How much had time passed since your loss?

 

Q:

How much time has passed since your angel grew their wings?

Do you find it easier to cope as more time has passed?

How much had time passed since your loss when it seemed a little easier?

When is the hardest and easiest time to cope for you?

Ch. M.: 8 years. It is easier than day one, but it seems I'm the only one who remembers.
As more time passes I don't understand how people can abuse their children, or put them in harms way and they still get their kids. Life isn't fair.

K. C.: 9.5 years and no its not easier whoever said it would be LIED! Some days its like it just happened and other like its been forever.

K. M. N.: 13 months and honestly it hurts just as much.

T. O. P.: It's been 17 years since my 1st miscarriage and 15 years since my 2nd miscarriage. But for me, they were blessings in disguise. I wasn't near ready...especially with my 1st one, as I was a 16 year I'd child.

D.: Nearly 8 months first angel 6 weeks second angel for me by 6 months found easier to cope with first angel never forget second Angel healing has come quicker than expected but going to counseling to deal with issues due date always hard as you wonder.

C. L. F.: 3 weeks 2 days my baby boy fell asleep and its been so hard if it wasn’t for my 2 year old and 9 year old I would of cracked up I miss him so much. I woke at 3.50 to feed him and he was not breathing it hurts so much.

K.A. S. – W.: It has been almost 9 yrs for my first one and 6yrs for my second, the pain doesn't go away but you do get stronger in time. Every one is different. I know I still think about my three angels all the time, but I get thru the day knowing that I will see my angels soon some day.

T. B.: My first miscarriage was at 19, 3 yrs ago I had my son Aug. 10, 2011, I had my 2nd miscarriage Dec of last year it was really painful physically and mentally it was only a few months after my son was born my 3rd miscarriage was a few months ago my doc says if I have another I need to have tests done my body may not be able to carry another child my son is my miracle baby I cherish every laugh step breath that he breaths!

L. W.: It will be 11 years January 18th and he would be 12 January 26th. Idk that it gets easier so much as you get used to the pain and loss and you adjust to it. Chantal Morris, I know exactly how you feel.

J. S.: It has been a year and a half since my son has died. I have found it much easier to cope since time has went on. The sky has went from a gray back to blue, my tears have become smiles, and I have finally regained hope again. It took a long time, but I realized that I had to be strong and be the best mother I can be to my 3 year old daughter. My son was two months old when he died and my daughter talks about him all the time, sleeps with his blanket, and draws pictures of him. The hardest time is his birthday and death date. I think of him all the time.

J. S. S.: 14 weeks today since my little ones heart stopped beating at 38 weeks 3 days. It has started to get easier to cope with. I have 5 other children who need me to be here for them. I miss her everyday but God has extended His grace. That is the only way I am getting through this.

T. D. W. C.: It has been this Dec will be 2 years the pain never goes away.

T. B.: My son would have been 17 years old this past August 5th. He was born sleeping at 41 weeks. And I miss him every day, but I know he is always with me in my heart.

A. V.: It was 3 years October 21st. I wouldn't say it gets easier. I would say you get numb and you learn how to turn thoughts off so you don't burst into tears and a moments notice.

T. Mc A. O.: My due date is coming up on the 29th Oct but I lost my angel in March, so wish Oct was over, even when I’m writing this the tears are flowing.

D. G.: It has been 9 yrs since my first loss and almost 8 yrs since my last. Time does not heal all pain. And I agree with April you get numb and learn how to turn thoughts off.

J. D.: It doesn't go away. You learn how to cope & who can handle you with compassion & love & who you can freely open up to when you’re having a bad day. I say that because for me loss is something I've been too familiar with all of my life starting at 15 months of age. The thing that helps me the most is knowing 4 important people of my life that I never really got to know in this life, someday I will in heaven.

S. C.: My little baby girl Bethany was born asleep at 39+5 weeks. The pain of losing her will never go away.

A. G. M. N.: It will be 12 yrs on Dec. 18th. You never forget no matter how much time has passed.

S. H.: 19 years and it really doesn’t seem to get any easier.

S.: It has been over 3 years since my first loss, over a year for my second loss and its 5 days short of being 5 months since my third loss! I don't think time really helps with coping!! I just feel and think time makes it easier to hide the pain!!! RIP to all our little angels looking down on us!!

K. G.: It will be 6 months on Sunday since my little girl was stillborn. I think it’s been harder for me because we share a birthday. To be honest, it has really started to hit me hard this month, I think it’s due to the fact I feel I am missing all her 1sts and my only child.

The survey by 

Miscarriage, Stillbirth, SIDS Support Group

http://www.facebook.com/forever.angelbabies

Psychological Aspects of Infertility

reviewed by Tatiana A. ROMANOVA

   Which age is considered ideal for having the first child?

Being unable to conceive and give birth to a child has long been recognized as a very disturbing situation for the estimated 1 : 6 couples involved. Our society is generally seen as one that places a high value on couples bearing children and consequently may be less than supportive to those who cannot fulfill this expectation (Jim Monach).

