Delivery Mehods – Forceps Delivery and Breech Delivery

Posted on January 12, 2010 by steven

Forceps Delivery

This delivery methds is infrequently used because of the position of the baby or weak labor or other reasons, spontaneous delivery of the baby may not be possible or would be unnecessarily protracted, Forceps may be necessary. These are instruments with cuplike blades which are used with some form of anesthesia.

The use of forceps has greatly advanced the art of obstetrics. These extracting instruments were introduced by the Chamberlen family in the seventeenth century and kept a family secret for over one hundred years. Not until 1726 were forceps generally introduced into obstetrical practice in England.

There are many types of forceps, depending on their uses. For instance, there are forceps for turning the baby’s head if it is pointed in a wrong direction. The head may be rotated and delivered in the normal position. If the baby is in imminent danger, with poor heart action or extruding a great deal of stool (meconium), or if there is massive bleeding, labor can be promptly terminated by the use of forceps. There are circumstances in which forceps are not advisable – if the baby’s head is too big for the mother, if the baby is very high, or immediate delivery is necessary. In such circumstances, cesarean section is a safer means of delivery.

Breech Delivery

In three or four of a hundred deliveries, the baby’s buttocks instead of the head will be present at the birth canal. When this condition is noted by the obstetrician, x-ray pelvimetry is done to determine if the mother’s pelvis is of adequate size. If not, cesarean section is done before labor begins.

Labor in breech is usually longer than “headfirst” delivery. Usually the membranes are kept intact as long as possible to act as a wedge to dilate the cervix. There is a longer stage of pushing by the mother to bring the buttock down. Generally a large episiotomy is performed as soon as the buttock shows at the entrance to the vagina. As soon as the buttocks and extremities are delivered the patient is anesthetized and the trunk, upper extremities, and head are delivered.

The head may be born by pressure by the obstetrician on the inside of the baby’s mouth, pressure by the nurse from above on the abdomen, pushing the head down and through the vagina, or special forceps applied to the head. If labor is slow and progress unsatisfactory in a breech presentation, or if the umbilical cord should protrude, or if the pelvis is too small, cesarean section is done.

Induction of labor (artificial stimulation of labor before it starts naturally) is sometimes necessary for medical reasons such as Rh sensitivity or diabetes.

Induction may also be done for convenience when the time and circumstances are right.

Labor is induced by rupturing the membranes, particularly in a woman who has had several children and whose cervix is dilated and completely effaced, or by the use of oxytocic (contraction-stimulating) drugs.

Induction will not work unless the cervix is “ripe” – thin and dilated. For medical indications, induction may require several days with use of oxytocin. An obstetrician knows when labor may be induced for the convenience of the patient. Induction for convenience can only be performed on a ripe cervix with an infant of sufficient size.

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Emergency Contraceptive Pills for Stopping Unintended Pregnancy

Posted on July 23, 2009 by steven

There are more than 2.7 million unintended pregnancies per year in the United States and nearly half are due to contraceptive failure. According to the Centers for Disease Control and Prevention, more than 11 million American women report using contraceptive methods associated with high failure rates, including condoms, withdrawal, periodic abstinence, and diaphragms. These facts led the Food and Drug Administration (FDA) to approve the “Preven Emergency Contraceptive Kit.”

Emergency contraception can be used when a condom breaks, after a sexual assault, or any time unprotected sexual intercourse occurs. Emergency contraceptive pills(ECPs) are ordinary birth control pills containing the hormones estrogen and progestin. Although the therapy is commonly known as the morning- after pill, the term is misleading; ECPs can be used up to 72 hours beyond. The use of ECPs can reduce the risk of pregnancy by 75 percent.

Emergency contraceptives require a prescription. After a woman determines she is not pregnant, by using the pregnancy test included in the kit, the first dose of two light blue emergency pills is taken as soon as possible, within 72 hours after sex with a known or suspected birth control failure or sex without birth control. The second dose is taken 12 hours later. The most common side effects related to emergency use are nausea, vomiting, menstrual irregularities, breast tenderness, headache, abdominal pain and cramps, and dizziness.

Emergency minipills contain progestin only. Like ECPs, minipills can be used immediately after unprotected intercourse and up to 72 hours beyond. Emergency mini pills are equally as effective as ECPs, but nausea and vomiting are far less common. Emergency minipills are an excellent alternative for most women who cannot use ECPs that contain estrogen.

