June 8, 2016

FAQ’s

Our FAQ page includes

  • General FAQ
  • Confirming Pregnancy
  • Expected Problems and its Remedies
  • Diet and Exercise
  • Sex during Pregnancy
  • Travelling during Pregnancy
  • Breast feeding
  • Your Concerns
  • Weight Gain
  • Risks
  • Contraception
  • Incompetent Cervix
  • Repeat Caesareans

Family HistoryNormal delivery – My chances?

General FAQ

What can women do to promote a healthy pregnancy and birth?

Getting early and regular prenatal care is important for a healthy pregnancy and birth. Before a woman gets pregnant, a preconception care visit can help her take steps for a safe and healthy pregnancy. This is important because early fetal development occurs often before women even know they are pregnant. Certain behaviors, such as exposure to tobacco smoke and drinking alcohol, can increase the risk for complications, while other behaviors, like taking the recommended 400 micrograms of folic acid a day, can reduce the risk for neural tube defects, like spina bifida, by two-thirds.
During pregnancy, a woman’s prenatal care visits will include education and counseling about how to handle different aspects of pregnancy, the importance of good nutrition and physical activity, and what to expect during labor.

What health screenings are important for women?

Health screenings  are important for adults at every stage. The screenings recommended specifically for women include:

  • Breast cancer screening.A mammogram (X-ray of the breast) is recommended for all women beginning at age 50, or earlier if a woman has a family history of breast cancer. Screening is recommended every 2 years.
  • Cervical cancer screening.Screening for cervical cancer should include a Pap test, a screening performed during a pelvic exam that checks for changes in the cells of the cervix, and an HPV (human papillomavirus) test, which finds certain infections that can lead to cell changes and cancer. The recommendations for cervical cancer screening include:
    • Beginning at age 21, a Pap test is recommended every 3 years until age 29. An HPV test is not necessary if a woman has normal Pap test results.
    • For women between the ages of 30 and 65, Pap tests should also be done every 3 years but should be combined with an HPV test every 3 to 5 years.
    • Screening is not recommended for women ages 65 or older who have had three or more normal Pap tests in a row and no abnormal Pap test results in the past 10 years.

The screening recommendations do not apply to women who have had a hysterectomy (surgical procedure to remove their cervix and uterus). The recommendations do apply to women who have had the HPV vaccine.

  • Osteoporosis screening.A bone mineral density test should begin at age 65 or earlier if a woman is at risk for osteoporosis. Risk factors include older age (post-menopause), a family history, low body weight or a small, thin frame, a history of broken bones, a lack of calcium and vitamin D, smoking, an inactive lifestyle, an unhealthy diet, and drinking too much alcohol.

The screenings listed above are just a few of the many tests that women should seek throughout their lives. Some screenings, such as blood pressure and cholesterol checks and colonoscopies (to screen for colon cancer) are important for both men and women. Other screenings, such as tests conducted during pregnancy at regular prenatal visits, help protect the health, and could even save the lives, of the mother and her fetus as well as prevent complications during pregnancy and beyond.

What unique challenges do women with disabilities face?

Many  women have a disability, including physical, learning, and intellectual and developmental disabilities. The challenges faced by women with disabilities increase as they age and their abilities become increasingly limited. Some of the challenges faced by women with disabilities include:

  • Barriers to health care services, including a lack of knowledge among health care providers about disabilities. Younger women with disabilities are often less likely to seek health care
  • Increased risk for health issues such as depression, stress, being overweight, and high blood pressure5
  • Decreased levels of physical activity
  • Fewer opportunities to be screened for cancer, blood pressure, cholesterol, osteoporosis, and sexually transmitted diseases and infections
  • Additional challenges faced during pregnancy, including a lack of health care providers who are familiar with managing pregnancy in women with disabilities and increased discomfort and health complications as the pregnancy advances

What health issues or conditions are specific to women only?

Women experience unique health issues and conditions, from pregnancy and menopause to gynecological conditions, such as uterine fibroids and pelvic floor disorders. The health topics listed below affect women only. Some other conditions affect men too but affect women primarily or more severely.

Gynecological health and disorders affecting women include menstruation and menstrual irregularities; urinary tract health, including urinary incontinence and pelvic floor disorders; and such disorders as bacterial vaginosis,vaginitis, uterine fibroids, and vulvodynia.

Pregnancy issues include preconception care and prenatal care, pregnancy loss (miscarriage and stillbirth), preterm labor and premature birth, sudden infant death syndrome (SIDS), breastfeeding, and birth defects.
Disorders related to infertility include uterine fibroids, polycystic ovary syndrome, endometriosis, and primary ovarian insufficiency.

Other disorders and conditions that affect only women include Turner syndrome, Rett syndrome, and ovarian and cervical cancers.

Issues related to women’s overall health and wellness include violence against women, women with disabilities and their unique challenges, osteoporosis and bone health, and menopause

 

Confirming Pregnancy

Can pregnancy be confirmed only based on symptoms?

Pregnancy can be suspected – based only on symptoms – but needs confirmation by urine test or ultrasonography

How early can I confirm my pregnancy with the urine test?

