newsletter Feb06

The newsletter, Jan 2008

The reasons behind a caesarean section

For nine months, all women think about how the day of delivery will be like. And they imagine, for nine months, a natural delivery. But it happens, often few days before the estimated due date, to find out that there will be a necessity to resort to a caesarean section. For many women, this is a news that brings pain: all of a sudden, they feel more fragile, inadequate, they think that they made some mistakes or behaved in a way that caused this necessity. Those are understandable feelings, caused by a great disappointment. Which however must be rationalised: a caesarean section is a necessity that is resorted to in order to guarantee the well being of mom and baby. It is an act of practicability and love that allows the repeat of the wonder of birth and the fulfilment of a project of happiness.

According to statistical estimates, at least 33% of pregnancies end up, in Italy, with a caesarean section. This percentage, in reality, is too high, according to some health organizations. In any case, the decision of the medical team is based on medical and physiological reasons for which no woman should feel guilty. The caesarean section, so called elective, is resorted to, which means it had been decided and agreed upon with the gynaecologist before the child’s birth, when there are risk factors identified during gestation, such as the excessive size of the baby compared to the mother’s pelvis, his position which is incompatible with a natural delivery or in case of a twin pregnancy in which the foetuses obstacle each other. A caesarean section is often planned also when the mother suffers of hypertension or heart problems.

There are some instances however in which the caesarean section becomes unexpectedly necessary: for example, in presence of placenta previa or placenta abruption, conditions that could cause serious haemorrhages at the moment of delivery. Or when signs of fetal distress are detected connected to poor oxygenation due to the umbilical cord around the foetus’ neck. The complications of natural delivery can usually be overcome with adequate support to the woman in labour but, if this is not possible, a caesarean section is resorted to even in those instances. Those complications might not be present in a following pregnancy and women that had to resort to a caesarean section during their first pregnancy could, with the right medical support, hope for a natural delivery in case of a second child.

For a caesarean section, two types of anaesthesia, general and locoregional can be administered. The second one allows to assist to the child birth, but it is given only in case of planned caesarean sections. In case of an unplanned surgery, general anaesthesia is instead resorted to. In any case, the caesarean section is a delivery that is not very painful to the mother and not very tiresome for the baby. And also babies that are born through a caesarean section can be latched to the breast right away and breastfed naturally like all the others: the new anaesthetics, as a matter of fact, are eliminated by the body very quickly.

The caesarean section leaves only small marks: the incision is made just above the pubis, almost all the times in a horizontal way. It is a less invading method and more attentive to the woman’s beauty. Suture stitches are generally eliminated between the fifth and tenth day after delivery. The discomfort lasts for 6-8 weeks and the wound must be cared for with a careful hygiene and a cicatrising cream.

Psychological "marks" instead are felt above all before the delivery, but they can be overcome through to support of loved ones. It is important for women to share their own fears and own negative thoughts. Achieving quickly the awareness that the baby’s health is of primary importance and that his smile will regardless be able to give you all the joy of such an arrival, which has been so long awaited for.

Was the baby born? It is not true that it is all over: all is about to begin. This is why it is important that the mother tries to rest as much as possible, even during daily hours if the newborn sleeps, leaving behind the tasks that are not necessary and delegating to others household work, especially for the first month-month and a half. Lots of time is needed, as a matter of fact, for a woman's body to recover from the psycho-physical exertion of delivery. Rest is also important to overcome the normal, light depression, which takes place in the way of tiredness and tendency to crying, due to the hormonal fluctuations that follow childbirth.

In the first few weeks, the woman has to deal with the pain caused by the episiotomy, the "cut" to the perineum that often is executed in order to favour the child’s delivery. The discomfort goes away within five, six days: to feel less pain, a sort of "toilet seat cover"(which can be found in health stores) can be used and placed on the toilet seat when sitting down. Even proper hygiene, with frequent and lukewarm washes could relieve the discomfort. Eventually it is possible to assume a mild analgesic, suggested by a gynaecologist or an obstetrician if you intend to breastfeed.

Approximately 48-72 hours after childbirth, as a matter of fact, the so called "lactation" takes place. The mammary gland, under the stimulus of a hormone called prolactin, starts to produce milk. The woman is aware of it because her breast is swollen and painful. To favour lactation, it is important to drink a lot, apply warm-damp compresses and try to frequently latch the baby to the breast: the suction stimulates, as a matter of fact, the secretion of prolactin. In the meantime, it is a good idea to prepare the nipples with softening creams or almond milk, in order to render the skin more elastic and resistant. Breastfeeding favours uterine contractions, which accelerate the release of blood after childbirth (those are the so called "lochial discharges"). Those discharges, first bloody, then colourless, last about a month. During this period, it is advised to use cotton pads and change them often, following also an accurate personal hygiene.

