Daytime Sleeping Problems

Hannah’s baby girl will be two months on the 16^th October. Her most recent WhatsApp message to me reads: “The last few days I’ve been a walking zombie since my baby’s sleep routine is digressing. Sarah is up all day. I’ve tried everything. She naps for 20 minutes, and only when she is on my arm. Today is a good day! She’s been asleep for about three hours and I’ve taken advantage of this time to get things done.”

Don’t we all do this? Rush around like crazy women when baby is sleeping?

I don’t know how long Hannah’s baby is sleeping at night, but if her daytime routine is changing that allows her to sleep for longer stretches during the night, that’s a good thing. One reason could be that her body is establishing a diurnal rhythm – in other words synchronising her day/night time cycle. We are, after all, a diurnal species – meaning that we’re active during the day and sleep at night. (Some babies take a long time to learn this!)

The change from sleeping from feed-to-feed 24/7 in the first few weeks of life, to feeding less and sleeping longer during the night, feeding more often and sleeping less during the day, is a normal adaptation. It’s influenced by environment, exposure to sunshine (melatonin) and personality. 

Environment: It’s pretty dark and noisy in the womb where babies first become aware of their existence. During the first few weeks after birth, the need for food overrides environmental distractions like light, noise, and discomforts such as a wet or soiled nappy. During the first six weeks, babies gradually become aware of the difference between comforts and discomforts. They also learn to communicate how they’re feeling through body language, facial expressions, grunts, squawks, squeals and crying. Babies are learning through their senses and after six weeks, become easily distracted by what they see, hear and perceive with their ‘sixth’ sense – in other words, they instinctively know when you’re happy, sad or stressed - and behave accordingly!  

Melatonin: This hormone is made during the day and is used the night to induce sleep. The more sunlight we get, the more melatonin the body can store. Melatonin is also important for hormonal balancing and regulating immunity. Gradually, Hanna’s baby will sleep less and less during the day till about the age of four when she will only need a short nap at midday – usually with other children at nursery school. Playing in the sunshine build’s melatonin reserves and helps to contributes to a good night’s sleep.

Personality: Every baby has their own unique personality. While some need more sleep, others are happy with less. How your baby moved in the womb can be a hint – was your baby quiet or very busy? Personality is stamped into our DNA and stretches way back to previous generations. While babies don’t come with a printout of their personality, needs and preferences, parents quickly learn this by trial and error.

Top tips:

Cultural customs: When visiting Malawi, I watched mothers with their babies. Women carry their babies in a sling called a chitenje. This multi-purpose cloth has many uses. It’s used by mothers to ‘wear’ their babies either on their back, hip or chest. Tightly coiled, the chitenje cushions the head and helps to relieve the discomfort of carrying heavy items on their heads – from massive containers of water, to bundles of wood. Because babies are breast-fed for at least the first two years of life, they’re literally ‘attached’ to mom for all this time. There’s no time-keeping. Babies sleep, feed, or watch the world go by whenever it suits them. Our western life-style is so very different. Women working from home need to focus on their work, and stick to a strict schedule – which their babies also learn to do. There’s no harm asking your helper to carry your baby on her back while she works, learning to do this yourself or teaching your partner (especially if he is also working from home) to do this from time to time.  

Sleep induces sleep: Experience taught me that after a good night’s sleep, after a quick feed, your baby is ready for another nap – just for an hour or so. This little sleep helps to set the tone for regular naps during the day.

Bathing baby also makes them drowsy and ready for a sleep.

Don’t ‘tire’ your baby in the belief that this will induce sleep. Babies are not programmed like adults. Overstimulating them and tiring them only makes them ‘overtired’ and cranky.

Stick to routine – but be warned, this changes often and unexpectedly. No sooner do you get comfortable in one routine when your baby changes the game, and you find yourself changing gear once more. Be prepared for this to last for at least two years by which time your baby will be a toddler – and have you well trained!   

Photo: Burgie Ireland – Malawian woman using a chitenje

 

Going potty and loopy

 Where have I been?

Apologies to my regular readers for neglecting my blog. Truth to tell, I have been unwell for most of August. I put it down to another Lupus flare. But the symptoms just went on and on. The hospital where I go for regular treatment has been closed since the fire in April. I heard from other Lupus patients that doctors from our department were available on Wednesdays at the Helen Joseph Hospital. I really did not want to go to this hospital that’s struggling to cope now with patients from two busy government hospitals. But I had no choice. I had to bite the bullet and went yesterday.

My specialist suspects that I have POTS (Postural tachycardia syndrome) and I have been booked for CT scans later this month. Lucky for google I have been able to find out more about this syndrome – more importantly how to cope with it and understand that even though I’m feeling really crap at times, I will get over this, and if the diagnosis is confirmed, I will be able to find ways to live with it.

Sometimes it does one good to get out of your comfort zone and see the world around you for what it is. The fear of Covid has kept us so isolated, I could not imagine myself standing in long queues as we do at government hospitals. I had my good man with me for support and to help me find my way despite ‘brain fog' and vague instructions. The sun was shining on our first day of spring. People standing in the queues were friendly and patient. At first, the department where we were directed was relatively quiet and well controlled. But, by the time we left a few hours later, it seemed that thousands were packed into a small space (no social distancing) and people were getting irate and impatient. I was happy to leave.

When you’re unwell, it helps to know what’s wrong with you. Then at least you can do something about relieving the symptoms, or learning to avoid them in the first place. It seems that this POTS comes from my Lupus and Sjögren’s that I, along with my amazing specialist, have managed to keep under control for the past 15 years. It seems now that many who have had Covid are left with autoimmune symptoms, one of these being POTS.

