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Pregnancy

General information about pregnancy

What is the best age to have children?

Best time to have children is the time when the girl is physically mature and mentally prepared. Most suitable time biologically is between 20 and 29 years.

How does a woman become pregnant?

A woman usually becomes pregnant after having sexual intercourse with a man. During intercourse man ejaculates semen into the vagina of the woman. This semen contains millions of tiny sperm cells, which swim up from her vagina and uterus (womb) to the fallopian tubes where they may join with the tiny egg (ovum) released from one of ovaries of the woman every month. If fertilization or conception occurs, then she will become pregnant.

 

What is fertilization?

Fertilization occurs when a sperm cell from a man, introduced into the female vagina during sexual intercourse, meets and joins with an egg cell from the woman

 

When should a couple have sexual intercourse if they want a baby?

In women who have regular 28 days cycle, the sexual intercourse during fertile day (11-17days) is more likely to result in pregnancy. The first day should be counted from day one of the period. Fertile period will vary according to length and regularity of cycle.

 

Can K-Y jelly be used during sex, if it is done keeping pregnancy in mind?

Many lubricants kill the sperm. K-Y jelly does not kill them but it decreases the fertility of sperms. So, if you have baby in mind, do not use any lubricants. Foreplay produces natural lubrication and is not harmful to sperm.

Can a woman become pregnant when she has sexual intercourse for the first time?

Yes, a woman can become pregnant even when she has sexual intercourse only once

 

What are the chances of becoming pregnant from a single act of sex?

The likelihood of becoming pregnant from a single act of unprotected sex (for example, from a one night stand) varies from person to person, and also depends on the stage of a woman's menstrual cycle. The probability is highest around the time of ovulation (when the egg is released), that is around the 14th day of the menstrual cycle (about 7 to 10 days after stoppage of bleeding) when, on average, up to one third of women will become pregnant from having sex once.

 

If a man pulls his penis out before he comes (ejaculation) or does not put it in all the way, can a woman still get pregnant?

Unfortunately even if a man does not insert his penis all the way, or withdraws his penis before ejaculation, a woman can still become pregnant. This is because (the lubricating fluid that leaks out of a man's penis before and during sex can contain sperms. If this fluid gets in or around a woman's vagina, it can find its way inside, and she can become pregnant.

 

Is it right that passing urine immediately after intercourse avoids pregnancy?

No this is a myth. Passing urine immediately after intercourse cannot protect against pregnancy.

 

Is it right that standing up after intercourse avoids pregnancy?

A recommendation when trying to get pregnant is for a woman to stay lying down for about 30 minutes, after sex, with a pillow under her bottom to elevate the pelvis. This allows for gravity to help "pull" the sperm down towards the egg. When one stands up after sex, gravity may help to pull some of the sperm away from the egg. But, simply being in an upright position is not enough to prevent pregnancy. Sperm are tough swimmers and can work against gravity. They are also quick, so by the time a woman would get up after having horizontal sex; millions of sperm will have already made great strides towards their search for an egg.e

 

Is it safe to clean the genitals with fingers after sexual intercourse to avoid pregnancy?

No, this does not prevent pregnancy. Nor is it desirable to try to clean the genitals with fingers as it is likely to increase the chances of infection

 

What happens to semen after it has been ejaculated into a woman? Does it just stay there until it dies, or does it leak out? If it stays inside, what happens to it once it dies?

After semen is ejaculated into the vagina, it can either travel farther up into the vagina, through the cervix, and then up the fallopian tubes, or drip out. Most of it will come out when a woman stands up. Semen that remains in the body will carry sperms that can survive for approximately three to seven days. If a woman is trying to get pregnant, she should not stand up for some time after intercourse.

 

Can a woman become pregnant as a result of anal sex?

A woman cannot become pregnant as a result of anal sex directly, although if any sperm leaks from the anus and enters the vagina, pregnancy could occur.

 

Can sperms pass through clothes?

No, generally clothing acts as a barrier against sperms

 

What is a birth plan?

Every family should have a "birth plan" for dealing with unexpected adverse events, such as complications or emergencies that may occur during pregnancy, delivery and the immediate postnatal period, and should prepare this with the assistance of the ANM and ASHA and reviewed at least one month before expected date of delivery. These details are entered into the woman's ante-natal card:

  1. Details of institution and plan for delivery, including addresses and telephone numbers for the nearest facilities providing institutional delivery care- basic level or referral level- whichever is prioritized
  2. Identified referral transport (private/government/other) with contact numbers
  3. Name of identified blood donor with telephone no
  4. Decision of who is to escort pregnant woman and arrangements to take care of the home/children etc
  5. Finances needed at the time of birth.
  6. Preparing the home to receive the child and mother once they are back from the facility.
  7.  

How can one determine the due date of delivery?

A pregnancy generally lasts for 40 weeks from first day of your last menstrual period (LMP), if you know the date of your last menstrual period, and your cycles are regular, you should be able to determine your due date sitting at home. Based on LMP: If your cycles are regular and 28 days long, then you can determine your due date by adding 9 months and 7 days to the first day of your last menstrual period (LMP). For example, if your LMP began on September 5, then your expected due date (EDD) would be June 12 of the following year.

 

Pregnancy tests

What are pregnancy tests and how do they work?

Pregnancy tests look for a special hormone in the urine or blood that is only there when a woman is pregnant. This hormone, human chorionic gonadotropin (HCG), can also be called the pregnancy hormone. The pregnancy hormone, HCG, is made in your body when a fertilized egg gets attached to the uterus. This usually happens about 6 days after conception. The test can be done as early as a week after the missed period.

What are Home Pregnancy tests (HPTs)?

Home Pregnancy tests are do-it-yourself tests which can be conveniently done at home. They are easily available over the counter and cost approximately between 45-50 rupees. A woman is supposed to collect just about 5 ml of her urine in a clean container and perform the test using put one to two drops of the urine into a special container provided in the kit. Then the woman needs to wait a few minutes. Different brands instruct the woman to wait different amounts of time. Once the time has passed, the user should inspect the "result window." If a line or plus symbol appears, you are pregnant. It does not matter how faint the line is. A line, whether bold or faint, means the result is positive.

 

How soon after a missed period can I take a home pregnancy test and get accurate results?

