PROBLEMS IN EARLY PREGNANCY

One of the earliest predicaments to confront a woman who has missed one or two periods, involves this all absorbing question, “Am I pregnant?” There are several simple techniques to determine pregnancy with reasonable certainty, right within one’s own home. A suspicion arises when there is a miss of the normal menstrual period. If menses have been regular for several months, then the intuition heightens. Many women have months when they skip the cycle normally. Others have periods too scant to notice. Then the diagnosis of pregnancy becomes more difficult.
Symptoms of pregnancy may be present. You may experience a feeling of nausea, typically in the morning. This is occasionally associated with prolonged vomiting lasting throughout the day. The breasts may swell and become more tender than is usually associated with the premenstrual state. A slight change may occur in the vaginal discharge. Occasionally, a woman who has had previous children just “feels pregnant.” In pregnancy after three to four months, a “lump” may actually be felt above the pubic bone, located in the lower abdomen. This is probably the enlarging womb. By five months gestation it will usually reach to the navel, with an obvious rounded prominence in the lower abdomen. Fetal movements may be sensed at four to four and a half months, though they are sometimes detected earlier by experienced mothers carrying their second or third child.
In most pharmacies today, you can purchase a urine pregnancy test kit. This analysis very simply measures the amount of HCG (Human Chorionic Gonadotropin), a hormone secreted by the developing placenta. A positive test for pregnancy develops within three to six weeks after conception. Use a concentrated morning urine sample for best reliability. If performed according
to directions, these tests are quite dependable in confirming the suspicion of pregnancy.
Vague abdominal pains are sometimes felt in early pregnancy. Pelvic pain may occur from pressure on an enlarged ovary, or from a “tilted” uterus. As it enlarges, the organs become tighter in the pelvis, while the womb has not yet risen into the abdominal cavity. Pain could be related to constipation, or to cystitis. Usually, a bladder infection is characterized by burning combined with a frequent urge to urinate. Stretching of the ligaments that support the uterus may produce pain. In later months, the pressure of a fetal part on a pelvic nerve or a sudden shifting of the baby within the womb may give rise to such symptoms. Usually reassurance is all the patient needs. Severe pain or sudden changes in health status should be called to the attention of a physician immediately, however, since it could be an ectopic (tubal) pregnancy. If this goes unrecognized it could rupture, with internal hemorrhage and potential disaster. Appendicitis may occasionally be superimposed upon pregnancy, requiring early diagnosis and prompt surgical treatment as usual.
Vaginal bleeding sometimes occurs, even after pregnancy begins. Usually this appears scant and transient, but at times it may be profuse. When an actual hemorrhage develops after pregnancy has established, this constitutes an obvious threat of miscarriage. The presence of regular contractions and pelvic pain, combined with vaginal bleeding, should alert to this possibility. At times a miscarriage may occur with the complete passage of the placenta and the subsequent stoppage of bleeding. If incomplete expulsion of the placenta or fetal tissue occurs, a simple operation, called a D and C (dilation and curettage), should be performed, so the bleeding will stop and the uterus can return to its normal size. Fever in the presence of a miscarriage is a more ominous sign, as it probably indicates the presence of pelvic infection.
For treatment of threatened miscarriage, bed rest is always advisable. The absence of straining, standing, or moving about lessens the flow and usually decreases the likelihood of a miscarriage. Sexual intercourse should be avoided in early pregnancy, particularly near the times when a menstrual period would otherwise occur. Uterine cramping and the likelihood of miscarriage is greater at these cycles, for reasons yet unknown. Hormones are no longer given routinely to mothers threatened with miscarriage. They are powerless to stop the inevitable. Furthermore, progesterone concentrates may cause damage to the fetus, if it is carried to term. Scientists believe that many spontaneous miscarriages are the result of some chromosomal defect, which
otherwise would have led to congenital deformity. They are eliminated by nature before the pregnancy goes too far. This is of considerable consolation to parents, suddenly disappointed by the premature loss of a long-looked-for baby. Most couples can wait a few months, then try again.
One of the more troublesome conditions of early pregnancy, sometimes lasting for months, is an upset stomach. Called “morning sickness,” for obvious reasons, nausea and vomiting tends to herald the onset of pregnancy. Although only a few ladies find it incapacitating, these symptoms tend to hinder proper nourishment, so important in the early months of pregnancy. This nausea may last throughout the day. On the other hand, it may be relieved by eating some crackers or other form of dry food. Frequently, the appetite completely changes, and the “lady-in-waiting” craves foods that were formerly disliked. In extreme cases this so-called pica (abnormal craving) is manifested by the “clay eating” habit of southerners, or the strange love for “pickles and ice cream” that ordinarily seems like a repulsive combination.
Mothers need to be careful that their appetites are controlled by reason when such cravings become abnormal. Where vomiting in pregnancy becomes persistent, hospitalization may prove necessary. One or two days of intravenous feedings is normally sufficient to bring back a normal digestion once again. Emotional contributions to this gastric problem are frequent. These can be related to ambivalence about being pregnant, or an underlying temperament of nervousness manifested in an unusually sensitive stomach. Nevertheless, the physiologic and hormonal changes that occur are profound. Such endocrine considerations may well explain these early digestive symptoms. A tolerance for food usually emerges by the fourth month, enabling a normal digestive tone to continue for the remainder of pregnancy.
Adequate fluid intake is vitally important from the start. It is suspected that the common, insufficient intake of water is one principal cause of persistent nausea and vomiting. Drink at least six to eight glasses of water per day, at whatever temperature is best tolerated by the sensitive stomach. If the mother avoids soups and creamed mixtures, and chews thoroughly a rather dry meal of whole grain crackers, breakfast cereals, or raw vegetables, her food will stay down better and permit the best nutrition at this critical stage. Vaginal discharge is often troublesome during the latter months of pregnancy. This may be due to the parasite Trichomonas, but is more commonly caused by a buildup of yeast or Monilia (Candida albicans).
Hormone changes combined with increased perineal moisture and warmth, create an environment favorable to the growth of these organisms. Diabetes mellitus, particularly aggravates the tendency to develop yeast infections.
Administration of hormones such as the birth control pill may produce a diabetes-like state in non-pregnant women. However, pregnancy increases this trend. Nylon underwear, panty hose, and tight slacks tend to increase the propensity for vaginitis. This is because greater warmth and moisture are produced in the perineum when one wears those synthetic fabric materials. Air circulation around the body and “breathing” of the skin is impeded. Then it leads to the rapid multiplication of yeast germs with such unpleasant symptoms as discharge, burning, itching, and skin rash. Gentle vaginal douches, with a dilute vinegar solution (one tablespoon of white vinegar to one quart of warm water) can help decrease the discharge and restore normal acidity to the birth canal. Specific agents are available to help in acute stages (such as Massingill products). However, the intestinal tract always harbors these germs, so it is impossible to completely escape from them. Therefore,you will find it preferable to build up resistance and let improved health of the body create its own defense. Marital relations should be avoided, not only when discharge or infection is present, but during any time of spotting or uterine cramping. Moreover, for at least four to six weeks prior to the birth of the baby, intimate relations should likewise be curtailed, since a significantly increased risk of infection in the amniotic fluid surrounding the baby has been linked to intercourse at this stage. Sexual continence at this critical time will be rewarded with better health, as well as peace of mind.

