Keep your reproductive health intact this Xmas

If you are keen on your health, it’s very likely you consult every now and again for various reasons. It may be with your regular gynecologist, or a family physician. Does it ever bother you sometimes that consultation charges can spiral out of control? At first glimpse, it may not seem relevant if you are paying a few thousands on staggered consultation visits.

Think of all the partying, with plenty of food and drink that will be at your disposal. What will you choose to eat and drink? You could go for the fat-laden and roasty stuff, and top it up with processed carbohydrates. Then wash it all down with fizzy sugary drinks, finally settling down to several rounds of alcoholic beverages.

That will certainly get you into the right mood for a party. But you will also get more than you bargained for. Those are the choices that will predispose you to diabetes, heart disease and some cancers, especially if you continue with the same eating habits beyond the festivities.

If you want to keep yourself onto the healthier path, eat plenty of plant stuff. You know what this is. Lots of greens, vegetables, salads, fruits, and complex carbohydrates. Wash it all down with fresh juices and water. You are allowed a bit of the unhealthy stuff, but make sure to only take little bits just to please your taste buds. The more disciplined you are about food choices, the more you keep away from chronic diseases.

Excessive partying is a good recipe for risky reproductive health behavior. Untamed drinking, coupled with the odd temptation to try some drugs will get you onto a regrettable path. Real risks for unsafe sex creep in, getting you onto the surest path for sexually transmitted infections including HIV. Many unwanted pregnancies happen during festive periods, with consequent risks of unsafe abortions.

If your partying leads you to an erotic direction, make sure to have some condoms handy. If not on long-term contraception, remember you could always get emergency contraception. Any other way is just too risky for your reproductive health.

Remember to burn all your excesses with some exercises. Doesn’t have to be anything fancy. A brisk walk round the neighborhood will do. Or a light jog, or even some make-do physical activities right where your partying will be. If you can sustain this beyond the festivities the better. It will get you a long way into reducing health risks associated with sedentary lifestyles.

Don’t let any festivities wipe out your memory about preventive reproductive health initiatives. It’s a good time to talk to your teens about sexual health, and get them vaccinated against HPV. Don’t forget your own schedule for health screening, like routine pap smears and mammograms. If pregnant, don’t forget all the dos and don’ts. Party all you want this festive season, with your reproductive health in mind. Merry Christmas.

Consultant obstetricians hardly required for normal deliveries

Labor and delivery are key moments that mark the end of a pregnancy. Understandably there are many anxieties that surround the delivery of a baby. Not least is who actually conducts the delivery. Should it be the midwife, or the consultant obstetrician?

Key decisions surrounding labor and delivery should be made well in advance during the antenatal period. It is important to realize that labor and delivery is usually a team effort. You play the main role, with collective supervision between midwives and obstetricians. Neither must be deemed to have a lesser role.

Labor and delivery are natural processes, and for the vast majority, spontaneous delivery is the norm. All that is required is due monitoring to detect any deviation from normality, and act accordingly. Both midwives and obstetricians are trained in conducting normal vaginal deliveries. None of them can claim superiority in normal delivery skills. But some studies show an advantageous edge with midwives compared to obstetricians as far as normal delivery is concerned.

So the general idea that you need a consultant obstetrician to be present for a normal vaginal delivery is a fallacy. If everything is proceeding normally, the presence of an obstetrician is hardly required. Midwives will skillfully and safely deliver your baby. Observational studies show that you are far less likely to require interventions during vaginal birth if being supervised by a midwife. We are talking of interventions that deviate from a spontaneous birth. Midwives appear to be more patient, allowing the natural course of events to unfold whilst still upholding your safety and that of your baby.

Do consultant obstetricians have any use then as far as normal vaginal deliveries are concerned? Yes they do. Theirs should mainly be a behind the scenes supervisory role. As soon as you arrive in labor ward, your obstetrician should be informed. Part of their briefing is a reminder of your antenatal course, and prior plans for your delivery. All being normal, they don’t necessarily need to see you in person, but should be easily available should your labor deviate from the norm. They must be kept informed on the progress of your labor. Routine decisions can easily be communicated verbally, but your obstetrician must remain ready to physically come in if any complications arise, or unforeseen interventions become necessary.

You retain the liberty to select between being delivered by a midwife or by an obstetrician. Remember though you may not have an advantage either way. When labor is progressing normally and a spontaneous vaginal birth is anticipated, having a consultant obstetrician physically present hardly adds value. What adds value is the team effort, with each member of your delivery team responding appropriately as events unfold. The presence of a consultant obstetrician when hardly anything requires to be done just crowds your delivery room, and adds onto your costs.

