EXERCISE IN PREGNANCY

 This is a question I am often asked in obstetrics consultations regarding exercise in pregnancy. Most of the women we see take part in some sort of recreational physical activity, but only 15% of them exercise at the recommended level, which is 30 minutes of moderate activity every day of the week. 

Most women believe that pregnancy is the time to eat everything and gain as much weight as possible. Too much pregnancy weight gain can lead to problems such as Gestational Diabetes, large for gestational age babies, and a higher rate of caesarean section. We know that the woman's body changes during pregnancy, for example, her blood volume is increased by 40% and the stroke volume by 10%. There is decreased vascular resistance to enhance the placental perfusion. The growing uterus can shift the center of gravity and cause lumbar lordosis and back pain in 50% of pregnant women. The ligaments of the bony pelvis also become lax and can lead to severe discomfort. 

Moderate exercise can have multiple benefits for the mom and the baby. It can decrease the gestational weight gain and decrease the rates of pre-eclampsia, insulin resistance, and gestational diabetes. The guidelines suggest that overweight women should not gain more than 10% of their body weight in pregnancy. The recent trials have not found an increased risk of preterm birth or low birth weight in women who exercised in pregnancy. 

In summary, moderate exercise is encouraged in uncomplicated pregnancies. There is no evidence that moderate exercise can harm the mother and baby. We do not recommend exercise for women with chronic diseases such as severe anemia, cardiac disease, intrauterine growth restriction, or extreme morbid obesity. Forms of exercise such as horse riding, scuba diving, or skiing are also not recommended. I personally found moderate walking in the third trimester very helpful, although I was in so much pain and felt that my symphysis pubis in ripping apart. I tried to bounce on the gym balls as well, although I did not go to spontaneous labour and required induction of labour, but my labour progressed well, and I feel the exercise played an important part. 

FRECKLES

 I am back to reading fiction, and I am enjoying it. Back in the day, I used to enjoy novels from local authors, Jane Austen and Agatha Christi. In my late 20s, I decided to strictly read non-fiction books about politicians, famous people, etc. I think the last non-fiction book I read was Laura Bush’s memoir. I came across this book in the library, and the title suggested it must be a girly story. I finished it in less than two weeks! It was a beautiful and touching story about a girl who grew up in a boarding school from the age of five. She would spend time with her dad on weekends. They stayed in the rural parts of Ireland on Valentia Island.  Her mother left her after she gave birth. The book describes the girl's relationship with her dad beautifully. He has always been there for her and understood her. She had her freckles from her dad’s side. 

After finishing school, she moved to Dublin to pursue a career and to find her biological mother. Her struggles in Dublin are described in detail, and how she is shy and awkward around people. She comes across a guy who tells her she is the average of the five people she spends most of her time with. She is trying to find those people amongst influential celebrities, and starts writing to them. For sure, she knows her dad is at the top of the list of influential figures in her life. She even tries to find that popular girl from her school days that she always wanted to be friends with. At the end, she realizes she has enough friends and influential figures around her already who inspire her and love her. 

The moment of truth in the book is when she finally introduces herself to her biological mother, and it is quite a surprise. Another touching moment in the book is when she is in a hair salon, and her biological mother is doing her hair, and she is loving it! I enjoyed reading contemporary fiction where people post things on Instagram, send emails, and have smartphones. She is a hardworking girl trying to figure things out while trying to build her self-confidence and pay her bills. There is a lot of growth in her throughout the story, and her love for her father is as strong as ever. It is quite unique because he is the one who wanted her and raised her. 

HPV VACCINE

 It breaks my heart when I come across patients who have negative misconceptions about vaccination. We have come a long way in medicine when we used to have various infectious diseases wipe out a whole population, or leave thousands with multiple disabilities. The discovery of the Human Papillomavirus by Harold Zur Hausen as the causative agent for various cancers, such as the cervix, anus, and oropharyngeal, was a major scientific breakthrough. He won a Nobel Prize for this. Later on, we had the HPV vaccine coming around 2006, to prevent our youth from being infected with the virus, and decrease the rate of precancerous cervical lesions and other HPV related cancers. 

The HPV vaccine has been available in South Africa since 2009. There have been numerous international studies showing that the vaccine works. The number of women diagnosed with precancerous lesions has declined after the introduction of the HPV vaccines. What we need to do as health care providers is to educate young women, to get vaccinated before they become sexually active, around the age of 9. HPV is a sexually transmitted disease, and boys also need to be vaccinated. Due to financial constraints, the governments are funding women to be vaccinated. 

