Tag: pregnancy

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Ladies, sex is safe in pregnancy.

A baby was born that was so advanced that he could talk. He looked around the delivery room and saw the doctor.
“Are you my doctor?” he asked.

“Yes, I am.”
The baby said, “Thank you for taking such good care of me during birth.”
He looked at his mother and asked, “Are you my mother?”
“Yes, I am,” she said.
“Thank you for taking such good care of me before I was born,” he said.
He then looked at his father and asked, “Are you my father?”
“Yes, I am,” his father answered.
The baby motioned him closer, then poked him repeatedly on the forehead with his index finger and said, “Hurts, doesn’t it?”

Ok, that is a joke from the Internet. Seriously speaking, pregnant women and their partners often wonder and ask their doctor if sex is allowed in pregnancy. They wonder if there are any adverse effects if they engage in sexual activity. Can sex be used to induce labour? When is it safe to have sex after delivery?

These are some of the questions discussed in an article published in the Canadian Medical Association Journal (CMAJ April 19, 2011).

Most couples engage in sexual activity during pregnancy with reduced frequency during later part of the pregnancy. Decreased sexual activity may be due to nausea, fear of miscarriage, fear of harming the fetus, lack of interest, discomfort and physical awkwardness, fear of membrane rupture, fear of infection or fatigue.

What are the likely complications if a couple engages in sexual activity during pregnancy?

Potential complications include preterm labour, pelvic inflammatory disease, and early pregnancy bleeding in placenta previa (an abnormal implantation of the placenta) and possible venous air embolism (gas bubbles in a vascular system) which is extremely rare. One study reported 18 deaths caused by venous air embolism out of 20 million pregnancies.

Generally speaking, low-risk pregnancies have no increase in the frequency of preterm labour in women who abstained from sex compared with those having sex. Women with low-risk pregnancies who have no symptoms or evidence of lower genital tract infection should be reassured that sex does not increase the risk of preterm delivery, says the CMAJ article.

Women who have a history of preterm labour, multiple gestation or cervical incompetence are considered to have high risk pregnancy. The article says that there is limited evidence to guide recommendations on sexual activity in this group.

Overall there is no evidence to support the theory that sex at term has any effect to induce spontaneous onset of labour, cesarean delivery rates or neonatal outcomes. The article says that sexual activity can be resumed after delivery as soon as the woman is comfortable and the perineal wound from episiotomy has healed. This may take two to four weeks.

So ladies, sex in pregnancy is normal. There may be some exceptional situations where one has to be careful. So there is no harm in discussing your situation with your doctor and follow the advice.

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Alcohol, Drugs, Date Rape and Unwanted Pregnancy

“The contribution of alcohol and other drugs to sexual assault has been increasingly recognized during the last 15–20 years,” says an article in the Canadian Medical Association Journal (CMAJ March, 2009). The authors report that 20.9 per cent of victims of sexual assault met the criteria for drug-facilitated sexual assault, also known as date rape.

As we know, rape occurs when sexual intercourse is non-consensual. A person forces another person to have sex against his or her will. It is not uncommon to find that drugs and alcohol are involved in the rape. Rape includes intercourse in the vagina, anus, or mouth. Rape is among the most serious crimes a person can commit. Men as well as women and children can be raped.

The person who commits rape uses violence and fear to force the person to have sex. Victims of rape are physically and emotionally traumatized. Unwanted pregnancy and infection may be some of the unfortunate outcomes.

Date rape occurs when a substance is administered to a person which lowers his or her sexual inhibition and increases the occurrence of unwanted sexual intercourse. Usually, the victim and the person who commits the crime are known to each other and have been together socially in the past.

Rape is common with an estimated lifetime risk of up to one in four for women. About 25 per cent of the 1400 women who contact the Canadian Sexual Assault Centre each year report that drugs were a factor in a rape.

The drugs used in date rape usually have no colour, smell or taste and can easily be mixed with different kinds of drinks without the victim’s knowledge.

Drugs most commonly used in date rape are alcohol, marijuana, benzodiazepines, cocaine, heroin, amphetamines, GHB (gamma hydroxybutyric acid), Rohypnol (flunitrazepam), and Ketamine (ketamine hydrochloride). This list is extensive. Most of these drugs are often metabolized and excreted before the victim even perceives that a sexual assault may have occurred. Unfortunately, this contributes to the underreporting of drug-related sexual assault.

Alcohol is involved in most of the cases of date rape. Urine samples submitted by rape victims to treatment centers across the United States within 72 hours of a suspected drug-facilitated rape, alcohol was detected in 69 per cent of the samples, marijuana in 18 per cent and cocaine in 5 per cent.

The patient requires immediate attention regarding safety, management of injuries, forensic examination, emergency contraception, prophylaxis for sexually transmitted infections and psychosocial support.

Prevention is better than cure. If you are out drinking then vigilance is the key word. Drink your beverage slowly, keep an eye on your drink when mixed and obtain a fresh one after leaving the drink unattended. Do not accept drinks from strangers.

If you think that you have been drugged and raped then go to the police station or hospital right away. Get a urine test as soon as possible. Do not douche, bathe, or change clothes before getting help. You will destroy the evidence you need to find and convict the offender.

