Early Pregnancy Symptom - How to Detect Pregnancy by Yourself By Anupriya Jain Pregnancy calls for one of the most

beautiful phase in a woman's life being accompanied by each early pregnancy symptom. These pregnancy symptoms have always been a source of joy as well as often anxieties. Many women are unaware of early pregnancy symptoms and what development each symptom indicates. Moreover, to start planning for a family with your new baby, you must be knowledgeable about pregnancy symptoms and to what extent they are normal. If you observe the signs of pregnancy to increase and decrease abnormally, you must consult with your physician. Therefore, pregnant women need to be familiar with all the probable early pregnancy symptoms. She also needs to know the difference between pregnancy and non-pregnancy symptoms. The period, intensity and the sequence of arrival of pregnancy symptoms largely vary from one woman to another. So, before you start fretting over absence of a particular symptom that your friend or sister might have undergone at your stage, get facts on each early pregnancy symptom from this article. How Your Body Tells That You Are Pregnant During pregnancy, women undergo many changes. Drastic hormonal changes in body are because of the physical and psychological changes a woman undergoes during pregnancy. This hormonal change takes place to support the development of the fetus inside. All women tend to experience some common symptoms in the early trimester of the pregnancy period. Each early pregnancy symptom appears in the same manner, but slight differences can be expected. Now let us discuss about pregnancy symptoms and how to identify them -

Implantation Bleeding Implantation bleeding is also known as vaginal spotting. This is a very common early pregnancy symptom and takes place when the fertilized egg gets attached to uterus walls. In following ways you will get to differentiate implantation bleeding from common vaginal bleeding -

bleeding of menstruation. ancy. implantation bleeding. If you happen to experience similar symptoms within a week of conceiving, consider a home pregnancy test to confirm your pregnancy. Frequent Urination Increased frequency in urination is a significant early pregnancy symptom. Stretch in ligaments and hormonal changes may lead pregnant women rush to loo. As your uterus enlarges to accommodate development of the fetus, it starts occupying spaces of bladder and pushes it, which is why you may feel a surge of urine now and then. Tender, Sore Breasts Another very important early pregnancy symptom is tenderness and painful breasts. After conceiving, you will notice your breasts to enlarge accompanied by a feeling of tenderness due to the hormonal changes in body. High Temperature

If you notice that your basal body temperature is increasing after conception, then you know you are pregnant. When your body temperature remains high for a number of days even if you are not having menstruation, it is an early pregnancy symptom. Missed Periods A missed period id considered one of the surest pregnancy symptoms to be felt at the earliest stage. However, it may arrive before or after any other early pregnancy symptom and extensively vary in women. Fatigue and Weakness Pregnancy brings enormous feeling of exhaustion. When you tend to feel fatigue and dizziness with any other symptom, you need to contact an expert. As per medical experts, fainting is a common early pregnancy symptom. Along with exhaustion, you might feel sickness in different time of the day with discomforts of nausea. Though pregnant women may feel at any time or throughout the day, this early pregnancy symptom is known as 'morning sickness'. Before you consult your gynecologist, you need to prepare a proper and detailed pregnancy journal mentioning each early pregnancy symptom to help him or her detect pregnancy accurately. An early pregnancy symptoms, while on one hand brings joy it breeds anxiety too. However, mere presence of pregnancy symptoms does not confirm pregnancy. Therefore, when you start witnessing signs of pregnancy, maintain a pregnancy journal and visit you doctor for a pregnancy test and for further instructions. Early Pregnancy Symptom has more information on signs to detect early pregnancy. Article Source: http://EzineArticles.com/?expert=Anupriya_Jain

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How To Detect Pregnancy - Identifying 2 Early Signs By Abhishek Agarwal

Is it possible to ascertain pregnancy without subjecting yourself to any pregnancy tests? Yes, you can tell that you are pregnant by making a close observation of your body. You can catch some early, subtle signs of pregnancy without having to purchase home pregnancy testing kits or visiting the doctor. So, watch out for those early pregnancy signs. To determine if you are pregnant by watching out for early signs of pregnancy, you need to know exactly what signs to watch out for. Here is a list of early signs of pregnancy. Keep a sharp look out for these signs if you are trying to become a mother. The early signs of pregnancy are nausea, fullness in the breasts, tender nipples or breasts, fatigue, vomiting, frequent urination, headache, constipation, spotting, cramps, cravings for food, bloating, and mood swings. 1. Tenderness in Breasts Several women report a fullness in their breasts during the earliest days of their pregnancy. Tender nipples and enlarged breasts are among the earliest signs of pregnancy. Two weeks after conception, a woman's breasts will feel sore, heavy, tender, and even tingly. This is because of hormonal changes in your body, a rise in the level of estrogen that prepares your body for

motherhood. You might especially notice tenderness and enlargement of breasts if you are becoming pregnant for the first time. 2. Cramps and Spotting Another early sign of pregnancy that could manifest even before you miss a period is cramping and spotting. The woman might experience light bleeding and a cramping sensation in her uterus a week or two after conception. This light bleeding, also referred to as implantation bleeding, is initiated when the embryo attaches itself to the wall of the uterus. It is different from the usual period because it is lighter, shorter, and spottier. Some women also experience cramps during the earliest stages of pregnancy, and these cramps might be feel just like a menstrual cramps. Before you visit your doctor, wait till your have missed your period or taken a home pregnancy test to determine pregnancy. The above-mentioned signs are very early signs of pregnancy and can provide information about your condition even before you miss a period. At the same time, you must remember that very early signs of pregnancy need not really mean pregnancy. They could very well mean the beginning of another monthly cycle or some physical illness. If you notice any of these signs within you and you suspect pregnancy, take a pregnancy test or wait for a missed period before you see your doctor. Abhishek has got some great Pregnancy And Childbirth Secrets up his sleeves! Download his FREE 77 Pages Ebook, "Understanding Pregnancy!" from his website http://www.Childbirth-Guru.com/774/index.htm. Only limited Free Copies available. Article Source: http://EzineArticles.com/?expert=Abhishek_Agarwal

http://ezinearticles.com/?How-To-Detect-Pregnancy---Identifying2-Early-Signs&id=1660606 How to Detect Pregnancy Soon After Conception By Bill Herrfeldt, eHow Contributor updated January 31, 2011

Print this article

Early signs of pregnancy? A woman wakes up one day and something seems different. Whether it's by accident or plan, could it be that she's pregnant? While many women begin thinking that is the case when they miss a monthly period, others begin showing signs even earlier. You may be able to detect if you're pregnant soon after conception. Not every woman will experience the same symptoms; you can decide for yourself. Difficulty:

Moderately Challenging Instructions 1.

o

1 Note if you are tired, even though you have not worked harder or have had difficulty sleeping. This, along with dizziness, could be the result of a hormonal change as your body is preparing to feed and care for a growing baby. You should give in to this condition and allow more time for rest. 2 You are nauseated, even though you have eaten nothing and haven't come down with a bug. So-called "morning sickness" often happens during the first trimester of pregnancy and quite frequently within the first couple of weeks since conception. Unlike its name might imply, many women have been nauseated at all hours, day or night. 3 You have heartburn, a condition that may happen to you infrequently. At the beginning of your pregnancy, heartburn can be controlled with Tums or Rolaids. During your pregnancy, you should avoid any medication before discussing it with your doctor. 4 You notice changes taking place in your breasts. This can happen within two weeks of conception. Many women say that their breasts are tender to the touch and that they are experiencing a tingling feeling. Others experience no changes at all. Toward the end of the first trimester, you will notice a darkening of the area around your nipples as your body prepares to care for the baby. 5 You feel the need to urinate more frequently. That is caused by the pressure exerted on your bladder by your growing uterus. Frequent urination can also be caused by infections, diuretics,

diabetes or stress. If you find later that you are not pregnant, you should see your doctor about your condition. Tips & Warnings

Take a home pregnancy test; they are more accurate and easy to use than ever before. If you get a positive result, make a prenatal appointment with your doctor to confirm your findings

http://www.ehow.com/how_4487735_detect-pregnancy-soonafter-conception.html Read more: How to Detect Pregnancy Soon After Conception | eHow.com http://www.ehow.com/how_4487735_detectpregnancy-soon-after-conception.html#ixzz1S5UD2QLu Pregnancy From Wikipedia, the free encyclopedia This article is about pregnancy in female humans. For pregnancy in non-human animals, see Gestation. For pregnancy in males, see Male pregnancy. Pregnancy Classification and external resources

A pregnant woman at the end of the second trimester. ICD-10 Z33.

ICD-9 DiseasesDB MedlinePlus eMedicine MeSH

650 10545 002398 article/259724 D011247

Pregnancy is the carrying of one or more offspring, known as a fetus or embryo, inside the womb of a female. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets. Human pregnancy is the most studied of all mammalian pregnancies. Childbirthusually occurs about 38 weeks after conception; in women who have a menstrual cycle length of four weeks, this is approximately 40 weeks from the last normal menstrual period (LNMP). The World Health Organization defines normal term for delivery as between 37 weeks and 42 weeks.

Contents [hide]

1 Terminology 2 Progression o 2.1 Initiation o 2.2 Prenatal period o 2.3 Postnatal period o 2.4 Perinatal period o 2.5 Duration o 2.6 Childbirth 3 Diagnosis 4 Physiology o 4.1 First trimester o 4.2 Second trimester o 4.3 Third trimester o 4.4 Embryonic and fetal development o 4.5 Physiological changes 5 Management o 5.1 Nutrition o 5.2 Weight gain o 5.3 Immune tolerance o 5.4 Medication use o 5.5 Exposure to toxins o 5.6 Sexual activity during pregnancy o 5.7 Abortion 6 Complications 7 Concomitant diseases 8 Stem cell collection 9 See also 10 References 11 External links

Terminology One scientific term for the state of pregnancy is gravid, and a pregnant female is sometimes referred to as a gravida.[1] Neither word is used in common speech. Similarly, the term "parity" (abbreviated as "para") is used for the number of previous successful live births. Medically, a woman who has never been pregnant is referred to as a "nulligravida", a woman who is (or has been only) pregnant for the first time as a "primigravida",[2] and a woman in subsequent pregnancies as a multigravida or "multiparous".[1][3][4] Hence, during a second pregnancy a woman would be described as "gravida 2, para 1" and upon live delivery as "gravida 2, para 2". An in-progress pregnancy, as well as abortions, miscarriages, or stillbirthsaccount for parity values being less than the gravida number, whereas a multiple birth will increase the parity value. Women who have never carried a pregnancy achieving more than 20 weeks of gestation age are referred to as "nulliparous".[5] The term embryo is used to describe the developing offspring during the first 8 weeks following conception, and the term fetus is used from about 2 months of development until birth.[6][7] In many societies' medical or legal definitions, human pregnancy is somewhat arbitrarily divided into three trimester periods, as a means to simplify reference to the different stages ofprenatal development. The first trimester carries the highest risk of miscarriage (natural death of embryo or fetus). During the second trimester, the development of the fetus can be more easily monitored and diagnosed. The beginning of the third trimester often approximates the point of viability, or the ability of the fetus to survive, with or without medical help, outside of the uterus.[8]

Progression

Stages in prenatal development, with weeks and months numbered from last menstrual period. Initiation

The initial stages of human embryogenesis. Although pregnancy begins with implantation, the process leading to pregnancy occurs earlier as the result of the female gamete, or oocyte, merging with the male gamete, spermatozoon. In medicine this process is referred to as fertilization; in lay terms, it is more commonly known as "conception". After the point of fertilization, the fused product of the female and male gamete is referred to as a zygote or fertilized egg. The fusion of male and female gametes usually occurs following the act of sexual intercourse, resulting in spontaneous pregnancy. However, the advent of artificial insemination and in vitro fertilisation have also made achieving pregnancy possible in cases where sexual intercourse does not result in fertilization (e.g., through choice or male/female infertility).

The process of fertilization occurs in several steps, and the interruption of any of them can lead to failure. Through fertilization, the egg is activated to begin its developmental program, and the haploid nuclei of the two gametes come together to form the genome of a new diploidorganism [9] At the beginning of the process, the sperm undergoes a series of changes. As freshly ejaculated sperm is unable or poorly able to fertilize,[10]it must undergo capacitation in the female's reproductive tract over several hours. This increases its motility and destabilizes its membrane, preparing it for the acrosome reaction, the enzymatic penetration of the egg's tough membrane, the zona pellucida, which surrounds the oocyte. Prenatal period Prenatal defines the period occurring "around the time of birth", specifically from 22 completed weeks (154 days) of gestation (the time when birth weight is normally 500 g) to 7 completed days after birth.[11] Legal regulations in different countries include gestation age beginning from 16 to 22 weeks (5 months) before birth. Postnatal period Main article: Postnatal The postnatal period begins immediately after the birth of a child and then extends for about six weeks. During this period, the mother's body returns to prepregnancy conditions as far as uterus size and hormone levels are concerned. Perinatal period The perinatal period is immediately before to after birth. Depending on the definition, it starts between the 20th to 28th week of gestation and ends between 1 to 4 weeks after birth (the word "perinatal" is a hybrid of the Greek "peri-" meaning 'around or about' and "natal" from the Latin "natus" meaning "birth.").

