Posts Tagged ‘risk’

NAIL FUNGUS
Over the last several years, nail fungus has garnered public attention completely out of proportion with its seriousness. The medical term, onychomycosis (oh-nick-o-my-CO-sis), is long and scary, but it just means fungal infection of the nail. Perhaps so many people are curious about this topic because nail fungus is very common. In addition, the development of
•    Soak your nails in a solution of one-third vinegar to two-thirds water
•    Prepare a cornmeal suspension and soak nails for an hour a week
•    Apply Listerine to infected nails daily
•    Coat the nails with Vicks VapoRub
•    Soak the nails in tea tree or vitamin E oil
•    Try Pau d’Arco tea soaks
•    Ask your MD about a prescription for urea paste 40 percent to remove the infected nail
•    Apply prescription Penlac (ciclopirox)
•    Consider the pros and cons of Lamisil (terbinafine) and Sporanox (itraconazole)
new antifungal drugs that can treat (dare we say cure?) nail fungus has encouraged the pharmaceutical industry to advertise in magazines, in newspapers, and on television.fbe popularity of sexy sandals as footwear may also have contributed to the interest in treating nail fungus.
For diabetics, nail fungus is a medical issue.fbey need to be extremely vigilant about foot care and attend promptly even to things that may seem minor. For the rest of us, though, thick, yellow toenails that are crumbly or hard to cut are more of a nuisance than a serious health concern. They look ugly, and if they get very thick, they may be uncomfortable as well. Sometimes they split, which can be quite painful.
In our opinion, though, it would be a mistake to put your life on the line to clear up your funny-looking nails. Mat’s why we have collected so many home remedies for this problem. They probably won’t work for everyone, but they shouldn’t be very risky, either.
Q. My husband took Lamisil to treat toenail fungus, The drug worked but was ultimately responsible for his death.
The fine print for this prescription drug noted that it might cause neutropenia. For my husband, it did. This led to MDS (myelodysplastic syndrome), which was followed thereafter by AML (acute myeloid leukemia) and his subsequent death.
He had suffered with periodic flare-ups of toenail fungus and athlete’s foot for most of his life. Neither condition was life threatening. The Lamisil was!
Even though serious side effects mentioned in prescription drug labels may affect only 1 percent of users, anyone could be in that I percent. People should ask themselves if it is worth taking that chancel
A. We are so sorry to hear of your husband’s tragic death. In rare cases, Lamisil may trigger serious blood disorders such as neutropenia, a lack of white blood cells. This drug can also damage the liver; there have been deaths associated with this problem. This is a high price to pay to cure toenail fungus.
Patients must always take into account not only common side effects but also the possibility of rare but deadly adverse reactions.
Home Remedies
It’s hard to say just where nail fungus comes from and why some people appear to be more susceptible than other-, Occasionally readers report that they first noticed nail fungus after going for a manicure or a pedicure. Presumably, it is possible to pass the organism that causes nail fungus from one person to another, and surely from one nail to another.To minimize that likelihood, we suggest that any tools such as scissors or clippers that have been used on a nail that might be infected be soaked in rubbing alcohol for 15 minutes before being used on an uninfected nail.
We think home remedies are the place to start for treating nail fungus, whether it affects the toenails or fingernails. (”This does not apply to people with diabetes, who should seek medical care for this problem.) Needless to say, some doctors are not fond of the idea of using home remedies for nail fungus.
Some time ago, we heard from a podiatrist who was very unhappy with our recommendations. “Home remedies hardly ever work,” he wrote. “The unproven treatments you mentioned are little more than urban legends. In 23 years of practice, I have never seen even one patient who responded favorably to Vicks VapoRub, dilute vinegar soaks, or vitamin E oil. Don’t make me waste time dispelling these myths.” He recommended that people take FDA-approved prescription drugs like Lamisil, Penlac, or Sporanox instead.
We certainly heard from readers who disagreed with him. One person who had success treating nail fungus with vinegar soaks expressed this opinion: “If a treatment is relatively harmless, as this is, and there’s even a chance it can work, I believe doctors should encourage alternative methods instead of high-priced medicines laden with potential side effects.”
A pharmacist also weighed in with some information on the effectiveness of the prescription medications:
I would like to point out some facts about the FDA-approved drugs the podiatrist prefers (Lamisil, Penlac, Sporanox). Does this doctor know that Penlac’s success rate for a complete cure, accord-ing to the manufacturer’s prescribing information, is only 5.5 to 8.5 percent after 48 weeks? When using Sporanox, the percentage of overall success rises to a dizzying 35 percent.
Also, does he know the costs of these medications? A bottle of Penlac costs $72.99. To reach 48 weeks of treatment once a day to a single affected nail, I conservatively estimate that the patient will need six bottles of the lacquer (one bottle approximately every other month), So Penlac will cost the patient, without insurance, 5437.94 to reach an outstanding 8.5 percent cure rate.
For Sporanox, one pulse-pak costs ME99. This is a 14-day supply. The manufacturer recommends 12 weeks of treatment, bringing the patient cost, without insurance, to $1,535.94! No wonder people are looking for alternatives to these medications.
Oral medicines such as Sporanox can occasionally trigger serious reactions as well. No wonder some people are willing to spend time and effort—but not much nioney—trying a low-risk home remedy.
I assumed toenail fungus was a fact of life forme. khad spread to five or six toenails when I finally saw a dermatologist The prescribed treatment was costly, and after it began, the dermatologist told me the odds of reinfection after treatment were about 50 percent
I had a nightmare reaction to the pills a week later I was in remote Finland, of all unlikely places, when I developed hives and severe itching. After 24 hours of nonstop, nonsleep itching, I got through to my doctor and was told to stop taking the pills.
When I got home, / decided to try the vinegar treatment I applied a drop of distilled white vinegar to my toenails with a cotton swab each time I got out of the shower As the nails grew out the fungus was completely gone, along with slight traces of athlete’s foot
Cost: under $ZOO over 9 months.
Side effects: none.
Effectiveness: 1019 percent (or 200 percent it you include the athlete’s foot).
Vinegar
One of our favorite home remedies is a vinegar soak. It is surely, one of the cheapest remedies for nail fungus. People who sit still to read, use the computer, or watch television could soak the foot with the affected toenails or hand with the affected  Vinegar
Use two parts of water to one part vinegar for a soaking solution. It does not seem to matter whether you use white vinegar or apple cider vinegar, so we suggest the cheaper
white vinegar.
Downside: Your toes may smell of vinegar.
Cost: $1.60 to $2 for 64 fluid ounces—enough for at least four treatments, and possibly eight
fingernails in a solution of one part white vinegar to two parts water. Vinegar is acidic, and acid makes the environment inhospitable to nail fungus. Because it is a home remedy, there is no “prescribed” method. Some people have had success soaking for an hour each week, all at one go; others soak once a day; and still others use the technique of daubing undiluted vinegar on the affected nail with a cotton swab every day. Persistence is needed with any home remedy. Nails grow slowly, especially toenails, and you need to give them time to grow out healthy and fungus free.
Cornmeal
Another natural fungus fighter may be cornmeal. We first learned of this approach from a public radio listener: “Put about an inch of cornmeal in a plastic dishpan. Pour in hot water, stir it so the cornmeal gets dissolved, and when it is cool enough not to hurt, soak your feet for an hour. If you do this regularly, it will get rid of the fungus.”
When examining me my doctor noticed that I had nail fungus affecting toes on each foot He recommended that) make a batter by mixing cornmeal and water in a shallow pan, let it sit for an hour, and then soak my feet for an hour He told me to do this once a week for a month. I did the cornmeal therapy for 3 weeks and the fungus was gone. I don’t know why it works, but it’s cheap, harmless, and it worked for me.
We haven’t found any scientific support for cornmeal as a nail fungus treatment, and fewer people have written us regard-Cornmeal
A footbath of cornmeal mush is neither expensive nor dangerous, and it takes just 1 hour a week. Put about an inch of cornmeal in a shallow pan and add enough hot water to dissolve it. Let it cool to a comfortable temperature and soak your tootsies for an hour.
Downside: This treatment could be somewhat messy. Don’t spill it on the carped
Cost: $2 to $4 for 5 pounds of cornmeal—enough for at least five treatments, and probably more
ing their success with cornmeal than with vinegar, but some have used it to eliminate their nail fungus.
Cornmeal does seem to be a popular home remedy in the garden, though. Gardeners claim that working some cornmeal into the soil around a rose bush will discourage black spot disease, a fungus that affects roses.
Vitamin E
We are always impressed by our readers’ ingenuity. We would never have thought of putting vitamin E oil on fungus-infected toenails, for example. We can’t think of a good reason why vitamin E in particular would be useful against fungus, and yet a number of people have tried this approach with some success.
I keep reading about treatments for toenail fungus so I thought I would pass on my solution. When I had this problem several years ago, I used a simple approach. I kept my toenail soaked with vitamin E oil and the fungus disappeared completely. I can’t recall exactly how long it took but it wasn’t too long.
As we understand the vitamin E tactic, a capsule that you would take as a vitamin—any dose will do—is pierced with a needle or a pin.’Iben the contents are squirted out all around the edge of the nail and particularly under the nail, between it and the skin. The key here, as with most nail fungus treatments, is patience and persistence.
Listerine
The old-fashioned mouthwash Listerine is one of America’s favorite all-purpose home remedies. (The other is Vicks VapoRub; more about it in just a bit.) Amber-colored original flavor Listerine contains a mixture of herbal extracts that can fight fungal pasties from dandruff to jock itch. Some people have also reported having good success with soaking infected nails in Listerine.
0. 1 cured my toenail fungus using a fifty-fifty mixture of vinegar and Listerine. I kept the mixture in a quart jar with a screw-on lid and used a clean paintbrush to apply the liquid to the affected toes morning and night. I wore socks to protect the bedsheets at night.
The fungus took about 3 months to clear up. It is slow growing but is also slow to cure. I hope this helps someone else.
A. You combined a couple of favorite remedies. Many people have reported success with soaking infected - nails in one part vinegar to two parts water. Others got good results soaking their toes in Listerine. Such remedies won’t work for everyone and take several months to produce results.
*** Listerine
This amber-colored mouthwash contains a fair amount of alcohol along with a mix of herbal oils including thymol, eucalyptol, methyl salicylate, and menthol. The thymol and the eucalyptol, at least, seem to have antifungal activity, and the other two may fight fungus as well. Soaking the nail in Listerine (original flavor) or daubing on a bit of Listerine after the daily bath has worked for some people.
Side effects: None known
Downside: Your nails may smell like Listerine. Cost: Approximately $5 for a liter  Vicks VapoRub
This ointment contains herbal oils such as camphor, menthol, thymol, eucalyptol, cedarleaf, nutmeg, and turpentine. Some of these have antifungal activity, and they may work synergistically. Apply Vicks VapoRub all around and under the affected nail or nails once or twice a day. Putting it on right after a shower or bath seems to help. If you apply it at night, wear socks to bed to protect the sheets. It may take 6 months to see results.
Side effects: Allergic rash is possible. In addition, we heard from a few people whose fungus-infected nails came off with this treatment. This might increase the effectiveness of the remedy, but it could be painful.
Downside: Inconvenience
Cost: Approximately $12 for 6 ounces. You could probably treat several toenails twice daily for 6 months with this much Vicks.
People have conjectured why Vicks seems to be beneficial against nail fungus. There is a compound in Vicks—thymol—that is now listed as an inactive ingredient.
When I was a premed student at UCLA in 1951, 1 met a mycologist (an expert on fungus). During World War It he devised a preparation to treat fungal infections that were common among the troops in the North African campaign. ft was an ointment that relied heavily on thymol as the most effective antifungal agent and reeked of thyme.
Vicks contains three active ingredients and 22 considered inactive. One or more of these might help thymol penetrate the tissues. I suspect that a pure preparation of diluted thymol, without other ingredients except a solvent, would be a good antifungal nail treatment
Vicks VapoRub certainly does not work for everyone. But we have heard from a great many people who have tried it and gotten a positive response. Some could see the results within a few weeks; others needed to keep applying it for month-s. Even prescription drugs take quite a while to clear toenail fungus, however, because the toenails grow so slowly. The infected nail must grow out completely and be replaced by uninvolved nail.
I had nail fungus fora long time. Medicines recommended by my doctor didn’t work. Then I read about using Vicks VapoRub. I applied it to the nail every day for about 5 months and now the fungus has disappeared. I’ve been cured.
Tea Tree Oil
Tea tree oil comes from an Australian tree, melaleuca. It has long been used to treat skin problems, particularly fungal infections. You don’t need to go to Australia to get it, though. It is marketed widely in stores and on the Internet in the United States. Applying tea tree oil to the infected nails daily can overcome some cases of nail fungus. Some people do develop allergic rashes in response to tea tree oil, however, so be alert for any itching or redness.
Q. Some years ago I was diagnosed with a fungal infection on one toenail. The intense throbbing pain made it difficult to wear a shoe.
My podiatrist said the only way to treat the toenail was to remove it. I had several more months of pain while the toe healed.
After the surgery I was alarmed when another toe showed signs of fungus. I asked about a natural treatment at the health-food store and was told to try tea tree oil.
I applied it liberally several times that day. Within 10 hours, the pain had diminished. I continued using tea tree oil on the nail daily for a few months. The base of the nail grew in pink and healthy.
I am angry that my podiatrist chose to operate on my toenail rather tha” recommend a natural, pain-free tMMYnent.
A. Tea tree oil (derived from the Australian melaleuca tree) has antifungal activity. It has long been used to combat skin and nail problems. Your podiatrist may not know about this herbal product, however.
Pau d’Arco Tea
The lure of the exotic can be seen not only in tea tree oil but also in Pau d’Arco, also called taheebo. This product is the inner bark of a South American tree that has been used medicinally by the natives of Brazil. Argentina, and Paraguay. It contains at least one compound with antifungal activity. Some readers report that using an infusion of Pau d’Arco to soak toenails, much as one would use vinegar or Listerine, can help clear the infection.
Oregano Oil
Oregano oil doesn’t come from a tropical rain forest, but it is hardly a common household staple. Nonetheless, some people have used it topically for fighting athlete’s foot, and others have reported success in using it against nail fungus. Like Listerine and Vicks VapoRub, oregano oil contains thymol. It also contains carvacrol. These two herbal oils together seem to have some antifungal action. Some people are allergic to oregano oil. Anyone who has experienced a reaction to basil, sage, lavender, marjoram, or mint probably should steer clear of oregano oil.
Can you stand another toenail fungus cure? I have found one that works for me, and I have tried them all, including prescription Lamisil pills.
I read somewhere that oil of oregano will kill anything, so tried putting a drop down between the nail and the skin every day. Slowly but surely the toenail is growing out normally! I hope someone else can benefit from this as well.
Lemon
Some years ago, we heard from a reader who maintained that sleeping with a lemon attached to the toe for 3 nights running would clear up toenail fungus. Only a few others have tried this -and reported back to us. It did not work for at least one person, though it seemed to help another.
0 0 *
0. Many people write to you about toenail fungus, but you have never mentioned a remedy I learned from an elderly lady in South Carolina. This remedy requires three fresh lemons. At night cut a hole in the top of one and scoop out a hollow just large enough for the toe.
My mother had a great toenail so thick and hard that she could hardly wear a shoe on that foot. I used duct tape to hold the lemon on Mother’s foot, and put a sandwich bag over it to protect the bed. Do this for 3 nights in a row. The toenail becomes so soft that it can be peeled right off, and the new nail that grows in is normal. It worked for my mother!
A. We have been collecting nail fungus remedies for years, but this is the most unusual. Fungus doesn’t thrive in an acidic environment, which may be why dilute vinegar soaks are so effective. The citric acid in the lemon may work in a similar manner.
Prolonged exposure to pure lemon might be irritating for some people, so we suggest that anyone who wants to try such an approach test it first. Removing a
toenail should be done only with medical supervision,
because there is a risk of infection.
* 0 0
Prescription Treatments
Unlike home remedies, prescription medications for nail fungus have been scientifically tested and have performed better than placebo. That is the criterion applied by the FDA before approving any prescription product. Don’t expect too much from these medicines, though: They don’t work for everyone, even though they might be more effective than home remedies. Before beginning a prescription medicine for nail fungus, make sure you understand the risks.
Urea Passe
One treatment for toenail fungus is to remove the nail surgically and then treat the underlying skin with an antifungal cream while the nail grows back without fungus. Many people are understandably reluctant to undergo surgery for nail fungus. Infection is always a risk. We hate it when the cure is worse than the condition it’s intended for.
Dermatologists have studied a different approach that is Urea Paste
The high-strength 40 percent urea paste that dissolves infected nails is available only by prescription. Its use should be supervised by a physician who is familiar with the treatment.
Side effects: Irritation, itching, or burning
Downside: Many doctors are not familiar with this approach. Cost: Approximately $75 for an 85-gram tube
far less traumatic. Urea paste at a 40 percent concentration will dissolve infected nail and leave healthy nail alone. It is essential to work together with the prescribing physician, however, as removing a nail is not a trivial issue. Please do not do this at home by yourself.
0. 1 have ugly, thick, yellow toenails that are hard to clip. My doctor says they are infected with fungus but he doesn’t want to prescribe Sporanox because it could interact with other medicine.
I have tried home remedies, including Vicks VapoRub, and none has worked. The podiatrist wants to remove the nails surgically. I know you have written about urea paste to dissolve away the infected nail. Where do I get it and how do I use it?
A. Surgical removal of nails can be painful and there is a risk of infection. Stanford dermatologist Eugene Farber, MD, discovered the urea treatment many years ago while traveling in Russia. 761 Urea (40 percent) is available only by prescription (Ureacin-40, Carmol 40, Gordon’s Urea 40). Your doctor should supervise the treatment.
Penlac
A lot of people are reluctant to take an oral antifungal drug. Some worry about side effects, others are concerned about potential interactions with other drugs they take. Both are valid concerns.
One manufacturer came up with a topical prescription antifungal medicine that is applied like nail polish. Penlac (ciclopirox) was approved by the FDA for the treatment of mild to moderate nail fungus. Like most of the home remedies we’ve already discussed, Penlac requires a lot of persistence. It needs to be applied to the affected nail, including between the nail and the skin, every day. It can cause redness or irritation, and it may take up to 6 months to produce results.
When people use Penlac, they need to see a health-care professional on a regular basis to have any unattached, infected nail removed so it won’t continue to spread the infection. We have no way of comparing Penlac’s effectiveness to that of other treatments. Presumably it is as good as most of the untested home remedies, but it is not really too astonishing. About 12 percent of the patients treated with Penlac in clinical trials were able to clear their toenails of fungus. One of the biggest differences between Penlac and a home remedy is the cost. A little bottle (6.6 milliliters) costs $130 or more.
Sporanox or Lamisil
The heavy artillery for treating nail fungus is an oral antifungal medication. If it is crucial to eliminate the infection, the physician will prescribe a drug such as itraconazole (Sporanox) or terbinafine (Lamisi)). (You may have seen magazine or television ads for Lamisil that feature a cartoon character, Digger the Dermatophyte.)
In a long-term head-to-head study, patients with toenail fungus were given either terbinafine or itraconazole according to the recommended dosing procedure for 3 to 4 months. 762 At the end of that time, 46 percent of the people who had taken Lamisil and 13 percent of those who had taken Sporanox had no detectable fungus in their nails. The follow-up extended for another 4 years or so. The investigators (some of whom worked for the maker of Lamisfl) found that relapse rates were significantly higher among those who had taken Sporanox.
An analysis of cost-effectiveness found that terbinafine is the most cost-effective treatment a doctor can prescribe. 761 Penlac was judged to be at least three times more expensive than the others, considering cost per cure. This analysis did not take any of the home remedies into account. If there were scientific data on them, they might well demonstrate low effec-tiveness, but because they are cheap, their cost-effectiveness might compare well to some of the standard treatments.
Another advantage of home remedies is the low likelihood of serious side effects. Lamisil is considered fairly safe, even for children and the elderly.764 Nonetheless some people taking Lamisil have developed liver failure.’W~ People who already have liver problems should not be given this drug. Other people taking Lamisil have come down with a very serious skin reaction, so anyone who develops a rash should get in touch with the doctor promptly. People who have lupus could get worse while taking Lamisil, so it’s generally not recommended for them.
As we mentioned at the beginning of this discussion, Lamisil occasionally can lower white blood cell counts to dangerous levels. Usually, the count comes back up once the person stops the drug. This drug may interact with other prescription medicines, including antidepressants. beta-blockers, and certain other medications that regulate the heart’s rhythm. By now, we hope we have convinced you to stay in very close touch with the doctor who prescribes Lamisil for your toenail fungus. It’ll probably run you more than $800 for the 12 weeks of treatment, but because it works so well, it is quite cost-effective.
Conclusions
Nail fungus, particularly toenail fungus, is usually more of a nuisance than a serious medical problem. (For diabetics, however, nail fungus or any other foot problem qualifies as serious and requires medical care.) As a result, we feel comfortable in recommending that most people try home remedies first. We don’t have any data on how well they work, but the testimonials we have received indicate that they do work for some people. In addition, they are inexpensive and don’t cause dangerous interactions or reactions.
A palm) who needs a higher likelihood of cure may need a prescription for Lamisil. It is the most cost-effective of the prescription nail fungus drugs. Even so, it does not work for everyone, and it is not always appropriate. Some people may be taking other medicines that could interact with Lamisil. Others may be at risk of liver problems or complications such as lupus. Most of the time, nail fungus is a problem you can live with; some of the rare side effects could be deadly.
•Toenails grow slowly. It takes a year to a year and a half for them to grow out completely, so be very patient and persistent.
•    After cutting fungus-infected nails, soak the clippers or scissors you used in alcohol for 15 to 20 minutes so you don’t spread the infection.
•    Soak your feet in a footbath of one part vinegar to two parts water for 20 minutes a day.
•    Mix cornmeal with hot water, allow it to cool to a comfortable temperature, and soak the affected nails for 1 hour once a week for at least a month.
•    Squeeze vitamin E oil or tea tree oil around the cuticle and under the nail once or twice a day.
•    Soak the feet in original Listerine or apply it daily to the affected nails.
•    Smear Vicks VapoRub around and under the nail every day.
•    Brew an infusion of Pau d’Arco for soaking the affected nails every day.
•    Stick your toe in a lemon overnight to soften the infected nail for removal.
•    If the nail needs to come off, ask your doctor about prescribing urea paste (40 percent).
•    Lamisil is the most effective prescription pill for fighting nail fungus.

