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

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.

Motion Sickness

There are people who will get in a matatu, with groundnuts on one hand, fries on their laps and a container of milk on the other. For them, the process of travelling is as simple as eating their fries slowly, washing them down with a sip of milk and occasionally confusing their digestive juices with a ground nut or two. Others will get in a matatu and sleep as soon as they are in motion. They will sleep through bumps and rough patches in the road. Then there are those who will get in a matatu and head for a seat by the window roll down the window, rummage through their luggage for a black polythene bag and keep it close. Once the vehicle is in motion, their stomachs churn and they retch and retch. Most will throw up the bitter acid from their stomach and food from a day ago. The other passengers will of course look at them and wonder why people eat too much just before they travel. Bad conductors will bark nasty stuff like having to clean the matatu and self-control and stuff like that.

Well, what most people don’t know is that, throwing up when travelling is a disease! Motion sickness is a disease just like malaria. And no, you can’t fight the urge to vomit.

So what is motion sickness?

Also called car sickness or sea-sickness, is the feeling you get when the motion you sense with your inner ear is different from the motion you visualize

Symptoms of motion sickness begin as soon as a car is in motion. These include;

  1. Uneasiness
  2. Cold sweat
  3. Dizziness
  4. Hyper salivation
  5. Headache
  6. Fatigue
  7. Nausea
  8. Vomiting

There are people who will get in a matatu and travel for fun. There are those of us who try as much as possible to avoid travelling. For those of us who suffer from motion sickness, travelling is an awful experience that will be punctuated by retching, vomiting and awful glances from fellow passengers.

Motion sickness is an awful experience that for some reason is commoner in women and young children. Those prone to this condition will avoid travelling as much as is possible. But they will more often than find themselves in a matatu, clutching a black polythene bag travelling to school, to their places of job or to the country-side.

The good news is, motion sickness can be prevented. Here is how;

  1. Avoid fatty meals 24 hours before traveling
  2. During Car travel- sit in the front seat if possible- this helps to visualize the motion that you will perceive
  3. Avoid smoking- cigarettes are not only bad to your lungs apparently! (Of course you know this).

You can also take some anti-emetic (drugs that prevent vomiting) before travelling. Here are some that can be used;

  1. promethazine- these tiny tablets work wonders.

They will prevent nausea and vomiting but they will make you very sleepy, you will miss the scenery and if you are too unlucky, You might get robbed ( God forbid)

  1. Cyclizine- can be bought over the counter. Take 30 minutes before travelling.
  2. Scopolamine- this is administered as an injection.
  3. scopolamine- may also be used.

So next time you are seated to a bored young lady who won’t accept your roasted maize in a matatu, don’t be quick to call her proud. She might be suffering from motion sickness.

If you are among the lucky majority, here is how you can make life a little better for the unlucky minority;

  1. Let them have the window seat- you can always look at the scenery on the return journey.
  2. If you must eat, please avoid njugu karanga, roasted maize and fries. The smell from this food stuff worsens the nausea!
  3. Avoid strong perfumes and body sprays!
  4. Don’t remove your shoes in the matatu ( PLEASE)
  5. Don’t drink and travel ( ha-ha).
  6. Fill your petrol tanks before passengers board( DRIVERS and CONDUCTORS)
  7. Travel clean- with brushed teeth!
  8. You have a right to be disgusted but remember everybody hates vomiting. Be kind!