Chitika1

Sunday 4 December 2011

BIRTH CONTROL-CAESAREAN BIRTH


Introduction to birth control types and options

If a woman is sexually active and she is fertile — physically able to become pregnant — she needs to ask herself, "Do I want to become pregnant now?" If her answer is "No," she must use some method of birth control (contraception).
If a woman does not want to get pregnant at this point in her life, does she plan to become pregnant in the future? Soon? Much later? Never? Her answers to these questions can determine the method of birth control that she and her male sexual partner use — now and in the future.
There are a number of different ways to describe birth control. Terms include contraception, pregnancy prevention, fertility control, and family planning. But no matter what the process is called, sexually active people can choose from a plethora of methods to reduce the possibility of their becoming pregnant. Nevertheless, no method of birth control available today offers perfect protection against sexually transmitted infections in women, and sexually transmitted infections in men (sexually transmitted diseases, or STDs), except abstinence.
It is estimated that there are over three million unplanned pregnancies every year in the United States. Half of these unplanned pregnancies happen because a couple does not use any birth control at all, and the other half occur because the couple uses birth control, but not correctly.
In simple terms, all methods of birth control are based on either preventing a man's sperm from reaching and entering a woman's egg (fertilization) or preventing the fertilized egg from implanting in the woman's uterus (her womb) and starting to grow.
Birth control methods can be reversible or permanent. Reversible birth control means that the method can be stopped at essentially any time without long-term effects on fertility (the ability to become pregnant). Permanent birth control usually means that the method cannot be undone or reversed, most likely because it involved surgery. Examples of permanent methods include vasectomy for the man or tubal ligation for the woman.
Birth control methods can also be classified according to whether they are a barrier method (for example, a condom) that blocks sperm, a mechanical method (for example, an intrauterine device [IUD]), or a hormonal method (for example, the "pill").
"Natural" methods do not rely on devices or hormones but on observing some aspect of a woman's body physiology in order to prevent fertilization.
The direct responsibility for most of the methods of birth control that are currently available rests with the woman. The input of a health care practitioner may sometimes be essential in choosing appropriate birth control. New methods of birth control are being developed and tested all the time. And what is appropriate for a couple at one point may change with time and circumstances.
Unfortunately, no birth control method, except abstinence, is considered to be 100% effective.


Barrier methods of contraception

Barrier methods of contraception work by creating a physical barrier between sperm and egg cells so that fertilization cannot occur. The most common forms of barrier contraception are condoms (male and female), diaphragm, cervical cap, and contraceptive sponge.
Spermicides, a form of chemical contraceptive that work by killing sperm, are often combined with barrier methods of contraception for greater effectiveness.
While barrier methods of contraception generally do not have the side effects of hormonal contraceptives, some forms of barrier contraception (contraceptive sponges and condoms) may be obtained without a prescription.
The only medical contraindication to the use of barrier contraception is latex allergy (when using latex condoms). However, with the exception of male and female condoms that can provide protection against infection with sexually-transmitted diseases (STDs), most methods of barrier contraception are not effective in preventing STDs.

