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OBSTETRICS

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One of the most meaningful and memorable events in one’s lifetime is the birth of a child. As obstetricians, we are privileged to share in this special experience by offering the most comprehensive obstetrical care. From the initial positive pregnancy test, we are involved in ensuring that our patients receive the most personal care possible. We keep ourselves informed of the most up-to-date guidelines and management of all pregnancy conditions.

GENERAL OBSTETRICS

Preconceptual Considerations

  • Good Health Before Pregnancy:  Preconceptual Care
  • Reducing Your Risk of Birth Defects
  • Preconception Carrier Screening

 

Antenatal Screening and Counselling
Regular medical visits, screening tests, and diagnostic tests to help assess your health status to keep you and your baby in a healthy condition during your pregnancy. The routine visits to the doctor are scheduled so that any problems present may be recognized and treated well in advance. These visits also educate you on handling various aspects of your pregnancy. Your doctor will discuss about healthy eating, activity, screening tests necessary and what can be expected during labour and delivery.

Counselling for Third Trimester Issues and Considerations

  • Car Safety for You and Your Baby
  • Air travel in pregnancy
  • Cord Blood Banking
  • Early Preterm Birth
  • Group B Streptococcus and Pregnancy
  • If Your Baby is Breech
  • What to Expect After Your Due Date

Foetal Monitoring
Foetal monitoring is the procedure used to assess the rate and rhythm of the foetal heart and determine the foetus’s health. It is generally recommended during late pregnancy and labour.

The average heart rate of the foetus lies between 110 and 160 beats per minute, which can vary up to 5-25 beats per minute. The heart rate may vary as the foetus responds to the uterine conditions, but an abnormal pattern may indicate problems such as the lack of oxygen supplied to the foetus.

Birthing
Birthing, also called labour or parturition is the act or process of giving birth to offspring. Every woman’s labour is different, even from first pregnancy to the next.

The process of normal child birth is categorized into 3 stages of labour:

First stage: This stage commences with dilation and thinning of your cervix to allow the baby to reach the end of the birth canal. This stage is usually the longest part of the labour and is further divided into early labour and active labour.

  • Early labour: In early labour your cervix may dilate and you may experience mild to moderate contractions lasting for 30 to 90 seconds. A thick, stringy, blood-tinged liquid may discharge through the vagina. The duration of early labour is unpredictable, but can be longer for a first delivery and shorter for subsequent deliveries.
  • Active labour: During active labour your cervix dilates more rapidly and the contractions are stronger, closer together and may last longer. The transition phase is considered as the last part of active labour.

Second stage: This stage is the birth of your baby and usually lasts from a few minutes up to several hours depending on the position of the mother and the baby. During this stage your cervix is fully dilated, uterine contractions become more frequent and you feel a strong urge to push. With each contraction you may be encouraged to push to speed up the process. You may be asked to withhold some pushes to help prevent tears in the vaginal tissues. After your baby’s head emerges the airway will be cleared and the umbilical cord is clamped and cut. The rest of the baby’s body is delivered soon after the head.

Third stage: During this stage the placenta, an organ connecting the uterine wall and the foetus, is expelled. Gentle uterine massage may help to release the placenta. The placenta should be intact and any remaining parts within the uterus should be removed to prevent bleeding and infection.

Complications:
The complications of the birthing process include:

Weak contractions: Weak contractions can make the mother exhausted and can cause foetal distress. Foetal distress occurs when there is lack of oxygen. Improper or weak contractions may be caused by rigid or oedematous cervix.
Passage obstruction: Difficult labour may occur when the birth passage is obstructed by tumours, cysts, fractures, and physiological changes such as degenerative joint disease.

Abnormal presentation of the foetus: Abnormal position of the foetus could be either upside down or breech (buttocks down) position. In face presentation the baby’s face is leading with the neck in extension. In shoulder presentation, the shoulder, arm or trunk may present first and this type of presentation is more common in multiple pregnancies.

Forceps delivery: In this type of delivery forceps are used to grasp the foetal head. Use of improper forceps technique can result in injury to the foetus.

Caesarean Section: It is a surgical procedure of delivering a baby though an incision in the lower abdomen. Caesarean section is indicated in foetal distress, maternal (mother) distress, abnormal position of the foetus, and narrow birth passage.

 

Natural Birth

Natural birth is a method of delivering a baby without relying on medication and other medical interventions.

When the baby is ready to come out, your cervix (opening of the womb) thins out and begins to widen (dilate) to about 10 cm. Contractions help the baby to move down the birth canal. This is described as intense pain and pressure that increases during the course of the delivery, and is generally feared by many women.

