Baby Care: Glimpses from my book

Chapter One of my book: Pregnancy Issues

Pregnancy Issues

The moment a child is born, the mother is also born. She never existed before. The woman existed, but the mother, never. A mother is something absolutely new. – Author unknown

Planned Parenthood and Planned Family:

In modern times, young couples often decide to wait for several years after marriage before starting a family. Their purpose behind such a delay is manifold.

a) They are both professionals or are working - often long hours or odd hours - so that they can collect lots of money that will be useful in the future.
b) They want to enjoy life without the trouble of being grounded by children.
c) They want to see the world.
d) They want to put off taking the responsibilities of parenthood - a sort of procrastination.

I have seen young men and women sometimes delaying the arrival of their first child until almost 7-8 years after marriage. You would do well to remember that the best age for women to carry babies is between 17 and 25 years. At an age younger than 17, the woman is neither physically nor emotionally mature to look after a new life. After 25-30 years of age, a woman who decides to raise children will find the going tough, both for herself and for the baby, as the medical risks begin to increase for the mother, and risks of chromosomal and genetic abnormalities increase for the baby.

At the same time, once you have had a baby, it is essential to space the next pregnancy: a gap of at least 3-5 years between any two children is not only desirable, but also recommended. This is to allow the mother to recuperate completely, to allow her to pay undivided attention to the last-born and to allow the child to grow up with 100% maternal care and love. By the time the next baby is born, the previous one will have already begun to go to nursery school.

To learn how to space babies, you should consult your gynecologist. He/she may advise a suitable method of contraception such as a “loop” (a type of intrauterine device).

This chapter will deal with aspects of pregnancy which have a bearing on the baby. For more details, you should consult a “Pregnancy Care Book” or look up some of the web-sites at the end of this chapter.

Fertilisation/Conception:

The process of conception will occur best between the 13th to 18th day of the menstrual cycle of the mother, as this is the time when the egg is released from the ovary and travels down to the mother’s womb.

The moment one of the father’s sperms unites with one of the eggs of the mother, new life is said to have been conceived! This process, also called fertilisation, occurs anytime shortly after sexual intercourse has taken place between the two adults. Of the millions of sperms released by the father, just one will actually unite with the mother’s egg (ovum). The rest of the sperms will perish.

The fertilised egg (zygote) then selects a suitable spot inside the womb and implants itself on to the inside wall of the womb for further development.

How The Baby Grows Inside Her Mother:

The one-celled zygote weighs 0.005 mg. It will grow at a phenomenal rate from the moment it is fertilised. Cells will multiply quite rapidly, till they reach a figure of over two billion at birth. Their mass will have increased 600 million times to 3000 grams or more! See the table below to get an ide


Age of the growing fetus Size
Conception Microscopic
12 weeks 14 grams/7.5 cm
28 weeks 1000 grams/35 cm
Full term 3000 grams/50 cm

At 12 weeks, most of the fetus’s organs are already formed and the face is almost developed. At 20 weeks, the baby begins to move, and the mother can feel the baby “kicking” inside her womb. The doctor will be able to hear her beating heart with a stethoscope or a fetoscope. However, at this stage, the baby’s lungs are not well developed and the baby cannot survive outside the womb.

At 26-28 weeks, the baby is about 700 grams and if born at this stage, the baby has less than favourable chances of surviving, even with the best possible neonatal care. At 28 weeks and a weight of 1000 grams, the odds are better for the baby, and given proper neonatal care, the baby is likely to survive.

During all these days, the baby floats in a liquid known as amniotic fluid. It is free to move around inside the womb. As its size increases, however, its movements become increasingly difficult, and it settles down into one or the other position, most commonly, the head-down position, also called “vertex” (Fig.1-1). Sometimes though, the baby remains aligned with its head up (breech), or transversely or obliquely. In such cases, there can be complications at the time of delivery.

