Pregnancy & Delivery

Always talk to your doctor before beginning any exercise program.Once you're ready to get goning: Start gradually.Even 5 minutes a day is a good start if you've been inactive.Add 5 minutes each week until you reach 30 minutes. Dress comfortably in lose-fitting clothes and wear a supportive bra to protect your breast. Drink plenty of water to avoid overheating and dehydration.Skip your exercise if you are ill. Opt for a walk in air-conditioned mall on hot,humid days.

PRE NATAL EXCERCISES

Pelvic Tilt

This important movement lengthens muscles of lower back and helps keep abdominal muscles strong enough to take weight of growing baby.Start against a wall so you can not cheat by moving top half as well.Feet should be slightly apart and away from wall and knees slightly bent.Feel back of the head,shoulder blades and spine resting against wall and breathe in.As you breath out press back of the waist into wall so that bottoms moves away from it a little.This is a small movement repeat several times slowly with correct breathing.

Sideways Pelvic Tilt

Standing with the feet apart, lift left hip towards left ribs and then the right hip towards the right ribs. Repeat several times, transferring smoothly from side to side with a good rhythm, and then try it with knees bent.

Breathing

Sit in any comfortable position where the spine is lengthened and ribs are free and concentrate on taking each breath down to the baby and then letting each breath out completely. Think about your baby as you do this. stroking and circular movements with palms over the bump will be comforting for you both too. Breathe down to the baby at back to the body as well.

Pelvic Floor

To locate your pelvic floor muscles, test them out while you are passing water (not on an extremely full bladder through, such as first thing in the morning) by stopping flow of urine mid-stream. You should be able to stop it completely with no drips. If you can't pelvic floor muscles need working on. Lift them up a little (as though stopping urine flow mid-stream), then squeeze upwards as much as you can. Hold for a slow count of and then lower in three stages as before. Don't worry if you can't get all stages up or down at first you will become more precise with practice. Try to do this atleast 5 times a day. Left and squeeze pelvic floor in one quick movement too repeat several times daily. When you are familiar with exercise, try combining it with pelvic tilt.

Leg Swings

These will get circulation moving in the hips and legs. Try them forwards and back and across and out away from the body, holding lightly onto the back of a chair for support.

Side Stretch

Sitting cross-legged, breathe in and stretch one arm up and over head. Reach over to opposite side enjoying stretch and breathing out. Breathe in as you return to center and then change arms stretch to other side Repeat several times.

Twist

Sitting Cross-legged, place one hand on opposite knee and press the other into floor behind you to help lift spine as you take a good breathe in. As you breathe out, twist gently round towards arm at back and look round gently too. Think of spiralling round on a well-liftes spine as you do this. Hold for a few moments, breathing normally, then repeat to other side.

Warning signs or symptom requiring urgent consultation

• Your baby is moving or kicking less than usual (once he begins moving regularly). Ask your doctor whether you should monitor your baby's activity by doing daily "kick counts." She can give you specific instructions on how to count and when to call.
• Severe or persistent abdominal pain or tenderness.
• Vaginal bleeding or spotting.
• An increase in vaginal discharge or a change in the type of discharge-that is, if it becomes watery, mucousy, or bloody (even if it's only pink or blood-tinged). Note: After 37 weeks, an increase in mucus discharge is normal and may indicate that you'll be going into labor soon.
• Pelvic pressure (a feeling that your baby is pushing down), lower back pain (especially if it's a new problem for you), menstrual-like cramping or abdominal pain, or more than four contractions in an hour (even if they don't hurt) before 37 weeks.
• Painful or burning urination, or little or no urination.
• Severe or persistent vomiting, or any vomiting accompanied by pain or fever.
• Chills or fever of 100 degrees Fahrenheit or higher.
• Visual disturbances such as double vision, blurring, dimming, flashing lights, or "floaters" (spots in your field of vision).
• Persistent or severe headache, or any headache accompanied by blurred vision, slurred speech, or numbness.
• Any swelling in your face or puffiness around your eyes, anything more than a little swelling in your hands, severe and sudden swelling of your feet or ankles, or a rapid weight gain (more than 2kgs in a week).
• A persistent or severe leg cramp or calf pain that doesn't ease up when you flex your ankle and point your toes toward your nose or when you walk around, or one leg being significantly more swollen than the other.
• Trauma to the abdomen (such as a fall or a car accident).
• Fainting, frequent dizziness, a rapid heartbeat, or heart palpitations.
• Difficulty breathing, coughing up blood, or chest pain.
• Severe constipation accompanied by abdominal pain or severe diarrhea that lasts more than 24 hours.
• Persistent intense itching of your torso, arms, legs, palms, or soles, or a feeling of itchiness all over your body.
• Seek immediate emergency medical care if you're experiencing shortness of breath or difficulty breathing, chest or abdominal pain, sudden dizziness or confusion, severe or persistent vomiting, decreased fetal movement, or if you have a high fever despite taking acetaminophen.
• Exposure to a communicable disease like chicken pox or rubella if you're not immune or are showing signs of infection. Call your caregiver-don't show up at the office without phoning first.
• Depression or severe anxiety. If you are feeling a profound sense of sadness or hopelessness, having panic attacks, are unable to handle your daily responsibilities, or are having thoughts of harming yourself, seek help immediately.
• Any other health problem that you'd ordinarily call your practitioner about, even if it's not related to your pregnancy (like worsening asthma or a cold that gets worse rather than better).

