What is Cervical Incompetence?

McDonald Cervical Cerclage

[vc_row][vc_column][vc_column_text]A few weeks ago, a friend rang me up and told me that her doctor had just called her cervix incompetent. Here is how our conversation went.

Friend: Hello?

Me: Long time I have missed you.

Friend: (Sounding bored) Well, yeah, been busy

Me: Are you okay?

Friend: Actually, the doctor I am seeing just called my cervix incompetent

Me: Oooh, I um…..

Friend: I will sue him. How can he talk like that? Is that even professional?

Me: Haha haa haaaa

Friend: ( Hangs up).

An incompetent cervix is one that opens prematurely under the pressure of the growing fetus and results in early second trimester miscarriages.

Causes of cervical incompetence include:

1. Genetic weakness of the cervix

2. Severe laceration during previous pregnancies

3. Multiple gestation (twin, triplet, etc)

People with cervical incompetence normally experience multiple pregnancy losses all which occur in the second trimester of pregnancy.

The treatment usually involves placement of a cervical stitch (MC Donald’s stitch) that closes the cervix and prevents it from opening usually from the 12th to the 16th weeks of pregnancy

Your doctor will need you to abstain from sex if you have a MC Donald’s stitch in place till delivery.

People with MC stitch can still deliver vaginally except, the stitch will need to be removed before delivery or any time after the 37th week of pregnancy.[/vc_column_text][/vc_column][/vc_row]

Pre-Conception Care

Pre-Conception Care

Well before each baby is conceived, the two parents involved should actually decide to conceive the baby (as opposed to find yourself pregnant), carry the pregnancy to term and give birth to a healthy baby, while ensuring the mother is healthy throughout the pregnancy and during the post delivery period. During the preparation phase of conception, the two parents to be should undergo pre- conception care.

Pre- conception care is the care given to both men and women who are planning to conceive, with the aim of increasing chances of conception, and reducing the risk of death during pregnancy, with an aim of giving birth to a healthy baby.

It offers patients an opportunity to discuss risk factors that can be minimized before and during pregnancy to ensure a healthy outcome for the mother, father and the baby. The issues to be discussed and addressed include;

Contraception
Couples on contraception who wish to get pregnant should discuss it with their obstetrician and gynecologists. Those on implants and intra-uterine devices should have them removed. Those on three monthly injections should be counselled on the possibility of a delay in the return to fertility for about three or so months.


Maternal chronic diseases

Before pregnancy, women who suffer from chronic diseases like diabetes, hypertension, epilepsy, HIV should be seen by their gynecologists. They should be treated to a level where their diseases or the drugs they take won’t affect the well being of the baby.

    Diabetic women

should have their sugars well controlled before they become pregnant. They should also have their medicines changed from oral tablets which have teratogenic potential to insulin injections.

Pre-Conception Care
Pre-Conception Care

    Hypertensive women

should have their pressures well controlled before pregnancy. They should also discuss the potential to have their drugs changed to drugs that have no teratogenic potential.

    Epilepsy

– women with epilepsy and who are on medications should not ideally get pregnant without discussing it with their doctors. Most of the anti-epileptic drugs they use may cause birth defects such as spina bifida. They are therefore supposed to be started on a course of folic acid supplementation several months before they become pregnant. They should also have their drugs changed to drugs that don’t cause fetal defects.

    HIV positive women

should be put on anti-retrovirals till their viral load is undetectable so as to reduce the possibility of mother to child transmission.

    Hyperthyroidism

– women using anti-thyroid drugs should be seen by their doctors and advised if at all getting pregnant is safe at all. They should also have their drugs changed to drugs that don’t cross the blood placental barrier hence causing fetal defects.

Mental illnesses
Such as depression and anxiety disorders should be screened and treated before pregnancy. Women who are on continuous treatment for mental illnesses should be put on medications that are safe for the child who is about to be conceived.

