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PHOTOGRAPHY
Photography (IPA: [fә’tɒgrәfi] or IPA: [fә’tɑːgrәfi][1]) (from Greek φωτο and γραφία) is the process, activity and art of creating still or moving pictures by recording radiation on a sensitive medium, such as a film, or an electronic sensor. Light patterns reflected or emitted from objects activate a sensitive chemical or electronic sensor during a timed exposure, usually through a photographic lens in a device known as a camera that also stores the resulting information chemically or electronically. Photography has many uses for business, science, art and pleasure.
Lens and mounting of a large-format camera.
A historic camera: the Contax S of 1949 – the first pentaprism SLR.
Nikon F of 1959 – the first 35mm film system camera.
The word “photography” comes from the Greek φώς (phos) “light” + γραφίς (graphis) “stylus”, “paintbrush” or γραφή (graphê) “representation by means of lines” or “drawing”, together meaning “drawing with light.” Traditionally, the products of photography have been called negatives and photographs, commonly shortened to photos.
The discipline of making lighting and camera choices when recording photographic images for the cinema is dealt with under Cinematography
Contents
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Function and cameras
The camera or camera obscura is the image-forming device, and photographic film or a silicon electronic image sensor is the sensing medium. The respective recording medium can be the film itself, or a digital electronic or magnetic memory.
Photographers control the camera and lens to “expose” the light recording material (such as film) to the required amount of light to form a “latent image” (on film) or “raw file” (in
digital cameras) which, after appropriate processing, is converted to a usable image. Digital cameras replace film with an electronic image sensor based on light-sensitive electronics such as charge-coupled device (CCD) or complementary metal-oxide-semiconductor (CMOS) technology. The resulting digital image is stored electronically, but can be reproduced on paper or film.
The movie camera is a type of photographic camera which takes a rapid sequence of photographs on strips of film. In contrast to a still camera, which captures a single snapshot at a time, the movie camera takes a series of images, each called a “frame”. This is accomplished through an intermittent mechanism. The frames are later played back in a movie projector at a specific speed, called the “frame rate” (number of frames per second). While viewing, a person’s eyes and brain merge the separate pictures together to create the illusion of motion.
In all but certain specialized cameras, the process of obtaining a usable exposure must involve the use, manually or automatically, of a few controls to ensure the photograph is clear, sharp and well illuminated. The controls usually include but are not limited to the following:
- Focus – the adjustment to place the sharpest focus where it is desired on the subject.
- Aperture – adjustment of the iris, measured as f-number, which controls the amount of light passing through the lens. Aperture also has an effect on focus and depth of field, namely, the smaller the opening aperture, the less light but the greater the depth of field–that is, the greater the range within which objects appear to be sharply focused. The current focal length divided by the f-number gives the actual aperture size in millimeters.
- Shutter speed – adjustment of the speed (often expressed either as fractions of seconds or as an angle, with mechanical shutters) of the shutter to control the amount of time during which the imaging medium is exposed to light for each exposure. Shutter speed may be used to control the amount of light striking the image plane; ‘faster’ shutter speeds (that is, those of shorter duration) decrease both the amount of light and the amount of image blurring from motion of the subject and/or camera.
- White balance – on digital cameras, electronic compensation for the color temperature associated with a given set of lighting conditions, ensuring that white light is registered as such on the imaging chip and therefore that the colors in the frame will appear natural. On mechanical, film-based cameras, this function is served by the operator’s choice of film stock or with color correction filters. In addition to using white balance to register natural coloration of the image, photographers may employ white balance to aesthetic end, for example white balancing to a blue object in order to obtain a warm color temperature.
- Metering – measurement of exposure so that highlights and shadows are exposed according to the photographer’s wishes. Many modern cameras meter and set exposure automatically. Before automatic exposure, correct exposure was accomplished with the use of a separate light metering device or by the photographer’s knowledge and experience of gauging correct settings. To translate the amount of light into a usable aperture and shutter speed, the meter needs to adjust for the sensitivity of the film or sensor to light. This is done by setting the “film speed” or ISO sensitivity into the meter.
- ISO speed – traditionally used to “tell the camera” the film speed of the selected film on film cameras, ISO speeds are employed on modern digital cameras as an indication of the system’s gain from light to numerical output and to control the automatic exposure system. A correct combination of ISO speed, aperture, and shutter speed leads to an image that is neither too dark nor too light.
- Auto-focus point – on some cameras, the selection of a point in the imaging frame upon which the auto-focus system will attempt to focus. Many Single-lens reflex cameras (SLR) feature multiple auto-focus points in the viewfinder.
Many other elements of the imaging device itself may have a pronounced effect on the quality and/or aesthetic effect of a given photograph; among them are:
- Focal length and type of lens (•telephoto or “long” lens, macro, wide angle, fisheye, or zoom) Filters placed between the subject and the light recording material, either in front of or behind the lens
- Inherent sensitivity of the medium to light intensity and color/wavelengths.
- The nature of the light recording material, for example its resolution as measured in pixels or grains of silver halide.
Exposure and rendering
A photographer using a flash.
Camera controls are inter-related. The total amount of light reaching the film plane (the “exposure”) changes with the duration of exposure, aperture of the lens, and, the effective focal length of the lens (which in variable focal length lenses, can change as the lens is zoomed). Changing any of these controls can alter the exposure. Many cameras may be set to adjust most or all of these controls automatically. This automatic functionality is useful for occasional photographers in many situations.
The duration of an exposure is referred to as shutter speed, often even in cameras that don’t have a physical shutter, and is typically measured in fractions of a second. Aperture is expressed by an f-number or f-stop (derived from focal ratio), which is proportional to the ratio of the focal length to the diameter of the aperture. If the f-number is decreased by a factor of , the aperture diameter is increased by the same factor, and its area is increased by a factor of 2. The f-stops that might be found on a typical lens include 2.8, 4, 5.6, 8, 11, 16, 22, 32, where going up “one stop” (using lower f-stop numbers) doubles the amount of light reaching the film, and stopping down one stop halves the amount of light.
Exposures can be achieved through various combinations of shutter speed and aperture. For example, f/8 at 8 ms (=1/125th of a second) and f/5.6 at 4 ms (=1/250th of a second) yield the same amount of light. The chosen combination has an impact on the final result. In addition to the subject or camera movement that might vary depending on the shutter speed, the aperture (and focal length of the lens) determine the depth of field, which refers to the range of distances from the lens that will be in focus. For example, using a long lens and a large aperture (f/2.8, for example), a subject’s eyes might be in sharp focus, but not the tip of the nose. With a smaller aperture (f/22), or a shorter lens, both the subject’s eyes and nose can be in focus. With very small apertures, such as pinholes, a wide range of distance can be brought into focus.
Image capture is only part of the image forming process. Regardless of material, some process must be employed to render the latent image captured by the camera into the final photographic work. This process consists of two steps, development and printing.
During the printing process, modifications can be made to the print by several controls. Many of these controls are similar to controls during image capture, while some are exclusive to the printing process. Most controls have equivalent digital concepts, but some create different effects. For example, dodging and burning controls are different between digital and film processes. Other printing modifications include:
- Chemicals and process used during film development
- Duration of exposure – equivalent to shutter speed
- Printing aperture – equivalent to aperture, but has no effect on depth of field
- Contrast
- Dodging – reduces exposure of certain print areas, resulting in lighter areas
- Burning in – increases exposure of certain areas, resulting in darker areas
- Paper texture – glossy, matte, etc
- Paper type – resin-coated (RC) or fiber-based (FB)
- Paper size
- Toners – used to add warm or cold tones to black and white prints
Uses
Photography gained the interest of many scientists and artists from its inception. Scientists have used photography to record and study movements, such as Eadweard Muybridge’s study of human and animal locomotion in 1887. Artists are equally interested by these aspects but also try to explore avenues other than the photo-mechanical representation of reality, such as the pictorialist movement. Military, police, and security forces use photography for surveillance, recognition and data storage. Photography is used by amateurs to preserve memories of favorite times, to capture special moments, to tell stories, to send messages, and as a source of entertainment. Many mobile phones now contain cameras to facilitate such use.
Commercial advertising relies heavily on photography and has contributed greatly to its development.
History
Nicéphore Niépce’s earliest surviving photograph of a scene from nature, c. 1826. This image required an eight-hour exposure, which resulted in sunlight being visible on both sides of the buildings.
Photography is the result of combining several technical discoveries. Long before the first photographs were made, Chinese philosopher Mo Ti described a pinhole camera in the 5th century B.C.E,[3] Ibn al-Haytham (Alhazen) (965-1040) studied the camera obscura and pinhole camera,[4][3] Albertus Magnus (1193-1280) discovered silver nitrate, and Georges Fabricius (1516-1571) discovered silver chloride.[citation needed] Daniel Barbaro described a diaphragm in 1568.[citation needed] Wilhelm Homberg described how light darkened some chemicals (photochemical effect) in 1694.[citation needed] The fiction book Giphantie, by French author Tiphaigne de la Roche, described what can be interpreted as photography.[citation needed]
Photography as a usable process goes back to the 1820s with the development of chemical photography. The first permanent photograph was an image produced in 1825 by the French inventor Nicéphore Niépce. However, because his photographs took so long to expose, he sought to find a new process. Working in conjunction with Louis Daguerre, they experimented with silver compounds based on a Johann Heinrich Schultz discovery in 1724 that a silver and chalk mixture darkens when exposed to light. Niépce died in 1833, but Daguerre continued the work, eventually culminating with the development of the daguerreotype in 1837. Daguerre took the first ever photo of a person in 1839 when, while he taking a daguerreotype of a Paris street, a pedestrian stopped for a shoe shine, long enough to be captured by the long exposure (several minutes). Eventually, France agreed to pay Daguerre a pension for his formula, in exchange for his promise to announce his discovery to the world as the gift of France, which he did in 1839.
Meanwhile, Hercules Florence had already created a very similar process in 1832, naming it Photographie, and William Fox Talbot had earlier discovered another means to fix a silver process image but had kept it secret. After reading about Daguerre’s invention, Talbot refined his process so that portraits were made readily available to the masses. By 1840, Talbot had invented the calotype process, which creates negative images. John Herschel made many contributions to the new methods. He invented the cyanotype process, now familiar as the “blueprint”. He was the first to use the terms “photography”, “negative” and “positive”. He discovered sodium thiosulphate solution to be a solvent of silver halides in 1819, and informed Talbot and Daguerre of his discovery in 1839 that it could be used to “fix” pictures and make them permanent. He made the first glass negative in late 1839.
In March 1851, Frederick Scott Archer published his findings in “The Chemist” on the wet plate collodion process. This became the most widely used process between 1852 and the late 1880s when the dry plate was introduced. There are three subsets to the Collodion process; the Ambrotype (positive image on glass), the Ferrotype or Tintype (positive image on metal) and the negative which was printed on Albumen or Salt paper.
Many advances in photographic glass plates and printing were made in through the nineteenth century. In 1884, George Eastman developed the technology of film to replace photographic plates, leading to the technology used by film cameras today.
In 1908 Gabriel Lippmann won the Nobel Laureate in Physics for his method of reproducing colours photographically based on the phenomenon of interference, also known as the Lippmann plate.
Processes
A filter may be used to enhance or diminish the rendering of certain light wavelengths. For this photograph, a wratten #25 was used.
Black-and-white
All photography was originally monochrome, most of these photographs were black-and-white. Even after color film was readily available, black-and-white photography continued to dominate for decades, due to its lower cost and its “classic” photographic look. It is important to note that some monochromatic pictures are not always pure blacks and whites, but also contain other hues depending on the process. The Cyanotype process produces an image of blue and white for example. The albumen process which was used more than 150 years ago had brown tones.
Many photographers continue to produce some monochrome images. Some full color digital images are processed using a variety of techniques to create black and whites, and some cameras have even been produced to exclusively shoot monochrome.
Color
Color photography was explored beginning in the mid 1800s. Early experiments in color could not fix the photograph and prevent the color from fading. The first permanent color photo was taken in 1861 by the physicist James Clerk Maxwell.
Early color photograph taken by Prokudin-Gorskii (1915).
One of the early methods of taking color photos was to use three cameras. Each camera would have a color filter in front of the lens. This technique provides the photographer with the three basic channels required to recreate a color image in a darkroom or processing plant. Russian photographer Sergei Mikhailovich Prokudin-Gorskii developed another technique, with three color plates taken in quick succession.
Practical application of the technique was held back by the very limited color response of early film; however, in the early 1900s, following the work of photo-chemists such as H. W. Vogel, emulsions with adequate sensitivity to green and red light at last became available.
The first color plate, Autochrome, invented by the French Lumière brothers, reached the market in 1907. It was based on a ‘screen-plate’ filter made of dyed dots of potato starch, and was the only color film on the market until German Agfa introduced the similar Agfacolor in 1932. In 1935, American Kodak introduced the first modern (‘integrated tri-pack’) color film, Kodachrome, based on three colored emulsions. This was followed in 1936 by Agfa’s Agfacolor Neue. Unlike the Kodachrome tri-pack process, the color couplers in Agfacolor Neue were integral with the emulsion layers, which greatly simplified the film processing. Most modern color films, except Kodachrome, are based on the Agfacolor Neue technology. Instant color film was introduced by Polaroid in 1963.
Color photography may form images as a positive transparency, intended for use in a slide projector or as color negatives, intended for use in creating positive color enlargements on specially coated paper. The latter is now the most common form of film (non-digital) color photography owing to the introduction of automated photoprinting equipment.
[edit] Full-spectrum, ultraviolet and infrared
Main article: Full spectrum photography
Ultraviolet and infrared films have been available for many decades and employed in a variety of photographic avenues since the 1960s. New technological trends in digital photography have opened a new direction in full spectrum photography, where careful filtering choices across the ultraviolet, visible and infrared lead to new artistic visions.
Modified digital cameras can detect some ultraviolet, all of the visible and much of the near infrared spectrum, as most digital imaging sensors are sensitive from about 350nm to 1000nm. An off-the-shelf digital camera contains an infrared hot mirror filter that blocks most of the infrared and a bit of the ultraviolet that would otherwise be detected by the sensor, narrowing the accepted range from about 400nm to 700nm[5]. Replacing a hot mirror or infrared blocking filter with an infrared pass or a wide spectrally transmitting filter allows the camera to detect the wider spectrum light at greater sensitivity. Without the hot-mirror, the red, green and blue (or cyan, yellow and magenta) colored micro-filters placed over the sensor elements pass varying amounts of ultraviolet (blue window) and infrared (primarily red, and somewhat lesser the green and blue micro-filters).
Uses of full spectrum photography are for fine art photography, geology, forensics & law enforcement, and even some claimed use in ghost hunting.
Digital
A handheld digital camera.
The Nikon D1, the first DSLR to truly compete with, and begin to replace, film cameras in the professional photojournalism and sports photography fields.
Nikon DSLR and scanner, which converts film images to digital
Sony Ericsson K800i camera phone.
Traditional photography burdened photographers working at remote locations without easy access to processing facilities, and competition from television pressured photographers to deliver images to newspapers with greater speed. Photo journalists at remote locations often carried miniature photo labs and a means of transmitting images through telephone lines. In 1981, Sony unveiled the first consumer camera to use a charge-coupled device for imaging, eliminating the need for film: the Sony Mavica. While the Mavica saved images to disk, the images were displayed on television, and the camera was not fully digital. In 1990, Kodak unveiled the DCS 100, the first commercially available digital camera. Although its high cost precluded uses other than photojournalism and professional photography, commercial digital photography was born.
Digital imaging uses an electronic image sensor to record the image as a set of electronic data rather than as chemical changes on film. The primary difference between digital and chemical photography is that chemical photography resists manipulation because it involves film and photographic paper, while digital imaging is a highly manipulative medium. This difference allows for a degree of image post-processing that is comparatively difficult in film-based photography and permits different communicative potentials and applications.
Digital point-and-shoot cameras have become widespread consumer products, outselling film cameras, and including new features such as video and audio recording. Kodak announced in January 2004 that it would no longer sell reloadable 35 mm cameras in western Europe, Canada and the United States after the end of that year. Kodak was at that time a minor player in the reloadable film cameras market. In January 2006, Nikon followed suit and announced that they will stop the production of all but two models of their film cameras: the low-end Nikon FM10, and the high-end Nikon F6. On May 25, 2006, Canon announced they will stop developing new film SLR cameras.[6]
Camera phones, combined with sites like flickr have lead to a new kind of social photography.
Though most new camera designs are now digital, a new 6*6cm/6*7cm medium format film camera was introduced in 2008 in a cooperation between Fuji and Voigtländer.[7][8]
According to a survey made by Kodak in 2007, 75 percent of professional photographers say they will continue to use film, even though some embrace digital.[9]
According to the U.S. survey results, more than two-thirds (68 percent) of professional photographers prefer the results of film to those of digital for certain applications including:
- film’s superiority in capturing more information on medium and large format films (48 percent);
- creating a traditional photographic look (48 percent);
- capturing shadow and highlighting details (45 percent);
- the wide exposure latitude of film (42 percent); and
- archival storage (38 percent)
Because photography is popularly synonymous with truth (“The camera doesn’t lie.”), digital imaging has raised many ethical concerns. Many photojournalists have declared they will not crop their pictures, or are forbidden from combining elements of multiple photos to make “illustrations,” passing them as real photographs. Many courts will not accept digital images as evidence because of their inherently manipulative nature and they could be completely fake, do they only take solid evidence. Today’s technology has made picture editing relatively simple for even the novice photographer.
Recent changes of in-camera processing allows digital fingerprinting of RAW photos to verify against tampering of digital photos for forensics use.
Modes of production
Amateur
An amateur photographer is one who practices photography as a hobby and not for profit. The quality of some amateur work is comparable or superior to that of many professionals and may be highly specialised or eclectic in its choice of subjects. Amateur photography is often pre-eminent in photographic subjects which have little prospect of commercial use or reward.
Commercial
Manual shutter control and exposure settings can achieve unusual results.
Commercial photography is probably best defined as any photography for which the photographer is paid for images rather than works of art. In this light money could be paid for the subject of the photograph or the photograph itself. Wholesale, retail, and professional uses of photography would fall under this definition. The commercial photographic world could include:
- Advertising photography: photographs made to illustrate and usually sell a service or product. These images are generally done with an advertising agency, design firm or with an in-house corporate design team.
- Fashion and glamour photography: This type of photography usually incorporates models. Fashion photography emphasizes the clothes or product, glamour emphasizes the model. Glamour photography is popular in advertising and in men’s magazines. Models in glamour photography may be nude, but this is not always the case.
- Crime Scene Photography: This type of photography consists of photographing scenes of crime such as robberies and murders. A black and white camera or an infrared camera may be used to capture specific details.
- Still life photography usually depicts inanimate subject matter, typically commonplace objects which may be either natural or man-made.
- Food photography can be used for editorial, packaging or advertising use. Food photography is similar to still life photography, but requires some special skills.
- Editorial photography: photographs made to illustrate a story or idea within the context of a magazine. These are usually assigned by the magazine.
- Photojournalism: this can be considered a subset of editorial photography. Photographs made in this context are accepted as a documentation of a news story.
- Portrait and wedding photography: photographs made and sold directly to the end user of the images.
- Landscape photography: photographs of different locations.
- Wildlife photography that demonstrates life of the animals.
- Photo sharing: publishing or transfer of a user’s digital photos online.
The market for photographic services demonstrates the aphorism “one picture is worth a thousand words,” which has an interesting basis in the history of photography. Magazines and newspapers, companies putting up Web sites, advertising agencies and other groups pay for photography.
Many people take photographs for self-fulfillment or for commercial purposes. Organizations with a budget and a need for photography have several options: they can employ a photographer directly, organize a public competition, or obtain rights to stock photographs. Photo stock can be procured through traditional stock giants, such as Getty Images or Corbis; smaller microstock agencies, such as Fotolia; or web marketplaces, such as Cutcaster.
As an art form
Classic Alfred Stieglitz photograph, The Steerage shows unique aesthetic of black and white photos.
During the twentieth century, both fine art photography and documentary photography became accepted by the English-speaking art world and the gallery system. In the United States, a handful of photographers, including Alfred Stieglitz, Edward Steichen, John Szarkowski, F. Holland Day, and Edward Weston, spent their lives advocating for photography as a fine art. At first, fine art photographers tried to imitate painting styles. This movement is called Pictorialism, often using soft focus for a dreamy, ‘romantic’ look. In reaction to that, Weston, Ansel Adams, and others formed the f/64 Group to advocate ‘straight photography’, the photograph as a (sharply focused) thing in itself and not an imitation of something else.
The aesthetics of photography is a matter that continues to be discussed regularly, especially in artistic circles. Many artists argued that photography was the mechanical reproduction of an image. If photography is authentically art, then photography in the context of art would need redefinition, such as determining what component of a photograph makes it beautiful to the viewer. The controversy began with the earliest images “written with light”; Nicéphore Niépce, Louis Daguerre, and others among the very earliest photographers were met with acclaim, but some questioned if their work met the definitions and purposes of art.
Clive Bell in his classic essay Art states that only “significant form” can distinguish art from what is not art.
| “ | There must be some one quality without which a work of art cannot exist; possessing which, in the least degree, no work is altogether worthless. What is this quality? What quality is shared by all objects that provoke our aesthetic emotions? What quality is common to Sta. Sophia and the windows at Chartres, Mexican sculpture, a Persian bowl, Chinese carpets, Giotto’s frescoes at Padua, and the masterpieces of Poussin, Piero della Francesca, and Cezanne? Only one answer seems possible – significant form. In each, lines and colors combined in a particular way, certain forms and relations of forms, stir our aesthetic emotions. | “ |
On February 14th 2006 Sotheby’s London sold the 2001 photograph “99 Cent II Diptychon” for an unprecedented $3,346,456 to an anonymous bidder making it the most expensive of all time.
