Nutrition during pregnancy : You are what you eat!

Much has been said about what should be eaten and when and how, and what not; during pregnancy. From new age ideas backed with scientific evidence, to age old dadi maa's nuskhas, there is so much to know, to follow, to be careful about. Many a times there are contrasting opinions on certain foods/drinks, or eating habits, which make a mommy-to-be very confused. I understand everyone from the doctors to the family mean well for the mothers, but following every bit of advice to the T is also not easy. Yes as a mom we want to ensure we consume the right stuff which is required and healthy for us and the baby, but sometimes we cant help but cheat on the rigorous routine to satisfy our cravings! :D

That said, planning out your meals, the content, the quantity, the timing, is very important. And there is no one template for all: every woman has different needs and reactions to food, and thus the diet should be followed accordingly. Couple of things to be kept in mind:

1. Consistent Weight gain:

It is total nonsense that once you get pregnant you need to eat for two. You need to eat only for yourself, but eat well and healthy so the baby gets all the nutrition it needs from you. Overeating especially in the first trimester will only lead to digestion issues and too much weight gain. In the first trimester ideally one gains little or no weight, in fact some even lose weight due to nausea/vomiting. In the second trimester one should put on maybe a kilo per month. Its only in the third trimester that one should pack in the pounds as by then the baby's development is complete and it's all about growing big. How much weight gain is ok? For a petite structured woman, 16-20 kgs is required. For an average weight woman, 11-16 kgs. For overweight moms, 7-11 kgs should be the aim.

2. Balanced diet as per your health:

Now as an individual you may like or dislike some foods, may or may not follow a "balanced diet". Once you get pregnant your priorities, including diet, have to change. Whether you like them or not, you would need to get your daily dose of fruits, veggies, milk, water, nuts etc. You may be advised to reduce salt intake to avoid swelling, or sugar intake to maintain baby's glucose levels. You may have to quit your favourite foods or eat/drink stuff you hate. Especially if you have a chronic condition like diabetes, hypertension etc like me, you will need to follow a strict diet to avoid any complications towards the end. Ask me, it has been difficult to manage the long list of Dos and Donts, but in the end it is all worth it. Just a matter of a few months for your baby, once its born you have more control on what you eat. More, not full, because then the advise for nursing diet starts: there is really no end to this actually! Haha!

3. Quality, Quantity, Timing:

Its very important to choose the right kind of calories to consume, in the right quantities and at the right time. All experts recommend going for six small meals rather than three big meals. So instead of your usual breakfast. lunch, dinner routine, it is better to go for breakfast, morning snack, lunch, evening snack, dinner, late night snack. Smaller quantities makes it easier for the body to digest the food, given the increasing pressure of the uterus on the stomach. Spaced out meals help with nausea, indigestion, gas/acidity etc. Equally important is to choose the right calories: substitute maida with whole wheat/multigrain bread, parathas with roti, white rice with brown rice, processed foods with fresh foods. Prefer to eat freshly cooked food and drink freshly squeezed juices over readymade, from the can/tin variety. While some doctors are against eating out at all during pregnancy, you can indulge once in a while in good food prepared hygienically in a good restaurant: given you're pregnant and not allowed medication, falling sick is not a good position to be in. Always prefer home cooked food made in minimum oil and masala to outside food.

This brings us to the next point of discussion: what are the main nutrients required, in what quantity and what foods/drinks can give them to me? Lets go one by one:

1. Calcium

Calcium as we all know is very important for the growth of the baby's bone structure. So even if you take enough calcium in your diet, your doctor will still make you have supplements. During pregnancy a minimum of 1200 mg of calcium is required, even more if you have an existing deficiency. Along with Calcium its also important to consume Vitamin D3 as it helps in the absorption of the same. Top sources for Calcium are all milk and milk products. Other sources include seeds like pumpkin, flaxseeds; beans like channa and rajma; almonds, oranges, bananas in fruits and nuts; in vegetables methi and drumsticks. Those who have lactose intolerance can go for home made curd, paneer, buttermilk; and soya milk.

