Domain

Explanation

Child birth?

• The bearing, "live-hatching" & rearing of infants from the wombs of their mothers

Process?

• Intercourse
• Fertilization
• Pregnancy
• Labour & contractions
• Birth of child: in the birthday suit on the birthday
• Post-natal care
• Growing pains

Pregnancy

• Menstruation
• Pregnancy and Fetal Development
• Before the advent of the modern midwifery & obstetrics, women probably had 1-2% chance of dying every time they gave birth; e.g. the mother of the founder of Buddhism, Gautama Buddha, died almost immediately upon giving birth to the baby Buddha under a tree
• For newborn babies, the world is a treacherous one for them
• ~5% of children are stillborn: baby is dead when it is delivered from the womb
• ~10% of infants died in the period immediately after birth
• The Chinese have bestowed the first month of birth as a critical period of the infant mortality; beyond which, the infant is generally well with much better chance of survival; so sacred is the end of this very first month that the Chinese celebrates it with great festivity: gathering of relatives, friends & neighbours with lots of foods, well-wishing & many eggs dyed in red 紅雞蛋
• Example: my mother married at the late age of 30; after trying actively for 4 years (she insisted that she might have miscarried during that period), I was born at her age 34 on the mature 40 weeks (almost perfectly timed, she always said); but she developed uterus complications a few years later & had to have surgery; but the primary surgeon who operated on her was ill-informed & ill-prepared; he was supposed to perform an exploratory surgery, i.e. to probe & find out what was my mother's actual complications - she complained pain & had vaginal discharges; this surgeon conducted the operation too rashly - he cut open my mother's stomach from the base of the rib cage, right down to the bladder - the cut was easily more than 15 cm or 6 inches; any well-trained doctor would know that such a long cut in such a short time would kill; & an exploratory surgery is just to probe, not an autopsy on a dead person; my mother nearly bled to death; by a stroke of luck perhaps; she recovered & her complications was in the uterus, & not anywhere above the navel à pls, biomedical professionals, have a heart & mind over your actions 醫者仁心; never let the mind run wild; a person is not only a person, but a whole family of people; I might have lost my mother just like that
• My mother went on to have my sister, six years later after my birth, at the very late age of 40; my sister is born premature (she was early by one week, i.e. 39 weeks); yet shortly after this, on the night of the first day of the lunar year in 1992, she almost fainted from a massive, but painless vaginal discharge of dark-red blood; she was immediately sent to hospital; after a few years, my mother has again developed complications; but this time, we made sure of the medical preparations; it turned out that my mother had benign tumours in the uterus; surgery was performed to have her uterus & benign tumours removed; but she also lost the ability to conceive again
• Later on, my mother developed the fatal terminal-stage lung cancer 末期肺癌; the pain was constant, unrelenting & omni-present, always increasing towards the end - a punishing period for my mother, typical of all chronic illnesses; Singapore Cancer Society conducted house-visits; the female doctor helped my mother with her piles, elevate her pain temporarily through the restricted drug, morphine (extracted from opium) & prepare us for the worst; Hospice Care provided the oxygen-breathing machinery & limewater (to cleanse the mechanical oxygen) that is critical for my mother during her last month as she struggled constantly with her breath à her lungs are being slowly but surely drowned with mucus & tumour discharges (abet like pneumonia patients), she requires the oxygen in order to survive, but she insists on staying at home with us; we searched desperately for any remedy; a Chinese physician diagnosed the root cause for the cancer as Gastroesophageal Reflux Disease 胃酸倒流, a simple ailment that can be prevented by any measure, yet leading to such a painful, terrible, chronic cancer that stole my mother's precious life; the lunar dinner I would never forget is the last meal my mother cooked for me & my family (it was a team effort, my mother direct us & we follow her instructions to the dot); I remember vividly all of us had a slow, quiet dinner, seemingly ignorant of the ambient festivities at that time; my mother ate slowly - she was struggling with both the food & breathing as well as the agony of such moments; later that night, she was rushed to hospital due to excessive pain - the result of accumulating fluids in the lungs; she was hospitalised with intravenous tubes, draining those evil fluids from her lungs into a bottle beside the hospital bed - that was her deathbed; I noticed that as the day progressed, she was increasingly tired, being drained of her life; steadily, she drifted on & off into sleep; sometimes waking up & telling us of aches around her feet (I massaged them, but they felt so bony - she was as thin as her skeleton); she was sweating then, as the room is open-air & not air-conditioned; she touched her hair, & grimaced she didn't have the time to go the hair-dresser; in her sleep, she mumbled some sounds that until now, I'm still unable to decipher, but I have a feeling that those belong directly to her unconscious; a sign that (self-) consciousness is eroded & her precious life (as well as my family's) was slipping away; my mother passed away on 5^th March 1996
• Dear readers, pls take care of yourself & your loved ones & not let such stupidity re-surface
• Hence, childbirth is perilous for both mother & child: pls take care
• Beware of obstetrical disasters like technological disasters

