Laparoscopic Gynecologic Surgeries

All About Pregnancy-Related Stroke, Something That You Must Know Well For Healthy Pregnancy

Pregnancy in every woman is a phase that comes with immense happiness and excitement and a lot of fear. It is a stage where a woman has to be extra cautious about both her physical and mental health and must be aware of an imminent risk that may affect her baby inside the womb. Interestingly, the risk of a type of stroke that causes bleeding in the brain has been found to be higher among women during pregnancy and in the weeks following the delivery, as per a new study. It has shown that women have an increased risk for stroke-causing blood clots during pregnancy and the postpartum period and have three times the risk of intracerebral haemorrhage compared to women who are not pregnant. The approximate rate of pregnancy-related stroke stands at 30 per 100,000 pregnancies. Though it is not common, it is a matter of concern for women and newborn health that needs to be addressed at the earliest. 
 
Risk factors leading to pregnancy-induced stroke
 
With an increasing prevalence of obesity, pregnant women are found to be at a greater risk of getting hit by a stroke during the gestational period or immediately after delivery. Other risk factors of pregnancy-related stroke include:

• Hypertension

• Diabetes

• Valvular heart disease

• Hypercoagulable disorders

• Sickle cell disease

• Lupus

• Abuse of tobacco 

 
High blood pressure during pregnancy: It is one of the leading risk factors that may lead to stroke during pregnancy. Interestingly, women with otherwise healthy blood pressure level may develop high blood pressure during pregnancy and may result in stroke among pregnant women or women who have recently given birth. 
 
Preeclampsia: It is a severe kind of high blood pressure during pregnancy and can cause vision problems, headaches, swelling in the hands and face, premature delivery, and a baby with low birth weight. Severe preeclampsia may also cause seizures and lead to stroke during or after pregnancy. 
 
Gestational Diabetes: Women with gestational diabetes, a condition where pregnant women develop problems with blood sugar during pregnancy are more prone to the risk of getting high blood pressure during pregnancy and stroke, in severe cases. 
 
Blood clots: During pregnancy, there are more chances of a blood clot which can lead to stroke. Pregnancy may lead to swelling in certain parts that curb the blood flow, typically to the lower legs. When there's less blood circulation, the chances of developing blood clots get higher. Also, towards the end of pregnancy, the body produces a substance that helps the blood to clot. While that reduces the chance of excessive bleeding while delivery, it also increases the risk of getting a stroke.
 
Consult the best gynaecologist in Bangalore if you have any doubt related to pregnancy. There are high-risk pregnancy doctors in Bangalore who are expert in dealing with high-risk pregnancies.
 
Deciphering the signs of pregnancy-related stroke
 
The keystroke symptoms during or immediately after pregnancy include sudden numbness or weakness in the face, arm or leg, especially on one side of the body, sudden confusion, trouble while speaking or difficulty in understanding speech, sudden difficulty in seeing, walking, dizziness, balance loss, lack of coordination and sudden severe headache without a known cause. 
 
Ways of preventing stroke during pregnancy
 
Pregnancy is a hyper-coagulable state due to hormonal changes associated. History of stroke or severe migraine with aura after taking hormonal medication such as oral contraceptives increases chances of stroke in pregnancy. Importance of pre-conceptional consultation to assess risk factors before planning a pregnancy. Here are some tips for a healthy pregnancy that would help in preventing stroke. 
 
Quit smoking: Using tobacco products before or during pregnancy may increase the risk of stroke. It is essential to quit smoking at that time. 
 
Maintain healthy body weight: Having a well-balanced and healthy body weight to help get healthy blood pressure and blood sugar levels during pregnancy. It is important to aim for a healthy body weight during pregnancy. 
 
Eat healthy foods: Have a diet that is rich in whole grains, nuts, healthy fats, fruits and vegetables and low in sodium that can support healthy blood pressure and sugar levels. 
 
Be physically active: About 30 minutes of moderate exercise and activities are a must for pregnant women to get healthy pregnancies. 
 
Coordinate well with the healthcare team: One must talk to the doctor about the risk of stroke or other problems at the time of pregnancy and should monitor blood pressure and blood sugar well throughout the pregnancy. 
 
Talk to the gynaecologist in Bangalore to know more about do’s and don’ts during pregnancy.

