March 11th, 2009
Most women will recognize the gradual build-up of strength and frequency contractions and other signs (show of blood and breaking of the waters) that signal that labour has started. But not all labours go according to the books, of all you’ve learned, you can be taken by surprise. My favorite story, though unusual, is of a friend who, without any warning, at 37 weeks delivered health on the dining-room floor within minutes of serving the soup to dinner guests! Don’t be alarmed: this is a very rare experience.
It’s generally better to set off for the hospital early rather than too late. Check with the delivery suite if in doubt (there is someone on duty 24 hours a day). Your partner or the taxi driver could probably rise to the occasion if necessary, but I’m sure that both you and they would prefer
experienced hands for your delivery! Until about 70 years ago, most babies were born at home, usually with the help of the local midwife or GP. During the 1920s the trend to having a baby in hospital began, and by 1950 a home birth in Australia was a rarity. Childbirth in hospital became (and still is) favoured for its greater safety, leading to the rapid growth of obstetrics as a speciality, and medical technology was applied to childbirth. We’ve now gone the full circle. Since the late 1970s there’s been an increasing demand for the services of midwives for home births and for hospital services that would allow a natural delivery if appropriate, rather than every confinement being subjected to high-technology
interference.
Twenty years ago women rarely questioned what happened to them during hospital confinement. Today the reason and need for many common obstetric procedures has been challenged, and women expect to have a much greater say about how they would like their childbirth to be managed. The aim of all obstetric interventions should be the birth of as healthy a baby as is possible with minimum risk to the mother. Here are some of the controversies.
Recent changes in approach to childbirth
Many women these days have well-formed ideas about how they would like their labour and delivery to proceed. Judith was delighted when I confirmed her first pregnancy. She said: ‘I want to have this baby naturally. Jim and I have decided that we want our baby to be born without anaesthetics or any interference.’ Marie’s reaction was quite different. She said: ‘Refer me to a hospital where they believe in pain relief in labour. I don’t mind how the baby is born, as long as everything is done to ensure a safe delivery.’
Which approach is best? It’s impossible to say. It’s good to gather information about modern childbirth services so that you can decide what you would prefer, and then find a birth attendant – GP, midwife or obstetrician – who will respect your wishes, answer your questions clearly and carefully explain anything that necessitates a change in plans.
Judith may be sadly disappointed if, for safety’s sake, she needs assistance during delivery. On the other hand, Marie may be pleasantly surprised if she doesn’t need pain relief during labour. Because what’s going to happen is so unpredictable, I think it’s better to keep an open mind.
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March 11th, 2009
This is vasectomy, in which the tube that carries sperm from the testis into the semen – the vas deferens – is cut and tied in the scrotum.
It wasn’t until the invention of the microscope in the late eighteenth century that sperm were seen in semen and identified as the male contribution to pregnancy. At this time sperm were thought to be miniature men, and one scientist of the time even claimed to have seen microscopic horses cantering through semen! The first human vasectomy was performed in England in 1893, but for treatment of a prostate disorder rather than sterilisation. Over the next few decades die operation became disreputable because it was used involuntarily to treat sex offenders, to prevent masturbation and for eugenic purposes. Voluntary vasectomy as a method of birth control didn’t become established until after the Second World War, and even then there were doubts about its legality in some countries. The first nationally promoted vasectomy programme began in India in 1956, but acceptance of male sterilisation worldwide was slow until the 1970s and it is still forbidden by some nations and religions.
How vasectomy is done
This simple operation is usually done with local anaesthetic in a doctor’s rooms or outpatient clinic. Counselling, preferably of the couple, is best done at a separate visit beforehand.
A small incision is made in the centre font of the scrotum after injecting a small amount of anaesthetic (some surgeons use an incision on each side). The vas from each side is brought through the opening, cut, folded back on itself and tied. Many surgeons also cauterise the cut end. Each bid is then buried in the tissue beneath the skin. The incision rarely needs a stitch; a small dressing is usually enough. The procedure takes 30 minutes or less and most men say it causes little or no discomfort. Afterwards there may be discomfort, swelling and bruising of the scrotum that usually settle in a week or so. A scrotal support or firm-fitting underpants should be worn until the scrotum returns to normal. Usual activities can be resumed the next day (including sex if the man feels like it), though heavy exertion should be avoided for about a week.
