Women Uninterrupted is an inter-generational podcast bringing you difficult, different and uninterrupted conversations about being a woman.
Head swimming with information from all the parents who have ever been pregnant before you? For help, we invited an expectant mother to talk to a gynaecologist. We conversed about trimesters, sperm banks, exercise, gestational diabetes, myths and other pregnant matters.
Apparently, you can go ahead and eat that papaya.
Host: Anna Thomas Guests: Dr Shefali Tyagi & Ashwini Athavale
Title music - The Carpet Beat:Maya Dwarka
Production:Anna Thomas
Email: editor@thehindu.co.in
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Not love at first sight
By @sreedevi.thekkedath, musician
Last year started well for me. That January, we were leaving for Kochi to stay for three months. The aspiring singer in me couldn’t be any happier, getting to live in the hub of the Malayalam film industry. I had been looking forward to the trip for months now! With such happy and positive energy in me, I was quite hopeful about having some “good news” as well to share that month.
I had been testing for a week, using pregnancy kits available over the counter. I would always end up seeing really faint lines that no one else could even spot. There were times I thought I was seeing lines because I was expecting them. On the morning of January 4, before we left for the airport, I decided to use the kit one last time, and guess what - there they were - two pink lines!
It felt surreal. I couldn’t believe what I saw. I couldn’t believe there was a tiny human growing inside me. Every morning, I’d wake up with a smile on my face, thinking about the little one forming inside me. I couldn’t contain the excitement of becoming a mother,
Until some sort of fear started overshadowing it. Seeing how the lives of most women in generations before ours had drastically changed since the arrival of a baby, I was under stress. I was scared of being tied down, not being able to follow my dreams, and compromise my career. I was afraid of not being able to do a lot of things I could freely do before pregnancy. This constant fear about the new life waiting for me stayed for weeks. I found it weird that something I had been waiting for was now making me uneasy and scared. The elders in my family could not understand the fear. I was told I shouldn’t be stressing out thinking so much about it.
I slowly realised that this is quite normal, and it’s okay to feel this way. After all, I was going to be responsible for this new tiny human I had made. He/she was going to be completely dependent on me for the following few years. I let myself be, and decided to take it as it comes.
Three months into my pregnancy, I received my very first call for playback singing. As I progressed into my pregnancy, days would get more and more exhausting, even without exerting. I had promised myself that I was not going to let pregnancy compromise my career, and that’s probably where I got all the energy I had while recording. This was followed by two more projects. I realised that this little one growing inside me was my lucky charm.
Six months later, on a September morning, I was rushed into the labour room as I had started experiencing contractions. The labour pain got stronger and harder to handle. Hours passed by, and I couldn’t take it any more until, at 2:48 AM, I gave birth to my beautiful baby girl. Quite honestly, I haven’t experienced anything more painful and traumatic than childbirth. I had been pushing someone who was refusing to come out, until the doctor pulled her out using forceps.
No, I didn’t get excited when my daughter was brought to me. I was exhausted beyond words. They say that you know it’s all worth it when you see your baby in the nurse’s arms. I couldn’t even process what that feeling was. My body was in so much pain, having suffered a fourth-degree tear. I wanted to feel normal again.
It was over time that I developed a bond with my daughter. It was nothing like ‘love at first sight,’ as they say.
It took time, and that’s fine.
Transcript
Anna: Hello, I’m your host Anna Thomas on Women Uninterrupted and with me I have Dr. Shefali Tyagi, obstetrician, gynecologist and an author, with more than 21 years of experience. Welcome, Dr. Shefali. In this episode of Women Uninterrupted, we are talking about pregnancy so I have invited Ashwini Athavale, who is in her third trimester and looking forward to having her second baby. Thank you for coming, Ashwini, and welcome. How are you feeling today? And second question: Do people ask that of you enough?
Ashwini: Thank you for having me over, Anna…Feeling very fit! And yeah, I’ve been getting a lot of that recently from friends and family.
Anna: That’s a refreshing change from the usual answers I get from pregnant women. What steps do you take to keep fit?
Ashwini: During my first trimester, I went gymming regularly. Starting from the second trimester, I’ve been either walking or going swimming regularly.
Anna: Is that following doctor’s advice? I guess that’s from your advice, Dr Shefali. What kind of exercise would you recommend for the three trimesters? Are they different? Can we do the same things throughout the three trimesters?
