New Beginnings

A Unit of The Aga Khan Hospital and Medical College Foundation, Licensed under Section 42 of the Companies Ordinance,
1984
Registered Office: Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
NEW BEGINNINGS
Having a baby is an important milestone in your life and is a life-changing experience.
At the Aga Khan University Hospital our team of doctors, midwives, nurses and support staff are
committed to making this experience safe and happy, for you and your baby.
As you plan on how to proceed, you are likely to have a lot of questions. The more you know about your
pregnancy, the more prepared you will be to carry it to delivery and enjoy this special time in your life.
This booklet brings together the information you need to know before you become pregnant, during
pregnancy, labour and delivery and then the time after your baby is born also known as postpartum.
BEFORE BECOMING PREGNANT

If you are thinking about becoming pregnant, first select your doctor (obstetrician) and make an
appointment. There are some lifestyle considerations that you should keep in mind for a healthy
pregnancy:
 Talk to your doctor if you are on any medication or have any chronic health issues.
 Talk to your doctor about getting your and your husband’s blood group tested, if you don’t already
have this information. It is important in order to anticipate and manage any potential complications.
 Talk to your doctor about ensuring you have had the right vaccinations to protect you and your baby
during pregnancy. These include but are not limited to, whooping cough, flu, rubella etc.
 Start taking Folic Acid, which helps in the development of your baby’s brain and spine.
 Exercise regularly to maintain a healthy weight.
 If you or anyone in the house smokes, now is the time to quit. Smoking can be very harmful to the
baby before and after birth.
CONGRATULATIONS YOU ARE PREGNANT!
What should you do?
Select your doctor (obstetrician) if you haven’t already done so.
Call for an appointment and keep a list of all your questions ready.
Register at the hospital for the baby’s delivery. Registration for delivery at The Aga Khan University
Hospital must be completed latest by 22 weeks of pregnancy.
Enrol in the Pregnancy and Childbirth Education Programme: The Aga Khan University Hospital
offers Pregnancy and Childbirth Education Programmes to assist expectant couples during pregnancy,
labour and delivery, childbirth and in the adjustment to the parental role. You are invited to actively
participate in identifying your learning needs and interests.
This is a four-session programme. Each session is held on a Saturday morning and includes teaching and
discussion on multiple topics.
Session 1: Physical and emotional changes during pregnancy, their management and body toning
exercises.
A Unit of The Aga Khan Hospital and Medical College Foundation, Licensed under Section 42 of the Companies Ordinance, 1984
Session 2: Benefits of breastfeeding, related problems and their management; nutrition during
pregnancy and while breastfeeding.
Session 3: Signs and symptoms of labour, identification of true and false labour pain, breathing
exercises during labour, care of episiotomy, self-care after delivery of the baby and family planning.
Session 4: Pain relief options available during labour, the role of the father in delivery and afterwards, a
tour of the labour room, private, semi-private and general ward area. Fathers are especially invited to
attend this session.
HEALTHY MOM, HEALTHY BABY

The health of the mother-to-be plays an important role in the health of her baby. A pregnant woman
should look after her own medical and emotional needs to give her baby the best chance for a healthy
start in life. Following are some important questions related to your basic health that a pregnant woman
should be aware of.
Do I need to follow a special diet during my pregnancy?

What you eat and drink during pregnancy is your baby’s main source of nourishment. You should choose
healthy foods to provide the important nutrients a baby needs for growth and development. Compared to
a woman who is not expecting, a pregnant woman needs more:
 Calcium
 Folic acid
 Iron
 Protein
Calcium: Calcium is needed to build a baby’s bones and teeth.
Major food sources include milk, yoghurt, cheese, other dairy products, almonds and okra.
Folic Acid: Folic acid, also known as folate, is important in helping prevent birth defects in the baby’s
brain and spinal cord.
Major food sources include leafy green vegetables, fortified cereals, bread, pasta, beans and citrus fruits.
Iron: Pregnant women need double the amount of iron than women who are not expecting. Iron is
needed to make more blood to help supply the baby with oxygen. Getting too little iron during pregnancy
can lead to anaemia.
Major food sources include meat, poultry, fish, dried beans, peas, iron-fortified cereal and spinach.
Protein: Women who are pregnant need to eat more protein. Protein helps to build important organs in
the baby, such as the brain and heart.
Major food sources include meat, poultry (chicken), fish, dairy products, dried beans, lentils, eggs, nuts
and peanut butter.
There are certain foods that you will need to avoid when you are pregnant because they may contain
bacteria, parasites or toxins that could harm your baby. These include:
 Unpasteurized or fresh milk and foods made from it (including cheese, shakes, desserts).
 Raw or undercooked meat including chicken, beef, mutton, lamb or organ meat.
 Raw eggs and raw fish.
Can I drink tea, coffee and/ or sodas?

If you feel like you must have caffeinated drinks then limit yourself to 200 mg of caffeine a day, which is
about 1 cup of coffee or 2-3 cups of tea. Try and avoid drinking caffeinated sodas.
Which supplements should I take during my pregnancy?
During the fifth or sixth week of your pregnancy, the baby’s neural tube (a hollow structure from which the
brain and spinal cord form) starts to develop. This is before most women know that they are pregnant.
Ideally to start taking your prenatal vitamins, primarily folic acid, before you start trying to conceive.
Always talk to your doctor before taking any additional supplements or medication. As the pregnancy
develops, your doctor may recommend that you switch over from just folic acid alone to a vitamin that
contains other minerals and nutrients such as iron and calcium.
Can I exercise during my pregnancy?

The simple answer to this question is, yes! In fact, the more active and healthy you are during your
pregnancy, the easier it will be for you to adapt to your changing shape and weight gain. It will also help
you to cope with labour and to get back in shape once the baby is delivered.
Keep up your normal daily physical activity and exercise for as long as you feel comfortable. However,
remember not to engage in activities that may leave you too tired and exhausted. You should also avoid
those exercises which have risk of falling and injury e.g horse riding, cycling etc. As a general rule, you
should be able to hold a conversation as you exercise.If you become breathless as you talk, you are
probably exercising too strenuously.
Can I travel during my pregnancy?

