Maternity Insurance|Maternity Care|Postpartum Care

We are currently facing a nursing shortage in the United States and it is predicted that this need for qualified nurses is only going to increase. Through advances in healthcare people are living longer than ever which has produced an increased population of elderly people who are in need of medical care. There is also a great need for nurses in non-hospital settings. Another factor in the shortage is that current nurses are growing older as well and choosing to retire. A new crop of nurses will be needed to fill these positions. This makes nurses today, especially nurses who hold a Bachelor of Science Degree in Nursing (BSN), are just about guaranteed to obtain a job directly after school. They can also count on there never being a shortage of need for their skills.

The average beginning yearly pay for a new RN is about $44,600, which is more than many careers that have comparable education and experience requirements. The Bureau of Labor Statistics puts the yearly median earning of a registered nurse in 2004 at $52.330. While the middle percent of registered nurses took home yearly incomes between $43.370 and $63,360, with the highest earners making more than $74,760. Even the lowest earner made around $37,200. As experience is obtained yearly incomes go up. When you factor in wages made for shift differentials and over time, most nurses make well over their base incomes. Going into management and administration can add even additional income.

Nurses can be found in every area of the hospital setting. They are at the patients bedsides, in operating and emergency rooms. There are nurses that specialize in x-ray and diagnostics as well as in the labs. Some nurses focus on children or maternity care. Not only are nurses working in large hospital settings but also same-day surgery centers and as part of emergency response teams who care for patients as they are transported to the hospital.

Only about half of nurses fulfill the various positions at hospitals. The rest are split between many other places. There are also more options than ever before for nurses to do exactly the type of work they enjoy most and work for who they want when they want. They work in long-term care facilities and nursing homes. Also medical offices, clinics, schools, various businesses, research centers and in the military. They also hold instructor positions teaching nursing students. These are just a sampling of the different career options nurses have today.

RNs who seek additional education have even more opportunities to specialize their care. They can be clinical nurse specialists, who focus their energy on one particular health crisis such as mental illness or cancer. There are certified nurse midwife opportunities for nurses who feel the need to assist women through the various steps of pregnancy and childbirth. Nurse anesthetists work along size anesthesiologist in operation and emergency rooms. There is an over whelming need for nurse practitioners who can take care of most of the daily health issues and free up doctors to tackle more invasive concerns. Then there are the nurses who participate in the research for new technicians, methods and equipment.

Nagoya is a major city in Japan situated on the Pacific coast. It is the capital of Aichi province and one of the most important ports of the country. This beautiful city is a leading economic, trade and industrial center of Japan. Nagoya provides its visitors with many good public and private hospitals that deliver excellent treatment for any health issue. The major hospitals in Nagoya offer the services of English speaking staff. Here is a note on some of the leading hospitals in Nagoya.

Nagoya Daini Red Cross Hospital is a leading hospital in the city that offers medical care at par with international standards. This hospital was founded in 1914 and gives special attention to the rights of its patients. The 76,116 square meter hospital offers excellent medical care in every medical discipline by employing 299 doctors, 877 nurses and 6 registered dietitians. The hospital is accredited by the Japan Council for Quality Health Care is a nationally recognized center for cancer treatment, blood stem cell and bone marrow transplants.

The hospital's well-equipped surgery unit offers service in all major fields. The National Emergency Medical Center is also located on this hospital campus. A modem and spacious new emergency center include a stroke center (SCU), operation rooms, various Intensive Care Units (PICU, CCU, NICU) and a high-care unit which was opened in 2001. Telephone: 052-832-1121

Nagoya University Hospital is another well-known modern hospital in the area. This hospital was originally founded in 1871 and has since undergone many modifications to become one of the most distinguished health care facilities of the country. The hospital offers a wide spectrum of diagnostic and clinical services. The surgery department is also well equipped to carry out every type of operation including vascular surgery, gastroenterological and transplantation surgery. Effective service is offered in the departments of endoscopy, blood transfusion, maternity and prenatal care. The emergency medicine center and ICUs of the hospital have all the newest facilities including many life saving devices. The radiology department is also well equipped. The hospital has very friendly payment desk and they receive all major credit cards and bank transfers. This is a major center of medical education, training and clinical research. Tel: (052) 741-2111

Meijo Hospital situated at Naka-ku, Nagoya city, Aichi Prefecture, is another reputable health care facility that offers modern and cost effective medical service. Meijo Hospital, approved by Japan Council for Quality Health Care follows global standards on quality and patient safety. The surgery department has six operating rooms and all modern facilities. The center is located in a quiet, picturesque place and provides luxurious accommodations. TEL: 052-201-5311

There are only 4 reasons why we get health insurance. The goals of health insurance are:

1. to avoid the risk of financial ruin from illness


2. to save money,


3. to stay healthy and


4. to have the feeling of security that comes with thinking that our care is paid for.

This article looks at reasons 1 and 2, and poses some questions to ask yourself to choose the insurance that will save you the most money.

Reason 1 for getting insurance: avoiding the risk of financial ruin from illness.

The primary function of health insurance, if not all insurance, is to pool the risk among many people, so that no single person is brought to ruin from an adverse event. Anything else that insurance offers is extra to the entire concept of insurance. Catastrophic care is a basic necessity for any plan. Your agent or insurance adviser should be able to help you with any questions about this aspect of health insurance. Many states have insurance commissions and laws that assure minimum standards. Contact your state commission to see if they have a brochure or web page outlining those standards. Understand that you might want to go above those minimum standards for catastrophic care.

Helping you define your personal choice about the amount of catastrophic insurance you want is not really the purpose of this article, but some of the things. Many have high lifetime maximum benefit payments, also referred to as "caps," between $1 million and $3 million. Once the cap is reached, your insurance company will not pay for any medical expenses and your health insurance policy will become void. Also, it should be noted that most catastrophic health insurance plans do not cover pregnancy, and other plans do not cover maternity care for a full year after your effective date.

Reason 2 for getting insurance: saving money

Can insurance save you money? Acquiring insurance through your employer, who essentially buys in bulk, will almost surely provide a savings over buying it yourself. The present expectation of low-deductible, low co-pay insurance began during World War II, when there was a shortage of workers, and, to prevent wage competition, there was a cap put on wages that could be paid. Employers began to offer insurance with more and more and more benefits to attract workers, and the value of the employer-offered insurance was further enhanced when employers' contributions for healthcare were considered as pre-tax dollars. In other words, if your employer pays for insurance, you are not taxed on the cost of that insurance as income.

