CHAPTER I

PRELIMINARY

1.1 Background
Pregnancy is the growth and development of the intra uterine fetus starting
from conception and ending until the beginning of labor. pregnancy, childbirth,
childbirth, newborns and the choice of contraception is a physiological and
continuous process. So that a mother's pregnancy, childbirth and childbirth run
normally, mothers need good health services. For government regulation number
61 of 2014 concerning reproductive health states that every woman is entitled to
health services to achieve a healthy life and be able to give birth to a healthy and
quality generation and reduce maternal mortality. These health services were very
much needed during this period.
The maternal mortality rate in Indonesia itself is still very high compared
to other ASEAN countries. According to Indonesia's demographic and health
survey (IDHS) in 2015 the number of AKI in Indonesia was 305 / 100,000
(Directorate of Family Health, 2016). Most maternal mortality is during childbirth
(49.5%), death during pregnancy (26%) during childbirth (24%) (Ministry of
Health of the Republic of Indonesia, 2012). While the infant mortality rate in 2015
in Indonesia was 22.23 / 1000 KH (directorate of family health, 2016). Most
neonatal deaths were asphyxia (51%), LBW (42.9%), SC (18.9%), premature
(33.3%), congenital abnormalities (2.8%) and sepsi (12%) (Riskesdas , 2015).
East Java province data itself for the last three years has tended to decline.
This can be understood considering that so far there has been support from a
number of programs from the province to the district / city in the form of several
facilities both in terms of AKI program management and recording and reporting,
improving the skills of officers in the field themselves and involving many parties
in the implementation of the KIA program. According to the 2015 MDGs the
target for AKI is 102 / 100,000 live births. And this figure has decreased
compared to 2014 which reached 93.52% per 100,000 live births, for the highest
cause of death for mothers in 2015 was eclampsia which was 162 (31%) while the
smallest cause was infection by 34 (6%). while for problems related to KIA, that

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the AKB is stagnant at 25.3 / 1000 KH (Health Office of East Java Province,
2015).
In responding to the high AKI in Indonesia the government has formed a
program consisting of 4 pillars including family planning, antenatal care, safe or
clean delivery and neonatal esendial obstetric or emergency services. Maternal
health services are realized through providing antenatal care at least four times
during pregnancy. Integrated antenatal services are comprehensive and quality
services provided to all pregnant women as well as other integrated programs that
require intervention during pregnancy. The minimum status of pregnancy care that
must be performed is 14T such as weight, blood pressure measurement, height
measurement of uterine fundus, complete TT immunization, administration of iron
tablets, HB examination, VDRL examination, urine examination, urine reduction
examination, breast care, exercise pregnancy, administration of malaria medicine,
administration of iodine oil capsules, discussion in preparation for referral.

1.2 Formulation of the problem

“How the description of pregnancy and the problems that occur in
pregnancy.”

1.3 Purpose
1. Knowing getting pregnant
2. Knowing test and special pregnancies
3. Knowing antenatal care and health
4. Knowing pregnancy problems
5. Knowing signs and signals from the baby

1.4 The benefits

1. Knowing about getting pregnant
2. Knowing about test and special pregnancies
3. Knowing about antenatal care and health
4. Knowing about pregnancy problems
5. Knowing about signs and signals from the baby.

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 CHAPTER II

THEORY AND DISCUSION

2.1 Pregnancy And Childbirth

2.1.1 Getting Pregnant

Let’s start with the female genital organs. On the outside is the vulva
which is enclosed by teo pairs of lips, the outer lips, or labia majora, and the inner
lips, or labia minora. At the top of the vulva the labia minora meet to enclose the
clitoris, which corresponds to the penis in the male. The clitoris plays no specific
role in the reproduction but is involved in the female sexual response. The urethra,
or entrance to the bladder, and the vagina, or birth canal, open into the vulva. The
vagina is a tube 10 to 15 centimetres long with smooth muscle walls and a lining
of pink tissue called squamous epithelium. Usually the vaginal walls lie flat
agains each other but they are capable of great elasticity. The vaginal can stretch
easily to accommodate the penis during intercourse, and even more so to permit
the passage of the baby in childbirth. At the top of the vagina is the cervix, or neck
of the uterus. At the time of ovulation, the glands of the cervix supply the mucus
that is necessary for the sperms to pass up through the cervix to fertilise the ovum.
When it is in the nonpregnant state, the uterus is very small, roughly 5 centimetres
wide by 8 centimetres long. During pregnancy, the cervix remains tightly closed
while the rest of the uterus grows larger to accommodate the growing foetus, the
amniotic sac and the amniotic fluid that surrounds the foetus. During labour, the
contraction of the uterus help to open up the cervix to allow the baby to pass
trough the vagina. The fallopian tubes are attached to the corners of the uterus and
the ova pass down these tubes from the ovaries to the uterine cavity. The process
of fertilization takes place in the fallopian tubes, when one of the sperms
penetrates the wall of an ovum.
A man’s primary sex organs are located outside his body. Two sex glands,
or testes, are suspended in a protective sac of skin called the scrotum. Each testis
contains hundreds of tiny tubes, or tubules, which produce the male reproductive
cells, or sperms. On the side of each testis is the tube called the vasdeferens,
which nourishes and stores the sperms. The sperms are mixed with seminal fluid