It is relatively safe to travel up until 24 weeks of pregnancy. However, it is always a good idea to discuss
your travelling plans with your doctor. Long distance travel (longer than 5 hours) carries a minor risk of
thrombosis (blood clots) in pregnant women. During your travel drink plenty of water to stay hydrated and
do any exercises recommended by your doctor. Some airlines may ask for a medical certificate indicating
the due date and any medical conditions you may have.
HOW YOUR BODY CHANGES DURING PREGNANCY

As your baby grows, it occupies more and more space inside your body. As well as expanding outward
and developing the pregnancy bump, your internal organs are put under a significant amount of pressure,
which can cause some discomfort. You should not be alarmed as the discomfort you feel is common and
the more you are aware of what to expect, the better you will be able to manage.
Backache is a common complaint, especially in the second half of pregnancy. As your baby grows, the
increasing weight may put strain on your lower back and cause backaches. These can also be caused by
changes in hormones and body postures. If you did not experience back pains before pregnancy there is
a high possibility that the backache symptoms will go away after the delivery. Different ways to ease your
backache include regular exercise, applying heat and cold pads to your back, improving your body
posture especially when picking up things from the ground and sitting. Avoid sleeping on your back.
Bleeding, tender, red and swollen teeth and gums is experience by about 50% of women who are
pregnant. This mild form of gum disease known as pregnancy gingivitis is caused by the hormonal
changes in the body. During pregnancy, it is important that you maintain good oral hygiene. Brush your
teeth thoroughly and gently at least twice a day, floss daily and visit a dentist for a check-up.
Constipation is a very common problem during pregnancy and happens due to hormonal changes in the
body. To prevent and ease constipation, include high fibre foods in your diet e.g. whole grains and wheat
found in breads, cereals and oats, fruits such as pears and melon, vegetables such as carrots, broccoli,
peas, beans and pulses, nuts and seeds. Drink plenty of water and exercise regularly.
Cramping during pregnancy occurs when the uterus expands to accommodate the baby’s development.
Cramping is felt at both sides of the abdomen as a pulling sensation. This is a normal part of pregnancy.
Bloating, constipation, or having sexual intercourse may also cause cramping.
Dizziness/ feeling faint is more common in the first trimester. To avoid episodes of feeling faint, try
getting up slowly from either sitting or lying down; do not stand for long periods; wear loose, comfortable
clothing and eat regularly.
Genital infections are more common during pregnancy due to the rising levels of hormones in the body,
which changes the pH levels. It is very important to keep your genital area clean to prevent infections.
Wash your genital area regularly but not excessively (twice a day). After washing, dry the area to prevent
accumulation of moisture, which may breed bacteria. Use cotton towels and do not wear tight
undergarments.
Heartburn and indigestion is the feeling pain and discomfort, along with a burning sensation in the chest
area or stomach, which may extend up to your neck after eating or drinking. To avoid this common
symptom, eat several small meals instead of three large meals a day, eat slowly and stay away from fried,
spicy or fatty foods. If the heartburn or indigestion starts to interfere in your daily activities, your doctor
can recommend medicines that will ease the symptoms.
Incontinence is when you have issues with bladder control and experience urine leakage. Due to the
body and hormonal changes during this time, many women urinate when they sneeze, cough, or laugh.
To minimize such incidences, try to schedule your bathroom breaks and practice the pelvic floor
exercises. In most cases, this condition will improve after delivery of the baby, however if it does not, then
seek help from your doctor.
Nipple discharge is very normal. The first leakage is the first thick, creamy milk (colostrum) that your
breasts make before producing breast milk. If the leakage becomes bothersome you can place absorbent
tissues or nursing pads (easily available from pharmacists) in your bra.
Nosebleeds can happen more often in dry weather or when you have a cold or sinus infection. If your
nose starts to bleed, sit down and place your head higher than your heart and apply pressure on the
bleeding nostril. Applying ice can also help. Do not lie down or tilt your head back to avoid swallowing
blood, which could cause nausea or even vomiting.
Passing urine often begins around 9-16 weeks of pregnancy and later as the growing baby puts
pressure on your bladder. Drinking less caffeinated beverages including coffee, tea and soft drinks may
help. Drink plenty of fluids during the day but cut back in the hours before you go to bed to avoid making
frequent visits to the bathroom at night.
Piles also known as haemorrhoids, are enlarged and swollen veins in or around the lower rectum and
anus. These become relaxed during pregnancy due to your changing hormone levels, and may cause
itching, soreness and pain in and around the anal region. Constipation can also cause piles. To prevent
piles, do not sit for long periods of time and talk to your doctor about using laxatives or other remedies if
you are getting constipated.
Skin, hair and nails may change throughout your pregnancy. You may get stretch marks on your belly,
breasts, hips and buttocks. This is because these regions of the body are growing and making your skin
stretch. Pregnant women may also notice a dark line on the midline of their lower abdomen. This is called
the linea nigra. Along with these changes, many women also notice brownish or yellowish patches
around their eyes, on the cheeks and nose. All of these skin changes should fade away once the
pregnancy is over. The texture of your hair and nails may grow faster and break more easily after the
baby comes.
Swollen ankles, feet and fingers are a very normal experience during your pregnancy as your body
starts retaining water. After you deliver your baby this will subside.
Tiredness/Fatigue is as a result of the hormonal changes and the work your body is doing to
accommodate the needs of the growing baby during pregnancy. This is especially common during the first
and third trimesters.
To cope with fatigue during pregnancy make sure you get enough rest, ask friends and family to help you
out with your chores, eat a balanced diet and exercise moderately.
Vaginal discharge is very common during pregnancy. This is called leucorrhoea, an odourless or mild-
smelling milky discharge. This increases as you approach your due date. There is nothing you can do to
stop the discharge. However, if it becomes bothersome you can use sanitary pads and replace them
every few hours. Avoid wearing tight undergarments and keep your genital area clean.
Varicose veins are a condition that occurs in your legs where the veins swell and bulge near the surface
of the skin. They may cause discomfort (itching, heaviness in the legs and pain) or no symptoms at all.
Being overweight, carrying twins, and standing for long periods are common causes of varicose veins. To
help prevent varicose veins exercise daily, try to eat healthy foods and not gain unnecessary weight. Do
not stand for long periods. Sleep on your left side.
THE THREE TRIMESTERS