To aid in a pain-free delivery, many turn to a regional anaesthesia called epidural to block the pain. Apart from this, many others opt for caesarean section surgery, where the baby is surgically removed (under anaesthesia) through an incision made on the abdomen Here, you would not have to push at all. However, pain medications may be associated with certain side effects such as nausea and drop in your blood pressure, while surgery may lead to potential complications such as excessive bleeding, infection, longer recovery and breathing problems in your child.

On the contrary, some women opt for a natural birth, and avoid pain relievers to numb labour pains and choose a normal vaginal delivery. Medical interventions such as epistomy (surgical incision made between the vagina and anus to facilitate child birth) or foetal monitoring are also avoided. Labour pains are important indicators, as each contraction acts as a guide for the progression of labour and encourages the movement of your baby down the birth canal. Without pain, labour is more likely to slow down and become less effective. As labour proceeds and pain increases, the body produces endorphins, natural pain killers, which will help you, continue with the birthing process.

 

Painless Birth

Apprehensions, anxiety and fear about the labour pains have always existed. This perception of pain is gradually getting changed with the introduction of labour analgesia for painless labour. Some women can control their pain by breathing, focusing or relaxing techniques while for others the pain is very severe, anxiety further acts as an additive factor. In some cases, the labour may be short i.e. 4 to 8 hours, but in other cases it may go on up to 24 hours, especially in first pregnancy. This new technique of making labour a painless experience has been appreciated and acknowledged by all those patients who have opted for this procedure. Epidural Analgesia is the very popular and is being used safely for more than 20 years. There are other methods of pain relief but they are not as safe and effective as this one.
In this method patient’s back is cleaned with an antiseptic liquid and the area where the catheter is to be introduced is numbed with a local anaesthetic. The needle is then passed into the epidural space (space surrounding spinal column), small doses of medicines is introduced into the lower back spine through a fine plastic tube. This medicine so injected relives pain while labour and descent of the baby continues.

The early mild labour pains have to be borne by the patient Epidural analgesia is given only when labour is well set and the cervix or the opening of the uterus is at least 3-4 cm. This requires close monitoring by a team of Gynaecologist and Anaesthetist. Drug is introduced at regular intervals depending on the requirement and intensity of the pain. This procedure is SAFE for both the baby and the mother.


Caesarean Birth

Caesarean birth happens through an incision in the abdominal wall and uterus rather than through the vagina. There has been a gradual increase in caesarean births over the past 30 years.The normal caesarean procedure averages 45 minutes to an hour. The baby is usually delivered in the first 5-15 minutes with the remaining time used for closing the incision.

A Caesarean section is often performed when a vaginal delivery would put the baby’s or mother’s life or health at risk. Some are also performed upon request without a medical reason to do so, which is not recommended. Planned caesarean sections also known as elective caesarean sections should not be scheduled before 39 weeks gestational age unless there is a medical reason to do so.

HIGH RISK OBSTETRICS

A high-risk pregnancy is one that threatens the health or life of the mother or her fetus. For most women, early and regular prenatal care promotes a healthy pregnancy and delivery without complications. But some women are at an increased risk for complications even before they get pregnant for a variety of reasons. A high-risk pregnancy might pose challenges before, during or after delivery. If you have a high-risk pregnancy, you and your baby might need special monitoring or care throughout your pregnancy.

Sometimes a high-risk pregnancy is the result of a medical condition present before pregnancy. In other cases, a medical condition that develops during pregnancy for either mom or baby causes a pregnancy to become high risk.

Specific factors that might contribute to a high-risk pregnancy include:

  • Advanced maternal age. Pregnancy risks are higher for mothers age 35 and older.
  • Lifestyle choices. Smoking cigarettes, drinking alcohol and using illegal drugs can put a pregnancy at risk.
  • Medical history. A prior C-section, low birth weight baby or preterm birth — birth before 37 weeks of pregnancy — might increase the risk in subsequent pregnancies. Other risk factors include a family history of genetic conditions, a history of pregnancy loss or the death of a baby shortly after birth.
  • Underlying conditions. Chronic conditions — such as diabetes, high blood pressure and epilepsy — increase pregnancy risks. A blood condition, such as anemia, an infection or an underlying mental health condition also can increase pregnancy risks.
  • Pregnancy complications. Various complications that develop during pregnancy pose risks, such as problems with the uterus, cervix or placenta. Other concerns might include too much amniotic fluid (polyhydramnios) or low amniotic fluid (oligohydramnios), restricted fetal growth, or Rh (rhesus) sensitization — a potentially serious condition that can occur when your blood group is Rh negative and your baby’s blood group is Rh positive.
  • Multiple pregnancy. Pregnancy risks are higher for women carrying twins or higher order multiples.
  • You had a problem in a past pregnancy, such as:
    • Preterm labor.
    • Preeclampsia or seizures (eclampsia).
    • Having a baby with a genetic problem, such as Down syndrome.