Duration The expected date of delivery (EDD) is 40 weeks counting from the first day of the last menstrual period (LMP), and birth usually occurs between 37 and 42 weeks.[12] Though pregnancy begins at implantation, it is more convenient to date from the first day of a woman's last menstrual period, or from the date of conception if known. Starting from one of these dates, the expected date of delivery can be calculated using the Naegele's rule for estimating date of delivery. A more sophisticated algorithm takes into account other variables, such as whether this is the first or subsequent child (i.e., pregnant woman is a primip or a multip, respectively), ethnicity, parental age, length of menstrual cycle, and menstrual regularity. There is a standard deviation of 8-9 days surrounding due dates calculated with even the most accurate methods. This means that fewer than 5% of births occur at exactly 40 weeks; 50% of births are within a week of this duration, and about 80% are within 2 weeks.[13] It is much more useful and accurate, therefore, to consider a range of due dates, rather than one specific day, with some online due date calculators providing this information. [2] Pregnancy is considered "at term" when gestation attains 37 complete weeks but is less than 42 (between 259 and 294 days since LMP). Events before completion of 37 weeks (259 days) are considered preterm; from week 42 (294 days) events are considered postterm.[14] When a pregnancy exceeds 42 weeks (294 days), the risk of complications for both the woman and the fetus increases significantly.[12][15] As such, obstetricians usually prefer to induce labour, in an uncomplicated pregnancy, at some stage between 41 and 42 weeks.[16][17] Recent medical literature prefers the terminology preterm and postterm to premature and postmature. preterm and postterm are unambiguously defined as above, whereas premature andpostmature have historical meaning and

relate more to the infant's size and state of development rather than to the stage of pregnancy.[18][19] Accurate dating of pregnancy is important, because it is used in calculating the results of various prenatal tests (for example, in the triple test). A decision may be made to induce labour if a fetus is perceived to be overdue. Furthermore, if LMP and ultrasound dating predict different respective due dates, with the latter being later, this might signify slowed fetal growth and therefore require closer review. The age of viability has been receding because of continued medical progress. Whereas it used to be 28 weeks, it has been brought back to as early as 23, or even 22 weeks in some countries. Childbirth Main article: Childbirth Childbirth is the process whereby an infant is born. It is considered by many[who?] to be the beginning of the infant's life, and age is defined relative to this event in most cultures. A woman is considered to be in labour when she begins experiencing regular uterine contractions, accompanied by changes of her cervix primarily effacement and dilation. While childbirth is widely experienced as painful, some women do report painless labours, while others find that concentrating on the birth helps to quicken labour and lessen the sensations. Most births are successful vaginal births, but sometimes complications arise and a woman may undergo a cesarean section. During the time immediately after birth, both the mother and the baby are hormonally cued to bond, the mother through the release of oxytocin, a hormone also released duringbreastfeeding.

Diagnosis

Linea nigra in a woman at 22 weeks pregnant. The beginning of pregnancy may be detected in a number of different ways, either by a pregnant woman without medical testing, or by using medical tests with or without the assistance of a medical professional. Most pregnant women experience a number of symptoms,[20] which can signify pregnancy. The symptoms can include nausea and vomiting, excessive tiredness and fatigue, cravings for certain foods that are not normally sought out, and frequent urination particularly during the night. A number of early medical signs are associated with pregnancy.[21][22] These signs typically appear, if at all, within the first few weeks after conception. Although not all of these signs are universally present, nor are all of them diagnostic by themselves, taken together they make a presumptive diagnosis of pregnancy. These signs include the presence of human chorionic gonadotropin (hCG) in the blood and urine, missedmenstrual period, implantation bleeding that occurs at implantation of the embryo in the uterus during the third or fourth week after last

menstrual period, increased basal body temperature sustained for over 2 weeks after ovulation, Chadwick's sign (darkening of the cervix,vagina, and vulva), Goodell's sign (softening of the vaginal portion of the cervix), Hegar's sign (softening of the uterus isthmus), and pigmentation of linea alba Linea nigra, (darkening of the skin in a midline of the abdomen, caused by hyperpigmentation resulting from hormonal changes, usually appearing around the middle of pregnancy).[21][22] Breast tenderness is common during the first trimester, and is more common in women who are pregnant at a young age.[23] Pregnancy detection can be accomplished using one or more various pregnancy tests,[24] which detect hormones generated by the newly formed placenta. Clinical blood and urine tests can detect pregnancy 12 days after implantation.[25] Blood pregnancy tests are more accurate than urine tests.[26] Home pregnancy tests are urine tests, and normally cannot detect a pregnancy until at least 12 to 15 days after fertilization. A quantitative blood test can determine approximately the date the embryo was conceived. In the post-implantation phase, the blastocyst secretes a hormone named human chorionic gonadotropin, which in turn stimulates the corpus luteum in the woman's ovary to continue producing progesterone. This acts to maintain the lining of the uterus so that the embryo will continue to be nourished. The glands in the lining of the uterus will swell in response to the blastocyst, and capillaries will be stimulated to grow in that region. This allows the blastocyst to receive vital nutrients from the woman. Despite all the signs, some women may not realize they are pregnant until they are quite far along in their pregnancy. In some cases, a few women have not been aware of their pregnancy until they begin labour. This can be caused by many factors, including irregular periods (quite common in teenagers), certain medications (not related to conceiving children),

and obese women who disregard their weight gain. Others may be in denial of their situation. An early obstetric ultrasonography can determine the age of the pregnancy fairly accurately. In practice, doctors typically express the age of a pregnancy (i.e., an "age" for an embryo) in terms of "menstrual date" based on the first day of a woman's last menstrual period, as the woman reports it. Unless a woman's recent sexual activity has been limited, she has been charting her cycles, or the conception is the result of some types of fertility treatment (such as IUI or IVF), the exact date of fertilization is unknown. Without symptoms such as morning sickness, often the only visible sign of a pregnancy is an interruption of the woman's normal monthly menstruation cycle, (i.e., a "late period"). Hence, the "menstrual date" is simply a common educated estimate for the age of a fetus, which is an average of 2 weeks later than the first day of the woman's last menstrual period. The term "conception date" may sometimes be used when that date is more certain, though even medical professionals can be imprecise with their use of the two distinct terms. The due date can be calculated by usingNaegele's rule. The expected date of delivery may also be calculated from sonogram measurement of the fetus. This method is slightly more accurate than methods based on LMP.[27]Additional obstetric diagnostic techniques can estimate the health and presence or absence of congenital diseases at an early stage. Diagnostic criteria are: Women who have menstrual cycles and are sexually active, a period delayed by a few days or weeks is suggestive of pregnancy; elevated B-hcG to around 100,000 mIU/mL by 10 weeks of gestation.[citation needed] Physiology Pregnancy is typically broken into three periods, or trimesters, each of about three months.[28] While there are no hard and fast

rules, these distinctions are useful in describing the changes that take place over time. First trimester Traditionally, doctors have measured pregnancy from a number of convenient points, including the day of last menstruation, ovulation, fertilization, implantation and chemical detection. In medicine, pregnancy is often defined as beginning when the developing embryo becomes implanted into the endometrial lining of a woman's uterus. In some cases where complications may have arisen, the fertilized egg might implant itself in the fallopian tubes, the cervix, the ovary or in the abdomen, causing an ectopic pregnancy. In the case of an ectopic pregnancy, there is no way for the pregnancy to progress normally. If left untreated, it can cause harm and possibly death for the mother when a rupture occurs. Sometimes it will go away on its own, but otherwise a surgical procedure or medicine is given to remove the tubal pregnancy, since there is no way of the pregnancy being able to continue safely.[29] Most pregnant women do not have any specific signs or symptoms of implantation, although it is not uncommon to experience minimal bleeding at implantation. Some women will also experience cramping during their first trimester. This is usually of no concern, unless there is spotting or bleeding as well. After implantation, the uterine endometrium is called the decidua. Theplacenta, which is formed partly from the decidua and partly from outer layers of the embryo, connects the developing fetus to the uterine wall to allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply. The umbilical cord is the connecting cord from the embryo or fetus to the placenta. The developing embryo undergoes tremendous growth and changes during the process of fetal development. Morning sickness occurs in about seventy percent of all pregnant women, and typically improves after the first trimester.[30][dead link] Although described as "morning sickness", women can

experience this nausea during afternoon, evening, and throughout the entire day. In the first 12 weeks of pregnancy, the nipples and areolas darken due to a temporary increase in hormones.[31] The first 12 weeks of pregnancy are considered to make up the first trimester. The first two weeks from the first trimester are calculated as the first two weeks of pregnancy even though the pregnancy does not actually exist. These two weeks are the two weeks before conception and include the woman's last period. The third week is the week in which fertilization occurs and the 4th week is the period when implantation takes place. In the 4th week, the fecundated egg reaches the uterus and burrows into its wall which provides it with the nutrients it needs. At this point, the zygote becomes a blastocyst and the placenta starts to form. Moreover, most of the pregnancy tests may detect a pregnancy beginning with this week. The 5th week marks the start of the embryonic period. This is when the embryo's brain, spinal cord, heart and other organs begin to form.[32] At this point the embryo is made up of three layers, of which the top one (called the ectoderm) will give rise to the embryo's outermost layer of skin, central and peripheral nervous systems, eyes, inner ear, and many connective tissues.[32] The heart and the beginning of the circulatory system as well as the bones, muscles and kidneys are made up from the mesoderm (the middle layer). The inner layer of the embryo will serve as the starting point for the development of the lungs, intestine and bladder. This layer is referred to as the endoderm. An embryo at 5 weeks is normally between 116and 18 inch (1.6 and 3.2 mm) in length. In the 6th week, the embryo will be developing basic facial features and its arms and legs start to grow. At this point, the embryo is usually no longer than 16 to 14 inch (4.2 to 6.3 mm). In

the following week, the brain, face and arms and legs quickly develop. In the 8th week, the embryo starts moving and in the next 3 weeks, the embryo's toes, neck and genitalsdevelop as well. According to the American Pregnancy Association, by the end of the first trimester, the fetus will be about 3 inches (76 mm) long and will weigh approximately 1 ounce (28 g).[33] Second trimester Weeks 13 to 28 of the pregnancy are called the second trimester. Most women feel more energized in this period, and begin to put on weight as the symptoms of morning sickness subside and eventually fade away. In the 20th week, the uterus, the muscular organ that holds the developing fetus, can expand up to 20 times its normal size during pregnancy. Although the fetus begins to move and takes a recognizable human shape during the first trimester, it is not until the second trimester that movement of the fetus, often referred to as "quickening", can be felt. This typically happens in the fourth month, more specifically in the 20th to 21st week, or by the 19th week if the woman has been pregnant before. However, it is not uncommon for some women not to feel the fetus move until much later. The placenta fully functions at this time and the fetus makes insulin and urinates. The reproductive organs distinguish the fetus as male or female. Third trimester

Comparison of growth of the abdomen between 26 weeks and 40 weeks gestation. Final weight gain takes place, which is the most weight gain throughout the pregnancy. The fetus will be growing the most rapidly during this stage, gaining up to 28 g per day. The woman's belly will transform in shape as the belly drops due to the fetus turning in a downward position ready for birth. During the second trimester, the woman's belly would have been very upright, whereas in the third trimester it will drop down quite low, and the woman will be able to lift her belly up and down. The fetus begins to move regularly, and is felt by the woman. Fetal movement can become quite strong and be disruptive to the woman. The woman's navel will sometimes become convex, "popping" out, due to her expandingabdomen. This period of her pregnancy can be uncomfortable, causing symptoms like weak bladder control and backache. Movement of the fetus becomes stronger and more frequent and via improved brain, eye, and muscle function the fetus is prepared for ex utero viability. The woman can feel the fetus "rolling" and it may cause pain or discomfort when it is near the woman's ribs and spine. There is head engagement in the third trimester, that is, the fetal head descends into the pelvic cavity so that only a small part (or none) of it can be felt abdominally. The perenium and cervix are further flattened and the head may be felt vaginally.[34] Head engagement is known colloquially as the baby drop, and in natural medicine as the lightening because of the release of pressure on the upper abdomen and renewed ease in breathing. However, it severely reduces bladder capacity, increases pressure on the pelvic floor and the rectum, and the mother may experience the perpetual sensation that the fetus will "fall out" at any moment.[35] It is during this time that a baby born prematurely may survive. The use of modern medical intensive care technology has greatly increased the probability of premature babies surviving, and has pushed back the boundary of viability to much earlier dates than

would be possible without assistance.[36] In spite of these developments, premature birth remains a major threat to the fetus, and may result in ill health in later life, even if the baby survives. Embryonic and fetal development See also: Prenatal development Prenatal development is divided into two primary biological stages. The first is the embryonic stage, which lasts for about two months. At this point, the fetal stage begins. At the beginning of the fetal stage, the risk of miscarriage decreases sharply,[37] all major structures including the head, brain, hands, feet, and other organs are present, and they continue to grow and develop. When the fetal stage commences, a fetus is typically about 30 mm (1.2 inches) in length, and the heart can be seen beating via sonograph; the fetus bends the head, and also makes general movements and startles that involve the whole body.[38] Some fingerprint formation occurs from the beginning of the fetal stage.[39] Electrical brain activity is first detected between the 5th and 6th week of gestation, though this is still considered primitive neural activity rather than the beginning of conscious thought, something that develops much later in fetation. Synapses begin forming at 17 weeks, and at about week 28 begin to multiply at a rapid pace which continues until 34 months after birth. It is not until week 23 that the fetus can survive, albeit with major medical support, outside of the womb, because it does not possess a sustainable human brain until that time.[40]

Embryo at 4 weeks after fertilization[41]

Fetus at 8 weeks after fertilization[42]

Fetus at 18 weeks after fertilization[43]

Fetus at 38 weeks after fertilization[44]

Relative size in 1st month (simplified illustration)

Relative size in 3rd month (simplified illustration)

Relative size in 5th month (simplified illustration)

Relative size in 9th month (simplified illustration) One way to observe prenatal development is via ultrasound images. Modern 3D ultrasound images provide greater detail for prenatal diagnosis than the older 2D ultrasound technology.[45]While 3D is popular with parents desiring a prenatal photograph as a keepsake,[46] both 2D and 3D are discouraged by the FDA for non-medical use,[47][dead link] but there are no definitive studies linking ultrasound to any adverse medical effects.[48] The following 3D ultrasound images were taken at different stages of pregnancy:

75-mm fetus (about 14 weeks gestational age)

Fetus at 17 weeks

Fetus at 20 weeks Some people are confused about the differences between an ultrasound and a sonogram. An ultrasound is the actual machine that lets you observe pregnancy. A sonogram is the image of the embryo that the ultrasound produces. 4D Ultrasounds take 3D sonograms. Some people refer to the procedure as prenatal imaging, 3D imaging, a 3D scan, or 4D scan. Physiological changes Main article: Maternal physiological changes in pregnancy