Spermicides

During sexual intercourse, hundreds of millions of sperm are normally released into a woman's vagina. The large majority of these sperm die. They die because of the unfriendly environment of the vagina, which is acidic, and because the mucus in the cervix above the vagina acts as a selective filter for the sperm. Only about 1% of all the sperm released in an ejaculation successfully pass through the woman's vagina and cervix to reach the uterus (the womb). However, it only takes one sperm to fertilize the ovum (the egg) and to achieve conception.
Spermicides are a type of contraceptive agent that work by killing sperm.
Spermicides need to be in place in a woman's vagina before intercourse if they are to prevent viable sperm from reaching her uterus. Spermicides come in a wide variety of forms, including jellies, creams, foams, films, and suppositories. The active ingredient in essentially all spermicides is Nonoxynol-9. This is a detergent-like chemical that kills sperm.
Once placed inside the vagina, the spermicide melts into a liquid that coats the vagina in order to set up a chemical barrier between the sperm and the cervix. Spermicidal foams are more effective than creams or jellies. Not only is it possible to achieve a better distribution with foam, but foam adheres better to the vaginal walls and cervix.
Suppositories are solid or semi-solid and need to be inserted in the vagina 15 minutes before intercourse in order to liquefy with vaginal moisture.
Vaginal contraceptive film needs to be in place in the vagina about 5 minutes prior to sexual intercourse in order to liquefy and become effective.
Spermicides are like all other methods of birth control in that they must be used properly in order to prevent pregnancy. Each type of spermicide has a unique method of use. For example, spermicidal creams, gels, and foam need to be deposited high up in the vagina near the cervix. Spermicidal suppositories must be unwrapped and inserted in the vagina. Squares of spermicidal film should be inserted into the vagina with a woman's finger. It is important to follow exact instructions on the package for each different type of spermicide.
A spermicide should be placed in the vagina prior to the man's penis getting anywhere near the vagina. It is a common mistake for a couple to wait too long before using the spermicide.
There are two basic concerns with any given spermicide. 1) How long the spermicide stays in the desired place; and 2) how long the spermicide is active in killing sperm. Therefore, the timing of spermicide use must take into account both of these factors.
In general, spermicides tend to be effective soon after their application. They can be inserted 15 minutes or more before intercourse. However, if there is a significant delay before intercourse (for example an hour), more spermicide must be added.
A fresh application of spermicide must also be used for each act of intercourse.
Douching should be avoided for at least 8 hours after the last intercourse.
The effectiveness of spermicides in preventing pregnancy varies from 70 to 90%. This depends on the amount of spermicide and how it is used, the timing of use prior to intercourse, and how well the instructions on the package are followed.
Spermicides should not be used as protection for the woman or man against sexually transmitted infections (sexually transmitted diseases, or STDs). While spermicides may be partially protective against certain organisms that cause sexually transmitted infections, including chlamydia and gonorrhea, they also do not protect against the human Immunodeficiency virus (HIV) infection.
The main objection voiced about spermicides is that they are "messy." A small percent (2% to 4%) of people may have an adverse reaction to Nonoxynol-9, which is experienced as an irritation or a burning sensation.
Spermicides, however, have some positive features. They are relatively inexpensive and they are available over-the- counter (OTC) without a prescription.
Note that some lubricating jellies also available over-the-counter do not contain spermicide and are not meant to be used as a form of birth control. It is important to check the information on the package to be sure that the product contains spermicide or that the word "contraceptive" appears on the label.



Summary and conWhat are intrauterine devices (IUDs)?


The intrauterine device (IUD) is a method of birth control designed for insertion into a woman's uterus so that changes occur in the uterus that make it difficult for fertilization of an egg and implantation of a pregnancy. IUDs also have been referred to as "intrauterine contraception (IUC). IUDs approved for use in the U.S. contain medications that are released over time to facilitate the contraceptive effect.
The IUD is a small "T"-shaped device with a monofilament tail that is inserted into the uterus by a health care practitioner in the office setting. When inserted into the uterus, the arms of the "T" are folded down, but they then open out to form the top of the "T". The device rests inside the uterus with the base of the T just above the cervix and the arms of the T extending horizontally across the uterus. A short piece of monofilament string attached to the IUD extends through the cervix into the vagina. This string makes it possible to be sure that the IUD is still in the uterus.

What are the types of intrauterine devices (IUDs)?


Intrauterine devices (IUDs) come in two different types: 1) copper-releasing, or 2) progesterone-releasing.
  1. The TCu380A (Paragard) is a copper-containing IUD. It releases copper from a copper wire that is wrapped around the base. The released copper contributes to an inflammatory reaction in the uterus that helps prevent fertilization of the egg. It is approved to remain in place for up to 10 years.
  2. Levonorgestrel-releasing IUD (Mirena): This form of IUD releases a progestin hormone from the vertical part of the T. Progestin acts to thicken cervical mucus, creating a barrier to sperm, as well as renders the lining of the uterus inhospitable to implantation of a pregnancy. This form of IUD is approved for up to five years of use.

How does an intrauterine device (IUD) work?


