30 Mar 09 FAMILY MEDICAL CARE: BABY ARRIVES
So, day by day, the pregnancy advances. The outward physical signs develop. The woman suddenly discovers her periods have ceased, and she develops the typical indications of pregnancy.
Development in the early weeks is rapid. Cells continue to divide quickly. The vital internal organs of the new life take shape, and soon the heart and the blood-vessel system are in operation.
Movements occur soon after, and this is termed the time of quickening. Sensible women have long since checked-in with the doctor and are now taking the usual steps and precautions that will guarantee them and their developing baby every chance of a safe journey through the prenatal period.
Pregnancy is commonly divided into three segments. These are termed “trimesters,” and each trimester is one-third of the total duration of the pregnancy, in other words, about thirteen weeks.
It is simply an arbitrary subdivision worked out for ease in describing the events that take place during the various sections of the pregnancy interval.
During the final segment of pregnancy, the foetus increases mainly in weight. Legally, the foetus is alive or “viable” when it reaches the age of twenty-eight weeks. But it is most unlikely it would survive if born at this stage.
For practical purposes, it must reach the age of thirty-six weeks, and even then, it will be premature and underweight. However, under certain pressing circumstances, when its life is endangered by complications, every effort is made to reach the thirty-six or thirty-seventh week before delivery is contemplated. Every day beyond this increases its chances of survival.
However, for the average baby (which equals at least 85 per cent of the total number born, and will most likely include yours), the average duration of pregnancy is 280 days (from the last menstrual period). This equals nine calendar months.
For many weeks, and indeed many months before this anticipated date (termed the E.D.C.—estimated date of confinement), painless contractions of the womb commence. These may be felt if the hand is placed lightly over the pregnant abdomen. These take place especially at night, and may occur every few hours. This is termed “pre-labour,” and is aimed at preparing the womb for the actual onset of true labour.
Finally, as the important hour approaches, true labour actually sets in.
This is often heralded by one or more events:
• (1) Regular, painful contractions occur in the abdomen.
• (2) There is a sudden “show.” This means a jellylike, blood-stained plug of material is discharged from the vagina. (This is the “plug” that has sealed the cervical canal, the narrow duct leading from the vagina into the womb itself.) Now that delivery is imminent, the canal is unsealed and made ready for the exit of the baby.
• (3) Appearance of fluid. This is called the “breaking of the waters.” It means the sealed bag of fluid in which the baby has been situated throughout pregnancy has burst, and the fluid is now flowing out via the vaginal canal. This may or may not occur at this stage. Indeed it may not occur until the actual birth is imminent. It varies.
With any of these signs, the mother is aware that the time of delivery is very close. It is a sign that she had better get her packed bag in hand and go to the hospital.
The abdominal pains quickly become more marked and more rhythmical and more uncomfortable.
Labour is traditionally divided into three stages. Each has certain characteristic events that take place.
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Tags: General Health
30 Mar 09 EXCITING HAPPENINGS OF PREGNANCY: SPERMS
Great numbers of sperms are present in seminal fluid. The volume gradually accumulates until intercourse occurs. Then, with the overpowering and very sensuous experience called orgasm (known colloquially as a ”climax”), between two and four ml of fluid are deposited high up into the female’s vaginal tract. The act is known as intercourse, and the emission of the fluid is referred to as ejaculation.
This represents the culmination of copulation (intercourse), and for the male is the most climactic part. It is associated with enormous psychological overtones for both sexes. Indeed, it is the tremendous physical and mental impact of this event that has given “sex” (in its fullest meaning) such forceful connotations in the world at large.
Because the erect male penis is firm and elongated during intercourse, the seminal fluid is deposited usually at the far upper end of the vagina. In the fluid there are myriads of actively swimming sperms, with their tails thrashing madly about. The number may be as high as 700 million, although on average, it is around the 200-million mark.
Imagine this: There are enough sperms present in one single ejaculation to totally populate the entire United States of America in one fell swoop! Or it would populate a less populous nation such as Australia fifteen to twenty times over! But the truth is that only one single sperm is required to produce the anticipated pregnancy!
