Pregnancy week 28 wellness guide

Your Body

changes in the body
What to expect
You have entered the third trimester of pregnancy. You may start getting new symptoms, such as nosebleeds and indigestion. Your feet are likely to be swollen, your back is hurting and you get tired easily. Your baby’s kicking keeps you awake at night and worried during the day. It may feel that your baby is constantly restless and that can be annoying. It hasn't been easy.

Baby size

Week 28 baby size
What to expect

Your baby is the size of a Large Eggplant/Aubergine (roughly 36 cms long and nearly 1 Kg in weight)

Your Baby

Pregnancy weekly guide - baby size
What to expect
Your baby’s heart is beating fast (140 beats per minute) but not nearly as fast as in weeks 9-10 (170 bpm). He/she is practising breathing and trying to settle into position for birth. Your baby is probably having dreams now and sticking his/her tongue out to make faces!

Taking care

Pregnancy week 28 wellness guide
Tips
  • It is important that you have your 28 week antenatal appointment. Your doctor is likely to measure your blood pressure, test your urine for protein and discuss the results of any screening tests.
  • Know about harmful infections in pregnancy and learn about the signs of labour.
  • Find out your Rh status and get advice whether you need to take a vaccine-like injection.
  • Use hot water bags and have bed rests if you suffer from sciatica pain - shooting pain, tingling or numbness that starts in your buttocks and goes down the back of your legs.

Ask your doctor

Pregnancy weekly guide - ask your doctor
Questions
  1. I get exhausted very easily. Is that normal?
  2. How can I avoid harmful infections in pregnancy?
  3. Do I need a urine test for protein?
  4. What were the results of my screening test?
  5. What is my blood type? Do I need to take an injection for it?

Your to do list

Pregnancy week 28 wellness guide
Action points
  1. Have blood pressure measured.
  2. Have iron supplement and prenatal vitamins.
  3. Attend week 28 antenatal appointment.
  4. Find out which blood type.
  5. Wash hands regularly with soap and water.

Questions you may have

“I was told having breast cancer during pregnancy especially if you are under 35years is very rare. Apparently, changes that happen to breasts in pregnancy cause them to feel much more lumpy, heavy and firm than what we are used to. If you are concerned about a tender lump talk to your doctor.”

“It’s because of all that extra weight you are having to carry and the strain it puts on your muscles and body. Add to that the shortness of breath you experience!”

Pregnancy week 29 wellness guide

Your Body

changes in the body
What to expect
You may be feeling excited as your due date approaches, or quite nervous! You can get breathless. Sleep is problematic because of leg cramps and needing to go to the toilet frequently. You are also prone to urinary tract infections. You may find it difficult to maintain your balance and stumble. You may also have quite leaky breasts.

Baby size

Pregnancy week 29 wellness guide
What to expect
Your baby is the size of a large Cauliflower (roughly 38 cms and 1.2 Kilos).

Your Baby

Pregnancy weekly guide - baby size
What to expect
Your baby is well formed. He/she is getting fatter and his/her organs are maturing. The bones are hardening and muscles are getting stronger. There is lots of activity and movements. He/she has begun to smile, mainly in sleep.

Taking care

Pregnancy week 29 wellness guide
Tips
  • Avoid standing or sitting for long stretches to avoid varicose veins.
  • Carry on eating high fibre foods to prevent constipation.
  • Know what infections to avoid in pregnancy.
  • Lear and know more about what happens during labour and birth. Learn what happens when you get to the hospital and how you need to be prepared.
  • Talk, talk and talk to share your emotions – you will have a range of feelings and can get quite sad and emotional about loved ones, especially those who have passed away.

Ask your doctor

Pregnancy weekly guide - ask your doctor
Questions
  1. I am very emotional most of the time. What should I do?
  2. Are my baby’s movements’ okay? What should I expect when I go to the hospital to deliver? Are there any injections I need to prevent getting infections in pregnancy?
  3. When I go to the bathroom it burns; I get lower-abdominal pain and dark foul-smelling urine. I don’t feel good. Please help.