BREAST FEEDING

Many benefits transpire from choosing nature’s method for infant feeding. Popularized by the La Leche League in a book called The Womanly Art of Breast Feeding, this routine is finding increasing acceptance among educated mothers and the thinking classes of society. Many scientific facts have amplified our understanding of the superiority for breast feeding over formula. In spite of infant formula propaganda, motivated by economic considerations, human milk and cow’s milk are very dissimilar. Only the water and lactose (milk sugar) contents resemble each other. The protein is different, with amino acid ratios that are quite distinct. Much less phenylalanine (a factor in the PKU syndrome, called phenylketonuria) is present in breast milk. The principal protein of cow’ s milk is beta- Lactoglobulin, while those of human milk are lysozyme and lactoferrin. The casein in the two milks are quite different. Fat content, cholesterol levels, and vitamins are likewise dissimilar.
Although technological tinkering has modified cow’s milk to make it less inappropriate for the human baby, hindsight proves the story of formula production to be a procession of errors. Additions and subtractions of Vitamin B6, Vitamin E, protein, sodium, and other substances have occurred. Various additives are employed in baby formulas, such as emulsifiers, thickening agents, and antioxidants. Although these are known not to be essential for nutrition, they seem for the most part to be lacking in normal breast milk.
Breast feeding affords considerable protection against infection, particularly the diarrheal diseases. Lack of cleanliness and contamination of bottles and formulas has produced a high mortality in developing nations where bottle feeding was introduced. Human milk is, moreover, rich in a wide range of “host resistance factors.” It contains Immunoglobulin A, which protects against a number of infections. Lysozyme, an enzyme particularly effective against viruses and bacteria, is rich in milk from the baby’s own mother. Factors that regulate the micro-organisms in the intestinal tract, as well as white blood cells (called macrophages), are there to combat diseaseproducing germs in the intestinal tract. A breast-fed baby develops a flora primarily of Lactobacilli, much different and more harmless than the normal germs resident in the intestine of a bottle-fed baby. Cow’s milk protein is the most common food allergen in infancy. About 1% of bottle-fed babies are affected by allergies to cow’s milk. These foreign cow (bovine) proteins enter the body through the relatively “open” young intestinal wall. In later childhood and adult life, these foreign proteins are normally broken down. However, in early infancy they are absorbed intact.
Breast feeding and the avoidance of semisolid foods—particularly eggs, meat, and wheat—until four to six months of age is considered the best protection against food allergies in infancy. Child spacing is relatively successful when the baby is breast fed full time. When the baby is totally nourished from his or her mother’s breast the menstrual period ordinarily does not return until at least six months after birth. A hormone called prolactin is secreted by the pituitary gland. This inhibits the onset of mother’s menstrual cycle. World estimates indicate that “lactation amenorrhea” has a larger statistical effect on large scale birth control than any other available contraceptive program! Breast feeding in Western cultures consists of a limited number of feedings, usually only in the daytime. Often the early use of solid foods will negate further this protective effect, explaining why many breast-feeding mothers become pregnant within the first year. Breast feeding has great economic implications. In all communities this form of nourishment conserves resources. Not only concerning the ingredients used in cow’s milk formulas, but also in canning tins and bottles, energy is consumed in production. Formula manufacturers have turned largely to the third world to promote their wares today. Sales personnel, dressed in white uniforms (milk nurses), enter the hospitals to give free packages of their artificial nutrition to mothers as they are about to leave. When mothers finally realize that they can neither afford the formula, or that it is unavailable, their breasts have already dried up. Then, thousands of babies lose their lives. One most important benefit of breast feeding, however, prevails in the emotional realm. An intense attachment between the mother and her infant was shown to be related to early contact. Called “bonding,” this occurrence is most significant during the first twenty four hours of life. Maladjustment developing later in the child, may be traced to the absence of this “mother— baby interaction” within the first few days after birth. Closer contact is more likely to occur when the mother breast feeds. She holds the baby more, cuddles it more, and is less likely, according to a number of surveys, to abuse the child physically subsequently.
In summary, then, we realize that there are many rewards to a natural birth and a natural feeding program. Whether the baby is born in a hospital or at home, reared on a farm or in the city, fed at the mother’ s breast or cradled at her side, both parents and babies will find happiness, health, and security in these simple, natural, satisfying approaches to parenthood.

HOME DELIVERIES (part two)

