|
|||||||
|
|
|
|||||
|
|
|||||||
*Disclaimer* The information contained
in this packet is intended for entertainment purposes only and
should NOT be used as a guide in real life!
**Please Note** the Pern on Dragonsfire is set in the future but the culture, civilization and technology level closely mirrors what we know about the Middle Ages and Early Renaissance. With this in mind all medical practices should be tailored to fit this mind set. It is very important to realize this if you are asked to conduct a C-Section. While C-Sections were known at this time, mostly in animals, their use on humans would not have been widespread ( IMHO) nor would they have been all that successful. Mother, child or both probably would not have survived.
First - Third Trimester | Birthing | Postpatum Care |
Complications and Problems
Dragonriders | Complications
of Delivery | Multiple Births | Care of newborn | Healer
Hall Home Page
Healer Hall Home Page Scroll Section
ALl scrolls by Healer Zelanzy
Pregnancy is a natural process which begins with conception,
follows through development and growth of the fetus and delivery,
and ends with return to a fully normal state approximately 6
weeks after birth. Pregnancy causes physiologic changes in the
mother's bodily functions to allow for growth and development of
the fetus. For the fetus, pregnancy is a time of dependency on
the mother for nutrition and, thus, exposure to whatever agents
to which the mother is exposed.
Although a healthy pregnancy is normal for the majority of women,
for some there may be complications that can lead to adverse
outcome for the mother or the fetus.
It is widely accepted that women who receive prenatal care have
fewer complications of pregnancy and birth and have healthier
babies. It is also known that the earlier and more consistently
the care is received, the better the outcome. Education about
pregnancy and child-bearing is an important part of prenatal
care, as are detection and treatment of abnormalities. Assessment
and reassessment of risk to the mother and fetus are inherent in
the provision of prenatal care.
The average biological length of human gestation, from conception
to delivery, is 266 days or about 9 months. Due to the difficulty
in assessing the exact date of conception, however, the clinical
length of pregnancy is considered to be 280, days or 40 weeks,
calculated from the last normal menstrual period before the
cessation of menses, or menstrual flow. This calculation assumes
that ovulation occurs 14 days after the last menstrual period.
Human gestation is further divided into trimesters, each of which
lasts slightly more than 13 weeks.
*****Information preceeded by a star indicates information that
is provided for you as a background of what is going on, it is
most likely that the healers of Pern would not know this.
However, if the mother wishes to experience a fall or other
injury, this information will be valuable in determining the
damage, if any, to the baby.
A. First Trimester
**Most fetal development, with the exception of such complex
functions as brain development, occurs in the first trimester.
The heart begins to beat after 4 weeks. By 8 weeks, the eyes,
ears, nose, mouth, fingers, and toes are easily recognizable, and
male and female reproductive systems have differentiated.
**By 12 weeks, all of the recognizable organs have developed.
During these first weeks the fetus is most vulnerable to
potential teratogenic or birth-defect-inducing agents, such as
drugs, radiation, and viruses. Substances taken in by the mother
during the first weeks can be of particular harm during this
time.
An early sign of pregnancy is the cessation of menses. Nausea and
vomiting may begin at approximately eight weeks gestation. Herbs
such as ginger, and mint as well as pepsin wll alleviate most of
these symptoms. Pepsin is an enzyme derived from the stomachs of
sheep and is commonly used by the Beastcrafters for treatment of
animals with digestive abnormalities. Increased urinary frequency
is common due to the pressure of the enlarging uterus on the
bladder. Breast soreness or tingling often occurs due to hormonal
stimulation. Fatigue is also a common complaint.
B. Second Trimester
**Although the fetus begins to move in the first trimester, it is
not until about 20 weeks gestation that the mother begins to
perceive the movements, the onset of which is called
"quickening."
**During the second trimester, thin-walled skin develops, organs
begin to function, and blood begins to be formed in the bone
marrow. In addition, scalp hair appears, subcutaneous fat
increases, and bones begin to harden.
Increasing abdominal girth and pressure from the growing uterus
can lead to constipation. Normal intermittent uterine
contractions may occur. The mother may experience lightheadedness
and may even pass out due to the effects of the hormones on the
blood vessels and the amount of blood diverted to the uterus,
placenta, and fetus. Heartburn becomes an ever increasing problem
because of the increasing pressure on the stomach by the
enlarging uterus and delayed emptying of the stomach. Despite
these discomforts, women are generally more comfortable during
the second trimester than the first.
