Pregnancy

Pregnancy
THE COMPLETE CHILDBIRTH BOOK
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Pregnancy
THE COMPLETE CHILDBIRTH BOOK
NUTAN LAKHANPAL PANDIT
IMPORTANT
Please use this book in consultation with your doctor

This book is dedicated to my
sons Pranav and Akshaya
Also my aunt Pushpa Sharma,

whose encouragement and blessings have led me
to teach Natural Childbirth Classes.
Copyright © Nutan Pandit 2004
First Published 1991

Revised Edition 2004
Twentieth Impression 2012
Published by
Rupa Publications India Pvt. Ltd.
7/16, Ansari Road, Daryaganj,
New Delhi 110 002
Sales Centres:
Allahabad Bengaluru Chennai

Hyderabad Jaipur
Kathmandu Kolkata Mumbai
All rights reserved.

No part of this publication may be reproduced, stored in a
retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording or otherwise,
without the prior permission of the publishers.
Text illustrations by Priya Nagarajan

Designed by Studio Lynx, Faridabad.9//9
Printed in India by
Brijbasi Art Press Ltd.
Acknowledgements
I would like to thank Mrs. Merry Wood, the lady from Canada, who taught me breathing practices before my first
delivery; the staff of the National Childbirth Trust, London, for permitting me to attend study days, workshops and
childbirth classes when I went to London; Dr. Michel Odent, who allowed me to watch how he conducted squatting
deliveries, and for showing me his unit replete with facilities for water birth and an operation theatre; Dr. S.K.
Bhandari for her encouragement.
I am grateful to Dr. R.L. Bijlani for his invaluable help with my manuscript. Thanks to the following persons for
helping me with the completion of my book: Dr. Asha Singh, Dr. Meera Luthra, Dr. Kanwal Hazuria, Dr. Nalini
Singh, Dr. Kamla Tiwari, physiotherapist Daulat Dastoor, Dr. Jayant Banerjee, Dr. Prakash Punjabi, Dr. Ratna
Zaffar Hussein, Dr. Ashima Abbott, Dr. Preeti Bijlani, Malka Punj, Ashwini Mehta, Sangeeta Gupta, Nita Seth, R.
Maniraj, Nirupam Chatterjee, Chitra Sharma and Pradeep Kapoor.
Nutan Lakhanpal Pandit
For classes in natural childbirth contact:

Nutan Lakhanpal Pandit,
Natural Childbirth Centre, D-178, Defence Colony, New Delhi 110 024
Tel: 2460 1689, 2469 0552
email: nutanpandit@yahoo.com
website: http://www.ncbchildbirth.com
Ideally contact for classes in the 5th month of pregnancy so that you can attend the course in the 6th month.
Contents
Pregnancy Beliefs
1. Birth without Fear
Pain perception—Brain, the Boss—Sympathetic Nervous System—Muscle Action—The Body's Design for Birth
—Experience of Women
2. Your Anatomy
The Development of the Baby—The 3 Trimesters
3. Pregnancy
Blood/Urine Test—Planning a Healthy Baby—Genetic Counselling—Pre-conception Care—Antenatal Visits
—Blood Tests during Pregnancy—Urine Tests—Internal Vaginal Examination—Abdominal Examination
—Ultrasound—Amniocentesis—Anti Tetanus Injection—Medical Termination of Pregnancy—Boy or Girl?
4. Common Problems of Pregnancy
Physical Changes—Digestive Problems—Urinary Tract Infection—Conditions Needing Special Attention
—Toxaemia and Pre-Eclempsia
5. Diet in Pregnancy and After
Eating for Two—A Parasite—Foods You Need—Wholesome Foods—Tea, Coffee, Cola drinks and Chocolates
—To Avoid Putting on Too Much Weight—Body Weight—Diet in Labour—Diet When Breastfeeding—Our
Traditional Recipes—Ghee—Tips on Weight Control
6. Some Simple Exercises
Grounding—Neck Exercise—Shoulder Rotation Exercise—Deep Breathing—Bust Exercise—Pelvic Floor
Exercise—Ankle Movements—Leg Lift—Curling Leaf—Leg Swing—Pelvic Tilting—Aum Breathing
—Relaxation
7. Sex During Pregnancy
Intercourse—Breast Stimulation—After the Birth
8. Labour time
Fluid Leak—Positions to Adopt in Labour—Upright Position for Labour—Backache in Labour —When on a
Drip—Comforters—For a Backache
9. Breathing and Relaxation for Labour
Ignorance-Fear-Tension-Pain Syndrome—Quick Relaxation in Labour—Breathing for Labour—Conditioned
Reflex—Breathing Patterns—Concentration Breathing—As a Distraction Breathing—Not-Pushing Breathing
—Transition—Pushing
10. Induced Labour
The Estimated Date of Delivery—When Labour is Induced—Different Methods of Induction—Home Induction
—Prolonged Pregnancy
11. Birth
Stages of Labour—Prepared Childbirth—The Baby at Birth
12. Gentle Birth
The Trauma of Birth—Pioneers of Gentle Birth
13. After Childbirth
After a Natural Birth—Exercise After a Normal Delivery—After a Caeserean Section—Bleeding/Sex—Post
Natal Depression
14. Contraception
Methods of Contraception
15. Breastfeeding
Why Should I Breastfeed?—How Does the Baby Feed?—How to Feed—Breast Size—Flat Nipples
—Breastfeeding at Birth—Rooming In—Exclusive Breastfeeding—Constant Demand Feeding—Leaking Breasts
—Let Down Reflex—Feeding When III—To Stop Feeding Suddenly—Breast Preparation for Feeding—When
Feeding—Forerunner to Milk-Colostrum—Mature Milk—Engorgement—How to Deal with Engorgement—To
Express Breast Milk—How to Feed Expressed Milk—If the Baby's Nose Gets Blocked—Feeding Time—Relax
When you Feed—Night-Feeds—Foremilk and Hindmilk—Will My Milk be Enough?—Less Milk—Burping the
Baby—How to Position the Baby—Position After Caeserean Birth—Twins-How to Position Twins—Bonding
—Contraceptive Effects of Breastfeeding—Breast or Bottle-How Long to Breastfeed—Breastfeeding and the
Working Woman—Case Against the Bottle— The Bottle and Nipple Confusion—Milk Powder—Cow's Milk
—How to Sterilise Bottles—How to Bottle-feed—Problems During Breastfeeding—Babies with Problems
—Cleft Palate
16. Neonatal Conditions that Require Surgery by Dr. Meera Luthra
17. Teratogenesis by Dr. Asha Singh
Recommended Reading
Informed Choices
Index
Preganancy Beliefs
MYTH: The pain is unbearable.

FALSE! In case of unbearable pain, nature's safety mechanism makes one pass out, i.e. lose
consciousness. In labour, women are rendered unconscious by drugs but never by pain. The right attitude
to contractions can make it pretty easy to bear.
MYTH: Have a spoon of ghee daily to lubricate your nerves.
FALSE! To make yourself supple, you need exercise, not ghee. Ghee will make you fat. Be active so
that your joints are not rusty and creaky. Earlier, women worked in fields, milked cows, churned butter
or ground wheat, hence they could digest the ghee (see p. 77-78).
MYTH: The umbilical cord is attached to the mother's navel.
FALSE! The umbilical cord is attached to an organ inside the womb called the placenta. (The placenta is
also called the afterbirth since it is delivered after the baby.) This organ prepares and passes the food and
nutrition to the baby, through the umbilical cord, which on the other end, is attached to the baby's navel.
MYTH: Be happy, read good books.
TRUE! If you are afraid or under stress, the chemistry in your body changes as different hormones are
released. The baby living within, senses these changes. It is therefore important to strive to be happy.
MYTH: Push when in labour.
FALSE! When in labour never push until the doctor or the nurse asks you to. If you begin to push when
the mouth of the womb is not fully dilated, there is the danger of the baby's head hitting against an
unopened cervix (mouth of womb), so that the baby's head and cervix become swollen and tender.
MYTH: Walk when in labour.
TRUE! The best thing you can do is to walk when in labour. Gravity hastens the baby's descent, and
therefore shortens labour. Also, when you lie on your back, the weight of your baby and uterus press on
a major blood vessel called the vena cava, hence reducing the supply of blood to you and your baby.
Less pain is felt when a woman walks in labour, (see page 110)
MYTH: Eat for two.
FALSE! One does not need to eat for two people, but it is important to eat wisely during pregnancy. The
baby grows like a parasite, in that, it takes all that it needs, whether the mother has enough or not.
So if you don't eat well, you might end up with a rundown feeling, which comes from the lack of iron in
the blood.
MYTH: If you sit cross legged on the floor it flattens the baby's head.
FALSE! The best thing you can do is to sit cross legged, as this exercises the pelvic joints, the very
joints that 'open up' when the baby is being born.
With regular exercise, the joints become flexible and open easily at birth. Little wonder sweeper women
deliver easily. The baby is safely ensconced in the womb and gets no direct pressure on its head.
MYTH: Baby gets suffocated if you pull in the stomach.
FALSE! The baby does not suffocate, since it gets oxygen through the umbilical cord, which is attached
to its navel and to the placenta on the other end. If you pull in your stomach, the weight of the baby is
borne by the pelvic bones, so that your stomach muscles get a respite from constant stretching.
MYTH: Have a glass of milk and ghee or have badam milk before going to hospital.
FALSE! If you have started labour and feel like eating something, eat something light. Once labour has
established, if you have something heavy like badam, ghee, milk, you'll feel like vomiting (see p. 73-
74).
MYTH: Bind abdomen after delivery.
FALSE! If you make a jumble of your clothes and fling them in the cupboard, they'll fall on your face
when you open it next. If you push your muscles back with a girdle, they'll flop out again. It is important
instead to do mild exercises for the first forty days or three months and more vigorous ones later to build
back tone in your muscles (see p.159 & 161).
MYTH: If the cord is around the neck it is going to be a Caesarean section.
FALSE! Babies are often born with the cord wrapped loosely around their necks. The delivery can be
normal.
MYTH: If the baby is in breech presentation, that is feet first, it will be a Caesarean section.
FALSE! If the baby is breech early in pregnancy, it is likely to turn to a head down position a few weeks
before the estimated date of delivery. If it does not turn to a head down position in a woman having her
first delivery, a Caesarean will be performed. One month before the estimated date of delivery,
homoeopathic medicine taken from a classical* homoeopath could turn around a breech baby. Also
accupressure point B67 at the base of the nail of the little toe is known to turn around a breech baby.
* A classical homoeopath is one who asks innumerable questions about how you feel mentally, what
illness your parents had, what your likes and dislikes are, etc.
MYTH: The baby comes on the expected date of delivery.
FALSE! Labour starts on estimated date of delivery in only 4% cases.
One week on either side in 50%, 2 weeks earlier and 1 week later in 80%, at 42 weeks in 10% and at 43
weeks plus in 4% cases.
Source: Text book of Obstetrics by Dr. D.C. Dutta
1.

Birth without Fear
One truth we gain from living through the years,
Fear brings more pain than does the pain it fears.
John Golden
Childbirth is a natural and universal phenomenon, and yet the knowledge of it among average women is rather
haphazard, incomplete, or distorted.
A woman generally has a vague notion that childbirth is unbearable pain and danger. This notion is formed as a
result of the distorted tales heard during adolescence or later. What can be pieced together from gossip, movies or
fiction draws a picture of passive pain, to which a woman has to submit in utter helplessness. A negative attitude
during labour causes her entire body to tense up with fear.
If one undergoes unendurable pain, one passes out as a rule, i.e. loses consciousness. This is nature's safety
mechanism. However, women in labour maybe rendered unconscious by drugs, but never by pain. Hence, what pain
can be felt, can be endured.
Pain Perception
Pain and childbirth have been associated with each other for so long that normal uterine contractions are often
referred to as pain.
Uterine contractions and pain have become synonyms. A woman is often told that pain is the signal of labour. In
France, labour wards in many units are referred to as the "Hall of Pain". Women who have had babies also talk of
"the pain" hence a temporary connection between words and nerve centres takes place.
The uterine nerves signal the beginning of labour to the brain. The brain translates it inevitably into pain,
anticipating it.
When the human body is healthy and functioning efficiently, the organs constantly send streams of messages to
the brain to inform it of their working. Coming from various internal and external sources these messages have to
compete with each other. Hence many of them get ignored completely.
However, when the potential force of the brain is reduced, say by shock, we can painfully feel the working of
internal organs, e.g. a shocking news can cause a stomachache or a pain in the throat.
In labour, the potential force of the brain can be reduced by a whole lot of negative feedback over a period of
time, resulting from the expectation of unbearable pain. In other words, if you expect pain, it can impair the normal
activity of the brain, and make you feel greater pain. Each negative feedback regarding labour received over the
years has the same effect as drops of water falling regularly at the same spot on a hard stone. Millions of drops do
succeed in making a dent.
It is therefore important to think positively about labour. Think of it as a natural experience. As you grow up you
experience menstruation, intercourse, and then childbirth. It is a normal and natural function of your body. When
labour is allowed to be natural and undrugged, the body releases endorphine hormones that are natural painkillers
and give a feeling of well-being.
The Brain, the Boss

When in labour, the uterus contracts. Stimulus is received and sent to the brain by the nerve endings in the uterus. If
the brain interprets it as 'fearful pain' the protective mechanism which advocates flight or fight will take over a
woman's body. As a result, the woman, incapable of flight, will fight each contraction by building up muscular
tension throughout her body. Along with general muscular rigidity, her uterus will also become rigid and offer
resistance to the uterine muscles working towards birth. This is perceived as pain.
However, if the woman understands that the strain her body' is undergoing is part of the physical strain
associated with the expulsive efforts of her uterus, of which she has no reason to be afraid, the contractions will be a
new experience for her. The muscles of her uterus will work unhampered by fearful tension and with each
contraction get closer to birth, so that the woman will have a shorter, less painful labour.
Hence the pain a woman will feel in labour will greatly depend on her brain's interpretation of 'pain' as either
something fearful or as something to work with.
Sympathetic Nervous System

When the sympathetic nervous system is stimulated by fear, it restricts the blood flow to and from the uterus. In the
absence of adequate fuel and no effective means of disposing of waste products, no organ can function optimally.
This is one of the most serious influences of fear on the reproductive organs, and is directly responsible for many of
the unpredictable complications of an otherwise normal labour.
According to Langley and Anderson (1893-94), stimulation of the sympathetic nerves to the uterus by fear
causes the uterus to appear pallid, firm and bloodless, but when the stimulation is removed, it rapidly fills with blood
and becomes an elastic, deep pink uterus. A bloodless, white uterus can lead to urgent distress of the fetus and a
Caesarean may have to be performed.
Impairment of circulation is a cause of pain, because the blood flow is too weak to dispose of the by products of
metabolism. Restricted circulation can also give rise to severe pain in the muscle tissues of the uterus thereby
prolonging the process. Even if the bodily organs are in order, e.g. the pelvis is adequate for the baby's head, and the
baby is in the correct position for coming out, psychological fear and its associated pain—not real pain—can make
labour long.
Fear and its effects not only prolong labour but are also responsible for haemorrhage and tissue injury in the
mother, and anoxaemia (less than normal concentration of oxygen in the blood), respiratory failure, and exhaustion
in the newborn infant (see p. 119&121)
Muscle Action
All over the body there are sets of muscles that work in harmony with each other. For example, the muscles in front
of and behind the upper arm. Try raising your arm and feel the muscles in front of your upper arm tense. Then lower
your arm and feel the muscles in the back of your upper arm tense. Now tense both these muscles together and feel
the arm becoming rigid. If the contraction is strong and maintained for some time, the whole arm will quiver and in
a short while, there will be considerable pain in the arm.
The same kind of harmonious muscle action is seen in the uterus during childbirth. The uterus is made up of
many muscle fibres. One set of muscle fibres are longitudinal, that is, they run from the mouth of the womb, over
the front, top and back of the uterus. Contraction of these muscle fibres brings about the expulsion of the baby out of
the womb. Then there are circular fibres concentrated in the lower part of the uterus, near its mouth or outlet. The
stretching and relaxing of these fibres opens the mouth of the womb. However, if the circular fibres stiffen, they will
cause the cervix or mouth of the womb to close and hold up or inhibit the activity of the uterus. This uncalled for
rigidity caused by tense muscles can make labour longer and more painful, (see p. 120)
The Body's Design for Birth

A woman's body is designed for giving birth. To begin with, a woman's pelvic bones are broader than a man's. A
woman's pelvis is heart-shaped, whereas a male pelvis is apple-shaped.
The female pelvis

There are three joints in the female pelvis that spread apart at birth. Two are at the back, on either side of the sacrum (2), i.e. the lower
portion of the backbone where it joins the iliac bones (1) or the basin-like bones of the pelvis. These are called the two sacro-iliac joints.
Then there is one joint in front of the pelvis, called the symphysis pubis (3). These three joints spread apart to make way for the baby's exit.
After the baby has passed through the cervix or mouth of the uterus, it makes its way through the vagina. The vagina
is made up of folds and is therefore capable of unfolding, just as the pleats in front of a saree can unfold. As the baby
passes through the vagina, it opens up to make way for the baby. The more relaxed a woman keeps the muscles of
the vaginal passage, the less tension the baby's head encounters during birth.
The cranial or head bones of the baby are not fused. As the baby's head negotiates the birth canal, these bones
can mould to the size of the vaginal passage. They can also override each other if necessary. At birth the bones come
back to their original shape. It is because of this that some babies are born with funny bumps on their heads, which
smooth out in a few days.
The body releases hormones to control the process of birth and make it pain-free.
An interesting fact is that uterine contractions and their associated 'pain' form a very short part of the total
labour. For instance, if you have 1-minute contractions every 5 minutes, it will mean that in 1 hour you will have 12
minutes of contractions and 48 minutes without them. At the start, contractions could be every 15 minutes and last
for 30 seconds. So in 1 hour, one would have only 2 minutes of contractions.
Experience of Women
More than 2,000 women have gone through childbirth preparation classes conducted by the author. They have felt
more confident about the birth experience, and have gone through it with little or no pain.
A psychologically prepared woman can handle any kind of labour confidently. Says Rita, who had a Caesarean
section: 'Around 4.30 a.m. there was a heavy flow of blood as the placenta had started separating from the uterine
wall. It was accidental haemorrhage. By the time I was operated two-thirds of the placenta had separated and there
was foetal distress. The best thing about my delivery was my cute baby girl whose life and mine were saved by
timely treatment administered to me by my efficient doctor, as my case had become very serious.'
One must have positive feelings-that's what counts. You can face anything.
NEHA BALI
Computer based training developer
When a woman understands that in her casse a Caesarean section is necessary, she accepts the decision
consciously. Moreover, since she has been handling her labour with breathing and relaxation, she is in good mental
and physical health. Since she is calm and collected, she will let the anesthetist send her to sleep with a greatly
reduced amount of anesthesia, so that both she and her baby will experience less discomfort afterwards. At the same
time, when women become knowledgeable, they will not accept anything blindly.
I tried to help her by reminding her and helping her to concentrate and breathe.
VIVEK BALI
Neha's husband
When a woman has not prepared herself at all for giving birth, and she fears it, she may be filled with a dread of
labour. Each contraction will become a signal of pain and therefore pain will result. On the other hand, a trained
woman can have a very positive attitude towards birth and may have a smooth and easy labour.
Found that the breathing and relaxation helped tremendously. Thanks to the classes and exercises, I
did not feel at all apprehensive and on the whole found labour not difficult to bear.
RUKSHANA SHROFF
There is one category of women who fail to make progress once labour begins. Throughout pregnancy they
display no anxiety and appear to be happy. But once labour begins, they lose heart, and begin complaining that
nothing is happening and often end up with slow progress, long labour, and may be a Caesarean. Such a woman is
one who suppresses her innate fears and leaves them buried in her subconscious mind, only for them to surface at
the time of labour, hampering the normal sequence of events.
Labour was absolutely wonderful. I knew exactly what to expect-the breathing was great-otherwise
my mom had said she would not be able to see me through the labour pains. Breathing helped me so
much that it was almost painless.
AMRITA KHOSLA
second delivery (first by Caesarean)
In Dr. Dick Read's book, Childbirth Without Fear, a case is mentioned that illustrates this point. There was a
physio-therapist who had been 'a very keen exponent of relaxation and preparation for childbirth'. She had a very
easy and trouble-free first labour, with minimum discomfort. When she had her second baby, she suddenly
experienced very strong contractions. They were so strong that she immediately suspected that something was
wrong. She suddenly 'lost her nerve and literally began to scream the place down.' She was immediately given
inhalation analgesia and brought under control, and the baby was born normally. She later admitted that she had
expected her second labour to be easier than her first, and when she had felt more discomfort than expected, she had
thought the worst and lost control of herself, so that fear took over. In the labour following her second one, she had a
comparatively easy time again, since the circumstances of her fear had been explained to her. She understood that no
two labours were alike, and that sometimes in second and subsequent labours strong contractions are experienced.
Fears repressed into the background can lead to problems during birth. So it is important for every pregnant
woman to come out with her fears or imaginings, to discuss them with the doctor, and understand them. No two
labours are alike; each is different. Even in one woman, two labours will not be alike. Divest yourself of any
preconceived notions about labour. There is no right or wrong, perfect or imperfect in labour. Your labour just
happens, you cannot set specific goals for it. You simply equip yourself with some knowledge and relaxation and
breathing techniques.
Like a Buddha she would sit up and mumble something each time a contraction came-I thought she
was muttering her mantra but she said it was he' breathing.
VANDANA JAGWANI'S MOTHER
Natural Childbirth
Natural childbirth implies having one's baby the natural way, that is, in a relaxed attitude, without anesthesia or
analgesics and without any mechanical aid to birth.
An interesting description of a woman in labour is given in Dr. Dick Read's book Childbirth Without Fear,
London, 1977, which influenced Dr. Read to such an extent that he became a pioneer of natural birth in Britain.
He describes the incident thus: 'In due course the baby was born. There was no fuss or noise. Everything
seemed to have been carried out according to an ordered plan. There was only one slight dissension: I tried to
persuade my patient to let me put the mask over her face and give her some chloroform when the head appeared
and dilation of the passage was obvious. She, however, resented the suggestion and firmly but kindly refused to
take this help.
It was the first time in my short experience that I had ever been refused when offering chloroform. I asked her
why she would not use the mask. She looked from the old woman who had been assisting, to the window
through which was bursting the first light of dawn and then shyly turned to me and said: "It didn't hurt. It wasn't
meant to, was it, doctor?" I began to realise that there was no law in nature and no design that could justify the
pain of childbirth.'

2.

Your Anatomy
It is important for every woman to understand the anatomy of her body. To do so a woman should freely feel and
examine her body. Do not be shy of your body. Most women are not familiar with the appearance of their sexual
organs as compared to the other parts of their body. Women tend to consider themselves unclean "down there" and
have as little to do with the area as possible. It is good to know that the vagiria, which has a natural self-cleansing
process, is cleaner than the inside of the mouth. Feel good about your body, it is not unclean or obscene. It is you.
Get familiar with yourself. You are unique in your ability to reproduce. Each month your periods reaffirm your
fertility. Take a mirror and have a look at yourself "down there". Lie down on the bed, bend legs at knees. Place feet
flat on bed, move thighs apart and hold a mirror between them. In a mature woman the single most obvious feature
will be the pubic hair.
If you look lower down from the pubis, which is the fatty hair-covered mass just below the lower abdomen, you
will notice your sexual as well as your excretory organs. You will notice an area shaped like an inverted V, within
the outer hairy flaps. The two arms of the V are the lips of the vagina. The tip of the V, which is on top instead of
down, has in it the clitoris and the hood of clitoris, which is the most sensitive spot in the area. The clitoris becomes
erect during sexual arousal, just as the penis becomes erect during sexual arousal in a man. Within the lips of the
vagina, and below the clitoris, there are two openings or orifices. The small opening just below the clitoris is the
urethra from where urine is passed. Below the urethra is a larger opening, the vagina. Your vagina is the opening
through which the menstrual flow passes, and through which your baby will be born. It is made up of folds which
afford it elasticity. These unfold when the vagina expands during intercourse or childbirth. Below the vagina, further
back, is the anus. Through the anus stool is passed. The urethra leads up to the bladder, a bag in which urine collects
before urination. The anus leads up to the rectum, the last part of the large intestine where faecal matter collects
before being expelled as stool.
1. Pubic hair
2. Clitoris
3. Urinary Opening
4. Vaginal Opening
5. Anus
6. Perineum
The uterus is the organ that is going to carry your baby when you get pregnant. It has thick walls and lies
between the bladder and the rectum. It may be folded backwards or forwards slightly, in which case it is called
retroverted or anteverted respectively. It corrects itself in pregnancy and will not cause complications at birth. Its
upper part is called its body, and the lower, narrower part is called the cervix or mouth of the womb. If you wash
your hands and insert a finger in your vagina, you can touch your cervix since it protrudes into the vagina. It feels
like a dimpled nose tip or like a chin. The entrance into the uterus through the cervix is very small and is called the
os.
1. Rectum
2. Uterus
3. Bladder
4. Cervix
5. Urinary opening
6. Vaginal opening
7. Anus
The top part of the uterus has two openings on either side that lead to a fine tube on either side, called fallopian
tubes. The other end of the tube is funnel-shaped and leads to the ovaries on either side. The ovaries are two in
number and the size of an unshelled almond. They are placed on either side of the uterus. The ovaries have 2
functions. They produce the female sex hormones oestrogen and progestrone. They also produce the ovum or egg
which is wafted into the fallopian tube on being released. It is then fertilised by the sperm, which travels from the
vagina, through the cervix, into the uterus, and from the uterus to the fallopian tube.
The fertilised egg then journeys back to the uterus from the fallopian tube and houses itself in the body of the
uterus, where it begins to grow. As the fertilised egg grows, the thick walls of the uterus thin out as it enlarges and
balloons up with the pregnancy. In rare instances the fertilised ovum implants itself not in the wall of the uterus, but
in the fallopian tube, and very rarely in the abdominal cavity on the ovary or the cervix. Such a pregnancy is called
an ectopic pregnancy and surgery is normally required to end it. Signs of ectopic pregnancy are sharp abdominal
pain. Pain due to ectopic pregnancy is aggravated by body motion, such as bending over, rising or travelling in a car.
Discomfort connected with ectopic pregnancy usually occurs in the first 3 months of pregnancy.
The Development of the Baby

It can be divided into three specific periods of 3 months each, together making 9 months.
The first trimester: 1-3 months
By the end of the first 3 months the baby is about 3½ inches long. The vital organs and limbs are fully formed but
not sufficiently developed. The amniotic sac contains about 3.5 ounces of amniotic fluid and the fetus has plenty of
room to move about, although the movements will not yet be felt by the mother. The heart is beating, the eyes,
though closed, are in position. The facial features are properly formed and the ears are in place on the sides of the
head. The sex organs are developed so that the baby has a male or female identity.
The fetus swallows the amniotic fluid, most which is used by its body, and it produces drops of sterile urine. The
amniotic fluid is constantly refreshed by the amniotic sac. As the baby is not breathing, it does not choke, it gets its
oxygen from the mother's bloodstream through the umbilical cord.
The second trimester: 4-6 months
By the end of the second trimester the baby is about 14 inches long, roughly the length of his mother's fist and
forearm, and weighs about 1 kilogram.
At the start of the second trimester, or from the 4th month onwards, the mother begins to feel movements of the
fetus, and she begins 'to show'. The fetus can now smile and suck its thumb. At the ends of the fingers and toes,
ridges develop, giving the baby a unique identity of fingerprints.
The trunk and legs of the fetus lengthen and the head no longer looks too large for the rest of its body. Eyelashes
and eyebrows appear, although the eyes remain closed until the end of this trimester.
The skin begins to grow a coat of fine downy hair called lanugo, which is shed before or shortly after birth.
During this period the baby also develops a whitish greasy coating called vernix from the oil secreted from its skin
and dead skin cells.
The fetus now swallows a pint of amniotic fluid daily and returns it to the amniotic sac through urination. The
amniotic fluid is recycled every hour, when one-third of it is absorbed into the mother's bloodstream and replaced
with fresh fluid secreted from the amniotic sac.
The third trimester: 7-9 months
During the last 3 months the baby gains weight, slowly grows to reach right up to the mother's breastbone. As the
fetus becomes large it can no move freely as before, since it gets cramped for now instead of movements of the
fetus, the mother feels its kicks and pokes.
During this trimester the baby stores up protein to build muscles, calcium for its bones, iron for its red blood
cells, fat to insulate it against changes in temperature afterbirth.
By the end of the 7th month the fetus' brain matures to be able to cope with breathing and swallowing. Thumb
sucking is now resorted to more frequently. If born at this stage the baby has a 90% chance of surviving.
1. Uterus/womb
A muscular organ in which the baby lives until birth.
2. Placenta/afterbirth
A tissue growth on the inside of the uterus. It is delivered after the birth of the baby, after its need and function
are over; hence the name afterbirth. The placenta matures towards the end of pregnancy.
3. Umbilical Cord
A rope of blood vessels attached to the baby at its nave! on one end and to the placenta on the other. Through it
nutrients reach the baby.
4. Amniotic Sac/Bag of Water
A membrane sac filled with liquid called amniotic fluid, in which the baby floats, and which acts as a shock
absorber, protecting the baby in case of accidental knocks.
5. Cervix
The mouth of the uterus, leading to the birth canal. The baby passes through the muscular opening at the cervix
and then through the birth canal to the outside world.
6. Mucus Plug
A plug of mucus and blood, that plugs up the cervix much as a cork plugs up a bottle. It prevents infection from
entering the womb.
By the end of the 8th month the fetus looks quite like what it will at birth. Although the lungs are not yet fully
operational, the baby has a 95% chance of surviving if born at this stage.
It is during the last trimester that the fetus' eyes open. The senses undergo their greatest development at this
stage. The hair on the head grow and fingernails and toenails develop.
Sometime during the 9th month the fetus generally turns head down in the womb. About 2 weeks before birth, it
descends about 2 inches, settling in the mother's pelvic bones. This is called lightening, engagement, fixing, or,
dropping of the head.
The mother feels lighter as the pressure of the fetus pushing on her diaphragm and lungs is reduced, so that she
can breathe more easily. Mild contractions of the muscles of the womb may be felt in the 9th month as the womb
changes the baby into the head down position or as the womb prepares its muscles for delivery. Some times babies
are born feet first. Such babies are called breech babies.

3.

Pregnancy
The simplest way of knowing that you are pregnant is the missed period. Along with a missed period a woman may
feel nauseous, may need to urinate more frequently and feel tenderness in the breasts. When you go to the doctor in
order to reconfirm your pregnancy, the doctor will check you for an enlarged uterus, softening of genital organs and
during an internal vaginal examination the cervix will be seen to have taken on a purplish-velvety look, typical of
pregnancy.
Blood /Urine Test

A blood or urine test can help detect the presence of a pregnancy. The blood or urine is tested for the presence of
HCG, human chorionic gonadotropin. The developing placenta begins to produce this hormone to prevent
menstruation and protect the pregnancy. For an earlier result the blood test is more reliable.
High dose hormone tablets used to be given earlier to test pregnancy. It would make the period occur if there
was no pregnancy. If there was a pregnancy and if the fetus was female there was a possibility that the tablet could
produce masculinisation. Tablets are not used to test for pregnancy anymore. Instead, tablets with a different
hormonal combination are now used to abort an unwanted pregnancy. If tests or a visit to the doctor confirm that
you are pregnant, you must immediately start taking care of yourself and your baby by eating nutritious food,
avoiding too much tea, coffee, and colas, stopping alcohol, tobacco, and indiscriminate use of medicines and
tranquillisers.
When you visit your dentist or general physician tell him that you are pregnant, because medicines of all kinds
should be avoided, particularly in the first 3 months of pregnancy The thalidomide tragedy in 1962 jolted people into
realising that drugs taken by the mother affect not only her but also the baby.
Thalidomide was a sedative prescribed to women in early pregnancy. Over 5000 children throughout the world were
born with limb defects, in some cases with no limbs at all. Drugs that affect the rapidly developing fetus in the first
12 weeks are called teratogenic. As Dr. Gordon Bourne says in Pregnancy, 'Teratogenic drugs should not be given at
any stage of pregnancy. These include thalidomide, phenytoin, antithyroid drugs, anti-cancer agents, some sex
hormones, alcohol, tetracycline and some anesthetic agents.' Only a doctor will be able to tell the correct dose of a
drug, should it need to be used. If you are a patient of diabetes or epilepsy you must not stop your medication
without consulting your doctor. Any medicine should be taken strictly under the doctor's supervision, even if it is
only an aspirin.
Many ancient cultures like the Indian, Japanese and Chinese stress that the mood and activities of a pregnant
woman should be positive and happy, since they believe that what the mother is exposed to in pregnancy affects the
growing baby within her. Hippocrates tells of his belief that a pregnant woman directly influences the baby she
carries.
According to a legend, when Confucius' mother became pregnant, she withdrew to a mountain to pray and gave
birth to Confucius there. In ancient China a pregnant woman was told not to look at ugly things, not to listen to rude
talk, not to speak about trivial matters and not to listen to gossip.
Take time off to relax (see p.96). Researchers have recently inserted small microphones into the uterus and
recorded what the fetus hears. The womb, they find, is full of the mother's bodily music; the whooshing bowels, the
gurgling stomach and, the mother's heart beat.
Dr. Lee Salk, a leading psychologist, in his classic experiment took 2 groups of infants. One group was exposed
to a recording of the human heart beat of 80 per minute. The second group was unexposed. After four days the group
exposed to the sound of the beating heart had gained more weight on an average, as compared to the unexposed
group. In the second test he played a recording of a heart beating at 120 beats per minute, a typical rate achieved in
an anxious or frightened adult. The rapid rate was so distressing to the newborn babies that the experiment had to be
terminated at once. Little wonder that mothers the world over hold the baby close to their breast to comfort it. It
could be that the baby is soothed quickly in this position because it hears the familiar pulsation of the heart that it did
in the womb.
Planning a Healthy Baby

Today, with the means of contraception easily available and the number of working women on the increase, a
pregnancy is often planned and not accidental. If you are a diabetic, your condition will need to be assessed before
your pregnancy to avoid complications later:
To conceive, all contraception should be stopped. If you are on the pill, you should go off it, and switch to the
condom and spermicidal pessaries for 2 to 3 months, so that all hormones are out of your system , by the time you
conceive. Biologically it is best to have your baby in your 20s. Risks increase in the under 20s and over 40s, and
slightly in the over 30s.
Genetic Counselling
If there is a history of epilepsy or severe myopia in your or your husband's family, you may like to consult a genetic
counsellor. Genetic counselling is a way of discovering whether your child may be born with an inherited disorder.
It is available in most large hospitals. The counsellor will ask about your and your husband's family history. A blood
test may be done to get more information. If there is a problem, the counsellor will help you find out if you may pass
it on. You will also be told if tests that can detect the disorder in the fetus during pregnancy are available.
Using knees and legs for lifting
Pre-Conception Care
A few months before you plan to conceive, have a blood test taken to check if you are anaemic. If you get your
anaemia under control, it will go a long way towards producing a healthy baby. So eat foods rich in iron (see p. 64).
Eating wisely is important both for you and your husband. A nutritious diet, less stress, less alcohol and cigarettes,
less lead exhaust from vehicles, less caffeine from tea, coffee and cola drinks, no indiscriminate use of drugs, are all
factors that will contribute to a strong and healthy baby. If you and your husband can check these factors before you
conceive, it should give a strong foundation to your baby. You should check these factors 3 to 6 months before
conception, especially approximately 15 days before the next period is expected, because the pregnancy starts at that
time. Always check these factors throughout pregnancy. A man's diet, smoking and drinking habits, etc., can harm
his sperms. It is being increasingly proved that health and nutritional status of both the man and the woman before
conception is very important.
Step l
Standing close to a child or object, put one foot forward and drop to one knee.
A couple which takes care of all these factors have done their best to produce a healthy baby. It may require a
slight alteration of lifestyle, but it will give you a healthier baby and mother. A healthier mother will be able to cope
more easily with the care of the baby later.
Step 2
Rise to your feet keeping your back straight and lifting with the front leg while the back foot balances.
During pregnancy keep up your normal activities but do not overwork. Avoid lifting heavy things, as it can lead
to a miscarriage. Regular exercise will help you keep fit (see p. 81). Normal activities will help keep your muscles
toned up, making your delivery easy.
Antenatal Visits
When you become pregnant, you must consult an obstetrician or an Obstetrics OPD in a hospital or a medical centre.
Often 3 months pass by the time a woman goes for consultation. Under medical guidance you will go through
pregnancy and birth with fewer complications. Any potentially dangerous situation will be controlled through
preventive measures. For instance, a woman with a Rhesus-negative blood group will be given an anti-
Dimmunoglobin injection after the birth of her first baby so that her second delivery will be problem free. A Rhesus-
negative woman, who has not had an anti-D injection after her first delivery or after an abortion preceding her first
delivery, may have a baby that will need a complete blood transfusion at birth, (see p. 60)
A woman with swollen feet, hands and face will also need to follow simple medical advice so that other
complications do not crop up. Blood pressure and weight will also be checked at antenatal visits.
The doctor will ask about your previous pregnancies, miscarriages, abortions, about when you had your last
period, what contraception you have been using, what illnesses you have suffered from, etc.
Until the 7th month you will be called for a checkup once a month. Until the 9th month you will be called every
15 days and then every week until you go into labour. The doctor will prescribe certain tests.
Blood Tests during Pregnancy

