I had lots of clients asking what could be the cause of their stillbirths and how they could prevent this in their next Pregnancy.  They had many questions This may be helpful

#Definition of stillbirth

The definition recommended by WHO for international comparison is a baby born

with no signs of life at or after 28 weeks’ gestation.

#CAUSES OF STILLBIRTHS

🔴Placenta previa and placenta Abruptio

🔴Post maturity

The above conditions causes the blood that reaches the baby to be reduced and

therefore they get a reduced supply of oxygen and in turn causing fetal hypoxia

which results in stillbirths.

🔴Unknown causes

🔴Infections ,example, urinary tract infections

🔴Taking unprescribed drugs (alcohol and smoking)

🔴Growth restriction due to nutritional causes or medical causes.

🔴Trauma to the abdomen

🔴Chromosomal abnormalities

🔴High blood pressure

🔴Diabetes mellitus

Among others

#PREVENTION OF STILLBIRTHS

❤️Effective monitoring of all pregnant women to detect possible abnormalities

and correcting those abnormalities. Monitoring, recording, and interpreting

Fundal height rightly to detect growth restriction.

❤️Screening of patients to rule out infections that can cause growth restrictions

and possible treatments.

❤️Health education on nutrition, personal hygiene, danger signs, rest and

exercise, etc to promote a healthy lifestyle among pregnant women.

❤️Taking prescribed drugs

❤️Providing skilled delivery for all pregnant women to prevent and also

reduce the risk of having prolonged labor which can cause stillbirths.

❤ ️ Preconception care to expectant mothers and their partners.

❤️Performing fetal kick counts starting at 28 weeks of gestation and also being conversant with your body. In recent times it’s recommended that you will be familiar with your baby’s movement. Report if its excessive or reduced.

❤️Calling your midwife when you experience any unusual symptom or sign

❤ ️Taking nutritional supplements to reduce the risk of chromosomal abnormalities, for example folic acid.

Talk to your midwives or gynecologist as well. Remember most of these stillbirths are preventable.

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Catheters are used during cesarean section simply because:

The bladder which stores urine before the urge to urinate comes is just  close to the uterus.

The doctors want to keep it empty

So they don’t hurt your bladder or other vital organs close

When also in place your intake and output is easily measured which is very important in our work.

A diaper can’t do that for you

It can’t replace a catheter

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Many women believe there is a wound literally in the stomach or abdomen after birth, they resort to so many preparations and concoctions to heal this wound that is left in the stomach after birth.

Sometimes trying to heal this wound rather brings them more issues since the stomach does not really play a part during labor. Is  it the uterus they call stomach or this is to help new mum take good care of themselves? Let’s learn

During birth the baby is in the uterus/womb and attached to the mother via the placenta. The placenta is what connects mum and baby. After the baby is born in the 2nd stage of labor , the 3rd stage follows which is the birth of the placenta.

After the birth of the placenta the uterus continues to contract which makes it smaller, the smaller it becomes the more bleeding is also prevented. So literally we are more concerned about the place where the placenta detached to heal properly and regain its strength.

Within the next six weeks after birth contractions will continue and the uterus will continue to become smaller. The uterus sheds off all the leftover blood gradually over time and it’s called lochia. It is a natural process and will cleanse itself. The tips you will need to make sure you are safe and free from infection include

⛔Strict personal hygiene, bath twice daily

⛔Change pad frequently and wear clean cotton panties

⛔Take prescribed medications, examples pain medications,haematinics, antibiotics etc. (Please know the medications you are given depends on the individual’s situation)

⛔Eat nutritious meals rich in vitamins and minerals to promote healing

⛔Passive exercise, like walking, and deep breathing exercise

⛔Report immediately

if you have severe bleeding, pain or offensive discharge

⛔Remember, breastfeeding helps the uterus to contract after birth. Breastfeed baby

⛔Rest is also medicine. Get people to help you so you can have enough rest

These basic things will keep you healthy, there is literally no #wound in your stomach. You only need to take care of yourself after birth. If you feel sick talk to your midwife/doctor

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Did you know that as we speak many children born to mums who are HIV positive are free from the infection? Yes! This is a fact! The reality. With these simple steps a mum who is positive can have a child who is negative! This is good to know

✔️ Get tested! Every one should test for it. Its free

✔️ Once you get pregnant you are tested twice before pregnancy ends.

✔️If it’s positive you are immediately put on antiretroviral medications. Once you take it, the viral load decreases and the possibility of passing the infection to your child decreases.

