Planning To Conceive
1. Should we visit the gynaecologist as soon as we test positive for pregnancy or should we wait for a few more weeks so that the fetus is more visible in the ultrasound?
You should go visit your doctor as soon as you know you’re pregnant. We advise you to visit your gynaecologist once before you’re pregnant. You should always have a pre-pregnancy checkup. If you haven’t done it or even if you have done it, as soon as you know you’re pregnant, you have to visit once immediately. The doctor may ask you to do the ultrasound later or when feasible after the checkup.
If history suggests, you might have to do an ultrasound immediately. Visiting the doctor soon has many advantages as many tests can be done. If a pregnant mother arrives late, then sometimes it can already be too late for certain conditions to be diagnosed and treated.
2. What is the possibility of getting pregnant after the removal of one fallopian tube due to ectopic pregnancy?
Thankfully, we have two pairs of every important organ in the human body. The fallopian tube is one of the most important organs to a woman who wants to conceive so there are two of them. So even if one is removed, it should not be a problem in conceiving the next pregnancy because one is good enough.
However, if one has already gone through an ectopic pregnancy, then the possibility of the next pregnancy being ectopic will increase more in comparison to a normal person. So one can plan their pregnancy, and after getting pregnant, which they usually do, I advise them to consult their gynaecologist and have them examine you thoroughly as it is very important to do so.
3. Can fibroids affect pregnancy? How long should you wait after having fibroid surgery if you’re planning to conceive?
Nowadays, fibroids are very common as women plan their pregnancies a little later in their lives. If the fibroid is small, then it doesn’t affect the pregnancy at all. It is a low-risk pregnancy without any complications.
If the fibroids are big it might be difficult to conceive, and the location of the fibroid also plays a role. If the fibroid is in the inner lining which is also called submucosal fibroid, then it can sometimes affect the conception, and even after conception, there is a higher risk of miscarriage.
Sometimes even if there are no problems during pregnancy; but due to the big fibroids, there are chances of the pregnancy being very painful. There are high chances to go into preterm labour, or difficulty in normal delivery as the path of the fetus might be obstructed due to the fibrosis, there is also a high chance to have cesarean section delivery, and even during C section or delivery, there could be abnormal bleeding.
You should wait for six months after fibroid surgery before you plan a pregnancy.
4. If someone is trying to conceive naturally at 41, then what are the suggestions you would give her? (I am trying to conceive naturally at 41. What are some suggestions that would benefit me?)
Firstly I would suggest she consult a gynaecologist before attempting to conceive, because as age advances, sometimes, the woman can have underlying conditions such as diabetes, thyroid issues, blood pressure issues, heart disease, or any other issues. So she should consult her doctor and find out if all her system organs are normal or not because if there are any underlying issues, then that needs to be treated first.
Second thing is, as you age, women’s chances of getting pregnant or their fertility rate declines. So the same doctor will check her ovarian reserves to see her chances of becoming pregnant easily. So, if her ovarian reserves are good and everything is normal then she can plan her pregnancy, and hopefully, she‘ll conceive spontaneously without any assistance. But, usually what we see for women who are above 40 is her fertility chances would have gone down in a normal situation. So in such cases, she would need some assistance to conceive. The assistance can depend upon her ovarian reserve. Some can be solved by adding ovaries and using in vitro fertilization technique.
Third thing is, once she conceives, she will have to understand that there are certain risks related to pregnancy with advancing maternal age. So even if she was fine before pregnancy, she can develop diabetes, thyroid issues, hypertension, these issues might be seen and can start right after she becomes pregnant. So she should be ready to get the treatment after these issues arise.
Fourth thing is, there are also the risks associated with the baby that is growing in her womb. With advancing maternal age, chances of cases like that of down syndrome become slightly high after 40. So for that, one needs to know what the options are, what kind of testings are needed, what might be the results, what can be done after certain results, all those possibilities and its management should be discussed beforehand.
5. If someone has frozen their eggs at a younger age and plans to conceive after 40, then should they be concerned about similar age-related risks?
As I mentioned before, there are two aspects of age, that is pregnant women may suffer some conditions themselves, and another is, the baby inside the womb may have some issues.
