Contraception and family planning

Contraception methods

Population growth has many economic consequences, ranging from pressure on educational and health services and high demand for new jobs.In addition to social consequences like increase domestic disputes and divorce rate.In an attempt to control these pressures some countries have implemented family planning programs.

There are several reasons for increased population including wives who have many children to tie their husbands with them for life, families which have many children to make them work and support them financially, families which have many children till they find their desired baby sex. Lack of enough directed awareness on the consequences of population increase and how contraception works is a problem. Lack of efficient family planning programs and difficulty in attaining them is a big drawback. Some countries also encourage having children and constitute it as a national duty in order to supply a large population base for military endeavors.

There is also a religious interaction where some religions and cults prohibit certain contraception methods while allowing others according to their beliefs where some say that sexuality has as its end purpose, procreation; to interfere in this end would be a sin while others do not strictly limit sexual intercourse to procreation; it also constitutes an expression of love, while others assume that procreation within the family as a religious duty.

Some cultures reject family planning methods for fear that contraceptive use will encourage immorality and illicit sex. Feminist commentators have viewed prohibitions on birth control as a means to control female sexuality and independence.

Contraception and family planning are methods to prevent pregnancy.

Natural Methods

Easy to use but has a high percentage of error.

  • Safe period: It depends on identifying the woman’s fertile ovulating days and avoiding sex on those days.
  • External ejaculation: Ejaculating outside the vagina.
  • Lactation: Lactation hormones prevent ovulation thus it can be used as protection

Chemical methods

Found in all pharmacies but they have a high failure rate. E.g. vaginal creams, vaginal suppositories

Mechanical Methods

Condoms

It is a thin sheath made of latex and found in different sizes. It is slipped over the penis during erection to trap the semen when it is ejaculated and prevent it from entering the woman’s vagina. Some kinds have a chemical material that kills the sperms.

Dis-advantages

  • Might tear
  • Decrease sexual feeling

Advantages

  • No need for prescription
  • Cheap

Intrauterine device – Loop

The intrauterine device is inserted inside the woman’s uterus by a doctor. The woman can check the presence of the loop by feeling the threads which are attached to the loop and pass out of the cervix. The Intrauterine device prevents fertilized eggs from implanting in the uterus. Cooper loops kill sperms and impair endometrial formation. Loops are generally made of plastic material and they are shaped according to their kind.

Dis-advantages

  • Not indicated for women who never got pregnant
  • Not advised with pelvic inflammatory diseases.
  • Possible side effects like cramps and increased menstrual blood.

Advantages:

  • It can’t be felt
  • No interference with sex
  • No hormone interference.

Hormonal Methods

Pills

There are lots of kinds in the market. Their primary function is to stop ovulation and to make cervical mucus obstructive for sperms to pass through them.

Dis-advantages

  • Forgetting the pill
  • Side effects like dizziness in some people

Advantages

  • Regulates irregular cycles
  • Has other medical uses.

Patches

Same as pills and easy to use.

Emergency contraception

Used in cases of unprotected sex.

Ring

flexible ring inserted inside the vagina and it releases hormones just like the pills

Injections

stops ovulation but it has many side effects.

Intradermal capsules:

Injected under the skin and is viable for 5 years but have many side effects.

Permanent Methods (Sterilization)

They are used in cases of severe illness and life threatening problems, many children and failure of other methods of contraception.

In males (Vasectomy)

Ligate both spermatic cords either by laparoscope or open surgery.

In Females

Ligate both fallopian tubes either by laparoscope or open surgery.

Caring for your breast

Breast care for lactation

  • Cleaning: You should clean your breasts with warm water at least once daily then dry it out with a clean towel. Put lanolin creams or olive oil or coco butter cream on your areola and nipples at least 3 times per day to avoid nipple cracking. You should clean your hand well before breast feeding and also clean the nipples well before and after breast feeding. If breast cleaning is not done well, it might end in inflammation of the milk ducts.
  • Clothes: Avoid tight bras or bras with wire supports. Simple wide and cottons bras are preferred. No hard contact should be between your nipples and clothes and avoid using any irritating or allergic agents on your breasts.
  • Nipple Cracks and pain: it is caused by the baby not latching on the nipple the correct way or due to inflammation. If the cracks or pain is so severe avoid breast feeding with the affected breast for a period time till your breast heals and in the mean time draw the milk out by gentle massage of the breast and not by suction. If you feel good start breast feeding with the affected side again, but if your healing is slow consult a doctor.
  • Breast congestion: You can gently massage your breast during breast feeding and you can also use warm clothes over your affected side before feeding.  Try to breast feed on close intervals to empty the breast. You can visit your doctor if the situation persists.
  • Breast milk amount: If you feel that your breast milk is not enough you  have to check with your doctor. Milk release depends on repeated sucking of the nipples and breast .When the baby sucks the nipple 2 hormones are released prolactin and oxytocin. The former is  responsible for making milk and the latter is responsible for ejecting the milk.

Bottle feeding

Bottle feeding

Once you have made your choice to bottle-feed don’t let other people make you feel guilty. It is your baby, you body and your choice. Formula fed babies do thrive and you can be reassured that most infant formulas are designed to be as close to human breast milk as possible. Most formulas are fortified with all the necessary vitamins your baby and it is best to use a well-known and recognized brand.

