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Your Little Girl’s First Period

Your Little Girl’s First Period

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Wonder what to tell your child about periods? Here’s some help to get you started.

The earlier you have the ‘period’ talk with your child, the better. She needs to know about the menstrual cycle and all the changes that puberty brings. A one-time tell-all discussion might be too much for her to take in, so plan a series of conversations revolving around this subject. But most importantly, the conversations you have with your daughter about menstruation can lay the groundwork for future talks about dating and sexuality.

Alright, so where do you start?

What’s a period?

A period is the part of the menstrual cycle when a woman bleeds from her vagina for a few days.

What does it mean to get the first period?

Puberty is when a girl’s body changes from looking like a child to looking more like an adult, producing adult-level hormones. Every month, starting around the first period, estrogen and progesterone hormones prepare her body for a possible pregnancy. As a result, it causes the lining of her uterus to build up to provide comfortable housing for a fertilised egg to begin development. 

Approximately after a month, if the egg hasn’t been fertilised, the buildup of tissue in the uterus will break down and bleed. This blood is what is seen during a period. The cycle repeats every month and is called a menstrual cycle. 

It’s normal for a cycle not to be regular after the first period. Periods may be hard to predict. It usually occurs every 3 weeks (28 days). However, irregular periods are common for the first 1 or 2 years after the first period.

When do most girls get their first period?

Puberty often begins when the child is around 11 years old, although anywhere between 8 and 14 years is considered the “normal” age. It’s generally one of the most memorable events in a young girl’s life. On average, a first period occurs when a girl is about 12 years old.

How can you keep her informed about knowing when her first period is coming?

signs of the first period

How to prepare for her first period?

It’s always good to be prepared, especially as the first period is unpredictable. Here are a few steps to make sure she’s ready when her first period occurs.

  • Being able to talk with a trusted adult and ask any question she has
  • Always carry sanitary pads, tampons, or any other menstrual products 
  • Keep an extra pair of pants
  • Look for places in her school where she can get sanitary products in case of an emergency.
  • Explain some of the pros and cons of types of menstrual products
  • Emphasising that periods are natural
  • Use clear, concrete words for body parts and body functions

How can you keep her informed about knowing when her first period is coming?

Key takeaways

Most girls will get their first period sometime between the ages of 10 and 15. However, a first period can occur as young as 8, so it’s always better to be prepared. The age of the first period can be impacted by genetics, diet, environment, weight, and other factors.

You can help your child prepare for her first period by having an open and direct conversation about periods and what she needs to expect. It would also be a good idea if she could have a few extra menstrual products in her bag for emergency purposes. It’s important to be ready and educated about the first period as it is a great way for your child to approach this growing-up milestone.

If you have any concerns regarding menstruation, you can speak to a VOG doctor via  the oDoc app from the comfort and privacy of your home. GPs and Family Physicians are also available to consult.

Download oDoc today on the App Store or Play store.

References

  1. Tween and teen health, Mayoclinic (2020)
  2. All about periods, KidsHealth (2018)
  3. When will I get my periods, KidsHealth (2018)
  4. At What Age Do Most Girls Get Their First Period?, Healthline (2021) 
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Birth Plans – what you need to know

Birth Plans – what you need to know

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Yes, Birth Plans are a thing and it is also very useful to have one. 

If you are approaching your third trimester the chances are you have already given a lot of thought to childbirth and all the options available to you. It is vital you write your preferences down and share what your preference for labour and delivery is with a loved one. This should be done well in advance because whilst you are going through labour it will be quite a task to make decisions in the middle of, you know, all the pain and hormones and stuff. Having a birth plan in advance will help you focus on the most important thing on the day – bringing your new baby into the world. We have broken down everything you need to know while creating your birth plan. 

Before we proceed, let’s go through the basics quickly. 

What is a Birth Plan?

A Birth plan is a written, typed or even drawn document which states your preferences during labour, delivery and after childbirth. It’s similar to a wish list, for example, where you can list out who you want with you in the room while you are in labour, or if you want pain meds, dimmed lights in the room, background music and other preferences. You can add anything you wish to make your delivery day as comfortable as possible. 

