Are you a new mother grappling with one thousand new feelings, emotions, anxieties and fears? You want the best for your baby, but are worried whether what you are doing is right or enough. Well, you are not alone. It is normal to feel anxious, even afraid as you go through the initiation to the motherhood journey. In your mind you have a number to do and not to do lists, some provided by the doctor, some by family and friends. Yet, there are some decisions you need to take on your own.
The first big decision you take about your baby is whether or not to breastfeed. This one step can make a significant difference in your baby’s and your future health. Here’s how…
What is breastmilk?
It is the milk produced by the body of a new mother. Replete with fat, protein, carbohydrate, minerals and vitamins, it is the complete food for your baby. Breast milk has antibodies that protect you baby from illnesses.
Colostrum, the first milk, is yellow and thick. It does not have much water in it, so your baby needs only a very small amount. It helps the newborn’s digestive tract develop and prepare for digestion of breast milk. After colostrum come transitional milk, and finally mature milk.
How often do you need to breastfeed your baby?
This is mostly the baby’s decision and he or she will demand to be fed when hungry. Newborns usually want to be fed every 2-3 hours, by 2 months this is likely to change to 3-4 hours and by 6 months, the need would be about every 4-5 hours.
While choosing to breastfeed your baby is your personal decision, doctors strongly recommend it – exclusively for the first 6 months of the child’s life and intermittently with other food for the next 6 months.
Understanding the benefits of breastfeeding
For your baby:
It provides the ideal nutrition for infants with the right mix of fat, carbohydrates, vitamins and minerals
It contains antibodies that help your baby fight off infections – virus and bacteria
Breastfeeding helps in development of a healthy gut bacteria in your baby, thus giving them a healthy immune system for life
Breastfeeding lowers your baby’s risk of having asthma and allergies
Babies fed exclusively on breast milk for the first 6 months of their lives are known to have fewer ear infections, lung ailments and diarrhoea
Breastfed children have been linked to higher IQs
They are more likely to gain the right amount of weight, and not be overweight
It plays a role in prevention of SDS (sudden death syndrome)
Breastfeeding is also believed to lower risk of diabetes, obesity and certain kinds of cancer
For you:
Breastfeeding can help you lose your pregnancy weight faster, as it burns extra calories
It releases oxytocin, a hormone that helps your uterus get back to its pre-pregnancy size. It also helps in lowering stress and anxiety
It is known to lower your risk of breast and ovarian cancers
It is likely to lower your risk of osteoporosis
And most importantly, you develop this very special bond with your baby through the skin-to-skin and eye-to-eye contact. It makes your baby feel secure
Pregnancy is one of the biggest milestones in a couple’s lives and a truly life-changing experience. While it’s often the expecting moms who are the focus of attention, being the ones carrying the baby, the fathers-to-be do have a very crucial role to play as well. Just like the moms-to-be, the would-be dads are also filled with a kaleidoscope of emotions, ranging from anxiety and fear to excitement, pride and joy. It’s that seismic shift from being a man to becoming a parent, which is going to change your life forever.
By staying actively involved in the entire lifecycle of pregnancy, childbirth and baby-care, fathers can hugely support their partners, helping them cope better with the burden of anxiety and fear, expectation and responsibilities. In fact, studies have revealed that paternal involvement has a significant “impact on pregnancy and infant outcomes”. Increased involvement of fathers during pregnancy helps in lowering the risk of preterm birth, low birth weight and fetal growth restriction. This aspect gains even more importance if you are going through assisted reproduction (IVF). The role and responsibility of the father-to-be increases manifold, as he has to deal with his own associated anxieties as well as be there as a biggest support for his partner.
How can a to-be father help his partner?
Celebrate this extraordinary life moment and stay engaged through the entire cycle. Here are some broad tips:
# Prepare yourself emotionally: Like the mom, the dad also gets 9 months to prepare himself emotionally to welcome the baby. This period is best utilized by staying totally engaged and participating in all the activities relating to the pregnancy. This should include accompanying the partner to obstetrician or fertility doctor visits, watching ultrasounds of the baby together, shopping for the baby, reading up on parenting and in general, preparing yourself for impending fatherhood.
# Work in tandem: It is important to plan things together and share responsibilities spontaneously rather than assuming that household chores are best left to the mom. You should discuss and plan for the changes that the baby will bring to your lives. Yes, there will be increased responsibilities, but those will come wrapped in countless moments of pure joy that make everything worthwhile. So stay positive and help your partner remain happy as well. Make the necessary adjustments with a sense of pride and joy so that the mom-to-be feels reassured and relaxed.
# Open up about your concerns: Of course, looking forward to the baby’s arrival is always an exciting prospect for both the parents. However, it often comes accompanied with money worries and apprehensions about the future. Discuss your worries frankly and threadbare with your wife/partner, so that the weight is lessened and you get clarity of thought, and are able to relax. You can also speak to your friends/relations who have recently experienced fatherhood.
