HAPPY WORLD BREASTFEEDING WEEK!

( BABIES, INDULGE………)

The world breast feeding week officially starts today. It is August first, a time to celebrate, encourage and teach all mothers (and fathers)how, why and when to breast feed their babies!

It is popular belief that breastfeeding is a skill that is inherent in all women. Attaching a baby on the breast is however not an ability with which a mother is born. Breast feeding is a skill that must be learned by observation and experience. Learning to breastfeed is as hard as learning to drive and as anxiety provoking. Mothers must therefore be apprenticed ante-natally, and even after their babies are born.

New mothers should start breastfeeding their babies as soon as they are born. A midwife should be present to help guide the mother through. Note that, she will find it tough at first. The first feeds will be problematic. But re-assure them that it doesn’t mean that they can’t do it, and most importantly, their babies will not starve. Therefore, there is no reason to be fast in giving those formula feeds.

How to breast feed

Successful breast feeding starts with the belief that you can do it. Don’t be uncertain or anxious.

-Mother and child should breastfeed in a relaxed environment.

-The mother should be helped into a comfortable position- lying by her side or seated in a comfortable chair.

-The infant should be cradled next to the breast with their head propped up by the mother’s hand.

-The infant should be placed with the their stomach flat against the mother’s upper abdomen (stomach to stomach).

-When the mouth is open the nipple and lower part of the areola is pushed well back into the infant’s mouth against the palate. This way, the hard palate compresses and massages the milk sinuses that lie beneath the areola

Your baby is well attached to the breast if;

  • The mouth is wide open
  • Baby’s chin touches the breast
  • Baby’s lower lip is curled outward
  • Usually the lower portion of the areola is not visible( areola is the black of the breast that normally surrounds the nipple)
  • Their nose is not buried into the breast as this might interfere with nasal breathing

Once the baby is properly attached to the breast, then you should;

Continue feeding until the baby releases the breast

Then hold the baby vertically and gently (note to fathers) tap their back two to three times to drive out swallowed air (burping the baby).

Place the baby in bed either lying on their side or prone (lying on their back).

Heartburn in Pregnancy

A HEARTBURN is Known as gastrointestinal reflux disease in medical circles and is a common symptom experienced during pregnancy.

This is normally felt as a burning pain in the centre of the chest.

It is caused by regurgitation of gastric juice from the stomach to the esophagus.

Gastric juice normally contains hydrochloric acid which is responsible for the burning felt in the chest

A heartburn is commoner in pregnancy due to the following reasons;

  1. An increase in abdominal pressure caused by the pregnant uterus
  2. Relaxation of the lower esophageal sphincter- that normally serves as a barrier between the stomach and the esophagus

IT IS NOT BECAUSE- your unborn child has lots of hair!

TREATMENT

The goal is to reduce symptoms and increase comfort via;

LIFESTYLE MODIFICATION

  1. Elevate head –use extra pillows
  2. Avoid bending or stooping positions
  3. Eat small frequent meals as opposed to one large meal
  4. Avoid eating within three hours of sleeping
  5. Do not lie down immediately after eating
  6. Avoid sour foods at all costs – this may be hard if you are craving sour fruits, sour milk or sour porridge. Most of the time, the craving will be too much to ignore!
  7. Avoid spiced foods if you can- pili pili will make it once

MEDICATIONS

These should be used if lifestyle modification doesn’t relieve symptoms;

Before taking any drug during pregnancy, you must remember to ask yourself what effect it has on your child.

To avoid any harm to your unborn child, avoid self medication at all costs

  1. Antacids and sucralfate are safe in pregnancy (remember to get an obstetrician to prescribe)
  2. Histamine 2 blockers cimetidine, ranitidine

NOTE;

There are women who lick ash, and those who eat toothpaste- it is best to abstain from such practices no matter how better you feel after ingesting tooth paste.

You can never know what tooth paste will do to your unborn child!

The outcome for pregnant patients with GERD is good, but the condition tend to recur in future pregnancies

 

Why do these things happen?

