Pregnancy Stages – Your Guide to Bump Watch!!!

– who you want to be there, how you would prefer to manage your pain and what you would like to do if things don’t go as planned.

Many women and their partners write a birth plan, so that when the time comes, all of those involved in the birth of your baby will know what you want. Writing a birth plan can also help you and your support person to think through, and prepare for, a range of possible scenarios.

Let’s quickly make a list of things that will assist us during the journey of Pregnancy both for the mom and the partner. Let’s see what the list is,

 A birth Plan

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It is also useful for fathers or birth partners, who will feel more empowered by a birth plan to advocate on your behalf, especially if you have prepared the birth plan together.

The following are examples of things you might want to consider when you are writing your plan,

  •  Support in labor – The people you have around you during your birth can actually improve your experience of it. In fact, research shows that having the right support people can reduce your need for pain relief, assisted vaginal birth and cesarean section.
  • The Early Stages – A sudden gush or a slow leak of fluid from the vagina when your waters break or your membranes ruptures.
  •  The First stage – This stage begins when the cervix starts to soften and to open. At The end of the first stage of labor, you will start feeling a little more restless and tired and your pain will become more intense. It is time to go to the hospital
  •  The Second stage – Second stage describes the period of time from when the cervix is fully dilated to when the baby is born.
  • The Third stage – The third stage begins after your baby is born and finishes when the placenta and membranes have been delivered.

The above said guidelines will further be discussed in detail. Each stage and what are the symptoms and what should be done opposed to them ill be discussed in the coming blogs.

The idea of this blog is to make you aware of a BIRTH PLAN Chart. This chat will be of great benefit and a very helpful guide when you break down the journey of bump watching.

Induction of labour

Approximately one quarter of women have an induction of labor. You will only be offered an induction if your health or your baby’s health is at risk. The most common reasons are:

  • health concerns, such as diabetes or high blood pressure
  • the health of your baby
  • the pregnancy has gone more than 10 to 12 days beyond the due date and there is a risk that the placenta can no longer sustain the baby’s life
  • Your waters have already broken, but you are not having contractions.

When your doctor recommends an induction you can expect that they will explain:

Some women will choose to ‘wait and see’ if labor will start on its own. It’s important that you consider all the risks and benefits in your particular situation so that you are able to make a well-informed decision.

Risks with induction

While not having an induction can put the health and even the life of your baby at risk, there are also risks with having an induction.

  • Having an induction for reasons other than prolonged pregnancy may increase the chance that you will need an emergency cesarean section.
  • Women who are induced are more likely to experience above average blood loss after the birth.

How is labor induced?

123 First the doctor  will do an examination of your cervix. The examination takes only a few minutes but it can be a little uncomfortable. Based on this examination your doctor or midwife will recommend one of the following methods of induction:

  • artificially breaking the waters (the membranes or the sac around your baby)
  • artificially breaking the waters and oxytocin
  • prostaglandin
  • Cervical ripening balloon catheter.

An induction might involve on or several of these methods.

Breaking your waters 

If your waters have not broken, the midwife or doctor can do this for you. The procedure is called Artificial Rupture of Membranes or ARM. The midwife or doctor makes a hole in your membrane sac to release the fluid inside. This procedure is done through your vagina using a small instrument. Sometimes releasing the waters is enough to get things going and labor will start. However, most women will also need oxytocin.

Things to know

  • The vaginal examination needed to perform this procedure may cause you some discomfort.
  • Although ARM is usually straightforward, it can increase the risk of cord prolapse, bleeding and infection

Oxytocin Oxytocin is the hormone that causes contractions. A synthetic version can be given if your waters have broken but contractions don’t start. Oxytocin is given through a drip in your arm. Once contractions begin, the rate of the drip is adjusted so that contractions occur regularly until your baby is born. This process can take several hours. Your baby’s heart rate will be monitored throughout labor using a CTG machine.

