Herbal Health

The purpose of regular checkups during pregnancy is to make sure that everything’s progressing normally. These via also provide a good opportunity for you
and your doctor or midwife to get to know each other better, and for you to ask the questions you’ve thought of since last visit.

Routine checkups in an uncomplicated pregnancy are usually done every 4-6 weeks until 28 weeks, then every 2-3 weeks until 36 weeks, and then every week until the baby is born. If there are problems, checkups will be more frequent. If anything worrying happens between appointments, don’t wait: contact your doctor or hospital straight away.

During a routine checkup, you’ll be asked how things have been going since your last visit. Your blood pressure and weight will be measured, and a urine sample tested. Your abdomen will be examined to check the size of your uterus and, after around 26-8 weeks, the position and heartbeat of the foetus.

If any problems are suspected from these quick and simple checks, other tests may be needed for more accurate diagnosis. Early treatment of many problems may prevent more serious complications. These problems include:

• high blood pressure (pregnancy-induced hypertension). This rarely develops before 28 weeks and is most common after 34 weeks and in first pregnancies. If hypertension isn’t controlled, it can lead to eclampsia or antepartum haemorrhage

• uterus larger than expected. This finding prompts ultrasound examination to find the cause, which is most commonly that the pregnancy is more advanced than the dates suggest; occasionally multiple pregnancy

• uterus small for dates. This suggests that the foetus isn’t growing at the normal rate. Ultrasound is used to find out why

• unusual position of the foetus. It is important to know if the foetus isn’t in the usual head-down position when delivery is close. Fortunately, many foetuses in breech or transverse positions turn to head down before labour commences.

If any problems arise during pregnancy, you and your partner will be given every opportunity to discuss possible causes and consequences, and the available treatment options.

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Withdrawal (also called coitus interruptus) means withdrawing the penis from the vagina immediately before ejaculation so that all the ejaculate is deposited outside. Its alternative names include ‘being careful’, looking after the wife’, ‘pulling lout’, ‘getting off at Redfern’ (if you live in NSW – if you live in other states substitute the station before your capital city terminus for ‘Redfern’) and no doubt many other indelicate colloquialisms. It’s claimed that withdrawal is the oldest method of contraception. It is referred to in the Talmud as ‘threshing inside and winnowing outside’ and is the only method of contraception mentioned in the Bible. Onan was instructed by his father Judah to sleep with his brother’s widow Tamar so that his brother may have descendants. But Onan, knowing that the children would not be his brother’s, chose let his semen spill on the ground whenever he had intercourse with Tamar, and for this he was slain by Jehovah (Genesis 38:4-10).

This has been interpreted as ‘the sin of Onan’. ‘Spilling the seed in coitus’ was condemned by St Augustine, St Hubert and
many later Christian teachers. However, the method became widely used in the eighteenth and nineteenth centuries and is thought to be responsible for the trend to smaller families in Europe over that time. It is still popular in many Mediterranean countries, where the know-how is handed down from father to son.

How effective is withdrawal? Failure rates of 8 to 17 per hundred woman-years have been reported. It can be very effective if the man has good control and can withdraw in time, so that all the ejaculate is deposited well away from the entrance of the vagina. Some couples report using it from marriage to the menopause without a single unplanned pregnancy. Most failures are put down to faulty technique or inconsistent use.

Many people believe that withdrawal can’t work because there may be sperm in the pre-ejaculatory lubricating fluid. This seems to be very unlikely, though it is difficult to study, as you can imagine. However, several studies over the past 40 years have reported no sperm or insufficient for fertilisation in the pre-ejaculate.

It’s almost impossible to know how many couples are using withdrawal. A survey in England in 1949 found that about half of all couples studied used this method.

Advantages of withdrawal

• It is free, and you never run out of supplies.

• There are no adverse effects on health.

• It can be very effective for those who are good at it.

Disadvantages of withdrawal

• Some couples find that intercourse is unsatisfying without ejaculation in the vagina.

• It is forbidden by some religions.

• Women, who generally have the biggest stake in contraception, may be anxious during intercourse in case the man doesn’t withdraw in time.

Coitus interruptus is generally overlooked in discussions about contraception. It can be a very handy back-up or emergency method.

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What is the best way to take the Pill?

All packs contain detailed instructions on how to start and continue taking the Pill. Read and follow these instructions carefully. They may seem a bit complicated at first, but once you start you’ll find that it’s easy. If you are unsure about any aspect of taking the Pill, contact your doctor or a Family Planning Centre.

Some tips to help you take the Pill properly

• When you first start, study and get to know your pack. All packs are well designed so that you can tell at a glance which is the right tablet to take on any particular day.

• Make a habit of taking your Pill at the same time each day. Combine it with some other habit that is routine, such as brushing your teeth at bedtime.