It is not fully understood how IUDs work. They are thought to prevent conception by causing a brief localized inflammation that begins about 24 hours after insertion. This causes an inflammatory reaction inside the uterus that attracts white blood cells. The white blood cells produce substances that are toxic or poisonous to sperm. The progesterone-releasing IUDs also cause a subtle change in the endometrial environment that impairs the implantation of the egg in the uterine wall. This type of IUD also alters the cervical mucus, which, in turn, inhibits sperm from passing through the cervix.
IUDs are only available by prescription and must be properly inserted by a health care professional. A pelvic exam is required to insert an IUD. The IUD is usually inserted into the uterus during a woman's menstrual period although it can be done at any time during her monthly cycle as long as she is not pregnant.
The woman must check her IUD every month to be sure that the IUD is still in place. Sometimes, the uterus expels (pushes out) the IUD. The spontaneous expulsion rate has been reported to be as high as 10% during the first year of use. Expulsions may not cause any specific symptoms and can be overlooked. In addition to the woman checking the IUD, the device must also be checked periodically by a health care professional.

What are the advantages of an intrauterine device (IUD)?


The advantages of the IUD include the fact that it is highly effective in preventing conception, is reversible, and starts working almost immediately. A woman with an IUD does not need to use other birth control methods before she has sexual intercourse, and once the IUD is removed, there is a quick return to fertility. The levonorgestrel-releasing IUD (99% effectiveness) is replaced every five years. The copper IUD is also 99% effective and only needs to be replaced every 10 years.

What are the side effects of an intrauterine device (IUD)?


Side effects of the IUD are limited primarily to the uterus. These include:
It is also possible for the IUD to pass through (perforate) the uterine wall and enter the abdominal cavity, where it must be retrieved surgically. Perforation of or trauma to the uterus by the IUD occurs in 1/1,000 insertions. Warning signs of possible complications from an IUD include abdominal pain, heavy bleeding, abnormal spotting or bleeding, and a smelly vaginal discharge. If a woman experiences any of these signs, she should contact her health care professional.

How is an IUD removed?


An IUD must be removed by a health care professional. It is very important that a woman not attempt to remove an IUD on her own, as serious problems may result. IUD removal is carried out by determining the position of the uterus, then locating and grasping the stings of the IUD with a special forceps or clamp. The health care professional will then remove the IUD by gentle traction on the strings.
Occasionally, the strings of the IUD will not be located. In these situations, the strings have often slipped higher into the cervical canal. Your health care professional can use special instruments to locate the strings and/or remove the IUD. Complications of IUD removal are rare, and removal can take place at any time. Some studies have shown that removal is easier during the menstrual period, when a woman's cervix is typically softer, than during other times in the menstrual cycle.

What are the risks and complications of intrauterine devices (IUDs)?


An IUD may not be appropriate for women who have heavy menstrual bleeding, had previous pelvic infections, have more than one sexual partner, or plan on getting pregnant. This is because IUDs do not protect against sexually transmitted infections (STDs) and should not be in place if a woman intends to become pregnant.
If women become pregnant with their IUDs in place, 40% to 50% of the pregnancies end in miscarriage.
Women who use non-progesterone types of IUDs are 50% less likely to have an ectopic pregnancy compared to women using no contraception. When a woman using an IUD does become pregnant, the pregnancy is more likely to be ectopic, but still ectopic pregnancy in a user of an IUD is a rare occurrence.
Serious complications due to infection associated with an IUD may prevent a woman from being able to become pregnant in the future.
Also, with the progesterone-releasing IUD (levonorgestrel IUD), a reduction in menstrual flow and a decrease in painful menstrual cramping are often observed with continued use. This is because the progesterone hormone can cause thinning of the lining of the uterus. These menstrual changes are not dangerous in any way and do not mean that the contraceptive action of the IUD is diminished.
The IUD provides no protection against sexually transmitted diseases (STDs).
source:medicinenet.com



CONCLUSIONS

Many methods of birth control and contraception are available today. There are many options. Unfortunately, most of these choices offer little or no protection against sexually transmitted infections (sexually transmitted diseases, STDs), especially against HIV, the human immunodeficiency virus that causes acquired immunodeficiency syndrome (AIDS).

