Relactation: Can you breastfeed your weaned baby again?

November 2, 2020November 2, 2020Leave a comment

Just how easy is it to stimulate milk supply after stopping or induce lactation as an adoptive mother? Charlene Yared West explores the topic of relactation and induced lactation to find out more.

Firstly, what is relactation?

According to Leana Habeck, La Leche League Leader (llli.org/southafrica), there is a difference between relactation and induced lactation. “Relactation is about re-establishing of milk secretion after weaning baby from the breast,” says Leana. “Adoptive breastfeeding, also called induced lactation in a woman who was not pregnant with the current baby, may involve hormonal preparation (oestrogen and/or progesterone – simulating a pregnancy) followed by sudden cessation of the hormones (simulating a birth) and then the commencement of pumping or suckling and a galactagogue that increases prolactin secretion.” Internationally Board Certified Lactation Consultant, childbirth educator and midwife Emma Numanoglu explains the protocols for inducing lactation, developed by Dr. Jack Newman and Lenore Goldbarb, as involving a regime of taking the contraceptive pill together with domperidone. “A few weeks before the expected arrival of the baby the mother stops taking the pill, continues with domperidone and starts expressing milk (this mimics the process of pregnancy and lactogenesis after birth). This method has been used successfully and safely for three decades by many women who induced lactation,” she says. “A mother who is planning to apply one of the protocols will need to find a doctor who is supportive of breastfeeding, can explain risks and benefits of taking the medication, and is willing to take responsibility for prescribing domperidone in doses that exceed guidelines for licensed use.”

Commitment to breastfeeding is key to success

Relactation, explains Emma, is also an option for those mothers who have have decided to bottlefeed and have then changed their minds and wish to go back to breastfeeding, or even for those mothers whose babies are not tolerating formula well. “In my practise, this is the most common reason for relactation and the reasons are important as it requires quite a commitment from the mother. For example, if the baby is intolerant to the breast milk substitutes being given, the mother may be more committed to resuming breastfeeding,” she says. “It is important not to place emphasis only on her milk as evidence of success, as this can cause anxiety and thereby inhibit her milk production and ejection reflex. For these reasons it is important to discuss with the mother the benefits, the concerns and problematic elements of relactation.” Emma sees the most success in relactation with babies under three months, but older than that is not impossible, it may just take more effort. “Induced or adoptive lactation is becoming more popular. Mostly adopting couples and lesbian couples seek assistance in breastfeeding their adoptive baby.”

The aim is bonding and creating a milk supply

“For both adoptive breastfeeding and relactation, the aim is to bring about (or back) a milk supply and bring the baby back to the breast. These two are interconnected endeavours, as the best thing for a milk supply is to have a baby breastfeeding frequently and a baby is more likely to breastfeed or return to the breast if there is plenty of milk there,” says Leana. “The difference between the two is such that with a natural pregnancy the milk making tissues are built, whereas with adoptive breastfeeding (if a mother has never been pregnant) she may need hormonal preparation. For many adoptive mothers it may be more about connecting deeply with the new baby through breastfeeding, than producing large volumes of breastmilk.” Emma adds that relactation can fail if mothers are not given the correct support and professional advice preferably from an IBCLC or SACLC trained consultant and La Leche League leader. “Success also depends on quite a few other factors, such as the determination of the mother, no underlying medical conditions and the baby’s age.”

How the breasts work

Leana describes the anatomy of the breast as 10 to 20 branches (milk ducts), heavy with clusters of grapes all intimately bound together by interweaving vines and vegetation. Each single grape an alveoli or milk sack where milk is made and each alveoli is surrounded by a basket of muscle cells that squeezes the milk out into the ducts when it contracts. The 10 to 20 branches are all rooted in the nipple, though each nipple has only between four to nine openings through which the milk is excreted. “Baby’s suckling acts as a stimulus to mom’s body – sending a message to the brain to release the milk producing hormones, prolactin and oxytocin into bloodstream,” she says. “Prolactin, released with the Milk Ejection Reflex (MER), acts on the alveoli to produce milk and Oxytocin, released with the MER, acts on the muscle cells around the alveoli causing them to contract and squeeze out the milk towards the nipple.” It is important to note that large amounts of milk are not stored in the ducts before the MER and that the rapid sucking action of the baby stimulates the let down of milk. The most important thing is to ensure a good latch to help the MER during breastfeeding as well as a good breast pump to stimulate the production of milk too.

