FREQUENTLY ASKED

QUESTIONS

FREQUENTLY ASKED QUESTIONS

Below are some of the most frequently asked questions from our patients.

Please feel free to contact us if you need any further information.

PREGNANCY NIGGLES

Common Ailments During Pregnancy

  • Exercise regularly, as this helps to keep bowel movements.
  • Drink plenty of water- up to two litres a day.
  • Increase your intake of fibre. Fibre holds water and allow for formation of softer, bulkier stools that can pass through the colon more rapidly. Wheat bran, cereals, whole wheat, fresh vegetables and fresh and dried fruit are good sources. If this does not help, ask your doctor about a fibre supplement.
  • A dessertspoonful of linseed (readily available at most supermarkets) which has been soaked in a glassful of water overnight and swallowed first thing in the morning, every morning, is highly recommendedable for those who are readily inclined to become constipated.
  • Try to move your bowels st the same time every day. Do not ignore the urge to move your bowels, as this can worsen constipation.
  • Do not use laxatives, unless your doctor prescribes them. Some laxatives cause dangerous dehydration and electrolyte imbalances. In addition, your body may come to depend on laxatives for bowel movement, and lose the ability to pass a stool unaided.

Lower back pain is a very common complaint during pregnancy, particularly during advanced pregnancy, when the weight of the growing baby plus strain on a woman’s back muscles. During pregnancy, your body produces a hormone, relaxin, which makes your ligaments softer and more elastic. This makes joints more susceptible to strain and pain.

To minimise backache, get regular exercise, make a conscious effort to stand or sit up straight, wear low-heeled shoes and get plenty of rest. Ease aches and pains by relaxing in a warm bath or having an aromatherapy back massage.

For relief from cracked and some sore nipples, air your breasts for 10 minutes after each feed and then place a used Rooibos tea bag over the nipples. Leave on inside the breast-pad until the next feed.

  • “Morning” is a misnomer as the feeling of nausea can happen at any time of the day. It is largely caused by the hormonal changes taking place in the body, and its severity is highly variable.
  • Dry, plain biscuits, water and apples help alleviate nausea.
  • Often movement makes the nausea worse. Try not to eat whilst travelling or on arrival.
  • Anxiety has also been linked to morning sickness, and so relaxation methods may help.
  • Keep away from aromas which trigger nausea, like during cooking. In any event fresh fruit and vegetables (if thoroughly washed) are healthier.
  • Keep up your fluid intake.

To help ensure a good flow of breast milk, keep up your liquid intake with at least four cups of Rooibos tea and four glasses of water a day. Drinking too much can actually suppress milk
production, so limit your fluid intake to 2 litres a day. Always have a thermos of Rooibos tea, rather than drinks containing caffeine (such as coffee’ I normal” tea), will help to prevent and treat tummy cramps in the breastfeed baby.

If your perineum (area between vagina and anus) is uncomfortable after delivery, brew a pot of strong Rooibos tea and add it to a sitz bath with a handful of coarse salt. Sit in the sitz bath for at least 15 minutes. This will help to soothe the area. You could also soak a flannel in
strong, cold Rooibos tea and hold it against the perineum for 20 minutes.

To relieve swelling, also take an Arnica D6 tablet every two hours for the area to sunlight for 10 minutes twice a day to speed up healing.

Pregnant women commonly experience sharp or tingling pain in the groin area and down the insides of the thighs later in pregnancy, usually worse after walking or standing for long periods. This is caused by the weight of the baby pressing on the pelvic nerves. Lying down should help to ease any such pains.

Pelvic pain classically gets worse when ”lightening” occurs at approximately 8 months in women having their first baby. This is when the baby’s head ”drops” into the birth passage of the mother’s pelvis.

  • Anal itching and irritation.
  • Pain when sitting, or  when passing a motion.
  • Bright red blood on the stool, or toilet paper or even in the toilet bowl.
  • Sensation of a tender or hard lump in the anal region.

Stretch marks (striae gravidarum), develop in 50% and 90% of pregnant women. These vary from pale pink lines to deep purple ridges on the stomach, breasts, hips and buttocks.
Research suggests that avoiding excessive weight gain during pregnancy, along with maintaining a healthy skin, may help to minimise the appearance of stretch marks. Eat a healthy diet and drink lots of water to keep your skin healthy. Oils, creams or lotions high in vitamin E or linoleic acid massaged into the abdomen, buttocks and thighs regularly may also help to condition the skin and possibly minimise stretch marks.

Another common pregnancy skin niggle is pigmentation. The ”mask of pregnancy” (melasma)- a blotchy, brownish pigment- may appear on the skin of the forehead and checks. Pigmentation may also increase in the skin surrounding the nipples and a dark line commonly appears down the middle of the abdomen from the navel to the pubic bone.