The newborn baby needs immediate care once the cord has been divided. He or she should be wrapped in warm dry blankets, and the head gently covered. A small cap made of stockinette helps to prevent heat loss from the scalp as well as the baby’s body. Prompt breathing and rapid delivery of oxygen to the tissues are enhanced when the newborn is kept warm. If the home is unusually cold, the child should be placed “skin-to-skin” upon the mother. Then, both should be wrapped in a blanket. The use of insulating “aluminum foil” may be helpful, but in such cases monitor the child’s temperature frequently with a thermometer to prevent overheating. Some newborns enjoy the experience of suckling, and will lay at their mother’s side to nurse for several minutes. A newborn baby who has been delivered with minimal trauma will have its eyes open, looking around. He or she may recognize the mother and “imprint” her image in their mind within hours after birth. This “bonding” is very important for the mother-and-child interaction, often conditioned by the immediate experience of the postpartum period.
Several emergency situations should be kept in mind. Their possibility, although rare, may require immediate intervention. The prolapse of the umbilical cord is one urgent complication. If the umbilical cord appears before the baby has been delivered, emergency rescue measures may help to save the infant’ s life. The head should be firmly pushed back into the birth canal, to prevent its pressing tightly against the cord, and thus obstructing the flow of blood to the baby. Usually a Cesarean section is indicated in such cases. If performed soon enough, surgery may save the life of the child.
Breech delivery sometimes presents unexpectedly. Either a foot, both feet, or the rump of the baby will appear at the opening of the birth canal. If this was the first pregnancy, the baby is particularly in danger. Ignorance concerning the size of the “aftercoming” head leads most physicians in a hospital setting to do a Cesarean section on the mother whose firstborn baby is a breech presentation. However, if the mother has delivered previous children, this baby could be delivered with the feet grasped and held by an assistant, elevated above the mother’s abdomen. Then, the baby is rotated so that the head can be delivered face down. Exert a gentle pulling with a finger in the baby’s mouth. When its chin appears at the entrance of the birth canal, help to deliver the head with minimal trauma. At times, premature babies come unanticipated in the home. They are particularly sensitive to heat loss, and should be kept very warm and close to the mother. Usually the tiniest ones are unable to suck well and must be tube fed. With practiced skill, this small feeding tube can be placed in the baby’ s stomach with each feeding. Give a small amount of breast milk for nourishment every two or three hours. Most premature infants should be cared for in a hospital with facilities for newborn intensive care.
Hemorrhage involving the mother is a serious emergency. Usually, this will occur immediately after the birth of the baby or within the first few hours. When the blood flow is bright red, there exists the possibility of an overlooked laceration. Look for it carefully. Pressure may help stop the bleeding until the patient can be transported to an emergency room. If there is no laceration, then the bleeding usually originates from the uterus. Firmly massage the softened dome of the uterus immediately, while applying an ice pack to the lower abdomen. This may help the uterus to contract. Place the infant at her breast to nurse and stimulate the release of oxytocin. This hormone aids in uterine contraction and shrinkage (involution). However, if bleeding is not immediately controlled, the mother should quickly be taken for emergency care. Blood transfusions and medications designed to contract the womb may be lifesaving.
Fever occurring immediately before or after childbirth may be ominous. It may indicate infection in the bladder, particularly if a catheter has been used. Occasionally, fever may be due to unrelated conditions, such as influenza or respiratory illness. However, it could emanate from infection of the womb itself. Urgent treatment may help to prevent blood poisoning and serious complications. Cooling measures, such as the hot blanket pack, will open the pores. On the other hand, a dripping wet sheet for evaporative cooling may be beneficial. Maintain careful records of the delivery, including the weight of the newborn, and the time and date of birth. Birth certificates may in most states be filed and signed by the individual who attended at the delivery, whether they are husband, friend, nurse-midwife, or physician. A drop of antibiotic ointment or 1% silver nitrate solution should be put in each eye of the newborn baby, required by state law to prevent gonorrhea infection.
After a brief rest the mother should walk, go to the bathroom, and take a shower if she feels able. Early physical activity after the delivery of a baby will enable her to gain strength as soon as possible. Exercise also helps to prevent complication such as venous clots (thrombosis), that formerly were common with prolonged bed rest. Textbooks of maternity nursing and midwifery describe in more detail the equipment needed for a home delivery and the most efficient setup of the bedroom.

HOME DELIVERIES (part one)