Methods of relactation

Emma recommends holding your baby skin to skin as often as you can, in a calm relaxed environment such as lying in your bed, in a comfy chair or even carrying them around in a sling at home. Directly feeding your baby from the breast is the most effective way to increase your supply or relactate. Offer your breast to your baby frequently when they are happy! Do not try breastfeeding when your baby is upset or irritated as it will be nearly impossible to latch them on. “This is an extremely important step. Although it sounds so simple, often this is how babies get interested in breastfeeding again.You can start pumping if you find your baby does not want to breastfeed for very long, or is not interested in taking the breast. Since you are trying to build your supply back up or induce lactation again, it is important to pump frequently,” she says. “If you can pump every two to three hours, that would be ideal. At night you can go for longer between pumping but try to get at least one pumping session in per night. When you start pumping you might not get any milk at all or just small amounts, just keep on going! Some women find it takes a couple of months to really get their supply going again, especially if their babies are not breastfeeding or are only occasionally breastfeeding.” She adds that women who have had an extended period of time since breastfeeding might find they do not build up enough of a supply to exclusively breastfeed, but most women will at least be able to partially breastfeed their babies and many women will eventually be able to exclusively breastfeed their babies.

What is a supplemental nursing system?

A nursing supplementer is a device that allows a baby to receive extra milk at the breast rather than by bottle and teat. It consists of a container that is worn on a cord around the mother’s neck. Fine tubing carries expressed breastmilk or artificial baby milk from the container to the nipple. When the baby sucks at the breast, milk is drawn through the tubing into his mouth, along with any milk from the breast. “Most mothers who have problems getting breastfeeding started will solve them without using a breastfeeding supplementer. Often all some mothers need is information and support. Talking the problem over with someone who understands and supports your wish to breastfeed and who knows a lot about breastfeeding can help you work through any problems. Often they will be able to suggest new ideas to try,” says Emma. “Sometimes, you can solve your own problems by learning more about how breastfeeding works. It is important that the baby is able to suck well at the breast, even if he tires easily, in order for the breastfeeding supplementer to work. A baby with a poor or abnormal suck may not be able to get the milk through the tubing any better than from the breast itself.”

I breastfed my adopted babyDanielle Bischoff is a photographer and storyteller and lives and works in Cape Town with her husband comedian, Rob van Vuuren and their six-year-old adopted daughter, Bijou.
“Rob and I both have adoption in our families and when falling pregnant became increasingly difficult and a cause of huge distress for us, the doctors said the only option was to go the IVF route. We both felt like we needed to take a breather from the whole thing and put the baby plans aside for a few months. We didn’t want to rush into a whole IVF mission. We felt that we had been through enough of a wringer just trying to figure out what the problem was. So we left it for a while. After a couple of months we both felt that adoption was the best way forward. I can’t describe it in any other way than I just new our baby was coming to us through adoption. I felt a deep connection and I had even chosen her name before our first meeting with our social workers. There was just this indescribable knowing that baby was on the way and I had to get ready. I didn’t even know that inducing lactation was a thing, but I was so determined to make it happen. So you can imagine the relief I had when contacting Internationally Board Certified Lactation Consultant Jean Riddler, who immediately promised she could help me. It was important to me for two reasons, because I didn’t get to experience a pregnancy I felt like I didn’t want to miss out on the experience of breastfeeding. I had also done some reading on all the amazing benefits. Strengthening the bond was a huge reason and because Bijou was adopted I felt like I had some catching up to do as I hadn’t carried her.I started on the birth control pill to mimic a pregnancy. I wasn’t really happy about going on the pill but as I mentioned before I was pretty determined about it. Once we got the news that a birth mother had chosen us and we had Bijou’s due date, we sped up the process by taking the vomidom (domperidone) and using a double breast pump to stimulate the breasts. This was honestly the hardest part of the whole business. There were moments while sitting there with pumps on my breasts with nothing happening where I really questioned my sanity. Anyway just over a week later the milk started coming out! I was totally amazed and in awe of the human body. I wasn’t able to produce enough milk to purely breastfeed which I was initially quite sad about, but after sometime I was just grateful for the opportunity. I soon realized that being able share the feeding duties with my husband was beneficial for all of us. So in the end we mainly bottle fed her and did top ups with breast milk. I breastfed Bijou until she was about two-years-old. It was a bit of a roller coaster ride to be honest. I felt emotions that I didn’t know I would have. The feelings of inadequacy I felt when I realized that I wasn’t able to purely breastfeed did overwhelm me. I felt like I had let her down and how could I be a mother if I couldn’t feed her. Obviously in retrospect I realize how irrational all that thinking was. Luckily my husband was there to help me through all that. It was totally worth every second on my mothering journey with my precious daughter.”

