Experiencing pregnancy and childbirth during the lockdown has been harrowing for several women in India. Take the case of three such women living in the slums of the M-East ward in Mumbai, a city with a vast network of public and private health facilities. After failing to arrange transport to the hospital, Anila and Varsha delivered their babies at home with untrained birth attendants. Anila went into labor unexpectedly, and although it was live birth, the baby survived for only a few hours. Varsha had complications that required an early delivery. When she arrived at the municipal hospital with her newborn in arms for a check-up, she decided to return seeing the large number of COVID patients being treated there. Pramila, on the other hand, admitted herself for an emergency cesarean delivery at a large municipal hospital but ended up being COVID-positive resulting in an extended hospital stay for herself and her baby.

All these cases point to late-stage complications, which could have been avoided by continuous monitoring throughout pregnancy, which these women did not receive. This corroborates the research findings that interruptions in routine services, due to priority for COVID-19 cases, have a devastating impact on maternal and child health. With government frontline workers either ill due to COVID-19, quarantined, or redirected to COVID-19 treatment, families are forced to consider the more expensive private care. Interactions with 1000+ families of pregnant women indicate that loss of wages has increased the financial burden for maternal and child healthcare, which has led families to skip routine prenatal and postnatal care, and even opt for home delivery. What they don’t realize is that the resulting complications of these practices often lead to catastrophic healthcare expenditure, pushing the family below the poverty line.

CareMother, a digital pregnancy care solution, offers a simple yet effective intervention to this critical issue. An AI-enabled innovation for early identification and management of high-risk pregnancies, the CareMother app allows health providers and mothers to track pregnancy symptoms and warning signs, and know when to seek institutional care. The pandemic urged us to think of newer ways to support mothers like Anila, Varsha and Pramila in their pregnancy journeys, while urging more women to get online. We are now adding digital tools such as:

A) ‘What not to miss’ for customized guidance on prenatal tests and immunizations at critical pregnancy milestones available through our app;

B) Gynecologist led guidance on pregnancy care during the pandemic;

C) Home care kit for mothers; and

D) Location specific listing of hospitals/clinics for pregnancy and delivery services, with a certification on their safety.

We are already leveraging platforms such as WhatsApp to reach out to a large number of pregnant women, to support them with information and advice. In the process, we hope to encourage more women to go digital, and take charge of their own health and well-being.

The post Pregnancy Journeys During the Pandemic appeared first on careMother.

Sadly, the principle that all human beings are equal seems to be limited in principle only. Can we bring life of dignity, beyond survival, to every human being? If yes, how can it be possible without ensuring quality healthcare to everyone which acts as a foundation for our very existence.

It’s with this larger vision in mind that the team of CareMother stepped into the arena of the healthcare delivery. Soon it was clear that a lofty dream of achieving equitable access to healthcare is not possible without special attention towards women’s wellness and care, as half of the total human population consists of them. Even so, the state-of-the-art healthcare services fall short to pay attention towards women’s health problems — let alone the problem of scarce healthcare coverage for women who come from resource constrained settings. This incompetence and inadequacy of healthcare industry compelled us to sharpen our focus towards the most prominent and impactful women health problem of all — the problem of enabling access to quality maternal and child care. To give you an idea of the gravity of the problem, know that out of over 3 million pregnancies each year only 21% receive basic checkups and counselling. Further, more than 60% of maternal mortality and morbidity is preventable through regular health checkups and timely treatments as per the research. Thus, we dove in the arena of maternal health with a mission to bridge the healthcare access gap and enhance its quality by making healthcare services personalised to individual women. It’s especially noteworthy that we are doing this in a time and space of private healthcare which is known for rampant exploitation and scarce availability because we have to ensure that social impact and our sustainability goes hand-in-hand.

