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Maternity Services

Maternity Services

Tab 1

Preconception counseling

Preconception counseling is an appointment with your doctor that is used to plan for a future pregnancy. Your family history, medical conditions and lifestyle are all discussed. This appointment is an important part of a healthy pregnancy.

What is preconception counseling?

Caring for your health before you become pregnant helps you to prepare for a healthy pregnancy. Preconception counseling is a visit with your doctor where you can discuss many aspects of pregnancy and you can plan for a healthy pregnancy.

This appointment should take at least three months before you start trying to get pregnant. During this visit, your doctor will discuss the following topics:

Family history:

Your family history and your partner’s family history can provide insight into any genetic conditions or disorders that may be passed on to a child. Understanding your medical past can help your doctor to treat you and your child. This information may also tell your doctor if they need to perform any extra tests or watch for the growth of certain conditions during the pregnancy. Specific parts of your family health history include such as:

  • Hypertension (high blood pressure).
  • Diabetes.
  • Mental disorders.
  • Blindness.
  • Deafness.
  • Birth defects (congenital conditions).
  • Ethnic-related diseases (Tay-Sachs, sickle trait/sickle cell disease).
  • Twins or multiples.

Your general medical history:

Your doctor needs to see the whole picture of your health before your pregnancy. During your appointment, your doctor wants to discuss:

  • Surgeries, transfusions you may have had in the past.
  • Any pre-existing medical conditions.
  • Any allergies.
  • Any medications you may currently be taking.

Your OB/GYN history:

During the discussion of your medical history, your doctor will ask you about OB/GYN history. Some STDs and vaginal infections can also affect a woman’s ability to conceive. Your doctor may do cervical cultures or blood tests to make sure there are no infections that could cause issues during conception or pregnancy. Specific topics your provider may discuss include:

  • Any previous pregnancies.
  • Your menstrual history.
  • Contraceptive use.
  • Any sexually transmitted diseases (STDs).
  • Any history of known uterine abnormalities.
  • Pap smears or any treatments for abnormal paps.
  • Vaginal infections.

Lifestyle: An healthy lifestyle is very important during pregnancy. This includes a particularly balanced and nutritious diet, exercise, and stop using any drug and smoking, as well as exposure to any environmental hazards.

Vaccination: Your doctor may need to update or give you additional vaccinations before you become pregnant. Some of these vaccinations may require a time gap between when they are given to you and when you become pregnant. Bring your vaccination records with you on your appointment.

What happens during my preconception counseling appointment?

During preconception counseling, your doctor may do several tests which include :

A physical exam: Your doctor may do a physical exam during your preconception appointment.

  • Checking your heartbeat, lungs, breasts, thyroid, and abdomen.
  • Doing a pelvic exam.
  • Checking your blood pressure.
  • Recording your weight.

Lab tests: These tests are used to check various diseases and conditions.

  • Testing for rubella.
  • Testing for hepatitis.
  • Complete blood count (CBC).
  • A pap smear.
  • Diabetes screening.
  • Testing for thyroid issues.
  • Testing for HIV.

Your doctor may also discuss how to record or record your menstrual cycles when you ovulate each month. You may be given a drug known as a prenatal vitamin with 400 to 800 micrograms of folic acid. You should take this before you are pregnant. Your baby can benefit from a prenatal vitamin before you may even know you are pregnant.

Tab 2

Antenatal Checkups

When a woman is pregnant, it is important for her to have regular check-ups with a doctor. These check-ups are called as antenatal care or antenatal checkups. Antenatal means before the birth. A midwife is someone who is specialized in caring for women during her pregnancy, birth and after the birth of the baby.

Going to regular antenatal checkups plays an important role in staying healthy and making sure the baby is healthy. Regular checkups during the pregnancy can assist in identifying and reducing risks to either to the mother or the baby.

Even though the mother may be feeling well, it is still important to go to all the antenatal checkups.

Antenatal visits also give you the chance to ask any queries and to talk about any issues that the patient is doubtful about, such as pains, the birth, feeding the baby or any other issues. Before each visit, it is a good idea to think and note down about the things that the mother wants to talk about with the doctor and clarify all the arised doubts or queries

When to start going to antenatal checkups?

