Natural Childbirth Options
There is considerable evidence that preparation for childbirth can significantly modify the pain experience. Fear, fatigue, and anxiety can all enhance pain perception, thus good antenatal education may modify the experience, but it will not lead to painless childbirth. Labor support and relaxation and breathing techniques form the basics for this technique. The continuous presence of a midwife or female support person (doula) has been shown to decrease the severity of pain reported. Relaxation techniques and or self-hypnosis can relieve anxiety and tension and thus modify the pain experience. These techniques should be encouraged for all pregnant women.
Given this complexity, precise definitions of its start and end are elusive. Adolescence is a phase of continuous change within a lifespan of continuous change, while cultural-legal demarcations of the onset of adulthood vary widely. Behavioral neuroscience assumes a general concept of peri-adolescence as the passage of the individual from characteristics of mind, brain, and behavior specific to, and shared among, children of different ages (i.e., from birth to ages 10-15), to characteristics shared among healthy adults (i.e., from age 18-25 and older) (Erickson and Chambers 2006 Romer and Walker
Pioneering work (Box 3.1) has given birth to biopharmaceuticals that are now on the market to improve human health. In more recent years, these technologies have been gradually adopted and integrated into the research and development processes of most of the major pharmaceutical companies. Today, major established pharmaceutical companies and dedicated biotechnology companies alike are using these advanced tools and resources to stay competitive in accelerating the discovery and development of pharmaceuticals.
Calcium is an essential nutrient and the natural diets of all mammals are rich in calcium. Calcium requirements vary throughout an individual's lifetime, with greater needs in three critical periods of life (a) during the times of childhood and adolescence, (b) in women during pregnancy and lactation and (c) in later adult life (Table 6.1). From birth until about age 18, bones are forming and growing, and during late adolescence, through young adulthood, adult bone is formed and reaches its maximum strength and density. A sufficient calcium intake is essential to those processes. Pregnancy represents a significant physiological stress on calcium homeostasis. A full-term infant accumulates approximately 30 g of calcium during gestation, most of which is
The targeting construct is often introduced into mouse embryonic stem (ES) cells by electroporation. Cells that fail to integrate the targeting construct into the genome are killed by application of neomycin in the culture medium (positive selection). The majority of the remaining cells, in which the entire construct (including the TK gene) inserts randomly, will die as a result of the incorporation of ganciclovir or fialuridine (inactive thymidine analogs), which block DNA synthesis. Homologous recombinant clones that do not contain the TK gene are used to prepare chimeric mice. Cells from these clones are microinjected into the fluid-filled cavity of 3.5-day-old embryos at the blastocyst stage. The injected embryos are then surgically transferred into the uterus of pseudopregnant females. These animals will give birth to chimeric mice. Breeding can be used to generate mice that are heterozygous and homozygous for the mutation. Homozygous mutants may express the gene of interest in...
Back pain after childbirth is common. In the absence of epidural analgesia, early studies estimate that the incidence of back pain within the first six days post partum is about 38 .32 Whether or not long-term back pain is caused by epidural analgesia is controversial. In a large retrospective study, investigators surveyed patients who had delivered a baby in their institution within the previous nine years. Their results indicated that there was a strong association between epidural use and long-term back pain.33 The authors concluded that this association was probably causal. However, retrospective studies concerning peripartum back pain are subject to important inaccuracy and potential biases. In particular, women are unable to consistently recall the magnitude of their back pain near the time of childbirth, when asked about it later. In a one-year follow-up study, Macarthur et al. found that only 56 of women accurately recalled the amount of
Transcutaneous electrical nerve stimulation (TENS) is a modality employed to reduce pain in an array of acute and chronic pain states, including labor pain, postoperative pain, neuropathic pain, and musculoskeletal pain (Loeser et al. 1975 Tyler et al. 1982). When TENS is used in such settings, patients require less in the way of analgesics (e.g., opiates) and, depending on the circumstances, report increased activity, less interference with work, and improved functional abilities. A TENS unit consists of a battery and electrodes. The electrodes are placed along the surface of the skin overlying painful areas. The battery generates electrical currents of approximately 100 milliamperes the rate and width of the pulses are modifiable by the patient. The efficacy of TENS has been supported by evidence of counterirritation techniques (see also Chapter 2, Sensory Pathways of Pain and Acute Versus Chronic Pain, of this book), whereby stimulation of AP fibers inhibits the pain-promoting...