C. Third Trimester
**Ear lobes begin to develop cartilage, testes begin to descend
into the scrotum, nails begin to grow over the tips of the
digits, and creases develop over the soles of the feet. In
addition, the fetus begins to demonstrate coordinated patterns of
behavior that are similar to the cycles of wakefulness and
activity of a newborn.
The majority of fetal ( and thus mother) weight gain occurs in
the third trimester.
The last weeks of pregnancy become increasingly uncomfortable.
Headaches, discomfort in sitting, a dilation of the veins, and
swelling of the legs may occur. Shortness of breath is common due
to the enlarged uterus, which prevents full expansion of the
lungs. In the last days of gestation increased pelvic discomfort
develops, caused by the dropping of the fetal head into the
pelvis. False labor pains, or contractions of the uterus that do
not lead to progressive dilatation, or opening, of the cervix,
can be particularly uncomfortable. Insomnia may also be common in
the days before delivery.
The delivery of a full term child may take place
at or about the 280th day of pregnancy. The labor preceeding
birth of a child is divided into three stages.
The first stage begins at the onset of regular contractions which
cause progressive dilatation of the cervix. This first phase is
indicated by an urge to urinate and defecate, accompanied by
aching pains of the lower back and excitement or nervousness of
the patient. It is helpful at this point to provide a warm bath
for the mother. Garments should be loose and easily slipped off.
During the first stage of labor the head of the child is
presenting itself to the birth canal. The first stage of
pregnancy ends with the rupture of the membranes surround the
child and escape of the "water" contained therein. Upon
this even the mother must be made to lie down on her left side or
otherwise prepare to deliver the child. In some cases delivery
kneeling or immersed in water is an alternative position to lying
prone and is normally considerably more comfortable for the
mother.
The second stage of labor begins at the onset of complete
dilatation of the cervix and continues to the birth of the baby.
Upon the water breaking the entire pubic area should be washed
down with redwort to prevent infection of the mother or child.
The Healer's hands should also be scrupulously clean and treated
with redwort. As the labor pains get closer together, the more
forcible pains of the second stage of labour must be harnessed by
the mother to bear down on the child and speed delivery. Allowing
the mother to hold onto a towel tied to the headboard of the bed
is a useful tool to aid in bearing down with the abdominal
muscles. It should be noted that during the actual birth of the
child the bearing down must be carefully controlled to prevent
tearing of the soft tissues of the pelvis.
As the child's head becomes visible, push the head slightly so
that the infant's chin rests on it's chest, aiding in the
delivery. When possible, reach a finger around the neck of the
child to ensure that the cord is not wrapped around it. If so,
the cord can be safely repositioned at this stage as long as no
undue pulling is done on the mother. After the delivery of the
head the shoulders of the child may be turned and the child ill
be delivered completely at the next following contraction.
Following delivery, the umbilical cord must be severed - it is
important during this operation that the cord not be pulled or it
may tear, causing severe bleeding of the mother. To sever the
cord, tie off an end near the mother's body to cut prevent
bleeding when the cord is cut. Clamp the cord about 6 inches from
the child's body (failure to do this will likely cause the child
to bleed to death) and cut the cord between the two sealed ends.
Remove the forceps from the cord, which will later be expelled
with the rest of the afterbirth. The child's eyes may then be
gently swabbed and the mucus removed with a suction tube. The
child may begin crying on it's own, a sure sign of proper
breathing, or the child's buttocks may be lightly spanked to
encourage the child to cry. The child should be washed carefully,
wrapped in soft clothes and presented to it's mother for a joyful
first meeting.
The third stage of labor begins at the birth of the baby and
continues through the expulsion of the placenta. In general, the
contractions of the uterus get progressively stronger and closer
together over the course of labor. Following delivery of the
baby, in approximately 1 hour, a gentle pressure on the abdomen
will generally bring away the afterbirth, which consists of the
placenta and umbilical cord, along with other membranes.
Following delivery of the afterbirth the vaginal area may be
examined and if any tears exist they must be repaired
immediately. Dressings are not commonly applied to the area
unless severe tearing has taken place.
