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+Content
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A teacher, a mother and a wife
+Health 6 The effects of antibiotics during pregnancy 10 Things you should know about Zika virus and pregnancy 16 Maintaining A Healthy Pregnancy 20 Nutritional needs during your first trimester
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+Event 25 Our Children Today, The Wings of Our Future
+Life Inspired 28 A teacher, a mother and a wife. 34 Nurture Yourself... First 38 Baby Bump — It’s a new feeling
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Maintaining A Healthy Pregnancy
Content+
34
Nurture Yourself... First
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38 The effects of antibiotics during pregnancy
44 The Lady With The Hummingbird Heart
+Lifestyle 46 Tips on Developing Your Birth Plan
Baby Bump w e It’s a n g feelin
PLUS 3
Jul–Aug 2016
+Publisher Info
I
Dear readers,
n keeping with our theme of motherhood and a large focus on pregnancy, we’ll keep this message short and sweet because even though nine months may seem like a lifetime for some to be pregnant, when you think about it, nine months is actually not a very long time at all in the grand scheme of things. Pregnancy is usually an exciting time for everyone involved but it is also a time that brings about many questions and concerns. We hope to alleviate some of those concerns with some very interesting and informative articles that address the nutritional needs of pregnant women, the safety, indication and contraindications of antibiotics during pregnancy and also one that provides a guide to writing out your birth plan. We also discuss the steps you can take right from the moment you find out you are pregnant to ensure the best for yourself and your baby and provide essential information about the Zika virus. Plus+ also had the pleasure of sitting down with three amazing
women, all glowing during their pregnancy term. First, we have Lorene Anne Fong, a teacher in her second pregnancy. She shares the differences between her first and second pregnancy and also the symptoms she experienced through all three trimesters. Then we have a first-time mum-to-be, Aqeelah Afefe who describes her happy surprise of falling pregnant and the preparations and cravings she has gone through so far. Last but not least, we spoke with Dr Nourul Hayati Azrina Haji Jaman, who is in her 4th pregnancy and reminds us how important it is to take care of yourself first before others during pregnancy, especially in a profession as demanding of her time and care as hers. Don’t forget you can follow us for the latest updates @PlusBrunei on Facebook and Instagram, where we post behind the scenes pics and sneak peeks of upcoming features. Many thanks and happy reading, The Plus Team
+Publisher Nexploit Services
Oleh Melnyk John M. Rey
+Editor-At-Large Plus Team
+Photographer Aron Tan’s Studio Magic Media
+Talent Editor Elizabeth Sim Syazwana Souyono +Proof Reader Monica Lim +Marketing and Digital Content Nursadiqin Misir +Graphic Designer Anna Thien
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+Featuring Lorene Anne Fong Dr Nourul Hayati Azrina Haji Jaman Aqeelah Afefe Dk Hjh Mas Joliwane Pg Hj Tejudin +Contributors Syazwana Souyono Shelley Ann Busque Joana Tan
All rights reserved. Neither this publication nor any part of it may be reproduced, stored in a retrieval system, or transmitted in any form of by any means electronic, mechanical, photocopying, recording or otherwise, without the permission of Nexploit Services. Where option is expressed it is that of the author and does not necessarily reflect the editorial views of the publisher or Plus. All information in Plus is checked and verified to the best of the publisher’s ability, however the publisher cannot be held responsible for any mistake or omission enclosed in the publication.
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+Health
The effects of antibiotics during pregnancy
O
ne of the biggest dilemmas a pregnant woman and her gynecologist may face during pregnancy is deciding whether or not antibiotics should be prescribed to treat an infection. This is a decision that should made by both parties based on the individual case of the pregnant woman and various factors like the infection to be treated, the pros and cons of treatment versus no treatment, how much of the antibiotic is to be prescribed and the stage of pregnancy. This dilemma is induced by the fact that many babies are born with birth defects every year, and most of the time, it’s because of environmental toxins or the mother’s negligence during the gestation period. This period is between the moment of conception to birth,where any chemicals ingested by the mother
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such as drugs and alcohol can slowly enter the placenta and cause a negative effect on the baby. Generally, the earlier in the pregnancy the antibiotic is taken, the higher the risks posed to the fetus. When making a decision, it is best to weigh the potential benefits of the antibiotics against the risks the fetus faces. It also depends on the prescribed antibiotics as some antibiotics known to be teratogenic like streptomycin, tetracycline and kanamycin should be entirely avoided in pregnancy.
safe to take some antibiotics like clindamycin, cephalosporins and erythromycin as long as the pregnant women also take their daily dose of multivitamins. Penicillin is considered safe for use in pregnancy and it is also widely used for treating various infections in pregnant women. Amoxicillin is chemically and pharmacologically similar to ampicillin but is quickly and completely absorbed from the gastrointestinal tract.
SAFE ANTIBIOTICS DURING PREGNANCY
EFFECTS OF ANTIBIOTICS DURING PREGNANCY
Antibiotics are considered safe to take during pregnancy only when the risks of not treating the infection are higher than taking antibiotics. It’s
Accutane is a harmful antibiotic used for treating acne and it may cause severe birth defects in pregnancy. Nitrofurantoin is another antibiotic
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prescribed to treat urinary tract infections, but can cause jaundice in the newborn child. While tetracycline is an antibiotic that can lead to stained and discolored teeth and bone abnormalities in the child; gentamycin, neomycin, streptomycin and kanamycin can cause deafness and other fetal deformations. Tetracyclines like doxycycline and minocycline can also damage a pregnant woman’s liver. Tetracyclines are also not recommended during pregnancy, especially in the last half of pregnancy as they are excreted into human milk in small amounts.
NOT ALL MOTHERS ARE ALIKE However, just because one mother experiences some fetal effects after taking some antibiotics, it doesn’t mean that the same thing will happen to all pregnant women. In case an infection in the pregnant woman cannot be treated using a safe antibiotic, there’s no other option but to use an antibiotic which will effectively treat the infection. If there’s no other option apart from taking antibiotics that are quite
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risky to the fetus, your obstetrician will first discuss the situation with you as sometimes, untreated infections can do more harm to the fetus and mother than the antibiotics. Pregnant women should however never consider self-medicating themselves. They should also never take medications which are not prescribed by their obstetricians for illnesses they experience during pregnancy. Moreover, just because a woman has safely taken an antibiotic to treat a similar infection before, it doesn’t mean that the antibiotic can be safely used during pregnancy.