<Sidebar> PATIENCE AND PERSEVERANCE!Many women who keep persevering and gently encourage their babies to breastfeed while doing heaps of skin to skin with their babies do get results, says Emma. “Don’t give up. It just takes a lot of patience, perseverance and time. It will not happen overnight. Support helps too and is very important. Ask for help with cleaning, laundry, cooking and other household chores, while you focus on just being with your baby. Rest and just “hang out” with your baby.”

<Sidebar>Amazing motherhood hormonesAt every stage of motherhood there are hormones present to facilitate the changes taking place. In addition to a very long list of natural ingredients, breastmilk also contains the following amazing hormones: Prolactin is the hormone of milk production. The suckling newborn increases prolactin levels which physically works in creating more milk, and emotionally, prolactin encourages the mothering instinct of nurturing and selfless devotion to the baby’s health and well being. Oxytocin is known as a shy hormone and is present in orgasm, labour, birth and breastfeeding and causes the Milk Ejection Reflex (MER). Emotionally it is a bonding hormone, also known as the love hormone because it occurs at intimate, private moments of family bonding and love. Physically it is a contracting hormone and as such contracts the uterus in orgasm, facilitates contractions in labour and birth and allows for the milk let down as the milk ducts are contracted and squeezed to allow for milk to flow. Endorphins are the body’s own natural painkiller and can create euphoria and are released during sex and breastfeeding.

<Sidebar> A word on galactagoguesGalactogogues are medications or other substances believed to assist initiation, maintenance, or augmentation of the rate of maternal milk production. Human milk production is a complex physiologic process involving physical and emotional factors and the interaction of multiple hormones, the most important of which is believed to be prolactin, explains Leana. “One should caution against inappropriately recommended galactogogues prior to emphasizing the primary means of increasing the overall rate of milk synthesis, such as frequent feeding and regular draining of the breasts.”A galactagogue may be helpful to speed up the process but are not magic bullets, she adds. They provide building blocks for milk production but effective removal of milk is essential since milk supply seem to be calibrated based on how well the breasts are drained. “If baby is not breastfeeding (well) yet, it is advisable to double pump with a good quality electric pump using the hands-on method.” According to Leana, the currently available pharmaceutical galactogogues are all dopamine antagonists and will increase prolactin levels. Herbal remedies have been used throughout history to enhance milk supply. Some herbs mentioned as galactogogues include fenugreek, goat’s rue, milk thistle (Silybum marianum), oats, dandelion, millet, seaweed, anise, basil, blessed thistle, fennel seeds, marshmallow, and many others. “Although beer is used in some cultures, alcohol may actually reduce milk production. A barley component of beer (even non-alcoholic beer) can increase prolactin secretion, but there is no hard evidence supporting this,” she says. “Mothers wanting to make use of a galactogogues should contact their doctor for a prescription since La Leche League Leaders or International Board Certified Lactation Consultants are not allowed to prescribe any medication be it natural or pharmacological.” Emma points out the most important thing to remember is that an herbal or prescribed galactogogue will only work if you take it while actively trying to build your supply at the same time. “You will not see an increase if you do nothing but take a galactogogue.You should only take a galactogogue if your doctor is in agreement and all side effects and contraindications have been discussed,” she says.

