Articles about Informed Decision Making

Caesarean sections should only be performed when medically necessary

A News release in April 2015 by the World Health Organisation said that caesarean section is one of the most common surgeries in the world, with rates continuing to rise, particularly in high- and middle-income countries. Although it can save lives, caesarean section is often performed without medical need, putting women and their babies at-risk of short- and long-term health problems. Caesarean section may be necessary when vaginal delivery might pose a risk to the mother or baby – for example due to prolonged labour, foetal distress, or because the baby is presenting in an abnormal position. However, caesarean sections can cause significant complications, disability or death.

Ideal rate for caesarean sections

Since 1985, the international healthcare community has considered the “ideal rate” for caesarean sections to be between 10% and 15%. New studies reveal that when caesarean section rates rise towards 10% across a population, the number of maternal and newborn deaths decreases. But when the rate goes above 10%, there is no evidence that mortality rates improve. In other words there is no benefit to mom or baby if the caesarean rates are above 10%. Within the private sector in South Africa, the caesar rate stands at over 70% with some gynaes caesar rates well into the 90%.

The following information is from http://www.childbirthconnection.org/giving-birth/c-section/research-evidence/ showing exactly what the researched evidence says about caesarean sections. Visit their website to view the actual research reviews.

 Is vaginal birth or caesarean safer?

Vaginal birth is much safer than a caesar for most women and babies. But sometimes a caesar is the only safe option, like when the baby is positioned side-to-side in the uterus (transverse lie) or the placenta is covering the cervix (placenta previa). In other situations, having a caesar might possibly have benefits, which need to be weighed against possible harms. You have the right to know these possible harms and benefits, and only you can decide how important they are to you.

When a caesarean is truly needed, its benefits likely outweigh possible downsides. However, without a clear medical reason for caesarean birth, vaginal birth is likely to be the far safer path for both you and your baby. This page summarises results of systematic reviews comparing outcomes of caesarean and vaginal birth. We look at shorter- and longer-term outcomes in women, caesarean-born babies and babies in future pregnancies that develop in a scarred uterus. This page also reports on studies that point to problems that only occur with one or the other type of birth.

 What are the possible outcomes of caesars for women?

Systematic reviews have found that women with caesareans are more likely than women with vaginal birth to experience:

  • Impaired physical health for at least the first two months after birth
  • Emergency surgery to remove their uterus (hysterectomy)
  •  Not establishing breastfeeding, which benefits both women and babies; this especially occurs when caesareans are scheduled before labour.

In the long term, systematic reviews have found that women who have given birth by caesarean are more likely than those with vaginal births to experience:

  • Difficulty becoming pregnant, leading to a lower pregnancy rate
  • Difficulty remaining pregnant, leading to a lower birth rate
  • A desire to wait longer before becoming pregnant again
  • Ongoing pain in the pelvis area

 What are the possible benefits and harms of having a vaginal birth?

Even though labour and vaginal birth can be hard work, they are generally easier on a woman’s body than a caesar. Recovery after vaginal birth is usually shorter and less painful than after a caesar, and allows the woman to spend more time with her baby.

New research is discovering ways that labour and vaginal birth are good for babies, too. The hormones that cause labour to start and progress actually help the baby get ready to be born and reduce the chance of breathing difficulties and other problems. These hormones help prepare mother and baby for a safe transition at the time of birth, and help them feel close and connected and get breastfeeding off to a good start.

Babies born vaginally also have lower rates of some serious childhood diseases like asthma, Type 1 diabetes and allergies, and are less likely to become obese. Researchers think these benefits have to do with healthy bacteria babies are exposed to during vaginal birth.

Other benefits include avoiding complications that can occur with major surgery like a caesar

The following complications can happen with vaginal birth, but do not happen with caesarean birth:

  • Injury to the vulva or vagina, with possible pain and infection (genital trauma)
  • A tear or intentional cut (episiotomy) from the opening of the vagina toward the anus, with possible pain and infection (perineal trauma)

 What are the possible risks to my baby associated with caesareans?

Systematic reviews have found that caesarean-born babies are more likely than vaginally-born babies to experience:

  • Not establishing breastfeeding; this especially occurs when caesars are scheduled before labour
  • Increased risk of breathing problems
  • Less blood flowing from the placenta to the baby at birth and less iron
  • Systematic reviews have found that being born by caesarean rather than vaginally is associated with greater likelihood of developing several chronic diseases, including:
    • Childhood-onset (Type 1) diabetes
    • Childhood obesity
    • Autism spectrum disorder
    • Chronic inflammatory bowel disease with abdominal pain, diarrhoea, weight loss, anaemia and fatigue (Crohn’s disease)
    • Asthma
    • Food sensitivities and allergies
    • Hay fever

 What are possible effects of a caesarean on my future pregnancies and births?

Women with pregnancies after previous caesarean are more likely than those without previous caesar to experience:

  • Splitting open of the scar in the uterus (uterine rupture)
  • Emergency surgery to remove the uterus (hysterectomy)
  • Serious condition of the placenta covering the opening of the cervix (placenta praevia)
  • Serious condition of the placenta growing into the wall of the uterus (placenta accreta)
  • Serious condition of the placenta separating from the wall of the uterus before the birth (placental abruption)
  • A stillborn

A systematic review found that risk of the following complications associated with caesarean increases with each additional caesar:

  • Measures of serious maternal health problems (severe morbidity)
  • Emergency surgery to remove the uterus (hysterectomy)
  • Serious condition of the placenta covering the opening of the cervix (placenta praevia)
  • Serious condition of the placenta growing into the wall of the uterus (placenta accreta)
  • Excessive blood loss (haemorrhage)
  • Blood given through IV line (blood transfusion)
  • Scars that cause organs to bind together and may lead to pain and other problems (adhesions)
  • Surgical injury

A systematic review suggests why these conditions are “serious.” The review found that placenta praevia, when the placenta covers the opening of the uterus, is associated with increased risk of:

  • Preterm birth
  • Admission to neonatal intensive care unit (NICU)
  • Newborn death (in the 28 days after birth)
  • Perinatal death (combined late pregnancy and early postpartum death)

Even if you do not plan to have more babies, it is important to know about these risks because many women change their minds or have unplanned pregnancies.

