By: Dr Emanuel Gracias, Obstetrician and Gynaecologist at Gracias Maternity Hospital.
The whole conundrum of ‘What to expect when you’re expecting’ doesn’t get more daunting until the water breaks, vigorous contractions ebb and flow, and it’s about time you know that the life you held in your womb for so long is about to show. A bittersweet apprehension coupled with extraordinarily diverse emotions equips you with the might to push the baby out. The child crowns, and it all begins to feel intensely real and raw. Overwhelming, isn’t it?
Being prepared to deal with the course and corollary of normal delivery is essential for all the right reasons.
One can’t expect a magical maternal instinct to strike a new mother even before the baby arrives, neither can they decide if she is ‘mother enough’ based on her knowledge of preparing for birth and after. Hence, a well-planned strategy has to be chalked out to muster the wits to normally deliver a baby. The preparations scale right from what the expectant mother eats, to what she ultimately carries to the hospital before delivery.
The diet of an expectant mother is indeed the source of endowment and nourishment for the unborn baby. A rather stimulating skirmish in Indian households, this aspect seems to have become the business of relatives, near or far.
Traditionally, the ‘eat for two’ notion has been ingrained in our understanding of what a typical pregnancy diet should be. However, that is something that an expectant mother should be extremely cautious about.
A well-balanced diet is necessary to ensure that the baby is born with a healthy weight. A diet smothered with copious calories has the potential to result in the baby being overweight. This creates a condition called cephalopelvic disproportion (CPD) in which there is a mismatch between the mother’s pelvis and the baby’s head. Such a situation hampers the ability to deliver the baby normally. At the Gracias Maternity Hospital, a dietary programme is introduced to each patient, enabling her (or them) to meet the nutrient goals, whilst ensuring that she finally delivers an average-sized baby. We attach ourselves to a ‘pro-normal’ ideology, taking all measures; including a customized dietary plan to encourage vaginal birth.
Moreover, along the lines of minimizing calorie intake, calorie expenditure too, is vital. While exhaustive workout is not the idea in this case, basic exercise can lower the risk of preterm or cesarean birth, and even excessive weight gain. Walking- this simple exercise can do wonders. A low-risk activity, walking is one of the best ways to maintain both fitness and mood. Such an activity is essential for the foetus to be in the best position for labour- head down, facing the mother’s back. It will encourage the baby’s head, the heaviest part of the body; to gravitate downwards, prompting a normal delivery, avoiding cases of breech birth in which the foetus is in the feet-first position. The breech position makes it difficult to deliver the baby normally.
Within the realm of exercise, we also have an in-house physiotherapist who helps patients deal with pain, and teaches them the right techniques to protect their joints, whilst keeping them fit before delivery, and fostering recovery after giving birth. All within the umbrella of antenatal classes, in addition to the doctor’s directives and guidance on what to expect at various stages of pregnancy, these provisions are bound to adequately prepare the mother for a successful delivery.
The haphazard nature of last-minute plans is a tale as old as time. A hospital bag checklist should be prepared well in advance to avoid forgetting any essentials for the baby’s arrival as well as the mother’s pre and post delivery requisites. One should have the maternity hospital bag ready between 32 and 35 weeks of the pregnancy. Keeping this bag handy is imperative to be able to comfortably leave for the delivery, without worry and restlessness over missing out on the vitals. A few essentials include towels, nappies, baby wrappers, white frocks, mittens, caps, socks, soap, coconut oil, steel cup and bowl for the baby. For the mother, post-delivery pampering calls for a comfortable pillow, cushy pyjamas or night gowns, flip-flops, toiletries, thermos flask, breast pump and other nursing supplies. The nursing staff assists the patient to curate this list to streamline the process; providing a comforting, helpful hand.
Stepping into the hospital, on the anvil of delivery is quite a chilly prospect. Emotions are diffused and the thought of leaving the hospital with a little human being is at once, a revelation and an intoxication. Sometimes, it’s so unnerving that many would want to give up before the finish line. All these overwhelming emotions require an appropriate outlet. That is exactly what our ‘Birthing Buddies’ programme offers. At our medical facility, we allow mothers-to-be the option of having a birthing buddy accompany them in the labour room and assist with the birthing process.
The Birthing Buddy Programme aims to make labour more relaxed with the support of a trusted partner – this could be the woman’s husband, a close friend or relative. The ‘buddy’ would accompany the expectant mother to the ante-natal visits, getting acquainted with the birthing plan. Posing as a liaison between the hospital staff and the mother, the birthing buddy is responsible for helping the mother and eliminating any element of confusion in aspects like paperwork, medication, or packing of the hospital bag.
Additionally, to find solace in the arduous process of labour, a pre-labour room has been created. The birthing buddy can set up this room according to the preferences of the mom-to-be. It can be adorned with scented candles, enlivened with soothing music or the mother’s favourite shows – all as a constant reminder to relax. Even during the spine-chilling phase of labour, this trusted partner can motivate the mother to endure a few more minutes of pain until the bundle of joy finally arrives. We have observed that birthing buddies have significantly raised the success rate of normal deliveries. While patients arrive on a wheelchair, they are urged to walk back with their newborn in their arms – a manifestation of their heroic charm.
Labour is hard, and that’s a truth universally acknowledged. Generally, spontaneous labour implies a natural, vaginal delivery that occurs without any tools to pull out the baby. Sometimes, labour has to be induced; that is, the obstetrician augments labour through non-pharmacological methods such as enemas, perineal massage to strip off membranes, releasing local chemicals like prostaglandins. The pharmacological modalities of cervical ripening include the use of medicine to induce labour. As for the decision on using epidural, it’s the choice of the patient as long as she is not fully dilated. While toiling away in labour, monitoring the foetal heart rate is crucial. We don’t want the stress of labour to threaten the baby’s delivery and health, and for that very reason, a close assessment of this measure is necessary. Gracias Maternity Hospital is the only hospital in Goa to operate with a wireless foetal ECG (Electrocardiogram), enabling the doctors to view accurate results in real time on their phones, wherever they may be.
It’s alright if the baby doesn’t latch immediately. It’s fine if attachment towards the baby doesn’t show instantaneously. It does not make the birthgiver any less of a mother, nor does it imply weakness or a character flaw. Past experience doesn’t necessarily give another person the agency to demean the maternal instincts of a new mother. These strategies to prepare for delivery only entail until childbirth. As for the journey after, a mother will learn to be a mother in her own stride, at her own pace, and with her own judgement.
Box 1. Measures for a Smooth Normal Delivery
A well-balanced diet
Light exercise, preferably brisk walking
Checklist for the hospital bag
Bring a birthing buddy
Box 2. Hospital Bag Essentials
For the Baby
For the Mother
(Dr. Emanuel Gracias, is an Obstetrician and Gynaecologist at Gracias Maternity Hospital in Margao)