I, Dietitian Sharanjeet Kour Sodhi, Head Consultant Dietitian from Sir Ganga Ram Hospital’s Venture Reach Out want to share that We had our Symposium recently,in which we had panel discussions of several Department Heads from the hospital.So,sharing the Panel Discussion round from Gynaecology and Obstetrics Sciences.
DOCTORS IN PANEL
Dr.Chandra Mansukhani (Senior Consultant Gynae & Obs. , Sir Ganga Ram Hospital)
Dr.Punita Bhardwaj (Laproscopic Gynaecologist,Sir Ganga Ram Hospital)
What are the nutritional requirement post delivery and post-Caesarian section?
All family members ask questions separately about the patient’s diet and there are several myths. The mother needs an adequate diet in order to give proper nutrition to the child and for the child’s growth.
The diet should be tailored depending on a few factors
The mother’s age- whether young or over 35 years of age. The diet should be rich in protein, minerals and vitamins to overcome the stress of the delivery. The diet should give healing power to the mother. The diet should be adequate for breastfeeding.
Weight gain during pregnancy – if weight gain is excessive or less. In excessive weight, calories and fat restriction are advised and more protein added.
The number of babies delivered- if twins have been delivered, more protein and double the amount of
protein. Small frequent nutritious meals can be given.
Additional requirement for breastfeeding – 500 extra calories to be added.
Some mothers are on long-term medication, supplements or drugs. Does this affect breastfeeding the neonate?
Any long-term medication will be present in the milk by passive diffusion. This depends on the amount of the drug in the mother’s blood, the ionization and the lipid solubility. Very small amounts are secreted in the mother’s milk and the baby is not harmed. Common medicines like antibiotics, painkillers are secreted in minimal amounts and the baby can be breastfed. If the mother is on medication for chronic conditions the baby should first be breastfed and then the medication is taken.
What are the drugs contraindicated in breastfeeding?
Amiodarone, cancer drugs, gold salts, iodine-containing medication, retinoids should be avoided completely in mothers who are breastfeeding.
What is the quantity and level of lactation sufficient for the baby?
Ideally, purely breastfed babies should draw 150ml/kg body wt/day. If the baby sleeps for more than 1 to 2 hours, after a feed, in the initial 3 to 4 months, then the feed is sufficient.
Doctors suggest that the entire areola should be put in the baby’s mouth while sucking not only the nipple as it is just a passage. The lactiferous ducts are in the areola. If only the nipple is sucked, it may lead to painful cracks and subsequently non-lactation.
What should the frequency of feeding be?
The feed should be either demand or two hourly initially.
We have a good support system in Indian families.
There are certain important aspects to be considered in the lactating mother’s diet.
- Milk does not cause pus formation as it does not enter the scar tissue. Milk contains protein and calcium required by the lactating mother.
- Tea and coffee should be avoided.
- Water intake to be increased as it helps in protein metabolism.
- Iron and calcium are very important dietary constituents. A vegetarian diet is low in iron and supplements are needed in the postpartum period. This will take care of the iron depletion as well as provide adequate iron to the baby.
What advice should be given to a patient on discharge after a Laparoscopy?
In a simple surgery soft diet can be started post procedure. The patient can then be switched over to a normal diet with chapatti and vegetables.
If complex dissection involving the bowel or bladder is done, then clear liquid like water, coconut water, etc should be given in the initial 4 to 6 hours. Once the patient tolerates liquids then juice, soup, tea, and biscuits can be added. If a patient’s pain threshold is low, too many painkillers to be avoided, as the bowel motility will return faster.
Convalescence depends on a patient’s attitude and their nutritional health preoperatively.
Whole fruit instead of juices to be given as it has the added advantage of fibre. Most patients feel full and do not feel like eating so small frequent meals are advised. Lighter fruit like apples and bananas prevent constipation. Carbonated drinks to be avoided. Patients should eat whatever they can tolerate.
We Launched our book with other Doctors from Sir Ganga Ram Hospital of different specialties have answered nutrition related questions , also on various general questions.For orders, do write us at [email protected]