Your body is changing so rapidly that it's hard to know whether what you're experiencing is "normal." If you're not sure whether a symptom is serious, you don't feel like yourself, or you're uneasy, trust your instincts and make the call.

  Preparation for Labor & Delivery

After months of anticipation, your baby's due date is near.
Start preparation, whenever you come to hospital for delivery do not forget to bring

• Pair of cotton comfy clothes for yourselves
• Nursing Bra
• About six pair of underwears preferabbly cotton
• Toileteries incules soaps, toothbrush, freshen-up.
• Cellphone, camera and their charging cord
• Phone no. of all those who you wish to inform
• Nipple cream for soaring nipple if they occur
• Baby clothes-the hospital usually will provide for some but you may need more
• The insurance card , documents , chequebook.
• Soft washed cotton clothes to wrap the baby,nappies and diapers,baby wipes

Signs of Labor

No one can predict with certainty when labor will begin -- the due date your doctor gives you is merely a point of reference. It is normal for labor to start as early as three weeks before that date or as late as two weeks after it. The following are signs that labor is probably not far away:

• Lightening:-This occurs when your baby's head drops down into your pelvis in preparation for delivery. Your belly may look lower and you may find it easier to breathe as your baby no longer crowds your lungs. You may also feel an increased need to urinate, because your baby is pressing on your bladder. This can occur a few weeks to a few hours from the onset of labor.
• Bloody show:- A blood-tinged or brownish discharge from your cervix is the released mucus plug that has sealed off the womb from infection. This can occur days before or at the onset of labor.
• Ruptured membranes:-Fluid gushing or leaking from the vagina means the membranes of the amniotic sac that surrounded and protected your baby have ruptured. This can occur hours before labor starts or during labor. Most women go into labor within 24 hours. If labor does not occur naturally during this time frame, doctors may induce labor to prevent infections and delivery complications.
• Contractions:-Although it's not unusual to experience periodic, irregular contractions (uterine muscle spasms) as your labor nears, contractions that occur at intervals of 10 to 15 minutes are usually an indication that labor has begun.

Stages of Labor

Labor is typically divided into three stages:
Stage 1:-This stage has three phases:

Stage 2:- Stage 2 begins when the cervix is completely opened. At this point, your doctor will give you the OK to push. Your pushing, along with the force of your contractions, will propel your baby through the birth canal. As soon as your baby's head comes out, your doctor will suction amniotic fluid, blood, and mucus from his or her nose and mouth. You will continue to push to help deliver the baby's shoulders and body. Once your baby is delivered, doctor clamps and cuts the umbilical cord.

Stage 3:- After your baby is delivered, you enter the final stage of labor. In this stage, you deliver the placenta, the organ that nourished your baby inside the womb.

