Department of Obstetrics
Obstetrics is the branch of medical science that deals exclusively with pregnancy, the process of childbirth and the time period immediately after child birth (post-partum period). We at Gleneagles Global Hospital understand that these can be extremely stressful periods in women’s lives and we do our best to make them feel safe, comfortable and looked after. Our range of services cover the following:
- Pre conception counselling and care
- Pregnancy and delivery
- High-risk pregnancies
- Various infertility treatments
We have a team of expert surgeons and support staff who offer nothing but the best in services. Highly skilled, experienced and trained, they have handled both normal and high-risk surgeries with confidence. They are aided by the latest in infrastructure and equipment. Our success rate in infertility treatment is high and we believe that we can keep it that way as we are driven by the need to provide our patients with the highest quality care and comfort.
For some women, pregnancy may be a breeze while not be so for others. We understand that every woman’s need is unique and we strive to tailor our services to individual needs and expectations. We promise to do our best to make sure women have a stress-free pregnancy.
Pregnancy care and Childbirth
This involves looking after the mother and the baby before, during and after delivery. The doctor will guide the mother on all the do’s and don’ts during pregnancy. In fact, the groundwork for ensuring a safe pregnancy and delivery starts three months before conception. If pregnancy is being planned, the following will help:
- Avoiding alcohol
- Quitting smoking
- Taking folic acid supplements
- Letting the doctor know about any previous/current health conditions – also any medications the patient is on should be made known.
During pregnancy, monthly check-ups to review the mother’s health and the growth of the fetus are very important. The frequency of the check-ups might increase towards the end of the pregnancy. The mother’s weight, blood pressure and other parameters will be monitored and blood tests will be prescribed. The doctor will give advice on the kind of exercises that can be carried out and will also guide the mother on the importance of nutritious food during this time. Routine scans will also be done to check on the fetus’ growth and positioning.
High risk pregnancies will need frequent monitoring and what is advisable for a regular pregnancy may not be advisable here. The doctor will guide the patient through every step of the way and easy communication between the doctor and patient is encouraged.
The 4-6 weeks that follow delivery of the baby is called the post-partum period. It is a tough time for all mothers. The body is undergoing a lot of changes and they have to deal with it while taking care of the baby. Mothers who feel overwhelmed should not hesitate to reach out for help. It might be a difficult time but it will pass. During the post-partum period, the following pointers might prove helpful:
- Eating healthy
- Trying to sleep whenever the baby sleeps
- Getting extra help
We at Gleneagles Global Hospital are committed towards making every delivery as peaceful and worry-free as possible. For any questions or doubts, do not hesitate to contact us.
Family Planning procedures
There are various ways by which pregnancy can be avoided and family planning done. A detailed discussion with the doctor would be best before choosing one. Listed below are some of the options:
- Long-Acting Reversible Contraceptives (LARCs) are an effective means of contraception. They last for a number of years depending on the type chosen and this is definitely an advantage of this kind of birth control. LARCs are intra uterine devices which can be removed when pregnancy is desired. But inserting and removing the device should be done only by doctors.
- Birth control pills are tablets that are taken to prevent pregnancy; they contain hormones to prevent pregnancy. The duration for which the pills have to be taken depends on the particular pill and will be explained by the doctor. They are quite effective in protecting from pregnancy; if taken regularly.
The main advantage of pills is that they are an easy way of contraception while being reversible. Sometimes they might even help in regularizing periods cycle. They also prevent heavy bleeding during periods and thereby reduce the risk of anemia.
- Barrier method or condoms while preventing pregnancy also protect from sexually transmitted infections. As the name implies, in this method, a barrier (condom) is placed between the sperm and egg to prevent pregnancy. There are male condoms, female condoms and diaphragms available.
- Emergency contraception comes in the pill form as well as in the form of a copper intra-uterine device (IUD). The pill should be taken within three days after sex to avoid pregnancy. Weight of the person plays a role and the doctor will help determine which form of emergency contraception is best. The copper IUD should be inserted within five days after sex.
- Permanent contraception is a permanent method of birth control – having children after undergoing this is not possible. Men can undergo vasectomy and women can undergo tubectomy to avoid any future pregnancies.
Being aware of contraception methods is the responsibility of both the man and the woman. Talking to the doctor to find out the best form of contraception is advised.
Maternal Fetal Medicine
Women who have problems during pregnancy are handled by maternal fetal medicine (MFM) specialists. These specialists have been trained in this field. The following are the typical situations during which an MFM specialist may be required:
- When the mother suffers from conditions like hypertension, diabetes, auto immune diseases, etc.
- When the mother has a history of miscarriages or deliveries that are pre-term.
- The pregnancy involves twins, triplets or more.
- When an abnormality is found in the developing fetus.
In such cases, an MFM specialist will monitor the pregnancy closely performing ultrasounds, blood tests, etc. If any problem is found with the fetus, the doctor will help manage it. He/she will also advice on future pregnancies.