Our baby steps towards helping mothers and babies began by working through partner healthcare organisations like hospitals, government bodies, and NGOs. At every step of the way we were careful not to let the technology aspect overpower the core philosophy: Understand what our mothers and babies need and make it accessible to them. Instead of copying our competition or being overwhelmed by our own technological prowess, we collaboratively worked towards building tailored solutions. After a few years of walking on this road, we have numbers to speak for themselves. CareMother has helped to triple the maternal healthcare coverage, halve operational costs, and bring down mortality to almost 50% of previous value. These numbers are obtained from 77 partner healthcare organisations from 11 states which have been able to provide healthcare service to 43000+ mothers till today.

CareMother’s scale and coverage so far

As we waded through these murky waters, the picture became clear that bridging access gap is only a small part of the entire spectrum. To have a wide and long-lasting impact, we had to think in terms of quality, affordability, accessibility, and personalised healthcare delivery. Even understanding the social angle became necessary for us as by empowering the women in the family and making her in-charge of decisions regarding her own health proved to be vital for us. This understanding also corroborates with the most common behavior trends observed by numerous market research agencies as below.

• 80% of household healthcare spending is done by women

• Working-age females spend 29% more per capita on healthcare compared to males

• Women are 75% more likely to use digital tools for healthcare than men

Source: https://hitconsultant.net/2020/02/12/analysis-digital-health-investors-femtech/#.XwRxUZMza3I

These insights have helped us define a motto with 3-Es to embark on.

1. Enable women with knowledge for wellness and care for themselves
2. Ensure women with access of quality healthcare
3. Empower women to make decisions about their own health

It was but obvious that CareMother alone wouldn’t be able to do everything that is needed to sail alongside these 3-Es. Thus, a platform strategy is adapted in which the collaboration with other ecosystem players to jointly enable access to quality women care & wellness services is possible. As a facilitator, CareMother’s real challenge in the future is to tightly align the core philosophy (Enable, Ensure, Empower) with the business goals of ecosystem players in such a way that anything that doesn’t obey this conjecture gets thrown out.

CareMother’s collaborative strategy for equitable health

We believe in testing and experimenting whether it’s products or our philosophy. In the quest to expand our vision to build upon our past work and acquire a larger dimension, we tested out our hypothesis by directly engaging with the real world. Our platform-first approach now has changed our growth model in a way that we can see hope for immediate scalability. The value offered by a larger platform with some free services to our already built network of healthcare organisations, doctors and caretakers is coming to fruition leading to an organic growth. We believe that the skeletal aspect of our vision is ready, and the blood and flesh will be created over it in coming time.

The post Dignified life through apt healthcare for women and families appeared first on careMother.

A similar trend will be observed in the healthcare sector too. The apprehension to visit a hospital, combined with the convenience of the home will exponentially increase the demand for home healthcare products and services. While the demand for products has already started to increase, the real expansion would take place once the provider access reaches home.

>> Trends in COVID – 19 VS Post COVID – 19

Recent trends suggest that the demand for home healthcare care products has increased. ‘There is a notable increase in demand for self-monitoring devices such as oximeters, diabetes monitoring, blood pressure monitoring, etc.

On the other hand, demand for services at home has reduced significantly as doctors, nurses’ phlebotomists, etc are discouraged within societies and containment zones. This has created several operational gaps as providers are unable to provide the best in class health outcomes to their patients. Both the diagnosis and treatment demand has taken a severe hit due to the lack of an ecosystem to enable complete care at home.

The demand for home healthcare services is likely to rise as soon as the situation under pandemic improves. This small phase of 5 to 6 months is likely to be followed a joint upsurge in demand for both products and services in the home healthcare segment. This will also be driven due to the emergence of new operating models; which innovators will develop to fill the infrastructure gap.

>> Need to create a link

Innovators will need to devise new mechanisms to engage both with the clinicians and the patients. These direct linkages may or may not involve the hospitals/ clinics. The idea will be to create hard and soft infrastructure, patient education framework, operating models, revenue models, and new treatment pathways with measurables health outcomes for a specific disease.

There needs to be a seamless integration between provider, clinician, patient, manufacturer, and payer, to enable the best outcomes. Home healthcare will play a vital role in helping clinicians in owning the disease. Chronic diseases present lucrative opportunities as adherence becomes a vital element of the long-term treatment outcomes.