Pregnancy can be confirmed as early as day one of first missed periods that is 31-32 days after menses. It could be confirmed as early as 27-28 days after the menses by the Elisa method.

I have confirmed my pregnancy by a home test. When should I see my doctor?

It is good to see your doctor at the earliest, for preliminary assessment advice, and certain routine blood tests. Intake of vitamins like B-Complex and folic acid are important in the first three months of pregnancy.

I menstruate exactly on the 28th day of every month. If my cycle is delayed by one week, can I consider myself pregnant?

It is most likely that you are pregnant. Since there could be other causes for a delayed cycle, have a urine test done to confirm your pregnancy.

I was expecting my cycle at 30 days. I had only a slight spotting on the 31st day. Am I pregnant?

Even though you had only slight spotting, pregnancy cannot be ruled out. It may be an implantation bleed (normal) or bleeding could also imply a disturbance in pregnancy. Consult your doctor, who would confirm and keep track of the growth of pregnancy.

My cycle is delayed by two weeks and I have extreme nausea and a bloated feeling in my stomach. Am I pregnant? How can I confirm it?

Confirmation of pregnancy is by a urine test which could be performed by you using a home-kit or done in any laboratory or at your doctor’s clinic.

I have regular menstrual cycles. My urine pregnancy test done on the 35th day was negative but by the 45th day it was confirmed positive. Will it be a healthy pregnancy?

This could be a delayed conception (late beginning) or unhealthy pregnancy. Your doctor would request for an ultrasound scan and reset your dates for delivery or will tell you that all is not very well and ask for a reassessment to make a decision about continuing this pregnancy.

Can the urine test result be wrong?

Most of the times it would be correct. It can be false ‘negative’ in a pregnant woman when levels of hCG are below the sensitivity level of the test (either in delayed conception or very dilute urine sample or unhealthy pregnancy). It can be ‘false positive’ in conditions, with hCG secretion other than pregnancy like trophoblastic disease.

Is there any blood test to confirm pregnancy?

Yes, pregnancy can be confirmed by doing serum b-hCG estimation.

How can I calculate the due date?

With the regular cycle of 28 days, the due date is calculated by adding 9 months and 7 days to the 1st day of your last menstrual period. For example: If the 1st day of last menses was on 01.01.2001, the due date is 8.10.2001.

Congratulations if you are pregnant!

 

Expected Problems and its Remedies

It is most likely that you would be told by others at home or friends or colleagues, that there are going to be some discomforts, some uneasiness, especially in the early part of pregnancy and that you have to live with it. Some of the phrases you would hear, most part of the pregnancy are ‘We, went through the same problems, you too have to put up with it’. ‘It will settle with time, it is a passing phase. Do not fuss too much’.

Here is an account of what to expect and how to cope.

Why is there vomiting in the early part of pregnancy?

Commonly called Morning Sickness – Vomiting is mainly caused due to rapid rise in hormone (gonodatropin) in early pregnancy. The level of this hormone reduces after 3-4 months and the appetite improves.

Why do I feel very uncomfortable in my chest for most parts of the day?

The discomfort in the chest is called heartburn – also called gastritis. It is because of excess gastric juice or gastric acid in the stomach causing a burning sensation in the food pipe. It is common in pregnancy due to distaste for food leading to starvation or craving for spicy food. It is good to have a few sips of milk and small frequent meals to avoid this problem.

I have breast pain especially while riding on two wheelers.

It can happen early in pregnancy due to hormone changes or later in pregnancy due to pressure by the uterus.  At times, severe heartburn mimics breast pain.

Are Mood disturbances – (mood swings) common in pregnancy? I feel like crying just at the drop of a hat. I used to be so active, positive and cheerful – but now in the 2nd month of pregnancy, I feel very tired, sleepy, irritable and depressed. Why?

These changes are very common due to hormonal changes associated with pregnancy. Many women may find themselves going through periods of depression. They may experience frequent ups and downs in moods. Warn, communicate and or tell your near and dear ones of how you feel, to avoid misunderstanding. It is a normal passing phase and needs no treatment.

Increased sleep, feeling tired and lethargic is very common in the early part of pregnancy.

Feeling drowsy during the day and restless during the night is not uncommon in pregnancy.

I have tendency for constipation. It has worsened now.

In pregnancy, it is due to hormone (progesterone) which makes the intestine relax and movement of food becomes sluggish. Constipation is at times induced by tablets (especially iron tablets). Intake of warm water with a drop of ghee, anytime during the day is simple home remedy. Eating salads, lot of vegetables and fruits and dried figs will also help.

I have bleeding from the mouth while brushing. Is it dangerous?

Gums get soft during pregnancy and you will need to use a soft tooth brush or tooth powder. Extra intake of calcium and multivitamins will help.

 

Diet and Exercise

I have confirmed my pregnancy last week. I hate drinking milk. But everyone at home is forcing me to drink milk.

Throughout pregnancy, especially in the first three months, there will be strong likes and dislikes towards some common food substances. Do not force yourself to take what you cannot. Instead of milk, alternatives like ice cream, milk shakes, buttermilk or curds would be good enough.