The timing of the visits to the concerned doctor will be arranged on the individual basis after the patient talks with hospital management.

  • A normal pregnancy lasts for about 38–42 weeks.
  • After the first antenatal visit, the next visit will be around 19-20 weeks, then again the next visit will be at 28 weeks gestation, visits become more frequent as you get closer to your due date.
  • You may need to have antenatal visits more frequent if there are any issues with the mother or baby. You can also make appointments to see the doctor at any time during the pregnancy if you are worried about how the pregnancy is progressing.

Tab 3

Post Natal Care For Mother & Baby

While most attention to pregnancy care focuses on the nine months of pregnancy, postnatal care is very important too. The postnatal period lasts for six to eight weeks, beginning from right after the baby is born.

During this particular period, the mother goes through many physical and emotional changes during learning to care for her baby. Postnatal care includes taking proper rest, nutrition, and vaginal care

Getting Enough Rest

Rest is the crucial thing for new mothers who need to rebuild their strength again after pregnancy. To avoid getting too much tired as a new mother, They may need to:

  1. Sleep properly when the baby sleeps.
  2. Keep the bed near to the baby’s cradle to make night feedings easier.
  3. Allow anyone else to feed the baby with the bottle during your sleep.

Eating Right Food

Getting proper nutrition in the postnatal period is important because of the changes the body goes through during pregnancy and labor.

The weight that the mother gained during pregnancy helps to make sure you have enough nutrition for breast-feeding the baby. However, you need to continue to eat a healthy diet after delivery also.

Experts have recommended that breastfeeding mothers eat when they feel hungry. Make a proper effort to concentrate on eating when you are craving not just busy or tired.

• Avoid snacks that contain high-fat snacks.
• Focus on eating low-fat foods that contain proteins, carbohydrates, and consume more fruits and vegetables
• Drink plenty of fluids which is more important for mother.

Tab 4

Pediatrician Care

In many health care institutions in India, sick children up to 12 or 13 years are registered under Pediatric service and older children under adult Medicine service. This age cut-off has been traditional. Some 3 to 4 decades ago, sick children were treated by physicians who were primarily responsible for adult medical service. Children were considered miniature adults and the main concern was only to scale down the doses of medicines according to the body weights of children. It did not matter very much where a child was admitted for treatment, because the same physicians treated children and adults. The children's wards had short beds and only children below about 12 or 13 would fit in them. Taller children, who were usually older, were admitted in adult wards. Even after Pediatrics came of age as discipline, somehow the traditional age cut off remained. Even today, when sick persons are registered at the hospital reception desk, those under 12-13 years are sent to Pediatric clinic and older children are sent to Medical clinic.

Adult Medicine (or Internal Medicine as it is often called) is usually preoccupied with the diagnosis and treatment of physical illnesses. Symptoms without disruption of functions of organs or issues are often attributed to 'functional' illness, usually without going into further details. The strength of Internal Medicine is this ability to dissect out deviations from normal physiology and we must agree that such diagnostic expertise is absolutely essential for us to understand disease processes and to be able to treat them according to pathology and/or etiology.

Pediatrics is also concerned with such diagnostic accuracy of physical illness. Since the patterns of illnesses vary very much between adults and children, the same principles as those used by Internists are necessary for Pediatricians also to diagnose and under- stand disease processes and to treat diseases rationally. But Pediatrics goes beyond disease. Childhood is the formative stage of life towards adulthood and we are concerned about growth, development and disease prevention, both physical and otherwise. This process or growth, development and vulnerability to deviation from the normal or optimal path of growth and development do not cease with age 12 or 13 years, but proceeds up to the late teen age, that is, until a person is an adult. For this and other reasons, there are many advantages for teenagers td cone under the purview of Pediatric care. Obviously, it does not matter as to who, the Internist or the Pediatrician, treats a teenager with typhoid fever or thyroid nodule. But, special skills are necessary to counsel a teenager who faces the stress of rapid body changes and the consequent confusion of self image and relationships.

Policy Statement

Policy on Age of Children for Pediatric Care (1999)
For fulfilling the professional obligations of pediatricians to the society at large, the purview of pediatrics commences with the fetus and continues through newborn, infancy, preschool and school age including adolescence up to and including 18 years of age.

