Costometic

Pregnancy can be a difficult time for the expecting mom - both mentally and physically. Not only is your body changing in a million different ways that are totally new to you, but every little twinge can throw you into a state of panic, making you worry that something is seriously wrong. Relax, say the experts. “Women need to remind themselves that the vast majority of pregnancies go smoothly”, says Dr. Bruce Flamm, M.D., an ob-gyn in California, US. Still, pregnancy problems can - and do - happen. That is why it is important for every expecting mom to know the warning signs she should look out for and never ignore. Some symptoms require an immediate phone call to your gynecologist.

1. Extreme Vomiting

Most cases of morning sickness are annoying - but not harmful. But if you are throwing up so much that you can’t keep liquids down or if you are not urinating, you need to let the doctor know. “This can lead to severe dehydration, which is not good for you or your baby”, says Isabel Dr. Blumberg, M.D., an ob-gyn in New York City, US. It can also be a sign that you are suffering from hyperemesis gravidarum, a type of extreme morning sickness that can last throughout your entire pregnancy. Also call if you haven’t been able to keep food down for two days straight, if you think you have food poisoning or if the vomiting is accompanied by a high fever. In these cases, you may need to be given IV fluids.

2. Intense Pain in Your Abdomen

If you are less than 12 weeks pregnant, you are feeling sharp cramps on one side of your stomach and you are not yet to get an ultrasound done, your doctor will want to rule out an ectopic pregnancy (one in which the egg has implanted itself in the fallopian tube rather than in the uterus). Later on in your pregnancy, call if the pain is intense or recurrent, since it could be anything from contractions to appendicitis.

3. Watery Discharge or Contractions

If you are near the end of your pregnancy, this discharge probably means you water has broken, so head to the hospital. But if you suddenly experience a gush of fluids anytime before 37 weeks, call your doctor pronto. It might be a sign that your amniotic sac has ruptured and you are going into preterm labour. Still, don’t assume the worst. “Many women think their water has broken too early, when the baby may have just kicked their bladder hard and they lost some urine”, says Dr. Flamm.

Contractions may be another sign of preterm labour. So if you suddenly feel them coming on when you are between 24 to 36 weeks pregnant, pick up the phone.

4. Bleeding

Talk to your doctor immediately if you have vaginal bleeding. “In your second or third trimester, it could mean you have a tear in your placenta or another problem that should be diagnosed by an ultrasound”, says Dr. Flamm. Don’t panic: Bleeding during pregnancy does not always lead to long-term problems. If you are in your first 12 weeks, keep in mind that many women spot in the first trimester, so bleeding doesn’t always indicate a miscarriage.

5. Severe Headache or Swelling All Over Your Body

If you get a bad headache in your first trimester or regularly suffer from migraines, it is probably no big deal. Ditto if you have some swelling in your ankles as your pregnancy progresses - that just means you are retaining fluid. But, if you suddenly get a splitting headache in your second or third trimester, or if your hands and face swell like crazy and won’t go down, you could be suffering from preeclampsia (pregnancy induced high blood pressure) and need to see your doctor immediately. Another possible sign of preeclampsia to tell your doctor about: Your vision suddenly becomes blurry.

6. Lack of Foetal Movement

If you have not felt much in the way of kicking for about an hour, no need to call right away. Instead, drink a glass of fruit juice (the sugar in juice will make your baby’s blood-sugar levels jump, increasing the chances that he will start kicking), then lie on your left side in a quiet room for half an hour. “If you don’t count three to four movements within that time frame, give your doctor a call”, says Dr. Blumberg. “Usually it is nothing - the baby is just being especially still - but your doctor will probably want you to have an ultrasound to make sure there aren’t any problems”.

When Rachel from Detroit, MI learned she was pregnant after battling infertility for three years, she was thrilled. But soon, her excitement vanished. All she could do was lie in bed and stare at the ceiling. She stopped eating and lost three kilos in her first trimester. She even began to wish she wasn’t pregnant.

“I don’t recognize myself”, Rachel says. “I told my husband I didn’t want the baby anymore. He had no idea how he could help me. I couldn’t stop crying. After all that we had been through to have a baby, it was a terrible blow”.

