Tag: pregnancy

Polycystic Ovarian Syndrome: A lifestyle-related disease?

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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?

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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

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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. 

Own your birth: Why you need a birth plan

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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. 

Medication & pregnancy

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

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

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

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

Medication to avoid in pregnancy

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

Chronic medication in pregnancy

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

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

Common Pregnancy ConditionsSafe medications and remedies Advice: 
Allergies-Allergex-Loratadine-Nasal decongestant spray-Nasal steroid sprayMay 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 -ParacetamolIf a respiratory infection is suspected, your doctor should be consulted.
Diarrhea-Kaolin-Pectin-Imodium-Smecta -RehidratContact 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 HConstipation 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-ParacetamolIf 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-MaaloxSteer clear of foods which can exacerbate symptoms. 
Insomnia-Antihistamines listed above for allergies have a sedative effect.-Sleep eazeTake 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; ZoferIdentify 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 creamsYour 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)-CitroSodaContact 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 CreamContact doctor as a Yeast infection may cause harm to the unborn baby. Use a probiotic like Interflora when recurrent.

‘Surrogacy gave us the gift of twins’

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

Surrogacy chose us

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

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

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

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

The medical side

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

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

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

Surrogacy Quick Facts 

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

Pregnancy and Diabetes

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Have you been diagnosed with gestational diabetes? While that might sound overwhelming at first, it turns out the condition is more common than you may think. / Recent studies indicate that gestational diabetes is on the rise. How can you protect yourself and your baby during pregnancy from this condition? 

Gestational diabetes only happens during pregnancy and affects about three to five out of every 100 pregnant women. Even women who have not have diabetes before can experience gestational diabetes in pregnancy. So, what are the risks and how can they be overcome to ensure a healthy mom and baby throughout the nine months of pregnancy? Charlene Yared-West speaks to Dr Bandile Masuku and Dr Gaontebale Matlhaga, two obstetrician/gynaecologists from Life Suikerbosrand. 

What causes gestational diabetes?

Pregnancy can affect the normal way a woman’s body processes sugar. In normal circumstances, explains Dr Gaontebale Matlhaga, obstetrician/gynaecologist from Life Suikerbosrand, food is ingested and digested and glucose from the food enters the bloodstream. “In response to this increase of sugar in the blood, the pancreas releases the hormone insulin, which helps to move the sugars from your bloodstream and into your body’s cells, where it is used as energy,” he says. “In pregnancy however, the placenta produces pregnancy hormones, which impair the action of insulin, which automatically then raises the blood sugar levels.” As your pregnancy progresses and your baby grows, the placenta, he says, produces even more insulin-blocking hormones, which create a cycle of  increased blood sugar levels. He adds that the condition is most common from around 20 weeks of pregnancy, but generally not earlier than that. “It isn’t always easy to notice signs or symptoms – which are non-specific and so it is usually picked up in the urine test, which is then followed up with a fasting blood test to ascertain if the woman has this condition,” he says. 

<Sidebar> What are the different types of Diabetes Mellitus?
Diabetes mellitus, otherwise known as diabetes is a metabolic condition where there are uncontrolled high blood sugar levels over a long period of time. Symptoms can include increased hunger and thirst, as well as frequent urination. 

Type 1 Diabetes: An autoimmune disease, where the pancreas produces very little or no insulin at all. It is most common in people under the age of 20. 

Type 2 Diabetes: A disease found in people who are overweight as they get older, where the pancrease does not produce enough insulin, or the body does not use it properly. It can be considered a lifestyle disease which is usually triggered by little or no exercise and being overweight. 

Type 3 Diabetes: A condition otherwise known as gestational diabetes, which occurs in pregnancy.

<Sidebar>Who is at risk of gestational diabetes? 

  • Women older than 25 years of age are more prone to metabolic conditions.
  • Women with polycystic ovary syndrome. 
  • Family or personal history and pre-pregnancy diabetes. 
  • Women with a body mass index of 30 or higher. 
  • Women who are black, of indian origin or Asian are more likely to develop gestational diabetes. 

What are the complications of developing gestational diabetes? 

