A woman is considered the foundation of a family; however, her health at times gets neglected for the sake of family. There is a drastic need to change the mindset of society when it comes to women's health and it should be given utmost importance. Reproductive health in females implies that women have a healthy reproductive system and a total well-being in all aspects of reproduction. To understand pregnancy, infertility, low platelet levels, social stigma related to not having a baby, Rising Kashmir Health Correspondent Mansoor Peer spoke exclusively with Dr Rifat Ara, HOD Gynaecology and Obstetrics, SKIMS Medical College and Hospital, Bemina, Srinagar.

 

 

What are the essential things for a newly married woman?

As the newlywed lady starts a new chapter of her life and enters a new home, she must adapt to the new environment mentally and emotionally. This is only possible with the love, care and support of her new family. As mostly seen, the woman is repeatedly reminded by the family of the offspring that everybody wants to see and hold in their arms.

This repeated questioning whether the new bride is pregnant or not by everyone, even  by friends and neighbours, puts the woman under undue mental pressure which is wrong both ethically and socially. Instead, she should be given assurance and support by her family members, especially her husband.

As long as a woman is less than 35 years of age and has no previously diagnosed reproductive tract conditions like PCOS, endometriosis, ovarian cysts, fibroids, irregular cycles etc, she can easily wait for spontaneous pregnancy for up to 1 year of marriage with her husband.

However, a woman with the above conditions or age above 35 years needs to seek advice from her gynaecologist after 6 months of marriage in case she is not able to conceive spontaneously.

If the woman is planning a pregnancy, she should start improving her diet and taking care of her health. She should start taking folic acid tablets even before the pregnancy because it prevents neural tube defects in the foetus.

Overweight women are recommended to reduce weight before pregnancy for the betterment of the child and herself.

If the woman is taking medicines for hypothyroidism, she should consult her physician to make sure her thyroid hormone levels are within normal range.

 

What health tips should women follow once they are pregnant, especially for the first time?

The first pregnancy is indeed a challenge for the new mother, both physically and mentally.
As her body undergoes several hormonal changes, the various symptoms associated with it are perceived as disease by the pregnant woman.

Pregnancy is not a disease, it is a physiological phenomenon. Nausea, vomiting, constipation, increased frequency of urination, loss of appetite are all common in early pregnancy which later on subside on its own and the woman need not worry about them unless her daily activities are hampered.

After missing her period, she should get a urine pregnancy test which can easily be done at home. If positive, she should consult a gynaecologist and take advice.

Baseline investigations and an ultrasound must be done to confirm the pregnancy. A thyroid profile should be done since hypothyroidism is prevalent in our valley.

The woman should get herself registered in a nearby hospital and receive the antenatal card to keep her records for future purposes.

In order to combat nausea, vomiting, the woman should take small but frequent meals, and avoid spicy and oily food. She must be well hydrated.

She must never be forced to eat a particular food like meat, chicken, eggs or any other food that she has developed a distaste for. Folic acid tablets must be started if not started already.

The woman should strictly avoid all medicines in early pregnancy unless prescribed by her doctor as it may have dangerous effects on her child. Even x-rays and other radiation must be avoided at all costs.

A detailed ultrasound, called level 2, is performed at 5 months of pregnancy to detect any foetal defects. If a woman is more than 35 years of age, a specific set of investigations called triple test and quadruple test have to be performed to rule out Down’s syndrome.

From the 4th month of pregnancy, iron and calcium supplements should be started and tetanus immunization should be done.

After 3 months of pregnancy, the woman should visit her doctor monthly up to 7 months and thereafter fortnightly till 9th month. In the 9th month of pregnancy, weekly visits must be made and the woman should be explained as to how she can keep count of her foetal kicks.

Certain warning signs like bleeding pv, leaking, pain abdomen, headache and blurring of vision, loss of fetal movements, require immediate medical attention and should be considered an emergency without any delay in reaching the hospital.

Throughout the pregnancy, the woman should be properly counselled regarding labour and the fear of labour should be alleviated. Normal vaginal delivery should be encouraged due to its enormous benefits. If it is not possible, then a caesarean section can be easily performed with the aid of spinal anesthesia nowadays, which is safe for both mother and foetus.

After the birth of the child, exclusive breast feeding should be encouraged for the first six months.

How can women manage vomiting during the first months of pregnancy?

This is due to hormonal changes in the body. During the first pregnancy, the woman may get apprehensive and stop taking food completely so she should be counselled properly and small frequent meals should be taken. This usually subsides as the pregnancy advances. But if the vomiting is excessive enough to hamper daily life, the patient should consult her doctor and might need a short stay in hospital for hydration.

In-case of low platelet levels, what needs to be done?
In Kashmir, we have seen a lot of women with low platelet count during pregnancy. However, the platelet function remains normal and their coagulation profile is also within normal limits.

As such it is not a matter of concern, unless the count is very low or she has severe pregnancy induced hypertension. Also, some women may have inherited platelet disorders. In all such cases the woman may require haematological consultation and platelet/blood transfusion accordingly.

How is the healthcare system in rural Kashmir?

In our valley, the healthcare system has tremendously improved over the past few years. Most of the pregnancies without complications are being handled at the rural setup. However, high risk pregnancies or complicated pregnancies require referral to tertiary care centres.

With the expansion of the healthcare system all over the valley, it has now become easier for people from rural areas to avail the healthcare facilities in their nearby areas without having to travel long distances for just a mere checkup.

Various national policies like JSSK provide benefits like free and cashless delivery, free medicines and consumables, free transport between facilities etc.

What causes infertility? What is primary and secondary infertility?

Infertility is defined as not being able to get pregnant despite having frequent unprotected sex for one year for most couples. Primary infertility is when a woman has never conceived in her life. Secondary infertility is when a woman has conceived once in her lifetime whether it was an abortion or a successful delivery and now is not able to conceive again.

Causes of infertility can be male factor or female factor or both. This is in contrast to what our society usually perceives as the female is only responsible for infertility which is absolutely unscientific and unethical.

Causes in males are decreased sperm count or no sperm at all, or some issues with the genital tract. Causes in females are failure to produce eggs (ova), block in fallopian tube where the sperm and ovum travel and meet, defects in uterus, or some other issues like PCOS, endometriosis, hypothyroidism, hyperprolactinemia, APLA syndromes, etc.

Late marriages should be discouraged as fertility declines after the age of 40 and if at all a pregnancy occurs, the chances of complications are more like birth defects, hypertension, diabetes etc.

There are IVF cases that have not been successful. What are the reasons?

Assisted reproductive techniques like IVF are being performed for infertility. As these are not natural procedures, on an average, only 25percent of the embryos used in IVF can result in live birth showing that it does not have a very significant success rate. Chances of IVF failure are more likely in older women due to the poor quality of eggs, low AMH levels or scarcity of ova. The couples are already informed by the IVF centres about the chances of a successful pregnancy.

Are junk foods causing infertility among women? 

Junk-foods lead to obesity, PCOS, diabetes, metabolic syndromes which can lead to sub fertility and infertility. Ideally, junk food should be avoided not for this reason only but also for overall good health.

There is social stigma related to not having a baby? How should women manage such situations?

A huge misconception in our society is that if a couple is infertile, it is attributed solely to the woman. Even the husband sometimes accuses the woman for the same. It is a moral responsibility of each one of us to change this mentality and remove all the social taboos related to this.

If the couple is infertile they can opt for treatment, and various assisted reproductive techniques. If everything fails, they still have an option of adoption. However, demeaning the woman and putting her under so much stress only worsens the situation further.