Premature deliveries are best avoided

Dear doctor,
I am now 36 weeks pregnant and too exhausted with my pregnancy. I want to be delivered early but my doctor has refused. What should I do?

There is no doubt that pregnancy can be stressful in many ways. There is initial excitement when a desired pregnancy becomes a reality. But as pregnancy advances, many changes occur in your body. Some changes are undesirable; like poor sleeping patterns, easy exhaustion, and pelvic discomfort among others. Most of such symptoms are luckily of an innocent nature. But it can all get too much, hence the wish to get it all over and done with when you get too overwhelmed.

But nature is clever, and will allow your pregnancy to progress till about 40 weeks before spontaneous labor ensues. This ensures delivery of an optimally mature baby, who is ready to live outside the uterus. Thus in pregnancies without any complications, decisions to deliver the baby prematurely are best avoided. Complicated pregnancies are a different matter altogether. In such cases, there may be compelling reasons to terminate the pregnancy earlier, either in the mother’s or the unborn baby’s interests.

If your desire to be delivered early is based on mundane but annoying symptoms, you may wish to reconsider your wishes. Babies born before 37 completed weeks are considered premature. They are prone to a multitude of problems of immaturity, and in extreme cases may require prolonged care in newborn units. It can be very distressing to care for a premature baby, both emotionally and financially.

The best way out for you is to review your ongoing symptoms with your doctor. There are many remedies to help cope with most innocent symptoms in pregnancy. It may be worthwhile to check that your exhaustion is nothing to do with low levels of iron, which commonly occurs in the second half of pregnancy. A simple test can confirm whether all you need is some supplements. There are other micro-nutrients that may need to be supplemented, and your doctor should be able to advice.

On a personal level, you need to review your daily activities. If your day is full of physically demanding commitments, this may be contributing to your exhaustion. Take it easier, even if it means taking some days off work to get some rest. Or reducing your working hours to manageable limits. Get your partner to be involved as much as possible with your pregnancy, this helps with your coping mechanisms.

In exceptional cases, labor can be induced early even in uncomplicated pregnancies. Such a decision must be carefully made, balancing all the potential poor outcomes with any perceived benefits of an earlier delivery. Special precautions would normally be put in place, but the potential drawbacks cannot be completely eliminated.

Age-related fertility decline occurs in men too

There’s a common misconception that men retain their fertility potential for almost a lifetime. Nothing could be further from reality. Men suffer from a similar decline in fertility as much as their women counterparts.

The dual age-related fertility decline is a natural phenomenon, thus skewed blame of women in matters of fertility should be avoided.

The decline in fertility starts in the late thirties, and gets more pronounced from the forties. The overall sperm quality decreases as age advances. Older men will increasingly become incapable of fathering more children, or just contribute to age-related miscarriages and fetal abnormalities.

Men should make decisions in matters of reproduction early enough, balancing this with other competing interests like careers and personal development.

Your reproductive plans must take account of your current age. You may choose to bring forwards, rather than delay child bearing if creeping towards the fourth decade. This may not always conform to your overall ambitions, but must be factored in if you harbor an eventual interest in having a family.

Awareness of fertility decline must be coupled with a lifestyle that maintains optimal sperm quality. Smoking, chewing miraa and use of other recreational drugs are all very toxic to sperm quality. It doesn’t end there. Sedentary lifestyles leading to obesity and other illnesses like diabetes also contribute to declining fertility potential. You want to keep yourself in optimal health, and avoid preventable conditions that may accelerate the decline in your reproductive potential.

But we are living in an age where even the best laid plans may come to a cropper. So what if you get caught up with the humdrum of competing interests, and have to push back your plans for raising a family to the later decades?

Just like for women, men also have the option of fertility preservation. You could choose to freeze your sperms as a backup for later use, when conditions for starting a family are more favorable. Better still, you could freeze fertilized eggs (called embryos), if already in a stable relationship but not ready yet to start a family. Frozen sperms or embryos maintain their quality till eventual use. But there are costs and ethical dilemmas involved in such matters that you must be willing to contend with.

Remember even advances in assisted conception techniques cannot fully compensate for age-related fertility decline. Aim to seek help early if conception does not occur within six months whilst in the advanced age group. Don’t send your female partner alone to a fertility clinic, you should always accompany her as you may be the one with a problem. It doesn’t matter if you have fathered a child before, you must accept the natural fertility decline that comes with getting older.