Prenatal Care

Prenatal care helps decrease risks during pregnancy and increase the chance of a safe and healthy delivery for the mother and child. Regular prenatal visits can help your doctor monitor your pregnancy and identify any problems or complications before they become serious.

Prenatal care ideally starts at least three months before you begin trying to conceive. Some healthy habits to follow during this period include:

  • quitting smoking and drinking alcohol
  • taking folic acid supplements (400 to 800 micrograms)
  • talking to you doctor about your medical conditions and any dietary supplements and over-the-counter or prescription drugs that you take
  • avoiding all contact with toxic substances and chemicals at home or work that could be harmful

During Pregnancy

Once you become pregnant, your physician, or midwife will schedule regular appointments throughout each stage of your pregnancy.

A schedule of visits may involve seeing your doctor:

  • every month in the first six months you are pregnant
  • every two weeks in the seventh and eighth months you are pregnant
  • every week during your ninth month of pregnancy

During these visits, your doctor will check your health and the health of your baby.

Visits may include:

  • taking routine tests and screenings, such as a blood test to check for anemia, HIV, and your blood type
  • monitoring your blood pressure
  • measuring your weight gain
  • monitoring the baby’s growth and heart rate
  • talking about special diet and exercise

Later visits may also include checking the baby’s position and noting changes in your body as you prepare for birth.

Your doctor may also offer special classes at different stages of your pregnancy.

These classes will:

  • discuss what to expect when you are pregnant
  • prepare you for the birth
  • teach you basic skills for caring for your baby

If your pregnancy is considered high-risk because of your age or health conditions, you may require more frequent visits and special care. You may also need to see a doctor who works with high-risk pregnancies.

 

Pre Conceptional Care

What is preconceptional care and why is it important?

Having a healthy pregnancy is one of the best ways to promote a healthy birth. Getting early and regular preconceptional care improves the chances of a healthy pregnancy. This care can begin even before pregnancy with a preconception care visit to a health care provider.

Preconception Care

A preconception care visit can help women take steps for a safe and healthy pregnancy before they get pregnant.

Women can help to promote a healthy pregnancy and birth of a healthy infant by taking the following steps before they become pregnant

    • Develop a plan for their reproductive life.
    • Increase their daily intake of folic acid (one of the B vitamins) to at least 400 micrograms.
    • Make sure their immunizations are up to date.
    • Control diabetes and other medical conditions.
    • Avoid smoking, drinking alcohol, and using drugs.
    • Attain a healthy weight.
    • Learn about their family health history and that of their partner.
    • Seek help for depression or anxiety.

 

Postnatal Care

The postnatal period lasts six to eight weeks, beginning right after the baby is born.

During this period, the mother goes through many physical and emotional changes while learning to care for her newborn. Postnatal care involves getting proper rest, nutrition, and vaginal care.

Getting Enough Rest

Rest is crucial to new mothers who need to rebuild their strength. To avoid getting too tired as a new mother, you may need to:

  • sleep when your baby sleeps
  • keep your bed near your baby’s crib to make night feedings easier
  • allow someone else to feed the baby with a bottle while you sleep

Eating Right Nutrition

Because of the changes your body goes through during pregnancy and labor, getting proper nutrition in the postnatal period is crucial. The weight that you gained during pregnancy helps make sure you have enough nutrition for breastfeeding. However, you need to continue to eat a healthy diet after delivery.

Experts recommend that breastfeeding mothers eat when they feel hungry. Make a special effort to focus on eating when you are actually hungry—not just busy or tired.

Try to:

  • avoid high-fat snacks
  • focus on eating low-fat foods that balance protein, carbohydrates, and fruits and vegetables
  • drink plenty of fluids

Vaginal Care

New mothers should make vaginal care an essential part of their postnatal care. You may experience:

  • vaginal soreness if you had a tear during delivery
  • urination problems, such as pain or a frequent urge to urinate
  • discharge, including small blood clots
  • contractions during the first few days after delivery

Schedule a checkup with your doctor about six weeks after delivery to discuss symptoms and receive proper treatment. You abstain from sexual intercourse for four to six weeks after delivery so that your vagina has proper time to heal.

 

Ovarian Cancer

Ovarian cancer is a type of cancer that begins in the ovaries. Women have two ovaries, one on each side of the uterus. The ovaries — each about the size of an almond — produce eggs (ova) as well as the hormones estrogen and progesterone.

Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen. At this late stage, ovarian cancer is more difficult to treat and is frequently fatal. Early-stage ovarian cancer, in which the disease is confined to the ovary, is more likely to be treated successfully.

Surgery and chemotherapy are generally used to treat ovarian cancer.

Symptoms

Signs and symptoms of ovarian cancer may include:

  • Abdominal bloating or swelling
  • Quickly feeling full when eating
  • Weight loss
  • Discomfort in the pelvis area
  • Changes in bowel habits, such as constipation
  • A frequent need to urinate

Causes

It’s not clear what causes ovarian cancer.

In general, cancer begins when a genetic mutation turns normal cells into abnormal cancer cells. Cancer cells quickly multiply, forming a mass (tumor). They can invade nearby tissues and break off from an initial tumor to spread elsewhere in the body (metastasize).

Types of ovarian cancer

The type of cell where the cancer begins determines the type of ovarian cancer you have. Ovarian cancer types include:

  • Epithelial tumors, which begin in the thin layer of tissue that covers the outside of the ovaries. About 90 percent of ovarian cancers are epithelial tumors.
  • Stromal tumors, which begin in the ovarian tissue that contains hormone-producing cells. These tumors are usually diagnosed at an earlier stage than other ovarian tumors. About 7 percent of ovarian tumors are stromal.
  • Germ cell tumors, which begin in the egg-producing cells. These rare ovarian cancers tend to occur in younger women.

Risk factors

Certain factors may increase your risk of ovarian cancer:

  • Ovarian cancer can occur at any age but is most common in women ages 50 to 60 years.
  • Inherited gene mutation. A small percentage of ovarian cancers are caused by an inherited gene mutation. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These genes were originally identified in families with multiple cases of breast cancer, which is how they got their names, but women with these mutations also have a significantly increased risk of ovarian cancer.

The gene mutations that cause Lynch syndrome, which is associated with colon cancer, also increase a woman’s risk of ovarian cancer.

  • Estrogen hormone replacement therapy, especially with long-term use and in large doses.
  • Age when menstruation started and ended. If you began menstruating before age 12 or underwent menopause after age 52, or both, your risk of ovarian cancer may be higher.
  • Never being pregnant.
  • Fertility treatment.
  • Smoking.
  • Use of an intrauterine device.
  • Polycystic ovary syndrome.

If you have a genetic predisposition to ovarian cancer, your doctor may recommend regular pelvic imaging and blood tests to screen for the disease.

Tests and diagnosis

Your doctor is likely to start with a pelvic examination:

  • The outer part of your genitals is carefully inspected.
  • The doctor then inserts two gloved fingers into the vagina and simultaneously presses a hand on your abdomen to feel your uterus and ovaries.
  • A device (speculum) is inserted into the vagina so that the doctor can visually check for abnormalities.

Your doctor also may recommend:

  • Imaging tests, such as ultrasound or CT scans, of your abdomen and pelvis. These tests can help determine the size, shape and structure of your ovaries.
  • Blood test, which can detect a protein (CA 125) found on the surface of ovarian cancer cells.
  • Surgery to remove a tissue sample and abdominal fluid to confirm a diagnosis of ovarian cancer. Minimally invasive or robotic surgery may be an option. If cancer is discovered, the surgeon may immediately begin surgery to remove as much of the cancer as possible.

Staging ovarian cancer

Your cancer’s stage helps determine your prognosis and your treatment options.

Stages of ovarian cancer include:

  • Stage I. Cancer is found in one or both ovaries.
  • Stage II. Cancer has spread to other parts of the pelvis.
  • Stage III. Cancer has spread to the abdomen.
  • Stage IV. Cancer is found outside the abdomen.

Treatments and drugs

Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy.

Surgery

Treatment generally involves removing both ovaries, the fallopian tubes, the uterus as well as nearby lymph nodes and a fold of fatty abdominal tissue (omentum) where ovarian cancer often spreads. Your surgeon also will remove as much cancer as possible from your abdomen.

Less extensive surgery may be possible if your ovarian cancer was diagnosed at a very early stage. For women with stage I ovarian cancer, surgery may involve removing one ovary and its fallopian tube. This procedure may preserve the ability to have children.