# Look after your health: Concentrate on staying healthy together by eating healthy, exercising regularly and making sure the expecting mom doesn’t miss any scheduled doctor visit.
# Chip in with chores: Since the mom already has so much on her plate, look out for avenues to offer help with household chores, fetching things from the market or preparing for the baby in various ways. You can always make a difference. So make that effort.
# Plan for childbirth: This in itself will take up a lot of your bandwidth. There are a clutch of critical decisions to make. There will be plenty of questions in your mind as well as the mom’s. So, you should discuss the birthing plan in detail with your doctor, attend birthing classes in tandem and make sure you are covered on all fronts for the big moment.
# Be there for her: At times, all she needs is you by her side to offer emotional support and reassurance. The mother goes through draining periods of anxiety and your mere presence can provide succor in so many of those foggy moments. Even a simple massage to relieve cramps in her legs in the middle of the night or her backaches can go a long way in relaxing her.
# Prepare for role of new father: The first few days after childbirth might see severe mood swings and/or postnatal blues in the mother, which are perfectly normal. Be there by her side and handhold her through these difficult phases. But don’t forget that you may need help to, particularly if you and your partner have gone through one or more IVF cycles to attain a much-waited for parenthood. Don’t hesitate to talk to your doctor or counselor whenever you feel the need.
As you step into the 7th month of your pregnancy, you enter the months categorised as the 3rd trimester. You are nearing your delivery time, your baby is almost fully developed, and now you have to start preparing for not just the delivery itself, but also welcoming a new member into your family, who is going to take up the majority of your time and attention.
The frequency of your pre-natal check-ups will increase
Instead of your usual monthly visits, you may be asked to go for check-ups every two weeks. You will be assessed for:
Any unusual symptoms or discomfort that you may be facing
Your weight and blood pressure
Urine test will be conducted to test for albumin and glucose as these may be indicative of conditions like preeclampsia and gestational diabetes
Growth and development of the baby
The position of the baby
Foetal heartbeat
Height of the fundus – top of the uterus
Changes you may experience
The pregnancy experience is usually individualistic. And this is no different during the 3rd trimester. While some women have to deal with acute discomfort, including difficulty in taking deep breaths and sleeping, others are able to breeze through without any problem. Your body is constantly changing as your baby is growing inside you. Some things you can expect include:
Feel increasingly hot – this is because your baby is generating heat inside you and this is turn increases the temperature of your skin
The frequency of urination is likely to increase as the pressure on your bladder increases
The foetus pressing on the main vein to the heart can result in your blood pressure dipping
Fluid retention in your hands, ankles and face may cause some swelling
Due to increased hormone stimulation, coarse hair may begin growing on your arms, legs and face
You are likely to experience leg cramps
You may experience Braxton-hicks contractions (false labour)
Stretch marks may appear on your thighs and breast
Colostrum (a fluid that nourishes your baby) may start leaking from your breasts
You skin on the stomach may feel itchy as it become dry and stretches
Skin pigmentation on your face is may become more visible
Your sexual drive may decrease
Constipation and indigestion are two issues that can be a large part of the discomfort you face
White-coloured vaginal discharge may become a common occurrence
Back pain may become a chronic problem
If you have Hemorrhoids or varicose veins, the problem is likely to intensify
Meanwhile your baby is growing fast!
Your child is now almost completely developed and getting ready to function independently. The foetus begins to move and position its head downwards preparing for delivery. During the 3rd trimester, the developments in your baby include:
Your baby can see and hear
At the beginning of this trimester, the baby’s brain is still developing and lungs & kidneys still maturing
Normally by 36th week, the baby’s head will drop into the pelvic area, preparing for the delivery
The skull bones remain soft to enable it to easily pass through the birth canal
The baby can suck his/her thumbs and can cry
By weeks 38-40, the fine hair on the baby’s body and limbs begins to disappear
By now the lungs have matured completely as the baby is getting ready to breathe on its own
The baby is covered with a protective creamy coating called vernix
As you inch towards the completion of your nine months, some of you may experience a plethora of discomforts, while the lucky ones may not face much difficulty. As your delivery date comes nearer, it is common to experience anxiety and a degree of fear, particularly if it is your first pregnancy. But remember, you have people who care for you around you, so share your feelings with them, seek help whenever required and keep in touch with your doctor. Staying positive is often the key to a healthy delivery.
Infertility, or failure to conceive, is a problem that a growing number of couples are having to live with today. The reasons for this can be varied, some due to medical or genetic factors, some age-related, and some due to lifestyle factors like smoking, stress and obesity. When a couple is unable to conceive naturally, and there is no significant medical history that may point towards a cause, the first areas to look at usually are ‘problems with production’ – that is ovulation in a woman and sperm production in a man. Let us try to understand what is ovulation and the role it plays in fertility of a woman.
What is
Ovulation?
It is the process where a mature egg is released from the ovaries and moves down the fallopian tube. It stays here for 12 to 24 hours. This is the window when it can be fertilized by sperm. Post sexual intercourse, sperm can live inside the female reproductive tract for about 5 days.
