maryannewaweru

A Kenyan Journalist Writing About Health

Archive for the tag “pregnant”

Sex and People with Disabilities

By Maryanne Waweru-Wanyama

Many are the times that Susan has come across people who have, with some astonishment, blatantly asked her, “You mean even people like you have sex?”  Such questions have come from her friends, relatives and strangers alike, and her reaction is almost always the same – one of consternation and bemusement at her sexuality.

You see, Susan, 25, has a physical disability. “Even though hurtful, I have learnt to live with society’s ignorance towards people like me,” she says.

One of the common societal attitudes towards people with disability is that they are asexual; that they do not have sexual relationships. Ignorance fuels these attitudes, where engaging in sexual intercourse does not seem acceptable – at least according to society.

Phitalis Were Masakhwe, a disability rights activist says the idea that people with disabilities do not engage in intimate relationships is the norm in society.

“People with disability are constantly portrayed as incapable of having sexual feelings. Yet, they are normal human beings who also seek meaningful relationships with members of the opposite sex. Just because one has a disability does not mean a diminished need to experience love and affection,” he says.

Often, sex is associated with physical fitness and the virility of youth. And with the media awash with the perfect body image, sex is also associated with the perfect physical body – one with a balanced symmetry devoid of physical limitations. Many people with disability, and especially women endure constant internal battles with the ideal body type, knowing only too well that they may never achieve it. For many, this affects their self-esteem and their relationships with other people, especially those of the opposite sex.

Susan says that society is fed on unrealistic images through the media – where boy meets a perfectly flawless beautiful girl, and they instantly fall in love.

“The sex which then follows is always mind-blowing. Physical attraction is always the dominant theme, and I am yet to see a soap opera that has the lead character as a person with disability. When cast in a programme, they are often portrayed negatively,” she says.

Besides the perfect body image, people with disability have a myriad of other issues to deal with, all of which can affect their sexual functioning. These include feelings of anxiety, fear and depression. Other times, certain prescribed medications may affect sex drive and sexual function.

For those with physical disabilities and whose mobility is aided by wheelchairs or crutches, their ability to move in what can be considered standard sexual ways is limited. Some have to contend with among others; pain and loss of sensation in areas where their partners expect them to be sensitive, as well as impaired bowel and bladder control. In men, it can have an effect on their erection and ejaculation.

For many people with disability, sex is not as spontaneous or as frequent as that of their able-bodied counterparts. Many times, it has to be a planned activity where issues of physical location and fatigue have to be considered. In some cases, the use of assistive devices to achieve pleasure is required.

“It takes a lot of effort and courage to explain some of these things to a sexual partner, especially one without disability,” says Susan. “That is why we prefer to date our kind most of the time – someone with a disability because they understand these things.”

Susan says that even though she gets attracted to people without disability, it is the fear of rejection that makes her stay away.

Even worse is the fact that some members of society consider it ‘embarrassing’ to date someone with a disability.

“Many men have sex with women with disability under the cover of darkness. They have intercourse with them at night but during the day, shun them. This accounts for the high number of women with disability who are single mothers. Often, their children have been sired by different men,” says Masakhwe.

Such a man, Masakhwe says, fears the likely ridicule he will receive from his family and friends, who will question his selection of a wife and tease him for his ‘unsuitable’ choice. “Such is the shame of our society”, he says.

In some communities, people with disabilities are often sterilized against their knowledge or will. Some women have even been forced to undergo abortions in the anticipated disgrace the pregnancy will bring to the family.

“It is this kind of prejudice that makes people with disability fear seeking health information,” Masakhwe says. “Even though sexually active, most lack confidence enough to seek information and services on ‘private matters’ such as reproductive health, even when this information is life-saving for them.

Caroline Agwanda, the proprietor of Hyacinth Ornament Production Enterprise (HOPE) in Kisumu, and who has a physical disability concurs with Masakhwe and further decries the reaction pregnant women with disability receive from society.

“Many express their sympathy at your pregnancy. They tell you ‘pole’ and question the morals of the man who ‘dared’ impregnate you. ‘What was he thinking? Why didn’t he look for another woman if he really wanted to have sex?’ they ask, while shaking their heads in disgust.

But it does not end there, Agwanda adds. “Woe unto you when society discovers that such a woman did indeed plan for the pregnancy,” says the mother of one.

