I am Dr Gayatri Deshpande, a consulting gynecologist since 2001. I have practiced earlier at Jaslok hospital and am now a full time consultant at Nanavati. I also have a personal clinic at DN Nagar, Andheri.I specialize in successful vaginal delivery
Its every lady’s right to have normal vaginal delivery. There are a lot of things which have to be taken care of for this. Successful antenatal care is crucial. Good weight of baby should be maintained. Basic exercises and physical activity should be practiced by mother.
1st trimester: Nutritious diet should be the main focus to overcome loss of nutrition due to acidity and morning sickness. Avoid dehydration and acidity. Once sonography shows heartbeat then you can go for proper nutrition plan. Simple food should be consumed during phase of morning sickness. Mostly Bland without too many spices. Medicines for morning sickness should be consumed if nausea is too much. The medicines prescribed by your gynecologist will not affect the baby in fact it ensures good nutrition intake.
Hormonal tests, resistance to insulin test, vitamin deficiency test, Nuchal Translucency scan (11-13 weeks) and blood test. Some may have vitamin b deficiency which should be corrected as soon as possible. NT Scan shows the risk of baby having chromosomal anomaly like down’s syndrome. Nt scan measures the fold of nape of the baby. If it is within specified range then baby’s health is normal. After NT scan the next parameter to be checked is development of nose which is crucial in determining the development of baby’s other organs. Dual marker requires every detail including medical history of mother to be fed into a program which then scans for possible complications in current pregnancy. If it is negative then baby is safe.
Heartbeat range is 170 to 180. 172 is fine as the range is often relaxed upto 5. It’ll come down if you practice relaxation.
Pain in abdomen is often due to gas or stretching of the uterus. Relax and practice light exercises. Consume antacid in case of gas.
At 36 weeks it is difficult for the baby to turn. Keep up exercise. In this situation normal delivery isn’t safe. Consult your gynecologist for alternatives.
3rd month to 6th month is fine. Avoid after 7th month to reduce chances of premature delivery or stress to the mother.
Fetal anomaly scan is important. Tip to toe scan gives you an idea of minute abnormalities. Blood tests also called antenatal profile. This test will give Blood count, blood group, hhh (Australia antigen, hcv and hiv), vdrl, blood sugar and thyroid. Also The mother needs to take a tetanus shot and then second injection one month later.
Keep control of blood pressure, swelling, diet and diabetes. Check for diabetes by blood test. Check blood sugar after 30 weeks and if it is high undertake Glucose screening test. Avoid salt to keep swelling and blood pressure under control. Remain physically active and do not follow a sedentary lifestyle. Take regular walks and practice yoga. Actually specific exercise routine for normal delivery starts after 8th month. The routine is 20 min walk twice daily. Butterfly exercise is easy to do and you can start with 50 sets. Squats should be done with the help of support and you can start with 20 squats and increase it as per your comfort level. Follow the given sequence: First butterfly followed by squats and then doggy kicks. This relaxes pelvic area. Don’t do squats before 8th month or it will cause premature delivery. De-stress. Don’t be anxious about normal delivery. Make yourself aware and if you are not comfortable with pain, opt for painless delivery which will ensure you are not exhausted. Contractions should be established or uterus dilation should be 3 cm before administration of medicine. Painless delivery can either be by gas mask or epidural anesthesia. Learn relaxation exercises like shavasan, pranayama and yoga-nidhra. This will ensure confidence regarding labour.
In most cases we have elective c section where it is pre decided. Few indications based on which this decision is taken are:
Placenta previa: When there is central placenta previa labour doesn’t begin as placenta has detached from uterine wall and completely covered the mouth of the cervix.
History of C-section: If mother has undergone caesarean for previous delivery then vaginal delivery is inadvisable.
Bridge baby: This is the case where baby is positioned with feet towards cervix. In such cases normal delivery should absolutely not be considered as it carries high risk for baby.
Apart from these indications there are emergency indications like blood pressure, health complication or less fluid.
Around 36 weeks the contraction of uterus increases gradually which is body’s preparation for labour. Light mucus discharge is normal. It means mouth of uterus is opening. Labour pain usually starts from back, comes to the front and then moves to the thigh. 3 rhythmic contractions in 10 min lasting 30-40 second each indicate healthy labour pain. Some women pass a big mucus plug. One major indication is leaking of water. In such a case get to the hospital within the next hour so that gynecologist can induce labour if there is no contraction.