Remember for each woman labor is different. The amount of time spent in each stage of delivery will vary. If this is your first pregnancy, labor and delivery usually lasts about 12 to 14 hours. The process is usually shorter for subsequent pregnancies.

Pain Treatments

Just as the amount of time in labor varies, the amount of pain women experience is different, too.

The position and size of your baby and strength of your contractions can influence pain, as well. Although some women can manage their pain with breathing and relaxation techniques learned in childbirth classes, others will need other methods to control their pain.

Some of the more commonly used pain-relief methods include:
Medications:- Several drugs are used to help ease the pain of labor and delivery. Although these drugs are generally safe for the mother and baby, as with any drugs, they have the potential for side effects.

An epidural block continuously administers pain medication to the area around your spinal cord and spinal nerves through a catheter inserted into the epidural space. Possible risks of both include decreased blood pressure, which can slow the baby's heart rate, and headache.

Non-Drug Options:- Non-drug methods for relieving pain include acupuncture, relaxation techniques, and changing position frequently during labor.

Cesarean section Cesarean delivery - also known as a C-section-is a surgical procedure used to deliver a baby through an incision in the mother's abdomen and a second incision in the mother's uterus. A C-section might be planned if you develop pregnancy complications. Often, however, the need for a first-time C-section doesn't become obvious until labor is under way.

Sometimes a C-section is safer for you or your baby than is a vaginal delivery. doctor might recommend a C-section if:

• Non progress of labor: Slow progress or non progress labor is one of the most common reasons for a C-section. Perhaps your cervix isn't opening enough despite strong contractions over several hours - or the baby's head is simply too big to pass through your birth canal.
• Fetal distress:If your doctor is concerned about your baby's oxygen supply or changes in your baby's heartbeat, a C-section might be the best option.
• Breech presentation.:A C-section might be the safest way to deliver the baby if his or her feet or buttocks enter the birth canal first (breech) or the baby is positioned side or shoulder first (transverse).
• Twins, triplets or other multiples: When you're carrying multiple babies, it's common for one or more of the babies to be in an abnormal position. In this case, a C-section is often safer.
• Low lying placenta or placental separation: If the placenta detaches from your uterus before labor begins (placental abruption) or the placenta covers the opening of your cervix (placenta previa), C-section might be the safest way to deliver the baby.
• Medical problems:Your doctor might suggest a C-section if you have a medical condition that could make labor dangerous, such as unstable heart disease or high blood pressure.
• You've had a previous C-section: Depending on the type of uterine incision and other factors, it's often possible to attempt a vaginal delivery after a previous C-section. In some cases, however, your doctor might recommend a repeat C-section.
• At home: You might be asked to shower or bathe with an antibacterial soap the night before and the morning of the C-section. This helps reduce the risk of infection. If you regularly shave your public hair, don't do it the day before your operation.
• At the hospital:Before your C-section, a member of our health care team will cleanse your abdomen.
• Anesthesia: Most C-sections are done under regional anesthesia, which numbs only the lower part of your body - allowing you to remain awake during the procedure.
• Abdominal incision:The doctor will make an incision through your abdominal wall. It's usually done horizontally near the pubic hairline (bikini incision).
• Uterine incision:After the abdominal incision, the doctor will make an incision in your uterus. The uterine incision is usually horizontal across the lower part of the uterus (low transverse incision).
• Delivery: If you have spinal anesthesia, you'll likely feel some movement as the doctor gently removes the baby from your uterus - but you shouldn't feel pain. If you have regional anesthesia, you'll be able to hear and see the baby right after delivery.
• After the procedure:After a C-section, most mothers and babies stay in the hospital for about three days.
  Soon after your C-section, you'll be encouraged to get up and walk. Moving around can speed your recovery and help prevent constipation and potentially dangerous blood clots
• When you go home: Take it easy. Rest when possible. Try to keep everything around that you and your baby might need. within reach. For the first few weeks, avoid lifting from a squatting position or lifting anything heavier than your baby.
• Support yourself: Use good posture when you stand and walk. Hold your abdomen near the incision during sudden movements, such as coughing, sneezing or laughing. Use pillows or rolled up towels for extra support while breast-feeding.
• Drink plenty of fluids: Drinking water and other fluids can help replace the fluid lost during delivery and breast-feeding, as well as prevent constipation.
• Take medication as needed:Take your medications as advised by the doctor at the time of discharge.
• Avoid sex: Don't have sex for four to six weeks after surgery. You don't have to give up on intimacy with your partner though. Spend time with your partner, even if it's just a few minutes in the morning or after the baby goes to sleep at night.

