Blog - Dr. Rajeshwari Pawar

Using a menstrual cup? The best way to clean it

October 19, 2020 Dr Rajeshwari Pawar iDiva Comments Off

Menstrual cups have become extremely popular owing to the fact that they are convenient, don’t need much changing, and are better for the environment than pads and tampons. If you have switched to a menstrual cup, you might be familiar with folds, and how to insert it; but do you really know how to clean it? We asked two gynaes for their expertise.

Let’s start with the basics, wondering how to insert a menstrual cup?

Dr. Rajeshwari Pawar, Consultant, Obstetrics & Gynecology, Motherhood Hospital, Kharadi, Pune shares her expertise:

1. Start by washing your hands

2. Fold and hold- Since it is flexible, the menstrual cup is easy to fold

3. Insert: Then, gently insert the folded cup into your vagina, tilting it back to the base of your spine.

4. Ensure that it is snugly fitting into the vagina and stays there.

5. You can use it up for up to twelve hours

6. Remove and empty into the toilet bowl.

7. And it can be reused.

How to clean it?

Dr. Rajeshwari Pawar, Gynecologist in Kharadi, Pune shares her Do’s and Don’ts for cleaning your menstrual cup.

Do’s:

1. Hand Hygiene

Clean hands and fingernails are prerequisites prior to taking the necessary steps to clean a menstrual cup.

2. Sterilisation

Before and after each period, the cup is sterilized by immersing it in a vessel of boiling water for 10-20mins.

3. How to clean it during your cycle

The cup should be emptied every 6-12hrs depending on the flow, wash with a mild liquid soap that is free of fragrance and oil with a ph of 3.5-5.5; thoroughly rinse with water and dry with a clean cloth before insertion. The air holes are cleaned by filling the cup with water; placing a palm on it; turning it upside down and squeezing it to allow the water to squirt out through the openings. A toothbrush dedicated for this purpose can also be used to clean the air-holes.

4. Cleaning it in a public space

One can’t exactly sterilize a cup in a public loo, so Dr. Rajeshwari has an alternative, “In the absence of water and mild soap, the cup can be emptied and wiped clean with an unscented wipe or cloth prior to insertion.”

DON’Ts

1. Avoid scented soaps and detergents as they could lead to vaginal irritation.

2. Oil-based soaps form a coating on the cup and should not be used to clean the cup.

3. Avoid the cup from touching the bottom of the pan during sterilization to avoid damage to the cup by filling the pan with enough water to make the cup float or placing the cup in a metal whisk.

4. Do not use the cup if it is cracked or emitting a foul odor even after sterilization or if the stipulated number of years of usage has gone by. Change over to a fresh cup and experience a hassle-free period.

Pregnancy and Coronavirus FAQ’s: Here’s what expectant mothers need to know about COVID – 19

October 19, 2020 Dr Rajeshwari Pawar Times Now Comments Off

There’s a lot to learn about COVID-19, including how it impacts pregnant women. Here, a gynaecologist-obstetrician answers commonly searched questions about pregnancy and coronavirus.

New Delhi: The coronavirus pandemic has put all of us in a stressful situation. But, for pregnant women, it can be even more stressful in such virulent times. In fact, several gynaecologists are now reportedly advising women to postpone pregnancies at least for the next two to three months. Although there is no proof of vertical transmission of the coronavirus from the mother to the baby during pregnancy, however, doctors said it’s important that women take precautionary measures to avoid any risk.

Recently, North Carolina health officials said that pregnant women are now included in the ‘high-risk’ category for the COVID-19 caused by the SARS-CoV-2 virus. According to the CDC, pregnant women experience changes in their bodies that may increase their risk of some infections. Also, women have had a higher risk of developing severe illness with viruses from the same family as COVID-19, and other viral respiratory infections like the flu.

While there is hardly any information available about coronavirus infection in pregnancy, there are several queries that arise in a pregnant mother, her spouse and her close relatives. In this article, Dr. Rajeshwari Pawar, Gynaecologist -Obstetrician, Motherhood Hospital Kharadi, Pune, answers some of the most commonly asked questions about pregnancy and coronavirus infection.