The most common
cause of female infertility in often due to an ovulation disorder.
What is an ovulation disorders?
Infrequent
ovulation, or no ovulation is termed as an ovulation disorder. This
can be caused due to problems with the regulation of reproductive
hormones or problems in the ovary.
Some common
causes are:
Polycystic
ovary Syndrome (PCOS): This is a condition that causes hormonal
imbalance and is usually associated with insulin resistance and
obesity. PCOS
has been seen to be a leading cause of infertility.
Hypothalamic
dysfunction: Follicle stimulating hormone (FSH) and Luteinizing
hormone (LH), produced by the Pituitary Gland, are responsible for
stimulating ovulation every month. Excess stress (both physical and
mental), low body weight or a sudden weight gain or loss can cause an
imbalance in the normal production of these hormones. This, in turn,
can affect ovulation.
Primary
ovarian insufficiency, also known as ‘Premature ovarian
failure’, could be due to an autoimmune issue or premature loss of
eggs from the ovary. This may be due to genetic condition or a
fallout of a medical therapy (chemotherapy). In such cases the ovary
no longer produces eggs and oestrogen levels are lowered before the
age of 40.
Too much
prolactin: Hyperprolactinemia is a condition where the pituitary
glands produce too much prolactin, which causes the production of
oestrogen to reduce, thus causing infertility. This condition can be
a fallout of taking medications for some other condition.
How can an
ovulation disorder be diagnosed?
If you are unable
to conceive after trying naturally over a prolonged period, a visit
to a fertility specialist is recommended. The doctor may suggest the
following to see whether you have an ovulation problem.
An
over-the-counter test kit to test whether your LH hormone production
is as it should be
Blood test
to check progesterone and prolactin levels
Ovarian
reserve testing: To determine the quantity and quality of eggs
available for ovulation in your ovary. Women above the age of 35 are
more likely to have a depleted quantity of eggs.
Hormone
testing to check levels of ovulatory hormones as well as thyroid and
pituitary hormones that control the reproductive process.
In rare
instances laparoscopy or genetic testing may be required to detect
abnormalities
How are
ovulation disorders treated?
Treatment largely
depends on the cause. Medications are usually the first option of
treatment. Fertility drugs are prescribed to regulate and stimulate
ovulation. These drugs do the work of the normal – LH and FSH –
hormones and help in inducing ovulation. They may also be used to
increase the number of eggs produced and for improving the quality,
in women who may have inadequate ovulation.
Are there any
risks in taking fertility drugs?
Oral medications
usually carry no risk. Injectables may have a risk of inducing
multiple pregnancy or Ovarian hyperstimulation syndrome (OHS), but
the risk is low. The results are usually positive.
The role of
assisted reproduction
In women with
ovulation disorders, if fertility drugs alone are unable to produce
the desired result, In-vitro
fertilization (IVF) is a recommended treatment that
can help a couple in getting pregnant. Post stimulating ovulation
with the help of drugs, matured eggs are extracted from the ovary and
fertilized in a petri dish in the laboratory with sperm donated by
the male partner. The fertilized egg is then implanted in the uterus
to induce pregnancy.
Now that you have got through the 1st Trimester, the first three months of your pregnancy, things begin to settle down somewhat. As you enter your 2nd trimester of your pregnancy, the morning sickness and fatigue that you may have felt earlier will slowly fade away. Your system is now more adjusted to your ‘new status’ and the hormonal changes that your body has undergone when you conceived. Now you begin to feel more ‘normal’, less exhausted, and more energetic.
For most women
this is the easiest three months of their pregnancy. So, it is time
to take advantage of this feel-good phase and start planning for your
baby!
What happens
during the 2nd trimester?
Now your baby is
growing quickly. Your doctor will do an ultrasound between week 18
and 24 to see your baby’s progress. You may even pleasantly learn
that you are going to have not twins!
The changes
taking place in your body
You may feel
cramps, dull ache and sometimes sharp stabs of pain in your abdomen.
This could be because:
Your uterus
is expanding and this puts pressure on the nearby muscles and
ligaments
Your round
ligament muscle stretches causing cramps
Of
constipation or gas
Minor cramps and
aches are normal. A warm bath, relaxation exercises, shifting your
body’s position or a hot water bottle compress can be helpful in
easing the discomfort. However, if you experience intense pain or
discomfort, call your doctor immediately.
Backache is a
common problem
The extra weight
you are putting on, particularly on your belly, can be hard on your
back. The increasing pressure is likely to cause backache. Certain
home remedies that can help:
Sitting up
straight – choose a chair with good back support
Sleep on
your side with the pillow tucked between your legs
Avoid
lifting or carrying anything heavy
Comfortable,
low-heeled shoes are a must for stability as you walk
If nothing works,
then a good pregnancy massage can be relaxing both for your body and
mind!
