Pregnancy Related; A Woman’s Health Centered Narrative

By Kofi Kwaw-Asante

This well written and informative narrative is for every pregnant woman! Whether it is guidance you seek or insight into your pregnancy, Pregnancy Related; A Woman’s Health Centered Narrative, has the answers to put your mind at ease. It caters to all aspects of your pregnancy from preconception to delivery as well as altered pregnancy states such as twin pregnancies, miscarriages and ectopic pregnancies. Each chapter is well rounded with directed question and answer sections, aimed to address the worries and concerns of the modern day pregnant woman.

Written by trusted Obstetrician and Gynecologist Dr Kofi Kwaw-Asante and with you, the expectant mother to be in mind, Pregnancy Related; A Woman’s Health Centered Narrative pays careful attention to what you need to know regarding common pregnancy states, symptoms and signs as well as all the expectations that come with your baby’s birth day and the processes involved.

Natural vaginal deliveries and cesarean sections are outlined in an in depth, comparative and easy to understand manner, allowing the expectant mother to be, to appreciate all aspects of the two processes, long before her big day arrives.

Furthermore, common danger signs in pregnancy and the indicators and symptoms thereof, are carefully profiled to keep you well informed in deciding if or when to seek help.

Pregnancy Related will give you the peace of mind in knowing that you have a specialist companion and opinion, available to you in the palm of your hands, when expecting the most precious gift of life.

• Language: English
• Publisher: Kofi Kwaw-Asante
• Release date: Nov 12, 2022
• ISBN: 9781005799427

Book preview

1.png

Pregnancy Related

A Woman’s Health Centered Narrative

Dr Kofi Kwaw-Asante

© Dr Kofi Kwaw-Asante 2021

Pregnancy Related

A Woman’s Health Centered Narrative

Published by Gynae Worx – The Related Series

Cnr Cedar Road and Cedar Avenue West, Fourways

Johannesburg, South Africa

[e-mail]

[e-mail]

010 745 5942

ISBN 978-0-620-89539-2

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means electronic, mechanical, photocopying, recording or otherwise without the written permission of the copyright owner.

Cover by Mariza Schreuder

Layout by Boutique Books

Contents

Part 1: A Short Letter to the Expectant Woman

Part 2: Why Obstetrics and Gynaecology?

Part 3: Obstetrics/Pregnancy

1 The Normal Menstrual Cycle

2 Pre-Pregnancy

3 Stopping Birth Control/Contraception

4 When Is the Ideal Time to Fall Pregnant?

5 The Fertility Work-Up

6 In Vitro Fertilization Overview

7 What Kind of Pregnancy Tests are Available?

8 The Unwanted Pregnancy/Termination of Pregnancy

9 Pre-Existing Medical Conditions

10 Costs and Medical Aids

11 Medical Insurance

12 Choosing a Healthcare Provider: Midwife Versus Obstetrician

13 Pregnancy Signs and Symptoms

14 Expectations in Each Trimester

15 Miscarriages

16 Molar Pregnancies

17 Blighted Ovum

18 Ectopic Pregnancy

19 Stillbirths

20 Pregnancy and Endometriosis

21 Twin Pregnancies

22 Antenatal Visits

23 Blood Tests in Pregnancy

24 Ultrasound Scans

25 Danger Signs in Pregnancy

26 Delivery

27 Delivery Methods

28 Inductions

29 Pain Management in Labour

30 Differences Between Caesarean Section Delivery and Normal Vaginal Delivery

31 Postpartum

32 Maternity and Paternity Leave

33 Coronavirus: an Obstetric Outlook

34 The Role of a Man in Pregnancy

35 Woman Abuse And Rape

Part 4: General: Frequently Asked Questions

Testimonials

Glossary

Preface

Dr Kofi Kwaw-Asante is a Ghanaian-born, South African-raised and qualified Specialist Obstetrician and Gynaecologist, currently practising in Johannesburg, South Africa. He is the founder of Gynae Worx, a dedicated health group providing trusted obstetric and gynaecological healthcare to his patients and women in general.