“When I was expectant, many people asked me why I wanted to bring yet another disabled person into society. For them, it was automatic that I would give birth to a child with a bad leg like mine, and wondered what kind of a person I was to want to do so.”

Agwanda says that society’s ignorance on disability issues further manifested itself after she delivered. “After I got my baby girl, I was excited by the huge number of people who came to see me and my baby. However, I was to later discover that most were merely coming to ‘confirm’ that my child had been born with a bad leg too. This greatly saddened me.”

Too often, women with disabilities are teased, humiliated or otherwise harassed by peers and healthcare workers should they decide to become pregnant, decreasing the likelihood they will receive appropriate reproductive healthcare.

“Many are the times a clinician will ask a pregnant woman with disability; ‘Who got you pregnant? Why were you having sex in the first place?’ Even worse is that they ask this out loud along the hospital corridors, something that is really embarrassing,” says visually impaired Jacqueline Osoro, 31.

According to the Association for the Physically Disabled in Kenya (APDK), 1.6 million Kenyans have a form of disability.

Of these, about 640,000 are physically challenged. One such woman is Godliver Omondi from Mumias, who shares that pregnant women with physical disability have an especially hard time accessing antenatal care.

“I remember when I was pregnant, a nurse asked me to climb onto the examination table for an examination procedure during an antenatal visit. I use a wheelchair for mobility, and it is hard for me to get atop an examining table without assistance. The nurse did not bother to assist me,” says the mother of three children aged between five and twelve years.

“All health facilities must be made accessible to women with disabilities, and these include accessible examining tables, ramps and sign language interpreters. Clinicians should also be trained on how to be more sensitive to our needs,” she says.

One time when she was in labor and on her wheelchair, Godliver says many nurses passed her, assuming that she was there to visit a patient.

“I kept asking for assistance, and when I finally managed to catch the attention of one nurse, she asked me which patient I had come to see. The nurse was shocked when I told her I was in labor. She had not imagined that I could possibly be pregnant”.

Dr Julius Rogena of Machakos District Hospital admits to the lackluster attitude of health providers.

“Just like any other person, people with disability engage in behaviors which place them at various health risks, such as HIV infection. It is unfortunate that the attitudes of some healthcare workers do not reflect this reality.

As it is, people with disability have limited access to HIV education, information and prevention services. They may be turned away from community HIV education forums because of assumptions that they are not sexually active, and therefore at little or no risk of infection,” Dr Rogena says.

This is despite a growing body of research that indicates that those with disabilities are at increased risk of HIV due to their vulnerability.

Thoraya Obaid, Executive Director of the United Nations Population Fund (UNFPA) alludes to studies that show that persons with disabilities are up to three times more likely to be victims of physical and sexual abuse, and are at increased risk of HIV/Aids.

Yet for people with disability to be responsible about their reproductive health, they must be provided with sexual health information and given the safe space to openly express their sexuality. Rarely do adolescents with disabilities receive, either at home, or in school, reproductive health education that enables them to prepare for or appropriately respond to their specific needs and situations.

Jacqueline, who attended an integrated school for her secondary education says the only credible information she ever received on reproductive health was what she learnt during her form three biology class.

“Those who attend special schools hardly receive any sex education, and depend on those who listen to radio or television programmes to ‘educate’ them. Most of the information people with disability have on sex is what they learn from their peers,” she says.

Daniel Aghan, Advocacy Officer at Handicap International says there is an urgent need for the development of policies on access to disability-friendly information, education and communication materials, which take into consideration the different facets of disability.

For the visually impaired, Masakhwe advocates for their special needs.

“To protect themselves from HIV, blind persons use condoms, but their privacy is infringed when for example, they need to check the expiry date on the condom pack.

“They have to rely on a seeing person to read it for them. It is time brailed condoms were designed and made available to this population,” he argues.

Masakhwe says reproductive health programmes should be more accessible through disability-friendly adaptations such as cassette tapes, sign language interpretation, Brailled information, or in formats that are easily readable (such as pictures) for those with intellectual disabilities.