A blood test will be taken to find out the haemoglobin content of the blood. Haemoglobin is the red colouring matter
of the blood that carries life-giving oxygen to all parts of the mother's body, including the baby. Haemoglobin levels
tend to fall in pregnancy and could drop to as low as 9.5gms/ 100ml (see p. 58-59)
Your blood group will also be noted, in case you need a blood transfusion in an emergency. The blood will be
checked to see if it is Rhesus-negative or Rhesus-positive (see p. 60). A blood test, Hbs Ag is also recommended
sometimes to test for hepatitis.
VDRL Venereal Disease Research Lab test
The Venereal Disease Research Lab test is a blood test that checks for the presence of any sexually transmitted
disease or venereal disease. If, for instance, a woman is found to have syphilis, she can give birth to a deformed
child. Both the woman and her husband should have the VDRL test. Even if it turns out that one of them has the
disease, both will receive a course of antibiotic injections to protect themselves and the baby. It is important that
both partners cooperate with the doctor.
There may be other instances when the doctor would prescribe a blood test. Medical supervision is therefore
essential.
AFP Alpha-Feto- Protein test
The Alpha-Feto-Protein test is a specialised blood test that can reveal if there are any major defects in the baby. The
mother's blood is checked for alpha-feto-protein which is a protein that is produced by the baby's liver and is passed
to the mother's bloodstream through the placenta. It is most accurate between 16 and 18 weeks of pregnancy. If the
test suggests that the baby is not normal, it should be repeated. If the second test gives similar results the fetus also
should be checked by an ultrasound scan and amniocentesis.
TORCH
A comprehensive blood test called TORCH tests the blood for various infections like toxoplasma, syphilis, rubella
or german measles, cytomegalovirus, and herpes or Hepatitis B.
When these infections are found present they may manifest in the child in the months following birth. If they are
already present then their treatment can begin at birth. For instance, immunisation against Hepatitis B can be given
to the baby in the weeks following birth if the infection is present in the mother. Likewise, treatment for toxoplasma
infection or syphilis infection can be started at birth. In other words, prior knowledge of any infection can make it
possible for an early diagnosis and appropriate medical care for the child.
Pets, Gardening, Raw Meat (Toxoplasma)
Toxoplasmosis is a parasitic infection that can be acquired from soil, cat faeces and raw meat.
It is an infection present in birds and animals. It is also a common dormant infection in humans. Its presence in
humans varies from population to population, but it is more prevalent in warmer, more humid climates.
A woman who has already been infected by it before becoming pregnant, will be immune to it. Her baby will not
be threatened by it. It is only when a woman acquires this infection in her pregnancy, that the baby could be affected
by it. Approximately 50% of women who acquire this infection and are not treated can pass it to the baby. However,
if this infection is identified and treated with antibodies (spiramycin for instance) it reduces the risk of damage by
50% to 60%. Infection can result mainly in abnormalities of the brain and growth retardation.
The damage caused by this infection is the greatest in mothers who acquire this infection in the first three
months of pregnancy. (Interestingly the incidence of transmission of infection to the baby is least in early pregnancy,
and greatest in late pregnancy.)
To prevent this infection a woman can follow simple guidelines. She should eat only well cooked meat and eggs,
and drink only pasteurised milk or boiled milk Avoid handling raw meat. If handling raw meat, the hands should be
washed immediately, and kitchen surfaces and vessels washed well thereafter. Do not touch mouth or eyes while
handling raw meat. Wash fruits and vegetables before consumption. Protect food from flies and cockroaches. When
gardening or handling faeces of animals use gloves.
HIV/AIDS
A blood test, tests for the Human Immunodeficiency Virus. A person who tests positive for HIV has a strong
possibility of developing AIDS (Acquired Immuno-Deficiency Syndrome), in which case a person's immunity or
strength to fight infection falls drastically so that the person picks up all kinds of infections like cold, respiratory and
skin infections, etc. If a woman is suffering from AIDS she can pass the infection to her new born baby.
The time of transmission of infection to the baby could be within the womb or at the time of birth. Breast milk
can also transmit the infection. A child born to an HIV infected mother should have regular investigative tests until
the age of 6 to 8 months to check if the child has got the infection from the mother or not. If the mother has HIV
infection, pregnancy can increase her chance of developing AIDS.
However if a woman is known to be HIV or AIDS infected and gets pregnant, recent research has shown that the
use of two standard drugs azt and 3tc can block the passing of the virus from the mother to the baby. Recent
research also shows that without treatment 17% of babies can be infected, whereas with treatment the infection of
babies can be lowered to 11% percent if the two drugs are given when labour begins, and continued for a week after
birth. The medicine can be given to the mother when labour starts and it must be given to both mother and child for
a week following birth. This is to protect the child from exposure to HIV contaminated blood and secretions as well
as from virus in the breast milk, which causes 1/3 rd of all infections in the young.
The risk of infection can be further reduced to 9% if treatment is begun 26 weeks before delivery and continued
for a week afterwards.
A new drug, Nevirapine is also known to reduce the transmission of HIV from mother to baby, and costs much
less than azt. Nevirapine is administered to an HIV infected woman in labour, and another dose is given to the baby
within 3 days of birth.
Urine Test
A urine test is routine in pregnancy. The urine will be analysed for infection, and for glucose which will show up if
there is diabetes. Ketones may show up if you are vomiting a lot or not eating enough. In late pregnancy albumin or
protein in the urine will indicate preeclampsia (see p. 57).
Internal Vaginal Examination

An internal examination could be done at the start of pregnancy and at its end, and sometimes during its course. At
the start of pregnancy it could be done to confirm the pregnancy and exclude any possibility of abnormalities of the
pelvis, vagina, or cervix.
At the end of pregnancy it could be done to check the readiness of the cervix or its ripeness. It does not harm the
baby. It will help if you breathe out slowly through the mouth while it is being carried out, and relax your pelvic
floor as you do when passing urine.
Abdominal Examination
When you go for a checkup the size and shape of your abdomen will be felt by the doctor after making you lie down.
The doctor will examine your abdomen for its shape and size, for abdominal scars and for the movements of the
fetus. By palpating your abdomen with one or both hands the doctor can gain a lot of information about the size of
the baby, in what position the baby is lying and the presentation of its head.
The height of the growing uterus also gives an idea of the growth of the baby. At 3 months the uterus can be felt
in the lower abdomen, rising out of the pelvis. At 5½ the uterus reaches the height of the navel. At 7½ months the
uterus will be halfway between the navel and the breastbone, or the region below the breasts. In the 9th month the
uterus will reach the area below the breasts.
Ultrasound
Ultrasound was first used during the Second World War to detect submarines. In a pregnant woman, sound waves
are directed to the fetus inside the uterus, and as they bounce off the baby's bones and tissues, a picture of the fetus
appears on a TV screen. The picture may not make much sense to you, but the expert working the machine will be
able to interpret it. It is really quite simple. Even a novice would be able to differentiate the dark areas, which are
fluid-filled, from the white areas which are solid.
When you go for an ultrasound scan, you must have a full bladder. You will be made to lie down next to the
machine and an oily substance will be spread over your abdomen. A small flat device will be moved slowly all over
your abdomen during the scan.
It is a fairly new technology that has begun to be widely used in obstetrics in India only from the early 1980s. In
other words, it is in its infancy. It does not appear to harm the mother or the baby in any way but there is no
evidence that it is completely safe either. It took 4f) years to discover the harmful effects of X-ray, which was the
only technique of getting some information of the baby in the uterus before the ultrasound scan.
As a diagnostic tool the ultrasound is invaluable, since it can give the doctor vital information on diagnosis of
pregnancy, missed abortion, hydatidiform mole, ectopic pregnancies, twin pregnancies, the position of the fetus and
placenta, the age of the fetus, abnormalities of the fetus or uterus. Scans should be done in pregnancy if the doctor
thinks it advisable for investigative purposes. As a routine procedure it is avoidable.
According to Maye's Midwifery (1997) 'An Ultrasound scan is usually performed between 16 and 18 weeks
gestation, and maybe repeated later in pregnancy if indicated.' An ultrasound done between 16 to 20 weeks gives an
accurate idea of how old the pregnancy is. After 24 weeks, the baby's age in the uterus cannot be accurately
predicted by an ultrasound.
Dr. Ian Donald, professor of obstetrics from Glasgow who pioneered the use of ultrasound in obstetrics*, wrote
40 years later: 'Perhaps the time has now come to stand and stare and to take stock of where we are going.. .bearing
in mind that sonar** must never lose its submissiveness to the medical art and the paramount importance of the
patient...viewed with a sense of proportion sonar comes as a commodity only, though with many uses. Out of
control, it can be an obsession, a tail that wags the dog...sonar is not a new medical religion...nor an end in itself. A
tool exploited for its own sake is no better than a saw given to a small boy for cutting wood, who must presently
look around the house for suitable objects of furniture inviting amputation...the possibility of hazard should be kept
under constant review.' (Source: Association if Improvement m Maternity Seruices-AIMS-UK,1994)
Amniocentesis
This is a procedure where a small amount of fluid is taken out from the pregnant mother's abdomen (amniotic sac) to
test for chromosomal and other abnormalities. It is not a routine test. Under local anesthesia a needle is inserted into
the mother's abdomen and a little bit of amniotic fluid is withdrawn. This is done along with an ultrasound, so that
the placenta and the fetus are not disturbed by the needle. The fluid which contains fetal cells can then be analysed
for the detection of abnormalities of the nervous system, mental handicaps, including Mongolism or Down's
Syndrome, inherited disorders, etc.
Even though it might be carried out efficiently under hygienic conditions, there is a 1-2 % chance that it might
lead to a spontaneous abortion. Besides, the couple should first decide what they want to do with the results of the
test. If the tests suggest an abnormality, are they ready to opt for termination of the pregnancy? This can be difficult,
for the test cannot be done before 14 weeks of pregnancy, when a termination would mean having an induced
labour. If a woman already has one abnormal child, she might want to consider this test. She should seek the advice
of her doctor.
Anti-Tetanus Injection
Anti-tetanus injections are given routinely to all pregnant women. An anti-tetanus injection taken by the mother in
pregnancy protects both the mother and the baby from tetanus infection for up to several months after the birth. It is
usually given in 2 doses in the 26th week and 6 weeks later.
Medical Termination of Pregnancy

Amniocentesis or the AFP test may suggest the baby has a severe abnormality of the spine or brain. If you catch an
infection of German measles or rubella in the first 3 months of pregnancy, it can physically and mentally handicap
the child. Chickenpox can do similar things. In such cases the doctor would advise an abortion. It is better to go for
an abortion than to live with an abnormal child for the rest of your life with a guilty feeling that you could have
avoided all this pain to yourself and your baby. Discuss things with in your doctor and if you like, with a
psychotherapist as well.
Medical termination of pregnancy is now easily available and quite safe. It is offered by voluntary organisations
like the Marie Stopes Clinic, public hospitals and private clinics. It should not be resorted to as a contraceptive
method, in which case repeated abortions can seriously harm a woman's health.
Boy or Girl ?
When the ovum is fertilised by the male sperm, 23 chromosomes each are contributed by the male and the female,
making a total of 46 chromosomes. Of the sex chromosomes, one is contributed by the male and the other by the
female. These are the famous XX (girl) chromosome present in the female and the XY (boy) chromosome present in
the male. The mother always contributes the X chromosome. The sex of the child is determined by the father's
contribution of the sex chromosome. If it is X the baby born will be female. If it is Y the baby born will be male.
There are some not very scientific theories that claim to be able to tilt the balance towards the conception of a
male or female child, as desired. One such theory propounded by a French doctor, Francois Papa, claims that if a
woman follows a particular kind of diet for 2 to 3 months before conception, she can choose a male or female baby.
This diet is discussed at length in the book Boy or Girl: Choosing Your Child Through Your Diet. (Ritana Books,
New Delhi)
Some doctors in Canada and France have been advocating the diet theory and say it has an 80% chance of
success. For a girl, they advise a diet rich in starch, milk and milk products, and low in salt. They also recommend
taking a tablet of calcium every day. For a boy, they advise eating a high salt diet, with plenty of meat and fruit.
Milk and milk products are not permitted. A daily potassium tablet may also be recommended.
According to The Complete Handbook of 'Pregnancy edited by W. Rose-Neil, research studies have shown that
the more often you have intercourse, the more likely you are to have a boy. More boys tend to be born, for example,
in the first few years after marriage, immediately following a reunion after a long parting, and in younger parents.
The timing of intercourse is also said to influence the sex of the child. If conception takes place within 48 hours
after ovulation you are more likely to have a male child. Within 48 hours of ovulation, intercourse should take place
at least 3 times, and then one should refrain until the next period. The opposite would apply to conceive a female
child. That is, intercourse should take place 48 hours after ovulation to conceive a female child. In order to pinpoint
the exact time of ovulation, ultrasound clinics offer a package deal. You are called for an ultrasound every day, 3
days after your period is over. You have to go early in the morning on a full bladder. You go until ultrasound detects
that ovulation has taken place.
Another way to pinpoint ovulation would be the temperature method (see p.170).
Douching is also said to influence the sex of the child. An alkaline vaginal douche before intercourse is said to
help conceive a boy. An alkaline vaginal douche can be made of 1 tablespoon bicarbonate of soda dissolved in 500
ml of warm distilled water. To conceive a girl, an acid douche can be made from 1 tablespoon of white vinegar and
1 tablespoon of warm distilled water. If you are very keen on conceiving either a daughter or a son you could discuss
these methods with your doctor.
* a branch of medical science concerned with pregnancy and childbirth
** ultrasound

4.

Common Problems in Pregnancy
Most of the common ailments during pregnancy are minor and can be relieved by simple changes in lifestyle. As a
result of tremendous changes occurring in the body, discomfort, muscle pulls, bleeding gums and cramps, are some
of the accepted problems a pregnant woman is likely to encounter. However, some lucky women never face any
problem at all. Consult your doctor if you are in doubt about your symptoms.
Physical Changes
Darkening pigmentation
With pregnancy it is common to develop a darkening of certain areas of the body, like the darkening of the nipple
and areola; or the darkening of a line starting from below the navel and ending at the pubic hair; or the development
of dark patches on the face.
These are caused by pregnancy hormones. These hormones tend to make skin cells containing dark pigment
enlarge, so that any birth mark, freckles, moles or scars tend to become darker after the 3rd month of pregnancy.
These changes mostly disappear after birth, but in some cases they remain. These are normal accompaniments of
pregnancy and therefore no cause for worry.
Breast changes
Breasts often become tender and sensitive to touch in early pregnancy. The tenderness passes by middle pregnancy.
The dark area around the nipple, the areola, gets darker. This is a permanent change in most women.
Stretch marks on the breasts may occur in women with large, heavy or sagging breasts. Hence, in case of a
dramatic increase in breast size, you must wear a well-fitting cotton bra, that supports the weight of the breasts. (A
nylon bra tends to sag with the weight.) This will not only prevent stretch marks, but prevent sagging too.
Varicose veins
These are dark, swollen veins that might appear on the legs during pregnancy, and sometimes remain forever
afterwards.
The veins in the legs do the job of carrying impure blood back to the heart for purification. In some women the
veins become lax or weak during pregnancy. Due to this laxity they cannot push back the blood through the
congested pelvic area, so that the blood tends to pool in the legs, causing the appearance of varicose veins.
To prevent their appearance, avoid standing for long periods without moving. Do not cross your legs when
sitting on a chair, since this reduces circulation in the legs. Put your feet up on a stool whenever possible. At least
once in the day, place your legs higher than your hips. Sit on a chair, put your feet on the table. Or, lying down on
the floor, place your feet on a stool, low chair or bed. When sitting for long periods, like at a desk for instance, write
alphabets, A,B,C etc. with your toes in the air.
PRECAUTION
Do not point toes if prone
to leg cramps, (see p.36)
Teeth and gums
During pregnancy the gums soften and are therefore more likely to catch infection and start bleeding. Infection in
the gums can mean infection in the teeth also, and consequent tooth decay.
Plaque is a layer of bacteria that grows on gums and teeth. Bacteria in plaque thrive on the pieces of food stuck
between the teeth, and feed on sugar. If you eat a lot of sugary foods, you increase the amount of plaque in your
mouth. If you eat less sugar, the bacteria will not get such a good chance to grow and multiply.
Plaque left on the teeth can eat into the enamel, which is the surface of the tooth. If this is continued, the tooth
will keep on decaying until it affects the nerve inside, in the centre of the tooth, causing a toothache.
Home Remedies
After a meal, rinse your mouth with warm salt water.
Brushing with a twig from a kikaror neem tree can be done once a day. However, if you have fillings in your
teeth, a twig might dislodge them.
Another good thing for teeth and gums is a mango leaf. Roll a mango leaf and chew on it for some time. Discard
the pulp and most of the juice. With a little of the remaining juice, massage your gums with your fingertips. It
will make your gums tighten and your teeth shine. It is perfectly safe for fillings too.
Source: Hansaben Yoga
Ashram Santacruz, Mumbai
In order that plaque does not get a chance to form, it is important to brush your teeth regularly and to keep your
mouth clean. The good old Indian habit of swishing the mouth a few times with fresh water after a meal is good.
That apart, brush before sleeping. The best thing is to brush after every meal.
In pregnancy your gums and teeth are in a more delicate condition, so a soft brush is preferred to a hard one. A
brush with a small head will reach all the corners and surfaces of your teeth more easily. Change your toothbrush
when the bristles begin to look droopy or flat.
Bits of food left between the teeth can irritate the gums and cause them to bleed. You can visit your dentist if
you have bleeding gums. Eat fewer sweets and more of salads and fruits. Try home remedies to keep gums and teeth
healthy.
There is an old wives' tale that for every baby you lose a tooth. This need not be true. Remember that your gums
soften, not the teeth. When the body needs extra calcium to form the baby's teeth and bones and there is not enough
in the mother's body, the womb will steal from the mother's bones, making them brittle. The teeth themselves are
unaffected. They have to be protected by proper cleanliness.
Leg cramps
Leg cramps may occur suddenly in pregnancy and be quite painful. They mostly occur in the last months of
pregnancy. Sluggish blood circulation, lack of calcium, and lack of Vitamin B or E are thought to cause these
cramps.
Massaging the area when cramps occur is relieving. Also, point the toes inwards towards the face when the
cramp occurs. Someone can hold the painful area of the leg with one hand and with the other hand guide the foot
and toes to point towards the face.
A hot water bottle could be used in winter to warm your bed. Place a hot water bottle in bed before you go to
sleep so that your bed is already warm
One can increase the intake of milk products, so that the body can get the much needed calcium. Cottage cheese,
milk, curds, buttermilk, cheese and greens of radish, turnip, cauliflower, methi, dhania, pudina and all varieties of
kerae are good.
Whole and split (chhilka) dais are a good source of Vitamin B. Whole moong, whole masoor, whole urad, split
moong and split urad are some examples of this.
Exercising to get the circulation going in the legs should also help. When you have to sit for long periods, draw
the letters of the alphabet (A,B,C, etc.) with your toes, in the air. Before sleeping, walk across about a six-foot-long
area, on your toes, then on your heels and lastly, on the outer sides of your feet. Done every day before sleeping at
night, it has given relief to a lot of women
Take extra salt, especially at night, in case cramps occur when you are trying to go on a salt free diet.
Shortness of breath
As the pregnancy advances, the uterus presses towards the lungs. This results in shortness of breath and panting
when you climb even a few steps, or the need to take a deep sigh frequently. This is more so in case of a twin
pregnancy, or if you are fairly short, so that the uterus feels very large. The discomfort will be more when you sit on
something low, when you slump your shoulders or when you lie down. If you sit up straight, it will relieve the
discomfort.
It is nothing to worry about, the discomfort will vanish with the birth of the baby.
Palpitations
You might feel that your heart is beating unusually fast. This is called palpitation . Sometimes you might feel your
heart is missing a beat. You are more likely to notice this when you exert physically, like walking, climbing stairs,
etc. It is quite normal.
It happens because your heart does a lot of extra work when you are pregnant. It needs to pump enough blood
around your body to supply both you and your baby with oxygen and nutrients. Also, your blood supply increases in
volume by about 40% to keep pace with the increased demands. To cope up with this extra volume of blood, the
heart actually enlarges, so that it is more powerful. This enables it to pump through the extra blood without speeding
up the rate of heartbeat.
Thus it is not surprising to occasionally notice a difference in the way your heart beats. However, palpitations
are nothing to worry about.
Fainting and dizziness
Because of lowering of blood pressure, not enough oxygen reaches the brain. Sometimes this causes fainting or
dizziness. Dizzy spells may also be caused by anaemia.
In the first 3 months of pregnancy, the blood pressure is lower than normal. This is why some women complain
of dizziness when they first become pregnant. Some of them might actually lose consciousness for a moment or two.
This is not harmful to the baby or the mother, except that the mother might injure herself if she falls to the ground in
a faint.
In case you have a tendency towards dizzy spells or fainting, avoid crowded and smoky places and long
journeys. Avoid moving too suddenly from a lying or sitting position.
Itching
Some pregnant women develop an itchy skin, and find red bumps appearing on the abdomen and breasts. This is
primarily due to the stretching of the skin and can be aggravated by heavy perspiration or stress. For temporary relief
try an oil massage. Women with large breasts often find that it affects them just under the breasts. Calamine lotion
may have a soothing effect.
When you do not show
Some pregnant women, who have been athletes, dancers, or who have been exercising regularly and are tall, do not
show much. Their abdomen does not protrude outwards like that of other women in the same month of pregnancy.
This is because they have a strong set of healthy muscles. It does not mean that something is wrong with the baby.
Stretch marks
The skin is made up of elastic and non-elastic fibres. When stretching beyond the normal limits occurs, as in
pregnancy, the non-elastic fibres tend to break, causing stretch marks. At first these marks may occur as streaks.
After birth they take on a kind of purple or brown shade and finally end up as whitish streaks. Excessive water
retention (which does not occur as a result of drinking excess water), or weight gain can also cause stretch marks.
These marks may appear on the stomach, breasts, bottom and thighs.
To an extent the marks may be controlled by regulating weight to avoid overstretching of the skin but the
stretching on the tummy cannot be avoided as it is the result of an expanding uterus. Besides, hormonal changes that
encourage water retention may cause an increase in fluid retention on your bottom and thighs, causing stretch marks
to appear, even in an aware, weight-regulated woman.
The reason why stretch marks are worse in some women, is simply because the elasticity of the skin varies from
person to person. Women with fewer stretch marks have more elastic fibres in the skin. There is no way in which the
skin's elasticity can be increased to reduce stretch marks.
Many women believe that oiling the skin helps, especially with Vitamin E oil. There is no evidence to support
this theory. However, there is no harm in a gentle massage of the stretched abdomen. It is very relaxing. Moreover if
you are lucky, you may find that the marks do not appear at all.
Footwear
Your feet might swell or flatten further because of the extra weight you now carry. You might need shoes a size
larger as compared to what you normally wear. Do not wear high heels, they will upset your balance, coordination,
and posture.
Your footwear should be flat. Avoid wearing heels during the day and walk barefoot in the evenings at home.
All shoes, whether walking shoes or slippers, should have a similar height throughout pregnancy.
Nasal congestion
Mucous membranes inside the nose and sinuses often swell up during pregnancy, on account of certain hormones
that also soften up the vagina and the mouth of the womb, in preparation for birth. Some women therefore develop a
permanent cold in late pregnancy. However, this will not interfere with your ability to do breathing exercises at the
time of labour.
Backache
The weight of the baby is supported by the backbone, with the assistance of the muscles of the back and abdomen.
When these muscles are weak, the pressure on the backbone is greater and causes discomfort. When these muscles
are strong and toned up, the baby's weight exerts less pressure on the backbone and no backache occurs.
Bad posture also causes backaches. A good posture is simply good balance of the different parts of the body. As
you stand, gravity has the effect of constantly pulling you down to the floor, but you remain upright against the force
of gravity, by using your muscles to hold yourself erect. If you allow some of your muscles to slacken, other
muscles will tighten in order to compensate for the slackening resulting in bad posture and a strain on your back and
other parts of your body.
Typically in pregnancy, one stands with one's bottom out and the hollow of one's back exaggerated. Instead, one
should learn to stand straighter. Keep your bottom tucked in and use your abdominal muscles to support the extra
weight, instead of overstretching them by just letting them go.
You will benefit by looking and feeling better, and suffering less from backache and tiredness. Also, your
stomach will flatten faster after delivery. Tightening your abdominal muscles is not harmful to the baby at all. The
baby is comfortably cushioned in the uterus with the amniotic fluid; it gets its supply of oxygen through the
umbilical cord; and makes place for itself by nudging the intestines, bladder, liver and other organs away.
To relieve backaches, pull your tummy in, tuck your bottom in and straighten the length of your backbone
against a wall.
Rest should also help soothe your backache. Do not let yourself get overtired. Lie down more often. When lying
on your back with legs straight, place a small pillow or folded towel in the hollow of your back.
Or else, lie with your legs bent at the knees, feet flat on the floor. As you lie like this, flatten the hollow of your
back against the floor.
If you prefer to lie on your side, place pillows as high as your hips. Bend and place the leg on the upper side,
bent at the knee, on top of the pile of pillows. Place the arm on the underside, towards your back, along the length of
your backbone.
Severe low backache may sometimes be caused by lack of calcium, or by the baby's position. If it is due to lack
of calcium, the doctor would recommend supplementary calcium.
Upper backache may be caused by poor posture or heavy breasts. Correct your posture and wear a good well-
fitting cotton bra, adjusted at the straps to carry the weight of the breasts.
Pain in the breasts
Pain under the breasts or just below the ribs is common as pregnancy advances, say after the 6th month. The reason
being, that, as the baby grows, it extends upwards to below the breasts and tends to push up your organs like the
liver, stomach, etc., towards the chest cavity. You will find stretching your arms up, straight above your head, helps
relieve discomfort, since it lifts the ribcage off the growing uterus. Also, sitting straight rather than slouching
forward will be more comfortable.
Pain in the groin and sides of the abdome
In late pregnancy it is common to have pain in the pelvic region, since the joints of the pelvic girdle soften in n
preparation for birth. Avoid standing for a long time. The pain might also result from stretching of the round
ligament, which holds the uterus in place.
Tingling and numbness
Tingling and numbness may be felt in the hands in the morning. It is caused by the pressure on the nerves and
tendons by the accumulated fluid in hands and wrists. It is felt more in the morning when your wrists have
accumulated fluid during the night. To relieve the discomfort, hold your hands above your head for a few minutes
and point your fingers towards the ceiling and open and close your fists alternately. Try and control the swelling in
your body by reducing salt in the diet.
Swollen hands and feet
Pregnancy can bring with it swelling of hands, feet, ankles and face. This is called oedema. Since the body retains
extra water in pregnancy, a little bit of swelling is normal. Swelling can also be caused by hot weather, tight or ill-
fitting shoes or exertion; but this kind of swelling generally disappears during the night, when you are comfortable
and it is cooler.
Natural Healing
According to Raikadu Balamma, a popular healer in Pastapur, Andhra Pradesh, oedema can be treated by a
handful of crushed fenugreek (methi) leaves and about 10 grams of ginger (adrak) crushed separately. She
mixes these to make three tablets. The woman with swelling has to swallow a tablet with water first thing each
morning for 3 days. Many women have been cured by this treatment.
Source: Touch Me, Touch-Me-Not (Women, Plants and Healing), Published by Kali for Women,
1997
Severe swelling of the hands and feet that does not go away at night could be a symptom of the onset of
toxaemia and should be reported to the doctor.
Increase your protein intake and reduce salt intake. Salt encourages retention of water in the body. Avoid foods
with a high concentration of salt, e.g. pickles, salted fish, cheese and papad (see p. 67).
Avoid standing for long periods of time without rest. Sit whenever possible, and if possible, put your feet up on
a stool.
Behavioural Changes
Abnormal cravings
Desire for abnormal foods like coal and soil is called pica. Generally it is due to lack of minerals like iron or calcium
in the body. It was more common in the past. Any leaning towards pica should be dealt with by a correction of iron
or vitamin deficiencies. Your doctor will tell you what your body misses and how you can correct it.
It should not be confused with a desire for a particular kind of food, like chocolates, in pregnancy. That is,
preference for a particular food should not be made an excuse for eating an excess of fattening and sweet things,
since heavy food always leads to increased weight, which may lead to complications.
Tiredness
Tiredness is a sign that you need to slow down and take it easy. Try and get at least 10 hours of sleep daily. If you
cannot manage it at night, sleep a few hours in the afternoon. Also try and go to bed sooner at right.
In some cases, tiredness may be caused by anaemia (see p58 & 64).
Mood swings
Mood swings are common in pregnancy owing to the hormonal changes associated with it. Normally stable women
might find themselves going through periods of depression, with tears just beneath the surface. Or a woman might
feel high one moment and low the next moment. Warn your near and dear ones of how you feel, to avoid
misunderstandings.
Sleeplessness
Stress and worry can cause sleeplessness. If you are worried about your pregnancy or approaching childbirth,
discuss it with your spouse or doctor. It is likely that once you have voiced them, the worries will disappear.
At times although sleep comes to you when you retire to bed at night, you may be woken up in a few hours, by a
desire to pass urine or by the baby kicking. Thereafter it may be difficult to go back to sleep.
Restrict your fluid intake at night or in the late evening. Try not to worry too much about not being able to go
back to sleep. Recite a prayer or a poem in your mind, or, your favourite song. Avoid coffee in the evening, as it is a
mild stimulant and might keep you awake at night.
A cup of hot milk just before retiring to bed will help you to relax. A warm salt water bath is also relaxing. Try
and consciously relax by doing some deep breathing or the yogic shavasana, the corpse pose.
If you sleep in the afternoons, it would help if you stopped your afternoon nap, so that you can sleep better at
night. Instead of a nap in the afternoon you could just relax for about half an hour with music or a book, putting your
feet up as you do so.
Medicines
Avoid taking medicines on your own. Whatever medicine you take should only be under your doctor's advice, after
you have informed the doctor of your pregnant condition. Indiscriminate use of certain medicines or drugs can harm
the baby. It is best to keep drug intake to the minimum.
Travelling
Travelling is no cause for worry if the pregnancy has been normal and stable. Travelling long distance is better done
by train than by car or bus. Sitting for long periods should be avoided, since it causes congestion in the legs and
pelvic region. In a train, movement is possible and therefore, the discomfort is reduced. Also, a pregnant woman has
the need to empty her bladder frequently.
Autorickshaws are safe if you are used to them. But avoid long, bumpy autorickshaw rides on rough roads. On a
long, bumpy route, take a bus for most part of the journey and an autorickshaw for a small part of it. Request the
driver to drive slowly
If you have high blood pressure or if you have had a miscarriage or bleeding at the beginning of your pregnancy,
then travelling by air, even in late pregnancy is not advisable, since the change in altitude may cause premature
labour.
Even in a perfectly normal pregnancy, avoid travelling great distances by air in the last 6 weeks, also avoid
travelling abroad, across time zones, for instance. In the last 4 weeks you must remain close to your home and
hospital.
Flying in an unpressurised aircraft can cause serious oxygen deprivation to the baby in the first 3 months.
However, all modern passenger aircrafts are properly pressurised.
Smoking
Research has shown that smoking has a marked negative effect on the baby. Smoking after the 4th month of
pregnancy causes mental and physical retardation in later childhood, i.e. retardation in the child's reading ability and
in its skeletal growth.
Smoking is known to reduce the size of the baby and therefore its chances of survival. Also, smokers lack
Vitamin B12, since it is used by the liver to detoxify the effects of smoking.
Smoking reduces the oxygen supply to the baby by causing constriction of the vessels in the placenta, causing
intra-uterine growth retardation in the fetus, even passive smoking, that is, inhaling smoke by sitting in a smoke-
filled room, or the husband smoking in the presence of the wife in the bedroom.
Smoking has also been associated with intra-uterine death, premature delivery and rupture of membranes. A
doubled risk of early spontaneous abortion, stillbirth, congenital abnormality, neonatal death, pre-and post-delivery
haemorrhage.
Most women who smoke find that they dislike the taste of cigarettes at the start of pregnancy. It is good for a
woman to stop smoking as soon as she finds that she is pregnant. Research has shown that the first 3 months are
very crucial, and women should not smoke during this time.
Smoking should be given up totally by women suffering from kidney disease, high blood pressure, pre-
eclampsia and bleeding at any stage of pregnancy; also, by women who have lost a baby in the first 2 weeks of its
life and who have delivered a stillborn child. Smoking would interfere with the development and function of the
placenta, so that adequate nourishment and oxygen would not reach the fetus.
Cigarette smoke contains 2 harmful substances, nicotine and carbon monoxide—which do a lot of damage.
Nicotine reduces blood supply to the baby, and carbon monoxide, which is like poison, enters the baby's circulation
because its blood pigment has a strong affinity to it.
Alcohol
Alcohol in pregnancy must be avoided. In the 1960s research began to show that alcohol is teratogenic, that is,
capable of causing malformations in the fetus.
Even moderate drinkers can give birth to babies with Fetal Alcohol Syndrome, that is, babies born with jitters,
irritability, lethargy and weak sucking reflex.
Parents who consume alcohol can have low birth-weight babies, babies with mental retardation, and facial
deformities, including flat features and cleft palates.
Even a single heavy-drinking session can impair the growth of a particular organ of the fetus, depending on the
stage of development reached at that time.
Since social drinking is common, alcohol does not seem so dangerous, but remember, it is as potent as any drug
or medicine taken in the form of a pill. If you are trying to conceive, or if you have just discovered that you are
pregnant, cut out alcohol.
Research as to the safe limit of alcohol consumption in pregnancy is continuing. An occasional glass of wine or
beer for a perfectly healthy mother may be harmless. Recent research has shown that 25% of women having as little
as 2 ounces of alcohol in a week are more likely to have spontaneous abortions as compared to women who do not
take alcohol at all.
Alcohol also damages the liver and uses up the B12 vitamin in the body. It is therefore, best avoided.
Tobacco chewing
Many people chew tobacco either in a pan (betel leaf) or plain. Tobacco leads to contractions of the blood vessels,
so that blood circulation in the uterus and the placenta is impaired. Tobacco consumption during Common Problems
in Pregnancy not only diminishes birth weight and length but increases the risk of stillbirths. It is also associated
with increased loss of male fetus and increased placental weight. It has also been shown that nicotine (a substance in
tobacco) is excreted in breast milk, saliva and urine.
Driving
Driving is quite harmless if you remember to drive slowly and carefully. Avoid braking suddenly or any rash
driving, since you do not want any mishap like the steering wheel pushing into your abdomen.
Digestive Problems
Vomiting and nausea
With pregnancy there is decreased intestinal tone and gastric mobility. This slows down the passage of food through
the digestive system and increases the possibility of the absorption of nutrients. On the other hand, it may be one of
the factors leading to vomiting in early pregnancy and to constipation in later pregnancy.
Vomiting may also be caused by a rapid rise in hormones in early pregnancy. The level of the hormone
gonadotrophin is reduced considerably by the 3rd or 4th month, and this is when a woman tends to feel less sick.
Home Remedies
Things that will help conquer nausea are sucking a lime or peppermint sweet, saunf or aniseed, strong ginger
flavour, sipping iced water, herbal tea, that is, light tulsi or mint tea without milk, or sugar.
A woman may feel nauseous at any time of the day or night. It usually happens when the stomach is either very
empty or very full. So, it makes sense to have 4 moderate meals a day, rather than a heavy lunch and a heavy dinner.
Breakfast, lunch, tea and dinner can each be fairly filling, but should not give a stuffed feeling. Or else, you can have
6 to 7 small meals in a day. You can make sandwiches in advance or keep biscuits, dal sprouts and fruits handy.
Nibbling on a biscuit or toast in the morning, before you get out of bed, helps. Also lying still for about 10
minutes before getting out of bed. Have breakfast 1 hour after waking up.
Avoid tea, coffee, fruit juice, fried and spicy food and alcohol. Eat a banana between meals.
When you find that you can keep something down, resist eating too much at once. Try eating and drinking things
you would not normally eat, in order to find out what you can keep down.
Avoid strong smells. Get someone else to do the cooking. Carbohydrates generally stay down more easily. That
is, bread, biscuits, rice, chappatis, potatoes, etc. Do not worry too much about weight gain. Discard tight clothing.
Your clothes should be comfortable around the stomach and bust.
Home Remedies
A midnight snack is easier to keep down. Keep a snack by your bedside and have it in the course of the night.
Severe vomiting that continues beyond the first 3 or 4 months of pregnancy is called hyperemesis. A woman
with hyperemesis is really ill, since she cannot retain any food. Some psychiatrists and obstetricians feel that it is a
symptom of disturbed relationships, and if a woman can get away from anyone who is causing her stress, the
vomiting will ease off.
It should be a good idea for a woman, who is vomiting at all hours of the day, to get away and live with people
she knows slightly. It is a good time to visit an aunt or a relative in another town. The change will settle her down,
and she will come back to cope with renewed strength.
Although vomiting does not harm the baby or the pregnancy, in some cases the doctor may recommend
hospitalisation. On being admitted the woman will be fed fluids sweetened with sugar or glucose. If the woman has
lost a lot of weight, and cannot keep down the fluid she is being fed, she might be put on an intravenous glucose
drip. The body needs sugar for its daily requirement. In the absence of adequate intake of sugar the body starts to
make acids known as ketones. When these show up in the urine, it is a sign that vomiting is severe and
hospitalisation is necessary.
Heartburn
This is common from mid-pregnancy onwards. Small amounts of food from the stomach re-enter the food pipe since
the stomach valve relaxes and also because of the pressure the growing baby exerts against the stomach. If this
happens several times in a day, a burning sensation is felt in the food pipe. To avoid it happening, the stomach
should not be completely full or empty. In an empty stomach, acid formation causes this feeling. Sips of cold water
should relieve this burning.
To sleep on a full stomach will also cause discomfort. It is a good idea to stay propped up during the night, if it
gets very bad. A few extra pillows or cushions will help you stay more upright while you sleep, and it can be quite
comfortable. Better still, eat dinner at 7.30 or 8 p.m.
Avoid eating spicy or vinegary foods, excessive salads and green leafy vegetables, and alcohol. Have 4 moderate
meals, instead of 2 large meals, in a day.
Flatulence
Flatulence, or wind, is not harmful, but embarrassing. Try keeping away from company when you are passing wind.
Avoid gaseous foods like beans, peas, rich food, and excessive amounts of greens.
Constipation and Piles
In pregnancy a muscle-relaxing hormone, called relaxin, is secreted by the body, which relaxes, among other things,
the digestive system. Relaxing of the digestive system leads to its sluggishness. It therefore requires greater amounts
of bulk in it, so as to aid the movement of food through the alimentary canal. Constipation is therefore common in
pregnancy.
If you find that you have developed a tendency towards constipation, eat less bread, rice and maida. Eat more
chappatis, preferably made of unsieved flour, pulses or dais. Increase the intake of fruits, salads and vegetables.
Bhindi or lady's fingers can be eaten. Dried figs (anjir) are also very good, and easily available at dry-fruit
shops. An increase in fluid intake helps, so drink more water. Drink 2 glasses of water on waking up in the morning.
Isab Gol (fleaseed husks) can be taken regularly. It is available in packets at chemists' shops. Follow the
instructions on the packet. Avoid allopathic laxative pills.
If constipation lingers over a period and is not treated, it can cause veins around the anus to protrude, from
straining that accompanies constipation, leading to piles or permanently protruding veins around the anus.
If piles occur, keep constipation in check and avoid spicy food.
Diarrhoea
This sometimes occurs in pregnancy and it should be reported to the doctor if it persists for more than a day or two.
Iron tablets can cause it in some women. In such cases it can be remedied by simply changing the brand of the
tablets.
Home Remedies
In case of diarrhoea having a mixture of black tea and a slightly over ripe mashed banana helps. One could put
the mashed banana in a soup bowl and pour black tea over it Cool it before having it.
Many women who add lots of fruits and vegetables to their diet find that their stool is a little loose or that they
pass stool twice in a day. This should not be confused with diarrhoea.
Urinary Tract Infection

Frequent urination
In pregnancy one urinates more often as the growing uterus puts pressure on the bladder and restricts the space
normally reserved for the storage of urine. The problem will stay until the birth of the baby. At the most you can
limit the intake of fluids in the evening, so that you do not have to wake up at night too often to go to the toilet.
Urinary tract infection
An infection in the urinary tract causes inflammation of the bladder and urethra, the pipe through which urine is
passed. This is called cystitis. Cystitis is a common complaint that could occur in pregnancy.
The first symptom is usually the desire to pass urine more frequently, sometimes only minutes after having
already done so. Most of the time you will not be able to pass much urine, perhaps only a trickle or not at all. This
can be accompanied by a burning sensation or stinging. When you do manage to pass some urine, it may be very
dark yellow in colour, and in extreme cases, streaked with blood.
This infection is easily caused in women because of the female anatomy; since the openings of the urethra,
vagina and anus are all very close together. Germs from the stool get transmitted very easily to the urethra and
vagina.
Cystitis
It is important to consult your doctor as soon as possible if you have an attack of cystitis, because if it is left
untreated the infection can travel to the kidney and be very painful and dangerous. Cystitis is very easily treated,
once diagnosed early. A course of antibiotics will soon rid the infection.
To relieve the symptoms of cystitis immediately, drink a glass of water every half hour, to dilute the strength of
the urine, and to help flush the infection through, before it gets a chance to take a hold. Any watery liquid will do,
for example, a lemon or barley drink, weak tea, lassi, etc. This helps make the urine less acidic (alkaline urine is
inhospitable to germs) and therefore less painful when passed or excreted.
If you have suffered from cystitis several times before, and think you may be prone to developing the infection
again, there are 2 things you can do to lessen the likelihood of an attack. First, drink plenty of fluids. It is a good idea
to make it a habit to drink 2 glasses of water on waking up in the morning. It will also help relieve constipation.
Second, be more hygienic. Every time you pass stool, wash the anal area not only with water, but with soap and
water; and do not bring your hand forward towards your urethra as you do so. Better still, wash from behind. During
your bath, use soap and water to wash the vaginal area. Similarly wash your anus thoroughly.
Vaginal discharge
It is normal to have increased vaginal discharge in pregnancy, because the glands at the mouth of the womb increase
their output.
The discharge is actually cleansing the vagina and keeping it free of infection, as well as lubricating the tissues
of the vagina as they become thicker, softer, and more elastic in preparation for birth. During subsequent
pregnancies the discharge will be less. Make sure you wear cotton underwear to allow your skin to breathe.
If you notice a change in the discharge from white to yellow or green, and if it causes itching or irritation,
becomes thicker or smells unpleasant, you probably have an infection. It is a minor, harmless infection called thrush,
Candida or monilia.
It is easily treated with creams or pessaries, under the doctor's guidance. Sometimes the pessaries may be
supplemented with antibiotics. Early treatment is desirable to prevent future complications.
During the advanced stage of pregnancy, that is, if your baby is due within a month and you have a discharge
that looks like the beginning of a period, a thick mucus discharge, tinted with dried blood (pink or brown), it is a
sign that your body is getting ready for birth. Take it as a signal. It is just that, and not an emergency.
Conditions Needing Special Attention