Q. Are pregnant mothers at higher risk of infection?

A. A woman has lowered immunity during pregnancy and, therefore, has to be extra careful and is advised to stay indoors to minimize exposure to the virus.

Q. Is my baby at risk of coronavirus infection?

There has been one case that is reported where the baby has been found to be positive for the COVID-19. And it is the opinion of the experts that the baby had probably acquired the infection after it was born. The published medical literature from China supports the view that pregnant mothers whose blood samples were positive for COVID-19 did not detect the coronavirus in the amniotic fluid when tested and also the throat swabs of the babies were also negative after they were born.

Q. Are there any reported cases of coronavirus infection in pregnant mothers?

A. There is one reported case in the literature, where the pregnant mother developed severe respiratory symptoms at 30 weeks and needed ventilation. A decision was taken to do an emergency cesarean section and both mother and baby are said to be doing well.

Q. Are the symptoms of coronavirus any different in pregnant mothers?

A. The same symptoms of cough, fever, breathlessness are noticed, but if the infection gets severe, then pneumonia and respiratory failure may develop requiring ventilation. Are there increased chances of miscarriage?

At present, there is no data to suggest that coronavirus infection increases the chances of miscarriage or pregnancy loss.

Q. Are there increased chances of congenital defects in the babies of mothers infected with COVID-19?

A. As already mentioned, from the limited evidence that is available, the virus is not known to go to the fetus or cross the placenta, and, therefore, there is no evidence to suggest that there’s an increased chance of congenital defects in the babies of infected mothers.

Q. What is the general advice to pregnant mothers in ‘high-risk’ areas?

Report to your obstetrician regarding the exposure.
Self-isolate for at least 2 weeks (self-isolation means not to go to work, not to use public transport, stay at home and not allow any visitors, stay in well-ventilated rooms, do not share towels, soaps, plates, cups, spoons with the other family members).
Visit a hospital only if urgent medical care is needed (in which case the obstetrician should be informed in advance about the self-isolation so that the hospital takes the necessary precautions on the premises even before the patient reaches there).
If diagnostic tests are advised, the same protocol is followed like for any other person suspected of COVID-19 and the samples sent to the designated labs.

Disclaimer: Tips and suggestions mentioned in the article are for general information purposes only and should not be construed as professional medical advice. Always consult your doctor or a professional healthcare provider if you have any specific questions about any medical matter.

Mental well-being for expecting mothers during lockdown 2.0

October 19, 2020 Dr Rajeshwari Pawar IANS Life Comments Off

New Delhi, April 15 (IANSlife) The outbreak of coronavirus is worrisome enough, the extended nationwide lockdown while stressful for many people, especially pregnant women, is for their better protection.

While fear and anxiety about COVID-19 can be overwhelming, some mental coping strategies can help during pregnancy.

“It is vital for pregnant women to take charge of their mental well-being during the outbreak. To-be-moms may worry, panic, get paranoid, scared, anxious and stressed. Moreover, they will also fear about the health of their loved ones.

“There will be changes in the sleeping or eating patterns for women who are expecting. They may also find it difficult to get a good night’s sleep or even concentrate. Likewise, the paranoia owing to coronavirus can also worsen chronic health problems,” Rajeshwari Pawar, consultant obstetrician and gynaecologist at Pune’s Motherhood Hospital told IANSlife.

How can Coronavirus mentally impact pregnant women? “Pregnant women may feel lonely and anxious due to the lockdown and social distancing that has been advised to tackle the crisis. Moreover, it can also invite a depressive episode. Pregnant women may become anxious about what the impact it may have if any or problems to the baby? What if someone in the family or they themselves get sick? What if the spread of Coronavirus doesn’t stop,” the doctor said.

Here are some tips that can help pregnant women to improve their mental well-being.
Say no to panic. A pregnant woman should let go of the thought of COVID-19 and take all the necessary precautions to fight it. Furthermore, it is the need of the hour to accept the situation and only believe the information from reliable sources.

Avoid exposing yourself to disturbing content. Do not keep watching the news of Coronavirus compulsively or obsessively. Avoid paying heed to rumors.

Keep in touch with your family members via phone. Spend some quality time with your family members.

