DR SANTOSH SIDID - couldn’t have succeeded for so many years if it weren’t for the members of the Pune community. That’s why I feel it’s my duty to share my knowledge and experiences with my patients. Read on to learn about health tips and medical innovations, and feel free to subscribe to my newsletter to stay up-to-date.
Dietary tips in pregnancy
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A healthy diet is an important part of a healthy lifestyle at any time, but especially vital if you're pregnant or planning a pregnancy. Healthy eating keeps you feeling good and gives your baby the essential nutrients they need in the womb.
Overall, aim for a balanced diet, with an appropriate blend of all the 5 food groups:
1) Vegetables and legumes
2) Breads and cereals
3) Milk, and milk products
4) Meat, poultry, fish and alternatives
Aim to drink plenty of water every day.
You will find that you are more hungry than usual. It is more important to concentrate on the quality of the food you eat rather than the quantity. Eating healthily means just changing the quantities of different foods you eat so that your diet is varied, rather than cutting out all your favorites. For example, if you have a healthy breakfast every day you can avoid snacking on foods that are high in fat and sugar. You have to be careful with your diet if you develop gestational diabetes.
Fruit and vegetables :- Eat plenty of fruits and vegetables because these provide vitamins and minerals, as well as fiber, which helps digestion and prevents constipation. Eat a variety of fruit and vegetables a day — these can be fresh, frozen, canned, dried or juiced. Always wash them carefully. Cook vegetables lightly in a little water, or eat them raw but well washed, to get the benefit of the nutrients they contain.
Starchy foods (carbohydrates) :- Starchy foods are an important source of vitamins and fiber, and are satisfying without containing too many calories. They include bread/Chapati/Bhakari, potatoes, breakfast cereals, rice, pasta, noodles, maize, millet, oats, sweet potatoes. These foods should be the main part of every meal. Eat whole grain/meal instead of processed (white) varieties when you can.
Protein :- Foods containing protein help the baby grow. Sources of protein include beans, legumes and nuts, meat (but avoid liver), fish (however, avoid sea fish, poultry, eggs. Eat some protein every day. Make sure eggs, poultry are cooked all the way through. Check that there is no pink meat.
Dairy :- Dairy foods such as milk, cheese and yoghurt are important because they contain calcium and other nutrients that your baby needs. Choose reduced-fat varieties wherever possible.
Healthy snacks :- If you get hungry between meals, don’t eat snacks that are high in fat and/or sugar, such as sweets, biscuits, crisps or chocolate. Instead, choose from the following nutritious snacks:
salad vegetables, such as carrot, celery or cucumber
ready-to-eat apricots, figs or resins
vegetable and bean soups
unsweetened breakfast cereals, with milk
milky drinks or unsweetened fruit juices
baked beans on toast or a baked potato
Foods to limit :- When you are pregnant, you should reduce your intake of:
1) Foods that are high in sugar, such as chocolate, biscuits, pastries, ice-cream, cake, puddings and soft drinks. Sugar contains calories without providing any other nutrients and contribute to weight gain, obesity and tooth decay.
2) Foods that are high in fat, such as all spreading fats (including butter), oils, salad dressings and cream. Fat is very high in calories, and eating more fatty foods is likely to make you put on weight. Having too much saturated fat can increase the amount of cholesterol in the blood, which increases the chance of developing heart disease. Try to cut down on saturated fat, and have foods rich in polyunsaturated or monounsaturated fat instead, such as oils, spreads, nut butters/pastes and avocado
3) Foods that contain added salt. Don’t add salt in cooking or at the table
4) Alcohol: There is no safe level of alcohol during your pregnancy. Whether you are planning a pregnancy, already pregnant or breastfeeding, not drinking is the safest option as alcohol can harm your unborn baby
Preparing food safely :- Wash fruits, vegetables and salads to remove all traces of soil, which may contain toxoplasma, a parasite that can cause toxoplasmosis, which can harm your unborn baby.