A normal full-term pregnancy is 40 weeks long but can range from 37-41 weeks. Pregnancy is divided into
3 time frames called trimesters (beginning with the first day of your last menstrual period and ending with
delivery). The first trimester of pregnancy is week 1 to the end of week 13. The second trimester is week
14 to the end of week 23. The third trimester is week 24 to delivery.
Each trimester comes with its own specific changes to your body. These changes can cause discomfort in
various ways. Being aware of these changes as they happen and knowing what to expect will help you
take care of yourself in the way you need to. It is also helpful to be aware of the risk factors and
associated medical tests for each of the three trimesters.
First Trimester: Week 1-13

What can I expect during my first trimester?
During this time, you may experience the following early pregnancy symptoms.
Morning sickness: This term refers to the nausea women feel during pregnancy. This usually begins
around the fifth or sixth week of pregnancy. Despite its name, nausea can affect a pregnant woman at
any time of day.
Breast tenderness: It is normal for your breasts to be sore and sensitive at first. This discomfort often
decreases with time. You will also notice your breasts increasing in size as the pregnancy progresses.
Fatigue: Most women feel very tired during early pregnancy. This is due to the changes that are taking
place in your body and is normal. Rest as much as you can. A healthy diet and exercise may help boost
your energy.
Food aversions: When you are pregnant, you may become more sensitive to certain smells and your
sense of taste may change. Listen to your body and eat those foods that you enjoy and can tolerate.
Constipation: During pregnancy, food may travel more slowly through the digestive system. This can
lead to constipation (infrequent, hard bowel movements). Iron supplements and pregnancy vitamins can
add to the problem. To prevent or relieve constipation, include lots of fibre in your diet and drink lots of
water. Regular physical activity like walking can also help.
Increased urination: You may find yourself urinating more often. This is no cause for worry unless it is
accompanied by pain. If there is pain with urination make sure to see your doctor.
Mood swings: This is a normal part of pregnancy and due to the hormonal changes that are going on in
your body. Take care of yourself and look to your loved ones for understanding and support.
How much weight gain can I expect?

During the first trimester, usually there is no significant weight gain. If you are suffering from appetite loss
(likely due to nausea), you might even lose some weight. This is usually not worrisome as long as you are
following up with your doctor for regular antenatal checkups and the doctor is reassured that the weight
loss is not too great. Regular visits to your doctor will ensure that your pregnancy is progressing in a healthy
manner.
Will morning sickness do my baby or me any harm?
Morning sickness usually has no effect on you or your baby. However, rarely it can progress to the extent
that you may require hospitalization.
What can I do to minimize morning sickness?

Eat frequent small meals, about 5-6 times a day. Eat whenever you feel like eating. Never go with an
empty stomach for long periods. Lie down right after eating. Do not drink water soon before or
immediately after meals.
Have some dry bread or cereal by your bedside to eat when you get up early in the morning.
Get up very slowly, taking 5-6 minutes. Avoid sudden movements when you are feeling nauseous.
Sniffing lemons, drinking lemonade, or eating watermelons or eating aniseed (sonf), cumin (zeera) or
cardamom (elaichi), or ginger may relieve nausea.
Drink enough fluids during the day to prevent dehydration (drink small amounts each time especially if
you are vomiting).
If your nausea and vomiting do not subside, talk to your doctor. Avoid taking any medication unless
prescribed by your doctor.
What symptoms should I be concerned about?

Please note that during the first trimester your chances of a miscarriage are the highest. Contact your
doctor immediately if you experience the following symptoms:
 Vaginal bleeding
 Abdominal pain
 Painful urination
 Fever
Which medical tests will I need?

During your first trimester you may be asked to undergo the following blood tests to:
 Screen for anaemia (low red blood cell level).
 Check for immunity to rubella (German measles).
 Test for hepatitis B and C.
 Know your blood type and Rh (rhesus) factor - Women, whose blood group is Rhesus negative, can
carry a baby who is Rhesus positive if the baby’s father is Rhesus positive. Rhesus negative mothers
are offered anti-D injections at 28 weeks or after the birth of their baby. This helps prevent any
reaction in case the blood of mother and baby mixes.
 Screen for red blood cell antibody.
In addition to these blood tests, you may also be asked to get your urine tested for any signs of infection
and undergo an ultrasound to confirm your due date.
Second Trimester: Week 14-23

What can I expect during my second trimester?
The second trimester (weeks 14-24) is the most comfortable period of time for most pregnant women.
Most of the early pregnancy symptoms, like nausea, will slowly disappear. You will also likely notice a
return of your energy.
However, some new symptoms may appear. Remember that these symptoms are very common and are
experienced by most women during their pregnancy. These include:
Heartburn/ indigestion: Burning pain or sensation in the chest due to acid in the stomach that travels
upward and sometimes into the throat.
Nasal congestion (stuffy nose): Some pregnant women may have trouble breathing through their nose.
Constipation: Please see the first trimester section for details.
Dizziness/ lightheadedness: Your blood pressure will be lower during this time of your pregnancy than
at any other time. This is not a problem but it may make you feel light-headed or dizzy if you get up
quickly. Be sure to take your time and move slowly when getting out of bed or standing up from a chair.
Haemorrhoids (piles): This is a painful swelling or lump in the anal region due to swollen veins often
caused by constipation. To prevent piles, try methods and remedies that ease constipation.
Painful swelling of the ankles and feet: Putting your feet up and elevating them when you can help with
some of the swelling.
Forgetfulness: Be patient with yourself.
Skin changes: Brown patches on the forehead, cheeks and neck.
Fetal movements: At around 16 weeks you will start to feel a slight fluttering in your belly – that is the
baby moving around. Fetal movement is the term used to describe this sensation. From here on you will
become more aware of this as the baby increases in size.
If you ever notice a decrease or absence of fetal movements, see your doctor right away.

