{ LABOUR - HOW TO GET READY }

From: CompleteWellbeing.com

Pregnancy is time to be happy, healthy and stress-free. As women near the ninth month, they start to feel the pressure—in their body and mind— and worry about their delivery. It is important here to note that labour and delivery is the end of pregnancy and beginning of a new life. Thus, nine months of pregnancy is a preparation for the process of labour and delivery.

Antenatal care plays an important role to achieve a successful labour and delivery process. Regular antenatal classes help in the physical and mental preparation of women and help them relax during those last months.

Role of antenatal care

To ensure maternal and foetal wellbeing:

Regular visits to the doctor during pregnancy are aimed to ensure that the health of the pregnant woman and the growing foetus is well-maintained. When all stays well and proper care is taken, the pregnancy is generally low-risk. If any abnormalities develop during pregnancy or if there are any pre-existing risk factors, then it becomes a high-risk one. The abnormalities that could develop during pregnancy include increased blood pressure, diabetes, and growth restriction in the baby to name a few. The pre-existing risk factors include previous caesarean sections, and pelvic abnormality.

To prepare for labour, delivery and the post-partum period:

Normal labour and delivery depend on good physical and mental preparation during the antenatal period. The pregnant woman is taught good breathing exercises, relaxation techniques and muscle toning exercises. Yoga is now a well established form of therapy for this purpose. In order to relieve anxiety and fear, knowledge should be given about the labour and delivery process. This includes a clear understanding of what to expect in labour, ways of monitoring the labour, options for pain relief and the modes of delivery.

Normal labour:

At about 36 weeks gestation the mode of delivery should be discussed with your doctor. If the decision is taken to proceed with normal labour and vaginal delivery, then regular visits are continued till labour starts. These weekly visits ensure that all is well and thus it is important to feel good foetal movements during this time. You will also feel contractions and pains intermittently, but these are just warm up [practice] labour pains. These help your womb muscles to get better coordinated as they are getting ready for the actual labour stage.

Onset of normal labour

The start of labour happens with one of the following:

Abdominal pains and contractions. There is backache and the contractions are typically felt coming from the back towards the lower abdomen. Initially they come every 20 – 30 minutes, but then the frequency increases. In established labour, these contractions will come every three minutes and will last up to a minute.

Leakage of clear water. You may think it to be urine, but then realise that it is coming continuously. Sometimes the bag of water around the baby breaks and the surrounding liquid starts draining.

Blood stained mucous discharge. Occasionally the mucous plus gets dislodged from the neck of the womb. This is seen as a sticky discharge with blood staining.

In any of the above events, if you are unsure, it is best to contact your doctor for guidance. You may be asked to come for a check-up. If the neck of the womb has started to open, then it indicates the start of labour. If it is very early, you may prefer to be at home and go to the hospital later.

What to do at home when labour begins?

Get ready to travel to hospital. Do not take a heavy meal as there is a risk of vomiting when pain gets strong and this will get worse if your stomach is full. Liquids are the best form of intake from now on and they are good for rehydration. You will urinate frequently; this is normal. Take as much rest as possible so that you can cope with active labour. If possible, lie down on your left side.

When awake it is good to move around. This helps the baby’s head to push against the neck of the womb and improves the contractions. During contractions you can take support and lean forward on a steady surface [wall or bed] or be supported by your husband. Sometimes a good hot water shower is very helpful. When the contractions get stronger and frequent it will be difficult to cope and you will have to go to a hospital.

What is expected at the hospital?

If you are confirmed to be in labour on examination you will be admitted. A heart rate tracing of the baby can be reassuring at this stage. You will be encouraged to mainly take liquids. If all is well, you can continue to move around. At times, it is necessary to put an intravenous needle. Sometimes caesarean section is needed on an urgent basis. If this situation arises suddenly, anaesthesia can be given to you safely. During labour, soothing music, good aroma and massage can help you cope better.

Stages of labour

Labour has three stages. The first stage is from the onset of labour to the full dilatation of the neck of the womb. The second stage is from the full dilatation to the delivery of the baby. The third stage is from the delivery of the baby to the delivery of the placenta and membranes.

First stage

In the initial phase of the first stage [latent phase], the neck of the womb is getting ready for active labour. It is getting softer and thinner. This phase continues till 3 – 4cm dilatation occurs of the neck. This phase could continue for 10 – 12 hours.

