Contents Note: only the chapter headings have links
1.1 Mothers have a difficult life.
1.2 How many mothers die? The maternal mortality rate (MMR).
1.3 Five killer complications.
1.4 Preventing maternal deaths.
1.5 A problem for the whole family.
1.6 The perinatal mortality rate (PMR).
1.7 Words and style.
1.8 Communicating.
1.9 Ecology, demography, etc.
1.10 Customs, culture and the community.
1.11 Physiology and anatomy.
1.12 Making love.
1.13 Conception.
1.14 Contraception.
1.15 Pregnancy.
1.16 Labour.
1.17 Breastfeeding, nutrition.
1.18 Anaesthetics and operations.
1.19 Diseases.
1.20 More useful words.
1. 21 Learning, teaching and practising.
2.1. How much grain?
2.2. Carrying capacity.
2.3 Demographic entrapment.
2.4 Falling fertility - how far and how fast?
2.5 China.
2.6 Malawi
2.7 Rwanda.
2.8 The Iron Age Taboo.
2.9. Traditional societies.
2.10 The demographic transition.
2.11 Family building by fate and design.
2.12 What regulates fertility?
2.13 What regulates the regulators?
2.14 Benign uproar - another indirect determinant ?
2.15 1-child families.
2.16. More benign uproar.
2.17 ‘Population numbers wherever’.
2.18 Is the world demographically trapped?
3.1 Aims and indicators.
3.2 Ten rules for good care.
3.3 The community diagnosis of pregnancy and labour.
3.4 Caring for mothers in the private sector.
3.5 ‘Money’!
3.6 Care in your district.
3.7 Empowering the community.
3.8 Building the mother care team.
3.9 Traditional birth attendants (TBAs).
3.10 TBAs and the killer complications.
3.11 Working with TBAs.
3.12 Measuring maternal mortality.
3.13 Measuring perinatal mortality.
3.14 Statistics for you to improve.
4.1 When fertility starts.
4.2 Ovulation and conception.
4.3 The menstrual cycle.
4.4 Husbands and boy friends.
4.5 The ‘Six rules of sex’.
4.6 Sex - all societies need rules.
4.7 Societies change.
4.8 What do religions say?
4.9 Love careingly.
4.10 What will make me (or her) pregnant?
4.11 Preventing pregnancy and infection.
4.12 Risks with pregnancy and infection.
4.13 Safer sex.
4.14 Teenage pregnancies.
4.15“No!- not yet”'
4.16 ‘SRE’ Sex and relationships education.
4.17 Family planning for teenagers.
4.18 ‘SRE’ in schools.
5.1 Precoital methods.
5.2 No method is ‘perfect’.
5.3 Safety, reliability and failure.
5.4 The failure rate.
5.5 Risk and benefit.
5.6 Which is the best method for them?
5.7 ‘Spacers’, ‘limiters’, ‘avoiders’ and ‘chance takers’.
5.8 Child spacing.
5.9 Methods for husband and wife.
5.10 Other ways of looking at precoital methods.
5.11 ‘Social marketing’
5.12 Discontinuing and ‘dropping out’.
5.13 Teaching family planning.
5.14 Running your clinic.
5.15 A family planning supermarket.
5.16 Evaluating family planning.
5.17 Indicators for family planning.
5.18 Are you succeeding?
5.19 More help in small print.
6.1 Breastfeeding as a family planning method.
6.2 Withdrawal and heavy petting.
6.3 Fertility awareness.
6.4 The hormones of the cycle.
6.5 Cycles vary.
6.6 How reliable are natural methods?
6.7 Who can use these methods?
6.8‘Dry patterns’ and ‘mucus patterns’.
6.9 Other fluids at the vulva.
6.10 The cervical mucus method.
6.10a The CycleBeads method.
