Thursday, 18 May 2017

Speak out and save the next person

Image result for chisom anekwe

Hardly does a week go by without one learning of a maternal death in Nigeria. Today the Nigerian media is awash with the news of a certain Chisom Anekwe, her travails at Magodo Specialist Hospital in Lagos, and her eventual death under completely shocking circumstances; going by the version of the story in circulation. Just like in almost every such case, people come out and recall their experiences from similar encounters with health practitioners who handle human lives with laxity and the question one always asks is  "so what did you do?", one almost always gets answers like  "nothing oh, at least I was grateful to have survived " or " reporting the doctor or nurse would have made him/her loose her job and I wouldn't want that" bla bla bla....   Answers which leave so much to be desired. A health practitioner's job and someone's life which should rank higher in importance?


It all boils down to our selfishness. It is always me, my children, my loved ones. We hardly think of the next person.  Selfishness is the main reason why we are where we are today. What happened to altruism? What happened to saving the next person? Magodo Specialist Hospital probably did what they did because they had gotten away with so many such cases, same with every health practitioner that handles human life with laxity. Though laxity permeates almost every sector of the Nigerian society but not all cost human lives.

A woman during childbirth in one of our "prestigious" teaching hospitals was given an episiotomy that cut through her anus and when asked what she did she said "I was thankful for little mercies and didn't want to push it".  You loose someone under questionable circumstances and all you say is " will my action bring back the dead?" or "it is the will of God". What happened to comments like "No one else should be allowed to go through this"?

You may not have the money to seek legal redress but there are authorities you can report to; everyone has a superior even if the superior in question is the regulatory authorities. Do something let it be that nothing came out of your efforts. Today we are lucky to have the internet and social media, use it. Let your voice be heard. Tell your story.  There are media houses that will be very willing to carry the news. Just do something to prevent another occurrence; not just because of yourself but because of the next person. Even if the regulatory bodies end up doing nothing, you would have told the public your story and people would be mindful of such health outfits and experiences. Health and medical practitioners would also be careful because of the consequences and kind of publicity their laxity could generate in the event of the loss of a life. One way or the other,  you would have helped save at least one more person from the consequences of doctors' and nurses' carelessness.

Certainly that hospital in Magodo would never remain the same again, at least not in the nearest future if they survive the current media onslaught. Many other such health outfits will also take precautions. More people now know where not to go to and what not to tolerate.

People get away with so many bad things because we let them to, which led to the vicious circle we find ourselves in today.  It happened to Chisom because the victims before her took it in their strides. Who knows who it will be tomorrow? Please let us stop the culture of licking our wounds in good faith and imbibe one of saving the next person. Let us join hands to ensure preventable deaths are prevented.

Thursday, 4 May 2017

Memoirs of a Nigerian Mum: Discretion when buying baby's items in Nigeria

I read your post on expectant mums' checklist and thought  sharing  my experience could help an expectant mum out there.  Being a first-time mum can be quite tasking and if you have no prior experience handling babies you could be in for a lot of mistakes and surprises.

I had my first child last year. When it was time to start buying baby stuff I asked colleagues and friends with experience what I needed to buy and their approximate costs. I was shocked when a colleague told me she spent 120k on baby items, another said she went to market with 100k, spent it all and yet couldn't get all she had in mind. I braced up for the expense when I went to the market. Surprisingly, I bought everything I needed with just a little over 40k. Where did my colleagues' excesses come from?

In the market there are local and foreign versions of almost everything. I saw a local baby bath set of about 3k and a foreign one of about 10k, a local baby cabinet of 5k and foreign one of 16k, imported diapers of 17k a carton and Nigerian Pampers of about 2k for a jumbo pack and so many other items. When I inquired about the differences between the local and foreign versions, they bordered mostly on our love for foreign items. Why buy a foreign bath set when the local one will serve the same purpose  at almost a quarter of the price? Same with baby cabinet (which I didn't even buy as I figured out it wasn't a need) , why will I buy foreign diapers if the local one will be just as good? No be shit and wee-wee my baby wan use am for? I made up my mind to buy just one pack of Nigerian Pampers and watch my baby's reaction to it which would ultimately decide which diaper I would stick to in the long run.