If left undiagnosed, the complications for mother and baby can be dire, explains Dr Bandile Masuku, obstetrician/gynaecologist from Life Suikerbosrand. “Babies are born with a high birth weight, because of the extra glucose in the bloodstream, which crosses the placenta and triggers the baby’s own pancreas to make extra insulin – and this causes the growth rate to speed up. As a result, many of these babies with this condition known as macrosomia, are born via Caesarean because of their size,” he says. “Preterm labour is also a risk, which also means that the baby’s lungs are not fully developed and the baby will not be able to breathe on its own. In addition, babies can also develop low blood sugar, because their insulin production is so high, which can also lead to seizures. As a result the blood sugar levels in the baby must be closely monitored after birth to help normalise the baby’s blood sugar level. Babies of mothers who have gestational diabetes also have  an increased risk of developing obesity and type 2 diabetes later in life,” Dr Masuku adds gestational diabetes can also increase the risk of high blood pressure and preeclampsia, which are also dangerous to mother and baby. Furthermore, women with gestational diabetes also often develop future diabetes; whether in a future pregnancy or type 2 diabetes later in life.

Why is it challenging to fall pregnant when you have diabetes?

Women suffering from Type 1 or Type 2 diabetes usually face challenges when trying to fall pregnant as the “conception environment” can be compromised, explains Dr Matlhago. Type 1 Diabetes sufferers also tend to have higher incidences of miscarriage or have a baby born with a birth defect. In a healthy person, food is digested with the help of the hormone insulin – and in diabetics, there are flaws in this metabolism system. Hormones and hormone production are an essential part of the reproductive process – especially for a person wanting to conceive – and diabetics have a compromised system of hormonal control. “In addition, diabetic men may also want to consult their doctor about problems that can arise such as erectile dysfunction and damaged nerves, which can cause the sperm to enter the bladder during ejaculation,” he adds. 

Getting ready for pregnancy: Consult your ob/gyn

“It would be beneficial for all women who want to fall pregnant to see their obstetrician/gynaecologists before conception, for counselling and to develop a plan – especially if they have diabetes as an existing condition. It is important for all women to gain control of their blood sugar levels before pregnancy, which can also help to avoid the onset of gestational diabetes,” says Dr Masuku. “It is also more challenging for women who have pre-existing diabetes to fall pregnant, so a consultation can help to see where the problem is and also to create a programme, which includes dietary advice and exercise guidelines. It even helps if a woman can lose extra weight before conception to also help achieve a healthier pregnancy and lower her chances of getting gestational diabetes.” 

Managing gestational diabetes

According to Dr Masuku, it can be psychologically challenging and inconvenient to be diagnosed with gestational diabetes, because of the lifestyle and dietary changes that come with the treatment strategy. “Daily checking of the sugar levels, before and after meals is necessary to make sure the levels are within a healthy range,” he says. “In addition, eating the right kinds of food in healthy portions is one of the best ways to control the sugar levels and help to avoid weight gain. Exercise also plays an important role and can help lower your blood sugar by encouraging your body to move glucose into your cells where it will be burned for energy – and less insulin will be necessary.” He adds that if diet and exercise are not impacting your sugar level, medication might be necessary, which is assessed on an individual basis. “Medication in the form of oral drugs and injectible insulin might be necessary to control the condition.” 

<Case Study>Millicent Ndlovu 

“I was 30 weeks pregnant, on the highway and driving to work one winter’s morning in June, when I suddenly felt extremely hot, so I opened the car window and then felt terribly nauseous. I started vomiting and moved over into the slow lane. Luckily I was close to the office, but the nausea wouldn’t go away and I started vomiting some more. My colleague took me to hospital, where I was kept for observation. They measured my sugar levels and they were exceedingly high and wouldn’t go to normal levels even that evening when the levels were taken again. It was decided to put me on insulin, which brought my levels back to normal. I also had to speak to a dietician who advised me on diet and exercise. Diabetes is hereditary in my family; both my parents and sister have it, but I did not – and I thought I was having a healthy pregnancy; no morning sickness or nausea, I only had fatigue.  It was very frustrating for me to have this condition and of course I was worried about the health of my baby too. Thankfully, through diet and injectible insulin I controlled my sugar levels well and my 4.5kg baby girl, Humelelani was born on July 22, last year, via caesarean section. The gestational diabetes cleared after I had given birth, but after a health screening at work about a year later, it was determined that I had diabetes type 1, which I now manage with medication and a strict diet.”

