No bones about it

November 2, 2020November 2, 2020Leave a comment

Osteoporosis and broken bones do not need to be a normal part of aging… you can take charge of your bone health and longevity.

Not many of us spare a thought for our hardworking skeletons, until of course, we experience a bone fracture. Only then do we realise how much we appreciate each and every one of the 206 bones of the skeletal system. Our bones provide protection just like body armour, keeping our essential organs safe, such as the skull for the brain and the spinal column and the rib cage. Our bones also allow the body movement, through the leverage of the muscles and are also magnificent storehouses of minerals, such as calcium and also work as factories to produce blood cells. As we age, our bones change, break down, repair and rebuild themselves throughout our lives, which makes it a necessity to understand the ins and outs of optimising our bone health. Charlene Yared-West speaks to Life Healthcare Orthopaedic Surgeons and brothers, Dr Duwayne Vermaak and Dr Slade Vermaak on the topic and finds out how to achieve this lifelong goal.

Your bones are alive and changing
Skeletons conjure up images of Halloween, where bones are dry and stiff. However, this idea couldn’t be further from the truth of the bones which are in your body. In truth, your bones are made of tough, healthy, living tissue. “When bones crack or fracture, they are able to recover through rebuilding themselves and are usually restored to their original strength,” says Dr Duwayne Vermaak, Orthopaedic Surgeon at Life Healthcare Little Company of Mary. “However, the age and general health of the person must be taken into account – as this can affect the healing and regeneration process, which happens all the time – even when there is no injury.” Dr D Vermaak points out that there are often little or no warning signs that one can pick up on that could indicate a problem. “Bones don’t tell you much until it is too late – and then they break… Only then does the patient seek advice – and in most cases, some form of pain relief, as fractures can be very painful,” he says.

What is osteoporosis?

The body uses calcium to rebuild bones and 99% of the 1kg calcium in our bodies is located in the skeletal system. “If there is a shortage of calcium in the body, there is less building material available to the bones for rebuilding, repair and maintenance, which can mean more brittle, weaker and fragile bones; a condition known as osteoporosis. The word literally means ‘porous bone’,” explains Dr Slade Vermaak, Orthopaedic Surgeon at Life Healthcare Little Company of Mary. “Healthy bones can look like a honeycomb, but when you have osteoporosis, the holes in the spaces of the honeycomb comparison, are much bigger.The bigger holes indicate that your bones have lost density or mass, which means that your bones are weaker and more likely to break as you age.” Dr S Vermaak recommends going for a bone density test to assess your bone health.

Who is affected the most?

Worldwide, over 200 million people are affected and one in three women and one in five men over the age of 50 will suffer from a fracture due to osteoporosis. An osteoporotic fracture occurs every three seconds and by 2050, the worldwide incidence of hip fracture in men is projected to increase by 310% and by 240% in women. At the age of menopause, women experience a reduced level of oestrogen, which simultaneously causes a rapid reduction in their bone mass. In men, bone loss occurs at the age of 70 years old. Broken bones can occur anywhere in the body, but most commonly occur in the wrists, spine and hips.

When it comes to bone health… prevention is better than cure

Bone health begins in the womb, where good maternal nutrition ensures the healthy development of the baby’s skeleton in utero, which continues into later life, through living a healthy lifestyle and eating right, explains Dr S Vermaak. “The focus for children and adolescents is on building the maximum bone mass, which happens until the age of around 25, where about half of our bone mass is accumulated. Thereafter, as adults, the emphasis is on maintaining healthy bones and avoiding premature bone mass loss, which can occur through unhealthy lifestyles,” he says, adding that gastrointestinal disorders also affect the nutrient absorption – especially calcium, in people of all ages – and they can be at risk of bone disease, and therefore, may need to supplement with calcium and vitamin D. “When in doubt, consult your GP,” adds Dr D Vermaak.

How can you prevent osteoporosis?

There are certain risk factors which increase a person’s susceptibility to bone disease and these are a sedentary lifestyle and poor nutrition, smoking and alcohol use. In addition, the age is taken into account, previous injuries, the body mass index and existing metabolic and health conditions, such as arthritis. “Smoking and alcohol use should be avoided as much as possible and exercise, including weight bearing and muscle strengthening is important for building strong, healthy bones. This applies to both men and women,” says Dr S Vermaak. “A well-balanced diet cannot be emphasised enough – and one that is high in calcium-rich foods, vitamin D and proteins, as well as other micronutrients, including vitamin K, magnesium, zinc and carotenoids – can reduce the risk of osteoporosis.”