✔️Regular and specialized antenatal care is very crucial. Attend an antenatal clinic and report early when you have any infection or concern.

✔️You will need skilled delivery to help reduce the chances of passing the virus to the new born baby. Deliver in a hospital

✔️After birth, the baby is also put on medication starting on the day of birth. It also reduces the chances of acquiring the infection from the mum.

✔️ ️Mother can breastfeed exclusively as long as she is on the medications and the baby as well on her medication. She should also eat nutritious meals and maintain good personal hygiene.

✔️If you tested negative it doesn’t mean you are free, you can never get it if you do not practice safe sex, we are all vulnerable and remember the ABC’s to prevent HIV transmission.

✔️Partner and family support is very important, be there to support them emotionally and remind them of their appointments.

Be open, speak to your doctor or midwife about  all your concerns. There is support in our various health facilities to help you stay healthy.

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It’s difficult to sometimes get our clients to understand that labor is a natural process.

You only need to be #guided

Your body will do the work

A typical example from a client..

” Midwife… Give  me some medicine so baby will come fast

Push my tummy. Give me fundal pressure…”

Hmmm.. Labor has stages you will go through

It takes time. You don’t need to intervene unnecessarily. It can lead to further complications

You need to prepare from day 1 when you are pregnant

1.Learn how to ease your labor

2.How to cooperate with your midwife

3. Don’t push your midwife to intervene when its not needed

4. Educate yourself about birth before you get there

Ask all the questions you don’t understand before labor sets in.

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The leading cause of maternal deaths during delivery is hemorrhage (Bleeding)

It’s important that women do well to keep their blood levels high above 11g/dl HB. During pregnancy before labor sets in

Also make sure you choose a hospital ready for emergencies

In case you need a transfusion there should be a blood bank and blood products available

In case you need an emergency obstetric care when bleeding occurs  items should be available

Medication to stop bleeding should also be available

If you need a referral, there should be an ambulance and it should be available

Feel free to ask all these from your facility

It’s your life!

There is no second life!

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During labor, it is expected that your baby’s head drops and also cervix dilates as contraction goes on.

A full bladder can hinder the cervix from dilating . If you cannot get up and urinate due to pain and discomfort a folley’s catheter will be inserted to empty your bladder.

During a cesarean section your bladder has to be empty to also prevent possible Injury during the procedure. A folley’s catheter will be inserted

It may be used to drain the urine and removed immediately or retained until the procedure is done or completed.

A full bladder can prevent the uterus from contracting after birth and this can cause bleeding.

Cooperate with your doctor or midwife during the process of catheterization.

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Having severe pains doesn’t mean you should push the baby out! 

When labor sets in you get strong contractions which can be felt on your abdomen, it becomes hard and comes with pain and back ache. These contractions help the opening of the uterus (cervix) to open.  It opens gradually and with time. The stronger, longer and closer the contractions are, the likelihood of the cervix opening also increases.

Vaginal examination is done four hourly to determine the dilatation which is measured  in centimeters. From 1cm to 10cm. It takes on average an hour for each cm dilation. At 10 the cervix will be fully taken up and the baby can be born peacefully. Pushing before the cervix is fully dilated can cause cervical tear which is difficult to repair.

In new mums labor lasts longer than women who have already delivered. 

In some cases contractions can be adequate but cervix dilatation may not correspond. It leads to prolonged labor or fetal distress. Other measures are put in place to hasten birth or an emergency cesarean section is done.

Remember to stay hydrated and Cooperate with your midwife. Do not push through an undilated cervix. Communicate with your midwife throughout the process.

Lets help you prepare well for your pregnancy and birth

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EPISIOTOMY is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician.

 Episiotomy is usually performed during the second stage of labor when the baby’s head is crowned  to quickly enlarge the opening for the baby to pass through.

It’s done so baby can quickly be delivered and also to prevent tears that can be difficult to repair

The midwife during labor will assess the need for it. If the perineum is not stretching enough and she anticipates it can cause a tear or delay in the birthing process she may decide to give an episiotomy after seeking your consent

Some other conditions that may necessitate an episiotomy include… Big baby,vacuum or force delivery , breech birth, prolonged birth, premature birth etc

It’s not a routine. Many women do not need an episiotomy.  Preparing your perineum can also help in reducing the need for it.

Self care after an episiotomy is also a necessity for proper healing !

Ask you midwife or doctor about it

 What has been your experience about it?

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