Routine Medical Checkup & Precautions to take during Pregnancy
Having confirmed conception or even if be a matter of surmise, a visit to obstetrician is a must. Notwithstanding the ‘seasoned’ old aunties, mother-in-law or even mother’s guidance, consulting the expert in the line is indispensable. The first consultation of the pregnant lady with the obstetrician is of greatest importance.
When she visits the doctor, he would note down the specific details: the name, age etc. The normal questions following the formalities that the doctor would ask would be: the state of the lady’s health during her childhood, her suffering any major ailment earlier or any history of specific diseases in her family. He may also ask her the gap between her marriage and conception; her using any contraceptive devices; her job or work involving any strenuous exercise; the regularity of her periods prior to conception and the quantum of the menstrual flow etc. The lady should be equally specific in answering these questions freely and frankly. The normal difficulty with the Indian ladies in such cases is their feeling extremely shy about these details. They must remember that the more their physicians have known about them the better would be their treatment and care shown to them. The lady must realize that notwithstanding the various gadgets available in the market and the technologist advance’s capability to reveal the body details, the lady has the last word on these matters. For only God can be known what goes on really in a pregnant lady’s body. Also, tell your doctor whether you would prefer to deliver the baby at the hospital or home. Be forthright and give as many details to your doctor as you think might hold him in knowing about your case. Then the doctor would record your personal data like weight, height etc. The weight of the lady is recorded not only at the time of the first visit but also at every subsequent visit. The changes are closely followed, and the lady is given detailed guidance as to how to avoid an excessive increase in weight. The blood pressure is also checked and recorded at every visit. The size and shape of the breasts are also checked as she has got to eventually feed the baby. Her heart and lungs are examined with a stethoscope to ascertain their condition.
The Expected Date of Delivery (EDD)
In the medical parlance, the delivery is expected to take place nine months and seven days from the first day of the menstruation preceding the conception or the last Menstrual Period (LMP). In simpler words, the reckoning of the date of conception is the lady’s last menstrual period. If the period beginning on the first January 2018, the expected date of delivery would be 8th October 2018. However, there is no hard and fast rule about it. The date varies depending on the conditions of the pregnant lady.
The Growth of the Baby in the Foetus
The lady’s visit to the doctor at least ones in a month in the initial stage and every fortnight in the final stages is necessary not only for ascertaining the condition of the expectant mother but also the growth of the baby in the uterus. How the baby develops in a fetus is shown in the table given below:
|Elapsed weeks from
|Average Height of
the fetus (in cmp.)
|Average weight of
foetus (In grms).
Routine Medical Checkup during Pregnancy
The expectant mother should begin, after having consulted her family physician to get herself registered in a reputable clinic/home/hospital-of course with the advice of her doctor and follow the directions given by her doctor. Then she should begin to visit the chosen establishment regularly and keep her doctor informed fully about the progress of her pregnancy, the state of her health and all details especially if she notices any departures from the normal expected pattern. It must be remembered that the more she cooperates with her physician the easier be the travails of delivery. Besides taking the medicines regularly and eating the recommended food the lady has to be especially circumspect about the possible mishap or miscarriage. There are many women who conceive alright but tend to miscarry. There are many causes of it. Some of them are listed below.
The Causes of Repeated Abortions and Miscarriage
- Lifting a very heavy object.
- Running or jumping at great speed.
- All of a sudden the two feet of the woman falling on different levels; climbing high or mounting high steps.
- Having very hot drinks or eating very hot foods.
- Having the muscles of the ovaries rather loose causing its mouth to open soon, at little exertion.
- Having syphilis or some other venereal disease.
- Having the husband’s sperm or your ovum’s inherent strength very weak.
- Being anaemic or having some blood deficiency or having an inherent incompatibility between the husband’s or yours blood groups.
- Being too chicken-hearted and timid by nature to withstand any trauma or shock or sudden explosion of sound.
Besides these, your husband’s, callousness to care for your comfort and safety or his being reckless during coitus while you are pregnant are the other potential causes of your aborting or miscarry.
A lady has to be extremely careful about these pitfalls and should take every precaution to avoid them.