Vaginal bleeding
In early pregnancy, vaginal bleeding may be caused because the level of your pregnancy hormone is not sufficiently
high to stop your period. The bleeding will be scanty and it will occur when a period would have been due. Such
bleeding is not a miscarriage. The doctor may give an injection of progesterone hormone or advise bed rest.
Sometimes a few drops of blood may appear after intercourse, or a vaginal examination by the doctor.
Late in pregnancy bright-red bleeding, like that which flows at the height of a period, is serious, although quite
rare. It can be caused by the placenta, the organ that nourishes the baby, detaching from the wall of the uterus. The
seriousness will depend on how large a portion of the placenta has separated from the uterus. The doctor should be
informed immediately
You might be advised to go to the hospital for bed rest. Lying down increases the blood flow to the uterus and if
the placenta is not firmly rooted, gives it a chance to root itself firmly to the wall of the uterus. If bleeding stops and
all is well with the baby, you will be permitted to go home in a few days. In this case it is wise to avoid intercourse
and orgasm until after the baby is born.
Sometimes bleeding is caused by the placenta lying too low between the baby's head and the mouth of the
womb. This is called placenta previa and means delivery by Caesarean section. It could also mean bed rest, at home
or hospital, before the birth of the baby.
Any physical movement such as running or jumping can temporarily raise the blood pressure, but it returns to
normalcy after a period of rest.
Excessive weight gain could raise blood pressure. Also, a stressful lifestyle, or a nervous, easily agitated and
highly strung person, tends to be prone to blood pressure. It is therefore important to rest when you feel you are
getting tired and tense. Avoid unnecessary nerve-racking activity like watching a late night horror/violent movie.
Rising blood pressure will be a cause for concern to your doctor. At every visit to your doctor, the blood
pressure is measured, the reason being that rising blood pressure could herald the beginning of certain complications
of pregnancy, such as toxaemia, which need special attention and care.
If the diastolic blood pressure (the lower figure of the recorded level, e.g. 120/70) rises by as much as 20, you
are considered to have high blood pressure or hypertension. Bed rest will be prescribed, since the placenta will work
more efficiently if you stay in bed. In late pregnancy, many obstetricians induce labour if the diastolic reading of
your blood pressure rises up to 90 or above.
If you have high blood pressure, try taking a warm bath before going to bed at night. It will help you relax and
sleep better.
Toxaemia and Pre-Eclampsia

Toxaemia: When rings do not fit
Toxaemia usually occurs only during the last few weeks of pregnancy and is recognised by 3 typical symptoms. Any
of these symptoms appearing by itself does not mean you have toxaemia. It is only when they appear together that
they spell toxaemia. The first symptom is increased blood pressure. The second sign is swelling of hands, feet and
face, the third sign is the appearance of protein in the urine.
These are warning signals. If they are not heeded, convulsions may occur. The toxaemia has then become a
serious condition known as eclampsia. Vigilant pre-natal health care can prevent this condition or make it less
serious. Once a woman is excreting a high proportion of protein in her urine, pregnancy is not likely to continue for
longer than 2 weeks.
A well-balanced diet, with more protein and less carbohydrates and salt, reduces the incidence of toxaemia. Rest
will also help.
If symptoms continue, the woman is usually put into a hospital for further treatment, and if necessary, early
delivery of the baby. However, once the conditions are identified, complete bed rest in hospital with careful
monitoring of the symptoms is usually enough to prevent it from getting worse.
Toxaemia can harm the unborn baby. If it progresses unchecked, it can cause the placenta to fail, and lead to
premature labour before the baby is mature enough to survive. When toxaemia becomes eclampsia, it can cause fits
and coma. The following are signs of eclampsia: headache, flashing lights, nausea, vomiting and pain in the
abdomen.
Toxaemia and eclampsia should not be taken lightly. Starting as a minor ailment they can develop into a
dangerous disease.
Anaemia
In pregnancy, blood tests are taken to find out the haemoglobin content. Haemoglobin is present in the red blood
cells, and is the means by which oxygen is conveyed from the lungs to the cells in the body, including the baby in
the womb. If there is not enough haemoglobin in the mother's blood, there may not be enough oxygen reaching the
baby for its optimum growth and development.
Haemoglobin levels tend to drop in pregnancy, since the fluid volume of the mother's blood increases, so that
more fluid-carrying nutrients become available to the baby. However, if the haemoglobin falls below 9gms/100ml, a
woman is considered anaemic.
Home Remedies
To increase haemoglobin levels, soak one raisin (kishmish) overnight in water. In the morning boil it in a cup of
milk, then drink the milk and eat the raisin. On day two soak 2 raisins overnight in water. In the morning boil
them in a cup of milk, then drink the milk and eat the raisins. Likewise go on to 3,4,5,6,7,8 and finally 9 raisins.
Then go back to 8,7,6,5,4,3,2, and finally one raisin.
On completion of 18 days your haemoglobin level is likely to rise.
Source: Anand P Verma,
Accupressurist
A woman who is anaemic feels tired, exhausted, irritable, lethargic, weak and over worked, even though she
may be doing little physical work. She might also experience shortness of breath and dizzy spells.
If a woman is found to be anaemic, she should increase her daily intake of iron, until the required haemoglobin
level is reached. This can be done by taking a course of iron tablets, and by adding iron-rich foods in the diet.
Foods rich in iron are green cabbage leaves, cauliflower leaves, mustard leaves or sarson, leafy greens, ganth
gobhi or knol khol greens, mint or pudina, dhania or coriander leaves, jaggery, eggs, etc. Although spinach has iron,
most of it cannot be used by the body, because other substances present in spinach block absorption of iron by the
blood.
If a woman avoids putting on too much weight in pregnancy, she will need less haemoglobin to sustain her body.
Unnecessary weight gain requires extra blood, haemoglobin, oxygen and nutrients, thus overworking all the
mechanisms of the body. Hence, excessive weight gain always works to your disadvantage.
Rhesus-negative
All blood is either rhesus-negative or rhesus-positive. You run a risk only if you have a rhesus-negative blood group
while your husband has a rhesus-positive blood group. A routine blood test at the beginning of the pregnancy will
show whether you are rhesus-positive or negative. There is no symptom of rhesus incompatibility that you will
notice.
If you are a rhesus-negative mother bearing a rhesus-positive baby, some of the baby's red cells may leak into
your blood circulation. This is most likely in late pregnancy or at the time of delivery. Your body responds to the
baby's blood as it would to an invader and your natural defence mechanisms will produce antibodies against it. If
these antibodies leak back to the baby's circulation, they can destroy a large number of the baby's blood cells and
cause severe anaemia and jaundice in the newborn.
In the first baby there is not enough time for this to happen, since the leak mostly occurs at the time of delivery.
But the mother's antibodies can damage the blood cells of any rhesus-positive baby carried by the mother in future.
The antibodies can vigorously attack the baby's blood so that the baby might get anaemia, jaundice or brain damage
and may not survive.
In order to avoid this happening, an injection of anti-Dimmunoglobulin can be given to a rhesus-negative mother
in pregnancy or immediately after the birth of a rhesus-positive baby. This injection is a serurn which is to be given
within 48 hours after the birth of a baby. It stops the mother's biological defence mechanism from acting against the
foreign rhesus substances. A fresh injection is given after every deli very, miscarriage or abortion. It is possible for
blood from an aborted fetus to enter the mother's bloodstream.
German Measles, Rubella
This is a mild but very infectious disease that lasts a few days. It is caused by a virus and may cause a slight rash and
fever, sometimes accompanied by swollen glands and aching joints. On the other hand, it may go unnoticed. The
rash is the main sign, and lasts only 12 to 24 hours. If you fail to see a doctor when the rash occurs, a blood test
taken 2 weeks later will show a high-level of antibodies from recent infection and confirm the diagnosis.
Rubella has grave consequences for the unborn child. If you suffer from it in the first 3 months of pregnancy it
may cause deafness, blindness, and congenital heart disease or any other type of abnormality. Later in pregnancy the
risk is much less, and could be restricted to deafness. The virus may also cause a miscarriage, low birth-weight baby
or stillbirth. If you catch rubella in the first 3 months of pregnancy, your doctor will advise a medical termination of
pregnancy.
If you have been in contact with someone who has measles or has recently had measles, or who develops
measles within 2 or 3 days of seeing you, consult your doctor. A couple of blood tests done 2 weeks apart will help
the doctor decide whether the pregnancy should be continued or terminated.
Do not be shy to avoid relatives or friends when they have measles in the house. Tell them it is doctor's orders.
Absent yourself from your place of work if there is measles there.
Mothers should immunise their daughters against rubella when they are around 10 to 14 years of age.
If you are not sure whether you have had rubella, a blood test for rubella antibodies will make it clear. If a blood
test shows that you have never had rubella, you can be immunised after your baby is born, to avoid worry in future.
However, the inoculation should not be taken in pregnancy, and once taken in the non-pregnant state, conception
should be avoided for next 3 months.

5.

Diet in Pregnancy and After
Eating for Two

There is a common belief that a pregnant woman should eat for 2 people. This is not necessary, but it is essential to
eat the right food. (One needs to eat nutritious food. Everything that you eat should have good food value, that is,
one should eat for 2 but not twice as much.
We may live without books -

what is knowledge but grieving?
We may live without hope -
what is hope but deceiving?
We may live without passion -
what is passion but pining?
But where is the man that
can live without dining?
Owen Meredith
A Parasite
The baby within is like a parasite; that is, it takes the nutrients it requires, regardless of whether you have enough or
not. It takes, for instance, enough iron to store in its liver for the first 3 months of its life, not to mention the iron it
uses up for the formation of its blood.
Then it takes calcium from your body to form its bones and the foundation of its teeth. If you do not consume
enough calcium, it is going to take calcium away from your bones. You cannot afford to let this happen, for you will
need good health and strength to look after your baby after it is born. So you must make it a point to eat well.
Foods You Need

The foods you need to take are those rich in iron, calcium and proteins.
Iron
Iron is present in green leafy vegetables. It is a good idea to keep pudina or dhania (mint or coriander) chutney
handy. Make small quantities of it and store in a covered bottle in the refrigerator. Prepare it every 3rd or 4th day.
Two teaspoons of chutney a day will meet a good part of your daily iron requirement. You can use it instead of
butter to spread on bread when making a sandwich (see p.58). Iron is also present in kishmish or raisins. It is present
in gur or jaggery and powdered brown sugar, which is different from caramelised white sugar. It is present in any
dish cooked in an iron pan. However, food cooked in an iron pan gets black, unless the pan is treated with a thin
layer of oil, and heated before being used for cooking.
Dried fish is especially rich in both iron and calcium. So are yeast tablets, radish leaves, knol-khol or ganth
gobhi leaves, kerae or leafy greens, cauliflower leaves, etc.
The iron in spinach is not easily absorbed. Vitamin C promotes iron absorption.
Soyabean, kabuli channa or whole bengal gram, kala channa or horse gram, rajrna or kidney beans, sabut
moong or green gram are also rich in both iron and calcium.
Also, if you do not sieve the atta or flour before making chapattis you will get iron and Vitamin B from it.
Clean, wash and dry wheat for this purpose, before sending it to the flour mill. If you lack the time, buy the cleaner,
more expensive wheat.
Calcium
Calcium is available from milk and milk products. You must drink about 3 glasses of milk in a day. You can have
milk in whichever form you like. As curd, cheese, paneer, custard, buttermilk or lassi, even curry made from curds.
Calcium is also present in green leafy vegetables. But if you have gas or flatulence, heartburn or sour burps, you
should not have too much of green leafy vegetables. About one tablespoon at a time is enough.
Eggs and lemons are a good source of calcium. Lack of calcium in the long run makes you weak. It can also
cause severe backache or cramps. It causes irritability, for its lack causes the nerves to twitch. It is a good idea to
take a cup of hot milk before you sleep.
Protein
Protein is the body's building material. You need protein not only to build a baby's body but also to look after the
wear and tear and maintenance of your own body.
If you have an egg a day, and pulses or dais with your meals, you should get enough proteins.
However, if you are a pure vegetarian and do not eat eggs at all, you must take care to see that your diet contains
adequate protein. Dais are a good source of protein, but not the best.
The best source is a mixture of dal and wheat. A combination of dal and wheat is complementary, since together
pulses and wheat provide a mixture of all essential amino acids or proteins. A mixture of dal and rice is also a good
source of protein.
For non-vegetarians who eat meat at least thrice a week, the protein intake is adequate. But if you eat meat only
when you eat out or entertaining at parties, you should consider yourself to be a vegetarian.
Another good source of protein is milk and milk products, that is, paneer, curd and so on. Nuts like peanuts or
moong phali, almonds or badams, cashewnuts or kajus, etc., are also a good source of protein. Badam traditionally is
considered superior to other nuts, but nutritionally it is of no superior value. Nuts also have a fair amount of fat.
Channa too is a very good source of protein, be it channa dal, besan, or the roasted channa sold by
channawalas. Channa is a good thing to keep handy to eat between meals. You can eat it instead of biscuits or fried
namkeens. It will be better for your figure as well as for your nutrition. You can keep channas mixed with little
pieces of jaggery in a jar to eat when hungry. While channa will provide you with protein, jaggery will provide you
with iron.
Another good source of protein is soyabean and soyabean products. You can get soyabean products in the
market. All you have to do is soak the soya nuggets or granules in warm salt water. Prepare your favourite masala, it
could be onion, capsicum, tomato. Then squeeze the nuggets or granules thoroughly and add them to the masala,
when it is done. It makes a nutritious dish. You could also add the nuggets or granules to whichever vegetable is
made, to increase its quantity and nutrition.
Or else you could buy soyabean in 1 kilogram packets, soak them overnight like kidney beans or rajrma, and
cook them in a similar way, in a gravy, the next morning.
Further you could buy about 5 kilograms of soyabean, have it ground into flour or atta at the flour mill or
chakki, and store it separately at home. When you knead your flour for chapattis, add a handful of the soyabean
flour to it. There will be no difference in taste, and the whole family will get more nutrition.
Wholesome Foods
A cereal, pulse and vegetable mixture makes a very wholesome meal. For example, dosa or idli with sambhar and
coconut chutney.
Another such combination can be made with parathas. If you make a dough of half besan or chick-pea flour and
half wheat flour and add to it chopped radish or mooli leaves or green cabbage leaves, it will make quite a
wholesome meal. Also, a paratha made of a mixed flour of wheat, horse gram or kala channa and barley or jawar
with radish or cabbage leaves chopped in it is good. These parathas are a meal in themselves and can be eaten with
curd for breakfast, lunch, or dinner.
Pickles have a high concentration of salt and are to be avoided if you are getting swollen hands and feet. Butter
should be avoided if you are overweight.
Food groups at the bottom of the pyramid nourish your body well.
Food groups on the top of the pyramid damage your body when taken in excess.
Another nutritious food is sprouted whole green gram or moong dal. It is best eaten raw. Cooking reduces its
food value.lt has protein and Vitamins B and C Clean, wash and soak the dal at least 4-5 hours in summer and 8-10
hours in winter. You could soak it overnight. Then drain the water and place in a large jar. Tie a cloth over the
mouth of the jar. Pour water and drain out, not leaving any water in the jar. Repeat twice more during the day. In a
day or two it should sprout. It can be added to chopped salad, to cucumber cubes or grated radish. It can be sprinkled
on vegetables or added to sandwich fillings. It can be made into a savoury by itself, by adding lemon juice, chopped
onions, coriander, green chillies and salt. You can sprout any dried beans or pulses in a similar fashion, for example,
horse gram or Kala channa, Egyptian lentil or sabut kala masoor dal, etc.
Sprout Farms
A 'sprout farm' of acrylic trays is available in the market. You place soaked lentils in the trays and pour a glass
of water on the first tray. It drains to the trays below and sprouting occurs.
Potato is a highly misunderstood vegetable. Although potatoes do have carbohydrates, they are 99.9% fat-free
and 100% cholesterol-free. They have vitamins B and C, and some proteins. Boiled potatoes are a good and cheap
source of nutrition. Potatoes become fattening only when they are fried. At tea time one can have boiled potatoes
with salt, chopped onions, lemon juice and chopped mint or coriander leaves added to them. Potatoes contain more
moisture or water than cereals; therefore they contain fewer calories as compared to cereals.
If you keep boiled potatoes in the fridge, they can be handy when you need a quick bite, but lack the time to
cook. Do not skin or cut potatoes before you boil them; that way they lose nutrition. Boil them in their jacket. When
boiled, the skin should not break.
Then there is the highly recommended category of seasonal fruits and vegetables. Guavas, oranges,
watermelons, and bananas. Cabbages and carrots eaten raw will give you vitamins and minerals.
Tea, Coffee and Cola Drinks and Chocolates

Excessive amounts of tea, coffee and cola drinks and chocolates should be avoided. They contain caffeine and other
related substances like tannic acid, which impair and upset digestion.
Caffeine is a diuretic, that is, it causes more urine to be passed. This also washes away essential salts and water
soluble vitamins. Further, it reduces absorption of iron and calcium. It can also cause sleep disturbances, anxiety and
heartburn.
The amount of caffeine present in a cup of tea or coffee depends on the quality used and the amount of time
taken to brew it. The more bitter it is, the more the caffeine content.
To Avoid Putting On Too Much Weight

You must make sure you do not eat out of compulsion when you get tense. Instead, have a warm water bath with a
spoonful of salt added to it. It is very relaxing. Or, start some activity like tidying your cupboard, baking a cake,
embroidery, making pickles, etc.
Avoid white sugar as far as possible. Palm sugar and sugar made from powdered jaggery have nutritional
elements in them; but white sugar is so overprocessed that 99% of its non-carbohydrate constituents are taken away
from it, and it ends up as a plain energy-giving carbohydrate.
Methods of Cooking
Steaming is the best method of cooking as loss of nutrients is minimal. Boiling is good only if the water in
which food has been boiled is also consumed. Frying, overcooking, and reheating cause a loss of nutrients and
are best avoided.
Sugar is quickly digested, and is readily absorbed by the body, giving a tremendous lift of energy. This lift lasts
until the sugar gets used up, and immediately one feels like eating something sweet again, to get over the low feeling
that follows. So you develop a sweet tooth. What you do is that you inhibit the body's ability to produce the
necessary energy from all other food. The body takes energy from sugar instead and the other energy is converted
into fat. This would also apply to women who have several cups of sweet tea or several glasses of cold drinks a day.
If you feel you are developing a sweet tooth, the first thing to do is to have naturally sweet things instead.
Example: Jaggery, raisins, mango, chikoo, honey, dates, etc. These sweet things will also give you nutrition, along
with sweetness. Avoid chocolates, sweets, lollipops, ice creams, cakes, pastries, etc. Then switch to substituting a
few sweet things with cheese, channa, apple, carrot, cucumber, sprouted moong dal, etc.
Gradually wean yourself away from your addiction for sweet things. Make it a slow but sure process. Be gentle,
but firm, with yourself and you will find that you have retrained your taste buds by the end of it, and your desire for
sweets will have diminished.
Do not use sweetex or other sugar substitutes. Remember, you are trying to cultivate a new taste. It is hard to
stop craving for sugar if you take artificial sweeteners.
Avoid excessive oil in your cooking. Reduce the number of deep fried things you eat. For example, chips and
pakoras, puris, fried namkeens, fried papads etc. When you have made a vegetable, there should be no oil left in the
serving dish after the vegetable has been eaten. If oil remains, it is a sign that the oil used was in excess. Also, when
you make curries, there should be no oil floating on the surface of the curry
Kidney beans or rajma, chick peas or kabuli channa, horse gram or kala channa, all kind of pulses or dais can be
boiled with salt, turmeric, garam masala, onion, ginger and a teaspoon of oil; and eaten with vegetables and
chapattis. Avoid fried masalas in them. Thick rich masala curries are fattening. So are white sauce, thick soup,
mayonnaise and foods laced with creamy sauces. All highly refined foods should be avoided, because most of the
goodness or nutrition has been taken away from them. Maida and sugar-based foods would come under this
category; also samosas, cakes, noodles, white bread, jalebis, jams, rice, kachoris, mathris, etc.
Interestingly, khoya, besan and paneer-based Indian sweets also give protein, apart from being loaded with
sugar. Bengali mithai, ladoos, rasgullas, channa murkhii, barfi, patisas, are some examples.
If you tend to eat a lot at meals, fill yourself with lassi, raw vegetables or fruit. Do not add ghee to your dal or
chappatis
Body Weight
How much weight should a woman put on in pregnancy is a matter of great interest and controversy. Earlier the
permitted weight was 9 to 10 kg. Then it became 12.5 kg and now it is accepted that it may be a little higher than
12.5 kg.
Estimate of Expected Weight Increase in Pregnancy

Fetus and placenta 5.0 kg
Water 1-1.5 kg
Uterus 0.5-1 kg
Breasts 1-1.5 kg
Fat storage in tissues 4-4.5 kg
Total expected weight gain 13.5 kg

Source: Obstetrics Illustrated,
Churchill Livingston, 1980
If at the start of pregnancy you were underweight, you can take the advantage of putting on more weight than a
woman who started pregnancy being overweight. If you have a tendency to gain weight more rapidly than other
women, you will have to be careful with the weight increase.
One thing is for sure, pregnancy is not a time to diet or try and remain slim. If you do so, you will be harming
the baby.
All the weight you put on is not added to you, it is needed by your body to support and nourish the baby. After
birth, a lot of fat laid down in the tissues is used up to breastfeed the baby. Women who do not feed their babies find
it difficult to lose the weight they put on in their tissues; that is, on their hips, back, thighs, etc.
Percentage Weight Increase During Pregnancy

On an average a woman puts on a total of 25% of her nonpregnant weight.
In the first 3 months of pregnancy there may not be any weight gain. Weight might actually fall as a result of
nausea, vomiting and loss of appetite. Gain in weight usually starts in the 3rd month. Weight gain up to the 5th
month is not usually very great. It could account for 25% of the total weight increase. The greatest increase occurs in
the 5th, 6th and 7th months. However, it should not exceed 1 kilogram in any 1 week. Excessive weight gain at this
time is associated with toxaemia and the doctor may ask you to watch your weight if she finds the weight gain
excessive. After 7½ months the rate of weight increase slows down until the 9th month after which there is very
often no weight gain in the last 4 weeks of pregnancy.
According to Dr. Tom Brewer, an American obstetrician, nutrition is important. His theories are based on a
series of controlled antenatal experiments, and go against the widely held belief that the baby is a parasite, and takes
whatever it needs, regardless of the mother's nutrition. He believes that even mild degrees of under-nutrition in the
mother especially in the last few weeks of pregnancy, can interfere with the normal growth and development of the
baby's brain. He and his wife discuss this in their book, What Every Pregnant Woman Should Know, New
York,1979. Many doctors now feel that even 16 kg (35 pounds, and up is a reasonable weight gain for some women.
In case of twins, 18 kg and above (40 to 50 pounds) weight gain may not be excessive.
Estimated Rate of Weight Increase

1 to 3 months No weight gain
3 to 5 months 25% of weight increase
5 to7½ months 50% of weight increase
7½ to9months 25% of weight increase
9th month No weight gain.
When a mother is undernourished, her uterus and placenta do not grow enough. The baby will weigh less than
the normal birth weight of over 5½pounds. During delivery, contractions may be poor. Delivery may have to be
induced and Caesarean section is often necessary.
Diet in Labour
There is a widely held belief that if you have a glass of milk with ghee, or have almond or badam milk before going
to the hospital, it helps. However, once labour is established (i.e. when one contraction lasts a whole minute), your
digestion slows down greatly and the body concentrates on the birth.
At this stage of established labour, if you have eaten something heavy, it will remain in the stomach and make
you feel like vomiting. On the other hand, light things eaten in labour will get digested and will have passed through
the stomach, giving your body energy.
Therefore if you have started labour and are hungry, eat something light, like glucose biscuits, sago, beaten rice,
toast with jam. In other words, eat carbohydrates and avoid fat and protein.
Above all, learn to listen to your body; if you feel like eating, eat something light. If you do not feel like eating,
don't. You can have sips of water with sugar, glucose or honey mixed in it, if you feel you need some energy. These
things do not need time to get digested and get absorbed immediately by the body, giving you instant energy. Mishri,
toffees, sweets, lollipops can also be had. Tea, coffee or nimbupani should be avoided as they cause a lot of acidity
which can be a problem, if anaesthesia has to be administered.
If your labour is well established, you will simply not have the desire to eat, even if your favourite dish is placed
before you.
Diet when Breastfeeding

Remember, when you are pregnant or when feeding the baby, you need a lot of nutrition; so it is a wrong time to
diet. A woman who is feeding the baby needs more calories than a woman who is pregnant. In pregnancy, a woman
needs 300 more calories than she normally would, whereas a woman feeding a baby would need 550 more calories.
Most women who feed their babies do feel ravenously hungry; a fact that shows you the importance of listening
to your body and having faith in it. If you feel hungry, you must eat. A newborn baby needs about 120 calories per
kilo per day, and weighs about 3 kilograms. Therefore the baby should get about 360 calories from milk. The mother
uses more than 400 calories to nourish the baby.
In fact, a lot of weight that you put on during pregnancy consists of fat deposits, placed by nature, to be used up
while feeding. If you continue to eat wisely, you can lose weight while feeding.
A woman feeding a baby should avoid too many spices, since these could give a peculiar smell to the milk,
making it repulsive to the baby. She should drink plenty of fluids in any form, be it milk, soup, nimbupani or lassi,
to make up for the loss of her body fluid in making breast milk. She does not need to drink lots of milk to make
milk. In a relaxed mother the milk flows more easily. Less water does not reduce the amount of milk produced, but it
makes mother's urine very concentrated which is unhealthy for her.
A woman feeding a baby can have a normal non-spicy diet, with greater concentration on pulses, green
vegetables and milk.
Alcohol and cigarettes are to be avoided. But a glass of beer or wine is permissible as both have a very low
alcohol content, which relaxes the mother. Beer being barley based increases milk supply.
Our Traditional Recipes

A word about our traditional recipes of ladoos, panjiri, dry fruit or mewa, jaggery, or whatever else you may make,
to feed a woman who has just delivered a baby. They contain ingredients that are traditionally believed to be
beneficial to a woman who has just delivered a baby.
The point is to have the traditional recipes in moderation. Eat about 3 to 4 tablespoons of panjiri, or ½ or 1 ladoo
with your early morning tea, when you know that activity will follow; or after a period of activity. Do not eat it as
dessert after dinner and go to sleep. That is the best way to put on weight.
To Get the Maximum Goodness from Your Food

■ Clear vegetable soup is very nutritious. All the vitamins, minerals, proteins, etc. from the vegetables are
passed into the soup. Thick soups are not good, as flour and fat are used to thicken them.
■ Greens, like kerae, palak, methi, sarson, bathua, cholai, should be washed first and then chopped. If you cut
them first and then wash them, you will lose most of the water-soluble vitamins while washing.
■ Keep your vegetables away from heat and light. Heat and bright sunlight destroy some of the vitamins.
Further destruction comes with cooking, so that by the time you eat it, a fair amount of vitamins are lost.
Boil potatoes whole.
■ With fruits and vegetables avoid peeling if possible, or peel lightly, e.g. carrots, apples, pears. Wash
vegetables and fruits before peeling, not afterward.
■ Do not overcook vegetables; keep them crunchy. Try and cook just before eating, in order to avoid reheating.
Avoid storing cooked vegetables in the fridge for more than 24 hours. When you reheat food, first leave it
outside the fridge for about ½ an hour so that the change of temperature is not too sudden. Avoid over
cooking vegetables to death. Steaming in the pressure cooker protects vitamins.
■ It is best to use stainless steel utensils for cooking, since it is a metal that does not react to the food, like many
other metals do. If you do not have them, the next best thing is to transfer food into stainless steel or plain
glass bowls as soon as it is cooked.
Overeating of anything heavy like ice cream, chocolates, mithai or pastries can make you put on weight, so why
blame panjiri?
An interesting example illustrating the wisdom of our traditional practices comes to mind, in parts of South India, a
woman who has delivered a baby is given water to drink in which an iron rod has been boiled. This makes it a
wonderful iron rich drink. On account of monthly periods and childbearing, women generally lack iron and therefore
are often prescribed iron tablets. Boiled water would also be safer to drink, since boiling destroys germs or infection
present in it.
Ghee
If you take ghee regularly, but do not do much work in the house and do not go for regular walks either, it could
result in extra weight and stiff joints, making delivery difficult. However, if you are active and if you are not
overweight, and if you do not have any cholesterol problem, you can go ahead and have ghee.
A Recipe
YOU WILL NEED:
ghee (clarified butter) ............. 1 tbsp
sooji (crearn of wheat) ............ 1 tbsp
chotti elaichi (small green cardamom) ....... 1
badam (almonds)........... 2 to 3
milk ......................... 1 glass
sugar......................... to taste
METHOD
Warm ghee, add sooji to it and cook till light brown. Add milk and bring to a boil. Cook on a slow fire for 5
minutes so that the ghee blends with the milk. Add sugar, crushed elaichi and badam. Drink while hot the first
thing in the morning starting from the 9th month and continuing till the birth.
Source: Sonia Bajaj
Over the years several women have said that eating butter or badam rogan or ghee in the last month of
pregnancy helped them to have an easy delivery. This needs to be medically validated.
As such fats in the diet help in the absorption of fat soluble vitamins A,D,E and K.
All these factors could be of significance in relation to childbirth. For instance, keeping infection away would be
useful, strong bones and good skin, and blood that clots could all be of enormous help.
1 gram of ghee has 9 calories. 1 tablespoon of ghee has 15 grams of ghee and therefore 135 calories. According
to Dietary Guidelines for Indians published by the National Institution of Nutrition, Hyderabad, 1998, 'Visible fat
intake should be increased during pregnancy and lactation to 30 grains and 45 grams respectively.'
15 grams of fat therefore falls within permissible limits. However, for today's aware, weight-conscious women,
who do not want to put on too much weight, here are a couple of tips. When you add one tablespoon of ghee or
butter to your diet in the 9th month, you can avoid other intake of calories like puddings, chocolates, cold drinks,
foods with thick gravies, fried foods etc. Or else you can increase your calorie expenditure by going for long walks,
which will also be beneficial in preparing your body for an easy and natural childbirth.
One could have a tablespoon of pure home made butter or a tablespoon of pure home made ghee in the last
month of pregnancy. Butter could be consumed with chapatti, paratha or dal. The ghee could be had in a cup of hot
milk, sweetened as preferred.
Tips on Weight Control
■ Learn to relax before a party. When you are relaxed you will not have an urge to reach out for snacks. When
you are jittery, you will tend to eat more. Lack of sleep and rest, the caffeine in coffee and colas can make
you jittery. Apart from the jitters, anxiety makes you overeat. When you are anxious about some problem,
you tend to find comfort in food. It is therefore important to eat at regular hours and not munch between
meals. If you reach out for food every time you feel anxious, you will aggravate your weight problem and
looking at your overweight self will lead you to further despair. It will give you a poor self-image and lack
of confidence. You will tend to console yourself further with food.
■ If this applies to you, you should learn to take responsibility for your body and its needs. You should be in
control of your food and not let your food control you. This does not mean that you should starve yourself
for long periods and then overeat. If you do starve yourself, you are most likely to overeat, because when
no food has been eaten, the blood sugar level drops and you crave for food. Therefore it will not be
surprising if you lose control. Never skip a meal. Regular eating habits protect you from hunger pangs that
make you reach out for the wrong foods. More important, regular food intake makes the body function
more efficiently.
■ Do not go where you know you will find temptation. At weddings and parties, do not stand near the table
laden with fattening food. At home, serve yourself in a thali and eat, rather than dipping into dishes just to
taste, or just to finish that little bit of rice or chapatti or to give others company, or to finish left-overs, to
finish a dish full of expensive ingredients, or to clean up your child's plate; the list is endless.
■ Eat slowly, take at least 20 minutes over your meal. It takes about that much time for the stomach to tell the
brain it is no longer hungry. Chew slowly, at least 20 times and savour each mouthful. It will give you
greater satisfaction from your food.
■ Weigh yourself regularly on the same weighing scale. Don't fool yourself that a few kilos here or there is not
much. Think of the stuff you buy in the market. 5 kilos is a lot of weight
■ Do not talk about your efforts to change your food habits, as people will try and talk you out of it. If you are a
compulsive eater, keep the right kind of snacks around; moong sprouts, boiled potatoes, carrots, cucumber,
seasonal fruits, channa.
■ Learn to drink plain, clean sparkling water instead of tea, coffee, sherbets, colas, etc. Set yourself a goal as to
what weight you want to achieve. Then work towards it steadily. Do not encourage people to pamper you
with food.
■ There is an interesting book called Dieting Makes You Fat (London, 1984), by Geoffery Cannon. The author
has spent dozens of years of his life following various diet plans. According to him, frequent dieting gives
the body starvation signals, and when food is once again available the body reacts by overstoring, being
unable to differentiate between a weight loss regime and serious food deprivation. He further says that the
rate of the breakdown of food is considerably reduced while dieting, as this is one of the survival tactics the
body uses when food is scarce. This sluggish metabolism makes weight loss more difficult.
■ Constant yet moderate eating habits, with occasional indulgences on weekends, is the best path to try and
follow. It is a good idea to consult an expert on nutrition to chalk out a diet for you in accordance with your
taste and preferences. Nutrition experts can be found in Home Science colleges, hospitals and nursing
homes and in weight reduction clinics. They take into account your lifestyle. Do you cook and do other
housework or are you physically inactive? They will consider whether you are pregnant, feeding the baby,
or are just a simple housewife? Are you a vegetarian or a non-vegetarian? Taking all these factors into
account, a diet chart will be made up specially for you.
■ And lastly, if you are putting on weight in leaps and bounds, although you are not eating much, get yourself
checked by a doctor for any physical problem like malfunction of the thyroid gland.

6.

Some Simple Exercises
During pregnancy, certain exercises should be done, keeping in mind the limitations and the needs of the pregnant
body. The following exercises are recommended.
STEP1
Sit cross legged on a firm surface, be it a carpet, dari and/or blanket. As you sit cross-legged, become aware of
the areas of your body that are touching the ground.
STEP 2
Now imagine that you are a plant, and from the areas of your body that are touching the ground, imagine that
there are roots growing down into the ground. Your backbone is like a stem that rises straight and strong out of
the ground. Your head on the top is like a flower on the top of the stem and it reaches up towards the sun. Feel
the top of your head reach up without raising your chin.
STEP 3
Breathe in slowly and deeply the nourishment from the roots straight up to your head and slowly exhale.
Imagine you are exhaling all your tensions with your breath.
Do this for 2 minutes.
Grounding
This exercise will help you sit up straight in the correct posture to do your exercises. It will also calm you and
quieten your mind before you start your exercise regimen.
Neck Exercise
In order to mobilise and strengthen the neck and shoulder muscles, the following exercises are helpful. It also helps
relieve tension in the neck and shoulder muscles.
STEP 1: Sit cross-legged with the back straight. Keep the head and the neck in one straight line.
STEP 2: Incline the head slightly downwards, so that the chin moves towards the chest.
STEP 3: Then straighten the head again and take it backwards with your mouth open, so that you are looking at the
ceiling. Close your mouth, feeling the stretch in front of the neck and hold the position for a count of 6.
STEP 4: Bring the head back to starting position.
Do this 3 times.
Shoulder Rotation
Good for the upper back This exercise helps relieve pain in the upper back and nape of the neck.
STEP 1: Sit cross-legged with the back straight. Keep the head and neck in a straight line.
STEP 2: Bring shoulders forward.
STEP 3: Raise shoulders up to your ears.
STEP 4: Thrust shoulders backwards, so that chest juts outwards.
STEP 5: Bring shoulders back to starting position.
STEP 6: Repeat these movements in one fluid motion, so that you make a circle with your shoulders.
STEP 7: Make circles in the opposite direction.
Do 5 circles in each direction.
Deep Breathing
This is not a simple exercise. You are exercising all the muscles of your carriage. It provides a lot of oxygen to you
and your baby. Besides, when you breathe in, the diaphragm presses on the abdominal organs, massaging and
invigorating them
POSITION
Sit cross-legged with the back straight. Keep the head and neck in a straight line.
STEP 1: Take a short breath in, then exhale slowly through pursed lips, to the maximum.
STEP 2: Let your lungs naturally fill up with air when exhalation is complete.
STEP 3: Breathe normally for about 3 breaths.
STEP 4: Repeat the first 3 steps.
Do this 3 times.
It is best to do this exercise early in the morning near plants (since when the sun shines, plants make oxygen).
Moreover, exposure to the morning sun makes Vitamin D which helps in calcium absorption. There is also less dust
and vehicle exhaust in the atmosphere at that time.
Bust Exercise
Exercises the pectoral muscles and helps lift and firm the breasts.
STEP1: Sit cross-legged with the back straight and keep your head and neck in a straight line.
STEP 2: Join both palms together under the breasts like a namaste away from the body in a flat position, that is, with
the fingertips pointing straight ahead.
STEP 3: Press the palms firmly together and hold to a count of 10.
STEP 4: Release pressure on both palms.
STEP 5: Repeat 3 times.
STEP 6: Join both palms together like a namaste, in front of the breasts, away fom the body, in a slanting position.
STEP 7: Press the palms firmly together and hold to a count of 10.
STEP 8: Release pressure on both the palms.
STEP 9: Repeat 3 times.
STEP 10: Join both palms together like a namaste, with the fingertips pointing to your chin, yet not touching your
body.
STEP 11: Press palms firmly together and hold to a count of 10.
STEP 12: Release pressure on both palms.
STEP 13: Repeat this 3 times.
Pelvic Floor Exercise

The pelvic floor muscles support the womb. They help to hold the extra weight of the growing uterus in pregnancy.
Exercising these muscles helps to strengthen them and maintains their shape.
POSITION
Sit cross-legged. Can also be done while standing or lying down. Start with Exercise A. After 3 days start Exercise
B. After 3 more days graduate to Exercise C.
Exercise A
STEP 1: Exhale. Leave your pelvic floor absolutely relaxed, as when passing urine.
STEP 2: Now imagine that you interrupt or stop the flow of urine for a while, by a slight contraction of the muscles.
STEP 3: Repeat the above steps 3 times.
Exercise B
The pelvic floor muscles are used during this exercise.
An Exercise for Every Woman

Women need to do this exercise always. Beginning in pregnancy for the rest of their lives. Done mildly after
delivery (exercise B) promotes healing. After healing is complete do exercise C. It helps regain the pre-
pregnant tightness of these muscles.
In the middle years around age forty when a woman exercises her pelvic floor muscles they remain strong and
support the uterus. If they sag and lose their ability to support the uterus, an operation may be performed for a
prolapsed uterus.
STEP 1: Exhale. Relax the pelvic floor.