Small spider like blood vessels (spider angiomas) may also appear in the skin. Usually above the waist, as may thin-walled, dilated capillaries, especially in the lower legs.

Urinary incontinence is leaking of urine from the bladder at inopportune moments. During pregnancy, the added weight and pressure of the uterus on the pelvic floor muscles and bladder can cause leaking of urine.

Performing Kegel exercises (exercise that involve contracting and relaxing pelvic muscles) regularly is important, to strengthen the pelvic floor muscles and so avoid incontinence both during and after pregnancy.

HEMORRHOIDS

Hemorrhoids (piles) are swollen, congested and enlarged (but normally present) blood vessels in and around the anus and lower rectum that stretch under pressure. Veins inside and around the opening of the anus (back passage). They can be described as ”varicose veins” of the rectum. These blood vessels lie just below the surface of the anus lining, and may cause pain, irritation and itching and may even bleed slightly.

The blood from haemorrhoids is bright red in colour, and may show up on the stool or on toilet paper after a bowel movement. Sometimes, haemorrhoids develop ulcers/sores and produce mucous which may be seen on toilet paper. Sufferers may feel as if they have a lump or bump hanging down from the anus.
Haemorrhoids can occur just inside the rectum (internal haemorrhoids) making them undetectable to you, they may prolapse or protrude outside the rectum (protruding haemorrhoid), or may appear as a lump under the skin in the area of the rectum (external haemorrhoids). Haemorrhoids that protrude through the anus may cause continual discomfort and difficulty in cleaning the area.
Excessive straining, itching or rubbing around the anus can cause bleeding and irritation in the affected area. Haemorrhoids can make proper cleaning pf the area difficult, resulting in skin irritation and even infection. It is important for haemorrhoid sufferers to take extra care to wipe the area clean with soap and water and dry thoroughly after every bowel movement.

Many anorectal problems, including fissures, fistulae, abscesses, or irritation and itching (pruritus ani), have similar symptoms and are incorrectly referred to as haemorrhoids.

During pregnancy, women may develop haemorrhoids for several reasons:

  • The increasingly heavy uterus (womb) puts pressure on the veins taking blood from the lower body to the heart. When the walls of these veins are weakened by increased blood pressure, the results can be a bulging blood vessel such as a varicose vein or hemorrhoid.
  • The hormone progesterone, which is produced during pregnancy, relaxes the walls of the veins, causing them to swell.
  • Progesterone also slows down the digestive system, increasing the pregnant woman’s tendency to become constipated. When she strains to pass a hard stool, added pressure is put on the blood vessels in the rectal area.
  • Iron supplements, which may be needed during pregnancy, may cause constipation. This also results in straining during bowel movements.
  • As the uterus grows, it can press on the bowel and slow down the passage of stool, resulting in straining during bowel movements.

Hemorrhoids develop when increased pressure causes the blood-vessels in the anal region to become dilated and stretched, and then to protrude through the walls of the anal region.

The blood in these swollen vessels may even clot and so form a firm or nodule. Pile containing clots are particularly likely to bleed.

In some cases, the hemorrhoids that develop during pregnancy shrink after delivery, causing no further symptoms. However some women develop hemorrhoids for the first time after delivery. This is because of immense pressure put on the weakened blood vessel walls during the straining of labour and delivery.

Women may find that they have hemorrhoids, or even painful varicose veins in their vaginal and perineal area, after delivery.  
Constipation may also develop after delivery, due to the effects of pain-killers, or due to reluctance to pass stool because of pain in the vaginal and perineal areas. This ultimately results in a vicious cycle of straining during bowel movements, avoiding bowel movements because of pain, worsening constipation and consequent straining.

This constant straining can cause new hemorrhoids to develop.

Few people talk about one of the most common problems experienced during pregnancy- haemorrhoids. Also known as piles, haemorrhoids are thought to affect more than half of people in the Westernised world, and a large percentage of pregnant women. Determining how many people are affected is not always easy, because haemorrhoids are one of those subjects people prefer to keep to themselves.

While haemorrhoids are more irritating than dangerous, it is important to have a doctor confirm that any symptoms you have (such as rectal bleeding) are indeed caused by haemorrhoids, and not by more serious condition.

Those most likely to develop haemorrhoids include Westernised people who eat a low-fibre diet, the elderly, pregnant  women, those chronically straining with constipation, people with heavy lifting jobs and those who are overweight.

Consult your doctor if you notice any changes in bowel movements or rectal bleeding, as these could be symptoms of more serious conditions. These doctor may examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids. The doctor may also perform a digital rectal examination with a gloved finger, to check for abnormalities. Examinations may also be done using anoscope or proctoscope (fibre-optic devices that a doctor passes through the anus to examine the inside of the bowel)

If hemorrhoids are diagnosed, the initial treatment will focus on relieving the symptoms. Treatment might include sitting in warm water several times a day, applying a topical hemorrhoid cream or using suppositories, and increasing the amount of fibre in the diet.

