Pregnancy and child birth

• 1. To look at health issues surrounding pregnancy• 2. To look at stages of development of the foetus• 3. To look at the stages of birth• 4. To look at care for the mother during pregnancy• 5. To look at care of mother and baby at birth• 6. Health and infancy• 7. Health complications for mother and baby

Preparing to get pregnant• Get fit• Loose extra weight• Take folic acid to prevent spina bifida• Give up smoking (Mum and Dad) and drugs/misuse of alcohol.• Save cash• Have lots of sex• Monitor body temperature to identify ovulation• See doctor about any pre-existing medical conditions and

medication• Get counseling and genetic testing if relevant.

Conception

• Normally through natural fertilisation• Risk of STD transmission• May be unwanted• Can take place outside the womb (in vitro)

fertilisation followed by implantation.

Fertilisation

Development within the mother

• Baby develops within the womb (uterus)• Supplied with food and oxygen from mother’s

blood• Wastes removed via mother’s blood• Baby and mother’s blood separate • Transfer is by diffusion between blood vessels

in the placenta

Function of the placenta

Stages of pregnancy

Medical issues in pregnancy• 1. Ectopic pregnancy – baby develops in fallopian tube –

potentially fatal and compromises future chances of pregnancy• 2.Excess weight gain – may also affect blood pressure• 3. Pre-eclampsia –high blood pressure, inflammation and odema

(in last trimester) bed rest• 4. Eclampsia – potentially fatal blood pressure can lead to

strokes Immediate caesarian• 5. Gestational diabetes associated with obese mothers/diabetic

families. After birth, mother must be treated as type 2 diabetic until her glucose levels normalise.

• 6. Miscarriage – very traumatic for mother. May be result of compromised pregnancy or trauma during pregnancy. Smokers, drug use, malnutrition.

Rhesus negative mother.• Mother is Rhesus negative• 1st Baby is rhesus positive and fine• 2nd baby is rhesus positive and mother become very ill and

terminates pregnancy• Rhesus +ve baby causes mother to create antibodies which

kill second baby• Mother can receive vaccination immediately after 1st birth to

prevent this• If mother has had a rhesus positive blood transfusion there is

nothing that can be done and all rhesus positive babies will die.

Medical issues in pregnancy (baby)

• 1st Trimester• Placenta previa (placenta too low in uterus) – can

lead to miscarriage. Next pregnancy will not normally have same problem

• 2nd trimester • Genetic and developmental malformations such as

hare lip, heart defects, kidney. Can be operated in utero saving many post partem operations.

• May be traumatic to foetus – science cannot agree.

Third trimester

• Birth may occur early due to eclampsia• Placenta can start to die and calcify early• This has to be carefully monitored• May result in early delivery of baby.• Babies of smokers small and undeveloped with

respiratory problems• Babies of drug and alcohol misuse small with other

developmental problems: often neurological or mental• Caffeine in pregnancy and whilst breast feeding up to 3

months: irritable baby syndrome

Birth

Usually supported by another woman “midwife”. May be medically trained or may not.

Stages of Labour• Length of time very variable• Baby’s head is engaged at top of cervix• Hormone oxytocin initiates contractions• Contractions gradually become stronger and more frequent• Mucus plug in cervix is expelled “the show”• Vagina starts to dilate• Amniotic sac is burst and fluids expelled (breaking of waters)• Vagina dilates further and contractions become increasingly

frequent and stronger• Baby is delivered down vagina

Possible complications

• Breech birth (baby comes legs first and head may get stuck)

• Baby may get cord tied around neck• Vagina may tear or be cut (episiotomy). Good

episiotomy thought to aid healing and reduce risk of incontinence and loss of sexual pleasure

• Mother may become exhausted and stop pushing (poor antenatal education; too early to go into labour ward)

• Post-natal depression• Still birth (poor medical care or practice)

Birthing choices

• Most births are natural and proceed perfectly without event.

• But if something goes wrong mother and baby are in mortal danger thus choices involve weighing risks

Birthing choices continued• Mother can opt to have baby under medical supervision in a hospital• Or at home• She may opt for a birthing pool• She may opt for a sitting kneeling or squatting position. You don’t

have to be on your back• May have support of midwife and birthing partner (doula)• A caesarian may be offered or needed.• Pain control may be offered.• There are opinions in favour or against most of these.• Mothers may feel deeply unsatisfied with the birth process or

treatment and it is up to the midwife to aid them to understand events.

