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Waterbirth – Facts vs Myths

9 Jun

Hydrolabour is defined as the use of water during the active phase of first stage of labour. Hydrobirth entails the actual delivery of the baby that is the second and third stage of labour in the pool of warm water.

The equipment used is a disposable inflatable tub about 5 and ½ feet in diameter and two feet tall. The water is maintained at a constant 37* Celsius i.e body temperature which is warm to hot. Monitoring of labour for both patient & baby is just as we do in routine labours.

Patients are admitted early in labour and essentially the entire process of labour remains the same. Due consent is taken for the use of water in labour and delivery. The patient enters the pool of water in the active phase and labours and delivers there.

The baby is born active and calm as the mother holds and brings it out of water after a few seconds of adaptation. The cord is now cut and respiration is established. Placenta delivery may take place in the pool or after shifting the patient out. Episiotomy can be given underwater with local anaesthesia.

The average duration of second stage is shorter and the incidence of instrumentation is lower in patients undergoing Hydrobirth. None of our patients has had any significant 3rd stage complications.

There is absolutely no difference in the neonatal condition at birth or the incidence of neonates requiring resuscitation or other assistance.

 Facts Vs Myths

Myths/ Fears

Scientific Facts

The baby will aspirate water or drown . There is no attempt to breathe till the cord is cut or exposure to air occurs.
Infection risk to the mother. Theoretical- never reported in the last 50 yrs.
Infection risk to the baby . Almost all babies are bathed in most hospitals after birth. We use the same water for our Hydrobirths.
Hygiene? Disposable equipment available for each patient.
What about Episiotomy & the placenta. Episiotomy under local anaesthesia can be given underwater. Delivery of the placenta may be done underwater or on the delivery table nearby

So why water?            

  • 60% of our body is water!!!
  • Water is the essence of life – natural & pure.
  • Water is a muscle relaxant it rejuvenates and refreshes.
  • Water increases blood supply to the uterus – takes away toxic local hormones.
  • Water makes labour more efficient … more progress with lesser number of contractions.
  • Gives buoyancy and makes you weightless.
  • Results in shorter and less painful labours –without increasing the risk to mother and baby in any way.

In water stress hormones are reduced and pain relieving chemicals or endorphins are released in excess. Also the shock of sudden lights sound and other sensory stimuli to the baby is reduced if the baby goes from water to water to air rather than from water to air directly and these babies are reported to be more balanced and stable individuals who have better adaptive capabilities as adults later on in life.

The subjective reporting of pain relief has us completely stunned and very enthused about what we have seen.

We did not use any drugs or medication to hasten or accelerate these labours which is an important concept of natural birthing.

Benefits of Water Birthing?

  1. Water is a muscle relaxant – it aids the passage of the baby through the birth canal.
  2. Relives pain.
  3. Refreshes & rejuvenates the mother – making her more co-operative
  4. Shortens the duration of labour & reduces incidence of artificial instrumentation at delivery (Forceps/Vacuum)
  5. Causes weightlessness- overcomes gravity- allows the mother relief and comfort.
  6. Gives the baby a smoother medium of transition from the womb to the out side world…..And many, many

Reference Reading:

Cochrane Review : Of more than 40,000 Waterbirths worldwide. No directly attributable fatality and No specific risk above Normal deliveries.

British Medical Journal 1999 : Dr. Gilbert et al. 4032 Waterbirths – Perinatal Mortality 1.2 / 1000 live births. Lower than normal Deliveries.

Choosing Waterbirth : Lakshmi Bertram
Gentle Birth Choices : Barbara Harper
Waterbirth Unplugged : Beverly A Lawrence Beech
Waterbirth Handbook : Eileen Herzberg

www.waterbirth.org
www.waterbirth.com
www.yourwaterbirth.com

About the Author:

Dr. Rajeev Punjabi:  Dr. Rajeev V Punjabi started his Practice in 2000, and spent 4 years performing Sonography in Obst. & Gynaecology, besides working as a Gynaecologist in Mumbai. In July 2003, he joined hands with his colleague from LTMMC, Sion Hospital, Mumbai and long time friend Dr.Sheetal J Sabharwal to start Tulip Women’s Healthcare Centre in Khar(W), Mumbai, India. In October 2003, he performed Mumbai’s First and one of India’s first documented and reported Underwater Deliveries – Hydrobirth successfully. He continues to promote the use of Water in labour and delivery ( Waterbirth ) with great enthusiasm.