Your to do list

Pregnancy week 29 wellness guide
Action points
  1. Find out what injections you need to prevent infections in pregnancy.
  2. Book an antenatal appointment with your doctor.
  3. Discuss and plan with your husband what happens and how to prepare for labour and birth.
  4. Speak to your mother and best friend to talk about how you feel and the emotions you are going through.

Questions you may have

“I was on an emotional rollercoaster! At times I felt excited. Other times I was nervous or both. I also felt sad thinking about my father who had passed away the previous year, especially knowing he would never get to meet my baby. I got advice to talk a lot. So, talk, talk, and talk. Talk to friends, family, your doctor, and discuss anything that's worrying you. That helped me a lot.”

“Chickenpox in pregnancy can be dangerous for both mother and baby. You should talk to your doctor if you never had chicken pox before. CMV is herpes like virus which is quite common especially in children and it can be dangerous for your baby. Washing your hands regularly with soap and water and not sharing food with children can help prevent CMV. There are a few other infections you can find out more about by asking your doctor.”

For pregnant women gender injustice is THE obstacle to wellness.

#genderinequality #maternalhealth #storytelling #digitaldivide

United Nations Population Fund (UNFPA) has released its "State of World Population Report 2020" highlighting the scale and pervasiveness of gender injustice and stereotyping in the world today. The statistics are appalling and makes me at times wonder in despair why we continue to be stuck in medieval attitudes, beliefs and practices in the 21st century.

UNFPA advocates for a world where every woman and girl should be free to chart her own future. That’s a no brainer and why not! Yet, as the report highlights the reality is quite different. Causative factors are detailed in the report, and some of these are that we experience in Kushal day to day and work towards. For example, when we speak to family members of pregnant women, we are often told,

“Why does she have to learn what happens to her body in pregnancy? My mother and aunt live with us. They tell her what to do. They are who should make decisions for her and for us as a couple.”

It’s easy to get upset and react angrily. But to change mindsets of those who hold power and deny bodily autonomy demands patience. It can’t be done by sermonising, which is why we rely on story-telling, an effective tool for social change and by engaging male members of the family.

The report also presents data from 57 countries, stating that only 55 per cent of women aged 15 to 49 years who are married or in a union make their own decisions about sexual relations and the use of contraceptives and reproductive health services (UNFPA, 2020). We have some preliminary data to this affect as well, and continue to monitor so that we can come up with innovative ways and approaches to address gender related barriers.

For those who would like to know more about gender-biased sex selection, Female Genital Cutting and child marriage the report is a good read. However, I would have liked for the report to articulate strongly enough how and why it is essential to also address the digital divide in today’s world. To make a better case for leveraging technology effectively in order to facilitate autonomy, decision making and wellness in women.

You can also read Prof. Maya Unnithan's commentary who heads Centre for Cultures of Reproduction, Technologies and Health (CORTH) at Sussex University. She concludes by pointing out,

"Although rights have arrived, justice has not followed!"

"Men as husbands, fathers, policymakers, healthcare providers need to use their privilege to redress gender discrimination for greater social justice."

Training frontline workers on COVID

We have been getting requests for COVID -19 Training for frontline workers nearly everyday. That is not surprising.

Pregnant women in urban slum and rural communities are facing unexpected hardship because of COVID -19. The antenatal support provided through Government of India's Janani Sishu Suraksha Karyakram programme in Andhra Pradesh has come to a standstill as Anganwadi Centres (AWCs) have had to be closed because of the COVID - 19 related lockdown.

The closure has not only meant that services such as routine checkups, educational sessions, peer support and distribution of food has been affected. It has also compounded pregnancy related anxiety. In such circumstances, front line community health workers, that is, ASHA and AWC workers who are from the communities too feel helpless and despondent that they are not able to do more.

Most of these frontline champions have been reassigned to COVID related general awareness raising duties. However, there remains a huge gap in knowledge and information in relation to pregnancy at the time of the COVID-19 pandemic.

We keep getting requests from our frontline colleagues for information and training on pregnancy and COVID - 19. In response, we have developed a one hour training session curriculum which helps community health workers answer questions and give advice on antenatal issues in relation to COVID. The training will equip them to reach out and advice and support pregnant women with wellness and allay anxiety.

To know more about the training curriculum you can view the deck here.