Well, she is almost a year old now and I have found no reason to not use Nigerian Pampers.  I bought one local thermometer with 100 Naira which still serves till date as against one type of digital thermometer that costs above 1k. I bought a set of Cussons Baby toiletries which I have had no reason to regret yet, as against the advice to buy some foreign products which would have cost me like 10 times the amount I spent on the Cussons set. I bought good baby cloths, I looked more at durability and not whether it was foreign or local. I also considered the fact that babies outgrow their cloths so fast and wondered  why I should  spend so much on high-end cloths which my baby wouldn't even notice. The most important thing is to get the baby clothed.

At then end of the day, I spent much less and achieved same. My baby's skin is as beautiful as any baby's can be. At the end of the day, what is noticed is how healthy your baby looks and not which designer or foreign products  she/he is wearing or using. With the current economic situation in the country, I hope mums learn to use their discretion when spending, you do not have to follow the trend, get exactly what you need and that which you can afford.



Tuesday, 2 May 2017

After birth comes the postpartum period. Here are things that may happen to a new mum after childbirth

Pregnancy is a beautiful thing but can also mean a lot of stress for you and your body. There is so much information (both good and bad) available about pregnancy and what it may entail.  At the end of pregnancy is what is usually called the Postpartum period filled with its own unique set of challenges. Pregnancy can so mess with your body that you fail to recognize your postpartum self. Some new mums get scared of their new bodies and often go back to their doctors with complaints  about things that often are normal.

Below are few things that could happen to you postpartum

(1) After birth contractions. Contrary to what many mums think, uterine contractions do not end in the labour room with the birth of your baby, it continues as the uterus tries getting back to its pre-pregnancy state. The contractions can get really painful and many mothers report increasingly painful afterbirth contractions with each subsequent child.  You tend to notice it more when you put your newborn to your breasts for feeding because a baby's suck triggers the release of the hormone oxytocin  which causes uterine contraction.   If the contractions get too painful , you could ask your midwife or doctor for some pain relief. But do not be alarmed as it is quite normal.

(2) A weak pelvic floor.  This is said to affect about one third of  new mums who had a vaginal birth. It could cause urine leaks when you cough or sneeze. Do not panic when it happens to you, it usually gets better by the time your postpartum period is over; that is 6 weeks after birth.

(3) Bleeding : Many mums-to-be know women bleed after birth but majority do not know to what extent the bleeding occurs. Woman, you will pass out a good amount of blood that you find yourself changing maternity pads about 5 times the first day . The blood may also come in thick clots, thicker than what most people see monthly as menstrual blood. Don't worry, you aren't hemorrhaging, at least your doctor or midwife would check the color and intensity of your bleeds at intervals the day after delivery and beyond to ensure it is normal. They may also inquire about the number of used pads you've disposed, and so long as they say it's okay then you should relax. The bleeding reduces with each passing day but could last for weeks. You will be needing maternity pads for the first few days after birth after which you can use sanitary pads when the bleeding has reduced to what you feel sanitary pads can handle.

(4). Breastfeeding may be difficult. The image most mums have of breastfeeding a child is that of simply putting the child to your breasts and voilĂ , the baby starts sucking. Well, after delivery you will know it is hard work. Though nature made it a bit easy by equipping new born babies with the 'rooting reflex' that ensures when their cheeks are stroked, they turn towards the direction of the stroke making sucking  motions. But you still have to ensure you get a correct latch else you will end up with sore nipples that make you cringe once it's time to breastfeed. You could ask your midwife to show you how to achieve a correct latch.
Image result for correct latch
Source: https://themilkmeg.com

Engorged breasts could also be a huge challenge that you find yourself begging your newborn to suck. When the mature milk finally comes in, you may also grapple with excess supply especially if you are practicing exclusive breastfeeding. Nursing pads can come in handy at such times.


