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How Will My Antenatal Visit Go?

Antenatal care is the attention others receive during pregnancy. It ensures you and your baby are in the best state of health. Over the period of pregnancy, the doctor follows up on you and your baby’s health to ensure your pregnancy goes as smoothly as possible.

Attending your antenatal appointments is quite important. Any potential risks to the baby can be identified and prevented or reduced. Antenatal care is important in the prevention of several pregnancy complications such as preeclampsia.

Antenatal clinics serve as good avenues to learn more about the baby’s growth per trimester. This is a chance for the doctors and midwives to educate you on any important changes in lifestyle you may need to make.

Some hospitals have classes just before the clinics begin. Others have these on special days. Here, you will get information that will prepare you for childbirth, care of your baby such as bathing, diapering, breastfeeding.

What happens during the antenatal clinic?

Your doctor would obtain an account of your medical history and lifestyle from you to determine any risks you may have

The antenatal care you get throughout your pregnancy depends on:

  • your health and any risks you or your baby may have
  • the stage of pregnancy you are at, and
  • any problems you may experience.

The doctors would ask some questions like:

  • when you had your last period, tell you when the baby is due, what trimester you are in and what this means for you and your baby
  • finding out about your medical history, general health, and how any previous pregnancies were
  • the ethnic origins of you and your partner to find out whether your baby may be at risk of certain genetic inherited conditions
  • what medication you may be taking
  • ensuring you’ve had a recent pap smear (to assess the risk of cervical cancer)
  • making sure your mental health is OK, and supporting you if you have depression or anxiety
  • checking your blood pressure and weight and testing your urine
  • providing advice on a healthy diet
  • feeling and measuring your tummy to find out how many babies you are carrying
  • estimate the baby’s position and size, and listening to the baby’s heartbeat
  • advise you on care for your baby after pregnancy

How many antenatal visits will I have?

The frequency of your antenatal visits is determined by the doctor’s assessments. Pregnancies with possible complications would come with more antenatal visits, for example, if a mother has gestational diabetes or sickle cell disease, the doctor needs to monitor the pregnancy more closely than others.

In most hospitals in Nigeria, they schedule you to have one visit per month until the pregnancy is about 22 weeks. Then one visit every two weeks till about 32 weeks and once a week till birth.

What assessments would I undergo?

Image: Shutterstock

You would have ultrasound pregnancy tests done between 8 to 14 weeks to check for any abnormalities in the baby’s organs. These are repeated based on need.

Also, you would have blood tests to check for your blood group and genotype, HIV, hepatitis B and syphilis and other infections that can affect your pregnancy or be passed on to your baby. Every visit, your doctor would also examine your pregnancy to check the baby’s heartbeats and movements.

Antenatal visits can seem very stressful and time-consuming. However, it is still in the best interest for you and your baby. To get the best out of your visit, be sure to write down beforehand questions or concerns you have. Always ask questions and make notes of the responses your doctor gives you.

Antenatal care has been shown to improve pregnancy outcomes

Good luck!

References

NHS; 30/6/2020; https://www.nhs.uk/conditions/pregnancy-and-baby/antenatal-midwife-care-pregnant/

https://www.pregnancybirthbaby.org.au/antenatal-care

CAN I HAVE A VAGINAL BIRTH AFTER C-SECTION? HOW?

Ngozi dreaded the possibility of another C-section. Although the last one was successful, she desperately wanted a vaginal birth this time. In addition, she considered one surgery to be more than enough.

There are two major means of giving birth in today’s world. The more common one is the vaginal birth. This involves the mother pushing out the baby from the uterus through the vagina.

The Caesarean method (C/S) involves the doctor making a cut in the belly and uterus and the baby is delivered via this means. Under certain conditions, the doctor may recommend you having a C/S instead of a vaginal birth.

Quite a number of women, like Ngozi, prefer a vaginal birth for their next pregnancy after Caesarean Section (VBAC). Thankfully, this is acheivable.

According to a study done in the United States, seven out of ten women who opted for a vaginal delivery after a C/S had successful deliveries.

As usual, we’re here to guide you and supply all the relevant info you need on this journey.

What is VBAC?

VBAC stands for Vaginal Birth After Caesarean. It is a term that connotes having a vaginal birth (delivery) after a previous delivery through a Caesarean section.

VBAC is not right for everyone though. Some factors put some women at risk of some complications if they go for VBAC. The first step in the VBAC process is a meeting with your doctor to determine the possibility of it working out.

Things To Consider Before Opting For A VBAC

1. The Incision

This refers to the type of incision (cut) made on your uterus (womb) during the previous C-section. It is important to note that this incision differs from the one made on your skin during the procedure.

The direction of cut made on your uterus largely determines the possibility of a VBAC. If you had a transverse incision (a side-to-side cut) across the lower, thinner part of your womb, you’re more likely to have a successful VBAC.

2. Number of Previous C-sections

This follows a simple rule; The more C-sections you’ve had, the lower the chances of a successful VBAC.

3. Health Factors

Sometimes, medical tests reveal that a vaginal birth may be risky for you and your baby. Examples include whether you are obese, have pre-eclampsia. As a result, your doctor may insist on another C-section.

4. Number of Developing Babies

Here’s another simple rule; The more the babies, the more the push.

Delivering multiple babies can cause an obvious strain, making the vaginal birth process more difficult. Therefore, a woman carrying multiple pregnancies following a C-section birth may have to undergo another C-section.

5. Your Baby’s Weight

The larger your baby, the least likely a VBAC will be successful and thus it may not be offered.

What Are The Benefits Of VBAC?

1. No surgery.

This is definitely a big relief to most women. A vaginal birth after C-section simply means that no cut will be made on your body.

2. Shorter Recovery Time.

In clear terms, the recovery process for a vaginal birth is shorter than what is required after a C-section. This affords you more time to spend with your little one and loved ones.