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.

Medication & pregnancy

November 1, 2020November 2, 2020Leave a comment

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’

November 1, 2020November 2, 2020Leave a comment

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.

Multiples: A dream come true through IVF

November 1, 2020November 2, 2020Leave a comment

If you have been trying for a baby for more than a year, but have been unsuccessful, you are one of at least 50-million couples who experience infertility worldwide. The number of children being born in South Africa is also on the decline and according to the Recorded Live Births 2013 to 2015 report, the number of birth registrations decreased by 6.8% from 1.6-million in 2013 to 1.08-million in 2015. As a result, many couples are turning to infertility treatment to fulfil their hopes of having a baby. If you’re a good candidate for In Vitro Fertilisation, it may be the only way to help you grow your family unit from husband and wife to three… or even four… or more!

Multiples and IVF

“IVF treatment can result in multiple births because, often, more than one embryo is transferred into the uterus of the mother,” says Dr Henk Burger, gynaecologist and obstetrician at Life Carstenhof in Gauteng. “The chance of having multiple births can be reduced considerably by only putting one embryo back into the womb.” The cost of IVF ranges from R30k to R50k per attempt, which explains why many couples opt for implanting more than one embryo to increase their chances of a successful pregnancy the first time around, explains Dr Burger. He notes that sometimes a termination of one of the embryos is requested after implantation, but this is very difficult and dangerous for the embryo that stays behind.

Multiples and risk

We all know how adorable twins are – and they make for an instant family unit, but they also come with a certain level of high risk in pregnancy. “Around 30% of multiples are prone to prematurity – and born before their due date. There is also the risk of intrauterine growth retardation, birth defects and miscarriage. The mother is also five times more likely to get pre-eclampsia and six times more likely to have polyhydramnios and antepartum haemorrhage,” says Dr Burger. “Mothers carrying multiples must ensure they attend each and every antenatal consult; every four weeks up to 20 weeks, every two weeks up to 28 weeks and every week up to birth thereafter. The aim is to get the mother to carry her baby to at least 36 weeks, but this is often not the case.” He also advises mothers to eat a balanced diet, not to smoke and to take antenatal supplements. “Simple things like positioning of the safety belt in the car when driving are also important to remember to reduce risk,” he adds.

Natural or Caesarean birth for multiples

According to Dr Burger, birth by caesarean section is the safest for multiples, because of the risk, especially for the babies born after the first one. “There is positional risk such as breech or transverse positioning, especially for the second baby. There is also the risk of premature labour, placental abruptia, fetal distress and even early closure of the cervix,” he says. “There was a case reported where the cervix closed after the mother had naturally birthed the first of her twin babies. Her cervix remained closed for 56 days before she birthed the second one! It is the longest reported period between delivery of the two babies.”

Breastfeeding your babies

Dr Rebecca Makate is a paediatrician at Life Carstenhof and is experienced in helping parents adjust to life with their new babies. “Breastfeeding for any baby offers major health advantages such as less infections and better neurodevelopment. The breast can make enough breastmilk for two or more babies as breastfeeding is based on supply and demand,” she says. “In other words, the more you breastfeed the more milk your breast produces. It is also possible to breastfeed twins at the same time on different breasts. Having said that, having more than two babies can come with huge challenges during feeding time.Even if you breastfeed, occasional supplementing your babies formula will give you some much needed freedom and sleep.”