2. Iron

Iron and folic acid are again the most important nutrients that a pregnant woman must consume. Pregnant women need a healthy hemoglobin level to sustain themselves during pregnancy  and a steady supply of folic acid ensures there are no neuro tube defects in the baby. In addition, DHA vitamins help with baby's brain development. Again no matter how healthy you are and how much of all this you get in your diet, your doctor will insist on a supplemental pill to fulfil your requirements. Apart from the pills, you can get your daily fix of iron from all green and leafy vegetables and peas, exceptions being beetroot and tomato which are red but have ample amount of iron. Apart from nuts, a lot of fruits are also iron rich: apples, pomegranate to name a few. In non vegetarian food, red meat and sea food are rich sources. Having Vitamin C rich fruits and juices helps with good absorption of iron. On the other hand never consume iron and calcium tablets together as they interfere with each other.

3. Vitamins

While Vitamins A, E, K are also required by the body, apart from Vitamin D that one has along with calcium, the most important Vitamins required during pregnancy are Vitamins B complex and C. Vitamin C is required for a lot of metabolic processes for mom and baby and since it cant be stored, one needs a fresh supple daily of the same. Most requirements can be fulfilled through diet, but if needed, supplements can be taken. Vitamin B complex has a lot of vitamins in the family and all requirements may not be fulfilled through diet so in most cases doctors suggest going for a Vit B complex supplement. Some rich sources of vitamins are: citrus fruits and juices, green and yellow fruits and vegetables and their juices. The more colourful your food and drinks, the better. However, remember a lot of nutrients from fruits and veggies are lost during cooking, so have enough raw fruits and salads as well.

4. Proteins

Proteins are probably the most important requirement for a baby to grow. The amount of protein the mother consumes directly affects the physical growth of the baby. Many calcium rich products are good sources of proteins as well. The best sources of proteins are: all dairy products, seafood, red and white meat. For vegetarians, beans, peas, lentils are good sources, along with whole grains and nuts, sprouts and roasted channa. Vegetarians may have trouble in getting enough proteins from their diet as animal proteins are superior and better absorbed by human body than plant proteins, so they may have to make more efforts in their diet or take protein powders if insufficient.

5. Fibre

During pregnancy, due to hormonal changes, many women face constipation. Since pregnant women cant have a lot of medicines, including fibre in food is very important. Substitute Maida with whole wheat as much as possible. Add whole grains like jowar, bajra, etc which are fibrous and nutritious and fulfilling as they have complex carbohydrates. Oats, muesli, dates, prunes and figs, are very good sources of fibre. When eating fruits, don't remove the outer skin. In vegetables, cabbage, cauliflower and broccoli are very good.

6. Carbohydrates and Fats

Carbohydrates and fat give you the energy which is required to maintain the levels of metabolism during pregnancy. Most of your grains, beans, protein consumption will also make up for your carbohydrate and fat requirement. However the trick is to get the right kind of carbs and fat. Go for whole grain over refined carbs, brown rice over white, wholewheat over regular pasta/pizza, olive oil over ghee, margarine over butter, etc. The idea is to get energy but also not pile on those pounds too quickly, as after the baby it will be a challenge to get rid of them!

7. Fluids

Last but definitely not the least, pregnant women need to keep themselves hydrated sufficiently. Apart from keeping the body healthy, toxin free, keeping the skin clear, helping with digestion; it also aids in production of amniotic fluid which is essential for the baby. Adequate fluids also ensures no swelling or UTIs. Usually we are in airconditioned environment at work or home and do not end up drinking much water, but during pregnancy one must force themselves to drink at least 2 litres. Not all fluid has to come from plain water: mix it with lemon, syrups; or have milk, juices, coconut water, soups etc for variety. Good helpings of fresh vegetables and fruits also provides fluids.

That's it? Oh no. How can a lesson on eating habits be complete without a list of Donts!

