Female Reproductive System
as the receptacle for the male’s sperm, and the ovaries, which produce the female’s ova. All of these parts are always internal; the vagina meets the outside at the vulva, which also includes the labia, clitoris and urethra. The vagina is attached to the uterus through the cervix, while the uterus is attached to the ovaries via the Fallopian tubes. At certain intervals, the ovaries release an ovum, which passes through the fallopian tube into the uterus.
If, in this transit, it meets with sperm, the sperm penetrate and merge with the egg, fertilizing it. The fertilization usually occurs in the oviducts, but can happen in the uterus itself. The zygote then implants itself in the wall of the uterus, where it begins the processes of embryogenesis and morphogenesis. When developed enough to survive outside the womb, the cervix dilates and contractions of the uterus propel the fetus through the birth canal, which is the vagina.
The ova are larger than sperm and are generally all created by birth. Approximately every month, a process of oogenesis matures one ovum to be sent down the Fallopian tube attached to its ovary in anticipation of fertilization. If not fertilized, this egg is flushed out of the system through menstruation.
A missed, lighter, or shorter menstrual period than usual Breast tenderness or enlargement Nipple sensitivity Frequent urination Feeling unusually tired Nausea and/or vomiting Feeling bloated Cramps Increased or decreased appetite Feeling more emotional than usual
There may be other reasons besides pregnancy that you are experiencing some of the above. If you do not want to be pregnant, do not assume that you are; use birth control until you take the test.
Finding Out Any woman who has begun her period, has not experienced menopause, and who has vaginal intercourse with a man can become pregnant unexpectedly. Whether you are fourteen or forty-five, every method of birth control can fail, even tubal ligation. It is possible, though very rare, for you to become pregnant without intercourse if the man’s sperm got near the entrance of your vagina. If you suspect you are pregnant now, try to take a test within the next twenty-four hours.
The Test A simple way to find out is to take a home pregnancy test, which tests your first urination of the day. The test is easy to use, available in the family planning section of drugstores, and costs between $6 and $12. Follow the directions exactly. The test can detect pregnancy starting at the time of your missed period, a bout two weeks after ovulation.
Family planning clinics, women’s health centers, and medical offices offer both urine and blood tests. A blood test can detect pregnancy six to eight days after ovulation.6 Both tests, known as monoclonal antibody tests, detect human chorionic gonadotropin (hCG), a hormone present first in the bloodstream and then in urine during pregnancy. Be cautious about assuming that a negative urine result means you are not pregnant. Test results can be negative because the test wasn’t performed correctly or because you tested too early in the pregnancy for the hCG levels to be detected.
Be aware that some clinics, sometimes called pregnancy crisis centers or abortion alternatives, offer free testing and counseling to frighten you away from considering abortion, or to convince you to choose adoption with their agency. When you seek testing, medical care, or counseling, it is normal to feel both greatly relieved and vulnerable. Professionals, consciously or not, may also treat you with some bias depending on how they perceive your age, marital status, race, disability, or other factors. No matter what your circumstance, you should receive advice that clarifies your needs and desires and does not presume anything about your life.
Strategies to Ease Labor Pain There are many different ways to deal with the intensity of labor and birth. A quiet environment with dim light is often most relaxing.
If you are having your baby in a hospital and you want to labor spontaneously, without interruption, you may have to be firm in insisting on having your wishes met at the very time when you should be focusing on your labor. Hospitals are not usually peaceful places. Most of them have or impose medical interventions that can deplete your sense of competence, your optimism, and your strength.
You can most successfully create your own pool of calm and determination in the midst of a busy atmosphere when supportive birth attendants inspire and sustain you; when they take responsibility for creating a safe cocoon or protected space around you; when they support your capacity to labor naturally; and when you have the freedom to incorporate into your experience some of the elements mentioned below.
The Presence of Others Up until the twentieth century, when hospital births became the norm, female relatives, friends, and midwives attended women in labor. The continuous presence of people who love you and believe in you (your midwife or doula, a supportive physician and/or nurse, your husband, partner, or a family member or friend) can provide comfort and strength. The presence of a support person who stays with you continuously through labor makes labor shorter and more efficient; women who have support people have fewer medical interventions and are less likely to have a cesarean birth.4 Choose people who understand your wishes and can focus on your needs. Even if you want to be left to yourself at times, nearby support is reassuring.
Listen to Yourself Whatever you want or don’t want during labor is fine. Don’t be surprised if what you thought you might want differs from what you actually do want. Listen to your body’s messages. Feel free to surrender yourself to each moment.
