21 January 2008

Uganda: The Ghosts That Hover Over Pregnant Mothers

Kampala — LONG with the joys that come with pregnancy, many mothers, especially first-time ones, are haunted by a wide range of fears. It may be a nagging concern or a deep-seated anxiety about the days to come, in regard to their health and that of their babies.

"I had heard of women giving birth to snakes, lizards, leopards... These stories haunted me and I often wondered: 'I am I really carrying a baby?'" says Annette Muto, who is now expecting her second child.

"It is not until I had an ultrasound scan that I relaxed. Even then, other fears set in as the pregnancy advanced, especially when women narrated their heart-rending labour experiences," Muto adds.

For Robinah Mukisa, who is now expecting her fourth child, the fears were overwhelming with the first child, but they still recur with each pregnancy.

"At first, my major concern was regaining my pre-pregnancy shape. I particularly feared vaginal birth because I thought I would become 'wide down there' and would not enjoy sex and my husband would shun me. I feared my breasts would sag, I would get stretch marks and become physically unattractive," she recounts.

"Even now, there is nothing like contentment when it comes to issues of childbirth. I dread pregnancy blues (morning sickness, heartburn, backache, funny cravings .) because each pregnancy comes with its own share of discomfort," Mukisa says.

She says she has never gotten used to the birthing process: "Will it be a C-section? Will I get a tear, stitches, intense pain? Will I die in labour? All these worries keep haunting me.

In a country like Uganda, where 6,000 women die every year and many others suffer ill-health because of pregnancy and childbirth-related complications, these fears are not unfounded.

Rachel Nanono, a midwife at International Hospital Kampala (IHK), says women who have had a difficult time conceiving, have had one or more miscarriages or stillbirths, or those who have previously given birth to a child with disability tend to wrestle with these fears and insecurities more intensely.

Sometimes, she says, women who have made grave mistakes like carrying out an abortion may worry they will have serious problems as a punishment.

The fears are also reportedly intense in women with health problems such as high blood pressure, diabetes, weak cervix, asthma, sickle cell, and HIV/AIDS.

"Mothers always fear their babies may die or they may infect them," Nanono says.

The fears are also heightened when one or more complications such as cord around baby's neck, abnormal blood pressure or bleeding is experienced or detected during pregnancy.

Sikola Nabifo, a midwife at Mulago Hospital, observes that many of these fears arise out of ignorance, misconceptions and superstitions.

Nabifo says some mothers rely on information from other people's experiences only to discover that pregnancy and childbirth is not as 'horrifying' as they had been made to believe. "There are also mothers who fear they will give birth to disabled children because they have used modern family planning methods. Others think when they have thick vaginal discharge, they will give birth to a blind baby or when they gain a lot of weight or are told their baby is big, they will automatically have a C-section," she says.

For others, when the due date passes, they worry there is something wrong with the pregnancy. They think the baby should be out exactly on the predicted date, which is not a must.

Then there are those who fear their pregnancies and labour may not progress well because they have not used herbs as advised by their mothers or in-laws.

"Others worry about baby's sex, especially when the spouse shows preference for a particular sex. Many mothers rush for scan even when it is not necessary, just to ascertain the sex of the baby," Nabifo says.

Worrying can only lead to obsession, stress or depression, which may affect the mother physically, mentally or emotionally and impede her decision-making ability.

"If a woman is stressed, she may miscarry. Others may opt for an abortion or even abandon their babies after birth," Nabifo says.

Signs of unhealthy fears include altered eating or sleeping habits, or worse still, depression.

Juliet Babirye, a midwife at Paragon Hospital in Bugolobi, says pregnancy fears often manifest as soon as one discovers she is pregnant and intensify as the the due date approaches.

Women who find themselves constantly worried, she says, may opt for a caesarean birth without weighing the consequences.

"Some end up moving from one health worker to another or even consulting witchdoctors in search of 'better options'. Other cling to unfounded beliefs that when you eat certain foods, the baby will be stupid, have a lot of saliva, skin rash... and end up eating unbalanced diet, putting themselves and their unborn babies at health risk," Babirye says.

She advises mothers to talk to their partners, a trusted friend and, most importantly, a skilled health worker, about their fears.

Many hospitals today offer antenatal classes which can give mothers useful information and confidence to deal with these fears.

"But, most importantly, husbands need to support, encourage and reassure their wives," she says.

According to www.motherhood.com, an internet site on parenthood, there is no way around the fact that childbirth involves pain, but you can do something to keep yourself fairly comfortable. The site urges mothers to develop a positive attitude. "Remember a woman's body has handled labour long before there were the kinds of pain relief we now rely on. Have faith that your body was designed to do the job, and that the people you have chosen to assist you will see you through the rough spots.

The site says even some congenital defects (the defects a baby is born with), can be corrected without complication in infancy or early childhood.

It notes that maintaining a healthy diet, avoiding alcohol, cigarettes, drugs and other toxic substances, and taking good care of oneself can prevent many problems from ever developing.

"Regular antenatal care can also help alleviate some of these fears, as the tests carried out will rule out any foetal defects or problems.

"And, because most concerns stem from simply not knowing what to expect, learning a bit about the problem you fear most can help keep stressful feelings under control," the site says.

Nevertheless, it is often not until the birth of the baby that mothers are able to let go of the fears and embrace the reality.

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