If you are self-employed, in most situations you lack the bulk purchase benefit, although organizations of self employed persons may offer some benefits. You may, however, have other possibilities for tax savings. Again, ask your agent, accountant or financial adviser for clarification.

But the more complex question into which we will be looking is - can you save money by increasing your deductible or co-pay? You will certainly have a lower monthly payment, or keep more money in your paycheck, but will that help you achieve your other goals, protection from financial insolvency, achieving security, and keeping healthy?

Health savings accounts - HSA's, as they are known - allow you to put a percentage of the value of your insurance deductible into a tax-deductible account that can be used for whatever health costs you have, from recommended nutritional supplements to dental care, and includes most forms of medical care, including chiropractic, acupuncture and some other alternatives. And, particularly if you are fairly healthy, the dramatic savings you will have in insurance premiums can outweigh the cost of healthcare you will purchase out of what you put into your HSA. What you don't spend you keep; like a retirement account, it can accrue interest and dividends tax-free and can be passed to your beneficiaries. Many employers offer this option as well. We will go more deeply into this in part 4.

The savings (or extra expenses) you will realize when you lower the amount you pay for insurance, however, will be based on how you actually use healthcare, how disciplined you are and how you choose to commit to your health.

Here are some things to begin thinking about now.

1. Simply having insurance, no matter how high the deductible is, may entitle you to discounts. Another personal story: I have a $5,000 deductible on my insurance but when I went to get a $1,400 MRI for my broken ankle last year, which I had to pay myself, I was only charged the insurance rate of $720 because of the agreement the radiologist had with the insurance company, even though I was paying out of pocket.


2. How do you actually use your healthcare? Are you a person that goes to the doctor once every couple of years, or do you go every time you get the flu? Do you believe in prescriptions as a way to keep healthy, or do you do tend to exercise, do yoga, and take herbs and nutrients to keep healthy? Do you mostly stay with medical doctors for your care, or do you go in for alternative medicine?


3. Do you have conditions for which you use expensive prescription drugs regularly? (If yes, are you happy with your situation or would you like to look into alternatives?)


4. Are you a person who likes to take charge of your health, and make your own decisions? Do you research your condition yourself, or do you like to just let the doctor tell you what to do?

While different insurances may have different formulas, your choice of insurance plans is about much more than money, it can actually reflect and support your personal philosophy of health.

Controlling Eczema during pregnancy is often a worry for expectant mothers. Due to hormonal changes in the body eczema flare ups can often occur while pregnant and there will regularly be concern about how to treat and control break outs.

The health and well-being of your developing baby is of course the number one concern for all expecting mothers and so the use of drugs to control skin problems and the use of drugs in general while pregnant needs to be considered with caution.

If you have taken treatment for your skin problems before being pregnant and if you have used medication to control eczema you must consult your dermatologist and obstetrician before continuing to use these drugs. Some medications used in the control of skin problems can cause developmental defects in developing fetuses. Your dermatologist can help you to decide the risks and analyse the benefits of using your prescribed medication while pregnant.

Remedies that are natural in nature can be used in pregnancy but only after consultation again with your dermatologist and obstetrician. Treatments that have been advertised as natural or herbal sometimes have proved to be harmful to both the mother and baby during pregnancy. Please only ever use a treatment or remedy after full consultation about it with your health care professional.

While pregnant you should try to take extra care of your skin if you suffer from eczema. Good skin care can help cut out flare ups so avoiding the need to use drugs in treatment. Follow these tips to help look after your skin.

* Avoid long showers and baths. Taking longer showers and baths can dry out your skin.

* Use warm water to bathe not hot water. Hot water again dries the skin by using warm water you will avoid dying the skin out and prevent flare ups.

* Use a cleanser. Cleaning the skin with a gentle cleanser will help to wash dirt and germs away from your skin.

* Use a good moisturizer. Keeping your skin moisturized is essential in avoiding dry cracked skin.

You know your own body better than anyone else. Avoid things that trigger flare ups. These may be things such as pets, fragrances, certain foods, avoid these to avoid flare ups.

All of the above points can equally be raised when nursing your new baby and breast-feeding. It is essential to try to avoid unnecessary use of drugs when nursing. Drugs and other substances that enter your body can end up in your breast milk and hence be transferred to your baby.

With over 4 million births in the United States and between 128 and 138 million births in the world every year, the need arises for proper care during pregnancy. Here are some tips for taking care of yourself during your pregnancy.

Get Prenatal Care

The number one most important thing you can do to insure you have a healthy baby is to get prenatal care from a reputable doctor. Regular prenatal checkups can detect potential problems early, determine whether a c-section may be needed, determine the sex and just insure things are going smoothly. A prenatal checkup will generally include blood and urine tests to check for bacteria, blood sugar problems, high blood protein levels, iron levels and other typical complications of pregnancy. Your blood pressure and weight will also be checked. Ultrasounds may also be done to check the growth of the baby and its position in the womb.

Eating Right

In addition to prenatal care, it's essential that you eat right. Balanced meals are crucial, as you are now feeding your baby, as well as yourself. A diet with plenty of whole grains, high quality proteins, fruits and vegetables and dairy is usually recommended for most expectant mothers. It is also recommended that you avoid some items like too much caffeine, artificial sweeteners and any raw or not fully cooked foods like eggs, fish or meat. Also not recommended are soft cheeses and unpasteurized dairy products as these can contain bacteria that could cause an infection. Some types of fish contain higher levels of mercury, which should be avoided, these fish include tuna, shark, swordfish and mackerel. Only two or three servings of fish are recommended for most pregnant women. Above all, drink plenty of fluids, especially water, during your pregnancy.

Vitamins & Supplements

In recent years, studies have found that the B vitamin, folic acid, helps to prevent birth defects when taken during pregnancy. Doctors recommend you take 400 mcg every day. Your doctor may also recommend a multivitamin formulated for pregnant women as well. Many women also take other vitamins and supplements during pregnancy, but be sure to let your doctor know what other supplements you're taking. Consulting a nutritionist or naturopath can be beneficial and they can customize a supplement plan for your specific health needs.

Exercise

In general, most pregnant women can do the same types of exercises that they did while they weren't pregnant. Though some types of weight lifting, very strenuous exercise, as well as certain yoga poses and pilates movements aren't recommended for pregnant women. You should do your research to make sure you are doing safe exercises for your baby. Generally, swimming and walking are excellent, lower impact exercises for pregnant women and are therefore most recommended.

