Maternity Insurance|Maternity Care|Postpartum Care

My mothers-to-be are astonishingly different from one another as they arrive ready to give birth in all possible shapes, sizes, and stages of delivery. Yet, in another way, they are mostly of one mind... determined to do anything medically necessary for the well-being of their baby.

Fortunately, the majority of births are pleasantly routine and everyone goes home a bit sore, but happy, healthy and determined to be a successful family. Once in a while, a delivery that may seem quite routine at first, can suddenly become complicated for any number of reasons. If the problems become overwhelming, the OB/GYN will strongly suggest that the parents give their consent for delivery via cesarean section, commonly known as a C-section.

This decision should not be suggested lightly because, after all, it's surgery! Only after the OB/GYN deems that the risks of a C-section are lower than the risks of a vaginal delivery should the C-Section option be chosen. Safety for the mother and baby always come first and only the physician is trained to know when this procedure is medically necessary. In rare cases, parents may be told ahead of labor that a C-section will be medically necessary, (i.e. if the child did not turn around in the womb). This is not considered elective because the need for surgery is decided in advance.

After delivering more than 3,000 babies, I thought I had heard it all

A case history

B.P. is a 40 year old professor of obstetrics from a major university hospital who is admitted to labor and delivery at term contracting every 5 minutes for the last hour. This is her first child-having been conceived through in-vitro fertilization. She is a healthy woman with no medical problems, has had a completely uneventful pregnancy with all routine prenatal testing showing normal results, appropriate fetal growth, adequate amniotic fluid, baby in a perfect head down position, and a recent ultrasound estimating the baby to weigh approximately 7 pounds. On admission to the delivery floor she requests an elective cesarean section.

It has been established that an individual has the right to refuse medical procedures, but does it also follow that a person has the right to demand a medically unnecessary treatment?

C-section Trends

Obstetrical care throughout the world is undergoing dramatic changes. Cesarean deliveries are increasing to the extent that in some countries, such as China and parts of Latin America it is well over 50%. There have always been certain traditional reasons for performing a cesarean section but recently "maternal request" has been added as a new indication. The rate of elective cesareans in the United States is now estimated to be between 4 % and 18%.

Reasons for elective C-sections

Fear of labor-(tocophobia)

Some women have a fear of pain, fear of an emergency and/or having to undergo a traumatic experience involving higher morbidity and mortality associated with complications.

Maternal convenience

Scheduling takes into account childcare, work concerns, support systems, choice of surgeon.

Prevention of maternal floor damage

Concerns about urinary or bowel injury or future sexual functioning resulting from traumatic vaginal delivery.

"Designer Baby"

Expensive reproductive technology needed for conception and the need to deliver in the least traumatic way to avoid any risk to the child.

Neonatal benefits

Elective cesarean is associated with lower newborn infection rates, lower risk of intracranial hemorrhage, neonatal asphyxia, and encephalopathy.

Prevention of any birth asphyxia or potential birth trauma

Avoidance of injury such as bone fracture, nerve injury.

Prevention of stillbirth

The need for preventing a stillbirth or overdue pregnancy with the inherent associated risks.

Sterilization

Doing a cesarean can allow for a subsequent sterilization procedure in some countries where reproductive rights are not available to women on request.

As obstetricians, we are faced with a difficult situation. Should a mentally competent patient have the right to choose, ethically, how they would like their baby delivered? While patients have the ability to make personal choices in many other areas of medicine, clearly this can not apply to obstetrics. Why? Because the lives of not one, but two humans, are at stake.

Are there viable disadvantages to an elective C-section?

Surgery always poses additional risk factors. Elective cesarean section has a 2.84 fold greater risk of a woman's death than a vaginal birth.

Added risks include:

1. Maternal morbidity
   This includes surgical injury such as damage to other organs, risk of hemorrhage, hysterectomy, infection, fever due to other causes, hematoma, anesthetic complications, and blood clots.


2. Respiratory issues in the newborn
   Transient tachypnea (rapid breathing) of the newborn occurs more frequently after elective cesarean and respiratory distress more likely if the surgery is booked prior to 39 weeks.


3. Potential complications with future pregnancies
   This includes increased risk of uterine rupture if laboring during a subsequent pregnancy if you have a uterine scar from a previous cesarean, increased risk of placenta previa (low lying placenta adhering to the scar), placenta accreta (placenta growing into a previous uterine scar), and placental abruption (separation of the placenta from the uterine wall).


4. Complications from adhesions
   Surgery can lead to abdominal adhesions which might effect future fertility, causing chronic pelvic pain, increase risk to bowel and bladder in future abdominal surgeries,and higher risk of ectopic pregnancies and miscarriages.


5. Injury to the baby
   There is a 1.9% chance that a surgeons knife can accidentally lacerate the fetus when doing a cesarean. However, emergency cesarean sections after labor has a greater incidence of lacerations compared to elective cesareans.

What is the answer?

In today's day and age, is it acceptable practice to allow the patient to determine the medical decision, assuming she is competent and well informed of any additional risks she is placing on herself? (i.e. informed consent) Could a physician be at risk for denying a patient's request for a cesarean if, postpartum, the procedure results in injury to herself, or her child, immediately or several years down the road?

It behooves the obstetrician, or midwife, to weigh all the risks and benefits of providing this option after exploring the reasons for the request. The ethics committee of Gynecology and Obstetrics (FIGO) states "Only the woman can decide if the benefits to her of a procedure are worth the risks and discomfort she may undergo." We must respect the rights and autonomy of a mother. However, "performing cesarean section for non-medical reasons is not ethically justified."

The American College of Obstetrics and Gynecology, however, feels that after exploring the request and proper counseling with informed consent, the physician can comply with the patients request if it is felt that cesarean will promote the overall health of the patient and the fetus more than a vaginal delivery.

This ethical controversy will continue to plague us, especially with health care costs spiraling. Having patients elect to have more expensive procedures, can threaten the solvency of the larger community. Why? Because a C-section requires not only a surgeon and an assistant, but an anesthesiologist, additional nursing, added supplies, equipment, an operating room, possibly blood for transfusion and longer hospitalization stays for both mom and baby.

We must ask ourselves if it makes sense to utilize the valuable time of medical professionals, as well as the financial resources of a community, in order to accommodate a woman's desire to have the more expensive, and luxurious, C-section delivery?

Does respect for the rights of an individual outweigh the allocation of resources within a community? Right now, I personally don't have the answer. I just want all my babies and mothers to leave happy and healthy.

Earlier this year, researchers in Scotland examined the disjunction between the idealism of exclusive breastfeeding and the reality that many families experience. The World Health Organization recommends exclusive breastfeeding for the first 6 months of life for all babies. Other organizations, such as the American Academy of Pediatrics, recommend that all babies consume breast milk for the first 12 months of life for maximum developmental and immune benefits. According to the Scottish study, most women find these goals unrealistic, despite the known long-term benefits of breastfeeding for both mom and baby.

