"It is I who bring both death and life."
Deuteronomy 32:39

"Did not He who made me in the womb make him?
And did not one fashion us in the womb?"
Job 31:15

You formed my inmost being;
You knit me in my mother's womb.
I praise you, so wonderfully you made me;
Wonderful are your works!
My very self you knew;
My bones were not hidden from you,
When I was being made in secret,
Fashioned as in the depths of the earth.
Your eyes foresaw my actions;
In your book all are written down;
My days were shaped, before one came to be.
Psalms 139:13-16 [New American]

"Yahweh called me when I was in the womb,
before my birth he had pronounced my name."
Isaiah 49:1

"Before I formed you in the womb I knew you."
Jeremiah 1:5

"In those days Mary arose and went with haste into the hill country, to a city of Judah,
and she entered the house of Zechariah and greeted Elizabeth.
And when Elizabeth heard the greeting of Mary, the babe leaped in her womb;
and Elizabeth was filled with the Holy Spirit and she exclaimed with a loud cry,
"Blessed are you among women, and blessed is the fruit of your womb!
And why is this granted me, that the mother of my Lord should come to me?
For behold, when the voice of your greeting came to my ears, the babe in my womb leaped for joy."
Gospel of Luke 1:39-44

"But when he who had set me apart before I was born,
and had called me through his grace"
Paul to the Galatians 1:15

"Blessed be the God and Father of our Lord Jesus Christ,
who has blessed us in Christ with every spiritual blessing in the heavenly places,
even as he chose us in him before the foundation of the world,
that we should be holy and blameless before him."
Paul to the Ephesians 1:3-4

"Whosoever shall shed man's blood, his own blood shall be shed,
For man was made in the image of God."
Genesis 9:6

MEDICAL ASPECTS

LIFE IN THE WOMB
Individual life begins with conception by the union of the couple's sex cells or gametes. The 23 chromosomes of the paternal sperm (male pronucleus) fuses with the 23 chromosomes of the maternal oocyte (egg or female pronucleus) at fertilization to create a single cell embryo or zygote containing 46 chromosomes. The fertilization process takes about 24 hours.
The new human zygote has the inherent capacity or potential to become a fully rational and cognizant person
Each one represents a unique, irreplaceable, never-to-be-reduplicated human being!

The Pre-embryonic Period extends from the moment of fertilization of the ovum to the 4th week after conception. During this phase, the zygote undergoes continual cell division, implants in the uterus, and forms the primary germ layers, which give rise to the organs of the human body.





The zygote begins dividing about every 12-20 hours , first into 2 cells called blastomeres. The blastomeres divide repeatedly without growth and thus decrease in size. By three days division into 16 cells has taken place, and the zygote assumes the shape of a mulberry, becoming known as a 16 cell morula. The morula then leaves the fallopian tube and enters the uterine cavity three to four days after fertilization. Cell division continues, and a cavity known as a blastocele forms in the center of the morula. With the appearance of the cavity in the center, the entire structure is now called a blastocyst.

The presence of the blastocyst indicates that two cell types are forming: the embryoblast (inner cell mass on the inside of the blastocele), and the trophoblast (the cells on the outside of the blastocele). The inner cell mass becomes the embryo, and the trophoblast becomes the placenta. The blastocyst implants into the endometrial lining of the uterus via its trophoblast from the 7th to 10th day after fertilization. The pre-embryonic period includes the formation of the three primary germ layers, the ectoderm, mesoderm, and endoderm, from which come the organs of the human body.

The Embryonic Period is characterized by dramatic cell differentiation from the fourth through the eighth week, so that the beginnings of all essential structures of the human body are present.

A fully recognizable human embryo is complete after the eighth week!
The human embryo now measures just over one inch long and weighs about 4.5 grams.

The Fetal Period lasts from the ninth week to the 38th week after conception, and is characterized by rapid growth. Viability is the time when the fetus can live outside of the womb, independently of the mother.

Prematurity is defined when an infant is born before 37 weeks of gestational age. With modern neonatal units, extremely premature babies may survive at 23-25 weeks gestation (21-23 weeks embryonic growth), although there is a high risk of permanent handicap. Premature infants with very low birth weight are those who weigh 1500 grams (3.307 pounds) or less; those with extremely low birth weight weigh 1000 grams (2.205 pounds) or less. The decision to resuscitate or offer comfort care for the extremely premature infant is a complex one: the goal to care should be one that will increase survival and decrease the prevalence of disability among survivors. The likelihood of a favorable outcome with intensive care can be better estimated by consideration of four factors in addition to gestational age: female sex, exposure to antenatal steroids, single birth, and higher birth weight in 100 gram increments (Note: one gram = 0.002205 pounds; one pound = 453.59 grams). <sup>11

As physicians do not know when fertilization occurs, we measure the term of the baby from the first day of the last menstrual period, which is approximately two weeks prior to fertilization, and this is known as the Gestational Age. Thus while the human takes 38 weeks (266 days) to develop in the womb prior to birth, the Gestational Age is given as 40 weeks (280 days) or 10 lunar months (each lunar month being 28 days), or roughly 9 calendar months and 7 days. This time is divided into the three trimesters of pregnancy, lasting 3 months each. The expected Due Date for delivery, or EDC (Estimated Date of Confinement), is calculated by adding 7 days to the first day of the last menstrual period and then subtracting 3 months. For example, if the pregnant patient's first day of her last menstrual period was February 1, then her due date is November 8.

