Postpartum depression

Being a new mother is a challenging phase as lots of adjustments are needed. Hence dealing with disruption of sleep wake cycle, responsibility of the baby, breastfeeding irregularities and recovery from the delivery is difficult. All these issues can lead to “Baby blues” or minor mood swings and irritability which generally disappears in a week or two post delivery without any treatment.

Postpartum depression is severe clinical depression after child birth.It can occur soon after delivery or within a year and requires treatment.

Causes of postpartum depression

Causes can be

  • Changes in body both before and after delivery
  • Changes in work and social relationships
  • Less time and freedom for leisure
  • Lack of sleep
  • Worrying about the ability to be a good mother
  • Inadequate support from the partner and family

What are the risk factors?

You may have a higher chance of developing postpartum depression, if you are

  • Under 20 years of age
  • Did not plan the pregnancy and have mixed feelings about it.
  • Had history of depression in the past or in the family
  • Have poor relationship with the partner, or a single parent
  • Financial and social issues
  • Currently drinks alcohol, smokes or takes illegal substances
  • Dealing with death, illness of a dear one

Symptoms of postpartum depression

Feelings of anxiety, restlessness, mood swings and tearfulness just after pregnancy is known as baby blues which mostly disappear in a week without treatment.

Postpartum depression may occur when the baby blues do not fade away or when signs of depression start 1 or more months after childbirth.

The symptoms of postpartum depression are the same as the symptoms of depression. Along with a sad or depressed mood, you may have some of the following symptoms:

  • Agitation or irritability
  • Changes in appetite
  • Feelings of worthlessness or guilt
  • Feeling like you are withdrawn or disconnected
  • Lack of pleasure or interest in most or all activities
  • Loss of concentration
  • Loss of energy
  • Problems in doing daily routine tasks
  • Significant anxiety
  • Thoughts of death or suicide
  • Troubled sleep

Also a mother with postpartum depression will be unable to take care of the baby and herself, will be afraid to be alone with the baby and may have negative feelings towards the baby.

Diagnosis

Diagnosis is made by the doctor on the basis of symptoms and history of your illness. If you feel you have any of the symptoms mentioned above, see your physician immediately.

Treatment

Treatment of postpartum depression includes medication and counselling. You may be advised appropriate medication which help in balancing certain brain chemicals linked to depression.

Counselling by a psychologist will help in dealing with the depression better. It helps in recognising negative feelings and handling them in a better way. So it is important to seek help of the psychiatrist as soon as the diagnosis is made.

If you’ve been diagnosed with postpartum depression, there are many things you can do to help yourself

  • Ask your partner, family, and friends for help with the baby’s needs and in the home.
  • DO NOT hide your feelings. Talk about them with your near ones.
  • DO NOT make any major life changes during pregnancy or right after giving birth.
  • DO NOT try to do too much, or to be perfect.
  • Make time to go out, visit friends, or spend time alone with your partner.
  • Rest as much as you can. Sleep when the baby is sleeping.
  • Talk with other mothers or join a support group.

Having good support of your family, partner and friends may help reduce the seriousness of the illness. Also timely diagnosis and treatment will help in quicker recovery. If you have any symptoms of depression as mentioned above, do not ignore it as just mood swings and seek medical help at the earliest.

-Dr Prerna Gaur

Acknowledgements

https://www.psychiatry.org/patients-families/postpartum-depression/what-is-postpartum-depression

https://www.nhs.uk/conditions/post-natal-depression/symptoms/

https://www.medicalnewstoday.com/articles/237109.php

 

Premenstrual syndrome (PMS)

PMS is a condition that affects women’s physical and mental health which typically begin from 2-7 days before menstruation and usually disappears as soon as the periods start.
PMS is frustrating not only for the women but also for those around her.

Symptoms:

  • Breast tenderness
  • Acne
  • Sudden Mood swings
  • Irritability
  • Bloating of stomach
  • weight gain(temporary)
  • Swelling of fingers, toes and face.
  • Depression
  • Lethargy
  • headache
  • Back pain
  • Joint pain
  • Food cravings
  • Irritability, mood swings, crying spells 

No one knows what causes PMS, but hormonal changes trigger the symptoms.

