The systematic supervision in the form of examination and advice to a woman during the entire duration of her pregnancy is called antenatal care.
2. What is the objective of antenatal care?
To ensure a safe pregnancy culminating in the delivery of a healthy baby from a healthy mother.
3. What is the frequency of visits to your doctor during pregnancy?
The first visit should ideally be immediately after missing a period. Subsequent visits should be at an interval of 4 weeks upto the 28th week of pregnancy. From the 28th to the 36th week, the interval between visits should be 2 weeks, followed by weekly visits thereafter, until the expected date of delivery.
4. What are the cases that require more frequent visits of monitoring?
High risk pregnancies like
• Maternal age greater than 35 years
– History of previous stillbirth/recurrent abortions
– History of previous baby with congenital anomalies
• Diabetes Mellitus
• Heart disease, Tuberculosis, Renal disease
• Multiple pregnancy
• Intra uterine growth retardation
• Decreased foetal movements
5. What are the procedures during each visit?
Blood Test – Haemoglobin
– Group & Rh
– Thyroid function tests
– Serological test
– HBV & HCV
– Blood sugar
Each Visit – Regular checkup of BP, weight
– Clinical assessment of foetal growth
Ultra Sono Graphy – The first scan is done between the 2nd and 3rd month
– 5th month scan for anomalies
– In the third trimester as per doctor’s advice
Breast examination – This is essential to check for cracked or retracted nipples, changes
in the breasts and skin areola
6. What are the Do’s and Dont’s of pregnancy?
• Wear loose and comfortable garments
• Light nutrition and easily digestible diet
• Sufficient rest. Avoid strenuous activities
• High heels should be avoided
• Travel by jerky vessels should be avoided
• Coitus should be avoided during the first trimester and in the last six weeks
7. What are the conditions for which a patient should report immediately to the doctor?
1. What are the changes that an expectant mother feels near full term?
Initially there is a feeling of relief as the baby’s head sinks into the pelvis and there is less pressure on the lungs, heart and the diaphragm. You may experience false labour pains, which begins 2-3 weeks before the onset of labour in a prime primi gravida and for a few days before in a multi gravida.
2. Can I differentiate between false and real labour pain?
False pain occurs more frequently in prima gravida and is often due to indigestion or a loaded rectum. They are irregularly felt all over the abdomen and do not progress.
The actual labour pain begins with recurrent pain at intervals of half an hour, and becomes more frequent as the labour progresses. Each time, the pain lasts for 45 seconds to 1 minute. They increase in intensity, reach a peak and then diminish in intensity. The pain begins in the back, radiates to the lower abdomen and sometimes down the legs. They may be associated with nausea and vomiting and urine may be passed frequently. Just before the beginning of labour, a small amount of red tinged mucus may be passed.
3. What must a woman do when in labour?
If the pains are not strong she can have a bath. Enema is usually given and the genital area is shaved and cleaned. In the initial stages, she can walk about and is advised to take small quantities of liquid nourishment. It is better to avoid any solid food should anaesthesia become necessary. When the pain recursat shorter intervals, the patient is put to bedand at the time of actual delivery, she is encouraged to push during the pain i.e. hold her breath and push as her contractions peak in intensity.
4. What are the chances of having a caesarian operation?
Usually 25-30% of normal pregnancies will require a caesarian operation. The incidence can be higher in complicated pregnancies. You can discuss the chances of having a normal delivery/caesarian operation with your doctor.
5. What happens after delivery?
Labour ends with the birth of the baby and the expulsion of the placenta and membranes. If there is an episiotomy, it is sutured. The patient is observed for a while before being shifted to a room.
The importance of breast feeding
1. Why is breast feeding best?
The breast is a bilateral glandular structure. Initial secretion from breast is called colostrums. It is the ideal food for any new born baby as it contains 1.5% protein, 4% fat, 6.5% sugar. 1 oz. of breast milk gives 20 calories of energy.
2. What happens when I breast feed?
While breast feeding, certain glands are stimulated that release hormones like prolactin, oxytocinete. As a mother, it adds to your physiological and psychological well being.
3. Why is breast milk secreted in two colours?
The first secretion is a deep yellowserous fluid called colostrums. Colostrum is a source of high protein, vitamin A, sodium chloride and has lower carbohydrates, fat and potassium. The actual milk secretion begins from the third or fourth day postpartum.
