Normal pregnancy does not require bed rest
Dr Meenal Kumar

Shruti, 30, pregnant for the first time, entered the doctor’s clinic and complained, “Doctor, I am fed up with the bed rest, and the diet loaded with desi ghee. I used to be slim but now….”.

“Who advised you to take rest and excess of oily foods?” the doctor enquired.

“My pregnancy is precious. My mom advised me complete rest and healthy diet since the inception of pregnancy, to make my unborn healthy and to prevent any complications for myself.”

The doctor smiled and then counselled, “Your complete rest and over-eating are doing exactly the same what you wished to prevent. You are now prone to obesity and the consequent complications like diabetes, high blood pressure, heart disease, bone weakness, depression, difficult labour or caesarean delivery, loss of figure, besides fetal distress,. You may also suffer joint pain and muscle-aches. You may feel dizzy when you stand up. Bed rest may increase the risk of blood clots in the veins of your legs. Emotionally, you may feel confined and isolated”, the doctor continued.

Pregnancy is a normal process. Current evidence is insufficient to support recommending bed rest to normal pregnant women for preventing complications. Ask your physician the exercises you can safely do to keep your blood flowing and your muscles active. He might suggest Kegel exercises (muscle exercises that tighten the pelvic area), deep breathing exercises, pelvic tilts, neck circles, and even leg lifts under medical supervision. Eat a sensible and healthy diet and don't think of bed rest. Keep a basket of nutritious snacks next to your bed -- things like whole-grain crackers, fruit, and cereal bars are ideal.

Who requires bed rest during pregnancy?

The pregnant woman can work like any other woman during the day. However, one in five women may be required to spend part of her term in bed as a treatment for pregnancy-related issues --- danger of delivering too early, or medical conditions like high blood pressure, weak cervix, bleeding during pregnancy, premature labour, or chronic heart disease. However, a pregnant woman requires more lying down in the bed as compared to a non-pregnant woman. Lying down, according to the American College of Obstetricians and Gynecologists, lowers stress on a mom's heart, kidneys and other organs, and reduces the pressure of the baby on the cervix, which in turn decreases the risk of premature contractions.

Rest also increases blood flow to the placenta; so, the baby gets more nutrients and oxygen. The need for sleep during normal pregnancy is about eight hours daily. However, many a times sleeping may be difficult during pregnancy for various reasons and that may be problematic.

Why is sleeping difficult?

l The frequent urge to urinate: Your kidneys are working harder to filter the increased volume of blood, and this filtering process results in more urine. Also, as your baby grows and the uterus gets bigger, the pressure on your bladder increases. This means more trips to the bathroom.

l Increased heart rate: Your heart rate increases during pregnancy to pump more blood, and as more of your blood supply goes to the uterus, your heart will be working harder to send sufficient blood to the rest of your body.

l Shortness of breath: At first, your breathing may be affected by the increase in pregnancy hormones, which will cause you to breathe in more deeply. Later on, breathing may feel more difficult as your enlarging uterus takes up more space.

l Leg cramps and backaches: Pains in your legs or back are caused in part by the extra weight you're carrying and the effects of relaxing in the loosening of ligaments, making pregnant women less stable and more prone to injury.

l Heartburn and constipation: Many women experience heartburn, which occurs when the stomach contents reflux back up into the esophagus. Heartburn and constipation can both get worse later on in the pregnancy when the growing uterus presses on the stomach or the large intestine.

l Increasing size of the foetus, which can make it hard to find a sleeping position. If you've always been a back or stomach sleeper, you might have trouble getting used to sleeping on your side

However, if the pregnancy is normal and without complications the woman can lead an active normal life.

The writer is a Chandigarh-based senior gynaecologist.

EYESIGHT
Breakthrough in cataract surgery
Dr Mahipal Sachdev

Cataract is the leading cause of blindness in India. It is noticed usually after 45 years of age and is considered a problem of ageing. Almost 11 million cases are there in India. The unfortunate aspect of cataract blindness is that it is reversible by surgery, but lack of surgical facilities in the rural areas has resulted in the backlog of patients needing cataract surgery.

Cataract blindness is a public health problem of major proportions in the developing world. As much as 41.8 per cent global blindness; in which 23.5 per cent is contributed by India; is caused by cataract alone. Blindness is a disease which has severe economic repercussions and adversely affects productivity.

But now with the advent of better technologies and modern innovations, cataract surgery has come a long way. It has been a long journey from the traditional extra-capsular cataract surgery to small incision cataract surgery to phacoemulsification surgeries. We have gone one step ahead and achieved ways to reduce the incision size of the cataract surgery (making it less than 1.8 mm) there by speeding the wound healing and wound stability and decreasing the post-operative corneal astigmatism.