Despite their widespread occurrence and a very considerable research effort, the use of prostaglandins or prostaglandin analogues themselves in medicine, has been limited. Among the reasons for this are the length of syntheses, problems in achieving selectivity and their rapid metabolism. Some applications include the use of prostaglandins E2 and F2 (dinoprostone 5.44 and dinoprostol 5.46) in the induction of childbirth, misoprostol 5.50 in the treatment of peptic ulcers and latanoprost 5.51 in the treatment of glaucoma.
The first Cochrane Centre was opened in October 1992 in Oxford, United Kingdom. One year later, the Cochrane Collaboration was founded as a non-profit organisation. It was established as a company, limited by guarantee, and registered as a charity in the United Kingdom. The first Cochrane systematic reviews were prepared by the Pregnancy and Childbirth Group. These reviews have had considerable influence on obstetric and paediatric practice Pregnancy and Childbirth Group
At the same time, however, the increase in life span, coupled with static or even reduced child birth rates, changes the composition ofthe population dramatically The median age in the world is projected to increase between 2000 and 2050 by over 10 years. In future, there will therefore be considerably more older people populating developed countries. At the same time, there will be considerably fewer younger people, in relative as well as absolute terms. A related trend is being observed in the developing world, which is likely to undergo similar population changes a couple of decades later than the developed countries.
In 2000, some of the major groups working on characterizing protein families joined their efforts and skills, giving birth to the InterPro consortium (Apweiler et al. 2000), a documentation resource aiming at integrating the different and, to some extent, complementary methodologies employed by the founder groups to derive accurate and comprehensive protein signatures. Up to now (Mulder et al. 2007), ten databases have become members of the consortium PROSITE (Hulo et al. 2006), PRINTS (Attwood 2002), ProDom (Servant et al. 2002), Pfam (Finn et al. 2006), SMART (Letunic et al. 2006), TIGRFAMs (Haft et al. 2003), PIRSF (Wu et al. 2004), SUPERFAMILY (Gough et al. 2001), Gene3D (Buchan et al. 2003) and PANTHER (Thomas et al. 2003). Furthermore, InterPro cross-references to SCOP, CATH and ModBase (Pieper et al. 2006). The integration of multiple data sources allows InterPro to reach extensive coverage of the proteins reported in UniProt (Wu et al. 2006) release 15.1 of InterPro covers...
Hyperekplexia or hereditary startle disease is a predominantly autosomal dominant disorder caused by a defective function of the GR. In rare cases, the disorder is caused by autosomal recessive defects of GLRA1, the p-subunit of the GR, mutations in the GR-clustering proteins gephyrin and collybistin, or by defects in the glycine transporter GlyT2 (Rees et al., 2006). The main features of the disorder are disturbances of muscle tone and an exaggerated startle response usually to auditory stimuli. In the newborn period a generalized stiffness or stiff baby syndrome'' is present from birth onward. Hypertonia, hyperreflexia, and exaggerated startle response to noise or handling complicated by feeding difficulties, aspiration pneumonia, inguinal hernias, and an increased risk of sudden death are features in newborns. Nose tapping in a newborn with hyperekplexia typically induces a startle (head retraction) response and provides an important diagnostic clue. After the first years of life...
Blue cohosh is one of the primary uterine tonics, uterine antispasmodics, and smooth muscle relaxants used in Western herbalism. It is commonly used as a partus pre-parator, a substance used in the last 6 weeks of pregnancy to help prepare for birth. It is also used to promote efficient uterine contractions during birth. In recent years, concern regarding its use for these purposes has been raised. There are no reported adulterants of blue cohosh.
Doses are often needed, especially in the early third trimester, to effect or maintain disease remission (Hostetter et al. 2000). Another time of increased risk is the postpartum period, when women are at a threefold higher relative risk for depression compared with non-child-bearing women (Cox et al. 1993). It is estimated that 13 of women develop depression following childbirth (O'Hara and Swain 1996). Furthermore, children of women with postpartum depression suffer from a number of social and intellectual impairments thought to be associated with compromised mother-infant bonding (A. Stein et al. 1991). Consequently, postpartum depression represents a significant health risk to both mother and child, and treatment with antidepressants during this period is often necessary.
Several studies however have documented that the highly lipophilic opioids (e.g. sufentanil, fentanyl, alfentanil, butorphanol, pethidine) demonstrate little dose reduction when comparing the intravenous with the intrathecal mode of application 248 . When comparing the intrathecal with the epidural mode, clearly there is an advantage for the intrathecal route, and in order to achieve similar cerebrospinal concentrations, the epidural dose has to be increased 5fold 249 . For morphine and fentanyl there are similar dose differences, whereby morphine 0.3 mg or fentanyl 25 g in combination with bupivacaine results in a good analgesic level during labor pain. In spite of such encouraging results, and contrary to the peridural use of opioids, there are only few controlled studies. In order to give general recommendations and definitively outline the putative advantage of an intrathecal use of opioids, additional studies are needed. Since the known side effects, as Figure III-80. Visual...