Whenever I come out of a flare, I resolve to make the most of each and every day. I know that others may find it difficult to understand what I am going through, and it’s best for me to do something positive like read, hand-crafts, play the piano or just sit in the sun and listen to the birds. That I have opened my laptop and filled in the gap of my blog speaks volumes. It means that I am on the road to recovery, and we’ll catch up with Hannah and baby Sarah just as soon as I can.  

The first week after birth with Hannah and Sarah

 Day five – Hannah’s home and feeling good

Hannah* and baby Sarah are home and adapting to their new life. In this short time, Hannah is learning not to be too hard on herself (mistakes can and will happen she says), to communicate her needs and share responsibilities with her partner and to accept help from family and friends.

Hannah is trying not to be a ‘worry machine’, but it’s easier said than done. “Like knowing when Sarah’s full and when she’s hungry. Today I’m on ‘poo patrol’ because Sarah didn’t poop yesterday. I stress when she doesn’t. But I also stress when she does – it’s so yucky.”

Baby’s first poop is called meconium. It’s a slimy, sticky, blackish, tarry-looking thick mucus. It’s what collected in baby’s bowels during pregnancy (babies don’t poop when you’re pregnant). During the first few days after the birth, this mucous is gradually cleaned out. It changes to dark bottle-green, green-mustard colour, mustard colour to yellow when bilirubin is excreted. Breastfed poops smell ‘sweeter’ than formula poop. Formula-fed babies can have firmer or even hard stools. Its important to mix the formula according to instructions, and not to pack the scoops too tightly – or add extra formula in the belief the more is better. Breastfed babies can have up to five poops a day – or one big poop every second or third day.

It's important not to give newborn’s laxatives or suppositories or to add brown sugar or cooking oil to formula. This is because the baby’s bowel needs to build up natural organisms called microbiomes that are so important to prevent allergies, set-up an immune system and help digest milk. It’s better to stimulate peristalsis by massaging baby’s tummy or pressing baby’s knees into the tummy when the baby is lying on his/her back.

Adapting to motherhood is a topic Reva Rubin, an American midwife, studied and wrote extensively about in the 1960’s. Now in her sixth day, Hannah is at the ‘letting go’ stage: letting go of her pregnancy, her independence and ‘singleness’. She’s becoming more responsible for Sarah’s safety and survival while recognising Sarah’s independence (Sarah still associates Hannah as part of herself and will do this till she is about six months old). Hannah is also adapting her lifestyle to include Sarah. It wasn’t like this on the first and second day after birth. During this time, according to Reva Rubin, a new mother focuses on self, because she needs to recover from the birth. She only wants to eat and sleep, is dependant on others for help and has a strong need to talk about her birthing experience. On the second and third day after birth, the new mother is recovered enough (especially after a c-section) to start coping with the needs of her baby. This is when she takes more care of her physical recovery, asks questions about baby-care and is preparing to look after her baby on her own. It’s helpful to have a midwife either in hospital, or at home to give advice about feeding, burping, bathing and swaddling.

Luckily, most babies are sleepy and very co-operative during the first week – especially while they’re in the hospital. In Hannah’s words: “It’s been a blissful bubble of every emotion a new mother can ever experience….and all of them, totally worth it!” 

* We have been following Hannah’s pregnancy (see previous blogs). Her baby girl was born by c-section on Monday, 16^th August, 2021.

Photograph: Aloise Ireland

An ode to a daughter

 Hannah’s baby girl is here!

Very slightly early, Hannah’s baby girl was born at 3am on Monday morning, 16^th August – her c-section was booked for Tuesday 17^th August. I don’t have the details yet, but here is a passage I would like to share with her, and all new mothers out there – especially if you have given birth to a baby girl.

Mom and baby are well and healthy.

This is an extract from “A Daughter for a fortnight” by Mrs. Robert Henry.

“There is a belief that every woman first longs for a son, but a son, by the very nature of things is lost to her after the tenderness of his early years. A woman who has no daughter of her own misses most the intellectual companionship she can only obtain from an adolescent version of herself. Our intelligence differs from that of men. It is sometimes deeper and invariably more subtle. There is great satisfaction in having continually at one’s side a daughter with whom one can share interests and problems peculiar to one’s sex. For that reason, a daughter must be the most precious of joys.

“It is true that a mother soon loses her daughter by marriage, though her daughter’s marriage will be the very thing she will strive for most.”

Photograph: Aloise Ireland

Ready for lift-off: Ready for baby now

 One week to go

This time next week, Hannah and her partner will be holding their baby girl – and a whole new life would have begun. Everything has been packed and planned, and understandably, Hannah – who has never spent a day in hospital – is anxious about the unknown and the unexpected, the drips and injections, the operating theatre, and the recovery room. The only reassurance I could give her is that the staff knows what they are doing. It's something they do every day. Hannah doesn’t have to do their job for them. She and her baby girl will be safe.

Hannah was also asking how she will know that she is doing the right thing for her baby girl. It’s something every new mother worries about, not understanding how our ‘mother instinct’ kicks in. I refer here to an extract from Niall Williams's book ‘Boy and Man’.

“How do you know you are doing the right thing? That’s a question, isn’t it?” the Master asked at last. “How do you know? And is it enough to, say, do this one good thing, and by doing that does that mean you are doing the right thing? Because it can seem so small, can’t it? One small good thing, what’s the use of that, a voice in the back of your head says. And sometimes that’s the voice that wins!” He shrugged. Then again, he had the classroom before him. “But I don’t think the other voice gives in. It comes back. All the time, we have something telling us to go ahead, do the good thing. Believe in it. That’s the thing. It keeps coming back because that’s our nature, we want to do good. And that’s a kind of proof to me.”