 Does caesarean protect against sexual, bowel and urinary problems?

The best available research has found no difference between women with vaginal and caesarean birth for:

  • Anal incontinence (leakage of stool or gas)
  • Urge urinary incontinence (leakage of urine with a sense of “got to go”)
  • Any severe urine leakage

However, in the short and long term, best research finds that women with vaginal birth are more likely to experience stress urinary incontinence (leakage with exertion). Current studies cannot clarify whether this is due to vaginal birth itself or to practices that are common with vaginal birth. Concerning practices include:

  • Lying on your back or with legs in stirrups when pushing and giving birth (women with epidurals)
  • Assisted vaginal birth (with vacuum or forceps)
  • Common interventions that increase the likelihood of assisted vaginal birth (epidural analgesia, continuous electronic foetal monitoring)
  • Staff pushing on your upper abdomen to move the baby out (fundal pressure)
  • Episiotomy (a cut just before birth to enlarge the opening of the vagina)

It would be wise to avoid these practices when possible and to follow other practices (such as having a healthy weight and not smoking) that help avoid problems in your pelvic floor.

For more in-depth information go to

http://www.childbirthconnection.org/giving-birth/c-section/research-evidence/

With regular vaccinations, baby weigh-ins, the sleepless nights and constant feedings, mums the world over would agree that they have enough on their plate. However, many South African parents remain unaware of thyroid disease and its impact on their little one.

An under-functioning thyroid gland (hypothyroidism), is a condition that can affect new born babies, and if undetected and left untreated, it can impact your child’s development with varying degrees of severity. Below is some insight on thyroid disease from Merck, the global pharmaceutical company headquartered in Germany.

Why is the thyroid gland important?
It may be just a small, butterfly-shaped gland in your neck, but the thyroid gland produces hormones that are essential to the body’s metabolism. It is important for the physical growth, maturation of the central nervous system and skeleton.

What causes hypothyroidism in babies?
There are many causes of hypothyroidism, the most relevant being congenital hypothyroidism, i.e. when an infant is born without a thyroid gland or if the gland cannot manufacture the thyroid hormone for a number of reasons. In areas with iodine deficiency, infants may also be prone to hypothyroidism. Since 1995, table salt has been iodized in South Africa, to combat hypothyroidism due to iodine deficiency.

In addition, if a mother suffers from thyroid disease during pregnancy, this may impact her unborn foetus and the newborn baby. Therefore it is important that a foetal ultrasonography is performed and the newborn baby is evaluated by a paediatrician.

What are the symptoms?
Undiagnosed babies affected with hypothyroidism show a variety of symptoms, including decreased activity, a large fontanelle, poor feeding and low weight gain, small stature or poor growth, delayed developmental milestones, jaundice, constipation, and a hoarse cry. The features are generally not present at birth and only develop after the first few weeks of life. Quite often, affected babies are initially viewed as ‘good’ infants, because they cry little (as they are inactive) and sleep a lot.

Affected newborns look totally normal at birth. The physical signs only develop gradually by which time the child’s development is irreversibly affected. Obvious physical signs are often missed as they are very subtle. These include coarse facial features, a big tongue, an umbilical hernia (when part of the intestine protrudes through the umbilical opening), mottled skin that is cool and dry, and anaemia.

“Testing for hypothyroidism in infants is as simple as a heel-prick test usually after 2 to 3 days of age,” says Dr Kiran Parbhoo, paediatric endocrinologist at the Chris Hani Baragwanath Academic Hospital. “The test is quick and simple, and yields results quickly, equipping doctors and supporting healthcare professionals to intervene early by setting up a treatment regime.” An alternative to heel prick testing is the testing of cord blood at birth. The advantage of heel prick testing however, is that it may be possible to screen for other inborn errors (as is the case in many developed countries). Detecting and managing inborn errors is cost effective as the treatment of these conditions is expensive if the condition is diagnosed later in life.

The risk of non-treatment
Failure to diagnose and treat hypothyroidism in an infant could lead to growth problems, heart problems, and if left untreated, severe intellectual disability.

Babies with congenital hypothyroidism on newborn screening programmes can be treated by simply administering thyroxine, which is delivered via crushed tablets included in breast milk or formula in infants, or swallowed by children as they grow older. By screening and treating congenital hypothyroidism one can prevent mental retardation.

Newborn screening for congenital hypothyroidism has been practised in the USA and most developed nations for the past fifty years. The United Nations has advocated for children to enjoy the highest standard of health in the Rights of the Child. In this context, screening for congenital hypothyroidism is being and should be more widely adopted.

By CAPFSA (Child accident prevention foundation of SA)

 

From the beginning of a child’s life, products intended for a child must be selected with safety in mind. A safe surrounding for nursery furniture is just as important as the safe design of the furniture itself. A safe environment and safe nursery furniture are a good start to protecting your baby.

Cots

Babies and small children spend a lot of time in cots, therefore it is important to choose a cot that is safe

Safety checklist and design :

Dropsides :

Fastening devices for the cot’s dropsides should be at least 850mm apart to prevent a child from lowering a side unaided

With the dropside lowered the depth of cot should be at least 250mm

Wheels :

If castors are fitted they should be fitted only on two legs; or if fitted on all legs at least two should be capable of being locked.