Some women may
develop gum problems
Hormonal changes
during pregnancy cause more blood to flow to your gums, this can make
them swollen and tender, and even lead to bleeding. This is usually a
temporary problem that goes away after the delivery of the baby. It
is, however, necessary to maintain dental hygiene, as women with gum
disease are more likely to deliver premature babies. Use a soft
toothbrush to ease your discomfort as much as possible.
Short,
irregular contractions are normal and not a sign of labour.
During the 2nd
trimester, your uterus muscles may tighten for about a minute
periodically. These are not real contractions and are not indication
of labour. They can be triggered by intense exercise, sex,
dehydration, a full bladder or even somebody touching your baby bump.
When this happens, try to relax by having a warm bath, have a cup of
warm tea, drink some water, or turning on your side if you are lying
down.
Your breasts
will continue to grow
Though the breast
tenderness you felt is likely to be less now, they will keep growing.
Wearing a good support bra is recommended for better comfort.
You may
develop snoring!
When your partner
complains about your snores at night, it may come as a surprise to
you. The mucous membranes in the lining of your nose swell due to
hormonal changes, causing stuffiness which is the reason for the
snore. You may also experience nose bleed due to this. It is
advisable to avoid decongestants and use saline water or other
natural methods to relieve the stuffy nose.
Some vaginal
discharge is normal
A milky white,
thin discharge from your vagina may be cause of some discomfort, but
it is normal. However, if the discharge is foul smelling, green,
yellow or bloody, or happens in large quantities
You may
experience some dizziness
This could be
caused by your expanded uterus pressing against blood vessels,
hormonal changes or low blood sugar. Some precautions you need to
take:
Avoid
standing for too long
Stand up
slowly from a sitting position
Keep
yourself well hydrated
Eat small,
frequent meals
Lie on you
side, and not on your back
Wear loose
clothes
The problem of
frequent urination will be lesser now, as your uterus rises
away from the pelvic cavity, giving you some respite.
The most
visible effects of pregnancy will be seen on your skin.
The
‘pregnancy glow’ is the result of the changing hormone levels
that causes the skin on your face to look flushed
Brown marks
may appear on your face due to increased melanin levels
At this time
your skin is overtly sensitive to sunlight. Whenever you go out,
choose clothes that give maximum coverage to your skin, always use a
broad spectrum sun-screen and if possible, avoid going out in the
sun between 10am and 2 pm
Stretch
marks – reddish-purple lines – may appear on your breasts,
thighs and abdomen, as you skin stretches. You doctor may prescribe
some lotions or creams for this. These marks will gradually fade
after the delivery of your child.
Some common
health problems that some of you may experience may include
headache, heartburn, constipation or leg cramps. Try to balance your
meals, exercise and sleep to reduce the discomfort. Avoid
self-medicating. If the discomfort is intense, then talk to your
doctor.
Varicose veins
may sometimes form as haemorrhoids around the anus, which can be
itchy and uncomfortable. Talk to your doctor about how to relieve the
discomfort. Varicose (swollen) veins can also form in your legs owing
to slower blood flow resulting from the pressure from the growing
baby. Taking the pressure of your feet by not standing for a long
time and putting your feet up while sitting can help in easing the
discomfort.
Urinary Tract
Infections (UTI) are common during the 2nd trimester.
This may be because the growing uterus often makes it difficult to
empty the bladder. Be aware of the symptoms like a burning sensation
while urinating, pain in the lower abdomen, smelly or reddish urine,
and immediately visit your doctor. Untreated UTI can spread to your
kidneys and lead to severe complications.
What happens
to your baby during the 2nd Trimester?
Your baby
will grow about 16 inches and by one and a half kilos.
The brain
and other organs begin to develop
The lungs
develop fully though they are not able to breathe on their own
The baby can
kick, move, turn around, suck and hear your voice
The eyes and
ears move to the correct position, eye lashes and eyebrows grow
Fingers and
toes separate, nails grow, they develop finger prints and footprints
Eyelids can
open & shut, the baby wakes and sleeps in normal cycles
Hair grows
on the baby’s head
The placenta
develops fully and through it the baby receives the nutrients from
you and is able to discard the waste
As we all know, a normal pregnancy lasts
around 9 months. However, for the sake of easy monitoring of the progress, the
associated healthcare workers including, doctors, nurses, midwives, etc. break
this period up into 3 trimesters. Trimesters are particularly helpful, since
the changes that occur in a woman’s body during pregnancy and the growth and
development of the child in her womb, can be broadly categorized early, middle
and late pregnancy. These are called the First, Second and Third trimesters.
What is the 1st Trimester?
The first trimester of your pregnancy is
counted from the first day of your last period to week 12 of your pregnancy.
This is the time when your body is undergoing a lot of hormonal changes, that
are likely to impact you both physically and mentally.
Your body will change
Your breasts will become larger, heavier
and tender. Your uterus will grow and begin putting pressure on your bladder
thus increasing your urge to urinate more often. Pregnancy affects different
women in different ways, while some may have certain food cravings, others may
have food aversions. Morning sickness is a common problem that most women face.
Some, lucky ones, remain unaffected, and can continue with their normal daily
routines without any change or discomfort.
