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

 

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.


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.

Some tips on newborn care

 Things would have been a lot easier if babies were born clutching a little pamphlet titled "Instructions manual"; well, they don't and even the most experienced mothers often find each new baby a challenge unique from every other baby they have handled. Evolving guidelines on childcare and daily medical research often demands a little difference in newborn care than we may have always known.  Below are some tips on how to handle your newborn baby.

(1).The baby should be put to its mother's breast as soon as possible after delivery. This not only gives the baby it's much needed supply of the nutrient-rich colostrum, it also starts the baby's journey towards achieving a perfect latch.

(2) Request for help or assistance from the midwife or doctor who helped deliver your baby. You can never go wrong on this; well unless your instincts tell you otherwise. Well-trained medical practitioners are the best people to go to for advice and assistance with newborn care.

(3) Ensure you follow medical advice as regards umbilical cord care. You would very likely get different views on how to care for your baby's umbilical cord; from salt to toothpaste and so on. As well meaning as the advisers may be, please desist from usage of such potentially harmful substances. Well-trained midwives and doctors will give you time tested and trusted ways of caring for the cord. It may not fall off very early as compared to crude methods, but it sure will, after all no adult walks around with his/her umbilical cord still attached.

(4) Please no matter how much they try convincing you, do not perform circumcision on a girl child. The right word is even 'genital mutilation' and not 'female circumcision ' . It serves absolutely no purpose than exposing your baby girl to unnecessary harm, and , making your girl child imagine what her life would have been like if her genitals weren't mutilated.


(5) Get help when you need it. It is often customary for grandparents or experienced relations to come around when there is a new born as they know it could get overwhelming for the new parents. Please let them help when you need them to, but let it be by your rules and under your supervision. Do not let them do things you do not approve of to your baby.


(6) Do not let any sick person carry your newborn, not even someone with cold. It is your duty to protect your child and if commonsense will not tell the person  to not carry the baby, remind him/her. After all you would be the one to bear the burden of a sick child if your child gets infected with whatever infection the person is carrying. You do not really have to be nice about it if circumstances so demand.


(7) Ensure your baby gets all the necessary vaccinations. It is usually advised that newborns in our part of the world get their Hepatitis B and BCG vaccinations before discharge from the hospital. We need to protect our babies from diseases as much as possible.

(8) Ensure hygienic environments around the baby at all times. Also ensure the baby always sleeps under a mosquito net. You wouldn't want your baby getting malaria very early in life, would you?

(9) Dress the baby up in appropriate clothing. When the weather is hot, there is absolutely no need for the overalls and so on; go light. And when it's cold, cover your baby up very well.

(10) If you can, please practice exclusive breastfeeding; feed your baby on breast milk alone for at most the first six months of the baby's life.

The list is by no means exhaustive but can serve as guide especially to new parents. Our babies are precious and should be handled as such.

Making a case for exclusive breastfeeding.

Source :WHO

Breastfeeding is a norm in Nigeria, but exclusive breastfeeding is not. Babies below six months of age most times are given other foods or liquids. Exclusive breastfeeding; feeding an infant on breast milk alone, is the gold standard for babies below six months old as it not only contains all the nutritional needs of babies that age but also protects them from several types of diseases. It has repeatedly been described as the safest and healthiest option for feeding infants. Experts recommend it should start from the first hour of a baby's life as this not only gives the baby good supply of the nutrient-rich colostrum which safeguards infants from dying during the most vulnerable time of their life,  but also helps establish and increase the supply of the more mature breast milk.

Today, the evidence on the power of exclusive breastfeeding is stronger than ever. 

Many mothers choose to practice this form of infant feeding  but get discouraged at some point either by the opinions of family members or the advice of poorly trained health workers,or even by several myths surrounding exclusive breastfeeding. 

Breast milk is said to be a potent medicine for disease prevention that is tailored to fit the needs of a baby, it has been described as the perfect elixir of immunity for infants. Feeding a baby below six months on breast milk alone gives the baby a complete dosage of this potent medicine; this also keeps the baby safe from contaminants in food and water that can cause diarrhea. It also makes makes the baby less susceptible to ear infections, pneumonia and several other childhood illnesses. 

