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.

Gynecological health screening: which tests, how often?

Gynecological health screening has been proven to prevent certain cancers and other serious diseases. Women should adhere to recommended screening programs. Often questions arise about when to commence screening, frequency of screening visits, what to be screened for and when to stop.

Predisposition to Gynecological diseases depends on reproductive age. Just after onset of puberty and prior to sexual activity, the risks of Gynecological diseases are very low. Most screening programs commence shortly after starting sexual activity, or between the ages of 21 – 25 years.

An annual pelvic assessment may be combined with annual general health screening for other conditions. This is usually an opportunity to discuss general Gynecological health, and review any symptoms that may warrant further interrogation. An internal examination is not always mandatory.

Young women, below the age of 25 and with multiple sexual partners, should be screened for sexually transmitted infections including HIV. This also applies to older women with new or multiple sexual partners. Sexual infections have undesired fertility consequences, and prevention and prompt treatment is paramount.

Pap smear tests screen for changes that may lead to cervical cancer. This may be coupled with Human Papilloma Virus (HPV) testing. Testing should begin about 3 years after starting sexual activity, and no earlier than 21 years. Between the ages of 9 – 26 years, HPV vaccine may be offered to women who have not been exposed to HPV, but Pap smear screening should continue. The interval of Pap smears depends on individual risk factors, but studies have a shown that an interval of 3 years is safe for those who have had previous negative results and no new symptoms or risk factors. Women with concurrent diseases like HIV should be tested more frequently. After the age of 65, the risk of cervical cancer is very low if previous Pap smears have been negative, hence women in this age group could stop testing.

All women should learn how to do self-breast examination, and if any abnormal changes are detected, seek advice immediately. Mammography imaging to screen for breast cancer is recommended from 40 years, and only earlier if additional risk factors (like family history of early onset of breast cancer) are present. Testing should be done every 1 – 2 years.

Some diseases, like ovarian cancer, do not yet have a recommended routine screening test. Annual blood tests and ultrasound scans may lead to unwarranted interventions. Some women may however benefit from such surveillance, depending on personal and family medical risk profiles.

The medical industry is rife with fancy screening tests that have little scientific basis. An example is full body scans, searching for non-existent but potential future diseases in healthy individuals! Such tests often lead to undue anxiety and unnecessary interventions, and are not recommended

Helping your teen with abnormal bleeding

Dear doctor,
My teenage girl is experiencing irregular, heavy and painful bleeding. It’s now about 3 years since she started having periods. Does she require any treatment, or should we just wait and see?

The encounter you describe is not unusual, and occurs quite often. You may well have been at the brink of disaster, and the gynecologist you mention aptly came to your aid. It’s good all ended well, and you are alive and kicking. But I can sense your frustration at not being able to express your gratitude at an opportune moment.

Teenage girls are especially vulnerable to irregular bleeding, which sometimes can be heavy and painful. It’s mostly blamed on the transitional immaturity of the reproductive system. Teenagers can find this distressing, as it can interfere with their schooling and other social activities. Luckily for most, it’s just a transient period in their reproductive life. Spontaneous resolution tends to be the norm.

The transition into puberty requires a lot of education. This is the only way teenage girls will know what to expect, and how to react. If your teen is well prepared about having periods, and already versed with sanitary precautions, they are more likely to cope with their bleeding patterns. If they are however ignorant of the events linked to puberty, the inevitable bodily changes will leave them more confused and distressed.

Parents have the initial responsibility to judge if their teenagers’ bleeding patterns are abnormal. It may initially be unclear to your daughter about how much bleeding to expect. Having a chat with them will help you make a judgment. Changing several soaked pads in a day is undoubtedly heavy, and bleeding well over a week is certainly prolonged. Irregularity may mean several months without getting a period, but for some the bleeding may be too frequent, occurring unexpectedly in between the month. Pain will vary, but its intensity can be judged by the need for more potent painkillers.

Once you make out that your teenager’s bleeding pattern is abnormal, please arrange a gynecological review. Waiting for spontaneous resolution whilst your daughter is struggling to cope is no good. If they bleed too much, they could become anemic. If in too much pain, they will be unable to concentrate with their day to day activities. All that is needed is a basic assessment, there’s hardly any requirement for intrusive examinations or extensive testing. But a minority may require some blood tests and pelvic imaging. Most will end up with a simple diagnosis, with no longterm reproductive implications.

Heavy bleeding can easily be controlled with tablets, with the addition of iron boosters if the girl was already anemic. If bleeding is very irregular and too frequent, hormonal treatment will likely be required. Some parents will worry about the use of hormones, but they are safe and only need to be used for a short period. There are lots of potent painkillers to choose from, or a combination if required. Those already on hormonal treatment will easily notice an improvement of their pain though. It’s very rare for teenagers and adolescents to require any surgical interventions. But it can happen with uncommon diagnoses.