Bars :

Apertures should not be smaller than 68mm or larger than 70mm. This will prevent the child from injuring himself by inserting his head or limbs through gaps between vertical rails

No horizontal openings, slots or rails which could provide a foothold for a child to climb out of the cot, should be included in the design

Materials :

All metal parts within reach of a child should be corrosion resistant or be adequately protected against corrosion

Safe use :

  • Place cot away from windows, heaters and power points
  • Avoid having small objects and food and drink in the cot which could cause choking
  • The cot mattress should fit snugly with no more than two fingers width between the edge of the mattress and the cot side

Warning :

Most injuries with cots happen from unsafe design features and incorrect use of cots

Injuries occur from :

  • cords or strings in or near cot (strangulation)
  • clothing pulling tight on protruding part of the cot
  • child’s head becoming trapped
  • falling from the cot when the child attempts to climb out

Highchairs

You will want a chair for your baby so that he can sit and join the family meals. They are normally used for children between six months and three years

Safety checklist and design

  • If chair is collapsible, the design should be such that the child’s weight would keep the chair open
  • Movement by a child in the seat should not make the chair tilt over
  • The vertical distance between the seat and top of the backrest should be more than 350mm
  • There should be no holes, openings or parts which could trap the child’s finger or flesh
  • Chairs should be fitted with restraining devices or straps. Crotch straps if fitted, should be at least 5mm wide

Safe use

  • The child must be supervised when in a high chair
  • Always fasten the restraining devices
  • Make sure there is no foam exposed by splits in the chair’s seat or back which a child could chew or pull out and cause choking
  • Do not allow a child to stand in the chair
  • Place the high chair in a safe position and use a safe level surface

Warning

The most serious accidents with high chairs happen when children fall out because they are not strapped in or not supervised

Bath Seats

A bath seat will give your child added support while in the bath, but it will not protect him from injury or drowning

Safe use

  • Collect all bathing materials before bringing baby into the bathroom
  • Never use a bath seat on textured or non-skid surfaces unless the manufacturer’s instructions specifically state that the seat is intended for such surfaces
  • Place the seat in the bath so baby cannot reach the taps or spout
  • Bath rings should be used with children who are capable of sitting upright unassisted

Gates and enclosures

When your baby can crawl, it’s time to block doorways and stairways with gates. Always follow the manufacturer’s instructions for installation and use

Safe use

  • Gates with expanding pressure bars should be installed with the bar side away from baby
  • Anchor the safety gate securely in the doorway or stairway
  • Always close the gate when you leave the room and never leave baby unattended

Prams and Strollers

Babies and children spend a lot of time in prams, it is therefore important to choose one that is comfortable and safe

Safety checklist and design

  • Make sure that the brakes, safety catches and child restraint work properly
  • Check for sharp edges and points
  • Should be stable and not tip over easily
  • A folding pram should have two separate locking devices. Make sure locking devices engage automatically so that it cannot unfold suddenly
  • Prams should have safety harnesses – a 5 point harness is recommended
  • One-hand fold strollers should have a second fold lock to prevent stroller collapsing with a child inside by accident

Safe use

  • Children must be supervised at all times
  • Do not overload pram
  • Avoid hanging shopping bags over handles

Warning : injuries occur when

  • design is unsafe
  • incorrectly used
  • children fall from pram when not strapped in properly
  • pram tips over when overloaded
  • pram collapses when not locked in correctly
  • pram is operated by another child

Changing tables

Safety checklist and design

  • Make sure that units are stable when drawers and cupboards are both open and closed
  • Should have a strap to help keep the child in place
  • Sides should be raised / sloped to prevent the child from rolling from the table

Safe use

  • Always stay with baby when using unit
  • Make sure you can reach everything you need without leaving baby – have nappy, wipes etc. close at hand
  • Never turn your back on baby when reaching for baby products

Warning

  • Most accidents at changing time happen when the child falls off the unit or raised surface

Pregnancy is often a time during which a great deal of care is taken to ensure that the health of the developing child is fully considered. Most expectant mothers stop drinking alcohol (or smoking), look at optimum supplementation and spend more time reading the labels on the products that they eat or drink. However, many mothers unknowingly expose their unborn children to potential risks from the everyday chemical burden placed on their bodies through the use of various personal care products.

The average woman uses 12 personal care products daily, exposing herself and her baby to approximately 168 chemicals. Once born, babies are directly exposed to these chemicals through the various creams, lotions and washes applied to their bodies. Not all of these chemicals are safe. In fact, many have been shown to have a range of very negative health and wellbeing consequences.

As many as one in eight ingredients used in personal care products are industrial chemicals which have been identified as potentially harmful. Many of these chemicals have shown links to hormone disruption, infertility, a weakened immune system and cancer. Other more common effects are allergies such as asthma and eczema, enzyme dysfunction and altered metabolism. We need to examine the total daily chemical burden our modern lifestyles place on our own and our children’s bodies, and raise questions about possible links to the increase in conditions such as autism, infertility, breast cancer and the ever increasing levels of asthma and eczema.

Children at higher risk

Protection from exposure to harsh toxins and chemicals is even more important for children than it is for adults. A child’s immune and detoxifying systems are still very immature and neurologically they are still developing. In addition to this, a baby’s skin is not as thick as an adult’s and children don’t start producing an acid mantle until around the age of seven. This means that they are much more sensitive and vulnerable to irritants than we are.

Very little regulation

The cosmetic industry in South Africa is generally very poorly regulated and there is virtually no control over the ingredients that end up in the products we use. One of the main reasons there aren’t tighter regulations in place is because the effects of these toxins are often not immediate but cumulative, and it is very difficult to clearly link exposure to a specific product or ingredient with a certain health risk. In addition, we are exposed to so many different factors on a daily basis, that certain diseases and conditions are unlikely to be attributed to one particular chemical through one particular means, but more likely to an accumulation of various lifestyle exposures from our food, air, water and other factors.

