Valerie Gommon Midwife’s Blog

Archive for the ‘termination of pregnancy’ Category

Pregnancy

“The condition of having a developing embryo or fetus in the body.”
“The process by which a human female carries a live offspring from conception until childbirth.”

Pregnancy is referred to as a gestation period – the time between conception and birth. Approximately 40 weeks (280 days). Measured from the first day of the last menstrual period. For women who use a procedure that allows them to know the exact date of conception (such as in-vitro fertilisation IVF, or artificial insemination) the gestation period is 38 weeks (266 days) from conception.

Pregnancy is divided into three stages – called trimesters, each lasting about 3 months.

An embryo is a multicellular diploid (has two sets of chromosomes) eukaryote (an organism whose cells contain complex structures enclosed within membranes) in its earliest stage of development; from the time of first cell division until birth. In humans, it is called an embryo until about eight weeks after fertilization (i.e. ten weeks after the last menstrual period or LMP), and from then it is instead called a fetus.
Embryo is the term used to describe the developing baby in the first 8 weeks and the term Fetus is the term used after 8 weeks until birth (when all the structure of the baby and systems of the body such as the digestive and nervous systems have developed).

Facts at 24 weeks
24 weeks is the legal cut off gestational age for a legal abortion (although abortions or terminations can be carried out later in the pregnancy on medical grounds).

COMPLICATIONS OF PREMATURE BIRTH
Babies born after 34 weeks have a low risk of problems although they are sometime slower to feed.
A baby born before 33 weeks will have more serious problems such as immature lungs.
Very premature babies (born under 28 weeks) need to be delivered in a hospital with a neonatal intensive care unit.
Doctors have been able to improve dramatically the survival hopes for babies born as early as 22 or 23 weeks.
However, very premature babies face a huge battle at the start of life. They are at risk of serious conditions including:
* Hypothermia, due to lower levels of fat
* Low blood glucose, which can lead to brain damage
* Respiratory distress syndrome – which can cause blindness
* Brain haemorrhage
Long-term they may have cerebral palsy and have sight and hearing problems.
They are also more likely to have motor impairments and co-ordination and concentration problems.

Birth
Occurs at around 38 weeks after fertilization, so 40 weeks pregnant. Term is considered to be 37 – 42 weeks gestation. The fetus has developed enough to survive easily outside its mother’s body. Babies are usually born head first but occasionally are born breech.

http://www.babycentre.co.uk/v1027487/inside-pregnancy-weeks-28-37

There are a variety of birthing methods; the majority of babies are born by a natural vaginal birth but some labours might need help such as
Ventouse, Forceps, Caesarean section.

The process of natural birth involves what is known as “labour” the baby passing from the mother’s abdomen through the vaginal passage and into the world. There are three stages of labour:

Stage 1: The cervix has to open and stretch around the baby’s head until it is 10cm open.

Stage 2: The baby has to come out, either by the expulsive efforts of the uterus and the mother breathing the baby out, or by her actively pushing the baby out.

Stage 3: The placenta or afterbirth has to be expelled.

Linked blog posts:

https://midwifevalerie.wordpress.com/2008/12/07/so-you-are-pregnant-preparing-for-the-birth/
https://midwifevalerie.wordpress.com/2008/12/19/the-big-day-the-birth/

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I confess that I’ve been quiet – I’ve actually been away!  As I have no babies currently due (in my Independent Midwifery Practice www.3shiresmidwife.co.uk) we took advantage and went up to the wilds of Cumbria for a week and had a great time staying at Dent railway station www.dentstation.co.uk – my husband is a train spotter!  So lots of walking, snow, eating and drinking for a week – fantastic.

Whilst away I saw a couple of interesting items in The Daily Telegraph.  One article discussed that scientists have found that young women are sensitive to babies physical appearance whereas post-menopausal women and men were less able to distinguish between babies.  The researchers believe that the difference could be a hormonal one and plan further research in relation to postnatal depression. www.telegraph.co.uk/scienceandtechnology/science/sciencenews/4306406/Women-can-distinguish-cute-babies.html

In the same newspaper there is an item discussing that early terminations of pregnancy (up to 9 weeks gestation) are to be provided in some GP surgeries www.telegraph.co.uk/health/healthnews/4306534/Abortions-in-GP-surgeries-to-be-extended..html

On a happier note, today I have been to a first birthday party – the baby was born at home a year ago.  Her mother had previously had a caesarean with her first baby but really wanted a natural birth second time around.  She laboured in a birthpool and had a relatively short and easy labour and birth second time around – wonderful!  It was lovely to visit and catch up with the family.

VBAC or vaginal birth after previous caesarean section has previously been controversial, but with better surgical procedures even doctors are keen that the majority of women attempt a vaginal birth next time as this is a safer option for both mother and baby.  Obviously it is important to review what happened during the last labour, and for some women a repeat caesarean may be the best option, but for many a vaginal birth will be possible.  Doctors and many midwives will recommend that a woman planning a VBAC give birth in hospital and that she be closely monitored, for example by having continuous external monitoring of the baby’s heart, and by having intravenous access in case of  uterine scar rupture which is a rare but very serious possibility.  Scar rupture rates are quoted at between 1:200 and 1:2000 depending upon which research you read, there is an excellent booklet discussing the subject “Birth after Caesarean” published by AIMS www.aims.org.uk/pubs3.htm However there are some who believe that by labouring at home, in a calm and relaxed environment, with no monitors or drips, will give the woman the best chance of giving birth normally.  Indeed some hospitals are now comfortable with “allowing” VBAC clients into the birthing pool for labour.  Most midwives and doctors agree that women attempting a VBAC should not have their labour “interfered” with; it can be dangerous to induce or augment a labour when a woman has a scar on her uterus.  If you are considering a VBAC I recommend that you discuss the matter carefully with your midwife or doctor and give yourself the very best chance of having a normal birth next time – many, many women are now achieving VBACs, and indeed I know of several women who achieved vaginal births after several previous caesareans so it is possible!

There was a very interesting and saddening item on Woman’s Hour (BBC Radio 4) yesterday.  Two years ago Nicaragua’s parliament introduced a blanket ban on abortion, making it a crime for a woman to end a pregnancy or have what is called a therapeutic abortion, there are no exceptions for victims of rape and incest or even when a woman’s life is in danger.

The programme can be heard at http://www.bbc.co.uk/radio4/womanshour/05/2009_03_wed.shtml

I really don’t want to get into an abortion debate – we all have our own opinion, and as a midwife my professional stance has to be that it is a personal decision and my job is to support a woman in her choices, however the programme made for difficult listening when I heard of (probably) hundreds of young women dying from pregnancy related conditions.

Also in the news this week was the sad story of a woman who died as a result of a brain haemorrhage.  The woman was 25 weeks pregnant and although she was “brain dead” the doctors managed to keep her artificially ventilated until they were able to perform a caesarean section to deliver her baby daughter.  http://news.bbc.co.uk/1/hi/health/7824462.stm


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