Exercise during Pregnancy
Together with the above-mentioned precautions, the lady should take adequate physical exercises suiting her body condition. If the development of the fetus is proceeding normally and there are no physical reasons to the contrary, she should take routine exercises as are advisable in her condition. But she must always too careful that she doesn’t overtire herself. In particular, she should perform exercises which tone up the muscles of the waist, the back, and abdomen. More about it in a separate chapter devoted to the exercises advisable for the expectant mothers.
Rest and Sleep during Pregnancy
Shakespeare was not wrong when he observed in one of his plays: ”Sleep the chief nourisher of the life’s feast!” Sleep provides that rest to the body limbs without which they can’t sustain themselves no matter what you eat. Good sleep is the indication that your body has assimilated the nourishment you have given to it for food. However, the slight complication occurs in the pregnant women’s case because they generally get tired more easily, especially in the first and last trimesters (three month periods of pregnancy). She should provide for sufficient rest in her daily routine. Normally it would be advisable for her to rest daily for eight hours at night and at least two hours in the daytime. As the time for delivery draws near, she needs long periods of rest. She should increase the daily periods of rest to at least 10 hours at night and at least four hours in the daytime, making a total of 14 to 16 hours of rest in every 24 hours. The expectant mother must from the habit of sleeping with her feet resting at slightly higher levels than the rest of the body. On no account should she sleep with her knees bent, nor sit with the leg folded under as in a kneeling position. Such positions are likely to obstruct the circulation of blood in the lower regions of the legs, causing those parts to smell.
Insomnia often troubles pregnant women. In general, their tendency is to resort to taking sleeping pills. But such drugs may cause harm to a pregnant lady as well as to the baby inside her. In such cases, the advice of the physician should be sought.
Self-Cleaning And Clothing/footwear etc. during pregnancy
Bathing regularly is a must because it itself is a mild but effective exercise. She should bath every day, scrubbing each part of the body well. Preferably a tub should be used for the baths. However, she should exercise great care while sitting down, standing up or moving in the bathroom so as to avoid slipping. Even a minor accident at this stage could have grave consequences. Taking bath with warm water is advisable although the lady, owing to vagaries of the weather may take the cold bath also. But the genitals should be cleaned thoroughly with warm water.
The expectant mothers should wear clothes that allow them to move freely, without any inconvenience whatsoever. Nowadays in vogue are the loose-fitting robes called ‘maternity gown’ which cover the body well and present a becoming experience, as they deftly cover up the bulge of the abdomen in their folds. The breasts ought to be supported by a well-fitting brassier. She should stop wearing high-heeled footwear. Besides giving extra pressure to the torso they make it difficult to keep one’s balance. Only flat-soled shoes or chappals must be worn. While walking she should always maintain a leisurely pace an should never rush for anything.
Exposure to Radiation x-ray etc. during Pregnancy
It is well-established fact that X-rays are harmful to the fetus, especially in the embryonic stages. The expectant mother should never permit herself to be X-rayed, or take radiotherapy or any treatment which exposes her to harmful radiations. Such radiations may not give any adverse effect immediately but might cause deformity in the baby even after delivery. In case she needs to be x-rayed for some medical reason, she must seek her physician’s advice.
Journeys during Pregnancy
A pregnant woman should avoid any journey in which she is forced to sit unmoved for long hours. Barring a two-three hours car/bus/travel, she shouldn’t undertake long journeys. Of course, she can travel by train which allows freer movement to the passengers. But she must travel only after proper reservation of the birth. She should avoid taking the upper birth. However, in the last stages, she should not take any long journey by one mode of travel.
Smoking during Pregnancy
Nicotine is a harmful substance for the pregnant ladies’ body chemistry. The babies born to women who are given to smoking are generally smaller in size and lighter in weight. Their deliveries are generally not easy, and in a large number of cases, the pregnancies end in miscarriages. Even if pregnancies are successfully carried to term, the babies are generally found vulnerable to bacterial infections and respiratory diseases. The nicotine from the tobacco can find its way to the fetus, which would induce malformations of certain organs or defects in the hearts of the babies. Such babies start having chest pains in the very first year of their lives. Smoking women often become victims of hemorrhages during pregnancy. Hence smoking should be shunned by the pregnant women if they want to trouble during pregnancy or even later.