Some innovators have already commenced their evolution in this space and will hold a definite advantage due to their early inroads. Some interesting use cases are presented below:

USE CASE 1: PREGNANCY CARE AT HOME BY CARE MOTHER

Care Mother’s pregnancy care at home is an ideal commercial platform that provides portable kits that can be carried by trained nurses. In addition, the nurses are equipped to educate patients, collect samples, and link virtual consultation remotely.

• The mother also has the option of using a self-monitoring device (BabyBeat). The reports can be shared with the doctor using email, WhatsApp, or in-app communication.
• It not only assists in increasing the fee revenue (5x revenue in comparison to virtual consultation) but does not lose out on the potential referral income.
• Doctors can provide better pregnancy care at home while being more productive (lower time spent on addressing minor queries as well as marketing additional services).
• Patients on the other hand get comprehensive care while enjoying the convenience of home.
• A simple on-boarding procedure for doctors and expecting mothers help in improving access.

USE CASE 2: POCKET ECG

With the advent of simple, convenient wearable monitoring technologies, clinicians are now turning to Long Term Continuous (long term Holter) monitoring due to the significant increase in diagnostic yield compared to the traditional 24/48-hour monitoring period. High-end pocket ECGs had also created a favorable referral model for clinicians. However, the biggest limitation was the fact that doctors did not have the time to continuously monitor the reports, and patients on the other hand got more anxious due to triggers created by the device.

Hence, a few players have created a between patients and doctors by employing intermediate cardiologists to validate trigger events. The use of devices, cloud, AI, and app-based monitoring is helping these companies in providing complete care to patients. In this method the Doctors’ productivity is optimized while patients can expect better health outcomes. 

USE CASE 3: DIALYSIS AT HOME

In-center hemodialysis is usually done three times a week for about three to four hours or longer each session. In-center treatments are done at a pre-scheduled time. Home dialysis not only provides convenience but also provides better clinical results. Due to co-morbidity associated with COVID-19, there was a significant rise in demand for dialysis at home.

However, the cost of treatment and the need for the nurse to monitor the device has limited access. Some providers aligned with innovative start-ups to quickly address this problem. However, there is still an opportunity to optimize these models.

CONCLUSION: OWNING THE DISEASE

While the market is flooded with innovative products that address a specific problem; they either provide incomplete home healthcare solutions or create a new problem. Hence, there is a clear need to develop end to end solution. Innovators can focus on treatments for a specific disease and create solutions that engage the patients from pre-diagnosis to the aftercare.

Home Healthcare will create a far bigger impact when offered as a complete service rather than an individual product offering. 

The post The “New Normal” will bring opportunities for innovators in home healthcare segment appeared first on careMother.

In September 2019, officers from the Central Health Ministry visited our Program site at ‘Lambkana Primary Health Centre (PHC)’ in Aurangabad, collaborating with Savitribai Phule Mahila Ekatma Samaj Mandal (SAFU), an NGO working with Hedgewar Rugnayala.

The review by Ministry officers was very motivating for our team! They were amazed by the standard practices followed by our health workers (ASHAs) to take care of pregnant women.

We are happy to share some of these practices:

1. The health worker registers a pregnant woman within the first 12 weeks of pregnancy.

2. At the time of registration, she performs her first prenatal check-up.

3. She updates new pregnancy registrations to the ANM (Auxiliary Nurse Midwife) daily.

4. She mandatorily uses gloves during every ANC check-up.

5. She opens the CareMother portable screening kit and begins by checking the mother’s weight on a digital weighing scale. She ensures that the scale is on a flat surface and the mother is standing still and looking straight.

6. Point-of-care random blood-sugar and hemoglobin tests: This involves a finger-tip prick. She uses the standard sterilized lancet for a safe and secure prick, wipes out the initial blood flow, and uses a drop of blood, first for hemoglobin, and then for the blood-sugar test. Both tests give results in 10-12 seconds.

7. Temperature: We have provided a digital thermometer in the kit. After completing the test, the health worker uses a sanitizer-wipe to clean the thermometer. 

