|HEALTH TRIBUNE||Wednesday, March 19, 2003, Chandigarh, India|
problems during pregnancy & lactation
is unavoidable but manageable
In today’s world stress is inevitable. An imbalance between the demands of one’s environment and one’s capabilities results in stress. In fact, it is the distress which causes the problem and can be defined as every physical and mental tension that we experience as unpleasant.
The environment today is more demanding. From childhood to young age and latter, the development of capacities and capabilities of a person is not able to keep pace with the increase of demands on him. The gap in most cases goes on widening. The long queues and congregations in mandirs, gurdwaras, churches and mosques in some way or the other are related to this imbalance. We go there to pray to almighty to perform the balancing act.
One, however, should not be under the impression that stress in any amount of form is bad. In fact, some amount of stress is good to bring out the best potential of an individual. It is important to learn to manage stress and keep it under control.
Stress analysis: According to the principles of thermodynamics, whenever there is an action a reaction is bound to occur. The reaction may look good or bad according to the state of one’s mind.
Of the same event, reactions are different and the outcome different. Epietetus in 60 A.D. said, "Men are not disturbed by things, but the views, they take of them". It is important to note that a positive frame of mind keeps a person cheerful and unstressed.
Causes of stress: The most common causes of stress are anger, greed, attachment, desires, ego, jealousy and fear. Corruption of deed like character or conduct, thought and interpersonal dealing is another cause of stress. An environment where ethics has little or scant regard, self-interest is more important, under cutting and backbiting are a common feature and sadistic pleasure gives satisfaction, is conducive to stress development.
Response to stress: The physical response to stress involves three systems: the autonomic nervous system, the endocrine system and the muscular system.
The nervous system consisting of the brain, spinal cord and nerves regulates all other systems functioning in the human body. It has two distinct parts: voluntary and involuntary. Most of the ordinary functions of the body like walking, eating, singing, etc, are voluntary. The involuntary part controls the vital functions like respiration, circulation, digestion, etc. The involuntary part is known as autonomic nervous system.
The muscular system: During the periods of stress, there is an increased tension in the skeletal muscles. This is manifested in the form of generalised body pains, specially in the neck and the back. The environment is not under our control but we play an important role in responding to it.
Result: Health has a lot of bearing on stress. The result of continuous stress shows one or more of the following diseases at a young age of 30 to 40 years: Obesity, stomach ulcers, chronic digestive problems, asthma, diabetes, insomnia, hypertension, cardiac problems, spondylitis.
Stress management: Stress probably cannot be avoided. It can, however, be managed. The following actions may help reduce/eliminate the stress.
1. First one has to be aware of the stress and has to try to let it go. Sharing your tension with a friend and/or a family member may solve the problem to a great extent. You cannot wish away the problem by non-acknowledgement/ acceptance.
2. Movement helps in reducing tension which means walking, jumping, making noise, swimming and playing. Researchers have found that stress accumulates on the joints in the body and the movement helps to dissipate it. Rotation of the neck and shoulders in many cases helps a lot. In Japan many corporates have established stress-relieving chambers where employees may shout, screams or hit a hanging pillow to relieve tension.
3. Yoga is different from exercise, though it includes it. It is a way of life. Regular practice of Pavanmuktasana series, surya namaskar and shavasan not only tones up the joints but also increases the tolerance level of stress.
4. A hobby is a great help in relieving tension. You are able to successfully divert your mind from an unpleasant occurrence by a hobby like music, painting, cooking, surfing Internet or any such thing. Playing with your pet for sometimes may help relieve your tension.
5. Breathing is one of the easiest ways of stress relieving. Whenever you feel tension, the breath becomes shallow. Take a few deep breaths and feel the difference. Try to feel the breath flowing through the tense spots.
6. Imagination: Close your eyes and visualise a happy and favourable situation. It is different from daydreaming. You may do imagination before and/or after stressful situation. Imagination is today widely adopted by players and athletes for improving their performance. After a stressful encounter, coolly sit in your chair, close your eyes and visualise the episode as an act of an ignorant person and excuse him for the incident.
7. Positive self-suggestion. Take out negative thoughts stored since childhood.
8. Progressive deep relaxation: Stretch the body part by part and relax. (Any posture preferably shavasana) Lie on a piece of close on a level surface, head straight, face upwards, arms spread about 45 degrees to the body, palms upwards, fingers slightly bent and feet apart. Loosen the body parts. Now stretch the body parts one by one from toe to head and let the part relax. A little bit of practice will help understand the method. It is possible to do this exercise sitting in a chair. Yogic nidra is another good method of relaxation. In yog nidra, the idea is not to sleep, but to relax the body part by part without stretching. You have to bring your awareness on each and every part one by one and relax. After some practice one feels a very relaxing sensation in the body parts and the whole of the body.