Risk factors:

Women who are at an increased risk of suffering from PMS :

  • Have a family history of PMS
  • Lead a sedentary lifestyle
  • Take an unhealthy diet
  • Are below 30 years of age
  • Have more than two children
  • Suffer from high-stress levels


Some Dos and Don’t for to manage PMS

Do’s:

  • Have a diet high in carbohydrate and low in fat
  • Consume foods rich in vitamin B6 and vitamin E like fish,whole grains, and wheat germ as well as green leafy vegetables and fruits.
  • Take calcium- rich foods such as milk, paneer, curd, fenugreek, drumstick leaves and ragi
  • Finding relaxing activities that relieve tension, such as reading, watching a movie, going for a walk, or having a bath
  • Regular walking, cycling abdominal and pelvic exercises
  • Stretching and breathing exercises, such as yoga
  • Quit smoking, if you are a smoker

Don’t

  1. Take foods containing caffeine like coffee, tea and chocolate in excess.
  2.  Take refined carbohydrates, sugars and tobacco.
  3. Take foods which are oily, fried and spicy.
  4. Skip meals. Follow a regular meal schedule to maintain a more stable blood sugar level.
  5. Sleep too little
  6. Drink alcohol.

When to see a doctor:
You need to visit a doctor if any of your symptoms especially your mood swings, depression, or abdomen, joint and muscle pains are interfering with your day to day activities, or if they do not go away even after menstruation has stopped.

Treatment:

  • Many women experience relief from PMS symptoms through lifestyle changes alone.
  • Over-the-counter pain relievers such as ibuprofen, aspirin or naproxen may help
  • For more severe cases though, your doctor may prescribe medicines such  as..
  1. Antidepressants
  2. Nonsteroidal anti-inflammatory drugs
  3. Diuretics
  4. Hormonal contraceptives
  5. Oestrogen-only patches and implants.
    Prognosis:
    In most women, PMS symptoms begin to subside after age 35. They end at menopause.

Dr. Krishna priya.

https://www.everydayhealth.com/pms/pms-articles.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418247/

Emergency Contraceptives

In modern times, couples try to balance family and work hence unintended pregnancy is a concern in the event of unprotected intercouse. Unprotected intercourse occurs for multiple reasons which includes lapse in adherence to an ongoing method of contraception, a contraceptive mishap (such as condom breakage), lack of knowledge about contraceptive use and sexual assault.

Fortunately, several options are available for contraception that can be used after unprotected sex has already occurred; these methods, collectively referred to as emergency contraception,

Emergency contraceptives can prevent pregnancies upto 95% if taken with 5 days of unprotected intercourse.

Most common methods of emergency contraceptives are-

  1. Emergency contraceptive pills (ECPs)-These pills include the hormones like estrogens, progestins, or both and are advised to be taken at the earliest or within 72 hours.
  2. Copper-bearing intrauterine devices (IUDs)-These are inserted by a doctor up to 5 days after unprotected intercourse to prevent pregnancy.

Mode of action

  • Emergency contraceptive pills work by delaying release of egg and hence prevent ovulation.
  • IUD makes the uterus unfavourable by chemical changes for sperm and egg to meet and grow.
  • Emergency contraception cannot interrupt an established pregnancy or harm a developing embryo.

Advantages

Emergency contraception is a relatively safer form of backup birth control if your choice of contraceptive fails(like condom breakage,missed pills) or if you have unprotected sexual intercourse. It is used after intercourse but before pregnancy has occurred.

This pill does not affect future fertility.

Side effects

  • Side effects of emergency contraceptives are Nausea,vomiting,fatigue,headache,dizziness,breast tenderness and abdominal pain.
  • Side effects usually do not occur for more than a few days after treatment, and they generally resolve within 24 hours.

Points to keep in mind before choosing Emergency contraceptives

  • Emergency contraceptives should not be taken without prescription or bought over the counter.Only a registered medical practitioner after carefully assessing the situation can prescribe it.
  • There is no restriction of age and these can be prescribed to women of any age if need be. In minors, it can be prescribed after discussion with the guardian.
  • Frequent use of emergency contraceptive is not recommended as it can lead to complications. hence discuss with your gynecologist regarding use of a long term contraceptives.
  • It does not protect against sexually transmitted disease, so to avoid such a risk condom use is advised.
  • As the method is effective, most women get their next menstrual period at expected date, but in few cases there can be dysregulation of cycle or heavier bleeding.

According to WHO recommendations, every women who is at risk of unintended pregnancy should have the right to access emergency contraception. In India, after carefully assessing the health of the woman, a registered medical practitioner can prescribe emergency contraceptives.

Avoid buying emergency contraceptive pills over the counter without prescription.