If these measures do not relieve the symptoms, further treatment may be needed. Whilst much depends on the severity of the piles and where they are situated, procedures that are commonly used to treat hemorrhoids include:

  • Rubber band ligation- in which a rubber band is placed around the base of the hemorrhoid. The band cuts off circulation, and the hemorrhoid withers away within a few days.
  • Infrared coagulation- in which the hemorrhoid is burnt off using a special infrared device.
  • Sclerotherapy – in which a chemical solution is injected around the blood vessel to shrink the hemorrhoid.
  • Hemorrhoidectomy- in which the hemorrhoids are surgically removed.

Because hemorrhoids are worsened by constipation and the resultant straining during bowel movements, the most important step towards minimising hemorrhoids is to avoid constipation. Drink plenty of fluids and increase your fibre intake to improve bowel function. Cut  down on processed foods.
You could also try a soothing sitz bath to clean the area and soothe the irritated skin. Use a specially- designed sitz bath that fits over the toilet, or simply sit in a bath of warm or ice-cold water for 10 to 15 minutes, three be used, to clean the rectal area and help to reduce the swelling. If a hemorrhoid is extremely painful after a bowel movement, you could try applying an ice pack to the area for a few minutes.

Creams and suppositories can help to reduce swelling, inflammation and itching. Treatments are usually available in topical cream for external hemorrhoids or suppository form for internal hemorrhoids. Fibre supplements may also be useful. To reduce constipation.
Do NOT strain when attempting to pass a motion, and don’t linger on the toilet because it puts pressure on the area. In addition do not scratch or wipe vigorously- or the condition may well worsen.
Do Kegel exercise daily: Tense the muscles around your vagina and anus and hold for eight to 10 seconds before releasing and relaxing. Repeat 25 times. Not only will these increase circulation in the rectal area and strengthen the muscles around the anus (thereby decreasing the chance of hemorrhoids), but they also strengthen and tone the muscles around the vagina and urethra, which aids in postpartum recovery.

Avoid sitting or standing for long stretches of time during your pregnancy. If your job involves sitting, get up and move around for a few minutes every hour or so. At home, lie on your side when sleeping, reading, or watching TV to take the pressure off your rectal veins and help increase blood return from the lower half of your body.

HEARTBURN

Heartburn is one of the most common discomfort experienced during pregnancy, affecting up to 80% of all pregnant women. It may begin as early as the first trimester and symptoms may worsen as the pregnancy progresses. During pregnancy, the hormone progesterone relaxes the lower esophageal sphincter (LOS) – the valve through which food passes into the stomach. This allows stomach acids to pass upwards into the oesophagus (food pipe), causing burning discomfort. In later pregnancy, the growing baby and uterus take up more and more space, cramping the stomach, making digestion slower and reflux worse.
To avoid heartburn, eat smaller meals more often, avoid spicy and fatty foods, citrus and caffeine, try chewing a non-mint chewing gum, and wait at least an hour after eating before lying down. Fortunately, heartburn usually clears up completely after delivery.

The common burning sensation of heartburn is experienced most often after meals. Sometimes, the acid moves far enough up the oesophagus to reach the mouth and the throat, causing a bitter, sour or salty taste in the mouth, and causing hoarseness or laryngitis.


The symptoms of heartburn are the same in pregnant women as in anyone else However, pregnant women may experienced heartburn more frequently, and often experience it when lying down. Heartburn may also develop after the movement that increase the pressure on the abdomen, such as straining, lifting coughing or bending over. It often worse at night, and in third trimester of pregnancy

If your heartburn doesn’t improve with smaller meals and avoiding factors such as caffeine and citrus, you could also try natural treatment such as drinking a smaller glass of water or milk, or eating natural yoghurt or raw almonds at the first time of heartburn. This may help to neutralise the acid that causes the burning.

You can also treat heartburn with over-the counter antacids to neutralise the stomach acids. Normally, calcium/magnesium antacids act only on the acids in the stomach and are not taken up into the bloodstream, where they could affect the unborn child. Pregnant women therefore regard them a safe for use.

However, as with all medication taken during pregnancy, you should consult your doctor or pharmacist first and try not to rely too heavily on this medication. Bear in mind that some antacids may be very high in sodium content that cause fluid retention.

Excessive use of antacids could also reduce your body’s ability to absorb essential vitamins and minerals- such as iron from your food. Heartburn can also be treated with Alginate based products which are unlike antacids, as they work by forming a raft on top of the stomach contents, preventing the reflux of acid into the oesophagus thus avoiding the occurrence of heartburn.

In addition, Alginate products usually contain low sodium, decreasing the risk of fluid retention.