3. Lower risk of infection.

With vaginal delivery, you’re at a lower risk of contracting any infection.

4. Minimal blood loss.

Thankfully, blood loss in a vaginal delivery is minimal compared to a C-section.

What Are The Risks?

  1. Uterine Rupture: During the process of labour after a previous C-section birth, the womb faces a small risk of tear. This arises as a result of unhealed cuts or high-risk incisions. However, this is a rare occurrence.
  2. A Possible Return To C-section: During a vaginal birth, unplanned situations may force your doctors to fall back to a C-section in order to preserve both lives (You & Your Baby).

How Can You Prepare for a VBAC?

First things first! Consult with your doctor at the first antenatal visit after the previous C-section to know if a VBAC is possible.

Ensure that your doctor has your complete medical history. This will enable your doctor make the best decision in your interest. You will only be allowed to go into spontaneous labour. Your health team will be on standby for an emergency Caesarean section. They will monitor your progress in labour carefully, no medication to make the womb contract or induce labour will be given for safety reasons. If your doctors are not happy about your progress an emergency Caesarean section will be provided.

Treatment

Above all, it is safer to register with a hospital that is known for handling emergency C-sections.

Conclusion

Yes, having a vaginal birth after a C-section is possible. In addition, the chances of a successful VBAC increases when labour starts without any induction on your due date or before it.

Nonetheless, you need to take every necessary precaution to ensure that everything goes well. Finally, ensure your doctor has all of your previous medical history and whatever is going on with you currently.

REFERENCES
  • March of Dimes (2015). Vaginal Birth After Caesarean. Accessed on 25th August, 2020 from https://www.marchofdimes.org/pregnancy/vaginal-birth-after-cesarean.aspx
  • Mayo Clinic Staff (2020). Vaginal Birth After Caesarean (VBAC). Accessed on 25th August, 2020 from https://www.mayoclinic.org/tests-procedures/vbac/about/pac-20395249
  • The American College of Obstetricians and Gynaecologists (ACOG) (2017). Vaginal Birth After Caesarean Delivery. Accessed on 25th August, 2020 from https://www.acog.org/patient-resources/faqs/labor-delivery-and-postpartum-care/vaginal-birth-after-cesarean-delivery

Cervical Cerclage

It’s another day and you catch yourself looking at the calendar again, counting down the few weeks left to meet your little bundle of joy. Although this pregnancy is just 7 months old, you still worry if it would be like the others; perhaps this one would also arrive too early.
Hopefully, it would be different this time. Especially when you remember all the precautionary measures you have put in place.
These measures are based on medical advice from your last antenatal clinic appointment. Actually, the doctor suggested a cervical cerclage.

From that moment, although the doctor did her best to explain, you still wonder if it would be enough to save your child.

What Is a Cervical Cerclage?

Cervical cerclage refers to a couple of procedures done to keep your cervix closed before delivery.
It is also called a “cervical stitch”.

The cervix is the funnel-shaped lower part of your womb. It opens during childbirth to allow your baby free passage out of the womb and into the world. However, opening of the cervix too early could lead to premature labour. Therefore, a cervical cerclage is done to help support the cervix during pregnancy, keeping it closed until childbirth or at least baby is mature enough to thrive outside the womb.

Source: Shutterstock

Why Is It Done?

The cervix is closed, long and firm in the absence of pregnancy.

During pregnancy, it gradually softens, shortens and expands as your body prepares to ease your baby into the world.
In some cases, the cervix begins to efface (stretch and thin out) and open too early. This usually occurs in women with a short or weak cervix. It can lead to premature childbirth or in some severe cases, a miscarriage.

Cerclage
Shutterstock/ Medical Art

You may need a cervical cerclage if :

  • You have a short or weak cervix that starts to open in the second trimester (before 24 weeks of pregnancy).
  • There’s a history of miscarriage with painless dilation of the cervix in the second trimester.
  • You had a cervical cerclage in your previous pregnancy.
  • The previous pregnancy ended in a preterm delivery (before 34 weeks of pregnancy).

This procedure is usually done between 12 to 14 weeks of pregnancy. However, a doctor may recommend a cervical cerclage as late as the 24th week. Anything after this would be too risky.

A cervical cerclage cannot always be recommended as a quick fix for everyone at risk of premature delivery.

It is discouraged in cases where active vaginal bleeding, preterm labor, and an intrauterine infection are present. Your doctor is also less likely to recommend this procedure if you are pregnant with twins or more.

How Effective Is Cervical Cerclage?

Research suggests that a cervical cerclage helps reduce the risk of a premature delivery. However, this is greatly affected by some factors such as the timing and degree of cervical change before the cerclage.

What To Expect

  • Before The Procedure; An ultrasound image of your womb would be taken to check the health of your baby. Also, a swab of your cervical mucus may also be taken to rule out any infections.
An ultrasound scan should be done before and after a cervical cerclage
  • During the Procedure; A cervical cerclage is usually done through the vagina (transvaginal) or less commonly, through the belly (transabdominal). You would be given medicine to numb the pain before the doctor begins. This could be a pain-numbing injection in your back (such as an epidural) or something to sedate you. You may also fall asleep depending on what kind of medicine is given.
  • After The Procedure; You may experience some symptoms immediately after the procedure such as;
    • Mild Spotting
    • Mild Cramping
    • Increased Vaginal Discharge (colourless and odourless)

Spotting cramping and vaginal discharge after a cerclage all normal. If you notice any increase, please inform your doctor. Avoid any unnecessary physical activity for about 2-3 days after the procedure and just give yourself time to relax. Sometimes you may be asked to abstain from sexual intercourse as well.

  • Before Delivery; Your cervical cerclage stitches have to be removed before childbirth as the cervix is the only non-surgical passageway for your baby. Your doctor would recommend this when childbirth is around the corner, usually around 37 weeks of pregnancy. It might be required sooner if you go into labor.