Nutrition
All women desiring pregnancy should have their nutrition assessed. They should start feeding on folic acid rich foods and taking folic acid supplements if need be. Folic acid prevents against neural tube defects.

Obesity
Women with a body mass index (BMI) of 30 and above should be advised to lose some weight. Obesity is a risk factor for infertility among women. It is also a risk factor for other pregnancy complications like deep venous thrombi i.e clots.

Sexually transmitted diseases
Both parents should be screened and treated for sexually transmitted illnesses such as syphilis so as to eliminate the risk of transmitting it to the unborn baby.

Family and Genetic history
Assess pregnancy risks on the basis of maternal age, maternal and paternal health, obstetric history and family history. Possibility of passing genetic defects like sickle cell to the unborn baby should be discussed.

Advanced maternal age and the risk of getting babies with Down syndrome should also be discussed.

Images courtesy of Citizen Kenya & Lune Magazine

Health Is Now Devolved

Photo source: The Sun Nigeria.

A twenty-year old walks to the County referral hospital with the dignity of a married woman, tummy protruding before her, she is walking with her legs slightly apart, thanks to her protruding belly. She is in the company of three women; her mother in law, her own sister and an elderly neighbor. Every twenty or so minutes, she pauses, puts her hands on her waist and takes long purifying breaths as a strong contraction starts at the fundus of her uterus and radiates down, causing indescribable pain. The long, slow breathing, she has realized helps. She is hopeful that everything will be fine, she is not worried about anything. The most important thing to her is that she is married. This child is not a bastard. He (she hopes it will be a son) has a father and hence a future.

At the entrance to the wards, she is allowed in without delay. The security people don’t keep women with protruding bellies and dancing feet waiting. She is ushered into the maternity ward. The admitting doctor gets her details. She is a first time mother. She doesn’t remember when she got her last period, like ninety percent of all the women admitted into maternity. Currently she has low abdominal pain, that begun about sixteen hours before she presented to the hospital. Her baby is kicking just fine but her water hasn’t broken. The admitting doctor notes that. She asks for the antenatal clinic book. She is handed a purple booklet which, except for the name, is essentially blank. ”Mama ulienda clinic?” She asks. The patient answers in the affirmative. How many times? Once. The reason why no test was ever done is because she was unable to go back a second, third and fourth time. The county health care workers were all on strike over unpaid salaries. She couldn’t afford the private hospitals because she has no insurance cover. And she couldn’t go to the next county hospital either because she had no bus fare.

The doctor performs her examination and realizes she is carrying twins. Her cervix is five centimeters dilated. She hastily draws blood, to check her hemoglobin level and do other basic tests like HIV testing, blood grouping, et cetera. Her HIV sero-status comes out positive, her hemoglobin level a mere seven. The doctor summarizes the patient’s condition; “a first time mother, who is anemic and HIV positive, carrying twins, never been on ARVs.” This is definitely a recipe for post-partum hemorrhage and other chaos.

She decides to look for blood for her just in case she develops post-partum hemorrhage. When she goes to the lab, the fridge is opened so that she can see for herself that there is no blood. Because seeing is believing. So the doctor goes back to the ward just to consider her options; take out her prayer beads and say a continuous prayer for the poor clue-less woman. Pray that she delivers safely. Pray that she doesn’t bleed excessively after delivery, or refer her to the next county hospital. Her cervix is now nine centimeters dilated. The first baby will be born about one hour from now. The next county hospital is one hour thirty minutes away. So referral is clearly out of question. but she still calls the hospital for the sake of it. But the person on the other end is so sorry they also don’t have blood. So the doctor goes back and sits in the maternity ward and waits for a miracle, the miracle of safe delivery, good health to the mother and the babies. Because she can’t have a maternal mortality. Mothers shouldn’t die when bringing a new life to earth. And also mothers shouldn’t die because maternity care is “free” paid for by the government. Our dear government!

