Category: Blogs by Dr. Nikhil Datar

By Dr Nikhil D Datar. MD DNB FCPS FICOG DGO LLB

Obstetrician, Gynaecologist and Health Rights Activist, Mumbai

www.mygynaec.com

“Patient no 13/2017” calls out a nurse. A patient reduced to a number, as if she were in jail. Sounds demeaning, doesn’t it? May I say that this practice is legal and in fact, desired in India by the “Medical termination of pregnancy regulations 2003” (MTP regulations). Shocked? Confused? The Government of India framed these regulations in 1975 and amended them in 1993. The regulations state that the name of the woman undergoing termination of pregnancy (TOP) should not be entered anywhere except on the admission register and consent form. At all other places it is the serial number assigned from the admission register that is to be entered. This “special” provision has been made to safe guard the privacy of the woman. Well, that is fantastic! Privacy of every patient is of paramount importance.

However, let us see how this provision works in real life.

A woman comes to my clinic. An OPD case sheet is made in her name before I see her. Only after some conversation can it be determined that she wants to terminate her pregnancy. Thus it is obvious that one cannot not have the patient’s name on OPD sheet. If an MTP is to be done surgically I need to admit her in the hospital. Now I need to inform the clerk on admission counter to make an indoor paper/ case sheet with a serial number instead of her name. Since this provision is only meant for MTP cases, the clerk or non-medical staff automatically understands the purpose of this admission. Moreover there is a system of obtaining general administrative consent upon admission. When the woman signs it, her name is naturally revealed to those administrative personnel not connected to patient care.

In addition to that, since her name is not written on any other paper work, how should the nursing staff address her? By number? Our teachers in medical college used to be very upset if a medical student would call out any patient by their bed number or by the name of the medical condition patient suffered from. The practice of reducing a human being to a number is a bad bed side practice and extremely devaluing. However in this case it seems to be perfectly legal.

Even the anaesthetist should not (officially) know the woman by her name. The WHO patient safety checklist gives a lot of importance to the identification of the patient in order to reduce medical errors. However here we are expecting the anaesthetist to administer anaesthesia without even knowing the name of the patient!

These MTP regulations state that the consent form should be sealed into an envelope with the serial number and the word “secret” be written on it and sent to the administrator. In India most of the MTP services are provided by small healthcare facilities which are single doctor owned. This means that the doctor doubles up as an administrator or the owner. Thus, the regulation would require a doctor to send the envelope to himself with the word “secret”. Absurd, isn’t it? But the rule of law is followed to the T by government inspectors. They want to see these sealed envelopes presented by the doctor to himself!

According to the regulations, even the discharge card or follow up card should not have the name of the woman on it. So what happens if the patient asks the doctor to write a certificate stating that she has undergone termination of pregnancy? Should the doctor write her name?

The Ministry of Health and Family Welfare itself has contradicted it’s own provision of not writing the name on the follow up card. In 2010 the ministry released a publication titled “Comprehensive abortion care guidelines”. (http://www.nrhmhp.gov.in/sites/default/files/files/Guidelines_CAC%20Training%20%26%20Service%20Delivery%20.pdf ) On page 50 of this guideline the ministry has showcased a standard format of the follow up card. The first column of the format reads as patient’s name followed by the phone number!

Privacy is paramount, not only for the termination of pregnancy but for healthcare in general. The question is: Is the designed system achieving its goal? Or else we are just making complex systems that are more prone to clerical errors for which individuals can be held liable?

PS: In last 32 years no doctor’s association has raised any objection to these absurd, anomalous and impractical provisions or suggested any change.

By  Dr Nikhil D Datar

Gynaecologist and Health Rights Activist

“Doctor, you stood behind us like a rock when we felt all else had failed and showed us the way forward to get justice!” said a 42 years old man. He was accompanied by his wife and daughter of 11 with tears rolling down their eyes.

While most of the doctors do get their share of appreciation while doing their professional duty as healers, this was different. The little girl was brought to me few years back. She was just a  child of eight years and was referred to me for treatment of “precocious puberty”, as she had started menstruating way too early. The girl looked tensed, sad,always had her head low and never talked. Initially I thought that she was just reacting to the medical condition and the physical, emotional and psychological stress. However, soon I started noticing that she was not responding to the treatment. When I tried to dig a bit deeper into why this was happening I found that she kept herself very lonely lately and refused to go to school often which was very unlike herself according to the parents. It was soon found that she was a victim of sexual abuse by a school teacher. This came as a huge shock and the parents were shattered.