Is walking compulsory?

Many career women or those at home who generally do a lot of work need not worry about compulsory walking. But if you have the time, a leisurely walk is the best exercise for the body and mind.

I am not at all used to doing any household work. Since the time my pregnancy was confirmed, people at home insist that I should do the sweeping and swabbing, which will help me for an easy delivery?

Suddenly getting on to household work will do more harm than good. The rule in pregnancy is to continue to do all the accustomed activity.  Since pregnancy is a natural event and not a disease process, there is no need to restrict the ususal activities unless advised by your doctor (in certain special situations like high BP, low placenta).

 

Sex during Pregnancy

Can I continue having intercourse during my pregnancy?

You can continue to have intercourse almost until end term. Avoid intercourse when vaginal bleeding occurs, when you have abdominal pain or a history of miscarriage.

Will the baby be harmed?

The baby remains safe and unharmed due to the thick mucus plug that seals the cervix and helps guard against infection. The amniotic sac (water bag) and the strong muscles of the uterus also protect your baby.

Could there be a change in my partner’s sex drive?

The pregnant lady is very attractive to most of the people. The desire of some may wane due to apprehensions about parenthood and a feeling of self-consciousness about making love in presence of their unborn child.

Your doctor is your best friend and will maintain confidentiality. Be frank and clear all your doubts. With the proper advice, couples can become closer and enrich their emotional bonds during pregnancy.

Comfortable positions

  • Lie sideways
  • Use the bed as a prop.
  • Lie side by side in the spoon position.
  • Get on top of your partner.

KISS during pregnancy – Keep ISimple and Safe!!

Does it feel the same?

For some women it is even better, for some not so. Increased blood flow to pelvic area can cause engorgement of genitals heightening sensation; other women may feel uncomfortable or have abdominal cramps during or after intercourse.

 

Travelling during Pregnancy

Travelling by a two wheeler vehicle

As soon as you suspect that you may be pregnant, it is better to avoid driving a two-wheeler yourself. However, you may be a pillion rider with a responsible person who carefully avoids speeding, bumps and uneven roads. Hold on to the driver, and do not try to balance on your own. If possible, do not travel long distance, and use a bus or a safe auto rickshaw instead.

Are long car trips safe during pregnancy?

There is no reason to avoid car travel when you are pregnant provided you maximize your own comfort by planning extra time for a leisurely journey. Driving or sitting in the drivers seat could put you at risk as the pregnant womb is very close to the steering wheel. It is dangerous if you apply the brake, suddenly. Sitting comfortably in the passenger seat is the best.

How can I be comfortable while traveling in a car?

Sitting for long periods could make your feet and ankle swell and cramp your legs. Take frequent breaks, move out and stretch your legs. This helps to avoid stagnation of blood circulation. You could rotate your ankles, wiggle your toes and generally feel comfortable and not cramped. Keep a supply of warm clothes, a flashlight, some non-perishable food, drinking water and toilet paper handy. Wear loose clothing that you feel good in, use a rest room during the stops on the way and drink plenty of water.

Will pregnancy make me carsick?

If you are having morning sickness, extended car travel may aggravate your nausea. But in general being pregnant does not make you carsick.

Travelling by plane – is it safe to fly during the first and second trimester?

If your pregnancy is associated with problems (like spotting, diabetes, high blood pressure), then check with your doctor before flying.

It is safe to fly during my third trimester?

If you are not at risk for pre-term deliveries (you are not carrying twins or multiples or have not had any prior pre-term deliveries, medical complications), then you can fly till your 36th week of pregnancy.

But pregnant women should not fly on small planes that do not have pressurised cabins. After the 36th week most airlines discourage flying because they do not want an emergency in air. You could be questioned about your due date at the gate. If the airline can prove that you are flying within one week of your due date, they can bar you from travel. To avoid delays it is better to get a written permission to fly from your doctor. The letter should state that you have been examined and are not likely to go into labour in the next 72 hours. Travel policies vary with each airline, so ask about restrictions when you book your flight.

Will security X-rays harm my baby?

No, when you walk through the security gate at the airport, you pass through a metal detector. Only your luggage is X-rayed.

Will cabin pressure harm my baby?

Airliners are required to maintain a standard level of cabin pressure. There is no evidence that this pressure is harmful to your growing baby.

Travelling by bus and train – Is traveling by bus and train safe when I’m pregnant?

There are no restrictions on traveling by bus or train. Checking with your doctor before traveling is better because medical facilities on both bus and train are very limited.

Will pregnancy make me prone to getting seasick?

Ocean travel can upset your stomach whether you are pregnant or not. If you are already suffering from morning sickness, you may want to postpone ocean travel until it subsides. Before you sail, ask your doctor about seasickness medications that are safe to take during pregnancy.

How can I travel comfortably on a cruise ship?

Ships can be remarkably comfortable. Food and bunk beds are good. There will be plenty of ways to exercise on the ship, like early morning walks.

Happy and safe travelling!

 

Breast feeding

Why should I breastfeed?

