Q. The last time I was pregnant I developed very dark mask like markings on my face. Will this happen next time I am pregnant and what is the cause?
A. Unfortunately the answer is yes. If you have developed this skin condition during pregnancy the first time it will probably occur again with your next pregnancy. Pigmentation changes are directly related to melanocyte-stimulating hormone (MSH) elevations during pregnancy. Some evidence suggests that elevated estrogen and progesterone cause hyper-pigmentation in some women. The mask like facial darkening that you describe is known as chloasma, but skin discoloration may also occur on the nipples, umbilicus, and the line of skin that runs centrally down the belly, (this is known as the linea nigra).
Q. I am paranoid about giving birth prematurely after my best friend went through this experience with a baby that did not survive at 7 months. At what stage of pregnancy are babies considered viable?
A. This is a complex topic. No definite age or stage exists, and even experts disagree; the survival rate of infants born after 23-25 weeks’ gestation increases with each additional week of pregnancy. The survival rate of infants born before 23 weeks’ gestation is very low. (Note: in Indonesia the survival of infants born at 32 weeks or less is very low due to the lack of neonatal intensive care facilities). It is interesting to note that premature baby girls have a better chance of surviving than premature boys. If a woman is suspected of being in premature labor then the infant’s chance of survival will increase if the physician administers cortisone injections before the delivery in order to mature the lungs. Babies born during these early weeks may require prolonged and intensive medical care, including care with a variety of life-support measures.
Q. I have always been prone to lower back pain, and now that I am pregnant the pain seems to be constant. Why is back pain prevalent during pregnancy?
A. Half of women report having back pain at some point during pregnancy. The pain can be lumbar or sacroiliac. The pain also may be present only at night. Back pain is thought to be due to multiple factors, which include shifting of the center of gravity caused by the enlarging uterus, increased joint laxity due to an increase in relaxin, stretching of the ligaments (which are pain-sensitive structures), and pregnancy-related circulatory changes. Treatment is heat or ice (whichever works for you), pain relieving medication (acetaminophen or paracetamol), massage, proper posturing, good support shoes, and a good exercise program for strength and conditioning. Pregnant women also may relieve back pain by placing one foot on a stool when standing for long periods of time and placing a pillow between the legs when lying on their side, or under the knees when lying on their back.
Q. Now that it is compulsory to wear seatbelts in Indonesia, I am concerned as I have heard that it is not safe to do so during pregnancy. Should women wear seatbelts during pregnancy and if not how do I convince the local police that I should wear a belt?
A. Seatbelts should absolutely be worn during pregnancy. Trauma to the mother is more devastating to the child than any potential entrapment of the pregnant abdomen in the seatbelt. The seatbelt should be placed low, across the hip bones, and under the pregnant abdomen. The shoulder strap should be placed to the side of the abdomen, between the breasts, and over the mid-portion of the clavicle.
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And the not so serious!!
Q: Should I have a baby after 35?
A: No, 35 children is enough.
Q: I’m two months pregnant now. When will my baby move?
A: With any luck, right after he finishes college.
Q: What is the most reliable method to determine a baby’s sex?
A: Childbirth.
Q: My wife is five months pregnant and so moody that sometimes she’s borderline irrational.
A: So what’s your question?
Q: My childbirth instructor says it’s not pain I’ll feel during labor, but pressure. Is she right?
A: Yes, in the same way that a tornado might be called an air current.
Q: When is the best time to get an epidural?
A: Right after you find out you’re pregnant.
Q: Is there any reason I have to be in the delivery room while my wife is in labor?
A: Not unless the word “alimony” means anything to you.
Q: Is there anything I should avoid while recovering from childbirth?
A: Yes, pregnancy.
Q: Do I have to have a baby shower?
A: Not if you change the baby’s diaper very quickly.
Q: Our baby was born last week. When will my wife begin to feel and act normal again?
A: When the kids are in college.
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Kim Patra is a qualified Registered Nurse and Midwife that has been living and working in Bali for almost twenty years. She now runs her own private practice and medical referral service from her Kuta office. Kim is happy to discuss any health concerns with you and she may be contacted via e-mail at info@chcbali.com”.