Regarding the age when ideally the first child should be born, two trends were found in the sample of those who have remained childless so far (the data were collected in Germany): 38% of all respondents articulated the wish to have their first child between the ages of 25–29 years. Another 38% wanted to fulfill their wish of having a child between the ages of 30 and 35 years; the first child was desired at a mean age of 29.9 years. With increasing age, the ideal age for the first gravidity also increased. Respondents up to 20 years of age therefore preferred to have their first child by the age of 26 years. Respondents between 21 and 30 years dated their ideal age when having the first child at 29 years. Finally, respondents between 31 and 40 years dated the ideal time of birth of their first child at 36 years of age. Compared to the women, the men articulated a higher age.East Germans preferred to have their first child at a younger age than West Germans; this was particularly the case for East Germans in the age group up to 20 years (ideal age for having their first child at 25.6 years) (Yve Stobel-Richter, Manfred E. Beutel, Carolyn Finck, Elmar Brahler, 2005).

In Japan the first child is desired averagely at age of 30 years and as for German, the results are depends of gender and current age of respondents. As for women in 20 years old her planed age to have the first child between 25 – 30 years. Female respondent in age 21 – 30 years old would like to have their first child at 29 – 30 years old. In age between 31 – 40 years old women’s ideal age to have first child is about 35 – 36 years old. Respondent after 40 years old desire to get their first child as soon as possible. Male respondent 20 years old desire to have their first child at 30 years. Respondents in age between 25 – 30 years old want to get first child at their 33 – 35 years old. Men in 31 – 40 years old would like to have first child at 35 – 36 years old, the same as women in Japan. But men after 40 years old and older usually abandon the idea to have child at all (by Takeuchi M.).

   What is the importance of having a child compared to other life values?

When asked to rate the importance of major areas of life, health (1) was given the highest priority, followed by income and financial security (2), work (3), partnership and sexuality and living conditions (4). Family life/children were rated at the sixth (6) rank, followed by friends and leisure time activities (5). Having children was more important for women than for men and for the older versus younger age groups. East German women rated ‘having children’ as most important, and West German men rated it as least important. (Yve Stobel-Richter, Manfred E. Beutel, Carolyn Finck, Elmar Brahler, 2005).
 

  What condition should be considered as infertility?

 

Most experts define infertility as not being able to get pregnant after at least one year of trying. Women who are able to get pregnant but then have recurrent miscarriages are also said to be infertile. The infertility definition made a difference. The World Health Organization definition based on 24 months of trying to get pregnant is recommended as the definition that is useful in clinical practice and research among different disciplines (Prasanta Kumar Deka, Swarnali Sarma, 2010).Infertility is defined as the inability of a couple to achieve a pregnancy despite unprotected intercourse for a period longer than 12 months. However, after the age of 35 years, impaired fecundity is well documented and an infertility workup is suggested after 6 months. For most couples having regular unprotected intercourse, the chance of getting pregnant during any given month is 25%. After 3 months of repeated attempts, about 60% of couples conceive. By the end of 1 year, about 85% of couples will conceive. Statistically, 8 to 15% of all couples are infertile (Reed, Susan A., 2001).

  Magnitude of the Problem

It is a growing problem and across virtually all cultures and societies almost all over the World and affects an estimated 10%-15% of couples of reproductive age. In recent years, the number of couples seeking treatment for infertility has dramatically increased due to factors such as postponement of childbearing in women, development of newer and more successful techniques for infertility treatment, and increasing awareness of available services. This increasing participation in fertility treatment has raised awareness and inspired investigation into the psychological ramifications of infertility. Researchers have looked into the psychological impact of infertility per se and of the prolonged exposure to intrusive infertility treatments on mood and well-being (Prasanta Kumar Deka, Swarnali Sarma, 2010).

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Types of Pregnancy Loss

Chemical Pregnancy

Posted on July 27, 2011 by Heidi Faith

 

If you have begun to miscarry, and hadn’t yet been able to hear your baby’s heartbeat with a doppler, your doctor might have said that you are having a chemical pregnancy.

This means that it’s a very early miscarriage.

This very early miscarriage–or the name of it–doesn’t make your baby any less real.  At 5 weeks gestation, just about the time you may have found out that you were pregnant, your baby was about the size of a sesame seed.  And, at 5 weeks gestation, your tiny baby’s heart has already begun to beat.  It’s just too small to be heard on a Doppler.

While identifying your baby at this stage is probably just not going to happen, because of everything that is delivered during the miscarriage, including uterine lining and lots of blood, your baby is real.  Your feelings about your baby are real.

Ectopic Pregnancy

Posted on July 25, 2011 by Heidi Faith

 

An ectopic pregnancy means that your baby has attached itself to an area outside of the uterus rather than inside your actual uterus.  This situation can be fatal to the mother unless the pregnancy ends as quickly as possible.