Six top tips to get bone healthy…

Soak up the sun! Get 600 IU of vitamin D per day. Sunlight has become the enemy in the last few years, as consensus tells us to cover up with sunscreen… Also, young people spend less time outdoors, as computers, mobile phones and television take centre stage. All that is required is 10 to 20 minutes of sun exposure on bare skin, outside of peak sunlight hours (before 10am and after 2pm), without sunscreen, while taking care not to burn.
Ensure sufficient calcium, vitamin D, protein and micronutrient intake daily.
- Calcium-rich foods: Milk, yoghurt, cheese, broccoli, dried figs, almonds, tofu.
- Vitamin D-rich foods: Salmon, sardines, tuna, shitake mushrooms, egg yolk.
- Protein-rich foods: dairy products, meat, fish, poultry, lentils, beans, nuts.
- Micronutrient-rich foods: green and leafy vegetables, cabbage, kale, liver, seeds, carrots, red peppers.
Avoid smoking and excessive alcohol and caffeine. If you love your coffee, or other caffeine-heavy beverages, drink less than four cups per day, as more than three cups could be associated with a 20% increase in the risk of osteoporotic fractures… and make sure you are getting enough calcium!
Include daily exercise and muscle strengthening into your regime.
Identify your risk factors.
Take prescribed medication if necessary.

<Sidebar>Are you getting enough calcium?

Calculate your average daily calcium intake in three easy steps. Available online and on mobile devices. http://www.iofbonehealth.org/calcium-calculator

<Sidebar> Knowing your risk factors

Take the International Osteoporosis Foundation One-Minute Osteoporosis Risk Test to find out whether you may have specific factors which place you at higher risk of osteoporosis and fractures.

www.iofbonehealth.org/iof-one-minute-osteoporosis-risk-test

<CASE STUDY>
May Lubbe (75)

(Daughter – carina – 0824664368 carinavd@mweb.co.za)

“One day, like any other day, I was making my bed and as I lifted the corner of mattress slightly, I heard something crack in my back. I lay down on the half-made bed and prayed that when I got up, I would be able to walk. Luckily I could walk after a rest and so I continued with my day, not giving the niggling sensation in my back a second thought. The sensation became painful as it became evening and in the morning, I visited my GP, who prescribed pain medication. No medication seemed to work; it only got worse. Two weeks later after seeing numerous doctors and having an XRAY, I was diagnosed with osteoporosis, a condition I had never heard of. I am a diabetic and have been living with the condition since 1957, so it was bad news that I now had to contend with another ailment. One thing I didn’t know was that as a diabetic, it is even more important to consume calcium-rich foods, which is now a priority in my diet. I have since been on medication to treat the osteoporosis and have made certain lifestyle adjustments and thankfully, I am pain-free and living a full and happy life.”

Polycystic Ovarian Syndrome: A lifestyle-related disease?

November 1, 2020November 2, 2020Leave a comment

Polycystic Ovarian Syndrome (PCOS) is common in South African women and affects about one in 10 women globally. It is caused by a complex imbalance of hormones in the ovaries. Charlene Yared West spoke to Life Kingsbury endocrinologist, Dr Jocelyn Hellig and gynaecologist Dr Philip Zinn to find out more about this condition.

So what is PCOS?

In a woman’s body, the ovaries release eggs each month as part of a healthy menstrual cycle. However, with PCOS the egg is not released as easily, which leads to irregular ovulation and menstruation and can impact fertility. “The ovaries are described as polycystic because there is an excess of the fluid-filled, egg-containing sacs called follicles, all of a similar size, when seen on an ultrasound image,” says Dr Zinn. “This excess occurs due to disturbance of the growth of follicles – to the size required for ovulation.”

It’s all about the hormones… or is it?

Dr Hellig explains that the exact cause of PCOS is unknown. “There is no one singular factor which causes PCOS. It is considered to be a complex trait arising from the interaction of genetic and environmental factors, usually first presenting when mature gonadotropin levels (hormones essential for reproduction)are achieved at puberty. It occurs naturally in primates as well as humans,” she says. “The disorder arises clinically by the presence of two out of three criteria: irregular periods or the absence of ovulation, features of high androgen levels (acne or excess hair growth) and a certain appearance of polycystic ovaries on ultrasound,” she says.

You could be predisposed to PCOS if…

You have insulin resistance.
You have Type 2 diabetes.
You have unhealthy eating habits.
You do not exercise regularly.
You are overweight or obese.

Trying to fall pregnant?

If you are trying to fall pregnant, but it is proving difficult, PCOS might be the culprit, says Dr Zinn. “Many women are unaware that they even have PCOS until they start trying to have a baby. Once they start treatment and their symptoms are managed, then their chances of conceiving are increased.”

QUIZ: ✓Tick the boxes below to see if you might have symptoms of PCOS

Irregular menstrual cycle
Thinning hair or hair loss on the scalp (male-pattern baldness).
Acne on the face, back and chest.
Too much hair on the face or areas where men usually have hair (hirsutism affects up to 70% of women with PCOS).
Weight gain and difficulty losing weight.
Darkening of skin pigmentation, along the neck, groin and under the breasts.
Skin tags in the armpits or neck area.

How is PCOS diagnosed?

“If you think you have PCOS, make an appointment with your gynaecologist. There is no single test to diagnose PCOS, but we take your medical history and can conduct a physical exam with a pelvic ultrasound and do some blood tests,” says Dr Zinn. Dr Hellig adds: “Of utmost importance is that PCOS is a diagnosis of exclusion and it is important for your medical professional to look for other causes of your symptoms before ascribing it to PCOS.”

