All India Congress of Obstetrics and Gynecology and was awarded the Best Thesis in Gynecology and Obstetrics.

Dr Astha is also an active member of the Royal College of Obstetricians and Gynaecologists (RCOG), London (UK). She is also associated with the World Association of Laparoscopic Surgeons (WALS).

She has had a number of firsts to her name the latest of them is the first successful water birth delivery in Gurugram.

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Advise to young gynecologists

I meet a number of bright gynecologists and these are my top 5 advice to them

1. As gynecologists, we meet women in their most vulnerable situations and it’s important to be empathetic to them.
2. You will find yourself in high pressure situations early up in your career and you should keep your cool while in stressful situations
3. Your job as a gynecologist gives you an opportunity to just not cure a patients immediate illness but to provide them with holistic advise on how they can lead a more healthy and happy life
4. While it is important to keep yourself up to date with new advances, it is equally important to document and research your own experiences to create evidences that help other medical practitioners.
5. Have fun

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Benefits to the baby

1. Breast milk may be regarded as the baby’s first vaccine. It protects the infant from diseases and builds immunity.
2. Up to one third of respiratory infections and almost half of all diarrhea episodes could be avoided in low- and middle-income countries through breast-feeding.
3. It cuts the risk of sudden infant deaths by more than one-third In the high-income countries
4. Children breast fed for a longer duration has been found to have higher intelligence

Benefits to Mother

1. It could prevent about 20,000 extra deaths from breast cancer each year.
2. It also reduces the risk of ovarian cancer.
3. It helps losing pregnancy pounds much faster.

How to Breastfeed successfully?

Although breastfeeding is though to be natural and easy, but its mostly not! Most women face issues during breastfeeding.

You should know when to ask for help or consult your doctor for the same.

Position

1. Make sure that both the baby and you’re comfortable.
2. You should have your back well supported and then get your baby in position.
3. Extend your forearm and hand to support the baby’s neck, spine, and bottom
4. The baby’s nose should be opposite your nipple and his head and body should be in a straight line so that he can swallow easily. Also his neck, shoulders and back should be well supported.

Latching

• The baby should be latched on smoothly; his lower lip should be as far away from the base of your nipple as possible.
• His head should be tilted back slightly, and the area around the nipple should also enter the mouth.

Common problems faced by breastfeeding moms:

Pain

The most common reasons for pain during breastfeeding are

Thrush –

Thrush there could be fungal infection in the milk ducts of the breast, causing pain, more towards the end of feeding. You might find spots of cottage cheese or milk curds in the baby’s mouth and on your nipples. 

Milk letdown 

Milk letdown i.e. the discomfort due to the milk filling up the breast. Proper supportive bras, relaxation techniques, and occasional painkillers usually relieve it.

Mastitis

Mastitis meaning inflammation of the breast. It feels red, hard, sore, hot or swollen and you may also notice a lump, caused by milk in the breast tissue. There may be flu-like symptoms, such as chills, headaches, exhaustion and low-grade fever. You need to contact your doctor urgently if you are having these symptoms.

Breast engorgement 

Breast engorgement : The sudden increase of milk in the breast a few days after delivery can cause the breast becoming hot, swollen and engorged. It is generally relieved with feeding. While this can be painful in the early days, the discomfort should pass once your baby starts feeding. In case the baby has trouble latching on with engorged breasts, expressing some milk by hand or using a breast pump would help. Also, hot fomentation by putting warm damp towels on your breasts before feeding and cold towels or cabbage leaves after feeds helps reduce the engorgement

Sore nipples

Sore nipples – This can be avoided by latching the right way, i.e. the baby should not just nibble at the nipples, a part of the breast should also be in his mouth. A hot wet cloth can soothe sore nipples. Keep nipples moisturized after feeding by nipple creams/lanolin/breast milk itself and avoid washing them with soap.

Not enough milk

Most mothers have the natural capacity to produce milk sufficient for the baby. Despite this most mothers complain of not having enough milk. You must remember that the stimulus for milk production is by the suckling of the baby and emptying of the breast. If the baby were given top feeds, the breast milk would automatically reduce.

