Web Links

After you read the above box in your text, and the accompanying "Check it out!" question, to http://www.nofas.org/ for information on behaviors of those affected by Fetal Alcohol Syndrome and Fetal Alcohol Effects, including national statistics and contacts. Resources available, including newsletters, support groups, audiovisual materials, and information packets.

After you read the above box in your text, and the accompanying "Check it out!" question, go to the following for more information:

http://www.noah-health.org/

A March of Dimes-sponsored Web site with facts about amniocentesis.

or

http://www.epregnancy.com/info/prenataltests/test-amnio.htm

Part of a Web site called epregnancy.com. This link focuses on amniocentesis, with links to fact sheets about other prenatal tests, including AFP, CVS, and ultrasound.

In Nepal, one term for pregnancy means "being with two bodies" (Escarce, 1989), a feeling shared by many pregnant women as their bellies inexorably expand. For the expectant mother the physiological changes during pregnancy are unlike those at any other time of her life. From the time a woman realizes she is pregnant, she makes many decisions, conscious or not, which have far-reaching effects on the creature growing in her womb. If she is wise, she will become more careful about her diet, give up smoking (if she ever started), and forego the occasional beer or wine she might ordinarily enjoy. Almost every choice she makes and every experience she has that affect her physical and emotional well-being may influence this child, whose presence will continue to alter her life in ways she cannot yet imagine.

Expecting a baby, especially a firstborn, changes more than the mother's body and lifestyle; it changes the life of everyone in the family. The months of preparing for a birth affect parents' personal identities, their emotional outlook, and their relationships with each other, with their own parents, and with the rest of the world.

As the new life develops, so do the parents-to-be. Even before they have a baby to hold, they may begin to feel a strong emotional attachment to the developing child (Stainton, 1985). Still, they may be ambivalent. They may worry about the cost of having and raising a child, about being tied down, and about whether they are ready to be parents. Usually, positive feelings outweigh the negative ones, especially once the fetus makes its presence known by its sudden kicks and thrusts. A man may experience "sympathetic" symptoms--nausea, backaches, and headaches--which help him feel like an active partner in the pregnancy.

Prospective parents may wonder what their fetus looks like and what its sex is, or they may have already found out the sex through prenatal assessment. The main purpose of such assessment, of course, is to confirm or put to rest the chief concern of most expectant parents: "Will my baby be born with a birth defect?" In the unlikely event that the answer is yes, there may be difficult decisions or preparations to make.

By the eighth month, the expectant parents may be aware of their fetus's sleep-wake cycles and temperament (DiPietro, Hodgson, Costigan, & Johnson, 1996). As they accept their relationship with the child they will have, they try to recognize that this child will be a distinct individual. As they acknowledge their willingness to raise and care for the child, their awareness of what parenthood entails may further their psychosocial development (Valentine, 1982). They may work out unresolved relationships with their own parents and gain new respect for them; or the pregnancy may trigger feelings of wanting to be better parents than their own parents and may raise anew issues and conflicts that had been buried for years. Parents may also have to deal with how the new baby will affect any children they already have.

Go to the following for further information:

http://www.cdc.gov/nchs/index.htm - the National Center for Health Statistics for the latest information on pregnancy trends in the United States.

www.multiplebirth.com

This site disseminates information on the risks of multiple births; resource center for media and the public.

www.icea.org - the International Childbirth Education Association offers a free catalog of materials on pregnancy, childbirth, and childcare.

What happens when state-of-the-art technology is applied in the service of ancient cultural mores?

Amniocentesis and ultrasound were developed to detect birth defects; coincidentally, they can disclose the sex of the fetus. Thousands of women in Asian countries, where male babies have traditionally been preferred over female babies and efforts to fight poverty depend on holding down the birth rate, have undergone amniocentesis or ultrasound solely to determine the sex of their unborn children. Many female fetuses have been aborted, with the result that in these populations males now predominate (Burns, 1994; Kristof, 1993; WuDunn, 1997).

In many male-dominated societies, sons are wanted because they carry on the family name and family traditions, perform religious rituals, and often support aging parents. Since daughters usually go to live with their in-laws after marriage, their economic value to their parents is limited. Furthermore, their dowry can be costly; in India, although such payments are technically outlawed, in practice the expected sum can be more than 10 times a rural family's entire income for a year (Burns, 1994). These customs and attitudes have resulted in mistreatment of girls, who often receive less food, less schooling, and poorer medical care than boys.

In recent years, as a result of the new sex-screening technology, far fewer girls have been born. In China, where the government since 1979 has decreed that families have no more than one child--a policy that still stands, even though it is unevenly enforced (Faison, 1997)--an estimated 12 percent of female fetuses are aborted (Kristof, 1993). Laws to ban such testing except for medical reasons have been adopted, but their effectiveness is questionable.