Breastfeeding can reduce the incidence of diabetes, asthma, obesity, ear infections, upper respiratory infections, and SIDS. In fact, the World Health Organization has been quoted to call colostrum-the breast milk that a mother makes in the first few days after a baby is born-"baby's first immunization" because of the immunological benefits that it confers to newborns. According to the authors of Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers, "exclusive breastfeeding for six months by 90% of U.S. mothers could prevent 911 infant deaths and save the U.S. healthcare system US$13 billion." Research has also shown that babies who have been breastfed excel in speech and language development and have higher IQ levels. Breastfeeding also provides myriad health benefits for mothers as well-there is a significantly lower incidence of aggressive breast cancer, osteoporosis, cardiovascular disease, ovarian cancer, and diabetes in women who have breastfed.

If a mother and her infant have so much to gain from breastfeeding, why are exclusive breastfeeding rates at 6 months postpartum only at 15% in the U.S., according to the CDC? Despite much promotion of the benefits and joys of breastfeeding, these low rates are likely due to a lack of support within in the infrastructure of the health care system and in our communities at large. In fact, the mothers interviewed in the Scottish study said that the lack of support from healthcare providers, family members and friends contributed to their decision to stop breastfeeding before their baby was 6 months old.

The unfortunate reality is, not all healthcare professionals fully support breastfeeding and what's more-not all healthcare professionals are knowledgeable or skilled in providing breastfeeding support and counseling during nursing challenges. Many women receive some education in breastfeeding prenatally say, during a childbirth education class, but then get very little continued counseling during the postpartum. Furthermore, the women in the study are right when they said that many healthcare providers paint a rosy picture of breastfeeding, choosing only to speak of the beautiful bonding experience that the mother-baby nursing dyad has during breastfeeding or the long term health benefits. Too few of us actually talk about the common challenges and pitfalls that a woman may face while establishing breastfeeding out of fear of discouraging new mothers from getting started. In the end, however, the women who are challenged by getting a good latch, sore nipples, pumping at work, or getting chided in public while nursing often feel blindsided by these challenges or feel guilty about not achieving the "ideal picture" of a breastfeeding mother. These are but a few of the challenges that breastfeeding mothers may face.

To say that many women are not getting the support that they need from their communities to continue exclusive breastfeeding until 6 months postpartum would be an understatement. While some companies support breastfeeding by having on-site lactation consultants, clean places for expressing breast milk, and on-site day care centers, many employers still do not have good systems in place to support a mother who needs to express her milk every few hours to maintain her milk supply for her growing baby. Despite the fact that many states have laws that protect a woman's right to express milk in a clean place other than a bathroom-for up to 3 years after the birth of their baby-some women are asked to pump in the tiny stall of the company bathroom. Others struggle to get the break time that they need to express milk every few hours to prevent engorgement which can lead to a breast infection.

Breastfeeding mothers have been escorted off of airplanes, asked to leave restaurants and courtrooms, and shuffled into dressing rooms of major department stores while breastfeeding their infant. The reasons cited? Some members of the public find breastfeeding lewd, offensive or inappropriate. In Maine, the law states "a mother has the right to breastfeed in any location, whether public or private, as long as she is otherwise authorized to be in that location." Raised public awareness of the rights of nursing mothers is greatly needed to encourage mothers to continue breastfeeding and maximize the health benefits for her and her baby.

So where do we go from here? First we need to change the cultural attitudes around breastfeeding in the U.S. Breastfeeding our babies is the way that nature intended for us to nourish and nurture our offspring. There are often a number of key moments in the first 6 months of a baby's life where mothers are faced with the decision to persevere through the nursing challenges or to switch to formula or exclusively feeding solid foods. However, more support from knowledgeable, skilled healthcare providers who utilize a non-judgmental approach to counseling that extends beyond the first 6 weeks postpartum is paramount during these critical times. Let's be open and honest about the realities of breastfeeding-which can be hard and frustrating at times and beautifully transcendent at other time. By supporting one another, we can chip away at the goal of exclusively breastfeeding for the first 6 months of life day by day, one feeding at a time.

People mostly rely on their brain when conducting day to day activities and in the process it becomes drained and exhausted. Due to the ever growing demands at the workplace people tend to overwork and also have very little time off for relaxation. This often leads to breakdowns, anxiety and depression. It decreases a person's efficiency at work and thus makes the situation even worse. On the other hand there are ways that one can easily rid him or herself of depression and be on his way to being productive.

Anxiety depression is a state where a person behaves in an irregular manner and is not able undertake simple day to day activities properly. This is triggered by an ongoing exposure to stress. Stress at the workplace is the main reason behind anxiety depression. People need to be determined to take on the pressure and not succumb to it. It is tough to maintain your composure but you must try to do the same and eventually you will succeed.

When you really want to get over the anxiety depression problem you need to really motivate yourself and think towards getting rid of it. Analyze your situation with the help of a friend and consult a qualified psychiatrist who can accurately diagnose the problem for you. The various types of depression are:

Manic or Bipolar depression - An abrupt change in one's metal state for instance, from joyous and relaxed to a grim state of mind can signal depression.

Postpartum depression - An expectant mother may feel anxious about her new baby and feel stressed as a result of the extra responsibility that she has to take on.

Dysthimia - It is a condition of moderate depression; not so serious but should be treated as soon as possible.

Cyclothemia - This is one type of illness which a person with a hectic lifestyle suffers from. Although rare, there are sudden changes in one's mood.

Seasonal Affective Disorder - The name suggests that it is seasonal (in winters, summers, spring). More people have been found to feel that they are stuck in a rut in winters. It is also characterized by sudden changes in mood.

The above types are the conventional types but the type which people most suffer from is anxiety depression. Anxiety by itself is completely normal human behavior. You may get anxious about your exam next morning or your dream date. Being anxious actually helps you to cope with the increased stress levels. On the other hand anxiety depression cannot be ruled out as just "nerves". It is a serious illness and can be due to hereditary reasons.

Various types of anxiety depressions are characterized by unique symptoms. GAD or Generalized anxiety disorder is a severe form of anxiety depression in which a person becomes unreasonably paranoid even when there is no reason to be so. The anxiety levels remain on a high, person suffers from lack of sleep and feels tired easily. They have a strong feeling of depression which is curable but takes time and will from the patient. Average anxiety depression is not that complicated as GAD and can be cured comparatively easily.

In both cases a reputed therapist should be consulted and care should be taken to complete the course of medicines prescribed with treatment.

During pregnancy a woman's thyroid hormones take on newfound importance. For the first 10-12 weeks of gestation, the developing baby depends solely on its mother's production of thyroid hormone to meet its developmental needs.

After that the baby will begin to produce thyroid hormone on its own, but still depends on the mother's adequate dietary intake of iodine in order to make thyroid hormones.

If a woman is suffering from hypothyroidism, of which Hashimoto's disease is the most common cause, even at a subclinical level, her baby could be seriously affected. Further, because many of the symptoms of hypothyroidism -- fatigue, weight gain, constipation -- mimic those of pregnancy, the condition can be incredibly easy to miss.

Health Risks to Baby from Mom's Hypothyroidism

If your body is not producing enough thyroid hormone during pregnancy both your health and your newborn's could be at risk.

When left untreated, hypothyroidism can lead to preeclampsia -- a potentially serious condition involving high blood pressure -- placental abnormalities, low birth weight infants, stillbirth, miscarriage, anemia, and postpartum hemorrhage (bleeding).

