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The Birthplace Blog

Ease Your Body. Erase Your Worries.

The Birthplace


A developing bump, pregnancy glow, good hair days are welcoming changes which pregnancy brings, along with a sense of happiness. They also bring with it a multitude of not- so welcoming changes to your body. Evidence shows that physiotherapy, in principle, is helpful in tackling these unpleasant changes and provide relief from certain pregnancy related conditions like pelvic pain, urinary incontinence, lower back pain etc.

Before we get to these conditions, lets understand why exercising is important and how does it affect you and your baby.

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WHY SHOULD YOU EXERCISE DURING PREGNANCY?

Exercising during pregnancy has a positive influence, both, on the mother and the baby. It can also help during the postpartum rehabilitation period. It can  ensure a comfortable nine months of pregnancy compared to not exercising at all. It is important to consult your obstetrician before starting any exercise regime.

Benefits for mom-to-be:

  • Reduction in risk of developing gestational diabetes and pregnancy-induced hypertension
  • Fewer obstetric intervention (forceps, vacuum extraction)
  • Reduction in the ‘active stage’ of labor
  • Quicker return to pre-pregnancy weight
  • Reduction in bone density loss during lactation state
  • Decreased incidence of ‘incontinence’ during pregnancy and postpartum
  • Reduction in common pregnancy complaints (leg cramps, back pain, hemorrhoids etc.)

Benefits for the baby: 

  • Infants have less body fat at birth
  • Infants are less cranky which in turn has reduction in the incidence of infant colic
  • Greater neurodevelopmental scores in oral language and motor areas (tested at age 5)
 Dr. Snigdha Reddy is a certified Physiotherapist with over 7 years of clinical experience . She has worked as a Consultant in various hospitals in Hyderabad & has been associated with the Birthplace for the last 4 years. She is the co-owner/founder of Physio Pro.  To know more or to consult Dr. Snigdha, please call 040-30911234. You can also write to her at  contactus@thebirthplace.com

Dr. Snigdha Reddy is a certified Physiotherapist with over 7 years of clinical experience . She has worked as a Consultant in various hospitals in Hyderabad & has been associated with the Birthplace for the last 4 years. She is the co-owner/founder of Physio Pro.

To know more or to consult Dr. Snigdha, please call 040-30911234. You can also write to her at contactus@thebirthplace.com

PREGNANCY-RELATED CONDITIONS

Most women during pregnancy experience one or more of these conditions at different stages of gestation, at different levels of severity. Physiotherapy can help you deal with all these conditions for a smooth labor and easy recovery. Here are few pregnancy-related conditions that you may experience during your 9 months. 

Lower Backache:

As your belly gets bigger throughout your pregnancy, the hormonal changes that cause the otherwise stable joints to ease up; because of which, the lower back and pelvis loosen up, preparing the body for a vaginal delivery. In turn, your lower back curves more than usual to accommodate the load – resulting in strained muscles, soreness, stiffness, and pain in the lower back.

Urinary Incontinence:

Do you accidentally leak urine when you exercise, laugh, cough or sneeze? Do you experience a need to get to the toilet in a hurry?

Urinary incontinence is defined as a complaint of any involuntary loss of urine. This is due to the weakening of the pelvic floor muscles, which play a major role in bladder control, with the progression of pregnancy. As the pelvic floor muscles and the pelvis stretch and widen to accommodate the growing baby and its increasing weight, particularly in the final trimester, the muscles become weak and make it difficult to control the bladder.

Coccydynia:

Does it pain between your buttocks when you sit on a chair for long hours?

Coccydynia is commonly known as the Tailbone (Coccyx or bony area located deep between the buttocks above the anus) pain.  It is caused due to inflammation of the tailbone manifested by pain and tenderness. Your tailbone is right behind your uterus and as the baby develops and gets larger, it's bones push against yours, causing discomfort. The other cause is the pregnancy hormones. They make the ligaments (support and connect bones) in your body relax anticipating a vaginal delivery during which the bones could shift causing discomfort and pain. 

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Carpel Tunnel Syndrome:

Do you have tingling sensation and numbness in your hands?

The carpal tunnel is a bony canal formed by wrist bones on three sides and a ligament that runs across the wrist on the other. Fluid retention and swelling which is common during pregnancy can increase pressure in the narrow space compressing the median nerve that runs through it. This pressure on the nerve causes a tingling sensation, numbness, pain or a dull ache in the fingers, hand or wrist, worsening at night.

Diastasis Recti:

Noticed any obvious gap in your stomach muscle near the belly button area?

It is the separation of your outer most abdominal muscles  which creates a gap that allows your belly to pooch out. This may not be a painful condition but affects the physical appearance of your belly.  You may still look pregnant even after you delivered your baby.  Training your core abdomen muscles can help treat this condition. 

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Pelvic Girdle Pain:

Does it pain while moving your legs apart, especially when sitting, lying down or getting out of the car? Is turning over in bed painful?

Your pelvic girdle is the bony arched structure in your hip area that supports your legs - including the symphysis pubis joint, hip joint, coccyx, sacrum, and sacroiliac joint. Pain can occur during pregnancy when there is a mechanical problem within these joints. 

Looking for one-on-one counselling?

Pelvic pain is likely to be caused by a combination of factors, including:

  • the joints in your pelvis moving unevenly
  • changes to the way your muscles work to support your pelvic girdle joints
  • one pelvic joint not working properly and causing knock-on pain in the other joints of your pelvis

All the above conditions can be alleviated. Meet a certified physiotherapist today  at the Birthplace to cope with these pregnancy conditions.


Ectopic Pregnancy: All you need to know

The Birthplace

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Have you got your periods too late? Are you feeling nauseated? Are you undergoing those pregnancy cramps or shoulder pain with a lot of queasiness? Do you experience some discomfort in the abdomen?