In European countries most babies are delivered at home. Until recent years in the United States, the same custom was true. Among idealistic college youth, natural living enthusiasts, and those with no insurance, home delivery still holds an attraction. Midwives and occasionally physicians usually attend these patients. Husbands, wives, nurses, and family physicians should
all become acquainted with the techniques of a home delivery. Either through planning or in an emergency, this knowledge may prove most useful.
First in importance is the recognition of labor. For several weeks prior to delivery there may be painless, irregularly spaced contractions. These so - called Braxton—Hicks contractions serve to firm up the uterus and, as it were, “prime” it for the main event. The baby typically “drops” several weeks before labor is to begin, as the head descends into the pelvis, creating a “lightening” sensation. Slight cervical dilation then follows, with increased secretion of mucus—like discharge.
When labor actually ensues, however, one of three changes heralds its onset. The loss of the mucus plug, at times coated with blood (bloody show), may coincide with the onset of labor. Second, the cervix begins to thin (called effacement) and dilate. Regular contractions then commence, usually coming every eight to ten minutes, lasting at least sixty seconds. They then increase in frequency, becoming quite intense. Labor contractions located in the low back may be extremely painful. They are commonly associated with an “occiput posterior” delivery. In this more challenging type of labor, the back of the head orients toward the mother’ s back, making passage through the birth canal during labor more difficult. The “bag of waters” (amniotic sac) may burst, causing a sudden flood of warm clear fluid. Occasionally, the escape of urine or a vaginal discharge may mimic the breaking of the water. This must be tested with pH paper (litmus or nitrazine). The amniotic fluid is always alkaline, turning nitrazine paper blue. When labor initiates itself by the breaking “bag of water,” it normally proceeds faster. In fact, it is important for the delivery to be accomplished within twenty-four hours after the water breaks, to lessen any risk of infection in the mother’s womb.
Labor usually progresses steadily through three distinct stages. The first stage consists of progressive cervical dilation and thinning (effacement). When the cervix is completely dilated, the opening is 10 cm. in diameter, the average diameter of a baby’s head. The second stage of labor begins when the head passes through the completely dilated cervix, and descends into the birth canal (vagina). The first appearance of the baby’ s head between the labia is called crowning. Progressive dilation of the vulva then occurs, requiring special self-control on the part of the mother. Periodic panting with each contraction, helps to avoid pushing the baby out too fast, thus preventing laceration of either vagina or cervix. If all goes smoothly at this point, the baby enters the world into the waiting hands of an attendant midwife or physician.
Your first maneuver, after the baby’ s head emerges, should be to clear its mouth and nose of mucus. A rubber suction bulb works excellently for this purpose. Clearing the airway of mucus should be performed thoroughly, with the baby’s head in a downward position (for a normal ‘‘face down” delivery).
Quickly check the baby’s neck for the umbilical cord. If a loop of the cord is discovered, slip it gently over the head to make the delivery of the shoulders and trunk easier. This helps prevent its strangling the baby, or accidentally tearing the cord. A hemorrhage would then result, depleting the baby of its precious blood. The upper shoulder of the infant is usually delivered first, followed by the lower. Finally, the rest of the body slips out easily. Continue holding the baby in a head down position, and suction the mouth and nose again. Wait “patiently” for the first cry and a few deep breaths that ventilate the lungs and bring a healthy pink color to the newborn body. The pulsing umbilical cord should be left alone for a minute or two, to allow further blood flow from the placenta into the baby. This acts as a mild “transfusion” to give the baby some of its own blood, which would otherwise be lost. “Stripping” the cord of its blood in this fashion retards the later development of anemia, commonly seen in babies a few months old. When the cord quits pulsating, it can be tied or clamped. In a normal home-like setting it is convenient to boil a clean white shoelace, and use this to tie the cord. About ¼ to ½ inch from the skin of the navel, tie the cord securely, with care taken to avoid pulling or traumatizing the umbilicus. Place two ties about an inch apart, the second one being further from the baby than the first tie. Then use a pair of sterilized scissors to cut between the cord ties. The third stage of labor involves the delivery of the placenta. The “afterbirth” follows within five to forty five minutes, and usually separates on its own accord with no manipulation required. If necessary, use your hand to gently massage the uterus. Another “push” on the mother’s part, and the placenta comes easily.
The uterus should again be massaged carefully. The baby can be positioned to nurse at mother’s breast. This enables both hormonal and neural mechanisms to contract the uterus and lessen the likelihood of hemorrhage. Periodically, for the next hour massage the uterus to keep it firm and
minimize bleeding. If there has been a laceration of the perineum during the delivery, it should be carefully inspected. If the tear is extremely small and not bleeding, it may be allowed to seal by merely lying still with the mother’s legs together for a few hours. All deeper lacerations, particularly those involving the muscle of the rectal sphincter should be sutured. Even if this means a trip to the emergency room or doctor’s office, it should be repaired, so complete healing
will occur. Then the rectum and birth canal will not lose their normal anatomic relationships, leading to incontinence or discharge. One most important qualification for a successful nurse-midwife is the ability to remain calm under pressure. The delivery of a baby is an exciting
time. All the attendants should continually remain alert, interested, and composed. Encouragement to the mother during the strenuous pushing stage can make all the difference between a successful home delivery and one that needs obstetrical assistance in a hospital. The use of forceps can often be avoided if mothers receive the proper coaching and encouragement during this labor stage. Patience in waiting for the placenta will likewise be rewarded. Although excited viewers may request to take pictures, it is much more important to attend to the physical needs of the newborn than obtain a few precious snapshots.