In the baby, thyroid hormone is essential for normal brain and nervous system development, so low-functioning thyroid in the mother may lead to cognitive and developmental disabilities in the newborn. Even mild subclinical hypothyroidism during pregnancy may lead to subtle brain abnormalities in the child.

For instance, research published in the New England Journal of Medicine revealed that children born to women who had untreated hypothyroidism during pregnancy were nearly four times as likely to have lower IQ scores, and also were significantly more likely to have problems with attention, language and reading.[1]

Because the effects may be most severe when hypothyroidism is left untreated during the first trimester... a time when many women may not even realize they are pregnant yet... it's often important to get your thyroid checked prior to pregnancy.

Thyroid Screening for Pregnant Women Remains Controversial

A debate is raging over whether or not thyroid screening should be a routine part of pregnancy care. As it stands, pregnant women are NOT routinely screened, as the potential health benefits have been deemed inconsequential in relation to the costs of testing millions of pregnant women each year.

The exception is those at high risk of thyroid disease. Women with the following thyroid risk factors WILL be routinely tested for thyroid problems during pregnancy:

• Family or personal history of thyroid disease


• Goiter


• Symptoms of thyroid disease, including anemia or high cholesterol


• Type 1 diabetes or other autoimmune disorders


• Have received radiation to the head or neck as part of a medical treatment


• History of miscarriage or premature delivery


• Infertility

The concern is, however, that since many women may be suffering from hypothyroidism on a subclinical level, they may miss out on being screened and never know they have the condition.

In fact, a new study in the journal Clinical Thyroidology revealed that over half (55 percent) of pregnant women with Hashimoto's disease would be missed if only high-risk criteria like those listed above were examined.[2]

Another concerning issue has to do with thyroid antibodies. It's recommended that pregnant women be tested for thyroid problems if they test positive for thyroid antibodies, as this can be a sign of impending thyroid problems.

Research suggests that 3 percent to 20 percent of women have circulating thyroid antibodies during or shortly after pregnancy, and this increases the risk of becoming hypothyroid during pregnancy. However, thyroid antibodies are not normally a part of routine testing for pregnant women.

What Should You do if You're Pregnant or Thinking of Becoming Pregnant?

First, be aware of the signs and symptoms that you may have low-functioning thyroid:

• Fatigue


• Unexplained weight gain


• Cold intolerance


• Dry skin


• Joint and muscle pain and stiffness


• Muscle weakness


• Constipation


• Thinning hair


• Heavy or prolonged menstrual periods and impaired fertility


• Depression


• Slowed heart rate

If you notice any of these symptoms, insist that your health care practitioner check your thyroid function, ideally before you become pregnant.

However, it's very possible to have subclinical hypothyroidism and not experience (or notice) any symptoms at all. In fact, it's estimated that about 13 million Americans have hypothyroidism but have never been diagnosed. You could be in this group even if you've had your thyroid levels tested, as conventional lab tests to diagnose the disease can be misleading, labeling thyroid hormones as within the normal range when a problem still exists.

So if you suspect that you may have a thyroid problem, find a knowledgeable health care practitioner in your area who will work with you to determine if a problem is present. This is of crucial importance if you are pregnant or planning to become pregnant, as your baby's healthy development during the first trimester of pregnancy depends on your healthy thyroid function.

Keep in mind, too, that pregnancy places an increased demand on your thyroid gland. Because of this, if you are currently being treated for hypothyroidism you may need to adjust your treatment plan to account for this extra demand. Again, it is imperative that you work with a practitioner who understands the complexities of thyroid function, including during pregnancy, for your health and the health of your baby.

References

1. New England Journal of Medicine 1999 Aug 19;341(8):549-55.

2. Clinical Thyroidology Volume 22 Issue 11 November 2010 "Over half (55%) of the pregnant women with clear abnormalities suggestive of autoimmune thyroiditis with or without thyroid insufficiency would be missed if only the high-risk criteria are examined."

Majority of patients in the age group of 12 to 25 years attending the out patient clinic of the Department of Endocrine Surgery, Government General Hospital,Chennai ( a tertiary care Hospital in South India) are suffering from Thyroiditis. Most of these patients seek medical aid when they develop a diffuse goiter. Some of them presented with palpitation and tremors without thyromegaly but the majority of patients presented with diffuse goiter in Hypothyroid state.

Investigations done to confirm the diagnosis: (1) FT3,FT4,TSH (2)Thyroid antibodies: Antimicrosomal antibody (TPO) and Anti thyroglobulin antibody(ATG) and (3) Fine Needle Aspiration Cytology

Thyroiditis is confirmed by positive Antimicrosomal Antibody titre (AMA). All Thyroiditis patients with diffuse goitre had elevated serum TSH with decreased FT3 & FT4 confirming Hypothyroid status.Hence,they were all treated with thryoxine 50 to 100mcg OD. Patients who presented with palpitation and tremors had elevated FT3 & FT4 associated with decreased TSH confirming that they were in the toxic phase of thyroiditis.Hence, those patients were treated with beta blocker propranolol.

AntiThyroglobulin antibody titre was used to differentiate Toxic phase of thyroiditis from Graves' disease. Toxic phase of thyroiditis is due to increased liberation of stored hormone in to the system, due to follicular damage and not due to increased production of thyroid hormone.Patients in toxic phase of thyroiditis developed severe hypothyroidism when treated with antithyroid drug carbimazole for a few weeks.

FNAC is a very useful investigation to confirm Thyroiditis. Cytology revealed Lymphocytic infiltration in all patients with thyroidtis.

AMA(TPO) titre became negative in most of our patients over a period of 12 to 18 months. Hence the treatment was given for the same period. Negative AMA(TPO) titre is an indication to withdraw the medical treatment.

There are countless methods to help with weight loss. Many are dull and ineffective. Too often, low-salt dishes lack flavor. However, a number of natural herbs and spices can actually help you lose belly fat, while making your low-calorie dish taste absolutely delicious.

Perhaps the most well-known spice is cinnamon. All your body needs is 1 tablespoon of cinnamon a day to reduce blood sugar, and help prevent diabetes. It can also promote healthy circulation of your blood for increased energy levels. Meanwhile, the spice causes carbs to be digested more efficiently for quicker weight loss. At the same time, cinnamon can significantly lower your bad LDL cholesterol. However, don't go crazy throwing the spice over everything that you eat. Cinnamon contains coumarin, a chemical that can cause your lips and mouth to itch. On a much more severe level, cinnamon can lead to damage to your liver if too much is consumed. Regardless, it is most commonly used on pancakes, French toast and a wide variety of desserts.

Spicy cayenne peppers stimulate your metabolism, as well as your nervous system to make heat. This heat burns up calories for help with weight loss. The spice also increases energy levels and works as an appetite suppressant, causing you to eat less sugar and unhealthy carbs. At one fell swoop, it helps your digestive system, causing gas and bloating to be eliminated. Even your blood pressure can be lowered from cayenne peppers. The spice is used to add a little flavor to bland pieces of chicken and fish, such as salmon, along with bitter vegetables, like eggplant and asparagus. If you simply do not care for spicy foods, you can get a hold of cayenne peppers in pill form.

