The body of a new mother has undergone such massive changes that can even beat the demands expected from an Olympian athlete. The process of conceiving, developing, and delivering a young baby is something that has used up every ounce of your body and its different resources. The outcome is that the body now needs a lot of time and effort to get back into its original shape and energy levels.
Post delivery you go through a number of hormonal changes with the progesterone and estrogen levels going down by 90 percent within a few days of the delivery. Along with this the physical inconvenience and tiredness play havoc with your emotional state. You need to be treated like a precious thing that has the family’s support to get her physical and emotional energies back. There should be a good twelve hour sleep to enable you to overcome depression and mood swings.
Losing weight gained during pregnancy is every woman’s biggest worry. It is very important to let the body recover at its own pace because it has just completed a marathon effort of giving birth. During this period you must eat well, rest, and build your reserves again. You can avoid high protein, low carbohydrates from your diet and get recommendations from a dietician to enable you to loose weight sensibly. Exercise is another good option to get back into your original shape. It not only makes you loose weight but also makes you feel good and happy. Most important exercises are the pelvic floor exercises. One can start with gentle exercise like walking and go on to do yoga, swimming, and Pilates. You must remember to take things at a slow pace. There are so many aspects of your body, which you cannot change after delivery like breast shape, stretch marks, so it’s advisable to start respecting yourself and your body to get mental happiness.
There are a many parts of your body (internal and external) which need to get back into shape –
- Abdomen – After delivery your abdomen still looks pregnant and the uterus is enlarged. Within the next six weeks, the uterus and the abdomen muscles become taut and uterus contracts back to its normal shape. This process is called involution.
- Breasts – The breasts of a nursing mother at times are over capacitated and this may cause trouble for the baby to latch on. In such a case, you should express a little milk manually and soften the areola. To protect and help the tender breast tissues you must wear a supportive bra.
- Constipation – This is one of the most common side effects of childbirth. Factors like sluggish intestine, out–of-shape abdominal muscles, use of anesthesia, epidurals, and pain killers can make the problem all the more severs. The only solution is to keep moving, drink plenty of water, and eat high fiber foods, raw fruits and vegetables.
- Skin – the skin starts glowing in pregnancy and following childbirth, everything changes. Due to fatigue and other physical changes, your skin may become drier and loose its radiance. It regains its old charm when your menstrual cycle begins. Stretch marks unless very strong also begin to fade in due course of time.
- Hair – Post delivery there is so much hair loss due to physical and hormonal changes as against pregnancy when there is not much hair loss, that it may create a panic. But because the hormonal levels starts falling again, things become normal within one year of the delivery and you may have your crowning glory back.
By the end of six weeks, your body starts recovering and you are quite set and adjusted in your new routine with the baby. Now you can go in for a physical examination where the following things can be checked –
- Weight – should be down by 20 pounds
- Thorough check-up of vagina, ovaries, cervix, fallopian tubes, and perineum
- Size, shape, and location of the uterus to check if it has returned to its original state.
- Blood pressure
- Legs for swelling or varicose veins
- Birth controls
- If there was a c-section, whether the stitches have healed.
Any problem in any area needs to be thoroughly checked, examined and discussed with your health care provider.
Pregnancy and subsequent delivery brings with it joy and a number of changes in life style including fatigue, anemia, pain, and breast soreness. It is very important for a woman to get her thyroid levels checked before, during, and after pregnancy. Women who are pregnant or want to get pregnant should discuss the possibility of a thyroid problem with her doctor. Any symptoms of thyroid should stimulate her to go in for a thyroid (TSH) test. A woman adjusts to all the complications brought about by the change in lifestyle by the third month after delivery. But a few of them find that a change in their thyroid function after delivery does not let them gain good health.
When a woman gets pregnant, it becomes very necessary to get a routine test for any possibility of a thyroid problem and for thyroid stimulating immuno globulins and thyroid antibodies. During pregnancy the thyroid function increases or decreases and in case of an under active thyroid it will not be able to make the required hormones during pregnancy. A TSH enables you to find your hormone level. If necessary the thyroid level needs to be boosted up during pregnancy. The fetus initially depends on the mother for the supply of thyroid hormone because the thyroid gland of the fetus develops only at about tenth week of pregnancy. The thyroid hormone which crosses the placenta and reaches the baby especially during the first trimester can be harmful for the baby. This is because at first trimester, the baby’s brain starts to develop but the thyroid gland has not started developing by then.