PRE-MATURITY

When you get pregnant, the world congratulates you. Mothers share their labor stories with you. They will mostly tell you about the pain which is always so much, words cannot describe it. They will tell you about the not so wonderful regular vaginal examinations that you will be expected to endure. They will advise you about where to go for your antenatal clinic, what to eat and what to avoid, where to buy your maternity and baby clothes, how much pain you should anticipate et cetera. Nobody will ever talk to you about going into labor pre-maturely. Nobody will talk to you about giving birth to a one kilogram child. Because it is never expected. Everybody assumes you will get pregnant, have an uneventful pregnancy, deliver at term to a bouncing baby boy or girl and everything will just be normal.

But sometimes, you will give birth pre-maturely for one reason or another. While a normal pregnancy is assumed to last for forty weeks, some women may deliver at late second trimester or early third trimester. A child born before term is usually under-weight, has immature lungs, is unable to regulate their body temperature, has fewer stores of essential vitamins and minerals and has reduced or no native reflexes. These are children whose suckling reflex is either absent or not well developed hence cannot attach on the breast. They need to be fed via a naso-gastric tube, need to nursed in a warm environment. They may need to be put on oxygen, especially during the first days of life.

Some of the reasons why a pregnant woman may go into labor prematurely include;
– Multiple pregnancy– most twin or triplet pregnancies will rarely get to term.
Mothers carrying multiples should be psychologically prepared to deliver before term
– Hypertensive disease in pregnancy– severe cases are normally induced at thirty four weeks
– Preterm rupture of membranes– followed by drainage of liquor “water”
This is mostly caused by infections
– Third trimester bleeding– may be due to placental separation or abnormal placentation. If the bleeding is massive, then delivery may be done before term.

Going into labor before term is actually a nightmare, the child comes when you are just not ready for them, both emotionally and psychologically. One minute you are pregnant and the next minute you are holding a tiny little thing on your hands who is then quickly snatched from you and rushed to a nursery. Then you literally become a prisoner, living in the hospital waiting for your child to grow to at least two kilograms. Every three hours of the day or night, you are seated before your child, who happens to be sharing an incubator meant for one with four other pre-terms who look extremely like your own.

So you live in the hospital waiting. Your child adds three grams in three weeks and loses five grams in a day. Sometimes you leave them well only to come back and find cardiac monitors sticking from an impossibly small chest, and nasal prongs inserted into the tiny nostrils, with oxygen being literally driven into those tiny lungs. But they live through such days and so do you.
When you have your child too early, the temptation to leave and quit the whole motherhood thing is strong. But then you draw strength from your pre-term child every time you see them work their muscles so hard in a bit to breath. Every time you see their eyes open and they gaze at you, you learn that the gaze is just as genuine, just as penetrating as any other and that alone is enough to push you through the rainy days!

Children born before term, if they receive good care, grow. They grow up normally, attain normal milestones and become as normal as those born at term. No, prematurity doesn’t cause intellectual disability or short stature. I have seen big men and women whose birth weights were as little as one kilogram. I know a doctor who was born pre-maturely, a university student pursuing engineering and as teacher. With pre-maturity, once you grow past the neonatal age, then you can grow on and conquer the world with your smallness!

LABOUR

I knew the time had come when I had my first contraction. Never in my life had I experienced such pain that intense. I remember calling the names of my relatives to the third generation, pacing the entire length of the sitting room, clenching and unclenching my hands, closing my eyes tightly and gritting my teeth. It passed after what seemed like an eternity. My next contraction found me in the hospital on the examination couch. I remember shouting obscenities in my mother tongue. I caught a glimpse of amusement on the face of the male nurse who was putting on gloves, ready to examine me.

He was kind enough to let the contraction pass before finally doing the vaginal examination. I was not a good patient I must confess. First off, I had climbed onto the examination table with my panties on! That didn’t sit well with my nurse who gave me a little pep talk. Apparently, there are some things you must lose when you walk into maternity and one of them is your undergarments. The second thing is shame. Yeah, once you walk into the maternity walk, you hang your ability/tendency to be ashamed on the maternity door and get in.