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produced by the seminal vesicles and prostate gland to form the thick, whitish
fluid called semen. During sexual excitement, the penis swells with blood and
becomes erect, so that it can be inserted into the woman’s vagina. When the men
reaches a climax, the muscles at the base of the penis contract and the semen is
ejaculated.
For fertilization to occur, however, intercourse must take place near the time
of ovulation, which is about halfway through the menstrual cycle (or roughly 14
days before the next periode). In the course of ovulation, one of the ovaries
releases a ripe egg cell. During intercourse, as many as 500 million sperms may
enter the vagina. They have a difficult journey, however, and only a
smallpercentage survive and reach an egg for fertilization, having first travelled
from the vagina, into the uterus, and on to the fallopian tubes. Once the egg and a
sperm cell unite, other sperms cannot penetrate the fertilized egg. The fertilized
egg starts to grow during its passage down the fallopian tube, and when it reaches
the uterine cavity it implans itself in the thick uterine lining and continues its
development. Each month the lining of the uterus is stimulated by the ovarian
hormones to prepare for the fertilized egg.
If for any reason fertilization does not occur, the ripened egg dies after about
24 hours and passes out with the uterine lining in the process known as
menstruation. Sperms may live for 72 hours or even longer after ejaculation.
1. Sexual Diseases can Damage A Woman’s Reproductive System
Sexual diseases can sometimes damage the fallopian tubes or uterus. If
you have had any of these disorders and are worried about your fertility,
your doctor can arrange for attest called a hysterosalpingogram. In this test,
an X-ray-blocking fluid is injected into the uterus and flows through the
fallopian tubes. The course of the fluid can be recorded on X-ray film and
thus any obstruction or defects detected. In a simpler test the pressure of gas
passed into the uterus is used to detect blocked fallopian tubes.

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2. Factors That Inhibit Pregnancy
Since you are young and healthy, it would probably make more sense to
wait a few month more and try some things that may help with conception.
Firstly, too frequent intercourse may mean too few or immature sperms, so
it might be advisable to abstain from intercourse for a few days early in your
wife’s menstrual cycle. Make sure you do have intercourse about two weeks
before the start of the next menstruation; this is when ovulation normally
takes place and pregnancy is most likely to occur. Watching for the
appearance of cervical mucus may help to pinpoint the time of ovulation.
Secondly, since you both lead busy lives, remember that job and
personal stress may affect your wife’s menstrual cycle and your sperm
count. Thirdly, fatigue can be a factor in lowering sperm count, as can
overindulgence in tobacco and alcohol, exposure to X-ray, and sexually
transmitted diseases
Finally, your wife may have other conditions, such as pelvic
inflammations, fibroids, and other uterine disorders, that may also decrease
her fertility. If either of you is aware of any such problems, discuss them
with your doctor.
3. Reproductive Health Check
Since you have been timing your sexual relations with ovulation for a
year and have had no positive result- and considering that you are both
healthy- yes, it might be a good idea for you to consult your doctor. He will
possibly refer you to a gynaecologist or to the infertility clinic at your local
hospital.
Both you and your husband will be tasted. A check will be done a
sample of his semen to determine the health of his sperm. In order to
evaluate the regularity of your ovulation, you will be asked to keep a record
of your body temperature, to be taken first thing each morning. Ovulation
can be detected in this manner because when the body produces ova, or egg
cells, the temperature rises half a degree or so for ten days or more. A
sample of the mucus may also be tested, and a biopsy of the endometrial
tissue that lines the uterus may be made to see if it’s responding to

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 hormones produced by the ovaries after ovulation. If the doctor attending
you suspects that you might have endometriosis- the abnormal build- up of
endometrial tissue outside the uterus he may ask you to undergo a
diagnostic procedure called a laparoscopy.
In this procedure, the exterior of the fallopian tubes and the ovaries are
examined for the scarring and adhesions that can be caused by
endometriosis. This disease, which if often associated with infertility, can be
treated with surgery to remove tissue and with hormone treatmens. Another
reason for infertility in a woman may be a shortage of thyroid hormone, so
the doctor may also want to check the thyroid gland.
As for treatment, infertility specialists prescribe a mild fertility
medication, called Clomid, which enables you to ovulate on a precise
schedule so that you can plan sexual relations accordingly. A stronger
fertility drug, called Pergonal, may be suggested by the specialist, but
because this drug increases by the chances of multiple births occurring, it is
prescribed only under certain circumstances and with special precautions.
4. Artificial Pregnancy (In Vitro Fertilization Techniques)
Artificial insemination involves semen provided by the husband (AIH)
or by an anonymous male donor (AID). The donor is carefully screened to
rule out the presence of genetic problems and sexually transmitted diseases.
It is a procedure often advocated to couples who want children, but where
the man cannot produce enough healthy sperms to achieve fertilisation. The
donated semen may be fresh, or it may be selected frozen from a sperm
storage bank. The semen is placed in the woman’s cervix when she is due to
ovulate.
A new technique, known as in vitro fertilisation, allows conception to
occur even though a woman’s fallopian tubes are not functioning properly.
In the simplest procedure, the ripened egg is taken from the woman’s ovary
by laparoscopic operation at the time of ovulation and mixed with the man’s
semen in a Petri dish. If fertilisation occurs, the embryo is injected a few
days later into the woman’s uterus through her vagina. If the embryo
attaches itself and grows in the uterus a pregnancy will result. There is an