Melasma pigment changes to the face due to pregnancy During pregnancy, the woman undergoes many physiological changes, which are entirely normal, including cardiovascular, hematologic,metabolic, renal and respira tory changes that become very important in the event of complications. The body must change its physiological and homeostatic mechanisms in pregnancy to ensure the fetus is provided for. Increases in blood sugar, breathing and cardiac output are all required. Levels of progesterone and oestrogens rise continually throughout pregnancy, suppressing the hypothalamic axis and subsequently the menstrual cycle. The woman and the placenta also produce many hormones. Management Main article: Prenatal care Prenatal medical care is the medical and nursing care recommended for women before and during pregnancy. The aim of good prenatal care is to detect any potential problems early, to prevent them if possible (through recommendations on adequate

nutrition, exercise, vitamin intake etc.), and to direct the woman to appropriate specialists, hospitals, etc. if necessary. Nutrition Main article: Nutrition and pregnancy A balanced, nutritious diet is an important aspect of a healthy pregnancy. Eating a healthy diet, balancing carbohydrates, fat, and proteins, and eating a variety of fruits and vegetables, usually ensures good nutrition. Those whose diets are affected by health issues, religious requirements, or ethical beliefs may choose to consult a health professional for specific advice. Adequate periconceptional folic acid (also called folate or Vitamin B9) intake has been proven to limit fetal neural tube defects, preventing spina bifida, a very serious birth defect. The neural tube develops during the first 28 days of pregnancy, explaining the necessity to guarantee adequate periconceptional folate intake.[49][50]Folates (from folia, leaf) are abundant in spinach (fresh, frozen, or canned), and are found in green leafy vegetables e.g. salads, beets, broccoli, asparagus, citrus fruits and melons, chickpeas (i.e. in the form of hummus or falafel), and eggs. In the United States and Canada, most wheat products (flour, noodles) are fortified with folic acid.[51] DHA omega-3 is a major structural fatty acid in the brain and retina, and is naturally found in breast milk. It is important for the woman to consume adequate amounts of DHA during pregnancy and while nursing to support her well-being and the health of her infant. Developing infants cannot produce DHA efficiently, and must receive this vital nutrient from the woman through the placenta during pregnancy and in breast milk after birth.[52] Several micronutrients are important for the health of the developing fetus, especially in areas of the world where insufficient nutrition is prevalent.[53] In developed areas, such as Western Europe and the United States, certain nutrients such as Vitamin D and calcium, required for bone development, may

require supplementation.[54][55][56] A 2011 study examined cord blood of healthy neonates and found that low levels of vitamin D are associated with increased risk of lower respiratory tract infection the first year of life.[57] Dangerous bacteria or parasites may contaminate foods, particularly Listeria and toxoplasma, toxoplasmosis agent. Careful washing of fruits and raw vegetables may remove these pathogens, as may thoroughly cooking leftovers, meat, or processed meat. Soft cheeses may contain Listeria; if milk is raw, the risk may increase. Cat feces pose a particular risk of toxoplasmosis. Pregnant women are also more prone to Salmonella infections from eggs and poultry, which should be thoroughly cooked. Practicing good hygiene in the kitchen can reduce these risks.[58] Weight gain Caloric intake must be increased to ensure proper development of the fetus. The amount of weight gained during a single pregnancy varies among women. The Institute of Medicinerecommends an overall pregnancy weight gain for women starting pregnancy at a normal weight, with a body mass index of 18.5-24.9, of 25-35 pounds (11.4-15.9 kg).[59] Women who are underweight, with a BMI of less than 18.5, may need to gain between 28-40 lbs. Overweight women are advised to gain between 15-25 lbs, whereas an obese woman may expect to gain between 11-20 lbs. Doctors and dietitians may make different, or more individualized, recommendations for specific patients, based on factors including low maternal age, nutritional status, fetal development, and morbid obesity. During pregnancy, insufficient or excessive weight gain can compromise the health of the mother and fetus. All women are encouraged to choose a healthy diet regardless of pre-pregnancy weight. Exercise during pregnancy, such as walking and swimming, is recommended for healthy pregnancies. Exercise

has notable health benefits for both mother and baby, including preventing excessive weight gain.[60] Immune tolerance Main article: Immune tolerance in pregnancy The fetus inside a pregnant woman may be viewed as an unusually successful allograft, since it genetically differs from the woman.[61] In the same way, many cases of spontaneous abortion may be described in the same way as maternal transplant rejection.[61] Medication use Main article: Drugs in pregnancy Drugs used during pregnancy can have temporary or permanent effects on the fetus. Therefore many physicians would prefer not to prescribe for pregnant women, the major concern being over teratogenicity of the drugs. Drugs have been classified into categories A,B,C,D and X based on the Food and Drug Administration (FDA) rating system to provide therapeutic guidance based on potential benefits and fetal risks. Drugs like multivitamins that have demonstrated no fetal risks after controlled studies in humans are classified as Category A. On the other hand drugs like thalidomidewith proven fetal risks that outweigh all benefits are classified as Category X.[62] Exposure to toxins This article needs references that appear in reliable third-party publications. Primary sources or sources affiliated with the subject are generally not sufficient for a Wikipedia article. Please add more appropriate citations from reliable

sources. (December 2010) Various toxins pose a significant hazard to fetuses during development. A 2011 study found that virtually all U.S. pregnant women carry multiple chemicals, including some banned since the 1970s, in their bodies. Researchers detected polychlorinated biphenyls, organochlorine pesticides, perfluorinated compounds, phenols, polybrominated diphenyl ethers, phthalates,polycyclic aromatic hydrocarbons, perchlorate PBDEs, compounds used as flame retardants, and dichlorodiphenyltrichloroethane (DDT), a pesticide banned in the United States in 1972, in the bodies of 99 to 100 percent of the pregnant women they tested. Bisphenol A (BPA) was identified in 96 percent of the women surveyed. Several of the chemicals were at the same concentrations that have been associated with negative effects in children from other studies and it is thought that exposure to multiple chemicals can have a greater impact than exposure to only one substance.[63]

Alcohol ingestion during pregnancy may cause fetal alcohol syndrome, a permanent and often devastating birth-defect syndrome. A number of studies have shown that light to moderate drinking during pregnancy might not pose a risk to the fetus, although no amount of alcohol during pregnancy can be guaranteed to be absolutely safe.[64][65][66] Numerous studies show that children exposed to prenatal cigarette smoke may experience a wide range of behavioral, neurological, and physical difficulties.[67] Elemental mercury and methylmercury are two forms of mercury that may pose risks in pregnancy. Methylmercury, a worldwide contaminant of seafood and freshwater fish, is known to produce adverse nervous system effects, especially during brain development.[68] Eating fish is the main source of mercury exposure in humans and some fish may contain

enough mercury to harm the developing nervous system of an embryo or fetus, sometimes leading to learning disabilities. Mercury is present in many types of fish, but it is mostly found in certain large fish. The United States Food and Drug Administration and the Environmental Protection Agency advise pregnant women not to eat swordfish, shark, king mackerel and tilefish and limit consumption of albacore tuna to 6 ounces or less a week.[69] The Center for Children's Environmental Health reports studies that demonstrate that exposure to air pollution during pregnancy is related to adverse birth outcomes including low birth weight, premature delivery, and heart malformations. Cord blood of exposed babies shows DNA damage that has been linked to cancer. Follow-up studies show a higher level of developmental delays at age three, lower scores on IQ tests and increased behavioral problems at ages six and eight.[70][71] According to the U.S. Centers for Disease Control, the developing nervous system of the fetus is particularly vulnerable to lead toxicity. Neurological toxicity is observed in children of exposed women as a result of the ability of lead to cross the placental barrier and to cause neurological impairment in the fetus. A special concern for pregnant women is that some of the bone lead accumulation is released into the blood during pregnancy. Several studies have provided evidence that even low maternal exposures to lead produce intellectual and behavioral deficits in children1.[72] A 2006 study found that children who were exposed prenatally to the insecticide chlorpyrifos had significantly poorer mental and motor development by three years of age and increased risk for behavior problems.[73] A 2007 study using a mouse model suggested that exposure to polycyclic aromatic hydrocarbons prior to conceiving and when lactating reduces the number of eggs in the ovaries of female offspring by twothirds.[74] A 2009 study of pregnant women exposed to tetrachloroethylene in drinking water found an increased risk

of oral clefts and neural tube defects in their children.[75] A 2009 study found that prenatal exposure to phthalates, the chemical compounds used as plasticizers in a wide variety of personal care products, children's toys, and medical devices, may be an environmental risk factor for low birth weight in infants." [76] A 2010 study found that prenatal exposure to flame retardant compounds called polybrominated diphenyl ethers is associated with adverse neurodevelopmental effects in young children.[77] Sexual activity during pregnancy Most pregnant women can enjoy sexual activity during pregnancy throughout gravidity. Most research suggests that, during pregnancy, both sexual desire and frequency of sexual relations decrease.[78][79] In context of this overall decrease in desire, some studies indicate a second-trimester increase, preceding a decrease.[80] However, these decreases are not universal: a significant number of women report greater sexual satisfaction throughout their pregnancies.[81] Abortion Main article: Abortion An abortion is the termination of an embryo or fetus, either naturally or via medical methods. When done electively, it is more often done within the first trimester than the second, and rarely in the third. Natural abortion (miscarriage) is rare more than two months after fertilization.[37] Complications This section needs additional citations for verification. Please help improve this article by adding reliable references. Unsourced material may

be challenged and removed. (December 2010) Main article: Complications of pregnancy Each year, according to the WHO, ill-health as a result of pregnancy is experienced (sometimes permanently) by more than 20 million women around the world. Furthermore, the "lives of eight million women are threatened, and more than 500,000 women are estimated to have died in 1995 as a result of causes related to pregnancy and childbirth".[82] Pregnancy poses varying levels of health risk for women, depending on their medical profile before pregnancy. The following are some of the complaints that may occur during and/or after pregnancy due to the many changes which pregnancy causes in a woman's body:

Anemia[83] Back pain. A particularly common complaint in the third trimester when the patient's center of gravity has shifted. Carpal tunnel syndrome in between an estimated 21% to 62% of cases, possibly due to edema.[84] Constipation. A complaint that is caused by decreased bowel mobility secondary to elevated progesterone (normal in pregnancy), which can lead to greater absorption of water. Braxton Hicks contractions. Occasional, irregular, and often painless contractions that occur several times per day. Edema (swelling). Common complaint in advancing pregnancy. Caused by compression of the inferior vena cava (IVC) and pelvic veins by the uterus leads to increased hydrostatic pressure in lower extremities. Regurgitation, heartburn, and nausea. Common complaints that may be caused by Gastroesophageal Reflux Disease (GERD); this is determined by relaxation of the lower

esophageal sphincter (LES) and increased transit time in the stomach (normal in pregnancy), as well as by increased intraabdominal pressure, caused by the enlarging uterus. Haemorrhoids. Complaint that is often noted in advancing pregnancy. Caused by increased venous stasis and IVC compression leading to congestion in venous system, along with increased abdominal pressure secondary to the pregnant space-occupying uterus and constipation. Pelvic girdle pain. PGP disorder is complex and multi-factorial and likely to be represented by a series of sub-groups with different underlying pain drivers from peripheral or central nervous system,[85] altered laxity/stiffness of muscles,[86] laxity to injury of tendinous/ligamentous structures[87] to maladaptive body mechanics.[88] Musculo-Skeletal Mechanics involved in gait and weightbearing activities can be mild to grossly impaired. PGP can begin peri or postpartum. There is pain, instability or dysfunction in the symphysis pubis and/orsacroiliac joints. Postpartum depression Postpartum psychosis Round Ligament Pain. Pain experienced when the ligaments positioned under the uterus stretch and expand to support the woman's growing uterus Thromboembolic disorders. The leading cause of death in pregnant women in the USA.[89] Increased urinary frequency. A common complaint referred by the gravida, caused by increased intravascular volume, elevated GFR (glomerular filtration rate), and compression of thebladder by the expanding uterus. Urinary tract infection[90] Varicose veins. Common complaint caused by relaxation of the venous smooth muscle and increased intravascular pressure. PUPPP skin disease that develop around the 32nd week. (Pruritic Urticarial Papules and Plaques of Pregnancy), red

plaques, papules, itchiness around the belly button that spread all over the body except for the inside of hands and face. Concomitant diseases In addition to complications of pregnancy that can arise, a woman may have other diseases or conditions (not directly caused by the pregnancy) that may become worse or be a potential risk to the pregnancy. Diabetes mellitus and pregnancy deals with the interactions of diabetes mellitus (not restricted to gestational diabetes) and pregnancy. Risks for the child include miscarriage, growth restriction, growth acceleration, fetal obesity (macrosomia), polyhydramnios and birth defects. In the case of concomitant systemic lupus erythematosis and pregnancy, there is an increased rate of fetal death in utero and spontaneous abortion (miscarriage), as well as ofneonatal lupus. Stem cell collection

Two different types of stem cells can be collected before childbirth: amniotic stem cells and umbilical cord blood stem cells. The collection of amniotic stem cells is part of the process ofamniocentesis. Umbilical cord blood stem cells can be stored in both public and private banks, such as the Biocell Center in Boston.[91][92][93] http://en.wikipedia.org/wiki/Pregnancy

Home Pregnancy Tests vs. Clinic Pregnancy Tests If you are exhibiting pregnancy symptoms it is important that you do a pregnancy test right away. But what kind of test should you use? Can you really rely on those home pregnancy tests or do you have to traipse all the way to your doctor's office to find out

the results? Well, this article will give you the lowdown on both home and clinic pregnancy tests. Avoid the hassle of repeated tests and false positives by finding out how pregnancy tests work and how you can be sure to get accurate results. How Does a Pregnancy Test Work? Pregnancy tests work by detecting human chorionic gonadotropin (hCG). hCG is a hormone found only in pregnant women. It is produced by cells in the uterus and is responsible for signaling the ovaries to produce estrogen and progesterone to help your fetus grow. hCG levels continue to rise as your pregnancy progresses. Both urine and blood pregnancy tests can detect hCG. Types of Pregnancy Tests There are two main types of pregnancy tests. Both are commonly used to detect pregnancy. The Urine Test The urine pregnancy test is one of the most popular ways to detect pregnancy. It works by detecting levels of hCG in the urine. Home pregnancy tests are actually urine tests that can be performed in the privacy of your own home. There are a wide variety of urine pregnancy tests available on the market today. Each test ranges in sensitivity, with some urine tests being able to detect hCG levels as low as 15 ml/u. Performing a Home Pregnancy Urine Test A home pregnancy test is pretty easy to perform, though each test varies in procedure. Be sure to read the instructions included with the test before you use it. Also check to make sure that the expiration date hasn't passed. Most urine tests come with a testing strip which, when exposed to urine, detects the presence of hCG.

Remove the test strip from the package.