A recent document published by the World Health Organization titled "From the first hour of life: making the case for improved infant and young child feeding everywhere" described breast milk as 'the most personalized form of medicine that any of us will receive in our lifetime'; this is largely because antibodies are produced to combat specific infections a baby is exposed to- a mother's body writes a prescription for illnesses unique to her baby's needs and environment. Human milk apart from being an excellent source of nutrients for an infant also contains a variety of immune components such as antibodies, growth factors, cytokines, antimicrobial compounds and specific immune cells. Feeding infants the recommended way gives the infant the recommended dosage of this highly personalized medicine.

Source:WHO

Exclusive breastfeeding has been described as a high-impact, cost-effective solution for saving children's lives. As infants breastfeed, the immune composition of breast milk adjusts to the properties of their saliva. If the mother's body detects pathogens, it produces antibodies to fight them. There is the risk of contamination from non-breast milk feedings which can expose vulnerable newborns to life-threatening pathogens; besides they can take up valuable space in the newborn's stomach, leaving little room for complete breast milk . 

Exclusive breastfeeding guarantees infants a food source that is uniquely adapted to their needs while being safe, clean, healthy and accessible. According to the WHO document quoted above, feeding a baby below six months of age other things except breast milk makes the baby 2.8 times more likely to die than those who were exclusively  breastfed; exclusive breastfeeding can prevent 53% of hospital admissions for diarrhea and 27% of hospitalizations for lower respiratory infections each month. Research also suggests increases in a child's long-term heart capacity and shape in exclusively breastfed babies than those fed with infant formula. 

For a child six months and below, other foods are at best unnecessary and at worst life-threatening. Let us therefore join hands to promote this great infant feeding practice which has the potential to save countless lives.

Refuting some myths surrounding Exclusive breastfeeding in Nigeria

Today, more than ever, evidence abound on the immense benefits of exclusively breastfeeding a baby

below six months old. Like many practices, there are also myths surrounding Exclusive Breastfeeding (EBF) among which are;

Source: www.Malaysianparenting.com

1.  Exclusive breastfeeding could make a child dehydrated, so a baby needs water: Breast milk is said to be about 88% water, especially the first milk that comes out in each feeding session. Thus, breast milk contains as much water as a baby below 6 months of age needs. Babies on EBF should simply be offered breast milk when it is suspected that they are thirsty. Giving water to babies comes with a lot of concerns especially in our part of the world where safe, drinking water is hardly assured.
2.  EBF is stressful: Motherhood and all it entails can be really stressful but when it comes to ranking stressful activities, putting a baby to one's breasts for feeding can hardly be compared to preparing formula (or in fact any other baby food) as the latter is much more stressful.
3. Exclusive breastfeeding must last up to 6 months.While six months is the standard length of time for practising EBF, it is nowhere etched in stone that it must last that long. Many Pediatricians recommend 6 months as the maximum length of time and 4 months the minimum. That is, complementary feeding can be introduced when a baby is four months of age, but not before then if the mother for one reason or the other feels there is need to do so. Some babies start showing interest in other foods before 6 months, some pediatricians recommend such babies should be introduced to other foods to sustain their interest in foods besides breast milk. 
4.  You need to drink milk/tea always to keep up your milk supply: There is absolutely no scientific evidence to back this up. In fact, milk and other dairy products are linked to infant gas pain. EBF mums should simply take enough water to keep themselves hydrated. 
5. Not every woman can produce enough milk to EBF: Research suggests that above 90% of women can produce enough milk to exclusively breastfeed an infant. Milk supply can only be affected when the mother does not eat well or when she doesn't frequently put the baby to her breasts.
6.  Breast milk alone does not sustain some babies below 6 months: Breast milk is more than enough to satisfy any baby aged 6 months and below. Giving a baby that young any other thing is unnecessary at best and very risky at worst as it could expose your baby to contaminants in food and water at that vulnerable stage of your baby's life.
7.  Exclusively breastfed babies tend to be picky-eaters once weaned. This is absolutely untrue and has been proven so. Picky eating is a trait found in many babies both mix-fed and exclusively breastfed.
8.  Exclusive breastfeeding is only for mums who cannot afford quality formula or those who cannot assure the safety of their drinking water. This is also absolutely untrue. EBF is for every woman who knows its advantages and can practice it; rich and poor alike.

