Car Seats for Children

December 9, 2009 by  
Filed under Education

This information is about car seats for children. It tells you why you need them, how to buy and use them, and how to help your child adjust to them.

Most states have laws, which require that children be in approved child seats when riding in a motor vehicle. The laws vary slightly in different states, and in different areas within states, as far as the ages and weights of children are concerned. If you would like to know more about the specifics of the law in your area, contact your State Department of Transportation. These laws were enacted because it is very clear that correctly using approved car seats reduces the risk of serious injury and death to children involved in accidents.

In most local areas, police are serious about issuing tickets to drivers when they see children riding unrestrained in cars. It is important that you obtain a federally approved car seat, and learn how to use it correctly. If you buy a car seat, make sure it meets federal safety standards. This should be clearly marked on the box, or a sticker should be attached to the seat itself. If you use an older seat, make absolutely sure it was made after 1981. Many seats sold before 1981 do not meet current standards. If you use an older seat, also make sure it was never involved in any kind of accident. It may be weakened or damaged in a way that you can not easily see, but would effect its ability to protect your child.

There are two types of approved seats. The first is only for children under 20 lb. It is installed facing the rear of the car. The second type, called a convertible, can be adjusted to fit either infant or toddler. For children under 20 lb., the seat is installed facing the rear of the car, and then is turned to face forward when the child reaches 20 lb. Household infant carriers, and portable beds do not provide any crash protection and must not be used in cars.

Children over 20 lb. who can sit up alone should be in toddler or convertible seats. These seats are larger than infant seats and are used in a forward facing position. You should keep your child in this type of seat until he or she becomes too large for it. Then a booster seat can be used.

Car seats provide the most protection for your child, and should be used as long as possible. After outgrowing car seats, your child should always wear a seat belt while riding in a car. You need to know how to use your car seat safely. Put your child into the seat with his normal clothing on. Do not bundle blankets before adjusting the car seat harness. Blankets make it impossible to position the seat harness correctly. Tighten the seat harness so that it is snug against your child. Then, make sure the car seat is held firmly in place by putting the seat belts from your car through it. The seat belt should be tight enough to keep the car from moving. Every new car seat comes with directions for installing it in your car and using it correctly.

Read the directions carefully, and contact the manufacturer if you have any questions. Your child is safest sitting in the back seat of the car, especially in cars with safety air bags. Children have suffered greater injuries when the air bag opens up. If the child must be place in the front seat, the front seat should be moved back as far as possible from the dashboard and positioned facing the rear of the car.. Most important, a locking clip should be used on the seat belt to keep the car seat and belt tight. This clip usually is attached with the car seat instructions.

You teach your child the importance of car seats every time you buckle your seat belt. If you haven’t done it already, make a new rule for your family, “The car doesn’t move unless everyone is buckled up!” Help your child adjust to the car seat. Toddlers who have never been in car seats may resist. So train your child from the beginning by using the seat for every trip, no matter how short.

To help make the experience more pleasant, try having one or more travel toys that are left in the car and used only while riding. A favorite picture book or stuffed animal encourages quiet play, and keeps your child occupied. It also helps to engage your child in quiet conversation while you ride. Be sure to give praise for good behavior in the car. At some point, most children will fuss about being in the car seat. Stay firm and calm.

Remember your role: “The car doesn’t move unless everyone is buckled up!” After one or two tries, your child will stop fussing.

Remember these key points:

  • All children should be in approved car seats for every car ride.
  • Make sure the seat is tightly buckled with the seat belt, and the child can not wiggle out of the car seat.
  • Everyone always should be buckled up whenever the vehicle is moving.
Tags: State Department of Transportation, baby car seats, Car Seats for Children, children car seats, Your child

Upper Respiratory Flu

December 9, 2009 by  
Filed under Education

This information is about upper respiratory flu — or “influenza.” You’ll learn what flu is, how to recognize it, how to treat it, and how to help prevent it.

Upper respiratory flu is a viral illness that affects your nose, throat, and chest. It’s like the common cold — but flu usually produces a higher fever. Upper respiratory flu is not the same as stomach flu, which disrupts your digestive system.

Learn to recognize upper respiratory flu.

It usually starts with a mild sore throat, headache, and mild muscle pain — especially in your back, arms, and legs. Your muscles may feel as if you’d over-exercised them. You may develop a cough and a fever. Your temperature may be normal or go as high as one hundred and four degrees. The fever may be accompanied by a chilly feeling. Occasionally, symptoms include nausea and diarrhea too. The fever and cough usually start to go down after about three days ??? but you may feel weak and tired up to a week or more.

How to treat upper respiratory flu.

Often neither you nor your doctor can tell whether you have the common cold or influenza during the first three days of your illness. This is why no specific treatment is usually given. Even if it is the flu, antibiotics such as penicillin don’t work on flu because they kill only bacteria. The flu is caused by a virus. Your body’s defenses do the best job in fighting this illness themselves.

You can help your body fight flu in two important ways. First, get as much rest as possible. Do light activities if you need to, but rest as soon as you get tired. If your job requires a lot of physical activity, you may need to stay home from work, especially if you have fever, generalized aching, nausea, and vomiting. Also, by resting at home you won’t risk infecting others at work. Secondly, drink plenty of clear fluids like water, apple juice and clear soups. Seven-Up and other soft drinks are fine, if you let them go flat before drinking. Clear fluids replace lost moisture in your body, help loosen secretions and let your stomach rest and recover.

If you smoke, stop. Smoke irritates your nose, throat, and chest, and it could produce a severe chest infection later.

While your body fights the illness, you can reduce the symptoms. For congestion and coughing, cough syrups such as Robitussin-DM may help. They can be bought without prescription.

For fever and pain, adults can take aspirin or Tylenol every four hours. But for children under nineteen, avoid aspirin, which may possibly increase the risk of a serious illness called Reye’s Syndrome. Give a child Tylenol only if discomfort is severe. However, if a child under five has previously had convulsions due to fever, give Tylenol as soon as the child has a fever. For both adults and children, use light clothing or covers when fever is present. Never bundle up to “sweat the fever out.” However, do cover up if shivering or chilliness occurs.

Finally, if your cough and fever don’t start to get better after three days, telephone your health care provider for advice. If you are better after 3-5 days, but you continue to have a cough which produces yellow or green sputum, or if sinus drainage persists for more than two weeks, contact your doctor.

Upper respiratory flu can usually be prevented by getting a flu shot each year in the fall beginning in October or November, at least three weeks before the flu season. This is especially important if you have a chronic medical condition such as diabetes, or heart, lung or kidney disease or if you’re 65 years of age or older. In addition, if you are in any of these higher-risk groups, you should call your health care provider if you get the flu or if you’re exposed to it.

Upper respiratory flu is spread through coughing, sneezing and nasal drainage. If you are coughing or sneezing, it may be wise to avoid contact with the general public, especially at work or at school. Protect others by covering your mouth when you cough or sneeze. Be sure to wash your hands after touching your nose mouth and after blowing your nose.

Remember these key points about upper respiratory flu:

  • The most effective treatment of flu is plenty of rest and fluids.
  • Cough syrup and pain relievers can reduce the symptoms, but avoid giving aspirin to children or adolescents.
  • If fever and cough don’t begin to improve after three days, call your doctor for advice.
  • If you are at high-risk for flu, get a flu shot at least three weeks before the winter flu season.
Tags: influenza, cold, flu, common cold, Upper Respiratory Flu

How to quit smoking!

December 9, 2009 by  
Filed under Education

is the single most preventable cause of disease in the United States today. Smoking is related to the development and complication of many major diseases, including lung , emphysema, and strokes. Stopping smoking now will greatly improve your health – regardless of how much you currently smoke or how long you have been smoking!

Remember that all forms of tobacco are dangerous; there is no safe use of tobacco. So, the term “smoking” refers to the use of cigarettes, pipes, cigars, and even smokeless tobacco, often called chewing tobacco or snuff.

The National Cancer Institute, in its pamphlet called “Clearing the Air”, has outlined the following comprehensive strategies for quitting smoking. You can get a copy of this pamphlet by calling NCI at 1-800-4-cancer. The National Cancer Institute recommends that you begin by preparing to stop. You must decide positively that you want to stop more than you want to remain a smoker. List all the reasons you want to quit and reread them often. Begin to prepare yourself physically as well as mentally for your quit day: start a modest exercise program, drink more water and juice, get lots of rest and avoid fatigue. As you prepare to quit, remember that smoking cessation isn’t easy, but it is something that you can do! More than 3 million people quit smoking each year in the United States!!! Also remember that withdrawal symptoms will occur but will subside after the first few weeks. You can make it!!

This time of preparation may be a good time for you to involve someone else in your quit efforts. Maybe you can invite your spouse or friend to quit with you or enlist their positive support as you make this important step toward a healthier future!

Just before you stop, practice going without cigarettes as much as possible. If you want to smoke go to one designated area of your house that you can smoke in, such as a garage, porch or basement. Ceremoniously eliminate all smoking materials- cigarettes, lighters, and ashtrays. No longer carry cigarettes around with you. If you need to smoke, stop whatever it is that you are doing and go to the designated area to smoke. Also, try buying cigarettes one pack at a time.

These tips make it very inconvenient to smoke, will force you to slow down your smoking, and hopefully eliminate some of the more unnecessary cigarettes in your habit. Keep your mind focused on the immediate challenge at hand: to go for one day without smoking. Don’t shoot for a whole smoke-free lifetime at this stage!

