Preparing for motherhood

Handling motherhood and the process leading up to it is no easy feat. In fact it’s arguably one of the hardest jobs a person can take on. It requires much care, patience, support and effort, from both the woman and her family. There are many complications that can arise during this period. Hence for the safety of the woman and baby, it’s vital that medical advice is sought before conception, during pregnancy and after giving birth. Consultant Obstetrician & Gynecologist, Dr. Kalinga Nanayakkara weighed in to discuss the medical aspect associated with this topic.

Maintaining a healthy lifestyle during pregnancy
A well balanced diet during pregnancy is essential for the wellbeing of both the mother and child. In fact, having a nutritious diet can help reduce the chances of complications during a pregnancy. 

• A well balanced pregnancy diet includes,
• Iron rich food
• Protein
• Folic acid
• Calcium
• Fruits and vegetables
• Dark green leaves
• Multivitamins
• Whole grains 

Dr.Nanayakkara recommended food rich in both protein and iron, such as beef and mutton for those who consume meat. He added that dark green leaves have a high iron content and food such as lentils, broccoli and green gram contain the necessary protein. Fruits should also be an important part of the diet. Sweets, fat and alcohol consumption should be kept to a minimum. He further cautioned against drinking tea and consuming any food with cocoa immediately after meals as it severely reduces the iron absorption of the meal. 

The doctor noted that while there is no exact gauge to measure nutrition levels, a full blood count will show the haemoglobin levels, which is important. “The average haemoglobin levels of an adult are between 12g%-15g%. During a pregnancy there is a dilution in the blood as the body starts to conserve water. If the haemoglobin levels drop below 10g%, physical symptoms such as tiredness and breathlessness may be experienced.  This is why maintaining a healthy diet is important,” stated Dr.Nanayakkara. Checking the blood sugar levels is vital, as high blood sugar levels may lead to abnormalities in the baby. 

“It’s important to check the blood sugar level when it’s at its highest, which is two hours after the biggest meal of the day. In medical terms it’s called the Post Prandial Blood Sugar test,” he explained.  Folic acid, is a vital component of the diet because it can help reduce defects of the brain, spinal cord and neural tube defects. He recommended that it be taken prior to conception and through the pregnancy. 

Regular exercise is as important as a well-balanced diet. Mild to moderate exercise is encouraged and can benefit both mother and child. It’s important to consult the doctor before beginning an exercise regime especially if the mother was not physically active or is in the high risk category. Dr.Nanayakkara, said that walking for about a kilometre a day is recommended and he encouraged those who are employed to continue working. Therefore,a healthy diet, appropriate vitamin and mineral supplements and regular exercise are the key components of a healthy lifestyle during pregnancy. 

Pregnancy brings a variety of changes to the body. Among them are the changes in the hormonal levels of the woman.This can lead to physical changes such as, morning sickness and amplify certain emotions like anxiousness and ‘feeling down’. Some women can develop a mental health problem, either during pregnancy or within a year of giving birth. This is chiefly seen in the perinatal period. Conditions such as anxiety , ‘baby blues’, postpartum depression and postpartum psychosis can manifest as mild, moderate or severe, requiring different kinds of care and treatment.

Post-Partum Depression
The National Institute of Mental Health (NIMH), the lead federal agency for research on mental disorders in America, defines it as a ‘mood disorder than can affect women after childbirth’. While there is no fixed cause, it can occur through a combination of both physical and mental factors. But it’s not caused by ‘anything a mother did or didn’t do’. The levels of oestrogen and progesterone drops quickly after childbirth, leading to chemical changes in the brain, causing mood swings. Additionally, sleep deprivation can lead to exhaustion, contributing to the symptoms of postpartum depression. “Due to the changes in the hormonal levels and the psychological imbalance at birth and after birth, it can result in postpartum depression and other psychological issues. This is a very vulnerable and crucial period, especially the first 24 hours, for the mother and it’s important to be vigilant and attentive to her needs,” said Dr.Nanayakkara. If undiagnosed and untreated, it can affect the mother-infant relationship and the child’s growth and development as identified in research published by the World Health Organisation.

Some of the common symptoms identified by the NIMH are as follows,

• Feeling sad, hopeless, empty, or overwhelmed
• Crying more often than usual or for no apparent reason
• Losing interest in activities that are usually enjoyable
• Suffering from physical aches and pains, including frequent headaches, stomach problems, and muscle pain
• Eating too little or too much
• Withdrawing from or avoiding friends and family
• Having trouble bonding or forming an emotional attachment with her baby
• Avoid feeding the baby
• Persistently doubting her ability to care for her baby
• Thinking about harming herself or her baby.
• Having trouble concentrating, remembering details, and making decisions

The Doctor said that counselling is important during the period of pregnancy and immediately after. To ease the stress, he suggested monthly antenatal classes by her medical consultant, together with showing the mother the labour ward before delivery, be introduced to the staff and to have the process of labour explained to her. Having the husband stay during labour can also be of help, although this isn’t possible in a government hospital.Counselling can help to ease the burden and frustrations the mother feels in a non-judgemental environment. A qualified counsellor would be able to explain the panic based reactions and over time help desensitise the trauma experienced. Seeking a counsellors help is advisable, especially if experiencing certain symptoms such as anxiety. Dr.Nanayakkara suggested an experienced nursing midwife would be ideal for this role.

Consulting a doctor
Dr.Nanayakkara, advised a visit to the doctor once a month in the first seven months (0-28 weeks), between 28-36 weeks a visit once in two week and in the 36th week and onwards, a visit once a week. It’s important to have regular visits to ensure that both the mother and baby are healthy.“The medical staff will give a list of risk factors that can be experienced during pregnancy and may advice to maintain a movement chart of the baby. These instructions must be followed,” advised the doctor.

Delivery and after care
When a safe vaginal delivery isn’t possible a caesarean delivery/C-section is performed. Some caesarean deliveries are planned and are usually performed around 14 days prior to the expected date of delivery. “If conditions detrimental to the mother or the baby occur during labour, an emergency caesarean section is performed. It’s performed under spinal or epidural anaesthesia, while the mother is conscious and is a completely painless procedure.” He revealed,painless labour is possible for vaginal deliveries under epidural anaesthesia, but it’s a very elaborate procedure. 

After delivery, the baby must be kept warm and immediately breast fed. It’s unadvisable to allow other people to handle the baby unnecessarily. Obtaining clear instructions from midwives and nurses on breastfeeding, bathing and management of the surgical site, is vital. Further, a doctor should be consulted on methods of family planning.