Time really flies，距预产期只剩下短短的33天了。赶紧查查资料，再温习一遍临产前的各种症状。Hehe，早作准备，希望到时能临阵不慌。 
According to the American College of Obstetricians and Gynecologists, the following symptoms indicate the onset of labor:
1. Bloody show（见红）: You notice a pink stain on your underwear or toilet tissue. This indicates that you lost the mucus plug.
2. Rupture of membranes（破水）: You feel fluid gush or trickle from your vagina, indicating that the bag of water containing your baby has ruptured.
3. Regular contractions that intensify（频率和强度不断增加的阵痛）: You feel contractions that are frequent and increasingly painful. They don’t go away but instead intensify with physical activity.
4. Pain in lower back（放射性后背痛）: You feel a regular and intense pain in your lower back that radiates to your lower abdomen and sometimes even to your legs.
5. Cramps that feel like intestinal upset（产生便意）: You feel cramping that seems like the onset of diarrhea, and you may actually experience diarrhea.
Important note: Don’t insert tampons, take a tub bath, or have intercourse after the rupture of membranes. If the fluid from the rupture is tinted green, brown, or gold, contact your doctor immediately. This is a possible sign of fetal distress.
August 10th, 2005
Mommy
孕晚期常见的并发症可能有：妊娠高血压综合征、妊期糖尿病、胎儿宫内发育受限、还有孕晚期产前出血的一些疾病。
1. 妊高征主要表现就是下肢浮肿、尿里出现蛋白，以及血压升高，而且往往是水肿可能首先出现，所以当体重增长过快，下肢水肿逐渐增多的时候，就要警惕是否有尿蛋白或者血压高。如果有轻度的血压增高，或者有微量的尿蛋白出现，首先应该注意休息，有的时候休息好了这些症状就可以缓解。如果通过一般的休息不能缓解症状，血液逐渐增高，就要在医生的指导下服用药物，或者是住院治疗。如果在这期间有不舒服的感觉，比如头晕、头痛，更要及早的去医院就诊，以免发生妊高征的严重并发症比如子痫。
2. 糖尿病的筛查应该是在孕早期和孕28周的时候，如果通过筛查已经诊断你是糖尿病，要及时的饮食控制、调整血糖，如果饮食控制血糖不理想，应该及时应用胰岛素，这个药对胎儿不会有任何的危害，但最关键是要使血糖保持正常，因为如果血糖高的话，胎儿会有很多的并发症。比如出生后的低血糖、红细胞增多症、高胆红素血症，尤其是胎儿的肺要比一般的孩子晚成熟两周。所以经常会有呼吸窘迫综合症发生。所以孕期糖尿病不可怕，关键是要把血糖控制在正常的范围。
3. 宫内发育受限是每次在产前检查的时候，大夫会发现你的宫高和腹围都是在正常孕周的下线，或者是近一段时期增长缓慢或者不增长，B超检查胎儿双顶径和股骨长都比相应的孕周小很多，如果这种情况是在孕晚期才出现的，一般都是外在原因造成的。 比如说营养不良，或者饮食不合理，或者是胎盘功能不好，通透性差，所以尽管你吃得不差，但到孩子体内吸收的不多。如果是这种情况，必要的时候应该住院输液治疗，使一些必须的营养素通过静脉直接供给胎儿，效果一般是比较好的。
4. 孕晚期还有一种比较严重的并发症就是产前出血，这种情况可以见于前置胎盘或者是胎盘早剥，前置胎盘就是指胎盘的位置比较低，最严重就是胎盘整个盖住宫颈口，这种情况出血往往一次量比较大，病人有可能一次就会造成休克，出血的时候不伴有腹痛，这种情况通过B超可以确诊。 所以如果有孕晚期无痛性的出血，一定要做B超排除前置胎盘的可能。胎盘早剥是指在胎儿没有娩出之前，胎盘就已经在宫腔内剥离，这时胎儿会缺氧，同时如果血不能流到阴道外，就会往子宫基层渗透，造成子宫的卒中。这种情况会危及到母亲和胎儿的安全。还会造成母体的凝血功能障碍。 如果是这种情况，孕妇表现是阴道出血可多可少，同时会伴有腹痛，所以发生这种情况的时候，一定要赶紧上医院，以便及时的治疗，防止母亲的休克或者是胎死宫内的发生。
August 5th, 2005
Mommy
时间：孕34周+4天
内容：Baby’s heartbeat (with a Doppler): 142 bpm
blood pressure (110/80 mmHg) / body weight (127 lb) / urinalysis / height of fundal (30cm) / baby’s position (head down)
结果：各项指标正常。
PS: 今天OB在ER有紧急case处理，例行检查换了Anne Grove （midwife）来做，没想到她在香港住过6年，广东话讲得很是不错。见到我们好像故人重逢似的，呱唧呱唧了不少广东话。临了我还开玩笑说，早知道就选她做我的midwife了，她也趁兴说对啊对啊，可以用广东话教你push。 