<Sidebar> So what is life like with multiples?Despite some challenges and drawbacks, having multiples is a great joy, says Dr Makate. “There is a level of convenience and efficiency in parenting children simultaneously; some of the unpleasant aspects are sleepless nights, feeding times, potty training and teenage troubles which all have to be endured at once. Mostly though, there is a great pleasure and enjoyment in parenting multiples, every moment is multiplied and every simple joy is magnified,” she says. Dr Makate lists the following challenges couples should consider before IVF:-Pregnancy and birth risks when carrying multiples.-Fetal complications and time in the NNICU.-Lack of sleep.-Difficulty bonding.-Economic impact on the family unit.-Relationship with your spouse is put under pressure.-The need for extra help with caring for the babies.

<Sidebar> What are Monozygotic and Dizygotic multiplesMonozygotic multiples: In monozygotic multiples, the embryo splits and the babies are born identical. In utero, they share one placenta and one amniotic sac. Dizygotic multiples: In dizygotic multiples, there are two separate embryos, each with their own placenta. Monozygotic multiples are higher risk for a few reasons: Placenta abruptia: where the placenta tears away from the uterus during birth and deprives one or more of the babies from it’s life source of oxygen and blood. Cord prolapse: where the umbilical cord of the second baby born prolapses out of the mother’s vagina. Twin-to-twin transfusion syndrome: where the babies share a joint blood circulation through the placenta, which contains abnormal blood vessels, where blood is transfused disproportionately from one twin (the donor) to the other twin (the recipient).

Lindy and Michael’s* story
We fell pregnant after many, many years of trying to conceive – almost ten years. Initially we tried naturally, then Artificial Insemination and then only In vitro Fertilisation. As I am an older mom it was necessary to go this route. It’s a very drawn out process with lots of steps and checks and balances. One needs to eliminate the options that are not viable first and the doctors are all very cautious and considered in how they approach IVF in South Africa. It is a very expensive process, but we were committed to being parents, and I was not willing to give up, so we just kept on trying until we had a positive outcome. We first attended the Cape Fertility Clinic but after no luck there, we moved to Aevitas which is based at Life Vincent Pallotti. Prof Kruger and Prof Siebert from Aevitas were absolutely amazing, as were all the sisters that worked with them in their team. A number of eggs were fertilised and the best quality eggs were implanted and we were very lucky that two fertilised eggs resulted in our gorgeous twins, Jacques and Stella. It was a very long and stressful process. We lost a baby at full term, Ruby Mae, who was stillborn at 41 weeks. Soon after this loss, we tried again to conceive and with the help of Aevitas got pregnant with the twins who were born on 1 May 2015. It was amazing and unbelievable to find out we were pregnant with twins after losing our previous baby. We were elated and also scared as twins are a major change in one’s life. On the 13th of January we felt our first big kick after steak strips with Szechuan pepper and salad for dinner, it was wonderful! We made it through to 38 weeks and delivered them with the help of Dr Marie Pienaar and her team and Panorama Mediclinic. We love them to bits and they entertain, inspire and motivate us each day to be better, kinder parents. Its tough with two but the highlights are by far in excess. It is stressful and one learns how to cope. Support makes all the difference, whether it is grandparents, siblings, night nurses, nannies or friends. Also each baby is so unique and has their own personality and it’s such a joy to experience the gift of twins.*Names have been changed.

Vanessa and Philipp’s storyWe had been trying to conceive for a long time, but I knew that with my pre-existing conditions of Polycystic ovarian syndrome and Hashimoto’s Thyroiditis, it would not be without some challenges. In 2015 I had a molar pregnancy – very rare – where a non-viable fertilised egg implants in the uterus and grows as abnormal tissue.In that time, we had been in touch with an adoption agency to come ‘kangaroo parents’, which are like safety parents for babies under 3 months old, where we would care for them for up to 90 days until they were transferred to their forever homes. When we started the paperwork, I found out I was pregnant and we felt it might be too much to go through with the adoption agency, but then later that year, I miscarried and this broke me on so many levels. After that I left for Europe and shortly after we received a call from the adoption agency to know if we were perhaps keen to foster twins who were 6.5 months old. We slept on it and the next morning we decided that we would do it and eight days later they arrived. We lost our hearts completely to the babies and decided to start the process of legally adopting them. We still kept our sights on having our own biological child one day, so we kept on trying naturally at first and then decided on IVF at the Aevitas Clinic at Life Vincent Pallotti. On the day of the transfer they implanted two eggs and at the 9 week scan we heard three heartbeats! The two boys shared one placenta, but each had their own sac and the girl had her own placenta and sac. I honestly felt as though I lost the ground under my feet and the world was spinning… we would be parents to five children now, the twins included! My pregnancy was easy until 26 weeks when I started having contractions and had to have bedrest at Life Vincent Pallotti until my caesarean birth on the 24th of April at 30 weeks pregnant with Dr Jacky Searle at Life Vincent Pallotti. My precious babies weighed 1290g, 1220g and 1540g at birth and now we are a beautiful family of seven. I am thankful for blessings in abundance and the good health of all my children.