Commonly used with Asian dishes, ginger can be used as an effective diuretic. Your metabolism will be sped up, quickly burning calories from your frame. The spice also speeds up your digestive system, along with fighting off bad LDL cholesterol in your body. Both dieters and weight lifters rely on the seasoning to help their muscles make use of oxygen. It is even used to reduce vertigo and upset stomachs. In fact, many doctors recommend the spice for pregnant women to decrease morning sickness. Ginger is commonly used on chicken and tofu, as well as added to tea. Not unlike cayenne peppers, ginger can be consumed in the form of capsules to help with weight loss.

Found in just about any kitchen cabinet, black pepper is wonderful for your overall digestion. It actually assists different nutrients in getting absorbed all over your body. Meanwhile, your metabolism is sped up from the pungent tasting spice. Mustard seed has the same positive effect on your metabolism. In fact, medical studies have found that mustard seed can boost your metabolism by a whopping 25% after eating, burning off many more calories from an overweight body. Along with the other beneficial spices, mustard seed is ideal for flavor, as well as help with weight loss.

If you are looking for money for single moms then there are plenty of grants and other federal and state sponsored programs available. These programs are usually designed with certain needs in mind such as food, housing, medical care, college, and so on. The following is a brief overview of a few of the more commonly used programs that are an excellent place to start on your search.

While school lunches are not typically expensive, every little bit of money for single mothers you can get your hands on is a help. This is why you should apply for the National School Lunch Program. This will provide your child with nutritious lunches, afternoon snacks, and fresh fruits and vegetables. Now there is even a School Breakfast Program and a Special Milk Program that will help you keep your child fed while they are at school.

If you are looking for other ways to provide food for your children you may want to look into the many government and private sponsored programs available. There are many institutions out there that are willing to give money for single moms as long as they will use it to purchase food. The Food Stamp Program is perhaps the best well known. It was developed in order to provide low income families with the food they need in order to stay healthy. Benefits are now provided on electronic debit cards which are easy to use. To apply you simply fill out your state's application form.

Another program which provides money for single mothers which you may be interested in is WIC, a USDA sponsored program for Women, Infants, and Children. WIC provides Federal grants to individual states in order to fund a whole host of programs including foods, health care, nutrition education for pregnant and postpartum women, and young children who may be at nutritional risk. To find out more about these programs and to see which ones you may qualify for, simply visit the official government Web site for WIC, GovBenefits.gov. This site will provide you with information on over 1,000 different programs that WIC has to offer.

One final program that we will look at for money for single moms is the Low Income Home Energy Assistance Program or LIHEAP. This program provides low income families with financial assistance in order to help them pay for their heating and cooling costs. In order to qualify for this one you can't have an income over $20,535 for a single income household. Each state has its own guidelines and qualifications however, so make sure you do a little research before applying. In some cases they will even pay to weatherproof your home, so make sure you don't pass up this excellent opportunity.

What do Women Want?

...everywhere women want to be whole together
make stew, simmer all that is true
in the broth of human goodness, invite

every man, woman and child to toss in
a favored spice, a wish, a way to rebuild
our fractured world and with tomorrow
in our wombs, we will carry bowls of peace
from hearth to each table, however remote...
- 穢Perie Longo, from What do Women Want?

Women want peace, respect, self-esteem, and healthy ways to express anger. Women want to love, be loved, be heard, dance, wear red dresses, and feel safe in the world and with our families. What else do we want?

As women we may:

care a lot about what other people think
have trouble saying "no"
worry about being seen as "mean" or a "bitch" as opposed to being "nice"
try to take care of things at home and at work -try to do it all
like to connect with others
gather strength from our connection to others
find self esteem in small clothing sizes

What's good about being a woman

I'm going to talk about the challenges women face in today's world, but I want to start out by stressing how much is good about being female. The beauty of the body and mind connection and the inclination in humans to reach towards health and healing are both very apparent in women. Women's bodies are miracles of motherhood, creation, and healing. Women's minds and emotions, at their best, are paragons of empathy and compassion. As Perie Longo says in the excerpt of her poem above, women are child-bearers, healers, and peacemakers.

Our challenge is to cope with the difficulties we are born with and acquire along the way, and to find the means to strengthen mind, body, and spirit. This can be done with the support of others, through learning and developing, and through looking for ways to create fulfilling and successful lives.

What do you like about being a woman?

Do you like the permission to be emotional, peaceful, connected to the feminine, under the influence of estrogen, not under the tyranny of testosterone? How about the freedom to enjoy flowers, express yourself through clothes and jewelry, be soft, and love babies and small animals? Do you love the feminine body with hips and breasts made for having children? What about girlfriends, intimate talks, and cooking?

What do you not like about being a woman?

Do you dislike being disregarded, disempowered, disrespected, and invisible? Do you not like the idea that a woman is a "bitch" if she is just angry or grouchy? How about being discriminated against for age or marital status, or for how many children you either have or don't have? Do you dislike worrying about what other people think of you? And what about being expected to take care of household work? And how about PMS?

Women and psychotherapy

Going into psychotherapy is a way for women to understand themselves and find more empowerment, hope, and happiness. When you start therapy you will begin to tell your story to someone who has no preconceived ideas about you and who is there to support and understand you. The therapeutic process happens as you begin to feel more comfortable and safe, consider helpful changes, and find relief from shame or fear. As you talk about your thoughts, feelings, and needs, you may discover ideas or insights that can help you find new directions. As a woman in therapy with a female therapist, you can find support, connection with another woman in a helpful and self-esteem-building manner, and the experience of empathy and respect. You can understand how you may be judging yourself, and how normal many of your reactions may be.

Challenges women face in today's world

One look at the television show "Mad Men" will tell you that women's roles have come a long way in the last 50 years. There are far more opportunities and freedoms in the U.S. today. What follows are my thoughts on what the remaining challenges are for women.

How our society thinks about women and what our society expects from us

Women are supposed to be pretty, and thin, and wear make-up. If a woman has an important career, she's supposed to work out and dress well, not just to feel good, but to look the right way. Women are expected to be great mothers, lose baby weight right away, work happily outside the home or happily stay home with the baby. Women are supposed to be in couples;. Single women are encouraged to find someone and are pitied if they are alone. Older women consider surgically fixing or botoxing their faces so they won't be invisible. Women of all ages consider augmenting their breasts. Models' images are air-brushed and idealized in magazines. TV and movie stars are, for the most part, expected to be very thin and buff. This brutal Hollywood environment can be what the average woman uses to judge herself by.

Women are encouraged at times to think of life as a romantic fantasy. It's no wonder so many women feel depressed and anxious given the difference between that fantasy and reality.

In the workplace, women may be getting more promotions, but they may also feel sexually objectified when in positions of power. There is still a pay differential between men and women (women earn 23% of what men earn in the same jobs), and men still hold more positions of power than women do.

The way our minds and bodies work

If you're female, then you know the power of hormones! Men have hormones, too, but PMS, menopause, pregnancy, childbirth, postpartum depression, infertility-that's the female body at work or misfiring. And women tend to get more fibromyalgia, migraines, osteoporosis, and breast cancer than men.

Even women's brains are different from men's. Although as humans, we are more similar than different, having a women's brain leads us to communicate more effectively, notice non-verbal cues such as tone, emotion, and empathy, have more creative problem-solving awareness, tend and befriend rather than fight or flight, and have enhanced language skills.