Exercise at home as it can help you stay positive, stress-free and energetic. Opt for relaxation techniques such as yoga and meditation. Say no to smoking and alcohol and sleep well.

Try to do activities which you enjoy like reading, listening to music, painting or gardening. This can help you shift your attention from the distressing Coronavirus headlines and allow you to de-stress.

Be in touch with your doctor for any complications that you may have. Be sure to plan out checkups and tests with your healthcare provider, so as to avoid any last-minute stress about appointments and commuting.

Pregnant Kalki Koechlin planning water birth; know the meaning and process of water births

October 19, 2020 Dr Rajeshwari Pawar Financial Express Comments Off

One of the finest new age actors of Bollywood Kalki Koechlin recently announced that she, with boyfriend Guy Hershberg, is expecting her first child in approximately four months. She is set to become mother in December 2019. Since announcing her pregnancy, Kalki is talking about her plans about childbirth and parenting. Apart for many progressive and different things she said regarding childbirth and parenting, the thing that caught the attention of everyone was water birth. Everyone wants to know what is water birth.

What is Water Birth?

Kalki said that she is planning a natural water birth for her first child. In water birth, the expectant mother labours and delivers baby in a pool filled with lukewarm water. The period of labour may vary but she spends at least a part of the labour in lukewarm water’s pool. In some cases delivery takes place in it as well. Many such birth pools are created in some hospital or at a birthing centres.

According to experts, some mothers go for water birth because it is believed that water birth soothes the labouring mother and reduces her labour pain. It softens tissues and helps in easy descent of the foetus via birthing canal.

Dr Rajeshwari Pawar, Consultant, Obstetrics & Gynecology, Motherhood Hospitals, Kharadi, Pune has recently written in Indian Express about Water Birth. Here are some of the advantages of water birth according to Dr Pawar’s article in IE. .

Advantages of water birth

1. Pain relief is considered as the main advantage of water birth. When muscles start contracting during the onset of labour pain, the warmth of lukewarm water eases and calms the labouring mother. It thereby reduces the need for analgesics and pain relievers. Water birth improves circulation and relaxes back and perineal muscles. As the labouring mother feels relaxed, process of delivery becomes easier for her.

2. During the delivery process on a standard hospital bed, the mother’s movement are restricted. She can only move right or left and stay mostly in a semi-reclining position. But some women want to walk during labour. In water birth, the mother gets more freedom of movement during the early stages of labour pain.

3. It is observed that chances of perineal tear are far less in women who opt for water birth. The reason is that in water birth, tissues become softer.

How safe if water birth?

Some women only prefer to have first stage of labour in water while others want to go through the second stage in water as well. The baby, in foetus form, is in a pool of water called amniotic fluid for nine months and it sounds natural that the baby will take birth in water but this can be dangerous. The baby starts breathing in the utero itself and water birth may cause a complicated condition known as meconium aspiration. It can get complicated further and cause a life-threatening condition called Meconium Aspiration Syndrome generally known as Pneumonia. According to Dr. Pawar, the second stage of labour in which the full dilatation of cervix takes place and the baby is delivered, should not take place in water.

Also, during water birth, it is not possible to constantly monitor baby’s vital parameters like heartbeat and contraction recordings. It will be extremely inconvenient for the mother to intermittently come out of birthing pool and on to the bed for the monitoring of her unborn baby to take place.

Pregnant women, who carry twins or those who have undergone “Lower Segment Caesarean Section” previously or have high blood pressure or carry any other complication are also advised against going for water birth. Only pregnant women with no medical risks should go for only the first stage of labour in water and under strict medical guidance. The general and normal delivery of the baby “on land” is far safer than in a “pool of water”.

Baby with critical congenital lung condition gets a new lease of life

October 19, 2020 Dr Rajeshwari Pawar Mid-Day News Comments Off

The doctors at the at Motherhood Hospital in Kharadi helped a newborn baby girl breathe freely by initially removing fluid from the cyst that was present in her left lung.

A team of paediatric surgeons operated on an a-day-old baby born with a congenital defect, wherein she had fluid-filled cysts formed in the lung cavity. It was a delicate and critical surgery wherein the survival and later the prognosis of the baby could have been compromised.