This can be a very heartwrenching situation for a mother, who may mistakenly believe that she needs to have an “elective abortion”.  In an elective abortion, a mother electively chooses to terminate her pregnancy-despite the knowledge that the baby most probably would go on to develop through a full term pregnancy, and have a live birth.  In an ectopic pregnancy, the very high probability of the both the baby dying and the mother dying, make delivering the baby as quickly as possible a necessity.

see more

 

© The Self-relaxation Practice with Shikyu-chan

Masato TAKEUCHI, Tatiana A. ROMANOVA A touch sensitivity or tactition it is the first among fife life sensations what an embryo of 12 weeks old obtains in the development progress. That meant each of us had the very first experience to communicate with the world by touching the inner uterus wall. Then we had the first response from the world by being touched back. Feeling the uterus wall discovers for us that there is exists the World and we realized that stay here not alone. Physiology of touch-relaxation effect (see more) When somebody touches us, there's pressure pushing on the skin at the point of contact. And just under the skin are pressure receptors called "Pacinian corpuscles. They receive pressure stimulation, and the pressure receptors send a signal to the brain. A touch activates the brain’s orbitofrontal cortex, which is linked to feelings of reward and compassion. Touch signals safety and trust, it soothes. Basic warm touch calms cardiovascular stress. It activates the body’s vagus nerve (n. vagus), one of the 12 cranial nerves in the brain, which in turn slows the heart and decreases the production of stress hormones including cortisol (hydrocortisone). The same time it triggers release of oxytocin, AKA “the love hormone” or "cuddle hormone", what makes feel more trusting and connected.(Dr. Dacher Keltner, Dr. Matt Hertenstein and Dr.Tiffany Field). Why to hold something is good for relaxation? When we touch something it also “touches” us. Our body is balancing a temperature with something or someone during holding or hugging it. Then the phenomenal effect arises: our spatial sensation change and our inner space increase. Now “we” are bigger on the size of the subject or object that we interact with. The walls of our private box move aside and we are getting opener to the Universe. A benefit of this practice is an ability to be less vulnerable, more adoptable and accept easier any hard situations what we face each day. The touch relaxation practice turns us from a “hard nut” what can be crushed down by any powerful blow, to a “soft ball”, what just reflect it and back to previous condition very next time.  We recommend the Self-relaxation Practice with Shikyu-chan © for any people under any life circumstances. If you are a hard-working man or business-woman, busy housewife and mother, to-mush-learning student and stay by yourself grandparent; you are far away from your close person and relative, you feel lonely – © The Self-relaxation Practice with Shikyu-chan is match to you. © The Self-relaxation Practice with Shikyu-chan and pregnancy If you are pregnant, pick Shikyu-chan yourself or ask you doctor or midwife how to practice with.      Obstetricians, midwifes and nurses may suggest © The Self-relaxation Practice with        Shikyu-chan  for: 1.    pregnant women, it helps them to develop connection to their baby. To activate a touch sensation helps to raise a positive feeling for baby’s movement into the womb. That practice establishes inner communication in the way mother-baby without an interruption from external world. A flow of contradictory Information will not able to put pregnant woman to worry and panic condition; 2.    women in labor, it helps them to keep their mind under control during the labor pain, reminds them to keep doing their “work”. Holding the Shikyu-chan imitates for woman in labor her partner’s hand, what is really supportive in that hard time; 3.    women after delivery, it help to feel not lonely. During 10 months of pregnancy women was a center of people attention and support, then, after her baby was born, all o them sifted their sights to newborn infant and there are no one hold her hand and share kindness with. © The Self-relaxation Practice with Shikyu-chan simply can give her to feel physical touch and shrink lonely feeling.   4.       woman who is going to or trying to get pregnant for while as an infertility treatment method.          Caregivers may suggest © The Self-relaxation Practice with Shikyu-chan for people in grief after lost their loved one, patient who suffer with pain and in termination stage. In all of these physical and mental conditions to feel someone’s “hand” in own palm is very supportive.  How to practice There is no any especial way to practice. Just softly squeeze the Shikyu-chan in your palm for 30 – 60 minutes. During this time try do not think about anything in particular. Some people who practice the Self-relaxation with Shikyu-chan image themselves a womb what embraces and accepts of fragile embryo – Shikyu-chan.

Evidence That Little Touches Do Mean So Much

By BENEDICT CAREY

Published: February 22, 2010 

 

Psychologists have long studied the grunts and winks of nonverbal communication, the vocal tones and facial expressions that carry emotion. A warm tone of voice, a hostile stare — both have the same meaning in Terre Haute or Timbuktu, and are among dozens of signals that form a universal human vocabulary.

But in recent years some researchers have begun to focus on a different, often more subtle kind of wordless communication: physical contact. Momentary touches, they say — whether an exuberant high five, a warm hand on the shoulder, or a creepy touch to the arm — can communicate an even wider range of emotion than gestures or expressions, and sometimes do so more quickly and accurately than words.

“It is the first language we learn,” said Dacher Keltner, a professor of psychology at the University of California, Berkeley, and the author of “Born to Be Good: The Science of a Meaningful Life” (Norton, 2009), and remains, he said, “our richest means of emotional expression” throughout life.

The evidence that such messages can lead to clear, almost immediate changes in how people think and behave is accumulating fast. 

Students who received a supportive touch on the back or arm from a teacher were nearly twice as likely to volunteer in class as those who did not, studies have found. 