Confiding in her ob-gyn didn’t help. “At ten weeks, I told her I was afraid of what I was doing to myself. But she kept telling me I’d be okay”, Rachel says. It wasn’t until the hormonal surge of early pregnancy stages began to subside at around 14 weeks that she started to feel better. The experience haunts her: “I still feel guilty that I wasn’t more joyful in those early days”. It was only after Rachel switched to a new ob-gyn and gave birth that she learned she’d suffered from prenatal depression - and could have got help.

Her experience isn’t rare. “Major depression is one of the most common complications in pregnancy stages”, says Dr. Shaila Kulkarni Misri, M.D., author of Pregnancy Blues: What Every Women Needs to Know About Depression During Pregnancy. At least 10 percent of pregnant women are likely to get the blues during pregnancy (and many will go on to have post-partum depression), yet two-thirds go untreated, according to a study at the University of Michigan Depression Center, US.

“SHAMEFUL” SYMPTOMS

The signs of prenatal depression are often similar to those of post-partum depression - extreme fatigue, irritability, anxiety, crying, sleep problems, decreased energy, appetite changes, lack of excitement about having a baby, disinterest in activities, obsessive thoughts and worries, lack of concentration, feelings of guilt, worthlessness and hopelessness. “The most troubling symptom is probably the feeling of detachment from the baby”, says Child advisors. Many pregnant women are , however, either unaware of the significance of these symptoms or are too ashamed to ask for help. “So many people believe that pregnancy protects women from depression”, says Sonia Murdock, Executive Director, Post-partum Resource Center, New York, US. “They say, ‘Why would a woman be miserable during such a happy time?’” Many depressed moms-to-be never discus their emotions with anyone because they are afraid of being ridiculed, or worse, judged. Post-partum depression, considered less taboo, receives much more attention - even celebrities talk about it.

Some experts believe the medical community doesn’t screen vigorously enough for depression in expectant moms. They argue that most prenatal visits are focused on how the mother and baby are doing physically, even though depression affects a woman’s overall health. “Psychological issues get attention only when they become severe”, says Dr. Misri. “Doctors and patients usually dismiss symptoms of depression”.

THE IMPACT ON MOM AND BABY

Keeping moodiness and anxiety a secret - or brushing them off - can have serious consequences for both the mother and the baby. Depressed women may not seek regular prenatal care and are more likely to self-medicate with alcohol, cigarettes and even drugs; in extreme cases, they may even consider terminating the pregnancy or become suicidal”, says Dr. Diana Lynn Barnes, Psy. D., founder of the Center for Post-partum Health in California, US.

One-third of women who are diagnosed with post-partum depression in pregnancy stages, also struggle with the blues while they were pregnant. Experts believe that post-partum depression cases could be avoided if prenatal symptoms are identified and treated. And it is not just the mother’s mental and physical health that’s at stake. Research shows that a woman’s depression affects her unborn child (since they share the same bloodstream - and the same elevated levels of stress hormones), increasing the risk of preterm birth and low birth weight. “A baby born to a depressed or anxious mother is also more likely to suffer from anxiety after birth”, says Dr. Misri. Prenatal depression can interfere significantly with mother-infant bonding and cause developmental delays and behavioral problems in the child.

ARE YOU AT RISK?

Pregnancy itself probably doesn’t cause depression, but it can be a trigger in women who are already genetically prone to it. The most vulnerable women are those with a family or personal history of depression or those with previous post-partum depression. Other risks include an nonsupporting partner, an unplanned pregnancy, infertility treatments and problems prior to pregnancy like a miscarriage. “Sometimes the stress of pregnancy brings on depressive symptoms”, says Dr. Joanne, “Physical discomfort due to water retention, morning sickness, aches and pains as well as a sense of exhaustion are contributory factors”. Hormones play a big role (depression tends to emerge during the hormonal surges of the first and third trimesters), though experts aren’t yet sure of the exact nature of how or why this happens and why depression hits some expectant mothers and spares others.