When the later phase [active labour] starts, the contractions will get stronger, more regular and frequent. If the membranes are not ruptured, your doctor may choose to break the bag of water now. If the baby has opened its bowel [meconium], then the fluid is green coloured and is a worrying sign. This phase will become very uncomfortable. It is important to breathe in and out during the contractions and relax your body muscles. You must avoid pushing as valuable energy will get wasted and the baby will get tired sooner. The regular, frequent and strong contractions will lead to full dilatation of the neck of the womb. The active phase can take about 6 – 7 hours.

Pain relief. Various options can be considered to help you cope with the labour pains. In the early stages, intramuscular pain killer injections can be considered. Gas inhalation [nitrous oxide and oxygen] can also be of help.

The most effective pain relief is with epidural analgesia [painless labour]. In this form, a catheter is put into the back through a needle. The pain-killing medicine is injected through the catheter. This is very effective and takes away the pain. In case a caesarean section becomes necessary, it can be performed with the help of the epidural catheter.

Epidural analgesia cannot be used in women with bleeding disorders or spinal cord abnormalities. The disadvantage is that labour may sometimes get prolonged and your ability to push the baby at full dilatation may get compromised. In this situation, the chances of instrumental delivery may be higher. The other disadvantage is the additional cost. This form of pain relief needs close monitoring. Sometimes the anaesthetist may stay with you till the delivery.

Monitoring. It is important to assess the progress of labour and maintain foetal wellbeing. The baby’s heart beat pattern is monitored at regular intervals. At any stage, if the mother or the baby’s wellbeing is compromised; a caesarean section delivery of the baby would be performed.

Second stage

Once the neck of the womb is fully open [about 10cm], the second stage starts. The delivery is now expected within two hours. During contractions it is important to relax and take a deep breath in and push right down. If there is any delay, this stage can be shortened by applying an instrument such as forceps [metal blades] or a suction cup [ventouse delivery] on the foetal head. A cut on the perineum is sometimes necessary to facilitate the delivery of the baby. This is repaired post-delivery and heals within few days.

Third stage

This stage extends from the delivery of the baby to the delivery of the placenta. Generally, this is completed in 15 – 20 minutes. Rarely, the placenta may not get separated. This can become a problem as bleeding may start. In this situation, you may need to be taken to the operation theatre for a manual removal of the placenta.

If approached in an ill-prepared manner, it is unlikely to be a positive experience. Hence it is important to take utmost care and proper preparation. The first labour and delivery is most challenging and the subsequent ones become relatively easier on most occasions.

{ THE A B Cs OF POTTY TRAINING }

Reviewed by Sarah Pearson, M.D., September 2006

Most parents eagerly anticipate toilet training as a milestone in their child's development, if for no other reason than that it means an end to changing diapers. But few moms and dads are prepared for how long toilet training can take. Sure, some children master it within a few days, but others can take several months. In fact, it's generally true that the earlier you start, the longer it takes.

You and your child have a better chance of success if you understand the elements of training and approach the process in a clear fashion. Here are the basic steps:

A. Assess your child's readiness — and your own
Some children are ready to start potty training by 18 months or so, but others aren't interested in the process until they're closer to 3 years old. Many parents begin potty training when their children are about 2 and a half.

Watch for signs that your toddler is ready to start (can she follow simple instructions? can she walk and sit down?) but try not to put on the pressure. Rushing her when she's not ready will be counterproductive. And remember that what worked for your older child might not work for this one — boys tend to train a bit more slowly than girls, while second (and subsequent) children may learn more quickly than firstborns.

Look beyond your toddler's developmental readiness, too. If she's experiencing any turmoil or major change in her life, like a new school, caregiver, or sibling, the potty-training process is likely to hit some snags and should probably be put off until things have settled down.

There's also no sense in beginning potty training when you — or your child's primary caregivers — won't be able to devote time, patience, and a dash of humor to the process. If you're in the middle of remodeling your house, have just taken a challenging new job, or are suffering from morning sickness with your next pregnancy, it's probably not a good time to try to potty-train your toddler. Wait a couple of weeks — or months — for other pressures to ease.

B. Buy the right equipment
First and foremost, invest in a child-sized potty chair or a special adapter seat that attaches to your regular toilet. This eases the anxiety some children feel about the grown-up toilet — some fear falling into it, others dislike the loud noise of the flush. Figure out what equipment is best for your toddler before you go shopping.

If you have a boy and are buying a potty chair, look for one without a urine guard or with a removable one. You may have to wipe up a little more stray pee, but the guards tend to bump into and scrape a boy's penis when he sits on the potty, which can discourage him from training.