Surroundings You may feel most comfortable at home; where you can create the atmosphere you want. In freestanding birth centers, you can cook, use the living room, walk outside, and spend time with children and friends. In hospitals, bring home along with you, in the form of clothes, personal objects, and recordings of music that you love. Most women need privacy, dim lights, and calm, all of which enable labor to flow efficiently and naturally.
Nourishment Eat and drink what you want. Juices, teas, energy drinks, or light soups during labor keep you hydrated and give you energy. You are doing very hard work, after all, and need sustenance. Pee often.
Activity and Positions of Comfort Moving around, being upright, walking, changing positions, dancing, rolling your hips, rocking on hands and knees if you are in back labor, squatting: All work with the forces of gravity and can help your uterus to work effectively. Many women find sitting or lying on large rubber birth balls useful. Some women focus best, relax, and labor effectively lying on their side once active labor is established. Lying flat on your back is not an ideal position.
The Solace of Water Water can be wonderfully soothing. It can help start contractions or pick them up into a new rhythm. Some women stay in the shower for hours. The flow of hot water on your back can ease discomfort, especially if you experience contractions and intense pressure mostly in your lower back (back labor). Immersion in a tub of deep water can help you feel lighter.
Touch Sometimes you may seek support, touch, and massage, and sometimes not. Many midwives and doulas give wonderful massages. Ask others to help you when you stand, squat, or kneel, to let you hang from them, or to hold you however you want to be held. Application of cold or heat may be soothing. If anything feels wrong, say so.
Stillness Sometimes being very still, being quiet and focusing inward, or sleeping between contractions leads to deep relaxation. You may want to draw upon skills learned in yoga, meditation practice, mindfulness-based childbirth preparation classes, or hypno-birthing classes.
Breathing There really is no special way to breathe that works best during labor. Breathing takes care of itself. Focusing on natural rhythm can center you and help you work with your labor. You can pay attention to your breath, letting it anchor you to the moment as your contractions begin, become stronger, peak, and subside. Focusing on breathing out slowly between contractions can help you relax muscles and get rid of tension. Each breath brings you closer to when your baby will be born.
Vocalizing Women run the gamut of emotions during labor. You may feel exaltation, anger, fear, pain, or wonder. You may sing, laugh, giggle, or make low, open sounds, “ohhhhs” and “ahhhhs” and “oms.” You may fear that making sounds means that you are losing control or being undignified. In fact, it means that you are present and aware, working with the descending, opening process as it is happening.5 Feel the vibrations in your body.
Epidural An epidural is similar to a spinal but has some distinct differences. An epidural is placed along your backbone, generally in the low back area, but it can be anywhere along your spine as needed for your surgery or pain relief. Again your doctor will clean and numb an area of your back and place a needle into you back, this time staying outside the balloon surrounding your spinal cord. Once this space is reached a small soft plastic catheter in inserted into your back, into this epidural space and the needle is removed. This soft plastic catheter can be used to deposit numbing medication at anytime it is needed for your surgical procedure, for labor pain, or for pain you might experience when recovering from a major surgery. The numbing medicine will bath the nerves as they exit the spinal cord and decrease your experience of pain. This small soft catheter may be left in place for days allowing your physician to provide you with pain relief by numbing medication bathing the nerves for your recovery period. It is removed by simply pulling it out and does not hurt at all when removed. All you need is a Band-Aid and you are done.
Birth by Cesarean Section Surgical deliveries have increased alarmingly over the past thirty years. The 2002 cesarean rate in the U.S. was 26.1 percent, the highest ever in this country (in the 1960s, the national average was 5 percent). The rate varies from practice to practice and hospital to hospital.
A cesarean is major abdominal surgery. It must be done in a hospital, where anesthesia, antibiotics, and blood transfusions are available. Cesarean sections are lifesaving operations when performed on women who have certain problems during labor, including umbilical cord prolapse (the umbilical cord precedes the baby’s head); placenta previa (the placenta covers the cervix); placental dysfunction producing fetal distress; or failure of the baby to descend through the area between your pelvic bones.
I’d always dreamed of having a home birth, and if that wasn’t possible, to give birth in a birth center with a midwife. At 32 weeks, I had some bright red spotting. My midwife came to the hospital with me for an ultrasound, which showed that my placenta was partially covering my cervical opening. The obstetrician held out the possibility that the placenta might still move away from the cervix, although he was doubtful. I returned home with directions to call immediately if there was any more bleeding. At 35 weeks, I woke to find blood pouring. With a towel between my legs, I called my midwife, jumped in the car, and headed to the hospital, where my lovely five-pound daughter Chiara was delivered by cesarean section.