Set a quit date when you will finally quit smoking. Set this date for no more than 7 days from now, so you don’t lose your initial enthusiasm! Set yourself up for success and pick a good day when you are ready to tackle such a monumental challenge. The day when you have a big presentation to deliver at work, the kid’s carpool to drive, and a dinner party to make is probably not a good quit date!! Ask yourself, is there anything in my life that is going to prohibit me from giving this my best effort?

On the day that you quit, keep yourself very busy!! Go to the movies, take a walk, exercise – and fill your time with activities that would make it very hard to smoke, such as washing dishes, gardening, shopping, or taking a shower.

Celebrate your first smoke-free day with a smoke-free activity with some non-smoking friends! (Don’t worry! You don’t have to give up your friends who are smokers!) You may want to temporarily avoid spending a lot of time with them during your first few smoke-free days. If you see them smoking, your resolve may be weakened. You may also want to avoid alcohol during these critical first days; it tends to weaken your willpower!

When you have the urge to smoke, remember that the urge will go away, whether or not you have a cigarette!!!! Remind yourself that you are now a nonsmoker and remind yourself of all the reasons you listed for wanting to stop. Find some substitute activities to occupy your hands, mouth, and mind when craving cigarettes. Try doodling, writing letters, or organizing your sock drawer to keep your hands busy. Fill your mouth with non-fattening goodies, such as vegetable sticks, pretzels, rice cakes, or sugarless gum and candies. Occupy your mind with positive thoughts of a future smoke-free vacation, home and life!

Try wearing a rubber band around your wrist, and when you really feel like you want a cigarette, snap the rubber band a few times and say stop to yourself. While you are snapping, picture a red stop sign. You will slowly be teaching yourself to stop craving cigarettes!!!

Figure out right now what you are going to do during future high risk situations, such as at a party where many people are smoking of maybe on your drive to work when you used to always have a cigarette. Plan now for future success!!!

It may help you to change your daily routine, especially your morning routine. After meals, get up from the table and brush and floss your teeth or start washing the dishes, rather than sit there and linger over a deadly cigarette. Eat your lunch in a different location or try taking a different route to work. You’re starting a new smoke-free life. Why not try some new smoke-free routines?

During your entire quit effort, keep a positive attitude! If negative thoughts start to creep in, remind yourself that you are a non-smoker and that you are in control of your life and health. You do not want to start smoking again!! It will get easier with every craving that you refuse to give in to. Try some relaxation techniques to help you stay relaxed and better able to handle the challenges of quitting. There are numerous relaxation techniques you could try.

After you have made it through those initial days and weeks after quitting, don’t let your guard down! You must act like a non-smoker everyday! If, however, you do have a slip, don’t worry! Many people make several quit attempts before they are ultimately successful. Begin your quit strategy again. Remember what it was that got you into trouble the last time and plan to be better prepared to stay quit. How will you handle that urge if it should come up again? Always have one trustworthy coping skill that works for you when the cravings get tough.

You can quit smoking!! There are more than 40 million Americans alive today who have quit – you can join them!! Remember, quitting smoking now will greatly improve your health! Try it!

Tags: Lung cancer, Tobacco, cancer, Tobacco packaging warning messages, Tobacco smoking, Smoking, relaxation techniques, Cigar

Allergies in Children

December 9, 2009 by  
Filed under Education

This information is about childhood allergies. It covers what they are, what forms they take, what causes them, and how to deal with them.

An allergy is the body’s reaction to a foreign substance. The reaction may involve the eyes, nose, lungs, the skin, the stomach and the intestines. The allergic reaction may be red, watery, itchy eyes and a runny nose; sneezing or coughing, wheezing; rash, dry skin, or hives — or internal upset after eating certain foods.

The tendency to allergies is inherited but specific allergies are not. So if you are allergic to feathers, don’t automatically assume that your child’s allergic reaction is also to feathers.

A tendency to allergies continues throughout life, but your child’s sensitivities and reactions may well change.

During a child’s first eighteen months, food allergies are most common. Most allergists feel that breastfeeding may be best for babies born into families with a history of allergies. Introduce other foods after six months of age, one-at-a-time, and feed each new food for at least four days before adding another. Some allergists recommend up to two weeks between each new food.

If your baby has a reaction, omit the new food for two weeks to see if the symptoms improve or disappear. If they do, double check by starting the suspect food again. If the reaction reappears, eliminate the food and see if the symptoms improve. Be patient, because the improvement may take several days to appear.

Foods that can cause problems for sensitive children include cow’s milk, wheat, corn, tomatoes, soy, peanut butter, strawberries, and eggs. Allergic reactions to foods usually include skin rashes, nausea, vomiting and/or diarrhea.

Reactions to medications can be very similar to food reactions, and they can happen even if your child was given the medicine previously without any reaction. If your child develops a reaction to a medication, call your health care provider. Let him or her decide whether the reaction is allergic or not. Children who have very severe reactions to drugs should wear special bracelets or necklaces identifying the drug allergy.

When children begin to crawl and walk, they come into contact with other things that can produce allergy Soaps, powders and bubble bath; natural clothing fibers such as wool and silk; even some metals can produce skin reactions. Pollen, dust, feathers, pet dander, and molds may cause nasal allergy or asthma. Children who seem to have a constant cold, but without any fever, may be allergic to airborne substances.

If your child has an allergy, the best way to treat it is by avoiding the substance that causes it. If that’s impossible (as in the case of pollen) the symptoms can be treated with medications. In more severe cases, allergy shots may be needed. These are prepared by an allergy specialist to fit your child’s particular needs, as determined by allergy skin tests. (However, skin tests are often negative in children under five.)

Allergy shots can be effective for hay fever and asthma. They reduce but do not eliminate allergic sensitivity. There is no cure for allergies, but some children improve naturally during their teenage years. Meanwhile, the purpose of allergy treatment is to minimize symptoms and help your child live a normal, comfortable life.

If you suspect that your child has an allergy, discuss it with the child’s health care provider. And if your child is no longer responding to the usual treatment for an existing allergy problem, you should discuss this too.

Remember these key points:

  • Allergic reactions show up in the respiratory, skin, and digestive systems. In children under 8 months, the most common allergy is food allergy. Introduce new foods one-at-a time and determine whether or not they cause reactions.
  • For older children, medications can control the symptoms of milder allergies, and allergy shots may help in some of the more severe cases. But the best treatment for allergies is to avoid the substances that cause them — whenever that’s practical.
Tags: drug allergy, hay fever, suspect food, Allergology, Cat allergy

Risk Factors For Heart Disease In Women

December 9, 2009 by  
Filed under Education

Risk factors are habits or traits that make a person more likely to develop a disease. Many of those for heart disease can be controlled. These include:

  • Cigarette smoking
  • High blood pressure
  • High blood cholesterol
  • Overweight
  • Physical inactivity
  • Diabetes

The more risk factors you have, the greater your risk. So take action–take control!
Coronary Heart Disease

Coronary Heart Disease is a woman’s concern. Every woman’s concern. One in ten American women 45 to 64 years of age has some form of heart disease, and this increases to one in five women over 65. Heart disease is the number one killer of American women. In addition, 1.6 million women have had a stroke, and 90,000 women die of stroke each year. This fact sheet tells you what kinds of habits and health conditions increase the chances of developing these diseases- and how you can help keep your heart healthy.
What Are These Diseases?

Both heart disease and stroke are known as cardiovascular diseases, which are disorders of the heart and blood vessel system. Coronary heart disease- the main subject of this fact sheet- is a disease of the blood vessels of the heart that causes heart attacks. A heart attack happens when an artery becomes blocked, preventing oxygen and nutrients from getting to the heart. A stroke occurs when not enough blood gets to the brain, or in some cases, from bleeding in the brain. Some other cardiovascular diseases are , angina (chest pain), and rheumatic heart disease.
Who Gets Cardiovascular Diseases?

Some women have more “risk factors” for cardiovascular diseases than others. Risk factors are habits or traits that make a person more likely to develop a disease. Some risk factors for heart-related problems cannot be changed, but many others can be.

The three biggest risk factors for cardiovascular disease that you can do something about are cigarette smoking, high blood pressure, and high blood cholesterol. Other risk factors, such as overweight and diabetes, also are conditions you have some control over. Even just one risk factor will raise your chances of having heart-related problems. But the more risk factors you have, the more likely you are to develop cardiovascular diseases- and the more concerned you should be about protecting your heart health.

Major Risk Factors
Smoking

Smoking by women in this country causes almost as many deaths from heart disease as from lung cancer. If you smoke, you are two to six times more likely to suffer a heart attack than a nonsmoking woman, and the risk increases with the number of cigarettes you smoke each day. Smoking also boosts the risk of stroke.

are not the only health risks connected to smoking. Women who smoke are much more likely to develop lung cancer than nonsmoking women. Cigarette smoking is also linked with cancers of the mouth, larynx, esophagus, urinary tract, kidney, pancreas, and cervix. Smokers also are more likely to develop other kinds of lung problems, including bronchitis and emphysema.

Smoking during pregnancy is also linked to a number of problems. They include bleeding, miscarriage, premature delivery, lower birth weight, stillbirth, and sudden infant death syndrome, or “crib death.” Also, young children who breathe in cigarette smoke have more lung and ear infections.

There is simply no safe way to smoke. Although low-tar and low-nicotine cigarettes may reduce the lung cancer risk somewhat, they do not lessen the risks of heart diseases or other smoking related diseases. The only safe and healthful course is not to smoke at all.
High Blood Pressure

High blood pressure, also known as hypertension, is another major risk factor for coronary heart disease and the most important risk factor for stroke. Even slightly high levels can increase your risk. High blood pressure also boosts the chances of developing kidney disease.