Drinking Alcohol during Pregnancy
Drinking alcoholic beverages is positively harmful to a pregnant woman. A baby developing in the womb of a woman who drinks may be defective in one way or the other. Defects of heart muscles, fingers, toes and even faces are commonly observed in such babies. The nose is flattened, the jaws lack their normal contours, the nervous system doesn’t function well, and stammering or stuttering is likely to mar the speech of the child when it grows up. Even for the lady alcohol is injurious. In case the woman is addicted, she might take some light wines to satisfy her urge partially that too after consulting her physician.
Sex During Pregnancy
Doctors generally opine that coitus need not be avoided till about 36th week of pregnancy. However, if there is a history of abortion then coitus ought to be avoided in the first four months. The husband must take care of choosing the posture for the sexual intercourse an see to it that the abdomen of the woman is not exerted pressure upon in any condition.
Drugs & Vaccines during Pregnancy
During the first four months of pregnancy, no vaccine should be administered unless the doctor advises under specific prescription. Normally tetanus vaccines are generally administered in the sixth, seventh and eight months of pregnancy. Once these injections have been taken during the first pregnancy, only one injection of tetanus vaccine suffices during subsequent pregnancies. Drugs of any kind are strictly prohibited during pregnancy unless recommended by the treating physician in some special conditions.
Place of Delivery
Nowadays very rarely delivery is arranged at home, purely for the safety reasons. Generally, Hospital/Nursing Homes/Private Clinics are preferred. However, with the going charges for delivery getting exorbitantly high, some still prefer to have delivery at home. In case delivery is arranged to take place at home, the confinement room should be airy and well lighted. The bed should be placed in such a way as to leave sufficient space for movement on all four sides. Unnecessary articles of furniture etc. Should be removed from the room. The doctor, nurse or midwife finds it more convenient if the cot or bed is sufficiently high. All equipment and material necessary for the mother and baby as advised by the doctor should be kept ready and accessible so that there is no occasion for rushing about looking for things at the crucial time.
General Precautions about Medication During Pregnancy
The pregnant woman must always bear in her mind that she is now responsible for the life of two beings: she herself and her baby in the womb. Her eating, drinking and even taking patent medicines ought to be guided by this fact, for anything was taken by a pregnant woman finds its way into the body of the within an hour. The limb of the baby is in the process of formation during the first twelve weeks of pregnancy. The foreign substance like drugs introduced into the system during this part may disturb this process or development. Most, if not at all, congenital defects of the babies are traceable to the ingestion of excessive amounts of powerful toxic drugs. There are numerous instances on record of babies with malformed defects and various other deficiencies in development born to mothers who had been taking drugs like thalidomide (a sedative), androgens, synthetic progesterone, and drugs for the treatment of cancer, during the period of their pregnancies. That is precisely why it is desirable for the expectant mother to avoid taking any medicines, with the exception of vitamins, minerals or insulin. She should n’t voluntarily resort to taking any drug unless recommended by the physician treating her.
There are certain special cases also. If the mother-to-be is a diabetic, the amount of sugar in her blood has to be controlled with the help of insulin, administered in the right amount. Usually, tablets containing organic iron are also given to a pregnant woman to prevent anemia. These tablets are usually formulated specifically for women in this condition and are, therefore, comparatively safe. Often other elements required in minor proportions, such as copper, manganese, magnesium, and cobalt are included in the formulation of such tablets. Tablets of folic acid are also prescribed for the pregnant woman at her very first visit to the doctor, and she is usually required to take these tablets throughout the duration of her pregnancy. Calcium formulation is administered to relieve muscular pain. All these substances are enzymes and food supplements rather than drugs or medicines, and so are considered relatively safe. Acetaminophen is administered to the pregnant woman in place of aspirin as an analgesic, but even this drug is not entirely harmless. It has a deleterious effect on the liver and kidney and should be taken only if it becomes absolutely necessary. Immoderate quantities of drugs affecting nerves, such as barbiturates, amphetamines, and opium preparations are dangerous for the baby, as they may impede growth, and even lead to a reduction in the weight of the baby. That is why a pregnant woman must not resort to any medicine in the hope of finding an immediate cure which is the prevalent tendency nowadays. The expectant mother should exercise greater discretion and should accept only those medicines that are prescribed by her doctor.
