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Childbirth is one of nature's greatest wonders. We live in an age where we expect a perfect outcome but throughout history until just a couple of generations ago, childbirth was a most precarious event. Mercifully mortality has been reduced to just 2% compared to a century ago and we can now concentrate more on the outcome for the baby.
We are increasingly turning to the internet for information. Questions about health are amongst the more common reasons for Web searches.
Patients rightly wish to be involved in decisions about their care. There are often options
relating to investigations and management. The purpose of this Web site is to present the background for decision making and to explore areas of current debate.
For those
without medical training, all medical terms in the text have a link to the
explanation.
'2 Women's Health .com' is for discerning
people who wish to appreciate the background to pregnancy related treatment
options. Health professionals, including nurses, medical students, junior
doctors and general practitioners looking for a text that provides a
balanced discussion of the issues, rather than a basic review of the
essential clinical facts, may find this book helpful not only for obstetrics
and midwifery but as a framework for the caring aspects in the art of
medicine. Those
studying for postgraduate qualifications, may find the presentation, with
links to clinically relevant medical abstracts, to be of assistance. Links to
the abstracts of selected medical papers are provided to allow a more
in depth understanding. This area of the Web site will be an ongoing
project. The ethos of this e-book is to explain the advantages and
disadvantages of the various options whilst leaving it to each individual to
come to their preference according to their particular circumstance.
This Website has been developed as a result of experience gained from its sister gynaecology site - www.2womenshealth.com. During pregnancy one (or more) offspring, known as an embryo (early pregnancy) or fetus (from about 8 weeks into the pregnancy), develop inside the uterus of a woman. Pregnancy occurs as the result of the female gamete or oocyte (egg) being penetrated by the male gamete spermatozoon in a process referred to, in medicine, as "fertilization", or more commonly as "conception". The fusion of male and female gametes usually occurs through the act of sexual intercourse. However, the advent of artificial insemination and in vitro fertilization (IVF) has also made achieving pregnancy possible in such cases where sexual intercourse is not potentially fertile (through choice or male/female infertility). In the majority of human pregnancies, only one baby develops (singleton pregnancy) but there can be more (multiple pregnancy) as in the case of twins or triplets. Some infertility treatments, particularly IVF, are prone to result in multiple pregnancy. The outer layers of the embryo grow and form a placenta, for the purpose of receiving oxygen and essential nutrients and removing carbon dioxide and waste products. The umbilical cord in a newborn child consists of the remnants of the connection to the placenta. The developing embryo undergoes tremendous growth and changes during the process of foetal development. Pregnancy is the carrying of one or more offspring, known as a fetus or embryo, inside the uterus of a female. More than one baby may develop, as in the case of twins or triplets. Obstetrics is the medical field that studies and treats pregnant patients. Childbirth usually occurs about 38 weeks from fertilization, which is approximately 40 weeks from the start of the last menstruation. Thus, pregnancy lasts about nine months. One scientific term for the state of pregnancy is gravid, and a pregnant female is sometimes referred to as a gravida. Both words are rarely used in common speech. The term embryo is used to describe the developing human during the initial weeks, and the term fetus is used from about two months of development until birth. A woman who is pregnant for the first time is known medically as a " primigravida" or " gravida 1", while a woman who has never been pregnant is known as " gravida 0". Similarly, the terms " para 0", " para 1" and so on are used for the number of times a woman has previously given birth. If a woman has never given birth, she is referred to as nulliparous. In many societies' medical and legal definitions, human pregnancy is somewhat arbitrarily divided into three trimester periods, as a means to simplify reference to the different stages of prenatal development. The first trimester (unitl 16 weeks) carries the highest risk of miscarriage. During the second trimester (from 16-28 weeks), 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. Pregnancy occurs as the result of the female gamete or oocyte (egg) being penetrated by the male gamete spermatozoon in a process known as "fertilisation", or more commonly known as "conception". The fusion of male and female gametes usually occurs through the act of sexual intercourse. However, the advent of artificial insemination has also made achieving pregnancy possible in such cases where sexual intercourse is not potentially fertile through choice or in some cases of infertility. Though pregnancy begins at implantation, it is more convenient to date from the first day of a woman's last menstrual period (LMP). This is used to calculate the expected date of delivery (EDD). Pregnancy usually lasts between 37 and 42 weeks, with the EDD at 40 weeks after the LMP. 40 weeks is equivalent to a little more than nine months and six days, which forms the basis of Naegele's rule for estimating date of delivery. 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 pre-term; from week 42 (294 days) events are considered post-term. When a pregnancy exceeds 42 weeks (294 days) it can begin to pose significant risks to mother and fetus. Obstetricians usually prefer to induce labour, in an otherwise uncomplicated pregnancy, at some stage between 41 and 42 weeks. Medical literature tends to use the terminology pre-term and post-term rather than premature and post-mature. Pre-term and post-term are unambiguously defined as above, whereas premature and postmature have historical meaning and relate more to the infant's size and state of development rather than to the stage of pregnancy. Though these are the averages, the actual length of pregnancy depends on various factors. For example, the first pregnancy tends to last longer than subsequent pregnancies. Fewer than 10% of births occur on the due date; 50% of births are within a week of the due date, and almost 90% within two weeks. Accurate dating of pregnancy is important, because it is used in calculating the results of various prenatal tests such as the triple test used to screen for Down Syndrome (mongolism). A decision may be made to induce labour if a fetus is perceived to be overdue. Due dates are only a rough estimate, and the process of accurately dating a pregnancy is complicated by the fact that not all women have 28 day menstrual cycles, or ovulate on the 14th day following their last menstrual period. A number of medical signs are associated with pregnancy. 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, missed menstrual 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 two 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 Vaginal fornix), and Linea nigra, (darkening of the skin in a vertical line on the abdomen, caused by hyperpigmentation resulting from hormonal changes; it usually appears around the middle of pregnancy).[15][16]