PRENATAL CARE

Before your baby arrives, a great deal of care needs to be maintained to preserve the your best health. Although pregnancy is a normal physiologic event, many physicians treat it as a disease, and attempt to control too closely the behavior of the mother. Most women, however, can be taught the basics of hygiene during pregnancy. That means taking take responsibility for your own health.
During the monthly visits a pregnant lady makes to her midwife or physician, she will have a urine test for protein and sugar. Sugar in the urine raises a suspicion of diabetes. The diabetic mother is at increased risk during pregnancy, and has a greater likelihood of difficult labor, due to the predictably excessive size of her baby. Blood incompatibilities and hemorrhagic problems are more severe in a baby born to a diabetic mother. In addition, the stability of a mother’s diabetes is greatly influenced by her pregnancy. It could even trigger the death of a baby in utero, or a miscarriage, if care is not taken to control the diabetes with appropriate levels of insulin. Still, one can perform the simple test for urine sugar right in the home with commonly available strips of Tes Tape or Clinitest tablets, available at any pharmacy.
Toxemia in pregnancy has several facets. With the mother’s excessive accumulation of body tissue, fluid overload becomes generalized edema. Her weight may go up several pounds within a few days, creating puffiness not only in the ankles, but the hands, eyes, and occasionally her entire body. Along with this dilemma, the kidneys show signs of damage, losing large amounts of protein. A simple dip—stick urine test for protein may show 2+, 3+, or 4+ protein, implying heavy losses of this important substance. Third, the blood pressure rises, frequently producing symptoms of headache, painful pressure behind the eyes, or outright nosebleed. When these three manifestations of toxemia (hypertension, proteinuria, edema) occur late in pregnancy, it is crucial to evaluate the reflexes. Tap gently, for example, with the doctor’s little hammer on the tendon just below your knee. Then, for preventive treatment, secure a calm, quiet environment, strictly limit your salt intake, and eat adequate protein to replace the heavy losses. Prolonged bed rest in a darkened room is occasionally prudent to prevent external stimuli that could trigger seizures. Convulsions are the most frequent cause of death (for mother and child) when toxemia develops. This grave complication should be prevented, whenever possible. Modern management with I.V. administration of magnesium sulfate (Epsom salts) prevents most serious and life-threatening convulsions that could occur without warning.
For many timely reasons, during every pregnancy I recommend the routine measurement of weight and blood pressure on a monthly basis. Mothers, be sure to limit weight gain during pregnancy to approximately twenty five to thirty pounds. Extreme austerity in diet is not necessary, but neither is overindulgence and its resulting obesity a boon. Mothers who later breast feed their infants, find their weight returning to normal much sooner.
Nursing helps because it utilizes significant numbers of stored calories to manufacture milk. As a general rule, very little weight gain is advisable during the first three months of pregnancy, about two pounds per month in the second trimester, and one pound or more per week during the final three months. This adequacy of weight gain provides for a mother’s and child’s needs with plenty of nutrients that will build bone and blood, muscle and connective tissue. Even more importantly, good nutrition promotes health to the nervous system and brain of each developing fetus. Proper diet for every pregnant mother is vital. You should strictly avoid all use of alcoholic beverages, because of their toxic effect on your baby. Moreover, beverage alcohol sabotages your brain and will power. Tobacco should also be eliminated, for numerous reasons mentioned above. Coffee and tea are unnecessary, as every pregnant mother needs a calm environment without stimulants or any chemical that would weaken the nervous system.
Recent research shows caffeine definitely harmful to the unborn child, capable of transmitting a legacy of irritability to the high—risk offspring.