You can read more about Tulip and Dr Punjabi at: http://www.tulipwhc.in/ (Powered by Websites For Doctors)

You can also email him at: rvpgynaec@rediffmail.com

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Pregnancy guide if you are going to become a Mom

18 May

Body: In a woman’s life, pregnancy is one of the most exciting times and thus during this period the mothers need to very careful and conscious for the growth of their growing child. This time period starts being a great mother when these mothers come to know about their pregnancy. Once they conceive, along with that the growth of their unborn child tends to grow and below is some guidelines to keep themselves and their baby healthy during the time period of pregnancy.

First of all go to doctor for regular checkups and treatments

In India, the prenatal care at the regular intervals of time is very much important and thus it is quite helpful for a woman to keep her baby fit and fine in her womb. Most of the women have normal pregnancies and it is only due to the proper care and thus prevents pregnancy related complications. These complications could be life threatening and thus a mother needs opt be very careful during this time period. A physician specializing in obstetrics and midwives are healthcare professionals that particularize in caring for expecting mothers.

Go for healthy diet

A well balanced and healthy diet can help the mother as well as the baby to get the right nutrients.  The pregnancy always keeps in mind that the diet they take helps in the growth of their baby. The baby food intake all depends upon the diet of the mother. If the mother takes the wrong diet and goes for hard drinks then it could adversely affect the baby’s growth. Ladies are supposed to make sure that they eat good deal of whole grains, lean protein, veggies and fruits. Swordfish, canned tuna, undercooked meat, hot dogs and delicatessen meats should be fended off.

In addition, ladies may ask their doctor or midwife about considering a fish oil supplement. Fish oil contains omega 3 carboxylic acid, which are necessity for the baby’s mental capacity growth. Omega 3 fatty acids can also help out in reducing the risk of preeclampsia, which is the chosen cause of parental and fetal death.

Stay away from smoking and hard drinks

This may seem like a contributed, but both hard drinks and smoke can harm the growing baby. Smoking enhances the danger of bearing to a low-birth weight baby. Hard drinks increase the danger of a circumstance called FAS (fetal alcohol syndrome). It has been connected to heart defects, retarded growth and facial disfigurations.

Pregnancy specialist exercises

Many doctors and experts suggest that women gain amongst 25-30 pounds throughout pregnancy. Women who acquire more than the suggested amount of weight gain their risk of formulating preeclampsia and gestational diabetes. Proper exercise helps pregnant ladies to maintain standard weight. It also put in order the body for labor and finally the delivery. It not only does well for the mother, but it also does well for the baby. Researchers have shown that light exercise during this time period helps in strengthening the baby’s heart. Yoga or the great Indian meditation techniques have been practiced since centuries to cure many diseases and disorders. It helps the pregnant women to relieve stress and increase fertility who face problem in conceiving. Perform these techniques either at home or join some center to take better care of your unborn child.

About the Author:

Anna Cleanthous is a enthusiastic author who writes about various topics such as health, travel and tourism. She enjoys traveling and teaching.
My mail id: anna.cleanthous@gmail.com

Understanding Female Sexual Response: An overview

10 May

About the Author:
Dr. Anand Shinde, M.D., Gyn

IVF Consultant & Director of Andrology At“IVF Pune”, 7th floor Deenanath Mangeshkar Hospital Pune-4
Phone : +91 20 26876396 / 40151777
Mobile : +91 9822012166
Email : shinde.ivfpune@gmail.com

Dr Anand Shinde is Trained in High Risk Pregnancy Management & also in A. R. T. at Birmingham. He currently practices with Nirmiti Clinic and IVF Pune.

Website: http://www.dranandshinde.com/ (Powered by Websites For Doctors)

Do We Treat Male Infertility in the Era of ICSI ? – Dr. Anand K. Shinde

31 Mar

 

About the Author:
Dr. Anand Shinde, M.D., Gyn

IVF Consultant & Director of Andrology At“IVF Pune”, 7th floor Deenanath Mangeshkar Hospital Pune-4
Phone : +91 20 26876396 / 40151777
Mobile : +91 9822012166
Email : shinde.ivfpune@gmail.com

Dr Anand Shinde is Trained in High Risk Pregnancy Management & also in A. R. T. at Birmingham. He currently practices with Nirmiti Clinic and IVF Pune.