However, it is important to keep in mind that unexpected things can happen during labour so it might be quite difficult to follow your birth plan to the T. 

So how do you create a birth plan?

First, start with the basics. Include your

  • Name 
  • Age 
  • Brief medical history like chronic medical conditions, medicine allergies etc.

Here are a few other things you should consider when adding to your birth plan: 

Location

Where do you want to give birth? At home or at the hospital?

State your location so everyone is aware of where they need to take you when the labour pain starts.

Atmosphere

Who do you want around you when you are giving birth? Do you want a spacious room so you can walk around? Do you want a TV to help you calm down? Would you like music to be playing in the background – if so what playlist?

Listing these preferences out will help your loved ones set the atmosphere to your liking. 

Birthing positions 

Would you like to give birth on a birthing bed or stool or ball? 

There are many positions you could try if you opt for a birthing bed. Some are listed below. 

  • Lying down: On your back, with your head flat or elevated, and your legs elevated
  • Side-lying: With one leg elevated (this is good if you’re tired or if your blood pressure levels are fluctuating)
  • Kneeling: On the lower part of the bed with your arms or upper body resting on the upper section (this posture helps ease the backache)
  • All fours: With your stomach facing down, supported by your hands and knees (helps ease backache)
  • Squatting: On your feet, with support from bed or partner (this position takes advantage of gravity and shortens the depth of the birth canal)

It is good to know the different options so you can experiment with these during childbirth easily. Please note that in Sri Lanka these positions are not practiced regularly but do talk to a VOG if you’d like to explore these positions.

Pain management 

An important component of childbirth is pain management. It is common to be confused about whether or not you should take an epidural. Please note that whatever you choose in the birth plan, you can always change your mind on the day. It is advised you discuss the pain management options available to you with your VOG doctor well before your due date. A few examples of questions you can ask are listed below: 

  • What are my choices?
  • What is the risks of taking an epidural?

 

Delivery

Expecting mums, it’s never too early to discuss this with your VOG doctors. Have a think about if you’d like a normal vaginal birth or a C-Section. Other important things to consider are: 

  • Would you like your partner to cut the umbilical cord? 
  • Would you like to opt for an episiotomy (an incision through the area between your vaginal opening and your anus to make your vaginal opening larger for childbirth) or only do it if medically required? 

Feeding after the baby is born

How do you want to feed your newborn – breastfeed or bottle-feed? It is important to let your doctors and caregivers know this beforehand. 

The above list might seem obvious, but under the pressure of labour, the raging hormones and pain, it will be difficult to communicate your choices. So we encourage you to build your birth plan well in advance and share it with your partner and most importantly your VOG doctor so they know what your preferences are when it comes to labour and delivery.   

If you would like to discuss your birth plan or would like some guidance on how to build it, you can speak to a VOG doctor via oDoc from the comfort and safety of your home.

Source

  • Dailey, K. (2012, June 8). How to Create a Birth Plan. WebMD. Retrieved November 19, 2021, from https://www.webmd.com/baby/guide/how-to-create-a-birth-plan#1

  • NHS website. (2021, November 18). How to make a birth plan. NHS UK. Retrieved November 19, 2021, from https://www.nhs.uk/pregnancy/labour-and-birth/preparing-for-the-birth/how-to-make-a-birth-plan/

  • Dorfner, M. (2018, November 7). The Importance of a Birth Plan. Mayo Clinic. Retrieved November 19, 2021, from https://newsnetwork.mayoclinic.org/discussion/the-importance-of-a-birth-plan/

  • Slide show: Labor positions. (2021, February 23). Mayo Clinic. Retrieved November 19, 2021, from https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/multimedia/labor/sls-20077009?s=9

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Sexually Transmitted Infections And Diseases: What You Need To Know

Sexually Transmitted Infections and Diseases

Sexually Transmitted Infections And Diseases: What You Need To Know

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What are STIs and STDs?

