The Baby Bump

Me teaching a student pain management.

Even a couple of decades ago, Indian men kept away – by choice or due to tradition – from all things connected to a pregnancy. The mother-to-be was mostly on her own, left to deal with the changes her body – and mind – were going through. Sometimes, confused yet loving men, accompanied wives to the obstetrician visits and walked with them around a park. While times are changing, the men are still confused about how to deal with this new development in their lives – the baby bump. Yet, like in every other area, change is happening. And it’s a good thing.
In earlier days, pregnant women went about their daily chores not knowing what was happing to their bodies, today’s woman knows something’s changing. She has the internet and can Google anything. But what she does not realize or know is that while it is a great resource, there is a lot of misinformation also floating around, and that can confuse the issue.
On a recent visit to my school, I met up with my teacher who was pregnant with her first baby when I was her student. “I did not know I was pregnant,” she remembered. “Suddenly, one day, in the middle of a class, I broke out in a sweat. My hands and feet were wobbly, I felt faint.” She ran out of class. I ran out behind her and watched over her as she splashed water on her face. As I lived in a joint family, and had seen pregnancies, I knew she was in the family way. “Ma’am, you must be pregnant,” I pronounced to a horrified teacher. Turned out I was right. She has never forgotten that first realization.
Now that I am a Childbirth Therapist, I know why pregnant women sweat more. Here’s why. With the new being growing within, their bodies prepare to nurture it. Blood vessels expand to accommodate the extra volume of blood that the baby needs. It takes three months for a mother’s body to adjust to nurturing the new being. This causes nausea, sweating and light headedness.
Today’s parents-to-be need the reassuring knowledge from a professional who is qualified to teach them about the changes that take place in their lives and bodies right through the pregnancy and into parenthood. Most pregnancy classes insist the father attends too. Because he is most likely to be his wife’s birthing companion and he needs to know what she is going through and what he can do to help. “We learnt a lot during our classes,” says Sri, a software engineer, who attended antenatal classes with his wife, Mangal. “I fell asleep during the relaxation. I was that comfortable,” he smiles, a little embarrassed. Well, dads need to relax too. Especially after baby arrives.
Attending pregnancy classes is best during the second trimester. The mother’s mind and body are by now adjusted to the body’s changes, and this is the time she needs to take care of her nutrition. During the classes, couples learn nutrition, bodily changes, baby’s growth, the birth process, how to tell when it is false labour, exercises – both before the baby and after the birth, when to go to the hospital, how to help the doctor deliver the baby, pain management techniques and lots else. An entire session deals with breast feeding: how to prepare her breasts for feeding, how to feed the baby, techniques that can be used to ensure the baby gets all he needs. “I had many doubts during my pregnancy,” says Hemlatha who came for classes in Chennai all the way from Kanchipuram. “My legs were swollen. In my class I learnt why it happens and what to do. I found the exercises and home remedies taught to us were most useful.”
Most husbands accompany their wives to the classes. Some are still embarrassed about becoming dads. One husband actually wanted to know how he could help ease his wife’s discomfort during labour, and later told me her found the massage taught during the class really worked. He felt involved.
Another dad, Gautam, got very involved in coaching his wife through the labour. He was with her even during the birth. “Did you see your baby’s head crown?” I asked him, quite thrilled with the work he did. A look of confusion appeared on his face. “No,” he said, like he had done something wrong. “Why?” I wanted to know. “Well,” he explained, “I was at the wrong end of the action!” apparently, he was supporting his wife, Girija’s head and shoulders while urging her to push.
Ameeta Agnihotri is a Childbirth Therapist, practicing at her studio in Velachery.
Contact: littlemiracles.10@gmail.com or call 9840284249.
The above article appeared in Gallop, the magazine from Madras Race Club

Wait a little

Vidya was due on February 11th. On 28th January she went to see her doctor. An internal examination was done and she was found to be 1 cm dilated. She went for a scan on the February 5th. The doctor told her that her due date had advanced to 8th February. If the contractions did not start she was to admit herself on the 9th and Dr. Rajshri – her obstetrician would induce labour. This would negate everything that Vidya stood for. I kept praying for her and hoping the baby would be born normally.
All day long in the 8th, my thoughts kept going back to her. Was she in labour? Will she be able to hold on till the baby decided to be born or would she succumb to pressure from the hospital and get induced.
After talking to Nutan Pandit I called her and asked her to do the acupressure and the hot towels. She did both as well as drank pomegranate juice which is supposed to release oxytocin.
On February 9th, at 3 am, Vidya began feeling contractions. They were 10 minutes apart. At 3.30 am they began coming 5 minutes apart. As she was reaching the hospital, she called me at around 5 am. I had kept my mobile near my head on normal mode. I jumped the moment the phone rang. Before even looking at the name, I knew it would be Vidya. She was 5 cms dilated. At 6 am she was still 5 cms dilated. Epidural was administered just as I walked in. “I’m exhausted,” she said looking at me. The epidural calmed her. Right through her labour, she did the breathing. “I feel most comfortable doing the chest level breathing,” she said. I had to leave the room as it is a small room and three is really a crowd. Besides hospital staff walking in and out. She really did not need me as her husband was providing her with ample support. She had her mother with her too. The room had space for one single chair. Her mother sat in it while Vidya’s husband sat next to her on the bed massaging her back. I felt like an unwanted but invited intruder. Vidya was too tired to walk around so she lay on her side. “I can feel the baby coming down,” she kept saying. “I can feel the contractions, but not the pain.” Vidya was given very little pitocin as she had not dilated enough. The drip was removed within 5 minutes when she was fully dilated. She could feel the baby coming down by itself. “I felt as if my baby and my body were really working together.” One to birth and the other to be born.
She stayed on her side and was being helped by her husband. He is a really brave man who did every single thing he could to support his wife. He went with her into the birthing suite. “I supported her shoulders so she could bring her neck to her chest and push,” he said. “Since I was not at the working end of the show, I did not see my daughter being born.” With only 10 minutes of pushing, her baby – a baby girl – was born at 9.07 am. No episiotomy was needed. The baby yelled at birth, but became quiet the moment she was handed over to her father. “I talked to her, and she calmed down.” He held her for around 10 minutes and then placed her next to Vidya, who touched and caressed her little wonder. There was no skin to skin contact. Vidya was not allowed to choose her birthing position. She felt the urge to be upright, but instead was strapped to the birthing table.
“They took my baby and kept her in the crib in the birthing room. She began yelling. And I just called out to her, ‘Pappu’ – which was my name for her and she became quite.” It was a miracle, really.
In 45 minutes, Pappu was brought to her mother’s room, and she had her first feed. By the time I spoke to Vidya she had already fed four times and was looking like she would be feeding some more.
Pappu’s first night outside the womb was restless. She kept waking up, needing that contact with her mother.
The baby – now named Shruti - weights 3.4 kgs.