If you are prone to heartburn during pregnancy, there are steps you can take to minimise the discomfort. Most of these involve improving the digestion process, and so reducing the amount of acid in the stomach.

Eat smaller meals. Two or three larger meals will distend your stomach and increase discomfort. Rather have five or six smaller meals and snacks during the day.

Break food into smaller, more manageable portions and take smaller bites.

Eat slowly, do not rush, and chew food properly. The more you chew food properly. The more you chew the less time food stay in your stomach for proper digestion.

Drink only small amount of water with meals. You may swallow air as you drink, which makes heartburn worse.

Avoid spicy, or greasy food as these lower LOS tone.

Stay away from drinks containing caffeine, such as coffee and colas

Avoid citrus food and drinks such as oranges, orange juice and tomato juice.

These may irritate the lining of the oesophagus.

Avoid the alcohol and cigarettes.

Say no to chocolate, as this lowers LOS tone.

Try chewing a non- mint chewing gum. Chewing gum decreases the discomfort of heartburn. However peppermint can make it worse.

Do not eat while lying down.

Wait two hours before after eating before lying down, and immediately before bedtime.

Sleep at a slight incline. Prop your shoulders on a pillow or two, or elevate the head at the bed-time. This keep your stomach below your diaphragm, so that gravity will help to keep your stomach contents where they belong.

Try to avoid excess weight gain during pregnancy, as obesity worsens heartburn.

Wear loosely fitting clothing especially in the third trimester.

Between the lower part of the oesophagus and the stomach is a valve called the
lower esophageal sphincter (LOS) . Normally this is a ‘one way valve’ that allows food to enter the stomach, but does not allow the stomach content to move out of the stomach again. However, if the (LOS) relaxes, the stomach acid will pass upwards into the oesophagus, causing the burning discomfort.
Factors such as fatty food ,cigarette, alcohol, chocolate and caffeine can relax The LOS, increasing the reflux. Reflux can also occur as a result of poor diet, hiatal hernia and obesity.

During pregnancy, the LOS can also relax due to the effects of hormone progesterone, which relaxes the walls of the uterus. Unfortunately this hormone also relaxes other muscle tissue, including the LOS, as well as slowing down the wavelike contractions of the stomach. This means that food takes longer to digest and more acids builds up in the stomach at the same time as the LOS is more relaxed than usual.
In later pregnancy, the growing baby and uterus up more and more space, cramping the stomach and making digestion even slower. The result in increased acid in the stomach and more severe reflux more often.

If you experience heartburn for the first time during pregnancy, your doctor will probably not order any further investigation, beyond taking a through look at your medical history.
However, in highly exceptional cases, more tests might be needed to determine the cause of the heartburn. These tests might include:

  • Gastroscopy, using a flexible viewing tube passed through the mouth (you will be sedated). This may show signs of gastro- oesophageal reflux, such as redness or ulceration of the esophageal lining.
  • Barium swallow/ meal- you swallow Barium, which shows up on spacial X-rays This rarely if ever done in pregnancy because of the wish to avoid X-ray if possible.

In most cases, heartburn peaks shortly before delivery and cleans up completely after the baby is born. However, if you suffer from heartburn after delivery, with symptoms surfacing more than twice a week or becoming debilitating, you could have gastro-oesophageal reflux disease (GORD). This has a physical cause and requires treatment by a doctor.

With effective treatment, using a range of prescription medications, you may become symptom-free and avoid any potential complications.

ROOIBOS

Rooibos tea can help to prevent and treat colic in babies. Offer baby 25 ml to 50ml between feeds. Give the tea using a syringe if baby is nursing, or drink it yourself so that baby gets it via your breast milk.

Rooibos is a special indigenous (found locally) plant that has been used by South Africans for its health and beauty properties for generations.
Rooibos is a small, shrub-like bush most commonly found in the Western Cape mountain regions.

It belongs to the Aspalathus plant group, which falls under the legume family.
Its distinctive aroma and flavour make the plant a favourite as a basis for drinks and foods, and it is increasingly being used in toiletries and cosmetics, because of its soothing and antioxidant (antioxidants are special components of food that have health-promoting characteristics) properties.

While locals have been benefiting from the health-giving properties of the shrub for many years , it is now coming to the attention of the international market too, with new studies providing a range of health benefits.

Rooibos contains no additives, preservatives or colourants, so it is completely pure and natural. And safe for all ages. Its soothing properties make it useful for people suffering from irritability, headaches, disturbed sleeping patterns, insomnia, nervous tension, mild depression or high blood pressure. Rooibos tea also has a soothing effect on the digestive system, making it effective in treating mild nausea, vomiting, heartburn, indigestion and constipation, as well as colic and cramps in infants.

Because of its soothing effects, Rooibos can also be used directly on the skin to relieve itching and irritation caused by eczema, nappy rash, sunburn or insect bites. Its soothing and antioxidant properties also make it a good face wash for treating acne.