In the second trimester, your baby bump may start to show. This is because the baby inside the womb
starts growing more quickly during this time. In addition, you may experience a significant weight gain
because of your appetite returning. If you started out your pregnancy at a normal weight, expect to gain
around half a kilogram per week.

Usually, between 18-22 weeks of pregnancy, you will be asked to have an ultrasound to assess the
development of the baby’s organs and to detect any abnormalities.
How often should I get my pregnancy check-up (antenatal care)?

In your second trimester, you will most likely have a check-up with the doctor every 4 weeks (unless the
pregnancy demands otherwise). At each visit you will be checked for your weight, your blood pressure,
the height of your fundus (top of your uterus) and the baby's heartbeat to ensure everything is
progressing normally.
Third Trimester: Week 24-40

What can I expect during my third trimester?
The third trimester begins in week 25 of pregnancy and lasts until you give birth, which is usually around
week 40 of pregnancy.
During this time your belly will get noticeably bigger as the baby starts to grow at an increasing pace. The
third trimester of pregnancy can be physically and emotionally challenging. Your baby’s size and position
might make it hard for you to get comfortable. Some of the symptoms you experience may include:
False Labour/ Braxton Hicks contractions: As the due date nears, you may experience false labour
or Braxton-Hicks contractions. This is when it feels like your uterus (womb) is cramping in attempt to deliver
the baby. This may occur weeks or even months before the actual due date. At times you may not be able
to differentiate false labour from true labour. To differentiate between the two, you need to know that unlike
true labour, the false cramps are usually felt as painless tightening of your belly that happens irregularly
and do not increase in intensity. Resting or shifting your body’s position may help to ease the cramping.
Fatigue: Some women feel more tired than usual again, during the third trimester.
Heartburn/ indigestion: The burning pain or sensation in the chest experienced in the second
trimester may continue into third trimester.
Varicose veins: The veins in the legs become swollen, enlarged and even painful. Elevating your legs
may offer relief. Regular exercises such as walking, rocking your legs or lifting your legs up and down,
may also help reduce the pain.
Haemorrhoids (piles): The painful swelling or lump in the anal region may continue into the final
trimester.
Stretch marks: As the belly grows, the skin stretches resulting in long, narrow stripes or lines on the
skin.
Backache: As your body gains the extra weight you begin to experience lower back pain. When you sit,
choose chairs with good back support. At night, sleep on your side with a pillow tucked between your
legs. Try applying a heating pad or ice pack for relief. Regular exercise and stretching will also help.
Urine leakage (incontinence): This occurs as your growing baby moves lower down in the uterus
and as a result puts extra pressure on your bladder. This extra pressure can cause you to leak urine,
especially with laughing, coughing, sneezing, bending and lifting. If this is a problem, consider using an
undergarment liner or pad.
Colostrum leakage: This is a creamy milky discharge from the breast that is high in protein, made by
your body in preparation for feeding your baby.

Most women put on between 10-12.5 kilograms in pregnancy and most of it after the twentieth week.

Between 25-28 weeks of pregnancy, you will be advised to take an Oral Glucose Tolerance Test for
screening and diagnosis of gestational diabetes (condition in which a woman without diabetes develops
high blood sugar levels during pregnancy). If the tests indicate that you have gestational
diabetes then your doctor may advise diet control, oral medicine and/or insulin.
Complete Blood Count (CBC), a blood test, may be ordered to check for any disorders including anaemia
or infection, or other health markers.
If you were found to be Rh negative, then at 24-28 weeks you will be recommended for antibody testing
again.
An ultrasound called fetal growth scan will be offered in the third trimester of pregnancy. This will be done
between 28 and 32 weeks of pregnancy and will show your doctor how your baby is growing.
Your doctor will discuss with you details about a tetanus vaccination. The first dose is administered at 28
weeks of pregnancy. This is followed by a second dose at 32 weeks. This will help protect you and your
baby from tetanus, which is a life-threatening infection.
How often should I get my pregnancy check-up (antenatal care)?
In your early third trimester, you will most likely have a check-up every 4 weeks followed by 2-3 weeks
from 28-36 weeks, which will then switch to once-a-week visits until you deliver.
When should I be concerned?

Contact your doctor immediately if you experience the following symptoms:
 Vaginal bleeding
 Fever
 Abdominal pain
 Sudden weight gain
 Decreased or absent fetal movements
 Contractions that increase in intensity and get closer and closer together.
If these symptoms occur or if you are worried about anything else that does not feel normal, call the
Labour Room (+92 21 3486 4302/4303) or visit Labour Room triage for medical advice immediately.
TYPE OF DELIVERY
All our doctors are highly trained in managing different types of deliveries. We have 24-hour consultant
coverage to ensure the safety of you and your baby. Kindly note, that whilst your primary doctor may
not be present at the time of delivery, all decisions for your labour are supervised by your primary
doctor and the doctor on duty.
Normal vaginal birth

A normal labour and vaginal delivery is when the baby passes from the uterus, through the vagina and
delivered out without any medical intervention. Many women who are having their first baby will have an
episiotomy, where the doctor will make a small cut at the opening of the vagina, to prevent the tissues
from tearing as the baby comes out. After the birth, the doctor will stitch up (suture) the cut. A normal
vaginal delivery is the most common type of birth.
Caesarian section birth

A caesarian or C-section delivery is when the doctor makes a cut through the lower abdomen and uterus,
and then lifts the baby out. A C-section can be planned/ scheduled known as an elective surgery or it can
be in emergency. The reasons for having a C-section are usually based on medical findings and any
potential risk of a normal delivery, to you or your baby’s health. A C-section is major surgery and
providing there are no complications, it takes up to six weeks to heal and recover.
Pain management during delivery