To prepare bottles and nipples

  • you must first wash them in hot soapy water and scrub the inside of the bottle with a brush
  • Nipples must be washed inside and out with detergent then rinsed off thoroughly
  • You have three choices of sterilization, boil them in a pot, soak them in an antimicrobial solution or a microwave bottle sterilizer
  • You will need to use boiled water to make up the formula. Measure the formula out carefully and don’t compress the powder in the scoop.
  • Scrape excess powder off the scoop level with a knife. Once you have prepared the bottle shake it thoroughly.
  • Cradling your baby in your arms is the easiest position for feeding. To protect your clothes and your baby’s clothes, remember to put a bib on the baby.
  • When your baby finishes his bottle tip any left over milk out because Bacteria from your baby’s mouth can be introduced into the milk and multiplies quickly.

Breast feeding directions

Breast feeding

  • Hold your baby in a way that his abdomen faces yours and his face towards your nipple. You can lift him by one hand where his head lies in your elbow and his bottom with your other hand.

Or You can also lie on your side and hold the baby head towards your breast. The last two are good for women who delivered by cesarean section.

Or You can also place the baby on a pillow and rest your elbow on the same pillow and lift the baby head with your hand.

  • Surround your areola and nipple with index and thumb fingers.
  • Make the baby open its mouth as if yawning by rubbing his lips or mouth with your nipple.
  • As soon as he opens his mouth pull him towards the nipple with your hands and don’t bend yourself towards him.
  • Latching: make sure that your baby took in the whole nipple and most of your areola. If you feel pain then the latching is not correct. Put your finger at the side of his mouth to open it and pull your your nipple and repeat the steps again.
  • After the first few gulps your baby will develop a rhythm of his own. Sometimes the baby sleeps in the middle for a while then continues. If you pull out your nipple and he objects then he wants to continue feeding. If done correctly, it can be a beautiful experience. Younger babies need to be burped after each feed so sit your baby up and support him on your chest or sit him on your legs or lay him across on your legs abdomen down.
  • Rub your baby’s back gently in round circular movements until he burps. If your baby is gaining weight then you must be feeding him or her correctly.

Bathing your new born

Baby bath

  • Preparing the changing area: You have to choose a place that is safe and clean. Then you have to prepare the tools that you will use because it is not safe to leave the baby un-attended to go get a tool that you forgot to prepare. You can use a baby tub or a regular tub. Water should be warm and not hot, you can measure it with special water thermometers or with your elbow or wrist.
  • Take off the baby’s clothes slowly while holding him closely to give him a sense of security.
  • Put the baby in the tub slowly while holding him firmly with one hand and holding the bathing cloth or towel with the other hand. Start by washing from top first to bottom last. You can use special shampoos and soaps.
  • When you finish lift the baby out and cover him well with his towel and leave the bathing tools for a later time.
  • Put a new diaper and dress him well.
  • When the baby sleeps you can clean the bathing tools and the bathroom.

Diapering your new born

Changing baby’s diaper

  • Preparing the changing area: you have to choose a place that is safe and clean. Then you have to prepare the tools that you will use because it is not safe to leave the baby un-attended to go get a tool that you forgot to prepare.
  • Unfasten the old diaper but leave it in place because air can make the baby let go one more time.
  • Hold the baby from his heels and raise the bottom a little bit, then wipe all over the bottom and inside of legs with wipes. After you make sure everything is clean remove the old diaper and set it aside and put a new diaper under the baby
  • Use anti rash cream between the legs and buttocks and at the genitals.
  • Fasten the sides well. For a newborn you can tilt the upper part of the front side down a little bit to give room for the umbilical cord and clamp. Take the old diaper and make it into a small ball and toss it in the garbage pin.

What happens after delivery

After delivery

Puerperium period (return to pre pregnancy time) is usually from 6- 8 weeks after labor. It involves body organs returning to their original state.

  • Emotional changes: Some mothers experience post delivery depression or stress. It is usually due to the sense that they are now responsible and life won’t be the same again. Responsibility can sometimes be heavy but on the other side a baby in your life is something cheerful for sure. Your husband can help you by giving you time to sleep and rest and help with house work. He can even encourage you and also take you out every now and then.
  • General care: You will start to loose weight after labor. You need extra  calories and certain nutrients to maintain successful lactation and for your body to heal. You are also advised to do some walking as early as possible.
  • Uterus: After labor the uterus starts to return to its original size  before pregnancy. It might be associated with minor contractions and it will reduce in frequency by time.
  • Urine: There will be frequency of urination as the body is trying to get rid of extra fluids, and at the same time urine will be constipated. A woman is encouraged to urinate every 6 hours.
  • Intestine and bowel: you will be viable to constipation in the first period of time, you can overcome that by eating vegetables and fruits and some laxatives.
  • Skin care and stretch marks and cholasma (skin darkening): the stretch marks change color from red to bright silver and cholasma lightens up.
  • First menstrual period after labor: It differs from one woman to another. It can extend from few weeks to a whole year. A lactating woman can have her periods later than a non-lactating woman.
  • Sexual relations: Sometimes after labor there would be a wound  (especially if episiotomy is made) and some pain and vaginal discharges. The mother also would not be psychological ready to resume her sexual life again. With time those symptoms heal and then she can try the first relation. Till that happens continue sharing your support with your husband.
  • Family planning: family planning and contraception are discussed with the doctor in the first visit after delivery.
  • Post delivery exercises: You are advised to start exercising early.
    • Sleep on your back with your knees bent , raise your head and shoulders with your arms towards your knees then come back (Repeat 5-10 times )
    • Sleep on your back with your knees bent , raise your hips up and keep it for 30 seconds then return back ( Repeat 5-10 times)
    • Sleep on your back with your knees bent , push your leg forward then up and move your sole front and back then return it again , repeat with your other leg( Repeat 5-10 times)