Vasectomy doesn’t immediately result in sterility.
The long spermatic ducts between the site of vasectomy and the prostate are full of sperm-containing semen at the time of the procedure. It takes about 15-20 ejaculations to clear out all these sperm. Couples are advised to continue their usual method of contraception until semen examination has shown that all sperm have disappeared. The first test is usually done two months after vasectomy (or after 15 ejaculations, whichever is sooner), when more than 95 per cent will have zero sperm counts. If any sperm are seen, the check is repeated four weeks later. Checking picks up failure in the operation before there’s any risk of pregnancy.
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March 11th, 2009
In the early years after DPMA was introduced there was some uncertainty about its long-term safety. Some safety studies in animals (which used huge doses – 50 times those used in humans) had suggested a possible link with increased risk of pre-cancerous changes in Pap smears and of cancer of the endometrium and breast. There is now sound and convincing evidence that these risks do not apply to humans. There was also the worry (now also disproved) that the delay in return to fertility may be permanent.
The main reasons for the continuing controversy are moral and political. It is feared that injections may be given to women against their will or without telling them that they are for contraception and/or without telling them of the possible side-effects or problems. This is an abuse of human rights that should be condemned in every circumstance.
The opponents of DPMA certainly have a strong case against its abuse, but their arguments against its proper use to treat disorders or for contraception tend to ignore the evidence that it is safe and exaggerate the risk of side-effects.
To eliminate the possibility of abuse, any woman who is offered DPMA must be given full details about all its possible effects plus an unbiased account of the controversy, so that she can make a fully informed decision about using it.
DPMA has been used for many years in high dosage to treat breast and endometrial cancer, and has been used in low dosage for contraception by more than 10 million women. As a contraceptive, it has less health risks than the Pill, and no deaths have resulted from using a contraceptive injection. DPMA is used for contraception in more than 80 countries, and has been endorsed by such prestigious groups as WHO, the International Planned Parenthood Federation and the American and British Colleges of Obstetrics and Gynaecology.
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March 11th, 2009
Common questions about menstruation
How long do periods last?
They usually continue for three to six days. The most common pattern is for the discharge to be slow and darkish for the first few hours; then a steady, brighter red flow; for the next day or so; becoming slower: and darker over the next couple of days.
How much blood is lost at menstruation?
First of all, the menstrual flow is not all blood, though there is blood in the endometrium when it is shed, plus some more that leaks from the raw surface it leaves behind. The flow also contains the liquefied endometrium and some secretions from the cervix and vagina.
The average blood loss per period is around 40 ml, though it seems like more when it’s spread out on pads and tampons (but pour just 10 ml – 2 tsp – of coloured liquid onto a pad and see what a wide area it covers). A loss of more than 80 ml is abnormally heavy bleeding.
How can menstrual flow he measured?
The usual way has been to get women to save all the tampons and pads used during a period, and to extract the blood pigment (haemoglobin) they contain. By measuring the amount of haemoglobin per ml in each woman’s blood, her blood loss during the period can be calculated. Measuring the total amount of fluid in the Sow is more difficult. One way would be to weigh all pads and tampons before and after use and attempt to calculate the weight of the fluid, but this doesn’t give an accurate measurement.
Why doesn’t menstrual blood clot?
This is because the liquefied endometrium contains substances that dissolve blood clots. If there are clots in the menstrual flow it means that blood is flowing so quickly that it dilutes these substances I too much for them to be effective.
How long is the menstrual cycle?
It’s conventional to describe a menstrual cycle as covering 28 days, and in the majority of women menstruation does occur around every four weeks. However, anything from 22 to 35 days is within the normal range, and for most of us the cycle can vary by a few days from one month to the next.
Other questions about the menstrual cycle
Do other animals menstruate?
Only mammals (animals that breast-feed their young) have reproductive functions similar to those of humans. In cycles where there is no conception most other mammals absorb the dead lining of the uterus back into their bodies. Apes and some species of monkeys menstruate.