There is pain during labour and delivery, and every woman’s experience is different; depending on your
level of physical fitness, health status and own ability to deal with pain.
There are three main medical pain-relieving options for labour:
Entonox (Nitrous oxide + Oxygen)
Entonox is nitrous oxide, also known as ‘laughing gas’, mixed with oxygen and you can receive it through
a face-mask or a tube held in the mouth. Nitrous oxide does not stop the pain entirely, but it helps reduce
the intensity felt with each contraction. It does not interfere with the contractions and it does not linger in
either your or your baby’s body. It may cause some nausea and vomiting. Entonox does not give the
same pain relief to every woman and in some cases, it may not work at all.
Injection
Nalbuphine is a strong pain reliever, usually injected directly into a muscle in the buttock. It may also be
administered intravenously (directly into a vein). Depending on various factors, the effect of the injection
can last anywhere from 4-6 hours.
Epidural anaesthesia
Epidural injection is an effective form of pain relief. It is used for vaginal birth and also for caesarean
section, because it allows you to stay awake and alert during the baby’s birth. The anaesthetic is injected
into the lining of the spinal cord through the back, which makes you feel numb from the waist down. Your
baby’s heart rate will be monitored continuously.
Possible side effects and complications of epidural anaesthesia include:

 The anaesthesia may not be complete and you may still experience some pain. This may
require the procedure to be repeated.
 After the epidural has been inserted, your blood pressure may drop, causing you to feel faint
and nauseated. This may also cause stress to your baby. This is treated by giving
intravenous fluid.
 An epidural often causes some muscle weakness in the legs, so women who have had an
epidural anaesthetic may be confined to bed.
 The lack of sensation in the lower body means that you will not be able to tell when you
need to urinate. A urinary catheter will be inserted in most cases.
 Epidurals can lengthen the second stage of labour.
 The likelihood of assisted vaginal delivery is increased. If you are unable to push effectively,
due to altered sensation and reduced muscle strength, the baby may have to be delivered
by forceps or vacuum cup.
 Some women experience pain or tenderness where the epidural was injected or ongoing
numbness.
 Very rare complications include infection, blood clots and difficulty breathing.
During your check-up visits, you will discuss with your doctor which type of delivery/ birth is safest for you
and your baby, as well as which pain relief you may opt for, if any.
8 SIGNS THAT YOUR LABOUR IS COMING

1. Your baby drops. This usually occurs one to four weeks before your due date. This is when your
baby comes down into your pelvis (area between the abdomen and thighs) and gets into position to
make his/ her final exit.
2. Your cervix dilates. As your cervix (narrow passage from the uterus to the vagina) prepares for
birth it starts to open up and thin out in the days or weeks leading up to the impending birth. Your
doctor may track the progress of both during your final check-ups through an internal exam but don’t
worry if little progress is made, every pregnancy is different.
3. More cramps. You can expect cramps to increase, more pain in your lower back and pain in the
groin area. This is due to your joints and muscles preparing and stretching for birth.
4. Joints feel looser. Throughout your pregnancy, the hormone relaxin makes all of your ligaments
soften and loosen. Before you go into labour, you may notice your joints feel a bit looser – this is just
nature’s way of opening up your pelvis for your baby to make his or her way into the world.
5. Diarrhoea. This is usually a strong sign that the baby is on its way. Remember to drink lots of fluids
and keep well hydrated.
6. Stop gaining weight. Your weight will begin to level out in the last few weeks of your pregnancy.
You could even lose a few pounds.
7. Feel extremely tired. Feeling extremely tired is normal and you should rest as much as possible
before the baby is born.
8. Vaginal discharge. In the last week or so expect a change of colour or more frequent vaginal
discharge.
WHAT SHOULD I PREPARE TO BRING TO THE HOSPITAL?

You may have a due date or planned C-section date in mind but it is always best to be prepared, at least
a couple of weeks before your expected delivery date. Keep a small bag ready with the following:
1. Personal clothing to wear when you leave the hospital.
2. Slippers and basic toiletries can be obtained from the hospital, however, if you have your own
preference, bring them along.
3. Clothing, blanket and carrier for your newborn baby when you are ready to leave the hospital.
4. Your antenatal card and any other documents, as advised.
GOING INTO LABOUR and DELIVERY

What is Labour and Delivery?
Labour and delivery are the terms used to summarise the changes that your body goes through, including
contractions that open up your uterus, cervix and vagina, to help the baby move from your uterus through
the cervix, through the vagina and come out into this world and be born. Another term for delivery is
childbirth.
Labour and Delivery involves three stages: First stage: Begins from the onset of true labor and lasts
until the cervix is completely dilated to 10 cm. Second stage: Continues after the cervix is dilated to 10
cm until the delivery of your baby. Third stage is the delivery of the placenta and is the shortest stage.
What is labour induction?

Induced labour is when you are given medical treatment to start your labour. Induced labour may be
recommended by your doctor if:
 You are overdue (more than 41 weeks pregnant).
 There is a medical concern for you or your baby’s health.
How long can labour last?

Every labour experience is different and it is very hard to predict how long it will take. It depends on how
many babies you have delivered previously. It will also depend on how far along your labour has
progressed when you came to the hospital.
Will I be allowed to have anyone with me in the delivery room?

Your husband is allowed to accompany you in the delivery room to provide you with the support and care
you need.
What happens when I arrive at the hospital?
If you have registered, you may go straight to the labour and delivery ward, where you will be first
required to present your antenatal card to the staff.
A medical team that includes doctor, midwife and or nurse will be assigned to care for you and support
you through the childbirth process. Before getting settled in the labour room, you will be asked to empty
your bladder and change into a hospital gown. The baby will be monitored and a duty doctor will examine
you. Your consultant doctor will be informed about your examination findings, upon which the decision to
admit you will be made.
What can I expect during a normal delivery?

