Bengaluru: “God could not be everywhere and therefore he made mothers”– Rudyard Kipling. This is so true. Where would we be without our mothers!

Throughout history, mothers have been revered, worshipped and given a cult like status and yet they have also been reviled and demonised depending on the era and the country they lived in. The modern mother has a more complex role than ever before.  She dons several hats now, mother, wife, provider, boss at work, keeper of sanity at home and of course juggler par excellence of all these and more jobs.

The thought of becoming a mother and a new arrival in the family is always exciting.  Couples and their families look forward to this joyous event and the birth of a baby is cause for celebration.

It is a known fact that a planned pregnancy is safer than an unplanned one. Despite this, four in ten pregnancies are unplanned. 

Here a few things you ought to do and know before you become pregnant:

Visit Your Doctor

“Pregnancy is not a disease so why should I see a doctor before I fall pregnant. After all, my mother and grandmother hardly saw doctors”.

True, pregnancy is not a disease, but optimal outcomes for the mother and the baby can only be achieved by taking the best possible care before, during and after the pregnancy.

Your doctor will take a detailed history regarding your health – present and past and any medical conditions that you may have. He or she will enquire about any diseases in both families and seek relevant details of your past pregnancies. The doctor will also discuss the medications that you are taking, vaccinations and supplements.

Medical and Hereditary Conditions

Some of the medical conditions that can affect a pregnancy are Hypothyroidism (problems with the thyroid gland), Epilepsy, Diabetes and Hypertension. It is important that pre-existing diseases are well controlled, and tests are done to confirm that you are healthy. 

A detailed personal, family and past pregnancy history will help screen for hereditary and genetic conditions for which you and your partner may need genetic counselling. 

Vitamins and Supplements

Folic Acid is a B vitamin which is vital for the healthy development of the baby’s nervous system. It helps prevent serious abnormalities of the brain and spinal cord such as Anencephaly and Spina bifida in about 70% of women who take it. This has to be taken as a daily supplement of 400 mcg for at least 3 months before you fall pregnant. If the pregnancy is unplanned, take it as soon as possible and continue till the 12th week of pregnancy.

You may also need Vitamin D supplementation, check with your doctor.

Diet and Exercise

Trying to change lifestyle habits is difficult for most people. However, planning a pregnancy is a good motivator, since you will be doing this for the health of your baby as well as yourself.

Start by eating healthy. Include protein foods such as pulses, bean, nuts, chicken, meat, fish and eggs.  Rice, cereals, pasta and potatoes make up the starch component in your diet.  Aim to include at least 5 portions of fruits and vegetables daily. Dairy products such as milk, curd and paneer should form a part of your diet. Drink plenty of water and avoid carbonated drinks and processed products.

If you do not exercise regularly, this is the best time to start –for both you and your partner. Regular exercise will improve your health, reduce your risk of having gestational diabetes in the pregnancy, reduce stress, and help you cope better with the pregnancy and labour. Walking, swimming and yoga are recommended. Avoid contact sports and sports in which there is a risk of falling or losing your balance.

If you are overweight or obese, it may be a good idea to reduce your weight before you embark on a pregnancy. Being overweight or obese can increase your risk of high blood pressure, gestational diabetes and blood clots during pregnancy. It can also contribute to difficult vaginal deliveries as the baby may be big.

Medications and Vaccinations

Most of the development of the baby takes place in the first three months of the pregnancy. Hence it is important to avoid all (including over the counter medication), except essential medication in this period.

If you are on regular medications for a medical condition, be sure to tell your doctor that you are planning a pregnancy or are pregnant. They may need to be modified.

Vaccinations to be considered pre pregnancy are Rubella vaccine (against German measles or Rubella infection), Hepatitis B, Chicken Pox and Influenza. Td and Tdap (Tetanus, Diphtheria and Pertussis) are to be given during pregnancy.

Smoking/Alcohol/Substance Abuse

It would be best for you and the baby if you and your partner stopped smoking. Continuing to smoke pre pregnancy can reduce your fertility. Smoking during pregnancy can cause miscarriages, preterm birth, low birth weight and stillbirth. Babies whose parents smoke are at a higher risk of chest infections, cough and Sudden Infant Death syndrome.

Alcohol can damage sperm production and excessive drinking can lead to impotence.  Prior to and during the pregnancy, it is best not to drink at all. 

Psychoactive substance use must be discontinued while trying for a pregnancy and throughout the pregnancy. 

Mental Health

Pregnancy itself is rather overwhelming. Not only because there are so many physical and hormonal changes, but also because there seems to be a complete emotional makeover. If you go through periods of anxiety and depression you need to talk to your doctor about this. If you are already on medication your doctor will tell you if it is safe to continue the same or change to a safer drug. Regular follow up with the counsellor or psychiatrist is recommended, especially during and after the pregnancy.

During the Pregnancy

Your doctor will advise about the scans and blood tests that will be performed routinely in pregnancy. He/she will also advise you regarding specific concerns or conditions pertaining to your pregnancy.

Pain relief in Labour

Most women quite naturally are concerned about how they will cope with labour pains.  There are various methods of pain relief both non-medical and medical. Start preparing early in pregnancy for the big day. Make sure that you are exercising regularly during the pregnancy to build up your muscles and stamina. Yoga, breathing exercises, squatting exercises are especially important. During labour try these various options: walking about, breathing deeply, back massage and a partner or friend to support you constantly. Medically, the options are – pethidine injections, gas and air inhalation and epidural injection in the back or “painless labour”.

Your Partner

It is equally important for your partner to be healthy and follow healthful practices.  Exercise, healthy diet, avoiding smoking, alcohol and drug abuse is a part of his commitment to the pregnancy. 

After all he is going to be a parent as well!

And finally

Becoming a mother for most women is a much-anticipated event. But remember that it is also ‘one of the most dangerous journeys that a woman can undertake’. And this is not without reason as pregnancy and childbirth is associated with a maternal mortality and morbidity rate. Regular pregnancy check-ups, adhering to your doctor’s advice, seeking medical advice early and timely interventions if required will help contribute to a safe and healthy pregnancy.

(Author - Dr Prathima Reddy, MBBS, MRCOG (London), FRCOG (London), FACOG (USA) is the director, senior obstetrician and gynaecologist at Fortis La Femme Hospital, Richmond Road, Bengaluru)