The rise of vaccine misinformation in conventional and social media has contributed to growing distrust in vaccines in general, including the HPV vaccine. All related health care workers, such as paediatricians, Obstetricians and gynaecologists, and public health experts must respond with evidence-based messaging that emphasizes cancer prevention. Social media sends controversial messages that the HPV vaccine causes infertility, autoimmune disorders, or promotes early sexual activity.   

PALLIATIVE CARE

 When we are in medical school, we have a totally different mindset, we enjoy learning the science and the pathophysiology of diseases, and we are eager to save the world. Later, during our clinical rotations and patient interactions, we eagerly await hearing the cardiac murmur, lung sounds, and crackles, among other findings. Then we grow up a little more, and we learn the various blood investigations and imaging. As time goes by, we probably touch the patients less and spend more time figuring things out through the investigations. 

There are certain clinical situations when a diagnosis has been made, and the patient’s prognosis is poor. We feel like we have done our part, and perhaps not much can be done from our side. There is still so much that the team looking after a patient with end-of-life issues can do. It is important to be straightforward with the patient from the day the diagnosis of cancer, or organ failure such as cardiac failure, liver failure, or dementia, has been made. We are not God, and we might not know how much time they have, and they may end up being very sick at some point. They need to have those important conversations with their loved ones while they are relatively better, to be able to make plans for the future. 

If they need additional support, the social worker and the palliative care team can come to play. We need to ensure that we have a support structure for our patient and make sure the family member or caregiver who is looking after them is coping. We need to guide them in terms of hospice placement. Make sure they are not in pain and make their end-of-life journey as easy as possible. I am an OBGYN and I often bring babies to the world, but I also have a special interest in the oncology field. Perhaps one day, when I retire, I will volunteer to help these patients and provide support. I was so touched when I saw our palliative care team had brought Art therapy to our ward, and the patients are creating crafts and feeling busy and happy. 

MY FIRST MAMMOGRAM

 I can not be an advocate for women’s health and not look after myself. The challenge with a screening test is that a lot of women have no symptoms, and they tend to postpone and not make time for it. Another factor is that most women feel uncomfortable getting that gynaecology exam or getting naked and getting their breasts exposed for the screening test, or they might be terrified of the findings.  I was trying to get the mammogram done during my leave time, but the appointment was full, and I finally managed to squeeze it in the morning of my work day. 

Overall, I had a pleasant experience. The staff in the radiology department were very friendly. The atmosphere was pleasant and welcoming. There was a private changing area for me to change my clothes and get into a gown. There wasn't a long waiting time until the mammogram was done. There was an interval between the mammogram and the routine ultrasound. I had a cup of coffee. The sonographer who examined my breasts was very friendly. One thing I learned was that it is advisable to do your mammograms and exams in one radiology center, to allow the team to compare the images and make the right diagnosis. 

I was very anxious about the results. The report was emailed to my referring Doctor and me, and I was even able to access the images on the radiology link. My medical aid paid for the exam, and I even had vitality points. I feel happy that for the next three years I do not need to do this. Next up are some blood tests and a dental check-up. I have also decided to keep a digital copy of all my medical records. 

ME AND MUSIC

 I have a special relationship with music. I am listening to a 90s playlist and writing this. I grew up in the eighties and '90s in a Middle Eastern country where music, especially Western music, was banned. I had some music exposure while I stayed in South Africa between 98 and 2000. We were struggling financially and still didn't have a CD player. I remember the new Westlife Album was released, and my High school friend Sandra recorded it on a cassette for me to listen to. It must be somewhere in my grandparents’ house, along with a hundred other cassettes I recorded from different radio stations and channels. I used to be crazy about Celine Dion. I would play her music, record my voice with the microphone, and feel like a diva! These days, when I listen to her old songs, I feel sad…I think about the days I used to be wild and young and free. 

The world of music became more colourful for me after we managed to get a satellite TV around 2005, and in those days, I could watch different international videos and enjoy them. Shakira and Jennifer Lopez were the new emerging artists in those days, and they are still going strong and going on tour. By then, I had given up on becoming a singer and was going to medical school. By 2010, when I was an intern, I got my first MP3 player. It was so life-changing! Having music while walking to work or using public transport was lovely. I was using various internet channels to download music. 