The lochial discharges always take place, even when the woman has undergone a cesarian section. In this case, however, the mother has to try to rest even more. For sure, she can already get out of bed the day after and cuddle her baby, latch him to her breast and change his diaper. She has to be more careful though when making efforts which involve the use of the abdominal muscles (such as lifting the baby), but only during the first two or three days. In the meantime, it is advised to check the cut on the abdomen, applying on it hydrogen peroxide every day and trying to leave the skin uncovered as much as possible, to favour cicatrisation. If pus appears, it is important to visit immediately your gynaecologist or go to the emergency. Stitches must be removed by the doctor after about ten days and, as months pass by, the wound becomes increasingly less visible.

"Ma-ma-ma", "da-da-da", "pa-pa-pa". Those will be the first "speeches" that you will hear from your child. A repetition of simple syllables through which the child, in the first months, tries to communicate. He still doesn’t know how to talk, but in his own way he starts to experiment the sounds that he has learnt, performing actual vocal exercises. This is a typical phase for children called lallation. A very important stage in the development of speech, during which mom and dad can do a lot to help the child reach the ability of pronouncing the first real words.

The period of lallation is rather variable, it usually starts around the fourth, fifth month of life. According to some studies, this is also the moment in which the child starts to distinguish his own identity from the others, perceiving therefore the need to communicate with those that are close to him. During this period, the child plays with his voice to discover his expressive potentials and to learn to coordinate lips’ and tongue’s movements. He has fun repeating the sounds that he heard others pronounce, sounds which apparently have no meaning, but that are actually very important because they express, through the variation of rhythm and melody, his emotional moods, his needs. Parents often think to be able to identify some words in the sequence of sounds emitted by the child. In reality, the child does not attribute any meaning to those syllables, when he says pa-pa he is not calling dad yet: it is just a way, his way, to get attention. Even though lallation only takes place after the development of the child’s oral musculature, this is influenced above all by the care and attention that the newborn receives starting from the first weeks of life.

No child is born with a developed speech ability. If he learns it, he shapes it by listening to those who speak around him. The child, already from birth, has a good hearing sensitivity, ready to pick up every sound. But in order to learn how to speak, he needs an actual "shower of words". It is important, therefore, that mom and dad, already from the first months, speak a lot to their child. This does not mean to force the times, but simply to help the child learn words and their meaning. Stimulate him through fairy tales’ and nursery rhymes’ readings and talk to him, trying for example to describe what you are doing, revealing him the names of the objects you are using, even though he is still not able to understand what is being said. It is very important that you speak to the baby formulating the words in a correct way, avoiding to imitate his funny sounds. On the contrary, challenge him to repeat the simplest words correcting him, without scolding him, when he is not able to do it. As soon as the child starts to pronounce the first words, it is proper to stimulate him with images, trying to associate objects with words. Immerged in the loving sentences pronounced by parents, in the rhymes, in the lullabies, the child absorbs, he sets in his mind words in an indelible way. Reaching this way, without effort, the ability of speech.

Blood from the nose is a common problem in children. In general, it is not a worrying discomfort. Especially in small children, epistaxis is due to "constitutional" reasons, in the sense that blood vessels that supply the nasal mucosa are very superficial and can be broken easily. Therefore, no worries. A few simple precautions may be useful to stop the phenomenon, prevent it from occurring again and mainly calm the child.

The causes that determine the trauma of nasal capillaries in general, are fairly banal and not serious. For example, the nose may bleed if the child blew his nose too roughly. During the winter, it may happen that nasal mucous membranes are dry due to excessive overheating of the internal environment: in view of this, just humidify the air with a humidifier, especially during the night. During the summer instead, the excessive heat dries the nose's interior, together with the exposure to sun which has a vessel-dilating action. If the problem derives from excessive dryness, you can massage the internal walls of the nose with some Vaseline, and apply during the day isotonic saline solutions to clean the nose, which perform a hydrating action. If your child suffers of allergic rhinitis, he is more subjected to this phenomenon. At this age, it may occur that the child has the habit to put his fingers inside his nose or put foreign bodies in it, which may cause small traumas.

When epistaxis phenomena occur, do not worry and calm your child. Let him sit down with his head down, to prevent him from swallowing blood: blood is irritating for the stomach and may cause vomit that, in addition to worry the child even more, could favour the occurrence of epistaxis once has stopped. The child must expel the blood that he feels in his mouth and throat. Let him blow his nose in order to expel possible coagulations which may alter the cicatrisation processes of damaged vessels. Hold nostrils for exactly ten minutes and if needed, repeat the operation. It may be helpful to place an ice bag at the bottom of the nose, since the cold is a vasoconstrictor and helps stopping the haemorrhage.

Some behaviours may be instead counterproductive. It is wrong for example to let him recline his head backwards, because this favours blood swallowing. Do not introduce cotton inside nostrils, because it leaves residues that when removed, could cause further traumas for the mucosa. If your child is subjected to epistaxis, do not administer acetyl-salicylic acid based medicines, which increase the organism's inclination to bleed even after one week after assumption and may therefore extend the duration of nose bleeding.