(5) Putting in a diaper correctly could be challenging and could cause tear-jerking accidents. Many mums assume wearing a baby a diaper is easy till they need to do it. A seemingly simple thing could continually ruin your day or night till you learn to do it right. And newborn poo is not a sight you will love on your dress or mattress. If possible, practice putting a diaper on a baby before yours arrive to avoid embarrassing or tear-jerking accidents involving baby poo.

(6) Your belly will be big for a while and could look quite horrible like a deflated, rumpled  balloon. It will also look quite dark. It is not usually a beautiful sight but don't worry it clears gradually. Reversing the effects of a process that took about 9 months does not happen overnight. You should learn to appreciate your postpartum body because it is your warrior scar; a reminder that you partook in the miracle of creating a human like you.

(7) Postpartum blues. Many women expect to feel elated after birth. Well it isn't always the case. Some even report not wanting to hold their babies at first. Relax, the love for your baby isn't always as mushy and immediate as we often imagine it to be, it can come after a while. You may also not feel 100 percent normal and could cry easily without provocation. This can be quite normal and is called Postpartum blues. Get as much help and assistance as you can lest you feel overwhelmed. But if you ever start nursing thoughts of harming yourself or your baby, please seek medical help immediately as it may have gone beyond postpartum blues into postpartum depression which can get really bad when ignored.

(8) If you had a vaginal birth, you will definitely feel so sore below, this could affect hitherto easy practices like pooing and even urinating. But fear not, the pain subsides overtime.

(6) Hemorrhoids. Some women are left with souvenirs of their pregnancy and birth in the form of Hemorrhoids. It is said to occur more in women who birthed quite heavy babies. Well, it disappears with time but if it doesn't, take it as one of the evidences of your partaking in the miracle or creation.


You may also want to read the following
Refuting some myths surrounding Exclusive breastfeeding in Nigeria

Colostrum; baby's first vaccine

Infant gas pain; that great source of distress to newborns and their mums

Some tips on newborn care

Getting your hospital bag ready for childbirth? Here are things you would likely need to take along.

Getting  your bag ready for the hospital can be a very confusing task  especially for first time mums as one may not always be sure of what would be needed in the hospital for birth and the few days after. This can lead one into buying things around the hospital which usually could be more expensive, or to repeated requests for one thing or the other to be brought to the hospital from home. This list is different from what hospitals usually demand for delivery which often includes delivery mat and all that; it contains the items a new mum will need for herself and the baby; it is by no means exhaustive but will hopefully give Nigerian-based mums an idea of what to pack in their hospital bags.

ITEMS FOR THE NEW MUM

1. A bag or box. This should be something portable which you can grab with ease.  The size should just be enough to contain the needed items; not too big but not too small either. It should be a light-weight bag or box that will not add unneeded weight to the few things you need to throw into it.
Image result for carry on bagImage result for carry on bag

2.Cloths for you the new mother- to-be. If the health outfit where you intend to give birth does not provide clothing for women in labour, you can never go wrong with wearing a loose, free gown to make you covered but also available for checks especially if you are the kind that would not like to walk round the labour room naked. The gown should make it easy for you to be checked for dilation. Some hospitals provide gowns so inquire if yours will. You will also need cloths you will wear during your hospital stay as well as going-home cloths. If you plan breastfeeding (which most Nigerian women do) then wear cloths that will allow you do so. When choosing such cloths, bear in mind that your belly will still have a bump. Two to three cloths will be okay even though one cannot predict exactly how long the hospital stay will last. Trousers or skirts should be soft- rimmed.

(3). Maternity pads. The most common ones in Nigeria come in a pack of 10 pads. It is safest taking two packs of those though one may end up using just one pack depending on how long the hospital stay lasts. The first few days will come with fairly heavy bleeding and you may find yourself changing your pad 5 to 6 times a day.
one of the most common maternity pads in the Nigerian market

(4) Pants for the new mum. 4 to 5 black coloured pants are recommended especially if you will be able to wash and dry used ones.

(5) About 2 nursing bras.  These should be comfortable and not too tight as your breasts may get sore at some point. You need something that could be soothing to your sore breasts. They should allow you breastfeed your newborn with having to unhook the bra.


