Pregnancy

All,

Does anyone have infants that have had hearing problems, or older
kids that have had hearing problems?

My wife and I are concerned for our 9-month old son. He doesn’t seem
to be responding to many sounds. My wife says that she can clap her
hands or call his name, rattle toys, etc and he doesn’t really
respond. She has read by 9-months babies are supposed to be
responding to their names being called out.

I am in the military and am at training about 1500 miles away from
home right now. Our son’s hearing is causing her a lot of anguish,
and naturally is causing me as much, if not more, being so far away
from what is going on. Have been away for about six months now, so
being away isn’t anything new, but it’s times like these that really
causing me a lot of grief.

My wife went to the pediatrician this morning and they didn’t seem
too concerned over the whole situation. They said she had to wait
for a referral from our insurance company, and that is going to take
at least three business days. She was also told by the audiologist
that Thursday was likely going to be the earliest appointment time.
The timing of the appointment is something I don’t agree with in the
least.

For those that have had kids with hearing issues, or know someone who
does, how did you/they know that your/their child had a problem?

Hoping that you all can give me some good information about this
matter. If nothing else though, support and prayers are wonderful as
well!! I know you all have given out great information to others…

Thanks!!

In this discussion of exercise during pregnancy you will learn which muscle groups you should concentrate on when you exercise. Tips for exercising during pregnancy are also offered. You will find out what kind of exercises you are allowed to do and when you should stop exercising. You should not exercise to lose weight while you are pregnant.

What are the benefits of exercise during pregnancy?

Childbirth is among the most physically stressful challenges a woman ever faces. Regular exercise during pregnancy:

•  strengthens muscles needed for labor and delivery
•  helps reduce backaches, constipation, bloating, and swelling
•  improves posture
•  gives you energy and improves your mood
•  lessens some of the discomforts of pregnancy
•  helps you feel less tired and sleep better.

When should I start exercising?

Regular exercise is a very important part of a healthy lifestyle. If you haven’t been exercising most days of the week and are thinking about getting pregnant, now is a good time to start. The sooner you begin exercising, the better you will feel during and after your pregnancy.

A big mistake many women make is not starting an exercise program until the last 3 months of pregnancy, when they start childbirth classes. Some exercise can be harder to do during the last 3 months because your enlarged uterus and breasts change your center of gravity, affecting your balance. Also, hormonal changes make your joints looser. This makes it easier to develop spasms and injure yourself. Also, if you have not been exercising regularly until this point in pregnancy, even moderate exercise may decrease the oxygen supply to your baby. Simple walking may be the best exercise at this time of pregnancy.

Before you begin an exercise program, discuss it with your health care provider. Make sure you follow his or her advice on an exercise program that is right for you. If you are having problems with your pregnancy, you should not exercise. Exercise can affect the amount of oxygen your baby gets. Even light exercise might hurt a baby that already has problems with getting enough oxygen.

Which muscle groups are most important to exercise?

In addition to your heart, the 3 muscle groups you should concentrate on during pregnancy are the muscles of your abdomen, back, and pelvis.

•  Strengthening your abdominal muscles will make it easier to support the increasing weight of your baby. You will also be able to push with more strength and more effectively during the last phase of delivering your baby.
•  Strengthening back muscles and doing exercises to improve your posture will reduce the strain of pregnancy on your lower back. It will help prevent discomfort caused by poor posture.
•  Strengthening pelvic muscles will allow your vagina to widen more easily during childbirth. This will help prevent urinary problems (leaking urine when you cough or sneeze) after delivery.

What kinds of exercise can I do?

Many old ideas about strenuous exercise during pregnancy have been disproved in recent years. The type and intensity of sports and exercise you participate in during pregnancy depend on your health and on how active you were before you became pregnant. This is probably not a good time to take up a new strenuous sport. If you were active before you became pregnant, however, there is no reason you cannot continue, within reason.

•  Walking. If you did not do any exercise before becoming pregnant, walking is a good way to begin an exercise program.
•  Tennis. If you are an active tennis player, you can probably continue to play unless you have special problems or feel unusually tired. Just be aware of your change in balance and how it affects rapid movement.
•  Jogging. If you jog, you probably can continue as long as you feel comfortable doing it. Avoid becoming overheated and stop if you feel uncomfortable or unusually tired. Remember to drink plenty of water.
•  Swimming. If you are a swimmer, you can continue to swim. Swimming is an excellent form of exercise. The water supports your weight while you tone and strengthen many different muscles. Scuba diving is not advised.
• Golf and bowling. Both of these sports are good forms of recreation. You will just have to adjust to your enlarged abdomen. Be careful not to lose your balance.
• Snow skiing, water skiing, and surfing. These sports can be dangerous because you can hit the ground or water with great force. Falling while traveling at fast speeds could harm your baby. Talk to your health care provider before participating in these activities.
•  Climbing, hiking, and skiing above 10,000 feet. Elevations above 10,000 feet can deprive you and your baby of oxygen. This can cause premature labor. Avoid strenuous exercise at this altitude, especially if you normally live close to sea level. Walking or swimming may be OK but do not do exercises that cause make you short of breath or give you muscle cramps.
•  Kegel exercises. Kegel exercises help strengthen your pelvic muscles and prepare them for childbirth. Your health care provider can tell you how to do these exercises.

What are the guidelines for exercising during pregnancy?