If you are in labour, you will be assessed at regular intervals and your consultant will be kept informed on
your progress. If required, certain tests maybe ordered:
Blood tests: to check your level of haemoglobin (for blood typing and cross-match), to check your liver
and kidney function, ability of your blood to clot and screen for infection.
Cardiotocography (CTG): similar to an ECG; a belt is tied around your waist to monitor your baby’s
heart beat and your uterine contractions.
As the contractions get stronger and more painful, you should take a deep breath and push down. Try to
remember the relaxation and breathing exercises you learned if you attended the childbirth education
programme. You may push multiple times during each contraction and you should rest between every
contraction. Your midwife and or husband can help support you through this phase.
Once your cervix is completely dilated, the medical team will guide you on when to push and they will be
ready to receive your baby as you push it out. When your baby is born, you will hear the cry and providing
everything is normal, your baby's nose and mouth will be suctioned and your baby will be placed on your
chest. The umbilical cord will be clamped and cut. You and your husband will meet your baby for the first
time.
The medical team will then take your baby for cleaning, a head to toe assessment and perform the Apgar
test (a score which helps determine whether your newborn is ready to meet the world without additional
medical assistance). The baby’s measurements will be recorded.
Meanwhile, your uterus will continue contracting and you will deliver the placenta. This completes the
delivery.
After delivery, you will be kept in the labour room for 45-60 minutes to assess your blood pressure and
bleeding. When the doctor has determined you are safe to be moved, you will be taken to your ward or
room.
Most women will have a vaginal delivery as planned, however, if your or your baby’s wellbeing becomes a
concern, then a Caesarian section (C-section) may be recommended.
What can I expect during a C-section delivery?

If you are having a planned or unplanned C-section, the anaesthesiologist will give you a proper
assessment to ensure that you are given the painkillers that are safe for you specifically. It is usually
regional (spinal), however, in some cases, it may be general anaesthsia.
An intravenous needle will be inserted into a vein in your hand or arm to allow for the administering of
fluids and medications during your surgery. Your lower abdomen will be washed and shaved. The
anaesthesiologist will administer the spinal . After you have been given the spinal, you will begin to feel
numb from the waist down. A catheter will be inserted into your bladder to collect the urine and drain it
into a bag. You will remain awake, alert and should be fully aware of your surroundings.
You will be taken to the operating room and your doctor will check to ensure that you cannot feel any
pain, in your abdomen, before beginning the C-section surgery.
A screen will be placed above your abdomen blocking your view of the surgery and keeping the surgical
area sterile. As the doctor makes the incision (cut) through your skin in the lower abdomen to reach your
uterus and placenta, you should not feel any pain, just pressure. The doctor will ease your baby out
through the incision and if necessary, a suction pump or forceps may be used. The doctor will give your
baby to another nurse or doctor who will be responsible for your baby’s health and well-being from then
on. Your doctor will clamp and cut the umbilical cord and proceed to remove the placenta.
Meanwhile, your baby’s medical team will suction your baby’s nose and mouth, clean and perform a head
to toe assessment including the Apgar test (a score which helps determine whether your newborn is
ready to meet the world without additional medical assistance). The baby’s measurements will be
recorded.
What can I expect immediately after labour and delivery?

You will probably be exhausted from the physical effort and emotional excitement and want to rest. You
will remain in the recovery room where the nurses can check on your progress. Your newborn baby be
taken to the nursery and will also be tired from the birth, and may fall asleep.
You will be moved from the recovery room to the ward or room when the medical staff determines it is
safe to do so. Your baby will be brought from the nursery to join you.
DEALING WITH POST PARTUM

What is postpartum?
Postpartum is the term used to describe the time after the birth and the weeks following. It commonly
lasts for six weeks after childbirth and is a very important time for both you and your newborn baby as you
adjust to each other and live in your expanded family.
In the first few hours and days after childbirth, you will experience many changes, both physically and
emotionally. If you had a caesarean section, your physical recovery will be different from that of a normal
or vaginal delivery.
When can I breastfeed my child?

Your breasts, which began enlarging during pregnancy, will be filled with a special clear fluid called
colostrum for the first few days after childbirth. As this happens, your breasts may become enlarged, firm,
and painful. This is called breast engorgement, and it should disappear after a few days.
You can begin breastfeeding your baby as soon as you wish after the birth. Breastfeeding for the first time
can be easy or it can be challenging. Place a pillow behind your waist (to support your lower back) and
another pillow on your lap to rest your baby on so he or she is at the right height to reach your nipple.
Some babies latch on to the nipple and breastfeed more easily than others. If you are having trouble,
feeling pain or discomfort, talk to your doctor, midwife or nurse. They can help you improve your
technique. Try to persevere with breastfeeding during this time, as breast milk is the ideal food for your
newborn baby.
Allow your baby to feed whenever he or she demands. Let the baby feed on one breast for the first 5
minutes and then on the other for the next 5 minutes. Feeding duration will increase with time; make sure
to alternate breasts with each feed. During the first few days, your baby will want to be fed every two
hours. This interval increases as your baby settles down to his or her required needs.
How long does the bleeding last after delivery?
A blood stained discharge for 3-4 weeks, on and off, after childbirth is normal. It will gradually reduce and
change colour from red to yellow and then to white. If your bleeding is heavy, i.e. 2 to 3 pads are soaked
every 2 to 3 hours or clots are passed, go the Emergency Department immediately.
How should I care for the episiotomy or abdominal stitches?

You may have received a cut and then stitches at the entrance of your vagina (episiotomy) during the
delivery or in your lower abdomen during the C-section. Either way, it is important that you pay attention
to the stitches and keep the area clean to avoid infection.
Clean the stitches and area around them with soap and clean water, every time you go to the bathroom or
2-3 times a day. Dry the area carefully.
The area where the cut was made may result in a throbbing and sharp pain for the first week or so. Wrap
some ice in a cloth and place it on your vagina to help sooth the soreness. Take the pain medicine
regularly or as prescribed by your doctor. Walking, standing and sitting for long periods may be
uncomfortable, so lie down. If you have severe pain and redness, or a foul smelly discharge, go the
Emergency Department immediately.
The episiotomy stitches should dissolve in about 2 weeks time whereas the abdominal stitches have to be
removed at a specific time as advised by your doctor.
Will I need the Rubella vaccination after the delivery?

If you were found to have no immunity against rubella, you will be offered the vaccination after delivery.
Rubella infection during pregnancy has serious consequences; it can cause miscarriage and birth defects.
Ideally you should get this vaccination before getting pregnant. However, getting the vaccination
afterwards, will at least help prevent infection in any future pregnancy. You should get this before you
leave the hospital.
What other type of problems can I expect during post partum?

