‘Going natural’ during pregnancy: Is it worth the risk?

30 year old friend of mine was enthusiastic and determined about ‘going natural’ during her much awaited first pregnancy. She questioned the need for regular antenatal check up and believed that doctors did more number of unnecessary ultrasound scans which would harm her baby( ultra’sound’ is innocuous sound wave, unlike radio-frequency waves in X-rays or CT scan). When she was diagnosed to have increased blood pressure in the 7th month of pregnancy, she stopped consulting that doctor and started trying out ‘natural’ measures to decrease her blood pressure.

She was not uneducated or uninformed and was fortunate to have uninterrupted access to the internet unlike majority of pregnant women in our country. When her feet got swollen and failed to shrivel even with rest, she kept them dipped in warm saline instead of consulting a doctor. (Age old traditional wisdom of saline as an answer to swelling was tried with conviction). She felt triumphant when she delivered a healthy baby girl.

Her zeal did not last long because she went into cardiac arrest due to uncontrolled blood pressure following delivery. With the effort, wisdom and courage of the doctors who practiced ‘evidence based medicine'( not to be imprudently equated to ‘allopathy’ ,’western medicine’ or ‘modern medicine’), she was revived! For the rest of us, she was reborn!

By the time I recovered from the shock of this incident, various media reported the release of a document titled “Mother and Child Care” by Central Council for Research in Yoga and Naturopathy( CCRYN), an autonomous body under the Ministry of AYUSH with the aim of ‘taking the well known benefits of Yoga and naturopathy to pregnant mothers’ (Reference is ‘Clarification of M/o AYUSH on media reports relating to “Mother and Child Care”, a booklet published by the Central Council for Research in Yoga and Naturopathy (CCRYN)’, dated June 14 by Press Information Bureau, Govt of India).

My response to the above document is not different from the wonted reply I provide to patients in daily practice. Many of the patients with chronic diseases I counsel, ask about the benefits of alternate systems of medicine as therapeutic options. With due respect to their concern, I deliver a standard answer that I am not qualified in any other system of medicine to give a verdict on the efficacy of that regime, but I am trained to provide scientific information  based on existing evidence on any condition pertaining to physical and mental health. I am not the right person to talk about the merits of Yoga and Naturopathy in pregnancy and delivery, but I am qualified and authorised by the law of this land to provide evidence based information on pregnancy and antenatal care. Strangely  in our country, opinions are provided by people who are the most ineligible to do the same.(Politicians give health advice to people, media personnel teach history, pseudo scientists discourse on religion and what not!). Such futile opinions serve only to cloud the understanding of public and deny them the opportunity to avail ethical and science based health care.

The American Congress of Obstetricians and Gynecologists (ACOG) is an organization dedicated to the advancement of women’s health care and has published guidelines and statements on issues pertaining to women’s health which is freely accessible from their website for professionals and public. I revisited the ACOG guidelines to understand the strength of evidence for dietary modifications and sex during pregnancy as these were the most controversial statements in the “Mother and child’ document.

Is there evidence for vegetarian diet affecting the outcome of pregnancy?

  •  Based on recommendation by ACOG, a normal weight  pregnant woman needs additional 300 calories in last 6 months of pregnancy. This can be derived from vegetarian or non vegetarian diet depending on the local custom, easy availability and social practices. Ensuring adequate and appropriate supply of carbohydrates, proteins, fat, minerals and vitamins is the key to a successful pregnancy.  Dietary restrictions and food faddism imposed by the family, society or the government without any rationale will adversely affect the future of this country by preventing adequate nutritional supply to the baby in the womb.

Is there evidence for avoiding sex during pregnancy?

  •   AYUSH ministry has clarified that their document does not mention any rule for sex during pregnancy. ( After all, who is bothered about the sexual needs of a pregnant woman?!)  ACOG has not been reluctant in addressing the sexual needs of a woman during pregnancy. If there is no contraindication in an individual patient due to preterm labour, low lying placenta and bleeding, there is no harm in having sex during the entire period of pregnancy, provided both partners are comfortable with the idea and method. Whatsoever the baby remains protected inside the womb in a see-no-evil, hear-no-evil and speak-no-evil world!