- Conceptual photography: Photography that turns a concept or idea into a photograph. Even though what is depicted in the photographs are real objects, the subject is strictly abstract.
Scientific and forensic
Original Tay Bridge from the north showing structure based on towers built from cast iron columns. When enlarged this plate shows a key design flaw in the bridge: the smaller surviving towers were supported by a continuous girder at their tops, while the fallen towers lack this essential reinforcing element.
Fallen Tay Bridge from the north. The two surviving high towers show a gap in their tops.
The camera has a long and distinguished history as a means of recording phenomena from the first use by Daguerre and Fox-Talbot, such as astronomical events (eclipses for example) and small creatures when the camera was attached to the eyepiece of microscopes (in photomicroscopy). The camera also proved useful in recording crime scenes and the scenes of accidents, one of the first applications being at the scene of the Tay Rail Bridge disaster of 1879. The court, just a few days after the accident, ordered James Valentine of Dundee to record the scene using both long distance shots and close-ups of the debris. The set of accident photographs was used in the subsequent court of inquiry so that witnesses could identify pieces of the wreckage, and the technique is now commonplace both at accident scenes and subsequent cases in courts of law. The set of over 50 Tay bridge photographs are of very high quality, being made on large plate cameras with a small aperture and using fine grain emulsion film on a glass plate. When scanned at high resolution, they can be enlarged to show details of the failed components such as broken cast iron lugs and the tie bars which failed to hold the towers in place. They show that the bridge was badly designed, badly built and badly maintained. The methods used in analysing old photographs are known as forensic photography.
Between 1846 and 1852 Charles Brooke invented a technology for the automatic registration of instruments by photography. These instruments included barometers, thermometers, psychrometers, and magnetometers, which recorded their readings by means of an automated photographic process.
5×7 in. unretouched photograph of the Wright brothers’ first flight, 1903.
Photographs have become ubiquitous in recording events and data in science and engineering.
Other image forming techniques
Besides the camera, other methods of forming images with light are available. For instance, a photocopy or xerography machine forms permanent images but uses the transfer of static electrical charges rather than photographic film, hence the term electrophotography. Photograms are images produced by the shadows of objects cast on the photographic paper, without the use of a camera. Objects can also be placed directly on the glass of an image scanner to produce digital pictures.
Social and cultural implications
There are many ongoing questions about different aspects of photography. In her writing “On Photography” (1977) Susan Sontag discusses concerns about the objectivity of photography. This is a highly debated subject within the photographic community (Bissell, 2000). It has been concluded that photography is a subjective discipline “to photograph is to appropriate the thing photographed. It means putting one’s self into a certain relation to the world that feels like knowledge, and therefore like power” (Sontag, 1977: p 4). Photographers decide what to take a photo of, what elements to exclude and what angle to frame the photo. Along with the context that a photograph is received in, photography is definitely a subjective form.
Modern photography has raised a number of concerns on its impact on society. The concept of the camera being a ‘phallic’ tool has been exemplified in a number of Hollywood productions. In Alfred Hitchcock’s Rear Window (1954), the camera is presented as a promoter of voyeuristic inhibitions. ‘Although the camera is an observation station, the act of photographing is more than passive observing’ [Sontag Susan 1977: p 12]. Michal Powell’s Peeping Tom (1960) portrays the camera as both sexual and sadistically violent technology that literally kills in this picture and at the same time captures images of the pain and anguish evident on the faces of the female victims.
“The camera doesn’t rape or even possess, though it may presume, intrude, trespass, distort, exploit, and, at the farthest reach of metaphor, assasinate- all activities that, unike the sexual push and shove, can be conducted from a distance, and with some detachment” [Sontag Susan 1977: p 12]
Photography is one of the new media forms that changes perception and changes the structure of society (Levinson, 1997). Further unease has been caused around cameras in regards to desensitization. Fears that disturbing or explicit images are widely accessible to children and society at large have been raised. Particularly, photos of war and pornography are causing a stir. (Sontag). Sontag is concerned that “to photograph is to turn people into objects that can be symbolically possessed”. Desensitization discussion goes hand in hand with debates about censored images. Sontag writes of her concern that the ability to censor pictures means the photographer has the ability to construct reality.
Plastic Surgery
Plastic surgery is a medical and cosmetic specialty interested in the correction of form and function. While famous for aesthetic surgery, plastic surgery also includes a variety of fields: craniofacial surgery, hand surgery, burn surgery, microsurgery, and pediatric surgery. The word “plastic” derives from the Greek plastikos meaning to mold or to shape; its use here is not connected with the synthetic polymer material known as plastic.
Contents
1 History
2 Techniques and procedures
3 Reconstructive plastic surgery
4 Cosmetic surgery
5 Plastic surgery sub-specialities
6 See also
7 Notes
8 References
9 Further reading
10 External links
History
Walter Yeo, a British soldier, is often cited as the first known person to have benefitted from successful plastic surgery. The photograph shows him before (left) and after (right) receiving a skin graft performed by Sir Harold Gillies in 1917.
Plastic surgery was being carried out in India by 2000 BC.[1] Sushruta (6th century BC) made important contributions to the field of Plastic and Cataract surgery.[2] The medical works of both Sushruta and Charak were translated into Arabic language during the Abbasid Caliphate (750 AD).[3] These Arabic works made their way into Europe via intermediaries.[4] In Italy the Branca family of Sicily and Gaspare Tagliacozzi (Bologna) became familiar with the techniques of Sushruta.[4]
British physicians traveled to India to see Rhinoplasty being performed by native methods.[5] Reports on Indian Rhinoplasty were published in the Gentleman’s Magazine by 1794.[5] Joseph Constantine Carpue spent 20 years in India studying local plastic surgery methods.[5] Carpue was able to perform the first major surgery in the Western world by 1815.[6] Instruments described in the Sushruta Samhita were further modified in the Western world.[6]
The Romans were able to perform simple techniques such as repairing damaged ears from around the 1st century BC. Due to religious reasons they didn’t approve of the dissection of both human beings and animals, thus their knowledge was based in its entirety on the texts of their Greek predecessors. Notwithstanding this Aulus Cornelius Celsus has left some surprisingly accurate anatomical descriptions, some of which —for instance, his studies on the genitalia and the skeleton— are of special interest to plastic surgery.[7]
The Egyptians were also one of the first people to perform plastic cosmetic surgery.
In 1465, Sabuncuoglu’s book, description, and classification of hypospadias was more informative and up to date. Localization of urethral meatus was described in detail. Sabuncuoglu also detailed the description and classification of ambiguous genitalia (Kitabul Cerrahiye-i Ilhaniye -Cerrahname-Tip Tarihi Enstitüsü, Istanbul)[citation needed] In mid-15th century Europe, Heinrich von Pfolspeundt described a process “to make a new nose for one who lacks it entirely, and the dogs have devoured it” by removing skin from the back of the arm and suturing it in place. However, because of the dangers associated with surgery in any form, especially that involving the head or face, it was not until the 19th and 20th centuries that such surgery became commonplace.
Up until the techniques of anesthesia became established, all surgery on healthy tissues involved great pain. Infection from surgery was reduced once sterile technique and disinfectants were introduced. The invention and use of antibiotics beginning with sulfa drugs and penicillin was another step in making elective surgery possible.
In 1792, Chopart performed operative procedure on a lip using a flap from the neck. In 1814, Joseph Carpue successfully performed operative procedure on a British military officer who had lost his nose to the toxic effects of mercury treatments. In 1818, German surgeon Carl Ferdinand von Graefe published his major work entitled Rhinoplastik. Von Graefe modified the Italian method using a free skin graft from the arm instead of the original delayed pedicle flap. In 1845, Johann Friedrich Dieffenbach wrote a comprehensive text on rhinoplasty, entitled Operative Chirurgie, and introduced the concept of reoperation to improve the cosmetic appearance of the reconstructed nose. In 1891, American otorhinolaryngologist John Roe presented an example of his work, a young woman on whom he reduced a dorsal nasal hump for cosmetic indications. In 1892, Robert Weir experimented unsuccessfully with xenografts (duck sternum) in the reconstruction of sunken noses. In 1896, James Israel, a urological surgeon from Germany, and In 1889 George Monks of the United States each described the successful use of heterogeneous free-bone grafting to reconstruct saddle nose defects. In 1898, Jacques Joseph, the German orthopaedic-trained surgeon, published his first account of reduction rhinoplasty. In 1928, Jacques Joseph published Nasenplastik und Sonstige Gesichtsplastik.
The U.S.’s first plastic surgeon was Dr. John Peter Mettauer. In 1827, he performed the first cleft palate operation with instruments that he designed himself. The New Zealander Sir Harold Gillies, an otolaryngologist, developed many of the techniques of modern plastic surgery in caring for those who suffered facial injuries in World War I. His work was expanded upon during World War II by one of his former students and cousin, Archibald McIndoe, who pioneered treatments for RAF aircrew suffering from severe burns. McIndoe’s radical, experimental treatments, lead to the formation of the Guinea Pig Club. Plastic surgery as a specialty evolved tremendously during the 20th century in the United States. One of the founders of the specialty, Dr. Vilray Blair, was the first chief of the Division of Plastic and Reconstructive Surgery at Washington University in St. Louis, Missouri. In one of his many areas of clinical expertise, Blair treated World War I soldiers with complex maxillofacial injuries, and his paper on “Reconstructive Surgery of the Face” set the standard for craniofacial reconstruction. He was also one of the first surgeons without a dental background to be elected to the American Association of Oral and Plastic Surgery (later the organizations split to be renamed the American Association of Plastic Surgeons and the American Association of Oral and Maxillofacial Surgeons) and taught many surgeons who became leaders in the field of plastic surgery.
Techniques and procedures
Common techniques used in plastic surgery are: Liposuction, Breast Augmention, Eyelid surgery, Face lift, Tummy tuck, Collagen injections, Chemical peel, Laser skin Resurfacing Rhinoplasty, Forehead lifts.
In plastic surgery the transfer of skin tissue (skin grafting) is one of the most common procedures. (In traditional surgery a “graft” is a piece of living tissue, organ, etc., that is transplanted.
Autografts: Skin grafts taken from the recipient. If absent or deficient of natural tissue, alternatives can be:
Cultured Sheets of epithelial cells in vitro.
Synthetic compounds (e.g., Integra—a 2 layered dermal substitute consisting superficially of silicone and deeply of bovine tendon collagen with glycosaminoglycans).
Allografts: Skin grafts taken from a donor of the same species.
Xenografts: Skin grafts taken from a donor of a different species.
Usually, good results are expected from plastic surgery that emphasizes:
Careful planning of incisions so that they fall in the line of natural skin folds or lines.
Appropriate choice of wound closure.
Use of best available suture materials.
Early removal of exposed sutures so that the wound is held closed by buried sutures.
Reconstructive plastic surgery
Reconstructive Plastic Surgery is performed to correct functional impairments caused by:
burns
traumatic injuries, such as facial bone fractures
congenital abnormalities, such as cleft lip, or cleft palate
developmental abnormalities
infection or disease
removal of cancers or tumours, such as a mastectomy for a breast cancer, a head and neck cancer and an abdominal invasion by a colon cancer
Reconstructive plastic surgery is usually performed to improve function, but it may be done to approximate a normal appearance. It is generally covered by insurance coverage but this may change according to the procedure required.
Common reconstructive surgical procedures are: breast reconstruction for women who have had a mastectomy, cleft lip and palate surgery, contracture surgery for burn survivors, creating a new outer ear when one is congenitally absent, and closing skin and mucosa defects after removal of tumors in the head and neck region.
Plastic surgeons developed the use of microsurgery to transfer tissue for coverage of a defect when no local tissue is available. tissue flaps comprised of skin, muscle, bone, fat or a combination, may be removed from the body, moved to another site on the body and reconnected to a blood supply by suturing arteries and veins as small as 1-2 mm in diameter.
Cosmetic surgery
Cosmetic Surgery defined as a subspecialty of surgery that uniquely restricts itself to the enhancement of appearance through surgical and medical techniques. It is specifically concerned with maintaining normal appearance, restoring it, or enhancing it beyond the average level toward some aesthetic ideal. In 2006, nearly 11 million cosmetic surgeries were performed in the United States alone.
It is important to distinguish the terms “plastic surgery” and “cosmetic surgery”: Plastic Surgery is a recognized surgical specialty and is defined as the subspecialty dedicated to the surgical repair of defects of form or function – this includes cosmetic (or aesthetic) surgery, as well as reconstructive surgery. The term “cosmetic surgery” however, refers to surgery that is designed to improve cosmetics alone. Many other surgical specialists are also required to learn certain cosmetic procedures during their training programs. Contributing disciplines include dermatology, general surgery, plastic surgery, otolaryngology, maxillofacial surgery, and oculoplastic surgery.
The most prevalent aesthetic/cosmetic procedures are listed below. Most of these types of surgery are more commonly known by their “common names.” These are also listed when pertinent.
Abdominal etching, or Ab etching, is used to contour and shape the abdominal fat pad to provide patients with a flat stomach.
Abdominoplasty (or “tummy tuck”): reshaping and firming of the abdomen
Blepharoplasty (or “eyelid surgery”): Reshaping of the eyelids or the application of permanent eyeliner, including Asian blepharoplasty
Mammoplasty
Breast augmentation (or “breast enlargement” or “boob job”): Augmentation of the breasts. This can involve either fat grafting, saline or silicone gel prosthetics. Initially performed to women with micromastia
Breast reduction: Removal of skin and glandular tissue. Indicated to reduce back and shoulder pain in women with gigantomastia and/or for psychological benefit in women with gigantomastia/macromastia and men with gynecomastia.
Breast lift (Mastopexy): Lifting or reshaping of breasts to make them less saggy, often after weight loss (after a pregnancy, for example). It involves removal of breast skin as opposed to glandular tissue.
Buttock Augmentation (or “butt augmentation” or “butt implants”): Enhancement of the buttocks. This procedure can be performed by using silicone implants or fat grafting and transfer from other areas of the body.
Chemical peel: Minimizing the appearance of acne, pock, and other scars as well as wrinkles (depending on concentration and type of agent used, except for deep furrows), solar lentigines (age spots, freckles), and photodamage in general. Chemical peels commonly involve carbolic acid (Phenol), trichloroacetic acid (TCA), glycolic acid (AHA), or salicylic acid (BHA) as the active agent.
Labiaplasty: Surgical reduction and reshaping of the labia
Rhinoplasty (or “nose job”): Reshaping of the nose
Otoplasty (or ear surgery): Reshaping of the ear
Rhytidectomy (or “face lift”): Removal of wrinkles and signs of aging from the face
Suction-Assisted Lipectomy (or liposuction): Removal of fat from the body
Chin augmentation: Augmentation of the chin with an implant (e.g. silicone) or by sliding genioplasty of the jawbone.
Cheek augmentation
Collagen, fat, and other tissue filler injections (e.g. hyaluronic acid)
Laser skin resurfacing
Male Pectoral Implant : It is a procedure used to enhance chest size in men by inserting silicone implants under the chest muscle.
In recent years, a growing number of patients seeking cosmetic surgery have visited other countries to find doctors with lower costs.[8] These medical tourists seek to get their procedures done for a cost savings in countries including Cuba, Thailand, Argentina, India, and some areas of eastern Europe. The risk of complications and the lack of after surgery support are often overlooked by those simply looking for the cheapest option.
Plastic surgery sub-specialities
Plastic surgery is a broad field, and may be subdivided further. Plastic surgery training and approval by the American Board of Plastic Surgery includes mastery of the following as well:
Craniofacial surgery is generally divided into pediatric and adult craniofacial surgery. Pediatric craniofacial surgery mostly revolves around the treatment of congenital anomalies of the craniofacial skeleton and soft tissues, such as cleft lip and palate, craniosynostosis, and pediatric fractures. Because these children have multiple issues, the best approach to providing care to them is an interdisciplinary approach which also includes otolaryngologists, speech therapists, occupational therapists and geneticists. Adult craniofacial surgery deals mostly with fractures and secondary surgeries (such as orbital reconstruction). Both subspecialities usually require advanced training in craniofacial surgery. The craniofacial surgery field is also practiced by maxillofacial surgeons (see craniofacial surgery).
Hand surgery is concerned with acute injuries and chronic diseases of the hand and wrist, correction of congenital malformations of the upper extremities, and peripheral nerve problems (such as brachial plexus injuries or carpal tunnel syndrome). Hand surgery is an important part of training in plastic surgery, as well as microsurgery, which is necessary to replant an amputated extremity. Most Hand surgeons will opt to complete a fellowship in Hand Surgery. The Hand surgery field is also practiced by orthopedic surgeons and general surgeons (see Hand surgeon).
Microsurgery is generally concerned with the reconstruction of missing tissues by transferring a piece of tissue to the reconstruction site and reconnecting blood vessels. Popular subspecialty areas are breast reconstruction, head and neck reconstruction, hand surgery/replantation, and brachial plexus surgery.
Burn surgery
Aesthetic or cosmetic surgery is concerned with the correction of form and aging. Plastic surgeons usually excel in this field because of their thorough knowledge of anatomy and extensive experience with reconstruction and congenital anomalies correction. Popular operations include amongst other breast augmentation, rhinoplasty, face lift, liposuction and mastopexy.
Pediatric plastic surgery. Children often face medical issues unique from the experiences of an adult patient. Many birth defects or syndromes present at birth are best treated in childhood, and pediatric plastic surgeons specialize in treating these conditions in children. Conditions commonly treated by pediatric plastic surgeons include craniofacial anomalies, cleft lip and palate and congenital hand deformities.
Although not a traditionally recognized plastic surgery subspecialty, facial plastic and reconstructive surgery is concerned with the aesthetic and reconstructive problems in the head and neck region. Facial plastic surgeons have extensive experience in the head and neck surgery after completing a five year otolaryngology residency, and subsequently one-year facial plastic and reconstructive surgery fellowship. However, facial plastic surgeons are not plastic surgeons in that their training does not encompass 3-7 years of general surgery training and 2-4 years of comprehensive plastic surgery training. Facial plastic
surgeons commonly performed procedure such as rhytidectomy, rhinoplasty, blepharoplasty, brow lifting, and skin cancer reconstruction.
Jokes, Qoutes and Use of Jokes in your Speeches
For A Best Man Speech?
Joke 1
The husband says to his wife, “You always carry my photo in your handbag to the office. Why?”
She says, “When there is a problem, no matter how impossible, I look at your picture and the problem disappears.”
He smirks and replies, “You see, how miraculous and powerful I am for you?”
She calmly replies, “Yes, I see your picture and say to myself, ‘What other problem can there be greater than this one?'”
Joke 2
In the Garden of Eden God called Adam to him and said, “Now I shall teach you how to kiss.”
“Lord, what is kiss?” asked Adam.
“I will show you,” said God and taught him all he needed to know about kissing. Whereupon Adam went to Eve and kissed her.
Then God called Adam back and said, “Now I shall teach you about intimacy.”
“Lord, what is Intimacy?” asked Adam.
“I will show you,” said God and taught him all he needed to know about intimacy. Adam then went to Eve, but came back almost immediately…
“Lord,” asked Adam, “what is headache?”
Joke 3
Two aerials met on a rooftop – fell in love – got married. The ceremony was rubbish but the reception was brilliant.
For Any Speech Or Presentation
Joke 1
If you think YOUR day is going bad, just check out this story!
Fire authorities in California found a corpse in a burned-out section of forest while assessing the damage done by a forest fire. The deceased male was dressed in a full wet suit, complete with scuba tanks on his back, flippers, and facemask.
A post-mortem test revealed that the man died not from burns, but from massive internal injuries. Dental records provided a positive identification. Investigators then set about to determine how a fully clad diver ended up in the middle of a forest fire.
It was revealed that on the day of the fire, the man went diving as an instructor off the coast, some 20 miles from the forest. The fire fighters, seeking to control the fire as quickly as possible, had called in a fleet of helicopters with very large dip buckets. Water was dipped from the ocean and emptied at the site of the forest fire.
You guessed it. One minute our diver was making like Flipper in the Pacific, the next, he was doing the breast stroke in a fire dip bucket 300 feet in the air. Some days it just doesn’t pay to get out of bed.
Joke 2
Two men are going down the street, one digs a hole the second fills it in.
They carry on down the street and again one digs a hole and the second fills it in.
A passer by is bemused by this and goes over to the Irish men and asks them “What on earth is going on?”.
One of the men replies saying, “Our mate who plants the trees is off ill today.”
For Business Speeches
Joke 1
A man is flying in a hot air balloon and realizes he is lost. He reduces height and spots a man down below. He lowers the balloon further and shouts: “Excuse me, can you tell me where I am?” The man below says: “Yes, you’re in a hot air balloon, hovering 30 feet above this field.”
You must be an engineer” says the balloonist.
“I am” replies the man. “How did you know.”
“Well, ” says the balloonist, “everything you have told me is technically correct, but it’s no use to anyone.”
The man below says “you must be in management.”
“I am” replies the balloonist, “but how did you know?”
“Well, ” says the man, “you don’t know where you are, or where you’re going, but you expect me to be able to help. You’re in the same position you were before we met, but now it’s my fault.”
Joke 2
How many union guys does it take to change a light bulb? Fifteen. You got a problem with that?
