Obstetrics Quotes

Friendship is an obstetric art; it draws out our richest and deepest resources; it unfolds the wings of our dreams and hidden indeterminate thoughts; it serves as a check on our judgements, tries out our new ideas, keeps up our ardor, and inflames our enthusiasm.

All truths wait in all things, They neither hasten their own delivery nor resist it, They do not need the obstetric forceps of the surgeon, The insignificant is as big to me as any, (What is less or more than a touch)...

I liked that in obstetrics you end up with twice the number of patients you started with, which is an unusually good batting average compared to other specialties. (I’m looking at you, geriatrics.)

All truths wait in all things, They neither hasten their own delivery nor resist it, They do not need the obstetric forceps of the surgeon, The insignificant is as big to me as any, (What is less or more than a touch?)” -from "Song of Myself

(...) The new nine muses, Commerce, Operatic Music, Amor, Publicity, Manufacture, Liberty of Specch, Plural Voting, Gastronomy, Private Hygiene, Seaside Concert Entertainments, Painless Obstetrics and Astronomy for the People.

A suburban mother's role is to deliver children obstetrically once, and by car forever after.

My mind went back to that picture in the obstetrics book. A cow standing in the middle of a gleaming floor while a sleek veterinary surgeon in a spotless parturition overall inserted his arm to a polite distance. He was relaxed and smiling, the farmer and his helpers were smiling, even the cow was smiling. There was no dirt or blood or sweat anywhere. That man in the picture had just finished an excellent lunch and had moved next door to do a bit of calving just for the sheer pleasure of it, as a kind of dessert. He hadn't crawled shivering from his bed at two o'clock in the morning and bumped over twelve miles of frozen snow, staring sleepily ahead till the lonely farm showed in the headlights. He hadn't climbed half a mile of white fell-side to the doorless barn where his patient lay.

Of course, if 40% of women need oxytocin to progress normally, then something is wrong with the definition of normal.

All truths wait in all things, They neither hasten their own delivery nor resist it, They do not need the obstetric forceps of the surgeon, The insignificant is as big to me as any, (What is less or more than a touch?) Logic and sermons never convince, The damp of the night drives deeper into my soul.

We repeatedly tell patients we are not in a hurry; there are no trains to catch and we don't care when the baby comes, only how! A doctor who is in a hurry does not belong in the field of obstetrics. As my chief pointed out, 'An obstetrician should have a big rear end and the good sense to sit calmly thereupon and let nature take its course.

liked that in obstetrics you ended up with twice the number of patients you started with, which is an unusually good batting average compared to other specialties. (I’m looking at you, geriatrics.) I also remembered being told

I liked that in obstetrics you ended up with twice the number of patients you started with, which is an unusually good batting average compared to other specialties. (I’m looking at you, geriatrics.)

And thus, through the courage and great skill in obstetrics of Queequeg, the deliverance, or rather, delivery of Tashtego, was successfully accomplished, in the teeth, too, of the most untoward and apparently hopeless impediments; which is a lesson by no means to be forgotten. Midwifery should be taught in the same course with fencing and boxing, riding and rowing.

One room in the hospital had not been cleaned up. No one, not even the nuns, had had the courage to enter the obstetric ward. When Joel Breman and the team went in, they found basins of foul water standing among discarded, bloodstained syringes. The room had been abandoned in the middle of childbirths, where dying mothers had aborted fetuses infected with Ebola. The team had discovered the red chamber of the virus queen at the end of the earth, where the life-form had amplified through mothers and their unborn children. (95)

If the cardiologist thinks the heart is a wonderful organ, the cardiologist never have heard of the uterus.

And thus, through the courage and great skill in obstetrics of Queequeg, the deliverance, or rather, delivery of Tashtego, was successfully accomplished,

Believing that only under God Almighty, to Whom we render all homage, do we Americans hold our vast Power, we shall guarantee to all persons absolute freedom of religious worship, provided, however, that no atheist, agnostic, believer in Black Magic, nor any Jew who shall refuse to swear allegiance to the New Testament, nor any person of any faith who refuses to take the Pledge to the Flag, shall be permitted to hold any public office or to practice as a teacher, professor, lawyer, judge, or as a physician, except in the category of Obstetrics.

The second reason caregivers may be silent about the dark side of epidurals is that they generate big bucks for anesthesiologists and hospitals. Epidural charges range from $500 to $2500. A hospital consultant explained to me that hospitals have to maintain staff anesthesiologists around the clock to handle obstetric emergencies. In order for these doctors to make what they consider an adequate income, the hospital has to maintain something like an 80 percent epidural rate. Given this, how strongly do you think medical staff would resist the notion that epidurals are not always a good thing and most women can cope without them?