I wonder why ‘suggestions’ and ‘code of conduct’ specifically target women more than men. I yearn for a day when politicians, policy makers and governing bodies come up with a modus operandi for partners of pregnant women and I would like to incorporate the following suggestions.

Some guidelines and evidence based suggestions  for men to be of aide to their pregnant partners. 

  • Stop smoking as it has been shown beyond doubt that passive smoking affects the baby’s growth and has been implicated as a risk factor for Sudden Infant Death Syndrome.(SIDS)
  • Do not hesitate to give a hot warm bath  for your pregnant partner and massage her legs and back. Pregnant women are prone for muscle cramps and lower back pain.
  • Cuddle more often with your pregnant partner and put her to sleep. Hormonal imbalances in pregnancy causes sleep disturbances in your partner and the best effective treatment for sleeplessness is not sleep medicine but a good sleeping partner. ( If you cuddle more, there will not be any need to drill your wall to ‘hang good and beautiful pictures in your bedroom’! Courtesy: AYUSH Ministry)
  • Help your partner in household works or rather give her adequate time to rest. Pregnancy is a time when the female body demands adequate rest.( Then your partner would always be in ‘good company’ as advised by AYUSH ministry!)
  • Be kind to your pregnant partner; then your partner can stop seeking kindness and solace in ‘lives of great personalities’  as prescribed by AYUSH ministry.

My intention is not to ostracise people like my friend who negate rational thinking and end up in trouble pursuing alternative therapeutic options, because I believe in their freedom of choice. But I wish people are not denied the right to scientific information before making informed choices that essentially concern their lives.

 

An open letter to a young adult on World Blood Donor day!

Hello my dear!

Hope you are aware that World Health Organisation has chosen June 14th as World Blood Donor Day. Since you are a potential voluntary healthy donor, I thought I should write to you about the importance of this day, so that you can plan to commemorate this day with the same enthusiasm and effort you display to celebrate February 14 every year!

I assume that as a responsible young adult, many a times you would have thought about how you could make yourself useful to the society. If this question has crossed your mind and if you are above 18 years of age, please visit a blood bank near to your place, to donate blood on June 14th this year. Blood donation is a simple, harmless and convenient way to boost your self confidence and make you feel worthy of yourselves. The WHO has put forward an apt slogan this year targeting people like you; “Don’t wait until disaster strikes. What can you do? Give blood. Give now. Give often”.

Hope you know that blood is essential for people suffering from anaemia, blood loss due to accident, trauma, during childbirth and surgeries. (I do not wish to scare you with statistics).There is a need to ensure constant supply because blood cannot be stored for long. In a country like India where the demand for blood is growing day by day, only by ensuring voluntary donation from people like you, we can be assured of adequate supply of blood.

Voluntary blood donation requires you to give your consent. When you visit a blood bank, you will be asked to fill a form with all your details including weight, history of previous donation, major and minor illnesses, date of last donation etc. Then your blood group and haemoglobin levels will be checked by a simple blood test which will not be more painful than an ant bite.(Unlike an ant bite, this won’t itch!) If you are a non pregnant woman, with haemoglobin of more than 12g/dL, or a male with haemoglobin of more than 13g/dL, you are eligible to donate blood.

If you have some minor illness like fever, body ache and have taken antibiotics for some infection, it is better to wait till 14 days before blood donation. If you are weighing below 45kg, you will not be accepted as a potential donor. If you have donated blood in last three months, you will be asked to come back later. If you are a menstruating female, you can donate, provided you feel comfortable and your haemoglobin level is above 12g/dL; but if you have delivered or if you are lactating, it is not advisable to donate blood for at least 6 months. A qualified doctor will assess your potential to be a donor before the procedure is done. So you need not worry about all these in excess.