Physical exam: Checks your blood pressure, BMI and waist size. Also checking for extra hair on the body, skin discolouration, hair loss and any other signs of excess testosterone such as an enlarged clitoris. It is important to exclude other health conditions.
Pelvic ultrasound: A sonogram will examine the lining of the uterus and check the ovaries for the polycystic features.
Blood tests: To check your androgen hormone levels, as well as other hormone checks, including your thyroid.

Can I be cured from PCOS?

8Dr Hellig explains that there is no cure for PCOS, but symptoms can be effectively managed and therefore treated. “We take into account if you want to conceive, your risk of long-term health problems, especially diabetes and cardiovascular disease, and will help formulate an effective treatment plan through lifestyle changes and medication where necessary,” she says.

What can I do to alleviate my symptoms?

Dr Hellig and Dr Zinn agree on the following steps that women can take to treat PCOS:

Lose weight: This will help to stabilise your blood glucose levels and alleviate insulin resistance. Even a 5 – 10% loss in body weight can improve your chances of conceiving.
Remove hair: Using facial hair removal creams, laser hair removal or electrolysis. Medication is not very effective for permanent hair removal.
Hormonal birth control for women not wanting to conceive: Can help to regulate menstruation cycles, stabilise weight, improve acne and reduce new hair growth on face and body.
Anti-androgen medicines: Although not safe for pregnancy, can help reduce PCOS symptoms.
Metformin: A drug used to treat type 2 diabetes and may help some women with PCOS symptoms in certain circumstances.

Do you have the pregnancy glow?

November 1, 2020November 2, 2020Leave a comment

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.

Healing from incontinence

November 1, 2020November 2, 2020Leave a comment

Urinary incontinence is common in pregnancy and is reported by about 60 percent of women. For these women, the severity of their condition can increase during the course of their pregnancy, especially peaking in the second and third trimesters. Of these women who experience incontinence in pregnancy, 70 percent go on to resolve the condition postpartum – and within the first year, the prevalence of incontinence drops down to 11 to 23 percent. Dr Bongi Makhubo, obstetrician gynaecologist from Life Anncron in Klerksdorp sheds more light on the topic.

Early incontinence is normal

Pregnancy can affect the normal way your urethra relaxes and contracts and many women, particularly those who had a vaginal birth, can experience incontinence after childbirth. “The pubic and pelvic muscles and the anal sphincter can be injured in up to 40-80% of births and so, leaking a little bit after birthing your baby vaginally is quite within the normal range, but it is not normal if it lasts for months afterwards,” says Dr Makhubo. “Directly after birth, using a thick maternity pad helps to absorb the leaks, but once you have stopped bleeding and incontinence persists, you might need a specialist appointment to discuss the problem further.”

Stress incontinence is also quite common in new mothers and affects roughly a third of women in the first year after birth. Stress incontinence leaks happen when the mother laughs, coughs, sneezes or goes for a run. Lifting heavy things can also cause these leaks, which are due to increased intra-abdominal pressure and a defective urethral support or closure.

<FACT BOX>What causes incontinence after birth? Dr Makhubo shares the facts:

Weakening of the pelvic floor muscles or injury to the nerves supplying the structures of the pelvic floor, due to a prolonged or difficult labour.
Carrying a bigger than normal baby in utero, leading to difficulty in delivering or stretching and compression of the pelvic floor.
High levels of elastin, a hormone which allows for more stretching of the skin and connective tissue, can cause prolapse and in turn, incontinence (as opposed to collagen, which is decreased during pregnancy).
Assisted delivery, especially with the use of forceps. Research shows that there is less injury and urinary incontinence noted with the use of ventouse in comparison.
Maternal age; the higher the age the higher the association with urinary incontinence.
Parity; incontinence is more common with parous women, however of note is that the highest risk of incontinence is with the first delivery, then 10% risk increase with each subsequent birth.
Vaginal delivery definitely predisposes women to a higher risk of incontinence and most women will be incontinent for a few weeks; however most will be normal within a year.

What can help?

“Pelvic floor muscle training or kegels exercise are by far the best way to combat the problem postpartum, although the research differs as to how much of the exercises should be done. However, these can be done anywhere, and one way to remember to do them is to pick an anchor which will remind you to do them. For example, when stopping at a robot or boiling the kettle: each time you do one of these activities, do some pelvic floor exercises too,” says Dr Makhubo.

She suggests that physiotherapy can also help in some cases. “A physiotherapist will give you cones or a pessary that can be used to squeeze and strengthen the pelvic floor muscle.” Dr Makhubo also encourages lifestyle modifications, such as drinking less coffee and alcolhol and stopping smoking. Decreasing BMI can also help improve incontinence issues. “If lifestyle modifications have been made and incontinence persists, then medical treatments can be offered,” she says. “The last resort is surgery.”