• avoid unpasteurized milk products and soft cheese
• avoid raw papayas and pineapples
• avoid raw eggs and seafood and meat
• avoid food cooked and kept for more than a day
• avoid herbal teas and sugar substitutes
• avoid raw veggies, fruits, sprouts from outside
• avoid coffee, tea and caffeine rich drinks, and chocolate
• consume salt and sugar in moderation
• OBVIOUSLY NO DRINKING, SMOKING, DRUGS

Well that brings us to the end of the long lecture on nutrition. There is so much to have and also to avoid. So many conflicting opinions. My suggestion: eat what you like, in moderation, and if in doubt just say no. Do your best but dont get stressed about getting the right amount of everything or eating something wrong. Our bodies are miraculously built to manage us as well as our babies, and nature knows how to make do best with whatever we give ourselves. Have faith in yourself and whatever you eat or drink, think of the baby. Your baby will tell you what is right! :)

The great Indian baby planning!

In India, the three things that are most important in life are: birth, marriage, and death. Much has been said about marriage and death. What about birth? Having a baby in India is a family affair, and not a personal choice. It all starts from the day you decide to get married.

Talking about a typical Hindu North Indian wedding scenario, there is a function that's always there: god bharayi. When all the married women from both the bride and groom's family come together and bless the to-be-bride with fertility (specifically bearing a baby boy). The girl sits down with a doll in her lap, and women come and bless her with money and dry fruits and sweets and what not, hoping for a baby to be born ASAP.

Once a couple is married, within reasonable time (from a few months to a year or two, depending upon their ages and level of family conservatism), one or both sides of the family start pushing the couple to bear children. Whether they are ready or not. There is always a teary eyed grandma hoping to see her great grandson before she dies, or a mother/mother-in-law requesting the couple to bear kids as long as she is in good health so she can help with the baby. It seems everyone needs a baby more than the couple in question who actually have to physically give birth to, and financially/mentally/emotionally take care of the child.

And if parents were not enough, as we grow up, we hear of stories everyday of xyz getting married, and abc having a baby. Peer pressure is just as bad. Parents see their siblings' children having babies, or their children's friends having babies, and their yearning becomes stronger. "dekho ab to tumhari friend manisha, jo tumse badi hai. ka bhi baby ho gaya, tum kiska wait kar rahi ho? jaldi karo warna kahin der na ho jaye."

Its assumed that after marriage, having babies is the natural progression. Sooner or later the couple will realise this and start planning for a baby. But today things aren't that simple. Many couples don't want to rush into having children, and many even decide never to have kids at all! Its a tough life for them to fight against all the pressure from all sides, but such is life in the Indian society. Of course there are some lucky few who want to have kids and thus aren't perturbed by the constant winking at every function by everyone - "kyun bhai good news kab suna rahe ho?" Or they have never been pushed by their own family at least and can plan as per their convenience.

Once the news is out that the couple has started planning, start all the suggestions and advice. When to start planning, how to do it, which days etc etc. Friends, family, Internet.... there is no dearth of information pouring in. Enough to make a couple so overwhelmed that they may give it up midway or never plan again!:P
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But its still nothing compared to the hell that breaks loose when you actually confirm you are pregnant. A huge list of Dos and Donts is shared and regular updates are taken by everyone (more than the doctor) on your eating, workout, sleeping etc routines. "Have 2 glasses of milk every day, have 5 white almonds and walnuts, don't have pineapple or papaya, don't sleep on your stomach, don't have sex, don't exert yourself, don't stay in bed, pray everyday. Don't tell anyone in the first trimester else you will miscarry due to buri nazar". etc etc

Haha. Buri Nazar. Evil Eye. Bad wishes for you by others. Who don't like you, want to ruin your life. I don't understand why all the buri nazar of the world resides in India? Are we such horrible people that we cause tragedy in people's lives by just looking at them in a way or wishing bad for them? Abroad, people tell everyone excitedly about their pregnancy and are so open about the whole thing. No evil eyes there? Its so stupid. Forget telling others, sometimes people have issues telling their own parents. How do you tell you male father-in-law that you are pregnant? Cuz its embarrassing? Cuz one gets pregnant by having sex? Well hello! The father in law also did that to make the husband. So whats the big deal? I fail to understand.

Once the pregnancy starts to progress, there are more terms and conditions. Don't travel, don't drive a car, don't go out much, don't be out in the sun, don't wear heels, don't wear western clothes, don't eat or drink xyz stuff. Cover your baby bump when you are out. Pray tell me why??? Again - Buri Nazar. For God's sake if you are pregnant and showing, covering yourself with a scarf will not hide it! Also clicking baby bump pictures or announcing on facebook will not lead to a miscarriage! We are such an insecure bunch of people!