Physicians have three primary means of detecting pregnancy - the physical examination of the mother, the pregnancy test, and the ultrasound.

The trophoblast after implantation begins secreting the protein HCG, human chorionic gonadotropin. All pregnancy tests - home urine and hospital serum pregnancy tests - detect this protein at varying degrees of sensitivity. Since implantation occurs 7-10 days after conception, a serum pregnancy test may detect pregnancy as early as 7-10 days after conception, and almost certainly within two weeks of conception, or 4 weeks of gestational age. Once implantation occurs, human chorionic gonadotropin doubles every 1.4 to 2.0 days.

The ultrasound has become a most valuable tool in assessing life in the womb. The earliest definitive finding on ultrasound is the gestational sac, which may be detected from 4-6 weeks of gestation. The heartbeat may be detected on ultrasound as early as 6 weeks of gestation! The baby's heartbeat may be heard with a stethoscope by 16 to 19 weeks of gestation. The normal fetal heart rate ranges from 120 to 160 beats per minute.

A fully-formed baby can readily be seen on ultrasound by the first trimester of pregnancy.</sup>


NORMAL LABOR AND DELIVERY
Parturition is the birth process of the baby. Labor begins with involuntary uterine contractions that first result in effacement and dilation of the cervix, and then, in conjunction with voluntary bearing-down of the mother, the progress of the baby down the birth canal. Crowning is the presentation of the baby's head at the introitus or vaginal opening. Delivery occurs with the complete birth of the baby!

Five essential factors influence the process of labor: the baby or the passenger, the size of the birth canal, or "passageway," the "power" or strength, frequency, and duration of uterine contractions, the position of the placenta, and the psychologic state of the mother.






Vertex and Breech Presentations
The ideal situation is for the baby to be in a longitudinal or vertical lie and to present head first in the birth canal, or vertex presentation. Delivery may be difficult if the baby is in a vertical lie but a breech presentation. Breech presentations are called frank when the pelvic sacrum enters first, complete when the pelvis and both feet enter, and footling when one foot enters the birth canal. Delivery is impossible if the baby is in transverse lie, and this generally leads the obstetrician to surgically remove the baby by Caesarean Section.

There are three traditional stages to labor.
The first stage occurs from the beginning of uterine contractions to the complete dilatation of the cervix. The beginning of labor often coincides with "show," the discharge of the mucus plug of the cervix, and the "water breaking," the release of amniotic fluid with the rupture of the amniotic sac. Effacement of the cervix means the thinning of the cervix, and dilatation refers to the widening of the cervical diameter from 1 cm to 10 cm, to allow for the progress of the baby down the birth canal.

The second stage lasts from full dilatation of the cervix with transition down the birth canal, to the actual delivery of the baby. Progress in the descent of the presenting part (usually the head) is determined by vaginal examination until crowning occurs. The location of the head in relation to the ischial spines is designated the station, and is a mean of determining the progress of the baby down the birth canal. The level of the ischial spines is considered to be station 0, and the position of the head is described in centimeters minus (-1 to -5) above the spines or plus (+1 to +5) below the spines.










Delivery of the Infant
Once crowning (A) occurs, gentle delivery of the head (B) follows. Gentle downward traction brings descent and then delivery of the anterior shoulder (C). Subsequent gentle upward traction allows delivery of the posterior shoulder (D). The rest of the body easily follows once the shoulders are delivered, and the newborn is here!

The baby enters the world of relationship!

The third stage occurs from the delivery of the baby to the delivery of the placenta.


IMMEDIATE CARE OF THE NEWBORN
The newborn must receive immediate care upon delivery. The delivery team must first ensure a clear airway. A bulb syringe is used to suction the mouth to prevent aspiration. Then the nares (nose) is aspirated. Suctioning of the nares stimulates the neonate to take a breath.

The umbilical cord is clamped about 30 seconds after delivery when cord pulsations cease. The cord is examined for the normal presence of two arteries and one vein.

The newborn must be kept warm, generally by placing a blanket around the baby's head and body, and then placing the baby on the mother's abdomen.

The condition of the baby is assessed at one minute and 5 minutes, generally by using the APGAR Score. The APGAR Score assesses the baby's heartbeat by auscultation with the stethoscope; respirations by observance of chest wall movements; muscle tone, based on movement of the extremities; reflex irritability, the response of the baby to suctioning; and color, whether blue or pale, body pink with cyanotic feet, or all pink. The one-minute score is variable, but a score of 7 or greater is generally indicative of a healthy baby, and the ideal five-minute score is 10.

NEWBORN APGAR SCORE
	0	1	2
Heart Rate	Absent	Less than 100	Over 100
Respirations	Absent	Slow	Good cry
Muscle Tone	Limp	Some Flexion	Active Motion
Reflex	No response	Grimace	Cry
Color	Pale or Blue	Feet Blue	All pink

The giving of the baby to the mother and father brings overwhelming joy.
The birth of a baby is truly a miracle of love!





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