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Guest Post : Effects of Malnutrition during Pregnancy

Malnutrition in Third World country

Malnutrition in Third World country

Malnutrition is the word we associate with the Third World and emaciated faces desperate for food and fresh water. However, malnutrition affects people all over the world from all social classes and in all conditions, even during pregnancy.

A pregnant woman must be in tiptop condition to support both her own body, and the developing body of her unborn child. Never in a woman’s life will a properly balanced diet with the correct levels of nutrition be more important. Many think they should be ‘eating for two’, but really only an extra 200 calories per day are required, and only during the third trimester.

New research suggests that if a mother wishes to, it is safe to diet during pregnancy if they are working to lose a small amount of weight or to maintain a healthy weight already attained. However, the diet must ensure the mother takes in everything she needs.

Pregnancy

Sometimes during pregnancy, a mother may suffer malnutrition. This could be for a number of reasons:

  • Pre-existing medical conditions such as cystic fibrosis, colitis or Crohn’s disease
  • Severe morning sickness
  • Psychiatric conditions such as body dysmorphia or anorexia.

Thankfully, pre-existing medical conditions can be managed during pregnancy, and mothers may need to supplement their diet with advanced medical nutrition. Where malnutrition is caused by severe morning sickness, this should improve once the morning sickness has passed (usually between 14 and 16 weeks) although some mothers do have it to a degree for most of their pregnancy.

It is harder when a pregnant woman suffers from anorexia or body dysmorphia, as the problem lies deeper, often stemming from insecurity and may require constant hospital monitoring.

Malnutrition during pregnancy not only weakens the mother, making it difficult for her to carry the baby, but can also have both short-term and long-term implications for her baby. Anaemia resulting from lack of iron in the diet means that less oxygenated blood travels around the body and to the placenta. If baby’s brain tissue does not get enough oxygen it can cause mental defects.

One of the biggest implications of malnutrition is a low birth weight baby. Lighter babies can be harder to deliver and there is also a higher risk of postpartum haemorrhaging for mum. Having a low birth weight can also cause a lot of problems for the infant outside of the womb, such as respiratory complications (the baby may need some help with their breathing or may spend some time in the special care unit). Other problems can include poor vision, low co-ordination, faltering growth and impairment to cognitive development.

Woman with vege

For many mums, malnutrition is completely manageable if not preventable. By ensuring a healthy intake from discovering the pregnancy, you can give your baby the best start in life before they are even born. Speak to your midwife or healthcare professional if you are concerned about malnutrition during your pregnancy.

” This article was written by Bianca Ridley, a nutritionist who is currently working with Nutricia, the largest specialist nutrition company in Europe. You may contact Bianca through her email bianca.c.j.ridley@gmail.com

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Checklist before going to the hospital

Going To Hospital :
Mothers :
Nightdress / Nightgown (2 Sets) – Ideally loose fitting with buttons to the front for easy breastfeeding.
Dress / Robe (1-2 Sets) – For receiving visitors or when checking on baby in the nursery room.
Warm Socks (2 Pairs) – To wear in the delivery room.
Nursing Bras (2 Pairs) – For breastfeeding.
Breast / Nursing Pads (A Few Pairs) – For breastfeeding.
Disposable Underwears / Panties (4 – 5 Sets).
Sanitary / Maternity Pads (1 Pack) – Most hospital will provide only one pack and will charge if you get more.
Slippers (1 Set) – Preferably one with non-slip sole.
Audio CD & Player / Books & Magazines – For relaxation.
Breast Pump – Helps to stimulate milk production as babies tend to be sleepy during the first few days after birth.
Nursing Pillow / Support – Assists in positioning of babies during breastfeeding especially for c-section mothers.
Toiletries – Mild fragance-free soap, shampoo and deodorant so that baby will recognise the natural scent of mother long before sight recognition.
Toothbrush, Toothpaste & Floss
Glasses or Contact Lenses
Cosmetics & Make Up
Comb / Hair Brush
Handphone & Charger
Fathers :
Camera, Films & Batteries / Camcorder, Tapes & Batteries.
Address Book / Phone Number List – To call to announce the birth of baby.
Money – Preferably coins for vending machines or pay phone.
Admission Form – Bring this form everywhere you go after 36 weeks gestation as you might deliver anytime.
Infant Carrier / Moses Basket.
Siblings :
Gift From Mom & Dad – Helps to ease jealousies after baby arrives.
Favourite Toys, Dolls / Books – Helps to keep them occupied.
Going Back Home :
Dress For Mother – Preferably a loose fitting and comfortable outfits.
Clothes For Baby.
Mittens & Booties For Baby
Receiving Blanket For Baby.
Disposable Diapers For Baby.

My first beautiful labour experience

Have you ever heard of natural birth? I got to know about this during my second pregnancy. I was searching for ways to ease my labour pain and I came across this method. Natural birth is a method of delivery used by the older generations before the modern labour room policy was made.