SUGGESTIONS TO SAFELY TREAT PREGNANT WOMEN So as the debate about the safety and efficacy of taking antibiotics in pregnancy is never ending, the following suggestions are best implemented while medicating a pregnant woman. » »Medications should be taken only if absolutely necessary. So in case of antibiotics, it means it should and can be prescribed for treating confirmed infections like urinary
tract infections, appendicitis and pyelonephritis. » »Try to avoid starting any treatment during the first trimester, as this is the period when fetal structural development takes place and the risk of having iatrogenic teratogenicity is the highest. » »Single-agent therapy is always better than multi-agent therapy and narrow-spectrum antibiotics are better than broad spectrum antibiotics for treating established infections and intrapartum GBS chemoprophylaxis. » »Always prescribe and use the lowest effective dose of safe medications. In some cases, older drugs with a proven track record in pregnancy can be a better option than the many other new drugs in the market. » »Always avoid and discourage taking over-the-counter drugs as they may interfere with the efficiency of prescription medications. So if the antibiotic is necessary, and is the best way to treat your condition, your gynecologist will decide on the safest antibiotic to be prescribed to you at the safest dosage.
+Health
THINGS YOU SHOULD KNOW ABOUT ZIKA VIRUS AND PREGNANCY
I
t was on January 15th 2016 that the Center for Disease Control and Prevention(CDC) issued a travel alert to Caribbean and Latin America, with a special note for pregnant women. This alert was the consequence of a cluster of cases of microcephaly in Brazil and Columbia being linked to the Zika virus. While Zika virus has been around for decades, it was believed to cause only mild flu-like symptoms. Mosquitos spread the virus and it is spread as far as Mexico and Hawaii. Since then, researchers across the world have started studying the link between Zika virus and microcephaly. CDC scientists have thus announced that there is sufficient evidence to conclude that Zika virus can cause microcephaly and other severe fetal brain defects and problems in infants like eye defects, impaired growth and hearing loss.
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ZIKA IS NOT A SERIOUS INFECTION Zika is basically not a serious infection as ¾ people with Zika are asymptomatic. Out of the ¼ who experiencedsymptoms, the symptoms were not severe enough to warrant a hospital visit. However, current reports state that Zika is highly associated with microcephaly in infants in Brazil, especially if the mother contracts it during pregnancy. It is this severe impact of the virus which has triggered panic.
HOW THE DISEASE SPREADS It is the Aedes aegypti species of mosquito which transmits this virus and yellow fever, which is a virus from the same family as Zika virus, and is widely distributed even in United States. While Zika was first identified in humans and monkeys in
Africa, specifically in the Zika forest, it spread to African and Asian countries and eventually Latin America through mosquitos. A mosquito can bite any person infected by Zika and bite and infect another person to spread the disease. While there are no reports of Zika being transmitted by human saliva, it can be transmitted from mother to child by crossing the placenta (transplacental transmission). While it’s not proven if a person who has been bitten by an infected mosquito will get infected, some people who have been bitten by infected mosquitoes get infected asymptomatically or symptomatically with the virus.
ZIKA VIRUS AND PREGNANCY Brazil has reported more than 3000 cases of microcephaly, which
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have been linked to the virus in the transmission area. This is why pregnant women and women intending to become pregnant should avoid travelling to Latin American countries to prevent the risk of their babies developing microcephaly.
the birth defect cannot be identified until the second trimester, couples have to make a difficult decision about the pregnancy as raising a baby with microcephaly can cost up to $2 million in the first few years of life, should the child live that long.
However, based on existing evidence, women who are not pregnant but get infected by the Zika virus do not pose a risk for birth defects in future pregnancies once the virus is cleared from her blood. In fact, like similar infections, people who got infected with the virus are more likely to be protected from its future infections.
Scientists at National Institute of Health are however now tweaking a vaccine which was first developed for the West Nile Virus, and which is expected to be launched for a safety trial in September. The need now is the formulation of a vaccine and not a drug, since the infection lasts for a few days and is better prevented than cured.
TREATMENT OR PREVENTION
The emphasis now is on taking measures to prevent pregnant women from travelling to places with reportedZika transmission. If a pregnant does have to travel to or lives in an area with Zika transmission, she has to consult her doctor.
There’s nothing much pregnant women who think they were exposed to Zika can do, except for taking rest and drinking fluids to avoid dehydration. There are no approved drugs or vaccines for Zika as scientists have always considered it to be benign. They should get frequent ultrasounds to detect microcephaly before the baby is born. However, as
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Pregnant women should avoid mosquito bites by wearing longsleeved shirts, long pants, a hat and use a bed net at night. They should also remove any standing water around their homes and clean all vessels. The eggs can remain
dormant and survive for months even after the water source dries out.
DIAGNOSTIC TESTS FOR ZIKA VIRUS There are no commercial diagnostic tests for Zika. Its testing is only done by state and federal health authorities. As there are so many blood samples waiting to be tested, only pregnant women and travelers to Zika-infected areas are given priority. It’s still not known why only some pregnant women with Zika give birth to babies with microcephaly and others do not and at what point in pregnancy the risk for infection is greatest.It’s also not known how the virus halts brain development and what other brain problems it may cause. This is why some countries like Puerto Rico and El Salvador are recommending that women delay pregnancy. However, this is not feasible in all cases as some couples are growing older and don’t have the time to delay. It’s up to the couple to discuss the matter with their doctor in order to come up with the best solution.
+Health
Y
Maintaining A Healthy Pregnancy
our pregnancy should be an exciting and wonderful experience. To make sure that you are healthy both physically and emotionally during this time there are several things that you will want to do. You will want to start implementing all the right steps right from the moment you discover that you are pregnant.