(6) Breast pads to trap the leaked milk. After colostrum comes the mature  breast milk;  usually by the second day.  This could  leak a lot and  breast pads could come in handy in such cases.
Image result for breast pads
(7)  Toiletries. These should include a towel,  bathing soap, toothbrush, toothpaste, hair comb, sponge and  make up for the new mum. After birth, you will very likely want to look as good as you can so your make up bag needs to be taken along.

8) Foot wear. You will need something to wear on your feet in the hospital and on your way home. A flip flop will do for the hospital and something free and nice for going home.

(9) Sizeable water flask. You will at some point need hot water for tea, bath or any other thing.

(10) Some snacks. You could get hungry and need something to munch before or after delivery. Whatever snacks and drinks you fancy will do.

(11) Your phone's charger. The number of calls one will likely make or receive after birth can be enough to run your battery down. You may need to put a spare phone charger in your bag as it is one of the most easily forgotten items.

12. Recharge cards. You will need to make a lot of calls and may not have the convenience of someone to send on errands in the hospital.

(13). Camera. This could come in handy if you are picture freak. You may need to capture those first moments. A phone can also play the same role if you have a camera phone.


ITEMS FOR THE NEWBORN

(1) Baby cloths. The most common ones used in Nigeria are onesies and overalls. Three to four onesies and same number of overalls should do. It is nice to have a variation in  baby cloths sizes as you don't know how big your baby will be.
overall
Onesie
(2) Baby diapers.  A pack or two will do depending on the number of diapers in each pack. The baby usually passes out tar-like poo at first followed by mustard-like poo. Sometimes frequency could be up to 5 times a day. Since one isn't sure of how long one would end up staying in the hospital, a total of about 20 diapers will do.

(3) A pack of Baby wipes. These should be fragrance-free and suitable for sensitive skin. Some pediatricians suggest using cotton wool and warm water to wipe the baby's sensitive bum the first few days so a pack of cotton wool may be brought in place of wipes.

(4) 2 baby caps. These should be soft-rimmed and not tight on the newborn's head.
Image result for baby cap
Baby cap
(5) one baby towel for bath or cleaning times. 

(6) One baby flannel. It's advisable to spread your baby's own flannel on the bed before laying your baby down.

(7) Insecticide-treated bed net. You wouldn't want to expose your baby to mosquitoes that early.

(7) Baby oil and petroleum jelly. These usually come in handy when the baby's body is cleaned and needs oiling. They also come in handy when changing diapers. Fragrance free ones are recommended.




For the checklist of what to buy in preparation for baby's arrival in general read this

Wednesday, 26 April 2017

Pregnant and resident in Nigeria? Read this.

Pregnancy in Nigeria like most other health issues carry significant risk; and unlike many other health issues, has  almost countless myths and old wives tales associated with it.
Being pregnant in Nigeria means you will get a lot of unsolicited advice; both good and bad but here are some things you need to know and practice.
Image result for pregnancy
Photo credit: americanpregnancy.org
(1). Being pregnant and giving birth in Nigeria is a miracle; you need to do same in a developed country to realize that. And like all miraculous occurrences, you need to appreciate it and handle it with utmost care. Take your prenatal vitamins as much as you can and try your best to eat well and stay healthy.

(2). Get yourself registered for antenatal checkups at a good health facility. As it relates to pregnancy, a good health facility is one with at least one midwife on duty at each point in time. There are so many private health facilities in Nigeria made up of one or two doctors and no licensed nurse. Such places could be tolerable for medical checkups where you will have little or no contact with the so called nurses they parade there but when it comes to pregnancy, especially as it would likely be the nurses who would handle delivery, please go to a facility that has a licensed midwife. Licensed midwives know their limits, they do not take most unnecessary risks as they have in-depth knowledge of the likely consequence of whatever action they take. They also know which complications are within their power to handle and how fast you need to get to a doctor when they need arises. Most times, they have a doctor on call who can handle emergencies. So when choosing a facility for your antenatal and child delivery services, look beyond  the doctor's qualification to that of the nurses. If need be politely ask the nurses which nursing school she attended. They are usually the ones that handle birth and afterbirth care. Many maternal or infant deaths have been linked to the nurses and you certainly do not want to be part of the statistics.