Towards the end of the pregnancy, all the post birthing gyaan starts: how to manage labour, what to eat/drink to make it easy, what to do after birth, with self and baby etc. And also start the last leg of advices: don't decide on names or buy any clothes or baby furniture before the birth, its ill luck, Well its more practical in my opinion than anything to be ready for the baby before the baby arrives. I want to have a name in place so my baby isn't christened munnu guddi after birth for weeks, and I'd rather have all the stuff ready so I'm good to go as soon as I'm home. I still don't get any scientific connection between preparing for a baby leading to disasters.

The funniest thing though, is all the baby gender prediction: based on the shape and size of tummy, the complexion of the mother, the way she walks or her cravings, people are 100% sure what the gender is. Again there is no scientific connection of all this with gender, and whatever your belief is, you have a high chance 50% being right about the gender, so don't gloat! :P

Last but not the least when the mother goes into labour, comes the question: will the father go into the labour room with her and witness the birth? Well unlike Western countries, its still a new concept in India for the fathers to be allowed inside the labour room by hospitals, and for fathers willing to sit through the ordeal. I can imagine its not a small deal to see your wife writhing in labour pain, and all the blood and stuff which accompanies birth. But most men today take that step and go in with their wives and hold their hands through it all. still there are many who object to this cuz its embarrassing or disturbing. well i think every husband should be forced to be in the labour room to appreciate what his wife is going through to bring their child into the world, it will help increase the respect they have for the wives. And embarrassing? C'mon, its less embarrassing for your husband to see you half naked than the dozen doctors and nursing staff that will hover around you for hours, prying your legs apart and staring at your privates! Grow up people!

Baby is out? Congratulations and good luck with all the stuff that follows. Make baby wear old, worn out clothes, after baby no going out for 40 days, keeping head covered, tying up the tummy to keep it slim, making baby wear sacred threads around the neck pr wrists and putting kohl on forehead or eyes to ward off the famous Buri Nazar... there is no end to post natal advice for both mom and baby, which unfortunately has no scientific base and clashes with the doctor's advise. Managing what the doctor has said, with expectations and eagerness of grandparents to unfurl all their knowledge of child rearing can be quite a task, as there is a good chance you will end up upsetting the "bade buzurg" by your "modern ideas". "what are you telling us, this new age nonsense... you doubt us? we had more children than you at a much younger age!" True that Mummyji, no offense but it would be great if you allow the actual mom and dad to make the important decisions on bringing up their baby :)

A I was thinking about all this and more, I put up a post on cultural influence on pregnancy, on a pregnancy group online, and to my surprise, I learnt that there are many such beliefs in other countries as well! A sample of answers I got:

• Mexico: if someone is staring at your baby and wants to touch him/her but doesn't, the baby will be super fussy, don't cross legs after baby, don't bend, don't cut hair of baby before one year
• Africa: not step out for first 6 weeks as body is fragile
• New Zealand: mother not allowed to cut hair or fingernails
• Philippines: don't eat bacon, eggplant and crab; don't bathe for 10 days after birth, eat light coloured foods to ensure complexion of baby is fair; and the best: if you sleep on your back, put a hand on your tummy else the monsters will get the baby! :P

So it seems its not just India but other cultures as well which have their amazingly fascinating beliefs and traditions regarding pregnancy and childbirth. While its fun to talk about them, let's hope all parents around the world get the opportunity to make the decisions they think are right for themselves and the baby, and the families/friends/society helps rather than inhibits them in doing the same!

Cord Blood Banking: Expensive whim or useful tool?

While it is quite popular in western countries, Cord Blood Banking (CBB), a relatively unknown phenomenon until a few years ago, has surely come of age in Urban India.

Since time immemorial, the umbilical cord and blood have been discarded immediately after birth, as they were deemed to have no value once the baby is out. However, with exponential advancement in medical research in the field of genetics in the past decade or so, the concept of CBB has garnered ample interest lately. Today you can arrange for the cord blood and cells to be harvested during birth, and preserved for 21 years. The blood/cells can be used for medical therapy in curing various diseases, not just for the baby from whom it was extracted, but also its siblings, parents or even grandparents.