“A proof?”

“Oh yes, definitely, because we want to do good, because, despite everything, and I mean so much evidence to the contrary, we still believe in it, that’s the proof.”   

All packed? Here’s a checklist for my readers:

Don’t leave packing till the last minute. It’s best to be prepared from 36 weeks onwards. Do things like bulk shopping and filling up the deep-freeze with ready-made meals in good time. Decide what you will wear when you come home. Put baby’s home-coming clothes into the car seat and let your partner know where these are for the Big Day.

Take Hannah’s advice. Don’t write a ‘birth plan’. Wait and see what happens.

For your labour bag you will need:

Documents: medical aid/hospital card, ID, booking forms

Comfortable pants, top, and shoes to ‘labour’ in

Toiletries e.g. face cloth, toothbrush, and toothpaste

Disposable panties

Tissues and moisture cloths

Lip balm or Vaseline

Hand cream

Hair accessories

Energy snacks and drinks

Distraction: cell phone

Nightie

Pads (if the hospital has asked for these)

Socks

Packet for your clothes to be taken home in.

 

While you’re in hospital you will need:

sanitary pads

breast pads

disposable panties

breastfeeding bra’s

toiletries for mom

disposable nappies

toiletries for baby:

Soap

Shampoo

Powder

Vaseline / bum cream

Aqueous cream

Cord care: cotton buds, surgical spirits

babygrows

vests and socks

wrapping blankets

 

Take along some things for dad:

‘Snack pack’

something to drink

reading material

camera/cell phone

 

Photograph: Aloise Ireland

 

An important message to pregnant women

 An important announcement. 

THE SOUTH AFRICAN SOCIETY OF OBSTETRICIANS AND GYNAECOLOGISTS (SASOG) CALLS ON PREGNANT AND BREASTFEEDING WOMEN TO VACCINATE

The South African Society of Obstetricians and Gynaecologists marks National Women’s Day 2021 by encouraging all women to be vaccinated against Covid-19 to protect themselves against severe disease.  This includes women who are pregnant and those who are breastfeeding.  In the case of pregnant women, SASOG recommends taking the vaccine after 14 weeks of pregnancy.

Studies show that the risk for critical illness is higher for pregnant than non-pregnant women, particularly in the 3rd trimester.  It has been found that, while most women will have no COVID-19 symptoms in pregnancy, pregnant women who experience COVID-19 symptoms have a higher risk of being admitted to ICU, needing mechanical ventilation and dying, than non-pregnant women of the same age.  Taking the vaccine also means a potential reduction in the risk of Pulmonary TB associated with Covid-19 and a reduction in the risk of passing on the virus to vulnerable members of the household. 

While there is a lack of information on pregnancies during vaccine trials, there is mounting evidence that taking the vaccine during pregnancy is safe for both mother and fetus and that the vaccine provides protection of the newborn from Covid-19.

SASOG also recommends that women who are planning to become pregnant or undergo fertility treatment should become vaccinated and need not delay conception.

“If you are uncertain about which vaccine you should take or the risks that the vaccine poses to you or your baby, we strongly advise that you consult your doctor or clinic who will be able to provide you with the most up to date and reliable information to assist you in making your decision”, concludes Dr Haynes van der Merwe, SASOG President.

Dreams and nightmares during pregnancy

 Two weeks to go – in a whirlpool of dreams

According to doctor’s estimations, Hannah’s baby weighs between 3.3 and 3.5 kgs. A good weight for a newborn. Hannah is in good health, just very tired and ‘lazy’, sleeping well but having weird, and sometimes really scary dreams.

Dreams and nightmares happen a lot during pregnancy. I remember having really weird dreams when I was pregnant. Dreams are not just a figment of the imagination. I believe dreams are manifestations of your subconscious, and when you string them out and search them for their meaning, they can be interpreted to make sense, help you solve a problem and even face your fears.

A very well-used book in my bookcase is Denise Linn’s book called ‘Signposts – The Universe is Whispering to You.’ In her introduction, Denise writes “In every moment the universe is whispering to you. There are messages for you carried on the winds. There is wisdom for you in the morning songs of the birds outside your window and in the soft murmurs of an ebbing sea. All ordinary everyday events in your life carry communications from the realm of spirit.”

Hannah shared her nightmare with me. Admitting that she is not a good swimmer, Hannah found herself swimming in a shark tank. There was a strong whirlpool and she was desperately trying to get away from the sharks. She woke up in a sweat and was very frightened.

Let’s unpack the meaning of this nightmare with the help of Signposts.

Water – “is a universal sign. It’s connected to our emotions and the mysterious realms of the archetypal female energy, representing fertility, new life, and new creative potential. Birth is associated with amniotic fluid or ‘waters’. Disturbed water can indicate chaos, but Denise writes that this ‘is not necessarily a bad sign, as sometimes it takes a huge upheaval to release old belief patterns’.” Hannah told me that during this pregnancy, she has made a conscious effort to ‘let go’ past hurts and move forward.

Shark – according to Denise, this could be a sign of hidden fear. Before a woman gives birth, it’s normal to have hidden fears of the unknown or what to expect. The sharks in her dream acknowledge Hannah’s fears

Swimming – perhaps Hannah has a hidden fear of swimming, and her dream could motivate her to go for swimming lessons in the future? Denise writes: ‘Do you feel like you are swimming against the current?’ Her advice is to ‘go with the flow and life can become fun instead of a great effort’.

