Motherhood is a beautiful experience. Nothing beats the charms of it. In these times of Covid, pregnant women have gracefully handled their pregnancies amidst uncertainties and dilemmas. Lots of credit also goes to obstetricians and gynaecologists who ensured safe and happy deliveries of pregnant women even in these tough times. Medicircle is conducting an exclusive series to spread awareness about the significance of Safe Motherhood across all segments of society. 

Dr. Monika Agrawal is a Gynaecologist, Laparoscopic Surgeon (Obs & Gyn), and Infertility Specialist associated with Her Care Clinic, Mumbai. She has more than 14 years of experience. She possesses the exemplary skills for duties in the delivery suite, operating theatres, outpatient clinics, and ward activities. She has performed and assisted in various major & minor gynaecologic, obstetric, general surgery, and infertility related procedures including abdominal and vaginal hysterectomy, exploratory laparotomy, operations for vaginal and uterine prolapse, myomectomy, repair of genital fistulae, tubal sterilization by vaginal and abdominal approach, operative and diagnostic laparoscopy, hysteroscopy etc.

Simple steps for ensuring safe motherhood 

Dr. Monika mentions, “Safe motherhood is not only about pregnancy, rather the journey starts from adolescence. Advice on infections, safe sex, importance of vaccination like hepatitis B and HPV, prevention of unplanned pregnancy, etc. should be given to adolescents. A good trend is being observed these days that couples are visiting doctors before pregnancy unlike the past when they visited only after pregnancy. This is known as preconception counseling. This counseling is very important in picking up the high-risk factors like hypertension or diabetes and working on them to avoid any complications during the time of pregnancy. However, this trend is more common in urban areas. We need to make this trend common in rural areas as well.

We need to focus on post-pregnancy care too. After pregnancy women are strained not only physically but also mentally. It’s called postpartum blues. Family support and expert counseling would help in this situation. So, to ensure safe motherhood, there is a need to adopt a holistic approach touching upon all areas from pre-pregnancy to post-pregnancy stage” she says.

Active management of pregnancy is a vital need in rural areas

Dr. Monika points out, “In rural areas, it is a common trend that a pregnant lady should see the doctor only in the 7th month. This is wrong thinking. If someone visits a doctor from the very first day, then important supplements can be given to prevent several defects. It has also been observed that because of the advice of the elders, couples are reluctant for sonography. However contrary to the belief that sonography is harmful, this technique is a boon to detect complications that can get life-threatening later. Sonography is important at intervals and a regular visit to an obstetrician is required every month if we want to ensure safe motherhood.

Also, in rural areas, there is not enough access to the healthcare system. A safe and clean delivery place is required for safe delivery and to avoid post-delivery complications which are lacking in many places. FOGSI has taken initiatives to train Anganwadi workers for the active management of pregnancy in rural areas. Such training is highly important for them as well as traditional birth attendants (local dais) so that they are well aware of the concepts of ensuring clean delivery places and safe deliveries,” says Dr. Monika.

Measures to further lower down the maternal mortality rate

Dr. Monika emphasizes, “Maternal mortality rate compared to the 1990s has come down. We need to further control the reasons for maternal mortality by putting a stop to (1) bleeding during delivery or abortion (2) sepsis or infection during abortion or delivery (3) dangerous blood pressure levels as out of 10 pregnant women, 1 suffers from hypertension which can get life-threatening (4) obstructed labor leading to uterine rupture.”

Dr. Monika lists down the following three significant Cs to ensure safe motherhood:

1. “Crisis Control – Pregnant women should know the crises that occur during pregnancy and should have the insight about when to contact the doctor. They should be made aware of the red flags.
2. Care – This comprises adolescent care, pregnancy care, postnatal care. There could be helplines or special clinics for adolescents to have easy access so that they can take the advice of experts without any fear or inhibition. Institutional delivery is everyone’s right. Initiatives by FOGSI like drills for Anganwadi workers to train them to identify high-risk cases is important. Nutrition or supplements information especially to women of lower socioeconomic strata is required, antenatal classes can be helpful to make them understand what to consume and what to avoid during pregnancy. 
3. Cure – Right treatment from grassroots to tertiary level is the need. Government has already made initiatives in this regard wherein every 9th day, practitioners of private clinics and hospitals are required to visit and provide services at grassroots levels.” 

Common symptoms and red flags that every pregnant woman should be aware of

Dr. Monika emphasizes that every pregnant lady should know about common signs and symptoms during pregnancy and also to understand that if they become excessive in nature, then they are red flags of health and need immediate doctor consultation. She lists down the following points

• “Nausea and vomiting – It is normal to experience these, the good part is that they exist in the initial phases of the pregnancy only and then would subside. 
• Headache, giddiness, more sleep in first three months, less sleep or insomnia in last three months
• Heavy breasts
• Acidity in general, which can aggravate if someone has been suffering from it before the pregnancy stage too
• Constipation, bloating – more fiber and water intake required
• Vaginal discharge 
• Cramps in the feet, abdomen
• Dehydration 
• Frequency of urine
• Urinary tract infection
• Pain, bleeding, leaking of fluid, 
• Fetal kick count of 8-10 is required in the last 3 months.

Covid vaccine and menstruation-related distorted ideas debunked

Dr. Monika clarifies, “Contrary to the belief that covid vaccine should not be taken a week before, during or after periods, one can take the vaccine during this phase. Immunity does not come down during menstruation and it does not become a contraindication. Some Covid affected women have found their immediate or next cycle irregular or there has been more bleeding during menstruation but you can safely take the Covid vaccine during menstruation.”

Covid vaccine during pregnancy

Dr. Monika mentions, “Recently there has been a guideline by FOGSI that pregnant women should be given a choice explaining that they could experience fever due to vaccines but there is no risk to the baby whatsoever.” She further adds, “Pregnant women can refrain from taking vaccines in their first 3 months. However, there has been vaccination of 10, 000 pregnant women in the US and no complications reported so far. So, pregnant, lactating as well as women who are planning pregnancy can be given a choice and it should be the patients’ call. There is not going to be an ill-effect of the vaccine on the baby and neither on the mums,” says Dr. Monika.

(Edited by Amrita Priya)