During pregnancy, your body needs potassium to function at its best. An essential mineral, potassium helps maintain fluid and electrolyte balance, aids in the transmission of nerve impulses, and release of energy from carbohydrates, fat and protein. The daily recommended dosage of potassium in a woman is about 4700 mg per day. Low potassium during pregnancy can cause serious adverse effects. Dr. Aruna Muralidhar, Senior Consultant Obstetrician and Gynaecologist, Fortis La Femme, Bengaluru breaks down the significance of potassium during pregnancy.

What is the significance of potassium during pregnancy?

Although the requirement of potassium does not increase during pregnancy, regular intake of potassium-rich food is important as the blood volume expands by 50 percent during pregnancy. There may also be a loss of potassium and other minerals due to pregnancy-related vomiting.

What causes low levels of potassium during pregnancy?
Low potassium is most often the result of chronic or severe vomiting or diarrhoea, or certain medications such as diuretics (medicines used for treating high blood pressure), rather than a shortage of the mineral in the diet. Low potassium can be diagnosed by a routine blood test. Irregular heartbeats can be seen on an ECG.

What happens when potassium levels are low during pregnancy?
Initial symptoms are very difficult to recognise as most of them are common during pregnancy. You may experience fatigue, swelling of the feet and ankles due to water retention, dizziness due to lower blood pressure, numbness of fingers and toes, unusual weakness in the muscles, constipation, and mood swings. You may also experience abnormal heartbeat, depression, confusion or hallucinations in severe cases.

How can low potassium during pregnancy be treated?
In the initial stages, when the deficiency is mild, increasing potassium-rich foods in the diet would suffice. Foods rich in potassium include bananas, tomato, spinach, mushroom, fish, avocados, and potatoes. Moderate deficiency may need oral potassium replacement treatment like syrups, capsules, and tablets. In very severe cases, an intravenous drip of potassium may be required for which intensive monitoring is essential.

What happens when potassium levels go up during pregnancy?
Hyperkalemia or high potassium levels during pregnancy can be dangerous. In extreme cases, this may result in a cardiac arrest. However, this is extremely rare and is likely to happen due to kidney failure or consumption of certain drugs and alcohol. Severe dehydration and type 1 diabetes mellitus may also trigger this condition.

How can hyperkalemia be treated?
Hyperkalemia is a medical emergency and needs to be treated in a hospital setting.

Keep in mind that early recognition and treatment would help avert unnecessary adverse outcomes. Regular routine check-ups during pregnancy are a must.

By Nutritionist Kavita Devgan

We all know that protein is essential because everything in our body from hemoglobin to enzymes, hormones, antibodies to our bones is made up of proteins. In fact, every cell where the metabolism occurs contains proteins. Which is why eating enough protein every day is mandatory for every normal healthy adult. The need of this nutrient goes up substantially during pregnancy and lactation because it helps to form new cells and build the body of the foetus and produce milk to feed the infant after birth.

The average daily requirement of protein is 1 gram per kilogram of body weight. Which means that an average man weighing 70 kg will need 70 g protein per day and a woman weighing 60 kg will need about 60 g of protein per day. According to Nutrition Foundation of India, during pregnancy, this requirement goes up by 23 g per day and during lactation 19 g per day (for 0-6 months) and 13 g per day (6-12 months). A deficiency at this life stage can have a drastic negative effect on the health of both the mother and the baby.

Hence, it is important to take adequate protein during these stages of a woman’s life. You should look closely at your plate to check if there is enough high-quality protein in there, and must ensure proactively that your diet is rich in optimal amount and quality of protein.

These pointers can help in deciding if you are consuming the right quantity and quality of protein:

1. Focus on both right quantity (required number of grams) as well as high-quality protein that meets your protein needs completely. You can obtain protein from animal products like meats, milk, and eggs or vegetarian sources like nuts and seeds, milk and other dairy products, pulses and soy products.

2. While there is no doubt that the protein you get from animals and animal products (meat, fish, eggs, dairy) scores high on the quality of protein index (as they supply all the essential amino acids, whereas vegetarian sources tend to have some missing elements of protein), women who eat a vegetarian diet can still get all their essential amino acids by eating a wide variety of foods and making smart pairs by combining grains with , legumes or seeds or also milk products.