Chemotherapy

After surgery, you’ll likely be treated with chemotherapy to kill any remaining cancer cells. Chemotherapy drugs can be injected into a vein or directly into the abdominal cavity or both.

Chemotherapy may be used as the initial treatment in some women with advanced ovarian cancer.

Prevention

There’s no sure way to prevent ovarian cancer. But certain factors are associated with lower risk:

  • Use of oral contraceptives, especially for more than 10 years
  • Previous pregnancy
  • History of breast-feeding
  • Daily use of aspirin

 

Natural Family Planning

What is natural family planning?

Natural family planning is a method of preventing pregnancy, without using pills or devices. It is based on being able to predict your fertile time. This is the time you are likely to conceive. Pregnancy is avoided if you don’t have sex during this fertile time or use other methods of contraception, such as condoms. It can be a very effective form of contraception. However, it needs a high level of commitment from both you and your partner. It has the advantage that there are no chemicals involved, and therefore no side-effects.

How effective is natural family planning?

If natural family planning is used correctly by 100 women for one year, somewhere between one and nine women would become pregnant. This compares to 80 or 90 women who would become pregnant using no method of contraception. This method will be less effective if not used correctly.

When is the fertile time?

The fertile time lasts for approximately 8-9 days in each cycle. It is from seven days before ovulation until 1-2 days after ovulation. Ovulation is when a woman releases an egg from an ovary – usually once a month. An egg survives for about 24 hours. However, sperm can survive for up to seven days after sex. This is why the fertile time starts from seven days before ovulation. So, if you know exactly when you will ovulate then you can predict when your fertile days are.

How do I know when I will ovulate?

Knowing when you ovulate is the key to this method. Once you are confident that you can predict this then this method of family planning can be very effective. It takes good instruction and 3-6 menstrual cycles to learn how to do natural family planning. This is much more difficult to do if you have irregular periods.

You need to make a record each day of one or more ‘indicators’. These include the following:

  • Body temperature. This typically rises slightly when you ovulate and remains higher until your next period. There are many factors that can upset this, such as illness, and taking medicines (like paracetamol, which can lower your temperature). However, if you take your temperature before getting out of bed each morning, a pattern usually emerges. This will show you when ovulation has occurred. Computerised thermometers are also available which work by combining information about the length of your menstrual cycle and temperature.
  • Secretions from the neck of the womb (cervix). These change throughout the menstrual cycle:
    • Just after a period there is not much secretion and the vagina is dry for a few days.
    • About eight days before ovulation, the secretions become more moist, sticky, and cloudy.
    • Four days before ovulation the secretions become wet, clear, slippery and stretchy (like egg white).
    • A day or so after ovulation the secretions dry up again until after the next period.

So by observing the changes in your secretions you can predict the 7-8 days before ovulation.

  • Cycle length. Ovulation usually occurs 12-16 days before a period. If your cycle is very regular then this may help to predict ovulation.
  • Ovulation prediction kits. These are devices that you can buy from a pharmacy. There are two types of ovulation prediction kits. They both measure hormone levels. One measures them in your urine and the other measures them in your saliva.The urine-based kit detects the increase, or surge, of a hormone called luteinising hormone (LH) that occurs approximately one to two days before ovulation. The main device available in the UK is called Persona®. Although a small amount of LH is always present in your blood and urine, in the days before ovulation, the amount increases by about two to five times.Saliva-based kits test for rising oestrogen levels as you near ovulation. As oestrogen levels rise, the salt content of your saliva increases too and when the salt dries it crystallises into a fern-like pattern. With these kits, you see if ‘salivary ferning’ has occurred as your saliva has dried. The saliva-based kits are less accurate than the urine-based kits. These are not advised for avoiding pregnancy, but may be helpful in planning pregnancy.

Is breast-feeding a natural family planning method?

Yes – this is known as the lactational amenorrhoea method of contraception. Lactational means while you are breast-feeding, and amenorrhoea means not having any periods. Suckling by the baby stimulates hormones that suppress ovulation. Ovulation is unlikely for six months after childbirth if you breast-feed fully (this means the baby has no other food or drink apart from breast milk) and if you have not had a period since childbirth.

Less than one woman in one hundred would become pregnant in these circumstances. However, once you drop feeds, or start having periods this would not be an effective method of contraception.