Sex of the Baby:

All our body cells contain the information about our inheritance in the form of chromosomes, tiny strands of protein material that contain DNA. While there are 22 pairs of general chromosomes (or autosomes), there is one pair of sex chromosomes: these are called either the X or the Y chromosomes. Males contain one of each type of sex chromosomes, while females have a pair of X chromosomes. The sperm or the ovum has only one of this pair in it, so while a sperm may have either a X or a Y chromosome, all ova have X chromosomes only.

During conception, when a sperm and an ovum unite, one can have a zygote with one of the two combinations. These are:
1. Father’s X sperm + Mother’s X ovum = female
2. Father’s Y sperm + Mother’s X ovum = male

If you closely examine the above two combinations, you will find that it is the father’s sperm which decides what the baby is going to be – whether a boy or a girl (Fig.1-2).

The sex of the child is not determined by the mother, but by the father.

Indian people are obsessed with the idea that a son is preferable to a daughter. This obsession has taken the lives of thousands of female fetuses (feticide), small female infants (female infanticide) and even older female children. While the male child is given the choicest food, the female child has to make do with leftovers. Even in illness, while the male child receives the best medical care at the hands of the most expensive doctor, the female child is often given “home-remedies” and substandard care. This deplorable state of affairs has resulted in a drastic decline of the nationwide female: male ratio from an ideal of 1000:1000 to just 779:1000 as per the 2001 Census of the Government of India.

Many people believe that while the son will be the “torch-bearer” of the family, contribute to the family’s income and bring in “dowry” at the time of his marriage, a daughter cannot continue the family name, will not work on the “farm” (or other similar occupation) and will be a “financial burden” on the family at the time of marriage.

It is true that with the advancement of society, many of the older traditions are gradually dying out, but the mindset of the masses will take much longer to change. Women are educating themselves and adding their incomes to the family’s kitty; many women are the family’s sole bread-winners. Dowry is illegal, and many modern grooms are refusing to be a part of this extremely retrograde practice. Old parents are often abandoned by their much hyped sons, who think nothing of setting up new homes with their spouses and leaving their infirm parents to fend for themselves.

Blaming the mother for giving birth to girls is the name of the game, and totally incorrect, as we have just seen above. Many mothers go through childbirth again and again in the desire for a male child; marriages are broken, and males are made to marry a second time to “improve” the chance of siring a boy. This is happening not just in illiterate homes, but also in rich, elitist families labouring under a traditional mindset.

Choosing the sex of the baby:

At every conception, there is a 50:50 chance of having either a boy or a girl. There is no fool-proof method of conceiving a baby of a pre-determined sex. A Chinese calendar is supposed to correlate the date of conception to the sex of the baby. Dietary manipulations, recourse to astrological formulas, tying of the spermatic cord and many such heroic techniques have been tried, but to no avail.

The Y-sperm has a shorter life, and it is believed that a couple that indulges in sex more often (or where the father “empties” the testes by masturbating daily) has a greater chance of a male child as more sperms will be the fresher, faster Y-sperms.

There is no medicine, drug or herb which can ensure the birth of a child with a desired sex, and many such remedies may be potentially harmful to the developing fetus, as many of them are taken “after” conception has already taken place and the mother has missed her period.

There is no natural method that can guarantee birth of a child with a desired sex. High-tech medical methods are only approved for genuine cases and not for sex selection.

The only reliable method of ensuring a male child is to go in for new technology, where a Y-sperm is identified and selected outside the body, in a test-tube, and is “made” to unite with the natural mother’s ovum in it (test-tube baby). Once the zygote is formed, one waits for it to develop a bit more. Then it is implanted into the mother’s womb, where it will develop further, like a normal pregnancy. To avoid the chance of failure of implantation, the fertility technologist will often fertilise more than one ovum with the Y-sperms, and implant more than one zygote. As a result, multiple pregnancies may also result.

The problem with this technology is that although it looks simple, it is very complex in practice and may cost lakhs of rupees. Also, the Government of India has made sex-selection of a baby a crime punishable with fine, imprisonment, or both. Thus, under normal circumstances, it would be an unethical and criminal act and a waste of resources.