Pain relief during labor

Pain relief in labor

The pain during contraction is caused by dilation of the cervix by uterine contractions. Labor pain is different from one mother to the other and is also different from each delivery to the other, this is why different pain control plans have been developed and individualized according to each mother’s sense of pain, personal preference and what is suitable for her and her baby’s health. Some pregnant women change their decision of pain relief during the course of labor itself from one type to another. others think that they don’t deserve to be mothers if they don’t stand the pain of delivery. Our personal advice is not to mix up your pain endurance ability with your sense of motherhood.

  • Analgesic drugs :They provide pain relief over the entire body without causing loss of consciousness. Often given as an injection or combined with other drugs to relieve tension or nausea, they act on the whole nervous system. They may cause drowsiness and make it hard to concentrate; because these drugs can slow the baby’s reflexes and breathing at birth, they are usually avoided just before delivery.
  • Local or regional Anetheistic drugs: They make you loose sensations and with some kinds you may also lose consciousness.
  • Epidural Block: it is a form of local anesthesia which numbs the lower half of the body. It is injected into the lower back, where the nerves that receive sensations from the lower body meet the spinal cord.
  • Local anesthesia: it is usually injected into the vagina or area surrounding it and they are useful when the doctor has to make an episiotomy or fix any tears that might have occurred during birth
  • General anesthesia: If used the mother will not be awake or feel any pain during delivery. It is given in one of two ways: through a face mask or through IV line. Serious side effects, though rare can occur.
  • Alternative methods:    Lamaze technique: Lamaze teaches pregnant women that pregnancy is something natural and it tries to change their comprehension of pain by training them to link pain to breathing or meditation so that by time pain can be substituted by positive feeling. It is all supervised by a coach. Bradley method: the coach is the father himself and it consists of the same methods of lamaz plus good nutrition of the mother.

Induction of labor

Induction of labor

Induction involves use of drugs or procedures that starts uterine contraction to terminate pregnancy and start labor. It is used in cases where pregnancy has to be terminated (pregnancy complications like hypertension, diabetes, heart problems , rupture of membranes with no associated contractions) or when  normal labor contractions didn’t start in due time.

Normal vaginal delivery

Normal vaginal delivery

It occurs when the baby’s time inside the uterus is over and it is coming out of the uterus vaginally. The uterus starts to contract(he uterus tightens and relaxes at regular intervals, causing the abdomen to feel hard, then soft. which make the cervix thin out (efface) and open as wide as it can (dilate).  Contractions also help in pushing the baby deeper into the pelvis till it comes through the vagina. Normal labor occurs on 3 steps:

First stage

It takes about 8-12 hours in primigravida (First time to deliver) and shorter in multigravidas (Delivered before). It is the part where the cervix dilates to 10 cm full dilation. Don’t push down and do your first stage breathing exercises.

Second stage

It takes about 30-60 minutes. The baby comes out here. It occurs in a well prepared operative theater. It is preferred to perform the breathing exercises in this stage. The doctor might a small incision between the vagina and the anal opening (episiotomy). It is done to enlarge the vaginal opening to facilitate an easy delivery. Not all deliveries need an episiotomy

Third stage

It takes about 10-30 minutes. The placenta comes out in this stage. When the placenta separates a gush of blood and the cord comes out more. Your doctor massages your abdomen and pulls the placenta out then massages again to help the uterus to contract. The doctor will fix the episiotomy at that time.

Fetal follow-up

The fetus should be followed up all the time of labor using sonic aid Doppler to hear the fetal heart beats or CTG to draw the fetal movements against uterine contractions.

What are the signs of labor?

Signs of labor

If any of the following signs happen call your doctor and head to the hospital immediately:

  • Contractions in your lower abdomen which increase in strength and frequency. The interval between contractions decreases from 30 min to 15 min to 10 min and then less and usually becomes more felt in the lower abdomen. Each contraction lasts from 30-70 seconds.
  • Pressure and heaviness in your lower abdomen with the urge to pee.
  • Expulsion of a brownish mucus discharge (THE SHOW: mucus which closed the cervix during pregnancy, thus denoting the starting of cervical opening and dilation)
  • Water flowing out of your vagina.