A sympathetic touch from a doctor leaves people with the impression that the visit lasted twice as long, compared with estimates from people who were untouched.  

Research by Tiffany Field of the Touch Research Institute in Miami has found that a massage from a loved one can not only ease pain but also soothe depression and strengthen a relationship.

In a series of experiments led by Matthew Hertenstein, a psychologist at DePauw University in Indiana, volunteers tried to communicate a list of emotions by touching a blindfolded stranger. The participants were able to communicate eight distinct emotions, from gratitude to disgust to love, some with about 70 percent accuracy.

“We used to think that touch only served to intensify communicated emotions,” Dr. Hertenstein said. Now it turns out to be “a much more differentiated signaling system than we had imagined.”

To see whether a rich vocabulary of supportive touch is in fact related to performance, scientists at Berkeley recently analyzed interactions in one of the most physically expressive arenas on earth: professional basketball. Michael W. Kraus led a research team that coded every bump, hug and high five in a single game played by each team in the National Basketball Association early last season.

In a paper due out this year in the journal Emotion, Mr. Kraus and his co-authors, Cassy Huang and Dr. Keltner, report that with a few exceptions, good teams tended to be touchier than bad ones. The most touch-bonded teams were the Boston Celtics and the Los Angeles Lakers, currently two of the league’s top teams; at the bottom were the mediocre Sacramento Kings and Charlotte Bobcats. 

The same was true, more or less, for players. The touchiest player was Kevin Garnett, the Celtics’ star big man, followed by star forwards Chris Bosh of the Toronto Raptors and Carlos Boozer of the Utah Jazz. “Within 600 milliseconds of shooting a free throw, Garnett has reached out and touched four guys,” Dr. Keltner said.To correct for the possibility that the better teams touch more often simply because they are winning, the researchers rated performance based not on points or victories but on a sophisticated measure of how efficiently players and teams managed the ball — their ratio of assists to giveaways, for example. And even after the high expectations surrounding the more talented teams were taken into account, the correlation persisted. Players who made contact with teammates most consistently and longest tended to rate highest on measures of performance, and the teams with those players seemed to get the most out of their talent.

The study fell short of showing that touch caused the better performance, Dr. Kraus acknowledged. “We still have to test this in a controlled lab environment,” he said.

If a high five or an equivalent can in fact enhance performance, on the field or in the office, that may be because it reduces stress. A warm touch seems to set off the release of oxytocin, a hormone that helps create a sensation of trust, and to reduce levels of the stress hormone cortisol. 

In the brain, prefrontal areas, which help regulate emotion, can relax, freeing them for another of their primary purposes: problem solving. In effect, the body interprets a supportive touch as “I’ll share the load.” 

“We think that humans build relationships precisely for this reason, to distribute problem solving across brains,” said James A. Coan, a a psychologist at the University of Virginia. “We are wired to literally share the processing load, and this is the signal we’re getting when we receive support through touch.”

The same is certainly true of partnerships, and especially the romantic kind, psychologists say. In a recent experiment, researchers led by Christopher Oveis of Harvard conducted five-minute interviews with 69 couples, prompting each pair to discuss difficult periods in their relationship.The investigators scored the frequency and length of touching that each couple, seated side by side, engaged in. In an interview, Dr. Oveis said that the results were preliminary.“But it looks so far like the couples who touch more are reporting more satisfaction in the relationship,” he said.

Again, it’s not clear which came first, the touching or the satisfaction. But in romantic relationships, one has been known to lead to the other. Or at least, so the anecdotal evidence suggests. 

The Project べびー福 / Baby-fuku : Donation of used baby's clothing.

We collect used baby's and kid's clothing in sizes from 0 till 3 years old, then provide direct delivery to mothers who live in devastated areas and developing countries.

Also we are truly appreciating small donations what covers a delivery cost and a new baby goods purchase.

 

A used baby clothing: some people will say: “It is just a trash”, some people think: “It is smart way to reuse it”, but for some of people it could very supportive.

Our babies have a magic feature: they grow up as yeast dough. Just couple months ago your baby was born and now you need to have a shopping, perhaps third times already.
How about those stuffs what have been used less than five times only?
Should its be sent to trash box?
We do not think so and there are several reasons, why:

First of all, if they still look like as new and in good quality it better to be reuse. Japanese language has very meaningful word: “mottainai”, what laterally “sad for waste of something”. In reality, to throw almost not used clothing out IS mottainai. We suggest: do not do like this.

Then, a family budget could be rescue by getting used baby clothing approach. To get a dozen new T-shirts and panties each month is really could crush a financial stability even a wealthy people.

The most important to understand, then at any time and any part of our world can happen difficulties, troubles or even a disaster, That can heard each individual and turn persons to change their life style and needs. Furthermore, for some of people daily surviving is their life style for many years. Many of these people are mothers. Each day in the motherhood they have to manage ways and sources to obtain food and clothes for their baby. To have some shirts, panties, hats and shoes as a gift could be supportive a lot.

To donate used clothing is absolutely not a bad manner, it is smart way to conserve resources and support people in their needs.

