Difficulties with breastfeeding are common, especially in the first week after birth. As a rule, the milk, which is present all the time, ‘comes in’ at any time from 24 hours after birth. It is common for the breasts to become engorged early on, but in some cases, there is insufficient supply.

ENGORGED BREAST

WHAT IS ENGORGEMENT?

In some women, a few days after delivery the milk supply comes on so quickly that the breasts become swollen, hard, and sore.

This is called engorgement. There is an increased supply of blood and other fluids in the breast as well as milk.

WHAT WILL YOU NOTICE?

The breasts and nipples may be so swollen that the baby is unable to latch on and suckle. The soreness makes it difficult for you to relax and enjoy your baby.

HOW ARE ENGORGED BREASTS MANAGED?

• Feed your baby on demand from day 1 until he or she has had enough.
• Finish the first breast completely; maybe use one side per feed rather than some from each breast Offer the second breast if the baby appears hungry.
• Soften the breasts before feeds or expressing them with a warm washer or shower, which will help get the milk flowing.
• Avoid giving the baby other fluids.
• Express a little milk before putting the baby to your breast (a must if the baby has trouble latching on) and express a little after feeding on the other side if it is too uncomfortable.
• Massage any breast lumps gently towards the nipple while feeding.
• Apply cold packs after feeding. Many women use washed, cool, crisp cabbage leaves (left in the refrigerator) between feeds. An opening is left for the nipple and the leaves are usually changed every 2 hours when appropriate. Some women prefer to use hot packs.
• Wake your baby for a feed if your breasts are uncomfortable or if the baby is sleeping longer than 4 hours.
• Use a good, comfortable bra.
• Remove your bra completely before feeding.
• Take ibuprofen or paracetamol regularly for severe discomfort. Remember that regular feeding is the best treatment for your engorged breasts. Follow your demand and your baby’s demand. As your breasts are used in this way, they gradually become softer and more comfortable

INSUFFICIENT SUPPLY

Studies have shown that many women wean because of low milk supply.

The problem is due mainly to lactation mismanagement such as poorly timed feeds, infrequent feeds and poor attachment.

This is sometimes a problem in mothers who tend to be under a lot of stress and find it hard to relax.

A ‘let down’ reflex is necessary to get the milk supply going, and sometimes this reflex is slow.

If there is insufficient supply, the baby tends to demand frequent feeds, may continually suck his or her hand, have hard stools and fewer wet nappies, and will be slow in gaining weight.

Remember that there is always some milk present in your breasts. Mothers tend to underestimate their milk supply.

WHAT SHOULD YOU DO?

• Try to practice relaxation techniques to help condition your ‘let down’ reflex.
• Put the baby to your breast as often as he or she demands, using the ‘chest to chest, chin on breast’ method.
• Feed your baby more often than usual.
• Give at least one night’s feed.
• Express after feeds, because the emptier the breasts are, the more milk will be produced.
• Make sure you get adequate rest, eat well, and drink ample fluids, but if you feel overly tired go to your doctor for a check-up

Congratulations on becoming an expectant parent.

Even though you might felt flat and sick at first but this is a very exciting time in your life,

Your baby is very special and deserves every opportunity to get a flying start in life by growing healthily in your womb. Pregnancy is a very normal event in the life cycle and usually goes very smoothly, especially if you have regular medical care.

WHY HAVE REGULAR CHECKS?

Antenatal care is considered to be the best opportunity in life for preventive medicine.

It is important to check the many things that can cause problems—these are uncommon but preventable.

A special possible problem is pregnancy-induced hypertension, which can lead to a serious condition called preeclampsia or toxemia of pregnancy, a condition of weight gain, high blood pressure, and kidney stress, which shows up as protein in the urine.

Areas that need to be checked include:

• The blood count
• Blood grouping and Rhesus antibodies (Rh factor)
• Immunity against infections that may affect the baby (e.g. rubella, varicella (chickenpox), hepatitis B and C, HIV)
• Number of babies (one or more)
• Size and state of your pelvis
• Blood pressure
• Urine (for evidence of diabetes or pre-eclampsia)

CERVIX(PAP TEST)

• Progress of the baby (e.g. size of the uterus, heartbeat)
• Mother’s progress, including emotional state
• Blood sugar (for possible diabetes)
• Vitamin D
• The risk for Down syndrome through first-trimester combined screening test.

WHEN SHOULD YOU BE CHECKED?

The recommended routine is as early as possible and then every 4 to 6 weeks until 28 weeks of pregnancy, then every 2 weeks until 36 weeks, and then weekly until the baby arrives (usually 40 weeks).

