How to reduce back pain during and after pregnancy

Back pain after delivery affects up to 50% of women and is a very often overlooked problem. A woman's quality of life can be substantially affected especially during this very stressful period. Prevention is of course better than cure. Awareness that back pain will plague a great many women during and after pregnancy is the first and foremost important step. Why do pregnant women get back pain. Firstly, the hormonal changes in pregnancy affect the mobility of the joints of the spine. As a result the muscles that normally support the spine are in constant use and in overdrive what with the extra weight of the progressing pregnancy. During the labour, there is the added insult to the spinal muscles of the straining and awkward positioning that accompanies the delivery. And after delivery, the lack of sleep and extra work to the back muscles of having to carry the baby in and out of the cot.
Taking pain killers is not the answer and can be dangerous for the babies health when breastfeeding.

How then can one reduce back pain. The following are some suggestions:

1. As mentioned earlier, being aware and conscious of ones back throughout the pregnancy. Making sure that when standing, the centre of gravity is pushed slightly behind. So if one were to draw a straight line it would fall somewhere behind your heel. Of course, avoid using anything with heels! as this will add even more strain to your back. Always keep a straight posture and avoid slouching.
If you have a weak back you may benefit from a a pregnancy support belt.

2. Bend your knees first before lifting anything from the floor, and avoid bending forward to reach for objects at a distance.

3. When sleeping, bend your knees in a flexed position and rest the knees with a bolster behind. Your mattress should be moderately hard and definitely not sagging!. Adjust your pillows and position so that you are comfortable. You may take sometime to find the best position but it is well worthwhile so as to get the best sleep. Lack of sleep and anxiety will aggravate backache.

4. Do some light flexibility excercises as stiffness will always lead to back pain. Try to do some core muscle excercises as well, so that they are strengthened as the pregnancy progresses. The main ones would be the lower abdominals and back muscles. Remember to stretch before and after excercising!.

5. Do go for relaxing back and neck massages as often as you can during and after the pregnancy.

6. If you are to have to sit for long hours, it is best to get hold of a back support for your chair. It is also a good idea to get up and stretch, walk every 20 minutes or so.

7. Labour and delivery can cause a great deal of harm to the spine as the baby goes through your pelvis. It is a known fact that the baby's head may even cause a fracture of the tip of your spine (the coccyx) on it's way out!. Your pelvic bone joints which have been loosened in preparation for the labour will undergo a great deal of stretching and soreness. This will resolve after delivery and should not be too much of a concern. During the labour and delivery one should avoid harsh and sudden movements during labour pains. Having a good pain relief such as an epidural will go a long way to avoiding any such strain on the back. It is of course a fallacy that epidurals will cause back pain.

8. After the delivery, any back pain can be relieved by spinal manipulation. This is best done by an osteopath and  should be instituted as early as possible to avoid future chronic back pain.

Ways To Reduce Preterm Labour/ Delivery

Preterm delivery is the largest cause for perinatal mortality and morbidity amongst newborns, . It is also responsible for a multitude of problems in child development later. How can pregnant women reduce this risk factor then. There are several things that are within your control:

1. Check whether you yourself were premature. If you were,  then you would be at higher risk in your pregnancy. Your obsterician should be made aware of this.

2. Make sure that you are at an ideal weight before you are pregnant. Obesity and a high BMI carries an increased risk of preterm labour. Do not gain excessive weight during your pregnancy.

3. Make sure that if you have any medical condition such as diabetes, high blood pressure or thyroid problems that these are well controlled before pregnancy.

4. Ensure that there is a sufficiently long gap between pregnancies. A gap of at least 6 months would be ideal.

5. Ensure that you are not too stressed, have adequate rest and sleep throughout the pregnancy. Also eat well and nutritiously.

6. Have a checkup early in the pregnancy and have a cervical length measurement done at your first visit with an obstetrician. A short cervical length is associated with a higher chance of preterm labour.

7. If you are at risk of preterm labour your obstetrician should prescribe a hormone, progesterone as early as possible and continue this until the 36th week of your pregnancy.

8. You should have a swab taken at 32 weeks to rule out any vaginal infection which may cause you to have a premature rupture of the membranes.

9. Monitor for signs of impending preterm labour such as frequent painless contractions or bleeding early in the third trimestor. Inform your doctor as soon and early as possible. 

Ways to reduce exposure to toxic chemicals

1. Avoid all processed and canned foods. If possible eat only certified organic products. If not thoroughly wash all vegetables and fruits.

2. For beef and milk products only organic grass fed cows so as to avoid hormones, pesticides and fertilisers.

3. Fish should not be farm raised as they contain higher amounts of contaminants such as mercury and PCBs. Salmon should be Alaskan wild salmon

4. Avoid using chemical based toiletries and cleaning products. Instead choose organic, and earth friendly, animal friendly and non GMO products.