You should breast feed because both breast milk and breast-feeding are good for your baby. Breast-feeding is easier and safer. There is no time involved in preparation, sterilization, etc. and the milk is available to the baby at the required temperature. Breast milk is not contaminated nor can it be adulterated. Artificial feeding may make your baby prone to infections, malnourishment, allergies, and obesity.

In contains the exact quantity and proportion of nutrients necessary for the baby. It is easily digested and utilized by the baby’s body. Breast milk has many anti-infection properties that protect the baby against infections-especially against diarrhea and respiratory infections. Breast-feeding helps to establish a close and loving relationship between you and your baby – this is called bonding. Breast-feeding will make you feel emotionally very satisfied and also protects your health. It helps your uterus to involute i.e. to return to its original size after delivery. It may also help delay another pregnancy.

Should I feed the baby every time he/she cries?

Yes you should. This is called demand feeding where the baby is fed as often and as long as he/she wants to, provided the baby is not crying because he/she is wet or uncomfortable. Feed the baby whenever he/she cries.

How will I know that I have enough milk to feed my baby?

If your baby has had an adequate breast-feed he/she will sleep contentedly for about two hours after a feed, pass good amount of urine and gain the required amount of weight.

Is there any medication to improve breast milk secretion?

If you have started breast-feeding your baby soon after delivery and your baby is sucking well and frequently it is most unlikely that any medication will be required. A good diet, drinking sufficient liquids, adequate rest and a bright and positive outlook will ensure adequate milk secretion even without medication. On rare occasions the doctor may prescribe a drug called metoclopramids to increase milk secretion.

I could not breast feed my first baby. What precaution should I take to make sure I could have enough milk for the next baby?

First of all you should get rid of the idea that breast feeding may fail the second time also. A positive attitude that you can and will breast­feed this baby is very important. During your pregnancy check and see that the nipples are not retracted.

Daily massaging and pulling the nipples forward will set this right. The next thing is early frequent feeding and right technique. Put your baby to the breast as early as half an hour after birth. This is the time when the newborn baby is most responsive and will learn to grasp and suck correctly.

Frequent feeding will ensure complete emptying of the breasts which is very important for continued and adequate secretion of milk, because milk left out in the breast prevents fresh milk from being produced and secreted. Besides this, nutritious diet, enough liquid intake and rest will go a long way to ensure that you can breast feed your next baby.

Up to what age can I feed the baby?

You can breast feed your baby for as long as you can wish to, because milk will go on being produced and secreted as long as the baby suckles. Ideally you should breast feed your baby for at least two years.

I stopped feeding my child at 10 months. I have terrible pain and engorgement of the breasts. Please help.

You could foment the breast with hot water, express some milk manually (by squeezing) take a painkiller and ask your doctor to give you a tablet to suppress the secretion.

How exactly should I breast feed? Is there a perfect and special technique?

Breast-feeding though instinctive is an art and a skill; some knowledge about the technique of breast-feeding will help you develop the confidence to successfully breast-feed. Breast feeding should be started within half an hour after birth and the baby should not be given any feeds like water, sugar water or honey prior to breast feeding. These extra feeds will satisfy the baby’s hunger and prevent the baby from sucking as well as increase the risk of infections. Even if there is not much milk initially the baby should suckle. Full term babies of normal weight can sustain themselves even on the little colostrums (first yellowish secretion) that are secreted.

Ideally you should sit up and feed but lying down is also acceptable. You should be relaxed and comfortable. The baby should be held close facing the breast. The baby’s head and body should be straight and the bottom should be supported.

For better understanding plz attend our breast feeding classes before delivery

I have delivered by C-section. How can I be expected to feed my baby in the first few days before I recover?

You can feed your baby after a c-section soon after you have recovered from the effects of anaesthesia, initially you could feed lying on your back with the baby on top of you and subsequently by turning on your side. You should position the baby correctly to prevent him/her from kicking the incision.

 

I have heard that there is no chance for a pregnancy while I am feeding my baby. Is it true?

Though the chances of becoming pregnant during breast-feeding are less, this is no full proof method of preventing a pregnancy.

 

Your Concerns

I became pregnant again just ten weeks after I delivered my first child. I’m worried about what effect this might have on my health and on the baby I’m now carrying.

Conceiving again before you have fully recovered from a recent pregnancy and delivery puts an extra strain. Though conception in the first three postpartum months is rare, it has been seen in some cases and most of them have delivered normal, healthy infants at such short intervals.

It is essential to be aware of the toll that frequent and consecutive pregnancies can take and one should do everything possible to compensate. Conception within three months of delivery puts the new pregnancy in a high risk category, which in this case is not as ominous as it sounds, particularly with proper care and precautions.

I’m pregnant for the sixth time. Does this pose any additional risk to my baby or to me?

It has long been believed in medical practice that women who have five or more children are putting both themselves and their babies at risk with each additional pregnancy. This may have been true before the advances in modern obstetrical care and it is probably true today for women who receive inadequate care – but the fact is that women getting good antenatal care have an excellent chance of having healthy, normal babies even in their fifth or later pregnancies. In a recent study the only increased risk discovered for fifth and subsequent pregnancies was a small increase in the incidence of multiple births (twins or triplets) and in babies born with trisomy 21, a chromosomal disorder.