Discuss with your physician/ gynecologist about the emergency contraception and the best option for you in case of an accidental intercourse.

-Dr Prerna Gaur

Acknowledgements-

https://www.webmd.com/sex/birth-control/emergency-contraception#1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216625/

https://www.emedicinehealth.com/emergency_contraception/article_em.htm#what_is_emergency_contraception

 

Effect of Losing Weight in treatment of PCOS and associated Obesity:

PCOS(Poly cystic ovarian syndrome) is the most common hormonal abnormality seen in women and also considered as the leading cause of infertility in their reproductive age. 50-60% of women with PCOS  are overweight or obese. Obesity  is strongly associated and is a common finding in PCOS ,aggravating many of its reproductive and metabolic features. The relationship between PCOS and obesity is complex, not well understood. The diagnostic criteria for PCOS is based on presence of 2 out of 3 features (Rotterdam criteria):

  1. Anovulation
  2. Polycystic ovary morphology
  3. Hyperandrogenism- clinical or biochemical

Does obesity cause PCOS?

Interesting part is that Obesity causes PCOS and vice versa.

Characteristics and features of PCOS:

Women with PCOS may have both reproductive and metabolic disturbances. In first part it causes increased androgen production, menstrual irregularity, hirsutism, and infertility. In second part , metabolic disturbances include defects in insulin action and β-cell function of pancreas causing glucose intolerance and eventual development of Type-2 Diabetes Mellitus. Other than Type-2 diabetes, PCOS is also associated to in causing dyslipidemia, hypertension, cardiovascular disease and endometrial cancer.  

PCOS and its Management:

Treatment of PCOS must focus both on  treating hyperandrogenism and anovulation and on reducing metabolic complications.

Treatment includes medical management and lifestyle intervention. Usage of Metformin based combination medications will help in balancing the metabolic issues like increasing sensitivity of tissues to insulin and also helps in regularizing menstrual cycles along with losing weight.

Losing weight is an Important strategy in treatment of PCOS:

The best approach to PCOS treatment is through lifestyle modification. So physical activity and taking low calorie diet plays an important role in restoring ovulation and decreasing infertility.

  1. Low caloric diet:Eat a high-fiber, low-sugar diet. Take more of fruits, vegetables, and whole grains. Avoid processed and fatty foods to keep blood glucose under control. Instead of taking 3 large meals take 4 to 6 small meals throughout the day
  2. Physical Activity: Along with the above diets, following a good exercise and making it upto 45 minutes per day helps in reducing weight and keeping insulin and other hormone levels under control & also increases insulin sensitivity and improves psychological issues that are present due to PCOS.

-Dr.Bhavani Sagar Surampally

 

WOMEN AND DIABETES -WORLD DIABETES DAY 2017

Globally, 2.1 million women die due to diabetes as opposed to 1.8 million men and diabetes is the ninth leading cause of death among women. Diabetes increases risk of heart disease by six times and reduces life span by 8 years as compared to women without diabetes.

In India, prevalence of the disease is 17.7% among urban middle class women while it is 10% in rural areas. Higher body fat percentage and abnormal lipid profile has been attributed as the major factors responsible for increased prevalence of diabetes among women in the developed and developing countries Continue reading “WOMEN AND DIABETES -WORLD DIABETES DAY 2017”

Prepare your body for conception

 

There are no statistics reporting as to how many women in India are pregnant at a given point of time, but I am sure the number is really huge. Pregnancy is considered as just another phase of the life cycle in women but actually it is THE MOST IMPORTANT PHASE because it not only marks the arrival of a new human being but is also a rebirth for the mother. The health and well being of both is very crucial since their survival depends on each other.

Most women are very receptive to changes in diet and lifestyle during pregnancy as every mother wants a HEALTHY BABY. So no matter what they have been doing all this while, they want to build a healthy foundation for a normal healthy infant. Unfortunately, the much needed focus on nutrition during this phase is lacking with Doctors hardly acknowledging the need for a structured and specific diet regimen. Except that they mostly monitor weight closely but don’t tell the mothers the right way to gain or lose to achieve the ideal.   Continue reading “Prepare your body for conception”

TOP FEEDS FOR NEONATES

-A neonate is a new born baby till 28 days of life according to WHO.

-Top feeds are the feeds anything apart from breast milk of the mother for new born babies.

-It is very important for the baby to feed only on mother’s milk since birth till 6 months of age.

-Common top feeds that are given include water, honey, sugar water, formula milk, cow milk, buffalo milk etc. which are not good for the baby.