Baby preparation

Labor bag preparation

  • A baby sleeping crib with a blanket
  • Baby walking stroller
  • Easy to wear going out outfit (better with buttons from top to bottom or two pieces)
  • Cotton hats for the summer sun or winter cold
  • Gloves to protect the face from involuntary hand movements
  • Soft socks and shoes. Try to choose a material that does not cause allergy to the baby
  • Under wear, Food covers
  • Diaper changing: foldable plastic pad for changing outside the house, baby diapers, cream to put on before wearing the new diaper, wipes
  • Pacifiers which comply with orthodontic standards to protect the jaw,
  • milk bottles of large size.
  • A nipple which comply with orthodontic standards and has the right flow (slow, medium and fast).
  • Sterilizing choice of a boiling pot, antimicrobial solutions or microwave/steam sterilizer.  , A Water heater and brushes to clean the bottles,
  • baby shampoo, baby lotion, baby sponge, baby tub, soft towels, water temperature thermometer, Special soap for washing the baby’s cloth, Nose suction , and soft hair comb and brush.

Ectopic pregnancy

Ectopic pregnancy

It is a pregnancy that implanted outside the uterus. Ectopic pregnancy usually happen in the fallopian tube and rarely in cervix or abdominal cavity. An ectopic pregnancy can’t survive, and the growing tissue may destroy various maternal structures and also cause internal hemorrhage.

Placenta praevia

Placenta Preveia

Normally the placenta is formed at the upper part of the uterus, sometimes the placenta is formed at the lower part of the uterus and part of it or all of it is covering the cervix. This is a dangerous situation as it might lead cause the placenta to bleed from cervix. It can be diagnosed by ultrasound scan. The pregnant woman is advised to rest more and have no sex. There is no medication to treat placenta praevia. If bleeding occurs and the baby’s gestational age is suitable for delivery, the mother can be delivered by a Cesarean section.

Intra uterine growth retaradation

Intrauterine growth retardation

The growth retarded baby presents with less than expected size either at labor or at time of ultrasonography. It is diagnosed by the doctor when he is doing his routine ultrasonography or a previous history of delivering a growth retarded baby

Premature labor

Premature labor

It occurs when a baby is delivered before 36 weeks of pregnancy. Factors that lead to premature labor are e.g. premature rupture of your membranes, weak cervix, and placenta separation. The baby is not yet ready to face life outside the mother’s uterus in terms of respiration, temperature control and bleeding, liver function and infections. So the babies are kept in special incubators for a period of time till they are ready.

Gestational diabetes

Gestational diabetes

It is a kind of diabetes that occurs only in pregnancy. If a pregnant woman gets gestational diabetes there would be increased risks during her pregnancy like: abortion, bleeding, fetal problems like fetal death or increased fetal size or increase in amniotic fluid volume. A doctor can follow up with sonography and laboratory tests of glucose in blood and urine. G.D can be controlled by special diets and exercise in moderate cases or drugs like insulin in severe cases.

Headache in pregnancy

Headache in pregnancy

Pregnancy Hormones increase result in dilatation of vessels thus pooling blood into them resulting in lowering of mother’s blood pressure; also blood glucose level is lowered. Other factors that contribute to dizziness are lying on your back in the third trimester or severe pregnancy induced anemia. Headaches are caused by hormonal changes, blood expansion or lack of sleep. Eat well and rest well.

Heart burn in pregnancy

Heartburn in pregnancy

The commonest symptom in pregnancy, it is due to acid reflux from the stomach to esophagus. It is relieved by dividing your meals into smaller meals and limiting your spices and oily meals intake. Consult your doctor If the condition persists.

Hip pain in pregnancy

Joint and hip pain in pregnancy

due to pregnancy hormones, laxity in joints occur which lead to pressure on the nerves within them. Symptoms range from pain to parathesia. Consult your doctor at once.

Skin and breast in pregnancy

Skin care in pregnancy

Skin care

Skin changes occur in pregnancy due to hormonal changes. Sometimes there are stretch marks on your stomach, breast, and buttocks. And also there might be darkening in the skin. Use of moisturizing cream daily rich in vitamin E is advised. Also rubbing skin oils on your stretch marks help in decreasing them. Start oiling from your fifth month.

Breast changes

Breast change clearly in pregnancy, it starts to be soft early then it increases in size and hardens by time. Nipples and areola become darker and larger. Breast milk ducts develop towards delivery. Use bras with good lifting and clean your nipples daily with warm water and clean the skin around them with skin oils to prevent stretch marks starting from the fifth month. If you think that your nipple is not visible or flat it will be difficult for the baby to feed. You can do some nipple preparation exercise, press at the base of the nipple to push it out then pull it out and around in a circular soft motion. Do it in a non painful way.

Nausea and morning sickness in pregnancy

Nauea and morning sickness

The real cause is not known yet but it is generally attributed to increased pregnancy hormones. It can be reduced by eating food that is easily digested and not spicy or fatty. It is also advised to split your meals over many small and frequent meals instead of 2 or 3 big meals, not to lie back immediately after a meal and lastly avoid nauseating smells and aromas. Symptoms tend to end by the 16th Week. Consult your doctor for treatment and advise as sometimes vomiting becomes persistent (Hyper emesis gravidarum) and needs hospitalization before deterioration.

Leg cramps in pregnancy

Leg cramps in pregnancy

Very common in late months of pregnancy and especially in the evening .It happens due to pressure of the uterus on the leg veins and nerves. Exercise and leg massage are advised.

Teeth and gum in pregnancy

Teeth and gum in pregnancy

Because of the hormonal changes, blood increases towards your gums making it more sensitive. At the same time infection occurs more frequently increasing mouth inflammation and infection. Brush your teeth daily before sleep and after eating. Check with your doctor if there is any problem.