For some individuals, economic considerations dictate their choice of contraceptive method. Abstinence is 100% effective and costs nothing, but may not always be a popular choice. "Natural" methods cost essentially nothing (if one does not use test kits or electronic monitors) but they require considerable discipline to be effective. Barrier methods, such as spermicides and condoms, are affordable to most people and can be effective if they are used consistently and correctly. The hormonal methods, such as "the pill," are highly effective but their cost can add up if they must be purchased over a period of time.
The choice of a particular method of contraceptive also depends on a person's age, health, and personal situation. For example, behavioral methods (fertility awareness or withdrawal), IUDs, and tubal ligation are not contraceptive methods recommended for teenagers. Surgical sterilization (vasectomy or tubal ligation) is not appropriate for a man or woman who wishes to have children in the future because surgical reversal is not guaranteed. Certain medical conditions can be contraindications for a woman using a hormone-based method of birth control.

Birth Control At A Glance

  • Methods of birth control include barrier, mechanical, hormonal, and natural methods, as well as emergency and permanent methods.
  • All methods of birth control are based on either preventing a man's sperm from reaching and entering a woman's egg (fertilization) or preventing the fertilized egg from implanting in the woman's uterus (her womb) and starting to grow.
  • No birth control method, except abstinence, is considered to be 100% effective.
  • No method of birth control available today offers perfect protection against sexually transmitted infections (sexually transmitted diseases, or STDs), except abstinence
  •                                CAESAREAN BIRTH



Cesarean delivery, also called c-section, is surgery to deliver a baby. The baby is taken out through the mother's abdomen. Most cesarean births result in healthy babies and mothers. But c-section is major surgery and carries risks. Healing also takes longer than with vaginal birth.
Most healthy pregnant women with no risk factors for problems during labor or delivery have their babies vaginally. Still, the cesarean birth rate in the United States has risen greatly in recent decades. Today, nearly 1 in 3 women have babies by c-section in this country. The rate was 1 in 5 in 1995.
Public heath experts think that many c-sections are unnecessary. So it is important for pregnant women to get the facts about c-sections before they deliver. Women should find out what c-sections are, why they are performed, and the pros and cons of this surgery.

What Are The Reasons For a C-Section?


Your doctor might recommend a c-section if she or he thinks it is safer for you or your baby than vaginal birth. Some c-sections are planned. But most c-sections are done when unexpected problems happen during delivery. Even so, there are risks of delivering by c-section. Limited studies show that the benefits of having a c-section may outweigh the risks when:

Can a Woman Choose to Have a C-Section (Patient Requested C-Section)?


A growing number of women are asking their doctors for c-sections when there is no medical reason. Some women want a c-section because they fear the pain of childbirth. Others like the convenience of being able to decide when and how to deliver their baby. Still others fear the risks of vaginal delivery including tearing and sexual problems.
But is it safe and ethical for doctors to allow women to choose c-section? The answer is unclear. Only more research on both types of deliveries will provide the answer. In the meantime, many obstetricians feel it is their ethical obligation to talk women out of elective c-sections. Others believe that women should be able to choose a c-section if they understand the risks and benefits.
Experts who believe c-sections should only be performed for medical reasons point to the risks. These include infection, dangerous bleeding, blood transfusions, and blood clots. Babies born by c-section have more breathing problems right after birth. Women who have c-sections stay at the hospital for longer than women who have vaginal births. Plus, recovery from this surgery takes longer and is often more painful than that after a vaginal birth. C-sections also increase the risk of problems in future pregnancies. Women who have had c-sections have a higher risk of uterine rupture. If the uterus ruptures, the life of the baby and mother is in danger.
Supporters of elective c-sections say that this surgery may protect a woman's pelvic organs, reduces the risk of bowel and bladder problems, and is as safe for the baby as vaginal delivery.
The National Institutes of Health (NIH) and American College of Obstetricians (ACOG) agree that a doctor's decision to perform a c-section at the request of a patient should be made on a case-by-case basis and be consistent with ethical principles. ACOG states that "if the physician believes that (cesarean) delivery promotes the overall health and welfare of the woman and her fetus more than vaginal birth, he or she is ethically justified in performing" a c-section. Both organizations also say that c-section should never be scheduled before a pregnancy is 39 weeks, or the lungs are mature, unless there is medical need

