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When and How to Push during Labour & Delivery?
Pushing in labour forms the second stage of labour. This phase occurs after the cervix dilates completely and the head is ready to exit the birth canal. A well-synchronised pushing effort by the mother enables a smooth passage of the baby.
This article shall help you understand the science behind pushing during labour and things to be careful about.
How to know when to push during a delivery?
Complete cervical dilation marks the end of the first stage of labour, and with this begins the second stage, wherein you are ready to push your baby out. The baby’s head when ready for delivery at the vaginal canal can be perceived as a natural indicator for a woman to exert pushing force in her lower body region. The urge is so strong that pushing becomes a natural and necessary response for relief.
Increased pelvic floor pressure, heaviness in the genital region, amplified blood circulation together trigger the active stage of labour.
Contractions while pushing
In the active(pushing) stage, the fully pregnant uterus contracts strongly every five minutes, each lasting for 45 to 90 seconds. It might not be easy to identify true contractions. Contractions are usually forceful and may or may not be associated with a desire to push. It certainly feels different when your baby travels down the birth canal. At this moment, stay calm and let nature welcome your baby into the world.
How Do You Feel When Your Body Urges You To Push?
With the baby’s descent, mothers’ feel the weight and a strong urge to push sometimes even before they are fully dilated.
It is important that your baby gets delivered safely rather than quickly. Each stage of labour takes its own time and is necessary for nature’s process to complete. Usually, women in the pushing stage may feel various types of urges:
Strong urge: An uncontrollable urge, a feeling like your body is experiencing the baby coming. It is hard to resist. A gravity neutral position may be helpful in this situation.
Normal urge: Women may feel like pushing with every contraction or at the peak of contractions. It can be best controlled by changing the position and breathing until you feel a strong urge.In selected cases, the baby may just move down easily and you will not experience any strong pains.
Absent urge: It is possible that a woman may not feel any urge to push. Time and position are critical here. If dilatation is complete for more than 30 minutes following which, one may consider an instant urge to push by herself or direct pushing that is directed by another person.
How Long Does Pushing Take During Labour?
The pushing stage lasts up to a few hours in women giving birth for the first time. And in those who are giving birth for the second or subsequent times, the pushing stage can last for as less as 10 minutes. In general, it can take a few minutes to some hours. The pushing time varies depending on the following factors.
First delivery or subsequent delivery:The pelvic floor muscles are tight if they have never been stretched to accommodate a baby. Stretching is slow and steady, and therefore takes time. If it is a subsequent delivery, it will take lesser time to push out your baby. Women who have had multiple deliveries can push just once or twice because the muscles have already been stretched out previously.
Pelvic structure: The anatomy of the pelvic apparatus varies amongst different women. An ideal shape is an oval-shaped pelvis. Some pelvic outlets are small but most babies manage to pass through them. In rare cases, the pelvic outlet is too small for the baby to get delivered. Such cases of disproportion usually prolong the delivery and might be associated with birth complications.
Baby Size: A few babies have large heads, with oversized cranial bones which overlap on each other during delivery to accommodate through the birth canal. In such cases, the baby’s head may be elongated and termed as a “caput”. This usually normalizes sometime after birth.
Alignment of foetal head and the pelvic apparatus: The normal position of the baby during a vaginal delivery is head as the presentation, with face towards the mother’s back or the sacrum. This is termed as the anterior position.
In certain cases of vertex presentation, the baby may be facing towards the pubis, the posterior position, which requires manual rotation of the baby while delivering.
Labour force: It is the effort with which the mother pushes the baby out. Uterine contractions are vital for cervical dilatation. Without any of the two, delivery isn’t possible naturally. Synchronized contractions with adequate dilation facilitate a smooth delivery.
How to push during labour?
There are two types of labour pushing techniques:
1.Coached Pushing: Coached or directed pushing is where you are directed how to push during the delivery by your health attendant or midwife, once your cervix is fully dilated. It is carried out irrespective of whether you feel any urge to push or not. Few experts believe that coached pushing may be hazardous to both the mother and the baby.
2.Spontaneous Pushing: This is considered to be a safer and more natural way of pushing during labour. In this method, the mother starts pushing only after she feels the urge to push out the impending baby through her vaginal canal for relief. This method is advised and preferred by doctors, and it is also documented to be safe by various competent authorities.