In her book, Denise asks the question: ‘Do you feel that you are having trouble staying afloat amidst emotional changes?’ Her advice: ‘Relax and let the current carry you to the centre of your soul.’

 

Now that Hannah is approaching her final two weeks, she should just ‘go with the flow’ and have a bit of fun. This suits her personality perfectly!

Understanding this nightmare reveals special messages for Hannah. Dreams, even if they’re nightmarish, can carry powerful messages and help your inner soul resolve issues in a way that only you can understand.

Dealing with deep emotions before birth is very important because the connection between a mother and her newborn is profound. While overwhelming emotions of elation come about not only through endorphins (happiness hormones), birth can exhume buried traumas – from as early as a woman’s childhood or even her subconscious babyhood. Buried issues can create a barrier between a woman and her baby, inhibiting bonding. Babies can sense this distancing, and become upset to the point of fussing at the breast, not feeding or fretting when left to sleep. This is when the ‘baby blues’ could develop into post-natal depression.

The best way to overcome these issues is to have someone to talk to. Ideally, your partner, but sometimes you need a good friend you can open up to. Church groups often offer counseling and a therapist is trained to help reveal past and forgotten hurts. Talk about them and let them go so that as a new mother, you can move on and look into your future with hope, joy, and fulfillment. 

 

Symptoms of late pregnancy

 

Three weeks to go – In my little bubble

Hannah’s slowly coming to the end of her marathon. Her baby girl could start knocking to come into the world any day now. Here are the typical late pregnancy symptoms she’s experiencing:

False labour

Feeling like a lazy cat on the couch – with intermittent spurts of energy

Tight shoes – even though they’re a size bigger

Swollen ankles by the end of the day

Fingers that feel like a bunch of bananas

Porridge brain (type porridge brain into the subject block on the gadgets panel to learn more about this syndrome)

Symptoms nobody warned Hannah about:

Having to depend on her partner for just about everything – from opening a jar to getting off the couch. I remind Hannah that this is not a sign of weakness, but rather admitting that there are times when we need help. Something women find difficult to do because we’re so fiercely independent. Partners often feel left out and want to know what they can do to help.

Hannah finds that she may be hearing her partner, but she’s not listening to him. When he asks a question, she has no idea what he’s talking about!

She feels like a sloth. If anything falls on the floor, Hannah couldn’t be bothered to pick it up when she doesn’t manage to do this with her toes!

Everything is an effort – even the things Hannah once enjoyed

All her good intentions (yoga, regular exercising, eating only healthy) have gone out the window while Hannah fantasises about the things she’s going to do when her pregnancy is over.

There’s a light at the end of the tunnel – and it’s not a train coming towards her:

Hannah is realistic and knows that this difficult stage of her pregnancy WILL PASS. She sympathises with overweight people who have to deal with a bulky body for life.

Hannah has a new appreciation for her mom and respects her for what she did for herself and her sisters. “I don’t know how she did it – being a single-mom,” Hannah told me. “I don’t know how I would have managed without my partner.”

“I am looking forward to the day when I can go back to work and pick up my career where I left off. Already we are making plans to move into a bigger space where my partner can work from home. I would prefer going to an office – but we will have to wait and see what 2022 brings.”

“I am learning to trust my instincts and listen to my body.”

“Knowing the date for my c-section means I don’t have to worry about when I will go into labour.”

“I know that I must enjoy living in my ‘perfect little bubble’ for now. I don’t think I will ever have this time again.”

Must do tips:

Have your finances in order

Share chores with your partner

Ask for help

Talk to your partner about how you feel about being intimate

Discuss parenting values.  

 

 

 

 

Breastfeeding - a community effort

 World Breastfeeding Week – 1 – 7 August

Why is breastfeeding so important?

Justus von Liebig, a chemist introduced formula in 1865. Back then, the marketing tactics persuaded women that formula-feeding was superior to breast milk. Today, bottle feeding is just easier. Now that we understand the benefits of breastfeeding, both for mom and baby, especially the development of the immune system, the tide is turning, and more women are opting to breastfeed, especially during the first six months.

Sharing this responsibility.

Successful breastfeeding begins before the birth when future parents learn as much as they can about breastfeeding. Hospitals have also adopted a breastfeeding policy, using ‘The Ten Steps to Successful Breastfeeding’ guidelines, and closing the milk kitchen where formula feeds were mixed.  Nurses and midwives working in these units attend regular breastfeeding updates so that they can advise new moms on how to prevent breastfeeding problems. Lactation Consultants specialise in breastfeeding difficulties and help moms with home visits or online consultations. They’re also registered with medical aid providers.

Immediately after the birth, the baby is put skin-to-skin on the mother’s chest for what is called the ‘first magic hour. This is when the baby is most alert, the sense of smell the strongest, and when bonding between mom and baby begins. Left undisturbed, the baby instinctively nuzzles looking for the nipple. When the baby suckles, s/he gets their first taste of sweet colostrum (baby’s first milk) and mom’s breastfeeding hormones kick in.

Dealing with Covid-19:

To minimise the risk of getting Covid-19 in the hospital, when there are no complications, mom and baby are sent home after the first 24 hours. Women who have had a c-section go home on their third day. All women are encouraged to get breastfeeding help and advice from organisations like La Leche League, the Gauteng Breastfeeding Forum, their ante-natal midwife or a Lactation Consultant.

According to Professor Priya Soma-Pillay, obstetrician gynaecologist who heads the research centre for maternal, foetal and new-born child health at Pretoria University, lactating women can safely be inoculated and continue breastfeeding.