Backpain in pregnancy

Backpain in pregnancy

As pregnancy progresses, the growing uterus press on your backbone vertebra causing pain. Consult your doctor if you can’t stand the pain.It can be decreased by not sleeping on your back, exercise and massage.

Leg swelling in pregnancy

Leg swelling in pregnancy

During pregnancy your legs start to swell, this happens due to the pressure of the uterus on veins and lymphatic of your legs making them pool into your legs and swells them. Sometimes this is confused with hypertensive problems of pregnancy. Consult your doctor to make sure everything is normal. It can be decreased by avoiding long stands, raising your legs on a pillow while sitting and decrease your salt intake.

Constipation in pregnancy

constipation in pregnancy

It is very common in pregnancy due to pregnancy hormones which leads to intestinal muscle relaxation. In addition to pressure of the growing uterus on your intestine. You should drink lots of fluid and eat enough fibers in fruit and vegetables to relieve constipation.

Pregnancy urinary frequency

Urinary frequency in pregnancy

It is normal that urination increase in pregnancy as the uterus presses on the bladder while it grows. Frequency only increases and not pain. If there is pain you should consult your doctor because it might be a urinary tract infection.

Traveling in pregnancy

travelling in pregnancy

Vacation is an exciting thing, you can travel after the first trimester because nausea and fatigue would be less by that time. It is preferable if you wear loose clothes and flat shoes. It is also good to have some snacks for the trip. Please walk every 2 hours to avoid swelling up your legs. Always revise your travel plans with your doctor.

Smoking in pregnancy

Smoking in pregnancy

It is highly recommended that you do not smoke during pregnancy or to be around smokers. Smoking reduces the capacity of blood to carry oxygen leading to small-for-dates babies and sometimes preterm delivery.

Pregnancy Wear

Pregnancy clothes and shoes

It should be easy to wear, comfortable, putting in mind that your size will increase with time. Underwear is preferred to be from cotton.

Shoes with flat heals are better than high heals. On the contrary to the misconception that high heals results in abortion or premature labor. All what high heals does is adding extra load on the back muscles to keep the body straight and thus stressing them.

Sex in pregnancy

Sex in pregnancy

No need to stop sexual activities unless you have a history of previous abortion or premature labor. It is advised to decrease it in the first 3 month where the gestational sac is not yet stable and in the last month as the seminal fluid has elements which cause contractions and might induce premature labor. Sex should be gentle and not rough, using positions which doesn’t add pressure on the abdomen. Some women feel disgusted from having sex during pregnancy because of her hormones or nausea or discharges while on the other hand other women have a more powerful sexual drive in pregnancy.

Resting in pregnancy

Rest in pregnancy

8 hours is the best amount of sleep per day. Sleeping in the afternoon is important too. You may find it hard to lay in bed now because of your growing abdomen or your back pain or even heartburn. You can lay down on your left side as it has been proven that it increases blood flow to the baby and reduced pressure on the inferior vena cava.

Pregnancy Exercise

exercise in pregnancy

Pregnancy Exercise

Exercise allows blood to run more thus pushing more oxygen and nutrients to the baby and to the mother’s muscles. Exercise decrease nausea, back pain, mal digestion, muscle spasms and also nervousness. It increases appetite, muscular power to pelvic muscles promoting easier delivery.

Exercise guidelines

  • Consult your doctor for advise on safe exercises.
  • Exercise should be regular and increase in intensity gradually.
  • There should be rest periods between exercises.
  • Stop exercising on any danger signs and consult your doctor.
  • Avoid exercising for long periods of time or in hot weather and always drink enough water.
  • Wear good cotton exercise suites and shoes.
  • Eat a small snack before exercise with 30 minutes and good meal after.
  • A pregnant woman in her third trimester should avoid doing any exercise that involves lying on her back for a long time
  • Exercise should be prevented in a woman with history of: Diabetes, hypertension, cardiac or chest problems, anemia, previous history of abortion or premature rupture of membranes or contractions or labor.

Exercise types

Outer Thigh Lift

Outer Thigh Lift
Outer Thigh Lift

Exercise to strengthen your outer thigh (abductor) muscles, glutes.

Lie on your left side, your head resting on your hand, your shoulders, hips, and knees in a straight line. Slowly lift your top leg straight up and slightly back as high as you can and hold for 5 seconds then lower slowly . Do 5 times then change sides

Cat

Cat
Cat

Exercise to strengthen your back.

Start on your hands and knees, with your back in a natural relaxed position. By tightening your abdomen and buttocks, push your back up into a hump, and drop your head down and hold this position for 5 seconds then  slowly return to the starting position. Repeat 10 times.

Step Up

Step Up
Step Up

Exercise to strengthen thighs, hip flexors, hamstrings and gluteal muscles.

Start by standing with your feet 30 cm apart and infront of a step which is around 40 cm higher. Allow your arms to hang comfortably down by your sides. Keep your back straight and step up with your left leg.  Step down off the step with your right foot first and then the left foot and return to the starting position. Repeat this action, alternating the leading leg each time. Do approximately 20 to 30 total repetitions.

Wall Press

Wall Press
Wall Press

Exercise to strengthen your chest , shoulder, back and arm muscles.