Life is amazing now with music streaming platforms such as Spotify! A lot of the artists probably miss the good old days when they would sell records, making less money through these platforms.  With a small monthly subscription, I listen to a wide range of music on my devices. There is no need for downloading or recording cassettes, CDs, or MP3 players. I listen to a wide range of music from my home country, French, Jazz, classical, Arabic, Indian, Latino, and pop from the '60s up to now. The only time I feel like a diva these days is when I am driving and I sing along to my favourite song. I have a little fantasy to have a little band and sing in a bar or something when I retire…

I still have my first MP3 player; it is such a sentimental item to me

MY HAPPY PLACE

 I am an introvert. When I was small I enjoyed doing my own thing, listening to children’s story cassettes, playing with my Legos, or drawing. Whenever we had visitors I would get irritated as a child because the house was so messy, mom was busy cooking, setting the table, or clearing the table and washing the dishes. Later on, I started having a special interest in books. I enjoyed reading a wide range of fiction. From Authors back home, and the classics from British and Russian authors. 

Another introverted and creative joyful activity for me was drawing and painting. It started with sketching in high school art classes and then became more sophisticated such as watercolour or oil on canvas. A lot of the artworks are framed and on the walls back home. Three of my favourite works are framed by mom’s house, 2 other nice oil paintings are by my brother’s house and a small daffodil painting and some random watercolour work are in my office. My life has been crazy with all the medical school and specializing, getting married, and having a child. I have not had the passion or energy to frame any new works or put them on the wall in our house. 

Recently I started gathering pictures of some of the previous art and decided to laminate some others and put them on the walls in the spare room. Some of my early favourite sketches are from the book I found at my grandparent’s house and which had beautiful black and white pictures of ballerinas from the Bolshoi Ballet in Russia. I used to love those beautiful and graceful ballerinas. Later on, when I grew up I watched the movie Black Swan and it changed my point of view on the ballet story. 

After having a baby I lost my identity. The whole day and night revolves around the care of the baby. Only now that the child is about two and half years old and can play with herself independently and go to school I am starting to find myself again, and reflect on my favourite hobbies and activities. One of my very favourite places to go are the bookstores and libraries. I try to avoid the bookstores because I can't control myself and I end up buying books that I won't read or need. The Norscot library has a beautiful building and garden, and it offers a very tranquil environment. I usually go there once a month to unwind, do some deep reading or writing, and pick some interesting books for myself and Aryana. 

THINGS I WISH I TOLD MY MOTHER

 This book caught my eye in the public library in May. I was very excited because it is dedicated to mothers! We are all in the Mother’s Day hype. The book offers a contemporary look at a mother and her adult daughter’s relationship. The daughter is an only child in her late thirties, she is in the marketing business. She is divorced with no children. She is not into glamour brands and cosmetics. The little that she knows is through her marketing job. Her father passed away a couple of years ago from pancreatic cancer. Her mother is a very well-known and busy obstetrician and gynecologist. She is in her sixties, she makes good money and also spends it well. Full skincare routine, make-up, glamour, branded clothes, shoes, and handbags. 

The book gives a brief background of how the daughter has been traumatized by her mother’s critical behaviour and has chosen to me to be more withdrawn and hide her opinions. Another factor that came up that traumatized her in her adult life was her divorce from her husband. How things turn another way when her hubby decides to go after his college sweetheart after he finds out that she is divorced knowing he still has feelings for her. The book was published in 2023. It is very modern showing the effect of smartphones and the challenges of modern dating. 

The mother and daughter travel story to France was very interesting. I enjoyed how the different historical sites, cafes and restaurants and food items on the menu were described with detail. I felt like I was there experiencing all the outings, shopping and sightseeing. The mother and daughter managed to have several bonding sessions, several fights but it all made them come closer together. 

They also travelled to Norway where the mother was born and raised until she had immigrated to the USA to go to medical school. Meeting up with her extended family brought them closer. The ending of the book was a bit shocking. However, I enjoyed reading a story about a mother-daughter dynamic, with little episodes of romance here and there. It teaches us that regardless of the conflict and differences we may have as adults with our parents, we should try and reach out to them not take them for granted and spend as much time as possible. 

MOTHERHOOD REFLECTIONS

 Reflecting on my motherhood journey, I can't believe that my little one is two and a half years old! I was looking at my graduation pictures from April 2022 when I was 12 weeks pregnant, and I realized how much I have changed. The beautiful long hair is gone, I have put on more weight and have more wrinkles on my face. I thought going through specialist training and long hours of work makes us age faster, but the burden of responsibility of looking after another baby is worse. With all the running around and sleepless nights. 

She is tall and beautiful. Her speech is starting with a bit of delay but we are getting there. Her new words and phrases are teacher, I'm talking, no George, daddy pig, orange. She calls my husband’s mother Auma, my mother FaFa which is short for Fariba! 