A TSH test indicating a high or a low level will first indicate whether your thyroid levels are normal or not. Post pregnancy, any body with hereditary thyroid history should get a TSH function level test done. Disorder in one’s family like rheumatoid arthritis, anemia due to lack of vitamin B12, colitis, juvenile diabetes and premature gray hair indicates a thyroid problem in you. A TSH test (to ensure normal thyroid levels) is very necessary because minor changes in thyroid levels are never accompanied by any symptoms. If you have thyroid, then it can be treated and you will recover very fast. About 33 percent women do not recover fully from their thyroid dysfunctions and have to take life long treatment.
Thyroid problems crop up post pregnancy because after delivery the immune system which was suppressed during pregnancy has a marked increase in its activity. A rise in thyroid levels, (hypothyroidism) puts your total body system on a rise. Your heart races and you have symptoms like shaking hands, insomnia, increased sweating, and anxiety. On the other hand if your thyroid levels go down you feel sluggish, depressed, tired, run down, have muscle cramps and constipation. Recent studies show that women with hypothyroidism have more chances of giving birth to children with lower IQ levels as compared to children of women with normal thyroid levels.
Thyroid levels will experience a change in your subsequent pregnancies if there has been a change in the thyroid function in first pregnancy. Also conception is very difficult if a woman has abnormal thyroid levels. The levels can be kept under check by regular TSH test. Your thyroid problems during pregnancy and after delivery are not passed on to your new born baby. In some countries such as in USA, each and every baby is checked for normal thyroid function at birth. This is done to ensure them child’s proper physical and mental growth.
Pregnant women should take multivitamins or prenatal vitamins containing 150 micrograms of iodine in each capsule as a daily recommended dosage. Please make sure that you include this iodine dosage only after taking a proper advice from the doctor. A timely check and treatment will ensure the birth of healthy babies with proper mental growth and will also ensure good health for the mother.
It is very important for you to take care of your diet during pregnancy because you have the added responsibility of taking care of your baby along with yourself. A pregnant woman is supposed to eat for two and should include a good amount of nutritive food full of vitamins, proteins, fats, roughage, and minerals.
The following food constituents should be included in your diet in pregnancy –
- Vitamins – A prenatal vitamin all through your pregnancy is very important. A few Vitamins like D and A, are quite important for you during pregnancy. They ensure the exact nutrients in your pregnancy. The best source of Vitamin A and D are margarine, cheese, eggs, and fatty fish.
- Omega 3 supplements with fatty acids – They should be a part of your diet to improve the baby’s eye and brain development. They are found in fish and other seafood.
- Folic acid – It should be a part of your diet before conception till at least the first three months of your pregnancy to ensure that there are no birth defects of the spine and brain in the fetus. Folate or folic acid rich foods include broccoli, chick peas, lentils, spinach, oranges, peas, leeks, cauliflower, cabbage, Brussels sprouts. Wholegrain bread, parsley and so on.
- Iron – The growing fetus takes enough iron from your body to last it for the first 6 months of its life. Thus your requirements of iron increase during pregnancy. There is no iron loss during pregnancy because there are no menstrual cycles and hence during pregnancy you draw more from the gut. Apart from this it is beneficial to include foods which are good sources of iron in your diet every day along with foods that are good sources of Vitamin C to help absorb the iron. It is recommended to take 22-36 mg (10 mg more than for a normal woman) of iron on a daily basis in your pregnancy.
- Calcium – In the third trimester the baby needs a large share of calcium because it begins to grow and strengthen its bones and if you do not take calcium supplements in your diet, it is extracted from your bones. This loss anyway gets replaced once you have stopped breastfeeding. Dairy foods such as milk, cheese, yogurts, and calcium fortified soy milk are excellent sources of calcium. The daily dose of 1,100mg of calcium per day (300mg per day more than for non-pregnant women) is recommended for pregnant women.