Not at all, it is a common problem. This happens because head of the baby puts pressure on the bladder. Place a pillow or roll of Turkish towel under your waist while you sleep so pressure on bladder decreases. Otherwise sleep in such a way that waist is aligned slightly higher than head.
Unless the placenta covers the cervix completely it will migrate upwards. Don’t exercise till the conditions become favourable as low lying placenta can give rise to spotting due to strain.
Don’t lift heavy things. Don’t have lot of salt which will increase swelling and blood pressure. If you don’t have blood sugar avoid high sugar like ice cream and pastries. Expecting mothers are encouraged to walk regularly and follow light exercise for upper and lower body. Do not lead a sedentary lifestyle.
Posterior placenta doesn’t allow baby to come down. This sometimes doesn’t favour normal delivery. Consult your gynac for an opinion on method of delivery. AFI should be appropriate. If it is low take protein rich supplement and ARG medicine which improves blood supply to baby.
Hypertension can cause complications. Consult your gynac for medication. Restrict salt. Eat salads with lemon instead of salt. High BP reduces water around baby and restricts baby’s growth. Monitor fetal development using doppler and scans. If the baby is too small it will not sustain contraction. Try to achieve 2.5 to 2.8 kg baby weight by 37 weeks. This is safe for labour trial with continuous fetal monitoring(CTG).
Eat small portions frequently. Eat 4 to 5 times a day. Avoid spicy, sour and fried as it causes acidity. Take short walks after breakfast and definitely after dinner. Keep 3 hour gap between dinner and bedtime. It is safe to consume pan-d or digene for relief from acidity.
Pain could be premature labour pain or due to vitamin or calcium deficiency. You can use physiotherapy exercises which relaxes pelvic, thighs and back muscles. Back pain and leg pain are common during pregnancy. Remain active and exercise. Eat calcium rich food.
If your height is less than 5ft then your pelvic bone or diameters may be short. In this case the baby's head doesn’t come down. If your height is above 5 ft then you can do the butterfly, squats and doggy kicks. Don’t worry, the baby’s head takes position by 39 weeks.
Ghee and castor oil only do the job of lubrication which reduces pain. Otherwise maintain balanced diet.
If you have had a caesarean before there are certain parameters that should be taken into consideration like age of mother, weight of baby and health complications
One week before pregnancy sonography should be done to check the health of previous scar. If the scar is strong you can undergo controlled trial of normal delivery. So that we can monitor if the scar is tearing under pressure. Ideally scar should be thick and strong as thin scar will affect baby’s heartbeat. Such deliveries are called VBAC- vaginal birth after caesarean. There’s a risk if the scar tears then it can cause complications. VBAC should be done in a good institute which has emergency care facility. Never take excessive risk. If the uterus tears the suturing will be very difficult.
Cooking, sweeping, dusting and topwork is perfectly safe as it keeps the mother active and increases her appetite. Housework will also keep the weight gain in check between 12-15 kg. For normal delivery, squatting and wiping the floors is also a good way to exercise as it relaxes the cervix and makes it easier for childbirth. Don’t overdo it and be cautious of slipping and falling.
If vertex position is there then it is very good. Start exercising and remain stress free.
Bridge baby is the case where baby’s feet are positioned towards cervix. Exercise regularly to tone stomach muscles so baby can comfortably turn and vertex goes down. Sometimes there is less space in the uterus. This is called arcuate uterus which has less space on the upper side. Since the hips of the baby is wider it comes down. By the 6th month if the baby comes into the cat's-paw position then it is easier for the baby to turn naturally later on. Consult your physiotherapist.
Congratulations and good luck on having successfully made it this far. Have good amount of liquid like tang, chaas to give energy. Do light squats to cope with labour pain. Consume castor oil or ghee to relieve gas in bowel and ensure that bowel is lubricated. Remain stress-free and do not hesitate to ask for painless delivery if you think the pain will be too much.
Average weight of the baby should be 2.5 kg and above. To increase weight gain increase protein intake. ARG-9 sachets will improve blood flow to baby. First focus on weight gain of the baby and then practice exercises to aid in normal delivery.
At the end of the day focus on your health and your baby’s health and ensure there are no medical complications which will reduce the chances of nicu. Practice yoga and relax regularly. Don’t hesitate to ask your doctor for painless vaginal delivery which will reduce your hypertension and help you to focus on caring for your baby.
Also read: Eat Healthy Foods During Pregnancy Easily