Your stiches may be left in before childbirth if you are having a C-section, . You may also decide to keep it in for a longer period, but this should be discussed with your doctor as it may make it difficult for you to get pregnant.

Listen to your body..

In the end, the goal is for you to have a safe delivery and give birth to a healthy child. Therefore, it is essential to inform your doctor on time of any changes you may notice, seek and heed their medical advice as regards your pregnancy, to the ultimate benefit of you and your baby.

References
  • Zarei, M., Zahedifard, T., & Nori, R. (2018). Successful treatment with home care during the second half of a twin pregnancy complicated by a short cervix: A case report. Biomedical Research and Therapy, 5(02), 2045-2049. https://doi.org/10.15419/bmrat.v5i02.419.
  • Nivin Todd 2020, Cervical Cerclage and Your Pregnancy; What You Need to Know, WebMD, Viewed on June 3, 2020,

Are Epidurals Really Painful?

Cynthia’s threshold for pain was really low. As a child, she avoided any form of rough play that could result in painful injuries. Eventually, the inevitable call of puberty and menstrual cramps came along, and she had to rely on minor analgesics (paracetamol and others) to deal with the pain every month. When pregnancy came, she couldn’t get her mind off the possibility of extreme pain during childbirth. During one of her antenatal clinics, she explained this fear to the attentive doctor, who prescribed an epidural as a means to block out the pain.

Some women get bad headaches with pre eclampsia
Source: Shutterstock
Your Antenatal Clinics Are Very Important
Source: Pexels

What Exactly Is An Epidural?

The word ‘epidural’ means ‘near the spinal cord’.

It refers to an injection that is administered close to the spinal cord with the aim of preventing pain. These injections usually contain steroids or pain relief medication.

It is a common pain relief method during labour.

Source: Pexels

Epidurals create a certain degree of numbness from your bellybutton to the upper parts of your legs. This enables you to stay awake and active all through the delivery process. They allow you to watch your little one come into the world while causing you minimal pain.

How Is It Done?

In cases where an epidural is necessary, the doctor will insert a needle and a tiny tube (catheter) into the lower section of your back. After insertion, the needle would be removed while the tube would remain in place to serve as a delivery channel for the medication.

Source: Shutterstock

 

When Does It Begin?

An epidural can begin at any point during labour.

Some women prefer it at the beginning while others would rather wait till the end. Actually, the choice is yours to make (in consultation with your doctor)

Is It Really Painful?

Not really.

Just before the procedure, the doctor will numb the region where the medication is to be administered. In most cases, this action may result in a quick burning sensation at the selected site.

However, this is very helpful because it prevents you from feeling any pain as a result of the epidural injection. Although, most people tend to feel a little pressure when the needle is inserted.

What Are The Advantages?

  • They reduce pain during labour
  • You can continue to receive pain relief medications via an epidural for as long as you require
  • The amount of medication delivered through an epidural can be regulated as necessary
  • It aids relaxation, thereby speeding up the first stage of labour in most women.

Is Your Child At Risk After An Epidural?

The quantity of medication that reaches a baby from an epidural is really small. Therefore, there is little or no risk to your little one after having one.

Additionally, studies show no evidence of a birth defect caused by an epidural. 

Is There Any Side Effect?

Generally, epidurals are very safe.

Most Epidurals Are Used To Reduce Pain
Source: Pexels

In most cases, there is a very low risk of complications as a result of epidural. However, as it is with all drugs, there are potential side effects.

These Include;

  • Decreased Blood Pressure (hypotension). The doctor will be on the lookout for this and be on hand to carry out measures or give medications to prevent or counter this effect.
  • Headache
  • Sore Back

If you experience any of these symptoms after an epidural, please consult your doctor for proper care. Learn more about the causes of back pain after childbirth.

One More Thing

It is a really good idea to share all concerns with your doctor before delivery day. Don’t be afraid to seek out help or ask for medications to deal with pain in this period.

Epidurals are safe, easy and advisable in most cases.

Source: Shutterstock

You Are Not Alone.

REFERENCES
  • Salynn Boyles, 2003. Epidural Injections for Childbirth Rising https://www.webmd.com/baby/news/2030122/epidural-injections-for-childbirth-rising.
  • Epidurals. https://www.asahq.org/whensecondscount/pain-management/techniques/epidural/
  • Shutterstock
  • Pexels.com

HIV IN PREGNANCY: WHAT YOU NEED TO KNOW

HIV…the feared Human Immunodeficiency Virus. In Nigeria, it is associated with so much stigma and fear because most people consider a positive diagnosis to be a death sentence. For women living with HIV in pregnancy, the stakes are even higher due to their relationship with their unborn child.

You can protect your unborn child from HIV  by taking your medication, preactising safe sex and registering early for antenatal care.

However, contrary to popular opinion, a diagnosis of HIV does not automatically mean a woman cannot get pregnant. If you are HIV positive and you plan on having children, here are a few things you need to know about HIV and pregnancy.

What Should I Do Before Getting Pregnant?

Discuss with your doctor early on if you plan to get pregnant. He/she would inform you about the effects of HIV on pregnancy. Your doctor will also guide you on how to best prepare for a healthy pregnancy.

Everyone diagnosed with HIV needs to take their medicines and keep up with their check-ups to remain healthy. This is especially important if you plan to get pregnant. Doing this way before your pregnancy will lower the risk of passing the virus to your baby.

Worried about infecting your partner? There is no need to be!

If your partner is HIV negative, there are still ways you can get pregnant that will greatly reduce the risk of your partner getting infected. These are part of the things you need to discuss with your doctor.

I Am HIV Positive , Can I Transmit It To My Baby?

Yes, it is very possible to transmit HIV to your baby. This can happen during pregnancy, childbirth or breastfeeding. Therefore, necessary precautions need to be taken throughout your pregnancy and birth to prevent this from occurring.

The single most important factor in spreading the virus to your baby is your viral load. This is more or less the volume of the HIV detectable in your bloodstream.