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A taste of fruit
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Bottle-feeding
Feeding schedule
7am—bottle of 170-200 nil
(6-7 fl oz)
11 am—vegetables + bottle of approx information on ultram tab 50 medication . 170 ml (6 fl oz) 3pm—fruit + bottle of approx plavex paxeva altace .
170 nil (6 fl oz)
7pm—bottle of 170-200 ml
(6-7 fl oz)
11 pm—bottle of 170-200 ml
(6-7 fl oz)
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In general, the last feed can be dropped between the ages of five and six months multiple sclerosis valtrex . This feed is then divided over the four bottles which the child has during the daytime indocin gout .
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Weaning with bottle-feeding
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Bottle-feeding based on almond paste for 4-6 months Ingredients per 100 ml (per 8 fl oz):
50 nil (4 fl oz) full-fat cow’s milk
50 ml (4 fl oz) water
2 g (1 tsp) rice flour
4 g (2 tsp) lactose
3 g (11/2 tsp) almond paste
Preparation with rice flour:
Cook the flour in the water until it is cooked (see instructions on the packaging) and dilute the lactose and almond paste in the warm liquid drug evista mg . Stir in the milk and pour everything through a tea strainer singulair canine . If necessary, add cooled boiled water to replace the evaporated water up to original quantity deltasone for premature ejaculation .
Practical Advice for
Six to Nine Months
Psychomotor development
Now that the baby has gained control of his head, arms and trunk to some extent, he has a degree of freedom of movement does estrace cause bloating . First, he discovers his feet as enjoyable toys tetracycline treat pneumonia . The child can experience his whole body from head to feet, though still with a rather dreamy consciousness zetia blood sugar levels . The child starts to move about, first by rolling over, and later on, at approximately nine months, by crawling loratadine causes acid base imbalance .
During this stage, many children learn to raise themselves up into a stable sitting position coumadin and muscle relaxers counterindication . Some children move about on their front or shift themselves on their back
sides, another method of exploring space barbara schmidt caffeine american 2006 .
The child’s sounds can start to incorporate words such as gaga, dada or baba user reviews on fluoxetine .
During this stage, the child learns to distinguish between familiar people — usually the mother and father, and others incontinence discussion urispas psychological . It is typical of this stage for the baby to start to cling to a particular person, and seek security with those people to whom he is most attached maximum zoloft dosage .
Sleeping and waking
The pattern of sleeping and waking still largely follows the pattern of feeding news on otc prilosec . There are usually four meals in the day, at seven and eleven o’clock in the morning, and at three and seven o’clock in the afternoon and evening what is levaquin for .
Most children still like to have a nap after the first and second feeds clomid after lupron . The nap between three in the afternoon and seven o’clock gradually becomes shorter or disappears altogether zocor and hair loss . Many children like to be put in bed for a while, even if they do not sleep glucophage for polycystic ovaries . For children who do not like this, the day is often just a little bit too long, which means they start to grizzle by teatime viagra auxiliary labels . In this case, try to give the seven o’clock feed slightly earlier herbs with same effects as clomid . Most children will now sleep through the night claritin azo vitamin c .
Care
Washing and bathing
At this age it is not really necessary to bath the baby with soap every day discount depression medications prozac . However, when a child starts to crawl on the floor, it is important to devote extra attention to hygiene does cocoa butter have caffeine .
Many children catch colds during the crawling stage because the floor is cold and there is often a draught close to the ground propranolol . Children cannot blow their noses at this age, so treat the face with an oily ointment such as calendula baby cream, so that the skin does not dry out too much sarafem unavailable .
The playpen
As the baby’s freedom of movement and exploratory drive increases, it is quite an art to arrange the time spent in the playpen and outside to meet the child’s needs dexamethasone average dosage . The playpen provides support for sitting and standing up, and gives the child an opportunity to examine and discover toys in a quiet place safty of drugs during pregnancy zoloft . Outside the playpen, the big world beckons, and the child is able to roll over and crawl about freely alternative herbal viagra .
Do not put too many toys in the playpen, but make sure they are regularly changed prednisone and high blood glucose level . It is often useful to have a bag hanging from the wooden rungs to put the toys in effects of bupropion . The baby should play with other toys outside the playpen, as this will increase the attraction of being put back in the playpen elavil causes rl .
Toys and playing
When the child is in the playpen, he will not just look at and explore the toys, he will also use them cheap cialis . For example, he will hit a ball so that it rolls away, or grab hold of a rattle and hit it against the rungs of the playpen how often liver enzymes diflucan . The child can use any objects which are used for his daily care, such as a soap dish or flannel, or a spoon and beaker, provided they are safe can you take phentermine and prozac .
Playing with adults, the child really enjoys games which involve moving, such as ‘horsey games’ or ‘Round and round the garden poster american society hypertension labetalol .
Once the child is crawling, the voyages of discovery really expand; it feels everything around it and often hits things with a flat hand zestoretic identification . The child likes to hold something in his hand when crawling, and a wooden spoon or a lid of a jam jar can be used to make surprising sounds, for example, by hitting it on a wooden or tiled floor smoking on cardizem .
Every crumb, piece of fluff, bead or pin will be carefully picked up from the floor with the thumb and index finger and put into the mouth seroquel used as a sleep aid . Therefore it is important to pay attention to what is left on the floor, and remove anything that is dangerous k2 lithium 4.0 .
Safety
The most common accidents during this period are caused by falls, knocks and bumps, burns, poisoning, drowning, strangulation and suffocation neutropenia and renagel . Take the following precautions lithium ion hammer drill .
Falls
— From the dressing table, out of the high chair and the pram amoxycillin common dosages . Make sure that the chair or pram is stable and use a harness orlistat and cholecystectomy .
— From the stairs, install stair gates at the top and bottom of the stairs trim spa diet pill finasteride .
Knochsftmps
— If necessary, place protective corners on sharp edges and points cavaties and zoloft .
Burns/poisoning
— Keep hot drinks out of the child’s way; use place mats rather that a tablecloth, so that baby cannot pull hot drinks and food over himself if he pulls on the tablecloth, make sure that electric cables are out of reach, for example; for a kettle order soma online cheap .
— Make sure that toxic substances and plants, or any stray ashtray are kept out of the way bad side effects of topamax .
Drowning
— Never leave the baby in the bath on his own, and place an anti-slip mat on the bottom of the bath caffeine libido .
Strangulation/suffocation
— Do not use a clamp to keep the blankets in place, or a harness in bed actonel and teva patent . However, many children no longer want to lie down in bed once they have learnt to stand up pet health insurance tramadol . This can lead to great drama at bedtime, and indicates that it is now time to lower the cot mattress caffeine and affect on the bladder . Use a baby’s sleeping bag or make a warm overall, and make sure that the side of the bed is high enough so that the baby cannot fall out generic lithobid er prescribing information . If necessary, discuss this with the baby clinic mdx caffeine .
— Once a baby reveals a tendency to stand up, remove everything from the playpen which could lead to strangulation or with which the child
could hang himself; lines stretched across the playpen are also dangerous fosamax without prescription . Cords for Venetian blinds pose a very real risk and should be tied up out of reach prozac albendazole .
A number of the safety measures described here apply for children who can sit or stand up zocor skin reaction . Because of the safety aspect, these situations are discussed at this stage, although many babies do not sit or stand up until the next stage, between nine and twelve months novartis lamisil coupon .
Feeding
During this stage, the feeding pattern does not usually change very much mixing zovirax and benadryl . Usual feeding times are on waking, late morning, during the afternoon and early evening (see also Sleeping and waking, pp coumiden warfarin risk hazards .69f) ibuprofen doctor free .
However, there is a change in the actual diet who prescribes metformin . Often, breastfeeding comes to an end during this period, there is more variation in vegetables and fruit, and cereals and sour milk products such as live yoghurt can be introduced feel high on abilify . A general diet could be as follows:
On waking
breastfeeding or bottle-feeding or porridge
Late morning
vegetables + cereals + pudding (breastfeeding, bottle or sour milk products)
Afternoon
fruit (+ cereal flakes) combined with breastfeeding, bottle-feeding or dairy products lithium 3.6 volt colombia .
Early evening
breastfeeding or bottle-feeding or porridge
Breastfeeding
At the start of this stage, many babies are still breastfed four times a day straterra and prozac together . When the sucking reflex diminishes, two of the feeds can be dropped, that is, at 11 am and 3pm cipro indicated uses . Gradually, the morning and evening feeds can be replaced with a bottle or with porridge nexium lcd .
When you want to stop feeding, you should gradually reduce the number of feeds avandia medication recall . The pressure and the increased chance of mastitis often determine the rate at which you stop depression effects lamictal medication side . It takes approximately five days to stop one feed info on actonel . When you stop the last feed, it is not necessary to wait until the breasts are completely empty glaxo epivir . When you no longer feel the milk coming in, you can stop feeding boniva versus calcium supplements . Any milk that remains will be assimilated by the body tramadol antacid safe .
Bottle-feeding
For bottle-feeding with bottles that you prepare yourself, you should now use the following ingredients:
Flour, milk, water, sweetener and cold-pressed sunflower or olive oil proscar finasteride louisiana . At this age it is no longer necessary to add almond paste amoxicillin instructions dosage . The quantity can always be found on the packaging of the type of flour that was chosen imitrex imatrax . The milk is still diluted zyrtec syrup for allergies in children .
In our opinion, it is not necessary to give healthy children next stage milk rather than cow’s milk (see also p aleve causes heart attacks .40) imodium results .
Note: The instructions on some baby cereals state that the (diluted) milk should be cooked with the flour order omeprazole free shipping . It is better to boil the flour in enough water to produce a sort of paste, and then add the milk interaction carbamazepine propoxephine . Make sure that the baby gets 450 to 500 ml (’/2 quart) of milk products per day, if necessary, by adding some extra sour milk products (also see Weaning below) cefaclor titration .
Porridge
Porridge which is eaten with a spoon can be made with cereal flakes or flour carisoprodol carisoprodol onlinefrontru onlinefrontru .
The advantage of porridge made of cereal flakes is that you can vary these with different flakes and the child becomes used to a coarser type of porridge tramadol hydrochloride 2c acetaminophen . Furthermore, cereal flakes are cheaper than flour plavix and indocin . Buy the flakes in small quantities at a time so that they are always fresh altace canada .
Flakes which are suitable (in order from easily digestible flakes to slightly more difficult to digest flakes) include rice, buckwheat, millet, oat and barley flakes claritin doses for dogs . Oat flakes have a laxative effect and sometimes give the baby a red bottom depakote kruszewski .
Porridge made with cereal flakes
1 buy fluoxetine online no prescription . Soak the flakes for thirty minutes (or longer) in a small but sufficient amount of water diabetes caused by prednisone usage .
2 molybdenum lithium grease . Bring the flakes in the water to the boil, stirring all the time with a wooden spoon xenical co uk .
3 ambien and wellbutrin more depression . Leave the flakes to soak for twenty or thirty minutes with the lid on
the pan on the hob or to warm in a pan of hot water (au bain marie) most effective dose of robaxin . You can also leave the flakes to soak overnight in a preheated thermos flask (with a wide mouth) what is brethine .
4 tinnitis zocor . Place the pan on a low heat and add milk at a temperature of approximately 60°C (140°F), stirring with a whisk effect alcohol sertraline . Leave the porridge to soak with the lid on the pan, off the heat for about fifteen minutes zocor questions efficacy .
5 warfarin ppi . Liquidize the porridge if needed albuterol dosing .
6 pictures of ranitidine . Sweeten the porridge with unrefined sugar, baby malt, rice or barley malt syrup or maple syrup, approximately one teaspoon per bowl premarin vaginal cream libido .
No quantities are given for the preparation of the porridge made of cereal flakes coffee caffeine in tea . The total quantity per bowl is approximately 200 ml (7 fl oz) aristocort 0.1 cream usual dose . After a while, you will know exactly how much you need of all the different sorts of flakes to prepare porridge of the right consistency red meat and norvasc . Experience and a good quality pan also contribute greatly to the success of your porridge reviews on clomid for men .
Weaning
Vegetables
The composition of the vegetables is two thirds cooked vegetables to one third cooked cereal flakes and one teaspoon of cold-pressed sunflower or olive oil danazol purpura . Altogether make 150 to 200 ml (5-7 fl oz) of pureed vegetables, or if they are soft and prepared with cereal flakes, they can be mashed amantadine hydrochloride 100mg shingles . You can also add a teaspoon of almond paste to the vegetables to give it a richer mixture steroid clomid .
When the baby has got used to the vegetables mentioned for three to six months (see p coumadin hair loss .66), you can start to vary them with other vegetables u s airways lithium ion batteries . A summary of vegetables is included again on p popping promethazine pills .75 to show the possibilities arava border terminal .
The vegetables are shown in the order of the ease with which they can be digested, from those, which are easy to digest to those which are more difficult rude viagra jokes . The vegetables marked with an asterix (*) are rich in nitrates and should not be given more than twice a week trial generic viagra . However, they do not have to be left out of the diet altogether as they make a healthy change from the other vegetables what is the generic for prevacid .
Flakes
The flakes which were mentioned above (p propranolol adverse effects .73) for the porridge can also be added to the vegetables snort lexapro . To prepare them, follow the recipe for the porridge with cereal flakes up to step 4 tramadol dogs post . If you like, you can also prepare the flakes for two days and keep them in the fridge dosage size for amoxicillin .
Tip: If you have little time, you can also add instant cereals used for bottle-feeding to the green vegetables gabapentin suicide .
Dessert
If the baby is not breast or bottle fed after the vegetables, a dessert made of dairy products can complete the meal seroquel dose .
Types of dairy products
Give approximately 100 nil live yoghurt or approximately 40 ml of curds, diluted with water why tenormin vs lopressor . It can be sweetened with concentrated apple or pear juice, maple syrup, or rice or barley malt syrup celexa monograph . Curds are diluted because they contain two to three times as many proteins as full-fat milk mudvayne prozac .
Fruit
The fruit consists of purled fruit with cereal flakes, which may or may not be combined with some dairy products celexa birth defect lawsuit . Again the ratio is 2/3 fruit to ‘/3 flakes (together 100-150 ml, 3-5 fl oz), supplemented to 150-200 ml (5-7 fl oz) with sour milk products do testosterone supplements work .
Types of fruit
Apple, pear, tangerine, blueberry, raspberry, blackberry, peach, orange fish flex cephalexin 500mg .
In moderation: strawberry, plum, and banana, as these might lead to a hypersensitive reaction or influence bowel movements cheap injectable depo provera .
Bread
Your child can start to eat bread from about eight months vytorin class action law suits . To get used to it, give the baby a crust to munch and gnaw on, closely supervised effects zoloft and alcohol . From nine months, when the child can sit on his own, he can also start to join you at the table to eat bread neurontin via peg .
Root Stem/leaves Flower/fruit
carrot cauliflower broccoli
*beetroot *spinach pumpkin
Jerusalem artichoke *endive courgette
parsnip *lettuce peas
*salad greens french beans
*leaf beet runner beans
*fennel mangetout
*kohlrabi fruit *lamb’s lettuce
*pak choi
AI I vegetables are cooked avelox patient information . Green vegetables can be added to the carrot, pumpkin etc use diphenhydramine with allegra d . when it is nearly done, and cooked with it fora short while ivermectin kills fleas .
* Vegetables rich in nitrates; do not give more than twice a week generic lipitor drugs .