Many studies which support the safety of these chemicals, focus on the low dosages used in products, but fail to take into consideration our entire environmental exposure to toxins, the number of products we use daily and the frequency with which we use them. Over time, these low doses add up. As an example, in cases such as obesity or low sperm count in adults, it is unlikely that research will find or provide a direct causal link to childhood exposure, since the research would be required to span at least two decades.

How can this be allowed?

There are no clear legal standards in South Africa around the use of chemicals in cosmetics. The industry is self-regulated. In addition, studies on safety are looked at in isolation and don’t account for the cumulative effect of using various products with a wide range of chemicals on the body. Companies are also reluctant to change when there is loyalty to certain products. If companies are not legally required to change and there is no consumer pressure to do so, then they certainly won’t.

Change can happen

The plastics industry changed rapidly once consumers started demanding BPA free materials. The smoking industry also changed once customers became aware of the real health risks they were exposing themselves to. This industry can change too. Consumers need to be more aware and more informed and demand safer products which are free of harmful chemicals.

How do you take action?

Know the ingredients to avoid and always read product labels. Stay away from phthalates, parabens, synthetic fragrances (which can “hide” certain chemicals), triclosan, sodium lauryl sulphate, aluminium, DEA, MEA, TEA and 1,4-dioxane. If you are in doubt, find out more about an ingredient on independent platforms such as www.safecosmetics.org. The easiest way to protect yourself is to choose products which have been certified by an independent natural or organic certification organisation such as Ecocert Greenlife, The Soil Association, USDA or BDIH. These companies ban the use of ingredients that haven’t been tested or proven safe for use, and they audit the companies that carry their certification to ensure they comply with their standards.

You have a choice

We live in the real world and we can’t completely avoid modern life or all harmful exposures. But we do have choices. Be smarter when you shop. Substitute poorer quality chemical laden products for natural ones, even if they are a little more expensive. Your health and the health of your children depend on it.

By Barbara Hanrahan – Nursing sister and midwife, masters in midwifery, SA certified perinatal course developer

Do you know you can have a vaginal birth after a previous caesarean birth? (VBAC)?

Research has proven that this is possible – with about an 84% to 91,3% rate for successful VBAC. In Johannesburg, in the private sector, there are obstetricians who will assist a woman with a VBAC – recognizing that the best way to approach this is with a private midwife – as she provides one on one labour support and monitoring during labour. This vigilance reduces the risk of complications and the very low risk of a possible uterine rupture. An added value of one-on-one care means that if a caesarean is required, the midwife and team that the woman knows, go to theatre with her. Thus reducing stress associated with an unscheduled repeat caesarean birth.

The impact of a negative birth experience and the affects impact a woman in the long term. For some women, a caesarean birth may leave them dissatisfied with their birth experience. This can affect whether the woman chooses to breastfeed her baby, the length that she breastfeeds for, her mothering ability in the first year, the risk of postpartum depression and increases the risk of post-traumatic stress disorder.

The first blow to a woman’s confidence in her body is usually quite early in the pregnancy, when her doctor initiates the subject of a caesarean section. So doubt arises early in the pregnancy and gets “fed” by the horror stories women insist on regaling to any pregnant women they see. Women do have an altered body image in pregnancy as their pregnancy develops and this is the time to affirm that her body is strong and capable (the very fact that she is growing a foetus with no technical help!)

“Rupture of the uterus” is the number 1 reason for health practitioners to prefer a repeat caesarean. This is when the previous caesarean scar’s internal structure starts to separate. A true rupture of the uterus is rare when there is sufficient monitoring in labour. Rupture of the uterus is a potential problem with hyper-stimulated contractions, prolonged labour and CPD (cephalo-pelvic disproportion). All of which have early warning signs.

Criteria for doing a VBAC include the baby’s head being in the correct position ie head first, transverse scar in the lower segment of the uterus and an average foetal weight. These criteria do not rule out incidental problems such as foetal distress – which can happen in any labour. With vigilant monitoring – not continuous foetal monitoring, foetal distress can be detected early enough to investigate the nature of the distress and the options for care at that point.

Women deserve and need a full account of the benefits and risks of a VBAC or repeat caesarean. Yes any caesarean has inherent risks – which women are often not told about all the risks – or it is put in a way that caesarean minimizes the risks and women feel “it’s no big deal”. The terms used to explain the situation can be “massaged” to draw the woman into the decision the doctor wants her to agree with. Equally this surreptitious enhancing of the facts can be done by a practitioner who readily supports VBAC and wants to lead the woman to the decision to go for a VBAC.

On examining the research evidence, factors which influence a VBAC can be from events around the first caesarean, some relating to the woman’s previous birth experience and some around learning from a previous caesarean.