Women and girls tend to feel shame and self-doubt, especially if they express anger, have addictions or are simply being true to themselves. Women and girls also have to contend with higher rates of sexual assault. It's staggering to think that 1 in 5 women in the US today has been sexually assaulted, and some say it is more like 1 in 3. Childhood sexual abuse is an extremely damaging event in a girl's life with many repercussions over the victim's life cycle.

Sexually, women may forgo their own pleasure in relationships with men. In lesbian relationships, women may find it hard to initiate sex because women are not socialized to be sexually aggressive.

How we grow and develop through life

As girls, we hope that we will be encouraged to feel good about our accomplishments and achievements, instead of just our looks. Although there is more emphasis nowadays on helping girls feel confident in science and math, there is still a strong gender stereotype that says boys will do better in these areas. So much more emphasis is placed on girl's and women's bodies!! I have heard repeatedly in my (therapy office about women who were told they had a weight problem growing up, only to look back in astonishment when they see pictures of themselves as children with totally normal or average-sized bodies.

Sometimes women have difficulty with the transition from one phase of life to another. This problem could be produced by an expectation to be superwoman, -work, raise kids, and conduct fulfilling relationships,-or it could be caused by basic needs left unfulfilled in childhood. This insecurity can cause some women to stay in self-destructive, abusive relationships or it can produce a tendency to "lose the self" in relationships. For women who have been emotionally, sexually, or physically abused or neglected, there can be a pattern of compromise or self-doubt in relationships that may feel "natural", rather than self-detrimental. Abused women do not tend to act out as perpetrators in adult life, although sometimes this can happen when a woman who has survived child abuse is abusive to her children. Abused women are more likely to engage in self-destructive behaviors, such as drinking and drug abuse/addiction, or choose unhealthy or abusive relationships.

As women age, changes in their looks and hormones can cause depression and anxiety. Some women worry that their lives and chances for happiness are over.

If these challenges ring true to you, please do not give up hope! Even if you are very financially challenged, and experience discrimination because of color, religion, sexual orientation, body size, or drug and alcohol addiction, there is help and hope available. Even in times of economic distress there are still services available in the community for women in need. In my years of working as a psychotherapist, I have seen many, many women blossom. If you feel isolated and disconnected, there is always a way to reach out.

Psychotherapy won't take away the difficulties women face, nor can it change what happened to you while growing up. What therapy can do is offer you a relationship with someone who cares and has your best interests at heart. It can give you a way to understand yourself and learn new coping skills. You can feel better about yourself in close relationships and in the world.

Experiencing hair loss for an average of 50-100 hairs a day is quite common for a normal person. The majority of these are prone to regrow due to the healthy and intact hair follicles. Seeing this as a viewpoint, a healthy adult scalp consisting of 150,000 follicles of hair does not need to undergo treatment for hair thinning. The amount of hair receding is greatly dependent on the person's hair volume, age and growth cycle.

It would take approximately 2-3 years for the normal cycle of regrowth. During this stage, a one centimeter growth of hair is experienced each month. Ninety percent of hair is regarded as growing and the remaining ten percent is in the resting stage. Resting ones fall out after 3-4 months and new ones grow to replace it.

There are certain instances that the normal process of baldness tends to increase, thus, showing more fallen hair than ever. The condition is known as male pattern baldness or Androgenetic Alopecia, wherein it is the usual cause of balding in men.

This trait is most probably genetic and may develop to extensive baldness if the condition started at an early age. The occurrence of male pattern baldness is usually distinguished by baldness on the crown of the head and a receding hair line.

The equivalent of the balding condition to women is the female pattern baldness, in which hair thinning takes place over the whole scalp. It might begin during the 30's or younger and may be visible following the menopausal period.

The following are the several factors that support the male pattern baldness condition:

• Hormonal changes- it is commonly the main cause of hair loss in aging men. Once the 5-alpha reductase enzyme (DHT) attacks the hair follicles on the scalp, hair miniaturization happens and causes it to thin, resulting to hair balding.

Changes in hormones usually occur to women after giving birth; this is known as postpartum hair loss. Also, birth control pills do account in triggering this condition.

• Illness or Disease - Scalp ringworms, Alopecia Areata, Thyroid diseases and Iron deficiency Anemia are just some of the disorders that contribute to hair loss. Alongside with these disorders, stress may also be included in this list.

• Medications and Treatments - When the process of dividing the hair cells is stopped caused by chemotherapies and radiation, hair shedding takes place. Hair treatments may also encourage hair loss due to chemical and hair styling, which weaken hair and causes it to break.

Always remember that a stress-free lifestyle, vitamin-rich diet and a daily exercise is effective in maintaining normal and healthy hair.

The philosophy that the Federal government currently upholds for teenage mothers is to promote values of abstinence, education, and paternity identification. Many services for single mothers on the Federal level have been curtailed or delegated to local agencies however; private organizations have also stepped in to fill the gap.

Childcare

Although Aid to Families with Dependent Children (AFDC) is still available, the requirement that a teenage mother complete high school or live at home in a supervised setting means that childcare and housing must be available for the teenage mother. Either she must work to pay for childcare, or she must find programs that help her to get assistance in this area. If her family is not supporting her then housing and childcare both need to be met and become her first priority.

Housing

The Department of Housing and Urban Development (HUD) has programs to establish Second Chance housing for teenage mothers. These are usually delegated to local housing authorities such as apartment complexes or designated communities. Included in the services for young mothers, among the many other services, HUD offers:

• Adult supervision to ensure single mothers focus on commitments


• Parenting classes to strengthen their child rearing skills


• Access to childcare and health services to ease financial burdens


• Available transportation to support employment


• Mentoring to help them in making wise decisions


• Education and job training to promote advancement in the workforce

The need for a myriad of services for young single mothers as they face the challenge of parenthood while finishing their educations is immense. These steps point them in the right direction but still require maturity on their part.

Mentoring

Other local agencies may offer mentoring or foster grandparents to help young mothers learn valuable parenting skills or to provide daycare while the mother is in school. Teenage mothers have often not matured themselves and they have to learn how to become responsible for another human being. The mentoring program services for young single mothers provide emotional support while passing on skills in infant care and decreasing the chance of child abuse as the child matures.

The Public School System

Some schools, recognizing the need of services for young single moms, have on-site childcare programs. Some even allow the mother to bring the child to class with them, but these are few and far between. In addition, a teenage mother may feel the stigma of being an unwed mother and refuse to continue her education. However, there are local services that do try to provide a support system and services for young single mothers to help them overcome their inhibitions and adjust to their new roles.

Other local agencies that can provide services beyond shelter and childcare are local hospital and clinics. They often have special prenatal and postpartum programs for young single mothers. The local branch of the Health and Human Services office also can pinpoint more resources. For example, agencies such as Women, Infant, & Children (WIC) can provide nutritional support for infants and their mothers.

The Message

The key to moving forward is to take personal responsibility for your own life. Anything you can dream, develop a realistic plan for and stay the course until you see results can be the basis for change in life. You will find that opportunities will begin to seek you out as you work towards your goal. But first there's maturity, second responsibility to yourself, your child and the people who extend a hand to help you. And most important remember that no one owes you anything. But when you exhibit the characteristics mentioned above you will become the person you choose to be.