General Points of View
In this section we describe a number of points of view which serve as a guideline for the way we view, and relate to, young children.
The child’s development and care, sleeping and waking, play and toys, safety and feeding are subjects which will be tackled in this section in terms of content. A practical approach to these subjects can be found under the advice for every stage (see Chapters 3-6).
The child’s development
From the moment the child is born, the parents have the important task of monitoring his or her development. This gives rise to many questions. How can we best prepare for the child’s future? Should we, or should we not, familiarize the child with elements of adult life at an early stage, so that she will be prepared for this later on? The answers to these questions will depend on your view of the child’s developmental stages.
We proceed on the assumption that the more successfully a child is able to fully develop at a particular stage, the more harmonious the development will be. This also applies for future development.
Fora baby and young child, this means that we must create the conditions in which a baby can most successfully be a baby, and a young child can most successfully be a young child.
The first developmental stage after birth is strongly centred on the child’s physical and motor development. Growth is quite exceptional during the first year of life, and is still rather like the growth of the embryo. The development and growth, which takes place outside the womb in humans, takes place completely inside the womb in other mammals. When the child is one year old, the development has reached a level comparable to the birth level of other mammals.
For the baby’s development, it is good if the conditions after birth are still quite similar to the situation in the womb. This particularly concerns the protective cocoon around the child. Warmth, a sense of security and some protection against environmental influences promote the baby’s health. It is extremely important for the baby’s physical development for her to have physical contact — rocking, cuddling or simply holding the baby in your arms. Children who lack this physical contact do not develop well, even if they have ‘the best feeding.’ These babies immediately start to grow again when attention and care is devoted to physical contact. Satisfying the need for physical contact gives the child a basis for the rest of his or her life.
Nevertheless, in humans, a good environment alone does not guarantee development. Every person has his own rate of development and his own way of developing. For example, there are babies who develop motor skills very quickly, sit up at an early stage, roll over, stand and walk. On the other hand, other children appear to ’stand still’ in their development fora long time, then seem to miss out a few stages and can suddenly walk, even though they never crawled. Some children start to develop speech very early, while others remain unintelligible for a long time.
It is important to be aware of a child’s own way of developing. There may be a tendency to a certain one-sidedness. This sort of one-sidedness — for example, the slow development of speech — can be regarded as the child’s own way of developing. It is only when this one-sidedness is particularly strong that it may be seen as a developmental disorder.
Thus, the first year of the child’s development can be seen as a continuation of the embryonic stage.
During this first year of life, the body matures to the extent that the child becomes able to control it for herself. A one-year-old child can stand and go where she likes and move about freely in space. It is as though she is taking charge of her own physical body. This stage of development depends on healthy physical growth and development. Illness and malnutrition will immediately delay the process. Development at this stage is mainly influenced by the physical organism and the care of this organism.
The basis for the later development of speech is laid during the first year of life. Talk to, and with, the baby, and play with her. She sees the gestures which accompany words, and hears the songs. All this contributes to the child becoming increasingly familiar with human language. The clearest sign of this is contented baby talk by the end of the first year of life.
After the first year, the child depends on being able to imitate what she has heard. She will start to copy the words herself, first words of one syllable and then words of several syllables. She then begins to combine words, and finally produces short sentences. In this way, the child enters a second area in which she can move about freely — the field of language. By mastering speech and language, the child takes part in social life in her own way, and becomes able to express herself through the spoken word.