Some interesting facts

  • If a woman has given birth vaginally prior to caesarean then the risk of rupture of the uterus is significantly lower.
  • Single layer suturing of the caesarean wound is infinitely riskier in a future VBAC vs double layer repair. Women need to know the “real” reason for a caesarean and how that caesarean has been stitched – they will have to ask. Review your medical file before you leave the maternity facility.
  • Postpartum fever has been associated with an increased risk of uterine rupture in the next labour. Interpreting this fever needs to consider whether it was connected to epidural or spinal anesthesia or the use of Misoprostol to reduce post caesarean bleeding. Both of these instances are known to raise maternal temperature.
  • Previous caesarean done for non-repeatable reasons eg breech position offers more chance of a successful VBAC. Poor progress in labour or CPD offers a higher risk of a repeat caesarean.
  • Women in whom there was a 24 month period before falling pregnant again had the smallest risk of rupture of the uterus. This suggests that the scar in the uterus needs two years to heal to its optimal strength.
  • The risk of rupture of the uterus increases after each caesarean. Previous research quoted an incidence of 0,6% after 1 previous caesarean, increasing to 1,7% after two or more caesareans.
  • Results of vaginal delivery following more than one previous lower segment caesarean section are no different to those following one previous caesarean section
  • There is a direct correlation between perinatal mortality and induction of labour in women who have had a previous caesarean.
  • Women who had a successful VBAC were less likely to get a raised temperature vs women who had an elective caesarean.
  • Women who had a successful VBAC are markedly less likely to receive a blood transfusion than women who have had an elective caesarean.
  • Babies born by elective caesarean are significantly more likely to encounter breathing difficulties. Babies born by emergency caesarean after attempted VBAC had a higher rate of postpartum infections. Babies born by successful VBAC have good neonatal outcomes. Thus a successful VBAC is of benefit to the baby and an unsuccessful VBAC is no worse than an elective repeat caesarean birth.
  • A woman’s birth experiences will contribute to the interest in a VBAC. Women who have experienced a “traumatic caesarean” for foetal distress or failure to progress in labour may be more likely to choose an elective repeat caesarean vs a VBAC. Debriefing the birth irrespective of the mode of birth, helps a woman focus her thoughts on another childbirth experience in the future – so that she goes away from the recent birth experience with a more global perception of a successful birth strategy for the next pregnancy. And knows all the important facts of this birth – so that the woman can process them and make sense of her birth experience.

VBAC is a personal choice – The Guidelines to Maternity Care in South Africa allows for a woman with a previous caesarean to choose an elective repeat caesarean. But the old adage “once a Caesar – always a Caesar” cannot be applied to all births following a previous caesarean. Especially in South Africa with its very high primary caesarean rate. Be encouraged to work thoughtfully through your birth options, including feeling secure with your caregiver if the “what if’s” happen and provide emotional support and debriefing for women who have experienced an unexpected birth outcome which the woman may view as traumatic.

(This article is also available in an audio format)

By Hettie Grove – Nursing sister, advanced midwife, internationally certified childbirth educator, internationally certified lactation consultant, SA certified perinatal educator, SA certified lactation consultant curse developer and coordinator

Every person has a genome, which nothing changes, it is a complete set of genetic material that babies inherit from their mom and dad. But babies and adults also have a microbiome, which is interchangeable and that is all the bacteria, yeast and microorganisms present in and on our bodies. The gut is the starting point of a baby’s immune system. The gastro-intestinal tract is a constant changing collection of nutrients, bacteria and pathogens. It is obvious that if good bacteria reign the harmful bacteria have a much lower chance to have an influence. Bear in mind that a disruption in balance may lead to illness. Very important is the fact that the first influences or microbes to colonise your baby’s gut will be the starting point of the trajectory of your little angel’s immune system for the rest of his life.

Your baby’s community of gut microbes is unique and the groundwork is laid during pregnancy and birth. The thought is that the baby inherits the microbiome from the mother and we need to remember that what we do is going to influence not only our children but also our grandchildren. Your body is busy transferring an entire bacterial community to that little baby that is so snug in your uterus right now.

This is an ever increasing community and is influenced through the placenta, expanded when the amniotic sac ruptures and your waters broke in labour or before, expands again as it moves through the birth canal, expands again when the baby is in skin-to-skin contact on your chest and increases further through breastfeeding. The cycle doesn’t stop there but even in the first week as you hold your baby you will seed baby with a bacterial microbiome and lay the foundation forever.

As a mother you pass your bacterial communities to your baby. Numerous studies provide us with information that a mother with a healthy microbiome has less chance of a host of conditions. Unfortunately some of the things we can’t change but we have an awesome opportunity to change some of them. The microbiome is a relatively new concept yet we already know so much that we can actually make a large difference.

A few tips for expectant mothers to be able to make this difference

  1. Oral health

Your placental microbiome resembles the oral microbiome. Your mouth has a multitude of bacteria and research has indicated that mothers who have problems with their mouth and teeth may have an increased chance of preterm birth. The reason is that the unhealthy bacteria in the mouth are transferred via the bloodstream to the placenta. By taking care of your teeth brushing, flossing, seeing your dentist as well as using a mouth rinse you not only decrease your chances of preterm birth but you also care for the placenta

  1. Watch what you are eating

We are what we eat, even more so in pregnancy. Your baby is what you eat and guess what you and only you have control over that. We used to think that the baby had a sterile gastro-intestinal tract, but more and more studies show that baby already has some gut bacteria, and they think it’s from the mother’s digestive system. Be sure you try and keep it “clean and green” without processed and unrefined foods and you may influence your baby and his gut as well

  1. Try and avoid antibiotics as much as you can

Always outweigh the benefit versus the risk. Viruses don’t benefit from antibiotics and yet sometimes you need to take them. Make sure if you need antibiotics you take some probiotics as well

  1. Stop smoking and avoid second-hand smoke

Stopping smoking improves a better microbiome and a myriad of other health reasons as well

  1. Ask your healthcare worker to evaluate you for bacterial vaginosis

Bacterial vaginosis is a common vaginal infection that disturbs the normal flora of the vagina resulting in an increase of bad bacteria. Symptoms are usually an increased discharge and a “fishy” smell

  1. Decrease stress

Stress hormones usually decrease your body’s ability to have a healthy microbiome so consider some relaxation techniques, deep breathing and take some ME time

  1. Avoid douching

Douching disturbs the vaginal flora and the microbiome and has been linked to low birthweight, preterm birth and infections of the sac around the baby. It also increases the risk of transmission of sexually transmitted disease and HIV

  1. Consider your birthplace

Homebirth may result in avoiding the hospital bacteria and a more favourable microbiome profile for your baby

  1. Push for a normal birth

Emerging research shows that bacteria are absolutely vital for human health, and imbalances in the human microbiome significantly contribute to chronic non-transmissible diseases, as the baby moves through the birth canal he is exposed to all sorts of bacteria, because of this the baby is colonised with all the healthy bacterial species of the vaginal microbiome.

