chatwithketch

Q: Good evening ma’am. Please ma’am, what is the solution to a pregnant woman which her EDD has passed, and she is not feeling any labour sign?

A: Usually pregnancy lasts for 40 completed weeks plus or minus 2 weeks. This is usually through pregnancy dating using ultrasound scan in the first trimester.Generally though, from 37 weeks, your baby is good to be born…all things being equal. Therefore,, if a woman gets to 40 weeks without any sign of labour, she is tentatively given 2 more weeks, especially if there are no other risk factors present in the pregnancy. This is called watchful waiting and during this period, the baby’s kicks are counted, baby’s heartbeat is monitored and indeed, baby’s growth and other parameters are monitored. From the 41st week,if she does not spontaneously go into labour (without help), then there is a plan made for induction, having fully informed the woman of all possible scenarios. Some women do not like the idea of induction and so, having discussed with the medical team, may opt for a sweep of the membranes. This involves the separation of the membranes (the ‘bag’ in which the baby lies)from the lower part of the womb (uterus). This releases prostaglandins, which help stimulate labour.

When a pregnancy goes beyond the Expected Date of Delivery (EDD) which is 40 weeks, it is called a post-dated pregnancy. If the pregnancy lasts beyond 42 weeks, it is called post term.

It is not really clear why some pregnancies become post-dated but some associated risk factors include previous post dated pregnancy, first pregnancies, mothers with high BMI and advanced age.

The main challenge with allowing a baby to remain in the womb beyond the 42nd week is that of the placenta no longer being able to supply sufficient amounts of oxygen to the baby. This can lead to brain damage or even death of the baby. The second issue is the threat of the baby having its first poop inside the womb and then aspirating (breathing in) same.

So, have a long chat with your medical team and discuss options available and the ones you are comfortable with.

All the best! Let’s know when the baby is born! Lots of love and hugs.

Have a good night, people 😀

Q: Good evening Dr., it’s been 10 months that I gave birth. I haven’t seen my period. Is it normal?

A: Hello and Congratulations on your new baby! Return of menses following delivery is varied between individuals. Some women would see theirs a few weeks after, some others after a few months or even a year, while in others there is no return of menses before another pregnancy begins.

Different women also report different changes with their menstrual periods after childbirth. Some report longer periods. Others report shorter periods; some others report less pain and others observe absolutely no change at all 😀

However, the pattern of your menstrual cycle prior to your previous pregnancy (if it was regular or irregular) also plays a role. The duration of your labor and the presence of complications like bleeding after delivery could all play a part in the return of your period. Exclusive breastfeeding and presence of underlying infection also could delay the return of menses. Don’t stress out about this for now…. except if you are really looking forward to another pregnancy soon. If this is the case I would advise you see your doctor for a proper evaluation. Otherwise enjoy your period of no bleeds 😀

And please, remember to discuss contraception/family planning options with your doctor during your 6 weeks appointment if you’ve had a baby. I’ve had quite a number of people writing in to ask if breast feeding protects against pregnancy and if it was possible for them to get pregnant even before their periods return or if it was safe to breastfeed a baby while pregnant (The answers by the way, are yes to getting pregnant while breastfeeding, yes to possibility of getting pregnant before periods return and yes to breastfeeding while pregnant); this means that there are probably a couple of people getting pregnant earlier than they had planned. Let’s take the right decisions.

How is your week going?

Have a good night, y’all 😀

Q: Good day Dr. Ketch. I have a 10-month-old grandson who is living with me…how do Ideal with his behavior he gets angry when he wants something he can’t have. He pinchesscratches and hits in the face. Screams at the top of his voice when he wantshis way, doesn’t want to go to bed at night, fights off sleep as much as hecan. He started walking at 9 months so he is very active. He puts everythingand anything in his mouth. He has no teeth yet. How do we get him to listen andto get him to calm down? Thank you.

A: Dear grandma, thanks for writing in. Thanks especially for your labour of love taking in your grandson to raise. May God reward you – not just in heaven but in this lifetime, Amen!