To increase the milk supply,

Put the baby to breast more often, during the day and night, if the baby doesn’t latch that often, pump the breast to stimulate milk production.

1. Have a nutritious diet
2. Have enough fluids, don’t dehydrate yourself
3. Have enough rest

Also, remember, every child has a different feeding pattern. Some baby’s may need to be fed every 40 minutes and some not even up to 3 hours.

As long as the baby is active and is gaining weight appropriately, you are doing a good job!

Returning to work

Companies use many solutions to give feeding mothers time and a private and clean place at work for feeding/expressing milk at work.

A variety of permanent, flexible, and even mobile space options provide support, privacy, hygiene and amenities even when space is limited.

Schedules may be managed in creative ways so that women can have enough time to express milk.

Expressing breast milk

• A good time to start expressing is when your milk supply is well established which is usually at around the six to eight weeks after delivery. Expressing after the first feed of the day is helpful.
• You can either express by hand or by manual or electric breast pumps or a combination of both compliments each other and makes it similar to your baby feeding.

Breast milk can be stored at room temperature for up to six hours or in the fridge for up to two days.

It is important to know that breastfeeding is not easy and doesn’t come naturally to most mothers. A nursing mother needs plenty of support and encouragement.

Don’t hesitate in seeking help from a nurse, doctor, family member, or friend, to get over possible bumps in the road.

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सभी महिलाओं में से 75 प्रतिशत से अधिक महिलाएं पर्सनल हाईजीन के बारे में नहीं जानती हैं। अपने निजी अंगों को साफ रखना बहुत महत्वपूर्ण है। प्राइवेट पार्ट को को सूखा रखें, सिंथेटिक अंडरगार्मेंट्स या ऐसे कपड़ों से बचें जिससे वहां पसीना आ सकता है।
खासकर मासिक धर्म के दौरान स्वच्छता बनाए रखने के लिए हर 4 घंटे में पैड बदलने का ध्यान रखें। वॉशरूम का उपयोग करते समय, हमेशा आगे से पीछे की ओर सफाई करें, भले ही जेट स्प्रे का उपयोग कर रहे हों।

साफ-सफाई रखें

खासकर मासिक धर्म के दौरान स्वच्छता बनाए रखने के लिए हर 4 घंटे में पैड बदलने का ध्यान रखें। वॉशरूम का उपयोग करते समय, हमेशा आगे से पीछे की ओर सफाई करें, भले ही जेट स्प्रे का उपयोग कर रहे हों।

अधिक जानकारी के लिए यँहा पढ़े !

https://navbharattimes.indiatimes.com/lifestyle/family/gynaecologist-aastha-dayal-explain-how-to-improve-sexual-reproductive-health/articleshow/98267434.cms

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The most common reason for a couple not getting pregnant is usually stress and anxiety.

Ideally, a young couple should be given about 12 months to try, before we start treatments for fertility, but we soon fall into the vicious circle of tests and treatments, which further adds on to their stress and worsens their fertility.

Tips for getting pregnant

Try at the right time

• For pregnancy, the woman should be ovulating, the sperm should be healthy and the couple should be trying at the right time.
• Understand your period cycle and the fertile period. In a 28-30 day cycle, a couple should try between 12-16th day of period every 1-3 days to have a better chance of pregnancy.Women can use Temperature charts, cervical mucus, or ovulation kits to check ovulation days in urine.
• You should schedule a visit with your gynecologist for a basic evaluation and discuss the fertile period. Ref Planning Pregnancy

Try at the right age

• A womans fertility starts falling with age. If you want to get pregnant naturally, without using treatments like IVF, then it is best to complete your family by 35. A womans fertility would be maximum at around 23years of age and falls after rapidly after 37years

Maintain Healthy diet

• Increase more antioxidants in your diet like colorful fruits and vegetables, green leafy vegetables, complex carbohydrates, nuts, seeds, fibre rich foods.
• Avoid high sugar and salt in the diet. Also avoid preservatives, artificial flavours, additives, sweeteners, caffeine in your diet.