9. Meditation: Sit in a comfortable posture, preferably padmasana or sidhasana. Do Om kirya three times or take three deep breaths. Visualise your body parts from toe to head, especially the joints, and relax them. Repeat the process two to three times so that the body is completely relaxed. Quietly visualise the flow of breath. Imagine that you are inhaling fresh air, which is red in colour and exhaling toxins, which are of blue colour. A practice of this type of meditation will freshen you up. This can be performed any time of the day. It is better to do this with light stomach.
The above mentioned methods of relieving/managing stress are not sequential.
As stress is related to the environment and the tolerance capacity of different people is different, each individual has to settle for his own method for managing his day-to-day problem of this kind.
It should be clearly understood that a person is himself responsible for any of his health problems and he is capable of scoring over it by his actions. He may take any outside help, including medical, for it, but it is his own efforts and will power which will ultimately grant him the boon.
problems during pregnancy & lactation
Profound changes occur in the maternal breast during pregnancy to prepare it for infant nurturing. These include an increase in the breast size and weight beginning in the first trimester. By the end of the gestation period breast weight doubles and the mammary blood flow increases by almost 200 per cent. Colostrum is produced before delivery in small amounts, significant milk production begins two to five days after delivery. Stimulated by sucking, lactation continues virtually indefinitely until milk is no longer regularly removed from the breast. Milk production falls rapidly when nursing and mechanical removal of milk are stopped. Involution of the breast follows rapidly after the end of lactation.
Pregnant women may develop any of the breast problems seen in non-pregnant female population. Certain problems are unique to pregnancy. The physiological changes associated with pregnancy make the evaluation of the breast difficult and serial examinations are critical. A baseline breast examination at the time of the first obstetrical visit is critical as later on it becomes difficult to detect a small lesion. Cancer of the breast during pregnancy is sometimes misdiagnosed as a breast abscess. The difficulty in palpating lumps and a reluctance to perform a biopsy contribute to prolonged delays. Increased vascularity of the breast predisposes to bleeding and haematoma formation; thus careful control of bleeding is extremely important. This problem is less with fine needle aspiration biopsy. If biopsy is done in the post-partum period, lactation should be suppressed. If surgery is performed while breast feeding continues, an increased incidence of breast abscess and milk fistula will occur.
The most common problems fall into a spectrum of infection-related complications from milk stasis to frank abscess formation, nipple discharge, massive breast enlargement, and tumours (simple and cancer).
Cracked nipple is not an uncommon condition and results from the lack of care in the preparation for lactation and neglect of the hygiene of the nipple during lactation. Its importance lies in the fact that it may lead to inflammation of the breast. During the last two months of pregnancy, the nipples should be washed and dried, and the same routine continued after suckling. At the first sign of soreness the nipple is rested for 24 to 48 hours and the breast emptied with a breast pump. The nipple is washed and a mild antiseptic cream is applied. When the soreness ceases, normal feeding is gradually resumed.
Occasionally, bloody nipple discharge occurs during the second or third trimester of pregnancy. The condition is normally self-limited. The treatment is observation and reassurance. If the discharge persists even after delivery, further investigations are undertaken.
Benign tumours: Fibroadenomas are easy to recognise as they are well demarcated, smooth, and mobile. During pregnancy the often increase in size, become painful and may be confused with cancer. Excision is required to confirm the diagnosis. Because of this, the removal of a lump in the breast is advised prior to pregnancy.
Breast cancer: Approximately 1 to 2 per cent of breast cancer cases are diagnosed during pregnancy. Careful serial examination is still the cornerstone of detection. A high index of suspicion and the willingness to aspirate or excise suspicious masses remain the best approach. Surgical treatment should proceed without delay. Allowing the pregnancy to progress to foetal viability has not been shown to be beneficial to the mother of foetus. When cancer is diagnosed near term, delivery may be accomplished prior to surgery. Locally advanced malignancy diagnosed very early in pregnancy may justify therapeutic abortion. Other factors which need to be considered before contemplating pregnancy termination include the ability of the patient and the family to cope with dual demands of a new-born infant and the possible ongoing therapy for cancer.
Normal changes in pregnancy make the evaluation of the breast difficult. Serial examinations are critical. The majority of breast lesions encountered during pregnancy are benign. The mortality of breast cancer during pregnancy is related to a delay in diagnosis.