The post Genesis Clinic gets official ‘Mother-and-Baby-Friendly’ status appeared first on All4Baby.
]]>“This is a great accolade for us, and a real endorsement of natural, active birth,” says Jude Polack, director and founder of Genesis Clinic. “There are those in the local medical fraternity who believe that by helping moms deliver naturally, we are taking the riskier route. Instead they claim that Caesareans and medical intervention are the safer method of giving birth. Based on a vast quantity of global research, however, WHO and UNICEF have declared that natural birth is the safest for both mom and babe, which is a significant reassurance for our clients.”
Genesis Clinic has achieved its Mother-Friendly status thanks to its pro-mom labour and birthing practices. “We view labour and birth as a natural process,” says Polack. “It’s all about giving moms the freedom to follow their instincts, while supporting them with sound and safe birthing procedures.”
This means giving mom unrestricted access to birthing companions, encouraging her to eat and drink during labour, and giving her the freedom to walk and move about, as well as assume whichever position feels most natural to her for the birth, provided there are no complications.
The Clinic also discourages medical interventions, and offers natural pain control such as massage and nitrous oxide. “In emergencies however, we have obstetricians and gynaes on stand-by, as well as a fully equipped operating theatre should the need arise,” says Polack.
For the Baby-Friendly part of its accreditation, Genesis Clinic adheres to 10 steps for supporting and maintaining successful breastfeeding. “For us, breastfeeding is simply an extension of our philosophy about birth – that it’s a beautiful and natural process which most women embrace instinctively if given the right support and encouragement,” says Polack.
So, for instance, babies are placed skin to skin with their moms immediately after birth, and moms are helped to recognise when their newborns are ready to breastfeed. “We also encourage breastfeeding on demand, which is made easier at Genesis because all babies room in with their moms throughout their stay with us.”
All of which means happy, and most importantly, healthy babes and moms… and a big thumbs-up from WHO and UNICEF.
For more information, visit www.genesisclinic.co.za
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]]>The post Perineal tear: The lowdown on tearing down low! appeared first on All4Baby.
]]>When baby’s head crowns during childbirth, the tissue around the vaginal opening can tear. Typically, tears range from mere skin snicks which heal on their own after childbirth (called first-degree tears), to tears involving vaginal tissue and the perineal muscles, which will need a few stitches in the delivery room (second-degree tears). Far more rare are third- and fourth-degree tears, involving the vaginal tissue, perineal muscles, anal sphincter and at worst, tissue within the rectum. These tears require repair in theatre.
Understandably, moms delivering vaginally are often concerned about the pain of tearing. The good news is that you are unlikely to feel the tear during labour, since the skin is stretched taut, making it quite numb.
Afterwards however, pain will vary depending on the severity of the tear; in most cases, since the majority of tearing is either first- or second-degree, moms report stinging rather than actual throbbing pain.
The only delivery where a wound is a certainty is a Caesarean section. For a natural birth, the chances of going home with a tear are significantly smaller: around 40% for first-time moms, and 20% in subsequent deliveries, with only 0.6%-0.9% of vaginal deliveries resulting in a severe tear, according to James, Steer, Weiner and Gonik in “High Risk Pregnancy Management Options” (2005, Saunders Elsevier).
Baby’s size and position during the birth have a big influence. Babies who are large for their gestational age or over 40 weeks are more likely to cause tearing. Risks also increase with babies born face first or facing mom’s front instead of her back, and with those who have a hand, elbow or shoulder protruding.
Mom’s position during delivery is another factor. The rate of perineal tearing is higher in a traditional hospital environment where moms are required to deliver on their backs, often with their legs in stirrups; this is a particularly bad position for tear prevention.
Medical intervention also significantly raises the risk, with forceps delivery probably the biggest culprit. Epidurals also have an impact, since they stop moms feeling the urge to push. Moms often end up pushing too early which can lead to a prolonged second stage of labour – a known risk factor in tearing – or they push too hard before the perineum has stretched sufficiently.