Now to the young man in question J

What he is doing is throwing a temper tantrum. Why does he do that? It’s his way of expressing frustration with the challenge of the moment which could be not finding the right words to express a need/desire, not being able to figure out how to do something, or just plain old tiredness and hunger lowering the threshold for frustration and subsequent anger/temper tantrums. It may be jealousy of another child in the family or even in this case, feeling insecure and not really understanding why mum had to bring him to grandma.

While you may not be able to prevent tantrums (remember the causes), you can reduce the frequency and encourage better behavior.

When my children were younger, they knew that I had no time for temper tantrums…actually tantrums of any kind. I had way too much on my plate 😀 If one came to me screaming about what had happened, wherever, I would nicely tell him/her to get a hold of him/herself, put their feelings/anger into words and calmly explain what had happened (I will nicely exclude other tested and trusted means I also employed :D). As they grew older, this worked more and more because they learnt to make arguments for why they had to have something or why some other sibling behavior was robbing them of whatever right they were sure they had at the moment 😀 Today, they are all proficient speakers winning debate and public speaking awards nationally and globally. #proudmama 😀 But I digress…

Key tips for encouraging better behavior:

At 10 months, it may be difficult to explain the decisions that led to him being with grandma, but you could try distracting him for the moment

Be consistent – establish a routine so that he understands what to expect and stick to it so that he knows to a large extent, what to expect. As the bible says, ‘let your yea be your yea and your nay be your nay’. Don’t give in and agree to something you had previously refused, because I’m sure you had good reasons for refusing in the first instance. If your child knows that a tantrum gets them the stuff they want, even if it’s bad for them, they have every incentive to continue this ‘bad’ behavior

Try holding him firmly, if you can, until the episode passes. Engulf him in a huge bear hug until he settles down

As he gets older….

Encourage the use of words – As soon as he is able to start expressing himself, please encourage him to verbalize. Let him explain what he needs and why he is angry. You may yet make a champion speaker out of him! 😀

Give him options – It’s also a great idea to make him feel in control sometimes by offering options from a variety of things eg rice or pasta; carrots or green peas, red or blue shirt etc

If tantrums occur during shopping, you could ignore him or have him go to a timeout spot any spot in the shop will do where you ask him to sit or stand and not move away from there.

For the pinching, scratching and hitting, here are ways to make him understand this is unacceptable. A couple will be more useful when he is older:

Don’t hit back, please! 😀 A 10-month-old doesn’t quite understand that he’s hurting you and if you hit back, you are saying that this behavior is okay

Reinforce your love for them by talking to them and no matter how upset you are, be sure to communicate that you love them, just not their behavior.

Praise them when they do well. This will help reinforce the right behaviour

As they grow older, have a timeout spot where you can send them for bad behviour or send them to their room. I know in Nigeria, we generally think this is an oyibo thing, but I did it and it was quite effective. Don’t over-use this though as it then loses its usefulness. Make sure it’s also not for too long. A good rule of thumb is one minute for every year of life – so a 2 year old gets 2 minutes of timeout. Your 10-month old is too young for that right now J

Encourage them to find ways to utilize all that energy. Sporting activities would be great!

Typically, by three and a half years of age, the tantrums should be over and perhaps even earlier if you were consistent with the rules we gave above.

It’s also normal for children to put stuff into their mouths. It’s part of discovering this new interesting world they have been put in. So, his caregiver has to be vigilant and try to keep everywhere, including toys clean.

Hang in there, grandma! Seek help from his mum and/or his doctor if you’re still worried.

Hugs coming your way!

Best,

DK

Q: Hi Doctor what can i do to avoid sickle cell among children?

A: Interesting question!

Parenthood is a huge job. It involves a human being literally sacrificing all for another. You want to protect your children from pain, hurts, losses etc even when you know it is impossible. When they are ill, you want to take over the illness and leave them well. So imagine if you were the parent of a sickler, who has to deal with crises after crises, in pain and sickly most of the time. You’re constantly praying to God to please let this crisis pass, please reduce the pain and indeed you are in the hospital more often than not with this child.