If you're using an adapter seat, make sure it's comfy and secure, and buy a stool to go with it. Your toddler will need the stool in order to get up and down from the toilet quickly and easily, as well as to brace her feet while sitting, which helps her push when she's having a bowel movement.

C. Create a routine
Set your toddler on the potty seat, fully clothed, once a day — after breakfast, before her bath, or whenever else she's likely to have a bowel movement. This will help her get used to the potty and accept it as part of her routine. If there's not an easily accessible bathroom around, bring your child's portable potty outside, to the playroom, or wherever your toddler may be.

Once she's fine with this routine, have her sit on the potty bare-bottomed. Again, let her get used to how this feels. At this point, let her know that this is what Mommy and Daddy (and any older siblings) do every day. That is, taking off your pants before you use the bathroom is a grown-up thing to do.

If sitting on the potty with or without clothes is upsetting to your toddler, don't push it. Never restrain her or physically force her to sit there, especially if she seems scared. It's better to put the potty aside for a few weeks before trying again. Then, if she's willing to sit there, you know she's comfortable enough to proceed.

D. Demonstrate for your child
Children learn by imitation, and watching you use the bathroom is a natural way to understand what using the toilet is all about. If you have a son, it's simpler to teach him to pee sitting down at this young age. Later, when he's mastered that, he can watch his dad, older brother, or friend pee standing up — he's bound to pick it up quickly with just a little encouragement.

When you demonstrate for your toddler, it's helpful to explain what's going on as you're using the bathroom and let her see afterward what you "made." Then show her how you wipe with toilet paper, pull up your underwear, flush the toilet, and wash your hands.

Even though you'll be helping your toddler with these activities for some time, especially wiping after a bowel movement, seeing you do it and hearing you talk through it will help her get used to the whole process. (When you wipe your toddler, make sure to go from front to back, especially after a bowel movement, to minimize the risk of urinary tract infections.)

If your toddler has older siblings or friends who are potty-trained, consider having them demonstrate, too. It can be helpful for your child to see others close to her age exhibiting the skills she's trying to learn.

E. Explain the process
Show your toddler the connection between pooping and the toilet. The next time she poops in her diaper, take her to the potty, sit her down, and empty the diaper beneath her into the bowl. Afterward, let her flush if she wants to (but don't force her if she's scared) so she can watch her diaper contents disappear.

You also may want to pick up a few potty-training picture books or videos for your toddler, which can assist her in taking in all this new information. Everyone Poops, by Taro Gomi, is a perennial favorite, as well as Uh Oh! Gotta Go! and Once Upon a Potty, which even comes in a version with a doll and miniature potty.

Keeping a book like this in the bathroom, or a poster or flipbook that illustrates the steps in using the potty, can help your toddler get familiar with the process and relate it to what she does in the bathroom.

F. Foster the habit
Encourage your toddler to sit on the potty whenever she feels the urge to go. If she needs help getting there and taking off her diaper, make sure she knows it's okay to ask you for help any time.

If you can, let her run around bare-bottomed sometimes with the potty nearby. The more time she spends out of diapers, the faster she's likely to learn, although you'll have to steel yourself to clean up a few more puddles. Tell her she can use the potty whenever she wants to, and remind her occasionally that it's there if she needs it.

Sometimes toddlers won't sit on the potty long enough to relax and let anything come out. Calmly encourage your toddler to sit there for at least a minute or so. You'll have the best luck getting her to stay put if you keep her company and talk to her or read her a book.

When your toddler uses the potty successfully, shower her with praise. Chances are that she'll continue to have accidents, but she'll start to grasp that getting something in the potty is an accomplishment. Still, try not to make a big deal out of every trip to the potty, or your toddler may start to feel nervous and self-conscious under the glare of all that attention.

G. Grab some training pants
Once training is under way, consider adding training pants — extra-thick cloth or disposables that pull on like underwear — to your routine. They'll allow your toddler to undress for the potty on her own, which is a critical step toward becoming completely potty-trained.

While cloth training pants are less convenient than disposable pull-ups, many parents say they work better because your toddler can really feel when she pees or poops in them. Whichever option you choose, introduce them gradually — probably for a few hours at a time — and stick with diapers at night for the time being.

When your child consistently seeks out the potty whenever she has to go, it's time to move on to "big-kid" underwear. Many moms and dads have found that undies with a favorite character on them give kids a dandy incentive to stay dry.