Dealing With Morning Sickness

Vomiting and nausea are the two most prevalent symptoms of morning sickness in pregnant women. Some ways to alleviate morning sickness include eating more small meals throughout the day instead of 3 larger ones and also eating less greasy or fatty foods.

Prevention Of Complications

Taking care of yourself from the moment you are pregnant can not only protect the health of yourself and your unborn baby, but it can also prevent post birth health complications, including postpartum depression. Postpartum can be prevented by getting proper physical and mental health care during pregnancy, but if after birth, you still come down with a level of postpartum depression, it can be dealt with by using medication or counseling, including an innovative online counseling method, called eCounseling. eCounseling provides effective counseling services by certified counselors, for treating postpartum depression right in your own home.

Remember to take care of yourself during pregnancy, since you're not just taking care of yourself anymore, but also another living being.

World leading experts in both pregnancy and postpartum depression have been looking very seriously at the cause and effect of Kangaroo Mother Care (KMC) on the depressive illness known as PND for some years. By all accounts it would appear that the general consensus from the experts is that the technique can be extremely effective in reducing the onset of PND in new moms.

Arising from the way that Kangaroos care for their newborn Joey for around four months after birth, in a pouch positioned just below the mother's chest, KMC is about skin-to-skin contact between mother and newborn baby. This same technique used immediately after childbirth for women, is having a resounding effect on both Mothers and their newborn baby's. In relation to PND, The increased hormone known as Oxytocin is thought to be at least partially responsible for the reduction in symptoms associated with PND.

Looking at the various studies that have been conducted over the years, it would be safe to say that the concept of KMC is working wonders in reducing and eliminating the stress and anxiety often experienced by new mom's. It does not matter if Kangaroo Mother Care is done intermittently or continuously, the benefits are amazing. This of course, in turn reduces the number of women, men and families suffering, as a result of postnatal depression.

There is no disputing from experts or mom's alike, that KMC definitely helps the bonding process between mother and baby, and this bonding process starts the very moment that a baby is conceived. It is also being shown and accepted that Kangaroo Mother Care reduces the symptoms often associated with PND, as much as KMC enhances the physiological stability in the baby. Interestingly, through KMC a Mothers growing awareness of her newborn baby's cues contributes to the possibility of sustained breastfeeding.

Studies have shown that there are no unwanted side effects from the implementation of KMC. Furthermore, KMC enhances bonding as well as reducing the symptoms of PND. These are just a few of the reasons why and the benefits of the introduction of KMC as soon as possible after birth. The great thing about introducing KMC immediately is that it does not interfere with further procedures that may be necessary after giving birth and should in most situations be the priority. Most procedures can be carried out unhampered by baby being skin-to-skin with mom. Kangaroo Mother Care should not only be introduced as soon as possible and there is also room for dad and other siblings to get involved in this process.

Study and research has been carried out around the world and in various demographics. People from both ends of the economic spectrum have been involved in Kangaroo Mother Care research, and there seems to be no apparent discrepancy in the benefits discovered. So, Kangaroo Mother Care is for every baby and every parent regardless of your location in the world.

Your first trimester pregnancy months are the time when you need to accept and absorb all the changes you and your body are about to go through. When you first suspect that you are pregnant, a lot of different feelings go coursing through your body and mind. You may be thrilled at the prospect of becoming a parent, and at the same time you may be terrified of the very idea that you'll be responsible for the life of another human being.

During the first trimester pregnancy months you'll have many things to think about. One of these is your choice of doctor to guide you through your pregnancy. Although many women visit their general practitioner throughout their pregnancy, it's advised that you seek out the care of an obstetrician during the first trimester pregnancy weeks.

This type of doctor has extensive training and experience in dealing specifically with pregnancy and delivery. It's a good idea to visit an obstetrician during your first trimester pregnancy weeks to find out your exact due date and also to learn more about nutrition. He will also prescribe a pre-natal vitamin for you during your initial visit.

One body change you are likely to notice during the first trimester pregnancy weeks is how easily you become tired. As your hormones change, so does your need for rest. Don't be surprised if you find yourself having to catch a quick nap in the middle of the afternoon or when you return home from work. Your body is telling you to rest and you need to listen and obey it.

One effect you may also experience during the first few weeks of your pregnancy is morning sickness. Although this doesn't happen to all women, a good majority suffer from at least some symptoms of morning sickness. The name itself is a bit misleading as morning sickness can occur anytime during the day or evening. If you happen to experience this first trimester pregnancy symptom, keep in mind that it will pass. Morning sickness rarely lasts for the duration of the pregnancy, it's almost always restricted to the first trimester.

Things can go wrong during a pregnancy and in most cases, if that does happen, it will be during the first trimester pregnancy period. Miscarriages are unfortunately a fact of life, and quite often are nature's way of protecting a fetus that has some sort of birth defect. Should you suffer from a miscarriage, take comfort in the fact that most women who lose a pregnancy go on to give birth to one or more healthy children. It's very rare for a miscarriage to happen beyond the first trimester, so if you are into your second trimester, take comfort in that.

It is for this reason that many people wait beyond the first trimester pregnancy weeks before informing others of the impending birth. You usually won't be showing until your fourth or fifth month of pregnancy so it is relatively easy to keep the secret until you are far enough along to know that the baby is healthy and secure.

Make sure that you take time during the first few months of your pregnancy to do some research into caring for a new baby. Many people, particularly first time parents, don't have the experience or knowledge they would like to have when the baby arrives. Read as much as you can about both child birth and caring for a newborn so you can feel confident in your parenting skills once the baby arrives.

Babies are a joy and you should cherish each and every day, right from your first trimester pregnancy weeks through to the day you give birth. These are memories that will last forever, so be certain you take some time to thoroughly enjoy all the changes you are experiencing.

Since April 2010 the Care Quality Commission has gradually introduced legal requirements for a number of organisations, in relation to the provision of health, adult social care and dental services. These requirements relate to all providers of a regulated service as defined by the Health and Social Care Act 2008.

The Care Quality Commission has developed a document detailing the Essential Standards of Quality and Safety that they have identified providers should be meeting in order to be delivering services in a safe and patient focused way. These essential standards replace the previous guidance provided in the form of The Standards for Better Health for NHS Trusts and the previous regulations under the Care Standards Act 2000.