You are likely to be on an emotional
roller-coaster!
As your body goes through hormonal
changes, you may experience a range of emotions. You are likely to feel
moody, irritable and emotionally drained. These feelings are normal. But if you
feel depressed or anxious then share your feelings with your partner/family and
your doctor.
Your baby is developing
During this period your baby is developing
too. From being an ovum to a foetus. By the end of 12 weeks your baby’s heart
will start beating and brain, stomach, intestine will begin to develop. His/her
arms and legs will begin to grow.
Your check-up routine
Post confirmation of your pregnancy, health
checks during the first trimester usually happen at gaps of 4 to 6 weeks. This
can, however, vary depending on various factors like how your baby is
developing, your health status and allied complications. You may be offered an
ultrasound scan at the end of 12 weeks to hear the heartbeat of your child and
estimate the baby’s size and due date. Apart from this, you will have to
undergo the following:
Periodic blood tests to check
your iron levels, blood sugar, and detect infections (if any).
Urine tests to detect urinary
infections so that they can be treated immediately.
General health and wellbeing
checks, that would include both your physical and mental wellbeing.
Do’s & don’ts
Quit smoking if you are a
smoker
Avoid alcohol
Focus on wholesome, nutritious
food. Remember, it is the quality and not quantity of food that matters. You
baby shall need nutrition to develop
You may need folic acid and
iodine supplements, but only if the doctor advises it
Regular exercise is a must.
Movement will help both you and your baby. So, stay active
Do not self-medicate. If you
experience any problems with your health, then talk to your doctor
A “spontaneous miscarriage” is the loss of a pregnancy before gestation of 20 weeks. Nearly 80% of spontaneous miscarriages occur within the first 12 weeks of pregnancy. While approximately one in four pregnancies end in miscarriage, many of these unfortunate events aren’t detected since these occur very early during pregnancy.
What causes a miscarriage?
A miscarriage
usually occurs because the pregnancy is not developing properly. While a large number of miscarriages occur as a result
of genetically abnormal embryos, there could be a plethora of factors
responsible. These include:
# Random
chromosome disorders
# Blood clotting disorders
# Hormonal disorders
# Submucosal fibroids
# Structural abnormalities in the womb
# Hormonal issues linked to polycystic ovaries
# An inherited genetic abnormality
# Being over 35 years of age, with a decline in quality of
eggs
# For men over 40, the quality of sperm decreases, raising the risk of
miscarriage
How
does a woman understand that she’s having a miscarriage?
Look out for the following signs:
# Heavy bleeding
# Severe abdominal or shoulder pain
# Fever or chills
# Dizziness or fainting
# Vaginal discharge with an unpleasant odor
# Diarrhoea or cramps
A miscarriage
can trigger a whole gamut of emotional upheaval, particularly in the woman. Regardless
of whether the pregnancy is planned or unplanned, the emotional impact of
miscarriage can be great, and that’s perfectly normal. A sense of
profound loss is very common and expected, and though people may react
differently to this tragic event, the loss can bring on:
# A sense of total emptiness
# Anger and utter disbelief
# A crestfallen feeling
# Acute melancholy and a sense of isolation
But remember that it’s important to stay
positive while riding out the emotional rollercoaster, and summon up enough
courage and willpower to try again. This is when one needs the love and support
of family and friends. Do not shut out the people who care for you and do not
hesitate to turn to them for encouragement and support.
Do not give up hope, you have to try
again!
However, while trying for another pregnancy
after a miscarriage, remember to:
# Quit smoking
# Exercise regularly and follow a balanced
diet
# Reduce stress
# Watch your weight
# Take folic acid tablets
Is any treatment required for a
miscarriage?
Once a miscarriage
has begun, it can’t be reversed. So the doctor would typically try to prevent heavy
bleeding and infection as the main treatment protocols, besides providing
emotional support. Heavy bleeding with clots and cramps would indicate that the
patient is still passing the pregnancy tissue. These symptoms should settle
once most of the pregnancy tissue has been passed.
Sometimes, following
a miscarriage, some residual pregnancy tissue remains in the uterus. Doctors
then use a spoon-shaped instrument called a curette to scrape the uterus, a
procedure called ‘dilation and curettage’, usually performed under a light
general anaesthetic and the patient can go home the same day.
The role of IVF in miscarriage
In
recurrent miscarriages, IVF or In Vitro Fertilization with genetic testing “can significantly minimize the risk of
miscarriage and improve chances for a safe and successful pregnancy”.
# Genetic screening:
Since genetic abnormalities in the embryo are the most prevalent cause of
miscarriage, genetic screening is a very useful tool.
# Embryo screening:
Doctors can now screen for chromosomal
abnormalities and identify the healthiest embryo for implantation with a very high
degree of accuracy.
# Frozen embryo transfer: In thisform of IVF treatment, a cryopreserved embryo created in a full IVF cycle is thawed and transferred to a uterus.