The vaginal examination was a little worse than your worst nightmare. Nobody had warned me that a reasonably fat gentleman would thrust two fingers inside my vagina then try stretch them and then look at my face and tell me that I am “only four centimeters dilated, and that my pelvis is adequate”. I had four more vaginal examinations before my son came out. And I remember each one of them. I remember fighting with the nurses but giving in in the end.

In between contractions, I remember counting from one to one thousand, counting the number of boxes in the ceiling board, listening to music from my phone, playing phone games and listening to other women wail and collectively curse the male gender for putting them in the family way. One woman vowed to remove her uterus. Another vowed to join the convent after having this one child. A teenager promised the gods to go back to school and chew the books like she was supposed to do. I remember one woman swearing to become a secondary virgin and remain thus till death. I on the other hand cursed my husband silently. All this time he was pacing in the hospital parking lot, dead worried about me. He sent me thousands of texts telling me the way after all it was just me he wanted and no child would ever come between us (I am not sure if this holds to date).

I had my son after what felt like hours and hours. he wasn’t easy that boy. I remember pushing and pushing, with some nurse standing at the foot of the bed urging me to keep pushing. And I pushed. Pushed all the stool from my rectum, then pushed out a three kilograms male who announced his arrival on earth with a shrill cry. Thirty minutes later, I was holding the boy on my hands, my husband was hovering around with a big chicky grin, and I couldn’t help but think to myself that it was all worth it, that I could go through all the pain if in the end I would hold a little version of me on my hand!

FEAR KILLS

I have been seated across from this woman for four or five minutes now. I have been wording and re-wording the sentences I will say to her in my mind. It is an incredibly cold morning. Been raining all cats and dogs, and still, the skies are heavily laden with dark clouds. It is windless outside, but the relative calm is punctuated with the sound of thunderstorm from time to time. I can’t stop thinking that ‘I am cooking a storm’ for the young lady seated before me. She looks older than her thirty eight years. Must be the doings of cancer. Her once beautiful face is now just bones covered in a thin sheet of muscle and skin, with minimal fat.

She looks at me for the first time our eyes meet. I have been hoping that she will somehow read my mind, pre-empt my thoughts and save me from having to open my mouth and utter the very words. But there are no signs this will happen. So I clear my throat and look in the general direction of her face. She avoids my eyes and looks right past me to a point on the wall behind me. “It is stage four (b)”, I say. She sighs and focuses her eyes on mine. She frowns and I count five lines on her forehead. “surgery?”, she asks. “No”, I reply. Before I explain further, she stands up, unties her wrapper and re-ties it. She walks to the door then walks back to her sit and lowers her little self onto it. Today is one of her good days; she can actually walk without feeling dizzy, thanks to the multiple transfusions she has had.

There is a knock on the door as I lean foward to tell her more. Whoever is on the door shouldn’t have cared to knock in the first place. she lets herself in even before I let her in. Turns out it is the counsellor from the palliative clinic. I had been waiting for her. I am over- joyed. I quickly forget her bad manners and offer her my chair. I had briefed her about this lady. She will definitely do a better job than I have been trying to do. I leave her to it and quickly close the door behind me without as much as glancing behind me.

I let out air from my lungs once I step out. Didn’t know I had been holding my breath all this while. As I walk away, I can’t stop thinking about this lady. She will be lucky if she lives to forty. Cervical cancer stage four (b). It means it is no longer a local disease. The cancer cells have spread to the liver, and the spleen. The only option we have is to palliate her (add quality to her remaining days, not quantity). Send her for radiotherapy to reduce the local disease, take care of her pain and do serial blood transfusions. Sad, right? It is actually sadder when you think about her children who will remain mother-less thanks to a highly preventable and treatable disease like cervical cancer.