It's also important to know when to contact your health care provider. Make the call if you experience:

• Any signs of infection - such as a fever higher than 100.4 F (38 C), severe pain in your abdomen, or redness, swelling and discharge at your incision site
• Breast pain accompanied by redness or fever
• Foul-smelling vaginal discharge
• Painful urination
• Bleeding that soaks a sanitary napkin within an hour or contains large clots
• Leg pain or swelling

Postpartum depression - which can cause severe mood swings, loss of appetite, overwhelming fatigue and lack of joy in life - is sometimes a concern as well. Contact your health care provider if you suspect that you're depressed. It's especially important to seek help if your signs and symptoms don't fade on their own, you have trouble caring for your baby or completing daily tasks, or you have thoughts of harming yourself or your baby.

What to Expect After Delivery

Just as your body went through many changes before birth, it will go through transitions as you recover from childbirth.
Physically you may experience the following:

• Pain at the episiotomy site:- An episiotomy is a cut made by your doctor in the perineum (the area between the vagina and the anus) to help deliver the baby or prevent tearing. If this was done, or the area was torn during birth, the stitches may make walking or sitting difficult. It also can be painful when you cough or sneeze during the healing time.
• Sore breasts:- Your breasts may be swollen, hard, and painful for several days as your milk comes in. Your nipples may also be sore.
• Hemorrhoids:- Hemorrhoids (swollen varicose veins in the anal area) are common after pregnancy and delivery.
• Constipation:- Having a bowel movement may be difficult for a few days after delivery. Hemorrhoids, episiotomies, and sore muscles can cause pain with bowel movements.
• Hot and cold flashes:- Your body's adjustment to changing levels of hormones and blood flow can cause you to perspire one minute and reach for a blanket to cover yourself the next.
• Urinary or fecal incontinence.:-Muscles stretched during delivery, particularly after a long labor, may cause you to leak urine when you laugh or sneeze or may make it difficult to control bowel movements.
• "After pains":- After giving birth, you will continue to experience contractions for a few days as your uterus returns to its pre-pregnancy size. You may notice contractions most while your baby is nursing.
• Vaginal discharge(lochia):- Immediately following birth you will experience a bloody discharge heavier than a regular period. Over time, the discharge will fade to white or yellow and then stop entirely within two months.

Emotionally you may experience irritability, sadness, or crying, commonly referred to as the "baby blues," in the days or weeks after delivery. These symptoms occur in up to 80% of new mothers and may be related to physical changes (including hormone changes and exhaustion) and your emotional adjustment to the responsibilities of caring for a newborn.

If these problems persist, inform your doctor or other health professional; you could be experiencing postpartum depression, a more serious problem that affects between 10% and 25% of new mothers.

 Breast Feeding

The first time you hold your newborn is a right time to start breastfeeding. Initially your body produces small amounts of a thick yellowish milk called colostrum that will help protect your baby from infection.
Turn your baby's whole body toward you, chest to chest. Touch her upper lip with your nipple, and, when she opens her mouth wide, pull her onto your breast, holding your breast for support. Her mouth should cover not just the nipple but as much of the areola (the darker part surrounding it) as possible. Breastfeeding requires patience and lots of practice. Don't hesitate to ask a nurse to show you what to do.

How frequently you should feed

The more you nurse, the more milk you'll produce. feeding eight to 12 times every 24 hours is usually adequate.

Feed on demand: According to guidelines from the American Academy of Pediatrics (AAP), rather than nursing according to a rigid schedule, you should nurse your newborn whenever she shows early signs of hunger, such as increased alertness or activity, mouthing, or rooting around for your nipple. Crying is a late sign of hunger ideally, you should start feeding your baby before she starts crying.During the first few days, you may have to gently wake your baby to begin feeding, and she may fall asleep again mid-feeding. (To keep her awake during feedings, you may want to tap her on sole or remove a layer of clothing.) To make sure your baby's eating often enough, wake her up if it's been four hours since your last nursing session.