If you need to give birth by cesarean section, you will be moved to an operating room, where you will receive a spinal or an epidural to make your abdomen and legs completely numb. A urinary catheter will be inserted to keep your bladder empty. You will remain awake. In the rare instance when a cesarean section needs to be performed very quickly, you may be given general anesthesia and put to sleep because it is faster than making you numb with a spinal or epidural.
When the anesthesia has taken effect, the physician will make a horizontal cut in the abdominal wall low down near the pubis (vertical cuts are reserved for rare emergencies), make another cut through the uterine muscle, and ease your baby out. She or he will suction your baby’s nose and mouth, clamp and cut the umbilical cord, and assess the baby’s breathing. Once all is well, you or your partner can hold your baby as the doctor removes the placenta and sews up the incision. The whole procedure takes about an hour.
Cesarean sections can be lifesaving and health-enhancing in emergency situations, but they are not simply another way of being born. While safer than they were fifty years ago, cesarean sections are still major operations that carry considerable risks to mother and baby that don’t exist in vaginal birth. Although the overall incidence of death during childbirth is extremely small.
In addition, women who have a cesarean birth are more likely to experience an infection, be rehospitalized, and experience ongoing postpartum pain. A rare long-term risk to the mother, often unacknowledged, is death from bowel obstruction. This can happen up to twenty years after the surgery if the membrane that wraps around the uterus and bowels develops scarring and adhesions. Cesarean delivery is a special concern for women who have repeated pregnancies or plan large families, as it increases risks for subsequent infertility and serious placental problems for mothers and babies in future pregnancies. Babies born via cesarean section are more likely to have respiratory distress than babies born vaginally; are less likely to breast-feed; and are more likely to experience asthma in childhood and adulthood.
The side effects of widely used medical interventions (induction of labor, electronic fetal monitoring, and epidurals) lead to the “necessity” of cesareans. Physician training may favor operative deliveries–especially forceps and vacuum–over other approaches to problems, and concerns about liability often constrain a physician’s willingness to adopt nonoperative approaches. Obstetricians are sometimes pressured to practice defensive medicine to avoid being sued or losing lawsuits. Thus, they may not offer women who have had previous cesareans the choice of a vaginal birth after cesarean (VBAC), or they may practice in a hospital where VBACs are no longer allowed. Some haven’t learned the skills they need to deliver breech babies or twins vaginally. Elective cesareans (the term used for cesarean sections done without a medical need) are increasingly presented by doctors and the media as an option for healthy pregnant women. Women who fear labor or don’t want to go through the stress of childbirth are being allowed to choose cesareans. So far, elective cesareans make up a tiny portion of all cesarean sections, but the numbers are growing. The latest “reasons” for the recent increase in elective cesareans include the concern that vaginal delivery leads to pelvic floor damage and urinary and fecal incontinence. There is limited evidence to support this concern, and more important, the absolute risk and magnitude of these problems are not sufficient for most obstetricians ever to recommend an elective cesarean, or for most women to choose an elective cesarean. When considering a cesarean section, ask for a list of benefits and risks to you and your baby, both short-term and long-term. The information you are given should be based on the best evidence available as it applies to your pregnancy and situation.
Emergency Child Birth
[back to top]
Preparing for Birth
Make the room warm, and the mother comfortable with pillows. Put a clean sheet underneath her, if possible with a large plastic sheet beneath it. If the mother seems distressed or in a lot of pain, be calm and reassuring. As the birth proceeds, there may seem to be a lot of fluid, some of it bloodstained. This is normal.
Delivering the Baby When the baby’s head is visible in the vagina (crowning), birth is imminent!
The head and shoulders emerge, support the baby, but do not pull on the head or cord. Keep the baby warm. While holding the baby with its head lower than its feet, wipe mucus from both nose and mouth. Breathing by rubbing the back or flicking feet. If breathing does not start within a minute of birth, give artificial respiration. (See DRABC
of resuscitation in babies and young children ) Stimulate breathing by rubbing the back!