Under the CQC's new system, the intention is that all registered providers will be demonstrating the same set of essential standards of quality and safety whilst also demonstrating respect for their service users' dignity and rights. This uniform set of standards applies across the board, whether providing community based healthcare, domiciliary care within the home or long term residential nursing care. The focus of this new registration system is the assessment of outcomes from the point of view of the patient or service user.

This means that providers will need to be able to demonstrate that their patients are happy with the services that they are receiving and that they have proactively consulted with them in designing and re-designing their provision. This patient focused approach thus demonstrates a slightly different approach to the previous regulatory body, who were more targeted towards the implementation of robust policies and procedures. Further differences can be seen in the fact that providers will need to be registered for each regulated activity that they carry out rather than as an organisation as a whole; the regulated activities that require registration are listed below:

- Personal Care
- Accommodation for people who require nursing or personal care
- Accommodation for people who require treatment for substance misuse
- Accommodation and nursing or personal care in the further education sector
- Treatment of disease, disorder or injury
- Assessment of medical treatment for people detained under the Mental Health Act 1983
- Surgical procedures
- Diagnostic and screening procedures
- Management of supply of blood and blood derived products
- Transport services, triage and medical advice provided remotely
- Maternity and midwifery services
- Termination of pregnancies
- Services in slimming clinics
- Nursing care
- Family planning services

With such a broad spectrum of activities that need to be registered it is hoped that this new system of registration will ensure that services are being provided in line with service users' needs and that patients can expect a uniform approach to the care and treatment that they receive regardless of when or where it is delivered. Additionally, with details of registrations being made available on the Care Quality Commission's website it will be possible for the general public to assess a service's registration status and compare it with alternative options, thus providing choice and an incentive for providers to maintain and/ or improve standards.

With so many people giving their opinion on what to do and what not to do during pregnancy, it becomes hard to determine what is fact and what is fiction. Below is a list of some of the more important factors to consider in regards to pregnancy do's and dont's.

Food during pregnancy

Certain foods need to be avoided during pregnancy. Listeria, which is caused by uncooked meats, some seafood, unpasterized milk and soft cheeses, can cause birth defects, miscarriages and stillbirth.

Cat litter

Toxoplasmosis, is a disease which is contracted by contact with cat feces. It is spread by a parasite which can lead to miscarriages, stillbirth and birth defects.

Smoking

Smoking during pregnancy is definitely a no no. It has been linked to a low birth weight, miscarriage and premature birth in many different studies. Second hand smoke poses the same dangers during pregnancy, and should be avoided at all costs.

Caffeine

Some studies on caffeine during pregnancy have led to the conclusion that the two do not mix well together, as caffeine may increase the possibility of miscarriage and low birth weight. On the other hand, other studies have shown no link between the two. Obviously an excessive amount of caffeine is a bad idea regardless of pregnancy. An excessive amount of caffeine is generally regarded as over 300 milligrams per day. If you stay well clear of this figure, caffeine during pregnancy is less likely to cause problems.

Safety around the house

There are many hazards around the house for pregnant women, but almost all can be easily avoided. If you still insist on doing all the house work yourself, try to stay clear of aerosol cans, industrial strength cleaners and fumes from paint, solvents and strippers. All of the above have been linked to birth defects and other pregnancy complications. It also pays to take it a little easier around certain parts of the house such as stair cases.

Body temperature

Keeping a moderate body temperature during pregnancy (especially during first trimester) is important as it may lead to birth defects. It is a good idea to keep an eye on your temperature during exercise and keep your fluids up. Things such as saunas and hot baths are not recommended during pregnancy.

Alcohol and drugs

To be safe with alcohol during pregnancy it is probably best to avoid it altogether, as there is no safe level of consumption. It can have detrimental affects on an unborn child. In comparison to a fully grown woman, a baby is very small, so you could imagine the potential damage to the baby if the mother was drunk or even tipsy. Drugs during pregnancy have been shown to have a negative effect. Drugs such as cocaine have been shown to hinder the development of a baby's vital oxygen and nourishment, leading to complications such as birth defects and even an addiction in the child itself.

Exercise

Exercise during pregnancy is recommended for most women, but only at a moderate pace. Women who participated in high impact exercise, weight lifting, contact sports, high altitude training or scuba diving before pregnancy, will have to readjust their routines. Walking is highly recommended for at least the first two trimesters, as it can help your body withstand the rigors of labor and delivery more easily.

The do's and don'ts of pregnancy are different for each woman and each pregnancy. The above information is not a medical opinion and should not substitute a professional medical opinion. Always consult your doctor or care provider before making any major decisions before, during and even after pregnancy.

Pregnancy is one of the pivotal moments of a woman's life but not when you're young with a bright future ahead. Teen pregnancy is one of the most difficult experiences any young woman can go through. The stress of pregnancy, revelation of pregnancy to parents, and moving on despite the shame and worry can be nerve-racking. Indeed pregnancy especially during teenhood will never be easy.

According to studies, teenage pregnancies in the United States have decreased steadily over the years. In 1991, there were 60 out of 1000 young women who gave birth and in 1998, 51 out of 1000 gave birth. This decrease may be due to the effective use of birth control and decreased sexual activity among teens.

Yet teen pregnancy rates remain high. According to Women's Health Channel, in the United States alone, approximately 1 million teenage girls experience pregnancy every year. At least 5% of young girls give birth and in 1997, at least 13% of the births in the US are of teenage girls. ??
Health risks to the baby and children out of teen pregnancy are more likely to experience health, social, and emotional problems. An increased risk for complications such as premature labor in teen pregnancy and socioeconomic consequences are present.

But there are more serious problems for the teenage mothers-to-be than the statistics and how the world views them either negatively or positively. Both the baby and the mother are at risk in major areas of life such as school failure, poverty, and physical or mental illness.

Pregnant teenagers may not seek proper medical care that may lead to a bigger risk of medical complications. In their pregnancy, they need understanding, medical care, and education - particularly in nutrition and complications of pregnancy.

Pregnancy to teenagers brings all sorts of emotions. Some do not want their babies while others feel that its creation is an achievement. Some feel guilty and anxious while others feel that they need to baby to love but not aware of the special care it would need. Also, depression is common during pregnancy in teenagers. And when worse comes to worst, a pregnant teenager may even require the help of a mental health professional.