Medical treatment and surgical options

Medication:
- Estrogen creams, duloxetene and even botox can help to alleviate incontinence.
Medical devices:
- A vaginal pessary, which can be used for prolapses. It is a ring-like device and acts as a support for the bladder. A disposable urethral insert may also be prescribed and serves as a leakage barrier.
Bulking agents:
- Bulking agents are injected into the urethra to help plump up the tissues where urine is released from the bladder and help to hold it in.
Surgery: The underlying principle of surgery is to support the urethra, so that the bladder can work effectively.
- “Retropubic urethropexy ( Burch’s Colposuspension ) is used most common surgery for this condition. It is an abdominal procedure, where the pubocervical fascia is attached to a copper ligament or to the pubic symphysis (pelvic bone),” explains Dr Makhubo. “This helps lift the anterior vaginal wall and tissues surrounding the urethra and bladder, which helps to alleviate incontinence.
- Slings: There are various kinds of slings and they are all made of mesh. The use of mesh has been approved by the FDA and the South African Urogynaecology Society endorses and supports the use of this method for incontinence. A ‘hammock’ is created using mesh and tissue to support your urethra and can be done under local anaethesia.
  - Pubovaginal slings, mid-urethral slings, mini-slings and micro-slings are used as a means to help incontinence, but implanting mesh where it is needed, in and around the urethra. These range from being quite invasive to non-invasive. Your care provider will help you decide on the best approach for you.

Healing… after miscarriage

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Miscarriage is the most common type of pregnancy loss and according to the American College of Obstetricians and Gynaecologists, 10-25% of all recognised pregnancies end in miscarriage and about 80% of all pregnancy loss occurs in the first trimester. Unrecognised pregnancies, which are also known as ‘chemical pregnancies’ account for 50-75% of all miscarriages, where the pregnancy is lost shortly after implantation, where bleeding occurs around the time of the woman’s expected period. Charlene Yared West unpacked the topic with Dr Francis Maleka from Life Mercantile Hospital. “In short, miscarriage is more common than we think,” he says.

Why does miscarriage happen?
“Not every miscarriage has a clear cut reason and often the cause isn’t identified. Women will ask themselves why – and often blame themselves, but the truth is, there is very little you can do to prevent a miscarriage,” says Dr Maleka. Reasons include chromosomal abnormality, hormonal problems, infections, maternal health problems, maternal age, maternal trauma, lifestyle (smoking, drugs, malnutrition) and implantation of the egg that does not occur properly. “Things that do not cause miscarriage are sex, working outside of the home and moderate exercise,” he adds.

Men – the forgotten grievers

Women are the ones who have to cope physically and emotionally after the loss of a baby. Often, the grief men experience goes unacknowledged. According to research carried out in 2014 by Dr Petra Boynton at the University College London, dads said they felt happy, excited, thrilled or delighted about the pregnancy before the miscarriage – and 55% of those men had already picked out a name for the baby. After the loss, many fathers reacted with feelings of sadness (85%), grief (63%) and shock (58%), but nearly a quarter didn’t share their feelings with their partner, usually for fear of upsetting her more or saying the wrong thing. “I encourage couples to talk about what happened and also to see a therapist if they find it difficult to access those emotions,” says Dr Maleka.

Getting pregnant after miscarriage

Deciding to have another baby after miscarriage can cause mixed emotions for both parents. “On one hand they want a baby, but the next time around is often fraught with fear of another loss. We have to pay special attention to the next pregnancy even more carefully,” says Dr Maleka. Parents may choose to delay falling pregnant again due to surgery from the miscarriage, a delay in menstrual cycles, genetic testing and autopsy reports, and emotional issues and readiness. “Seek support from family and friends, as well as your doctor or midwife and professional support groups, to help you heal after miscarriage,” he says. “Remember that you are still grieving the loss of your baby while attempting to get pregnant again. Be gentle on yourself.”

A case study: “How I moved forward”

We fell pregnant for the first time in 2011 and were so excited. We decided not to wait until the 12 week time period to share our news with friends and family – as for us, a life is a life and we told everybody! I had all the pregnancy symptoms; sore breasts and bouts of nausea. Then I was at work one day and started bleeding heavily. The doctor confirmed the miscarriage and we were distraught. I was so heartbroken and this heaviness weighed down on me for weeks. My husband and I went away on a relationship workshop weekend camp and for me that was the turning point. The camp was situated in a beautiful place in nature, which brought me a lot of comfort. There was also a small chapel there that my husband and I would visit. In the quiet of this tranquil place, I came to the realisation that I had to give her a name as I sensed she was a girl and that I needed to somehow name her. So, we named her Faith and I think just the act of giving her a name gave me such a sense of relief. I was much better afterwards and fell pregnant soon after… and gave my baby the second name of Faith, so that I would never forget the first little life that came to me. I think a lot of people after miscarriage tend to want to close it off and not talk about it – and try their best to forget about it. I somehow embraced the experience as painful as that was and named her, letting myself to feel the loss that occurred. This is what gave me closure. We have two daughters now, but have never forgotten baby Faith.

Own your birth: Why you need a birth plan

November 1, 2020November 2, 2020Leave a comment

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.