COVID – 19 and pregnancy related anxiety

20 July 2020

Pregnancy related anxiety has shot up because of COVID and needs to be recognised and addressed.

The number of people with COVID – 19 continues to spike in India. The Hindu (www.thehindu.com) reports that the number of people who have tested positive for the coronavirus has been nearly 2000 a day for three days straight. The Health Department has confirmed 408 COVID – 19 related deaths so far in the state. Krishna district where Kushal is present has been hit hardest with a 3.17% death rate. Not surprisingly, COVID - 19 anxiety in pregnancy has sky rocketed in Andhra Pradesh.

Communities in Andhra Pradesh are concerned. In ordinary circumstances, perinatal mood and anxiety disorders are among the most common complications that occur in pregnancy or in the first 12 months after delivery (The American College of Gynaecologists and Obstetricians). And these are unprecedented times.

Our beneficiaries are worried, and there is little recourse to advise and comfort because of strict lockdown being enforced.  Antenatal services have been stripped resulting in limited access to information and education. Kushal India is proactively filling the gap by responding to requests with urgency and using digital technologies to surpass these barriers.

Poorer communities are affected the most. All Anganwadi Centres in the state where women from disadvantaged communities generally access government antenatal services have been shut down. We are supporting the local health department to reach out to 700 pregnant women who are linked to urban health centres on their mobile phones with counselling and befriending sessions.

A difficult question colleagues working in the front line are increasingly facing these days is -

“Amma, if I get infected, can I pass the coronavirus to my unborn baby? Will that lead to my child having problems or deformities in the future? My mother-in-law has suggested that I should terminate my pregnancy.”

Difficulty in accessing reliable information and having to take recourse on attention grabbing headlines in the media has spread misinformation and consequently led to fear and panic in communities. Most of our beneficiaries are first time pregnant and young. To have to be under pressure to resort to termination because of myths and misinformation is unfortunate.

We make sure to advise women –

  • The COVID-19 pandemic is a rapidly evolving situation and each day scientists and researchers are learning more on how to prevent and mitigate the impact of the virus. New information comes out nearly each day and at times can contradict previous knowledge. So, it is important to remain updated on information.
  • However, it is crucial that you seek information from reliable and reputable sources, for e.g. WHO, UNICEF and the National Health Mission.
  • If you come across a piece of information in the media and especially social media such as YouTube that makes you curious or worries you, please verify that information from reliable and authentic sources. Do not act on a single source of information.
  • Do not be hasty in taking actions or decisions. Verify your doubts. Consult your doctor first.

To read more about our activities, please click here.

Pregnancy week 39 wellness guide

Week 39

Your body

changes in the body
What to expect

You feel increased pressure in your lower abdomen and may have severe back pain. On the other hand you could also have bursts of energy. There is likely to be a lot of vaginal discharge. If there is a small blob of mucus, it is likely to be 'show'. It is natural to feel anxious - when am I going to deliver?

Baby size

Honeydew melon - Week 39 size guide
What to expect
Your baby is about the size of a large green watermelon - approximately 48 cm long and weighs 3 kilos.

Your baby

Pregnancy weekly guide - baby size
What to expect
Your baby is full term – Congratulations! Baby has acquired birth weight and length and does not grow anymore. However, the nervous system and brain continues to develop rapidly. Baby even has eyelashes!

Taking care

Pregnancy week 39 wellness guide
Tips
Look out for signs of labour, such as -
  • Breaking of water or rupture of the membranes
  • Diarrhoea or nausea, which many women experience just before the onset of labour
  • Spurts of energy or nesting instinct
  • "Show", that is, the loss of the mucous plug (which seals the opening of the uterus)
  • Bloody show - streaks of blood
At this stage -
  • Keep track of foetal movements.
  • Learn how to differentiate between Braxton Hicks and labour contractions.
  • Keep practising relaxation and breathing techniques.
  • You may be advised (very likely in India) induction of labour by your doctor. In many other countries, doctors advise this procedure after 40 weeks.

