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Dr. Vijaya

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As the new batch of would-be mothers and dads join our Healthy Mother childbirth education classes, more than a few mothers have come up to me or have called me with a myriad of questions. One such call was from a first time mother-to-be, who wanted to find out how our program could help ease her fears regarding childbirth; more importantly she also said to me: “Why are you against the use of epidural if it can relieve the pain?” and “I have heard that Lamaze really doesn’t help (during labor)”. I called her in to meet with me and explained to her the Lamaze philosophy. I told her that Lamaze is not just a “breathing technique”, but a source of knowledge and information that she could use to empower herself in order to make informed choices about her pregnancy and childbirth. By the end of her discussion, she was convinced and is looking forward to start her classes.


As I finished this discussion, I thought I would write about how Lamaze “really” helps women give birth with confidence. The Lamaze philosophy and the Six Care Practices that Promote Natural Childbirth are fundamental to the organization’s efforts to prepare women and their families physically and emotionally to give birth normally. “Breathing” which was once the hallmark of Lamaze (which was what the expectant mother who was questioning Lamaze’s efficacy was referring to), is now simply one of the many different techniques that women learn and have in their “labor tool-bag” to help them in the exciting journey of giving birth.


In a position paper titled “Lamaze for the 21st Century”, Lamaze International has presented a wonderful reorganization of thoughts that ultimately helps parents in understanding how and why Lamaze is so effective in promoting, supporting and protecting natural childbirth. Hand-in-hand with its six care practices, Lamaze talks about:

Reframing Pain: Pain is protective – By responding to labor pains with physical movements and position changes, the mother actively helps her baby descend down her pelvis. This process, by which as she moves a little her baby moves a little, also helps to protect mom’s body. As the pain increases, women also find that they have energy and strength to cope with the stronger contractions because of help from nature’s narcotics – endorphins, which are released during this stage.

Rethinking Relaxation and Breathing: These two techniques are wonderful tools to decrease the perception of pain and are fairly simple to learn. Women in Lamaze classes are shown a variety of breathing patterns; however, they are encouraged to find a pattern that is comfortable to them. As each woman has her own way of dealing with pains/discomforts, many women prefer breathing and relaxation techniques a part of the larger gamut of rituals that they can use to decrease their pain perception in labor and to actively release tension when they can.

Retiring the Coach: The person who supports the mother during labor, be it the doula or her husband, is just that – her continuous source of encouragement and support. They are not present to take charge and run things for the laboring mother. Although there might be times when they need to “coach” her through a particularly difficult contraction, more often than not, they are her best source of calm and gentle support that she knows she can fully depend on. They also become her advocates during labor, so that they can help her with any decisions that she may need to make in the course of her labor.

Reshaping the Birth Environment: Lamaze classes provide information and encourage expectant parents to find a birth environment where staff shows empathy, one that provides the mother confidence, space and continuous support and where medical interventions are as minimal as possible. Environments where birthing balls, rocking chairs, showers etc, promote comfort for the laboring mom. Where ultimately, with a truly supportive environment, the mother is able to achieve a fulfilling birthing experience as well as outcome.

Respecting the MotherBaby Connection: Lamaze classes encourage the mother to keep the baby close from the moment of birth, to breastfed within the first hour of birth and also sensitize them to the amazing capabilities of their newborn. Finding hospitals that respect this mother-baby connection and those which actively promote this bond, is extremely important in the first few hours of the newborn’s life, as well as influences early parenting.

Reclaiming Normal Birth: The goal of Lamaze classes is that every woman is entitled to give birth confidently, supported by her family and health care professionals. Lamaze classes (such as those conducted by Healthy Mother) reinforce the fact that a laboring mom has great inherent strength, the wisdom and the ability to give birth naturally, and assists her (as per her needs) to achieve her goal of normal birth.

Finally, I think that the position paper’s conclusion really emphasizes how Lamaze classes and Lamaze Certified Childbirth Educator help the mother to give birth with confidence: “Birth does not change, but over time the environment in which birth takes place has changed. Our understanding of both the simplicity and the complexity of birth deepens. As a result, Lamaze preparation for birth has evolved and will continue to evolve. The Lamaze Certified Childbirth Educator promotes, protects and supports every woman’s right to give birth confident in her own ability, free to find comfort in a variety of ways, and supported by her family and all members of the healthcare team.”

Please find the link to the entire paper here

As always, please do write in your comments and questions.

Dr. Vijaya

Wishing All Mothers and their Families a Very Happy, Healthy and Prosperous 2009.

The year 2008 was exciting for Healthy Mother, as we started our Lamaze and fitness classes for would-be mothers and new moms. I am happy to inform you that two weeks ago I was awarded the Lamaze Certified Childbirth Educator (LCCE) certification by Lamaze International.

