It’s true that during pregnancy the body’s demand for vitamins increases. Just keep in mind that vitamins don’t mean calories!No matter how happy a woman is about being pregnant, there is always stress involved: worries about whether the child will be healthy, whether there will be enough money to pay the bills, whether you’ll have to leave your job, and so on. And these stresses take their toll on mother and fetus.The body responds to stress by producing more adrenal hormones. These provide the extra energy that’s necessary when action is called for. But if there’s no physical outlet for the energy, it’s redirected to the digestive or nervous system or to some other organ system. In many instances, this is what’s responsible for pregnancy fatigue, headaches, insomnia, and morning sickness. But, more important, this accelerated adrenal hormone production revs up the metabolism to such a degree that stores of valuable calcium are depleted, along with protein, phosphorus, and potassium, which are rapidly excreted just when the growing fetus needs them most.*5/137/5*
Many women in this age group take supplementary iron and vitamins. A good all-round diet, including vegetables, fresh fruit, a reasonable amount of meat and dairy products, nuts, fish and poultry, will usually provide all the items necessary for good health. Just the same, an added multi-vitamin capsule or tablet may assist, in the event of an absorption deficiency being present in the bowel. So will a daily iron tablet or capsule (dosage is usually written on the label). A blood test indicates whether there is anaemia.Apart from this, getting hooked on masses of so-called ‘health foods’ and fringe medicine medications is often quite useless and enormously expensive, a waste of time, money and effort. Stick to well-known proven principles, and let the fringe medicine ideas quietly slip by.Think positively: A positive, happy outlook on life, claiming confidence, eating sensibly, exercising regularly and becoming involved in outside activities, will enable an enjoyable and action-packed life for many years ahead.Happy days. Happy nights, and a happy lifetime ahead.*118\45\4*
Could you be born with cells that have within them the possibility of growing into a full-blown case of endometriosis? In answering this question, researchers noted that many women do not have any classical symptoms of endometriosis while having the disease. Another dilemma involved women who had undergone abdominal surgery; there it was found that masses had developed that contained endometriosis like cells. That is, these patients appeared to have the disease, but in fact, they did not. How might this happen?
Noteworthy embryo logical studies uncovered some fascinating evidence. During intrauterine life, the fetal reproductive organs germinate from different types of cells. Vaginal tissue originates from a different set of genetic blueprints than uterine tissue, although both organs have the quality and capability of, for example, elasticity to accommodate childbearing. These embryonic studies went on to show that the tissue lining the ovaries, the endometrium, and the peritoneum—the smooth, transparent, and highly sensitive membrane that lines the pelvic and abdominal cavity—all originated from the same embryonic cell membrane.
It was then postulated that some of these cells could be transformed into endometrial cells or endometrial like cells through repeated irritation, such as pelvic infections, or by hormonal stimulation. In many cases, the physiological result is identical to having actual endometrial cells run wild and implant themselves: pain, cramps, and possible infertility. Thu mimicking of the disease posed some conclusions that interest scientists. The story that follows reveals why.
*26\43\4*
As a result of the tests carried out your doctor will advise you as to the best course for a desired pregnancy.
If all is normal with your partner’s semen analysis it may be suggested that you are failing to ovulate and that a course of fertility drugs such as Clomiphene (Clomid) be taken to induce or increase egg production.
You will be told to start taking Clomid on either day 2 or day 5 (depending on the length of your cycle).
The Clomid will encourage the production of an egg(s), the ultrasound scan will determine its maturity and the HCG injection will ensure it is released into the fallopian tube within 3 6 hours. You will be told to coincide intercourse during that 36 hours.
If these treatments are not successful you will need to consider your options. At this stage the options may include deciding to have no further treatment or to investigate your suitability for IVF (in vitro fertilisation) or GIFT (gamete intra fallopian transfer). However, before embarking on either of these programmes it should be noted that the success rates for full term pregnancies is 10% and 20% for IVF and GIFT respectively.
*96\83\2*
A definite diagnosis of endometriosis is one made when a gynaecologist has actually observed endometrial implants or cysts in your pelvic cavity during a laparoscopy (a minor surgical operation using a laparoscope) or, occasionally, a laparotomy (major abdominal surgery).