An Explanatory Note

This policy has been adopted by the Academy by unanimous approval both at the Executive Board and General Body, during the Annual Conference at Jaipur, in February, 1999. It must be pointed out that we were guided very much by the 'Convention on the Rights of the Child', adopted by the United Nations General Assembly on 20 November, 1989. Article 1, of the Conventions states: "For the purposes of the present Convention; a child means every human being below the age of 18 years unless, under the law applicable to the child, majority is attained earlier". In India, the right to vote in political elections is attained at the age of 18. In the United States of America, Pediatrics covers up to 21 years of age. Thus, we could have defined the age as below 18, or up to 21 or till the last year of the teens (nineteen), but our collective wisdom has accepted it as up to and including 18 years. There is little to gain by hair-splitting.

It is generally accepted that children with chronic illnesses and who are under the continuous care of a pediatrician will continue to be cared for by the same doctor for a while longer, and not just up to the age defined here.

What Actions Do We Need to Take?

By stating a policy, it does not mean that all pediatricians have the training, aptitude, knowledge or skills necessary to care for adolescents. We must learn them, and we must teach and train. For this purpose an ad hoc Committee has been appointed and we will be guided by their recommendation about the modalities and range of contents for training Pediatricians in Adolescent Medicine and Care. Once these are decided upon, the Academy will establish a process by which training opportunities will be made available widely.

In the newly published lAP Textbook of Pediatrics, a whole section has been included on Adolescent Care. If Medical Colleges will adopt the new curriculum on Pediatric teaching as described by the Medical Council of India; this .section will become essential, and thus, future Physicians and Pediatricians will have already learned the foundations of Pediatrics including Adolescent Care.

We have amidst us a number of Pediatricians with special interest and skills in Adolescent Care. It will be in order for us to include topics of adolescent issues in our seminars, conferences and Continuing Education programs

The Government of India is establishing a major program under the title, 'Reproductive and Child Health'. The WHO has created a new Department called 'Child and Adolescent Health and Development'. Both these developments are indicative of the changing world view on the needs and opportunities for care in the adolescent period of development. The Academy is not far behind them.

The purpose of the new policy is not to gain any advantage from anyone, not for new departments or beds for admission, but to voluntarily take upon ourselves the responsibility to provided a service that no one else has been giving. Some of us have acted as Pediatricians for many children from birth up to 12 or 13 years. So, we become naturally the doctors with whom they are comfortable, and whom they trust. But we have to learn to listen care- fully and to understand them and their situations with professional competence. We have to provide the adolescent-friendly atmosphere in our clinics and make it known that they are welcome to come and speak to us. We must develop a realistic approach about consultation charges for teenagers. Adolescent Care should not become another gimmick for income generation. For this reason, perhaps public sector clinics must come forward readily to establish Adolescent Clinics. We must be sensitive to their gender perceptions and we must carefully plan our physical examination routine when it is required. We have to get help from psychologists, counsel- ling experts, endocrinologists and even gynecologists. To a certain extent we might be treading unchartered territory but there is a lot of expertise already available in the country. Any constructive suggestions will be very welcome. Let us put the policy into practice.

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Tab 5

Phototheraphy Unit

Phototherapy is the use of apparent light to treat critical jaundice in the neonatal age. Nearly 60% of term infants and 85% preterm infants will exhibit clinically visible jaundice, which classically becomes visible on day 3, increase days 5-7 and resolves by 14 days of age in a term infant and by 21 days in the preterm baby. Treatment with phototherapy is performed in order to stop the neurotoxic forces of powerful serum unconjugated bilirubin. Phototherapy is a harmless, efficient method for lowering or stopping the rise of serum unconjugated bilirubin levels and decreases the necessity for transfer transfusion in neonates.

Please record that while drafting the TSB level onto the Phototherapy or Exchange Transfusion charts, in the presence of danger factors (sepsis, hemolysis, acidosis, asphyxia, hypoalbuminemia) TSB values should be framed on the scale 1 lower than the neonate’s gestational age/weight. That is because of the uncertainty of growing kernicterus rises in the presence of the above danger factors.