H. Handle setbacks gracefully
Virtually every child will have several accidents before being able to stay dry all day long. When this happens, don't get angry or punish your child. After all, it's only recently that her muscle development has allowed her to hold her bladder and rectum closed at all, and she's still learning why it's important to use the potty. Mastering the process will take time.

What can you do? Reduce the chance of accidents by dressing your toddler in clothes that are easy to remove quickly. When she has an accident anyway, calmly clean it up and suggest (sweetly) that next time she try using her potty instead.

I. Introduce night training
Don't give away that stash of diapers just yet. Even when your child is consistently clean and dry all day, it may take several more months, or even years, for her to stay dry all night. At this age, her body is still too immature to wake her up in the middle of the night reliably just to go to the bathroom.

When you're ready to embark on night training, your toddler should continue to wear a diaper or pull-up to bed, but encourage her to use the potty if she has to pee or poop during the night. Tell her that if she wakes up in the middle of the night needing to go, she can call you for help. You can also try putting her potty near her bed so she can use it right there.

If she manages to stay dry for five nights in a row, it's a good time to start nighttime training in earnest. Put a plastic sheet under the cloth one to protect the mattress, and put your toddler to bed in underwear (or nothing) and see how it goes.

There's not much you can do to help things along, short of limiting liquids before bedtime, so if your toddler doesn't seem to get the hang of it, put her back in nighttime diapers and try again in a few months.

J. Jump for joy — you're done!
Believe it or not, when your child is mentally and physically ready to learn this new skill, she will. And if you wait until she's really ready to start, the process shouldn't be too painful for either of you.

When it's over, reinforce her pride in her achievement by letting her give away leftover diapers to a family with younger kids, or by packing up the cloth diapers and sending them away with the diaper delivery service one last time.

And don't forget to pat yourself on the back. Now you won't have to think about diapers ever again — at least, not until the next baby.

{ HOW NOT TO DIET }

from CompleteWellbeing.com

Do you remember all that you learnt about dieting? Good. Now forget it. And read on to learn the right way to change your food habits to actually start losing some weight!!!

If you are constantly on and off diets and still don’t seem to fathom why you never achieve your weight loss goals, you might be following diets that are just not for you. In fact, following blanket diets that encourage cutting off major food groups can completely cause more harm than good. You need to learn to stay away from such diets and understand where you may be going wrong. Here’s some advice in that direction…

Target setting: Understand that your current weight is an end result of your eating habits over a period of several years. Your age, hormone imbalances if any, health problems, activity levels, social life, preferences for certain foods and the number of times you have gained and lost weight all affect the weight loss process. When setting a weight loss goal, you need to take all these factors into consideration, which often doesn’t happen. People start off setting an unrealistic target.

Starting off with the wrong target in mind is like following the wrong directions to your destination—you are obviously going to get lost! So, be realistic about the weight you actually can lose over a period of time. Ideally, you can target ½ – 1kg of weight loss per week if you are dieting and 1 – 1.5kg a week [depending on how overweight you are] if you are dieting and exercising. If you attempt to lose more than this, not only will you be disappointed, but also end up harming your health.

Dieting v/s starving: Diets that recommend eating as little as possible may show you success on the scale, but may leave you feeling weak and perennially tired or irritable and low on energy. If that’s the case, re-evaluate.

Dieting is supposed to teach you to understand your food and make healthier choices so that you can make permanent changes in your eating habits. If the changes you make are going to be only temporary, then your weight loss will be temporary too. And I’m sure you do not want to be a candidate for weight loss all your life! Choose healthier food options that are not only slimming, but that also help you get fit.

Magic diets: If your diet or the result you might get from it seems too good to be true, it probably is! If losing weight was a simple matter of downing a shake or just cutting down most of your food, we would not need expert guidance for it. Dieting involves a complex balance of calories and nutrients from the food you eat. So instead of following something you read somewhere or what a friend tells you, seek advice from a trained professional and follow what is best for your health in the long run.

Mono diets: Certain diets follow the premise that for some time, you should drop all but one particular food group and eat foods only from that particular group. While this may help you drop the kilos, what you are really losing is probably your muscle mass and consequently, your health and strength. Over a period of time, this will also cause your metabolic rate to be lowered, which will actually make your body more efficient in storing fat!

Pill-popping: If simply popping a pill could give you the body of your dreams, then I doubt there would be a single fat person on this planet! Pills that promise you weight loss give no explanation as to how they really work and if they do, there is no research to support their claims or theories. So if you want to shape up, and boost your metabolism why not choose the safer and surer alternative—exercise?