If one has frozen their eggs at a young age then the eggs that have been frozen are very young, it’s a healthy egg. So the risks of down syndrome problems that might occur in the baby will not increase. However, if the mother is already above 40, her systems are old, so she may suffer from hypertension, diabetes, thyroid, and other issues. But her fetus will get the advantage of being a young and healthy egg and will not have other risks. But the mom will not have these advantages and she may have other risks related to age.
6. Can pregnancy cause uterine polyp? Can Uterine polyp be cured without surgery?
No, pregnancy does not usually cause uterine polyp. There is a condition called placental polyp which is a very rare condition. The treatment of uterine polyp is always surgical: that it needs to be removed surgically.
7. I have been trying to conceive on and off for about two years and I am still not able to get pregnant. I am concerned about infertility. What would you suggest I do?
So even after two years, if you’re not able to conceive, then I would suggest you do a fertility workup and all other investigations with both wife and husband to find out the problem. And depending upon the reason why they’re unable to conceive, we have to do the treatment accordingly. If it’s already been two years then they should consult a fertility specialist without delay.
During Pregnancy
1. Most women suffer from pain in the pelvic areas during pregnancy, which makes it hard for them to move around a lot. Is there anything one needs to be concerned about or are these pains normal during pregnancy? What can one do to ease such pain?
During pregnancy, the hormones make the joints and ligaments relaxed; the joints in the pelvic area, are more affected. So moving and changing positions in such a case cause pain in these joints and ligaments. To some extent, these pains are considered normal.
One can ease and reduce such pain by being very active and doing pregnancy exercises by taking help from physiotherapists or yoga instructors. One can learn particular exercises to ease the pain and these exercises can benefit a lot during pregnancy.
However, sometimes there can be severe pain where even exercises cannot help ease the pain. So in those conditions, we advise mothers to take a rest in the position that they’re comfortable in and avoid resting in positions and areas that are painful. At times, we recommend mothers to wear belly and pelvic areas supporting pregnancy belts which can ease a lot of pain.
2. I am 22 weeks pregnant and I get severe leg cramps and calf muscle pain. Are there any solutions to relieve this pain?
During pregnancy, pain in the calf muscles and cramping are very common problems. Again, physical activity is very important. Those who are more physically active experience fewer of these problems during pregnancy.
However, if these crampings and muscle pain occur during exercise, then we advise mothers to do leg stretching exercises for a few minutes before going to bed at night or one can even do oil massages to soothe their pain. Here we can ask their partners to support them and help them to massage their feet which can provide both physical and emotional comfort during pregnancy.
And at times, dietary roles also play an important part. Some women may be having calcium deficiency so they can consult their doctors to increase their calcium dose. One can take a lot of nuts and include other magnesium-rich foods in their diet.
But despite doing everything, sometimes women suffer from severe pain in calf muscles, so we recommend and prescribe some medicines to the mothers. However, we do this only as a last resort and when the pain is very serious. Otherwise, as I said, simple home remedies, massages, and dietary improvements usually will decrease a lot of pain in many cases.
3. Talking about dietary needs, we do hear a lot of people say that bananas are very rich in potassium.
Yes absolutely. And sometimes when we drink a lot of rehydration solutions (Jeewan Jal) and lots of liquids which are packed with electrolytes then it helps to balance the electrolytes of the body. So we do recommend drinking a lot of rehydration solutions during pregnancy especially when the mothers have muscle pain and cramps during pregnancy.
4. A lot of people are concerned if certain foods lead to miscarriage like papaya, pineapples, red and black peppers, mint, etc., is this true or are they just myths?
Those are the most commonly asked questions that we get from pregnant couples. They ask us about what foods they can eat and what foods they have to avoid during pregnancy.
So a lot of concerns about food during pregnancy are myths. These myths usually come from our homes and the history of our society and its culture and people usually get incomplete information on such myths. For example, if you take papayas and pineapples raw, then according to Ayurveda, it can cause contractions in the uterus and there can be a possibility to cause miscarriage. So the myth about papaya causing miscarriage could have stemmed from this information.
But if you take ripe fruits, healthy and organic fruits, even if it’s papayas or pineapples or any fruits, then it will not cause any harm during pregnancy. Similarly, if we talk about mint or any herbs, it will not cause any harm if you’re taking it in small amounts as a seasoning to your food. So these are all myths.
