Motherhood is a unique experience.Every woman possibly dreams to be a mother.As an expectant mother you would seek answers to many questions,doubts or problems.This booklet is an attempt to address some of them.

When to expect the baby:

It is not possible to tell the exact date when the baby will be born.The average duration of normal pregnancy is 40 weeks or 280 days.The expected date of delivery is calculated by adding 9 months and 7 days to the first day of the last menstrual period.However this is only a probable date.Variations of one or two weeks either earlier or later may occur.

How early should I see the doctor:

Following a missed menstrual period you should see your obstetrician as soon as possible.Examination at this time confirms the pregnancy and also helps in fixing the date of the pregnancy.

During the first examination your doctor would take a detailed history and give a complete examination.Certain blood tests may also be ordered.

How often should I see my doctor during pregnancy:

At the initial examination your doctor would tell you about the frequency of subsequent visits.

For a normal,low risk patient,the recomended schedule of visits is as follows:-

Every four weeks until 28 weeks of pregnancy,thereafter every two weeks until 36 weeks of pregnancy and thereafter weekly until delivery.

What is a 'High-Risk Pregnancy':

It is a term doctors use to describe a pregnancy in which the infant or the mother may be at a special risk. It is important to identify high risk factors in early pregnancy so that adequate measures are taken for the safe outcome of the pregnancy.

Some high risk factors are:-

1. Maternal age,below 16 yrs or above 35 yrs.

2. Short height.

3. Problems in previous pregnancies like repeated abortions,

death of the foetus in womb,neonatal death.

4. Previous difficult delivery or caesarean section.

5. Having delivered a baby of birth weight less of than 2.5 Kgs or more than 4 Kgs.

6. Medical problems like Heart disease,High Blood pressure,Diabetes,Kidney problems,Anaemia.

7. Bleeding in pregnancy.

8. Twins,abnormal presentations of the baby etc.

Do I need to take Iron and Multi Vitamins during pregnancy:

From third month onwards your doctor would prescribe iron and multi vitamins.Iron preparations are not prescribed in the first three months of pregnancy as the requirement of Iron is very little during this period.Also,a mother may have nausea or vomiting during the first three months which may be aggravated further with Iron tablets.There is an increasing requirement of iron and multi vitamins,during the second and third trimester.This increased demand cannot be met with diet alone.Therefore it is important to take iron and vitamins regularly as prescribed by your Obstererician.

What precautions should be taken regarding medications during pregnancy:

Certain medicinescan harm the baby.All medications should be taken under your doctor's supervision only. During the first threemonths of the pregnancy new organs are being formed in the baby's body. Wrong medicines can harm the baby during this period. After the first three months also care should be exercised. The common fever pill-Aspirin should be avoided throughout, use paracetamol instead.Tetracycline-an antibiotic, should not be taken during pregnancy or while nursing the baby. Its use may resultin ugly brownish-yellow discolouration of baby's teeth and also may adversely affect baby's bone growth. Alternative antibiotics should be used after consulting your Obstetrician.It is well to remember "When in doubt-ask."

Do I need special diet during pregnancy:

Yes.Duringpregnancy it is important to stress the quality of your diet,not the quantity.Though your developing baby is drawing its nourishment from you, it is neither necessary nor desirable to eat for two.Just eat the reasonable amounts of the proper foods. Do not eat too many starchy, fatty or sweet foods.Your baby needs minerals and calcium for bone development. He will draw on you for these requirements.Milk is the best source of calcium.Increase your intake of milk(3 glasses of milk a day) and milk products.Green leafy vegetables, cereals and meat are good sources of iron. Eat them liberally.

How much weight should I gain during pregnancy:

During a normal pregnancy with single foetus the average weight gain is around 9-11 Kgs. It is important that you do not gain too much or too little. Excessive weight gain can cause problems to both you and the baby.Too little weight gain can result in a baby with low birth weight.

When shall I feel the foetal movements:

A woman who is pregnant for the first time starts feeling the foetal movements around 20-22 weeks of pregnancy. A multigravida orawoman who has borne more than one child would start feeling the foetal movements as early as 16-18 weeks of pregnancy. Initally the movements are felt as a flutter and not a kick.

What are the common complaints during pregnancy:

Nausea and vomiting: Nausea and vomiting are the common complaints during the first four months of pregnancy.These appear between the first and second missed menstrual period. Symptoms are more acute during morning but may continue throughout the day.Usually no medications are required and symptoms settle on their own.For profuse and persistent vomitings intervention is necessary.Medicines orintravenous fluids may be administered.All medicines should be taken under the supervision of your Obstetrician.

Backache: Most pregnant women experience backache to some extent.It is helped by rest and elimination of strain.

