Archive for March, 2009
FAMILY MEDICAL CARE: SMOKING IN PREGNANCY
Author: admin
Here we come to a very important topic. Over the past few years, the facts relating to deleterious effects of smoking on both the mother and the unborn baby have gradually accumulated. Now it is very well documented that smoking is considerably harmful. This affects the mother. But the adverse effect is even greater on the baby.
Cigarette smoke contains three essential ingredients.
(1) Carbon Monoxide. When this unites with the blood, it forms a potent chemical called carboxyhaemoglobin. It links with the haemoglobin, the red material of the blood that normally transports oxygen to all parts of the system. In this way, the oxygen-carrying capacity of the blood is drastically reduced. This is one potent way in which cigarette smoke damages the body in general.
But when this oxygen-reduced blood reaches the placenta, and the blood circulation of the growing infant, reduced amounts of oxygen are available for use at the vital centers. Extremely damaging effects can occur, and the results are serious to the infant. Many detailed studies have now been carried out in major maternity hospitals in all parts of the world which testify to the same net effect.
(2) Nicotine. This is a powerful nerve stimulant. But while it is stimulating the nerves, consider what it is doing to the blood vessels. It can act directly on the blood-vessel walls, causing them to contract, and this may initiate a rise in blood pressure. Such a situation in the pregnant state is definitely undesirable. Besides, a net detrimental effect on the heart and blood-vessel system can accrue from a continual supply of nicotine being pumped into the system. It is adverse for the baby to receive this drug also, and this is inevitable with continual maternal smoking. Smoking is never a virtue; during pregnancy it is doubly harmful. No expectant mother who has any consideration for her unborn child will indulge in the habit.
(3) Carcinogenic Agents. These are a complex number of powerful chemicals which are known causes of cancer. During the baby’s nine-month stay inside the maternal womb, the chances of cancer formation are not high. But the continual irritation of the mother’s bronchial system with these irritants does little to maintain the general high level of health which is essential during pregnancy.
So the evidence is definitely very positive, very real. It is no longer a fanciful whim of doctors. Indeed, about 75 per cent of doctors who once smoked have given up the habit. This is due to general consideration of their own better health. Even more important is it that mothers carrying a developing foetus desist from the habit. Please don’t say, “I can’t give it up.” If you care about your baby, you must give it up. Please don’t be controlled by a weed wrapped in paper!
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read comments (0)PREGNANCY: ADVICE AND “ADVICE”
Author: admin
Even in these enlightened days, there is advice and there is “advice.” Good advice can often provide a sound, helpful backdrop for future events, but there is a surprising number of people who seem to recall only the negative side of parenthood. Maybe it is a reflection of their own personalities or of their own personality defects, inner inhibitions and anxieties. But some older women seem to delight in offering “advice” that is not worth having.
They seem to delight in going over the unhappy incidents of their own past adversities in minutest detail. They will describe with intimate detail the pain, the suffering and the agony of their own confinements. They will take great delight in downgrading the doctor, the hospital, the nursing staff, the food, the circumstances. Nothing, it seems, went right. So they will tell and retell to any available ear, of the unhappy event that constituted their obstetric past.
Turn a deaf ear to these Job’s comforters. A closer check will often pinpoint the true source of the problem. It was not the medical attendants, or the unsatisfactory hospital conditions, or the lack of attention in many cases, but their own strange approach to life. Many expected trouble from the start. Maybe they had been adversely programmed by some foolish woman early in their pregnancy, and looked for things to go wrong. In this world, “Seek and you shall find.” This often means bad things as well as good things! Never forget it.
So, try to avoid the troublemakers, and those who seem to find a fiendish glee in unnerving you and throwing unhappiness your way in the guise of offering “sound advice.” Turn away, and steer clear of these Jeremiahs (male and female) from that point forward.
If you have questions, the best idea is to make a note of these day by day. Then, when you attend your doctor for your regular prenatal checks, take the list along with you. Check them off with him one by one. He will give you an honest, experienced, straightforward answer. This is by far the best way of gaining accurate answers to any question you may have in your mind. This applies to any part of your forthcoming confinement or the events occurring during your pregnancy.
So, summing up. Share your happiness with your close friends and those you feel you can trust. Enjoy their encouragement and approval. But go easy on the potential troublemakers. Lastly, stick with the doctor and his advice in most matters.
There are lots of factors that you will need to know. There are certain matters on which you must make a decision. Many of these must be done in consultation with somebody else. But here are some of the chief features that will exercise your mind from an early start.
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FAMILY PLANNING: OTHER METHODS OF CONTRACEPTION
Author: admin
Quite apart from the Pill, several other methods of contraception are also available, and some of these are relatively popular.