For my second pregnancy, I went into labour at 38 weeks of gestation. I was determined to go through this labour as natural as possible. I had chosen natural birth methods and had sticked to my birth plan.  I refused any form of drugs for pain relief, be it epidural or injections. During contraction, I did not lie down  because it would worsen the pain. At certain times, I sat down facing and holding the back of the chair with my thighs apart. There was no birthing ball available, if not I would have used that too. My husband helped to massage my lower back with lavender aromatherapy oil. At other times, I practiced the breathing method during contractions. I kept myself well hydrated and ate light snacks during the labour process. In conclusion, I did not stay in bed during the hours of labour. These natural pain relief methods have helped me go through the intense labour pain.

After almost 10 hours,  I was finally ready to give birth. That was the first time I felt the feeling of bearing down.  I remember back then during my time as the medical officer attending to a woman in labour. She used to say she has the feeling of passing motion at the time the baby was about to be delivered. I experienced the exact feeling and the urge to push was tremendous. As my second son’s head came out through my perineum, I felt the most glorious feeling and I mentioned ‘Alhamdulillah’ (Graceful to Allah) for this moment. The sound of my second son crying was another great moment as he was brought to my chest immediately. I managed to cuddle and breastfeed him for about 10 minutes before he was taken by the nurses to be cleaned and properly wrapped in a towel. At that particular moment, I realised that I have successfully gave birth to a healthy baby without any medical intervention. I was very much satisfied.

Hours later, the obstetrician was amazed to see me looking so fresh after a day of labour pain. A friend of mine, who saw my picture in Facebook, mentioned that I did not look like anyone who just delivered a baby. Was it the power of this homeopathy, Salindah that I have been taking? I wonder. Fortunately, my baby and me were well and healthy. We were discharged the very next day. Now, our second son, Muhammad Ayyub is a bubbly, cheerful boy about to turn 2 years old in July. Again, we thank you, Ya Allah for this blessing.

The bad labour

For every new mother, going into labour can be a traumatizing experience. As a doctor, I am experienced in conducting deliveries of other women. However, that experience could never be compared with my own first encounter of labour.

On the day the labour started for my first pregnancy, we went to a university hospital in Kuala Lumpur, Malaysia. Despite the regular contraction pains, my cervical os was found opened only at 2 cm. At that moment, I kept telling myself that I shall not take any painkiller for this pain.

As my labour progress, I was told to stay in the labour room. I was forced to be in the bed with the CTG straps on my tummy.  The labour room was flooded with loud thudding sounds of my baby’s heart beat. My husband started to recite Surah Luqman and Surah Maryam as we went through the labour. An hour later, I was given intravenous Syntocinon to speed up the labour. My movement were restricted and I became uncomfortable. Hours went by and the low back pain became worse. The contraction pain was increasing. At one time, the pain was unbearable that I finally requested for an epidural. Unfortunately, the epidural was not properly functioning. The pain was still there, only this time it was on one side of lower half of my body. I couldn’t sleep the whole night but i refused any form of painkiller injections except for Entonox. The attending medical officer wanted to give me Pethidine injection. Finally, feeling too exhausted, I succumbed to one injection at about 5 am. The officer was at fault for not checking on my cervical os before giving the Pethidine. At 6.30am, the specialist came only to find out that I was fully at 10cm and that I was ready to push the baby out. Unfortunately, I was too drowsy and I didn’t have the strength to push.  My son was finally delivered vaginally assisted by vacuum due to my poor efforts. He didn’t cry at the first minute and was brought to the neonatal resuscitation room to be given Naloxone. Moments later, I could hear his cry and I was glad. I was too sleepy and I slept at the labour room while my perineum was being sutured by the obstetrician.

Up in the maternity ward, I realized that my baby did not received my breastmilk during the first hour of delivery. I was really sad for this is the most important meal for the newborn. I stayed in the hospital for a week because my first son had neonatal jaundice secondary to caephalohaematoma. He received double UV phototherapy. I cried at times looking at him so tiny, wearing only diapers and pads over his two eyes. I knew at that time I need to be strong for him.

My husband kept telling me that this was Allah’s test on us and for that we must stay strong. I was thankful that I survived the labour. I realized that this bad labour experience was a step for me to improve myself in future. I was not properly prepared for the labour,  physically, mentally, nor spiritually. From that moment, I vowed to improve myself with the next pregnancy and be better at facing the next labour. And, I did. Thank you Ya Allah.

 

Improvement in the second pregnancy

My first experience in pregnancy and labour has taught me enough for me to take charge of my second pregnancy. At that time, I was a full time student and a trainee medical lecturer, doing Master in Medical Science. I was about to enter the Second Semester, learning Head and Neck, Pelvis, Abdomen and Neuroanatomy.

During the first trimester, I began to feel the similar symptoms of ‘morning sickness’. I could not concentrate much in class due to the overwhelm nauseous  feeling. My good friend introduced me Salindah, a homeopathy remedy for pregnant women. She gave me a few bottles to try out, which she did not finished during her last pregnancy. I read on about the origin of Salindah and its benefit. I then decided to buy the whole set for my pregnancy and postnatal care.