  • Foams, Suppositories, Jellies, and Creams Like condoms, jellies, creams, suppositories, and foam do not require a prescription. Chemically, they are referred to as spermicides­ substances designed to kill sperm. Foams, suppositories, jellies, and creams usually contain nonoxynol-9, a detergent believed to be effective in also killing viruses, bacteria, and other organisms. Although they are not recommended as the primary form of contraception, spermicides are often recommended for use with other forms of contraception. While they help prevent the spread of certain STDs, they are most effective when used in conjunction with a condom.

Jellies and creams are packaged in tubes, and foams are available in aerosol cans. All have tubes designed for insertion into the vagina. They must be inserted far enough to cover the cervix, providing both a chemical barrier that kills sperm and a physical barrier that stops sperm from continuing toward an egg.

Suppositories are waxy capsules that are placed deep in the vagina and melt once they are inside. They must be inserted 10 to 20 minutes before intercourse to have time to melt but no longer than one hour prior to intercourse or they lose their effectiveness. Additional contraceptive chemicals must be applied for each subsequent act of intercourse.

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Female Sterilization as a Permanent Contraceptive Method

Posted on June 30, 2009 by steven

Sterilization has become the leading method of contraception for women(10.7 million women), closely followed by the oral contraceptive pill(10.4 million women). Since the 1970s, perfection of sterilization procedures has made this method popular. Although some of the newer surgical techniques make reversal of sterilization theoretically possible, anyone considering sterilization should assume that the operation is not reversible. Before becoming sterilized, people would think through such possibilities as divorce and remarriage or a future improvement in their financial status that may make them want a larger family.

  • Female Sterilization One method of sterilization in females is called tubal ligation. It is achieved through a surgical procedure that involves tying the fallopian tubes closed or cutting them and cauterizing(burning) the edges to seal the tubes so that access by sperm to released eggs is blocked. The operation is usually done in a hospital on an outpatient basis. First, the abdomen is inflated with carbon dioxide gas through a small incision in the navel. The surgeon then inserts a laparoscope into another incision just above the pubic bone. This specially designed instrument has a fiber-optic light source that enables the physician to see the fallopian tubes clearly. Once located, the tubes are cut and tied or cauterized.

Ovarian and uterine functions are not affected by a tubal ligation. The woman’s menstrual cycle continues, and released eggs simply disintegrate and are absorbed by the lymphatic system. As soon as her incision is healed, the woman may resume sexual intercourse with no fear of pregnancy.

As with any kind of surgery, there are risks. Some patients are given general anesthesia, which presents a small risk; others receive local anesthesia. The procedure itself usually takes less than an hour, and the patient is generally allowed to return home within a short time after waking up. Women considering a tubal ligation should thoroughly discuss all the risks with their physician before the operation.

The hysterectomy, or removal of the uterus, is a method of sterilization requiring major surgery. It is usually done only when the patient has a disease of or damage to the uterus.

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Birth Control Methods and Techniques

Posted on May 12, 2009 by steven
  • Depo-Provera Depo-Provera is a long-acting synthetic progesterone that is injected intramuscularly every three months. Although used in other countries for years, the FDA did not approve it for use in the United States until 1992. Researchers believe that the drug prevents ovulation.

Depo-Provera encourages sexual spontaneity because the user does not have to remember to take a pill or to insert a device. Those who want to start a family can easily decide to do so without much of a waiting period. There are fewer health problems associated with Depo-Provera than with estrogen­containing pills. The main disadvantage is irregular bleeding, which can be troublesome at first, but within a year, most women are amenorrheic(have no menstrual periods). Weight gain(an average of five pounds in the first year) is common . Other possible side effects include dizziness, nervousness, and headache. Unlike other methods of contraception, this method cannot be stopped immediately if problems arise,

  • Norplant Approved for use by the FDA in 1990 and marketed since February 1991 for use in the United States, Norplant is one the newest forms of hormonal contraception. It has been tested by more than 1 million women in 45 countries and is now approved for use in 14 countries. Increasing numbers of women in the United States are considering this option because of its convenience, effectiveness, and safety.

Six silicon capsules that contain progestin are surgically inserted under the skin of a woman’s upper arm, For five years, small amounts of progestin are continuously released. The progestin in Norplant works the same way as oral contraceptives do; it suppresses ovulation, prevents growth of uterine lining, and thickens the cervical mucus.

Norplant is one of the most effective methods of birth control ever developed, A serious disadvantage to Norplant use, however, is its lack of protection against STDs.

Norplant can be inserted by a specially trained doctor, nurse, or nurse practitioner in 10 to 15 minutes. A local anesthetic is administered to the upper arm, a small injection is made, and, with a special needle, the six capsules are placed just under the skin in a fan shape. The capsules are similarly removed after five years or, if necessary, at any point after their insertion.