Tamlyn’s Birth Story

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What a pleasure to be Tamlyn’s birth doula. From the moment I met her quite early in her pregnancy, she embodied a certain positivity and exuded a confidence I rarely saw in a first time pregnant mama. She shares her story of trusting the process for her home birth.

I’m a new Mamma, my baby boy Charlie is 4 months old. I’m just starting to emerge from my cocoon of love and bonding, embracing a new way of being and living, finding balance between motherhood and my purpose of serving you. What an incredible journey I’ve been on, from the start of my pregnancy to today, it’s been life changing on so many levels and I am looking forward to sharing it with you. 

It all started on the 8th of March at 2.30am when I woke up to a pop, and my waters releasing. I couldn’t believe it was the start of the journey to meet my baby boy. I wanted a natural, intervention free home birth, I was excited and had no idea how things would unfold but had a deep trust that things would happen as they should, a trust and surrendering I’d spent several months cultivating during my pregnancy.  

I spent the months leading to my baby’s birth doing the work to birth a new part of myself, a mother. I meditated, visualised, went to healers, coaches and massage therapists, did family constellations work, hypnobirthing, re-created my own birth, did inner child work, went on yoga retreats, painted, walked, prayed and wrote every day. I learned so much. (I have many pregnancy and birth related resources if anyone would like them, please just reply and ask. )

I knew that my pregnancy and birth would have a deep impact on me and my baby and I wanted to go as natural as possible.  I had many fears and doubts and whenever they would show up, I would go within and do the work to release them. I’d remind myself to pray for the highest good for all, to let go of control and to remain open to what life would present. 

The work for me here was about letting go of the outcome, of control, and also not putting it in the hands of someone else, but to lean in, trust myself, my body, my baby and nature. This was a pattern I’d been playing on repeat most of my life, forever trying to control the outcome of situations or just putting my head in the sand and letting someone else take over. This was my biggest test yet. This time I really wanted to be intentionally conscious of what I wanted to co-create and at the same time know that whatever the outcome, to remain open to what life was offering. 

For this reason, I chose my midwives and Charlene Yared-West from Relax Into Birth as my Doula. The moment I met with them, it felt right, very natural and mother and baby-led. I met Charlene at the The Birth Hub Antenatal classes and just loved her segment and felt so comfortable with her. I would highly recommend Charlene as a Doula, I couldn’t have done it without her. Throughout my pregnancy I formed such a beautiful bond with them all and I felt so safe and held with them as my birth team. 

So, back to my birth story…

After my waters released, I had very mild intermittent rushes which were not painful at all so I tried to sleep and in the morning I let my midwives know that things could be happening soon. I spent the day painting, watching funny shows and walking in nature to ground myself. I let go of trying to predict what was happening and allowed myself to fold into the experience.  I remember thinking to myself, this is easy, I’ve got this. The mild rushes continued on throughout the day and evening and at 10pm that night I told my midwives things were still the same and would get in touch in the morning. As I snuggled up to go to sleep, a strong surge rushed through my body, so strong I had to get on my knees. 

A few minutes later, another, I knew it was time. I told Matt to let my midwives and doula that things were progressing. I moved to my birth room where we’d set up the birth pool, affirmations, playlist and positive imagery. I knew now was the time to get out of the way, to let go and let my body and my baby do the work. I instinctively knelt on the floor in the corner of the room on my knees, my upper body resting on my ball. I focused on spiralling my hips and moving back and forth to help the baby move down. The room was dark and quiet and all I could hear was the beautiful kundalini music from my birth playlist which helped me go within. 

