WOMEN IN LEADERSHIP

 As an obstetrician and Gynaecologist we work in a female-dominated environment, however, a lot of the high management posts are held by male doctors. We assume a lot of female doctors compromise on work and research to try and have time to build a family. Even though a lot of the male partners try and be hands-on fathers and help with the raising of kids, the mothers carry most of the burden and they are the organizing and nurturing person who keeps the family together.

 I was very privileged to train in the Wits Obs and Gynae unit under the leadership of Professor Yasmin Adam from 2017. I stepped into community service at Chris Hani Baragwanath Hospital in 2017 and she was the head of the Obs and Gynae Unit. I was extremely overwhelmed to see the high number of registrars and consultants who work at Bara and the high turnover of the patients. Professor Adam was an excellent leader. She could easily manage the clinical aspect of work which involved patient care and academic activities.

She was a great mentor and had a special interest in the screening and treatment of women with cervical cancer in Sub-Saharan Africa. She would personally run the colposcopy clinic on certain days, had numerous publications, and supervised a lot of research projects. We all enjoyed her bedside teachings in the labour ward rounds, and we had lots of teaching episodes when we were preparing for our final FCOG exams. She helped me a lot during my final research corrections, and in that process, I learned a lot from her although I was quite tired and exhausted at that time with the process, now I miss doing research and academic work.

I did not know much about Professor Adam’s personal life, but I know that having a demanding job really takes a great toll on a woman’s personal and family life.  In April the Obs and Gynae department celebrated her retirement and it was a beautiful and emotional night with lots of laughter and tears. She gave us a beautiful speech and highlighted her struggles in the apartheid system as a medical student of Indian ethnicity, and now we are in a place where we have access to education regardless of our race and colour.

 

22 MAY WORLD PRE-ECLAMPSIA DAY

 I am on call and about to leave my house at 6:30, and I get a phone call that a pregnant patient has been admitted to labour ward with eclamptic seizures. The medical officer on call was concerned that despite loading the patient with Magnesium Sulphate the patient had another seizure and was considering other agents such as intravenous Lorazepam and Diazepam. Instantly a lot of things go through my mind, regarding this patient's management. We know that stabilizing the mother takes priority over the baby, and we know once the mother is stable and loaded with Magnesium Sulfate and her blood pressures are controlled we can plan the delivery of the baby which is the ultimate treatment for pregnancy-induced hypertension.

 Pre-eclampsia is a severe complication related to hypertension affecting pregnant women. It can be life-threatening for the mother and the baby. It is still on top of the list of the causes of maternal mortality. In our facility, we had about 3 maternal deaths due to severe pre-eclampsia in 2023. Two patients passed away due to cerebral haemorrhage, one patient changed condition after being intubated with eclamptic fits and demised. Problems with pre-eclampsia can start from week 20 of pregnancy and can last up to 6 weeks after delivery.

It is important to know that pre-eclampsia is a common disease with an incidence between 2-8%, and it affects 4.1 million women per year worldwide. It is responsible for 9% of maternal deaths in Africa and Asia and 26% in Latin America. Things look better in high-income countries however 16% of maternal deaths are seen in African Americans and Latin Americans.

Pre-eclampsia can start with slightly elevated blood pressure and proteinuria, it is a progressive disease that can bring complications such as eclampsia, haemorrhagic stroke, haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome, placenta abruption, renal failure, and pulmonary edema. I never forget our patient who was admitted for severe early onset pre-eclampsia at 28 weeks, and we were monitoring her blood pressure and blood tests regularly trying to buy time to deliver the baby later, who ended up with an abruption placenta, massive haemorrhage, pulmonary edema, and ICU admission. We lost the baby, but the mother survived.

The discovery of Magnesium Sulfate as an agent to stop eclamptic seizures and prevent their recurrence has saved a lot of lives over the years. Its use was introduced in the 1900s via an intramuscular injection, however, it wasn’t until the 1920s that major controlled studies demonstrated its superiority over other anticonvulsants.                                                       

We know that a lot of the adverse events in pregnancy tend to repeat in subsequent pregnancies. Another agent that we use very commonly in the ante-natal period is low dose Aspirin to decrease the risk of severe early onset pre-eclampsia. Women who survive pre-eclampsia have long-term consequences such as the risk of stroke, cardiovascular disease, and diabetes, and need to follow up with their healthcare practitioners to keep those risks under control. 

WHY PRECONCEPTION CARE MATTERS

 

Preconception care refers to health measures and planning done before becoming pregnant to ensure a healthy pregnancy and birth outcome. It is best to ensure that reproductive-age women are in optimal health before falling pregnant.