In general, a laparoscopy is the preferred method of diagnosing endometriosis because it is a simpler and shorter operation and the use of the laparoscope enables better detection of small implants as it magnifies them to several times their actual size.
Classical endometrial implants and cysts can usually be easily recognised and diagnosed by a gynaecologist during a laparoscopy. However, atypical implants and microscopic endometriosis can be missed if the gynaecologist relies only on a visual impression. An increasing number of gynaecologists are using biopsies to diagnose endometriosis in doubtful cases. This involves removing a sample of tissue, known as a biopsy, from any area that the gynaecologist thinks may be the site of an endometrial implant for examination and diagnosis under a microscope.
A definite diagnosis is extremely important as it enables an accurate assessment of the severity and extent of the disease to be made and provides a guide as to the likely effect of the condition on your fertility. This is essential information if you are to think about and make informed decisions regarding the management of your endometriosis.
The Commonwealth Department of Community Services and Health, which administers the Pharmaceutical Benefits Scheme, will not subsidise the cost of some of the drugs used in the treatment of endometriosis unless a definite diagnosis has been made.
*37\83\2*
To-date, no treatment has been developed that is effective for all women with endometriosis because little is known about the causes of the condition. However, many different approaches have been tried.
In general, the treatments aim to relieve the symptoms and, where desired, improve the chances of conception by eradicating as many endometrial implants, cysts and adhesions as possible.
The main options available for the management of endometriosis are:
* observation
* symptomatic management
* hormonal treatment
* surgical treatment
* combined treatment
* alternative therapies
Observation
Observation or a ‘wait-and-see’ approach involves no active treatment. Rather, as the name suggests, it simply involves a period of observation and monitoring. Such an approach should still involve regular visits to your gynecologist to monitor any possible progression of your endometriosis and its symptoms.
Some gynecologists believe that a period of observation is the most appropriate form of management for young women who have minimal endometriosis with no significant symptoms. Others believe that it is inappropriate because they believe endometriosis should be treated as it usually progresses.
A period of observation may be the most appropriate form of management if a woman decides that she does not want to have active treatment, particularly if she has minimal or no symptoms.
Symptomatic management for endometriosis involves treating only the symptoms – usually the pain – without attempting to treat the underlying disease.
It usually involves the use of various analgesics or anti-inflammatory drugs if the pain is intermittent, or a range of pain management techniques if the pain is chronic and ongoing.
Symptomatic management may be appropriate if a woman decides not to have treatment or if she has symptoms that have not responded to previous treatments.
Symptomatic management may also be used as an adjunct to conventional or alternative treatments in order to relieve ongoing symptoms.
If you decide to have only symptomatic management you need to be aware that it will not treat your endometriosis in any way and that in fact your endometriosis may progress.
Hormonal treatments
The hormonal treatment of endometriosis uses drugs to treat the condition. In general, hormonal treatments aim to eradicate the endometriosis by suppressing the menstrual cycle and preventing the growth and development of the endometrial implants and cysts.
Surgical treatments
In general, surgery for endometriosis aims to remove as many endometrial implants, cysts, endometriomas and adhesions as possible and to repair any damage caused by the disease. In the case of a hysterectomy, surgery aims to cure the disease by removing the uterus and sometimes the ovaries as well.
Combined treatment
Combined treatment is the use of a course of hormonal treatment before, or after, surgery to enhance the effects of the surgical treatment.
Alternative therapies
A variety of treatments are used by alternative therapists. Each therapist uses a combination of treatments, although the actual treatments used for each individual will usually depend on an assessment of her problems.
*29/41/5*
Caesarean section is the delivery of a baby through an incision in the mother’s abdomen and uterus. Most historians believe the name has no association with the birth of Julius Caesar. The operation was used centuries before his time in an effort to save unborn babies whose mothers had died during labour. The Roman law governing the procedure was known as Lex Regia, later changed to Lex Caesaria
(the Caesar’s Law) and this is thought to be the origin of the modern name.
Before the Second World War caesarean section was used only as a desperate last resort because of its high complication rate. One hundred years ago, more than nine out of ten mothers died after the operation: now the death rate is one to two in 10000, and usually occurs in mothers for whom it is performed because they are too ill for labour. Since 1940 improvements in surgical and anaesthetic techniques and the availability of antibiotics and blood transfusion have made caesarean section a safer option in circumstances where mother and baby would be at risk from a difficult vaginal delivery.