I advise mothers to avoid taking anything raw and uncooked food. And if you are doubtful about any food then avoid eating it.
5. Can mothers take caffeine during pregnancy?
Although this is not a common question, I do advise mothers to limit their tea or coffee intake to a max of one or two cups a day. But it’s even better if you can avoid drinking it entirely.
Green tea is also known as a healthy drink but green tea has more caffeine than regular tea so it is better to avoid green tea. Drinking it too much can affect the baby’s growth and have the possibility to hamper the overall growth of the baby.
6. Can you mention more about hyperpigmentation during pregnancy?
Hyperpigmentation is a big issue during pregnancy. It is because of the hormonal changes in the body, that the hyperpigmentation tendencies increase. The main areas affected by hyperpigmentation during pregnancy is the area around your nipples or areolas, which can get darker, a vertical dark line may appear in the growing belly, the axillary areas, the neck, the genital, pubic, and thighs will also get darker. Many women get hyperpigmentation in their faces as well.
So to ease the hyperpigmentation especially in your face, avoid going out in direct sunlight and use a very good skin moisturizer and sunblock. Usually, many of these skin changes and pigmentation are reversible. After the pregnancy is over, you will get back your colour, it’s not going to be there permanently.
7. What is the most common diagnosis in Kathmandu of pregnant ladies that you made in your career?
By diagnosis, if you mean the underlying medical conditions during pregnancy in Kathmandu then the answer would be Thyroid condition during pregnancy, which is the most common diagnosis during pregnancy.
8. Is it common to have pubic and lower belly pain during pregnancy? I’m in my 35th week and it hurts especially when I get up to turn.
Pain in the lower part of the body, in the pubic area, or joint pain in the hips, are very common during pregnancy. There are so many hormonal changes that are happening in your body as the body is getting ready for the baby to be born. The muscles are relaxed to make way for the baby so having pain during pregnancy is natural. However, if it’s causing a lot of discomforts then we teach them some prenatal exercises which provide some relief to the joint pains. They can also use the tummy supporting belts found in the market. Oil massages will also help to some extent, right posture and diets will also help. Taking adequate calcium supplements along with all mentioned advice will help relieve the pain. But even after doing all these things, sometimes you may not get relief from all the pain so you will have to adjust with some discomfort but do what makes you comfortable and find ways to relieve the pain.
9. I have a high LFT level in 32 weeks. Is there any specific food I must eat?
High LFT levels during pregnancy could be caused due to several reasons, most probably you are having a condition called obstetric cholestasis of pregnancy. This means that your pregnancy hormones are affecting your liver as a result of which your liver enzyme level is high. It has nothing to do with the food that you eat. You can consume a balanced nutritious diet and for the treatment of your condition, you can consult your doctor. You will be prescribed some medicines for your condition.
Postpartum
1. After how many days of delivery should we use the postpartum belt? Are there any specific belts that you can recommend?
There are no specifics that one has to use the belt after a particular time after delivery. But if you do use any abdominal belts after normal or C- section delivery, then it will provide support and help relieve backaches. Traditional abdominal cloth bands which are also known as Patukas in Nepali have their advantages. So the belts that we find in the market now are the fancier versions of those traditional cloth bands. So whichever is comfortable for you, you can use that.
You can use our traditional cloth bands which are made of Muslin (malmal) which can also give you a soothing effect. There are different commercially available postpartum belts that you can try on and use if that’s comfortable for you.
2. After delivery, I have a lot of white vaginal discharge and the colour varies from time to time. Should I be concerned?
If your vagina is itchy, and vaginal discharge has a bad smell or abnormal colour to it, you should consult a gynaecologist.
3. Can you say something about postpartum depression?
Some degree of emotional disturbance is very common during pregnancy and after childbirth. Up to half to two-thirds of the postpartum mothers may suffer from a milder form of these mood changes also commonly known as “baby blues”. Around 10 to 15 per cent of mothers may suffer from more severe symptoms known as postpartum depression. For milder forms like “baby blues”, one does not need medical intervention, but cases of postpartum depression should be managed with the advice of a psychiatrist.
