Becoming a mother is beautiful and overwhelming. It is important for women to feel safe and secure while on this journey. Many mothers have had to go on the journey of motherhood during this coronavirus pandemic and they have handled the situation quite gracefully. On the occasion of National Safe Motherhood Day, Medicircle is conducting an awareness series featuring successful mompreneurs, healthcare professionals, obstetricians, gynecologists, entrepreneurs working on safe motherhood to raise awareness about adequate access to care during pregnancy, childbirth, and postnatal phase. 

Dr. Rishma Pai is an Honorary visiting Consultant Obstetrician, Gynecologist, and Infertility specialist at the Lilavati, Jaslok, Hinduja Healthcare Services and Every Woman Cliniqs, Mumbai. She is the only Indian selected to be on board the International Federation of Fertility Societies (IFFS), an organization of infertility specialists from over 68 countries. She is the first Indian to have been appointed as the Board Member of the World Endometriosis Society (WES). She is the President of the Mumbai Obstetrics & Gynecological Society (MOGS). She has also been the President of ‘Federation of Gynecological Societies of India’ (FOGSI) and the IVF Council of India. She has received the inspiring Gynecologist of Western India award by The Times of India group in 2019 and has been awarded many more such prestigious awards. 

Pillars for safe motherhood

Dr. Rishma lists down the following pillars of safe motherhood and reproductive planning:

• “If couples use contraception, lakhs of lives can be saved. Due to the lack of family planning measures, there is an increased number of abortions and many lives are at risk during the abortion. So, adopting family planning measures is important. 
• Girls and women who want to experience healthy and safe motherhood later in life should take simple early measures. Young girls from the teenage stage only should be particular about their hemoglobin, ideal weight, iron, and calcium levels in the body. 
• Couples should meet doctors at the planning stage itself instead of the time when the woman has already got pregnant. Meeting a doctor before the wedding or just after it is very important for good reproductive planning. If they come to doctors at this stage, doctors can do simple health checkups like thyroid, hemoglobin, blood sugar, ovary, thalassemia tests, etc. to ensure that there are no complications later on and if there are any complications, then preventive measures are taken well in advance before the pregnancy.
• In Covid times, teleconsultations are also very popular, so young couples can do that as part of their reproductive planning. 
• Also, it's important to be under the guidance of doctors in the post-natal phase. Generally, people tend to disappear and meet doctors during the time of the second pregnancy. This should be avoided, rather regular checkups at that stage are also important for a woman’s reproductive well-being.
• There is a tendency of increased sexually transmitted diseases (STIs) in modern women due to more than one sex partner. So, visiting doctors to keep STIs under checks is also very important,” suggests Dr. Rishma.

Strategies of healthy pregnancy

Dr. Rishma points out that “It is unfortunate that one of the biggest reasons for death in India of women is iron deficiency. So, the strategy for women to keep themselves healthy is to keep a check on it and go for regular checkups to ensure desirable blood pressure, hemoglobin, blood sugar, and ideal weight levels so that there are minimal complications at the stage of pregnancy. Women should not ignore bleeding during pregnancy even if it is negligible and should take steps against infections or sepsis which is common during pregnancy. Ignoring it is a big reason for maternal mortality.” She also advises choosing a good hospital for childbirth to ensure safe delivery. These steps would reduce the risk of mothers dying during childbirth.

Pregnant women should have knowledge about their own bodies

Dr. Rishma mentions that it is vital for any woman to know about her own body and the changes it is going through so that she can take care of herself in the best possible way. “Women should understand that vomiting, nausea, acidity, gas, constipation, etc. are common ailments during pregnancy and should not get very worried about it when the occurrences of these are not very frequent. If there is vomiting once or twice a day it's ok. If it exceeds 15 or more times then it's an alarming factor and a doctor should be immediately consulted. Doctors would help with diet modifications as well so that they can have minimal problems when the child is inside the womb. Women also suffer from piles either due to constipation or the weight of the growing baby. Doctors’ guidance would help tackle these issues. Backache is a universal problem during pregnancy. Women should go for back strengthening exercises or physiotherapy to get rid of it. Pelvic floor exercises, walking, and few stretches are suitable for most women during pregnancy,” suggests Dr. Rishma.

Warning signs during pregnancy

Dr. Rishma lists down the following warning signs during pregnancy for which immediate doctor’s consultation is required:

• Vomiting or loose motion more than 15 times a day
• Bleeding is a warning sign – sonography can help understand the reason
• Too much mucus discharge
• Itching, red rash, or burning sensation during the passing of urine
• Reduced fetal movement
• High blood pressure and swelling in feet, legs, face, etc. due to that – one can keep instruments of blood pressure check-up at home itself for better monitoring. 
• Tightness in the abdomen area, stomach ache”

Dr. Rishma emphasizes, “Women might have the tendency to search solutions to their problems on the internet. The Internet is laden with different opinions on the same issue which is generic in nature and not tailor-made as per individual requirement. Moreover, you would see information on the internet as per what you want to see instead of what exactly you require to know. The balanced information can only be gathered from a doctor’s consultation as the doctor would guide you on the basis of your individual history. So don’t hesitate to go to a doctor and choose a doctor who is willing to give you enough time in listening to your problem and accordingly advise as per your individual requirement.” 

Egg Freezing – an effective measure to ensure healthy child-delivery any point of time

Dr. Rishma explains, “Egg freezing is a standard technique which enables women to choose when they want to give birth to a healthy baby without worrying about the quality or insufficiency of the eggs if they are planning late pregnancies due to professional commitments or other reasons like delay in choosing the right partner. This technique was brought by us from Japan in India about 10 years back. Now, it’s a popular concept with not just celebrities but also middle-class women. This process is practical and easy. It is also important because some women might be young in an age like in their 20s but somehow their ovarian age might be that of women in their 40s. This is a common trend that is getting observed in these modern times. These are known as premature ovarian insufficiency or premature ovarian failure, depending upon individual conditions. In such scenarios too egg freezing is extremely vital so that there are chances of being mothers even if one wants to delay pregnancy. Also, women are suffering from ailments like breast cancer in their early 20s and there can be chances of suffering from cancer due to family history. Egg freezing can help them to have the experience of motherhood even then. It takes less than 15 days to prepare and extract the eggs through a non-invasive procedure of sonography. There are no cuts or stitches involved and on the final day when the egg gets extracted, just 4 hours of admission to the hospital is required. This is an effective measure and it has been found that those who had gone for egg freezing, 10 years back are able to deliver healthy babies now. Even big organizations particularly in the foreign countries are encouraging their women employees to go for it and they are also paying for this technique of fertility preservation so that their women employees can experience healthy motherhood and genetically own children whenever they desire,” informs Dr. Rishma. 

(Edited by Amrita Priya)