Index of topics:
2. Now that I am
pregnant, what are the special precautions that I should take?
3. What special
food should I take during pregnancy ?
4.Symptoms of Pregnancy:High temperature, vomiting,
5.Traditional beliefs about pregnancy
Introduction: Pregnancy is a unique period in a woman’s life
time. Each and every moment of that wonderful period
remains in a woman’s mind for years to come. The
various changes that occur during one’s pregnancy, the various people who
encourage you in pregnancy, and the innumerable doubts that come to one’s
mind during that period, come as flash backs throughout a woman’s life.
What follows is a list
of questions that a normal obstetrician faces in her
day to day practice from pregnant patients. Scientific
answers to those questions follow.
1. Am I pregnant?
The cardinal symptom that gives suspicion of pregnancy
is the missing of normal menstruation on the expected day. This may be accompanied by symptoms like nausea or
vomiting. However, a positive diagnosis of pregnancy
cannot be made on these symptoms alone, for the following
- Delayed periods may be caused by mental tension, change in the
hormonal milieu of the woman, etc.
- Similarly, nausea and vomiting may be caused by indigestion,
- Positive diagnosis of pregnancy in the early days is currently made
by the examination of urine pregnancy kits.
Pregnancy test kits:
Urine of the
pregnant woman is collected in a clean dry bottle. Most
of the pregnancy kits come in the form of cards with 2
depressions in it. Urine is placed in one of the
depressions and the result is read in the rectangle beside it. If there
are 2 dark lines in the rectangle, the test is said to be positive,
meaning, the woman is pregnant. If there is only one
dark line the test is negative, meaning, the woman is not pregnant.
Timing of urine testing: The test becomes
positive as early as 2 days after a missed
pregnancies, like in women who have conceived after treatment of
infertility, blood level of a substance
called HCG is measured to determine
if she has conceived.
Ultrasonography: The use of an
ultrsonography is frequently used to confirm pregnancy. Ultrasonogram is commonly called “Scanning”or ultrasound
scan. It uses sound waves to detect changes in the body
The foetus, after conception usually lies in a bag
called the gestational sac inside the uterus. The
detection of this sac inside the uterus on scanning is confirmatory of
pregnancy.The sac appears 1 week after missed
period. 2 weeks after a missed period, the
heart beat of the foetus can be seen on the scan, confirming that the
foetus is alive.
Safety of USG:
Ultrasonography is generally safe in pregnancy and there are so far no
reports of any documented abnormalities in a fetus caused by
ultrasonography in pregnancy. Millions and millions of ultrasonography has
so far been done world over in
Clinical examination: Enlargement of the uterus
can be perceived clinically by doing a per vaginal examination to know the
enlargement of the uterus by about 15 days of missed periods. However, pregnancy kits currently can diagnose pregnancy much
sooner than that, so by and large diagnosis of pregnancy is done by
examination of the urine.
2. Now that I am pregnant, what are the
special precautions that I should take?
In an uncomplicated pregnancy, not many special
precautions need be taken. However, the following
doubts may arise in the woman’s mind.
Should I take rest?
The fact is that many
studies have shown that bed rest does not decrease the
incidence of miscarriages. Even in sterility
conceptions, there is no role for bedrest. A woman can continue to go for
work even when pregnant. The reason why many doctors
advocate bedrest in precious pregnancies is probably because bedrest does
not harm any pregnant woman and it is a popular and probably unshakable
belief that bedrest can prevent mishaps in pregnancy. However, if there is vaginal bleeding after a confirmed pregnancy,
rest is essential.
Can I travel?
Ordinary travel, by bus, car,
autorikshaw, aeroplane, etc is permissible in early pregnancy. However, while traveling by two-wheelers, care must be taken not to
travel for long distances through very bumpy roads.
Is intercourse permissible?
In uncomplicated pregnancies, there
is no bar for intercourse during pregnancy.
