Dr. Banka Soujanya Discusses the Importance of Nutrition During Pregnancy and Post-Delivery (Part-8)

Dr. Banka Soujanya: Yes, of course. If it is a second pregnancy and the baby is in a breech position (head up) we can give a trial for a procedure called external cephalic version ( ECV). Once the baby has reached approximately 36 weeks, we can check whether the baby's head is down or up, as the baby can rotate freely until around 36 weeks.

However, once a baby reaches 36 or 37 weeks. We assess whether the baby's head is down or still in an upward position. After 36 weeks, the baby remains fixed in one place, and if the baby still head is still up, we can proceed with a trial for an external cephalic version.

During the procedure, we are under the guidance of ultrasound to check the position of the baby, also provide some medicines for relaxation of the uterus, and ensure that the umbilical cord is not wrapped around the baby's neck. We will check whether the operation theater is ready in case of any abnormality in the procedure, where the baby is not able to tolerate the ECV procedure, and then we will allow for an immediate Caesarean delivery.

This is called the external Cephalic version which involves gently manipulating the baby by holding the head and the bumps and rotating the baby in such a way that the head will be fixed in the passage. We can give a trial for that, but before proceedings, we will obtain all the necessary consents and ensure that all documentation and resource facilities are ready. If the parents and partner agree, we can attempt the procedure where a few cases have been successful with this external Cephalic version.

After the procedure, the mother will be monitored approximately for the next half an hour during which we will perform a scan and also a nonstress test (nst), and if everything appears normal, we will advise them to go home. Once labor begins naturally, they will return for delivery and will go home.

Dr. Banka Soujanya: Nutrition throughout pregnancy is very crucial as the mother requires extra calories to support the fetus. Additionally, some people believe that they need to eat double the quantity to be sufficient for nourishment to both themselves and the baby, but the amount doesn't matter; rather, the quality of food matters in this case. Whatever the food women are taking, it is essential to focus on getting high-quality food with nice protein sources like boiled eggs, pulses, and green leafy vegetables along with fiber-rich foods like carrots.

I recommend to all my patients to have a cup of salad daily as that will help them in the absorption of all the vitamins, prevent constipation, and promote weight gain. Such a gain will be a good weight gain. Many people tend to indulge in eating rice, sweets, cool drinks, cakes, and chocolates, specifically when people come to visit her, bring a sweet box.

It's essential to avoid eating sweets, junk foods, and preserved foods. Instead prioritize nice fruits, leafy vegetables, salads, legumes, and all non-vegetarians can consume fish and chicken to build nice protein.

During the pregnancy, whereas after the delivery the nutritional principles apply but there is a common myth that eating proteins can lead to infections. They avoid all these food substances, despite repeated counseling and explanations to the parents when they come for follow-ups.

They say that they are not feeding dal to their daughter or daughter-in-law because it might lead to some infections. Despite repeated counseling, they don't listen to me and they never listen to anyone. So, I often find myself having to prescribe some protein supplement powders, tablets, or biscuits to aid in the healing of the surgical scar.

The first thing after the delivery is nutrition counseling, must occur before discharge. Our nutritionist will give brief guidance about the food substances that are crucial for physical strength, and good healing.

The first thing is the uptake of a protein diet The second thing is an iron-rich diet, to replenish the losses that have happened during the delivery process. The third thing is the oral fluids and the fourth is fiber-containing food, because constipation is the most triggering thing in post-delivery to relieve that constipation.

Generally, oral fluids, a fiber-rich diet, zinc, vitamin C, and magnesium supplements heal the wound. Vitamins C and zinc are essential. Sometimes we prescribe some supplements also for that sake. The digestion process will be better with this light food than eating some oily masala, and spicy foods.

By dietary considerations the digestion process will be good as post-operatively they mostly feel a bloating sensation, a feeling of stomach fullness, leading to discomfort. And all the food substances don't get digested much like the normal person. So soft easily digestible food will be the most preferable thing post-delivery.

Dr. Banka Soujanya: If the cervix is fully dilated and there is significant bleeding, we deliver the baby as quickly as possible, often using forceps or vacuum extraction, then we assess from where the bleeding is as sometimes the cervix is fully dilated, but the blood supply to the cervix gets tore off.  In such case we immediately substitute with vaccumated delivery and we have to see the bleeder. . After delivery, we try to identify the source of bleeding and perform suturing if necessary.

This is one scenario and If delivery is not possible with these methods, or if the cervix is not fully dilated, the baby descend has not come down to such an extent where I can apply forceps or vacuum, we proceed with an emergency C-section.

In rare cases, the uterine gets ruptured posteriorly or laterally, which we cannot assess vaginally so we proceed immediate C-section delivery and identifying where the rupture has happened and further proceed with suturing. The approach depends on the stage of labor and the specific situation.like to what extent that labor has been progressed, whether I can take a decision for vaginal birth or immediately C-section, identify the bleeders and stop it.

But the same bleeding, if it is happening before patient set into labor. There are 2 scenarios: One is abruption placenta and second is placenta previa. In these 2 scenarios. If it is placenta previa, no waiting for normal delivery, just proceed with Caesarean section, deliver the baby, stabilize the patient. For placental abruption, if the baby's heartbeat is present, we proceed with an emergency C-section. If there is no fetal heartbeat but the mother's condition is stable with good vitals, we induce labor to deliver the dead fetus. The management always depends on the condition of both mother and baby.