Inside the blood donation room, after taking your consent, you will be asked to lie down on a bed and relax for a few minutes before a doctor or technician comes with a yellow ball asking you to squeeze the ball as they tie a tourniquet on your arm and prick you with a needle to draw blood. Obviously it will hurt; but believe me, only for less than a minute! Some amount of blood will be taken for tests like HIV, hepatitis B, hepatitis C, malaria etc.(Please do not bother; this does not mean that you have these diseases or you will get them! ) Blood will be collected in a 350ml bag and this should take an approximate of 10- 15 minutes. After that you will be asked to remain seated in another room while they serve you cool drinks and biscuits. If you donate blood as part of a campaign, you might even get a certificate!

The blood that you donate (350ml) will be separated into different blood components like red blood cells, platelets etc and hence can be used for upto five different individuals! This is unlike all other organ donations where the donated organ can be used only by a single individual! Hope this would make you would feel confident enough to visit your nearest blood bank and donate blood this year! Every donor like you counts!

Best Wishes!

 

 

 

Revealing my menstrual history on World Menstrual Day!

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Three weeks ago, on the day her mother in law expired, a friend called frantically, to ask for the name of  a tablet to postpone her imminent menstruation. I was perplexed because in the first place, I didn’t know the name of the tablet (Universally people expect any ‘female doctor’ to be an expert in all issues related to women without giving any thought about her field of expertise!) and I was wondering why she would want to stop menstruation which according to her was about to commence any moment! I took help from another colleague and conveyed the name of the tablet to her, but did not ask why she wanted to postpone her period. I could not comprehend what was so unnatural in her menstruating that particular day. Whatever the reason, her discomfort was palpable. When postponement of a physiological phenomenon like menstruation which is as natural as sneezing, is demanded by the society from a woman, by altering her hormone levels  by using chemicals, no woman would feel elated.This event happened in Kerala,  one of the most educated states in India, where even today menstruation is a taboo and menstruating women are considered ‘unclean’ and are not allowed to enter prayer houses. This event forced me to ponder about the various issues I had with menstruation and recapitulate my ‘menstrual history’ on World Menstrual Hygiene Day this year. Menstrual history is not something to be hidden and it is high time we have an open discussion about a process which is as inevitable  as  diet, exercise, sleep and sex.

World wide, May 28 is observed as Menstrual Hygiene Day to spread awareness about good menstrual hygiene management for women and adolescents. The 28th day of the 5th month in a year was selected by a German NGO, WASH, because women in general bleed for an average of 5 days every 28 days. Though I do not appreciate the fact that there needs to be a specific day for creating awareness about a completely natural physiological process which occurs in half the population of the globe, such efforts serve to initiate some discussion in mainstream media and social media , aiding people to reflect and respond.

Issues I had with menstruation even before I started to menstruate!

Yes! Long before I even started menstruating, I had my own issues with this phenomenon.  In my mother’s highly conservative family, during menstruation women had to sleep on the floor in a separate corner of the house for three days without touching anybody else. They were served food in a separate plate and had to wash their plates and clothes separately. In my childhood, during summer holidays spent in my mother’s house with grown up cousin sisters who already had attained menarche, I used to feel sad and dejected that I couldn’t be with them for those three days while they remained confined to that small corner of the house ! As a child I never understood why I had to take bath before touching others or entering into other rooms in the house after accidentally touching my cousin sisters who were menstruating! Sometimes  I used to insist that  I wanted to sleep with them and eventually they had to struggle to wash all my clothes along with theirs!

Issues I had when I  started menstruating 

When I got my first period, my parents informed all my relatives about this phenomenally natural event! I really wonder why even now this practise prevails in my community. Recently when my mother called to tell that one of my nieces started menstruating, I had to take additional effort in making her understand that, as a Geneticist I was interested only in children who did not menstruate at appropriate age!Why is the commencement of menstruation given so much of unwanted publicity? Why should it be made a public affair where adult relatives visit your house and give  new clothes and money instead of any sensible and scientific information  on menstruation? How much ever I try to forget, the awkward grin on the faces of relatives who visited my house that day, still remains etched in my mind.