尧尧今天一切都好，不过宫高竟然比两周前少了1cm。让为娘的我又有些不安了…… Anne说会consult我的OB，看要不要再做一次B超，她个人倒是认为这个和宝宝的位置有关，不是一个大的concern。
回来后查了一些资料，说是宝宝入盆之后子宫底会下降，但一般是在36周左右。尧尧该不会是开始drop了？ 
看着我们这两天忙着给她洗衣服、消毒玩具，难道她也迫不及待地想早早跟爸爸妈妈见面了？
August 5th, 2005
Mommy
时间：孕32周+4天
内容：Sonogram (2nd time): baby’s heartbeat 152 bpm; baby’s position head down; baby’s weight 4lb1oz; amount of amniotic fluid normal; location of placenta in the back of uterus; baby’s age 32w+3d; due date Sept 13
Blood pressure (92/56 mmHg) / body weight (125.2lb) / urinalysis / height of fundal (31cm)
结果：各项指标正常。
July 22nd, 2005
Mommy
Are you dreading labor? Do yourself a favor–learn as much as you possibly can about labor beforehand. Most women fear labor because of what they think will happen. And while, grant you, labor is no picnic, you can allay many of your fears by understanding what will be happening to your body.
Labor is different for each woman and for each pregnancy, there are 3 main stages:
Stage 1–the longest stage
During this stage–which begins with the first uterine contractions and ends with complete dilation of the cervix–you’ll probably spend most of your time at home. At first, the contractions are like strong menstrual cramps, lasting from 30 to 40 seconds and occurring every 5 to 15 minutes. They increase in rhythm, strength, and duration until, eventually, they last as long as 60 seconds and come every 2 to 3 minutes.
What’s happening during stage 1:
Your uterus and cervix, which together look like an upside-down pear, are rearranging themselves into the shape of a keg. The cervix, or neck of the pear, is getting shorter and dilating or opening so baby’s head can get through. This change is called effacement. At the end of this stage, the cervix will be dilated to about 10 centimeters (nearly 4 inches).
备注：产妇分娩顺利与否，除了胎儿大小， 胎位如何，骨盆大小及形态的因素以外，还有一个很重要并起决走性的因素，这就是产力。所谓产力即指子宫肌肉和腹肌的收缩力而言，子宫收缩需要一定的能量。据实验表明，每一次子宫收缩所需要的能量相当正常人上一层楼梯。而一个初产妇平均产程需要8～16小时，按临产后正常的子宫收缩为3 ～5分钟一次计算，一个初产妇在整个产程宫缩约200次左右,也就是说相当正常人走200多层楼梯，可见其消耗能量之 大。因此，增加一定量的热能以补充体力消耗是很有必要的。 在这一产程中，孕妇应照常吃些高热量的液体或半流质食物。比如红糖水加鸡蛋、鸡枣汤、桂园汤等营养丰富，热量高的食物。对不能进食者，应给予10％的葡萄糖液500～1000毫升静脉滴注，内加维生素C 500毫克。另外产妇经过一段时间熟睡， 改善全身状态后，也能使体力恢复，子宫收缩力转强。如若做不到产妇临产后和产程中及时补充营养和热量，势必影响产力的正常发挥，使产妇过于疲劳，导致产程延长，给产妇和未出世的孩子带来不利。巧克力是由奶油或牛奶、白糖、可可粉等精制而成的营养丰富、热量较高的食品。因此，产妇在临产后和产程中吃些巧克力，无疑是一种简便、易行、增强产力的方法。
Stage 2–pushing and delivery
Now it’s time to go to work. Although this stage is no more comfortable, at least you’re an active participant, pushing with the contractions. Using the techniques learned in childbirth classes will help you breathe and bear down, making each contraction more effective. Plus, you’ll get lots of coaching from your partner and the medical personnel.