A healthy and nutritious diet will ensure good health for you and your baby. You should eat as per your appetite but learn to manage your weight accordingly. The normal weight gain for a healthy woman is 10-13 kg. It is not recommended to eat too much during pregnancy. During the first trimester your calorie intake should be the same as it was prior to your pregnancy. During the next two trimesters the calorie intake is increased by about 10 percent, approximately about 600kJ extra per day. But still it is the nutritional content of your diet that matters more than the calories intake. It is of utmost importance to include the following foods in your diet –
- Low fat milk and milk products
- Chicken, fish and lean meat
- Green leafy vegetables
- Food high in fat, sugar and salt to be taken in small quantities
- Nuts and seeds
- Fresh fruits, whole grain cereals and breads
If you are eating a restricted diet or go on crash dieting during your pregnancy because of the fear of gaining extra weight, then you are making a serious compromise on your as well as your baby’s health. If you are adolescent and pregnant, then you need more nutrients than your older counterparts because you yourself are still growing. Lack of iron or Anemia is very common among adolescents. Calcium intake is also important because you have still not reached your peak bone mass and may have osteoporosis later in your life.
At times due to physical and emotional changes and change in food habits you tend to get heartburns. To avoid them during pregnancy you should –
- Eat small meals frequently than eat few large meals
- Avoid eating late at night
- Avoid excessive intake of tea, coffee or alcohol
Avoid lying down after meals.
When you are in this situation, an abortion may seem to be the only answer. Unexpected pregnancies are very difficult to handle and may make things very difficult for you. An abortion is a medical procedure that may involve a consequential change in your life.
If you decide to go in for an abortion, there are many products available. Each one of them has risks associated with them.
- Morning after pill (MAP) – This absorption technique comprises of a pregnancy test and two portions of pills. One portion of MAP is taken within 72 hours from the date of last intercourse even when the pregnancy test is negative. The second dose is taken 12 hours after the first dose. If you had conceived within the 72 hours frame, the life is expelled. This pill is also called “Emergency contraception”.
- RU486, Mifepristone – If the pregnancy is 28 to 49 days old, which means, it is 4 to 7 weeks after LMP, then this drug can be taken. These pills are taken in conjunction with the second medicine called misoprostol. The two medicines compel the uterus to throw out the fetus.
- Early Vacuum Aspiration – A surgical procedure to abort the baby is done when the pregnancy is less than or equal to 7 weeks of LMP. In this procedure, Dilators are used to stretch cervical muscles and abortion instruments are passed into the wide opening of the uterus. The fetus is sucked out of the uterus with the assistance of a syringe.
- Suction Curettage – This is carried out within 6 to 14 weeks after LMP. The doctor opens the cervix with a dilator and inserts tubing attached to a suction machine into the uterus. The suction machine pulls the fetus out of the uterus. A variation of this method is called “D & C “Dilations and Curettage. A loop shaped knife called a curette is used to take off the parts of the fetus out of the uterus.
- Dilation and Evacuation (D&E) – If the pregnancy continues till the second trimester the D & E procedure needs to be carried out. The fetus is now double the original size between the 13 and 14 weeks of pregnancy, the body of the fetus cannot be broken down with the help of suction methods. Here the cervix is opened quite wide and a laminaria is inserted two days before the abortion. When the cervix opens to the required width, the doctor pulls out the fetal parts using a force and the fetus skull is crushed to ease removal.
Abortion not only ends pregnancy but also pose serious long term physical and emotional risks. Generally there are no complications in a normal abortion. In case of early abortions there are 1 percent chances of complications and in later abortions the risk rate is 2 percent. The various complexities associated with abortions are –
- Heavy Bleeding – At times a uterine artery may erupt and cause a hemorrhage causing an alarm, otherwise bleeding after an abortion is normal.
- Infection – A major concern during an abortion is that the chances of the uterus catching a bacterial infection. A severe infection results in high fever persistent over several days.
- Allergic reaction to drugs – At times the patient may have allergy to the anesthesia used during the surgery. This may result in convulsion, heart attack or even death.
- Incomplete abortion – At times while carrying out the RU486 method of abortion there are chances that some fetal parts are left inside only resulting in bacteria and infection.