Sexually Transmitted Infections (STI) and Sexually Transmitted Diseases (STD) are usually acquired by sexual contact. The bacteria, viruses or parasites that cause sexually transmitted diseases may pass from person to person in blood, semen, or vaginal and other bodily fluids. However, these infections can be transmitted nonsexually as well. For instance, from mothers to their babies during pregnancy, childbirth, breastfeeding, blood transfusions or shared needles.

What is the difference between STIs and STDs?

It is the fundamental difference between an infection and disease. Most diseases start with infections. Infection occurs when the bacteria or virus first enters the body and multiplies, progressing it into a disease. Likewise, sexually transmitted diseases initially begin as sexually transmitted infections. 

There are more than 20 known types of STDs/STIs. In Sri Lanka, annual estimates of detected STI cases vary from approximately 60,000 to 200,000, of which government clinics report only 10-15%. About half of these are detected in people aged 15-24. Luckily, most STDs can be treated and cured.

What are the most common STIs/STDs in Sri Lanka?

  • Genital herpes
  • Gonorrhoea
  • Non-gonococcal urethritis (NGU)
  • Syphilis
  • Genital warts
  • Chlamydia infection

What are the most common symptoms of STIs/STDs?

Why is it important to prevent STIs/STDs?

Most STDs can be cured or treated with medication. However, the consequences of ignoring it can include infertility, cervical cancer,  pregnancy complications, congenital disabilities, pelvic inflammatory disease and an increased risk of HIV transmission.

How can the transmission of STIs/STDs be prevented?

The only effective way to completely prevent the transmission of STIs/STDs is abstinence. However, for sexually active persons, consistent and correct use of condoms is highly effective in preventing such infections or diseases.

Questions to ask your doctor?

There has almost always been a stigma around any STD, and it usually trickles down to anyone diagnosed with it. People also feel ashamed that they are somehow damaged. It is important to remember that only a few STDs could be life-threatening. However, with proper treatment, most of it has minimal health impacts. You can have a good life despite having an STD. The majority of it is treatable, and some are even curable. Those STDs for which there is not yet a cure, such as HIV, can still be manageable if adequately taken care of.

Here are a few questions you could ask your doctor:

  1. Should I be checked for STIs?

  2. Can I get an STI by open-mouth kissing?

  3. What if I am pregnant?

  4. Can STIs/STDs cause other health problems in women/men?

  5. How can I prevent having STIs/STDs?

Suppose you are experiencing any of the symptoms mentioned above or need any information on STIs and how to protect yourself or get tested. In that case, you can consult a Sexual Health specialist or an on-demand GP via the oDoc app.

Reference:

  1. What you need to know about sexually transmitted infections, MedicalNewsToday (2021)

  2. Sexually transmitted infections (STIs), World Health Organisation (2019)

  3. What is a sexually transmitted infection?, FPA Sri Lanka (2017)

  4. Types of Sexually Transmitted Infections, Healthy children.org (2015)

  5. How to Reduce Shame and Stigma When You Have an STD, Everydayhealth.com (2019)

  6. How Can You Tell If You Have HIV? HIV.gov (2020)

  7. STD vs STI: Common Types, Symptoms, and Treatment, State Urgent Care (2019)

  8. Sexually transmitted infections (STIs), NHS (2021)

  9. HIV/AIDS in Sri Lanka, The World Bank (2012)

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Am I Just Having “Baby Blues” Or Do I Have Postpartum Depression?

postpartum depression

Am I Just Having “Baby Blues” Or Do I Have Postpartum Depression?

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You’ve just given birth. You’ve created a new life. Your body and mind have gone through a huge transformation over the last nine months. And now you have this whole other tiny human being that you need to care for and nurture. Obviously, you cannot go back to regular scheduled programming and you shouldn’t have to!

Even if you’ve been waiting so long for your baby and it is everything you’ve ever wanted and dreamed about, you are still bound to feel overwhelmed, emotional and maybe even moody. Let us shout it from the rooftops: THIS IS COMPLETELY NORMAL AND VERY COMMON FOR NEW MOTHERS.

