Health care during pregnancy

Who looks after you when you’re pregnant?

Apart from your mom and best girlfriend, once you’ve recovered from the excitement (or shock) of a positive pregnancy test, you need to think about where your baby will be born, and a health-care professional to look after you.

Think practical. Your choice of healthcare professional depends on whether or not this will be a high, moderate or low-risk pregnancy, and your financial circumstances. You may want to have a home-birth, but is there a midwife in your town or village who can come to you? Will your medical aid cover the cost of private health-care or will you need to go to your local provincial/government hospital?

My advice would be to start with your family doctor who has your medical records. He/she will also be able to assess your pregnancy risks, and whether to refer you to a specialist or a midwife.  

Low risk pregnancy:

The best age to have a baby is when you’re in your 20’s and early 30’s. This is because your body is subtle and you have high endurance levels to cope with the physical demands of pregnancy and motherhood. Being the right weight for your height means that your body can cope with the extra weight of pregnancy. Younger women are also active and mobile which is just what your developing baby and your body needs to cope with labour and birth. Women who fit this profile can safely have their babies at home or a natural-birthing unit, or her baby can be delivered by a midwife at a government hospital. Ante-natal care can be followed-up by a private midwife, or a midwife at your local municipal ante-natal clinic.  If you choose to have your baby at a private hospital, you can go to a gynaecologist or obstetrician attached to the hospital of your choice.  

After initial blood tests, you need to go for monthly check-ups until you are seven months pregnant. Then every two weeks until the last month of your pregnancy. During your final count-down, you will need to go for weekly check-ups until your baby is born.

Should your doctor/midwife pick up any problems along the way, you will be referred to a specialist if you’re using private health care, or a tertiary hospital attached to a university if you are going to a government hospital.  

Moderate risk:

Women in this category are ‘first-timers’ younger than 20 or older than 35.  ‘Second-timers’ with a moderate risk are women who have had a previous c-section (at least three years ago), or medical problems during her previous pregnancy and those who have a family history of birthing problems such as haemorrhaging. Finally, women with chronic medical conditions like asthma, diabetes, high blood pressure and epilepsy are a moderate risk, providing these are under control. If these medical conditions deteriorate, a woman will be notched into a high-risk category.

High risk pregnancy:

Many more women are falling into this category today – either because they’re having their first baby when they’re younger than 18 or older than 38. A woman who has had fertility treatment, and more especially if she is carrying twins (or more) is considered high risk. Women with severe medical problems such has heart, liver or kidney disorders, uncontrolled diabetes, chronic high blood pressure or an auto-immune disease like lupus or arthritis must not only be closely monitored by an obstetrician, she must also be monitored by her specialist.  

Let’s not forget that girlfriends, mothers, grandmothers and other family members are especially important for pregnant women. Where I come from, we say: “It takes a village to raise a child”. Pregnant women shouldn’t feel isolated and alone. A friendly call, SMS or WhatsApp message, a coffee break, helping with her shopping or just being with her at the doctor’s rooms can boost her morale and help her cope in times of stress.

Cleaning cupboards helps to unclutter your life

The fun part of cleaning cupboards

         

It’s amazing the treasures you find when you clean out your cupboards! We’re in the throes of moving and cleaning out after nesting in the same tree for the last 30-something years. Memorabilia from yesteryear – cards and letters, photographs and report-cards, certificates and awards in boxes and files, just sitting in the dark. Things you put away for a ‘rainy-day’ or when you have the time. But where do you find the time when you’re bringing up a brood of children, working on your career and surviving the day-to-day frustrations and interruptions of life?

A fun part has been giving things away that others can make use of. My over-locker to a dressmaker, my keyboard to an 8-year-old wanna-be musician. Plates, cups, glasses, odds and sods ….. I asked myself, why do we ‘need’ so much? I suppose with a growing-up family there are always bits and bobs that you need for school projects and the like. Now I can give them all away.

