PLANNING A PREGANCY

Pre Conceptional Care

Planning a family includes:

Because one or a combination of these factors has direct link with the outcome of pregnancy, welfare of family, society and nation. 

When to have 1^st child is also a common concern to young couple, when they start their married life. Allow some time say about 6 months to get into shape, start picking up good habits and get rid of bad ones. If you have any of the following risk factors, consult your gynecologist before you plan to become pregnant. 

• Age < 16 years OR > 35 years   

• Two or more abortions in the past. 

• Blood pressure in previous pregnancy.    

• Previous gynecological surgery. 

• Gestational diabetes.

• Chronic renal diseases. 

• Heart diseases. 

• Tuberculosis.

• Any major complications in previous pregnancy leading to hospitalization, surgery, emergency blood transfusion.

• Rh – incompatibility.

• Previous mentally retarded child. 

• Either of the parents mentally retarded.  

• Previous neonatal death. 

• Preterm delivery.

• Anaemia warranting blood transfusion.

• Recurrent still births. 

• Congenital anomalies of previous baby.  

• Previous caesarean delivery.  

The aim of evaluation in these case, is to identify the disease at an early stage, calculate its incidence and start treatment at an early stage to decrease the risk to the baby and mother.Before you plan to become pregnant, you must inform your doctor 

PEOPLE WITH SPECIAL NEEDS

Diabetic Mothers   

Fertilisation in Sexual Activity and in first few months of pregnancy, there are high chances of baby having congenital abnormalities of heart and brain. These might lead to a high incidence of death of the foetus inside the uterus or after delivery. The pregnancy,for these women should be planned under a diabetiologist, gynecologist.

Mothers with blood pressure         

Women having blood pressure for a long time or with prior record of blood pressure in post pregnancy need special attention. Weight reduction, regular exercise, healthy nutritious diet and medications should be followed. These women need to be monitored by special tests to have optimal growth of foetus and minimal complications in mother during pregnancy and delivery.

Women with Anaemia :      

Diagnosis of the type of anaemia and finding out the cause of anaemia is vital in the treatment of these women.The anaemia must be adequately treated before planning a pregnancy. Adequately spaced children, additional supplementation of iron during pregnancy, lactation, treatment of piles or any intestinal worms, must be followed.

Women with prior two or more abortion :
Before planning pregnancy in these women, it is important to locate the cause of these abortions. A battery of blood test is carried out to arrive at a diagnosis.Depending on the diagnosis, treatment is initiated. It is important to take complete treatment before going ahead with pregnancy otherwise it may result in another abortion.

Women with thalassemia – a blood disorder:
An anaemia, which is not responding to routine iron treatment, needs to be investigated.Thalassemia is a type of blood disorder, which results in anaemia due to gene defect since birth. Depending of the type of thalassemia i.e. major or minor, pregnancy can be planned and executed under strict vigilance of a haematologist, gynaecologist and later a neonatologist for the baby.

Women with Rh – incompatibility:
When the mother’s blood group is negative and father’s is positive, there are chances of Rh – incompatibility. The mothers fighting cells (antibodies)  recognise baby’s red blood cells as foreign and starts killing them. Depending on the severity of the disease, the baby is at risk from mild jaundice to the death of baby due to severe anaemia in baby. However, observing the pregnancy carefully and taking Anti-D immunisation can reduce the risk. Anti-D immunisation contains ready-made fighting cells injected artificially in the  mother’s body to reduce the chances of disease formation. It is given 1st at 8 months of pregnancy (300 mg) and 2nd after delivery within 72 hours usually. It is advisable to take the same drug in appropriate doses as advised by your gynaecologist following abortion, ectopic pregnancy, death of baby inside the uterus, etc.

If the mother is previously exposed to Rh positive cells,the protocol of treatment differs and requires a specialized set-up with an experienced gynecologist , neonatologist and a radiologist.