The only ethical place for such technology is when there are genetic disorders in the family that affect only females. Here, sex-selection to favour a male child may be excused on medical grounds. Similarly, in diseases such as hemophilia (a type of bleeding disease), where only males are affected, the above technology may be used to select X-sperms, so that only a girl child can be conceived.

Sex Determination during Pregnancy:

Again, it is not only unethical, but also criminal to detect the sex of the unborn child with the help of any technique. The only ethical reason would be to give the option of terminating the pregnancy of a particular sex in case of genetic disorders that affect that sex only.

As per the above, going in for CVB (chorionic villus biopsy), amniocentesis or ultrasonography with the aim of identifying the sex of the baby is a crime that can bring punishment to both the patient and the doctor who performs it.

Antenatal care:

Once you miss your period, your first hope is bound to be that you have probably conceived a baby! Naturally, you are delighted. Your first task should be to approach a doctor - either your family doctor or your gynecologist. He/she will confirm the pregnancy with a simple urine test.

Routine antenatal visits to the obstetrician must begin as early as possible after detection of pregnancy. The doctor will examine the mother-to-be and call her for regular follow-up visits. She may ask for an early antenatal ultrasound examination to see if all is well with the developing embryo and to confirm if the mother’s womb and placenta too are all right. She will usually ask for urine and blood tests such as blood grouping, Rh typing, complete blood counts and hemoglobin estimation, tests to rule out presence of any infections in the mother which can be transmitted to the fetus and a urine sugar test with/without a blood sugar test to rule out gestational diabetes mellitus.

She will take the mother’s blood pressure, weight and other measurements to establish base-line values at the first visit and repeat these at each follow-up to ensure the health of the mother. She will advise the mother about diet, use of supplements, give Tetanus Toxoid vaccine and do all that is needed to keep the mother and baby in the pink of health.

I advise you, the mother-to-be, to follow all the instructions of the obstetrician and to go for follow-ups every month till the seventh month, every fortnight from then till the ninth month and then every week till you begin to have labour pains.

Sometime during these visits, you will have to make a choice of which maternity home or hospital to register in for the delivery. This is a very important choice to make. Try and choose a reputed institution which has facilities for all the necessary tests and treatments that may have to be carried out on you or your baby once it is born. Along with these parameters, try and find out if the institution is a certified “Baby Friendly Hospital”. BFH’s are hospitals that are staffed with personnel that are trained in the Art and Science of breastfeeding. (See http://www.babyfriendly.org.uk/home.asp and http://www.storknet.com/cubbies/breast/10steps.htm for more details on the Baby Friendly Hospital Initiative. In India, guidelines are currently being formulated by a task force which is located at Indian Medical Association, Indraprastha Marg, New Delhi 110002.)

What to Avoid in Pregnancy:

The first two to three months of pregnancy are the ones when the baby’s organs are taking shape (the period of organogenesis). As such, any adverse events during this delicate period can create problems in the baby. In the event that these actually affect the baby, the baby will likely have physical defects (congenital anomalies), mental retardation and so on.

You should strictly avoid the following during the entire pregnancy:

1. Any medication, whether to “abort” the baby, or for any illness without a doctor’s opinion; a special mention must be made of certain anticonvulsants (sp. diphenylhydantoin) used by epileptics;
2. Any X-rays for non-essential reasons;
3. Any exposure to nuclear radiation (includes anti-thyroid medicines, thyroid or other scans, etc.);
4. Smoking, consumption of gutkha, drugs or alcohol as these can definitely affect the developing fetus;
5. Excessive consumption of tea, coffee or other stimulants;
6. Excessive use of cough and cold medicines, sleeping agents and other stuff that makes the baby drowsy;
7. Vitamin-A containing facial creams and tablets, mostly used for severe acne;
8. Getting any other family member vaccinated against Polio, Measles, Rubella or Chicken-pox vaccines. These are live vaccines and the virus may be transmitted to you, and through you, to the unborn baby;
9. Lifting unusually heavy weights or carrying out strenuous work: this can abort the baby or cause preterm onset of labour;
10. Fights and a vitiating home atmosphere: these can conceivably cause fetal distress and even preterm onset of labour; and
11. Putting on violent T.V. shows and loud music shows: these can act similarly.
12. Sauna baths: It has been shown that if the pregnant mother is exposed to ambient temperatures above 40­degrees C in the first three months, the fetus can be harmed.