Some women do not like the concept of the Pill, believing it has not been around for a sufficient number of years for its true probable long-term effects to be really established. They have horrible forebodings that it may cause cancer later in life, or probably in their next generation. Although there is no basis for this on today’s knowledge, their views are nevertheless appreciated. But the big problem comes when they ask about alternative forms of contraception.
The next most widely practiced method in the Western world is at present the intra-uterine contraceptive device, commonly referred to as the I.U.C.D. or simply I.U.D.
The concept has been around for fifty years or more, and past models, formed mainly of metals, were in use about fifty years ago. The most widely used was the Graafenberg ring, but this fell into disfavour because haemorrhages occurred as well as infections.
But with the advent of the plastics era in the late 1960s, a new form of the I.U.D. suddenly caught on. Plastic is very well tolerated by the body, which tends to shed it far less readily than other substances. Thus the current models were hatched. Some of the early devices were not very satisfactory but many modifications have since taken place. Now, smaller devices, frequently with a fine filament of copper wire wrapped around them, are used with considerable success.
In fact, they have been given the official recommendation in Australia, and most Western countries use them widely. The presence of the device, often shaped like a figure “7,” has several effects. These are enhanced by the copper which gradually is shed into the uterine cavity. Not only does this kill male reproductive cells, but the device itself helps check products of conception from being embedded in the endometrium, the lining of the uterus, which happens in normal pregnancy. In short, pregnancy is prevented in many cases. If it occurs, what many claim is a miscarriage, takes place. Whatever the mechanical reason, the pregnancy rate is reduced, and protection for the woman is greatly augmented.
Some women find it a good idea to use a spermicidal cream or jelly for additional protection at the time when ovulation is due. This is when pregnancy risks are at their peak. It could give the method additional efficacy, and may be worth while in those choosing this form of protection.
It is essential that the device be very accurately and carefully fitted, preferably by a competent gynaecologist. It seems that if not placed in the exact place where it should be, its efficacy wanes considerably.
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MARRIAGE: WHAT ABOUT RELIGION?
Author: admin
Most people have fairly definite ideas about religion. Many find that it fills a positive need in their life. In Western lands, it is customary to follow the Christian faith, although in other countries many other religious sects exist, and the adherents can often teach modern society something about faith and adhering to the principles one claims to believe.
The concept of religion is an ideal one, and modern society has based many of its laws on what are basically Christian principles.
If you are a regular church-attender, it is quite probable that your partner of the future attends the same church group. It is very common for couples to meet initially at church socials, or at church-type schools or colleges. I believe this is a good thing, for at least the two will have a concept of living, ideals and morals approximately the same. This may be vital, and I feel it gives the marriage a firm foundation. The risk of the marriage falling apart is generally far less.
Ideally, church-going couples should belong to the same denomination. It always fills me with some trepidation seeing two from widely differing church beliefs marrying. Trouble lies ahead. In some cases, it can bring families close to dissolution. It may not be for some years, but when the children come along, certain religious groups are adamant that the child be baptized and educated according to their beliefs. This may breed arguments, and rifts are possible.
It is wise to have a firm decision made well before children arrive. Ideally this attitude should be discussed and a decision made even before marriage. It is unwise to wait until trouble could flare up.
Is your partner a committed Christian or merely an “also-ran”? Does he subscribe to church beliefs merely to make you happy (if you are a keen church person yourself)? Or is it really because he too is sincere in his religious beliefs?
Going to church a few times merely to please a future partner will not last. There must be an inherent desire to be involved, to become part of the church scene. Unless this enthusiasm is present, there is not a great chance of changing your partner after marriage. As with most other things, his interest will tend to wane. Other things will take over, and you will find yourself attending church alone.
It is well to remember also that, with the passage of time, people who are interested in religion tend to become more religious. Conversely, those who are not interested in their younger days, tend to grow further away from a religious faith. However, this is not always so. The opposite can occur. Sometimes with advancing years, people tend to reassess themselves. ”What is life all about?” they might ask themselves as they look in the mirror one day while shaving. ”Where am I headed? What is the use? What am I working for? Is there something better to look forward to than just old age and a six by two foot wooden box at the far end? Is there a heaven? Is there a God? Is there something to hope for after I’m dead and buried?”
They might become interested in religion, and find that it has real appeal. There is little doubt that it gives a person something more than physical attributes to live for. I personally believe that religion and the Christian way of life have a lot to offer.
Many thinking, intelligent people accept the Christian philosophy and gain a great deal of spiritual help and guidance from it. After all, Christianity is based on the Biblical concept, and if you want some sensible, clear-cut thinking, simply read the Bible.