..............................................................................................................
『べびー福』は、０歳から３歳までの子供服を集め、発展途上国や災害地の子供たちへ届けるプロジェクトです。

人によっては「そんなの、ゴミ同然。そんなものを人にあげるなんて。」と思うかもしれません。
でも中には「子供服を使い回すのは、賢い活用法！！」と思う方もいるでしょう。

０歳から３歳までの子供たちは私たちが予測もつかない様なスピートで成長します。
特に最初の１ヶ月では、出生時の体重の1.5倍も大きくなるのです！！
お祝いでもらったおしゃれ着が、５回も袖を通さないうちに小さくなってしまった。。。なんてことも。
また、外出機会の少ない月齢では、洋服の痛みも少なく、靴などは新品同然の物もあるでしょう。

これらを着られなくなったからと言ってゴミ箱に捨ててしまうのはもったいない！！

子供の成長に合わせてサイズのあった洋服を着せることは、子供たちが自由に活発に動き回ることができます。
運動能力や精神的に発達していくためにも、とても大切な事です。
また、お母さんやお父さんも、子供に可愛い洋服を着せる楽しみは育児の疲れを癒す助けになるでしょう。

お金のかかる妊娠、出産、育児です。
しかし、必要不可欠な子供服にかかる費用を削減出来れば、食事や教育などに予算をあてられるでしょう。

古着を活用することは決してマナー違反ではありません。
『服』を賢く活用して、子供、お母さん、お父さんに『福』が届くことを願っています。

http://www.ninpumama.jp
http://www.tokyo-hcc.com

 

Midwifery Practice in Nepal

At present, midwifery is neither an independent profession in Nepal, nor exist a separate cadre of midwives. Maternal and child health workers (MCHW) with three-month basic training in the clinical settings after class 8 passed mainly focusing on maternal and child health, and Auxiliary Nurse-Midwives (ANM) with 18-months of programme after grade 10th are the only midwifery care provider in the community. These workforces have limited educational background, limited midwifery training and lack of logistics support from the health system.

There is no legislation and no recognition of midwives. However, the Government of Nepal has recognized the need of producing professional midwives in the country in improving Maternal and Newborn health. It is mentioned in the National Skilled Birth Attendants Policy Long term (Pre-service) Measures (GON 2006).

(MIDSON) 

Women’s Health Status and Services in Nepal

From 1996–2006, Maoist rebels fought a civil war against the Nepal government, a democracy with a House of Representatives. As a result, the overall health situation of the country is poorer than it should be. For instance, availability of essential health care services is 78.8% and life expectancy is 60 years. As in other developing countries, diseases of pregnant women and children, infections and malnutrition account for two-thirds of Nepal's illnesses.

Women in Nepal face discrimination and marginalisation in the family, society and state. This is because of the low status of women in the society. As a result, in a country where the health system is already poor, the level of women's health and education is particularly low. To compound the problem, many districts of Nepal are remote, making access to health services and information very limited.

Reproductive and maternal health is of particular concern among Nepali women. In Nepal, the key role of a woman is to bear children, particularly sons. In fact, early and excessive childbearing weakens women, many of whom die or are chronically disabled from complications of pregnancy. It is not uncommon for Nepali women to experience a prolapsed uterus following birth. This is often due to recommencing, too soon, the expected workload, which is demanding and strenuous. Often, the prolapse remains untreated and women continue their remaining reproductive life miserable due to pain and suffering.

Pregnancy is taken as a natural process and God's gift, for which any medical care is regarded as unnecessary. As a result, a majority of Nepalese women have been suffering from the aforementioned problems and complications related to childbirth. Because their overall health is poor, they have very little opportunity for exercising their reproductive and human rights. The majority of Nepalese women have no pregnancy-related contact with modern health services and maternity services in Nepal are very poor, underused and of poor quality.

According to the Nepal Demographic Health Survey (NDHS) 2006, 44% of women receive antenatal care from skilled birth attendants (SBAs), that is, a doctor or nurse-midwife; only 29% of pregnant women make antenatal care visits during their pregnancy; and less than 19% of births take place with the assistance of SBAs in a health facility, whereas 81% take place at home. Most of these homebirths are assisted by family members, neighbors, or traditional birth attendants who may be trained or untrained; or the woman may be on her own. A large proportion of maternal and neonatal deaths occur during the 24 hours following delivery. In addition, the first two days following delivery are critical for monitoring complications arising from the delivery. However, only one in five (20%) women receive postnatal care within four hours of delivery; slightly more than one in four (27%) receive care within the first 24 hours; and four percent are seen within one or two days following delivery. Each day in Nepal, 12 mothers and 75 babies die in childbirth.