This represents nature’s absolute attention to detail. From the strictly biological point of view, nature’s task is to guarantee reproduction of the species. Therefore, to be absolutely certain this takes place, a superabundance is generally provided.
The many attractions of intercourse, the male-female relationship, and the pleasurable sensations to be derived from physical contact are another capricious ploy of nature. But sensible couples realize that the implications of sexual intercourse, although pleasurable and a physical and mental delight, are best reserved for the marital unit. The flow-on – namely, the production of a new life -requires much more than the promiscuous casual relationships that premarital or extramarital sex can offer. New life means the need for a home that can succour and care for it, in all aspects.
The sperms, with tails wildly thrashing, quickly find their way through the cervical canal into the womb, which is technically known as the uterus. The cervix is the neck of the womb, jutting into the upper part or vault of the vagina. A narrow canal allows penetration into the inner part of the womb, which is lined with special cells called the endometrium.
If intercourse occurs about midway through a menstrual cycle, then the chances of encountering an egg (or ovum) are quite high.
Several thousand sperms will manage to penetrate into the inner part of the womb but untold thousands perish in their fight to gain entry.
Branching out from either side of the uppermost part of the womb are two canals which lead into the Fallopian tubes (or oviducts). The tubes are several inches in length, and they end at a point closely related to the ovary on each side.
Once a month, the ovary produces an egg or ovum. There are two ovaries, one on each side, which again indicates the attention paid by nature. If one should become destroyed for any reason, there is always the back-up second one on the opposite side.
When a female baby is born, its ovary contains thousands of primitive eggs. When puberty occurs at the age of nine years or onwards, the ovaries suddenly commence activity, and produce an egg on a regular twenty-eight-day cycle. In a twenty-eight-day-cycle woman, this occurs on about the fourteenth day. The egg comes to the surface of the ovary, and bursts through the surface, to become free in the pelvic cavity.
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Tags: General Health
30 Mar 09 FAMILY MEDICAL CARE: RH BABIES
In Western lands such as Australia, New Zealand, and America and the U.K., about 85 per cent of people contain a blood factor, or “antigen” called the Rh factor. This is short for “rhesus,” because it was first discovered in rhesus monkeys. These people are referred to as Rh positive. The remaining 15 per cent do not have the Rh factor, and are called Rh negative.
The Rh factor is a complex, inherited characteristic. Problems are possible when an Rh negative woman becomes pregnant to her Rh positive husband and the foetus is Rh positive.
At the time of labour, some of the baby’s Rh positive blood enters the maternal circulation. This can cause the production of chemicals called “antibodies,” which will circulate in the mother’s blood from that time on. The risks of this having an adverse effect on the first baby are not high, but if a subsequent pregnancy yields another Rh positive baby, then risks start to mount. The mother’s antibodies can pass the placental barriers and enter the foetal circulation. Here they can have a highly destructive effect. They can progressively destroy the baby’s red cells. In severe instances they can result in the death of the infant before birth.
An enormous amount of work has been carried out to try to prevent this situation from occurring. It is now well established that if an Rh negative woman receives a blood transfusion during her life, this may act in a similar manner, and anti-Rh antibodies may be formed. This may have a similar adverse effect on her next baby, whether it is the first or not. In general terms, the risks to the first baby are small, if the mother has not previously been sensitized with a Rh positive blood transfusion or injection. But with each subsequent pregnancy, the risk to the foetus increases dramatically. Many methods of gauging the risk to the infant have been worked out. As pregnancy advances, samples of the fluid in which the baby swims (called the amniotic fluid) can be checked, and the rate of red cell destruction can be calculated from the amount of a product called bilirubin contained in the fluid. The greater the amount, the higher the risk to the foetus.
Babies adversely affected were often given an “exchange transfusion” soon after birth. In this way, their affected blood was completely removed and fresh blood introduced into their system. This method saved many lives.