Article courtesy: The Star

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Lilian Madonye: When Infertility Leads to a Life of Reckless Abandon

By Maryanne Waweru-Wanyama

When 37-year-old Lilian Madonye took her marriage vows 14 years ago, she looked forward to the exciting life that lay ahead of her. In her early twenties, she was marrying the man of her dreams, an athlete whom she had courted for two years.

The wedding marked the beginning of her new life, a life that would be filled with untold happiness from both her husband and the beautiful babies they would raise together.

Lillian, a second born in a family of three, had been raised in a relatively comfortable upbringing in Eldoret town. Her father, a banker, and her nurse mother had provided them with a stable home and good education.

Nurtured in a Christian environment, Lilian was a role model in her school, neighbourhood and church where she served as a worship leader. And her marriage did not disappoint.

Lilian Madonye

Photo: Lillian Madonye during the interview

The first year was full on love, warmth and laughter. However, in the second year, the couple became worried when they were unable to conceive.

After trying for a baby for three years in vain, Lilian decided to seek professional help and saw a doctor who put her on fertility drugs and supplements. However, the desire for a baby became a dominant, crippling thought which consumed her whole being.

“Sex became a laborious task that was no longer enjoyable because of the pressure to conceive. Family, friends, neighbours and church members were already spreading rumours about my barrenness,” she remembers.

Meanwhile, Lilian kept hopping from one doctor to another seeking a miracle treatment, but none helped her conceive.

“The day I would receive my period each month would send me to a very dark place where I would spend the duration of the menses in tears. Helpless, I wondered what worth I was as a woman if I could not bear a child. What justification did I have to call myself a woman if I could not have a child?” she asked herself.

Frustrated and at her wits end, she one day asked her husband to take a fertility test if only to encourage him to be part of their quest for a baby.

“Even though I knew I was the one with the problem because I believed that infertility was a condition only for women, I asked him to get tested anyway.” But the results of the semen analysis test on her husband shocked her.

“My husband had a low sperm count, hence my difficulty in conceiving! The news took me aback because all along I thought I was the one with the problem,” Lilian says.

A low sperm count decreases the odds of a sperm fertilising an egg which results in pregnancy. Lilian’s husband was then put on fertility treatment aimed at boosting his sperm count.

At the same time, out of curiosity, Lilian decided to take a fertility test as well, and whose results showed that she was perfectly capable of conceiving and bearing a child.

“I stopped all the drugs I was taking. I wished we had both done the tests earlier as it would have saved me all the medicines I had taken for three years!”

For the next two years, the couple continued trying for a baby, but were unsuccessful. During this time, their marriage began undergoing turmoil.

“We would constantly engage in verbal confrontations about anything and everything. We were both frustrated and very desperate about wanting a baby. At some point, the fights became physical. Our marriage became filled with extreme tension and anger. We both became very unhappy in our marriage. There were infidelity issues and I was constantly rebuking women with whom my husband was having dalliances with. We stopped talking and even slept in separate rooms. I felt there was nothing left to hold on to and I eventually walked out of my marriage,” she remembers.

Lilian then moved to Nairobi where she landed a job as a sales representative in a bank. Older, wiser and with her newfound freedom — her faith in God long gone, Lilian took to alcohol and drugs. A short while later, she got a transfer to Mombasa.

“As soon as I landed in the beautiful Coastal city, I met up with people who introduced me to a wide variety of hard drugs which were easily accessible unlike in Nairobi. Soon, I began engaging in prostitution to finance my new lifestyle as my salary could obviously not cater for my needs. I would have multiple affairs with married men who would take care of my different financial needs.

Lilian Madonye

Despite being aware of the dangers, I would have unprotected sex with my partners. I didn’t care about HIV, venereal diseases or drug overdoses because I had nothing to live for. With no husband and no children, my life had no meaning,” she confesses.

Lilian says she was on a constant high because when sober, the reality of her empty life would hit her, something she did not want to face. One morning after a night out, she began feeling sick.

“I knew that Aids had finally caught up with me,” she remembers. Lilian went to the hospital, but the doctor’s diagnosis shocked her. She recalls his words:

“Lilian, your HIV test is negative. But there is another test that has yielded positive results. Congratulations, you are pregnant!” She did not believe it.

“I was living a very evil life, engaging in all the abominable acts mentioned in the Bible, but yet God remembered me? I wondered why, yet when I was a good Christian, faithful in my marriage and with enviable morals, he ignored me. But now, when I was fully immersed in sin, he remembered me?”