Coping with the Physical Changes during Pregnancy
As pregnancy advances the pregnant woman would find certain changes occurring in her body. The breasts begin to swell and harden. The areola around the nipples begins to darken, abdomen gets protruded and marks start quickly appearing in this region whenever it is scratched. In medical parlance, this condition is called Linca Alba.
These are natural and not abnormal changes that occur in a pregnant lady’s body. Some of these symptoms occur because of high blood pressure which most of the pregnant ladies normally suffer from.
(i) High Blood Pressure: It is not a very common problem although some ladies do have high blood pressure during the Second Trimester. However, high blood pressure problem with the ladies having a history of the trouble is definitely a matter of great concern. When the doctor comes across a pregnant woman with a history of high blood pressure he generally considers three possibilities.
(a) Pregnancy itself may have raised the blood pressure.
(b) She may be having undiagnosed-pre-existing-high blood pressure.
(c) The rise in blood pressure may have been caused by toxemia of the pregnancy-a condition in which there are salt and water retention, protein in the urine, and swelling of the ankles and fingers-all due to poisoning by bacteria. Toxaemia of pregnancy not caused due to toxemia can be treated in much the same way as a non-pregnant woman suffering from it, but there are some differences. Detailed examinations, such as x-ray examination should be avoided until the baby is born. Doctors may prescribe as few drugs as possible, especially those which are known to be safe and the drugs which aim at weight reduction and salt restriction.
Ladies with a history of high blood pressure must inform the doctors as soon as conception takes place. Always remember, the more details you tell about yourself the easier it would be for the doctor to treat you. With modern treatment even very severe cases of high blood pressure can be brought through pregnancy safely.
(ii) Early Fatigue: As hinted earlier, fatigue and lethargy are the commonest symptoms of the initial period of pregnancy. In fact, in the rural area of India where the medical facility is not easily available the old ladies would confirm pregnancy by these symptoms only. this is a nature’s way to force the pregnant lady to relax and shun indulging in strenuous jobs. It is essential to relax for an hour after taking your bath and then at least for two hours after taking your meals. Many a time the pregnant lady’s mother-in-law or other old ladies fail to realize that this fatigue or a slight loss of vitality cannot be made good by feeding the lady extra rich-ghee-filled-diet. For diet, howsoever rich it may be, cannot replace the efficacy of sleep. Hence sleep is essential to overcome this feeling of early fatigue. Another disadvantage of having very rich diet is its enhancing fat of the body unwantedly. This accumulated fat is difficult to get rid of even in the post-delivery period. That is the reason why in India of yesteryears the lady used to be fat but weak. Because the diet steeped in ghee and butter doesn’t provide those extra vitamins, minerals, and protein without which the vitality of the body cannot be enhanced.
It is after 18th week or so of conceptions that this feeling of fatigue vanishes, only to return in the last month of pregnancy. This is the normal cycle of waxing and waning fatigue. However, if fatigue has been caused by mal-nutritious diet the doctor and the ladies of the household should pay more attention to the pregnant lady’s diet.
(iii) Cramps: Most of the pregnant ladies experience cramps at the onset of night. These cramps are the outcome of lack of calcium in the body. This can be easily controlled by increasing the intake of calcium in the body through diet and calcium tablets. The age4 old remedy-‘The Banslochan’ is also very useful to eke out this trouble. Sometimes these cramps result due to varicose veins. These can be treated by the ‘leg-lift’ exercises given ahead. The lady should be taken the precaution of not sitting in any position which requires hanging of the feet.
(iv) Pains In Hips And Waist: These are also the common complaints. Owing to the distention of the upper stomach due to pregnancy, extra pressure is put on the spinal chord which manifests itself in the form of pains in these parts. To ease this pressure on the spine the lady must learn how to carry her boy in a fully balanced way which is elaborated in the exercises explained in the chapter ahead.
Another reason for these pains is somewhat ‘loosening’ of the tissues joining the pelvic region with the backbone. The hormone progesterone which is discharged in the large quantity is actually responsible for loosening of these tissue joints. But it is nature’s way of facilitating the delivery of the child. Those ladies with heavier built feel it in a more pronounced way. The only way to redeem this trouble is to learn how to carry yourself in a more balanced way and to avoid hanging your feet.