I have been diagnosed with a fibroid uterus. Will I have any problem, if I conceive?

Most women with fibroids go through the pregnancy without much problem. Pain and pressure could be at times be worrisome but settle with simple medication. Premature delivery or tardy labour are also concerns. Surgery for fibroids is needed very rarely during pregnancy, if there are complications like twisting or degeneration of fibroids.

I have had fibroids for several years, and they have never caused me any problem. But now that I am pregnant, I am worried that they will cause problems.

Fibroids occur most commonly in women over 35, and since women in that age group who are having babies are increasing, fibroids are becoming relatively common in pregnancy (estimates range from 1 to 2 women in 100). The vast majority of pregnant women with fibroids can expect to go to term without added complications related to this condition. Occasionally, these do cause problems, increasing the risk of ectopic pregnancy, miscarriage, placenta praevia (a low-lying placenta), abruptio placenta (a premature separation of the placenta from the uterine wall), premature labour, premature rupture of membranes, stalled labour, and breech and other foetal malpositions. Discuss the problem of fibroids with your doctor so that you become better informed on the condition in general and the risks in your particular case and be particularly attentive to symptoms that could signal impending trouble.

Sometimes a woman with fibroids notices pressure or pain in the abdomen, and though it should be reported to the doctor, it usually is not anything to worry about. Bed rest and safe pain relievers for four or five days usually bring relief. If doctors suspect that the fibroids could interfere with a safe vaginal delivery, they may opt to deliver by caesarean section.

I had a couple of fibroids removed a few years ago. Will these cause problems now that I’m pregnant?

In most cases, surgery for the removal of small uterine fibroid tumors does not affect a subsequent pregnancy. Extensive surgery for large fibroids could, however, weaken the uterus; it may be unable to tolerate labour. If, on reviewing your surgical records, your doctor decides that this might be true of your uterus, a caesarean delivery will be planned. You should become familiar with the signs of early labour, in case contractions begin before the planned surgery. And if you do go into labour, you should rush to the hospital immediately.

 

Weight Gain

I have not gained any weight even after the 3rd month of my pregnancy. I have been told that I should gain about 1 kilo every month. I am worried if my baby will not have proper growth?

Because of vomiting, nausea and altered appetite, it is not uncommon that in the first three months of pregnancy, women may not gain any weight and in fact, some women may even loose one or two kilos. This will not affect the growth of the baby.

My weight is 80 kilos. I am in my 2nd month of pregnancy. I do not want to gain any more weight since I am already overweight.

With whatever weight you start, you must gain at least 10 to 12 kilos of weight by the time you are ready for delivery. This is not the time to cut down your diet and to regulate your weight. In fact, if you do not gain at least 10 kilos, it is likely that your child will be born underweight and prone to certain growth restriction problems.

 

Risks

I am 38 and pregnant I have read so much about the risks of pregnancy after 35. I am worried.

In women over 35 years there a greater chance of having a baby with Down’s syndrome (associated with mental retardation) This risk increases with the mother’s age: (1 in 10,000 for 20 year old mothers, and 1 in 100 for 40 year old mothers.) Antenatal diagnosis is possible through special tests like amniocentesis. The chromosomal study of the cells cultured from the amniotic fluid will rule out such genetic disorders. If however, a problem is detected, the decision regarding continuing the pregnancy is to be discussed with a genetic counsellor.

There are more chances of developing high blood pressure, diabetes and cardio vascular disease which will require closer surveillance

Older mothers are more prone to miscarriage, preterm labour and post partumhemorrhage. In some women, a decrease in muscle tone and joint flexibility may cause difficult labour. Incidence of operative deliveries is higher.

I am only 32, but my husband is over 50, does advanced paternal age pose risks to a baby?

Throughout most of history, it was believed that a father’s responsibility in the reproductive process was limited to fertilization. Only during this century it was discovered that a father’s sperm held the deciding genetic vote in determining his child’s sex. And only in the last few years has it begun to be postulated that an older father’s sperm might contribute to birth defects such as Down’s syndrome. From the isolated studies that have been done, there is some evidence that in about 25% or 30% of Down’s syndrome cases, the faulty chromosomes can be traced to the father.

 

Contraception

I am recently married, I am 23 yrs old. I don’t want to conceive for another 2 years. Please advice.

Since you are recently married and young, you can use the Barrier method of contraception namely, condoms. It is safe and effective if used correctly. However, if you feel that it may interfere with your pleasure the other alternative for you would be to use the Oral Contraceptive pills. The pills are the most effective, reliable method if used correctly. Its effect is reversible and you will conceive in 3 to 6 months of stopping the pill. The present day newer pills are very low dose, with minor side-effects occasionally, like nausea, vomiting, breast tenderness etc. However you must consult your gynaecologist before you start the pills.

Will the use of contraceptives have any side effects? Like not being able to conceive in future?