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 increased risk of spontaneous miscarriage, and to date success rates are still
low.
Various other techniques of in vitro fertilisation have been developed to
improve the success rate and extend the procedure to other infertile groups.
These include: artificial stimulation of the ovary to produce multiple egg-
two or three are implanted and the rest frozen for a later attempt; collection
of egg by a needle guided by ultrasound, instead of laparoscopy; use of
donor semen where the man also has impaired fertility; and use of donor egg
where the woman cannot produce suitable eggs. There is also the GIFT
technique, or gamete intra- fallopian transfer, where the egg is mixed with
semen and transferred directly to the fallopian tube so that fertilisation
occurs there.
There is still controversy over the social, moral, legal and financial
issues arising from these techniques. Obviously research and education
should also be directed to the prevention of infertility and particularly the
prevention and treatment of pelvic inflammatory disease.

2.1.2 Test and Specials Pregnancies

The process of having a baby makes a variety of demands on the body.

Normally, the body is well prepared to meet such requirement, but to make sure,
your doctor will order routine test to be made. If you have a history of any
medical problems that might affect your ability to meet your baby’s needs, your
docyor may order special test. Routine tests that are repeated during pregnancy
include blood pressure readings, a full blood count, blood typing, blood or urine
sugar level and various other urine tests. You will also be checked for the
presence of syphilis and gonorrhoea and fir active herpes, if indicated. The
question of AIDS may also be raised. Whether or not you are immune to German
measles should also be determined, ideally three months or more before
pregnancy. If any of the tests produce unsatisfactory result, your doctor may
suggest changes in your diet, medication or other treatments to correct the
problem.

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1. The Ultrasound Scan
The ultrasound scan is a painless diagnostic test in which a technician
directs high-frequency waves at the uterus by gently rubbing a probe over
the abdomen. You can’t hear or fell the sound, but she the waves that
rebound from various tissues and stuctures in the abdomen are transformed
into electronic signals that from an image on a screen. In you friend’s case,
the image was of her unborn child
The image an ultrasound scan prodeces can reveral important
information.firstly. the best can help determine the age of the foctus (this is
especially helpful if the mother in unsure of her last menstrual period and
due date). Secondly, the test can confirm the presence of twins. Thirdly, it
can spot certain abnormalities in the heart, spine or brain of the foctus.
Fourthly, the scan can detect what is know as placenta praevia. A dangerous
condition in which the placenta, which nourishes the baby, blocks the mount
of the uterus. And finally, ultrasound can in some instances indicate the sex
of the unborn child, although it has been found that it.s not always accurate
in doing this.
An ultrasound test may cause a minimal amount of discomfort: it
doesn’t involve radiation, anf ti date no harmful effects to either mother of
foetus have been demonstreted. Many women have one or more scans
during their pregnancy, the first usually at 16 weeks: the test is more likely
to be arranged for a first pregnancy or if there are many problems.
Additional test may be made later in the pregnancy to allow the doctor to
monitor the baby’s growth and development. Some autthorities, however,
feel that ultrasound should be used only where a medical benefit is
anticipated and not as a routine procedure in pregnancies and investigatory
technique in other areas of medicine including general gynaecological and
abdominal examinations, echocardiograms ti check the functioning of the
heart and investigations of the brain.
2. High Risks Pregnancy
The large high-risk category includes women with epilepsy,
overactive thyroids, chronic urinary tract infections and diabetes. It also

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 includes women who have uterine abnormalities, anaemia, heart promblems.
Asthma, systemic lupus, high blood pressure, hepatitis, certain genetic
disorders, and viral disease such as German meales and genital herpes.
Drug-addicted women-and these include habitual smokers and drinkers-are
also in high-risk group. Risks are also increased in women with inadequate
nuristion, very young and older women, and women with too many or too
closely spacedd pregnancies.
3. Pregnancy In Old Age
Studies indicate that if an older woman (aged 35 and over) begins her
pregnancy in good health, the chances re that she will have a healthy,
normal child. The major risk that older women face is an increased
possibility of having a child with Down’s syndrome, a disorder involving
chromosomal abnormalities in the foetus, which result in mental retardation.
By the time a woman reaches 35 years of age, the chances are 1 in 365 that
her unborn child may have Down’s syndrome, and by the age of 40 the
chances inrease to 1 in 109.
However, there is a reliable test, called amniocentesis (see below),
which can detect Down’s syndrome and other genetic defect. This test is
perfomed between the 16th and 20th week of pregnancy. A new test, known
as chorionic villus sampling (see below), can detect genetic defect even
earlier.
4. Amniocentesis Test
Many people are under the impression that amniocentesis rules out all
possible birth defects, but this is not so. The test, which incidentally is 99
per cent accurate, is not routie, but it is suggested for all women 37 and over
to ensure that the chromosomal make-up of the foetus is normal and that the
unborn chill will not therefore suffer from Down’s syndrome. The test can
also detect certain congenital metabolic disorders and spinal cord problems,
as well as the sex of the child.
The amniocentesis test is done unde a local anaesthetic, using an
ultrasound scanner to locate a safe pocket of fluid. A long needle is inserted
into the mothers abdomen. Through the wall of the uterus, and on into the