Many home pregnancy tests (HPTs) claim to be 99% accurate on the day you miss your period.

 

If one gets a negative result on a home pregnancy test can she still be pregnant?

Yes. So, most HPTs suggest women take the test again in a few days or a week.

 

What are the reasons for absence of periods with negative pregnancy test?

pregnancy test? If the pregnancy test was done too soon (see above), then the female might still be pregnant. However if the test was done at the right time, then it may be stress that has delayed the period. Worrying about pregnancy (or anything else) can drive the stress hormones up, and this can in turn interfere with the menstrual cycle. If there is abnormal loss or gain of weight recently or history of excessive exercising or if there is history of irregular periods generally, these could also be responsible for delay in periods with a negative pregnancy test.

Check-ups during pregnancy

Why the checkups during pregnancy are required/ necessary?

Although most of the pregnancies are normal, a woman needs more care during pregnancy. Some times during pregnancy health problems/complications may arise which can be detected earlier and safely managed if the pregnant woman is under regular care. The complications during pregnancy can be sudden and can occur any time during pregnancy.

When should a pregnant woman first visit a hospital/ health centre/ clinic?

She should visit a health facility at the first sign / symptom suggestive of pregnancy; definitely within first three months of pregnancy.

 

How many visits a pregnant woman should made to the health centre?

A woman should visit the health centre for check-up every month till 28 weeks of pregnancy. Thereafter she should visit every two week till 36 weeks of pregnancy. After that she should visit every week for check-up. She can be called earlier if the doctor thinks so. Minimum 4 visits should be there during the entire pregnancy period. These visits can be as follows:

  1. 1st visit: Within 12 weeks-preferably as soon as pregnancy is suspected-for registration of pregnancy and first antenatal check-up. Height, weight, blood pressure, pallor and general physical examination is done during the visit. Routine blood investigation is also ordered
  2. 2nd visit: Between 14 and 26 weeks. Weight and blood pressure is checked. Urine is examined for presence of sugar or protein. USG can also be advised. Tetanus toxoid injection is also given. Abdominal examination is done.
  3. 3rd visit: Between 28 and 34 weeks. Weight and blood pressure is checked. Urine is examined for presence of sugar or protein. USG can also be advised. Second dose of tetanus toxoid injection is also given. Abdominal examination is done.
  4. 4th visit: Between 36 weeks and term. Weight and blood pressure is checked. Urine is examined for presence of sugar or protein. USG can also be advised. Abdominal examination is done. Internal examination can be done to assess the size of birth passage.
  5.  

When are additional visits required during pregnancy?

She must go to health facility/ doctor where she is seeking care if she has excessive nausea and vomiting, weakness and tiredness, swelling of feet, headache, vaginal discharge, burning micturition and heart burn.

 

How many visits does a health worker make after delivery??

Minimum four home visits should be made by a trained health worker (ANM or PHN). These visits take place as follows:

  1. A first visit within 24 hours (would occur in hospital- if delivery takes place there)
  2. A second visit on 3rd Day (on discharge at hospital and at home after discharge
  3. A third visit on 7th day
  4. fourth visit at 6 weeks
Three additional visits - on 14, 21 days if the baby is low birth weight (<2.5 kg at birth). This is done in rural areas by the government.

Tests during pregnancy

What diseases are regularly tested for during a normal pregnancy?

Some of the conditions routinely checked for in most normal pregnancies are AIDS, Hepatitis B, Syphilis, Rh Incompatibility and Rubella. The doctor can test for all these condition with blood samples, taken at different times in the pregnancy.

When should routine blood test during pregnancy be done?

It is done as soon as the lady understands that she is pregnant and consults a doctor for advice. Blood tests are advised in the first visit to the health centre only.

 

Why ultra sonography is done in pregnancy?

Ultrasonograpphy is done in pregnancy to rule out any congenital disease which an unborn child may be suffering from. It also helps in knowing the growth of the baby and the health of placenta. Even expected date of delivery can be predicted through USG report.

 

When are the ultrasound advised?

All women are offered ultrasounds in pregnancy, but the number and the timing varies considerably between pregnant mothers. For dating the pregnancy, the first ultrasound can be ordered at about 10-16 weeks. A mid-trimester USG is essential to detect any congenital disorder. It is done between 18 to 20 weeks.

 

Is ultrasound safe for my unborn baby?

It has been over 40 years since ultrasound was first used on pregnant women. It is safe for the baby if done at the correct time and from a recognised place

Is ultrasound safe for my unborn baby?

It has been over 40 years since ultrasound was first used on pregnant women. It is safe for the baby if done at the correct time and from a recognised place

  1. Congenital diseases in the previous ba
  2. History of congenital anomalies in the family which are likely to be repeated
  3. Maternal age is above 35 years, then there is a higher chance of the baby getting Down's syndrome.
  4. Mother is diabetic.
  5. Mother is exposed to certain drugs, X rays and radiation.
  6. Certain viral infections in mother in pregnancy
  7. Increased age of Father.

Can birth defects be detected with regular blood tests?

Studies have shown that 90 % of birth defects cannot be detected through prenatal blood tests. In order to isolate the remaining 10 % of the identifiable birth defects, there are four main types of tests: amniocentesis, chorionic villi sampling, and certain blood tests like the Alpha feto-Protein (AFP) test, and ultrasound scans.

Early pregnancy: first trimester

What are the early symptoms of pregnancy?

Most women equate a missed menstrual period with the possibility of being pregnant, but other symptoms and signs are experienced by most women in the early stages of pregnancy. These include

  1. Feelings of breast swelling, tenderness, or pain.
  2. Nausea and vomiting traditionally associated with morning sickness.
  3. Frequent urination.
  4. Fatigue and tiredness.
  5. Food aversions or cravings.
  6. Moodswings.
  7. Deepening of the color of the area around the nipple.
  8. Pigmentation of the face.

Is a missed menstrual period always the first sign of pregnancy?

A missed menstrual period is most often the first sign of pregnancy, although a woman may still experience some bleeding or spotting around the time of the expected period. However, if a woman does not have regular menstrual cycles, she may notice some of the other symptoms of early pregnancy before it is apparent that the menstrual period has been missed.

 

Does nausea and vomiting always occur in the morning during early pregnancy?