3. Try to include grains with a higher amount of proteins like quinoa, oats, buckwheat, and amaranth. All of these deliver much more protein than the regular staples like rice and wheat.

4. Often, it gets difficult to meet protein needs through food. In such cases, supplementation with a high-quality protein source might become necessary to help bridge the dietary gap especially if you are pregnant or lactating as you fall in the high requirement groups. When choosing a supplement, it may be a better option to select hydrolysed protein, as these deliver the already half digested (predigested) proteins. These are created by breaking down intact proteins into a mixture of amino acids and smaller proteins, which are far easier for the body to digest and absorb. This leads to better and faster delivery of amino acids from the blood to muscles. Additionally, hydrolysed proteins are less allergenic and they are good for babies who are at risk for food allergies. Therefore, read the labels carefully before selecting the protein supplement.

Being a mother comes with a lot of responsibility and this begins during pregnancy itself. Hence, protein intake of pregnant and lactating mothers determine the child’s health, and must not be taken lightly.

 

Sonali Shivlani Internationally Certified Pregnancy Consultant and a Child Nutrition Counsellor helps you understand your labour and when you’re ready to head to the hospital to give birth to your bundle of joy.

As you enter your ninth month, with every cramp and every movement, your first thought is, ‘Is this it?’ Now, if this is your first pregnancy, there’s a good chance you’ve been to the hospital thinking it’s time, only to realise it’s nothing but a false alarm. Let me assure you, this is completely normal and most first time mums will have a few false alarms before the real thing.

However, before the real deal, your body will give you some clues as it prepares for labour and birth. If you are alert, you might be able to spot these signs and symptoms, and correctly differentiate between pre-labour and labour.

Understand the signs and symptoms
Your baby will begin descending into the pelvis between week 35 and 37. Moms can help this natural progression by doing exercises recommended by their doctor. Some of these include walking, half squats and the butterfly postures.

In the last few weeks, expectant mothers will also notice an increased number of Braxton Hicks contractions as the body prepares for actual labour contractions. Women who experience Braxton Hicks contractions are usually experiencing what is called false labour as Braxton Hicks do not have any action on the cervix. These contractions are short, sporadic and relatively painless and can feel like a hardening of the abdomen and a subsequent relaxing.

A little closer to their due date, expectant mums may also notice mucus discharge with some blood streaks, mild cramps in the lower back, a feeling of frequent urination and an extra surge of energy. Most women are surprised by this surge in energy and can do almost anything, as the ninth month is generally considered a very lethargic time. Expectant women find themselves shopping, cleaning, cooking and even make time to run many errands. This sudden surge in energy is rather instinctive, perhaps because women are subconsciously aware of the fact that they’ll soon be confined to their homes, and they need to accomplish a lot before the baby comes.

Brace yourself
If you start noticing these signs, you need to prepare for the birth of your baby. And while it may feel like it’s time, know that you are not yet in labour. It is best to wait at home till labour actually starts. However, if you notice a bright red bloody discharge but are not experiencing any discomfort, then it does make sense to go in for a checkup.

Another thing to watch for is leaking. Your baby lives in a bag of water which is called the amniotic sac. This is your baby’s sterile environment. In some cases the bag of water may break —either as a leak or a gush— prior to the onset of contractions. Naturally, this is a sign that you must go to the hospital. If the baby’s sterile environment is now open, chances of infections become higher. However, for some women, despite the water breaking, if labour doesn’t progress, chances are that the doctor will induce labour and deliver the baby.

In most cases, contractions begin before the water breaks. To give you an idea what to expect before you head to the hospital, here’s an example. If you start feeling abdominal cramps or spasms in your lower back, and you start to feel uncomfortable, you must begin timing them. Doing so will help you differentiate between real and false labour. However, when it comes to timing your contractions, you need to make a note of the frequency and duration of each contractions. The frequency is measured from the start of one contraction to the start of the next contraction and the duration is measured from the start of one contraction to the end of the same contraction. In early labour, the frequency is far apart and the duration is very short, at times a contraction lasts for just a few seconds. However, as labour progresses, the time between each contraction shortens, and the duration of each contraction increases, lasting as long as 90 seconds. If you notice a pattern—the frequency is shorter with the duration longer —then you know that you are in labour and it is time to head to the hospital.