When you have a new child, you will often find that the commitment of having one is going to be very time consuming at first. For many parents, this can add an additional level of stress that needs to be dealt with and for that, a confinement nanny can be helpful to many parents.

What you are going to find is that this confinement nanny is someone who is devoted to helping you when you are recuperating from childbirth and adjusting to the new life you are going to have with your child. This individual is devoted to making the most of life for both the new child and the mother as well. They will do this through providing assistance to the mother and teaching her the basics of childbirth as well. This will of course be an essential element to take into consideration in this process.

Because this is going to be a person you may not know, it will be important to look for specific qualities in the confinement nanny that you choose. While some people feel you can simply go online and pick up someone from a help wanted ad, there is going to be a better approach to it.

A good idea will be to sit down with an agency before your child is born and discuss with them some of the possibilities that are available to you. What you are going to find is that they will have a number of different choices available and the background of the women in the agency will already have been verified and that should bring you some peace of mind.

Another option you do have is doing this on your own as well. However, unlike going through an agency, you are going to need to review the background of this individual and determine if their knowledge and understanding of this process is going to work for you. What some people find is that this proves to be a very complex and time consuming experience, especially when exceptional nannies are found through many of the agencies around.

If you are new to the process, take a few moments to contact a couple of the local confinement nanny agencies and start the process of finding a nanny that is going to provide you with a level of comfort in your own home. That may mean you take a little time to go through each of the different options you have, but there is no doubt that with a little effort, you are going to be able to select and work with a professional that is going to help you take care of your new bundle of joy and you get ready to start your life as a new parent. There are a number of great options, so choose the best one around.

Many first time parents do not realize that their new baby will have to undergo a test for Phenylketonuria (PKU) shortly after birth and again at two weeks of age. Phenylketonuria (PKU) is a rare condition in which an infant is born without the ability to properly break down an amino acid called phenylalanine. Testing involves sticking your newborn's heel and milking out enough blood to fill the circles on the test form. The first test will be performed in the newborn nursery before you leave the hospital.

You will need to take your baby to the lab, usually at the hospital where they were born, for the second mandatory testing. The heel stick is painful and will most likely make your newborn cry. This can be very hard on a new mom and may cause her to cry as well. Happily there are several things you can do to make this necessary procedure less stressful for both mom and baby. Prior to the PKU test be sure to give baby a good feeding before leaving home. Be sure to burp baby well to prevent a tummy ache and put on a clean, dry diaper. It can greatly reduce the stress of a new mother to take a trusted friend, family member or postpartum doula with you for the procedure. Allow this person to hold the baby during the procedure. Many new mother's will become very stressed if they try to hold their baby during the heel stick.

Infants are quick to pick up on mom's stress and this can make them cry even more. Have your support person hold the baby on their shoulder as though they were going to burp the baby. Cover with a warm blanket so that they do not feel exposed. Hold their body close and allow baby to suck a pacifier or your finger throughout the procedure. Sucking is a very important self-soothing method for newborns. If the baby is crying, loudly shush in their ear. Your shushing should be continuous and as loud as the baby is crying. This loud shushing provides a white noise similar to what was heard inside the mother's womb. This white noise will help to calm your babies cries.

The majority of babies will quickly stop crying once the procedure is finished. If your baby has a hard time calming down after the procedure find a quiet place to nurse or give a bottle. Rest assured your sweet baby will forget the pain of the heel stick much more quickly than mom and dad. Congratulations you have just successfully navigated a stressful, new parent hurdle.

Enlargement of the buttocks or buttock enhancement is a plastic surgery procedure that has become more commonly requested and performed in the past several years than ever before. Ten years ago, this was a procedure that was unheard of and rarely done. Due to cultural influences and a changing population mix, the shape and size of the buttocks has become an aesthetic issue of importance.

The buttocks is a three-dimensional structure of which its size and shape are both important. For some patients, their buttocks is too flat and lacks any definition, for other patients it is an issue of size more than shape. As a result, when it comes to buttock recontouring, one has to consider what procedures can increase size as well as shape. It often takes a combination of procedures to create the best buttock result.

When it comes to increasing buttock size, it is a choice between natural fat injections or the use of synthetic implant. Both work and are capable of adding volume to the buttocks, but they are different in the results achieved and their associated potential risks and complications.

Buttock implants remain the gold standard for buttock enlargement. They have a long-standing history of success and their primary advantage is that the volume they add to the buttocks is both stable and permanent. The implants will not change in size over time as the material of which it is made (silicone rubber) does not degrade in the body. While implants do have traditional risks of malpositioning, infection, and seroma (fluid) development, improved surgical techniques with intramuscular placement has gone a long way in decreasing these issues. Nonetheless, these potential risks still exist and a patient must be willing to accept that a small percentage of buttock implants will develop these problems.

Fat injections, using the patients own fat, is a 'newer' buttock implant approach that has only become popular in the past few years. Its recent popularity is linked to the emergence of fat grafting in plastic surgery in general and as an easier alternative than traditional implant placement. Fat injections into the buttocks is less invasive and has a quicker recovery than an implant. It also uses the patient's own fat which, if one is having liposuction anyway uses the discard, or if done by itself offers an aesthetic contouring benefit from the donor site. The primary disadvantage to fat injections is their unpredictability and that only a modest gain in buttock size can be achieved with one surgical treatment. It is far to say that fat injections can not create the same volume size that an implant can......in one surgical session. Multiple fat injections sessions, however, can create the same volume but at the disadvantage of considerable more expense and effort.

Which is better for any buttock enlargement patient....fat injections vs implant? If one is opposed to the thought and risks of an implant, then fat injections are the way to go with the understanding of the limitations in size that can be obtained. Or if one is having liposuction anyway, then fat injections are worth trying since enlargement of the buttocks may not be the sole objective of the surgery. But if considerable buttock size is wanted and one wants the most predictable result, buttock implants are the best choice.....if one can accept their risks.

Reflux in babies occurs when the muscle at the top of the baby's stomach does not work effectively and therefore that muscle does not work in stopping the contents from the stomach going back up and spilling out of baby's mouth.

Sometimes you may notice that your baby isn't their 'self' but you can't quite work out what is wrong with them, most parents find it hard to determine the cause of this and later discover that their baby has been experiencing reflux for some time before they were able to pick up on it. Don't distress over it as reflux can be quite difficult to pin point if you haven't experienced it in an infant before.

The symptoms from reflux to watch out for in an infant include:

o Refusal to feed

o Crying during and after feeding, and especially when lying down (ie. When changing nappy or sleep time)

o Vomiting/posseting

o Crying and/or screaming

o Disrupted sleeping patterns

o Congestion

o Poor weight gain

Some babies with reflux may experience discomfort or pain with it, while other babies with reflux may be quite happy and content but will vomit or posset without any of the associated discomfort or pain. Other babies may not vomit or posset at all, but experience the discomfort from reflux, this is known as 'silent reflux', it is where the food in your baby's stomach only makes it part of the way up the oesophagus.

