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The Birthplace Blog

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 040-45208108. 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 040-45208108. 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 040-45208108. 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 040-45208108. 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.

Looking for one-on-one counselling?

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 040-45208108. 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.

Schedule your baby's scan today!

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

The Birthplace

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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 040-45208108. 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 040-45208108. 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?

The Birthplace

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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 040-45208108. 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 040-45208108. 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.

Looking for one-on-one counselling?

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 040-45208108. 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 040-45208108. 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

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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.

Don't Let Periods Stop Your Life

The Birthplace

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Karuna is a 31year old with no children and has never been pregnant though mothering is definitely on her life’s “to-do” list.  She has heavy period bleeding for over a year and has been through tests and hormonal medication with no major relief. She feels it’s debilitating, humiliating, painful and uncontrollable – and it could all quite possibly end in removal of her uterus – and with it, her hopes of ever having her own children.

She is one amongst every 3 women worldwide who suffer from abnormal, heavy menstrual bleeding (HMB) at some point in their lives.

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

A normal period comes every 21 to 35 days and lasts for 3 to 7 days. The following signs can show that the periods are heavy- A need to change the sanitary towel frequently, large blood clots with pain, bleed that happens through to the clothes, normal activities such as going out or working are affected, the woman feeling excessively tired, depressed or becoming anaemic as a result of it.

There are many causes for prolonged bleeding – from something as simple as stress to serious conditions such as cancer. The hormones estrogen and progesterone control the uterus lining (endometrium) which is shed during a period. A hormonal imbalance causes it to build up so, when it is eventually shed, bleeding is heavier. Thyroid hormonal imbalance and pregnancy complications such as a miscarriage and ectopic pregnancy may also cause heavy bleeding. 

In young girls, or in women approaching menopause, irregular periods are not unusual due to improper ovulation and changes in hormone levels. For others, HMB can be a result of polycystic ovary syndrome (PCOS), infections, endometriosis, adenomyosis, fibroids and polyps. However, the most common cause is Dysfunctional Uterine Bleeding (DUB) witnessed by women in midlife where a hormone imbalance leads to HMB. It is often impossible to predict how long this imbalance may last for. It could vary between few months to few years.

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Diagnosis and Treatment : 

Detailed history regarding possibility of bleeding disorders or cancers in the family, simple blood tests, ultrasonography and biopsy may be needed to arrive at a diagnosis.

Uterus removal is not needed in majority of women and they can be treated with hormonal pills or with a hormone containing intrauterine device (Mirena). For some women, a day-care procedure called endometrial ablation destroys the lining of the uterus using electric current or heated fluid to reduce or stop menstrual flow.

If uterus removal (Hysterectomy) is warranted, laparoscopic surgery is possible that facilitates quick recovery.

Helping yourself :

Having heavy periods can lead to low iron levels. Taking iron supplements and eating iron rich foods such as green leafy vegetables, meat, dry fruits like raisins, dates, apricots would replace the lost iron.

Exercise may be the last thing on your mind during periods but drinking plenty of water and regular exercise like walking or Yoga can reduce the pain and ward off depression. It’s always advisable to keep sanitary towels on you and use hot water bottle to help relieve abdominal pain and cramps. 

You should not put up with the bleeding affecting your quality of life as many simple treatment options can help.

Do You Really Need A Hysterectomy?

The Birthplace

12 lakh women will undergo a hysterectomy this year.

12 lakh women will undergo a hysterectomy this year.

Dr. Jyotsna is an MD (Ob Gyn) from one of the top medical institutions in the country (JIPMER). In addition to her passion for obstetrics and preventive women's health, she is also an expert in gynecological endoscopy, with a special interest in the management of uterine fibroids and endometriosis.  To know more or to consult Dr. Jyotsna, please call 040-45208108. You can also write in to her at  contactus@thebirthplace.com  or visit www.thebirthplace.com

Dr. Jyotsna is an MD (Ob Gyn) from one of the top medical institutions in the country (JIPMER). In addition to her passion for obstetrics and preventive women's health, she is also an expert in gynecological endoscopy, with a special interest in the management of uterine fibroids and endometriosis.

To know more or to consult Dr. Jyotsna, please call 040-45208108. You can also write in to her at contactus@thebirthplace.com or visit www.thebirthplace.com

What is a Hysterectomy?

A hysterectomy is a surgical procedure to remove the womb (uterus). It the most common surgical procedure performed on women after cesarean section. Various studies show that on an average 7-8 % of women undergo hysterectomy every year in India.

Hysterectomies are carried out to treat conditions that affect the female reproductive system, including:

  • heavy periods (menorrhagia)

  • non-cancerous tumours (fibroids)

  • long-term pelvic pain due to endometriosis

  • ovarian cancer, uterine cancer, cervical cancer or cancer of the fallopian tubes

A hysterectomy is a major operation with a long recovery time and is only considered after alternative, less invasive, treatments have been tried.