Dr Kwaw-Asante is the second of three sons to Kwaw and Agnes Kabaah and a husband of five years to wife, Theresa, as well as proud father to his beautiful daughter of three years, Neoentle.

Dr Kwaw-Asante completed his undergraduate MBCHB (Bachelor of Medicine, Bachelor of Surgery) degree at the University of Pretoria in November 2009. Thereafter, he spent a year of internship at Groote Schuur Hospital in Cape Town and the following year at the Charlotte Maxeke Johannesburg Academic Hospital. Dr Kwaw-Asante performed his community service at the Ventersdorp District Hospital in 2012, before commencing his four-year specialisation in Obstetrics and Gynaecology in 2013 at the University of Pretoria. He successfully completed this in December 2016, before commencing work in private practice.

Dr Kwaw- Asante’s passion for all things women’s health and pregnancy related, coupled with his desire to provide relevant guidance to expecting mothers and women in general, has led to Pregnancy Related: A woman’s health-centred narrative: a narrative aimed to equip the modern-day pregnant woman with the necessary knowledge regarding certain pregnancy related conditions and pregnancy in itself. With its appeal to pregnant women of all ages, Pregnancy Related: A woman’s health-centred narrative, aims not only to inform and educate the reader, but also to bridge the information divide that commonly exists between women and their healthcare providers, as well as granting women the much-needed insight into their pregnancy and any associated conditions.

The more women know about their health, common conditions and pregnancy itself, the better equipped they will be to identify early signs of these conditions and their related complications, and thus avert them by seeking timely assistance.

Through Pregnancy Related, Dr Kwaw-Asante aims to reach and educate women from all parts of the globe, most of whom he may not have the privilege to examine, diagnose or treat in person.

Pregnancy Related serves as guidance for women’s health and pregnancy related issues, and should in no way be seen as a substitute for regular check-ups with a qualified healthcare professional.

"The end goal of each and every pregnancy, has always been, is, and always will be, a healthy baby, delivered to a healthy mother.

Thank you for allowing me to accompany you on your journey and for choosing Gynae Worx."

Dr Kofi Kwaw-Asante

DEDICATION

This book is dedicated to my entire family.

To my mother, Mrs. Agnes Kwaw Kabaah, and father, Mr. Kwaw Kabaah, thank you for all the sacrifices and for your guidance as well as the leadership roles that you have both played in my life. Without you guys, there wouldn’t be me, literally and figuratively. I wholeheartedly appreciate you and love you.

To my father, you are a true visionary. The smartest person I know and am privileged enough to call my father. You have seen things in me that I never thought were possible. You have always motivated me to be the best I can be at whatever I pursue and have always been behind me, above and beyond your call of duty as a father. I have never ever received bad advice from you and for that I am eternally grateful. You have always been and continue to be an advocate for me, no matter what. Thank you.

To my mother; wow. What a phenomenal woman you are. What a mother you are to your children. What a mother you are to me. My safe place. My place of comfort. My place of zero judgement. My place of solitude. My place for that hug, that talk, that pick-me-up, that counsel that only you know how to give so well. Not forgetting that home-cooked meal on a Sunday over laughter and conversation. You are all this and much, much more to me. Ma, m3 daa si.

Thank you to my brothers, Bernard Nana Ofori and Kwaw Kabaah Junior for all you have done and continue to do for me. Though we have had and continue to have our differences, I am grateful for these along with the good times and all the times that signify our bond as friends, as brothers.

To my wife, Theresa Mashila Kwaw-Asante, and our beautiful daughter Neoentle Obaasima Kwaw-Asante, my humblest gratitude to the both of you, for your love, your patience, unwavering support and understanding. Being in this speciality means you sharing your husband, Theresa, and you, Neoentle, your father, with patients at all times of the day, very much beyond the normal call of duty. It takes the very special kind of people I have found in both of you to not only understand the demanding nature of this profession, but to also allow the constant growth and everyday evolution within myself, to be able to strive for the best for you and my patients alike. I appreciate you. My patients appreciate you. Thank you.

