“Children are a blessed heritage,” and the decision to start a family should be a joint venture by both parents. There is need for some pre-pregnancy preparation to discuss and understand the implications of having a child. A positive relationship between partners is a prerequisite. It will eliminate any psychological stress or conflict which might arise between partners in the course of the pregnancy. Every child should be a wanted child.
Pregnancy and childbirth are no longer exclusively “women’s affairs.” The father must be an active participant in the whole process. The husband must take the responsibility of understanding and adjusting to the various physiological changes that will take place in his wife – her moods, her morning sickness, her expanding body – confident that these are only temporary changes that must take place to meet the demands of the baby. A woman who knows that she has the full support of her husband every step of the way, will fall in love with him all over again, for the security and dependability he ensures. The quality of the relationship will psychologically affect the course of the pregnancy.
Some couples suffer from pre-pregnancy stress. Previous abortions or complications of pregnancy, or abnormal babies, might have them worried. In such cases, discussing these matters with a doctor would set their minds at ease. .Where there is a family history on either side, of hereditary diseases or genetic defects, it would be appropriate to go in for genetic couselling before deciding on starting a family.
“Childbirth is an expression of health rather than illness.” So, Motherhood should be an exciting experience. Our great grand mothers did not have the advantages we have today, of High Tech hospitals and modern gadgets. Midwifery was then “a non-medical lay craft,” attended by married women of mature age, or a traditional birth attendant. The majority of women delivered normally, though the infant mortality was comparatively high.
Even so, High Tech doesn’t mitigate fears, and every prospective mother has feelings of anxiety about the outcome of her pregnancy. Worries increase when other women, with the very best of intentions, insist on enumerating the likely complications, or grandmas fill one’s ears with old wives’ tales.
It is therefore important for the woman to understand her body and all the exciting changes that will take place, in anticipation of the needs of the child within her. She should bear in mind that she has been ‘fearfully and wonderfully’ designed to be the bearer of life.
The period of pregnancy is divided into three trimesters. Signs and symptoms vary with the period of pregnancy. In the first three months, though there are no external changes, a pregnant woman exudes a kind of radiance. The missed period, the feeling of fullness in the breasts, and the desire to urinate frequently alerts her that pregnancy has begun. Many women can’t wait to run for a pregnancy test even if the period is delayed for just a couple of days. To avoid disappointment, it is better to wait until six weeks after the missed period.
Morning sickness is a positive sign that the foetus is alive. It is seldom seen in smokers or tobacco users where the foetal outcome is poor. It starts between the fourth to sixth week after a missed period. Morning Sickness was first recorded on a papyrus in
200 B.C, by the Egyptians. To some it is just nausea. Here, the husband could be of help in bringing his wife a cup of tea and a biscuit, before she gets out of bed. Many women vomit only in the morning, and the sensation eases off later in the day. It occurs because of the high levels of hormones in the blood, and can be minimized by eating small meals at frequent intervals, drinking plenty of water in between meals, and avoiding greasy, spicy or fried foods. However, persistent vomiting needs to be treated so as to prevent dehydration. Medication in the first trimester is to be used judiciously. The thalidomide disaster of yesteryears still haunts our memory. Excessive vomiting could be due to a molar pregnancy or multiple pregnancies.
Excessive salivation, and craving for peculiar foods (pica eating) are also experienced during early pregnancy.
Being aware of the likely changes that will occur will eliminate unnecessary anxiety and stress. Aches, pains and discomforts are an inseparable part of pregnancy. Lower back ache is due to altered posture; pain in the abdominal wall is due to stretching of muscles to accommodate the growing uterus; pain over the pubis is due to relaxation of the pubic ligaments. Leg cramps felt in the back of the thighs and calves can be relieved by bending the feet upwards so as to relax the calf muscles.