4. What are the benefits of breast feeding?
Brest milk is ideal infant food. It protects the baby from infection and allergies, gives the baby a sense of comfort, warmth and security. It acts as a natural contraceptive, and builds a close mother-child bond. It helps in the involution of the uterus and the chances of acquiring cancer are 20% less in mothers who breast feed.
5. How do I breast feed?
• Hold your baby close to your breast.
• Lightly touch the nipple to the baby’s lower lip.
• Lift your breast – hold the breast in such a way that the thumb is above the breast and four fingers support it from underneath.
• Firmly pull the baby towards you.
6. How do I know that my baby has had adequate milk?
• Your baby nurses at least 8 times every 24 hours.
• Your baby wets six or more diapers every 24 hours.
• Your baby’s stool turns yellow after the fifth day or so.
• Baby gains weight and will sleep soundly in between feeds.
7. How do I increase my milk supply?
• The longer your breasts are stimulated at feedings, the more milk you will produce.
• Start the next feed with whichever breast feels heavier.
• Increase your fluid intake.
• Eat nutritious food – 3000 Kcal/day
• Get as much rest as you can.
8. What are the problems I am likely to face?
• Reluctance to breast feed
• Anxiety and stress
• Inadequate milk secretion
• Breast ailments – engorgement of breast. Cracked nipples, depressed nipple and mastitis
9. How do I become a successful mom?
• Be confident in your ability to breast feed
• Get the support of your family and friends.
• Take adequate care of your breasts and nipples during pregnancy.
• Begin breast feeding as soon as possible after your delivery.
• Ensure your baby feeds on your colostrums.
• Let your baby suck on demand.
• Brest feed your baby whenever he/she cries.
• Maintain body hygiene and wear clean clothes. Ensure that your baby is always clean.
1. What are the things to be taken care of during the postnatal period?
Baby can be breast fed immediately following a normal delivery. It is necessary to tend to the episiotomy wound. The mother can be discharged on the third day after delivery. Mother should breast feed every two hours or on demand.
If the delivery was by a caesarian section, the mother will be discharged only on the fourth or fifth day. The mother can begin breast feeding four hours after the operation. Mothers should breast feed every two hours or on demand. After a month’s rest, the mother can resume all normal activities.
2. What happens if the baby is not properly breast fed?
If the baby is not breast fed properly, your milk supply will decrease. The more you nurse, the more milk will be secreted. If the baby does not feed, there is a chance for you to develop an abscess in your breast. This could necessitate surgery.
3. Is it essential for a woman to take six month’s rest?
After delivery, you require a lot of rest for the first three months. After that you can resume all activities of your daily life.
4. For how long should I be careful of the episiotomy stich?
For ten to fourteen days.
5. For how many days the bleeding will continue?
Until the place where the placenta was situated in the uterus is healed the vaginal discharge will continue. It might prolong from two weeks to two months.
Exercise in Pregnant women
• Pregnancy is a time of tremendous musculoskeletal, physical and emotional change and yet is a condition of wellness. Thus, women present a unique challenge for a therapist during and after pregnancy.
• Physically, there is progressive weight gain and thus the centre of gravity shifts and requires postural compensation for balance and stability. You can notice a wide base gait and Lordotic spinal posture.
• Anatomically, all internal organ systems are affected by the enlargement of the uterus.
• The chest diameter increases, the diaphragm is elevated, and the depth of respiration increases.
• Pressure on the bladder increases, thereby increasing the frequency of urination.
• Musculoskeletal system – stretch of abdominal muscles to its limits resulting in tears.
• Hip joint hypermobility and ligamental laxity.
• Pelvic floor drops due to the weight of the uterus.
Due to all the above changes, some problems encountered are :
• Development of faulty postures- postural adjustments in all working positions – sitting, lying, standing, household activities are essential.
• Change in body image and its awareness
• Altered circulation – lower extremity odema, cycling exercises of lower limb, foot circling exercise, shoulder and upper limb exercises
• Abdominal muscle stretch – strengthening exercise to prevent flabbiness
• Pelvic floor stress – urinary incontinence. Rehabilitation of pelvic floor is a must
Other areas to be taken care of are:
• Fatigue – break up the activities
• Advice on lifestyle – Adaptations and alterations
• Abdominal muscle stretch marks – do oil massage
• Generalised exercises like walking, static cycling to improve strength, flexibility, stamina and endurance
• Breathing exercise to avoid chest discomfort
• All the points mentioned above are for normal pregnancies. All exercises should be well planned for individuals and especially for high risk pregnancies. Hence, the therapist plays an important role in assessment, assistance and maintenance of a healthy pregnancy.