The basics of car-seat safety

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In 1769, the first steam-powered car was invented, with subsequent improvements as better automobiles were built throughout the years. It took almost 200 years later for the first safety belt to be invented by the mid 19th century. It was only in 1966 that an Act was enforced, requiring all vehicles to comply with certain safety standards. In 2015, the South African National Road Traffic Act enforced the regulation that all infants (0-3 years) be restrained appropriately when travelling in cars. By Charlene Yared West.

The danger of being unrestrained in cars

According to the World Health Organisation, children who are not restrained during a car crash can either be thrown against the interior of the vehicle or be ejected from the vehicle. The use of seatbelt and child restraints is the most effective action of preventing the severity of injuries during a car crash. Chances of survival increase drastically when restrained appropriately. The World Report on Road Traffic Injury Prevention states that the use of child restraints in vehicles reduces infant deaths by about 71%. A study conducted in Sweden showed that about 50% of fatally injured children aged up to 3-years had been involved in side impact collision.

What car seats are age appropriate?

The main determining factor for choice of an appropriate car seat is the child’s weight. Older children who are above the height and weight specifications for using car seats require a properly fitting three-point lap and diagonal seat-belt when riding in a vehicle. A review of various studies has shown that child safety seats that are correctly installed and used for children aged 0-4 years can reduce the need for hospitalisation by 69%. The risk of death for infants is reduced by 70%, and that for children aged 1–4 years by 47–54%.

(Table extracted from the American Academy of Pediatrics http://www.healthychildren.org)

Protecting vulnerable travellers

The skulls of infants are far more malleable before 24 months and so they need less force to sustain a brain injury, explains Anna Bizos, physiotherapist at Life New Kensington Clinic. “Travelling at a speed of 60km/h can inflict horrendous injury on the unrestrained child. The acceleration is too great – and it has been shown that an adult holding a child in the backseat, will not be able to hold onto them at the moment of impact, but will release their grip, which means the child will be flung around the car or be ejected from the vehicle. The airbags, if deployed, can also cause suffocation for the child on the adult’s lap,” she says. The bottom line is, children cannot be unrestrained in cars! Parents must be consistent and model good car safety habits – for everyone in the car, every time, even if there are tantrums.” CEO of the QuadPara Association of South Africa, Ari Seirlis agrees; “The consequences of a spinal cord injury especially for children and young people, are too dire to contemplate,” he says. “QASA promotes that seat belts are essential to use in a vehicle and our road safety programme has the slogan buckle up, we don’t want new members.”

Rehabilitation Paediatric Programme at Life Hospitals

Life Healthcare’s Rehabilitation paediatric programmes are focused on providing holistic, interdisciplinary individually targeted interventions that are developed for each child, based on a variety of standardised and internationally recognised assessments, says Nomsa Mbuyisa, Nurse Manager at Life New Kensington Clinic. “We hold interdisciplinary team meetings weekly to assess the child’s progress and, based on this, whether any adaptations should be made to the programme.”

<Sidebar> Sister Mbuyisa shares her top car safety tips for infants

Everyone in the car must always buckle up!
Always check that the car seat is correctly installed.
Ensure that the child is in the correct age car seat. Infants need to stay in a rear facing seat in the back seat, making sure to install the seat at a 45-degree angle to help support the baby’s head and back.
Make sure your car seat works in the type of car that you have. Not every child safety seat is compatible with every car.
Replace the car seat after a crash. Even a minor accident can compromise the structure of the seat. Avoid buying used car seats since you don’t know its history.
Never leave a child alone in the car as they can overheat quickly when it’s warm.
Never share a seat belt. Do not use one seat belt to buckle two kids.
Ride in the backseat. Children who are younger than the age of 12 should always ride in the backseat. In an accident, the airbag can injure a small child.
Stay calm. Teach kids to be quiet and calm in the car. They must not jump around, yell or

scream in the car as this can distract the driver. This can put everyone in the car at risk.

In the unfortunate event of a car accident, the Road Accident Fund is able to assist with medical expenses, loss of support, funeral benefit and general damages for pain and suffering. To lodge a claim, claimants can contact the Call Centre on 0860 23 55 23.

Caesarean birth: Safety is the priority

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When planning for your birth, you must consider your options; an attempt at vaginal birth, which may or may not result in an emergency caesarean, or choosing to have a caesarean, also called a Caesarean Delivery on Maternal Request. Charlene Yared West spoke to Dr Jacky Searle, an obstetrician-gynaecologist at Life Vincent Pallotti about the risks and benefits of caesarean section.

Reasons for a planned caesarean include:

Placenta praevia (a low-lying placenta)
Breech presentation
Previous caesarean section
Previous shoulder dystocia
An elective caesarean delivery, also called Caesarean Delivery on Maternal Request (CDMR) in the absence of a medical or obstetric reason for avoiding a vaginal birth.