Insert the test strip in your urine stream or dip the strip into a cup of urine (follow the instructions on the box). Wait for the indicated time (usually a minute or two). The test strip should have changed colors or be displaying a symbol that alerts you to whether you are pregnant or not. The Blood Test Pregnancy blood tests are performed at your doctor's office or health clinic. They detect pregnancy by measuring hCG levels in your blood. There are actually two types of pregnancy blood tests: Quantitative Blood Test: The quantitative blood test detects pregnancy by measuring the exact amount of hCG in your bloodstream. It can also be used to detect how far along you are in your pregnancy. Qualitative Blood Test: The qualitative blood test detects pregnancy by indicating the presence of hCG in your blood. It does not measure your hCG levels, and only provides a yes or no answer as to whether or not you are pregnant. Performing a Blood Test Blood pregnancy tests are performed by health care professionals in an office or a clinic. It is just like a simple blood test:

A spot on your arm will be cleaned with alcohol. A needle is inserted into your arm. Blood is drawn from the needle into a little tube. The tube is sent to a laboratory where it will be tested. Pregnancy test results typically take a day or two. Pregnancy Test Accuracy The accuracy of pregnancy tests has improved over the years. Both urine and blood pregnancy tests are surprisingly accurate ' in fact, they claim to produce results that are 97% to 99% accurate. Of course, mistakes can happen and it accuracy often depends on how the test was performed.

Home Pregnancy Tests Home pregnancy tests are usually about 97% accurate, but this varies from brand to brand. In order to get the most accurate results, it is a good idea to wait for about a week after your period is due before testing. This allows more hCG to build up in your urine, which will allow for a more accurate test. Some urine tests can be used on the first day that your period is due, however, it is unlikely that you will achieve that 97% accuracy rate if you test so early. It is best to perform a urine test in the morning, before you drink or eat. This will allow for a buildup of any hCG in your urine. Clinic Tests Blood tests performed at your clinic have a 99% accuracy rate and can detect pregnancy earlier than most urine tests. Blood tests can be performed 7 days after you ovulate (which is about a week before your period is due) and still provide accurate results. Sometimes, lab oversights can affect the accuracy of results, however this is rare. False Results It is possible to receive false results, both positive and negative, from your urine or blood pregnancy test. If you get a false positive from a home pregnancy test, it is usually the result of faulty test strips. Most home pregnancy tests now have an indicator that shows whether or not the test is working correctly. If you leave your pregnancy test too long before checking it, this can also cause a false positive. Eventually, the urine will soak through the test, exposing the chemical strip that indicates pregnancy. Be sure to follow the instructions as closely as possible. Both blood and urine tests can also produce false positives if you are taking a drug that contains hCG. These drugs are commonly used in fertility treatments, so ask your health care provider about whether your medications could affect pregnancy test results.

False negative pregnancy tests are also possible and typically occur with early pregnancy tests. If you test too early you may not have enough hCG in your urine or blood to indicate pregnancy. It is important to repeat your pregnancy test again a few days later, even if you test negative. Where to Get a Pregnancy Test Pregnancy tests are fairly easy to obtain, especially in North America. Home pregnancy tests are available at your local drugstore or pharmacy and at some large department stores. You can also order home pregnancy tests online. Your local sexual health clinic or doctor's office can also provide you with a urine or blood test. Our online pregnancy test can also help you to find out if you are pregnant or not. Chat with other women about the signs and symptoms of pregnancy and about when can you tell your are pregnant, in our pregnancy forum. For more information on pregnancy symptoms, click here. http://www.epigee.org/pregnancy/pregnancy_tests.html

Natural childbirth
From Wikipedia, the free encyclopedia

Natural childbirth

Intervention

MeSH

D009321

Natural Childbirth is a philosophy of childbirth that is based on the notion that women who are adequately prepared are innately able to give birth to their child, without external intervention. The term "natural childbirth"

was coined by obstetrician Grantly Dick-Read upon publication of his book Natural Childbirth in the 1930s, which was followed by the 1942 Childbirth Without Fear
Contents
[hide]

1 History 2 Physical aspects 3 Psychological aspects 4 Alternatives to intervention 5 Preparation 6 Prevalence of medical intervention in the U.S. 7 Additional reading 8 See also 9 References

[edit]History
Historically, most women gave birth at home without medical intervention. These births were generally attended by a midwife, local family physician, or members of the birthing woman's family. At the onset of the Industrial Revolution in the 19th century, giving birth at home became more difficult due to congested living spaces and dirty living conditions. This drove urban and lower class women to newly available hospitals, while wealthy and middle-class women continued to labor at home.[1] In the early 1900s there was an increasing availability of hospitals, and more women began going into the hospital for labor and delivery. In the United States, the middle classes were especially receptive to the medicalization of childbirth, which promised a safer and less painful labor.[2] In fact, the ability to labor without pain was part of the early feminist movement[1]. With this change from primarily homebirth to primarily hospital birth came changes in the care women received during labor: although no longer the case, in the 1940s it was common for women to be routinely sedated and for babies to be delivered from their unconscious mothers with forceps (termed by Dr. Robert A. Bradley as "knock-em-out, drag-em-out obstetrics"). Other routine obstetric interventions have similarly come and gone: shaving of the mother's pubic region; mandatory intravenous drips; enemas; hand strapping of the laboring women; and the 12 hour monitoring of newborns in a nursery away from the mother.[citation needed] Beginning in the 1940s, childbirth professionals began to challenge the conventional assumptions about the safety of medicalized births. Physicians Michel Odent and Frederick Leboyerand midwives such as Ina May Gaskin pioneered birthing centers, water birth, and safe homebirth as alternatives to the hospital model. Research has shown that low-tech midwifery provides labor outcomes as good as those found in hospital

settings with fewer interventions, except for a small percentage of high-risk cases.[3] Today natural childbirth is taught through a variety of childbirth classes and books.

[edit]Physical

aspects

Natural childbirth aims to maximize the innate birth physiology and laboring movement of healthy, wellnourished women. For the mother, a natural birth increases the probability of a healthier postnatal period and an easier recovery due to fewer post-intervention discomforts including recovery from major abdominal surgery (caesarean section), instrumental delivery (by forceps or vacuum), cutting of the perineum (called episiotomy), bruises from IV lines, or severe headache or backachedue to a possible side effect of epidurals. For the infant, a natural birth reduces the exposure to narcotics and drugs that augment labor. A natural birth also reduces the likelihood of needing to separate the infant from its mother after birth. This is important, as immediate skin-to-skin maternal contact and breastfeeding in the first hour after birth increases the likelihood of successful breastfeeding for a longer duration.[4]

[edit]Psychological

aspects

Many women consider natural birth empowering.[5] A woman who is supported to labor as she instinctively wants to, is a woman who will likely feel positive about her birth experience and future parenting skills. Her baby is more able to be alert and placed on her skin (promoting maternal bonding) and breastfeeding is more likely to be enjoyable and successful.[6]

[edit]Alternatives

to intervention

A variety of methods are implemented during natural childbirth to aid the mother. Pain management techniques other than medication include hydrotherapy, massage, relaxation therapy,hypnosis, breathing exercises, acupressure for labour, TENS, vocalization, visualization, mindfulness and water birth. Other approaches include movement and different positions (i.e. using a birthing ball), hot and cold therapy (i.e. using hot compresses and/or cold packs), and receiving one-on-one labor support like that provided by a midwife or doula. Having a doula present during a woman's labor has been show to reduce requests for pain medication by %60 and reduce c-section rates by %50.[7] Some methods used to augment labor without medication include changing positions frequently, remaining in an upright position to increase pressure of the baby on the cervix, and walking or walking up and down stairs. Methods to reduce the need for an episiotomy include managing the perineum with counter-pressure,[8] hot compresses, and pushing the baby out slowly.

[edit]Preparation
Some women take birth education classes (such as Lamaze, the Bradley Method, Brio Birth, CAPPA, ICEA, Hypnobabies, or Hypnobirthing.) to prepare for a natural childbirth. Several books are also available with information to help women prepare. A midwife or doula may include preparation for a natural birth as part of the prenatal care services. However, a study published in 2009 suggests that preparation alone is not enough to ensure an intervention free outcome [9] It is important to prepare a birth plan before arriving at the hospital to be sure that the staff is aware of your choices. Having a written birth plan that has been pre-approved by your doctor or midwife will help ease the stress of making a decision during labor, when the pain is very real and strong. In addition, if the staff knows that pain intervention is not an option, it won't be offered, causing further distress.

[edit]Prevalence

of medical intervention in the U.S.

A recent study revealed the rates of medical intervention in childbirth in the U.S. found that 93% of mothers used electronic fetal monitoring; 63% used epidurals; 55% had their membranes ruptured; 53% received pitocin (a man-made chemical that simulates oxytocin) to stimulate labor progress; and 52% received episiotomies. [10]

http://en.wikipedia.org/wiki/Natural_childbirth 13 july 2011

J Perinat Educ. 2000 Fall; 9(4): 4446. doi: 10.1624/105812400X87905 Copyright 2000 A Lamaze International Publication

PMCID: PMC1595040

Why Natural Childbirth?

Judith A. Lothian, RN, PhD, LCCE, FACCE
JUDITH LOTHIAN is a childbirth educator in Brooklyn, New York, and the Chair of the Lamaze International Certification Council.

Abstract
A reader asks for help in answering the question Why natural childbirth? Understanding the simple story of normal, natural birth, what helps and what sabotages nature's plan for birth, and the appropriate use of interventions are discussed and form the foundation for coming to the conclusion that nature's plan makes sense. Women are inherently capable of giving birth, have a deep, intuitive instinct about birth, and, when supported and free to

find comfort, are able to give birth without interventions and without suffering. Keywords: natural childbirth, confidence, support, childbirth education.

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Question: I have taught Lamaze classes for over 10 years. The epidural rate in the hospital in which I teach is over 90%. Over and over again, I am told that women no longer want natural childbirth and the statistics certainly support that opinion. I need help answering the question, Why natural childbirth? Answer: The first step in finding an answer to the question, Why natural childbirth? is to understand the simple (not the medical) story of natural, normal birth. Strangely enough, the more we know about birth, the easier it is to lose sight of how well designed and simple birth actually is. In Lamaze class, our teaching too often focuses on the mechanics of anatomy and physiology and ways to deal with pain rather than telling and retelling the simple story of birth the way it is meant to be.

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What Happens in Normal Birth?

In the last month of pregnancy, the cervix softens and ripens like a piece of fruit. Contractions of the uterus become noticeable, and the baby settles into the pelvis. The contractions become stronger, the cervix stretches and opens, and the baby moves lower and rotates, eventually moving down the birth canal. With each contraction, pain sends a signal to the brain and oxytocin is released. With the release of oxytocin, the contractions increase in intensity. As the pain of contractions increases, more oxytocin is released and the contractions become harder. The pain of labor is what most women worry about. It is important to understand that the pain of the contractions in labor is valuable. It is an important way in which nature actually helps women find their own ways of facilitating birth. In a very real sense, the pain of each contraction becomes a guide for the laboring woman. The positions and activities she chooses in response to what she feels actually help labor progress by increasing the strength and efficiency of the contractions and encouraging the baby to settle in and move down the birth canal. When the pain is entirely removed, the feedback system is disrupted and labor is likely to slow down and become less efficient. As labor progresses and pain increases, endorphins (much more potent than morphine) are released in increasing amounts. The result is a decrease in pain perception, quite naturally. Nature's narcotic! The rising level of endorphins also contributes to a shift from a thinking, rational mind-set

to a more instinctive one. Endorphins create a dream-like state, which actually helps women manage the tasks of birthing. Inner experiences become more important than the external environment. As labor progresses and the pain of labor increases, women go into themselves, become much less aware and, at the same time, much more focused on the work of labor, and are able to tap into an inner wisdom. A woman surrounded by family, friends, and health care providers who remind her of the power of labor and encourage her quietly and patiently is a woman who is not afraid. Her support team is totally present and comforts her as she does the hard work of labor. She eats and drinks and, even if labor lasts a long time, she has the energy she needs to persevere. She rests between contractions. No one looks at the clock. Everyone trusts the process of birth and believes that she has the strength and the wisdom to give birth. In a very real sense, the pain of each contraction becomes a guide for the laboring woman. The woman moves in response to what she feels. Whether she gives birth in a hospital, birthing center, or at home, she is able to use a wide variety of comfort measures; for example, moving freely, listening to music, taking a shower or bath, and having her feet and hands massaged. She is able to create an environment that is just what she needs as she does the hard work of labor and birth. She pushes her baby down the birth canal, responding now to the pressure of contractions and the baby as he rotates through the pelvis and moves down the birth canal. She moves, changes position, and grunts, sometimes holding her breathall in response to what she is feeling. In this way, she not only protects the muscles of the birth canal and perineum but also protects her baby as he is born. A great surge of adrenaline insures that the mother is alert, even if her labor has been long. She is totally focused on her baby, ready and eager to embrace him. Baby is eager and alert, too. The stimulation of his journey has primed him for the transition to life outside the womb. With her baby in her arms, the mother is engrossed, excited, at peace, proud, and astounded at the miracle she has produced. No one tells her what to do. They know that she knows what to donot because she and her baby have read the books or attended Lamaze class, but because their journey has physically and emotionally prepared them both for this moment. The weight of her baby on her belly helps her uterus contract and expel the placenta. Baby stays warm in his mother's arms. Baby knows just what to do to survive in the world he has entered. He is awake and looks around. Within seconds or minutes, he has his hands in his mouth and is smacking his lips. Unpressured, he slowly but methodically crawls to his mother's breast and self-attaches. As he nurses, his mother's uterus contracts, insuring that bleeding will not be excessive. The two greet each other

unhurried, confident, and unpressured. Together, over the next hours and days, they will get to know each other and fall in love.