Dealing with infertility, when he has the problem

November 1, 2020November 2, 2020Leave a comment

It’s not just a women’s issue

Struggling to fall pregnant? Usually women are the first to seek help when trying to conceive. However, if the woman has been thoroughly examined and it is not due to her that she is unable to fall pregnant, it falls to the male partner to be tested. According to a study published in 2015, infertility affects about 15 per cent of couples globally, amounting to about 48.5-million couples. The study also found that males are found to be solely responsible for 20-30 per cent of infertility cases and contribute to about 50 per cent of cases overall. Furthermore, at least 30 million men worldwide are infertile with the highest rates in Africa and Eastern Europe. If a male factor is what’s making it tough for a woman and her partner to conceive, it’s important to understand what may be causing his infertility and what the couple’s options are. Charlene Yared West speaks to the experts to find out more…

Infertility and feelings of inadequacy and impotence

“Research indicates that the male partner is not willing to seek medical advice about infertility. They feel embarrassment for not being able conceive naturally and suffer guilt, self-blame and shame,” says Dr Liezel Anguelova, Counselling Psychologist at Life Roseacres Hospital. “Many men do not feel comfortable with the testing procedure as it includes the examination of their testicles and penis and the production of a sperm sample. As such, men often associate infertility with impotence, when they are actually unrelated.” Dr Anguelova explains how infertility can be devastating to the man who experiences the failure of his procreative nature, as it is so intrinsically linked to his sexuality. “It is often an assault on the masculinity of the male partner and it is not uncommon for him to develop sexual problems such the loss of sexual desire or erectile dysfunction, which can leave him feeling that he is ‘less of a man’,” she says.

What causes male infertility?According to Dr Sulaiman Heylen, Specialist in reproductive medicine at Life Kingsbury Hospital, male infertility is diagnosed by an abnormal semen analysis. “We always start at the beginning of the fertility testing with the semen analysis. We don’t want to do a lot of testing on the female without knowing what the male factor is. Semen analysis is very easy and inexpensive.”
There are three parameters important in the semen analysis according to 2010 WHO criteria:
1. sperm count: must be over 15 million sperm per milliliter.
2. sperm motility (how they move): 50% of sperms cells must be motile.
3. sperm morphology (their shape): at least 4% of the sperm cells must have a normal morphology.
“If one of these parameters is abnormal we speak of male infertility in combination with an inability to conceive,” he explains. Dr Heylen lists the following as possible causes of male infertility;Varicocele: These are varicose veins of the testis, they can contribute to up to 30% of all cases of male infertility. Trauma of the testicles; related to accidents or sports injuries.Sexual transmitted disease which can lead to infections of the testis and blockage of the epididymis (tubes of the testis)Mumps of the testis.Pollution and environmental factors (estrogen like factors in the environment): These are called xenoestrogens. Estrogen is the normal female hormone. Xenoestrogens are chemical compounds that mimic estrogen. There is more and more evidences that pollution and environmental factors can contribute to male infertility.Unhealthy lifestyle: Obesity, excessive alcohol, smoking and drugs. Anabolic drugs are well known to cause low sperm counts. Antibodies that attack sperm: Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to destroy them.Undescended testes: During fetal development one or both testicles sometimes fail to descend from the abdomen into the scrotum. Genetic: there are genetic defects in the chromosomes or small defects of the Y-chromosome. Unknown: We not always can identify the cause of the low sperm count.