CHOOSE YOUR HEALTHCARE PROVIDER The first thing you will want to do is choose the professional who is going to assist you with your pregnancy needs. If this is your first pregnancy,
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then you may not be aware that you have several choices for a prenatal practitioner; which are… »» Obstetrician/Gynaecologist »» Midwife »» Family Physician »» Doula Your healthcare provider will guide you through the process of staying healthy during your pregnancy, and will monitor your health and the health of the baby during this time.
PROPER NUTRITION If you were a healthy eater prior to your pregnancy, then continuing to
do this will be easy and will really support a healthy pregnancy. If this was not a habit for you then you may have to make some major changes in your eating habits. It is important that you eat three balanced meals a day, and rely on good choices for snacks in between meals. Your choices should be a good selection of fruits and vegetables and whole grains. Also add low fat dairy products to your menu. Staying hydrated during pregnancy is good for both you and the baby, so be sure to drink plenty of water. A good diet will ensure you and the baby are getting the proper nutrition and it will also help to keep your bowel movements regular.
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There are some food items that you may want to avoid during your pregnancy. Don’t eat meats that have been undercooked. Stay away from unpasteurized cheeses, and avoid raw fish and deli meats. Fish is a good option to add to your diet, but make your choices carefully. It is recommended that 12 ounces of fish per week can be added to the diet, but choose those that are known to have low methylmercury levels. You will also want to be cautious about how much soda, tea and coffee you consume during your pregnancy. This is something you will want to discuss with your healthcare provider. Don’t fall for the myth that you have to eat double the amount because you are eating for two. You will want to maintain a steady weight increase during your pregnancy. The proper amount of weight gain you should experience during your pregnancy is partially dependent on what your weight was prior to becoming pregnant. For example, women who were underweight pre-pregnancy will be expected to
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gain more weight than women who were overweight prior to pregnancy.
MEDICATION Your healthcare provider will monitor any medication that you may be on for any reason. You may also be advised to start taking folic acid for the health of the baby. In addition to this, you may be prescribed prenatal vitamins. Any medications or supplements you are taking during your pregnancy should be monitored by your healthcare professional.
EXERCISE This is another very important part of your pregnancy regime. If you were actively exercising prior to your pregnancy, then your healthcare provider will probably advise that you continue to do so. You may, however, be told to refrain from participating in high impact sports during this time. Normally activities such as walking, swimming and yoga are allowed and recommended. The right amount of proper exercise during your pregnancy will help
to keep your weight under control, help you to get good sleep, and will assist during your delivery.
YOUR MENTAL HEALTH During your pregnancy, your body is going through some hormonal changes. You may find that you have mood swings or are more sensitive during this time. Make sure that you take time out for yourself, and that you still maintain your normal socializing habits.
THINGS TO AVOID Refrain from alcohol and smoking as both of these are not good for both you and your unborn baby. Be sure not to get overtired as your rest is important.
CHILDBIRTH CLASSES In addition to following these few tips, you may also want to join some childbirth classes that can educate you more about maintaining a healthy pregnancy and preparing you for birth.
+Health
Nutritional needs during your first trimester O
nce you have discovered that you are pregnant, one of the first concerns that may arise for you is, are you eating properly? You really need to focus on your diet right from the start. You will want to begin with the nutritional needs during your first trimester. There are many nutrients that are critically important to both you and the baby during your pregnancy. These may vary throughout the different trimesters of your pregnancy, but mostly in the amounts that you are consuming. The foundation of the first trimester diet is built on the four food groups which are… »» Fruits and vegetables »» Starches »» Protein
FRUITS AND VEGGIES: It is recommended that you consume between five to seven portions per day. Seeing as fruit contains more sugar, it is better to go with more veggies than fruits. Based on your preferences, you can go with fresh, frozen or dried veggies and fruits. Watch for salt and sugar in these.
STARCHES/GRAINS: Here you will want to focus on your root veggies as well as your grains. Your grains are important for providing you with fibre, iron and B vitamins. Ideally you will want to be sure that at least half of your grain consumption consists of whole grains.
»» Dairy
PROTEIN:
Based on these four groups, you now want to make the best choices on the kinds to consume as well as decide on the quantity you will need during this phase of your pregnancy.
This is where your meat intake comes in. There is a wide range of choices that also includes eggs and pulses. Your first trimester nutrition should include at least two portions of fish per week, making sure that they are fish
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that are known to have low mercury absorption. Try to ensure that any of the meats you consume, are lean.
DAIRY For your dairy needs, those that are low fat and low sugar are your best choices. Your selection here includes milk, cheese and yoghurt. Dairy products are important for providing you with the calcium you and the baby needs.
THE IMPORTANCE OF THE NUTRIENTS While every component of a healthy diet is important, there are some specific ones that you should be aware of during your first trimester of pregnancy. The proteins you consume assist with the baby’s growth and are important for fetal brain health. For you, they help to maintain healthy growth of your breast and uterine tissue. They assist in increasing your blood supply, which your baby requires. Aside from the meats that are known for protein, protein can also be found in peanut butter. The calcium intake through your diet helps your body with the proper use of fluids. Calcium is critically important for building strong bones in the baby. While the majority of your calcium will come from dairy
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products, calcium can also be found in cabbage. The iron from your diet works in conjunction with the sodium and potassium in your body to help increase blood flow. Good blood flow is paramount for the oxygen supply that you and your baby require. Choose dark leafy green vegetables as well as dried fruits to help increase your iron intake. Folic acid has become known as being highly important for reducing the risk of defects in the neural tube. Neural tube defects include anencephaly and spina bifida. Folic is found in several of the foods that you will be consuming under the specific food categories. Some examples are liver, nuts and peanut butter.
SUPPLEMENTS Your healthcare provider will monitor your nutritional needs very carefully and may order supplements that provide some of these critically important nutritional components. You may be prescribed a multi-pregnancy vitamin, or just an iron or folic supplement. This will all depend on your specific needs according to the findings of your healthcare provider.