Ask your doctor

Pregnancy weekly guide - ask your doctor
Questions you may have
  1. I feel contractions. Are these labour pains? When do I need to go into hospital?
  2. What are the emergency signs I should look out for?
  3. How painful is labour!? Can I take medication for the pain?
  4. Is it okay to eat or drink during labour?
  5. Do I have to stay in the hospital? How many days will that be? Can somebody from my family be with me in the hospital?
  6. What do I need to bring to the hospital for my baby?

Your to do list

Pregnancy week 39 wellness guide
Actions
  1. Keep track of baby's movements
  2. Practice relaxation and breathing techniques
  3. Monitor contractions, foetal movements and level of pain
  4. Keep your hospital bag ready and close to the front door.
  5. Keep emergency and important phone numbers at hand.

Questions you may have

“All new mothers are offered a thorough physical examination for their baby within 72 hours of giving birth. The aim is to spot any problems early so that treatment can be started as soon as possible. Usually, nothing of concern is found. I know that my son’s eyes, heart, hips and testicles were examined.”

“I was frightened of going to the toilet at first because of the burning sensation! I then drank a lot of water and the stinging sensation I was feeling went. I was also constipated for the first few days.

There was some bleeding from my vagina. It was heavy at first and took a few weeks to decrease. The discharge turned brownish before stopping. I also got stomach cramps similar to period pains. I had a normal delivery and did not need stitches because I did not need to have an episiotomy."

Pregnancy week 38 wellness guide

Your body

changes in the body
What to expect
Are you having sleepless nights, a little anxiety and leaking breasts. That is not uncommon. You could also be having diarrhoea. It can be boring and you may be frustrated – you have waited for so long and can’t wait any longer for the big day! Rest assured, your body is preparing for the big day just as your baby is – the cervix (opening of the uterus) is dilating. There’s a chance you might meet your baby this week! Most women go into labour between 38 and 42 weeks.

Baby size

Pregnancy week 38 wellness guide
What to expect
Your baby is the size of a small Watermelon (roughly 48 cms and about 2.8 Kilos).

Your baby

Pregnancy weekly guide - baby size
What to expect
Baby is preparing for birth and is ready to cry! His or her vocal chords have developed. Some  small but important changes like fine tuning of the nervous system are taking place. Baby has swallowed some amniotic fluid (the fluid in the sac) and that will be his or her first bowel movement.

Taking care

Pregnancy week 38 wellness guide
Tips
  • Call your doctor or hospital at any time if you have worries about your baby, such as,  your baby’s movements.
  • You need not worry too much about going past the due date. Only about 5% of babies are born on their due date.
  • Your mind must be racing with many thoughts and you may be not be able to sleep. Read a magazine or do something that you find relaxing.
  • Wear loose clothing that keeps you cool and comfortable.
  • Go for a walk – gentle and easy without straining your ankles or knees. A gentle walk can help your baby get into position.
  • Practise meditation and relaxation techniques to help you cope with pain during labour.
  • Staying rested, relaxed and positive will help you.

Ask your doctor

Pregnancy weekly guide - ask your doctor
Questions
  1. Is it okay that my water hasn't broken as yet?
  2. I have high blood pressure. What are the risks I or my baby can have during or just after delivery?
  3. What happens if I go beyond 40 weeks of pregnancy?
  4. What is a caesarean section?

Your to do list

Pregnancy week 38 wellness guide
Actions
  1. Check and count foetal kicks.
  2. Double check hospital bag is ready.
  3. Have folic acid supplement and prenatal vitamins.
  4. Book antenatal appointment with doctor.
  5. List who needs to be contacted to inform that baby has arrived.
  6. Find out the hospital layout -entrance to labour room and which entrance to use after hours.

Questions you may have

“ At this stage, loose bowel movement is nature’s way of making enough room for baby to emerge. After months of feeling constipated it's just the opposite now! Your baby could be born any day! At this point I was asked to drink lots of water and eat lightly.”

“Swollen feet or oedema affects about 75% of pregnant women and usually starts around week 22 to 27 of pregnancy and stays until birth. Mild swelling is harmless and normal. However, if there is excessive and persistent swelling and your blood pressure has gone high contact your doctor immediately.”