Care for the infant

• Checks immediately after birth• Breathing• Check anus is connected to rectum• Check passages are clear of muconium• Check sex• Weight• Temperature• APGAR

Score of 0 Score of 1 Score of 2 Component of backronym

Skin color/Complexion blue or pale all over

blue at extremitiesbody pink(acrocyanosis)

no cyanosisbody and extremities pink

Appearance

Pulse rate Absent <100 ≥100 Pulse

Reflex irritability no response to stimulation

grimace/feeble cry when stimulated

cry or pull away when stimulated Grimace

Muscle tone none some flexionflexed arms and legs that resist extension

Activity

Breathing absent weak, irregular, gasping strong, lusty cry Respiration

APGAR Score

Interpreting APGAR• Done one and five minutes after birth, and may be repeated later

if the score is low. Scores 3 and below are generally regarded as critically low,

• 4 to 6 fairly low, and • 7 to 10 generally normal• Low score on the one-minute test may show that the neonate

requires medical attention

• not necessarily an indication of long-term problems, particularly if there is an improvement by the stage of the five-minute test.

• If the Apgar score remains below 3 at later times such as 10, 15, or 30 minutes, there is a risk that the child will suffer longer-term neurological damage

Possible complications

• Infant jaundice. Normally not a problem as it is due to break down of foetal haemoglobin and its replacement with normal.

• Blue baby – may indicate heart or lung problems. May naturally heal or may need surgery

• Diabetic cherub. V large but not very well developed.

Why breast is best• Mother’s milk is obviously evolutionary designed to be best for baby’s needs it’s

personal mother produces exactly what her baby needs• Has exactly right quantities of each nutrient• Provides baby passive immunity• Is better for baby’s breathing• Prevents later allergies and milk intolerance• Is better for mother’s health – reduces chances of osteoporosis and breast

cancer• Helps mother loose weight• Semi-contraceptive • All women can breast feed – breast size and nipple shape not an issue.• Must not do it if HIV +ve• Adoptive mothers can have induced lactation but it is not necessarily the best

for baby or mother

Weaning• At ages 6 months (after which quality of mother’s milk falls)• First start on liquidised food (best at 6 months)• Avoid any foods with added sugar or salt• Liquidise your meals• Continue to breast feed• Cease breast feeding when you and baby feel ready (no right

age)• No eggs, citric fruits, strawberries, chocolate, pea nuts, spices,

chillies because they may produce allergies• Mother must allow child to try all flavours, not just those she

likes. Start veg before fruit

Baby illnesses

• Weak immune system – more prone to colds etc and any communicable diseases

• Never let baby get too warm – only put second or third layer on when ready to walk out the door. Baby easily overheats

• Prone to colic and other gastrointestinal inflammations – especially if not breast fed Linked to mother’s diet. If food upsets mother it will upset baby.

• Delicate so cannot be shaken or dropped

Foetal testing and monitoring

• For things like spina-bifida and Down’s syndrome

• Done by amniocentesis – usually following a less invasive protein test

• Can test for CF – makes for much better treatment of child

Ultrasound

• Need one per trimester• (unscrupulous doctors here give you more

because you pay)• Advise • Week 8 – 10• Week 18• Week 30• More if problems identified

Pre-implantation genetic testing

• Done if parents carry genetic diseases such as cystic fibrosis and Huntington’s disease

• Requires IVF• A series of embryos are created• Tested to see if they have the healthy or

diseased genetic compliment • Several healthy embryos implanted

What if you don’t want it.

• Option 1 contraception• Barrier methods (prevent transmission of STDs

as well• Chemical measures. Pills or for the forgetful

implants and injections• Cervical implants (coils) • Copper implants in arm• Behavioural methods

If it’s too late

• The morning after pill can be taken up to 3 days after pregnancy

• Similarly a course of antivirals can be taken if it is thought you’ve been exposed to HIV

• Abortion (legal only in DF)• Adoption (huge shortage of potential babies in

US and Europe) Not so here?

Plenary

• Imagine you’re an expectant mother and write down three questions you have about pregnancy, birth or care for the child.

• Carefully review the presentation• Ask question of expert panel members• Be prepared to be on the expert panel and to

get asked questions as well.