The Phototherapy and Exchange Transfusion charts onto which total SBR is considered are for the initial 7.5 and 5 days of life respectively. After the first 5-7 days renew using these charts, as levels plateau and can proceed to be documented.

  • Evaluate general skin color whenever measuring and recording vital signs. Ensure the Phototherapy tick box in the EMR Flow sheets is stimulated and document the point of origin and cessation. Take blood sample to measure whole serum bilirubin levels (either venous, arterial or capillary)
  • Record hourly the variety and quantity of light lines and the presence of eye protection.
  • Obtain blood sample to estimate whole serum bilirubin levels (either venous, arterial or capillary) Ensure the lights are turned off while sampling so the correctness of current blood levels can be accomplished. Initially SBR levels may need to be evaluated every 4-6 hours until reduction. Attend the medical guidance and order of SBR levels according to the acuity of levels plus plan on the proper arrangement of the chart. Inspect for symptoms of laziness and poor feeding
  • Examine for signs of laziness and poor feeding

During phototherapy, neonates need ongoing monitoring of:

  • Plenty of hydration (urine output) and diet(weight gain)
  • The temperature of the baby
  • clinical change in jaundice
  • TSB or SBR levels in the baby's body
  • potential symptoms of bilirubin encephalopathy

Tab 6

High Risk Pregnancy

Most of the time having a kid is a natural procedure. After a full-term reproduction, a lady goes into labor on or near her due date and gives birth to a strong infant. A day or two next she leaves the clinic to start day-to-day life with her expanding family. Although not all reproductions go easily. Few ladies undergo a high-risk pregnancy. A pregnancy is considered high-risk if there are potential difficulties that could harm both mom and kid. High-risk pregnancies need supervision by a specialist to assist ensure the best result for the mom and child.

Risk Factors for High-Risk Reproduction

1.Maternal Age: One of the common risk factors for a high-risk pregnancy will be the age of the woman. Ladies who will be below age 17 or above age 35 while their child is due are at higher risk of difficulties than those between their late teens and early 30s. The chance of miscarriage and genetic flaws further doubles after age 40.

2.Medical conditions that are before pregnancy: Conditions like increased BP; lung, kidney, or heart problems; diabetes; sexually transmitted diseases; such as HIV can be a risk for the mother and her unborn baby. A past of miscarriage, difficulties with the previous pregnancy or pregnancies, or a family history of genetic disorders is also risk factors for a high-risk pregnancy

If the woman has a medical condition, it is important to consult the doctor before the woman decides to become pregnant. The doctor may run a few tests, adjust medications, or advise to take precautions that are necessary to take to optimize the well-being of the mother and the child.

3.Medical conditions that occur during pregnancy: Even if the woman is healthy when she becomes pregnant, it is probable to develop or be diagnosed with obstacles during pregnancy that can harm the woman and the baby. Few common pregnancy-related problems are:

• Preeclampsia is a sign that involves high blood pressure, urinary protein, and swelling; it can be serious or even mortal for the mother or baby if not treated. With proper control, however, most women who exhibit preeclampsia have healthy kids.

• Gestational diabetes is the type of diabetes that usually occurs during pregnancy. Women with gestational diabetes may have healthy pregnancies and kids if they follow the medication treatment from the doctor. Normally diabetes resolves after delivery. Yet women with gestational diabetes are at raised risk of generating type 2 diabetes.

4.Pregnancy-related issues: Usually pregnancy is categorized as high risk because of problems that occur from the pregnancy and that hold little to do with the mom's health. These include:

• Premature labor is the labor that will start before 37 weeks of pregnancy. Although there is no means to identify which women will undergo preterm labor or delivery, there are factors that put women at higher risk, such as several infections, a compressed cervix, or past preterm delivery.

• Multiple births mean if a woman is carrying more than 1 baby. Many of the pregnancies, which are common as women are using more extra infertility treatments these days, improve the risk of premature labor, gestational diabetes, and pregnancy-induced high BP

• Placenta previa is the condition in which the placenta covers the cervix. This condition can create bleeding, mainly if a woman has contractions. If the placenta still covers the cervix close to delivery, the doctor might schedule a c-section to decrease bleeding risks.