8. Blood pressure: She asks the mother to rest on a chair for 5-10 minutes and breathe slowly. She uses a digital BP monitor and ties the cuff on the mother’s left arm.

9. Fetal Heart Rate: The kit includes a fetal doppler device that detects the baby’s heartbeat. She performs this test after the 22nd week of pregnancy. We have trained health workers to detect the baby’s heart position on the mother’s abdomen.

10. Urine test: She asks the mother to provide the urine sample mid-stream and provides a sterilized container for the same. The kit includes a urine strip necessary for measuring protein (for hypertension) and sugar (for diabetes).

11. While performing these tests one by one, health workers put the data into the CareMother app, and counsel mothers on the next steps for any high-risk conditions.

12. As per high-risk status, the application’s decision-support guides the health worker to either conduct more follow-up visits, or refer the mother to the ANM’s care, or to the PHC, or a higher center.

These practices have tremendously improved health workers’ credibility and acceptance of the intervention among families of pregnant women.

The post Standard Practices Improve Credibility of Grass-Root Level Pregnancy Care appeared first on careMother.

Most of the providers were in the process of creating patient-centric ecosystems that included the launching of apps, patient education /engagement campaigns (video, blogs, AI-based chatbots, etc.), unique IDs/ single truth applications, electronic health records, etc. 

In parallel, the med-tech and digital health platforms are working on self-monitoring devices, e-commerce, uberisation & aggregation of diagnostic labs, virtual consultation, etc. There is also an attempt to integrate all the offerings through a common platform to attain greater patient stickiness in this competitive environment. For instance, Apollo 24X7, myFortis, Max Myhelp have been attempting to bring all infrastructure under one umbrella.

Several start-ups engaged with providers to work on one or many components of this new model. The focus of most of these start-ups was B2C business models. Providers /physicians were only seen as influencers, resulting in an unclear operating model. A majority of the start-up failures can be attributed to this gap in the product/service offerings. Many companies also tend to underestimate the B2B marketing efforts, referral commissions, partnership requirements, usability, etc.

In addition, several players in the wellness sector are also trying to get a share of this pie by trying to align peripheral products and services to the clinical space. Some of the med-tech players like Curefit, Goqii, Wellthy, etc are trying to position themselves as providers of holistic care. These companies are struggling with the clinical acceptance of their products and services.

Even though the preventive market itself is growing rapidly, the lack of integration on the provider side is refraining them from their ultimate objective of providing holistic care. As a result of all these factors, there are several unused med-tech apps in every smartphone and most of the start-ups are restricted to local or provider-centric markets (with the exception of a few).

The convenience of the home is restrained by incomplete and inefficient care.

Home care has been broadly classified into pre-primary care and after care. In the pre-primary care segment, most of the leading innovation is focused on self-monitoring, home sample collection, symptom checkers, appointment aggregation, virtual consultations, and electronic health records. Many providers are currently engaged in creating enabling platforms and partnering with technology and device manufacturers for providing pre-primary care at home. Some of the aggregators are also trying to assist clinics and small hospitals in enhancing their access through digital engagements (e.g. Practo). 

After care sector on the other hand is far more evolved, as patient’s information, enabling equipment, nursing facilities, business models, etc are already available. Both large MNCs and local start-ups are creating devices portable and easy to use products for home use.

With the COVID 19, the reluctance to visit hospitals has significantly increased the demand for home care.

However, there are serious gaps that need to be addressed for complete care. In addition, platforms are not available to small and medium-sized hospitals/ clinics are not available. These hospitals form the core of primary care in India, where Doctors are still the decision-makers.

Challenges: How to provide clinic level care within a home environment?

In order to provide quality care in a home environment, all the components must adapt to the new normal. Currently, the virtual consultations and treatments are ineffective and inefficient because of the following key missing elements:

Access to equipment

Most of the equipment available in the market is designed for the hospital environment. While the point of care revolution is currently underway, the efficacy of these devices does not meet the clinical gold standards. Hence, in most cases, these devices are used as an additional tier. Further, most of these devices are not user friendly and require significant training.