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Nature's Plan
For all of its simplicity, nature's plan for birth actually requires a fair amount of flexibility. Each mother and each baby are different. While the anatomy and physiology are standard, how each labor and birth proceeds is fine-tuned through the active involvement of the laboring woman. All through labor, her body tells her what is happening and helps her discover what she needs to do to help. The active involvement of the laboring woman is a critical piece of nature's plan for birth, and it is the least understood. The hard work of labor is not meant to be accomplished alone. Changing position, avoiding exhaustion, and staying adequately nourished require assistance. So across the world, women giving birth are supported, encouraged, and comforted by family, friends, and professional birth attendants. Giving birth as nature intended is not biting the bullet and letting it happen. The Everyday Miracle section of the Lamaze video, Celebrate Birth! (2000), is an excellent resource to use in your classes. It shares several women's experience giving birth naturally. The commentary highlights the simple story of natural birth. Women are confident, working very hard, supported, and encouraged. I can do that! is the exclamation I hear every time I show Celebrate Birth! In your classes, it is important for you to emphasize that natural childbirth is not about suffering. It is about having the freedom to find comfort in many different ways. Choosing to give birth naturally does not mean that interventions will not be needed or that complications will not occur. Nature's plan for birth includes pleas for help when help is needed. Choosing natural childbirth means that women prepare for the birth of their babies confident in their own ability to give birth, being willing to feel contractions, and finding comfort in response to what they are feeling. It means that they will be surrounded by family, friends, and professionals who will encourage them to trust their inner wisdom. It means that wherever they give birthhospital, birthing center, or homethey will have the freedom they need to respond to their contractions. The video Born in the USA (2000) powerfully demonstrates the differences between natural birth and births that become complicated with the cascade of interventions. The women attended by midwives give birth confidently, finding comfort in many different ways, supported and encouraged by family, friends, and their midwife. In stark contrast, the women who give birth attended by physicians in a busy hospital find it difficult to find comfort without medication and appear pressured to give birth quickly. The cascade of

interventions is dramatically and realistically presented. Women know how to give birth without machines, epidurals, and fear.

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Conclusion
Why natural childbirth? Ultimately, women find the answer to that question themselves. What they need from us as childbirth educators is to know that nature's design works beautifully. Confident women who are supported and encouraged and who enjoy the freedom to tap into their own wisdom find deep satisfaction in giving birth naturally. The process itself prepares mother and baby perfectly in every way to continue on their journey together. Some women choose to give birth naturally because they love the challenge. Others find great satisfaction in working hard and getting the job done. Many women are eager to avoid anything that might harm their babies or themselves. But the most compelling reason to choose natural childbirth is a universal one. Women know how to give birth without machines, epidurals, and fear. Why natural childbirth? The more important question might be Why not?

References

Injoy Productions. 2000. Celebrate birth! [Video]. (Available from Injoy Videos, 1435 Yarmouth, Suite 102-B, Boulder, CO 80304; also available from Lamaze International Media Center,www.lamaze.org)

Jarmel M, Schneider K., (Producers). 2000. Born in the USA. [Video]. (Available from Fanlight Productions, 4196 Washington Street, Suite 2, Boston, MA 02131)

Articles from The Journal of Perinatal Education are provided here courtesy of Lamaze International

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595040/

Pain During Labor and Delivery

Pain during labor is caused primarily by uterine muscle contractions and somewhat by pressure on the cervix. This pain manifests itself as cramping in the abdomen, groin, and back, as well as a tired, achy feeling all over. Some women experience pain in their sides or thighs as well.

Other causes of pain during labor include pressure on the bladder and bowels by the baby's head and the stretching of the birth canal and vagina.

Although labor is often thought of as one of the more painful events in human experience, it ranges widely from woman to woman and even from pregnancy to pregnancy. Women experience labor pain differently for some, it resembles menstrual cramps; for others, severe pressure; and for others, extremely strong waves that feel like diarrheal cramps. In addition, first-time mothers are more likely to give their pain a higher rating than women who've had babies before. The intensity of labor pain isn't always the determining factor that drives women to seek pain management often it's the repetitive nature and length of time the pain persists with each contraction

Preparing for Pain

To reduce pain during labor, here are some things you can start doing before or during your pregnancy:

Regular and reasonable exercise (unless your health care provider recommends against it) can help strengthen your muscles and prepare your body for the stress of labor. Exercise can also increase your endurance, which will come in handy if you have a long labor. The important thing to remember with any exercise is not to overdo it and this is especially true if you're pregnant. Talk to your health care provider about what he or she considers to be a safe regimen, given your prepregnancy fitness level and the history of your pregnancy. If you and your partner attend childbirth classes, you'll learn different techniques for handling pain, from visualization to stretches designed to strengthen the muscles that support your uterus. The two most common childbirth philosophies in the United States are the Lamaze technique and the Bradley method.

The Lamaze technique is the most widely used method in the United States. The Lamaze philosophy teaches that birth is a normal, natural, and healthy process and that women should be empowered to approach it with confidence. Lamaze classes educate women about the ways they can decrease their perception of pain, such as through relaxation techniques, breathing exercises, distraction, or massage by a supportive coach. Lamaze approach takes a neutral position toward pain medication, encouraging women to make an informed decision about whether it's right for them. The Bradley method (also called Husband-Coached Birth) emphasizes a natural approach to birth and the active participation of the baby's father as birth coach. A major goal of this method is the avoidance of medications unless absolutely necessary. The Bradley method also focuses on good

nutrition and exercise during pregnancy and relaxation and deep-breathing techniques as a method of coping with labor. Although the Bradley method advocates a medication-free birth experience, the classes do prepare parents for unexpected complications or situations, like emergency cesarean sections. Other ways to handle pain during labor include:

hypnosis yoga meditation walking massage or counterpressure changing position taking a bath or shower distracting yourself by counting or performing an activity that keeps your mind otherwise occupied

http://kidshealth.org/parent/pregnancy_center/childbirth/childbirth_pain.html?tracking=P_RelatedArti cle#

Cesarean Birth
By admin Filed under Education 1 Comment

A major operation, each cesarean actually involves a series of separate incisions in the mother. The skin, underlying muscles and abdomen are opened first and then the uterus is opened allowing birth of the newborn. There are two main types of cesarean operations, each named according to the location and direction of the uterine incision:

Cervical--a transverse (horizontal) or vertical incision in the lower uterus, and Classical--a vertical incision in the main body of the uterus.

Today, the low transverse cervical incision is used almost exclusively. It has the lowest incidence of hemorrhage during surgery as well as the least chance of rupturing in later pregnancies. Sometimes, because of fetal size (very large or very small) or position problems ( breech or transverse), a low verticalcesarean may be performed. In the classical operation, a vertical incision allows a greater opening and is used for fetal size or position problems and in some emergency situations. This approach involves more bleeding in surgery and a higher risk of abdominal infection. Although any uterine incision may rupture during subsequent labor, the classical is more likely to do so and more likely to result in death for the mother and fetus than a cervical incision.

Why Have Cesarean Rates Increased?

Many factors account for rising cesarean birth rates. By the 1960's, increasing emphasis was being placed on the health of the fetus. With declining birth rates and couples having fewer children, even greater attention was given to

improving the outcome of pregnancy, and infant survival in general. The nation's infant morality rate began to be seen as an international yardstick on the quality of health care. At the same time, advances in medical care combined to make maternal death from cesarean childbirth a rare occurrence. The safer the procedure became, the easier it was to decide to perform the operation. As a safe alternative to normal delivery, the cesarean became a practical way to try to improve the outcome of difficult pregnancies. Studies suggesting the benefit of cesarean birth in dealing with various pregnancy complications also led to more cesareans. Obstetricians came to favor surgery in pregnancies with difficult deliveries that formerly would have required the use of forceps. The diagnosis of "dystocia", a catch-all term meaning difficult labor, was made more frequently and handled more often with the cesarean operation. Fetal distress during labor--a condition often resulting in a cesarean--was more apt to be detected with the introduction of electric fetal monitoring. Increasingly, physicians used the cesarean method to deliver infants in the breech position prior to birth, adding still further to the rising cesarean rate. Another important contributing factor was the rising number of repeat cesareans. As the number of women having their first cesarean increased, the long-held tenet "once a cesarean, always a cesarean" led to rapid increase in the number of repeat cesarean births.

What Is The Current Medical Thinking About Repeat Cesarean Deliveries?

Having had a prior cesarean delivery is one of the two major reasons women have the operation today. (The other is the diagnosis of dystocia.) The consensus development panel found that the rate of repeat cesareans is likely to increase further if present trends continue. Currently more than 98 percent of women in the U.S. who have had a cesarean undergo a repeat cesarean for subsequent pregnancies. This practice was begun in the late 1900's to avoid the risk of uterine scar rupture and hemorrhage during labor. At that time the classical cesarean incision was most widely used and the cesarean birth rate was extremely low. Physicians now know that the classical, low vertical and "inverted T" incisions have a higher rate of rupture than the low transverse incision now in general use. The low transverse cervical cesarean also has been shown to result in fewer cases of lasting health disorders or death among mothers and infants. Today, many women who had earlier low transverse cesareans safely deliver subsequent children vaginally. In studying the issue, the consensus panel found that the risk of maternal death in a repeat cesarean is two times that of a vaginal delivery. In addition, the maternal mortality rate for repeat cesareans has not fallen since 1970. The group concluded that the practice of routine repeat cesarean birth is open for question, and that labor and vaginal delivery after previous low transverse cervical cesarean birth are of low risk to the mother and child in properly selected cases. The panel recommended that: In hospitals with appropriate facilities, services and staff for prompt emergency cesarean birth, some women who

have had a previous low transverse cervical cesarean may safely be allowed a trial of labor and vaginal delivery. The present practice of repeat cesareans should continue for patients who have had previous cesareans with classical, inverted T or low vertical incisions, or for whom there is no record or the type of incision. In hospitals without appropriate facilities, services and staff, the risk of labor for women having had a previous cesareans may exceed the risk to mother and infant from a properly timed, elective repeatcesarean birth. To allow patients to make an informed decision, they should be told in advance about the limits of the institutions

offering this service. More adequate information should be compiled on the risks and benefits of trying labor in patients with previous low transverse cervical incisions. Institutions offering labor trials following low transverse cesareans should develop guidelines for managing those labors.

Patient education on initial and repeat cesarean birth should continue throughout pregnancy as an important part of patient participation in making decisions about the delivery.

What If The Baby Is In The Breech Position Prior To Birth?

There is a continuing trend to use the cesarean method to deliver a "breech baby"--a fetus positioned in the womb to be born in some way other than the normal head first manner. Nationally, the proportion of breech positioned infants delivered by cesarean rose from about 12 percent in 1970 to 60 percent in 1978. Breech positioning involves higher risks for the mother and child, regardless of whether the delivery is vaginal or cesarean. Cesareans are being selected more often in these cases to try to improve the outcome in the face of the increased risks. But the consensus group found scientific data in this area generally inadequate to make firm conclusions about desirability of one approach over the other. Most clinical reviews suggest that the cesarean may involve less risk for the premature breech infant, but this may not be true for term breech babies. Several studies indicate vaginal delivery of the uncomplicated term breech infant is preferable because an elective cesarean birth involves risk significant complications for the mother and little or no decrease in the risk of infant death. Deciding which method of delivery to use in these situations involves considering many factors. These include maternal pelvic size, size of the fetus, the type of breech position and the experience of the physician with vaginal breech delivery. In general, the consensus panel concluded that the cesarean presents a lower risk to the infant than a vaginal delivery when the breech fetus is 8 pounds or larger, or when a fetus is in complete or footlingbreech position or when the fetus is breech with marked hyperextension of the head. The group recommended that vaginal delivery of term breech babies should remain an acceptable choice when the following conditions exist:

anticipated fetal weight of less than 8 pounds; normal pelvic dimensions and structure in the mother; frank breech positioning without hyperextended head; and delivery by physician experienced in vaginal breech delivery.

What Is The Single, Most Common Reason For Performing A Cesarean?

Dystocia is a catch-all medical term covering a broad range of problems which can complicate labor. The consensus group found that this diagnosis was the largest contributor to the overall rise in the cesareanrate, accounting for 30 percent of all cesareans. Included under the dystocia, or difficult labor, diagnosis are the following three basic types of problems which may impede labor:

abnormalities of the mother's birth canal, such as a small pelvis; abnormalities in the position of the fetus, including breech position or large fetal size; and

abnormalities in the forces of labor, including infrequent or weak uterine contractions. The first two categories are well-defined areas. The physician usually recognizes size or position problems early; guidelines for appropriate obstetrical action are available; and the effects of the various approaches for mother and infant are reasonably well known. The consensus panel agreed that the last category--forces of labor--is most in need of scrutiny and offers an opportunity for moderating the cesarean rate. Generally, this diagnosis occurs with low-risk infants of normal weight and size. Studies have not shown that infants in the group are better off with either cesarean or vaginal deliveries, although the maternal mortality rate for dystocia in 1978 was 41.9 deaths per 100,000 cesarean births compared with 11.1 deaths per 100,000 vaginal births.

The panel concluded that in handling a difficult or slowly progressing labor without fetal distress, a physician should consider various options before performing a cesarean. These include having the patient rest or walk around, sedating the patient or stimulating labor with a drug called oxytocin. The panel recommended that because the diagnosis of dystocia is poorly defined and so prominent in increasing the cesarean rate, practice review boards in hospitals should include dystocia cases when conducting reviews. The panel also stressed the need for more research on the factors affecting the progress of labor.

Has The Use Of Electronic Fetal Monitoring Led To More Cesareans?

Another diagnosis accounting for the rise in cesarean birth rates is fetal distress. Occurring during labor, this problem can result in various complications, the most serious being fetal brain damage because of oxygen deprivation. The use of electronic fetal monitoring techniques has led to an increase in the diagnosis of fetal distress but not necessarily to increase in cesarean deliveries, according to the consensus panel. Because current data are insufficient on the possible risks or benefits of handling this condition with either cesarean or vaginal deliveries, the panel recommended studies to gather information on the outcomes of births involving fetal distress and development of new techniques to improve the accuracy of the diagnosis. These steps, the panel said, may be expected to improve fetal outcome and lower cesarean birth rates.

Are There Other Medical Conditions Which Would Necessitate A Cesarean?

Because of a need for early delivery, certain medical problems in either the mother or fetus can lead to cesarean birth. Examples include maternal diabetes, pregnancy-induced hypertension, vaginal herpes infection, and erythorblastosis fetalis, a blood disease related to the Rh factor in the mother. This entire group, however, contributes only a small part of the cesarean birth rate increases. The consensus panel said that in some of these situations vaginal birth would be a safe alternative if a more effective method of stimulating labor before term was available. The panel recommended research to develop such methods.

What Are The Benefits Of The Cesarean Method?

There are certain times when conditions in the mother or infant make cesarean delivery the method of first choice. By providing an alternate route of delivery, the procedure offers great benefit in situations when a vaginal delivery carries a high risk of complications and death. A cesarean is usually used when an expectant mother has diabetes mellitus. Such women have a high risk of having stillborns late in pregnancy. In these cases, a slightly early cesarean helps prevent this occurrence. The cesarean can also be a lifesaving procedure when the following conditions are present: Placenta previa--when the placenta blocks the infant from being born.