- Instrument Complications – Another danger is that abortion instruments may leave a life long scarring of the uterine lining and may also end up cutting the cervix.
- Perforation of the Uterus – When the pregnancy is of longer duration, there are chances that the abortion instruments may puncture or tear the uterus. When this happens, then there is the risk of damage in other internal organs like bladder or bowels also occur.
- Death- In a very extreme and unlucky case, due to all these complications or some of them happening at the same time, the patient may never recover and die. But such cases are very rare.
- Breast Cancer – Abortions increase the risk of Breast Cancer. It has been concluded after some research that there is a link between abortion and breast cancer because abortion causes a sudden drop in the estrogen level. This makes the breast cells more prone to cancer.
- Difficulty in conception – Any kind of physical injury during an abortion may prevent or make a future pregnancy difficult. Also women who have had their first pregnancies aborted face a greater chance of miscarriages the next time.
Most pregnant women use prescribed or non-prescribed drugs during pregnancy. The drug use in pregnant women may result in birth defects. Therefore unless it is imperative to use drugs, they should be avoided during pregnancy. This precaution is taken because any medicine taken by a pregnant woman reaches fetus by crossing the placenta, just like oxygen and other nutrients. The medicines may affect the fetus in several ways like causing damage to body parts, hampering development, or even causing death. At times, due to intake of drugs by a pregnant woman, the supply of oxygen and nutrients to fetus is restricted and the baby is born underweight and underdeveloped. Consumption of certain drugs causes a contraction in the muscles of the uterus and reduction in the blood supply to the fetus thus kick starting a preterm labor and delivery.
The dosage of the drug and the fetus development stage are the two factors which determine what affect a certain drug will have on the fetus. The fetus is very susceptible to birth defects between 3 to 8 weeks after fertilization. This is the time when its organs are developing and any harsh or wrong drugs taken at this time may give rise to irreparable damage or a miscarriage. Certain harmful drugs taken after 8 weeks of pregnancy may end up retarding the growth and function of the organs formed because this is the time when the organs of the fetus are already developed.
Different drugs have different effects on a pregnant woman and the fetus growing inside her. Always a safer drug is recommended to substitute the drug causes harm during pregnancy. For example oral hypoglycemic drugs are replaced with insulin during pregnancy. The safe drugs do not cross the placenta but control diseases. There are several drugs which cause birth defects even after 6 months of discontinuation of its use. This is because such drugs gets stored in fats beneath the skin and gets released eventually. Under such circumstances, it is best to wait for one year before planning a baby. A pregnant woman is not given liver virus vaccines and only in emergency conditions vaccines such as cholera, plague, rabies, and typhoid are given. Pregnant women may be given drugs like Antihypertensive to cure high blood pressure but after that the patient is closely monitored. It is best to avoid drugs that can cause damage to fetus. These drugs include Angiotensin-converting enzyme (ACE) and thirazide diuretics.
A few risks involved in using drugs during pregnancy are:
- Anti anxiety drug – These drugs cause depression, irritability, and shaking in a new born.
- Antibiotics – Some of these drugs may cause damage to the fetus’s ear resulting in deafness, jaundice, brain damage, slowed bone growth, and yellowing of teeth in the new born.
- Anticoagulants – Some of these anticoagulants may cause birth defects and bleeding problems in fetus and pregnant women.
- Chemotherapy drugs – Some of these drugs cause underdevelopment of lower jaw and skull bones spinal and ear defects and abnormal before birth growth of the fetus.
- Mood stabilizing drugs –These drugs cause poor feeding, under active thyroid gland, lethargy, and birth defects of the heart in the fetus.
- Sex Hormones – These drugs if taken during pregnancy may lead to abnormalities of sex organs in newborn and menstrual problems in female babies when they grow up.
- Thyroid drugs – Some of these drugs cause an overactive or under active thyroid gland in the fetus.