4. When does the regular period start after delivery? I had mine after two months. Is it normal?
The start of a period after childbirth may happen any day between six weeks and one year and sometimes even longer. It is completely normal to have your periods after two months of childbirth.
5. For how long after delivery should moms do an oil massage?
Usually, it is done for six weeks postpartum, that is six weeks from the time of your childbirth, but its benefit is not limited only to the six-week period you can continue to do oil massage if you want.
6. I recently gave birth, and my baby has a tongue and lip tie. I have had issues with breastfeeding pain from also developing breast abscess, would this be related to the tongue and lip tie?
Yes, tongue and lip ties can cause breastfeeding issues and as a result, the mother may suffer from breast abscess.
7. If I haven’t had the chance to visit the doctor due to Covid after having my baby 17 months ago, do I need to be concerned?
Normally, in the postpartum period, there are visits after one week of delivery, and there are visits after 6 weeks or 45 days of delivery. So usually we schedule these two visits after delivery. And they both have their reasons.
In the first week, in the normal delivery, the mothers usually have many stitches in the perineum, so to check the wounds and how they’re healing, to check if the mother can breastfeed or not, to check if they’re doing okay because this is also the period where the mothers are more prone to getting postpartum depression, so we would want to talk to them and see how they’re feeling and to check if they need any assistance. So a one-week visit is recommended.
And another is a 6 week or 45 days visit where usually, it’s also the vaccination time of the baby and in the same visit, we also recommend them to visit the paediatrician and ask them to go to the vaccination centre as well. And we also ask them to visit the gynaecologist where we examine her uterus which expands during pregnancy and we check whether it has come back to a normal size or not. We also check to see if there are any infections in her genital organs or if she’s bleeding. Along with that, at the same time, we occasionally do a pap smear for cervical cancer screening as well. We offer all these checkups routinely after postpartum.
And at the same time, we also discuss contraception, as usually, the parents get very busy with their baby and other issues that they forget about contraception and sometimes they come with unwanted pregnancy when their baby is small and the mom is pregnant again and it causes a lot of stress to the whole family. So just to avoid all that we talk to them about contraception during this visit. So it’s a very important visit that we suggest to them.
In case, sometimes when they can’t do their routine visits, one should go even if they’re late. They should meet their gynaecologist and discuss all these matters that I just mentioned.
8.Is it true that if we don’t do oil massages after delivery then we will have back pain in the future?
Oil massages are something that has been done for ages in our society. It has a lot of benefits and there are no doubts about that. Oil massages help with postpartum stress and postpartum depression but you also feel like you’re taken care of. And during pregnancy the joints and muscles that got loose and were untoned, oil massages help with that as well. And it also helps to reduce the immediate pain in the body.
However, it’s not true that you’ll get back pains in the future if you don’t do oil massages. So one does not need to worry about that.
If you’re breastfeeding your baby then you need to take enough calcium supplements because usually in the postpartum period when you’re feeding your baby, the demand for calcium increases a lot and due to some reason if you haven’t been supplementing yourself with enough calcium, then, in the long run, backaches can be caused due to that reason.
If you’re not taking care of your posture, or if you gain a lot of weight after postpartum, as some women get fed a lot after postpartum which increases their weight then due to that, the back of their vertebral columns may have problems which can cause backaches.
So if you are taking enough calcium supplements and if you’re taking enough care of your weight gain and if you’re attaining good posture then you shouldn’t be worried about backaches even if you haven’t taken oil massages.
9. Will the stretch marks go away after pregnancy? What can we do to reduce stretch marks?
It’s very common to have stretch marks in pregnancy. And I get asked a lot if they can do something to reduce or avoid stretch marks during pregnancy.
The first thing is, there are so many commercial creams and oils available nowadays that claim to reduce or avoid stretch marks. But different studies have shown that stretch marks depend on one’s body and skin texture. Maybe to some extent, the stretch marks creams will reduce the incidence of stretch marks but it all depends on the body and skin texture as I said.
To reduce stretch marks, there are different creams available but even with no applications of the cream, the red stretch marks will become lighter with time and it will fade away. It will match the skin colour of your body.
However, if you want quick results, as I said before, there are creams available, but for that, we refer them to the dermatologists first as they have many solutions for it and can help them with it. They also offer surgical treatments as well. But as I mentioned before, the mild stretch marks will get lighter with time.