Toni Harman wrote “Two amazing events happen during childbirth. There’s the obvious main event which is the emergence of a new human into the world. But then there’s the non-human event that is taking place simultaneously, a crucial event that is not visible to the naked eye, an event that could determine the lifelong health of the baby. This is the seeding of the baby’s microbiome.

However, with interventions like use of synthetic oxytocin (Pitocin / Syntocinon), antibiotics, C-section and formula feeding, this microbial transfer from the mother to baby is interfered with or bypassed completely.”

An article in Science Daily reported on such research stating:

“Communities of vaginal microbes change during pregnancy in preparation for birth, delivering beneficial microbes to the newborn. At the time of delivery, the vagina is dominated by a pair of bacterial species, Lactobacillus and Prevotella.

In contrast, infants delivered by caesarean section typically show microbial communities associated with the skin, including Staphylococcus, Corynebacterium, and Propionibacterium.

While the full implications of these distinctions are still murky, evidence suggests they may affect an infant’s subsequent development and health, particularly in terms of susceptibility to pathogens.”

Differences in bacterial colonisation are now being blamed for why caesar babies are at increased risk for asthma and obesity. An unplanned caesar after normal labouring may help the microbiome by some of these healthy bacteria still being transmitted.

Dr Hannah Dahlen, associate professor of midwifery at the University of Western Sydney, explains: “A baby born vaginally is exposed to about 300 different bacteria as it comes down the birth canal. These bacteria set up the child’s microbiome, which is what enables their body to defend against all kinds of diseases. Obviously, when a baby is born by C-section, they aren’t exposed to these bacteria and their immune system isn’t as strong as a result. We believe this is part of the reason why children born via C-section have an increased risk of autoimmune diseases.”

  1. In the event of a caesar be pro-active

We call this the “icky-Factor” very new to South Africa. Some believe it will become a standard recommendation in future. Here goes: if you are going to have a caesar because this is the way you want to or need to birth your baby, consider taking a vaginal swab of your vagina or even a piece of gauze, keep it in a sterile container and after the birth rub these secretions/good bacteria on your baby’s skin, mouth and hands. Sounds a bit “icky” but when the baby moves through the birth canal that is exactly what happens. They are then coated with the secretions and bacteria so what you are now doing is mimicking that exposure. Ask your healthcare worker to help you or do it yourself if you are comfortable.

  1. Lots of skin to skin as soon as possible, as long as possible

Skin to skin soothes and it transfers all your healthy bacteria on the baby, some sources even state take your own towel to dry the baby after you have put him in the skin-to-skin position or cover both of you with it. Remember skin-to-skin soothes and while the baby is left in this position the nine instinctive stages proceeds and with his little hands he actually leaves little trails of amniotic fluid on your body which will help him to get to the breast easier.

  1. Postpone the first bath for at least 24 hours

Although this might be the latest protocol in some hospitals ask for it. The rationale for not bathing the baby is actually to establish this healthy microbiome and allow the vernix which is awesome for the baby’s skin to be absorbed. Definitely delay the bath till after the first efficient latch and breastfeeding session. This is easier if you communicate it with your birth team so that no misunderstandings happen.

  1. Skin to skin with the father

If the mother can’t do skin-to-skin let the father do it. Familiarity soothes and the baby knows his father’s voice and baby will not experience separation distress.

  1. Breastfeed your baby

Breast milk is high in all the beneficial bacteria but also contains a certain oligosaccharide to support the growth of these bacteria. It’s better to give the baby the colostrum and breast milk even if it’s just for a while although breastfeeding is dose relevant – the more you feed, the lesser the risks of artificial feeds for your baby.

Storing your baby’s stem cells at birth is a once in a lifetime opportunity to protect your family against serious illness or disease. It is important that all families are fully informed on the benefits of storing their babies’ stem cells before making this important decision.

What are stem cells?

Stem cells are known as the master cells of the body, because they have the amazing ability to become a specialised cell such as blood, muscle or bone. For over 20 years now, families have been able to cryo-preserve cord blood stem cells for potential future medical use.

The first stem cell transplant using stem cells found in the umbilical cord blood was in 1988 for a little boy suffering from a serious blood disorder called Fanconi’s Anaemia. Since then, with the advancements in regenerative medicine, there are now over 70 blood related diseases and immune disorders being treated through stem cell therapy including leukaemia, multiple myeloma, and thalassemia.

Current research in regenerative medicine is resulting in tremendous discoveries in science, technology, health and medicine, and show great potential for improving methods to diagnose and prevent multiple diseases, as well as develop innovative treatments for injuries and illnesses. Today, there are over 4 000 clinical trials underway looking at potential future cellular therapies for diseases such as diabetes, heart disease, bone reconstruction and -neuro-degenerative diseases.

How are the stem cells collected?

Cord blood collection is a simple process and poses no risk to mother or baby. Immediately after the baby’s delivery, the umbilical cord is clamped and the baby is separated from the cord. A needle is inserted into the umbilical cord vein and drawn by gravity into the collection bag. The process of collecting cord blood is non-invasive, painless and generally takes just 3-5 minutes to complete. Once a sample is collected, it is transported to the laboratory for processing and cryo-preservation.