The nausea and vomiting associated with early pregnancy can occur at any time of the day or night.

 

How could one cope with the nausea and vomiting associated with pregnancy

Try some of these tips to help prevent and soothe nausea

  1. Eat frequent, small meals (6 to 8 small meals a day) rather than 3 large meals.
  2. Avoid fatty, fried, or spicy foods.
  3. Try eating starchy snacks like rusk/toast when you feel nauseated. Keep some by your bed and eat them before you get out of bed in the morning. If you feel nauseous in the middle of the night, reach for these starchy foods.
  4. Get out of bed slowly.
  5. Try to suck a lemon when in case you have nausea.

 

Should a doctor be consulted for nausea and vomiting?

A doctor should be consulted if you think that you are vomiting too much. Excessive vomiting can lead to dehydration for which hospitalization may be required.

Why does frequent urination occur in pregnancy

Early in pregnancy, the growing uterus presses on your bladder. This causes frequent urination.

Can birth defects be detected with regular blood tests?

Studies have shown that 90 % of birth defects cannot be detected through prenatal blood tests. In order to isolate the remaining 10 % of the identifiable birth defects, there are four main types of tests: amniocentesis, chorionic villi sampling, and certain blood tests like the Alpha feto-Protein (AFP) test, and ultrasound scans.

Second trimester

What are the signs and symptoms of the second trimester of pregnancy?

During the second trimester:

  1. Nausea/vomiting and fatigue become less
  2. Abdominal expansion.
  3. Weight gain.
  4. Backache.
  5. Stretch marks on the abdomen.
  6. Skin pigmentation on the face

Third trimester

What are the signs and symptoms of the third trimester of pregnancy?

During the third trimester, the following signs and symptoms are manifested:

  1. Breathing becomes more difficult due to pressure by the growing baby.
  2. Frequent urination.
  3. Burning pain in the chest
  4. constipation.
  5. Swollen tender breasts.
  6. Trouble sleeping
  7. Abdominal contractions

Why do abdominal contractions occur?

Abdominal contractions are painless which start as early as the 10th week but are clearly appreciated in the last trimester. When these contractions become more frequent and intense, they could even be mistaken for the beginning of real labour.

Delivery

What is labour?

Labour can be said to be a series of events that take place in different organs in an effort to expel a live baby out of uterus through the vagina into the outer world.

What is pre term or pre mature labour?

Pre term or pre mature labour occurs before 37 weeks of pregnancy.

What are the symptoms of premature labour?

The symptoms of pre mature labour include:

  1. Pain or pressure in the lower back.
  2. Pressure in the thighs
  3. a vaginal discharge that is watery, pinkish and brownish
  4. Menstrual-like cramps, nausea, diarrhoea or indigestion
  5. A rupture of membranes in your vagina (excessive watery discharge per vagina)

WhWhy should a woman deliver in a hospital/ health centre?

Hospitals/health centres have better facilities and trained staff to deal with normal delivery as well as any health problems which may arise at the time or immediately after the delivery, both in mother and newborn.

In what condition, a woman must opt for hospital delivery?

  1. All first deliveries
  2. Previous operative deliveries
  3. Previous abortions, still birth or death of new born baby
  4. Where baby‘s position is not norma
  5. Associated health problems during pregnancy like diabetes, heart disease, HIV, high blood pressure etc.
  6. Small baby
  7. Bleeding from vagina in pregnancy
  8. Where advised by a doctor/ health worker

How should mother be looked after the delivery?

The mother should be given a light meal and allowed to rest. The baby should be put to breast within an hour of normal delivery to promote secretion of milk and avoid swelling and pain in breast. She should keep herself clean and use clean sanitary pads. After home delivery, mother and baby should be seen by Health worker/ Doctor within 48 hours.

When must a recently delivered mother consult Doctor/ Health worker?

If a recently delivered mother has:

  1. Excessive bleeding
  2. Feve
  3. Foul smelling discharge
  4. Swelling and pain in breast
  5. Swelling and pain in legs/feet
  6. Pain in private parts

Caesarean Section

What is a Caesarean Section?

Caesarean section (C-section) is the delivery of a baby through a cut in the mother‘s lower abdomen and the uterus..

What are the conditions for which a planned caesarean section is done?

Following are the conditions for which a planned caesarean section is done

  1. Previous 2 or more caesareans
  2. Low lying placenta
  3. Mal-presentations of your baby
  4. Small pelvis
  5. Underlying conditions like Pregnancy induced Hypertension, diabetes.

What are the conditions for which an emergency caesarean section is done?

Following are the conditions for which an emergency caesarean section is done:

  1. Distress of the foetus: Your baby may not be tolerating the forces of labour well, and may show problems like irregularity or slowing of the heart rate, or acid in the blood. Sometimes greenish discolouration of the amniotic fluid (passage of meconium or foetal stools in utero) may be a sign of distress. If vaginal delivery cannot be completed quickly, a caesarean may be the best way to save your baby.
  2. Non-progress of labour.
  3. Bleeding from the placenta

Alarming signs during pregnancy

WWhich are the symptoms which can indicate danger in pregnancy?

The following symptoms may be signs of a serious condition:

  1. Vaginal bleeding or spotting.
  2. Sudden weight gain
  3. Persistent headache.
  4. Blurredvision.
  5. Sudden swelling of hands/ feet.
  6. Prolonged vomiting
  7. High fever with chills.
  8. Sudden intense abdominal pain in early pregnancy.
  9. Inability to appreciate foetal movements
  10. Profuse watery discharge from vagina.
  11. Fits..

What does vaginal bleeding or spotting indicate?

Vaginal bleeding or spotting in the early months accompanied by abdominal pain may be a warning sign of a possible abortion. Vaginal bleeding in the later months may indicate a low lying placenta or separation of placenta from the uterine wall.

What do sudden weight gain, persistent headache, blurred vision, sudden swellings of hands/ feet indicate?

These symptoms may indicate high blood pressure in pregnancy, a condition also known as toxemia. A woman with these symptoms may need to be hospitalized to bring down her blood pressure or for fetal testing. Toxemia could result in complications like inadequate fetal growth, premature labour or fetal distress during labour.

Why is high fever dangerous in pregnancy?