STEP 2: Imagine that you want to pass urine badly, but you are at a public toilet and have to wait in the queue; and
as you wait, you have to control the passing of urine by a strong contraction of your muscles.
STEP 3: Hold the contraction till a count of 6 and release.
Exhale and repeat the contraction twice. Your anus might also contract slightly, that does not matter, since your
anus, vagina, and urethra are in one band of muscles. You might feel a slight tightening above the pubic hairline.
You should not feel a tightening around the navel of your abdomen. If you do, it is a sign that you should locate the
contraction backwards towards the anus instead. You are now ready for the final step of the
Precautions
Always exhale before starting this exercise.
Exercise C
STEP 1: Exhale.
STEP 2: Contract your pelvic floor muscles a little bit. Count to 6.
STEP 3: Contract your pelvic floor muscles a little more. Count to 6.
STEP 4: Contract your pelvic floor muscles the maximum you can. Count to 6.
STEP 5: Exhale slowly and gently release or let go of your pelvic floor muscles, while you exhale.
STEP 6: Breathe normally for 3 to 4 breaths.
Repeat. Do this exercise 5 times.
If you develop an ache in the muscles, it is because these muscles are not used to being exercised. The pain is like
the pain you would get in your arm if you played badminton after many days. So do not stop the exercise, but do it
in one continuous contraction to the count of 6, instead.
Repeat at least 5 times.
Ankle Movements
This exercise has its base in yoga. It exercises the ankles, a part of the body not generally exercised. It feels good,
since the strain of the extra weight of pregnancy is carried by this area of the body.
STEP 1: Sit with one leg outstretched, the other leg bent at the knee, and the lower part of the bent leg (just above
the ankle) resting on the thigh of the outstretched leg.
Rest your back against the wall if you like.
STEP 2: Hold the bent leg just above the ankle with one hand; and with the other hand rotate the foot from the ankle.
STEP 3: Rotate the foot 5 times clockwise and 5 times anti-clockwise.
Repeat with the other leg.
Forward Backward
This exercise provides relief from general back pain and sciatica pain in pregnancy.
1. Sit on your heels with knees bent.

2. Separate your knees.
3. Bend forward, place forehead on the floor and place your palms in front of you on the floor.
4. Stretch palms forward at arms length & rise on your knees.
5. Separate your feet placing them in line with your knees.
6. Lunge forward to look up at the ceiling and lower your pelvic area towards the floor.
7. Hold for count of six or ten and then return to starting position. (Repeat 3 to 5 times.)
Pelvic Lift
Strengthens the back muscles and relieves lower backache feeling of congestion in the groin.
STEP 1: Lie down flat on your back. Bend both legs at knees and place feet on the floor.
STEP 2: Now put your weight on both feet and raise your hips off the floor.
STEP 3: Once raised, stay in position for at least 10 counts.
STEP 4: Then gently lower yourself back to the floor.
Do once or twice.
Help in lifting the pelvis may be taken from someone if you are unable to do so independently. Someone can
stand by your side next to your hips and place both arms around your lower back and help you rise off the floor.
Knee Chest Position
When you are upright all day, the organs hang from the spine as a flag hangs from a pole. When you position
yourself for this exercise by going on all fours, the organs hang from the spine like clothes from a line. Hence this
exercise relaxes the back.
When you do this exercise, the weight of the pregnant uterus is shifted away from the pelvic floor and the spine. It
therefore takes care of backache and radiating pains in the hips and legs.
This exercise also feels good if you have a gastric problem and are wanting to burp to relieve yourself
STEP 1: Kneel on the floor with knees slightly apart. Then go forward on all fours, by placing your palms on the
floor in front of you directly under your shoulder joint. Keep your head down and back straight. Keep your head
down all the while. Raising the head will tend to encourage the hollowing or caving in of the back. If the back is
allowed to hollow, it can give rise to a backache.
Stay for a while in this position.
STEP 2: Go down, putting your elbows in place of your palms, and point palms towards opposite elbows.
STEP 3: Rest your head on your arms. If your stomach pushes against the thighs, separate your knees further, so that
your stomach fits in the hollow between your thighs. Secondly, guard against hollowing of the back. If
hollowing occurs, correct it by gently pulling in your stomach.
STEP 4: Stay in position as long as you comfortably can. Breathe normally. While in position you will feel a rush of
blood towards the face which will make your face warm. Do not worry.
Precaution
If you have high blood pressure, stay in the all fours position but avoid getting the head down.
This exercise is to be done once.

The longer the position is maintained, the greater the benefit derived from it.
Leg Lift
In pregnancy there is a tendency to form varicose veins in the legs. Varicose veins are dark looking veins that
appear above or below the knees as a result of pooling of impure blood in the legs. Due to the congestion in the
groin region impure blood cannot easily flow back to the heart for purification.
This exercise helps prevent varicose veins by assisting the blood to flow back towards the heart past the groin area.
It soothes the legs.
Precautions
If you are prone to leg cramps, do not point your toe as you raise the leg. It will give you a cramp.
STEP 1: Lie on your side with one arm stretched outwards under your head, and the palm of the other arm placed in
front of you. Place a pillow between your abdomen and the floor.
STEP 2: Raise the upper leg higher than your hip.

STEP 3: Hold for a count of 6.
STEP 4: Gently bring back to the starting position.
Repeat 3 to 4 times with each leg.
Curling Leaf
Takes off the strain from the back while you are getting up and reduces the possibility of backache.
STEP 1: Lie flat on your back. Bend the left leg at the knee, placing the foot next to the knee of the outstretched leg.
Stretch the right arm behind your head.
STEP 2: Put the weight of your body on the foot of the bent left leg.
STEP 3: Roll your body in the opposite direction, that is, to the right.
STEP 3: Simultaneously, as you roll on to the right side, bring your left palm to rest on the floor, in front of your
abdomen.
STEP 5: Now straighten your left leg and rise up with your weight supported by both palms.
Repeat with the other leg.
Practise 4 times till perfected. Then use simply as a way of getting up.
Leg Swing
There are 3 joints in the pelvis which spread slightly apart during delivery.
The present day lifestyle of sitting on chairs all the time makes these joints inflexible. This exercise is to make them
flexible, by bringing some movement in them.
POSITION
Stand with your hands on your hips and feet placed normally.
Exercise A
STEP 1: Tilt very slightly to the left side and swing the right leg forward and then backward 4 times.
STEP 2: Repeat with the other leg.
The swing forward and backward should not be exaggerated. About 1 foot forward and 1 foot backward is fine.
Done overenthusiastically, it could cause an ache in the sacro-iliac joints that have already been softened by
hormones in preparation for birth.
If you tend to lose balance, then pause, at the starting position between each forward and backward swing.
Exercise B
STEP 1: Stand with hands on hips.
STEP 2: Swing one leg outward sideways and bring back to the starting position. Repeat 3 times.
STEP 3: Repeat with the other leg.
Pelvic Tilting
This exercise relieves lower backache and also helps retain abdominal tone, so that after your baby is born, the
abdomen will tone up faster and more easily.
Your bony pelvic basin houses your reproductive organs like your ovaries and uterus. As the uterus balloons up
with pregnancy, it spills out of the pelvic basin, putting its weight on the abdominal wall. The baby lies on the
abdominal wall as though it were lying on a hammock. This weight on the abdominal wall puts pressure on the
lower back muscles which begin to pain. It also causes the abdominal wall to stretch to its maximum and lose its
tone and elasticity, giving rise to stretch marks.
This exercise tilts the pelvis in a way that the contents of the pelvis that press the abdominal wall are pushed
inwards, so that their weight is taken by the bony pelvis during the duration of the exercise. This gives respite to the
abdominal wail from stretching and relieves backache.
Exercise A
STEP 1: Stand normally.

STEP 2: Exhale.
STEP 3: Bend slightly at the knees.

STEP 4: Contract and tighten your bottom as if you are holding a hundred rupee note in your bottom! As you tighten
your buttocks, and tense the muscles there, your pubic area in the front will be thrust forward and upward
towards your navel. Your abdomen will be tilted backward towards your backbone. At the same time the curve
in the middle of your back will straighten out.
STEP 5: Hold the position for a count of 6.
STEP 6: Release and go back to the starting position Repeat 5 times.
Exercise B
If you are fairly advanced in pregnancy, you could do this exercise in a lying position.
STEP 1: Lie down flat on your Bend legs at the knees and place feet flat on the floor.
STEP 2: Place a folded hand towel or napkin in the hollow of your back.
STEP 3: Exhale or sigh out.
STEP 4: Tighten the buttock muscles and draw in the lower abdomen.
STEP 5: Simultaneously flatten the hollow of your back against the floor and press on the folded towel.
STEP 6: Hold for a count of 6.
STEP 7: Release and breathe normally.
Repeat this excercise 5 times.
Walking for Cramps and Arches of the Foot
Cramps can sometimes occur due to lack of blood circulation. This exercise gives a boost to circulation of blood in
your lower limbs.
STEP 1: Stand normally You should have about 6 feet of open space for walking.
STEP 2: Walk across the 6-foot space on your toes.
STEP 3: Then walk back on your heels.
STEP 4: Finally walk on the outer sider of your feet.
Do once every day before bedtime.
Sometimes cramps can also occur due to lack of calcium, Vitamin B or E. If cramps do not get alleviated with
walking, check your diet.
Squatting
While squatting, the pelvic inlet, outlet, and canal are at their widest. Those using the squatting type toilet are at an
advantage as it exercises your joints and muscles without having to do much. Use it more frequently if you have one
in the house.
Squatting correctly positions the growing baby and the uterus. It also cures constipation.
STEP 1: Squat as when using an Indian toilet. If you are well advanced in pregnancy, with a big stomach, follow
these steps:
STEP 2: Stand normally, with your bottom touching the wall.
STEP 3: Now rise on your toes.
STEP 4: Go down into a squat.
STEP 5: Do not go into a complete squat, remain in a slightly raised position.
STEP 6: Rest your lower back against the wall, and spread your knees as wide apart as you can.
STEP 7: Stay for at least 2 minutes in the final position.
STEP 8: Now go forward on your hands and then your knees to come out of the squatting position.
In the 9th month when the baby is in a head-down position, in order to encourage the fixing or the engagement of
the baby's head, instead of squatting, one could sit with knees bent and a couple of cushions on one's calves.
This position would cause the pelvic structure to be raised to above the level of the knees, with a forward tilt to it, so
that the angle becomes perfect for the baby to enter the pelvic inlet. This position called 'Optimal Foetal Positioning'
was advocated by Jean Sutton and Pauline Scott, midwife and childbirth educator from New Zealand. It can be
adopted by a woman as she watches TV or when she is sitting on the bed.
Precaution
Squatting should not be done by a woman who has had a stitch put on the mouth of the uterus by the doctor, nor
by one who is bleeding in pregnancy, or who is on bed rest because of a low-lying placenta.
Squatting should also be avoided in case of severe or painful varicose veins or piles.
Aum Breathing
This exercise has its base in yoga and is relaxing both to the mother and the baby. (Source: Swami Satyanand, Bihar
School of Yoga)
STEP 1: Sit cross-legged with the back straight. Keep the head and neck in a straight line.
Place you thumbs firmly on the small triangular flap before the ear orifice. In this way you will block out any
distraction caused by surrounding sounds.
Place the 2 fingers after your thumb lightly on your eyes.
Place the next 2 fingers one above and one below the lips.
STEP 2: Breathe in.
STEP 3: As you breathe out or exhale say the word Aum.
Repeat 5 times without a break.
If while doing this exercise you feel breathless, take a pause by taking a sigh, that is, a deep inhalation and
exhalation, in between the Aum breaths.
Relaxation
It is very important for a woman to remain as relaxed as she can through pregnancy. A good time to practise
relaxation is when you know you are not going to need to rush off in 10 minutes, when all your work is done, when
you do not expect to be called or made to answer the telephone or door bell.
Lie down quietly and allow your mind and body 5 to 10 minutes to quieten down. Use this time to also shift around
and find a comfortable position to relax in, taking cushions, pillows, sheets or blankets as required. Once settled,
allow your thoughts to pour in. Close your eyes and watch your thoughts in a detached way, as though you are
watching a movie on the screen. Be detached: do not judge your thoughts; simply watch them for about 10 to 15
minutes.
Now try to do some conscious relaxation. Tape the following relaxation and play it to yourself or have someone read
it to you:
Relax the toes, feet and ankles.

Relax the nerves that hold the muscles of my toes, feet and ankles. Relax my calves.
Relax the nerves that hold the muscles of my calves. Relax my knees.
Relax the nerves that hold the muscles of my knees. Relax my thighs.
Relax the nerves that hold the muscles of my thighs. Now my lower limbs are relaxed and will not get
unrelaxed.
Relax my pelvic floor.
Relax the nerves that hold the muscles of my pelvic floor. Relax my buttocks.
Relax the nerves that hold the muscles of my buttocks.
Relax my womb and my lower abdomen.
Relax the nerves that hold the muscles of my lower abdomen.
Now my lower abdomen is relaxed and will not get unrelaxed.
Relax my back.
Relax my shoulder blades.
Relax the nerves that hold the muscles of my back.
Now my back is relaxed and will not get unrelaxed.
Relax my upper arms.
Relax my lower arms.
Relax my palms and fingers.
Relax the nerves that hold the muscles of my arms.
Now my arms are relaxed and will not get unrelaxed.
Relax my neck.
Relax the nerves that hold the muscles of my neck.
Now my neck is relaxed and will not get unrelaxed. Relax my chin and face.
Relax the nerves that hold the muscles of my chin and face.
Now my face is relaxed and will not get unrelaxed.
Relax the top of my head.
Relax the back of my head.
Relax the nerves that hold the muscles of my head.
Now my head is relaxed and will not get unrelaxed.
Now relaxation is seeping into my brain.
Relax the nerves that hold the muscles of my brain.
Now my brain is relaxed and will not get unrelaxed.
Keep lying down with your eyes closed. After relaxation do not get up suddenly. First become aware of your
surroundings. Remember the room in which you are lying, and the furniture/doors/windows in it. Slowly move your
hands and feet. Rise gently.

7.

Sex During Pregnancy
Sex in pregnancy is perfectly normal. In fact it can bring a new delight with it since contraception is out of the way.
However, if you have previously lost a baby, been treated for infertility, or miscarried, the doctor may tell you to
avoid sex when your period would have been due, or generally. If you have been asked to avoid intercourse, you can
always indulge in caressing, stroking, etc. Do not feel shy to ask the doctor how long you have to avoid intercourse,
since doctors may forget to say when you are past the time you are likely to miscarry. You may be asked to avoid
intercourse if you have had an earlier premature labour.
If you are under great strain at work, or if you are worried about the financial responsibility of having a baby, or
if you are angry about being pregnant, then you may not desire or enjoy lovemaking.
Some women feel inclined towards sex in pregnancy, while others do not. A woman's feeling should be
respected. When making love certain considerations have to be kept in mind, like the growing abdomen or the
increased sensitivity of the breasts. Different positions can be experimented with, in accordance with whatever is
comfortable.
Men often fear that during intercourse they may in some way harm the baby. You cannot hurt the baby during
intercourse. The baby is protected by the water bag and the water around it. The water acts as a shock absorber to
protect the baby from accidental blows or jerks. The uterus is housed in the bony framework of the pelvic bones,
which provide protection. In the mouth of the womb, called the cervix, is a plug of mucus which seals the womb and
prevents infection from entering the womb.
If a woman is overly anxious about her pregnancy, and her husband shares her anxiety, they will together make
each other more tense. They may be so afraid of sexual arousal that they may not even lovingly touch and feel each
other. A perpetual state of tension is not going to help matters. Stress of any kind is to be avoided in pregnancy.
Both partners need to relax. Stroking and massaging the tension away is a good idea. Do it to each other in turns.
Bleeding
Bleeding in early pregnancy may be caused if the level of your pregnancy hormone is not sufficiently high to stop
your period. Such bleeding is slight, occurs for a month or a few months, when your period would have been due. It
is slight with a darkish discharge, for an hour, a day or two, and there is no pain. The true significance of bleeding at
the time of the period is not clear. Many women who experience it otherwise have a perfectly normal pregnancy,
and a perfectly healthy baby.
However, any bleeding which occurs during pregnancy is considered a threatened abortion, and the doctor's
advice must be sought. When a threatened abortion occurs, the bleeding is usually bright red or pink, which signifies
that the loss is from within the uterus. When the bleeding stops, the vaginal discharge changes to dark red or brown.
Normally bed rest is continued until 3 days after the brown discharge has stopped.
A threatened abortion most commonly occurs during the first three suppressed periods, that is, in the first 3
months or the 4th, 8th or 12th week of pregnancy. It could also occur in the 14th week, when the placenta takes over
the production of hormones from the ovaries.
In case of threatened abortion, the doctor will advise immediate bed rest. A woman is allowed to get up only to
go to the toilet. She must stay quietly in bed. She should use sanitary towels, which should be changed frequently
and saved for the doctor to examine. A threatened abortion indicates an unstable pregnancy and care should be taken
to rest when a period would have been due. Sexual intercourse should not take place until the doctor permits it (see
p. 56).
The penis in the vagina is not threatening as commonly believed. It is more the contractions of the uterus which
are triggered off when a woman reaches orgasm that can be followed by further contractions. If you are ready to
start labour or about to miscarry, these contractions may set off labour.
Intercourse
It therefore follows that if your delivery is overdue this may be a more pleasant way of starting labour than a glucose
drip given with a synthetic hormone added to it. Also, semen contains prostaglandin hormones which may cause the
uterus to contract, or its mouth, the cervix, to soften. The greater the penetration of the penis during intercourse, the
closer it will get to the cervix and bathe it with semen. It would be a good idea to place a pillow under your hips
during intercourse. After your partner has ejaculated he should stay inside for a few minutes and the position must
be maintained so that the prostaglandin hormone in the semen reaches the cervix. You should delay washing
yourself by 10 to 15 minutes. Keep lying with the pillow under your hips.
From intercourse or from masturbation if you have an orgasm, it causes 5 to 15 contractions, and these may be
sufficient to induce labour. If you are not ready to go into labour, the effects of an orgasm in a normal stable
pregnancy are not known. However, it has been suggested that when a woman reaches orgasm or a climax, and her
uterus contracts, the fetus may get extra blood from the congested blood vessels.
Ordinarily uterine contractions are quite common. They occur every few minutes throughout a woman's
reproductive life from puberty to menopause, without being felt. Unless a woman is at the end of her pregnancy,
unless her cervix is ready or she has a history of premature birth, uterine contractions during intercourse will not
cause premature labour (see p. 137).
Breast Stimulation
Breast stimulation can also help start labour if your body and your baby are ready for the birth, so you need not
worry about it starting labour prematurely. Stimulation of the breasts brings about contractions of the uterus, since it
produces a powerful endocrine hormone by the pituitary gland, called oxytocin. A synthetic form of the same
hormone in much larger doses is used by doctors to stimulate labour. If you have a tendency to start labour
prematurely, avoid breast stimulation.
Breast stimulation during labour speeds up the process of labour, and in pregnancy assists in the effacement of
the cervix or mouth of the womb, whereby it thins out, and softens or ripens, in preparation for birth. If a woman's
delivery is overdue and labour is induced by an intravenous drip, the labour has greater chances of ending in a
normal delivery if the cervix has been softened and thinned out. Hence with breast stimulation an induced labour is
more likely to end up in a normal delivery rather than in a Caesarean section. On the other hand it may even
stimulate labour to start spontaneously (see p. 137).
After the Birth

After the birth of the baby you will have a longish period lasting a week or several weeks. Then, if you are
breastfeeding you may not have a period for several months. Even though you do not have a period, you can still
conceive and become pregnant. It is therefore advisable to use a contraceptive when you resume intercourse. You
can resume intercourse after 40 days or 6 weeks, since it takes that much time for the vagina to heal. You can use a
lubricant like vaseline the first few times. You must consult your doctor as to which contraceptive you should use.
Should intercourse take place earlier, a contraceptive like the condom can be used (see p. 176).

8.

Labour Time
There are 3 signs that could herald the onset of labour. These may appear by themselves or 2 may even appear
together approximately 15 days before the expected date of delivery or after.
Mucus Discharge or the show
You may notice a thick mucus discharge which could be white, pink or brown in colour. Sometimes the mucus may
even contain some amount of bright red blood mixed in it.
The discharge occurs from the mouth of the womb or cervix which is plugged with mucus to prevent infection
from entering the womb.
A week or so before labour begins, the cervix can thin out and flatten. As this happens, the mucus plug escapes
and you notice a thick lumpy mucus discharge. This discharge is a sign that your body is getting ready for the birth
process. It is no cause for alarm.
The doctor would say that your cervix is now ripe, ready, or effaced.
Contractions
The muscular contractions of the uterus are felt as periodic discomfort, and often referred to as pain. Initially
contractions are mild. They may feel like the mild discomfort felt at the beginning of a menstrual period. Or one
may mistake them for discomfort that accompanies an upset stomach, since it is not uncommon to have diarrhoea
before labour begins. On some occasions women feel it is discomfort arising from tight clothing around the waist.
However, even when you switch to more comfortable clothing or lighter food, the discomfort persists. It comes and
goes periodically.
When you realise this, begin to make a note of the time whenever the discomfort occurs. If you find it occurring
half-hourly, you know it is real labour. It could also occur more frequently, for example, every 15 minutes. So, when
it occurs at fixed intervals, you know it is real labour.
Sometimes, before labour begins you feel practice contractions or false contractions. These are contractions of
the uterus in preparation for birth. Practice contractions feel similar to real contractions, but they occur at irregular
intervals.
So while practice contractions have a haphazard interval between them, real contractions will have fixed,
rhythmical intervals.
It is possible that after starting at periodic intervals, contractions might stop for a day or so, only to restart later.
There is no harm if contractions stop. There is, at times, a slowly unfolding labour that starts and stops on and off,
until it gets properly established. So you can safely stay at home until your contractions get to be 10 minutes apart.
Once they are timed every 10 minutes, they are properly established and less likely to stop.
Do not panic if contractions start at 5 minute intervals.
Contractions may stop for a while when you check into the strange atmosphere of the hospital or nursing home.
If that happens, just walk around and get familiar with the place. See where the toilet is, where the nursing station is,
the position of your room on the floor where you are. Stroll in the corridor and your contractions will start again as
you get familiar with your environment. You could also go and have a look at the nursing home or hospital earlier,
while pregnant.
After 10 minute intervals the contractions will shift to 5 minute intervals and for a short while before birth, to
every 2 minutes. During birth again the interval will become 5 minutes.
Fluid leak
The baby is encased in the amniotic sac. Sometimes the amniotic sac bursts and all the amniotic water gushes out, as
though a tap were opened inside you at full blast. The amniotic sac may burst before labour begins. It could happen
at any time in the 9th month, but it mostly happens at night. So you could spread a rubber sheet or rubber cloth
across the middle of your bed. It can be bought from a chemist or a cloth shop. (It is called momjama in Hindi).
When this happens, the amniotic fluid also sweeps out the mucus plug on its way out. The protection of the plug
and the amniotic fluid is now absent. For this reason, the woman is now more susceptible to infection each time an
internal examination is given. So, once the water bag bursts, doctors like to deliver the baby within 24 hours.
When Urgent Medical Attention is Needed

A Coloured Trickle
The trickle that appears from the amniotic sac is usually clear. But if the trickle appears muddy or greenish and
has a foul smell, you must get in touch with your doctor immediately. The colour in the amniotic fluid comes if
the baby passes stool inside the womb, which it normally does after birth. So, once you have what is called
meconium staining of the amniotic fluid you need to be under medical observation. If, along with meconium
staining, there is an adverse effect on the baby's heart rate (the normal heart rate is 120 to 160 beats per
minute), it would indicate a need for a Caesarean section. If the fetal heart rate is not affected, labour can
progress normally, culminating in a normal delivery.
Bright Red Bleeding
If you experience bright, fresh, red bleeding like when you cut your finger, or as at the height of a period, you
should be in touch with your doctor immediately. Bright, fresh, red bleeding occurs if there is placenta previa, a
condition in which the placenta lies between the baby's head and the mouth of the uterus, blocking the baby's
exit. Or, it could occur if the placenta, the organ that nourishes the baby, detaches or peels away from the wall
of the uterus. If a small portion has peeled away, it may be quite harmless, but nevertheless you will have to be
under observation, to make sure it does not adversely affect the heartbeat of the baby. The normal heartbeat of
the baby in labour would fluctuate between 120 and 160 beats per minute. Below 120, or above 160 are both
considered fetal distress. Occasionally, a few drops of blood may escape a couple of days after intercourse or a
vaginal examination by the doctor. This is quite harmless.
The common practice is to put a woman whose water bag has burst on a drip of glucose to which a synthetic
hormone called syntocinon has been added in order to trigger off contractions artificially.
However, if you wait 4 to 5 hours before fixing a drip, it is possible that contractions may start spontaneously,
on their own and thus eliminate the need of a drip. It would be more pleasant if this happened, since spontaneous
contractions are gentler than contractions that are artificially induced.
So, if the water bag bursts, you check into a hospital, but request for the drip to be delayed by 4 to 5 hours. It is a
simple request. Keeping in mind that the baby should arrive within 24 hours, waiting 4 to 5 hours still leaves an
ample period of 19 to 20 hours for the birth.
On some occasions the amniotic sac may not burst, but might just trickle instead. The trickle will be clear and
uncontrollable. Wear a sanitary pad and take rest at home. After some time the amniotic sac might seal itself and the
trickle might stop. It might recur after some time, or it might be followed by contractions.
Go to the hospital when the contractions are 10 minutes apart, or if the trickle gets out of control and cannot be
contained by a sanitary pad. The sanitary pad should be changed often to avoid infection.
Positions to Adopt in Labour

Once labour begins, it is best to be upright rather than lying down flat on your back. Upright would mean
walking/kneeling/standing and other positions we shall discuss shortly. Being upright in labour gives the following
advantages:
■ The force of gravity helps in the descent of the baby. (The force of gravity is constantly pulling down things.)
The baby with its own weight will descend through the birth canal sooner when the mother is upright, rather than
when she is lying down.
■ When the mother lies flat on her back, a blood vessel gets compressed by the weight of the uterus and the baby on
the one hand and the backbone on the other. This hampers the blood flow to and from the heart, and increases
the chance of distress in the mother and the baby
■ Being upright lifts the compression on the blood vessel, so that the blood flow to the mother and the baby is more
efficient and both are therefore more alert and awake during birth.
■ When the mother is lying down, the vagina is at upward slant, so the baby has an uphill task before it. When the
mother is upright, e.g. standing, it becomes a downward descent for the baby
■ During birth the head of the baby passes first the top brim of the pelvic basin and then the bottom outlet of the
pelvic basin. Forming part of the outlet at the bottom of the pelvis is the tail bone. The tail bone is a flexible
bone. If you do not lie or sit on it while in labour, it moves away as the baby comes through the outlet of the
pelvis, and the space for the baby's exit increases by as much as 30%.
■ In 1977, a study in Birmingham Maternity Hospital compared a group of women who walked about during labour,
with a group that lay down horizontally through most of labour. The results showed that in women who walked
about during labour,
(i) the duration of labour was shorter;
(ii) there was less need for painkillers;
(iii) the incidence of fetal heart abnormalities was markedly smaller; and
(iv) they experienced less pain.
■ Further studies have revealed that:
Precaution
There is just one instance when it is better for you to lie down rather than be upright.
At about 36 weeks, the head of the baby fixes in the brim of the pelvic basin. In some instances, the head does
not lower and fix in the pelvic basin, but remains floating above the pelvic inlet. This is called a floating head.
Fairly often, a floating head fixes in the pelvic basin after labour begins.
In the last month of pregnancy when you go for weekly check ups to your doctor, ask if the baby's head has
fixed or engaged. If you have a floating head and the water bag bursts, it is possible that as all the water drains
out, the umbilical cord may also be swept downwards with the water and come to lie between the baby's head
and brim of the bony pelvic basin. In this case, if you remain upright, you may cause the cord to be squashed
between the baby's head and the pelvis, a most undersirable situation, medically called cord prolapse. It is
through the cord that the baby receives oxygen and nourishment.
When there is the rare combination of floating of the baby's head and the bursting of the water bag, you must
remain lying down or adopt the knee-chest position, or go into the all fours position.
(i) the strength or intensity of contractions is greater when women are moving about in labour; and
(ii) there is greater regularity and frequency of contractions.
Upright Position for Labour

Walking
Walking is the best position for labour. You can walk about your room, at a relaxed leisurely pace. Avoid brisk
walking; it will tire you out. Stroll about, and when your contraction is felt:
■ Stop walking. Stand where you are, with your feet nicely apart, to take the even distribution of your weight. Place
both palms on your lower abdomen. Make a circular rotating movement with your hips, during the duration of
your contraction. When the contraction is over, you can resume walking.
■ If you happen to be near a wall when a contraction is felt, stop walking. Stand facing the wall. Place your feet
nicely apart, about 6 inches away from the wall. Place your palms on the wall at shoulder level. Keeping your
body straight, bring it slightly forward by bending elbows, then push back with your palms. Keep up this gentle
forward and backward movement while the contraction lasts. Avoid jutting the stomach forward and increasing
the curve of your back, as this can lead to backache.
If you do not find the forward and backward movement comfortable, you can instead make circles with your
hips.
■ Alternatively, while you stand facing the wall, place your feet a little away from the wall, with raised arms bent at
the elbow on the wall, and use them to rest your forehead on. This position helps to make the contraction
stronger, especially beneficial if contractions are weak.
When the contraction passes, resume walking.

A bin, In case the water bag bursts
In case the bag bursts, and all the water gushes water out altogether, the uterus is emptied of one litre of fluid.
However, the water bag carries on making water which collects in the uterus and is expelled during a contraction.
This would cause water running down your legs in case you are standing, or water wetting your bed in case you are
sitting on a bed. In case you are walking, to avoid wetness, you could sit on a waste bin so that the water drips into
the bin and you are left dry. Alternatively you could sit on a bed pan if you are on the bed. Or, ask for a chair with a
commode.
Using dining chair
If you have labour at night when you are a bit sleepy, or if you are tired and do not want to walk or stand, this
position can be used.
A dining chair is used, since it narrows on the back and has no arms. Sit facing the back of the chair, with legs on
either side (as you would sit when riding a horse). Use the back to rest your head.
As you lean forward to rest your head on the back of the chair, your tail bone lifts off and moves away from the
pelvic outlet, making room for the baby.
When you are tired of walking, you can switch to kneeling. You could kneel on the hospital bed.
Kneeling
Place a soft thick pillow on the back of your legs, that is, on the calves. Sit on the thick pillow when you are not
having a contraction. When a contraction is felt, rise up on your knees, hold the headboard or footboard and bend
forward or make rotating circles with your hips.
Resume sitting when the contraction passes.
Backache in Labour
Standing with back to wall
If you feel most of the discomfort of your contraction on your lower back, you are experiencing back labour. Back
labour would mean that the baby is posterior, that is, instead of facing the mother's backbone, it is facing the
mother's abdomen. The back of the baby's head puts pressure on the mother's backbone, causing a low backache.
Counterpressure on the lower back will relieve the discomfort.
You will feel comfortable if you stand with your back to the wall and press the part of the back that hurts,
against the wall. To get maximum pressure on the lower back, you can hunch your shoulders forward.
In case of a backache and posterior baby this position helps relieve the backache and guide the baby to an anterior
position.
It also slows down fast labour.

First kneel with your knees one foot apart. Place your hands in front of you and go into the all fours position. Rotate
the hip in circles.
When on the Drip

The drip implies that glucose drips from a bottle through a tube, straight into your vein, through a needle that is
inserted in your arm. The bottle of glucose is attached sometimes to a rod at the side of the bed; and sometimes to a
rod attached to a stand with wheels (see p. 135).
Sitting on the bed
If the drip is fixed to the side of your bed, you have to remain in bed. Instead of lying down, you can adjust your
bed in a sitting position.
When contraction occurs, lean forward, cross your legs and place the arm free of the drip, on the bed in front of
you. Do your breathing. When the contraction is gone, sit back again and close your eyes and relax until the next
contraction.
Alternatively you can get off the bed and sit on a chair in front of the bed or stand in front of the bed. When the
contraction comes, you can stand, hold the edge of the bed for support with your free hand.
As you stand like this, if you like, you can also move your hips in circular motion.
Comforters
Palming
Placing the palms on the lower abdomen and lower back of a woman who is having a contraction is of immense
comfort to the labouring woman.
Just behind the muscles of the lower abdomen, the uterus contracts vigorously during a contraction. On the
lower back, the joints of the pelvic structure spread apart at birth. Hence placing of palms on these two areas soothes
the mother. It could be practised along with any position of labour.
Hand squeeze
Often a woman in labour desires to hold on to something or someone very tightly. If you have this urge, your partner
should hold your palm with a firm, tight pressure. You should avoid gripping your partner's hand, so that you do not
waste energy ,and strength while doing so; and you do not tense your body Remove rings before trying this, they
could hurt.
Your partner's thumb should be placed at the back of your hand. The remaining 4 fingers should fold on the back
of the hand from the opposite side. The grip should be firm. You should tell your partner if you want to increase the
pressure or have it lessened.
Effleurage
The skin and muscles of the abdomen are very tense during a uterine contraction. A light massage or brushing will
lessen this tension.
Effleurage is a light moving of your fingertips on your lower abdomen, that is, between the navel and the pubic
hair. Place the fingertips of both hands on either side of the navel. Make circles by moving fingers lightly in a
circular motion from the centre of the abdomen, outwards, towards the hips. Then down towards the pubic hairline
and up towards the navel.
If you are on the drip and one hand is immobilised, you can massage with the fingertips of one hand, from side
to side; that is, from one hip to the other, across the lower abdomen. Your partner could do this massage for you.
The fingertips should move in light strokes, rubbing should be avoided. The lighter the strokes, the better. It
should be done simultaneously with breathing exercise. Apply talcum powder as needed.
Leg massage
If you feel your legs are weak or shaky, a massage firmly up from above the ankles, on the sides of your legs, will
feel good. You can use talcum powder so that your fingers run smoothly and are not hampered by perspiration.
If you feel shaky on the thighs, this massage can be done from above the knees, on the inner and outer sides of
the thighs. Sometimes this massage could be done after the birth of the baby.
For a Backache
In labour, a slight discomfort in the back is common. Backache is more pronounced in the case of back labour or a
posterior baby, when the discomfort of labour is concentrated more in the lower back than in the lower abdomen.
Back massage
Lie on your side. Take a pillow under your head and another pillow between your knees.
Your partner should sit facing your back. With one hand he can hold your hip, so that you do not have to brace
yourself, and with the other hand, locate the flat, hard surface of your lower back, just above your hips. Once
located, the heel of the palm should be pressed on the spot, and once pressed, rotate it clockwise and anti-clockwise.
This massage can be practised during pregnancy too, in case of a backache.
Since a great amount of pressure is applied by the palm, it helps the person massaging, to support the elbow of
the hand on the thigh. However, if tiredness sets in, your partner can instead sit back-to-back with you.
Back to back
You should continue lying on your side, as for the backmassage. Your partner should sit against your lower back, as
close as he/she can get, with his/her back straight. That is, leaning on you should be avoided, or else you will feel
that you might tumble over.
At times, if your partner is male, just this sitting is adequate. However, if you feel the pressure is less, your
partner should lean forward, cross both palms at the back, place them on your lower back and straighten again. This
will add to the pressure and bring greater comfort.
You can guide your partner as to where exactly you would like the pressure, higher, lower, or a little to the side.
Tennis ball
A tennis ball can be effectively used to massage your lower back. To use a tennis ball, you must have a foam
mattress. It cannot be used on a cotton or coir foam mattress.
Lie down on a foam mattress, placing a tennis ball between your lower back and the mattress. The tennis ball
will massage your lower back as you lie on it. It will bring comfort for 15 to 20 minutes.
The tennis ball could also be used in a standing position. Stand straight against the wall. Balance the ball
between your back and the wall, you could place the ball on your upper or lower back, wherever there is pain. Move
from side to side so that the ball massages you.
During a contraction stand and have your partner place one hand on your lower abdomen, just above the pubic
hairline, and the other hand should be placed on the lower back, above the hips. No pressure is required to be
given with the hands. The hands are to be placed gently on these two places.
After a contraction, with both hands in place, exhale, then let go of your abdomen. Relax your abdomen
towards the hand. Relax your pelvic floor. Leave the pelvic floor relaxed as though you are passing urine.
Imagine your pelvis is opening up, and having passed through it your baby is now coming through your relaxed
vagina. Relax your hips and buttocks. Relax your inner thigh and your outer thigh.

9.

Breathing and
Relaxation tor Labour
Ignorance-Fear-Tension-Pain Syndrome
The uterus is made up of strong muscles whose action causes it to open and let the baby pass first through its
opening (cervix), and then through the vaginal passage into the doctor's hands. Childbirth therefore depends largely
on the efficient working of the muscles of the uterus and the vagina.
Muscles in our body are of 2 types, voluntary muscles and the involuntary muscles. Voluntary muscles are those
over which we have direct control, the muscles of the arms and legs for instance. Involuntary muscles are those over
which we have no direct control, like the muscles of our heart or uterus.
If a woman is tense during labour, her uterine muscles will also get tense and perform with great difficulty,
because tension in the body is infectious; it passes from one muscle to the other. However, if she is relaxed. her
uterine muscles will work unhampered, and with each contraction they will get closer to complete dilation of the
cervix, so that the woman will have a shorter, less painful labour.
This is called the ignorance-fear-tension-pain syndrome. That is, ignorance of how the body functions during
childbirth causes a fear of the unknown. Fear causes tension, which in turn leads to rigid abdominal muscles, more
pain and longer labour. Whereas, if you eliminate ignorance by understanding the physiology of birth, you eliminate
the fear of the unknown. Without fear, tension will be absent, leading to easy muscle action, so that your body
functions as nature intended it to, without being hampered by tension.
Quick Relaxation in Labour

Relax the lower abdomen, pelvic floor, hips and buttocks and your thighs, each time a contraction is over. Then go
on to general relaxation.
There are certain points in the body where tension tends to accumulate. If you work at relaxing these points, you will
quickly achieve relaxation.
■ Relax your forehead. Stop frowning. Pinch your eyebrows and stroke your forehead.
■ Relax your jaw. A relaxed jaw is a relaxed vagina.
■ Separate your teeth and let your tongue be static in the middle of your mouth.
■ Relax your shoulders.
■ Relax your elbows. Loosen them and move them away from your body.
■ Relax your hands.
■ Relax your feet.
If you find it difficult to relax any of these points, have your partner massage them for you. For instance, your
partner can massage your shoulders, face or feet, to help you relax. Practise this daily, so that you use it with ease
during labour.
Each time a contraction is over, go into relaxation. During a contraction, the uterus is partially deprived of blood
and oxygen. Relaxation after the contraction sends a plentiful supply of this life-giving fluid to the uterus. When the
body is relaxed, the muscles in the body use a minimum of energy, and oxygen enriched blood reaches the uterus
and the baby, ensuring a healthier and alert baby. Also, using the rest periods between contractions to your
maximum advantage will not allow tension to build up and accumulate in your body, keeping you relaxed right
through.
When a contraction occurs, concentrate on keeping your face relaxed. If you keep your face relaxed,
automatically the rest of your body will also become relaxed. Tension anywhere in the body will show on the face.
Breathing for Labour

Properly regulated breathing during labour will help take away the pain of labour.
Breathing has to be practised regularly before delivery, so that you can slip into breathing effortlessly when you
go into labour.
Conditioned Reflex
Reflexes are instantaneous and involuntary responses to stimuli. There are 2 types of reflexes. The inborn reflex, e.g.
blinking to protect the eyes from a blow, or the conditioned reflex of feeling hunger at meal times.
As an inborn reflex, a dog will salivate if meat is put in his mouth. If, however, the introduction of meat is
preceded by the ringing of a bell, and this process is repeated several times, the dog ends up salivating when just the
bell is rung and no meat is given. Hence, a conditioned reflex has been established, which associates food with the
sound of the bell and so determines the response of salivation.
In the same way, breathing regularly practised for labour establishes a pathway to the brain which associates
breathing with labour. When labour actually sets in, the brain determines the response of breathing.
Breathing Focus
Breathing during labour brings about a focus of activity in one part of the brain, from where it has a tendency to
develop and spread. For instance, a pupil paying attention to what the teacher is saying is not aware of noise in the
street, because the attention he is paying to the teacher's lecture localises the focus of activity in his brain, and
becomes surrounded by a zone of inhibition into which all the stimuli from surrounding noises drain. In the same
way, a toothache, which is hardly noticed when one is busy with some important activity, becomes stabbing during
inactivity.
The aim of preparation for labour by learning breathing patterns is to reinforce to its maximum the inhibition of
the brain, by bringing about a focus of breathing activity during labour.
The strength of inhibition brought about by your focus on breathing activity will depend on the strength of your
focus on your breathing patterns. This in turn will depend on the work and practice you have put into the
development of this focus. The success of your labour is therefore in your hands.
This is stressed by the French doctor, Lamaze, in the psychoprophylactic method of childbirth, based on Pavlov's
experiments carried out in Russia.
According to Dr. Lamaze, in the book Painless Childbirth, (New York, 1972), 'a woman learns how to give birth
the same way she learns how to swim or write or read—and she does so without pain.'
Breathing Patterns
Deep cleansing breath
Before any kind of breathing is practised, first take a deep cleansing breath. That is, you fully fill and empty your
lungs.
Breathe in deeply through the nose and let it out through the mouth. Take this breath at the beginning and at the
end of a breathing practice.
Waist-level breathing
Breathe in deeply through the nose, and breathe out slowly through your mouth, as though you were trying to flicker
the flame of a burning candle held at arm's length, with the air that you are exhaling.
Practise a few times.
Now, do your quick relaxation, then practise this breathing for 30 seconds, beginning and ending with a deep
cleansing breath.
The number of waist-level breaths should be between 4 and 6 in 30 seconds. If it is more than 6 you are
breathing too fast. Slow down your breathing accordingly.
Chest-level breathing
Place your hands at your chest, below your collarbone. In addition, you can have your partner place one hand at the
bra level on your back. Now breathe in and out through your mouth up to your hands, a shallow, slow, and gentle
breath.
So that your mouth does not get dry, place the tip of your tongue on the roof of the mouth.
Do your quick relaxation. Practise this breathing for 30 seconds, beginning and ending with a deep cleansing
breath.
Count the number of chest-level breaths practised without the deep cleaning breaths. The number should be
between 10 and 12 breaths in 30 seconds. If you exceed 12 breaths, slow down your breathing.
Jaw-level breathing, 'Out'
The jaw-level breathing entails simply saying the word 'Out' with a stress on the 'T'. Do not worry about your
breathing, it will take care of itself as you say the word.
Precaution
If you ever feel dizzy while doing the breathing practices, cover your nose and mouth with your palms and
blow out once. Then breathe normally. This will re-establish the proper balance of oxygen and carbon dioxide
in your body and relieve dizziness if it is experienced.
Do your quick relaxation. Practise the breathing for 30 seconds, beginning and ending with a deep cleansing
breath.
You could get between 20 and 25 breaths in 30 seconds, not counting the deep cleansing breaths. If you exceed
25 breaths slow down breathing.
Now you are ready to do a breathing practice. Let us imagine you are having a contraction which slowly builds
up to a peak and then tapers away.
Practise this a few times with verbal instructions.