Exercise during Pregnancy and after delivery
The more active and fit you are during pregnancy, the easier it will be for you to adapt to your changing shape and weight gain. It will also help you to cope with labour (delivery pains) and get back into shape after the birth. Keep up your normal daily physical activity or exercise (sport, running, yoga, dancing, or even walking to the shops and back) for as long as you feel comfortable .Exercise is not dangerous for your baby.
General exercise tips for pregnancy :-
1) Do not exhaust yourself. You may need to slow down as your pregnancy progresses or if your doctor advises you to. As a general rule, you should be able to hold a conversation as you exercise when pregnant. If you become breathless as you talk, then you're probably exercising too strenuously.
2) If you were not active before you got pregnant, do not suddenly take up strenuous exercise.
3) Always warm up before exercising, and cool down afterwards
4) Try to keep active on a daily basis – 30 minutes of walking each day can be enough, but if you cannot manage that, any amount is better than nothing
5) Avoid any strenuous exercise in hot weather
6) Drink plenty of water and other fluids
7) If you go to exercise classes, make sure your teacher is properly qualified and knows that you're pregnant, as well as how many weeks pregnant you are
8) Exercises that have a risk of falling should only be done with caution. Falls carry a risk of damage to your baby
Exercises for upper body :-
Exercises for lower body :-
Exercises for pelvic muscles and smooth labour :-
Exercises for spine and lower back pain :-
Exercises for breathing during labour :-
Post pregnancy exercises :-
Sex in pregnancy
It's perfectly safe to have sex during pregnancy unless your doctor has told you not to. Having sex will not hurt your baby.
However, it's normal for your sex drive to change during pregnancy. This isn't something to worry about, but it's helpful to talk about it with your sexual partner. You may find having sex very enjoyable during pregnancy, or simply feel you don't want to. You can find other ways of being loving or making love. The most important thing is to talk about your feelings with your partner.
If your pregnancy is normal and you have no complications, having sex and orgasms won't increase your risk of going into labour early or cause a miscarriage. Later in pregnancy, an orgasm or even sex itself can set off mild contractions. If this happens, you'll feel the muscles of your womb go hard. These are known as Braxton Hicks contractions and can be uncomfortable, but they're perfectly normal and there's no need for alarm. You might want to try some relaxation techniques or just lie down until the contractions pass.
When to avoid sex in pregnancy
Your doctor will probably advise you to avoid sex if you've had any heavy bleeding in this pregnancy. Sex may increase the risk of further bleeding if the placenta is low or there's a collection of blood (haematoma).
You'll also be advised to avoid sex if:
your waters have broken – it can increase the risk of infection (ask your doctor if you're not sure whether your waters have broken)
there are any problems with the entrance to your womb (cervix) – you may be at a higher risk of going into early labour or having a miscarriage
you're having twins, or have previously had early labours, and are in the later stages of pregnancy
Travelling in Pregnancy
With the proper precautions, and with information on when to travel, most women can travel safely into their pregnancy. Wherever you go, find out what healthcare facilities are at your destination in case you need urgent medical attention. Take your maternity medical records with you so you can give doctors the relevant information if necessary.
Make sure your travel insurance covers you for any eventuality, such as pregnancy-related medical care during labour, premature birth and the cost of changing the date of your return trip if you go into labour.
When to travel in pregnancy :- Some women prefer not to travel in the first 12 weeks of pregnancy because of nausea and vomiting and feeling very tired during these early stages. The risk of miscarriage is also higher in the first 3 months, whether you're travelling or not. Travelling in the final months of pregnancy can be tiring and uncomfortable. So, many women find the best time to travel or take a holiday is in mid-pregnancy, between 4 and 6 months.
Tips to ensure you and your baby stay healthy during travels :-
Flying in pregnancy
Flying isn't harmful to you or your baby, but discuss any health issues or pregnancy complications with your doctor before you fly. The chance of going into labour is naturally higher after 37 weeks (around 32 weeks if you're carrying twins), and some airlines won't let you fly towards the end of your pregnancy. Check with the airline for their policy on this. After week 28 of pregnancy, the airline may ask for a letter from your doctor confirming your due date, and that you aren't at risk of complications. Long-distance travel (longer than 4 hours) carries a small risk of blood clots (deep vein thrombosis (DVT)). If you fly, drink plenty of water and move about regularly – every 30 minutes or so. You can buy a pair of graduated compression or support stockings from the pharmacy, which will help reduce leg swelling.