In 2001, the American Journal of Obstetrics and Gynecology declared the G spot a “modern gynecologic myth,

The bicycle was proclaimed a boon to all mankind, a thing of beauty, good for the spirits, good for health and vitality, indeed one’s whole outlook on life. Doctors enthusiastically approved. One Philadelphia physician, writing in The American Journal of Obstetrics and Diseases of Women and Children, concluded from his observations that “for physical exercise for both men and women, the bicycle is one of the greatest inventions of the nineteenth century.

Wednesday, February 28, 2007 In gynae clinic, I go online to look up some management guidelines for a patient. The trust’s IT department has blocked the Royal College of Obstetrics and Gynaecology website and classified it as pornography.

Mary was the wife of Fowler Greenhill, M.D., of Fort Beulah, a gay and hustling medico, a choleric and red-headed young man, who was a wonder-worker in typhoid, acute appendicitis, obstetrics, compound fractures, and diets for anemic children.

It was bizarre to see the expectation that mothers-to-be must be “masked” as they were in labor. Everyone in the birthing community teaches the critical importance of breathing correctly, for safe births. That well-documented central belief was dropped by the right-on obstetric and doula community overnight.

The Three-Decker "The three-volume novel is extinct." Full thirty foot she towered from waterline to rail. It cost a watch to steer her, and a week to shorten sail; But, spite all modern notions, I found her first and best— The only certain packet for the Islands of the Blest. Fair held the breeze behind us—’twas warm with lovers’ prayers. We’d stolen wills for ballast and a crew of missing heirs. They shipped as Able Bastards till the Wicked Nurse confessed, And they worked the old three-decker to the Islands of the Blest. By ways no gaze could follow, a course unspoiled of Cook, Per Fancy, fleetest in man, our titled berths we took With maids of matchless beauty and parentage unguessed, And a Church of England parson for the Islands of the Blest. We asked no social questions—we pumped no hidden shame— We never talked obstetrics when the Little Stranger came: We left the Lord in Heaven, we left the fiends in Hell. We weren’t exactly Yussufs, but—Zuleika didn’t tell. No moral doubt assailed us, so when the port we neared, The villain had his flogging at the gangway, and we cheered. ’Twas fiddle in the forc’s’le—’twas garlands on the mast, For every one got married, and I went ashore at last. I left ’em all in couples a-kissing on the decks. I left the lovers loving and the parents signing cheques. In endless English comfort by county-folk caressed, I left the old three-decker at the Islands of the Blest! That route is barred to steamers: you’ll never lift again Our purple-painted headlands or the lordly keeps of Spain. They’re just beyond your skyline, howe’er so far you cruise In a ram-you-damn-you liner with a brace of bucking screws. Swing round your aching search-light—’twill show no haven’s peace. Ay, blow your shrieking sirens to the deaf, gray-bearded seas! Boom out the dripping oil-bags to skin the deep’s unrest— And you aren’t one knot the nearer to the Islands of the Blest! But when you’re threshing, crippled, with broken bridge and rail, At a drogue of dead convictions to hold you head to gale, Calm as the Flying Dutchman, from truck to taffrail dressed, You’ll see the old three-decker for the Islands of the Blest. You’ll see her tiering canvas in sheeted silver spread; You’ll hear the long-drawn thunder ’neath her leaping figure-head; While far, so far above you, her tall poop-lanterns shine Unvexed by wind or weather like the candles round a shrine! Hull down—hull down and under—she dwindles to a speck, With noise of pleasant music and dancing on her deck. All’s well—all’s well aboard her—she’s left you far behind, With a scent of old-world roses through the fog that ties you blind. Her crew are babes or madmen? Her port is all to make? You’re manned by Truth and Science, and you steam for steaming’s sake? Well, tinker up your engines—you know your business best— She’s taking tired people to the Islands of the Blest!

I spend almost two weeks with Dewhurst's Text book of Obstetrics and Gynecology (eight edition) and looking at videos available on the Internet before deciding that these materials needed to be supplemented with practical experience. It was like reading a book on karate - useful to a point, but not sufficient for combat preparation.

Dyspnea during pregnancy may be “physiologic” but still requires evaluation insofar as it may represent respiratory or cardiac illness.

The earliest and most dramatic changes in maternal physiology are cardiovascular. These changes improve fetal oxygenation and nutrition.