What’s happening during stage 2:
Near the end, the baby’s head can be seen during and after a contraction. That’s called crowning. At this point, the doctor may do an episiotomy–a shallow cut into the lower vagina to keep your tissue from tearing. Next (the part you’ve been anticipating forever!) the baby is born, usually head first and face down. At this point, the doctor may place your baby face down on your abdomen for skin-to-skin contact. Your newborn may take a first breath at that moment, or perhaps the doctor will have you gently massage the baby’s back. Sometimes the doctor will perform a little suctioning to make sure the baby breathes freely. Finally, the umbilical cord is cut. Your partner may be allowed to assist here. There also may be other activity, for example treating baby’s eyes to prevent gonorrheal infection, evaluating baby’s condition, or perhaps injecting baby with some vitamin K to aid in blood clotting. And of course, someone will take footprints and issue the ID bracelets–one for you and one for baby.
备注：此产程胎儿胎头由子宫进入阴道。因胎头压迫直肠，产妇有要排大便的感觉；这时产妇应先吸二口气，然后随着宫缩向下用力，靠迸气增加腹压来逼出胎儿，是加速分娩的重要做法。宫缩停止后就休息、产妇应尽可能的不要乱喊或乱动，以免消耗体力。产妇在产床上的有利姿势是：平卧，两腿屈曲，足蹬在产床上，两手拉住产床的把手，然后随着阵缩的加强向下迸气。
Stage 3–the afterbirth
One more job to do–deliver the afterbirth. Your contractions may have stopped but will restart, and will last between 5 and 20 minutes until the placenta is expelled.
Fetal monitoring
During the first 2 stages of labor, your baby’s progress may be monitored electronically.
What about pain control?
While labor pains sometimes can be significant, there are several ways you can help alleviate the pain.
• The epidural.
This is the most common anesthetic used in labor and delivery. Here, the doctor threads a catheter through the vertebrae and into your lower back. Then, moderate doses of anesthetic are injected about once an hour. The anesthetic blocks both your motor and sensory fibers. The sensory nerves are easier to numb than the motor nerves, so you may, for example, be able to move your legs a little bit but you won’t feel them very well. So, when it’s time to deliver, you can’t feel your contractions and don’t have a sense of when to push, which is a drawback.
• The continuous epidural.
This newer version solves that problem. As with the epidural, a catheter is inserted, but now only small amounts of anesthetic are administered by a pump so your nerve fibers are continuously bathed in anesthetic, rather than overwhelmed with one large dose. As a result, your sensory nerve fibers are blocked, but not your motor nerve fibers, so you’re able to push.
• The walking epidural.
This newest option allows you to remain mobile. Ask your doctor about this new one.
• Analgesics like Demerol and Stadol.
If you’re given either of these medications through an IV or as an injection, they can take the edge off the pain of contractions. While they are narcotics, addiction is not a problem because the medications aren’t used for days at a time.
Drug-free pain control
In addition to the pain-relief options that include medication, you also may consider the following:
• Hydrotherapy. If your hospital has a whirlpool spa, you can spend the most intense part of your labor letting the warm water jets massage your aching back. Perhaps even more importantly, the water will let you relax and ride through the pain and work with your contractions. Today many hospitals include spas in their maternity unit for this very purpose. If your water has broken, you may not be able to take advantage of this therapy. Check with your doctor about any limitations that may be necessary.
• Self-hypnosis. This allows you to focus on a pleasant image while relaxing your body.
July 19th, 2005
Mommy