Older women have a higher risk of high blood pressure, with more than half of all women over age 55 suffering from this condition. High blood pressure is more common and more severe in black women than it is in white women. Using birth control pills can contribute to high blood pressure in some women.

Blood pressure is the amount of force exerted by the blood against the walls of the arteries. Everyone has to have some blood pressure, so that blood can get to the body s organs and muscles. Usually, blood pressure is expressed as two numbers, such as 120/80 mm Hg. Blood pressure varies through the day and in response to your activities. It is considered high when it stays above normal levels over a period of time.

High blood pressure is called the “silent killer” because most people who have it do not feel sick. That means it is important to have it checked each time you see your doctor or other health professional. But because blood pressure changes often, your health professional should check it on several different days before deciding if your blood pressure is too high. If your blood pressure stays at 140/90 mm Hg or above, you have high blood pressure.

Although high blood pressure can rarely be cured, it can be controlled with proper treatment. If your blood pressure is not too high, you may be able to control it entirely through weight loss if you are overweight, regular physical activity, and cutting down on alcohol, table salt and sodium. (Sodium is an ingredient in salt that is found in many packaged and processed foods, baking soda, and some antacids.)

But if your blood pressure remains high, your doctor will probably prescribe medicine in addition to the lifestyle changes described above. The amount you take may be gradually reduced, especially if you are successful with the changes you make in your lifestyle.

During pregnancy, some women develop high blood pressure for the first time. Other women who already have high blood pressure may find that it gets worse during pregnancy. Without treatment, such high blood pressure can be life-threatening to both mother and baby. Since you can feel perfectly normal and still have high blood pressure, it is important to get regular prenatal checkups so your doctor can find and treat a possible high blood pressure problem.

Blood pressure tends to get higher as you age. That means even if your blood pressure is normal now, it makes sense to take steps to prevent high blood pressure in the years to come. You will be less likely to develop high blood pressure if you are physically active, maintain a healthy weight, limit your alcohol intake, and cut down on table salt and sodium.
High Blood Cholesterol

High blood cholesterol is another very important risk factor for coronary heart disease that you can do something about. Today, about one-quarter of American women have blood cholesterol levels high enough to pose a serious risk for coronary heart disease.

Blood cholesterol levels among women tend to rise sharply beginning at about age 40, and continue to increase until about age 60. The higher your blood cholesterol level, the higher your heart disease risk.

The body needs cholesterol to function normally. It makes enough to fill its needs. But cholesterol also is taken into the body through the diet. Over a period of years, extra cholesterol and fat circulating in the blood settle on the inner walls of the arteries that supply blood to the heart. These deposits make the arteries narrower and narrower. As a result, less blood gets to the heart and the risk of coronary heart disease increases.


Getting Your Cholesterol Checked

Getting your blood cholesterol level checked is a relatively simple process. Your doctor or other health professional will take a small sample of your blood and measure the amount of cholesterol. When you have this test for the first time, it is important to have the following measurements taken:

Total Blood Cholesterol
For all adults, a desirable level of total blood cholesterol is less than 200 mg/dL. A level of 240 or more means you have high blood cholesterol. But even “borderline-high” levels (200-239) boost your risk of coronary heart disease.

High Density Lipoprotein
You also will need a measurement of your level of high density lipoprotein, or HDL, if an accurate result is available. Lipoproteins are the packages that carry cholesterol through the bloodstream. HDL is often called “good cholesterol” because it helps remove cholesterol from the blood, preventing it from piling up in the arteries.

If your HDL level is less than 35, your risk of heart disease goes up. This is true even if your total cholesterol level is within a desirable range. The good news is that if your HDL level is 60 or above, you have a lower risk of developing heart disease.

Low Density Lipoprotein
Your doctor also may want to measure your level of low density lipoprotein, or LDL. LDL is often called “bad cholesterol” because it carries most of the cholesterol in the blood, and if the LDL level is too high, cholesterol and fat can build up in the arteries. An LDL level below 130 is desirable, while levels of 130-159 are “borderline-high.” An LDL level of 160 or above means you have a high risk of developing coronary heart disease.
If your LDL level is not checked during your first test, your doctor still may want to measure it if your initial tests show that you have any of the following:

  • high total blood cholesterol
  • borderline-high cholesterol and at least two other risk factors for heart disease
  • desirable or borderline total blood cholesterol but low HDL levels.

Treatment
After studying your total cholesterol, HDL and LDL levels, and other risk factors for heart disease, your doctor may recommend a treatment plan for you. Lowering LDL cholesterol is the main goal of treatment. Cutting back on foods rich in fat, especially saturated fat, and in cholesterol, can lower both total and LDL cholesterol.
Weight loss for overweight persons and increased physical activity may also lower blood cholesterol levels.

Losing extra weight and becoming more physically active, as well as quitting smoking, also may help boost HDL cholesterol levels.

Your doctor may also suggest that you take cholesterol-lowering medications. This recommendation will depend on how high your LDL cholesterol level remains after you have made the diet and lifestyle changes described above. The need for medicine will also depend on whether you have any other risk factors for coronary heart disease.

Other Important Risk Factors
Physical Inactivity

Various studies show that physical inactivity is a risk factor for heart disease. Heart disease is almost twice as likely to develop in inactive people as in those more active.

So by getting regular physical activity even mild to moderate exercise you ll lower your risk of heart disease. The best exercises to strengthen your heart and lungs are aerobic ones, such as brisk walking, jogging, cycling, and swimming. Do them for 30 minutes, three or four times a week.

But even low-intensity activities, such as gardening and housework, can help lower your risk of heart disease if done daily.


Overweight

Excess body weight in women is linked with coronary heart disease, stroke, congestive heart failure, and death from heart-related causes. The more overweight you are, the higher your risk for heart disease.

Overweight contributes not only to cardiovascular diseases, but also to other risk factors, including high blood pressure, high blood cholesterol, and the most common type of diabetes. Fortunately, these conditions often can be controlled with weight loss and regular physical activity.

What is a healthy weight for you? There is no exact answer. Check the “What Should You Weigh?” table for the weight range suggested for women of your height. Ranges are given because women of the same height and amounts of body fat can differ in their amounts of muscle and bone. Weights above the suggested ranges are believed to be unhealthy for most people.

Body shape as well as weight may affect heart health. “Apple-shaped” individuals with extra fat at the waistline may have a higher risk than pear-shaped people with heavy hips and thighs. If your waist is nearly as large, or larger, than the size of your hips, you may have a higher risk for coronary heart disease.


Diabetes

Diabetes, or high blood sugar, is a serious disorder that raises the risk of coronary heart disease. The risk of death from heart disease is about three times higher in women with diabetes. Diabetic women also are more apt to have high blood pressure and high blood cholesterol.

Diabetes is often called a “woman’s disease” because after age 45, about twice as many women as men develop diabetes. While there is no cure for this disorder, there are steps a person can take to control it. Being overweight and growing older are linked with the development of the most common type of diabetes in certain people. Losing excess weight and boosting physical activity may help postpone or prevent the disease. For lasting weight loss, get regular exercise and eat foods that are low in calories and fat.


Stress

In recent years, you may have heard a lot about the connection between stress and heart disease. In particular, you may have heard that “type A” behavior being aggressive, competitive, and constantly concerned about time is linked to the development of heart disease. But while some studies have shown this connection in men, there is no evidence that type A behavior in women is linked with coronary heart disease.

Employment outside the home is another factor that often has been connected to women s heart disease. But so far, studies show no difference in rates of coronary heart disease between homemakers and employed women. However, more research is needed before we can rule out stress as a risk factor for women.


Birth Control Pills

Women who use high-dose birth control pills (oral contraceptives) are more likely to have a heart attack or a stroke because blood clots are more likely to form in the blood vessels. These risks are lessened once the birth control pill is stopped.

The risks of using low-dose birth control pills are not fully known. Therefore, if you are now taking any kind of birth control pill or are considering using one, keep these guidelines in mind:

  • If you smoke cigarettes, stop smoking or choose a different form of birth control. Smoking boosts the risks of serious cardiovascular problems from birth control pill use, especially the risk of blood clots. For women over 35, the risk is particularly high.
  • Use of birth control pills may increase blood pressure, and the risks appear to increase with age and length of use. If you take oral contraceptives, you should get your blood pressure checked regularly. If hypertension develops, you should stop using the pill.
  • If you are a diabetic or have a close relative who is and you take birth control pills, you should be especially careful to have regular blood sugar tests. Blood sugar sometimes changes dramatically in women who take birth control pills.
  • If you have a heart defect, if you have suffered a stroke, or if you have any other kind of cardiovascular disease, oral contraceptives may not be a safe choice. Be sure your doctor knows about your condition before prescribing birth control pills for you.

Alcohol

Several recent studies have reported that moderate drinkers those who have one or two drinks per day are less likely to develop heart disease than people who don’t drink any alcohol. If you are a nondrinker, this is not a recommendation to start using alcohol. And certainly, if you are pregnant or have another health condition that could make alcohol use harmful, you should not drink. But if you re already a moderate drinker, you may be less likely to have a heart attack.

But remember, moderation is the key. More than two drinks per day can raise blood pressure, and the “Dietary Guidelines for Americans” recommend that for overall health women should have no more than one drink a day. Further, binge drinking can lead to stroke. People who drink heavily on a regular basis have higher rates of heart disease than either moderate drinkers or nondrinkers.

