By Dr Sharon Rasquinha
Mar 31: The first time a new born is placed in her mother’s arm is a moment of joy, a joy that every new mother should have the right to experience. But for some pregnant women around the world this memory will never come to be. Without the right care, becoming a mother can be stressful and in worst cases, tragic event.
The economic progress of a country is directly linked to health indices of that particular nation. When we talk about the health indices, maternal and child health are in the forefront which indirectly reflects the well-being and prosperity of that nation.
For achieving the goals of healthy mother and child the mission should start at grass root level.
Immunization of communicable diseases begins during infancy as scheduled Immunization against diseases like diphtheria, polio, pertussis, rubella hepatitis B and other respiratory pathogens. All these ailments have steady impact on subsequent health of the going to be mother and her child.
Due importance to be given to an adolescent girl child in her early teens to detect ailments or prevent form getting it which would have impact in future child bearing. Some of the best examples are anaemia in adolescent girls, which is highly prevalent in low socio economic group. Epilepsy congenital heart ailments, rheumatic valvular disease and genetically transmitted disease eg. Sickle cell anaemia or thalassemia. All these diseases will have an impact on maternal and child health once she conceives. Deworming the child and correction of anaemia by simple remedial measures like supplementing iron tablets will go a long way helping out this adolescent girl, which otherwise may have a bearing in her subsequent childbirth. If the childhood immunization was erratic or not undertaken, this is the ideal time to immunize her at her early teens before she embarks upon her pregnancy. The best example would be if the girl child was not immunized in her infancy against rubella, it should be done during her teens. Rubella vaccine being a live vaccine is not administered during pregnancy.
In many developing countries like our own country majority of the pregnancies are not planned as scheduled, the topic of ‘pre-pregnancy counselling’ is an important topic to be discussed with married couple. Hereditary diseases congenital cardiac problems or ailments like diabetes, hypertension and epilepsy and some of the medications already the patient is taking will have a bearing on the child to be born. We may have to stop some of the medication what the patient is taking and switch on to a safer alternative medications that have less impact on the baby. Folic acid supplementation is started couple of months prior to planned pregnancy.
Once the pregnancy is confirmed the need for routine antenatal check-up should be stressed. The patient should have monthly visit for the first three months and then every fortnight till 8 months and once a week for last four weeks.
Supplementation of folic acid tablets in the first trimester, iron and calcium tablets form the beginning of 3rd month onwards is essential. Iron has to supplement irrespective of mothers haemoglobin status as there is extra need for the iron which is required for the growing foetus and cannot be met by diet alone. Government of India and W.H.O. have their own programmes of supplementing iron for 100 days in the latter half of pregnancies.
India being an endemic place for type 2 diabetes and is bestowed with the honour of having highest number of diabetes in the world routine screening for diabetes has to be done early in pregnancy. All the routine blood tests and serological investigations has to be done as per schedule. Haemoglobin estimation should be repeated every trimester and extra Iron has to be supplemented accordingly as the growing foetus requires more iron in the latter half of pregnancy.
Two mandatory ultrasound examinations (scan) are done between 11 to 12 weeks and other between 18-20 weeks.
Eating a nutritious diet during pregnancy is linked to good brain development and a healthy birth weight, reducing risk of birth defects. Iron rich foods for non-vegetarians like meat products eg: chicken liver and other dairy products and for vegetarians’ green leafy vegetables raagi, jaggery are ideal. One and half litre of pure milk a day which supplements to 1 to 1.5 gm of calcium is sufficient, but for those not able to take milk then calcium supplements has to be given.
High roughage diet in the form of vegetables and fibres and 2 litres of water are essential to overcome the constipation which is usually associated with normal pregnancy.
Tobacco smoking during pregnancy is a definitely a serious risk to the developing baby. There is also plenty of proof that smoking during pregnancy is Hazardous. Smoking deprives the baby of oxygen supply, carbon monoxide and the hydrocarbons in the tobacco renders growth restriction of the baby and pre disposes to preterm delivery.
Drinking alcohol during pregnancy is linked to a wide range of problems in the developing baby. Alcohol in any form that is consumed enters the foetal blood stream from the mother enters the foetal blood stream from the mother and results in ‘Fetal Alcohol Syndrome’ with abnormal facial features and mental retardation.
Exercise in the form of brisk walking, light jogging and flexing of upper and lower limb simple yoga would suffice. Squatting and Kegel exercises focuses on perineal and pelvic muscles.
At every antenatal visit apart from routine examination obstetrician takes care to record the blood pressure, weight of the pregnant women. Pregnant women should report to her doctor immediately if she has any of the following symptoms.
1. Severe headache, blurring of vision, pain the upper right half of abdomen.
2. Decrease foetal movements.
3. Spotting or bleeding per vagina
4. Pain in back radiating to lower abdomen with increasing intensity and frequency.
5. Sudden gush of water from vagina (Rupture of fore waters)
Thus maternal and child health service is an important and essential service related to mother and child’s overall development.
Our Motto is ‘Healthy Mother and a Healthy Baby’.
Dr Sharon Rasquinha is a consultant at Unity Hospital, Falnir, Mangaluru.
Unity Care and Health Services Pvt Ltd, PB No.535,
Highlands, Mangaluru - 575002
Tel No. +91 824 4245555
Fax No. +91 824 2432691