Before Surgery


Cesarean delivery takes about 45 to 60 minutes. It takes place in an operating room. So if you were in a labor and delivery room, you will be moved to an operating room. Often, the mood of the operating room is unhurried and relaxed. A doctor will give you medicine through an epidural or spinal block, which will block the feeling of pain in part of your body but allow you to stay awake and alert. The spinal block works right away and completely numbs your body from the chest down. The epidural takes away pain, but you might be aware of some tugging or pushing. See Medical Methods of Pain Relief for more information. Medicine that makes you fall asleep and lose all awareness is usually only used in emergency situations. Your abdomen will be cleaned and prepped. You will have an IV for fluids and medicines. A nurse will insert a catheter to drain urine from your bladder. This is to protect the bladder from harm during surgery. Your heart rate, blood pressure, and breathing also will be monitored. Questions to ask:
  • Can I have a support person with me during the operation?
  • What are my options for blocking pain?
  • Can I have music played during the surgery?
  • Will I be able to watch the surgery if I want?

During Surgery


The doctor will make two incisions. The first is about 6 inches long and goes through the skin, fat, and muscle. Most incisions are made side to side and low on the abdomen, called a bikini incision. Next, the doctor will make an incision to open the uterus. The opening is made just wide enough for the baby to fit through. One doctor will use a hand to support the baby while another doctor pushes the uterus to help push that baby out. Fluid will be suctioned out of your baby's mouth and nose. The doctor will hold up your baby for you to see. Once your baby is delivered, the umbilical cord is cut, and the placenta is removed. Then, the doctor cleans and stitches up the uterus and abdomen. The repair takes up most of the surgery time. Questions to ask:
  • Can my partner cut the umbilical cord?
  • What happens to my baby right after delivery?
  • Can I hold and touch my baby during the surgery repair?
  • When is it okay for me to try to breastfeed?
  • When can my partner take pictures or video?
  • After Surgery


    You will be moved to a recovery room and monitored for a few hours. You might feel shaky, nauseated, and very sleepy. Later, you will be brought to a hospital room. When you and your baby are ready, you can hold, snuggle, and nurse your baby. Many people will be excited to see you. But don't accept too many visitors. Use your time in the hospital, usually about four days, to rest and bond with your baby. C-section is major surgery, and recovery takes about six weeks (not counting the fatigue of new motherhood). In the weeks ahead, you will need to focus on healing, getting as much rest as possible, and bonding with your baby — nothing else. Be careful about taking on too much and accept help as needed. Questions to ask:
    • Can my baby be brought to me in the recovery room?
    • What are the best positions for me to breastfeed?

    What About a Vaginal Birth After a C-Section (VBAC)?


    Some women who have delivered previous babies by c-section would like to have their next baby vaginally. This is called vaginal delivery after c-section or VBAC. Women give many reasons for wanting a VBAC. Some want to avoid the risks and long recovery of surgery. Others want to experience vaginal delivery.
    Today, VBAC is a reasonable and safe choice for most women with prior cesarean delivery, including some women who have had more than one cesarean delivery. Moreover, emerging evidence suggests that multiple c-sections can cause serious harm. If you are interested in trying VBAC, ask your doctor if you are a good candidate. A key factor in this decision is the type of incision made to your uterus with previous c-sections.
    Your doctor can explain the risks of both repeat cesarean delivery and VBAC. With VBAC, the most serious danger is the chance that the c-section scar on the uterus will open up during labor and delivery. This is called uterine rupture. Although very rare, uterine rupture is very dangerous for the mother and baby. Less than 1 percent of VBACs lead to uterine rupture. But doctors cannot predict if uterine rupture is likely to occur in a woman. This risk, albeit very small, is unacceptable to some women.
    The percent of VBACs is dropping in the United States for many reasons. Some doctors, hospitals, and patients have concerns about the safety of VBAC. Some hospitals and doctors are unwilling to do VBACs because of fear of lawsuits and insurance or staffing expenses. Many doctors, however, question if this trend is in the best interest of women's health.
    Choosing to try a VBAC is complex. If you are interested in a VBAC, talk to your doctor and read up on the subject. Only you and your doctor can decide what is best for you. VBACs and planned c-sections both have their benefits and risks. Learn the pros and cons and be aware of possible problems before you make your choice.
    SOURCE:MEDICINENET.COM

    The National Women's Health Center. C-Section

No comments:

Post a Comment