WHAT NOT TO CONSUME While there are plenty of foods that you need to focus on eating, there
are several that you want to exclude from your first trimester diet, and preferably throughout your entire pregnancy. These include… »» Caffeine (reduced amount) »» Alcohol »» Some types of fish »» Foods high in salt and sugar »» Some types of cheese
QUANTITIES Another big question that arises during determining the best diet for the first trimester is how much you should consume of each of the food groups on a daily basis. The specifics of this should be determined by your healthcare provider, but there are general rules that can be followed. For your fruit and veggies, take 5 to 7 portions with the vegetable component being higher in quantity. Your protein consumption should amount to 2 to 3 servings. Your starches and whole grain consumption should consist of more grains with a total of 3 servings per day. The dairy products you consume should amount to 3 servings per day. When it comes to calories for your first trimester of pregnancy, a 300 a day increase in caloric intake is considered average and acceptable.
Event+
OUR CHILDREN TODAY, THE WINGS OF OUR FUTURE ROOTS AND WINGS CHARITY CONCERT 2016
A
ccording to a song popularized in the mid 80’s, “The Children Are Our Future”.
Would you agree that today at the present time, the things we work towards and achieve plus the time in which we invest, together become the future world? What about, the progress of today, would it really depend on our children, the youth generation? Our present world is being dandled and created (even destroyed),
and what remains will be our future world — and how we maleate and shape it.But how? We can start within ourselves. When you start to care for that which is around you, it makes for a good beginning. Is the future you foresee under a cloud of selfishness or sadness or do you imagine a brighter and more colorful world for our children to grow in? Would it not sound more promising if the present children are molded in their values, ideas and ideals, so we can expect a better and more organized world of tomorrow and achieve the design for the world
that we hope for at this moment? It doesn’t require a lot of money to teach a child to say “sorry” when they hurt someone. It wouldn’t require a single dollar even, to teach a kid to say “thank you” as a token of gratitude. In some countries, mainly countries we categorize as “third world countries” (nations with predominant cultures and with widespread poverty,) the children seem to be neglected and it is a depressing fact. Hence, this article could really go on and on about the root cause, may
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+Event
it be social, economical, or political. So why don’t we start with our surroundings, our environment? With the children around us? Having the ability to read is such an advantage to make use of, is not it? Change starts when you act upon the change you want! But what kind of change is determined by the growing generation, really? When we say that today’s children are our future, we mean that we must strive now to mold the children to think correctly, to judge rightly. Children not only learn from books. These higher values that we apply in adult life cannot be imparted to students by institutions, by a society or a community, or even a committee. It shall always be imperative to start with us as adults. How we mold them and shape them into better people. Everybody will accept the idea that our children are our future, true enough. But we have not realized or started thinking about the implication of the idea. So if the future is to be bright, we have to mold our children to think, not in the current world’s pattern, which is disastrous — but in a new pattern with
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a new inspiration, and with a new and brighter vision in their minds. As adults, we say we have too much too handle in our “adult life”; paying bills, dealing with work, and preparing for “our better future”. We all wish for a better tomorrow, but it won’t work unless we start to care. We have to take responsibility for molding the children of today, in preparing
them to face the world of tomorrow and to lead and guide the world of the future. It is undoubtedly a tremendous responsibility but responsibility and taking charge is the only way. Once you realize the responsibility and are able to experience the joys of having the opportunity to guide the children of today more intelligently, the result will definitely priceless. The remedy is us. It is within us.
+Life Inspired
A teacher, a mother and a wife. L
orene Anne Fong talks about her pregnancy and how she deals with that and… everything else! Please tell us about yourself. My name is Lorene Anne Fong, I’m 33 years old and I’m a teacher. This is my second pregnancy and I’m currently in my 32ndweek. I have a daughter who is 3, turning 4 in August. I love to read (hence the bad eyesight!). I read mostly children/teens/ young adult books (staying away from adult fiction and horror as I don’t want my daughter to pick up books with questionable content). I also like to eat, which is why I like being pregnant as I can eat without fear of being called fat. Of course, it’s all food that I’m allowed to while pregnant. I love to teach, had always wanted to be a teacher since the age of six. Being with students makes me feel young! Haha… It also helps to remember that I was once young so it makes it easier for them to relate to me and vice versa. Interesting start. So, how do you feel being pregnant again? I was shocked as it was unplanned. It clashed with my plans to do my Masters in Educational Management, but it did make my next step in life very clear; which was to stop working for a while to focus on my soon-to-be two kids and be a stay-at-home mom. Another member of the family coming soon! Are you excited? I’m definitely excited since this baby is a boy. If it’s not, I will blame my husband who was sure he saw male parts during the ultrasound at 5 months! I had no idea what I was even looking at!
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Is your daughter looking forward to having a baby brother? My daughter initially wanted a girl and even after I told her it was a boy, she kept insisting on calling him “Sofia” (from Sofia the First, one of her favourite cartoons). Now she loves the fact that she has a baby brother on the way and talks to him and tells him she’s his “jiejie” (big sister). She has also been telling me that she will help with cleaning, feeding, playing and the general taking care of the baby…we shall see! Good for her! I’m sure she will keep her word. Are you looking forward to delivery? What preparation have you done so far? I’m actually nervous because my first experience wasn’t actually the best. People tell you that you will forget the pain of childbirth — I haven’t forgotten the first! Or they will tell you the second baby will just pop out very fast (I’m really hoping for that!). Because this next one is a boy, we had to buy a few more clothes. We are reusing all the white clothing we have from when my daughter was younger but we did buy more gender-specific clothes. I’m also panicking a little bit as there are a few more things I need to get/prepare, like diapers and finding someone to help me during my “confinement”. I don’t really follow all the “rules” but I do appreciate the special diet that comes with confinement period- do you know anyone? Haha. Hahaha.. Unfortunately I do not. Must be difficult to get things in order while dealing with daily stuff and also working at the same time! Tell us, are there any differences during your 1st, 2nd and 3rd trimester with regards to work and being pregnant? What changes do you need to adapt to?