Keep in mind, too, that alcohol provides little in the way of nutrients mostly just extra calories. So, if you are trying to control your weight, you may want to cut down on alcohol and substitute calorie-free iced tea, soda, or seltzer.


Hormones and Menopause

Should menopausal women use hormone pills? There is no simple answer to this question. Menopause is caused by a decrease in estrogen and other hormones produced by a woman s ovaries. At this time, some women begin to take prescription hormone pills every day. Some women take pills that contain only estrogen. Others take estrogen combined with a second hormone called progestin.

Estrogen has several important benefits. Taking estrogen pills may relieve “hot flashes” and generally help you feel more comfortable as your body adjusts to lower estrogen levels. They also help to prevent osteoporosis, a thinning of the bones that makes them more likely to break in later life. Estrogen pills also may help protect women from developing coronary heart disease, but more research is needed before we will know this for sure.

Estrogen pills also have risks. They may increase the chances of developing gallbladder disease, and they may worsen migraine headaches. They also may increase the risk of .

But by far, the biggest risk of taking estrogen pills is cancer of the uterus. Women on estrogen pills after menopause are up to six times more likely to develop uterine cancer than women not on this treatment. It is important to point out that women are much more likely to die of coronary heart disease than from uterine cancer. Still, the cancer risk exists and must be taken seriously and discussed with your doctor.

To reduce the risk of uterine cancer, some doctors now prescribe estrogen in combination with the hormone progestin. But we don t yet know how this newer “combo” treatment affects the risks of heart disease, osteoporosis, and breast cancer.

At present, a woman and her doctor must decide whether the benefits of hormone pills are worth the risks. If you are thinking about starting this treatment, you will need to consider your overall health and your personal and family history of heart disease, osteoporosis, and uterine and breast cancer.

If you are now taking hormone pills, check with your doctor to be sure you are taking the lowest possible effective dose. At least every 6 months, you and your doctor should discuss whether you need to continue treatment. Be alert for signs of trouble abnormal bleeding, breast lumps, shortness of breath, dizziness, severe headaches, pain in your calves or chest and report them immediately. See your doctor at least once a year for a physical examination.


Aspirin

You may have heard that taking aspirin regularly can help prevent heart attacks. Is this a good idea for you? Maybe.

A recent study found that women who took a low dose of aspirin regularly were less likely to suffer a first heart attack than women who took no aspirin. But since this was the first study to show this benefit in women, more research is needed before we can be sure that aspirin is safe and effective in preventing heart attacks in women.

What we do know for sure is that aspirin is a powerful drug with many side effects. It can increase your chances of developing ulcers and having a stroke from a hemorrhage. Because of these serious risks, you should not take aspirin to prevent a heart attack without first discussing it with your doctor.

Preventing Heart Disease

You now know something about the kinds of habits, health conditions, and other factors that affect your chances of developing heart disease. Just as important, you know that by taking an active role in your own heart health, you can make a difference.

Tags: rheumatic heart disease, Aging-associated diseases, Cardiology, heart diseases, cholesterol, Hypertension, congestive heart failure, Cardiovascular diseases, breast cancer, shortness of breath

Prostate Cancer

December 9, 2009 by  
Filed under Education

Prostate cancer is the second leading cause of death in men, second only to heart disease. Prostate cancer has become the most diagnosed cancer in the U.S. In 2008, more than 186,000 men were diagnosed with prostate cancer, and more than 28,000 men died from the disease. One new case occurs every 2.5 minutes and a man dies from prostate cancer every 19 minutes. As the population ages, these numbers will increase every year.

Even though we hear about it on TV and read about it in newspapers and magazines, most people don’t have a real understanding of prostate cancer and how it can be found. Hopefully, after reading this information you will be more informed about prostate cancer and will have less uncertainty about the exams and tests used for finding it early. Maybe this basic information will provoke you to act on behalf of your own health. Maybe it will persuade you to have the routine exams needed to find cancer in its early stages, when it can be cured.

The Prostate Gland
The prostate is actually a collection of glands and is part of the male reproductive system. Its function is to produce fluid that becomes part of semen. The prostate is about the size of a walnut. It is located below the bladder. The outside of the prostate is a thin capsule of fibrous tissue. Just outside the prostate is a layer of fat.

The prostate is divided into the right and left sides, called lobes. The widest part of the prostate, up next to the bladder, is called the apex. The tip opposite the bladder is called the apex. The word anterior is used to describe the front, and the word posterior is used to describe the back.

Just below the prostate is the wall of the rectum. On each side of the prostate are blood vessels and nerves that play an important part in making choices for cancer treatments. The glands right next to the prostate are called seminal vesicles, and fluid from them drains into the prostate. The vas deferens are tubes from the testicles which also drain into the prostate.

The prostate surrounds the urethra. The urethra is the tube that comes from the bladder, passes through the prostate, goes past the urinary sphincter muscle and through the penis. Its purpose is to carry urine from the bladder to the outside of the body. The urinary sphincter muscle is a circular muscle that prevents urine from leaking.

There are lymph nodes clustered along the sides of both walls of the pelvis. These lymph nodes are part of the lymphatic system. The lymphatic system cleans all of the cells in the body with lymph fluid. The fluid is filtered through the lymph nodes. Any impurities, germs and cancers are captured. After the fluid has been filtered, it is recycled into the bloodstream. There are veins that take blood from the prostate to the heart. These veins run along side the spinal column.

Because of its anatomical position in the body, continued growth of the prostate causes problems, called symptoms. As long as your body produces male hormones, your prostate will continue to grow. Also, cancer in the prostate can cause the prostate to grow. The position of glands and structures closest to the prostate is also important, as they are the first places that prostate cancer spreads when it grows outside of the prostate gland.

The Prostate Exam

The prostate exam is a basic, relatively painless exam, that is performed by your primary care physician or a urologist. You can expect to have several of these exams over your lifetime, especially if you are actively watching the health of your prostate.

The prostate exam is often called a rectal exam, prostate exam, or digital rectal exam. Digital comes from the word digit, meaning finger, and has nothing to do with digital imagery, sound, or computers. The examination is done by the physician inserting a gloved, lubricated finger into the rectum. Fortunately, the wall of the rectum is thin enough that cancers can be felt on the back side of the prostate.

The physician is feeling to “see” if there are any areas that are not smooth or are not soft. The prostate should feel symmetrical, that is, both lobes should feel the same. There should not be any hard nodules or firm areas. If an abnormal area is felt, there may be a reason for it other than cancer, such as previous surgery or a past infection in the prostate. There are growths that are not cancer that can cause nodules or areas that are not smooth.

To rule out the abnormal area as cancer your physician will probably have you go though additional testing. Also, only the back side and not the entire prostate gland can be felt through the rectum. The digital exam is like feeling the back of your head and trying to decide what your face looks like. For these reasons the PSA blood test is often done in addition to the prostate exam if there is a reason to think cancer may be present.

The PSA Blood Test
The PSA Blood Test and the digital rectal exam combined provide the best information needed to determine whether or not prostate cancer is present. A PSA test alone can help detect prostate cancer before it can be felt. Especially, prostate cancer that occurs in areas of the prostate that cannot be reached by a digital rectal exam.

PSA stands for Prostate Specific Antigen. The PSA blood test is testing for the presence of an enzyme that is produced by the cells of the prostate gland. It is produced by both normal prostate cells and cancerous prostate cells. Significant amounts of PSA are not found anywhere else in the body.

A small amount of PSA is released into the blood stream all of the time. If the prostate becomes irritated, more PSA leaks into the bloodstream and can be measured by taking a blood sample. The PSA is a very good test for identifying cancer of the prostate as well as other non-cancerous problems.

Normal Ranges for a PSA test are from 0.0 to 4.0. PSA levels can go up into the 100′s. When cancer is diagnosed, the PSA levels are often consistently in the 10′s or 20′s. A PSA level that is extremely high almost always means advanced prostate cancer is present. If PSA test results are in the higher levels, other test are usually ordered to determine if the cancer has spread into the lymph nodes or the bones.

If your PSA test results are in the normal range and your prostate exam was normal, you can feel pretty sure that everything is probably normal and cancer is not present in the prostate. However, this is only a snap shot in time. One exam does not mean you can go for the rest of your life without an exam. As a matter of fact, you should keep records of your exam results and compare them. Keeping records will allow you to watch for trends, such as slight increases, over time. A sudden change in your exam results may mean a problem. There are guidelines discussed later that show you how often to have your prostate checked.

Having a higher than normal PSA level does not mean that you have cancer! It is simply a warning signal. The PSA blood test can tell you that you have a problem with your prostate gland, but it can’t tell you exactly what the problem is. Cancer is only one of the problems it could be. A high PSA level can be caused by those items shown below. If your first reading is high, and your digital rectal exam is normal, your doctor will probably try treating you with medicine first and then a repeat PSA about 6 weeks after treatment. Six weeks may seem like a long time to wait, but enough time has to pass to make sure the repeat test is as accurate as possible.

Causes For A Higher than Normal Elevated PSA Level

  • Urinary tract infection
  • Urinary catheter in the bladder
  • Urinary retention
  • Stones in the prostate
  • Cancer of the prostate
  • Recent prostate surgery or biopsy
  • Noncancerous enlargement of the prostate
  • Infection of the prostate
  • Guidelines For Having PSA Exams

The following are general guidelines only! You should talk with your doctor about your personal needs for this or any other medical test.