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 amniotic sac. Since a unborn child’s cells and secretions are found in the
amniotic fluid, the fluid can suply a great del of information abut the baby.
There is a small element of risk involved-including he possibilities of
bleeding, leaking of amniotic fluid, cramping and miscarriage.
5. Chorionic Villi
Chorionic villi are microscopic hair-like projections located on the
membrane surrounding a foetus: they contain cells genetically similar to
those of the foetus. A small number of villi can be removed in the eighth
week of pregnancy and their cells analysed. Unlike amniocentesis, this test
doesnt involve the use of needles; instead, a thin flexible tube, caalled a
catheter, is passed through the vagina into the uterus. With suction, the
doctor removes a sample of the villi. Test result are available within four
days instead of the four weeks or so needed for amniocentesis. Although
still under study, the risks of miscarriage following chorionic villus
sampling seem to be about the same as those of amniocentesis.
6. Alpa-Foetoprotein (AFP) Test
It is called the alpa-foetoprotein (AFP) blood test-a safe and
inexpensive way of screening an expectant mother to thetermine if her
unborn child is free of neural-tube birth defects (that is, defects of the brain
or spinal column) and certain other birth defects, involving primarily the
digestive system. In the test, a sample of the mothers blood is drawn to
determine the amount of alpha foetorotein in it.
Too much AFP may indicate a birth defect. If the test results are
positive, the doctor may order an AFP test of the amniotic fluid, which is
obtained by amniocentesis.

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 ANTENATAL DIAGNOSTIC TESTS

The following tests, usually recomended for high-risk pregnancies, can

detect genetic defect and other abnormalities is a foertus

Test How and when perfomed Advantages/risks

Alpha- Blood drawn from the Elevated AFP levels may indicate
foetoproein expectant mother is tested for brain, spinal or digestive system
(AFP) blood its a AFP levels (14th to 16th defect in the foetus. No risks
test week of pregnancy)
Amniocentesis A needle is inserted through Can detect such genetic disorders
the abdomen into the uterus as Down’s syndrome and Tay-
and amniotic fluid is Sachs disease. Miscarriage rate is 1
withdrawn for analysis (16th in 300; involes some pain; analysis
to 20th week of pregnancy) takes about four weeks
Chorionic A catheter inserted into the Can detect genetic disorders earlier
villus sampling uterus through the vagina is than amniocentesis and without
used to suction out tissue needles; result available within four
samles from the membrane days
surrounding the foetus (8th Miscarriage rate and other possibl
to 10th week of pregnancy) effect are still being studied
Foetoscoy A fibre-optic tube inserted Can be used to take foetal blood
into the uterus through an samples and to treat defect before
abdominal incision provides birth. Involves some bleeding and
direct view of the foetus the risk of infection; miscarriage
(18th to 20th week of rate is 4 per cent
pregnancy)
Ultrasound Sound waves aimed at the Can detect foetal malformations
uterus create a picture of the and the presence of twins without
foetus (any time during use of X-rays; helps determine
pregnancy) foetal age. No knows risks.

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7. Tay-Sachs
Tay-Sachs disease is an inherited condition in which the lack of a
certain enzyme results in the build-up of fatty subtances in the brain. This,
in turn, causes the brain to gradually cease to function until the victim dies.
Because the gene that causes the disease is carried by ore people of Jewish
castern European extraction than by any other population group, the disease
is especially prevalent among them. The genefor Tay-sachs is recessive-that
ia. A baby will be have the disease only if it receivers two faulthy genes,
one form each parent; it cannot get the disease if neither parent or only one
carries the gene. The symptoms of the disease-blindness, convulsions,
mental retardation and general weakness-appear after the victim is wo
month old. Prospective parents can seek genetic counselling and may have
chemical tests perfomed to reveal whether they are carriers of a defective
gene.

If there is a possibility that a child may be born with Tay-Sachs

disease, an amniocentesis test can be performed when the foetus is abous
16th to 20th weeks ols. If the disease is detected, the parent can choose to
have a therapeutic abortion and attempt to have another chlid later on.