How did this happen? Well it was when two sickle trait carriers (people with AS) decided to get married. This automatically meant that for each pregnancy, they had a 25% chance that the baby would be born with genotype SS. This is a mathematical probability and so it could very well be that none of this couple’s children would be SS or it could very well be that all or half of them could be SS! So imagine starting out on a journey of parenthood knowing that your heart is going to be broken again and again as you deal with your child’s continual visits in and out of a hospital.

Therefore, before marriage, a couple should be sure to carry out tests. I’m not talking about those carried out by churches to confirm pregnancy at al 😀 but a serious desire by couples to seek answers as they make the decision to undertake a voyage together. This should ideally be done or known by both parties early enough in a relationship before emotional investments are made on either side.

If two people are carriers of the sickle cell trait, it is only pragmatic not to marry. Before you all lynch me, I know it is not as easy as it sounds. But marrying because you’re emotionally invested is really exchanging one type of heart break for another…because your heart will surely break when you have to watch your child go through the pains of the many crises he or she has to deal with or have them die in your hands.

If I were to choose, I most definitely know what the choice would be for me. It may not be an easy choice but we’ve got to break the trend of these increasing numbers of people living with sickle cell anaemia in our communities. If ignorance is the problem, let’s spread the knowledge; if love being blind is the problem, ladies and gentlemen, please bring a flashlight along and show the light!

For more on this topic, please click on these links: https://chatwithdrketch.com/2014/06/24/daily-health-tips-my-fiancee-and-i-have-as-genotype-should-we-get-married/

Daily Health Tips: Can Parents With AA And AS Genotypes Avoid Having A Baby With Sickle Cell Trait?

Daily Health Tips: How Come My 4-Year Old Baby With Sickle Cell Anaemia Has Never Had A Bone Pain Crisis?

Have a fabulous weekend!

Are you a morning or evening person? Do you know what that means? An online dictionary defines a morning person as someone who feels awake and full of energy in the mornings. A night person? A person who prefers to stay up late or who functions best during the nighttime hours. Why do these matter? What do these have to do with breast cancer? Read!

https://www.bbc.com/news/health-46102193#=

Q: Doc how safe am I? I’m on 2 months injection. I was supposed to go on the 05th for my next injection but I went on the 7^th

A: How safe are you? Well, not safe if you had sexual intercourse during the two days you had no means of contraception. If you find yourself in that situation ever again, please abstain or use a condom. Another option is the morning after pill which can be taken within 72 hours (some can be taken within 5 days) of unprotected intercourse and can help prevent pregnancy.

Q: Please Dr. I am close to my delivery date yet no water is coming out of my breast, Please ma’am, is it OK for me or not?

A: Hi dear, worry ye not! 😀 I’m sure your breasts will rise to the occasion of breastfeeding as soon as it’s time.

You didn’t mention how many weeks or months pregnant you are. Generally, the milk glands start the job of milk production early in pregnancy (1^st trimester). Some women may notice leakage of yellowish milk from their breasts as early as second trimester but some may not see anything until after baby has been delivered.

Feeding should, ideally, start within one hour of having your baby. Your breast already has a stock of breast milk but it does take your baby sucking to make the breast milk ‘come out.’ So, the earlier you put the baby to the breast, the sooner proper breastfeeding can be established. Your baby will probably sleep away the first 24 hours or so, so it may be a challenge to put the baby to the breast. Try the best you can and make sure that your baby’s mouth covers the areola which is the dark coloured area of the nipple.

Some women who had their babies through Caesarian Section may also experience delays in breast feeding just like some other women. There’s no specific reason for this and the same advice of putting the baby to the breast often suffices. The more often you put your baby to the breast, the better your milk supply will be.

Just in case you’re worried that your baby will starve before full breast feeding is established, don’t be. Your baby doesn’t need more than a few teaspoonfuls of colostrum (which your breast already has and baby gets as he suckles) in the first few days. They contain a lot of substances that help build your baby’s immunity. If, however, by 72 hours you’re still not making breast milk, be sure to discuss with your doctor so that he can confirm that your baby is getting enough to eat. Before this time, don’t get tempted to offer glucose water or formula feeds if you plan to breast feed.