The capsules usually cannot be seen, nor does insertion leave a scar in most women. At this time, no serious side effects are known, Less serious side effects include irregular bleeding and irregular menstrual periods, acne, weight gain, breast tenderness, headaches, nervousness, depression, and nausea.

Norplant is one of the most effective reversible methods of fertility control. In addition to being very convenient, the implant is easy for a trained practitioner to do, so there is little chance of error. It costs less than the pill-$550 compared to $1,180 over five years. Medical assistance programs in many states will pay this cost for poor women.

  • Vaginal Ring A method that is not yet approved by the FDA but that appears promising is the vaginal ring. Rings that are 2 to 3 inches in diameter and contain estrogen and progesterone or progesterone alone are placed by a woman in he vagina. They may be left in place continuously or removed every three weeks for one week to allow regular bleeding. The rate of effectiveness is similar to that of the pill.

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New Approaches for GBS disease

Posted on April 16, 2009 by steven

Currently, researchers are investigating two other approaches: the development of a vaccine against group B strep and the development of a rapid, easily available, and accurate screening test that could be performed in labor with immediate results. A screening test would identify the women who carry GBS at the time of delivery and reduce the overall number of women receiving treatment. Screening tests are currently available but not considered accurate enough to determine treatment to prevent newborn GBS infection.

Informed Consent

To allow for informed consent, women should know the following:

  • Approximately 1 in 200 newborns born to a mother colonized with GBS will develop GBS disease early in the newborn period.
  • The risk of a newborn’s acquiring GBS from a mother who tests positive for the organism is 29 times higher than the risk for a newborn whose mother had a negative prenatal culture.
  • The risk of a newborn’s acquiring GBS in a labor that is preterm or complicated by long duration of membrane rupture or fever is 7 times higher than the risk for newborns born without these labor complications.
  • Five to 20 percent of newborns infected with GBS Will die.
  • The treated woman’s risk of a mild allergic reaction to penicillin is 1 in 10.
  • The treated woman’s risk of a serious allergic reaction to penicillin is 1 in 10,000.
  • The risk of dying from an allergic reaction to penicillin is 1 in 100,000 treated women.
  • Treatment for GBS before labor is not effective in preventing newborn GBS disease.

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Sudden Infant Death Syndrome is the Sudden Death of a New Born Baby

Posted on April 10, 2009 by steven

Stillbirth is one of the most traumatic events a couple can face. A stillborn baby is one that is born dead, often for no apparent reason. The grief experienced following a stillbirth is usually devastating. Nine months of happy anticipation have been thwarted. Family, friends, and other children may be in a state of shock, needing comfort and not knowing where to turn. The mother’s breasts produce milk, and there is no infant to be fed. A room with a crib and toys is left empty.

The grief can last for years, and both partners may blame themselves or each other at some time. Some communities have groups called the Compassionate Friends to help parents and other family members through this grieving process. this nonprofit organization is for parents who have lost a child of any age for any reason.

  • Sudden Infant Death Syndrome The sudden death of an infant under one year of age, for no apparent reason, is called sudden infant death syndrome(SIDS). While SIDS is the leading cause of death for children aged 1 month to 1 year, affecting about 1 in 1,000 infants in the United States each year, it is not a disease. Rather, it is ruled the cause of death after all other possibilities are ruled out. A SIDS death is sudden and silent; the death occurs quickly, often associated with sleep and no signs of suffering.

Because SIDS is a diagnosis of exclusion, doctors do not know what causes SIDS. However, research done in countries including England, New Zealand, Australia, and Norway has shown that by placing children on their backs or sides to sleep, the rate of SIDS was cut by as much as half. In 1994, the American Academy of Pediatrics began a campaign called “Back to Sleep,” urging American parents to lay their infants on their backs when they put them to sleep. Additional precautions against SIDS include having a firm surface for the infant’s bed, not allowing the infant to become too warm, maintaining a smoke-free environment, having regular pediatric visits, breast-feeding, and seeking prenatal care.

Any sudden, unexpected death threatens one’s sense of safety and security. This is especially true in a sudden infant death. The lack of a discernible cause, the suddenness of the tragedy, and the involvement of the legal system makes a SIDS death especially difficult, leaving a great sense of loss and a need for understanding.

Miscarriage Loss of the fetus before it is viable; also called spontaneous abortion.

Rh factor A blood protein related to the production of antibodies. If an Rh-negative mother is pregnant with an Rh-positive fetus, the mother will manufacture antibodies that can kill the fetus, causing miscarriage.