Why does one need CBB? Blood and stem cells found the in the umbilical cord binding a mother and baby have been used in studies to cure cancer, blood related and other congenital diseases. So if you have a family history of such diseases, chances are that going for CBB can help the baby and possibly other related family members with the diseases. But what if you do not have a history of these diseases? Medical researchers are looking at expanding the use of the stem cells to cure other diseases as well, like heart disease, diabetes, strokes etc. It is expected that with time, the uses of cord blood will increase manifold.

However, there is also a flip side to CBB: Currently cord blood cells can help with limited diseases only, and although research promises more uses in time, some people may not find that a good enough reason to go for it in case they do not have history of blood/cancer diseases. Secondly even if there is a family member with a disease that can be addressed by CBB, the cells may not be a match and hence be useless for that case. Last but not the least, there is a cost involved with CBB: anything from Rs 75000 to Rs 500000 for preservation for 21 years; depending on the processing method and multiplication of cells required.

So what's the verdict on CBB? I asked a lot of first time moms in my pre-natal class. Many of them were aware of CBB and had signed up with some or the other bank. Some were still thinking about it. There were also others who did not seem to like the idea, and had flatly refused to go for it. Either ways, everyone knew about it, even if they did not opted for it. When I asked the Lamaze instructor, she refused to comment, saying that she doesnt believe in promoting or snubbing CBB as its not a well established enough practise yet: it is up to the couple to take an independent decision. My gynecologist was more forthcoming: he was clear about the limitation of uses but still suggested we think about it, in case it ends up helping. Most of his patients - young, educated, urban couples in Mumbai, are going for it these days. He however refused to promote a particular bank and requested us to make a choice based on own research.

Personally, being the MBA couple we are, we applied game theory to make this decision:
it was better to go for it just in case it comes handy, if it doesnt then it's just a small affordable cost. But in case it could be used and we did not go for it, the loss will be much more.

And so we did our research and educated ourselves with the cord blood banks in India, the uses of CBB, actual success stories, various options/costs/payment methods, references from people who have done it etc. And finally we zeroed-in on CryoBanks.

So what happens once you finalise a bank? You contact them, they come over with a presentation and lots of material for you to read on the theory of CBB and actual application and success stories. They also inform you about the benefits and limitations, the way they process and preserve the cells, their policies and costs, and various options depending on your needs. Once you are on board, they take a detailed note of medical history of both mother and father and their families. Once the agreement is signed and all paperwork finished, they provide you with a collection kit which you need to carry as is to the hospital when you go into the labour. Most good banks have tie-ups with all the major hospitals in major cities, and the hospital staff is well aware of the protocol. The moment the mother goes into labour, she is to inform the bank, so they can come in time and collect the blood/cells. It takes hardly a few minutes and is a safe and painless procedure. Once teh samples are collected, they are tested to see if they can be preserved. In case they cannot, any money paid is refunded minus basic expenses. If all goes well, the blood/cells are banked and you get regular updates on the status. At the end of 21 years the agreement lapses but can be renewed if required.

Ideally people bank the cord blood/cells from the first baby. If a couple has more than one children, it is generally considered a waste of money to bank their blood/cells as well, as the amount of stem cells that can be multiplied and used from the first baby are enough to help the whole family. However, in case the first sample doesnt yield results for a family member due to matching issues, people may undertake CBB for second/future children too.

So what to look for in a cord blood bank:

• it should be well reputed with experience in the arena
• it should have state of the art facilities for preservation
• it should have a good network with hospitals and easy to reach customer support
• it should have transparent and customer friendly agreement and policies, and no hidden charges

What options does one have in India? The top three cord blood banks (basis popularity) are:

CryoBank , LifeCell , CordLife

In the end, irrespective of research and expert opinion, CBB is a highly personal decision that every couple today is faced with : it is like having a bio-insurance. It pays off if it comes handy in case of a disease. If it doesn't, it was just payment for insurance. And that's a call everyone takes when the time comes.

What is in a name?

What is in a name? Ummm... these days? Everything.