All the contraceptives have minor side-effects, for e.g., while using condoms, very rarely allergy to latex, the material used to make condoms, has been reported. Oral contraceptive pills may cause nausea, vomiting, breast tenderness.

With CuT, there may be a little excess bleeding during menses or occasional pain during menses. But all these side-effects are very minor and treatable. These effects disappear on stoppage of using the contraceptive. Conception generally occurs within 1 month to 1 year after stopping any method of contraception. So, one need not worry about not conceiving in the future.

What is Cu-T ?

It is a copper bearing intra-uterine device, which is inserted into the uterus by a professional. It is recommended for women who already have one child and wish to delay the 2nd pregnancy. It can remain in the uterus for 3 years. It acts by preventing the implantation of the fertilized ovum. It has nylon threads which hang out through the cervix into the vagina. The woman can and should regularly check the threads to ensure that the Cu T is in place.  The woman is advised to come for periodic check­up to make sure all is well. It is a safe and effective method of contraception.

Is usage of condoms harmful?

Condoms are the most commonly used contraceptive and when used along with a spermicidal, it is an effective method of birth control. Its usage is definitely not harmful. The only disadvantage being, it requires the couple to interrupt their love-making. Some people also feel that it reduces sensitivity. Very rarely allergy to latex is reported and if that occurs the couple has to discontinue using it. In fact condoms offer protection against sexually transmitted diseases, including HIV and AIDS.

Safe sex please!!!

I have two children and we have decided not to have any more. I am 33 years old. Kindly suggest the options.

Since you have completed your family, you could either go in for a permanent method of contraception, namely, sterilisation or you could use a Cu T, which is an intra uterine device. You could either undergo the regular conventionalTubectomyor the Laparoscopic method. (This is almost irreversible). The other option is to use a Cu T, which needs to be changed once in 3 to 5 years. Some Cu T, have a life span of 8 to 10 years. If you are wary of undergoing an operative procedure, this is a viable option for you.

Is there any injection that one could take for preventing pregnancy?

There are two types of injectables that you can take to prevent pregnancy. One is the Progestin-only injection, called Depo-Provera or the Oestrogen containing injectable called NET EN. The latter is not available in India. Depo injection can be initiated within seven days of menstruation or within six weeks post-partum. (Post-Delivery) It should be correctly taken once in two months. If you are more than a week late for your next injection, you can take the injection but you need to back it up with a spermicide or condoms.

After an unprotected intercourse, is there any way pregnancy could be prevented?

Yes, but this method is to be used only in cases of emergency. It consists of taking pills with large-doses of oestrogens. It must be started within 72 hours of unprotected intercourse. Two pills have to be taken at an interval of 12 hours. It is said to be 98% effective.

Please let me know which the safe period is and what is the unsafe period?

This is calculated depending on the date on which ovulation is most likely to occur. Suppose a woman has regular 28 days cycle, the ovulation is most likely to occur on the 15th day, but could happen anytime between the 13th to the 17th day. A woman can calculate as to when she will ovulate. The sperm can live in a woman’s cervix for up to about 72 hours. Four days before this are also unsafe and since the egg is fertilizable even 24 hours after ovulation. This gives approximately a total of 10 unsafe days from the 9th to the 18th day of the cycle. The other part of the cycle is the safe period, where you can have an unprotected intercourse, without the fear of conception.

I am 40 yrs old and having cycles once in 35 to 40 days. Are there any chances that I could become pregnant? Do I need to use contraceptives?

Yes, although your cycles are irregular, there are chances that you may conceive. Hence, it is better that you consider using contraceptives. You could either use one of the barrier contraceptives or you could consider having an intra-uterine device like Cu T. There is also the option of considering the permanent method of family planning, namely the sterilization method.

What is the difference between sterilisation and tubectomy?

Sterilisation is a permanent method of contraception and tubectomy is the procedure done to achieve this. It is the most effective method of birth control and also the most final solution. In the sterilisation procedure, the fallopian tubes are cut, tied and completely or partially removed. Thus the egg cannot pass from the ovary to the uterus and the sperm is unable to reach the egg. It is an effective & safe method.
Sterilisation performed in men is called Vasectomy. Technically it is a more simple, safe and effective. Half an hour of stay in the hospital and half a day’s rest is all that is needed. It is a misconception that it affects the sexual performance.

What is laparoscopic tubectomy?

This is the most common form of female sterilisation. It involves the use of an instrument called the Laparoscope. This is inserted through a small cut in the abdomen and small plastic bands are placed around a loop of fallopian tube, effectively blocking it off.  Eventually the loop withers off. This involves only a few hours of stay in the hospital and normal routine can be resumed well within a week.

What is the chance that I could get pregnant despite the use of contraception?

There is a difference between the effectiveness of contraceptives in theory and in practice. The combination pill has theoretical effectiveness of 99% which in practice drops to 96%, that means of the woman using combination pills, 4 out of 100 women become pregnant. This is mostly because of user failure (forgetting to take the pill).

If on barrier contraception, the improper use of condoms or tearing, can result in an unwanted pregnancy.

Intrauterine contraceptive devices can also fail in 3 to 4 per thousand women.