Car travel in pregnancy
It's best to avoid long car journeys if you're pregnant. However, if it can't be avoided, make sure you stop regularly and get out of the car to stretch and move around. You can also do some exercises in the car (when you're not driving), such as flexing and rotating your feet and wiggling your toes. This will keep the blood flowing through your legs and reduce any stiffness and discomfort. Wearing compression stockings while on long car journeys (more than 4 hours) can also increase the blood flow in your legs and help prevent blood clots.Fatigue and dizziness are common during pregnancy so it's important on car journeys to drink regularly and eat natural, energy-giving foods, such as fruit and nuts. Keep the air circulating in the car and wear your seatbelt with the cross strap between your breasts and the lap strap across your pelvis under your bump, not across your bump.
Road accidents are among the most common causes of injury in pregnant women. If you have to make a long trip, don't travel on your own. You could also share the driving with your companion.
Food and drink abroad in pregnancy
Take care to avoid food- and water-borne conditions, such as stomach upsets and travellers' diarrhoea. Some medicines for treating stomach upsets and travellers' diarrhoea aren't suitable during pregnancy. Always check if tap water is safe to drink. If in doubt, drink bottled water. If you get ill, keep hydrated and continue eating for the health of your baby, even if you're not hungry.
Work/Job during pregnancy
It is your right to work while you're pregnant. Pregnancy is not a disease but a normal physiological condition in any women's life.
If you're working while you're pregnant, it is your your right to get best antenatal care, maternity leave and other benefits.
If you have any worries about your health while at work, talk to your doctor. You can also talk to your employer, or someone in the personnel department (HR) where you work.
Once you tell your employer that you're pregnant, they should do a risk assessment with you to see if your job poses any risks to you or your baby. If there are any risks, they have to make reasonable adjustments to remove them. This can include changing your working hours. If you work with chemicals, lead or X-rays, or in a job with a lot of lifting, it may be risky for you to continue to work.
You may worry about using computer screens in pregnancy. But the most recent research shows no evidence of a risk to your baby or pregnancy from visual display units (VDUs) on computers.
Coping with pregnancy symptoms at work
You might get more tired than usual, particularly in the first and last few weeks of pregnancy.
Try to use your lunch break to eat and rest. If travelling in rush hour is exhausting, ask your employer if you can work slightly different hours for a while.
Don't rush home and start another job cleaning and cooking. If possible, ask your friend, partner or a member of your family to help you.
If you're struggling with nausea and vomiting (morning sickness), you might be finding it hard at work.
You can ask your employer about working slightly different hours to avoid times when you feel worse, or working from home on days when the morning sickness is bad.
Your baby's movements
When you'll feel your baby move
To be mothers usually start feeling baby movements at around 16 and 24 weeks of pregnancy. If this is your first baby, you might not feel movements until after 20 weeks. If you have not felt your baby move by 24 weeks, tell your doctor. They'll check your baby's heartbeat and movements. You should feel your baby move right up to and during labour.
Other people cannot feel your baby move as early as you can. When they can feel the movements, by putting a hand on your bump, is different for everyone.
What your baby's movements feel like
The movements can feel like a gentle swirling or fluttering. As your pregnancy progresses, you may feel kicks and jerky movements.
Call your doctor straight away if
your baby is moving less than usual
you cannot feel your baby moving any more
there is a change to your baby's usual pattern of movements
They'll need to check your baby's movements and heartbeat. Do not wait until the next day – call straight away, even if it's the middle of the night.
How often should your baby move?
There's no set number of movements you should feel each day – every baby is different.
You need to count the number of kicks or movements you feel each day.
The important thing is to get to know your baby's usual movements from day to day.
Do not use a home doppler (heartbeat listening kit) to try to check the baby's heartbeat yourself. This is not a reliable way to check your baby's health (as you are not trained to do so). Even if you hear a heartbeat (which you feel it to be so), this does not mean your baby is well.
