Please join me in welcoming our newest guest writer to Jeddah Blog, Dr. Saba Aslam Epthorp. Dr Saba is a gynaecologist from Delhi, North India and has worked at Al Abeer medical centre as a specialist from 2007-2012. She has a number of versatile interests which we will persuade her to discuss with us at some point in the future, but for now she has very kindly agreed to share her tips and information on pregnancy – a must read for all expectant mums (and dads), especially for first-time parents-to-be.
To experience pregnancy is every woman’s dream come true. Some conceive naturally and others through lots of treatment and struggle.
On a visit to the doctor during pregnancy, a couple may harbour many questions, such as whether it will be a normal delivery or whether it will be a C- section. One of the most common questions patients ask me is whether they can know the sex of the baby.
Well my dear ladies, the whole process of pregnancy is much more than knowing the gender of the baby or what kind of delivery you will have. You have a full 38 weeks to carry this pregnancy, in other words it is a 9 month process. No doctor in the world can tell you on your first visit whether it will be a girl or boy, or whether you will deliver normally, or otherwise. Especially if it is your first baby, keep in mind that each course of pregnancy is different. Even if your first child was delivered normally, the second is not guaranteed to also be a normal delivery. It all depends on a variety of factors.
THINGS TO REMEMBER ON YOUR FIRST VISIT
1) Confirm your pregnancy with a blood test if you have missed your periods for over 5 weeks. Always tell your doctor about your last menstrual date (if you remember).
2) If the test shows up negative you should still wait for ten days and do not take any medicines to start your periods, because sometimes, even if it is negative, you still could be pregnant.
3) Likewise, if the home urine pregnancy test shows up as positive, that also does not confirm that you are pregnant.
4) Always confirm with a Serum Pregnancy Test which will show beta hCG hormones which are produced in large quantities in the blood during pregnancy. Non-pregnant levels are too low to show up in the test, so if this hormone level has increased and you have missed your periods, it confirms that you are pregnant.
5) Once it is confirmed that you are pregnant ladies, the next step is that you have to get your blood work done. This means that you need to get your Complete Blood Count, Routine Urine Test, Blood Group and Rh type. And you will need your screening for HIV, HbsAg, HCV and Random Blood Sugar Test.
6) All patients ask me why they must undergo these tests. Well dear ladies, it is for your own good and for the baby. When the doctor asks you for these tests, she is assessing your baseline which in medical terms we call pre-pregnancy blood work. Pregnancy brings about lots of changes in a woman, other than weight gain. For example, the heart changes, kidney function changes, blood volume , Haemoglobin, protein and liver. In non-medical language ladies, your entire body changes with the growing fetus.
7) Therefore always listen to your doctor when he/she asks you to get your investigation done. It for your own good and for baby. Regarding HIV/ HCV/ HBsAg, it is a must-do test, which is made mandatory by the American Society and Royal Obstetrics Societies and WHO as HIV is a silent and dangerous disease which affects the baby too. If not detected during the screening in early pregnancy, and discovered only later in pregnancy then not only you but even the unborn baby is at high risk. You doctor will ask you to get yourself screened as there are ways to prevent transmission from mother to baby.
The next question I am asked by patients is why the blood group test is required. Blood group type and Rh is important in order to know your haemoglobin levels. Rh type decides whether you are A+ OR B+ OR AB+. In the event of any bleeding or complications during pregnancy, the doctor should be able to inform the blood bank in the hospital to keep your blood type ready in case you need a transfusion. Please note that this test is done only once. You don’t need to repeat it for each pregnancy.
8) HIV HCV and HBsAG is done every two years. Not more frequently than that.
9) Always be cooperative with your visiting doctor when you are asked to be examined for your blood pressure, pulse rate, temperature and weight. All this is important for your doctor to have your baseline. When you visit next, she will know how well your pregnancy is advancing.
10) Now coming to how often you should visit the doctor. It all depends on whether you are experiencing any symptoms of vomiting, abdomen pain, cramping or spotting etc. The warning signs will ascertain when you have to return for a follow-up.
11) According to the WHO and ACOG a woman must be registered. This means that you must go to the hospital and register yourself with your doctor. You must then complete at least three visits in the first three months, at least two visits in your second trimester and two in your last trimester.
In simple terms, make sure to visit your doctor every month in your first three months. Once you reach your fourth month, you have to visit twice; once in your fifth month and then in your sixth month.
12) Each visit you have to bring your previous visit reports and scan reports. The first scan is very important as it will give a clear idea of how old your baby is, and to check for any signs of any abnormality. So NEVER ignore your first scan. Even if the doctor has not specified it, as a patient you can ask your doctor to refer you for an early pregnancy scan if you are over seven weeks due.
13) Please take your medicines prescribed by your attending doctor. Do not ignore them. Apart from folic acid 5mg after food, you can take any other supplements, but avoid any other paracetamol or antibiotics as it does affect the growth of the baby.
14) If you have sadly had an early abortion in the past, or your baby had been born dead, or the baby died after giving birth, or even died after 4 years, you must tell your doctor. Giving all of your history to your doctor is absolutely vital as she will be better equipped to take care of you and your baby in this pregnancy. She will be able to advise you about precautions or don’ts in this pregnancy.
15) The most important thing is to trust your doctor because during the 9 month period it is important for us to develop a healthy relationship with the patient. In case you feel you cannot trust your doctor, then go ahead and change her.
I always tell my patients that if they think I’m not doing my job as a doctor then they can visit someone else. Since the role of the doctor is to take care of not only the mother but the growing baby too, if you cannot trust her advice and opinion then change the doctor. Of utmost importance is the health of you and your baby.
SIGNS AND SYMPTOMS/ WARNING SIGNS TO VISIT YOUR DOCTOR IMMEDIATELY
If you get any of the following signs or symptoms in first three months go visit your doctor immediately, irrespective of time and day. Do not delay.
1. Pain Abdomen; cramps, or backache.
2. Vomiting more than 3 times in a day.
3. Spotting/ Brownish red color discharge/ single episode of fresh bleeding.
4. Severe nausea, loss of appetite, severe gastritis or acid reflux.
Make an appointment with your doctor if you have any of the following symptoms from 4-6 months of pregnancy
1. Any fresh bleeding or lower abdomen pain
2. Hardening of your abdomen. Very frequent or any watery discharge or fresh water.
3. Fetal movement less than 10 times a day, ie you haven’t felt your baby move at least 10 times in a day.
Symptoms which warrant a visit to the doctor in the last three months, during which you must visit the doctor every fortnight
1. Keep a watch on any watery fluid being discharged.
2. Fresh bleeding.
3. Severe cramps at regular intervals accompanied by bleeding.
If you have any questions that have not been covered by Dr. Saba in this blog post, leave a comment at the end of this post and we will pass them on to her. Good luck – we wish you all bouncing, healthy babies!