* Warming up and cooling down are very important. Start slowly and build up to more demanding exercises. Toward the end of an exercise session, gradually slow down your activity. Try working back through the exercises in reverse order.

* Regular exercise most days of the week is better for you than spurts of exercise followed by long periods of no activity.

* Check your pulse during peak activity. Slow down your activity if your heart starts beating faster than the target range recommended by your health care provider. Don’t exceed a heart rate of 140 beats per minute. Exercise that is too strenuous may speed up the baby’s heartbeat to a dangerous level. In general, if you are able to carry on a conversation comfortably while exercising, your heart rate is probably within the recommended limits. Check to make sure.

* Don’t try to do too much. Remember that the extra weight you are carrying will make you work harder as you exercise. Stop right away if you feel tired, short of breath, or dizzy.

* Drink water often before, during, and after exercise to prevent dehydration. Take a break in your workout to drink more water if needed.

* Don’t participate in sports and exercise in which you might fall or be bumped.

* Be very careful with your back. Avoid positions and exercises that increase the bend in your back. They put extra stress on the stretched abdominal muscles and compress your spinal joints. Deep knee bends, full sit-ups, double leg raises, and straight-leg toe touches also may injure the tissues that connect your back joints and legs.

* After the first trimester avoid doing exercises while you are lying on your back because it decreases the oxygen your baby gets from your blood.

* Your exercise program may need to change somewhat after 20 weeks of pregnancy because of your large stomach and possible problems with balance.

* Do not get overheated. Avoid outdoor exercise in hot, humid weather. Also avoid hot tubs, whirlpools, or saunas. Becoming overheated during pregnancy increases the baby’s temperature. If the baby’s temperature increases too much, it can affect the cells developing in the baby’s nervous system and brain.

* Do not exercise if you have an illness with a temperature of 100[degrees]F (37.8[degrees]C) or higher.

* Avoid jerky, bouncy, or high-impact motions that require jarring or quick changes in direction. Examples of such movements are those that can occur with contact sports, jump-roping, and trampoline jumping. These motions may cause back, abdominal, pelvic, and leg pain. They could also cause you to lose your balance.

* Wear a good-fitting and supportive bra to protect your enlarged breasts.

* Make exercise a part of your daily life. Daily tasks can double as exercise sessions if you do the following:

** Tighten your abdominal muscles when you are standing or sitting.

** Squat when you lift anything, whether it is light or heavy.

** Rotate your feet and ankles anytime your feet are elevated.

** Check your posture each time you pass a mirror.

When should I stop exercising?

You should stop exercising and call your health care provider if you have any unusual symptoms, such as:

* pain, including pelvic pain, uterine contractions, or chest pain

* trouble walking

* bleeding or fluid leaking from the vagina

* faintness or dizziness

* an increase in shortness of breath

* muscle weakness

* pain the the calf of your leg

* irregular heartbeat (skipped beats or very rapid beats)

* you notice that the baby is moving less during or after exercise.

Do not exercise when you are pregnant and have:

* heart or lung disease

* an incompetent cervix

* more than 1 baby (such as twins)

* vaginal bleeding or leaking of fluid from the vagina

* placenta previa

* premature labor

* ruptured membranes

* preeclampsia,

Remember that it is very important to discuss your plans for exercise with your provider. If you are having problems with your pregnancy, exercise is not advised.

What are the benefits of a postpartum exercise program?

Now that your baby is here, you are probably thinking about shedding some of those unwanted pregnancy pounds and getting back into shape. Along with losing weight, an exercise program can help you:

What is a healthy diet for infants from birth to twelve months?

You should breast feed your baby when he acts hungry. You will be able to tell if your baby is crying because he is hungry or for another reason. Your baby will usually want to eat every two to three hours when he is first born. Your baby does not need to be fed on a strict schedule because every baby is different. Your baby will need about eight to twelve feedings every 24 hours. If he sleeps for more than four hours at one time, wake him up to eat. Babies should breast feed for about 10 to 20 minutes or longer, on each breast. As your baby gets older, he will go longer between feedings. There may be times when he breast feeds more or less often than usual. Ask your caregiver for more information about breast feeding.

Cow’s milk formula: These formulas are made from cow’s milk that has been changed so that it is safe for babies. Do not give your baby regular cow’s milk. Vitamins and minerals are added to make sure babies get all the nutrients they need. Most babies can drink cow’s milk formulas without a problem. Some babies cannot digest (break down) the protein in cow’s milk. Because of this they may develop a rash, throw up, or have diarrhea.

Soy milk formula: Parents who want their baby to have a vegetarian (made from a plant source) formula may choose soy formula. This formula may also be given to babies who cannot digest cow’s milk. Vitamins and minerals are added to the soy milk formula to make sure babies get the nutrients they need. Babies who have a reaction to the protein in cow’s milk formula may also have a reaction to the protein in soy milk formula. Soy milk formulas may not be a good choice for babies that are premature (born early), or have trouble growing.

Other special formulas: Babies who have a reaction to the protein in cow’s milk formula or soy formula can usually drink these formulas. The fat in these formulas is also easier to digest for some babies. Babies sometimes have a hard time learning to like the taste of these special formulas. They may also cost more money.

Feeding your baby: Your baby will want to eat every two to four hours. Feed your baby each time he lets you know he is hungry. At first, your baby will want only two to three ounces every few hours. He will slowly start to drink more formula and may want to eat less often. He may drink up to six or eight ounces every three or four hours, as he gets older. When he has a growth spurt, he will be hungry more often and may want to eat more often. Burping your baby in the middle of his feeding may help him to spit up less.

