Motherhood, the birthright of every woman, a condition that is cherished and anticipated like none other, can sometimes become a nightmarish, painful experience for some women. It can take the joy out of an event that has been eagerly anticipated by the whole family, which usually sets the benchmark for all the good times the future has in store. Take the case of this unfortunate lady. (Dr. Naveen Kini)
Manjula (obviously not her actual name) slowly walks into the clinic with her first born baby, her mother and mother-in-law, with a duck-like waddling gait, and a face that looks ready to burst into tears any moment. She has been made to wear a sweater and a muffler (at the peak of summer!) and is obviously dehydrated, in severe pain from the stitches lower down and seriously sleep deprived. The mother-in-law, with her "I have delivered 5 children, and know what to do" attitude, has decided that Manjula is incapable of producing breast milk, and is insisting on bottle feeds. Sure enough, on questioning, Manjula breaks down and starts weeping, and says that she feels like a complete failure. Her baby bawls incessantly the whole day, her nipples are sore from the constant feeding for hours at a stretch, and she can't remember when she last had a good night's sleep. She is being bombarded by confusing and conflicting advice by well meaning relatives, making her feel inadequate and depressed. I try to cheer her up by saying that these are only starting problems, and it only gets better from now on. I tell her that she will not face the same difficulties in her next pregnancy, and her immediate and vehement response is "Oh no, never again. This will be my one and only child!"
What is it that drives young women to get fed up and disillusioned about something as natural and emotionally fulfilling as pregnancy? And can certain steps be taken before hand to ensure a comfortable and enjoyable experience throughout pregnancy and lactation? Here are my views:
Up-to-date knowledge, adequate preparation and corrective action against foreseen problems has been the success formula of most good managers, and the same can be applied to pregnancy, childbirth and breast feeding. Most young women have very little knowledge of what motherhood actually involves, and are mostly depending on the experiences of close relatives and friends for information. Many a times the suggestions given may not be appropriate for her, and so when unanticipated problems occur, the woman is at a complete loss, and panic begins to set in. It is therefore very important to plan each pregnancy thoroughly, arm yourself with the latest knowledge about the complete birthing process and have regular periodic checkups to ensure everything is going smoothly. And there is no other person better suited to guide you throughout this period than your doctor!
The first and most important decision a young couple have to make is when to start a family. This decision should be taken only after considering the physical, emotional and financial readiness of both partners, and not because of pressure from anyone else, as is often the case. Unplanned or unwanted pregnancies will surely put a strain on the relationship, with undesirable consequences.
During pregnancy, the most important initial requirement is a visit to the gynaecologist, to make sure that all is well. Repeated ultrasound scans, blood and urine tests and blood pressure measurement will be required to ensure the well being of both mother and child. Do not hesitate to ask questions to your doctor, as he/she is the person best qualified to answer them.
I would like to specially mention about care of the nipples. Many women have retracted or even inverted nipples, which can hinder breast feeding. It is important that this fairly common condition is looked for and treated before delivery, so that breast feeding is easily established soon after birth. Syringe extraction of the nipple will help most women; severely inverted nipples may require to be set right by a small surgery.
Watch what you eat! The temptation to let go and binge on high calorie food is great, and usually encouraged by relatives. But it is easy to get carried away, and before you know it you will have put on a huge amount of weight. Being overweight can not only cause problems during birth, but also after delivery, this can lead to feelings of unattractiveness and guilt, and sometimes depression. A healthy diet with plenty of fruits and vegetables, and adequate amount of sleep and daily exercise is a good way to start off a pregnancy.
Chalk out the hospital you are going to deliver at before hand, and plan how you are going to get there in an emergency situation. Keep a trusted friend or relative informed. Visit the hospital and familiarize yourself with the place, procedures and staff, including the pediatrician who will be taking care of your baby. It is always more comforting to deliver in a known and trusted environment.
Breast feeding should be started soon after delivery, and unless indicated otherwise, the child should be fed on demand. Most babies will soon settle down into a pattern of feeding and sleeping, which is easily recognizable, and should be respected. Take care to see that the breast is not offered as a pacifier the moment the baby starts crying, because constant and prolonged suckling can cause chapped and sore nipples. 15 to 20 mins per breast per feed is a good thumb rule for comfortable breast feeding. Do not forget to burp the baby properly after each feed. Continue exclusive breast feeding till the baby completes 6 months of age, as it is very important for the all round development of the child.
Not all babies are made the same way, and some may be cranky, irritable, voracious feeders, poor feeders and occasionally, the real "cry baby" who can drive a first time mother up the wall! Night after night of sleeplessness, combined with the pain, the anxiety, the expectations and sometimes caustic remarks of so called well-wishers, can make even the strongest of girls break down and cry. When all the usual measures fail, I advise, once in a while, a practice that is quite the rule in the west, but not acceptable to most Indians, that of 'letting the child cry itself to sleep'. Young first-time mothers too are entitled to some 'me time', and so periodic indulgences like a pizza or ice cream, a visit to the parlour or movie, or anything else that can help the mother relax, should not be frowned upon. On the other hand, practices like restriction of fluids, wearing warm clothing when not climatically warranted, bland and insipid food etc. are unnecessary, and can be potentially detrimental to breast feeding. Fathers can do their bit by helping in the routine care, and supporting and shielding the mother from unwanted interference.
Sometimes, despite the best efforts of both family members and doctors, some women feel that their world is falling apart, and feelings of hopelessness and detachment can set in. These symptoms can be signs of 'post partum depression', a well known condition that can occur in the first 6 months after delivery. This condition should be diagnosed and treated aggressively, to ensure the well being of both mother and child. The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item questionnaire that helps to identify women who have this condition.
Childbirth and motherhood are completely natural and usually uncomplicated phenomena. Minor hiccups should not deter women from enjoying both thoroughly, and they should take the help of both doctors and technology to make the experience as smooth as possible. For the few who have a difficult time in the first few months, just take heart in the fact that your little bundle of joy will soon compensate you with hours of pure and unconditional love, which will make all those sleepless nights worth it!
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