Things to know

  • It will be hard to move around because you are attached to a drip and the CTG monitor. While you can stand up or sit down, it will not be possible to have a bath or move from room to room.
  • Sometimes oxytocin can cause the uterus to contract too frequently, which may affect the pattern of your baby’s heartbeat. If this happens you will be asked to lie on your left side and the drip will be slowed to reduce the number and strength of your contractions. Another drug may be given to cancel the effect of the oxytocin.
Prostaglandin

Prostaglandin is a hormone that prepares your body for labor. A synthetic version can be inserted into your vagina, either in the form of a gel or a pessary. When the prostaglandin is in place, it’s a good idea to lie down and rest for at least 30 minutes. Once the prostaglandin has been inserted you will need to remain in hospital. When the prostaglandin takes effect, your cervix will soften and open. If you have the gel, you may need one, two, or three doses (given every six to eight hours). The pessary slowy releases the prostaglandin over 12 to 15 hours. When the cervix is soft and open, your body is prepared for labour. The next steps will vary from woman to woman – some might need an ARM to break their waters, and some women might need oxytocin to stimulate the contractions.

Things to know

  • Prostaglandin sometimes makes your vagina sore. However, there is no evidence to suggest that your labor will be any more painful than a labor that has started naturally.
  • A few women will react to the prostaglandin and have nausea, vomiting or diarrhea, but this is rare.
  • Very occasionally prostaglandin can cause the uterus to contract too much, which may affect the pattern of your baby’s heartbeat. If this happens you will be asked to lie on your left side. You may be given a medication to relax the uterus. If you have a pessary this may need to be removed.

Cervical ripening balloon catheter Your doctor may recommend using a cervical ripening balloon catheter over prostaglandin. This is a thin tube or catheter with balloons on the end. The catheter is inserted into your cervix and the balloons are inflated with saline. Once inflated the balloons apply pressure to the cervix. The pressure should soften and open your cervix. When the catheter is in place, you will need to stay in hospital but you can move around normally. Fifteen hours after the catheter has been inserted or when it falls out, you will be re-examined. During this time the midwives will periodically check you and listen to your baby’s heart. What happens next will vary from woman to woman – some might need an ARM to break their waters. Some women might need oxytocin to stimulate the contractions.

Things to know

  • The vaginal examination needed to perform this procedure may cause you some discomfort.

Forceps birth

Forceps are used to help the baby out of the vagina. They may be used if you are too exhausted to push, the baby is in an awkward position or there are concerns for your baby’s well being. Sometimes the forceps leave a mark on the baby’s cheeks, but these soon fade. You will usually need an episiotomy.

Vacuum (ventouse) birth

This is more commonly used in labor than forceps. The vacuum cup is made of plastic and is attached to a suction device. The cup is inserted into the vagina and creates a vacuum against the baby’s head. This helps the doctor to gently pull the baby out. It may cause a raised bruise on the baby’s head, but this soon fades, usually within a day. You may need an episiotomy.

Episiotomy

An episiotomy is a cut made in the perineum (the tissue between the vagina and the anus). Sometimes it is necessary to make the opening to the vagina bigger, especially if you need a forceps birth or if the baby is distressed. A local anaesthetic is used to numb the area and you will need stitches afterwards. The stitches will dissolve by themselves and you will be offered ice packs to reduce swelling and pain. Some caesarean births are planned in advance (elective caesarean) because of existing problems with your pregnancy. In other cases, the decision to perform a caesarean is made during the course of labour. This is called an emergency caesarean.

  • An emergency caesarean is recommended for the following reasons:
  • concern for your baby’s well being
  • your labor is not progressing
  • there are maternal complications, such as severe bleeding or severe pre-eclampsia
  • There is a life-threatening emergency for you or your baby.

Menopause – Premature Rising Risks

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Recent pan-India surveys conducted have brought an alarming new phenomenon of premature menopause among Indian women to light.  This is increasingly becoming a source of consternation among the medical community. Changing Dynamics in society is leading to increased pressure which, coupled with the lack of proper nutrition and education is ringing in such a thing among women.

Indian women invariably feature at the bottom of global health and wellness surveys. But that’s not all. A recent survey now shows that they are at a phenomenally high risk of suffering from ‘premature menopause’ with many experiencing this biological transition even before they’ve hit the third decade of their lives! One such survey shows, on an average nearly 4% of Indian women are already menopausal between the ages of 29-34 years, one of the lowest thresholds for menopause in the world. The natural age for menopausal onset is between 45 to 55 years with a mean age of 51 years, worldwide. A higher numbers of illiterate women experience premature menopause as against those who are educated the figures being 20 % as opposed to 11.1% respectively.

Interestingly, women who marry and have children late have less reason to worry as they experience a delayed onset of menopause.