1sttrimester was pretty uneventful. I’ve actually been really blessed to have “good” pregnancies- no cravings or morning sickness. Although I was nauseous at certain times of the day, which I never got in my first pregnancy, work was pretty much unaffected. 2ndtrimester saw me getting tired very easily and this time around, I got bigger faster although my weight didn’t increase too much. My blood tests showed that I had insufficient iron so I had to take more supplements. Walking around was harder and I had occasional abdominal pains, which were quite scary, especially when you’re not sure if it’s serious or otherwise. Had to walk slower at work and had to stop carrying books! 3rdtrimester brought about more acid reflux (compared to the 2ndtrimester) and still the occasional abdominal pain but doctors say it’s probably just the baby pushing down on the organs, and all that walking (up and down the stairs to go to class) at work! I still have slightly lower than normal levels of iron, hoping it will stabilize closer to my due date! Lets hope so. So, how do you manage your work, home and your daughter on top of your pregnancy? Does your routine change as your pregnancy progresses? I just let my husband do everything, haha! No seriously, there are things I cannot do, like take my daughter to the toilet (having to lift her up, bending over to clean her etc) or showering her, even though I still want to. But my husband understands and he’s very good with my daughter. At home, we have a helper so she helps with the cleaning, the laundry and cooking but there are days when I get a little bit OCD and start cleaning the house or making whoever is at home rearrange furniture in (nesting stage,
Life Inspired+
haha). I do forget sometimes that I’m pregnant, so a few people (my family and colleagues) have told me multiple times to slow down and let other people help me. So I’m at a slowing down phase now, although it’s very hard because I’m a naturally fastpaced person at work (walk fast, talk fast hahaha). I must say, it’s tough to slow down when you’ve so used to being fast. Can you recall any differences from your first pregnancy? The main differences between the first and second pregnancy are the nausea in the first trimester, the low iron levels and the abdominal pain. Oh, and I feel so much heavier!! Even though I’m about the same weight as I was in the first pregnancy. I still feel anxious. I think that doesn’t go away despite experience. Do you do any fitness exercises? Has your diet changed? Exercise… No. Hahaha. I think I get a lot of it walking up and down the stairs as I go to classes (from Ground to 3rdfloor). As for my diet, I just make sure I drink more milk, eat more vegetables and fruits when I can and also drink more water. I also avoid undercooked eggs and raw fish (which I don’t eat anyway).
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Jul–Aug 2016
+Life Inspired INTERVIEW: Lorene Anne Fong ARTICLE BY: Swee Ann PHOTOGRAPHER: Aron Tan’s Studio
What does your doctor recommend for maintaining a healthy pregnancy? My doctors (private and government ones) have not really recommended anything other than the usual, maybe because this is not my first pregnancy so I know what I should be eating and doing. Although they do remind me to take folic acid and my iron supplements, as well as increasing my intake of fibre and water. Also, being aware of the baby’s movements and changes in my body as the pregnancy progresses helps to keep things in check. Oh, and avoiding stress too! Another few more weeks to go! Thank you for sparing your time to do this interview. All the best to you and your family.
32 PLUS Jul–Aug 2016
+Life Inspired
NURTURE YOURSELF... FIRST D
r Nourul is used to spending most of her time in the hospital taking care of people who need her and at home, she takes care of the whole household. As a doctor, that’s the norm for her. But being pregnant made her realize that she also has to take care of herself. Read through what she has to say about her pregnancy experience. Tell us more about yourself. My name is Dr Nourul Hayati Azrina Haji Jaman. I am 36 years old and I’m a doctor. This is my fourth pregnancy. My first child is 7 years old. His name is Amreen. Haziq is 2 and Sofia is 1. According to my LMP, I’m 30 weeks but my ultrasound indicates that I’m in my 32nd week.
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How do you cope with being pregnant while working in your profession? When I found out that I was pregnant again, my husband asked me to change fields. I was a neurosurgeon for six years but now I am a doctor in public health. I deal with disease control and surveillance, environmental health, health lifestyle, health promotion and occupational health in the workplace. Wow! Neurosurgeon? Do you miss what you used to do? I miss operating but I do not miss the alternate 24-hours on call! Last year, when I was 7 months pregnant with my third child, I was on call 24 hours
on alternate days. That’s 15 days in a month! I still love opening skulls. Maybe when then the kids are settled, I will go back. I have not decided yet. After three children, are you excited for another little one? I have mixed feelings. I feel happy because we found out that I will be having another girl. So, we have a pair of boys and girls each. However, it is going to be a challenge in parenting, as we will be having three small children under the age of 3, after the baby is born. Although, I do have a helper and my husband is also very hands-on! I’m thankful for that.
Life Inspired+
PLUS 35
Jul–Aug 2016
+Life Inspired
36 PLUS Jul–Aug 2016
Life Inspired+ supporting husband helps. So, what I cannot do, my husband does. How does this pregnancy differ from your previous? Any advice from friends or family? I have been getting a lot of advice on how to get my placenta to its normal position. I was also told to “hang upside down”! I am not sure how a heavily pregnant woman can hang upside down or how that would help my placenta to move from its current position. The people who gave me that advice said that they got it from YouTube! I just laugh.
Are your kids looking forward for another sibling?
be mindful of my troubles that I had during my first trimester.
My eldest son is happy as long as the baby is not another boy! My two year old kisses my belly every night, so that says it all! My kids are really looking forward to another sibling.
In my third trimester, I found out that my placenta was low and baby was breech, which meant a possibility that I may have to undergo C-section.
Since this is going to be your fourth delivery, do you feel nervous about the impending D-day?
Although I’m still in my 32ndweek, there is still time for baby to turn around to be in the normal birth position (head first). Hopefully! I accept that I may have to have a C-section but I would still prefer a normal delivery.
