Pregnancy and Child Birth - Part 1
Dr. Preeti Kachroo Bhagat & Dr. Abhishek Bhagat Pregnancy is a very special moment in women’s life. The reproductive phase of a woman’s life is a precise interplay and a dynamic equilibrium of hormonal and biochemical events. Puberty, ovulation followed by menstruation or conception, pregnancy, parturition and lactation are essentially physiological phenomena. But each of these phenomena is associated with a high level of biochemical turbulence and the resultant physiological, neurological and psychological responses.
But among all these phases, pregnancy and the subsequent two phases could be most turbulent parts of her life considering the length of both pregnancy and puerperal phases. While, the duration of pregnancy is not a real matter of significant variations – the practical duration of puerparium is still a matter of debate. Till recent times, a total of 6 weeks calculating from the day – 1 of parturition was dealt as puerparium. However, considering the available data on energy fatigue levels of parturient women, the arguments go in favor of redefining the duration of puerperal periods.
Steps of Puerparium:
Puerparium is associated with few specific physiological phenomena, which signify the overall puerperal health of the mother.
ü Involution: The progressive return of uterus to a pre-gravid state is defined as involution. This process is effected by an autolysis of muscle protein by proteolytic enzymes. The muscle peptone and creatinine are excreted through urine. The process begins on day-2 and by day – 11, the uterus sinks behind the symphysis and becomes a pelvic organ1.
ü Lochia: is a normal uterine discharge occurring for over 3- 4 weeks following a full term parturition. The discharge comprises of a blood tinged necrotic decidua3. Till recent times, the patterns of lochia are considered to be uniform al across the puerperal populations. However, Sherman, D et al have reported recently4, on prolonged occurrence of lochia and also that, it is of diverse patterns. According to their observations, there exist at least, 3 different types of color patterns occur and of them, the Type-1 is the most commonly occurring in women having a spontaneous vaginal delivery and providing breast feed.
ü Colostrum & Lactation: The earliest part of secretion from breast is termed as colostrum. Its appearance could begin during pregnancy in scanty volumes. On day – 1, the volume reaches 40 mL and continues till day 3 or 4th. It occurs as an alkaline serous discharge with higher specific gravity, protein content, sodium chloride, but has lesser concentration of carbohydrate, fat and potassium as compared to milk. The value of colostrum for newborn is considered from immunological point of view as it contains all types of anti-infection immunoglobulins. From day – 4 or 5 the composition of breast secretion is modified to milk5.
Placental oestrogen and progesterone contribute to the breast development (mammogenesis) during pregnancy. However, prolactin is the hormone directly involved in the lactogenesis. After day 21, its release becomes pulsatile and the persistently high level of serum prolactin is not generally encountered.
ü Maternal Weight: A weight gain during pregnancy, of 10 kg (or 24% of pre-pregnancy weight) is accepted as a standard for Indian women. Both reproductive (such as foetus, gravid uterus, mammogenesis, liquor amnii) and metabolic factors (such as increased water retention, blood volume, fat synthesis) contribute to this weight gain6. During puerparium, such gained weight is shed gradually though; a part of it is generally retained.
Reviewing the weight gain and weight loss patterns during pregnancy and puerparium, Crowell7 suggests that, lactation seems to have largest effect on weight loss between 2.5 – 6 m during postpartum. Immediately after delivery, a weight loss between 4.5 and 5.8 kg is usually expected and this attributed to expulsion uterine contents. On day – 3, weight gain most often is recouped partly – due to increase of adreno-cortical hormone and arginine vasopressin associated with stress of labor and this also is a transient phenomenon. On an average, only 28% of women tend to return to their pre-pregnancy status of body weight. Women having an average weight gain during pregnancy will retain about 1 kg after the birth of each child. Such postnatal retention of weight goes proportionately with the weight gain during pregnancy. On the contrary, nutritional status during lactation has a negative bearing – which takes the woman towards negative scale if, there is a gap between lactational demand and supplies of nutrition. About the Author:
Author, Dr. Preeti Kachroo Bhagat, (BAMS , MD (AM), CFN) is a renowned Ayurvedic Physician. With an expertise in the field of ayurveda research and development.
Also visit:- http://preetikachroo.8m.com
Contact mail:- ayurvedoconline@rediffmail.com
Dr. Abhishek Bhagat, (MBBS), the second author of article is a research scientist who has spent considerable amount of time refining his knowledge on various health subjects.
Contact mail:- docmail@rediffmail.com
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