Joke 3
I was in the VIP lounge last week on my way to Seattle. While in the lounge, I noticed Bill Gates sitting in the corner enjoying a drink. I was meeting with a very important client who was also flying to Seattle with me but he was running a bit late.
Being a forward type of guy, I approached Mr. Gates and introduced myself. I explained to him that I was conducting some very important business.
I asked him if he would be willing to throw me a quick “Hello Chris” while I was with my client. He agreed.
A few minutes later while I was meeting with my client, I felt a tap on my shoulder. It was Bill Gates. I turned around and looked up at him.
He said, “Hi Chris, what’s happening?” To which I replied “Buzz off Gates, can’t you see I’m in a meeting!”
Joke 4
A young businessman had just started his own firm. He had just rented a beautiful office and had it furnished with antiques. He saw a man come into the outer office. Wishing to appear the hot shot, the businessman picked up the phone and started to pretend he had a big deal working. He threw huge figures around and made giant commitments.
Finally he hung up and asked the visitor, “Can I help you?”
“Yeah, I’ve come to activate your phone lines.”
Joke5
A preacher dies, and when he gets to Heaven, he sees a New York cab driver who has more crowns. He says to an angel, “I don’t get it. I devoted my whole life to my congregation.”
The angel says, “We reward results. Did your congregation always pay attention when you gave a sermon?”
The preacher says, “Once in a while someone fell asleep.”
The angel says, “Right. And when people rode in this guy’s taxi, they not only stayed awake, but they usually prayed!”
Joke6
An archaeologist was digging in the Negev Desert in Israel and came upon a casket containing a mummy. After examining it, he called the curator of a prestigious natural-history museum. “I’ve just discovered a 3,000 year-old mummy of a man who died of heart failure!” the excited scientist exclaimed.
To which the curator replied, “Bring him in. We’ll check it out.” A week later, the amazed curator called the archaeologist. “You were right about the mummy’s age and cause of death. How in the world did you know?”
“Easy. There was a piece of paper in his hand that said, ‘10,000 Shekels on Goliath’.”
Joke7
A Marketing Manager got married to a woman who had previously been married eight times. On his wedding night, his wife informed him that she was still a virgin. This was her explanation:
My first husband was a sales representative who spent our entire marriage telling me, in grandiose terms, “It’s gonna be great”!
My second husband was from software services; he was never quite sure how it was supposed to function, but he said he would send me the documentation.
My third husband was an accountant. His comments were that he knew how, but he just wasn’t sure whether or not it was his job.
My fourth husband was a teacher, and he simply said, “Those who can…do; those who can’t…teach”.
My fifth husband was an engineer. He told me that he understood the basic process but needed three years to research, implement, and design a new state-of-the-art method.
My sixth husband was a psychiatrist and all he ever wanted to do was talk about it.
My seventh husband was a help-desk coordinator and he kept teaching me how to do it myself.
My eighth husband was in technical support, and he kept saying, “Don’t worry, it’ll be up any minute now.”
The wife said sweetly to her new husband, “Now I am married to you, a man of marketing”. The husband looked at his wife and simply said, “I know I have the product, I’m just not sure how to position it”.
Joke8
How many archaeologists does it take to change a light bulb?
Three. One to change it while the other two argue about how old the old one is.
How many brewers does it take to change a light bulb?
Third as many as for a regular bulb.
How many carpenters does it take to change a light bulb?
“Sod you! That’s the electrician’s job.”
How many cashiers does it take to change a light bulb?
“Are you kidding? They won’t even change a five dollar bill.”
How many civil servants does it take to change a light bulb?
Twelve. One to change the bulb, and eleven to do the paperwork.
Joke9
A man was given the job of painting the white lines down the middle of a highway. On his first day he painted six miles; the next day three miles; the following day less than a mile. When the foreman asked the man why he kept painting less each day, he replied “I just can’t do any better. Each day I keep getting farther away from the paint can.”
Joke10
Those three boys are in the schoolyard bragging of how great their fathers are.
The first one says: “Well, my father runs the fastest. He can fire an arrow, and start to run, I tell you, he gets there before the arrow”.
The second one says: “Ha! You think that’s fast! My father is a hunter. He can shoot his gun and be there before the bullet”.
The third one listens to the other two and shakes his head. He then says: “You two know nothing about fast. My father is a civil servant. He stops working at 4:30 and he is home by 3:45”!!
Joke11
An unemployed guy got a new job at the zoo. They offered him to dress up in a gorilla’s skin and pretend to be a gorilla so people will keep coming to the zoo.
On his first day on the job, the guy puts on the skin and goes into the cage. The people all cheer to see him. He starts really putting on a show, jumping around, beating his chest and roaring.
During one acrobatic attempt, though, he loses his balance and crashes through some safety netting, landing square in the middle of the lion cage! As he lies there stunned, the lion roars. He’s terrified and starts screaming, “Help, Help!”
The lion races over to him, places his paws on his chest and hisses, “Shut up or we’ll both lose our jobs!”
Joke12
If lawyers are disbarred and clergymen defrocked, doesn’t it follow that electricians can be delighted, musicians denoted, cowboys deranged, models deposed and dry cleaners depressed?
Laundry workers could decrease, eventually becoming depressed and depleted! Even more, bedmakers will be debunked, baseball players will be debased, landscapers will be deflowered, bulldozer operators will be degraded, software engineers will be detested, and even musical composers will eventually decompose.
Joke13
A dog ran into a butcher shop and grabbed a roast off the counter. Fortunately, the butcher recognized the dog as belonging to a neighbor of his. The neighbor happened to be a lawyer.
Incensed at the theft, the butcher called up his neighbor and said, “Hey, if your dog stole a roast from my butcher shop, would you be liable for the cost of the meat?” The lawyer replied, “Of course, how much was the roast?” “$7.98.”
A few days later the butcher received a check in the mail for $7.98. Attached to it was an invoice that read: Legal Consultation Service: $150 .
Joke14
What’s the difference between a good lawyer and a bad lawyer?
A bad lawyer can let a case drag out for several years. A good lawyer can make it last even longer.
Joke15
A Mexican bandit made a specialty of crossing the Rio Grande from time to time and robbing banks in Texas. Finally, a reward was offered for his capture, and an enterprising Texas ranger decided to track him down.
After a lengthy search, he traced the bandit to his favorite cantina, snuck up behind him, put his trusty six-shooter to the bandit’s head, and said, “You’re under arrest. Tell me where you hid the loot or I’ll blow your brains out.”
But the bandit didn’t speak English, and the Ranger didn’t speak Spanish. Fortunately, a bilingual lawyer was in the saloon and translated the Ranger’s message. The terrified bandit blurted out, in Spanish, that the loot was buried under the oak tree in back of the cantina.
“What did he say?” asked the Ranger.
The lawyer answered, “He said ‘Get lost, you turkey. You wouldn’t dare shoot me.'”
Joke16
A lawyer opened the door of his BMW, when suddenly a car came along and hit the door, ripping it off completely. When the police arrived at the scene, the lawyer was complaining bitterly about the damage to his precious BMW.
“Officer, look what they’ve done to my Beeeemer!!!”, he whined.
“You lawyers are so materialistic, you make me sick!!!” retorted the officer, “You’re so worried about your stupid BMW, that you didn’t even notice that your left arm was ripped off!!!”
“Oh my gaaad….”, replied the lawyer, finally noticing the bloody left shoulder where his arm once was, “Where’s my Rolex???!!!!!”
Joke17
When the man in the street says: “If it ain’t broke, don’t fix it,” the lawyer writes:
“Insofar as manifestations of functional deficiencies are agreed by any and all concerned parties to be imperceivable, and are so stipulated, it is incumbent upon said heretofore mentioned parties to exercise the deferment of otherwise pertinent maintenance procedures.”
Joke18
A group of terrorists hijacked a plane full of lawyers. They called down to ground control with their list of demands and added that if their demands weren’t met, they would release one lawyer every hour.
Joke19
A little girl came home from school and said to her mother, “Mommy, today in school I was punished for something that I didn’t do.”
The mother exclaimed, “But that’s terrible! I’m going to have a talk with your teacher about this … by the way, what was it that you didn’t do?”
The little girl replied, “My homework.”
Joke20
Little Johnny returns from school and says he got an F in arithmetic.
“Why?” asks the father.
“The teacher asked ‘How much is 2×3?’ and I said ‘6’”
“But that’s right!”
“Then she asked me ‘How much is 3×2?'”
“What’s the fucking difference?”
“That’s exactly what I said!”
Joke21
“If there are any idiots in the room, will they please stand up” said the sarcastic teacher. After a long silence, one freshman rose to his feet.
“Now then mister, why do you consider yourself an idiot?” enquired the teacher with a sneer.
“Well, actually I don’t,” said the student, “but I hate to see you standing up there all by yourself.”
Joke22
The English teacher’s husband walked in and caught his wife sleeping with a young co-ed. He said, “Why, Susan, I’m surprised.” She bolted upright, pointed her finger and corrected him, “No. I am surprised. You are astonished.”
Joke23
The Evolution of a Math Problem
1950:
A lumberjack sells a truckload of lumber for $100. His cost of production is 4/5 of this price. What is his profit?
1960 (traditional math):
A lumberjack sells a truckload of lumber for $100. His cost of production is 4/5 of this price, or in other words $80. What is his profit?
1970 (new math):
A lumberjack exchanges a set L of lumber for a set M of money. The cardinality of set M is 100, and each element is worth $1. Make 100 dots representing the elements of set M. The set C is a subset of set M, of cardinality 80. What is the cardinality of the set P of profits, if P is the difference set M\C?
1980 (equal opportunity math):
A lumberjack sells a truckload of wood for $100. His or her cost of production is $80, and his or her profit is $20. Your assignment: Underline the number 20.
1990 (outcome based education):
By cutting down beautiful forest trees, a lumberperson makes $20. What do you think of his way of making a living? In your group, discuss how the forest birds and squirrels feel, and write an essay about it.
1995 (entrepreneurial math):
By laying off 402 of its lumberjacks, a company improves its stock price from $80 to $100. How much capital gain per share does the CEO make by exercising his stock options at $80? Assume capital gains are no longer taxed, because this encourages investment.
1998 (motivational math):
A logging company exports its wood-finishing jobs to its Indonesian subsidiary and lays off the corresponding half of its US workers (the higher-paid half). It clear-cuts 95% of the forest, leaving the rest for the spotted owl, and lays off all its remaining US workers. It tells the workers that the spotted owl is responsible for the absence of fellable trees and lobbies Congress for exemption from the Endangered Species Act. Congress instead exempts the company from all federal regulation. What is the return on investment of the lobbying?
Joke24
(On going to war over religion:) “You’re basically killing each other
to see who’s got the better imaginary friend.”
** Rich Jeni
“I found my wife in bed naked one day next to a Vietnamese guy and a
black guy. I took a picture and sent it to Benetton. You never know.”
** Franck Dubosc
“I got kicked out of Riverdance for using my arms.”
** Gary Valentine
(On the difference between men and women:) “On the one hand, we’ll
never experience childbirth. On the other hand, we can open all our
own jars.”
** Jeff Green
“And God said: ‘Let there be Satan, so people don’t blame everything
on Me. And let there be lawyers. so people don’t blame everything on
Satan.'”
** John Wing
“What are the three words guaranteed to humiliate men everywhere?
‘Hold my purse.'”
** Francois Morency
“The Web brings people together because no matter what kind of a
twisted sexual mutant you happen to be, you’ve got millions of pals
out there. Type in ‘Find people that have sex with goats that are on
fire’ and the computer will say, ‘Specify type of goat.'”
** Rich Jeni
“Luge strategy? Lie flat and try not to die.”
** Tim Steeves
“Women might be able to fake orgasms. But men can fake whole
relationships.”
** Jimmy Shubert
“There are only two reasons to sit in the back row of an airplane :
Either you have diarrhoea, or you’re anxious to meet people who do.”
** Rich Jeni
“My girlfriend always laughs during sex-no matter what she’s
reading.”
** Emo Philips
“What’s with squeegee kids? I mean, they don’t really wash the
windshield, do they? They simply redistribute the dirt.”
** Ken Scott
“Clinton lied. A man might forget where he parks or where he lives,
but he never forgets oral sex no matter how bad it is.”
** Lenny Clarke
“My cousin just died. He was only 19. He got stung by a bee – the
natural enemy of a tightrope walker.”
** Emo Philips
“I saw a woman wearing a sweatshirt with ‘Guess’ on it. I said,
‘Thyroid problem?'”
** Emo Philips
“Honesty is the key to a relationship. If you can fake that, you’re
in.”
** Rich Jeni
“Hockey is a sport for white men. Basketball is a sport for black
men. Golf is a sport for white men dressed like black pimps.”
** Ren Hicks
“Things you’ll never hear a woman say : ‘My, what an attractive
scrotum!'”
** Jeff Green
List of Top Ten Reasons to go to Work Naked: Top 10 Reasons to Work Naked Joke
Work can be so tedious. Day in and day out, the same reports, the same tiny cubicle. Icons in cornflower blue and TPS reports. Coming to work naked would definitely spice up the day, wouldn’t it? I wonder if you could get away with it on a Casual Friday. It would have to be on reaaaaaally casual Friday, wouldn’t it? You’d definitely blow that weird guy and his Hawaiian shirts out of the water. That shirt is hideous, isn’t it? On the upside, going to work naked means your shoes match no-matter what you’re not wearing….
1. Your boss is always yelling, “I wanna see your ass in here by 8:00!”
2. Can take advantage of computer monitor radiation to work on your tan.
3. “I’d love to chip in, but I left my wallet in my pants.”
4. To stop those creepy guys in Marketing from looking down your blouse.
5. You want to see if it’s like the dream.
6. So that with a little help from Muzak you can add “Exotic Dancer” to your exaggerated resume.
7. People stop stealing your pens after they’ve seen where you keep them.
8. Diverts attention from the fact that you also came to work drunk.
9. Gives “bad hair day” a whole new meaning.
10. No one steals your chair.
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“Quotes, Jokes & Ideas for a Wedding Speech
We have had a lot of requests in the past few months for some one liners for wedding speeches. We thought that it would be easy for people to find a good selection of these on the Internet – until we started looking. There are so many people trying to sell you something that we thought it was time that we put up this page to give you some free help with your wedding speech.
You may also wish to look at some one liners for a wedding speech, best man’s speech, bride speech, groom speech, maid of honour or
father of the bride.
We also have an article on how how to structure a wedding speech. This also contains information on the structure and etiquette of a wedding speech as well as the running order.
We also feature a selection of free wedding clip art.
Jokes and One Liners
Speech-making is a bit like prospecting for black gold. If you don’t strike oil in 10 minutes, stop boring.
I’m told that the best speech makers follow three simple rules. Stand Up. Speak Up. Then, very quickly, Shut Up. I’ll try to stick to that advice.
The brain is a wonderful thing. It never stops functioning from the time you’re born until the moment you stand up to make a speech. – Herbert V Prochnow and Herbert V Prochnow Jnr
Every man needs a wife because things sometimes go wrong that you can’t blame on the government! – Unknown
“How To be Happy Though Married” – book by Rev. E.J.Hardy, 1910
Advice to person about to marry – Don’t. – Punch magazine, 1845
Let’s have a wedding – Charles Dickens (Great Expectations)
Marriage has many pains, but celibacy has no pleasure – Dr. Johnson
Composed that monstrous animal a husband and a wife – Henry Fielding
The bridal day, which is not long… – Spenser
The guest are met, the feast is set
May’st hear the merry din
– Samuel Taylor Coleridge
Wedlock, indeed, hath oft compared been
To public feasts, where meet a public rout
Where they that are without would fain go in
And they that are within would fain go out
– Sir John Davies (17c.)
For a light wife doth make a heavy husband – Shakespeare
How to structure a wedding speech
In this article we describe how to structure a wedding speech and the required ettiquette . We explore the order that you need to follow as well as a few hints for planning and delivery.
We also have included links to some of our other pages with jokes and one liners to make your wedding speech more memorable.
The normal structure of your wedding speech depends upon the speech you are giving – whether it is as the best man, bride, groom or father of the bride.
Father of the Bride Speech
Traditionally you are the person who was paying for the wedding so it usually falls to you to start off the speeches.
– You welcome everyone to the wedding and the groom’s parents into the family
– Say how beautiful the bride looks (you then have the chance to recount a story about when she was younger)
– Welcome the groom into the family
– Offer some advice or words of wisdom about married life (often a good place to tell a joke or two)
– Thank anyone who has made the wedding special (caterers, vicar etc)
– Propose a toast to the bride and groom
If you do not have a master of ceremonies you will then need to introduce the groom to speak.
Bride Groom’s Speech
You start by welcoming everyone into the family and often to make a point of praising people who have come out of their way to be present.
– You thank the bride’s parents for raising such a nice daughter (historically this was to thank them for giving you her hand in marriage)
– You give some thanks to people who have made the wedding or reception special
– You say some nice words about the bride
– You propose a toast to the bridesmaids
– You also thank the best man for coming and you have the option to say a few brief words about him
If you do not have a master of ceremonies you then introduce the Best Man to speak.
Best man speech
You start by thanking the groom for asking you to be his best man.
– You tell a few funny stories about the Groom
– If you know the bride, you may be able to tell a few anecdotes about the bride (be extra careful about this)
– You have the option to read out a couple of cards from people who were not able to attend (be brief on this as it can be a bit boring for the audience)
– If you like you could propose a final toast to the bride and groom – wishing them happiness in their life together.
If there is no master of ceremonies you will need to introduce the next item – cutting of the cake – or thank the audience and invite them to carry on with enjoying themselves.
Bride’s speech
There is no traditional formal structure to a bride’s speech – mainly as in the Victorian past it was only men who were expected to speak. However as a guide I would recommend the following structure.
– Thank everyone for coming
– Highlight any people who would like to have come, but were unable to come due to poor health
– Possibly tell the story of how you met the groom (if appropriate)
– Tell an amusing story
– Any special words that you would like to say
Since there is no formal structure, you should make sure that you have told the master of ceremonies where you would like to be featured.
^ home ^ next page >> “Quotes, Jokes & Ideas for a Best Man’s Speech
You may also find our article on how how to structure a wedding speech useful. This also contains information on how to structure a best man’s speech.
We also have a range of example best man speeches that you can use, or if you are really pressed for time we even have a “fill in the blanks” that you can crib and pass off as your own.
•How to write a best man speech
•Fill in the blanks speech
•Example of a witty speech by Ryan Marshall
Doing your duty you also find that your groom is starting to panic. Well we have also thought of that and have got a couple of pages specially for him.
•Fill in the blanks groom speech example
•Jokes and one liners
^ home ^ next page >> “Quotes, Jokes & Ideas for a Best Man’s Speech
You may also find our article on how how to structure a wedding speech useful. This also contains information on how to structure a best man’s speech.
We also have a range of example best man speeches that you can use, or if you are really pressed for time we even have a “fill in the blanks” that you can crib and pass off as your own.
•How to write a best man speech
•Fill in the blanks speech
•Example of a witty speech by Ryan Marshall
Doing your duty you also find that your groom is starting to panic. Well we have also thought of that and have got a couple of pages specially for him.
•Fill in the blanks groom speech example
•Jokes and one liners
Best man Jokes and One liners
The trouble with being the best man at a wedding is that you never get to prove it.
Marriage is based on the theory that when a man discovers a particular brand of beer exactly to his taste, he should at once throw in his job and go to work in the brewery – George Nathan
Here’s to the groom, a man who keeps his head though he loses his heart.
I had to make sure that (grooms name) day went according to plan,
so I took it upon myself to check (grooms name) post. I need to tell (grooms name) that the carpet people cannot supply your carpet this weekend, but you will get your underfelt tonight!
What can you say about a man who came from humble beginnings and is now quickly rising to the very top of his profession based solely on intelligence, grit and the willpower to push on where others might fail? A man who is beginning to distinguish himself amongst his peers and where none can say a bad word against him? Well, that’s enough about the best man. I’m here to talk about _____.
I can honestly say that in all the years I’ve known him, no one has ever questioned _____’s intelligence. In fact, I’ve never heard anyone even mention it.
_____’s very classy. When we had an evening of music and drink in his house recently, I asked whether he had any Rachmaninoff. Gary replied he didn’t have any vodka, only beer.
I tell the people that on a night of recent revelry I asked the groom what he wanted to get from his marrage. He said “Well, I want to be a model husband. I want to be a model citizen.
And I want to be a model lover!” Being a naive chap I looked up “model” in the dictionary. It said “A small miniature replica of the real thing!”
To ____ and _______, may all their ups and downs be between the sheets.
Here’s to _____ a helluva pal, every girls guy and every guys gal.
He’s a prince, he’s a topper, he’s the King of the dance.
And he frightens the horses when he takes down his pants.
It is a woman’s business to get married as soon as possible, and a man’s to keep unmarried as long as he can – George Bernard Shaw
Let me not to the marriage of true minds admit impediments – Shakespeare
His designs were strictly honourable, as the saying is; that is, to rob a lady of her fortune by way of marriage – Henry Fielding
A happy bridesmaid makes a happy bride – Tennyson
There was an old party of Lyme
Who married three wives at a time/
When asked “Why the third?”
‘He replied “One’s absurd/
And bigamy, sir, is a crime!” – Cosmo Monkhouse (19c.)
It seemed to me pretty plain, that they had more of love than matrimony in them – Oliver Goldsmith (18c.)
There you are. We hope that you enjoy being the best man and good luck with the speech!
You may also find our article on how how to structure a wedding speech useful. This also contains information on how to structure a best man’s speech.
Here is a funny example of a best man speech that has given by our speech writer – Ryan Marshall
There are probably elements of it that you could use in your own best man speech.
