Isisu Sokukhulelwa: Izinguquko, Ukunakekelwa, Nemizwa: Umbono Onemininingwane Ngohambo

Ukukhulelwa kuvame ukuchazwa njengolunye lwezinto eziguqula kakhulu umzimba umuntu angake abhekane nazo. Ukusuka emzimbeni osebenza njengesistimu eyodwa kuya kowonakekela impilo entsha kudinga izinguquko ezingenakubalwa emzimbeni, ezingokwengqondo nangokwezwela. Omunye wemibimbi ebonakalayo kakhulu yalezi zinguquko wukwanda kwengxenye ephakathi, okuvame ukubizwa ngokuthi isisu sokukhulelwa, esixhunywa abaningi ngobubele nobumnene nobuzali obusondelayo. Inhloso yalesi sihloko ukuhlola ukuthi le ngxenye ishintsha kanjani kusukela emasontweni okuqala kuze kube izinsuku zokugcina ngaphambi kokubeletha, kuyilapho kuxoxwa futhi ngokubaluleka kokudla okunempilo, ukuhlolwa kwezokwelapha, inhlalakahle engokwengqondo, nokuchitha izinganekwane. Kuyo yonke le mbono ebanzi, kugxilwa ekuchazeni ukuthi lezi zinguquko zenzeka kanjani nokuthi kungani zenzeka ngaphandle kokuphinda ulwazi olufanayo kabili.

Isingeniso

Ngesikhathi sokuqala sokukhulelwa, umzimba uqala inqubo eyinkimbinkimbi eqhutshwa amahomoni elungiselela ukukhula kwempilo entsha. Yize kungase kungabonakali emasontweni okuqala, isisu siqala kancane kancane ukuguquka ukuze samukele isibeletho esikhulayo. Lesi sikhundla esisha siholela ezinguqukweni eziningi zangaphakathi nezangaphandle, sakhe lokho ekugcineni okuvame ukubonakala njengomumo owahlukile womzimba womuntu okhulelwe.

Phakathi kwalezi zinguquko, isisu sokukhulelwa sidlula ekuthuthukisweni okumangalisayo. Izakhiwo ezakhiwa ngaphakathi kwesisu somuntu okhulelwe—okuhlanganisa isibeletho esikhulayo, i-placenta, nesaka le-amniotic—kufanele zihleleke ngokulinganisela okuphelele ukuze zisekele ukuthuthuka kombungu. Isigaba ngasinye sokukhulelwa siletha izingqinamba zalo nezimpumelelo zalo, kugcizelela ukubaluleka kokuqonda ukuthi umzimba uyazivumelanisa kanjani nalezi zinguquko.

Kwabazali abaningi abalindele, izinguquko emzimbeni zivusa imibuzo: Kufanele kudliwe kanjani ukuze kusekelwe umbungu okhulayo? Yiziphi izinhlobo zokungakhululeki emzimbeni ezivamile? Yiziphi izindlela zokwelashwa noma ukuqapha ezibalulekile? Le mibuzo iveza indima ebalulekile yolwazi ekuphatheni ukwenyuka nokwehla kokukhulelwa [1].

Izinguquko Zokuqala

Isigaba sokuqala sokukhulelwa (i-first trimester) sivame ukuba yisikhathi sokuwa kwentuthuko ethule futhi engabonakali. Iqanda elivundisiwe linamathela odongeni lwesibeletho, likhuthaze uchungechunge lwezimpawu zamahomoni. Izinga eliphezulu le-progesterone ne-human chorionic gonadotropin (hCG) lizisa umzimba ukuthi kufanele uqale ukweseka umbungu. Nakuba abantu abaningi bengase bangasiboni kahle isisu sokukhulelwa kulesi sigaba, izinguquko ezisezingeni elincane zenzeka kakhulu ngaphakathi.

Isibeletho, ekuqaleni esilinganiselwa usayizi wephere elincane, siqala ukujiya nokunwebeka, silungiselela ukugcina umbungu okhulayo. Kulesi sigaba, ukugobeka kancane kwesisu kungavela ngenxa yokugcinwa kwamanzi nokuguquguquka kwamahomoni. Nakuba umumo wesisu ungase ungabonakali ushintsha kakhulu, abanye abantu bazwa ukufinyela okuncane noma ukuqina esiswini.

Lesi sigaba sokuqala sigcizelela ukubaluleka kokuzinakekela ngobumnene kanye nokuqala ukuthatha amavithamini e-prenatal. I-folic acid, ikakhulukazi, isiza ukunciphisa ingozi yokungaphethse kahle komgogodla nengqondo (neural tube defects), kanti ukudla okunempilo nokulinganiselayo kwakha isisekelo sokukhula kombungu onempilo kudala ngaphambi kokuba kuvele izimpawu zangaphandle ezinkulu [2].