When I explained the need to inform the police, they were just not willing to do so.They had almost decided to leave their life in Mumbai and move to another city. The mother’s quivering voice still rings in my ears. She said “Doctor, please leave us alone. Don’t make us go through the trauma all over again. What are police going to do? They will come home to investigate. The whole locaility will know. Soon the media will come to know and our names will be all over the place. It will be just one more ‘story for them but our lives will be ruined. We have no one here in the city. It is only three of us. The police, courts, delays… they will make my daughter narrate all those things in the open court. She is a small child. It will be like making her undergo same thing again and again.”

I was stunned and shocked. I had no words to express. On one hand I was an advocate for legal remedies and on the other hand I did understand the child and her family’s pain and suffering. They were living under constant fear. Looking at the bigger picture, I knew that pusuing a legal course was important so that the offender is punished otherwise he would go scot-free and destroy the childhood of another little girls and boys.

I sat with the the parents and gave them my time to explain why going to the police was important. I explained to  them the  provisions of the POCSO Act… the law that is made for the protection of  children from sexual offences. This Act deals with child abuse with great sensitivity. Under this Act, only senior female police officers are supposed to investigate the matter. The police are normally not supposed to visit the house but in case they do so they have to be in plain clothes and not in uniforms. The child is not supposed to be called again and again to police station. The child can not be kept for long in the police station.  In case of a medical examination, it is conducted by a lady doctor and in the presence of the victim’s parents. The special courts under POSCO Act conduct in camera proceedings. The media is not allowed in the court. The child is not exposed to the  offender and no aggressive questioning (what we typically see in the movies) is allowed. The media is not allowed to reveal the identity if the child in any way. I helped them connect to a social worker to boost their morales for a legal recourse.

Two years after, the same family was in front of me. The mother said that the offender was immediately arrested and is now behind bars. “Every thing happened exactly how you had told us. We were on the verge of leaving our house. We stay in the same house today. The police came in plain clothes and no one in locality even knows about it. The news papers did give the news but no where did our name or location featured. No one knew that we were those victims.  The lady judge made my daughter sit next to her, played with her gave her a chocolate while questioning. The offender has hired a veteran lawyer but all in vain. He is still in jail,” she said.

The father said that they did end up changing the school though, and their daughter really enjoys it now. She is again her churpy, bubbly self. Their lives have returning to normal and they live with confidence again. While the trauma cannot be forgotten, the family has solace in justice atleast.

All three of them were crying in front of me. The mother said “Doctor, we still remember your words. You had said to us then “I am with you. Call me whenever you want. I will be with you for any help right from going to police station to whatever you need. I will walk with you shoulder to shoulder in this fight for justice” That sentence was enough for us to keep going.”

I felt proud of my self and the police force. I felt proud of my country in which there is a law that protects children and the law is not merely on paper but is in action.

 

When Mr. Das went to the hospital for his wife’s surgery he proudly flashed his insurance card for availing cashless services. He was under the impression that his financial responsibility will be over only by showing the card. At least that is what was told to him by his agent when he took the cashless mediclaim policy.  Most of us do not really pay attention to the fine print of the insurance policy.  Most of us come out of the hospital with a mixed feeling… On one hand we feel happy that our near and dear one is safe and in good health but on other hand we are not happy with the administrative experience related to the billing and insurance. If you want to avoid this, you must know how the system works! As a consumer on insurance company it is your right to demand the benefits and services for which you pay the premium.

How does the cashless mediclaim work?

An individual or group of individuals buy mediclaim policy or healthcare insurance from an insurance company. The company enters into a contract with the consumer. The insurance company in turn allocates your policy to a third party administrator (TPA). The TPA in turn have contracts with the hospitals. These network hospitals basically agree to treat the patient of TPA at pre-decided rate. Thus the hospital will be able to claim only that sum of money which is pre agreed with TPA and it has nothing to do with your sum assured.

What should you know about the policy?

The policy specifies certain terms. Almost all insurance companies have a fixed allowable room rent which is proportional to the sum assured. For example, an insurance company may specify that the room rent allowable shall be 1% of the sum assured. Thus, if you have a cover of 500000 (This is called as “sum assured”) then company will only take upon itself the financial liability when you stay in a room that has a rent of Rupees 5000/- or lower. It is important to understand that all other charges such as theatre charges are linked to the basic room tariff. So you must know this aspect of the insurance policy correctly.