Postpartum “baby blues” are extremely common. You’re operating on very little sleep, your hormones are on a rollercoaster, you’re adjusting to the realities of parenting a new baby so it’s no wonder you’re experiencing mood swings!

postpartum depression

But still you might be worrying about whether it is normal to feel this way. You might be wondering if this low feeling will go away in a few days or if you have something more serious, such as postpartum depression.

Symptoms of “baby blues”

  • Anxiety
  • Irritability and grumpiness
  • Exhaustion
  • Feeling joy and happiness one minute and then sadness the next
  • Unsure of your ability to take care of your baby
  • Trouble eating and taking care of your own health

How long are “blues” expected to last?

One important distinction between the “baby blues” and postpartum depression is that the “baby blues” are temporary. You are most likely going to experience “blues” for the first few days after giving birth. Symptoms that last more than two weeks might signal that you could have potentially developed postpartum depression and it is time to have a discussion with your doctor.

Symptoms of postpartum depression

  • Anger and irritability
  • Extremely low energy and wanting to sleep all the time
  • Feeling numb and disconnected from the people around you
  • Feeling you’ve failed as a mother
  • Thoughts of self-harm and thoughts of harming your baby
  • Crying excessively
  • Trouble bonding with your newborn

Postpartum depression does share many of the same moodiness as “baby blues” but symptoms are usually more intense and disturbing.

baby blues

Treatment for “baby blues”

Just because postpartum blues are very common doesn’t mean it’s easy to go through. Here’s what you can do to cope.

  • Assure yourself that what you’re feeling is completely normal and is experienced by all new mothers
  • Sleep as much as you can, which means sleeping when the baby is sleeping, or having your partner or family member look after the baby for an hour while you nap
  • Eat healthily and regularly
  • Exercise can do wonders! Even if its just a walk outside.
  • Talk about what you’re going through with loved ones or other mums
  • Don’t be hard on yourself if you don’t have the energy to do housework or other chores. You just had a baby!

Treatment for postpartum depression

If your baby “baby blues” don’t ease up after 2 weeks or if you’re experiencing symptoms of postpartum depression, don’t wait till your next check up with your doctor. Get in touch right away.

You may feel ashamed or embarrassed that you’re feeling this way, especially after this magical thing has happened in your life but you’re not alone with these feelings. 1 in 5 women experience postpartum depression after childbirth. Your doctor may recommend medication and/or therapy. You can also make healthy choices in your lifestyle such as:

  • Talk to people you trust about what you’re going through
  • Cut back on other errands. Use your energy to take care of basic needs for you and your baby
  • Build community by speaking to other mothers, joining a depression support group or just reach out to trusted friends and family. Fight isolation.
  • Rest whenever you can. Reach out to close friends and family to take the baby shift so you can sleep for a few hours. This does not mean defeat.

Causes of postpartum depression

The exact cause isn’t clear but experts say that postpartum depression may be triggered by both physical and emotional factors.

  • Hormonal changes – While you’re pregnant, your levels of estrogen and progesterone are higher than usual. After you give birth, these hormone levels drop significantly. Such a drastic change in hormones can contribute to postpartum depression.
  • Sleep deprivation
  • Not eating meals at regular hours or eating an unhealthy diet
  • Social isolation
  • Underlying medical conditions
  • Alcohol and drug abuse

Risk factors of postpartum depression

Any new mother can experience postpartum depression after childbirth, even if its not their first baby. However, your risk increases if:

  • You have a history of depression
  • You’ve had postpartum depression after a previous pregnancy
  • You’ve had family members who’ve had depression or other mood disorders
  • You’ve experienced stressful events recently
  • You have difficulty breastfeeding
  • You have a weak support system
  • The pregnancy was unplanned or unwanted

Speak to a doctor on oDoc if you think you might be having the above symptoms. This is a judgement-free zone where your doctors will NOT shame you and will only help you to feel better. Click here to download the app. 