Dr Shefali: It actually depends on how active you were before pregnancy. What I find is that the majority of people are sedentary, and the moment they become pregnant, they want to start everything. My advice to the listeners would be if you’re planning pregnancy, please start becoming active now. Your body needs to get used to these exercises before you jump into exercise during the pregnancy. In pregnancy, a lot of changes are happening to each and every organ of your body. And suddenly, if you’re not used to exercising, it might be slightly difficult to cope up. But if you have been exercising, then it’s a good idea to continue in all three trimesters. Walking is one of the easiest to do…30, 40, 45 minutes of walking every day. If you have been doing yoga or stretching, that can be continued. It’s a good exercise which can be continued all three trimesters. It’s highly recommended to be physically active during pregnancy.
Dr Shefali and Ashwini
Ashwini: Dr Shefali, my glucose tolerance test numbers are a bit above normal. Any advice on the diet and exercise for gestational diabetes?
Dr Shefali: Gestational diabetes is rampant in Indian population. In fact, we have almost five times the world average, and every third to fourth woman for whom we are testing in pregnancy is turning out to be a gestational diabetic. You have to be very careful about diet from day one. That usual concept that, “Oh, you’re pregnant, you eat for two,” - it has changed now. You need 300 kilocalories more in pregnancy, which is easily doable. You have to just increase slightly from your non-pregnant state. We generally recommend five to six small meals rather than three major ones. Breakfast, mid-morning snack, lunch, evening snack, dinner, and maybe midnight snack if required. And in food, you have to stick more to the proteins and the vegetables rather than high carbohydrates or fried food or desserts, etc. That you must cut down. Plus, regular walking exercises are strongly recommended. If you start following these steps from day one, majority of times you will not pick up diabetes. But if you have shown higher numbers, then you need to be careful. And then of course a dietitian consult is a must. Improve your diet, cut down the carbohydrates, watch out for the calories, and monitor your sugars regularly.
Anna: Dr Shefali, now that Ashwini is in her final trimester, I think she wants to ask you about…
Ashwini: What are the signs and symptoms of labour and how do I recognise if they are real? Similarly, how do I identify preterm labour?
Dr Shefali: For labour, there are generally four main signs. One is labour pain. In labour pain, you will start feeling like a period cramp type of feeling. The whole baby bump becomes absolutely tight as if somebody is squeezing you, and a wave of pain will start from back to front. The pain and the tightness will remain for, let’s say,10-15 seconds and it will go away. Initially it’s very irregular, but then it starts building up. The frequency and the intensity will continue to increase. From 15 seconds, it might start lasting for 30-35 seconds and it might start coming every 20 minutes,10 minutes, five…It’s like that. Initially, you can wait and see whether it’s just an irregular contraction. But once it starts building up, that might be the start of the true labour pains. If you’re close to your term, then it starts coming every 10 minutes, and you need to go to the hospital.
The second symptom is water discharge. Your full dress will get wet, as if one or two glasses of water have come out of your vagina. It will kind of wet your outer clothes, your bedspread, etc. And then a small trickle will start and whatever you change into will get wet. You don’t have to panic. Just keep a pad and go to the hospital. Third symptom is any spotting, bleeding, any mucus tinged with blood: that also needs to be looked into. And the fourth one is the baby’s movements. That’s extremely important. That is indirectly checking your baby’s well-being. Basically, you need to keep an eye on the movements. If you feel that the movements are less any day, you have to eat something sweet, play loud music, count for two hours. If you can’t find 10 movements in two hours, it is better to go and get something called NST done in the hospital, which is the best test to see that baby’s doing fine or not. These are the four main indications for labour, and if there’s any of these before 37 weeks, you’ll have to get checked for preterm labor.
Ashwini: Any other red flags to watch out for during pregnancy overall, especially during the third trimester?
Dr Shefali: Bleeding is one of the commonest threatening signs and it’s always very worrisome at each trimester, so at seven weeks or 20 weeks - anytime you have any bleeding, brown discharge et al - it has to be checked by the doctor; don’t take it casually. And in the third trimester, movements, severe back pain which is just not settling, or too much of pelvic pain, period-like cramps: these also need to be looked into early. It should not be that at 32 weeks you do nothing about the labour type of cramps; then you ultimately land up in preterm labor. In these conditions, especially pain abdomen, which you are not able to judge, it’s better to go and get checked.
Ashwini: I’m exploring stem cell banking as an option. Is that something you recommend; any benefits? How many families are opting for it? What is the cost?