I love you.

……………………………………………………………….

DR KOFI KWAW-ASANTE

MBCHB (PRETORIA) MMED O & G (PRETORIA) FCOG (SA)

SPECIALIST OBSTETRICIAN

AND

GYNAECOLOGIST

GYNAE WORX PTY LTD

PART 1

A SHORT LETTER TO THE EXPECTANT WOMAN

A SHORT LETTER TO THE EXPECTANT WOMAN

Dear expectant mother to be…

Congratulations on your pregnancy!

For this child you have prayed; The Lord has granted you your petition, which

you have asked of Him.

He will surely not forsake you on this journey.

Keep Him close during this pregnancy and at all the times

beyond it.

While it may be a very uncertain period in your life, seek the guidance you require

from God and your gynaecologist and use Pregnancy Related to put you at ease

and fill in the gaps.

Do not be nervous. Do not be anxious.

You are woman enough.

Woman enough to see this pregnancy through to a favourable outcome.

Woman enough to overcome any challenges you may face directly or indirectly as

a result of this pregnancy.

Woman enough to deliver this child safely.

And you most certainly are woman enough to be called a mother at the end of it all.

With love from someone who is rooting for you,

Dr Kwaw-Asante

PART 2

WHY OBSTETRICS AND GYNAECOLOGY?

As a male in a profession that focuses entirely on females, I often get asked by my patients: Why did you choose to specialize in this discipline out of all the other disciplines in medicine, doctor? I believe that the answer to this is two-fold: that the discipline chose me and that I chose the discipline.

Most say that to be an obstetrician and gynaecologist is a calling in itself. I thank God for choosing me and for guiding me on my journey towards this profession that I so deeply and wholeheartedly love. To be in this profession without God on your side, is, in my opinion, impossible. The hours, drive, dedication and heart needed to enter and sustain such a profession are nothing short of divine.

This is a profession of sacrifice: of your time and also in various aspects of your life. These are, in my opinion, sacrifices that are absolutely worth it. I view this profession as the most rewarding field in all of medicine. Most medical specialities aim to preserve, enhance, protect and nurture the human body and life in itself.

This speciality is, however, the only specialty that gives birth to life. From obstetrics comes the newborn. From gynaecology comes the care given to a woman to achieve optimal gynaecological health, putting them in a favourable position to one day successfully conceive and give birth to life. This is the only speciality that requires care of three patients simultaneously: the woman, the mother to be and the unborn baby. I am yet to encounter any aspect of medicine more rewarding than being able to accompany and guide expectant parents through the wonderful journey of pregnancy, to ultimately safely deliver a new life to them.

For many women, however, conceiving and seeing a pregnancy through to the end may not be a straightforward journey and difficulties may be experienced. I feel so blessed to be a part of their journey as well. Whether it’s a cyst that needs to be treated or a growth that needs removal or simply advice that needs to be shared, to be able to assist a woman desirous of pregnancy to achieve her ultimate wish brings insurmountable joy for me.

I strongly believe that women are by far the superior of the sexes. Not by virtue of childbirth alone, but because of all a woman is and provides to the world at large. This fact is further emphasized by British novelist, playwright and poet William Golding, in his famous quote below:

I think women are foolish to pretend they are equal to men. They are far superior and always have been. Whatever you give a woman, she will make greater. If you give her sperm, she will give you a baby. If you give her a house, she will give you a home. If you give her groceries, she will give you a meal. If you give her a smile, she will give you her heart. She multiplies and enlarges what is given to her. So, if you give her any crap, be ready to receive a ton of shit!