Standardized equipment

Since, several players are selling products in a B2C environment, their efficacy and usage are in-consistent, thereby making the diagnosis and treatment difficult for the doctors. The patients also are confused about the efficacy of the products.

Monetization

Most of the equipment and service providers do not have a well thought out business models on the impact of new offerings on providers. For instance, the Virtual consultations only provide a fraction of revenue for the providers (it’s a small fraction of fee charged for consultation, diagnostics, referral income, etc.)

Patient records

In India, electronic health records are not yet available to the doctors in a different hospital. Hence, integrating the information provided by home care devices into the system is a major operational challenge.

Physicians’ perspective is ignored

India continues to be a B2B2C dominated market. However, the home care market is currently focusing largely on B2C. As a result, the doctors’ perspective in terms of revenue, usage, diagnosis, etc is ignored.

Hence, Home Care especially in pre-primary set-up needs to develop significantly to cater to its rising demand. Recently companies have been successful in providing complete solutions for pregnancy care at home (refer use case), long term arrhythmia, dialysis, etc. that can address the above-mentioned challenges.

Need of the hour: Complete solution for a particular therapy

These industry challenges also present a lucrative opportunity for innovators. An ideal solution would focus on a particular therapy area and comprise three qualities:

1. A complete platform that has clearly defined business models and outcomes for all stakeholders (doctor, hospital/clinic, patient, etc.). 
2. Enabling links with providers keeping physicians/doctors’ perspectives in mind. The enabling platform must cater to the specific/customized needs of each provider category.
3. Portable and easy to use equipment that requires minimum or no training.

Pregnancy care at home by CareMother is a good example of a complete service offering that addresses the requirements of all stakeholders.

Pregnancy care at home by CareMother

CareMother’s pregnancy care at home is an ideal commercial platform that provides portable kits that can be carried by trained nurses. In addition, the nurses are equipped to educate patients, collect samples, and link virtual consultation remotely.

It not only assists in increasing the fee revenue (5x revenue in comparison to virtual consultation) but does not lose out on the potential referral income.

Doctors are able to provide better pregnancy care at home; while being more productive (lower time spent on addressing minor queries as well as marketing additional services). Patients on the other hand get comprehensive care while enjoying the convenience of home.

Upcoming Blog in The Series: Opportunities for Innovators in the Home Care segment in New Normal.

The post COVID 19 – Expediting the Evolution of Home Healthcare Market Segment appeared first on careMother.

Small teams at Startups are no exception to this rule — where prioritizing healthcare safety of teams over the work is more important — we learned that the inherent lean & fail fast approach of the startup equips it with enough agility to cope up with major cultural shifts or product pivots.

In this light, it only made sense to write about our team’s experience at CareMother. CareMother is working towards making motherhood a happy and safe experience for mothers & their families. We have officially completed 5 years of startup journey in the month of March 2020.

That said, as a health-tech company, we could witness a rapid shift in consumer behavior to demand online & virtual care delivery services like never before. Our business needed to embrace and adapt to those changes quickly by reinventing product & business strategies. This in turn implies that there will be a change in job roles, business processes, and responsibilities for the team members.

Nevertheless, the last three eventful months of the lockdown have provided us with an opportunity to self-reflect, reflect about our team and consciously act upon certain priority aspects — to the extent that we all could re-discover ourselves. Of course, we might not be the only one team here as this pandemic could very well bring the best out of anyone, below are 5 simple but not-so-obvious C’s which our team has followed to outdo itself :

1. Confrontation

The anticipation of what is going to happen began even before the lockdown. Our team had a joint meeting to confront each other about the leftover work, failures, and expected impact of it. Even when no one had anticipated a long time stretch of working-from-home as such, everyone was prepared towards accepting the change which has inevitably come along the way.