Then, practise with pressure on the wrist. At the inner wrists the nerves are sensitive, and by exerting pressure on
them, we acquaint the nerves with the message that the greater the pressure, the shallower the breathing. For
instance, when you walk, you do not breathe as shallow as you do when you are running.
In labour the pressure will not be given on the wrist in this manner. When labour begins, the nerve endings on
the uterus will send similar messages to the brain as contractions progress. The brain will automatically respond to
greater discomfort with shallower breathing, due to the earlier practice with pressure on the wrist.
Your partner should hold your wrist, and exert pressure in accordance with the verbal instructions, during a
breathing practice.
Do 5 rounds of breathing practice daily. Remember to do your quick relaxation before you begin, and repeat the
relaxation after each breathing practice. You can practise on waking in the morning or before sleeping at night.
In labour you will do whatever breathing you feel like doing. What you eventually use will depend on whether
you are naturally a deep or shallow breather; whether your labour is artificially induced or a natural labour, whether
you are sleepy or awake, etc.
Concentration Breathing
Choose a spot above the eye level. Concentrate on it. Imagine you see there the image of someone you worship, or
an image of something beautiful, like a beautiful sunset you might have seen recently, or a favourite picture.
Concentrate on the image and leave your mouth open slightly. Breathe naturally and effortlessly through your
mouth.
Concentration breathing can be used as a distraction breathing.

If you are being given an internal examination, take a deep cleansing breath and go into concentration breathing,
leaving your pelvic floor muscle relaxed as when passing urine.
If you are distracted by another patient, a member of the staff, or by well-meaning relatives, go into your
concentration breathing. It will remove you from your immediate environment and you will not feel disturbed. You
can couple your concentration breathing with the other breathing levels, that is, as you do waist-level, chest-level
and out-breathing, you can concentrate on your image at the same time.
If you are wheeled into the operation theatre and want to take your attention off the frightening equipment
around you, concentration-breathing will help.
When an injection is being given, or when the drip is being fixed on your arm, do the concentration breathing.
Not-Pushing Breathing
The old wives' tale which says that one must push the moment labour begins, is false. Physically pushing out the
baby should be done only at birth. Before birth, both lips of the cervix have to move away from baby's head.
Just before the birth of the baby, while one lip could have moved away, the other could still be covering part of
the baby's head. If you push prematurely, it could cause the baby's head to hit against the unopened lip of the cervix,
causing swelling and tenderness.
You might experience a desire to bear down and push the baby out, in the middle of a contraction. It is important
to immediately inform the staff how you feel, and not bear down until the staff or the doctor says that you can do so.
To avoid bearing down do the following breathing:
2 shallow pants Blow

If the urge to push is very strong, you may need to blow out several times in a row. That is:
2 shallow pants Blow. Blow. Blow.
Occasionally, some women who have had induced labours have used this breathing during labour.
Transition
Transition is an intense period before the birth of the baby. The cervix dilates to a total of 10 cm to permit the
passing of the baby's head. During transition the cervix could be about 8 cm dilated (10 cm is full dilation). That is,
the dilation of the cervix is soon going to be complete and the expulsion of the baby through the vagina is going to
begin. There is soon going to be a transition from the first stage of labour to the second stage. Transition can last
from 10 minutes to an hour approximately. It is a sign that you are almost there.
You might just sail through the transition without feeling a thing. On the other hand, you might feel cold or hot
or nauseous during this phase. This is the time you need the quiet presence of your partner.
During transition your contractions are closest together. They could come 2 minutes apart and can be sharp long
ones, lasting a whole minute. The 'Out' and concentration breathing should be most suitable at this stage. After
transition, the contractions again become 5 minutes apart.
Typical of this stage is a premature desire to push the baby out. If you push before the cervix is fully dilated, the
cervix can become swollen and resist opening up.
Transition can also be characterised by a negative change of mood. You might suddenly feel angry or
discouraged or helpless or in need of a painkiller. You might be angry with the hospital set-up or your partner. You
might feel discouraged that having being in labour for hours, nothing is happening. You might feel helpless at your
situation and your inability to run away from it. A combination of strong contractions and a negative mood swing
might tempt you to ask for a painkiller. This is also the time when you might be offered a painkiller. Medication at
this stage is best avoided, as it can slow down the birth process and require the use of instruments at birth that is, the
use of forceps, or the use of vacuum extraction.
If your partner reminds you, that this must be transition and therefore a sign that you are at the end of labour, it
helps. Some women find the hand squeeze comforting at this stage, whereas others do not like being touched. The
unobtrusive presence of a partner is most welcome at this stage. This is the time when a woman internalises and
knows she has to make a go of it all by herself. She is one with the process her body is undergoing. It is a short and
intense phase.
Pushing
When dilation of the cervix is complete to 10 cm or 5 fingers, and the baby is being pushed out through the birth
canal or vagina, the second stage of labour has begun
At this stage, you will be taken to the delivery room. The delivery room has a special table on which you will be
made to lie, with your legs apart. Your legs may be supported by stirrups. Alternatively you will be told to place
your legs bent at the knees and your feet placed flat on the table
When the doctor tells you to push, you do the breathing described below.
During practice, either lie down using 2 pillows under your head, or sit with your back supported by the wall and
your legs stretched out in front of you, then take:
1 waist-level breath (inhale through the nose up to your waist and blow out through pursed lips).
A 2nd waist-level breath.
During the 3rd waist-level breath, after inhaling, hold your breath.
While you hold your breath, incline your chin slightly towards your chest, so that whatever pressure you apply at
the time of birth, does not get concentrated in the neck, and is automatically diverted towards the pelvic floor. When
you cannot hold your breath any longer, it is a sign that your body needs more oxygen, so exhale and quickly inhale
and resume holding your breath. When doing so you can raise your head so that exhalation and inhalation come
more easily. Once done, resume bending chin towards your chest.
Do not physically apply pressure downwards as when you are constipated. Physical application of pressure is to
be practiced only at the time of actual birth. When practicing, just practise holding your breath, and then release your
pelvic floor as when passing urine.
So when you feel the start of a contraction and are told to push, you do:
Waist-level,
Waist-level,
Waist-level. Hold it. (Incline chin towards chest, and relax the pelvic floor.)
Exhale, inhale (if needed).
Hold it.
Do your quick relaxation when the contraction is gone.
10.

Induced Labour
The Estimated Date of Delivery

The estimated date of delivery is not a date of appointment. It is simply a date arrived at by a rough calculation, to
estimate the average duration of pregnancy. A pregnancy might exceed it or terminate before it. Studies show that
only 4 to 5% of babies arrive on the estimated date of delivery.
On an average a pregnancy lasts 280 days, 40 weeks, or 9 months and 7 days, after the first day of the last
menstrual period. There is no disadvantage to the baby if the birth takes place any time between 38 and 42 weeks of
pregnancy.
To calculate a woman's estimated date of delivery, one takes into account the last menstrual period before her
pregnancy. Suppose it began on 25 March, one would count 7 days ahead and arrive at 1 April. Then one would
count backwards 3 months, that is 1, March, 1 February, 1 January. The estimated date of delivery would be 1
January. This is a short-cut to counting 280 days from a fixed date.
However 40 weeks or 280 days is merely an average. The maturity of the baby could be anywhere from the 38th
week to the 42nd week.
The actual birth date of the baby will be influenced by the menstrual cycle of the mother. Some women have a
25 or a 28 day menstrual cycle, while others may have a 35 or 40 day menstrual cycle. Ovulation and conception
generally occurs about 14 days before the onset of the next period. A woman with a 25 day cycle will have
conceived sooner and will deliver sooner than a woman with a 35 day cycle, since the gap between her periods is
shorter than the gap of a woman who has a 35 day cycle. A lengthy cycle would mean birth beyond the due date. In
calculating the estimated date of delivery it is important for a woman to be sure of her dates.
A woman with a regular cycle will deliver more predictably than one with an irregular cycle. A twin pregnancy
could be shorter by 3 weeks. Triplet and quadruplet pregnancies could be shorter still. However, it is better to retain
the pregnancy until full term, so it is important to avoid physical stress in the last few weeks of a multiple
pregnancy. It is better for the babies.
A woman who has been on the pill may conceive without having regular periods. It is a good idea to use some
other contraceptive after the pill has been stopped and have at least 3 regular periods before conception.
Although the exact reason why labour starts when it does is not known, there is a great amount of evidence that
shows that the fetus, when it is ready for existing outside the womb, produces a hormone which leads to the onset of
labour.
When Labour is Induced
Induction is a way of artificially stimulating the uterus into labour contractions, with the intention of controlling the
birth of the baby.
Sometimes labour may be induced for the sake of your convenience or the doctor's. Your convenience could be
your desire to rejoin work on a particular date, to time a transfer of residence to your convenience, or to attend a
wedding or some social function. The doctor's convenience may be a plan to attend a long-awaited medical meeting
or a long-planned vacation. Or it could be the timing of the birth at a time when most medical staff are on duty.
For an induction to be successful, the baby must be full term and term size, with its head pressing down at the
mouth of the womb, which should be soft, short and partially dilated. If these conditions are absent, the induction
can terminate in a Caesarean section.
As you go past your due date you might begin to get anxious about when the birth will take place. People who
phone and ask what news there is, only add to your anxiety. The doctor may have told you that if you go past your
due date labour may be induced.
Doctors are divided in their opinion as to when labour should be induced for post-maturity. When everything is
normal, some doctors would not mind allowing a pregnancy up to 43 weeks. Each pregnancy should be treated as an
individual case. Certain factors like hypertension or toxaemia would warrant an induction.
Different Methods of Induction
Castor-oil
Earlier at full term women used to be given castor oil, and the next day labour would be triggered off if they were
really ready to go into labour. Sometimes it was coupled with a hot bath and enema.
About 25 to 50 ml of castor oil could be whisked in a hot sweetened cup of milk and drunk by the woman a
night before she is scheduled for an induction of labour.
Sweeping and Stretching or stripping
Just before or during labour, when the cervix is lax, this or procedure can be carried out. About 25 to 50 ml of castor
oil could be whisked in a hot sweetened cup of milk and drunk by the woman a night before she is scheduled for an
induction of labour. While an internal vaginal examination is being given, the membranes of the water bag are swept
off the wall of the uterus around its mouth, by the fingers, and the cervix is also stretched a little by the fingers. This
speeds up labour. It may be followed by an induction.
Gel or Pessary
A gel or pessary containing prostaglandin hormone could be placed at the mouth of the womb or cervix during a
vaginal examination. As it melts and comes in contact with the cervix, it causes it to soften in preparation for birth.
Artificial Rupture of Membranes
Artificial rupture of membranes, often referred to as ARM, consists of artificially rupturing the membrane of die bag
of waters surrounding the baby in the womb. It is done during an internal vaginal examination.
If the membranes are not made to rupture, they might rupture spontaneously during the course of labour, more
typically when dilation of the cervix has been completed. In some instances the membranes may rupture at birth.
After the bag is made to burst, the contractions will increase in intensity. ARM speeds up labour, and is one way
of inducing contractions. It is useful in prolonged labours with little progress. It is also useful when the fetal heart
shows signs of distress. The breaking of the water then facilitates the doctor to check the water for meconium
staining. If the water is coloured green or muddy coloured from the baby's stool, it is a sign of distress, for the baby
normally should pass the first stool after birth, not in the uterus.
Dr Ian Donald says in his Practical Obstetric Problems: 'With very few exceptions, intact membranes mean an
intact mother and an intact baby.'
There are also fewer chances of cord prolapse when the membranes are intact. Cord prolapse occurs when the
cord on being swept down with the waters, comes to lie between the bones of the pelvis and the baby's head, causing
distress to the baby. Pressure on the cord is another possibility when the rupture of membranes causes powerful
contractions that exert pressure on the cord and reduce the flow of blood and oxygen to the baby.
When the membranes are intact there are fewer chances of infection. Also, intact membranes mean that an even
hydrostatic pressure is applied to the whole fetal surface, so that the birth experience is gentler for the baby.
When a baby is born with membranes intact, there is less likelihood of the uterus closing up after the birth of the
baby, and before the delivery of the placenta.
Keeping all these points in mind, routine ARM is most undesirable.
Intramuscular injection
An injection of pitocin may be given in the arm or on the hip. Pitocin speeds up labour when contractions become
lax. Once labour is established a course of 3 to 5 apidocin injections may be given to speed up the opening up or
dilation of the cervix.
Intravenous drip
The commonly used procedure for induction these days is to trigger off labour with the use of synthetic form of the
oxytocin hormone, which in natural labour is secreted by the mother's pituitary gland and makes the uterus contract.
The artificial form of oxytocin, called syntocin, is added to a bottle of glucose solution and introduced straight into
the mother's blood stream through a drip attached to her arm. A fine needle is inserted into a vein in the arm and kept
in place.
Doctors like to use the drip because the glucose gives you energy without your needing to eat anything. So if a
Caesarean section is needed, your stomach is likely to be empty as needed for the administration of anaesthesia. If
you eat, there is the risk that while under anaesthesia you might vomit and inhale the contents of it. Glucose or
dextrose solution drips energy straight into your veins, bypassing the stomach.
The energy you can get from glucose will be useful if you have had a long-drawn labour and become tired. So
while in labour you can also drink glucose dissolved in water, with the consent of your doctor, when you begin to
feel tired.
Once a drip is set up, any drug apart from syntocin can be introduced into the blood stream through it, without
your being aware of it. If you are on the drip, each time the bottle is changed ask what it is. The bottle would have
'Synto' written on it to indicate the syntocin hormone.
Routine use of the drip is best avoided. It will make you immobile in labour, confining you to the bed. It will
also make labour sharper and stronger, unnecessarily adding to your discomfort. There are times, such as prolonged
labour, when a drip may be needed.
Labour may be triggered off by the intravenous glucose drip in certain conditions like toxaemia, very high blood
pressure, diabetes, prolonged pregnancy, if some hours have elapsed after the bag has burst and labour has not begun
on its own.
If you happen to need the drip, remember to pass urine frequently while on it, to avoid your bladder getting very
full. Request for the glucose bottle to be fixed on a stand with wheels, rather than for it to be fixed to the side of your
bed. That would allow you to go to the toilet when required and also allow general mobility. If the drip is fixed to
the side of your bed, request for a long tube so that you can turn over and move about in bed. If it is short, you will
feel trapped. Avoid putting weight on the arm on which the drip is fixed.
Home Inductions
Breast stimulation
If your partner sucks at your nipples, or either of you stroke and massage the nipples and the breasts, it will stimulate
the release of oxytocin hormones in your body, and if your body is ready, over a period of time, it can cause labour
to start. Applying a warm cloth to your breasts can have the same effect. 15 days before your estimated date of
delivery, you can take a mug of warm water and dip two face towels in it. Wring the water out of them and apply
them on the front of the breast, so that they cover the nipple, and areola. This will cause you to feel a pleasant warm
sensation. When you feel this, remove the towels and dip them in water again and re-apply them on the breast. Do 6
times altogether. Repeat 4 times a day Morning, afternoon, evening and night.
At the Letterman Army Medical Center in San Francisco, 2 groups of a 100 women each in the 39th week of
pregnancy were instructed to rub both nipples gently between their fingertips for an hour, thrice daily. By the 42nd
week 89 breast stimulators had gone into spontaneous labour, as compared with 77 non-breast stimulators in the
other groups. Also only 5 breast stimulators had unripe cervixes as compared to 17 in the other group (see p. 103).
Intercourse
If your delivery is overdue and the doctor says an induction may be considered, it is a good idea to indulge in
intercourse. Seminal fluid is rich in prostoglandin hormones which are known to ripen the cervix and stimulate
contractions. The cervix is thus affected locally and labour begins more naturally as compared to being put on the
intravenous drip in the hospital (see p. 102).
The growth of the baby is estimated not by the largeness of the mother's abdomen but by the
height of the growing uterus. It is only in about the 4th month that the pregnancy begins to
show externally, as the abdomen enlarges. A few weeks before delivery the uterus may drop
or lower as the baby's head goes into the pelvis.
Prolonged Pregnancy
A pregnancy can go 14 days over the estimated date of delivery. However, most obstetricians do not like the
pregnancy to prolong beyond 7 to 10 days after the estimated date of delivery. If pregnancy goes more than 14 days
beyond the due date, doctors are concerned that:
■ Beyond this time the placenta begins to get 3 months fibrous and its efficiency to nourish the baby decreases.
■ The measure of amniotic fluid dwindles as the baby gets bigger, so it could result in a dry labour.
■ The cranial or head bones harden and no moulding of the head takes place during birth.
Whether labour needs to be induced or not depends on the baby's well-being. The baby's well-being can be
assessed in the following ways:
Fetal heart rate
If the fetal heart rate is normal, it is a sign that all is well with the baby. The average fetal heart rate is 140 beats per
minute It could vary slightly. Your doctor would know what the heartbeat of your baby has been throughout
pregnancy.
Placental insufficiency I.U.G.R.
Placental insufficiency will be suspected if the doctor feels that the baby is not growing, since the size of the uterus
will be smaller than it should be. This could occur in underweight, malnourished women, in women prone to drug
abuse, women with high blood pressure, chronic kidney disease or diabetes. It could also happen in women prone to
pre-eclampsia, heart, lung or gastro-iritestinal disorders, and women suffering from infection
According to the book Obstetrics and the Newborn, 1997, in case of I.U.G.R., the second baby is likely to fare much
better than the first baby.
If the doctor suspects a slow fetal growth, improve your diet. If you are already eating well, rest. Rest
encourages blood flow to the uterus and the baby, and after bed rest, a sudden spurt in the baby's growth may be
noticed at the next checkup. As you rest, favour lying on your side to lying on your back, it will encourage greater
blood and oxygen supply to the baby. Lying on the left side encourages optimum oxygen supply to the baby. Avoid
a smoke-filled atmosphere. If this does not help the baby's growth, the baby may be delivered by a Caesarean section
or labour may be induced, depending on what the doctor thinks best.
Diabetic mother
Some women may develop diabetes in pregnancy, while some others may be diabetic to begin with.
Diabetes that starts in pregnancy is called gestational diabetes, and is more likely to occur in the last 3 months of
pregnancy. A high glucose level in early pregnancy could mean that the mother was diabetic before pregnancy
without realising it. Most women who develop gestational diabetes will find that their glucose levels return to
normal after delivery. However, gestational diabetes could return with the next pregnancy. The possibility can be
reduced by following a healthy diet and not putting on too much weight.
Frequently, pregnant women may show glucose in their urine without having diabetes, as, in pregnancy the
resistance level at which glucose spills into the urine comes down. A glucose tolerance test can identify whether the
woman has an unusually low renal threshold, but not diabetes, or whether she has diabetes.
Women who are diabetic before becoming pregnant have an excess of blood sugar which the baby absorbs and
tends to become very large. The doctor will recommend a restriction of sweet foods to these mothers.
A diabetic mother may be induced early so that the baby does not get so big that a safe vaginal delivery is
impossible. Despite its large size, the baby may not be mature and may need special care after birth. Sometimes if
the cervix is not soft and ready to open up, a Caesarean section may be performed.
Whether you develop diabetes will depend on whether there is a history of diabetes in your family Also women
who have previously given birth to exceptionally large babies, say 4 kilograms or 9 pounds, may be prone to
diabetes. Often diabetes disappears after the birth of the baby. However, it is a sign that you have latent diabetes and
it would be a good idea to keep a check on your diet and weight.
Toxaemia
When a woman's blood pressure is up the whole day (not only when she visits the clinic), when she has albumin in
the urine and when she is retaining fluids so that her fingers, ankles and possibly her face is swollen, she would have
toxaemia. A woman with toxaemia might also have a sudden weight gain. In severe toxaemia—the placenta, which
nourishes the baby—provides it with oxygen and helps excrete its waste products, will not be able to function well,
so that there is a risk to the baby. In such cases, labour will be induced so that the baby Is born while the placenta is
still functioning well (see p 57).
Very high blood pressure
In the last 3 months of pregnancy, when a woman's blood pressure is checked during an antenatal visit and it is
found to be high, say 140/90 or more, the doctor will try and treat the high blood pressure so that the pregnancy can
be maintained to allow adequate growth and maturity of the fetus, so that it will be able to survive at birth. Often rest
might control the blood pressure. If required, sedation may be given to control it. If these measures are inadequate,
labour may be induced (see p 57).
When the water bag bursts
When the water bag bursts in a great gush, and contractions do not start spontaneously, an induction is set up to
deliver the baby within 24 hours, beyond 24 hours the risk of infection sets in. Interestingly the risk of infection rises
with each internal examination.
There is no harm if you wait for 4 to 5 hours or longer after the bursting of the bag before the drip is fixed. It is
possible that as you wait, the contractions may start on their own. Contractions that start spontaneously are gentler
and less intense than those induced by drip.
Prolonged labour
When labour lasts for many hours without progress, say approximately 12 to 18 hours, an induction could speed up
the progress of labour.
Rhesus negative
If you are rhesus-negative and there is a possibility that your baby is going to need blood transfusion at birth, labour
may be induced so that your baby will be born at a time when laboratory facilities, the paediatrician and other staff
will be available. This will be the case if, while you are pregnant, you have a positive antibody test, that is, a blood
test reveals that you have antibodies in your system (see p.60). However, this danger today is almost non existent,
since an injection of anti-Dimmunoglobin is given to the mother in the ante-natal period as a preventive.
11.

Birth
Straightforward uncomplicated birth comprises 3 distinct stages. In the 1 st stage of labour the mouth of the womb
opens up and dilates to make way for the baby's head to pass through. In the 2nd stage of labour the baby passes
through the vagina and is born. In the 3rd stage of labour, the placenta is delivered, having completed its function of
nourishing the baby.
The first stage of labour

The 1st stage is the longest - about 12 hours with a little plus or minus. The 2nd stage could be from 30 minutes to
an hour and a half and the 3rd stage could take about 10 minutes. In the first delivery, the 1st stage is usually longer
than in subsequent births.
In the 1st stage, the lips of the womb or cervix thin out and stretch apart over the baby's head, while the body of
the uterus shrinks on the baby and pushes it towards the cervix. This is what happens during the contraction or pain
of labour. Sometimes before contractions are felt, a harmless, thick mucus discharge may be noticed. On the other
hand, a water leak may herald the onset of labour (see p. 107).
When you go to the hospital, your husband or relative will be given certain forms to be filled up, while you will
be taken to a room where you will be told to change into a hospital gown. Then your pubic hair will be shaved. It
will be followed by an enema. An enema is a process whereby a tube is inserted in the anus and a fluid flushes the
bowels thoroughly. This avoids the passing of stool during birth. Often after an enema, contractions become
stronger. Remember, an empty rectum and an empty bladder will aid the progress of labour, so in labour pass stool
whenever you desire to and keep drinking fluids and pass urine every 60 to 90 minutes. A full bladder can cause
discomfort and pain and inhibit uterine contractions. Later it can lead to diminished bladder tone and infection. Do
not limit your fluid intake. You will specially get thirsty if you perspire a lot.
After the enema, your husband or relative will be permitted to join you, and can be with you until when you are
ready for birth, and taken into the delivery room. If you have booked in a big hospital, you may not be permitted to
have your husband or relative with you.
During labour your blood pressure could be taken now and then. The nurse would also take your pulse and
temperature, and listen to the baby's heartbeat. The position of the baby may be ascertained by palpitating your
abdomen or by an internal examination. An internal examination could also be carried out to check how many
centimetres the cervix has dilated. A note would be made of whether the membranes have ruptured and whether
there is any bleeding, you will be asked when and what you ate last and whether you have taken any medication.
Labour can begin quite gently and build up to powerful sensations. Between contractions, you must make an
effort to practise quick relaxation. If labour starts during the day, move about the house at leisure. If labour starts in
the evening or night, try and get some sleep. Do not tire yourself out by being physically overactive. Conserve your
energy for the other half of labour, but do try and remain upright. When you are upright, the pressure of the baby's
head on the cervix will stimulate your uterus to contract. If you lie down for a while, remember lying on your side is
better than lying on your back, since it relieves pressure on the vena cava, a major blood vessel, so that the oxygen
content of your blood is enhanced, much to your and the baby's advantage.
You will find further details on how you can remain upright and when not to remain upright in the chapter
Labour Time.
Labour can be handled quite comfortably with breathing, various positions and relaxation techniques. However,
there are some drugs that are used for pain relief in labour. Their use will depend on the discretion of your
obstetrician. You may or may not need them during labour.
Drugs, analgesics and anesthetics are sometimes administered, although they are often unnecessary and can have
harmful side effects. Refrain from asking for them. Family members accompanying the woman in labour should
avoid becoming unnecessarily anxious, constantly requesting the doctor to do something. Labour will take its own
time.
Some women may have an unnatural or difficult birth. Complications sometimes occur, in which case you must
leave the decisions to your doctor. Some complications could arise in labour, whereas in some cases risk factors are
already present, for instance, a woman with a previous Caesarean delivery, a previous stillbirth, kidney problems, or
diabetes. In such cases a good public hospital, if situated within reachable distance, is a good choice A big public
hospital would have a highly experienced and qualified staff, blood bank facilities, a paediatric unit to take care of
the newborn and there would be no commercial pressures.
Second stage of labour
The 2nd stage of labour is recognised by strong contractions coming every 1 to 2 minutes and lasting a whole
minute. After a while the contractions will slow down. Typical of this stage is also the desire on your part to bear
down and push the baby out. Some women feel nauseous at this stage of labour. The 2nd stage of labour begins
when the cervix has dilated to its full 10 cm and ends with the delivery of the baby. At this stage you are taken into
the delivery room and made to lie down on your back with legs bent at the knees and feet resting flat on the bed.
Alternatively, you will be made to lie down on your back and your legs will be supported by a set of stirrups on
either side of the delivery table, so that your legs after being bent at the knee would be supported wide apart on
either side. The stirrup would support the back of your bent knee and ankles.
Prepared Childbirth
If labour progresses without drugs, while a woman uses prepared childbirth techniques or naturally handles
labour in a relaxed way, the body produces endorphin hormones. Endorphins are natural painkillers and are secreted
by the body during hard physical exercise and labour.
Some prepared childbirth methods concentrate only on psychologically training a woman for birth, while other
methods equip a woman to deal with labour by using certain breathing rhythms, as explained in this book, in the
chapter Breathing and Relaxation for Labour.
Prepared childbirth is ideal for a woman who would prefer to avoid medication in labour either completely or as
long as possible. Just moving about in labour from one position to another, as one desires, reduces the discomfort of
labour greatly. So does the practice of breathing and relaxation.
Painkillers are often freely offered and accepted in labour because in our civilised society nobody likes to lose
emotional control. As women often say, 'I don't want to make an ass of myself; It is not socially acceptable for a
woman to make a show of her feelings in labour. She is expected to be a patient who lies down quietly in her bed
making as little noise as possible. Women often do not realise that they have another option.
It is best to avoid any kind of drug in labour, since whatever you inhale or receive intramuscularly, or through
the drip while in labour, passes to the baby through the placenta in a matter of minutes. What you receive will be
given to you in accordance with your body weight and it immediately passes to the baby who is only a traction of
your weight. So a drug that will make you sleepy or knock you out, will do the same, manifold, to the baby.
Most sedatives and painkillers given to the mother would depress her breathing and lower her blood pressure,
doing the same to the baby. As a result the baby would be born sluggish, which may jeopardise the baby's respiration
in the few precious moments after birth. Lack of oxygen at birth can have a serious effect on the child's brain, even if
mild; it can affect its ability to learn in later years.
Drugs must be used with great caution if the baby is premature or small, because the baby's liver will be
immature and will find it difficult to break down the drugs and eliminate them from the body. In labour, a drug, in
order to be of use, should not be given in so large a dose that it results in dangerous side effects. At the same time
the dose should be large enough to give the desired effects, that is, the dose should not be too small and therefore
ineffective.
The more medication a mother receives in labour, the longer and more difficult will be the baby's adjustment to
life after birth. Medication can also affect breastfeeding negatively, especially in the first 5 days.
Most mammals like to have their babies in a quiet dark corner, where, left to themselves, they move about
restlessly and deliver by themselves. People having pets may have noticed this kind of behaviour in dogs and cats.
Human beings with their learned behaviour find it difficult to regress to such natural primitive behaviour.
A woman should learn to flow with her body and experience the birth of her baby as a basic function of her
body. Each contraction should be considered an effort of her body to give birth to her baby. Handled positively and
naturally, many women speak of the delight of feeling the baby's body slip through, of feeling a warmness and a
wetness followed by the baby's cry. Whereas many drugged or anaesthetised women may feel they missed out on it
all.
Two obstetricians, Dr. Dick Read and Dr. Lamaze, taught women how to cope with labour. Dr. Read stressed
relaxation and understanding labour in order to remove fear. Dr. Lamaze stressed teaching preconditioned breathing
responses to women to use at the time of labour. Presently, Dr. Michel Odent is teaching women how to regress to
primitive consciousness in labour, by being given quiet and gentle support by birth attendants, while the labouring
woman moves instinctively to find naturally comfortable positions. She is encouraged to forget what her culture has
told her about labour, and to be in touch with her body.
This is often referred to as the working stage of labour, for you have to work along with the uterine contractions
to expel the baby and deliver it, by adding your efforts to physically push the baby out.
At this stage the folds in the vagina unfold to accommodate the baby's head. The pressure of the baby's head on
the pelvic floor gives a feeling of fullness in the rectum, which many women describe as a desire to pass stool.
Finally the baby's head comes in contact with the perineum or the muscular outlet of the pelvis, which is stretched
until the baby's head appears through it, just as your head would appear out of the top of a polo neck sweater when
you are putting it on. The baby's head is normally delivered face down and the back of the head towards the ceiling.
After the head is delivered, the baby's shoulders appear, followed quickly by the rest of its body. You may hear your
baby's cry or whimper. The absence of loud cry does not mean that something is wrong.
Third stage of labour
This stage begins with the birth of the baby and ends with the expulsion of the placenta, which peels away from the
wall of the uterus and is delivered after the baby.
After the birth of the baby, the umbilical cord continues to pulsate and supply the baby with oxygen through the
placenta, while simultaneously, the baby's own breathing gets established. The cord is clamped a few inches away
from the baby's navel and a few inches away it is incised between the two clamps. A stump of the cord will be left
on the baby's abdomen. After a few days the stump will dry up and fall off, leaving the baby's navel as a permanent
mark of its past existence.
The baby is born with mucus or fluid in its nose, mouth and throat. Some of it is wiped away when the head is
delivered. After birth the baby is kept head down to encourage further draining of the mucus. If the mucus seems to
be interfering with the baby's first breath and there are chances of it being inhaled, it will be removed by a suction
device. A little mucus remaining in the baby's lungs gets absorbed into the bloodstream when the baby's breathing is
well established. At birth the baby's lungs are in a collapsed state like deflated balloons, stickily held together by
mucus. The first breath fills them with air. The filling of the lungs with air causes blood to rush to them and the
oxygen from the air is absorbed by the baby's bloodstream. When this happens the baby's blood circulation switches
from receiving oxygen from the placenta to receiving oxygen from the baby's lungs.
The baby's heart starts to function. The artery that fed the baby's heart blood from the placenta stops functioning
when the cord is incised, and the baby's heart begins to function independently.
The delivery of the placenta is not unpleasant or painful. The last few contractions cause the placenta to detach
from the wall of the uterus and it is delivered through the birth canal. Sometimes an injection of syntometrine or
syntocinon is given to make the uterus contract and hasten this stage. Sometimes the doctor tugs at the cord and at
the same time the abdomen may be massaged to help free the placenta from the uterus. On the other hand, after 10 to
15 minutes of the birth, uterine contractions spontaneously start again. They take another 10 to 15 minutes to
become strong enough to separate the placenta from the uterine wall and expel it.
The doctor checks the placenta to see that it has come out whole. Bits of it left inside can create problems later,
of heavy bleeding and passing of clots.
The Baby at Birth
At birth a baby looks wet with plastered down hair. The body is covered with a cheesy substance called vernix
which gives waterproof protection to the baby in the uterus. The baby might also be streaked with a little blood. At
first the baby may look blue, but will change to a pink shade as its circulation gets established. At first the baby
breathes around 110 breaths per minute and may cough and splutter or gasp.
Occasionally the baby's head might be a little oddly shaped as a result of its moulding during birth. The baby's
breast may also be enlarged in either sex. A male baby's testes may seem blue and enlarged. A female baby's labia
may be red and swollen. The baby may be covered with fine hair. After a few days the oddities of appearance will
disappear.
12.

Gentle Birth
In recent years the limelight has shifted from the labouring mother to the labouring baby. At first all attention was
focused on providing pain relief to the mother. Now, science has realised that the baby is not born deaf and
insensitive to its environment as was previously believed. The baby is very sensitive to light, sound and touch. Just
as the mother labours to give birth, the baby labours to be born, to wriggle itself out of the birth passage, to see the
light of day.
Birth is also painful for the baby. How painful, one cannot say, since no one remembers the birth experience.
Until labour begins, the baby is safe inside the warm waters in the uterus. The baby does not have to breathe. Its
body is supplied with oxygen through the umbilical cord. It is never hungry or thirsty. Nourishment reaches the baby
through the cord. It is nurtured by the placenta and the umbilical cord and feels safe and familiar with its
environment. Suddenly, the nurturing womb becomes hostile and begins to shrink on it, the space getting more
cramped with each contraction. It gets expelled towards the opening in the mouth of the womb. From the womb it is
propelled further down towards the birth passage. Realising the inevitable expulsive efforts of the womb, the baby
also tries to struggle free in the direction of the expulsive forces. It joins in the struggle in the hope of setting itself
free of these incomprehensible forces.
Finally comes freedom, or birth. And what does the baby encounter? In order to survive, it has to breathe, and
quickly. For the cord supplying it with oxygen is cut immediately. Its lungs fill with air for the first time in its life,
and it probably feels the passage of air searing in, and finally reach in its lungs to inflate them instantaneously like
bicycle tyres. There is blinding light, which causes it to close its eyes. It gets held upside down and probably
slapped, so that its cry can reassure birth attendants that it is well.
There are strange sounds or deafening noises. Its skin, used to the soft touch of warm water, experiences the
rough feel of fabric. It gets laid on a cold, hard table. Tubes may be pushed into its nose or mouth right down to its
lungs. Burning eye drops may be put in its eyes.
In other words, the trauma of labour is followed by the trauma of birth. Today, many psychologists feel that the
trauma of birth can leave a permanent mark on the baby's psychology. Also many obstetricians believe that the
trauma of birth can be greatly reduced by giving a warmer welcome to the baby at birth.
DR. R.D. LAING

According to him when the baby is born, the umbilical cord is wet and pulsating. It is full of blood which reaches the
baby through it, from the placenta. As soon as the baby is born, the doctor clamps the cord and cuts it. It takes
approximately 5 minutes for the baby's own blood circulation to establish. If the cord is not cut immediately, it gives
the baby oxygen while this transition is being made. The blood vessels carrying blood from the cord seal off as the
baby's own system of circulation takes over. So if the cord is cut after the newborn's own circulation has taken over,
the newborn's adjustment to breathing and the world will be smoother and gentler.
DR. FREDERICKLEBOYER
Dr. Leboyer, a French obstetrician, feels that the baby's cry at birth is a cry of anguish from the pain it suffers. He
believes the baby should be delivered in a gentle and loving environment of dim lights and hushed voices. The
newborn baby should be lifted and placed face down on the mother's abdomen. The mother should gently massage
the baby's back as it unfolds into the world. The cord should be cut after it has stopped pulsating, even though the
baby would have been breathing on its own for some time.
Leboyer in his book, Birth without Violence (U.K., 1975), says, 'Instead of howling as expected, each baby
merely uttered two or three healthy cries and then contented itself with powerful breathing. So that in the silence that
followed, what each woman heard was the very absence of her baby's cry. Her eyes soon betrayed first surprise and
then alarm, darting questioningly from one of us to the next.'
'Why isn't my baby crying ?' They seemed positively aggrieved. The surprise, the regret, the accusation in those
questions dumbfounded us. We had not realised how deeply ingrained is the assumption that the newborn child must
cry, how profound is the unconscious acceptance that birth and suffering are one.
'To be fair, we must admit that a newborn baby who begins gurgling happily after just a cry or two, who yawns
and stretches, who enters life the way we awake from a restful sleep—is something of a surprise.
'When a child comes into the world, it must undoubtedly cry. But it need not weep.'
Once the cord is cut, Dr. Leboyer believes the baby should be lowered gently in a small tub or basin of warm
water. The baby will feel the warm lightness of moving in water, just as when it was safe and warm in the water bag,
in the mother's womb.
DR. MICHEL ODENT

Dr. Odent has been greatly influenced by Dr. Leboyer's teachings.
However, while Dr. Leboyer concentrates on the baby, Dr. Odent also takes into account the woman in labour. He
believes that a woman should be trained to accept labour as a very natural process of her body, and that she should
regress to her primitive consciousness to be in touch with her body while it is accomplishing a very basic function.
Women should be taught various upright positions they can adopt in labour. In labour a woman should do whatever
she wants to. She can go through labour as she likes. If she wants to scream, she screams. If she wants to sit she sits,
walks if she wants. The room where she delivers has no menacing stainless steel equipment exposed. It is done up in
warm shades of orange and brown. The room is softly lit and comfortable. It could have a low platform, cushions
and birthing chair. A woman is told to remain upright in labour and to give birth in squatting position, just as
advocated by the traditional Indian dais (midwives).
Dr. Odent feels this is specially useful in delivering breech babies, or babies being born feet first. When a mother
is squatting at birth, a breech baby gets born much faster, so that the danger of the baby breathing in mucus before
the head is delivered is greatly reduced.
Dr. Odent also has a small pool of warm water in which a woman in labour can sit. The warm water relaxes a
woman's tense muscles and eases contractions. Babies are sometimes born in the pool of warm water when the
mother does not desire to leave the pool. The baby emerges into the water while it is still getting oxygen from the
umbilical cord. It transfers from the watery medium of the womb to the watery medium of the pool. It breathes when
it is lifted out of the water of the pool.
Dr. Odent's uniqueness lies in his belief that each woman possesses an instinctive ability to give birth naturally.
This ability is held suspect by modern obstetric practice which concentrate on skills to control labour. Dr. Odent
witnesses each birth as it occurs and does not intervene in anyway. He does not use pain-killing drugs, synthetic
hormones, epidurals or forceps. He believes that without any medical intervention the body releases complex
neurohormones. It is on the natural balance of these hormones that spontaneous labour depends.
Dr. Odent in his book, Birth Reborn (U.K., 1986), says, 'It has also become more and more obvious that
endorphins play an important role in the complex hormonal equilibrium that makes a spontaneous delivery possible.
Neurohormones with morphine like functions, these 'endogenous opiates', act as natural pain-killers, not only
protecting against pain but also suppressing anxiety and inducing a general feeling of wellbeing. High levels of
endorphins may, for example, induce so called alpha brain waves that are associated with states of serenity or
beatitude. It is almost as if people have always sensed the presence of this natural capacity for wellbeing and sought
ways to trigger it. Running, for example, raises our endorphin levels; prayer, meditation, yoga and acupuncture may
do the same.'
After the baby is born, it is placed on its stomach, on a soft towel between the mother's legs. The baby's head is
turned to a side so that if the baby has some liquid in the mouth, gravity helps to drain it out and prevent it from
entering the baby's lungs. The baby lies like this until it lets out a cry and takes some deep breaths, coughs, sneezes
and shows good body tone. The room is heated to a comfortable temperature or the baby is covered with a blanket.
Then the baby is scooped up by the mother in her arms while it is still linked to her body by the cord. In the first half
hour or so after birth, mother and baby get to know each other. The cord is cut unhurriedly after this first contact has
been made.
Although Dr. Leboyer and Dr. Odent strongly believe in gentle birth, they are backed up by a full medical team
should emergencies occur. They know how to look out for maternal or fetal distress, should it occur, and how to take
care of it. Dr. Leboyer points out that mother and child should never be allowed to go short on oxygen. Dr. Odent
performs Caesarean sections when they are necessary. Interestingly, their Caesarean section rate and their rate of
babies dying are lower than the average.
Caesarean Section Rates

Dr. Odent 6 to 7%
U.S.A. 19%
U.K. 13%
France 15%
(Source. Birth Reborn by Dr. M. Odent p. 101)
In France perinatal mortality rates (i.e. death immediately before or after birth) rates in the last 8 years
have dropped from 20 per 1,000 to 10 per 1,000. Dr. Leboyer is said to have greatly contributed to this.
13.

