Cervical Cerclage

What is cervical cerclage?

It is a stitch placed around your cervix (the opening of the uterus), during pregnancy, so, as to keep the cervix closed.

Why is it done?

During pregnancy, the baby grows inside the uterus for 10 months and once the baby is ready, the cervix shortens and opens up eventually leading to the delivery of your baby.

In some women, the cervix is much weaker and starts opening up way before time, thus, leading to abortions and/or premature births. In such cases the cervix is stitched and kept that way until your doctor feels it is safe for you to deliver your baby.

When will a cerclage be recommended to me? 

• If you have had atleast previous two abortions or preterm labours after the second trimester.
• If on an ultrasound examination, your cervix is found to be short and/or dilating.
• If you have symptoms of preterm labour and your obstetrician feels that a cerclage will salvage your baby and give your pregnancy more time.

How is it done?

Your cervix can be stitched either vaginally or abdominally. The vaginal route is the most common method followed nowadays.It is usually done as an out-patient procedure under regional or general anesthesia.It is not a painful procedure, although at times you might have abdominal cramps and pain for which pain killers will be provided.

What happens after the procedure?

If yours was a history-indicated cerclage (a cerclage was done based on your history of preterm births, even though your cervix was not dilating at the moment), you will be discharged from the hospital after you recover from anaesthesia. As a precaution your obstetrician might advise you to avoid having sex for atleast 2 weeks after the procedure.

If you had a cerclage because your cervix was short or already dilating, you might have to stay in the hospital for a day or two for observation. On discharge you will be advised to avoid doing heavy physical activity and having sex until 34 weeks of pregnancy.

Before being discharged from the hospital, your obstetrician will do an ultrasound to check your baby's well being. You will also be asked to come in for biweekly visits to check if things are alright.

What are the things I should look for after the procedure?

You should report to your obstetrician if you see any of the following:

• Watery vaginal discharge
• Smelly or unusual vaginal discharge
• Abdominal/pelvic pains
• Spotting or vaginal bleeding

When will the stitch be removed?

Typically, it is removed when you have completed 37 weeks of gestation. But at at times it is removed earlier, 

• If you experience labor pains 
• Have a rupture of membranes (indicated by watery vaginal discharge)
• Your baby needs to be delivered earlier

What is the outcome I can expect after a cerclage?

This depends on the timing of the cerclage, the indication for the cerclage and the presence/ absence of other complications like vaginal infections.

But almost 80% of pregnancies reach term after a cerclage.

WHAT PREGNANT WOMEN ARE REALLY THINKING

Pregnancy is a wonderful journey, no denying. But like all journeys it does have its bumps. Here are some instances when people just assumed its super wonderful to be pregnant only to be wrong, oh so wrong!  

   Oh, you are pregnant. It must be wonderful!

Oh yeah, I vomited like a billion times since morning, peed a trillion times. My cool new super power of spewing fluids from both the upside and downside sure does feel super wonderful!

Some random aunty at the super market is walking straight at you with that determined look of I'm going to touch your belly and say some seemingly nice bullshit.

Don't you dare aunty, or I'll cut you up, chew you and spit you out! ( Horrifying , i know. But waht do you know of the inner power of a mother! )

My God, look at you, you are a huge!

I know, wonder why. Is it because of this actual human inside of me! 

What have you been eating, my child. You look so undernourished. ( Mind you, this is just after establishing the fact that they think you are huge. )

I've been having only 3 shots of vodka a day. Do you think I should up the number?

Postures In Pregnancy

Posture is the way in which you hold your shoulders, neck and back while standing, sitting, sleeping, driving, etc.

Good posture in pregnancy involves carrying your shoulders, neck and back in such a way so as to put the least amount of strain on your back.

Importance of good posture in pregnancy:

It's a common misconception that pregnancy comes with all sorts of discomforts. You complain about your back hurting, the bloating sensation you feel, the leg cramps, your heamorrhoids, you will invariably get a series sympathetic nods blaming it all on pregnancy.  That is so totally not true.