How is coached pushing done?
The second stage of labour begins when the cervix is fully dilated to 10 centimeters and goes until the delivery of the baby. This phase may go on for hours and this is when the coaching takes place.
Taking a deep breath before each push or contraction, you should bear down the pressure, keeping the muscles of your abdomen taut. The effort is similar to that felt during hard stools.
Pushing can be done to a count of ten. Two to three pushing efforts for each contraction may be adequate and fruitful. It is important to coordinate pushing with the baby’s descent in order to prevent tearing.
Why is coached pushing done?
A prolonged second stage of labour might be detrimental to the baby’s survival. Coached pushing helps reduce the duration of the second stage. Hence in indicated cases, it is now widely applied in deliveries around the world.
Prolonged second stage of labour can be estimated as per the guidelines of the American college of obstetricians & gynaecologists. It states that a second stage more than three hours without epidural, and two with epidural is prolonged for primi mothers. While it is 2 and 1 hour respectively for multigravid mothers.
There are recommendations to go for a C-section, assisted labour techniques like vacuum or forceps if the second stage is prolonged. It may be managed without intervention if both the mother and the baby are comfortable. However, coached pushing is advisable in order to avoid intervention and a prolonged second stage.
Pros and Cons of coached pushing
According to a 2006 study, which assessed about 300 women undergoing normal delivery without epidural anesthesia, found that there wasn’t any significant difference in the pushing stage of both, coached versus spontaneous pushing groups. Neither the mother nor the baby had any significant benefits according to the study.
A higher risk of urinary problems was reported previously by the same research team in women who were offered coached pushing. Spontaneous pushing did not have any adverse effects reported.
Coached pushing was also associated with one or more of the following:
Higher likelihood of episiotomy or perineal damage.
Mothers’ had a higher risk of damage to pelvic tissues and/or urinary apparatus.
Exhaustion and malaise in mothers – the push takes up plenty of energy needed later when you have an urge to push.
Features suggestive of foetal distress.
Higher requirements of C-sections and assisted deliveries.
How is spontaneous pushing done?
In this approach, you are allowed to push only in response to the contractions and urge you feel from within. It is a more natural way of facilitating delivery by the mother. You may follow these steps:
As contractions start, breathe deep and complete, while preparing yourself for the pushing efforts.
Continue breathing with each push. It is normal if you are making loud grunting noises. You should keep breathing every five seconds until the urge is no longer felt. You shouldn’t be holding your breath for long.
When the contractions are over, relax while breathing easy and awaiting the next contraction for you to sync while you start pushing.
When the urge is felt again, you may start to push for a few seconds during the peak of contractions.
As the baby’s downward movement occurs and pressure on the pelvic floor increases, you will want to push more frequently and strongly during contractions.
Pushing the baby out in Labour With an Epidural
Epidural anesthesia will numb your pelvic region and this will greatly affect your efforts. Without a sensation in the pelvic area, an urge to push is difficult to perceive. It is scary for first-time mothers’ as they aren’t used to it. At this point of time, if your cervix is felt to be fully dilated on a PV, you will be asked to push. If it is the correct time, there may be some pressure felt on the pelvic floor.
One should watch for the contraction to peak and then push to sync with the uterine contractions. The baby’s position may also be determined at this stage. The effect of epidural may fade off in certain cases, giving the urge to push again. If the birth canal is adequate for the baby and the contractions persist, the baby will constantly keep moving down and out. This is also referred to as labouring down.
It is advisable to acquire and get into a suitable position to push. It is to be done at regular intervals, thrice per contraction or whenever the urge is felt. You might be tired in the procedure and may take intermittent rest.
Best Pushing Positions During Labour
Various positions have been advised in order to aid a safe delivery. The tense abdominal muscles significantly help the uterus to push out the baby.
The position you take has an important role to play in progressing your labour, especially sitting and squatting positions, which is aided by gravity. If you are delivering too spontaneously, you may try some other positions, like lying on a side or getting on your hands and knees, to neutralize the effect of gravity.