Ectopic pregnancy Implantation of a fertilized egg out­side the uterus, usually in a fallopian tube; a medical emergency that can end in death from hemorrhage for the mother.

Stillbirth The birth of a dead baby.

Infertility Difficulties in conceiving.

Pelvic inflammatory disease(PID) An infection that scars the fallopian tubes and consequently blocks sperm migration, causing infertility.

Endometriosis A disorder in which uterine lining tissue establishes itself outside the uterus; it is the leading cause of infertility in the United States.

Low sperm count A sperm count below 60 million sperm per milliliter of semen; it is the leading cause of infertility in men.

What Do You Think?

Have you talked to your health-care provider about a birth plan and arranged for it to be in your chart? What do you think would be the advantages and disadvantages of breast-feeding?

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Premature Rupture of Membranes

Posted on March 27, 2009 by steven

Premature rupture of the membranes(PROM) occurs as an uncontrollable gush or leakage of fluid. By definition, PROM is rupture of the membrane that occurs more than 12 hours before the onset of labor. If this occurs before 37 weeks gestation, it may be called preterm premature rupture o/the membranes(PPROM).

In the past, due to concern that prolonged rupture of membranes would lead to maternal and fetal infection, babies were all delivered shortly after rupture, regardless of gestational age. Research has not shown this to be beneficial to mother or baby.

Today, one of two care paths generally is followed when a woman has PPROM without labor:

1.

Nothing is done except to wait for labor with monitoring of maternal temperature and avoidance of all vaginal examinations.
2. Corticosteroid therapy is initiated, with or without medications to try to stop labor.

Delivery is only induced in the presence of maternal fever, indicating infection. Most women with PPROM will be in labor, either immediately or within 2 days.

Women with ruptured membranes before 37 weeks usually are admitted to the hospital for observation. The woman may be discharged home before the baby is born if the leakage of fluid stops and certain other conditions exist. The baby should be in the vertex or head down position; there must be no sign of infection; the woman must be able to rest and avoid vaginal intercourse at home; the woman or somebody in her family must be able to read a thermometer; the woman must be able to return for prenatal care visits at least weekly. This is a decision to be made individually for each woman.
born, ready to provide expert care from the moment of birth.

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Down Syndrome in Babies

Posted on March 23, 2009 by steven

More than half of the average American woman’s expected life span is spent between menarche(first menses) and menopause(last menses), a period of approximately 40 years. During this 40-year period, she must make many decisions regarding her reproductive health. Deciding if and when to have children, as well as how to prevent pregnancy when necessary, are long-term concerns.

Today, a woman over 35 who is pregnant has plenty of company. While births to women in their 20s are declining, the rate of first births to women between the ages of 30 and 39 has doubled in the past decade, and births to women over 39 have increased by more than 50 percent. Many women who wait until their 30s to consider having a child find themselves wondering, “Am I too old to have a baby?” Researchers believe that there is a decline in both the quality and viability of eggs produced after age 35. Statistically, the chances of having a baby with birth defects do rise after the age of 35. Down syndrome, a condition characterized by mild to severe mental retardation and a variety of physical abnormalities, is the most commonly occurring genetic condition. One in every 800 to 1,000 live births a year is a child with Down syndrome, representing approximately 5,000 births per year in the United States alone. A common myth is that most children with Down syndrome are born to older parents. The truth is that 80 percent of children born with Down syndrome are born to women younger than 35 years of age. However, the incidence of births of children with Down syndrome increases with age. The incidence of Down syndrome in babies born to a mother aged 20 is 1 in 10,000 births; it rises to 1 in 400 by age 35, to 1 in 110 by age 40, and to 1 in 35 when she is.

Women who choose to delay motherhood until their late 30s also worry about their physical ability to carry and deliver their babies. For these women, a comprehensive exercise program will assist in maintaining good posture and promoting a successful delivery.

There are some advantages to having a baby later in life. In fact, many doctors are encouraging older women to become pregnant because they find that these women tend to be more conscientious about following medical advice during pregnancy and more psychologically mature and ready to include an infant in their family than are some younger women.

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Delivery of Premature Infants

Posted on March 12, 2009 by steven

Several decades ago, some experts proposed that elimination of the stresses of labor by delivering all preterm babies by cesarean would increase the newborn survival rate. The rationale was that reduced stress on the infant’s head would reduce the possibility of bleeding into the skull. This complication, called intraventricular hemorrhage, is another major cause of death in premature newborns. The best evidence now shows that cesarean delivery does not prevent ventricular hemorrhage. The best currently available evidence does not support performing a cesarean if the only reason for the surgery is a premature infant. Of course, there are times when cesarean is performed for the same reasons as it is in mature babies.