The language of the old King James Version may be out of date for many people. However, many modern versions abound, and some of the more recent translations are a delight to read.
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MARRIAGE: BABY’S INBUILT COMPUTER
Author: admin
However, after the initial euphoria has worn off a little, it soon gets down to a fairly regular routine. And routine there must be. Wives and husbands would do well to consider this, and if it has not already been done, work out a sensible, workable timetable. Maybe there will be a reassessment of the “delineation of duties”. Often the husband will have to give added time and attention to duties that once belonged to his wife. Caring for a baby can take time and effort. Breast-feeding (still the best idea, safest and most economical) takes time and effort too. Often wives become very tired particularly with night feeds and the interruptions that inevitably occur during the first year
Many mothers get out of bed an inordinate number of times at night, just to make sure baby is “still breathing.” Fortunately, most are.
However, it is a mistake to overdo the attention factor. Babies have their own little built-in computers too. Very quickly they learn that being nursed is great. Having fuss and attention is also very reassuring. Yelling babies invariably find that soothing, cooing, maternal care will result, so they rapidly learn how to gain attention.
Parents should quickly learn how to control the situation, and not to let the baby start to rule the home. I’ve seen this happen so often I’ve long since stopped thinking it funny or desirable. It is pathetic. A great many women (often first-time mothers) wear themselves to a frazzle by letting the baby take over and rule their lives. In this way, they lose precious sleep, and simply dance attention on their offspring.
It is best for parents to have certain fairly well-planned ideas on baby care. For example, how often have we seen a mother trying to settle the baby down at night, only to see dad walk in (full of exuberance, having told the office all about junior’s latest advances) wake up the child and play with him, overexcite him, and then listen to him yell and carry on for the next several hours because of his overexcited state? When it comes to settling him down when he (dad) thinks it is time to opt out, the baby wants to keep up with the fun and games. So, a vicious circle is easily established.
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PROLAPSE REPAIRS
Author: admin
Aims. To repair the loose or stretched tissues, so that the organs sit where they did originally.
Indications. Women who have symptoms from prolapse of the vaginal walls or uterus.
Symptoms may include a lump, feelings of pressure or dragging, pain, discharge, sexual difficulties, and urinary or bowel problems.
Method. There are different techniques for fixing a prolapse, depending on what is in the wrong place and why. Basically, the operations can include or combine:
• repair of the front or back vaginal wall tissues (anterior or posterior colporrhaphy)
• repair of the perineal (pelvic floor) muscles (perinorrhaphy)
• surgically hitching and securing the uterus in place, rather than relying on stretched ligaments.
Vaginal repair can be performed with hysterectomy, as this will sometimes give a better result than vaginal repair alone.
Complications. The complications common to most surgery (anaesthetic problems, infection, bleeding) could occur, but precautions would be taken to prevent these.
Specific problems which may be encountered include urinary trouble, as the bladder neck (outlet) and the urethra are close to the action when operating. That is why most surgeons would use a urinary catheter to drain the urine away from the bladder for the first few post-operative days.
Because the vaginal skin and surrounding tissues are usually cut and then sewn up again, the sensation to the area may be altered. This may lead to altered sensation during sexual contact. Cut skin usually regains normal sensation within a few months.
One occasional complication of prolapse repair is not really a complication, but the fact that the condition may recur, despite surgery. Removing the potential aggravators, like obesity, straining, coughing, etc., is a way of increasing the likelihood of the operation being successful.
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BREAST CANCER AND THE PILL
Author: admin
One of the more frequent concerns about the oral contraceptive pill (after the rumour that it makes you fat), is that it gives you breast cancer. Unfortunately, sweeping statements like that are difficult to make. There is (and probably always will be) controversy about this issue.
There have been many studies, involving hundreds of thousands of women all over the world, looking at whether the pill is linked to breast cancer. The suggestion that it might be probably arose out of what we know about breast tissue being sensitive to oestrogen and progesterone (the hormones in the pill). We know that some forms of breast cancer have what are called oestrogen receptors, which infers that oestrogen may stimulate that particular tumour.
The studies have individually come out saying ‘there is no association between breast cancer and the pill’, and ‘yes, there is’, and ‘maybe’. The studies we tend to hear about in the media are the ones which show a correlation.
Researchers have now had a look at all the studies which have been done, and have analyzed them. It seems that the vast majority of the studies showed no correlation between the pill and breast cancer. A couple of studies said there could be (they are the ones we heard about).