One should have An ultrasound usually at about 18 weeks.

WHAT COMMON THINGS CAN CAUSE PROBLEM IN THE BABY?

• Infections such as rubella, varicella, and genital herpes
• Diabetes (can develop in pregnancy)
• High blood pressure
• Smoking—retards fetus growth and should be stopped (if impossible, limit to 3 to 6 cigarettes per day)
• Alcohol—causes abnormalities, including mental retardation. 
•  ‘not drinking alcohol is the safest option for the developing fetus’
• Other social drugs
• Aspirin and various other drugs (check with your doctor)

WHAT IS USUALLY PRESCRIBED?

Folic acid is now recommended for 4 weeks and preferably 12 weeks before getting pregnant

And then for the first three months after you get pregnant.

No iron tablets are needed if you have a healthy diet and do not have severe morning sickness.

WHAT IMPORTANT AREAS YOU SHOULD ATTEND?

NUTRITION

A healthy diet is very important and should contain at least the following daily allowances:

1. Eat most:
• fruit and vegetables (at least 4 serves)
• cereals and bread (4 to 6 serves).

2. Eat moderately:
• dairy products—3 cups (600 mL) of milk or equivalent in yogurt or cheese
• lean meat, poultry or fish—1 or 2 serves (at least 2 serves of red meat per week).

3. Eat least:

• sugar and refined carbohydrates (e.g. sweets, cakes, biscuits, soft drinks)

• polyunsaturated margarine, butter, oil and cream.

• Bran with cereal helps prevent constipation in pregnancy.

• Drink ample fluids (e.g. 2 litres of water a day).

• Talk to your doctor about Listeria infection, which is contracted from fresh and unprocessed foods such as soft cheeses, pâté, and unpasteurized milk

ANTENATAL CLASSES

• Trained therapists will advise on antenatal exercises, back care, postural advice, relaxation skills, pain relief in labor, general exercises, and beneficial activities such as swimming.

• Breastfeeding and nursing mothers Breastfeeding is highly recommended.
• Contact a local nursing mothers’ group for support and guidance if you need help.

EMPLOYMENT AND TRAVEL

Check with your doctor. Avoid standing in trains. Avoid international air travel after 28 weeks.

NORMAL ACTIVITIES

You should continue your normal activities. Housework and other activities should be performed to just short of feeling tired. However, get sufficient rest and sleep.

WHEN YOU SHOULD CONTACT YOUR DOCTOR OR HOSPITAL?

Contact your doctor or seek medical help:

• If contractions, unusual pain, or bleeding occur before the baby is due
• when the baby is less active than usual
• If membranes rupture and a large amount of fluid comes out
• When you are getting regular contractions 5 to 10 minutes apart. Help is only a telephone call away

In the following topic understanding your menstruation, we will learn and understand the Menstruation in detail.

WHAT IS MENSTRUAL CYCLE?

When we talk about the menstrual cycle the first thing many of us think of is ‘periods’. The period (Menstruation) is just part of a continuous cycle of changes in the body that is regulated by hormones.

The cycle usually begins during the teenage years and continues until menopause, at about the age of 50. The purpose of the menstrual cycle is to prepare the body for reproduction.

WHAT IS NORMAL CYCLE?

The menstrual cycle can vary from woman to woman. For some, it is normal to have a shorter cycle (e.g. 21 days) and for others a longer cycle (e.g. 35 days). The average for all women in the world is 28 days.

This means that the time of ovulation varies, but the average is the 14th day.

The periods can last from 1 to 8 days, with the average being about 4 to 5 days

WHAT CAUSES IRREGULAR PERIODS?

The cycle will vary in a woman from time to time. This can be the result of

• hormonal fluctuations,
• emotional stress illness,
• travel
• sudden weight change or
• the use of some medicines
  

WHAT ARE THE SOME OF THE PROBLEMS?

Many women will experience problems with their menstrual cycle at some time. The most common problems are

• period pain,
• premenstrual tension,
• irregular periods
• and very heavy periods.
  
  

If you have any problems or questions about your menstrual cycle, discuss them with your doctor

WHEN IS PREGNANCY LIKELY TO OCCUR?

You are most likely to get pregnant between the 8th and the18th day, depending on when you ovulate and how long the sperm remain active. It is useful to know when you ovulate—you may feel a pain in the abdomen and notice that your vaginal mucus changes from jelly-like to watery. Intercourse at this time and for the next 2 days is most likely to result in pregnancy

Source: women’s health