The fact that 67% of maternal deaths take place at home and a further 11% on the way to hospital, coupled with the fact that 47% of deaths are due to postpartum haemorrhage, strengthens the case for skilled attendants both in the community and in accessible institutions (Pathak et al. 1998). Most of the mothers die of severe bleeding, a complication that can be treated even in basic health centers. The maternal mortality ratio (MMR), an indicator of the overall health of a population, stands at 281 deaths per 100,000 births in Nepal (NDHS, 2006). This is among the highest in the world. In comparison, the MMR is 90 in Sri Lanka and just eight per 100,000 in the US, according to the World Health Organization. Similarly, the perinatal mortality rate in Nepal is also one of the highest in the world (75 per 1000 live births). In Nepal, one woman dies every four hours from complications related to pregnancy and childbirth. The presence of a midwife could save many of them. Having a skilled professional at birth protects the life of the mother and the child by recognizing problems early, when the situation can still be controlled, and by intervening quickly.

In the 1990s, Nepal invested in two types of health workers to provide maternal/child health services and obstetric first aid at the village level: Maternal and Child Health Workers (MCHW) and Auxiliary Nurse Midwives (ANM). Neither category of worker has successfully functioned as a skilled birth attendant due to a number of factors. These include inadequate length of the midwifery component of the training; lack of competency-based training; lack of adequate clinical training and experience; professional and social isolation at post; and lack of support from the health system to enable MCHWs and ANMs to provide quality emergency obstetric and neonatal care, especially during life-threatening complications.

Since less than 19% of births take place with the assistance of an SBA, Nepal has a challenge in achieving the Millennium Development Goals (MDG) to reduce child mortality and improve maternal health (MDG 4 and 5 respectively) by addressing factors related to various morbidities, death and disability caused by complications of pregnancy and childbirth. The targets for SBAs set for the country are: 40% of all births to be assisted by an SBA by 2005, 50% by 2010, and 60% by 2015. In order to achieve this target by 2015, a total of 4907 SBAs must be in post by 2012 (from 2395 at present) (GON 2007). This is an enormous challenge because currently, as per the internationally accepted definition, only a limited number of health workers in Nepal qualify as SBAs. Furthermore, unequal access to SBAs, depending on the area in which one lives and one’s economic status, is a barrier to achieving these MDG indicators. Fifty-one percent of deliveries in urban areas are attended by a SBA, compared to 14% of births in rural areas (NDHS 2006). Against such a backdrop is a need to produce skilled birth attendants who can proficiently deal with these national maternal and child health issues.

New clues to preventing miscarriage or pre-term births.

• 20 April 2011 by Hayley Crawford and Helen Thomson
• Magazine issue 2809.

MISCARRIAGE and pre-term birth are the two things all parents-to-be worry about. Two studies published this week could help establish why some pregnancies go wrong, and offer hope for new treatments to prevent pregnancies ending this way.

One in five pregnancies end in miscarriage, and the risk increases with the age of the mother. Patricia Hunt and colleagues at Washington State University in Pullman have now identified a surprising contributing factor: a lack of quality control during egg-making.

Hunt's team found that not all of the immature egg cells, or oocytes, produced by mice contain the correct number of chromosomes. Egg or sperm cells divide through a process called meiosis, rather than the mitosis that is typical of cell division elsewhere in the body. There are several checks in place to make sure that meiosis occurs correctly, but Hunt's team found that this process isn't as strictly controlled in eggs as it is in sperm.

Specifically, when the pairs of chromosomes line up at what is called the meiotic spindle at the centre of the parent cell, they should await a chemical signal called the spindle assembly checkpoint (SAC) before dividing into daughter cells. However, the team found that eggs bend this rule. When they observed eggs dividing in ovaries removed from mice, they noticed that the SAC trigger for cell division waits for most - but not all - of the chromosomes to be lined up correctly. The consequence is either too many or too few chromosomes in the resulting egg cells, which can lead to birth defects or miscarriage (Current Biology, DOI: 10.1016/j.cub.2011.03.003).

The cell division process "is highly conserved between mice and humans", says Hunt, suggesting that the same lack of quality control also applies to us. She reckons that we may be evolutionarily programmed to allow defective cells to divide because eggs are precious. "It is better to try and fail than to simply give up on an egg before it is even fertilised," she says.

As the absence of a control mechanism can only increase the risk of chromosomal abnormality, So Iha Nagaoka, co-author of the study, says that IVF could be adapted to include screening that sorts the bad eggs from the good in a way that the body does not, helping to reduce the risk of miscarriage.

Premature birth is also a distressing experience for parents, and it is this aspect of pregnancy that Justin Fay at Washington University School of Medicine in St Louis, Missouri, concentrates on. Some 12 per cent of babies are premature, and caring for them costs the UK £1 billion ($1.64 billion) a year.

Fay and colleagues think they have identified a contributing factor. "Humans have a shorter gestation period relative to their brain and body size than you would expect looking at other primate lineages," he says. This is a result of our large brains and the narrow female pelvis, which mean that in order to maximise the chance of both mother and baby surviving, our gestation period has had to shorten.

The researchers think that this shortening is encoded in the genes involved in birth timing, some of which must have evolved rapidly since we diverged from other apes, to keep up with the growth of our brains.