Obstetrics and the Pregnant WomanObstetrics is the medical field that studies and treats pregnant women and the doctors who specialise in obstetric medicine are known as obstetricians. Childbirth usually occurs about 38 weeks from fertilization, i.e., approximately 40 weeks from the start of the last menstruation. A commonly used scientific term for the state of being pregnant is gravid, and a pregnant woman is sometimes referred to as a gravida. Similarly, the term "parity" (abbreviated as "para") is used for the number of previous deliveries occurring after 24 weeks. Women who have never been pregnant before are referred to as "nulliparous" and during a first pregnancy as a "primigravida" ("gravida 1, para 0") and in subsequent pregnancies as "multigravida" or "multiparous". Hence during a second pregnancy a woman would be described as "gravida 2, para 1". Pregnancy is divided into three trimester periods. The first trimester of pregnancy concludes at 16 weeks and carries the highest risk of miscarriage. In some cases the fertilized egg might implant itself in a fallopian tube, causing an ectopic pregnancy. The second trimester of pregnancy tends to be less prone to complications. 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. Although the fetus begins moving 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 by the fourth month. The placenta is now fully functioning The third trimester of pregnancy commences at 28 weeks and approximates the point of viability, or the ability of the fetus to survive, with or without medical help, outside of the uterus. The use of modern medical intensive care technology has greatly increased the probability of premature babies living, and has pushed back the boundary of viability to much earlier dates than would be possible without assistance.0801 These advances in the quality of neonatal care have resulted in survival of many babies delivered at 24 weeks and even earlier. An unfortunate complication of extreme prematurity is morbidity. Calculating Dates In Pregnancy Most pregnant women do not have any specific signs or symptoms of implantation, although it is not uncommon to experience light bleeding at implantation.Though pregnancy begins at implantation, it is more convenient to date from the first day of a woman's last menstrual period (LMP). Starting from one of these dates, the expected date of delivery (EDD) can be calculated. Counting from the LMP, pregnancy usually lasts between 37 and 42 weeks, with the EDD at 40 weeks, or 38 weeks following conception. 40 weeks is nine months and six days, which forms the basis of Naegele's rule for estimating date of delivery. Less than 10% of births occur spontaneously on the EDD; 50% of births are within a week of the due date, and almost 90% within two weeks. Dating a pregnancy is only a rough estimate, and the process of accurately dating a pregnancy using the LMP method is complicated by the fact that not all women have 28 day menstrual cycles, nor ovulate on the 14th day following their last menstrual period. Unless a woman's recent sexual activity has been limited, or she has been charting her cycles, or the conception is as the result of some types of fertility treatment (such as IUI or IVF) the exact date of fertilization is unknown. Pregnancy is considered 'at term' when gestation attains 37 complete weeks but is less than 42. Events before completion of 37 weeks (259 days) are considered pre-term; from week 42 (294 days) events are considered to be post-term. When a pregnancy exceeds 42 weeks (294 days), the risk of complications for mother and fetus increases significantly. This is one indication for obstetricians to recommend induction of labour, generally between 41 and 42 weeks.(Induction of Labour) Obstetricians have tended to refer increasingly to pre-term and post-term rather than premature and post-mature. Accurate dating of pregnancy is important for several reasons. It is used in determining the significance of results of various prenatal tests such as the triple test - a screenig test for Down syndrome. Assessment of the appropriateness of the fetal size depends on an accurate knowledge of the gestational age. Interventions may be indicated if the fetus is small or large for dates. A decision may be made to delay delivery if labour begins prematurely and to administer steroids to reduce complications or to induce labour(Induction of Labour) if a fetus is believed to be overdue.
A number of symptoms and signs are associated with pregnancy:-
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, missed menstrual 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 two 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 Vaginal fornix), and Linea nigra, (darkening of the skin in a vertical line on the abdomen, caused by hyperpigmentation resulting from hormonal changes; it usually appears around the middle of pregnancy). The beginning of pregnancy may be detected in a number of ways, including various pregnancy tests which detect hormones generated by the newly-formed placenta (afterbirth). Clinical blood and urine tests can detect pregnancy within a few days of implantation, which is as early as 6-8 days after fertilization. Following the development of the blastocyst (early embryo) a hormone named human chorionic gonadotropin (HCG) is produced and this stimulates the corpus luteum in the woman's ovary to produce progesterone (hormone in favour of pregnancy). This maintains the lining of the uterus so that the embryo will continue to be nourished. An early ultrasound examination can accurately determine gestational age. This method is slightly more accurate than methods based on LMP.9901
During the first three months of
pregnancy, feeling sick or nauseated is quite common, as is vomiting.