Potty training attempts have not been successful. She sits on the potty but with her clothes on and refuses to take out her pants. She has become more aware of her nappy and last week when she made a poop, she came to me and immediately pulled down her nappy and her pants. We are getting into the cooler seasons, so we might attempt more potty training when it gets warmer in August. She still sleeps with us. I usually put her to bed in the spare room, once I am done with cleaning up the house or admin,  I carry her to our bed and all three of us sleep. I have heard about other parents training their children to sleep in their bed and be able to soothe themselves when they wake up. Our little princess is still very spoiled and she loves sleeping with us, cuddling, or holding our hands in her sleep. It gives her comfort knowing Mom and Dad are nearby. 

I have noticed that toddlers get bored with toys very easily, so I have stopped buying different toys. We enjoy riding the little bike outside or playing with the ball. At home, she enjoys looking at her books, playing with her balloon, or watching Peppa Pig. I love the Peppa Pig stories, books, and other things. The other day my husband went to eat at Burger King and he saw the special kids burger that comes with the Peppa Pig toys. He got her the meal with a cute Daddy Pig, and she loves it! 

 

A DAY IN MY LIFE AS A WORKING MOM

 I would like to explain how my days look as a full time working mother. Aryana usually goes to school three days a week which is Monday to Thursday. The rest of the week or the weekends she stays by my mother. I am up by 5am, shower and get ready by 5:45. I always make toast or muesli and yogurt which I eat while driving. I also make tea for the road. When I am ready wake Aryana up, change her nappy, dress her and we leave the house by 6:20. She is in school in 10 minutes and I drive to work. The drive in traffic takes me approximately an hour. 

I work in an Academic Hospital, so every morning our registrars present their admissions in the morning meeting. All the consultants usually pull a straight face and ask random questions. Last week Wednesday I was covering the labour ward. After the meeting we attended the handover in the high care and labour ward. After that we did a ward round to see the patients in the antenatal ward. I usually take a little lunch break before the afternoon handover. 

Some consultanta take very long for the afternoon handover. and grill the registrars with questions. I stick to patient care, but it is quite entertaining when you start asking the medical students different questions. We had an uneventful handover and by 3 pm I left work. I usually make a strong cup of instant coffee to give me energy to survive my other 5 to 9 job which is Motherhood. 

Around 5pm I make it to the school, I sneak in to catch a glimpse of Aryana while she is playing in her fun environment. We drive home, change into comfy clothes and Aryana has a nappy change. I start cleaning up right away, from the bedroom to the kitchen. hubby has cooked lunch, i usually pack that for lunch the following day. we don't have any family dinner. Nawaaz is either watching something or out doing admin. 

Aryana has a bath, a bottle of milk and we both sleep in the spare room. After she falls asleep i get up and do more cleaning like folding the laundry, taking out trash or hanging the washing. if I am in the mood some reading and writing and creative work also happens on the laptop like writing this blog. I sweep the floors in the morning, and mopping the floors happens on demand and routinely on fridyas. laundry is done throughout the week. sometimes when I am in the mood I play music and me and Aryana will do a little dance together. 

ME AND MY MOTHER

My mother and I are very close. We see each other almost daily since we stay in the same complex. As a daughter I grew up witnessing my mother’s sadness, loneliness, and struggles raising us. My father worked out of town most weeks, and he had no clue how we were raised. All the school drop-offs, illnesses, good days, bad days, homework, etc. My mother had to do it all on her own, with a bit of support from her parents. Her role as a homemaker was very underrated by Dad.  My father’s financial support was there to pay for the groceries and school fees. But I give the credit to my mom. Me and my brother are who we are because of her sacrifices. Her marriage was not an easy journey. 

I chose to be a career woman. I wanted control and financial independence. I wanted to feel that I do not stay in an unhappy partnership because I have nowhere to go, or I will die of starvation. I just love to get up and go out and explore something new every day and have a legacy other than being a homemaker. 

My parent’s marriage did not work in the end and my dad filed for divorce after over 30 years of marriage. Trust me it was not easy for me and my brother as adults. I overreacted to it very harshly and did not talk to Dad for about 4 years. I had two options, the first was to send mom back home to granny and uncle or to support her fully in South Africa. She has been here since 2006 but she needs support in a lot of things. 

I often find my husband being frustrated at me for the extra financial support me and my brother provide for Mom. I am a Middle Eastern girl and we often have this duty to do what we can to support our parents. Having a husband, a baby, and a full-time job has been an extreme challenge, but I try to make time for mom, to see her, have a nice cup of tea, and have some outings to make her life more exciting and stimulating.