• It doesn’t matter when you take the Pill in relation to food. You can take it on a full or an empty stomach.

• Never take your Pill in the dark. If you’re already in bed and remember that you haven’t taken your Pill, put the light on to take it. You must be able to see the pack so that you’ll know you’re taking the right tablet for that day.

• Keep an eye on your supply so that you don’t run out. Prescriptions are usually written for 12 months’ supply, which is dispensed in three lots of four packs. When you start on the last pack of a prescription, arrange an appointment to get another so that it can be dispensed in plenty of time for you to start the next cycle on the right day. Starting a cycle even one day late can reduce the Pill’s effectiveness.

• Keep a spare pack of your Pills in the toilet bag that you take when you’re away from home, in case you leave in a hurry and forget your current pack. If you know your pack design it will be easy for you to find where you’re up to and the right Pill to take.

• If you’re travelling by air over time zones and your 24-hour schedule is disturbed, it is better to take your next Pill early than late.

What to do if you miss a Pill

The leaflet in each pack tells you what to do in case of missed Pills. In case you can’t find it, here are the Family Planning Association’s (FPA’s) recommendations.

• If you are late in taking a Pill, but less than 12 hours late, take it as soon as you remember, take the next Pill on time and continue the pack.

•If you are more than 12 hours late or have missed more than one Pill, take one Pill when you remember and the next Pill at the correct time. Then continue the pack as usual and use another method of contraception as well as the Pill for the following seven days. If you have less than seven hormone Pills left in your current pack, you should miss out on the Pill-free week (or the ‘dummy’ pill section) and go straight on to the hormone Pills in your next pack. If you miss one or more Pills, you may have some withdrawal bleeding. Follow the instructions above whether or not you bleed. You should have another withdrawal bleed at the end of the cycle you go on with after the missed Pill. If not, see your doctor to rule out pregnancy.

If you are unsure about these instructions, contact your doctor or Family Planning Centre. The most dangerous Pills to miss are those at the beginning and end of the hormone cycle. Anything that makes the break between hormone cycles longer than seven days can reduce the effectiveness of the Pill.

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The following services maybe useful. You’ll find them listed in your local telephone book. Most have toll-free numbers.

• Lifeline Centres provide counselling (and referral if needed) in emotional and social crises. There are Lifeline centres in all cities and many large towns.

• Other telephone counselling services such as Care-line and Centacare are listed under ‘Counselling: Marriage, Family and Personal’ in the yellow pages of the telephone book.

• The Family Planning Association provides women’s health checks (including breast checks, Pap smears, checkups for STD), contraceptive services, counselling and education about sexuality, pregnancy testing and counselling and referral for antenatal care or abortion. In some cities there are special clinics for young women.

• Sexual Health and Sexually Transmissible Diseases – there are clinics for these in all major cities. If there’s no clinic in your district, your doctor or the Family Planning Association will help. The Free AIDS Hotline listed under the index for ‘Community: Personal and Other Emergencies’ at the front of the white pages of the telephone book offers counselling and information about AIDS.

• Pregnancy Counselling and Support, Abortion Referral and Pregnancy Termination services are listed in the yellow pages of the telephone book.

• Rape and Sexual Assault These 24-hour telephone counselling services are listed under ‘Emergency Help’ in the index for ‘Community: Help and Welfare’ at the front of the white pages of the telephone book.

Other services are listed under the indexes for ‘Community: Personal and Other Emergencies’ and ‘Community: Help and Welfare’ at the front of the white pages of the telephone book. They include:

• youth services

• alcohol and drug problems

• lads’ help-line (24 hours)

• emergency accommodation

• services for people with disabilities.

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I have often referred to what happens to the ‘average’ girl; however, there is a wide range of normal variation from this average. If what’s happening to you is near one or the other end of the normal range, you may worry about your progress. This is especially likely if you reach your mid-teens without having a period.

When should you start to worry? It depends. If your general health is good and you have other signs of puberty such as growth spurt, breast and genital development, there’s no need to worry until you’re 16 years of age. If you haven’t started by then you should see your doctor. If you’re not in good health, or if you or your parents have reason to believe that your puberty is not progressing normally, see your doctor earlier.

Your doctor will take a full health history and perform a physical examination, including genital and pelvic examination. If no reason for the delayed menarche is found, your family doctor will refer you to a gynaecologist for some special tests. The tests are fairly simple and include taking a blood sample for measurement of hormone levels and a swab of cells from inside your mouth for examination under the microscope (to provide information about your chromosomes). Other tests that may be suggested include examining the pelvis with ultrasound and an X-ray examination of the kidneys.

If the tests show that nothing is wrong, it may just be that you are a ‘late developer’ and need to wait a bit longer. Your gynaecologist will advise you if the tests show any condition that needs treatment.

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