 

Incompetent Cervix

What is Incompetent Cervix?

If the cervix (the mouth of the uterus) opens or gives way under the pressure of pregnancy, well before the expected date of delivery, the cervix is said to be incompetent. If this diagnosis is made, your doctor would suggest a cervical stitch in the early part of pregnancy to hold the cervix closed.

I had a miscarriage in my fifth month in my first pregnancy. The doctor said it was caused by an incompetent cervix. I have just had a positive home pregnancy test and I’m terrified that I will have the same problem again.

An incompetent cervix, one that opens prematurely under the pressure of the growing uterus and, is estimated to occur in 1 or 2 of every 100 pregnancies; it is believed responsible for 20% to 25% of all second-trimester miscarriages. An incompetent cervix can be the result of genetic weakness of the cervix, extreme stretching of or severe lacerations to the cervix during one or more previous deliveries; cervical surgery or laser therapy; or traumatic D and Cs or abortions. Now that your incompetent cervix has been diagnosed, your obstetrician should be able to take steps to prevent it from causing you to miscarry again.

Incompetent cervix is usually diagnosed when a woman miscarries in the second trimester after experiencing progressive painless effacement (thinning) and dilatation of the cervix without apparent uterine contractions or vaginal bleeding. Ideally, doctors would like to be able to diagnose the problem before the miscarriage occurs so that steps can be taken to save the pregnancy. Recent attempts at diagnosing an opening cervix early on with ultrasound look promising.

If you have lost a prior pregnancy because of an incompetent cervix, tell your obstetrician about it. It is likely that a she would plan cerclage (suturing the opening of the cervix). This can be performed early in the second trimester (12 to 16 weeks) to prevent a repeat of this tragedy. This simple procedure is performed in the hospital after a normal pregnancy has been confirmed by ultrasound. After surgery and 12 hours of bed rest, the patient is usually allowed to get up to go to the bathroom and 12 hours later can resume normal activities. Sexual intercourse may be avoided for the duration of the pregnancy, and frequent exams by the doctor may be necessary.

Similar treatment may also be initiated when ultrasound or a vaginal examination shows the cervix is opening, even if there was no previous late miscarriage.

Usually they are removed a few weeks before the estimated due date; in some cases they may not be removed until labour begins unless there is infection, bleeding, or premature rupture of the membranes.
Regardless of which course of treatment is taken, your chances of carrying to term are good. Still, you will have to be alert for signs of an impending problem in the second or early third trimester: pressure in the lower abdomen, vaginal discharge with or without blood, unusual urinary frequency, or the sensation of a lump in the vagina. If you experience any of these, go immediately to the doctor’s office or the hospital.

My first pregnancy was rough, with several serious complications. I am very nervous now that I am pregnant again

One complicated pregnancy does not necessarily predict another complication. Often a woman who weathered high seas the first time around is rewarded with smooth sailing the next. If it was a one-time event, such as an infection or an accident, that caused the complications, then they are not likely to recur. Nor will they recur if they were caused by lifestyle habits that you have now changed (such as smoking, drinking, or using drugs).

If the cause was a chronic health problem, such as diabetes or high blood pressure, correcting or controlling the condition prior to conception or very early in pregnancy can greatly reduce the risk of repeat complications.

With my first child, I had a very uncomfortable pregnancy and labour, 42-hour labour with 5 hours of pushing came as such a shock. I am glad I’m pregnant again, but I dread another labour like the first one.

Second and subsequent deliveries (barring a few with less than ideal foetal position or some other unforeseen complication) are almost always easier than first ones, thanks to a more experienced uterus and a laxer birth canal. All phases of labour tend to be shorter, and the amount of pushing necessary to deliver generally decreases dramatically.

 

Repeat Caesareans

I had my last baby by caesarean I am pregnant again and I am wondering what the chances are of my having a vaginal delivery.

Once a caesarean always a caesarean was, until very recently, an obstetrical edict engraved in stone, or rather in the uteruses of women who have had one or more surgical deliveries. Repeat caesareans should not be considered routine. Vaginal Birth After Caesarean (VBAC) can be tried in many cases.

Whether or not you will be able to try VBAC will depend on the conditions in present pregnancy and the type of uterine incision (which may be different from your abdominal incision) made in your previous caesarean and on the reason for your caesarean section. If you had a low-transverse incision (across the lower part of the uterus), as 95% of women do today, your chances of succeeding at VBAC are good.

I had a caesarean my first time after an agonizing, long labour. My doctor said I should try to have a vaginal delivery this time, but I would rather have a caesarean and avoid another ordeal.

Many repeat caesareans are performed at the request of the expectant mothers. The most common reason for mothers to opt for the planned repeat surgical delivery over VBAC is to avoid another prolonged and painful labour.

It is normal for the human being not to want to suffer again. Discuss the options with the doctor.

 

Family History

I recently discovered that my mother and one of her sisters both lost babies shortly after delivery. No one knows why. Could that happen to me?