Rooibos is a refreshing drink for people on a kilojoule/calorie-restricted diet, and it contains no oxalic acid, so it can be drunk freely by people suffering from kidney stones.

Importantly, new research has found that Rooibos has potent antioxidant properties. When the tea is brewed for longer than 10 minutes, its antioxidant properties increase dramatically.

Antioxidants are chemicals that protect the body from the effects of free radicals, which are naturally produced substances that lead to ageing and age-related illness. The antioxidants in rooibos help to boost the immune system and counter ageing and age-related diseases. Japanese research has also found Rooibos to be beneficial in the treatment of high blood pressure, diabetes, atherosclerosis (hardening of the arteries), allergic diseases, various forms of skin rash/dermatitis, liver diseases and cataracts.

If your baby contracts a contagious, itchy disease such as chicken pox or measles, make a solution of Rooibos tea and bicarbonate of soda. Dab the solution all over the itchy areas or add it to the bath water.

If baby has itchy, dry skin rashes, brew a strong pot of Rooibos and add it to baby’s bath water. The rash should show marked improvement within a few days. Baby soaps, shampoos and creams containing Rooibos are also available, to help prevent rashes.

Treat a small but persistent patch of rash with a moistened Rooibos tea bag. Secure the tea bag to the affected area with a bandage or plaster for two to three hours. Repeat until the rash clears up, which is usually within two days.

If your baby suffers from frequent fevers, offer II ice lollies” made from a mixture of Rooibos tea and fresh fruit juice. Freeze the mixture in moulds.

These lollies will help them to keep their liquid intake up, as well as cooling them down. They are also a good alternative to other treats.

In most cases, heartburn peaks shortly before delivery and cleans up completely after the baby is born. However, if you suffer from heartburn after delivery, with symptoms surfacing more than twice a week or becoming debilitating, you could have gastro-oesophageal reflux disease (GORD). This has a physical cause and requires treatment by a doctor.

With effective treatment, using a range of prescription medications, you may become symptom-free and avoid any potential complications.

DIETARY & NUTRITIONAL STRATEGIES FOR PREGNANT WOMEN

A balanced diet containing protein, carbohydrate, fats, vitamins, minerals, water and fibre will contain important micronutrients (vitamins and minerals), but supplements may be required during pregnancy. If you are unsure, consult your doctor.

  • Almond, peanuts, wheat germ, soya, orange juice, peas and beans, dark green leafy vegetables all contain folic acid, which essential for the neurological development of the foetus.
  • Salmon, mackerel, trout, sardines, pilchards contain Omega 3 fatty acids, which are important for the development (and maintainance) of the brain. It is recommended that at least one option of these fish are eaten at least three times per week, for the normal mental development of the foetus.
  • Low fat or fat free milk, yoghurt, cottage cheese, soya, sardines, dark green leafy vegetables are all excellent sources of calcium and are important for the development of bones and teeth. The low fat or fat free dairy products actually contain more calcium than the full-cream alternatives.
  • Meat, sardines, egg yolk (dark green leafy vegetables) contain iron, which is essential for the delivery of oxygen to the foetus, especially during the second half of pregnancy. Remember that iron absorption is adversely affected by drinking tea and coffee.
  • Guavas, kiwifruit, oranges, berries, naartjies, grapefruit all contain vitamin C which not only helps absorb iron, but also assists with blood pressure and fluid retention amongst other things.
  • Beans, lentils, sweet potatoes, rice, pasta, oats and pearled barley are the best types of energy foods, as they are slow-release energy foods, maintaining stable energy levels throughout the day and delivering B-complex vitamins.

Below are some practical examples of healthy, balanced and delicious recipes to help you maintain a healthy diet during your pregnancy. They will demonstrate what you need, why you need it and how to prepare it! Finally, the I 14 Day Pregnancy Eating Plan II below puts it all together for you.

Sea-food Stirfry

  • Courgettes (baby marrows) contain vitamin C, which keeps your skin, gums and teeth healthy and contributes towards the absorption of iron. They also contain folic acid, which works with vitamin B12 to form red blood cells and produce genetic material essential to the healthy development of the baby.
  • Mussels, salmon and especially oysters are rich in zinc, which is necessary for growth, development and a healthy immune system.
  • Garlic and Olive oil, have immeasurable nutritional properties.
    Make a healthy meal by slicing courgettes with spring onion and stir fry in olive oil. Then add mussels, salmon, oysters and fresh herbs. Toss into a home-made tomato sauce and serve with fresh pasta.

Chicken avo and Spinach Salad

  • Cooked chicken is rich in protein and vitamin B which helps alleviate stress. It also contains zinc and iron, so important during pregnancy.
  • Lightly blanched spinach is one of the best sources of folic acid and also contains iron.
  • Avocados are high in magnesium and potassium, which has a calming effect on the body and helps alleviate leg cramps often associated with pregnancy. Lemon contains vitamin C helps with absorption of iron.