I Don’t Have HIV. Why Should I Get Tested During Pregnancy?

Pregnant or not, everybody needs to know their HIV status at regular intervals.

Even if you have never been confirmed positive for the HIV virus, you still need to get tested for HIV if you are pregnant. This is because it is possible to have the virus and not know.

In such a case, early detection will not only protect your baby from also getting an infection, but will also improve your overall health.

What Should I Do If My Partner Is The One With HIV?

Women are more likely to get an HIV infection through vaginal sex than men.

This means that if your male partner is the one with the infection, you have a higher risk of getting HIV while trying to get pregnant. However, it is still possible to get pregnant without getting infected as long as the necessary precautions are taken.

The first thing to do is to talk to your doctor about your options. You may be recommended to be on HIV medicine that would help protect you and your baby from HIV. Your doctor may also suggest you use donor sperm or assisted reproductive technology to get pregnant. However, keep in mind that these options are more expensive.

I Am Already Pregnant. Will My Baby Have HIV?

As a person living with HIV, contact your doctor immediately you get miss a period and have a positive pregnancy test. This would help him/her direct you on the right path to a safe and healthy pregnancy.

We want you to know that you having HIV does not automatically mean your child would have HIV. With recent advances in medicine, it is now possible to lower the risk of mother-child transmission to almost zero!

How Can I Protect My Baby From Getting Infected?

If you have HIV, you can take these steps to reduce the risk of passing it to your baby:

  1. Inform your doctor you want to get pregnant. This is the only way to get professional guidance on how to have a healthy pregnancy and baby.
  2. Get prenatal/antenatal care, and take it seriously. This is the only way your doctor can closely monitor you to ensure you and your baby are fine. It is advisable to choose a hospital or doctor that is specialized or experienced in caring for babies exposed to HIV.
  3. Start HIV treatment. Your doctor would most likely put you on antiretroviral drugs to reduce the risk of you infecting your baby. If you were on medication before pregnancy your meds may be modified slightly to ones that are safe for pregnancy. With HIV treatments, come some side effects that may be especially challenging during pregnancy. Still, you have to take your drugs. Discuss with your doctor about whatever side effects you may experience and how to best manage them.
  4. Stay the course: You will have tests done at regular intervals to monitor your viral load and make sure you and your baby are healthy. Please don’t skip them and if you do try and make arrangements to make up.
  5. Breastfeeding: Breastmilk has so many benefits for your baby. It provides immunity and more. However, a few precautions need to be taken. The virus can be transferred to your baby through breast milk; even if you are on medication. Recommendations vary based on where you live, your financial situation etc. In some countries, formula feeding is recommended. While in others where the risk of not breastfeeding (eg. diarrhoeal diseases, malnutrition) outweigh the benefits, it is recommended that you give your child breastmilk. Please speak to your doctor about your options.
  6. Do not mix feeds: If you are planning on formula feeding, stick to that. Please do not mix breastmilk and formula. Irritations from formula feeding can compromise your baby’s gut and leave them vulnerable to any virus in your milk.

How Will My Care During Pregnancy And Delivery Be Different?

During pregnancy, your doctor would most likely put you on HIV medication. This would reduce the risk of you transferring HIV to your child. You may also need to visit the hospitals more often as your doctor will need to monitor you closely.

It is important to discuss your delivery options with your doctor as soon as possible. Your doctor may recommend either a C-section or a vaginal delivery. A C-section is usually recommended for an HIV positive mother that has had no prenatal care nor been on any anti-HIV medication.

What Happens To My Baby After Birth?

Your baby should be given some anti- HIV medication immediately they are born or within 12 hours of birth. This which will be continued. They will then be tested at birth, 2 weeks old, 4 weeks, 6 weeks and so onto monitor their status when the antibodies to HIV would have cleared from their system.

Your doctor will inform you on whatever follow-up tests your baby would need and when they need to be carried out. Discuss with your doctor about whether your baby would need to start HIV treatment immediately. Most doctors will prescribe antiretroviral drugs for your baby for the first 4 weeks after birth to prevent your baby from getting HIV.

What Happens To Me After Birth?

Your doctor may decide to stop or change your anti-HIV drugs after birth. However, do not alter your regimen without approval from your doctor as this could lead to problems.

You would also need to continue with your medical care through routine medical checkups, family planning services, mental health services and HIV specialty care.

Consult with your doctor about which of these services you may need and how to access them.

If you choose not to breastfeed, please inform your doctor so they can prescribe medication to help stop your breastmilk flow and prevent complications such as mastitis, abscesses or discomfort from breast engorgement.

Should I Be Worried?

In today’s world, living with HIV is no longer a death sentence.

People who are diagnosed with an infection do go on to live healthy, normal lives with the option of giving birth to healthy HIV-free babies! So even if you or your partner is HIV positive, there is absolutely no need to worry. Given the current COVID- 19 pandemic please read through the current guidance for pregnant women.

Speak to your doctor, follow all advice given and take your medications and keep up with your screening tests. We assure you that you and your baby would be fine.

Learn about malaria in pregnancy/
REFERENCES

Is Your Pregnancy Putting You At Risk For Diabetes?

Are you pregnant? Yes? Then you may be at risk for diabetes!

How does this happen?

Gestational diabetes is a form of diabetes that appears only during pregnancy. As strange as it may sound, studies show that 6-7% of pregnant women will develop this form of diabetes during the course of their pregnancy.

What causes gestational diabetes? Are the symptoms obvious? Is it possible to keep you and your baby healthy after a diagnosis?

Read on to find out!

What Causes Gestational Diabetes?

Our body releases a hormone called Insulin every time we have a meal.

This hormone helps to break down fats and carbohydrates, turning the sugar from our food into energy. At times, hormones from the placenta can prevent the production of insulin and sugar cannot be broken down properly.

Therefore, excess sugar remains in the blood and causes gestational diabetes. Gestational diabetes usually starts around the 24th to 28th week of pregnancy.