The umbilical cord can safely be left uncut until help arrives or mother and baby reach hospital. It may pulsate for a few minutes. After 10 to 20 minutes of birth, the placenta (after birth) will emerge. Do not pull on the cord, it may tear off. If bleeding seems very heavy, massage the mother’s lower abdomen gently every few minutes until medical help arrives. The Three Stages of Labor:
Stage One: The mother experiences regular contractions, which increase in strength and frequency. Stage Two: When the cervix is fully dilated, the baby moves down the birth canal. The head rotates and appears at the opening. As the head emerges, it rotates again to help the shoulder out. Stage Three: After the baby has been born, the mother’s uterus continues to contract to expel the placenta, or afterbirth. The contraction also prevents excess bleeding from the wall of the uterus as the placenta is pulled away. This completes the third and final stage of labor. Presentation of Different Stages of Labor: The first sign in a normal labor:
It comes when you feel contractions of the muscles of the uterus. At first, these may seem like irregular bursts of indigestion-like pain or twinges of backache. Throughout pregnancy, the uterus has been contracting in preparation for labor (although these contractions are rarely noticeable until the last few weeks of pregnancy). As labor starts, the mucus plug, which during pregnancy has formed a barrier between your uterus and vagina, will be expelled as a bloodstained discharge – the “show”. Contractions are not always a reliable sign to indicate that labor has started. Another important sign – bursting of the membranes surrounding the amniotic fluid:
You may either have a slow trickle of fluid from your vagina, or there may be a sudden gush – your “waters break”. In either case, rupture of the membranes is usually a sign that delivery is not far off. If you are having your baby in a hospital, you go through the “prepping” procedure. You are given a vaginal examination to see how far your labor has progressed and in what position the baby is lying. You will probably also be given an enema to empty your bowels. In some hospitals, it is also the custom to shave off all or part of the pubic hair as a precaution against infection. If contractions are not accompanied by any other signs and do not increase in frequency, then you are probably not in labor. Labor can be divided into three stages: The First Stage The mother experiences regular contractions, which increase in strength and frequency. Events:
It starts with the first contractions. With each contraction, the cervix – the baby’s exit from the uterus – is gradually pulled open and up, until it merges with the walls of the uterus and is fully opened or dilated. Full dilation occurs when the opening of the cervix is 10cm (4inches) in diameter. At this point, the uterus, cervix and vagina have merged to form the birth canal. Duration: The average duration of the first stage of labor is 12 hours for a first baby and 6 to 8 hours for a subsequent birth. However, for some women, having their first baby, the first stage can last for more than 24 hours (although every effort is made to prevent this); and for some women who have had several children, it may last only a few minutes. Transition period b/w 1st & 2nd Stage: When the cervix is fully dilated, there is a transition period between the first and second stages of labor. For some women, labor seems to come to a temporary halt at this point, while others feel hot, then cold, and may even vomit. The Second Stage: The mother experiences regular contractions, which increase in strength and frequency. Events:
When this stage begins, contractions become much more powerful and are usually accompanied by an urge to push the baby out and down the birth canal. The baby’s decent through the birth canal causes pressure on the rectum and may make you feel that you want to defecate. You will be advised to push only when you are having a contraction, so that the two forces combine to expel the baby and you conserve energy between contractions. However, when delivery is imminent, you may be told to stop pushing, as a push that is too forceful could result in the baby’s head tearing the tissues of your vagina. Ideally, the baby’s head should be eased out. The second stage of labor ends when the baby emerges completely from your birth canal. Duration:
The second stage lasts on average anything up to an hour for a first baby and up to 30 minutes for a subsequent baby. After the baby is delivered, the umbilical cord connecting the baby to the placenta inside the uterus is tied and clipped in two places – about 10cm (4inches) and 15cm (6inches) from the baby’s abdomen. The cord is then cut between these two points. The Third Stage It is the delivery of the placenta (afterbirth).
Your uterus continues to contract in an effort to separate the placenta from the wall of the uterus and to expel it. This is marked by some extra bleeding and by the umbilical cord moving a little further out of the vagina. To speed up the expulsion of the placenta in order to prevent the possibility of bleeding after the delivery (post-partum hemorrhage), the midwife may pull gently on the cord while pressing upwards on your abdomen with the other hand. The third stage of labor usually lasts about 15 minutes. After the placenta has been delivered:
You may be given an injection to re-enforce your body’s efforts to make the uterus contract firmly, and so prevent excessive bleeding. Any tears or incisions that have been made in the vagina are cleaned and stitched, and you may be able to hold your baby in your arms while this is being done. After holding the baby in the arms, the mother experiences a feeling which cannot be described in words – it’s a gift from God!