WHY OBSTETRICS AND GYNAECOLOGY

FREQUENTLY ASKED QUESTIONS

How long does it take to specialize in Obstetrics and Gynaecology?

In the Republic of South Africa, qualifying as any medical specialist has the attendance of five to six years of medical school as a prerequisite. Some medical schools offer a five-year programme where others offer the programme over six years. Thereafter internship of two years is another prerequisite, followed by another two years of community service.

At completion of community service, approximately 10 years of intense and gruesome, but very necessary, training would have been completed. At this point, the title of Medical Practitioner or General Practitioner is acquired. The decision to specialize can be made at this point or one can choose to practise as a General Practitioner (GP). Should one wish to then specialize further in a particular discipline in medicine, another four to six years of training as a registrar would be required.

For obstetrics and gynaecology, this period is four years in duration. Therefore, at the end of it all, as a Specialist Obstetrician and Gynaecologist training for 13 to 14 years would have been successfully completed.

Can you specialize in each of Obstetrics and Gynaecology separately?

This is not done in South Africa. The training required for the two specialities is conducted concurrently. One can, however, upon qualifying in the speciality, decide to practise either or both of these specialities. For General Practitioners with an interest in Obstetrics, the option to obtain a diploma in Obstetrics alone is possible and enables them to practise Obstetrics as a single entity.

What would you have done had you not gone into medicine?

At the crossroads, after successful matriculation, there was a decision to be made between engineering and medicine. Engineering came more from my father’s career as a successful mining engineer and the desire to follow in his footsteps. Added to this was the fact that my oldest brother was at the time already an engineering student at tertiary level. The desire for medicine was something which I, at the time, could not properly articulate to my parents, maybe because I myself never truly had a complete understanding of where this desire was coming from. Moreover, bursaries for engineering were everywhere at the time, adding more fuel to my parents’ plea to pursue engineering. I decided to go against the grain and embark on my journey toward becoming a doctor, although poorly funded financially, but with the full support of my parents, nonetheless.

What is the most rewarding aspect of your profession?

The actual delivery process, be it normal delivery or caesarean section, is always 100% fulfilling and never disappoints. Also, for a couple desiring a pregnancy to finally conceive, it is always a moment to cherish. Another rewarding and absolutely priceless aspect to my job is to see the babies I have previously delivered, now toddlers, accompany their mothers for gynaecology visits and have them run around my rooms causing all kinds of havoc.

What is the worst or least satisfying aspect of your profession?

The loss of any life, be it an early pregnancy, a stillbirth or the loss of a mother’s life.

What is your strongest quality?

Being human. A lot of professionals sometimes forget to, first and foremost, be human, especially towards other humans. We were human before we became doctors and this should not be lost upon being blessed with doctor status. If anything, it is from this status that humanness is most required. Humanness through sympathy, empathy, kindness and understanding, go a long way and one should not look at the possibility of a reward to define the extent of your human nature towards others.

What is your worst quality?

Striving to do the best at each and every single aspect of life can sometimes be seen as a flaw and an irritation.

Do you come from a family of doctors?

No, I do not. First doctor in my family.

Would you encourage your children to follow in your footsteps as a medical professional?

No. I aim to adopt a more liberal approach to parenting, the same that was afforded to me and my siblings by my parents. This, I believe, played a key role in my being able to embark on my chosen career path.

What message would you give to aspiring gynaecologists?

Have inexplicable passion and love for your future career. With hard work and determination, the remainder will fall in place.

Would you ever leave gynaecology to pursue another career option?

I strongly doubt this. It is very difficult to leave something that is a part of your mind, heart and soul on a daily basis. I am truly blessed.

What was the main aim behind writing Pregnancy Related?

To share my knowledge with the person who needs it the most, the pregnant woman. To provide the pregnant woman with a point of reference for any issues that are pregnancy related and to give her peace of mind regarding her pregnancy. The mindset of a pregnant woman is a very important aspect and contributor to her pregnancy outcome.

What is The Related Series?