If you are not at high risk, you should begin having a PSA blood test by age 50. If you are over age 80, there is no consensus on recommended guidelines for annual PSA tests. Following your doctor’s advice is probably the best course of action for you.

If you are at risk for prostate cancer you should have a PSA and digital rectal exam more often than someone that is not at high risk. Being at high risk means you are more likely to get prostate cancer than someone who is not at high risk. However, being at high risk does not mean that, for certain, you will get prostate cancer. Just as not being at high risk does not mean that, for certain, you won’t get prostate cancer.

You are at high risk if you have a family history of prostate cancer. That means, you are at high risk if your grandfather, father, or a brother have had prostate cancer. You should have a PSA blood test by age 40. You should have a PSA blood test every year thereafter.

African-American men have a higher risk of getting prostate cancer than other men. African-American men should have a PSA blood test every year beginning by age 40.

Just Do It!

Your doctor will not call on your 40th birthday and tell you it’s time to start having prostate exams. He will not call you every year and remind you to have a prostate exam and PSA blood test. It’s up to you to remember, to schedule an appointment, and to keep it! Try picking a meaningful day and do it on the same day every year. Do it on your birthday as a present to yourself. Do it on your wife’s birthday as a present to her. Do it on your anniversary as a present to you both. Just do it!

Tags: Rectal examination, Prostate cancer, cancer of the prostate, Cancer Management of prostate cancer, Prostate, Prostate-specific antigen, Prostatic intraepithelial neoplasia

Cesarean Birth

December 8, 2009 by  
Filed under Education

A major operation, each cesarean actually involves a series of separate incisions in the mother. The skin, underlying muscles and abdomen are opened first and then the uterus is opened allowing birth of the newborn.

There are two main types of cesarean operations, each named according to the location and direction of the uterine incision:

  • Cervical–a transverse (horizontal) or vertical incision in the lower uterus, and
  • Classical–a vertical incision in the main body of the uterus.

Today, the low transverse cervical incision is used almost exclusively. It has the lowest incidence of hemorrhage during surgery as well as the least chance of rupturing in later pregnancies. Sometimes, because of fetal size (very large or very small) or position problems ( breech or transverse), a low vertical cesarean may be performed.

In the classical operation, a vertical incision allows a greater opening and is used for fetal size or position problems and in some emergency situations. This approach involves more bleeding in surgery and a higher risk of abdominal infection. Although any uterine incision may rupture during subsequent labor, the classical is more likely to do so and more likely to result in death for the mother and fetus than a cervical incision.

Why Have Cesarean Rates Increased?

Many factors account for rising cesarean birth rates. By the 1960′s, increasing emphasis was being placed on the health of the fetus. With declining birth rates and couples having fewer children, even greater attention was given to improving the outcome of pregnancy, and infant survival in general. The nation’s infant morality rate began to be seen as an international yardstick on the quality of health care.

At the same time, advances in medical care combined to make maternal death from cesarean childbirth a rare occurrence. The safer the procedure became, the easier it was to decide to perform the operation. As a safe alternative to normal delivery, the cesarean became a practical way to try to improve the outcome of difficult pregnancies.

Studies suggesting the benefit of cesarean birth in dealing with various pregnancy complications also led to more cesareans. Obstetricians came to favor surgery in pregnancies with difficult deliveries that formerly would have required the use of forceps. The diagnosis of “dystocia”, a catch-all term meaning difficult labor, was made more frequently and handled more often with the cesarean operation. Fetal distress during labor–a condition often resulting in a cesarean–was more apt to be detected with the introduction of electric fetal monitoring. Increasingly, physicians used the cesarean method to deliver infants in the breech position prior to birth, adding still further to the rising cesarean rate.

Another important contributing factor was the rising number of repeat cesareans. As the number of women having their first cesarean increased, the long-held tenet “once a cesarean, always a cesarean” led to rapid increase in the number of repeat cesarean births.

What Is The Current Medical Thinking About Repeat Cesarean Deliveries?

Having had a prior cesarean delivery is one of the two major reasons women have the operation today. (The other is the diagnosis of dystocia.) The consensus development panel found that the rate of repeat cesareans is likely to increase further if present trends continue. Currently more than 98 percent of women in the U.S. who have had a cesarean undergo a repeat cesarean for subsequent pregnancies.

This practice was begun in the late 1900′s to avoid the risk of uterine scar rupture and hemorrhage during labor. At that time the classical cesarean incision was most widely used and the cesarean birth rate was extremely low.

Physicians now know that the classical, low vertical and “inverted T” incisions have a higher rate of rupture than the low transverse incision now in general use. The low transverse cervical cesarean also has been shown to result in fewer cases of lasting health disorders or death among mothers and infants. Today, many women who had earlier low transverse cesareans safely deliver subsequent children vaginally.

In studying the issue, the consensus panel found that the risk of maternal death in a repeat cesarean is two times that of a vaginal delivery. In addition, the maternal mortality rate for repeat cesareans has not fallen since 1970. The group concluded that the practice of routine repeat cesarean birth is open for question, and that labor and vaginal delivery after previous low transverse cervical cesarean birth are of low risk to the mother and child in properly selected cases.

The panel recommended that:

  • In hospitals with appropriate facilities, services and staff for prompt emergency cesarean birth, some women who have had a previous low transverse cervical cesarean may safely be allowed a trial of labor and vaginal delivery.
  • The present practice of repeat cesareans should continue for patients who have had previous cesareans with classical, inverted T or low vertical incisions, or for whom there is no record or the type of incision.
  • In hospitals without appropriate facilities, services and staff, the risk of labor for women having had a previous cesareans may exceed the risk to mother and infant from a properly timed, elective repeat cesarean birth. To allow patients to make an informed decision, they should be told in advance about the limits of the institutions offering this service.
  • More adequate information should be compiled on the risks and benefits of trying labor in patients with previous low transverse cervical incisions.
  • Institutions offering labor trials following low transverse cesareans should develop guidelines for managing those labors.
  • Patient education on initial and repeat cesarean birth should continue throughout pregnancy as an important part of patient participation in making decisions about the delivery.

What If The Baby Is In The Breech Position Prior To Birth?

There is a continuing trend to use the cesarean method to deliver a “breech baby”–a fetus positioned in the womb to be born in some way other than the normal head first manner. Nationally, the proportion of breech positioned infants delivered by cesarean rose from about 12 percent in 1970 to 60 percent in 1978.

Breech positioning involves higher risks for the mother and child, regardless of whether the delivery is vaginal or cesarean. Cesareans are being selected more often in these cases to try to improve the outcome in the face of the increased risks. But the consensus group found scientific data in this area generally inadequate to make firm conclusions about desirability of one approach over the other.

Most clinical reviews suggest that the cesarean may involve less risk for the premature breech infant, but this may not be true for term breech babies. Several studies indicate vaginal delivery of the uncomplicated term breech infant is preferable because an elective cesarean birth involves risk significant complications for the mother and little or no decrease in the risk of infant death.

Deciding which method of delivery to use in these situations involves considering many factors. These include maternal pelvic size, size of the fetus, the type of breech position and the experience of the physician with vaginal breech delivery.

In general, the consensus panel concluded that the cesarean presents a lower risk to the infant than a vaginal delivery when the breech fetus is 8 pounds or larger, or when a fetus is in complete or footling breech position or when the fetus is breech with marked hyperextension of the head.

The group recommended that vaginal delivery of term breech babies should remain an acceptable choice when the following conditions exist:

  • anticipated fetal weight of less than 8 pounds;
  • normal pelvic dimensions and structure in the mother;
  • frank breech positioning without hyperextended head; and
  • delivery by physician experienced in vaginal breech delivery.

What Is The Single, Most Common Reason For Performing A Cesarean?

Dystocia is a catch-all medical term covering a broad range of problems which can complicate labor. The consensus group found that this diagnosis was the largest contributor to the overall rise in the cesarean rate, accounting for 30 percent of all cesareans.

Included under the dystocia, or difficult labor, diagnosis are the following three basic types of problems which may impede labor:

  • abnormalities of the mother’s birth canal, such as a small pelvis;
  • abnormalities in the position of the fetus, including breech position or large fetal size; and
  • abnormalities in the forces of labor, including infrequent or weak uterine contractions.

The first two categories are well-defined areas. The physician usually recognizes size or position problems early; guidelines for appropriate obstetrical action are available; and the effects of the various approaches for mother and infant are reasonably well known.

The consensus panel agreed that the last category–forces of labor–is most in need of scrutiny and offers an opportunity for moderating the cesarean rate. Generally, this diagnosis occurs with low-risk infants of normal weight and size. Studies have not shown that infants in the group are better off with either cesarean or vaginal deliveries, although the maternal mortality rate for dystocia in 1978 was 41.9 deaths per 100,000 cesarean births compared with 11.1 deaths per 100,000 vaginal births.

The panel concluded that in handling a difficult or slowly progressing labor without fetal distress, a physician should consider various options before performing a cesarean. These include having the patient rest or walk around, sedating the patient or stimulating labor with a drug called oxytocin.

The panel recommended that because the diagnosis of dystocia is poorly defined and so prominent in increasing the cesarean rate, practice review boards in hospitals should include dystocia cases when conducting reviews. The panel also stressed the need for more research on the factors affecting the progress of labor.

Has The Use Of Electronic Fetal Monitoring Led To More Cesareans?

Another diagnosis accounting for the rise in cesarean birth rates is fetal distress. Occurring during labor, this problem can result in various complications, the most serious being fetal brain damage because of oxygen deprivation.