PROBLEMS IN EARLY PREGNANCY part 2

Vaginal bleeding sometimes occurs, even after pregnancy begins. Usually this appears scant and transient, but at times it may be profuse. When an actual hemorrhage develops after pregnancy has established, this constitutes an obvious threat of miscarriage. The presence of regular contractions and pelvic pain, combined with vaginal bleeding, should alert to this possibility. At times a miscarriage may occur with the complete passage of the placenta and the subsequent stoppage of bleeding. If incomplete expulsion of the placenta or fetal tissue occurs, a simple operation, called a D and C (dilation and curettage), should be performed, so the bleeding will stop and the uterus can return to its normal size. Fever in the presence of a miscarriage is a more ominous sign, as it probably indicates the presence of pelvic infection.
For treatment of threatened miscarriage, bed rest is always advisable. The absence of straining, standing, or moving about lessens the flow and usually decreases the likelihood of a miscarriage. Sexual intercourse should be avoided in early pregnancy, particularly near the times when a menstrual period would otherwise occur. Uterine cramping and the likelihood of miscarriage is greater at these cycles, for reasons yet unknown. Hormones are no longer given routinely to mothers threatened with miscarriage. They are powerless to stop the inevitable. Furthermore, progesterone concentrates may cause damage to the fetus, if it is carried to term. Scientists believe that many spontaneous miscarriages are the result of some chromosomal defect, which otherwise would have led to congenital deformity. They are eliminated by nature before the pregnancy goes too far. This is of considerable consolation to parents, suddenly disappointed by the premature loss of a long-looked-for baby. Most couples can wait a few months, then try again. One of the more troublesome conditions of early pregnancy, sometimes lasting for months, is an upset stomach. Called “morning sickness,” for obvious reasons, nausea and vomiting tends to herald the onset of pregnancy.
Although only a few ladies find it incapacitating, these symptoms tend to hinder proper nourishment, so important in the early months of pregnancy. This nausea may last throughout the day. On the other hand, it may be relieved by eating some crackers or other form of dry food. Frequently, the appetite completely changes, and the “lady-in-waiting” craves foods that were formerly disliked. In extreme cases this so-called pica (abnormal craving) is manifested by the “clay eating” habit of southerners, or the strange love for “pickles and ice cream” that ordinarily seems like a repulsive combination.
Mothers need to be careful that their appetites are controlled by reason when such cravings become abnormal. Where vomiting in pregnancy becomes persistent, hospitalization may prove necessary. One or two days of intravenous feedings is normally sufficient to bring back a normal digestion once again. Emotional contributions to this gastric problem are frequent. These can be related to ambivalence about being pregnant, or an underlying temperament of nervousness manifested in an unusually sensitive stomach. Nevertheless, the physiologic and hormonal changes that occur are profound. Such endocrine considerations may well explain these early digestive symptoms. A tolerance for food usually emerges by the fourth month, enabling a normal digestive tone to continue for the remainder of pregnancy.
Adequate fluid intake is vitally important from the start. It is suspected that the common, insufficient intake of water is one principal cause of persistent nausea and vomiting. Drink at least six to eight glasses of water per day, at whatever temperature is best tolerated by the sensitive stomach. If the mother avoids soups and creamed mixtures, and chews thoroughly a rather dry meal of whole grain crackers, breakfast cereals, or raw vegetables, her food will stay down better and permit the best nutrition at this critical stage.