Teen pregnancy can be risky to unborn babies. Teen pregnancy results to underweight babies, poor eating habits of the teenager, and smoking and drinking tendencies of the pregnant girl. Lastly, pregnant teens are less likely to seek prenatal care.

Unwanted pregnancy can be prevented through open communication and providing guidance regarding sexuality, contraception, and risks and responsibilities of possible pregnancy. Sexual education and family life in schools can also prevent unwanted pregnancies. Finally, support of family and love will greatly help pregnant teens.

Note: This article may be freely reproduced as long as the AUTHOR'S resource box at the bottom of this article is included and and all links must be Active/Linkable with no syntax changes.

Reproductive health is a crucial part of general health and a central feature of human development. Among women of reproductive age (15-49 years), the burden of reproductive ill-health is far greater than the disease burden from tuberculosis, respiratory infections, motor vehicle injuries, homicide and violence. Women run the risks of pregnancy, childbirth and unsafe abortion, take most of the responsibility for fertility regulation and are socially and biologically more vulnerable to reproductive tract infections and sexually transmitted diseases. The National Population Policy (India), 2000, affirms the commitment of government towards voluntary and informed choice and consent of citizens while availing of reproductive health care services, and continuation of the target free approach in providing family planning services.

The Ministry of Health and Family Welfare (MOHFW), Government of India, through its National Rural Health Mission (NRHM) has introduced the rapid home pregnancy test kits (Nishchay). The Nishchay program is not a program for the promotion of the pregnancy test kit alone, but is an entry point to RCH and family planning services for women seeking quality and assured RCH and FP services.

Important key issues addressed by Nishchay are:

1. Low percent of women starting ANC in first trimester due to late detection
2. Contraceptive Provisioning (IUD/Pill) not started after ruling out pregnancy
3. High unsafe abortions due to late detection of pregnancy

The key strategies of the program are community awareness, especially among eligible couples, on Home Based Pregnancy Test Card and RCH services, increased utilization of RCH and FP services, following the test results. Important activities include capacity building of ASHAs (Accredited Social Health Activist) through resource persons with field and NGO experience, brand and logo visibility using mass media campaign, community outreach activities using mid -media campaign, and integrating the card into the monitoring system of NRHM/RCH-II.

Implementation of the program is in all Indian States and UT's. The states have been classified into high, medium and low priority groups based on the NFHS-3 data on birthrate and institutional deliveries. In the first phase, the program is launched in the following 11high priority states - Uttar Pradesh, Bihar, Madhya Pradesh, Uttarakhand, Chattisgarh, Jharkhand, Rajasthan, Assam, Meghalaya and Nagaland.

The implementation team was formulated at the central office of Hindustan Latex Family Planning Promotion Trust, comprising of a Senior Program Manager (Atul Bahl), Training Managers, Training Officers and a Communication Officer. State level consultants were hired in the states for additional support in monitoring of NGOs and on ground activities. The Senior Program Manager is assigned the responsibility of the national roll out of the program and the linked activities.

As planned, the service delivery strategy is being addressed through building capacities of ASHAs on understanding the pregnancy test card, making it easily available to all Eligible Couples in the community and tracking the outcome. Relevant training materials were conceptualized and designed for training of ASHAs. These were shared with the Ministry of Health & Family Welfare and have been printed after the approval. NGOs at district level were contacted in all the states, meetings held and the Master trainers identified by them were trained by the project implementation team. Special training materials were designed for them as well.

Demand generation is through using mass media and mid media campaign using local folk, edu - entertainment modality through mobile vans. The program has been very well received by the public and early detection of pregnancy offers many advantages for the mother and the fetus. Many medical benefits depend on early detection, including social and emotional well-being and the avoidance of medications, irradiation, and other teratogenics.

http://bahlatul.googlepages.com

Maternity Insurance In The US

When we discuss finding maternity coverage, we know that we are probably attracting two groups of people. One group is planning ahead for the time when they would like to have a baby. In this case, no family member is actually pregnant yet. This is, of course, a much better time to find maternity coverage. The other group of people who are reading this article already has a pregnant family member. In this case, they are probably scrambling to find some help covering all of the bills associated with having a healthy baby. This will be a little tougher, but there are still some options.

If You Are Planning Ahead For Pregnancy.

If nobody in the family is pregnant yet, but you plan on having a baby in the future, here are some common ways to find maternity health insurance. Some of these options, like payment plans or group health, may still work if you are already pregnant too.

Group Health Insurance - A work related health plan usually covers pregnancy. This is probably the easiest and most common way to find maternity coverage. If your current employer does not offer this, it may be time look for for one who does.

A pregnant woman may still be covered on her parent's insurance if she is young enough. There could be other qualifications like she must be unmarried or a student too. A wife should be covered by her husband's policy if they opted into that coverage. And of course, she would be covered by her own employer's plan if it covers maternity.

Individual Health Insurance - I am not an expert on the private health plan market in every state. In my own state, I can tell you that most family or individual plans do not cover normal maternity costs, or they cover them with a very high deductible. The basic health plan should cover complications of pregnancy. So a C section should be covered. However a basic private health plan probably does not cover office visits, tests, or a normal delivery.

The only health insurance company that I know of that offers a maternity rider (option) is Time. This will vary by state, and it is an extra option with an extra premium. It also has a waiting period before it will pay benefits. If you think that you need this benefit, you must take it well before anybody gets pregnant!

HSA Health Insurance - In some states, there is an individual HSA (health savings account) major medical plan with a maternity rider (option). The health savings account part of the plan is a tax deductible account you must contribute to before you need it. The major medical has a maternity option you can choose. Keep in mind that this option will have a waiting period before it will pay any benefits so this will only work if you plan ahead. But if you do plan ahead, your HSA balance should help you defray the costs of the higher deductible.

Your HSA, on its own, can be helpful even if the major medical plan does not cover maternity. You could use your cash balance, for instance, to pay for prenatal care.

Supplemental Insurance - Some disability policies may cover time lost from work because of a pregnancy. I have also seen some supplemental hospital or illness policies that will pay in case of maternity. These plans are unlikely to accept anybody who is already pregnant though, and I have never seen one that would cover the whole cost of maternity.

Save Money - If you can afford it, and you have no maternity coverage, or you do not have much maternity coverage, you can save for it like you save for a down payment on a house or new car.