2. Commitment

CareMother’s purpose is to contribute to enabling access to better pregnancy & child care services. With this thought process in mind, team members have cultivated additional skills and capacities to help partner hospitals provide better digital engagement and consultations to pregnant mothers. We now see how these efforts are slowly paying off after getting to know the positive testimonials from mothers & doctors. In a nutshell, the level of commitment our team has shown towards the purpose was simply amazing. One can access more detailed information about this work from this article: https://www.linkedin.com/feed/update/urn:li:activity:6662245369952505856

3. Compulsion

There are always certain aspects of making things mandatory to be more effective or productive. Hence, the reinforcement of the processes which simplify the coordination of work virtually pushes team members to become the best versions of themselves. Improved peer-to-peer communication, being concise over video calls, minimizing the frequency of meetings, respecting each other’s availability, etc. are some of the parts and parcels which have come along the way. For e.g one such process we introduced was to make it compulsory for everyone to log the exact time period required for doing a certain task on a daily basis.

Moreover, strict communication with external stakeholders — being partners/customers, etc. — about following certain protocols for onboarding patients, providing quality services, etc. has helped to a great extend. Needless to mention that this willingness was from both ends so as to be more effective & efficient in the respective tasks. Working with the ecosystem partners became a little easier in the period of uncertainty — as the healthcare delivery was going through digital transformation to be more getting matured and evolved. For e.g follow up calls with the first 50 clinics to increase utilization of fetosense product (A smartphone-based fetal heart monitor) has achieved approximately 30% monthly growth in the number of tests performed.

4. Cancellation

Extreme prioritization has proven to be very effective for cost reduction & extended runway. Work-wise, we quickly learned that not-to-do lists tend to be more useful than to-do lists. The entire energy of a focused team brings a self-multiplying effect, not merely because of peer-to-peer support and encouragement but because of the sense of a common goal. Defining a unit of success at an organizational level and encapsulating implicitly in the day-to-day work processes further amplifies this effect. One may have to cancel almost all un-aligned tasks in the pipeline to justify above heuristic in practice as multitasking is generally very hard to do.

5. Confession

Ultimately, the assessment of whether above 4 C’s are contributing towards increased maturity or productivity of the team was important. It was a bit evident in the first few weeks that the vehicle of team-spirit needed fuel of face-to-face interactions. Confessing about things which have worked individually and sharing them with each other was the key. Additionally, a confession about the lack of specific skillset in the team helped identify areas of improvement. Based on these insights, the decision of providing support for respective team members to work on their skillsets was easy.

All in all, the above paradigm made us realize once again that no matter how bad the situation is, a great team possesses an amazing ability to overcome. Even market trends, customer behavior change, etc. can prove to be the next big opportunity to try out something new. Needless to say that the most resilient teams with upgraded skill sets that will be standing after the pandemic era will be the ones that would have contributed a little in changing the world. And our team would like to be the one at the end!

The post An opportunity to outdo ourselves! appeared first on careMother.

We at CareMother, along with Larsen and Toubro Public Charitable Trust,
routinely provide antenatal care to tribal women in Talasari, who live in huge
disadvantages of cost, time, and distance. We serve pregnant women by our
‘doorstep’ care model, frontline workers, and real-time decisions via a smartphone application.

However, since routine antenatal services are closed down, and ANMs and ASHAs are busy in COVID screening, we brainstormed all possible ways to maintain a constant flow of services to pregnant women in this difficult terrain.

• A critical piece of antenatal care (ANC) is tetanus (TT) vaccination.

When ‘full’ ANC coverage in India is only 32% as quoted in the latest national health survey (NFHS-5), one can imagine the pressure of maintaining coverage in such hard times in a tribal area! So, we started listing the sub-center wise numbers of high-risk pregnant women, with pending vaccination of TT-1 and TT-2, and who were expecting delivery soon (in the following month), so that the newborn does not acquire the deadly disease (tetanus).

• We could obtain this information thanks to our back-end data (Cloud) and prior information entered by health workers in the CareMother application.

Empowered with this list, we contacted our local NGO partner and the Talasari Health department and they coordinated with the under-pressure ANMs and ASHAs to ensure that these vaccinations, at a minimum, are provided to women approaching their delivery dates. We played our part in their truly safe deliveries, and would continue these efforts!

• We believe that COVID-19 need not and should not interrupt routine antenatal services.