Ukuqhubeka Kwenguquko Esigabeni Ngasinye Sokukhulelwa

Ngesigaba sesibili sokukhulelwa (second trimester), abantu abaningi baqala ukubona ukwanda okucacile engxenyeni ephakathi komzimba. Lolu shintsho ukusuka ekugobekeni okungenzeki kalula ukuba kuvele umumo ocacile lwenzeka njengoba isibeletho sikhuphukela phezulu. Amahomoni asiza ukuthambisa imisipha nemigqa yamathambo ethangeni nasemalungeni (ligaments), okuvumela ukwakheka komzimba ukuthi kuzijwayeze. Kwezinye iziguli, lesi sikhathi siletha ukukhululeka ezimpawini zokuqala zokukhulelwa ezifana nesicanucanu nokukhathala okweqile [3].

Ngenkathi ingane iqhubeka nokukhula, isisu somfazi okhulelwe sivame ukuba yindawo egxilwe kuyo—abangani nomndeni bangase baphawule ngezinguquko zaso, futhi nosayizi wezingubo uvamise ukushintsha. Isibeletho singafinyelela eduze nenkinobho yesisu cishe emasontweni angama-20, nakuba umehluko emzimbeni nasemzileni usho ukuthi akukho mizimba emibili yabakhulelwe efana ngokuphelele. Ngenkathi isibeletho siqhubeka nokunwebeka, abaningi babona ushintsho olukhulu kumumo nosayizi wesisu sabo cishe amasonto angama-20 esisu, isigaba lapho isisu sokukhulelwa siba sobala kakhulu futhi siqala ukuthinta indlela umuntu ahamba ngayo nokuma komzimba. Abanye babona isisu sibiyele kakhudlwana sibe yindilinga, kanti abanye basithwala phezulu noma phansi kancane.

Ngenkathi kungena isigaba sesithathu sokukhulelwa (third trimester), umbungu uqala ukwanda ngokushesha ngobude nangesisindo, okungeza umumo omkhulu, okhuphukele phambili. Udonga lwesisu luyanwebeka luze lufinyelele emkhawulweni walo, okungenza kwesinye isikhathi kubuhlungu emhlane ongezansi noma eduze kwamathambo ombele. Ukusekelwa ngokomzimba, njengamabhandeabakhulelwe (maternity belts) noma izingubo ezakhiwe kahle, kunganciphisa lokhu kunzima njengoba usuku lokubeletha lusondela.

Okusemqoka Ngaphakathi Komzimba Okhulelwe

Ukwakhiwa okumangalisayo ngaphakathi kwesisu somuntu okhulelwe kuwubufakazi bokumangalisa komzimba womuntu. Isibeletho asikhuli sodwa nje ngaphandle kokunye; sakha indawo ephephile ezungezwe uketshezi lwe-amniotic, esekelwa i-placenta. Leli thambo elikhethekile elikhula ngenxa yokukhulelwa, lisiza ukudlulisa ukudla, umoya-mpilo (oxygen), namahomoni phakathi komzali nengane. Ngesikhathi esifanayo, uketshezi lwe-amniotic lusiza ukuvikela umbungu, lunikeze bavikeleke futhi babe nendawo yokuzihambela.

Ngasikhathi sinye nokunwebeka kwesibeletho, amathumbu, isisu nomchamo (bladder) kuyanyakaziswa kancane kancane kuye phezulu noma eceleni. Kubaningi, lokhu kubonakala njenge-heartburn (ukushisa esifubeni), ukushintsha kokulangela ukudla, noma ukuya endlini encane kaningi. Lezi zinguquko zigcizelela ukuthi kungani inkulumo ethi “udlela abantu ababili” ingadida—nakuba isidingo sokudla sikhula, uhlelo lokugaya ukudla luvame ukucindezeleka, okuwenza kube ngcono ukudla ukudla okuncane kaningi kunokuphindaphinda inani lokudla.

Ukuqonda ukuthi konke kuhleleka kanjani ngaphakathi kwesisu somkhulelwe kugcizelela ukubaluleka kokudla okunempilo nokulandelela kahle impilo. Kuyamangalisa ukuthi ngaphakathi umzimba uyashintsha ngokushesha kangakanani ukuze uqinisekise ukuthi umbungu uthola ukwesekwa owudingayo kusukela ezigabeni zokuqala kuze kufike amasonto okugcina okukhulelwa.