Episiotomy is another procedure that has been advocated as a way of reducing stress on the skull of the immature fetus. Studies are not available to demonstrate whether this is beneficial. The resistance of the perineal muscles, through which the infant passes just as it leaves the vagina and which are cut with an episiotomy, is less than the resistance of the cervix and the vaginal muscles through which the infant has already passed. Despite a lack of definitive evidence, some experts recommend episiotomy for the delivery of preterm infants. Others recommend it only when there is resistance in these muscles, rarely seen except in women having a first baby. This is an area worth further research.

Most important for the premature baby is the presence at the birth of personnel skilled in resuscitation and care of premature infants. Whenever possible, the delivery should take place in a hospital with a neonatal intensive care unit and with constant attendance of physicians, nurse practitioners, and nurses who are knowledgeable in caring for these tiny infants. A staff member, or team of staff members, should be present in the delivery room whenever a premature baby is

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Prenatal Testing Techniques- Aminocentesis, Sonography, Fetoscopy, Chronic Virus Sampling

Posted on February 26, 2009 by steven

Modern technology has enabled medical practitioners to detect health defects in a fetus as early as the 14th to 18th weeks of pregnancy. One common testing procedure, amniocentesis, which is strongly recommended for women over the age of 35, involves inserting a long needle through the mother’s abdominal and uterine walls into the amniotic sac, the protective pouch surrounding the baby. The needle draws out 3 to 4 teaspoons of fluid, which is analyzed for genetic information about the baby. This test can reveal the presence of 40 genetic abnormalities, including Down syndrome, Tay-Sachs disease(a fatal disorder of the nervous system common among Jewish people of Eastern European descent), and sickle-cell anemia(a debilitating blood disorder found primarily among blacks). Amniocentesis can also reveal the sex of the child, a fact many parents choose not to know until the birth. Although widely used, amniocentesis is not without risk. Chances of fetal damage and miscarriage as a result of testing are 1 in 400.

Another procedure, ultrasound or sonography, uses high­frequency sound waves to determine the size and position of the fetus. Ultrasound can also detect defects in the central nervous system and digestive system of the fetus. Knowing the position of the fetus assists practitioners in performing amniocentesis and in delivering the child. In 1999, a new three-dimensional ultrasound technique clarified the images and improved doctor’s efforts at detecting and treating defects prenatally.

A third procedure, fetoscopy, involves making a small incision in the abdominal and uterine walls and then inserting an optical viewer into the uterus to view the fetus directly. This method is still experimental and involves some risk. It causes miscarriage in approximately 5 percent of cases.

A fourth procedure, chorionic virus sampling(CVS), involves snipping tissue from the developing fetal sac. CVS can be used at 10 to 12 weeks of pregnancy, and the test results are available in 12 to 48 hours. This test is an attractive option for couples who are at high risk for having a baby with Down syndrome or a debilitating hereditary disease.

If any of these tests reveals a serious birth defect, parents are advised to undergo genetic counseling. In the case of a chromosomal abnormality such as Down syndrome, the parents are usually offered the option of a therapeutic abortion. Some parents choose this option; others research their unborn child’s disability and decide to go ahead with the birth and offer the baby the love and support all children deserve.

Down syndrome A condition characterized by mental retardation and a variety of physical abnormalities.

Human chorionic gonadotropin(HCG) Hormone detectable in blood or urine samples of a mother within the first few weeks of pregnancy.

Trimester A three-month segment of pregnancy; used to describe specific developmental changes that occur in the embryo or fetus.

Embryo The fertilized egg from conception until the end of two months’ development.

Fetus The name given the developing baby from the third month of pregnancy until birth.

Placenta The network of blood vessels that carries nutrients to the developing infant and carries wastes away; it connects to the umbilical cord.

Amniocentesis A medical test in which a small amount of fluid is drawn from the amniotic sac; it tests for Down syndrome and genetic diseases.

Amniotic sac The protective pouch surrounding the baby.
What Do You Think?

What are your most important concerns when considering a health-care practitioner for your or your partner’s pregnancy? What behaviors might you or your partner need to change if you found out that you or your partner were pregnant? Are there any behaviors that you would consider integrating into your lifestyle now that would be of benefit to you or your partner, if you were planning a pregnancy? How much emphasis should be placed on male preconception planning, if any?

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