Why store at birth

Currently there are no public stem cells banks on the African continent, and there is 1:100 000 change of finding an unrelated donor; which can be a lengthy and expensive process. Storing your baby’s cord blood privately, ensures that these valuable stem cells are immediately accessible for your baby and family should you need them. A baby’s umbilical cord stem cells will remain a 100% match for them and there is also a chance these stem cells could be a match for another family member. Should these cells be needed for transplant, having a 100% match reduces the risk of tissue rejection (Graft versus host disease). Stem cells found in the umbilical cord are at their purest form as they have not been exposed to any illnesses, making them the preferred source of stem cells for transplant.

Storing your baby’s stem cells at birth is a once in a lifetime opportunity to protect your family against serious illness or disease. It is important that all families are fully informed on the benefits of storing their babies’ stem cells before making this important decision.

By Dr Welma Lubbe – Author of Prematurity adjusting your dream, www.littlesteps.co.za

Premature birth means a baby is born before 37 weeks of the pregnancy is completed and in South Africa this occurs at a rate of 12% and in the public sector even as high as 25%.

What can be the causes of premature labour?

This early arrival can be due to medical conditions as well as lifestyle conditions. Medical conditions may include (but are not limited to) conditions such as maternal infection, low lying or ruptured placenta, premature rupture of membranes (waters breaking early), abdominal injury and foetal abnormalities. Pregnancy induced hypertension, resulting in pre-eclampsia and HELLP syndrome is a major cause for preterm birth. Multiple pregnancies also increase the risk for prematurity due to limited space in the womb, twin-to-twin transfusion in identical twins and intra-uterine growth retardation, which is also a risk for singleton pregnancies. A previous premature delivery and medical interventions, such as cervical cerclage or progesterone supplements may also cause premature birth. Other risk factors include previous preterm birth, miscarriage, multiple abortions, short period between pregnancies, obesity, diabetes and in vitro fertilization and the list goes on.

Premature births may also be the result of lifestyle factors such as mothers holding high profile and stressful jobs or jobs that require long hours of standing. Late or no antenatal care is a huge contributor to the problem, smoking, drugs and alcohol consumption during pregnancy and illegal drugs as well as a dangerous physical environment, such as exposure to lead paint, crowding and pollution are also contributing factors. Domestic violence, lack of social support and stress are all factors that increase the risk for preterm birth. And sometimes babies just arrive early for reasons not known.

Warning signs of preterm labour

When a little person plans to arrive early, her mom will experience the normal signs of labour, which include contractions every 10 minutes or more often, a change in vaginal discharge, such as water or bright red blood draining, pelvic pressure which may be described as a feeling that the baby will ‘fall out’. Low, dull backache (which may be common in many pregnancies), period-like cramps and abdominal cramps with or without diarrhoea are also regarded as warning signs.

Prevent preterm labour

Mothers can lower the risk for premature delivery in some cases, but it cannot be prevented all together. There are a few precautions moms can take:

Control medical conditions

Problems such as high blood pressure and diabetes can be identified, monitored and controlled through antenatal care.

Healthy lifestyle

By not smoking, consuming alcohol or using drugs, risk factors are lowered. Dads should also stop smoking, since the nicotine inhaled through passive smoking is not good for the mom or her baby and has been shown to lead to intra-uterine growth restriction. Follow a healthy eating and exercise plan and relax! Stress hormones can cross the placenta and affect your unborn baby. A pregnancy massage may help you carry your baby full term, since it aids in decreasing stress hormone levels and this is a wonderful way in which dad can be involved in the pregnancy. Mothers who receive massage therapy during pregnancy feel less anxious after a massage session, and a foot massage has shown to lower the mother’s heart rate, blood pressure and respiration. Massage increases foetal activity and moderate exercise produces an increase in foetal heart rate and breathing, which is excellent for development of the foetus.

Prevent and treat infections

Vaginal and urinary infections can all cause premature labour. Have any symptoms of a vaginal and urinary infection checked out and treated, if necessary. In addition women are more susceptible to gingivitis (gum infections) during pregnancy due to hormonal changes. These infections can also cause preterm labour therefor regular dental cleanings can be very beneficial in preventing preterm labour.

Good hydration

When you become dehydrated the concentration of oxytocin can rise in your blood thus causing contractions, so remember to takes lots of fluids, especially during the summer months.

Prenatal appointments

By keeping regular prenatal appointments your doctor or midwife can help screen you for risk of preterm labour and treat it as early as possible if you do develop signs of premature labour.

Avoid oxytocin and prostaglandin

Oxytocin is the hormone that initiates contractions and is also released by means of breast or nipple stimulation, semen and having an orgasm. If you are at risk for preterm labour use a condom during sex or avoid it all together.

What can you do if you experience preterm labour?

Be aware of the early signs of labour and make sure that you are able to monitor contractions and the movements of the baby at home. Contact your doctor immediately in case of an infection to prevent infection-related premature labour. Avoid high stress levels, such as work-related stress when pregnant, especially from the second trimester onwards. When receiving infertility treatment, request the implantation of only one embryo to decrease the risk of a multiple pregnancy, which often results in premature birth.

If you have five or more contractions in an hour, or the time between the beginning of one contraction and the beginning of the next is less than 15 minutes, stop what you are doing, empty your bladder, and drink some fluids and rest lying down on your left side for an hour. Put a small pillow under your hip to support your back, if needed and feel for the uterus tightening. If this uterine activity persists while you are resting, then you may be in preterm labour and you should contact your healthcare professional.

From how many weeks does baby have a good chance of survival outside the womb?