During the 1980s there was some controversy about the increasing rate of caesarean delivery: up to four out of ten deliveries in some parts of the USA. In Australia the present rate is close to one in five deliveries, and there has been public and professional concern about whether so many caesarean deliveries, with their accompanying physical, psychological and financial costs, are justified. Are some doctors (and parents) choosing caesarean delivery rather than waiting to see if vaginal delivery can proceed safely? It’s impossible to answer this question because the circumstances in every case are different. If you’re advised to have a caesarean delivery, whatever you’ve heard about the controversy may raise doubts in your mind. You must discuss your uncertainties with your doctor.
Elective caesarean section
About half of all problems that need caesarean section are discovered during pregnancy so that the operation can be planned. This is called elective caesarean section. Common reasons include:
• placenta praevia, where the placenta is attached over the cervical outlet and would lead to severe haemorrhage during labour
• previous caesarean delivery, where the reasons for doing it still exist
• some cases of breech presentation, especially if the mother’s pelvis is smaller than average, if the mother is over 35, or if it is the first delivery
• severe pregnancy-induced hypertension
• some cases of diabetes or Rhesus incompatibility, when vaginal delivery can’t be risked
• rarely, when there is obstruction in the pelvis, such as a fibroid, or if there is certain knowledge that the mother’s pelvic outlet is too narrow to allow the baby’s head to pass through.
Emergency caesarean section
This is done when problems arise during labour, such as:
• foetal distress due to lack of oxygen in the first stage, indicated by change the foetal heart rate. If allowed to go for long, lack of oxygen could lea foetal brain damage or death
• haemorrhage during the first stage labour
• obstructed labour
• failure of labour to progress because cervix is not dilating.
Emergency caesarean section is often d with general anaesthetic when the needs to be delivered as quickly possible.
Maternal recovery is usually slower caesarean than after vaginal delivery, though there may be some delay mother-child bonding if a general anaesthetic is needed, there’s no evidence this has any bad effect on the long-term relationship.
Many women are sadly disappointed their baby must be delivered by caesarean, especially if it is done as an emergency and they don’t have time to adjust to the idea. Of course we would all prefer to have normal deliveries, but some babies need to be helped into the world and no one wants to take any risks. In many pregnancies caesarean delivery can be life-saving for both mother and baby, or can prevent serious illness.
You may have heard ‘once a caesarean, always a caesarean’. With modern surgical techniques, this is not necessarily true. Many mothers who have had a previous caesarean delivery may safely have a subsequent vaginal delivery, provided the reason for caesarean no longer exists or doesn’t recur in the next pregnancy. Ask your doctor about your future chance of vaginal delivery.
The most important result of pregnancy is a healthy outcome. Without the safety of modem caesarean delivery we would have to accept a higher rate of foetal and maternal loss, as our grandparents did. So don’t feel a failure if you need caesarean delivery: if a healthy baby is delivered, your pregnancy has been a success.
*174/31/5*
The circumstances in which women decide to terminate a pregnancy are enormously varied. The decision to have an abortion is never without some соnflict, and for some women and some couples it is a very painful choice.
Unwanted pregnancy
Women usually experience a mixture of powerful feelings when an unwanted pregnancy is confirmed. If it’s you, you maybe overwhelmed by anguish, fear, anger and sadness. You mightn’t know how to decide what to do or whom to turn to for help. You may fear the reactions of your partner, family and friends. You may also be afraid of parenthood or of abortion and its consequences.
You may be angry at yourself and your partner for not being careful enough about contraception, or because your contraception failed. And you may feel sad because you may want to be pregnant but know that your present circumstances are quite wrong for having a baby and supporting it properly.
The first step in sorting out your feelings is to talk the matter over with someone you oust: your partner, family, a close friend, your doctor or perhaps all of these. Be prepared for different reactions and advice from different people, and a range of opinions that may help or hinder you in deciding what to do about the pregnancy. Though you will take into account the views expressed by those who are important to you, the final decision must be your own: value judgments of others have no place in your choice.