The next stage of development is the time at which the child starts to say ‘U Prior to that stage the child called herself by her own name. This can be seen as an expression of the fact that the child was not yet deeply connected with her own body; thus in a sense the child saw herself from outside, as other people see her.
When she becomes more closely connected with her own body, the first, still primitive, sense of self-consciousness emerges and the child experiences a sense of self; she starts to say ‘F and experiences herself as a centre. As a result of this process, the child may also feel cut off from the world around her.
By the age of three or four, the child has gone through a sort of first cycle of development. By learning to stand and walk, she has achieved a certain degree of freedom in space. By learning to speak and understand, she can develop socially and communicate with others. With the deeper connection of the self and the body, self-consciousness emerges for the first time, and this is expressed when the child uses the word ‘I’ to talk about herself.
Learning to use language independently is an important psychological development, as is developing a sense of individuality. However, healthy physical development is always a prerequisite for this. Motor development is particularly important for the development of psychological functions later on. Playing
THE CHILD’S DEVELOPMENT    21
with bricks, simple ball games, finger games, circle games — in short, everything we do with the physical organism of the child as the point of contact — will have a positive influence on development.
The behaviour of the people in the child’s direct environment is very important for development. A small child learns and develops by imitating what she sees, hears, feels and so on. In this way the child learns to walk, speak and think, and during this first learning process carefully assimilates all the details — particularly during the first three years. This once again underlines the importance of being conscious of our own behaviour as well as the material environment of the child (see also Impressions, p.25).
Admittedly, the aspects of child development described here are very general, but they can still provide a direction for the way in which we behave with the child. The care for the physical processes of growth and development are of central importance. We can measure and weigh growth, while we can assess development from the development of the motor system, the mastery of language, and the birth of the ’self’ when the child starts to say ‘F.
Sleeping and waking
During the course of life a person’s need for sleep undergoes great changes. A newborn baby often sleeps for between eighteen and twenty hours out of every twenty-four. A one-year-old can sleep for fourteen hours, while an adult needs between six and eight hours of sleep. Therefore, in the first year of life, the child should spend a great deal of the time asleep.
We have seen that there are two important things in this first year — growth (a baby’s weight triples in the first year) and development. Growth takes place particularly during sleep, while development is stimulated during the waking hours. The various organs ‘learn’ to operate in a sense, with the use of the body during, the daytime (by eating, moving, etc.). What the organs ‘learn’ during the day continues to have an effect while the baby sleeps, and is assimilated in the body’s growth activity.
A one-sided predominance of growth and excessive stimulation to develop both have a negative effect. There should be a healthy balance between the two processes; an alternation between waking and sleeping which is suitable for each stage. When the child is about one year old, this balance will have become established in the operation of the organs, in a particular day/night rhythm — the biological clock.
For good health and for the child to be able to make use of his physical capabilities properly, it is essential for this day/night rhythm to become well established. Therefore, it is literally of vital importance for a small child to establish a steady pattern during the day with regard to sleeping, eating and waking.

A steady pattern of set times in the life of a child promotes growth and development and helps to establish a healthy rhythm of sleeping and waking. Too much stimulation during the day may prevent the child from falling asleep; however, a completely unstimulating environment, without healthy challenges for the child, can also lead to problems with sleep because the child is not sufficiently tired. A healthy routine in the day, alternating challenges and periods of quiet, being together and being alone, can help to correct sleeping problems. Rituals for going to sleep can also be helpful — rocking, singing lullabies, the use of musical boxes or a prayer for the child are methods used by many families.
Sleeping well means that the child must be able to surrender and ‘let go.’ This is not as easy for some children as for others. It is helpful to give the child a sense of security, for example, in the enclosed space of the cradle (possibly with a hood) or lying against the mother. Warmth promotes a sense of comfort and relaxation; a bonnet, a sleeping bag, some drops of lavender water on the pillow, or a hot water bottle can sometimes help babies who find it difficult to fall asleep. Hot water bottles should always be removed before the baby is placed in the warm cradle. A light silk bonnet is appropriate for indoor use, but be aware of the risk of overheating. Wrapping the child up firmly pro-
SLEEPING AND WAKING    23
vides a sense of security as well as a feeling of warmth.
However, there are babies who assimilate everything that happens around them so greedily that they actively seem to suppress their feelings of tiredness and the need for sleep. The more stimulation they are given, the hungrier they seen to be. They are unable to set their own boundaries. Increasingly, we see babies who spend many hours of the day — and sometimes the night —awake, constantly asking for attention from the environment. For these children, the parents must learn to see when they show signs of being sleepy. The fact that this is quite an art is clear from the many stories told about this problem. If you miss the right moment, the child appears to go past his sleepiness and will keep going for many hours. Signs of sleepiness are restlessness or agitation, looking away, rubbing the eyes and face, warm hands and red ears, grizzling and crying. By responding to these signs of sleep immediately and consistently, by placing the baby in his cot, it is possible to create a healthy need for sleep. By not responding straightaway every time the baby cries, he will learn to resolve minor discomfort for himself. It is important to realize that any attention wakes the baby up. All the extra attention and special behaviour associated with going to sleep often achieve quite the opposite of what the parents hope to achieve.

I’m over my due date

What is happening to my baby after 40 weeks?
In many pregnancies, there are no changes to your baby’s activities after 40 weeks and his movement patterns will be the same, although your baby’s head will probably move lower into your pelvis as he gets ready for labour, resulting in a lighter feeling under your ribs and a heavier feeling down in the pelvic area. In other pregnancies, mothers may notice a slowing down of movements as the pregnancy progresses. The placenta, which feeds the baby, operates on a lower efficiency after about 38 weeks, and certainly after 41 weeks This means that your baby’s growth tends to slow down the further your pregnancy goes. As it is not possible to accurately predict whether or not the placenta will continue to function well, most hospitals have an induction policy to avoid the risk of distress to the baby, which increases the longer the pregnancy continues.
What happens if you go over your due date?
This varies slightly from area to area, however you would normally be offered an induction of labour between 41 and 42 weeks of pregnancy, which means that your labour will be started off artificially (see opposite). Different hospitals have their own criteria for how long past your due date they will wait before suggesting an induction of labour, but this is usually between 10 and 14 days after your expected date of delivery (EDD).
If an induction is considered, your doctor or midwife should discuss all your options with you before any decision is reached. Although you are within your rights to decline induction, you should make sure that you are fully aware of the reasons why it has been suggested so that you can make an informed decision.
I have a long menstrual cycle. I don’t think I’m as overdue as they say. Can nature take its course?
The ”due date” is calculated from the first day of your last period, and assumes you have an average 28-day menstrual cycle. However, if you have, for example a 35-day cycle, your due date would be a week later If this is the case, an ultrasound scan during the first 20 weeks of pregnancy would have measured the growth of the fetus and this would have given you a due date that reflected your menstrual cycle more accurately.
Current guidelines recommend inducing labour between 41 and 42 weeks of pregnancy if it has not begun on its own. If you choose not to be induced, you will be monitored regularly.
What is a “membrane sweep” and could I have this instead of being induced?
Prior to an induction of labour, at 41-plus weeks of pregnancy, it is recommended that all women are offered a membrane stretch and sweep to assess the readiness of the cervix for labour. A membrane sweep involves your midwife or doctor placing a finger just inside your cervix and making a circular, sweeping movement to separate the membranes from the cervix. The aim of this is to stimulate the release of hormones that may start labour contractions. Although this is likely to be an uncomfortable procedure, it should not cause you actual pain; you may also experience a mucus/bloodstained ‘’show” -like a discharge - following this, which is quite normal (see p.167).
Membrane sweeps have been shown to increase the chance of labour starting naturally within the next 48 hours and therefore reduce the need for other methods of induction.
I don’t like the sound of the amniotic hook. What exactly is this?
An amniotic hook is a long thin piece of plastic with a hook shape at one end. This is used to make a hole in the membranes surrounding your baby to release the amniotic fluid in an attempt to kickstart labour. The procedure, known as ”breaking the waters”, amniotomy, or ARM (artificial rupture of the membranes), is as uncomfortable as an internal examination, and isn’t usually painful, although some women do need some form of pain relief, such as gas and air, during the procedure. An amniotomy is carried out by the midwife or doctor, who will carefully guide the hooked end of the instrument into the vaginal canal with his or her fingers He or she will then press the end against the membranes to pierce them, which can help to stimulate contractions and in turn start labour.
In some cases, contractions become established quite quickly after this procedure. If this is not the case, then you will need to remain in hospital and be induced with an oxytocin drip (see p. 191)
Fetal monitoring in labour
During labour in hospital, you may spend some time attached to a cardiotocograph (CTG) machine This monitors your contractions and your baby’s heartbeat to check whether your baby is showing any signs of distress in labour Two straps are placed around your waist. One records the movement of your uterine muscle and the other measures your baby’s heart rate. The machine you are attached to produces a printout of the two readings so that the midwife or doctor can review the progress of you and your baby. If your labour is straightforward and the CTG readings show no problems, then you can be unstrapped and disconnected from the machine so that you are free to move around. Your midwife may then want to monitor you and the baby again at regular intervals throughout labour.
Can an amniotic hook harm my baby?
An amniotic hook, which is rather like a long crochet hook used to tear a little hole in the amniotic membrane surrounding the baby and the amniotic fluid, is actually fairly blunt and shouldn’t come into contact with your baby at all, so there isn’t really any risk that he could be harmed
Why do I need to be induced?
The main reason for induction of labour is when your pregnancy continues past your EDD, or estimated delivery date, as after this stage the efficiency of your placenta can decline, which can put the baby at risk.
Can I refuse an induction of labour?
You have a right to say no to any intervention
and when induction is considered, your doctor or midwife should discuss all your options before any decision is reached. However, if you wish to delay induction beyond 42 weeks, then it may be suggested that you attend the maternity unit for regular monitoring to check on your baby’s and your own health which may include a Doppler ultrasound to check the blood flow in the placenta You will also be offered an ultrasound scan to check on the amount of water surrounding your baby, as this can be a good indicator of how efficiently the placenta is working and the overall wellbeing of your baby
I’m scared about sudden full-on contractions after induction. Will it be more painful?
Some women do report that an induced labour is more painful than a spontaneous labour. This may be because induced labours can be longer, although this is not always the case. In a spontaneous labour, the body responds to the gradual onset of contractions with the release of natural painkillers called endorphins. In the case of induction, where the onset may be more sudden the body has less of a chance to do this However, some women do still get a gradual build-up of contractions after induction.
It is quite natural to be scared of pain, but -you may find it a help to be prepared mentally and physically by planning which pain relief options you are going to consider and ensuring that your birthing partner knows your plans so that he or she can give you plenty of support Many women opt for ”low-tech” forms of pain relief, such as TENS, massage, being active and changing position, and aromatherapy, in early labour, and these are all options with an induced labour. If you find these
are not enough, you can try gas and air, drugs such as pethidine, and even consider an epidural. If you know in advance how you are going to cope then you will be better able to deal with the pain
Will I need to be monitored continuously throughout labour if I’m induced?
If a syntocinon (hormone) drip is used to stimulate the contractions then, yes, continuous monitoring
of your baby’s heart rate is normally recommended. This is so the midwife and doctor can ensure that the
contractions are not too close together and that your baby is coping with the contractions and not becoming distressed. During the early stages of induction you will be monitored before, during, and following induction procedures Then intermittent monitoring of your baby’s heart rate will take place If you do need continuous monitoring, many units now have “wireless” monitors, which means that you are not physically attached to the machine and can still move around during labour.
Can my partner be present throughout?
Yes, -your partner can be with you throughout your induction and labour, and his continued support is likely to have a positive impact on your wellbeing and help your ability to cope with the pain and stress of labour. Ensure that your partner is aware of your birth plan too (see p.149) so he can support you in any decisions you need to make A lot of units allow up to two birthing partners, which can be a good idea if things are going to be long and drawn out.
What if I don’t go into labour after the induction?
Very rarely, women will experience an unsuccessful induction. especially if their cervix is unfavourable, meaning that it has failed to soften and dilate. This may ultimately result in a Caesarean section being performed As always, discuss the options with your midwife or doctor so that you are fully informed about the procedures being offered.