TREATMENT OPTIONS

Since almost all women feel tired and emotional during pregnancy stages, it can be hard to know whether you have prenatal depression. “But if your symptoms last for at least two weeks, interfere with work or affect your relationships, you should see your doctor”, says Dr. David Fassler, M.D., co-founder of the Walden Behavioral Care in MA, US. Fortunately, prenatal depression is treatable. Your ob-gyn will examine you to rule out other health issues and then refer you to a psychiatrist or another mental-health professional. If you have mild or moderate symptoms, therapy alone may be enough. But in moderate or severe cases, antidepressants may be necessary. This could seem scary, considering news reports about how the drugs might affect a foetus. Experts don’t know that these medications are 100 percent safe to use during pregnancy stages: Recent studies show that some newborns experience hypertension or withdrawal symptoms. “However, the risks of antidepressants are small compared with the negative impact of untreated depression on you and your baby”, says Dr. Misri. Ultimately, you should talk to your doctor to make the decision that’s right for you and for your unborn baby.

Antenatal care is the care that you receive from health professionals during your pregnancy. A healthy diet and lifestyle during pregnancy is important for the development of a healthy baby and may have long-term beneficial effects on the health of the child. It is also important for a pregnant woman to have regular checks with an obstetrician throughout pregnancy, to ensure that any conditions that may pose a risk to you or the baby’s health can be identified and treated. Regular antenatal care is important to ensure that both you and your baby are well.

The major goal of focused antenatal care is to help:

• Identification of pre-existing health conditions.
• Early detection of complications arising during the pregnancy.
• Health promotion and disease prevention.
• Lifestyle management counseling.
• Preparation for birth and possible complications.

A good antenatal care program should be designed in such a way that it detects problems of pregnancy that might need treatment - such as anemia, infection, vaginal bleeding, hypertensive disorders of pregnancy and abnormal fetal growth. It should also incorporate a comprehensive screening program to detect fetal anomalies such as heart and brain defects and also screen for conditions such as Downs Syndrome. Hence it is important to have regular ultrasound scans done by ultrasonologists specially trained in fetal medicine. The program should also incorporate a multidisciplinary team involving an Obstetrician, Ultrasonologist and a Neonatologist so that the results of the screening tests can be discussed and appropriate actions taken when necessary. Oxford Medical Publication’s book A Guide to Effective Care in Pregnancy and Childbirth is a complete guide to take best care of your life, ensure the best for you and your unborn child.

Counseling and health promotion is a very important but often forgotten aspect of antenatal care. Counseling should begin as early as possible and in fact preconception counseling should be offered at all maternity centers where women wanting to conceive are advised about the importance of taking folic acid to prevent congenital anomalies. Preconception counseling should also include providing information leaflets about the Do’s and Dont’s of pregnancy, especially during the immediate period following conception. For example women should be advised not to take Vitamin supplements and medications without consulting their doctor during the first trimester since it can result in malformation of the heart and nervous system.

Following conception it is very important to discuss with the obstetrician about lifestyle habits such as exercise, smoking, alcohol and any medications that may affect your developing fetus.

In addition to the above a good antenatal care program should involve the services of a dietitian and physiotherapist. The importance of a healthy, nutritious diet in pregnancy cannot be stressed more "A nutritious and wholesome diet is the key to a healthy baby ". You should make it a point to spend time with the dietitian to tailor make a diet that is healthy but also acceptable to you.

A value add to any antenatal care package would be a child birth instructor who would be able to explain to you what happens during labor and birth and also teaches you exercises to keep you fit during pregnancy and help you during labor. Out of many books I read when I was first pregnant, I remember a very good book The Baby Care Book: A Complete Guide from Birth to 12-Month Old by famous Jeremy Friedman, helped me take initial precautions and prepare for the little one. The book gave me a clear picture of what to expect at the time of delivery and how to take care of the child after birth.

Finally, it’s always useful if your antenatal classes are held in the hospital where you would be delivering your baby. It gives you a chance to familiarize yourself with the surroundings so that when you arrive for the delivery, you do not feel out of place. It also gives you a chance to visit the labor ward as well as the other medical facilities in the hospital such as the nursery.

Pregnancy is an important time of your life, ensure the best for you and your unborn child by availing good and safe antenatal care during this period. I think good antenatal care is not an option but a basic necessity to ensure a bright future for your child.