We know, it would be hard to identify what’s normal and what needs a medical examination, given the minimal expression of unique characteristics.  But experiences such as these may call for immediate medical attention, as this might be a typical case of ectopic pregnancy.

 Dr. Girija Lakshmi is an Obstetrician & Gynecologist with a focus on Fertility & Preconception.  She has also trained in hysteroscopy and laparoscopy. She  has helped hundreds of women successfully manage symptoms of poly-cystic ovary syndrome, uterine fibroids  and even menopause related issues through medical and surgical interventions.  To know more or to consult Dr. Girija, please call 040-30911234. You can also write to her at  contactus@thebirthplace.com  or visit www.thebirthplace.com

Dr. Girija Lakshmi is an Obstetrician & Gynecologist with a focus on Fertility & Preconception.  She has also trained in hysteroscopy and laparoscopy. She  has helped hundreds of women successfully manage symptoms of poly-cystic ovary syndrome, uterine fibroids  and even menopause related issues through medical and surgical interventions.

To know more or to consult Dr. Girija, please call 040-30911234. You can also write to her at contactus@thebirthplace.com or visit www.thebirthplace.com

Ectopic pregnancy is a condition when the embryo implants itself outside the uterus, or as called in medical terms “Extra-uterine Implantation”. Such pregnancies are often considered complicated and exhibit certain symptoms. Listed below are few of the experiences which to-be-moms undergo:

  • Common symptoms include vaginal bleeding and torrents of sharp abdominal or pelvic pain. Other symptoms in some cases can be diarrhea, nausea or vomiting  accompanied by pain.
  • Ectopic pregnancy is qualified when there is a  very less increase in the amount of hCG during the test or also when the hCG level does not double in 48 hrs.
  • Fallopian tube rupture may cause severe discomfort in the pelvic region in addition to dizziness or fainting.  

Medical demonstration of ectopic pregnancy generally occurs between 4-8 weeks counted from the last normal menses.

Ectopic pregnancies, medically, have never been regarded as safe for expecting mothers and can lead to death if left untreated. Ectopic embryos, which do not have a normal development, may reduce the chances of further normal pregnancies, esp., in the advancing age, therefore, necessitating immediate embryo removal for mother’s health and fertility. Embryo removal is administered through medication or surgery depending on the location of the implanted embryo.

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Since the symptoms are masked and largely imitate symptoms of first-trimester pregnancy, I advise you to maintain regular visits with your doctor, and follow the suggested regime and tests.

An ectopic pregnancy can be very overwhelming and unaccounted for. Engage yourself in various activities and care for yourself  through healthy diet and proper rest.

Talk to your doctor about how to ensure a healthy pregnancy in future.

Struggling To Understand Your Newborn?

The Birthplace


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Holding a newborn in one’s hand gives immense happiness. At the same time, parents struggle to understand the typical anomalies. Even simple questions like ‘when to feed my baby?’, ‘is the stool normal?’, ‘how long should my baby sleep?’ and ‘can my baby see me?’ haunt the minds of the parents. 

In our earlier article, we have covered  Apprehensions And Concerns About Breastfeeding  and this learning exercise is to provide insight into various aspects of care-taking and healthy development of infants between 0 to 3 months of age. Here are few questions commonly asked by new parents. 

What are the sleeping patterns in a newborn?

Babies sleep 16 to 22 hours per day in the newborn period and this gradually decreases to 12 to 16 hours in the 3rd month. Initially, most babies sleep well during the day and are awake during nights. To facilitate proper sleep patterns simple things may be followed like allowing natural light during the day and dim light during sleep time in the night with soft music.

How to prevent infection in the umbilical region?

The cord will shrivel and fall between 7 to 13 days of age and  some sticky blood stained secretion is common. Avoid applying any cream or antibiotic powder. The umbilical area must be kept dry and must not be allowed to smudge with the diaper. Frank pus and reddish changes of the skin around the cord region warrants immediate attention from a pediatrician.

When and how to bathe a newborn?

Bathing can be initiated once the cord falls off and the area becomes dry. Until then sponge bath is recommended. In the first few weeks, bathing twice a week is more than enough. Mild soap and shampoos can be used for the same. Refrain using any other items like bath-powder or turmeric to bathe the baby. Massaging can be started from the 2nd week. Coconut oil or olive oil is preferred when compared to mineral oils. For hair, only coconut oil is recommended to prevent cradle cap. It is recommended not to apply any lotion, cream or powder following bath.

Does a newborn have a taste?

Newborns have a sense of sweet and bitter taste. Reactions to salty foods can be seen after 5 months of age. They can also smell and localise the source of odour including breast milk.

How much vision does a newborn have?

During the first one week after birth, the eyesight of the baby is fuzzy. Babies can look with crossed eyes in the first 3 months of age. Babies are pretty sensitive to light and can see in 3 dimensions.

 Dr. Madhavi, a senior Pediatrician, is an author of more than 600 articles in the field of medicine and nursing.  An expert in the field of Pediatric Asthma and Neonatal Resuscitation, she is trained to meet the unique needs of children, through all of their developmental stages, as they grow and mature.  To know more or to consult Dr. Madhavi, please call 040-30911234. You can also write to her at  contactus@thebirthplace.com  or visit www.thebirthplace.com

Dr. Madhavi, a senior Pediatrician, is an author of more than 600 articles in the field of medicine and nursing.  An expert in the field of Pediatric Asthma and Neonatal Resuscitation, she is trained to meet the unique needs of children, through all of their developmental stages, as they grow and mature.

To know more or to consult Dr. Madhavi, please call 040-30911234. You can also write to her at contactus@thebirthplace.com or visit www.thebirthplace.com

What are normal newborn stools?