The length of the postpartum period is
traditionally six weeks. This is the length of time required for
the mother's uterus and other reproductive tissues to return to
their former condition. It may take this number of weeks for the
woman to return to her previous emotional state and her previous
level of vigor as well.
For the most part, however, a well rested woman enjoys these
early weeks after delivery. Women are usually discharged to rest
in their homes within two days after a vaginal birth and within
3-4 days after a cesarean birth.
It is suggested that the Healer instruct the patient to spend
this time solely dedicated to learning to care for the new child.
In particular, the Healer should visit the pair at least once per
day to provide information on proper care of the child. This
includes:
1] Feeding
2] Bathing
3] Diapers (Changing and washing)
4] Making the Weyr, Hold or Hall safe for baby to play in.
Although it is a normal process, some women have
severe problems during pregnancy. Problems of pregnancy include
the following.
In some cases, where circumstances require, pregnancies can be
terminated. This practice is most common in female dragonriders
through frequent trips between, which will induce an abortion.
This practice however can lead to excessive bleeding, which is
often life-threatening. In situations of extreme life threatening
illness, abortion is also occasionally the only solution to
preserve the life of the mother by terminating the increased load
on the body imposed by a maturing fetus. Abortion by herbal
remedy can be accomplished through ingestion of a mixture thrice
daily for five days. During this time, the fetus may be aborted
at any time with the same symptoms and treatment as spontaneous
abortion. Due to the extreme dangers of any such abortion, the
composition of the mixture is available only to Masters of the
Healing Craft.
Spontaneous Abortion
Anywhere from 10 to 40 percent of human pregnancies end in
miscarriage, or spontaneous abortion. Often, increased vaginal
bleeding and cramping occurs around the time of a normal
menstrual period and may go unnoticed by the woman.
Ectopic Pregnancy
A pregnancy that occurs at a site other than inside the uterus,
such as in the fallopian tube, on the ovary, or at sites outside
the abdomen, are termed ectopic. Such pregnancies are generally
not viable and can in fact be life threatening to the mother.
Inducing an abortion is common in these circumstances, or
operative removal of the fetus from the affected cite in extreme
cases.
Infectious Diseases
A variety of infectious diseases can lead to abnormalities of
fetal growth and development. Some venereal diseases can be
transmitted to the fetus, particularly gonorrhea and syphilis.
Poor Nutrition
It is ideal for the growing fetus if the mother gains at least
25-30 pounds during her pregnancy. Low prepregnancy weight or low
weight gain, particularly if food is low in protein, vitamins,
and minerals, can impair fetal growth at the time when brain
cells are rapidly developing.
Alcohol and stimulants
Heavy drinking of alcohol impairs the mother's nutrition and can
cause damage to her liver. In addition, the fetus can develop
fetal alcohol syndrome, a cluster of mental and physical birth
defects. Babies are smaller, sicker, and more likely to be
stillborn.
Expectant mothers are required to refrain from imbibing alcoholic
beverages and excessive amounts of stimulants such as klah.
With female dragonriders becoming more common, precautions must be taken to avoid premature birth or spontaneous abortion of the fetus. As a blanket rule, when there are no complications riders may go between for short periods up until the third trimester. Riders are prohibited from riding between beyond the third trimester of pregnancy due to their ungainly size as the risk of fall and injury is at its greatest.
In extreme emergencies, birth can be achieved by
operative means through a cesarean section. A cesarean, when
needed, can be a life-saving measure for the mother or the baby.
Reasons for a cesarean include: cephalopelvic disproportion (baby
is too large for mother's pelvis), transverse lie, fetal
distress, prolapsed cord, failure to progress in labor, and
maternal diseases such as diabetes, or heart disease.
Other operative deliveries can be conducted using forceps. This
technique is used most often to "lift" the baby out of
the birth canal during the very last stages of labor. Using
proper technique, these procedures can be very safe for mother
and baby but are used only when a reason exists to justify their
use.
Most often, pregnancy and birth results in an uncomplicated
spontaneous vaginal delivery. However, complications of labor and
birth may occur, many of which can pose serious problems for the
mother or fetus or both.