An augmented labour, where labour is helped along by drugs, further ups the risk. Contractions are often stronger than normal, which can cause the baby to crown too early and quickly.
This used to be the accepted thinking, but experience has shown that episiotomies, where the perineum is cut by the doctor or midwife, do not reduce the severity of tearing. In fact, an episiotomy increases the risk of having a more severe third- or fourth-degree tear. Just think how hard it is to tear material, yet if you make a little nick, the fabric rips easily; the same happens with an episiotomy.
A perineal tear is usually only superficial, running through the skin, whereas an episiotomy cuts right through skin and muscle. This means episiotomies are usually more painful and slower to heal since they’re much deeper. The ragged edge of a natural tear is easier to match back if stitches are needed, so the wound heals with less scarring.
Episiotomies are only necessary in emergency situations when your baby needs to come out immediately, and there is no time to allow the perineum to stretch naturally.
There is no way to guarantee that you won’t experience some degree of tearing during birth, but there are a number of ways to minimise the risk.
Second-degree tears will be stitched by your doctor or midwife under local anaesthetic, while third- and fourth-degree tears will be repaired in theatre.
Good wound care is important; ice packs will help reduce swelling and discomfort. Keep the area clean and don’t fiddle with the wound; salt baths are a great way to disinfect your wound while easing the discomfort.
If the wound stings when you go to the loo, pour warm water over the area while you urinate. You can also take stool softeners if it’s painful when you have a bowel movement.
How you decide to have your baby is your personal choice, but remember that whether natural or by Caesarean, there is no pain-free, risk-free way to get a baby out of your body. Neither birth routes are without risks; both have their own set of associated problems which you should take into consideration.
While you’re weighing up your risks of getting a bad perineal tear, also weigh up your chances of having an infected C-section incision that will require surgical repair, which happens in around 4-8% of Caesareans. And while you might be caring for a wound if you give birth naturally, you’ll definitely be caring for one after a Caesarean.
For more information on Genesis Clinic, visit www.genesisclinic.co.za
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]]>The post Babies shouldn’t die of a broken heart, says Hudson Initiative appeared first on All4Baby.
]]>Around 1 in every 100 babies is born with a heart defect, and in South Africa, many of those go undetected. It’s estimated that at least one in every five babies who dies of Sudden Infant Death Syndrome (SIDS) was an undetected CHD sufferer – but it doesn’t have to be that way.
Cardiac surgeon Professor Robin Kinsley says advances in paediatric cardiology and cardiac surgery have made it possible for survival into adulthood for the majority of babies born with congenitally malformed hearts, but this is not the case on the African continent.
“Here, this is a dream as roughly 280 000 neonates born every year on the continent are left untreated, demonstrating the natural history of the congenitally malformed heart by default,” he says. “This is due in point to lack of finances, lack of locally developed personnel and proper understanding of the problem.”
The statistics get scarier when you hear that globally, twice as many children die from congenital heart defects each year than from all forms of childhood cancer combined, yet funding for pediatric cancer research is five times higher than funding for CHD.
The Hudson Initiative faces a long, arduous road – one that is starting with awareness, will encompass a growth in research funding and the collection of funds to help families who cannot afford the surgeries needed to help their babies, and will end in the creation of Hudson’s Law.
To explain the end goal, detecting CHDs is as simple as administering a test, called Pulse Oximetry, which measures how much oxygen is in a baby’s blood, after the baby is 24 hours old. This dramatically increases their chances of survival, says Andrea Slater, the driving force behind The Hudson Initiative.
“This is the most important part of our focus: We’re going to make sure that screening for heart defects become as normal a scan as the Downs Syndrome check at 20 weeks. We’re going to make sure that Pulse Oximetry tests are performed on all newborn babies before they are sent home. And we’re going to make sure that the terms CHD and congenital heart defect is no longer foreign or misunderstood,” says Slater.
“If mothers are armed with the information they need to protect their babies from CHD-related issues, these deaths could potentially be avoided. CHDs are scary but they’re not the end. CHD babies live. They thrive. Post-surgery, hope is very much alive.”