How to find out the hospital which will provide cashless mediclaim to you?

The TPA will provide a list of its network hospitals to you. It is expected that TPA should update this list from time to time. You may be able to find the list of network hospitals from the call centre or website of the TPA.  You should then choose a hospital based on the vicinity, quality of services, speciality offered and of course the doctors working at the hospital.

What should you do when you go to the hospital?

Hospitals have a dedicated help desk or nominated person for insurance related work. You must carry the valid insurance card, your identity proof, and policy document along with to the hospital. If you are going to use the cashless mediclaim you must inform the hospital before hand.

What does the hospital do?

When the hospital treats a patient it should clearly know about who is going to pay for the services. Individuals pay for themselves. In cashless arrangement, since you are the customer of the TPA, it is the TPA  that pays to the hospital for the service provided. The TPA issues “Authorisation letter (AL)” to the hospital indicating that it will take the responsibility to pay the hospital as per terms of contract. Actually getting the AL is the responsibility of the consumer. But hospitals help to initiate the process by sending the requisition for the AL to TPA. As a consumer it is important to be vigilant and be actively involved in procuring the AL.  

When can hospital ask you to pay directly?

1.  When TPA has denied to pay. : In such a case you need to sort it out with your TPA.  It is common that health information given by you while taking insurance is found to be in mismatch with the medical information given by the doctor from the hospital. Hence you should disclose the truthful and factual details about your health when you take insurance.
2. Co- payment : Some companies have a co-payment system. It means that you have to pay your share and only then the company will pay or undertake to pay.
3. Exclusions: It is important to read the small print in the policy document. There are few exclusions in the policy. Your company may have put restrictions that it may not pay for specific treatments or for first few years.Besides that the insurance company or TPA may not pay for few items needed during the treatment. For example, diapers, baby soap , certain antiseptic solutions , disposable towels etc.

   It is obvious that the customer has to pay for the expenses incurred directly.

4. Additional expenses : The hospital incurs certain expenses such as registration, documentation, postage etc.  The TPA does not pay these charges to the hospital and the consumer has to pay directly to the hospital.

What happens when patient is discharged?

Before the discharge the TPA has to give final authorization to the hospital. Only upon receiving the same the hospital discharges the patient. The hospital has to do a lot of paper work before discharge. This may cause delays in discharge process.

Even after the discharge is done, the TPA may raise queries which need to be addressed jointly by the patient and the hospital.

In conclusion, consumer of cashless mediclaim must exercise his/her rights dutifully. Being vigilant and informed is the need of the hour.

 

 

I proudly share this article penned down by my patient Swati Iyer.

I recently consulted Dr. Nikhil Datar for my ongoing pregnancy. After a thorough examination of the files and a check-up, he recommended that get a few additional tests done immediately and I come back to him with the reports. I stay at the other end of town. Given the Mumbai traffic it is tough to travel some times. I checked if I could send him the reports via e-mail and then follow up with a visit in the following week, to which he readily agreed.

( source: Google)
I received the test results in a couple of days (there were a bunch of reports that seemed like Greek and Latin to me!) and I was unsure how could I send them to him in a way that would be easy for him to read the respond quickly. Dr Datar is a renowned and busy doctor who deals with many patients on day to day basis. Email being a non-personal communication, with no ability to get clarifications across (unlike a face-to-face meeting), I felt it was necessary for me to ensure I provide him with all the required information at hand, so that he does not have to rely on his memory to respond to my email, while also ensuring there is a right context to the reports I was sending to him.

 

So here’s what I used as a frame work while I wrote an email:

 

1. Name of Patient (Obviously!)
2. Date of first consultation
3. Place of consultation (i.e name of the hospital/clinic)
4. Purpose of consultation and the follow up actions that was recommended by the Doctor
5. The test reports, along with photographs/ scans
6. My questions regarding follow up actions, if any, required and/or the suggested next steps to be taken. I asked very specific questions. I did not ask non-specific question like “What should I do?”. I asked specific question such as “Should I take XYZ medicine?”

Tip: If you are attaching multiple reports or scans, it’s a good idea to label (filename) each file so that the Doctor can quickly identify the report it corresponds to.