PENNY SIMKIN WORKSHOP

Penny Simkin. The name sounded so familiar. Not because she is Andrew Simkin, the Consul General’s mother, but because she is quoted on the back cover of the book I’m currently reading and reviewing – Birthing From Within by Pam England. To meet her was an opportunity I would not have missed for anything in the world, especially since she was in my town and was conducting a workshop for Childbirth educators. The knowledge she was sharing came free.
People from across India were there. Priyanka from Kochi, Divya Deswal from Noida, Dr Manisha Gogri and Shalini from Mumbai, Dr. Padmini Balagopal, Deepa Santhosh, Rekha Sudarshan, Preethi Rao and me from Chennai were part of the morning session for Childbirth Educators.
The session was a beautiful power point presentation. It began dramatically with the statement One’s past experiences shape the birth.
In any pregnant woman, labour pain is the second greatest concern. The first is the survival of the mother and the baby. Pain is an unpleasant sensory or emotional experience associated with an action that causes or may cause tissue damage.
Neuromatrix Theory:
Pain perceptions and reactions are influenced by:
• Painful stimuli
• Pain modulators
• Past experience and learning
• Present circumstances
Essentially pain has three components:
• Cognitive: evaluative components, cultural learning, past experiences, personality variables along with input from brain (attention, expectations, anxiety, depression)
• Sensory: discriminative
• Motivational
Does exercising actually reduce the pain?
On a mental level, it does bring a different thought process. Two of the doctors present did mention that they found women who had done yoga were better able to give birth than those who had not. They were breathing better, and their bodies were able to cope with the physical changes very well. In fact, Dr. Sooriya SreeKumar said she would instantly know when a labouring woman has exercised and when she has not. She went on to state that older mothers were better in the labour room than those in their 20s. She had come to the workshop after a normal delivery by a 41 year old first time mom.
Suffering and trauma during labour may lead to PTSD (Post Traumatic Stress Disorder). The symptoms are often as follows:
• Staying away from location or people involved. One woman who had a bad birth experience actually drove around blocks so she could avoid passing by the hospital where she had delivered
• Panic attacks
• Emotional stress – they need to talk about it. In many cases they don’t stop and in an equal number they don’t want to at all.
When someone is suspected to be going through PTSD, you need to watch out for fear, panic, mental defeat, disassociation, frustration, depression, and the caregiver needs to take steps to make that person normal again.
A birth plan must be made ready by the 32nd week if not earlier.
Asking yourself between contractions what was going through your mind during contractions?
Coping has constructive responses which are positive or neutral
Distress focuses on fatigue, time tis taking, self doubt, inability.
The 3 Rs of labour are rhythm, ritual and relaxation. Rituals come when she enters labourland. Women discover their won rituals. These can be mental, physical, singing, reciting, breathing, moaning, etc.
Epidurals increase the length of labour. They cause numbness waist down and bring about other discomforts. The labouring woman feels helpless and the baby’s wellbeing is at stake. Often epidurals cause a fever which necessitates the baby to be kept in the nursery and undergo a battery of totally un-required tests.
Penny talked about THE CODE WORD. This is something that is predecided and is a word or a phrase that a woman uses when she needs an epidural.
When a woman is allowed to change positions during labour, the following happens:
• Improved contraction intensity
• Shortened labour
• Less need for pain medication
• Fewer variant Fetal Heart Rate patterns
• Increased maternal autonomy and control
• No harmful medical side effects
As far as possible, Penny recommends doctors do not use the episiotomy route as sometimes it can go really wrong, and the mother can suffer from its after effects throughout her life. She could develop incontinence, a deep infection, etc. At this point Dr Sooriya invited those gathered there to her hospital where most mothers deliver normally without an episiotomy. She talked about how older mothers deliver far easier than young women in their twenties. In fact, just the day before a 41-year-old first time mum had delivered normally in her hospital.
Cutting the cord was another point of discussion. It is best for the baby to wait before the cord stops pulsating to prevent anaemia. Even for stem cell collection, place the baby on the mother – skin to skin contact – wait for two minutes and then cut the cord.
During pregnancy, sing to the baby, chant prayers, or simply recite nursery rhymes. The baby doesn’t care how you sound. When baby arrives, into a completely new environment, with bright lights, loud noises, the reassuring sound of the father’s voice is a very welcome feeling. Many babies are known to turn towards their dads almost as soon as they are born.
Ameeta Agnihotri.