# Single embryo
transfer: In thisprocedure, a single embryo, selected
from a larger pool of available embryos, is placed in the uterus.
# Fertility care: This is extremely beneficial since
tests prior to treatment can determine the risk for miscarriage and, possible contributing
factors.
# Supervision
& monitoring: Close supervision and monitoring is part of fertility care and helps
mitigate risk and optimize chances for an ongoing pregnancy and live birth.
A miscarriage is more often than not precipitated by a combination
of factors over which one had little control and it’s a wrong notion that the
event has a propensity to recur. Women who have miscarried once or twice, are
usually not sent for tests since it’s highly unlikely that anything would be
found amiss. However, those who have had three back-to-back miscarriages, are
at risk of miscarrying again, and must seek medical advice.
Pregnancy loss is usually hard to deal with and difficult to discuss. It is sad and personal, but not uncommon or unnatural. Certain myths surrounding pregnancy losses often make it harder for the person going through it. This blog tries to unravel long-standing misconceptions about pregnancy, miscarriage, and recurrent pregnancy loss and start an open conversation that may lift the burden of secrecy and stigma, and help couples cope with recurrent pregnancy loss, understand the furture implications.
What is Recurrent pregnancy loss?
Recurrent pregnancy loss or RPL is defined as having two or more miscarriages. After two miscarriages, an examination and testing are recommended.
What tests are available to find the causes of repeated miscarriages?
To help find the cause of repeated miscarriages, your healthcare professional will ask about your medical history and past pregnancies. A complete physical exam, including a pelvic exam, might be conducted. You may have to undergo blood tests to detect underlying issues with the immune system. Testing can be done to detect genetic causes of repeated pregnancy losses. Imaging tests may be considered to find if a uterine problem is causing recurrent pregnancy loss.
Can recurrent pregnancy loss cause infertility?
There is no evidence to suggest that RPL causes infertility. However, there is a possibility that a woman who has experienced pregnancy loss might experience another. This is most commonly due to underlying health conditions.
What causes recurrent pregnancy loss?
According to ACOG, approximately 60% of all recurrent miscarriages are a result of a genetic abnormality. As a woman ages, the risk of miscarriage resulting from genetic abnormalities increases – from 15 to 20% if she is under 35, to more than 50% if her age is over 40. The common causes of pregnancy loss include the following:
Genetic abnormalities
Genetic abnormalities can occur when an embryo is the recipient of an abnormal number of chromosomes during fertilization. In approximately 2–5% of couples with recurrent miscarriage, one of the partners carries a balanced structural chromosomal anomaly (Reciprocal or Robertsonian translocation). Their pregnancies are at ncreased risk of miscarriage and may result in a live birth with unbalanced chromosomal arrangement. The risk of miscarriage is influenced by the size and genetic content of the rearranged chromosomal segments.
Anatomic abnormalities
A septet uterus, in which a wall of tissue divides the uterus into two sections, occurs commonly and may result in recurrent pregnancy losses. While it is not clear why this leads to recurrent pregnancy losses, some believe that poor vascularity in the septum prevents the embryo from growing if it implants there. If the pregnancy makes it to term, the fetus may be breech. However, removing a uterine septum is easy surgically. An incompetent cervix cannot remain closed due to weakened muscles. As the developing fetus reaches a certain weight, the weakened cervix cannot support the fetus and often results in miscarriage.
Medical conditions
Certain medical conditions tend to increase the risk of recurrent pregnancy losses, including:
Antiphospholipid syndrome (APS) – An autoimmune disorder that occurs when a person’s immune system makes antibodies necessary for blood clotting
Thyroid/hormonal issues – An overactive or underactive thyroid can result in hormonal imbalances, which can cause a miscarriage if the uterine lining does not develop normally for implantation and nourishment of a fertilized egg. Elevated prolactin (reproductive hormone produced in the pituitary gland) levels can alter the development of the uterine lining
Fibroids and polyps – Non-cancerous growths that can invade the uterus
Asherman’s syndrome – A condition where scar tissue forms inside the uterus, causing miscarriage
How is Recurrent Pregnancy Loss treated?
The treatment of RPL must be based on imaging, clinical, and laboratory findings. Couples in which one of the partners carries a chromosomal rearrangement or abnormality should be referred for genetic counseling to discuss the probability of viable pregnancy based on the chromosomes involved. Women with intrauterine adhesions, a uterine septum, or uterine fibroids (especially submucosal fibroids) can choose surgical corrections, which per research is associated with reduced risk of pregnancy losses.
Next Steps Following Pregnancy Loss
It is essential to know that pregnancy loss does not mean that you will not be able to have children. Most people suffering a miscarriage will go on to give birth to a healthy baby. Even if pregnancy loss is recurrent, there are still treatment options. Besides a fertility specialist, a reproductive endocrinologist is often the go-to-specialist (or is part of the team) that offers treatment for recurrent pregnancy loss.
What to Expect from a Fertility Specialist in Kolkata Following an RPL?