Preparations for pregnancy

• For a safe pregnancy & delivery, pls take note of the following:

1. Basics: teaching women how to tell when their birth is running into problems, or training local midwives to refer difficult births to hospitals
2. Perinatal mortality: maternal malnutrition & infections
3. Maternal nutrition: 3 simple, but crucial things depending on diet of the mother-to-be à (1) baby's birthweight 5-10 lbs; (2) mother's ability to undergo successful, rapid labour; (3) mother's ability to recover & supply sufficient milk to sustain her baby
4. Diet: sufficient nutrition, high-proteins, high-fibre, low-sugar diet rich in folic acid, calcium & iron; iodine (relatively scarce in mountainous regions - a recent study in XinJiang 新疆, supplementation of irrigation water with iodine reduced infant & neonatal mortality by half), vitamins - especially lacking in poverty-stricken regions of the world
5. Hygiene & care: prevent infections by bacteria & bugs like Listeria monocytogenes (infects placentas & causes stillborn), Toxoplasma gondii (fecal contamination) à wash mothers & baby immediately upon delivery with simple antiseptic (reduced fatal neonatal infections by two-thirds in Malawi) à medical professionals & midwives, pls wash your dirty hands & equipment, even if they don't seem dirty
6. Medical innovations: medicine should be available, even the simplest can be remarkably effective; simple disinfectants is desperately needed in impoverished areas; modern facilities like ultrascan, magnetic resonance image (MRI), etc. can be good, but may not be reachable by the public à it is imperative that the poor learn the basics & has access to these, if needed

• Preparations for a healthy baby:

1. Start your family at a younger age: according to medical research, anywhere between 16-35 would be best; below 16, too immature & might jeopardise future pregnancies; above 35, considered high-age maternity, lower quality eggs, poorer womb, less elasticity & increasingly difficult for both mother & child; the higher the risk of chromosome abnormalities (detected by amniocentesis) - (structural, brain, face, heart, intestinal tract, kidneys, bones, spine), birth defects, diabetes, raised blood pressures, fetal growth restrictions & premature labour
2. Medical check-up before pregnancy: to detect medical conditions (e.g. anaemia, thalassaemia, syphilis, rubella, rhesus negative blood type, diabetes, hepatitis B, toxoplasmosis, chicken pox, parvovirus, HIV, cytomegalovirus) that may cause complications during or after pregnancy; pre-existing illnesses (e.g. diabetes, raised blood pressure, auto-immune diseases); genetic disease (thalassaemia, cystic fibrosis, Duchenne's muscular dystrophy)
3. Pre-conception wellness: cultivate (healthy, balanced diet; exercise & relax frequently; sufficient rest; not under- or over-weight); avoid (obesity - higher blood pressure; unnecessary medication; smoking; alcoholism); healthy lifestyle
4. Avoid medications that affect developing fetus: alcohol, aspirin, captopril (treat high blood pressure), carbamazepine (treat fits or epilepsy), distilboestrol (hormone), lithium (treat mood swings), X-ray (causes cell death); ro-accutane (treat acne), phenytoin (fits, epilepsy), ponstan (relieve headaches & menstrual cramps), smoking, synflex, tetracycline (infections), thalidomide (severe abnormalities), sodium valproate (fits, epilepsy), vitamin A (abnormalities), warfarin (defects)
5. First Trimester: avoid miscarriages due to chromosome/genetic abnormalities, structural deformity in the fetus, inadequate placental implantation (inadequate pregnancy hormones), infections, auto-antibodies in the mother's blood; illnesses of mother (e.g. abnormal thyroid function or diabetes); uterus abnormalities (fibroids or tilted uterus)
6. General advice for First Trimester (1^st 14 weeks): confirm pregnancy early (missed your period, positive urine pregnancy test); note date of last menstrual period; see doctor; eat balanced diet, no unnecessary medications, no smoking, no alcohol; serious if any bleeding (see doctor immediately); avoid intercourse & excessive physical activity (especially if vaginal bleeding); relief nausea & cramps; not over-eat & eat too little; remain firm & flexible
7. Keep fit during pregnancy
8. Prenatal tests: FA scan, ultrasound à >20kHz sonar waves to detect baby by Doppler effect à 4 basic assumptions: (1) use appropriate ultrasound machines; (2) gestational age is appropriate; (3) Must have specific reason for ultrasound (might not be completely safe for baby); (4) scan performed by byan experienced & skilled medical specialist
9. Regular check-ups
10. Antenatal classes: birth-preparation classes