Along the way, in 2008, we were incredibly fortunate to have met with a number of people who have enriched our lives and those of our program participants. These include doctors who are willing to give natural birth a chance, nurses and hospital staff who show incredible empathy for mothers who want to give birth normally, often against unwritten hospital policies, NGOs working tirelessly for the welfare of pregnant women and newborns, journalists who are not afraid to highlight the worrying trend of increasing, unnecessary c-sections and the medicalization of childbirth, and last but not the least, those hundreds of would-be mothers, their spouses, and families who were determined to follow nature’s simple plan for birth.

We dedicate 2009 to all the above, and also to those thousands of childbirth educators worldwide, who like us, are working hard to effect this movement of change, literally one mother at a time.

So here’s wishing all of you a very Happy, Healthy, Safe and Prosperous 2009.

Dr. Vijaya Krishnan

Recently I had the opportunity to read most of the 128-page report published by Childbirth Connection (www.childbirthconnection.org) the non-profit maternity care research and advocacy group, Milbank Foundation, a non-partisan endowment working in the health care field, and the RSG, a voluntary association of legislative leaders and policy makers in the US. Here is the link to the report – http://www.childbirthconnection.org/pdfs/evidence-based-maternity-care.pdf

The report is an excellent one, and gives credence to what maternity and newborn advocates have been saying for many years – procedures and practices which have been repeatedly known to cause harm, and which has been recommended to be used only in limited circumstances are today widely in use, and are often routine in most hospitals. As I kept reading, I could not help wonder that if the US health care system, with its watchdogs and numerous checks and balances can receive such an indictment then what are the implications for India, where advocacy is almost non-existent, and many hospitals have almost 80% c-section rates?

The report mentions that US hospital charges for maternal and newborn care in 2006 were $86 billion, a nearly 9% jump from 2005 figures. Of these, unnecessary c-sections took up $2.5 billion, representing almost 33% of all US deliveries. Further, I was surprised to note that a 2008 study conducted by Agency for Healthcare Research & Quality (AHRQ), looked at 2005 data and concluded that childbirth in the US was the leading cause of hospitalization, surpassing heart-failure, cancer, and stroke. Maternity care (pre and post-partum visits) was the third-most frequent reason for all outpatient visits. Further, at $79 billion, cost of hospitalization with respect to maternity care (women and new born) was by far the largest component of health care costs in the US, according to the same study conducted by AHRQ.

Private insurance paid 51% of costs of hospital stays in the US, with government Medicaid picking up 42%. It was also surprising to note that going by 2005 data, 49% of all hospital procedures done on the 18 to 44 year-old population were related to childbirth. Six of the 15 most commonly used procedures done on the entire US population involved childbirth, according to AHRQ. Some of these include medical induction (2nd), c-section (7th), fetal monitoring (13) and artificial rupture of membrane (14th).

So what does this mean to us in the Indian health care context? I would love to read such a report prepared for India that captures some of the same facts in the above report. I encourage anyone interested in creating such a research finding to get in touch with us so that we can collaborate or point us to good, existing  research data. I know of two not-so recent research studies, one conducted in Delhi and one near Chennai.

I would also imagine insurance companies, both government and private payers, would be interested in knowing where their money is being spent and how. Evidence-based research has shown repeatedly that physiological approach to childbirth without routine intervention provides the best outcomes for a healthy mother, and for her baby AND is less expensive for insurance companies, specifically by avoiding costs involved as a result of technology-led interventions, and post-partum issues that occur because of c-sections. I invite responses from Indian insurance company stakeholders on what their company’s view is. It would be interesting to note their take on the issue.

We at Healthy Mother believe in the power of physiological approach to childbirth and in the natural ability of a woman’s body to give birth without external intervention in most cases. In our classes we reinforce this confidence in the minds of women and their families and follow evidence-based practices that facilitate a fulfilling and healthy childbirth. It is our belief that a system that promotes normal childbirth with continuous labor support in the form of midwives/trained labor support personnel, and one which relies on medical intervention only as a backup, is more beneficial to families, society, and to the entire nation as a whole.

As usual please send me your comments…

In most of my labor and childbirth classes at Healthy Mother, moms- to-be are concerned about whether their baby is getting sufficient nutrition from their diet alone. At the same time, some of you are concerned about excessive weight gain during pregnancy. Both of these concerns can be taken care of, if you follow a well- balanced diet everyday.

As your baby’s nutritional needs increase during the final growth spurt of the last trimester, you may be more at risk for developing nutritional deficiencies. Since nature intends that your baby’s extra nutritional needs are met before your own, you have to make sure that whatever food you eat is nutritious, and at the same time, provides the extra calories that you need. Also, the baby gains maximum immunities from the mother in the last trimester, so eating healthy will also lay the foundation for your baby’s good health in the long run.