Regular readers of my blog will know that I revived my interest in knitting and crocheting this year. Yesterday I came across a file of knitting and sewing patterns I used when my children were growing up. Although many of the styles and colours have changed, I realised that I can keep the basic instructions to a good few of these patterns and adapt them to trendier colours and styles for my current brood of grandchildren. Even more exciting was a book of crocheting and Tunisian patterns for blankets, scarves, poncho’s and shawls that have made a comeback.

Bottom line? Mom was right when she insisted that we children clean our cupboards out every school holiday. In that way we could find the things we had ‘lost’, put our lives into some sort of order, and get rid of unnecessary clutter. Hoarding ‘stuff’ only takes up space, attracts fish-moths and gets ‘old’. Besides, one man’s trash is another man’s treasure. Thrift-stores and Charity-shops make a profit for a good cause, give people a job and for the creative junkies out there, with a bit of imagination and elbow-grease, they can give new-life to something old. It’s a win-win and recycling at its best.

An early resolution for the New Year?

         

What to do about worms

Eeeu …. Worms!

Worms may be a tasty treat for the birds in your garden, but they’re pretty nasty in your body. Worms in children (and adults) is more common than we think. Tots, who are still developing their immune systems, play in the sand, eat dirt, share toys and food, and use their hands to eat with, are especially vulnerable. A listless, irritable, miserable child, may well have worms. Children with worms may have a ferocious appetite or no appetite at all. They can have diarrhoea or be constipated. Luckily, treating worms is simple and complications can be avoided when treated early. Speak to your pharmacist about regular family and pet deworming.

How children get worms:

Worm eggs are mostly spread in faeces and dirty water. Clean toilets, fresh running water and proper sanitation is fast becoming a problem in South African communities.  Worms commonly found are roundworm, threadworm, whipworm and tapeworm with hookworm more prevalent in KwaZulu-Natal. Threadworm and pinworm eggs can survive even in the dirt and can spread where there is overcrowding. Eggs contaminate sheets, toilet seats, toys and the fur of animals. An infected child can re-infect themselves. Tapeworm for example, irritates the anus during the night. A child may scratch, then suck his fingers. Contaminated puddles can infect children playing in them. Tapeworm eggs are found in raw meat and cause cysts to develop anywhere in the body.

Symptoms to look out for:

Restless sleep – because of an itchy bottom. Threadworm and pinworm infect the intestine and eggs are laid in the rectum at night. This causes the itch. Worms can be seen as tiny white threads in faeces or the eggs can be identified if removed from the rectum the next morning with sticky-tape. It’s useful to take these or a stool specimen to the doctor.

Bed wetting is associated with a pinworm infection. Swallowed eggs hatch and mature in the small intestine and female worms crawl to the rectum where they lay their eggs at night. The worms may hatch and crawl back into the bowel, but in little girls, they can also crawl into and infect the vagina. In severe cases, the womb and fallopian tubes can become infected.

Wet cough. The larval stages of round worm occur in the lungs with symptoms of bronco-pneumonia, coughing and general illness.

Weight loss. Despite a good appetite, children with intestinal worms can become malnourished and lose weight.

Nausea / No appetite. Roundworms are shiny white, live in the small intestine and can grow up to 15 cm and longer. They can block the intestines or be vomited. 

Anaemia – hookworm and whipworm attach themselves to the lining of the bowel where they suck the blood and cause loose, blood-stained stools.

Treatment:

Most medicines used to treat worm infections kill worms by either starving them or paralysing them; for example:

• Mebendazole, albendazole and thiabendazole work by preventing the worms from absorbing the sugars they need for survival.
• Praziquantel and ivermectin work by paralysing the worms in the gut (intestine).

Please take your child to the doctor or clinic. You can also speak to your pharmacist. Treatment is usually for a week or a single oral dose of a de-wormer that’s repeated a week later.  The whole family needs to be treated; bedding should be laundered on the hottest wash cycle and sand-pit sand changed regularly. Make sure children (and adults) wash their hands every time after using the toilet. Always wash fruit and vegetables and cook meat well. Keep your children’s nails short and clean.

When is it serious?