Example of a Best Man’s Speech
Ladies and gentlemen; bride and groom.
May I first say that the bridesmaids are looking absolutely smashing today (winks and points to one in a flirtatious yet funny way), and, only rightly so, second to none to our lovely bride, Lauren. I’m sure you will all agree with me there.
For those of you who don’t know me, my name is Ryan Marshall, a long time friend of Thomas’. I’ve known Tom for 15 years; ever since I blew my nose on his glasses case back in school. Since then, we have had many epic adventures together: from running away from school, running from the police, bar brawls, women and trips around the world. So the time we have spent together means that Tom has, in a way, shaped my sense of humour – so if you find this speech rather unfunny, you can blame him.
So, Tom – my wingman; my partner in crime. After all of our evenings in the pub with Tom chasing women around the pool table with his tongue hanging out in a drunken stupor, he finally found the woman of his dreams. For those who entered the lottery of this magnificent number, and Tom, we all know your lucky number now, 86. So, if you have that raffle ticket there’s a free drink waiting at the bar for you.
But Tom and I have had many memorable experiences together, that even now we still share over a pint:
our days off school, Tom making a cigarette out of a piece of A4 paper, our trip to America and our falls down the ski slopes – too many times we have come close to death. And now I have the honour of sharing the top table with him and standing as his best man. And for that, thanks mate.
Last week I asked Tom what he wanted from the marriage; he said long lasting love and a family, and of course, Lauren. Later that day I asked Lauren the same question. She replied: a toaster and a microwave. You see men – some are easy to please.
But, as I have had my orders from Lauren and Tom not to mention the stag night at String-fellows, I have had no alternative in finding another funny and embarrassing story to share with you.
So here goes:
On our ski trip to America in 2002, Tom and I had to share a bed – so Lauren, I know what you’re going through. Here is the number of my therapist if you need him. But anyway, it was cold and snowy when we arrived. Tom has always been a joker and the first thing he did when we got to our hotel was hide a rubber snake in my bed. It was 3 in the morning when I discovered it, and I nearly fainted. But instead of helping me, Tom sat back with a cup of coffee and laughed until he cried.
Unamused, I plotted revenge. The next night I opened the patio door on our second floor room, and carried him outside whilst he was sleeping. After I had locked the door, I woke him up. He was in nothing but his underpants. I told him that if he didn’t apologise I wouldn’t let him in – being a stubborn 17 year old he refused and chose to climb down the drainpipe instead. Half way down I opened the door and went to watch – the sight was hilarious. Picture this: Tom, 30 feet above the floor in only his underpants and stuck as the ledge beneath him had broken. I couldn’t stop laughing, and had no way of helping him either.
As for him, it got worse. It started to snow. And snow heavy. After a few more minutes of laughter and bombarding him with snowballs, I began to worry. He was turning blue, but me being the brains of our operation, had a plan. I got dressed, went outside and placed a skip under him to cushion his landing. After persuading him, for around 5 minutes, to fall into it, he let go and missed the skip.
He never forgave me for misplacing the skip. Nor, for getting all our other school friends outside to watch him.
Anyway that’s enough embarrassment for him today.
Tom has been a changed man since he met Lauren – not going to the pub so often so that he can spend more time with her. And nowadays he always has the largest smile on his face, one that they both have and I hope will keep for the rest of their lives.
Finally, there are a couple of thank-you’s that I’ve been asked to say.
Firstly, the seating arrangers. There was a method to where you are seated – the gift list. Mentioning no names, but Sue and Barry at the back, thanks for the candles.
Secondly, there are two people who have worked very hard in making tonight possible, so first a round of applause for them. Ladies and gents, the bar staff.
But on a serious note now, a massive thank you to everyone who has contributed and made Tom and Laurens day so wonderful.
Ladies and gentlemen. Please could you all stand and raise your glasses, and join me in wishing them both all the love and happiness a couple can possibly have.
To Thomas and Lauren.
The Bride’s Speech
Why does a woman work for 10 years to change a man’s habits, and then complain he’s not the man she married? – Barbara Streisand
I require only three things of a man. He must be handsome, ruthless and stupid. – Dorothy Parker
Behind every great man there is a surprised woman. – Maryon Pearson
Husbands are like fires. They go out if left unattended. -Zsa Zsa Gabor
Most girls seem to marry men who happen to be like their fathers. Maybe that’s why so many mothers cry at weddings! – Jenny Éclair
I was at a wedding recently where the Bride gave a speech to thank everybody for their wedding presents. Unfortunately, she’d had a bit too much to drink, and, pointing at a shiny new coffee percolator, said, “And finally I’d like to thank my husband’s parents for giving me such a lovely perky copulator.
The best way to get husbands to do something is to suggest that perhaps they are too old to do it. – Shirley MacLaine
Why are women so much more interesting to men than men are to women? – Virginia Woolf
A young couple, just married, were in their honeymoon suite on their wedding night. As ____ undressed for bed, her husband (who was a burly bruiser) tossed his pants to his bride and said, “Here, put these on.” She put them on and the waist was twice the size of her body. “I can’t wear your pants,” she said. “That’s right,” said the husband, “and don’t you ever forget it. I’m the man who wears the pants in this family!” With that, she flipped him her panties and said, “Try these on.” He tried them on, and found he could only get them on as far as his kneecaps. He said, “Hell, I can’t get into your panties!” She said, “That’s right and that’s the way it’s going to be until your damn attitude changes.
Three women were talking about their love lives. The first said, “My husband is like a Rolls-Royce; smooth and sophisticated.” The second said, “Mine is like a Porsche; fast and powerful.” The third said, “Mine is like an old banger- he needs a hand start and I have to jump on while it’s still going.”
Never go to bed mad. Stay up and fight. (Phyllis Diller)
Every man should marry – and no woman – Bernjamin Disraeli
The amount of women in London who flirt with their own husbands is perfectly scandalous. It looks so bad. It is simply washing one’s clean linen in public – Oscar Wilde
Be plain in dress, and sober in your diet; In short, my deary, kiss me, and be quiet. — Lady Mary Wortley Montagu
^ home ^ next page >> “Quotes, Jokes & Ideas for a Bridegroom’s Speech
Why does a woman work for 10 years to change a man’s habits, and then complain he’s not the man she married? – Barbara Streisand
Many people say that your wedding day is the happiest day of your life. So, if that’s the case, I’d like to ask the husbands amongst you, does that mean it’s all downhill from here?
I remember the first time _____ and I dated. When I arrived at the house, her father said she was just putting the finishing touches to her make-up and would be down presently. Then he added, “Fancy a game of chess while you’re waiting?
A man inserted an ‘ad’ in the classified: “Wife wanted”. Next day he received a hundred letters. They all said the same thing: “You can have mine.”
My girlfriend told me I should be more affectionate. So I got myself two girlfriends.
Our parents helped us in every way, our friends encouraged us, and my girlfriend was a dream! There was only one thing bothering me and that was her younger sister. My prospective sister-in-law was twenty years of age, wore tight mini skirts and low cut blouses. She would regularly bend down when quite near me and I got many a pleasant view of her underwear. It had to be deliberate. She never did it when she was near anyone else. One day little sister called and asked me to come over to check the wedding invitations. She was alone when I arrived. She whispered to me that soon I was to be married, and she had feelings and desires for me that she couldn’t overcome and didn’t really want to overcome. She told me that she wanted to make love to me just once before I got married and committed my life to her sister. I was in total shock and couldn’t say a word.She said, “I’m going upstairs to my bedroom, and if you want to come up and get me.” I was stunned. I was frozen in shock as I watched her go up the stairs. When she reached the top she pulled down her panties and threw them down the stairs at me. I stood there for a moment, then turned and went straight to the front door. I opened the door and stepped out of the house. I walked straight towards my car. My future father-in-law was standing outside. With tears in his eyes he hugged me and said, “We are very happy that you have passed our little test. We couldn’t ask for better man for our daughter. Welcome to the family.” The moral of this story is: Always keep your condoms in your car.
Being a husband is a whole-time job. That is why so many husbands fail. They cannot give their entire attention to it – Arnold Bennett
‘Grow old along with me, The best is yet to be.’ – Robert Burns
I’d like to thank you for your presence and thank you for your presents – Steve Harris wedding speech in its entirety.
So there you are. I hope that you enjoy being a Bride Groom and enjoy the wedding. Good luck with the speech!
Jokes & Ideas for a Father of the Bride’s Speech
It was an emotional wedding. The mother of the bride cried. Even the cake was in tiers.
After a quarrel, a wife said to her husband, “You know, I was a fool when I married you.” The husband replied, “Yes, dear, but I was in love and didn’t notice.”
A man approached a very beautiful woman in a large supermarket and asked, “You know, I’ve lost my wife here in the supermarket. Can you talk to me for a couple of minutes?” “Why?” she asks. “Because every time I talk to a beautiful woman, my wife appears out of nowhere.”
There are only two times in a man’s life when he can’t understand a woman – before marriage and after marriage. (Anonymous)
Confucius say, “Man who sinks into woman’s arms;—Soon has his arms in woman’s sink”.—
We call him the exorcist in our house. Every time he comes around, he rids us of all our spirits.
Here’s to our wives and lovers. May they never meet.
Don’t marry for money; you can borrow it cheaper. – Scottish Proverb
The most effective way to remember your wedding anniversary is to forget once.
If you are afraid of loneliness, don’t marry. – Chekhov
A husband and wife are getting cosy in bed. The passion is heating up. But then the wife stops and says, ” I don’ t feel like it. I just want you to hold me.” The husband asks why. She explains that he must not be in tune with her emotional needs as a woman. The husband realizes that nothing is going to happen tonight and he might as well deal with it. So the next day the husband takes her shopping at a big dept. store. They walk around and she tries on three very expensive outfits. He then tells his wife “We’ll take all three of them”. They then get matching shoes, a set of diamond earrings and a diamond bracelet. The wife is so excited (she thinks her husband has flipped out, but she does not care) and goes to the pay desk. Her husband says, ” No – no – no, honey we ‘ re not going to buy all this stuff.”. His wife’s face goes blank. “No honey – I just want you to hold this stuff for a while. ” Her face gets really red and she is about to explode and then the husband says “You must not be in tune with my financial needs as a man!
Marriage is like wine – It gets better with age. – Dudley Moore
A toast to sweethearts – May all sweethearts become married couples, and may all married couples remain sweethearts. – Unknown
An archaeologist is the best husband a woman can have; the older she gets the more interested he is in her. – Agatha Christie
Whenever you’re wrong, admit it. Whenever you’re right, shut up. – Ogden Nash
A gentleman, who had been very unhappy in marriage, married immediately after his wife died: Johnson said, it was the triumph of hope over experience – Dr. Johnson
Strange to say what delight we married people have to see these poor fools decoyed into our condition – Samuel Pepys
If men knew how women pass the time when they are alone, they’d never marry – O. Henry
Marriage is like life in this – that it is a field of battle, and not a bed of roses – R.L. Stevenson
Marriage is popular because it combines the maximum of temptation with the maximum of opportunity – George Bernard Shaw
I am not against hasty marriages, where a mutual flame is fanned by an adequate income – Wilkie Collins
Though women are angels, yet wedlock’s the devil – Byron
There you are. I hope that you enjoy your role as the father of the bride and good luck with the speech!
We have put together an example of a Maid of Honor (Leading Bridesmaid) speech that you can customise to your own requirements.
You may also find our article on how how to structure a wedding speech useful. This also contains information on how to structure a best man’s speech.
Maid of Honor Speech
(To follow the best man’s speech.)
Thanks to .. (The best man) .. for his enlightening speech there. I think I speak for a couple of us who have learned something new about the groom there. I don’t quite know how I’m going to follow what the best man said, but I’ll give it a try. I’d like to start by saying thanks for the compliments but all the bridesmaids that are over a certain age are all spoken for, sorry!
But me and .. (the Best Man) .., the best man, do agree on two things: firstly, .. (the bride).., she does look fantastic, and the dress is amazing. I just feel sorry for whomever it is that’s picking up the bill for it. Only joking .. (the Groom) .. it wasn’t too expensive, but the dress and your lovely wife combined look a million dollars. And secondly, I think we all agree that the couple are a match made in heaven – the perfect couple.
Every couple will have their ups and their downs; it’s inevitable, and they’re bound to have their differences.
For example, I asked .. (The Groom) .. what he wanted from the marriage. He said to me that he wanted happiness, a family and to be with his lovely wife until the end of time. And when I asked .. (The bride) .. what she wanted from the marriage, she replied, a new George Forman grill and a toaster. Not quite the same as .. (the Groom) .. , but still at least she is easy to satisfy.
I’ve known .. (the Bride) .. for X amount of years now. I’ve seen her with old boyfriends, but never happy, or in love. That’s how I knew that .. (the Groom ) .. was the one for her. The first time I saw them together, she was a different person. She was relaxed, happy and carefree. This must have been the way that .. (the Groom) .. made her feel, like the princess she is. He has shown her that she is special and shown her true love. I know that if I am half as happy and loved as .. (the bride) .. is when I get married, I will be blessed. And .. (the bride and Groom) .., it’s hard to put into words how seeing you together, so happy, makes all of us here today feel. And when we all witnessed you in the church today make those vows we all knew they would last forever.
I know how insecure the bride has felt in relationships before and this morning she was a bag of nerves, wondering if .. (the Groom) .. will show and listing all the things that may have gone wrong. So .. (the Bride) .. , I’ll tell you again what I told you this morning; . .. (the Groom) .. loves you. Your new life as Mrs ??? is just starting, so enjoy it.
.. (The Bride,) .. it is a real honour to be your Maid of Honour. I am deeply moved for even knowing you, and even more so that you would grant me this opportunity. So thank you very much.
Ladies and Gentlemen, please could you stand and raise your glasses once again for the “Bride and Groom”.
“Long may their love and happiness last”.
Here is another example of our “fill in the blanks” wedding speeches – Father of the Bride
Every father knows that one day his daughter will find a great man, fly the nest and get married. Every father also wishes his daughter the best of luck in finding the right man, one that will make her happy beyond belief. And when the time comes when this happens, all the father can do is observe and hope for the best for her. Today, that is my role.
As a child, Karen was outgoing, strong and loving, something that she has brought into her adult life. But along the way she has picked up many skills, some from working and some from love. But everything she has done has made me the proudest father I know. Always wanting to become better in what she does, and being the generally caring person that she is, makes me unbelievably proud. When I was giving her away today, I cannot deny I felt a loss. After all, I was giving my daughter away to be married. But when we reached the altar, I felt something else, and for a while I didn’t know what it was. But then it dawned on me, that the feeling I was having was joy and happiness that I was giving my daughter away and that she was happy, happier than I have ever seen her.
When I first met her now husband, Paul, I instantly knew he was a good man, and would not be the type to mess my daughter around. Over the next few weeks I saw my daughter become happier and more confident in herself, wearing clothes that previously she had thought “made her bum look big”, or for other reasons chose not to wear. But Paul changed that. He has brought her out of her shell, let her be herself and not tried to change her to make him happy. After seeing how she was after the first couple of weeks, I hoped for her sake that it wouldn’t end, and leave her upset and heartbroken. But deep inside I think I knew that with her, I could trust Paul.
My main fear as a parent was my daughter making the wrong decisions in life; marrying for the wrong reasons was one of these. But once I had got to know Paul, I couldn’t have chosen anybody more suitable. Simply for the way he treats and makes my daughter feel about herself, I cannot thank him enough. So Paul, thank you.
Ladies and Gentlemen, I would finally like to say a couple of thank you messages. Firstly, to my daughter and her husband, for making me the happiest, proudest father around today. Thank you. Secondly, to all of you for joining us in our celebrations here today; you have all helped make it such a magnificent occasion.
I am sure that I could go on all day thanking everybody, but I won’t bore you all now, but I will say it to you when I see you. Thank you.
Ladies and Gentlemen, please join me as I wish the bride and groom all the happiness in the world. The Bride and Groom.
We accept no responsibility for these jokes!!!
Eye Health: Protecting Your Eyes During Allergy Season
Every season is allergy season. In the spring, it is the tree and flower pollen; with summer’s arrival the tree and flower pollen are joined by grass pollen; and in the fall it is weed pollen. The result? Red itchy eyes that also burn and sting. For some allergy sufferers in warmer parts of the country, these eye-aggravating allergies can be a bother for as many as 10 months out of the year.
How do I protect my eyes during allergy season?
Because seasonal allergies are most often caused by plant life that releases pollen into the air, they can be difficult to avoid. Nevertheless, there are some approaches that you can take to help lessen your allergy symptoms:
•Pay attention to the pollen reports. Your local weather channel or weather-related Internet site regularly gives the pollen counts for your area of the country. When pollen counts are high, restrict your outdoor activities when possible.
•Have someone else mow your grass when possible.
•Limit your exposure to wooded areas.
•Close your doors and windows and use your air conditioning during warmer months. However, because allergens are spread through the air, they can be circulated throughout the house through the air conditioning’s filter. If you have severe reactions to pollens, the use of air conditioning may not be wise if flare-ups are severe during this time.
•Consider purchasing a HEPA (high efficiency particulate air) filter. These filter systems are very effective at removing allergens from the air in your room or house.
Taking these preventive measures is often just the first step to controlling seasonal allergies. For many people, the next step is discussing with their doctor possible allergy drugs to help relieve their symptoms. There are many effective medications to help eliminate allergy symptoms, and by making a trip to the doctor for an eye allergy evaluation, he or she can prescribe the correct medication to help prevent irritation or itchiness from occurring.
Over-the-counter allergy drugs can also be purchased to help an eye allergy sufferer with mild symptoms. The medicine is usually less expensive than prescription medications and can clear up mild irritation. Eye drops are also available that can help wash out the eyes. The drops usually contain antihistamines and decongestants that help calm eye allergies.
Regardless of whether your medication is over-the-counter or prescribed, be sure to follow the directions exactly as stated by the label or by your doctor. If you have any questions about your medication, ask your doctor or pharmacist.
Eye Care
Eye Care
“Oh, something is wrong with my eye!” We have all said this at some time. How uncomfortable it can be! Fortunately, many common eye (ocular) disorders disappear without treatment or can be managed by self-treating. Various products — from artificial tears and ointments to ocular decongestants — are available over the counter (OTC). These products can help with dryness, itching, or excessive watering of the eye. However, a word of caution: In some instances, what may seem like a minor eye problem may lead to a severe, potentially blinding condition.
Many safe and effective OTC products for mild eye disorders are available for self-treatment. Two important factors to remember when considering self-treatment are: (1) if the problem appears to involve the eyeball itself, you should consult a physician immediately; and (2) if you use an OTC eye-care product for 72 hours without improvement of the condition being treated or the condition worsens, you also should see a doctor immediately. If blurring of vision or visual loss is one of your symptoms, see an ophthalmologist (MD) immediately.
To self-treat common ocular disorders with OTC eye-care products, viewers should understand: (1) the structure of the eye; (2) the cause of the disorder; (3) which disorders are safe to self-treat and which should be referred to a physician; (4) the types of OTC eye-care products that are available and the disorders in which they are useful.
What is the structure of the eye?
The eyes are complex sensory organs. About 85% of the total sensory input to our brains originates from our sense of sight, while the other 15% comes from the other four senses of hearing, smell, touch, and taste. The eyes are designed to optimize vision under conditions of varying light. Their location, on the outside of the face, makes them susceptible to trauma, environmental chemicals and particles, and infectious agents. The eyelids and the position of the eye within the bony orbital cavity are the major protective mechanism for the eye.
The eye itself has the shape of a sphere measuring about 1 inch in diameter. It consists of a clear, transparent dome at the front (the cornea) that is surrounded by the white of the eyeball (the sclera). The iris of the eye is the circular, colored portion within the eye, and behind the cornea, and the pupil is the central opening within the iris. Behind the iris and pupil is the eye’s lens. The space behind the back of the cornea and the front of the lens is called the anterior chamber and is filled with the aqueous fluid. Behind the lens is a large space that is filled by the transparent vitreous gel. The inside of the back of the eye is lined by the retina, the thin, light-sensitive tissue that changes light images to electrical signals via a chemical reaction. These electrical signals generated by the retina are sent to our brain through the optic nerve. Our brain interprets what our eyes see.
The inner sides of the eyelids, which touch the front surface of surface of the eye, are covered by a thin membrane (the palpebral conjunctiva) that produces mucus to lubricate the eye. This thin membrane folds back on itself and covers the visible sclera of the eyeball. (This continuation of the palpebral conjunctiva is called the bulbar conjunctiva.) Natural oil for the tears is produced by tiny glands located at the edges of the eyelids, providing additional lubrication for the eye. The main component of tears are formed by the lacrimal gland located under the upper lid at the outer corner of the eye. The tears are composed of a combination of the substances produced by the lacrimal gland, the oil glands, and the mucus glands. Tears flow toward the nasal side of the eye and drain into the lacrimal sac in the area between the eye and the side of the nose.
Which common disorders of the eye can (sometimes) be self-treated?
Blepharitis: Blepharitis is a common condition that is caused by inflammation of the eyelid. It results in red, scaly, and thickened eyelids and typically some loss of the eyelashes. Blepharitis may be due to either Staphylococcus epidermidis or Staphylococcus aureus (types of bacteria), seborrheic dermatitis (a type of skin inflammation of unknown cause), or a mixture of the two. It is sometimes associated with rosacea of the face. The most common complaints are itching, flaking of the lids, and burning. Blepharitis is initially treated by applying hot compresses to the affected eye, followed by an eyelid scrub. If the condition persists, you should see the doctor, who may prescribe antibiotics.