Squatting position: It helps widen the pelvic region to its maximum width, that is up to one to two fingers width. It also requires less bearing down to push. Gravity has a significant role to play. It’s quite helpful to mothers with no urge to push. It helps Improve baby’s descent in a difficult delivery.
If you find squatting position difficult, you may try a semi-squatting position on a stool or heap of cushions or pillows. Birthing beds with pre-fitted squatting bars that are comfortable are also available.
Sitting Position: This position provides good rest. It is usually done with foetal monitoring attached. Gravity plays a key role. Leaning forward is permissible, which helps the woman relieve a backache.
Semi-sitting or Upright Position: Gravity again helps here. You may try pushing against your partner’s hands kept against your lower back by tilting motion of the pelvis. It helps pelvic cavity to stretch to its maximum width. This can be done with the foetal monitoring alongside. It also is a relaxing position. In this position, a vaginal examination is also made easy.
Getting on Hands And Knees: Gravity isn’t dominant and therefore a quick delivery is prolonged. It may help relieve back pain by correcting the baby’s alignment. It helps turn the baby from the posterior position.
Lying on One Side: Provides good rest and permits vaginal examinations. This position may be done with foetal monitoring. It could help avoid an episiotomy.
You may try individual positions and choose a comfortable position.
Techniques for Breathing while Pushing
Breathing adequately will let you be in comfort and avoid distress. Correct breathing will ensure efficient muscle contractions. You will acquire the adequate oxygen supply for subsequent contractions.
Mouth open and jaw flexed: For adequate abdominal and perineal muscle contractions, you should keep your mouth open and jaw flexed. This also helps increase the volume of air taken in while breathing.
Place your hands on the fundus: Keep your hands on the highest part of your abdomen. This will facilitate the pushing down efforts.
Breathe easily regularly and exhale completely.
Let go of all the spontaneous sounds. For a few women, holding a breath makes pushing easier. Such females may hold their breath during pushing but not for long periods.
Tips to help you push your baby out
A few important and simple tips to help you push your baby out is:
Push like a hard stool: Relax your body and breathe well. Focus just on pushing down, irrespective of whether you pass urine or stools during the same.
Touch your chin to your chest: While on your back , try to keep your chin towards your chest for pushing. This helps towards a focused push.
Switch positions: If the push is not effective enough\, trying different positions may help.
Relax: Do not panic while pushing and stay calm.
Push your best: The more effectively you push, the more strength you will gather, and the quicker you can have your baby delivered.
Rest adequately: While waiting for the next contraction you should simply rest and rejuvenate.
Push with your instinct: Nobody can guide you in pushing better than yourself. It is you who knows the best time to push.
Witness your milestone: Watching your baby get delivered can give you an adrenaline rush and motivate you. You may request a mirror. Remember that the baby’s head may appear transiently as pushing is an intermittent job.
Push downwards: You won't experience the terrible flushing of the face, fullness in the head or tightness of the chest if you are focusing well and pushing downwards. Focused contractions of the lower abdominal muscles like one do while urinating.
Scream: Pushing requires intense strength and you can let the world know what it takes to deliver. Yelling out simply keeps you going. You should instead make deep and long sounds, helping to push downwards.
Touch your baby: You can touch the baby's emerged head to feel and guide your push. You will feel the baby sliding out.
Use the loo: If you have not passed urine, it is sensible to do it before pushing.
Breathing right: Breathe easy and comfortably. This helps you push for a longer period without getting exhausted.
What if Even After Pushing Hard, Your Baby Doesn't Come Out?
In some cases, your baby might not be delivered despite adequate pushing. Though you did put in all the energy, it may just not pop out, leading to fatigue. This will further weaken your subsequent pushing efforts and make delivery even more difficult.
Your baby at this stage requires correct positioning. After two to three hours of pushing efforts, your clinician may decide to deliver using instruments while you carry on with pushing. Forceps or a vacuum device are usually employed, but only after the baby is visible. The clinician will route the baby correctly while you push, but would never pull the baby out.
What If You Don’t Feel The Urge To Push?
Even after being fully dilated, it may happen that a woman doesn’t feel the urge to push. Changing positions is one of the easiest things to do at the earliest, to develop an urge to push. If you have been supine for long, try and stand up erect, enact how you get into the tub, brisk walking, lunges, etc. Sitting on a birthing ball can be of some help. It may help you feel the urge quite quickly.