Honestly, I never look forward to delivery! Labour pain is something that I will always remember. But in saying that, it’s worth it and the pain goes away after laying eyes on the little one once they’re born. Any challenges that you faced during your three trimesters? Overall, my greatest challenge is reminding myself to slow down and not to do too much work. It applies to all three trimesters. I feel that the first trimester was the most challenging one for me. I had less energy and on top of that, I was having abdominal cramps and bleeding! I had to be confined to bed rest for two weeks to prevent miscarriage. The doctor advised me to rest more, slow down and take care of myself. Sometimes, when you are busy, you tend to forget that you need to take care of yourself before taking care of others. Besides that, I also had the usual symptoms of nausea, loss of appetite and weight loss. My second trimester went quite well. I had more energy and I ate a lot better. Although I had to remind myself not to overdo myself and still
Like most pregnant woman in the third trimester, I too have the usual reflux (gastric). So, instead of having big meals, I usually take small meals but more regularly. That helps, but if it gets really bad, then I take Gaviscon. As my tummy grows bigger, sleeping is more uncomfortable. I cannot really sleep on my back! I have to sleep sideways and that helps me to have achieve some shut-eye during the night. Last but not least, the contractions! As my pregnancy progresses, I have been having more and more contractions. Once they get closer, I will know it’s time to go to the labour room! Did your daily routine change during this pregnancy? My routine is actually still the same. I prefer to be as active as possible. I still drive to work and send my kids to school. I would say I am not as mobile as I would like to be, especially having to chase my two younger children around. Having a
With this pregnancy, I also notice that the baby is bigger than my previous babies. So, my bump was noticeable during my earlier weeks. Also my blood pressure has been extremely good compared to previous pregnancies. Do you do any exercise during this pregnancy? I do not do any fitness exercises. I just keep myself active and busy. Living on the third floor also helps as I have to climb three sets of stairs. When one is pregnant, there is a tendency to sit around and do nothing, especially when you don’t have the energy. How about your food intake? What advice have you gotten from your doctor? I follow a low-salt diet and drink more water because during my previous pregnancies, I had high blood pressure so I make the effort to watch what I eat. The one thing my OB keeps telling me is to slow down, rest more and to not do too much. I think being a doctor myself, one is so used to taking care of others that we have to remind ourselves that we have to take care of ourselves first before we can take care of others. Mothers are the same; we are so busy taking care of the whole household that sometimes we forget we need to take care of ourselves as well. True indeed! All the best and do take care! INTERVIEW: Dr Nourul Hayati Azrina Haji Jaman ARTICLE BY: Swee Ann PHOTOGRAPHER: Aron Tan’s Studio
PLUS 37
Jul–Aug 2016
+Life Inspired
Baby p m u B w e n a s ’ t I feeling
T
he first few weeks of pregnancy are both exciting and exhausting! Nevertheless, Aqeelah is getting ready for her little munchkin. The mother-to-be talks about her experience and how she’s preparing for the arrival of her first child. Tell us a bit about yourself. I am Aqeelah Afefe, 26 years old and an F&B entrepreneur. My passion for cooking and baking started when I was in primary school as I used to help my mother and grandmother in the kitchen. I was even in the cooking club in primary school so I could try cooking in school. The passion grew when I was in secondary and pre-university — where I used to sell cookies, and kept growing as I set up my business in selling food to cube stores and shops in Brunei. I love watching cooking shows and cooking and baking YouTube channels from which I would try the recipes and enjoy them with the family. This is your first pregnancy, yes? How far along are you? Was your
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pregnancy planned and how did you feel when you first found out? Yes, that is correct! I am 25 weeks pregnant as of now and the pregnancy was definitely not planned. It’s a honeymoon baby! (chuckles). We weren’t trying or anything, then a month after our honeymoon, my body started to change and I didn’t feel comfortable. I even had my blood tested but it was negative for pregnancy, so I thought my body was just changing due to having just gotten married. A month later, I tested again with an over-the-counter pregnancy test and the test was positive. I was overwhelmed with joy! Called up my husband at work and he just rushed home straight after. We couldn’t help but thank Allah for it. Describe your experience so far? Any weird cravings? I was very tired and exhausted in my first trimester but it got better in my second trimester. I still need to take a nap during the day, otherwise I’ll get very tired by early evening. So far, I don’t really crave for many foods but I started to realize that I preferred
western dishes compared to malay dishes since the start of my pregnancy. I only had specific cravings in my first trimester, which was sour mangoes with soy sauce, belacan and birds eye chillies. Just my luck, they weren’t in season at the time and my in-laws had to buy them from neighbouring countries. There are things that I can’t bear to do now, so having a great support system in my family and in-laws is a blessing and makes my pregnancy so much easier. What are your preparations for the little one? We have shopped for most necessities such as clothes, bottles, breast pump, crib and cleaning utensils. There was a sale last month on baby items, which helped us save as we got to bargain on many things because baby items are not cheap. We don’t have a nursery yet as I would want to have my baby with us in the bedroom. Since this is your first pregnancy, are you excited for D day? Do your
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+Life Inspired family and friends give you advice on what to expect? We are excited and more nervous, actually. We are counting the weeks now and didn’t realize that time has flown by so fast. Many friends and family members have shared their experiences so I can prepare myself better. My sister-in-law is also pregnant with her second child, so that helps a lot as she shares many stories and pregnancy experiences with me. Has your routine changed throughout your pregnancy? What are the changes that you need to adapt to? Throughout pregnancy I just rest and sleep more so I can get through the day easily (laughs). I can’t carry heavy items anymore and bending down is a struggle nowadays so I leave that to my husband whenever he is around. As an F&B entrepreneur, I have to prep food very early in the morning to be sent out to shops so that does make a difference when I am pregnant. Waking up is the easy part but keeping myself awake is a problem by mid-morning. So I take enough rest throughout the day and keep myself hydrated most of the time. Being an F&B entrepreneur makes pregnancy much easier as I have more time to rest compared to an office job with restricted hours and I am more flexible with time, which gives me the non-restricted days for antenatal appointments. Are there any taboos that you should or shouldn’t do or eat during your pregnancy? Some that I have been told include not hanging towels on your neck and shoulders (both husband and wife), for my husband not to hammer nails in the walls and not to eat squid and stingrays. We are quite careful with the taboos but then again, it is up to Allah SWT on what His Qada and Qadar will be. My mum and husband aren’t quite strict with most of the
40 PLUS Jul–Aug 2016
Life Inspired+ taboo, especially on what I feel like eating, so it’s less stress for me if I don’t get to eat some food. What’s your best experience so far? Any classes you attended to get yourself ready? As a Bruneian, I’m fortunate to have free antenatal check ups and classes with our local clinics. I recently just joined the breastfeeding class at my local clinic and it was quite helpful for my husband and me as both of us attended the class. The class taught us the importance and need of breastfeeding your child, as well as how to breastfeed, benefits of breast milk and the consequences of giving formula to babies. I believe that it is an important part of a baby’s growth. I would love to exclusively breastfeed my child, given the chance. I have heard so many stories of failed breast feeding that it makes me feel determined to breastfeed my child soon, if Allah SWT permits. There are also one-to-one breastfeeding consultancy services by a Ministry of Health specialist dietician if one needs to have specific conversations for one’s need. I am grateful for the initiative of the Government for trying to help new mothers breastfeed their children. I am also very happy to see small businesses that specifically cater to breastfeeding products such as breast pumps, milk boosters, nursing clothes and nursing covers. These small businesses are lifesavers for mothers, especially new mothers as some shops are limited to only selling 1 or 2 items. There are not many local entrepreneurs selling maternity and breastfeeding products but I salute those businesses who are already established as they cater to the constant needs of the many pregnant ladies and breastfeeding mothers. Well done you! Let us know how you get on and Good Luck!
