Question: Hi, i am 24 weeks pregnant with my first baby. I like to have a natural birth. But only thing worries me is that I’m having very narrow vagina. I had problems early days when i was having sex but with time it was solved without any medication or going through any procedures. Also once, when i had my smear test done the nurse told me that my vagina is narrow. So, though i like to have a natural birth, i am bit worried since this is my first baby, and i really do not like the idea of assisted births. How may i find out that my vagina still very narrow? Do they examine my vagina when i am getting closer to the term before i go to labour? K. (UK)
Answer: You absolutely don’t need to worry about the ability of the vagina to allow passage of the baby. Almost all cases of so-called narrow vagina apply to sexual intercourse and vaginal examination but not childbirth. This may sound rather puzzling because the baby is supposed to be so much bigger but it is true. Vaginal ‘narrowness’ has more to do with nerves than actual physical restriction. The vagina, like the rest of the genital tract has an amazing capacity to undergo changes that facilitate both the carriage of pregnancy and the subsequent childbirth. The elasticity of the vagina increases significantly during pregnancy in readiness for the stretching that will be required to allow the baby to pass. You will not need to be examined prior to going into labour. That is never necessary unless you are having an examination for some other reason. Please do not worry. If everything is normal with your pregnancy, the vagina will not be a problem in labour. My best wishes.
Comment: I resent the presentation of information on the vegan diet in relation to iron requirements. I am a pregnant vegan with what has been described as a 'better iron level than most omnivores'. I certainly would question your categorical statement that iron tablets are IMPERATIVE in pregnancy. What is imperative in pregnancy (whether as an omnivore, vegetarian or vegan) is that women are aware of which food groups provide which minerals and vitamins and ensure they eat a diet which is able to service the increased requirements. I have friends who eat meat who have been anaemic in pregnancy, who are constantly catching colds and flu. Since I have been vegan (strict vegetarian for 18 years then vegan for the past 18 months) I have not been ill, I have very high levels of energy, and I feel great. It's therefore quite offensive to read a blanket statement that my iron levels are likely to be inadequate. L.L. (UK)
Reply: Thank you for your passionate defence of what you obviously believe to be a healthier lifestyle and what it provides diet-wise. I’m afraid we stand by every single word we have said with regard to what a vegan pregnant woman should normally be advised. Various types of lifestyles can be associated with unique challenges during pregnancy. That is just a fact of life. Plant food products are a poor source of iron and even that iron is absorbed poorly in the gut. That means strict vegans are at increased risk of iron deficiency, a state that is exacerbated during pregnancy because of the increased demand during this time. It is an undisputed fact that most vegans show evidence of iron deficiency anaemia during pregnancy hence the strong advise to take iron supplements. It is just a sensible precaution which should not be taken as an attack on the lifestyle. The majority will benefit from heeding that and it should be viewed in the spirit it is meant. If you are one of the exceptions who do not need this; good for you. You can afford to ignore the advice but that does not invalidate its essence. You have compared yourself (favourably) to friends who are meat eaters. I do not dispute that. However, that’s akin to a heavy smoker pointing a triumphant finger at a neighbour who has been diagnosed with lung cancer despite being a non-smoker all his life. Life simply cannot be viewed in such black-and-white prisms. As practising physicians we have a duty to give evidence-based advice. Strict vegans are prone to iron-deficiency anaemia. Pregnancy makes this problem worse. Iron supplements ought to be strongly advised. This advice may apply for Vitamin B12 and calcium for many vegans.
Question: I have really irregular periods that for the last 7-8 months i have had around a 43 day cycle, me and my partner have been having unprotected sex for the better part of 5 months and after doing an ovulation calculation because i was beginning to worry something was wrong with me it seems i ovulated around the 3rd feb. Roughly around 3-4 days later i spot bled for 2 days which for me is really unusual for it not to turn into a period more than a week later? Could this have been implantation bleeding or just a coincidence and that i am going insane. Hope you can help. Thank you. D. (UK)
Answer: You appear to have a long (rather than irregular) cycle. At around 43 days, it means you ovulate about 4 weeks after the onset of your period. You see, the post-ovulation phase of the cycle is constant at 14 days and this is regardless of the length of any cycle. I hope your ovulation kit is telling you the same otherwise its reliability should be in question. Can I say the vaginal spotting you had was an implantation bleed? Of-course I can’t. Implantation bleeding is quite uncommon and only a handful of women experience this. What I’m reading between the lines here and; forgive me if I’m mistaken, is that you are quite anxious. That is not helping. You have only been trying for a few months and, the reality of the matter is, even in the most perfect circumstances, it can take up to a year for most women to conceive. Do keep trying and try to relax. As for what might be happening in this cycle, well, to borrow a phrase, the proof of the pudding is in the eating: If your period does not arrive when expected, do a pregnancy test. That will give you a definitive answer. My best wishes.