Why your baby's movements are important
If your baby is not well, they will not be as active as usual. This means less movement can be a sign of infection inadequate nutrition/oxygen supply or another problem.
The sooner this is found out the better, so you and your baby can be given the right treatment and care. This could save your baby's life.
Can your baby move too much
It's not likely your baby can move too much. The important thing is to be aware of your baby's usual pattern of movements.
Any changes to this pattern of movements should be checked by doctor.
Reducing the risk of stillbirth
Stillbirth is when a baby ( 24 weeks of pregnancy or mare) dies before she or he is born.
Not all the causes of stillbirth are currently known, but experience suggests that if pregnant women know the risk factors, the signs to look out for and when to seek help, this can reduce how often stillbirth happens.
It's not possible to prevent every stillbirth. But we do know that certain factors increase the risk, and there are simple things you can do to reduce these risks.
Go to all your antenatal appointments without missing any. Some of the tests and measurements that can identify potential problems have to be done at specific times.
Going to all your appointments will also mean your doctor can give you relevant information as your pregnancy progresses.
Breastfeeding Support Centre/Lactation Clinic
Lactation Clinic at Hospital provides you support throughout your breastfeeding experience. This is a specialty service, managed by a qualified lactation consultant who is experienced in caring for newly delivered mothers and newborns, preterm and special needy babies. It offers support during and after pregnancy.
Support during pregnancy :-
- Preparing for Breastfeeding
- general information session.
- Individual consultations with a lactation consultant to discuss previous breastfeeding difficulties .
Support after delivery :-
- Information regarding breastfeeding techniques and assistance in the postnatal wards. .
- Individual inpatient consultations for breastfeeding problems in postnatal wards.
- Breastfeeding follow-up outpatient clinic
Some of the tips regarding breast feeding are as follows :-
1) Anticipate Your Baby’s Desires
Rather than waiting for your baby to cry, you can anticipate their needs by watching for a few tell-tale signs. When your baby is hungry, they may:
Turn or raise their head repeatedly.
Open and close their mouth.
Stick out their tongue.
Suck on whatever is near.
If you see your baby making these moves, offer your breast right away. Your baby will be happy that they don’t have to struggle to get your attention, and you’ll build a level of intimacy that will deepen your mother/baby relationship.
2) Let Your Baby Determine How Often And How Long To Nurse
Baby knows his/her needs better than you do right now. Let him/her determine how often to nurse. Don’t set a predetermined interval between feedings and then deny your baby food just because not enough time hasn’t gone by.
On the other hand, there’s no need to wake a sleeping baby to feed them simply because three hours have passed. Let your sleeping baby lay peacefully and feed them when they wake.
Similarly, let your baby determine how long to nurse. Remember, your little one knows how much they need better than you. Don’t worry if nursing time only lasts ten minutes, and don’t panic if it stretches on for forty-five. Some babies are fast eaters, while some like to take their time.
3) Get Comfortable While Nursing
You’re going to be spending a significant amount of time holding your baby to your breast while they feed. If you do this in an unsupported sitting position, it can get uncomfortable quickly. Additionally, trying to maintain an uncomfortable position for a prolonged period of time can lead to significant back, shoulder, and neck pain.
Not to mention, the constant squirming and moving on your part can disrupt your baby’s breastfeeding and result in irritability and increased hunger. That’s why it’s so important for you to be comfortable throughout the process.
We recommend one of two positions for comfortable breastfeeding:
Lie on your side with your baby facing you.
Sit in a reclined position with your baby lying in your arms.
A bed or a large couch with plenty of pillows to support your back and arms make these positions ideal for breastfeeding. Find the one that’s right for you but don’t be afraid to mix it up once in a while depending on your own needs. The more attentive you are to your own comfort, the more nursing sessions will be a pleasant break for both you and your baby.
In addition to making sure you and the baby are comfortable while nursing, try your best to relax. Your baby can sense if you’re tense and nervous about breastfeeding, and they won’t latch on correctly. Your baby can’t relax if you’re not relaxed.