Female prophecy must be situated in the crisis of reproduction in the middle of the seventeenth century. This was the peak period for the criminalization of women in England and throughout Europe, as prosecutions for infanticide, abortion, and witchcraft reached their highest rate. It was also the period in which men began to wrest control of reproduction from women (male midwives appeared in 1625 and forceps soon thereafter); previously, "childbirth and the lying-in period were a kind of ritual collectively staged and controlled by women, from which men were usually excluded." Since the ruling class had begun to recognize its interest in increased fecundity, "attention was focussed on the 'population' as fundamental category for economic and political analysis." The simultaneous births of modern obstetrics and modern demography were responses to this crisis. Both, like the witchcraft prosecutions, sought to rationalize social reproduction in a capitalist context - that is, as the breeding of labor power. A recurring motif in the ruling-class imagination was intercourse between the English witch and the "black man" - a devil or imp. The terror was not limited to an imaginary chamber of horrors; it was an actuality of counterevolution.

our knowledge physical, metaphysical, physiological, polemical, nautical, mathematical, ænigmatical, technical, biographical, romantical, chemical, and obstetrical, with fifty other branches of it, (most of ’em ending, as these do, in ical) have, for these two last centuries and more, gradually been creeping upwards towards that Aκμ4 of their perfections, from which, if we may form a conjecture from the advances of these last seven years, we cannot possibly be far off. When that happens, it is to be hoped, it will put an end to all kind of writings whatsoever;—the want of all kind of writing will put an end to all kind of reading;—and that in time, As war begets poverty, poverty peace,5——must, in course, put an end to all kind of knowledge,—and then——we shall have all to begin over again; or, in other words, be exactly where we started. ———Happy! thrice

We all knew where the goop originated and could have defended ourselves, but the origin of the fusillade doubled as the center of the action. Once the baby’s scalp protruded, we all hunkered down and braced ourselves.

The word “doula” comes from a Greek term meaning “woman servant.” Today, doulas master the art of providing skilled comfort measures to ease the pain of birth. They lovingly aid and attend to women in labor. Doulas stand at the doorway of life. They support birthing women as they transform into open vessels. Although the aim of midwives or an obstetric medical team is to safeguard the health of the mother and the child, a doula focuses on the mother. A doula mothers the mother.

We judge ourselves by our intentions but others by their actions. We tend to think other people's mistakes are caused by character flaws while our mistakes are due to situational factors. "I had a headache on the day of the examine, but he's not very smart." Then we have the opposite. Our good behavior is attributable to fundamental traits while other people's is temporary and situational. "I'm returning this wallet to lost and found because I'm a moral and ethical person. Others do so only if they're seen picking it up." Thus we own our strengths and disavow our weaknesses. This is a big obstetrical to overcoming self-destruction behavior, it justifies all our attempts to deny or put off our need to change and rationalizes the consequences of our actions.

It is no accident that propels people like us to Paris. Paris is simply an artificial stage, a revolving stage that permits the spectator to glimpse all phases of the conflict. Of itself Paris initiates no dramas. They are begun elsewhere. Paris is simply an obstetrical instrument that tears the living embryo from the womb and puts it in the incubator. Paris is the cradle of artificial births. Rocking here in the cradle each one slips back into his soil: one dreams back to Berlin, New York, Chicago, Vienna, Minsk. Vienna is never more Vienna than in Paris. Everything is raised to apotheosis. The cradle gives up its babes and new ones take their places. You can read here on the walls where Zola lived and Balzac and Dante and Strindberg and everybody who ever was anything. Everyone has lived here some time or other.Nobody dies here...

The first stage of labor is evaluated by the rate of change of cervical effacement, cervical dilatation, and descent of the fetal head.

The pioneer in this branch of obstetrics was a Dr J. W. Ballantyne of Edinburgh University.

EFM certainly seems like a good idea. A machine that measures and records a baby’s response to contractions provides scientific data about a particular woman’s labor. Logic says—and many people assume—that EFM improves birth outcomes. Actually, three decades of research shows that EFM doesn’t improve birth outcomes. When EFM is used during labor, no fewer babies die and no fewer have problems at birth. However, more women have cesareans when EFM is used.21 If EFM doesn’t help babies and puts mothers at higher risk of surgical intervention, it is not safer care. In 1988, a Harvard Medical School report described EFM as a “failed technology” but also predicted that doctors wouldn’t stop using it because they fear being sued. Fear of malpractice litigation is pervasive in obstetrics. Doctors too often make patient-care decisions based on their fear of a lawsuit rather than on evidence-based standards of practice established by their profession.

Screening for gestational diabetes at 26 to 28 weeks; generally consists of a 50-g oral glucose load and assessment of the serum glucose level after 1 hour.

active phase cannot be reliably defined until 6 cm of dilation.

however, if the progress is prolonged or uterine contractions are inadequate, oxytocin is an option.