Even after changing positions and walking, you fail to generate an urge to push, then there’s barely anything more you could do. If you feel comfortable and the baby is moving correctly, try to rest and calm down.
If you wish you may attempt bearing down a bit and see if it helps. Women sometimes don’t feel an obvious urge to push and bearing down during contractions help. This little push may trigger an urge to push and you might shortly deliver.
How To Reduce The Risk Of Tearing
It is important that mothers’ know how to push during labour without tearing. After acquiring a correct position for labour, having a good perineal support is of utmost importance for minimizing the risk of perineal tears and birth-related genital injuries in the mother.
Start kegel exercises and daily perineal massage during the mid-pregnancy. These can help strengthen the perineal musculature for the shearing stress of delivery. Various other techniques may be used during the time of delivery to protect the perineal region intact.
While the baby descends, warm compresses may be applied to the perineum. It relaxes the area and helps reduce the pain and inflammation. A massage with oil is also given to the perineal tissues to help lubricate the area as it stretches.
If you’ve got existing perineal problems, you should inform your clinician. She will ensure adequate perineal support.
Certain cases may need an episiotomy. Tears are said to be better than episiotomies as they damage only soft tissue and hence heal faster. Episiotomies involve skin and muscular layers that can cause scarring and urinary incontinence later on.
When is Episiotomy needed?
An episiotomy is a surgical tear made at the posterior vaginal wall to enlarge the birth canal and facilitate the baby’s head to deliver. Previously it was believed that every delivery should receive an episiotomy. Around 70 percent women experience a natural tear of vaginal tissues while giving birth.
Following are the conditions when an episiotomy is considered :
Tissue tears that involve delicate parts like urethra and clitoris.
Foetal distress indicating urgent delivery through the vaginal canal.
Non-progressive labour: Excessively delayed second stage.
Episiotomy cannot be predicted, but certain factors that can help prevent episiotomy are:
Balanced and nutritious diet.
Gentle periodic vaginal stretching around four weeks prior to delivery.
Pregnancy and Labour are both natural processes, which your body gets well adapted to by itself. You should be aware of the phenomena in order to stay calm, avoid mistakes, and have a good experience of childbirth. Read more
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Your Baby This Week : 5 Month Week 4 Old
Your baby’s development, is now working in your favour. When he’s fussy, he’s increasingly distractible. Your child is intensely interested in the world around him, and is growing rapidly. The brain focuses on things that are new and different. So, when your child is a little cranky, use his growing interestto your advantage by making a funny noise, singing a song, gently banging a pot to snap him out of his grumpy mood. As your child grows from strength to strength, and it is better to be able to sit up, he’ll be ready for a high chair. To fall from a high chair is one of the most common accidents to babies and small children, so you have to make sure to use it in your own home. Choose a high chair that is sturdy with a wide base. It should be difficult to tip over and have no sharp edges or splinters. Always use the restraint system for the baby. It should include a seat belt that goes across the child’s hips and between her legs. Do not place a chair near a table or counter top where your child may be in a position to tip the chair over. Always keep an eye on your baby while he is in the chair.
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9 Best Tips for Announcing Pregnancy at Work
Announcing the exciting news about your pregnancy to the world is one of the best parts of being pregnant. While breaking this “good news” to the family can be quite a breeze, it is the part where people at the workplace have to be informed, that gives us sleepless nights.
How to Announce Pregnancy at Your Workplace
Announcing pregnancy to work colleagues needs some amount of preparation (and a lot of tact) so that one can devise the best way to approach this topic.
However, your office pregnancy announcement need not be as stressful as you think it will be. Here are a few super-practical tips you can implement when you decide to spill the beans at the office:
1. Let the Boss Hear it from You
Deliver this piece of information to your immediate boss personally, preferably face-to-face. This provides a dual benefit; your boss will value the importance you give him and you will be able to gauge the reaction first-hand. Make sure you keep your pregnancy news off social media till the time you disclose it to your boss, since many of your colleagues will be on your friend list. Experience says that the first-person tactic is the best in such a situation and is appreciated by the upper echelons of the corporate hierarchy.