References:

  • Is It Postpartum Depression or ‘Baby Blues’?, 2021, WebMD
  • Do I have Postpartum Blues or Postpartum Depression, 2020, VeryWell Family
  • Everything You Need To Know About Postpartum Depression, 2016, Healthline
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We Need To Stop Saying Breastfeeding Is “Easy”

breastfeeding is hard

We Need To Stop Saying Breastfeeding Is “Easy”

And focus on supporting mothers instead

Nicole Parakrama | BSc Hons Molecular Cell Biology, UCL (UK) | 14th August 2021 |
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Just recently, we all tuned in to watch the Olympic Games held in Tokyo. We admired the beautiful performances of the athletes, and we acknowledged and celebrated all the sacrifices, hard work and preparation that led up to that day.
breastfeeding

What if we viewed breastfeeding the same way?

What if instead of glorifying only the ‘highlights reel’ of breastfeeding, we all agree that breastfeeding needs education, preparation and hard work to get through the first few weeks. What if we supported and empowered mothers on this journey filled with sacrifices and challenges and collectively took responsibility for it? What if we celebrated them loudly and genuinely when they achieved their goals?

The recently concluded ‘World Breastfeeding Week’ was triggering for a lot of mothers. For many women, any mention of breastfeeding brings back feelings of pain, anxiety and a lack of support. It serves as a reminder of the guilt and shame that they felt for stopping breastfeeding, the feeling that their bodies weren’t doing what they were meant to do.

Changing the Messaging

A Sri Lankan mum recently told me:

“Breastfeeding is hard… everyone tells you how painful labour is and how difficult pregnancy is, but no one tells you how hard breastfeeding is! All you see are images of moms with babies on their breasts and they make it look like it’s the easiest thing!”

Amy Brown, Professor of Child Public Health, Swansea University says: “When we gloss over the realities of breastfeeding, women feel unprepared for what it’s really like. If we tell women to expect easy, and they hit a hurdle, they may think they’re doing something wrong. . Women then end up depressed, blaming themselves, thinking they didn’t try hard enough because after all, isn’t breastfeeding easy?”

Without swinging towards ONLY the positive or the negative, perhaps the good, the bad and the ugly all need to be portrayed together. We need to find a balance.

So what are the benefits of breastfeeding?

  • We sometimes refer to breastmilk as “liquid gold”! Mums often joke that breastmilk is the cure for nearly everything:baby acne, sore eyes, heat rash,eczema and healing our cracked and sore nipples.
  • The composition of breastmilk is biochemically and nutritionally complete, giving numerous long term and immunological advantages.. It protects from infections, diarrhoea, UTIs, and chronic diseases like diabetes, childhood cancers, obesity, inflammatory bowel disease, asthma and allergies. In preterm babies, it reduces the risk of sepsis and necrotising enterocolitis (NEC).
  • For mothers, it has been proven to reduce the risk of hypercholesterolaemia, diabetes, hypertension, cardiovascular disease, as well as reduce the incidence of breast and ovarian cancer and osteoporosis. It stabilises endometriosis and confers partial contraception.
  • The process of breastfeeding stimulates the release of oxytocin, the bonding chemical. Babies don’t only breastfeed to eat, but also to help themselves settle: it provides them comfort and helps them regulate their emotions.
  • From a practical standpoint, breastfeeding is free and convenient! No stumbling around in the dark to boil water and prepare a bottle! Your baby has access to fresh milk straight from the source.

OK, I’m convinced of the benefits. Now hit me with the challenges of breastfeeding!

Here in Sri Lanka, we are seeing a rise of an ‘Instagram mum brigade’ who raise awareness on issues surrounding motherhood whilst sharing experiences and building community. They are finding their voices and being the support that they wished they had as new mums.