Your experience with a recurrent miscarriage specialist will start with a consultation visit where you can expect to discuss the medical history and plan further evaluation. For a thorough diagnosis, your partner also needs to attend the initial appointment. Depending on your needs, you may be referred to a fertility specialist in Kolkata, who may ask you to take a range of tests, including some anatomical, hormonal, and autoimmune ones. Those undergoing the procedures can get home the same day. Once a fertility specialist is aware of the problem, they can even recommend a fertility treatment plan tailored for your needs.
As the number of individuals who have taken the COVID-19 vaccine
rises, so do the anecdotal stories about its unseen side effects. Some women have claimed that after taking the shot, their menstrual period has gotten lighter, heavier, or the duration changed.
To better understand these abnormalities, as a fertility specialist in Kolkata, I have decided to answer some of the frequently asked questions about the Covid-19 vaccine and menstruation, pregnancy, and breastfeeding.
Covid-19 vaccines and menstruation
Can the vaccine be administered when a woman is menstruating?
While there is a lot that remains yet to be learned about menstruation, there is not enough evidence to support that a COVID-19 vaccine can induce problems with menstruation. There is, in fact, no endocrine, immunological, and endocrine basis for such a consideration. If you are still wondering if it is a good idea to take the vaccine when menstruating, the answer is always a big YES! Women should take the vaccine even if they are menstruating.
Covid-19 vaccine and pregnancy
The Federation of Obstetric and Gynaecological Societies of India (FOGSI), an organization representing obstetrics and gynecology practitioners in India, acknowledges that there is limited data on the use of COVID vaccines available in India during pregnancy.
However, the data derived from animal studies and sciences have not shown teratogenic or fetal, or neonatal effects of the vaccine. As matters stand in our country, every individual needs protection from the deadly COVID-19 infection.
We are in the midst of the second wave. We must work actively to prevent future waves and the vaccine is the best long-term solution in this respect.
The protection should extend to both pregnant and lactating women.
The real benefits of vaccinating lactating and pregnant women far outweigh the remote and theoretical risks of vaccination. That being said let us look at the following:
Can vaccines be administered to a pregnant woman who has already been infected in the past?
A pregnant woman is at risk in pregnancy if she is infected with the coronavirus. Vaccination is, hence, recommended even if the woman had the infection in the past. For the general population, vaccination must be deferred for 12 weeks from the infection or about four to eight weeks from recovery.
Can a breastfeeding woman take the vaccine?
There is no evidence of harm if a vaccine is administered to a breastfeeding woman. Researchers are finding possible benefits from the passage of antibodies to the neonate. Breastfeeding women should be vaccinated per the usual schedule and method used for the general population.
Is pregnancy testing before administering the vaccine necessary?
This is not mandatory and creates a hurdle to vaccine acceptance. It is not recommended to test for pregnancy before taking the Covid-19 vaccination.
Should the Covid-19 vaccine be avoided in the preconception period or for women undergoing fertility treatment, including assisted reproduction?
The answer is no. Women must take the vaccine when available before pregnancy is confirmed. There is no need to delay fertility treatments or pregnancy for taking Covid-19 vaccines. There is currently no evidence that vaccine administration affects miscarriage or fertility rates.
Can Covid-19 vaccines cause infertility issues in men and women?
The answer is that there’s zero evidence supporting that a COVID-19 vaccine can interfere with fertility. Remember that COVID-19 vaccines are incapable of casting reproductive control via proxy. Nothing is. This is because it is a vaccine and not a mere spell.
Is it advisable to receive Covid-19 vaccines in between IVF treatment or Embryo Implantation?
You can do either of the following:
Get vaccinated and wait for a month to two months after completing the 2nd dose of Covid-19 vaccine to start an IVF cycle or,
If you are already in between your IUI/IVF/ICSI cycle and want to get the vaccination done, consult your fertility specialist and proceed.
For pregnant ladies, the general population, or lactating women who take the vaccine can still be infected even after taking two doses. This is why, it is essential to follow preventive measures like wearing a mask, hand washing, and social distancing.
A hormonal imbalance due to thyroid during pregnancy can lead to several complications. Know how to manage thyroid problems and achieve a healthy pregnancy.
