For some women, having their own children is not as easy as it seems. Suffering from more than two or more miscarriages is known as recurrent miscarriage. This experience affects every aspect of a woman s life from her mental and emotional health to her physical health and social well-being. 

It is important for a woman undergoing this experience to keep in mind that she can still give birth to a healthy baby even after recurrent miscarriages.

Look after your health: Miscarriages are not very uncommon and in many instances are a result of the woman s body not being able to take the strain if a growing fetus. Hence, pay attention to your health to prepare your body for future pregnancies. Avoid smoking, alcohol, caffeine and exposure to toxins that can cause fertility problems. Eat healthy food and start taking a multivitamin with folic acid on a daily basis. Exercise regularly, but avoid strenuous activities that involve heavy lifting or dangerous contact sports. Yoga is great for pregnant women or women planning a family as it tones your body keeps your stress levels low.
Talk to people: A miscarriage can affect your emotional health and self-image, but you must remember that you are in a way responsible for the miscarriage. Talk to other women who have had a similar experience and share your feelings with them. Men and women cope with a miscarriage in different ways and hence work on communicating your feelings with your partner. Do not suppress your feelings, but acknowledge them and work through them. You may also find it beneficial to talk to a counsellor or get involved with a support group.
Give yourself a break: It s ok to not attend your friend s baby shower when you ve recently suffered a miscarriage. Instead of surrounding yourself with your friend s babies and children, take a break and pay attention to yourself. Develop a hobby or find something to keep yourself busy. Take a holiday with your partner and find ways to reconnect with them. Find your own way of acknowledging the pregnancy. This could be in the form of writing about it, naming the baby or planting a tree in memory of the baby.
Get proactive: Don t sink into despair because of your miscarriages. Educate yourself about the various reasons you may have miscarried the baby by reading books or talking to medical professionals. This can help prevent future miscarriages.

Recurrent Miscarriage - How to Deal With It?

There are two methods by which abortion can be done:

Medical Abortion - Non-surgical abortion in which medicines are used to induce abortion

Surgical Abortion - Use of transcervical procedures for terminating a pregnancy, including vacuum aspiration, and dilatation and evacuation (D and E).

Surgical or Medical Abortion for Unwanted Pregnancy

If pregnancy is lesser than = 7 weeks; medical method with Mifepristone with Misoprostol is favorable as the success rate is as high as 97%.

If pregnancy is between 7-12 weeks; surgical abortion is the only option.

If pregnancy is beyond 12 weeks - 20 weeks, then the woman needs to be hospitalized and will be given either Mifepristone followed by Misoprostol tablet or only Misoprostol tablets and woman will then abort like a miscarriage in the hospital. If any products are remaining, then it will be evacuated surgically.

Surgical abortion is preferred if patient desires concurrent tubal ligation or IUCD (CuT) insertion.

If a woman fulfills the criteria for selecting either method i.e. before 7 weeks, final choice has to be given to the woman.

Summary of choice between Surgical or Medical abortion in India

lesser than = 7 weeks - Medical method or surgical method

7-12 weeks - Surgical abortion

12 - 20 weeks - Medicines with or without surgical procedure in hospital

Advantages of Medical Abortion

Avoid surgery

Controlled by the woman and may take place at home

No need for admission to the hospital

Usually, well tolerated by women, if properly counselled and motivated

No need to take leave from work, as bleeding can be managed with menstrual pads even while in the office or at work.

Disadvantages of medical abortion

Takes time (hours to days) to complete abortion, and the timing may not be predictable. Women experience bleeding and cramping, and potentially some other side-effects (nausea, vomiting, fever, and shivering). May require more clinic visits than surgical abortion.

Advantages of Surgical Abortion

Quick procedure

Complete abortion easily verified by evaluation of aspirated products of conception

Takes place in a hospital so Sterilization or placement of an intrauterine device (IUD) may be performed at the same time as the procedure. It can be performed under local anaesthesia if woman is properly motivated and counselled

Disadvantages of surgical abortion

Requires instrumentation of the uterus

Small risk of uterine or cervical injury

Timing of abortion controlled by the doctor and hospital

Anaesthesia needs to be administered. Most doctors perform this procedure under short general anaesthesia. A woman needs to be in the hospital for at least 6 hours. Effect of sedation will be there throughout the day.

Methods of Abortion for Unwanted Pregnancy

Women tend to develop high levels of blood sugar during their pregnancy (especially within the 24th and 28th weeks), irrespective of whether they already had suffered from diabetes prior to their pregnancy. However, gestational diabetes, if not taken proper care of, might escalate the risks of developing diabetes in the near future for both the mother and the child, accompanied by complications in pregnancy or labor. Gestational diabetes is usually characterized by mild symptoms such as excessive urge to urinate, excessive thirst, blurred vision and fatigue.