6.11 The temperature method.
6.12 The symptothermal method.
6.13 The rhythm method.
7.1 Family planning Pills.
7.2 Which Pill?
7.3 Combined oral contraceptives (COCs).
7.4 How reliable are COCs?
7.5 Who distributes Pills?
7.6 Pills and drug interactions.
7.7 How to use COCs.
7.8 Changing and stopping COCs.
7.9 Missed COCs.
7.10 COC failure, pregnancy.
7.11 Other difficulties with COCs.
7.12 Progestogen only pills (POPs).
7.14 Family planning injections DMPA, ‘Noristerat’.
7.15 Using oestrogens.
7.16 Implants (‘Norplant’).
8.1 Male condoms.
8.2 Female condoms.
8.3 Diaphragms.
8.4 Spermicide.
8.5 Sponges with spermicides.
8.6 Intrauterine devices (IUDs).
8.7 When to fit an IUD?
8.8 Fitting an IUD.
8.9 Danger signs with an IUD.
8.10 Difficulties with an IUD.
8.11 Voluntary surgical contraception (VSC).
8.12 Tubal ligation (TL).
8.13 Quinacrine sterilization.
8.14. Vasectomy.
9.1 Postcoital methods.
9.2 Should pregnancy be terminated?
9.3 What does the law say?
9.4 What do you think is right?
9.5 Family planning after unprotected sex.
9.6 The postcoital Pill.
9.7 Postcoital mifepristone.
9.8 The postcoital IUD.
9.9 Menstrual regulation.
9.10 Mifepristone for abortion.
9.11 Vacuum aspiration.
9.12 Illegal abortions.
9.13 Traditional postcoital methods.
9.14 Improving the safety of traditional postcoital methods.
10.1 Difficulty making love.
10.2 Infertility.
10.3 Is she pregnant?
10.4 How long has she been pregnant?
10.5 Using an obstetric calculator.
10.6 Staying healthy.
10.7 Bodily changes during pregnancy.
10.8 Nausea and vomiting.
10.9 Constipation.
10.10 Backache.
10.11 Low abdominal pain.
10.12 Urinary symptoms.
10.13 Pregnancy oedema.
10.14 Piles.
10.15 Vein diseases.
10.16 Other difficulties in pregnancy.
11.1 HIV infection.
11.1a The HIV epidemic.
11.2 How HIV spreads.
11.3 Preventing AIDS.
11.4 HIV in pregnancy.
11.5 Mother to child transmission (MTCT).
11.5a Has he been infected?
11.6 Breastfeeding or artificial feeding?
11.7 Voluntary counselling and testing (VCT).
11.8 Organising MTCT services.
11.9 Mama Mbewe has another view
12.1 The sexually transmitted infections.
12.2 HIV and the STIs. 12.3 Vaginal discharge.
12.4 Urethral discharge.
12.5 Syphilis.
12.6 Chancroid.
12.7 Herpes genitalis (HSV2).
12.8 Donovanosis (granuloma inguinale).
12.8a Lymphogranuloma venereum (LGV).
12.9 Genital ulcer disease (GUD).
12.10 Pelvic inflammatory disease (PID).
12.11 Viral warts.
13 Other diseases in pregnancy
13.1 Ectopic pregnancy.
13.2 Abdominal pregnancy.
13.3 PIH and eclampsia.
13.4 Fits.
13.5 Heart disease.
13.6 Diabetes.
13.7 Malnutrition, intrauterine growth retardation (IUGR), and weight changes.
13.8 Anaemia.
13.9 Malaria.
13.10 Sickle cell anaemia.
13.11 Tetanus.
13.12 Rubella.
14.1 Where is the blood coming from?
14.2 Implantation bleeding.
14.3 Several kinds of abortion.
14.4 Spontaneous abortions.
14.5 Emptying the uterus.
14.6 Septic abortions.
14.7 Recurrent abortions.
14.8 Missed abortions.
14.9 Other causes of vaginal bleeding.
14.10 Caring for a mother who bleeds before the 24th week.
14.11 Antepartum haemorrhage (APH).
14.12 Placenta praevia.
14.13 Abruption of the placenta.
14.14 Caring for a mother who bleeds after the 24th week.
15.1 ‘Complications’ - the ‘risk approach’.
15.2 Compliance.
15.3 Looking for risk factors.
15.4 The antenatal history.
15.5 Examining an antenatal mother.
15.6 Examining a pregnant abdomen.
15.7 How high is her fundus?
15.8 Sorting out the problems of fundal height.
15.9 Some examples.
15.10 Vaginal examination.
15.11 Pelvic assessment - PA.
15.12 Organizing antenatal care.
15.13 The first visit.
15.14 Later visits.
15.15 Making a birth plan.
16.1 Changing a mother’s behaviour.
16.2 Beliefs and customs.
16.3 A bad custom: female genital mutilation.
16.4 Community health education.
16.5 Antenatal health education.
16.6 Coping with difficulties.
17.1 The powers of labour.
17.2 The four stages of labour.
17.3 A mother’s ‘passages’.
17.4 Her passenger.
17.5 The position of the presenting part.
17.6 The baby’s head descends and turns.
17.7 His head moulds and caput forms.
17.8 Rupture of the membranes.
17.9 His head rotates, crowns and restitutes.
17.10 ‘Fifths above the brim’.