A New Zealand obstetrician named Liley devised an ingenious system for giving affected babies a transfusion while they were still in the womb. Many lives were also saved in this manner.
However, the most recent advance in the field has been a dramatic one. Mothers who are Rh negative and are carrying an Rh positive baby can now be given a special injection of high potency “anti-D gamma globulin” within seventy-two hours of the birth of the baby. This effectively reduces the formation of maternal antibodies to the baby’s cells. In short, it removes the possibility of Rh disease occurring in a subsequent pregnancy.
This must be carried out on each occasion. The method has now been in operation for several years, and the results are extremely promising. It may not completely eliminate Rh disease, but could go a long way in this direction.
There are still many women around who are reproducing, and who had their initial pregnancy prior to the introduction of the special serum. They run the original risks, and the serum will be of no value to them, for they have already developed the antibodies.
But for women having their first babies, the method offers unequalled protection. It is one of the major advances of this modern era. In due course it may completely remove the need for exchange transfusions, or for Liley’s uterine transfusions. It will make the world a happier place. It will make many mothers much happier too.
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30 Mar 09 FAMILY MEDICAL CARE: WATCHING YOUR WEIGHT WHEN YOU ARE PREGNANT
Watch your weight when you are pregnant!
These days, women are more weight-conscious than ever before. This is because weight is related directly to physical appearance, and the “figure.” In Western society, a “good figure” is equated with physical attraction and feminity. Many women find the temptation of excessive eating too hard to resist, so they become overweight.
As the mirror stares back and reproaches them, the majority realizes their folly, but usually after it is too late.
Overweight is recognized as a national emblem of an affluent society. The more money there is to spend, the more people eat (both men and women). But this is poor solace when a woman is suddenly stripped of her attractive appearance, and becomes part of the forlorn race whose looks have ceased to be.
However, an alteration in figure during pregnancy is unavoidable. It is part of the physiology of reproducing, and this aspect of a woman’s life is accepted and acceptable. It is a self-limiting situation, and usually merely a matter of time before most women are able to regain their former silhouette. However, as many women who have previously reproduced know so well, there are many hazards encountered during pregnancy, avoirdupois is concerned.
A gain in weight and alteration in shape there will assuredly be. But it is very easy to let this merge into unacceptable weight gain. If this occurs, when the pregnancy is over, it may be very difficult to slip back to the pre-pregnant weight or figure.
So, for purely “social” reasons, women should take a second look at the weight factor during their days of pregnancy.
As a general rule, the total weight gain during pregnancy should not be in excess of 33 lb (15 kg). Women are well advised to gain no more than 1 lb (0.5 kg) a week during the last twenty weeks of pregnancy.
When these limits are exceeded, the risks of permanent weight increase are very high. Every woman knows the difficulty in reducing. After the birth of a baby, it can be even more difficult, so that many women slip silently into a permanent increased weight, complete with its potential hazards, socially and medically.
During pregnancy, weight increase is also important, as it may be related to serious complications. One of the most important is a condition called pre-eclampsia. If this takes place, it may lead to even more dangerous complications which may eventually be a problem to the woman and her baby.
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30 Mar 09 MEDICAL CARE FOR PREGNANT WOMEN: DRUGS MAY BE DANGEROUS
In the early 1960s, the first warning shots that certain drugs administered during early pregnancy might be dangerous were fired by an Australian obstetrician named William McBride.
It was reported in London’s medical magazine Lancet in the form of a short letter in the correspondence pages. Of course, what transpired is now well-established, world-wide medical history.
It was the start of the thalidomide disaster revelation. This drug had been prescribed with good intent by physicians around the world as a safe and reliable sedative. But given to pregnant women during the early months, it proved to be a monster in disguise. It had a profound effect on the development of certain key parts of the body, and subsequently great numbers of deformed and crippled children were born.
Since the tragic sixties, an enormous amount of research has been pumped into the study of drug therapy during pregnancy. The results have been so startling that now there is a blanket procedure followed by most obstetricians throughout the Western world. It is simple, clear and straightforward. In essence it merely says: “No drugs of any description during pregnancy.”
