Pregnancy

Conception, the fertilization of an ovum by a sperm, can occur in women from menarche to menopause, and takes place in one of the Fallopian tubes. Pregnancy occurs when the fertilized ovum moves down and implants on the wall of the uterine cavity – usually four or five days later – and ends as labor takes place and the baby is born. If pregnancy is suspected, do not use basil, cinnamon, hyssop, myrrh, rosemary or sage.

For riders, conceiving can be difficult as going *between* is a natural method of abortion (mistletoe also works). If a rider becomes pregnant she should be restricted from going *between* in her first and third trimesters.

Initial Signs and Symptoms of Pregnancy

=> Note: These signs and symptoms vary with each expectant mother. If a pregnancy is suspected, the woman should be examined by a trained Healer. (Refer to the section on "Pelvic Exams" for more information.)

Engorgement and Soreness of the Breasts

Breasts may become enlarged and very tender to the touch early in the woman's pregnancy (in some cases, this also occurs during menstruation) due to an increased blood flow to the breasts and hormones as the breasts prepare themselves for nursing.

Easy Fatigue

Even simple, daily chores may tire the expectant mother. She may tire easily and sleep for longer periods.

Morning Sickness

Morning sickness may be experienced as early two or three weeks after conception. And, unlike its title implies, morning sickness may occur at any time of the day or night. If the sickness is severe, you may consider administering goldenseal.

Under most circumstances, morning sickness ceases to occur after third month. However, it is not uncommon for the woman to experience morning sickness through the entire duration of her pregnancy. An administration of dilute lavender in hot water as an occasional drink, may aid the expectant mother.

Missed Menstrual Cycle

The woman should wait until she's missed at least two periods before assuming she's pregnant—it's not uncommon for a woman, especially a dragon rider, to miss a period once in a while.

Frequent Urination

The woman may feel the need to urinate often.

Anxiety

Although anxiety is a common symptom, it varies depending on the individual.

Dark Discoloration of the Nipples

The disc-shaped area around the woman's nipples (areolae) may become unusually dark.

Diagnosis of Pregnancy

Pregnancy can only be confirmed after a pelvic examination. Unfortunately, some women experience all the symptoms of pregnancy and yet are not pregnant. This is called false pregnancy and is often found in those who greatly desire to be pregnant but cannot conceive. It may also be found sometimes in those who fear pregnancy. False pregnancy may cause vomiting, missed menstrual periods, weight gain and even quickening ('feeling life'). Unfortunately, these individuals must eventually realize that they are not pregnant and should be treated carefully with compassion on the part of the Healer.

Pelvic Examinations

In addition to the pelvic examination, you will also need to examine the expectant mother's head, neck, chest (including heart, lungs and breasts), abdomen, arms and legs in a general way. It helps if the woman is positioned on a special examining table lying on her back with her knees drawn up and her feet in stirrups. However, some back and muscle conditions may prevent this—it is possible to examine the woman with a little more effort if necessary. By positioning the woman this way you can conveniently check her female organs. If the woman is tense, making the exam more difficult to conduct, it may help to have her take a deep breath and then slowly let it out for ten seconds. This will help her relax, as will talking and reassuring her. Having her partner present may also help.

Once the patient is in position for the pelvic exam and is fairly relaxed, insert a long, narrow instrument called a speculum into the vagina. This will enable you to look at the cervix (mouth of the uterus) and observe if it has undergone the typical changes related to pregnancy. During pregnancy, the cervix changes color from pink to blue and becomes softer (like the difference in consistency between your nose and your lips). With two fingers in the vagina and the other hand placed gently on the abdomen, perform the pelvic exam, checking for the outlines of the uterus, Fallopian tubes and ovaries. The more relaxed the woman is, the easier it will be for you to detect the softening changes of pregnancy in these tissues as well as any abnormalities such as cysts, tumors or ectopic pregnancies.

Approximate Rates of Fetus Growth

At one month, the embryo is half the size of the end of your little finger.
At two months, the embryo is as large as the end of your thumb.
At three months, the fetus is the size of your entire thumb.
At four months, the fetus is about the size of a herdbeast sausage.
At five months, the fetus may weigh a little less than a pound and is about ten inches long.
At six months, the fetus weighs about one to one and a half lbs and is a little over one foot long.
At seven months, the fetus weighs about two to two and a quarter lbs and is fifteen inches long.
At eight months, the fetus weighs four to five lbs and is sixteen to seventeen inches long.
At nine months, the baby weighs approximately seven lbs and is twenty-one inches long.

Pregnancy Changes Observed in the Expectant Mother

At three months, the breasts are the most obvious sign. The areolae (the dark ring of tissue surrounding the nipple) becomes enlarged and the sebaceous (oil) glands become more prominent. The woman may also experience 'cravings' in these early months.
At four months, the uterus enlarges to be palpable above the pubis and thereafter abdominal swelling is plainly visible. Fetal movements can be felt at this time by a women experiencing her first pregnancy, a little earlier for those who have previously had the experience. At eight months, there is 'lightening' as the fetal head descends into the pelvic brim.