• Fetal problems, which can be noticed on ultrasound. Around 2% to 3% of all infants have a minor or major basic problem in growth. Seldom there may be a family story of fetal difficulties, but some times certain problems are totally unexpected.

Tab 7

Diet & Nutrition

A Pregnant Woman's Daily Diet

At no other time in life is nutrition as important as before, during, and following pregnancy. On the other hand, women can still eat foods that come in a box or a bag, eat out several times a week, or order pizza to go as long as they also follow a few simple eating-for-two dietary guidelines.

A Pregnant Woman Should Include in Her Daily Diet at Least:

1) Five servings of fresh fruits and vegetables (including at least one serving of a dark orange vegetable, two servings of dark green leafy vegetables, and one serving of citrus fruit)

2) Six servings of enriched, whole-grain breads and cereals. Three servings of nonfat or low-fat milk or milk products

3) Two to three servings of extra-lean meats, chicken without the skin, fish, or cooked dried beans and peas

4) Eight glasses of water

Diet and Exercise After Pregnancy

If you are breastfeeding, the food you eat helps your baby grow strong and healthy, too. Good eating habits and exercise will help you lose the weight you gained.

Healthy Eating Tips

Eat a variety of foods. Try to eat a balanced diet of fruit, vegetables, grains, protein foods and diary each day

Drink plenty of liquids.Your body needs lot of fluid (about 6-10 glasses a day) especially if you are breastfeeding your baby. Drink mostly water, milk, and fruit juice.

Eat foods that have protein such as milk, cheese, yogurt, meat, fish and beans. Protein rich foods are important to help you recover from childbirth and keep your body strong. If you are under 18, or were underweight prior to pregnancy, you need to eat more protein.

Eat your fruits and vegetables. Try to make half your plate fruits and vegetables. Fruits and vegetables have vitamins and minerals that keep you healthy. They also have fiber, which helps prevent constipation. Make sure to wash fruits and vegetables under running cold water before eating them.

Lose weight safely. Talk to your doctor about safely losing weight after your baby is born. Losing weight too quickly can affect your breast milk supply. Do not take diet pills. They contain harmful drugs that can be passed to your baby through breast milk.

Take prenatal vitamins. If you are breastfeeding, it is a good idea to continue to take your prenatal vitamins. Your doctor can prescribe these pills so that your health insurance will cover a portion of the cost.

Limit junk foods. Soda pop, cookies, donuts, potato chips and french fries are okay sometimes, but don’t let them take the place of healthy foods!

Avoid these Foods when Breastfeeding

There are some foods and other substances that can be harmful to both you and your baby if you are breastfeeding.

Alcohol: Wine, wine coolers, beer, drinks like hard lemonade and other malt liquor beverages, shots and mixed drinks contain alcohol that passes to your baby through your breastmilk and can harm your baby’s brain and body development.

Caffeine: Caffeine is a stimulant that passes through breast milk to the baby and may affect growth. Caffeine is found in tea, coffee, chocolate, many soft drinks and over-the-counter medicines.

Swordfish, Shark, King Mackerel and Tilefish: These fish have high levels of a toxin called mercury. Mercury is harmful to your growing baby’s brain. If you eat tuna, it is okay to eat up to 6 ounces of canned tuna a week but make sure to choose light tuna.

Exercise After Pregnancy

Exercise helps you:

  • Lose the weight you gained during pregnancy
  • Reduce backaches, constipation and bloating
  • Lifts your spirits and improves posture
  • Helps build muscle tone and strength
  • Promotes better sleep

Once your doctor says it is okay to start exercising, there are many ways to be active.

Walking is a great way to exercise because it puts very little stress on your body. Your baby will probably enjoy being walked in a stroller too. Try walking briskly for 20-30 minutes every day or at least 3 times per week. Meet with a friend or other new moms to go walking. It’s good to get out of the house and connect with friends or other new mothers. You will enjoy the chance to talk about your baby or to just be with other adults!

Exercise classes are another fun way to get in shape and sometimes you can find a class that will include your baby. For example, look for a mom and baby yoga class in your area.