Irene Nabusoba
10 December 2007
Kampala — WHEN Deborah discovered she was pregnant again, the first thing she thought of was an abortion. Her son was only four months old. "I was devastated. I felt ashamed. How was I to go back to work with another pregnancy? What would people think of me?" she recalls.
"I never got my menstrual period between these two kids," Deborah says pointing at a picture of the toddlers who look more like twins.
Mark and Noah are aged four and three years respectively. "I was waiting for my periods to return so I could seek my doctor's advice on which contraceptive method to use, but the unbelievable happened."
Deborah says her mother became suspicious when Mark become sickly. "He was getting frequent diarrhoea; he refused to breastfeed and was always moody.
"All the lab tests did not show any infection, but the baby was sickly. My mom asked me whether I had had my periods ever since I gave birth. When I said I had not, she confirmed her fears, which sent my heart racing. Lab tests revealed I was two months pregnant
"But how? My baby is just four months and I am still nursing him," I tried to plead with the doctor. A stream of thoughts flowed through my mind. My baby...my job... finances ...how am I going to manage? What a shame!"
Ruth Mutoya, a counsellor with Healing Talk Services, says one thing that disturbs most women, especially working mothers is shame. They worry about what people are going to think of them? Many get confused. They don't know whether to carry on with the pregnancy or to terminate it, but we always try to help them cope with the pregnancy."
Mutoya says some mothers who have had a caesarean birth fear the scar might tear; others are confused about breastfeeding because it is commonly believed the breast milk is harmful to the baby. Others think breastfeeding while pregnant can cause a miscarriage. First-time mothers are, especially overwhelmed.
"The first pregnancy tends to be emotionally and physically draining. The thought of another one, when memories of the previous one are still vivid can be scary," Mutoya says.
Normal versus C-section
"It all depends on whether a mother had a normal or caesarean birth," says Dr Godfrey Alia, a gynaecologist at Mulago Hospital.
Medically, it is recommended that, under normal circumstances, mothers should resume sex six weeks after childbirth.
"A mother can accidentaly get pregnant at this time or 10 days after a miscarriage, but we normally advise them to wait for at least two years. This is to allow the body to heal and to allow the baby enough time to grow," Dr Alias says.
"But we get cases where mothers conceive immediately. For a normal birth, the mother may have just the physical and emotional demands to deal with, especially because breastfeeding while pregnant can be overwhelming. However, for those who had caesarean births, it depends on the doctor's judgement on whether it is safe for her to carry the baby," Alias adds.
Dr Melton Awudo of Marie Stops says mothers who get pregnant shortly after a caesarean birth risk rupture of the scar.
"We monitor them closely when they reach five or six months of pregnancy. Most times we do not allow them to go into labour. We carry out elective C-section," Awudo says.
Is it safe to breastfeed during pregnancy?
"There is no harm," says Nelly Birungi, a nutritionist at Mulago Hospital. "If the baby is hardly six months or if the mother cannot afford formula milk, we advise her to continue breastfeeding.
"The only problem is that breast milk changes composition in relation to the growing foetus, but it cannot harm the baby. The mother can continue breastfeeding until late pregnancy," Birungi says.
However, doctors advise that a mother stops breastfeeding and embraces replacement feeding once the baby gets used to other foods because breastfeeding during pregnancy can be overwhelming.
"Some toddlers may just shun breast milk because of the change in taste. But diarrhoea in such toddlers is not linked to the milk going bad because of pregnant as most people believe," says Birungi.
"Once a mother discovers she is pregnant, the first instinct is to stop breastfeeding and introduce replacement feeding. Birungi explains that it is this transition that triggers changes in the baby's health. In such cases, diarrhoea may be obvious, especially in cases of poor hygiene."
According to Breastfeeding Through Pregnancy and Beyond, an Australian Breast-feeding Association booklet, the mother's body may start making colostrum during pregnancy or this may occur if the child stops feeding for a while. Colostrum is the first yellowish fluid secreted through the mothers' breasts towards and after childbirth.
"The taste of colostrum may encourage weaning, at least temporarily, as it is salty. Colostrum is a natural laxative that helps the newborn pass the meconium- the greenish black stool passed by newborns - so bowel motions may become far more liquid. This will not harm the child at all," the booklet says. "If the baby is under nine months, the mother should eat a healthy diet and offer the breast whenever the baby seems interested. Breast milk remains a major part of the baby's diet. In some mothers, the breast milk supply diminishes because of the hormones released during pregnancy," it says.
The document further notes that there are various possible side effects to breastfeeding while pregnant, with some mothers reporting worsened morning sickness during a feed ( possibly due to hormonal release in the body), hunger, thirst or tiredness.
A mother may also experience nipple tenderness as a result of pregnancy hormones, lasting a trimester or longer. Paying careful attention to positioning can help relieve the discomfort - lying down to feed may be a better option.
But while the book says that it is okay for mothers to breastfeed, give birth and continue doing so for both babies (tandem feeding), Birungi warns that this is not good because it robs the newborn of sufficient milk.
She adds that it may also wear out the mother, lead to some attention deficits for the new baby.
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