birth plan – Charlene Yared West

In pregnancy, your skin can exude a truly healthy glow because of a combination of factors, such as greater blood volume, which can give the cheeks a flushed look and more sebum on the skin, which can make the skin shine. While every woman experiences hormone changes in pregnancy, not every woman will get that pregnancy glow. It is well-documented that pregnancy brings with it a whole new set of skin concerns – not just the most common of problems, namely stretchmarks. Charlene Yared West spoke to Life Fourways Hospital Gynaecologist, Dr Abigail Lukhaimane, Life Mercantile Hospital Dermatologist, Dr Zinzi Limba and Genesis Maternity Clinic Maternity Coach & Spa owner, Tsholo Bless, to find out more about skin conditions in pregnancy.

Acne-oh-no!

What is it? “Acne is very common in pregnancy, especially in the first and second trimesters and in some cases can be quite severe. When your hormones settle by the third trimester it can subside for most women, but this is not always the case” says Dr Abigail Lukhaimane. “I do my best to reassure moms that it is a natural , cosmetic condition and that it will get better when hormones stabilise.”

Primary cause: Dr Zinzi Limba explains that increased levels of androgen hormones, believed to be important for cervical ripening at full term, as well as for maintaining a healthy pregnancy, can cause acne.

What can you do? “Managing acne in pregnancy can be tricky because many prescriptions and over the counter treatments are contraindicated for pregnancy and can cause birth defects,” says Dr Limba. She encourages moms to talk to their doctor to plot the best and safest way forward before taking any acne treatment.

Tsholo Bless recommends some easy drug-free options for managing zit outbreaks:

When washing your face, use an oil-free, alcohol-free cleanser, limiting washes to twice a day. Avoid over-cleansing as this stimulates the oil glands in the skin to produce more oil.
Change your pillowcases often – use cotton pillow cases which encourage the skin to breathe.
Keep your hands away from your face so that you do not spread bacteria from your fingers to your face. This goes for your mobile phone too – a device dripping in bacteria, even on the best days!
Avoid the temptation to squeeze or pop your pimples, as this can cause re-infection and scarring.
If you have clogged pores, treat yourself to a professional salon facial.

Chloasma: The Mask of pregnancy

Dr Lukhaimane explains that chloasma, also known as melasma, is a common skin problem where the condition causes dark, discoloured patches on your skin (hyperpigmentation). Most common on the forehead, nose, cheeks and chin. According to the American Academy of Dermatology, 90% of people who develop this condition are women.
Primary cause: “Estrogen and progesterone sensitivity often accompany this condition and can trigger it,” says Dr Lukhaimane. “Usually it is self-limiting and will fade after the pregnancy. Sun exposure can also predispose melasma. In addition, darker skinned people are more at risk than those with fair skin.”

How do I know I have it? A visual exam of the area is often enough for your care provider to diagnose it, says Dr Limba. “However, dermatologists can perform a bed-side test using a Wood’s Lamp – a special kind of light that allows the doctor to check for any bacterial and fungal infections to determine how many layers of skin the melasma has affected.”

Living with melasma: Not all cases clear up with treatment, but there are methods of behavioural changes that can help minimise the worsening of the condition. “Visit your doctor to discuss prescription options that are safe to use for pregnancy,” says Tsholo.

Use Paraben-free makeup if you are self-conscious to cover up areas of discolouration.
Wear Sunscreen containing Titanium Dioxide & Zinc Oxide – every day!
Wear a wide-brimmed hat and protective clothing when you are out and about in the sunshine.
Seek out support groups for your condition.

The Pregnancy Line

The pregnancy line is also known as linea nigra and is a normal and natural part of pregnancy. It is brown and darker than the skin tone of the woman and is a vertical line running down the middle of the belly, between the belly button and the pubis, explains Dr Lukhaimane.

Primary cause: “It is understood that the linea nigra and the darkening around the nipples is caused by the hormones estrogen and progesterone, which stimulate the production of melanin, the pigment which darkens and tans the skin in pregnancy,” says Dr Limba.

Does it fade? After pregnancy and birth it goes away on it’s own – you do not need treatment.

Stretchmarks? You earned your stripes mama!

“Stretchmarks are very common in pregnancy, affecting about 8 out of 10 women – and do not cause harm to the mother or baby, but can cause itching on the area for some women,” says Dr Lukhaimane.

Primary cause: Dr Limba explains that skin is highly adaptable and can stretch and contract, but during pregnancy, the skin does not have enough time to adjust, which causes the skin to tear, which in turns results in a scar that forms – and this is known as a stretchmark.

Who gets stretchmarks? “Lighter skinned women often get pink stretchmarks forming, while darker skinned women will have lighter stretchmarks than the surrounding skin area. Stretchmarks can occur anywhere; on the hips, thighs, belly breasts, lower back and buttocks,” says Dr Limba.

Treatment: Tsholo says that there is no absolute treatment for stretchmarks, but that women can be comforted to know that they will fade into paler scars and sometimes become less noticeable, but will not go away completely. “The best advice would be to make sure that you keep the skin well nourished and a cream or oil made from plant oils rich in Omega 3,6, & 9 can be very useful. A study published in International Journal of Molecular Sciences by T.Lin et al showed that the topical application of some plant oils can have anti-inflammatory and skin barrier repair effects. This also means that the itching is reduced. So it is wise to seek information from your skincare therapist,” she adds.

TOP TIPS

Sunscreen is imperative.

When pregnant, all medication should be cleared by your physician / gynaecologist.