More so when pregnant women need good health and nutrition to boost immunity and fight all infections. We know that this is directly linked to a healthy baby, and it is our responsibility as a powerful digital platform to put all possible efforts to continue antenatal care.

Context: Talasari is a tribal municipal council in Palghar district of Maharashtra, touching the Gujarat border, just 140 km from Mumbai. CareMother program, with LTPCT and Zilla Parishad’s Health Department, started with two primary health centers (PHCs) to cover 1500 pregnancies, and in 2019, it has expanded to four PHCs to serve 3000 pregnancies, so far.

The post Ensuring pregnancy care during COVID-19 using CareMother technology in the tribal block of Palghar appeared first on careMother.

“How will Coronavirus affect me?” or “Hospital is not safe, shall I deliver at home?” – we are resolving about 100 such queries every week, over the last two months. Most of these queries relate to the mother’s and baby’s safety at the facility, not-to-miss tests, medicines, and myths around COVID-19.

From these interactions, our biggest takeaway is: ‘New Normal’ is going to require a hybrid nature of care i.e. essential visits at the clinic, routine care at home, and online engagement beyond the facility.

Are we ready for it? Here is a way ahead:

Some initiatives by hospitals and doctors during lockdown using CareMother technology:

• Medipoint Hospital in Pune used CareMother’s wireless and portable fetal monitoring solution for home monitoring and 15+ doctors associated with the facility could remotely monitor their patients.
• Gynecologists and counselors are getting online for virtual consultations as well as counseling sessions. CareMother started the “Don’t Panic – Protect” video series with Dr. Supriya Puranik which was viewed by 1.1 million people.
• CareMother along with some key hospitals started home care and WhatsApp group management in Maharashtra, Andhra Pradesh, Kerala, Delhi, and Chandigarh.
• NGOs and the Government delivered 1200+ teleconsultation for high-risk pregnant women. CareMother platform helped them to identify the list of mothers at high risk and due for immunization.

So do our practice and infrastructure allow us to achieve it? In the new normal how can we bring these examples together and offer complete care to expecting mothers?

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• Give it importance! Sleep needs to be prioritized. We have discussed more on this under the section called ‘Sleep Hygiene’ (below).
• Drink a lot of liquids during the day, especially water, but reduce liquids before bedtime.
• To avoid nausea, which can interrupt your sleep, try to eat bland snack items during the day like crackers or biscuits.
• Sleep on your left side to improve the flow of blood to your baby.
• Install a mild “night-light” in the bathroom instead of turning on the full light – this will be less arousing to your eyes and help you return to sleep. This is relevant because in pregnancy, you will get up frequently to pass urine and that will disturb your sleep.
• Add daytime sleep or short naps to compensate for poor night-time sleep, as much as possible.

Sleep hygiene:

The following points are important in pregnancy, as otherwise. One or more techniques may help you get better sleep, although every case of sleep deprivation is different and unique.

