Expert Empathy - DR Lakshmi Ratna

A common problem that pregnant women face these days, the rate of miscarriages in pregnancy has gone up to almost 15-30% in present times. And while one miscarriage needn’t be given much importance, it’s not just the trauma of the loss of her baby that a woman goes through. Throwing light on this issue along with others is Dr Lakshmi Ratna, Senior Consultant at Apollo Cradle.   

Tell us a bit about your experience in the medical field.
Eariler, I was the Head of Department at Fernandes Hospital, and now I am a Senior Consultant at Apollo Cradle. My passion is on the clinical side – looking after my patients. It is not only the sympathy, but empathy and understanding of their problems that is important to me. This had been my wish right from my school days; I either wanted to become a teacher or do medicine. There were no other alternatives for me; I was so certain.

I completed my MD in ‘84, and then went to the UK to do my laparoscopy and endoscopy training. I had the opportunity to undergo a special advanced training course in ultrasound with Professor Campbell, who is the top person for ultrasound studies in London. It was a wonderful experience. I then trained at Kings College, for ultrasound. After this I went to Sheffield where I underwent training in microsurgery, before I returned to India to pursue my career.

You are known for treating women who undergo the trauma of multiple miscarriages. Can you elaborate a little on this?
My speciality is in recurring pregnancy loss. Especially in those women who undergo lots of miscarriages. When a woman has a miscarriage, she is dealing with more than losing a baby. Women are so mentally vulnerable that they often want to commit suicide. They harbour feelings like not being useful, just because they cannot give birth to a child. As a doctor I listen to them patiently, almost like a therapist, since they need to be heard. So I understand their issues before reassuring them and considering the problem in detail.

I first talk to the women before opening any files, then come to a diagnosis and see if I can do anything to help. There are situations when everything is okay, but women can’t carry on their pregnancy. There are certain anatomical defects like problems with the uterus or cervix, genetic issues, hereditary, hormonal or even chromosomal problems that can be the reason. We must assess which group the women fall into, and then work out the best solution for them.

I also specialise in the procedure of abdominal cerclage. I get a lot of women from all over south India who come for this procedure. It’s very rare and is only performed by very few doctors.

Is there any way for women to avoid having a miscarriage?
If one miscarriage happens, it needn’t be given too much importance. 15-30% of pregnancies end up in miscarries; since only one single cell turns into a human form, it has to multiply a lot. In the process, there are certain steps that can go faulty, and even one small step can result in a big problem, and in turn become a bigger problem later on. Nature has a way of weeding out abnormal babies by doing spontaneous miscarriages. Many women end up having miscarriages before their third month. If a woman undergoes one miscarriage, there is no need for a hue and cry. But if the couple is interested, we still do a complete evaluation. But after two or three miscarriages, we definitely need to look into it further, to see what could have gone wrong.

Can a woman have a normal pregnancy after having several miscarriages?
Yes, if it is something to do with the baby or another cause. If it is a genetic or chromosomal cause of the parents, then it is likely to repeat. If it is related to the baby then it is not likely to repeat. This can be found out by examining the material, which we evaluate thoroughly. If it is a uterus or cervical incompetence problem, there are steps that women can take to keep the problem from recurring in the future.

Women go through a lot of trauma and stress while dealing with a miscarriage. What is a good way to counsel women and families who’re going through this?
She should have a good rapport with her doctor. Doctors should also have good empathy and try to help the women in many ways. Lot of counselling is important; we need to boost their morale and try to understand their problems. The woman needs to be mentally and physically prepared for it.

“I first talk to the women before opening any files, then come to a diagnosis and see if I can do anything to help. ”You also specialise in premenopausal problems.

Tell us a little about this.
Premenopausal problems can be looked at in two ways – in rural and in urban areas. In the latter, women approach doctors if there are any issues. However, in rural areas these symptoms are accepted as a way of life. They believe, “I don’t have to go to the doctor.” Some of the symptoms are lot of sweating, feeling warm; they come because of a change in hormones. Suddenly women feel very hot, and then very cold; that’s the first symptom. But the most important thing – apart from mood changes – is that bones and muscles start weakening. Bones, because calcium is important, and when oestrogen levels drop, bones need support. Muscle and join pains are also common. The silent killer is oestoperosis, where bones become brittle and even a slight fall causes problems. Quality of life is affected. Urinary tract problems also are common. In urban areas, vitamin D deficiency is also common. In rural areas, middle aged women neglect their diet, since they don’t have any big goals for themselves once their children leave the home. People should be aware that these are all symptoms that can be addressed.

Any tips on how women can deal with menopause?
For the premonpausal age group of women, from 35 onwards, it is crucial to improve their habits and make lifestyle changes. More exercise and physical activity is the number one priority. Even if it’s a small thing like dancing at home with music; something that’s feasible. There are 24 hours in a day. It should be possible to give yourself one hour of total me-time to improve your health. Concentrate on physical exercise and mental health.     --- as told to Suneela