Some social drugs like cigarettes, alcohol, and caffeine should be avoided during pregnancy. Smoking cigarettes may cause a reduction in the birth weight of the fetus and also can have a birth defect of brain, heart, and face. Consumption of alcohol can also cause birth defects and increases the chances of having a miscarriage. Drinking of caffeine during pregnancy in moderate quantities does little or no harm to the fetus. It is a stimulant which crosses over from the placenta to the fetus and may stimulate the fetus, increasing its heart beat and breathing. Over consumption of caffeine leads to decrease in absorption of iron by the body and restricts the flow of blood across the placenta.
Thus we realize that unless categorically imperative, drugs should not be consumed during pregnancy. But if they are equally essential for the health of the pregnant woman and fetus, then the patient should consult her health care provider about the risks and benefits of taking drugs and decide accordingly.
During pregnancy a woman may acquire certain disorders which may not be directly associated to her pregnancy. Certain types of disorder like anemia, urinary tract infection, and thromboemblic occur due to the changes in a woman’s body during pregnancy. Some other disorders such as fever and infections happen normally in the due course of the pregnancy. Some such diseases and infections are discussed below –
- Thromboembolic Disease – In this disease, the blood clots are formed in the blood vessels. The legs veins form blood clots called thrombophlebitis or thrombosis.
These clots cause swelling, tenderness and pain in the calves and also have the tendency to move up to the lungs and block an artery or two. This blockage, called pulmonary embolism, and at times block an artery supplying blood to the brain and can also cause a stroke. The thromboembolic disease is generally acquired or caught within 6 to 8 weeks of pregnancy. The complexities due to blood clots happen due to some injuries that happen during delivery. This disease is more likely to happen after a cesarean section surgery. An ultrasonography test may also be done to check the clots. Heparin is a medicine, which is used to cure clots. This medicine is quite harmless for the fetus as it does not cross the placenta and treatment is done up to 6 to 8 weeks after delivery.
- Urinary Tract Infections – In pregnancy the size of uterus increases so much that it puts an immense pressure on the tubes that connect the kidneys to the bladder. This slows down the flow of the urine and causes urinary infections. Because the passing of the urine is slow, the bacteria do not flush out of the tract. If these infections are not treated timely, they can cause premature labor or premature breakage of the membranes, which contain the fetus. At times the infection of the bladder moves up the urinary tract and reaches the kidneys causing a kidney infection. Large intake of water and antibiotic drug therapy are some treatments for such infections.
- Fevers – Any disorder where the temperature goes beyond 103° F (39.5° C) during the first three months of pregnancy boosts the chances of miscarriages and birth defects of brain and spinal cord in the baby. A fever in the later trimester multiplies the chances of having preterm labor.
- Anemia – Iron and Folic acid scarcity in the body of a pregnant woman causes anemia. Red blood cells are made by the iron and therefore needed in double strength during pregnancy to support growing fetus. In severe anemia the capacity of blood to carry oxygen decreases and in such condition even iron and folic acid supplements do not help. This affects the normal growth of fetus and especially the growth of brain is affected. Anemia also causes tiredness and shortness of breath in carrying mothers. This may bring about preterm labor, abnormal bleeding, and a major blood loss during delivery. A newborn baby suffering from birth defects of spine or brain is another major setback of having deficiency of folic acid in the body during pregnancy.
- Infections – Quite a few infections that happen during pregnancy can have devastating birth defects on the fetus. An infection called Cytomegalovirus is one such infection that crosses the placenta and damages the liver and brain of the fetus. Some other infections, which harm the fetus, include German measles, Herpes simplex and Chickenpox. Some vaginal bacterial infection during pregnancy may cause preterm labor or premature rupture of the fetal membrane. A protozoan virus called toxoplasmosis causes serious birth defects in fetus or may cause a death to fetus due to miscarriage. Antibiotic drug treatments reduce the intensity of these problems.
- Disorders That Require Surgery – At times a pregnant woman may need to go through an abdominal surgery. Due to abdominal operation, the chances of a miscarriage and preterm labor are escalated. Thus to be on the safer side, it is advisable to delay any kind of surgery till the delivery, unless until it is really urgent and the women’s long term health is at stake.