8. Twins Pregnancy
Twins are born in about one of every 80 birhts in Australia and New
Zealand, and so your question, not surprisingly, is one that is frequently
asked for doctors. The majority f twins born are the result of two separate
eggs that ripen during the same menstrual cycle and are fertilised by two
different sperms. Not always the same sex, such babies are referred to as
fraternal twins. Less often, twins result from the fertilisastion of a single
egss by just one sperm. (in the case the egg divides into two sections, and a
each section develops into its own foetus). The two infants thus produced
are known as identical twins, and are always of the same sex. A tendecy
towards having fraternal twins, apperas to run in families.
9. The Birth Of Twins (Prematurely)
Space inn the problem here, because as the two foetuses growm, and
even though each is a protected in a separate amniotic sac, they are

12
 somewhat crowded. This menas that pressure is put on the cervix, or
opening of the womb, which causes the cervix to dilate ad begin the birth
process premaurely. A twin pregancy generally ends about three weeks
earlier than the pregnancy of a single child. Twins also tend to be smaller in
size when they are born
Expectant mothers of twins must take extra precautions. They must
get plenty of rest to avois premature deluvery, and since they are eating fot
three, they shouls double their antenatal nutritional supllements. They are
also generall advised to refrain from sexual intercourse in their last three
month; intercourse could cause contarctions and thus trigger a premature
delivery.
Your cousin will also find that the extra weigt may cause her some
discomfort. It may lead to pre-eclampsia, or toxaemia, a type of
hypertention that may involves swelling of the hands, feet and face.

2.1.3 Antenatal Care and Health

Antenatal care should begin the moment you suspect you may be pregnant –
and certainly as soon as pregnancy is confirmed. The primary reason for this is as
obvious as it is important : the embryo strat developing immediately and within
days after fertilization, it implants itself in the uterus. There, rapidly dividing cells
soon protect and nourish it with a vascular organ known as the placenta and a sac
filled with a watery, cushioning liquid known as amniotic fluid, Fundamental
body systems are already forming, and by the third week a rather primitive
heartbeat can be detected. By the end of the second month human features are
distinguishable although it is not until the third mont that the embryo is designated
a foetus. At this time the baby’s sex can be identified.
During this period of rapid development – part of it even before the mother
is aware she is pregnant – many factors can adversely affect the formation of an
unborn child and the health of its mother,among them drugs, poor nutrition,
infection and other disorders, Thus, early antenatal care is essential.

Once the pregnancy is confirmed, it is important to decide where you will

have your baby and who will look after you. Regular monthly visits to your doctor

13
will be wssential until about your 32nd week of pregnancy, and rather more
frequently after that.

1. Calculate Gestational Age

Your doctor will probably do this for you. He arriver at the date by
using a formula that differs from the ninemonth pregnancy period familiar
to most people. Your doctor will determine your baby’s stage of
development, or gestational age, by taking the first day of your last 28-day
menstrual cycle and adding 280 days, or 40 weeks. In effect, he uses a lunar
(or 28-day) month in figuring your due date, whereas most people think in
terms of a 30- day calendermonth. Thus, your doctor may refer to your final
month as the tenth while you think of it as the ninth. Don’t worry, both
reckonings will turn out to be the same ! At best, you should probably think
of your due date as an approximate one and be prepared for the arrival of
your baby anytime from two weeks before to two weeks before to two
weeks after the date your obstetrician gives you.

2. Recommend a diet for pregnant women

An expectant mother’s obstetrician will recommend a diet that
includes a good supply of foods high in protein, calcium, iron, phosphorus,
zinc, iodine and magnesium. These important nutrients are found in meat,
fish, cheese, eggs, milk, nuts, green leafy vegetables and fruits. Folic acid,
which is needed for cell division, is also vital; it is supplied by green
vegetables, liver and some fruits. Fibre foods are also essential because they
help to prevent constipation, a common complaint of expectant mothers. A
mother-to-be will also be advised to drink a certain amount of fluid daily.
Tea, coffee and other drinks that contain caffeine should be reduce,
preferably eliminated; decaffeinated beverages are acceptable.

3. Weight Should a Women During Pregnancy

Doctors are more concerned about good nutrition and adequate weight
gain to ensure a healthy baby than specific targets. If a woman is of average
weight and height, for example, she may put on about 12 kilograms by the
end of her ninth month. Anything more than this is unnecessary and does

14
 not help the mother or the baby. The increase in weight, which is due to the
baby and the changes in the essential organs, depends on a mother’s stature
and her own weight.

4. Influence For Pregnant Women Who Are Smokers

This question is asked by many mothers-to-be and members of their
families. It has beed definitely established that smoking-even light smoking-
is linked to low brith weight. The constituents of cigarette smoke pass
across the placenta and result in smaller baby. Smoking can also increase
the risk of miscarriage, premature birth and other complications. If your
daughter-in-law cannot stop smokking during pregnancy, she should at least
try to cut back even further.