Maintain Healthy weight

• Weight has a huge role to play in improving your fertility. Being overweight or underweight can reduce your chances of getting pregnant. It is important to achieve and maintain a healthy BMI to get pregnant easily and have a healthy pregnancy.

No medical problems

• If you have a medical condition like diabetes, thyroid, get it in control.
• Also if you are on any medication for any condition, eg acne, check with your doctor if it’s safe in pregnancy.

Healthy habits

• Avoid alcohol, smoking, recreational drugs.
• Avoid refined and processed food.
• Make some changes in your lifestyle and adopt a healthy diet and exercise routines

Prenatal vitamins

• Add Folic acid supplements as advised by your gynecologist. 
• Vitamin D supplements should also be added if deficient.
• Also adding Zinc, selenium, Omega 3 fatty acids (DHA), Vitamin E, Vitamin C, L arginine and L carnitine help in improving fertility for both males and females.

Patience

• For a young couple with no health issues, there is only a 25-30% chance of conceiving in the first few months of trying.At the end of 1 year 80% would get pregnant so have patience.Stress can worsen fertility and is most often the reason for unexplained infertility.

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Types of preterm labour and birth 

Preterm labour can be unplanned or induced. Due to several risk factors, preterm labour can occur in any pregnancy. In certain situations, the obstetrician might also induce preterm labour if it is considered necessary for the health of the baby and/or mother.  

Based on the gestational stage (stage of the pregnancy) preterm birth can be classified into the following categories: 

• Extremely Preterm- Birth of a preterm baby less than 28 weeks into the pregnancy 
• Very Preterm- Birth of a preterm baby less than 32 weeks into the pregnancy but more than 28 weeks 
• Moderate or Late Preterm- Birth of a preterm baby after the 32nd week of the pregnancy but less than 37 weeks into the pregnancy 

Depending on how preterm the baby is, the more the complications involved. Due to this reason, if the preterm birth is planned, the obstetrician may decide to transfer the patient to a facility specializing in neonatal care. 

About the condition  

The ideal gestation period for human pregnancy is 40 weeks during which time, the fetus grows and develops. In some cases, contractions can start earlier, opening the cervix, preparing for birth before full term. If this occurs before the 20th week of the pregnancy, it is considered a miscarriage. If possible, the obstetrician would try to delay the birth as preterm babies are at a significant risk for multiple health problems. Preterm babies would also need special neonatal care as they are prone to infections and might have several developmental issues based on how premature they are.  

In certain cases, the obstetrician could also induce preterm labour if it is thought to be the best option for the mother and child. In such a situation the benefits and risks would be discussed in detail with the mother and the family. 

Risk Factors 

Preterm labour can occur in any pregnancy. Several factors have been known to increase the risk of preterm labour; these are: 

• Multiple pregnancy (twins, triplets or others) 
• Shortened cervix 
• History or preterm labour or preterm birth  
• Cigarette smoking or consumption of other narcotics 
• Infections especially involving the lower genital tract or amniotic fluid 
• Previous surgery on the uterus or cervix 
• Low or high pregnancy weight 
• Smaller interval between two pregnancies (less than 18 months) 
• Pregnancy conditions such as gestational diabetes, gestational or hypertension, preeclampsia and excessive amniotic fluid as well as complications with the placenta like placenta previa or placental abruption 
• Increased stress levels 
• Maternal age (younger than 17 or older than 35 years of age) 
• Vaginal bleeding in the second or third trimester 
• Any abnormalities in the fetus such as spina bifida 
• Physical injury to the mother 

Symptoms 

Symptoms of preterm labour include: 

1. Abnormal vaginal discharge (bloody, watery or mucus) 
2. Increase in the amount of vaginal discharge 
3. Lower abdominal pressure 
4. Throbbing and chronic backache 
5. Abdominal cramps (possibly accompanied by diarrhoea) 
6. Regular and frequent contractions  
7. Fluid from the vagina might indicate ruptured membranes 