Causes:
Insulin, a hormone produced by the pancreas, allows for the utilization of the glucose for energy. The food consumed is broken down by the digestive tract of the body, converting carbohydrates into glucose before releasing it into the bloodstream. The glucose is then absorbed by the cells to be used as an energy source. Now, at the time of pregnancy, the placenta (organ nourishing the fetus) connecting the baby to the blood supply also produces various other hormones in high levels, for instance, estrogen and human placental lactogen. Most of these hinder the normal functioning of insulin in the cells, hence raising the blood sugar count. With subsequent growth of the baby, the placenta keeps on producing more amounts of such insulin resistant hormones to an extent that they are capable of meddling with the development of the baby.

Treatment:
1. Monitoring the blood sugar count at least four to five times a day and keeping it under control might help to ease the complication.
2. A healthy diet consisting of whole grains, vegetables and fruits in the right proportion and limiting sugar or other highly refined carbs meets the nutrition and fiber requirement of the body. Guard against additional weight gain during pregnancy as that hampers the entire process.
3. Exercise or regular physical activities help to normalize blood sugar level by boosting glucose absorption in the cells. Furthermore, exercises also enhance the sensitivity of the cells towards insulin. This means that only a little amount of insulin production by your body would be enough for the transportation of sugar.
4. Medication, If exercise and diet fall inadequate, insulin injections are often administered to control blood sugar count.
5. Keeping the baby under close observation with the help of repeated ultrasound and other tests to record its growth and development is an essential part of the treatment plan.

Gestational Diabetes - How It Can Be Treated?

Nutrition for you will never be as important to you as it is during pregnancy, because while eating you have to think not only about you, but also the development of your unborn child. However, merely eating is not enough you have to eat right. Here is your guide of what to eat and what to avoid, during pregnancy, so that your child gets the best nutrition.
Things to eat: 
1. Whole grains- whole grains, which can be found in food items like cereals, whole-wheat breads and pastas, are rich in folic acid, iron and fibers. Make sure you incorporate ample amount of whole grains in your diet to remain healthy during pregnancy.
2. Beans- beans are extremely nutritious for pregnant women, as they contain protein, fiber, iron, folate, zinc and calcium, which are much needed for the development of a healthy baby.
3. Fish- incorporate enough fish in your diet because they contain healthy omega-3 fatty acids. Salmon, for example, is exceptionally good for health since it contains less mercury than other fish.
4. Eggs- eggs are rich in protein, and is also a good source of other nutrients like amino acids, vitamins and minerals, including choline which is crucial for the baby's brain development.
5. Berries- berries contain vitamin c, calcium, folate and fiber, which is important to your diet, besides being a delicious addition to your meal.
6. Low fat yogurt- sweetened yogurt is extremely bad for your health, but a cup of plain, low fat yogurt contains copious amount of calcium and is also a good source of proteins.

Things to avoid: 
1) soft cheese- soft cheese, like feta, blue cheese, brie, etc. Are made of unpasteurized milk, which contain listeria bacteria which might be fatal for you and your child. Hence, they are best to avoid.
2) undercooked or raw food-raw meat may contain toxoplasma and other bacteria. Raw eggs in sauces like mayonnaise, uncooked dough, desserts like tiramisu and salad dressings are also harmful for you. Fish in sushis or self caught fish may also contain harmful bacteria and parasites or chemicals released from nearby factories. Do ensure that your meat and fish are thoroughly cooked while dining out as well.
3) unpasteurized juices- there is always a risk of juices, which are squeezed and unpasteurized, being contaminated with e-coli or salmonella, which can be very harmful for you.
4) pre-dressed poultry- poultry that has been dressed and stuffed at the market often run the risk of being contaminated by the juices of slaughtered poultry, proving to be best breeding grounds for bacteria.
5) unwashed fruits and vegetables- toxoplasma can breed on unwashed raw foods, which also cause harm to your health, mainly in the prenatal period.
6) alcohol, coffee and unpasteurized milk- these beverages have been deemed unsafe for pregnant ladies since they can cause severe health damages.

Nutrition Tips for Pregnant Women

A preterm labour is referred to a condition when the cervix opens up within 37 weeks of pregnancy. An ideal pregnancy lasts for a span of 40 weeks. If preterm labour is caused due to preterm contractions, the baby is born earlier. This results in serious health risks for the baby. At times it requires long intensive care for the baby to ensure no mental or physical damage happens in the long term.