5. Pregnant Woman Should Avoid Alcohol

The New Zealand Medical Association, the National Health and
Medical Research Council in Australia, many doctors, however, who feel
that an occasional drink will not harm a foetus. A safe level of alcohol
consumption during pregnancy-or even whether such a level exixts-hasn’t
been determined, and thus there is no complete medical agree ment on the
issue. However, many studies have been conducted on the use of alcohol
during pregnancy, and the evidence indicates that heavy consumption other
medical bodies, and many leading physicians and obstetric researchers agree
with your friend. There are some can couse serious harm to an unborn child.
For example, heavy dringking has been linked to miscarriages, mental
retardation, physical deformities and underweight babies. Like many drugs,
alcohol may be absorbed by the palcenta, if a mother becomes intoxicated,
her unborn baby will too. Given the possible hazards of dringking, it is wise
to avoid alcohol during pregnancy.

6. A Dongerous Drug If Consumed In Pregnant Women

In the 1960s it was found that thalidomide, given to pregnant women
for morning sickness, could cause severe limb deformities in their babies.
The discovery led to the realization that other drugs could also cause
problems because they are all absorbed to some degree by an unborn child.

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 Your obstetrician will review in greater detail the list of drugs you should
avoid, especially during the first eight weeks of your pregnancy. But among
the types of prescription drugs that may harm the foetus are certain
antibiotics, diuretics, tranquillisers, barbiturates, amphetamines and certain
antifungal drugs. The list of potentially harmful over-the-counter drugs
includes aspirin, certain antihistamines, sodium bicarbonate, sedatives and
all drugs containing caffeine or iodine (check package labels). It is
especially important to consult your obstetrician before taking
anymedications during pregnancy.

Addictive drugs such as heroin or cocaine not only affect the physical
and mental health and development of a foetus but also cause the baby to
become addicted in the womb. Addicted infants face extremely serious
problems, in cluding withdrawal from the drug after birth. It is not clear just
how marijuana can damage a foetus, but it is certain that the carbon
monoxide in the smoke impairs the ability of the mother’s blood to carry
oxygen to the foetus. This holds true for cigarette smoking as well.

7. Execise Is Good For Pregnant

Most physicians believe that moderate exercise is essential to good
helath and this applies to mothers-to-be as well. Regular exercise helps to
keep the body in good shape; it can also increase stamina, which will help to
cope with the rigours of labour. In addition it make it easier to return to
normal physical tone after the baby is born.
It is normally recommended that the form of exercising practised before
becoming pregnant should be continued. However, sports that call for a high
de gree of reflex coordination, such as diving, skiing and skating, should be
avoided. More dangerous activities, such as mountaineering and horse
riding should also be given up.
8. A Safe Pregnancy For Travel
This is probably the best time during your pregnancy for you to travel.
You are now advanced enough to be free of the risk of miscarriage. If you
are planning a trip overseas or a long air flight, consult your obstetrician. As
long as he approves, you can travel right up to your ninth month. Some

16
 airlines, however, require written approval from your doctor if you are in
your ninth month of pregnancy.
9. Preparing For Labor (The Lamaze System)
One of the popular methods of preparing for childbirth is the lamaze
system-developed by the French physician Fernand Lamaze in the 1950s-
but there are others. In most of these approaches, you and your husband will
start weekly classes at the beginning of your seventh month and will
continue for six or eaght sessions. You will be taught breathing and
relaxation techniques to use in labour, as well as ways in which yor husband
can provide assistance and support for you.

Although none of the various childbirth preparation methods can

guarantee a totally painless childbirth, they can reduce pain and anxiety and
give you a hand in controlling the experience.

2.1.4 Pregnancy Problems

Let’s start with morning sickness, which is a combination of nausea and
vomiting. This common problem in the early months is largely due to various
changes in hormone productions. Your wife may be able to control morning
sickness by making a few single changes in her diet. Eating crackers, dried fruit or
boiled sweets should help to coat her stomach in the early moorning and reduce
gastric discomfort. Eating small but frequent meals can also alleviate the
symptoms. Your wife may also be bothered by an increase in saliva, known as
ptyalism, which will add to the felling of nausea she may have. Chewing gum
may provide some relief.
As you have surely heard, many pregnant women develop a yen for strange
foods. No one really knowns why such cravings develop, but these foods do not
harm the unborn child, and they may supply some special nutrients. Another
problem is heartburn, which is often caused by pressure on the stomach from the
uterus and by relaxation of the valve between the oesophagus and stomach. Your
wife can reduce this condition by avoiding fatty and spicy foods and late night
meals; milk and antacid medications (but not sodium bicarbonate; see p.534) will