In South Korea, aborting female fetuses has been a crime since 1994, and disclosing the sex of a fetus is also against the law. Still, women who feel they have failed their husbands by conceiving girls often bribe doctors to perform secret tests and abortions. Indications are that 1 female fetus in 12 is aborted because of sex. In some regions, 125 boys are born for every 100 girls (WuDunn, 1997).

In India, ending a pregnancy just because the fetus is female has been against the law for several years, but the practice has continued; child welfare organizations estimate that tens of thousands of such abortions take place every year. As a result of protests by feminist groups and health officials, the Indian Parliament passed a law in 1994 imposing fines and prison sentences on doctors or patients who give or take prenatal tests solely to determine the sex of the fetus. However, the penalties apply only to clinics, laboratories, and hospitals; thousands of mobile clinics equipped with compact ultrasound machines are beyond the reach of the law. Some women's advocates object to prosecuting women, whose husbands often are the ones who make the decision to abort. In the face of continuing pressure to bear sons, the net effect in India, as in China, may be to drive families back to the ancient practice of killing baby girls soon after birth or neglecting them so badly that they die of illness or starvation (Burns, 1994).

Demographers anticipate a problem when today's lopsided cohort of babies reaches marriageable age (WuDunn, 1997). In China, with its one-child policy, the girl shortage is particularly dramatic: official data show that of the 25 million babies born each year, 750,000 more are males than females. Predictions are that eventually about 90 million men will be unable to find wives (Hutchings, 1997).

For more information, visit the following sites: http://www.babyzone.com/pregnancy/default.asp provides links to pregnancy traditions around the world.

http://www.state.gov/www/global/human_rights/1999_hrp_report/china.html

An archived United States Department of State Report -1999 Country Report on Human Rights Practices. Released by the Bureau of Democracy, Human Rights, and Labor, February, 25, 2000.

At the end of the nineteenth century, in England and Wales, a woman who became pregnant had a risk of dying in childbirth almost 50 times as great as the risk facing a pregnant woman today (Saunders, 1997). A woman who conceived in 1950 in the United States was more than 3 times as likely as in 1993 to lose her baby either before or within 1 year after birth (USDHHS, 1996).

The dramatic reductions in risks surrounding pregnancy and childbirth that have occurred, particularly during the past 50 years, are largely due to new technologies, such as the availability of antibiotics, blood transfusions, safe anesthesia, and drugs for inducing labor when necessary (see Chapter 4). In addition, improvements in prenatal assessment and care make it far more likely today that a baby will be born healthy.

What further progress will the next 50 to 100 years bring? Will today's practices seem archaic to people at the end of the twenty-first century? Looking ahead, one medical expert (Saunders, 1997) has made several predictions about the future of maternity care, most of them based on recent discoveries and advances that are already under way:

• No more obstetrics. Although there will continue to be a need for skilled persons to perform operative deliveries, medical attention will be mainly on the beginning of pregnancy. A new medical specialty combining clinical genetics and fetal medicine will develop to do prepregnancy screening and counseling and diagnose abnormalities in the womb.
• A massive increase in genetic screening. The completion of the human genome map (see Chapter 2) will open virtually unlimited possibilities for advising couples of their risk of conceiving a child with an inherited defect or disorder.
• For couples with potentially harmful genes, greater use of assisted conception and preimplantation genetic diagnosis to make sure that affected offspring do not come into being.
• Earlier detection of fetal malformations by means of computer-assisted 3-dimensional images and by examination of fetal cells obtained from the mother's blood.
• Gene therapy and fetal surgery. By manipulating genes or doing surgical corrections in the womb, doctors will be able to prevent certain predicted or diagnosed conditions from showing up in a child.
• More emphasis on improving the fetal environment, even before pregnancy begins. The recent discovery of the value of giving folic acid supplements to women of childbearing age to prevent them from bearing children with neural tube defects is undoubtedly only one of a number of such measures that will prove to be beneficial. The impact of diet, exercise, work, and other lifestyle factors at critical periods of gestation will be more precisely known and closely monitored.
• Better understanding of the causes of miscarriage, which may make it preventable in some cases.
• Prediction and prevention of premature delivery--for example, through identification and treatment of genital tract infections.

Once a pregnancy is established, and it is clear that the fetus is well-formed and growing properly, not much will have to be done during the last half of pregnancy, other than to check for hypertension (high blood pressure), slowing of fetal growth, and the fetus's position in the womb. However, women probably will still be encouraged to see health-care professionals regularly--among other reasons, for the psychological reassurance such visits provide.

For more information on prenatal testing and other issues, go to

http://www.w-cpc.org/pregnancy/testing.html