Let us first look at what alternatives you may have before you take this decision!

Many women don’t know there are alternatives or less-invasive options, like laparoscopic surgery. For women aged 35 to 54, the most common reasons for a hysterectomy are fibroids, endometriosis, and abnormal bleeding; after age 55, the most frequent reasons are uterine prolapse or cancer. However, there are new treatments for fibroids and bleeding that can help women avoid a hysterectomy.

Even the largest fibroids can be removed surgically (Myomectomy); others methods that have been tried are Hi-frequency focused ultrasound waves and cutting off their blood supply with tiny plugs in blood vessels (uterine artery embolization). Abnormal bleeding can be halted by various means of destroying the uterine lining. Prolapse can usually be corrected surgically without removing the uterus.

Myomectomy means the surgical removal of just the fibroid, with reconstruction and repair of the uterus. It is usually offered for women who are young and those who wish to conserve their uterus for fertility or until menopause.

While bothersome symptoms such as very heavy bleeding or pain often respond to medications or other non-surgical treatment, sometimes the symptoms do not get better. For some women, when other minimally invasive surgical techniques may have failed, hysterectomy may be appropriate.

There are times when hysterectomy may be unavoidable; some women who have endured years of pain and bleeding do choose hysterectomy.

If there is no option other than going in for a hysterectomy, are there different ways of doing it?

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There are various ways to remove the uterus - Abdominal, Vaginal and Laparoscopic.

Out of all these, vaginal hysterectomy is the most comfortable for the woman and has least complications when performed by a well-trained gynecologist.

Laparoscopic surgery has made it possible for reducing the hospital stay and also providing more comfort with less pain. Abdominal surgery is opted for in some patients where the other methods are not feasible and in cases of cancer usually. It is a safe procedure but the woman has more pain and longer recovery time.

Currently, laparoscopic hysterectomy has gained popularity due to its relatively pain-free recovery and shorter hospital stay, and since it does not cause scars on the abdomen like an abdominal surgery. Hysterectomy is a major surgery. Do not opt for it unless a qualified gynecologist has evaluated you and recommended it.

Are you planning a family?

The Birthplace

Here’s something you should know about Preconception Care to ensure a healthy pregnancy and smooth birth


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Aristotle said that well begun is half done, and it rings true especially when you’re thinking about starting your family. When you’re looking forward to bringing a new life to this world – the first smile, the gentle grip of tiny fingers and that loud first cry – the best beginning you can make is by reaching out to your gynecologist for preconception care and counseling. It helps you prepare your mind and body for a smooth pregnancy and a healthy baby.

The foremost aspect of preconception care is preparing you and your partner with knowledge and information on the specific steps that you can take as a couple to ensure not only a healthy baby but also a healthy father and mother.

Seeking preconception care from your gynecologist will also help you identify and address specific health problems that you or your partner may have and prevent them from adversely impacting the health of your baby or yourself during your pregnancy. For example, if you have an iron deficiency, the most common type of anemia (low red blood cell count) during pregnancy, it can easily be treated with proper nutrition and supplements if caught earlier, even before you become pregnant. If you have any existing conditions for which you are on medication, your doctor may also advise adjustment of dosage during your consultations. The bottom line is that a majority of the health issues that affect the mother or the baby can actually be addressed well before your pregnancy, resulting in better maternal and child health outcomes.

There are many positive interventions through preconception care as well. Folic acid is an excellent supplement that has numerous benefits before and during your pregnancy. Especially during the preconception period, taking folic acid helps protect against birth defects and various pregnancy complications. Eating healthy and nutritious foods and moderate exercise are simple steps you can take that are in your control to be better prepared for your pregnancy. 

If you’re constantly stressed about work or are anxious about your pregnancy or anything else, always speak up with your partner or doctor and take concrete steps to manage and reduce your stress – even proper rest and exercise helps! Taking good care of your mental and physical health is important for a happy and healthy pregnancy.

In conclusion, if you’re thinking about having a baby, make sure you talk to your doctor – it is the first and best birthday gift that you can give your baby as parents-to-be!


Dr. Girija Lakshmi is an Obstetrician & Gynecologist with a focus on Fertility & Preconception. She has also trained in hysteroscopy and laparoscopy. She coaches and guides women through all the stages of their fertility treatments up to safe delivery & beyond.  To know more or to consult Dr. Girija, please call 040-45208108. 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 coaches and guides women through all the stages of their fertility treatments up to safe delivery & beyond.

To know more or to consult Dr. Girija, please call 040-45208108. You can also write to her at contactus@thebirthplace.com or visit www.thebirthplace.com

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