In the first 3 to 5 days, the baby passes dark-green colored stools. Typical breastfed babies pass 3 to 7 times soft, semisolid, yellow colored, mushy, stools with white freckles and organic smell. Some babies can pass stools once in a few days. Hard pellet-like stools, any number of times in a day, is a sign of constipation and must be reported to the pediatrician immediately. Formula fed babies can have stools that are solid in consistency and grey or green in color. Blood in stools, black colored stools, pellet-like stools and clay-colored stools are abnormal and must be reported to the pediatrician. The consistency and color of stools can vary depending on the mother’s diet in some babies.

What to know about urination in newborn babies?

Babies pass urine about 6 to 20 times a day depending on the season and the milk intake. The color is light yellowish or colorless. However, in the first few days, when the babies have mild jaundice, the urine is yellow in color. Pinkish orange deposits in the diaper is due to urate crystals. These deposits are typically seen in the first week of life and may indicate dehydration in some cases. Blood in urine warrants investigation. Crying before passing urine may be normal. In boys, one must check whether there is a good stream of urine.

What is the appropriate clothing ?

The tummy, palms and soles of the baby must be as warm as the mother’s tummy. The baby must be wrapped appropriately and the room temperature must be maintained around 28 degree Celsius. Swaddling must be done necessarily. Cloth diapers or disposable diapers can be used. Petroleum jelly may be applied to prevent diaper rash.

How to wash clothes of a newborn?

In the first month, clothes must be soaked in warm water for few minutes and then  washed using plain water. They must be dried in sunlight or must be ironed after drying. Use of antiseptic or disinfectant liquids  and detergents must be strictly avoided. Incase of staining, baby shampoo can be used to remove stains. From the third month, baby friendly detergent can be used.

What activities does a newborn do?

A Newborn is a bundle of joy!  Their activities are mere reflexes which gradually fade away as they advance. Few reflexes that you may observe are - 

  •  Startle reflex -  makes the baby arch her back and extend her legs or arms in response to sudden noise or movement.
  • Babinski reflex - occurs when the sole of the foot is stroked firmly. This reflex lasts during the first several months of life.
  • The tongue-thrust reflex  - makes the baby push out anything that is placed in the mouth.
  • Step reflex  - is seen when the baby's feet touch a solid surface.
  • Rooting reflex -  is seen when the baby starts turning head towards the nipple when the nipple is touched to the cheek of the baby. 

What developments can we expect in a normal newborn?

Babies change and grow at an astounding pace and every month new developments can be seen. In the first 3 months of age, the brain and body of the baby are learning to adapt to the outside world. It tracks objects with its eyes and follows light by the end of 3 months. The baby opens & shuts and starts bringing its hands to mouth. This is the beginning of 'mouthing' wherein the baby tries to put anything it holds into its mouth. It learns to grip objects in its hands and tries to reach out to dangling objects in front of it, although, it won't be able to get hold of them yet.

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What are the warning signs in a newborn which warrant immediate attention?

You must watch out for signs like sick, dull, bluish, pale or yellow appearance.  A Pediatrician must be contacted if the baby has been cranky for more than 2 hours, is vomiting excessively, has frequent loose stools, is feeling cold to touch, has skipped more than 2 feeds in a row, has a shrill cry, has abnormal movements or is not responding well.


Is Your Toddler a Fussy Eater?

The Birthplace


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Are you at a constant war with your little one over food? Are constant power struggles between you and your child a common thing at the dining table?

Feeding a fussy child can be a problem and could be a source of worry for most parents. Around 25-35% of toddlers and preschoolers are described by their parents as picky or fussy eaters. But fret not, as childhood food jags, fear of new food or other feeding challenges is usually part of normal development.

To rule out any acute or chronic illness, a detailed history and general physical examination of your child by a Pediatrician is necessary. This helps to diagnose the underlying cause(s) of food refusal and address the problem from the root.

But let’s face it, we cannot always blame it on our kids. Sometimes, children’s refusal to eat may come from “Unrealistic Parental Expectations”.

Unlike the common notion, the statement, “I’m born this way” may not be applicable to all picky eaters. Most of the times, parents’ effort to make their little ones eat more, makes them fussy. Parents should decide only the quality of food and let the child decide the quantity.

Most common complaint of parents, especially new mothers, is decrease in the appetite of their child. You must know, this is normal for children between 2-5 years of age as food consumption moderates to match a slower rate of growth.

 Dr. Rajesh, is a senior pediatrician at the Birthplace with more than 15 years of experience.  Being a pediatrician has been a lifelong dream for Dr. Rajesh and he truly enjoys the privilege of caring for young children. He has a calm and reassuring approach to explain things in a way that is easy to understand - especially for new parents in the early stages of their baby’s life.  To know more or to meet Dr. Rajesh, please call 040-30911234. You can also write to him at contactus@thebirthplace.com or visit  www.thebirthplace.com

Dr. Rajesh, is a senior pediatrician at the Birthplace with more than 15 years of experience.  Being a pediatrician has been a lifelong dream for Dr. Rajesh and he truly enjoys the privilege of caring for young children. He has a calm and reassuring approach to explain things in a way that is easy to understand - especially for new parents in the early stages of their baby’s life.

To know more or to meet Dr. Rajesh, please call 040-30911234. You can also write to him at contactus@thebirthplace.com or visit www.thebirthplace.com

Also, as toddlers struggle to develop a sense of autonomy, they may prefer “self-feeding” and become selective in their choice of food. If pressurized or forced to eat, their need for autonomy may lead them to resist eating. Sometimes food is not an issue at all, children often tend to use the dining table as a stage to express their mere independence. The eating process is just one more way they learn about the world.

Following are the secrets to outsmart your toddler!