After Childbirth
Immediately after the birth of the baby you may not be overcome by a gush of maternal love and instincts. You
might even be a little disappointed by the way your baby looks. This is quite normal. As you begin to breastfeed and
care for your baby, as you see your baby respond to you, your maternal feelings will be aroused and a deep love for
your baby will bloom.
It is a good idea to take a laxative tablet like Dulcolax after the birth of the baby, so that you can pass the first
stool with ease. Other tablets that may be prescribed by your doctor could be Calmpose to make you sleep and
antibiotics for your stitches, pain-killers, or tablets for bleeding.
After the birth of the baby, and always afterwards, do not wash yourself from the anus towards the vagina after
passing a stool. You could infect your stitches and make them septic or cause yourself a urinary tract infection.
Wash the anal area separately with soap, after passing a stool.
After a Normal Birth

After a normal vaginal delivery of the baby, you may find that you have to contend with discomfort in some parts of
your body. Your breasts for instance, a few days after birth, would become full/swollen/sensitive as the milk comes
in. Pressing out some milk when this happens will help relieve the discomfort. Sometimes you might experience
mild contractions while feeding, for, as you feed, hormones are released that contract the uterus and encourage it to
involute close to its pre-pregnant size. Practise waist-level breathing to get over this discomfort.
Your perineum or pelvic floor may be sore from the stitches, so for the first 4 to 5 days sitting may be a problem.
It will help if you use a round rubber tube to sit upon, like the one children use in swimming pools. It will avoid
direct pressure on the perineum when you are sitting, so healing will be quick and the discomfort less; specially
when you sit up to breastfeed the baby. If during your bath you bathe the perineum and the whole vaginal area with
a mug of warm water to which a few drops, 8 or 10, of the homoeopathic medicine Calendula Q have been added,
the healing will be much faster. The doctor will give you an ointment to apply, a mycin, and perhaps an anesthetic
ointment.
Your stomach will feel jelly-like, loose and unstable. You must exercise your abdominal muscles in the first few
weeks to regain abdominal tone. (See postnatal exercises below.)
Avoid wearing a corset or binding cloth around your abdomen. It will only get your muscles used to artificial
support. The minute the support is removed, the muscles will sag.
Immediately after birth the muscles are still under the influence of relaxing hormones. The exercises you do
should merely coax the muscles back to their original position from their stretched positions. Special exercises are
needed for this. Avoid squatting exercises. Do not lift both legs together when lying on your back. It will cause great
strain in the lower back. Do not cycle in the air.
Since your muscles are in a relaxed state and your body, especially your back, has been overstrained, get extra
help to take care of household chores for this period so that you can rest and take it easy.
Precaution
It you bend forward when passing urine you prevent it dribbling backwards towards the vagina' vaginal
stitches. This prevents infections.
When you work, say, when you wash or iron, make sure that you do so without unnecessary exertion. That is, sit
comfortably on a low stool when you wash the diapers. Make sure the ironing surface is the correct height for you.
You should not have to bend when you iron or push the baby's pram or cook. Keep your elbows relaxed and do not
tense your shoulders. Overstrain, when performing simple day-to-day tasks, can give rise to discomfort or pain in
some of the muscles in your body. If you are unlucky, this pain might stay with you even later; so make sure you do
not overstrain. Do not lift anything heavy. When lifting anything of moderate weight, bend knees and keep the back
straight as you do so. Whenever you bend down to make the bed or pick up something you may have dropped, pull
in your abdomen first.
Your lower abdomen may be streaked with brown or purple lines. These lines will slowly fade to white and
become less prominent. They are called stretch marks and tend to stay, getting fainter over the years.
At times you may be troubled with piles after childbirth. You might feel itchy around the anus. When piles are
greatly aggravated they may even bleed. If you splash the anal area with cold water and then dab it dry, it will
relieve the itching. Avoid spicy foods. A number of women have found the internal and external application of the
ointment Procto Sedyl very comforting.
You must make sure you do pelvic floor exercises as described in the postnatal exercises, so that you regain the
tone of those muscles and do not end up losing control of passing urine, or slackening of these muscles.
Tackling
household chores
Although you will lose some weight at birth, it will take some time to regain your figure. Give yourself 8 months to
a year. If you are considerably overweight you will have to work at it. At birth your weight loss will be equivalent to
the weight of the placenta, the baby, the amniotic fluid. Over the weeks following the birth you will lose a lot of
extra fluid content of your body.
A sling for the baby

Exercises after a Normal Delivery
When you lie down to exercise, always do so without a pillow.
Exercise 1 Days l & 2
Lie on your back with knees bent, feet resting on the bed. Breathe in slowly and deeply, breathe out. Do this every
day, between each exercise and at the end.
Do 5 times.
Exercise 2
Lie with your legs straight and slightly apart. Bend and stretch your toes. Bend and stretch your ankles. Roll your
feet round in circles in both directions. Do 5 times in each direction.
Repeat this 5 times.
Exercise 3
Lie on your back with knees bent and feet resting on the bed. Tighten your buttock muscles and pull in your
abdomen so that your back is pressed against the bed. Hold this position while you count 6, then relax.
Do 5 times.
Exhale and repeat, always exhaling before you start
Day3
Repeat the above exercises and add exercise 4, which will strengthen the muscles supporting the womb and help
keep it in its right position.
Exercise 4
This can be done sitting or lying down. Exhale, pull up the muscles through which your baby was born, thus
tightening your vaginal muscles, i.e. you contract just as you would when you try to stop the flow of urine. Hold the
contraction while you count 6; then relax. Exhale. Repeat.
Do 5 times, always exhaling before you start.
Days 4 to 7
Exercise 5
Lie with your right knee bent, and right foot on bed, left leg straight.
Slide your straight leg (left) down the bed, as far as possible, then slide the whole leg up the bed.
Only your waist muscles must work. Repeat with the other leg. Do 4 times with each leg.
Exercise 6
Lie with knees bent and feet on bed.
Draw in your abdominal muscles, reach across your body to place one hand on the opposite side of the bed, in level
with your hips. Return to the starting position. Now do this with the other hand. Do a total of 8 times.
In the afternoon sleep on your stomach. Take a pillow under your head and one below your breasts to avoid
discomfort.
After a Caesarean Section

After the birth of your baby by abdominal surgery under general anesthesia you will be on the intravenous drip for
some hours. The first thing to strike you after you come out of general anesthesia could be the discomfort of your
abdominal scar. You would then be introduced to your baby. If you do some deep breathing, as much as you can
comfortably manage, it will help to exhale the anesthesia out of your tissues and make you feel better.
It is common after a surgery to feel that you have a collection of mucus in your throat. Some women say 'I have
just developed a bad throat.' The discomfort in the throat is caused as a result of a rubber tube inserted in your wind
pipe during surgery, so that if you vomit while under anesthesia you do not inhale it into your lungs. It may cause a
lot of dryness in the throat and make you want to cough. If you feel dryness in your throat, cover your mouth with a
wet towel as you breathe, or/and put a couple of drops of water in your mouth to prevent dryness. When dryness
does not bother you any longer, suck some cough drops or rock sugar (mishri) to soothe the throat.
The sooner you cough up the phlegm from your throat, the better you will feel. You have to learn to cough in
your throat like singers before a vocal recital. Clear your throat and cough out. This will be more effective than
taking cough syrup. The sooner the throat gets cleared, the better you will feel. While pregnant, practise coughing in
your throat rather than from your abdomen.
The internal stitches on your abdomen will dissolve, but the external stitches may need to be removed a week to
10 days later. On the other hand, the external stitches may also be the dissolving kind. You will have to take it easy
to allow the healing to take place.
On the 2nd day the nurse will come to change the sheets of your bed. It will be better if you get out of bed while
she does so. Sit up in bed, by having your bed shifted to a sitting position. Place palms on either side of your body
and lift your body up and gradually move yourself to the edge of the bed. Gently swing legs off the bed on the
footstool or floor, hold a pillow in front of the abdomen for support, stand up and go to sit on a sofa/chair. Go gently
back to bed when it is made. The whole exercise will make you feel much better by the end of it, since it will give an
impetus to blood circulation.
If your first delivery is by a Caesarean section for a non-recurring factor like a failed induction or fetal distress,
then the second delivery could be a normal delivery. If the first delivery is by Caesarean section from a recurring
factor like a malformed pelvis, then the second delivery will also be by Caesarean section. Once you have had a
Caesarean, all future labours should take place in a hospital. A uterus with a scar is watched carefully throughout
pregnancy and labour. Rupture of the uterus is a serious but rare complication, occurring only in 0.5% of cases.
Signs to be watched for are fresh, unusual vaginal bleeding, and pain over the scar.
The following are gentle exercises to be done after a Caesarean section.
Exercises before stitches are removed
Exercise 1
Lie on your back. Breathe in slowly and deeply, breathe out. Do 5 times, at least twice a day.
Exercise 2
Lie with your legs straight and slightly apart. Bend and stretch your ankles. Bend and stretch your toes. Roll your
feet round in circles in both directions, (see p. 160)
Exercise 3
Can be done sitting or lying down. Exhale, pull up the muscles of the pelvic floor, thus tightening your vaginal
muscles, i.e. you contract just like you would when you try to stop the flow of urine. Hold the contraction till you
count 6, then relax. Exhale. Repeat. Do 5 times, always exhaling before you start, (see p. 160) jelly if required.
When you go to the doctor for a checkup you must inform him or her of any discomfort you might have with
your bowel movement, passing of urine, sexual intercourse, or piles. Pelvic or pelvic floor discomfort would also
need investigation.
You may walk up and down the stairs, but not more than is absolutely essential, that is, keep it to a minimum.
Get as much rest as possible. Sleep for 2 hours in the afternoon. Go back to bed after the early morning feed at 5 to 6
a.m.
Post-natal Depressions
It is common to have mood swings after the birth of the baby. Some women feel positive while others might feel
negative.
When a woman is overly depressed, it is called postpartum psychosis. A woman suffering from post-partum
depression will cry easily, sleep with difficulty, be tired and irritable, experience fear or a feeling of inferiority or
inadequacy.
At times a woman feels resentful that from being a pampered pregnant woman she is now a responsible mother.
Depression may also creep in when you feel depressed about the kind of birth experience you have had, or when you
are overburdened with work and have no help to tide over this physically taxing phase in your life.
Occasionally the reality of babycare might be overwhelming. One mother helplessly exclaimed, 'But my baby
smells shitty and vomity.' Your baby simply does not look and smell like the advertisements suggest. It will be better
if you do not discuss your feelings with unsympathetic persons. But do discuss them with a trusted friend. It is
healthy not to bottle up these negative emotions. Take things easy, do not worry too much about housework. There
is no harm if things go unattended for a short while.
If depression persists consult a sympathetic doctor, whether your family physician or a homoeopathic doctor.
Alternatively, you can consult a psychologist or psychotherapist. Discussing your feelings with them will help
tremendously in removing a psychological knot in your mind and unblock a lot of energy, so that you will feel and
function better.
Depression can occur in a perfectly healthy woman. It might be caused by a sudden withdrawal of hormones
from your body after the birth of the baby. The doctor might prescribe some artificial hormones for a while, the
dosage of which he will gradually taper off. Alternatively, the doctor may prescribe anti-depressant drugs.
Most women have responded very well to homoeopathic medicines. In case postnatal depression does occur,
women who take homoeopathic medicines tide over it quickly and effectively.
14.

Contraception
In order to understand contraception it is important to understand how pregnancy takes place. For pregnancy to take
place, an ovum or egg is released by one of the ovaries in the woman's body. When it is fertilised by a sperm,
pregnancy begins. The release of the ovum in the woman's body is called ovulation.
Sperms are contained in the semi-gelatinous seminal fluid of the male ejaculation, which is slightly alkaline.
Unless sperms gain access to the mouth of the womb or the cervix within 15 to 20 minutes following ejaculation,
they are killed by the acid medium of the vagina. The cervix has an alkaline environment, so that sperms rapidly
swim through it, up into the womb, and past the womb, along the fallopian tubes. In the fallopian tubes the ovum is
fertilised. This journey takes 45 minutes. Sperms can survive and fertilise the ovum for approximately 2 days.
Sometimes they can survive for 7 days. After being fertilised, the ovum takes 7 days to travel the length of the
fallopian tube and reach the womb or uterus.
Abstinence
The only sure way of not conceiving is to avoid intercourse altogether. However, this may be quite bad for your
relationship with your husband.
Coitus interruptus or the Withdrawal Method
It is a method in which the penis is withdrawn before ejaculation. It requires a great amount of self-control by the
man. Besides, sperms are present even in the leakage preceding ejaculation, and, from the region of the vulva where
they may be deposited they can enter the vagina even when penetration does not take place. From the vagina they
can enter the uterus and end up fertilising an ovum, leading to pregnancy. This is therefore a very unreliable method
and should not be depended upon.
Rhythm Method
This is a natural method of birth control. For it to be successful it is important to pinpoint the time of ovulation, that
is, the release of the ovum by the ovary, and its subsequent fertilisation. Ovulation generally occurs 14 days before
the onset of the next period. If the ovum is not fertilised in approximately 18 hours it dies.
The first requirement of the use of this method is a regular cycle of periods occurring at regular and fixed
intervals. The next step is to pinpoint the 14th day before the next cycle. If the periods occur at irregular intervals, it
will be difficult to pinpoint this day. The exact timing of ovulation may vary slightly.
Sometimes shock, tension, or strain can further interfere with ovulation, causing it to occur anywhere from the
11th to the 17th day before the next cycle. Also, a perfectly predictable menstrual cycle may become irregular as a
result of travel, strain, illness, in the age group of late 30s or early 40s, or after childbirth. During such times the
method is unreliable.
In a regular 28 day cycle, it is not possible for conception to occur in the first 8 days of the menstrual cycle,
beginning from the first day of the onset of the menstrual bleeding. So if there are 5 days of bleeding, 3 days after
the bleeding are safe. Then the fertile period would be from the 9th to the 17th day, both days inclusive. From the
18th to the 28th day would again be a safe period.
In a woman with a 35 day cycle, the fertile period would be from the 15th to the 25th day, both days inclusive.
The rhythm method presupposes a perfectly regular cycle.
Another pitfall of the rhythm method is, that occasionally ovulation maybe provoked by sexual stimulation,
regardless of the time of the fertile or non-fertile phase of the menstrual cycle.
Some lucky women find that this method works for them. They are very strict with their calculations and self-
control. It may be a problem for women whose husbands tour a lot and happen to be home on the wrong days of the
month. Besides it does not always work.
Added to the rhythm method, for greater accuracy one can follow the temperature method. Before ovulation a
woman's body temperature dips slightly and when ovulation occurs, it rises slightly. A dip in the temperature
signifies that the ovum is ready for release. A rise signifies the release of the ovum.
Temperature Method
The temperature dips by just about 1 degree below the normal body temperature, and rises by just 1 degree above
the normal body temperature on the Fahrenheit thermometer. It rises ½ a degree on the Centigrade thermometer
scale. The temperature should therefore be taken by a very sensitive thermometer. After rising, the temperature
remains high for 2 weeks, until the next period begins. A daily record has to be kept. It has to be tried for at least 6
months in order to be understood and followed accurately. If you are suffering from a fever or infection, the
temperature reading will not be accurate.
The temperature has to be taken at the same time every day. It has to be taken when you wake up in the morning,
before getting out of bed and before taking food and drink. The thermometer must be left in place for at least 3
minutes.
The temperature reading could vary according to your menstrual cycle, the shortest cycle being 21 days and the
longest 45 days. In a 28 day cycle the temperature would rise on approximately the 14th day after the first day of the
menstrual period. In a 37 day cycle the temperature would rise on the 22nd day after the first day of the menstrual
period.
If your temperature reading does not show the kind of reading mentioned here, continue to keep the record
nevertheless. It would be of interest to your doctor as and when you go for consultations.
Checking the cervical mucus or the Billings Method
Vagina 1 secretions change during your cycle. A few days after your menstrual period you may notice a thick,
cloudy and sticky mucus secretion. Around the time of ovulation it will change to clear, stretchy and abundant
mucus. This attracts the sperm and allows easy penetration of it to fertilise the ovum. After the fertility period is
over, the mucus again becomes thick, gelatinous and hostile to sperms.
To test vaginal secretions, you must first wash your hands with soap, then insert your finger in the vagina in
order to get a sample of the secretions. Notice the nature of the secretions. It will take you a few months to
accurately understand the secretions. Besides, sometimes semen may mask the true nature of your vaginal
secretions. This method is also undesirable because it can cause vaginal infection and the mucus secretions cannot
be accurately interpreted by the layman.
Breastfeeding
If your baby is 100% breastfed, it will change the levels of hormones in your body and prevent ovulation. That is, if
you are demand-feeding your baby with no complementary bottles or other foods, a high level of prolactin hormone
in your body will suppress ovulation Breastfeeding also delays the onset of your next period. If you breastfeed on
demand in the first few months, your penal can take 6 to 8 months to return. If you add complementary bottles and
other foods to the baby's diet, your period could return in 2 to 4 months. On the other hand, when breastfeeding is
continued unrestrictedly, your periods may take a year or more to return.
Even when you do not have a period, you could ovulate and become pregnant. On the other hand, some women
may have a period or two that may be anovular, that is, not accompanied by ovulation, or a release of the egg. Hence
breastfeeding and menstruation are unreliable indexes to whether you can conceive or not.
Along with breastfeeding if you take the progestogen-only pill or the mini-pill, it will help prevent conception,
since it will be combined with reduced fertility produced by breastfeeding. You should not have the regular
oestrogen-progestogen combined pill, since it will reduce milk production and have other undesirable side effects.
When you go for a check up 6 weeks after delivery, tell the doctor you are breastfeeding and ask for advice. If you
have intercourse before the 6-week period, you must use some other contraceptive, like the condom for instance.
The pill has one disadvantage. Its hormones are secreted in the milk and studies are continuing to find out if they
have any ill effects on the baby. If you find that after taking the pill your baby has become irritable and not gaining
weight as before, go off the pill and try some other contraceptive.
A breastfeeding woman should start the pill about 21 days before she plans to start weaning her baby on
supplementary foods. If her period does not come after the first course of tablets, she should wait 7 days and start the
next course of tablets. A period will come after weaning has been completed.
Pills
Pills are made of a combination of the 2 hormones, oestrogen and progestogen. The modern contraceptive pill has
approximately 10% of the dose of hormone as compared to the pill in use 20 years ago. As a result the side effects
are fewer and less severe. The hormones in the pill suppress the production of eggs by the ovaries by fooling them
into believing that you are already pregnant. The pill is easily available in the market under brand names of Ovral-L,
Triquilar, Mala D, Lyndiol, etc.
Since the hormonal dosage is greatly reduced, breakthrough bleeding sometimes occurs as a result of hormonal
imbalance. In the first few days or the first few cycles of taking the pill, bleeding occurs. The blood loss usually
occurs around the 17th day of the cycle and continues for a few days or until the next period. It appears in the form
of spotting. The pills should be continued nevertheless. However, if it recurs, inform your doctor. It is possible that
the doctor will change it to a pill with a higher hormone level to prevent further bleeding.
The pill should not be taken by young women whose bone growth is still not completed and who have not yet
reached physical maturity. It should also be avoided by women above 35 years of age, women who smoke, those
who have suffered from malignant disease, liver dysfunction, cardiac disease, kidney disease, diabetes, mental
depression, epilepsy, or those having a previous history of thromboembolic manifestations or thrombophlebitis
(problems with the clotting of the blood), bronchial asthma, or migraines.
When taken, it is important that it is taken at the same time every day. Its advantage is that it is the most efficient
means of contraception. The failure rate is nil. It does not interfere with the spontaneity of sexual intercourse, and
does not involve an)' mechanical device. It controls the menstrual cycle to 28 days, and reduces the amount of
menstrual flow. It also eliminates or controls menstrual pain.
Just as some people are sensitive to certain drugs, e.g. some kinds of antibiotics, in the same way some women
are sensitive to the pill. The possible side effects of the pill are nausea, fluid retention, weight gain, enlarged and
painful breasts, change in sexual desire, and fungus infection of the vagina. Should any of these symptoms arise, you
can discuss with your doctor whether you want to continue with the pill or switch to another contraceptive.
If on the pill, it is a good idea to take a break from it every 6 months. For 2 months use some other contraceptive
and then get back to the pill. Allow 2 to 3 months to pass before becoming pregnant, so that you are sure that all the
hormones have passed out of your system before you conceive. You will also be able to date your pregnancy more
accurately.
The pill does not reduce fertility or your chances of conceiving, as is commonly believed . It is just that a woman
who is already infertile may be taking it, and she becomes aware of her infertility only after she stops taking it.
The pill reduces the level of Vitamin B6 folic acid, calcium, manganese, zinc and ascorbic acid in your body. It
is therefore a good idea to take multi- vitamins along with it.
The Intra Uterine Device (IUD)
The intra-uterine device is a tiny device with a copper coil that can be inserted into the uterus during a
vaginal examination, and left there. It can be inserted 6 weeks after the birth of the baby, after a normal delivery.
The copper in this device makes the cervical mucus thick. Copper also makes the uterine lining hostile to the
implantation of the fertilised ovum.
Although the success rate with the IUD is high, it is not 100 percent reliable, since it is only a mechanical
hindrance to pregnancy. Should pregnancy occur and you decide to keep it, the IUD will be left inside. There is the
possibility that the IUD may not be there at all. That is, you might have lost it, without realising it. If it is there, it
can get embedded in the placenta, and be delivered with it after the birth of the baby or discharged with the period-
like discharge after the birth of the baby. Should you decide to go for a medical termination of pregnancy, it should
definitely be done within 12 weeks after the 1st day of the last menstrual period. During the abortion, the IUD will
also be removed.
There are various brands of IUDs available such as Copper T, the Copper-7, and the Mutiload. If the insertion of
the IUD does not suit a woman, that is, if it gives rise to profuse bleeding or pain, it can be removed and then
reinserted after 2 to 3 months. The first few periods after its insertion may be heavy. This may not matter in some
cases. However, if a woman already has heavy periods or is anaemic, it may not be advisable.
It is not advisable for a woman who has not had any children to use an IUD. IUDs have been known to cause
perforation of the uterus, septic abortion, pelvic inflammation and ectopic pregnancy. Women with fibroids in the
uterus or a prolapsed uterus should avoid the IUD.
In the case a normal delivery it can be inserted after 6 weeks, and 3 months after a Caesarean delivery.
Otherwise it is preferable to insert it 2 to 3 days after the period is over. It could also be inserted during a period, or
6 weeks after a medically carried out or natural abortion.
After insertion it will give you a 2-to-3-year holiday from worries of contraception since that is how long it will
remain effective. It is therefore a good device to be used between pregnancies, to space children. If pregnancy is
desired before that period, it can be removed as easily as it is inserted. It does not interfere with breastfeeding, nor
does it introduce hormones into a woman's body. It can be removed as and when another pregnancy is desired.
A woman who has had an IUD inserted must make sure she has it removed after its effectiveness has dissipated.
Condom
The condom is a rubber sheath that is placed over the erect penis before penetration. It works by preventing the
sperm from entering the vagina. Various kinds are available in the market under brand names like Nirodh, Masti,
Kohinoor, etc. If it is lubricated and freed of air before use, it is less likely to burst inside the vagina.
Sometimes it is not very effective because sperms may be deposited on the vulva before it is put on, through
mild leaking from the penis that may take place earlier. Its efficacy depends on the care with which it is used. Used
with a soluble spermicidal pessary in the vagina can greatly reduce its failure rate.
Some men do not like the condom as it takes away part of the sensation or because of the interference it brings
into lovemaking taking away spontaneity. However, used with care along with vaginal pessaries when other
contraceptive methods are not available, it is very valuable. It also reduces the chances of catching sexually
transmitted diseases, including the deadly disease AIDS.
Diaphragm or the Cervical Cap
These are cones made of rubber with metal at the rim. They are fitted by the woman inside her body, in the vagina,
over the cervix before intercourse and kept inside for 6 to 8 hours after intercourse. Along with them spermicidal
creams have to be used. They have to be fitted by medical personnel for the correct size, and kept clean to avoid
infection. Diaphragms, cervical caps, and spermicidal creams are not easily available in India.
Spermicidal Pessaries
Spermicidal pessaries are easily available in India under the brand name Today. It should be inserted into the vagina
at least 4 to 5 minutes before intercourse and its contraceptive effect lasts for up to 1 hour. It can be used by itself, or
together with the condom. It is more effective when used with the condom, since it must be at the cervix, not only
somewhere in the vagina, when the sperm reaches the cervix or the mouth of the womb. The manufacturer's
instructions should be followed carefully. Some women do not like the wetness of it.
Morning after contraception
This method should not be resorted to regularly. It is only to be used in emergencies. An IUD (intra-uterine device)
fitted up to 7 days after sexual intercourse can prevent implantation of the fertilised egg in the womb. Although this
will prevent a pregnancy, women often complain of a lot of pain and some bleeding.
Also, high dose morning-after pills can be had from a doctor or a family planning clinic. The pills are the
ordinary combined oestrogen-progestogen contraceptive pills, not the mini-pill. A woman should take 2 of these
pills as soon as possible and another 2½ hours later. These pills have to be taken within 72 hours or 3 days of the
intercourse. There generally is nausea and vomiting after it. Some women might also experience headache,
dizziness, and tender breasts.
Surgical sterilization: female
Surgical sterilisation of the female is called tubal ligation or tubectomy. During the operation the fallopian tubes
which carry the egg from the ovary to the womb are tied and cut, or alternately rings and clips are fixed on the
fallopian tubes to block the passage of the egg from the ovary to the womb. It requires general anesthesia and a stay
at the hospital for 2 to 3 days. If you have rings or clips on the fallopian tubes, the operation is more easily
reversible. However, when getting it done, one should consider it as being irreversible. If during the operation the
tubes get injured and bleed uncontrollably, they would be ait. When the tubes are cut or removed, reconstruction in
order to make the surgery reversible will be impossible. Careful thought should be given to the idea before getting it
done.
Apart from convalescence after the operation, it has no side effects. Periods, intercourse, menopause and sexual
desire remain unchanged. In very rare cases women have been known to become pregnant after this surgery.
Surgical sterilization: male
Surgical sterilisation of the male is called vasectomy. It is a simple operation. The tubes which carry the sperm from
the testes to the penis are cut and tied. It is a minor surgery needing 15 to 30 minutes and can be carried out under a
local anesthetic. If it is carried out under a general anesthetic the patient will need to stay in the hospital for a day.
It is a much simpler operation as compared with female sterilisation It has the further advantage of being
reversible in 70% of the cases. However, like female sterilisation, it should be regarded as irreversible.
After the operation there are no side effects, no change in sexual desire, strength or intercourse. If the man feels
any change of sexual feelings, the problem is purely psychological. The man ejaculates as before, only the fluid will
not contain any sperm. Following a vasectomy, sperms are still present in seminal fluid for some weeks.
Contraception has to be used until the seminal fluid becomes spermfree. This would require a seminal analysis.
When 2 consecutive analyses show an absence of sperms, only then can a man indulge in contraceptive-free
intercourse.
Medicine For Abortion
Recently the government has approved of a medicine for abortion. It is not available over the counter at
chemist shops. It is available with gynaecologists. It has to be taken within 49 days or 7 weeks of pregnancy, that is,
about 19 to 20 days after a missed period. Before the medicine is given, the doctor will check and rule out an ectopic
pregnancy. The medicine is made up of two drugs, one is an anti-pregnancy (anti-progesterone) drug and the other is
an expulsive drug (prostaglandin). After it is given, bleeding starts and can continue for 7 to 10 days. After the
bleeding stops, an ultrasound is done to make sure abortion is complete. In case of an incomplete abortion, a minor
operation (D&C) will be performed. This medicine therefore can be had only where medical support and back-up
are available. It has a 95% success rate. In 5% of cases when it fails, it has to be backed up by a D&C.
Contraception in the future
Various methods of contraception are currently being researched. However no ideal solution has yet been found.
Presently, research is taking place on vaccines or injections to prevent pregnancies; also on hormone implants
under the skin in women, for contraceptive purposes; on hormone preparations that can be taken like snuff; on better
quality condoms; on effective methods of pinpointing ovulation precisely, to help those who would like to use the
rhythm method. The male pill has been tried and found to have too many negative side effects. There is also research
on surgical insertion of a valve in the tubes of man and woman, to be removed as required at a later date. Who
knows what course future contraception will take?
15.

Breastfeeding
Why should I breastfeed?
That is all you need! Breast milk is nutritionally balanced and easily available. It prevents disease in the baby. Best
of all, it costs nothing, and is delivered according to consumer demand! It comes sterilised, and at the right
temperature.
Breastfeeding helps the mother lose weight, and encourages her uterus to contract to its normal size and position.
Incidence of breast and ovarian cancer, anaemia and osteoporosis tends to be lower in women who have breastfed.
Breastfeeding helps babies feel loved and secure. It encourages bonding.
The mother and the whole family can get better nutrition, whereas enormous amounts of money and energy are
spent on bottle feeding.
Breastfed babies are more active.
Breast milk is best for the proper growth of the baby. It also helps the baby's brain development. In pregnancy,
fat is deposited in the Mother's body to be used during feeding. Mother's milk has fat and lactose (carbohydrate) in
it; so you lose weight faster than a woman who is bottle-feeding.
Breast milk also protects the baby from allergies, and from disease. Since breast milk is always pure, breastfed
babies have fewer bowel upsets.
If you wear a good supportive bra while feeding, breastfeeding need not cause the breasts to sag. Breasts can
also sag with age or obesity, without ever nursing a child.
How does the Baby Feed ?

The baby's gums press on the areola, that is, the dark area behind the nipple. The nipple gets extended back towards
the baby's gullet, and the baby's tongue milks it, by pressing it against the roof of the baby's mouth or palate.
If the baby munches on the nipple instead of the areola, it will hurt the mother. A major part of the areola will
continue to be visible, and the baby will be dissatisfied because not much milk will come.
Since the baby has to munch for each sip of milk, its jaw development improves. Also, it makes it possible for
the baby to pause in between, just to breathe or look around.
As opposed to this, a bottle-fed baby gets a continuous flow of milk through the bottle's nipple and tends to
overeat. So the seeds of becoming overweight are sown right at the start.
How to Feed
When the baby latches on to the breast to feed, and it hurts, it is possible the baby has not latched on properly. If the
baby's gums press on the nipple it will hurt. If the baby's gums correctly press on the dark area behind the nipple, the
baby's sucking will not cause any discomfort. Correct sucking releases the flow of milk, and causes relief to the
mother, especially if the breasts are hard and sensitive from being overfull. The release of milk is accompanied by a
tingling sensation of the breasts.
Signs of the Baby Being Latched On
1. The muscle below the baby's ears moves as the baby sucks and swallows
2. The baby's chin touches the mother's breast
3. The lower lip curls outwards
4. More of the areola shows above the baby's upper lip and less under its lower lip.
If the baby's sucking hurts, insert a finger in the baby's mouth, between the gums, to break the suck. Then, in
order to avoid the baby's gums pressing on the nipple, put in more of the breast, so that correct latching on takes
place, and the baby's gums press on the areola, the dark area behind the nipple, instead.
To do so, stroke the baby's cheek towards the side you want to feed from. The baby will turn with the mouth
open to that side. Quickly pull the baby very close to you, so that the baby can latch on correctly.
Feeding the colostrum and foremilk helps to teach the baby how to suck, so that when the milk comes in,
sucking brings relief to the mother.
If the colostrum is not given to the baby, and instead sugared water or bottle milk is repeatedly fed, the baby will
get used to getting a constant flow from the bottle's nipple without having to suck very much
After a few days, when milk comes in, the breasts are painful and sensitive. A baby who has had the colostrum
will relieve this discomfort by sucking at the breast and emptying it. But a baby who has not sucked at the breast
before will take time to learn; and during this learning process, cause considerable discomfort to the mother.
If the baby feeds entirely on one breast at one feed and on the next breast at the other feed, it gets the fat rich
hindmilk which makes the mother lose weight and the baby put on weight. It also thoroughly empties both breasts.
The baby takes 20 to 30 minutes of suckling to empty one breast. If the baby is still hungry, you could feed it from
the other side briefly. Start the next feed from the side you fed briefly from.
Breast Size
The size of breasts in no way determines success or failure when feeding. Women with fairly small breasts can feed
as efficiently as women with large breasts.
During pregnancy you will put on a 1–1½ kg weight on the breasts, and as pregnancy advances you will need a
larger sized bra. The size could increase by two sizes, that is, a woman normally wearing size 34 could need size 38
as she goes past her 6th month.
After the baby is born, when the milk comes into the breast after a few days, the breasts become big, heavy and
uncomfortable. In the first 2 to 3 months, the breasts will remain fairly large. At times hardness and fullness may
also be experienced when the baby skips a feed.
After 8 to 12 weeks the breasts will go back to their normal size and feel soft, just as they were before
pregnancy. This does not mean that you are no longer producing milk. You might still be feeding the baby, but this
time the supply and demand balance is just right, and no overproduction of milk, or overfilling of breasts takes
place.
When feeding goes on for many months, some women might find their breasts going smaller than before they
became pregnant. It will take them time to put on the fat again and to regain their original size.
Flat Nipples
If your nipples do not project as nipples normally do, and appear flat or dimpled, they are called flat or inverted
nipples. Being flat, your nipples may project when you are cold, sexually aroused or when feeding the baby Flat
nipples are no longer considered to be a problem. As the baby suckles, a nipple-like shape gets formed with the area
of the nipple and part of the areola. Lack of projection of the nipple when the baby sucks could make the baby
unable to grasp it in its mouth.
If that is the case, the syringe method can be used to encourage the nipple to project.
Once projectivity is achieved, the syringe is removed and the baby quickly put to the breast. Also expressing
milk will make it easier for the baby to grasp the areola.
In case the baby has a problem grasping the nipple during a feed, express some milk from the breast first, so that
it becomes softer and easier for the baby to grasp. Expression can be done by hand or by a breast pump. When
offering the breast, both the nipple and areola must be put well into the baby's mouth. Once the baby has latched on,
the nipple will remain projected for the rest of the feed. Also, after manual expression of milk, if one drop of milk is
left on the tip of the nipple, it will act as an appetizer for the baby.
Types of Nipples
The Syringe Method(Nirmala Kesaree Method)You need:
Breastfeeding at Birth
If the baby is simply held in a relaxed manner, close to the mother's breast within 30 minutes after birth, it will latch
on to the mother's breast and start suckling. This is because babies are born with 3 reflexes:
■ Homing in reflex: the baby moves towards the areola,
■ Rooting reflex: the baby attaches itself to the mother's breast for feeding.
■ Sucking reflex: the baby sucks at the breast.
If and when the baby is breastfed at birth, it immediately learns how to attach itself to the breast and does not
struggle to do so after the breast gets filled with milk. Besides it gets some colostrum, which however little, will
protect it from infections.
Breastfeeding at birth also promotes bonding. According to J.C. Pearce in his book Magical Child (1980),
'Bonding is stage specific. Nature has designed the bonds to be established in the hours immediately following
birth... as is the case of learning to breathe, this is a critical period for bonding.'
Baby-friendly Hospitals
Some hospitals are labelled baby-friendly hospitals if their policies encourage breastfeeding. In such hospitals, the
resident doctors, consultant and labour room staff encourage breastfeeding of new bom, within half an hour in a
normal delivery, and within 4 to 6 hours after a Caesarean delivery. Such hospitals also avoid the routine use of
sedatives or analgesics which could lead to a depression in the infant and interfere with the normal sucking reflex
of the baby at birth.
The health care staff in these hospitals should inform the mother of the advantages of exclusive breastfeeding and
the disadvantages of artificial feeding. All newborns in such hospitals are routinely kept with the mother 24 hours
a day. The baby's cot would therefore be in the mother's room, next to her bed.
It is essential for baby-friendly hospitals to display their breastfeeding policy document in the antenatal clinic,
maternity ward, special care nursery, etc.
J.C. Pearce further explains that when the mother breastfeeds her baby at birth she stimulates all the 5 senses of
the baby, that is, touch, smell, sight (the baby can concentrate on a face 6 to 12 inches away from its own in the hour
following birth), taste and hearing (since most mothers will 'talk' to the baby while feeding). This in turn stimulates
the reticular formation of the brain, (an area of the brain that receives messages from the 5 senses). It gives the baby
better coordination between the brain and the 5 senses for the rest of its life.
When this happens, 'All adrenal steroid production has completely disappeared in a short time because the
infant, in being returned to, and recognising the known, relaxes. He then remains in an alert and yet calm state of
learning.'
Rooming In
It is best for the mother to have her baby with her in her room and feed it on demand. Initially, before breast milk
comes in, the colostrum being heavy will make the baby sleep long hours without demanding a feed. This gives the
mother the rest she needs. Further, colostnim and breast milk give the baby immunity or protection from infections
in the hospital and from visitors.
Each one of us has some bacteria or germs on our body. When the baby is next to the mother, it develops a
bacterial flora that is similar to that of the mother. When the child is in the nursery, it can catch the bacterial flora of
the nurse, who may be carrying some infection, or may not wash her hands before touching the baby. Plus, instead
of getting the mother's immunity rich, infection fighting colostrum, the baby may receive a bottle of milk, which will
make it further susceptible to infections. It is therefore better for the baby to be with the mother.
Glucose water or bottle milk may sometimes be given as a 'test feed'. Interestingly, if this test feed is aspirated into
the baby's lungs it can irritate the baby's lungs. Colostrum on the other hand if aspirated into the lungs will not
irritate, but simply get absorbed.
Stools of Breastfed Babies
Breastfed babies normally pass very frequent stools, that are not wholly formed. Sometimes with wind, a bit of
stool may be passed. Bottlefed babies pass harder stools which may give rise to constipation.
If you are expecting lots of guests, you can put a notice on the baby's crib saying 'Please do not touch me.' Or
else you could have the baby lie next to the mother on the bed and say the doctor has asked to keep the baby next to
the mother. This is in fact an excellent thing to do with small babies, because they get the body heat of the mother,
and the baby's own temperature control mechanism is not strained. Further you could put a notice, 'Please wash your
hands before you hold me' or 'Please do not hold me if you are unwell.'
Exclusive Breastfeeding
Feeding only breast milk is recommended for 6 months. That is, no other milk, water or mashed foods need to be
given. There is enough water in the breast milk for the baby. The mother will need to drink lots of water and eat
nutritious food when she is feeding.
Constant Feeding Demand

