THE GOLDEN HOUR

 The “Golden hour” is a term used to describe the first hour after birth. This is a crucial time when the mother and baby share their first intimate moments, initiating an emotional bond with significant health benefits. It is during this hour that the first breastfeeding usually occurs. Breastfeeding during the golden hour helps the baby stabilize its heart rate, breathing, and blood sugar. It also keeps the baby warm and helps the mother and baby develop a strong bond. The benefits of breastfeeding extend far beyond the golden hour.

I had a normal vaginal delivery with an epidural, my husband was present as a companion which meant a lot to me and added extra support. The epidural anaesthesia helped me be calm and cooperative during the second stage of labour. The baby was delivered with the assistance of a vacuum because my pushing efforts were not adequate and I’m sure my gynae did not have enough patience to wait for an hour for a primigravida to push this baby out. Everything went well. I was well and the placenta was delivered and I had a few sutures down there. The baby came out vigorous and crying! A paediatrician was also present to make sure the baby was breathing well, happy and pink, and safe to be with the mother.

Pregnancy and breastfeeding are protective against breast cancer in women. according to a report by the World Health Organization, the risk of breast cancer decreases by 6% for each year a woman breastfeeds. The reduction in cancer risk is thought to be due to changes in breast tissue that occur during lactation making the cells more resistant to mutations that lead to cancer.

Breastfeeding lowers the risk of cardiovascular disease and high blood pressure. It reduces the LDL levels which is the body’s bad cholesterol. It also reduces insulin resistance and the risk of diabetes. A study published in JAMA Internal Medicine found that women who breastfed for six months or more had a 47% lower risk of developing type 2 diabetes compared to those who did not breastfeed.

Breastfeeding is not always easy, and everyone will have a different experience. As healthcare professionals, we must provide help and support to mothers choosing to breastfeed their babies.  

 

OBSTETRIC HEAMORRHAGE

 Obstetric Haemorrhage is the leading cause of maternal morbidity and mortality worldwide. It is defined as excessive bleeding during pregnancy, childbirth, or the postpartum period. It is difficult to quantify the volume of blood loss. Still, most references suggest excessive bleeding of more than 500 ml after a vaginal delivery and more than 1000 ml after a caesarean section is significant. It also depends on how the mother has been optimized during the antenatal period to cope with bleeding. Anemia in pregnancy can on its own predispose pregnant women to postpartum haemorrhage.

We have made good progress in terms of training staff concerning the acute management of haemorrhage, maternal resuscitation, and the use of uterotonic agents. We believe that in the twenty-first century, we should not lose any woman with obstetric haemorrhage. Most of us know the tragic story of Mumtaz Mahal in 1631 who gave birth to her fourteenth child. Shah Jahan was devastated by her death and decided to build a magnificent mausoleum in her memory which is named the Taj Mahal in Agra, India. It took 22 years to be completed, and it is considered one of the seven wonders of the modern world. It is a testament to Shah Jahan's and Mumtaz Mahal's eternal love.

In the modern world, we have easy access to birth control. Most births occur in a level of health care facility. In our regional hospital, we still struggle to have access to a blood bank after 4pm, which is not ideal considering it is a mother-and-child hospital with about 1000 births per month. The other day we prioritized an elective caesarean section with a known placenta praevia to be done first thing in the morning while the senior doctors are on duty and the blood bank is available. We started the case with 2 units of blood in theatre and we also had the senior anesthetic consultant available. The fetal medicine unit had not found any ultrasound evidence of the anterior and low-lying placenta being morbidly adherent to the uterus. Intraoperatively the placenta was morbidly adherent and we had an obstetric haemorrhage and proceeded with a caesarean hysterectomy! The mom ended up in the ICU with a massive transfusion.

We try our best every day to decrease the incidence of obstetric haemorrhage and the morbidity and mortality that comes with it. A morbidly adherent placenta or a placenta accrete spectrum is on the rise due to a rise in caesarean section rate. We hope with recent advances in antenatal imaging we will be able to identify such cases and manage them appropriately in a tertiary-level hospital with experienced surgeons and, an anesthesiology team.

 

 

PADEL

 Padel is a sport that combines elements of tennis, squash, and badminton. It is played on a smaller court with solid walls and a net, using paddles and a plastic ball. This sport has recently gained a lot of popularity worldwide. It is fun, social, and fast-paced, and it is easy to learn and play, making it accessible to people of all ages and skill levels.