Reasons for an emergency caesarean include:

Cephalo-pelvic disproportion (baby’s head does not fit through the mother’s pelvis)
Fetal distress
Congenital malformations of the baby
Pelvic abnormalities
Infection of the mother
Situations where labour isn’t recommended such as; eclampsia (seizures resulting from high blood pressure) or prematurity of the baby

BEFORE: Preparing for a Caesarean

“For a scheduled caesarean, a protocol is followed, which includes not eating or drinking for six to eight hours before surgery and shaving the bikini area where the incision will be made.” Says Dr Searle. “On arrival at hospital, there are forms to fill out and the anaesthetist will meet you and make a pre-operative assessment before surgery. You will also meet the attending paediatrician shortly before the procedure.” Dr Searle adds that women may choose to have a doula to accompany them for their caesarean. “She will often arrive with you at the hospital and pamper you before going into theatre. This can help a mother relax and connect to her baby and the imminent birth.”

In the case of an emergency caesarean, the surgery is usually done within 30 minutes of the decision being made. The mother will be accompanied by her partner, and her doula, if she has one. “This can be stressful, and even traumatic for the parents, but an adequate explanation of the necessity of the caesarean should always be provided, enabling them to understand and process the experience. All pregnant women should understand that the outcome of labour is unpredictable, but a caring team can support her through the process of childbirth and help her to feel cared for and held throughout.”

DURING: In theatre for a caesarean

In theatre, the mother will have a drip inserted and anaesthesia is almost always regional (awake) – either spinal or epidural. A urinary catheter will be inserted once the anaesthetic is working. “Women, especially those who have not chosen a caesarean, are often pleasantly surprised to find that caesarean birth can be a truly beautiful experience for a mother and her partner,” says Dr Searle.

A gentle caesarean

A ‘gentle caesarean’refers to minimising the medicalisation of the process where possible and enhancing the gentleness. “I am proud to say that this is routine at Life Vincent Pallotti,” says Dr Searle.

A gentle caesarean includes;

Limiting unnecessary noise and chatter
Dimming the lights, playing the mother’s choice of music
Not removing the baby from its mother after birth
Early skin-to-skin contact and early latching

AFTER: Post-recovery form a caesarean

A regimen of analgesia will be prescribed to ensure that any post-operative pain is manageable, explains Dr Searle. “Mothers generally recover well post-caesarean, as they are motivated to get up and moving, and are distracted from post-operative discomfort by their baby! Breastfeeding is encouraged and assistance is provided for all new mothers in the maternity wards at all Life Healthcare hospitals. Mothers usually stay in hospital for four days/three nights after a caesarean section,” she says.

VBAC: Vaginal Birth After Caesarean

“It is appropriate for any woman who has a single pregnancy, with a baby in the head down position, and who has had one previous lower section caesarean, to consider a VBAC,” says Dr Searle. “A successful VBAC is more likely in women who have also had a previous vaginal birth, taller women, women less than 40 years old, where labour occurs before 40 completed weeks, and where birth weight is less than 4kg.”

Sam Suter’s empowering emergency caesarean

I had always wanted a natural birth, although I am hesitant to use that word now, as no birth is unnatural. A birth is birth, no matter how a baby comes. At 39 weeks pregnant, I was induced to attempt a vaginal birth, because my blood pressure reading was climbing and continued to increase to dangerous levels. This was around at 10am in the morning and at 10pm at night, although contractions had begun, they were ever so slight and my blood pressure was rising. The decision to have a caesarean was made because of the risk of a stroke.

I believe all birth experiences have an element of trauma, and this is all part of it – but for me the euphoria and the memory of seeing Tom for the first time, far outweighed any trauma. What I didn’t know is that even if you’ve had a caesarean, nature takes over and the ‘love and bonding’ hormone oxytocin is released – in both mom and baby. I was definitely feeling the oxytocin and looking back, the experience is such a happy one. Happy is in fact not the word to describe it… It was the most incredible human experience I have ever had.

The whole birth experience was not ‘perfect’ or how I had envisioned it, but I had to go with the flow, what was best for my baby and I, and I think that is a huge learning for parenthood overall.

Medication & pregnancy

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Knowing what medication is safe to take in pregnancy is very important when considering over the counter and prescription medications. There will be times in your pregnancy when you simply don’t feel well – and wonder if it’s safe to take the same medication you took before you got pregnant. Life Healthcare delves a bit deeper into this topic, making sure you and your baby stay safe during pregnancy.

Why is it important to know the facts about what’s safe and what’s not?

In the late 1950s the drug ‘Thalidomide’ was released as a non-addictive sedative, which could also effectively treat morning sickness in pregnant women. It was distributed to 46 countries and what followed was a medical disaster where over 10,000 children were born with a range of severe debilitating malformations. “That was one of the most devastatingly tragic events in medical history – one that should never be repeated. However, it is rare for something like that to happen again in our day and age, where women are more informed about what’s safe and what’s not – and do question everything,” says Dr Billy Joseph Jacobs, gynaecologist and obstetrician at Life Glynnwood. “We encourage all our patients to clear the medications they were on with us – and if they are experiencing symptoms, to check with us what medications are safe to take now that they are pregnant,” he says. “The greatest risk to the baby is in the first trimester of pregnancy when all the organs are forming. Oral medication used for acne is especially dangerous then. It is best to avoid all medication in the first trimester, unless prescribed by your doctor.”