Diagnosis 

Preterm labour can be diagnosed by monitoring the frequency of contractions and how long they last. Apart from this, the doctor might also diagnose preterm labour by: 

•  Cervical exam to look for any changes in the cervix 
• Physical examination to find the baby’s position 
• Transvaginal ultrasound to measure the length of the cervix 
• Check for amniotic fluid to see if the amniotic sac is broken 

Treatment 

In case there is a high risk of preterm labour, the doctor might recommend the following treatments: 

• Corticosteroids: These medications are prescribed if there is an increased chance of delivery in the next seven days. It is used to promote the baby’s lung maturity.  
• Magnesium Sulfate: The doctor might prescribe magnesium sulfate if there is a high risk of delivery between week 24 and 32 of the pregnancy. Certain studies indicate that it might also lower the risk of cerebral palsy for babies born before the 32nd week of the pregnancy 
• Tocolytics: This medication is prescribed to slow the contractions. It may be used for 48 hours to delay labour so corticosteroids may provide a maximum benefit or if there is a need to transfer to patient to a specialized healthcare facility 
• Preventive medication: If there is a history of premature birth or increased risk of the same, the obstetrician might prescribe a weekly dose of progesterone starting from the second trimester till week 37 of the pregnancy. Vaginal progesterone might also be prescribed to prevent preterm labour 
• Surgery: In certain situations, if the risk of preterm labour is due to a short cervix, the doctor might suggest cervical cerclage. In this procedure, the cervix is sewn shut with strong sutures which are removed after 36 weeks of the pregnancy unless they must be removed sooner.  

Prevention 

Preterm labour may be avoided by taking steps to promote a healthy full-term pregnancy. Some of the measures that can be taken are: 

• Healthy diet: Maintain a balanced diet rich in polyunsaturated fatty acids (found in nuts, seeds, fish etc.). You can design a diet tailor-made to your needs with the help of your doctor and nutritionist.  
• Avoid substances known to increase risk of preterm labour: This includes smoking, consumption of alcohol and other narcotic substances. 
• Seek regular prenatal care: Regularly visit your health care provider to monitor your pregnancy. In case you manifest any symptoms of preterm labour you might have to make your visits to the obstetrician more frequent.  
• Monitor and manage chronic conditions: In case you have any chronic conditions such as diabetes, hypertension or obesity monitor it closely and take measures to keep them under control.  
• Reduce stress: when possible, avoid anything that causes stress either mentally or physically. Do not overexert yourself and try relaxation techniques such as meditation to calm yourself.  
• If you are at a higher risk of preterm labour, seek medical advice for additional precautionary steps that can be taken. 

FAQs 

1. What are Braxton Hicks contractions?

Braxton Hicks are also called false labour pains. These can be felt for the first time around mid-pregnancy, increasing in frequency as the pregnancy progresses. They are considered to be practice contractions.

2. How do I differentiate between Braxton Hicks and regular contractions?

Braxton Hicks contractions are irregular and should subside by changing positions. Real contractions on the other hand will grow stronger and closer together with time. 

3. What are the health conditions that are common in preterm babies?

Preterm babies are prone to infections and many health complications such as breathing difficulties and developmental problems. The more preterm the baby is, the greater the risk of complications like cerebral palsy, Intellectual and developmental disabilities, low birth weight, underdeveloped organ systems and infections. They would need to stay in the neonatal intensive care unit for the required treatment. 

4. How can I make sure that I don’t go into preterm labour?

There are no methods to ensure that you don’t go into preterm labour. However, if you are at a higher risk of going into preterm labour, your obstetrician might suggest certain precautions to minimise the risk. Focus on maintaining a healthy pregnancy lifestyle and avoid stress.

Preterm labour also known as premature labour is the occurrence of regular contractions resulting in your cervix opening after the 20th week but before the 37th week of your pregnancy (3 weeks before your expected due date). Preterm birth is defined as the birth of live babies due to preterm labour (before the 37th week of pregnancy). It is estimated that around 15 million babies are born preterm every year and this number is constantly increasing.

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