Four to six months:

* Continue to breast feed your baby or feed him formula from a bottle. He may only want to breast feed or bottle feed every four to five hours. He may drink 30 to 40 ounces of breast milk or formula in an entire day.

* Ask your caregiver about starting to give your baby solid foods from a spoon. At this age, you may begin giving your baby iron-fortified infant cereal two or three times each day. You may mix cereal with breast milk or formula. Avoid mixing cereal with other flavors such as juice or fruit. At first, your baby will not seem to know how to eat. Offer him one to three teaspoons of infant cereal at one feeding. Have your baby sit in a high chair to eat solid foods.

Six to nine months:

* Continue to feed your baby breast milk or formula from a bottle four to five times each day, and infant cereal from a spoon three times each day. As your baby starts to eat solid foods, he may not want as much breast milk or formula as he did before. He may take 24 to 32 ounces of breast milk or formula each day.

* Your baby is probably ready to start eating other types of foods such as strained fruits, vegetables, or meats, along with infant cereal. Your baby can eat cooked egg yolks, but should not be given egg whites because they are too hard to digest at this age.

* The best time to give your baby a new food is when he is most hungry, such as in the morning. Give your baby only one new food each week to see how he handles the new food. Avoid giving your baby several different foods at the same time. If your baby has a reaction to a food, it will be hard to know which food caused the reaction. Avoid giving your baby fruit desserts because they have empty calories.

* When your baby is able to use his fingers to pick up objects, he will learn to pick up foods and put them in his mouth. He will be want to try this when he sees you putting food in your mouth at meal times. Your baby may also be ready to learn to hold a cup and try to drink one or two ounces of fruit juice from it. A small amount of juice may be given to your child but is not needed for a healthy diet.

Nine to twelve months:

* As your baby eats more solid food, he may only breast feed or take a bottle three or four times a day. He will be interested in eating solid foods in his high chair each time he sees you and other people in the family eat meals. Your baby may eat as much as six to nine tablespoons of soft foods and finger foods, four or five times each day. As more teeth come in, he will be able to chew soft foods. Some examples of soft foods are cooked vegetables, soft fresh fruits, breads, noodles, cheese, and soft meats.

What other diet guidelines should I know when feeding my baby?

* Avoid propping your baby’s bottle and letting him eat while you are doing other things. Hold your baby in your arms with his head higher than his body when you feed him. Never feed your baby while you are riding in a car or other moving vehicle. Your baby could choke while you are not watching. Being with your baby and holding him helps both of you bond with each other.

* Do not put your baby to bed with a bottle. The liquids that sit in his mouth while he is sleeping may cause cavities.

* Heating your baby’s milk or food in the microwave can be dangerous. The food may not heat evenly and have spots that are very hot. Your baby’s face or mouth can be burned this way. Warm milk or baby foods by placing it in it’s container, in a pot of warm water. If you need to warm food quickly, leave it in the microwave for only a few seconds, on a low setting. Shake or stir the food very well and check to make sure the food is not too hot before giving it to your baby.

* When your baby lets you know he is done eating, never try to get him to eat a little more. Your baby knows when he has had enough to eat. Your baby will show you that he has had enough to eat by looking around at other things instead of watching you feed him. He may chew on the nipple rather than suck on it. He may also cry to get out of the high chair. Trying to get him to eat more than he needs may teach him to overeat. It may also cause him to gain weight too fast.

* Some babies who are only being fed breast milk may need vitamin D supplements after two months of age. Talk with your caregiver about whether your baby needs vitamin D supplements.

Risks: Not feeding your baby enough foods or the right kinds of food can keep your baby from growing well, or make him very sick. Certain foods should not be offered to babies because babies may choke on them. Talk to your caregiver if you feel that your baby is not eating enough.

Pelvic relaxation is a weakening of the supportive muscles and ligaments of the pelvic floor. This condition, which affects women and is usually caused by childbirth, aging, and problems with support, causes the pelvic floor to sag and press into the wall of the vagina. 

Description 

The pelvic floor normally holds the uterus and the bladder in position above the vagina. When the pelvic floor becomes stretched and damaged, these organs can sag into the vagina, sometimes bulging out through the vaginal opening. A sagging uterus is referred to as a uterine prolapse, pelvic floor hernia, or pudendal hernia. A sagging bladder is referred to as a bladder prolapse, or cystocele. Other organs, such as the rectum and intestine, can also sag into the vagina as a result of a weakened pelvic floor. 

Causes and symptoms 

Childbirth increases the risk of pelvic relaxation. Other causes include constipation, a chronic cough, obesity, and heavy lifting. Some women develop the condition after menopause, when the body loses the estrogen that helps maintain muscle tone. Mild pelvic relaxation may cause no symptoms. More severe pelvic relaxation can cause the following symptoms: 

• an aching sensation in the vagina, lower abdomen, groin or lower back 

• heaviness or pressure in the vaginal area, as if something is about to “fall out” of the vagina 

• bladder control problems that worsen with heavy lifting, coughing, or sneezing 

• frequent urinary tract infections 

• difficulty having a bowel movement 

Diagnosis 

A thorough pelvic exam can help diagnose pelvic relaxation, as can tests of bladder function. 