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help. Many mothers- to- be are also bothered by stomach and intestinal gas. The
answer here is to avoid gas- producing foods, such as cabbage, cauliflower and
beans.
Also related to food are two further discomforts; constipation and
diarrhoea. Your wife can relieve constipation by drinking more fluids and eating
more fibre, fresh fruit and vegetables. Bowel changes also cause diarrhoea; in this
case, eating bland foods (such as rice, mashed potatoes, scrambled eggs and
bananas) can help; your wife may prefer to ask her obstetrician to recommend an
over- the- counter medication. Haemorrhoids, which are directly related to
constipation- and to the pressure produced by a growing uterus on veins in the
lower body- also afflict some expectant mothers. If your wife develops
haemorrhoids, her physician may prescribe suppositories to remedy the problem.
She may also find that she urinates more frequently because of the pressure her
uterus exerts on her bladder.
In addition to these discomforts, your wife may experience a number of
other problems, including headaches, nose bleeds, dizziness, lightheadedness, leg
cramps, fatigue, backache and insomnia. Another common problem is varicose
veins-prominent knotted veins on the surface of the legs, especially the calves. In
her last month, your wife may also get swelling of the feet, or oedema, due to the
retention of fluid. This is perfectly normal, but she can keep the problem in check
by resting with her feet raised in order to improve her circulation.
1. Anaemia in Pregnancy
Iron deficiency anemia is one of the most widespread complications of
pregnancy. Not only is iron essential to the manufacture of new blood cells,
it helps to blood in transporting oxygen to all parts of the body, including to
an unborn child. However, because of menstrual blood loss and poor diets,
many women are already iron deficient before they become pregnant. And
in pregnancy the need for iron increases. To build up her supplies, a
pregnant woman should eat iron-rich foods (see p.460), and will probably
also be given iron supplements.

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2. Toxanemia In Pregnancy
Better known today as pre-eclampsia, toxanemia usually occurs in the
first pregnancy of younger mothers or in the pregnancies of women with a
tendency towards hypertension (see p.148). Signs of this condition include
high bloodPressure, excessive fluid retention and rapid weight gain; routine
urine tests may reveal icreased amounts of protein in the expectant mother’s
urine
Treatment for minor pre-eclampsia involves gtting plenty of bed rest. A
woman with a more severe case may be haospitalised and given medications
to reduce her blood pressure. Sometimes it may necessary commence
deliver of the day, either by induced labour or by Caesarean section.
Pre-eclampsia can be serious problems during pregnancy, if it is not
dealt with, it may evolve into more severse disorder called eclamsia, in
which the mother may have caonvulsions or go into a coma; this carries
grave risks to both the mother and the baby.
3. Bleeding During Pregnancy
Some expectant mothers experience light bleeding without miscarrying.
The bleeding in this case generally related to the implantation of the
placenta, the bab’s support system. However, when a pregnant woman
expereinces excessive bleeding and cramping, she may well be having a
miscarriage, and her physician may have to perform a curettage to remove
the foetus and remaining tissue. Miscarriages are often an indications of
some foetal abnormality. Scanty bleeding an ectopic pregnancy, which can
rupture, causing internal haemorrhage and shock. Bleeding late in regnancy
may have serious implications; it may indicate internal haemorrhage or
placenta praevia. In all these conditions clse interventions may be necessary.
4. Tuba Pragnancy (Ectopic Pregnancy)
There are two terms commonly used for this condition, and it’s worth
distinguishing between them, ectopic pregnancy is a general term for a
pregnancy that occors outside the uterus. The term tubal pregnancy refers to
a type ectopic pregnancy in which a fertilised egg develops in one of the
mothers Fallopian tubes, because the eggg failed to travel downt to the

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 uterus. An ecyopic pregnancy may also develop in an ovary and, very
rarely, in the abdomen. A tubal pregnancy must be treated immediately.
Symptoms include abdominal pain and vaginal bleedingg. Surgery is
required to prevent from one hat has already reptured. Even it A Fallopian
tube is damaged or has to be removedsurgiacally, a normal pregnancy is still
possible later on.
Pelvic infections are one of the principal causes of tubal pregnancies.
Such infections may cause obstructions in the Fallopian tubes, thus delaying
the passage of the fertilized egg. Intrauterine contraceptive devices, or IUDs
are a risk because they can lead to pelvic inflammations and infections.
Scarring from endomentriosis may also lead to ectopic pregnancy.
5. Overcome A Weak Servik
A weak, or incompetent, cervix does not have the required tissue
strength to stay closed. As your friend’s unborn baby grew, it pushed on the
weakened cervix, which dilated, or opened, so that birth began
spontaneously-and prematurely. To correct an incompetent cervix, an
obstetrician may put a supporting stitch around the cervix to hold it clised,
an operation that can be performed under a general anaesthetic before
pregnancy takes place, or at about the 14th week of pregnancy. The sutures
are removed when labour stars or shortly before. In addition, some women
have contractions that cause the cervix to dilate prematurely; medication
may be necessary to stop such contractions.
6. Prevent Rh Blood Disease
When you were born, there was no way to prevent Rh blood disease.
This disease is the result of an immunological incompatibility between a
mother who has Rh-negative blood-that is, her red blood cells lack what is
known as the rhesus, or Rh factor D-and her unborn child who has father.
With the first pregnancy this incompatibility does not matter because the
blood of the foetus inside the placenta is quite separate from the mother’s
bloodstream. But during delivery, her blood and that of the baby may mix,
and she would them become immunised against the Rh-positive factor. If
this occurs the Rh-positive antibodies produced in the mother’s blood would

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 affect the blood of any subsequent Rh-positive baby-leading to anaemia,
brain damage, or even death of the baby. Second babies used to be given
blood-exchanging transfusions at brith, but today an injection of Rh(D)
immune globulin is given to the mother at the time of her first delivery or
miscarriage to destroy any of the baby’s red blood cells before she has had
time to develop anti-Rh(D) antibodies. This injection pregnancy and should
be repeated for each subsequent pregnancy.