High fever accompanied with chills and without symptoms of cold may be indicative of an inflammation of the membranes around the foetus, known as amnionitis. This can be potentially dangerous for the foetus and result in pre mature labour. These symptoms may indicate high blood pressure in pregnancy, a condition also known as toxemia. A woman with these symptoms may need to be hospitalized to bring down her blood pressure or for fetal testing. Toxemia could result in complications like inadequate fetal growth, premature labour or fetal distress during labour.

Diet during pregnancy

Why is so much stress laid on a healthy diet of a pregnant lady?

Mother is the only source of nutrition for her unborn baby; her eating habits will affect her baby‘s health and well-being. In order to cope with the increased demands, body needs a sufficient amount of nutrition. She needs a healthy diet for demands of her own body.

How many calories does an expectant mother require?

your diet. However, as the pregnancy advances, you may need to increase your calorific intake to 300 additional calories a day. This normally happens in the second and third trimesters. If you eat more than this amount, it is you who will gain the unnecessary weight, and not your baby. So make sure that you avoid junk foods like burgers, fries, cookies, etc. as these constitute empty calories. What you need is a sufficient amount of proteins, carbohydrates and foods that contain minerals and vitamins such as chappatis, pulses, soya, milk, eggs, non-veg foods, nuts, green leafy vegetables and fresh fruits.

They say that a pregnant woman should eat for two? Is it true?

Your pregnancy does not entitle you to eat for two. In fact, if you do eat for two, you will gain so much weight that you will not only be inviting unnecessary complications, but will also have difficulty in shedding your excess weight after pregnancy..

What is a balanced diet for a pregnant woman?

During pregnancy, your diet should consist of the following:

  1. Three helpings of first class proteins –egg, soyabean, non-veg item
  2. Two helpings of vitamin C foods –citrus fruits/ tomatoes
  3. Four helpings of calcium-rich foods (4 during pregnancy, and 5 during lactation) –milk, curd
  4. Three helpings of green, leafy and yellow vegetables or fruits –spinach, bathua, cholai, pumpkin, papaya, carrot, ½ serving of other fruits and vegetables –brinjal, bottleguard, cabbage
  5. Four to five helpings of whole grain and complex carbohydrates –chappatis, rice.
  6. Eight to ten glasses of water
  7. Dietary supplements based on your doctor's recommendation

  1. Breakfast: 2 chapatis/ 2 brown bread slices, 1 egg/50 gm pneer or tofu, 1 katori vegetables (beans or peas).
  2. Lunch/Dinner: 3 chapatis, 1 katori curd, 1 katori dal/non-vegeterian food.
  3. Snacks (twice): 1 or 2 small fruits of 100 gm each, 1 katori of sprouts/ 30 gm nuts.
  4. >

Which dietary supplements does a pregnant woman need to take?

A pregnant woman requires vitamins, iron and calcium in her diet. Iron-folic acid tablets and Calcium tablets are available free of cost at all government health centers. These supplements are also available over the counter. A doctor should be consulted for prescribing these dietary supplements

What is the ideal weight gain for a healthy pregnancy?

A woman should gain anywhere between 11-14 kg on average

What is the optimum trimester wise weight gain?

The optimum trimester wise weight gain is as follows:

  1. First trimester: 1-2 kg.
  2. Second trimester: 5-7 kg.
  3. Third trimester 4-5 kg.

Is it safe to drink tea/coffee or fizzy drinks during pregnancy?

Consumption of tea, coffee and fizzy drinks should be limited during pregnancy.

How can one cope with craving for foods that are less nutritious?

If you have a craving for something unhealthy, first try to distract yourself or find a healthy alternative. If it still persists, you may give in just a little bit but whatever you do, do not compromise upon your baby's nutritional needs

What is one supposed to do if there is a bizarre craving for peculiar non edible items?

A doctor should be consulted as this may be a sign of an underlying nutritional disorder.

Common health concerns during pregnancy

How can constipation be relieved during pregnancy?

As many as half of all pregnant women have problems of constipation. In general, some treatment measures include:

  1. Drink at least 8 glasses of water each day, including 1-2 glasses of fruit juice.
  2. Include bulk foods, foods high in fiber, such as cereals, and raw fruits and vegetables.
  3. Exercise daily-walking is a good form of exercise. Exercise and good physical fitness helps to maintain healthy bowel patterns.
  4. For occasional constipation, you may use a stool softener laxative such as Isaphgol, as prescribed by your doctor.

Is it normal for gums to swell and/or bleed during pregnancy?

The extra hormones in the body during pregnancy may cause the gums to swell and bleed. Brush regularly, using a soft toothbrush. Having a dental checkup early in pregnancy is a good idea to be sure your mouth is healthy.

What can be done to prevent burning pain in the chest?

To prevent burning pain in the chest:

  1. Eat small frequent meals, 5 or 6 per day instead of 2 or 3 large meals. Avoid drinking large amounts of fluids with meals.
  2. Avoid foods that cause gas and spicy or greasy foods.
  3. Do not eat or drink before bedtime.
  4. Wait 2 hours after eating before exercising.
  5. No alcohol or smoking.
  6. Avoid very hot or very cold fluids.

Is it safe to continue to have sexual intercourse during pregnancy?

Some couples worry about having intercourse during pregnancy. They may be afraid that it will cause a miscarriage. In a normal pregnancy, intercourse is safe except in early pregnancy and in last few weeks before the due date. Couples may prefer different positions during pregnancy that are more comfortable for the

Are leg cramps common in pregnancy?

Yes, you may find that you have an increase in leg cramps in the second and third trimesters of pregnancy. Get plenty of calcium (three glasses of milk or supplement) and potassium (bananas and oranges). Stretching your legs before going to bed may help relieve cramps.

How long can I continue working after I am pregnant?

Pregnant women who have no complications can continue working until the ninth month. They must however, take certain precautions such as avoiding strenuous activity, stair-climbing, extreme temperatures and smoky areas. They must also take frequent breaks and leave early if they are feeling exhausted. If they have been standing for a prolonged period, they should sit down and put their feet up. Standing for extended periods, lifting heavy objects, stooping and bending should be avoided in the last three months. Pregnant women must eat regular meals. A sedentary job that is not particularly stressful may be less of a strain than staying at home.