2. Choose the Right Time to Tell Your Boss
While your excitement about breaking the news is plausible, do not choose a time when your boss is busy or distracted. Ask for his time, sit face-to-face and deliver the news in a private space. When you treat this special announcement with care, your boss will realize how important it is to you and he will extend all his support. Most women wonder when to tell about pregnancy at work. Waiting until the end of the first trimester is a great idea. This can be done provided morning sickness does not spill the beans earlier than you actually intended to. Telling your boss just before promotions or raises are due or on the cusp of a new project being announced is also not a good time.
3. Choose an Appropriate Place to Break the News
Decide where you want to share this important piece of information with your boss. The coffee machine or in the office lobby are definite no-no’s, given the continuous foot traffic one can expect here. Your boss’s cabin is the best place or you could even grab a quick lunch with him/her if you are comfortable.
4. Talk Openly About Maternity Leave and Benefits
One of the primary concerns of your department will be if you will come back after your delivery. If you haven’t made a decision yet and need time to decide, be honest and tell your boss accordingly. Think about training someone to take over during your absence and you will convey a message that you are a responsible person who will not leave the organization in between. Speak to the HR department and get details of the leaves you are entitled to and any other benefits. Don't hesitate when asking about your maternity leaves and other benefits. Discuss clearly and enjoy your perks, you deserve them.
5. Stay Cool, Stay Professional
Pregnancy is an important phase of your life and you need not hesitate about the timing while announcing it to your boss or your team. Avoid the words “I am sorry” and be as professional as you can while sharing your happy news. If there is an important project you need to be a part of, make it obvious that you will do your best to prepare in advance and you will be as committed as earlier. At the same time, always acknowledge that pregnancy will affect work in some ways and you are willing to take it in your stride.
6. Make it Fun and Informal with Co-Workers
If you have been working in an organisation for a long time now then surely your relationship with your colleagues would be very cordial. You may not be that formal with each other and you could even be friends with some. So, why shy away from sharing your happy news? In fact, you can announce your pregnancy to coworkers in a fun way. Your absence will obviously increase their workload, so appreciate them. And if this is your second child, how about clicking a photograph of your child holding a placard that says, “I’m going to be a brother/sister now” and showing it to them? They will be extremely happy for you.
7. Do Not Be Afraid
Pregnancy is an experience of a lifetime, don't be afraid of sharing this news with your boss or other colleagues. Most women feel that they may be asked to resign and won’t find a place in the corporate set up after they have a baby. However, this is a discrimination and most professional organisations would refrain from doing something like this. The bosses of today are open-minded and they understand, so don't be afraid.
8. Be Proactive About Your Absence from Active Work
Show the company that you have thought about how things or a certain project can be managed while you are away. If you can commit to a certain time during the day when you can check on emails, phone calls and project updates, go ahead and do that. This will help you remain in the loop and will create a responsible image of you.
9. Keep Your Clients in the Loop
Do not forget your clients. If and when you decide to come back, you do not want to ruin the existing relationship because you “forgot” to tell them. This will send out a subtle message to them that they matter and that you care. It will also help you manage the expectations they have of you during your absence.
Announcing your pregnancy at work may get you worried, but your organization is in a dilemma too. They will be worried about work getting affected and projects being delayed, so give them and yourself enough time to take appropriate steps to manage things. Keep all lines of communication open throughout this period and you will be able to manage things well. Communicate to your boss that you are willing to take the effort to ensure there is minimum disruption but pregnancy is a tough and important time for you too.
Also Read: Taking Care of Your Pregnancy at Work Read more
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How to Condition and Nurture Your Child Without Trying "TOO" Hard
Initial years of a child are the parameters for his future development. What a child learns in the first 3 years of his life, shape and mould him for his future. In today's fast paced generation children start everything pretty early, and that becomes overwhelming for 1st time parents.
Well as it's said there are no set rules for parenting, and every parent curates their own rules today i'll be sharing a few rules that worked for us ''without trying too hard"
1.Start at the Very "START"
Yes that's true, there is no right time to start the "Conditioning" process.,so we should start from the very "start". While spending time with kids, start by reading to them, singing rhymes, alphabet songs ,number songs, and other creative stuff. These are the basic things which will help the children to recognise and learn these things faster in the future.