2.1.5 Signs and Signal from The Baby

As labour approaches, your sister may feel the baby’s head shift and
descend into the pelvis. As a result, the mild shortness of breath that she may have
experienced in the previous few weeks will probably disapear. Also she may start
feeling contractions (some women have them several weeks before the due date),
which prepare the uterine muscles for birth. These sensations, known as Braxton
Hicks contractions, are usually infrequent and, unlike labour pains, are
uncomfortable rather than painful.

The first real sign that seious labour is at hand is referred to as the show a
discharge of mucus, with some blood in it, from her vagina. Throughout her
pregnancy this mucus has formed a kind of plug in her cervix, and when it is shed,
it is an indication that labour is near. In some cases, however, it may appear as
much as three weeks before birth.

The next sign to watch for is the ‘breaking of the waters’, the release of the
fluid from the amniotic sac that protects and supports the baby. The fluid may
burst out, or it may tricle out slowly. If the sac breaks long before you sister’s
estimated due date, her obstetrician should be notified right away because there
may be some danger of infection to the baby. Labour contractions may precede or
follow the rupturingbof the sac, and will come with increased regularity. When
they last for more than 20 seconds or so and occur every five to six minutes,
labour is beginning. The obstetrician will have explained to your sister the timing
of the contractions and when she should go to the hospital.

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1. False labour and real labour
False labour pains seldom follow any set pattern, nor do they increase
in frequency. True labour pains, on the other hand, occur at gradually
decreasing intervals. As the contractions become more frequent, the
intensity of pain increases. In most cases false labour pains, even though
quite painful, cease when the woman changes position and stands up, for
example, or walks about. If you or your wife have any doubts or questions
about the possible onset of labour, however, you should call your physician
at once.
2. Labour Process
With a first child, labour can sometimes last up to 24 hours or so.
Labour is divided into three stages. The first begins with the onset of labour
pains and lasts until the cervix, through which the baby must pass, is fully
dilated. The second stage involves the actual passage of the baby through
the birth canal (which runs from the cervix to the vagina opening) and ends
when the child is born. The final stage occurs as the olacenta and amniotic
sac and other tissues are expelled. You will probably discover that the
duration of labour in subsquent child birth will be greatly reduced.
3. Therapy After Labour
The premise of natural childbirth is to have a baby as naturally- and
with as few medications as possible. In your childbirth classes you are
probablying to manage labour pain by doing various and relaxation
exercises. It is certainly more natural for the baby if no anaesthesia or drugs
are used and obstetricians today tend to use less medication than in the past.
However, some women are more sensitive to pain than others.
One of the simplest forms of pain relief in labour is the use of nitrous
oxide (laughing gas). Usually through a face mask. The woman is taught to
hold the mask herself, and to breathe during each contraction. Nitrous oxide
has a very short duration and is safe for both the mother and the baby.
Where this may not be adequate, the obstetricians may give her pain-
relieving coumpounds by injections or by mouth, or he may use of a number
of regional or local anaaesthetic techniques. A local anaethetic injected into

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the vaginal area is known as a pudendal block; this is often used in
conjuction with a surgical procedure called an episiotomy. In epidural
anaesthesia, an anaesthetic is injected, either continuosly or in a single dose,
into the space outside the protective covering of the spinal cord in the lower
back. Epidural anaethesia numbs the body from the waist down, but does
not affect the ability to cooperate and move. Because no drug is entirely
risk-free, it is better to avoid them if possible, but you certainly shouldn’t
feel you are a failure if you do require medication.
Acupunture and hypnosis are also used in some cases to help to relieve
pain in labour, but neither method is necessarily appropriate or effective for
aa women.

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 CHAPTER III

CONCLUDES

3.1 Conclusion
Pregnancy is an important event for any woman, it is desirable or not a
woman or expectant mother will be anxious about her health. Usually various
efforts are made to maintain his health. The pregnancy period starts from
conception until the birth of the fetus. The duration of normal pregnancy is 280
days (40 weeks or 9 months 7 days) calculated from the first day of the last
menstruation.
Midwifery management documentation is in accordance with Helen varney's
(1997) theory that midwifery management documentation consists of seven steps,
namely data review, data interpretation, identification of diagnoses, identification
of needs, planning, implementation, and evaluation. In the case we took, there
were also data gaps in the MCH handbook in the form of writing TFU that was
not appropriate for gestational age.

3.2 Suggestions
3.2.1 For Pregnant Women
Pregnant women should check their pregnancy regularly so that if there
are abnormalities can be detected early so that they can be overcome
immediately.

3.2.2 For health workers

Health workers should be more careful in carrying out ANC
examinations, so that if pregnant women want to move to another place,
check the ANC examinations for health workers who check further and find
no gaps in the data written in the MCH handbook.

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