Sometimes lack of calcium in the body also causes this pain. As we know a pregnant lady’s body has also to procure calcium required to develop the child body. Hence this deficiency is natural. If their food doesn’t supply calcium in an adequate manner for long the lady herself becomes a patient of ‘osteomalacia’ which is a medical term for the weakening of the pelvic region. So the lady and those attending on her must ensure that she gets the liberal amount of calcium through her diet and medication. This deficiency has to be taken care of immediately because it might weaken the bones of the child also.
(v) Short of Breath: This is also a common problem during the last phase of pregnancy. Owing to the increase in the size of the embryo more pressure is exerted on the diaphragm causing this problem. Since the head of the child slides down a few weeks before delivery, the lady feels the temporary relief, otherwise, because of this problem she is constrained to use a couple of pillows to breathe properly during her sleep. Lack of blood in the body also surfaces this problem. For making good this deficiency the lady must consume a lot of spinach, beet-roots, apples, besides having iron-rich tonics recommended by her doctor. If she practices pranayama regularly in the initial stages of pregnancy she might not feel this problem as much as others feel. More about it-i. e. the diet part is explained ahead.
(vi) Heart-burn: As hinted earlier, this problem has no concern with the heart. It is said heart-burn because near the heart-region a peculiar burning sensation is felt which is because of the acidity. It can be taken care of by having edible alkaline substance like milk of magnesia, carbonic soda, unsalted salad piece like cucumber in ample quantity etc. If the trouble persists with great acuteness, the lady should have very frugal diet and should sleep with her head propped up high.
(vii) Tastelessness: Because of certain hormonal secretions, saliva production increases in great quantity. This is also one of the old tests to confirm pregnancy. This causes the pregnant ladies to have the special liking for chalk and other unusual things which don’t even come in the edible category. The best way to fight this unusual longing is to make the lady have calcium-rich things like its special tablets, the Banslochan etc.
(viii) Changes in the Colour of Skin: As already explained, after 18 weeks the areola around the nipple begins to darken. It is less noticed in the fair complexioned ladies. Sometimes the darkness also spreads up to the breasts. These changes vanish after delivery but not completely. Application of special creams like the ‘E-cream’ helps remove them to the certain extent. Sometimes a long-line appears below the navel also. The rings around the eyes also get darkened which automatically vanish after the delivery.
(ix) Stomach Pain: A slight pain is experienced in the 16-20th week of the pregnancy which is due to the pressure experienced by the lady owing to the increase in the size of the embryo. This is quite normal. In case the pain is of shooting type, the doctor ought to be immediately consulted.
(x) Swelling of the Feet: This has also been explained and is caused by the veins getting rather varicose. Only when the feet continue to be swollen even after a full night’s sleep that the physician must be consulted.
(xi) Lack of Sleep: In the last trimester, lack of sleep is the common complaint. There could be several reasons for it, chief among them are the following:
(a) The repeated urge to urinate
(b) Due to the fast movement of the child inside the womb
(c) A slight abnormal temperature of the body
(d) Short of breath and heartburn complaints
(d) The nagging pain in the back or hip region
It is certainly not advisable to have sleeping pills or another kind of sedatives in the last trimester. The lady should try to sleep with a peaceful mind. Washing hand and feet with lukewarm water and having hot milk before retiring for the day are some of the time-tested formulae to induce sleep. In case the insomniac condition persists then the doctor should be consulted for having mild sedatives.
(xii) Falling Eye-Sight: This is also a common complaint in the last phase of pregnancy which also gets cured after the delivery. Some exercises, given ahead would help the lady to check her eye-sight falling. Even otherwise, it must be understood that there are the travails that the lady has to undergo to acquire the exalted status of motherhood.
(xiii) Bleeding Gums: Owing to enhanced blood circulations, many ladies feel as if their gums have become rather fat and big which do bleed when they brush their teeth. In this stage, it is advisable to use the very soft brush or resort to the old practice of cleaning your teeth with tooth-powder or tooth-paste applied on your finger.
Since most of these changes are the reversible type the lady shouldn’t get unduly worried about them. With patience and peace, she can easily cope with these changes.