Finally, the nonimmune rubella status should alert the practitioner to immunize for rubella during the postpartum time (since the rubella vaccine is live attenuated and is contraindicated during pregnancy).

The type of review book you need while attending school should be separated into four or five subject areas. These main sections are medical-surgical, pediatrics, psychiatric, obstetrics, and sometimes a fifth topic called community health. The

he had read in an encyclopedia article entitled “Obstetrics.” From boyhood he had had the habit of looking up things in that dependable work; but,

Cesarean delivery (for labor abnormalities) in the absence of clear cephalopelvic disproportion is generally reserved for arrest of active phase and ROM with adequate uterine contractions for at least 4 hours, or inadequate uterine contractions for at least 6 hours.

Of course, pregnant women are no less in need of safe, effective medical treatments than anyone else. Each year, over 400,000 women in the United States battle significant illnesses while pregnant. And many women have chronic conditions, from hypertension to autoimmune diseases to depression, that they must manage with medications. As bioethicist Francoise Baylis wrote in a 2010 Nature article, 'Pregnant women get sick, and sick women get pregnant.' Indeed, 90 percent of women take some medication during pregnancy, and about 70 percent take a prescription drug, according to the Centers for Disease Control and Prevention (CDC). The average woman receives 1.3 prescriptions per obstetric visit, and nearly two-thirds of women use four to five medications during pregnancy and labor. But with little actual research to go on, doctors are simply guessing at how drugs will affect a pregnant body, and their best predictions can be disastrously off.

The impact of obstetric drugs on the human race cannot be overemphasised. Globally, 500,000 deaths result from illegal drug use, and over 70 percent of these deaths are opioid-related. In 2018, some 58 million people around the world were known to use illegal opioids; the unknown number would be significantly higher. Between 2010 and 2018, the number of fatal opioid overdoses in America increased by 120 percent. Fentanyl and other drugs used in an obstetric context were involved in two-thirds of these deaths; in 2018, there were over 31,335 deaths involving fentanyl and other synthetic narcotics alone.

The relationship between obstetric drugs and sometimes ultimately fatal intoxication in adulthood is not accidental. Through amniotic fluid, the foetus develops a taste for the foods his mother prefers; this transmission is thought to assist the transition to nursing and, after weaning, to solids. The same transmission of preference applies to substances, meaning that a pregnant woman who drinks or uses drugs passes the preference to her foetus. Logically, this principle applies to the placental transference of obstetric drugs.

What this suggests is that ‘widely used’ obstetric and infant drugs such as phenobarbital dysregulate the infant’s dopaminergic (dopamine-activating) system, permanently reducing his potential for pleasure and creating an imbalance he later seeks to redress through dopaminergic compulsions – substance-use disorders involving drugs such as cannabis, heroin, or LSD, say. Or sexual addiction. And, while the nature of pornography is determined by the culturally sanctioned birth abuses of mothers and babies, the impact of pornography is determined by the susceptibility created by drugs given to mothers and children.

Given that observable neurobehavioural characteristics in adulthood are determined in part by GABA-A receptors in early life, and the impact of GABA-acting drugs during pregnancy – in particular, on the construction of the brain – have been said to lead to ‘a cascade of pathogenic consequences’, it’s clear that the long-term effects of phenobarbital regularly administered during infancy would be severe.

Mother: a humanoid thing blinded by bandages, nurturing breasts hidden, limbs restrained, tongue lolling from its slack mouth, and with no recognisable sweat signature.

We established an investigative team at each hospital and selected 11 nursing units for the study at the 2 hospitals: 5 intensive care units and 6 general, non-obstetric care units. David Bates was the leader of the Brigham team and David Cullen led the MGH team.

The most effective way of dealing with policy resistance is to find a way of aligning the various goals of the subsystems, usually by providing an overarching goal that allows all actors to break out of their bounded rationality. If everyone can work harmoniously toward the same outcome (if all feedback loops are serving the same goal), the results can be amazing. The most familiar examples of this harmonization of goals are mobilizations of economies during wartime, or recovery after war or natural disaster. Another example was Sweden’s population policy. During the 1930s, Sweden’s birth rate dropped precipitously, and, like the governments of Romania and Hungary, the Swedish government worried about that. Unlike Romania and Hungary, the Swedish government assessed its goals and those of the population and decided that there was a basis of agreement, not on the size of the family, but on the quality of child care. Every child should be wanted and nurtured. No child should be in material need. Every child should have access to excellent education and health care. These were goals around which the government and the people could align themselves. The resulting policy looked strange during a time of low birth rate, because it included free contraceptives and abortion—because of the principle that every child should be wanted. The policy also included widespread sex education, easier divorce laws, free obstetrical care, support for families in need, and greatly increased investment in education and health care.4 Since then, the Swedish birth rate has gone up and down several times without causing panic in either direction, because the nation is focused on a far more important goal than the number of Swedes.

