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.

Caesarean birth: Safety is the priority

November 1, 2020November 2, 2020Leave a comment

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.

‘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.

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.”

Ruwarashe’s Birth Story

August 30, 2020August 30, 2020Leave a comment

Ruwa was nervous at our first meeting. Soft-spoken, she asked about my role as a doula for her birth. I walked with her in pregnancy and birth and when she went into labour, I met her at the hospital. Her birth changed everything. She was shown how powerful her birthing body was and that she could do anything. Here is her story of the birth of her son…

My name is Ruwarashe and I am 21-years-old and I come from Zimbabwe. I’m currently studying at UCT. I became pregnant in September 2018. Pregnancy was going to be a hard journey for me, as I didn’t understand anything about birth and even worse, I was a long way from home where I had friends and family to guide and support me. In Cape Town, I have little support. So many people recommended I get a doula, especially since I felt quite isolated in Cape Town without my family near.

Choosing a doula for me was so important, because I needed someone compassionate and soft and when I went onto Charlene’s website, I knew she was the doula who would understand my fear and confusion of becoming a mother. ( I hadn’t even met her in person yet, but I just knew.)

I remember I wasn’t sure if I was going to have anyone close to me at my birth, because my family and fiancé stayed so far away… And I had so many fears of becoming a new Student mom. Charlene reminded me that she was going to be there for me – and that I would be ok, no matter what turn it took. She said this at our first meeting.

Charlene engaged with me every week reminding me to trust the process of the journey I was on, offering me her kind support along the way. I was at school from 8am to 5pm everyday and I was at school until I was 9 months pregnant.

She also made sure we were able to meet close by to where I lived, as I did not have a car. She did this without hesitation – and it was so kind of her. When I felt low, I would message her and we would chat and she would encourage me to keep my faith and to be strong.
I think what especially helped were the Relax Into Birth visualisation tracks. Listening to them regularly helped me realise that birth wasn’t just an event, it was a process – a beautiful process… Finally I was learning to trust the process – and trusting myself to do it! I felt strong enough to birth my baby boy. The strength seemed to come from within me. A deep knowing.

The Relax Into Birth classes made me realise I wasn’t just doing a duty a woman is required to do; no! My body was giving life to a soul, another human being. Although it was about birth, it also somehow helped me establish what type of mom I was going to be to my little boy.

When I finally went into labour, the emotional support for me and my fiancé was tremendous! She always made sure I was as comfortable as I could be in those circumstances. When it was time for me to deliver, I remember I was very tired – and our doula Charlene never once wavered, always trying ways to help energise me and encourage me to bring my son down to earth.

During my visits to the doctor, I was told we had to schedule an induction, because they didn’t want me going over my due date, which was the 26th of May. I wasn’t so sure I wanted an induction considering the potential complications. It was really not what I wanted.

In my 39th week, I went for cervix check to prepare for my induction. I was notified that soon I was going to be in labour – and that it was likely I would not need an induction. On Thursday 23 May, my waters broke as I was going to bed. I remember I kept my calm. I took an Uber with my fiance who had arrived from Zimbabwe, even though my contractions hadn’t kicked in properly yet. I didn’t want to stay at home after that because I didn’t want to be under pressure to rush to the hospital when it became necessary. I didn’t want something dramatic! Charlene did join us at the hospital when my contractions got regular and intense. She was there the whole time and I held onto her. She created such a calming environment in such a tense situation. I remember I had moved 1 cm in 4 hours and all I wanted was an epidural. I asked the nurses for an epidural, but was refused by them, saying it was too early to administer. In the face of that, my doula encouraged me to keep going and to stay strong as I was birthing my angel.

We used other forms of natural pain relief. We used the shower and we counted together and breathed together and finally at 7 am they decided to insert a dose of prostaglandin gel to help my cervix open. Once that was given to me, five minutes later I was standing to go poo in the toilet and another five minutes later I was walking myself to the tub in the delivery room. During that walk I definitely felt my baby was coming! I got into the tub for a few minutes and notified both my fiancé and Charlene that the baby was indeed coming.

The delivery room not prepared by the hospital staff (as they didn’t expect me to push so soon), they quickly put me on the bed, and there was my baby crowning! They quickly set up the room as I involuntarily pushed him out. A few pushes and I had birthed my baby.

My birth taught me to trust my body and trust my baby. I have never felt as strong or as empowered as I did in those first days. I was blessed to have such a positive, empowered birthing.