3. What special food should I take during
In the first 3 months of pregnancy, many
pregnant women suffer from nausea and vomiting. This is
said to be a protective mechanism to ward of noxious substances in
food. In the first 3 months, the organs of the baby are
formed and it is theorized that this protective mechanism prevents
congenital anomalies in the foetus.
Since it is a period
of general uneasiness for the woman, it is best to allow her to eat
whatever she fancies. There should be no restriction on
food fads during this time. She should take whatever
little she can at frequent intervals. If she is not
able to eat solid food, taking a glass of lemonade with lots of sugar or
glucose powder might help. Ginger is said to be helpful
in allaying vomiting. Taking dry food stuffs like
crackers early in the morning soon after getting up from bed can prevent
morning sickness. High protein diet like an egg or
pulses while going to sleep is also useful.
In the period after
the first 3 months:
After the period of organogenesis(The time
when the organs of the foetus are being shaped) in the first three months
is over, the woman tends to vomit much less and she begins to tolerate
food much better. From the fourth month onwards, the
baby begins to grow and the mother has to provide nutrients, both for
herself and for her growing baby. She has to have
a balanced diet containing carbohydrates , fats, proteins , minerals and
The usual diet contains enough of carbohydrates. In addition , the woman should be advised to take one half –boiled
egg per day to provide for proteins. In vegetarians, a diet rich in pulses and grams can act as
substitutes. If this is difficult to take, there are
many protein powders in the market and daily allowances
of protein can be completed from them.
The bone of the growing baby demands additional calcium
supplimentation. Calcium is available in milk and green
leafy vegetables. Deficiency in calcium intake can lead to high
blood pressure in pregnancy.
Pregnancy pushes the stomach up and may cause
acidity. Restriction of fried foods and spicy foods can
prevent aggravation of this condition.
In pregnancy the bowel movements are sluggish due to
increased levels of a hormone called progesterone. The
iron and calcium supplementation during pregnancy may aggravate the
constipation already caused by the sluggish bowel movements. Taking grapes, high fibre diet, like green leafy vegetables, or
drinking a glass of warm water at night can relieve this symptom to some
4. Symptoms of
There are many symptoms peculiar
to pregnancy as a result of many physiological changes in the pregnant
Nausea: The first three months of pregnancy
are usually accompanied by a tendency for nausea and
vomiting. Usually it is not of a magnitude that
requires medication. The woman is encouraged to take
frequent small meals . She should avoid oily
foods. The smell of fried food may be offensive at this
time and it would be useful to avoid such odours. The
quantity of food taken may be inadequate due to nausea and this may lead
to a feeling of being tired and sometimes giddiness may ensue. Many pregnant women and their caregivers mistake giddiness to be a
sign of anaemia, high blood pressure or even some other
serious illness. The difficulty of taking enough to go on with normal work
can , to some extent be overcome by taking frequent sips of glucose water or sugared
lemonade The solution should have high quantities of glucose, or sugar instead of the usual 2
teaspoonfuls. Glucose is a simple sugar and is digested
immediately and even if the woman vomits after a while, she gets the
calories she needs.
Taking dry biscuits or
crackers early in the morning, high protein diet at night, etc are some
other ways of combating this symptom.
Sometimes, nausea and vomiting
may prove to be too much to carry on with routine activities, and at such
times there should be no hesitation in taking some medications on the
prescription of a doctor. Most of these medications are
safe in pregnancy. Many women fear that taking
medications may lead to anomalies in the baby and try to avoid them
. This leads to uncontrollable
vomiting. Medicines on a doctor’s prescription
should be taken freely to control this symptom without fears of anomalies
to the foetus.
Sometimes inspite of
medication, there may be uncontrollable vomiting and this may need
admission to a hospital and intravenous drips. This
happens when excessive vomiting causes a condition called ketoacidosis in
the body. This leads to more vomiting and further vomiting aggravates the
ketoacidosis, thus creating a vicious cycle. Intravenous drips at this stage stops ketoacidosis and controls
Some women continue to have
nausea throughout pregnancy . Some of this is due to
gastritis and can be controlled with simple medications.
