Childbirth is an incredible time for a mother and the entire family. But it can be a time of great grief and pain when the family losses a mother during delivery or a baby at birth. According to World Health Organisation (WHO) statistics, about 130 million births occur annually, over 303,000 mothers lose their lives during the process, 2.6 million babies are born stillbirth (born dead), while 2.7 million children die in the first 28 days. Though the number of birth is impressive, reports on deaths are staggering because every statistic means a premature death has occurred.
Most of these deaths can be prevented with adequate knowledge and information on pregnancy and safe childbirth practices, early health-seeking habits, and appropriate maternal care during delivery and after childbirth.
Consequently, gaining knowledge on how to optimize pregnancy, prevent maternal and newborn deaths, and reduce complications and disabilities associated with childbirth remains largely an unmet need. Pregnancy and childbirth are not a one-time event but a process that starts before a mother is pregnant and continues after the birth of the baby to the postnatal period and beyond. Therefore, knowledge of preconception care, uneventful pregnancy, safe delivery, and postnatal care will equip us with the skills to navigate childbirths with optimism.
1. Optimize Pre-conception Health State
Pre-conception counseling is one way a couple can acquire knowledge on pregnancy and childbirth. Whether you are a first-time mum or have delivered before, every pregnancy is unique. Being prepared is a critical component of your overall health. It has an impact on your pregnancy and newborn baby. Several factors determine the success of your pregnancy. Age at first delivery is a significant determinant of success during pregnancy and childbirth.
Both early (adolescent) and elderly pregnancies carry significant health risks during pregnancy and increase negative birth outcomes. While early pregnancy increases the risks of premature birth, low birth weight babies, and stillbirths, elderly deliveries increase the risks of gestational diabetes, gestational hypertension, hypothyroidism, abortions, and stillbirth. In such circumstances, close obstetrical supervision and monitoring of the development of the pregnancy and childbirth are required for timely intervention to increase the survival of both the mother and the baby.
Delaying the first pregnancy until the age of 20s is preferred because, at this age, the reproductive system has matured and can adapt well to strains emanating from pregnancy and childbirth. This delay is becoming more common today as women excel more in academics and careers leading to later first-time mothers.
The nutrition status of the mother to be is another determinant of the state of pregnancy and birth outcome. Being overweight or underweight can all affect how a mother thrives during pregnancy. Intentional weight loss during pregnancy is not encouraged unless on medical grounds and under strict supervision. Physiological weight gain during pregnancy is anticipated. A mother gains gestational weight from increased blood volume, placental mass, bulky uterus, amniotic fluid, and the growing baby. This weight sheds off after childbirth.
An underweight mother will need to add some extra pounds, while an overweight mother will need to be stricter on her weight gain. Eating a healthy balanced diet from all food groups will provide the necessary nutrients to cater to the needs of the pregnant mother and the unborn baby. Adding an extra 300 calories drawn from healthy food groups will meet the demand without adding weight. Eating small frequent meals with additional snacks should suffice.
Though the state of health before conception is critical, chronic diseases like hypertension, hypothyroidism, and diabetes do not limit childbirth. However, such diseases must be well controlled before a woman attempts to conceive. During pregnancy, supervision by your obstetrician together with your physician is required. It is recommended that women preparing for pregnancy should be screened for such diseases to guide pregnancy preparedness.
2. Optimizing Healthy Pregnancy
Pregnancy is an incredible time for every woman and most mothers will carry healthy pregnancies and deliver healthy babies. But there is a small minority that does not end up as expected and experience pain and losses. Because you can never tell how your pregnancy will end, it is important to observe a few facts about pregnancy to optimize a healthy pregnancy and reduce associated risks associated.
Immediately you confirm or suspect that you are pregnant, it is a good thing to start your antenatal clinic. Most women will suspect that they are pregnant after observing several symptoms. The first cue may come from a missed period, increased breast size, loss of appetite that can be accompanied by nausea and sometimes vomiting, and later the weight gain may become apparent due to the growing uterus. The best thing to do is to seek health services to ascertain your pregnant state. Most health providers will book you for monthly clinic follow-up until you are 28th weeks pregnant, thereafter a two weeks visit then weekly until delivery. These visits are important to monitor the health of both the mother and the growing baby. As well, it is time to note and correct any ill-health, get vaccinated according to your antenatal schedule, and supplement with vitamins if necessary to boost your health or correct any anomaly discovered during the antenatal period.
Add onto your nutritional knowledge. This is a good time to receive nutrition counseling so that you can optimize your nutrition in preparation for the delivery and lactation. Underweight mothers will probably give forth undernourished newborns with risks of low birth weight. Being overweight during pregnancy equally carries its share of ill health. A proper diet will help you maintain weight within the expected ranges. Include quality protein, complex carbohydrates, vegetables and fruits, and healthy fats from nuts and seeds. Remember to rehydrate regularly with non-sugary fluids and water.