Website: http://www.dranandshinde.com/ (Powered by Websites For Doctors)

Ectopic Pregnancy—Medical management an overview

28 Mar

Introduction

The blastocyst normally implants in the endometrial lining of the uterine cavity. 1Implantation anywhere else is considered an ectopic pregnancy World Health Organization (2007) ,ectopic pregnancy is responsible for almost 5 percent of maternal deaths in developed countries .

Sites – Fallopian tube commonest

Dr Pratiksha Gupta, Ectopic Pregnancy, Female Reproductive Cross Section

 

 

 

 

 

 

Risk Factors

 

Factors Increasing  the Ectopic Pregnancy Rates

  • Increasing prevalence of sexually transmitted infections, especially those caused by Chlamydia trachomatis)
  • Identification through earlier diagnosis of some ectopic pregnancies otherwise destined to resorb spontaneously
  • Popularity of contraception that predisposes pregnancy failures to be ectopic
  • Tubal sterilization techniques that with contraceptive failure increase the likelihood of ectopic pregnancy
  • Assisted reproductive technology
  • Tubal surgery, including salpingotomy for tubal pregnancy and tuboplasty for infertility.

Fate of tubal ectopic pregnancy

Tubal Rupture

Tubal Abortion Abdominal Pregnancy

Broad Ligament Pregnancy

Interstitial and Cornual Pregnancy

Multifetal Ectopic Pregnancy

Symptoms and Signs

 Pain. Pelvic and abdominal pain  – 95 %

Abnormal bleeding. Amenorrhea with some degree of vaginal spotting bleeding -60% to 80 %

Abdominal and pelvic tenderness

Uterine changes

Vital signs ,Fall in Blood Pressure, Tachycardia.

gastrointestinal symptoms (80 percent)

dizziness or light-headedness (58 percent

Diagnosis of Ectopic Pregnancy

BETA-HCG

Serum Progesterone levels-25 ng/mL

Sonography

Culdocentesis

Management

Medical Management–with Methotrexate

This folic acid antagonist is highly effective against rapidly proliferating trophoblast

contraindication

Active intra-abdominal hemorrhage ,intrauterine pregnancy.breast feeding;

immunodeficiency,alcoholism; chronic hepatic, renal, or pulmonary disease;

blood dyscrasias; and peptic ulcer disease.

Patient Selection

The best candidate for medical therapy is the woman who is asymptomatic, motivated, and compliant, with.

Success rate depends on

  • Initial serum  Beta hCG level,

Success rate is 1.5 percent if the initial serum hCG concentration was <1000 mIU/mL;5.6 percent with 1000-2000 mIU/mL; 3.8 percent with 2000-5000 mIU/mL;

and 14.3 percent when levels were between 5000 and 10,000 mIU/mL

  • Ectopic pregnancy size

93-percent success rate with single-dose methotrexate when the ectopic mass was <3.5 cm, compared with success rates between 87 and 90 percent when the mass was >3.5 cm.

Fetal cardiac activity -relative contraindication to medical therapy

 Rupture of Persistent Ectopic Pregnancy

This is the worst form of primary therapy failure with a 5 to 10-percent occurrence in women treated medically.

Expectant Management

Tubal ectopic pregnancies only

Decreasing serial  – BHCG levels

Diameter of the ectopic mass not >3.5 cm

No evidence of intra-abdominal bleeding or rupture by transvaginal sonography

Resolution without treatment was more likely if the initial serum  -hCG level was <1000 mIU/mL.

Surgical Management

Laparoscopy

Laparotomy

References

1. F. Gary Cunningham, Kenneth J. Leveno,et al, Williams Obstetrics, 22edition, Section III, chapter10.

About the Author:

Author

Dr Pratiksha Gupta

Associate Professor

Department of Gynecology and Obstetrics

PGIMSR,ESIC,

Basaidarapur

New Delhi

Corresponding author

Dr Pratiksha Gupta

House number 11284 Laj building

No 1, doriwalan new rohtak road

Karol baghNew delhi110005

Mobile no. 09871128703

Email-  drpratiksha@gmail.com

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