The use of electronic fetal monitoring techniques has led to an increase in the diagnosis of fetal distress but not necessarily to increase in cesarean deliveries, according to the consensus panel.

Because current data are insufficient on the possible risks or benefits of handling this condition with either cesarean or vaginal deliveries, the panel recommended studies to gather information on the outcomes of births involving fetal distress and development of new techniques to improve the accuracy of the diagnosis. These steps, the panel said, may be expected to improve fetal outcome and lower cesarean birth rates.

Are There Other Medical Conditions Which Would Necessitate A Cesarean?

Because of a need for early delivery, certain medical problems in either the mother or fetus can lead to cesarean birth. Examples include maternal diabetes, pregnancy-induced hypertension, vaginal herpes infection, and erythorblastosis fetalis, a blood disease related to the Rh factor in the mother. This entire group, however, contributes only a small part of the cesarean birth rate increases.

The consensus panel said that in some of these situations vaginal birth would be a safe alternative if a more effective method of stimulating labor before term was available. The panel recommended research to develop such methods.

What Are The Benefits Of The Cesarean Method?

There are certain times when conditions in the mother or infant make cesarean delivery the method of first choice. By providing an alternate route of delivery, the procedure offers great benefit in situations when a vaginal delivery carries a high risk of complications and death.

A cesarean is usually used when an expectant mother has diabetes mellitus. Such women have a high risk of having stillborns late in pregnancy. In these cases, a slightly early cesarean helps prevent this occurrence.

The cesarean can also be a lifesaving procedure when the following conditions are present:

  • Placenta previa–when the placenta blocks the infant from being born.
  • Abruptio placentae–when the placenta prematurely separates from the uterine wall and hemorrhage occurs.
  • Obstructed labor–which can occur with a fetus in the shoulder breech, or any other abnormal position.
  • Ruptured uterus.
  • Presence of weak uterine scars from previous surgery or cesarean.
  • Fetus too large for the mother’s birth canal.
  • Rapid toxemia–a condition in which high blood pressure can lead to convulsions in late pregnancy.
  • Vaginal herpes infection–which could infect an infant being born vaginally, and lead to its eventual death.
  • Pelvic tumors–which obstruct the birth canal and weaken the uterine wall.
  • Absence of effective uterine contractions after labor has begun.
  • Prolapse of the umbilical cord–when the cord is pushed out ahead of the infant, compressing the cord and cutting off blood flow.

What Are The Maternal Risks In Cesarean ?

The risks of any medical procedure are determined by examining the related mortality statistics showing death rates and morbidity figures showing complications, injuries or disorders linked to the event. These vary from hospital to hospital and from locale to locale.

Although maternal death during childbirth is extremely uncommon, national figures show cesarean birth carries up to four times the risk of death compared to a vaginal delivery. The maternal mortality rate for vaginal delivery in 1978 was about 10 deaths per 100,000 births. For cesareans, the rate was about 41 deaths per 100,000 births. (In some cases, maternal deaths indicated in these figures were caused by illness rather than the surgery.)

The morbidity rates associated with cesarean births are higher than with vaginal delivery. Because major surgery is involved, the chance of infection and complication is greater. The most common are endometritis (an inflammation of tissue lining the uterus) and urinary tract or incision infections.

Does Cesarean Childbirth Require Special Anesthesia?

The use of anesthesia during childbirth is unique because it requires attention to the infant about to be born as well as the mother. Although rare, anesthesia-related maternal deaths continue to occur. Most, however, are potentially avoidable.

There are three major anesthetic techniques for cesarean birth. Spinal anesthesia is widely used, although the use of lumbar epidural anesthesia is increasing. Both are considered “regional” anesthesia because they deaden pain in only part of the body without putting the patient to sleep. General anesthesia, which renders the patient unconscious, is often used in an emergency situation and with women who object to the spinal or epidural approach.

The consensus panel recommended that the types of anesthesia available should be discussed among the patient, obstetrician and anesthesiologist. Each approach has advantages and disadvantages. If possible, the report recommends, the patient should have the option of receiving regional instead of general anesthesia.

Are There Risks To The Infant?

Infants delivered with elective cesarean surgery, especially if it is performed before the onset of labor, appear to have a greater risk of respiratory distress syndrome (RDS). This condition, in which the infant’s lungs are not fully mature, may result if an error is made in estimating the age of the developing fetus. Under these circumstances, an infant–who otherwise would have been healthy if allowed to develop fully–encounters the problems of prematurity when removed too soon by cesarean. These include RDS and other lung disorders, feeding problems and various complications which is some cases require a long hospital stay.

Measures and techniques to assess the maturity of the fetus and the degree of lung development are readily available in the United States. The consensus report stressed the need for improving physician and patient education about the safe and effective use of these techniques in planning for elective cesarean delivery. Respiratory distress is unlikely to be a problem, regardless of the type of delivery, if the infant is born at or near term.

What Are The Psychological Effects Of Cesarean Childbirth?

Other factors must be taken into consideration when weighing the prospects of cesarean. Although there has been only limited research on the psychological effects on parents following a cesarean birth, it is clear that surgery is an increased psychological and physical burden compared to vaginal delivery. In limited follow-up studies of infants, there has been no evidence of an adverse psychological effect on infants born by cesarean.

In some hospitals, family-centered maternity care has been extended to cesarean deliveries. The presence of the father in the operating room and the closer contact between the mother and newborn in this approach appear to improve the cesarean process.

The consensus panel recommended strengthening the information exchange and education of perspective parents about the overall cesarean experience. They urged hospitals to allow fathers in the operating room when possible and to avoid routinely separating the newborn from its parents immediately following delivery.

Tags: Caesarean, Breech birth, Stillbirth, Caesarean delivery on maternal request, Cardiotocography

Sharing Childcare

December 8, 2009 by  
Filed under Education

If in-home care is appealing but the costs are too high, consider shared care. It may provide you with just the services you are looking for. Many parents prefer to have their children cared for in a home environment. However, for some the cost of private, in-home care is too burdensome. The perfect alternative for these parents may be shared care.

In a shared care setting, several families work together to hire a nanny or other caregiver who usually rotates between the families??? homes. This option allows families to have the personalized services of in-home care, while keeping the cost down. Parents who hire shared-care help often feel they have more control over the kind of care their children receive, and the size and makeup of the group. They also have the ability to design their own program and include the activities which are important to them.

As you start investigating shared care alternatives, here are a few things to keep in mind:

  • How many kids do you want in the group?
  • Do you want all of the other children to be your child???s age?
  • Is it more convenient for you to seek out parents near your work or your home?
  • Do you prefer a caregiver who has been formally trained or one who has a good deal of practical experience?
  • Are similar religious and philosophical views important or do you prefer your child to be exposed to a variety of views?
  • Is your family vegetarian, or do you have other preferences for your child???s diet?
  • Is it important to you to have more of a structured program for your child or do you prefer spontaneous activities?
  • Do you prefer that your children are not exposed to certain things like too much TV or toy guns?
  • Does your child have special needs that would require specific care?

You can find other parents who are interested in setting up a shared care arrangement by checking local referral services, putting an ad in the paper, or posting a notice at your local grocery store, church or synagogue.

Tags: Shared care, Social work, Family, Home care, Geriatrics, new born

Information About Cesarean Birth

December 8, 2009 by  
Filed under Education

In the United States and Canada almost one in four babies is born by an operation called cesarean section. Consumer and medical groups alike have expressed concern over the rising numbers of cesarean sections. Yet many families seem to believe that a cesarean is just another way to have a baby. Are there definite disadvantages to a surgical birth? It’s time to look at some important facts about cesareans.

Why are there so many cesareans?

Researchers have listed many reasons for the high number of cesarean sections. These include a difficult or long labor, fetal distress, a breech presentation (when the baby is not arriving head first), placental problems, and other conditions in the mother such as toxemia, diabetes and severe bleeding, a greater use of technology such as electronic fetal monitoring and one or more previous cesareans. Some reasons are valid; others are not necessarily beneficial for the mother or the baby.

But cesareans save lives, don’t they?

Of course they do, when they are absolutely medically necessary. They also have risks and side effects that can physically affect the mother and her baby right away and can change the relationship among mother, infant and family by adding more and different stresses than those following a normal vaginal birth.

But a cesarean can prevent the pain of labor and birth.

That’s an interesting thought, but cesarean mothers usually have much more pain after their babies are born. After all, a cesarean is major surgery where several layers of body tissue are cut open and then repaired. This certainly makes it difficult to move, walk, urinate, and to hold and feed a newborn for at least several days or even weeks afterward. Mothers often need much medication to cope with the constant pain following a cesarean. Gas pains, which can be severe, and a sensation of one’s insides failing out are also quite common. Other discomforts include an itching or oozing at the incision area and a general feeling of exhaustion.

In addition, cesareans carry all the same risks of major abdominal surgery including:

  • Infections of:
    • the uterus
    • the bladder
    • the wound (incision)
  • Excessive loss of blood
  • Blood clots
  • Adhesions (scar tissue) within the abdominal cavity
  • Injury to nearby organs (bladder, bowel)
  • Blood transfusion complications
  • Pneumonia
  • Death related to surgery
  • Injury to baby

Major complications such as death following a cesarean are rare. Others such as infections are more common. When a cesarean is a possibility, you need to know about these risks. You should also find out about the possibility of even suspected long-term risks such as infertility due to scar tissue. At the very least, recovery from a cesarean section takes longer since mothers are usually in more pain and more tired afterward. Mothers also need more support physically and emotionally than those who give birth vaginally.