In practice it is modified a little. The risk is highest during the early months of pregnancy (particularly the first four.) So, doctors are loath to recommend any form of drug therapy during these first few vital months when cells are dividing and vital organs are being formed.
Many doctors order vitamin preparation, and I believe this is a good idea. Much misinformation has been printed about vitamins over the past few years, but there also seems a lot of evidence supporting their value, both for normal healthy people as well as for pregnant women. I think they have a lot going for them. Most are water-soluble, and any unwanted excess will be excreted. We gain enough vitamin D from the sunlight, and probably receive sufficient vitamin A from our food – A and D are the ones which may cause trouble if used in excessive amounts.
Some women may have heard of medication called Debendox, which was used for many years to check the nausea of pregnancy. In 1982 this was removed from prescribing lists and its manufacture ceased. Public pressure was against the medication, although for many years, thousands of women took it with good results, and with no ill effects either to themselves or their baby. Today, many doctors are swinging back to simple old vitamin B6, also known as pyridoxine, to check nausea.
But as for other forms of medication, doctors say, “Hands off – leave them all alone!” This extends even to simple everyday over-the-pharmacy-counter lines such as aspirin products.
So, any pregnant woman is well advised NOT to take any form of medication under any circumstances, particularly during the first three or four months of pregnancy. Be guided absolutely by your doctor’s recommendations. And do not forget that this includes any of the readily available products you might not place in the category of drug therapy. Think twice before you place anything in your mouth when you are pregnant! This could be the only way to guarantee complete safety.
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27 Mar 09 SEXUAL INTERCOURSE, REPRODUCTION: WHAT IS AN EMBRYO? WHAT’S A FOETUS? WHAT IS A MISCARRIAGE? WHAT IS A STILL BIRTH?
After an ovum has been fertilized and plants itself in the uterus, it begins the nine-month-long process of developing into a baby. For the first three months, it is referred to as an embryo. After three months, it is called a foetus.
What is a miscarriage? What is a still birth?
When an embryo or foetus dies, it is expelled from the mother’s uterus and this is called a miscarriage. Most miscarriages happen during the first three months of pregnancy. It is unusual for a woman to miscarry after three months, but it does happen. Doctors aren’t always sure why a miscarriage has happened, but usually the embryo or foetus has a defect or problem in its development that makes it impossible for it to survive. Having a miscarriage doesn’t usually affect a woman’s chances of having a normal baby in the future.
Still birth means that the baby is born dead. In some cases the baby has died during the birth process; in other cases the baby has died in the womb before birth. Sometimes the doctor can pin-point a defect in the baby that caused the death, but at other times the reason for the still birth remains a mystery. Fortunately, miscarriages after the third month of pregnancy and still births are rare. Most women have normal pregnancies and give birth to healthy babies.
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Tags: Men’s Health
27 Mar 09 SEXUAL INTERCOURSE, REPRODUCTION: WHAT IS A CAESAREAN SECTION?
If for one reason or another a baby can’t be born in the normal way, the doctor does an operation called a Caesarean section. The woman is anaesthetized so she can’t feel anything from her waist down. Then the doctor makes an incision in her abdomen and uterus and removes the baby from her body by lifting it out through the incision. Afterwards, the incision is sutured shut. Babies born by Caesarean section are usually perfectly healthy.
There are a number of reasons why a baby might have to be born by Caesarean section. For example, labour may be taking so long that the baby is getting worn out and its heartbeat is slowing down. Or the baby might be in a position that would make normal delivery difficult or impossible. The woman’s cervix might not be dilating properly or her contractions might be too weak to push the baby out. For these or other reasons, the doctor might need to do a Caesarean section.