To find out, the team compared numerous genomes from humans and other primates and pinpointed around 150 likely candidates for genes involved in accelerated birth timing. When the researchers looked for these genes in 328 mothers in Finland they found that variations in a gene called FSHR were more frequent in mothers who gave birth before 37 weeks of gestation. The team says the gene could be a new target for therapeutic measures to prevent pre-term births (PLoS Genetics, DOI: 10.1371/journal.pgen.1001365).

"It was surprising to find that FSHR was involved," says Fay. The hormone it controls- follicle stimulating hormone (FSH)- has a well-known function in the establishment of pregnancy rather than the initiation of labour. "It suggests that we should start looking at risk factors for pre-term births much earlier than 25 to 35 weeks into gestation," he says.

David Haig at Harvard University says that it may be significant that the neighbouring gene to FSHR - called LHCGR - is responsible for producing a hormone that helps to maintain a thick uterus during pregnancy. Any variations to FSHR might have a knock-on effect on nearby genes, he suggests.

Chimp births are surprisingly like our own

The process of human birth is unique among primates because the infant emerges with its head facing in the opposite direction from its mother, or so the argument goes. Now, the first close-up videos of three chimpanzee births suggest that theory is wrong. In all three cases, the newborn emerged with its head facing away from the mother (Biology Letters, DOI: 10.1098/rsbl.2011.0214).

It has also been suggested that the orientation of human newborns accounts for another uniquely human aspect of birth- the need for a midwife. Indeed, midwives contacted by New Scientist say that the differences in birth-related mortality rates between countries with good and poor levels of medical care shows the difference their assistance makes.

But this idea may also now be up for revision. Satoshi Hirata at the Great Ape Research Institute of Hayashibara Biochemical Laboratories in Okayama, Japan, who led the study, says that chimps make nests so that they have a safe place to give birth, which could allow this style of birth to occur without assistance.

Miscarriage: The loneliest grief of all.

Kate Evans has had six miscarriages. To her, each felt like a bereavement – yet she mourned in silence. So how do you deal with the loss of someone who never lived?

Tuesday, 27 January 2009

The doctor's silence tells me everything I need to know. Eventually, he clears his throat, and says in a voice deliberately gentled, "I'm very sorry". And so am I. There on the screen before us, I can make out the form of a tiny curled foetus and, where a few weeks earlier, its heart was thumping with life, it now lies still in the cavernous vacancy of my womb. This is no longer a baby. It is a miscarriage. 

It surprises me how surprised I am. This is the sixth baby we will have lost; you would think that I would be used to it by now. But maybe it's not surprising that I had to believe in this baby, as though by investing in it some hope, and some love, I could will it into being.

They have run all the tests. Like the majority of women with recurrent miscarriage, they have found nothing wrong with me. They don't know why this is happening. 

In my mother's generation, there were no early pregnancy tests, and you weren't officially pregnant until you had missed three periods. These days, it's different. The very first day of absent menstruation can find you racing to the chemist, and then fumbling with instructions and collection pots and testing sticks until that tell-tale blue line makes its announcement.

The next step is a visit to your GP, where you are told the day your baby is due. You are handed a free book on pregnancy containing photographs and descriptions of your developing baby. It confidently states that, by 12 weeks, the foetus is fully formed. (It doesn't warn you here that only five out of six pregnancies make it this far). The book suggests that you make an early appointment with your midwife and begin thinking about where you want your baby to be born. So you do. 

And you discover the unmistakable differences that pregnancy brings – the signs that women have never needed testing kits to tell them. A visit from the tit-fairy brings you newly enlarged and extra-sensitive bosoms. You have a vastly increased need for food and for sleep. You feel more squeamish, more nauseous, more emotional and more hygienic. The hormone rushes make you feel like you're stoned. Lack of food makes you violent. You feel the glow of life inside you. You begin to plan and to dream. You probably chat to your baby. You consider its sex and its name. 

And then you begin to bleed. 

So you've lost your baby. And it's such a massive thing to lose. You, me, everyone reading this, we all started out as a little smudge of amniotic cells. My children would be 18 months old, or four months old, or I would be five months pregnant. I've lost a good friend because her baby was born on the day that mine was due and I have never been to see him. It hurts too much. 

I have never known depression like the cloud that descends every time I lose a baby. I can compare it with the death of a close friend and I can honestly say that it's worse. When a friend of mine died suddenly, we viewed the body, we buried him and we were able to say goodbye. I had the company of others who were as grief-stricken as I was. My mind replayed moments with him – a ceaseless video stream of memories, which was part of the way that my brain processed the loss. 

With a miscarriage, I'm left battling through the layers of euphemism to even recognise that I have been bereaved. What is this that has happened? "Pregnancy loss"? The word "baby" was never mentioned by the staff in the Early Pregnancy Advisory Unit. When the scan revealed that my baby was no longer viable, I was referred for an operation with the horrendous name of "Evacuation of Retained Products of Conception". My child, described as clinical waste. 

If there's no body, how can I grieve? I feel as though I must be kidding myself, wallowing in a morass of grief over a person who never even lived. Every time my mind trips back to this death, this loss, it strikes on empty, because there's nothing there to miss. This jellybean, lying forlornly on some toilet tissue – how can that sum up all my hopes and dreams for this child? How can it contain all my love? 