Diet and Nutrition in Pregnancy:

Extra nourishment is needed in pregnancy for the healthy growth of the placenta, the uterus (womb) and the developing baby (or fetus). Blood loss during the delivery process has to be provided for. Also, the mother must create extra reserve stores of iron, calcium, fat and protein to face the delicate nursing period after the delivery of the baby.

Perversion of appetite and vomiting actually prevent the mother from eating well in the first three months of pregnancy. However, once these three months are up, the mother seems to settle down, and the appetite improves. She should then start eating extra food right till the end of pregnancy, and beyond, during lactation. The extra food includes an extra 250 calories and 30 g protein everyday.

You should eat a balanced diet with high fibre content, high-biological-value proteins and adequate calories. In particular, eat dals, germinated pulses (sprouts), fresh green leafy vegetables, whole wheat chapatis/bread, rice, milk or milk products, (yoghurt, paneer, cheese, khoya, kheer, etc.) and lots of fruit (Fig 1-3). Non-vegetarians may eat eggs, mutton, chicken, fish and organ meats like liver, kidneys, etc.

Excessive intake of refined sugars and fats, such as those found in cakes, desserts, sweets, chocolates, halwa, pinjiri etc. should be avoided, as these can cause obesity and other ailments in later life.

If you eat right, you should put on around 10-12 kilograms of weight during pregnancy. You should feel active, not lethargic, and be able to carry on with normal household activities without feeling tired.

Supplements:

Folic acid supplements are very essential around the time you start planning for a baby. Use of folic acid tablets before and up to eight weeks after conception has been found to prevent some rather serious congenital anomalies of the baby’s nervous system. You should take at least 0.5 mg/day of this vitamin throughout pregnancy.

Iron tablets sufficient to deliver at least 60 mg of iron per day are also essential during pregnancy. So also Calcium and Vitamin D supplements, which need to be eaten daily. Do take multivitamin pills containing Zinc as well.

Preparing for Breastfeeding:

Expectant mothers need antenatal counselling from trained persons on a) benefits of breastfeeding and b) techniques of breastfeeding. These persons can be mothers who have successfully fed their own babies with breast milk, trained health workers, nurses or even “maalishwalis”. Such educational sessions go a long way in helping new mothers acquire the much needed skills and confidence to successfully breastfeed their newborns.

If you are a senior woman in the household and have a pregnant daughter or daughter-in-law or sister-in-law, you need to motivate her right from the first trimester of pregnancy. Your effort will translate into a vibrant mother-child unit which will be an asset to the entire household.

To the first-time mother, here is an important bit of advice: Size does not matter. You can have small petulant breasts, and still be able to nurse your baby successfully. Do get the nipples checked out by your doctor if you feel they are misshaped or “inverted”. The doctor will advise you accordingly. If you feel your nipples are not protruding enough, take them between your thumb and first finger one by one, and roll them outward for a few minutes everyday.

As pregnancy advances, your breasts will start feeling fuller, bigger and heavier. Use bras with supports, choosing a bra size that fits comfortably without causing tightness. Some milky discharge may be seen in the last few months, and if it causes wetting of your dress, wear some absorbent cotton pads inside the bra while at work.