Pregnancy During Covid-19 Crisis: A Guideline For Expecting Mothers

Pregnancy is probably one of the most sensitive times in a woman’s life. The global Coronavirus outbreak that comes with loads of anxiety, fear and life like never before has made pregnant mothers even more worried. They are confused and not certain about what they should do and they should not. They have ample confusion and queries about whether the deadly virus can pose a threat to their newborns in the womb, what precautions they must take to remain safe from Covid-19 during the gestation and immediately after the delivery or how they keep their mental health fit during and post-pregnancy. Here is all a pregnant mum must know about the impact of a pandemic on the health of the mother and the new-born and the various ways both can remain healthy during the crisis time. 

How Covid-19 can affect pregnancy?

There is no evidence that reveals carrying a baby makes a woman more prone to contracting Coronavirus compared to other healthy adults without any co-morbidities. In case a pregnant woman tests positive for Covid-19, she may not be at a greater risk of developing severe complications as well. However, during pregnancy, the efficiency of one's immune system may decrease and that is why a pregnant woman must be more careful particularly at the present situation and follow the norms of social distancing and self-quarantine.

A pregnant woman may experience flu-like symptoms - mild to moderate, like most others. However, if the flu-like symptoms worsen in a pregnant woman or there is a delay in recovery, it may indicate the severity of the chest infection and that may require immediate hospitalization. 

Although Covid-19 is a new and evolving virus and not adequate evidence is available at present, it is not confirmed yet that Coronavirus may increase the risk of a miscarriage. Also, vertical transmission meaning direct transmission of the virus from the mother to the unborn baby has not been substantiated till now. A recently conducted Lancet study on women in their third trimester has shown that the risk of vertical transmission of Covid-19 is low and there is no evidence of foetal malformations due to maternal infection with Covid-19. 

Tips for pregnant women to remain safe from Coronavirus during pregnancy

Pregnancy is a critical time, especially the first trimester. Tackling Coronavirus during pregnancy certainly needs extra caution. These suggestions may result in a smooth pregnancy during the Covid-19 time.

• Be aware of the infection: It is essential for a would-be-mum to know about the virus - particularly its symptoms so that she can take immediate steps and visit a doctor in case they experience any. She must know the mode of transmission as well so that she can take necessary precautions to prevent contraction.

• Do not violate the prevention guidelines: It is wise to follow the social distancing guidelines set up by the government. Pregnant women must not visit crowded areas, wear a mask while going out in case of an emergency, know to use a mask appropriately and not touch the back and the front side of a mask must follow respiratory, hand hygiene and social distancing diligently.

• Maintain your regular check-ups: Skipping regular check-ups during pregnancy is not at all recommended. However, during the Coronavirus crisis, it is wise to opt for tele-consultancy/ online consultancy and get the routine check-ups done on time. ICMR has advised the mandatory visits to the hospital for pregnant women in 3rd, 5th, 7th and 9th months as they also involve other tests such as fetal scans and vaccines.

• Avoid touching face, eyes and nose: Despite washing hands thoroughly it is wise to not touch face, eyes and nose repeatedly as it may turn out to be harmful to the baby and the mother. 

• Sleep well: It is essential to get adequate sleep during pregnancy. Good sleep helps in enhancing body immunity and keeps one energetic. Sleep is particularly necessary for the baby in the womb. 

• Eat well: Due to decreased immunity during pregnancy, it is important to get a balanced and nutritional diet. The appropriate diet amps up the body's ability to fight against diseases. 

Coronavirus and breastfeeding - Things to keep in mind 

In case a new mum is tested positive for Covid-19, she can breastfeed her newborn. The reason, breastfeeding a child is far more beneficial compared to the risk of transmission of the virus through breast milk. However, there may be a risk of droplet infection due to close contact between the mother and the child during breastfeeding and the virus can spread to the baby while breaking. The following tips may help a Coronavirus positive new mum breastfeed her newborn without the fear of transmitting the virus.

1. Wash hands before feeding or touching the baby, breast pump or bottles

2. Try to avoid coughing or sneezing while feeding. Wearing a mask while feeding may help. 

3. While using a breast pump, follow instructions for cleaning and sterilizing properly.

4. Consider asking one of your healthy family members to feed your baby if you are expressing milk. 

 Following the doctor’s advice and working on mental health can make pregnancy, delivery and post-partum hassle-free and without worries during this crisis. 

Coronavirus and pregnancy: Keeping the mental health intact 

Social distancing and the complete lockdown have disrupted our lives to a large extent. Life will not be the same post lockdown as well. Social distancing may result in monotony, stress, anxiety and depression among the pregnant and the new mothers. Here are things that can help them keep their mental health fit.