Ukudla Okunempilo Ngesikhathi Sokukhulelwa

Ukuqinisekisa inhlalakahle yomzali nengane kuqala ngokudla okunempilo. Izingxenye ezisemqoka zihlanganisa amaprotheni, amafutha anempilo, amavithamini namaminerali. Inyama engenamafutha amaningi, amaqanda, imikhiqizo yobisi, ubhontshisi, okusanhlamvu okungakahlutshwa (whole grains) kunikeza ama-amino acid abalulekile nezakhi-mzimba. Izithelo nemifino, ezenothile nge-fiber nama-antioxidant, zisiza ukugcina ukugaya ukudla kuhamba kahle, okuyakubaluleka ikakhulukazi lapho ingcindezi esiswini yandisa amathuba okuba isisu sigobeke noma kube nokugcinwa kwendle.

I-ayoni (iron) iba semqoka kakhulu njengoba igazi lwanda. Lo mineral usiza ekwakheni amaseli egazi abomvu, adlulisa umoya-mpilo kumbungu okhulayo. Ukudla okufana nesipinashi, okusanhlamvu okuqinisiwe (fortified cereals), nobhontshisi kuyimithombo emihle. Kwezinye izimo, odokotela bangase batusa izithasiselo ze-ayoni uma imiphumela yegazi ikhombisa ukushoda.

Ukuhlala uphuza uketshezi olwanele kubaluleke ngendlela efanayo. Ukungenisa amanzi ngokwanele kusiza amazinga oketshezi lwe-amniotic nokusebenza okuvamile komzimba. Ukuphuza amanzi amaningi nakho kungasiza ukunciphisa izinkinga ezivamile ezifana nokukhathala noma ikhanda elibuhlungu.

Nakuba isifiso sokudla (cravings) singaba namandla futhi kwesinye isikhathi sigxile kokudla okungekho nenani elikhulu lezinto ezizuzisayo, ukulinganisela kubalulekile. Ukuzithokozisa ngezikhathi ezithile kujwayelekile, kodwa ukuqinisekisa ukudla okuphelele nokulinganiselayo kuzokhonza kangcono ukukhula komntwana nokugcina ukusebenza kahle kwesisu somkhulelwe.

Ukuqashwa Kwezokwelapha Ngesikhathi Sokukhulelwa

Ukuvakashelwa njalo kwa-prenatal kudlala indima ebalulekile ekuqapheni umzali nombungu. Lezi zikhathi zokuhlolwa zivame ukuqala esigabeni sokuqala sokukhulelwa futhi ziqhubeke ngezikhathi ezihleliwe kuze kuphele ukukhulelwa [3]. Abahlinzeki bezempilo balandelela ukwanda kwesisindo, umfutho wegazi, nokukhula kombungu ukuze baqinisekise ukuthi konke kuhamba ngendlela ejwayelekile. I-Ultrasound inikeza ukubukwa ngokuningiliziwe kwentuthuko yengane, kusukela ekulinganisweni kokuqala kuze kube ukuhlolwa okuphelele kwezakhiwo zomzimba esigabeni sesibili sokukhulelwa.

Ukuhlolwa kwezimo ezifana nesifo sikashukela sokukhulelwa (gestational diabetes) kuvame ukwenziwa cishe phakathi kwamasonto angama-24-28. Ukulawula ushukela wegazi kubalulekile ngoba izinga eliphezulu lingathinta ukukhula kombungu futhi liholele ezingqinambeni ngesikhathi sokubeletha. Uma kutholakala le nkinga, ukushintsha ukudla noma imithi kungasiza ukuyilawula ngendlela ephumelelayo.

Ngaphezu kokuhlolwa kwegazi okuvamile, abanye abantu bakhetha ukuhlolwa kofuzo noma izivivinyo ezibheka ukungajwayelekile kwama-chromosome. Lokhu kunganikeza induduzo noma kuqondise izinqumo uma kutholakala ukungajwayelekile. Lolu hlobo lokunakekelwa kusenesikhathi luqinisekisa ukuthi isisu somkhulelwe nomntwana abaphethwe kulo bayalandelwa eduze, kuncishiswe ingozi ngokutholakala kusenesikhathi kwezinkinga ezingase zibe khona.