Exercise and Travel:

Keeping yourself busy with household or office work is all right, but you must avoid over-working yourself or undertaking strenuous tasks that may harm your pregnancy’s outcome. Do take brisk walks in the mornings and evenings; cycling or swimming is also good. You may even play active games like table-tennis or badminton (at a slow pace). However, you must not play high-activity games like football, hockey etc. Participating in athletic events is also not permissible. An afternoon nap of at least 45-60 minutes is very desirable. If you have swelling of your legs, you might want to rest your feet above pillows while reclining on the bed so as to allow the extra water to get absorbed.

Travelling is also fine, but do not carry heavy weights. Do not travel without a companion. Avoid travelling a) over bumpy roads b) to remote villages c) in auto-rickshaws d) in crowded trains or buses and e) during the last one or two months of pregnancy.

Mental Relaxation:

The key to a healthy outcome of pregnancy is to have a continuous positive frame of mind and avoid undue anxiety, stress and negative emotion. You should occupy yourselves with any activity that keeps you happy and emotionally sound. If you are a working mother, continue to attend office as long as possible. If you are a housewife, stay away from internal family strife and keep yourself busy with jobs like knitting woollens for the arriving baby, learning new skills which help parenting, reading good self-help books, painting, cooking, or whatever else is your pleasure. Try and get at least 8-10 hours of sleep daily, including an afternoon nap. Join Yoga classes, meditation classes, Reiki classes and Lamaze classes if they are available in your vicinity. Ask your obstetrician or family doctor about these special classes. Listening to soft, soothing music will also be rewarding, and may even help the growing baby stay calm inside the womb. There is enough evidence to support the fact that whatever you can hear, the baby can, too. Hence avoid shouting, fighting and other unpleasant hearing experiences for the baby. Lastly, deep breathing must be practiced, as it will be of help in labour.

Sexual Intercourse:

There is a false belief among some people that normal conjugal relations between the husband and the expectant mother can cause the baby to abort. Normal relations can be maintained until seven months of pregnancy; thereafter, one may still continue to have relations but either with the wife on top or with both partners lying side by side with the husband penetrating from the rear or the front.

Too much nipple stimulation may cause milk to be secreted; at times, it may even cause the onset of premature labour pains. Hence, it should be avoided, especially after seven months of pregnancy. The couple may elect to abstain from sex in the last 2-3 months and instead concentrate on the emotional aspects of a lasting, loving relationship.

Symptoms to worry about:

The following danger symptoms should cause you to immediately contact your physician or obstetrician:

- Sudden bleeding per vaginum
- Severe nausea or vomiting, esp. in the first three months
- Burning sensation while passing urine
- Blurring of vision or seeing white or black spots before the eyes
- Severe or persistent headache
- Unusual abdominal pain that comes and goes, but without any bowel movement
- High fever (more than 100º F) without any obvious common cause
- Reduction or absence of baby’s movements
- Fainting or dizziness
- Accidents, falls or injuries to the abdomen from any cause
- Marked swelling of the feet and/or other parts of the body

The above symptoms may indicate either that your pregnancy is experiencing some difficulties or that you have some other undesired complication or infection. Pregnancy related complications include retention of fluids and rising blood-pressure, excessive weight gain, urinary infection, premature onset of labour, abortion, placental bleeding, distress to the fetus, pregnancy-related diabetes in the mother, fetal demise in the womb and many others. For complete details, please consult your obstetrician or look in an appropriate pregnancy book. Some useful web-sites are given below:

- www.pregnancy.org
- www.childbirth.org
- www.pregnancy.about.com
- www.pregnancyguideonline.com
- www.pregnancy-info.net

There are many good books available also. A few are listed here:

- The Mother of All Pregnancy Books: The Ultimate Guide to Conception, Birth, and Everything In Between (U.S. Edition) by Ann Douglas.
- The Pregnancy Journal – A Day to Day Guide to a Healthy and Happy Pregnancy by A. Christine Harris, Ph. D.
(End)


- ##Dr.Taher##

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With A Cherry On The Top  (ASR) Natasha would give anything to be allowed to eat just one more ice cream. #909828 by Dr Taher writes again!

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I do not suffer from insanity. I positively enjoy every moment living it!