• Do not panic: There is no need to panic and get scared about the Covid-19 outbreak. Take the required precautions and let go of panic and stress. 

• Stay away from news and fake content on social media: It is wise to not watch news related to Coronavirus continuously. Also, stay away from rumours related to the virus. 

• Keep in virtual touch with family: It is always good to remain among family and close friends during pregnancy as it keeps an expecting mother happy and stress-free. During the lockdown remain in touch with your family members online, do video calls and chat with them. 

• Remain physically and mentally active at home: Do exercises at home, sign in for online yoga and meditation classes, cook healthy food, try new recipes, engross in creative art, watch happy movies, listen to good music and de-stress. Keep away from smoking and drinking.

The surprising link between oral health and pregnancy

Can Oral Health Have an Effect on Pregnancy?

Recent research indicates a link between gum disease and childbirth complications. Pregnant women who have gum disease may be more likely to have a baby that is born too early and too small.

More studies are needed to confirm the exact correlation between gum disease during pregnancy and labor complications, but it appears that gum disease may trigger increased levels of biological compounds that induce labor. Data also suggests that when periodontal disease worsens during pregnancy, there's a higher risk of having a premature baby.

What Can I Do to Ensure I Have a Healthy Pregnancy?

Pregnancy and dental care are important for a healthy baby. Pregnant women and women who plan on getting pregnant should visit their dentist for a checkup and to treat any dental problems before conceiving.

Regular brushing and flossing, eating a balanced diet and visiting your dentist regularly will help reduce pregnancy dental problems.

What Oral Problems Might Develop During My Pregnancy?

Many pregnant women experience pregnancy gingivitis — when dental plaque builds up on the teeth and irritates the gums. Symptoms include red, inflamed and bleeding gums.

Pregnancy gingivitis occurs due to increased levels of hormones that influence the way gums to react to the irritants in plaque.

Keeping your teeth clean, especially near the gum line, will help dramatically reduce or even prevent gingivitis during pregnancy. 

What Can I Expect When I Visit My Dentist During My Pregnancy?

First, be sure to let your dentist know you're pregnant when you schedule your appointment. It's best to schedule your dental visit during the fourth to sixth month of your pregnancy. Avoid seeing a dentist during the first three months of pregnancy, are thought to be of greatest importance in your child's development and the stress of a dental visit may be detrimental to the foetus.

Typically, X-rays, dental anesthetics, pain medications and antibiotics (especially tetracycline) are not prescribed during the first trimester, unless necessary. 

During the last trimester, prolonged sitting in a dental chair can become uncomfortable and a dental examination may be infeasible.

If you need to schedule an emergency visit, let the dentist know about your pregnancy before you arrive. Discuss any relevant medical history, stress factors, past miscarriages and medications you are taking as these can influence your dental care plan and outcomes.

Avoiding A Toothache During Pregnancy

It is recommended by dental specialists that women see a dentist before they plan a pregnancy. This way, the office can do a thorough checkup and cleaning, as well as treat any existing dental problems. Of course, you can also consult a dentist while pregnant.

When you experience a toothache or gum problems during pregnancy, see a dentist as soon as possible for treatment. Dental health issues can adversely affect your pregnancy and early intervention is important for both mother and child.

Avoiding Tooth Decay

Cavities are formed when the bacteria in your mouth use the sugars and carbohydrates present in food to produce acid, which dissolves the enamel on your teeth. 

Pregnant women are at increased risk for developing tooth decay due to a number of reasons: unhealthy food cravings, decrease in brushing and flossing and vomiting as a result of morning sickness can intensify the amount of acid in the oral cavity.

To prevent tooth decay, brush your teeth twice a day, using a soft brush and appropriate toothpaste. Keep sugary snacks to a minimum. Rinse your mouth with water when you aren't able to brush, and floss once a day. 

It's fairly common for an expecting mother to complain about bleeding gums when brushing or flossing. Hormonal changes that come along with pregnancy can cause inflammation, sometimes called pregnancy gingivitis. To keep this condition from developing into more serious gum disease, intensify your dental care routine by using an antibacterial mouthwash and seeing your dentist for more frequent cleanings.

Look Out for Gum Disease

Some pregnant women experience a raw-looking swelling of gum tissue called a "pregnancy tumor" grows between the teeth. These growths bleed easily and may be caused by excessive plaque. Consult a dentist if you suspect you have a pregnancy tumor, even though they are usually benign.

Another uncommon complication of pregnancy is loose teeth. This can develop due to hormones affecting the ligaments that hold the teeth in place.