Constipation: It commonly starts early and persists throughout the pregnancy. It is caused by relaxation of bowels by hormones produced during pregnancy.Enema and laxatives should not be used.Fluid intake should be increased as also the consumption of vegetables and fruits.

Fatigue: Some women experience fatigue and want excessive periods of sleep.The condition usually improves on its own by the 4th month of pregnancy.

Heart-Burn: It is a burning sensation in the chest.It is the most common complaint during pregnancy.It is also caused by the hormonal effects of pregnancy.The acid content of the stomach regurgitates up in the oesophagus causing burning sensation in the chest. It can be alleviated by taking antacids and small frequent meals.

Leukorrhoea: Increased secretions of the glands of the cervix(neck of the uterus) lead to excessive vaginal discharge.This is duetotheeffects of hormones produced in the body during pregnancy.It is neither irritating nor foul smelling.If it is otherwise,please report to your doctor.

Cramps: Some women develop cramps in the legs.Gentle rubbing and changing the position of the legs helps in decreasing the pain of the cramps.

Pica: During pregnancy some women have craving for certain foods or may want to eat things hardly considered edible like clay.

What clothing should be worn during pregnancy:

The clothing should be loose and non constricting.During pregnancy breasts increase in size. They may become pendulous and painful.In such cases a well fitting and supporting bra with broad shoulder straps should be worn.

How much rest and sleep is needed during pregnancy:

Pregnancy is not a disease.You should remain active throughout,unless your doctor advises rest.You should sleep for 8-10 hours during the night and rest for an hour during the afternoon.

Can a working woman keep working during pregnancy:

If your occupation does not involve excessive physical strain, you should keep working as long as you feel comfortable.

What can be done to ensure proper breast feeding:

Invertedor cracked nipples will hinder your baby's breast feeding.Have your doctor check them and treat appropriately. Preparation of nipples begins few months prior to the birth of the baby.During pregnancy a well fitting,supporting bra with broad shoulder straps should be worn.

The general instructions are:

1. Use warm waterwhen bathing breast.Do not use soap on nipples during the last 2 months of pregnancy.Soap removes the protective film which prevents the nipples from drying.

2. Allow the nipples to air dry,or rub gently with a soft towel.

3. Expose nipples to the air as often as possible.

4. Breast massage:Cup the breast from below with the palm of the hand and with a soft wash cloth rub the nipples 4-5 times.This can be done once or twice daily.

5. Apply mild cream or baby oil to areola-the brown part around the nipples and to the sides of the nipples.

Do I need any immunization during pregnancy:

Yes,asa routine 2 injections of tetanus toxoid are given at four weekly intervals during the sixth and seventh months of pregnancy.However if during the previous two years you have recieved a tetanus immunization,then only one injection is required.

Can contagious diseases harm the baby:

Yes.Diseases likeGerman Measles during the first three months of pregnancy produce abnormalities of the organs of the foetus.Contact with such diseases should be avoided.Should such exposure occur,report immediately to your obstetrician.During later months of the pregnancy infections of the mother may be transmitted to the baby.

What is Rh factor:

Blood group is determined during pregnancy.Besides your blood group being A,B,O or AB, your doctor would tell you whether you are Rh positive or Rh negative.Rh factor is present in the blood of about 85-95% of the women.Presence of this factor makes the woman Rh positive and it's absence- Rh negative.It is a matter of concern,if you happen to be Rh negative and your husband Rh positive.In these circumstances your baby could be Rh positive.With an Rh positive baby,the mother's blood may produce Rh antibodies.These antibodies may affect the present or future pregnancies.

What is Amniocentesis:

It is the taking out of liquid(amniotic fluid) surrounding the baby.It is done for diagnostic and therapeutic purposes.It involves certain risks to the baby and mother.Amniocentesis should only be done when indicated.

Who should have amniocentesis done:

1. Pregnant women of age 35 or older: These women have a greater chance than younger women of having an infant with Down syndrome(mongolism).

2. Couples who have already had a child with certain genetic disorders.

3. Couples who have had a child with neural tube defect,a birth defect that results from improper development of the brain or spinal cord.

Danger signs which must be reported immediately:

1. Any vaginal bleeding.

2. Swelling of the face and fingers.

3. Severe or continous headache.

4. Blurring of vision.

5. Abdominal Pain.

6. Persistent vomiting.

7. Chills or fever.

8. Escape of fluid from the vagina.

What are signs of onset of labour:

You will not be much in doubt when actual labour starts.Uterus starts contracting. Initially the contractions are irregular - coming at 15-30 minutes interval and lasting for 10-15 seconds. As the labour progresses contractions become more frequent. Their intensity and duration also increases.Besides feeling the pain, you would also feel your tummy getting tight with the contractions.Along with the contractions you may pass blood mixed with mucus or there may be escape of fluid(amniotic fluid) from the vagina.