Stand a couple of cm from the wall and Place hands on the wall, shoulder width apart.  Bend your arms and lower your chest to the wall, then straighten your arms and return to the starting position, repeat 10 times

Pelvic Thrust

Pelvic Thrust
Pelvic Thrust

Exercise to strengthen your gluteal muscles and lower back.

Lie on your back, with your legs bent at right angles and your arms by your side, palms facing down then Lift your hips until your spine and thighs are aligned. Hold this for 5 seconds then slowly return back . Repeat 10 times.

Neck Rotation

Neck Rotation
Neck Rotation

Exercise to strengthen neck muscles.

Stand or sit in a relaxed position, with your eyes closed. Gently roll your head around, making a full circle. Repeat 5 times one way, then repeat in the opposite direction

Hamstring Lift

Hamstring Lift
Hamstring Lift

Exercise to strengthen your back, gluteals and hamstring muscles.

Start by resting on your hands and knees, with your back flat and abdominal muscles squeezed in tightly. Extend your leg straight behind you then left it up until it levels higher than your back . Hold for 5 seconds then lower your leg and repeat 10 times on one side then changes legs and repeat.

Forward Lunge Exercise

Forward Lunge Exercise
Forward Lunge Exercise

Exercise to strengthen your thighs, hip flexors, hamstrings and gluteal muscles.

Start by standing with your feet about 20 cm apart with your toes pointed forward.  Step forward with one leg and lower your body to 90 degrees at both knees then Push up and back to the starting position. Repeat 10 times then change legs.

Squat

Squat
Squat

Exercise to strengthen your leg muscles.

Stand with your feet about two feet apart and toes turned comfortably out. Slowly bend your knees, keeping your back flat. Rise slowly, concentrating on the leg muscles as you push upward. Repeat 5 times then increase to 10

Side Lunge
Side Lunge

Exercise to strengthen your adductor and abductor muscles, thighs and buttocks.

Start by standing with your feet comfortably apart with your toes pointed forward.  Step to the side with one leg and lower your body slightly at both knees. Then Push up and back to the starting position. Repeat 10 times then change to the other side.

Forward Bend

Forward Bend
Forward Bend

Exercise to strengthen your lower back.

Stand with your feet approximately 50cm apart. Then Bend slowly forward at the hips, keeping your back straight. Hold still for 5 seconds then raise your torso back to the standing position. Repeat 10 times.

Kegel

Pelvic floor muscles exercise-kegel exercise: pelvic floor muscles raise and support internal pelvic organs. For the exercise the woman imagines herself wanting to stop the flow of urine coming out. There is a certain muscle that she contracts to stop urine coming out. It should be contracted and held for some seconds then left to relax. She can go on contracting, holding for 3 seconds then relaxing the muscle repeatedly. She can do it while sitting or standing. The exercise intensity should rise gradually till she masters identifying the correct muscle.

Walking

Walking is one of the best kinds of activities you can do when you’re pregnant. It will give you more energy, improve your circulation, and reduce constipation, bloating, and swelling.

Yoga and pilates

They help strengthen your muscles and makes you comfortable.

Pregnancy Nutrition

Pregnancy nutrition

You are pregnant, you are scared to gain much weight and at the same time you want to eat enough for your baby. Nutrition is the golden rule of pregnancy. Some people don’t know what to eat to provide the best for the baby. The food that you eat is transferred to the baby through the placenta so what you eat is very important.

Food is changed to energy units called Calories; the body uses what it needs and converts the extra to fat. A woman needs about 2200 calories daily while the pregnant woman needs about 2500 calories.

Recommended weight gain

  • Women with normal pre pregnancy weight: 11-16 kgs gain
  • Less than normal :13-18 kgs gain
  • More than normal :7-11kgs
  • Twin pregnancy:16-20 kgs

Weight increase components : baby 3.34kg, placenta 0.9kg, blood size 2 kg, plasma 2kg, uterus 1kg, breast 1kg, amniotic fluid 3 kg

Rate of weight gain : 1-2 kgs first trimester, 0.5 kgs/week till the end.

Food Consists of

  • Proteins: build up body tissue.  Found in: Meat, fish, eggs, milks, green beans, rice, and bread.
  • Fats: Provide the body with energy. Found in meat, fish, egg yolk, milk.
  • Carbohydrates: Source of energy. Found in sugar, pastry, rice, fruits.
  • Essential elements: Iron is necessary for making Hemoglobin which carries oxygen. Found in Vegetables, liver, meat. Zinc is necessary for making proteins and enzymes. Iodine is necessary for thyroid gland function and Fluoride is important for teeth protection. Calcium is necessary for bone formation and to prevent leg cramps in the mother. Found in dairy products and milk. Magnesium, potassium and phosphorus are important for good muscular balance.
  • Vitamins: They help in all body bio-chemical reactions.
    • Vitamin B1: Helps in digestion. Found in whole grain wheat, yeast, potato.
    • Vitamin A : Essential for growth. Found in milk, butter, egg yolk, and fish. Its intake should be monitored as its excess is not recommended.
    • Vitamin B2, B5 : Necessary for cell division. Found in milk, whole grains, and vegetables.
    • Vitamin B3:  :Helps building neural cells. Found in whole grains, green vegetables, eggs, and fish.
    • Folic Acid: Helps in cell formation and well formation of the fetus neural tube. It also helps in forming red blood. (Green beans, cabbage, citrates, meat, and chicken)
    • Vitamin B6:  Helps in digestion, deficiency lead to neural psychosis and anemia.
    • Vitamin C:  Promotes the binding material of vessels & tissues. Found in vegetables and fruits.
    • Vitamin D:  Helps in calcium metabolism. Found in milk, egg yolk, butter.
    • Vitamin E is good for preventing varicosities and stretch marks. Found in carrots, tomatoes, soybeans, corn, asparagus, oatmeal, olive oil, sunflower oil, walnut oil, peanut oil.