These medicine-women devote their attention principally to obstetrics, and have many peculiar stories to relate concerning pre-natal influences and matters of that sort. Tze-go-juni wore at her neck the stone amulet, shaped like a spear, which is figured in the illustrations of this paper. The material was the silex from the top of a mountain, taken from a ledge at the foot of a tree which had been struck by lightning. The fact that siliceous rock will emit sparks when struck by another hard body appeals to the reasoning powers of the savage as a proof that the fire must have been originally deposited therein by the bolt of lightning. A tiny piece of this arrow or lance was broken off and ground into the finest powder, and then administered in water to women during time of gestation. I have found the same kind of arrows in use among the women of Laguna and other pueblos. This matter will receive more extended treatment in my coming monograph on "Stone Worship." Mendieta is authority for the

During the 1930s, Sweden’s birth rate dropped precipitously, and, like the governments of Romania and Hungary, the Swedish government worried about that. Unlike Romania and Hungary, the Swedish government assessed its goals and those of the population and decided that there was a basis of agreement, not on the size of the family, but on the quality of child care. Every child should be wanted and nurtured. No child should be in material need. Every child should have access to excellent education and health care. These were goals around which the government and the people could align themselves. The resulting policy looked strange during a time of low birth rate, because it included free contraceptives and abortion—because of the principle that every child should be wanted. The policy also included widespread sex education, easier divorce laws, free obstetrical care, support for families in need, and greatly increased investment in education and health care.4 Since then, the Swedish birth rate has gone up and down several times without causing panic in either direction, because the nation is focused on a far more important goal than the number of Swedes.

Women with PCOS typically have signs of hyperandrogenism, the most frequent of which are hirsutism and acne. Hirsutism is

OK, I'll tell you what did it for me. In my third year I read a book by some big obstetrical cheese. There was a whole load of bunkum in it, mainly about how all the problems women experience during pregnancy are due to their own small brains. But the bit that really got me was his dictum about new mothers should wash their breasts before and after each feed.' Gifford was smiling now. 'And that's a problem because . . . ?' ' Do you have any idea how difficult it is to wash your breasts?' From the corner of my eye, I saw someone glance in our direction. ' New mothers can feed their babies ten times or more in twenty-four hours. So, twenty times a day, they're going to strip to the waist, lean over the basin of warm water, give them a good lather, grit their teeth when the soap stings the cracked nipples, dry off and then get dressed again. And all this when the baby is screaming with hunger. I just thought : I don't care how technically brilliant this man is, he should not be in contact with stressed and vulnerable women.” Tora Hamilton

OK, I'll tell you what did it for me. In my third year I read a book by some big obstetrical cheese. There was a whole load of bunkum in it, mainly about how all the problems women experience during pregnancy are due to their own small brains. But the bit that really got me was his dictum about new mothers should wash their breasts before and after each feed.' Gifford was smiling now. 'And that's a problem because . . . ?' ' Do you have any idea how difficult it is to wash your breasts?' From the corner of my eye, I saw someone glance in our direction. ' New mothers can feed their babies ten times or more in twenty-four hours. So, twenty times a day, they're going to strip to the waist, lean over the basin of warm water, give them a good lather, grit their teeth when the soap stings the cracked nipples, dry off and then get dressed again. And all this when the baby is screaming with hunger. I just thought : I don't care how technically brilliant this man is, he should not be in contact with stressed and vulnerable women.

Women who gain more weight than the recommended range during the pregnancy tend to be heavier at 3 years postpartum than women who gained weight within recommended range during pregnancy, and this applies to both obese and nonobese patients.

All other societies die finally and with dignity. We die daily. We are always being born again with almost indecent obstetrics.

uterus is palpable just at the pubic symphysis at 8 weeks. At 12 weeks, the uterus becomes an abdominal organ, and at 16 weeks, it is usually at the midpoint between the pubic symphysis and the umbilicus. Between 18 and 34 weeks’ gestation, the uterus size or fundal height is measured in centimeters from the pubic symphysis to the upper edge of the uterine corpus, and the measurement correlates well with the gestational age in weeks (Fig. 6–1). The uterus is palpable at 20 weeks at the umbilicus. After 36 weeks, the fundal height may

The risk of major congenital anomalies correlates with the initial glycosolated hemoglobin level and the initial mean fasting glucose levels. The

Hirsutism is however, more than a cosmetic problem because it usually represents a hormonal imbalance, resulting from a subtle excess of androgens that may be of ovarian origin, adrenal origin, or both. The

The primary functional change in the cardiovascular system in pregnancy is a marked increase in cardiac output.

about one-fifth of the cardiac output goes through the uterus at term increasing the risk from postpartum hemorrhage substantially.