1. Know how much sleep you need. The recommended duration is 7-7.5 hours
2. Sleeping daily at the same time is critical to maintain the biological clock. Avoid bedtime procrastination, which means delaying your sleep time at night.
3. Set an alarm for the morning – at the same time daily – and get up at that time! This is critical, even if you had a disturbed or interrupted sleep the previous night. This ensures that your clock is not changed on a daily basis due to varying sleep times and duration and the brain sees its consistency.
4. A quiet bedroom is important. If there in unavoidable ambient noise due to TV, children, pets or outside noise, use a ‘white noise’ mobile application. Choose from nature sounds, meditative music or quiet ambient sounds. These have proven benefits in causing a sound sleep.
5. A dark room tells the brain that it is time to sleep. Keep your bedroom dark and cool. Reduce the brightness of your phone to avoid distractions due to notifications.
6. The best temperature for falling asleep is 16-18 degrees Celsius.
7. Use your bed only for sleeping. Use a comforting mattress and a blanket. 
8. Important: Keep the clutter away such as laptops, phones, tablets, TV remotes and chargers. Any kind of electronic distraction is against sleep hygiene! Perhaps the only useful item is the AC remote!
9. You may be tempted to use gadgets but try not having any screen time for an hour before sleeping. 
10. Follow a bedtime routine such as turning off all electronics, taking a warm bath and/or reading a book before sleeping. This helps the brain adapt to a predictable ‘cycle’ before falling asleep.
11. Avoid heavy meals before sleeping. They may make you feel “full” but they can cause a disrupted sleep in the middle of the night.
12. Staying hydrated during the day is very important for a good sleep later at night. But avoid lots of fluids soon before sleeping as it may cause increased urination that is common in pregnancy, which can disturb your sleep!
13. Coffee and alcohol intake should be reduced. Coffee should be avoided between 4 pm and 10 pm as latter-day caffeine levels in your blood can interfere with your night sleep.
14. Light exercise will physically tire your body by the time you are ready to sleep. Brisk walking in the evening is an example. But avoid strenuous exercise, especially 3 hours before bed-time.
15. Getting sunshine is equally important to set the biological clock and tell the brain that is time to be awake (not the artificial light of electronic devices!). So, try for a morning walk to combine physical activity with sunshine. This will energize you for the day and tire you by evening for a timely sleep at night!

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A C-section is a major surgery involving a surgical cut (wound) and a suture to close the wound. In all likelihood, you will feel pain in your wound for the first few days and discomfort in your tummy for at least the first seven days after the operation, while your body recovers. This may affect your daily activities. In some women, abdominal discomfort may last for a few months.

Infection

Infection can occur in three locations: a) the surgical wound, b) the uterus and c) the urinary tract. 

An infected surgical wound can become red, may pain, or discharge a liquid, or at times, may separate causing intense pain and discomfort, especially in the case of a pregnant woman with diabetes or who is overweight. Infection in the uterus can lead to bleeding, smelly discharge, or a fever after delivery. Infection in the urinary tract may occur due to the thin tube called urinary ‘catheter’ inserted during the C-section and left for at least 12 hours after the surgery. This can cause lower abdominal or groin pain, high temperature and chills. However, it is uncommon to get this infection if you deliver in any major hospital with standard precautions taken by doctors.

Bleeding

C-section leads to MORE blood loss than a straightforward delivery, although one may perceive the opposite. This is because, it is a major surgery. Bleeding will mainly occur during the surgery so it will be controlled by the attending doctor and the medical team. Rarely, a blood transfusion may be needed in case of heavy bleeding.

Blood clots

Any surgery can cause blood clots. These are normally removed but at times they may lodge in certain places such as your lungs, which can be life threatening. You may experience cough with shortness of breath, or pain and swelling in your calf, so call your doctor if you notice these things after your C-section. In any case, post-surgery, the doctor will give you drugs to increase blood flow (and lessen the chance of clot formation) and elastic stockings to improve the circulation. It is also important to move about as much as possible, after the C-section to increase blood flow in the limbs.

Adhesions

As you heal after undergoing a major surgery, bands of soft tissue may glue the abdominal organs to each other or to the inner wall of the tummy. These are called adhesions. These are uncommon and may not cause symptoms but in severe cases, they can cause problems with bowel movements or in fertility if they impinge on neighboring organs (e.g. such as the intestine in case of bowel obstruction).

Effect of anesthesia

You may experience a severe headache, or rarely a nerve damage (lasting for a few days or weeks). 

Surgical injury

Although rare, injuries to the bladder or bowel may occur. 

Risks to the baby

These are minor such as temporary fast breathing during the first few days after birth (in some babies) or an accidental cut to the baby’s skin during the surgery, which usually heals without causing any harm.

Risk in future pregnancies

There is a likely risk of low-lying placenta or placenta previa, or another condition where the placenta becomes abnormally attached to the wall of the uterus (placenta accreta) This can lead to significant blood loss during childbirth and a need for blood transfusion. There is a rare possibility of the uterus tearing open along the surgical scar line from a prior C-section (uterine rupture) if the woman attempts a vaginal birth the next time. This is rare as in most cases, the next delivery would have to be done through a C-section.

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