Lice: The eyelids can become infested with one of two different lice, the crab louse (Phthirus pubis) or the head louse (Pediculus humanus capitis). Lice in the eyelids cause symptoms and signs that are similar to those of blepharitis (red, scaly, and thickened eyelids, usually with some loss of the eyelashes). It is common in young school-age children. One can sometimes see movements of the adult lice at the base of the lashes. Petrolatum or a non-medicated ointment is applied to the eyelid and suffocates the lice eggs. RID, NIX, A-2000, or any other preparation that is designed for use in the hair should not be used near the eyes.
Contact dermatitis: Contact dermatitis is an inflammation of the skin that causes swelling, scaling, or redness of the eyelid with intense itching. This condition usually is triggered by the use of a new product (soap or makeup) or exposure to a foreign substance. If both the upper and lower eyelids are affected, the cause of the inflammation is likely to be an allergic reaction. Antihistamines that are taken by mouth can be used to treat contact dermatitis of the eyelid.
Foreign substance: Lint, dust, an eyelash, or other foreign matter can become stuck in the eye. When the substance cannot easily be removed either with your finger, water, or an eye irrigating solution, a doctor should be seen.
Thermal damage: Thermal damage is a burn injury to eye itself. Exposure to the sun’s UV radiation during outdoor activities is an example of minor ocular thermal damage. An eye lubricant can be applied to soothe the eye. If there is no relief to the eye after 24 hours, a physician should be seen. A more severe thermal injury to the eye, for example, from a welder’s arc or from sunlamp exposure, warrants the immediate attention of a doctor.
Conjunctivitis: Bacteria, viruses, fungi, allergy, or inflammation-promoting agents can cause inflammation of the palpebral and bulbar conjunctiva, also known as conjunctivitis. The inflammation causes enlargement of the blood vessels in the conjunctiva (“congestion”) and causes the conjunctiva to become red (“bloodshot”). Itchy eyes may or may not accompany the inflammation. The eyelids may be stuck together in the morning and there may be tearing or discharge from the eye or eyes. The congestion and itchiness can be temporarily treated with ocular decongestants, but the underlying cause may need treatment as well.
Dry eye: Dry eye is characterized by a white or mildly reddened eye combined with a sandy, gritty, dry feeling. Paradoxically, dry eye can sometimes be accompanied by excessive reflex tearing. The dryness itself can stimulate an increase in the production of tears. Dry eye, also known as KCS or keratoconjunctivitis sicca, is very common and is increasing in frequency due to an aging population and increased pollution in the air. Dry eye is more common in females. It is sometimes associated with dry mouth (Sjogren’s syndrome) or autoimmune diseases. Other factors thought to contribute to dry eye are some drugs such as antihistamines, antidepressants, or diuretics (water pills). There are many OTC eye drops available for the self-medication of dry eyes. These vary in their formulations, consistency, and preservatives used. Although these lubricants are effective for treating many cases of dry eye, a physician also should be consulted.
Hordeolum: Commonly referred to as a sty, a hordeolum is an inflammation of the glands within the eyelid. The primary sign of a hordeolum is a tender, raised nodule on the eyelid. Sometimes, the eyelid is so swollen that the eye appears to be completely shut. A hordeolum is usually caused by the same bacteria that are linked to blepharitis. Recurrent hordeolum can be associated with rosacea. Treatment usually is with hot compresses several times per day, but if the problem worsens or does not clear within a week, a physician should be seen. Antibiotics may be necessary.
Chalazion: A chalazion looks similar to a hordeolum. A chalazion is a raised nodule without the tenderness of a hordeolum. Like a hordeolum, it is treated with hot compresses. If the chalazion persists, a physician should be consulted.
What common eye conditions usually require treatment by a doctor?
Trauma: Blunt trauma to the eye requires immediate evaluation by an ophthalmologist or optometrist. Trauma to the eye can activate bleeding into the eye from ruptured blood vessels or cause detachment of the retina. Both situations can seriously impair vision.
Abrasion: An abrasion usually occurs when a fingernail or other foreign object rubs across the cornea or conjunctiva and removes some surface tissue. There is a risk of bacterial or fungal contamination and infection following an eye abrasion.
Chemical exposure: Exposure of the eye to household cleaning solutions, fumes, or an actual chemical splash requires immediate evaluation by a physician, though initially it may be self-treated with water or an irrigant.
Keratitis: Keratitis is an inflammation of the cornea that may occur alone or simultaneously with conjunctivitis. This inflammation may be infectious (resulting from a virus, bacteria, fungus, or parasite) or noninfectious in origin. The symptoms of keratitis include blurred vision, pain, and intolerance to light (photophobia).
Corneal swelling: Corneal swelling, or edema, is a condition in which fluid accumulates in the cornea. The edema causes visual disturbances such as halos or starbursts around lights. Reduced vision may or may not occur. Corneal swelling can arise as a complication of contact lenses, surgical damage to the cornea, or an inherited defect. Hyperosmotic drops or ointment can be used to treat corneal swelling, but additional treatment by a physician may be necessary.
Uveitis: Uveitis is an inflammation of the eye structures in the uveal tract (the iris and other structures within the eye to which the iris attaches). Uveitis may occur without an obvious cause or may be due to trauma or an inflammatory disease in other parts of the body. Symptoms and signs of uveitis include eye pain, tearing, light sensitivity, and visual blurring.
Acute angle-closure glaucoma: Angle-closure glaucoma is due to an obstruction of the system that drains aqueous fluid from the inside of the eye. As a result, fluid accumulates and the pressure within the eye increases. Patients usually have a tendency to develop angle-closure glaucoma because of crowding of the anatomy of the front of their eye. It is more common in people who are hyperopic (farsighted). This disorder may be triggered after an eye exam in which the pupils have been dilated or by taking certain oral medications in the susceptible individual. Common symptoms include a severe headache or eye pain accompanied by nausea and vomiting. Vision is also usually blurry. Angle-closure glaucoma should be suspected if these symptoms develop after an agent is used to dilate the pupils for an eye exam. Most patients with acute angle-closure glaucoma in one eye are at risk for developing it in the other eye.
What types of OTC eye-care products are there?
There are seven types of OTC eye-care products available. Each product contains one or more active and inactive ingredients.
1.Artificial tear drop: Lubricants (also called artificial tears) are synthetic (manmade), water-based solutions that are used to lubricate the eye and thicken tears. Artificial tears are formulated as solutions or suspensions, varying in viscosity. Popular examples of artificial tears include AquaSite, Bion Tears, Celluvisc, Duratears, Gen Teal, HypoTears, Liquifilm Tears, OcuCoat, Refresh, Systane, Tears Naturale, and TheraTears. Many people develop sensitivity to the preservatives in these solutions, causing increasing redness, burning or itching. Most of these products are also available in a preservative-free (PF) form. Artificial tears usually are used two to five times a day as needed for relief of symptoms.
2.Ointments or emollients: Ointments also are useful lubricants. These products are not water-based and contain lubricating ingredients similar to petroleum jelly. Examples of ointments include Lacri-Lube, Moisture Eyes PM, and Refresh PM. Their advantage over a water-based solution is that they remain in the eye longer. These ointments cause visual blurring immediately after their use. Therefore, they are often used only prior to sleep.
3.Eye washes: Eye washes (also known as ocular irrigants) are used to cleanse and/or rinse debris from the eye. These products are balanced to the proper acidity and electrolyte concentration so as to be non-irritating to the eye. Washes are available as liquids or drops. These products may contain boric acid with sodium borate, sodium phosphate, or sodium hydroxide to maintain the proper acidity. Examples of washes include AK Rinse, Dacriose, and Eye-Stream.
4.Hyperosmotics: Hyperosmotics are used to treat corneal swelling. Hyperosmotics draw water out of the cornea and thus reduce corneal swelling. Most OTC hyperosmotics contain sodium chloride in various concentrations as either a solution or an ointment. The 2% solution tends to cause less stinging and burning than the 5% solution. An example of a hyperosmotic for corneal swelling is Adsorbonac.
5.Scrubs: Eyelid scrubs are useful for removing oils, debris, or loose skin that can be associated with eyelid inflammation. Soap agents provide the foaming action. An example of this type of product is Eye-Scrub.
6.Decongestants: Decongestants are used to shrink swollen blood vessels in the congested (red) eye, for example, in conjunctivitis. Phenylephrine is the most common decongestant for this purpose. Patients at risk for angle-closure glaucoma should cautiously use phenylephrine because it can cause an attack of the disease. Rebound congestion, in which blood vessels become dilated even with continued use of decongestants, is a common side effect of phenylephrine. Therefore, if no improvement in redness or symptoms occurs within 72 hours of use, phenylephrine should be discontinued. A frequent side effect of phenylephrine is dilation of the pupils. If phenylephrine is absorbed from the eye into the body, an increase in blood pressure may occur, although this is rare. Nevertheless, patients with high blood pressure should be cautious in using phenylephrine. Additionally, if phenylephrine is absorbed, side effects may occur due to interactions with atropine, tricyclic antidepressants (imipramine) and monoamine oxidase inhibitors such as phenelzine sulfate (Nardil) or tranylcypromine sulfate (Parnate), reserpine (Hydropres), guanethidine (Ismelin), or methyldopa (Aldomet).
A second group of chemical decongestants are the imidazoles (naphazoline, tetrahydrozoline, and oxymetazoline). Imidazoles are longer acting than phenylephrine and have fewer side effects, including rebound congestion. Caution still is recommended with imidazoles because of the potential for an increase in blood pressure. Of the three imidazoles, oxymetazoline generally appears to exhibit the least side effects. Naphazoline may dilate pupils more in people with lightly pigmented (blue or green) eyes.
Examples of eye drops containing decongestants are Naphcon, Prefrin, and Opcon A.
7.Antihistamines: Ocular antihistamines are available OTC. These antihistamines are combined with ocular decongestants for the treatment of congestion (conjunctivitis), particularly when caused by allergy. Pheniramine maleate and antazoline both block histamine receptors in the eye, and thus provide relief from the symptoms of itchy, watery eyes. Antazoline may increase pressure slightly in the eye (of concern to patients with glaucoma) whereas pheniramine maleate has little effect on pressure. Common side effects of antihistamines include burning, stinging, and discomfort in the eye. Important side effects that may be associated with oral antihistamines have not been reported with ocular antihistamines. Antihistamines should not be used in patients at risk for developing angle-closure glaucoma. Examples of products that combine an antihistamine and decongestant are Naphcon A and Ocuhist.
8.Newer allergy eye-drop preparations: Recently, new classes of eye drops for the treatment of itching due to allergy have become available over the counter. Zaditor, a nonsteroidal antiinflammatory drop, is an example of these.
What inactive ingredients are contained in OTC eye-care products?
Most eye-care products contain ingredients that have no therapeutic value. If an individual has a known sensitivity to one or more of these ingredients, then products containing them should be avoided.
Vehicles: An ophthalmic vehicle is added to a product to enhance drug action by increasing the viscosity (thickness) of the product. Examples of ophthalmic vehicles are Dextran 70, gelatin, glycerin, poloxamer 407, and propylene glycol.
Preservatives: Preservatives are included to destroy or limit growth of bacteria that may be introduced into the product during repeated use. Examples of ophthalmic preservatives are benzalkonium chloride (BAK), cetylpyridinium chloride, chlorobutanol, methylparaben, sodium benzoate, and sorbic acid. To avoid allergies, many ophthalmic products are preservative free.
Excipients: An excipient is a substance that is added to provide physical form to the product, make it less irritating to the eye, or to preserve the ingredients within the product. Useful ophthalmic excipients are antioxidants, wetting agents, buffers, and tonicity adjusters.
Complete Cares During Pregnancy
Prenatal Care Before Getting Pregnant
Ideally, prenatal care should start before you get pregnant. If you’re planning a pregnancy, see your health care provider for a complete checkup. He or she can do routine testing to make sure you’re in good health and that you don’t have any illnesses or other conditions that could affect your pregnancy. If you’ve been experiencing any unusual symptoms, this is a good time to report them.
If you’re already being treated for a chronic condition, such as diabetes, asthma, hypertension (high blood pressure), a heart problem, allergies, lupus (an inflammatory disorder that can affect several body systems), depression, or some other condition, you should talk to your doctor about how it could affect your pregnancy. In some cases, you may need to change or eliminate medications — especially during the first trimester (12 weeks) — to reduce risk to the fetus. Or, you may need to be even more vigilant about managing your condition.
For example, women with diabetes must be especially careful about keeping their blood glucose levels under control, both before they begin trying to conceive and during their pregnancy. Abnormal levels increase the risk of birth defects and other complications.
This is also a good time to talk with your health care provider about other habits that can pose a risk to your baby, such as drinking alcohol or smoking. Ask about starting a prenatal vitamin that contains folic acid, calcium, and iron.
It’s especially important for women who are planning to become pregnant to take vitamins with folic acid beforehand, because neural tube defects (problems with the normal development of the spine and nervous system) happen in the first 28 days of pregnancy, often before a woman even knows she’s pregnant.
If you have or your partner has a family history of a significant genetic disorder and you suspect either of you may be a carrier, then genetic testing may be advisable. Talk this over with your health care provider, who can refer you to a genetic counselor if necessary.
If you find out that you’re pregnant before you do any of this, don’t worry. It’s not too late to get the care that will help to ensure your health and that of your baby.
Am I Pregnant?
If you’re unusually tuned into your body, you might begin to suspect that you’re pregnant within the first few days of pregnancy. Most women, however, don’t suspect they are pregnant until they miss a period, and a few don’t suspect or believe they are pregnant for months after conception.
Five very common signs of early pregnancy are as follows. You might experience all, some, or none of these symptoms, as pregnancy symptoms vary from woman to woman.
1. A missed period — Missing your period is the most clear-cut sign of pregnancy. But it is not definitive. Stress, excessive exercise, dieting, and other factors might cause irregular periods.
2. Frequent trips to the bathroom — Even before missing a period, many pregnant women report having to urinate more often. You might even have to get up during the night. This occurs after the embryo has implanted in the uterus and begins producing the pregnancy hormone called human chorionic gonadotropin (hCG). This hormone triggers frequent urination.
3. Fatigue — Utter exhaustion is a very early sign of pregnancy. Fatigue is a result of high levels of the hormone progesterone.
4. Morning (and noon and night.) sickness — Guess what? That queasy feeling isn’t limited to mornings. Most pregnant women who experience morning sickness — which can begin two weeks to two months after conception — feel slightly nauseated at other times during the day. About half have vomiting, but very few have severe enough morning sickness to develop dehydration and malnutrition.
5. Sore (and enlarging) breasts — If you’re pregnant, your breasts will probably become increasingly tender to the touch, similar to the way they feel before your period, only more so. Your nipples might also begin to darken and enlarge. Once your body grows accustomed to the increase in hormones, the pain will subside.
Other signs of pregnancy can include:
•Implantation bleeding (spotting) — Some women experience a light spotting or a brownish discharge. This spotting can occur at about the time the regular period would occur and can last for a few days to a few weeks.
•Food cravings, constant hunger — Some women begin to crave certain foods, constantly feel that they are hungry, or might avoid foods that they previously liked.
•Metallic taste in the mouth — Many women complain of a metallic taste in their mouths during the early stages of pregnancy.
•Headaches and dizziness — Headaches and the feelings of lightheadedness and dizziness are common during early pregnancy and are the result of hormonal changes and changes in blood volume.
•Cramping — Some women experience period-like cramps. If cramps are felt mainly on one side or are severe, it’s important to contact your doctor immediately.
Calculating Your Estimated Date:
One simple and common method for calculating your delivery date is as follows:
•Mark down the date when your last period started
•Add seven days
•Count back three months
•Add a whole year
For example, if the first day of your last period was September 9, 2000, adding 7 days will make the date September 16, 2000. Counting back 3 months results in the date of June 16. Finally, adding a year yields an estimated delivery date of June 16, 2001.
The above strategy is based on the assumption that conception occurred 14 days after the start of your last menstrual period. Also, it’s important to remember that no matter what ‘pen and paper’ calculations you use to estimate your delivery date, these methods are just that – estimates. Most babies are born between 38 and 42 weeks (the normal pregnancy is considered to be 40 weeks in length counting from the first day of your last menstrual cycle) and only a small percentage of women actually deliver on their estimated due date.
Your doctor can use more reliable methods to provide you with your delivery date, such as measuring the size of the uterus through a clinical exam or conducting an ultrasound examination.
Expecting Twin or Triplets
How do multiple pregnancies occur?
A multiple pregnancy occurs when one egg (ovum) splits before implanting or when separate eggs are each fertilized by a different sperm.
Identical twins or triplets occur with the fertilization of a single egg that later divides into two or three identical embryos. Identical twins or triplets have the same genetic identity, are always the same sex, and look almost exactly the same.
Fraternal multiples develop from separate eggs, each fertilized by a different sperm. Fraternal twins might or might not be of the same sex and might not necessarily resemble each other any more than two siblings from the same parents might.
In a pregnancy with triplets or more, the babies can be all identical, all fraternal, or a mixture of both. This can happen when multiple eggs are released by the mother and fertilized. If one or more of these fertilized eggs divides into two or more embryos, a mixture of identical and fraternal multiples will occur.
What increases the chance of a multiple pregnancy?
The chance that a woman will have fraternal multiples is higher if a woman is older, taller, and heavier. In addition, twins are more likely if a woman is herself a twin, or if having twins runs in the maternal side of the family. The use of fertility drugs increases a woman’s chance of having a multiple birth. Infertility procedures such as in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), and zygote intrafallopian transfer (ZIFT) increase the chance of a multiple pregnancy. These procedures often involve the transfer of more than one fertilized eggs into the mother’s womb to increase the odds of pregnancy occurring.
How common are multiple births?
Multiple births have become more common in recent years because more couples are using fertility drugs and treatments such as in-vitro fertilization (IVF) to help them conceive. In about 95 percent of multiple pregnancies, the mother is carrying twins.
What complications are linked to multiple births?
Most doctors consider multiple pregnancies higher risk than single pregnancies, but this does not mean that women who are pregnant with multiples automatically have problems. Some complications that can occur in multiple births include:
•Premature labor — The most common complication of multiple births is premature labor. Mothers carrying multiple babies go into premature labor (usually defined as before 37 weeks) more often than do women carrying only one baby. Many women strive to reach 38 weeks, considered full-term in a twin pregnancy, to increase the odds that their babies will be born healthy and at a good weight
•Pre-eclampsia, or pregnancy-induced high blood pressure — This complication occurs at twice the rate in women carrying multiples than in women pregnant with one baby. The condition also tends to develop earlier and be more severe in women carrying two or more babies.
•Placenta abruption — This condition occurs when the placenta detaches from the uterine wall before delivery. Placenta abruption is also more common when a woman is carrying more than one baby.
•Fetal growth restriction — This condition can occur when one or both twins is not growing at the proper rate. The condition might cause the babies to be born prematurely or at a low birth-weight. Up to nearly half of pregnancies with more than one baby have this problem, compared with slightly more than 10 percent of single pregnancies.
What can a woman do to stay healthy during a multiple pregnancy?
Eating nutritious foods, getting enough rest, and visiting the doctor regularly are important steps for any pregnant woman to take toward a healthy pregnancy, but these steps are particularly important during multiple pregnancies.
Women who are expecting multiple births have additional dietary needs to meet. Getting enough protein and enough hydration are important, as is getting extra calories for the developing fetuses. One rule of thumb is to eat an extra 300 calories a day per baby that is expected.
Women who are expecting multiples can experience the typical discomforts of pregnancy more intensely. Good self-care and getting plenty of rest can help to ease the stress of pregnancy.
Finally, women expecting multiples should find health care professionals who have experience with multiple births. Specialized health care can help ensure that mother and babies receive the best care available. The need for frequent, intensive prenatal care is very important in a multiple pregnancy. A family doctor or obstetrician/gynecologist can recommend a facility that specializes in multiple births.
Medical Care During Pregnancy
According to the Centers for Disease Control and Prevention (CDC), almost 4 million American women give birth every year. Nearly one third of them will have some kind of pregnancy-related complication. Those who don’t get adequate prenatal care run the risk that such complications will go undetected or won’t be dealt with soon enough. That, in turn, can lead to potentially serious consequences for both the mother and her baby.
These statistics aren’t meant to alarm you, but rather to convey the importance of starting prenatal care as early as possible — ideally, before you even become pregnant. Of course, this isn’t always possible or practical. But the sooner in your pregnancy you begin, the better your chances of ensuring your own health and that of your baby.
Finding Medical Care
Pregnant women are typically cared for by:
•obstetricians (doctors who specialize in pregnancy and childbirth)
•obstetricians/gynecologists (OB/GYNs) (doctors who specialize in pregnancy and childbirth, as well as women’s health care)
•family practitioners (doctors who provide a range of services for patients of all ages — in some cases, this includes obstetrical care — instead of specializing in one area)
•certified nurse-midwife (an advanced practice nurse specializing in women’s health care needs, including prenatal care, labor and delivery, and postpartum care for pregnancies without complications)
Any of these care providers is a good choice if you’re healthy and there’s no reason to anticipate complications with your pregnancy and delivery. However, nurse-midwives do need to have a doctor available for the delivery in case a cesarean section has to be performed.
Your health care provider may refer you to a doctor with expertise in high-risk pregnancies if you:
•have a chronic condition like diabetes or heart problems
•have an increased risk of preterm labor
•are older than 35
•have some other complicating factor that might put you in a high-risk category
Even if your pregnancy isn’t high-risk, this may still be a good time to make a change in health care providers if you’re not comfortable with your current doctor.