5. Do not use plastic bottles which can cause hormone disruption. Instead choose BPA free ones or glass.

6. Avoid using non stick pans for cooking and instead replace them with ceramic utensils.

5 ways to reduce the chance of miscarriage

1. Start your family as early as possible, the risks increase after 35 and are much higher after 40 years of age mainly due to abnormalities in the foetus.

2. Reduce your contact with all chemicals including hair dyes, lipstick, make-up etc. Reduce consumption of preserved and chemically treated foods.

3. Avoid flying as there is alot of radiation in the atmosphere.

4. Avoid taking any medication, even over the counter medicines such as panadol when trying to get pregnant.

5. Have a check-up with your gynaecologist and if it is suspected that you have an imbalance in your hormones, do a progesterone test as this is the hormone which sustains your pregnancy in your uterus. Ensure that you exclude any inheritable conditions diagnosable by a blood test.

Latest tests for Down's Syndrome and other genetic abnormalities

One of the greatest concerns for a pregnant woman is knowing whether her child will be normal. In this day and age when more women are getting pregnant at a later age especially in Singapore, this is of an even greater concern.
Fortunately, more advances have enabled us to do these tests at an earlier and earlier stage of the pregnancy. We are now able to allay a patient's fears even at 9 weeks of pregnancy!
The latest blood tests which now almost always replace amniocentesis (tapping of the baby's water bag) include the Harmony Test and the Panorama Test. These are non-invasive prenatal tests done as early as 9 weeks. During pregnancy some of the baby's DNA passes into the mother's blood stream. This DNA can be examined through a simple blood test. This is a great test since traditional tests such as amniocentesis or chorionic villus sampling all carry a slight risk of miscarriage. The Panorama test is about 99.5% accurate, however it is still a screening test and if the result comes back as positive the mother will still have to go through an amniocentesis.
The genetic conditions that are tested with the Panorama include Down's Syndrome (T21), Edwards Syndrome (T18), Patau's Syndrome (T13), Certain sex chromosome abnormalities such as Turner's Syndrome, Kleinefelters Syndrome, Triple X, Triploidy. The sex of the baby may also be known if requested.
The greatest drawback to these tests is the cost ranging from S$1500 to S$2000. I would normally advise these tests if the original Oscar test (traditional blood test for Down's Syndrome) comes back as positive or the patient is over 35 years. Of course it can be done for any patient upon request.

Hypothyroidism in Pregnancy

This condition is important to diagnose early in the pregnancy, and ideally before pregnancy begins. Even a mildly underactive thyroid may lead to conditions which affect the baby's brain development. It has been shown that low levels particularly those in the lower 5th percentile may lead to lower IQ's and autism.
Anyone with symptoms or a family history of Hashimoto's Disease ( an autoimmune disorder of the thyroid) should be treated before getting pregnant. I recently had a patient in her early pregnancy with this condition. She had been rightly treated by her GP with replacement therapy. However it is also important to have regular blood tests to monitor the thyroid levels as too high a thyroid hormone level may result in its own set of complications. The best tests would be the T4 and TSH, the latter of which should be kept to <2mIU/ml.
An underactive thyroid may be caused by a lack of iodine in the diet. Selenium taken before pregnancy may help in those who have mild hypothyoidism.

Types of Twin Pregnancies

I recently saw a young lady with no history of twins in the family thoroughly shocked but overjoyed (and maybe overwhelmed) when I told her she had twins. She was in her early pregnancy at 8 weeks. An ultrasound scan showed two distinct waterbags and two foetal echoes with heartbeats. This was a non-identical twin pregnancy which is more common than identical twins. It results from the fertilisation of two separate eggs that is released from the ovary. The incidence of twin pregnancies is 1% of which 2/3rds will be non identical and 1/3rd identical.
 Identical twins result from the splitting of the zygote after the egg and sperm have fused. There are two types of identical twins, one of which has two separate placentas and the other type has one single placenta. The types of identical twins is determined by the time at which cleavage of the zygote takes place. If before 4 days, the dichorionic diamniotic DC DA twin with two placentas is formed. This accounts for 25% identical twins. If between 4 and 8 days, the monochorionic diamniotic MC DA twin with a single placenta forms. This is the most common accounting for 75% identical twins. If cleavage takes place between 8 and 12 days, the monochorionic monamniotic MC MA twin with a single placenta occurs. This rare at less than 1%. Cleavge after 12 days may result in conjoined twins.
The importance of knowing which type of twin pregnancy lies in the complication rates. The MC MA twin unfortunately has an 85% chance of mortality mostly due to cord entanglement. The MC DA and DC DA have complications mainly resulting from twin-twin transfusion, and intra-uterine growth retardation resulting from the stronger twin drawing more nutrition and depriving the other. So as an obstetrician it is not always `joyful' to see a twin pregnancy and we have to be extra vigilant in the obstetric care of the patient.