Benefits of breastfeeding:

MOM or Mother’s Own Milk is unique and perfectly formulated according to the needs of each individual baby because her milk comes from what she eats and contains invaluable antibodies to protect her baby from infections

Colostrum – or baby’s first milk – has been called ‘liquid gold’ because contains everything a newborn needs. Just one teaspoonful at each feed for the first 12 hours is enough

Colostrum has a laxative effect that helps to prevent or minimise ‘baby jaundice’

Breastmilk has unique immunological benefits – in other words, it prepares the gut to absorb nutrients while minimising the risks of developing allergies and poor gut health

Babies benefit from amino acids (proteins) only found in breastmilk. These help to feed a baby’s fast-growing brain. 

Breastfeeding can help to reduce a woman’s risks of breast cancer

Breastfeeding helps mom to burn extra calories she may have gained during pregnancy

Breastfeeding means fresh milk at the right temperature is always ‘on tap’

Night-time feeds are easier to deal with

Research has shown that breastfed babies are less likely to get asthma, allergies and colic. Breastfeeding also helps to reduce the risks of obesity and type 11 diabetes in adulthood.

 Breastfeeding is economical and more hygienic.

For more breastfeeding information, type ‘breastfeeding’ in the subject line on the gadgets page.

 

Deciding what to pack for the hospital and feeding options

 

Four weeks to go - Breastfeeding dilemma – do I, don’t I?

Hannah says her baby girl is moving like crazy – day and especially at night. I’ve heard it said that the way a baby moves in the womb is a pretty good indication of their personality. With both her parents self-confessed ‘firecrackers of ‘get up and go’, it’s not surprising that Hannah’s little one will be a bundle of energy too. Time will tell.  

Hannah has been packing her bag for the hospital. Now that she knows she will be having a c-section, there’s no need to pack a ‘labour bag’. Only the essentials for her hospital stay which shouldn’t be for longer than three nights.  Hannah’s hospital will supply a bag of essential ‘goodies’ like pads, disposable panties and nappies. She only needs to bring toiletries and pj’s, her going-home clothes, sleep-suits and blankets for her baby. Her dilemma is: what does she pack for feeding?

If Hannah chooses to breastfeed, she will need feeding bra’s, disposable breast pads, possibly nipple cream and a cabbage in the fridge at home (in case her breasts are uncomfortably full on her third day when she comes home from the hospital).

Her paediatrician has recommended formula feeding (Hannah is HIV positive, taking ARV’s and has an undetectable viral load – which means that there’s a possibility she could breastfeed providing her viral load stays undetectable). If Hannah chooses to formula feed, she needs to bring formula, bottles, teats and all the necessary feeding and sterilising paraphernalia. This is because maternity hospitals no longer have a ‘milk kitchen’ for formula-fed babies. This is because all women are encouraged to breastfeed.

This is a toughie for women like Hannah. In the first place, not every woman WANTS to breastfeed and women should ENJOY their babies and not feel OBLIGED to breastfeed. An example of women who can’t breastfeed is those who have had a breast reduction – especially if the nipple was removed and reattached. Similarly, depending on the type of surgery, women who have had a breast enlargement or treatment for cancer such as a partial mastectomy or reconstructive surgery. There are also medical reasons, such as severe type 1 diabetes, certain auto-immune diseases or conditions requiring chronic medication like epilepsy.

Weighing up the pros and cons:

Hannah worries that if she doesn’t breastfeed, she will miss out on ‘bonding’, and the convenience of having milk ‘on tap’ – especially at night when she can simply lift her baby from the crib, and latch her. MOM (Mother’s Own Milk) is custom made for each individual baby which means not having to stress about which formula to use. Another bonus is that breastmilk changes according to the baby’s needs. (To learn more about breastfeeding, simply type the word breastfeeding into the subject line on the blog dashboard)

On the other hand, if Hannah chooses to formula feed, her partner, mom or sister can feed her baby – a satisfying and bonding experience for them. Formula feeding means that you don’t need to ‘wear your baby everywhere you go. Breastfeeding in public is still taboo – especially in restaurants where the strongest objectors are men. Formula-fed babies adapt more easily to a routine, and moms are spared discomforts like engorged breasts, cracked nipples or a hungry baby when the milk supply is low.

This is Hannah’s choice. My only advice for her (and all other women facing this dilemma) is: trust your instincts. This maternal instinct is a gift of motherhood. Learning to trust your instincts is the first and most important lesson you’ll learn. It comes naturally. Do you remember what happened 9 months ago? You realised that something was different – and instinctively asked ‘Am I be pregnant?’

Breastfeeding and Covid-19:

According to Professor Priya Sama-Pillay, head of obstetrics and Gynaecology and the Research Centre on Maternal, foetal and new-born and child health, Pretoria University, pregnant women should be vaccinated (preferably at or after 14 weeks), breastfeeding women can be safely vaccinated and shouldn’t stop breastfeeding.

Women who contract Covid-19 and are infectious can continue breastfeeding, but should be extra cautious – wearing a mask and sanitising. If she is unwell, she can express her milk, (this is safe to feed to her baby) taking all the necessary precautions to prevent contamination.

Photograph: Aloise Ireland

  

Physical and emotional changes in the third trimester

Five weeks to go. Hannah’s calling herself: ‘Fatty sitting on the sofa’

It’s been a week filled with fear and anxiety for all South Africans. Hannah* too. In fact, she’s been ‘down the rabbit hole’ of despair, calling it an ‘overwhelming week’.

Why has this happened?

Prolonged Covid isolation

Feeling hopeless and helpless in light of the country’s carnage

Feeling guilty that she is safe while others are in danger

Wondering what kind of world she is bringing their child into?