Treatment 

Exercises called Kegel exercises can strengthen pelvic floor muscles and lessen the symptoms of pelvic relaxation. These exercises involve squeezing the muscles that stop the flow of urine. The pelvic floor can also be strengthened by estrogen supplements. Physicians sometimes prescribe the insertion of a supportive ring-shaped device called a pessary into the vagina, to prevent the uterus and bladder from pressing into the vagina. Sometimes surgery is recommended to repair a sagging bladder or uterus, and sometimes surgical removal of the uterus (hysterectomy) is recommended. Patients are often advised to adhere to a high-fiber diet to reduce the strain of bowel movements, maintain a moderate weight, and avoid activities that strain the pelvic floor. They are sometimes prescribed medications to help control urination and prevent leakage.

Pica is the persistent craving and compulsive eating of nonfood substances. The Diagnostic and Statistical Manual of Mental Disorders , fourth edition, classifies it as a feeding and eating disorder of childhood. 

Description 

The puzzling phenomenon of pica has been recognized and described since ancient times. Pica has been observed in ethnic groups worldwide, in both primitive and modernized cultures, in both sexes, and in all age groups. The word pica comes from the Latin name for magpie, a bird known for its unusual and indiscriminate eating habits. In addition to humans, pica has been observed in other animals, including the chimpanzee. 

Pica in humans has many different subgroups, defined by the substance that is ingested. Some of the most commonly described types of pica are eating earth, soil or clay (geophagia), ice (pagophagia) and starch (amylophagia). However, pica involving dozens of other substances, including cigarette butts and ashes, hair, paint chips, and paper have also been reported. In one unusual case, the patient ingested transdermal patches of fentanyl, an opioid medication given for severe pain. Eating the skin patch increased the patient’s dose of the drug by a factor of 10. 

Although pica can occur in individuals of any background, a higher incidence of pica is associated with: 

• pregnancy 

• developmental delay and mental retardation 

• psychiatric disease and autism 

• early childhood 

• poor nutrition or low blood levels of iron and other minerals 

• certain cultural or religious traditions 

Causes and symptoms 

Evidence suggests that there may be several causes of pica. One widely held theory points to iron deficiency as a major cause of pica. Several reports have described pica in individuals with documented iron deficiency, although there has been uncertainty as to whether the iron deficiency was a cause of pica or a result of it. Because some substances, such as clay, are believed to block the absorption of iron into the bloodstream, it was thought that low blood levels of iron could be the direct result of pica. However, some studies have shown that pica cravings in individuals with iron deficiency stop once iron supplements are given to correct the deficiency. Another study looked specifically at the rate of iron absorption during pica conditions and normal dietary behavior, and showed that the iron absorption was not decreased by pica. In addition, low blood levels of iron commonly occur in pregnant women and those with poor nutrition, two populations at higher risk for pica. Such findings offer strong support of iron deficiency as a cause, rather than result, of pica. 

Other reports suggest that pica may have a psychological basis and may even fall into the spectrum of obsessive-compulsive disorder. Pica has a higher incidence in populations with an underlying diagnosis involving mental functioning. These diagnoses include psychiatric conditions like schizophrenia, developmental disorders including autism, and conditions with mental retardation. These conditions are not characterized by iron deficiency, which supports a psychological component in the cause of pica. 

Cultural and religious traditions may also play a role in pica behavior. In some cultures, nonfood substances are believed to have positive health or spiritual effects. Among some African Americans in the south, ingesting a particular kind of white clay is believed to promote health and reduce morning sickness during pregnancy. Other cultures practice pica out of belief that eating a particular substance may promote fertility or bring good luck. 

The hallmark feature of pica, consistently consuming nonfood substances, often does not present publicly. People may be embarrassed to admit to these unusual eating habits, and may hide it from their family and physician. In other cases, an individual may not report the pica to a physician simply because of a lack of knowledge of pica’s potential medical significance. 

Because the eating behaviors of pica are not usually detected or reported, it is the complications of the behavior that bring it to attention. Complications vary, depending on the type of pica. Geophagia has potential side effects that most commonly affect the intestine and bowel. Complications can include constipation, cramping, pain, obstruction caused by formation of an indigestible mass, perforation from sharp objects like rocks or gravel, and contamination and infection from soil-dwelling parasites. 

Amylophagia usually involves the consumption of cornstarch and, less frequently, laundry starch. The high caloric content of starch can cause excessive weight gain, while at the same time leading to malnutrition, as starch contributes “empty” calories lacking vitamins and minerals. Amylophagia during pregnancy can mimic gestational diabetes in its presentation and even in its potential harmful effects on the fetus. 

Pica involving the ingestion of substances such as lead-based paint or paper containing mercury can cause symptoms of toxic poisoning. Compulsive consumption of even a seemingly harmless substance like ice (pagophagia) can have negative side effects, including decreased absorption of nutrients by the gut. 

Diagnosis 

In order for the diagnosis of pica to be made, there must be a history of persistent consumption of a nonfood substance continuing for a minimum period of one month. Infants and toddlers are typically excluded from this diagnosis since mouthing objects is a normal developmental behavior at that age. Individuals with mental retardation who function at or below an approximate cognitive level of 18 months may also be exempt form this diagnosis. 