When this phenomenon occurs, be careful to calm the child, because the sight of blood frightens him. Epistaxis indeed is not painful: fear derives from the fact that the haemorrhage lasts fairly long and the child may think that something serious is happening. Be close to your child and talk to him calmly, explaining him what you are doing: "Now we hold the nose, so that the veins that broke can heal" or "now we put some ice on the nose and stop the blood". Explain your child that a bit of blood from the nose is not dangerous and above all, appear calm in order to convince him.

The rules to guarantee "positive" TV watching

For kids television is an attraction that is really irresistible. Unable to part from that magic box that is so fascinating, children risk spending in front of films, TV series and cartoons the majority of their free time, losing, this way, the pleasure of playing and creating. Watching TV is not a problem but watching it excessively creates an issue because it causes unquestionable negative effects on growth and on children’s development. It is a duty for parents to establish certain rules through which help their child establish a balanced and constructive relationship with what should be considered nothing more than a useful amusement and informative tool.

First rule, which probably will force many parents to revise their own habits: no television during meals. For two good reasons: first of all because lunch, and above all dinner, are the only opportunities during which mom, dad and the kids have the possibility to talk, share their own experiences, learn to relate and listen. Secondly, because proper food education involves the ability, for adults and children as well, to concentrate on what they are eating, to learn to "listen" to their hunger and to evaluate their own sense of satiety.

The second rule certainly concerns time. Establish once and for all a limit to the daily "exposure" to television; avoid useless and tiring daily negotiations often destined to transform themselves into discussions, tantrums and consequent reproaches. Within this established limit, it is possible to get organized, planning, for example, to register the programs that the child prefers, in order to afterwards watch them during the times which best suit the family. In many families, children watch TV before dinnertime, when dad has not yet come back from work and mom is busy preparing dinner. The use of registered programs, in those instances, helps to keep under control also the use of the remote control.

The third rule, as a matter of fact, concerns the "topics" that are broadcasted on TV, about which parents’ control is important. The biggest mistake that we could make as parents is as a matter of fact that of "leaving" the kids in front of TV, without checking what they are watching. We should not forget that children are not able to judge what they are watching, they absorb passively messages and speeches, they are often incapable of distinguishing what is real and what is fiction, they live strong and intense emotions in front of violent images. Without the need of demonizing television, it has been proven that excessive and uncontrolled use of television is often the cause of some sleep disturbances and some children’s anxiety conditions.

It is not a matter of denying the use of television, but to regulate how much it is watched. This commitment undoubtedly requires some additional efforts from parents. In order to convince a child to turn off television, it is, as a matter of fact, necessary to offer him "anti-boredom" solutions. Games to build and play together, books to read, music to listen to and to sing to, friends to meet, walks in the park. The life of a child, in short. Without commercials.

Behind the rejection to go to school

A month ago he was excited to leave kindergarten and start elementary school. Now, few months later, the child refuses to get out of bed, he complains about stomach-aches, he whines. It is clear, then, that he has a discomfort related to school. This is not a small problem, considering that he has just started his educational path. Instead of panicking and say "I knew this was going to happen", which could make the situation more serious, it is appropriate to investigate, tactfully and with sensibility, in order to solve the problem and find the best solution, case by case.

The reasons that could cause a child to reject school could be many. It could be due to a disappointed expectation: the child was expecting a stimulating and playful environment and he finds himself in the position of having to learn new and complicated concepts. This commitment could be burdensome, especially for a perfectionist and insecure child who tends to see in each correction a denial of love by a figure – the teacher – that at this age is still identified with the mother. The child has to be tranquillized, by explaining to him that a possible remark only means that he can and has to learn better. It is a gesture of attention by those who are taking care of his education. Every success, therefore, has to be praised, so that the child can understand, within himself, the concept that a result follows an effort. For sure, the teacher’s behaviour also has to be reflected upon with objectivity: a cold and distant teacher - and there are some, even today- could not have a positive feedback on a child’s personality.

Moreover small "physical" problems should not be disregarded, which could translate into learning difficulties. If the child is distracted and he does not follow at school, it is important to exclude, by having his eyes examined, the possibility of a defective vision which keeps him from following the explanations. In this case, a pair of glasses could be all that is needed to change the child’s life.

Dyslexia is more rare, but however not impossible; it is a condition that causes a certain difficulty in reading and writing in the child (who has an absolutely normal intelligence, that is actually often greater than the average). The parents have to be aware of the fact that the problem, if confronted during school years, has a positive solution and the child can have a normal school career. It is important to entrust the child to the care of psychologists and speech therapists able to provide some help in the learning method. Mom’s and dad’s love is also essential, even in the execution of homework.

Instead, special attention has to be paid to morning tears, to discomforts such as nausea and vomit, to the lack of interest not just for school but also for any other activity, also those that the child was previously interested in. In those cases tact and attention is needed, at school and at home: it could be the sign of children’s depression, a problem that has to be faced together with the teachers and, if necessary, with the aid of a psycho-therapist.