The final countdown

Now, for most first-time mums, panic usually sets in right about this time. You’re not only dealing with the contractions, you’re likely worried about every possible thing that could go wrong. Add to the fact that you can’t reach the people you really want to, particularly your doctor. Don’t worry. If you cannot reach your doctor, just get to the hospital so that you can be examined and the on-call doctor to ascertain whether it is real labour or not. Remember, take only those people to the hospital with whom you feel completely comfortable. Labour is very intense and you need all your focus on managing yourself and the contractions. Having people who are positive and comforting is very important. Now, once at the hospital, and after labour has been confirmed, you will be admitted and your own doctor will also be informed. The on-call doctor will then proceed to record all vital statistics like blood pressure, temperature, baby’s heart rate, etc., to ensure that everything is progressing well. You will also have an internal exam to check how far the cervix is dilated. The cervix has to dilate to 10 cms before the baby can be born. If everything is progressing well then you will be left in your own room with your partner and will just be monitored periodically. Once the doctor feels that the cervix is fully dilated, you will then be moved into the delivery room where you go through the second stage of labour which is the actual process of delivering your baby. The third stage of labour is when you deliver your placenta after the birth of your baby, and the umbilical cord is clamped. This happens spontaneously in most cases. The doctor will check and ensure that no parts of the placenta are left behind and then suture any tears or cuts. Both mom and baby are then moved into their room where the mother will be encouraged to breastfeed. Remember, labour is a natural, physiological process and your body knows how to birth. Just let your body follow its instincts.| MB

 

By Sonali Shivlani, an Internationally Certified Pregnancy Consultant and a Child Nutrition Counselor.

Exercising is  not only beneficial for the mother but  for the baby as well. But before you begin a fitness routine, getting a go-ahead from your doctor is important. And while every pregnancy is most certainly  different, exercises are suggested based on a mother’s health and capacity.  So before you start your fitness programme, here are three simple rules to follow:

Rule No. 1 – Don’t experiment
Remember, you need to avoid trying anything new. However, if you have been used to doing something, it’s safe to keep at it. then you can safely continue the same. However, if you have never exercised much before you got pregnant, don’t be a daredevil. Just follow the instructions given by your doctor.

Rule No. 2 – Start slow
Begin with just a few minutes every day; a few counts and reps will help you slowly and steadily build strength and resistence. There is no point in starting with something that leaves you exhausted and sore, requiring the next few days to recover.

Rule No. 3 – Take your time:
The next thing to keep in mind is to always perform the exercises slowly. There is really no rush. When you do the exercise slowly, you are better able to catch your mistakes and reduce the chances of injury.

Prenatal exercises

Here are simple exercises you can do in the comfort of your home. Remember to eat a small snack before your workout and stay hydrated at all times.

Pregnancy Squat

Find yourself a firm and heavy chair or use the wall for support. Spread your legs wide, make sure your toes are in line with your knees, ensure that your back is tall and straight and come down at least half way till your thighs are parallel to the ground. If you are comfortable and able to go a little lower without straining yourself, then that’s fine too. Start with about eight squats on the first day and slowly increase the counts. As time goes by, you’ll find that you can easily reach about 100 squats every day.

Butterfly Posture

Sit on the floor with your feet facing each other. Try and pull your feet as close to the pelvis as possible and press your knees as close to the floor as possible. You can flap your legs slowly or rapidly and you can even hold. I recommend sitting in this posture when you watch television or talk on the phone as this will get your exercise done without you having to take time out for it.

Kegels or Pelvic Floor Exercises

Imagine that you have to stop the flow of urine and you are holding your pelvic muscles tightly. This is the same movement that is required while doing the kegel exercise. Do not pull in your abdomen muscles or hold your breath. And definitely do not do it in the bathroom while trying to hold back the flow of urine. Aim at anywhere between 50 to 200 kegels every day. Simply tighten the muscles and then release. This exercise can be done anywhere, any time and in any posture.

