February is gazetted by the World Health Organisation as the Reproductive Health Awareness Month, and as such, awareness campaigns are staged on issues pertaining to pregnancy. According to gynecologists and obstetricians, there are several factors that could prevent a mother from carrying their pregnancies up to due delivery date. Most of these factors are avoidable, while others are not. Experts say some of these conditions can even lead to maternal death, premature births as well as miscarriages if not given due attention, especially if the mothers ignore antenatal care and other instructions.

Statistics from the Ministry of Health indicate that the main causes of maternal death is obstructed labour, infection, eclampsia and malaria, among others.

However, gynecologists say all these factors can come about due to a mother not adhering to advice from their physicians.

Ensure safe pregnancy in first trimester

The first trimester of pregnancy is week one through week 12, or about 3 months. According to Joseph Binama, a Kigali-based gynecologist, to achieve healthy pregnancy, one needs to differentiate the normal signs and the alarming ones during the first trimester.

"Signs such as too much nausea and vomiting, heavy bleeding and virginal discharge most of the time symbolise signs of miscarriage. To be on the safe side, pregnant women should seek prompt consultation,” he says.

Binama notes that sharp lower abdominal cramps could indicate an ectopic pregnancy. In this case, he says blood tests and ultrasound should be carried out to identify the cause.

Some discharges, on the other hand, can be an indication that the baby is at risk since they can be as a result of infections or sexually transmitted diseases, which most of the time, when treated on time, prevents further complications.

Binama emphasises that first-time mothers should watch out for these signs as they may not be aware of what is normal and what is not.

Dr Iba Mayale, a gynecologist and obstetrician at Doctors Plaza Clinic in Kimironko, Kigali, says the first trimester is when the formation of the baby in the womb occurs. For this reason, he says, it is the most critical time where a mother should be careful.

"Therefore, visiting health facilities for check-ups such as blood type and rhesus factor (RH), checking for anemia, hepatitis, HIV as well as immunity is vital to ensure a healthy pregnancy,” he says.

Mayale notes that it’s also ideal for pregnant mothers to start taking prenatal vitamins (folic acid) in the first two months after conception.

He explains that these vitamins help in reducing the risk of the child developing birth defects, adding that starting antenatal visits is also important, as it reduces risks of pregnancy complications.

Mayale says a good number of women shun antenatal visits, when in their first trimester, especially first-time mothers who are still in their teen age.

According to the Ministry, almost all pregnant women get antenatal care at least once during their pregnancies. However, the proportion of women who get these services in the first trimester of pregnancy and complete all visits throughout the pregnancy is still low.

However, Mayale warns against taking medicine without prescription from the right physician.

"During pregnancy most of the drugs are not safe to use. For example, if one has a skin condition, it’s better to consult dermatologist as most of the medicines used to treat acne may lead to birth defects,” he says.

Another vice to stay away from while one has conceived, according to Mayale, is smoking. He says it increases the risk of miscarriage, placental problems, slow fetal growth as well as still births and infant deaths.

Second trimester

The second trimester falls between weeks 13 to week 27 of the pregnancy. Rene Tabaro, a nutritionist and dietician at King Faisal Hospital, Kigali, says it is crucial for a pregnant woman to maintain a balanced and healthy diet during this phase.

"During this time, the baby needs to grow well. Embarking on diets that contain proteins is essential as it boosts the growth of the baby,” he says.

Soy, eggs, beans meat and fish are some of the proteins that should be included in their diets, Tabaro says. Foods rich in calcium are essential to ensure healthy growth of the nerves and muscles of the teeth and bones.

He notes that lentils, spinach and milk are some of the foods that contain the required calcium that is needed for the healthy development of the baby.

According to Tabaro, one should not forget to increase the intake of irons as they are important in maintaining the mother’s iron level as well as reducing the risk of anemia and low birth weight.

Tabaro points out that eating more often but in smaller proportions is essential. This, he says, reduces chances of one developing frequent heartburns and constipations.