The life and health of the woman and her unborn child are at risk if the mother to be smokes. It has been reported that among women of reproductive age, about 33 percent smoke on a regular basis. The fetus in her uterus is in contact with her bloodstream and any chemicals that the mother breathes or ingests will affect the fetus. This could be in the form of active smoking (where the mother smokes herself) or passive smoking (where the mother is inhaling smoke from the environment). The heavier the smoker a pregnant woman is, the more are the chances of this showing on the offspring. If you are an active smoker during pregnancy and smoked about 13-14 cigarettes a you are likely to have a “hyperkinetic” child as compared to a women who smoke around 6 cigarettes and give birth to normal children. It has also been proven that smoking women have lower fertility rates than women who do not smoke. Offsprings of smoker mothers have a three time higher mortality rate from SIDS (Sudden Infant Death Syndrome) than children of non smoker mothers.
The complications involved with smoking and pregnancy are:
- You may end up having preterm labor.
- Your child may be underweight- Low birth weight can result from poor growth before birth.
- Your chances of stillbirth, miscarriage and ectopic pregnancy (outside the uterus) are higher.
- Your baby may have growth delay inside the uterus.
Babies who are born with low birth weight have problems all through their life because they are at a greater risk of childhood and adult illness, which may be fatal. Premature and underweight babies have a higher chance of suffering from ill health during their initial life period. They may end up with major lifelong disabilities such as mental retardation, learning disability, and cerebral palsy. At times such children do not survive. The smoke contains many poisonous compounds and the presence of carbon monoxide in the blood stream of the fetus reduces the supply of oxygen to the developing baby. The hemoglobin in such babies has carbon monoxide instead of oxygen that hampers their development. Also your chances of a PROM (Premature Rupture of Membranes) are increased in case you smoke during your pregnancy. In PROM you feel a tickle from your vagina when the water bag breaks and you end up in labor within a few hours. If this situation occurs before the 37th week of pregnancy, it is termed as preterm PROM and you deliver a premature baby.
Infants born to smoker mothers have reduced lung function and may suffer from lower respiratory tract infections. In their lifetime, such children have an increased risk for impaired lung function and may also suffer from asthma and respiratory infections. There is a major rise in placental problems like placenta previa or placental abruption for women who are heavy smokers during pregnancy. This results in heavy bleeding during delivery, endangering the life of the mother and baby. To prevent any complication resulting in death, a cesarean section can be performed. Placental problems also may result in still birth.
A few guidelines mentioned below must be followed to prevent birth defects to you new born child:
- You must not drink alcohol during pregnancy
- You must not use illegal drugs
- You must start folic acid tablets. They prevent spinal birth defects to the fetus.
- You must quit smoking before planning a pregnancy.
If you plan to quit smoking then all things linked with this bad habit like ashtrays, lighters, cigarettes and so on must be thrown away. You must maintain a healthy lifestyle and go for walks, drink ample amount of water, and take your health care provider’s help if needed. It is recommended that a woman should stop smoking before she gets pregnant and does not smoke till her delivery. There are certain inspirational factors which may enable a woman to stop smoking during her pregnancy for example support from family and friends and understanding the harmful effects of smoking on the new born child.
Constipation refers to bowel movements that are hard in consistency and painful to eliminate. In constipation too much water is absorbed from the large intestines, thus leaving the faces dry and difficult to excrete. Pregnancy brings with it the woes of constipation which can be very uncomfortable and can work you up. It is estimation that about 20% pregnant women get constipation and around 29% continue getting it even after pregnancy. During pregnancy the digestive system also is influenced by the hormonal changes and it becomes very important for women to take care of their constipation.
Constipation during pregnancy could be caused by several intermixed factors. It is caused by irregular eating habits, little exercise, inadequate intake of fiber and fluids and some level of stress also. During pregnancy the body produces more female hormones, such as progesterone, because it is these female hormones that help in proper development of pregnancy. These female hormones slow down the intestinal movement causing constipation. The outside wall of the bowel is also made of muscles and relaxes with the excretion of progesterone. This way the bowl movements are made irregular and it is unable to move food and bodily waste along, thus causing constipation.
