Q. We have a dear friend in Bali that is 7 months pregnant.
Nengah has been told by the doctor that she must have an operation
as the baby is upside down (breech). This will be quite a
financial burden for them, is it absolutely necessary for
this baby to be born by ceasarian section? Is there any one
in Bali that can “turn” a baby?
A. Several points to consider here. One is that as the lady
is only 7 months pregnant, the baby may actually turn by itself.
Babies tend not to settle in to a fixed position until the
pregnancy is 8 months (36 weeks). Secondly we should consider
why the baby seems to be favoring a breech position. Sometimes
there seems to be no particular reason. Occasionally it can
be caused by the placenta filling the lower uterine cavity,
an unusually narrow pelvic outlet, and rarely can be caused
by babies head being larger than normal and of course a multiple
pregnancy (twins) will also affect babies position. All these
factors could be checked on ultrasound scan. If all looks
normal apart from the fact that the baby is breech, then a
non-surgical delivery is still possible. I would suggest that
one of the local midwives is probably more skilled at delivering
a breech baby by normal delivery than an Obstetrician. Doctors
will usually opt for caesarian section where any risk is involved
(and a breech delivery is a more difficult and higher risk
than a normal delivery). They tend not to wait for last minute
decisions on surgery as hospitals here do not have emergency
operating facilities that can be ready for action in a great
hurry. I suggest that Nengah have twice monthly visits from
now on; a detailed scan to check the abovementioned factors
before she makes any decisions. I have heard that there are
some practitioners here that will turn babies by external
manipulation, however the procedure in itself poses a risk
(tearing the placenta, pulling the cord). This procedure should
always be performed in a hospital where surgical facilities
are available.
Q. I had planned a surfing safari to the Eastern Islands
(Sumba / Sumbawa) with a group of friends next month, but
I have just found out that I am pregnant. According to the
local doctor I cannot take any malarial prophylaxis. Do you
think I should risk going unprotected? Or is there some form
of anti-malarial that I can take?
A. No & NO! Sorry, if the pregnancy is your ultimate
consideration than you may have to take a rain-check on the
surf and the travels. The East Islands of Indonesia are known
malaria risk zones, and unless you are staying at a 5 star
resort that has stringent mosquito controls in place, then
you can consider yourself a target. Unfortunately, pregnant
women seem to attract the mosquito more than non-pregnant
women. No-one knows quite why this is, but some theorize that
an increase in the metabolism (therefore body heat) of pregnant
women, makes them easier for the mosquito to detect. It’s
like you become a glow in the dark target with “bite
me” tattooed across your butt!! Even more mysteriously,
pregnant women who do contract malaria will generally be very
much more seriously affected than someone who is not pregnant.
Still not convinced? If you are really determined to go on
this trip, take all precautions not to be bitten. This mozzie
bites at night and late evening, so make sure you use a good
knock down spray in your bedroom before you go to bed (don’t
rely on hotel staff to do this for you…do it yourself!).
Use a plug in mozzie zapper; don’t wear dark clothing.
Stick to long sleeved, loose, light colored clothing with
no perfume, and use a personal insect repellant that is safe
for pregnancy.
Q. I am now 4 months pregnant and I have had a stomach upset
that comes and goes for the past 3 weeks. Now I have been
diagnosed with Amoebic dysentery after having a positive stool
test. The doctor has prescribed Flagyl tablets, and yet according
to what I read on the internet this drug is not recommended
for pregnancy. What can I do for my illness that will not
affect this pregnancy?
A. While this drug is not recommended for pregnancy, neither
is some tenacious little microbe that eats into your intestines,
and then starts munching on your liver! This is a risk vs.
benefit situation, and in this case the “benefit”
wins. All drugs are given a categorization code for safety
of use during pregnancy. “Category A” (Taken by
large numbers of pregnant women with no documented effects)
would be safe right down to Category X (High risk of causing
permanent fetal damage), which is a total contraindication.
“Flagyl” is a class B2 drug. This classification
states that “These drugs have been taken by a limited
number of pregnant women with no documented increase on fetal
malformation. Studies on animals may be lacking or inadequate”.
I would take the Flagyl for the full recommended course (usually
10 – 14 days). If your symptoms persist go back to the
doctor for another stool test as unfortunately we are now
seeing some resistance to this antibiotic by the amoeba. Oh,
by the way, don’t be alarmed at your urine turning a
psychedelic orange or reddish color. This is a very common
side effect of this antibiotic.
Q. 2 nights ago my baby was upset and crying continuously.
When I woke up in the morning there was a lot of pus coming
from her ear, and she was no longer distressed. I have been
to the doctor and he has prescribed antibiotic syrup, and
yet my friend’s baby had the same thing and her doctor
did nothing. My mother says that ear drops should be enough,
as I hate giving my baby unnecessary medicines.
A. It sounds like your baby has had a middle ear infection
that has ruptured the ear drum allowing the pus to leak in
to the outer canal. These days the trend is not to treat this
at all, but rather to let the ear drain and heal itself. This
sounds like a very alarming situation when the ear drum “ruptures”
but it is actually a very common problem in young children.
The eardrum will heal by itself and the bodies own defense
system will clear the infection. If this becomes a frequent
occurrence you may have to consult an ENT specialist that
may recommend a small tube be inserted into the ear drum to
allow fluid to drain from the ear constantly. These tubes
or “grommets” are removed when the child is older,
as the adult ear does not have the same drainage problems
as children’s ears do. DO NOT put ear drops into your
babies ear if a ruptured ear drum is suspected. Some ear drops
can damage the very delicate nerves of the middle ear. I suggest
that you clear away the debris from the outer ear canal with
a moistened cotton bud, remember not to poke too deep. If
there is no resolution in the next week or so, or if the baby
becomes ill, feverish and distressed, consult with a specialist
ENT Doctor.
Until next edition, have a Happy, Safe and Healthy NEW YEAR
2003!!
Kim Patra is a qualified Registered Nurse / Midwife, and
mother of three, who has been living and working in Bali for
past 15 years. She has assisted many traveller (... and others)
either as a flying medical escort or just a voice on the end
of the phone! Kim is happy to discuss any health concerns
that your may have. Here-mail contact is info@chcbali.com