This has been made possible by a combination of improved methodology and improved equipment availability. The combination of high vacuum flow restrictive tubing, STELLARISMICS needle, the Stellaris Microsurgical System and the MICROINCISIONAL lenses by Bausch and Lomb provide us just that.

In the Stellaris Micro Incision Cataract Surgery system, cataract can be removed through a very small incision of 1.8 mm followed by an implantation of AKREOS AO MIL.

Cataract Surgery is now being done routinely through 1.8 / 2 mm incision (STELLARIS Micro Incision Cataract Surgery / Micro Coaxial Cataract surgery).

Another important factor is the development of AKREOS AO MIL. These IOLs provide the advantage of being able to pass through a very tiny incision 1.8 / 2 mm. These lenses are also Aspheric lenses, aberration free which can increase the contrast sensitivity and the visual acuity for the patient.

Providing ways and means to make the incision small while doing Phaco would be fruitless if we had to increase the incision in order to place the lens.

Thus, with increasing popularity of micro-Phaco came the need to modify the lenses and their delivery system to make the effort worth while.

ADVANTAGES OF SMALLER INCISION

l Visual recovery is faster.

l The patient can return to his normal activities within 24-28 hours of surgery.

l Minimal or no trauma to the ocular tissue

l Better visual acuity

l Highly safe surgery

The writer is Chairman and Medical Director, Centre for Sight, New Delhi. Email: drmahipal@gmail.com

Life-threatening illnesses: Role of counselling
Namita Rishi

The very diagnosis of a life-threatening illness (like cancer, AIDS and heart disease) can be traumatic and can deeply impact the physical, emotional and spiritual well-being of the afflicted person. In such a situation it seems as if the survivor's life has changed in a moment. Almost all aspects of his/her life --- work, relationships and social interests --- get affected.

This kind of illness affects not only the survivor but also impacts the family. The family members become confused and helpless. The whole family may react differently to this stressful condition. Some members may experience anger and frustration, others may be in a denial mode, some may blame others and some may put the blame on themselves for the illness. The illness may also demand major shifts in everyone's roles and lifestyles, further creating stress, anxiety and depression in the family. Therefore, it becomes important to consider a holistic approach of treatment that is family-centred, and incorporates biological, psychological and social interventions that focus on the needs of the survivor as well as his/her family. The significance of the holistic approach or bio-psycho-social model of treatment has been realised with new advancements in the area of mental health counselling.

In this model, a mental health professional has a great role to play. He/she works in collaboration with other health-care professionals. He/she first assesses the current level of functioning of the affected family. The mental health professional gathers information regarding the family's conceptualisation of the illness, the family's assessment of the current challenges and losses, and the present and future expectations. He/she also gathers information about the family history of illnesses, prepares multi-generational illness-genogram, and assesses the family's emotional, social and financial resources to deal with the illness.

Then, the mental health professional sets two goals for counselling. The first goal focuses on the survivor and his/her family. The mental health professional helps the family to accept the presence of illness and its severity. He/she psycho-educates the family about the illness, and resolves their doubts and misconceptions. The mental health professional also uses different therapeutic interventions and helps the family members change their negative self-talk about “never recovering” to recognising how much has already been recovered and how much still can be improved. He/she also helps them shift the focus from blaming the self or others and thus reducing anger, guilt and depression. This is a difficult task but once achieved, the acceptance of illness reduces the feeling of helplessness and unpredictability. It rather enhances the sense of self-control over their lives. The acceptance of the reality also helps the family move on to the next stage of recovery where the family members develop a constructive approach to deal with the illness.

The second goal focuses on developing the support system for the family, both within the family and in the community in general. The mental health professional incorporates techniques that facilitate communication among family members, between the family and the health-care system, and between the family and the formal and informal social support system. He/she also helps the family develop support groups of people dealing with a similar kind of problems. Sharing their stories of illness, their struggles, fears and apprehensions as well as their successes with others helps in developing a rational attitude. The “Keep the door open” principle of a mental health professional allows the family to have a sense of security.

There is a need to make the public at large aware of the importance of the role of a mental health professional in such situations. Counselling has been recognised in the developed countries as one of the effective tools for enhancing the scope of recovery in the case of life-threatening illnesses.

In India, we have a good support system in the form of a strong family, friends and social ties. But there is a great need to psycho-educate the people about the benefits of mental health counselling in handling life-threatening ailments.

The writer is a professional counsellor.