Asking herself: Will I be a good mom? And …

Will I ever be ‘me’ again?

I love Hannah’s honesty. She’s not covering up this stage of her pregnancy in a bubble of maternal bliss. Coming from a marketing background, Hannah knows all about unrealistic ‘window dressing’, social media platforms that make pregnancy look like a breeze, glossy magazines with gorgeous models and photoshopped pictures depicting pregnancy and motherhood as heavenly bliss.

What’s happening to Hannah – and all pregnant women at this stage:

Pregnancy brings about both physical and emotional changes. During the first trimester, a woman’s thoughts are self-centered: ‘I’m pregnant'. In the second trimester, especially once she feels her baby move, her thoughts are ‘I’m having a baby'. In the last trimester, she realises, ‘I’m going to be a mom’. It's scary!

Hannah, a self-confessed ‘fashion queen’, socialite and people’s person who loves giving spur-of-the-moment dinner parties, enjoying a glass of wine or two with her girlfriends, relishing freedom and independence, is already mourning the loss of her ‘old self’ and has begun the journey of rediscovering who she is.

The pressure of deadlines and putting out fires in the chaos of the marketing world kept Hannah on her toes. The adrenaline rush gave her energy, and the success of pulling off yet another project gave her a sense of achievement. Now she’s is struggling to come to terms with losing her job, the loss of income, and finding a new job in the New Year.  

Covid restrictions have put just about everybody under house arrest. This means no more browsing malls and spending time in a coffee shop or book store. All we can do is wear a mask, arm ourselves with a sanitizer, avoid other shoppers, buy what we need and hurry home.

And then there are the physical changes of pregnancy. Hannah says she’s feeling ‘fat’ but she is just full of her baby, placenta, and amniotic fluid. Now her belly is getting in the way of her mobility, and simple things like getting in and out of bed, or off the sofa, are getting more and more difficult.

Many women struggle with mood swings that Hannah has managed (so far) to avoid. Feeling happy one minute, then bursting into tears the next, is common and confusing during pregnancy.

How is Hannah coping?

“Being able to talk to my mom is a big help,” Hannah told me. Her sister, who has a young baby, is on ‘speed dial’. Hannah is also attending online prenatal classes and benefitting from good advice from her midwife.

We discussed what Hannah has achieved so far: the nursery is ready, Hannah’s health is good, the date of her c-section has been set and her paperwork is in order (search ‘paperwork’ on the gadgets column for this post).

Now Hannah needs to fill her days with something constructive and creative, with an activity that’s easy and practical to do (the link to ’44 life-giving hobbies for tired moms’ is also on the gadgets column). Hannah has done a few color-in pictures, and painting. This week she is going to try hand-crafts like knitting. It’s relaxing, constructive, enjoyable, and easy to do.       

* We’re sharing Hannah’s journey through the last few weeks of her pregnancy. If you missed the first blog, check out last week’s post.

 

 

Following Hannah's pregnancy

 This is happening – six weeks to go!

Welcome, Hannah* - 33 weeks pregnant with her first baby, age 36, HIV positive with a positive attitude in life. This special lady is going to share the last leg of her pregnancy with us.

When Hannah was diagnosed with the Human Immuno-Deficient Virus (HIV) 15 years ago, she thought that getting pregnant “would never happen to me”. She was overwhelmed with the stigma attached to this viral infection. At the time she thought HIV would rob her of a “normal life”. “This pregnancy has shown my partner and I that we’re as normal as any other couple,” Hannah said in an interview.

The road to this point hasn’t been easy. When Hannah tested positive, she started anti-retroviral treatment. By sticking to a rigorous medication regime and healthy habits, like eating healthy and exercising regularly, Hannah focused on her career and living positively. Her persistence, patience and perseverance over the last ten years has resulted in an undetectable viral load and a healthy CD4 count.

Cape Town based HIV clinician; Dr Laurence confirmed in a medical webinar that modern ARV’s have changed the lives of people living with HIV. “Having an undetectable viral load reduces the risk of transmission by up to 96%”, he said. Although neither a cure nor a vaccine has been found, ongoing research in the field of gene therapy and injectable ARV’s is promising. Research for an HIV vaccine helped to develop the Covid-19 vaccine.    

To date, Hanna’s pregnancy – apart from setbacks like Covid restrictions and retrenchment – has gone smoothly. “Now that I’m not working, I’ve been able to escape corporate stress, spend time at home with family and look after my health,” she said.

Understanding viruses like HIV and Covid-19:

A virus on its own is weak. It cannot move, jump, slip, slide, grow or multiply. It’s absolutely helpless and, unlike a bacteria or fungus, without a host, it simply dies. BUT, once it gets into a host (human or animal) through the nose and mouth (as with Covid) or body fluids (HIV), it’s super powerful. This sneaky virus latches onto immune white cells (CD4) where it changes DNA into its own RNA, enabling it to multiply. The result is an increased viral load that damages the immune system (low CD4 count). Taking ARV’s helps to stop the multiplication of the virus and keep it under control. Providing a person living with HIV is taking their medicines regularly and without a break, the viral load can be kept low, even ‘undetectable’.

‘Let’s be real’ decisions:

Now that Hannah has only six weeks to go, it’s time to face the reality of giving birth. Her gynaecologist said that, although it is possible to have a vaginal birth with HIV, in Hanna’s circumstances, it will be best if her baby girl, is delivered by c-section. Luckily, Hannah did not have her heart set on a ‘birth plan’, preferring to put her trust in the decisions made by her specialists. A booked c-section can help to eliminate risks like prolonged labour, haemorrhaging, exposure to Covid and interfering with Hanna’s healthy immune system.