Quite a few women take iron supplements at this stage, which also is a contributory factor to constipation. Any alteration in diet due to change in taste also leads to constipation, especially if you have stopped including fiber rich food in your diet. Another reason is that the growing baby also puts a lot of pressure on the bowel and there is general lethargy. This makes you miss out on keeping the body exercised and active, thus leading to slow bowel movements and constipation. A pregnant women’s intake of iron and calcium supplements and prenatal vitamins, can also cause constipation. When the uterus grows, it puts a lot of pressure on the bowel and stops the passage of stool, thus causing constipation.
When you have constipation during your pregnancy, you may show the following signs –
- The faces are hard and difficult to pass.
- The interval between one bowel movement to another is four days or more.
- There is also lower abdominal pain.
- Hard faces may even result in bleeding from the rectum.
- At times there is a feeling that even after trying very hard, no faces are being passed.
Care and regularity has to be maintained in your lifestyle to get relief from constipation during pregnancy.
- Increase your fiber intake – You should consume fiber rich foods like fruits, vegetables, cereals , whole meal bread, prune and prune juice, which provides roughage to your body to enable the food to move in the intestines,
- Drink plenty of water or fluids. – A daily intake of 8-10 glasses of water is recommended as the fluid keeps the stool soft and easy to pass. Even juices specially prune juice help to ease the constipation.
- HI-Fiber – At times some home made or medicinal remedies may come in handy. Senokot Hi-Fiber granules can be mixed in a glass of water and consumed to ease out the problems of constipation. One sachet in the morning and one at night give you one third of the recommended dosage of fiber. This drink speeds up passage of waste through the bowel. Remember to consult your doctor always before taking any such medicine.
Exercise – Exercise is a must and lethargy will only spoil things further. It is necessary to exercise daily because exercise prevents the digestive system from becoming sluggish. Exercises, which are safe during pregnancy, include walking, swimming and yoga. Exercise will lead to improved digestion by stimulating the bowel.
In the past few years, the HIV (Human Immunodeficiency Virus) has brought unpleasantness and deaths among pregnant women. The HIV infection has grown by leaps and bound in the women population especially women in the child bearing age. This has resulted in a large number of children also acquiring this disease through prenatal (mother to infant) transmission. This has also resulted in a sharp increase in the number of cases of AIDS (Acquired Immunodeficiency Syndrome). The HIV infection also is causing a large number of deaths among children. To get out of this situation it is very essential that education and services for prevention of HIV must be available to all women who are pregnant or want to become pregnant.
Pregnant Women who suffer from HIV infection need to become aware of some information during their pregnancy such as:
- How risk for prenatal HIV transmission can be reduced?
- How can HIV infection in pregnant women and parentally infected children be managed?
- How can the survival rates and quality of life of HIV infected people be improved?
The basic plan to curb prenatal HIV transmission is to make prenatal HIV testing of pregnant woman compulsory. There can be three different prenatal HIV testing techniques –
- Opt-in – In this technique, a counseling session on HIV test is done for the pregnant women and they volunteer for an antibody test.
- Opt-out – In this technique, women are advised that an HIV test will be conducted along with the other routine prenatal test and they may refuse it if they so wish.
- Mandatory newborn HIV testing – In this technique all the babies born have to go through a mandatory HIV status test, whether the mother’s HIV status is confirmed at the time of the delivery or not.
For a carrying woman suffering from HIV the chances of passing it on to her baby are as high as 25 percent. For them, it is of utmost importance to get good prenatal care and services of a health care provider. The treatment to be followed is very similar to any other non pregnant woman. Initially they are asked to get a PAP test done and then a CD4 count. During the pregnancy another CD4 count may be required depending on your count during the first test.
In an ideal situation today, every woman should know her HIV infection status before going in for pregnancy. Organizations working in areas like family planning clinics, sexually transmitted disease clinics, and adolescent clinics should have voluntary HIV testing and counseling to women and adolescents regardless of the fact that they are pregnant or not. All pregnant women should go in for routine HIV counseling and testing so that in case of any infection, there can be timely and effective intervention and a life can be saved.
After a random testing, it has been found that an administration of Zidovudine (ZDV or AZT) in HIV infected pregnant women and their newborns reduce the risk of prenatal HIV transmission considerably. This drug benefits the most when the HIV virus is detected before pregnancy or during early pregnancy.
