The right time

www.maya.com.bd

When is the time right? Haven't we as girls wondered what age is the perfect age for motherhood? The answer to this question might not be as simple.

We'll look into two aspects of motherhood and what should help you decide if you are ready for it or not. The first and most obvious thing to think about is age. The second aspect that you should think about is how you can have a healthy pregnancy with diabetes, hypertension and any other problems you may already have.

If you have a child in your 20s, the benefits are many. That is why it is usually recommended by doctors and elderly relatives alike that you should have your first child when you're around 25 or 26. Your body is more supple and you are at your healthiest when you are in your 20s. You also have more energy in your 20s which means you will be able to better deal with the pressures of childcare as well as child chores once the baby comes.

Unfortunately most women have their first child when they are 17 or 18 in Bangladesh when they are children themselves and this practice should be discouraged. When women have their children very early, they tend to get pregnant quite quickly after the first time. This increases the possibility of suffering from malnutrition and anemia. Having children when you are younger also puts you at a higher risk of developing cervical cancer. Having a child when you are very young may mean you may have to miss out on an education or a career or you may get these things later than your friends. It may be harder to deal with the responsibilities of parenthood. Women who have children young also have a higher risk of postpartum depression.

More women are opting to delay motherhood to when they are 30 or above. With the advent of dependable birth control, good quality care during and after pregnancy, efficient neonatal intensive care units and fertility treatments in Dhaka, having your first child at 35 isn't considered impossible anymore!

Women in their 30s are more likely to have achieved their goals and reached a certain point in their careers where they can afford to take the time off for child rearing. They are more willing to make the sacrifices that mothers have to make for taking care of their children. They do not feel like they are missing out on life like their younger counterparts. Also the financial stability, education and emotional well being helps them be better mothers.

However, delaying pregnancy has its risks. It becomes harder to conceive. Many women require fertility treatment and some even require procedures like “in vitro fertilisation” or IVF.

Major risks for older mothers include miscarriage, ectopic pregnancy and spontaneous bleeding. Mothers over 35 or 40 have a higher risk of having children with chromosomal abnormalities like Down's Syndrome. There is a higher risk of stillbirth. This is because the eggs (ovum) in a woman's uterus have been around for longer and had more exposure to radiation and toxins.

But there's hope.  Options like embryo and egg freezing, IVF and artificial insemination are available in sophisticated health care centers in Dhaka today. Though they are expensive options, techniques like these  are helping many mothers who have been unable to have children during their earlier years, experience motherhood when they are ready to do so.

Advice for older mothers or those who plan to have their children later in life is to keep the body young.  It is really important to exercise regularly. Eat nutritious food like fruits and vegetables that are packed with antioxidants and vitamins. If you drink, then practice moderation and if you smoke, stop now!

If you have existing health problems...
Being overweight and pregnant
Being overweight when you are trying for a baby puts you and your future baby at an increased risk. Firstly, when you are overweight, it is harder to conceive. Once you are pregnant, you are at a higher risk of developing  pregnancy diabetes and pre-eclampsia in comparison to women with normal weight. They also have a higher risk of miscarriages and post Caesarean wound infection. Another problem overweight women have are babies with unusually high body weight so they have delayed deliveries or those that require induction or Caesarean section.

The solution to this problem is to lose weight before you try to get pregnant and maintain a healthy BMI during pregnancy. You should know what foods to avoid and you should try to go swimming and walking which are exercises good for any woman irrespective of whether she is pregnant or not.

High blood pressure and pregnancy
If you have hypertension before you conceive you will need to continue your medications but your prescriptions may change once you conceive. It is advised to keep the blood pressure down before you conceive. Some drugs are not suited to pregnancy and you may need to see your doctor so that you can be given a drug that suits you. It is important to keep your blood pressure under control during your pregnancy for your health and your baby's.

During pregnancy, there is a probability of developing high blood pressure. If your high blood pressure is associated with symptoms like fluid retention (resulting in swelling of legs and face) and presence of protein in your urine you may have a condition known as pre-eclampsia. Woman with pre-eclampsia can develop danger signs like blurry vision, headaches and flashing of bright lights in front of the eyes. This can build up to convulsions which may threaten the life of the mother and child. Hence any woman diagnosed with pre-eclampsia will require more frequent checkups and may require a delivery before their due dates.