EXCLUSIVE BREASTFEEDING:

-Exclusive breastfeeding is defined as breastfeeding but nothing else including water till 6 months of age of the baby. The baby can receive ORS, drops and syrups of vitamins, minerals, medicines as per doctor’s prescription. Breast feeding is the healthiest and the most ideal way of feeding the baby to achieve optimal growth, development and health.

-Babies don’t have enough immunity to fight against infections they can get outside mother’s womb after birth due to absence of IgA antibodies which act against a number of micro-organisms harmful to the baby.

-Breast milk has high levels of IgA antibodies which protect intestinal lining of the baby. Breastfeeding helps in improving the baby’s immunity by passing these IgA antibodies through mother’s milk.

-Breastfeeding hence decreases the risk of infections after birth until the baby develops its own immunity gradually and naturally and also from Vaccinations, given after birth.

-The goal is to encourage the mother to feed as many times as the baby demands, educate her about recognizing the cues from the baby when the baby is hungry, encourage her to take nutritious diet, drink plenty of fluids and proper rest.

-It is known that the baby is hungry when the baby puts hand in mouth or when the baby directs tongue to the side when that side of cheek is stroked gently with finger.

-Baby can be breastfed as many times as the baby is hungry and demands for, rather than keeping a certain time gap between two sessions of breastfeeding.

-Latching in such a way that baby’s mouth covers entire areola is equally important while breastfeeding for good amount of milk intake by the baby. Good latching also prevents mother from getting sore nipples.

-Emptying both breasts by starting feeding alternatively with each feeding is also very important for good breast milk production.

-Exclusive breastfeeding is ideal unless the baby has any complications or disease conditions that require formula milk along with mother’s milk (mixed feeding) for additional nutritional support or if the mother is not able to produce enough milk for exclusive breast feeding.
TOP FEEDS : Giving top feeds to the baby is unnecessary and inevitably exposes the baby to micro-organisms of external environment, increasing the risk of infection.

-Enterocolitis is the most common condition seen in newborns who are given top feeds. The baby develops diarrhea, vomiting leading to dehydration, improper nutrition which disturbs the normal growth and development of the baby.

-If top feeding is inevitable due to a medical condition of a baby, it is important for the caregiver to maintain proper hand hygiene while preparing formula feed and use boiled and cooled water for the preparation of the formula.It is also important for proper sterilization of the feeding bottles and nipples.

– Dr.Divya Teja Pasupuleti

https://www.ncbi.nlm.nih.gov/pubmed/6798576

http://www.who.int/nutrition/topics/infantfeeding_recommendation/en/

An approach for diagnosis and management of “vaginal discharge”

“Vaginal discharge” is the term used to describe the fluid that comes out of vagina. There are two types of vaginal discharge which are normal and abnormal.

Normal vaginal discharge: This is usually clear, white discharge which is not associated with any bad smell. Women can have vaginal discharge at different times like these.

-During periods women can have little vaginal discharge

-During their ovulation which is 2 weeks before she gets her period

-During pregnancy due to hormonal changes

-If they are on oral contraceptive medication

-Women will have comparatively less vaginal discharge after menopause.

Abnormal vaginal discharge: It is usually associated with the following symptoms and it requires treatment based upon the cause.

-Itching and pain around vagina, fever, bad smelly discharge, pain while passing urine, pain while having intercourse, change of colour which looks like curd/cheese, greenish, grey etc., bleeding after intercourse can also be noticed. There are several conditions which can cause abnormal vaginal discharge and some of them are

-Infections like candidiasis, Trichomoniasis, Bacterial vaginosis, Chlamydia trachomatis, Gonorrhea.

– A retained foreign body such as a tampon, condom, or vaginal sponge.

-If they use scented soaps, fragrances or wipes to clean that area.

Vaginal discharge during pregnancy:

Increased amount of vaginal secretions are thought to be normal due to the increased blood flow to the vagina and surrounding glands during pregnancy. It is normal if it is not associated with pain, itching, redness, fever, burning sensation while passing urine, foul smelling discharge etc. If a pregnant woman experiences any of these, visiting their treating doctor/Gynecologist is must for a physical examination to rule out possible causes.

Investigations needed:

In most of the cases empirical treatment is started without doing any investigations. Women with persistent or recurrent vaginal/vulvar symptoms should be examined and investigated.

