Becoming a mother is a beautiful and overwhelming thing. It is important for women to feel safe and secure while on this journey. Many mothers have to go on this journey of motherhood during the coronavirus pandemic, and they have handled the situation gracefully. At Medicircle, we present to you the National Safe Motherhood Day Awareness Series, where we are featuring successful Mompreneurs, Healthcare Professionals, Obstetricians, Gynaecologists, Entrepreneurs working on safe motherhood to raise awareness about adequate access to care during pregnancy, childbirth, and postnatal services.

Dr. Teena Trivedi Desai is Consulting Obstetrician, Gynecologist, and Fertility Specialist. She is associated with Four Care Hospital, Vileparle, and Aviva Clinic for Women and Fertility Clinic. She had been associated with R. N. Cooper Hospital, L.T.M.M.C and Sion Hospital, and K.B. Bhabha Hospital in the past.

Pillars of Safe Motherhood

Dr. Teena speaks, “Safe motherhood has been launched in 1985 to enforce that women must have availability and adequate access to care during pregnancy, childbirth, and post-delivery in order to achieve optimal health of mother and child. 

There are 6 pillars of safe motherhood.

Family planning –This is to ensure that couples are provided with information and services to plan a pregnancy and space for childbearing. A new terminology called the Cafeteria approach, which helps the couple to know about all the contraceptive methods available in the market and allowing them to make a decision which one would be right for them. Male or female sterilization is available for those who don’t desire future pregnancy. Reversible methods like contraceptive pills, IUCD, injectable contraceptives, and contraceptive implants for delaying childbearing or spacing between pregnancies are available. Emergency contraception (morning after pill) in certain cases. Fertility returns in 1-3 months after the most modern contraceptives. It is important to emphasize that there is no effect of reversible contraceptives on future fertility.

Antenatal care –It is the key element in the healthcare delivery system.  Early registration of pregnancy, minimum 4 antenatal visits -1st on missing period, 2nd between 14 – 16 weeks,3rd between 28-34 weeks, and 4th between 36 weeks to term are compulsory.  Regular checking of weight, blood pressure, and fetal growth at each visit,2 doses of injection TT, anemia prophylaxis with dietary advice, and iron-folic acid supplements for at least 100 days is mandatory.  Minimum investigations like blood group and Rh typing, HIV, VDRL, hemoglobin, a urine examination are necessary. At least 4 sonographies should be done during pregnancy - Dating scan between 6 -8 weeks, Nuchal translucency scan at 12 -14 weeks to rule out Down’s syndrome, Anomaly scan at 18-20 weeks, and Growth scan at 28-34 weeks. This provides adequate care for low-risk pregnancies and helps identify high-risk pregnancies to provide the necessary care. Involving the husband/ family members during counseling about the importance of good antenatal and postnatal care will help in a long way. 

Obstetric care – Institutional delivery and delivery by trained personnel are important components for safe motherhood. Registering and delivering high-risk cases that may require specialized multidisciplinary approaches like ICU, neonatal ICU in tertiary care hospitals should be provided. There can be a timely referral to a higher Centre during the course of labor if complications arise.

Postnatal care – Apart from ensuring proper healing of stitches and checking the general health of the mother, it is important to advise her about diet, personal hygiene, breastfeeding, and care of breasts. Minimum 2 postnatal visits are recommended. Contraceptive advice at 6 weeks post-delivery is important since after this time the couple can resume sexual activity. Inspite of lactational amenorrhea (irregular or no periods during breastfeeding) there is still a chance of pregnancy due to erratic ovulation.   

Post abortal care – Counselling and psychological support are provided to the couple. Proper counseling is done for contraceptive use to avoid unwanted pregnancy. 

Control of STI/HIV/AIDS – Sex education at 12-15 years of age about safe sex practice to adolescent girls and boys should be given so that they become sexually responsible partners. Educating married couples about safe sex practices at opportunities like routine antenatal or postnatal visits is also useful. Emphasizing the use of condoms to couples at high risk of STI, like drug addicts or those with multiple sexual partners, even if they are using any other method of contraception.”