Pica is most often diagnosed when a report of such behaviors can be provided by the patient or documented by another individual. In other cases, pica is diagnosed after studies have been performed to assess the presenting symptoms. For example, imaging studies ordered to assess severe gastrointestinal complaints may reveal intestinal blockage with an opaque substance; such a finding is suggestive of pica. Biopsy of intestinal contents can also reveal findings, such as parasitic infection, consistent with pica. Pica may also be suspected if abnormal levels of certain minerals or chemicals are detected in the blood. 

Pica in pregnant women is sometimes diagnosed after childbirth because of a health problem in the newborn caused by the substance(s) ingested by the mother. In one instance reported in Chicago, a newborn girl was treated for lead poisoning caused by her mother’s eating fragments of lead-glazed pottery during pregnancy. 

Treatment 

Treatment of pica will often depend on the cause and type of pica. Conventional medical treatment may be appropriate in certain situations. For example, supplementation with iron-containing vitamins has been shown to cause the unusual cravings to subside in some iron-deficient patients. 

Medical complications and health threats, including high lead levels, bowel perforation or intestinal obstruction, will require additional medical management, beyond addressing the underlying issue of pica.

Abortion, selective 

Selective abortion, also known as selective reduction, refers to choosing to abort a fetus, typically in a multi-fetal pregnancy, to decrease the health risks to the mother in carrying and giving birth to more than one or two babies, and also to decrease the risk of complications to the remaining fetus(es). The term selective abortion also refers to choosing to abort a fetus for reasons such as the woman is carrying a fetus which likely will be born with some birth defect or impairment, or because the sex of the fetus is not preferred by the individual. 

Purpose 

A woman may decide to abort for health reasons; for example, she is at higher risk for complications during pregnancy because of a disorder or disease such as diabetes. A 2004 case reported on an embryo embedded in a cesarean section scar. Although rare, it can be life threatening to the mother. In this care, selective abortion was successful at saving the mother and the remaining embryos. 

However, selective reduction is recommended often in cases of multi-fetal pregnancy, or the presence of more than one fetus, typically, at least three or more fetuses. In the general population, multi-fetal pregnancy happens in only about 1-2% of pregnant women. But multi-fetal pregnancies occur far more often in women using fertility drugs. 

Precautions 

Because women or couples who use fertility drugs have made an extra effort to become pregnant, it is possible that the individuals may be unwilling or uncomfortable with the decision to abort a fetus in cases of multi-fetal pregnancy. Individuals engaging in fertility treatment should be made aware of the risk of multi-fetal pregnancy and consider the prospect of recommended reduction before undergoing fertility treatment. 

Key Terms 

Description 

Selective reduction is usually performed between nine and 12 weeks of pregnancy and is most successful when performed in early pregnancy. It is a simple procedure and can be performed on an outpatient basis. A needle is inserted into the woman’s stomach or vagina and potassium chloride is injected into the fetus. 

Preparation 

Individuals who have chosen selective reduction to safeguard the remaining fetuses should be counseled prior to the procedure. Individuals should receive information regarding the risks of a multi-fetal pregnancy to both the fetuses and the mother compared with the risks after the reduction. 

Individuals seeking an abortion for any reason should consider the ethical implications whether it be because the fetus is not the preferred sex or because the fetus would be born with a severe birth defect. 

Aftercare 

Counseling should continue after the abortion because it is a traumatic event. Individuals may feel guilty about choosing one fetus over another. Mental health professionals should be consulted throughout the process. 

Risks 

About 75% of women who undergo selective reduction will go into premature labor. About 4-5% of women undergoing selective reduction also miscarry one or more of the remaining fetuses. The risks associated with multi-fetal pregnancy are considered higher. 

Normal results 

In cases where a multi-fetal pregnancy of three or more fetuses is reduced to two fetuses, the remaining twin fetuses typically develop as they would if they had been conceived as twins. 

Partial birth abortion is a method of late-term (after 20 weeks) abortion that terminates a pregnancy and results in the death and intact removal of a fetus. This procedure is most commonly referred to as intact dilatation and extraction (D & X). It occurs in a rare percentage of pregnancies. 

Purpose 

Partial birth abortion, or D&X, is performed to end a pregnancy and results in the death of a fetus, typically in the late second or third trimester. Although D&X is highly controversial, some physicians argue that it has advantages that make it a preferable procedure in some circumstances. One perceived advantage is that the fetus is removed largely intact, allowing for better evaluation and autopsy of the fetus in cases of known fetal abnormalities. Intact removal of the fetus also may carry a lower risk of puncturing the uterus or damaging the cervix. Another perceived advantage is that D&X ends the pregnancy without requiring the woman to go through labor, which may be less emotionally traumatic than other methods of late-term abortion. In addition, D&X may offer a lower cost and shorter procedure time. 

Precautions 

Women considering D&X should be aware of the highly controversial nature of this procedure. A controversy common to all late-term abortions is whether the fetus is viable, or able to survive outside of the woman’s body. A specific area of controversy with D&X is that fetal death does not occur until after most of the fetal body has exited the uterus. Several states have taken legal action to limit or ban D&X and many physicians who perform abortions do not perform D&X. This may restrict the availability of this procedure to women seeking late-term abortions. 

In March 2003, the United States Senate passed a bill banning partial birth abortions and implementing fines or maximum two-year jail terms for physicians who perform them. In June 2003, the House approved a ban as well. President George W. Bush signed the legislation into law, but a federal judge declared the law unconstitutional, so that the government had not been able to enforce it. One of the opponents’ claims was the legislation did not provide for exceptions for cases in which the procedure was needed to protect the mother’s health. 