10. When can one resume exercising after C-Section?
So normal exercises like walking, treadmill, aerobics, cardio can be continued after 6 weeks. This applies in normal delivery as well. But ab exercises where you want to reduce your tummy should only be done after 6 months if you’ve undergone C-Section as the wounds might be weak. The extensive and vigorous ab exercises will affect the wound and cause a hernia, also called an incisional hernia where the wound might come apart and can cause complications. So it’s best to wait for 6 months to continue the ab exercises.
11.The area above and below the wound is still very itchy even after 13 months post-C-Section. Is it normal? What is advisable to do in this situation?
Normally, itchiness shouldn’t occur after 13 months post-C-Section. It should be checked as sometimes the scar might have other issues or the skin around the scar might have infections. It’s not normal to itch, so it’s better to get it checked.
12. I took 4 pills within 3 months and now my period is irregular. The difference is I have my period in 15 days as well. Should I take any medication?
Are you talking about emergency contraceptive pills? If so, yes it can cause irregular periods and abnormal bleeding. So, you should consult your doctor regarding the available contraceptive methods which will not cause menstrual irregularities.
Second Baby
1. I am 32 years old and have a four-year-old boy. My husband and I are currently trying for another child. But last year, I had to medically abort due to some issues. It has been 4 months since we are trying on the fertility window but we are still unable to conceive. My blood USG is also normal. Is there any chance that I might have secondary infertility?
Abortion does not cause infertility. Normally, it can take up to six months to one year to conceive. So you shouldn’t worry about it for the time being. Sometimes due to too much worry and stress, the hormonal systems in our body might fluctuate and can cause imbalance, and that can cause some problems to conceive. You can try for a couple of more months without taking much stress. But even after trying, if you’re unable to conceive then you can consult a doctor for a fertility workup as sometimes minor hormonal issues can have some effect on conceiving.
2. Is it safe to carry your 13 kg toddler when you are in your second trimester?
13 kg is on the higher side to carry when in your second trimester. I advise mothers not to carry anything by standing and bending forward to carry heavy objects as it can put a lot of strain on the whole body and can cause some harm to the stomach as well.
If you want to put your child in your lap then maybe you can ask someone to help you to do that, or pick up the baby by first bending in the same level as your child, or if someone gives the baby to you then only carry the baby for some time only, and you can also carry the baby when you’re sitting down or in a sitting position. It is necessary to give love to your toddler but find a way where you’re not hurting the baby inside the womb and you’re taking care of the toddler as well. Quickly carrying the baby is not advisable.
3. What is the ideal gap between the first and second C-Section? Is it risky to have the second C-Section after 2.5 years?
Conventionally, we advise a two-year gap between C-Sections. This applies to normal delivery as well. As the first child is small, they need full care from the mother regarding breastfeeding and other attention, the mother’s body also needs to heal mentally and physically, so two years is a good gap.
However, due to many reasons, some want to conceive quickly and we do get a lot of questions regarding the gap between the two C- Sections. Normally, an 18 months gap between the two C-Sections is good enough.
Recently, I had a delivery where the first baby was just 14 months old when she delivered, meaning she conceived while her child was only five months old. We did a C-section on her which went very well and there were no issues.
So I am not encouraging, but by mistake, if one conceives then you can still continue the pregnancy even if the gap is six months or less than that. However, if the pregnancy is a planned one then it is advisable to have a two-year gap.
Vaccine
1. Can a pregnant woman take Covid vaccines? And is it okay to take vaccines when one is breastfeeding?
Initially, we were asking people not to take vaccines if they are planning to get pregnant, if they are pregnant or if they are breastfeeding. We told people not to take vaccines because it was recommended by WHO because the vaccine was very new and we did not know anything about how it would affect pregnant ladies, who are planning and breastfeeding.
But with time, they have known that it is safe and WHO’s recommendation has changed recently – it says everybody, all women, who are planning for pregnancy, who are pregnant, or who are breastfeeding can take the vaccine. They are more likely to get sick after getting infected and likely to get admitted to ICUs. So, these groups of women should be prioritized for taking Covid vaccinations. I would request all women to go and get vaccinated.