You can minimise the discomfort or pain associated with reflux by your baby through:

o Elevating the head of your baby's mattress

o Keep your baby upright during a feed

o Keep your baby upright for about 20 minutes after a feed

o Use a thickener to thicken up baby's milk, this can sometimes reduce vomiting or posseting

o Medicines (prescribed by doctor, or over the counter natural medicines)

Once your baby is able to sit upright unassisted, you may find that the symptoms of reflux may reduce. In the meantime try to ease the discomfort as mentioned.

A shampoo that blocks DHT (dihydrotestosterone) must work on the chemical level of the human body to prevent testosterone to convert into dyhidrotestosterone by accepting two hydrogen ions onto the benzene rings of testosterone. This happens in one of the target organs of testosterone, the zona reticularis of the adrenal cortex, via influence of 5-alpha-reductase.

By inhibiting 5-alpha-reductase, conversion of testosterone into dihydrotestosterone is inhibited. This inhibition of dihydrotestosterone will exercise its effects on the blood flow of all the organs that are recipients of DHT. Hair follicles in the layers of the dermis of the scalp generally receive large amounts of DHT.

Research

Hair loss is in most cases genetically determined. If your father was bald and his father before him was bald, you stand a good chance of being bald also in your later years. The difference between your grandfather's and father's time is that technology and medicine were not as far advanced as they are today. Almost daily there are breakthroughs happening even though you may not hear about all of them. These may be smaller successes all adding to the bigger picture.

Hair loss, because of its social and professional implications, has been the focus of many research labs all over the world for decades. With DHT blocking shampoos, you are receiving the benefit of thousands of hours of studying genetics, dermatology, chemistry and cosmetology.

Specialty Shampoos Can Inhibit Dihydrotestosterone

Some shampoos are specially formulated to remove excess DHT from the scalp. The purpose for this is that when DHT is removed, it cannot exert its blood flow reduction on the hair follicles, thus killing them over time. With regular blood flow, hair follicles will continue to grow and generate hair. Shampoos with herbal and botanically active particles in their ingredient list work to inhibit the DHT formation and to absorb excess DHT already in the scalp. Without the DHT, hair has the ability to strengthen and grow in higher numbers than with the minimizing effects of 5-α-reductase. Shampoos that contain Trichogen and Zinc or Zinc PCA have been shown especially helpful and blocking enzyme conversion.

Many Causes for Thinning

Stress and diet can affect the body's response to hair loss. The body's reaction to stress is to produce stress hormones. These hormones can affect hair in a negative way. Research has not discovered all the facts yet in this regard. Most people can empirically conclude from their own experience that there is more lost hair on their brushes or combs when they are under stress. Diet will affect thinning or growth if there are vitamins lacking in your daily diet, especially the vitamins responsible for making healthy red blood cells and circulation.

Good Hygiene For Good Hair

Other reasons for thinning, balding or shedding may be a lack of personal hygiene. When dirt and oil accumulates around pores and hair follicles, the pores and follicles become clogged and get infected. This will result in hair loss. Clogs are prevented by the massaging action of your fingers on your scalp when you shampoo your hair. Gently massaging your scalp while you wash your hair improves blood flow to the follicles. Better circulation brings fresh oxygen to the follicles and takes away the old and used carbon dioxide molecules from cellular respiration.

Our brains are not biased to our wants or don't wants.At one point, it was thought to be impossible to overcome. The depression and anxiety. The anger, the fear...the emotional disorders. While these issues are very different from one another, the scientific system they operate on is the same.

Drugs and medication don't fix the problem. They indirectly make it more tolerable, which ultimately only supports the condition - the depression, the anxiety. Unfortunately, many well intending organizations only support the issue by the very way they try to correct it. You'll understand why in a bit.

Our bodies, our actions, are simply an end result of our beliefs and habits. Scientifically, beliefs are NEURAL NETWORKS on our subconscious mind, and these neural networks are what command our bodies. They control everything: the healing, the operation of every cell in our body, our balance, sleep, etc. This leads me to mention that what we consistently focus on directly or indirectly, become part of our beliefs. You may have noticed how people who are constantly concerned about getting sick, are always sick. People who believe they're experiencing depression and anxiety, will be noticing everything that states the symptoms of depression or anxiety or whatever the case. This, my friend, only affirms your thoughts about the condition.

Let's step a tad deeper now.

In a nutshell, there are two mechanisms in the brain that are making this happen real-time. The one that we'll talk about in this article is called the RETICULAR ACTIVATING SYSTEM(RAS). The RAS is like a search engine in our brain, constantly searching for "data" or things that support our beliefs. Just like you use Google and enter a keyword or phrase, the RAS is on the lookout for the "keywords" of our brains: our beliefs. The data that is found, is then forwarded over to our conscious mind, and ONLY then do we consciously, or knowingly, recognize it.

To illustrate, think of how before you bought your car, you never really noticed how many cars just like yours are on the road. Then after you bought it, or really started looking into it, you began to notice a lot more of them. It's not that your eyes didn't see them before, it just wasn't what your RAS was looking for, so it got spit out before it came to your conscious recognition.

Our brains are not biased to our wants or don't wants. It works with the material we feed it - the things we focus on. So if depression and anxiety are part of our focus, they become our beliefs. Our beliefs then instruct the brain to find that. The RAS begins to notice the articles that talk about depression and anxiety. We'll start to see the depression and anxiety related shows and stories and stats. We will begin to learn from these articles and shows, etc about how difficult it is...but what's really happening scientifically is:

...we're creating reference points in our brains, suggesting that difficulty is associated with depression and anxiety, and that depression and anxiety are associated with us. Not a good time. But the brain just does what we tell it to do. It's like a field. The field doesn't care whether you plant a poisonous or edible seed, or both. It will return whatever you decide to plant. Our brains will return whatever thoughts and feelings we decide to focus on.

To your success,
Dennis Andrew

A typical newborn/infant is awake and in need of care for several hours every night. In order for mothers to properly recuperate, and for families to ease the transition into life with their newest member, some families choose to employ a baby nurse or newborn specialist.

Traditionally, overnight nanny responsibilities have been held by women with the title of baby nurse. By today's modern standards however, this person is a Registered Nurse (RN) or Licensed Practical Nurse (LPN). Further, in some states the term "baby nurse" can only be used legally if the person practicing this profession is an actual RN or LPN. For individuals who have extensive experience in newborn care, but do not hold medical licenses, the term "newborn specialist" can be used.

A baby nurse performs all tasks related to baby's well being including feeding, diapering, and soothing the child through the night. For breastfeeding mothers, the caregiver will bring the child to mother, but will then provide all other care for baby by burping, changing and easing baby back to sleep. Baby nurses are also required to keep the child's room orderly and clean, but do not perform household duties.

During the first nights home with baby, a baby nurse benefits the entire family. Knowing that baby is in capable, nurturing hands just as s/he was in the hospital nursery, mothers get the deep restorative sleep their bodies need to recuperate from the emotional and physical demands of childbirth. For fathers and partners, who in the vast majority of homes can not take significant time off from work, baby nurses allow for proper rest before starting back in the workplace. Older siblings who may not yet understand how the new family member could affect them, also benefit. Parents can be 100% available to comfort the older children when they inevitably wake up during the night as they adjust to life with the new baby.