Pregnancy dental care is an important part of your general health and the health of your baby. This is why, for a safe and healthy pregnancy, dentists and obstetricians encourage women to make their oral health a priority.

Oral hygiene maintenance during pregnancy

Unless it's a dental emergency, plan your dental visits throughout the entire pregnancy. Start by scheduling an appointment prior to becoming pregnant. That way, any necessary procedures can occur before you become pregnant. 

The first trimester isn't ideal for dental treatments as the fetus is in the initial stages of development. Instead, schedule non-emergency visits for the second trimester or early in the third trimester.

There a few experiences in a woman's life as special as being pregnant. Seeing a dentist while pregnant is often overlooked but it is important that you don't forget to maintain good oral health. That includes teeth cleaning while pregnant. 

Brush at least twice each day with good toothpaste and don't forget to floss, as it complements brushing by removing food particles that stick in places a brush can't reach. Taking care of your mouth ahead of time will allow you to focus on the joyful arrival of your child.

Management of High Risk Pregnancy

How can high-risk pregnancies be managed?

For all women who are diagnosed with a high-risk pregnancy, treatment options vary depending on the risk factors specific to the pregnancy and the woman’s medical history.

High Blood Pressure

It is important to regulate blood pressure during pregnancy which can be done by making some changes in the high blood pressure medication. Certain diet and lifestyle changes may also be recommended to keep the blood pressure under control.

Gestational Diabetes

Gestational diabetes, or developing diabetes during pregnancy, increases the risk of pregnancy complications. Often times the woman is diabetes only during pregnancy and is normal after the delivery. Many women having gestational diabetes have healthy pregnancies and healthy infants provided they follow a recommended diet and treatment plan. Some important points to be considered by a woman diagnosed with gestational diabetes include:

1. Regular monitoring of blood sugar level and maintaining control. A woman diagnosed with gestational diabetes must regularly track her blood sugar levels by testing several times a day.

2. Eating a healthy diet. A low carbohydrate diet with meals spread throughout the day helps to keep blood sugar under control. As diet plans may vary for each individual’s needs, one must always follow a diet as recommended by a dietician and the doctor.

3. Maintaining a healthy weight. The amount of weight gain that is healthy for a woman will depend on how much she weighed before pregnancy. It is important to track both overall weight gain and the weekly rate of weight gain.

4. Maintaining a daily record of diet, exercise, and glucose level. A woman with gestational diabetes should write down her blood sugar numbers, physical activity, and everything she eats and drinks in a daily record book.

Some women with gestational diabetes will also need to take medicine, such as an oral hypoglycemic tablet or insulin to help manage their diabetes.

HIV Treatment

HIV infection can be passed from a mother to her fetus as well as during childbirth and breastfeeding, but treatment can prevent transmission.

What steps can be taken to promote a healthy pregnancy?

Staying healthy is probably the first step that one needs to do to lower the risk of having a difficult pregnancy. With the increasing incidence of high risk pregnancies in the current times, it is highly recommended to follow a healthy lifestyle and also consider a pre conception evaluation by a health care providers to ensure fitness for a pregnancy.

Even during the pregnancy, there are steps that can be taken to reduce the risk of certain problems:

1. Taking at least 400 micrograms of folic acid (a type of vitamin B) every day before and during pregnancy.

2. Getting proper immunizations.

3.  Maintaining a healthy weight; eating a good diet; getting regular physical exercise.

4.  Smoking, alcohol, or drug use should be strictly avoided.

5.  Prenatal care appointments early during pregnancy and visiting a health provider for regularly scheduled appointments throughout the pregnancy should be given prime importance.

Management of High-Risk Pregnancies at Sakra World Hospital 

Sakra World Hospital being a multidisciplinary hospital has a highly qualified and experienced team of specialists from all departments. Our high-risk obstetrics team offers a well-coordinated comprehensive continuum of care for the management of complicated pregnancies throughout pregnancy, childbirth, and beyond to protect both the mother and the baby.

Being a tertiary care hospital, multidisciplinary team involvement is built in to give the best outcome. Experts in neonatology, critical care, endocrinology, rheumatology, cardiology, neurology, nephrology, gastroenterology, urology, interventional radiology, transfusion medicine, laboratory medicine are all available round the clock.