Breastfeeding: A key to Sustainable development

For the past 25 years, August 1 to 7 each year is celebrated as World Breastfeeding Week in many countries the world over. This year's theme is "Breastfeeding: a key to sustainable development". The activities mapped out for this year's celebrations hopes to highlight the links between breastfeeding and nutrition, food security, health, development, survival, achieving full educational potential and economic productivity.

The objectives this year are:

1. To inform people about the new Sustainable Development Goals (SDGs) and how they relate to breastfeeding and Infant and Young Child Feeding (IYCF). 
2. To firmly anchor breastfeeding as a key component of sustainable development.
3. To galvanize a variety of actions at all levels on breastfeeding and IYCF in the new era of the SDGs.
4. To engage and collaborate with a wider range of actors around the promotion, protection and support of breastfeeding.  

Each of the 17 SDGs has an individual link with breastfeeding. The links are outlined below as culled from   www.worldbreastfeedingweek.org. 

1.   No poverty: Breastfeeding is a natural and low-cost way of feeding babies and children. It is affordable for everyone and does not burden household budgets compared to artificial feeding. Breastfeeding contributes to poverty reduction.
2.  Zero hunger: Exclusive breastfeeding and continued breastfeeding for two years and beyond provide high quality nutrients and adequate energy and can help prevent hunger, under-nutrition and obesity. Breastfeeding also means food security for infants.
3.   Good health and well being: Breastfeeding significantly improves the health, development and survival of infants and children. It also contributes to improved health and well-being of mothers, both in the short and long term.
4. Quality education: Breastfeeding and adequate complimentary feeding are fundamentals for readiness to learn. Breastfeeding and good quality complementary foods significantly contribute to mental and cognitive development and thus promote learning.
5. Gender equality: Breastfeeding is a great equalizer, giving every child a fair and best start in life. Breastfeeding is uniquely a right of women and they should be supported by women to breastfeed optimally. The breastfeeding experience can be satisfying and empowering for the mother as she would be in control of how she feeds her baby.
6. Clean water and sanitation: Breastfeeding on demand provides all the water a baby needs even in hot weather. On the other hand, formula feeding requires access to clean water, hygiene and sanitation.
7. Affordable and clean energy: Breastfeeding entails less energy when compared to formula production industries. It also reduces the need for water, firewood and fossil fuels in the home.
8.  Decent work and economic growth: Breastfeeding women who are supported by their employers are more productive and loyal. Maternity protection and other workplace policies can enable women to combine breastfeeding and their work. Decent jobs should cater to the needs of breastfeeding women especially those in precarious situations.
9. Industry, innovation and infrastructure:  With industrialization and urbanization, the time and space challenges become more prominent. Breastfeeding mothers who work outside the home need to manage these challenges and be supported by employers, their own families and communities. Crèches near their workplace, lactation rooms and breastfeeding breaks can make a big difference.
10. Reduced inequalities: Breastfeeding practices differ across the globe. Breastfeeding needs to be protected, promoted and supported among all, but in particular among poor and vulnerable groups. This will help to reduce inequalities.
11. Sustainable cities and communities: In the bustle of big cities, breastfeeding mothers and their babies need to feel safe and welcome in all public spaces. When disaster and humanitarian crises strike, women and their children are affected disproportionately. Pregnant and lactating mothers need particular support during such times.
12.  Responsible consumption and production: Breastfeeding provides a healthy, viable, non-polluting, non-resource intensive, sustainable and natural source of nutrition and sustenance.
13.  Climate action: Breastfeeding safeguards infant health and nutrition in times of adversity and weather-related disasters due to global warming.
14.   Life below water: Breastfeeding entails less waste compared to formula feeding. Industrial formula production and distribution lead to waste that pollutes the seas and affects marine life.
15.  Life on land: Breastfeeding is ecological compared to formula feeding. Formula production implies dairy farming that often puts pressure on natural resources and contributes to carbon emissions and climate change.
16.  Peace and justice strong institutions: Breastfeeding is enshrined in many human rights frameworks and conventions. National legislations and policies to protect and support breastfeeding mothers and babies are needed to ensure that their rights are upheld.
17. Partnerships for the goals: The global strategy for infant and young child feeding (GSIYCF) fosters multi-sectoral collaboration, and can  build upon various partnerships for support of development through breastfeeding programs and initiatives.   