  • Eating should be an enjoyable activity. Bribes, threats or punishments have no role in healthy eating. Try to be creative, include a variety of colours. Appealing food presentation might entice your child to try food items which he/she might otherwise avoid.
  • Give small portion of each food item at every meal. If your child finishes everything on the plate, more food can always be added.
  • Snacks work best mid-way between meals but should not be offered if the timing or quantity of snacking interferes with the child’s appetite. Choose the snack items that are dense in nutrients. Try not to offer juice as a part of the snack. A child should not be allowed to graze throughout the day or to drink an excessive amount of milk or juice as both practices lead to eating less at meal times.
  • Parents should only insist on table manners that are appreciated to the child’s age and try not to make discipline an issue at meal time. A child who is crying or upset is unlikely to eat well.
  • Toddler’s time at the table should generally be limited to about 20 minutes. When mealtime is over, all food should be removed and only be offered again at the next planned meal or snack. It is unlikely that subsequent meal will be refused.
  • Exercise and play always help to stimulate the appetite, but they should not be tired or overstimulated. A 10-15 minutes heads-up before any meal will help to prepare and settle them down to eat.
Ask Dr. Rajesh
  • Distracting your child with toys/books/television during meals is a complete “No-No”. Eating with the family provides the toddler with a pleasurable social experience and the opportunity to learn by imitation. In this case, it’s up to parents to set a good example for their kids by making wise food choices, exercise regularly and follow an overall healthy lifestyle.
  • Get your child involved in meal planning. It always helps! If possible, read recipes together, even put your child in charge of writing down the grocery list. Do grocery shopping together during which you can teach your kid how to make healthy nutrition choices.

To conclude, “Make sure your child is hungry by meal time".


Passive Smoking is Equally Injurious when you are Expecting!!!

The Birthplace


Are you planning to have a baby?  Are you pregnant? If the answer to either of these questions is "Yes".  Then there is another important question for you, do you or your partner smoke?

Smoking is an addiction not many find easy to let go, but if you ’re planning to or already having a baby, here are a few things you must be aware of. 

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What does smoking do to your body?

Cigarette contains more than 4,000 chemicals, including cyanide, lead and other carcinogens. The smoke enters your bloodstream which is the only source of nutrition for the baby.

Usually, the first nicotine dose also makes a large difference by significantly tightening the blood vessels and it also hinders oxygen flow to the baby. If the baby doesn’t get sufficient oxygen it could lead to altered brainstem development, altered lung structure, and cerebral palsy, stunned growth, premature birth, or low weight during birth or stillbirth.    

What if you are not the one smoking?

Even if you are not smoking, being exposed to smoke during pregnancy has a detrimental effect on the prenatal health of the baby. It could lead to the following –

  • Delivery before full term is complete
  • Low weight at birth
  • Undermined psychological and physiological development
  • Asthma or allergic rhinitis
  • Unexpected Miscarriage
  • Sudden Infant Death Syndrome

Passive smoke, also known as Second Hand Smoke, that  gets transferred from husbands, friends or other family members can also affect the growth of the baby. The baby’s source of breathing is what you breathe in and if you inhale carcinogens and other harmful chemicals, it finds a way to get into your baby’s lungs too!

What are the other means of transferring smoke?

Toxins have a very sly way of creeping into your breathing or living space. This is usually referred to as Third Hand Smoke, which is residue left behind on furniture, rugs, paint on the walls etc. The surroundings could smell of smoke even if no one is currently smoking, there is a good chance that there is tobacco residue still there. Upon inhaling, these toxins are absorbed into your blood and shared with your baby.

Can effects of smoking be passed down genetically?

Yes! They can! If your grandmother smoked while your mother was pregnant with you, there is a high chance of you being affected by Asthma and other genetic disorders. Genetic history of smoking also alters your genetic make-up and increases your chances of acquiring and transferring diseases to your unborn child.

How can you ensure a smoke-free prenatal zone?

  • Encourage your partner to quit
  • Wear a mask to cover your nose
  • Practice breathing exercises and Prenatal Yoga
  • Avoid places where smoking is prevalent
  • Visit open area places, preferably the ones with a lot greenery!
Looking for one-on-one counselling?

How can we help you in getting the best prenatal growth for the baby?

We at the Birthplace have an excellent team of Obstetricians and Gynaecologists who can guide you and your partner on improving the prenatal health of your baby. We also have a specialist team of Nutritionists, Yoga and Lamaze  Instructors who can work with you to ensure your baby eats and breathes well!

Interested in what we have to offer? Reach out to us!


Multiple Pregnancy: Expecting Twins...or Triplets?!

The Birthplace


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Having twins, triplets or even quadruplets can be exciting, but it may also bring worries and concerns for you, your partner and family members. If you are expecting more than one baby, it is important that you are well prepared for the changes that will take place both during your pregnancy and after the babies’ birth.

Here is everything you need to know to be prepared!

What is a multiple pregnancy?

A ‘multiple pregnancy’ is the term used when you are expecting two or more babies at the same time. It occurs in about one in 80 pregnancies. Fertility treatment increases the chances of multiple pregnancy.

What are the different kinds of multiple pregnancy?

At your early ultrasound scan which confirms whether you are carrying twins or triplets, it is important to find out the ‘chorionicity’ of your pregnancy. This is to help identify whether your babies share a placenta and it is important because babies who share a placenta have a higher risk of complications.

Twins can be:

  •  Dichorionic-Diamniotic (DCDA) – if two eggs are fertilized or if one egg splits soon after fertilization, each baby has its own placenta with its own outer membrane called a ‘chorion’ and its own amniotic sac
  • Monochorionic Diamniotic (MCDA) – if the fertilized egg splits a little later, the babies share a placenta and chorion but they each have their own amniotic sac; these babies are always identical
  • Monochorionic Monoamniotic (MCMA) – much less commonly, the fertilized egg splits later still and the babies share the placenta and chorion and are inside the same amniotic sac; these babies are always identical; this is rare and carries additional risks.

Similarly, triplets can be Tri-chorionic (each baby has a separate placenta and chorion), Di-chorionic (two of the three babies share a placenta and chorion and the third baby is separate), or Mono-chorionic (all three babies share a placenta and chorion).

What does a multiple pregnancy mean for my babies and me?