Dr Shefali: Genetics is really advancing in India. In the last three-four years, we’ve seen a lot of change in the way the tests have been offered. What we used to read of only in books - everything is available, and it has become very affordable. Similarly, stem cell banking is being used in various fields, in many cases, in many experimental cases, in many definitive cases. I feel that it’s going to become better as the time passes. You can explore taking stem cells and storing it because it is kind of changing the way medicine will work in the next few years.
Ashwini: Dr. Shefali, just one question on IVF. Many people are still skeptical about it.
Dr Shefali: Infertility, unfortunately, has increased quite a bit because of late marriages and planning your baby late. In some cases, the egg reserves fall drastically and then women are not able to produce a good quality egg. In that case, IVF is suggested. It could also be that the husband has less sperm. IVF is quite safe now. There is a notion that IVF babies have more chances of malformations or abnormal babies compared to others. But in practical experience, I have not found that. So many of my patients have had IVF. It’s relatively safe and you must decide about IVF earlier than later because later, the chances of having a successful IVF will come down.
Anna: Dr. Shefali, can we go through some quick FAQs on each of the trimesters starting with: when your pregnancy test is positive, how do you choose a clinic?
Dr Shefali: Generally, it is word of mouth. Your friend delivered with her or she’s comfortable, so they’ll recommend - why don’t you go and try it - and once you go to the doctor, you have to have a little feeling that the connection is there. Sometimes you have, sometimes you don’t have: so if you feel the connection, look at the experience, see the background, the degrees or where the doctor has studied, which hospitals she has worked at, and then once you become comfortable, I think you can trust and stick with the same doctor.
Anna: So, the first sign would be missing a period.
Dr Shefali: …missing a period. Once you go and get checked, the doctor according to your gestation will tell you whether a blood test or ultrasound is required. Depending on that, the pregnancy will be confirmed.
Anna: What are the things you should expect for your first gynae visit? Supposing you’re pregnant for the first time. How would you reassure your…
Dr Shefali: Basically, the first thing is that you have to go and tell your entire history: your married life, whether it’s a first pregnancy - because some people have had a miscarriage or a termination before, which they would want to hide for whatever reason. And then the physical history - whether you had any surgeries, asthma or any chronic illnesses as a baby. All this history has to be clearly told. If you’re not aware, ask your parents before you go, because some things are very important for your pregnancy and at the time of labor and delivery. Plus, your family history, parents, aunts, uncles who have diabetes, who had blood pressure, any blood disorders which run in the family: all this has to be told to the doctor clearly. And then once all the questions are asked, there’s counselling on how you go ahead in your pregnancy.
Anna: You said that we could have a dietitian. Is there anybody else you’d recommend during pregnancy like, a counselor - what kind of other help do you need?
Dr Shefali: Generally, your physiotherapist is involved because the exercise part she takes care of. Nowadays, a lactation counsellor is also being involved for first-time moms who have hardly any idea. You start in the third trimester - when they are kind of getting ready for delivery - some counseling about how to feed the baby.
Anna: So that’s lactation, diet and physiotherapy.
Dr Shefali: Unless and until you require other doctors like endocrinologists; if you have thyroid, if you have sugars, or any other physical problems. Sometimes people have kidney disease, sometimes they come with high blood pressure, so we need other specialists’ help like nephrologists, physicians, etc. They are also on board.
Anna: Do we have childbirth classes quite commonly around now?
Dr Shefali: Yes. In Bangalore, the trend is there. Childbirth classes.
Anna: Would you recommend them?
Dr Shefali: Why not? The more aware you are…Sure.
Ashwini: I did those during my pregnancy with my first son.
Anna: Right now, she’s also working and dealing with the first child. I guess time is a factor there. But that is something we commonly would do in another country, for instance.
Dr Shefali: After the pandemic, it has generally become online also. People don’t find time to go to the hospital, etc. So online classes are there.
Anna: Can we choose the kind of childbirth we want to have? Like, there’s water andLamaze…what would you recommend?
Dr Shefali: Yes, you can choose. Water birth is not that common here, plus here, the risk of infection is always there. So, we are a little worried about that. Otherwise, between the vaginal birth and the Caesarian, many people will have their own choices. And they’re very clear from day one that I can’t go through the delivery or I need C-section only or I have to have a normal delivery. We try to honor their wishes as much as possible.
Anna: Ashwini, you had a question about intercourse during pregnancy…Is that safe?
Dr Shefali: So, from around seven-eight weeks when you’ve seen a good healthy pregnancy till around 34 weeks, it is safe to have relations unless and until the doctor has said no, which can happen if you have a low placenta, if you have a short cervix, if there are other chances that you can go into preterm labo - then we will specifically restrict it.