2. Should there be a minimum gap to breastfeed after taking a Covid shot?
No, one does not need to take gaps, the mothers can breastfeed their baby immediately after taking the vaccine.
3. I am a new mom with a 10-day old daughter. Can I take Covid Vaccine? Which one is better for lactating mothers? Vero cell or J&J.
Yes, you should go ahead and take your Covid vaccine as soon as possible as there are no contraindications of this vaccine to breastfeeding mothers. Both Vero cell and J&J vaccines are licensed for their use to breastfeeding mothers. Both vaccines are equally safe for lactating mothers, and you can take whichever is currently available.
Medications
1. For how many months do we use Folvin? Even after taking it for 3 months if we are unable to conceive then should we continue to take it or not?
Folvin is the brand name of the company. We call them folic acids. Normally the folic acids we find in the Nepali market are 5mg. However, nowadays we get good prenatal vitamins that contain many combinations of medicines needed for a healthy pregnancy.
So talking about folic acid, one can take it three months before planning for pregnancy or trying for pregnancy. People trying to conceive will usually get pregnant within 3-4 months. But if it is taking a long time for some, then they should continue taking folic acids. Folic acid is not something that will help you conceive, it will just make your system ready for a healthy pregnancy. Folic acid is not a fertility enhancer medicine, it just makes the system healthier for your baby. If your system lacks folic acid when you conceive then your baby might get abnormalities like neural tube defects. So the levels of folic acid should be balanced in your body when you’re planning for pregnancy.
So if you haven’t conceived and you’re still trying to conceive after 5-6 months then you should continue folic acids until you consult with your doctor on why you’re not able to conceive. Then after the doctor’s suggestion, you may have to continue folic acid for a longer period. And even after conception, we suggest mothers keep taking their folic acids for the first three months. And in fact, small amounts of folic acids are needed throughout the pregnancy. So we suggest they take a higher dose for the first three months then take a lower dose in the form of vitamins or when we start iron because iron also contains a few folic acids, so the lower level of folic acid is needed throughout pregnancy. So there is no harm in continuing folic acids as it is needed in the body, skin, hair and other systems of the body as well. So one should continue taking folic acids till they find a proper solution on why they’re not able to conceive.
2. What are the essential prenatal multivitamins and supplements except for iron and folic acids? Are the essential vitamins including magnesium and others available in the Nepali market as well, as a lot of them can only be found abroad?
Nowadays we get DHA prenatal gummies in the Nepali market. I think it is available online and it is available in a few hospitals as well. It is a very good gummy with orange flavour which contains all the ingredients needed for a healthy pregnancy along with DHA which is Omega. It is easily available in the market and has everything in it except for iron and calcium which can be additionally added. Many people have relatives abroad nowadays and I have seen them importing medicines with their help. Many also use amazon and it turns out they deliver to Nepal too. So there are quite some possibilities available.
3. Should folic acid be taken if we are planning for pregnancy ourselves or only with the doctor’s suggestion? For how long before conceiving it should be consumed and at what dose?
Yes, folic acid should be consumed at least 3 months prior to planning a pregnancy. Consulting a doctor for a preconception checkup is advised. However, if you have not been able to do so at least taking folic acid on your own is also advisable. Folic acid comes in different brand names, mostly in 5 mg doses which can be consumed once a day after your meal.
Consultation Timing Hours
1. What is your consultation timing and where can we get to have consultations with you?
I am available at Nepal Mediciti Hospital, Bhaisipati as a full-time consultant from 10 am to 2 pm every day except for Saturday. To make an appointment, you will have to call the hospital.
Instagram Live Q/A sessions with Expert is a series in which Yomā interviews experts related to various subjects on parenting based on the questions and concerns shared by the Yomā audience. Watch it on our Instagram Live: Yomā on Instagram: “Episode 2: Q/A with Dr. Nira Singh Shrestha, Head of Department of Obstetrics and Gynecology, Nepal Mediciti Hospital”
Writer details:
Nira Singh Shrestha, M.D., obstetrics, and gynaecology, is the Head of the Department of Obstetrics and Gynaecology at Nepal Mediciti Hospital, Bhaisipati. She is a laparoscopic surgeon and has received special training in Advanced Laparoscopy. She is soon introducing the first water birth facility in Nepal.