If not managed properly, this sustained rise in blood sugar can cause damage to the nerves, blood vessels and organs in your body.

Risk Factors For Gestational Diabetes

Although it is not certain why some women get gestational diabetes while others do not, there are some factors that places anyone at risk of this condition:

  • Obesity
  • High levels of tummy fat
  • Age (Women older than 35 years)
  • Polycystic ovarian syndrome
  • Family history of diabetes
  • Personal history of Gestational Diabetes
  • History of delivering large babies (more than 9pounds/4.1kilograms)
  • Sendentry Lifestyle
  • Race: Sadly, being black places you at a higher risk of this condition.

Symptoms Of Gestational Diabetes

Many women who develop gestational diabetes during pregnancy may not notice any symptoms. Most women find out after they have been tested for the condition.

However, some signs you should watch out for are:

  • Incessant thirst.
  • Frequent urination and in large amounts
  • Persistent Fatigue
  • Sugar in the urine during a dipstick test
  • Nausea
  • Blurred vision
  • Recurrent vaginal, bladder and skin infections

Your doctor will test you for gestational diabetes during your routine antenatal check ups. This is done between 24-28 weeks if you have never had it before or at your first visit if you had it in your previous pregnancy. This test is called an OGTT (oral glucose tolerance test).

How Does Gestational Diabetes Affect You and Your Baby?

If left unchecked, gestational diabetes could put you at risk for:

  • Preeclampsia
  • Miscarriages and pregnancy loss
  • Increased risk of having a baby by caesarean section.
  • Stillbirth

On the other hand, it puts your baby at risk for:

.Jaundice ( yellowing of the eyes and skin)

  • Breathing difficulties
  • Macrosomia; a condition where a baby is too large and the head too big for a vaginal delivery.
  • Low blood sugar levels
  • Low calcium levels
  • Issues with the formation of organs such as the heart
  • Obesity
  • Type 2 diabetes later in life

However, mothers who follow their obstetrician’s advice and recommendations for either medication or dietary changes do not have to worry about these risks.

Gestational diabetes can be adequately managed with diet and exercise
Gestational diabetes can be adequately managed with diet and exercise

Gestational diabetes can be adequately managed with proper diet and exercise. In some cases, supplementary insulin as injections may be recommended. Other times oral tablets are given to help control your blood sugar through other mechanisms .

A diagnosis of gestational diabetes can be overwhelming. However, there is no need to despair as it can be easily controlled so that you have a safe and healthy delivery.

Your pregnancy will need to be monitored more closely eg. more frequent antenatal visits. Follow your doctors advice at all times. Maintain a healthy diet, and remain physically active. Be consistent with your medications if you have any.

As long as you follow the guidelines above, you and your baby will be fine.

References

DO AFRICAN WOMEN EXPERIENCE PICA?

This pregnancy was confusing! Chike wondered what would make a pregnant woman want to eat paper. His wife, Louis had developed an insatiable desire for books, but not in a good way.

eating paper

Speaking to their family doctor, Chike complained his wife eats the paper. Ripping away pages, one by one, putting them in her mouth and chewing greedily on them.

Apart from her voracious appetite for books, his wife Louis was otherwise normal. In fact, she’d just given birth to their first daughter.

During the pregnancy, everything was normal; there was no complication or usual discomfort. Everything about her diet remained regular (except the paper consumption, of course).

He had no idea when it began nor how to stop it. He had first noticed it when she was consuming just bits of paper, loose pages, cutouts of newspapers, small flyers, and the likes. At that time, he thought it was just a phase that would soon pass away. However, Chike gradually watched his wife progress from bits of paper to whole books!

At this point, he decided to seek help

“What is happening?”, Chike asked the doctor. “Is this going to hurt her?”, “Is she depressed?”, “Should I be worried?”.

The questions kept on coming.

The desire to eat non-food items or things not normally considered to be food is known as PICA.

It is an eating disorder that makes people to eat things with no nutritional value such as paper, cloth, dirt, ashes, string, wool, starch, matches, cardboard, hair, laundry detergent, chalk and soap, talcum powder, gum, metal, pebbles, charcoal, paint chips, ice, among other things.

DIAGNOSIS

There are no laboratory tests to detect PICA. Instead, diagnosis is made through a patient’s medical history.

For efficiency, this diagnosis should be followed by lab tests for anemia and digestive tract blockages which may arise from the substances consumed.

AFRICAN WOMEN AND PICA

In Nigeria, most cases of PICA are usually unnoticed.

Therefore, it is unclear about how many people are affected by pica. However, one study reported that pica was a normal occurrence for pregnant women in Malawi, as this is how they know they are pregnant. Similar studies also reported a high prevalence of pica in Tanzania (63.7%), Kenya (73%) and Nigeria (50%).

SIGNS & SYMPTOMS OF PICA

Some of them include:

  • Stomach upset
  • Stomach pain.
  • Bloody stool
  • Constipation
  • Diarrhea
  • Bowel problems

HEALTH IMPLICATIONS

Repeated consumption of non-food items for a long period of time could prove dangerous. This is because some of these items have toxic, poisonous and bacterial content. Some health implications include;

  • Lead poisoning
  • Intestinal blockage or tearing
  • Teeth injuries
  • Infections
  • Iron defi

RISK FACTORS

Some risk factors of pica include;

  • Mental health disorders like autism, schizophrenia, e.t.c
  • Iron-deficiency anemia
  • Malnutrition
  • Pregnancy
Why you need folic acid during pregnancy

TREATMENT

The first course of treatment for pica is checking for nutritional deficiencies.

Medication

At times, the development of pica is an indication that your body is trying to compensate for a mineral or vitamin lack. Thus, using vitamins or nutritional supplements to treat such deficiencies usually helps resolve the pica. 

However, if pica is not caused by malnutrition or does not stop after nutritional supplementation, other forms of management need to be considered. There are a variety of behavioral therapies available.