Complications in Pregnancy

Miscarriage

Miscarriage is the loss of the embryo or fetus at any time before the twenty-eigth week. Abortion rates are high, with twenty percent of fertilized ova failing to implant and sustain their growth beyond the next menstrual period or survive beyond the eighth week. Many women do not even realize they are pregnant; those that do should be treated with compassion, although it should be noted that some women may be reluctant to confide in a stranger, especially if a man. Some women experience a 'threatened miscarriage' with only slight bleeding. Complete miscarriages carry the danger of severe bleeding and shock.

The woman is likely to be frightened and distressed. Be persistent with your offers of assistance—the woman must see a Healer. Signs and symptoms observed are cramp-like pains in her lower abdomen or pelvic area, vaginal bleeding which may be sudden and profuse, signs of shock and the passage of the fetus and other products of conception. Get her to lie down in a semi reclining position and give her a clean towel. Check her pulse rate; if it increases rapidly she is danger of going into shock so treat as appropriate. Beth-root can be administered to aid the bleeding.

Anemia

Anemia is basically a 'lack of blood' and is a deficiency of a component of the blood. Treat with dandelion and advise the mother on diet; usually a requirement for green vegetables or red meat is enough to re-address the balance.

Congenital Abnormalites

All these are evident at birth, and most children with them do not survive. However, children with mis-shapen limbs, blindness, deafness and muteness may survive.

Constipation & Hemorrhoids

In later months, the expectant mother may experience abnormal bowel movements. Infrequent movements from a poor diet may lead to hemorrhoids (piles) where the veins surrounding the anus become abnormally dilated. Hemorrhoids may also occur where there is obstruction to the flow of blood. Advise on a more fibre-rich diet and medicate - typically an administration of linseed oil.

Backache

Backache may be experienced in the final trimester of pregnancy; this happens as the ligaments in the back loosen. Correct posture, exercise and antenatal relaxation go far and will help to prepare the woman for labor. A back-rub of rose, lavender and chamomile can also help the woman, especially if her partner takes an active role.

Ectopic Pregnancy

An ectopic pregnancy occurs when the embryo grows in a different location from the womb. Commonly, it grows where fertilized—the Fallopian tubes. Normal symptoms of pregnancy are noted, followed by acute abdominal pain with shock (the tube normally ruptures), collapse and vaginal bleeding. The fetus should be aborted immediately and surgery may be required as an intervention. Note: Ectopic pregnancies are terminal for the fetus and can be dangerous for the mother and, but if treated effectively should not predispose her to infertility. Treatment with abortifacients, such as mistletoe, are recommended.

Excessive Amniotic Fluid

Amniotic fluid, also commonly referred to as 'water', will eventually surround the fetus, providing a watery cushion against any temperature changes, injure, pressure or inflammation as the baby increases in size. The water also keeps the baby from rubbing against the wall of the uterus. At first, the amniotic fluid comes from the mother's blood serum, but later on it receives urine from the fetus. As the baby swallows amniotic fluid, its kidneys secrete urine into the amniotic fluid and the process continues as the fluid is "recycled" through the fetus' kidneys.

The average amount of water in the amniotic sac is a little over one quart. When this amount exceeds two quarts, it is abnormal and becomes somewhat uncomfortable for the mother.

There are certain complications that may arise with excessive water. For instance, it is known that there are more defective babies when there is more than the normal amount of amniotic fluid. Also, when there is excessive water, there is a greater likelihood that the bag of water will break with a gush even before labor begins. At this time, the umbilical cord may 'wash' past the baby into the vagina. With subsequent labor contractions, the blood vessels in the cord then become compressed between the baby's head (or breech) and the cervix or pelvic wall. Unless this compression is relieved and blood allowed to flow through the umbilical cord, the baby will suffocate. Sometimes, the baby can be saved only by immediate delivery, which may require intervention.


Contraception

The following is a direct excerpt from a BB post on board 37, for the Harpers and Healers:

1. THE STANDARD, DE FACTO METHOD of birth control, especially among riders, is betweening. Period. Hopping between a few times a day is probably going to take care of any accidental pregnancies, though I will endeavour to post specifics on either the QRW or the OHW shortly. Kylara, from the books, deliberately aborts in an accepted practice by staying between for only a few moments longer than necessary to make her flight.

2. For non-riders, there is a mentioned, but to the best of my knowledge, never specified 'Plant' that is made into a tea for women. Ari has weighed in on this. The plant itself can be called 'Goldenthread' if you choose to name it. (There's an RL plant by the same name that performs the same function.) One cup of tea, hot or cold, must be consumed with the tea brewed to a certain potency, each day, excepting the days that a woman is on her cycle. Drinking the tea while on the cycle may prompt irregular cycles in the future, and may cause problems concieving further down the line. Drinking Goldenthread during the first few weeks of pregnancy will most likely either kill a viable fetus or severely hamper its development. Chances are high that the host body will self-abort. Drinking the tea during the rest of the pregnancy can cause complications up to and including still-birth and early labor. Goldenthread tea is easily obtained at any Infirmary, but MUST be distributed by a ranking healer! IC consequences may be levelled if the tea is knowingly distributed to a pregnant woman, or if the Healer does not offer Due Dilligence before distributing it. People around the weyr can and probably DO grow their own goldenthread plants. The efficacy of these plants cannot be guaranteed, and healers should recommend receiving their stock from a controlled source, though we have no authority in this respect.

Pregnancy on Pern is almost always had by choice. Because it is such a prevalant part of Pernese society, children are educated at an early age, and contraception is made available for those that wish to use it.

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