Abruptio placentae--when the placenta prematurely separates from the uterine wall and hemorrhage occurs. Obstructed labor--which can occur with a fetus in the shoulder breech, or any other abnormal position. Ruptured uterus. Presence of weak uterine scars from previous surgery or cesarean. Fetus too large for the mother's birth canal. Rapid toxemia--a condition in which high blood pressure can lead to convulsions in late pregnancy. Vaginal herpes infection--which could infect an infant being born vaginally, and lead to its eventual death. Pelvic tumors--which obstruct the birth canal and weaken the uterine wall. Absence of effective uterine contractions after labor has begun.

Prolapse of the umbilical cord--when the cord is pushed out ahead of the infant, compressing the cord and cutting off blood flow.

What Are The Maternal Risks In Cesarean Childbirth?

The risks of any medical procedure are determined by examining the related mortality statistics showing death rates and morbidity figures showing complications, injuries or disorders linked to the event. These vary from hospital to hospital and from locale to locale. Although maternal death during childbirth is extremely uncommon, national figures show cesarean birth carries up to four times the risk of death compared to a vaginal delivery. The maternal mortality rate for vaginal delivery in 1978 was about 10 deaths per 100,000 births. For cesareans, the rate was about 41 deaths per 100,000 births. (In some cases, maternal deaths indicated in these figures were caused by illness rather than the surgery.) The morbidity rates associated with cesarean births are higher than with vaginal delivery. Because major surgery is involved, the chance of infection and complication is greater. The most common are endometritis (an inflammation of tissue lining the uterus) and urinary tract or incision infections.

Does Cesarean Childbirth Require Special Anesthesia?

The use of anesthesia during childbirth is unique because it requires attention to the infant about to be born as well as the mother. Although rare, anesthesia-related maternal deaths continue to occur. Most, however, are potentially avoidable. There are three major anesthetic techniques for cesarean birth. Spinal anesthesia is widely used, although the use of lumbar epidural anesthesia is increasing. Both are considered "regional" anesthesia because they deaden pain in only part of the body without putting the patient to sleep. General anesthesia, which renders the patient unconscious, is often used in an emergency situation and with women who object to the spinal or epidural approach. The consensus panel recommended that the types of anesthesia available should be discussed among the patient, obstetrician and anesthesiologist. Each approach has advantages and disadvantages. If possible, the report recommends, the patient should have the option of receiving regional instead of general anesthesia.

Are There Risks To The Infant?

Infants delivered with elective cesarean surgery, especially if it is performed before the onset of labor, appear to have a greater risk of respiratory distress syndrome (RDS). This condition, in which the infant's lungs are not fully mature, may result if an error is made in estimating the age of the developing fetus. Under these circumstances, an infant-who otherwise would have been healthy if allowed to develop fully--encounters the problems of prematurity when removed too soon by cesarean. These include RDS and other lung disorders, feeding problems and various complications which is some cases require a long hospital stay. Measures and techniques to assess the maturity of the fetus and the degree of lung development are readily available in the United States. The consensus report stressed the need for improving physician and patient education about the safe and effective use of these techniques in planning for elective cesarean delivery. Respiratory distress is unlikely to be a problem, regardless of the type of delivery, if the infant is born at or near term.

What Are The Psychological Effects Of Cesarean Childbirth?

Other factors must be taken into consideration when weighing the prospects of cesarean. Although there has been only limited research on the psychological effects on parents following a cesarean birth, it is clear that surgery is an increased psychological and physical burden compared to vaginal delivery. In limited follow-up studies of infants, there has been no evidence of an adverse psychological effect on infants born by cesarean.

In some hospitals, family-centered maternity care has been extended to cesarean deliveries. The presence of the father in the operating room and the closer contact between the mother and newborn in this approach appear to improve the cesarean process. The consensus panel recommended strengthening the information exchange and education of perspective parents about the overall cesarean experience. They urged hospitals to allow fathers in the operating room when possible and to avoid routinely separating the newborn from its parents immediately following delivery

http://the-health-pages.com/topics/topics/education/cesarean.html

Caesarean section
From Wikipedia, the free encyclopedia

Caesarean section

Intervention

A team of obstetricians performing a Caesarean section in a modern hospital.

ICD-9-CM

74

MeSH

D002585

A Caesarean section, (also C-section, Caesarian section, Cesarean section, Caesar, etc.) is a surgical procedure in which one or moreincisions are made through a mother's abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies, or, rarely, to remove a dead fetus. A late-term abortion using Caesarean section procedures is termed a hysterotomy abortion and is very rarely performed. The first modern Caesarean section was performed by German gynecologist Ferdinand Adolf Kehrer in 1881. A Caesarean section is usually performed when a vaginal delivery would put the baby's or mother's life or health at risk, although in recent times it has been also performed upon request for childbirths that could otherwise have been natural.[1][2][3] In recent years the rate has risen to a record level of 46% in China and to levels of 25% and above in many Asian and European countries, Latin America, and the USA.[4]

Contents
[hide]

1 Etymology 2 Orthography 3 History 4 Types 5 Indications 6 Risks

o o

6.1 Risks for the mother 6.2 Risks for the child

7 Incidence 8 Analyzing the rise in Caesarean section rates 9 Elective Caesarean sections 10 Anaesthesia 11 Vaginal birth after Caesarean

11.1 Recovery period

12 Within Judaism 13 See also 14 References 15 External links

Etymology
The Roman Lex Regia, (later the Lex Caesarea) of Numa Pompilius (715-673 BC), required that the child of a mother dead in childbirth be cut from her womb. [5] This seems to have begun as a religious requirement that mothers not be buried pregnant, [6] and to have evolved into a way of saving the fetus, with Roman practice requiring a living mother be in her 10th month of pregnancy before the procedure was resorted to, reflecting the knowledge that she could not survive the delivery.
[7]

Rumours that the term

refers to the birth of the Roman Dictator Julius Caesar are false; although Caesarean sections were performed in Roman times, no classical source records a mother surviving such a delivery, [5][8] the earliest recorded survival dates to 1500 AD[9] and Caesar's mother Aurelia Cotta lived to serve him as an advisor in his adulthood.[7] The term has also been explained as deriving from the verb caedo, 'to cut', with children delivered this way referred to as caesones. Pliny the Elder refers to a certain Julius Caesar (not the dictator, but a remote ancestor) as ab utero caeso, "cut from the womb", a godly attribute comparable to rumors about the birth of Alexander the Great.[10] This and Caesar's name may have led to a false etymological connection with the ancient monarch.

Some link with Julius Caesar, or with Roman Dictators generally, exists in other languages as well. For example, the modern German, Danish, Dutch and Hungarian terms are respectively Kaiserschnitt, kejsersnit, keizersnede, and csszrmetszs (literally: "Emperor's cut").[11] The German term has also been imported into Japanese ( teisekkai) and Korean ( jewang jeolgae), both literally meaning "emperor incision." Similar in Western Slavic (Polish) cicie cesarskie, (Czech) csask ez and (Slovak) csarsk rez(literally "imperial cut"), whereas the South Slavic term is (Slovenian) crski rz, which literally means tzar cut. The Russian term kesarevo secheniye ( ksarevo senije) literally means Caesar's section. The Arabic term ( wilaada qaySaryya) also means pertaining to Caesar or literally Caesarean. The Hebrew term ( nitakh Keisri) translates literally as Caesarean Surgery. In Romania and Portugal it is usually called cesariana, meaning from (or related to) Caesar. According to Shahnameh ancient Persian book, the hero Rostam was the first person who was born with this method and term ( rostamineh) is corresponded to Caesarean. Finally, the Roman praenomen (given name) Caeso was said to be given to children who were born via c-section. While this was probably just folk etymology made popular by Pliny the Elder, it was well known by the time the term came into common use.

Orthography

The e/ae/ variation reflects American and British English spelling differences. The cap-versus-lowercase variation reflects a style of lowercasing some eponymous terms (e.g., cesarean, eustachian, fallopian, mendelian, parkinsonian, parkinsonism).[12] Cap and lowercase stylings coexist in prevalent usage. Intradocument style consistency is usually advocated.

History

Successful Caesarean section performed by indigenous healers in Kahura, Uganda. As observed by R. W. Felkin in 1879.
Bindusara (Born c. 320 BC, ruled: 298 - c.272 BC) , the second Mauryan emperor of India after Chandragupta Maurya the Great, is said to be first child born by surgery.[citation needed] His mother, wife of Chandragupta Maurya, accidentally consumed poison and died when she was close to delivering him. Chanakya, the Chandragupta's teacher and advisor, made up his mind that the baby should survive. He cut open the belly of the queen and took out the baby, thus saving the baby's life. [citation needed]

Pliny the Elder theorized that Julius Caesar's name came from an ancestor who was born by Caesarean section, but the truth of this is debated (see the article on the Etymology of the name of Julius Caesar). The Ancient Roman Caesarean section was first performed to remove a baby from the womb of a mother who died during childbirth. Caesar's mother, Aurelia, lived through childbirth and successfully gave birth to her son, ruling out the possibility that the Roman Dictator and General was born by Caesarean section. The Catalan saint Raymond Nonnatus (12041240), received his surnamefrom the Latin non natus ("not born") because he was born by Caesarean section. His mother died while giving birth to him. [13] In 1316 the future Robert II of Scotland was delivered by Caesarean sectionhis mother, Marjorie Bruce, died. This may have been the inspiration for Macduff in Shakespeare's play Macbeth". (see below). Caesarean section usually resulted in the death of the mother; the first recorded incidence of a woman surviving a Caesarean section was in the 1580s, in Siegershausen, Switzerland: Jakob Nufer, a pig gelder, is supposed to have performed the operation on his wife after a prolonged labour.[14] However, there is some basis for supposing that women regularly survived the operation in Roman times. [15] For most of the time since the sixteenth century, the procedure had a high mortality rate. However, it was long considered an extreme measure, performed only when the mother was already dead or considered to be beyond help. In Great Britain and Ireland the mortality rate in 1865 was 85%. Key steps in reducing mortality were:

Introduction of the transverse incision technique to minimize bleeding by Ferdinand Adolf Kehrer in 1881. This is thought to be first modern CS performed.

The introduction of uterine suturing by Max Snger in 1882. Extraperitoneal CS and then moving to low transverse incision (Krnig, 1912). [clarification needed] Adherence to principles of asepsis. Anesthesia advances. Blood transfusion. Antibiotics.

European travelers in the Great Lakes region of Africa during the 19th century observed Caesarean sections being performed on a regular basis.[16] The expectant mother was normally anesthetized with alcohol, and herbal mixtures were used to encourage healing. From the well-developed nature of the procedures employed, European observers concluded that they had been employed for some time.[16] The first successful Caesarean section to be performed in America took place in what was formerly Mason County Virginia (now Mason County West Virginia) in 1794. The procedure was performed by Dr. Jesse Bennett on his wife Elizabeth.[17] On March 5, 2000, Ins Ramrez performed a Caesarean section on herself and survived, as did her son, Orlando Ruiz Ramrez. She is believed to be the only woman to have performed a successful Caesarean section on herself. An early account of Caesarean section in Iran is mentioned in the book of Shahnameh, written around 1000 AD, and relates to the birth of Rostam, the national legendary hero of Iran.[18][19]

Types

Pulling out the baby.

A Caesarean section in progress.

Suturing of the uterus after extraction.

Closed Incision for low transverse abdominal incision after stapling has been completed.
There are several types of Caesarean section (CS). An important distinction lies in the type of incision (longitudinal or latitudinal) made on theuterus, apart from the incision on the skin.

The classical Caesarean section involves a midline longitudinal incision which allows a larger space to deliver the baby. However, it is rarely performed today as it is more prone to complications.

The lower uterine segment section is the procedure most commonly used today; it involves a transverse cut just above the edge of thebladder and results in less blood loss and is easier to repair.

An emergency Caesarean section is a Caesarean performed once labour has commenced. A crash Caesarean section is a Caesarean performed in an obstetric emergency, where complications of pregnancy onset suddenly during the process of labour, and swift action is required to prevent the deaths of mother, child(ren) or both.

A Caesarean hysterectomy consists of a Caesarean section followed by the removal of the uterus. This may be done in cases of intractable bleeding or when the placenta cannot be separated from the uterus.

Traditionally other forms of Caesarean section have been used, such as extraperitoneal Caesarean section or Porro Caesarean section.

a repeat Caesarean section is done when a patient had a previous Caesarean section. Typically it is performed through the old scar.

In many hospitals, especially in Argentina, the United States, United Kingdom, Canada, Norway, Sweden, Finland, Australia, and New Zealandthe mother's birth partner is encouraged to attend the surgery to support the mother and share the experience. The anaesthetist will usually lower the drape temporarily as the child is delivered so the parents can see their newborn.