Needless to add, my email had a prompt response and guess what, I was pleasantly surprised when he told me that this was the best email query written by a patient. He appreciated the methodical manner and further said “It made my life easy. I could correlate easily and respond immediately.” Besides that it also reduces the chances of errors too.

If you follow these simples steps it can make things easy, fast and accurate for yourself as well as your doctor!

PCOS, or polycystic ovarian syndrome, is a common hormonal disorder in women that interferes with the ovulation. It is the most common cause of infertility among women. PCOS occurs when a woman’s body overproduces sex hormones, called androgens. The hormone imbalance prevents fluid-filled sacs in the ovaries from breaking open and releasing mature eggs. The fluid-filled sacs bunch together, causing many tiny cysts.

PCOS Symptoms :

• Menstrual problems. These include few or no menstrual periods or heavy, irregular bleeding.

• Hair loss from the scalp and hair growth on the face, chest, back, stomach .

• Acne and oily skin

• Fertility problems, such as no ovulation or repeated miscarriages.

• Insulin resistance and too much insulin ( obesity and skin tags.

• Depression or mood swings.

Why does polycystic ovary syndrome cause weight gain?

PCOS makes it more difficult for the body to use the hormone insulin , which normally helps convert sugars and starches from foods into energy. This condition — called insulin resistance — can cause insulin and sugar to build up in the bloodstream.

High insulin levels increase the production of male hormones called androgens. High androgen levels lead to weight gain.

Furthermore, insulin resistance and weight gain can lead to Type 2 diabetes, high cholesterol, high blood pressure and sleep apnea.

Many of these conditions can lead to heart disease . In fact, women with PCOS are four to seven times more likely to have a heart attack than women of the same age without the condition.

PCOS diet – DO’s and Don’ts :

Do’s:

High-fiber foods can help combat insulin resistance by slowing down digestion and reducing the impact of sugar on the blood. This may be beneficial to women with PCOS. Great options for high-fiber foods include:

• cruciferous vegetables, such as broccoli, cauliflower, and Brussels sprouts

• greens, including red leaf lettuce and arugula

• green and red peppers

• beans and lentils

• almonds

• berries

• sweet potatoes

• winter squash

• pumpkin

Lean protein sources like tofu, chicken, and fish don’t provide fiber but are very filling and a healthy dietary option for women with PCOS.

Don’ts:

Refined carbohydrates cause inflammation, exacerbate insulin resistance, and should be avoided. These include highly processed foods, such as:

• white bread

• muffins

• breakfast pastries

• sugary desserts

• white potatoes

• anything made with white flour

PCOS, like many disorders, responds positively to proactive lifestyle choices. This includes exercise and daily physical movement. Both can help to reduce insulin resistance, especially when coupled with a limited intake of unhealthy carbohydrates. Many experts agree that at least 150 minutes per week of exercise is ideal.

Daily activity, low sugar intake, and a low-inflammation diet may also lead to weight loss. Women may experience improved ovulation with weight loss, so women who are obese or overweight and want to get pregnant may find physician-approved exercise especially important.

We cannot cure PCOS, but we absolutely can control it!