During pregnancy, arterial blood pressure follows a typical pattern. When measured in the sitting or standing position, diastolic blood pressure decreases beginning in the 7th week of gestation and reaches a maximal decline of 10 mm Hg from 24 to 26 weeks. Blood

Physiologic changes in blood pressure in midpregnancy may be misunderstood as hypotension unless allowance for gestational age is made.

Serial blood pressure assessment is an essential component of each prenatal care visit.

Measured blood pressure is highest when a pregnant woman is seated, somewhat lower when supine, and lowest while lying on the side.

In the first half of pregnancy, cardiac output rises as a result of increased stroke volume and, in the latter half of pregnancy, as a result of increased maternal heart rate, whereas the stroke volume returns to near-normal, nonpregnant levels. These

The period of gestation can be divided into units consisting of 3 calendar months each or 3 trimesters. The first trimester can be subdivided into the embryonic and fetal periods. The embryonic period starts at the time of fertilization (developmental age) or at 2 through 10 weeks’ gestational age. The

Fetal lung maturity is assumed after 39 weeks’ gestation but can be verified at an earlier gestational age by analysis of amniotic fluid by amniocentesis.

Increased morbidity and mortality may be associated with a macrosomic infant or a large for gestational age (LGA) fetus. This is defined as a fetus with an estimated fetal weight at or beyond the 90th percentile at any gestational age. At term, approximately 10% of newborn infants weigh more than 4000 g, and the weight of 1.5% of newborns is in excess of 4500 g. Excessive

Gestational diabetes refers to any degree of glucose intolerance with variable severity with the onset or first recognition during pregnancy. This

Women with high-risk factors should undergo screening at the first visit or as soon as possible, while individuals who continue to exhibit low-risk characteristics do not require screening. A

Through the lessons we have learned over the years, especially in obstetric anesthesia where we have seen (and our unfortunate patients have experienced) the unpleasant consequences of unblocked segments or hemi-block with epidurals, and many other clinical situations, we now realize that blocking 60% of the nerves that innervate a joint does not reduce pain by 60%. In fact, it focuses 100% of the pain into the remaining 40% of the joint, therefore, in actual fact, worsening the pain and suffering of the patient.

Diabetes mellitus is a metabolic disorder that can significantly alter the maternal and in utero environment, leading to complications. Optimizing

Routine screening at 24–28 weeks is recommended for those not meeting low- or high-risk criteria.

A suburban mother’s role is to deliver children obstetrically once, and by car forever after.” —Peter De Vries

Pregnancy is associated with an increase in total body oxygen consumption of approximately 50 mL O2/minute, which is 20% greater than nonpregnant levels.

Progesterone causes increased central chemoreceptor sensitivity to CO2, which results in increased ventilation and a reduction in arterial pco

Approximately 7% of pregnancies are complicated by diabetes that either develops during pregnancy (gestational diabetes) or was antecedent to pregnancy (pregestational diabetes mellitus). In

Gestational diabetes mellitus (GDM) refers to glucose intolerance identified during pregnancy. In most patients, it subsides postpartum, although glucose intolerance in subsequent years occurs more frequently in this group of patients.

These changes in stroke volume are due to alterations in circulating blood volume and systemic vascular resistance. Circulating

The cardiovascular system is in a hyperdynamic state during pregnancy. Normal physical findings on cardiovascular examination include an increased second heart sound split with inspiration, distended neck veins, and low-grade systolic ejection murmurs, which are presumably associated with increased blood flow across the aortic and pulmonic valves.

The average doctor in a high-risk practice like surgery or obstetrics is sued about once every six years. Seventy percent of the time, the suit is either dropped by the plaintiff or won by the doctor in court. But the cost of defense is high, and when doctors lose, the average jury verdict is half a million dollars. General

Obstetrics went about improving the same way Toyota and General Electric went about improving: on the fly, but always paying attention to the results and trying to better them. And

Informatics is the field of medicine that concerns itself with “the interactions among and between humans and information tools and systems.” In 2013, it became an official specialty, like cardiology or obstetrics, with its own board certification.