Stillbirth
Stillbirth may occur for a variety of reasons, discussed
elsewhere in this scroll as well as other related documents. It
should be noted however that even though a child displays the
signs of stillbirth - lack of respiration, heartbeat, pulsation
of the umbilical cord, or other signs of life - the Healer should
still undertake an attempt to resuscitate the child. This can be
done by placing the child in a warm bath and gently applying
artificial respiration, first clearing the mouth and throat of
the child of mucus with a soft rubber catheter. Some children who
are stillborn have been partially asphixiated by the cord or
suffering from shock. Only when the above measures have failed
must a child be declared stillborn. The Healer should be prepared
to deal with immediate mental distress on the part of the mother
and other concerned parties.
Premature Labor and Birth
Premature labor is defined as labor that begins before the 37th
week of pregnancy. Warning signs of preterm labor include mild
menstrual-like cramps, low backache, pelvic pressure, increased
vaginal discharge or light bleeding, and diarrhea. A prompt exam
will determine if preterm labor exists and if it should be
treated with medications in an attempt to stop labor.
Depending on gestational age, preterm birth frequently leads to
respiratory distress, leading to a large proportion of neonatal
(newborn) deaths. Due to the danger to the fetus, every attempt
is made to recognize and stop preterm labor.
Premature Rupture of the Membranes
Rupture of the amniotic fluid sac occurring prior to the onset of
labor in a pregnancy of any gestation is considered premature
rupture of the membranes. This may pose danger to the mother and
baby due to the possibility of infection and preterm birth. Labor
is sometimes induced if the pregnancy is far enough along, and at
other times the woman is placed at rest in the Healer Hall or
home to reduce the risk of infection and prematurity.
Malpresentation
About 96 percent of babies are born head first. Approximately 3
percent are born breech, with the buttocks and legs delivering
first, and these babies may be delivered vaginally or by
operative means (see below). About 1 percent of babies are born
in a transverse (sideways) position. These babies must be
delivered through operative means. Whatever method of delivery is
used, malpresentations pose added risk to the mother and fetus.
Disorders of Labor
Deviation from the expected progress of labor may result in
abnormal patterns of labor contraction, dilatation of the cervix,
or descent of the fetus through the pelvic passage. Many
disorders are treated by administration of a contraction inducing
drug called Pitocin. Other ways of managing labor disorders
include maternal rest, maternal and fetal position change, and
occasionally the administration of anesthesia. If treatment is
unsuccessful, operative delivery is almost always necessary.
Twins occur once in 80 births, triplets once in
10,000, and quadruplets extremely rarely. Multiples are more
likely to be born prematurely and these pregnancies are
consequently at higher risk for complications as compared to
single infant births. Upon delivery of a first child the healer
is advised to monitor patients carefully to ensure that the
placenta is delivered rather than a subsequent child. Should a
child be observed emerging, follow the procedures of delivery as
normal.
The Following is a Scroll on what to expect from
your newborn and
how to deal with the various problems that may arise. It also
attempts to answer the most frequently asked questions of new
parents. If you have any other questions, please talk to your
Healer.
This is a list of various foods that your baby will be able to
eat
along with the ages at which time its good to switch foods.
Age of child: Acceptable foods:
=========================================================
4-5 months pablum
5-6 months strained vegetables
8-9 months strained fruits and meats
Chunkier foods
No eggs until after the 2nd year.
Here is a tentative time chart for various "milestones"
that your
baby will have.
Action: Normal age:
=========================================================
Teething 5-6 months
Sit up 5-6 months
Crawl 6-8
Standing, etc 10 months
Walking 12 months
Make recognizable syllables 9-10 months
**NOTE: the ages are approximate:
some start things earlier, while others learn later.
The first week of a newborn's life s/he looses about 1/4-1/2
pound After that, they grow fast. By age 1 year, should of
tripled their weight. By their 2nd year, the child would be about
25-30 pounds.
Umbilical cord falls off naturally in about 10 days. clean it
with clinical alcohol every diaper change until then. Expect to
change diapers on an average of 10 times a day especially after
every feeding.
Yellow babies can be cured by placing the baby in sunlight
(window, outside, etc), but keep eyes covered, and make sure they
don't burn. Bathe everyday. This will help prevent them getting
rashes, fungus and yeast infections.
When taking out in the cold, keep the face covered to prevent
their lungs from freezing.
Babies don't like high altitudes, so taking them on dragons when
they are very young is not a good idea. Once they are older, they
can safely travel by dragon if they are well wrapped up.