As we mark the week-long celebration, let us make conscious efforts to encourage breastfeeding mothers to keep up the good work of contributing towards achieving the SDGs come 2030. 

Memoirs of a Nigerian Mum; breastfeeding

A breastfeeding mum is a common sight in Nigeria. In fact hardly would your baby start crying than people around you say things like "ah, ah, breast feed that child na". Stories abound of women who were handed over to the police for refusing to breastfeed. A crying baby and a mum unwilling to breastfeed raises eyebrows as to whether the child wasn't kidnapped.

When I became pregnant, I naively expected breastfeeding to only involve sitting down and putting the baby to my breast. I didn't envisage the sore nipples, the engorged and painful breasts, the night feeds and even the feeds during the day when I'd rather be sleeping or doing something else. I also didn't envisage the times my baby would rather play than suckle my breasts.

I had read and learnt a lot about exclusive breastfeeding by the time my baby was due for delivery that I made up my mind to practice exclusive breastfeeding. Shortly after he was born I put him to my breasts and worried like most mums do if the yellowish fluid coming out of my breasts was enough. My nutritionist sister and the dietitian in the hospital assured me of that and encouraged me to put the baby frequently to my breasts as that would help the more mature milk to come in faster.By the second day of breast feeding, I cringed whenever I was to put my baby to my breasts. My breasts had become so sore, painful and cracked. I was later to learn that I wasn't latching the baby on correctly.

Source:www.slideshare.net

Breastfeeding was moving smoothly till sometime around my baby's fifth month when he would easily get distracted and I had to go to quiet places to breastfeed him. I had more episodes of painfully engorged breasts at this time than any other period. My breasts always seemed to leak milk. Whoever discovered breast pads deserves an award.

Then came the seventh month and my baby completely refused to breastfeed. I almost gave up on trying. He would only breastfeed without a fight when he was feeling sleepy. I held on to those times and ensured I breastfed him then. That episode lasted for about two weeks. Suffice it to say he was already eating other meals by then. He repeated it sometime around his eleventh month.


My baby is 13 months old now and still breastfeeding with no end in sight. Our target is age two.

Colostrum; baby's first vaccine

Colostrum is the first milk produced by the mammary glands. The World Health Organization describes it as "the perfect food for newborns" . In humans, it is produced from about the fourth month of pregnancy. It's colour could be anything from clear fluid to yellow  and provides all the nutrients a child needs the few days before breast milk comes in. It is also known to contain many immunoglobulins and antibodies that protect a baby from infections hence some people refer to it as "a baby's first vaccine " . Colostrum also has a laxative effect which helps newborns pass out that tar-like poo called 'meconium'.

Source:www.pinterest.com

Compared to more matured human breast milk, colostrum is said to have a higher protein content and lower sugar and fat contents; exactly as needed by newborns. Experts suggest that the breasts produce enough colostrum to nourish a newborn baby till the more mature breast milk comes in after a few days; they also suggest that babies be introduced to the breasts within the first hour of life which they say has several advantages including stimulating milk production. The more your baby suckles, the faster your milk comes in. This is because the activity of  prolactin (the hormone which causes milk production) increases with frequent breastfeeding .

 A newborn's stomach capacity is said to be about (5ml) one teaspoonful and thus easily satiated by colostrum; this capacity increases to above 30ml by the fifth day during which the mum's milk would have "come in". Colostrum gives way to the more mature breast milk after about 2-4 days post delivery   It is therefore more important to frequently make newborns suckle the breasts than make each  session last long. It is best to put the newborn to the breast at least 8-12 times everyday.