Your First Visit
Your should call and schedule your first examination during the first 6 to 8 weeks of your pregnancy, or when your menstrual period is 2 to 4 weeks late. Doing so now helps your health care provider estimate the duration of your pregnancy and predict your delivery date.
During your first visit, you can expect to have a full physical, including a pelvic and rectal examination. A blood sample will be taken and used for a series of tests:
•a complete blood cell count (CBC)
•blood typing and screening for Rh antibodies (antibodies against a substance found in the red blood cells of most people)
•for syphilis, hepatitis, gonorrhea, chlamydia, and other sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV)
•for evidence of previous exposure to chickenpox (varicella), measles (rubeola), mumps, or German measles (rubella)
•for cystic fibrosis (health care providers have just recently started to routinely offer this to individuals even if there’s no family history of the disorder)
Women of African or Mediterranean descent are usually tested for sickle cell trait or disease because they’re at higher risk for having sickle cell anemia — a chronic blood disease — or carrying the trait, which can be passed on to their children.
During the first visit, you also can expect to provide a urine sample for testing and to have a Pap test (or smear) for cervical cancer. To do a Pap smear, your health care provider uses what looks like a very long mascara wand or cotton swab to gently scrape the inside of the cervix (the opening to the uterus that’s located at the very top of the vagina). This generally doesn’t hurt; some women say they feel a little twinge, but it only lasts a second.
Routine Visits and Testing
If you’re healthy and there are no complicating risk factors, you can expect to see your health care provider:
•every 4 weeks until the 28th week of pregnancy
•then every 2 weeks until 36 weeks
•then once a week until delivery
At each examination, your weight and blood pressure are usually recorded. The size and shape of your uterus may also be measured, starting at the 22nd week, to determine whether the fetus is growing and developing normally.
During one or more of your visits, you’ll be asked to provide a small urine sample to be tested for sugar and protein. Protein may indicate preeclampsia (a condition that develops in late pregnancy and is characterized by a sudden rise in blood pressure and excessive weight gain, with fluid retention and protein in the urine).
Screening for diabetes usually takes place at 12 weeks for women who are at higher risk of having gestational diabetes (diabetes that occurs during pregnancy). That includes women who:
•have previously had a baby that weighs more than 9 pounds (4.1 kilograms)
•have a family history of diabetes
•are obese
All other pregnant women are tested for diabetes at 24 to 28 weeks. This test involves drinking a sugary liquid and having a blood glucose test (which involves having blood drawn) after an hour. If the sugar level in the blood is high, further testing may be done to diagnose gestational diabetes.
Many expectant parents also choose to have one or more of the following prenatal tests, which can help predict the likelihood, or even detect the presence, of certain developmental or chromosomal abnormalities in the fetus:
Alpha-fetoprotein screening (AFP): Between 16 and 18 weeks, the level of alpha-fetoprotein, a protein produced by the fetus, can be measured in the woman’s blood. If the level is high, she may be carrying more than one fetus or a fetus with spina bifida or other neural tube defects. A high level can also indicate that the date of conception was miscalculated. If the level is low, the fetus may have chromosomal abnormalities, such as Down syndrome. It’s important to keep in mind that low or high results don’t automatically indicate a problem; rather, they indicate the need for further testing, which yields normal results in many cases.
Multiple marker screening (also called a maternal serum screening, triple screen, triple marker, quadruple screen, quad screen, quadruple marker, or quad marker): Also between 16 and 18 weeks, your health care provider may measure the levels of certain hormones in your blood, along with AFP. For this screening, a sample of blood is drawn from the mother to measure the level of AFP, as well as the levels of hCG (human chorionic gonadotropin) and estriol, which are produced by the placenta. The levels of these three substances (which is why the test is often called the triple screen or triple marker) in the blood can help doctors identify a fetus at risk for certain birth defects or chromosomal abnormalities. The test is called a quadruple screen (or marker) when the level of an additional substance, called inhibin-A, is also measured.
Amniocentesis (also called an amnio): In this test, a needle is used to remove a sample of the amniotic fluid from the womb; it’s generally performed between 15 and 20 weeks. Testing the fluid can identify certain fetal abnormalities such as Down syndrome or spina bifida. Typically, amniocentesis is recommended only if there is reason to believe that the risk for such conditions is higher than usual, perhaps due to maternal age (35 or older), abnormal AFP or multiple marker screening results, or family history. Although the test poses a small risk for causing preterm labor and inducing miscarriage, the large majority are performed without any problem.
Chorionic villus sampling (CVS): This procedure is used during the first trimester for the same purposes as an amniocentesis. (Women usually have one or the other, but not both, if such testing is deemed necessary.) It involves taking a sample of the tissue that attaches the amniotic sac (the sac around the fetus) to the wall of the uterus. Like amniocentesis, CVS is typically done only when there are certain risk factors; its primary advantage is that results are available sooner. CVS also carries a slightly increased risk of miscarriage and other complications.
Ultrasound (also called a sonogram, sonograph, echogram, or ultrasonogram): You’ll likely have at least one ultrasound examination to make sure the pregnancy is progressing normally and to verify the expected date of delivery. Usually, an ultrasound is performed at 18 to 20 weeks to look at the baby’s anatomy, but can be done sooner or later and sometimes more than once. An ultrasound poses no risk to you or your baby.
Some health care providers may have the equipment and trained personnel necessary to provide in-office ultrasounds, whereas others may have you go to a local hospital or radiology center.
Wherever the ultrasound is done, a technician will coat your abdomen with a gel and then run a wand-like instrument over it. High-frequency sound waves “echo” off your body and create a picture of the fetus inside on a computer screen.
Ultrasound scanning is used to:
•determine whether the fetus is growing at a normal rate
•record fetal heartbeat or breathing movements
•see whether you might be carrying more than one fetus
•identify a variety of abnormalities that might affect the remainder of the pregnancy or delivery
There are ultrasounds available at shopping malls as a way to have a “portrait” of your baby. However, the individuals using the equipment are not necessarily trained as ultrasound technicians. Before committing to having one of these done, it would be wise to discuss it with your health care provider.
Common Concerns
Some women are concerned about preexisting medical conditions, such as diabetes, and how they could affect a pregnancy. It’s important to discuss these concerns with your health care provider, who may recommend a change in medication or treatment approaches that could ease your concerns.
Whether or not you have a preexisting condition, you may be concerned about some of the other conditions that can be associated with pregnancy including:
•gestational diabetes: Up to 8% of pregnant women develop this condition, usually after the first trimester. During pregnancy, the placenta, which provides the fetus with nutrients and oxygen, also produces hormones that change the way insulin works. Insulin is a substance that’s made by the pancreas. It helps the body store the sugar in food so that later it can be converted to energy. When someone has gestational diabetes, the problem with the insulin leads to a high blood sugar level as well.
•preeclampsia (also called toxemia of pregnancy): An abnormal condition that develops after the sixth month, it causes high blood pressure, edema (accumulation of fluid in body tissues resulting in swelling of the hands, feet, or face), and protein in the urine.
•Rh-negative mother/Rh-positive fetus (also called Rh incompatibility): Rh factor is a substance found in the red blood cells of most people (a simple blood test can determine your Rh factor). If you don’t have it, then you’re considered Rh negative. If your baby does have the factor and is Rh positive, problems can result when the baby’s blood cells enter your bloodstream. That’s because your body may react by producing antibodies that can pass into the fetus’ bloodstream and destroy red blood cells.
These conditions are serious but manageable, so it’s important to educate yourself about them and discuss them with your health care provider.
Pregnant women also frequently worry about weight gain. It’s generally recommended that a woman of normal weight gain approximately 25 to 30 pounds during pregnancy. For individuals who start their pregnancy overweight, their total weight gain should be closer to 15 to 25 pounds. And those who are underweight should gain 28 to 40 pounds.
Pregnancy is not a good time to start a diet, however, it can be a great time to start eating healthy food if you didn’t before. It’s also a good time to get regular, low-impact exercise.
Controlling weight gain is more difficult later in a pregnancy, so try to avoid gaining a lot of weight during the first few months. However, not gaining enough weight can cause problems too, such as inadequate fetal growth and premature labor.
Taking Care of Yourself
For your baby’s sake and yours, it’s important to take especially good care of yourself during your pregnancy. Follow the basics:
•Don’t smoke, drink alcohol, or take drugs.
•Get enough rest.
•Eat a healthy diet.
Doctors generally recommend that women add about 300 calories to their daily intake to provide nourishment for the developing fetus. Although protein should supply most of these calories, your diet needs to be well-balanced, including fresh fruits, grains, and vegetables. Your health care provider will likely prescribe a prenatal vitamin to make sure you get enough folic acid, iron, and calcium.
Over-the-counter medications are generally considered off-limits because of their potential effects on the fetus. Most doctors will recommend that you don’t take any over-the-counter medications at all, but they might offer a list of those they think are safe to take. Be sure to discuss any questions about medications, including natural remedies, supplements, and vitamins, with your health care provider.
When you’re pregnant, it’s also important to avoid food-borne illnesses, such as listeriosis and toxoplasmosis, which can be life threatening to an unborn baby and may cause birth defects or miscarriage. Foods you’ll want to steer clear of include:
•soft, unpasteurized cheeses (often advertised as “fresh”) such as feta, goat, Brie, Camembert, and blue cheese
•unpasteurized milk, juices, and apple cider
•raw eggs or foods containing raw eggs, including mousse and tiramisu
•raw or undercooked meats, fish, or shellfish
•processed meats such as hot dogs and deli meats (these should be well cooked)
You should also avoid eating shark, swordfish, king mackerel, or tilefish. Although fish and shellfish can be an extremely healthy part of your pregnancy diet (they contain beneficial omega-3 fatty acids and are high in protein and low in saturated fat), these types of fish may contain high levels of mercury, which can cause damage to the developing brain of a fetus.
Pregnancy also can cause a number of uncomfortable, although not necessarily serious, side effects, including:
•nausea and vomiting, especially early in the pregnancy
•leg swelling
•varicose veins in the legs and the area around the vaginal opening
•hemorrhoids
•heartburn and constipation
•backache
•fatigue
•sleep loss
If you experience one or more of these side effects, keep in mind that you’re not alone! Talk to your doctor about strategies for alleviating any discomfort.
Talking to Your Health Care Provider
When your body is going through physical changes that may be completely new to you, it isn’t always easy to talk to your health care provider. Maybe you’re wondering whether you can have sex or what to do about hemorrhoids or constipation, or maybe you’re feeling a great deal of anxiety about the delivery.
You might feel embarrassed to ask these or other questions, but it’s important to do so — your health care provider has probably heard them all before. Keep a running list of questions between your appointments, and take that list with you to each visit.
It’s also strongly recommended that you call your health care provider immediately if you experience:
•heavy bleeding
•a sudden loss of fluid
•a marked absence of movement by the baby once he or she has begun moving
•more than three contractions in an hour
Staying Healthy During Pregnancy:
Now that you’re pregnant, taking care of yourself has never been more important. Of course, you’ll probably get advice from everyone — your doctor, family members, friends, co-workers, and even complete strangers — about what you should and shouldn’t be doing.
But staying healthy during pregnancy depends on you, so it’s crucial to arm yourself with information about the many ways to keep you and your baby as healthy as possible.
Prenatal Health Care
Key to protecting the health of your child is to get regular prenatal care. If you think you’re pregnant, call your health care provider to schedule an appointment. You should schedule your first examination as soon as you think that you are pregnant.
At this first visit, your health care provider likely do a pregnancy test, and will figure out how many weeks pregnant you are based on a physical examination and the date of your last period. He or she will also use this information to predict your delivery date (however, an ultrasound performed sometime during your pregnancy will help to verify that date).
If you’re healthy and there are no complicating risk factors, most health care providers will want to see you:
•every 4 weeks until the 28th week of pregnancy
•then every 2 weeks until 36 weeks
•then once a week until delivery
Throughout your pregnancy, your health care provider will check your weight and blood pressure while also checking the growth and development of your baby (by doing things like feeling your abdomen, listening for the fetal heartbeat starting during the second trimester, and measuring your belly). During the span of your pregnancy, you’ll also have prenatal tests, including blood, urine, and cervical tests, and probably at least one ultrasound.
If you still need to choose a health care provider to counsel and treat you during your pregnancy, there are several options:
•obstetricians/gynecologists (also known as OB/GYNs — doctors who specialize in pregnancy and childbirth, as well as women’s health care)
•family practitioners (doctors who provide a range of services for patients of all ages — in some cases, this includes obstetrical care)
•certified nurse-midwives (advanced practice nurses specializing in women’s health care needs, including prenatal care, labor and delivery, and postpartum care for uncomplicated pregnancies; there are also other kinds of midwives, but you should look for one with formal training who’s been certified in the field)
Any of these is a good choice if you’re healthy and there’s no reason to anticipate complications with your pregnancy and delivery. However, nurse-midwives do need to have a doctor available for the delivery in case an unexpected problem arises or a cesarean section (C-section) has to be performed.
Nutrition and Supplements
Now that you’re eating for two (or more!), this is not the time to cut calories or go on a diet. In fact, it’s just the opposite — you need about 300 extra calories a day, especially later in your pregnancy when your baby grows quickly. If you’re very thin, very active, or carrying multiples, you’ll need even more. But if you’re overweight, your health care provider may advise that you consume fewer extra calories.
Healthy eating is always important, but especially when you’re pregnant. So, make sure your calories come from nutritious foods that will contribute to your baby’s growth and development.
Try to maintain a well-balanced diet that incorporates the dietary guidelines including:
•lean meats
•fruits
•vegetables
•whole-grain breads
•low-fat dairy product
By eating a healthy, balanced diet you’re more likely to get the nutrients you need. But you will need more of the essential nutrients (especially calcium, iron, and folic acid) than you did before you became pregnant. Your health care provider will prescribe prenatal vitamins to be sure both you and your growing baby are getting enough.
But taking prenatal vitamins doesn’t mean you can eat a diet that’s lacking in nutrients. It’s important to remember that you still need to eat well while pregnant. Prenatal vitamins are meant to supplement your diet not be your only source of much-needed nutrients.
Calcium
Most women 19 and older — including those who are pregnant — don’t often get the daily 1,000 mg of calcium that’s recommended. Because your growing baby’s calcium demands are high, you should increase your calcium consumption to prevent a loss of calcium from your own bones. Your doctor will also likely prescribe prenatal vitamins for you, which may contain some extra calcium.
Good sources of calcium include:
•low-fat dairy products including milk, pasteurized cheese, and yogurt
•calcium-fortified products, including orange juice, soy milk, and cereals
•dark green vegetables including spinach, kale, and broccoli
•tofu
•dried beans
•almonds
Iron
Pregnant women need about 30 mg of iron every day. Why? Because iron is needed to make hemoglobin, the oxygen-carrying component of red blood cells. Red blood cells circulate throughout the body to deliver oxygen to all its cells.
Without enough iron, the body can’t make enough red blood cells and the body’s tissues and organs won’t get the oxygen they need to function well. So it’s especially important for pregnant women to get enough iron in their daily diets — for themselves and their growing babies.
Although the nutrient can be found in various kinds of foods, iron from meat sources is more easily absorbed by the body than iron found in plant foods. Iron-rich foods include:
•red meat
•dark poultry
•salmon
•eggs
•tofu
•enriched grains
•dried beans and peas
•dried fruits
•dark leafy green vegetables
•blackstrap molasses
•iron-fortified breakfast cereals
Folate (Folic Acid)
The Centers for Disease Control and Prevention (CDC) recommends that all women of childbearing age — and especially those who are planning a pregnancy — get about 400 micrograms (0.4 milligrams) of folic acid supplements every day. That can be from a multivitamin or folic acid supplement in addition to the folic acid found in food.
So, why is folic acid so important? Studies have shown that taking folic acid supplements 1 month prior to and throughout the first 3 months of pregnancy decrease the risk of neural tube defects by up to 70%.
The neural tube — formed during the several weeks of the pregnancy, possibly before a woman even knows she’s pregnant — goes on to become the baby’s developing brain and spinal cord. When the neural tube doesn’t form properly, the result is a neural tube defect such as spina bifida.
Again, your health care provider can prescribe a prenatal vitamin that contains the right amount of folic acid. Some pregnancy health care providers even recommend taking an additional folic acid supplement, especially if a woman has previously had a child with a neural tube defect.
If you’re buying an over-the-counter supplement, keep in mind that most multivitamins contain folic acid, but not all of them have enough folic acid to meet the nutritional needs of a pregnant woman. So, be sure to check labels carefully before choosing one and check with your health care provider.
Fluids
It’s also important to drink plenty of fluids, especially water, during pregnancy. A woman’s blood volume increases dramatically during pregnancy, and drinking enough water each day can help prevent common problems such as dehydration and constipation.
Exercise
The U.S. Department of Health and Human Services recommends at least 150 minutes (that’s 2 hours and 30 minutes) of moderate-intensity aerobic activity each week if you’re not already highly active or doing vigorous-intensity activity. If you are very active or did intense aerobic activities before becoming pregnant, you may be able to keep up your workouts, as long as your doctor says it’s safe. Before beginning — or continuing — any exercise regimen talk to your doctor first.
Exercising during pregnancy has been shown to be extremely beneficial. Regular exercise can help:
•prevent excess weight gain
•reduce pregnancy related problems, like back pain, swelling, and constipation
•improve sleep
•increase energy
•improve outlook
•prepare for labor
•lessen recovery time
Low-impact, moderate-intensity exercise activities (such as walking and swimming) are great choices. You can also opt for yoga or Pilates classes, DVDs, or videos that are tailored for pregnancy. These are both low-impact and work on strength, flexibility, and relaxation.
But you should limit high-impact aerobics and avoid certain sports and activities that pose a risk of falling or abdominal injury. Typical limitations include contact sports, downhill skiing, and horseback riding.
It’s also important to be aware of how your body changes. During pregnancy, your body produces a hormone known as relaxin, which is believed to help prepare the pubic area and the cervix for the birth. The relaxin loosens the ligaments in your body, making you less stable and more prone to injury.
So, it’s easy to overstretch or strain yourself, especially the joints in your pelvis, lower back, and knees. In addition, your center of gravity shifts as your pregnancy progresses, so you may feel off-balance and at risk of falling. Keep these in mind when you choose an activity and don’t overdo it.
Whatever type of exercise you choose, make sure to take frequent breaks and remember to drink plenty of fluids. And use common sense — slow down or stop if you get short of breath or feel uncomfortable. If you have any questions about doing a certain sport or activity during your pregnancy, talk to your health care provider for specific guidelines.
Sleep
It’s important to get enough sleep during your pregnancy. Your body is working hard to accommodate a new life, so you’ll probably feel more tired than usual. And as your baby gets bigger, it will be harder to find a comfortable position when you’re trying to sleep.
Lying on your side with your knees bent is likely to be the most comfortable position as your pregnancy progresses. It also makes your heart’s job easier because it keeps the baby’s weight from applying pressure to the large blood vessels that carry blood to and from your heart and your feet and legs. Lying on your side can also help prevent or reduce varicose veins, hemorrhoids, and swelling in your legs.
Some doctors specifically recommend that pregnant women sleep on the left side. Because one of those big blood vessels is on the right side of your abdomen, lying on your left side helps keep the uterus off of it. Lying on your left side optimizes blood flow to the placenta and, therefore, your baby.
Ask what your health care provider recommends. In most cases, lying on either side should do the trick and help take some pressure off your back. To create a more comfortable resting position either way, prop pillows between your legs, behind your back, and underneath your belly.
Some Things to Avoid
When you’re pregnant, what you don’t put into your body (or expose your body to) is almost as important as what you do. Here are some things to avoid:
Alcohol
Although it may seem harmless to have a glass of wine at dinner or a mug of beer out with friends, no one has determined what’s a “safe amount” of alcohol to consume during pregnancy. One of the most common known causes of mental and physical birth defects, alcohol can cause severe abnormalities in a developing fetus.
Alcohol is easily passed along to the baby, who is less equipped to eliminate alcohol than the mother. That means an unborn baby tends to develop a high concentration of alcohol, which stays in the baby’s system for longer periods than it would in the mother’s. And moderate alcohol intake, as well as periodic binge drinking, can damage a baby’s developing nervous system.
If you had a drink or two before you even knew you were pregnant (as many women do), don’t worry too much about it. But your best bet is to not drink any alcohol at all for the rest of your pregnancy.
Recreational Drugs
Pregnant women who use drugs may be placing their unborn babies at risk for premature birth, poor growth, birth defects, and behavior and learning problems. And their babies could also be born addicted to those drugs themselves.
If you’re pregnant and using drugs, a health clinic such as Planned Parenthood can recommend health care providers, at little or no cost, who can help you quit your habit and have a healthier pregnancy.
If you’ve used any drugs at any time during your pregnancy, it’s important to inform your health care provider. Even if you’ve quit, your unborn child could still be at risk for health problems.
Nicotine
You wouldn’t light a cigarette, put it in your baby’s mouth, and encourage your little one to puff away. As ridiculous as this scenario seems, pregnant women who continue to smoke are allowing their fetus to smoke, too. The smoking mother passes nicotine and carbon monoxide to her growing baby.
The risks of smoking to the fetus include:
•stillbirth
•prematurity
•low birth weight
•sudden infant death syndrome (SIDS)
•asthma and other respiratory problems
If you smoke, having a baby may be the motivation you need to quit. Talk to your health care provider about options for stopping your smoking habit.
Caffeine
High caffeine consumption has been linked to an increased risk of miscarriage, so it’s probably wise to limit or even avoid caffeine altogether if you can.