Examine your environment as well. If you’re in a stressful environment or an environment that makes you uncomfortable, opt for a change of scenery.
Maybe spend a few minutes before nursing to give yourself a pep talk. Take a few slow, deep breaths. Visualise your happy place. This is supposed to be an enjoyable time of bonding with your new bundle of joy, not a stressful one.
5) Help Your Baby Find The Right Position
Through the course of breastfeeding, your baby will likely find the position that’s best for them. Pay attention to this position so that you can make it easier to get into quickly. Every baby is different, but there are a few general guidelines that you can use to find a position that works for both you and your baby.
Your baby should be positioned so that their mouth is level with your nipple.
They should not have to turn their head much, if at all.
Their head should be tilted backward slightly.
If possible, they should latch onto the entire areola, not just the nipple.
Their chin should be right up against your breast so that their nose is clear.
First and foremost, don’t force these positions. Your baby may prefer a slightly different position. Just let it happen naturally while you make sure that your baby is comfortable and can breathe while they nurse.
6) Don’t Be Alarmed, Leaking Is Natural
In the first few weeks of breastfeeding, it’s common for milk to leak from your breasts. Don’t be alarmed, this is completely natural. It can happen when you hear another baby cry, when your baby hasn’t nursed for several hours, when you think about your baby, or even when you feel a strong emotion.
This leaking will eventually lessen or disappear completely as your baby continues to nurse. In the meantime, simply place a nursing pad in your bra to absorb the leaks.
7) Take Care Of Your Skin
The skin of your breasts is very delicate. With regular nursing, your skin can become dry, chapped, irritated, and even cracked over time. This can make breastfeeding a painful experience. Luckily, you can protect against chapped, cracked skin by taking a few precautions.
Don’t overwash. One or two showers a day with a gentle cleanser is plenty.
After a feeding, pat your breasts dry with a soft cloth.
Let your breasts air out periodically to avoid irritation from clothing.
After a feeding, apply any healing product available.
Taking care of your skin with a healing product is one of the best ways to keep the breastfeeding process enjoyable for both you and your baby. When you’re comfortable, your baby will be comfortable and you can use nursing as a way to deepen the already strong bond you feel for your newborn child.
8) Don’t Worry, You’ll Have Enough Milk
Milk production depends primarily on your baby’s needs. Your little one’s sucking stimulates the release of the hormones prolactin and oxytocin which further stimulate milk production. But it doesn’t start with your baby’s first suckle. Your breasts have been preparing to give milk since the start of your pregnancy.
So don’t worry, you will have enough milk. The more your baby nurses, the more milk you’ll have.
During the first two or three days of breastfeeding, you may notice a thick yellowish-orange fluid coming out of your breasts. Don’t panic. That fluid is colostrum and it’s just what your baby needs at the moment. Colostrum is very nutritious and contains high levels of antibodies. These antibodies boost your baby’s immune system so they can fight off infection.
9) Look For Signs That Breastfeeding Is Going Well
Your baby’s behavior and health will tell you if nursing is going well or not. Don’t worry if you don’t see these signs all the time. Even just one is an indication that your baby is well-fed.
While feeding, your baby should suck eagerly and swallow regularly. Keep in mind that, when your little one first starts feeding, they’ll swallow each time they suck. As milk decreases, they get full, or fall asleep, swallowing will decrease. That’s perfectly natural and nothing to worry about.
At the end of a nursing session, your baby should release your breast and appear drowsy. Their skin will be a healthy pink and their muscles will be totally relaxed.
Your baby’s diapers should be very wet while they are breastfeeding. They will likely have four to eight bowel movements each day during the first few weeks of life. This is due primarily to colostrum consumption. As time goes on, your little one will have fewer and fewer bowel movements. There may come a time when they only have one bowel movement or less per day. As long as those bowel movements remain soft and the diapers are wet with urine, there’s no need to be worried about constipation.
Your baby is gaining weight regularly. It’s not necessary, however, to weigh your baby daily or, worse yet, to weigh them before or after each feeding. That would serve no purpose other than to cause you anxiety. If your baby is healthy, the monthly weigh-in by the pediatrician is more than sufficient. Still, if it makes you feel better, you can weigh your baby once per week at home.