The nutrition requirement during pregnancy increases. It is important to make sure the mother gets enough protein, calcium and iron, taking into account the fetus within.
- Vegetables and fruits intake is always encouraged; with this make sure to add enough dairy products like low fat milk.
- Whole grains are also recommended.
- Limiting sugar intake is advised.
- Processed food is best avoided.
- Fish is healthy and can be consumed but the fish chosen should be free from mercury. Read up on the fish you are buying to make sure it is healthy.
- Coffee and tea – it is best to limit both.
- Juices with a lot of sugar, bottled drinks and energy drinks are not healthy.
- Alcohol and smoking should be stopped completely.
Caffeine stimulates the brain thus helping people stay alert. A lot of people begin their day with caffeinated drinks and this is fine as long as it is consumed within safe limits. However, during pregnancy, health experts recommend avoiding caffeine. Coffee, tea, energy drinks, etc. all contain caffeine. This caffeine when consumed by pregnant women can cross the placenta and enter the fetus’ bloodstream.
How can caffeine affect the developing fetus?
- While less than 200 mg of caffeine is considered safe, more than that seems to be linked to an increase in the possibility of a miscarriage.
- A baby with low birth weight is another potential side effect of caffeine.
- Caffeine might also result in hypertension, anxiety, fidgety behavior, etc. for the mother.
Some herbal teas also contain ingredients that are detrimental to pregnancy. Pregnant women are advised to consult with their doctor if they are consuming herbal tea.
Take Prenatal Vitamins
Prenatal vitamins supply the additional vitamins and minerals needed for pregnancy. While eating a healthy diet will give the nutrients the body needs, it is always good to take these supplements during pregnancy just to make sure the body receives everything needed. Doctors suggest that these vitamins can be started even while trying to conceive.
Make sure a pregnant woman’s vitamins and minerals include (but are not limited to) the following:
- Folic Acid – It helps prevent neural tube problems in the baby. Folic acid is given in the first trimester of pregnancy. Green leafy vegetables, nuts, beans, etc. are all good sources of folic acid.
- Iron is needed to prevent anemia.
- Calcium is needed for blood circulation, muscle movement and for maintaining hormones with proper balance. It is also needed for healthy bones and teeth. Calcium and vitamin D intake go hand in hand as vitamin D is needed for the body to absorb the calcium.
- Zinc is responsible for good immunity, growth, healing and a host of other benefits.
- Vitamin B12, also known as cobalamin, is good for a number of functions like RBC formation, preventing defects in fetus, reducing miscarriage risk, etc.
If the pregnancy is normal (not a high-risk one), exercise is recommended. Before starting any form of exercise, it is best to discuss it with the doctor. Once the doctor gives the go ahead, regular exercising can begin.
Benefits of Regular Exercise
- Prevents the onset of gestational diabetes
- Prevents excess weight gain
- Keeps the heart functioning well
- Can help with back ache
- Plays a role in preventing constipation
Regular Antenatal Check-Ups
Periodic consultations with the doctor (obstetrician) during pregnancy are called ante-natal check-ups. These check-ups will help make sure the mother and baby are both normal and pregnancy is progressing as desired. Women are advised not to skip these check-ups even if everything is proceeding normally. The body at this time will be undergoing many changes and any doubts/questions can also be cleared with the doctor. Dietary advice, how to exercise and the do’s and don’ts of pregnancy will also be discussed.
To summarize, an ante-natal check-up will involve the following:
- Scans and blood tests
- Evaluating any pre-existing health conditions
- Monitoring medication taken for other health issues
- Regular monitoring of blood pressure and weight gain
- Clearing doubts about the changes that pregnancy brings
There will be around 8-10 ante natal visits. A high-risk pregnancy will involve more. Partners are encouraged to attend these visits and to stay involved with the pregnancy.
When couples are considering having a baby, they should go in for pre-conception counselling that will help them have a healthy and happy pregnancy period. Typically, the first session should be around 3 months ahead of when the pregnancy is planned.
Pre-conception counselling will cover the following aspects:
- The family medical history of the parents-to-be. If there are any conditions that seem to be genetic in the family, having knowledge of it will help the doctor provide appropriate treatment. If needed, additional tests may be recommended for this purpose.
- Medical condition of the couple themselves will be discussed. The doctor should be informed about any previous surgeries, allergies, medication being taken, etc. The doctor might suggest tests like Pap smear or blood tests.
- The best dietary plan will be discussed. Vitamin supplements may also be prescribed.
- The doctor will want to know the duration and regularity of the mother’s periods.
- Information about the vaccines taken and any additional vaccines needed will be discussed.
Care for Emotional Health
Every woman handles pregnancy differently – some may sail through it while others may have a slightly more difficult time. Pregnancy is a period that brings on some never before experienced changes. The body is changing and women might experience mood swings, fatigue, increased morning sickness, etc. With all this going on, women need to focus on what brings them happiness. This is important because what affects the mother, affects the baby too. The following pointers might help with emotional well-being.