Reasons for Maternal Mortality

Dr. Teena informs, “Maternal mortality is the death of a woman while pregnancy or within 42 days of termination of pregnancy. The maternal mortality ratio in India in 2018 was 113 per lakh live births. Maternal mortality is a measure of the reproductive health of the women in that area. The causes of maternal mortality can be grouped into direct (80%) and indirect (20%). Bleeding during pregnancy or delivery or after the termination of pregnancy, infections, hypertensive disorders, ruptured uterus, obstructed labor, unsafe abortion, anesthesia complications are direct causes. Bleeding and infections following delivery and unsafe abortions are the major direct causes. Indirect causes include anemia, other medical disorders in the pregnant woman, and accidents, out of which anemia is a major cause in our country.” 

Ways to decrease Maternal Mortality

Dr. Teena suggests, “Good antenatal, intranatal and postnatal care is being promoted by various government programs will help to reduce the maternal mortality. Regular antenatal checkups, dietary supplements, correction of anemia, clean and safe delivery practices are some of the steps. Regular antenatal visits help to identify complications and related care can be provided. Family planning advice at postnatal visits to ensure adequate spacing between two pregnancies (minimum 3 years) can be given. This not only prevents unwanted pregnancies and unsafe abortions but is also important to build iron stores in the woman before the next pregnancy and hence reduce the incidence of anemia.” 

Other contributory factors for Maternal Mortality

Dr. Teena adds, “It is important to address the contributory social factors like gender inequality, malnutrition especially of the female child, ignorance, illiteracy, prejudices, social customs, poor environmental sanitation, age at marriage and childbirth. We can overcome this through sex education in schools, informal health education at local gatherings, events, and various social media platforms.” 

Advice for Teenage girls

Dr. Teena says, “Adolescent health is also an important aspect since the age at which girls start menstruating is as early as 10 years in some cases and teenage sex is on the rise. This leads to an increasing number of teenage pregnancies and unsafe illegal abortions which are a major cause of mortality in our country. It is important to adopt a non-judgmental attitude towards any teenage girl seeking contraceptive advice.  Pre conceptional checkup and counseling can also help in identifying high risk factors like hypertension, thyroid disorders, pre diabetic state before pregnancy and hence provide an opportunity to anticipate and treat complications likely to arise later.”

General complaints during pregnancy

Dr. Teena explains, “Common ailment as per trimester of pregnancy are:

1st trimester (month 1 -3) – Feeling tired, bloating, constipation, heartburn (acidity), morning sickness, giddiness, increased frequency of urination. Some women may also experience the appearance of dark patches on the skin. They are due to hormonal changes associated with pregnancy. These problems can be treated with small frequent meals every 2-3 hours, avoiding foods that trigger acidity and nausea, increasing fiber intake in the form of fruits and vegetables, drinking 3 liters of fluids daily. Most of them are relieved at the end of 3 months, though a small proportion of women may experience nausea and vomiting for a longer time. 

2nd trimester (month 4-7) – Backache, feeling tired, constipation, leg cramps can occur in the second trimester. Compared to the other two trimesters,2nd trimester is associated with fewer symptoms.   Bleeding gums or nose bleeds can happen and must be reported to the doctor. Maintaining a good posture and regular exercise and walks will help. Stretch marks begin to appear towards the end of the 2nd trimester. Moisturizing your skin adequately helps in preventing stretch marks.

3rd trimester (month 7-9) – Backache, increased frequency of urination, leg cramps, disturbed sleep, heartburn, feeling tired, mild swelling of ankles and feet are commonly seen in the last trimester. Most of these are due to the enlarged uterus. Some women complaints of piles, involuntary leaking of urine.”

Time to seek a doctor

Dr. Teena warns, “It is important to report any of the above-mentioned common ailments to the doctor in case they are severe. Pain in the abdomen and bleeding or blood-tinged vaginal discharge in any trimester should be reported immediately. Other warning signs may include severe vomiting which not relieved with oral medications, dizziness or fainting, severe headache, fever with or without rash. Warning signs for the second and third trimester include blurred vision, decreased baby movements after 28 weeks, sudden weight gain of more than 1kg in a week, painful swelling of the feet, swelling of  the feet above ankles, leaking fluid from the vagina, fit or convulsion, difficulty in breathing, severe weakness, itching  or rashes on the body, decreased urine output or difficulty in  passing urine.”

(Edited by Renu Gupta)