Description 

Intact D&X, or partial birth abortion first involves administration of medications to cause the cervix to dilate, usually over the course of several days. Next, the physician rotates the fetus to a footling breech position. The body of the fetus is then drawn out of the uterus feet first, until only the head remains inside the uterus. Then, the physician uses an instrument to puncture the base of the skull, which collapses the fetal head. Typically, the contents of the fetal head are then partially suctioned out, which results in the death of the fetus and reduces the size of the fetal head enough to allow it to pass through the cervix. The dead and otherwise intact fetus is then removed from the woman’s body. 

Preparation 

Medical preparation for D&X involves an outpatient visit to administer medications, such as laminaria , to cause the cervix to begin dilating. 

In addition, preparation may involve fulfilling local legal requirements, such as a mandatory waiting period, counseling, or an informed consent procedure reviewing stages of fetal development, childbirth, alternative abortion methods, and adoption. 

Aftercare 

D&X typically does not require an overnight hospital stay, so a follow up appointment may be scheduled to monitor the woman for any complications. 

Risks 

With all abortion, the later in pregnancy an abortion is performed, the more complicated the procedure and the greater the risk of injury to the woman. In addition to associated emotional reactions, D&X carries the risk of injury to the woman, including heavy bleeding, blood clots, damage to the cervix or uterus, pelvic infection, and anesthesia-related complications. There also is a risk of incomplete abortion, meaning that the fetus is not dead when removed from the woman’s body. Possible long-term risks include difficulty becoming pregnant or carrying a future pregnancy to term. 

Postoperative Depressive Symptoms Related to Abortion 

• Mild, transient, immediately postoperative depressive symptoms that quickly pass occur in less than 20 percent of all women who have had abortions (Adler et al., 1990; Zabin et al., 1989). Similar symptoms occur in up to 70 percent of women immediately following childbirth (Ziporyn, 1984). 
  

• Up to 10 percent of women who have abortions experience depressive symptoms of a lingering nature (Adler, 1989). Similar symptoms occur in up to 10 percent of women after childbirth (Sachdev, 1993; Ziporyn, 1984; Zolese & Blacker, 1992). 
  

• The experience of an unwanted pregnancy, rather than the abortion itself, may be the cause of any guilt or depression that exists (Adler et al., 1990; Zolese & Blacker, 1992). 
  

Serious Psychiatric Disturbances Following Abortion 

• Serious psychological disturbances after abortion are less frequent than after childbirth (Brewer, 1977). For example, rates of “postpartum psychosis” are reported as high as 19 per 10,000 and as low as 10 per 10,000 — 0.19-0.1 percent. Reports of the rates of severe psychological disturbance after abortion range from 18 per 10,000 to as low as 2 per 10,000 — 0.18-0.02 percent (David et al., 1985; Robinson & Stewart, 1993). 
  

• Researchers suggest that the predictors of severe psychological disturbances after abortion are 
  

• Delays in seeking abortion 
  

• Medical or genetic indications for abortion 
  

• Severe pre-existing or concurrent psychiatric illness 
  

• Conflict over abortion (Lazarus, 1985) 
  

• Rates of “postpartum psychosis” have been shown to decrease in societies that legalize abortion (David et al., 1985). 
  

Emotional Reactions to Adoption 

• The psychological responses to abortion are far less serious than those experienced by women bringing their unwanted pregnancy to term and relinquishing the child for adoption (Sachdev, 1993). 
  

• While first-trimester abortion does not affect most women adversely, and nearly all women assimilate the abortion experience by six months to one year after the procedure (Sachdev, 1993), one study indicates that 95 percent of birth mothers report grief and loss after they have signed their consent to adoption, and two-thirds continued to experience these feelings five to 15 years after relinquishment (Sachdev, 1989). 
  

• Of pregnant women who considered other options before choosing abortion, none considered having a baby and giving it up for adoption. Nearly all of the women believed that relinquishing a baby would cause even greater emotional trauma than abortion. They believed they would develop a deep emotional attachment to the baby that would be extremely painful to sever (Sachdev, 1993). 
  

Negative Effects of Unwanted Childbearing 

• A recent study documents the negative effects of unwanted childbearing on both the mother and her family (Barber et al., 1999). Women who have had unwanted births sustain lower quality relationships with all of their children, not only the child resulting from an unwanted birth. These lower quality relationships translate into socialization problems for the children, affecting their development, self-esteem, personality, educational and occupational attainment, mental health and marital relationships (Barber et al., 1999; Myhrman et al.,1996). 
  

• Mothers with unwanted births are substantially more depressed and less happy than mothers without unwanted births. Possible mental health consequences of unwanted childbearing also include less shared leisure time with children and more physical punishment, such as spanking. 
  

• The negative effects of unwanted childbearing persist across the life course — mothers with unwanted births have lower quality relationships with their children from late adolescence throughout early adulthood (Barber et al., 1999). 
  

When Women Are Denied Abortion 

• The mental health of women faced with unwanted pregnancy is at greater risk when they are compelled to deliver than when they are allowed to choose abortion. According to one study, 34 percent of women who were denied abortions reported one to three years later that the child was a burden that they frequently resented (Dagg, 1991). 
  

• Children of women denied abortion have more genetic malformations than average; have insecure, divorce-fraught childhoods; perform worse at school; have more psychosomatic symptoms; are often registered with welfare officials; and often need psychiatric treatment (Dagg, 1991; David, 1986). 
  