What relaxation techniques are helpful during pregnancy?

The following techniques are helpful in pregnancy

  1. Lie on your back with your head on the cushion and your lower legs raised on a chair. Close your eyes and relax for 10-15 minutes. This exercise will also help relieve swollen ankles and feet.
  2. Lie on your side and keep a pillow underneath your head. Bend your upper arms and legs upwards, placing a pillow under this knee. Keep your lower leg straight. Close eyes and clear your mind. Breathe in and count to 10. Breathe out slowly. Relax completely.

Why do doctors recommend that a pregnant woman should sleep on her left side?

Although sleeping on the back may be more comfortable to start with, it leads to backaches and haemorrhoids, and inhibits digestion, breathing and circulation. This is because the entire weight of the uterus on the back. Whereas, stretching out on your left side, allows maximum flow of blood and nutrients to the placenta, enhances the functioning of the kidneys, which leads to better elimination of waste materials (which in turn would cause swelling). So this should be, technically, the most comfortable position.

Why is it necessary to take Iron tablets during pregnancy?

Many women in India are anaemic (commonly called as deficiency of blood). In pregnancy the condition worsens as more Iron is required for both mother and the baby. To meet this additional demand, one Iron tablet (100mg Iron + 500µg Folic Acid) should be taken by all pregnant woman, 4th month onwards. Anaemic woman will need more iron.

If a pregnant woman feels weak/ tired, what should she do?

She should take healthy diet including Green vegetables, Seasonal fruits, Milk (atleast 1 glass per day), pulses, etc. If weakness persists or if there are other symptoms like fever and less of appetite, a doctor should be consulted

Does a pregnant woman with gall bladder stones need surgery? What are the ill effects of surgery on body?

If gall stones are causing severe pain. Surgery may be done during 4-6 months of pregnancy. The doctor will give medicine for preventing abortion, to avoid adverse effects on pregnancy

Should a Diabetic woman plan a pregnancy?

Diabetic woman can become pregnant, but she should visit to doctor before pregnancy so that medicines are prescribed to control diabetes and to maintain a normal blood sugar to have a normal baby

If a woman is short, will she need an operative delivery?

It is not necessary. A doctor should be consulted for assessment.

May one travel during pregnancy?

Most women with normal pregnancy can travel safely until close to their due date. Frequently, the most comfortable time to travel is in the middle of pregnancy. Problems are least likely to happen during this time. Doctors should be consulted before undertaking long journey

Exercise during pregnancy

Why should one exercise during pregnancy?

The exercises are aimed at the following:

  1. Improving posture and appearance.
  2. Relieving back pain.
  3. Strengthening muscles for delivery and for supporting loosened joints.
  4. Relieving muscle cramps.
  5. Enhancing circulation
  6. Increasing flexibility
  7. Increasing energy level by combating fatigue
  8. Promoting feelings of well-being and developing a positive self-image .Your doctor will advise you about the right kind of exercise.

Is exercise beneficial for baby?

Yes. Exercise is extremely good for the foetus because it causes blood flow to increase and improve the baby's growth and development. Exercise also makes the baby's brain and other tissues start functioning in optimum condition.

What kind of exercise is safe during pregnancy?

Continuing any sport or mild form of exercise should not be a problem, as long as it is done in moderation. You can do walking. However you must first consult your doctor.

What kind of exercises should one totally avoid during pregnancy

Exercises like jogging is very hard on the spine, pelvis, hips, knees, breasts and back and should be avoided. Exercises that pull your abdominal muscles, like leg lifts and sit-ups, are also not advisable during pregnancy. Further, do not try your hand at any new sport once you get pregnant; your body needs time to adjust to new movements. After the 4th month, do not exercise while lying flat on your back, as the weight of your uterus can compress major blood vessels, and restrict circulation.

Diseases of thyroid during pregnancy

How does hyperthyroidism affect pregnancy??

About 1 in 500 women have hyperthyroidism during pregnancy. In some, it is a preexisting condition; in others, the condition will develop during the course of the pregnancy. Hyperthyroidism may affect a woman's ability to become pregnant. You should continue with your normal anti-thyroid medication during your pregnancy as prescribed by your doctor. Most pregnant women and their babies will not experience significant problems if the hyperthyroidism is mild to moderate. If properly treated, the pregnancy can be expected to progress normally. If a woman has severe hyperthyroidism, her baby has a chance of having hyperthyroidism as well. There is a risk to the outcome of the pregnancy, having a small baby or a premature birth. Fortunately, most women who have hyperthyroidism in pregnancy can be successfully treated with medication. Following delivery, anti-thyroid treatment must continue. Your baby will be thoroughly checked to be sure he or she is well with no evidence of thyroid problems. Most babies born to hyperthyroid mothers whose hyperthyroidism has been well controlled during pregnancy are normal healthy babies

How does hypothyroidism affect pregnancy?

Hypothyroidism can develop during or after pregnancy. It also can affect a woman's ability to become pregnant. Hypothyroidism can affect pregnancy in these ways:

  1. It can cause infertility in women because it can prevent the production of eggs.
  2. A pregnant woman with hypothyroidism is at higher risk for miscarriage.
  3. Women with untreated hypothyroidism near the time of delivery are in danger of developing high blood pressure and premature delivery
  4. Babies born to women with untreated hypothyroidism may not achieve their full intellectual potential.
    Untreated hypothyroidism can cause serious problems for an unborn child. Every woman treated with thyroid hormone who anticipates becoming pregnant or is found to be pregnant should have her thyroid hormone levels monitored more closely. Some woman may need to have their dosage of medication increased by as much as 50% during pregnancy. Thyroid medication is safe to take during pregnancy.

Molar pregnancy

What is a molar pregnancy (hydatidiform mole)?

A molar pregnancy happens when tissue that normally becomes a fetus instead becomes a growth, called a mole, in your uterus. Even though it is not an embryo, a mole triggers symptoms of pregnancy.

What are the symptoms of molar pregnancy?

Women with a molar pregnancy usually feel pregnant and complain of vaginal bleeding. Many women with molar pregnancies develop nausea and vomiting. Some even develop rare complications like thyroid disease or very early preeclampsia (protein in urine, swelling of the body). The pelvic exam may reveal a larger, or smaller, than expected uterus. It may also reveal enlarged ovaries. The ultrasound will often show a ?cluster of grapes? appearance or a ?snowstorm? appearance, signifying an abnormal placenta.

