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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