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Tags: Men’s Health
27 Mar 09 SEXUAL INTERCOURSE, REPRODUCTION: WHAT HAPPENS WHEN A BABY IS BORN?
When a baby is ready to be born, the mother goes into what we call ‘labour’. During labour the muscles of the mother’s uterus begin to contract rhythmically and the mother feels a cramping sensation. At first the contractions aren’t very strong and come only once in a while. As labour continues, the contractions become stronger and stronger and come more often. At some point during labour or childbirth the amniotic sac, the bag of fluids inside which the baby grows, breaks open and the woman feels a gushing or leaking of fluid from her vagina. This is often called the ‘breaking of the waters’. If the amniotic sac doesn’t break on its own, the doctor will break it.
During labour the cervix, the lower parts of the uterus, begins to dilate (open up). When the cervix is fully dilated and the contractions are strong and regular, the force of the contractions begins to push the baby out of the uterus, through the cervix, through the vagina and out through the vaginal opening. Most babies are born head first, but some babies come out feet first or with some other part of the body coming first.
The average length of time for labour with a woman’s first baby is about twelve to fourteen hours, and about seven hours with her subsequent pregnancies. However, some women have shorter or longer labours than this. Doctors usually tell women to come to hospital when the contractions are coming regularly, every five minutes. Once the contractions are coming this regularly, it will usually be at least several more hours before the baby is born, but some women have very short labours and occasionally you will hear of a baby being born in a car on the way to the hospital. Sometimes, a woman will have some contractions in the week or so before the baby is born, but this is pre-labour and isn’t considered real labour.
For some women labour and childbirth are very painful; for others there is little or no pain. For most women there is some discomfort, for the contractions have to be very strong in order to push the baby out. Some women practise certain exercises during pregnancy and use breathing techniques during labour that help control the pain. If the pain is too intense, the woman may choose to have an anaesthetic that numbs her from the waist down so she doesn’t feel the pain.
Once labour has progressed to the point where the cervix is fully dilated (opened to about 100 mm or 4 in), the ‘pushing stage’ begins. During this stage the mother, if she hasn’t been anaesthetized, can help to bring the baby out by pushing along with the contractions. Even if she can’t help push, the contractions alone are usually enough to push the baby out into the world. This pushing stage usually lasts for one to three hours with a first pregnancy and for about half an hour with subsequent pregnancies, but it may be shorter or longer than this.
During the pushing stage, the baby begins to move out of the uterus and through the cervix into the vagina. When the entire top of the baby’s head is visible at the vaginal opening, it usually takes only a few more contractions to push the baby entirely out into the world.
When a baby is born, it has a cord, known as the umbilical cord, attached to its tummy. The other end of this cord is attached to the placenta. The placenta is a special organ that develops inside the uterus during pregnancy to bring blood and nourishment from the mother to the baby. The placenta usually comes out within a half-hour after the baby. The doctor then cuts the cord and disposes of it and the placenta. The cord is cut within a short distance of the baby’s tummy and is clamped or tied. By the time the baby is a couple of weeks old, the cord above the clamp or knot will have dried up and fallen off by itself.
After the birth, the doctor or nurse checks the baby and may clean it up a bit before giving it to its mother to hold. The boys and girls in our classes get a big kick out of hearing about their own births. You might ask your mother to tell you about her labour with you.
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Tags: Men’s Health
27 Mar 09 WHY ANOTHER SEX ARTICLE? WHY A ‘FAMILY, ARTICLE OF LOVE AND SEX?
Because many sex articles concentrate on people as if all that mattered were their genitals. This is ill-advised. Physical sex has been greatly over-emphasised in modern Western Society. The mood is now right for a article that looks at sex and sexuality in a wider context and this involves concepts of reason, loving, caring and togetherness. Far too many books have emphasised the ‘I’m the most important person in the world’ approach to the subject. Love and sex in reality involve other people’s lives and do so very intimately.
With the coming of AIDS more and more people are looking to their existing relationships to answer their needs for love and sex rather than throwing in the towel and starting again. This book helps make this possible by encouraging understanding, tolerance and flexibility.
Why a ‘family, book of love and sex?
Because our individual sexuality starts to express itself the day we are born. We need to understand the sexual components of life from birth to old age so that we can be more effective, happy and fulfilled human beings and parents and prevent our children from suffering from many of the problems we have as adults. We all want what is best for our children yet which of us is equipped to provide it in today’s changing and complex society?