What is to be done in molar pregnancy?

Treatment consists of a D&C (dilation and curettage) of the uterus, where a small vacuum device is inserted into the uterus, under anaesthesia, to remove the molar pregnancy. Blood test is ordered for determining HCG level, and sometimes a thyroid level. In unusual cases, where the patient has completed her childbearing, a hysterectomy may be preferable

Rh incompatibility

What is Rh incompatibility?

People with different blood types have proteins specific to that blood type on the surfaces of their red blood cells (RBCs). There are four blood types — A, B, AB, and O.Each of the four blood types is additionally classified according to the presence of another protein on the surface of RBCs that indicates the Rh factor. If you carry this protein, you are Rh positive. If you don't carry the protein, you are Rh negative.Rh incompatibility is a condition that develops when a pregnant woman has Rh-negative blood and the baby in her womb has Rh-positive blo

Why does Rh incompatibility occurs?

Rh incompatibility occurs if blood group of father is Rh positive and that of mother is Rh negative. During pregnancy, red blood cells from the fetus can get into the mother's bloodstream as she nourishes her child through the placenta. If the mother is Rh-negative, her immune system treats the Rh-positive fetal cells as if they were a foreign substance and makes antibodies against the fetal blood cells. These anti-Rh antibodies may cross the placenta into the developing baby, where they destroy the baby's circulating red blood cells. First-born infants are often not affected -- unless the mother has had previous miscarriages or abortions, which could have sensitized her system -- as it takes time for the mother to develop antibodies against the fetal blood. However, second children who are also Rh-positive may be harmed.

How to predict Rh incompatibility?

Most people, about 85%, are Rh positive. But if a woman who is Rh negative and a man who is Rh positive conceive a baby, there is the potential for a baby to have a health problem. The baby growing inside the Rh-negative mother may have Rh-positive blood, inherited from the father. Approximately half of the children born to an Rh-negative mother and Rh-positive father will be Rh positive.

Ectopic pregnancy

What is ectopic pregnancy?

Normally the fertilized ovum gets implanted in uterus and developed there. Ectopic pregnancy is one in which the fertilized ovum (egg) is implanted and develops outside the uterus. The most common site is fallopian tube. Normally fertilization occurs in the tube and the fertilized ovum moves into the uterus.

What are the main symptoms of an ectopic pregnancy?

A woman suspects she is pregnant when she has no periods. The pregnancy tests will confirm the pregnancy. If it is accompanied with severe abdominal pain, vaginal bleeding, nausea, vomiting and fainting attacks, suspicion of ectopic pregnancy which has gone wrong is highly likely.

What is to be done on suspicion of an ectopic pregnancy??

The women should be urgently rushed to a hospital. An ectopic pregnancy which is ruptured is a medical emergency. The woman is urgently given intra venous fluids. She requires blood transfusion if there is excessive bleeding. At the same time, surgery is done to take out the product of conception suture the ruptured tube.

Janani Suraksha Yojana

What is Janani Suraksha Yojana (JSY)?

Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission (NRHM) being implemented with the objective of reducing maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women. The Yojana, launched on 12th April 2005, by the Hon‘ble Prime Minister, is being implemented in all states and UTs with special focus on low performing states

What are the LPS and HPS states??

States with lower levels of institutional delivery rates have been classified as LPS states. These are - the states of Uttar Pradesh, Uttaranchal, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam and Jammu and Kashmir. The remaining states are named as HPS states.

Is there any cash benefit for pregnant women from BPL families preferring to deliver at home?

In LPS and HPS States, BPL pregnant women, aged 19 years and above preferring to deliver at home is entitled to cash assistance of Rs. 500/- per delivery. Such cash assistance would be available only upto 2 live births and the disbursement would be done at the time of delivery.

When would the cash benefit under JSY be disbursed?

The cash benefit should be disbursed to the beneficiary preferably at the institution. If ASHA is unable to organize transport (wherever applicable) disbursement of transport assistance should be done in the health centre as soon pregnant women arrive and registers for delivery. It should be the responsibility of ANM, MO, PHC/ASHA to take all proactive actions to ensure timely disbursement

If after having received the cash benefit, the child dies, would the benefit under JSY be extended for the next birth?

In Yes. Proper record should be maintained

If a still child is born in a health institution, can the benefit of JSY be disbursed to the mother?

In Yes. Proper record should be maintained

A poor woman needs treatment for C-Section or other obstetric complications. Is there any provision for such situations under JSY?s

Yes. Generally FRUs / CHCs etc. would provide emergency obstetrics services free of cost. Where Government specialists are not available in the Govt‘s health institution, experts can be hired to carry out the surgery in a Government medical facility.

If poor pregnant women do not have BPL Card but otherwise considered very poor and needy by the community, how to certify and disburse cash benefit under JSY?

The Panchayat and the local bodies need to be effectively involved in the certification of poor and needy expectant mother, in a manner that genuine poor pregnant women are able to benefit from the scheme. However, if the BPL certification is not available through a legally constituted process, the beneficiary could still access the benefit on certification by Gram Panchayat/pradhan provided the delivery takes place in a Government institution. The benefit available under JSY will be admissible in a private hospital only against a regular BPL card whose number etc. has to be quoted in the birth certificate to be issued by the private institution.

Will there be any requirement of BPL card in LPS states?

No, provided women access government or accredited health institution for delivery. However, for getting cash component for home delivery, BPL card would be essential.

What about SC and SC women?

Such women would also not require a BPL certification if they access government or accredited health institution for delivery.

Can cash benefit of the mother be handed over to the institution, in lieu of the services provide

No. Cash benefit to mother has to be given to the mother. It is upto the mother to decide, asto how it is to be utilized. Any deviation in this regard would be construed as violation and may lead to audit objectionss

What is the cash assistance in JSY scheme?

The cash given to the delivered mother depends upon the state and the area of the birth. It is as follows:

  1. LPS rural areas: Rs. 140
  2. LPS urban areas: Rs. 1000
  3. HPS rural areas: Rs. 700
  4. HPS urban areas: Rs. 600

HIV and pregnancy

What are the advantages of a planned pregnancy in an HIV positive woman/ her husband?