The way you carry yourself through your pregnancy has a tremendous effect on your well being, both during and after pregnancy. A good posture gives your body the opportunity to adapt successfully to the myriad changes of pregnancy. It allows your body to grow stronger in all the right places. A  good posture and mindful movement are the foundation for a pain free and natural pregnancy.

Benefits of a good posture in pregnancy:

• Reduces aches & pains.
• Improves your breathing, thus facilitating a better oxygen supply to your baby.
• Gives your baby more room to grow.
• Helps you access and increase the space in your pelvic outlet, thereby making your labour smoother.
• Better post delivery recovery.                 

Proper posture:

Imagine a straight line passing from your ears to your shoulders and to your hips and knees. This is the actual anatomical posture you should aim at maintaining for the best functioning of your body.

INCORRECT          CORRECT

Standing during pregnancy:

• Hold your head up straight with your chin tucked in. Do not tilt your head forward, backward, down or sideways.
• Make sure your ear lobes are in line with the middle of your shoulders.
• Draw your shoulders back and down while you lift your rib cage up.
• Pull your stomach in and up, as much as possible.
• Keep your buttocks tucked in. Do not tilt your pelvis forward or backward.
• Keep your knees relaxed and straight, but not locked.
• Point your feet in the same direction, with your weight balanced evenly on both feet.
• The arches of your feet should be supported with low-heeled shoes, with good arch support to prevent stress on your back.
• Avoid standing in the same position for a long time.

 Sitting during pregnancy:

• Sit up with your back straight and your shoulders back. Your buttocks should touch the back of your chair.
• Sit with a back support (such as a small, rolled-up towel or a lumbar roll) at the curve of your back.
• If you do not have a back support/lumbar roll, draw yourself up and accentuate the curve of your back as far as possible. Hold for a few seconds.Release the position slightly (about 10 degrees). This is a good sitting posture.
• Distribute your body weight evenly on both hips.
• Keep your hips and knees at a right angle (use a foot rest or stool if necessary). Your legs should not be crossed and your feet should be flat on the floor.
• At work, adjust your chair height and workstation so you can sit up close to your desk. Rest your elbows and arms on your chair or desk, keeping your shoulders relaxed.
• Don’t twist at the waist while sitting, instead, turn your whole body.
• While trying to stand up,move to the edge of your seat and stand up by straightening your legs. Avoid bending forward at your waist. 
• Take short breaks often, by stretching yourself. Avoid sitting continuously for more than an hour.

              

Lying during pregnancy:

• Try to sleep on your side with your knees slightly bent and with a pillow between your knees, such that the curve of your back is maintained. 
• Do not sleep with your knees drawn up to your chest.
• Try to avoid sleeping on your back, especially in the third trimester as the weight of the baby will not only add extra stress on your back but it will also block your blood circulation to and fro from your legs.
• If sleeping on your back is the only position you can feel comfortable in,try using a pillow below your waist so that your pelvis is tilted.
• Doctors recommend lying down on your left side as it is beneficial to your circulation, thus benefitting the baby too.
• Do not worry about changing positions in your sleep, it is natural and unavoidable. If you end up in an uncomfortable position, the discomfort will wake you up, most likely.
• Sleep on a firm mattress that does not sag under your weight.
• Use a pillow under your head and one if possible, between your legs. The pillow supporting your head should be of adequate thickness so as to keep your head in the normal position and not too high up, which will strain your back.
• Avoid a pillow below your shoulder.
• Avoid sudden, jerky movements.
• While standing up, turn to your sides, swing your legs to the side of the bed and sit up by pushing yourself up with your arms. Avoid bending forward at your waist.

There you go. Make a conscious effort at achieving and maintaining the right postures and I promise you an ache free and happy pregnancy. After all, you get to be pregnant only for 10 months and there are so many other fun things to do then, rather than complaining about aches :) 

Bowel Issues In Pregnancy

Bowel issues is a decent way of addressing your poop problems in pregnancy. Yes, you may have problems shitting during your pregnancy, but do not worry, you are not alone and there are ways to prevent and treat such problems.