This is a series of women’s health-centred narratives aimed to equip, educate and empower all women in aspects related to their obstetric as well as gynaecological health. The first in the series is entitled Pregnancy Related and takes the reader through all the expectations as well as commonly asked questions in relation to pregnancy and delivery.

PART 3

OBSTETRICS

/

PREGNANCY

1

THE NORMAL MENSTRUAL CYCLE

A woman’s menstrual cycle is an important part of her well-being and contributor towards fertility. Any irregularities in a woman’s menstrual cycle can lead to infertility, abnormal vaginal bleeding and lower abdominal pains.

Menarche is defined as the onset or the first menstruation in a female child. Menarche can occur at an early age of 9 years in some girls, with the mean ages being 9 to 14 years of age.

Instances of delayed or premature menarche can occur and may be as a result of:

Delayed

• Medical disorders

• Radiation therapy

• Genetic Disorders

Premature

Premature release of hormones causing early menstruation as a result of:

• Genetic Disorders

• Endocrine disorders

• Eating disorders/Obesity

To better understand the menstrual cycle, one has to think of each individual component of a woman’s reproductive system and know its purpose.

The components are the following:

The brain as a reproductive organ

The brain serves as the centre for the stimulus required for effective functioning of the reproductive system. This stimulus can come in the form of thoughts that precipitate sexual desire and arousal as well as in the release of hormones necessary for the control and regulation of the menstrual cycle.

In a woman, LH and FSH are released by the part of the brain known as the Pituitary Gland. These hormones stimulate the production of oestrogen and progesterone from the ovaries to regulate the menstrual cycle in a woman. Any irregularities that result in interference with the production and or secretion of these hormones can have a direct effect on a woman’s menstruation and, therefore, her ability to reproduce may be compromised.

It is thus of utmost importance to have any irregularities in one’s menstruation timeously investigated and treated, to promote a normal menstrual cycle and conception when desired.

The vulva/labia

This is the outermost part of the female genital area consisting of the inner and outer lips (labia minora and labia majora).

They function to protect the vaginal opening and contribute towards sexual stimulation and lubrication. They also serve to protect the clitoris and the orifice for urinating, known as the urethra.

The uterus (womb)

The organ within which a baby grows. This organ is muscular and is able to expand up to over 10 times its normal size in pregnancy, in order to accommodate a growing baby. Under the influence of oestrogen and progesterone, the inner lining of the uterus, the endometrium, is shed monthly, giving rise to menstruation in non-pregnant women.

The cervix

The opening or mouth of the uterus. It comprises of the internal opening (internal os) as well as the external opening (external os). It is this part of the uterus that dilates (opens) under the effect of uterine contractions, to facilitate the delivery of a baby.

The ovaries

There are two ovaries, which contribute to producing the hormones oestrogen and progesterone. These hormones regulate a woman’s menstrual cycle and contribute towards pregnancy-related changes in the event of a pregnancy. The ovaries are also the source of a female’s eggs, of which one is released on a monthly basis (ovulation), in anticipation of pregnancy.

The fallopian tubes

Found on either side of the uterus, these form the link between the uterus and the ovaries. They are conduits for the transport of sperm for fertilization and for the transport of the fertilized egg and sperm combination (zygote) back into the uterus. Partial or complete blockage of these tubes can give rise to difficulty in conceiving as well as abnormal pregnancy states, such as ectopic pregnancies, to be discussed later on.

The fimbria

These are the distal ends of each of the fallopian tubes. They are spaghetti-like structures which serve to capture the egg released by the ovary during ovulation, in anticipation of conception and pregnancy.

The vagina

For sexual intercourse, outflow of menstrual blood as well as delivery in cases of normal vaginal deliveries. The vagina is able to stretch during labour to accommodate the delivery of the baby. The vaginal environment is regulated by pH. It is able to cleanse itself through the production of secretions and specific cells to help in the regulation of its pH.