If you’re having a hard time cutting out coffee cold turkey, here’s how you can start:
•Cut your consumption down to one or two cups a day.
•Gradually reduce the amount by combining decaffeinated coffee with regular coffee.
•Eventually try to cut out the regular coffee altogether.
And remember that caffeine is not limited to coffee. Many teas, colas, and other soft drinks contain caffeine. Try switching to decaffeinated products (which may still have some caffeine, but in much smaller amounts) or caffeine-free alternatives.
If you’re wondering whether chocolate, which also contains caffeine, is a concern, the good news is that you can have it in moderation. Whereas the average chocolate bar has anywhere from 5 to 30 milligrams of caffeine, there’s 95 to 135 milligrams in a cup of brewed coffee. So, small amounts of chocolate are fine.
Certain Foods
Although you need to eat plenty of healthy foods during pregnancy, you also need to avoid food-borne illnesses, such as listeriosis and toxoplasmosis, which can be life-threatening to an unborn baby and may cause birth defects or miscarriage.
Foods you’ll want to steer clear of include:
•soft, unpasteurized cheeses (often advertised as “fresh”) such as feta, goat, Brie, Camembert, and blue cheese
•unpasteurized milk, juices, and apple cider
•raw eggs or foods containing raw eggs, including mousse, tiramisu, raw cookie dough, homemade ice cream, and Caesar dressing (although some store-bought brands of the dressing may not contain raw eggs)
•raw or undercooked meats, fish (sushi), or shellfish
•processed meats such as hot dogs and deli meats (unless they are reheated until steaming)
Also, although fish and shellfish can be an extremely healthy part of your pregnancy diet (they contain beneficial omega-3 fatty acids and are high in protein and low in saturated fat), you should avoid eating:
•shark
•swordfish
•king mackerel
•tilefish
•tuna steak
These types of fish may contain high levels of mercury, which can cause damage to the developing brain of a fetus. When you choose seafood, limit the total amount to about 12 ounces per week — that’s about two meals. Also, if you eat canned tuna, limit consumption to no more than 6 ounces per week. Also, check any local advisories before consuming recreationally caught fish.
Changing the Litter Box
Pregnancy is the prime time to get out of cleaning kitty’s litter box. Why? Because toxoplasmosis can be spread through soiled cat litter boxes and can cause serious problems, including prematurity, poor growth, and severe eye and brain damage. A pregnant woman who becomes infected often has no symptoms but can still pass the infection on to her developing baby.
Over-the-Counter and Prescription Medications
Even common over-the-counter medications that are generally safe may be considered off-limits during pregnancy because of their potential effects on the baby. And certain prescription medications may also cause harm to the developing fetus.
To make sure you don’t take anything that could be harmful to your baby:
•Ask your health care provider which medicines — both over-the-counter and prescription — are safe to take during pregnancy.
•Talk to your health care provider about any prescription drugs you’re taking.
•Let all of your health care providers know that you’re pregnant so that they’ll keep that in mind when recommending or prescribing any medications.
•Also remember to discuss natural remedies, supplements, and vitamins.
If you were prescribed a medication before you became pregnant for an illness, disease, or condition you still have, consult with your health care provider, who can help you weigh potential benefits and risks of continuing your prescription.
If you become sick (e.g., with a cold) or have symptoms that are causing you discomfort or pain (like a headache or backache), talk to your health care provider about medications you can take and alternative ways to help you feel better without medication.
Healthy Pregnancy Habits: From Start to Finish
During pregnancy, from the first week to the fortieth, it’s important to take care of yourself in order to take care of your baby. Even though you have to take some precautions and be ever-aware of how what you what you do — and don’t do — may affect your baby, many women say they’ve never felt healthier than when they carried their children.
Sex During Pregnancy
Pregnancy is a time of physical and emotional change. Personal history, symptoms and attitudes about becoming a parent influence the feelings that a woman has about her body and about making love during pregnancy. The pregnancy may alter how a woman and her partner feel about making love, and differences in sexual need may arise. The best way to deal with these differences is to talk, to listen and to be open to each other’s feelings and concerns. In addition, questions about sexual practices and their effect on the baby and the pregnancy should be discussed with a health care provider during prenatal visits.
Pregnancy Changes and Sexuality
For many women, the first three months of pregnancy can bring fatigue and nausea. If these symptoms are present, a woman may not feel like making love.
Pregnancy brings an increased blood supply to the pelvic area. During the second three months of pregnancy, after the first trimester symptoms have passed and before the growing uterus makes positioning more of a challenge, many women enjoy sexual intercourse. A woman’s breasts increase in size during pregnancy, enlarging even more with sexual arousal. For some women this is the first time that they truly enjoy having their breasts fondled, while others experience these changes as uncomfortable breast tenderness.
As the pregnancy progresses and a woman begins to lose her waistline, positioning and comfort become important in lovemaking. A woman may become depressed as the shape of her body changes. As the baby begins to move down into the pelvis, a woman may be bothered by increased pelvic pressure. She may not like the idea of intercourse and her partner also may worry about hurting the baby. In addition, orgasm may be somewhat frightening during pregnancy. Upon reaching orgasm, the uterus contracts in a rhythmical fashion. In a pregnant woman, these contractions last longer and in the third trimester they can occasionally turn into long, hard contractions that may feel uncomfortable. Sensitivity to each other’s wishes is vital. Cuddling and massage may be an alternate way to share time together.
Pregnancy and Safe Sex
Partners need to be honest and realistic about sex during pregnancy. Open communication may help to defuse frustration. Because AIDS/HIV infection is transmitted through sexual activity, always practice safe sex. HIV infections can be transmitted to the unborn child. If you have questions about what is safe sex and want to discuss concerns in confidence, call 1-800-FOR-AIDS and ask for a health provider.
Sexuality and High Risk Pregnancy
For most women and their partners, sex during pregnancy is fine as long as both partners consent and are comfortable. However, certain problems can occur during pregnancy that put the fetus at risk for premature delivery. If you are experiencing vaginal bleeding, preterm labor or ruptured membranes, you should not have sexual intercourse and you should avoid having orgasms. Your health care provider will tell you if sex could be harmful and do not hesitate to ask if you have questions or concerns.
Suggestions for Making Love During Pregnancy
Some hints for satisfying and comfortable sexuality during pregnancy include:
Positioning
•Side lying — partner behind woman
•Woman on hands and knees, partner kneeling behind
•Woman sitting on partner’s lap
Lubrication
•Water soluble lubricant jelly, such as Astroglide, KY Jelly. Do not use baby oil or Vaseline.
•Lubricated condom
Alternatives
•Cuddling
•Full body massage
Safe Skin Care During Pregnancy:
Highlights
Retinoids
Salicylic acid
Soy
Acne products
Hair removers & minimizers
Sunscreens
Makeup
The final word
Most pregnant women know that what they put (or don’t put) in their bodies is important to the well-being of their growing baby, whether it’s the right kind of protein, too much caffeine, or certain types of fish. But many pregnant women might not know that what they put on their bodies is just as important.
Most of us slather on oceans of lotions every day, but we don’t think about what might be passing the skin barrier and being absorbed into our bodies. With a developing baby in your belly, this is a vital concern.
“Everything you eat, apply, or come into contact with may affect not only you but also your baby,” says Sandra Marchese Johnson, a dermatologist with Johnson Dermatology in Fort Smith, Arkansas.
“Because some topical ingredients get absorbed into the bloodstream, there are some you want to avoid,” adds Leslie Baumann, a professor of dermatology at the University of Miami and author of The Skin Type Solution (Bantam, 2006).
The more powerful and targeted products get, the more we need to be careful about what we have in our skin-care regimens during pregnancy. While most commonly used products are completely safe, there’s a handful of ingredients considered potentially harmful to a growing baby. Below, see our guide to what to look for when shopping the beauty aisle.
If you plan to breastfeed, adds Johnson, continue following the guidelines noted below until you stop nursing.
Retinoids
These powerful substances, found in some antiaging moisturizers, are lauded for helping reduce wrinkles and improve skin tone. Retinoids are a type of vitamin A that speeds up cell division (quickening your skin’s renewal) and prevent skin collagen from breaking down.
But retinoids are one of the skin-care ingredients that experts, including Baumann, recommend that expectant moms stay away from. Some studies have shown that high doses of vitamin A during pregnancy can be harmful to an unborn child. And oral retinoids, such as isotretinoin (Accutane, an acne treatment), are known to cause birth defects.
If you’ve been using a skin cream that contains a retinoid, don’t panic. Retinoids have not been shown to cause problems in their topical form in pregnant women.
“There is no data to show these retinoids ingredients are harmful when used on the skin — doctors are just being extra cautious,” explains Baumann.
On the label:
Differin (adapelene)
Retin-A, Renova (tretinoin)
Retinoic acid
Retinol
Retinyl linoleate
Retinyl palmitate
Tazorac and avage (Tazarotene)
Bottom line:
Best to avoid
Salicylic acid
This mild acid is used to treat certain skin disorders, including acne, and you can find it in a number of skin products, such as cleansers and toners. It can penetrate facial oils to get deep into pores and clean out dead skin cells. Salicylic acid is in the aspirin family, so it can also help reduce inflammation or redness. BHA, or beta hydroxy acid, is a form of salicylic acid and is used in some topical exfoliants to reverse signs of aging.
But salicylic acid is another no-no for pregnant women. High doses of the acid in its oral form have been shown in studies to cause birth defects and various pregnancy complications.
Again, doctors are being cautious by recommending that pregnant women avoid the topical use of salicylic acid. Small amounts applied to the skin — such as a salicylic acid-containing toner used once or twice a day — are considered safe, says Johnson.
But the concern is stronger about face and body peels containing salicylic acid. “This kind of ‘soaking’ in the ingredient is similar to taking one or more aspirin when pregnant,” she explains.
“More product used equals more absorption into the bloodstream,” adds Baumann. Always check with your doctor before having a peel treatment. Better yet, she advises, if you must have a peel, have it done professionally at your dermatologist’s office. A dermatologist will know how to do it safely during pregnancy.
On the label:
Salicylic acid
Beta hydroxy acid
BHA
Note: Alpha hydroxy acids, sometimes listed as AHAs, glycolic acid, or lactic acid, are safe.
Soy
Some moms-to-be seek out natural ingredients such as soy in their skin-care products, thinking that they’re free from harmful effects. But that’s not necessarily the case, says Baumann.
While soy-based lotions and facial products are generally safe to use, “Soy can make the ‘mask of pregnancy’ (dark splotches on facial skin) worse, as can oil of bergamot, which is in many organic products,” she says.
Soy has estrogenic effects, which can make those dark patches, also known as melasma or chloasma, worse, Baumann explains. “The ‘active soy’ found in some product lines is okay, however, because the estrogenic components have been taken out.”
On the label:
Lethicin
Phosphatidylcholine
Soy
Textured vegetable protein (TVP)
Bottom line:
If you have dark skin or melasma, avoid these products, or choose ‘active soy’ products instead. Otherwise it’s safe to use.
Acne products
Many women have breakouts in the first trimester because of changing estrogen levels, even if they’ve always had clear skin. If you’re dealing with pregnancy-induced acne, a dermatologist can likely give you a safe topical antibiotic, advises Baumann. You can find a dermatologist in your area through your health insurance company or at the American Academy of Dermatology Web site.
But if you prefer to avoid yet another doctor appointment, Baumann recommends using a facial wash that contains no more than 2 percent salicylic acid (look for the percentage on the product label). This small amount is considered safe.
If you want to be doubly sure, ask your obstetrician or midwife before use. As for what to avoid when it comes to treating acne, stay away from leave-on acne lotions, gels, and creams, as well as at-home peels, which can contain salicylic acid or retinoids, says Baumann. And, of course, steer clear of the oral form of the retinoid Accutane.
On the label:
Beta hydroxy acid
BHA
Differin (adapelene)
Retin-A, Renova (tretinoin)
Retinoic acid
Retinol
Retinyl linoleate
Retinyl palmitate
Salicylic acid
Tazorac and avage (Tazarotene)
Tretinoin
Note: Glycolic acid is an AHA, and safe to use.
Bottom line:
Consult your dermatologist, or use mild over-the-counter cleansers only.
Hair removers & minimizers
Lotions that remove your hair chemically (depilatories) or that minimize hair between shaves sound like a dream come true when you can barely reach — not to mention see — your legs. The good news is that these products are considered risk-free.
“There are no specific ingredients to avoid when it comes to these types of products,” . “The only risk is an allergy.”
Catherine Lynch, director of the division of general obstetrics and gynecology at the University of South Florida, says, “As long as you use [chemical hair removers] as directed, they shouldn’t be a problem. It’s a topical solution that isn’t absorbed into your bloodstream, so it can’t have any effect on the baby.”
If you’ve had an allergic skin reaction to hair minimizers or removal creams in the past, then you should avoid these products during pregnancy as well.
Also, some women’s skin gets extra sensitive during pregnancy, so you may have a reaction to these ingredients even if you haven’t before. Before slathering your whole leg, do a patch test on a small piece of skin behind your knee and wait 24 hours to see if you react.
On the label:
Potassium Thioglycolate (depilatory)
Calcium Thioglycolate (depilatory)
Sodium Hydroxide (minimizer)
Sanguisorba Officinalis Root Extract (minimizer)
Hydrolyzed Soy Protein (minimizer)
Bottom line:
Safe to use
Sunscreens
Just because you’re pregnant doesn’t mean you can’t hit the beach. In fact, feeling the sand between your toes and that warm breeze in your hair may provide that perfect “relaxation point” your Lamaze instructor has been talking about. And as your mom always told you: Don’t forget the sunscreen.
Sunscreens, including those with ingredients that penetrate the skin, are perfectly safe when you’ve got your own bun in the oven, says Baumann.
“[Ingredients] that do go deep into the skin do so in such small concentrations” that they’re not worth worrying about, says Johnson. “I personally prefer titanium dioxide and zinc oxide — they are powerful physical sunscreens and do not penetrate the skin.”
She adds, “In addition to sunscreen, we advise sun-smart behaviors — avoiding the sun between 10 a.m. and 4 p.m.; using a sun hat, sunglasses and sun-protective clothing; and reapplying your sunscreen every two hours.”
And if you have melasma, adds Baumann, you can try a UV protector with a skin lightener.
On the label:
Titanium dioxide
Zinc oxide
Avobenzone (Parsol 1789)
Oxybenzone
Dioxybenzone
Benzophenone
Octyl methoxycinnamate (OMC)
Para-aminobenzoic acid (PABA)
Octocrylene
Bottom line:
Safe to use
Makeup
You may not give a second thought to the kind of makeup you use, but even cosmetics are something to consider when pregnant, says dermatologist Johnson.
Many makeup products are marked “noncomedogenic” or “nonacnegenic” — meaning they’re oil-free and don’t clog pores. These are safe and will not affect the health of your baby.
Avoid cosmetics that contain retinol or salicylic acid (found in some makeup for acne-prone skin).
If you want to be super careful during pregnancy, try some of the minerals-only makeup lines. These products use ingredients that primarily sit on top of the skin and don’t cause irritation for most people.
On the label:
Differin (adapelene)
Retin-A, Renova (tretinoin)
Retinoic acid
Retinol
Retinyl linoleate
Retinyl palmitate
Tazorac and avage (Tazarotene)
Tretinoin
Bottom line:
Avoid cosmetics that contain retinoids or salicylic acids. Otherwise, safe to use.
The final word
When you’re pregnant, it’s important to discuss any product you use on your skin with your healthcare provider.
But if you realize you have used a product that contains one of the potentially harmful ingredients noted above, don’t panic, says Johnson. Simply stop using the product now and pick one with known-to-be-safe ingredients.
“Most over-the-counter products by reputable brands are safe,” she says. “And if you are applying these products to less than 10 percent of your total skin surface, the risks of systemic effects are very low.”
Dental Care During Pregnancy:
It’s vitally important for you to take good care of your oral health while you are pregnant. This is because pregnancy causes hormonal changes that increase your risk of developing gum disease, and because your oral health can affect the health of your developing baby.
Below are some suggestions for maintaining good oral health – as well as your baby’s health and safety — before, during, and after your pregnancy.
Before you get pregnant
Make a dental appointment before getting pregnant (if possible). In this way, your teeth can be professionally cleaned, your gum tissue can be carefully examined, and any oral health problems identified can be treated in advance of your pregnancy.
While you are pregnant
· Tell your dentist (and doctor) if you know you are pregnant or are planning to become pregnant. This will help your health care providers plan for any treatments or procedures. It’s always best to complete any major dental treatment prior to pregnancy. Routine dental care, on the other hand, can be received during the second trimester. As a precautionary measure, dental treatments during the first trimester and second half of the third trimester should be avoided as much as possible. These are critical times in the baby’s growth and development, and it’s simply wise to avoid exposing the mother to procedures that could in any way “influence” the baby’s growth and development. All elective dental procedures should be postponed until after the delivery.
Tell your dentist the names and dosages of all medicines you are taking – including medicines and prenatal vitamins prescribed by your doctor – as well as any specific medical advice your doctor has given you to follow. Your dentist might need to alter your dental treatment plan based on this information. Certain drugs — such as tetracycline can affect the development of your child’s teeth and should not be given during pregnancy.
Avoid dental X-rays during pregnancy. If X-rays are essential (such as in a dental emergency), your dentist will use extreme caution to safeguard you and your baby. Advances in dentistry have made X-rays much safer today than in past decades.
Don’t skip your dental checkup appointment simply because you are pregnant and believe this appointment is not important. Now more than any other time, regular periodontal examinations are very important. Pregnancy causes hormonal changes that put you at increased risk for periodontal disease and for tender gums that bleed easily – a condition called pregnancy gingivitis. To remove irritants, control plaque, and maintain optimum oral health, you might actually benefit from more frequent professional cleanings during your second trimester or early third trimester rather than fewer dental visits. Pay particular attention to any changes in your gums during pregnancy. If tenderness, bleeding, or gum swelling occurs at any time during your pregnancy, talk with your dentist or periodontist as soon as possible.
Follow good oral hygiene practices to prevent and/or reduce gingival problems, including brushing your teeth at least twice a day and flossing at least once a day. Use a good-quality, soft-bristled toothbrush. Use a toothpaste that contains fluoride, and brush for at least two minutes to remove the plaque that forms on your teeth.
If morning sickness is keeping you from brushing your teeth, change to a bland-tasting toothpaste during your pregnancy. Ask your dentist or hygienist to recommend brands.
Rinse your mouth out with water or a mouth rinse if you suffer from morning sickness and have bouts of frequent vomiting.
Ask your dentist about the need for fluoride supplements. Since fluoride is found in water and almost all brands of toothpaste, fluoride supplementation might not be necessary.
Avoid sugary snacks. Sweet cravings are common during pregnancy. However, keep in mind that the more frequently you snack, the greater the chance of developing tooth decay. Additionally, some studies have shown that the bacteria responsible for tooth decay are passed from the mother to the child. So be careful of what you eat.
Eat a healthy, balanced diet. Your baby’s first teeth begin to develop about three months into your pregnancy. Healthy diets containing dairy products, cheese, and yogurt are good sources of these essential minerals and are good for your baby’s developing teeth, gums, and bones.
Consult with your dentist or doctor about the need for anesthesia or other medicines should a dental emergency arise. Make sure you tell all health care providers that you come into contact with that you are pregnant. This information could change their treatment plans. Dental treatments that could be considered “emergency” are those that are necessary to ease your pain, prevent an infection, or decrease stress on you or your fetus.
Care during pregnancy for women with type 1 or 2 diabetes:
INTRODUCTION — Prior to the development of insulin in 1922, pregnancy in women with diabetes mellitus posed very high risks to both mother and fetus. Today, most women with diabetes can expect an excellent pregnancy outcome, similar to that of nondiabetic women. This improvement is largely due to tight blood glucose control, which can be achieved with frequent daily glucose monitoring and insulin adjustment.
This topic review discusses care of women with type 1 or 2 diabetes during pregnancy, as well as fetal and newborn issues. It does not address gestational diabetes, which develops during pregnancy.
Type 1 diabetes is thought to be an autoimmune disease and requires insulin treatment because the pancreas has lost its ability to produce insulin. Type 2 diabetes , previously referred to as adult-onset diabetes, is usually caused by insulin resistance, and can be managed with insulin or other drugs that increase the body’s sensitivity to insulin or increase the pancreas’ production of insulin.
IMPORTANCE OF BLOOD GLUCOSE CONTROL — Glucose in the mother’s blood crosses the placenta and enters the baby’s bloodstream to help provide energy for it; thus, maternal hyperglycemia (high blood glucose levels) leads to high blood glucose levels in the developing baby as well.
High blood glucose levels can cause several problems:
Early in pregnancy, high glucose increases the risk of miscarriage and birth defects. These risks are highest when the A1C is >8 percent or the average blood glucose >180 mg/dL (10 mmol/L).
In the last half of pregnancy and near delivery, high glucose can cause the infant’s size and weight to be larger than normal (see “Ultrasound” below) and have a higher risk of complications during and after delivery (see “Newborn issues” below).
In particular, women with large infants are more likely to have difficulty delivering vaginally or require cesarean delivery.
These complications occur less frequently when blood glucose levels are carefully controlled.
General measures to control blood glucose
Most women with type 1 diabetes will require two to four insulin injections per day to optimally control blood glucose levels. An alternate option is to use an insulin pump.
Women with type 2 diabetes who have been controlled with diet or oral medications may require insulin during pregnancy
Women with diabetes need more insulin during pregnancy, especially during the last one-third of pregnancy (approximately 26 to 40 weeks of pregnancy) because the body becomes resistant to insulin as the pregnancy progresses. (See “Patient information: Diabetes type 1: Insulin treatment”).
