Better lifestyle, antenatal care could reduce miscarriages, stillbirths

The hope and prayer of any expectant mother is to be able to carry her baby to full term and deliver safely. Sometimes, however, circumstances beyond the mother’s control may lead to a miscarriage or still birth.

According to the World Health Organisation (WHO), a miscarriage happens when a baby dies before 28 weeks of pregnancy, while babies who die at or after 28 weeks are still births. 

What causes miscarriages? 
Miscarriages and still births are caused by different conditions, says Dr Alex Kakoraki of Murchison Bay Hospital, Luzira, Kampala. 

Dr Kakoraki says a miscarriage can be caused by uterus or cervix problems, exposure to certain environments such as those with high levels of radiations, diseases and infections, as well as abnormal body genes, including extra and missing chromosomes. 

“If the pregnant woman eventually suffers a miscarriage, she may experience abdominal pain, cramps and suffer bleeding that progresses from light to heavy over time,” Dr Kakoraki says, adding: “I urge women to seek immediate medical intervention upon noticing any of the above symptoms as quickly to enable you get immediate medical attention and most likely, save the baby.

Prone 
Women most likely to get a miscarriage, according to Dr Kakoraki, are older mothers (mostly above the age of 35 years), those who have chronic medical conditions, including diabetes and high blood pressure, those who drink and smoke, and those who are overweight, among other risk factors. 

And it is for such reasons Dr Kakoraki advises expectant mothers to  take good care of themselves during pregnancy by watching their lifestyle habits, including what they eat, but, by also, constantly seeking advise from a respective medical expert who will inform them of  the dos and don’ts during their pregnancy journey. 

Still births 
Recently, fans of Chrissy Teigen, a renowned model and prominent American musician John Legend, expressed their overwhelming sympathy after the couple announced on their respective social media platforms that they had lost their unborn baby, Jack, due to many complications, including excessive bleeding as a result of a weak placenta. 

“We are shocked and in the kind of deep pain you only hear about, the kind of pain we’ve never felt before. We were never able to stop the bleeding and give our baby the fluids he needed, despite bags and bags of blood transfusions. It just wasn’t enough,” Teigen wrote on her Twitter account. 

She was halfway through her pregnancy, which is around 20-24 weeks. 
There are many different reasons why a baby may die before or during delivery, besides due to complications such as excessive bleeding as a result of a weak placenta. 

For one mother, who preferred to be identified only as Nasuuna for the article, in 2010, lost her baby at six months due to issues with the umbilical cord. 

“After not feeling my baby’s movements, I called my doctor, who suggested I go to hospital immediately. While there, a scan revealed that there was no heartbeat. And on carrying out further medical examinations, we discovered that my baby girl died because the umbilical cord had knotted, hence, cutting off oxygen and food supply to the developing faetus,” she says. 

The experience was devastating for Nassuuna as she still had to be induced to deliver the dead baby. 
“I was given some medication (to help induce) and then had a vaginal birth. Imagine having to give birth to a daughter who was already dead and then leaving hospital without her in my arms. It was traumatising,” she says. Nasuuna says although it took her a while to recover, with support and counselling from family members and friends, she was able to. 

Infection
Other factors that can likely cause a still birth, according to Dr Vincent Karuhanga of Friends Polyclinic, include a mother’s medical condition, for example one battling high blood pressure or those with epilepsy, infections, complications encountered during labour, women having multiple pregnancies, those who drink alcohol or smoke, and those who are overweight, among other factors.

Antenatal care 

Mothers likely to suffer a still birth include those that lack access to antenatal care services, including quality care during childbirth.  

“This is why I urge expectant mothers to always be vigilant during pregnancy since any small problem can likely lead to the loss of a baby,” Dr Karuhanga says, adding: “Be mindful of your diet, sleep under a mosquito net, always avoid stressful situations, be in touch with your doctor and go for antenatal care, among observing other precautionary measures.” 

Statistics
Almost two million babies are stillborn every year, or one in every 16 seconds, according to the first ever joint still birth estimates released by the United Nations Children’s Fund (Unicef),  WHO, the World Bank Group and the Population Division of the United Nations Department of Economic and Social Affairs. 

The report notes that most stillbirths, more than 40 per cent, occur during labour due to poor quality of care, with lack of investments in antenatal and intrapartum services, strengthening the nursing and midwifery workforce being key challenges. 

The report suggestes that the losses could be avoided with access to a trained health worker at childbirth and timely emergency obstetric care.

Can stillbirths be prevented?
Many causes and risk factors are out of your control, so stillbirth cannot be completely prevented. But there are some things you can do to lower the risk:
• Have a checkup before you get pregnant again. If you have any risk factors, such as diabetes or high blood pressure, work with your doctor to manage and monitor them during pregnancy.
• If the cause of a previous stillbirth was genetic, meet with a genetic counsellor before getting pregnant again.
• Do not smoke or use alcohol, marijuana, or other drugs while pregnant. If you have a hard time quitting, talk to your doctor.
• Seek medical help right away if you experience bleeding or other signs of trouble during pregnancy.

Coping after a miscarriage or stillbirth

Bernadette Okiria, a counselling psychologist, says it is always traumatising for any expectant mother who suffers either a miscarriage or still birth. The emotional toll is unbearable.

But in circumstances it happens, a mother must find ways of coping with the tragedy. Once it happens, Okiria says, just know it is okay to cry. In some way, crying will help you release some of the pain that is clogged up inside your heart. 

The next steps should then focus on you getting some help. For instance, talking to someone who has been through a similar experience can be helpful as they can share with you the different ways they coped after the tragedy.

Their tips might be helpful to you as well. It will also be comforting in such a way of knowing that you are not alone in this and many other women go through the same things but still found a way of continuing their lives, afterwards. 

Alternatively, Okiria says, you could speak to a professional counsellor who will give you helpful tips on how you can cope through your ordeal. One may also consider joining a bereavement group that supports mothers who have suffered either a miscarriage or still birth. If it helps, try and keep yourself busy as a way of distracting yourself.

You could perhaps exercise often or indulge more into your favourite hobby such as reading. 
Praying also helps. Learn to take one day at a time. The pain of the loss gets lesser with time.