I was diagnosed last year. It wasn’t caught early enough, and so the doctors couldn’t operate on me. I was taken to theatre though, for staging under anesthesia and for biopsy harvesting. They told me I had stage three cervical cancer. I kept wondering what it all meant, what it meant to have stage three disease, until a young girl, with a smile between easy and plastic, in her twenties( most certainly), explained it to me. Now this girl was so good with words, the way she put everything almost gave me hope that I would live long, long enough to see my babies grow, long enough to retire and earn my pension, long enough to become a grandmother. I do not blame her, how can I abuse her good manners? How can I judge the poor thing yet I don’t know how she deals with women who are younger than me who have been diagnosed with cervical cancer? I appreciate all the hope that she gave me although it was too much I wish she told me the truth. I appreciate the time that she spent with me, she said people are different and disease progresses fast or slow depending on an individual, I agree, problem is, I belong in the category of fast progressors. Do you know what that means? It means that I die soon, maybe today or tomorrow or next week, or probably next year. I do not know when I want to die. I want it soon and later. I want it soon because living is costly. These days I leak shit and urine just trickles down my legs, adult pampers are too expensive, and I hate the smell of my beddings. I am tired of becoming anemic every now and then, I have received too much blood, and I wonder why my bone marrow can’t just make enough blood these days. I have slept in the hospital too many times, and I am just tired, I am tired of white beddings, of rude women dressed in blue and white in the name of nurses, of little boys and girls in white lab coats asking me every day of the number of children I have had, of the number of sexual partners I have had, and all those clinic questions.

Maybe now it has become stage four disease, maybe it is my two feet on the grave now not just one. I am dying. Who will teach Kanana how to become a woman? Who will teach her how to make chapattis? Who will show her how to wear her pad when she gets her first period? Who will even buy her pads? Who will be the woman in my son’s life? If I die now when he is only eight, then from whom will he learn how to treat women? Who will hold my children as I am being lowered into the earth? Who will hold them as they listen to the earth falling on the box wherein I will be contained? Cancer oh stupid cancer, I have only had thirty five years on earth. My twenties went just like that, when thirties came, I settled down with my babies, I was ready to make something out of this life. Then, I set down to work, to be the best wife, the best mothers, did I have many years to carry out my dream? No. you came knocking, just when I was beginning to know the meaning of life, just when I was learning how to be a mother. In just a year I am reduced to bones with a coat of thin flesh hanging here and there. I no longer wear clothes, I hate the frustration of looking for the smallest size and besides, where is the money to buy the clothes? This is not about money though but I must admit that I am poor now, I wonder how my funeral will be like, and huh si cancer has siphoned all the money?

The doctors don’t understand how I, a young beautiful educated woman sat at home with cancer, how I passed through stage one and two without ever going to the hospital. They don’t understand that I am a subject, I am part of the ruled, I have no luxury of walking to the hospital, the money in my pockets is too little. I am society and we in society, we only fight real battles, if there is no pain, then there is no need of going to the hospital. The hospital is for the wounded, for those who are bleeding and for the overly sick. we never worry about weight loss and lack of appetite, these only worry our leaders, but we, the ruled, cannot worry about lack of appetite when we don’t even have enough to eat. We are too emaciated that we never recognize additional weight loss, it is only our fat leaders (no pun) who can recognize as their necks become thinner and as the fats over their tummies melt. We, we only learn this things about screening and vaccines in KNH and Mulago hospitals as we struggle to be booked for radiotherapy. Then we are left imagining how this knowledge would have been good had we gotten it ten years earlier. But we the ruled cannot do much, we live in a country where we are governed. Whether I live through this week or not depends on whether the striking doctors resume work soon enough coz I am pale again. I know I need blood so badly. But the provincial general hospital has no doctors. I know they know that people are dying. But they don’t know that it is me, who is dying, leaving behind two small children and a husband who has married, because being a widower sucks. Whether I live through this strike depends on whether God wills me to. Oh the pains of living. The struggle we go through we, we who have terminal illnesses.