Diabetes and pregnancy
If you intend to get pregnant, controlling blood glucose within healthy levels is absolutely essential. In most cases, your doctor may change your medication and you may be prescribed insulin before or during the pregnancy. You should also watch your food intake. Follow the guidelines given to you by your doctor (most diabetics have diet plans in a book given by BIRDEM), in most cases you will be asked to have rice once a day and bread (atta roti) for breakfast and dinner. Avoid sugary food and try not to have too many sweet fruits and fruit juices. If you feel the need to have something sweet, try not to fall back on the low calorie sweeteners readily available in the market.

There is still some speculation about the effect of aspartame (which is the sweetening agent) on pregnancy.

Diabetic mothers need to deliver in hospitals with a skilled team of doctors. You have to keep that in mind.

Babies of mothers with diabetes are at a higher risk of stillbirth or congenital defects. Mothers with diabetes are almost always prescribed extra folic acid supplements as a result. You should be taking 5mg of folic acid, while other pregnant women only need 0.4 mg. You may consider having Vitamin B supplements before you conceive.

Asthma and pregnancy
If you have asthma then remember that though asthma won't be triggered by pregnancy or started by it, pregnancy may make you more breathless than before. If you are already diagnosed with asthma, then remember to take your asthma medications (after checking with your doctor). Avoid dust or pollen or whatever triggers your asthma attacks. If you have a cold your asthma may get worse, so you may need to take inhalers regularly or you may have to increase the dose. Your doctor may also ask you to regularly take antihistamines. If you feel your asthma is getting worse, for example you feel increasingly breathless or have developed wheezing, then you may need to see a doctor and you may be given a different prescription.

If you are or were suffering from mental illness
If you were suffering from mental illness in the past or are suffering from it now, then the stress and anxiety associated with pregnancy can make your symptoms re-appear or in some cases worsen. If you have been suffering from depression or any other form of psychiatric illness then you should get in touch with your psychiatrist if you plan on having a baby or you unexpectedly find out you're pregnant.

In some cases, your prescriptions will be changed because some of the drugs prescribed to you before may have harmful effects on your baby. Your doctor may also ask you to stop having these drugs altogether and suggest you go for counselling sessions or other modes of therapy.

The 'baby blues' is a time when you may feel low and tearful, and it usually occurs in the first weeks after the birth. It's a result of the normal hormonal changes taking place in your body, and affects around 80 per cent of new mothers. But for some women pregnancy and birth can trigger more serious depression. This is something you and your partner should prepare for when you talk about having a child. Your partner should also be co-operative on this after the baby arrives.

Medication, alcohol and illegal drugs
If you are having any form of medication then be sure to check them with your doctor when you are planning to conceive. Many painkillers, antipsychotics and even antibiotics may have serious effects on your unborn child so it is best you have every drug checked out before you take it. Whenever you go to see a doctor for any non-pregnancy related problem which can even be a skin problem like acne, make sure you mention the fact that you are planning to get pregnant. Even topical ointments like creams containing Retinoids should not be used during pregnancy and oral retinoids like isoretinoids or salicylic acids can cause birth defects and are not permitted during pregnancy.

However, if you are taking medication for thyroid problems, diabetes, hypertension and epilepsy, you can not stop taking them. Talk to your doctor when you start planning for a baby as your dosage may change or you may be offered a safer drug suited to pregnancy. But you need to regularly take medication for these chronic conditions for your general well-being.

X-rays should be avoided from the time you start trying to get pregnant.

If you are taking homeopathic or natural remedies for any cause, remember that it is important to verify that the practitioner you are going to see is qualified and what you are taking is safe.

If you drink or smoke, you have to stop immediately after having made the decision to get pregnant. Fetal alcohol syndrome are a group of problems that affect babies of mothers who drink especially during the first stages of pregnancy. Since there is a possibility that you may have already conceived and you don't know about it yet, it's important that you stop smoking and drinking as soon as you decide to have a child. Although evidence on consuming alcohol is not as strong, but it is always best to be safe than sorry. It could be your baby may have to suffer from restricted growth, facial abnormalities and learning and behavioural disorders. Smoking introduces more than 4000 harmful chemicals in your system which can cause your baby to have stunted growth, asthma, sudden infant death syndrome, heart defects, low IQs and a multitude of defects which may affect your baby for life. This also applies for second hand smoke so if your spouse or friends smoke, they should avoid doing so around you.

The perfect age for motherhood may depend on you and your partner but please do remember that having a healthy baby entirely depends on you. A healthy mother means a healthy family!

Medical Consultant at Maya
Photo: Sazzad Ibne Sayed
Model: Rummaella Siddiqui, Razaan Quddus, Rezayeh Quddus