Clinical Practice Pharmacist at Life Eugene Marais Hospital Kashmiri Ganas, agrees; “During pregnancy, many medications and supplements can be passed via the placenta directly to the foetus,” she says. “Some medications and supplements can cause harm or birth defects to the unborn child, so it is of utmost importance to consult your doctor before taking any medication or supplement. The same holds true once your baby is born and if you are breastfeeding.”

Medication to avoid in pregnancy

According to Dr Jacobs, medication containing alcohol and pseudoephrine, which is found in common cold and flu preparations, as well as aspirin and anti-inflammatory agents such as Ibuprofen and Diclofenac are not safe in pregnancy and should not be taken, unless directed under the supervision of your treating doctor. “Each medication has a risk factor classification associated with it and it is on an individual basis that safety is established,” he says.

Chronic medication in pregnancy

Pharmacist Kashmiri adds that it is very important to also inform your doctor of any chronic illness that you may have. “Your doctor will then decide on the risk benefit ratio when deciding whether to continue treatment or not. Conditions that require treatment such as epilepsy and depression must be treated adequately, as failing to do so may result in a risk to mother and baby,” she says. “The doctor will review all medication taken to treat the chronic condition and establish whether it is safe to take whilst pregnant, if it is deemed to be harmful during pregnancy an alternate drug may be prescribed or collaboration with a physician may ensue.” Dr Jacobs agrees, adding that it is imperative that all medication is taken as prescribed, at the correct dose, quantity and frequency as deviation in any way may cause harm to you or your baby. “Always read the label and look for allergic reactions, expiry dates and warnings – and be wary of side effects. In addition, be careful not to mix up your medications or skip medications when you should be taking them.”

<Sidebar> Dr Jacobs and Pharmacist Kashmiri share their advice on how to alleviate some common pregnancy conditions from A to Z.

Common Pregnancy Conditions	Safe medications and remedies	Advice:
Allergies	-Allergex-Loratadine-Nasal decongestant spray-Nasal steroid spray	May be used with caution in pregnancy, consultation with doctor is preferred. If allergic reactions last longer than a day or two, see your doctor.
Constipation	-Movicol -Glycerine Suppositories.	Increasing fibre and fluid intake may help relieve constipation, as well as adding dried fruit, prune juice and bran to your diet.
Common Colds and Flu	-Salex Nasal Spray/Rinse-Prospan Cough Syrup -Paracetamol	If a respiratory infection is suspected, your doctor should be consulted.
Diarrhea	-Kaolin-Pectin-Imodium-Smecta -Rehidrat	Contact your doctor if diarrhea is severe, if there is blood in the stools or if symptoms continue for longer than 24 hours. Most diarrheal illness last only a day or two without treatment. It is important to replace fluids lost with a rehydration solution.
Fatigue	-Prenatal vitamins-Folic acid -Magnesium.	Get plenty of rest, elevate feet, and eat a well balanced diet. If the problem is persistent, contact your doctor as this may also signal low iron levels. It is also very important to take folic to prevent a condition known as spina bifida in the baby.
Faintness and Dizziness	-Don’t self treat.	Fainting and dizziness that is not relieved by sitting down or lying down must best be assessed by your doctor. It may be a sign of either high/low blood pressure or glucose levels which may cause harm to the unborn baby.
Hemorrhoids	-Anusol-Preparation H	Constipation aggravates the symptoms of hemorrhoids, so ensure a high fibre diet and increase fluid intake. Don’t delay going to the bathroom. Sitting in a warm bath may help alleviate some symptoms.
Headache	-Paracetamol	If pain is not alleviated, contact your doctor, as this may be a sign of elevated blood pressure. It might also be an indication of dehydration so increased fluid intake may also help. If you have a fever, contact your care provider immediately.
Heartburn & Indigestion	-Gaviscon-CitroSoda-Rennies-Maalox	Steer clear of foods which can exacerbate symptoms.
Insomnia	-Antihistamines listed above for allergies have a sedative effect.-Sleep eaze	Take a warm bath before bed, try different sleeping positions or a maternity pillow, or ask your partner to give you a massage before bedtime.
Muscle Strain	-Slow Mag	Slow Mag is considered safe and is especially effective for leg cramps that are common during pregnancy.Taking a warm bath may also help.
Nausea and Vomiting, morning sickness	-Asic-After 8 weeks pregnancy; Zofer	Identify foods that may trigger these symptoms. Starting the day off with a dry bland meal such as toast may also relieve these symptoms. Eating smaller meals more frequently. Also easily digestible and less fatty meals.
Rashes	-Allergies medication-Mild steroid creams	Your Pharmacist will be able to advise on a suitable topical treatment or consult with your doctor. Identify the cause, skin irritation, food allergy, contact dermatitis. Mild steroid creams for a day or two is safe.
Urinary Tract Infection (UTI)	-CitroSoda	Contact your doctor as a UTI may cause harm to the unborn baby. Citro Soda relieves burning only. If persistent, see a doctor.
Yeast infection	-Canesten Cream	Contact doctor as a Yeast infection may cause harm to the unborn baby. Use a probiotic like Interflora when recurrent.