A woman who knows that she or her partner is HIV positive before she becomes pregnant is better able to plan ahead. If she does not want to have a child then she should consider effective contraception. If she decides to become pregnant, doctors will be able to advise the best approach suited to her situation, the need to adjust any treatment she is already receiving to protect her, her partner and her baby. Pregnancy does not make a woman's own health worse in respect of HIV

Can a HIV positive woman become pregnant without endangering her partner?

Yes, an HIV positive woman with an HIV negative partner can become pregnant without endangering her partner; by using artificial insemination (the process by which sperm is placed into a female's genital tract using artificial means rather than by natural sexual intercourse). This simple technique provides total protection for the man, but does nothing to reduce the risk of HIV transmission to the baby. If the man has HIV then the only effective way to prevent transmission is sperm washing. This involves separating sperm cells from seminal fluid, and then testing these for HIV before artificial insemination or in vitro fertilization. Sperm washing is a very effective way to protect both the mother and her baby, but it is only available at a few clinics and major hospitals and can be difficult to access.

If the mother is HIV positive, what are the chances for the baby to become HIV positive?

One out of every 3 or 4 babies born to a HIV infected woman are likely to become HIV positive. HIV positive men / women should plan pregnancy in consultation with doctor.

What are the options available to an HIV positive mother to reduce the chances of transmission of infection to her baby?d?

By using drugs and appropriate infant feeding advice, transmission of HIV infection from an infected mother to her baby can be prevented to a large extent. The medicines that can prevent HIV being passed from a mother to her baby are called antiretroviral (ART) drugs. These medicines also prevent HIV positive mothers, from becoming ill and arrest progress of disease. The most appropriate time for an HIV positive pregnant woman to take ARTs to prevent her baby getting infected is during pregnancy. She should consult her doctor for this. It is also strongly advisable that all pregnant women get their HIV status tested during pregnancy so that they can be given appropriate advice for prevention of transmission to their baby.

When should a HIV+ pregnant woman seek treatment?

She should plan the pregnancy in consultation with a qualified doctor and should be under close supervision throughout pregnancy, labour and post- delivery period for her own treatment as well as protection of unborn baby. Babies also require treatment after birth.

If a still child is born in a health institution, can the benefit of JSY be disbursed to the mother?

In Yes. Proper record should be maintained

Should the HIV positive women breastfeed the baby?

Breastfeeding ensures optimum growth and development of infants. It also protects them from infections. However, there is a chance that HIV infection may get transmitted to the baby through breast milk. Using animal/formula milk is not associat with risk of HIV transmission, but increase chances of diarrhoea and other serious infections in the baby many-fold. It can also lead to faltering of their growth. No mixed food should be given. Therefore, infant feeding option for a HIV infected mother has to be decided carefully. Counsellor and the treating doctor can help decide the most appropriate feeding option for individual women. This decision is best taken before the baby is born.

What are the chances of infection to the infant if the woman is on anti viral therapy and undergoes caesarean section?

When Anti viral therapy is given to a woman during pregnancy, the incidence of infection is reduced to about 5-8%. When C-section is performed and antiviral therapy is given during labor, the infection rate is further reduced to about 2%.

Breast feeding related concerns

How long after delivery must breastfeeding be initiated?

Breastfeeding may be initiated within half an hour following normal delivery and 4 hours following caesarean section.

How often should one breastfeed?

During day, the baby can be fed every two to three hours for at least 10-15 minutes on each breast. You may need to wake your baby (a diaper change and holding baby upright and talking to baby helps waken baby) during the day so your nights will be more restful. As baby's nutritional needs are better met during the day, baby will not wake as often during the night. Sometimes your breasts will be full during the night, and then the baby may be fed during the night.

What should a woman do if she has no/less milk for baby?

She should put baby to her breast more often. If the problem persists then she should consult an ANM, nurse or a doctor.

How can I tell if my baby is getting enough milk?

If your baby has four to six wet diapers in a 24-hour period, it means that you are supplying the baby with a good amount of breast milk. Another sign that there is good milk transfer is your breasts soften with nursing.

When should a HIV+ pregnant woman seek treatment?

She should plan the pregnancy in consultation with a qualified doctor and should be under close supervision throughout pregnancy, labour and post- delivery period for her own treatment as well as protection of unborn baby. Babies also require treatment after birth.

Does baby get anything before milk comes in?

InYes, your breasts supply colostrum, very concentrated milk full of antibodies. This colostrum acts as a laxative, helping clear meconium (black tarry stool) and bilirubin (which may make baby jaundiced or yellow) from your baby.

Breast related concerns after delivery

What is post partum breast infection and what is its cause?

Post partum breast infection occurswhen bacteria lodged on the nipple get into a breast through a crack on the nipple or through a duct when breastfeeding

What are the symptoms of post-partum breast infection?

It is characterized by pain and swelling of the breasts, redness of the overlying skin and may/ may not be associated with fever

What is to be done in case of a post-partum breast infection?

Breastfeeding should be continued and a doctor should be consulted for prescription of antibiotics.

How can I tell if my baby is getting enough milk?

If your baby has four to six wet diapers in a 24-hour period, it means that you are supplying the baby with a good amount of breast milk. Another sign that there is good milk transfer is your breasts soften with nursing.

What happens if prompt treatment is not sought?

If prompt treatment is not sought; it may lead to development of a breast abscess.

What causes sore nipples?

When you are first learning to breastfeed, sore nipples are the result of poor positioning.

How can sore nipples be managed?

Sore nipples can be managed by properly positioning baby's gums over the center of the nipple where the milk is pooling, not the tip of the nipple where you have lots of nerve endings

Why does the baby get suddenly hungry?

Babies have growth spurts, usually between 1-2 weeks old, at 6 weeks old and 3 months old. Baby may want to nurse twice as often for 1-2 days during that time, and this extra stimulation will automatically increase mother's supply to match baby's demands.

What causes breast lumps during nursing and how can it be managed?