Vaginal discharge is often troublesome during the latter months of pregnancy. This may be due to the parasite Trichomonas, but is more commonly caused by a buildup of yeast or Monilia (Candida albicans). Hormone changes combined with increased perineal moisture and warmth, create an environment favorable to the growth of these organisms. Diabetes mellitus, particularly aggravates the tendency to develop yeast infections. Administration of hormones such as the birth control pill may produce a diabetes-like state in non-pregnant women. However, pregnancy increases this trend. Nylon underwear, panty hose, and tight slacks tend to increase the propensity for vaginitis. This is because greater warmth and moisture are produced in the perineum when one wears those synthetic fabric materials. Air circulation around the body and “breathing” of the skin is impeded. Then it leads to the rapid multiplication of yeast germs with such unpleasant symptoms as discharge, burning, itching, and skin rash. Gentle vaginal douches, with a dilute vinegar solution (one tablespoon of white vinegar to one quart of warm water) can help decrease the discharge and restore normal acidity to the birth canal. Specific agents are available to help in acute stages (such as Massingill products). However, the intestinal tract always harbors these germs, so it is impossible to completely escape from them. Therefore, you will find it preferable to build up resistance and let improved health of the body create its own defense. Marital relations should be avoided, not only when discharge or infection
is present, but during any time of spotting or uterine cramping. Moreover, for at least four to six weeks prior to the birth of the baby, intimate relations should likewise be curtailed, since a significantly increased risk of infection in the amniotic fluid surrounding the baby has been linked to intercourse at this stage. Sexual continence at this critical time will be rewarded with better health, as well as peace of mind.

PROBLEMS IN EARLY PREGNANCY part 1

One of the earliest predicaments to confront a woman who has missed one or two periods, involves this all absorbing question, “Am I pregnant?” There are several simple techniques to determine pregnancy with reasonable certainty, right within one’s own home. A suspicion arises when there is a miss of the normal menstrual period. If menses have been regular for several months, then the intuition heightens. Many women have months when they skip the cycle normally. Others have periods too scant to notice. Then the diagnosis of pregnancy becomes more difficult.
Symptoms of pregnancy may be present. You may experience a feeling of nausea, typically in the morning. This is occasionally associated with prolonged vomiting lasting throughout the day. The breasts may swell and become more tender than is usually associated with the premenstrual state. A slight change may occur in the vaginal discharge. Occasionally, a woman who has had previous children just “feels pregnant.” In pregnancy after three to four months, a “lump” may actually be felt above the pubic bone, located in the lower abdomen. This is probably the enlarging womb. By five months gestation it will usually reach to the navel, with an obvious rounded prominence in the lower abdomen. Fetal movements may be sensed at four to four and a half months, though they are sometimes detected earlier by experienced mothers carrying their second or third child.
In most pharmacies today, you can purchase a urine pregnancy test kit. This analysis very simply measures the amount of HCG (Human Chorionic Gonadotropin), a hormone secreted by the developing placenta. A positive test for pregnancy develops within three to six weeks after conception. Use a concentrated morning urine sample for best reliability. If performed according to directions, these tests are quite dependable in confirming the suspicion of pregnancy.
Vague abdominal pains are sometimes felt in early pregnancy. Pelvic pain may occur from pressure on an enlarged ovary, or from a “tilted” uterus. As it enlarges, the organs become tighter in the pelvis, while the womb has not yet risen into the abdominal cavity. Pain could be related to constipation, or to cystitis. Usually, a bladder infection is characterized by burning combined with a frequent urge to urinate. Stretching of the ligaments that support the uterus may produce pain. In later months, the pressure of a fetal part on a pelvic nerve or a sudden shifting of the baby within the womb may give rise to such symptoms. Usually reassurance is all the patient needs. Severe pain or sudden changes in health status should be called to the attention of a physician immediately, however, since it could be an ectopic (tubal) pregnancy. If this goes unrecognized it could rupture, with internal hemorrhage and potential disaster. Appendicitis may occasionally be superimposed upon pregnancy, requiring early diagnosis and prompt surgical treatment as usual.