PLUS 41
Jul–Aug 2016
+Life Inspired
FEATURING: Aqeelah Afefe ARTICLE BY: Swee Ann PHOTOGRAPHER: Aron Tan’s Studio
42 PLUS Jul–Aug 2016
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+Life Inspired
The Lady With The Hummingbird Heart
L
ike many young professionals out there, the drive and ambition to reach the pinnacle of their career burns strong but when you throw a heart condition into the mix, things get complicated fast. This is what Dk Hjh Mas Joliwane Pg Hj Tejudin, 35, had to overcome despite being at her prime. Her life had been plagued with fatigue and heart palpitations for years before being diagnosed with Inappropriate Sinus Tachycardia, a condition caused by a defect in the heart’s natural pacemaker (or the SA/Sinus node). Dk Hjh Mas Joliwane had a resting heart rate of about 100 bpm which is on the extreme end of that of a normal heart (60-100 bpm) and this made leading an active lifestyle difficult, especially while caring for her toddlers. Now, the mother and career woman is more focused than ever to seize the moment and attain her goals with the bitter past adding fuel to her passion for success.
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Describe your life prior to being diagnosed. When I was a teenager, I was a very active person. My dad was a good badminton player, in fact he still actively is, and he is now 58 years old. I am the eldest out of three and spent a lot of time with my dad, especially during my younger years. Obviously, I took up badminton as my main sport from him. He coached me well and we would play badminton for at least 2 hours straight, a few times a week in the afternoon. At home, we both also played table tennis. When I was studying in a boarding school in England, I continued to pursue badminton as my main sport for most terms. However, I never participated in any official competitions as I merely just love the sport and it helped in keeping me fit. In my free time, I would also do aerobics.
Only when I was approaching my mid-20s did I begin having dizzy spells whenever exercising — sometimes I felt like fainting. One time, I had difficulties catching my breath while doing aerobics at home and because of this, I decided to reduce my physical activities. At first, I thought it might have just been temporary from being too tired with studies and/or work. Unfortunately, the problem persisted till I began to fear doing sports and avoided going on outings, because I would get dizzy very easily. This was very frustrating for me, as I felt like I was going down from hero to zero. Staying away from doing strenuous activities worked for a while, keeping me from having unnecessary palpitations, but the symptoms continued to build up until it got to a point where even talking for too long would cause palpitations. Imagine, I was a University Brunei Darussalam lecturer then, most of my modules
Life Inspired+ would take two hours per session and I would usually stand throughout my lectures. At 30, my condition worsened. Walking from my office to the car too had become a problem and I easily ran out breath. Finally, in 2010, I went to the Cardiology Department in Raja Isteri Pengiran Anak Saleha hospital and was eventually further referred to Gleneagles Jerudong Park Medical Centre in 2012. How did your condition affect your family life and those around you? In the beginning, only my family and close relatives knew of my condition. They were very understanding and supportive. Despite that, it was difficult for us. Usually, I am a very upbeat person and would be the first to organise family events or outings. But during those times, it was hard for me to even attend weddings and celebrate Hari Raya. As time went by, this was getting so frequent that my family began to really worry. I would be easily fatigued and it led to a lot of frustration, as I aspired to go far in my career, and I wasn’t going to let this condition be a hindrance. However, with my family’s support and a strengthened resolve, I was determined to get better and accepted the doctor’s advice to undergo treatment in Singapore. Could you tell us more about your diagnosis and steps taken to manage your condition? When I consulted the Cardiology Department in RIPAS, I was put on a holter monitor (a portable medical device) for several times over to monitor my heart rate. When I was referred further to Gleneagles Jerudong Park Medical Centre, another specialist from Singapore came down to run the electrophysiology (EP) study on me. And it was then that I was officially diagnosed with Inappropriate Sinus Tachycardia (IST). Initially, I was in denial and couldn’t fathom why this was happening to me. I thought I was still young and a very healthy person, so why was I suffering from this condition? But the doctor assured me that it could be fixed. Meanwhile, I was put on Ivabradine to control my heart rate and advised to undergo further treatment in Singapore if the symptoms persisted. Unfortunately, they did.