Izici Zengqondo Nezomzwelo

Izinguquko ezinkulu emzimbeni zingaba nomthelela omkhulu enhlalakahleni yokomzwelo. Ukuguquguquka kwamazinga amahomoni kungaholela ekushintshashintsheni kwemizwa, ukukhathazeka, noma ukusabela okukhulu ngokomzwelo. Umuzwa wokubukeka komzimba uba semqoka njengoba isisu somfazi okhulelwe sikhula, futhi abaningi bazithola bephatha imizwa emisha mayelana nokuthi umzimba wabo ubukeka kanjani. Ngenkathi abanye bemukela lezi zinguquko ngenjabulo, abanye bangase balwe nokuzivumelanisa nalokho okuhloswe umphakathi noma okulindelwe bona mathupha.

Kubalulekile ukwakha inethiwekhi eqinile yokusekelwa, kungaba abangani, umndeni, noma ochwepheshe bezeluleko (counselors). Ukwabelana ngezinkathazo noma ukwesaba kunganciphisa ukucindezeleka futhi kunikeze umbono ohlukile. Abazali abaningi bathola induduzo emiklasini ye-prenatal noma ema-forum aku-inthanethi, bexhumana nalabo asebehambe, noma abahamba khona manje, kulolu hambo.

Imikhuba elula yokuzindla, njengokubhala idayari noma i-meditation eqondisiwe, nayo ingasiza ukulawula imizwa. Ukuzibandakanya nezinto ezijabulisayo, ukufunda, noma ukuzivocavoca okuthambile kungasiza ukuzinzisa ingqondo. Ukwakha umuzwa wokuzilawula nokuzinakekela phakathi kwazo zonke lezi zinguquko kunganciphisa ukukhathazeka, kuvumele umuntu okhulelwe ukuba awubone umangaliso walo hambo lokuguquka [4].

Isiphetho 

Ekugcineni, ukuqonda ububanzi balezi zinguquko kubalulekile ukuze kube nolwazi oluhle nolunolwazi. Ukwazi kusenesikhathi, ukuzilungiselela, nokuhlonipha umangaliso wesisu sokukhulelwa kusebenza njengemigomo yokuqondisa noma ubani oqalayo lolu hambo oluguqula impilo.

Ngesikhathi samasonto okugcina, ukuguquka kwesisu sekucacile ngokuphelele. Impilo entsha ephelele, esilindele ukuzalwa, ihlala kule ndawo emangalisayo. Ikhono lomzimba lokuzivumelanisa—ukunyakazisa izitho zangaphakathi, ukuguqula amazinga amahomoni, nokwelula indawo yesibeletho—kugcizelela ubunzima nobuqiniso bomzimba womuntu. Ngaleyo ndlela, ulwazi ngokudla okunempilo, ukuvakashelwa njalo kodokotela, nokuzinakekela ngokomzwelo kungathinta kahle umzali nengane, kwenze kube lula ukwedlulela enkathini yasemva kokubeletha.

Uhambo ngalunye lokulindela ingane luhlukile, lukhombisa izinto eziningi kusukela ezifweni ezisemndenini (genetics) kuya endleleni yokuphila. Okusala kungaguquki wumangaliso wesisu somuntu okhulelwe njengoba silungiselela ukubeletha. Lapho isikhathi sifika, ugqozi lugxumela ekutheni kuphume ukondliwa ngaphakathi kuye ekwamukeleni usana olusanda kuzalwa emhlabeni. Lesi sigameko sivalisa isahluko esibalulekile sesisu somkhulelwe futhi simele ukuqala kwendaba entsha yobuzali.

Izinkomba

1. Blaas HG, Eik-Nes SH, Kiserud T, Hellevik LR. Early development of the abdominal wall, stomach and heart from 7 to 12 weeks of gestation: a longitudinal ultrasound study. Ultrasound Obstet Gynecol. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC484638/
2. Ertmann RK, Nicolaisdottir DR, Kragstrup J, Overbeck G, Kriegbaum M, Siersma V. The predictive value of common symptoms in early pregnancy for complications later in pregnancy and at birth. Acta Obstet Gynecol Scand. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9780714/#:~:text=Symptoms%20such%20as%20nausea,%20vomiting,self%E2%80%90limiting%20symptoms%20of%20pregnancy.
3. Lou S, Frumer M, Schlütter MM, Petersen OB, Vogel I, Nielsen CP. Experiences and expectations in the first trimester of pregnancy: a qualitative study. Health Expect. Available at: https://onlinelibrary.wiley.com/doi/10.1111/hex.12572
4. Kułak Bejda A, Kourkouta L, Tsaloglidou A, Koukourikos K, Aydin Avci I, Çelik Eren D, Shpakou A, Khvoryk N, Hutsikava L, Waszkiewicz N. Pregnancy and Childbirth Fear of Women from Poland, Greece, Turkey, Belarus, and Russia. J Clin Med. Available at: https://www.mdpi.com/2077-0383/13/13/3681