Frequent contact with health care providers is important for managing blood glucose levels and monitoring the health of the woman and her baby. The healthcare provider may want to review blood glucose levels and insulin doses one or more times per week; this can usually be done via telephone, e-mail, or fax.
Oral diabetes medications, (eg, glyburide, metformin) have been used to manage gestational or type 2 diabetes in some cases. These medications adequately control blood glucose levels, but large studies of their safety have not been performed. As a result, the American College of Obstetricians and Gynecologists and American Diabetes Association do not recommended these medications during pregnancy. Women who are taking these drugs when they become pregnant should speak with their healthcare provider.
A nutritionist can help to plan a diet that provides the optimal number of calories, carbohydrate, and distribution of snacks/meals throughout the day. The optimal calorie intake depends upon the woman’s prepregnancy weight and activity level.
Exercise is an excellent way to control weight and blood glucose levels. Most women who exercised before pregnancy can continue to do so during pregnancy at the same or a slightly reduced pace. Moderate intensity exercise, such as brisk walking, is recommended. Women who did not exercise previously may begin to exercise during pregnancy after consulting with their healthcare provider. Exercise intensity, type, and duration may need to be modified as the pregnancy progresses or if complications develop.
Target blood glucose levels — Frequent glucose monitoring is recommended during pregnancy, including testing before breakfast (fasting) and before and after each meal. (See “Patient information: Self-blood glucose monitoring”). Target blood glucose levels during pregnancy are slightly lower.
The American College of Obstetricians and Gynecologists recommends the following goals:
Fasting: 60 to 90 mg/dL (3.3 to 5 mmol/L)
Preprandial (before meals): less than 100 mg/dL (5.6 mmol/L)
One-hour postprandial (after meals): less than 130 to 140 mg/dL (7.2 to 7.7 mmol/L)
Two-hour postprandial: less than 120 mg/dL (6.7 mmol/L)
A1C is a blood test that represents the average blood glucose level over the previous three months. This test is usually done once per month during pregnancy. The goal is for the A1C to be at or near normal (6 percent or an average blood glucose of 120 mg/dL [6.7 mmol/L]), (show figure 1). However, attempting to maintain this level can cause frequent episodes of hypoglycemia (low blood glucose), so A1C goals should be determined individually.
CARE DURING PREGNANCY — Ideally, a woman with diabetes who is planning pregnancy should consult her health care provider well before she becomes pregnant. This provides an opportunity to make sure her blood glucoses are in optimal control, adjust her medication, evaluate and treat any medical complications related to diabetes, and start folic acid supplementation (at least 400 mcg per day is recommended, starting at least one month before conception). It is also an opportunity to discuss how pregnancy may affect diabetes and vice versa.
The care of diabetic women during pregnancy is a team effort involving an obstetrician and an endocrinologist or internist who oversees insulin management and medical care. Some family practitioners may perform all of these functions.
Eye examination — Retinopathy refers to abnormal, leaky blood vessels in the light sensitive tissue lining the back of the eye (the retinas). Retinopathy can lead to vision problems, and even blindness in severe cases. Pregnancy can worsen diabetic retinopathy, although the reasons are not entirely clear. It is known that the risk of worsening retinopathy during pregnancy is increased in those with the highest initial A1C values and in women whose A1C is significantly reduced (usually as a result of tight blood glucose control).
The impact of pregnancy on diabetic retinopathy is mild and temporary for most women; the retina usually returns to its prepregnancy condition within several months postpartum. Nevertheless, all women with type 1 or 2 diabetes should have an eye examination by an ophthalmologist or optometrist before pregnancy and during the first trimester (three months). In most cases, a follow up examination is recommended every three months until delivery, depending upon the results of the initial examination.
Women with severe retinopathy are more likely to experience progression and complications. Eye examinations before and during pregnancy, along with close monitoring and treatment (as needed) of retinopathy can minimize the risk of vision loss. Some experts have recommended cesarean delivery for women with retinopathy, although this is controversial; most women can attempt a vaginal delivery.
Blood pressure monitoring — Blood pressure may become elevated during pregnancy and should be measured at every appointment. High blood pressure often improves during the first half of pregnancy, but returns to baseline or worsens in the second half.
Medications to treat high blood pressure during pregnancy may include methyldopa, calcium channel blocking agents (nifedipine, diltiazem), hydralazine, or beta blockers (atenolol, propranolol). Beta blockers can mask some symptoms of low blood glucose and should be used with caution.
Angiotensin converting enzyme (ACE) inhibitors (captopril, lisinopril, enalapril) and angiotensin II receptor blockers (ARBs, losartan, valsartan) are not safe during pregnancy, and should be discontinued in any woman planning pregnancy.
Gestational hypertension (high blood pressure during pregnancy) and preeclampsia are more common in women with diabetes. Preeclampsia is a condition that can occur in pregnancy that causes hypertension (blood pressure greater than 140/90) and proteinuria (protein in the urine). Fortunately, most cases are mild. In severe cases (eclampsia), seizure, stroke, heart failure, kidney damage, and rarely, maternal death can occur.
Preeclampsia cannot be prevented; the only treatment is to deliver. Women with moderately elevated blood pressure may be monitored for days or even weeks if preeclampsia develops prematurely; this may require hospitalization. Steroids may be given to encourage the fetus’s lungs to mature more rapidly. However, steroids significantly increase the woman’s blood glucose levels, and usually require a temporary increase in the insulin dose.
Kidney function monitoring — Pregnancy does not cause diabetes-related kidney disease (nephropathy), but it can worsen existing disease. Kidney function is monitored during pregnancy by urine dipstick testing for protein, which is usually performed at every visit. Other urine or blood tests may be ordered depending upon the individual’s situation.
Nephropathy is associated with other pregnancy complications, such as preeclampsia, preterm delivery, babies who are small for their age (intrauterine growth restriction (IUGR)), and a higher frequency of maternal hospitalization and cesarean delivery (show table 3). Women with retinopathy and kidney disease are at increased risk of having a small infant because blood flow to the placenta may be reduced.
If a woman develops worsening nephropathy during pregnancy, it is usually temporary and reverts to the prepregnancy condition within several months of delivery. Nephropathy probably worsens because blood flow through the kidney increases by 50 percent during pregnancy, which increases the kidneys’ workload. In addition, some women develop high blood pressure or new pregnancy-induced high blood pressure, which further stresses the kidney.
Permanent kidney damage, including kidney failure, can occur in women who already have significant nephropathy before becoming pregnant. These women may require dialysis or kidney transplant sooner than a woman with severe chronic kidney disease who never becomes pregnant. (See “Patient information: Renal replacement therapy” and see “Patient information: Hemodialysis”).
Ultrasound — An ultrasound examination of the baby is recommended during the first trimester of pregnancy (before 13 weeks) if there is any uncertainty about the date of the last menstrual period or estimated due date. It is important that the due date is accurate because decisions about when to begin fetal testing and when to deliver the baby are based upon this date.
Ultrasound examination is recommended at 18 to 20 weeks gestation to screen for birth defects. The examination should pay particular attention to the spine because these infants may be at increased risk for neural tube defects. Some experts recommend a fetal echocardiogram (an ultrasound of the fetus’s heart) because of the increased incidence of heart defects among infants of diabetic women who have uncontrolled high glucose levels in early pregnancy.
Ultrasound is also used to monitor the amount of amniotic fluid around the fetus; polyhydramnios is an abnormal increase in the amount of amniotic fluid. This condition is more common in women with diabetes than in women without diabetes. Polyhydramnios related to diabetes is usually mild and does not cause problems. If it becomes severe, maternal discomfort, uterine contractions, premature rupture of the membranes (“breaking the water”), and preterm delivery can occur.
Ultrasound is also used to monitor the baby’s growth and development throughout the pregnancy, although ultrasound estimates of the baby’s weight can be off by as much as 15 percent. Macrosomia is a condition in which an infant weighs more than nine pounds (4000 grams) at or beyond 37 weeks of pregnancy, and is more common in women with diabetes. High fetal insulin levels, which can develop in response to elevated maternal blood glucose levels, are one potential cause of increased birth weight since insulin stimulates fetal growth.
Macrosomia occurs in 15 to 45 percent of diabetic pregnancies, compared to 10 percent in the nondiabetic population. Cesarean delivery may be needed if labor does not progress normally because of the large size or position of the baby. In addition, macrosomic infants are at higher risk of being injured during delivery and may be delivered by cesarean delivery before labor if there is a concern that the infant’s shoulders may be difficult to deliver through a woman’s pelvis (called shoulder dystocia).
Screening for birth defects — Birth defects are more common in infants of women with elevated blood glucose levels before and during the early weeks of pregnancy; most birth defects develops by the 10th week of pregnancy. There is no particular birth defect caused by maternal diabetes. Recent studies have demonstrated that tight blood glucose control before becoming pregnant reduces the risk of birth defects to a level that is similar to that in women who do not have diabetes.
Screening for birth defects such as spina bifida and Down syndrome is recommended to all pregnant women, not just those with diabetes. Women with diabetes are not at increased risk for having a baby with a chromosomal abnormality, such as Down’s syndrome, but they are at increased risk of having a baby with a neural tube defect (eg, spina bifida).
Screening may be performed in the first or early second trimester, depending upon the type of screening test. Screening tests are used to identify pregnancies at increased risk of a birth defect, and cannot determine with certainty if a baby actually has the birth defect. If the test is abnormal, an ultrasound examination and/or amniocentesis may be performed to determine if the abnormality is actually present.
Fetal testing — Close monitoring of the fetus is recommended during the third trimester, usually starting at 32 to 38 weeks of pregnancy. This usually includes weekly to twice-weekly nonstress testing. This is done by monitoring the baby’s heart rate with a small device that is placed on the mother’s abdomen. The device uses sound waves (ultrasound) to measure the baby’s heart rate over time, usually for 20 to 30 minutes. Normally, the baby’s baseline heart rate should be between 110 and 160 beats per minute and should increase above its baseline by at least 15 beats per minute for 15 seconds when the baby moves.
The test is considered reassuring (called “reactive”) if two or more fetal heart rate increases are seen within a 20 minute period. Further testing may be needed if these increases are not observed after monitoring for 40 minutes.
PLANNING FOR DELIVERY — A woman and her obstetrician may decide to schedule the date of her delivery (either an induction of labor or cesarean delivery), especially if there are risk factors, such as increased blood glucose levels, nephropathy, worsening retinopathy, hypertension or preeclampsia, or limited or excessive fetal growth. If delivery before the due date is planned, an amniocentesis to determine fetal lung maturity may be needed, depending on the individual’s situation and the fetus’s gestational age.
If the fetus appears to be very large (based upon ultrasound measurements), a woman and her obstetrician may consider cesarean delivery to avoid possible trauma from shoulder dystocia. The American College of Obstetricians and Gynecologists suggests that a woman and her physician consider a planned cesarean delivery if the estimated fetal weight (by ultrasound measurement) is greater than 4500 grams (9 lbs, 14 oz).
Waiting for labor to start on its own is reasonable if blood glucose levels are well-controlled and the mother and fetus are without problems. However, extending pregnancy beyond 40 to 41 weeks of gestation is generally not recommended; some practitioners routinely induce labor between 39 and 40 weeks in all women with type 1 or 2 diabetes.
The risk of stillbirth for pregnant women with carefully controlled diabetes is very low and is about the same as women without diabetes (less than 1 percent). The newborn mortality (death) rate in infants of diabetic women is slightly higher than in nondiabetics (2 versus 1 percent). This is mostly due to a higher rate of serious birth defects in infants of diabetic mothers.
INFANT CARE
Newborn issues — The infant of the diabetic mother is at risk for several problems in the newborn period, such as low blood glucose levels, jaundice, breathing problems, excessive red blood cells (polycythemia), low calcium level, and heart problems. These problems are more common when the mother’s blood glucose levels have been elevated during the pregnancy. Most of these problems resolve within a few hours or days after delivery. Infants of diabetic mothers are often evaluated in a special care nursery to monitor for these potential problems.
Infants of mothers with diabetes are at higher risk of having difficulties with breathing, especially if the infant is born earlier than 39 weeks of gestation. This is because the lungs appear to develop more slowly in infants of women with diabetes. The risk of respiratory problems is highest when maternal blood glucose levels have been elevated near the time of delivery.
Inheritance of diabetes — The children of parents with diabetes are at increased risk of developing the same type of diabetes. According to the American Diabetes Association:
Children of a father with type 1 diabetes have a 1 in 17 risk of developing type 1 diabetes. Children of a mother with type 1 diabetes have a 1 in 25 risk if, at the time of pregnancy, the mother is less than 25 years of age but a 1 in 100 risk if the mother is 25 years of age or older. These risks are doubled if the affected parent developed diabetes before age 11. If both parents have type 1 diabetes, the risk to the child is between 1 in 10 and 1 in 4.
The risk of diabetes in children of a parent with type 2 diabetes is 1 in 7 if the parent was diagnosed before age 50 and 1 in 13 if the parent was diagnosed after age 50. There is some evidence that the child’s risk is greater when the parent with type 2 diabetes is the mother. If both parents have type 2 diabetes, the risk to the child is about 1 in 2. (See “Patient information: Diabetes mellitus, type 1” and see “Patient information: Diabetes mellitus, type 2”).
AFTER DELIVERY CARE — Postpartum (after delivery) care for a woman with diabetes is similar to that for women without diabetes. However, it is important to pay close attention to blood glucose levels because insulin requirements change significantly in the first few days after delivery; some women require little or no insulin. Insulin requirements usually return to near-prepregnancy levels within 48 hours.
Breastfeeding — In all women (with and without diabetes), breastfeeding is strongly encouraged because it benefits both the infant and the mother. Insulin requirements may be lower while breastfeeding, and frequent blood glucose monitoring is important to prevent severe hypoglycemia. (See “Patient information: Breastfeeding”).
SUMMARY
Most women with diabetes can expect an excellent pregnancy outcome as a result of improvements in blood glucose control, as well as obstetrical and neonatal care. This requires adherence to diet, frequent daily glucose testing, and insulin adjustment, as needed.
Women with diabetes who have elevated blood glucose levels before or during pregnancy are more likely to have complications, including miscarriage, an infant with birth defects, or a large baby that requires cesarean delivery. Pre-existing nephropathy or retinopathy may worsen.
Frequent visits with a healthcare provider are recommended to monitor blood glucose levels and blood pressure, eye and kidney health, and also to monitor the health of the developing baby.
Target blood glucose levels during pregnancy are as follows: A!C level: less than 6 (show figure 1), fasting blood glucose: 60 to 90 mg/dL (3.3 to 5 mmol/L), before meals: less than 100 mg/dL (5.5 mmol/L), one hour after meals: less than 130 to 140 mg/dL (7.2 to 7.7 mmol/L), two-hours after meals: less than 120 mg/dL (6.7 mmol/L).
A woman and her obstetrician may decide to schedule the date of her delivery (either an induction of labor or cesarean delivery), especially if there are risk factors, such as poor blood glucose levels, nephropathy, worsening retinopathy, high blood pressure or preeclampsia, or limited or excessive fetal growth. Waiting for labor to start on its own is reasonable if blood glucose levels are well-controlled and the mother and baby do not have problems. However, extending pregnancy beyond 40 to 41 weeks of gestation is generally not recommended
If the baby appears to be very large (based upon ultrasound measurements), cesarean delivery should be considered to avoid possible trauma from shoulder dystocia.
The infant of the diabetic mother is at risk for several problems in the newborn period. These problems are more common when the mother’s blood glucose levels have been elevated during the pregnancy. Most of these problems resolve within a few hours or days of delivery. Infants of diabetic mothers are often evaluated in a special care nursery to monitor for these potential problems.
Postpartum (after delivery) care for a woman with diabetes is similar to that for women without diabetes. However, insulin requirements change significantly in the first few days after delivery; some women require little or no insulin. Insulin requirements usually return to near-prepregnancy levels within 48 hours.
Breastfeeding is strongly encouraged, and benefits both the infant and the mother. Insulin requirements may be lower while breastfeeding, and frequent blood glucose monitoring is important to prevent severe hypoglycemia.
After you’ve had your baby
If you experienced any gum problems (including pregnancy gingivitis or a pregnancy tumor) during your pregnancy, see your dentist soon after delivery to have your entire mouth examined and your periodontal health evaluated.
Complete Beauty Tips
Dark spots, and freckles, and skin-damage – oh my! Looking to lighten your complexion? Every shade of skin is beautiful, but as we grow older our skin tone can change. Freckles may appear, dark spots can arise, and skin may not be as light as it once was. So, if you’re still not ready to embrace your dark side, read on for a few natural whitening tips and tricks.
Use Sunblock
One of the easiest ways to stay fair is to use sunblock on a daily basis. Find a moisturizer that includes an SPF of 15 or higher and use it every morning after washing your face. Sunblock not only prevents your skin from getting darker, but also blocks harmful UV rays that can cause cancer and premature aging. Remember your hands when applying sunblock, as they are a prime area for age spots.
Exfoliate
Exfoliating once a week will remove dead skin cells to lighten and brighten your skin. Mix two tablespoons oatmeal and two tablespoons brown sugar with a quarter cup of milk, and stir until a paste forms. Gently scrub your face, rinse, and moisturize.
Make a Mask
A homemade mask is a great way to lighten your skin and a good excuse to kick back on the couch. Try using one once a week. Use one tablespoon of each of the following: sandalwood paste, lemon juice, tomato juice, and cucumber juice. Mix them all together to form a paste. Spread the mixture on your face and wait until it dries. Rinse and moisturize for a natural glow.
Licorice Extract
Licorice extract contains glabridin, a component that acts as a natural skin whitener. Apply a thin layer of the extract morning and evening, after you wash your face and before you moisturize. Licorice extract can be found at any health food store or ordered online. Be sure to store the bottle in a cool, dark place to maintain freshness. Note: test a small amount on the back of your arm before using on your face to be sure you do not have an allergic reaction.
Remember to love your skin no matter what color it is. It’s a part of who you are and that’s what makes you beautiful and unique.
Age-Defying Skin Secrets from GlamSpirit
I am not a beauty expert, but I am frequently told that I have really good skin. In my experience good skin comes from a wholesome, nutrient-rich diet, 8 hours of sleep each night, drinking plenty of water and keeping my energy body clear.
In addition the beauty regimen listed above, I do have one guiltless (unsolicited, non sponsored) beauty obsession. It’s called SKII. Someone gave me a bottle as a gift and that’s when I and became hooked.
For almost a generation, Japanese women have known a secret. This secret was discovered by a Japanese monk who visited a sake brewery in Kobe.
He was surprised to discover that the brewery workers had extraordinary soft and youthful hands. Even an elderly man with pronounced wrinkles on his face possessed the silky smooth hands of a young boy. This observation encouraged the monk to conduct a series of experiments. He eventually discovered a clear, nutrient-rich liquid that could be extracted during the yeast fermentation process. He shared his findings with a group of skincare scientists, who became equally excited by the potential of his discovery.
Suggestions for Cleansing and Detoxing Our Bodies
Fall is a particularly good time to pay attention to cleansing the body. People have cleansed throughout the ages to remove buildup of toxins and impurities in the system which constantly drain our immune systems.
There are countless ways to cleanse, but here is just a sampling of ideas to consider:
1) Digestive Cleansing
One of the most comprehensive ways to rid the body of the accumulated junk (mucous and build-up) in our digestive track. Digestive cleanses may involve fasting, wheatgrass juice, or juicing, cayenne pepper, enemas and colonics. Each of these is intended to assist the body in the process of elimination (particularly the elimination off all the “bad” things we’ve ingested over the years). Often the results of digestive cleansing – after the initial “reaction” stages of headaches or irritability- include feeling more “clear-headed”, lighter, more aware, less fatigued, energized.
Cleanse and Purify Thyself is a great book to read before doing a cleanse and Health and Yoga is a great resource on this topic.
2) Skin Brushing / Dry Brush
Brushing your skin with a dry body brush is one of the best ways to clean your skin. It may feel kind of odd but it is more effective than brushing your skin with a wet soapy brush or sponge.
3) Pranayama
Incorporating a breathing practice, with breath retention, and focus on expelling all the air out of the lungs helps invigorate and cleanse the lungs. Many yoga studios offer a pranayama class or incorporate pranayama in their scheduled classes.
4) Tongue Scraping / Tongue Cleaning
Ever notice that slimy white (or sometimes yellow, if you’re sick) film on your tongue? Sounds, gross, I know, but that’s the mouth’s eliminatation system and one of the causes of bad breath (the rest of it is coming from your digestive system). A tongue scraper can be used to scrape off coated tongues first thing in the morning.
5) Detox Bath
Use a combination of epsom salt, sea salt and baking soda to help pull out toxins from the skin (another great way to eliminate toxins). This one can be especially beneficial to ease emotional imbalances.
6) Water Flush
Most of us know that it’s important to stay hydrated and drink lots of water. A Balinese healer gave me another tip…drink 2 liters of warm water first thing in the morning to flush your system.
Beauty Foods and Natural Beauty Ingredients
Here are some healthy finds from the blogosphere:
Beauty Snob has a beautiful post about 8 foods you should eat every day. It includes a cute little key that indicates the bennies of each particular food.
Beauty by Nature talks about Pure and Positive Energy and treating your body like a temple so it can radiate with beauty.
Something sweet: Honey Skin Care Recipes from Yoga Coffee Outlook.
Homemade Skin Treats from Suite 101.
All Natural Mineral Makeup: Giella from GlamBlush.
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