After completing medical school and serving my residency in obstetrics and gynecology, I felt knowledgeable enough to be a parent. Between

Obstetric and Gynecological services in Dubai, Obstetric and Gynecological services in Dubai.

topmost obstetrics and gynecological services in Dubai

In obstetrics and gynecology, the term abortionist is still a dirty word.

Trained Obstetrician and Gynaecologist in Dubai Dr Elsa de Menezes Fernandes is a UK trained Obstetrician and Gynaecologist. She completed her basic training in Goa, India, graduating from Goa University in 1993. After Residency, she moved to the UK, where she worked as a Senior House Officer in London at the Homerton, Southend General, Royal London and St. Bartholomew’s Hospitals in Obstetrics and Gynaecology. She completed five years of Registrar and Senior Registrar training in Obstetrics and Gynaecology in London at The Whittington, University College, Hammersmith, Ealing and Lister Hospitals and Gynaecological Oncology at the Hammersmith and The Royal Marsden Hospitals. During her post-graduate training in London she completed Membership from the Royal College of Obstetricians and Gynaecologists. In 2008 Dr Elsa moved to Dubai where she worked as a Consultant Obstetrician and Gynaecologist at Mediclinic City Hospital until establishing her own clinic in Dubai Healthcare City in March 2015. She has over 20 years specialist experience. Dr Elsa has focused her clinical work on maternal medicine and successfully achieved the RCOG Maternal Medicine Special Skills Module. She has acquired a vast amount of experience working with high risk obstetric patients and has worked jointly with other specialists to treat patients who have complex medical problems during pregnancy. During her training she gained experience in Gynaecological Oncology from her time working at St Bartholomew’s, Hammersmith and The Royal Marsden Hospitals in London. Dr Elsa is experienced in both open and laparoscopic surgery and has considerable clinical and operative experience in performing abdominal and vaginal hysterectomies and myomectomies. She is also proficient in the technique of hysteroscopy, both diagnostic and operative for resection of fibroids and the endometrium. The birth of your baby, whether it is your first or a happy addition to your family, is always a very personal experience and Dr Elsa has built a reputation on providing an experience that is positive and warmly remembered. She supports women’s choices surrounding birth and defines her role in the management of labour and delivery as the clinician who endeavours to achieve safe motherhood. She is a great supporter of vaginal delivery. Dr Elsa’s work has been published in medical journals and she is a member of the British Maternal and Fetal Medicine Society. She was awarded CCT (on the Specialist Register) in the UK. Dr Elsa strives to continue her professional development and has participated in a wide variety of courses in specialist areas, including renal diseases in pregnancy and medical complications in pregnancy.

sighed with bliss. She’d always known he had beautiful hands and she needed that human touch for healing her frightened heart. ‘I’ll never sleep, but I will have to move. My legs have gone numb under Harley.’ ‘Here. Let me lift him. Would you like to sleep with him tonight in your bed?’ ‘Put him in his own bed and we’ll leave the door open. I’ll hear him if he wants me. I need your arms around me tonight, Iain. He won’t mind me sleeping with you – though he might come in in the morning.’ Iain laughed softly, dropped a tender kiss on her lips and lifted the boy easily out of her lap to carry him up the stairs. Chapter Fifty-two Noni Half an hour later, Noni had showered and was sipping the hot chocolate Iain had insisted she needed. He came back into the room, sat down and slid his arm around her. ‘This wasn’t quite the situation and setting I’d planned, but I do have something to say.’ Noni put down the cup and tried to calm the sudden thumping in her heart. She looked into the face of the man she’d come to love and knew, without a doubt, that she had to stay with him despite the dilemmas they hadn’t resolved. It wasn’t just Harley who’d been heartbroken that he’d left. ‘First of all, I’m sorry for accusing you of knowing Jacinta was planning on staying with you. On Saturday, it took me until about fifty kilometers south of Burra to realize that of course you hadn’t known she planned to stay behind. I think I always knew you’d never stoop to underhanded methods to arrange that change of plan.’ He sighed. ‘It was all Jacinta’s idea, although for the life of me I couldn’t understand why she left telling me until the last minute.’ He grimaced and squeezed her shoulder. ‘I was so disappointed in her lack of loyalty, I blamed you. And I was over the top about it. I’m sorry.’ Noni ran her finger along his jaw. ‘I understand that. Before she went to bed, Jacinta told me she wanted to make sure we still saw each other. That she could see we were good for each other if we could hang in there. She stayed so we would still keep in contact.’ ‘She’s a stubborn young woman.’ ‘Just like her father.’ Noni took a deep breath and hoped the offer was still open. ‘But I can see what she means. I will take you on your terms, Iain. I think we should try to make a life together, and it’s no good Harley and me staying in Burra if our hearts are down in Sydney with you.’ She expelled her breath. There. She’d said it and she meant it. He took her face in his hands and kissed her gently. ‘Ah, Noni. You’re too much for me. Thank you for your typically brave offer, but let me finish. Where was I? Oh, yes. I’m not stubborn, by the way! ‘It only took another five kilometers to realize I didn’t want to leave Burra, either. The challenges of a country practice might be the answer to rejuvenating my interest in obstetrics. But it’s you, not the town, which is drawing me back. If you’ll have me.’ Noni was lost now. ‘What are you saying, Iain?’ ‘I’m saying … I love you. I want to marry you. I want to live with you, be a part of your family and you be a part of mine, in Burra if you want to, for the rest of our lives.’ He took her hand in his and kissed her fingers. ‘Say that again,’ Noni whispered. She couldn’t believe it. ‘I love you. The first time I saw you it was as if I’d been searching for you my whole life. Or maybe we’ve connected before in