It is sad because women will experience symptoms up to one year, others two years before finally walking to a hospital. And why is that? You ask, it is because of fear. While some fear discussing ‘embarassing’ topics like vaginas, breasts, and sex, others fear being tested and diagnosed with illnesses like cancer, HIV and AIDS, and other sexually transmitted diseases. We all know a person or two who would rather die than be diagnosed with cancer. These are people who will never show up for voluntary screening and testing. For some weird reasons, they believe knowing they have a certain terminal illness will kill them faster. What they forget is that, the earlier some of these conditions are caught, the better for them.

Take cervical cancer for example, stage one is a totally treatable condition. Stage four is un treatable. The difference between stage one and four is just time. A person will be stuck in stage one cancer for a while before the disease becomes stage two, then three, then eventually four. While a few are lucky to be diagnosed with stage one disease, majority will show up three years too late when there is virtually nothing that can be done. Those who show up late will tell you that they feared coming early. And fear will be the cause of their death.

Men are worse off than women. First off, they are poor healthcare seekers. That coupled with the fear of the unknown will make them shy away from hospitals. That is why most of them will hide at home with their big prostates and only show up in hospital accident and emergency department in the wee hours of the morning when they can’t ignore the burning pain in their bellies thanks to retained urine.

I believe it is time we all took our health a little more seriously. Let us make use of all available screening tools. Let us have annual health check-ups. Let us make those decisions to lose a breast than a life early enough. Let us give up those problematic prostates. Because when we are dead, we won’t even need the breasts that we so refuse to part with in life. Or the prostates for that matter.

Free Maternity: A big fat lie

It is all quiet except for the blip blip of the anesthesia machine and the chiming of the clock. Standing on the right side of the patient cutting through skin, fat, fascia et cetera, I almost feel alone with my thoughts.

It is three thirty six hours, and the four humans in theatre four are either too lost in their own thoughts or too tired for small talk. Soon, the fifth person arrives and without respect for the silence, announces his arrival with a shrill cry. This brings a tired smile on the human lying on the operating table. He is wiped and wrapped with warm and fluffy blankets then placed under a warmer. He kicks and throws tiny pink fists punching the air, and then realizing he has been ignored, breaks into a continuous monotonous newborn cry.

Nobody tries to soothe him. I am stitching the uterus, the scrub nurse is busy massaging it, the anesthetist is trying to maintain the pressures, preventing them from falling, and the circulating nurse is on phone, calling everywhere she thinks we can get even a single bottle of oxytocin. Her pleas for oxytocin are punctuated by calls to the lab for blood. This woman walked to the hospital to have her second child. Her first child was born vaginally but this one wouldn’t just come out. Her uterus won’t contract on it own, and the last oxytocin dose was used on the previous patient hence nothing is left for her. So she is losing blood slowly but steadily, in other words dying, becoming a statistic, one among the many face-less women who die while giving birth. Her baby is about to become motherless, her husband is about to become a widower.

Women from her village or estate will have too much to talk about caesarian section. For many, it will re-affirm their strong hatred for c-section. She will be used as a warning, and so most women will prefer delivering under the watchful eyes of their mothers-in-law and traditional birth attendants. Most husbands will warn their wives against signing those theatre consent forms and we all know that maternal mortality will remain high.

Free maternity is a good campaign slogan that is currently a big fat lie; it has been a lie for the last one hundred and Fifty one days that nurses have been out of work. It was a lie for the one hundred days that doctors were on strike. It is a lie in many hospitals that make women to carry their own water to the hospital, their own cotton, their own examination gloves and their own infusion fluids, oxytocin, sometimes even cord clamps!

BREAST CANCER- AWARENESS SAVES LIVES!