Hannah’s paediatrician has also recommended formula feeding.

“I don’t want to have to feel guilty or explain to people why I have been booked for a c-section, or why we will be stocking up on formula,” Hannah said. “Everybody’s circumstances are different, and I trust my health-care providers who only want to the best for me and my baby girl.”

Right now, Hannah is enjoying good health, admittedly skipping yoga and spending more time on the couch than she intended, enjoying feeling her baby-girl move within her belly, and looking forward to the day when her carefully prepared nursery will be home to a very special little girl just waiting to make her grand entrance! 

*Not her real name.

Pregnancy niggles - constipation

 

Things we don’t talk about when we’re pregnant

Burping, breaking wind and constipation are just a few ‘unmentionables’ pregnant women don’t like talking about. Seemingly a minor issue, they’re never-the-less problematic, not to say embarrassing. Hormones, pressure, nausea and the lack of exercise usually trigger these problems.

Causes of constipation:

During pregnancy, progesterone tends to make the bowel sluggish. This delays the progress of food through the gut, maximising nutritional absorption. On the downside, this delay tends to reabsorb water and dry-out stools, making them hard and difficult to pass.  

Ongoing constipation often begins with bad bowel habits – like over-using laxatives, delaying the ‘call of nature’, not drinking enough water, a bland diet and not getting enough exercise.

Irritable bowel syndrome (IBS) with bloating, passing wind, constipation and diarrhoea is more common than we realise. This is mostly caused by today’s sedentary lifestyle, stress overloaded (no doubt exaggerated by Covid-19) and not eating enough raw fruit and vegetables.

Medical problems like diabetes or an underactive thyroid gland and depression tend to exaggerate constipation. More serious conditions like a damaged spinal cord, multiple sclerosis and Lupus Sjögren’s all cause chronic constipation. This means they won’t go away, and you’ll need to find ways to cope with this problem.

Chronic constipation is something you should talk to your doctor about because it could have more serious implications.

Supplementary Iron (folic acid) is prescribed during pregnancy. It should be taken with a glass of water to prevent constipation. Molasses is a good substitute because it’s rich in iron and doesn’t aggravate constipation problems. Other medications to avoid are codeine and calcium-based antacids. Some women have weird cravings. Called pica, nibbling on clay, chalk, laundry starch, toothpaste and even sand is not good for the gut.   

Fruit can help. Bananas, however, because they contain pectin, can either aggravate or relieve constipation.

Women confined to bedrest miss out on exercise. Fortunately, this is rare and most women can carry on with their regular exercise routine throughout pregnancy.  

What happens when you’re constipated?

Constipation can make you feel very uncomfortable – especially when your baby is taking up most of your tummy space. You could get haemorrhoids (piles) – best dealt with by using creams like Preparation-H. Passing big, bulky stools could split or tear the anus. This is evident when fresh blood is seen after wiping.  

What can you do about it?

Treatment depends on the cause. In mild cases, a change of diet, exercise and increasing fluid intake solves the problem. A mild laxative such as milk of magnesia can help. Glycerine suppositories help to soften hard-to-budge stools.

Bowel-training means getting into the habit of emptying your bowel regularly – not necessarily daily, but at least 3 – 4 times a week.

A prescribed laxative should contain natural ingredients. Ask your pharmacist or doctor. Don’t self-medicate.  Laxatives that contain fibre or softeners make stools easier to pass. Some laxatives draw water from the bowel or stimulates peristalsis. These are not recommended during pregnancy. It’s best to use herbal or natural laxatives – excluding Senna – during pregnancy.   

     

 

When you're struggling to breathe and you're pregnant

Why do I get breathless, and why do I have sore ribs when I’m pregnant?

In today’s world of Covid, we’ve all become anxious about feeling breathless – especially pregnant women who need 14% more Oxygen because they’re breathing for two. Painful ‘ribs’ are mostly caused by the softening of the intercostal muscles between the ribs. These muscles help you to breathe and are softened by progesterone. This helps to increase breathing capacity.

Oestrogen makes the rib-cage cartilage softer and more ‘elastic’. This can cause painful ribs. The pain may be worse at night when you’re lying down, or when exercising. Relax. It will come to an end after your baby is born.  

Breathing problems aren’t necessarily Covid-19 – unless of course, you’ve tested positive for the virus. Breathlessness can be caused by pre-existing breathing conditions such as asthma, TB, pneumonia, chronic bronchitis, or emphysema. Your doctor should know about these, and treatment shouldn’t be interrupted by pregnancy.

If you’re feeling breathless with mild exercise, this could be an undiagnosed ‘heart murmur’ that surfaces during pregnancy. This happens when extra circulating blood overloads the heart muscle. You should get this checked by your doctor.

Life-style i.e., lack of exercise, smoking, over-weight can lead to breathing problems (even when you’re not pregnant). Now is the time to get healthy – you’ll be pleased you did when you go into labour, and recover from the birth.   

Stress is a biggie when it comes to breathing problems (especially when wearing a cloth face mask over your face), as is over-exercising when you’re not fit. In the last few months when the top of your womb feels as though it’s under your chin, breathing can feel laborious – especially for short women. When your baby’s head ‘drops’ into the basin of your pelvis, breathing will become easier.

In the meantime:

• Focus on your posture
• Wear comfortable, flat shoes
• Join a yoga class and learn to focus on breathing exercises – these will come in useful when you’re in labour

If you’re struggling with a ‘blocked-nose syndrome’ – called pregnancy rhinitis – it feels as though you have a permanent cold. To ease this discomfort, breathe in steam water (even better, dissolve 1 tsp Vicks VapoRub into this boiled water). Ask your pharmacist to recommend a saline nasal spray. This too will pass once your baby is born.