Well, then, aren’t cesareans better for babies?

Once again, that is sometimes true, when the risks associated with a cesarean are outweighed by the benefits of having a baby born surgically. Sometimes a cesarean is performed before labor begins. However, even with advanced techniques (ultrasound or amniocentesis), there is a greater risk of respiratory problems even in term infants than when the start of labor determines the baby’s birthday. Truly premature infants are subject to breathing and other physical difficulties of low birth weight, whether they are born surgically or vaginally. In addition, cesarean babies can also have anesthesia complications and may be sluggish and slow to start breathing. They may also suffer from some neurological problems. Such a start can impair relationships with the new baby, including a more difficult beginning to breastfeeding.

I never knew such a simple procedure could have such effects.

Oh, but the point is, as cesareans have become more commonplace, we’ve accepted them as simple procedures. But, although cesarean sections are safer than ever and, when necessary, a true blessing, a cesarean is clearly not a simple procedure. And we haven’t even talked about those other side effects that are harder to measure.

What does that mean?

Well, there is no doubt that the immediate relationship between the cesarean mother and her baby is different from the relationship after a natural birth. The mother may be groggy and unable to hold her baby and baby is often moved out of sight and touch for an examination during the important introductory moments following birth. Infant and parents may be separated for a time while the baby is observed in a central nursery. After a cesarean, mothers often describe a wide range of feelings that include failure, anger, disfigurement, inadequacy and resentment, while at the same time feeling glad that their babies are born. Such opposite feelings can sometimes lead to an uneasy and confusing start for parenting. It’s harder to care for a baby when you need so much care yourself. Fathers and other companions may feel frustrated at having to give so much more physical and emotional support. After all, besides learning to care for her newborn and/or taking care of other children, a cesarean mother is recovering from surgery. The time following a baby’s birth is tiring. As sleep, housekeeping and general life patterns change to meet the needs of the new family, the additional needs of the cesarean mother may increase the typical difficulties of adjusting to the new baby.

If I really don’t need a cesarean, how can I avoid one?

Education is the key word in preventing unnecessary cesareans and having a safe and memorable birth experience. Find out about birth practices in your area. Why and how often do caregivers recommend and perform cesareans? Choose a supportive caregiver and birthplace with the lowest possible rate of cesarean sections. Contact local childbirth educators, midwives and consumer groups such as childbirth education or breastfeeding associations for their information. Even before you become pregnant, look for the many available publications and resources to help you find ways to have a more natural pregnancy, labor and birth. Find out about how you can naturally cope with labor and about trained labor support persons who can help you avoid pain medication and anesthesia. Read Unnecessary Cesareans – Ways to Avoid Them. If you have had a previous difficult birth (whether cesarean or not), you will want to consider what happened and why. Was the difficulty caused by a chain of events that changed the natural process? Unpleasant memories of events and interventions in labor can make it painful to look forward to another birth. It can be helpful to work through such past experiences before you become pregnant again.

Develop a confidence and belief that birth is a safe and natural process that generally succeeds without intervention. Recognize that when a cesarean section is necessary, it can be truly life-saving, but that giving birth naturally is the way it is meant to be.

Copyright 1992 International Educators Association (used with permission)

Common Feelings After Unexpected Cesarean Birth

  • Combination of relief, fear, shock – if labor has been long or difficult, if there has been anxiety for the mother or baby – a sense of not knowing what to expect, or having lost control.
  • Disappointment – especially common when parents have expected and prepared for a more active participation in the birth.
  • Loneliness – being separated at a time when support, closeness, and the need to be together occurs.
  • Failure – feelings of inadequacy because delivery was not vaginally. Support person may feel that she/he let the mother down by not being present for the birth.
  • Anger – “Why” and “why me”, anger at the doctor, nurses, baby’s father, and/or the family.
  • Resentment – towards the baby for the cause of her pain, discomfrot, and trouble. Cesarean mothers often have less energy at first and may resent the demands and responsibilities of child care.
  • Self blame and depression – turning anger inward – “if only I hadn’t gained so much weight, if only I didn’t do this, or had done that.”
  • Self esteem – sometimes suffers because they couldn’t do it “right” and that they are failures as women.
  • Body Image – may suffer. Not only have their bodys not worked “right”, but the scar is an ever present reminder. Some women may feel rejection from their mate due to the scar.
  • Depression – a period of the “blues” may be common after any mothod of childbirth. Cesarean parents may feel that the birth was a “let down”.
  • Mixed feelings of future births – many dread the anxiety and pain of another cesarean. Others may see it as a relief from the labor.
  • Guilt – over having negative feelings at a time when a mother (or parents) is (are) to be happy with their new baby.
Tags: Obstetrics, Breech birth, Elective caesarean section, Surgical procedures, Pregnancy, Midwifery, Childbirth

Vaginal Birth After Cesarean Birth – VBAC

December 8, 2009 by  
Filed under Education

You’ve had one or more cesareans and you’re looking ahead to your next birth. “Once a cesarean, always a cesarean” is no longer the rule, and for reasons that are uniquely yours, you want to have a vaginal birth this time. Good for you! You are about to join the growing number of women who have planned for a vaginal birth after a cesarean (VBAC).

Why have a VBAC?

Many women want to have a VBAC because of the feeling that they missed out on an important life experience when they had a cesarean. They want to feel a baby move through and out of their bodies and into their arms. Other women and medical professionals know that labor is important for the newborn’s adjustment to life outside mother. They also know that vaginal births are safer for mothers and infants than planned cesareans. Still others want a faster recovery from their births and to go home much sooner than when they had a cesarean. They want to mother and nurture their infants (and other children) without the restrictions that accompany surgical delivery. They want to avoid surgery and its risks and complications.

You may share these reasons or have different ones, but it’s important to remember that any reason to want a VBAC is a good reason.

What do I need to know about my previous cesarean?

It’s helpful to know why you had your cesarean(s). Most reasons for a cesarean don’t necessarily repeat themselves. These include:

  • Fetal distress – baby in trouble;
  • Cephalopelvic disproportion (CPD) – “too-big baby for too-small pelvis;”
  • Failure to progress – labor lasts too long;
  • Breech position – baby comes bottom or feet first;
  • Transverse – baby lies sideways;
  • Abrupted placenta or a placenta previa – location or separation of the placenta causing bleeding and problems with the baby’s supply of oxygen;
  • Prolonged rupture of the membranes – the bag of waters breaks, and either labor does not begin or the baby is not born within a specified amount of time;
  • Previous birth(s) by cesarean – including planned, repeat cesareans.
  • Despite cesareans for the above or other reasons, countless women have successfully and safely had their later babies vaginally.

What about my scar?

It is important to know the type of incision that was used on your uterus. The two most common incisions are the horizontal (low transverse), which is considered the safest, and vertical (classical or low vertical). You should check with your doctor or hospital records to see if your abdominal scar (outside, on your skin) is different from you uterine (inside) scar. It is encouraging to know that some women who did not know their type of uterine incision have been permitted to labor and gave birth vaginally without any problems.

In the past the most common reason for planned, repeat cesareans was a belief that the uterine scar would rupture (or separate) during a vaginal birth. Recent medical findings, however, show that this is extremely rare, particularly in the case of the more common low transverse incision. The risk of uterine rupture is far less than the risk of complications associated with a cesarean.

What about a caregiver?

In many places women planning VBAC can choose between midwives, obstetricians and family physicians. As VBAC becomes more common, it is easier for women to be accepted as VBAC clients by all practitioners.

The way a woman is treated in pregnancy and labor varies from one caregiver to another. Because midwives use fewer medical interventions, women under their care are less likely to have a cesarean section.

What about medical interventions?

Common interventions in pregnancy and labor might include the use of ultrasound, electronic fetal monitoring, drugs to start or speed up labor, breaking the bag of waters, intravenous fluids (IV) and the use of a wide variety of drugs for pain relief. Although advantages may exist for such practices in some instances, routine use of such interventions may interfere with the progress of labor and increase the possibility of another cesarean.

Not all midwives or doctors follow the same guidelines and procedures for VBAC. Some prefer using interventions, whereas others offer care with fewer restrictions and more choices. Recent medical guidelines state that women with one previous low-transverse incision should be treated the same as the woman without a previous cesarean! Professionals now even recommend that women with two or more cesareans can have a VBAC if they wish.

As with any birth, it is important for you to discuss with your caregiver and hospital what options exist for you during labor and birth. If you know your choices, you can negotiate for something different or even change to a caregiver who will respect your preferences and treat you as individually as possible.

How can I guarantee that I will have a VBAC?

No one can guarantee that you will have a VBAC, although current medical information makes it clear that most cesarean mothers can later give birth naturally. But there are some things that VBAC women have found helpful to increase the chances for a vaginal birth.

What can I do before I get pregnant (or in early pregnancy)?

  • Inform yourself and take personal responsibility for your birth experience. Learn as much as you can before you get pregnant and during your pregnancy. There are many excellent books, films, tapes and written materials on VBAC and birth in general. Such information can help you make informed choices and accept the responsibility for your birth.
  • Join a support group. Don’t overlook the value of cesarean or birth support groups that may exist in your area. The information and caring atmosphere in such groups can help promote healing of any past unhappy birth experiences and offer encouragement for upcoming births.
  • Take childbirth classes. Consumer-oriented childbirth classes or special VBAC classes offer a wealth of information and skills. They also give you and your partner an opportunity to consider this new pregnancy and birth as a separate experience from your cesarean(s). Learn and practice the skills you are taught to cope with the reality of labor.
  • Get in touch with yourself. Techniques such as visualization, meditation and affirmation can help you heal and accept feelings inadequacy, grief and failure from past births. Recognizing these feelings, even if they are not totally resolved, will help clear the way for more positive thoughts and more confidence in yourself and the birth process.