Women with a prior mentally retarded child:
Such women need to be carefully evaluated and investigated with special tests. At times, both the partners are investigated to come to a diagnosis.The probability of another child with similar disability is explained to the couple with the help of special tests.Folic acid supplementations, for the first 3-month with special investigation like chorionic villus biopsy or amniocentesis with special ultrasonography are done routinely to treat these patients.      

Women with heart disease:
Depending on the severity of the disease, the pregnancy is planned.If the pregnancy involves the risk to the life of mother, it is advisable to avoid it.Less excertion, adequate bed rest, continued medication under supervision with active management during delivery, helps in the better outcome of the pregnancy.

Obese Women:
Weight reduction prior to pregnancy is vital. Loosing of weight by following exercise routine , following a diet regime    , avoiding starvation or fasting is important. Regular antenatal exercises to strengthen  the abdominal, back and perineal muscles help in the process of delivery. Diabetes and blood pressure are routinely checked in these patients. Frequent visits with dietician, gynaecologist is essential for those women.

SELECTING THE SEX OF THE CHILD

There are various medical and non-medical means to plan the sex of your child. But none of them is full proof to achieve so. However, by practicing them, one can definitely improve the odds.

Scientific basic of sex of the baby:
X and Y chromosome determines the sex of the baby.The mature egg contains only ‘X’ type of chromosomes while the sperm has two types  ‘X’ type and ‘Y’ type. If the sperm of carrying the ‘X’ chromosome fertilises the egg, then the baby will be female child.If the sperm carrying the ‘Y’ chromosome fertilises the egg, then the baby will be a male child.So, the sex of the child entirely depends on ‘father’ and not on mother.

There is indirect evidence that shows the spermswith 'Y' chromosome swim faster, have shorter life span and are more alkaline. While the sperms with 'X' swim slower, have a longer life span of upto 72 hours and are acidic in nature.

Ways of planning the sex of the baby

Timing of intercourse:
As mentioned earlier, the ‘Y’ sperms are faster, alkaline and with a short life span while the ‘X’ chromosome are slower, acidic and live upto 72 hours. On the basis of this hypothesis, one can plan the timing of the intercourse to conceive a baby of desired sex.If you want a male child, then the couple should have relation at the expected time of ovulation. It is advisable to avoid intercourse for 4 – 5 days prior to ovulation.If the preference is for female child, then the couple should keep relation 2 – 3 days prior to the expected time of ovulation, and then not to have relation for 4 – 5 days the expected time of ovulation.

Based on diet:
The women can modify her diet during the ovulation period by taking either acidic or alkaline food stuff and increase the chance of male or female baby, depending on her preference. If she desires a female child, she should take more of acidic food like Citrus fruits (orange, lemon, mango, pickle salty items) since this will be unfavorable for alkaline nature of ‘Y’ sperms. Vice-a-versa, if she desires a male child she should restrict her salt intake, avoid taking Citrus fruits. 

Through lotions and creams:
If a male child is desired, then the lotion containing an alkaline medium is used which is unfavorable to acidic female sperm. If a female child is desired, the lotion will be more acidic, in order to neutralise the male sperms.

IMPROVING THE ODDS FOR GETTING PREGNANT

• Following the fertility calendar       will help you to become pregnant. Understanding the body’s language regarding ovulation, having intercourse during that period improves the chances of pregnancy.
• Alternate day intercourse during the middle 10 days of your menstrual cycle.
• During relations, preferably the woman should be below and the man up.
• After ejaculation, not to get up immediately or go to bathroom, or clean with soap water.
• Keep a pillow or two, below her buttocks, which helps the ‘cum’ to remain inside the vagina.
• Ovulation induction – (drugs given to increase the formation and maturation of egg) with follicular study under sonography guidance can be done.
• At the time of ovulation, if intercourse kept or intrauterine insemination done helps in improving the odds for becoming pregnant.

When to see a doctor

• If you belong to the high-risk group, you must see the gynaecologist before taking a decision to become pregnant.
• If you are trying to become pregnant for a year or more and failed to achieve it, you must consult the gynaecologist.  
• If you have missed your periods and suspecting to be pregnant, you must consult the gynaecologist.  .