How is male infertility uncovered?

Urologist, Dr Dap Louw from Life Beacon Bay Hospital explains how the physical examination entails a general exam, evaluation of the testes ( volume, masses, varicocele, infections, etc) and a prostate exam if needed. “The basis of the evaluation starts with taking a thorough medical history. We normally do a pelvic and scrotal ultrasound as well, to evaluate the testicular tissue and to look for signs of sperm transport blockage. Other more invasive diagnostic methods can be used especially when there is little or no sperm seen in the ejaculate. This would then be aimed at distinguishing between abnormal sperm production or blockage of sperm transport,” he says.

What treatment is available?

Dr Louw explains that treatment is aimed at the underlying problem whether it is advice on a healthier lifestyle, surgical correction of a testicular abnormality or medically treating an underlying infection, sexual dysfunction or hormonal abnormality. “When there is no urological correctable contributing cause to the infertility, I then like take a multidisciplinary approach and get the infertility specialists and/or gynaecologists involved,” says Dr Louw. “Together we can then decide on further optimal treatment, according to their hormonal levels, semen analysis and then also female factors. These can then vary from medical treatment, sperm washing with artificial insemination, IVF (in-vitro fertilization) or ICSI (intracytoplasmic sperm injection).” Dr Louw always emphasises to his patients that 20-30% of sub-fertile couples end up falling pregnant without any further help, which is positive – as nature is on their side! “Anxiety about infertility also plays a significant role and it is important to explain the normal conceiving time of 6-12 ovulatory cycles,” he says. “It does unfortunately happen where our patient is not able to have children and the couple would need to discuss alternate options like sperm donation or adoption.”

Can a couple survive infertility treatment?Infertility can be a relationship maker or breaker depending on how it is managed says Dr Anguelova. “It will put your relationship to the test, but if you focus on the importance of your relationship, it could be used as a opportunity to make your relationship stronger.” She shares some tips for surviving infertility;Stay in the moment, because it can be very overwhelming. Wait for each doctor’s visit to gather information on the process before making decisions and planning ahead. Communicate openly and honestly to address unmet expectations, fears, frustrations and stress. Find professional assistance and counselling if you are not communicating effectively. Do not get caught in a blame game of resentment, but rather become committed as a team. Remain positive about yourself and your partner.Keep your sexual relationship spontaneous and full of fun and nurture intimacy by touching, hugging and kissing outside of a sexual connotation.Do not let your entire life be merged into the fertility treatment process. Continue with other hobbies and keep other dreams alive.Build a support system. Support each other and include friends and family in the process.

Useful Resources

Working together to treat a tumour

November 1, 2020November 2, 2020Leave a comment

When it comes to cancer, patient care is a team effort and not the work of a single doctor. Life Healthcare doctors take a multidisciplinary approach and utilise good teamwork between the various specialists, which is crucial to the successful care of cancer patients from detection to treatment and follow-up.

Discovering the brain tumour

People with brain tumours present first to many different doctors due to the varied symptoms caused by brain tumours. These symptoms are mainly due either to raised pressure in the head or neurological symptoms that are caused by compression or invasion of brain tissue. “Headaches, seizures or stroke-like symptoms often cause patients to see a neurologist first, whilst blurred or double vision might prompt a visit to an ophthalmologist. For patients who are known to have other tumours that later spread to the brain the first contact is often the oncologist seeing them already. Some patients have the tumour picked up incidentally when having a scan for another reason, so see the radiologist first,” explains Dr Grant White, neurosurgeon at Life Vincent Pallotti Hospital. “Many patients will have been referred after starting with their General Practitioner for these and other symptoms.” Dr CF Kieck, neurosurgeon at Life Vincent Pallotti Hospital adds that not every headache is an indication of a brain tumour. “See your GP first if you are experiencing any problems or symptoms which are worrying and they will refer you on to the specialists.”