(3). If possible register for birth in more than one health facility. It is always good to have options. For example register at one place near your place of work and another near your home; or at one government-owned facility and another good private hospital. With pregnancy you never can predict when or where you will need the best of hands to handle a complication. Hospitals tend to act faster when you are a registered patient of theirs. Besides you would not want the doctors to wait for test results before attending to you.

(4).  Take medical advise only from doctors or licensed nurses/midwives. Experienced mums are not in the best position to do so, neither are religious leaders. Forget all the old wives tales and myths associated with pregnancy, or at least get your doctor or nurse's opinion concerning them. And please stick to medical advice; get second, third or even more medical opinions if your instincts demand so, but let the final decision be based on a medical advice.

(5). Ensure your doctor/nurse is someone you are very comfortable with, also let him/her know your birth plan. Do you intend trying a vaginal birth after a Cesarean Section? Discuss it with them let them be the ones to guide you through it and if they deem it too risky, get another opinion if need be but stick to medical advice. A healthy mother and baby is the most important outcome of a pregnancy, not the method of birth.

(6). If your practitioner ever mentions the need for you and your pregnancy to be monitored, PLEASE PLEASE and PLEASE let them do so. That is why you need a skilled and licensed practitioner who identifies risks when he/she sees them, you also need one you trust to always take decisions in your best interest. Complications often do arise in pregnancy and child birth,  and almost all times can be handled effectively by skilled medical practitioners.

(7).  After delivery, if your practitioner suggests the need for further monitoring in the health facility, please wait. Beyond pregnancy is the puerperium which can also pose a risk to new mums. Understandably, few hospitals in Nigeria are comfortable enough for a new mum to relax in after birth, but when there is need, remain under the professional eyes of your practitioner till you are declared fit to go home.

(8). If you do not have one already, get yourself and your family health insurance. Out-of-pocket payments for medical bills can be very expensive and inconvenient. Click here for more details


Always bear in mind that the cost of loosing one's life during childbirth is very high. While taking whatever decision during pregnancy look beyond the now; beyond the food you need to cook and the chores undone. Your family needs you beyond now. Several mums have lost their lives as a result of their  preferrence for one more domestic chore over their being monitored in a health facility when it was needed.

We look forward to a time when maternal health indications in Nigeria will shift from what is currently obtained to something better; when pregnancy in Nigeria will be no more risky. We all need to join hands to achieve that. We need to play our parts while we hope health practitioners play theirs.

Monday, 10 April 2017

Memoirs of a Nigerian Mum; maternal mortality in Nigeria


Isn’t it amazing how blind we could be to issues around us till someday, somehow, the scales fall of your eyes and you see clearly what has been so obvious?  Growing up, maternal mortality to me meant the statistics churned out by the World Health Organization and similar bodies; I never agreed with the figures, not even when my god-mother died in related circumstances.  I thought they were overestimates. I was probably busy growing up, studying and doing many other things except noticing the maternal health indicators around me.

Then I got married and extended family obligations demanded my new family’s stay in a semi-rural area in South-Eastern Nigeria. My first shock came with a case of a teenager whose placenta was retained hours after the delivery of her baby which was attended to by a local birth attendant who claimed she told the poor girl’s mother to take the girl to a nearby hospital where there would be capable hands to handle the case; they did so but not before inviting their religious leader who spent hours ‘commanding’ the retained placenta out. Long story cut short, the girl died leaving behind a helpless little baby.

Then I started to notice. I noticed the lady who went for her scheduled antenatal checks and was advised to stay back for monitoring as her blood pressure was abnormally high; she accepted but insisted she must cook for her family and return later. That was the last meal she made for her family.