Sakra Advantages – All under one roof:

    1. Exclusive labor and delivery rooms specially designed to create a living and safe setting during childbirth.
    2. Options for painless labor using analgesic and breathing techniques
    3. Ultra-modern operation theatres dedicated to obstetrics
    4. Day assessment unit
    5. Early pregnancy assessment 
    6. High dependency unit 
    7. Intensive care unit
    8. Neonatal ICU
    9. Round the clock blood bank services
    10. Laboratory medicine 
    11. Interventional radiology

High Risk Pregnancy

What is a High Risk Pregnancy?

A high risk pregnancy is the one in which some conditions puts the mother or the developing fetus or both at higher than normal risk of developing complications during or after the pregnancy and birth. Such women and their babies need close monitoring and care throughout the pregnancy. It is essential to understand what causes a high risk pregnancy and to manage it properly at the right time. 

What are the factors that increase the chances of a High Risk Pregnancy?

Pre-existing conditions/factors that can increase the chances of a High Risk Pregnancy include:

    1. Heart disease
    2. High blood pressure
    3. Kidney problems 
    4. Diabetes
    5. Thyroid disorders
    6. Epilepsy
    7. Respiratory disorders like asthma
    8. Autoimmune diseases (like SLE, Rheumatoid arthritis, APLA)
    9. Blood disorders (anemia, thalassemia, sickle cell disease, ITP, etc.)
    9. Underlying mental health conditions 
    10. Family history of high risk pregnancies, or genetic conditions
    11. Problematic past pregnancies
    12. Including previous adverse pregnancy outcome, repeated pregnancy losses, preterm labor
    13. Habits like – smoking, drinking alcohol, using illegal drugs
    14. Being overweight or underweight
    15. Maternal age over 35 years

Pregnancy complications - Various complications that develop during pregnancy pose risks, such as problems with the uterus, cervix or placenta. 

Other concerns might include too much amniotic fluid (polyhydramnios) or low amniotic fluid (oligohydramnios), restricted fetal growth, or Rh (rhesus) sensitization — a potentially serious condition that can occur when the mother’s blood group is Rh negative and the baby's blood group is Rh positive.

Other conditions/factors that can develop during pregnancy include:

    1. Preeclampsia (high blood pressure during pregnancy that can affect the mom-to-be’s liver, kidneys and brain)
    2. Gestational diabetes (diabetes that develops during pregnancy)
    3. Preterm labor (labor that starts before 37 weeks)
    4. Placenta praevia (placenta lying unusually low in the uterus so that it may be covering the cervix, which can cause excessive bleeding during delivery)
    5. Pregnancy with more than one baby (multiple pregnancies)

What else you must know about high-risk pregnancy?

Consult your health care provider about how to manage any medical conditions you might have during your pregnancy and how your health might affect labor and delivery. Ask your health care provider to discuss specific signs or symptoms to look out for, such as:

    1. Vaginal bleeding
    2. Persistent headaches
    3. Pain or cramping in the lower abdomen
    4. Watery vaginal discharge — in a gush or a trickle
    5. Regular or frequent contractions — a tightening sensation in the abdomen
    6. Decreased fetal activity
    7. Pain or burning with urination
    8. Changes in vision, including blurred vision

Also, find out which signs or symptoms should prompt you to contact your health care provider and when to seek emergency care.

A high-risk pregnancy might have ups and downs. Do your best to stay positive as you take steps to promote a healthy pregnancy.

How is a High risk pregnancy diagnosed?

A high risk pregnancy can be detected at an early stage in the pregnancy with a complete medical history of the mother, a thorough medical examination supported by certain investigations. Continuous monitoring of physical health and personal habits help a health care provider in identifying any risks/problems that develop during pregnancy. 

Once a diagnosis has been made, the woman with a high-risk pregnancy should receive specialized care from a team of health care providers adept in managing high risk pregnancies throughout the pregnancy to ensure that she carries the fetus or fetuses to term.

Get Closer to Your Baby’s Life Inside the Womb

Fetal medicine and its role in pregnancy

Fetal medicine is a specialty that provides a holistic approach towards fetal care and works in sync with Obstetrics and Gynecology to ensure a safe and healthy delivery. All kinds of specialized diagnostic and fetal screening tests necessary for monitoring the developing fetus are performed to ensure timely prenatal diagnosis and thus improved prognosis before and after birth. 

What to expect at your Appointment with a Fetal Medicine specialist?

Before your appointment 

    1. You should always try and go assisted by a family member for the appointment. It is also suggested to avoid taking small children along. 
    2. For Early Pregnancy Scan -  you need to have a full bladder, but not so full that you are uncomfortable
    3. For all other pregnancy scans: you do not need to have a full bladder for the scan.
    4. Always carry your maternity notes, scan reports, and prescriptions with you.