Shocked to the bone, Lilian decided to sober up for the sake of her unborn baby. She packed all her belongings and moved back to Nairobi to start a new life.

She got back her old sales job at the bank, and began piecing her life together, which was not easy. “I was used to men taking care of all my bills, but now I had to support myself and my unborn baby. It became very difficult to make ends meet, but I did not despair. My baby motivated me and kept me going,” she says.

One day, in her seventh month of pregnancy, she noticed some blood stains. She rushed to hospital, and by the time she got there, her clothes were soaked in blood and she was writhing in pain.

An ultrasound done on the foetus revealed that Lilian’s baby was already dead. Lilian had faced high blood pressure issues during the pregnancy, which led to her having pre-eclampsia, a condition characterised by a high level of protein the urine and which can be fatal.

But she had to deliver the baby anyway, and after six agonising days, she finally gave birth. “It was a baby girl. Even though I wanted to see her and hold her in my arms, the doctors refused and only showed me her legs. They said that because she had been dead for more than a week, she was already decomposed and in a bad state. I called her Zawadi, because she was my special gift,” she says, struggling to contain the tears welling up in her eyes.

As she walked out of the hospital on that day in May 2012, Lilian left with a new resolve. To completely turn her life around and find her purpose in life again.

“I don’t blame anyone for the path I took in life. I am responsible for all the decisions I made. I could have made better choices, but I did not. I have forgiven myself and I am embracing my new life.”

In January this year, Lilian formed a group for women struggling with infertility. The group is called Diamonds Women Ministry, and it brings together women struggling with infertility, and teaches them to focus on other areas of their lives even as they try for a baby.

“The reality is that not all women struggling with infertility will have a happy ending where they will get pregnant and have babies. I encourage women not to be consumed by the search for a baby to the extent that other areas of their life suffers. They should also not peg their worth as women solely on the basis of motherhood. I talk to women during bridal showers and talk to newlyweds about marriage expectations. I always use my personal experiences because I know I contributed to the loss of my marriage and advice them not to make the mistakes I made. I am a strong believer in marriage and just because mine did not work, it does not mean that it will not work for another couple,” she concludes.

Article courtesy: The Star

Does Being Short Disqualify a Pregnant Woman from Natural Birth?

By Maryanne Waweru-Wanyama

When Valerie Kasaya was in her eighth month of pregnancy, she one day noticed an unusual discharge. Having had a smooth pregnancy all along, the discharge deeply worried her.

A resident of Kawangware slums in Nairobi, 20-year-old Valerie decided to go for a checkup at a public health facility in Westlands, a distance of about 14km away. That is where she had been attending her antenatal clinics.

At the clinic, Valerie was informed that her cervix had started opening, that she could give birth anytime. The nurses further told her to begin preparing for a caesarean section as it would be impossible for her to deliver naturally.

“Nurses told me that because I was short, this meant that my pelvic bones were small, indicating that a natural birth would not be possible,” she recalls.

Valerie is just about five feet tall. The attending nurse then referred her to Kenyatta National Hospital (KNH) since the clinic did not have the facilities required for the surgery.

“Even though I was disappointed to learn that I would not deliver normally, I trusted the medic’s verdict because they are the experts,” she says. But back home, Valerie’s mother would hear none of it.

“My mother insisted that I could still give birth naturally. She said she had seen shorter women than me deliver naturally. She asked me to seek a second opinion, and accompanied me to a nearby clinic.”

Valerie Kasaya with her baby

Photo: Valerie Kasaya with her baby.

At FreMo clinic, a small privately-run health centre that serves the low-income population of Kawangware, Valerie and her mother were excited to learn that physical stature alone is not enough to determine if a woman will give birth normally or not.

“The midwife at FreMo said they would let me try natural birth first and if it failed, then they would refer me to KNH for a caesarean section,” recalls Valerie. She was then sent home and asked to return when labour started.

A few days later, labour started, and she immediately walked to the clinic — a distance of about two kilometres. During labour and while waiting for her cervix to fully dilate, the attending midwife helped Valerie engage in some exercises.

“She made me swing my hips, squat, and also instructed me on how to breathe. She said all this would help the baby descend, as well as ease my labour.”