Some babies want to be constantly fed. According to one mother, within 10 to 15 minutes her baby would want to be
fed again. When put to the breast again, however, it did not suck properly, so she gave him the bottle. On enquiry it
was revealed that breastfeeding was the only time she held her baby. So what the baby was demanding was not a
feed, but comfort sucking. If a baby seems to be wanting constant feeding, it may not be asking for a nutritious feed,
but comfort sucking. Abundant cuddling of the baby or strapping the baby on to the mother will reduce the baby's
need to fake hunger, when, what it actually wants is simply to be held close and feel secure.
Another time a baby may want constant suckling is when it experiences a growth spurt. When the baby grows, it
needs more milk. Feeding more often increases milk supply. So, if suddenly the baby seems to want more feeding,
just take a couple of days off. Stay in bed, eat well, and feed on demand. Once the supply is stepped up, the baby
will stop demanding constant feeding.
Leaking Breasts
As breastfeeding gets established, the breast may start leaking milk after a bath. Or when the mother feeds from one
side, the other side may leak. Sometimes when it is time for the baby's feed, or when the mother lovingly thinks of
the baby, the milk starts leaking. It is better not to wear water proofed backed bra pads, since they cause the nipples
to remain soggy and become sore. As the demand and supply settles down, leaking of breasts may reduce. You
could fold some cotton in an absorbent men's hanky and place inside the bra to avoid your clothes getting wet from
leakage when you have company. You could place an ever-dri baby nappy or a piece of blotting paper between the
breast and the hanky to keep nipples from becoming soggy.
Let Down Reflex

This is a reflex that causes milk to be 'let down' and flow when the baby is feeding. If the mother is worried,
stressed, extremely self-conscious, etc., it can interfere with the release of milk. It is therefore important that a
breastfeeding mother is relaxed, so that her milk can flow freely. If tension prevents the let down reflex or interferes
with it, a mother can have a glass of wine or beer to relax herself. Wine and beer both have a low alcohol content,
just enough to relax the mother. Moreover beer is known to aid lactation.
Feeding When III

Cold, flu, fevers should not require you to stop feeding. However, do let the doctor know that you are nursing the
baby, when he prescribes you medicines. Feeding should continue as long as possible, so that the baby can get the
maximum advantage of the immunities present in the mother's milk. An infected mother produces within her body
antibodies to fight the infection she has. These are secreted in breast milk. They become available to the baby and
protect it against infection.
When feeding, antibiotics such as tetracycline and streptomycin, steroids and sulpha-containing drugs should be
avoided.
Some laxatives may cause colic and diarrhoea in the baby. Anti thyroid drugs may cause goitre. Anticoagulants
and large doses of aspirin can cause bleeding problems in the baby.
Sedatives or tranquillisers such as valium can cause drowsiness and feeding problems.
To Stop Feeding Suddenly

If, for some reason, you have to stop feeding abruptly, do it under your doctor's supervision. The doctor will give
you a safe drug called bromocriptine that will dry up the milk. If you simply stop feeding abruptly, you may subject
yourself to extreme discomfort. It is best to taper off feeding gradually
Breast Preparation for Feeding

From the 6th month of pregnancy onwards, certain breast preparation techniques have to be started, to ready the
breasts and nipples for feeding.
Because of the manner in which the baby sucks, it is important to toughen the mother's nipples so that they can
avoid sore or cracked nipples.
With a dry towel, clean the tip of the nipples. You may find dry scabs falling off. Don't worry about it. At times
drops of colostrum get secreted unnoticed and dry at the tip of the nipple, forming scabs or flakes.
Hold both nipples as you hold a cigarette, that is , between your forefinger and middle finger. Now draw it in
and out of forward and backward 50 times. Hold nipple lightly. If you press with your fingers it can hurt.
Each time the baby sucks, its gums press on the dark area behind the nipple, and the nipple gets extended way
back towards the baby's throat, from where milk goes straight down the baby's gullet. So, you are acquainting the
nipple with the action of feeding when doing this preparation.
Every day, after the sixth month
Precaution
If you have premature contractions or bleeding or have been prone to either and are on medication to prevent
them, do not breast prepare after the sixth month of pregnancy. Instead, do it 15 days before the estimated date of
delivery.
If you like, this can be incorporated in your love life. That is, while making love your husband can suck at the
breast.
Hold the areola, the dark area behind the nipple, between the forefinger and thumb, and press. Do it twice. You
might notice a few drops of fluid appearing at the tip of the nipple. Don't worry if you do not notice any. It will
appear gradually over the weeks.
Wipe off the drops of fluid and lightly apply any natural oil on the nipple and areola. You can use coconut oil,
ghee or groundnut oil. Synthetic based oils, that is, petroleum based oils, are best avoided. Also, scented oils or
vitamin enriched oils are to be avoided.
When Feeding
The body has its own system of secreting lubrication from the Montgomery's tubercles (little prominences around
the areola), to keep the nipple supple and oiled. However, during a bath when soap is used, it gets washed away, so
women find rubbing oil useful. Continue to use coconut oil when feeding. That is, after a feed, apply a little oil on
the nipple and areola, in a thin film. Before the next feed, clean the nipple and areola with a small piece of cotton
soaked in water that has been boiled. So, keep bits of cotton soaked in a covered bowl of boiled water. Use a fresh
piece of cotton for each breast. You are not only wiping out the oil, but also stale breast milk, perspiration, and
threads from garments.
If you experience mild contractions when feeding, use your breathing for labour to deal with it. These are caused
because feeding releases oxytocin hormone which contracts the uterus and helps it to involute to its normal size.
Therefore involution of the uterus is more efficient when you breastfeed.
Forerunner to milk
Towards the end of pregnancy, say in the last 3 months, women often notice a yellowish fluid escape from the
breast. Even if they do not notice it, a few drops may appear and dry at the tip of the nipple, forming a crust or scab.
This is called colostrum, or foremilk. It is fed to the baby before the milk comes in. Milk might take 2 or 4 days
to come in. For about 10 days it is still mixed with colostrum and looks rich and creamy. Earlier, colostrum was
regarded as unclean milk, and mothers were forbidden from feeding it to the baby. This is yet another one of the old
wives' tales which should be ignored. Feeding colostrum to the baby is full of advantages. It definitely must be fed to
the baby.
Colostrum
It has more proteins than mature milk but has less carbohydrates and fat. The protein gives the baby a full feeling, so
that it remains satisfied longer after a feed, enabling it to sleep and rest for long periods in the first days of life. At
the same time, it also gives the mother time to rest.
Antibodies are present in mother's mature milk; only there are many more in colostrum. Later the baby will
produce its own antibodies, but in the first few months, it can't, and depends on its mother for them.
These antibodies protect the baby from a number of bacterial and viral infections that the mother may have
suffered from or has been immunised against, among these being pneumonia, whooping cough, E-coli
gastroenteritis, typhoid, flu, dysentery, tetanus etc. Although the extent of protection received by the baby may at
times be complete and at other times only partial, it is very important for the baby to get these antibodies from
colostrum and mother's milk, until its body can manufacture its own antibodies, or during what is called the
immunity gap.
Colostrum contains minerals like zinc and calcium and Vitamins A, B6, B12 and E. It also has a laxative effect
and helps the baby pass its first stool, which is black and sticky. It has a higher cholesterol content than milk, which
may be important at this stage for promoting the growth of the nervous system, and possibly later in life for helping
the body to cope with cholesterol.
Mature Milk
The colostrum gradually changes into mature milk during the first few days. There is no sudden change. The more a
baby feeds, the sooner milk will be produced in large amounts. If a mother is feeding her baby infrequently, it may
not come until the 4th or 5th day.
In the meantime you have transitional milk, that is milky looking colostrum. Transitional milk changes into
mature milk.
Mature milk is thinner looking whiter or bluish white. In the first year of breastfeeding, the protein present in the
milk gradually falls, regardless of the mother's diet. This is because the baby grows fastest in the first 6 months when
the protein content in breast milk is the highest.
Engorgement
A dramatic change occurs in the breasts when milk comes in, a few days after delivery. The breasts become larger
than ever, hard, sensitive, full, and uncomfortable. The change is due to the increased blood supply in the breasts and
the start of full milk production. This heavy uncomfortable stage is known as engorgement and lasts for 24 to 48
hours.
How to Deal with Engorgement

If engorgement occurs, emptying the breast will help to relieve the discomfort. In order to do so, one must slightly
oil the breast. Then, place both hands against the chest and around the breast and slowly slide hands down towards
the nipple. When the fingers reach the areola, the dark area behind the nipple, press it with the fingers in order to
release some milk. After pressing the areola from above and below, continue to press from opposite directions and
go around the areola. Repeat several times on one breast. Then follow the same procedure on the other breast. You
can keep a towel to collect the drips.
Sometimes during engorgement the baby might find it difficult to grasp the nipple and areola. In that case the
mother can express some milk by pressing on the areola. This will empty the breast slightly and make it easier for
the baby to grasp.
Cold compress used immediately after a feed will prevent engorgement by causing the blood-vessels to contract.
Alternatively a warm bath before a feed will soften the breast and help the nipple to stand out for feeding.
To express milk, place the thumb and fingers as flat as possible on the spot where areola and breast meet, and
press. After having pressed a few times, very gently move your finger and thumb together backwards towards the
chest, so that you press on the wider milk ducts behind the areola also. Pressing in this way move your thumb and
finger in a circle around the areola.
To Express Breast Milk

To manually express milk for collection, in order to be fed later to the baby, choose a time when you are not in a
hurry. Wash your hands with soap and water and dry them on a towel kept aside for this purpose. Once the flow has
begun, press on either side of the areola as illustrated. Soon after feeding the baby from one breast, you can express
from the second breast. Or you could apply warmth to your breast by applying a warm towel before .you begin to
express. During expression milk comes out slowly The flow is greater when the baby suckles.
Before feeding, expressed breast milk it should not be boiled. Just stand the bottle in hot water to warm the milk
slightly and feed. While standing in the refrigerator, the milk may separate into fat and water layers; that does not
mean it has gone bad. If the milk is not really chilled, there is no harm in feeding cold milk to the baby. If expressed
milk is to be fed at night, express during the morning, when milk production is greater, after you have been nicely
rested. Or express at night so that it can be fed at noon, the next day. Alternatively keep collecting expressed milk by
your bedside. It can be fed to the baby when required, for instance, if you sleep through a feed or are bathing when
the baby wakes for a feed, or if you need to go out for a few hours. Every 8 hours discard the remaining milk and
collect in a fresh sterilized glass.
Breast milk can also be expressed with a breast pump.
To express milk, place the thumb and fingers as flat as possible on the spot where areola and breast meet, and press. After having pressed a few
times, very gently move your finger and thumb together backwards towards the chest, so that you press on the wider milk ducts behind
theareola also. Pressing in this way move your thumb and finger in a circle around the areola
Expressed Milk
Expressed milk will stay unspoilt at room temperature for 6–8 hours even in the summer. It will stay in the
refrigerator for 24 hours, and in the freezer for 1 to 3 months.
Expression through Breast Pittas

The bulb type
This has a bulb of rubber and the rest is made of a glass funnel. First the rubber bulb is pressed and the glass funnel
is placed over the nipple and areola. Then the rubber bulb is released. This creates a suction and consequent release
of milk. The disadvantage of this pump is that the rubber bulb cannot be boiled for sterilisation. It should only be
used to remove and discard milk.
The syringe type
An imported breast pump kit that works on the same principle as a syringe. It is available at some major chemist
shops in big cities.
Precaution
All equipment used for expression must be sterilised by boiling. If they are sterilised by soaking in a sterilising
solution, they should be rinsed off with boiled water before use. Metal should not be put in a sterilising solution.
The Battery operated type
The electric type This is generally used in hospitals.
This version is available for home use.

They work well when the breast is very full. They are the opposite of the manually, operated ones.
How to Feed Expressed Breast Milk

Expressed breast milk could be fed either from a glass or with a cup and spoon to the baby.
When using a glass, a small glass with a round, smooth edge is good. It should not have a sharp edge.
A small katori (bowl) with a smooth edge can also be used. Put some expressed milk in the glass, cup or bowl.
Place the baby with the head slightly raised on your lap. Place the edge of the bowl at the baby's lower lip and tilt till
the level of milk reaches the lips of the baby. The baby will sense its presence and lap it up with the tongue like a
puppy! When the level of the milk goes down, tilt some more. Initially, if given to a baby who has already had a
bottle, the baby is likely to protest by flaying its arms. This might drop some milk, so make the baby wear a bib
before trying it for the first time or ask someone to hold the baby's arms. The alternative would be to swaddle the
baby or wrap it in a sheet so that its arms do not flay. Gradually the baby will become adept at it.
You could also feed the baby with a small spoon after positioning it on your lap as described above. A paladi or
traditional feeding cup can also be used.
A traditional feeding cup or paladi
Hiccups
Sometimes babies start hiccups after a feed. It is nothing to worry about, although some parents get anxious when
they hear the baby's rather loud hiccups. It is normal and will pass.
As the baby grows, apart from expressed breast milk, soups, juices, water, milk or any other liquid can be fed in
a similar way.
If the Baby's Nose Gets Blocked

If engorgement causes the breasts to become very full and the soft breast tissue presses against the baby's nose,
causing it to leave the breast in panic, do not press the breast down with a finger to free the baby's nose.
It will cause the nipple to project upwards, which in turn will lead to the nipple hitting against the roof of the baby's
mouth and block the ducts on the tip of the nipple, or cause the nipple to get sore or cracked.
Instead of pressing the breast down, place all your fingers below the breast and lift the breast. Let the thumb be
relaxed. This will cause a considerable part of the bulge to tilt towards the chest and meet the chest. It will also
present the nipple at the right angle to the baby for feeding.
If the baby's nose is blocked because of a cold you could feed the baby expressed milk with a spoon or cup.
Alternatively you can put a few drops of saline solution in the baby's nostrils to clear the block.
Feeding Time
The baby should be fed as and when it demands a feed. Hospital routine may encourage breastfeeds by the clock.
This regulated system is based on bottle feeding, and has no bearing on breastfeeding.
The letdown reflex or release of the flow of milk may take a few minutes to be established. It can be affected by
embarrassment at nursing, fear of discomfort, contractions during feeding, etc. Hence, if the baby is removed too
soon from the breast, the flow will be that much weaker.
In the first few days, the baby should be put to the breast as long as it likes, which could be 20 to 30 minutes at a
time. The more complete the emptying of the breast, the more successful the establishment of lactation will be.
Relax When You Feed

It is important to relax when you feed. If you do not relax, it will interfere with the letting down of milk, that is, the
release of milk does not take place when you are tense.
It is therefore a good idea to retire to a quiet, undisturbed corner with your baby at feeding time. You can carry
with you a tall drink to savour when feeding.
If you are tense when feeding, the baby will sense it immediately, and may not want to leave the breast as a
result. It does not mean that it is hungry; what it is doing is sucking for comfort and security. So, it is important to
relax.
If you have a problem with space, you can fix a curtain in front of your bed for privacy. Or, you can use a light
scarf of net or georgette to cover yourself and your baby.
If you cannot help being tense, express your milk and feed it to the baby from a sterilised cup and spoon.
Night-feeds
Newborn babies need to be fed frequently, because of their body weight and their fast rate of growth. Until the baby
weighs around 10 pounds it will need to get up at night for a feed. Once the baby weighs 10 pounds it can sleep for
about 5 hours without waking up with hunger.
Try and give the baby the last feed when you yourself go to bed at night. When the baby wakes up at night, you
can feed the baby in bed, and let it drop off to sleep with you. Keep a nappy change, and a torch close at hand.
Instead of a torch, you can keep a zero watt bulb switched on all night.
Do not delay the feed until the baby has cried itself hoarse. If the baby is allowed to cry when it is hungry, it will
fray your nerves; besides, when put to the breast, the baby will feed only for a short while and fall off to sleep from
exhaustion; only to wake up with hunger, after an hour or so.
So, when your baby wakes up for a feed at night, pick him/her up, or have your husband pass him/ her to you.
Your husband can help in this way, at least 3 times a week. Keep the room darkened. Do not play or otherwise
distract the baby. Sing a lullaby, which should be sung only at bedtime. Let the baby learn to associate minimum
activity with night time.
At least 3 times a week go to bed early if your baby regularly wakes up at night. Keep water by your bedside in
case you get thirsty. If you find it difficult to go back to sleep, try to relax by totally letting go your body. Make sure
you are comfortable. Being angry will not help. If you are very tired, you can express breast milk which can be fed
to the baby by your husband through a cup or a cup and spoon. This will enable you to sleep through one feed and
get 4 to 5 hours of undisturbed sleep. It is recommended that this is made routine since a mother who is well rested
can cope better with the demands of motherhood. The baby will also relax if it senses tire mother's relaxed mood.
Foremilk and Hindmilk

The early part of a feed is made up of foremilk which is low in fat, while the latter part is the hindmilk, and has 4 to
5 times the amount of fat and 1½ times as much protein. Hence the foremilk is thin, whereas hindmilk is thicker.
Many hungry babies whose mothers think they are not producing enough milk, get only the thin, low calorie
foremilk, and the mother stops feeding before the high fat hindmilk is consumed by the baby As a result, the baby
actually loses weight or fails to gain weight and is therefore started on cow's milk or powdered milk.
Will My Milk Be Enough?

Since we cannot measure the number of ounces of milk a breastfed baby gets, many mothers wonder whether it is
enough. Remember, it is Nature's food for the baby, the same Nature that nourished the baby inside the womb and
made it form into a little human being. Your milk is the best suited to your baby's needs, much as cow's milk is best
suited to a calf's needs.
To check if the baby is getting adequate nourishment, the doctor will weigh the baby when you go for a checkup.
If your doctor says the baby is putting on weight normally, it is obvious that your milk is sufficient.
Less Milk
If you feel you are producing less milk, all you have to do is feed more often. Each time you feed, the body releases
prolactin hormones, which further stimulate the formation of milk.
If you skip a feed in the hope of storing more milk for the next feed, it will not work, for the less you feed, the
more your milk supply will dwindle. The amount consumed at a feed can be determined by weighing the baby
before and after a feed without a change of clothes. It you feel the milk is not enough, feed more often and persist. If
you get panicky and mix breast with bottle., the battle is lost. It is also said that eating jeera or cumin seeds, methi or
fenugreek seeds increases the production of milk. So does a glass of beer/wine a day.
How to Tell If Baby is Getting Enough Milk

If a baby has 6 wet diapers in 24 hours, it is getting enough input, or milk. Besides, less volume of breast milk
is needed as compared to other milk given in a bottle, because all of breast milk gets absorbed.
You should check with your doctor about any medicine you take, even if it is an aspirin, just to make sure it will
not affect the milk supply.
Burping the Baby

Babies should be made to burp once or twice during a feed. The baby can burp once while being fed and at later the
end of a feed. With the burp the baby could bring up some milk or curd.
Burping brings up any wind that has been swallowed during feeding or crying prior to feeding, so that it does not
cause any discomfort to the baby. Babies vary a great deal in the amount of air they swallow, so some may burp
immediately, while others take longer to burp. Bottle-fed babies swallow more air than breastfed babies. So do
breastfed babies who gulp milk fast or cry while feeding. If not burped, the baby can become uncomfortable and
restless. However, if the baby does not burp when held upright in order to be made to burp, and seems otherwise
happy and satisfied, do not become particular about burping. Let it pass. Probably she/ he does not need burping
since she/he has not swallowed much air.
If the baby falls asleep while having a feed, do not wake it for burping. Put it on its side. This position will cause
the air to come up automatically. The milk it brings up with a burp will run out of its mouth and not bother it.
How to Position the Baby

The most common position of a mother feeding a baby is sitting, with the baby supported by her arm, bent at her
elbow. A pillow on the lap will provide support to the arm supporting the baby. The baby should be turned towards
the mother's body. That is, the baby should be held tummy to tummy with the mother. The mother should take a
back rest and sit with her back straight. It may not be possible for her to sit straight after the birth of the baby
because her pelvic floor may still be uncomfortable because of the stitches. In that case she can use an inflated
rubber ring (available at chemist shops for piles patients) to sit upon.
Alternatively, when the mother is tired at night, she can lie down on her side and feed the baby. It is important
for the mother to be relaxed in whichever position she adopts. Secondly, the breast should fall towards the baby. If
the breast is falling away from the baby, it will require the baby to tug at the nipple and may cause soreness or
cracks in the nipples.
Position After Caesarean Birth

If the baby has been delivered under general anesthesia, the mother is likely to be unconscious initially. As soon as
the mother responds to commands, that is, if she is told to move to her right or left, she responds, she can commence
feeding.
Within 24 hours or the 1st day of the birth of the baby, the baby can be placed on to the top of the mother for
feeding.
In the next 24 hours or 2nd day after the birth, the mother can roll to her side and feed lying on her side.
Subsequently, on the 3rd day after birth the mother can be propped up to sit. A pillow can be placed on one side.
The baby's body should turn towards the mother's body and taper off towards the side of the mother, below her arm.
Twins
Twins can be fed one at a time, or together. When two babies suck at the breasts, the breasts produce enough milk to
feed both.
You can feed twins 3 hourly rather than feeding them on demand. In the beginning, you can feed each baby
separately, so that you can get to know them individually. You can feed them one after the other. Start with whoever
wakes up first and then wake the other baby. Many twin babies develop a preference for their own breast. One baby
might be an eager sucker while the other may be lazy.
How to Position Twins

Place a pillow on your lap below the breast. Place the baby's head at the breast, and let the baby's body taper to the
side of your body, the feet falling to the side of your waist, below your arm. Place the other baby on the other breast
in a similar fashion.
Or else, you can place a baby in the usual way, that is, head at one breast, and the body tapering towards the
other breast, and the second baby, with the body tapering towards the side of your body.
Bonding
The more skin-to-skin contact your baby enjoys with your body when feeding the more strong a bond will develop
between you and the baby. You should hold the baby against your bare skin when feeding.
If you haven't felt very motherly at birth, you are going to feel a gush of maternal affection as your baby gazes
intently straight into your eyes when feeding. This is specially important if you have had a Caesarean birth.
Babies also tend to grasp your finger, or, when older, scratch your breast when feeding. As they feel relaxed and
satisfied at the breast, they begin to play around with their mother's necklace or chain.
Contraceptive effects of Breastfeeding

Breastfeeding is more likely to have a contraceptive effect if the mother is breastfeeding exclusively through the day
and night. That is, she is not giving the baby any other milk or water.
When the mother breastfeeds in this way, she is also likely not to have a menstrual period.
Both of the above are likely to be the case within the first 6 months of the child's life. Therefore, if a mother is
exclusively breastfeeding a baby less than 6 months of age, and not having a period, her chances of becoming
pregnant are as low as 2%. Each time she feeds the baby she releases prolactin, a hormone that suppresses ovulation.
Breast or Bottle
The advantages or breastfeeding undoubtedly far outweigh bottle-feeding. Sometimes the bottle may be resorted to
for some reason. There is no need to feel guilty if that is the case. The aim of both is a well-nourished, happy and
active baby
At times bottle-feeding may be resorted to if the mother is working. In that case the baby can still take one or
two breastfeeds, early morning and late at night.
If the baby does not gain adequate weight bottle-feeding is often resorted to. However, the mother should also be
reminded that the hindmilk or the last part of the breast milk is rich in fat. If the initial watery milk is 20% fat, the
hindmilk is 50% fat. Babies who are fed the hindmilk sleep well and grow healthy. The fat content increases
gradually towards the end of the feed. If the mother feeds from one breast at one feed for 20 to 30 minutes, the baby
is likely to get the fat rich hindmilk.
At times recurrent cracking of nipples, mastitis, or surgery for the mother might lead to a switch.
An exhausted mother, unable to cope with demand feeding and other household chores, may get so tired and
anxious that it might interfere with her lactation. It is therefore advisable to arrange for extra help at this time.
Calorie Content of Breast Milk

Foremilk 1.5cal/ounce
Hindmilk 25-30 cal/ounce
Source: Dr. Richard Applebaum, Nursing your Baby,
A woman may have in-laws, friends, or a husband who are not very enthusiastic about breastfeeding. On the
other hand, some women may give up breastfeeding from wrong advice or hearsay, for example, some women
believe breastfeeding ruins their figures. There is no credibility in this, as it has been seen from medical experience
that many women breastfeed several babies with no bad effects on their figure. Others end up with even better
figures. Very few women give up breastfeeding for the reasons listed above. Basically if a woman decides to
breastfeed, she normally succeeds. Most mothers give up because they feel they have fed long enough or as long as
they had planned.
A breastfed baby is not prone to allergies. There are less chances of diarrhoea, eczema, coughs, colds, and
asthma in breastfed babies.
Some women fear feeding will make them less sexy. This is not true, since sex, childbirth and breastfeeding are
linked with the same hormone. Many women feel more sexy when feeding.
It is easier to breastfeed if you are travelling. No hassles of sterilising bottles and running around to find a place
to make feeds. All you need is yourself and maybe a shawl or scarf to cover yourself discreetly.
How Long to Breastfeed?

A working mother can combine breastfeeding with bottle-feeding. Ideally a baby should be breastfed for 2 years; or,
for a minimum of 6 months.
Some mothers feed for 1 year or 8 months.
The reason why breastfeeding is recommended for 2 years is that it gives the baby greater immunity to fight
infection during the teething phase. At that time the baby will also be eating other food, and breastfeeding maybe
done just once or twice a day Also, if the mother is an air hostess or a doctor, her duty hours could be 24 hours or
longer, so that the bottle will have to be resorted to.
Breastfeeding and the Working Woman

Breast to bottle
If you know you have to go back to work, it is wise to combine breastfeeding and bottle-feeding. At the start give
the baby a breastfeed whenever it demands a feed, except for one bottle-feed in the morning around 10 a.m. When
the baby is 2 months old, start introducing a routine, in which you gradually cut out breastfeeds and introduce bottle-
feeds instead.
Start by cutting out breastfeeds that are due at the time you are likely to be away to work. By the 3rd month you
can be giving 3 to 4 breastfeeds, 1 early in the morning and 2 in the evenings. Or, 2 in the mornings and 2 in the
evenings. You can also introduce mashed bananas (slightly overripe) and bland preparations of khichdi /
kheer/halwa/upma/any daal without tarka with little ghee/ mashed potato.
If your work is going to require you to be away for a few days on and off, switch to the bottle totally by the 3rd
month.
Quickies
In order to reduce preparation time before a feed, or to be able to carry a quickie food while travelling, the
following ready mix powder can be kept handy. Take some rice grains and roast them on the tava in a cooking
vessel over the fire. When roasted cool them and dry-grind them in a mixie, so that you get ready cooked rice
powder. Bottle it. When required you can add water, milk, watery dal or any other liquid to it and feed the baby.
You could do the same with other grains like wheat grains or ragi.
Bottle to breastfeed
If you want to increase the number of breastfeeds and reduce the number of bottle-feeds, breastfeeding more
often will cause the release of prolactin hormone and an increase in breast milk production.
Each time you are to give a bottle-feed, first put the baby to the breast, and then give the other milk with a
spoon, not from the bottle. Gradually, in a few days your own milk supply will build up and you will not need the
other milk at all.
Case Against the Bottle

Bottle-feeding should be resorted to when absolutely necessary, and its potential hazards must be borne in mind.
Bottle-feeding also requires a lot of hard work, since one has to sterilise the feeding bottles, nipples, etc., and make
the feeds. This is very important. If sterilising is not done properly, it can cause diarrhoea and dehydration in the
baby. If the milk is not made properly, it can mean a sick baby.
Once you start on bottle-feed, the baby may begin to prefer it. It will upset the balance of your milk supply,
which will be reduced.
The contraceptive effect of breastfeeding will also lessen.
If you give a bottle-feed at night you will have to be fully alert and awake to make a bottle-feed and bring it to
the right temperature. It is easier to simply put the baby to the breast.
The Bottle and Nipple confusion

Feeding the baby from the bottle causes nipple confusion, and should be avoided. At the breast the baby needs to
work hard with its jaw to feed. The bottle on the other hand drips milk regardless of the baby's jaw effort. The baby
gets used to this easy flow from the bottle's nipple and dislikes working hard at the breast's nipple.
The disadvantage of the constant flow of the bottle's nipple is that the baby needs to suck and swallow quickly.
This results in a respiratory load on the child and is not recommended at all for small babies or premature babies. It
would be similar to your being asked to finish a bottle of water or cola without a break. It would leave you gasping
for breath.
Further, the baby gets used to overfeeding when drinking from the bottle. This can sow the seeds of overeating
and obesity.
Milk Powder
Making a powdered-milk feed should be done exactly according to the instructions on the can. Some people put
extra milk powder in the feed, since they feel the milk looks very thin. This could be dangerous. It could lead to a
concentration of minerals in the baby's bloodstream, which can lead to dehydration and illness.
On the other hand, some people might put less milk powder as compared to the instructions on the can, thus
running into the danger of giving inadequate nourishment to the baby.
You must discuss with your doctor which is the best milk to give the baby. If you are going to be travelling a lot,
it is best to give powdered milk, so that there are less frequent changes, since you can carry the milk powder with
you wherever you go. Besides, it is sterilised and does not become easily infected. The brand you use should not be
changed; it is best to stick to one brand.
When making a feed, a little extra milk can be prepared, in case the baby wants to have a little extra. If it is not
consumed, the extra milk should be thrown away after a feed.
Milk can be made in a large jug and kept covered in the refrigerator for not more than 24 hours. Little quantities
of it can be transferred to sterilised bottles when needed. Or, milk can be poured in sterilised bottles and kept in the
refrigerator. When needed, it can be removed, warmed, by using a bottle warmer or a mug of hot water, before use.
It is a good rule to follow, rather than let someone else make the milk.
Cow's Milk
Cow's milk has more protein than mother's milk. This unnaturally large intake of protein results in an large load of
nitrogen for the infant's kidneys. Cow's milk should therefore be given diluted with one part water to three parts of
cow's milk. The water dilutes the protein and minerals like sodium and nitrogen.
A little sugar should be added to the milk, since mother's milk has more lactose than cow's milk.
How to Sterilise Bottles

You must keep aside a large vessel in the kitchen for boiling bottles in. You can buy one with a lid, since a covered
vessel uses up less fuel. You will also need a bottle brush, which you must make sure is kept dean
Unscrew the covers of the bottles. Separate nipples. In order to get the slime off the nipples, rinse them in water,
then apply salt inside and outside them and put them in the sun on a plate.
Wash the bottles, rims and covers of the bottles, use a liquid soap like Teepol or a soapy solution of Surf
detergent power. Scrub them well with the brush to remove the slime that milk tends to leave behind. If left behind,
the slime forms a breeding ground for germs. You could fill used bottles with water after use so that milk does not
dry in them and they are easier to clean. When the bottles are nicely scrubbed clean, fill them with water before you
immerse them in the vessel of water, so that you have a minimum number of air bubbles in the bottles and they
remain nicely submerged.
When all parts of the bottle are scrubbed and immersed in water, put the vessel on fire, with its lid on it When
the water boils, it will send up steam and bubbles of air, and make a gurgling sound. It is important that this stage is
reached, for only when the water boils actively do the germs get killed.
When the water is boiling, bring the nipples inside and wash them thoroughly in running water, to remove every
trace of salt. It should not be left behind in the nipple, since the baby should not get an unnecessary extra daily
dosage of salt. Then remove the lid of the vessel, put the nipples in the vessel and turn off the flame after a couple of
minutes.
When the water is cool enough to handle, wash your hands with soap and remove the feeding equipment. Fix the
nipples on the rims, and put the covers on the bottles and keep aside for use during the day.
If you have to go out to work, you can make the milk and pour it into individual covered or sealed bottles and
leave behind in the refrigerator, so that it can be fed while you are away.
How to Bottle-feed
The baby, while being bottle-fed, should be held close as in breastfeeding. Do not place the baby on the bed and feed
it like a doll. Bottle-feeding should not only provide nourishment, but also warmth and security to the child. You can
also hold the baby next to your naked skin. This is specially important if the baby has been separated from you
earlier on, on account of illness, premature birth or any other reason. The mutual feedback you and your baby get
from each other at this time will build a new relationship and bond between you both.
Before giving the bottle, check the temperature of the milk by letting a few drops of milk fall on the back of your
hand from the bottle. If the milk feels pleasantly warm, it is the right temperature. If it feels hot, cool it by waiting a
little or placing it in cold water. If the milk is made and kept in the refrigerator in sterilised bottles, there is no harm
in giving the baby cold milk. If it is winter and the milk from the fridge is too cold, it can be stood in a mug of hot
water before being fed to the baby.
If during a feed you have to keep the bottle aside for a little while, cover it with a special cap that comes with
feeding bottles. Do not let the nipple be exposed to flies or do not cover it with your hanky or towel. Avoid touching
the nipple with the fingers.
When feeding, hold the baby upright, that is, head higher than the rest of the body. Hold the bottle firmly at a
slant, and make sure the nipple reaches way back in the baby's mouth. The nipple should always be full of milk, or
else the baby will take in too much air and have a lot of wind. If the teat flattens and the milk stops going through,
pull the bottle gently backwards to release the vacuum.
Check if the nipple's hole is large enough. When the bottle is inverted, it should allow several drops to flow in
one second. If you find the flow is very slow, enlarge the hole with a red hot needle. Hold the tip of the needle in a
flame, and when it becomes red hot in colour with the heat, pierce the tip of the nipple with it.
Let the baby have a pause during a feed, now and then. Burp the baby.
Problems during Breastfeeding
When the baby chokes
If a mother has too much milk that flows too fast, the baby might cheke on it. In case this happens, the mother
should express a little milk before feeding the baby.
Sometimes the baby may choke if the mother's nipples are too big and long, so that they go past the hard palate
and touch the soft palate. The baby turns its head away from the breast and cries, moving his arms and legs. In this
case, the mother should hold the baby a little away from the breast.
Sore nipples
When you want to stop feeding, if you pull and drag the baby off the breast, it might give you sore nipples. So
instead, you must break the baby's suction by putting the tip of your finger in the corner of the mouth between the
gums, and then take him/her off the breast.
Feeding Bra
A feeding bra should be worn, so that the breasts do not sag with the extra weight. Due to the extra weight of
the breasts, the bra should be well fitted and made of cotton, since cotton does not stretch with the increase in
size, and therefore gives better support. It also allows better absorbency and circulation of air, hence reducing
chances of sore nipples. During pregnancy, if the bra fits well but is tight below the breast, you can buy some
extra bra hooks called extension and fix at the back, to make the bra more comfortable.
The bra should not be too tight. It should not have bands at the top of the breasts, that cut into the skin when
the front cup or flap opens for feeding. This can cause blocked ducts. You can remove the bra at night.
Or, pull the chin of the baby downwards.