Though the deaths of the two babies under similar circumstances may just be coincidental, it would certainly make sense to see a genetic counselor or maternal-foetal sub specialist to get some advice. Your doctor can recommend one. For any couple that does not have information on possible hereditary defects in their families it may be wise to make an effort to learn more, possibly by questioning older family members. Because antenatal diagnosis is possible for many hereditary disorders, being armed with such information beforehand may make it possible to prevent problems before they occur or to treat them when they do.

There are several instances in our family about babies who seemed fine at birth but soon became sick and eventually died in early infancy. Will the history repeat in my case?

Among the major causes of infant illness and death in the first few days and weeks of life are what are known as inborn errors of metabolism. Babies born with this type of genetic defects are missing an enzyme or other chemical substances, making it impossible for them to metabolize a particular dietary element.

A prenatal genetic counselling is mandatory.

 

Normal delivery – My chances?

Why does my doctor say she can not assure me a normal delivery?

Towards the end of your pregnancy, (3-4 weeks before your due date), some tests are done to predict the nature of your delivery.

Tests:

  1. An internal or pelvic examination assesses the dimensions of the birth canal and whether it will accommodate the baby’s head and allows its passage through it. A perfect assessment is impossible as each body and each baby is different.
  2. An ultrasound assessment of the baby’s weight, amount of water and general normality.
  3. The ‘Non Stress Test (NST)’ checks the heart beats before labour and is predictive of well-being.

All these tests may be repeated depending on your condition. With the information from these tests, about 80% of the times, your doctor will be able to tell you about the mode of your delivery. However, during labour pains, if there are any signs of danger to the baby or mother, a C-section may become necessary. This is why the doctor usually uses the words “most probably” before predicting a normal delivery.

All along the pregnancy, my doctor was reassuring me of a normal delivery. But suddenly, they decided to operate.

During labour pains, the uterus literally squeezes the baby out through the vagina. Even though all the tests in pregnancy predict a normal delivery, only during labour, it is possible to know if the baby can withstand this uterine pressure. Some babies show stress during labour which may be harmful (or even fatal) if neglected. These cases require an urgent C- section.

Therefore, some decisions for the operation can only be taken during labour. A prolonged interval between the passing of the water and adequate labour pains is also a reason for C-section.

When the doctor says the head is not fixed, what does it mean?

The right and left hip (or pelvic) bones join to form a bowl open at both ends. It is through this ‘Bowl’ that the baby must pass before delivery.

In the first pregnancy, by the end of the 8th month (36 weeks) the baby’s head fits into the upper end of this bony bowl. After this has occurred, it is not possible for the doctor to move the head during an antenatal examination, i.e the head is “fixed”. A head that can be moved is called a “floating head”. A ‘fixed head indicates that the size of the birth canal may be adequate for normal delivery.

Do all breech deliveries occur by operation?

In a fully mature baby, the head has a larger diameter than the rest of the body. Therefore if the head is delivered first, the rest of the body will naturally have enough space to move out. In a breech delivery, the baby’s body up to the neck may deliver easily, but the head may not have enough space to be delivered. This may have serious consequences for the mother and child.

This is why, if a breech presentation occurs in the first pregnancy, a C-section is recommended as the birth passage has not been “tried out” previously.

A normal vaginal breech delivery is possible if the baby is small or if there has been a previous vaginal breech delivery.
In certain races in the world, the structure of the woman’s pelvis is broad and allows even a first breech delivery to be a vaginal delivery.

Can a twin pregnancy be a normal delivery?

The answer here is a guarded ‘yes’. Again, the position of the baby to be delivered first, decides the nature of the delivery. If it presents by the head (or vertex) or, if a small ‘first of twins’ presents by breech a vaginal delivery is possible. The second baby can usually be manipulated to follow the first.

I am afraid to have a C- Section because I have to rest for 3 months.

In earlier days, fear of the complications following a C-section made many patients refuse this operation. Now,    advanced techniques and improved suture materials, have made this procedure safe, requiring minimal post operative rest. You may sit up and move your limbs about 6-8 hours of the surgery and walk about in 12 – 24 hours time. You will require the same amount of rest as after a normal delivery.

Can I tie an abdominal binder or belt after an operative delivery?

The wound healing time is 7-10 days after the surgery. During this time, a soft abdominal binder may be used. A firm binder with space for adjustment or a post delivery belt may be used after this.

Can I feed my baby in the 1st two days after C-section?

The baby may be put to the breast as soon as you are shifted to the ward from the Operation Theatre or as soon as you have recovered from the drowsiness after surgery. It entirely depends on your comfort level. The earlier you feed, the better it is for both you and your child.

Can I climb stairs / squat after having section?

Usually, squatting and climbing stairs become comfortable 5-7 days after the C-section. This is especially true of a transverse scar.  Again, it depends on how comfortable you feel with these activities. Allow yourself time to heal and the muscle of the abdomen to regain their strength after 9 months of stretching. ‘Slow and Steady’ is the rule. Sudden short sharp pains due to muscle contraction occur up to 2 months after the surgery, as with abdominal surgery for any other reason. (Example: appendix removal) Therefore be careful when climbing stairs, while carrying your baby or any weight during this period. Remember that the muscles take 2-3 months to regain their original elasticity.