Breathing exercises:

• Start breathing exercises early in your pregnancy. Find a quiet place where you won’t be disturbed and sit comfortably for a few moments, focusing on the rhythm of your breathing. Allow your body to relax. Drop your shoulders, relax the muscles of your face and melt away the tension in your muscles
• Breathe in through your nose and out through your mouth. Spend some time breathing this way listening to the rhythm of your breathing, feeling your chest rising as you breathe in and dropping when you breathe out.
• Now breathe normally again, and notice how you use different muscles – including abdominal muscles.
• Practice this often – especially when you’re stressed.

 

 

 

 

Bladder health is as important as heart health

MAY IS BLADDER CANCER AWARENESS MONTH

“Blood in your pee? – see your GP”

Going to the loo is an everyday thing we take for granted – until …… your pee burns, or dribbles, or won’t come, smells funny or looks different.

Dr Kalli Spencer, a urologist in Australia, sent me the following information I’d like to share with you.

“Bladder Cancer is around more than we realise.  Although it affects mostly men over the age of 60, oncologists are finding that younger women are contracting the disease. Like many cancers, bladder cancer takes various forms from low grade to high grade/invasive, the latter becoming serious once it grows through the bladder wall. Like many other cancers, bladder cancer may be effectively treated if diagnosed early. Unfortunately, bladder cancer can be misdiagnosed as a urinary tract infection (UTI), so look out for other early warning signs such as blood in the urine, irregularity or pain when urinating. 

“How Covid has affected bladder cancer patients.  During covid, there has been a 30+% drop in cancer referrals simply because people are apprehensive about going to the doctor or hospital, and so they’re ignoring symptoms. This puts them at a bigger risk because this could lead to a surge in advanced stage cancers when people do finally pluck up the courage to get medical help.”

My late Father-in-Law started passing blood in his urine one Christmas morning. It was not until the New Year that he could see a doctor (being Christmas and all), but when he did, it was found that he was already in the advanced stages of cancer. His bladder was removed and he was fitted with a bag. He lived for another year.

Please share this information with friends and family - especially men (you know how they are when it comes to doctors).

More interesting bladder facts:

Urine is usually slightly acidic – this makes it slightly antiseptic – which helps to kill bacteria and prevent infections. Vegetarians, because of the alkaline salts found in vegetables, have more alkaline urine which may predispose them to infections. Vegetarians need to take the necessary precautions e.g. toilet hygiene, drinking lots of water, and emptying the bladder when you feel the urge. The average daily output is about 1,500mls.

Passing more urine than normal (especially at night) can be a sign of Diabetes, and passing small, frequent amounts could be caused by the pressure of an enlarged prostate gland, a tumour, kidney stones or an infection (UTI’s don’t always cause a burning sensation).

Passing less urine than normal can be a symptom of kidney disease, heart failure or the result of a fever. Difficulty passing urine can be caused by a stricture or damage e.g. to the spine, to the urethra or bladder after childbirth, surgery for piles (haemorrhoids) or pressure from a tumour. Anuria means not passing urine at all. This is serious and needs urgent medical attention.

Bladder health is as important as heart health. Don’t think of going to the loo as an inconvenience, think of it as an opportunity to give your bladder a few minutes of attention.

  

 

 

 

Getting ready for baby - paperwork

Getting organised for baby

Paperwork. Don’t you just hate it? Contracts, certificates, statements, invoices. The list goes on forever. I’m sure its happened to you when you literally turn your house inside-out looking for that elusive document to prove your registration, qualification, payment, etc and you would give your eye-tooth to find it.

My dear mom was a stickler for being organised, for neatness and tidiness. She taught me these skills because they don’t come naturally to me. I’m a great believer in comfort with everything that I need surrounding me in heaps and bundles – which means that things tend to get a tad untidy. My Ouma used to say: “Don’t put it down, put it away.”

What’s this got to do with you and expecting a baby? A lot really. You’re at the beginning of this journey, so let’s get you organised from the beginning. It may happen one day that your child asks for her birth certificate and you know exactly where to find it. You'll thank me then. 

Take a trip to your favourite stationery store and get yourself a plastic file with individual sleeves. Mark these into different categories e.g., certificates, leases, statements, banking, contracts. Now your new addition. Baby.

You can start filing medical details like test results, ante-natal records, invoices and receipts, bookings, scans, medical-aid application forms and maternity leave details. Hold onto these records because they can be very useful – even when your child is an adult. S/he may need a detailed medical history – beginning with your pregnancy – for a medical condition one day.

Once your baby is here, paperwork descends like confetti. Now it’s registration, immunisation records, growth charts, and medical records detailing the birth from your first contraction to the time of birth and baby’s APGAR score. Initially, you may want to record the time and length of every feed, baby’s daily weight, and sleep schedule – but as you become familiar with your baby’s needs and daily routine, the need to monitor these will fade.

Your baby’s “Road to Health Card” is a very important document, and you will need it to register your child for school one day. Not only does this card record your baby’s health and milestones during the first five years of life, it also records illnesses and essential immunisations that will keep your baby safe when mixing with other children in the community. Who knows, by the time your child goes to school, the Covid vaccine may be standard practice.

If you’ve ever had to deal with your parent's estate, you will realise the pyramid of paperwork involved, and how important it is to have ID, marriage and death certificates filed and marked to wind up the estate. You’ll be doing your child a favour by keeping this paperwork in an accessible file because ... in life, there are no guarantees and nobody can tell you what tomorrow will bring.