• Recommended diet:

1. Folic acid: green vegetables; liver, kidney; orange; grain cereals; nuts
2. Iron: red meat; liver; chicken; fish; eggs; broccoli; spinach
3. Calcium: milk; yoghurt; cheese; tofu; ikan bilis; beans
4. Protein: meat; chicken; fish; beans; eggs; vegetables
5. Fibre: bran cereals; beans; vegetables; fruits (bananas, papayas, apples, pears, oranges, water-melon, honeydew); unpolished/brown rice; brown wholemeal bread
6. Sugar (should eat, but eat little of these): ice-cream; cakes; cream biscuits; durians; sugar-cane drink; canned drinks; fruit juices; beverages; ice-kacang; crisps; chocolates; kaya; jam on bread)

• Beware of the following during the second & third trimesters:

1. Premature labour: risk factos - <16 years old; smoking; previous premature delivery; multiple pregnancies; cervical incompetence (weak cervix); premature rupture of membranes; fetal structural abnormalities; excessive amniotic fluid; genital tract infection (e.g. transmitted infected intercourse); bleeding in pregnancy à beware of signs of premature labour (intermittent contractions or vaginal staining) à antibiotics for bacterial infections à surgery à go to hospital immediately when in premature labour à premature babies: monitor breathing & ventilation à reasons for premature births: ruptures of membranes; loss of blood due to placental abruption; pre-eclampsia or fetal growth restrictions
2. Hypertension in pregnancy: (1) pre-exiting hypertension: under medications; (2) pregnancy-induced hypertension (pre-eclampsia): usually in 2^nd half of pregnancy; raised blood pressure; proteins present in urine; impaired liver & kidney functions à risk factors: 1^st time pregnant; <18yrs; >35yrs; known hypertension before; pre-existing kidney disease; auto-immune diseases (systemic lupus); diabetes; multiple pregnancy; abnormal uterine blood flow (detected by Doppler ultrasound studies) à prevention: seek treatment for hypertension before pregnancy; aspirin; diet rich in fish oils, calcium, vitamin E
3. Fetal growth restriction: occurs during the last (26-40) weeks; highest weight gain by baby during this period; may result in low oxygen levels or even, a still-birth à risk factors: mother is malnourished & underweight; 1^st time pregnant; <18yrs; > 35yrs; pregnant due to IVF (in-vitro fertlisation) & ICSI; presence of fetal structural or chromosome abnormality; viral infections in pregnancy; hypertension in pregnancy; kidney disease; auto-immune diseases like systemic lupus; multiple pregnancy; abnormal uterine blood flow à prevention: start aspirin, lower blood pressure, lots of rest, healthy diet, vitamins & well-hydrated (drink more fresh water)
4. Still-births (5~50 per 100 births, WHO 1999): baby's heartbeat stop before delivery à common causes: bleeding from placenta in pregnancy; fetal chromosome, genetic or metabolic abnormalities; fetal structural abnormalities; heart rhythm abnormalities; umbilical cord accidents; fetal hypoxia (lack of oxygen for baby) due to placental dysfunction; illnesses of mother (diabetes, hypertension in pregnancy, auto-immune diseases, baby infections, multiple pregnancy complications) à reduction of risk of still-birth: beware of baby's movements (derive the kick-chart by counting the daily number of kicks of the baby by the mother, of course); regular check-ups & urine tests; fetal anomaly scan at 18-22 weeks; take bleeding during pregnancy seriously; follow doctor's advice - eat healthily, stop smoking, take prescribed medications; go for ultrasound appointments; careful for diabetics; report virus infections immediately
5. Diabetes: especially in rapidly-developing world with high obesity & excessive consumption of sugar-rich foods à complications due to diabetes: increased risk of infections of mother; urine infection & vaginal candida (fungal) infection; increased risk of hypertension in pregnancy; fetal structural abnormality; macrosommia (big & heavy baby); polyhydramnios (excess amniotic fluid); risk of still-births; complications during labour; baby suffer from complications (low sugar levels, jaundice, poor temperature control, poor feeding, irritability) à risk factors: history of diabetes; repeated miscarriages; sugar in urine; hypertension in pregnancy à what to do if diabetes mother: high-protein, low-carbohydrate diet; cut out sugar from diet; consistent diet; active lifestyle; monitor blood sugar levels