In my final year of med school, I remember standing at the assistant’s side during a breast-removing surgery, which is otherwise known as mastectomy. After removing the breast tissue, the surgeon asked me if I felt like crying. He had performed several such surgeries and from his experience, mastectomy is a surgery that irks females the most. I have seen diabetics refuse toe amputations. Men will do anything to avoid prostatectomy (a surgery to remove the prostate gland). It is not easy for a woman to sign that consent form that will lead to the loss of her breast(s). Even those women who undergo breast reconstruction surgery soon after mastectomy have a hard time deciding to undergo mastectomy. It is certainly harder for those who undergo the surgery only to spend the rest of their lives with one breast and a large scar in place of the other one. While some are able to go on with their lives without a care, life changes for most of them. Such surgeries don’t just change the way they look, they change marriages. Most women will spend hours before the mirror trying to make their padded bras to “work” with their outfits.

While most women undergo mastectomy once diagnosed with breast cancer, Angelina Jolie, a Hollywood actress had a double mastectomy to reduce her risk of getting breast cancer after testing positive for BRCA1 gene. BRCA1 gene is basically a ‘breast cancer susceptibility gene’. Jolie’s mother had died at age fifty six to breast cancer ten years after she had been diagnosed with the disease. Jolie stated that the decision to have a mastectomy wasn’t an easy one. She was however glad to have undergone mastectomy as that reduced her risk to develop breast cancer greatly.

Unlike Angelina Jolie, most women who undergo mastectomy in our set up do so for curative rather than preventive purposes. Most of them present when already suffering from breast cancer. This is either because of our poor health seeking behaviors or because of poverty or ignorance.
As we draw towards the end of October, I would like to make you aware of some factors that may increase your chances of getting breast cancer. Women with these risk factors should visit their doctors for regular check-ups. Those with a high probability of suffering breast cancer should consider mastectomy early enough just like Angelina Jolie, because you are better off alive with no breasts than dead with breasts.

HERE ARE SOME RISK FACTORS;

  • Advancing age. The risk for breast cancer increases with age. Average age for diagnosis is fifty years.
  • No pregnancy. While pregnancy is protective of breast cancer, those who appear to be protected are those who get pregnant during their twenties.
  • Breast cancer in the contra lateral breastP. eople who have suffered breast cancer in one breast are at risk of developing cancer in the opposite breast. T hat’s why most people opt for a double mastectomy once diagnosed.
  • Family historyB. reast cancer tends to run in families. Daughters of mothers who have suffered breast cancer are at a higher risk of breast cancer.
  • Early onset of menstruation and late menopause. Onset of menses earlier than thirteen.
  • Late onset of menopause of later than fifty
  • Age at first delivery. If aged 30 years or older, relative risk is 2 times that of patients who gave birth when younger than 20 years.
  • Oral contraceptive pills.
  • Hormonal replacement therapy.
  • Obesity.
  • Cigarette smoking and Alcohol consumption. Smoking is actually a risk factor for several other cancers.
  • Diet-Fatty diet.
  • Exposure to radiation in the chest

 

NOTE1; while these risk factors increase the likelihood of suffering from breast cancer, they in isolation don’t cause breast cancer.
People with certain risk factors are likelier to suffer from breast cancer than others. Case in question here is a family history of breast cancer.
Therefore, people with these risk factors are advised to be extremely vigilant. Don’t forget to perform those regular self examinations on yourselves.
Make a point of visiting a doctor for regular check-ups.
If a suspicious lump is found during the course of these check-ups, have it investigated.
Remember cancer, if found early enough is curable.
When it comes to your healthy, be proactive

 

HAPPY BREASTFEEDING WEEK! (Pt 3)

While breastfeeding may not seem the right choice for every parent, it is the best choice for every baby- Amy Spangler

All these benefits and still a mother choose not to breast feed. Why?

  • Breasts are seen as sex objects and for these reason, some women will choose not to breastfeed so as to prevent their breasts from sagging.