After taking Salindah for a month, I realised my ‘morning sickness’ symptoms was much reduced. I did not experience any back pain like I used to have during the first pregnancy. I keep on reading on homeopathy and I started to believe in it. I started on Examo, another kind of homeopathy from the same manufacturer, which I use to take during secondary school. It is believe to help improve your memory. My pregnancy went on smoothly throughout the trimesters except for Braxton Hicks, which I started experiencing since 33 weeks of gestation. At that moment, I realized that this pregnancy seemed  similar to my first one. Nevertheless, I managed to finish the Master’s coursework and obtained good grades. With the examination over, I was feeling a bit relief and begun to concentrate on my pregnancy.

I began to read on labour pain and natural birth methods. I found out that it is a practice in the western countries to have birth plan, a plan which a mother and the attending obstetrician can adhere to during labour process.  This is not the practice in Malaysia. However, I was fortunate to have a good obstetrician with me for my second pregnancy. I downloaded an example of a birth plan and discuss it over with my husband and obstetrician. As a doctor myself, I knew the consequences and benefit of each plan. The obstetrician agreed to my birth plan even though I would be delivering my baby in a public hospital. From then on, I started visualizing the actual labour and the scenario in the labour room. I began mental preparation.

Some of the things that I request in my birth plan:

  1. I would like to attempt a normal delivery as possible
  2. I do not want any artificial augmentation i.e Intravenous Pitocin
  3. I do not want to strap myself to the bed with the CTG monitoring continously
  4. I would like intermittent CTG monitoring
  5. I want to be able walk and do whatever I feel comfortable with during my contraction pain
  6. I want my husband to cut the umbilical cord of my baby
  7. I want my baby on my chest immediately after delivery
  8. I want to breastfeed my baby immediately after the delivery
  9. I do not want any form of painkillers injections or epidural to relieve my labour pain

On the day I was supposed to present my research proposal for my Master, I succumbed to symptoms of labour. This time we were better prepared to face any challenge during the labour. We were hoping that the outcome would be better for us and the future baby. We prayed to Allah as we had done our best to get ourselves ready. Finally, I must say it was all worth while. Now, our second son, Muhammad Ayyub is a bubbly, cheerful boy about to turn 2 years old in July. Again, we thank you, Ya Allah for this blessing.

The first pregnancy

Being pregnant for the newly weds is the most wonderful thing to happen. Alhamdulillah, I found out I was first pregnant in January 2007. My husband and I were very excited.  I was working in the Emergency Department at that moment. So did my husband, only in a different hospital. I couldn’t wait to see the gynaecologist. So, I asked my colleague to perform an ultrasound scan to see the growing fetus, but it was all too early. The only thing that I could see was a yolk sac.

As time goes by, the stress of working as a medical officer started to kick in. During the first trimester, I started to experience low back pain. It was not just any kind of pain but a lingering, shearing pain along the lumbar spine. I was not able to sit down for long hours at the consultation rooms in the Green Zone. I begin to experience ‘morning sickness’ – nausea, bits of vomiting and lethargy. A week later, I was diagnosed to have threatened miscarriage as I had episodes of vaginal bleed. Repeat scan at that time showed a viable fetus. My husband decided that it was time for me to take a rest. Finally, I resigned as a medical officer in the Ministry of Health and start to do locums at my own leisure.

During that few months, I did a lot of reading on pregnancy and the changes associated with it. I equipped myself with Islamic knowledge and almost everyday I recited the Holy Quran. The fetus in your uterus actually listens to every word you read. This is the same practice by the Westerns, whereby the parents sing lullaby or put headphones to the mother’s belly while connecting to a CD player playing Mozart. I believe that once the baby is exposed to Quran as early as in the mother’s womb, Insya Allah the baby will grow into a great Muslim. I was very much focused on myself and the growing baby back then. I did not miss any of the antenatal check-up and I was satisfied with the baby’s development. However, I did not really put much emphasize on the upcoming events as I thought that everything will go on smoothly.

Time passed by and my pregnancy has reached the third trimester. My symptoms of back pain subsided and so did the ‘morning sickness’. However, I began to feel Braxton Hicks, a non painful hardening of the uterus which can be felt on the tummy. This is not a sign of labour unless it is accompanied by regular contraction pain and blood discharge from the vagina. It can occur to any pregnant lady from as early as 30 weeks gestation. Braxton Hicks is a normal phenomenon as it permits the uterus to practice contraction and relaxation before the real labour actually starts. I experienced this until I reached 38 weeks when I finally felt the contractions at regular intervals and slight low back pain.

I called my husband to come back from work early that morning. We brought with us a Quran Tafseer book and a weekend bag ready to stay overnight. We went straight to the designated hospital to get ready for the labour, thinking that we were ready for the delivery of our first son. Our parents were informed and everyone was excited. Allah knew best what I was supposed to go through. The pregnancy ended with a dramatic labour experience, which left a great impact on me as I begun my new role as a mother. Thank you to my husband for being there for me all the way during this first pregnancy. Our first son, Abdullah Yusuf is turning 4 years old this September. We love him very much. Thank you Ya Allah.