Pregnancy and childbirth follow their own natural course, yet it is best to be prepared and take proper measures in order to avoid complications and loss of life

A group of friends were spending an evening together. The talk turned to women, especially since one of them was expecting a baby. Of course, everyone was filled with advice, tips on everything from fashion to diet, eating for two, and taking life easy. A confirmed bachelor contributed his own views “What`s all the fuss about? In earlier days, women working out in the fields would go home when the labour pains began, deliver, and be back at work for the rest of the day. Today we make too much fuss over a perfectly natural occurrence”.

Of course, the women in the group were up in arms, against what they considered typically male views, but what exactly is the truth? True, pregnancy and childbirth are perfectly natural occurrences, and very creative ones at that. Nothing can compare with the joy and miracle of a brand new baby. But these processes aren`t always smooth sailing, so it`s best to be prepared.

First of all, having a happy, healthy pregnancy depends most of all on the expectant mother herself; as long as she is aware of the guidelines, and the possible risk factors, she can work towards having a healthy delivery.

A few facts Even with the best of care, 15 per cent pregnancies end up in complications — no one knows when these may arise. Some problems can be anticipated and prevented if handled skilfully so that the woman`s life is saved, but the slightest neglect can knock things out. A combined study, in 2000, by WHO, UNICEF, and UNFPA reports that Pakistan has the third highest maternal death rate in the world. In Pakistan, every 30 minutes a woman dies of pregnancy-related complications. Matters haven`t changed much over the years — the risks are rooted in women`s poor health, early marriage, too many children, too often, and also too late, when women are in their 40s.

“It`s important”, says Dr Azra Ahsan, consultant Gynaecologist & Obstetrician, “for every expectant mother to have at least four antenatal care check-ups, to ensure that all goes well with the pregnancy.” This is part of the overall planning for the new arrival. In these days of economic strain, families will need to start saving up for labour and delivery, perhaps at a hospital, or, if the family is based in a rural area that lacks a clinic or hospital, with skilled care at home. In all cases, it`s essential to identify a near-by maternity clinic or secondary care centre, plus an accessible major hospital, in case of emergency.

For greater safety, the expectant mother should also be aware of her blood group, arrange in advance for suitable blood donors, and identify a reliable, accessible blood bank for screening the blood prior to its administration. These steps will reduce the last-minute tensions and running around that invariably arise. Another important factor is transport — not everyone has their own means of getting around. Rather than wringing their hands while an emergency develops, it is better to prepare in advance, with the help of friends/relatives, or a reachable taxi driver. In extremely conservative families, women have been known to remain bound to their homes, unable to leave without the husband`s permission. Luckily, this doesn`t happen so often in urban, educated families, but wherever it does, such permission can be obtained well in advance, and friends, relatives or neighbours lined up, to accompany the woman to health centre or hospital.

There are a number of myths and misconceptions like `eating for two` about diet in pregnancy. There are times when women are held back from eating nutritious food, like meat and eggs; though these, together with lentils, fresh fruit, veggies, milk, yogurt, and chappati should be part of the daily diet. At other times, women are constantly plied with panjiri, halwas, and ghee, which will certainly not help the baby to glide out smoothly, as is commonly believed! Rather, it may add to complications.

Regular nutritious food, adequate rest and exercise, and normal routine are all that is required. A healthy mother-to-be can continue quite happily with her daily life, be it as homemaker or career woman, as long as she`s taken some common-sense precautions.

Supplementation with iron, calcium, and folic acid is vital. Indeed, folic acid, to be fully effective for the coming baby, must be used well before pregnancy, i.e. when the couple starts planning the baby.

Pre-marital or pre-pregnancy counselling is not widely practised in Pakistan, although this is valuable in preparing for, and having, a healthy baby. Genetic counselling of high risk couples is imperative to minimise the risk of chromosomal abnormalities, which can result in Down`s syndrome; it`s also important for reducing the risks of thalassaemia. 

Vaccinations are another prerequisite that tend to get pushed aside or forgotten. Of these, TT or tetanus toxoid shots, and hepatitis-B vaccinations are the important ones. Vaccination against German measles is not possible during pregnancy — that can be as bad as getting the disease itself; it`s a good idea to administer protective vaccine well in advance of pregnancy. In pre-pregnancy clinics women can be tested for immunity against this disease which, if contracted during pregnancy, especially in the first three months, can result in serious congenital malformations in the baby. Women who are not immune to the disease can be vaccinated and advised to avoid pregnancy for at least the next four weeks.

Conditions which can complicate a pregnancy include diabetes and high blood pressure. Sometimes `eclampsia`, a complicating condition with hypertension in pregnancy, occurs, and results in fits. Communities with low level of awareness consider such women to be possessed by the devil they are taken to maulvis, pirs, and fakirs, for `spiritual` treatment, instead of being treated for hypertension. There is immense need for raising awareness about healthcare, particularly with greater use of the electronic media.

In rural or under-served urban areas, the use of safe delivery kits are essential for those women who choose to deliver at home. These kits provide all the necessities that a skilled birth attendant is likely to need at the time of delivery.

Last, but crucially important, is the need to safeguard the brand-new mother from post-partum haemorrhage. After delivery, the drug that prevents the risk of post-partum haemorrhage, or heavy bleeding after childbirth can be used under the attending physician`s advice.

So, get ready to welcome that new baby, and in the process, have a healthy and enjoyable pregnancy! And yes, breastfeed your baby, preferably for at least two years — it will help make your child healthier, and provide immunity from many diseases. Start weaning foods around six months, practice contraception, and don`t even think of another baby before three years. That way, both you and your baby have greater chances of remaining healthy.

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