Indications

A 7-week old Caesarean section scarand linea nigra visible on a 31-year-old mother.
Caesarean section is recommended when vaginal delivery might pose a risk to the mother or baby. Not all of the listed conditions represent a mandatory indication, and in many cases the obstetrician must use discretion to decide whether a Caesarean is necessary. Some indications for Caesarean delivery are: Complications of labor and factors impeding vaginal delivery such as

prolonged labor or a failure to progress (dystocia) fetal distress cord prolapse uterine rupture increased blood pressure (hypertension) in the mother or baby after amniotic rupture increased heart rate (tachycardia) in the mother or baby after amniotic rupture placental problems (placenta praevia, placental abruption or placenta accreta) abnormal presentation (breech or transverse positions) failed labor induction failed instrumental delivery (by forceps or ventouse. Sometimes a 'trial of forceps/ventouse' is tried out - This means a forceps/ventouse delivery is attempted, and if the forceps/ventouse delivery is unsuccessful, it will be switched to a Caesarean section.

overly large baby (macrosomia)

umbilical cord abnormalities (vasa previa, multi-lobate including bi-lobate and succenturiate-lobed placentas, velamentous insertion)

contracted pelvis

Other complications of pregnancy, preexisting conditions and concomitant disease such as

pre-eclampsia hypertension [20] multiple births precious (High Risk) Fetus HIV infection of the mother Sexually transmitted infections such as genital herpes (which can be passed on to the baby if the baby is born vaginally, but can usually be treated in with medication and do not require a Caesarean section)

previous Caesarean section (though this is controversial see discussion below) prior problems with the healing of the perineum (from previous childbirth or Crohn's Disease) Bicorunate uterus

Other

Lack of Obstetric Skill (Obstetricians not being skilled in performing breech births, multiple births, etc. [In most situations women can birth under these circumstances naturally. However, obstetricians are not always trained in proper procedures]) [21]

Improper Use of Technology (Electric Fetal Monitoring [EFM])[21][22]

Risks
Risks for the mother
The mortality rate for both Caesarian sections and vaginal birth, in the Western world, continues to drop steadily. In 2000, the mortality rate for Caesareans in the United States were 20 per 1,000,000. [23] The UK National Health Service gives the risk of death for the mother as three times that of a vaginal birth.[24] However, it is misleading to directly compare the mortality rates of vaginal and Caesarean deliveries. Women with severe medical conditions, or higher-risk pregnancies, often require a Caesarean section which can distort the mortality figures. A study published in the 13 February 2007 issue of the Canadian Medical Association Journal found that the absolute differences in severe maternal morbidity and mortality was small, but that the additional risk over vaginal delivery should be considered by women contemplating an elective Caesarean delivery and by their physicians.[25] As with all types of abdominal surgery, a Caesarean section is associated with risks of post-operative adhesions, incisional hernias (which may require surgical correction) and wound infections.[23] If a Caesarean is performed under emergency situations, the risk of

the surgery may be increased due to a number of factors. The patient's stomach may not be empty, increasing the anaesthesia risk.[26] Other risks include severe blood loss (which may require a blood transfusion) and post spinal headaches.[23] A study published in the June 2006 issue of the journal Obstetrics and Gynecology found that women who had multiple Caesarean sections were more likely to have problems with later pregnancies, and recommended that women who want larger families should not seek Caesarean section as an elective. The risk of placenta accreta, a potentially life-threatening condition, is only 0.13% after two Caesarean sections but increases to 2.13% after four and then to 6.74% after six or more surgeries. Along with this is a similar rise in the risk of emergency hysterectomies at delivery. The findings were based on outcomes from 30,132 Caesarean deliveries.[27] It is difficult to study the effects of Caesarean sections because it can be difficult to separate out issues caused by the procedure itself versus issues caused by the conditions that require it. For example, a study published in the February 2007 issue of the journal Obstetrics and Gynecology found that women who had just one previous Caesarean section were more likely to have problems with their second birth. Women who delivered their first child by Caesarean delivery had increased risks for malpresentation, placenta previa, antepartum hemorrhage, placenta accreta, prolonged labor, uterine rupture, preterm birth, low birth weight, and stillbirth in their second delivery. However, the authors conclude that some risks may be due to confounding factors related to the indication for the first Caesarean, rather than due to the procedure itself.[28]

Risks for the child

This list is currently incomplete and should not be taken as comprehensive or reflective of current research. It covers some of the most commonly discussed risks to the child posed by the procedure itself rather than the medical indications that may call for it. Some risks are rare, and as with most medical procedures the likelihood of any risk is highly dependent on individual factors such as whether other pregnancy complications exist, whether the operation is planned or done as an emergency measure, and how and where it is performed.

Wet lung: retention of fluid in the lungs can occur if not expelled by the pressure of contractions during labor. [29]

Potential for early delivery and complications: Pre-term delivery is possible if due date calculation is inaccurate. One study found an increased risk of complications if a repeat elective Caesarean section is performed even a few days before the recommended 39 weeks. [30]

Higher infant mortality risk: in c-sections which are performed with no indicated risk (singleton at full term in a head-down position), the risk of death in the first 28 days of life has been cited as 1.77 per 1,000 live births among women who had csections, compared to 0.62 per 1,000 for women who delivered vaginally
[31]

Incidence
The World Health Organization recommends the rate of Caesarean sections between 10% and 15% of all births in developed countries. However, in 2004, the Caesarean rate was about 20% in the United Kingdom, while the Canadian rate was 22.5% in 2001-2002.[32]

In Italy the incidence of Caesarean sections is particularly high, although it varies from region to region. [33] In Campania, 60% of 2008 births reportedly occurred via Caesarean sections.[34] In the Rome region, the mean incidence is around 44%, but can reach as high as 85% in some private clinics. [2][35] In the United States the Caesarean rate has risen 48% since 1996, [36] reaching a level of 31.8% in 2007.[36] A 2008 report found that fully one-third of babies born in Massachusetts in 2006 were delivered by Caesarean section. In response, the state's Secretary of Health and Human Services, Dr. Judy Ann Bigby, announced the formation of a panel to investigate the reasons for the increase and the implications for public policy.[37] In Brazil's public health network, the rate reaches 35%, while in private hospitals the rate approaches 80%.[citation needed] China has been cited as having the highest rates of C-sections in the world at 46% as of 2008[38] Studies have shown that continuity of care with a known carer may significantly decrease the rate of Caesarean delivery [39] but there is also research that appears to show that there is no significant difference in Caesarean rates when comparing midwife continuity care to conventional fragmented care.[40] More emergency Caesareansabout 66%are performed during the day rather than during the night.[41]

Analyzing the rise in Caesarean section rates

The US National Institutes of Health says that rises in rates of Caesarean sections are not, in isolation, a cause for concern, but may reflect changing reproductive patterns: The World Health Organization has determined an ideal rate of all cesarean deliveries (such as 15 percent) for a population . One surgeon's opinion is that there is no consistency in this ideal rate, and artifcial declarations of an ideal rate should be discouraged. Goals for achieving an optimal cesarean delivery rate should be based on maximizing the best possible maternal and neonatal outcomes, taking into account available medical and health resources and maternal preferences. This opinion is based on the idea that if left unchallenged, optimal cesarean delivery rates will vary over time and across different populations according to individual and societal circumstances.[42] There has been a rapid growth in the number of c-sections performed. For example, there has been a fourfold increase from 1971 to 1991. (From 4.2 c-sections per 100 births). This may be accredited to the improved technology in detecting pre-birth distress. Malpractice has been looked into because of the rapid increase in c-sections. Some argue that the higher costs of c-section births compared to regular births make physicians quicker to recommend a c-section. Usually, if a doctor makes a recommendation people are quick to take it to heart and act upon it. The effect of relative c-section price on c-section usage should be examined. However, some commentators are concerned by the rise and have noted several evidence-based studies. Louise Silverton, deputy general-secretary of the Royal College of Midwives, says that not only has societys tolerance for pain and illness been significantly reduced, but also that women are scared of pain and think that if they have a Caesarean there will be less, if any, pain. It is the opinion of Silverton and the Royal College of Midwives that women have lost their confidence in their ability to give birth. "[43]

Silverton's analysis is controversial among some surgeons. Dr Maggie Blott, a consultant obstetrician at University College Hospital, London and then a Royal College of Obstetricians and Gynaecologists (RCOG) spokeswoman on Caesareans (and Vice President of the RCOG), responded: 'There isn't any evidence to support Louise Silverton's view that increasingly pain-averse women are pushing up the Caesarean rate. There's an undercurrent that Caesarean sections are a bad thing, but they can be life-saving.'[43] A previously unexplored hypothesis for the increasing section rate is the evolution of birth weight and maternal pelvis size. It is proposed that since the advent of successful Caesarean birth over the last 150 years, mothers with a small pelvis and babies with a large birth weight have survived and contributed to these traits increasing in the population. Such a hypothesis is based upon the idea that even without fears of malpractice, without maternal obesity and diabetes, and without other widely quoted factors, the Csection rate would continue to rise simply due to slow changes in population genetics.[44]

Elective Caesarean sections

Main article: Elective caesarean section

This section may stray from the topic of the article into the topic of another article, Elective_caesarean_section. Please helpimprove this section or discuss this issue on the talk page. (January 2011)

Caesarean sections are in some cases performed for reasons other than medical necessity. Reasons for elective Caesareans vary, with a key distinction being between hospital or doctor-centric reasons and mother-centric reasons. Critics of doctor-ordered Caesareans worry that Caesareans are in some cases performed because they are profitable for the hospital, because a quick Caesarean is more convenient for an obstetrician than a lengthy vaginal birth, or because it is easier to perform surgery at a scheduled time than to respond to nature's schedule and deliver a baby at an hour that is not predetermined. [45] Another reason for doctors to recommend C-section is money. In China, doctors are compensated based on the monetary value of medical treatments offered. As a result, doctors have an incentive to persuade mothers to choosing the more expensive C-section. In this context, it is worth remembering that many studies have shown that operations performed out-of-hours tend to have more complications (both surgical and anaesthetic).[46] For this reason if a Caesarean is anticipated to be likely to be needed for a woman, it may be preferable to perform this electively (or pre-emptively) during daylight operating hours, rather than wait for it to become an emergency with the increased risk of surgical and anaesthetic complications that can follow from emergency surgery. Another contributing factor for doctor-ordered procedures may be fear of medical malpractice lawsuits. Italian gynaecologyst Enrico Zupi, whose clinic in Rome Mater Dai was undermedia attention for carrying a record of caesarian sections (90% over total birth), explained: We shouldn't be blamed. Our approach must be understood. We doctors are often sued for events and complications that cannot be classified as malpractice. So we turn to defensive medicine. We will keep acting this way as long as medical mistakes are not depenalized. We are not martyrs. So if a pregnant woman is facing an even minimum risk, we suggest she gets a C-section "[33]

Studies of United States women have indicated that married white women giving birth in private hospitals are more likely to have a Caesarean section than poorer women even though they are less likely to have complications that may lead to a Caesarean section being required. The women in these studies have indicated that their preference for Caesarean section is more likely to be partly due to considerations of pain and vaginal tone.[47] In contrast to this, a recent study in the British Medical Journal retrospectively analysed a large number of Caesarean sections in England and stratified them by social class. Their finding was that Caesarean sections are not more likely in women of higher social class than in women in other classes. [48] Some have suggested that due to the comparative risks of Caesarean section with an uncomplicated vaginal delivery, patients should be discouraged or forbidden from choosing it.[49] Some 42% of obstetricians believe the media and women are responsible for the rising Caesarean section rates. [50] Some studies, however, conclude that relatively few women wish to be delivered by Caesarean section. [51]

Anaesthesia
Both general and regional anaesthesia (spinal, epidural or combined spinal and epidural anaesthesia) are acceptable for use during Caesarean section. Regional anaesthesia is preferred as it allows the mother to be awake and interact immediately with her baby.[52] Other advantages of regional anesthesia include the absence of typical risks of general anesthesia:pulmonary aspiration (which has a relatively high incidence in patients undergoing anesthesia in late pregnancy) of gastric contents and Oesophageal intubation.[53] Regional anaesthesia is used in 95% of deliveries, with spinal and combined spinal and epidural anaesthesia being the most commonly used regional techniques in scheduled Caesarean section. [54] Regional anaesthesia during Caesarean section is different to the analgesia (pain relief) used in labor and vaginal delivery. The pain that is experienced because of surgery is greater than that of labor and therefore requires a more intense nerve block. The dermatomal level of anesthesia required for Caesarean delivery is also higher than that required for labor analgesia.[53] General anesthesia may be necessary because of specific risks to mother or child. Patients with heavy, uncontrolled bleeding may not tolerate the hemodynamic effects of regional anesthesia. General anesthesia is also preferred in very urgent cases, such as severe fetal distress, when there is no time to perform a regional anesthesia.

Vaginal birth after Caesarean

Main article: Vaginal birth after caesarean While vaginal birth after Caesarean (VBAC) are not uncommon today, their numbers are shrinking.[55] The medical practice until the late 1970s was "once a Caesarean, always a Caesarean" but a consumer-driven movement supporting VBAC changed the medical practice. Rates of VBAC in the 80s and early 90s soared, but more recently the rates of VBAC have dramatically dropped owing to medico-legal restrictions. In the past, Caesarean sections used a vertical incision which cut the uterine muscle fibres in an up and down direction (a classical Caesarean). Modern Caesareans typically involve a horizontal incision along the muscle fibres in the lower portion of the uterus

(hence the term lower uterine segment Caesarean section, LUSCS/LSCS). The uterus then better maintains its integrity and can tolerate the strong contractions of future childbirth. Cosmetically the scar for modern Caesareans is below the "bikini line". Obstetricians and other caregivers differ on the relative merits of vaginal and Caesarean section following a Caesarean delivery; some still recommend a Caesarean routinely, others do not. In the US, the American College of Obstetricians and Gynecologists (ACOG) modified the guidelines on vaginal birth after previous Caesarean delivery in 1999 and again in 2004.[56]This modification to the guideline included the addition of the following recommendation: Because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.[57] This recommendation has, in some cases, had a major impact on the availability of VBACs to birthing mothers in the US. For example, a study of the change in frequency of VBAC deliveries in California after the change in guidelines, published in 2006, found that the VBAC rate fell to 13.5% after the change, compared with 24% VBAC rate before the change. [58]The new recommendation has been interpreted by many hospitals as indicating that a full surgical team must be standing by to perform a Caesarean section for the full duration of a VBAC woman's labor. Hospitals that prohibit VBACs entirely are said to have a 'VBAC ban'. In these situations, birthing mothers are forced to choose between having a repeat Caesarean section, finding an alternate hospital in which to deliver their baby or attempting delivery outside the hospital setting. [59]

Recovery period
Typically the recovery time depends on the patient and their pain/ inflammation levels. Doctors do recommend no strenuous work i.e. lifting objects over 10 lbs., running, walking up stairs, or athletics for up to two weeks.

Within Judaism
There is a dispute among the poskim (Rabbinic authorities) as to whether a first born son from a Cesarean section has the laws of a Bechor.[60]

http://en.wikipedia.org/wiki/Caesarean_section

Caesarean section
Approved by the BabyCenter Malaysia Medical Advisory Board Last reviewed: February 2011[Show references]

What is a caesarean section? What's the difference between a planned and an emergency caesarean? What will happen before my caesarean? What happens during my caesarean? What will happen after my baby is born?

What is a caesarean section?

A caesarean section is an operation in which an obstetrician makes a cut through your belly and uterus (womb) so that your baby can be born. It's the most common major surgery that women have.

What's the difference between a planned and an emergency caesarean?

A planned or elective caesarean is scheduled to take place before your labour begins.

An emergency caesarean is not planned before labour begins. It can happen if:

You were planning a caesarean, but went into labour before the operation. Your caesarean can go ahead within a few hours of your labour starting, as long as you and your baby are well.

You or your baby developed a complication during pregnancy or labour. This is more urgent and a caesarean should be done within about an hour.