Ultimately, the Initiative will realise the introduction of Hudson’s Law, which will see Pulse Oximetry testing becoming compulsory. In the meantime, the initiative is raising money to fund CHD awareness campaigns and pay for Pulse Oximetry testing in infants. The long-term goal is to pay for surgeries needed by babies whose families who cannot afford them.
Interested parties can sign a petition and spread the word by visiting www.hudsoninitiative.org. They can also be part of the social media campaign using the #JustAsk hashtag, which prompts expectant mothers to do three things:
“Our journey with Hudson was a very real, very painful, very testing and an extraordinarily fulfilling one. We like to think he chose us because he knew we would do something to address the concerning statistics around the sheer number of babies who are sent home with undiagnosed CHDs. We’re going to change things on behalf of the boy who changed our world.”
About the Author: Andrea Slater is mother to a CHD angel and all she wants is to help other tiny people get a fighting chance in this life. Readers are welcome to visit her blog for more on Hudson’s journey. For more information visit www.hudsoninitiative.org
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]]>The post The power of a mother’s touch – Kangaroo Mother Care appeared first on All4Baby.
]]>About four million babies die each year in the first week of life, according to The Lancet; replicating the protective and nourishing environment of a Kangaroo pouch, through Kangaroo Mother Care, could help 25% survive, says Dr Nils Bergman, a public health physician specialising in Kangaroo Mother Care (KMC) in South Africa.
“The very best environment for a baby to grow and thrive, is the mother’s body,” says Dr Bergman. “When placed skin-to-skin on her mother’s chest, a baby receives warmth, protection and food, and its brain can develop optimally.”
“Skin-to-skin contact should ideally start at birth, but is helpful at any time. It should be continuous day and night, but must be at least one hour to give benefit,” says Dr Bergman.
The next part of Kangaroo Mother Care is exclusive breastfeeding. That means that for an average mother, direct suckling by the baby from the breasts is all that is needed. For very premature babies, expressing milk and addition of some essential nutrients may be necessary.
Thirdly: support to the mother-child dyad means that whatever is needed for the medical, emotional, psychological and physical wellbeing of mother and baby is provided to them, without separating them. This might mean adding ultramodern equipment if available, or intense psychological support in contexts with no resources. It can even mean going home very early.
In the past, parents of premature babies were excluded from care directly after birth, including the neonatal ICU. Now, it’s known that separation causes harm to all babies – especially preterm infants.
Recent science shows that parents’ presence has a positive influence on brain development, says Jill Bergman, who has promoted Kangaroo Mother Care for 24 years. “We are realising more and more from neuroscience that the parent as central to the healthcare team is not just essential for survival, it ensures a good start to life,” she says.
1. Regulation
The baby at birth is wide-awake for the first 60-90 minutes and experiencing certain sensations. He hears mom’s familiar voice, feels her heartbeat, smells the familiar scent of her and her breast milk. The baby feels safe and comforted by these sensory signs and so his body calms.
Heart rate, breathing and oxygen saturation, blood pressure and temperature all stabilise far faster on mom than when they are separated. Baby has his basic needs for warmth, food and protection met.
2. Bonding and attachment
Baby’s brain also calms, and all of the expected sensations are collected and fire pathways in the brain. The baby will feel safe and open his eyes to make contact with his mother. This is the start of early bonding, and emotional and social intelligence. As continued contact and breastfeeding continues, a secure attachment is formed, which is the basis of all future physical and psychological health.
3. Breastfeeding
“A baby in the right place is very competent!” says Jill Bergman. A proper latch ensures adequate nutrition, and stimulation of all of the essential hormones. The mother’s chest will warm automatically if her baby is cold, and even cool baby if too warm.
4. Sleep
During quiet sleep, all of these sensations collected will fire and wire circuits to the emotional brain (amygdala), be organised and sent back to the cortex when he wakes again, thus completing the brain circuits for healthy development. Sleep should not be disturbed.
If a baby is separated from her mother early on, all those essential processes are disturbed and a stress response is created. When the baby cries, his heart rate and blood pressure goes up, and oxygen levels go down. The baby crying uses up more calories so is more likely to become hypoglycaemic; these calories are better used for growth.