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Tags: Men’s Health
27 Mar 09 INTRODUCTION
Sexuality is a vast subject covering many fields of study. Genitality, with which it is usually confused, is only a small part of it, yet sex books and sex education tend to concentrate on this aspect of it.
This is understandable because the anatomical differences between the sexes, and especially the genital differences, are the subject of endless fascination and interest from childhood onwards. In our western culture we put so many prohibitions on interest in our genitals and genitality that there is a danger of becoming absorbed with the topic to the exclusion of the more important aspects of sexuality in our relationships and lives.
Men and women are highly complex physical, emotional and psychological beings and to ignore the love, the feelings and the relationships that go hand in hand with genitality is like driving a car with only one wheel. The result is the same — a dangerous imbalance. For many people the sexual aspects of their lives are less fulfilling than they should or could be and they end up passing on their hang-ups, wrong perceptions and misunderstandings about sex and sexuality to their children.
As a culture we try to overcome our natural interest in but unnatural emphasis on the genitals by talking a lot about love and most readers would agree that if men and women could love each other perfectly the world would be a very different place. In a sense if we can love another human being perfectly we are half-way towards loving everyone and the world needs love more than ever before. The sort we need is not the vague love that teenagers feel for all mankind but rather a mature, practical and real love for another real human being.
Real love is in short supply and many people, because of their upbringing, do not love themselves enough to be able to love another person. Yet others are so obsessed with themselves that they are unable to allow another person to intrude in any significant way. Men and women in all kinds of relationships often feel they do not love each other very much and some even hate each other. Some men dislike all women and some women, all men. What a terrible state of affairs to have got ourselves into in a so-called Christian society that should be based on love.
Unfortunately, the man-woman relationship has many enemies. To the extent that the state or religions demand that their interests be given prior consideration and that the man-woman relationship itself should be governed by them, they intrude on and may even damage the relationship. Both, of course, do so ‘accidentally’ under the guise of trying to further the relationship.
In fact, for a supposedly caring society based on Judaeo-Christian morals, we seem to be doing rather badly in this area. Premarital pregnancies and sexually-transmitted diseases are on the increase in spite of efforts to curb them; over a third of marriages end in divorce; one in eight children live in one-parent families; most parents have problems in dealing with their teenagers’ emerging sexuality; and depression, the most widespread psychological illness of our society, is not only commoner than ever but often has a psychosexual basis. There is certainly no room for complacency. But what can the average family hope to do to redress the balance?
Obviously a way to change things is to shield our children from the negative cultural influences that we suffered, but this is not easy because we as parents are steeped in them.
Is to look at love and sex from the cradle to the grave and, with the benefit of knowledge of both family and psychosexual medicine, weave a picture of interlinking complexity that shows how a child grows up to become a sexual person. We then follow this person through life and look at other major milestones along the way. The subject is enormous and we have drawn on research from all over the world to add to our own clinical experience. After all, no one person can have seen it all and, in the final analysis, everyone is different.
In this completely revised edition, we have brought all the facts and figures up to date and have taken the AIDS epidemic into account. Because we have had to be brief on very important subjects we have tried to concentrate on what families most want to know and have tried to be as practical as possible. After all, unless you have had a wide experience of teenagers and talked to them about their intimate fears, problems, loves, hates and aspirations you can’t really know how your own child fits into the picture of ‘normality’. Many parents end up feeling hopelessly confused, especially in our fast-changing world.
Being a parent is probably more difficult today than ever before because the conflicts within society are so great, and the last thing that most parents need is yet another sex manual to tell them and their family how to behave genitally. Clinical experience repeatedly confirms that although genital sex can help cement a relationship in troubled times, sex nearly always looks after itself in a good relationship. Many people with so-called sex problems have personality or interrelationship problems deep down – the sex problem is simply the obvious symptom of which they complain.
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Tags: Men’s Health