The doctors at the at Motherhood Hospital in Kharadi helped a newborn baby girl breathe freely by initially removing fluid from the cyst that was present in her left lung by aspiration process and later performing a lung lobectomy (a surgery to remove one of the lobes of the lung) immediately a day after birth. The baby has now been brought home and is doing well.

Dr Rajeshwari Pawar, Gynaecologist –Obstetrician at the hospital in Kharadi, told mid-day, “The baby was diagnosed to have a Type 1 Congenital Cystic Adenomatoid Malformation (CCAM). It is a developmental defect where there is a benign lung lesion that appears before birth as a cyst or mass in the chest. It is also known as Congenital Pulmonary Airway Malformation (CPAM). The macro cyst present on the left side of the segment of the lung affected the lung tissue pressed the heart vessels and shifted the heart from its normal position, thereby occupying a lot of space in the chest. This type of CCAM happens 2 to 3 in 1, 00,000 live births. If left untreated, it would have compromised the growth of the underlying healthy lungs and would have become unusable. Likewise, heart compression could have invited foetal heart failure. A decision was taken to operate upon the baby immediately after birth and the couple was referred to Dr Pranav Jadhav, Paediatric Surgeon, for further counselling.”

At the sixth month of pregnancy, the sonographic weight estimated of the fetus was 964 gms, and thus a decision was taken by the fetal medicine consultant Dr Rajeshwari to aspirate the fluid from cyst with a fine needle through a sonographic guided procedure after anaesthetising the fetus with an intramuscular injection in the fetal thigh muscle so that she(fetus) doesn’t move. “It was a delicate procedure which posed a high risk to the life of the baby. The procedure was successful and was done thrice and substantial fluid from cyst was removed. But the cyst recurred, and then Shalini, the mother of the child, was continuously monitored from sixth to the ninth month of pregnancy, every week by Dr Pranav and me,” said Dr Pawar.

Dr Tushar Parikh, Chief Neonatologist at the hospital added, “A multidisciplinary counselling was given to her and after that, a baby girl Ruchika, weighing 2.5 kg was successfully delivered on December 13, 2019. The baby was shifted to the NICU as she encountered difficulty in breathing and had to be given continuous positive airway pressure therapy (CPAP), to help her breathe easily, and expand the lungs. Once, the baby was stabilised, a lung lobectomy surgery was performed on the second day of birth by Dr Pranav Jadhav and Dr Kalpesh Patil (Paediatric Surgeons), which took an hour. It is a delicate and complicated procedure to remove the lobe of the lung that is the portion of the diseased lung. The baby was growing well and has been accepting feeds very soon after surgery,” added Dr Pranav.

Dr Parikh added, “Post-operatively, the baby was quickly stabilised, and given oxygen therapy in the NICU. Once, the baby was shifted in the normal ward, her mother was explained the right way to feed the baby. The mother was discharged on December 25, 2019, and the baby was discharged on January 1st, 2020”

“When we came to know about the cyst that was present in the foetus, we were taken aback. But we didn’t panic, and stayed strong as being pregnant, the doctors advised me not to stress,” said Shalini.

A series of tests were performed on the baby after which she was diagnosed with CCAM. After getting discharged, we also went for follow-ups, and the baby is fine now and accepts feeds. Our lives have completely changed after the arrival of our baby, and we are extremely happy and blessed,” expressed Shalini.

-Chaitraly Deshmukh

World record attempt in Pune through awareness drive on menstrual health and hygiene

October 19, 2020 Dr Rajeshwari Pawar Hindustan Times Comments Off

While addressing the students, Dr Rajeshwari Pawar, consultant, gynaecologist and obstetrician from Motherhood Hospitals, Kharadi, said it is important to talk on issues like menstrual hygiene and myths surrounding it.

In an attempt to create a world record, City-based Motherhood Hospitals, a network of women and children hospital, joined hands with Spherule Foundation, a non-governmental organisation to educate adolescent girls on the importance of menstrual health and hygiene.

The event was attended by students of Kendriya Vidyalaya, Tingarenagar. At least 1,700 people including adolescent girls, boys, men and women were present under one roof. While addressing the students, Dr Rajeshwari Pawar, consultant, gynaecologist and obstetrician from Motherhood Hospitals, Kharadi, said it is important to talk on issues like menstrual hygiene and myths surrounding it.