PREGNANCY DANGER SIGNS

While some symptoms could wait till the next ante natal visit, other symptoms require immediate medical attention.
Here are some of those symptoms that need immediate medical attention;
Bleeding
Any bleeding during pregnancy warrants immediate medical attention.
First trimester bleeding accompanied with severe abdominal cramps could mean; ectopic pregnancy, a condition where a fetus is implanted outside the uterus.
First or second trimester bleeding could also mean a miscarriage.
Third trimester bleeding- could be caused by a low lying placenta or placenta abruption i.e. separation of the placenta from the uterine lining.
Severe headache
A severe persistent headache associated with visual disturbance and abdominal pain could mean pre- eclampsia, a condition associated with increases blood pressure, and passing of proteins in urine.
Pregnant women who experience these symptoms should see their obstetricians ASAP.
Severe nausea and vomiting
Nausea and vomiting is a common phenomenon in pregnancy
There are however women who experience severe nausea and excessive vomiting, a condition termed hyper- emesis gravidarum in medical circles.
Severe vomiting could lead to dehydration, and even low blood sugar levels
A pregnant woman who vomits virtually every food eaten should seek medical help
Decreased fetal activity
Most women will start perceiving fetal kicks at around week 20 of pregnancy.
A perceived decrease in fetal kicks needs the attention of a doctor sooner than later.
Your water breaks
“Water” or amniotic fluid is colorless.
If your water breaks, you will feel a gush of fluid rushing down your legs.
The event is often painless and some women may ignore it, but with time, infection may set in.


Excessive thirst, hunger and frequent urination
Especially in the second trimester could mean gestational diabetes.
Gestational diabetes is a disorder of blood sugar regulation that occurs in pregnant women
If a woman experiences the three symptoms, then their blood sugar level should be tested to rule out diabetes of pregnancy

Calf pain and swelling
Unilateral leg swelling, associated with increased temperature and pain on the calf area may mean there is a clot in one of the deep veins of the legs
This condition is called deep venous thrombosis and is a common phenomenon in pregnancy
Women who experience these symptoms should seek for medical care as soon as is possible

To be pregnant is to be vitally alive, thoroughly woman, and distressingly inhabited. Soul and spirit are stretched- along with body – Anne Christian

Morning sickness

Nausea and vomiting is often the earliest symptom of pregnancy for most women. It often starts from week six of pregnancy and persists till the end of the first trimester (week twelve). There are however no absolutes in the world of medicine, this could persist beyond week twelve (God forbid ooh).

Contrary to its name, it is not limited to mornings. It can happen a few six minutes past noon, seven thirty at night or even six in the morning! This is what actually makes it more miserable.

Mild nausea and occasional vomiting is normal in pregnancy. It is called emesis gravid arum in medical circles, a term that can be loosely translated to mean vomiting of pregnancy.

Emesis gravid arum is often mild and can be managed at home.

  1. Here is what to do;
  • Ask someone else to cook for you.
  • Sniff lemon- Cut a lemon into two halves and sniff it. This will reduce the nausea.

  • Eat small frequent meals- up to six meals in a day as opposed to three large meals!
  • Eat what you crave.
  • Drink small amounts of fluids frequently to prevent dehydration.
  • Eat dry foods-biscuits, toasted bread, crackers
  • Increase proteins and carbohydrates in your diet.
  • Add vitamin B6 to your supplements.

2. Avoid

  • Warm stuffy places- keep windows open and curtains drawn.
  • Spiced food
  • Lying down after eating
  • Fatty food, butter
  • Odors- stoves odor, strong perfumes et cetera.

A few women however experience a severe case of morning sickness, a condition termed hyperemesis gravidarum (as opposed to emesis gravid arum).

Apart from being nauseated, the mother to be vomits almost everything eaten, loses weight, and becomes dehydrated.

This is commoner in twin pregnancies or other higher birth orders like triplets or quads, first time mothers (primis), and obese women.

Women who vomit everything should definitely seek for medical help in hospitals earlier enough before they progress to the stage of weight loss, and dehydration. They might need to be admitted and put on intravenous fluids and medication till the vomiting reduces.

Their doctors will need to put them on drugs to prevent them from vomiting.

PS: Nausea and vomiting early in pregnancy could occur due to an illness. It is then prudent to seek medical help should it become too much or if it happens to be accompanied with other symptoms.