The surges were coming in heavier and faster now and I was struggling to breathe through them.  It was so intense so quickly. (My midwives later told me, I must have had a very good production of Oxytocin as things progressed very quickly in my active labour.) I was beginning to get more and more vocal, my groans and primal sounds getting louder and louder. Matt was sitting with me encouraging me gently, holding my hand which I was using to bear down on with each rush. At about midnight my Doula, Charlene arrived, I was so grateful to see her. By then I didn’t want to speak and was so focused on the surges. She knew exactly what to do to support me. I held her hand she began massaging my lower back which felt so good.  

In the meantime, Matt was preparing the birth pool. After a few hours of intense surges, I asked Charlene when she thought I would have my baby, she said soon soon, before the morning which encouraged me. I asked to move into the pool as the rushes were starting to feel unbearable. The moment I slid into the water it was a beautiful relief. It was so warm and took a lot of pressure off my back. However, when the next rush came, I’d forgotten all about the lovely water and roared through the rush. Nature had chosen wild and windy night for my birth which matched exactly what I was going through. 

I spent the rest of my labour in the birth pool, on my knees spiralling back and forth while resting my head on the edge of the pool. For each surge I needed to hold someone’s hand, I needed something to push down on, something strong.  My doula and Matt stayed by my side for most of my labour alternating for breaks. Giving me water, apple juice and honey to keep up my strength.  Charlene let the midwives know when they needed to come and they arrived around 2am, a few hours before my birth. I was hoping they could tell me how close. I asked my midwife, how much longer, and she said ‘’let’s wait and see’’, this was not what I wanted to hear. I wanted her to say any minute now.  I had chosen my midwives because they were very trusting in natural birth and in my body to birth my baby, with as little interference as possible however in that moment I wanted answers, my mind wanted to know the outcome, how much longer…! I knew they were doing exactly what they needed to do. I went within and let go.

I had no physical checks during my labour, my midwives spent most of my labour in the other room listening to my labour and doing the occasional listen to my baby’s heart rate which remained steady throughout.  My dog Zesa popped into the room a few times wondering what all the noise was about which made me smile to know he was there for me too. 

As time went on, I was getting more tired, I really needed him to be close now. My doula Charlene asked Matt what his name was, Matt said we hadn’t decided yet (which we had but he didn’t want to say). She said, if you knew his name you could call him and encourage him out. When I heard that I shouted CHARLIEEEEEE, and they both started laughing, I guess we knew the name after all. I started talking to him, encouraging him, telling him how much he was loved and wanted and that it wasn’t long now. That really helped me. It gave me a new boost of will power and determination. It was like I knew his birth was near. What also helped me was Charlene reminding me to relax and let go of each surge, this really helped me rest in between without tension. She would say one down, one less to go.  I could feel he was close now, I muscled up every bit of inner strength I had and focused intently on allowing the birth energy to move through me. I connected with the galaxies and imagined that energy spiralling through me, I knew I didn’t have to do anything, I just need to let go and allow. I looked up at my affirmations and read ‘’I feel the strength of all woman’’. I knew if millions of women had done this before me then so could I.  I had no idea who was in the room, and what was happening behind me, I was one with my body and baby. 

In my pregnancy I had also done a lot of work listening to Charlene’s Relax into Birth Tracks. In the labour I could hear her voice, saying those calming words over and over again, ‘’relax….open….peace…’’, reminding me to breath ‘’down and out’’.

The next rush brought a new sensation, an excruciating stinging and burning which was incredibly intense. I had read about this in many birth stories but experiencing it was a whole new story. I moaned to Charlene, ‘’IT’S STINGING’’. I remember the song playing at that exact time, ‘’The Power Is Here Now, By Alexia Chellun. 

The words to this song were divine timing…

The power of love is here now 
The power of now is here now 
The power of you and me is here 
To create magic on earth 
Let the water wash away your tears 
Let the fire burn away your fears 
Let the wind blow into your life such faith and trust 
Let the earth hold you, take care of you and nurture you

This song gave me the strength to get through the final few rushes. I didn’t need to be coached or told what to do. I just listened to my body and my baby. The body truly is built to show you how to birth your baby if you trust it and let it show you the way. Just like in life, you are always being guided, are you listening to that inner guidance.