17.11 Abdominal examination.
17.12 Vaginal examination.
17.13 The partograph.
17.14 Methods good and bad.
18 The first and second stages
18.1 Can a mother get help if necessary ?
18.2 A mother’s hostel.
18.3 An obstetric flying squad.
18.4 Examining and recording.
18.5 Should you refer her?
18.6 Preventing infection.
18.7. Getting ready.
18.8 Positions in labour.
18.9 A friend for her and a helper for you.
18.10 Pain in labour.
18.11 Has labour started?
18.12 The first stage.
18.13 The second stage.
18.14 Complications.
19.1 Changes in the uterus during the third stage.
19.2 Oxytocic drugs.
19.3 Managing the third stage.
19.4 Retained placenta, manual removal.
19.4 Postpartum haemorrhage, PPH.
19.6 Preventing PPH.
19.7 Hypovolaemic shock.
19.8 Treating PPH.
19.9 Vaginal tears.
19.10 Cervical tears, episiotomy.
19.11 Puerperal haemorrhage (secondary PPH).
19.12 PPHs for TBAs.
20 Special babies, special mothers
SPECIAL BABIES.
20.1 Foetal distress.
20.2 A baby’s first minutes.
20.3 His first hours.
20.4 His first feed.
20.5 Low birth weight babies.
20.6 IUGR (small-for-dates) babies.
20.7 Iso-immunised babies.
20.8 Alcohol and drugs.
20.9 Hopelessly malformed babies.
20.10 Dead babies, DIC.
20.11 Grieving.
SPECIAL MOTHERS.
20.12 Polyhydramnios.
20.13 Intrauterine infection (IUI).
20.14 Prolapse and presentation of the cord.
20.15 The membranes rupture too early.
20.16 Labour too early - preterm.
20.17 Labour too late - post term.
20.18 Pregnancy too young.
20.19 Pregnancy too old.
20.20 Grand multips in labour.
20.21 The mother with a bad obstetric history.
20.22 A previous assisted vaginal delivery.
20.23 Delivery methods good and bad.
21.1 Breech presentation.
21.2 Face presentation.
21.3 Brow presentation.
21.4 A transverse lie.
21.5 The occipito-posterior position.
21.6 ‘Shoulders stuck’ (shoulder dystocia).
21.7 Twins.
22.1 What should happen in labour.
22.2 What should not happen.
22.3 Delay , obstruction, and cephalo-pelvic disproportion (CPD).
22.4 Oxytocin and ARM?
22.5 Managing a long labour.
22.6 Delay before 4 cm.
22.7 Delay between 4 and 10 cm.
22.8 Delay in the second stage.
23 Obstruction, tears, fistulae
23.1 Primips and multips.
23.2 Obstructed labour.
23.3 Has she ruptured her uterus?
23.4 Episiotomy.
23.5 Perineal tears.
23.6 Fistulae.
24.1 Inducing labour.
24.2 Oxytocin drips.
24.3 The vacuum extractor.
24.4 Using a vacuum extractor.
24.5 Trial of vacuum.
24.6 Outlet forceps.
24.7 Symphysiotomy.
24.8 Destructive operations.
24.9 Caesarean section.
24.10 Repeat Caesarean section.
25.1 A mother’s first few hours.
25.2 Her baby’s first few days - danger signs in mother and baby.
25.3 The first home visit.
25.4 Her family and husband.
25.5 Fever in the puerperium.
25.6 Puerperal sepsis.
25.7 Retention of urine.
25.8 Lower abdominal pain.
25.9 A painful vulva.
25.10 Foot drop.
25.11 Depression.
25.12 Mental confusion.
25.13 Labour methods good and bad.
26.1 Is your hospital ‘baby friendly’?
26.2 Why mothers need help.
26.3 No prelacteal feeds!
26.4 How milk is made.
26.5 A baby’s reflexes.
26.6 Position and attachment.
26.7 Engorgement and mastitis.
26.8 Nipples.
26.9 Refusal to breastfeed.
26.10 Expressing breast milk.
26.11 Not enough milk?
26.12 Other difficulties
27.1 The gynaecological examination.
27.2 Lumps in the breast.
27.3 Bartholin’s cyst and abscess.
27.4 Gynaecological pain.
27.5 Dyspareunia (painful sex).
27.6 Dysmenorrhoea (painful periods).
27.7 Cancer of the cervix.
27.8 Cancer of the endometrium.
27.9 Fibroids
27.10 Ovarian tumours
27.11 Dysfunctional uterine bleeding (DUB).
27.12 No periods, amenorrhoea.
27.13 Incontinence of urine.
27.14 Prolapse.
27.15 The menopause.
27.16 Family planning at the menopause.
28.1 Antibiotics.
28.2 Blood tests.
28.3 What do the special tests mean?
28.4 Drugs and equipment.
28.5 References
29.1 An open letter to Kofi Annan.
29.2 Why is entrapment so taboo?
29.3 The case against Demon 21.
29.4 The population policy lockstep.
29.5 Demon 21 gets its ‘Genu robustum....
29.6 ‘Things fall apart...’
29.7 ‘Demon’ as a scientific term.
29.8 Sixteen false arguments for avoiding the diagnosis of entrapment
29. 9 The renaissance (rebirth) of British demography.
29.10 Moliere’s madness and Demon 14.
29.11 Epilogue.