Lumpy breasts can be normal when nursing and is caused due to a plugged duct. Before nursing, use heat (warm shower or warm compress) and breast massage (gentle circular motion with fingertips from chest wall, over lump towards nipple) then nurse or pump. It is important to clear a plugged duct because it can lead to a breast infection. If the lump doesn't clear with this treatment or you develop flu-like symptoms, call the doctor

What causes breast lumps during nursing and how can it be managed?

Lumpy breasts can be normal when nursing and is caused due to a plugged duct. Before nursing, use heat (warm shower or warm compress) and breast massage (gentle circular motion with fingertips from chest wall, over lump towards nipple) then nurse or pump. It is important to clear a plugged duct because it can lead to a breast infection. If the lump doesn't clear with this treatment or you develop flu-like symptoms, call the doctor

How can breast engorgement be prevented

Breast engorgement can be prevented by increasing the frequency of breast feeding such as every one and a half to 2 hours till the engorgement subsides.

Sometimes my breasts feel very hard. What should I do?

If there has as been a long time gap between feeds or you have not breastfed yourbaby, then you might get this feeling. You must feed your baby or express yourmilk with your hand.

How can sore nipples caused due to lactation be managed

Soreness of nipples results most often due to incorrect position of holding the baby while breast feeding. If baby is not held very close to the mother, he pulls at the nipple while feeding. Feeding the baby in correct position, i.e. holding him close to the mother‘s body prevents sore nipples. In this position the baby‘s gums press upon the areola which facilitates the release of milk. If a mother develops sore nipples, continue to breast feed in proper position and apply hind milk or some simple cream around the areola at the end of feeding. Applying the hind milk (milk expressed from a nearly empty breast) is equally effective since it is rich in fat. Plastic lined nursing pads should not be used since they hold the moisture. Avoid frequent washing of nipples with soap. If nursing the baby is very painful, express the milk from that breast manually and feed the baby using a cup and spoon till the nipple heals. Continue to feed from the other breast

How can sore nipples caused due to lactation be managed

Soreness of nipples results most often due to incorrect position of holding the baby while breast feeding. If baby is not held very close to the mother, he pulls at the nipple while feeding. Feeding the baby in correct position, i.e. holding him close to the mother‘s body prevents sore nipples. In this position the baby‘s gums press upon the areola which facilitates the release of milk. If a mother develops sore nipples, continue to breast feed in proper position and apply hind milk or some simple cream around the areola at the end of feeding. Applying the hind milk (milk expressed from a nearly empty breast) is equally effective since it is rich in fat. Plastic lined nursing pads should not be used since they hold the moisture. Avoid frequent washing of nipples with soap. If nursing the baby is very painful, express the milk from that breast manually and feed the baby using a cup and spoon till the nipple heals. Continue to feed from the other breast

How should engorged breasts be managed?

Sometimes the breasts get swollen due to milk collection. This usually occurs around the 3rd day after delivery. It is more likely to occur if baby has not been breast feeding. The breasts feel heavy and painful. The breast engorgement is best prevented by early feeding and frequent suckling of the baby. If engorgement continues, the baby may not be able to attach to the breast. In that situation, some milk can be manually expressed and collected in a clean container. The baby can then be put to breast for feeding. Hot fomentation relieves pain and facilitates manual expression of breast milk.

What causes breast lumps during nursing and how can it be managed?

Lumpy breasts can occur frequently when nursing and are caused due to a plugged duct. Taking warm shower or using warm compress before nursing and massaging the breast (gentle circular motion with fingertips from chest wall, over lump towards nipple) before nursing will open up the clogged duct and resolve lumps. It is important to clear a plugged duct because it can lead to a breast infection. If the lump does not clear with this treatment or mother develops redness and pain in it, consult a doctor.

What should be done if the mother has small nipples that a baby cannot take in his mouth?

Many women, especially those with the first baby have this problem. Sometimes these nipples are buried inside the surrounding areola. It is difficult for a baby to hold such a nipple in his mouth and breast feed. The mother should pull her nipple out and roll it gently between her thumb and index finger. She should then put the baby to breast immediately thereafter. A few attempts may be needed before baby can hold on to the nipple. The problem resolves in most situations once baby starts feeding from the breast following this manoeuvre for a few times, since suckling itself would help in bringing out the nipple.

What is breast abscess and how can it be treated?

Breast abscess occurs in a lactating mother when bacteria get into the breast usually through a crack in the nipple or through a duct. It leads to formation of a painful lump in the breast with redness of overlying skin. Breast abscess needs prompt treatment with antibiotics. In some cases drainage of pus is also required. A woman with breast abscess should continue to breast feed her infant from the unaffected breast and express the milk from the affected breast to prevent engorgement.

Are there any medicines available to stop production of breast milk if anyone has stillbirth (newborn delivered dead)?

A few of us have had the unfortunate and painful experience with having to stop lactation after stillbirth or neonatal death. Remedies which you can use are, wearing tight bra and applying cold compress over the breast. Earlier some medicine was used. But it had many side effects. Nowadays no drug is used.

Other post partum related concerns

How long does the perineal pain from delivery last?

Usually the discomfort/ pain disappear within a month. Sometimes it may take upto 2 months.

When can a couple resume intercourse after delivery?

The minimum time period for which a couple should refrain from resuming intercourse should be one and a half months. The period may be longer if local pain or discomfort persists or there are other health problems. The couple should start practicing a contraceptive as soon as they resume normal sexual activity after the delivery. There should be a gap of 3 years in between two consecutive deliveries

Can women suffer from uncontrolled passing of gas or even stool from the anus after delivery?

After vaginal delivery, some women do have difficulty holding their stool or gas, for which a doctor may be consulted.

What can be done about the loose vaginal opening after delivery?

For this, a doctor/physiotherapist should be consulted who will advice about exercises to increase the muscle tone.

What causes pain with urination, frequency, vulvar burning after delivery?

The hormones of pregnancy, high estrogen and progesterone, decline rapidly after delivery resulting in dryness of the vagina and inner mucosal lining of the vulva. As a result, it becomes sensitive to any irritation from soaps, rubbing, or contact with chemicals in pads, condoms, lotions or other topically applied agents.

Why do women suffer from uncontrolled passing of gas or even stool from the anus after delivery?

After vaginal delivery, some women do have difficulty holding their stool or gas. It occurs much more commonly after injury to the anal sphincter muscle, even if that injury is surgically repaired at the time of delivery

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