Types of induction
When your baby is overdue
Induction, when labour is started artificially, may be necessary for health reasons (your health or your baby’s) or if you are over your due date. If the baby’s health is at risk, your obstetrician may consider it better for your baby to be born rather than stay m your womb. For instance, a scan may show that your placenta is not working properly and your baby not growing - in this case it would be better for your baby to be born and fed orally
How will I be induced? There are several methods that can be used to induce labour. To start with, your cervix needs to ripen (soften) and begin to dilate (see p.181) You can be given gel or pessaries of prostaglandin for this to happen These are placed at the top of your vagina so that the drug can work on your cervix. Most units keep you in hospital after this, as the midwives will be regularly recording the baby’s heartbeat on
the cardictocograph machine (CTC) to ensure that you and your baby are coping with the induction drugs Occasionally the cervix does not ripen; if this happens, you may be given a second gel or pessary in six hours.
What happens next? If the gel still does not work, the midwife or doctor will break the bag of waters around the baby (artificial rupture of membranes, or ARM), which may cause discomfort. If you still don’t have contractions, a drip will be inserted into your arm and a synthetic hormone, syntocinon, is given to start contractions. Your baby’s heartbeat will be monitored while you are on the drip, as there is a risk that you may contract too much and the heartbeat be affected. Some women find this type of labour more painful and may need more analgesia, such as an epidural. If none of these works, you will be offered a Caesarean.

Sex in pregnancy

Can having sex in pregnancy harm the baby in any way?
Unless you have been told by your midwife or doctor to avoid intercourse because of specific problems, such as a history of miscarriage or unexplained bleeding, then sex is perfectly safe as your baby is cushioned in fluid in the amniotic sac inside your womb and protected by a cervical plug, and even deep penetration isn’t harmful. Enjoying intimacy with your partner will also be beneficial for your relationship.
I’m either uncomfortable when we make love or not in the mood. Should I fake it?
Levels of sexual desire in pregnancy vary greatly, with some women finding their sex drive is heightened, while others feel too ill, anxious, hormonal, or just too uncomfortable to attempt sex at all. If you really don’t want sex, be as honest and open as you can about your lack of sex drive. Don’t be pressurized into doing something you really don’t want to do, as this could complicate your relationship. Communication is very important at this time, so talk to your partner about how you are feeling — you may find that he is completely unaware of your feelings, anxieties, and worries.
You could use the presence of your ”bump” as an ideal excuse to experiment with different positions, as most couples find the missionary position very uncomfortable in late pregnancy Some couples prefer it if the woman is on top as this allows her more control over the amount of penetration and there is less weight on her bump. A ‘’spooning” position, with your partner behind you, also allows for shallower penetration and removes pressure on your bump totally Having a baby is all about adapting to new experiences, and most couples find they need to adapt their sex life too
Since we hit the second trimester I’ve wanted sex more than ever - why is this?
Often, in the second trimester, women find that once early pregnancy symptoms wear off they feel far more energetic and sexier than ever! However, this may not be the case for everyone as each woman is affected differently by the physical and psychological changes that occur in pregnancy, and women have different views about their changing bodies, which can affect their libido.
From a physiological point of view, an increased blood flow to the pelvic area combined with an increased lubrication of the vagina means that, in theory, having sex can be better than ever So if you and your partner are quite happy with your increased sex drive, this is not a problem.
My placenta is low and I’ve been told to avoid sex. Why is this? I’m only 30 weeks’ pregnant.
As the baby develops and grows so does the womb, with the result that the placenta is carried upwards away from the opening of the womb. However, in
10 per cent of women, the placenta remains low-lying during late pregnancy and then poses a risk because of potential bleeding (see p 92). A low-lying placenta is often first detected at an early scan and, if this is the case, it is usual for a repeat scan to be carried out at around 34 weeks of pregnancy to determine if the placenta is still low and exactly where it is situated in respect of the opening of the cervix (neck of the womb).
The biggest risk from a low-lying placenta is bleeding and if you have already experienced any bleeding, it is usual to recommend that you avoid sexual intercourse, as agitation of the cervix, which happens during sex, can encourage more bleeding If in doubt, it’s probably best to discuss your particular circumstances with your midwife or consultant obstetrician
My partner hasn’t wanted sex at all since I’ve become pregnant. Will he ever fancy me again?
It isn’t uncommon for either partner to experience a reduced sexual desire in pregnancy for a variety of reasons. It is important that you talk to your partner and ask about his feelings while also explaining your own thoughts and feelings.
Some partners find pregnancy a little scary, and some of these fears centre around sex and concerns about harming the baby or you. Sometimes, these worries may be based on real concerns, for example if there have been any problems in early pregnancy such as threatened miscarriage, bleeding, pain, or excessive morning sickness. Equally they can be based on misunderstanding, and this is where discussion between the two of you will help.
Although you may feel more attractive and sexy, perhaps your partner is feeling clumsy and
Talking to each other
Maintaining a healthy relationship
It is essential that you and your partner keep the lines of communication open during this time of change and some uncertainties.
* If you have gone off sex completely, reassure your partner that this is a
temporary situation and explain how the pregnancy is making you feel mentally and physically.
* Likewise, if your partner seems reluctant to initiate lovemaking, don’t take it
personally. Try to find out how he is feeling. * Don’t allow a quieter sex life to stop you being affectionate at other times.
uncomfortable. Each couple is different and you will need to talk to each other to find your way through this. You may also feel that you want to talk to someone who isn’t so closely involved, such as your midwife, doctor, a trusted friend, or a relative
Is it best to stick to oral sex during pregnancy?
Research on the benefits and risks associated with oral sex in pregnancy is limited and the findings are very often contradictory There is nothing that indicates that oral sex is recommended in place of penetrative vaginal sex unless you have been advised to avoid sexual intercourse because of the risk of bleeding, threatened miscarriage, or premature labour, when avoiding orgasm is also advisable and so complete abstinence is the better option for a while. Apart from this, it is important to remember that some infections can still be passed on easily by oral sex.
Will having an orgasm cause me to go into labour?
In a pregnancy without problems, an orgasm alone will not cause premature labour, and at full term orgasm will only cause the onset of labour if your body is ready for labour anyway. If you have had any signs of premature labour, or if you have had premature rupture of your membranes (see p.167) you will be advised to avoid sexual intercourse. This is because the hormone oxytocin increases during sexual arousal and the effect from the oxytocin is to cause the muscles of the uterus to contract.
During pregnancy the muscles of the uterus experience practice contractions, known as Braxton Hicks (see p 168), which are not harmful, and orgasm may increase these practice contractions
If you have gone past your due date and are at a point when your body is ready to go into labour, then sexual intercourse may help things to start for two reasons the prostaglandins in semen will help the cervix to soften at this stage of pregnancy, and the contractions stimulated by orgasm have more chance of developing into early labour contractions.
I’ve got problems with my pelvis - is there a comfortable way for us to have sex?
Problems with the pelvis, particularly symphysis pubis dysfunction or SPD (see p.82), tend to be made worse by moving your legs too far apart, so it is a matter of finding a position that you feel comfortable in that doesn’t involve too much stress on the pubic area. Many women find the “missionary position” the most difficult as it involves significant parting of the legs, plus there is the weight of a partner to consider Some, although not all, women find an all-fours position for intercourse more comfortable, both for sexual intercourse and for giving birth. If intercourse is really proving difficult, then it could be that while you are experiencing significant problems you will need to find alternative ways for you and your partner to be intimate that don’t involve penetrative sex.
Many women find that pelvic discomfort improves significantly once they have had the baby. A very useful organization that has a lot
of information and advice on pelvic pain during
pregnancy is the Pelvic Partnership (see p 310). You can also talk to your midwife or doctor for a referral to a physiotherapist, which may be beneficial and help you to achieve a greater degree of comfort during pregnancy
I’m 36 weeks. My boyfriend insists on regular sex and has been a bit abusive. Is this normal?
It is not normal for someone to be abusive to another person or to force them to have sexual intercourse when they don’t want to You should never be forced to do something that is against your will. In almost 30 per cent of all domestic abuse cases, the first incidence occurs in pregnancy. It is very important that you talk to someone about how your boyfriend is treating you, perhaps to a close friend or relative There are also organizations that offer confidential advice and help you if you really feel there is no one you can talk to or trust (see p.3 10). You could also try talking to your midwife, who will treat everything you say in the strictest confidence and will have details of local organizations that can help and advise you.

Comfortable lovemaking
You and your partner may need to experiment more during pregnancy to find lovemaking positions that are comfortable for you and your rapidly growing bump As pregnancy progresses, most women find that lying on their back in the missionary position becomes increasingly uncomfortable as your partner presses on your bump. You may find being on top an enjoyable position, which allows you to control penetration and does not put pressure on your tummy. Lying in the spoons position, with your partner behind you, can be pleasurable and puts no pressure on your abdomen. Other positions that don’t restrict your pleasure and are comfortable include sitting together, kneeling while your partner enters from behind, and lying side by side with your legs bent over your partner’s legs.

Not Getting Pregnant FAQs.

We’re not getting pregnant what do we do now?
We’ve been trying to conceive for 12 months - can the doctor identify the problem?
There are many factors that can increase or decrease your chances of becoming pregnant, but if you have been trying for a year, it would be sensible to contact your doctor. After an initial assessment of your general health and lifestyle, your doctor will offer your partner a sperm test (see below) and you will be offered tests to see if you are producing eggs and check whether or not your Fallopian tubes are blocked. Blood tests will be carried out to check your iron levels, your red and white blood cell count, and to check how organs such as your liver and kidneys are functioning In addition, couples are asked to agree to a sexual health screening to check for previous or current STls, such as HIV and syphilis.

My wife has been tested and has the all clear - how can I tell if I’m causing our fertility problem?
You will be offered a semen analysis to determine your sperm quantity and quality — how sperm move (motility) and whether they are a normal form. A healthy sperm count should have a concentration of 20 million spermatozoa per millilitre of semen, with
75 per cent of these alive and 50 per cent of these ‘motile”, or moving as well as possible Differences can occur over time in both the quality and quantity of sperm, so if your first sample is poor, you will probably be tested again a couple of months later.
You are also likely to be advised to give up smoking, reduce alcohol intake to 1-2 units once or twice a week, and to wear loose-fitting underwear to avoid overheating the testes If a problem is found, you will be referred to a specialist for a consultation Try to avoid becoming stressed as this can also affect fertility Learning relaxation techniques with your partner and practising these regularly will help.

We can’t conceive naturally - what do we do now?
Assisted conception; or assisted reproduction, is the term used when women are helped to conceive without having intercourse There are five main procedures available, listed below. Your consultant will go through each one with you, and together you can make a decision about which is most suitable depending on your problem. You can also contact the National Institute for Health and Clinical Excellence (NICE) for more information (see p.310)
* Ovarian Stimulation (OS), or Super Ovulation (SO), involves injections of fertility hormones to boost egg production This is followed by intrauterine insemination (IUI) of sperm, whereby sperm are collected and sorted so that only the strongest remain and these are then artifically placed inside the uterus via a catheter. This is ideal for couples when the man’s sperm is “slow” or the woman has problems ovulating, or there is a combination of both. * Gamete Intra-Fallopian Transfer (GIFT). This is suitable for couples for whom no cause for infertility has been found. It involves stimulating the ovaries to produce eggs, which are removed, mixed withsperm and replaced directly into the Fallopian tubes, allowing conception to occur inside the body.
* In Vitro Fertilization (IVF). This is the most widely used treatment and involves a seven-step process (see below and p.30) This is ideal for most problems including blocked tubes
* Intra-Cytoplasmic Sperm Injection (ICSI). This is used if the man’s sperm count is low, the motility of the sperm is very poor, or the woman is allergic to her partner’s sperm. The treatment involves injecting just one viable sperm into an egg (see box right). * Artificial Insemination by Donor (AID). This is simply the injection of donated sperm into the cervix This is used when a man is unable to maintain an erection or is sterile Similarly, women may require an egg donation if they are unable to produce their own eggs, although this is more complicated.
Whatever treatment is provided, it is important that you and your partner are treated as a couple rather than separate patients. It is also essential that you are kept informed throughout the process and given information on any risks and benefits.

What does IVF involve?
IVF, or In Vitro Fertilization, involves the surgical removal of an egg which is then mixed with sperm in a laboratory dish to fertilize and produce an embryo outside of the womb (see p.30).
IVF treatment occurs in cycles, as there are various stages that must be completed for it to be successful. Initially, a drug is used in the form of a nasal spray or injection to switch off the woman’s natural cycle of egg production in the ovaries, known as ”clown-regulation”. Fertility drugs are then given to stimulate the ovaries to produce more than one egg (ovulation induction). Mature eggs are collected from the ovaries using a fine needle guided by ultrasound. The procedure is usually uncomfortable rather than painful. On the same day, the partner’s sperm is collected and then the eggs and sperm are mixed in a dish. Within a few days, one or sometimes two embryos are transferred into the womb. If an embryo successfully attaches to the inside of the womb and continues to grow, a pregnancy results.