One of these Instagram mothers, Ameena (IG handle @raisingimaan) – expresses the challenges of breastfeeding so beautifully in a recent post. She said:

“Breastfeeding isn’t simply putting a breast into a baby’s mouth and transferring milk. It is SO MUCH more than that. And women pay for it with a unique currency of time, commitment, energy, mental and physical health, as well as bodily autonomy. That’s a massive price to pay. And to tell women that it’s all on themselves alone to manage. Frankly, it’s quite a raw deal”.

sore nipples
  • The first few weeks of breastfeeding, in particular, require a considerable investment of time. It IS time consuming, and new mothers can feel that all they do in the early days is feed!
  • In addition, the breastfeeding technique can take a bit of practice to get right. Mums need to experiment with different holds and find solutions for attachment and positioning issues.
  • There are potential physiological challenges, such as sore/cracked nipples, breast engorgement, blocked ducts, and mastitis/abscess which mums may have to navigate.
  • Feeling like there is not enough milk can be a significant challenge for many mothers in their breastfeeding journeys. However, as I have written about in a previous article, this is mostly a perception issue. In as many as 95% of cases, it is easily surmountable with the proper support.

How important is it to have a supportive community?

I cannot stress enough the huge role a supportive community plays in successful outcomes for breastfeeding. In “the fourth trimester”, women adjust to being mothers just as much as their babies adapt to life outside the womb. This postnatal period seems to be universally defined as 40 days.

Kimberly Ann Johnson, author of the book “The Fourth Trimester” says:
“Everything that a new baby needs, a new mom needs. So you know a new baby needs swaddling, you know a new baby needs a constant food source, you know a new baby needs eye contact, you know a new baby needs soothing. That’s everything a new mom needs.”

But the best way of caring for a breastfed baby is to care for their mother. Feed her, love her, support her by taking care of other stuff. Do housework, run errands, look after older children. The same goes for supporting women who are bottle feeding.

How can we as a society make breastfeeding easier for mothers?

As a society we can further encourage breastfeeding mothers when it comes to feeding in public. Public bathrooms are not acceptable places to feed infants! Establishments can train their staff on how to respond compassionately to a mother whose infant needs to feed, and to take a step further to provide a private space in which to do this, if required. Far too often this is left to the discretion of the staff, and so mothers have mixed experiences. Just one negative experience can be a huge setback to a mother’s breastfeeding journey, making her feel that she has to stop breastfeeding in order to leave the house and ‘have a life’.

Alongside all of this, the government MUST step up and make things easier for new families. In 2018, a significant amendment to the Shop and Office Act was passed in Sri Lanka which mandated the “provision of nursing intervals for nursing mothers” (previously only mandated in the state sector, although sometimes practiced informally in the private sector). This means that working mothers are now entitled to 2 paid feeding breaks of 1 hour per working day until their child is 1 year old.

This is a significant step forward – however longer, better paid leave for both mothers and fathers, as per the Swedish model, would do wonders for the well-being of the whole family, and in increasing breastfeeding figures.

If you are a new mum and are having trouble breastfeeding, you can speak to a doctor on oDoc. You can video call them from your home, baby in hand, even while breastfeeding! You can download the app here.

HOW I BECAME ‘THE MILK COACH’

When my first child was born, I was quite unprepared for what lay ahead. Particularly when it came to breastfeeding… I was naïvely expectant that I could just place him onto my chest, and let nature take its course. What a surprise I was in for! Cracked nipples from sub-optimal positioning, and my milk taking its own sweet time to come in, led to terrible pain. This pain became excruciating when my son developed oral thrush which travelled into my milk ducts. Fortunately, thanks to a lot of research and some wise mummy friends, I was able to power through the awful first few months. Most crucially, I was able to advocate for myself with health professionals, when the ‘system’ didn’t really support me.

This birthed a passion to counsel, support and advocate for my fellow Sri Lankan mums. To this end I am working to add to a science background (in Molecular Cell Biology) with an accreditation by La Leche League International (LLLI). My heart is to help YOU to achieve your breastfeeding goals – whether that is one week, one month, six months, or even a year and beyond.

Join the conversation, follow @themilkcoach on Instagram or Facebook.

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