• A study in Sweden indicated that 24 percent of women who applied for and were refused abortion seven years earlier had not yet been able to adjust emotionally. Another 53 percent had been able to adjust but with difficulty. Only 23 percent could be described as well-adjusted (Watters, 1980). 
  

• A 1981 study indicated that less than half of the women who elected to terminate a pregnancy would not have had an illegal abortion if that were their only recourse. Fifty-eight percent were uncertain or would have had an illegal abortion if that were their only alternative (Moseley et al., 1989). 
  

Some Pre-Abortion Variables that Affect Emotional Outcome 

• Emotionally unstable women with unstable living conditions, such as being in conflict with their parents, will most likely react to an unwanted pregnancy in a disturbed fashion — whether or not they bring their pregnancies to term (Major et al., 1990; Major et al., 1992; Petersen, 1981; Russo & Denious, 2001; Russo & Zierk, 1992). Women, however, who expect to cope well with abortion, do (Major et al., 1985; Major et al., 1990). In general, women having a high degree of social, partner, and parental support for their decisions experience less distress or regret over their decisions (David et al., 1985; Major et al., 1990; Zeanah et al., 1993). 
  

• Women whose partners do not expect to cope well with an abortion may be more depressed, particularly when the woman herself feels this way, than women whose partners have positive expectations (Major et al., 1992). 
  

• Adolescents who feel that they have decided to have an abortion without pressure to do so from parents or others are less likely to experience negative reactions. Obversely, women who are persuaded by their partners against their own wishes to elect abortion experience greater feelings of guilt (Dagg, 1991). 
  

• Those who choose abortion because of genetic conditions may suffer more serious emotional effects and may have a greater need for counseling than those who elect abortion for socioeconomic or psychological reasons (Beesen et al., 1993; Dagg, 1991). 
  

• Women who have second-trimester abortions by saline or prostaglandin instillation are more likely to have negative emotional responses than women who have first-trimester abortions or women who have second-trimester abortions with a D&E procedure (Adler et al., 1990). 
  

• Neither race nor religion appears to affect the well being of women who choose to have abortions (Russo & Dabul, 1997). 
  

Abortion and Contraception 

• Abortion is not seen by women who elect it as a preferred, or desired, form of contraception (Henshaw & Silverman, 1988). 
  

• Studies have indicated that while 70 percent of women used no form of birth control before their first abortion, only 9 percent failed to use a contraceptive method after their abortion (Henshaw & Van Vort, 1990). 
  

• Baltimore teenagers who chose an abortion were less likely to become pregnant in the following two years than those who had carried their pregnancies to term or who had not been pregnant. They were also slightly more likely to use contraception (Zabin et al., 1989). 
  

Effect of Abortion on Sexual and Other Relationships  One study shows that eight weeks after abortion 

• 70 percent of the subjects were continuing in the pre-abortion relationship; 5 percent had established new relationships; and 20 percent had no sex partner 
  

• 45 percent described their feelings toward their partners as unchanged; 39 percent felt closer to their partners; and 16 percent felt less close to their partners or described varying feelings 
  

• 46 percent felt the quality of the relationship was unchanged; 16 percent felt the relationship had improved; and 10 percent felt the relationship had deteriorated 
  

• 98 percent of partnered women had resumed sexual intercourse
  (Ashton, 1980)  

The So-Called “Post-Abortion Syndrome” A small number of studies, based primarily on anecdotal evidence, claim to document the incidence of “post-abortion syndrome” (PAS). Symptoms of this supposed condition include feelings of grief, depression, anger, guilt, and discomfort with small children and pregnant women. Alleged behavioral manifestations include frequent crying, flashbacks, sexual inhibition, and alcohol abuse (Speckhard, 1985). 

Although only a small minority of women report severe negative emotional effects post-abortion, the idea that abortion has severe negative effects continues to be widespread by abortion opponents (Boyle, 1997; Russo & Denious, 2001). The fact is that anti-abortion groups have invented this condition to further their cause. The American Psychiatric Association does not recognize “post-abortion syndrome” (1994), and all of the studies that purport to prove PAS contain methodological flaws that render their conclusions nongeneralizable beyond their subjects. The most egregious flaw common to all of these studies is that only women who already self-identified as having problems with abortion were recruited for them. For example: 

• In her doctoral dissertation, “The Psycho-Social Aspects of Stress Following Abortion,” Anne Catherine Speckhard chronicled how “abortion functions as a stressor” (Speckhard, 1985). However, she drew her conclusions from a subject pool of 30 women who “had high-stress abortion experiences” (Speckhard, 1985). As a result, in unpublished correspondence, her doctoral advisor clarified that Speckhard’s “findings apply only to the 30 women who volunteered to participate in her study and to absolutely no one else” (Boss, 1986). In fact, there is little evidence to support the notion that abortion will lead to severe psychological sequelae among the general population of women. The American Psychological Association assembled an expert panel to review the evidence of psychological risks of abortion. This panel concluded “the weight of the evidence from scientific studies indicates that legal abortion of an unwanted pregnancy in the first trimester does not pose a psychological hazard for most women (Beckman, 1998). 
  

• In his survey of women who had abortions, David Reardon found that 94 percent of his respondents experienced negative psychological effects (Reardon, 1987). However, he used a biased subject pool, drawing only from members of an anti-choice group called Women Exploited by Abortion (WEBA). 
  