The second trimester is a comparatively easier period when early symptoms disappear. There is a feeling of well being. After the sixteenth week she can look forward to the exciting feeling of “quickening.” It is the first subjective recognition of life within her. Though just a twiddle like the fluttering of a tiny bird, it ushers in a conscious relationship between her and her child. As the foetus grows movements become more appreciable.
Pregnancy is bedeviled by “minor” discomforts like heartburn, breathlessness which is usually of emotional origin, occasional spells of faintness and dizziness and sleeplessness due to the discomfort of the enlarging abdomen. Pigmentation of the skin on forehead and face, darkening of the areole around the nipples, and a dark line extending from the navel to the pubis also become visible.
Piles, constipation and some vaginal discharge can be quite worrisome. It is therefore good to be under the care of an obstetrician and have regular antenatal check ups through out pregnancy. This will ensure optimal health of mother and foetus, detection of complications, treatment of medical diseases, and education about pregnancy, labour and breast feeding.
At the initial antenatal visit, the diagnosis and duration of pregnancy will be established. A detailed history of both personal and family history is taken. Blood pressure is recorded, Blood tests like haemoglobin levels, blood group and Rh factor, VDRL, screening for Diabetes are done. Many hospitals offer screening for HIV too. Urinary and vaginal infections are also treated. Urine is tested for Albumin and sugar at each visit.
Antenatal visits are usually once a month during the first 28 weeks, once a fortnight for two months, then weekly thereafter, or as ordered by the doctor.
Rh Negative mothers are given Anti-D globulin early in the third trimester, which significantly reduces the risk of Rh immunization in the child.
Sonography is a very useful diagnostic tool to establish age and viability of the foetus, and to monitor the foetus periodically through pregnancy. It will also confirm that the pregnancy is intrauterine and not in the tubes.
Electronic Foetal monitoring has become possible throughout pregnancy. This allows greater supervision of women and babies at risk, and timely intervention when necessary, and the cardiotocograph shows the foetal heart rate pattern in relation to uterine activity. These gadgets have revolutionized the management of pregnancy and labour.
Bleeding is an abnormal sign and must be reported. In the early months bloody discharge with abdominal pain may be a sign of impending abortion.
Smelly, yellow discharge with itching could be due to a vaginal infection which needs treatment.
In the later months, abdominal contractions could be the onset of premature labour. However even in a normal pregnancy, painless contractions called Braxton Hick’s sign may be felt from time to time, which last for a few seconds.
Diminished foetal movements or excessive movements must also be reported to the doctor. If the movements in the third trimester are less than 10 in 24 hours, it is a distress call from the foetus.
Sudden increase in abdominal size or diminished growth must also be referred to the doctor.
Swelling of feet, headache, blurring of vision and high B.P. if left untreated, may proceed to fits. Many women through ignorance think it is due to some evil possession, and allow themselves to be branded with a hot iron rod or administered to by a priest. Precious time is lost this way, endangering the life of mother and child, as this is Toxaemia of pregnancy.
Painless bleeding or bleeding with severe abdominal pain in the last trimester must be promptly attended to in a hospital.
Diabetes: Mothers who are known diabetics should ensure that their blood sugar is under control for at least six months prior to pregnancy. They need to be carefully monitored through out pregnancy. If not controlled, the foetus may grow large but unhealthy, and may have several defects, or could be still born.
Certain mothers develop diabetes during pregnancy, which subsides after delivery. This is called Gestational Diabetes. Diet, medication and exercise will ensure a normal baby.
Similarly, women with heart disease will also need specialized care.
Sometime towards the end of the pregnancy, depending on the position and size of the foetus or on its wellbeing, the doctor will be able to predict whether one can expect a normal pregnancy or caesarean would be preferable. This information will help prepare the couple mentally for whatever decision is taken.
Pregnancy is not an illness, and so a mother must carry on with her routine work, though strenuous work or lifting weights is not advisable, Exercise must be moderate. A brisk walk, for half an hour or so, is good for circulation. Special attention should be paid to posture to keep the abdominal muscles firm. Wrong postures can hollow the back and make the abdomen sag.