[Grantly] Dick-Read proposed a theory in his 1942 book Childbirth Without Fear to explain what causes the pain that we're not supposed to feel: the fear-tension-pain cycle. The three evils, as he calls them, are antithetical to the body's design but have been "introduced in the course of civilization by the ignorance of those concerned with preparations for an attendance at childbirth." He concludes that "the more civilized the people, the more pain of labour appears to be intensified." The book can feel pejorative and coddling. Dick-Read believes that women's purpose is to give birth. I found this Madonna complex hard to stomach. But women weren't really Dick-Read's audience. He was speaking to his obstetric colleagues. Other men. He wanted them to stop drugging, cutting, and manipulating the birthing body when it was awesomely capably of ushering out a baby without those painful interventions. He anticipated contemporary research finding that such abuses threaten women and their bodies. He was so focused on reaching medical doctors that he even dedicated the book to Joseph DeLee, father of the "drug them and cut the baby out" school of obstetrics. It was a challenge and a plea: women can give birth and, in the right conditions, avoid pain.

Hands speak more intimately than words," writes author Aundre Aciman. He's discussing the deaf here, specifically his mother, but I immediately think about healthcare, about perinatal care specifically. Touch is intimate. It can excite, comfort, heal. It should also be welcome. [...] Entry to a person's body should occur by invitation only, never amid confusion, never by coercion.

Hands speak more intimately than words," writes author André Aciman. He's discussing the deaf here, specifically his mother, but I immediately think about healthcare, about perinatal care specifically. Touch is intimate. It can excite, comfort, heal. It should also be welcome. [...] Entry to a person's body should occur by invitation only, never amid confusion, never by coercion.

As a laboring person, it's hard to know whether the resident or nurse trainee is capable and caring or is following orders to do something to your body, to rush your labor because of hospital quotas and conventions, with or without your consent.

...when I became pregnant with my third kid, these seemingly small moments of nonconsent replayed in my mind—the obligatory pelvic exam, the needle in my arm, the bruise like rotten fruit, the lithotomy position someone put me in both times. Sure, both births were beautiful, vaginal, natural—tick, tick, tick on the boxes of imaginary birth "success." But these were the moments I couldn't shake, that wedged themselves in and made me angry, ill.

Tracey Vogel, an anesthesiologist also trained as a rape crisis counselor, told me that trauma-informed care, crucially, shifts power. "It takes us from 'I am your doctor, and this is what I'm going to be doing to you' to 'I want to know what you might need from me,'" she explained.

Globally, most women have babies, and it seems that a high percentage of them are still suffering postpartum injuries long after their births. Urine leakage starts with the pelvic floor. One doctor told me that families commonly give up on caring for their aging loved ones when they lose bladder control. Kids don't want to change their parents' diapers. Urinary incontinence is a leading cause of nursing home admissions for women. This means that whether or not you can live your final days independently may come down to what's unresolved from giving birth, in a part of your body you don't really understand or might not even know is there. The healthcare system isn't just failing postpartum women. It's failing women of all ages for their entire lives.

Squishy, stretchy babies adapted big brains but also soft, mobile heads to fit through their mothers' birth canals. Mom's hormones encourage pliability in the ligaments that hold her bones together—pelvises widen during the fertile years and, of course, during pregnancy and birth. [...] These adaptations seem to disprove the argument that birthing pelvises are the wrong size and shape to birth, that they lack compatibility with their babies. Labor is like two bodies dancing, not fighting.