Four hours after the onset of labour, Valerie delivered a healthy baby boy weighing 3.1kg. During delivery, it was just her and the midwife and she had a smooth delivery with no complications. She did not even have an episiotomy (surgical incision on the posterior vaginal wall during labour).

“I was surprised because I had successfully delivered my son naturally, yet other nurses had told me that I was a direct caesarean candidate because of my small stature,” she says.

Both mother and baby continue to enjoy robust health with no complications. Her son is now seven months old. Magdalene Katuku, the midwife who helped Valerie birth her baby, says that it is possible for short women to deliver naturally.

“Natural birth is determined by a number of factors, and it is wrong for one to make assumptions based on height alone. Having a small stature does not disqualify one from a natural birth. It all depends on the size of the baby, and the size of the pelvis. A big woman can have a small pelvis, which may not allow the baby to pass through, as her baby might be big. In the same breath, a small woman can have an adequate pelvis that may allow her baby to pass through,” she says.

At FreMo clinic, Magdalene says the emphasis is on natural delivery. Last year alone, of the 211 deliveries, 207 were natural births, with four being referred for caesarean section to KNH when there were obvious indications that a normal delivery would not be possible.

Magdalene says that their successful rate for natural births is by design, not coincidence. “Throughout the pregnancy, we help the women engage in certain activities that help keep her fit and which boost her chances for a natural birth,” she says.

Pregnant women who attend clinics at FreMo learn about chest stretches, which reduce pregnancy aches and pains and improve blood circulation. They also learn about exercises that reduce back pain — a common concern in pregnancy.

In addition, the midwives teach the women how to do special press-ups, which help prevent aches and pains due to the growing belly. “We encourage the pregnant woman to walk throughout her pregnancy. Walking is a good cardiovascular exercise, and helps keeps her fit. She should however be cautious not to walk to the point of exhaustion or breathlessness,” says Magdalene.

FreMo clinic also offers free childbirth classes for women in their last trimester. Here, they are given information about the birth process, where they are taken through the stages of a natural delivery.

“We encourage them to come with their spouses for moral support. It helps the couple prepare themselves psychologically for labour, and build their confidence about the birth process. During childbirth classes, we answer all their questions as they share their fears and expectations. We reassure them, helping them build confidence in the body’s ability to birth a baby,” she says. Their partners also learn how they can support the woman during labour, such as helping her with breathing exercises and massaging her back.

During labour, the pregnant women are encouraged to squat, as this not only speeds up labour but also fastens the opening up of the pelvis, providing room for the baby to descend. They are not encouraged to lie on their back, as this slows down baby’s descent therefore prolonging labour.

“We are also never in a hurry when the woman is labouring. We are patient with her, and attend to her throughout the birth process, the ultimate goal being a healthy baby. Due to the close monitoring, we are able to assess and anticipate any complications that would necessitate an immediate referral and transfer to KNH, which we facilitate as we offer them transportation. All the above are what we believe has led to our high success of normal deliveries,” she says.

 

An expert’s view

Is it possible to tell if a woman will not be able to have a natural delivery judging solely by her height? According to Dr Stephen Mutiso, an obstetrician / gynaecologist at Kenyatta National Hospital, a diagnosis of cephalo-pelvic disproportion (CPD) is often the key determinant in such cases. Cephalo refers to the size of the baby’s head, and pelvic means the size of the birth passage.

A diagnosis of CPD means that either the baby’s head is too big for the woman’s pelvis, or the pelvis is too small for a normal sized baby. In women diagnosed with CPD, normal delivery is difficult and at times impossible.

“Small women tend to have a small pelvis, and are likely to have difficulties during delivery. Any woman with a small pelvis and whose baby indicates being slightly bigger compared to her pelvis is not advised to try normal delivery,” he says.

However, Dr Mutiso clarifies that there are short women who have small babies and go on to have successful normal deliveries, hence the need for proper assessment by the health professional during antenatal care or when labour begins.

“This assessment will help determine if the pelvis is adequate enough to allow baby to pass through. If the baby’s size is small to average, then labour should be considered,” he says. Dr Mutiso warns of attempts to push a baby that cannot pass through a small pelvis.

“This could lead to prolonged labour and cause obstruction, which in turn may result in complications such as fistula, rupture of the uterus, serious infection, excessive bleeding after birth and foetal distress. In some instances both mother and baby may die.”