In the last trimester, including sources of calcium and B vitamins in your diet becomes very important. Some good sources of vitamins B6 and B12 are:

  • Fortified bread ( I find that “7-Must” bread available in most Indian stores is a good source)
  • Brown rice
  • Baked potato (with skin)
  • Bananas, prune juice, carrot juice
  • Nuts (and peanut butter, for those who like its taste)
  • Chickpeas (Chana)
  • Fortified cereals are a great source of B-Vitamins. For those of you, who are concerned about excess weight gain, try a low-fat cereal (such as Kellogg’s Special K) with Slim Milk. This will give you the vitamins and calcium, minus the extra calories.
  • Eggs and dairy products
  • For non-vegetarians: beef, pork, lamb, fish and poultry can complement your food intake.

Some good sources of calcium are:

  • Dairy products. Yoghurt is an especially good source of calcium.
  • Paneer, soyabean and tofu
  • Almonds and other nuts
  • Sesame seeds
  • Figs (ripe or dried) are an excellent source of calcium.
  • Calcium is also present is small amounts in green leafy vegetables and oranges

In the last trimester, some of you may experience discomforts from bloating, constipation or heartburn. Eating foods rich in fiber, such as bran breakfast cereals, dried prunes, apples with skin, rice, whole wheat rotis, etc. can ease some of these discomforts. Also, eating small meals, at regular intervals, can help ease heartburn.

In the end, focus on getting servings from all food groups. One way of looking at good nutrition is by “Making your plate as colorful as possible”. By all means, grab those occasional French Fries if you crave for it. However, the best way to ensure that you don’t put on too much weight while you are pregnant is by eating sensibly and by keeping as active as possible.

As always, do write in your thoughts, queries and concerns.

Dr. Vijaya Krishnan

When did you realize that you were pregnant? Perhaps you missed a period, or maybe you were feeling extraordinarily lethargic, or perhaps you felt that there was something “just different” going on with your body.

Once you confirm that you are pregnant, you may have started observing your body closely. This is just one of the many ways that you will navigate this entire journey called pregnancy. Being mindful of your body’s needs and responding to it, becomes vital to having a healthy and enjoyable pregnancy.


Even before your embryo (this is what your baby is called at eight weeks) implants in your uterus, your hormone levels start to shift. A hormone called the HCG (human chorionic gonadotropin) hormone, which is detectable using pregnancy tests, starts to rise. These hormonal shifts along with your growing baby change your body in amazing ways throughout your pregnancy.


You may experience nausea in the mornings – about two-thirds of all pregnant women do. Thankfully, it does go away somewhere between the third and fourth month. Think of this nausea as wellness insurance as described by one researcher. Pregnancy nausea protects the mother and the baby from harmful chemicals and food-borne illness. Conversely, her cravings may be for foods that are rich in nutrients in order to develop a strong and healthy baby. What can you do? Eat small, regular meals that are comforting and easily digestible. Most of the expectant moms in my program tell me that carbohydrates seem to work for them to quell the nausea, at least temporarily. You can also try tangy or salty foods.


You may also experience extreme tiredness and or mood-swings. Listen to your body and rest when you can. One mother-to-be told me recently – “I would wake up at 7:00 a.m. and be ready to be in bed again by 9:00 a.m.” It is okay to rest – the earlier you respond to your body’s signals, the more likely you will feel rested and ready to take the next steps with your baby in this wonderful journey of the next 9 months. I will talk about C-section in my next post, as this is the one topic that is topmost in the minds of would-be-moms in my program.


I invite you to share your experiences, thoughts, questions and concerns in this forum.

Dr. Vijaya Krishnan

Our older son turned 10 the other day. Phew!! it has been an exhilarating, and fulfilling 10 years.While I was carrying him we did not know much about what childbirth entailed, both from a physical and psychological perspective. Though our doctor and nurses at the Southern New Hampshire Medical Center (in Nashua, NH, USA) were very helpful, actually experiencing those emotions and physical changes was nothing like what we had heard and read (especially in books such as “What to expect….”).

After our older one was delivered via emergency c-section, I was determined to have our next child the normal way. Believe me, it took a lot of effort in terms of being mentally and physically prepared. But I finally succeeded with our younger son. We now have two adorable and active kids who are a constant source of joy.

As I started to practice physical therapy again after our older son was born, I had a chance to work a lot with mothers-to-be. That kindled an interest in applying my training to helping would-be-mothers to prepare for the childbirth process and to help them understand that it is a normal process.

All expectant parents want the same thing: a healthy baby. But, what are the steps to having a healthy baby? The Healthy Mother(TM) Program believes that a healthy baby begins with a healthy pregnancy and normal birth. It builds upon the well-established principles of Lamaze International to promote, support and protect normal birth through a mix of hands-on wellness programs, as well as by providing reliable, vital information to expectant parents about what is perhaps the single-most important event in their life.

Childbirth is a wonderful, joyous journey. When parents are prepared and well-informed about this natural process, the woman’s confidence in her ability to go through labor and childbirth increases dramatically, and she is able to enjoy this incredible phase in her life!

Watch out for my next post on early pregnancy. Until then, feel free to join in, and discuss anything that’s important to you about your pregnancy and childbirth. Share your experiences and ask questions. I will try to answer as accurately as possible.

Dr. Vijaya Krishnan