My husband started playing Padel last year, and when he asked me if I was keen to try I became defensive, saying that my working hours are long and unpredictable to book anything, and have never played any racket sports in my life and I am not interested in trying anything new. On top of that, I have a toddler that I have to look after when I get home. Back then I was working very far from home and the long drive was a big challenge. I got a new job just around the corner from my house and the working hours improved. Winter was over and I was in a more outgoing mood. I met my old friends in the Bryanston sports club. I found new padel courts that night and I watched people play, and I really enjoyed the vibe. That was the time I reached out to my husband to show me the logistics of how to book a court, hire rackets, and play the game.

I loved the first Padel game! It was exciting and competitive! I was running around the court trying to get the ball, sweating and not knowing how the time is passing. It was me and my Serbian friend versus my husband and his friend. We played for one and a half hours. Then we sat down had a drink and enjoyed watching other people playing. 

It is something I would like to continue playing. It improves hand-eye coordination and reaction time which is something I need to work on. It is a good cardiovascular exercise and helps with burning calories. The social interaction is very nice and every padel court has a nice café next to them overlooking the courts. It is something I look forward to the whole week, it is extremely fun and helps with stress relief.

 

 

 

BREAT CANCER AWARENESS MONTH

 October is Breast Cancer Awareness Month. It creates an opportunity to raise awareness and funds for breast cancer research, diagnosis, treatment, and support. It is one of the most common malignancies in women. The survivors experience severe trauma and major health issues. It is scary to know that 1 in 8 women will develop breast cancer in their lifetime. Early detection and treatment improve survival rates.

Most of us have a friend or family member who has been through the breast cancer treatment journey or has surrendered the battle. One of my colleagues whom I met during community service was diagnosed with early stages of breast cancer five years ago. She has been disease-free after her operation and chemo-radiation therapy. Another friend of mine that I met in the meet-up groups is also known to have been through the breast cancer treatment process and has been disease-free for over ten years now.

There are numerous ways to help raise funds, such as participating in different fundraiser events or functions. Wearing pink clothes and accessories shows support and increases awareness for the public. We need to educate women to perform self-breast exams and get mammograms to pick up the disease at an early stage. Pay attention to the family history as well. If there are first-degree relatives who had breast or ovarian cancer before the age of fifty, there might be a need for genetic testing to pick up dangerous genes such as BRCA1 and BRCA 2. About three months ago we lost a fifty-year-old woman with advanced breast carcinoma in our gynae ward. When I spoke to the family, it turned out that the patient’s own mother was a breast cancer survivor, and yet she did not have any screening and did not even present to us as soon as she felt a lump in her breasts.

Several celebrities such as Angelina Jolie and former French First Lady Carla Bruni have helped raise breast cancer awareness. Remember, every small action counts and collective efforts can make a significant difference in the fight against breast cancer!

 

THE CONFLICTS IN THE MIDDLE EAST

 When I started this blog, I was curious about how consistent I would be with my full-time job as an OBGYN and a toddler. I have many ideas about women’s health and many interesting things happen from day to day. I enjoy sitting down and putting my thoughts in writing. It gives a sense of purpose, and peace and brings on new ideas.

One of the current burning topics is the new conflicts in the Middle East. It is a big worry that in the twenty-first century countries are invading each other. As a person who advocates for women's and children’s health, I want to elaborate on the various consequences of a new war in this region.

A new war forces a lot of families to be displaced and flee their homes. Imagine being in that situation, wondering which precious belongings besides your life you can take and go to a safer place. Wondering when will you come back, and if you ever do, will your home still be there! At times family members are forced to be separated, and this leads to emotional trauma long-term psychological effects, and PTSD. I wonder if the new generation  of kids who grow up in these situations will be able to create peace in the world.

War damages and destroys essential social infrastructure such as schools, hospitals, and community centers. The fragile economy of most of the developing countries that are already struggling becomes completely dysfunctional during a war, and this leads to more unemployment and poverty in the society.

A lot of the low and middle-income countries that have been involved in war over the years such as Lebanon, Iraq, Palestine, and Yemen have lost some of their beautiful cultural heritage sites and buildings. The effect of various chemicals and weapons on nature and all the pollution can last for years. my Lebanese friend pointed out to me that their gardens and the olive trees in the South of Lebanon were damaged after the war and they haven’t been able to grow anything on that land.

The social consequences of war can persist for generations, affecting the social fabric of societies and perpetuating cycles of violence. These consequences underscore the importance of preventing war and promoting peaceful conflict resolution. It is crucial to address the root causes of conflicts and work towards a more just and peaceful world.

Below is a photo of me as a war refugee with my mother, grannies, and uncle.  

 

The entrance to Grandma's house where I was born and raised. I absolutely love that place, and it is still standing strong