Anandamide levels in turn appear to be fine-tuned by varying levels of FAAH. We further know that mRNAFAAH is present in preimplantation and implanting embryos as well as at the implantation site of the uterus (Paria and Dey, 2000 Paria ei a ., 1999), where it inversely correlates with anandamide levels. Maccarrone and colleagues reported FAAH downregu-lation in the uterus of pregnant and pseudopregnant mice during the implantation period (Maccarrone ei a ., 2000a), and in clinical studies this group showed that FAAH concentrations in lymphocytes of women who miscarried were lower than lymphocyte FAAH concentrations from women who gave birth (Maccarrone ei a ., 2000b). In addition, plasma anandamide levels were significantly higher in a subsample of pregnant women with a threatened miscarriage than in those women who gave birth at term (Habayeb ei a ., 2008). Recently, in placental tissue samples from pregnant women, an association was found between the expression of FAAH in the...
Milestone I Biological importance of vitamin E in reproduction and essentiality. Initially, vitamin E was recognized as a nutritional factor required to ensure normal reproduction in rats (1) and was named according to a consecutive alphabetical order preceded by the discovery of vitamins A-D (41). Later, vitamin E was called a-tocopherol from the Greek term tokos (childbirth), phero (to bear), and -ol, indicating an alcohol (42).
Both parabolic and bilinear relationships allow one to derive the optimum value of logP for transport to a given location, within the time of a biological assay. Evidence for an optimum in lipophilicity for CNS depressants was found by 1968 93 . Hansch was then able to assert that in order for drugs to gain rapid access to the CNS, they should preferably have a logP value near 2.0. Subsequently, studies on anesthetics, hypnotics, and other CNS agents have been made and have given birth to the Principle of Minimal Hydrophobicity in Drug Design 87 , The thrust of this is that to keep drugs out of the CNS, and thereby avoid CNS-related side effects such as depression, weird dreams, and sedation, one should design drugs so that logP is considerably lower than 2.0. This ploy has been successful in the new generation of non-sedative antihistamines.
Following the isolation of targeted ES cell clones, chimeras are made using either blastocyst injection or, more recently, aggregation techniques (Figure 9.2). In the blastocyst injection technique, ES cells are microinjected into the fluid-filled blas-tocoel cavity of 3.5-d-old embryos at the blastocyst stage. The blastocyst injection apparatus commonly includes an inverted microscope and micromanipulation equipment. The blastocyst is positioned using a holding pipette, and 10 to 15 ES cells are introduced into the embryo using an injection pipette. Both the holding and injection pipettes are fashioned from drawn glass capillary tubing using a microforge. The injected embryos are then surgically transferred into the uterus of pseudopreg-nant female mice. Pseudopregnant females are generated by matings with vasecto-mized males. The act of copulation initiates the endocrine changes of pregnancy, providing a suitable uterine environment for the survival and implantation of the...
An alternative strategy to drug design and discovery stems from investigating the secondary metabolites produced by humans instead of plants, animals or microorganisms. This rationale is inspired from the beneficial effects that the plant and microbial metabolites have on the host organism. Prostaglandins are a group of lipid mediators derived from the oxidation of C20 essential fatty acids 9 . They are produced on demand within the cell from arachidonic acid. These short lived messenger molecules have the ability to carry out numerous biological functions varying from inducing labour during childbirth to triggering pain and inflammation 10-12 . The prostaglandins are short lived as they are enzymatically converted to
Total body water, extracellular water, and intracellular water are functional compartments of pharmacological interest because the distribution of different classes of drugs within the body often corresponds to one of these spaces. The size of these body water compartments and the changes from birth to adulthood originally described by Friis-Hansen19 have been reviewed in the present context
The medical undertreatment of pain has been well documented for over 20 years.94 Its ethical implications, however, are not often recognized or addressed.95 One prominent study, for example, shows that 50 percent of hospitalized dying patients in the USA spent at least half their time (according to family members) in moderate to severe pain.96 The method that researchers employed to redress this undertreatment of pain in dying patients centered on staff education, not on ethics and certainly not on narrative, and it yielded no improvement. As an alternative method for recognizing and addressing the ethical implications of undertreatment for pain, narrative can hardly do worse. Consider the 1999 New York Times story about Mrs Ozzie Chavez.97 Mrs Chavez, a California Medicaid patient, was refused proper anesthesia in childbirth because she had not paid an additional (illegal) fee required by the anesthesiologist. The anesthesiologist wouldn't even come into the room until she got her
Oro-dental pain as a specific modality (Clark 2006) and a cardinal sign occurs as a result of inflammation and traumatic injuries or as a complication of elective oral and maxillofa-cial surgery. Toothache has been compared with earache and labor pain for its intensity and propensity for acute discomfort.