If You Are Already Pregnant Without Maternity Insurance

Public Health Insurance - CHIPS is the federal and state children's health insurance plan. It also covers pregnant women. Your income must be less than the guidelines, but it is a good option for people with moderate incomes. You will be restricted to using the doctors on hospitals that participate, but you should be able to find medical care in your area. Very low income people with few assets may qualify for Medicaid.

You may also be able to find low cost clinics and hospital systems in your area. Visit PPARX.org because they have a search by zip code.

Your local Department of Health and Human Services is another public resource. Again, these options are probably going to work the best for people with limited incomes.

Payment Plans - Some OB-Gyns and hospitals have payment plans for the normal cost of maternity. You may need this if you lack coverage, or if your own health insurance will not cover the bulk of the cost. It would actually be better to check this option out before you are pregant, but if you are pregnant, it is an option to research. Try asking your current doctor or a nearby hospital. You might also search online for maternity payment plans in your area.

Private Loans - Many maternity doctors will give you a fee schedule for normal deliveries. Even if they have a payment plan, you may do better with your own financing. I hesitate to advise anybody to go into debt, but when you are safeguarding the health of a mother and baby, this may be something to consider.

Are You Pregnant or Planning To Get Pregnant?

Keep in mind that a normal US delivery costs $5,000 - $10,000. This cost will be multiplied if there are any major complications. In a perfect world, this would all be planned for before conception. I am not writing this to preach because I am aware that this does not always happen because we are humans living in an imperfect world. The most important thing is to make sure that the mother and baby have the best possible health care.

It's very exciting to discover you are going to have a baby. It's easy to want to buy outfits and look at a crib. Some immediately start planning the nursery. However, one of the first steps is to make sure your insurance plan has maternity coverage. If it doesn't, there are other ways to make sure health insurance maternity coverage is included. Some families will purchase extra coverage, others qualify for state help, or some hospitals offer prepaid maternity packages.

If you want to save yourself from a lot of worries, make sure maternity coverage is included from the start. This is necessary if you fall in the appropriate age group, because pregnancy can occur at any time. When you're first looking, the best way to compare different rates is to go online. You can see the different levels of coverage, as some will take care of all bills, while others only cover complications. Obviously, the fuller the coverage, the more money out of the pocket prior to the event. However, the bills will be lower after the baby is born.

There are a lot of things to consider when a baby is coming. There are nine long months of prenatal care, lab work, doctor checkups, and ultrasounds even before you enter the hospital. The doctor and hospital have to be paid after the baby is born. For those who need a c-section, there will also be a higher anesthesiologist bill and surgeon bill. If you don't have sufficient health insurance maternity coverage, the expenses will add up very quickly.

If you don't have health insurance maternity coverage, there are several things to look into. There are ways to get extra insurance online. Some families will qualify for state help, while others buy a prepaid maternity package from their hospital.

Pregnant women understand the importance of taking good care of themselves and watching what they put into their bodies during their pregnancy. We are cautioned to take great care to avoid alcohol, bad foods, drugs, cigarettes, certain prescription medications and anything that could cause problems for the baby. Many women, however, use being pregnant as an excuse to overeat unfortunately. You have probably heard or even used the expression "eating for two." The truth, though, is a little different. When tempted to overindulge, remember that you are not actually eating for two full sized adults and overeating during pregnancy can lead to a number of issues.

There are many health issues that women experience during pregnancy and overeating can contribute to making some of them worse. Back pain is a common problem that many expectant women deal with and one that is certainly exacerbated by gaining an unhealthy amount of weight due to overeating. Similarly, heartburn is something a lot of pregnant women are susceptible too and again overeating can make it much worse. It is often difficult to get a good night's sleep and if your stomach is churning from indigestion caused by eating too much then tossing and turning is virtually guaranteed. The delivery and losing the excess weight following delivery can both be made more difficult by overeating as well.

So what is a normal amount of pregnancy weight gain and what can be considered overdoing it? Most doctors and dietitians cite twenty five pounds as the expectation for the average woman. If you are underweight to start you may gain more and likewise if you are overweight when you get pregnant you may gain less. During your first trimester, you do not need to take in a great deal of additional calories. You may only gain five pounds during your first trimester. During the second and third trimesters, one pound a week is normal and two pounds a week is acceptable. Gaining more than two pounds a week could be an indication that you are overeating.

Some women experience cravings while others report feeling hungry almost constantly. Neither one of these feelings are a reason to overeat, however. We all have different dietary habits and metabolisms, but these issues can be combated by making slight changes to the way we eat. Eating more frequent smaller meals and getting some regular, light exercise are ways to avoid hunger. You can still eat the foods you crave and work them into a healthy eating plan as long as you do not overindulge.

We all know how important it is to watch what we put in our bodies while we are pregnant. Overeating though is something that all too often is overlooked. Talk to you doctor about eating healthy and expected weight gain. Take care not to overdo it so your pregnancy and your delivery can be as comfortable and as smooth as possible.

Good health is essential, most especially during pregnancy. In this regard, dental care for pregnant women is highly recommended, as well. This will prevent the expecting moms from acquiring gum diseases which usually results from hormonal imbalance. The good news is that, pregnant women in UK are entitled to free NHS dental treatments as prescribed.

In order to avail of these costless dental services including routine check-ups, you need to be pregnant during the time of treatment, or begin the course of therapy within 12 months after giving birth. Application of a Maternity Certificate (MATB1) or a Maternity Exemption Certificate (MatEx) will be necessary. This will ensure your eligibility for acceptance of this type of health benefit. You can obtain these forms from the doctors, midwives and health visitors. Your attending practitioner needs to sign, as well. This is to confirm all the information that you have filled-up.

If you are scheduled for treatment after your baby is born, you will be asked to present the infant's birth certificate for further proof. You are entitled to this free NHS dental care, only if you have recently delivered in the last 12 months. In cases of unfortunate loss of pregnancy, women may still avail of this NHS treatment without any charge. Additional requirements such as the stillbirth certificate will be requested, for your compliance.

After completion of the certificates and other requisites, you are ready to avail of the necessary NHS dental care free of charge. Dentists are expected to start the course of treatment, during the second trimester of gestation. The first and the later part of the third trimester is usually avoided for precautionary measures. An intensive medical assessment is done to check if it is safe to expose the pregnant woman to a particular dental procedure. If the condition of the patient is unfavorable, the doctor will opt to postpone any elective dental intervention, after the woman gives birth.