Dice up all of the above and dress with olive ill and lemon juice for a power packed, mood­lifting salad. Served with simple and quick baked beans means ongoing energy for hours afterwards.

Nutty Baked Potatoes

  • Nuts, and seeds are also rich in magnesium.

Halve cooked baked potatoes and spread with cottage cheese, sprinkle with assorted crushed nuts and seeds, top with finely grated parmesan and grill.

Cervical Cancer

Yes, by avoiding the above risk factors. The second way to prevent this cancer is to have regular Pap smears. Most cervical cancers are found in women whom have not had regular pap smears.

If you have not been checked by Pap smears regularly, then you may end up having cancer. The symptoms only show once the cancer has started to spread. Usually you have bleeding in between your periods, bleeding or pain during intercourse and a discharge. Other diseases can also cause these symptoms, so when they happen please go for a medical check up.

Cervical cancer is difficult to treat and the treatment includes surgery, radiotherapy, chemotherapy and palliative care.

The pap smear is a screening test and has been the most successful way to prevent cancer. This can be done by your Doctor or your local clinic Sister. Please remember not to go during your menses as the bleeding will affect the result.

A speculum is inserted into the vagina in order to see the cervix and then a small brush is used to take some cells from the cervix. This is then sent to the laboratory and your results will be back after a few days. So please don’t forget to check your results. If something is wrong then treating is very easy and it only takes a few minutes.

From the time you are sexually active and ideally once a year. However, your clinic sister or Doctor will advice you as at times it may need to be frequent especially if you are HIV positive or had an abnormal Pap smear result before.

CHILD BIRTH OPTIONS

A caesarean section is a surgical method of delivering a baby (or babies) through an incision (cut) made in the abdomen and then the uterus. The procedure takes approximately thirty minutes and during this operation the mother receives a general or epidural anaesthetic. A caesarean section is often required during a normal delivery when:

  • The contractions of the uterus are not strong enough.
  • The cervix (neck of the womb) doesn’t fully dilate (open).
  • The baby’s head does not descend into the birth canal.
  • If the baby’s head does not descend into the birth canal.
  • If the baby becomes distressed during labour.
  • The position of the baby is unsuitable for a vaginal delivery- when the baby is not in the “typical head down” vertex position.
  • Sometimes if the baby is premature.

At times, the decision to do a caesarean section is made before labour. Conditions include: having placenta previa, if the baby is very big (e.g. diabetes), a pelvis that’s too small for the baby’s head to fit through, certain foetal malformations or some abnormality or scarring of the uterus.

Usually most women are up and about and eating the day after surgery and only spend about three or four days in hospital. Always discuss matters with your midwife or doctor if a caesarean section is recommended to be sure that you are comfortable with the reasons for it.

Although the onset of labour differs for each woman, there are certain signs that your baby is on his way:

  • Rhythmic contractions (tightening of the muscles of the uterus that serve to move the foetus through the birth canal) which are more intense than the irregular Braxton-Hicks cramping.
  • The classic “breaking of the water” is the result of rupture of membranes around the foetus.
  • You may also experience a “bloody show”, a vaginal discharge of blood-tinged mucus that previously closed off the cervix.

Most women are healthy enough to cope with giving birth to their baby via an uncomplicated normal vaginal delivery. Most births occur in hospital for reasons of efficiency and safety. Birthing usually takes place in a labour ward, under the supervision of your doctor or midwife. During normal vaginal delivery, certain procedures are often performed as a routine part of the process. These include:

  • Vaginal examinations are performed regularly during labour to monitor your progress.
  • Enemas may be given to empty the colon and prevent defecation (passing of stool) during labour.
  • An intravenous line may be inserted into your arm to administer fluids, medications and painkillers.
  • Shaving/Trimming of the pubic area- depending on your preferences or hospital policy.
  • Catheterisation of the bladder- here a thin flexible tube is inserted into the urethra (urinary orifice) to allow free flow or urine to empty the bladder.
  • Foetal monitoring is a method to have your baby’s well-being electronically monitored during delivery. If your cervix has not yet dilated and your abdomens are intact, an external ultrasound monitor is placed onto your abdomen. An internal minor can be used after the bag of water has broken and your cervix is sufficiently dilated. Here, a tiny, spiral shaped device is inserted through your vagina onto your baby’s scalp (a relatively harmless procedure)

Nature may take its course, but sometimes it needs a helping hand. Here are some common procedures used to assist delivery during childbirth:

  • Inducing labour (getting it started). Uterus contractions are stimulated either by using medications, or by amniotomy (breaking the waters by making a tear in the amniotic membrane with a small plastic hook). Among the reasons for inducing labour are post-term pregnancy, pregnancy-induced high blood pressure (hypertension), diabetes mellitus, previous stillbirth or the premature rupture of membranes.
  • Episiotomy, whereby an incision, under local anaesthetic, is made to enlarge the vaginal opening to facilitate delivery and to prevent tearing of the muscles of the vagina and the surrounding area during birth. It is usually performed when the baby’s head is crowning (pushing through)
  • Vacuum extraction is when soft plastic cup is placed upon the baby’s scalp and suction is applied. It is used to assist the mother if she becomes exhausted or if the baby shows signs of distress.
  • Forceps are medical instruments used to guide the baby’s head out of the canal.