For you:  Minor problems that many pregnant women experience, such as morning sickness, heartburn, swollen ankles, varicose veins, backache, and tiredness, are more common in multiple pregnancies. They get better naturally after the babies are born. Any problems that arise in any pregnancy are more common with twins and include:

 Dr. Samatha Kumar, is a senior gynecologist at the Birthplace with more than 11 years of experience, specializing in infertility, multiple births, and high-risk pregnancies.  To know more or to meet Dr. Samatha, please call 040-30911234. You can also write to her at  contactus@thebirthplace.com  or visit www.thebirthplace.com

Dr. Samatha Kumar, is a senior gynecologist at the Birthplace with more than 11 years of experience, specializing in infertility, multiple births, and high-risk pregnancies.

To know more or to meet Dr. Samatha, please call 040-30911234. You can also write to her at contactus@thebirthplace.com or visit www.thebirthplace.com

  • anemia – this is usually caused by a shortage of iron because developing babies use up a lot of iron
  • pre-eclampsia – a condition that causes high blood pressure and protein in your urine
  • a higher chance of bleeding more heavily than normal after the birth
  • a higher chance of needing a caesarean section or assisted vaginal delivery to deliver your babies

For your babies: You are more likely to have premature babies if you are expecting twins or triplets. Babies born earlier than 37 weeks of pregnancy have an increased risk of problems, particularly with breathing, feeding, and infection. The earlier your babies are born, the more likely this is to be the case. They may need to be looked after in a neonatal unit.

Also, having twins increases the chance of the placenta not working as well as it should. This can affect the babies’ growth and wellbeing. Twins sharing a placenta (monochorionic pregnancies) also share the blood supply. In around 15 in 100 monochorionic twin pregnancies, the blood flow may be unbalanced. This is called twin-to-twin transfusion syndrome (TTTS). One baby, the ‘donor’, receives too little blood and has a low blood pressure while the other baby, the ‘recipient’, receives too much blood and has a high blood pressure. You will be monitored with frequent scans for signs of TTTS. It can be mild and may not require any treatment, or it can be serious, in which case you will be offered treatment in a hospital with specialist expertise.

How will my pregnancy be managed?

You will be under the care of a specialist healthcare team and will be advised to have your babies in a consultant-led maternity unit that has a neonatal unit. Your team will usually include an Obstetrician who specializes in multiple pregnancies, Fetal medicine expert, Nutritionist, Lactation consultant and an excellent Neonatal Team.

  • Having a multiple pregnancy means that you will need more visits to the antenatal clinic at your hospital.
  • You will be offered extra ultrasound scans to monitor your babies’ growth more closely.  It could be as frequent as every 2 weeks from 16 weeks of pregnancy.
  • You may be advised to take iron tablets and folic acid each day throughout your pregnancy. Also, if there are risk factors for pre-eclampsia, you may be advised to take low-dose aspirin from 12 weeks of pregnancy onwards to reduce the risk.
  • Ultrasound / clinical assessments of the cervix may be done at regular intervals for measuring the length since a short cervical length is found to be associated with a higher chance of premature delivery. In case of a short cervix length, a cervical cerclage is done to suture the cervical opening.
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How will I deliver my babies?

Delivery depends on many factors including fetal positions, gestational age, the health of the mother and babies. If both the babies are in a head down positions and there are no other complications a vaginal delivery is possible.

Caesarean delivery is for babies that are in abnormal positions, who are discordant in growth, or in higher order multiples, like triplets and more. In latter case, the babies are usually delivered by cesarean section unless you are in very premature labor or you give birth to the first baby very quickly.

Vaginal delivery may take place in the operating room because of a greater risk of complications which may require a Caesarean Section. 

Your own preference is also important and you should be given enough time to consider all of the relevant information before deciding what suits you best.

Will I be able to sufficiently breastfeed my babies?

Breast milk is best for new-born babies and your body should produce enough milk for your babies. If you encounter difficulties, our lactation expert will offer you the advice and support you need.

How will I cope with two babies at once?

Twins often come early and you will have a bigger bump than if you were having just one baby. You might consider stopping work early, possibly at around 28 weeks. When the babies are born, it will be a very busy time for any household but it is made much easier if you are supported and accept help when it is offered.

What is the Multi-Fetal Pregnancy Reduction?

In recent years, a procedure called multi-fetal pregnancy reduction has been used for very high numbers of fetuses, especially four or more. This procedure involves injecting one or more fetuses with medications, causing fetal death. The objective of multi-fetal reduction is that by reducing the number of fetuses in the pregnancy, the remaining fetuses may have a better chance for health and survival.


Care begins in the womb

The Birthplace

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Nowhere is the privilege of experiencing miracles on earth more apparent than in the journey of pregnancy in one’s life. Science has made it possible to witness the baby’s growth with the help of advanced ultrasonography technology. Watching, hearing and feeling the little miracle growing inside you is an unforgettable experience.

Fetal Medicine is a branch of medicine that includes the assessment of fetal growth, well-being, diagnosis of fetal illness and abnormalities. With advances in technology and medicine, our capability to diagnose and treat problems while the baby is still in the womb has been better than ever. Therefore, the fetus is increasingly becoming an independent individual and fetal medicine is the specialty that addresses this “unborn patient”.

Fetal medicine includes prenatal diagnosis and fetal treatment. Prenatal diagnosis is the ever-improving ability to detect abnormal conditions of the fetus and to differentiate them from normal fetal development. The most common test used for prenatal diagnosis is ultrasound.

For the majority of women who undergo prenatal testing, the results confirm the absence of certain abnormalities. Thus, many of those who had entered pregnancy at increased risk because of a specific indication (for example, family history, advanced age or use of certain prescribed medication) or who were more generally anxious can gain welcome reassurance and continue enjoying their pregnancy.

Scientific advances in the last 20 years have improved our clinical ability to detect and address the many potential pregnancy complications from as early as the 12th week of your pregnancy. The schedule and content of antenatal visits is now much more personalized and specific to your pregnancy based on prenatal ultrasound diagnosis and reporting.