Your health care providers will be in the best position to recommend one.

In Conclusion

A majority of pica cases go unreported in Africa, because most people who have this disorder tend to be secretive about it. The onus thus is in the court of health-care providers to pay key attention to any tell tale signs or even inquire specifically about any abnormal eating habits. Find out about foods to avoid during pregnancy

References
  • Mary S. Jackson, A. Christson Adedoyin & Sarah N. Winnick (2020) Pica Disorder among African American Women: A Call for Action and Further Research, Social Work in Public Health, 35:5, 261-270, DOI: 10.1080/19371918.2020.1791778
  • Pica. (2018, February 22). National Eating Disorders Association. https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/pica
  • Abu, Brenda & van den Berg-van Antwerpen, Violet & Raubenheimer, Jacques & Louw, Vernon. (2017). Pica Practices among Apparently Healthy Women and Their Young Children in Ghana. Physiology & Behavior. 177. 10.1016/j.physbeh.2017.04.012.
  • Dr. Baffah Muhammad, Aminu & Mohammed, Alkali & Muhammed, Bala & Abdulrazak, Toyin & Chinedu, Aniobi. (2020). Prevalence of pica among pregnant women attending antenatal clinic in a tertiary facility in Nigeria. Annals of African Medical Research. 2. 10.4081/aamr.2019.89.
  • Sule S. Madugu HN. Pica in pregnant women in Zaria, Nigeria, Niger J Med 2001;10:25-7
  • Nyarohucha CN. Food cravings, aversions and pica among pregnant women in Dar es Salaam, Tanzania. Tanzan J Health Res 2009;11:29-34
  • Pexels.com

SUDDEN INFANT DEATH SYNDROME (SIDS)

Jennifer was shocked. In fact, she just couldn’t believe what she was seeing; her baby lying motionless on her tummy in her cot.

Yes, we know.

No one wants to lose their baby, especially in such an unexpected manner. Often times, the pain is heartbreaking and absolutely cruel. Like Jennifer, many women have lost their precious ones to the cold hands of SIDS.

In this article, we’d provide reliable info on SIDS; the causes, chances of occurrence and risk factors. In the same vein, we’d supply you with valid tips on how to prevent SIDS.

What Is Sudden Infant Death Syndrome (SIDS)?

This is the unexpected and sudden death of a child that is less than a year old. Most times, it occurs during sleep and the deaths cannot be affiliated with a particular cause even after extensive examinations.

Essentially, this syndrome claims the life of a seemingly healthy baby while he/she is asleep.

The rate of occurrence is higher in males compared with females and more common during the cold weather.

What Causes SIDS?

The exact cause of SIDS is unknown.

However, some experts suggest that it may be caused by a problem in the part of the brain that controls breathing and waking up.

The Signs & Symptoms

Although there are no obvious symptoms, studies show that the following conditions have a strong relationship with SIDS:

  • Breathing problems
  • Abnormal hand & leg movements
  • Not having enough oxygen in the blood

Close observation from the parents can reveal any of the first two symptoms. If you notice any of these, please consult your doctor immediately.

What Puts A Baby At Risk Of SIDS?

1. Wrong Sleeping Posture

In the first year of life, it is necessary for your little one to get enough sleep. In addition to the right amount, posture is also important. Babies who are made to sleep on their bellies face a higher risk of sudden death while asleep.

The correct sleeping posture for your child is to lie on his/her back.

2. Mums Or Parents Who Smoke

During pregnancy, a lot of substances pass from mother to her baby through the placenta. As a result of this, substances a mum is exposed to can have effects on her baby’s health.

Smoking or exposure to secondhand smoke during pregnancy greatly increases the chances of sudden death in the first year of a child’s life. This occurs as a result of the damage cigarette smoke poses to the developing respiratory tract of a baby.

3. Sleeping On An Adult’s Bed

Although most mothers prefer to keep their babies close in the first year of life because it’s easier to breastfeed or cuddle, this may be risky.

Sharing a bed with an adult increases the possibility of suffocation or breathing problems which can result in sudden death.

4. Poor Prenatal Care

It is important for every expectant mother to attend antenatal clinics regularly and get every form of care available to her. At these clinics, pregnant women receive routine checks which maintain their health status all through pregnancy.

When antenatal clinic visits are missed, certain red flags regarding health may be missed as well leading to issues later in life.

5. Passive Smoke

In plain terms, this is second-hand smoking.

When a baby breathes in air that is contaminated with smoke from cigarettes, dangerous fumes or alcohol, the chances of respiratory problems increase.

What Can I Do To Prevent My Baby From Having SIDS?

Thankfully, there are a number of ways to reduce the risk of your baby having SIDS. In addition, these steps can be taken before or after childbirth.

Before childbirth:

  1. Get early and regular ante-natal care. Go to the clinic on your days and ensure you don’t skip appointments .
  2. Avoid smoking, drinking alcohol or taking hard drugs during pregnancy.
  3. Take an infant CPR class. Do you know what to do if your baby is found unconscious or choking? All parents should learn how to carry out infant CPR (cardiopulmonary resuscitation). CPR done early can save your baby’s life.
rib. Avoid sharing the same bed with your baby. Co- sleeping increases the risk of suffocation.

After childbirth:

  1. Learn to put your baby to sleep on his/her back. If your child is old enough to roll over, let him/her sleep in a comfortable position.
  2. Put your baby to sleep in a crib. Avoid sharing the same bed with your baby. Co- sleeping increases the risk of suffocation.

3. If you have twins or other young children who still sleep in cribs, let them make use of a separate cribs.

4. Use a firm mattress for your baby’s crib. In addition, ensure that there is no gap between the mattress and the side of the crib.

5. While your little one is asleep, make sure that pillows, blankets, toys or other items do not prevent him/her from rolling over. If these items are wrongly placed, they can obstruct breathing and cause suffocation. So please take them out of the crib.