Today the young generation wants to be different. And they want to start with a different name. Earlier people were named after Gods, family members etc, but today there is a more definite purpose behind naming a child. After all, a lot is inferred these days about a person by the name he/she carries. Not only does a name give a hint of where the person hails from, it also forms a mental first impression.

A lot of people believe a name describes a person, or his/her talents/features. Many people also believe that a name can also shape a person's destiny. Hence the importance of keeping a name suitable to the child's looks, personality and future: not an easy task at all. I know of people who have lost so much sleep over choosing a name for the baby that they have had no names for months after birth! But it need not be so difficult if you have a clear strategy and know what you want. So how do people select names?

Gone are the days when people were given old fashioned auntyji/uncleji names like Suresh, Kamla; name siblings similar names like Chintu Pintu, Anju Manju, Seeta Geeta; or even recently the done to death common names like Neha and Rahul. In Hindu North Indian families in the 80s, people started to look for new, different names for their babies. There was a wave of long names like Vikramaditya, Adityavir, Malavika, Avantika, etc. And also very uncommon pure Hindi names, like Anaadi, Nachiket, Amrapali, Tanishtha etc. But typically all names were Hindu, and had origins in Hindi/Sanskrit.

Since the 2000s, things have changed even further. A lot of people started to mishmash their own names to make baby names: Anish and Ishita choose Anita, Aditya and Vani choose Adiva etc. I for one, wanted a simple yet unique name for my child. I also wanted sensible and in vogue names which wont make my child hate me forever for naming them that. E.g. naming a kid born in 2013 Pinky or Bhupender! :P Today I personally feel there is a need for global names: names which are easy to spell and pronounce, and at the same time, neutral without giving strong hints about the person's background : so that when one hears the name they do not automatically draw stereotypes about the person.

For instance, today it is very easy to figure out an adult Indian's name, and also analyse which state/region or religion they belong to. For example, many South Indians are named traditionally after gods, like Karthik or Bala. Bengali people have a strong flavour of their language in their names, like Shraboni or Moitreya. Gujarati names are also easy to point out: Snehal, Tejal, Jignesh. More than states, its easier ti figure out religion from first names: Iqbal or Ahmed are definitely Muslim, Paul or Karen are Christians, Jatinder and Sukhvinder Sardars and Manish and Bhavna are Hindus.

So I wanted a name which is not just smart to hear and gives a positive impression on people but also a neutral in nature. I was very open to names with non-Indian origins, like Latin, Arabic, Japanese, African etc. And so began my journey of hunting for names, for both a baby boy and a girl, since I don't know what I'm having. I cant imagine how people used to looks for names earlier, when there weren't so many books and websites dedicated to baby names! I personally sifted through a few books and a million websites, scouring through names from all origins, looking for something special, yet unique. Mind you, it isn't easy to do this, keeping the sensibilities of the extended family in mind - "you are keeping a firang name for your kid?" "doesnt that name sound very Christian/Muslim? You sure it's appropriate?" Apart from that the personal choices of both parents can really make this a daunting task.

But thankfully I started with the premise that whatever my husband and I choose as names, has to be accepted by the family, whether they like it or not. Everyone is free to suggest names but the final decision will be ours, and ours only. No offense. And that's what we did. After painstakingly going through various options, we made a final list of a dozen names for boys and girls. We shared them with friends and family and based on their votes and our personal liking, chose the names. The names are not very common, simple to spell and pronounce, neutral/global in appeal. Just like I wanted. Just one hitch though: I'm very touchy about my baby's name. If my baby is named Aryan, please call him Aryan. From the moment he is born. Not Chunnu, Munnu, Chhotu, Chintu, Pintu. I abhor stupid nick names. Small simple names don't require nick names. Im also not in the favour of my children having a "good/school name" and a "home name": like the formal name is Aditya, but home name is Manu. I dont wish to confuse my child. I want him/her to relate to just one name that becomes THEM. I hope I can avoid shortening of names/nicknaming by others for my little one!!

Anyway! Thank God a huge task is over. But who am I kidding? The hugest tasks don't even begin before the baby's birth! But that's ok, getting the names in place is one more tick off my never-ending to-do list! Here is wishing all the to-be parents in choosing names for their little ones! :)