• Healthy baby next time:

1. Interval before next pregnancy: 2-3 months for recuperation
2. Genetic or chromosome testing
3. Risk of recurrence of: structural abnormalities; maternal illnesses
4. Need for detailed ultrasound assessment & prenatal diagnosis in next pregnancy

• In short, monitor your nutrition, diet & health, prevent infection, maintain hygiene, understand basics of childbirth & be well-prepared mentally & bodily 飲食起居, 身體環境衛生, 身心舒暢

Labours

Labor has often been thought a mystery. In all honesty it is a mystery in many ways. Each woman will have a different labor and yet many parts are the same. Below you will find a crash course in the stages of labor, what each does, the parameters, and some average events of that stage. Remember, however, that very few women will follow this to the letter, there will be some variation.

First stage of labor is usually the longest part of labor. This is where you are having contractions and your cervix is dilating. This stage is broken down into three phases:

• Early Phase
  "Yippy! I'm in labor!"

• Active Phase
  "This is hard work."

• Transition Phase
  "Okay, I'll go home and come back tomorrow!"

Pushing usually feels better for most women. They have spent the first stage of labor relaxing and letting their body do all the work, now they can actually do something to help. This stage can last three or more hours, but for many women will not. The length of this stage is dependent upon the positioning of the mother (upright = faster), the positioning of the baby, whether medications have been used, etc. The contractions will usually space out a bit, going back to about four minutes apart. This stage ends with the birth of your baby!

After you are holding your beautiful baby, you may be asked to push again after some point, and you might be puzzled. Oh yes, the placenta! Don't worry this one has no bones and is much easier to push out. Nursing your baby after he or she is born will help the uterus to contract and expel the placenta, but most come within an hour after birth, usually within a few minutes. Don't worry about it, spend the time bonding with your new little one.

No real contractions to speak of, but postpartum is generally accepted as the fourth stage of labor. Your body is going through many changes now that the baby has been born. Not to mention the large changes your family is going through adding a new person to your family. Be sure to ask for help. Your body will slowly change and become more like your prepregnancy self, but not exactly. Hang in there, babies grow way to fast. I've often said that we need to save postpartum for when our children are about three years old so that we can enjoy the tiny newborns.

Enjoy your labor, believe it or not it's the hardest work you'll do, but it yields the most rewards.

How to Support a Laboring Woman FAQ - Childbirth.org