ICSI

This procedure may be used when it is thought that the quality of the partner’s sperm may be responsible for fertility problems. If the sperm count is low or movement is poor, sperm may be ”assisted” in fertilizing the egg. An individual sperm is injected directly into the egg and, if fertilization takes place, the resulting embryo is placed in the uterus.
What are the success rates of fertility treatments?
Success rates for treatments vary, depending on the treatments used and the health of the couple If you want to know the success rates of individual clinics, you can ask for their ratio of “live-births-per-cyclestarted”. This information is available from each clinic, but there are currently no nationally held data
Overall, couples have a better success rate if the woman is aged 23-39 years, has been pregnant or has had a baby, and has a normal body weight (a body mass index between 19 and 24). The older a woman is, the less likely she is to get pregnant
Figures show that for every 100 women who are 23 to 35 years, more than 20 will get pregnant after one PVT cycle; from 36 to 38 years around 15 will get pregnant at 39, around 10 will get pregnant; and in women over 40, around 6 will get pregnant

IVF is so expensive - can we get help with funding?
Since April 2005, women between the ages of 23 and 39 are entitled to one free IVF cycle on the NHS. However, you must meet the eligibility criteria set by your local Primary Care Trust (PCT), which varies across the country and depends on factors such as your marital status, weight, and whether you or your partner smoke Couples who can afford to, or who may have had one unsuccessful cycle already, often opt for a private clinic Although these are regulated by the Human Fertilisation and Embryology Authority (HFEA), this cannot set costs, and a private course of IVF can cost from E4,000 to £10,000
My partner is worried about producing his sperm sample. How can I reassure him?
As fertility problems affect 1 in 7 couples in the UK reassuring your partner that this is not an unusual situation is always a good start. You could try leaving out a leaflet on fertility problems for him to read for more information Try to empathize with him as much as possible by sharing your experiences and the tests you have undergone.
Your partner may be worried about ejaculating at the required time when he is already feeling anxious and is in a clinical environment Some men require a sex toy, magazines, or video clips to help. For others, restraining from sexual intercourse for a few days can make ejaculation easier If you live fairly close to the clinic, your partner may be able to produce the sample at home and deliver it.
Sometimes a medical condition such as diabetes prevents a man ejaculating If this is the case, sperm can be obtained through ‘’sperm recovery”, whereby a small needle is passed through the skin of the scrotum into the testes and sperm is withdrawn.

The drugs I’m taking for IVF are giving me terrible mood swings. Is this normal?
The drugs used in IVF treatment are female hormones (see p.30) to stimulate your ovaries to mature more than one egg at a time, and progesterone, which helps to sustain a pregnancy. Different levels of hormones can result in mood swings, as any woman who suffers with premenstrual tension (PMT) can testify, and this is also a common side effect of IVF treatment It’s worth considering too that couples undergoing IVF are under incredible stress, which has been linked to an increased risk of developing depression, so it’s important to decide whether you are feeling ”hormonal” or are in fact depressed. Your doctor can advise you and refer you if necessary.
My partner has a low sperm count - can you tell us what help is available for us?
Usually, two or three semen samples are taken to work out the average sperm count and to see if there are abnormal sperm present. A healthy semen sample of 2-5ml contains more than 20 million sperm per ml; a count below this is considered low If your partner has abnormal sperm, further testing may be necessary Lifestyle changes can boost sperm (see below). There are also hormonal treatments to improve sperm count and surgery to remove blockages You may be reassured to know that even poor-quality semen can be used to fertilize an egg with IVF or with ICSI (see p.29).
Can lifestyle changes really improve sperm?
Poor quality sperm has been linked to excessive drinking (more than three or four units of alcohol per day), smoking, and to wearing tight-fitting underwear,
which overheats the testicles and can affect their efficiency Excessive stress and a poor diet are also thought to affect sperm So yes, it is worth reviewing your lifestyle to see if improvements can be made Jobs that may expose you to harmful agents, such as pesticides, may also affect sperm, so if you think your partner’s job may pose a risk, it’s worth investigating.
I’m pregnant using a donor -what happens if my child wants to trace her biological dad?
From April 2005, children who were conceived using donor sperm have had a right when they reach 18 years of age to find out their parent’s identity. This also applies to children conceived using donor eggs and embryos. This right applies only to children conceived after this date and not retrospectively. Prior to this date, children had the right to know at 18 years of age if they were conceived using donor sperm, eggs, or embryos and to find out if they were related to someone they wanted to marry. The reason for this change in the law is that children conceived in this way are being given the same rights as adopted children regarding information on their genetic parents. However, some fertility experts fear that this will deter potential donors.
Is surrogacy allowed in the UK?
Currently, surrogacy is legal in the UK, although it is illegal to advertise it as a service However, the law does not recognize surrogacy
as a fixed agreement, which means that a surrogate can change her mind about the arrangement during the pregnancy and up to six weeks after the birth. It is usual for a surrogate to receive ”reasonable expenses”, although there is no definition of what is deemed as reasonable. Usually, this includes costs incurred by the surrogate relating to her pregnancy, If the father of the child is named on the birth certificate, this gives him equal rights to the child. If this is not the case, then six weeks after the birth the new parents can apply for a parental order that gives them full parental status At this point, the surrogate gives up any parental rights to the child.

Conception problems

There are a range of reasons why a couple may have difficulty in conceiving. Investigations and tests may uncover specific conditions, which may be treatable, or you may be offered help to conceive.
What can affect a man’s fertility? A semen analysis may reveal various reasons why sperm have difficulty in fertilizing an egg The sperm count may be low (less than 20 million sperm per ml); the motility of the sperm (how they move) may be poor, and there may be a high percentage of abnormally formed sperm Some men experience a failure to ejaculate at orgasm There may also be damage to the tubes that connect the testicles to the seminal vesicles where sperm are produced, and this may have been present from birth or caused by a later infection
What can affect a woman’s fertility? Conditions such as polycystic ovary syndrome
(a hormonal imbalance that causes ovarian cysts) and endometriosis (see p 19) can disrupt fertility. Other hormonal imbalances, such as low levels of FSH and LH, can affect ovulation; or levels of progesterone may be too low to sustain a fertilized egg. Damaged Fallopian tubes, caused by an ectopic pregnancy (see p 25), surgery endometriosis, or pelvic inflammatory disease, which may be caused by an infection such as chlamydia, can prevent conception. Damage to the ovaries can occur from scarring as a result of surgery or infection, or the supply of eggs may be low Some women have an abnormally shaped uterus, or have uterine scarring, that can prevent the successful implantation of an egg.

IVF treatment

In vitro fertilization or IVF, is a complex procedure with several stages, from the stimulation and harvesting of your eggs to the successful fertilization of the eggs, development of embryos and transfer of the embryos into the womb for implantation. Undergoing IVF can be a stressful and time-consuming undertaking, but knowing in advance how the procedure works and what you can expect at each stage can reduce anxiety and help you and your partner to cope.
What happens first? To optimize the chances of success with IVF more than one egg at a time is removed for fertilization Normally, your body produces one egg each month. In rVF, you will inject yourself with drugs, such as clomiphene and hMG (human menopausal gonadotrophin) to stimulate your ovaries to produce several eggs. While you are undergoing this treatment, you will need to visit your clinic every one to two days over one or two weeks to monitor the development of the eggs. Once it is thought that the eggs are mature, you will be given a blood test to measure your levels of oestrogen, which is released around ovulation.

What happens next? Once your follicles are ripe and ready for ovulation, your eggs will be collected at the clinic using ultrasound or laparoscopy to guide a probe. Once the eggs have been collected, they will be mixed with your partner’s sperm in a Petri dish in a laboratory ready for fertilization Your partner needs to produce the sperm on the same day as the egg collection. He can either do this at home, or come into the clinic with you and produce the sperm while you are undergoing the egg collection procedure.What happens in the laboratory? Once the egg and the sperm have been mixed, they are placed in the laboratory and monitored closely for the next few days. They will first be inspected around 18 hours later to see how many of the eggs have been fertilized and the clinic will usually pass this information on to you the day after the procedure It’s quite common for not all of the eggs to be fertilized and for only two or three to develop into embryos. The fertilized eggs are incubated in the laboratory over the next couple of days and their progress measured. The laboratory technician watches cell division under a microscope, waiting for the eggs to divide into two or more cells on their journey to becoming a blastocyst (see p.21).
If one or more fertilized eggs develop in the laboratory, you will be called back in for the embryo transfer, This is done by injecting eggs through a catheter into the uterus. No more than two eggs will be transferred and you will have the option to freeze any remaining embryos.

Surrogacy
A surrogate mother is a woman who reaches an agreement to carry a baby on behalf of another woman. She can either conceive the baby with the partner’s sperm, in which case she is the maternal mother, or the infertile couple may fertilize their own egg through fertility treatment, which is then transferred into the uterus of the surrogate mother for her to carry the baby through pregnancy and deliver at birth. This process can be beset with problems: such as the conflicting emotions of both the surrogate mother and the receiving couple, or legal issues if, for example, the surrogate mother has a change of heart after the birth and wishes to keep the baby, For this reason, it is important that all parties entering into the agreement have carefully considered the implications and are confident and happy in their roles.

Miscarriage FAQs. I’ve had a miscarriage why did it happen to me?

What is a miscarriage?
A miscarriage is the spontaneous loss of a baby at any time up until the 24th week of pregnancy After 24 weeks the loss is referred to as a stillbirth. The signs of a miscarriage are vaginal bleeding and period-like cramps. As not all miscarriages follow the same pattern, there are various terms to describe what occurs:
* A threatened miscarriage occurs when there is bleeding and possibly pain, but the fetus survives. * An inevitable miscarriage occurs when there is bleeding and pain due to contractions in the uterus, the cervix opens, and the fetus is expelled.
* A missed miscarriage occurs when the fetus dies but remains in the womb and either is expelled naturally later or removed in an operation

I’ve recently miscarried - why did this happen?
Miscarriage occurs in 10-20 per cent of pregnancies In the vast majority of these the cause is never identified, but it’s unlikely to be related to anything you did or didn’t do. There are thought to be several reasons why miscarriages occur (see p 25) There may be a genetic problem, in which the baby or placenta doesn’t develop normally, levels of the pregnancy hormone progesterone may be low; there may be an immune disorder m which the mother 3 immune system reacts against the pregnancy; an infection may be present; or there may be problems with the uterus or cervix. Miscarriages tend to be more common in older women.
The Miscarriage Association (see p.310) offers support and up-to-date advice and information about miscarriage. You may feel comforted to know that, statistically, any future pregnancy you have is likely to progress normally.
My period was late and now I’m bleeding really heavily -could I be having a miscarriage?
In the absence of a positive pregnancy test or a pregnancy confirmed by an ultrasound scan, it is difficult to know whether or not you were pregnant If you have had unprotected intercourse in the time since your last period, it is possible that you could have been pregnant and this is a miscarriage The lateness of your period may give a clue, but won’t confirm one way or another. If you have any other symptoms of pregnancy it might be worth doing a pregnancy test as sometimes, even when there has been bleeding, a viable pregnancy is discovered
However, it could also be a late period for no other reason than that this happens on occasion to everyone. A delayed period can be caused by  weight loss or gain, stress, or if you have been taking the oral contraceptive Pill but missed a dose.
Talk to your doctor if the bleeding continues:
you feel faint or experience palpitations; your period lasts for longer than seven days; you have more than six well-soaked pads a day; or if you have any severe abdominal pain Your doctor can carry out a blood
test to check your iron levels and possibly determine if you have been pregnant, in which case an incomplete miscarriage or ectopic pregnancy will need to be ruled out (see p.25)

I’m 10 weeks pregnant and getting cramping pains. Do I need to rest to avoid a miscarriage?
Cramping pains on their own without vaginal bleeding or spotting can occur at this stage of pregnancy. Sometimes pain can be felt as the ligaments stretch when the baby and -your uterus grows. There are also other possible causes for the pain aside from miscarriage, such as constipation or a urinary tract infection
Many doctors advise rest to avoid a ”threatened” miscarriage, but there is no strong evidence that this makes any difference to the outcome of a pregnancy If you feel like resting because you are in discomfort from the cramping pains then do rest, but if you feel happy continuing as normal then that may be the best option for you Soaking in a warm bath and practising relaxation techniques may ease the intensity of the pain If the pain increases or you get any bleeding or spotting, contact your doctor.
Does bleeding in pregnancy mean that miscarriage is inevitable?
No, many women experience bleeding in early pregnancy and then proceed to have a healthy pregnancy and baby. Indeed, some women have intermittent bleeding throughout pregnancy, Despite this, any bleeding should be investigated. This is usually done with a scan to determine if the pregnancy is viable (going to continue) and to identify if there is any indication of where the
bleeding is coming from. In very early pregnancy, it can be hard to see the pregnancy on a scan and a blood test to measure levels of the pregnancy hormone human chorionic gonadotrophin (hCG) may be done, mainly to rule out the possibility of an ectopic pregnancy (see p.25) Unfortunately for you this is a time of waiting; the timing of any further scans is usually determined by the findings of the initial scan and blood tests and the symptoms you are experiencing.