Side Lying Leg Raise

Lie down on your side, making sure that your body is aligned in a straight line. You can start with any side as we will naturally repeat the counts for the other leg as well. Fold your lower leg as this will make your body more stable. Now raise your leg to about 90 degrees. When you lower your leg, remember not to rest it down completely. Hold a little of the tension. Repeat for eight counts and then switch sides. You can slowly increase the counts till you are doing about 32 for each leg.

Deep Breathing

Deep breathing help build lung capacity and strengthen the abdominal muscles. You’re going to need both of these during labour, especially during the second stage when you have to push your baby out. Just close your eyes and focus on your breathing. Take a long and deep breath in and ensure that it reaches all the way to your lower abdomen; then slowly exhale. Do not hold your breath at any point. It’s best to do this early in the morning and in a non air-conditioned room. Aim at doing about 50 deep breaths every day.

Cat & Camel Posture

Get on all fours making sure that your arms are below your shoulders and your knees are hip width apart. Start with arching your back like a cat and then rounding your back like a camel.

Now that you know how to perform the exercises, follow this simple routine to be well on your way to a healthy pregnancy:
Step 1: Start with a little warm up by marching in place for about five minutes. You can also circle your arms, shoulders, wrist and feet.
Step 2: Next do about 16 squats,  take a deep breath and if possible repeat for another set.
Step 3: Sit on the floor and do the butterfly flaps for about 50 counts.
Step 4: Lie down on your side and do 16 leg raises for each side.
Step 5: Get on to all fours and do the cat and camel posture.
Step 6: Start the cool down by marching in place and stretching.
Step 7: Sit calmly with your eyes closed and complete your kegels.
Step 8: Finally, as you focus on your baby, practice deep breathing.

 

You might know all the fertility terms and jargons but knowing your body and understanding your cycle can be a little tricky. While doctors recommend having sex between day 10 and day 20 of the menstrual cycle when you are trying to get pregnant, it can still be difficult to exactly know when ovulation occurs. If you are not certain, you can always start with an ovulation predictor kit or use a simple calendar to map out your cycle. You can also use these suggestions to identify your fertile days.

Check your basal temperature: Your body temperature rises and stays at an elevated level for the rest of the cycle after you ovulate. The temperature drops again at the end of the cycle. So use a thermometer to check your temperature in the morning before you go out of the bed. For more accurate readings, use a digital or a glass basal thermometer. Then maintain a chart and write down your temperature every day. If you track your entire cycle, you will notice that the temperature is higher in the first few days of your cycle.

Evaluate the cervical fluid: The cervical fluid protects the sperms and helps it move through the cervix towards the uterus and then the fallopian tubes. When it prepares for ovulation, the cervical fluid changes in colour and texture. You can notice a mark difference in how the fluid looks and feels over the course of the cycle. The fluid is more sticky and white when you ovulate.

Use apps to track your cycle: You can also use an army of female-friendly applications that will allow you to track your cycle without writing cryptic notes on your pocket notebook. The apps will help you determine the days of the month you are fertile. There are a few free services applications that not just track your cycle but also keep tab of your period symptoms, breast exams, weight and more.

In this pregnancy class, Sonali Shivlani helps you brave through those labour pains, and helps you effectively manage those contractions, to help with a smooth delivery.

For most women, especially first-time mothers, it’s the pain they’re going to endure during labour that worries them the most. After all, there’s no doubt that they’ve heard plenty of stories of hours of labour, or watched numerous videos of women screaming in the delivery room, that the pain seems to get the better of them. This is exactly why, we talk about some of the pain management methods that you can opt for. Naturally, there are some pharmacological methods and some nonpharmacological methods you can choose from.

Medical Intervention

Epidural: A pharmacological method is also treated as an intervention, as it interferes with the natural process. However, in some cases, it can be a blessing. Let’s start with the epidural. This is an analgesic which is administered in the lower back, and numbs all sensation in the lower body. The contractions still proceed as normal; the only difference is that, now, the nerves do not carry the pain sensation to the brain. As it is administered in the lower back, most mothers feel that it causes a permanent backache. However, this is not true. Epidurals are used all over the world for most lower body surgeries. If  you experience a lot of pain and discomfort in labour, and are progressing slowly, then an epidural may be the right choice for as it can help you relax. On the other hand, if labour is moving well and you are coping with the contractions, taking an epidural can slow things down. It’s really your decision whether to take the epidural or not. However, you can take this call only during labour.