“High levels of stress hormones for long periods of time are toxic to the neurons that make the brain work. The stress hormone cortisol makes more neurons die off at a faster rate. This disrupts and disturbs developing pathways and circuits. With prolonged stress after birth, the brain is measurably smaller one year later. The only difference between toxic and tolerable stress is the absence or presence of mother or father,” says Jill.
Kangaroo Mother Care babies benefit from better brain and emotional development, less stress, less crying, fewer brain bleeds, more settled sleep. They are more alert when awake and feel less pain from injections, the heart rate stabilises, more breast milk is produced and babies gain weight faster.
Ultimately babies can go home earlier when they have done Kangaroo Mother Care and have better brain and emotional development.
Your baby only needs a nappy and cap. Put her on your bare skin – starting at birth – facing you, inside your shirt. Sit in a chair with cushions so you can be at a 30-40 degree angle to help baby’s breathing. Tuck her legs up in the foetal position. Put her hands near her face for self-soothing. Cover her and yourself. Your body will automatically warm up if your baby is cold or will cool down if your baby is hot. Relax, knowing that your body is the best place for her.
To do this for long periods with a small or premature baby, safe technique requires that the airway is secured, and the baby firmly wrapped against parent’s chest. In this way baby and parents can both sleep. When awake and feeding, the wrapper is loosened, allowing eye contact, and access to the breast.
For more details see the book Hold Your Prem by the Bergmans and www.kangaroomothercare.com
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]]>The post Born at 25 weeks, a story of hope appeared first on All4Baby.
]]>“This was our first child and we were very excited from the beginning. We had wanted to have a child for a long time. It felt like a miracle from the start, but I was naïve about what was going to happen later on. In my mind it was all going to work out perfectly, I was going to have a normal birth and breastfeed without any problems.All the signs up to that point showed everything was well,” says Tanya.
“But when the pain didn’t go away and I started bleeding, I knew something was wrong,” she says. Tanya and her husband, Davy, went to the hospital where their gynae did a physical exam and a scan and confirmed everything was in order.
But the pain escalated through that night and her instincts told her all was not well.
“I woke up early the next morning, but I was so weak I could hardly move. The pain was intense and I could feel the baby moving down into the birth canal. I knew I was in labour, I knew the baby was coming,” says Tanya.
“He was crowning in the car and I kept saying to Davy, ‘drive faster, drive faster’. Although we were only 10 minutes away from the hospital, it felt like the longest drive ever. I closed my eyes so I couldn’t see how far we still had to go.”
“We arrived at the hospital and I stood beside a pillar in the entrance and shouted for someone to help me. I had to keep my legs together to keep the baby from coming out.”
It wasn’t until the staff of the maternity unit saw the baby’s head that they realised Tanya was in an advanced stage of labour. The baby was delivered straight away, with one push.
“I looked at the faces around me in the delivery room and I saw expressions of sorrow and regret.” They looked at Davy, who was distraught and very emotional. The looks implied ‘I’m so sorry for your loss’. I picked my head up and I saw a tiny blue baby. We were overcome with sadness and anguish, thinking that he had not survived, and seeing his little body lying still, without any movement.
“Everyone was quiet, and the pause in conversation felt very long. Then, out of the blue, this sound came, like a gasp. Kyle had taken a breath. Our despair turned into hope.”
Tanya had suffered a placental abruption, where the placenta (which is the source of nourishment for the unborn baby) becomes separated from the uterus. The cause of the condition is unknown, but Davy recalls: “It was a very painful and traumatic experience – Tanya had labour pains for more than 24 hours.”
Kyle had arrived 15 weeks early, weighing just 700g. A foetus is deemed clinically viable from 26 weeks’ gestation.
“The gynae wrapped Kyle in a hospital gown, and the nurse took him and ran to neonatal ICU, where they resuscitated him. They worked on him for an hour to stabilise him and he was on life support for a day and a half,” says Tanya.