I’ve had three miscarriages before and I’m scared of trying again - is there anything I can do?
It is understandable given your experiences that trying to get pregnant again is a scary proposition. Following a third miscarriage, it is usual for your doctor to offer you a number of investigative tests
to see if a reason for the miscarriages can be found. In some cases, a cause is identified and treatment can be offered to help improve the outcome for subsequent pregnancies.
You are likely to be given a number of blood tests. These are to look for antibodies (proteins in the blood that fight any substance they recognize as foreign to your body), chromosomal abnormalities, and infection. You may also have a vaginal examination and swab and an ultrasound scan to check your womb and tubes. If a chromosomal abnormality is found, genetic counselling should be offered to discuss the implications for future pregnancies. The levels of the hormones progesterone and prolactin may also be checked as these can play a role in miscarriage. Sometimes, the cervix is found to be weakened and likely to open early If this is the case, you may be offered a cervical stitch that acts like a drawstring on the cervix and hopefully prevents future miscarriage or premature delivery
If you haven’t already been offered these tests, talk to your doctor about them before trying to get pregnant again so that you can begin any recommended treatment as soon as possible
My mum had two miscarriages -does that mean I am more likely to miscarry?
Ask your mum if she was given any particular reason for her miscarriages If for example, she knows that they were due to a chromosomal abnormality, such as sickle-cell disease, or if she had a medical condition such as heart disease, then there is a possibility that the condition is hereditary and the risk of miscarriage may be the same for you too.
However, it’s most likely that your mother’s miscarriages were unfortunate chance occurrences for which no reason was found If this is the case, then you are at no more risk of experiencing a miscarriage than any other woman your age. However, if you do become pregnant, it would be worth mentioning your mother’s pregnancy history at your initial antenatal appointment, as your family medical history is an important part of your medical notes during pregnancy.

I’ve had several miscarriages and my doctor has referred me to a genetic counsellor - why?
A genetic counsellor is a highly trained professional who supports families before and after conception. Quite often a miscarriage is caused by a genetic abnormality in the fertilized egg or embryo. This is usually a one-off and can affect any woman. However, if a woman has recurrent miscarriages, it may be that she is carrying a genetic condition
Women and their partners are referred to a genetic counsellor if either partner has a condition that can affect future children or the chances of becoming pregnant or continuing with a pregnancy (as they may be more likely to miscarry or be offered a termination) For example if there is a history of sickle-cell disease, a blood disorder that causes chronic anaemia and increases the risk of a preterm birth and health problems in the baby, it may be that either or both couples are carrying a gene that can affect a baby.
A genetic counsellor helps you understand how your genes could affect conception and pregnancy and about the tests available to determine if a fetus is affected. The counsellor will discuss a range of
issues, including the moral and ethical issues related to genetic testing, as it is common for couples to feel stress, guilt, and confusion in this type of situation.

I lost my baby, but I want to get on and try again - is this OK?
Although there are no hard rules about when to try for another baby, it is important that you allow yourself time to grieve and your body to recover before trying to conceive again. Some women feel able to try again within a month, while others may not feel ready for at least a year. Whatever you feel, it’s wise to let your hormones and body settle down after a miscarriage before considering another pregnancy. The usual advice is to wait for at least three months before trying to conceive again so that you feel both emotionally and physically prepared for another pregnancy. Your partner also needs to feel that the time is right for you both to try again.

We had a miscarriage at 20 weeks. Will the doctors find the cause so that we can move on?
Coping with the loss of a baby well into pregnancy is difficult and upsetting. Many women ask themselves why a miscarriage happened and feel unable to move on until that important question is answered. Unfortunately, unless this was a recurrent
miscarriage of three or more, there may not be an investigation, although it may be suggested that you have a cervical stitch in future pregnancies to stop the cervix dilating too early (see p 24)
It may be worth talking to a counsellor who
is trained to support women and families through such difficult times, your doctor or midwife may be able to refer you. You may find that discussing your miscarriage directly with a health professional helps to answer any concerns you or your partner have, and by communicating in this way you will have started to move forward and may begin to feel able to consider planning another pregnancy

My partner had a miscarriage. I’m being supportive, but I’m devastated too. What should I do?
Dealing with a miscarriage is very difficult for both women and men, but often far more attention is given to a woman, and a man’s feelings are simply ignored However, it’s important that you don’t internalize your loss and do acknowledge your feelings, which may range from feeling scared, disappointed, and out of control, to blaming yourself for not being supportive enough and mourning the loss of your identity as a father. Although you want to support your partner, you also need to recognize your own need to grieve, as working through your emotions can help you to come to terms with your loss more quickly
A good support network is important for both of you and it can help to find a sympathetic listener outside of your relationship. Initially, you may find discussing your feelings with another male easier than talking to your partner. You could also talk to your doctor, the midwife, or a counsellor, or contact the Miscarraige Association helpline.

What is a “D and C”?
D and C stands for dilation and curettage, a surgical procedure in which the opening to the uterus, called the cervix, is stretched (dilatation) and the tissue that lines the uterus is scraped away or removed (curettage). This procedure is sometimes carried out after a miscarriage to ensure that any of the remaining products of the conception and pregnancy have been removed
There are advantages and disadvantages to consider before having a D and C. The procedure is usually completed within two hours and most women resume their usual activities within a week. However, the need for routine surgical evacuation, or a D and C, following a miscarriage has been questioned because of potential complications, such as bleeding and infection. Ask your doctor for advice There are less invasive options than a D and C for dealing with a miscarriage. One method is simply to watch and wait to see if the uterus will spontaneously expel any remaining products of conception. Another option is a drug treatment that works by stimulating the uterus to contract and naturally expel pregnancy tissues.

The risk of miscarriage
There are several factors that can increase your risk of miscarriage.
Older women have an increased risk of having a miscarriage. It is thought that this is largely due to the fact that older women are more likely to have babies with chromosomal abnormalities, which may have problems developing and miscarry Some underlying medical conditions can also increase your chances of miscarriage, such as polycystic ovary syndrome or fibroids. Other factors that can increase your risk are if you are particularly underweight or overweight, smoke drink heavily, or take recreational drugs.
Miscarriages are also more likely the more pregnancies you have had.

Talking to others
Losing a baby during pregnancy can be devastating, leading to feelings of grief such as anger, depression, guilt, and anxiety. Talking to others can help you to work through your feelings.
* Ask your midwife or doctor to put you in touch with a counsellor who specializes in pregnancy loss
* Let close friends and family members know how you are feeling
* The Miscarriage Association is a great source of support and advice (see p.310). * Talk to your doctor or midwife about why the miscarriage may have happened.

Possible causes of miscarriage

About 1 in 4 first pregnancies ends in miscarriage, generally within the first 12 weeks. Often no cause is identified and it may not be investigated unless a woman has had three or more miscarriages in a row, known as ‘recurrent miscarriages”
Why has it happened? Some miscarriages occur because of a one-off genetic problem (caused by a faulty chromosome) when the baby does not develop properly. Genetic problems account for 60 per cent of early miscarriages If you think this may have been the cause, you can request tissue tests from the baby. Based on these results, you may be able to receive specialist counselling to discuss the risk of it happening again (see p.24). After 12 weeks, the chances of you losing your baby because of a chromosomal disorder reduce to about 10 per cent: however, if
Ectopic pregnancy
you are over 35, this risk is higher. Other less common causes of miscarriage include fibroids (non-cancerous growths), infection, problems with the uterus, hormonal imbalances, and immune system disorders. An ectopic pregnancy. below, occurs when the embryo implants in a Fallopian tube and needs to be removed
What can cause late pregnancy loss? A late pregnancy loss (referred to as a stillbirth after 24 weeks) can be due to the cervix being weak (or ‘incompetent’), causing the cervix to dilate too early. This accounts for 15 per cent of repeated miscarriages. In future pregnancies, a stitch around the cervix can strengthen this muscle and prevent it opening early Another cause of a late miscarriage can be if the placenta does not function properly and affects the baby’s growth.
fertilized egg implants in tube

Glossary
Abruption The detachment of part of the placenta from the wall of the uterus during late pregnancy, which may result in bleeding. Accelerated labour The artificial augmentation of contractions, after the cervix has started to dilate, by the injection of oxytocin through an intravenous drip Often used to speed up a long labour. Active birth An approach to childbirth that involves upright positions and movements during labour.
Active management of labour The constant monitoring and technical control of labour to monitor its duration
Alphafetoprotein (AFP) A substance produced by the embryonic yolk sac, and later by the fetal liver, which enters the mother’s bloodstream during pregnancy Alveoli Milk glands in the breasts, which produce a flow of milk when they are stimulated by prolactin and the baby’s sucking.
Amniocentesis The surgical extraction of a small amount of amniotic fluid through the pregnant woman’s abdomen. This procedure is usually carried out as a test for fetal abnormalities.
Amniotic fluid The fluid that surrounds the fetus in the uterus. Ultrasound scans may be done in late pregnancy to ensure that enough is present
Ammotomy The surgical rupture of the amniotic sac, often done to speed up labour This is referred to as ARM (artificial rupture of the membranes).
Anaemia A condition in which there is an abnormally low percentage of haemoglobin in the red blood cells, it is treated by iron supplements
Anaesthetic Medication that produces partial or complete insensibility to pain Anaesthetic, general Anaesthetic that affects the whole body, with temporary loss of consciousness.
Anaesthetic, local Anaesthetic that affects a limited part of the body
Analgesics Painkilling agents not inducing unconsciousness
Antenatal Before the birth
Anterior position See Occipital anterior Antibiotics Substances capable of
destroying or limiting the growth of micro-organisms, especially bacteria Antibodies Protein produced naturally
by the body to combat any foreign bodies, germs or bacteria
Anti-D An injection of antibodies given to women who have a Rhesus negative blood group if it is thought they may have been exposed to Rhesus positive fetal blood cells
Antihistamines Tranquillizers that are used in the treatment of nausea vomiting and certain allergies.
Apgar scale A general test of the baby’s wellbeing given shortly after the birth to assess the heart rate and tone respiration blood circulation, and nerve responses. Areola The pigmented circle of skin surrounding the nipple.
ARM See Ammotorny
Bile pigment See Bilirubin.
Bilirubin Broken-down haemoglobin, normally converted to nontoxic substances by the liver. Some newborn babies have levels of bilirubin too high for their livers to cope with See also Jaundice, neonatal. Birth canal See Vagina
Blastocyst An early stage of the developing egg when it has divided into a group of cells. Braxton Hicks contractions Practise contractions of the uterus that occur throughout pregnancy, but which may not be noticed until towards the end. Breast pump A device for drawing milk from the breasts.
Breech presentation When the position of the baby in the uterus is bottom down rather than head down
Caesarean section The delivery of the baby through an incision in the abdominal and uterine walls
Candida See Thrush,
Cardiotocograph (CTG) An electronic monitor that is used to measure the progress of the mother’s contractions and the baby’s heartbeat during labour.
Carpal tunnel syndrome Numbness and tingling of the hands arising from pressure on the nerves of the wrist In pregnancy it is caused by the body’s accumulation of fluids
Catheter A thin plastic tube that is inserted into the body through a natural channel to withdraw fluid from, or introduce fluid into, a particular part of the body This can be used to draw off urine from the bladder after an operation, or to maintain a constant input of fluids into a vein, or to introduce anaesthetic into the epidural space.
Cephalic presentation (Vertex presentation) The position of a baby who is head down in the uterus The most common presentation. Cephalopelvic disproportion A state in which the head of the fetus is larger than the cavity of the mother’s pelvis Delivery must therefore be by Caesarean section
Cervical dilatation See Dilatation.
Cervical incompetence A disorder of the cervix, usually arising after a previous mid-pregnancy termination or damage to the cervix during a previous labour, in which the cervix opens up too soon, resulting in repeated mid-pregnancy miscarriages. It is sometimes treated by suturing to hold the cervix closed. Cervix The lower entrance to the uterus, or neck of the womb
Chloasma Skin discolouration during pregnancy, often facial.
Chorion The outer membranous tissue that envelops the fetus and placenta
Chorionic gonadotrophin See Human chorionic gonadotrophin (HCG).
Chorionic villus sampling A method of screening for genetic handicap by analysis of tissue from the small protrusions on the outer membrane enveloping the embryo that later form the placenta.
Chromosomes Rod-like structures containing genes occurring in pairs within the nucleus of every cell. Human cells each contain 23 pairs. See also Gene
Cleft palate A congenital abnormality of the roof of the mouth
Club foot A congenital abnormality in which the foot is painlessly twisted out of shape. Colostrum A kind of milk, rich in proteins, formed and secreted by the breasts in late pregnancy and gradually changing to mature milk some days after delivery
Conception The fertilization of the ripened egg by the sperm and its implantation in the uterine wall.