BEFORE YOU CONCEIVE

Get ready. You do not want to be that woman who “finds” herself pregnant eight weeks into the pregnancy when their doctor points out that the anti-malarial drugs did not in fact fail, that they had no malaria in the first place, and that their nausea and vomiting is here to stay until they are done with their first trimester. Before you get pregnant, do yourself and your unborn (or is it un-conceived?) child a favor, take time and get healthy. This is the crucial part you will play in ensuring you give birth to a healthy baby with no birth defects, at term.

Here are the things you need to do before embarking on the too serious, too important baby making process;

1. GET SCREENED FOR INFECTIONS

To have a healthy baby, you need to be healthy;

-Get your partner and yourself screened for infections such as HIV, hepatitis, rubella, HPV, and other sexually transmitted infections like gonorrhea.

-If any of this infection is found present, then it will be absolutely necessary to get treated before you conceive.

Mother to child transmission occurs with infections like HIV, while rubella is known to cause hearing and visual defects!

2. SUPPLEMENTATION

Folic acid –

There is a vivid picture ingrained in my memory of a young girl seated on a wheel-chair asking her mother, “why didn’t you take the damn folate!?”

Most women start their folate and iron supplements when they have been pregnant for a long while, others never start at all!

All intending mothers should start taking folic acid supplements 8-12 weeks before conception

Supplementation can be in the form of tablets available as over the counter drugs sold in pharmacies or in diet

Foods rich in folic acid are dried beans, peas, nuts, avocado, lentils, spinach, citrus fruits.( given a woman could become pregnant even by accident, all women should always make sure their plates are over-flowing with these food stuff.

Deficient folic acid leads to spina bifida and other neural tube defects

Women who have had children with spina-bifida, diabetic women, women taking anti-epileptic drugs and those with a BMI of 35 and above MUST take supplements of folic acid before getting pregnant to reduce chances o getting malformed babies.

Iron

Many pregnant women suffer anemia due to low iron levels. Anemia could be detrimental to both baby and mother and therefore should be prevented

Pre-conception, women should increase their iron in diet.

Sources- spinach, liver, egg-yolk, beans.

Where it is difficult to take it in food, then women should take supplement tablets

Vitamin

Other important vitamins should be supplemented like vitamins C, and B.

3. RISK REDUCTION

Chronically ill women require the approval of their doctors before becoming pregnant (ideally)

Diabetic, hypertensive, epileptic, HIV positive lupus, heart failure and other chronically ill patients should discuss with their physicians before becoming pregnant.

Such patient should discuss their drugs and their possible side- effects on their unborn babies.

They should discuss possible pregnancy outcomes, (women with lupus are likelier to suffer miscarriages,) the effect of pregnancy on their conditions (pregnancy will worsen heart failure) and the effect of their conditions on pregnancy.

Where necessary, their doctors will stop some o their drugs and re-introduce new ones, or will advise against getting pregnant if at all pregnancy will be too risky for the mother.

4. BLOOD GROUPING

Both the father and mother-to-be should have their blood grouped.

This allows detection of rhesus incompatible parents early, and a frame-work for intervention is drawn.

5. DRUGS

Smoking- intending mothers should quit first hand and second hand smoking if they intend to have children weighing any more than one kilogram (you do want a baby who is heavier than a kilo of sugar right?

Alcohol and other alcoholic drinks, wine included!

Alcohol consumption and pregnancy should not be mentioned in the same sentence (except how I did it there, hehe).

Alcohol has untoward effects to an un born child including but not limited to, an abnormal facial appearance, low intelligence, and behavior problems. You don’t want to do this to your child.

Quit even before you get pregnant, and have your partner quit in solidarity with you (this is just to reduce temptations, apparently, a drunk sperm doesn’t cause fetal, alcohol syndrome, a drunk other does)

6. OTHERS

Pregnancy is no easy feat, and you need to be prepared psychologically so you can puke gracefully, grow fat and not give a damn, and look at the stretch marks on your tummy and chuckle.

Prepare the finances, for some reason, pregnant women get sick more often, eat more, and need new clothes every month

All women need pre-conception care.