‘Surrogacy gave us the gift of twins’

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Tasha and Wayne McKenzie wanted a baby even before they said their vows on their wedding day. After four years of trying to fall pregnant naturally and after six unsuccessful rounds of IVF, their friend Lee-Ann Laufs said she would be their surrogate. Charlene Yared West sat down with Tasha, Wayne and Lee-Ann to learn more about their surrogacy journey.

Surrogacy chose us

Wayne and Tasha felt that they had exhausted all their options to have a baby, save the adoption route. Their friend, Lee-Ann Laufs worked closely with with a safe house for abused and abandoned children called Miracle Kids in Cape Town. “I emailed her to get the details and she called me back saying that she had been telling my wife Tash for months that she would be our surrogate – and that she really meant it. I was blown away by what she said and wanted to laugh and cry simultaneously. I knew this could finally be it… We could have our baby!”

Tasha recalls how she got to know Lee-Ann in her beauty salon; “When she came for treatments, we got to know each other and would start chatting about where I was in fertility treatment. She always mentioned wanting to be our surrogate, but sometimes people say things they don’t really mean and I wasn’t sure if this was one of those times, so I left it at that. She gave birth to her second son and after the caesarean messaged me from the hospital saying she would do this for us. She told us to be patient and wait a little while longer until she had healed and was ready to be pregnant again. We left it at that and I still didn’t believe her!”

It was only after Lee-Ann and Wayne had spoken that the offer of surrogacy became real to Tasha. “Unless you have been through the process, you will never know the heartache of infertility and I was terrified to allow someone else to carry my baby.” adds Tasha. “It was the best news to hear that both eggs survived and we were expecting twins. Prof Thinus Kruger from the Aevitas Clinic dealt with the embryo transfer and making us pregnant.”

Lee-Ann recalls how during the pregnancy, Wayne started calling her “Smeg”, which was a code word for oven. “That was exactly how I viewed the pregnancy; I was an oven for their babies. Simply put; their sperm and eggs, my uterus. The babies don’t receive anything from the surrogate mom except food and a warm comfy womb.This is known as gestational surrogacy,” explains Lee-Ann. “There were no feelings afterwards of ‘I wish they were mine.’ The joy it gives others is so worth it and helps erase all the heartache they went through to finally have their babies.”

The medical side

“The surrogate and the commissioning mother need to sync their monthly cycle,” says Professor Thinus Kruger from Aevitas Fertility Clinic in Cape Town. “Hormone injections are administered to the surrogate to stop her from ovulating at this time. Her uterine lining also needs to be a certain thickness so that the embryo can be transferred into the lining to grow.” He explains how the commissioning mother’s eggs are stimulated to get as many as possible and are then grown until they are mature enough to be harvested and then fertilized by sperm from the father. “The laboratory scientist selected eight eggs based on quality and and then fertilized those. They are then grown and allowed to undergo cell-division outside of the body between three and five days. Not all the eggs will go through these stages of cell division and then another selection process takes place where only two embryos are transferred into the surrogate’s uterus at this time. After the transfer, there is a waiting period of ten days before seeing if the pregnancy is viable.” Prof Kruger explains that there are variations to this process and it is not successful at every stage.

Gynaecologist and obstetrician Dr Gary Groenewald was chosen by Lee-Ann to continue his care as her primary caregiver. “Lee-Ann is an extremely giving person and to do this for friends – to undergo pregnancy and surgery via caesarean section – is a major sacrifice. It really takes a special, very generous person to do this for someone else,” he says.

Since the McKenzies’ case, Life Healthcare developed a very practical and sensitive protocol to deal with future surrogacy cases. Wayne shared how special the caesarean was at Life Kingsbury and that he and Tasha were allowed to be there as well as Lee-Ann’s husband, Shaun. “It was the best day of our lives and we are forever grateful to Lee-Ann for what she did for us. We are adjusting to life with our baby girls, Lea and Madi and being parents,” says Tasha. “It has been an amazing journey and all the pain and disappointment of infertility is slowly fading, but it still feels like a dream sometimes… but then I see my daughters and I am so proud and happier than I could ever have imagined possible.”

Surrogacy Quick Facts

According to Surrogacy.co.za, women who want to be a surrogate need to have had experienced pregnancy and birth and have at least one living child of their own.
A surrogate also needs to be in good physical, emotional and mental health. A thorough medical and psychological examination is carried out to ascertain suitability of the surrogate and the parents.
Since 2010, new laws about surrogacy were passed and women wanting to be surrogates may no longer gain financially from the process. However, all medical bills for the pregnancy must be footed by the commissioning parents. You may only be a surrogate for altruistic reasons.
Commissioning parents opt for surrogacy because they are unable to conceive their own child via fertility treatment or otherwise. Many gay couples who want a child of their own often look for a surrogate to help them achieve this.
As a surrogate you have no rights to the child after birth.
A contract is drawn up with the Surrogate Lawyer so that your surrogate does not run away with your unborn child. In the contract it also states how many IVF processes the surrogate is willing to do and how many IVF processes the parents to be are able to afford before cancelling the contract.
Check out www.surrogacy.co.za for more info.