Breathing exercises can be practised by sitting in on an arm chair with hands over abdomen, and breathing in slowly, feeling the abdomen rise, then exhaling gently through the nose, as the diaphragm rises into the chest. This should be repeated six times a day, and is in preparation for the slow conscious breathing which will be required in the first stage of labour.
Relaxation techniques and abdominal exercises as ways to diminish the discomfort of labour, are now taught in antenatal clinics. Many husbands accompany their wives to these classes and also learn these techniques (Dick Read method), so that they can help their wives practise at home.
Sleep is important. Lying down for a couple of hours in the afternoon, and going to bed early, ensures enough rest for the mother. Rising from bed should be done gradually and not in haste.
It is wise to restrict long distance travel in the first and last trimesters, as there is fear of abortion in the former, and risk of premature labour in the latter. Besides, travelling may expose the mother to infections like colds or coughs.
A normal mixed diet of high protein, less fat and carbohydrate, with a glass or two of milk per day is advised. There is no need to over eat for two. The foetus will get enough nutrition and its health will be determined by the quality of food eaten by the mother. Overeating especially starchy food and sweets will only increase one’s girth, which will be difficult to shed post-natally. Fresh fruit, green leafy vegetables and salads are nutritious.
Eating too little is also not advisable, as the body will break down stored fats, increasing ketones in the blood. Constantly high ketones will lead to mental retardation of the child.
Supplements of Calcium and Folic acid will have to be taken, as the former is required for bone and tissue growth, and the latter will prevent defects of the brain, spinal cord, congenital heart disease and cleft palate. Iron is also necessary to prevent anaemia of pregnancy. These supplements must be taken regularly.
Salt should be kept to minimal, but water should be drunk copiously.
Alcohol is to be strictly avoided as it causes a spectrum of foetal disorders like abnormal facial features, slow growth, brain defects that interfere with learning, memory, communication skills and vision.
Smoking also produces babies that are small for dates, with low I.Q. and learning disabilities.
Snacks from wayside vendors, uncooked or undercooked foods could be teeming with bacteria, and should be avoided.
Be Cheerful and Well groomed.
This is the time to look and feel feminine. There is nothing more feminine than a pregnant woman. Good and comfortable sweatshirt (lưới cầu thang), not too tight or restrictive under garments, sensible low-heeled detroit tigers sweatshirt , hair well combed, and a smiling face, gives the husband pride in his wife. There are many flattering outfits for pregnant mothers sold in various boutiques today.
If planning to breast feed, the nipples should be massaged daily with olive oil, and pulled outwards. Prevention of striae on the abdomen can also be prevented by rubbing oil over the abdomen from the seventh month onwards.
Vaginal douching is highly dangerous and should not be done. Genital cleanliness can be maintained by washing with soap and water, after each visit to the toilet.
A calm temperament and a cheerful countenance make the mother as well as those around her feel good. It is known that emotions of the mother are felt by the child in the womb. Anger, sadness, rejection of the foetus translate as primal pain in the foetus. Unless one wants to have a cranky, irritable baby who grows into a troublesome, unsociable adult, it behoves the mother to be in a cheerful frame of mind at all times.
The husband should be involved in the welfare of his wife, and all that she feels and experiences during pregnancy. He must be patient and empathetic.
Finally, the power of pray in healing psychological stress has been proved beyond doubt. Both parents should praise God daily for the gift you are about to receive, and pray for a smooth delivery and a normal child. A couple I read about, placed both their hands on the mother’s abdomen every day, and prayed for the welfare of the unborn child.
Pregnancy and childbirth can be a happy and relaxing experience in which the husband plays an active and supportive role, whether you choose to have a natural birth at home or in a hospital where modern technology is available. Hospitals now encourage husbands to stay beside they wife during labour and delivery, so that this will be a participatory event, and will strengthen the bonds of love between them. A man who has witnessed the ordeal a wife has to go through, will be more appreciative of her role as partner and mother.
write by Charles