“The doctors gave him a 10% chance of survival. He’d been starved of oxygen and we were warned of the possible complications that could arise in the days ahead, like heart and lung conditions and brain bleeds. The first 48 hours were crucial.”
‘Don’t get your hopes up, expect the worst,’ they said.
“I cried so much when I saw him, he looked so tiny and underdeveloped. He had a drip in his head, a feeding tube into his stomach and two other cords attached to his tiny little feet.”
Kyle’s birth was a life changing experience and it put things into perspective for us. I held onto my faith – not the stats and science – based on that first breath, which I believe was him saying ‘I’m here for a purpose, I am going to fight to live, I am going to hold onto hope, it’s my time’.
“We were totally unprepared. We hadn’t thought of names, done the shopping, or got his room ready or anything. I was depressed those first few days, I blamed myself, and thought if I had done this or that maybe things would be different. But I also knew I had done everything to keep fit and healthy, I have never drunk alcohol or smoked in my life, and so it felt unfair that my baby was suffering.”
“But I had to put these things behind me. I never looked back, I just thought about what my baby needed from me. He needed to draw strength from us.”
Kyle spent three months in neonatal intensive care and has had two heart surgeries already.
“From the beginning, we knew we needed to prepare for complications. After a few weeks, Kyle became very ill and the cardiologist picked up some problems. The first was the congenital heart disorder PDA (patent ductus arteriosus) where a connecting blood vessel that is open when the baby is in the womb so that blood bypasses the immature, non-functioning lungs, fails to close at birth. In order to get blood oxygenated, Kyle had to have the gap closed surgically when he reached a kilogram in weight. Kyle was one month old and weighed 900g when this procedure was done.”
The second surgery which was done when Kyle was seven months old and weighed three kilograms, was to open a chamber of the heart that was too small.
Kyle has six-monthly check-ups with his cardiologist, and his third operation, to close the hole in his heart due to atrial septal defect (ASD), is planned for when he reaches 15 kilograms.
“The journey was very stressful and a huge emotional roller coaster for us. Good news and happy moments of bonding always preceded bad news from the doctors, nurses and specialists. Fear, nervousness and despair were common emotions that we experienced, together with pride, joy and hope,” say Tanya and Davy.
“The saying: ‘Where there is life, there is hope’ became our mantra. We never stopped believing that everything would turn out perfectly.”
“The day we brought him home for the first time was the best day of our lives. Our house finally became a home,” they say.
Touched by the Moodleys’ story, the Discovery Health Concierge team reacted to their situation and founded the Premmie Concierge Project, which aims to assist and support parents of babies in the neonatal ICU and beyond.
Although he still has heart defects (atrial septal defect and pulmonary valve stenosis) and poor weight gain, Kyle, who is about to celebrate his second birthday, is an energetic and fun-loving little boy. He learns at least two new words a day. He loves playing with his toy cars, trucks and buses but his favourite pastimes are snuggling up to mommy, playing with daddy and chasing after his cat, Bizzy.
For more information on the Premmie Concierge Project, visit www.discovery.co.za. For more Medical Miracle stories, visit DiscoverySA on YouTube.
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]]>The post Pre-term labour – what you should know appeared first on All4Baby.
]]>The British Medical Association says that 50% of premature deliveries occur for no known reason.
Other causes for going into early labour include;
The major complication for a pre-term baby is respiratory distress syndrome, where the lungs are not yet properly developed. Extra care should also be taken over the baby’s immunity, and his or her ability to suck.
Depending on the circumstances, pre-term delivery can sometimes be averted once labour has begun. Certain medications can be used to prevent contractions and relax the womb, helping to delay birth.
Pre-term birth can’t always be prevented, but there are some things that you can do to lower the risk.
While it can be frightening to go into early labour, modern medicine ensures babies have the best chances of survival, even as early as 24 weeks’ gestation. Many premature babies catch up with their full-term playmates, in terms of development, within the first year or two.
About the Author: Dr Noluthando Nematswerani is a Discovery Health Clinical Specialist. For more information on Discovery, visit www.discovery.co.za.
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