The accurate drawings by  Leonardo da Vinci  may have been the first to be made, but professional medical texts took centuries to catch up.  The Scottish anatomist  William Hunter , doctor to  Queen Charlotte , was an admirer of Leonardo's drawings in the  Royal Collection  and learnt from their clear depictions.  His own work,  The Anatomy of the Gravid Uterus Exhibited in Figures , was published in 1774 and based on extensive study of late pregnant corpses; [ 54 ]  how he obtained so many was the subject of suspicion at the time and subsequently. [ 55 ]


Some kinds of art have been designed with pregnant women especially in mind, though these are perhaps less common than art intended for women wanting to become pregnant (discussed in art history using the term " fertility ").  One of the many contexts and uses speculated for  Venus figurines  is that they were held in the hand during childbirth, for which their rather consistent size and shape seems well suited. However, there are a variety of other explanations. [ 56 ]


The  Madonna del Parto  and other images of the pregnant Virgin Mary were often mainly designed to offer a focus for the devotions of pregnant women and those concerned for them. In 1954 the mayor of  Monterchi , home of the  Piero della Francesca   Madonna , refused to lend it to an exhibition in Florence so as not to deprive the population of its benefits. [ 21 ]


The painted  desco da parto  ("birth tray" or "birth salver") was an important symbolic gift for married women in late medieval and  Early Modern   Florence  and  Siena .  Both sides were typically painted, but with different types of scenes. The upper side (or  recto ) generally had a crowded figure scene, usually secular, such as a scene from  classical myth  or a suitable  allegory . Scenes from the  Old Testament  or the Christian religious repertoire also appear in some cases. Birthing scenes were popular. [ 57 ]


The underside or  verso  generally has a simpler and often less elevated subject, with fewer, larger figures, and usually includes  heraldry , with the arms of both parents shown. [ 58 ]   Scenes with one or two naked boy toddlers, with the  coats of arms  of both parents at the sides, are especially popular.


In the Renaissance it was believed that the sights a pregnant woman saw affected her pregnancy and even what it produced.  Martin Luther  told the cautionary story of a woman frightened by a mouse in pregnancy, who then gave birth to a mouse. Manuals advised keeping images with a positive impact in the sight of pregnant women, and it is in this context that the recurrent naked boys, and the scenes showing the end of a successful childbirth, should be seen. This was also a factor in the display of images of the  Virgin and Child , which were ubiquitous in bedrooms. Probably the desci were hung with the verso displayed during pregnancy, to promote the production of a similar healthy boy. [ 59 ]


A  baby bonus  is a government payment to parents of a newborn baby or adopted child to assist with the costs of childrearing.


A baby bonus was introduced in 1996 for both born (and not yet born) and adopted children. [ 1 ]  Its means tested and varies by geographic location. [ 2 ]


The government of  Andrew Fisher  introduced a baby bonus of £5 [ 3 ]  per child in late 1912. The bonus was available irrespective of marital status and could also be received by husbands of women who died in childbirth. While Fisher told parliament that the aim was to help mothers in their time of need, the intention was also to increase birth and infant survival rates in the country. [ 4 ]


The baby bonus scheme reintroduced by the Federal Government of  Australia  in the 2002 budget was aimed at offsetting the expenses associated with bearing a child. The scheme was also introduced as a means of increasing Australia's fertility rate and to mitigate the effects of Australia's  ageing population . [ 5 ]  In the 2004 budget, the bonus was raised from $3,000 effective 1 July 2004 to $4,000 payable in 2007 but indexed to inflation so that in October 2007, the amount receivable per eligible child was $4,133. [ 6 ]  The bonus was paid in a lump sum to a nominated financial institution. From 1 January 2009, the payment is paid in 13 fortnightly installments. The receivable amount in January 2012 was $5,437. The receivable amount in September 2012 is $5,000 in 13 fortnightly instalments (parents will receive a higher first instalment of $846.20 and 12 fortnightly instalments of $346.15), or if the baby died or was a stillborn, parents may ask for their Baby Bonus to be paid in a lump sum instead of fortnightly instalments. [ 7 ]


In the draft of the 2013 federal budget, the "baby bonus" would be slashed from $5,000.00 to $2056.45 as of 1 March 2014. The first newborn child will receive $2056.45, and for every subsequent child thereafter, a limited $1028.15 will be submitted. There have been other changes recently.