The need to provide energy for
the growing baby increases the metabolic rate of the pregnant woman and
she may feel warm all the time. Many women feel
concerned at this and feel that they have fever of some pathological
origin. The presence of increased
amounts of the hormone called progesterone may also contribute to slight
elevations in temperature. No medications are needed
for this kind of “fever”. Whenever a woman feels feverish, it is best to
document the rise in temperature using a thermometer and confirm
it. This will prevent undue anxiety over many a so
called “fever”. However, very high temperature may
indeed be due to some pathological cause and certainly needs prompt
therapy. Infections may present with high temperature,
and if untreated, will lead to death of the foetus.
Pain in the abdomen
causes alarm in most pregnant women.
pain in the abdomen may be due to colics or it may be due to the presence
of harmless cysts in the ovaries.
These need not be a source of
-If the pain is
severe, medical attention is warranted, as it could be due to many
conditions related or unrelated to
- In later pregnancy, intermittent
abdominal pain may be symptom of impending labour.
-Abdominal pain just above the hairline may be due to bladder
-A discomfort felt in the lower
abdominal region in later pregnancy may be due to stretch on the ligaments
attached to the uterus.
constipation may lead to stasis of gas in the intestines, leading to
pain in the latter half of pregnancy may be a sign of preterm
labour and should receive immediate medical
The growing uterus in the abdomen displaces
the stomach and intestines. This leads to acidity and a
burning sensation in the abdomen. Simple antacid
therapy may cure it.
The pelvis is a bony cavity which initially houses the
uterus and it is through the outlet of the pelvis that the baby comes out
of the body. In preparation for the birth of the baby,
the ligaments, (fibrous bands uniting the bones) of the pelvis become
lax. The relative increased mobility of the bones leads
to backache in some patients. Back ache is aggravated
by wrong postures. As far as possible , the pregnant
woman should walk straight. As the abdomen enlarges,
there may be a tendency for the woman to push her tummy out and this will
worsen the back ache.
Normally, the baby lies with it’s
back lying just below the mother’s abdominal wall. In
occipito-posterior positions, the back of the baby will be in front of the
maternal spine and nearby structures. The baby is
literally lying on it’s back.. In such patients, backache is more
Back ache may be relieved by simple hot fomentation or
local pain-relieving balms. Paracetamol tablets,
normally used to treat fever is also useful for severe cases of
backache. Aspirin, and other regular painkillers are
best avoided in the latter half of pregnancy as these may cause
abnormalities in the circulatory system of the growing foetus.
patients complain that when they take rest, they do not have any backache,
but when they start working, they suffer from backache. It would be best to limit physical activities to the extent that
does not cause backache, rather than taking a lot of medications to be
able to give 100% work performance.
on at regular intervals in the latter half of pregnancy could be a sign of
impending labour and needs medical intervention. Backache caused
by contractions in the uterus comes at regular intervals as opposed to a
continuous dull aching pain that is usually seen.
belief about precautions in pregnancy:
There are many do's
and don'ts in Indian traditional belief . Some of them are listed
1..Papaya can cause abortions: Ripe papaya cannot cause abortion
and is in fact rich in VitaminA.
2.Pineapple can cause abortion: There
are no modern scientific studies to prove this fact.
can make the baby fair: the colour of the offspring is determined by the
genetic make-up of the parents. No change in food habits of the
mother can influence the colour of the baby.
4. Pregnant women should
not sleep in the afternoon: We do not know why this belief came
5.Pregnant women should sleep on one side: This is true as the
weight of the enlarged uterus will fall on the large blood vessels by the
side of the spinal cord if the woman lies on her back , thus impeding
6.A woman should expose her tummy by wearing sarees
during pregnancy to avoid jaundice in the newborn:
There is no
scientific evidence to this hypothesis.