6. We know regular tummy time sessions during the day are a key exercise for your little one. Please supervise every session.

7. Breastfeed your baby as much as possible. Research has shown that breastfed babies are less likely to die from SIDS.

A Final Note

We encourage you to ensure your baby gets all the recommended vaccinations and goes for regular check-ups. In addition to this, remember that smoking is not good for your baby’s health.

Don’t allow your child inhale smoke from cigarettes.

Above all, it is important to note that women like Jennifer still get to have healthy babies who grow to be strong and happy.

As long as you follow the preventive steps listed above and avoid the risk factors, your baby is going to be fine, strong and healthy.

REFERENCES

GLANDULAR HYPOPLASIA AND BREASTFEEDING

“Maybe you just need to give it a little more effort”

“Have you tried drinking more water?”

“I heard fenugreek helps mothers like you”

Many mothers who have difficulties with milk production receive this sort of advice countless times from family and friends (well, most have good intentions).

While most women produce more than enough milk for their babies, a small percentage of mothers find breastfeeding to be quite challenging.

Why Can’t I Make Enough Milk For My Baby?

Some mothers feel that they can not make enough milk for their babies because they have small breasts.

However, this is not true.

The size of a woman’s breast does not influence how much milk she can produce in anyway. A more reasonable cause for insufficient milk production is insufficient glandular tissue (IGT).

Glandular tissue is the milk-making tissue in a woman’s breast.

Therefore, breast milk production will be low if the glandular tissue present is insufficient to produce enough milk. Women with insufficient glandular tissue struggle with producing enough milk for their babies, even after practicing good breastfeeding management.

A word of caution!

Insufficient glandular tissue is a diagnosis of exclusion. Other factors that can affect breastmilk supply must be investigated first by your health provider or lactation consultant and found to be absent. Some of these include:

  • Hormonal imbalances (eg. thyroid or due to retained placenta)
  • Previous breast surgery
  • Issues with the baby’s ability to suckle and drain the breast (latching, tongue tie, cleft lip)
  • Not putting baby to breast enough.

Physical Signs of Insufficient Glandular Tissue 

Signs In Mother

It is important to emphasize that the size of your breast has no bearing on your glandular tissue or ability to breastfeed.

Women with small and large breast can suffer from glandular hypoplasia

Women with small and large breast can suffer from insufficient glandular tissue. Some physicals signs that can indicate insufficient glandular tissue are;

  • Asymmetric Breasts; In this case, one breast being much larger than the other
  • Breasts that are tubular shaped (narrow at the base and long instead of round, quite like bananas)
  • Very large and bulbous areolae; The areola is the dark skin around your nipple. When this occurs. the areola may look as if they are a separate structure from the breasts.
  • Wide-spaced breasts (The gap between both breasts can be up to 4cm )
  • No breast changes during or after pregnancy. This is something that should be taken note of during your antenatal. We expected your areola to darken, breasts to become larger and so on.

The more of these signs a woman has, the greater her chances of having insufficient glandular tissue. 

Signs In Baby

In the setting of glandular hypoplasia, the baby will show signs they aren’t getting enough breast milk. Some of these include:

  • loosing more than 10% of birth weight,
  • failure to return to birth weight by 2 weeks,
  • having less than the required number of wet or poopy diapers for their age,
  • gaining less than 20g of weight daily between 2 weeks old to 3 months old.

What Can You Do? 

Some mothers who have difficulty breastfeeding can easily adapt to using other measures like formula feeding.

With glandular hypoplasia , the reality of being unable to breastfeed can be a very hard pill to swallow.

However, for a mother who anticipated breastfeeding as an important part of her mothering journey, the reality of being unable to breastfeed can be a very hard pill to swallow.

Fortunately, there are some things these mothers can do to preserve the breastfeeding experience.

1. Use A Breastfeeding Supplement Tool

One thing some mothers with insufficient glandular tissue can try is using an at-breast supplementing tool.

A mother using a supplemental nursing system (SNS)

This tool is made up of a small, thin tube with one end attached to the skin around the mother’s nipple. This is the end that goes into the baby’s mouth. The other end is connected to a container that contains the feeding supplement.

This supplement could be the mother’s own expressed milk, milk from a donor, or infant formula. The amount of supplement required will depend largely on the amount of milk the mother is able to produce on her own. With this method, it is possible for mother who has difficulty with milk production to still experience breastfeeding.

2. Prescribed Medications

Some mothers with insufficient glandular tissue may still be able to breastfeed and produce most of the milk their babies will need.

Certain approved medication can greatly increase their milk supply and reduce the need of supplements to just once or twice a day. Before considering this option, remember to consult your doctor.

3. Bottle Feed First, Breastfeed Later

This is also an effective method of maintaining a breastfeeding relationship with your baby.

Since your body can not produce enough milk, you can feed your child with infant formula first. Then once she is beginning to have her fill, you let her finish at your breast.

Nigerian food that help increase breastmilk supply

A Final Note

No matter how little milk you may be able to make, it is still very precious and valuable to your baby.

Thankfully, most mothers with insufficient glandular tissue find that their breast milk supply improves with subsequent babies. This is because each pregnancy and breastfeeding experience causes an increase in glandular tissue.

With support from a lactation specialist many mothers with insufficient glandular tissue can still enjoy fulfilling breastfeeding experiences.

We understand that being unable to produce enough milk to breastfeed your child may be difficult to accept.

However, all hope is not lost.

With support from a lactation specialist many mothers with insufficient glandular tissue can still enjoy fulfilling breastfeeding experiences.

REFERENCES

HOW CAN I TELL IF MY BABY IS GETTING ENOUGH?

“Is my baby getting enough milk? ” New mums all over the world are constantly asking this quetsion. Newborn feeding constantly leads to friction between new mothers and their mother and mothers-in-law in Nigeria.