Now just in case you wondered about pap with milk and whether this helps breast milk come in faster? Well, my answer is this. If you want to take your pap, please indulge…in sizeable portions. If it helps your breast milk come in, that’s fine. I guess if the pap is watery enough, it will help hydration and you certainly need to be well hydrated for breast feeding to happen without stress 😀

Have a good night, people 😀

I visited my sister a couple of days ago and she was confused as to whether her sons (one and a half years four and a half years) needed to take the yellow fever vaccine again. I referred her to my blog 😀 I mean, after all, I spend all this time writing on it…people should read it, right?

I repeat the post below for your reading pleasure 😀

Q: Hi doc! I am kindly asking is it right to be given twice the yellow fever injection because l was given last year August which will last for 10 years.Is there a difference between yellow fever for ten years and life time? Thanks in advance

A: Hallos! Thanks for writing in.

Previously, the yellow fever vaccine was taken every ten years but since 2016, that regulation has changed. From 11th of July 2016, the WHO, on its website, states that the certificate of vaccination against yellow fever is valid for life for everyone vaccinated and that this validity refers to existing and new certificates. For the latter, the lifetime validity starts 10 days after date of vaccination. This has effectively cancelled out the need for re-vaccination.

So, there is no difference. The vaccination that used to be received and was valid for 10 years is now valid for the duration of your lifetime. If you had received the vaccination before, you don’t need to modify your certificate. The old one is still valid and will be recognized by countries that require proof of this vaccination.

I hope this helps.

All the best!

Have a good night y’all 😀

Q: Hi! I have a newborn baby. She’s 7 days old. I realized the eyes are yellowish. They said in the clinic to put her on the window when the sun appears. I’m only breastfeeding – her will that help

A: Jaundice is a condition in which there is yellowing of the eyes or the skin. It can happen in both children and adults. Usually, when old red blood cells are broken down, a yellow pigment, bilirubin is released as part of that process. The bilirubin is removed from the body through urine and stool. It is the bilirubin that gives rise to that yellow colour seen in jaundice.

Other symptoms of jaundice include deep yellow urine and pale stools.

In newborn babies, there are two types of jaundice (neonatal jaundice) that can occur: Physiological jaundice and pathological jaundice.

Physiological jaundice occurs as a natural process of life. While in the uterus, the baby’s bilirubin is removed through the placenta. Once the baby is born, he/she has to handle this bilirubin business by himself/herself 😀 (talk about responsibility immediately after touching down in planet earth!) because his organs are unable to deal with all the bilirubin released from breakdown of red blood cells. As the bilirubin accumulates in blood, jaundice results. Typically, this jaundice appears about 24hours after birth, actually gets worse until the 3^rd or 4^th day. It would usually have disappeared by the end of one or two weeks.

Pathological jaundice is due to a disease condition like infection, mother and baby’s blood groups not being compatible etc. This is typically present before 24 hours of birth.  Indeed, this is the main difference between the two types of jaundice. The one that occurs naturally is seen after 24 hours while the one due to disease is seen before 24 hours…rule of thumb 😀

Jaundice may be mild, disappearing on its own, especially physiologic jaundice. However, sometimes, the yellowness deepens, the baby may develop a high-pitched cry and/or develop arched back. These are dangerous signs and this child should be in a hospital. Indeed, if you observe jaundice in your baby after you have left the hospital, please get it checked out in the hospital just to be sure.  Most babies are able to deal with this excess bilirubin on their own without needing treatment. However, some other babies may be put under special lights called phototherapy or in more serious conditions, an exchange blood transfusion may be done (literally, this involves practically exchanging the baby’s bilirubin-filled blood with ‘new’ blood).

The main focus in jaundice is to bring down the level of the bilirubin. If this is not done, it could cross the blood/brain barrier and stain the brain leading to brain damage, a condition called Kernicterus.  More frequent feeding is usually suggested as this helps the baby get rid of more bilirubin.

Will breastfeeding alone help? You didn’t quite specify when your baby’s jaundice appeared. It is key to confirm if it’s pathological or physiological. This will determine the appropriate treatment.

Have a good evening, everyone 😀