My partner is nervous about a VBAC. What can I do?

Talking to each other about past birth(s) will help clarify ways in which you can work together toward VBAC. Involve your partner as you read and research. Reassure your partner that vaginal birth is safe and the best choice for you and your baby – and important to you! Another labor support person can assist both of you during labor. You might also ask your partner to read this booklet.

What about additional companions?

Some women have found it helpful to have one or more additional people with them as they labor and give birth. Such companions, professional or not, should be available to the woman throughout her labor and should know exactly what the pregnant woman wants from her birth.

If you choose to have others at your birth, let them know your desires before labor begins. For example, do you want a birth without medication or are you willing to accept medication under certain circumstances? When are you planning to go to the hospital? And so on…

What can help me in labor?

There are simple measures that can help a woman work with her labor. Many women have found it a good idea to wait until labor is well established before they telephone their caregiver or to go the place where they will give birth. Still others have found that eating and drinking in labor, walking, making noise, taking a warm bath or shower, being upright and/or avoiding interventions and drugs have helped them work better with their bodies. It is also important to know that lying flat on your back in labor is not helpful and can cause complications to your baby.

My friends think I’m crazy to want to labor.

VBAC is a very personal decision, and sometimes a lonely one. If you find that family and friends are not supportive of your goals, it’s probably best to keep your feelings and plans to yourself, or to share them only with those friends who understand your feelings. A local support group can be especially helpful at a time like this and give you any additional information you may need.

Being pregnant and planning a VBAC are not everyday occurrences. You deserve a supportive environment. You probably don’t agree with your friends and family about everything anyway. What you want for you, your baby, and your family is your responsibility.

What if I end up with another cesarean?

This is a difficult question. Certainly if you have planned and worked for a VBAC, having another cesarean can be, at the least, a disappointing or sad experience. You will have physical and emotional reactions common to cesarean mothers – some of which may be familiar to you. However, you will not be a failure, because you have worked at having the best possible birth experience for you and your baby. Sadness and grief over any loss (including the loss of a vaginal birth) is a part of living. As time passes, you will find that you have grown and learned from this experience too. Women who have repeat cesareans after planning vaginal births often say how glad they were to have tried. Many are delighted that labor began on its own and their babies were naturally ready to be born.

Is all this effort to have a VBAC really worth it?

Women who have traveled this road have found new strengths and confidence as a result. They have filled spaces in themselves emptied by previous births and have been pleased with the new discoveries of their abilities as women.

Combination of relief, fear, shock – if labor has been long or difficult, if there has been anxiety for the mother or baby – a sense of not knowing what to expect, or having lost control.

Disappointment – especially common when parents have expected and prepared for a more active participation in the birth.

Loneliness – being separated at a time when support, closeness, and the need to be together occurs.

Failure – feelings of inadequacy because delivery was not vaginally. Support person may feel that she/he let the mother down by not being present for the birth.

Anger – “Why” and “why me”, anger at the doctor, nurses, baby’s father, and/or the family.

Resentment – towards the baby for the cause of her pain, discomfrot, and trouble. Cesarean mothers often have less energy at first and may resent the demands and responsibilities of child care.

Self blame and depression – turning anger inward – “if only I hadn’t gained so much weight, if only I didn’t do this, or had done that.”

Self esteem – sometimes suffers because they couldn’t do it “right” and that they are failures as women.

Body Image – may suffer. Not only have their bodys not worked “right”, but the scar is an ever present reminder. Some women may feel rejection from their mate due to the scar.

Depression – a period of the “blues” may be common after any mothod of childbirth. Cesarean parents may feel that the birth was a “let down”.

Mixed feelings of future births – many dread the anxiety and pain of another cesarean. Others may see it as a relief from the labor.

Guilt – over having negative feelings at a time when a mother (or parents) is/are to be happy with their new baby.

In the United States and Canada almost one in four babies is born by an operation called cesarean section. Consumer and medical groups alike have expressed concern over the rising numbers of cesarean sections. Yet many families seem to believe that a cesarean is just another way to have a baby. Are there definite disadvantages to a surgical birth? It’s time to look at some important facts about cesareans.

Why are there so many cesareans?

Researchers have listed many reasons for the high number of cesarean sections. These include a difficult or long labor, fetal distress, a breech presentation (when the baby is not arriving head first), placental problems, and other conditions in the mother such as toxemia, diabetes and severe bleeding, a greater use of technology such as electronic fetal monitoring and one or more previous cesareans. Some reasons are valid; others are not necessarily beneficial for the mother or the baby.

But cesareans save lives, don’t they?

Of course they do, when they are absolutely medically necessary. They also have risks and side effects that can physically affect the mother and her baby right away and can change the relationship among mother, infant and family by adding more and different stresses than those following a normal vaginal birth.

But a cesarean can prevent the pain of labor and birth.

That’s an interesting thought, but cesarean mothers usually have much more pain after their babies are born. After all, a cesarean is major surgery where several layers of body tissue are cut open and then repaired. This certainly makes it difficult to move, walk, urinate, and to hold and feed a newborn for at least several days or even weeks afterward. Mothers often need much medication to cope with the constant pain following a cesarean. Gas pains, which can be severe, and a sensation of one’s insides failing out are also quite common. Other discomforts include an itching or oozing at the incision area and a general feeling of exhaustion.

Cesareans have all the same risks of major abdominal surgery including:

  • Infections of:
    • the uterus
    • the bladder
    • the wound (incision)
  • Excessive loss of blood
  • Blood clots
  • Adhesions (scar tissue) within the abdominal cavity
  • Injury to nearby organs (bladder, bowel)
  • Blood transfusion complications
  • Pneumonia
  • Death related to surgery
  • Injury to baby

Major complications such as death following a cesarean are rare. Others such as infections are more common. When a cesarean is a possibility, you need to know about these risks. You should also find out about the possibility of even suspected long-term risks such as infertility due to scar tissue. At the very least, recovery from a cesarean section takes longer since mothers are usually in more pain and more tired afterward. Mothers also need more support physically and emotionally than those who give birth vaginally.

Well, then, aren’t cesareans better for babies?

Once again, that is sometimes true, when the risks associated with a cesarean are outweighed by the benefits of having a baby born surgically. Sometimes a cesarean is performed before labor begins. However, even with advanced techniques (ultrasound or amniocentesis), there is a greater risk of respiratory problems even in term infants than when the start of labor determines the baby’s birthday. Truly premature infants are subject to breathing and other physical difficulties of low birth weight, whether they are born surgically or vaginally. In addition, cesarean babies can also have anesthesia complications and may be sluggish and slow to start breathing. They may also suffer from some neurological problems. Such a start can impair relationships with the new baby, including a more difficult beginning to breastfeeding.

I never knew such a simple procedure could have such effects.

Oh, but the point is, as cesareans have become more commonplace, we’ve accepted them as simple procedures. But, although cesarean sections are safer than ever and, when necessary, a true blessing, a cesarean is clearly not a simple procedure. And we haven’t even talked about those other side effects that are harder to measure.

What does that mean?

Well, there is no doubt that the immediate relationship between the cesarean mother and her baby is different from the relationship after a natural birth. The mother may be groggy and unable to hold her baby and baby is often moved out of sight and touch for an examination during the important introductory moments following birth. Infant and parents may be separated for a time while the baby is observed in a central nursery. After a cesarean, mothers often describe a wide range of feelings that include failure, anger, disfigurement, inadequacy and resentment, while at the same time feeling glad that their babies are born. Such opposite feelings can sometimes lead to an uneasy and confusing start for parenting. It’s harder to care for a baby when you need so much care yourself. Fathers and other companions may feel frustrated at having to give so much more physical and emotional support. After all, besides learning to care for her newborn and/or taking care of other children, a cesarean mother is recovering from surgery. The time following a baby’s birth is tiring. As sleep, housekeeping and general life patterns change to meet the needs of the new family, the additional needs of the cesarean mother may increase the typical difficulties of adjusting to the new baby.

If I really don’t need a cesarean, how can I avoid one?

Education is the key word in preventing unnecessary cesareans and having a safe and memorable birth experience. Find out about birth practices in your area. Why and how often do caregivers recommend and perform cesareans? Choose a supportive caregiver and birthplace with the lowest possible rate of cesarean sections. Contact local childbirth educators, midwives and consumer groups such as childbirth education or breastfeeding associations for their information. Even before you become pregnant, look for the many available publications and resources to help you find ways to have a more natural pregnancy, labor and birth. Find out about how you can naturally cope with labor and about trained labor support persons who can help you avoid pain medication and anesthesia. Read Unnecessary Cesareans – Ways to Avoid Them. If you have had a previous difficult birth (whether cesarean or not), you will want to consider what happened and why. Was the difficulty caused by a chain of events that changed the natural process? Unpleasant memories of events and interventions in labor can make it painful to look forward to another birth. It can be helpful to work through such past experiences before you become pregnant again.

Develop a confidence and belief that birth is a safe and natural process that generally succeeds without intervention. Recognize that when a cesarean section is necessary, it can be truly life-saving, but that giving birth naturally is the way it is meant to be.

Tags: Uterine rupture, Vaginal birth after caesarean, Caesarean section, Midwifery, Breech birth, Childbirth, Pregnancy, Obstetrics, vaginal birth

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