Completed weeks of gestation at birth (based on last menstrual period) Estimated chance of survival
21 weeks and less 0%
22 weeks 0-10%
23 weeks 10-40%
24 weeks 40-70%
25 weeks 50-80%
26 weeks 80-90%
27 weeks >90%
30 weeks >95%
34 weeks >98%

If baby is born too soon, what does it mean for you and your baby?

Preterm infants usually experience challenges that include continuing their normal development outside the supportive environment of the womb and with immature organs. Stressors such as noise, bright lights, pain and disruption of sleep and rest, result in them not being able to reach physiological stability, such as a normal heart rate, breathing and temperature regulation.

They also experience behavioural problems, including difficulty with self-regulatory activities, sleep and calming. Medical complications due primarily to the immature lungs and brain include: temperature instability, feeding difficulties, breathing problems (respiratory distress syndrome), tachypnoea (fast breathing), retinopathy, necrotising enterocolitis and jaundice. They are also at higher risk of longer hospitalisation and re-hospitalisation after discharge.

Preterm infants may or may not experience long-term challenges. The smaller the infant is at birth, the bigger the possible challenges and risks. Some developmental problems include mental and neurological problems such as problematic feeding (especially problematic for the mother), cerebral palsy, visual acuity and blindness, hearing and motor deficits, poor emotional regulation, emotional vulnerability and difficulties with self-regulation and self-esteem.

In the longer run, challenges may even include attention span difficulties and language delays which can lead to learning disabilities, lower IQ (which can be improved by doing skin-to-skin and breastmilk feedings), impaired executive function, attention deficit disorders, lower fatigue thresholds which may influence daily activities and lead to easy distraction, impulsiveness, concentration difficulties, spatial orientation disturbances and language comprehension and speech problems.

Meningococcal meningitis, a form of meningococcal disease, is a serious bacterial infection. Unlike viral meningitis, it can potentially kill an otherwise healthy young person within 1 day after the first symptoms appear. 1, 2

Meningococcal disease can be difficult to recognise, especially in its early stages because meningitis symptoms are similar to those of more common viral illnesses. But unlike more common illnesses, meningococcal disease can cause death or disability within just 1 day. 1

Many of the people who survive meningococcal meningitis can be left with serious medical problems that may include amputation of limbs, fingers, or toes, severe scarring, brain damage, hearing loss, kidney damage, and psychological problems. 2

Who’s at Risk for Meningitis?

Even people who are usually healthy can get meningitis. Although all age groups are affected, the highest-risk groups include infants and young children. 1, 2

How Meningococcal Disease Spreads

Common everyday activities can spread meningococcal disease. This includes kissing, sharing utensils and drinking glasses, living in close quarters such as a dormitory or summer camp, and smoking or being exposed to smoke. Activities that can make teens feel run down may also put them at greater risk for meningitis by weakening their immune system. These include staying out late and having irregular sleeping patterns.2

How to prevent the disease

  • You can’t watch your children every minute of every day. But you can help protect them from meningococcal disease (which includes meningitis) by getting them vaccinated. Getting your child vaccinated is the best way to help protect them from meningococcal meningitis. 1, 2
  • Simply talk to your child’s health-care provider about the importance of vaccination. Meningitis vaccines (indicated from 9 months of age) are available for individuals who wish to reduce their risk to contracting the disease. 1, 2
  • If you ever suspect that your child has meningitis, contact emergency services right away, where he or she can be evaluated and receive prompt medical care.1, 2

References:

  1. Thompson MJ, Ninis N, Perera R et al. Clinical recognition of meningococcal disease in children and adolescents. Lancet. 2006;367:397-403.
  2. World Health Organisation. Media Centre. Meningococcal meningitis. Available from: http://www.who.int/mediacentre/factsheets/fs141/en/#. Accessed on 13/08/14

Giving a baby medication is not an easy task for a mother. Not many babies just sit there with their mouth’s open waiting to swallow the often not so pleasant tasting mixture. A more skilled approach is needed.

  • Ensure you have the correct medication that your baby requires.
  • Know your baby’s weight and work out the correct dosage for age or weight. Check your calculations carefully – it is important your baby gets the correct dose for their age and weight as too small a dose would be ineffective and a larger dose could cause complications of overdose.
  • Read the instructions carefully as to whether the medication should be given before, with or after a meal.
  • Shake the medication well if that is required.
  • Make sure you have the correct dose and don’t confuse t (tsp) teaspoon with a T (Tbs) tablespoon.
  • Using a clean syringe without a needle, draw up the correct amount as prescribed by the doctor, or, if an over the counter medication, draw up the recommended amount for the age of your baby. It is very easy to draw up a very accurate amount of the medication using a syringe. With a syringe you have good control of the medication, and you don’t run the risk of the baby knocking a spoon of medicine out of your hand all over the floor (or yourself). Make sure that the syringe holds only medication in it and contains no air – as this would affect the accuracy of the dose.
  • Hold your baby in a good firm grasp on your lap. Hold the arm closest to you, firmly against you so that the arm is pinned out of the way.
  • Hold the arm furtherest away with your left hand, the head being supported on your left wrist.
  • Put the syringe to your baby’s mouth and gently depress it.
  • Some babies will actually suck from the syringe whilst others have to be coerced to swallow and little by little the medicine goes down.
  • If the baby is uncooperative, squeeze the medication slowly into the side of his mouth, not directly to the back of the mouth, as if the medication hits the back of the mouth, this could cause the baby to choke or vomit.
  • Administer a small amount at a time to give your baby a chance to swallow small manageable amounts at a time.
  • Keep medication safely stored away out of reach from children.
  • Store medication correctly – check what the correct temperature for storage is for that particular medication – some medications need to be kept in the fridge.
  • If a baby vomits up the medication immediately, repeat the dose. If he vomits after 30 minutes – don’t repeat the dose as a lot of medication has already been absorbed in that time.