Those days carrying a sanitary pad to school and ‘smuggling’ it from classroom to bathroom without the knowledge of others was a herculean task. We had coeducation till 7th standard and the girls who had to bring pads to school were so ashamed that they told the boys that those were biscuits which they ate inside the bathroom! Once some NGO had come to enlighten us about menstruation and strangely, boys were denied ‘enlightenment’! In high school, though we had only girls, I can vividly recall the embarrassment and humiliation we all experienced during our monthly cycle!  Sadly, no teacher in the school nor the counsellors who came, could inculcate in us enough confidence to carry a sanitary pad openly without discomfiture. Nobody could convince us to be bold enough to talk about menstruation. Like the name of some brands of sanitary pads (Whisper ), it was to be discussed in hushed tones.

In medical school

Only after living in a government hostel in a Medical college, with absolutely zero privacy, that I slowly overcame the uneasiness of menstruation. Most of our friends who stayed in the same room, used to get ‘menstruate together’, which we learnt was due to the effect of pheromones. Even in medical college, sneaking pads into bathrooms and toilets which were not women friendly, with no bins to dispose used napkins, was a strenuous exercise. I don’t wish to make a fuss about all those days where we worked 36 hours at a stretch, even during our menstrual days in the most unhygienic environment with indecent restrooms.

Issues I currently have with my menstruation

My cycles are painful and incapacitating at times which I manage by taking NSAID’s.  Even women have wrong notions about taking NSAID’s for relief of period pain. One of my friends firmly believes that taking antispasmodic tablets to reduce pain would decrease fertility!  I have failed miserably in convincing her that prostaglandins cause period pain by causing uterine contractions and taking medicines which temporarily block prostaglandins does not have any effect on a woman’s fertility. NSAID’s have made my period pain bearable enough to continue working on those days.

Like most women, I also deal with my cyclical emotional changes when I get moody premenstrually.(Don’t get me wrong here! Every time I get angry  I am not menstruating!) I don’t like the feel of the sanitary napkins between my legs. I prefer to decide for myself what I need to do about my period pain, period days, my activities and my blood stain and I don’t expect any unsolicited advice from anyone else.

Menstrual blood unlike urine and feaces, is not an excretory product but in reality is the endometrium which gets prepared every month for pregnancy, which if unused, gets shed.  I can’t understand why women are considered unclean and unhygienic when they menstruate. Whether you menstruate or not, hygiene depends on many other factors. I feel if ‘holy people’ in prayer houses feel ‘unclean’ menstruating  women should not be allowed inside, then anybody who urinates or goes to latrine shouldn’t be allowed inside. Because if ‘cleanliness’  is the main issue, they are the real excretory materials which are harmful and ‘unclean’! I don’t wish to engage in any conversation with people who bring up ‘pseudo- scientific’ explanations for menstrual taboos.( When a menstruating woman is considered herself as a Goddess , why does she need to go to a temple?!)

My latest experiment in menstrual hygeine

I have started using menstrual cups recently and I find them one of the most exciting inventions that can actually help women. They are environment and pocket friendly but demand a bit of expertise in being used effectively. They have always been in the market without much advertisement and exist mainly by word of mouth. Our conventional beliefs about saving a woman’s hymen, discouraging  any ‘insertion’  into her vagina and our inability to reuse things, have made these cups unpopular compared to sanitary pads. I am in the process of learning to use them effectively.

My utopian aspirations On World Menstrual Hygiene day

This day, I aspire to be part of a world where children(Including male, females, transgender and children with special needs) grow up with scientific knowledge about menstruation, voice out their concerns , find ways to manage menstrual issues effectively and more than that become confident in ‘being with’ a menstruator or ‘being a’ menstruator.