Congenital abnormality An abnormality or deformity existing from birth, usually arising from a damaged gene, the adverse effect of certain drugs or the effect of some diseases during pregnancy
Contractions The regular tightening of the uterine muscles as they work to dilate the cervix in labour and press the baby down e birth canal
Cordocentesis A fine needle is passed trough the mother’s abdomen into the fetal –vein in the umbilical cord. The technique allows fetal blood to be tested, facilitates intra-urine blood transfusions, and enables drugs to be injected directly into the baby Corpus lutuem A glandular mass that forms n- the ovary after fertilization It produces progesterone. which helps to form the placenta, and is active for the first 14 weeks of pregnancy
Crowning The moment when the baby’s head appears in the vagina and does not slip back again.
CVS See Chorionic villus sampling.
D and C The surgical dilatation (opening) of the cervix, and curettage (removal of the contents) of the uterus
Dehydration A physical condition caused by the loss of an excessive amount of water from the body, often resulting from severe vomiting or diarrohea
Depression, respiratory Breathing difficulties in the newborn baby
Diabetes Failure of the system to metabolize glucose, traced by excess sugar in the blood and urine.
Diamorphine A narcotic opium derivative used as an analgesic.
Dilatation The progressive opening of the cervix caused by uterine contractions during labour.
Distress See Fetal distress
Dizygotic See Twins
Domino scheme A scheme operated by some hospitals in which community midwives provide antenatal care and are present at hospital for the delivery.
Doppler A method of using ultrasound vibrations to listen to the fetal heart
Doula A supportive woman helper who provides physical and emotional support during childbirth
Down’s syndrome A severe congenital abnormality caused by an incorrect number
of chromosomes that produces physical abnormalities and reduced intelligence. Drip See Intravenous drip.
Eclampsia The severe form of pre-eclampsia, which is characterized by extremely high blood pressure, headaches, visual distortion, flashes, convulsions and, in the worst cases. coma and death The condition is now rare since the symptoms of pre-eclampsia are treated immediately See also Pre-eclampsia.
Ectopic (Tubal pregnancy) A pregnancy that develops outside the uterus, usually in one of the Fallopian tubes. The mother has severe pain low down on one side in her
abdomen at any time from the 6th to 12th week of pregnancy. The pregnancy must be surgically terminated.
EDD The estimated date of delivery Electrode A small electrical conductor used obstetrically for monitoring the fetal heartbeat during labour.
Electronic fetal monitoring The continuous monitoring of the fetal heart by a transducer placed on the mother’s abdomen over the area of the fetal heart, or by an electrode inserted through the cervix and clipped to the baby’s scalp
Embryo The developing organism in pregnancy from about the 10th day after fertilization until about the 12th week of pregnancy, when it is termed a fetus Endometrium The inner lining of the uterus. Engaged (Eng/E) The baby is engaged when it has settled with its presenting part deep in the pelvic cavity. This often happens in the last month of pregnancy
Engorgement The over congestion of the breasts with milk. If long periods are left between feeds, or the baby is not well latched on painful engorgement can occur. This can be relieved by putting the baby to the breast or expressing the excess milk Entonox A mixture of 50 per cent oxygen and 50 per cent nitrous oxygen, breathed in through a mask during tabour, that gives pain relief as contractions peak
Epidural (Lumbar epidural block) Regional anaesthesia used during labour and for Caesarean sections, in which an anaesthetic is injected through a catheter into the epidural space in the lower spine. Episiotomy A surgical cut in the perineum to enlarge the entrance to the vagina.
External version (External cephalic
version, or ECV) The manipulation by gentle pressure of the fetus into the cephalic position This may be done by an obstetrician at the end of pregnancy if the baby is breech or transverse
Fallopian tube The tube into which a ripe egg (ovum) is wafted along after its expulsion from the ovary along which it travels on its way to the uterus
False labour Braxton Hicks (rehearsal) contractions, which are so strong and regular that they are mistaken for the contractions of the first stage of labour,
Fertilization The meeting of the sperm with the ovum or egg to form a new life See also
Conception.
Fetal distress A shortage in the flow of oxygen to the fetus, which can arise from numerous causes
Fetus The developing child in the uterus, from the end of the embryonic stage at about the 12th week of pregnancy until birth FH Fetal heart.
Fibroid A benign (non-cancerous) muscle growth in the uterus.
Forceps Metal tong-like instruments placed either side of the baby’s head during labour to help deliver the baby
Hormone A chemical messenger in
the blood that stimulates various organs to action.
Human chorionic gonadotrophin (HCC) A hormone released into the woman’s bloodstream by the developing placenta from about six days after the last period was due. Its presence in the urine means that she is pregnant
Hyperemesis gravidarum Almost continuous vomiting during pregnancy Hypertension (High blood pressure) During pregnancy this can reduce the fetal blood supply.
Hypnosis A state of mental passivity with a special susceptibility to suggestion. This can be used as an anaesthetic, and can be self-induced.
Hypotension Low blood pressure.
Identical twins See Twins
Implantation The embedding of the fertilized ovum or egg within the wall of the uterus
Induction The process of artificially starting off labour and keeping it going.

Insulin A hormone produced by the pancreas that regulates the level of carbohydrates and amino acids in the system. It may be used as a means of controlling the effects of diabetes.
See also Diabetes.
Internal monitoring See Electronic fetal monitoring
Intravenous drip The infusion of fluids directly into the bloodstream by means of a fine catheter introduced into a vein Intravenous injection An injection into a vein
Invasive techniques Any medical technique that intrudes into the body
In vitro fertilization (IVT) A type of assisted conception where fertilization occurs outside of the womb and fertilized embryos are tranferred back into the womb.
Jaundice, neonatal A common complaint in newborn babies which is caused by the inability of the liver to break down successfully an excess of red blood cells See also Bilirubin
Lanugo The fine soft body hair of the fetus Lateral position Transverse lie or horizontal position of a fetus in the uterus (sometimes occurring if the mother has a large pelvis), where the presenting part is either a shoulder or the side of the head
Let-down reflex The flow of breast milk into the nipple.
Lie The position of the fetus within the uterus Linea nigra A line of dark skin that appears down the centre of the abdomen over the rectus muscle in some women during pregnancy
Lochia Postnatal vaginal discharge Longitudinal lie The position of the fetus in the uterus in which the spines of the fetus and the mother are parallel
Low-birthweight baby A baby who weighs below 2,5 kg (57 lb) at birth.
Meconium The first contents of the bowel, present in the fetus before birth and passed during the first few days after birth The presence of meconium in the amniotic fluid before delivery is usually taken as a sign of fetal distress
Miscarriage The spontaneous loss of a baby before 24 weeks of pregnancy
Monitoring See Electronic fetal monitoring Monozygotic See Twins.
Morula A stage in the growth of the fertilized
egg when it has developed into 32 cells. Moulding The shaping of the bones of the baby’s skull, which overlap to allow the baby to pass through the birth canal.
Mucus A sticky secretion.
Multigravida A woman in her second or subsequent pregnancy
Multiple pregnancy The development of two or more babies, See also Twins Mutation A damaged genetic cell. This can occur naturally or more commonly as an effect of outside agents, such as radiation. Neural tube defects Abnormalities of the central nervous system See also
Anencephaly, Hydrocephalus Spina bifida. Nicotine A highly poisonous substance that is present in tobacco During pregnancy this can enter the bloodstream of a woman who smokes and may affect the efficiency of the placenta, which often results in a lowbirthweight baby
Nucleus The central part or core of a cell, containing genetic information.
Occipital anterior The position of the baby in the uterus when the back of its head (the crown or occiput) is towards the mother’s front (anterior)
Occipital posterior The position of the baby in the uterus when the back of its head (the crown or occiput) is towards the mother’s back (posterior)
Oedema Fluid retention, which causes the body tissues to be puffed out.
Oestriol A form of oestrogen.
Oestrogen A hormone produced by the ovary
Opioids (Narcotics) Painkilling drugs that induce drowsiness and stupor,
Ovary One of the two female glands, set at the entrance of the Fallopian tubes, which regularly produce eggs until the menopause Ovulation The production of a ripe ovum or egg by the ovary
Oxytocin A hormone secreted by the pituitary gland that stimulates uterine contractions during labour and stimulates milk glands in the breasts to produce milk Palpation Feeling the parts of the baby through the mother’s abdominal wall. Pelvic floor The springy muscular
structure set within the pelvis that
supports the bladder and the uterus, and through which the baby descends during tabour,
Pelvis The pelvis is a solid ring of bone at the base of the abdomen: it shields the bladder and portions of the genital tract. Perinatal The period from the 24th week of gestation to one week following delivery Perineum The area of soft tissues surrounding the vagina and between the vagina and the rectum.
Pethidine See Analgesics
Phototherapy Treatment by exposure
to light, which may he used when a baby has jaundice
Pituitary gland A gland set just below the brain that among other functions, secretes various hormones controlling the menstrual cycle. In late pregnancy it releases a hormone, oxytocin, into the bloodstream, which stimulates uterine contractions and also the milk glands.
Placenta The organ that develops on the inner wall of the uterus and supplies the fetus with all its life-supporting requirements and carries waste products to the mother’s system.
Placental insufficiency A condition in which the placenta provides inadequate life support for the fetus, often after 40 weeks, resulting in a baby at special risk.
Placenta praevia A condition in
which the placenta lies over the cervix at the end of pregnancy. This part of the uterus stretches in the last few weeks of pregnancy, but the placenta cannot stretch, so it may separate, the result is bleeding during late pregnancy, A woman with a complete placenta praevia is delivered by Caesarean section
Posterior See Occipito posterior
Postnatal After the birth.
Postpartum After delivery.
Post-traumatic stress disorder Panic and anxiety experienced by some women after traumatic and disempowering childbirth Pre-eclampsia (Pre-eclamptic toxaemia or PET) An illness in which a woman has high blood pressure, oedema, protein in the urine, and often sudden excessive weight gain See also Eclampsia.
Premature A baby born before the 37th week of pregnancy and weighing less than 2.5 Ing (5 lb)
Presentation The position of the fetus in the uterus before and during labour,

lying directly over the cervix
Preterm See Premature
Primigravida A woman having her first pregnancy.
Progesterone A hormone produced by the corpus luteum and then by the placenta Progestogen A synthetic variety of the hormone progesterone used in oral contraceptives.
Prolactin A hormone that stimulates milk production for breastfeeding Prostaglandins Natural substances that stimulate the onset of labour contractions. Prostaglandin gel may be used to soften the cervix and induce labour
Proteinuria The presence of protein in the urine, which may be a sign of pre-eclampsia. See also Pre-eclampsia
PTSD See Post-traumatic stress disorder Pubis The bones forming the front of the lower pelvis.
Quickening The first noticeable movements of the fetus felt by the mother.
Respiratory depression See Depression, respiratory.
Rhesus factor A distinguishing characteristic of the red blood corpuscles. All human beings have either Rhesus positive or Rhesus negative blood If the mother is Rhesus negative and the fetus Rhesus positive, severe complications and Rhesus disease (the destruction of the red corpuscles by antibodies) may occur, unless prevented by anti-D gamma globulin.
Rooting The baby’s instinctive searching for the breast
Rubella (German measles) A mild virus that may cause congenital abnormalities in the fetus if it is contracted by a woman during the first 12 weeks of pregnancy
Scan (Screen) A way of building up a picture of an object by bouncing high-frequency soundwaves off it. The sonar or ultrasound scan is used during pregnancy to show the development of the fetus in the uterus. See also Transducer.
Show A vaginal discharge of bloodstained mucus occurring before labour, resulting from the onset of cervical dilatation. A sign that labour is starting
Small-for-dates Babies who are born at the right time but who for a range of reasons have not flourished in the uterus. See also
Placental insufficiency
Sperm (Spermatozoon) The male reproductive cell that fertilizes the female ovum or egg.
Spina bifida A congenital neural tube defect in which the fetal spinal cord forms incorrectly, outside the spinal column Spinal anaesthesia An injection of local anaesthetic around the spinal cord.
Steroids Drugs used in the treatment of skin disorders, asthma, hay fever, rheumatism, and arthritis. Because they alter the chemical balance of the metabolism they may very rarely cause fetal abnormalities if used extensively during pregnancy
Stillbirth The delivery of a dead baby after the 24th week of pregnancy
Streptomycin A broad-spectrum antibiotic that should not be taken in pregnancy See also Antibiotics
Stretch marks Silvery lines that sometimes appear on the skin after it has been stretched during pregnancy
Supplementary feeding Additional bottles given to a breastfed baby.
Surfactant A creamy fluid that reduces the surface tension of the lungs so that they do not stick together when deflated. Preterm babies may have breathing difficulties if surfactant has not developed sufficiently Suture The stitching together of a tear or a surgical incision.
Syntocinon A synthetic form of
oxytocin, which is used to induce or accelerate labour.
TENS machine See Transcutaneous electronic nerve stimulation
Term The end of pregnancy this is measured at 38-42 weeks from the first day of the last menstrual period. Tetracycline A wide-spectrum class of antibiotic that should be avoided during pregnancy. because it can affect the development of the fetal teeth and hones See also Antibiotics.
Thrombosis A blood clot in the heart or blood vessels.
Thrush A yeast infection that can form in the mucous membranes of the month, genitals, or nipples.
Toxoplasmosis, congenital A parasitic disease that is spread by cat faeces. If it crosses the placenta during pregnancy, it can cause eye or central nervous system damage in the baby
Transcutaneous electronic nerve stimulation A method of pain relief that uses electrical impulses to block pain messages to the brain.
Transducer An instrument that translates echoes of very high-frequency soundwaves bounced off the developing fetus in the uterus to build up an ultrasound image on a monitor. See also Scan.
Transition A phase between the first and second stages of labour when the cervix is dilating to between 7 and 10 cm
Trial of labour A situation in which, although a Caesarean section may be necessary, the mother labours in order to see if a vaginal delivery is possible
Twins The simultaneous development of two babies in the uterus, either after two eggs are fertilized independently by two sperm - dizygotic or fraternal twins - or, more rarely, after one fertilized egg divides to produce monozygotic or identical twins.
Ultrasound See Scan, Transducer.
Umbilical cord The cord connecting the fetus to the placenta
Uterus (Womb) The hollow muscular organ in which the fertilized egg becomes embedded, where it develops into the embryo and then the fetus
Vacuum extractor An instrument, used as an alternative to forceps which adheres to the baby’s scalp by suction and with the help of the mother’s bearing down, can be used to guide the baby out of the vagina
Vagina The canal between the uterus and the external genitals It receives the penis during intercourse and is the passage through which the baby is delivered
VE Vaginal examination.
Vernix A creamy substance that often covers the fetus in the uterus
Vertex presentation (VX) See Cephalic presentation.
Vulva The external part of the female reproductive organs, that includes the labia and the clitoris
Water birth Birth of a baby under water.