My patient shared a video of her baby’s massage or “Malish”. I was aghast and dumb stuck looking at the way the “Malishwali” lady was doing the baby massage. I shared the video on face book and other social media and it went viral! It has got more than 260000 views in a span to 2 days. Many women called me or sent messages to thank me for this video. Many expressed that “whether to massage or no” is a common reason of conflict between the new and old generation. Thus I thought of penning down this article on Do’s and Don’ts of baby massage.
Oil massage to the new born is an age old practice in our country. Ayurveda describes “Abhyangam” &“ Mardan” as a therapy. It does state that “Abhyangam” if correctly done improves circulation and muscle tone. However over centuries the original science has got drowned in the mysterious myths. It is common to see that “Malsihwali Bai” continuing to do unscientific massage followed by so called “exercises”… Even senior ladies in the family allow it under the genuine belief that it is beneficial to the baby!! Here are some myths regarding baby massage and exercises:
• baby becomes tall
• baby ‘s joints become flexible
• the skin, eyes improve
• resistance power improves
• baby sleeps well.
Let me tell you that there is NO scientific evidence to any of the above. But it is true that one has no counter argument when senior ladies in the house say that they have been seeing/ doing this for so many years and nothing has gone wrong so far. Honestly that is the real problem to tackle. I spoke to many paediatricians, orthopaedic surgeons and Ayruveda practitioners. All confirmed that they have seen complications and problems because of wrongly done massage and/or exercises.
I am sure all of us have taken an oil massage in our life? Do you like if someone gives a massage with “heavy hand”? Does your body not get soar and pain? Don’t you think that the babies will also be experiencing the same? Or just because the babies cannot talk we consider that they are happy while the massage and acrobatic exercises are being done?
When the Malishwali bai does some acrobatic stunts with the babies and claim that the legs get straight or baby starts walking early, we must understand few basics of anthropology. We see that a new born of an animal like cow or horse starts walking immediately after the birth. Does that happen to human babies? No. The human off springs take a while before they start even crawling. This means that the human body is not ready for doing certain acts till the human body reaches certain development. The bones are not fully ossified and joints are not fully ready for the movements.
Thus here are few tips regarding baby massage:
1.If the baby is sick, unwell, low birth weight, premature one should not be give massage without doctor’s advice
2.There is no specific recommendation on particular oil for massage.
The oil should be applied lightly in direction of the muscles.
3.It takes few months for the baby to develop the mechanism of controlling body temperature. Till then baby’s can really get cold or hot while bathing. You must cover the baby well.
4.

A complete NO to the baby exercises at any point of time. Even if you are an ambitious parent and want your child to be in gymnastics still is a big No!

Once upon a time there was a king. His kingdom had severe shortage of water. People used to suffer and die because of lack of water. One great architect built a huge reservoir of water. The citizens became happy as they could get sufficient water. Few goons started misusing the water for making an addictive drug. The people in the kingdom started getting addicted. The king was sad and angry. He decided to stop this completely. What he was doing was for the good for his citizens. The King told his ministers to stop this misuse at any cost. The brilliant ministers made a law called PCPNDT namely “Public control and prevention of Drugs & toxins (Misuse) Act”.
The ministers decided to make provisions to keep strict vigilance on the usage of water. Ultimately it was water that was misused. They made a stringent law. Any slightest violation of the law amounted to imprisonment and jail. So the intelligent ministers made following rules under the law:
• Every person who fetches water will first register by paying money and not fetch water without registration.
• Every person shall keep an accurate account of the amount of water used for every purpose measured in accurate manner in a prescribed format on daily basis and report online… that too before using the water. Thus a mother was supposed to first to do all administrative work before giving a glass of water to her child.
• Every person who fetches the water will keep his head and face uncovered so that his face shall be captured by the camera.
• Every person shall carry two boards of specific size in two languages in one hand stating that he shall not use the water for making the drug from the water. In the other hand the person shall carry the original license (no lamination allowed) and take care that the water is not spilt on it.
• Every person shall have a container only of a defined size, shape and colour.
The law was implemented. Everybody applauded the king for the great objective of the law. Still there were stories of addictive drug being available at places. Some addicts were willing to pay any price for the drug. There were some antisocial elements who were still making the drug and selling it at a steep price. The social workers made a big hue and cry and they were right. The next generation was getting addicted ultimately. Some social workers went to the extent that they wrote a letter to the king stating that the reservoir of water be shut so that there is no water for drinking … so that there will be no misuse of water. The king was kind enough not to listen to them but he got angry. He directed his officers to be very strict with the implementation of the law. The patriotic officers were working for the betterment of the country. Besides that there was a monetary incentive to find out the law breakers. Every body who was fetching the water was scrutinised and the paper work was checked thoroughly. For every smallest mistake in the paper work, cases were filed and arrests were made. The offenders were punished and put in the jail. The officers did not care whether the citizens were dying without water or otherwise. The officers reported to the king about efficient implementation of the law and gave an account of offenders that were booked and jailed. Actually no one was caught red handed while selling or making the drug. To tell you the truth they did not have a spy network or some mechanism for actually searching out the drug makers or pedellars. Most of the citizens that were booked were for faulty papers work. Some were arrested because they did not have a specific container, some were arrested because they first drank the water and then filled up the form and some were arrested because the license got wet. One person was arrested because his license to fetch the water had expired but the officer had delayed the renewal. And the man had to fetch water for daily chore. Now a mother would have to measure the water drunk by her child. The elderly and sick who could not go to the reservoir themselves or could not hold the container, boards and license at a time in two hands, could not get water at all.
Friends what do you think? Was the king right in making such a law? Would these mindless bureaucratic provisions work to solve the real problem? Will it not be better to improve the spy network and actually find out the real offenders?
If you think that the king should have understood this, then it is high time that you understand why doctors are agitating against the PCPNDT Act. Of course I am talking about the Pre-conceptional and prenatal diagnostic technique Act.
Dr Nikhil D Datar
Gynaecologist and Patient rights activist