Her lecture that lasted for 38 minutes and eight seconds was also an attempt to enter the Guinness Book of World Records for educating the largest group of adolescent girls, men and women.

Pawar said, “In India, only 18% of the 355 million menstruating women use sanitary napkins and with the remaining 82% of women unable to afford sanitary napkins, resort to using unhygienic substances such as newspapers, sand, leaves, mud or unsterilized clothes, rags. Such unhygienic practices lead to burning, vaginal and urinary tract infections, infertility and other reproductive health complications.”

“Motherhood Hospitals and Spherule Foundation followed and implemented the rules, as per the guidelines laid down by Guinness book of world record committee. All the proof and unedited footage will be submitted within a day. The Guinness book of world record committee will evaluate the proof submitted and issue the certificate to the hospital,” said Dr Krishna Mehta, facility director, Motherhood Hospitals.

Dr Pawar, said, “Young girls usually have fear, doubts and misconceptions about menstruation. This was an initiative to throw light upon a topic less talked about. The platform was created to stress on how to maintain menstrual hygiene and to demystify several myths related to this topic.”

Sharing some figures according to Unicef, Pawar said, “At least 80% of surveyed women, according to Unicef, store their menstrual cloth in a hidden dirty place for repeated use while 40% fail to change their clothes frequently or wash them with soap after use. They are found to be ashamed to wash their sanitary clothes in open and hence wear over soaked and dirty cloth for an entire day without a change. Close to 50% fail to dry their menstrual rags outside in sun which is an essential condition required to kill bacteria. Lack of privacy, safety and toilets make things worse. With such events we hope to fight the stigma attached with menstruation in the society.”

Dr Geeta Bora, founder, Spherule Foundation, said, “In India alone, 23 million girls drop-out of schools annually, which is one in every five girls, due to the lack of menstrual hygiene management facilities like availability of sanitary napkins and awareness of menstruation. Such collaborations with hospitals is a step towards fighting the taboo related to menstruation in India.”

Pune keeps Covid on pregnant pause with aggressive testing, strict delivery protocol

October 19, 2020 Dr Rajeshwari Pawar Hindustan Times Comments Off

PUNE Three months into the pandemic in Pune and city obstetricians claim there is evidence of any case in the city where the Sars-Cov-2 virus that causes the Covid-19 infection is transmitted from an infected pregnant woman to her new-born child.

Dr Madhuri Rokade, resident medical officer at the Pune Municipal Corporation’s (PMC) Sonawane hospital, said, “Our hospital was opened exclusively for Covid-19 positive women on May 2 and since then, we have had three deliveries.”

“ICMR guidelines state that a pregnant woman must be tested for Covid-19 five days before the date of delivery. There have been reports in some studies globally that the infection could cause pre-term delivery, but no such incident has been recorded in Pune yet, however, it would be too soon to say it cannot happen,” Dr Rokade added.

The civic body has been actively surveying pregnant women who are then followed up with, randomly, to check for any flu-like symptoms.

The civic body has conducted door-to-door surveys in which 2,502 pregnant women in the city were identified in containment zones as of June 5.

Of these 2,502 women, Hadapsar ward has 648, followed by Bhavani peth (378) and Aundh (233) – the three areas with the highest number of pregnant women.

The PMC’s mobile swab collection van focuses on comorbid, pregnant and senior citizens, all of whom are tested for Covid-19.

Dr Rokade details how strict care is taken to ensure safety of all involved in the delivery process.

“We adhere to the strict guidelines of wearing PPEs at the time of delivery. The woman is given an N95 mask and every person, including the ward boy and sanitation staff, who enter the operation theatre is given a PPE kit. Since there is no proof that the virus enters the placenta the only source of infection from a mother to a baby are respiratory droplets, which is possible during breastfeeding. Once the baby is delivered we check the baby for infection on the fifth day and if the result is negative, the baby is handed over to a relative,” she said.