Neglected worms can become serious. The parasite will deprive the child of nutrition, weaken the immune system and use the child as host to multiply. Cysts from threadworm and pinworm can develop on the brain causing pressure and fitting, lungs can become congested and intestines blocked. During their formative years when children should be growing, learning and having fun, those with worms are sickly and miserable and it may take a long time for them to recover. Regular deworming is such a simple solution!

Little children and their friends - appropriate and inappropriate behaviour

“Mom, Dad, I got a boy/girlfriend”

I remember my first boyfriend. His name was Paul and we were in first grade together. We were going to get married. Paul was going to be an airline pilot, and I was going to be an air-hostess. When I left the school because our family moved, we never saw each other again. Years later I was saddened to learn that Paul was tragically killed in a motor-bike accident before he finished school. He sure made those first few years of school fun! 

Parents are amused when little children innocently tell them they have a boy/girlfriend. Parents know that it’s normal and all part of growing up. In pre- and early primary school days (before hormones kick in) boys and girls happily play together and enjoy each other’s company. One little four-year-old girl, who only ever wanted to wear pants and shorts to school, suddenly insisted that she wear dresses. When her mother wanted to know why, she was told that her ‘boyfriend’ preferred her to dress like a girl.

Pre-school children are aware of their gender differences, and accept these unquestioningly as they do race differences. As far as they’re concerned, boys and girls are on the same page. While they watch what their parents do – mother’s looking after the baby and father’s cutting the grass or fixing the car – their roles are interchangeable. Girls are allowed to join-in with the boys’ games while boys are welcome to play in the Wendy-House with the girls.

In first and second grade at school, boy-girl games begin to change. Now they start ‘ganging-up’ against each another with the boys chasing the girls around the playground while the girls squeal in delighted-objection! Should the chase stop – or need a nudge to get started in the first place – the girls antagonize the boys till they get their attention. In the same way, the boys will tease the girls and interrupt their game and the girls will retaliate by chasing them away. Sometimes they become so engrossed in the chase, they forget about the game they were playing in the first place!

Children learn about life and each other through play. But what should adults do when play becomes inappropriate? I spoke to a social worker at the Teddy Bear’s Clinic at the children’s Transvaal Memorial Institute (TMI), Johannesburg.

“We must remember that children are naturally curious, and they also live what they learn,” she said. “Children of pre-school age (from four years) till Grade 1 (seven years) copy their parents in role play at school. But they’re also learning socially acceptable behavior. For example, if their parents walk around naked at home, that’s OK in their private capacity, but it’s not acceptable at school. Little children simply need to be told without making a fuss or making them feel ashamed or rejected because they can’t do this at school. If a child is integrating his curiosity to other children, then this must be looked at in context. One has to take into consideration how often this behaviour is happening, how severe it is and the extent of the invasion (of other children). For the most part, children only need to be told once that ‘it’s not nice to do that’ which is sufficient for the child not to try that trick again! However, when this behavior persists, one needs to investigate and speak to the parents and ask them why their child is behaving in this way.”

When parents are in denial, they may become aggressive or even turn on the teacher and other parents who are only trying to help. Let’s face it, family and work pressures are huge today. As a result, many children are growing up with single or divorced parents and they see their parents with different ‘boyfriends’ and ‘girlfriends’. They copy what they see at home when they’re at school. Some children are allowed to watch inappropriate TV. How are little children supposed to know the difference between what’s right and wrong when it’s not only cartoons they watching, but also sex and violence from the same screen?

When children become aggressive, this may come from something that has, or is happening to them. Depending on family circumstances, the child’s disposition and opportunities he has to overcome this aggression, aggressive children will not necessarily become aggressive adults, providing the problem is nipped in the bud.  The social worker I spoke to told me that children who are seen and treated at the Teddy Bears Clinic (a clinic for the rehabilitation of abused and sexually abused children) show a marked change in behavior six months to a year later.

Children should be taught ‘grace’ and courtesy’ towards other boys and girls at school, by their parents. This teaches them ‘respect and dignity’ towards others that will certainly come in useful when they’re teenagers and adults one day.