There are additional benefits for Aboriginal people. [ 8 ]


A baby bonus was introduced in  Canada  following  World War II , paying $5 to $8 monthly to all parents of children under 16. [ 9 ]


In 1988, the  Quebec government  introduced the  Allowance for Newborn Children  that paid up to $8,000 to a family after the birth of a child. [ 10 ] [ 11 ]


In 2008,   Newfoundland and Labrador  introduced the Parental Benefits Program, which offered a $1,000 lump sum and $100 payments for the first year after a birth or adoption. It expired in 2016. [ 12 ] [ 13 ] [ 14 ]


Today, the  Canada Child Benefit  is one of several benefits offered by the Government of Canada. [ 15 ]


Currently there is a baby bonus of 13000 CZK (approx. 670 USD) for each first child born to mothers with low income. The mother must be a citizen or permanent resident of the  Czech Republic .


A bonus of €944.51 is paid for each child born (means-tested). [ 16 ]


Currently, there is a bonus of €960 (approx. $1,133) for every child born to household with income lower than €26,000 (approx. $30,700), and €1920 (approx. $2,266) for every child born to household with income lower than €7,000 (approx. $8,271). [ 17 ]


Currently, there is a bonus of €405 ($475) for every child in  Lithuania .


Luxembourg's baby bonus system is split into three stages, known as  allocation prénatale  (prenatal allowance),  allocation de naissance  (birth allowance) and  allocation postnatale  (postnatal allowance). The allowance is universal and is not means-tested. [ 18 ]


The total allowance amounts to €1,740.09, paid in three sums of €580.03 once each stage is complete.


The prenatal allowance can be claimed once a woman has undergone 5 obstetric examinations and 1 dental examination.


The birth allowance can be claimed once a woman has undergone a postnatal gynaecological examination. This way, a woman whose baby is stillborn or dies shortly after birth is still entitled to the first two parts of the baby bonus.


The postnatal allowance can be claimed once the child has turned 2 years old and has undergone 6 medical examinations with a paediatrician.


In April 2016, the PiS government, in response to low fertility rates in Poland, introduced the Family 500+ program. For every second child, parents receive 500PLN ($133) monthly until the child turns 18. For example, if a family has three children, they would receive 1000PLN every month until the oldest child turns 18, after which they would receive 500PLN. [ 19 ]


In July 2019, the Family 500+ program was extended to include 500PLN for the first child, regardless of family's economic status.


As of 2020 [update] , Russia offers  616,617 RUB (USD 11606,89) for second and every following child. Amount is indexed annually with inflation. This can only be spent on housing, education, healthcare, or a mother's pension.


The Baby Bonus Scheme (formerly known as Child Development Co-Savings Scheme) was first introduced in Singapore on 1 April 2001. The scheme is continuously enhanced since its inception till 2021. The objective is to improve the country's fertility rate by providing cash incentives, with the hope of reducing the financial burden of raising children and thereby encouraging them to have more children. The scheme consists of two components, Cash Gift, and Child Development Account (CDA); which has a monetary grant and a savings matching scheme. [ 20 ]


As of 2022, here are the benefits given as part of the Baby Bonus scheme.


For Singapore Citizen children born on or after 1 January 2015, the maximum amount of cash gift from the government is S$10,000, which can be spent without any restriction. It is available to each children up to 18 months of age. [ 20 ]


The Child Development Account (CDA) now has two components. Since 24 March 2016, a First Step Grant of up to $3,000 is credited by the Singapore government to each child once a CDA account is opened. The government contributes a dollar for a dollar matching the amount of savings that parents contribute to their child's savings in the CDA with the cap reduced as a result of the Grant. The amount is capped at S$6,000 for the first child, S$9,000 for the second child, S$12,000 for the third and fourth child, and S$18,000 for the fifth and subsequent child. The savings in this account may be used by the child and his/her siblings at the approved institutions for Child Care Centre, Early Intervention Programmes, Healthcare Institutions, Kindergarten, Special Education Centre, Assistive Technology Device Provider, Optical Shop and Pharmacy. With effect from 1 January 2013, the CDA of a child will remain open until the end of the child's 12th year, instead of the current 6th year. [ 20 ]


Parents are given Parenthood Tax Rebate to be used to offset against income tax payable and it can be shared among the parents. The rebate amount is $5,000 for the first child, $10,000 for the second child, and $20,000 per child for all subsequent children. Unutilized balance is automatically carried forward to offset future income tax payable. [ 21 ]


A  baby planner  is a private  maternity  consultant. They meet with expecting and new parents and offer education, resources and support. They may also recommend products, resources, services, support and additional education for their clients. [ 1 ]


Baby planners may work with expecting parents throughout the entire duration of their pregnancy or may meet with them for just a few sessions.