Routine check-ups with your dentist should not be skipped. Regular periodontal exams are very essential during this time. Proper dental care will prevent gum diseases and other illnesses which may increase pregnancy risks. It is highly recommended to stick with you dentist appointments as much as possible. With the NHS dental benefits, you do not have to worry about the cost that these treatments would entail. This is a great advantage that you should take, to promote health and wellness for you and your baby.

With health insurance now mandatory in Massachusetts, people across the state are eager to find affordable Masshealth plans that offer quality coverage. Masshealth plans vary in the coverage they offer. As a consumer, it is important to understand the difference in Masshealth plans to know which is best for you.

Fortunately, Massachusetts law restricts health insurance companies from denying Masshealth coverage to someone due to health conditions or terminating them from a Mass health program for illness. This provides a safeguard for consumers of Masshealth programs that health insurance consumers in other parts of the country do not have.

Masshealth plans can differ significantly from plans offered elsewhere. Many of the larger companies do not offer Masshealth plans. Those that do offer Masshealth plans strive to provide a superior product.

What to Consider When Choosing a Masshealth plan

Most Masshealth plans do not include dental benefits. If you feel that you will need dental coverage, it will be an additional charge to factor into your health insurance budget. Vision benefits are covered by many Masshealth programs. For example, the Blue Cross Blue Shield PPO Mass health program offers 80% coverage on one eye exam every two years.

Coverage of women's health issues are something to be critical of when choosing health insurance. Masshealth programs often treat gynecological examinations in the same way as vision examinations by defining them by a number of examinations within a period of time. Many Masshealth programs have very specific rules and increased rates for maternity care.

Age is an important factor in deciding on a Masshealth program. How does health insurance coverage for children vary from that of adults under different Masshealth plans? Often, Masshealth plans have restrictions and price differences in relation to age. This can greatly impact coverage under a Mass health program for an older person.

All of these issues should be taken into consideration when choosing a Masshealth program. The more coverage offered by a Mass health insurance program for various medical issues will increase the overall price of the plan. At times the initial coverage of the Masshealth plan will require supplemental health insurance for problems that may not be covered, such as dental, or are minimally covered, such as vision. Choosing an appropriate Masshealth plan requires balancing the benefits of a plan against the cost of coverage, including the deductible.

Week by week your pregnant body will be changing and working extra hard to cope, so it makes sense to take extra care of yourself and avoid unnecessary risks especially in the first trimester. But don't be alarmed by the multitude of scare stories you mat hear. In reality, there is no reason why, with a bit of extra care and some common sense lifestyle changes, you can't sail through your pregnancy without putting either your baby or yourself in danger.

Here are some of the risks to avoid:-

Smoking

It's preferable for you and your partner to give up smoking before getting pregnant, but it should certainly be done as soon as pregnancy is confirmed. Smoking in pregnancy has been linked to premature birth and low-birth weight babies and to babies developing respiratory illnesses and it increases the risk of cot death.

Alcohol

Drinking alcohol can harm your baby. There is no safe limit, so it really is best to stop drinking altogether. If you do drink alcohol during pregnancy the Department of Health advice is to limit yourself to one or two standard units of alcohol once or twice a week (one standard pub measure of wine, half pint of cider, beer or lager) and NEVER binge drink (more than five standard measures).

Caffeine

Drinking over 200mg of caffeine a day can increase the risk of low birth weight babies and miscarriage.

Certain foods

P璽t矇, peanuts, under-cooked eggs and blue-vein or mould-ripened crust cheeses can be hazardous to your baby.

Toxoplasmosis

This is a parasite that lives in unpasteurised milk and cheeses, under-cooked meat, soil grown vegetables and cat faeces. It can also be caught through contact with lambing. It's only a problem if you become infected with it for the first time while you are pregnant and can cause miscarriage, birth defects and stillbirth.

Avoid the foods listed above, wear gloves to change cat litter, do the gardening or if lambing. Always cook meat thoroughly and wash all fruit and vegetables.

Prescription and over-the-counter medicines

It is best to avoid all drugs during the first 3 months, unless they are for a pre-existing medical condition, such as asthma, and have been prescribed by your GP.

Abdominal x-rays

All x-rays use radiation, which can harm your baby so they must only be used in situations where your condition is life-threatening. Dental x-rays are considered safe, but you must always tell your dentist you are pregnant.

Chickenpox and other viral diseases

Most adults have had chickenpox in childhood and are therefore immune to the disease. If chickenpox is caught in pregnancy there is a risk to both mother and baby. Viral diseases such as measles and slap cheek syndrome may affect your pregnancy and your unborn baby so always seek immediate medical advice if you have had contact with these.

The Domino scheme means, in theory, that one midwife looks after you throughout your pregnancy, goes into hospital with you for the delivery, and accompanies you home again a few hours afterwards. Although the scheme isn't available everywhere and in practice you may not have the same midwife with you in labour who looked after you during pregnancy, research suggests that it's a very popular scheme with women. It gives them the satisfaction of developing an excellent relationship with one midwife whom they can confide in and whom they can trust to help them achieve the kind of birth they want. You may, however, have to be persistent if you want to choose a Domino delivery.

Schemes very similar to Domino are likely to be available to more women in the future. This is because a recent government report, called Changing Childbirth, recommends that women should see just a few midwives for their maternity care. At present, it's quite likely that the midwife whom you see at your GP's surgery will not be the mid¬wife who helps you give birth, or that, if you are going to the hospital for your antenatal checks, you see a different midwife and doctor every time you have an appointment. This makes it very difficult for the health professionals to get to know you and for you to get to know them. All over the country, the way in which midwives work is now being changed and soon, pregnant women should find them¬selves being looked after by a small team of midwives who will take responsibility for them from when they find out they are pregnant until after the birth of their babies. This will make it much easier for women to get information about their choices for birth, to ask questions and to feel relaxed with their carers. Perhaps it's never been such a good time to be pregnant!

Some of the essential items that mothers of newborns should have are:

Breast pumps: Breast pumps are mechanical devices that help lactating women extract milk from their breasts. There are two main type of breast pumps, manual operated and electric or battery operated. Unlike dairy milking machines, breast pumps don't suck the milk out from the breast instead they stimulate the milk ejection response. Most women use breast pumps to continue breast feeding after they have returned to work and to keep up with their toddler's unusual feeding timings.