The following discussion reviews options for labor analgesia, including nonmedicated and medicated pain relief methods. Nonpharmacologic analgesia techniques include prepared childbirth (LaMaze), aromatherapy, hypnotherapy, acupuncture, and transcutaneous electrical stimulation. Pharmacologic techniques include systemic analgesia, regional analgesia, and nerve blocks.
Discovered Con-T was found to be a selective V1a antagonist with partial agonist activity at the OT receptor and no detectable activity at V1b and V2 receptors (Dutertre et al. 2008). Interestingly, this study found that replacing the Gly9 in oxytoxin and arginine vasopressin with Val9 found in Con-T converted these pep-tides from full agonists to full antagonists at the V1a receptor, demonstrating the role of position 9 as an agonist antagonist switch in these peptides. The role of cono-pressins in cone snail prey capture is unclear and their mode of action, receptor subtype specificity and structure are presently poorly defined. Therapeutic applications for this class of conotoxins, beyond potential in cardiovascular disorders and pre-term child birth, may relate to their central actions where effects on mood have been observed in animals.
As we stated before, the definition of a true interaction depends upon the type of events we want to focus on and on the level of detail that we want to achieve. Interaction identification depends on several physical, chemical, cellular, topological, functional and experimental constraints. Such a complex scenario gave birth to a number of different, non-overlapping definitions of interaction.
In pregnancy, the growing fetus represents a semi-allogeneic graft which is protected against expulsion by suppression of local defense reactions. As the time of parturition approaches, this delicate balance is altered towards the selective use of inflammatory reactions providing effective mechanisms for delivering the baby. At the hormonal level this shift is characterized by the retreat of effectors which maintain uterine quiescence (progesterone, prostacyclin, nitric oxide and relaxin) 148 and the growing influence of labor-promoting agents such as estrogens, glucocorticoids, oxytocin, prostaglandins, corticotropin-releasing hormone (CRH), endothelins, PAF and cytokines (Fig. 8-9) 148-151 , The precise mechanisms by which the orchestra of hormones and local mediators is coordinated to act on the main target sites, the cervix and the myometrium, are not yet known. In a very complex and poorly understood manner, hormones and other signal molecules of fetal and maternal origin...
Epidemiological and Human Dosimetry Studies. Information exists on the adverse health effects of boron compounds in humans. Studies of workers exposed to boron compounds demonstrated that boron can cause mild irritation of the eyes and respiratory tract (Garabrant et al. 1984, 1985). Other human studies involve case reports of accidental or intentional ingestion of large quantities of boron compounds (Litovitz et al. 1988 Locatelli et al. 1987). The studies identified key health effects (lung, kidney, brain, and liver) associated with boron exposure (Wong et al. 1984). Animal studies indicated the testes as a target tissue. Epidemiological studies of the birth rate of occupationally-exposed workers is currently underway at a major U.S. borate production facility (U.S. Borax and Chemical Corporation 1991).
Pathological mutations close to, or within, the AP domain of APP cause familial forms of AD (FAD) (www.alzforum.org res com gen alzgene default.asp). FAD mutations are also found in genes associated with AP processing, including presenilin 1 and 2 9,10 , while risk factors for late onset AD include apolipoprotein E4 (Apo-E4) and polymorphisms of alpha-2 macroglobulin (a2m). Although several genetic lesions associated with FAD result in elevated AP1-42 levels, this alone does not explain the aetio-pathogenesis of AD onset. Over-expression of AP1-42 occurs from birth in FAD and people with Down's syndrome (DS), however, amyloid deposition does not appear in childhood 11 . In all forms of AD, age-related metabolic or environmental changes are responsible for the slow but progressive onset of amyloid deposition and subsequent cognitive failure in early (FAD or DS) or late adulthood (sporadic AD). The neurochemical factors responsible for this age-related pathological process are still...
