Friday , May 25, 2018

Dumaguing: Have a normal pregnancy

HAPPY Mother’s Day! And definitely, it is not a belated greeting. After all, mothers, yours and mine are dutiful with their God given roles 7/24, 365 days year in, year out, with the same fervor and enthusiasm.

The essence of a woman, simply put is when she has fulfilled to the hilt being a dutiful wife to her husband and a doting mother to her children.

We join the whole world in celebrating Safe Motherhood Week which is on the second/third week of May, a fitting occasion when a deep sense of gratitude is extended to all mothers - of various colors, races and mind you, sizes or shapes - no pun intended.

After all, the hand that rocks the cradle, rocks a nation. However, the journey towards motherhood is not always a smooth, effortless process. It could be fraught with some risks, which at times could be a threat to both mother and her growing baby inside her.

The journey starts when the sperm cell of the husband meets with the egg cell or ovum of the wife, at the distal portion of the Fallopian tube, also called salpinx in a process called fertilization.

The formed zygote-fertilized egg slowly moves down and finds a home -called implantation - at the upper back portion of the uterus - called bahay-bata - where it grows and develops until it is ready for delivery called parturition.

At times, the zygote develops outside the uterus-called ectopic pregnancy, the most common site is the Fallopian tube - and enlarges there until, after eight weeks would rupture and this puts the pregnant woman into a rather serious surgical emergency.

Or even after implanting itself on the uterus, it could still be dislodged due to strong contraction which can be brought about by both physical forces like vigorous exercises or for that matter, mental or psychological stress, thus no visits by the mother-in-law - pun intended - or scrubbing the floor, bicycling and related activities during the first three months of pregnancy.

Ideally, pre-natal checkups should be done monthly, however, most obstetrician, considering the many other concerns as well as responsibilities of the pregnant woman, would be happy with at least four pre-natal visits; one each for first and second trimester and the last two during the final month -9th month- of pregnancy.

Initial visit would be basic education/information about diet and nutrition - iron supplementation, folic acid or vitamin B 9 and use of iodized salt to prevent cretinism or childhood hypothyroidism which is always associated with severe mental retardation. Weight gain in first three months should be only 2 pounds then 11 lbs. each for the second and last trimester. Urinalysis is done to detect protein (albumin) as well as sugar (glucose).

As much as possible, except for the above mentioned vitamins and minerals, no other medicines should be given as well as X-ray be done on the pregnant woman in the critical first three to four months, mentioned by doctors as time of active organ formation.

Gestation is defined as the duration of normal intrauterine pregnancy, which for the layman is the very familiar nine months, calendar months that is. Because in med school, 10 lunar months (1 lunar month is 28 days) is also accepted although for both obstetrician and pediatrician, they would rather use the 38 to 42 weeks as standard normal gestation period, because, by convention, any fetus/baby delivered earlier than 32 weeks is considered premature.

A full term baby that is 38 to 42 weeks should weigh from 2500 to 3500 grams or that's 2.5 to 3.5 kgs. Considered low birth weights are those less than 2500 grams, very low birth weight those less than 1500 grams and extremely low birth weight those with less than 1000 grams with all the attendant risks of infection and malnutrition as well as developmental issues later in life.

Common sense tells us that premature babies are underweight. But let it be emphasized that there are also the so called SGA or small for gestation babies - newborns who have adequate gestation and may even be full term but small in size and less in weight, very common among women who keep on smoking during pregnancy.

On the other extreme are the big babies - huge newborns delivered by diabetic mothers. At this juncture, it is high time, we correct a common misconception about pregnancy - myself an ardent believer before having been born and brought up in the fields/farms and boondocks of the province- that an eight-month-old pregnancy has more risk than a seven-month-old pregnancy, and another one is that a pregnant woman should double her food intake because there are now two people being fed- nothing could be farther from the truth!

Your columnist, being a practicing internist, says Thank you to Drs. Joann Badua - obstetrician and Liza Escano-Gallardo-pediatrician for their inputs and useful comments contained in this article. And with the kind indulgence of our dear readers and friends, also a big heartfelt gratitude to God and my mother Eloisa who brought me into this world on a May 21 many years ago. Let's make every day a happy Mother’s Day! Cheers and God bless!