Pregnancy week 37 wellness guide

Your body

changes in the body
What to expect
You may notice your breasts leaking some fluid. This is normal. You are also likely to be getting a lot of vaginal discharge. You feel emotional – you have done well and the big moment is to arrive.  Congratulations! Your baby is ready to be born. You may have to wait though as baby may take a few more days or weeks to appear. If this is not your first pregnancy, your baby may not move down until labour. In case you are carrying twins you are likely to give birth this week.

Baby size

Pregnancy week 37 wellness guide
What to expect
Your baby is the size of a Jackfruit (about 47 cms long and 2.8 Kilos in weight)

Your baby

Pregnancy weekly guide - baby size
What to expect
Baby is likely to be head down facing your back. 95% of babies are in this position. Baby is also practising facial expressions, such as frowning, smiling  and silent crying. Not to worry, this is not related to sadness or happiness! He or she is now big enough and mature enough to survive the outside world. Baby could come into the world any day!

Taking care

Pregnancy week 37 wellness guide
Tips
  • Know the signs that labour may be starting.
  • Know when to go to the hospital.
  • When you're sitting down, try leaning forwards, with your hips above your knees. It's a technique some say can help a baby get into position.
  • Don’t stop drinking water – 8 glasses a day.
  • There are many daily routine things you might be worrying about. Ask a family member to help keep track with you.
  • Establish a routine if you have been advised bed rest. It makes it easier for you and have magazines, books, your phone and the TV remote at arm’s length!
  • Don’t get annoyed if people keep reminding you that you won’t be sleeping well for a long time! They are just trying to be helpful!! You will be getting a lot of personal advice.
  • Learn more about what happens on labour day – this will help you to deal with terrifying thoughts that you may have.

Ask your doctor

Pregnancy weekly guide - ask your doctor
Questions to ask
  1. What position is my baby in? Is my baby okay?
  2. What are the signs of labour?
  3. I am feeling quite anxious. What do I do?
  4. What are my options for pain relief during birth?
  5. Do I need another scan?

Your to do list

Pregnancy week 37 wellness guide
Actions
  1. Make sure of the travel arrangements to get to the hospital.
  2. Have all important telephone numbers in one place and at hand.
  3. Get baby’s items ready – clothing and bedding.
  4. Book appointment with doctor.
  5. Talk about labour and birth with your husband or partner and ask for the kind of support that you would like to get.

Questions you may have

“There are several signs that labour might be starting – contractions, ‘show’ that is when a mucus plug comes away, your waters breaking and a lot of back ache. Most women go into labour within 24 hours of their water breaking.”

“The majority of women don't have an episiotomy. In the early days it was quite common practise believing that it could make delivery easier or to prevent tearing during delivery.

In some cases surgical cuts are necessary, such as, if your baby's heart rate drops and birthing needs to be hurried."

Pregnancy week 36 wellness guide

Your body

changes in the body
What to expect
You are getting aware of the tightening sensations or Braxton Hicks contractions that keep coming. You may not feel like going to your antenatal appointment because it’s such an effort, but make sure you do as it is very important! At your antenatal appointment your doctor will check on your blood pressure, urine, and the size of your bump. You must be wondering or even anxious about what will happen on the day of delivery. Find out from your doctor! Interestingly, you might feel this urgent need to keep everything tidy, organise the house and clean up. Its normal feelings in preparation for baby to arrive. But don’t overdo it!

Baby size

Pregnancy week 36 wellness guide
What to expect
Your baby is the length of Lettuce leaves (roughly 46 cms long and nearly 2.5 Kg in weight)

Your baby

Pregnancy weekly guide - baby size
What to expect
Baby’s digestive system is fully formed. He or she can suck and digest your breast milk. Baby’s lungs are also fully formed and ready to take the first breath of air. Your baby’s ears are extra sharp and he or she has started recognising your voice and the songs you sing. Overall, your baby’s growth has started slowing down. Baby looks like an infant with puffy ankles and chubby little legs!

Taking care

Pregnancy week 36 wellness guide
Tips
  • Make sure you attend your antenatal appointment with your doctor.
  • Do some pelvic exercises and keep your hips elevated to help with lower back pain. You can also apply warm compress to your lower back.
  • Take frequent rests between doing domestic chores and as many naps as you can in preparation for the big day.
  • Recognise the signs of labour. Contractions becoming longer, stronger and more frequent can be a sign that labour is starting. When contractions are a regular pattern, coming every 5 minutes and lasting at least 60 seconds, it’s time to go to the hospital!

