STARSPECIAL, TUESDAY 4 DECEMBER 2018 Expecting Mothers 9

Your weight matters

DURING pregnancy, many factors
contribute to the baby’s well-being.
Dr Haw Wan Lye, consultant
obstetrician and gynaecologist at
Columbia Asia Hospital – Cheras,
shares his concerns about the
increasing body mass indices
(BMIs) in the population, especially
that of pregnant women.
“If a woman with a high BMI
experiences high weight gain
during pregnancy, her risk of
developing gestational diabetes
will be increased,” says Dr Haw.
“Therefore, if your BMI is
already high, you must be careful
of your calorie intake. The
guidelines for weight gain during
pregnancy state that a 12kg to 15kg
weight gain is adequate for a
mother who is underweight or of
normal weight, while an 8kg to
10kg weight gain would be
appropriate for a pregnant woman
whose BMI is above 23.”
Dr Haw advises that there is a
need for expecting mothers to
monitor their diets and pay
attention to the glycaemic index
values of different foods to ensure
that their babies receive adequate
nutrition and reduce their risk of
developing gestational diabetes.
“A diet plan is divided into
three categories – carbohydrates,
protein and fat. If one’s BMI is
high, her carbohydrate intake
should be decreased to control
her blood sugar level and weight
gain,” says Dr Haw.
He recommends that pregnant
women undergo a modified
glucose tolerance test to check for
their risks of developing
gestational diabetes, so doctors
can advise them on their diet
plans accordingly.
He also states that a balanced
diet is essential to a baby’s growth.
Subsequently, he discourages
pregnant women from relying too
much on alternative medicine as
certain supplements can cause
more harm than good to them
and their babies.
He says, “It is strongly advised
that you take alternative medicine
sparingly as there is no scientific
evidence that proves their actual
benefits.”
“Intake of fresh fruits and
vegetables is encouraged.
Supplements such as
multivitamins, calcium and
docosahexaenoic acid can be taken
according to your doctor’s
discretion.”
Dr Haw insists that it is
important for pregnant women to
undergo regular health check-ups,
including HbA1c tests to monitor
their blood sugar levels over a
period. Regular exercise such
as prenatal yoga, swimming,
jogging and walking are
encouraged, especially in the
second trimester.
Finding a balance
According to Dr Haw Wan
Lye, consultant obstetrician and
gynaecologist at Columbia Asia
Hospital – Cheras, going through
a pregnancy with the
“It is better for women to
optimise their weight before they
get pregnant. However, if a
woman with a high BMI gets
pregnant, she should seek dietary
advice from a doctor or
dietician,” he advises.
Women with a high risk of
developing gestational diabetes
must get tested. Those with a
history of having bigger babies
or a high amniotic fluid index
need to be careful to prevent
premature labour.
If a woman is underweight and
it is affecting the growth of the
baby, it is necessary for her to
increase her protein intake.
n For more information,
call 03-9086 9999. Dr Haw Wan Lye.
appropriate weight gain is crucial that mother and baby can
because putting on too much or face because of the mother’s
too little weight can cause excessive or inadequate
complications. weight gain during
Below is a list of complications pregnancy.

Excess weight gain in mother Inadequate weight gain in mother

- Delivery complications - Increased risk of preterm labour

- Increased risk of infections
- Increased likelihood of
Mother operative delivery
- Increased risk of preterm labour
- Trauma from severe tearing

- Obese baby - Affected growth

- Hypoglycaemic immediately after birth
- Respiratory problems
Baby - Slower maturity of cells
- Increased risk of developing diabetes
later in life if mother is diabetic
- Smaller than normal for gestational age
- Hypoglycaemic immediately after birth
- Hypothermic immediately after birth
- Problems with cardiovascular system

Weight gain during pregnancy will affect the health of the baby.

