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.

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.

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. 

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.