To maintain a healthy pregnancy monitor other health issues. Avoid infections with malaria, flu, and urinary tract infection among others. Maintain a hygienic environment, and stay away from places that can increase your risks of infection. Try not to indulge in alcohol, smoking, or other illicit drugs. There is no evidence of the appropriate amount of alcohol that is allowed in pregnancy. Maintain a regular physical exercise routine. Your health provider will discuss with you the most appropriate exercises that you can effectively practice during pregnancy.
3. Optimize Safe Childbirth
Giving birth is hard work, and you must be ready for it. Being physically healthy is important to go through the process. To overcome fears and uncertainty, you require emotional support from your loved ones to walk you through the journey. Traditionally, women helped other women during delivery and immediately after childbirth. Hospital deliveries have restrictions but a mother can still identify a close family member or a friend who is available to give her the support and cater to other social needs. Knowing there is someone out there cheering you on is encouraging.
Before actual delivery, aim to gather as much information on safe childbirth as possible. Learn about the true signs of labor that should alert you that labor has started. Attending a labor and delivery class can help, alternatively, ask your health provider to explain what to expect. Being active throughout pregnancy is one way to prepare your body for strenuous childbirth.
When the time comes, be alert and observe some common signs of labor such as a steady low backache pain, strong and frequent uterine contractions, and for some mothers, the water breaking heralds the final stage of labor. The mother must identify early enough the health facility for her child’s birth. Many complications can arise and having skilled health staff at hand is one way to avert most of these complications from being fatal. For example, Post-delivery bleeding is a common cause of many maternal deaths yet it can easily be prevented using common medication and active management of labor. Other complications like retained placenta, delayed delivery, and obstructed labor when diagnosed early are easily managed in a health facility.
4. Optimize immediate Newborn care
Newly born babies are fragile and require utmost care for survival. After childbirth, the midwife assesses the baby and gives an APGAR score at 1 minute and 5 minutes after birth. APGAR score is determined by assessing the skin color, pulse, sounds, body movement, and breathing. This assessment determines the next phase of action. A baby with a poor APGAR score requires immediate resuscitation and specialized care. A baby with a good APGAR score (>7) requires only warmth and is ready to breastfeed. Early breastfeeding is beneficial to the mother and the baby, other than creating a strong bond, it aids in the evolution of the uterus to prevent bleeding. Breastmilk nourishes the newborn because it is wholesome, natural, and easily digested.
Proper positioning of the baby on the breast is important. Most mothers may fear breastfeeding when the nipple gets cracked. To prevent cracked nipples, position the baby by lifting the baby to the breast. Ask your midwife to demonstrate how to position the newborn to the breast especially if you are a new mother.
5. Optimizing your Postnatal Care
After delivery, a woman needs rest because she has just gone through a laborious process. In the hospital, the woman should rest for at least 24 hours under the watchful eyes of health personnel who are on the lookout for any new development. Before the mother is discharged from the hospital, she should receive adequate information on postnatal care, return visits, and family planning. Both mother and baby are examined to rule out any postnatal complications. The midwife will assess if the baby has established breastfeeding, the mother is positioning the baby well and she is not distressed. Some important information on the need for a balanced diet to maintain lactation and the health of the mother, hygienic practices to prevent infection for both the mother and baby, and cord care should be given before the mother is discharged. According to the hospital protocols, the first immunization may be given before discharge and the mother is advised on the importance of a follow-up clinic according to the nationally approved immunization schedule.
The first few weeks after childbirth are exhausting both physically and emotionally. A dedicated family member should be available to offer emotional support and relieve the mother of physical work. The mother should have ample time to rest and recuperate. As she lactates, the mother should feed on a balanced diet and take enough fluids. Wholesome grains, good sources of protein, fruits, and vegetables are essential to provide minerals and vitamins that will nurture the mother back to good health. Women who are undernourished or young mothers need extra caution with diet to rebuild back their health.
6. Child Care for the first 5 years
The period from childbirth to five years is a period of great vulnerability for the child. They are susceptible to nutrition maladaptation with the prevalence of malnutrition and overweight occurring in almost equal measures. It is also a period when most physiological processes occur that shape the child’s life. Try and maintain a healthy balance of nutrition so that the growth is moderated within the normal ranges. Exclusive breastfeeding for the first six months followed by complementary feeding from six months of birth is recommended. Continued breastfeeding for 24 months or beyond is important to ensure that the baby is cautioned against nutrition maladaptation.
Physical stimulation through play is another important aspect of child growth. Children learn through the environment where they grow. They learn to trust their surrounding from their caregivers. Give your child the opportunity to learn through listening to you, playing, and interacting with you to build their skills.
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Bridging Health Gap 
Handy information especially in the present times when the risks are high. More grace as you keep enlightening us. Thank you.
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