If these methods are inappropriate or not effective, then a caesarean section may be required.

Tolerance and perception of pain during childbirth vary enormously. The prospect of pain frightens some women, who request pain medication early in labour. Others want a completely “natural” birth, with all the intensity of sensation and the fewest interventions as possible. There are many options for pain relief, many of which do not involve medication:

 

  • Breathing techniques, like Lamaze, help women endure labour by providing stimulation to the brain, in the form of rhythmic breathing, which distracts the brain from the pain of labour.
  • Bradley techniques involve breathing, imagery and relaxation.
  • Transcutaneous electrical nerve stimulation (TENS). Mild electrical charges are administered to a woman’s back, distracting her from the pain.
  • Walking, bathing, back massages, rocking in a chair or squatting on a birthing ball are other non-medical ways to relieve pain.
  • Narcotic analgesia. Here a doctor inserts a fine plastic tube into the space surrounding the spine. Through the tube, pain-killing medication can be injected or continuously infused (run in) throughout labour. An epidural will numb you form the waist down, providing complete pain relief in most women. An epidural allows you to remain awake and aware, bur mostly pain-free during childbirth. It can diminish your ability to push, and its use may sometimes require forceps to aid delivery. All patients who have an epidural or spinal anaesthesia will require an intravenous drip for fluid administration and urinary catheter. These are usually removed four to six hours after delivery.

No matter how well prepare you are for childbirth, no matter how healthy or confident, the possibility always exists that things can go wrong. It may be that medical intervention (an episiotomy or an emergency caeserean section) becomes an absolute necessity for your well being or that of your baby. The more you learn about all the options- and about the process decisions during your own labour and delivery. Remember that your ultimate goal is a healthy, happy baby, no matter how he arrives.

HEALTHY PREGNANCY MAKES A HEALTHY BABY

It’s important for an expectant mother to create and maintain a healthy "inside”, and to do that you have to start on the "outside". Lifestyle factors and your behavior heavily influences the health of a newborn.

Studies show that alcohol interferes with the normal cell development of a baby’s brain and other organs. Drinking can result in recognized pattern of mental and physical defects known as Foetal Alcohol Syndrome (FAS). Unfortunately, the exact amount of alcohol needed for FAS to develop is not clear-any amount of alcohol could have a detrimental effect on the unborn child.

Characteristics of FAS include:

  • Low birth weight and slow physical development
  • Mental impairment, behavioural problems, short attention span and learning difficulties.
  • Distinctive facial features, including a small head, small eye openings, a short, upturned nose, thin upper lip and flattened face.
  • Deformed spine, ribs and sternum.
  • Finger and toe deformities
  • Near sightedness
  • Heart defects or murmurs
  • Kidney and urinary tract defects
  • Deformed genital system
  • While FAS occurs most often in women who drink moderate to large amounts, some of the characteristics of FAS can be seen in babies whose mothers report that they drank very little alcohol during pregnancy.
  • Characteristics seen most of ten- even where mother drank relatively little- are behavioural problems, hyperactivity and distinctive facial features. There is no safe limit for alcohol consumption during pregnancy.

Moderate exercise is not only healthy for you but also for baby, providing a host of physiological benefits during and after pregnancy. Consult your caregiver before starting an exercise program to ensure that your pregnancy is healthy and free of complications.

 

Your blood volume increases by about 40% during pregnancy, while heart rate increases by about 10 to 15 beats per minute. This ensures efficient transport pf nutrients on oxygen to the foetus. Exercise will increases the heart rate and blood flow again, so be careful of overdoing it. Never exercise to the point of exhaustion and keep your pulse rate at a level of 140 to 150 beats over minute. Stop exercising and contact your doctor at the first sign of problems.

 

The most comfortable exercises are those that don’t require your body to bear extra weight for long periods of time:

  • Swimming
  • Stationary cycling
  • Walking
  • Low-impact aerobics

Substances taken into a pregnant woman’s body travel to the foetus, primarily through the placenta, so baby is exposed to any chemicals mother is exposed to.