Dr. Saroja is a Fetal Medicine Foundation Certified Consultant and an MD in Obstetrics & Gynaecology. With over a decade of experience, she is an expert at ultrasound scans that let you get a peek at your baby and help your doctor in assessing and ensuring the well being of your pregnancy.

To know more or to consult Dr. Saroja, please call 040-30911234. You can also write to her at contactus@thebirthplace.com or visit www.thebirthplace.com

Your first scan is usually early in your pregnancy, between 6 to 9 weeks. The indication or need to perform an early ultrasound scan would normally be to identify the location and number of gestational sacs, to assign a gestational age to your pregnancy or to determine whether the pregnancy has a normal appearance. In certain cases, it could also be to evaluate maternal symptoms such as bleeding or pain.

During the first trimester of pregnancy, a unique and dramatic sequence of events occurs, defining the most critical and tenuous period of human development: the remarkable transformation of a single cell into a recognizable human being. As ultrasound technology continues to evolve and improve there is an increasing emphasis on early screening of fetal complications.

Fetal Nuchal ranslucency [NT] scans can rule out Down syndrome and other chromosomal abnormalities by detecting them early. This is also known as the first-trimester screening test. With prenatal testing, a wide range of congenital anomalies that can affect the brain, skull, abdominal wall, urinary tract, skeleton, and limbs can also be ruled out.

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For your ultrasound scan in 2nd trimester of pregnancy, the fetus has grown sufficiently in size and remarkable anatomic detail can be visualized. During this period, an anomaly scan or targeted imaging for fetal anomalies [TIFFA] is done. The main aim of this scan is to confirm that all fetal structures are normal.

In your second trimester of pregnancy, if you haven’t had the opportunity to undergo a first trimester screening test, it is recommended that you undergo a triple marker or quadruple marker test at around 16 weeks of your pregnancy. This is also known as the second trimester screening test.

The most common reason for a scan in the third trimester is to check that your baby is growing normally; this is referred to simply as a growth scan. If you have had complications in previous pregnancies or have a medical condition such as diabetes or high blood pressure, you will probably be recommended to undergo regular ultrasound scans in your third trimester. Ultrasound scans in the third trimester may also be prescribed to check the position of the baby and placenta or to monitor amniotic fluid levels and placental function with the help of Doppler scans. These scans in the third trimester help your doctor in planning the delivery of your baby.

While this article talks about the purpose of prenatal testing and various ultrasound scans, please remember that most babies are born healthy and that in a majority of pregnancies, prenatal testing confirms the absence of certain abnormalities. Early and accurate screening gives you and your family peace of mind during your pregnancy and expertise in fetal ultrasound and fetal medicine help your doctor to ensure good pregnancy outcomes for you and your baby.

The Birthplace wishes you a happy pregnancy!

Apprehensions And Concerns About Breastfeeding

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Just had a new little addition to your family or expecting one? Here are few tips to breastfeed the baby successfully.

When is the best time to start feeding the baby?

The best time to start feeding the baby is immediately after the delivery, once the pediatrician asserts that the baby is fit to start sucking. In most cases, babies are able to start sucking immediately after delivery. Even in a cesearean section case, breast feeding can be initiated while the final stage of surgery is still going on, unless the mother is sedated. Babies are vigorous and active during the first half hour after delivery. They have the urge to suckle during this time. Thereafter, the baby goes into slumber and is drowsier. It is therefore very important to initiate breast feeding soon after delivery to facilitate proper latching and sucking.

How frequently should the baby be fed?

 Dr. Madhavi, a senior Pediatrician, is an author of more than 600 articles in the field of medicine and nursing.  An expert in the field of Pediatric Asthma and Neonatal Resuscitation, she is trained to meet the unique needs of children, through all of their developmental stages, as they grow and mature.  To know more or to consult Dr. Madhavi, please call 040-30911234. You can also write to her at  contactus@thebirthplace.com  or visit www.thebirthplace.com

Dr. Madhavi, a senior Pediatrician, is an author of more than 600 articles in the field of medicine and nursing.  An expert in the field of Pediatric Asthma and Neonatal Resuscitation, she is trained to meet the unique needs of children, through all of their developmental stages, as they grow and mature.

To know more or to consult Dr. Madhavi, please call 040-30911234. You can also write to her at contactus@thebirthplace.com or visit www.thebirthplace.com

Ideally, a baby who is born after completion of the term of gestation and weighs more than 2.5 kgs, must be fed only on demand. Babies demand feeding by crying or by waking up from sleep and showing mannerisms like putting fingers to mouth, sucking of hands, moving towards the mother's breast, etc. However, in the first one week of life, the breastfeeding pattern is not well established and both mother and baby are learners and need practice. Sustained milk production is also not in place and this can happen only if the baby suckles for a longer time more frequently. Jaundice, which is common in newborns is more often seen in the first one week and frequent feeding reduces the levels of jaundice. It is for these reasons, that breastfeeding is advised atleast once in every 2 hours in the first one week after  delivery. After one week, baby can be fed on demand only. This rule applies only for healthy term babies who have more than 2.5 kg birth weight.

Both the breasts must be used equally through the day. Babies tend to prefer one side feeding, but that must be discouraged from the beginning. Otherwise, the ignored breast will gradually stop producing milk. There will also be disproportionate breast size for the woman, from cosmetic point-of-view. It is important to finish feeding from one side and then only go to the other side. When a baby starts feeding on one side, there will be trickling of milk from the other side. Mothers have a tendency to switch to that side thinking that the milk is getting wasted. That should not be done. One must allow the baby to complete feeding on one side and then only move to the other side. This is because, the initial milk, known as the fore milk is rich in carbohydrate. It gets digested easily and does not keep the baby satisfied for a long time. The milk that comes later, known as the hind milk is rich in fat. It digests slowly and keeps the baby satisfied for a longer time.