You or your baby had a life-threatening complication during pregnancy which meant that you needed an immediate caesarean. Your baby should be born as soon as possible, ideally within 30 minutes.

Your labour has stalled or is very slow.

Most unplanned caesareans give you, your husband and the maternity staff time to be prepared for the operation. Read more about the reasons for needing a caesarean.

What will happen before my caesarean?

Your doctor should talk you through the procedure. They will:

tell you what will happen during the caesarean section; explain why they think you need the operation; explain any possible risks to you and your baby ask for your consent, which you have the right to refuse.

Before surgery, you will need to change into a hospital gown. You'll have to take off jewellery. If you have a brace or false teeth, you'll need to remove these, too.

You will also need to take off makeup and nail varnish. This is so your skin tone can be monitored during the operation. You won't be able to wear contact lenses. If you wear glasses, give them to your husband or midwife, so that you can put them on to see your baby.

In most cases, your husband will be with you during your caesarean. He may have to change into surgical attire. These will include a mask for his nose and mouth, a hat and special footwear.

During your caesarean you'll lie on an operating table, which is tilted or wedged to the left. It's tilted so the weight of your uterus doesn't reduce the blood supply to your lungs and make your blood pressure drop.

Quite a lot of things will happen to prepare you for your caesarean:

A drip will be inserted into a vein in your arm. This will give you fluids and make it easy to give you drugs later if you need them.

You'll be given an anaesthetic. This will usually be regional, which means it numbs your bottom half, via a spinal or epidural. It's safer for you and your baby than a general anaesthetic, which puts you to sleep.

A thin tube, or catheter, will be inserted into your bladder via your urethra. This will make sure your bladder is empty. It can be put in after the painkiller is working so that you don't feel it.

The pubic area, where the cut will be made, will be shaved and cleaned with antiseptic.

You'll be given either white stockings, extra fluid or blood -thinning injections. This will reduce the risk of a clot forming in one of your leg veins (deep vein thrombosis).

You'll have a cuff put on your arm to monitor your blood pressure.

 Electrodes will be put on your chest to monitor your heart rate. You may have a finger -pulse monitor attached, too.

A sticky plastic plate will be attached to your leg. This is the earth for the electrical equipment used by your obstetrician to stop bleeding during the surgery. Don't worry, the earth plate won't affect you.

You'll be offered:

an injection of antibiotics to ward off infection; anti-sickness medicine to stop you from vomiting; strong pain relief during and just after the caesarean. pain relief for lasting soreness oxygen through a mask, if your baby is in distress.

You may be surprised how many people are needed to do a caesarean section.

What happens during my caesarean?

A screen is put up over your chest so that you can't see the operation. But you can ask for this to be lowered as your baby is born. Your anaesthetist will check that your painkiller is working properly.

Once you're numb, your doctor will make a straight cut, called a bikini cut, into the skin of your belly. It is usually two fingers width above your pubic bone, at the top of your pubic hair.

This sort of cut is less painful after the operation and looks better as it heals than a cut down the middle of your tummy. Layers of tissue and muscle are opened to reach your uterus. Your tummy muscles are parted, rather than cut. Your bladder will be moved down to expose the lower part of your uterus.

The cut to your uterus is usually small. Your doctor will make it bigger using scissors or fingers, so that it is torn. This causes less bleeding than a sharp cut. The opening to your uterus is usually in the lower part. This is why the operation is sometimes called a lower segment caesarean section (LSCS).

If you have a lot of fluid, you may hear and sense it whoosh out through the opening. Your obstetrician will lift out your baby. You may be aware of the assistant pressing on your belly to help your baby be born. If your baby

is breech, he will be born bottom first.

This all happens quickly. It's possible that only five or 10 minutes after arriving in theatre you will be able to meet your baby.

If you're having twins the lower twin is born first, just as if you'd given birth vaginally. Sometimes, forceps are used to bring out your baby's head carefully. They are usually only needed when your baby is in a breech position or is premature.

Surgeons may make a larger, vertical cut in your uterus if:

your baby is very premature, or is lying across your uterus; you have a condition such as a low-lying placenta or growths, known asfibroids.

What will happen after my baby is born?

Your baby may be placed on your chest for you to cuddle, or he may need to be checked by a midwife or paediatrician. Your husband can usually hold your baby if you are unable to. If you're having twins, you may be cuddling one baby each sooner than you expected! Babies born by caesarean tend to be a little colder than babies born vaginally, so they need wrapping up well.

Your baby will be given an Apgar score one minute and five minutes after he's born. The score measures your babys wellbeing.

If there has been concern about your baby's health, a paediatrician will do the checks. Some babies need oxygen or to go to the NICU (neonatal intensive care unit)for a while.

You'll be given the hormone oxytocin via a drip. This will help your uterus contract and reduce blood loss. Your doctor will gently tug the umbilical cord to pull out theplacenta. This will be checked to make sure it is complete before you're stitched up.

You'll be in the operating theatre for up to an hour. This is because it takes much longer to close you up than to open

you up. The process may take longer if you have had one or more caesareans. It depends on how many bands of scar tissue (adhesions) you have from previous operations.

Your doctor will probably use a double layer of stitches to repair your uterus. The cut in your belly will be closed in layers. Finally, your skin wound will be closed with stitches or staples. When you're ready, you'll be moved into your room where you, your husband and, if all is well, your baby or babies can be together.

You may start shivering, because your body temperature drops during the operation. The anaesthetic affects your body's ability to regulate your temperature, and theatres are often kept cool. The shivering can be unnerving, but is usually harmless and only lasts about half an hour. The midwife or nurse looking after you will warm you up with blankets and fluids.

If you want to breastfeed, it's a good idea to try while you're still in the recovery room. Your midwife will help you get comfortable for breastfeeding and to take care of you straight after the operation.

http://www.babycenter.com.my/pregnancy/labourandbirth/labourcomplications/caesarean/

C-section: Medical reasons

Cesarean birth is the birth of a baby by surgery. The doctor makes an incision (cut) in the belly and uterus (womb) and then removes the baby. The surgery is called a cesarean section or c-section. The natural way for a baby to be born is through the mother's vagina (birth canal). But sometimes vaginal birth isn't possible. If you or your baby have certain problems before or during labor, c-section may be safer than vaginal birth. You and your health care provider may plan your cesarean in advance. Or you may need an emergency (unplanned) c-section because of a complication that arises for you or your baby during pregnancy or labor.

Why might I have a c-section?

Your health care provider may suggest that you have a c-section for one or more of these reasons: You've already had a c-section in another pregnancy or other surgeries on your uterus. Your baby is too big to pass safely through the vagina. The baby's buttocks or feet enter the birth canal first, instead of the head. This is called a breech position. The baby's shoulder enters the birth canal first, instead of the head. This is called a transverse position. There are problems with the placenta. This is the organ that nourishes your baby in the womb. Placental problems can cause dangerous bleeding during vaginal birth. Labor is too slow or stops. The baby's umbilical cord slips into the vagina, where it could be squeezed or flattened during vaginal delivery. This is called umbilical cord prolapse. You have an infection like HIV or genital herpes. You're having twins, triplets or more. The baby has problems during labor that show it is under stress, such as a slow heart rate. This is sometimes called "fetal distress."

You have a serious medical condition that requires intensive or emergency treatment (such as diabetes or high blood pressure). The baby has a certain type of birth defect. A woman who has a c-section usually takes longer to recover than a woman who has had a vaginal birth. Women can expect to stay 3 to 4 days in the hospital after a c-section. Full recovery usually takes 4 to 6 weeks. Usually, the hospital stay for vaginal birth is 2 days, with full recovery taking less time than a cesarean. C-section may be more expensive than a vaginal birth.

What about the risks?

When c-sections are done, most women and babies do well. But c-section is a major operation with risks from the surgery itself and from anesthesia. The National Center for Health Statistics estimates that 1 in 3 babies in the United States are delivered by csection. Over the past few years, the rate of cesarean birth has increased rapidly. Some health care providers believe that many c-sections are medically unnecessary. When a woman has a cesarean, the benefits of the procedure should outweigh the risks.

The risk of late preterm birth

C-sections may contribute to the growing number of babies who are born "late preterm," between 34 and 36 weeks gestation. While babies born at this time are usually considered healthy, they are more likely to have medical problems than babies born a few weeks later at full term. A baby's lungs and brain mature late in pregnancy. Compared to a full-term baby, an infant born between 34 and 36 weeks gestation is more likely to have problems with: Breathing Feeding Maintaining his or her temperature Jaundice It can be hard to pinpoint the date your baby was conceived. Being off by just a week or two can result in a premature birth. This may make a difference in your baby's health. Keep this in mind when scheduling a csection.

Other risks for the baby

Anesthesia: Some babies are affected by the drugs given to the mother for anesthesia during surgery. These medications make the woman numb so she can't feel pain. But they may cause the baby to be inactive or sluggish. Breathing problems: Even if they are full-term, babies born by c-section are more likely to have breathing problems than are babies who are delivered vaginally.

Breastfeeding
Women who have c-sections are less likely to breastfeed than women who have vaginal deliveries. This may be because they are uncomfortable from the surgery or have less time with the baby in the hospital. If you are planning to have a cesarean section and want to breastfeed, talk to your provider about what can be done to help you and your baby start breastfeeding as soon as you can.

Risks for the mother

A few women have one or more of these complications after a c-section: Increased bleeding, which may require a blood transfusion Infection in the incision, in the uterus, or in other nearby organs Reactions to medications, including the drugs used for anesthesia Injuries to the bladder or bowel Blood clots in the legs, pelvic organs or lungs

A very small number of women who have c-sections die. Death is rare, but it is more likely with cesarean than with vaginal delivery. If a woman who has had a cesarean section becomes pregnant again, she is at increased risk of:

Placenta previa: The placenta implants very low in the uterus. It covers all or part of the internal opening of the cervix (the birth canal). Placenta accreta: The placenta implants too deeply and too firmly into the uterine wall. Both of these conditions can lead to severe bleeding during labor and delivery, endangering mother and baby. The risk increases with the number of pregnancies.

Making decisions
Every pregnancy is different. If you are considering a planned c-section for medical reasons or are interested inasking that your baby be delivered by c-section, talk with the health care provider who will deliver your baby. Carefully consider the risks and benefits for your baby and yourself. These questions may be useful when you speak to your provider. If your provider recommends delivery before 39 weeks: Is there a problem with my health or the health of my baby that may make me need to have my baby early? Can I wait to have my baby closer to 40 weeks?

About c-section: Why do I need to have a c-section? What problems can a c-section cause for me and my baby? Will I need to have a c-section in future pregnancies? July 2008

http://www.marchofdimes.com/pregnancy/csection_indepth.html

Elective and emergency caesareans

Babies born by caesarean (C-section) come out through incisions in your uterus and abdomen. If you decide to have a caesarean, or, more likely, you're advised to have one before you go into labour, it's called an 'elective' caesarean. One that takes place after you've already gone into labour is called an emergency caesarean, though despite the word emergency it doesnt mean there has to be any sort of urgent panic about the decision In your notes, you may see it written as CS, LSCS (lower segment caesarean section) or LUSCS (lower uterine segment caesarean section). Reasons you might need a caesarean include: Your baby's head is too large to fit through your pelvis The shape or size of your pelvis makes a vaginal birth more difficult

The placenta is lying low in the uterus (placenta praevia), blocking your baby's exit You're expecting twins or triplets (one of whom may be in a difficult position) Your baby's lying across the uterus, or is breech (bottom or feet first) Once labour has begun, your baby becomes distressed (suffering from a lack of oxygen) and isn't far enough down the birth canal for forceps or ventouse

You have eclampsia or severe pre-eclampsia You're ill, have high blood pressure, or become exhausted in labour
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How it's done

You'll be given an anaesthetic (if you haven't had one already). The anaesthetic used is almost always given as an epidural, which allows you to stay awake. Occasionally, a general anaesthetic is used. If you're conscious, you can have someone with you in the operating theatre. Usually neither you nor your companion will be able to see what's going on, as a screen will be placed across your abdomen. The surgeon makes an incision in your abdomen, just above your pubic hairline, and cuts through the uterus. The baby is then helped out. You might feel quite a bit of tugging and pulling when this happens. Once the baby is delivered, the cord is clamped and cut. If everything's all right, you can hold him, and theres normally no reason why you and your baby cant enjoy being close, skin to skin, getting to know each other in this way. The placenta and the membranes are then The placenta and the membranes are then delivered and you are stitched up. The whole thing takes about 45 minutes.
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Recovery
It's normal to feel very tired for a few days after a caesarean and you may experience some pain, just as you would with any abdominal operation. You can take pain relief to help with this. Trapped wind is a common problem, too. Recovery after a caesarean can take longer than a vaginal birth. There may also be aftereffects, such as infection, which is why you'll probably be advised to take antibiotics.

In the first day or so, you may be attached to a tube that collects any blood pooling under the scar. A drip in your arm makes sure you remain hydrated. At the very beginning, you may also need a catheter or bedpan to help you urinate. Ask what sort of stitches you have. They may dissolve or need removing later, or you may have clips that will need removing once you've healed.
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How you'll feel

Some women feel disappointed at having an emergency caesarean. If you feel like this, talk to the medical staff about the reasons why a caesarean was necessary. Understanding this can sometimes help you come to terms with it. You may have no negative feelings at all about your caesarean. This, too, is fine. Next time You may be able to have a vaginal birth in the future, depending on the underlying cause of your caesarean. There's no evidence that 'once a caesarean always a caesarean'. There's a very small risk that the scar on your uterus might start to rupture when you go into labour, but with proper care this can be spotted before it becomes a problem. Too many caesareans? There's some controversy about the number of caesarean performed: the total is rising year on year. The climate of 'over-medicalisation' of childbirth and fear of litigation if a vaginal birth goes wrong are thought to be among the reasons for the rising trend, which is viewed with serious concern by all the professional organisations, and by parents organisations. Statistics from the Department of Health show that one in four babies is born by caesarean in England, with many regional variations. In 1980, the number of caesareans in England was much lower, at nine per cent.
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Can I choose to have a caesarean?

You won't automatically be given a caesarean on request, at least not on the NHS. But your doctor should listen to your reasoning. If your doctor and midwife are reluctant to grant your request, it may be because they feel there's no medical reason for it.

Understanding what happens during birth might be one way of coping with any anxieties you have about vaginal birth

http://www.bbc.co.uk/health/physical_health/birth/birth_caesarean.shtml