Providing women with the care they need

UROGYNAECOLOGY is a branch of
gynaecology that deals with pelvic
floor dysfunctions in women.
Dr Nor Azhana Mohamad,
consultant obstetrician and
gynaecologist (with special interest
in urogynaecology) at Avisena
Specialist Hospital, explains, “The
pelvic floor is a structure that
consists of muscles, ligaments, soft
tissue and bony components that
supports pelvic organs such as the
bladder, uterus and rectum.
“Pelvic floor dysfunction causes
conditions such as pelvic organ
prolapse, overactive bladder,
urinary or bowel incontinence,
recurring urinary tract infections,
urogenital atrophy and
dyspareunia (difficult or painful
sexual intercourse).”
According to her, risk factors for
urogynaecological conditions
include ageing, menopause,
pregnancy and vaginal delivery,
obesity, constipation, chronic
coughing, smoking, manual labour
that involves heavy lifting and
genetic predisposition.
Women with urogynaecological
conditions commonly present with:
l Sudden and intense urge to
urinate that cannot be put off even
when the bladder is not full,
sometimes leading to leakage.
l Frequent urination, to the
point of restricting daily activity.
l Urinary leakage that occurs
during physical activity such as
laughing, coughing or changing
body posture.
l A dragging sensation or
heaviness over the vagina that
indicates the presence of pelvic
organ prolapse. In severe cases,
patients may feel or see a lump at
the vaginal opening or experience
severe backache.
According to Dr Nor Azhana,
“Urogynaecological conditions are
not life-threatening, but their
symptoms can be debilitating.
Many women with these
conditions have low self-esteem
and isolate themselves socially.
Some may end up with psychiatric
disorders such as depression.
“Other than psychosocial
implications, long-standing and
untreated urogynaecological
conditions may lead to Dr Nor Azhana Mohamad. Urogynaecological problems are common and easily treated.
complications such as skin
excoriation from prolonged usage organ prolapse and stress urinary urogynaecological conditions. With advancements in medical
of sanitary pads or diapers, vaginal incontinence, there are other Intensive pelvic floor exercise science, the population of elderly
infection, bleeding and urinary treatment options available for under the guidance of a trained women is on the rise. Dr Nor
obstruction (which may lead to pelvic floor dysfunction. physiotherapist is an effective first- Azhana shares, “Women nowadays
renal failure).” Conservative approaches are listed line treatment for stress urinary are productive even beyond their
below. incontinence. 50s, significantly contributing to
Seeking treatment l Behavioural – Making lifestyle
changes, including reducing
l Medication – This option can
control symptoms of overactive
the society and economy. Many
enjoy outdoor activities and
Urogynaecology is a relatively weight, adjusting your nature of bladder, but there are side effects. remain sexually active. We do not
new field in Malaysia. Lack of work and avoiding caffeine, Hence, good counselling by a want these treatable conditions to
awareness among our women carbonated drinks, fruit juices and urogynaecologist is crucial to deprive women from living their
causes them to suffer in silence. alcohol. Dr Nor Azhana advises improve the outcome of treatment. lives to the fullest.
Dr Nor Azhana says, “Women that you keep a bladder diary to l Non-surgical prolapse She highlights that the number
acknowledge the problem but treat identify your urinary patterns. treatment – Available in the form of urogynaecologists in the
it as part of the ageing process and Subsequently, training the bladder of ring pessaries. They reduce the country is increasing and advises
neglect to seek treatment. Fear of under the supervision of your protrusion of pelvic structures into Malaysian women to make use of
surgery is another reason older urogynaecologist can help alleviate the vagina. They are meant for the services available and seek
women choose to live with these symptoms of overactive bladder. lifelong use and require appropriate care when needed.
conditions.” l Pelvic floor exercise – Dr Nor monitoring for possible
Although surgery may be Azhana suggests doing pelvic floor complications such as infection n For more information, call
strongly advised to treat pelvic exercises to prevent and ulceration. 03-5515 1888.
10 Expecting Mothers
By SRIMAYEE SEN SARMA
WHEN you hear or read the word “breasts”,
what is the first thought that comes to mind?
For some people, the very word may draw
up an image of a raunchy magazine cover or
celebrities posing provocatively in movie
posters.
Over the years, women’s breasts have
been heavily sexualised in mainstream
media – perhaps even normalised in that
way – to the point that humans seem to have
forgotten that a mother’s breasts are
supposed to be a source of food for her child
and the reason we are classified as
mammals.
Derived from the Latin word mamma,
which means breast, “mammal” is defined
by the Cambridge English Dictionary as “any
animal of which the female feeds her young
one milk from her own body.”
This unsolicited sexualisation of breasts
has diverted the focus from this primary
function, leading to social stigmas that are
costing infants and mothers around the
globe their health.
Freedom from stigma
“Breastfeeding in public is the main
challenge nursing mothers face as it is
frowned upon in many countries, including
Malaysia, even though most women are
discreet in how they go about it.
“This is the reason most women look for
private spaces to nurse,” says Gina Yong,
breastfeeding consultant and founder of The
Breastfeeding Advocates Network, a support
group that encourages and teaches families
about breastfeeding.
However, infrastructure conducive to
breastfeeding is still lacking. An exclusively
breastfed baby needs to feed every two to
three hours. Yong says, “There are not
enough feeding rooms to begin with and
even if a mother manages to find one, it is
often already in use.”
In such instances, many mothers choose
public washrooms as their go-to place to
breastfeed, away from prying eyes.
The elixir of life
Breastfeeding needs to be destigmatised for the sake of nursing mothers and their babies.
To put things in perspective, have you
ever tried eating in a toilet cubicle? If the
mere thought grosses you out, imagine