At your appointment:

During the Scan

    1. You will have to lie on your back in the scan room with your tummy uncovered.
    2. The lights in the room will be dim for a clear view of the screen.
    3. A gel will be spread on your tummy so that a hand-held probe can be easily moved backwards and forwards over it.  The probe sends sound waves through your tummy.  The sound waves bounce back off the      baby and are translated into an image on the screen.

After your scan

    1. The results will be explained to you and a scan report with details of the examination will be released in a few minutes.
    2. Your next scan will be scheduled accordingly.                     

What is the need of different ultrasound scans during pregnancy?

There are several reasons why it is essential to take different ultrasound scans for women between 11 to 14 weeks of pregnancy.

    1. To see the baby’s heart beating
    2. Check whether there is just one baby
    3. Confirm how many weeks pregnant you are by measuring the baby
    4. Check for any major abnormalities
    5. To do screening for Down’s Syndrome 

What are the different types of Scans?

Early pregnancy scan (5 to 11 weeks) 

 This scan is done to locate the pregnancy, check the baby’s heart beat and diagnose multiple pregnancies.

Nuchal translucency scan (11 to 13 weeks + 6 days) 

This scan is done to assess the risk of chromosomal problems and rule out fetal anomalies in the baby.

Early Anomaly Scan (16 to 17 weeks)

Routine Anomaly scan (18 to 20 weeks) 

This scan helps to assess the baby’s growth, basic echocardiography, rule out anomalies, and check the placenta.

Fetal Echo (18 to 24 weeks) 

Fetal echo is a complete study of the baby’s heart.

Growth scans (24 weeks onwards)

These scans can be done according to the need any time after 24 weeks and are mainly done to assess baby’s growth, the amniotic fluid around the baby and to assess the blood supply to the baby (Doppler study).

What are the tests done under fetal medicine?

SCREENING BLOOD TESTS

    1. Double marker (10 to 13 weeks + 6 days)
    2. NIPT (Non Invasive Prenatal Testing) (10 weeks onwards)
    3. Quadruple test (16 to 21 weeks)

DIAGNOSTIC TESTS

CVS (11 to 14 weeks)

CVS is a test carried out during pregnancy, which involves removing tissue from the placenta to detect chromosomal abnormalities such as Down syndrome and some other genetic conditions, such as sickle cell disease or thalassemia major, if your doctor has asked for you to be tested for these.

Amniocentesis (15 weeks onwards)

Amniocentesis is a test carried out during pregnancy which involves using a fine needle to remove a small amount of the amniotic fluid around your unborn baby. Amniocentesis is used to detect chromosomal abnormalities such as Down syndrome. It can also detect certain other genetic conditions, and fetal infections. 

OTHERS

    1. Amnio Drainage/ Reduction 
    2. FBS (2nd Trimester onwards)

How to breastfeed?

Women have been breastfeeding since the beginning of time, but it cannot be stated that every woman is always prepared to breastfeed. Every woman who experiences childbirth for the first time is completely new to breastfeeding as well. Nursing can be a little tough in the beginning, but with patience, effort, guidance and lots of support, both the mother and the baby can get a hold of it.

It is always good to try and learn breastfeeding in the hospital as soon as possible and be get guidance from a nurse or a lactation consultant. Though a newborn knows instinctively how to suck, getting his lips and your nipple in the right position (called "the latch") may take some time to settle. Minor adjustments might be required as the nipple may slip out of baby's mouth, or the baby may not know, or may cry, or may just be too sleepy from the birth process.

The mother should not get discouraged due to the small challenges that might come in the beginning. These can be dealt with the help of nurses and lactation consultants or an older women in the family and can develop an understanding and get comfortable with the whole process. Also even if does not get right for several hours (or a whole day), the baby will not starve. 

Since feeds can take anything from five to 40 minutes, the mother should always be seated in a comfortable position for breastfeeding. It is important to have calm and comfortable surroundings especially in the early days of breastfeeding until one gets accustomed to it. 

The baby should be held in a position that is comfortable for the baby as well as the mother to avoid any pain in the arm or the back. Cushions and pillows can be used to give support to the baby or the mother's hand and back. Every mother and baby is unique and will have their own breastfeeding style.

It the latching or the sucking hurts, the suction can be interrupted by inserting the little finger in the corner of the baby's mouth between the baby's gums and the nipple. Once the baby latches on properly, the feeding can resume.