Ask Dr. Madhavi

What should be the duration of feeding?

“How much time should I feed my baby” is a frequently asked question. The meal-time at each breast is only 4 to 6 minutes. Beyond that time, only few drops of milk trickle. However, during the first one week of life, when breastfeeding is not well established, mothers need to feed for at least 15 to 20 minutes on each side. More the baby suckles; more milk is produced the next time. It is better to feed on both the sides during each feeding session until the baby is 3 to 4 weeks old. This will establish good feeding patterns. After that, the baby can be allowed to feed one breast only during each feeding session.

How can the mother know that the milk is sufficient for the baby?

When the baby takes sufficient milk, the baby will be able to sleep for at least 1 to 2 hours, will pass urine frequently and will gain weight adequately.

Vaginal Birth After C-Section Delivery (VBAC) – Is it an option for me?

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Sunita was excited to learn she was expecting again. She and her husband had a three year old little boy and they felt that their family wasn't complete yet. Her excitement was tempered by one concern, though. Several hours into labor with their son, he had started to show signs of fetal distress. Her doctor made the decision to do an emergency C-section and almost before she'd known what was going on she'd been wheeled into an operating room. Now, years later, Sunita wondered whether there was any chance she'd be able to have a vaginal delivery this time or if the only option was a repeat C-section.

Sometimes pregnancy can feel like a dizzying whirl of decision-making. Will you breastfeed or use formula? Should you do genetic screening? What about circumcision? Things get even more complicated if you've previously given birth via C-section and are expecting again. Suddenly, there's an additional important decision to consider: attempt a VBAC or not?

VBAC, or Vaginal Birth After Cesarean, is when you have a normal delivery after having a previous C-section. While a number of factors affect whether you're a good candidate for VBAC, in many cases it is a safe alternative to having a planned C-section and one that should be given serious consideration.

For many people, C-sections have come to be viewed as virtually routine, despite the fact that they remain invasive and expensive surgeries. While no one can debate the fact that C-sections can be critical, life-saving procedures, the rise in Cesareans in India over the last few decades raises concerns. Until 2010, C-sections represented only about 8.5% of births in India. Since then, the rates have skyrocketed, averaging around 50% for some areas of the country

 Dr. Pratibha Narayan is a Senior Obstetrician and Gynecologist at the Birthplace. In addition to her passion for obstetrics and preventive women's health, she an expert with many years of experience in VBAC. She excels and specializes in managing and treating routine and high-risk pregnancies, and recurrent pregnancy losses.   To know more or to meet Dr. Pratibha, please call 040-30911234. You can also write to her at  contactus@thebirthplace.com  or visit www.thebirthplace.com

Dr. Pratibha Narayan is a Senior Obstetrician and Gynecologist at the Birthplace. In addition to her passion for obstetrics and preventive women's health, she an expert with many years of experience in VBAC. She excels and specializes in managing and treating routine and high-risk pregnancies, and recurrent pregnancy losses. 

To know more or to meet Dr. Pratibha, please call 040-30911234. You can also write to her at contactus@thebirthplace.com or visit www.thebirthplace.com

This is an unfortunate trend, considering the possible advantages of VBAC compared to a C-section. First, VBAC, like all vaginal deliveries, involves a shorter hospital stay, a shorter recovery, and less pain after delivery. Babies born naturally are also less likely to experience neonatal breathing problems because vaginal birth forces fluid out of the baby's lungs. There may be emotional benefits as well as you and your partner will be more likely to play an active role in the delivery experience than you would during a C-section.

The choice of VBAC versus C-section becomes especially important if you are considering becoming pregnant again in the future. Each time a C-section is performed, it causes scarring to the uterus. As the amount of scarring increases, there is a greater likelihood of problems in subsequent pregnancies, especially with the placenta. Conditions such as placenta previa, placenta accreta, and placenta abruption all become more common with multiple C-sections. Bowel and bladder injuries are also more likely to occur with repeat C-sections. For these reasons, conventional wisdom suggests limiting the total number of C-sections a woman experiences.

Of course, there are also risks associated with having a VBAC. Most serious among these is the possibility of the uterus tearing at the site of a previous C-section incision. Known as uterine rupture, this rare condition can have dire consequences for both mother and baby, especially if the tear goes through all layers of the uterus. Fortunately, uterine rupture is rare, and may happen in only 0.5 percent of VBAC labors; and of the cases where ruptures do occur, less than 5 percent result in serious outcomes for the mother or baby.

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Besides uterine rupture, there is also the possibility that a VBAC attempt will result in an emergency C-section. Typically, a VBAC begins with a trial of labor where the mother is either allowed to begin labor naturally, or is induced to start contractions. The labor proceeds similarly to a typical vaginal delivery, although during a VBAC the doctor monitors both mother and baby closely in case an emergency C-section becomes necessary. While the majority of women who begin a trial of labor will complete a successful VBAC, roughly 20-30 percent will ultimately require a C-section to deliver.

If you are considering a VBAC, it's important to identify an obstetrician with specific experience performing these kinds of deliveries. She will be able to discuss what factors may affect your likelihood of having a successful VBAC, such as the reason for your previous C-section, the type of incision made during your C-section, whether you've previously had a successful vaginal delivery, the time since your last C-section, etc. She should encourage you to ask questions and fully explore all of your options. While not every woman is a good candidate for a VBAC, for most it is a safe option that the right doctor will feel comfortable discussing.

An experienced doctor will also be able to help you select the best place to deliver when considering a VBAC. Each hospital and birthing center is likely to have unique guidelines regarding VBAC attempts, so it's important to find out ahead of time what policies affect your choice to give birth at a specific location. It's also a good idea to confirm the location's ability to provide rapid access to surgery and anesthesia in case an emergency C-section becomes necessary. Locally, the Birthplace is proud to support mothers who choose to attempt vaginal births after having C-sections and has several successful stories to it’s credit.