Anna: The doctor will do a physical examination: that’s something a girl should expect when she goes. There are certain people who don’t really know what happens at the gynecologist. These are things we actually have to tell her about.
Dr Shefali: Internal checkup - what we used to do, that vaginal examination- is generally out of fashion right now. The ultrasounds have come in. Earlier we used to kind of check and like, okay, uterus looks pregnant - six to eight weeks. That was not a very complete confirmation and that is a little uncomfortable examination. That is done mostly towards the end when you are about to give birth - to see your pelvis, to see how the baby’s taken position and how your body is getting ready.
Anna: Is there anything more about the second trimester? Can you describe the three trimesters like, what are the specific features of each of those trimesters?
Dr Shefali: In the first trimester - four to 12 weeks - you might be more sick than the other times. This is the most difficult phase because of nausea setting in, loss of appetite, you’re tired all the time, breasts are hurting, your frequency of urination is very high, you might be feeling feverish, bloated, constipated. You were used to having a free life, and suddenly you’re feeling sick. This is the time where two ultrasounds are generally done, one at around seven weeks to confirm and see the quality of pregnancy, heartbeat et al in the baby. The second one is at 12 weeks to rule out something called Down Syndrome and chromosomal abnormalities, plus blood tests like haemoglobin, thyroid, sugar -infections are all screened. After 13 weeks, when you step into the second trimester, that becomes a better phase of pregnancy. In fact, that’s the best phase because you’re not very heavy. All these symptoms are first trimester and they start coming down, and you feel back to normal. In fact, many women will get scared. “I’m feeling normal, what’s the problem?” – That will be the complaint! Then your appetite improves, so you start enjoying your pregnancy. At around 19-20 weeks, another scan is done to see all the organs in the baby - the baby’s fully developed by then. After that the baby grows in size and then you are made to do a sugar test in between for gestational diabetes. From 28 weeks, you will be in the third trimester where generally a growth scan is done. Some discomfort will start. When you turn in bed, it hurts; when you get up, it hurts; you start becoming heavy, sleeping is not comfortable, you’ll become slightly uncomfortable in any position. Towards the due date, you feel less hungry, you feel nauseous, sometimes you feel as if you’re in first trimester. Generally, end of term can extend between 36 to 37 weeks. We then see the final weight of the baby and the growth, the fluid, and decide how long we should wait before we deliver you.
Anna: Is there a cure for morning sickness or the nausea? Is there something we can get?
Dr Shefali: We have medicines which help you feel better; otherwise, these home remedies of having ginger or having own smaller meals and not stuffing yourself: all this will help.
Anna: How can we prepare for morning sickness? Diet and exercise - do they help really to avoid morning sickness?
Dr Shefali: No. But morning sickness doesn’t affect all women. That is another scare. “I don’t have any nausea” - they’ll be very sad that they don’t have it. Pregnancy can be absolutely healthy without having any nausea. A few people will have bad morning sickness, a majority of people will have it mild and many will have no morning sickness.
Anna: Dr. Shefali, your book is called The Safe Journey to Motherhood. Tell us more about the book.
Dr Shefali: So, when I answered these questions day in and day out, I thought maybe I could put these questions together. The book is in a question-answer format. I mean, I get all sorts of questions. One of the favorite ones is, “Can I eat Maggi?” All these types I tried to answer, and questions about parlour, waxing, facial, hair colour. Many things keep popping up in your mind and every time you cannot ask the doctor. Sometimes you forget. I thought I would compile these and give the proper medical basis rather than the myths. The commonest one in our country is that you should not have pineapple/papaya. It’s so rampant that when I heard it the first time I was like, I’ve never been taught this in my medical school. I specifically joined a nutrition in pregnancy course from the US to see what we are missing, why I’m hearing this in my private practice. And then I realised it’s all Indian myth, nothing else.
Anna: Oh, it’s a myth. So, we can eat pineapple and papaya. Thank you, Dr. Shefali. Thank you, Ashwini, and do enjoy your final trimester of pregnancy. If you have questions on this episode, you can write in to us at this email: editor@the hindu.co.in with the subject line Women Uninterrupted or look for Dr. Shefali’s book, The Safe Journey to Motherhood.
Dr Shefali: It’s available on Amazon.
Anna: Signing off on this episode of the Women Uninterrupted podcast brought to you by The Hindu.