I wonder if this is what Anne Quindlen implies in this quote.”When an actress takes off her clothes on screen but a nursing mother is told to leave, what message do we send about the roles of women? In some ways we are as committed to the old Madonna-whore dichotomy as ever. And the Madonna stays at home, feeding the baby behind the blinds, a vestige of those days when for a lady to venture out was a flagrant act of public exposure”

  • Breast feeding is exhausting. Imagine having to be alert all the time, twenty four hours a day and seven day a week? Breast feeding is a tough job that cannot be performed by anyone else except the mother, and mothers happen to be humans who get tired, sleepy like all of us.
  • Partner

Some fathers seem to disagree with the fact that boobs are for breast feeding. They will do nothing to support the mother. Some will even make it worse by telling their wives not to breastfeed

  • Unfriendly working environment

Children need to be breast fed exclusively for 6 months. Very few employers will give their employees maternity leaves in excess of a day.

They don’t make matters better by allowing these women to have their babies around so they can breastfeed them on demand

Mothers are therefore left with one option, to wean their babies when they are barely two months old, and to limit the breast feeding sessions to before and after they leave for work. Sad

MY BABY IS ADEQUATELY BREASTFED IF;

Baby fed at least eight times/ day

Baby is calm and satisfied after feeds

Baby sleeps for 2-4 hours after a feed

Normal motion, no constipation-semi formed stools, with fermentive order. One motion after every feed to one motion in 2—3 days

Normal amount of urine about five to six times per day

Weight gain of 150-210 grams per week

YOUR BABY IS UNDERFEEDING IF,

Slow weight gain, weight loss or no gain at all

Decreased amount of urine

Cries after emptying both breasts

Suckling of fists between feeds

Sleeplessness or short sleep

Constipation or hunger stools-frequent, small, green in color

While some people underfeed their infants, some overfeed or should I say over breast feed theirs. Here are the signs of overfeeding:

Frequent regurgitation, vomiting

Large bulky stools

Abdominal distension

Polyuria- (excessive urination)

Baby overweight

Overfeeding should be managed by feeding the baby four hourly.

BREAST FEEDING MYTHS

Myth: “You can’t breast feed if you have small breasts”.

Reality: Breasts of all shapes and sizes can satisfy the hungry baby.

Myth: “Breast feeding is a lot of trouble”.

Reality: Breasts, as opposed to bottles, are ready when the baby is ready.

Myth: “Breast feeding ties you down”.

Reality: Breast milk can be stored if mother decides she wants to go out. When the mother goes out she always has the food supply for the baby no matter how long she plans to stay out.

Myth: “Breast feeding ruins your breasts”.

Reality: Breast-feeding does not change the shape or size of the breasts. There are other factors (i.e. – age, not wearing a bra, or excess weight) that can change the shape & size of breasts.

Myth: “The father is excluded during breast feeding”.

Reality: An involved father will take advantage of opportunity such as bathing, diapering, holding, & playing with the baby.

HOW TO EXPRESS BREAST MILK

Why learn how to express milk?

To relieve painful breast engorgement between feeds

To help nutrition when suckling is reduced for example in premature children or those with cleft lip

To help feed the baby when the mother is away working for example

To keep milk production going when necessary to rest the nipples e.g. when sore

The best way to learn is from a midwife, and by watching a mother who is already successfully expressing milk. Pumps are available from any chemist. If not, wash hands, and dry on a clean towel, then, try to start flow by:

  • Briefly rolling the nipple: this may induce a let-down reflex, especially if the baby is nearby.
  • Stroke the breast gently towards the nipple.
  • With circular movements, massage the breast gently with the 3 middle fingers.
  • Then start expressing or milking into a clean wide-mouthed container

Expressed milk can be stored in a fridge for up to 24 hours.