I almost welcome the pain and blood that happens when I miscarry. It seems more real to me than opting for an operation under general anaesthetic. There is pain involved. I want to feel it. 

When a friend dies, you can seek solace in the company of other mourners. Miscarriage, by contrast is an entirely private grief. There's me and my partner, and he's generally so intent on protecting and comforting me that it's hard for him to make space for his emotions. "How are you?" a friend will ask, in a conversational tone, and I wonder, do they really want to know the blackness of my mood? Every time it happens, I find it harder to struggle through, and yet I fear that, for my friends, this drama has become repetitive and boring. With each miscarriage I need help more, yet I feel I can ask for it less. 

I am a mother. I have a child, conceived after my third miscarriage. In an earnest attempt at consolation, I am repeatedly told "Well, at least you have got him". And it's true, and I love my son dearly: he is perfect, wonderful and amazing. I am aware that the pain of other women who never carry a child must be greater than mine. But that doesn't mean that I'm not hurting. Having had a baby, I know exactly what it is I've lost. I know what it feels like to give birth, to breast-feed and to raise a child. The stack of baby clothes that I have in the attic is slowly diminishing, pragmatically distributed to women who are actually having babies, not ghosts. 

And alongside the helplessness and hopelessness there is another, even darker emotion. It could be politely described as bitterness. How it actually feels to me is hatred. I hate pregnant women. This is nuts. I have been heavily pregnant myself and I know it's no fun. What I should feel is sympathy. Envy would be understandable, but hatred? What's going on here?

There's generally no point trying to bury your emotions. It's only by feeling them and naming them that you can get through them. And if you try to run away from them, they have a habit of catching up with you. Jealousy and hatred are impolite, socially unacceptable emotions, but they could serve a purpose. Throughout the animal kingdom, there are examples of bereaved mothers attempting to steal babies. Maybe I'm just part of a bigger picture here. The survival of the species is best achieved if there is a mechanism for matching up thwarted parents with unwanted babies. And I have reached the point where I've thought, "She's got my baby. That's my baby that she's growing." Insanity, I know, but possibly evolutionarily useful insanity. 

So where does this leave me now? 

The stakes keep rising but we have to keep playing the game. Maybe another baby will arrive to heal the hole in my heart. Or maybe my life will continue, trapped into this loop, like a needle that lands on a record but hits a scratch and lifts off again before the song even starts playing. 

On a practical level, we don't seem to have much problem conceiving, which isn't entirely a blessing. I am sincerely grateful that we haven't spent thousands of pounds on IVF to walk this difficult road. But it does mean that any time we want to step off the roller-coaster, to gather our energies for the next ride, we have to avoid trying to conceive a baby that we desperately want. Which makes our lovemaking very poignant. The only fixed point that I can see ahead is the eventual end of my child-bearing years. Either we will have had another baby, or we will have tried. I won't be so sentimental as to say that these unborn babies will stay with me, because they never really lived, but these scars will have made me part of who I am. And I am proud of that. 

Our society conspires to render miscarriage invisible. There is an unwritten rule that a woman should never announce her pregnancy until she reaches three months "just in case". Just who is this helping? The first trimester is when a woman does the work of creating the baby. Every organ in the baby's body is formed, and the mother experiences worse fatigue and nausea than at any other point of gestation. Women need to be supported through this vulnerable period and, with no outward sign that they are pregnant, how are they going to access that help if they can't ask for it? 

And if they miscarry, as one in six early babies will, women need even more support through their trauma. "Not telling" leaves women stranded with their grief. How can they begin to explain that they are mourning the loss of something whose existence was kept secret in the first place? 

Pregnancy is a superstitious time and I can see why women don't want to tempt fate by announcing their news too soon. But fate has dealt me that blow, the one people don't talk about, and I can tell you that the fact that people don't talk about it makes it a whole lot worse. 

So talk. Tell. We can be proud of our pregnancies, no matter how "successful" they are. A hurting heart is a sign of a loving heart. The only thing that has really helped me through this is knowing other women who have been through the same thing. Miscarriage is such a common trauma – there is no reason for us to be alone in our grief. 

When it all goes wrong: The facts about pregnancy loss

 

* Miscarriage is common. Between one in five and one in eight pregnancies ends in miscarriage. Most miscarriages occur during the first 12 weeks of pregnancy.

* About half of miscarriages are thought to be due to the fact that the foetus is not developing normally because of chromosomal, genetic or other problems. The causes of the other half are not known.

* The risk of miscarriage increases with age, rising to about one in four pregnancies in women over 40.

* Following one miscarriage, a woman has the same chance of a subsequent pregnancy being successful as a woman who has not miscarried. Even after three miscarriages, there is a 70 per cent chance that the next pregnancy will be successful if no cause for the miscarriage has been identified.

* If a woman has three consecutive miscarriages, this is known as recurrent spontaneous miscarriage and doctors will want to investigate any possible causes. But often no cause can be found. 

www.independent.co.uk/life-style/health-and-families/features/miscarriage-the-loneliest-grief-of-all-1516750.html