LACTATION AND ITS CHALLENGES

Inconsolable burning tears rolled down her eyes like a child chased down the street with a cane. In her tears were blue prints of the inexpressible agony she was feeling. Her eyes, like the red moon marking the feast of martyrs. She cried louder than her baby. Her joy had been stolen away by her favorite part and replaced with pain, her laughter disappeared like a ship in the Bermuda triangle . Her very natural asset which was well formed at her tender age and which she flaunts ridiculously to the attraction and admiration of the opposite sex both young and old and to the envy of her pearls , her breast, had now become a torn in her flesh.

The breast development orchestrated by the pregnancy hormones added color to the picture. Her breast had become full, more prominent, succulent and desirable. She wished this state would last forever, so like a virgin land ready to grow any crop, she quickly took to the ill-advice of her friends who told her that breastfeeding facilitates breast sagging. She decided to go on complementary feed for her new baby.

One week after her delivery, hell was let loose, nature had mobilised her armoury against her breasts for civil disobedience and denying her baby HIS BIRTHRIGHT. The war was so fierce that she wished her breasts off. The breasts had become very painful and unbearable with fever and chills which made her shake like men dancing the 'Ohafia war dance'. She was adviced again by same friends to take antimalaria, but, to no avail.
Her right reasoning returned from exile and like the prodigal son she decided to visit the clinic for expert management.

Breast Engorgement with mastitis

This is the diagnosis of the story above and therefore does not require any more emphasis.
The following should be done to prevent or alleviate the pain for breast engorgement.

• Place an ice park or warm water in a satchet/towel on the breast(s). This will take care of the pain.
• Express the breast and ensure the baby suckles to prevent reocurrance.
• Wear tight fitted bra. 
• Simple pain relief medications like NSAIDs can suffice.

Mastitis and Sour breastmilk

Mastitis is the inflammation of the breast tissue with or without infection(i.e Acute Inflammatory Mastitis and Infective Mastitis respectively).
When the infection/inflammation occurs within the duct system (Epidemic Adenitis), it produces pus which is expressed together with breastmilk. Babies generally avoid the affected breast and mothers interpret it as soured breastmilk but in reality there is no such thing as soured breastmilk.
This case should be managed by a physician.

Stopping lactation

 If you are desirous to stop the breast from further production of milk;

• Stop breastfeeding or expression and all forms of nipple stimulation.
• Wear tight fitted bra.

When this fails, consult your physician for expert management.

Nipple crack
This usually occurs due to inexperience in breastfeeding especially wrong positioning. Abnormal nipples,flat or inverted also contribute. A crack permits germs into the breast tissue with resultant mastitis and breast abscess. It's therefore adviced that it be managed by a qualified health personnel.

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COMPLICATIONS OF BIG BABY.

Her confidence was unparalled. Such faith when compared to the potential size of the biblical mustard seed would not only move mountains but the heavens.

Every medical advice from her physician was like pouring water on stone. She was more stubborn than a mule. She responded repeatedly that her previous pregnancies were Big Babies and if she could deliver them then, why not now? She drifted with her defence into spirituality and adopting herself as a HEBREW WOMAN, a Zionite... 

Few days later, her labor set in, she visited the clinic by 8am and clinical examination was assuring as the first stage of labor was said to be progressive.

Then came the tempter of Job, the accuser of brethren at the eleventh hour. It was a cascade of troubles. She had series of urge to bear down but all her efforts could not hold any water, the harder she tried the weaker she became, the baby could no longer decend. Few minutes later came trickles of frank blood through her vagina, her genital tract had been lacerated. To facilitate the labour, her membrane was ruptured and a thick greenish liquor gushed out like unchained furious mob (indicating fetal distress).
She was adviced by the midwife to opt for Ceaserean delivery but like one under a spell, kept reiterating the words of the scripture, "I can do all things, through Christ who strengthens me" amidst her obstructed labour,  bleeding, dying weakness and fetal distress.
Perceiving the imminent danger of loosing both wife and baby one of the midwives sneaked out of the labour room and whispered softly these piercing words into the ears of her husband, itching for a good news, "Oga, you may loose both your wife and daughter if you don't consent to C/S". This sent a very strong impulse to his spine and necessitated the surgery but one cannot undue the damage already done. What a provocative scenario, what foolishness (MY PEOPLE PERISH FOR LACK OF KNOWLEDGE), what a waste, what a loss. She was revived but lost the baby she had been praying for, a male child, for her previous four pregnancies were all females.

Complications of Big Baby

 Some of the complications have been highlited in the story above. There are both maternal and fetal complications . Those worth discussing will be given attention.

Maternal complications of Big Baby

Prolapse: this is the alteration in the anatomical position of organs with decent. It is due to damage of nerves supplying the supporting structures of the pelvic organs by the passage of the big baby. It may affect the uterus, vagina, bladder or rectum with resultant urinary embarrassment and affect sexual activity. Most women think themselves as strong when they deliver babies as big as 5kg but most pay the price later in life. It usually occurs later in life.

Diabetic retinopathy: uncontrolled sugar causing damage to the retina and resulting in blindness.

Fetal complications of Big Baby
This also includes

• Congenital anomalies
• Unexplained fetal or infant death
• Respiratory distress syndrome
• Metabolic syndrome; including hypoglycemia, hyperbilirubinemia, hypocalcemia
• Birth trauma;  including clavicular and limb fractures and Brachial plexus nerve injury. 

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BIG BABY AND DIETARY ROLE

It was her very first pregnancy and she had tried so hard to adapt to the lifestyle challenges posed by it on her but the more she tried, new doors introducing new challenges opened up.

Her first trimester was graced with nausea (urge to vomit), excessive salivating like a dog chained, on fast, and presented with the aroma of a sumptuous meal. She threw up even the best appetizing meal like an angry volcanoe and could only tolerate soft drinks which she soon became used to.

Later in her second trimester, the above episodes gave way, her appetite improved and she decided to recover the weeks the locust attacked. The more she ate the hungrier she became.
After her routine antenatal visit at 36 weeks, tears filled her eyes, as she kept staring at her protruding tommy. She had been counselled on ceaserean delivery of the 'big baby'.

BIG BABY
Known in medical parlance as Fetal Macrosomia is considered by some as weight of 4kg and above while another school of thought designates it as weight of 4.5kg and above.

BIG BABY AND DIETARY ROLE

Big baby may have a genetic predisposition but like most genetic conditions environmental factors, in this case, diet, plays a very important role.
Carbohydrates is a very important nutritional requirement in 1st and 2nd trimesters because it supplies the fetus energy for growth and development. In the third trimester, there is a switch in the nutritional need of a pregnant woman to favor more protein intake than carbohydrates .

Hormones, Diet and Big baby

The hormones of pregnancy notably Progesterone, Human Chorionic somammotropin and Pregnancy associated Plasma Proteins are 'anti-insulin' and increase in quantities as pregnancy advances. By 3rd trimester, they effectively stop insulin from driving sugar into maternal cells thereby increasing maternal blood sugar levels. More sugar therefore flows to the baby and results in Big baby.

Therefore the 3rd trimester is very crucial to dietary control especially carbohydrates in other to avoid having Big babies and it's complications to be discussed in the next article.

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