 

 

Pregnancy Nutrition

A typical pregnancy diet:  Your Diet has to be balanced: about 20% proteins, 30% fats and 50 % carbohydrates.

  • Proteins -6 ounce per day: an ounce is: 30g cooked fish, poultry or lean meat or lancheaon or sausage – 1/4 cup cooked beans(lentilse or hummus or beans) – 1 egg – 15 g nuts seeds.
  • Grains – 6 servings per day. a serving is: 1 slice 35 g bread –  ½ muffin 35 g – ½ cup 125 ml : Brown rice, white rice, pasta  – 3 cups 500 ml Popcorn – 1 cup cereals – 30g crackers – half cup oatmeal
  • Vegetables – 2.5 cups per day: a cup is:  1 cup yellow or orange vegetables (pumpkin, carrots, yellow beans, sweet potato, red sweet pepper) – 1 cup green vegetables (tomatoes, cabbage, peppers, broccoli, cucumber,  egg plant, okra, soy beans, garlic, onion, parsley) – 1 cup starchy vegetables (corn, green peas, potatoes) – 1 cup vegetable juice – 2 cups dark green leafy greens (dandelion green, collards, spinach, lettuce,spinach).
  • Fruits 2 cups per day: a cup is: 1 cup 100% fruit juice – ½  cup dried fruit – 1 Medium sized fruit (apple, orange, banana, pear, plum, guava, kiwi, peach, mango, grapefruit) or  3 apricots, 2 figs, 30 grapes, ½  cup parries – 1 cup chopped fruit (cantaloupe, watermelon)
  • Milk Products – 3 servings per day: Serving e.g. is: 1 (250 ml) cup milk or yogurt – 50 grams of cheese – 1 and half cup of icecream – 1 cup of milk shake.
  • Oil – 5-6 tablespoons of oil. One tablespoons is : half a tablespoon of margarine or mayaonise – 15 g nuts – 8 olives
  • Liquids: Drink at least 8-10 glasses of water every day.
  • Vitamins and minerals: it can be taken by supplements written by your doctor.

Food warnings

  • Don’t eat raw meat or eggs
  • Don’t eat non-washed vegetables and fruits.
  • Don’t drink un-pasteurized milk.
  • Lower your salt intake. (Make it less than one tablespoon)
  • Always try to choose lean meat like turkey meat.
  • Always choose food with enough fibers and low sugar and low fat.
  • Eat little meals to make sure stomach is never empty or full.
  • Steer clear of greasy, spicy or high fat food.
  • Remain upright after meal and sleeping.
  • Wash your hands before handling food, wash all vegetables and fruit thoroughly and cook raw meat well.
  • Limit your tea intake as it lowers your iron absorption.
  • Caffeine: Limit your caffeine intake as it is an element that does not have any vitamins or minerals or nutritional values. It is stimulating; it increases heart rate, irritability, insomnia and headaches and is diuretic. It also lowers your iron absorption.
  • Alcohol: it is better not to have alcohol during pregnancy as it is rapidly transferred from mother blood to the fetus through the placenta. It has many side effects which include premature labor, abortion, restricted mental and physical growth of born children and FETAL ALCOHOL SYNDORME which causes defects in heart and face development in addition to mental and physical growth restriction after birth.

Fetal movement and wellbeing

fetal movement and wellbeing

What is fetal movement?

During 20-22 weeks you should start to feel your first movement which can be like bubbling in your stomach or waves on your abdomen. Fetal movement is an indicator of fetal wellbeing, so it is important that you become aware of it and call your doctor if anytime you feel your baby movement is less than before

What is Biophysical scan?

Ultraosund scan is done to  document the fetus movement : breathing, limb extension, closing and opening of his hands, amniotic fluid volume which is an excellent indicator for placenta function.It can be done 1 or more times per week according to the necessity

What is Non stress test?

A simple non invasive examination which consists of putting two probes on the mother abdomen, one to measure fetal heart rate and the other to measure uterine contraction. The mother presses a button whenever she feels a fetal movement within the 20 minute exam time. The theory is that there should be a deceleration rate and pattern in the fetal heart rate that normally occurs after fetal movement in case of a well oxygenated fetus; if the pattern is not there exams should be done to know if there is a problem due to insufficient placental function, umbilical cord compression or drugs taken by the mother. If the exam results are not comforting prompt delivery should be done.

What is Doppler scan?

a Doppler can detect movement, it can be used to detect blood flow in vessels and is used in certain ultrasound machines while the other type can be used in clinics to hear fetal heart beats (sonic aid).