Ask your doctor

Pregnancy weekly guide - ask your doctor
Questions to ask
  1. What are the signs of early labour?
  2. Is my baby in the right position?
  3. Do I need to have a Vitamin K injection just after giving birth?
  4. I get contractions. Am I going into labour?
  5. What are my options for pain relief during pregnancy?
  6. What can I do in preparation so that I can breast feed?

Your to do list

Pregnancy week 36 wellness guide
Actions
  1. Take your iron supplement and prenatal vitamins.
  2. Book an antenatal appointment with your doctor and visit your doctor with a family member for your antenatal appointment.
  3.  Find out about breast feeding from your doctor.
  4. Check if your hospital bag is packed and ready.

Questions you may have

“It’s a myth that nursing comes naturally to mothers at birth! You need to know how to position baby, how to know if baby is getting enough milk and when the next meal is due. There is a bit of trial and error. When you first deliver, you will be producing colostrum, which is a thick, yellowy fluid full of vitamins, proteins and minerals to help your baby ward off harmful bacteria and infections. Doctors will advise that you feed your baby colostrum within the first hour of delivery. Ask your doctor more about
breast feeding. ”

“Antenatal classes help expecting mothers and their husbands with relevant information in relation to keeping healthy during pregnancy, what is best for your baby, how to prepare for birth and to explore any fears that women may have around labour and birth. The information helps you make right choices for you and you also get to meet other expecting mothers and couples.”

Pregnancy week 35 wellness guide

Your body

changes in the body
What to expect
You are nearing your term. However, labour starting before 37 weeks is considered premature and baby will need special care in a hospital. You would have started discharging colostrum (first milk, which is yellowish) in preparation for your baby. Colostrum is important for your baby’s protection against infections. Physically, you could be achy especially with sore ribs and getting severe headaches. Also, wanting to go to the bathroom comes with a feeling of urgency!

Baby size

Pregnancy week 35 wellness guide
What to expect
Your baby is as big as a Watermelon (roughly 45 cms long and 2.2 Kilos in weight)

Your baby

Pregnancy weekly guide - baby size
What to expect
Baby’s skinny arms and legs have got plump. She/he has little space but movements still take place, which you may be able to see. Legs are likely to be curled up. Baby is continuing to gain weight and will do so until delivery day. At this stage, baby’s brain is developing rapidly.

Taking care

Pregnancy week 35 wellness guide
Tips
  • You need to slow down now – reduce stress and do not over exert yourself.
  • Lean forwards to completely empty your bladder as much as possible.
  • Practice your pelvic muscle exercises.
  • Step out of the room to get fresh air if it feels stuffy. This can help prevent a throbbing headache.
  • Call your doctor if you notice any significant change in your baby’s movements.
  • Let your doctor know if you are feeling anxious or depressed.
  • Share with your husband or close family members what you would like during birth. Your loved one staying with you and beside you when in labour will be a big support.

Ask your doctor

Pregnancy weekly guide - ask your doctor
Questions to ask
  1. Do I need a whooping cough injection?
  2. When should I have contraception in place?
  3. How can I prepare for delivery?
  4. When should I go to the hospital?
  5. Is my baby’s position okay?

Your to do list

Pregnancy week 35 wellness guide
Actions
  1. Monitor facial swelling.
  2. Get weight checked and assessed.
  3. Have folic acid supplement and prenatal vitamins.
  4. Book antenatal appointment with doctor.
  5. Learn what to do first few days of breast feeding.

Questions you may have

“A plan that lists which hospital you want to give birth in, who you want to be with you during the birth, and what facilities you'd like to use. You can also ask your doctor what options you have for pain relief, what positions you could give birth in and then decide. In countries with higher chances of maternal mortality WHO strongly recommends hospital delivery.”

“You are having to make and go through many changes during pregnancy for your little one. Your husband can be supportive by also making adjustments alongside you. For example, to quit smoking and drinking alcohol, be more aware of what happens during pregnancy, go to antenatal classes like the Kushal wellbeing workshops and plan for the day of delivery, such as, arranging transport.”