It was 2012, and I was going on a work trip to Thailand when I had arrhythmia both times I was on board the plane, which made it hard for me to catch my breath. As soon as I returned to Brunei, I immediately consulted my specialist and it was then that he explained I had to undergo ablation (surgical removal) of my Sino-atrial (SA) node using Carto and Stereotaxis. Despite being nervous of the risks, I was determined to get better, so I agreed to do it. So how has the road to recovery been so far and how has your life changed since the treatment? It took me almost a year to try and adjust to my new heartrate, which was lower than before. I had to control my inhalation and also adjust my sleeping position — I couldn’t lie on my left side for a long time as it would affect my breathing. Although I still couldn’t do sports then, I was able to go out again, attend events and travel during my holidays. A year after the treatment, the first activity that I took up was horse riding. Then I started brisk walking. Sadly, I am unable to do strenuous exercises that involve cardio, like badminton, tennis and aerobics. Sometimes, I will do Tai Chi on Sundays. Although limited, at the very least I am able to do exercises suitable with my health capacity. I still have to be careful with what I consume though, as until now, there are certain food and drinks that I can’t take, such as drinks with certain food colouring and some medications, for example Actifed, Fedac and beta-blockers. I can’t take too much high protein food like red meat or nuts. But unlike now, when I was ill I couldn’t even eat chocolates or take caffeinated drinks like coffee or tea. I have to admit, my condition is now far better than before. Back when I was ill, I felt lethargic and health was a challenge for me. But now, I am healthier and happier. And after regaining my health, although not fully, I am determined to give the best in whatever I do, because I know how it felt when I couldn’t. I’ve become more confident and more focused in my profession, especially with the endless support from close colleagues and family. Alhamdulillah, my improving health has given me courage to continue doing well in my career.
Any words of advice for the general public to care for their cardiac health? If you start feeling unwell, please go for a check-up as soon as possible. You mustn’t take it lightly and be complacent just because you are eating healthy, or young, or an active person. And this is especially true when the symptoms are recurring, like in my case. I had let it go on for a long time until finally things took turn for the worst. Luckily, I was fortunate enough to have my condition diagnosed and overcome it. Exercise often. While you’re still up and able, have at it to your heart’s content! Try out new things. Pick up sports that you’ve never done before. Do something that you actually enjoy, and be consistent at it. Trust me, the lethargic feeling when you are sick isn’t great, especially when it makes you feel bad that you are missing out on a lot but avoid frequently taking unnecessary energy drinks! This was my previous bad habit, and it very often caused my heart to palpitate every time I consumed it. I would like to thank my family and close friends for helping me pull through the difficult times and for always being there for me. To all my doctors and staff at the Cardiology Department Raja Isteri Pengiran Anak Saleha Hospital and Gleneagles Jerudong Park Medical Centre, thank you for the constant support, advice and treatment, and for helping me regain my health. I am glad that I am now back to my daily routine and able to focus on my work, not having to worry about my health anymore. Lastly, thank you to Plus Magazine for providing me with the opportunity to share my experience. I hope it can motivate those in similar situations as myself to stay positive, because help is there. Do not fear consulting the doctor who will assist and monitor your conditions until you get better; and undergo treatments when deemed necessary. FEATURING: Dk Hjh Mas Joliwane Pg Hj Tejudin ARTICLE BY: Syazwana Souyono PHOTOGRAPHER: Magic Media Sdn Bhd
PLUS 45
Jul–Aug 2016
+Lifestyle
Tips on Developing Your Birth Plan P
regnancy is an extremely exciting time, but it is also one where many major changes occur. For new “soonto-be” moms, this time in their life raises many questions and sometimes concerns. To help you feel settled throughout your pregnancy, you might want to consider creating a birth plan. The birth process is the ultimate end goal of your pregnancy and you want to make it clear to those who will be involved in this special time what your wishes are. Your plan should be focused on your labor and the birth of your child. What would you like to take place during this time, and what are any concerns that you want to avoid? This plan is a guideline for those who will be assisting you with labor and delivery, usually your midwife or
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doctor. You will also want to include your birth partner in your planning.
PUT YOUR BIRTH PLAN IN WRITING While you can certainly make your birthing wishes known verbally, things can get misunderstood or forgotten about. By putting your plan on paper, it serves a couple of purposes: First, you will be able to review it to make sure that you haven’t forgotten anything that is important to you. If you develop this plan during the early stages of your pregnancy, then you can refer to it as you progress and add to it if things come to mind, or alter it if things change. Secondly, by having it in writing, you can give it to those who will be
assisting you with your birth prior to the time and they will get the chance to review it with you.
WHAT TO THINK ABOUT? When creating your birth plan, keep in mind what is offered at the location where you will be giving birth. This may be at your hospital or birthing center. You may be able to have a pre-visit to one of these places prior to your delivery so you can gather important information. Alternatively there may be written material provided by them, or you can call and speak to them. If at this time you discover that there are policies in place at your delivery location that you don’t understand or agree with, now is the
Lifestyle+ time to talk to your midwife or doctor about this.
DIVIDE YOUR PLAN INTO SEGMENTS You may want to have two sections for this. One will deal with an uncomplicated delivery, while the second section will cover your wishes should problems develop.
DOING YOUR RESEARCH During the early part of your pregnancy, you can start your research. There are all kinds of resources readily available for you to do this. One of the best sources will be other moms who can share their birthing experiences with you. What is even better is if you can talk to those who have used the same birthing location as you. Plus, if possible, talk to others who used the same medical assistance that you are going to rely on. You may be thinking about a home birth, or have not made
up your mind as yet. During your research for your birth planning, you can also collect information about this and this will help you greatly with your decision. You may want to think about taking prenatal classes, as these will give you some insight into what you can expect, as well as help prepare you for the birth. While you are doing your research, you are going to become much more informed as to what takes place during the process of giving birth. This will help you draft some specific questions that you want answers to so you can include these in your birth plan.
PAIN RELIEF There are several different options for pain relief and you will want to decide on which type you will want to use prior to going into labor. This way it will be well documented in your plan and your medical support can attend to this.
THINK ABOUT YOUR POSITIONING During your research, you will gather lots of information about different positions for birthing. Consider the options and in your plan, document which appeals to you. Every labor is different and what might work well for one may not do the same for you. So be flexible with this.
ASSISTED BIRTHS AND EQUIPMENT If, at the end stages of your delivery, it becomes difficult to give birth there may be an option to use equipment such as forceps. This is something you can think about during your birth planning. Develop your questions around your research, and remember that although it is a detailed plan that you have documented in writing, be flexible as things can change quickly during a delivery.
PLUS 47
Jul–Aug 2016
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