 

o   Women are encouraged to stay fit, and eat a balanced diet rich in essential nutrients such as folic acid, iron, and calcium. Any chronic illnesses such as anemia, diabetes, hypertension, or thyroid disorders are identified and managed accordingly

 

o   Women should be up-to-date with their vaccinations especially Rubella and Varicella, to avoid infection during pregnancy which can affect the fetus and cause severe abnormalities. We also offer screening for various sexually transmitted diseases such as HIV, Hepatitis, and Syphilis to make sure we treat the mothers and their partners and reduce vertical transmission.

 

o   We advise women to avoid harmful habits such as smoking, excessive alcohol consumption, and recreational drugs. They can increase the risks of congenital abnormalities, growth restriction, and intrauterine fetal death.

 

o   Genetic counseling can be done to discuss the family's medical history and the genetic risks. This was very important in my home country where Thalassemia was common and partners had to be screened for Thalassemia minor, and if they were both carriers chances of them having a baby with Thalassemia Major was 25%.

 

o   Women should be screened for mental health issues such as stress, anxiety, and depression. We all know that pregnancy and puerperium can affect a woman’s mental health in various ways. We need to ensure she has mental well-being and good social support to be able to take care of another human.

 

o   Women with previous miscarriages, or other adverse pregnancy outcomes are advised to book early in pregnancy so we have enough time to screen them for high-risk conditions such as pre-eclampsia, preterm labor, etc. By taking these steps individuals can reduce their risk of complications during pregnancy and child care.

 

 

 

ON MOTHERHOOD

 My mother and I have a wonderful relationship together. Since I had a baby myself, I have needed her support even more these days. We are very blessed to stay in the same residential complex. Every morning I drop the baby by her and I know I can focus on work while she is taking good care of her. If I am running late from work or there is an emergency the baby can stay with her longer.

My first memories of my mom, were probably when I was about 5 years old. My favourite bedtime story was the ugly duckling, and every single night I used to cry to that story even though it had a happy ending! The other memories are from the time my little brother was born. Back then we did not have disposable nappies and washing and drying the special cloths used as nappes was a process. I remember my little brother’s nappy time, bath time, and feeding times. The best memories of me and mom in my adult life is our little trip to Mauritius.

Another prominent part of my childhood was grandma. She was lovely. Always kind and patient.  We used to stay in the same house. She always had lots of stories to tell from how she met Grandpa, her teaching career and challenges, and how mom and uncle were raised and married. I always felt great around her. She even organized someone to sort out my sewing and knitting school projects in grade 6. Later on, I developed an interest in crochet when I was an intern, it used to help me relax from work stress. 20 years ago there were no YouTube tutorials, so I had to sit next to granny’s friend and follow her crochet steps!

Motherhood has really humbled me and there are several things I wish I had known before:

I always looked at my mom and felt like I would do better one day, but now I understand that all mothers are doing their best for their children, no matter what they go through in life.  Things I want to do differently from my mom is to be more fun and playful with my daughter and be her best friend.

It really takes a village to raise a child. We all need support from our partners, family, friends, and community to look after the children. I am blessed to have my parents around after I immigrated to South Africa.

We tend to lose our old identity after we become mothers, and it is difficult to be fully functional in our careers. Women often choose to work part-time or stay at home to be able to give the care the children need, and it is an extreme honor to raise small humans into adults.

Motherhood in the modern age is a complex topic. A lot of things need to be addressed such as the challenges of work and family life, the impact of social media on motherhood and parenting, and the importance of self-care and mental health for mothers.

 

The photos are of my mother and me,  then and now!

TRYING TO CONCEIVE

 There is a lot of pressure on women who are trying to conceive. Usually, there is a flicker of hope when they miss their period for a few days, and the hopes and dreams shatter when the period comes. This means the uterine lining gets thickened and becomes secretary with all the Estrogen and Progesterone, but the egg and the sperm do not get together to fertilize, therefor the endometrial lining sheds and menstruation occurs.

To work out the best time to fall pregnant we need to know how the menstrual cycle works. This starts from the first day of the last menstrual period (LMP) until the first day of your next period. On average this cycle takes 28-32 days. Based on a 28-day cycle, and counting from the first day of your LMP, the date of ovulation can be anywhere between days 11-21. This is when women are most fertile. There is usually an increase in cervical mucous, which is the perfect medium as it helps to protect and nourish the sperm as it proceeds towards the egg.

The egg only lives for a short time (12-48) after leaving the ovary, but the sperm can survive between 3-5 days in the female reproductive system. Millions of sperm are ejaculated by the male partner during sexual intercourse, but only a few reach the fallopian tubes. There needs to be at least one healthy and vigorous sperm already waiting in the fallopian tube when the egg is released during ovulation.

The best chance of conception occurring is when intercourse takes place during the 5 days before ovulation, there is a 33% chance of falling pregnant if the intercourse takes place on the day of ovulation. We are not the most fertile species but approximately 99% of humans do fall pregnant after having intercourse with no contraception for 12 months.

 

 

 That is me, heavily pregnant on the last day of work, before my maternity leave.