For Sunita, like most women, a VBAC ended up being a safe alternative to having a C-section. If you've had a previous Cesarean delivery, taking time early on in your pregnancy to discuss with your gynecologist whether a VBAC is right for you, will help put your mind at ease and leave you more time to wrestle with other important pregnancy decisions...like nursery colors and baby names!

Best Wishes from the Birthplace !

Surviving the Roller Coaster of Infertility

The Birthplace

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Whether you’ve always dreamed of being a parent or started to yearn for a baby later in life, having a child of your own can be a roller-coaster ride of emotions, and this is particularly true when you struggle with infertility and all that it entails. Having spent a lot of time with couples on their journey to have a baby, I thought that it would be helpful to note my observations on how it impacts your relationships and how you can be supportive of your spouse on this journey and trust the clinical aspects to a fertility expert who has delivered positive results in coping with this issue.

How Infertility Affects Your Marriage

Even the most solid, loving marriage can suffer when infertility raises its ugly head. Neha and Ankur are a couple that were often admired by many of their friends due to their caring relationship. At first, they started to question which party was "defective." Once the tests indicated that Neha was the one with the fertility problem, Ankur felt guilty, but deep inside, he was secretly relieved it wasn't his fault.

Over time, couples typically unite in their efforts to do whatever it takes to create a new life together, but after months, and sometimes years, of having sex on a rigid timetable, the romance may fade. The lack of spontaneity — having intercourse whether they are in the mood or not — the stress, financial burdens and medical interventions all start to take a toll on an otherwise happy marriage.

Frequent communication is the key to holding your marriage together through this journey. Openly sharing your frustrations with each other helps heal the emotional wounds that may otherwise fester. Talk with a trusted friend or relative about your struggles and frustrations. This is a wise way to gain a fresh perspective and to receive encouragement.

 Dr. Samatha Kumar, is a senior gynecologist at the Birthplace with more than 11 years of experience, specializing in infertility, multiple births, and high-risk pregnancies.  To know more or to meet Dr. Samatha, please call 040-30911234. You can also write to her at  contactus@thebirthplace.com  or visit www.thebirthplace.com

Dr. Samatha Kumar, is a senior gynecologist at the Birthplace with more than 11 years of experience, specializing in infertility, multiple births, and high-risk pregnancies.

To know more or to meet Dr. Samatha, please call 040-30911234. You can also write to her at contactus@thebirthplace.com or visit www.thebirthplace.com

Your Other Relationships

Suchitra and Pavan found themselves avoiding certain situations. They would make an excuse not to attend a child’s birthday party or an occasion where they needed to support their nieces and nephews in their school events. They found excuses to avoid attending baby showers and going to the park, zoo or other places where they often saw young families. It hurt them both emotionally to be around happy families and their adorable children.

They started considering all the joy they were missing by isolating themselves. They resolved to enjoy life fully by being the best aunt or uncle they could be and to be a caring adult in the children’s lives of their friends.

Don’t ever force yourself to go to a gathering with small children if you aren’t feeling strong emotionally. It’s perfectly understandable to sometimes say no, but it shouldn’t become a habit. Cut yourself some slack; if you need to buy a gift for a baby shower, new parents or a small child, ask one of your friends to pick up something for you, or shop online. This prevents you from being bombarded by beautiful infant clothes, bedding and other child-centered gifts.

Coping with the Never-Ending Questions

Khusboo and Prashant became weary when simple curiosity made the people in their lives ask when they were going to start a family. After discussing this with a close family friend they gained a new perspective. They learned that this subject is often a way to make conversation and wasn't meant to make them feel inadequate. Nevertheless, to both of them it seemed as if the person was implying that they didn't want to have children, and if so, “Why not?”

You may be tempted to tell your acquaintances all your intimate secrets and regale them with stories that show how hard you've tried to have a baby. This isn’t necessarily a wise option. If you don’t want to hear the question, “Well, do you have exciting news to share?” every single month, then don’t confide in them. If you don’t want their constant and unsolicited advice, keep this matter to yourself.

The best answer is a simple one, such as “You'll be the first to know” or “That’s a question I don't feel like discussing.” The choice is yours; you don't have to answer a question that is no one else's business.

Clinical Options

Looking for one-on-one counselling?

90% of couples conceive within twelve months of unprotected sex. If you are concerned that you have not conceived yet, it may then be a good idea to seek the counsel of an expert who can provide you with appropriate options.

Couples having trouble conceiving may increase their chances of getting pregnant through assisted fertility techniques. Causes of infertility in women can include endometriosis, pelvic inflammatory disease, hormonal imbalance, problems with ovulation, tubal dysfunction, hostile cervical mucus or idiopathic causes (unknown cause).

Fertility treatment can be quite expensive, so, it may be a wise idea that you explore all the avenues possible before spending a huge amount, which may not be necessary. Surgery may be an answer if you are suffering from Endometriosis, PCOS, or fibroids. On the other hand, fertility drugs may be all you need to become pregnant within few months.

Other alternatives include in vitro fertilization, intrauterine insemination, and intracytoplasmic sperm injection. Obtaining donor eggs and embryos, having a gestational surrogacy or a gamete intrafallopian transfer are other effective ways to become parents.

For women with blocked fallopian tubes or unexplained infertility, the best treatment is IVF. For men with low sperm counts, ICSI, a specialized form of IVF where an individual sperm is injected directly into the egg, is usually recommended.

Some couples forego expensive testing and treatments because they simply want to become parents, and it doesn’t matter if the baby is their biological child; instead, they opt for adoption or become foster parents to many children.

Whatever way you and your spouse choose to become parents is a personal and heartfelt decision, and the result is a gift that lasts a lifetime!

Note: Although the names have been changed to protect the privacy of the couples, rest assured that these are real stories and common experiences for those on the roller coaster ride of infertility.