What is a distorted menstrual pattern? 

Menopause is the strongest biological transitory phase in a woman’s life accompanied by volatile physical changes. The ovaries stop producing eggs, menstrual activity ceases and the body decreases the production of the female hormones (estrogen and progesterone) which play a catalytic role in conditioning the body for uniquely female functions such as pregnancy and child-bearing.

By stimulating skeletal growth, estrogen and progesterone help maintain healthy bones, protect the heart and veins by upping the body’s ‘good cholesterol’ (HDL or high-density lipoprotein) and lowering ‘bad cholesterol’ (LDL or low-density lipoprotein). But with the onset of menopause, and the subsequent dip in the levels of these hormones, a woman’s overall health, including her libido, gets impacted. The plummeting estrogen levels trigger increased blood flow to the face, neck, chest and back thereby resulting in the famed ‘hot flushes.

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Mood swings, decreased libido and vaginal dryness are also caused by this hormone dip. “The thinning of the vaginal wall tissues leads to vaginal dryness. In some cases, many physiological changes during menopause may go undetected. For instance, osteoporosis (loss of calcium in bones causing bone fragility) is often not diagnosed till a bone fracture actually occurs. So it is advisable for menopausal women to be in regular touch with their doctors.

Reasons of an Early Menopause

  • The increasing number of fertility treatments – As women delay motherhood, many opt for fertility treatments when they cannot conceive. This can reduce the ovarian reserve and hasten menopause
  • Cancer treatments – Chemotherapy and medication given to patients who get organ transplants are toxic to the ovary. As these treatments get more commonplace, the incidence of early menopause also increases
  • Hysterectomies – Most women finish having children by 25. So they opt for a hysterectomy. Women are getting their ovaries removed to prevent cervical cancer.
  • Unhealthy lifestyle – Smoking is a big reason for early menopause. Heavy smokers reach menopause five years earlier than normal, while passive smokers hit the stop button three years before time.
  • Stress – It found that more than eight per cent of women were infertile because of premature menopause. They were all in the age group of 30 to 32 years.

 Impacts:-

After menopause the body stops producing oestrogen and progesterone — the elixirs of youth for women. An early Menopause increases the chances of

  • Cardiovascular problems and osteoporosis in women.
  • Hot flushes,
  • dizziness
  • Problems in having sex
  • Urinary tract troubles
  • Sleep disturbances, trouble falling asleep, or if awakened, going back to sleep
  • A lack of oestrogen accelerates the ageing process.
  • Women suffer from skin dryness, hair fall and frontal balding
  • Their body image too takes a beating
  • Emotional setbacks such as anxiety, depression and irritability.

Sangita Kau could not understand why she was ageing so fast. The 26-year-old Chandigarh-based KPO professional noticed that her skin was becoming loose and that she had started balding. Worse, newly-married Sangita found her sex drive nose-diving.

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A chat with me further dented Sangita’s psychological state. She was diagnosed with premature menopause. A combination of excessive smoking and obesity had led to early menopause.

Sangita’s wasn’t a one-off case of untimely menopause. “In the last six months, I have seen 35 women with premature menopause. While the number of such patients is increasing, their age of menopause onset is decreasing. Till seven years ago, the patients were in their 30s. Now I get 25-year-olds hit by menopause. The average age for natural menopause among women in India is 46 years.

How to Treat it:-

  • Hormone therapy
  • Diet can, in fact, play a crucial role in combating the emotional, physical and mental stress of menopausal and pre-menopausal years.
  • A high-fibre, low fat and low-carb diet incorporating herbs,
  • Minerals and vitamins in one’s daily diet can work wonders.
  • One should eliminate tea, coffee, alcohol, caffeine, spicy foods and smoking during this period.
  • This automatically eliminates food cravings often experienced by women during this period. Also, one ought to keep one’s weight under check as being overweight augments these symptoms. Including soya, Vitamin E and herbal supplements in one’s diet also helps.
  • A menopausal nutrition plan usually includes lots of vegetables, fruits, fibre and whole grains. Focusing on lean proteins such as fish and chicken is a good idea. Eating five small meals per day rather than three huge ones is recommended as this helps keep blood sugar levels from fluctuating.

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Clearly, countless young women are paying a heavy price for leading stressful and unhealthy lifestyles — often with the untimely demise of their youth itself.