Physical problems after childbirth can include infections, difficulty urinating, constipation, hemorrhoids, or
other conditions. Make sure to get prompt and appropriate treatment from your doctor to avoid
unnecessary prolonged discomfort and have the problem treated.
Sudden mood swings, feeling irritable, indecisive and anxious after childbirth is normal and it can last just
a few days or a couple of months. Some women experience a depression that is so pronounced and
continuous that it disrupts their normal functioning. This is called major depression or postpartum
depression, and should not be left untreated. Talk to your doctor if you feel this way. Early diagnosis and
treatment is very important to your wellbeing and that of your baby.
How long will I have to stay in the hospital after the baby is born?
If the delivery was normal, not complicated and, you and your baby are doing well, then you can go home
within a day or two after the baby is born.
If the delivery was a C-section, not complicated, and you and your baby are doing well, then you can go
home within 3-4 days after the baby is born.
When should I follow up with my doctor (obstetrician) after leaving the hospital (discharge)?
Your first follow-up visit with your doctor usually 2 weeks after discharge from the hospital. During this
visit the doctor will assess how you are progressing through the post partum period and is there to answer
answer any questions or refer you to any other specialist, should you need any other health specific
consultations.
Your final post partum checkup with your doctor should be 6 weeks after the delivery. During this visit, the
doctor will check on your physical recovery from the pregnancy and delivery, see how you are doing
emotionally, and address your needs going forward. It is very important for you to have this final check-
up, please do not miss this appointment.
When should I follow up with my baby’s doctor (paediatrician) after leaving the hospital
(discharge)?
Your baby’s first follow up visit with his or her doctor should be within 3-5 days after leaving the hospital.
At the Aga Khan University Hospital, we have a wide range of specialty doctors specifically trained in child
health. Make sure to schedule this appointment before you leave the hospital.
CARING FOR YOURSELF AFTER CHILDBIRTH

After your child is born, you may feel a little nervous or frightened and have many questions. The more
you know about what to expect as a mother, the more confident you will feel, and the more you can enjoy
this important and special time in your life.
Which services are offered by the hospital to help me recover from childbirth?
The Aga Khan University Hospital offers various support services to help you adjust to this new chapter in
your life. Ask your doctor or nurse about our nutrition, physiotherapy, psychiatry, rehabilitation and other
specialized clinics.
How much can I do after delivering a baby?

For the first month it is normal to feel weak and tired. Your strength will gradually return. Try to rest as
much as possible during the day; if possible, sleep when your baby sleeps. Eat healthy and nutritious
foods and get help from your family and friends.
Generally you should move slowly and carefully. Avoid making sudden movements.
Do not do anything that makes you strain or grunt such as lifting heavy objects or reaching for something
high above your head.
Hold the railing when climbing any stairs. If you are tired, stop and rest midway.
You should bathe or shower everyday as usual. Do not lock the bathroom door in case you feel weak and
need to call for help. Keep yourself clean and make sure to change your sanitary pad at least every 4
hours to lower the risk of infection.
As you begin to heal physically, go out for short walks to get some fresh air and a change of scenery. It
will help if you are feeling stressed and overwhelmed.
What type of nutrition do I need during this time?

You need a nourishing diet to build up your strength and recover. If you are breastfeeding you will feel
hungry and thirsty often. Eat when you feel hungry.
Select nutritious foods from all the five food groups:
Grains: Foods that are made from wheat, rice, oats, cornmeal, barley, or another cereal grain are grain
products. Examples include whole wheat, brown rice, and oatmeal.
Vegetables: Vary your vegetables. Choose a variety of vegetables, including dark green, red, and orange
vegetables, legumes (peas and beans), and starchy vegetables.
Fruits: Any fruit or 100 percent fruit juice counts as part of the fruit group. Fruits may be fresh, canned,
frozen, or dried, and may be whole, cut-up, or pureed.
Dairy: Milk products and many foods made from milk are considered part of this food group. Focus on fat-
free or low-fat products, as well as those that are high in calcium.
Protein. Go lean on protein. Choose low-fat or lean meats and poultry. Vary your protein routine--choose
more fish, nuts, seeds, peas, and beans.
Oils are not a food group, yet some, such as nut oils, contain essential nutrients and can be included in
the diet. Others, such as animal fats, are solid and should be avoided.
Water. Drink at least 8-10 glasses of water and 2-3 glasses of milk each day.
When can I start exercising and what should I do?

Do not begin intense exercises until the doctor has given you permission to do so.
You can begin walking as soon as you are feeling a little better and not experiencing any pain. Begin a
daily routine, starting with 5 times a day and then progressing to 10 times a day, unless otherwise
recommended. Practice on a firm surface. Do not exercise when you are tired. When you are lying down
or sitting, make sure that your back is well supported with a pillow.
Aside from walking, there are several areas of the body you may want to focus on after childbirth. Pelvic
floor and abdominal muscles exercises can help:
 Decrease your pregnancy weight.
 Speed up your metabolism.
 Strengthen your pelvic floor and prevent urine leakage.
 Strengthen your abdominal muscles.
 Strengthen your back and relieve back pain.
 Improve your posture.
 Give you more energy.
There are several different ways to exercise your pelvic floor and abdominal muscles. Other areas of the
body that are easy to exercise are your neck and shoulders, and your thighs and buttocks. Some exercise
options that you can try are described below.
Pelvic floor muscle exercise

Sit up straight on a chair, with your feet slightly apart and touching the ground. Keep your hands by your
side, be comfortable and relax. Tighten the ring of muscles around your front and back external passages
(the holes from where you urinate and excrete stool) drawing the inside muscles together and upwards.
Hold the squeeze for a few seconds, relax and repeat about 10 times in one session. You may repeat the
sessions 3-5 times a day. To check that you are exercising your pelvic floor muscles, try squeezing them
midstream when you are urinating. If you are able to stop the flow, you are reaching the right muscles,
although if your muscles are already very weak then this test may not work for you.
Curl-up abdominal exercise