The birth plan: a tool pioneered by childbirth activist and midwife, Sheila Kitzinger in the 1970s, who believed that women and not their caregivers, should be the focus of childbirth and be able to advocate for themselves with this document, which detailed their wishes for the delivery. In the wake of birth plans, the Better Births Initiative was formulated as a way of educating caregivers on the general care of women in labour. The initiative was also rolled out in South Africa and expected to be adopted by all hospitals by 2015. Amongst the guidelines, it encourages respect, privacy and companionship for women in labour, pointing out that women should be able to labour and birth in whatever position they feel most comfortable, with as many birth companions as they choose to have. By Charlene Yared West.

Birth plans inform and educate

“Birth plans have become common practice now, as expectant mothers are more informed about their birth choices,” says Marié van Heerden, midwife and hospital manager at Genesis Maternity Clinic. “It is a good exercise for each expectant parent to inform themselves of their options through compiling a birth plan, so that they understand what they can expect, as well as benefit and risk of procedures and medication – and know where they can make certain choices. This applies to any type of birth, whether it is for a natural or planned caesarean section.” Laura Sayce, doula and lactation consultant at Genesis agrees; “I help my clients to compile their birth plans as a way of helping them make informed decisions. It also encourages them to do their own research into each element of the birth and then to make choices based on this information.”

What should a birth plan include?

According to a research paper Birth Plans, the good, the bad and the future by J.Lothian (2006), the focus of birth plans should be to answer three patient-focused questions: What will I do to stay confident and feel safe? What will I do to find comfort in response to my contractions? Who will support me through labour, and what will I need from them? “I encourage all my patients to write out their birth preferences and to make copies of it, one of which is placed into their file at the hospital and extra copies for the hospital midwife on duty for the day they go into labour,” says Dr Sean Drew, gynaecologist-obstetrician at Life Hilton Hospital. “It helps everyone onto the same page about what the parent’s intentions are for the birth, but it must also leave room for what happens in the event of having to resort to ‘plan b’ option, which is often not detailed in the plan, but should be.” Dr Drew explains that as medical professionals, their first obligation is to the safe and healthy delivery of baby and mother. “First we want to ensure life, then we can look at incorporating all the ‘quality of life’ elements from the birth plan. This is not to say we don’t observe what is written in the document. It is quite the opposite. We do try to fulfil the mother’s wishes to the best of our ability, within our scope of practice.”

Most important birth plan elements

Life Hospitals aim to work in an evidence-based way. Sister van Heerden points out that it is helpful to speak to your care provider and to do a hospital tour, so that you have a clearer insight into how the births are conducted at the hospital you have selected to birth at. “Once you have done that, you are ready to write your birth plan. There are so many templates on the internet, but here are some important factors to include,”:

Labour and birth: freedom to eat and drink in labour, play music, dance, make labour sounds without inhibition, use aromatherapy oils (safe for labour and birth), have freedom to move into any position and birth in any position on the floor, or the bath or the bed. A mother should be allowed access to a doula or birth companion of her choice, who will provide non-medical pain relief options, including hypnobirthing, massage and general encouragement. Delayed cord clamping after the baby has emerged to allow for all the baby’s blood to be drained from the placenta to the baby.
First hour: Uninterrupted, immediate skin-to-skin contact with the mother or the father (if the mom is unable to). Assistance with the first latch if requested, otherwise the baby should be allowed time to attempt a breast crawl. Weighing and measuring to be done after the first hour of bonding for the family. No separation of mother and baby unless absolutely medically necessary.
Postnatal: Rooming in with your baby, no formula unless there is informed consent of the mother, provision of pain relief if medically necessary and assistance with breastfeeding.
Plan B: In the event of an unexpected caesarean, there are still choices. The mother can request immediate skin-to-skin with the baby in the theatre after the initial checks by the paediatrician and no separation unless medically necessary. Early initiation and assistance with the first latch. If the baby has to go to the neonatal ICU, then the father may accompany the baby.

What are the roles of each of the professionals present at a birth?

Obstetrician-Gynaecologist: A medical doctor who is the primary caregiver for your birth and there to deliver the baby when it is time to push the baby out. He/She may also conduct vaginal examinations during labour, but this is more often performed by the hospital midwife on duty. It is also the role of the doctor to perform the caesarean sections either scheduled or emergency.
Hospital Midwife: The hospital midwife performs nursing duties during labour and ensures the medical needs of mother and baby are taken care of by checking foetal heart rate, mother’s well being,blood pressure and other medical checks. She/he may also conduct the vaginal examinations, under the instruction of the primary caregiver, the doctor. In private hospitals in South Africa, the baby is delivered by the doctor and not by the midwife, unless the baby is born before the doctor’s arrival at the birth. The midwives at Life Healthcare hospitals are however trained to conduct normal deliveries. In government hospitals, the hospital midwives are permitted to conduct deliveries.
Independent Midwife: She/he fulfils the same role as the hospital midwife, but may also deliver the baby and call on the obstetrician-gynaecologist in the event of an emergency. Independent midwives may also conduct homebirths, hospital births on low risk pregnant women, with confirmation and back up of a supporting gynaecologist-obstetricians.
Doula: A doula is employed privately by the parents themselves and works independently of the hospital. She is non-medical and is there for the mother’s physical and emotional support throughout the labour process. She may not advocate on the mother’s behalf to her caregivers. Research supports the use of a doula for a more empowered and positive birth experience, no matter what turn the birth takes, whether the baby is born vaginally or abdominally.
Anaesthetist: The anaesthetist is called in if the mother requests an epidural during labour and is also there for caesarean births to administer the spinal block and for ensuring adequate pain relief after the caesarean.
Paediatrician: The paediatrician is called in after natural births to check on the wellbeing of the baby. They are also present during caesarean sections to ensure the health of the baby.
Lactation consultant: Although the mother receives breastfeeding advice and assistance from the midwives in the maternity unit of the hospital, a lactation consultant is extremely helpful to ensure long-term breastfeeding success.