• To demonstrate that adolescents suffer greater psychological consequences after abortion than adults, Wanda Franz and David Reardon examine data from “a survey of organizations [such as WEBA] serving as support groups for women who have had negative reactions to abortion” (Franz & Reardon, 1992). They conclude by making generalizations about the effects of abortion on all adolescents, even though they derive their data from a non-representative, highly biased subject pool. In fact, a recent study of young women found that there is no evidence that abortion poses a threat to adolescents psychological well-being (Pope, 2001). 
  

• In an unpublished but widely circulated paper, Terry Selby limits her discussion of “post-abortion trauma” to “a population of women who have presented themselves in a general mental health practice with a variety of presenting psychological and psycho-social issues” (Selby, 1984). 
  

• In 1987, a white paper was presented to former Surgeon General C. Everett Koop describing the “problem” of PAS. In the paper, the writers admit, “the psychological risks of abortion are based mainly upon studies which have used small, uncontrolled and non-representative samples” and “cannot be predictive of national estimates” (Rue et al., 1987). 
  

In July 1987, anti-choice President Ronald Reagan directed Surgeon General C. Everett Koop, also anti-choice; to produce a report on the health effects of induced abortion. Although the resulting draft report acknowledges that induced abortion is medically safe, it claims that there is insufficient evidence to determine the psychological effects of abortion (Koop, 1987). This conclusion overlooks an enormous body of evidence — more than 250 scientific studies — disproving the existence of PAS (Tyrer & Grimes, 1989). Furthermore, in closed meetings in 1988, Koop told representatives from several anti-abortion organizations that the risk of significant emotional problems following abortion was “minuscule” from a public health perspective (House Committee on Government Operations, 1989). Koop initially did not release his study, apparently because it did not support the anti-abortion position (Arthur, 1997). The report was finally made public on March 16, 1989. Overall Conclusions by Health Experts 

In 1989, a panel of experts assembled by the American Psychological Association concluded unanimously that legal abortion “does not create psychological hazards for most women undergoing the procedure.” The panel noted that, since approximately 21 percent of all U.S. women have had an abortion, if severe emotional reactions were common there would be an epidemic of women seeking psychological treatment. There is no evidence of such an epidemic (Adler, 1989). Since 1989, there has been no significant change in this point of view.    

Emotional Effects of Induced Abortion Research studies indicate that emotional responses to legally induced abortion are largely positive. They also indicate that emotional problems resulting from induced abortion are rare and less frequent than those following childbirth (Adler, 1989). 

Anti-family planning extremists, however, circulate unfounded claims that a majority of the 29 percent of pregnant American women who choose to terminate their pregnancies (Henshaw & Van Vort, 1990) suffer severe and long-lasting emotional trauma as a result. They call this nonexistent phenomenon “post-abortion trauma” or “post-abortion syndrome.” They hope that terms like these will gain wide currency and credibility despite the fact that neither the American Psychological Association nor the American Psychiatric Association recognizes the existence of these phenomena. The truth is that most studies in the last 20 years have found induced abortion to be a relatively benign procedure in terms of emotional effect — except when pre-abortion emotional problems exist or when a wanted pregnancy is terminated, such as after diagnostic genetic testing (Adler, 1989; Adler et al., 1990; Russo & Denious, 2001). The many studies of the emotional effects of induced abortion, however, do not measure precisely the same variables in regard to culture, time, demographics, or the socioeconomic and psychological situation of women who seek abortion. Since the results of these studies cannot be combined or “averaged out,” the following data illustrate, in general, the conclusions of the overwhelming majority of more than 35 of the worldwide studies that have measured the emotional effects of abortion since its legalization in the U.S. in 1973. 

Abortion as a Positive Coping Mechanism 

• For most women who have had abortions, the procedure represents a maturing experience, a successful coping with a personal crisis situation (DeVeber et al., 1991; Lazarus, 1985; Russo & Zierk, 1992; Zabin et al., 1989). In fact, the most prominent emotional response of most women to first-trimester abortions is relief (Adler et al., 1990; Armsworth, 1991; Lazarus, 1985; Miller, 1996). 
  

• Up to 98 percent of the women who have abortions have no regrets and would make the same choice again in similar circumstances (Dagg, 1991). 
  

• More than 70 percent of women who have abortions express a desire for children in the future (Torres & Forrest, 1988). There is no evidence that women who have had abortions make less loving or suitable parents (Bradley, 1984). 
  

• Women who have had one abortion do not suffer adverse psychological effects. In fact, as a group, they have higher self-esteem, greater feelings of worth and capableness, and fewer feelings of failure than do women who have had no abortions or who have had repeat abortions (Russo & Zierk, 1992; Zabin et al., 1989). A recent two-year study of the psychological effects of abortion confirmed that most women do not experience psychological problems or regrets two years after their abortion. (Major et al, 2000). 
  

• A study of a group of teenagers who obtained pregnancy tests at one of two Baltimore clinics found that the young women who chose to have abortions were far more likely to graduate from high school at the expected age than those of similar socioeconomic status who carried their pregnancies to term or who were not pregnant. They showed no greater levels of stress at the time of the pregnancy and abortion and no greater rate of psychological problems two years after the abortion than did the other women (Zabin et al., 1989). 
  

The positive relationship of induced abortion to well being may be due in part to abortion’s role in controlling fertility and its relationship to coping resources (Russo & Dabul, 1997; Russo & Zierk, 1992).