Always let the baby feed fully from just one breast rather than alternating between both breasts, which can lead to the baby getting more of watery foremilk, but not enough of the fat-enriched hindmilk. This can lead to a fussy baby who wants to breastfeed often.

If the baby still feels hungry after feeding on the first breast, the second can be offered. But always remember to burp before restarting the feed. And after every complete feed.

Some Breastfeeding positions

What are the common problems that one can face in breastfeeding?

Some women adjust to breastfeeding easily while many new mothers find it hard to get used to it. A new mother’s breasts have never been subjected to the jaws of a hungry newborn before, so for most moms, it hurts in the beginning. In the first six weeks, as mother’s milk supply adjusts and the baby learns how to breastfeed, and the mother may suffer from some of the following problems:

1. Engorgement - overfull breasts

2. Mastitis – an infection in the breasts due to bacteria that enter the breast and multiply in the milk duct causing pain and inflammation.

3. Cracked, bleeding or sore nipples                                                     

Breastfeeding takes patience and practice. The mother should never lose hope and whenever faced with a problem should always seek help or advice. 

What is the right time and the right process to stop breastfeeding?

According to World Health Organization it is recommend that babies are given only breast milk for their first six months. This is called exclusive breastfeeding. It is also said that women should carry on breastfeeding even after their babies have started on solid food, until the end of the first year and beyond if they wish. 

Doctors advise breastfeeding exclusively for about six months. After which the baby can be supplemented with semi-solid diet while continuing to breastfeed, until the baby stops taking breast milk completely. Some mothers choose to stop breastfeeding (this is known as weaning) when the baby starts eating a wide variety of food.

Breastfeeding is not a choice. It is a responsibility

It is an act that not only helps you feed your baby but one that builds a special bond between you and your baby.

What are the benefits of breastfeeding for the baby?

It is the best source of nutrition for the baby as it contains all the essential vitamins, fats and proteins that are important for the baby’s growth, and are made available in a form that is easily digestible for the baby. Breast milk contains antibodies that boost immunity and helps your baby fight off various viral and bacterial infections.  It also protects the baby against many allergies and is known to significantly reduce the child’s risks towards cancers. It lowers your baby's risk of having asthma or allergies along with other common infections.

Breast feeding is also known to significantly reduce the incidence of stomach infections, lower respiratory infections, ear infection and meningitis in children. It also prevents children from a lot of diseases that develop later in life, like – type 1 and 2 diabetes, high cholesterol and inflammatory bowel diseases and conditions like obesity as well.

How does breastfeeding benefit the mother?

Breastfeeding is not only beneficial for the baby but also has many benefits for the mother. Apart from building the emotional bond between the mother and the baby, breastfeeding is very healthy for the mother as well. It even fastens the mother’s recovery from childbirth. The hormone oxytocin, released during breastfeeding, acts to return the uterus to its regular size more quickly and can reduce postpartum bleeding. 

It is also seen that women who breastfeed, experience reduced rates of breast and ovarian cancer later in life. Breastfeeding can also reduce the future risk of developing type 2 diabetes, rheumatoid arthritis, and cardiovascular disease, including high blood pressure and high cholesterol, in women. It can also help protect you against ovarian cancer and weak bones (osteoporosis) later in life. 

Exclusive breastfeeding also acts as natural form of contraception as it delays the return of the mother’s normal menstrual period, thus increasing the time between pregnancies. 

What is the essential diet and nutrition requirement of a breastfeeding mother?

It is important to have a good nutritional diet for a lactating mother for the following reasons:

    1. For sufficient production of breast milk  
    2. For providing adequate nutrients to the infant
    3. To meet the mother’s daily needs

The nutritional requirements of a breastfeeding mother are similar to those of a pregnant woman. It is recommended to continue eating just as they were eating during the pregnancy. However, breastfeeding mothers need a little more amount of calories. The lactation period demands an additional 500kcal in diet. Lactating mothers should also take a diet rich in proteins, vitamins, iron and calcium. 

High proteins products like – cereals, pulses, whole grains, dry fruits, eggs and chicken, are good for the mother and thus provide the necessary protein supplement to the baby.

Lactating mother should abstain from consumption of alcohol and aerated drinks as well. Healthier options like fresh fruit juices, tender coconut water and lime juice can be consumed to stay hydrated. Staying hydrated is very essential as it ensures regular supply of milk. It is advised to consume minimum 8 glasses of water a day, and try to drink one glass before every feed. 

Women can also continue the supplement of iron and calcium advised to them during pregnancy, until 3 months post-delivery.