2. Practice Good Habits with Kids
Parents often find it very challenging to discipline their kids, and it's very hard and exhausting at times. But in order to inculcate good manners and habits, parents have to practice them with their kids. Like teaching them the use of polite words (Please,thankyou,sorry,excuse me, etc) teach them to pick up thier toys, put away dirty dishes, use dustbins etc. When we practice with kids what we are trying to teach them, then it builds a trust bond with them and these good habits automatically insinuate in them.
3. 'Inculcate' Not Impose
We often as parents try imposing everything on our children like our views, thoughts, feelings and basically everything. And that is where things go south, kids these days do not like being imposed with anything.They often like to take the charge and not follow instructions. So parents instead of imposing should try inculcating good through showing calmer responses, favourable gestures, and effective techniques for moulding kids in a specific way.
4. Set Rewards and Punishments
When it comes to conditioning the most important thing for a kid is to understand the consequenses of his/her actions. Every good deed, be small or big must be appreciated with set rewards and every bad deed must be served with a punishment. In this way a kids understands the consequences of every good and bad decision made by them and more often they end up making the right choices.
5. Instill Optimism and Confidence
The most important step of good parenting is to instill good faith,optimism and self confidence in kids. Not all children are the same, some might be good at one thing and the others might be good at something else. Never weigh down a child under your expectations. Try understanding their strong pursuit and focus on refining that talent, FOCUS ON STRENGHTS NOT WEAKNESSES. Fill your child with optimism and confidence and then they can rule the world!
Disclaimer: The views, opinions and positions (including content in any form) expressed within this post are those of the author alone. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The responsibility for intellectual property rights of this content rests with the author and any liability with regards to infringement of intellectual property rights remains with him/her. Read more
Akifa Tahreem has added a new answer
Expecting Mom due in 7 months
9 hours ago
Q. hello doctor, I'm 3 weeks pregnant. can we sleep on our belly or which side We can sleep on during pregnancy...
Akifa Tahreem
Mom of a 7 m old boy
7 hours ago
A. no you can't sleep in your tummy
Dr Laxmi Chavan-Sawant has added a new answer
Trying To Conceive
6 hours ago
Q. @ask_the_expert
#ask the expert
I am having pcod problem.
when should I check pregnancy test at home?
Dr Laxmi Chavan-Sawant
Ayurvedic Gynaecologist
4 hours ago
A. If you have missed your periods you can wait for one week more and then do a urine pregnancy test to know about the pregnancy result and consult with your doctor according to the result for medication
Dr Priyanka Kalra has added a new answer
Trying To Conceive
6 hours ago
Q. I am having pcod problem.
At which day should I take pregnancy test
Dr Priyanka Kalra
Obstetrician and Gynaecologist
4 hours ago
A. after 2 weeks. do ultrasound n necessary tests after consulting a specialist. without proper check up we can't advise or help you.. Avoid shirt cuts when it comes to health if mother n baby. ok.
Dr Laxmi Chavan-Sawant has added a new answer
Trying To Conceive
6 hours ago
Q. I am having pcod problem.
when should I take pregnancy test?
Dr Laxmi Chavan-Sawant
Ayurvedic Gynaecologist
4 hours ago
A. after missed your periods you can wait for one week more ,then you can do a urine pregnancy test to know about the pregnancy result and consult with your doctor according to the result for medication
Dr Laxmi Chavan-Sawant has added a new answer
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Q. I am having pcod problem.
but having regular cycles below 35 days. some time it will extended upto 40 days.
so when should I take pregnancy test at home?
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Ayurvedic Gynaecologist
4 hours ago
A. If you have missed your periods you can wait for one week more or else you can do a urine pregnancy test to know about the pregnancy result and consult with your doctor according to the result for medication.
The best treatment to have Regular periods is by having a healthy lifestyle with regular daily walking or jogging along with mild exercise and meditation whenever possible. as medications will only act till you are taking them
Dr Ghouse has added a new answer
Expecting Mom due this month
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Q. Done my first routine blood test ..it shows thyroid border line.its my 6 week running as per USG.
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A. it is better to follow your doctors advice for treating the thyroid deficiency. if there is no relief it is better you see your doctor for proper examination particularly physical examination if there is need for doing investigations to find out the problem and treatment ok
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