If you press your breast down with the finger, by forming a big dent on the breast, in order to prevent the baby's
nose from getting blocked, the act of pressing the breast down will cause the nipple to project upwards and hit the
roof of the baby's mouth when it feeds. This hitting of the nipple on the hard palate will cause it to get sore. Besides
it will block release of milk from the front tip of the nipple.
Soreness sometimes occurs if the nipples are frequently washed with soap. Water is sufficient to wash them
with. Pressure applied at the same point constantly can also lead to soreness. It therefore helps to change positions
during a feed and to adopt different positions for different feeds, so that pressure is applied to different points on the
breast.
Soreness may be caused by a baby sucking too long after the breast has been emptied. A baby takes
approximately 20 minutes to empty a breast; after that he/she only indulges in comfort sucking. Restrict comfort
sucking.
How to Heal Sore Nipples
Soggy nipples, that is, nipples that remain wet for long periods, are more prone to soreness. It therefore helps to
expose your nipples to air and sunlight as much as possible, until the soreness heals. You can wear a loose garment
without a bra, or you can wear a tea-strainer without a handle inside your bra, to promote healing.
Avoid using creams on cracked nipples. Dry cornflour can be dusted on them instead. It is also very helpful to
express some milk after a feed and rub it on the sore nipple where it should be left to dry. This quickens healing
considerably. Avoid the use of water proof backed bra pads. Do not remove any crust appearing on the nipple. It is
part of the healing process.
Always offer the less sore side first. That will establish the flow on the sore side before the baby takes it, thus
making it less painful. You can use breathing for labour to be able to handle the pain. An aspirin or a mild alcoholic
drink (beer or wine) taken shortly before a feed will help reduce the pain. It can be taken if the pain begins to
interfere with the let down or release of milk.
You can try using a cold compress on your nipples before feeding. Apply an ice cube wrapped in a towel or
hanky. You can wear a blotting paper or an ever dry nappy liner inside the bra to keep the nipples dry. Sometimes, a
sore nipple may bleed. There is no harm if the baby swallows tiny amounts of blood with the milk. This can be quite
frightening, especially when the baby burps after a feed, and along with the curdled milk brings up a little blood.
However, this is harmless to the baby. Continue to treat your sore nipples and carry on feeding.
Home Remedy
You could dab the sore area with cotton soaked in water to which a few drops of calendula Q, a homoeopathic
medicine has been added, and leave it to dry.
There may be a risk of infection of sore nipples, if the baby has thrush, that is, white spots on the tongue that do
not wipe away. Thrush must be treated medically. You can take the baby off the breast for a few feeds until the skin
has healed. The milk can be expressed and fed to the baby from a spoon. Gentain violet can be applied to the baby's
tongue to clear it of the thrush.
A nipple shield can be used. It is a rubber shield that fits over the nipple and areola and prevents direct suction
on the nipple.
Blocked ducts
A blocked duct appears in the form of a tender red-looking lump on the breast or areola. It feels sore and can be
accompanied by a hot and shivery feeling.
It can be caused from pressure on the breast, as from a tight bra. Or, you may be holding the baby too tightly
against the breast, or your arm may be pressing on the side of the breast when lying in an uncomfortable position.
It can also be caused during engorgement by inadequate emptying of one duct in particular. This, or any of the
above factors, can cause a milk duct to get blocked, so that it does not empty properly, causing a tender or painful
lump to appear.
How to Deal with a BlockedDuet
Gentle but firm massage of the lump towards the nipple during a feed and after, if the block is still there, will help. A
hot water bottle should ease the pain; also a hot wet compress applied hourly. Do not stop feeding. Offer the affected
breast first for a few feeds, to ensure vigorous sucking, and drainage of the blocked duct. Lean forward over the
baby as you feed, so that gravity also operates. Give the baby some extra feeds. Express the remaining milk after a
feed.
Home Remedy
The last part of expressed breast milk applied on the sore nipple will encourage it to heal.
Check for tight bras, specially if your bra has a band across the top of the breast, when the flap is open.
Get plenty of rest. Actually go to bed for a day, it will make you feel better and make sure the blocked duct does
not lead to mastitis.
Exercise of the arms, shoulders, and upper half of the body may help disperse the painful swelling caused by a
blocked duct.
Non- infective mastitis
The symptoms are similar to those of a blocked duct. The infected area is red, swollen, hot and painful, with shiny
skin. The mother may feel nausea and shivering, as in flu.
It may be caused by milk leaking from a blocked duct into the surrounding tissues and bloodstream. The
treatment for this is the same as the treatment for blocked ducts, with the addition of an antibiotic.
There is no danger in continuing feeding, as the organisms responsible for this sort of breast infection are not
harmful and rarely present in breast milk.
This sort of sporadic mastitis often occurs after several weeks of feeding and occasionally without a duct being
blocked.
Infective mastitis
It normally occurs in the first 2 weeks of feeding. Its symptoms are that the whole breast is red, hot, tender and
swollen, and the mother feels feverish and ill. The milk becomes infected by a germ carried in the baby's nose from
the hospital nursery. The infection involves the milk duct.
It the milk is infected, the baby may have to be taken off the affected breast temporarily. The baby can be fed
from the non infected breast or be given powdered milk, 01 cow's milk. The breast should be emptied regularly and
the milk discarded until the bacteria count in the milk comes down to safe limits.
In the meantime, take rest and plenty of fluids. Also, swinging your arms (bent at the elbows) backward and
forward will help.
Prevention of mastitis
To avoid mastitis, the lactating mother should check her breasts for blocked ducts daily. The examination should
preferably be done when the breasts are relatively soft and empty. They should be checked for red patches. Fingers
can be lightly swept over the breasts to check for any unusual hardness which will be different from the all over
hardness of a breast full of milk.
The appearance of a red patch or lumpy hardness in the breasts means that a woman is heading for a blocked
duct. The moment signs of a blocked duct are noticed, the baby should be allowed to suck at that breast as soon as
possible. While the baby is feeding, massaging the lump towards the nipple helps to unblock the duct.
To prevent blocked ducts and engorgement, keep the breasts well drained. This can be done by feeding the baby
regularly and frequently, and by expressing any surplus milk that makes the breast uncomfortable. It can be done
with your hands, or with the aid of a breast pump.
Sometimes, the mother becoming cold probably leads to blocked ducts, because it causes circulatory changes in
the breasts, or because of the change in temperature that it causes in the mammary gland, it changes its bacterial
environment. Hence mothers who are feeding should be comfortably warm and not take long swims.
Breast abscess
Failure to treat mastitis or unnecessary weaning following mastitis may lead to breast abscess. A woman must not
stop feeding or expressing milk when she gets mastitis. The lump of a breast abscess is hard, red and painful.
It requires treatment by antibiotics or surgical drainage. The baby may have to be taken off the affected breast.
He can feed from the other breast until treatment is completed.
If a breast abscess is accompanied by a sore nipple, a nipple shield may be recommended by your doctor. The
nipple shield fits over the nipple, and prevents direct force on the nipple. However, if the breast abscess is near the
nipple, and the nipple shield also covers the abscess when worn, it can be very painful. Therefore, avoid a nipple
shield if the abscess is too close to the nipple.
The milk from the affected breast may be temporarily expressed and discarded. However, if the doctor feels that
infection from the abscess is not present in the milk, he may not advise you to take the baby off the breast.
Babies with Problems

Feeding in the incubator
If the baby is put in an incubator for special care immediately after birth, and it is not allowed to come to you for
feeds, express or pump your colostrum. It can be fed to the baby by a nurse with the help of a spoon, dropper, tube,
or drops fed from a soaked gauze. Do not be dismayed if the amount of colostrum seems very little. Remember it is
very little in the beginning, but each drop of it is worth its weight in gold, when you consider all the advantages it is
going to give your baby.
Subsequently breast milk should be expressed and fed to the baby in the incubator. Or, better still, the mother
can go to the nursery to suckle the baby at feed time.
Jaundice
There are three kinds of jaundice:
Physiological Jaundice
Physiological jaundice is fairly common, mild, and usually harmless. Within the uterus the baby has an abundance
of red blood cells. Once the baby is born and breathing, excessive amount of red blood cells is not needed, so they
break down until the level of cells is appropriate for the baby. A by-product of the breakdown is bilirubin, which
deposits in the skin and white of the eye, evident as yellow colouring.
Physiological jaundice normally appears after 30 hours. Peak levels of bilirubin are reached on the 4th or 5th
day, and eyes return to their normal colour by the 7th day. In physiological jaundice the bilirubin level normally
does not exceed 10 mg/100 ml.
Abnormal Jaundice
This kind of jaundice is today a thing of the past. An early pregnancy blood test identifies women with blood group
incompatibility (see p. 60). Such women are given an Anti D immunoglobulin injection to prevent abnormal
jaundice in the child. When this injection is not given, it results in blood group incompatibility.
That is, jaundice that occurs in the first 24 hours. It is more severe and serious and is called haemolytic jaundice.
It may be the result of blood group incompatibility between the mother and the baby and needs urgent treatment to
prevent brain damage in the child. The baby needs to be treated in a hospital. It may require complete transfusion of
blood, after which breastfeeding can continue normally.
It is quite safe to feed your baby even if your blood group is rhesus negative and your baby's is rhesus positive.
Rhesus antibodies are present in breast milk if they are present in the mother's blood, but they get inactivated by
digestion in the baby's gut; therefore you can safely feed the baby. It is also quite safe to breastfeed after having an
injection of Anti-D immunoglobulin.
Breast Milk Jaundice

This is a rare kind of jaundice that develops about 1 week after birth and could continue for 2 months. Although the
jaundice can become as deep as 20 mg bilirubin per 100 ml of serum it does not harm the baby's brain, because it
occurs after the first week of life, when the blood brain barrier is reasonably well developed. You can continue
breastfeeding.
However, if your baby's bilirubin level rises too high, your paediatrician may request you to interrupt
breastfeeding for a short while, say, 6 to 12 hours. If at the end of this time the bilirubin level has fallen by more
than, say, 2 mg per 100 ml of serum, breastfeeding can be resumed. Usually the bilirubin level then rises slightly
before falling slowly and steadily. If the level rises during the break or breaks, the jaundice is not being caused by
breast milk, and other causes will need to be investigated.
Other causes of prolonged jaundice could be infection, metabolic conditions such as low blood sugar, or even
administration of drugs to the mother in pregnancy.
While your baby is off breast milk, keep your milk supply going by expression or pumping more frequently than
your baby would have fed, and discard your milk until your milk can again be fed.
Generally jaundice is no cause to stop breastfeeding. Some people wrongly believe that breast milk jaundice
means that breastfeeding should completely stop. This is not so. The condition resolves itself spontaneously in time
with no ill effects on the baby from breast milk.
When Not to Breastfeed

Mothers suffering from tuberculosis, chronic nephritis (kidney trouble), or severe psychiatric disorders will be
asked not to breastfeed; also mothers who have suffered from some malignant disease. Some patients of epilepsy
may be discouraged from feeding if they are on a drug that can be excreted in breast milk.
Treatment
Babies with moderately raised levels of bilirubin are often treated by being placed uncovered in a cot 16 inches
beneath a daylight fluorescent tube with their eyes covered. This is called phototherapy. There is no harm if you take
the baby from under the light every 2 hours to feed, and may be more often if she demands it. Remove the eye
covers when you feed.
If your baby is otherwise well, your paediatrician may agree to your taking your baby home and giving it
exposure to sunlight. You can place the baby naked next to the window, but make sure she/he does not get too hot or
too cold. You can blindfold the baby if the sunlight is too strong, so that it does not affect the baby's eyesight. You
may have to take your baby back to the hospital for blood tests.
Phototherapy
To treat high bilirubin levels the baby may be exposed to contolled amounts of ultra-violet light, which breaks down
the pigment levels in the skin. The shades protect the baby from the light.
Cleft Palate
A cleft palate means that there is an opening on the roof of the baby's mouth. It might sometimes be accompanied by
a cleft in the lip also. The cause of the cleft happens sometime within the first 3 months of the baby's development in
the womb. There is not much you could have done about it, so do not add to your anxiety with your worry. Besides,
do not let your relationship with your partner be tinged with unnecessary suspicion that the anomaly was caused by
the other. Accept the baby and love it. Do not blame yourself.
A baby with a cleft lip and palate cannot suck. However, it can cup feed with considerable ease (see p. 198). For
such a baby, cup feeding has the added advantage of making the muscles of its upper lip work.
Feeding a baby with a cleft palate can be difficult. The baby needs to attach itself properly to the breast so that it
can suck well. The best position at the breast for a baby with a cleft palate is one with the nose and throat higher
than the breast. The upright position is therefore very good.
The baby's body should be in an upright position close to the mother's. This position will prevent milk from
leaking through the opening on the roof of the baby's mouth into the nose. If milk does go into the baby's nose, it
makes it difficult for the baby to breathe. When the baby is well attached to the breast, the breast tissue closes over
the cleft and helps the baby suck well.
Babies with a cleft palate have a tendency for their tongue to fall back. So another good position for feeding
such a baby is with the mother lying on her back and the baby lying on top of her for feeding. This position ensures
that the baby's tongue remains forward thus making it possible for the baby to suck well.
Apart from the above positions, the mother can also express milk and feed it with a spoon to the baby placed on
her lap with the head held higher than the rest of the body.
The baby will have to be fed thus until the condition can be rectified by surgery. Generally 2 or 3 surgeries will
be required. Apart from the paediatrician, the parents will also have to consult a plastic surgeon, a dentist, a
prosthodontist, and maybe a speech therapist.
As suggested by a leading paediatrician, a dentist (prosthodontist) may be consulted to fit the baby with an
artificial palate to cover the gap on the roof of the baby's mouth, so that the baby can be breastfed. Some doctors fear
that the artificial palate might cause infection at the site. But with breast milk the baby will receive infection fighting
properties and put on weight. Besides, any wound arising from the procedure will heal really quickly in a day or
two, since it is in the mouth, an area where healing is quick.
Whether the mother nurses the baby at the breast, or with a spoon, she should cuddle the baby and keep trying to
nurse it at the breast. Such non-nutritive suckling helps mother and baby bond to each other.
A cleft palate and/or lip must be operated within a year, before the baby starts to speak. Sometimes a baby with a
cleft palate may be more prone to ear infections.
This condition requires an enormous amount of patience on the part of the parents. However, one day, all of your
efforts will be behind you and your baby's condition will stand corrected with no cosmetic and functional problem.
At the present moment, if your baby does have this problem, it will help immensely if you can be in touch with a
couple who has gone through a similar experience recently. It may be someone distantly related or an acquaintance.
Search them out for they can be beacons of moral support to you. If you do not know anyone, or meet someone who
is not forthcoming, ask your paediatrician or plastic surgeon.
16.

Conditions that May Require Surgery at Birth
When the baby is born there is a lot of excitement and a sigh of relief at the birth. The mother is tired but happy. The
baby is looked at by the attending doctor, and now in most major centres and hospitals the delivery is attended by a
paediatrician who examines the baby for normal reflexes and that the baby is breathing normally and has no obvious
congenital anomalies.
It is increasingly becoming common to have antenatally diagnosed surgical conditions of which the parents are
already aware of. When such a situation arises then it is imperative that the parents are in touch with a paediatric
surgeon so as to counsel them about the problem. This is important as often the problem is completely curable and
rarely is it life threatening. Either way, it is good for the family to be mentally prepared.
There are a few conditions that alert the doctor to the immediate need for surgery in the baby:
Gastroschisis
The intestines are lying outside the abdomen through an opening in the abdomen.
Omphalocoel
A sac is covering the extruded intestines.

Oesophageal Atresia & Tracheo-Oesophageal Fistula
The baby has increased frothing at the mouth and is unable to accept feeds, due to a communication between the air
pipe(trachea) and food pipe (oesophagus).
Diaphragmatic Hernia
The baby has breathing difficulty. The abdomen is flattened and the intestines and liver are lying in the chest and are
detected clinically by hearing bowel sounds in the chest and plain X-ray of the chest reveals bowel shadows in the
chest.
Imperforate anus
There is no anal opening.
Other conditions needing immediate surgery are:

Intestinal Atresia
The baby vomits and does not pass stool and develops abdominal distention, that is, the tummy becomes big.
Hirschsprung's disease
It may manifest itself in vomiting and delayed passage of meconium, that is, the dark brown or black stool passed by
the baby at birth.
Some conditions are present at birth, but require planned surgery, that is, there is no need to do emergency
surgery:
Umbilical Hernia
Ofter waiting and watching a while will allow the hernia effect to close spontaneously.
Hypospadias
The urethral opening is on the underside (ventral aspect) of the penis and the penis is curved.
Epispadias
The urethral opening is on the upper side (dorsal aspect) of the penis and the penis appears short.
Extrophy Bladder
The bladder and the urethra are open.

Hernia Hydrocele, Inguinal Hernias Undescended Testes
These are best operated at about 2 to 3 months. Hydroceles often resolve themselves by waiting on them.
Undescended testes, if they do not come down to the scrotum by one year, require surgical intervention.
Ambiguous enitalia
Another problem that is perplexing is Ambiguous Genitalia, boy or girl? The parents are anxious and sometimes
even doctors do not have an immediate answer. It is helpful to have the history of the mother: If she has had some
androgenic hormones during pregnancy, or if there are other female children who have a large phallus. The latter
suggests a diagnosis of congenital adrenal hyperplasia - a condition in girls who have an enlarged clitoris.
Specialised X-rays help us to diagnose a male who has undescended testes and has a small phallus.
Sometimes the baby is truly intersex and with the help of hormonal and chromosomal studies we can designate
and make the baby a male or a female according to circumstances. The patient should be assessed by a paediatrician
and a paediatric surgeon, to discuss the further course of action.
Dr. Meera Luthra
M.S., M.Ch. DNB (Paediatric Surgery)
Senior Consultant Surgeon
Apollo Indraprastha Hospital, New Delhi
17.

Teratogenesis
Teratogenesis means the formation of abnormalities in the baby during intrauterine life. The factors that lead to
formation of these abnormalities are known as teratogens. Such abnormalities may be obvious when the baby is bom
or may remain undetected for a long time after birth. The degree of such abnormalities, if present, depends upon a
large number of factors, to name a few, the genetic make-up of the baby, the period of gestation (pregnancy), the
maternal health at the time of exposure to the teratogen, and the intensity and duration of exposure of the mother to
the teratogen.
Factors which lead to teratogenesis are as follows:
Infections
Infections in the mother, like viral infections, bacterial infections and a few fungal infections. Any micro-organisms
or the toxins released by them, which cross the placenta and reach the baby, might interfere with the growth and
development of the baby, thereby leading to malformations in the baby.
Addictions
Drugs, liquor, smoking and other addictions like tobacco chewing etc. in the mother. These cross the placental
barrier and might damage the baby. If the damage is too intense, it might lead to abortion. If the damage is of a
lesser intensity, the baby is born as an addict, to any of these agents.
chemical factors
■ Long-term antibiotics, anti-psychotic drugs like anti-depressants, mood elevators, sleeping pills, etc.
■ Drugs used for cancer treatment and hormones given as a tnerapeutic measure will have teratogenic effect if
the woman happens to be pregnant during such treatment. Such pregnancies might be terminated to save the
life of the mother.
Physical agents
■ Lowering of oxygen pressure in the blood of the mother during flights. This is unlikely to happen in modern
aircrafts, unless there is a fall in cabin pressure, in which case the mother-to-be should grasp the oxygen mask
and breathe deeply. Also she should avoid visits to high altitude areas like Leh and Ladakh, for the same
reason.
■ Exposure to X-rays, physical violence, trauma, radiation from sources like atom bombs, solar eclipse, etc., can
turn out to be harmful for both mother and baby. Physical trauma can occur from rough journeys, sports like
horse riding, trekking, mountaineering, or gymnastics undertaken during sexual activities.
Industrial pollution
This is relevant for women employed in various industries. Casual exposure to pollution is not likely to have
noticeable effects.
Malnutrition
Vitamin and mineral deficiencies can cause inadequate or under development of the baby.
It is very important for every pregnant woman to realise that she should protect herself from all such factors, which
might lead to fetal abnormalities, especially if she is exposed to these factors during the first 4 months of pregnancy.
These factors might either affect the placenta or, if they cross the placental barrier and reach the baby, will
interfere with its growth and development.
Precautions to be taken during pregnancy
■ Relax mentally and physically, so that you do not need any medicines to keep you calm. Over-exhaustion can
cause sleeplessness. Short periods of rest twice or thrice during the day are recommended.
■ Take a balanced diet. The golden rule about diet is, 'Eat a little bit of every food item but excess of nothing.' If
necessary consult your doctor for supplementation of vitamins, iron, calcium, etc. Some women get morning
sickness or vomit a lot or do not feel like eating. These women should avoid foods which lead to gastric
irritation and they should eat small quantities of nourishing food more frequently during the afternoons or
evenings when the nausea is relatively less.
■ Nowadays, young women want to maintain their slim figures. Some women think that if they eat less, their
babies will be smaller and they will have an easier delivery. The fetus is like a parasite and it will draw all the
nutrition it needs whether the mother has enough or not. This results in malnourishment of the mother. It is
advisable that the mother takes adequate quantity of a well-balanced diet.
■ Avoid consuming liquor, tobacco or any habit-forming drugs. It is wise to avoid the company of addicts. This
will keep you away from temptation and social pressures to consume such items. Spending time in the
company of smokers leads to passive smoking on the part of the mother.
■ Protect yourself from all kinds of infections. Do not visit sick relatives or friends. Send a bouquet of flowers or
a 'get well' card instead. Avoid visits to hospitals as you are likely to be exposed to a large number of
infections. Avoid going to crowded places like cinema halls, markets, etc.
■ Protect yourself from physical agents like fatigue, exhaustion, jerky journeys, joy rides in amusement parks,
horse riding, etc.
■ Avoid taking medicines altogether, if you can. If you get a headache or a backache use a pain balm instead of
painkillers.
■ Avoid being X-rayed. Tell your doctor about your pregnancy.
Do not be over anxious about teratogenesis; otherwise your mental tension will create problems for you. Take time
off to relax mentally and physically. Remember, 50% of your baby's health depends upon hereditary factors and the
other 50% depends upon how well you look after yourself.
During this period, members of your family tend to pamper you. Make the most of it and allow yourself to be
looked after by them. This is their way of looking after you and your baby. If you feel that they are not giving you
enough attention, then do not get into spells of depression. Instead, go out of your way and look after yourself, and
the baby will be looked after automatically by you.
Dr. Asha Singh
MBBS, MS. Ph. D (Genetics),
Prof, of Anatomy,
Maulana Azad Medical College, New Delhi

Recommended Reading
Pregnancy and Birth along with Practical Tips

Pregnancy and Childbirth
Sheila Kitzinger
Michael Joseph Ltd, 1980.
The Encyclopaedia of
Pregnancy and Birth
janet Balaskas, Yehudi Gordon
MacDonald & Co. Ltd, 1989.
New Active Birth Janet Balaskas
Unwin Paperbacks, 1989.
A New Look at Birth, stressing on the calm and quiet aspects of Birth
Birth without Violence
Dr. Frederick Leboyer
Fontana / Collins, 1977.
Birth Reborn
Dr. Michel Odent
Fontana / Collins, 1986.
Breastfeeding
The Breastfeeding Book
Marie Messenger Davis
Century Hutchinson Ltd.. 1988.
Helping Mothers to Breastfeed,
Felicity Savage and R.K. Anand. 1992
Available from: Association for Consumer
Action on Safety and Health (ACASH)
P.O.Box 2498, Mumbai 400 002
Breast Feeding, the Best Option 1994
Available from: Survival for Women &
Children Foundation (SWACH)
Sector 16, Panchkula, Haryana 134113
Tel (0172) 267770, 278376
Childcare
Dr. R.K.Anand's Guide to Childcare
Dr.R.K. Anand
Vakils, Feffer & Simons Ltd, 2001.
Baby and Child Care Dr.R.K.Suneja
Rupa & Co, 1998.
This includes addresses of:
• Institutions for the Handicapped
• Thallesemics India
• Main Center for Genetic Studies
What do You Really Want From Your Children?
Dr. Wayne W. Dyer
Arrow Books, 1997.
Miscellaneous
Woman's Experience of Sex
Sheila Kitzinger
G.P. Putnam's Sons, 1983.
A comprehensive book on sexual behaviour, feelings, difficulties, phases, grieving etc:
Hum Kya Khaiyen?
(What Should We eat?) Dr. Ramesh Bijlani
NCERT, 1989.
A book in Hindi that deals with Indian conditions, and answers questions regarding a balanced diet, ghee,
cholesterol, constipation, illness, etc.
Magical Child J.C.Pearce
Bantam Books, New York, 1986.
Highly recommended serious reading on how to positively influence a child from birth onwards, and infant and child
rearing from a different but scientific perspective.
Child Development Elizabeth B. Hurlock
McGraw Hill Co., (Psychology Series), 1978.
An excellent book on psychological, physical, social, emotional, moral and all-round development of a child.
Touch me, Touch-me-not, 1997
Available from: Kali for Women
B1/8, Hauz Khas, New Delhi 110 016
A book on the use of common Indian plants for healing of women's diseases like vaginal discharge, urinary tract
infections, menstrual disorders, uterine complaints etc.

Informed Choices
WHO Recommendations (Source Lancet (AQ:) 1985,2:437)

The World Health Organisation (WHO) recognises the importance of natural childbirth, and recommends that
minimum technology be used in childbirth. In 1985, WHO held a conference on appropriate technlogy for birth.
Over 50 participants specialising in obstetrics, paediatrics and other relevant professions came toghether in
Fortaleza, Brazil. The participants unanimously adopted recommendations which WHO believes are relevant to the
entire world. (Lancet 1985 2:437)
WHO Recommends:
IT IS NOT RECOMMENDED THAT PREGNANT WOMEN BE PLACED IN A DORSAL LITHOTOMY POSITION
DURING LABOUR AND DELIVERY. WALKING SHOULD BE ENCOURAGED DURING LABOUR AND EACH
WOMAN MUST FREELY DECIDE WHICH POSITION TO ADOPT DURING DELIVERY.
In simple words what this means, is that women in labour should be allowed to adopt upright positions like walking,
standing, sitting, kneeling etc., rather than being made to lie down flat on their backs. Indeed, in labour, when a
woman lies flat on her back, it is of disadvantage to her because of the following reasons.
Firstly, it results in the compression of a major blood vessel called the Vena Cava, which is positioned between the
pregnant uterus and the mother's backbone. Compression of this blood vessel reduces the flow of blood to and from
the heart, thus reducing the amount of oxygen available in the mother's body, to be used by both, the mother and the
bady. Therefore if the mother does not lie flat on her back, the amount of oxygen available to mother and baby will
be greater, so that both will be less likely to be distressed.
Secondly, when the mother lies flat on her back, her vagina is at an upward slant towards the front of her body. For
the baby to be born, the uterus has to work harder, by shrinking more forcefully on the baby to nudge it up the
vagina. It is similar to climbing up a mountain. When the mother is upright, on the other hand, the bady has a
downward descent, like going down a slide. This downward descent becomes speedier by virtue of the baby's body
weight. In 1868 it was calculated that the weight of a full term baby was enough to supply much of the force needed
to expel it, provided the mother was upright. As we are aware, the force of gravity, pulls things down in accordance
to their weight. That is, a brick will fall quickly with a thud to the ground by virtue of its weight, whereas a feather
will gently float to the ground because it is light in weight. An average Indian full term baby weighs about three
kilos, or six pounds. When the mother is upright, it is this weight of the baby that pulls the baby downward through
the vagina.
It also puts pressure on the mouth of the womb, encouraging it to open.
Thirdly, as the baby slides down the mother's body, to be born, it exits from the lower end of the mother's pelvic
structure. Part of the lower circumference of the mother's pelvic structure comprises of the tail bone. The tail bone is
a free and flexible bone which very easily moves out of the way, giving the baby a few extra centimetres to be born,
provided the mother is not in any way restricting its movement. Its movement can be free when the mother is in an
upright position.
(See Pg. 110 for Precaution)
Interestingly, till modern obstetrics came about and birth went to the hospital, all the world over, birth was always in
an upright position. In Asia, women sat up or squatted during birth, in the West birth-stools were used. Three factors
contributed to this changes:
(1) King Louis XIV of France wanted to watch his mistress give birth. He had her lie down at the time of birth and
this made it fashionable to lie down at birth.
(2) Birth went from the home arid the midwife, to the hospital and the doctor.
(3) The use of forceps came about, which required the mother to lie down.
THE WELL BEING OF THE NEW MOTHER MUST BE ENSURED THROUGH FREE ACCESS OF A CHOSEN
MEMBER OF HER FAMILY DURING BIRTH AND THROUGHOUT THE POSTNATAL PERIOD. IN ADDITION,
THE HEALTH TEAM MUST PROVIDE EMOTIONAL SUPPORT.
According to the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists, UK, the
presence of a supportive companion in labour is one of the most effective forms of care in childbirth.
The Midwives Information and Research Service points out, "ten randomised, controlled trails, which included over
3000 women, have examined the impact on a woman's labour, of having the continuous presence of a support
person......This person......had received brief preparation on how to support women during labour." The results are
remarkably consistent, they show that continuous support is associated with:
• lower use of pharmacological anesthesia and fewer epidurals.
• fewer instrument deliveries (example, forceps).
• fewer Caesarean sections.
• more five minute Apgar scores greater than seven. (That is, more babies were born alert, with a good supply of
oxygen).
All these trials which looked at women's preferences found that continuous support is associated with:
• labour being better than expected.
• a more positive overall experience for the woman
There were no negative outcomes associated with 'support in labour'.
* IMMEDIATE BREASTFEEDING SHOULD BE ENCOURAGED EVEN BEFORE THE MOTHER LEAVES
THE DELIVERY ROOM.
When the baby is born to a mother who has not received any drugs like pethidine, calmpose etc. in labour, it is born
very alert. If such a baby is placed at the mother's breast, it will start suckling. It brings forth a gush of maternal love
in the mother, who might until then be wondering about the odd appearance of her new born. Hence, it is said to
encourage bonding.
Suckling at birth also causes a release of oxytocin hormone in the mother which causes the uterus to contract, the
placenta to be expelled and haemorrhage to stop.
Apart from the above advantages the baby learns to latch on properly to the breast for feeding and does not need to
be coaxed and taught later when milk comes in. Also, the baby gets invaluable colostrum which could be the first
immunisation the baby receives. The baby is alert at birth, so it is best to feed within 30 minutes of it.
If you want to breastfeed your baby at birth, you could speak to your doctor about your desire. This would include
your desire to avoid sedatives being given to you in labour. If you feel shy or embarrased, do not be so. Remember,
for the doctor it is one of the ever so many deliveries. For you and your baby however, it is a unique experience that
will be etched in your memorey for a lifetime.
The baby does not need glucose water or artificial milk in the first day or two. The best is to breastfeed the baby
only when the baby demands a feed (which initially can be six hours or so) and to feed the baby nothing else.
Artificial feeds fill the baby's stomach and prevents suckling at the breast.
Realising the importance of this there is an international effort called the Baby Friendly Hospital Initiative (BFHI).
These hospitals as a matter of routine avoid over medicating the mother and encourage breastfeeding at birth and
afterwards.
In India, such hospitals are now honoured by UNICEF and a task force of the Indian government, and labelled
"Baby Friendly Hospitals'. Names and addresses of such hospitals can be had from BFHI, Indian Medical
Association, IMA House, Indraprastha Marg, New Delhi 110 002.
* OBSTETRIC CARE THAT CRITICISES TECHNOLOGICAL BIRTH CARE AND RESPECTS THE
EMOTIONAL, PSYCHOLOGICAL AND SOCIAL ASPECTS OF BIRTH SHOULD BE ENCOURAGED.
Using technology in birth stems from the belief that birth is a medicalised event of tremendous risk. According to
Ros Claxton in Birth Matters, Unwin Paperbacks, 1986, 'the routine application of medical techniques that occurs in
most hospitals creates more problems than it solves. Professor G. L. Kloosterman, the Dutch obstetrician, believes
that 80-90 per cent of women are capable of normal deliveries without medical intervention'.
Somewhere along the line, people forget that birth is a normal biological event.
Most of the techniques used at birth have not undergone thorough testing. An interesting fact is that the fetal heart
monitor, which is strapped on to the mother's abdomen and requires her to lie on her back, causes fetal distress. That
is, it causes abnormal heartbeat of the baby, because, when lying on her back the mother compresses a blood vessel.
Now, this machine which was designed to identify fetal distress, is found to be actually causing it, if over-used.
It is interesting to know that, during World War II, there was a tremendous strain on medical facilities and specialist
care for pregnancy and birth nearly came to a stop. At this time, for some unexplainable reason, obstetric mortality
rates (infant and mother death rates) fell to an unprecented degree. This worldwide phenomena seems to have no
explanation. (Source: 'Pursuing the Birth Machine', Ace Graphics, 1994, by Dr. M. Wagner, consultant to WHO on
Women and Child Health).
INFORMATION ON BIRTH PRACTICES IN DIFFERENT HOSPITALS, SUCH AS RATES OF CAESAREAN
SECTION, SHOULD BE AVAILABLE TO THE PUBLIC
This will help the public decide where they want to have their children delivered. They can choose a hospital where
the percentage of Caesarean section is low, where the use of routine medications is not the norm, where
breastfeeding is encouraged, where they will be allowed a labour companion etc.
* THE INDUCTION OF LABOUR SHOULD BE RESERVED FOR SPECIFIC MEDICAL INDICATIONS. NO
REGION SHOULD HAVE RATES OF INDUCED LABOUR HIGHER THAN 10%.
According to Wrigley (1962), it is 'questionable whether the oxytocin drip saved the life of a single baby and it is
certain that its employment never made labour more normal or more comfortable for the patient.'
However, induction of labour would be medically required if the mother suffers from high blood pressure, diabetes,
kidney problem etc.
If induction of labour is over-used it can lead to the rupture of the uterus and a medical emergency.
Futher, as Sheila Kitzinger writes in her book Freedom and Choices in Childbirth, "Induced labours have
disadvantages. They tend to be more painful, so induction starts a process in which powerful pain-killing drugs may
have to be given. These in turn slow down labour and may lead to a forceps delivery. Induced labours are more
likely than spontaneous labours to end in a Caesarean section".
* ARTIFICIAL EARLY RUPTURE OF MEMBRANES, AS A ROUTINE PROCESS IS NOT JUSTEFIABLE.
Sometimes, doctors may burst the bag of water routinely. What this would do is, speed up the birth process. To do
this routinely is not recommended, it could lead to distress of the baby, infection in the mother and/or baby, cord
prolapse etc.
The textbook Common Obstetric Problems' by Ian Donald says, 'With very few exceptions, intact membranes mean
an intact mother and an intact baby.'
* DURING DELIVERY, THE ADMINISTRATION OF ANALGESIC OR ANESTHETIC DRUGS (NOT
SPECIFICALLY REQUIRED TO CORRECT OR PREVENT ANY COMPLICATION) SHOULD BE AVOIDED.
Drugs are not beneficial to the baby when the mother is pregnant, neither are they beneficial to the baby when the
mother is in labour.
Drugs used in labour pass through the placenta and reach the baby's blood circulation, exerting a similar effect to
that which is exerted on the mother. Since the baby receives the same dose as the mother, it becomes a massive
overdose for the baby. If the mother recovers from the drug in two hours, the baby could take twenty hours to
recover from its effect. After birth the baby may be given an antidote injection to the drug. Some drugs, may remain
in the baby's system and strain the baby's immature liver to break down and excrete the drug. This could lead to
jaundice in the baby.
Apart from drugs, the discomfort of labour can be reduced in several ways. For instance, if the mother has a warm
bath or is soaked in a tub of warm water. The temperture of the water in the tub should be body temperature, that is,
98.4° F. Also, moving about in labour and having a sympathetic caring companion would greatly reduce the 'pain'
felt by a woman in labour. Further, a positive attitude, conscious 'breathing' and relaxation by the mother will be of
tremendous help.
However, it is not a good feeling to go into a hospital with the thought that you and your partner are going to say 'no'
to routine medication or procedures. It is better to discuss your choices in advance with your doctor. You could
follow it up with a list of preferences stating your choices. The list of your preferences could be attached by your
doctor to your case papers. This would be of great convenience to your doctor and to you. If the nursing home and/
or staff is not equipped to allow you your preferness and choics you could consider a change.
The following is an example of how a list of preferences could be:
1) You would like to have minimum of ultrasound.
2) You wish your partner or support person to be present with you during labour.
3) You wish to be able to move around in labour. (You will lie down for examination and if it is a case of a floating
head and the water bag bursts).
4) You do not need to have your water bag broken routinely on admission.
5) You do not wish to have medical intervention until you are informed of its necessity.
6) You would like to hold your baby at birth (see p.186-187).
7) You would like to breastfeed the baby exclusively, and so you would not like the bottle or glucose water to be
given to the baby.
8) You would like to keep the baby with you in your room.
9) In case your baby is put in special care after birth you would like to hold your baby and give it expressed breast
milk, or feed it directly.
10) You would like to attach your requests to your hospital notes.
11) Put the baby in a tub of warm water after the birth.
12) Would like to be informed of any procedure before it is carried out.

Index
A
Abdominal examination
Abortion
medical termination of pregnancy
medicine for
threatened miscarriage
Activities, normal activities in pregnancy
AFP, Alpha Feto Protein test
After childbirth
after a Caesarean birth
after a normal birth
Alcohol
Amniocentesis
Amniotic fluid
Amniotic sac
Anaemia
Anatomy
understand your anatomy
Antenatal visits
B
Baby
at birth
first trimester
second trimester
third trimester
Baby's head at birth
Baby-friendly hospitals
Backache
during pregnancy
during labour
how to cope during labour
Birth experiences of women,
Birth plan, list of choices in labour
Birth trauma reduced for baby/mother
Bleeding
in early pregnancy
bright red, around estimated time of delivery
Blood pressure, high/low
Blood test
Bonding with newborn
Bottle-feeding
how to
nipple confusion
pros and cons
sterilising bottles
Breast changes
Breast or bottle
Breast preparation for breastfeeding
after pregnancy
during pregnancy
Breast pumps
Breastfeeding
at birth
at night
baby's nose blocked
breast size
contraceptive effects
engorgement
exclusive
flat nipples
how long to
how much at each feed
how to
leaking breasts
positions
problems during
why breastfeed
working women
worries about producing enough breastmilk
Breathing
a focus in labour
as a conditioned reflex in labour
concentration breathing
levels to be practiced in labour
not pushing breathing
practices to be used in labour
pushing breathing
Breech baby
Burping baby
C
Cervix
Cleft palate
Colostrum
Comfort sucking by baby when breastfeeding
Common problems during pregnancy
behavioural changes
conditions requiring special attention
digestive problems
physical changes
urinary tract infection
Confirming pregnancy
Constipation and piles
Contraception after childbirth
Contraception in the future
Contractions
Cooking, best methods of
Cow's milk, for baby
Cravings
Cystitis
D
Darkening and pigmentation
Diahorrhea
breastfed babies
during pregnancy
from unsterilized bottles
Diet
calcium requirements
during labour
food to avoid
getting the most out of
ghee
iron requirements
protein requirements
traditional recipes after childbirth
while breastfeeding
wholesome food
Dizziness
Driving
Dropping of baby's head
E
Eclampsia
Ectopic pregnancy
Engagement of baby
Estimated date of delivery
Exercises after delivery
after Caesarean
after normal birth
Exercises during pregnancy
Expressed breastmilk
feeding of
how to
storing of
Estimated date of delivery
F
Fainting and dizziness
Fallopian tubes
Fear,
of labour
fear tension pain syndrome
Flat nipples,
Floating head
Food, see 'Diet'
G
Genetic counselling
H
HCG, human chorionic gonadotropin hormone
Heartburn
HIV drugs
azt
nevirapine
3tc
HIV, percentage of babies that can be affected
Home remedies for
anemia
dental problems
diarrhoea
nausea
oedema
sore nipples
Homoeopathy
Hormones
endorphins
oxytocin hormones
prolactin hormones
relaxing hormones
Household chores after childbirth
I
Immunities
from breastmilk, to baby
from mother
Immunoglobin Anti D injection
Infection prevention after childbirth
Itching
J
Jaundice
K
Kesaree, Nirmala
L
Labour,
backache in
eating during
fear of
first stage induced
muscle action in
positions to adopt
reasons for inducing,
second stage
starting signs
third stage
Laing, R.D.
Leboyer, Fredrick
Leg cramps
Lifting heavy objects
Lightening
Luthra, Meera
M
Mastitis,
Mature milk
Medicines
when breastfeeding
when in labour
when pregnant
Milk powder
Mood swings
N
Nevirapine
Nipple confusion
Nipples
flat / inverted / long / normal
sore nipples, how to heal
sore nipples, prevention
syringe method for flat/inverted nipples
Nasal congestion
in baby
in pregnant mother
O
Odent, Michel
Oedema,water retention
Oestrogen
Ovary
Ovulation
Ovum
P
Pain
in childbirth
perception
in the groin and sides of the abdomen
under the breasts
Paladi, a traditional feeding cup
Palpitations
Piles
Placenta detaches
before birth
afterbirth
Planning a healthy baby
Post-natal depression
Post-partum psychosis
Pre-conception care
Pre-eclampsia
Pregnancy does not show
Pregnant women, positivity
Prepared childbirth
Progestogen
Prolonged pregnancy
R
Relaxation
during labour
exercises, while pregnant
when breastfeeding
Rooming in, baby and mother together after childbirth
S
Senses of baby at birth
Sex
after the birth
during pregnancy
Sex of the child
Shortness of breath
Singh, Asha
Sleeplessness
Sling for baby
Smoking
Sore nipples,
how to heal
prevention
Stretch marks
Surgery, conditions requiring surgery for baby at birth
Swollen hands and feet
Sympathetic nervous system
Syringe method for flat/inverted nipples
T
Teeth and gums
Teratogenesis
Tetanus injection
Thalidomide
Tingling and numbness
Tiredness
Tobacco chewing
Toxaemia
Toxoplasmosis
Transition for baby preceding birth
Travelling while pregnant
U
Ultrasound
Umbilical cord
Urinary tract infection
Urine test
Uterus
anteverted
retroverted
V
Vagina
Vaginal bleeding
Vaginal discharge
Vaginal examination
Varicose veins
Vomiting and nausea
W
Water bag
Water retention
Weight control tips on
Weight gain, estimated in pregnancy
WHO recommendation


Pregnancy

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Pregnancy

THE COMPLETE CHILDBIRTH BOOK

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NUTAN LAKHANPAL PANDIT

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Also my aunt Pushpa Sharma,

Copyright © Nutan Pandit 2004

First Published 1991

Allahabad Bengaluru Chennai

All rights reserved.

Text illustrations by Priya Nagarajan

For classes in natural childbirth contact:

MYTH: The pain is unbearable.

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The Brain, the Boss

Sympathetic Nervous System

The Body's Design for Birth

The female pelvis

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The Development of the Baby

The third trimester: 7-9 months

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Blood /Urine Test

Planning a Healthy Baby

Using knees and legs for lifting

Blood Tests during Pregnancy

Internal Vaginal Examination

Medical Termination of Pregnancy

* a branch of medical science concerned with pregnancy and childbirth

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Urinary Tract Infection

Conditions Needing Special Attention

Toxaemia and Pre-Eclampsia

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Eating for Two

We may live without books -

Foods You Need

Tea, Coffee and Cola Drinks and Chocolates

To Avoid Putting On Too Much Weight

Estimate of Expected Weight Increase in Pregnancy

Total expected weight gain 13.5 kg

Percentage Weight Increase During Pregnancy

Estimated Rate of Weight Increase

Diet when Breastfeeding

Our Traditional Recipes

To Get the Maximum Goodness from Your Food

Tips on Weight Control

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Pelvic Floor Exercise

An Exercise for Every Woman

STEP 1: Exhale. Relax the pelvic floor.

1. Sit on your heels with knees bent.

This exercise is to be done once.

STEP 2: Raise the upper leg higher than your hip.

STEP 1: Stand normally.