Urine analysis, Random blood sugar, Vaginal or endocervical swab,Ultrasound abdomen and pelvis

How we can treat abnormal vaginal discharge:

Treatment completely depends upon the cause. For example if infection is the cause then we need to treat that infection, we must know for every infection the treatment is different and using medication for long time without doctor’s advice is not recommended.

For some specific infections like sexually transmitted diseases the partner will also need treatment. Treating partners is necessary and it will reduce relapses.

Recurrent infections even after treatment must be examined and evaluated for the possible cause.

 

How to prevent abnormal vaginal discharge:

-Avoid using wipes, scented soaps or fragrances. Instead of them use V wash which is safe but only for external use.

-Avoid intercourse till the time you receive treatment.

-Avoid satin or polyester undergarments instead of that use loose cotton undergarments. Change undergarments 2-3 times in a day.

-Keep the area clean and dry.

– You can use panty liners instead of sanitary pads during your last days of period when you have only spotting.

-Douching (forceful insertion of liquid inside vagina to rise it out) must be avoided.

-Don’t use hair removal creams for removal of hair in the perineal the area.

Drink plenty of water at least 2 to 3 liters, eat a well-balanced meal, plenty of fresh fruits and vegetables, skimmed milk and curd as it is also a rich source of probiotics  which are needed for normal bacteria growth in the vaginal secretions

 

– Dr.​​Alekhya Yelamanchili

 

Know your rights as a working mother !

Did you know that India ranks third on the list of countries with longest maternity leave yet only 45% infants are being breastfed within an hour of birth and just 65% are being exclusively breastfed as per WHO recommendations in India. The recently amended Maternity Benefits Act has increased  the duration of maternity leave available for women employees from the existing 12 weeks to 26 weeks

Laws to support a working new mother

  • 26 weeks maternity benefit leave i.e.8 weeks before the expected delivery date and extending up to 18 weeks after the child birth (Sec 5 (3).
  • Rs.3500 Maternity Bonus per maternity (Sec 8)
  • 6 weeks Leave for Miscarriage or medical termination of pregnancy,immediately following the day of her miscarriage
  • 2 weeks of leave for woman undergoing tubectomy (surgical procedure for sterilization) operation from the date of such operation (Sec 9 & 9A)
  • 4 weeks post maternity leave of 12 weeks, in case of “illness arising out of pregnancy, delivery, premature birth of child, miscarriage, medical termination of pregnancy  or tubectomy operation , supported by a Medical Certificate (Sec 10)
  • 2 breaks of prescribed duration for nursing the child until the child attains the age of fifteen months on returning to work, in addition to the interval for rest allowed to her, (Sec 11)
  • Three month imprisonment which may extend  up to one year and with fine not less than two thousand rupees, which may extend up to five thousand rupees as Penalties for contravention of the act by Employers (Sec 21)

 

Sec 5(4): Significance given to “Commissioning Mother”

“Commissioning mother: A biological mother who uses her egg to create an embryo implanted in any other woman”. This means even if modern medical technology is used via Surrogacy, the biological mother shall get the benefit of maternity leave. However, the entitlement of maternity leave in this case shall be for a period of 12 weeks from the date the child is handed over to her

Sec 5(4): Significance given to “Adopting Mother”

A woman who legally adopts a child below the age of 3 months, shall be entitled to maternity benefit for a period of 12 weeks from the date the child is handed over to her

The point to be driven home here is that “BREASTFEEDING IS A LIFE SAVING ENDEAVOUR” . Breastfeeding is a mother’s priority and responsibility and to be breastfed is a newborn’s birthright. Under no circumstances should these rights be undermined.

It is pity, however, that most working mothers despite being aware of these privileges continue to work throughout the maternity leave and lose on precious time for nurturing and nourishing their babies. What they do not realize is that the money earned at work is lost in managing health and psychological issues of a non-breastfed baby later in life.

 

Reference:

Ministry of Women and Child Development, 2015

http://coachieveindia.com/regdocs/uploads/The%20Maternity%20Benefit%20Act%202017_A%20Reveiw%20Note.pdf

 

One minute of running linked to better bone health in women

Bone health in women can be improved up to 4% by involving in high intensity weight bearing exercise such as running for one minute everyday. The brief burst of high intensity activity could mean a medium paced run for premenopausal women or a slow jog for postmenopausal women. Even during brisk walking, women can just pick up the pace a little bit to add running steps for one to two minutes; a bit like you might if you were running to catch a bus. Continue reading “One minute of running linked to better bone health in women”