 I noticed the case of the lady whose religious leader ‘prophesied’ that she will have a normal delivery; and convinced her to reject all pleas by her doctor to have a Cesarean Section when she had complications that demanded so.

 I noticed the case of the lady who died due to complications that arose from a C-Section that went wrong; doctors in all government hospitals were on strike so she went to one of the one-doctor-and-no-licensed- nurse hospitals found at almost every corner of the country.

I also noticed that a week hardly goes by before I learn of another case of maternal mortality on social media. Then I started arguing that the statistics did not give the true picture; that things are much worse than depicted.

More painful is the knowledge that almost all the deaths were preventable. They were largely errors in judgment from either the patient, her relations, her health practitioner, religious leaders, and even failures of the health institutions; errors which I blame the Nigerian health system for, for  failing to introduce innovative measures to minimize and if possible eliminate preventable maternal deaths and in fact all preventable deaths. There should also be punitive measure meted on persons implicated in preventable cases of maternal deaths; from birth attendants to religious leaders and even some patient relations.

Every case of maternal death translates into huge human and economic losses. It leaves behind a trail of heartbreak and despondency. While  we expect the government to make significant and sustainable changes to the health system, mothers and everyone concerned should be well-informed on what their choices and chances are to enable them make informed decisions. Every one should know what  their roles are in the bid to reduce the unacceptable maternal mortality rate in Nigeria


I look forward to a time when preventable maternal deaths in Nigeria will be a thing of the past. 

Tuesday, 28 March 2017

Methods of child delivery and what we as Nigerians need to know about them.

 Image result for childbirth memes

We would for the purpose of clarity,  and the different kinds of persons this write-up will reach divide methods of childbirth into 3.

The first and most common is the natural child birth method. It involves vaginal delivery of the baby without intervention; as per no pain medications and no use of whatever tools to 'bring out' the baby. It is the most preferable and recommended mode as the new mother heals very fast. In cases where medical treatment is done out-of-pocket, this method is the least costly. Midwives alone can handle this delivery method.

Next is the Cesarean Section . This mode of childbirth involves a surgical incision into a pregnant woman's abdomen and uterus to bring out the baby. Although can be an elective procedure, it is usually done when one of either the mother or the baby's life is in danger. It is much more costly than the vaginal mode of delivery and is handled by much more medical personel than the natural childbirth method. In the delivery room would be a doctor, a midwife, an anesthesiologist etc. Healing is usually longer and more painful than the natural method and the new mother is usually expected to stay longer in the hospital as she will be monitored till she is deemed fit to go home.

The third is the vaginal but assisted childbirth. Assistance here could be in the form of epidurals, forceps, vacuum extractor etc. The mother is aided in delivering her child either by numbing the labor pains or using devices to 'extract' her baby vaginally. This method of childbirth is not common in Nigeria and needs specific monitoring and child delivery devices not seen in a majority of the hospitals in Nigeria.

Whatsoever the mode of childbirth, the most important issue is the life and well-being of the new mother and her baby. No method diminishes the challenges of a pregnancy, none invalidates a mother, none makes one a better mother than another. They all make the new mothers face varying types of challenges during delivery and the healing process. They all make one a new mother at the end.
Image result for childbirth memes

In as much as the natural childbirth method is preferred, there are cases when it is not possible or medically advised. A pregnancy can come with certain challenges that could make a medical practitioner rule out natural childbirth; all in a bid to save the life of mother or child or even both. If that happens to be an expectant mother's case, she can seek a second, third of even more medical opinions from medical doctors and midwives but  NEVER religious leaders or other mums. Refusal of interventions during childbirth has been known to cost lives of either mother or child and sometimes both. No one has ever won an award for natural childbirth, at least not in Nigeria. So if interventions ever get recommended, get another medical opinion (if there is time left for that) and stick to medical advise. Except the slower healing pace and the deep hole it can dig in one's pocket, there is absolutely nothing wrong with assisted childbirth when it is needed to save lives. What is wrong is loosing one's life or that of the newborn as a result of one's refusal of assistance during delivery, and contributing to the already unacceptable maternal and child mortality rates in Nigeria.