Entonox gas: Another popular pain management option is Entonox gas which is popularly known as laughing gas, and is made of 50 per cent nitrous oxide and 50 per cent oxygen. These are natural gases and are considered safe for mother and child. Another plus is that it is self administered which means the mom takes it on an SOS basis. The effects are temporary and wears off very easily. It can also make you feel sick or nauseated. Many women find that taking it for long durations, can leave the mouth feeling very dry.

There are some other drugs available for pain relief during labour but these are injectables and directly get into the bloodstream. This affects the foetus as well, and unless absolutely necessary, are not prescribed for women in labour.

Non-pharmacological methods

While medical intervention can definitely present some form of relief, for a truly natural and wonderful experience, let’s get to the main, and possibly most interesting, part of the discussion —the non-pharmacological methods of pain relief.

Stay relaxed: First and foremost, the most important thing to do is go in with a positive frame of mind. The more relaxed you are, the faster labour progresses. Naturally, the opposite would mean prolonged labour. But, being relaxed is easier said than done. But, this small fact should not deter you from trying to achieve a state of calm and relaxation, despite the labour. After all, birth is natural, and as women, our bodies are designed to birth, so trust your instincts and the fact that your body knows what it has to do.

Get a birth companion: It is also important to plan who will be your birth companion. This person is someone whom you trust completely, as well as someone whom you can be completely natural with. Remember, birth is physical. You may also not realise what you are saying or doing. You don’t really want to dwell on formalities and niceties at that time. For most women, the best birth companion is their spouse. This is the person with whom you are physically and emotionally  most comfortable. You may also want to consider hiring a professional birth companion —a labour doula. These are qualified women who have been trained to support and guide women during labour and birth.

Do not scream: Now, here’s the tricky bit when it comes to giving birth—don’t  scream and shout. This just means you’ll use up all your energy and tire quicker. Also, when you are screaming, you’re not really breathing, adding to your exhaustion. If that’s not all, your screaming might make your support person and the medical staff a little nervous. Instead of using your energy to scream, direct it to helping you focus on your breathing.

Breathe right: Labour breathing is a little different—short breaths using only your chest and not your abdomen. We also encourage inhaling through the nose and exhaling through the mouth. This can actually help you relax. However, this may be difficult in the beginning so don’t just start  to use it during labour. It works best when it has been practiced regularly. Moms who attend regular pregnancy classes, and who have practicing this type of breathing a few times a week, for at least 12 weeks prior to their due dates, report  better pain management success than moms who learn breathing techniques during workshops. This is exactly why practice makes perfect.

Move around during labour: Remember, if possible, do move around in labour. This can actually help the baby get into position faster. You can also practice various labour positions like half squats, using the exercise ball, straddling a chair, lunging, etc. You never really know which position will make you more comfortable, and at what time, so trying a few different positions might just prove useful.

Experience counts
Over the years, many women  have let me in on some of their favourite labour pain management  techniques, and even though they may sound bizarre, they can actually work. For example, one mum binge watched Friends during her labour while another mom practiced chanting. One mom enjoyed her partner giving her a lower back rub while another preferred not to be touched at all.

From pacing the hallways to belly dancing, doing breathing exercises to practicing different positions to make yourself  comfortable, you can try it all. But remember, something that might help in the moment, may not help an hour later. You definitely need a big bag of tricks to help with the pain management. Pack a few massage tools in your labour bag, carry your favourite music along; you could also consider some relaxing essential oils, like lavender, which can soothe the senses.

You can also eat and drink during labour. Just small tiny tit bits like sweets, glucose biscuits or just sip on cooled water. This will help you stay hydrated as well as maintain your sugar levels. Naturally, discuss this with your doctor when you check in to the hospital as eating and drinking during labour is allowed, only if everything is progressing normally.

Labour can be long, labour can be painful, but one this is for certain, most women do not remember the pain once they hold their baby in their arms. This is why focus on powering through. The rest, as they say, is history !|MB