And for the babies themselves, professional care allows their needs to be met quickly, easily and lovingly.

Whether families opt for service a few nights a week, or a month or more, the most important thing a baby nurse provides is deep, restorative sleep. This is crucial for all parents, whether they work outside the home or are a stay at home parent. A good night's sleep allows families to enjoy and cherish their time, rather than just "get through the day."

Depression is the word that nobody would want to hear. Millions across the world get affected by various forms every year. One of the types is known as acute depression. It is also known as major depressive disorder or clinical depression. It is one of the most severe forms and less common as compared to the all other forms. The exact cause has still not been discovered. Psychological changes, biological changes, stress, loss of loved ones, physical disability, divorce and environmental changes are the common causes.

Following are the most commonly observed symptoms that will help you to distinguish between acute and other types of depression: The common symptoms are:

1. Considerable loss of interest enjoyable activities.

2. Constant sadness, anxiety or blues all the time.

3. Sleeping problems, sufferer usually exhibits Insomnia disorder. Insomnia causes difficulty to get off to sleep, early morning wake ups, less sleep than normal, disrupted sleep. In some cases symptoms of hypomania are also exhibited by the patients. Hypomania causes too much sleep than the normal sleep; sufferer finds it difficult to get out of the bed.

4. Sufferer might exhibit considerable amount of weight gain or weight loss due to poor appetite.

5. Loss of energy or fatigue is quite a common symptom.

6. Persistent feelings of worthlessness, hopelessness and guilt disturb the sufferer all the time.

7. Restlessness or tiredness without any reason.

8. Sufferers find it difficult to concentrate in all sorts of things associated with them, as a result of which they find it extremely difficult to make decisions.

9. Socially inactive behavior.

10. Suicidal thoughts or suicidal attempts are quite common.

11. Physical symptoms such as headache and ache in the stomach areas are also quite common.

12. Interest in the sexual intercourse decreases to quite a large extent.

You may not notice all the symptoms in sufferers as the symptoms vary person to person. If you notice majority of these symptoms in an individual, do ask him or her to seek medical attention. Do not ignore this state; if left untreated you might be victimized with the adverse affects. It is a treatable mental disorder and various treatment methods are available. Kids may find it difficult to cope up with treatment methods. The most effective treatment methods are:

1. Antidepressants as per the prescription of specialists.

2. Psychotherapy methods, especially cognitive behavioral therapy, talk therapy and interpersonal therapies are the best therapies.

3. Electroconvulsive therapy.

4. Combination of psychotherapy and antidepressants can also work in tandem to relieve you.

Do you want to avoid hysterectomy, surgery for urinary incontinence, or prolapse surgery for cystocele or rectocele?

"Susan"* had hysterectomy and "bladder lift" surgery scheduled to find relief from incontinence. She leaked pee so badly she was like a prisoner in her own home, chained to the bathroom. After just two weeks of kegels, she was able to take a two-mile walk with almost no leaks. Three months later, she says kegels have "given back my life and my freedom."

"Ann" had problems moving her bowels because of a rectocele (prolapsed rectum). She'd been doing kegels for years, but she was doing them incorrectly, without much benefit. She was planning surgery to treat the rectocele, but after two weeks of doing kegels right, the doctors couldn't find the rectocele anymore.

Hundreds of thousands of women have pelvic surgery every year to treat incontinence or prolapse (cystocele, rectocele, or uterine prolapse). For many women, surgery helps. For others, surgery doesn't solve the problem, or creates new problems that might be even worse.

Surgery may work well for some women. But before you rush into surgery, consider giving kegels a try.

I'm not talking about a few kegels here and there when you happen to think of it. That approach to kegels won't work. I'm talking about learning how to do kegels correctly -- contracting the right muscles, for the right amount of time, the right number of times a day, using the right position and the right breathing. Sounds like a lot of work? Not really; all it takes is a couple hours to learn and a few minutes a day to actually do it. Kegels do require your commitment, but for those who experience the benefits of kegels, it's a tiny investment for enormous positive gain.

Surgery is potentially dangerous (it can lead to many complications -- ironically, including prolapse). It typically involves painful recovery, and it's always expensive. (And I don't know about you, but for me, the idea of getting the sensitive, private parts of my body cut into and stitched up is not my idea of a good time!)

Kegels are completely safe: as long as you do them right, it's literally impossible to hurt yourself. You can do kegels at home on your own, keeping your independence and personal power intact. Kegels are painless. They can actually be fun and relaxing! There are no drugs, no complications. Doing kegels is free. And the one side effect kegels do have? Better sex. It's no wonder women love kegels!

Have you been living with prolapse or incontinence? Have you been considering a hysterectomy, incontinence surgery, or other prolapse surgery? Talk with your health care team, and consider giving kegels a try -- real kegels, done right. You have nothing to lose, and you could have a whole lot to gain.

*Susan and Ann are real women. Their names have been changed here to protect their privacy.

You will check the qualifications of any confinement nanny invited into your home, but will you check their attitude as well? Too many expectant parents spend adequate amounts of time ensuring that their confinement nanny has the experience and knowledge needed to properly care for an infant, while failing to check the nanny's attitude.

Your confinement nanny will become a member of your family for an extended period of time. If they have a negative attitude or tend not to listen to others, then they will bring a negative vibe into your household. If they have a positive attitude and are open, nurturing and caring, they will bring a positive vibe of happiness and peace into your household.

Unfortunately, most confinement nannies can seem pleasant and loving when they are interviewed for short periods of time. You may sometimes run across an independent nanny who is unpleasant right from the start, but most will put on their best smile when trying to secure a new position. This means unsuspecting parents-to-be will one day be pleasantly surprised when their nanny seems to be rude and inconsiderate.

The good news is most nannies enjoy their profession and are completely devoted to protecting the little ones and making life as easy as possible for the new mother. Their attitude is like sunshine in the home because they are so at peace when they are working.

So, how do you make sure you get one of the pleasant confinement nannies and avoid one of the unpleasant nannies? There are a few things you can do to check the attitude of every potential nanny before inviting them into your home:

1. Work with a reputable confinement nanny agency, rather than hiring independent nannies. If you are unsatisfied with the nanny you are assigned, you can have a new nanny sent to your home. Nannies employed by an agency have more incentive to do a great job and treat everyone in your home with great respect.

2. Meet with your perspective nanny face-to-face before agreeing to hire them. If you are working with an agency, make sure you meet the specific nanny assigned to your home before the baby is born. This ensures you feel comfortable with them and feel they have the right attitude for your household.

3. Speak with others who have worked with your confinement nanny in the past. This is easy to accomplish if you are working with a reputable agency, but it can be a bit more difficult if working with an independent nanny who can pick and choose which references to turn over.

Signs of an Attitude

Even if a perspective confinement nanny has their biggest smile on for an interview, there are some signs of a potential attitude problem that you may notice. One of these signs is the tendency to cut you off or avoid questions. If you feel like you pose questions and they tell you everything about themselves except for what you asked, then they may not be listening as intently as a confinement nanny should.

Similarly, if a nanny cuts you off or seems not to care about your concerns or ideas, then they may not be the caring nanny that you feel comfortable with in your home. A nanny should listen and answer all questions honestly, showing the knowledge they have in this field.