- Indulging in art, listening to music, maybe even learning something new.
- Bottling up feelings does not help – women are encouraged to talk with their partners, friends, etc. If needed, even professional help may be sought.
- Exercising regularly is definitely a mood booster.
- Eating healthy food also gives a sense of well-being.
- Practicing meditation helps immensely.
- Staying away from negativity can give mental peace.
A natural way to deliver the baby, normal delivery or vaginal birth, is delivery that happens on its own without any external assistance. Normal delivery is what is preferred unless complications are expected. It can be divided into three stages:
Stage 1: This stage sets in with contractions beginning. Dilation of the cervix happens in preparation for the baby’s delivery. The duration of this stage varies form 7-13 hours depending on whether it is the mother’s first or second baby. If it is the first child, delivery will take longer.
At the commencement of this stage, contractions will be spaced apart with the cervix dilating up to 4 cm. Slowly, the contractions will increase in strength and frequency. Dilatation of the cervix increases further to 7cm. The water is expected to break at this stage and once that happens, contractions become more frequent. Full dilatation of the cervix then happens (10 cm).
Stage 2: This stage involves the birth of the baby. The mother will be encouraged to push the baby with every contraction. The mother will experience pain and fatigue. The doctor might decide to do an episiotomy, which is a cut near the vagina, to make it easier for the baby to come out. The baby coming out concludes this stage.
Stage 3: The placenta which nurtured the fetus inside the uterus is now pushed out. This might take any time between few minutes to half an hour after the baby is born.
Advantages of a Normal Delivery
- Risk of infection is low
- Faster recovery period
- Normal delivery sparks milk production in the mother (lactation)
- Baby’s immunity is increased
- Baby has reduced risk of respiratory issues
Caesarean, also known as C-section, is the surgical way of delivering a baby – it is usually done when a normal delivery is not advisable due to complications. This procedure involves making incisions in the mother’s lower abdomen and uterus to deliver the baby. Caesarean is not performed before 39 weeks of pregnancy so that the baby’s development is complete. However, if there is an emergency situation, caesarean can be performed before 39 weeks.
The surgery will be performed under anesthesia and the doctor will let the patient know the anesthesia options available. Hospitalization of around 3 days will be needed and even after discharge the mother will need help till healing is complete. The doctor will give painkillers to deal with any post-operative pain.
When is a caesarean done?
- When the baby is very big
- When it is a breech birth – baby’s legs come out first
- Fetal distress – fluctuations in baby’s heart rate
Recovery after a caesarean takes longer compared to a normal delivery. The following tips might help:
- The mother needs enough rest to recover fast. Getting help from family/friends or maybe even hiring extra help are all options to be considered.
- Strenuous activity (including lifting anything heavy) should be avoided.
- Gentle exercise like going for a walk is advisable.
- Good nutrition is important even after delivery and the lactating mother has to make sure she eats healthy food and consumes enough fluids.
This is a vaginal delivery that is assisted by a ventouse (vacuum cup). This delivery might be decided upon when one of the following conditions is true:
- When the mother is too tired to push the baby out
- When the baby’s heart rate is not normal in second stage of labour, with baby’s head well descended in vagina.
In such cases, a vacuum cup is fixed to the baby’s head and the baby is gently pulled out through the vagina. An episiotomy can be done to aid delivery. Sometimes, instead of a ventouse, forceps will be used to assist delivery. If the doctor feels that the ventouse delivery is not going as planned, she might opt for a caesarean.
Vaginal Birth After Caesarean – VBAC
When the first child has been delivered through a caesarean, many people are under the impression that a caesarean for the second child is the only choice. However, this is not so. A vaginal birth after having undergone a caesarean is possible. It is important to note that some factors play a role in determining whether a VBAC is possible – the uterus should be strong enough to handle a vaginal birth after a caesarean and the hospital should have experienced surgeons and the necessary infrastructure to handle it. The doctor is the best person to judge if VBAC is a viable option.
Signs that help determine whether VABC is suitable for a woman include:
- Previous VBAC done
- Woman is lesser than 35 years of age
- If the previous caesarean involved a horizontal incision and not a vertical one
Some scenarios rule out the possibility of VBAC. These include:
- A vertical incision in the previous cesarean
- A difficult labour which does not proceed quickly
- If the pregnancy period is more than 40 weeks
- Baby is large
- Multiple cesareans previously
- Mother suffers from heart or lung conditions
VBAC has the following benefits:
- Lowered risk of infection
- No incisions on the abdomen
- Quicker recovery
- Decreased loss of blood
The risk associated with VBAC – the scar in the uterus from the previous cesarean might break open during a VBAC. This condition called a uterine rupture might necessitate an emergency cesarean. Hence VBAC can be tried only in the hospitals which have the required infrastructure to handle it.
The VBAC procedure will be the same as a normal delivery. An option of epidural for pain management is also possible. It is best to talk to the doctor and get all doubts cleared before deciding on it.