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Morning-After Pill

In Canada, one in four pregnancies is unintended and unwanted. In 2001 over 106,000 abortions were performed. Of these, 20,000 were in women under 20 years of age. This happens in spite of wide spread availability of contraceptives.

Studies have shown that a sexually active teenager, who does not use contraceptives, has a 90 percent chance of becoming pregnant within one year. The contraceptive method teenage women most frequently use is the pill (44 percent), and condom (38 percent). About 10 percent of them rely on the injectable contraceptive, four percent on withdrawal method and three percent on contraceptive implant.

Compared to an older person, a sexually active teenager is less likely to use contraception on a regular basis. This further increases the risk of unwanted pregnancy.

About 80 percent of teen pregnancies are unplanned. Unwanted pregnancy imposes significant emotional and financial burden on the people involved and their families.

Teens are also known to engage in unprotected sex and one in four teens acquires sexually transmitted disease like venereal warts, HIV, genital herpes, Chlamydia and gonorrhea.

The subject of unwanted pregnancy brings us to the subject of the “morning-after pill” called levonorgestrel or Plan B. According to an article in the Canadian Medical Association Journal (CMAJ), levonorgestrel has been available in Canada by prescription since 2000. A first dose taken within 72 hours of unprotected intercourse, followed by a second 12 hours later, is highly effective in preventing ovulation, fertilization and implantation.

What has changed is the “morning-after pill” is now available without a doctor’s prescription. This will allow pharmacists to dispense the oral contraceptive “morning-after pill” to women directly when they need it. The woman who needs the “morning-after pill” will consult with the pharmacist who will provide counseling on the contraceptive options.

The move is not without controversy. The CMAJ article questions the need for professional consultation with pharmacists (consultation fees to be paid by the patient) and questions the availability of privacy in a pharmacy for consultation, discussion and counseling.

These concerns have been refuted by the National Association of Pharmacy Regulatory Authorities and other pharmacists. But there are pharmacists, doctors and women who agree and disagree with the availability of levonorgestrel without prescription.

The main advantages are:
-the pill will be available without a prescription on week-ends and holidays when doctors’ offices are closed,
-the patient will not have to wait and agonize in emergency department waiting rooms to see a physician for a prescription, and
-it will reduce the number of abortions.

But the critics fear that this will encourage teenage sexual promiscuity and increase the incidence of sexually transmitted diseases.

The article says that levonorgestrel has shown no serious side-effects to the woman or to the fetus if the woman happens to be pregnant. The cost of the prescription and counseling is expected to be around $40.

Thought for the week:

“Age is not important unless you’re a cheese.” – Helen Hayes

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Breast Feeding

Human milk is the ultimate form of early nutrition for children, and the search for the ideal substitution infant formula will never be concluded satisfactorily.

Dr.Yap-Seng Chong, BMJ September 20, 2003

The year 2003 marks the 12th annual World Breastfeeding Week. It is celebrated on the 40th week of the year (October 1-7) because from conception to birth, breast feeding is initiated on the 40th week.

One would think that breast feeding would be a natural sequential process after pregnancy and birth. Body’s hormonal system is designed in such a way that the breasts are ready with milk when the baby arrives.

Then why have World Breastfeeding Week?

A report shows that in Canada, the overall rate of breast feeding initiation was 75 percent in 1991 and 1992. Fifty-four percent of women were still breast feeding at three months and 30 percent at six months of age.

In 1995, 60 percent of women in the United States were breastfeeding either exclusively or in combination with formula feeding at the time of hospital discharge; only 22 percent of mothers were nursing at six months, and many of these were supplementing with formula, says another report.

The target is to have more than 75 percent of mothers breastfeed their babies in the early postpartum period and to have at least 50 percent to continue breastfeeding until their babies are six months old

What are the obstacles to the initiation and continuation of breastfeeding?

There are many. These include physician apathy and misinformation, insufficient prenatal breastfeeding education, disruptive hospital policies, inappropriate interruption of breastfeeding, early hospital discharge, lack of timely routine follow-up care and postpartum home health visits.

Other obstacles are: mother’s place of employment (especially in the absence of workplace facilities and support for breastfeeding), lack of broad societal support, media portrayal of bottle-feeding as normative, and commercial promotion of infant formula through distribution of hospital discharge packs, coupons for free or discounted formula, and television and general magazine advertising.

These obstacles will have to be removed to encourage young mothers to provide the best possible care for their infants.

Extensive research has shown compelling advantages to infants, mothers, families, and society from breastfeeding and the use of human milk for infant feeding. These include health, nutritional, immunologic, developmental, psychological, social, economic, and environmental benefits.

Both the American Academy of Pediatrics and the Canadian Pediatric Society have recommended breast feeding as the preferred mode of infant feeding.

The World Health Organization and UNICEF have developed explicit guidelines to encourage breast feeding around the world.

More information can be obtained by visiting the websites of these organizations. Locally, you can phone Community Health Services (403-502-8200) and get more information and help.

All communities worldwide need to protect, promote and support breastfeeding. And to remove barriers which inhibit young mothers to feed their infants on demand. We should encourage mothers to continue breastfeeding for at least six months.

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