Read more in Bengali
মানুষের শরীরের হরমোন নিয়ন্ত্রণ করা এইচ আকৃতির থাইরয়েড গ্রন্থিটি মানুষের গলার সামনে, স্বর যন্ত্রের নিচে অবস্থিত। প্রায় ২ ইঞ্চি মতো লম্বা,এবং ওজনহীন হয়ে থাকে এই গ্রন্থিটি। থাইরয়েড গ্রন্থিটি মূলত ২টি হরমোন তৈরী করে, একটি হল টি 3 আরেকটি টি 4। এই ২টি হরমোন মানুষের শরীরের বিপাক প্রক্রিয়া, ওজন বৃদ্ধি, মস্তিষ্কের বিকাশ, শ্বাসকার্য, দেহের তাপমাত্রা এবং কোলেস্টেরলের মাত্রাকে নিয়ন্ত্রণ করে।গর্ভাবস্থায় থাইরয়েডের মাত্রা নির্নয় করা অত্যন্ত জরুরি নাহলে এটি ভ্রূণের স্নায়বিক ক্ষমতার উপর প্রভাব ফেলতে পারে।
সন্তানধারণওনারীরসমস্যা
নারীর জীবনে ফার্টিলিটি বিষয়ে থাইরয়েড হরমোনের গুরুত্ব সবচেয়ে বেশি। বন্ধ্যাত্ব, বারবার গর্ভপাত, গর্ভে সন্তানের মৃত্যু, গর্ভস্থ শিশুর বৃদ্ধি ও বিকাশে সমস্যা, সময়ের আগেই সন্তান প্রসব, গর্ভকালীন উচ্চ রক্তচাপ, প্রি একলাম্পসিয়া, ইত্যাদি জটিলতার মতো রোগ নারী জীবনকে কঠিন করে তোলে।
থাইরয়েডের মাত্রা স্বাভাবিকের থেকে একটু বেশি হলে বা বর্ডার লাইনের সামান্য উপরে থাকলেও তার চিকিৎসার প্রয়োজন । যে সব মেয়েদের গর্ভাবস্থায় থাইরয়েডের সমস্যা থাকে তাদের ক্ষেত্রে প্রত্যেক ৪ থেকে ৬ সপ্তাহে চিকিৎসকের পরামর্শ নেওয়া উচিত এবং পরীক্ষার মাধ্যমে ওষুধের মাত্রাও নির্নয় করা উচিত।
গর্ভাবস্থায় থাইরয়েডের উপসর্গগুলি
হাইপারথাইরয়েডিজম
(Hyperthyroidism) – এক্ষেত্রে উপসর্গগুলি উল্লেখ হল:
হাইপারথাইরয়েডিজমের
(Hyperthyroidism) ও হাইপোথাইরয়ডিজমের (Hypothyroidism) ক্ষেত্রে যেসব প্রভাব পড়তে পারে সেগুলি হল:
কনসিভ করতে সমস্যা
হাইপারথাইরয়েডিজমের চিকিৎসা না হলে বা থাইরয়েড হরমোনের মাত্রা স্বাভাবিক না থাকলে, গর্ভপাতের ঝুঁকি বেড়ে যাওয়া
হাইপোথাইরয়ডিজমের কারণে গর্ভস্থ শিশুর শারীরিক ও মানসিক বিকাশ বাধা পায়
থাইরয়েড হরমোনের মাত্রা অস্বাভাবিক হলে নির্দিষ্ট সময়ের আগে ডেলিভারি হতে পারে
বাচ্চা গর্ভে সঠিকভাবে বাড়তে পারে না
ভবিষ্যতে বাচ্চাটির থাইরয়েডের সমস্যা দেখা দিতে পারে
গর্ভাবস্থায়থাইরয়েডেরওষুধগ্রহণকতটানিরাপদ?
গর্ভাবস্থায় থাইরয়েডের ওষুধ খাওয়া নিরাপদ থাইরয়েডকে দেহের মধ্যে বয়ে নিয়ে চলা অথবা সেটিকে চিকিৎসা না করে ফেলে রাখা নিরাপদ নয়। ডাক্তারের পরামর্শ অনুযায়ী ওষুধগুলি খাওয়া উচিত।থাইরাক্সিন হল থাইরয়েড হরমোনের একটি সিন্থেটিক পদ্ধতি যা শিশুর জন্য নিরাপদ এবং থাইরয়েডের চিকিৎসার জন্য ব্যবহার করা হয় ।
গর্ভাবস্থায় সন্তানের উপর প্রভাব পড়া থেকে থাইরয়েড প্রতিরোধ কি ভাবে প্রতিরোধ করতে পারেনঃ
পর্যাপ্ত পরিমাণে আয়োডিনযুক্ত খাবার খাওয়ার চেষ্টা করুন
গর্ভাবস্থায় ধূমপানের অভ্যাস থাকলে সেটি বন্ধ করুন
মানসিক চাপ কমাতে নিয়মিত শরীরচর্চা করুন
যে সব মহিলাদের গর্ভাবস্থায় থাইরয়েডের সমস্যা ধরা পরে তাদের গর্ভাবস্থার প্রথম থেকেই কম মাত্রায়, ডাক্তারের পরামর্শ অনুযায়ী, থাইরয়েড ওষুধ শুরু করা উচিত
গর্ভাবস্থায় থাইরয়েডের লক্ষণগুলি নির্নয় করা গুরুত্বপূর্ণ, যার জন্য টি এস এইচ -এর মাত্রা বারবার পরীক্ষা করানোর প্রয়োজন হয়।যদি আপনি থাইরয়েডের কোনো লক্ষণ আপনার শরীরে উপলব্ধি করতে পারেন তখনি আপনার ডাক্তারবাবুর সাথে কথা বলুন যাতে সতর্কতা অবলম্বন করা যেতে পারে।