Best position for feeding

Since feedings can take up to 40 minutes, especially in the newborn months, choose a comfortable place. Hold your baby in a position that won't leave your arms and back sore. It works well to support the back of your baby's head with your hand, but the position you choose really depends on what's comfortable for you.

If you're sitting, a nursing pillow can be a big help in supporting your baby. Whether you're sitting or lying down, don't start the feeding until you and your baby are comfortable because you'll be in that position for a while.

Dietary advise

A normal healthy diet is all you need while you're nursing. Although you can produce milk for your baby even if your nutrition isn't up to par, eating a well-balanced diet will ensure that the quantity and quality of your milk is all it can be and will help you feel your best. Follow your hunger rather than counting calories, and drink fluids throughout the day to stay well hydrated.

Problems you may encounter

Some women adjust to breastfeeding easily, encountering no major physical or emotional hurdles. But many new moms find it hard to learn. If you're tensed, you're not the only one.

It's normal to feel overwhelmed by your baby's constant demands and exhausted from lack of sleep. And you may have questions: Is my baby getting enough milk? Should I have sore nipples? How long should my baby nurse? Should I wake her if she falls asleep nursing?

Although women have nursed their babies for centuries, breastfeeding doesn't always come easily. Many women face difficulties early on. Some of the most common breastfeeding problems you may encounter in the first six weeks include:

• Engorgement (breasts that are excessively full and uncomfortable)
• Sore nipples
• Mastitis (a breast infection)

Calcium requirement during pregnancy
Pregnancy is a critical time for a woman to consume more calcium. Even if no problems develop during pregnancy, an inadequate supply of calcium at this time can diminish bone strength and increase your risk for osteoporosis later in life.

The following guidelines will help ensure that you are consuming enough calcium throughout your pregnancy:

• The U.S. Recommended Daily Allowance (USRDA) for calcium is 1000 mg per day for pregnant and breastfeeding women .
• Eating and drinking at least four servings of dairy products and calcium-rich foods a day will help ensure that you are getting the appropriate amount of calcium in your daily diet.
• The best sources of calcium are dairy products including milk, cheese, yogurt, cream soups, and pudding. Calcium is also found in foods including green vegetables (broccoli, spinach, and greens), seafood, dried peas, and beans.
• Vitamin D will help your body use calcium. Adequate amounts of vitamin D can be obtained through exposure to the sun and in fortified milk, eggs, and fish.

Best Sources of Iron

• Meat and Seafood: Lean beef, chicken, clams, crab, egg yolk, fish, lamb, liver, oysters, pork, sardines, shrimp, turkey, and veal.
• Vegetables: Black-eyed peas, broccoli, Brussel sprouts, collard and turnip greens, lima beans, sweet potatoes, and spinach.
• Legumes: Dry beans and peas, lentils, and soybeans.
• Fruits: All berries, apricots, dried fruits, including prunes, raisins and apricots, grapes, grapefruit, oranges, plums, prune juice, and watermelon.
• Breads and Cereals: Enriched rice ,pastaand whole grain and enriched or fortified breads and cereals.
• Other Foods: Molasses, peanuts, pine nuts, pumpkin, or squash seeds.
• Vitamin C helps your body use iron. It is important to include sources of vitamin C along with foods containing iron and iron supplements.
• Caffeine can inhibit the absorption of iron. Try to consume iron supplements and foods high in iron at least one to three hours before or after drinking or eating foods containing caffeine.
• Iron is lost in cooking some foods. To retain iron, cook foods in a minimal amount of water and for the shortest possible time. Also, cooking in cast iron pots can add iron to foods.
• Constipation is a common side effect of taking iron supplements. To help relieve constipation, slowly increase the fiber in your diet by including whole grain breads, cereals, fruits, and vegetables. Drinking at least eight cups of fluids daily and increasing moderate exercise (as recommended by your doctor) can also help you avoid constipation.