An interesting observation of one large analytical study suggested that if there was any increased risk of breast cancer, it would be in the younger age group (under 45). There seemed possibly to be a protective effect against breast cancer in the older age groups in women who had used the pill. As the majority of breast cancers occur in older women (77 per cent occur in women over 45 years of age), the overall effect of the pill may be at least neutral for breast cancer, and possibly even protective against it.
There may be cases for avoiding the pill for fear of breast cancer. For instance if a woman has already had a breast cancer diagnosed and treated, most doctors would not suggest she have extra oestrogen in the form of the pill, or hormone replacement therapy if she is menopausal. It is also suggested that women with a very strong family history of breast cancer should also avoid the pill. These women are already at an increased risk of developing the disease, but the effect of added oestrogen is not known, so it is usually not prescribed just in case. However, the particular circumstances of women differ, and these decisions can be examined on an individual basis.
We are constantly making choices about what risks we are prepared to take, for what benefits we may gain. Each person should have the opportunity to make a decision based on accurate information. Unfortunately it is difficult sometimes to work out what is accurate, when we hear so many conflicting views.
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A vasectomy may not be possible with local anaesthetic for any of the following reasons.
• You have had surgery on your scrotum or it has been injured in the past The issue here is that there may be a lot of scar tissue, which would make the vas hard to move. If the vas can’t be moved easily, the procedure would be painful even with a local anaesthetic. It really would be better to have the vasectomy under general anaesthetic in hospital. The doctor will recommend the best procedure for you.
• You are very overweight This can make it hard to feel the vas easily within the scrotum.
• You feel very nervous about having the vasectomy and you really want to have it done under a general anaesthetic.
• Your scrotum has skin that is unusually thick or very tight.
• When you are examined by the doctor it is found that you need to have surgery under general anaesthetic for something else, like repairing a hernia It is usually better to have the vasectomy done at the same time.
• You have a varicose vein in the scrotum. The doctor may be concerned that it might bleed a lot during the procedure.
• You have had a lot of infections in your genital tract in the past. This can also lead to scarring which can make the operation more difficult and painful.
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During your menstrual cycle your cervix produces mucus that changes from dry to wet and stringy, and then back to dry again. When you know what these changes mean, you can tell when you are likely to be fertile, and can avoid having sex at that time.
How do you use the Billings (Mucus) method?
The Mucus method relies on you noticing changes in the mucus at the opening of your vagina every morning when you wake up. You feel just outside the vaginal opening with your finger and notice if you feel wet or dry. If there is any mucus on your finger you can see what it looks like. Depending on what the mucus looks and feels like, you can tell whether you are fertile or not Then you know whether it is safe to have sex that day.
There are three different types of mucus to check for. As soon as your period finishes, your vaginal opening will feel dry, and any mucus will be thick, flaky and sticky. Around the time that you are ovulating, your vagina will feel wet, and the mucus will be clear, watery and stretchy, like egg white. After you ovulate, the mucus will be cloudy, thicker, and sticky again, and your vagina will feel dry around the opening. With this method you can presume you are safe three days after you last feel the slippery wet mucus.
There are several things you must do to use this method as safely as possible. Firstly, in the early part of your cycle before ovulation, you can only have intercourse every second day because if there is any semen from the man in your vagina you would not be able to tell if there is any mucus there. Secondly, you can only have intercourse on a day when you have felt dry in the morning. Thirdly, if you have any bleeding or spotting during the cycle you must treat that as the same as fertile mucus.
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You must take the minipill at the same time every day for it to work effectively. Choose a time that will suit you to take it and take the very first pill at that time on the first day of your period.
The minipill works best to prevent pregnancy between three and 21 hours after you have taken each pill. It’s a good idea to work out the best time to take it so that you will be fully covered if you have sex. If you usually have sex at night, or first thing in the morning, then the best time to take the minipill would be at lunchtime or early in the evening, just swallow the pill with water.
The minipill comes in a pack of 28 pills, so when you’ve finished one pack, start straight away on the next pack. You don’t have any break from taking the pills.
If you are not having periods, for example if you are breastfeeding, and your periods haven’t returned since the baby was born, you can start taking the minipill whenever you like.
Keep on taking the minipill until you decide that you want to use another type of contraception, or you want to get pregnant
What do I do if I miss a minipill? If you miss taking a minipill, take the next pill as soon as you remember it, and take the following pill at the usual time. If you are more than three hours late taking your pill, and you have sex during the next two days you should use condoms, or another form of contraception.
If you miss pills around the time that you have unprotected sex you may want to think about using emergency contraception.
You can ring a Family Planning Centre or your doctor if you feel worried. It’s better to be absolutely sure what to do, than to wait and see what happens.
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