When the foetus is at risk
The decision for abortion has a very different emotional impact, often much more painful, if your pregnancy is planned and wanted but when something has put the foetus at risk of birth defect. It may be that you’ve taken certain medicines before you realized you were pregnant, or that you’ve had an infection known to be a danger (such as German measles or toxoplasmosis) during the early weeks. Or perhaps antenatal diagnostic testing has shown that the foetus is genetically or otherwise defective.
When antenatal testing was introduced, not much thought was given to the emotional side. It was thought that women would welcome the tests and gratefully accept abortion if a defect was found. It soon became clear that some women rejected both. The tests were refused by those whose feelings or beliefs would never allow them to consider abortion. Others who might have been prepared to abort an unwanted pregnancy chose to accept a child born of a wanted pregnancy, even at high risk of birth defect.
Most large hospitals now provide antenatal and genetic counsellors. If yours doesn’t, speak to your doctor. You should be given clear, unbiased information about any possible defect, the range of disability it could cause and the degree of risk in your case. If you decide on abortion, you will usually be offered counselling after the procedure as well as before. This can be a great help in working through your grief, which can be profound after a wanted pregnancy is terminated.
*146/31/5*
Most often these occur during or soon after insertion and are related to the skill of the inserter and the care with which the risks of using an IUD have been assessed.
Explusion Contractions of the uterus can sometimes push an IUD partly or completely out through the cervical canal into the vagina. This is most likely to happen soon after insertion, especially if the device was inserted during menstruation. Subsequent expulsions are most likely to occur during a period. Sometimes expulsion may not be noticed. This is why women are advised to check pads and tampons, and at the end of each period to feel for the strings at the cervix.
The expulsion rate varies from 5 to 20 per hundred in the first year of use. Different rates depend mainly on the size and type of device used, the size and shape of the uterus and whether the IUD has been correctly inserted.
Lost strings Sometimes the strings can’t be felt or seen at the cervix, even though the IUD may still be in the right position in the uterus. There are several reasons why this may occur.
• The woman may be pregnant. As the uterus enlarges (even slightly) the strings are drawn up through the cervical canal.
• The IUD may have been expelled. If it’s still in place it can usually be felt with a uterine sound. Ultrasound examination will confirm whether the device is missing or still in place.
If the IUD is still in the right place, it may be easy to bring the threads back into the vagina. If not, you must decide with your doctor whether or not the IUD should be removed.
Perforation
The uterus may be perforated by the device (though the risk is very small) if the position and direction of the uterus were misjudged during the pre-insertion examination. It is also more likely to happen if the device is inserted soon after giving birth, especially if the woman is breastfeeding.
Perforation needs immediate action. If the IUD is not entirely inside the uterine cavity (that is, has gone partly through its wall), it won’t work properly. If the device has gone right through into the abdominal or pelvic cavities, it should be removed.
*118/31/5*
Altered expectations of the roles of men and women in society has been one of the greatest changes since the Second World War. Mum is no longer portrayed wearing an apron in the kitchen in her role of looking after the house and kids. Unisex fashions and hairstyles have contributed to the changes in female and male stereotypes.
The majority of married women with children now work away from home. A man in the supermarket is no longer a rare sight: he may be doing the shopping because his wife is at work while he (because of redundancy, less earning capacity or role reversal) now does the ‘home duties’. When both partners work, some men are taking on their fair share of housekeeping and parenting chores, though my impression is that in most families it is still the women who are responsible for efficient household functioning and assignment of chores.
Even the advertisers are taking notice of pressure from female consumers for more realistic portrayals of women: we now see less of the stereotype whose only concerns are stain removal and keeping her hands soft. Not that these things aren’t important, but there’s much more to women’s lives!
Women are not the same as men (and vive la difference), but it’s great to see them gaining social equality though there’s still a long way to go, especially in employment opportunity and earning capacity. However, many women (and even more men) are ill-at-ease with women’s changing role in society. Some have deep philosophical or religious convictions that women’s traditonal role shouldn’t change. Others find it easier to slip into the traditional pattern.
Some have problems going against things we learnt as children: we know in our heads that the changes are in the right direction, but it feels somehow wrong when we do things differently from our mothers. So we try to fulfill both roles, which is like wanting to have your cake and eat it.
*88/31/5*