Morning sickness can occur in about seventy percent of all pregnant
women and typically improves after the first trimester.Most
miscarriages occur during this period.The
problem varies from woman to woman. Some just feel a little sick in the
morning and throw up once, whilst others suffer from constant nausea and
frequent vomiting throughout the day. About 75% of women are troubled and
the incidence has not changed over 20 years.0301,
0601
There is a some good news. Morning sickness is associated with pregnancies that are less likely to result in miscarriage, preterm delivery, or intrauterine growth retardation.0101 There is no evidence that morning sickness, even if severe, causes any harm to your baby. It has been suggested that morning sickness is promoted by secretion of human chorionic gonadotrophin (hCG), largely on the basis of the coincidence between the onset of NVP and hCG secretion and the peaks of both at around 12 to 14 weeks' gestation and also the increase in symptoms associated with twins. Furthermore, when there is a hydatidiform mole, hCG and morning sickness are both increased.
Treatment generally begins with non-pharmacologic interventions; if symptoms do not improve, drug therapy is added.
At night:-
Prenatal medical care is of recognized value throughout the developed world. Periconceptional Folic acid supplementation is the only type of supplementation of proven efficacy.
A balanced, nutritious diet is essential for a healthy pregnancy. Balancing carbohydrates, fat, and proteins, and eating a variety of fruits and vegetables usually ensure 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 intake has been proven to limit fetal neural tube defects including spina bifida. Folates (folia, leaf) are abundant in spinach (fresh, frozen or canned), and are also found in green vegetables, salads, melon, eggs and hummus. In Canada and the United States, most wheat products are fortified with folic acid. There is some evidence that omega-3 (n-3) fatty acids have a beneficial effect on the developing fetus, but further research is required.0701 At this time, supplementing the diet with foods rich in these fatty acids is not recommended, although it seems to be safe.0702 Potenteially dangerous bacteria or parasites may contaminate foods, particularly listeria (soft cheeses may contain listeria, if milk is raw) and toxoplasma. Cat faeces pose a particular risk of toxoplasmosis. Practicing good hygiene in the kitchen can reduce these risks.
Caloric intake must be increased, to allow for the development of the fetus. The amount of weight gained during pregnancy varies. The recommendation is that overall weight gain during the 9 month period for women who start pregnancy with normal weight be 10 to 12 kilograms. Excessive weight gain can pose risks to the woman and the fetus. Women who are prone to being overweight may choose to plan a healthy diet and exercise plan to help moderate the amount of weight gained. Most pregnant women can enjoy sexual intercourse throughout pregnancy. Most research suggests that, during pregnancy, both sexual desire and frequency of sexual relations decrease.0201 In context of this overall decrease in desire, some studies indicate a second-trimester increase, preceding a decrease.However, these decreases are not universal: a significant number of women report greater sexual satisfaction throughout their pregnancies. Until the mid 20th century, it was considered a socio-moral "taboo" action for pregnant women to engage in sexual activities. This is far from universal however, for example the Talmud recommends it for the health of the mother and child. Sex during pregnancy is a low-risk behaviour except when the physician advises that sexual intercourse be avoided, which may, in some pregnancies, lead to serious pregnancy complications or health issues such as a high-risk for premature labour or bleeding if the placenta is planted low in the uterus (placenta praevia).
We calculate your due date by simply adding 280 days to the day when you started your monthly cycle. The human gestation period is actually 266 days, so by adding 14 days, which is the average ovulation period to the first day of your cycle, we come to the 280 day figure. Of course, if you have been monitoring your cycle and know when you ovulated, it does make it easier to calculate your conception and due dates. 
Within this trimester the most rapid rate of growth and development take place. All the organs have developed. Of course the majority of early pregnancies fare well but complications including miscarriage and ectopic pregnancy can occur. Pregnancy symptoms, such as morning sickness, and pregnancy signs such as an enlarging uterus, occur. By the end of the 1st trimester, your son or daughter will have grown to 3.4 inches (8.7 cm) long and weigh about 1.5 ounces (43 grams). The majority of babies are healthy but abnormalities such as Down's Syndrome can occur and you will need to consider your options with regard to antenatal screening. Pregnancy Week by Week - Weeks 1 - 4
Picture - Four cell embryo
Four week embryo
Pregnancy Week by Week - Week 5
Pregnancy Week by Week - Week 6
Picture of a mother and her baby
Pregnancy Week by Week - Week 7
Pregnancy Week by Week - Week 8
Pregnancy Week by Week - Week 9
Photograph of a happy couple Pregnancy Week by Week - Week 10
Pregnancy Week by Week - Week 11
Pregnancy Week by Week - Week 12
Pregnancy Week by Week - Week 13
Picture of a mother with her twin babies Pregnancy Week by Week - Week 14
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