The clitoris

For sexual pleasure.

The skin as a reproductive/sexual organ

The skin contributes towards sexual intercourse and therefore contributes to the reproductive cycle. The physical interaction between a couple, particularly during intercourse, plays a role in a man’s ability to ejaculate and in a woman’s receptivity to conception.

All these components discussed above function together with the help of the hormones progesterone and oestrogen. These hormones act on the ovaries and the uterus to facilitate preparations for a potential pregnancy every month. Menstrual bleeding is in essence a sign of the absence of pregnancy. These hormones furthermore contribute towards the integrity of the vaginal wall, lubrication as well as sexual urges and desire (libido).

A woman’s monthly cycle can be divided into three phases:

The ovarian cycle

Your ovaries have hundreds and thousands of egg follicles, which all women are born with. This number decreases with age, as does the quality of the egg follicles. Under the influence of hormones, one egg is able to outgrow the rest every month and form what is known as the dominant follicle.

This dominant follicle is the one that is released at ovulation (usually on day 14, depending on length of your cycle), and can come from either one of your two ovaries. Once released, an egg can survive up to three days in anticipation of a sperm to facilitate fertilization. In the absence of this, the egg disintegrates and the process to grow another dominant follicle in the next cycle commences.

The uterine cycle (endometrial cycle)

This cycle involves the changes that the lining of the womb, known as the endometrium, undergoes in preparation for and anticipation of a pregnancy. Under the influence of oestrogen and progesterone, the lining is able to thicken and become rich in blood supply, to facilitate and support implantation, should it occur.

The hormone oestrogen is responsible for the thickening of the lining. Commonly in elderly women, an abnormal thickening of this lining may be one of the first signs of endometrial cancer. Progesterone stabilizes this lining and keeps it from breaking down prematurely as it awaits a pregnancy. In the absence of this, progesterone levels decline, allowing a woman’s menstruation to occur.

The menstrual cycle

The menstrual cycle, therefore, occurs as a result of the absence of fertilization and implantation. The endometrium that has been built up in anticipation of a pregnancy breaks down. This results in the bleeding that a woman then sees as her menstruation.

The duration of this bleed varies from woman to woman and can be influenced by factors such as hormonal contraceptives, excessive weight loss or weight gain, stress and other existing medical conditions. Most women usually experience four- to seven-day periods with the first few days being predominantly heavier than the latter days.

As a result of the shedding of the endometrium, some women may experience menstrual cramps for most of the duration of this shedding. These are uterine contractions that further facilitate the shedding of the endometrium. Excessive cramping may be caused by the presence of uterine fibroids and ovarian cysts or other contributors to imbalanced hormonal states, to be discussed further on.

THE MENSTRUAL CYCLE: FREQUENTLY ASKED QUESTIONS

Can I fall pregnant if my periods are irregular?

It is highly unlikely for conception to occur in the presence of irregular periods. Regular periods usually mean that your hormones are well balanced and, more importantly, that ovulation most likely takes place mid-cycle. In the event of falling pregnant with irregular periods, there is a greater chance of early miscarriages as the womb may not have been adequately primed for implantation and pregnancy related changes.

What are some of the causes of irregular periods?

Irregular periods are caused by any irregularity that affects your hormonal profile or balance. Excessive weight loss or weight gain, stress, infections, ovarian cysts, PCOS (Polycystic Ovarian Syndrome), endometriosis and fibroids are a few things that can cause this.

What are some of the causes of missed or absent periods?

Some causes include pregnancy, ovarian cysts, PCOS (Polycystic Ovarian Syndrome) and contraception. The use of emergency contraception, incorrect use of oral contraceptive pills, the progesterone-releasing intrauterine contraceptive device and injectable contraceptives can also result in missed or absent periods.

Is it possible to intentionally delay my period and is this safe?

Yes, it is possible and it is safe, if done correctly under guidance from your gynaecologist. This usually requires taking additional progesterone