PATHWAY TO PARENTHOOD

Diet in Pregnancy

The food you consume during pregnancy helps to provide sufficient nutrients for yourself as well as your growing baby. A well-balanced nutritious diet during pregnancy keeps you and your baby healthy and is required for your baby’s overall growth and development.

A diet consisting of the right balance of carbohydrates, proteins, fats, minerals, vitamins and water constitutes a healthy diet. Some important nutrients to be included into your diet are:

Folic acid: Folic acid prevents neural tube defects in the early stages of a developing foetus. Getting the recommended amount of folic acid alone from food may be difficult; hence, it is necessary to include folic acid supplements before and during your pregnancy.

Calcium and Vitamin D: A growing baby has high demands for calcium and vitamin D as bones and teeth develop. You can take in calcium through food or as supplements during pregnancy. Foods with high sources of calcium, such as milk, milk products and broccoli, should be included in your regular diet. Vitamin D can be obtained from milk fortified with vitamin D and from exposure to sunlight.

Iron: During pregnancy,your body produces more blood to carry oxygen to the growing foetus; hence, the quantity of iron required for this transfer of oxygen, needs to beincreased. You should include iron-rich food such as fish, poultry, lean red meat, prunes and dried beans into your diet. Including vitamin C rich foods, such as tomatoes and citrus fruits, helps in faster absorption of iron in the body.

Fish: Fish is a rich source of omega-3 fatty acids and an important nutrient for the development of your baby’s brain, before and after birth. Fatty fish like salmon is a good source of Vitamin D and sardines are rich in calcium. However, fish with high concentrations of mercury, such as shark and swordfish, should be limited or avoided during pregnancy as mercury is responsible for causing birth defects and damaging the baby’s nervous system.Consumption of alcohol and caffeine should be avoided during pregnancy.

Other foods to be avoided include:

  • Unpasteurised milk, cheese and juices
  • Raw eggs and foods that have raw eggs, such as Caesar salad
  • Uncooked seafood and meat
  • Processed meat products

Doctors generally do not suggest a vegetarian diet while pregnant, but if you are a vegan or vegetarian, you can continue with the same foods. Your doctor may suggest protein, vitamin B12 and vitamin D supplements if you do not consume meat, eggs, milk products and seafood.

Improving Mother’s Health

Prenatal care is very important to make sure you and your baby is healthy. Your obstetrician may advise you to practice various measures to ensure better health and safe pregnancy. listed below are some of the common measures for improving your health:

  • Maintain a healthy well-balanced diet by eating nutritious food, which contributes to your baby’s growth and development. Your doctor may also suggest nutritional supplements or preparations containing calcium, iron, and folic acid. Folic acid prevents problems in your child’s brain and spinal cord, and is usually recommended before you become pregnant.
  • Regular exercises may be beneficial as they may relieve discomforts during pregnancy. Walking and swimming are most preferred and recommended. However, you must consult your doctor before taking up these exercises and ensure that they are not overdone.
  • Drink plenty of water to prevent dehydration.
  • Get enough sleep during your pregnancy. Sleep on your left side as it prevents your baby’s weight from applying pressure to the large blood vessels that carry blood to your heart, feet and legs.

The below are some things to avoid during pregnancy.

  • Avoid cigarettes, abusive drugs and alcohol as they are harmful for you as well as your baby.
  • Avoid excessive intake of caffeinated products such as coffee as they increase your risk of miscarriage.
  • Avoid cleaning cat litter boxes and eating raw or undercooked meat as they may cause toxoplasmosis, an infection that leads to chances of foetal eye and brain damage, poor growth and premature birth.

Preparing for Delivery

You have a lot to prepare for in advance of your delivery date. The following list includes things that should be done before delivery and before you bring your new baby home.

  • Know when to go to the hospital.
  • Be pre-registered at the hospital where you plan to give birth.
  • Have your preferences for labour and delivery.
  • Know day and night phone numbers for your health care provider’s office and the labour and delivery unit.
  • Have transportation to the hospital.
  • Know where to go when you get to the hospital (including the after-hours entrance).
  • Have arrangements made if you plan to donate your cord blood.

 

Supplies You’ll Need for Your Newborn

  • Infant car seat as required by law
  • Breastfeeding supplies, such as a nursing bra and pads
  • Diapers, diaper pins, and diaper pail
  • Changing table, cotton balls, wash cloths, mild soap, diaper rash ointment, hair brush, and thermometer
  • Infant sleepers, T-shirts, and receiving blankets
  • Sweater and a cap for your baby
  • Crib sheets and blankets; your baby does not need a pillow
  • Waterproof pads for crib or lap
  • Crib, cradle, or bassinet