PMC commissioner Shekhar Gaikwad said, “The civic body has taken four major steps which includes creating a separate hospital for Covid-19 positive pregnant woman which is the Sonawane hospital. We also started surveying pregnant woman across the city and focused on them by following up on symptoms and testing. We also have tied up with a private hospital to treat Covid-19 positive pregnant women. Finally, we have reserved maternity wards for non-Covid-19 pregnant women.”

Dr Rajeshwari Pawar, obstetrician and gynaecologist, Motherhood hospital, said, “The fear of infection if mothers-to-be go to a multi-speciality hospital is more, since there is no guarantee that a person who comes to a hospital is not Covid-19 positive. Since maternity hospitals have pregnant women who have been tested and are found negative, there is some assurance. Also, all appointments are done in phases – be it delivery, vaccinations or routine check-ups.”

-Steffy Thevar

Link below to the live where I discuss why more pregnant mothers are choosing Motherhood speciality hospital during this pandemic!

Woman delivers baby boy after complex pregnancy

October 19, 2020 Dr Rajeshwari Pawar Sakal Times Comments Off

Pune: After 18 years, eight failed attempts, high risk and a complex pregnancy, a 35-year-old woman delivered a baby boy at city-based Motherhood Hospital in Kharadi.

Anita and Virendra Tripathi from Pune had a tough time coping with four miscarriages and four newborn deaths in 18 years. Anita lost her first baby in 2002. Even after consulting various doctors in Pune and Delhi, nothing worked in the couple’s favour.

Though her pregnancy reports were normal, the baby wouldn’t survive. However, the couple didn’t lose hope. Each one was of great moral support to the other during this time.

Finally, their prayers were heard when Anita become pregnant in June 2018. Since her pregnancy was high risk and complicated, she was referred to specialists at Motherhood Hospital at 7 months of her pregnancy after she suddenly broke her waters. This happened in January 2019.

The patient was given medications to ensure fetal brain protection and lung maturity along with antibiotics to keep infection at bay. Medications were also given to temporarily halt the imminent delivery.

On January 11 this year, Anita gave birth to a premature baby boy ‘Rudransh’ weighing 1.3 kg. Dr Rajeshwari Pawar, Senior Consultant Obstetrician and Maternal-Fetal Medicine expert at Motherhood Hospital said that the aim was to pull on the pregnancy in utero as much as possible because there is ‘no incubator in the world as good as the womb’.

“However, care was taken to curb the chances of infection and complications to the baby in view of absent of bag of waters covering the fetus. The patient had to be delivered at 30 weeks when there were hints of the baby being in danger in the womb,” said Pawar.

Dr Sachin Bhise, Consultant Neonatologist at Motherhood Hospital, highlighted that after birth, the baby had trouble breathing, and required immediate breathing support in the delivery room.

“The baby was shifted to the Neonatal Intensive Care Unit and given respiratory support with an advanced technique of a non-invasive ventilator. He was also given preventive measures to keep sepsis away and was provided nutritional support in the form of Total Parenteral Nutrition (TPN),” said Bhise.

In NICU, the baby underwent screening for metabolic diseases in view of the mother’s previous newborn deaths and screening to look for retinopathy of prematurity along with other tests for brain, kidney and liver for congenital anomalies.

During her hospital stay, the mother was trained for Kangaroo care, feeding and hygienic care of baby. The baby weighed 1.7 kg at one month and was declared fit to go home.

Anita Tripathi, Rudransh’s mother, said that she was devastated after 8 failed pregnancies.

“When I was pregnant for the ninth time, there was a question about the baby’s survival. I would panic and constantly ask the doctor whether the baby is fine. But my joy knew no bounds when I heard my baby’s cry for the first time. Rudransh is 4-months old and is fine now,” said Tripathi.

Importance of being on time
“India accounts for 24 per cent of world’s premature deliveries and 40 per cent of low birth weight babies. Unfortunately, India also accounts for more than 80 per cent of total newborn deaths among low birth weight and premature babies. This baby’s case is a perfect example of how we can save extreme premature babies if they come to tertiary perinatal centre well in time. There is need to create awareness amongst people at large that if premature babies receive timely treatment, they can be saved and lead a normal life,”said Dr Tushar Parikh, Chief Neonatologist and In-charge of NICU at Motherhood Hospital.