What is the duration of normal labour:

For a primigravida(first pregnancy) the average duration of labour is 10-12 hours.For a multigravida the duration is about 4-8 hours.However,variations often occur.

What is painless delivery:

To relieve the pain during labour,local anaesthetic is injected in the backbone(epidural anaesthesia).It makes the lower portion of the body numb.The patient does not feel the pain.Recently more and more women are opting for natural child birth.Though uterine contractions are painful,the intensity of pain of labour is also related to emotional tension.By training in breathing and muscle relaxation exercises during antenatal period,this pain can be minimised.Besides this,pain relief during labour can also be obtained by injecting certain medications.

What is an Episiotomy:

During birth of the baby the vaginal outlet is stretched. To prevent tearing of the vaginal opening and in facilitating the smooth delivery of the baby, a cut is made in the perineum (area between the birth canal and anus).It is stitched after delivery of the baby and the placenta.Commonly,self dissolving stitches are used which do not require removal.

What is a breech presentation:

Commonly the head of the baby is the presenting part during birth.When the presenting part is the legs,feet or bottom,it is termed breech presentation.It involves certain risks to the baby.Your obstetrician would decide the mode of delivery.

What is a Forceps delivery:

Forceps are spoon shaped instruments.They are applied around the baby's head to facilitate its delivery.

It is used in the following conditions:-

1. Foetal distress. 2. Mother's exhaustion.

3. Delay in the delivery of the baby.

What is a Caesarean section:

It is the delivery of the foetus through a cut in the abdominal wall and the uterus.It can be performed under general anaesthesia (putting the patient to sleep) or by injecting a drug in the backbone and temporarily paralysing the lower portion of the body (spinal or epidural anaesthesia).In some cases vaginal delivery is not possible or would cause undue risk to the mother or the baby.Some of the reasons for caesarean birth are:-

1. Foetal distress- This is the commonest indication for ceasarean section.This means that the baby is getting inadequate oxygen and is in need of immediate delivery.

2. Abnormal presentations like breech presentation or face presentation.

3. Vaginal bleeding-If the placenta is situated in the lower portion of the uterus (placenta praevia) it causes profuse bleeding.Also,if a normally placed placenta separates before the delivery of the baby,the flow of oxygen is interrupted and the baby may not survive.In both situtations caesarean section is indicated.

4. Cephalo-pelvic disproportion- It means the baby is too large to pass safely through the mothers pelvis.

5. Medical illnesses of the mother such as diabetes,high blood-pressure.

What does the expression 'rooming in' mean:

'Rooming in' means keeping your baby in your room at your bedside.'Rooming in' may be continous when the baby is with you constantly or intermittent when the baby visits you on request or during planned hours.

Should the baby be 'roomed in':

It is both natural to have the baby by your bedside and satisfying to the entire family.The incidence of skin infections as well as more severe chest problems or diarrhoea is also reduced.The mother who rooms-in becomes more adept at handling the baby before discharge from the hospital-thereby increasing her security in the early days at home.

However,soon after baby's birth,you will be tired.It is preferable to delay rooming-in until you have recovered enough to attend to baby's needs.During rooming-in,visiting is limited to one visitor at a time,besides the father. Children are allowed to visit their mother.

Should my husband be present in labour room:

Your husband's presence gives you confidence and involves him in the baby's birth.Though uncommon here,in certain countries,husband's participation in the whole process of delivery is taken for granted.However,it should be the choice of your husband. He shold not be forced to attend. He should also be informed about the process of labour and birth.

Will the Pediatrician be present:

Most births are normal.Your obstetrician with her nurse assistant can give adequate care to the baby.In certain circumstances,the pediatrician may be requested to attend the delivery.At time of caesarean or breech delivery or a high-risk delivery,a pediatrician should be present.

What should be taken to the hospital:

For the baby:-

1.Clothes- Clothing for the baby should be soft,loose fitting and comfortable.Be sure to launder baby's new clothes before use.Some of the basic items are:-

Diapers-1 dozen,Bibs-6,Sweaters (open in front)- depending on the season-2,Socks-2 pairs,Stretch suits or frocks.

2. Baby powder,baby oil,baby soap.

For the mother:-

1. 2 gowns open in front.

2. Other clothes to suit your requirements.

3. Sanitary napkins.

Ultrasound:

In obstetrics,ultrasound is used to examine the growing foetus inside the mother's uterus.It can provide valuable information about the health and well being of the foetus.

It is used for determining -

1. Age of the foetus.

2. Rate of growth of the foetus.

3. Foetal position,movement,breathing and heart rate.

4. Number of foetuses.

5. Detection of some birth defects.

6. Amount of amniotic fluid.