Can you tell when you’re ovulating?
Some women can. They notice brief lower abdominal pain at mid-cycle (also called mittelschmerz - German for ‘middle pain’) when the ovarian follicle ruptures. The pain may be followed by 12 hours or so of a tight feeling and tenderness in the lower abdomen due to irritation of the pelvic lining by the fluid released with the ovum. A few women regularly have a spot or two of bleeding from the vagina with ovulation.
If you’re watching your cervical mucus and basal body temperature, ovulation is near the time of peak fertile mucus, and you’ll know that ovulation happened 12-24 hours before the mucus becomes thick and sticky and the temperature rises.
Do women ovulate every month?
Regular periods don’t necessarily mean that you ovulate every month. The ebb and flow of hormones can lead to bleeding even if the ovarian follicles don’t ripen completely and release an ovum. This is called an anovulatory cycle. Without ovulation, bleeding may be somewhat heavier and longer and is usually painless.
Anovulatory cycles are very common for a year or so after the menarche and in older women approaching the menopause.
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March 11th, 2009
Adolescence is a time of discovering new aspects of life that you never thought of when you were a child. It can be thrilling (and sometimes a bit scary) to realize that so many new possibilities are open to you. Many teenagers want to have a go at everything: to test the limits of their ability and their new-found freedom.
The process of growing up includes! some experimenting and risk-taking to I find out what life has to offer and what is safe, good and right for you. If you didn’t take some chances you’d never grow up. Many of your new experiences will be wonderful and enrich your adult life. Unfortunately a few new adolescent activities bring risks to health and life.
Accidents
It’s a great day when you get your driving licence. What an exhilarating feeling of freedom and power to be in charge of a; car or motorbike. But whoa! It’s also a great responsibility. Are you ready for it? It takes time and practice to develop prudence and caution needed for safe driving.
I think the P-plate system helps young people learn to drive carefully. Most so keen to retain their licence that the] take all precautions during the provisions period. Still, road accidents seriously injure and kill more young people than any other cause. In more than half of the accidents, the driver is under the influence of alcohol or drugs. Even a blood alcohol level of 0.05 doubles the accident risk; at 0.15 a crash is 25 times more likely.
Never, never take a chance with drugs or alcohol on the road. Don’t drive yourself, and don’t be a passenger if the driver’s alertness and co-ordination could be affected by drinking (or anything else) This may sometimes mean that you must take public transport or a taxi home and collect the car next day. A nuisance? Yes, but it’s never worth risking serious injury or death.
Teenagers and alcohol
A survey of New South Wales school students that’s been going on since 1971 shows that they now drink twice as much as they did 15 years ago. Many are drinking regularly at the age of 14, with the heaviest drinking occurring among the 16-17-year-olds. Girls now drink as much as boys, so it seems that the old attitude that it was manly but unladylike to drink has disappeared in Australia. Boys tend to stick with beer, while girls prefer more sophisticated mixed drinks like rum and Coke (which don’t taste like booze but make you drank very quickly). Meanwhile health authorities continue to hammer away about the dangers of alcohol: its association with road accidents, domestic violence and increased risk of heart disease, liver disease, brain damage and all the social evils of alcoholism. You wonder why anyone drinks! Why do teenagers start drinking? And why so young? Teenagers see drinking as a thing adults do and seem to enjoy, so they want to try it. Often they see no harm come from it. They may doubt the message of the health authorities when they see no ill effects from Mum and Dad having a drink after work and a glass or two of wine with dinner, though the teenager whose home life is wrecked by a drunken parent may have a different opinion.
The fact is that alcoholic drinks are part of our way of life. Drinking is part of most of our social rituals. Australians swallow more alcohol per head than any other country in the Western world. It would be hypocritical to advise young people not to drink at all when they see their parents and other adults drinking all around them; alcohol is advertised everywhere and many big sporting contests are sponsored by breweries.
The credible message for young people is moderation, know your limits, don’t get drunk and, of course, never drink any alcohol if you’re going to drive. Still, a lot will get drunk once, just to see what it’s like. Let’s hope that most of them will decide in the misery of the next morning that they’ll never do it again.
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