Skin cream: The newborn baby needs constant care and attention. Diaper rashes and dry skin are some of the common ailments that affect babies. A variety of skin creams are available to tackle this. Post-pregnancy, women also use anti-marks creams to reduce the stretch marks around their abdomen.

It's a good idea to buy these products before the baby is born. All such products should be checked thoroughly to ensure that no hazardous chemicals or allergenic substances are used in them. A good idea is to check with your friends and family for recommendations. Your doctor could also recommend some creams. If you use cloth diapers, then the baby could get a nappy rash which causes them great discomfort. A diaper rash cream which soothes them is the perfect solution. The baby's skin is still very soft and requires constant care and hence using a baby lotion or oil is a good idea.

Maternity wear: During pregnancy, expectant mothers need to wear clothes that are loose and comfortable. Also post pregnancy they need clothes that will suit their body size. Nowadays maternity clothing is available in various styles and sizes which means that pregnant women do not have to wear dreary gowns to be comfortable. Various tops and stretch pants are available in a variety of fabrics that are suitable for pregnant women.

Mothercare Products: These are products that make it easier for the mother to care for her new born. These include items like new mother clothes, baby soother nipples, disposable breast pads that help feed toddlers, feeding bottles, pacifiers, baby bath lotions,shampoos and baby products, pregnancy pillows that are specially shaped to accommodate expectant mothers, maternity belts which help pregnant women avoid back pain and spasms, nursing bras that help mothers feed their babies.

These are just some of the multitude of products that are available for expectant mothers. Nowadays most of these products are available online and can be delivered to your doorstep. However one thing that must be noted is that all these products should be researched and checked before being used. The health of the new born and the mother is paramount.

Coronary heart disease, is a narrowing of the coronary artery: a large blood vessel that supplies blood to the heart. This narrowing is caused by fatty deposits in the artery itself and is the leading cause of heart attacks in the developed world. Cardiac disease of all types is, indirectly, the leading cause of maternal death in the UK. The risk of developing coronary heart disease increases significantly with age beyond 35 years and more significantly still in those over 50 years.

Large scale social changes have led to the increase in the number of pregnant women who suffer with coronary heart disease. The age at which women are able to conceive and sustain a pregnancy has, on average, increased with many factors driving this, not least, increases in health care and fertility medicine. Career and financial pressures also mean women are delaying having their first child and fluidity of family structures also have contributed to older women wishing to conceive with their second or third partners/spouse.

Lifestyle changes have, without doubt, contributed to the rise in younger women developing coronary heart disease. The huge rise in obesity is an obvious starting point and, according to current statistics, the number of young women who smoke far exceeds the number of young men who partake in this unhealthy habit.

Working and leisure patterns have also played their part with more and more jobs being sedentary and desk based in their nature and women far less likely than men to take part in organised sports but increasingly likely to drink more alcohol than is recommended on a regular basis.

Should women with coronary heart disease risk pregnancy at all?
This is a rather vexing question. It is only in recent times that the number of women with coronary heart disease has reached any significant level. The greatest risk posed by embarking upon a pregnancy with coronary heart disease is the risk of heart attack particularly during labour. Other diseases and conditions associated with coronary heart disease such as hypertension (high blood pressure) and diabetes serve only to increase the risk to mother and child. It is also possible that some medications you are taking to control your heart condition may not be suitable for use during pregnancy. Stopping or changing them may further increase the risk of heart attack.

Pregnancy itself may worsen symptoms of coronary heart disease. This exacerbated form of the disease is known as acute coronary syndrome and is three to four times more common in pregnant women compared to non-pregnant women of the same age. It is estimated that acute coronary syndrome affects one in every ten thousand pregnancies in the USA. The rates are assumed to be lower in the UK but large scale studies have yet to be conducted. This is likely the result of a host of factors common in pregnancy: mobility may become restricted in later stages, drug absorption may be affected particularly in mothers who suffer morning sickness and blood pressure may increase to dangerous levels.

Choosing to conceive if you have coronary heart disease is not a decision that should be taken lightly and certainly not without consultation with your doctor and cardiologist.

Risks of coronary heart disease during pregnancy
As already indicated, the greatest risk is that of heart attack. This could, of course be fatal or leave your baby starved of oxygen (hypoxia) which, in turn, can lead to permanent brain damage. The risk of heart attack is increased during labour and you may be advised to have a caesarian delivery.

Hypertension (high blood pressure) is a predisposing factor for coronary heart disease and a condition that develops in the last twenty weeks of pregnancy, pre-eclampsia can increase the risk of heart attack many-fold. Indeed, pre-eclampsia alone has the potential to be fatal. Pre-eclampsia superimposed on (chronic) hypertension has been seen to develop in as many as one quarter of women with pre-existing hypertension. Early detection is important to ensure a good outcome in this scenario so frequent and regular blood pressure monitoring is essential for pregnant women with hypertension and coronary heart disease.

Reducing the risks
Should you choose, on balance of risk, to try to conceive then you should prepare for pregnancy by taking folic acid supplements for at least three months before conception and throughout pregnancy, try to keep weight within a healthy range, eat a healthy and balanced diet, take exercise and avoid alcohol, caffeine and tobacco products - these are sensible steps for any woman wishing to conceive and have a healthy pregnancy but are especially important for women with coronary heart disease.

Consult with your cardiologist to establish which drugs will be safest for you during pregnancy. For those who are prescribed it Aspirin is, generally safe to use. It may be that your doctor will not change your medication so it is important to discuss the risk and rates of potential side effects for your baby if these drugs are generally not recommended during pregnancy. Discuss whether or not you should attempt to breast feed your baby. Do not stop taking medication you have been prescribed without consulting your cardiologist.

Birth choices for women with coronary heart disease are limited in the extreme and you should be under the care of a consultant obstetrician led (as opposed to midwife led) team. You should plan to give birth in a maternity unit within a hospital. Under no circumstances should you attempt a home birth or even birth at a birthing centre though, for most women with coronary heart disease vaginal delivery is possible. Wear medical alert jewellery and carry a medical alert card in case of an emergency and ensure those who you spend most time with are educated in how to properly conduct CPR.

A note to all women
Certain heart conditions, including but not limited to coronary heart disease, have symptoms not unlike those many women experience in pregnancy such as nausea, chest pain, indigestion like symptoms and breathlessness. For this reason, cardiac conditions in pregnant women often go undetected. If you are struck by a sudden breathlessness, pain in the centre of the chest especially pain radiating to the arm or jaw seek medical attention immediately.