Innate immunity is the most basic form of immunity and includes immune systems that are present in a human from birth. A clear distinction must be made between innate immunity and acquired (adaptive) immunity, which develops after birth, and then only after an antigenic challenge (Table 5.2). Innate immunity is the first line of defense against invasion by microbes and can be characterized as fast in response, nonspecific, and lacking in memory of the challenge. Acquired immunity develops through a complex system of reactions that are triggered by invasion with an infectious agent. It is slow in response to an infection, is highly specific, and has memory of previous infections. The memory, or anamnestic response, is responsible for the extremely rapid development of the immune response with subsequent challenges and is a hallmark of acquired immunity. Present from birth
The vagina, also called the birth canal, is a thin-walled fibromuscular tubular structure, 8 to 12 cm in length, that lies inferior to the uterus, posterior to the urethra and bladder, and anterior to the rectum. The vaginal orifice is the external opening of the vagina. The vagina of a healthy woman consists of numerous folds called rugae that help in distension. The vaginal wall consists of four layers the epithelial layer, the tunica adventitia, the muscular layer, and connective tissue.122
In some studies, both self-associative properties of hydrophobised pullulan and the type of chemical crosslinker used have been considered to give birth to ultrastructured macrogels endowed with finely tuned drug protein entrapment and release properties 133, 189, 229-231 . Associative microparticles of crosslinked pullulan and CMP amidified by akylated amine were obtained by using STMP and compared with those crosslinked with epichlorohydrin 189 . The property of the studied supports to retain great amounts of lysozyme, which is released in NaCl solutions, could be useful in separation purification processes of the enzyme from production media and to develop new crosslinked pullulan-based drug delivery systems. Moreover, the immobilised lysozyme retained its enzymatic activity. The lysozyme hydrophilic support complex could also be used for healing of the infected wounds, where it would act both as a fluid adsorbent and as a topical antibacterial agent.
During childbirth, oxytocin secretion is stimulated by dilation of the cervix and vagina. During the last stage of pregnancy, uterine responsiveness to oxytocin is elevated because of increased expression of oxytocin receptors, which is stimulated by estrogen. Oxytocin also increases local prostaglandin production, which further stimulates uterine
This may develop suddenly in an otherwise healthy individual or follow an infection, surgical procedure, childbirth, or an injection of vaccine or antibiotic. It usually begins as a severe pain around the shoulder on one side, followed by rapid development of weakness and atrophy. The muscles of C5 and C6 myotome are commonly involved, and the affected muscles may be very weak to the extent of being totally paralyzed. The pain is made worse by movement involving the affected muscles. It can be distinguished from cervical radicular lesions by the fact that weakness is usually not so severe in radicular lesions. It is usually unilateral, but occasionally bilateral. Rarely, it may be restricted to one or two nerve territories, or can present as an isolated phrenic nerve palsy. Pain usually disappears within a few days or weeks, and most patients show good recovery.
As labor pain becomes severe, the unmedicated patient's minute ventilation increases by 75 in first stage and 150-300 during second stage of labor. This results in maternal hypocarbia and alkalosis. These changes lead to uteroplacental and fetoplacental vasoconstriction and a leftward shift of the maternal oxyhemoglobin dissociation curve, potentially resulting in fetal hypoxemia. Effective regional analgesia will markedly diminish maternal hyperventilation. Oxygen consumption increases by 40 in stage 1 and 75 in stage 2. This is attenuated, but not eliminated by regional analgesia. Parenteral opioid administration does not effectively prevent hyperventilation, in contrast to regional anesthesia. Most mothers and fetuses are not adversely affected by the respiratory changes occurring with labor. However, in patients with marginal uteroplacental function effective regional analgesia may be advantageous.
Acupuncture and related interventions have been considered as alternatives for pain relief for epidural labor analgesia. Acupuncture and related interventions were compared with meperidine consumption for labor analgesia. A randomized, non-blinded, controlled study found a decrease in the requirement for meperidine in the acupuncture group as compared to a control group with the same parity (Ramnero et al. 2002). Chung and colleagues applied acupressure as the analgesic for the first stage of labor (Chung et al. 2003). These investigators found that during the first stage of labor the patients who received acupressure reported significantly less labor pain compared to patients who received sham or no treatment. A recent study by Lee et al. (2004) performed a sham-controlled RCT to evaluate the analgesic effects of acupressure on the intensity of labor pain and duration of labor. These investigators reported that labor pain score during the first hour following the intervention was...
Pregnancy And Childbirth
If Pregnancy Is Something That Frightens You, It's Time To Convert Your Fear Into Joy. Ready To Give Birth To A Child? Is The New Status Hitting Your State Of Mind? Are You Still Scared To Undergo All The Pain That Your Best Friend Underwent Just A Few Days Back? Not Convinced With The Answers Given By The Experts?