Akshay has come home … frustrated from the office. In fact he has been sacked from the job. Pranoti is his wife. She is on treatment for PCOS ( polycystic ovarian syndrome). She is taking treatment from her gynaec for becoming pregnant. She has been told by the doctor that today is “an important day” . The couple must have sex. Pranoti is trying to get her husband to the bed. Akshay is in no mood… It is the stress in his life… added to it is the performance anxiety which is hovering over him. He is unable to perform on the day… leading to further frustration and stress in the couple.
All this was being staged in a Marathi play “Don’t worry, Be Happy” written by Mihir Rajda. The Marathi play is doing well on box office and received lots of appreciation from audience as well as critics. It was the sixtieth show. My wife Dr Smita had given some technical medical inputs to the script. Thus we were invited for the play. The script was brilliant… dialogues sharp… and acting fantabulous. Umesh Kamat ( Akshy) & Spruha Joshi ( Pranoti) were cracking mind blowing humor on stage in this so called serious scene and audience was laughing… At the same time a serious message of how the stress has now creeped in the delicate relationships and into the bedroom was getting registered by the people. The spectators gave a standing ovation at the end of the play and they deserved it.
Being a gynaecologist I hear this every day from my patients. Today I was seeing it in a very hilarious way on the stage. The heroine Pranoti represented the modern age career oriented woman. She had postponed the pregnancy till now… in spite of the her mother’s and mother in law’s advice. The hero is working in corporate sector and burdened with targets. The couple has to kind of struggle to maintain the existing lifestyle. Pranoti is a perfectionist and wants her house to be well kept. She loves her pet dog too. On the other hand, Akshay typically represents “male” upbringing, he can’t cope up with Pranoti’s basic expectations nor does he like the dog. The couple although loves each other and cares for each other they also want their own space. I think it is a perfect setting… Today this is a story of this new generation…
Many couples come to me with a typical problem. In order to prioritize the careers they postpone the pregnancy. At around 30 or above, it is usually the woman who suddenly realizes that they have to now plan a baby. They want everything pre-planned. They expect quick results. They do not mind starting treatment, spending money but want immediate solutions. I distinctly remember one of my patients… The girl wanted to become pregnant in a particular month so that the child will be born in a certain month so that the school admission will not be difficult!

So here are some tips for those planning to be pregnant.
• The couple must have open ended discussion time to time after marriage about pregnancy. It is usually common to see that males want to post pone the pregnancy. A realistic thought must be given to this. Just delaying pregnancy for the sake of nothing may not be a great idea.
• Planned pregnancy is better than unplanned pregnancy.
• Adopt healthy life style. Quit smoking, exercise regularly, eat healthy diet, lose weight (if obese).
• Meet the gynaecologist and get pre-pregnancy investigations done.
• Understand that the egg formation (ovulation) occurs only once in the month. If pregnancy has to occur it will occur around that time. Intercourse before and after cannot lead to pregnancy. But that does not mean that couple should not have intercourse for pleasure and satisfaction.
• Understand that the chance of pregnancy occurring per month is low in human beings. The chance is considered to be just around 15% or so per month. It means out of 100 so to say normal couples only 15 will achieve pregnancy in that month.
• Do not lose the spontaneity in the sex life. The sex has to start from the mind. Do not get mechanical. Accept that performance anxiety is a real and genuine issue. Do not behave as if heavens have fallen if you miss the important day.
• Do not start medical treatment unnecessarily. Going to the doctor and starting the treatment can also cause stress. So first allow your body to work. Only if needed medical treatment should be started.
• Although pregnancy can be planned, it cannot be planned so accurately. Accept that nature and body takes time to work. Take things as they come.
• And lastly the most important thing: “ Don’t worry,be happy”

P.S:
I request the team of “Don’t worry Be happy” to upload the hilarious bedroom scene on You Tube… of course after a while. It can serve as an educational material for those who are planning their pregnancy.