AZT treatment is done in three regimens –
- From the 14th week of pregnancy till 34th week, a HIV infected pregnant women needs to take AZT. The dosage is at least 600 mg in a day, which can be taken as either 100mg five times a day or 200 mg three times a day or 300 mg twice a day.
- During labor and delivery, AZT should be administered intravenously.
- The new born should also be given AZT (in liquid form) every 6 hours for 6 weeks after delivery.
After this three regiment treatment of AZT, the chances of the new born getting HIV infection are reduced by 70 percent. For a HIV pregnant woman the AZT therapy is a gift of God and cannot be undercut. Still the effect of the drug in reducing HIV transmission from the mother to the infant cannot be fully explained from this therapy. A lot of research and development needs to done to ensure the technique involved to reduce prenatal transmission by AZT is safe. The risk factors involved in transmission at all levels of maternal viral load, also need to be found. Apart from these, other anti-HIV medications can help to treat the infection along with providing extra protection to the baby.
Pregnancy is a very exciting and eventful time in a woman’s life and if you are an epilepsy patient then your major concerns may be regarding the epilepsy medications that you are consuming. This is because the epilepsy medication may harm your unborn child. Epilepsy does not get any better or worse, when you get pregnant, but the risk of your pregnancy and labor getting complicated are much higher. A serious seizure during your pregnancy can be harmful to the unborn baby in your womb. The anti epilepsy medicines may also harm the unborn baby.
Women with epilepsy who want to have babies should go in for preconception counseling and coordinate with their health care provider. Women with epilepsy have a lower fertility rate and tend to generally have fewer children. A woman who has epilepsy and requires medicine should be informed before pregnancy that she has a 90 percent chance of having a healthy child. Their chances of having a mentally retarded child or a child with congenital malformations are three times higher than the average woman.
It is therefore advisable to discuss the risks involved in such pregnancies with your doctor, nurse or counselor, before conceiving. You could find out the risks and benefits of adjusting your epileptic medicines, if you are taking anti-epilepsy medicines. It is recommended to start taking 5mg of folic acid before conception and continue till 12th week of pregnancy. This dosage is higher than for normal women to avoid any spinal cord problem and defects to the fetus. You can discuss stopping your anti-epilepsy medicines if you have not had any seizures for quite some time before your conception. The chances of your child also having epilepsy can be discussed with your doctor.
The chances of getting a seizure during pregnancy are the same as when you are not pregnant. Depending upon the type of seizures you have during the epileptic attack, the unborn baby may be harmed. In partial, absence, myoclonic seizure, the seizure is not likely to harm the baby. In case of generalized tonic-clonic seizure, there are chances that a prolonged seizure may harm the unborn baby. Also such seizures do not occur during childbirth but precaution must be taken to have such deliveries at a hospital under medical supervision.
If during your pregnancy you are taking anti-epilepsy pills then there is an increased risk of giving birth to a baby with birth defects like congenital heart defects, neural tube defects (spina bifida), hypospadias (some defect in the penis) and facial defects. On an average 4 percent of epileptic women taking anti epilepsy medicines give birth to baby with birth defects. These risks also vary with the type of medicines being taken. Some medicines like sodium vaporate have a higher risk factor (7 percent) than others like lamotrigine (3percent) and hence they are not prescribed during pregnancy. If you are taking anti-epileptic medicines than it is recommended that you go in for high-resolution ultrasound scan at 18-20 weeks of pregnancy. This scan helps to screen for birth defects in the fetus. This scan can be carried out earlier also.
During pregnancy you may face various other obstetrical problems like anemia hyper emesis, gravid arum, and vaginal bleeding .There may be premature labor, failure of labor to progress and higher rate of cesarean sections. The solution to all these problems lies in eating a healthy diet, getting enough sleep and exercising regularly. This will ensure that you will have a safe and healthy pregnancy. You must take care of your vitamin supplements and folic acid (a type of Vitamin B) properly. If you have a history of brain or spinal cord defects in your family or your husband’s family then it must be discussed with the doctor. Epileptic women having unplanned pregnancy should not stop their medications without advice from their doctors but must start taking 5mg of folic acid at the earliest.