10) Avoid Engorgement
Engorgement is a painful swelling and hardening of your breasts that occurs when you produce more milk than your baby consumes. Engorgement is most frequent when your milk first comes in right after your baby is born.
The swelling can actually make it more difficult for your baby to feed, which only increases the likelihood that engorgement will continue. The best way to avoid this painful condition is to nurse your baby as often as possible.
If engorgement persists, you can hand-express breast milk by gently massaging the areola between your fingers. You may want to express milk under a warm shower, which helps the milk flow more easily. If you don’t succeed, try using a pump, and continue until your breasts soften and feel comfortable again.
11) Ask For Help
Reading and taking a class about breastfeeding is one thing — actually breastfeeding on your own is a different story. So ask for help within that first hour after birth when you’ll want to start breastfeeding your little one.
In your local hospital, a nurse will check on you and your baby while breastfeeding. She may even offer some advice and help you. But if you’re still having trouble, the lactation consultant can help further...but you have to ask. Otherwise, they won’t know your needs.
While you’re still in the hospital, the lactation consultant can come in to see for herself how your baby is latching on. She’ll be able to give you guidance and advice on how to position your baby and your body.
The lactation consultant is more than happy to help you and guide you in your breastfeeding journey. We know it can be a little nerve-wracking leaving the hospital and the support of the nurses, but feel free to call your local hospital and ask to speak to the lactation consultant with any questions you may have.
Breastfeeding might be uncomfortable at first when your baby latches on, but it shouldn’t be a painful experience for you. If breastfeeding is hurting bad enough to make you cringe, seek out help from a professional.
12) Stay Hydrated
Last, but certainly not least, stay hydrated. We can’t stress enough how important this tip is for you and your baby. After all, you’re still eating and drinking for two!
Water replenishes the body, so a good rule of thumb is to drink a glass of water whenever you breastfeed. Yes, every single time. This will ensure that your body can make enough milk and that you’re staying hydrated.
Fetal medicine services available
Ultrasound is done in the foetal medicine department. Following scans can be done:-
Early pregnancy scan - to conform pregnancy and foetal viability.
Nuchal translucency scan (NT) Scan (11-113) weeks. Double marker test (Down's/Edward's/Patau's syndrome screening)
Uterine Artery Doppler Study
Second trimester anomaly scan.(19 weeks)
TVS for cervical length
Growth scan, scan for foetal well being
Obstetric Doppler studies
Fetal 2D echo
3D, 4D scan
Invasive procedures :-
Following invasive procedures are carried out routinely in the department.
A detailed counselling of the patient / couple about the indication, sample analysis and associated risks is done prior to the procedure.
1. Amniocentesis :- This is the commonest diagnostic procedure offered to rule out chromosomal abnormalities in the feotus. The procedure is done after 16 completed weeks.
2. Chorionic Villi Sampling:-- This diagnostic procedure is done mainly for prenatal diagnosis of different genetic disorders where mutation analysis on foetal DNA is necessary for diagnosis. (Eg. Thalssemia, DMD, SMA, autosomal recessive metabolic disorders etc)
3. Fetal Reduction:- This is offered to patients with higher order multifetal gestation (Triplets / quadruplets) to improve survival chances of other foetuses and to improve pregnancy outcome. The procedure is also offered as a selective reduction procedure in Twin gestation when one of the foetuses show abnormality that is known to cause severe disability after birth in the affected foetus. The procedure is offered between 11-12 weeks of pregnancy.
4. Intrauterine foetal blood transfusion:- This is a life saving therapeutic procedure done in foetuses found to have severe anaemia in utero. The commonest indication is anaemia due to Rhesus iso-immunisation in the mother.
5. Amnioreduction :- This is offered to mothers with severe symptomatic poly-hydramnios with aim to prolong pregnancy to a deliverable gestational age.
6. Cordocentesis :- This is a diagnostic test offered to couples where foetal blood sample is necessary to diagnose rare suspected disease.
VOLUSON E8 USG machine is available in department
How to Stay Healthy Through the Winter
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