Fetal genetic scanning

Fetal genetic scanning

First trimester scan

It is a test performed at 11-13 weeks of pregnancy that can identify more than 85% of babies with Down syndrome and trisomy 18. The screening involves

  • Ultrasonographic measurement of nuchal translucency (a skin fold behind the neck). A positive result is not diagnostic but indicates that an increased risk for a problem exists and that additional testing should be considered.
  • Chorionic villous sampling in week 13 which is taking a sample of the chorionic villi of the placenta for genetic analysis under the guidance of ultrasound machines for safety.

Second trimester scan

It is a test performed at 14-17 weeks of pregnancy that can identify more than 85% of genetic abnormalities. The screening involves

  • Biochemical analysis of maternal serum levels of beta-hCG (From the placenta), Free Estriol (From the fetus and placenta) and alphafeto protein (From the fetus)
  • Ultrasound anomaly scan at 18-21 weeks
  • Amniocentesis: It is performed at 16-20 weeks and it consists of a study of amniotic fluid after taking a sample of it by an aspiration needle guided through the abdomen by ultrasound to choose the safest and best location for aspiration.

Fetal Ultrasound

fetal ultrasound

Fetal inspection is done to check the normal growth of the fetus including its internal parts, the absence of any growth anomalies due to hereditary or genetic factors, absence of any disease in any organ of the fetus.

This is done by ultrasound which is a machine uses ultrasound waves to draw the internal organs of the mother and fetus on a display screen. There is two dimensional black and white ultrasonography, 3D ultrasonography which gives a more detailed 3 dimensional picture of the fetus, 4D ultrasonography which gives 3D picture in motion.

Ultrasound is used to

  • Confirms presence of pregnancy and its location and accurate dating of pregnancy.
  • Placental location and status.
  • Cervical canal length measurement.
  • Detailed scan at about 20 weeks to check any abnormalities in the baby’s structural development and growth.
  • Doppler scanning for fetal growth retardation and repeated abortions.
  • Amniotic fluid details.
  • Baby presentation.
  • Fetal sex.
  • Biophysical profile by checking the baby respiration, muscle movement and tone.
  • Expected date of delivery.
  • Baby’s weight.

What happens at your obstetrician?

What does your doctor do in pregnancy

Your OBGYN does two roles, the first is inspecting your fetus and making sure it is growing well and without complications and the second is inspecting you to make sure that you are adapting well to pregnancy and interferes when he detects any problems. Your doctor will also provide a safe delivery plan and support during the post delivery period till you return back to your pre-pregnancy shape.

Good antenatal care has proven efficiency in reducing maternal and fetal problems and even death during pregnancy period or delivery period and after delivery period. In addition new techniques have been developed for prenatal testing that facilitated early detection of problems in the fetus which give parents time to check for medical or surgical treatment after birth and also to prevent the same problems from happening again in other pregnancies.

What does the doctor do in the first visit?

  • Your doctor will start an antenatal care file for you
  • He will ask you some medical  and family history questions which have to be answered accurately like:
    • Blood group and Rh factor?
    • What illness did you have before?
    • Did you do any operation before?
    • Are you taking any medication?
    • Were you pregnant before and how did it go?
    • Is there any a familial disease or hereditary traits in your family.
    • And some other questions which will help him have a general idea on any risk factor that might happen during your pregnancy period.
  • Then he will ask you when was the first day of your last period?
  • Your weight and blood pressure will be recorded in the first visit
  • You will  be asked to do some laboratory investigations (e.g. Blood Group, Rhesus factor, complete Blood picture, Blood Sugar, urine analysis, etc)
  • The doctor will decide upon the first ultrasound scan which will be around the 7th week of pregnancy. Usually the scan will be through your abdomen and you should have a full bladder. Sometimes the scan will be done through the vagina but the ultra sonographer will talk to you about this if it proves necessary.
  • He will give you instructions regarding nutrition, resting and exercising and will teach you the danger signs during pregnancy e.g. (vaginal spotting, fatigue, lower abdominal pain, severe vomiting or headache) any of which if you feel, you contact him at once. He will also explain all the fetal wellbeing exams that are performed.
  • Your doctor arranges your visit schedules according to your case. You have to follow your doctor instructions well to deliver a healthy baby. You have to discuss with your doctor any changes that happen so that he can differentiate between normal and abnormal changes.
  • Sometimes surgical interference occur (E.g. Cervical Cerculage)

What does the doctor do in every visit?

  • Each visit you will be inspected for weight, blood pressure, general inspection with the addition of inspecting the baby inside you .The doctor makes sure that everything is all right and there are no signs of danger like e.g. pre eclampsia, gestational diabetes.
  • Then he prescribes the appropriate nutrition for your pregnancy interval and exercises which are suitable for you.

How do I know if I am pregnant?

How do you know you are pregnant

A delayed menstrual cycle is usually considered the first sign of pregnancy for a woman who menstruates regularly and has a regular sexual life. But for a woman with an abnormal cycle it would be difficult to notice it. The accurate proof of pregnancy is pregnancy hormone testing, it can be either

  • Home urine test: Very easy to use, affordable, but can give false results as it is not very sensitive. Better done after 14 days from ovulation day.
  • Blood testing: It can detect the hormone with 100% accuracy and in a very early period nearly 7 days after fertilization. It also helps in dating pregnancy by measuring the quantity of the hormone.