Lie on your back with your knees bent and both feet on the ground. Bend your arms and place your
hands behind your neck. Tuck in your chin and slowly lift your head and shoulders towards your abdomen
as far as you can go. Breathe out as you do this. Hold for 10 counts, slowly lower your head and
shoulders to the ground and relax. Repeat 10 times. You may repeat the sessions 3-5 times a day.
Curl-back abdominal exercise
Sit on the ground with your knees bent, feet on the ground and hands on your abdomen. Breathe out and
curl back about half way. Hold for 10 counts. Return to the sitting position and relax. Repeat 10 times.
You may repeat the sessions 3-5 times a day.
Neck stretch exercises

These exercises can be done while sitting, standing or lying down. Keeping your back straight, bring your
chin towards your chest, bend your head forward, and hold in this position for 5 counts. Bring your head
back to the resting position and relax. Repeat 10 times. You may repeat the sessions 3-5 times a day.
Keeping your back straight, turn your head to the right, and hold in this position for 5 counts. Bring your
head back to the resting position and relax. Repeat 10 times. Now, do the same except this time, turn
your head to the left. You may repeat the sessions 3-5 times a day.
Shoulder exercises
These exercises can be done while sitting, standing or lying down. Put your hands on your shoulders and
make a slow, large circular movement anti-clockwise with your elbows sticking out towards your sides.
Repeat 5 times and then relax. Now perform this exercise moving clockwise. Repeat 5 times and then
relax. You may repeat the sessions 3-5 times a day.
Thighs and buttocks exercise

Lie on your back with your knees bent and your arms at your side. Lift your hips off ground but do not
arch back. Hold for 10 counts. Slowly lower your back down and relax. Repeat 10 times.
MAJOR HEALTH PROBLEMS YOU MUST BE AWARE OF

It is very important that throughout the course of pregnancy you immediately report any form of discomfort
or abnormality you experience. Some major health problems you may develop during pregnancy that
require immediate medical attention include preterm labour, placenta previa and high blood pressure.
Preterm labour is when you go into the labour stage prior to 37 weeks of pregnancy. You may
experience ruptured membranes (breaking of water) with or without any pain which may lead to the early
birth of your baby.
Look out for symptoms like cramping, backache, contractions (that do not subside with changing positions
or drinking water); fluid leaking from the vagina or vaginal bleeding.
Placenta previa or a low-lying placenta is when the placenta is attached in the lower part of the uterus,
near to or covering the cervix. If the placenta is low in the uterus, there is a higher chance that you could
bleed during your pregnancy or at the time of delivery (birth). Placenta previa can be diagnosed with an
ultrasound. In case of bleeding, you need to go to the labour room for evaluation immediately.
High Blood Pressure: Your blood pressure will be checked at every doctor check up (antenatal
appointment). This is because a rise in blood pressure can be the first sign of a condition known as pre-
eclampsia – also called pregnancy-induced hypertension (PIH) or Pre-Eclamptic Toxaemia (PET). It
affects 10% of pregnancies. Symptoms of pre-eclampsia include:
 Headaches.
 Blurred vision or lights flashing before the eyes.
 Severe pain just below the ribs.
 Vomiting.
 Sudden swelling of the face, hands or feet.
However, you can have severe pre-eclampsia without any symptoms at all. Although most cases are mild
and cause no trouble, it can be serious for both mother and baby. It can cause fits (seizures) in the
mother (called eclampsia) and affects the baby’s growth. It can be life threatening if left untreated. This is
why your routine doctor checkups (antenatal appointments) are very important and should not be missed.
WHERE SHOULD I GO IN CASE OF AN EMERGENCY?

Come straight to the labour room at The Aga Khan University Hospital, if you are already
registered for delivery and your pregnancy is more than 24 weeks or 6 months.
Go straight to the Emergency Department at The Aga Khan University Hospital if your pregnancy
is before 24 weeks or if you have not registered with the hospital.
If you would like to learn more about being pregnant or have any questions, do not hesitate to ask your
doctor or nurse. We are with you in this journey every step of the way.

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A Unit of The Aga Khan Hospital and Medical College Foundation, Licensed under Section 42 of the Companies Ordinance,

BEFORE BECOMING PREGNANT

CONGRATULATIONS YOU ARE PREGNANT!

What should you do?

Select your doctor (obstetrician) if you haven’t already done so.

HEALTHY MOM, HEALTHY BABY

Do I need to follow a special diet during my pregnancy?

Can I drink tea, coffee and/ or sodas?

Can I exercise during my pregnancy?

Can I travel during my pregnancy?

HOW YOUR BODY CHANGES DURING PREGNANCY

THE THREE TRIMESTERS

First Trimester: Week 1-13

How much weight gain can I expect?

What can I do to minimize morning sickness?

What symptoms should I be concerned about?

Which medical tests will I need?

Second Trimester: Week 14-23

How much weight gain can I expect?

Which medical tests will I need?

How often should I get my pregnancy check-up (antenatal care)?

Third Trimester: Week 24-40

How much weight gain can I expect?

Which medical tests will I need?

When should I be concerned?

Normal vaginal birth

Caesarian section birth

Pain management during delivery

Possible side effects and complications of epidural anaesthesia include:

8 SIGNS THAT YOUR LABOUR IS COMING

WHAT SHOULD I PREPARE TO BRING TO THE HOSPITAL?

GOING INTO LABOUR and DELIVERY

What is labour induction?

How long can labour last?

Will I be allowed to have anyone with me in the delivery room?

What can I expect during a normal delivery?

What can I expect during a C-section delivery?

What can I expect immediately after labour and delivery?

DEALING WITH POST PARTUM

When can I breastfeed my child?

How should I care for the episiotomy or abdominal stitches?

Will I need the Rubella vaccination after the delivery?

What other type of problems can I expect during post partum?

CARING FOR YOURSELF AFTER CHILDBIRTH

How much can I do after delivering a baby?

What type of nutrition do I need during this time?

When can I start exercising and what should I do?

Pelvic floor muscle exercise

Curl-up abdominal exercise

Neck stretch exercises

Thighs and buttocks exercise

MAJOR HEALTH PROBLEMS YOU MUST BE AWARE OF

WHERE SHOULD I GO IN CASE OF AN EMERGENCY?

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