The effect a drug has on the foetus depends on the drug itself and the stage of development of the foetus. Between days 17-57 after fertilization, baby is particularly susceptible to harm, as his vital organs and nervous system are developing. Drugs reaching him at this stage could cause miscarriage, deformity or defects that may only be detected later.

Certain drugs are known to harm the foetus. These include:

  • Certain antibiotics, like tetracycline’s, may be stored in the foetus’s bones and teeth, resulting in slow bone growth and soft tooth enamel, as well as discoloration of teeth. Other antibiotics may result in deafness, joint abnormalities, jaundice and brain damage.
  • Acne drugs. Isotretinoin, used to treat skin disorders, can cause major birth defects, including heart defects, small ears and hygfrocephalus (water on the brain)
  • Anti-emetics. Cyclizine frequently taken for motion sickness, nausea and vomiting, could possibly cause birth defects.
  • Anticonvulsant drugs may cause baby to have a cleft palate and abnormal heart, face and skull, hands or abdominal organs.
  • No steroidal anti-inflammatory drugs (NSAIDs), like aspirin and ibuprofen, can reach the foetus in significant amounts. Taking large doses can delay the start of labour, and may dangerously reduce the amount of amniotic fluid surrounding the foetus.
  • Anti -anxiety drugs and antidepressants may cause defects when taken during the first three months of pregnancy.
  • Anticoagulant drugs, like Warfin, can cause significant birth defects if taken during the first three months of pregnancy.

The sedative drug, thalidomide, prescribed for scores of pregnant women in the 1950s and 1960s, shockingly illustrates the extent to which drugs can affect the unborn child. Thalidomide resulted in birth defects like severely underdeveloped arms and legs and defects of the intestine, heart and blood vessels.

Use of illicit drugs like cocaine, heroin, cannabis and others during pregnancy increases the risk of:

  • Miscarriage
  • Early detachment of placenta from the uterus
  • Brain defects
  • Defects of the kidney and genitals
  • Babies may also be born addicted to illicit substances, and will endure painful withdrawal symptoms after birth.

It is also wise to check all II alternative II treatments (like St. John’s Wort or Echinacea) with your Doctor. Remember, if they can have a beneficial effect, they have the potential to have side effects in some people too.

Always check with your caregiver before taking any medication and do discontinue any chronic medication you or on without consulting your doctor.

It’s important to maintain the best possible mental health throughout your pregnancy. A relaxed mother often results in a more relaxed baby. Any fears you have should be discussed with your health care professional- sometimes reassurance alone can set your mind at ease. In addition, try the following:

  • Yoga – this is an excellent practices for fitness and mental relaxation, and you can practice it right up to the last stages of pregnancy, with a qualified teacher or at home.
  • Meditation-Taking time out to meditate can facilitate physical and mental relaxation, as well as more peaceful sleep.
  • Breathing exercises- Learn some breathing exercises from the many videos or books available, and use them to “centre” yourself to promote calmness and peace. This will be invaluable during labour.

Pregnancy gives you one of the best reasons you can have to give up smoking. The best possible thing you can do for your unborn child is to stop or drastically cut down. Smokers inhale nicotine and carbon monoxide, which reach the baby through the placenta and prevent him from getting the nutrients and oxygen needed to grow.

During breastfeeding nicotine is carried to the baby via our breast milk if you are a smoker. Even second-hand (passive smoking) smoke poses a risk. Nicotine may affect the quantity of milk your body makes.

Studies show an increase in the foetal heart rate for 15 minutes after each cigarette the mother has, as well as a decrease in foetal movement.

Complications include an increased risk of a sudden Infant Death Syndrome, allergies, childhood cancers, respiratory illness and ear infections.

These conditions may present in the newborn.

CHRONIC (ONGOING) ILLNESS

Diabetes is a condition in which your body isn’t able to use the sugar (glucose) in your blood as well as it should, so the level of sugar in your blood becomes higher than normal. Diabetics must practice must practice stri,ct control with their diets and medications.

Gestational diabetes is a type of diabetes that usually begins in the fifth or sixth month for pregnancy (between the 24th and 28th weeks), and affects about 4% of all pregnant women. If there’s a history of diabetes in your family, or you have had gestational diabetes before, you must inform your doctor. If untreated, your baby may be more likely to have problems at birth, like low blood sugar or jaundice- or weigh much more than is normal. Gestational diabetes usually goes away after the baby is born.

Although many pregnant women with high blood pressure (HBP) have healthy babies without serious problems, it can be dangerous. Women with pre­existing HBP are more likely to have certain complications during pregnancy than those with normal with normal blood pressure.

However, some women develop HBP while they are pregnant (often called gestational hypertension).

The effects of HBP range from mild to severe. High blood pressure can harm the mother’s kidneys and other organs, and can cause low birth weight and early delivery. In the most serious cases, the mother develops pre-eclampsia, which can threaten the lives of both mother and the foetus.

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