What are the symptoms of pre-term labour?
While some women show evident signs of pre-term labour, some women present symptoms that are more subtle. Some unmistakable symptoms of pre-term labour include regular contractions, sense of tightness in the lower abdomen, vaginal discharge, diarrhoea, constant backache, bleeding from the vagina, watery discharge from the vagina, pain in the abdomen and abdominal cramps. One or more of these symptoms should be immediately reported to the doctor to negate the chances of any miscarriages or serious complications.

What are the risk factors?
While there are no proven risk factors of preterm labour, lots of factors have been tagged with a pre-term labour. Some of the notable ones include:

Little pre-natal care
Premature birth in previous pregnancies
Giving birth to more than one baby at a time. This is especially applicable while giving birth to a triplet.
A stressful event such as a personal loss or events related to extreme emotions
Bleeding from the vagina during pregnancy
Any infection of the genital tract
Any complications related to the placenta, uterus and cervix
Any birth defect related to the vagina
Chronic health conditions such as diabetes or high blood pressure
Putting on weight more than the recommended level
An excess of amniotic fluid
Consumption of illicit drugs or smoking at a heavy rate
The shorter length of the cervix than the normal one
What are the complications involved?
Pre-term labour cannot be stopped with any medical procedures. If pre-term labour is caused due to smoking or an infection, the same can be addressed. Any pre-term labour that eventually leads to giving birth can confront with complications such as low weight, problems related to the vision of the baby, behavioural problems and learning disabilities.

Diagnosis and tests:
A doctor will closely monitor the symptoms a woman is facing. In the case of regular contraction, a close look at the cervix helps a doctor to decide the condition of a patient. To be assured a doctor might recommend a full pelvic exam, ultrasound test, uterine monitoring, and maturity of amniocentesis. A test of the vaginal secretion further gives the doctor enough evidence about the possibility of a pre-term labour. If you wish to discuss about any specific problem, you can consult a Gynaecologist.

Pre-Term Labour - Can There Be Complications?

'Congratulations! You're pregnant!' Almost all women long to hear these words and nothing should come in the way, even diabetes. So, if you are a Type 1 or Type 2 diabetic, here are a few things you should keep in mind to have a healthy baby.

1. Your blood sugar must be monitored regularly-
The most important thing you can do to have a healthy baby is to keep your blood sugar as close to normal before and during your pregnancy. Testing is recommended a minimum of four times a day. Glucose passes through the mother's blood to the fetus and hence if your blood sugar fluctuates, so will your baby's. High blood sugar levels are especially harmful during the first 8 weeks of pregnancy when the baby's brain, heart, kidneys and lungs are formed.

2. Your pregnancy is considered high risk-
High blood sugar levels can increase the risk of a miscarriage as well as the risks of your baby being born with birth defects. Diabetes can also increase the risk of developing preeclampsia during the second half of your pregnancy. This could result in a C section or premature birth. Thus, maintain regular checkups and keep your doctor in the loop of all your activities.

3. You should watch out for signs of ketosis-
When you have low blood sugar, the body produces ketones that can be passed on from you to your baby. This production of ketones is a result of the body's burning of fat instead of glucose to provide energy and can develop a condition called ketosis. Symptoms you should watch out for are stomach aches, nausea, fatigue, muscle stiffness, frequent urination and fruity breath.

4. You need Vitamins and Supplements-
Most women require vitamin and mineral supplements at the time of pregnancy. Of these, folic acid, iron, calcium and vitamin D are the most important. These supplements help in the healthy growth of the baby.

5. You should exercise regularly-
Maintaining a regular physical activity routine is very important for diabetics who are expecting a baby. This will help you regularize your blood sugar, relieve stress and strengthen your heart. Avoid activities that increase your risk of falling and aim for at least thirty minutes of daily exercise such as walking, swimming or yoga.

6. Check your medication-
Some medication can be detrimental during pregnancy such as cholesterol and blood pressure medication. Consult your doctor to find a suitable alternative if needed. You may also need to change the kind of insulin you take and its frequency and amount. As you get closer to the delivery date, your insulin requirement may even double or triple.

The key to preventing complications during pregnancy is controlling your diabetes. So take your insulin regularly, maintain regular checkups and eat healthy. You need to be seen by your obstetrician more frequently. Your pregnancy will be monitored closely by more frequent ultrasounds and NST. If your sugar level remains under control and pregnancy is advancing well, a natural onset of pains is aimed for and normal delivery is expected.

Diabetes - How To Handle It While Pregnancy?

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