how mothers everywhere feel when they
try to breastfeed their babies in public
washrooms. It is not only disgusting but
unhygienic for the baby as well.
This lack of public empathy and proper
infrastructure is the biggest reason many
women decide to give up on nursing.
Although various international
organisations have taken it upon
themselves to hold “breast is best”-type
campaigns to spread awareness about the
benefits of breastfeeding, it will get us
nowhere until we go out of our way to create
a world where women feel comfortable
nursing their babies anywhere.
Yong, who is a mother of four, advises,
“Malaysia needs to normalise breastfeeding
by educating people about it at the
grassroots, such as in science classes at
schools and Malaysian mothers need to start
nursing in public to desexualise it.”
She believes that the government has a
role to play as well, saying, “In some
STARSPECIAL, TUESDAY 4 DECEMBER 2018
Breastfeeding in public
is the main challenge
nursing mothers face
as it is frowned upon in
many countries, including
Malaysia, even though
most women are discreet in
how they go about it.
Gina Yong
countries, breastfeeding in public is
protected by law. Malaysia needs to enforce
the same.”
Choosing the right way
Yong opines that when it comes to
making a choice between nursing and
formula-feeding an infant, social stigma is
just one of the reasons that pushes new
mothers towards making misinformed
decisions.
Another factor is the lack of awareness,
knowledge and proper support, such as:
l Negative self-image – Breastfeeding
can lead to sagging of the breasts and this
can deter women who are conscious about
their body image from breastfeeding.
l Unsupportive spouses – Spouses play
an important role in supporting expecting
mothers and boosting their morale. A
mother could potentially choose to not
breastfeed if it means not having the
affection of her spouse or if he has a
negative attitude towards breastfeeding.
> SEE NEXT PAGE
STARSPECIAL, TUESDAY 4 DECEMBER 2018
Break the stigma and prioritise health
> FROM PREVIOUS PAGE
l Sore nipples, engorgement and
mastitis – Some first-time mothers face a lot
of difficulty when it comes to breastfeeding,
such as experiencing sore nipples and
engorgement. Others may, in more serious
cases, develop mastitis – a painful infection
of the breasts that needs to be treated with
antibiotics.
l Post-partum depression – One of the
least discussed and unaddressed issues
surrounding motherhood, post-partum
depression can lead new mothers to
withdraw from their infants and refuse to
breastfeed. Mothers who undergo drug
treatment sometimes give up breastfeeding
for fear of passing on the medication they
take to their babies through breast milk.
As these are issues that can be resolved
with proper guidance and counselling,
Yong suggests, “Hospitals and medical
practitioners can be more supportive of
breastfeeding and strive to educate new
mothers and their families about the benefits
of nursing.”
Penalties we must pay
The consequences of not breastfeeding
have far-reaching effects on infants and
mothers, and society needs to understand
the dangers.
According to an article titled World
Breastfeeding Week 2018 by World Health
Organization, the lives of at least 823,000
children under five years old could be saved
each year if breastfeeding practices were
improved worldwide.
In fact, the risk of a leading cause of infant
mortality – sudden infant death syndrome
(SIDS) – reduces significantly with
breastfeeding, as reported in a Reuters
article titled Breastfeeding at least two
months tied to lower SIDS risk.
Expecting Mothers 11
Besides that, breastfeeding reduces
the risk of infant diarrhoea and
respiratory infections.
In communities that have limited access to
basic health facilities and clean water, breast
milk guarantees an accessible and safe
source of nutritious food while also
protecting infants from disease.
A 2013 publication by World Health
Organization titled Long-term effects of
breastfeeding: A systematic review found that
although the benefits of nursing dilute as the
baby grows older, infants who breastfeed
exclusively for the first six months and with
supplements for at least two years grow up
with lower risks of developing certain
diseases such as diabetes, obesity and high
blood pressure than infants who are
formula-fed from the beginning.
New mothers beware
The adverse effects of not nursing or
giving it up early can affect mothers as well.
Yong warns, “Mothers who do not
breastfeed are at a higher risk of developing
breast cancer and ovarian cancer.”
A 2002 study titled Breast cancer and
breastfeeding: collaborative reanalysis of
individual data from 47 epidemiological
studies in 30 countries, including 50302
women with breast cancer and 96973 The release of the hormone oxytocin while breastfeeding can strengthen the bond between
women without the disease published in mother and baby.
The Lancet bears witness to the reality of
Yong’s statement. The research found that release of the hormone oxytocin that induces down by nursing because for older children,
for every 12 months of breastfeeding, contractions in the uterus, which is essential nursing can be a form of security.”
a mother’s risk of developing breast for expelling lochia (vaginal discharge after Also worth mentioning is the unique bond
cancer was lowered by 4.3%. giving birth),” Yong adds. that is fostered during the act, which has a
Additionally, a 2013 study titled Ovarian Apart from health benefits, nursing has long-term effect on the mental well-being of
cancer risk is reduced by prolonged lactation: psychological benefits for mother and baby. the baby.
a case-control study in southern China For instance, oxytocin – known as the love Mother Nature fashioned women’s bodies
published in The American Journal of Clinical hormone or cuddle hormone – can lower the to be able to create and nurture life. It is our
Nutrition confirms that women who risk of post-partum depression in women. obligation henceforth to ensure that future
breastfeed for more than 13 months have a For babies, the psychological benefits are generations are not denied the benefits of
lower risk of developing ovarian cancer. instantaneous and long-standing. Yong being nursed with breast milk – a
“Another benefit of breastfeeding is the explains, “Mothers can easily calm a toddler foundation of good early childhood health.