Referral to a neurologist
“Very often the neurologist is the first port of call after the patient has consulted a GP. Patients might present with complaints of blurred vision, headaches, weakness, slurred speech, etc. The location and size of the tumour plays an important role in how the patient might present. For instance, if the tumour is located in the left side of the brain, the patient might experience difficulty expressing themselves or might complain of right-sided weakness. If the tumour is located in the right side of the brain, their visuospatial ability might be affected and they might experience left-sided weakness. Should the tumour be located in the front part of the brain, the patient might present with behavioural disturbances or personality changes,” explains Dr A Rawoot, neurologist at Life Vincent Pallotti. Neurologists are clinical specialists who diagnose and manage neurological disorders. If a neurologist suspects a brain tumour based on the patient’s symptoms and examination, a scan of the brain would be requested to confirm the diagnosis. The patient will then be referred to a neurosurgeon for further management.”

Meeting the radiologist
When a tumour or an abnormality is detected, the first task of the radiologist is to identify the exact location of the tumour and the extent of the disease, says Dr Christian Stoyanov of Life Empangeni Private Hospital, “C Stoyanov Radiological Services Inc.” “After the detection of cancer, the radiologist interprets the cross-sectional images of the patient, makes the diagnosis and determines the stage and extent of the disease based on their findings,” he says. “Image interpretation is the most visible contribution of radiologists. Diagnosis by expert radiologists is based on the extensive knowledge of anatomy, normal variants, pathology and technical principles of the imaging modality.” In some cases, the radiologist may intervene and provide treatment using small catheters and needles under the guidance of the imaging equipment. These techniques can assist in the treatment of many conditions, including cancer, with minimally invasive interventions, thus avoiding open surgery. “With the technological advances in the field of medical imaging, brain tumour imaging has become an essential component in diagnosis, treatment planning, and monitoring treatment response as well as patient prognosis,” adds Dr Stoyanov.

Consulting the neurosurgeon

Once the tumour has been confirmed via high-tech imaging, the neurosurgeon would take on the role of decision-making regarding further treatment of the patient and this is where the collaboration with the radiologist and oncologist is essential. “Often, the specific diagnosis of the tumour may be made only after surgery when part of the tumour has been provided to the pathologist for microscopic and laboratory analysis.” says Dr White. “Distinguishing between benign and malignant tumours and between different types of tumours allows for the best treatment to be selected for a patient. The neurosurgeon’s most specific expertise is in the planning and performance of surgery for the brain tumour. This involves balancing the risks of various surgical approaches against their benefits, choosing the right tool for the job and deciding on the specific aim of the surgery and then doing the procedure as safely and effectively as possible.” Guiding and educating the patient and family is an essential preparation before any operation; brain tumour surgery is particularly challenging and everyone needs to understand the risks and limitations of surgery, adds Dr CF Kieck; “After surgery, the neurosurgeon will continue to look after the patient through their hospitalisation and will refer them for any rehabilitation needed and involve the oncologist where chemotherapy or radiotherapy is appropriate. The neurosurgeon will usually continue to check up on a patient who has had a brain tumour at intervals for the rest of their lives.” he says.

Seeing the oncologist

Once the diagnosis has been established, patients are then referred to an oncologist for treatment. “Secondary brain tumours are often diagnosed by oncologists, as we are following up patients with previously diagnosed cancers and when they present with brain associated symptoms we would proceed with a scan. We would then sometimes refer them to a neurosurgeon if we felt surgery was possible or necessary,” says Dr Jacqueline May Hall, clinical oncologist, Life Vincent Pallotti Hospital. “We also sometimes enlist a neurologist to help us with the management of associated seizures. An oncologist’s role is to perform treatment (obviously other than surgery) and would oversee, monitor and prescribe any radiotherapy or chemotherapy required. We would also support the patient holistically with for example – symptom control that includes steroids, analgesia, anti-seizure medication; referral for physiotherapy, occupational therapy, rehabilitation and we would also counsel and refer for counselling as needed. We also refer to Hospice as appropriate.”