Teenagers Now Susceptible to Heart Disease

Nutritional biochemist, famous Dr. T. Colin Campbell of Cornell University has found that one out of two children born today will develop heart disease, and a new study from the American Heart Association Scientific Sessions (http://www.americanheart.org/), shows that heart disease actually begins developing early in childhood. Fatty deposits in the coronary arteries begin appearing by the age of 3, in children who partake in a typical American diet -processed foods laden with fats. By the age of 12, nearly 70% of our children have advanced fatty deposits, and by the age of 21, early stages of heart disease is evident in virtually all young adults! Dr. John Knowles, of the Rockefeller Foundation, has cited that 99% of all children are born healthy, yet are made sick as a result of their eating habits. The tender years of childhood should be the healthiest of all, bones are strong, hair is thick, liver and endocrine glands are functioning to full capacity, and they should have inexhaustible energy; yet, their bodies are being fed hamburgers full of steroids, antibiotics, hormones and chemicals; milk that is often indigestible which can cause ear aches, colds, allergies, asthma and lots of health problems. The latest studies find “adult” diseases are related to what we eat throughout our early years in life. In fact, 95% of coronary disease can be prevented by implementing healthier eating habits earlier in life - reducing dietary fat and consuming more fresh vegetables, fruits and natural complex carbohydrates such as whole grains is very important. Prevention is important - reward your child for good behavior with fresh fruits, instead of sugary processed candies; establish healthy eating habits before any damage to their health occurs.

Fun Games to Play with Your Children

One of our readers wrote in to remind parents that “children don’t always need the big things. They tend to remember the little things like books you read together, games you play, and trips to the zoo.” We think this is excellent advice! Here are some ideas for “little things” that
you can do with your child, one on one:
One to Three Months
Fly, baby, fly: Sit on the floor with your baby facing you. Support her body and head with your hands. Say, “Are you ready to fly? Wheee!!” Lift your baby as you gently roll onto your back. As you lie down, hold your baby in the air.
Follow the bee: Hold your baby comfortably. Place your finger in front of her eyes while making a buzzing sound. Move your finger around in the air. Your baby’s eyes should follow your “bee.” Next, take your baby’s finger and move it around with a buzzing sound; land the “bee” on your cheek ornose.
Elevator: Lie on your back and lift your baby up over you. Say, “I’m going to kiss you!” while you lower her down and give her a kiss. Bouncing rides: Place your baby on your lap and hold her under her arms. Move forward until you’re at the edge of the seat, then raise and lower your heels to give her a gentle bounce. Reciting rhymes while you do this will add to the fun and encourage language development.
Four to Seven Months
Balance game: Stand your baby on a bed while supporting her trunk, and gently bounce her on the mattress.
One, two, three!: Babies love to anticipate movement, so this is a favorite. Hold your baby’s hands while she’s lying down and say, “Are you ready to stand up? Here we go . . . one, two, three!” while pulling her up gently.
Balls and push toys: As your baby becomes more mobile, she’ll be more interested in objects that move, such as balls and toys with wheels. Remember to remove these once she’s trying to pull herself up to a sitting or standing position.
Food painting: Place some pureed food or pudding on your baby’s highchair tray, and let her “finger paint” with it. It’s messy, but it’s a lot of fun for your baby.
Peekaboo: This old standby will delight your baby, with her budding understanding that even when an object or person is covered, it still exists (a concept called object permanence). Cover your face with your hands, then remove your hands and say, “Peekaboo, I see you!”
Eight to Twelve Months
This little piggy, itsy-bitsy spider, and pop goes the weasel: Babies love to learn these nursery rhymes and anticipate the accompanying movements.
One, two, buckle my shoe: This counting rhyme is ideally suited for climbing up and down stairs.
Hide-and-seek: This game exploits your baby’s understanding of object and person permanence. Hide your baby’s toys—or yourself—and encourage her to seek.