However, avoiding heavily spiced foods, taking a lot of water and including fiber-rich foods in the diet will ensure good growth of the baby up to the third trimester, where little is required before the baby is born, he explains.

During pregnancy, mothers are at risk of developing diseases such as diabetes and hypertention. Tabaro advises that doing exercises at least three times a week helps keep away these conditions.

"Exercises reduce the risks of developing types of diabetes that are more common in pregnant women. Also, it aids in preventing back pains and boosts energy required to cope with labor and delivery,” he says. 

According to Eugene Hategekimana, a nurse at Polyfam Polyclinique Familiale in Kisimenti, Kigali, a pregnant woman ought to continue getting antenatal care during this phase and they should be able to feel their baby’s movement.

In case of decrease in the baby’s movements as the days go by, immediate check-up is needed to rule out the cause.

On the other hand, Hategekimana points out that this is not a good time to gain much weight much as too little weight is also not good. On the contrary, maintaining a healthy weight, he says, is essential in nourishing the baby.

Third trimester

The third trimester of pregnancy spans from week 28 to birth. Here, Josephine Murekezi, the president of Rwanda Association of Midwives, says a lot of things need to be avoided as it’s a delicate time since one mistake can lead to birth and pregnancy complications.

"One should stay away from long journeys as they could lead to premature labour. Having enough rest and sleep help in one gaining energy in preparation for labour,” she says.

Murekezi notes that a mother should be aware of danger signs such as bleeding, high fever, premature rupture of membranes, eclampsia as well as severe abnormal pains. When these are experienced, immediate check-up is required.

She also notes that sleeping under treated mosquito nets will ensure a mother stays free from malaria as it increases chances of infant mortality.

Murekezi also says reduction of sexual intercourse is vital for the mother to stay away from stress.

"During this period, the mother should also sleep on their sides to avoid compression of blood vessels. Tight clothes should not be worn at any cost,” she says.

In most cases, premature babies may be as a result of infections, hypertension trauma in the uterus, as well as deformation of the uterus (where the cervix is not well closed), according to Murekezi.

She emphasises that infant deaths after birth can also be controlled if the mother has been attending all the antenatal visits.

"Follow-up check-ups are ideal especially when a woman is about to give birth. These help in prevention of some birth problems that could arise while giving birth,” she says.

However, Murekezi says throughout the pregnancy, a mother should maintain a well balanced diet to ensure a healthy baby.

She adds that doing stretching exrcises will help loosen up the body in readiness for birth. On the other hand, a woman should make sure they have all the required items ahead of delivery such as clothes and shawls to avoid inconveniences.

Traditional ways of ensuring safe pregnancy

Josephine Mukarugima, a mother of three

Back in the day, our grandparents used to mix ibumba (a concoction of clay soil) with some traditional medicine which were given to a pregnant woman. This medicine acted as an energizer throughout the nine months of pregnancy. The medicine still works only that modernity has affected its usage.

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Epiphanie Vumiliya, the director, MEG Foundation School Kinamba, Kigali

There is this medicine extracted from the forest known as Icyuko, which was given to pregnant women. It’s believed that the medicine prevents a woman from any kind of complications that may arise due to pregnancy. The woman was closely monitored so that immediate care is administered in case of any abnormality.

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Angelique Akimana, a resident of Gisozi, Kigali

Although it’s common nowadays, back in the day we used to use traditional medicines. They were of different kinds. For instance one would swallow or apply them on their stomach depending on the stage of pregnancy. However, we were also advised to go for check-ups in hospitals in case of an unusual feeling.

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Aline Tuyisenge, a mother of four

Grandparents always used different medicines for massaging the mother to make sure the baby is alright. Such traditional medicines helped a woman not to fall sick often. Today, not all people practice traditional ways of keeping pregnancy safe as most of them prefer hospitals, which are believed to be safer.