Is my baby getting enough? is a constant source of arguments

The anxiety this causes tempts us to introduce water or formula in the first few days of life when our actual goal was to breastfeed exclusively.  

Anxiety and fearof starving the baby causes mums to introduce formula

These conflicts stem from:

  • Ignorance of individual and general signs of hunger and feeding patterns in newborns
  • Lack of knowledge of the normal progression of weight gain/ fluctuations
  • Not knowing the signs that a baby is being adequately nourished.
  • Poor infant feeding practices or alternatives when challenges arise

What are the general signs of hunger in newborns?

Babies are usually good communicators.

The trouble is we don’t often pay attention or know what to look out for. The following are common signs that your baby is hungry: 

  • Baby keeps opening the mouth
  • Sticking out the tongue
  • Making sucking movements 
  • Your little one is constantly bringing their hands up to their mouth
  • Moving their limbs as though crawling or cycling in the air
  • Turning their head towards the chest or breast of whoever is carrying them
  • Crying and being irritable. When they cry, it is a late sign of hunger. Some may get so worked up that they won’t want to latch onto your breast or teat of the bottle! Alternatively, they could latch onto your nipple in their haste and annoyance.

This, I assure you, will bring you exquisite pain while breastfeeding

Are Preemies Different?

When preemies are hungry they could lick their lips, become restless, stick out their tongue or flutter their eyes.

Conversely, when they have had enough they relax and their colour changes if they are light-skinned). Some of them may change the rhythm of their nursing and they may touch the breast.

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7 Signs your baby is hungry

A satisfied baby is relaxed with inactive limbs. The baby may turn away from your chest, lets go from breast or bottle feeding and fall asleep.

Baby’s tend to cluster feed at times when they are experiencing rapid growth. Cluster feeding is characterised by showing signs of hunger more frequently than usual.

This is often observed by mothers who schedule their baby feeding times at intervals (as opposed to feeding baby on demand). A baby who usually feeds every 3 hours may demand food every 2 hours for a span of 3 days. For breastfeeding mothers, it’s natures way of increasing your milk supply. Demanding more milk from you in response to your babies next stage of growth characterised by the need for larger quantities of milk. Growth spurts can be observed at 2 days old, 3 months old, and  6- 9 months old

How much milk does my baby need?

Your newborn’s stomach size is really small at first.

At the first to the third day of life, your baby’s tummy is the size of a cherry or 1 grape and can only hold a teaspoon of milk ie. 5-7 mls per meal. By day three to five, it is the size of a table tennis ball or walnut.

From six days old up to 3 weeks old baby’s stomach is the size of an egg and so on.  Knowing this should restrain you from overfeeding your baby which could cause undue discomfort and distract you from the real cause of why our child may be fussy.

All babies lose no more than 10% of their body weight within the first 5-7 days of life before returning to their birth weight by week 2. Baby’s weight should increase by 50% at 6-8 weeks old and double his/her birth weight at 4-5 months old.

This topic, weight gain, is another source of anxiety and potential conflict with loved ones as far as a first-time mum is concerned. Look out for these variations and verify during your first well-baby visit after childbirth. Make sure you use an appropriate infant weighing scale.

Any deviation from this may then prompt investigation of your baby’s nutrition or breastfeeding practices. The weight and length measurements for your baby should be entered in a chart which usually comes with your immunisation card. Each entry is benchmarked against the normal range for baby’s age within our environment which is also indicated on the chart. This forms a more objective view of if your baby is being adequately nourished.

Signs That Your Baby Is Being Adequately Fed

A well fed baby will :

  • Have 4 -6 wet diapers (urine) and 3-4 poopy diapers daily. Note that exclusively breastfed babies can go up to 3 days without passing stool at 3 months old. Also, formula-fed babies can get easily constipated if you fail to follow the instructions for proportions of water to formula while preparing their meal.
  • Gain weight in accordance with the normal range for his/her age and race as entered in the growth monitoring chart mentioned above

Is there a need for vitamin supplements in infants? Formula-fed babies do not need multivites. However, babies being exclusively breastfed are required to get vitamin D drops. There apparently isn’t enough vitamin D in breast milk and babies and mums don’t get as much sunlight as needed.

What Can I do When Challenges Arise

The bedrock of a breastfed newborn getting enough milk from its mother is ensuring your little one is draining the breast adequately. Next mother has to have an adequate supply.

Your infant will drain your breast if he/she latches on properly ie. your nipple and most of the areola complex are in baby’s mouth with the areola in contact with baby’s hard palate and tongue.

If your breast is constantly being drained by the end of each feeding session, the initial increase in milk production and supply which is governed by demand and supply feedback will be activated.

Nigerian food that help increase your supply

Some structural challenges such as tongue-tie in the baby or a mismatch between the size of your their mouth and your nipple-areola complex can hinder adequate feeding. It is important that these are found early and addressed by a trained health professional or lactaction specialist.

As mentioned above, it is important that the exact instructions for preparing a baby’s formula are followed. This prevents them from developing hard stools that are difficult to pass out (constipation). Constipation will come up from a concentrated mix of formula. On the other hand, a formula mix that’s too dilute will result in their not getting enough calories.

What if my baby doesn’t like feeding on a bottle?

This is a question that worries mothers who may need to return to work or leave their baby in the care of others for a few hours. If they refuse to breastfeed or accept a feeding bottle, the following alternatives are viable feeding options:

  • Cup and baby spoon 
  • A small syringe (without the needle)
  • Feeding cup 

Feeding a newborn as a first time mum can seem daunting. It is important to arm yourself with the right information to avoid common mistakes. Furthermore, information gives you the confidence to push back and advocate for yourself and your little one when the need arises. These are tips you should learn during an antenatal visit or birthing and breastfeeding class.

References

Wagner C. Counselling the Breastfeeding Mother. Emedicine. February 2015 Accessed September 9th 2019
https://emedicine.medscape.com/article/979458-overview

How to increase your supply and build a stash of breast milk
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