FAQS IN PREGNANCY
On booking with Dr Shweta you will receive a pack with extensive information about your pregnancy care and various options. A condensed version with some of the more common questions is included here.
It is ideal but certainly not compulsory to have a pre-pregnancy planning visit. This may be as simple as addressing common questions and misconceptions or as complicated as reviewing difficult medical conditions or previous pregnancy complications.
The first visit in the pregnancy is scheduled at 7 weeks gestation unless there is a high risk to your pregnancy that needs addressing earlier. Subsequent visits are individualised depending on pregnancy risks or needs but are usually 4 weekly from 7 weeks, fortnightly from 28 weeks then weekly from 34 weeks.
The most accurate way of dating a pregnancy is with ultrasound, and the earliest scan that can detect a baby with a heart-beat is usually the best.-at 6-8 weeks. Ironically the "number of weeks" you are quoted is from the first day of bleeding of the last menstrual period and the pregnancy is actually two weeks younger than this (at 40 weeks your baby is actually 38 weeks old). Nevertheless an ultrasound is far more accurate than an estimate of the last period and accurate dating is very important later in the pregnancy, for instance to estimate how far overdue is safe.
There are a number of screening tests for genetic conditions, the most common concern being Down Syndrome. Many women find it worthwhile to have a personal discussion with their obstetrician about these, however it is worthwhile thinking about them beforehand or writing down any questions or concerns you might have. None need to be organised before 10 weeks.
The best known are the first trimester combined screen (a blood test and an ultrasound) or the newer blood test that examines fragments of fetal DNA in the maternal blood. Important things to consider include:
- All are screening tests and give you a numerical risk of your baby having the particular condition. They do not give you a "yes or no" answer. This requires an invasive test (a CVS or amniocentesis).
- Generally the newer fetal DNA blood tests are the most accurate but also the most expensive.
- It is important to consider what you would do if the test came back as high risk. Everyone feels differently about invasive tests (which carry a small risk of miscarriage) and termination of pregnancy (if the invasive test comes back positive).
Nausea and Vomiting of Pregnancy
This usually is self-limiting and resolves by 20 weeks (often earlier) but can be distressing. Milder cases are often successfully treated with dietary modification and a supplement which contains Vitamin B6 and Ginger. Medication is safe but may carry some unfounded concern because of very questionable pregnancy safety classification systems. Nonetheless they should be discussed with an obstetrician before starting.
It is hard (but not impossible) to meet all the demands of pregnancy with diet alone. In India, our diet is commonly low in iron (important as a "back-up" store for red blood cells and also for breastfeeding). Iron and Vitamin D are sometimes separately examined via blood tests and supplemented if required. Folic acid/folate 0.5mg should be started pre-pregnancy (2-3 months) and continued until week 12 (this prevents spinal fusion defects)
What food do I need to avoid?
There is a huge amount of information and misinformation circulated about what pregnant women must not eat. It can turn a time of joy and excitement into a time of unnecessary worry and culinary disappointment. There is no doubt that certain infections in food can present a risk to the baby but these infections are rare in India. Excessive weight gain can be a risk for gestational diabetes and can be difficult to lose post-partum but once again pregnancy should be as much as possible a time of excitement: no-one should feel guilty about a particular treat or craving. Enjoy it!
Almost all forms of exercise are safe before your booking visit at 7 weeks. The heart and blood volume changes of pregnancy (outlined in detail in your booking pack) are more noticeable by the end of the second trimester so no specific maximum heart rate needs to be adhered to this early on. Extreme exercise, however, can alter nutritional state and body temperature both of which can have an effect on a developing baby and clearly high-impact/contact sports are always best avoided.
There are no inherent risks to a developing baby in flying. The only concern in early pregnancy is the risk of miscarriage, which is NOT caused by the flight. Clearly this would be distressing and difficult if it occurred during the flight or it might leave you away from family and friends and your preferred clinician for treatment if it occurs at the destination. Therefore if you have experienced early pregnancy bleeding or have had an ultrasound that questions the viability of the pregnancy, it is better not to fly until this has been sorted out. The risks of flying later in the pregnancy centre around the increased risk of forming clots in the legs or lungs, going into labour on the plane or overseas, or any specific pregnancy risk that may have arisen and should be discussed individually. Before booking any flights always ask about the airline policy regarding pregnancy - these are extremely variable and no-one wants to be denied travel at the gate or, even worse, stranded overseas. It is very important to know if your travel insurance covers delivering overseas and to discuss with me the risk of this occurring. Costs can be hugely expensive.
Very few vaccinations are unsafe in pregnancy. Some are advised against but the risk is theoretical and not proven. In general it is usually best to wait until after the pregnancy for vaccination "top-ups" (eg Rubella) but there are several exceptions to this rule. The most important is the flu vaccination. It is highly advisable for ALL pregnant women or anyone contemplating pregnancy to be seasonally vaccinated against the flu. The flu during pregnancy can be incredibly serious - previously healthy women and babies have died from a simple flu infection.
Common pregnancy myths debunked
- It is safe to dye your hair during pregnancy.
- Sexual intercourse is safe unless you have certain specific pregnancy complications. People are often embarrassed to discuss this but it is a common concern.
- It is safe to have a bath or a spa during your pregnancy. It is not possible to raise your core temperature to a degree that could affect your baby unless it is extraordinarily hot (probably intolerable) for a long period of time. Be wary that pregnancy usually drops your blood pressure and you may feel light-headed on standing up too quickly particularly in a warm environment.
- It is not necessary to routinely weigh yourself during pregnancy. If you want to that is fine - the average weight gain is approximately 12kg.
- You can sleep on your back in the first and second trimester. Late in the third trimester prolonged periods of rest on the back can potentially decrease the blood return to your heart because the uterus and baby press backward onto the vena cava. The human body is a smart organism - most pregnant women do not feel comfortable on their back late in pregnancy anyway.
Doctors do routine episiotomies and Caesarean sections
I prefer nature to take its course. Your recovery is much quicker after a normal birth, but both these surgical procedures have their place. Caesars and episiotomies are done for reasons of safety for both the mother and the baby.