What are the bowel issues you may face during pregnancy?

• Your shit may be hard and really difficult to pass (constipation)
• You may notice an increase in the frequency of stools
• The stools may be blood stained or discolored
• Passing stools may get painful
• You may notice heamorrhoids (swollen and enlarged veins in and around the rectum and anus)

Should I discuss my bowel issues with my doctor?

Of course, you should discuss such issues with your doctor, even if you are not questioned about it. Because it's these issues which develop during pregnancy, that later become worse and have a significant impact on your lifestyle. Many of these problems are completely treatable and also preventable.

How can I prevent such problems?

• Document your symptoms: 

During pregnancy, it is easy to blame everything on pregnancy and take many of your symptoms for granted. This is not true, many of the symptoms and uneasiness of pregnancy can be avoided by making conscious changes in our lifestyle.

• Maintain a food journal:

This will help you identify if any, foods you eat is aggravating your problem. And common sense will tell you to avoid those foods in the future.

• Drink, Drink, Drink, plenty of water:

I cannot stress enough on the fact that water,is the elixir of life. The demand for fluids by our body increases during pregnancy, so, it is important to keep your body hydrated. Bowel issues are a sure fire sign that your body is not getting the adequate amount of water it needs.

• Take in a high fiber diet:

Fibres are natural laxatives and are essential for a healthy bowel. Apart from helping shit out your troubles, they also provide you and your baby with an abundance of vitamins and minerals.

• Avoid spicy, greasy, fatty and fried foods:

These provide no extra nutritional value. Apart from being unhealthy, they also add strain to your digestive system giving rise to digestion problems during pregnancy.

• Move your body:

If you have not started yet, consult with your obstetrician and start a mild exercise routine. A sedentary lifestyle does more harm to the digestive tract than good.

• Visit your obstetrician at the earliest:

If you experience a change in bowel habits, it is always best to inform your doctor at the earliest and get professional help, lest the problem gets worse.

How To Get Rid Of Back Pain During Pregnancy

Suffering from back aches during your pregnancy? You are not alone! Studies show that back pain is one of the top 3 most common discomforts of pregnant women.

Do not worry as yet, though it is common, there are quite a few ways which you can resort to, to relieve your ache.

In this article, you will read about

• The causes of back pain in pregnancy
• Tips to relieve back pain
• When to consult your doctor

Causes Of Back Pain In Pregnancy

• Hormone changes

During pregnancy your body produces a hormone, Relaxin , which helps to loosen the ligaments in the pelvic area, making the joints loose, preparing your body for childbirth. This relaxin also relaxes the ligaments attached to the spine leading to instability and pain.

• Posture changes
• 
  

As the mother's abdomen grows outward, the centre of gravity shifts forward due to the pull of the baby and amniotic fluid. This leads to your spine curving forward  excessively, leading to pain.

• Stress

In mid-pregnancy, as the uterus gets heavier, even without noticing, we tend to lean back putting more stress on our spine.

• Weak abdominal muscles

These muscles play an important role in the overall health of your spine by supporting them. As your baby grows the muscles stretch and get weak contributing to backaches.

Minimizing Back Pain During Pregnancy

• Exercise to improve the strength of your core muscles
• Wear shoes with low heels to support the curve of your foot well.
• Be conscious of your posture when you sit, stand, walk and lie down.
• Get help carrying weights.
• Applying heat or cold to your back helps.
• Dress up right. Wear the correct size bra with comfortable cups and straps to avoid strain on your shoulders.
• Wear an abdominal support garment or maternity pants with wide support bans which fits under the belly.
• Eat healthy.
• Make sure you avoid constipation or treat the problem at the earliest if you have one.

When To Contact Your Doctor

If all the above measures do not work or if you are suffering from severe back pain for more than a week or so, contact your doctor as you may need investigations and medications to sort out your problem.