Oatmeal, is also a good option for lactating mothers, as it is helps reduce cholesterol and regulate blood pressure. It's also seen to increase the milk supply and is a good nutritional diet for lactating mothers.

Blossoming on wheels!

0n 14th Feb 2017, while Sakra World Hospital was launching its new comprehensive maternity program – Birth and Blossom, one of their trained nursing staff was doing a miraculous emergency delivery in an ambulance. It was around 3 PM when patient - Ms. Smita (name changed) called the emergency of Sakra World Hospital complaining of pain abdomen and vomiting. An ambulance was immediately sent to the address with a nurse on board to assist the patient. As soon as they reached and examined the lady it was found that she being full term pregnant, was in labor and needed to be transferred to the hospital immediately. It was barely 10 months since they had left for the hospital when the nurse observed that the baby was crowning and she might deliver before they reached the hospital. Assessing the situation the nurse (Madhu Kumar) took the courageous decision to stop the ambulance and deliver the baby with the best possible resources available. He updated the hospital immediately and another ambulance with a doctor and some more essential supplies was immediately dispatched from the hospital. Meanwhile with constant telephonic support from the team at hospital and with the help of the husband and mother in law, Madhu prepared to deliver the baby in the ambulance. He performed the entire procedure with immense courage and confidence, and considering the situation he did a commendable job using every resource in the most efficient way possible. At the end of 45 minutes when the ambulances arrived at the hospital the baby and the mother were safely moved in and admitted at Sakra World Hospital. 

Silent Epidemic: Osteoporosis has affected 200 million women worldwide

Osteoporosis is estimated to affect 200 million women worldwide - approximately one-tenth of women aged 60, one-fifth of women aged 70, two-fifths of women aged 80 and two-thirds of women aged 90.Worldwide, osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporotic fracture every 3 seconds. Overall, 61% of osteoporotic fractures occur in women, with a female-to-male ratio of 1.6. Nearly 75% of hip, spine and distal forearm fractures occur among patients 65 years old or over. A 10% loss of bone mass in the vertebrae can double the risk of vertebral fractures, and similarly, a 10% loss of bone mass in the hip can result in a 2.5 times greater risk of hip fracture. In India: Expert groups peg the number of osteoporosis patients at approximately 26 million (2003 figures) with the numbers projected to increase to 36 million by 2013.In a study among Indian women aged 30-60 years from low income groups, BMD at all the skeletal sites were much lower than values reported from developed countries, with a high prevalence of osteopenia (52%) and osteoporosis (29%) thought to be due to inadequate nutrition. It is projected that more than about 50% of all osteoporotic hip fractures will occur in Asia by the year 2050.

As osteoporosis has no obvious symptoms. Traditional X-rays can’t measure bone density, but they can identify spine fractures. Bone mineral density (BMD) has to be measured by more specialised techniques. A number of different types of BMD tests are available, but the most commonly used is DXA (dual-energy X-ray absorptiometry), capable of detecting quite small percentages of bone loss. It is used to measure spine and hip bone density, and can also measure bone density of the whole skeleton. While most limb fractures (such as at the wrist or hip) are obvious, spinal fractures can be more difficult to diagnose. This is because they might be painless, or if there is pain, a person may not know it is caused by a fracture due to the many different causes of back pain.  More obvious signs of spinal fractures are:

• Loss of height

• Development of a curved upper back (sometimes called a Dowager's Hump)

Since there are usually no outward signs of osteoporosis developing, doctors will often recommend diagnostic testing depending on your age and if you have other risk factors for the disease.

Prevention: Calcium and vitamin D supplementation reduces rates of bone loss and also fracture rates in older male and female adults, and the elderly. Ensure a nutritious diet and adequate calcium intake, Avoid under-nutrition, particularly the effects of severe weight-loss diets and eating disorders, Maintain an adequate supply of vitamin D, Participate in regular weight-bearing activity, Avoid smoking and second-hand smoking, Avoid heavy drinking.

We in Sakra have started an “Osteoporosis Clinic” the first of its kind in Bangalore to tackle this silent epidemic on Monday, Wednesday and Friday afternoons under guidance of our Endocrinologist Prof.Dr.C.V.Harinarayan.

Dr. C.V. Harinarayan
Director - Diabetes & Endocrinology
M.D. (Int. Med), D.M. (Endocrinology) (AIIMS) F.A.M.S., F.R.C.P.(Glasgow), F.R.C.P.(Edindurgh), F.R.C.P.(Lond), F.A.C.E.(USA)