Babies should be breast fed on demand i.e. whenever the baby or mother wants with no restrictions on length or frequency. Breast feeding on demand is important because;

  • It keeps the baby happy, and enhances milk production.
  • Fewer breast problems like breast engorgement arise
  • Less incidence of jaundice
  • Breast milk flow is established sooner
  • Earlier passage of meconium ( meconium is the greenish sticky stools that a baby first passes, before their stools become normal)

WHEN NOT TO BREASTFEED

  • If you have active tuberculosis and are on anti-tuberculosis medication {some of the drugs are secreted in breast milk
  • If a mother has cancer and is on anti-cancer medication
  • A mother on anti-biotics- like tetracycline that are secreted in breast milk
  • HIV is not an absolute contra-indication to breastfeeding.
  • Pregnancy- is also not a contra-indication to breastfeeding

It is however prudent to stop breastfeeding at the fifth month- so as to maintain nutrients for the growing fetus

BREASTFEEDING PROBLEMS

  1. Breast Engorgement

Treat by frequent breastfeeding, or manual expression

  1. Breast Abscess

Treated by antibiotics

  • Sore Nipple

This is corrected by ensuring that the baby is correctly attached on the breast

DO YOU HAVE A QUESTION ON BREAST FEEDING? DON’T HESITATE TO ASK! SEND AN EMAIL TO oyunged@gmail.com with your question and I will send you a reply!

IT IS THE WORLD BREAST FEEDING WEEK! (Pt 2)

There are three reasons for breast feeding; the milk is always at the right temperature, it comes in attractive containers; and the cat can’t get it- Irena Chaimers.

Exclusive breastfeeding is defined as “an infant’s consumption of human milk with no supplementation of any type (no water, no juice, no nonhuman milk, and no foods) except for vitamins, minerals, and medications.

Infants should be fed exclusively for the first six months of their lives.

The benefits of breast milk to the child and the mother are numerous;

  • Breastfeeding helps mother and child to bond

You already love your child when they are born, when you breast feed them, you love them more and they love you back.

“Mother and child mutually gazing into each other’s eyes, telling each other secrets with just their eyes”

It is often said that a child knows the smell of its mother, and that a mother’s breast will produce milk on its own when the child cries, no matter how far apart mother and child are.

  • Breast fed children have a higher IQ than their counterparts who were never breast fed

See, breast feeding your child makes them wiser and brighter.

Breast milk contains galactose for brain development

  • Breast milk is cheap, clean and gives babies an attractive smell

I do not need to overemphasize the fact that breast milk is cheap, and readily available. Any mother who has tried formula feeds will tell you how much pocket damaging they can be.

Then apart from the issue of cost, there is the other problem of water, your feeds are as clean and safe as the water you use for mixing them and the containers you use

  • Breast milk protects against allergies

Compared to their bottle-fed counter- parts, breast fed infants have a low incidence of allergies such as atopic dermatitis.

  • Colostrum has endorphins good for birth associated stress

Colostrums is the first milk that is normally yellowish in color because it contains a high fat content

  • It reduces the risk of juvenile onset diabetes mellitus , rheumatoid arthritis and inflammatory bowel disease

These diseases are commoner in children who were not breast fed for some reason or another

  • It reduces infant mortality- otitis media, pneumonia and diarrhea are less in breast fed infants

This is because breast milk contains anti-bodies which protect the baby from infections

  • Breastfeeding helps mothers lose weight

Pregnancy is a weight gaining experience (he he) some mothers also gain a lot of weight during the period after giving birth. (What with everyone musing about the way they should eat so that they can breast feed their younglings?)

Breast feeding helps lose some of that undesirable weight

  • Suckling promotes uterine involution and this prevents post- partum hemorrhage

After the baby is born, the uterus contracts and this helps to prevent bleeding

Breast feeding helps in further contraction of the uterus hence reducing the chances of post partum bleeding

  • It is a contraceptive although it is not 100 percent effective

Some women will not start getting their periods until six months after giving birth. This phenomenon is known as lactational amenorrhea.

It is more pronounced in women who breast feed their children exclusively.

During this period, such women will not get pregnant

Note; this is not very effective and it is therefore important to use a contraceptive. If you do not want to be that woman who finds themselves pregnant when her baby is barely five months old

  • Breast feeding helps reduce breast and ovarian cancers