Finally, after an intense surge, and a crazy burning and stinging sensations, my baby’s head came out, and immediate relief came flooding through me, this was it. I then had to stand up and get out of the birth pool and and gave one almighty push and Charlie was born at 4.25am on Monday 9th March weighing 3.92kgs. He slid out into my midwife’s arms. I remember her saying, hello baby, hello baby and rubbing his chest. Charlie was born to the song, Grace of God by Gurunam Singh. It was a special synchronicity that out of my entire playlist Charlie was born to two of my favourite songs and that they came on in the perfect time when I needed them most.

My midwife Lana and Doula Charlene helped me to lay back on the bed and passed my little baby Charlie to me. Matt was by my side through it all. I was completely exhausted and overcome with relief that it was over, and awe that my little man, baby G was finally here. Tears welled in my eyes as held him skin to skin and spoke softly to him. I had done it, we had done it, I had given birth just as I had intended to, at home, naturally, surrounded by love and all was well. 

The next few hours were pure bliss. Charlie never left my chest and Matt and I cuddled up in bed and just gazed at him and studied his tiny body. My midwives and doula were incredible, they made our morning even more special. They tidied up around us, brought us tea and left us to bond for a few hours until everyone had had some rest. A few hours later my midwives did all his checks while he lay on Matts chest. I cut the cord and saved my placenta to bury one special day. The next few days were just as incredible getting to know this little soul. He was feeding well, sleeping well and I was in good hands with my midwives coming back every day to check up on us. It couldn’t have been a better first week. I felt so grateful to be a mum and was loving every moment of it. Charlene also came back the week after and gave me the most beautiful foot massage, I felt so taken care of. 

Although my birth was pretty close to my dream birth. It wasn’t what I expected. I thought I would breath him out in a blissful meditation.  It was way more painful and intense than I ever expected. I could see how woman in hospital would end up with interventions and pain medication and I was just grateful that I was at home and none of that was available. It was just me and my baby working together. 

My midwives gave me homeopathic remedies including calendula and seaweed to help with the minor stitches. Charlene made me some beautiful bath salts to soak in.  It took me a few weeks to get my energy and strength back, but I am grateful I never had any baby blues or any baby problems. While I was tired, I woke up each day feeling sunshine in my heart so happy to see my little baby. He spent the first week in our bedroom and we didn’t leave home for 40 days. We had minimal visitors, (thanks to Covid-19) and spent our days sleeping, relaxing, singing and getting to know each other. I massaged him daily and he got daily skin to skin and sunshine. We bonded deeply with him and both had the best possible start to our new journey together. 

Charlie is now 4 months and thriving. He’s happy, calm, sleeps and feeds well, we’ve never had any issues. I’m so grateful he was born just before lock down, I’m grateful for the bubble it gave us. Just Charlie, Matt, my mum and me. My mum was supposed to be here 3 weeks and ended up being here 4 months, which again was divine planning. I don’t think we could have asked for a better start.  

I am incredibly grateful to my birth team. My midwives and Lana who joined on the day and my Doula Charlene. I couldn’t have done it without them. The space they held with me throughout my pregnancy, birth and the days and weeks that followed made this the most incredible experience for me. Their encouragement and trusting approach is what gave me the trust and faith to birth my baby and to be the mum I knew I could be. 

I am grateful to Matt for being a non-judgemental support through it all. His help doing everything else allowed me to focus on what I needed to do. We were also so lucky that he got to work from home and still is for this first part of Charlie’s life. 

I am grateful to my mum for the 4 months of being here throughout lockdown, her early morning time with Charlie helped me catch up on my sleep, her cooking, cleaning and care, really helped us thrive during these first few months. 

I am grateful to my baby Charlie, for being the gift of love and grace that he is. Thank you Charlie for choosing us. We love you. 

Thank you for reading my birth story and for joining me on this life-changing journey. A new chapter has begun in my life and I look forward to sharing many more lessons and learnings along the way in the hope that they will too inspire you to live your happiest life.