Dr Mutiso says that in the event vaginal delivery goes on to take place, the mother can sustain serious perineal tears or cause damage to her reproductive organs. Further, caesarean deliveries done when one has been trying to push are more difficult and associated with increased complications.

“In as much as most pregnant women plan to delivery naturally, it is necessary for them to understand that complications may arise during labour, and which may necessitate a caesarean section. These complications include failure for labour to progress despite good contractions, foetal distress and excessive bleeding.”

Article courtesy: The Star

What Foods Should a Pregnant Woman Eat? Should Pregnant Women Eat Liver?

What foods should a pregnant woman eat to ensure she maintains a healthy pregnancy and delivers a healthy baby? There is also lots of talk that pregnant women should not eat liver. How true is that? Dr. Stephen Mutiso, a consultant obstetrician / gynaecologist gives us answers to this.

What Foods Should You Eat While Pregnant?

Pregnant women should eat healthy foods in order to provide adequate nutrition to the growing baby. A pregnant woman must strive to eat a balanced diet, as this is crucial for the healthy development of the baby.

A diet is balanced if it contains the following: starch, proteins, vitamins and minerals. Thankfully, many of our locally available foods are rich in these nutrients, and they are affordable.

Foods rich in starch include ugali, rice, chapati and potatoes. Common sources of proteins include beans, peas, fish, milk, eggs and meat. There are many fruits and vegetables available locally which are a good source of vitamins and nutrients and include spinach and sukuma wiki.

It is also important to note that the demand for iron in pregnancy is very high and cannot be met purely through foods. That is why iron supplementation is recommended during pregnancy.

A high intake of fiber and water is recommended during pregnancy, as it helps to reduce constipation because pregnancy slows down bowel movement.

What about Liver During Pregnancy? Should you or Should you not Eat?

It is not advisable to eat foods rich in vitamin A –such as liver or if eaten, they should be eaten in moderation. This also applies to supplements that contain high doses of vitamin A. This is because high doses of this vitamin have been associated with significant birth defects, hence caution to avoid prenatal vitamins containing this vitamin. This caution is especially important for women planning to get pregnant, and during the first trimester of pregnancy when the organs are forming.

Pregnant women are also advised to avoid raw and undercooked meat which may increase risk of acquiring toxoplasmosis which may affect the baby.

Alcohol must be avoided at all times.

Should I be Eating for Two When Pregnant?

From a nutritional point of view, a pregnant woman eats for two, hence the need for her to eat nutritious food. However, this does not mean eating twice as much in pregnancy. She should focus on ensuring she eats quality food, not quantity food. Eating too much is bad both for the mother and baby and could lead to problems.

How Much Weight Should I Gain During Pregnancy?

Weight gain during pregnancy is vital in preparation for breastfeeding. The recommended weight gain for non-obese women by the end of pregnancy is 10-12kg.This translates to about 0.5kg per week. If one is obese, the recommended weight gain is about 8kg.Weight loss during pregnancy is not recommended, so one should not be on a weight-loss diet.

Most of the weight gain occurs after 20 weeks of pregnancy when nausea and vomiting has reduced or even ceased.

Gaining too much weight increases the risk of gestational diabetes, backache, high blood pressure and a likely caesarean section due to a big baby. Too little weight gain can lead to low birth weight and premature birth.


Dr. Stephen Mutiso is based in Nairobi, and he provides a wide range of gynaecological services including: antenatal care, delivery (normal and caesarean), infertility treatment, fibroids, fistula issues, and screening for reproductive tract cancers, and gynaecological operations.

He is based at KNH Doctor’s Plaza, Suite 26/27

Tel: 0722 678 002 or 0788 306 674

Email: mutisoh@yahoo.com Website www.drmutiso.com

Post originally published in Mummy Tales – A blog by a Kenyan mom.

 

Pregnancy Forum for Expectant Moms

Pregnant women love talking and sharing about their pregnancy journey. One woman in Nairobi, Lucy Muchiri, who is a consultant midwife has found a way to bring them all together, where they can not only share their experiences, but also learn about the different physical, emotional and hormonal changes they are going through as they prepare for the arrivals of their little bundles of joy.

Here is a review of one such session.

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