While baby planners are involved with helping expecting parents plan their pregnancies and guiding new parents through the  postpartum period , baby planners who do not hold additional medical licensing are not medical professionals and do not provide medical opinions, treatments, examinations or diagnoses.


While each baby planner may have their own list of services that they provide, most services baby planners offer center around educating their clients, referring their clients to specialty service providers and helping their clients to get and stay organized throughout the pregnancy and beyond.  Baby Gear consulting is the cornerstone service of baby planners and was first provided as a fee based service when baby planning was created in 2006.  However, some baby planners do not specialize in gear consulting and offer a variety of other services to meet a client's need.  Baby Planners offer many specialties and should customize their business to meet each client's need.


Services may include:


A  baby shower  is a party centered on gift-giving to celebrate the delivery or expected birth of a child. It is a  rite of passage  that celebrates through giving gifts and spending time together. [ 1 ]


The term  shower  is often assumed to mean that the expectant parent is "showered" with gifts. A related custom, called a  bridal shower , may have derived its name from the custom in the 19th century for the presents to be put inside a  parasol , which when opened would "shower" the bride-to-be with gifts. [ 2 ]


Traditionally, baby showers are given only for the family's first child, and only women are invited to party .... [ 3 ]  though this has changed in recent years, now allowing showers being split up for different audiences: workplace, mixed-sex, etc. [ 4 ] [ 5 ]  Smaller showers, or showers in which guests are encouraged to give only diapers or similar necessities, are common for subsequent babies. [ 5 ]


Activities at baby showers include gift-giving and playing themed games.  Giving gifts is a primary activity. [ 1 ]  Baby shower games vary, sometimes including standard games such as bingo, and sometimes being pregnancy-themed, such as "guess the mother's measurements" or "guess the baby".


According to etiquette authority  Miss Manners , because the party centers on gift-giving, [ 6 ]  the baby shower is typically arranged and hosted by a close friend rather than a member of the family, since it is considered improper for families to beg for gifts on behalf of their members. [ 7 ]  The pregnant mother, as well as her mother and mother-in-law, and any sisters and sisters-in-law are commonly considered too closely related to properly host a baby shower, but a more distant family member, such as a cousin, might be accepted. [ 5 ]  However, this custom varies by culture or region and in some it is expected and customary for a close female family member to host the baby shower. [ citation needed ]


Pre-birth baby showers may be held late in the pregnancy, but not usually during the last few weeks, in case of a pre-term birth. [ 5 ]


Many cultures do not have pre-birth celebrations. [ 5 ]  When a baby shower is held after a baby's birth, an invitation to attend the shower may be combined with a  baby announcement . In China, it is considered unlucky to have a baby shower before the baby is born, and gifts are usually sent after the birth, unrelated to a party. [ 8 ]  In the US, if a baby shower does not happen before the arrival of the baby, a sip-and-see party or other similar events can be organized after the birth.


Guests bring small gifts for the expectant parent. Typical gifts related to babies include  diapers , blankets,  baby bottles , clothes, and toys. It is common to open gifts during the party; sometimes the host will make a game of opening gifts.


Whether and how a  gift registry  is used depends partly on the family's class, because wealthier families do not depend on the gifts received to care for the baby. [ 1 ]  Preparing a gift registry is a time-consuming and potentially fun activity for the parents-to-be. [ 1 ]  It may result in less personal gifts (e.g., the purchase of a store-bought item instead of a handmade one). [ 1 ]  As with gift registries for other gift-giving occasions, some guests appreciate them, and others do not. [ 1 ]


Some families discourage gifts, saying that they want "your presence, not presents", or organizing a different activity, such as a blessing ceremony. [ 1 ]


In the United States, the baby shower is the only public event that recognizes a woman's transition into motherhood. [ 1 ]


The baby shower is a family's first opportunity to gather people together to help play a part in their child's life. The new parents may wish to call on people to assist in the upbringing of their child, and help educate the child over time. People around the family, who care for them, want to be involved in the child's life, and a baby shower presents an opportunity for them to give gifts and be of help, showing their love for the family. [ 9 ]  If it happens before the birth, it allows the new family to thank everyone.


Baby showers are relatively new, having become popular only in the middle of the 20th century, [ 1 ]  but other celebrations and rituals associated with pregnancy and childbirth are both ancient and enduring. [ 10 ]


While continuing the traditions from the 1950s, modern technology has altered the form a baby shower takes: games can include identifying baby parts on a  sonogram . Moreover, although traditional baby showers were female-exclusive, mixed-sex showers have increased in frequency. [ 10 ]


Baby showers and other social events to celebrate an impending or recent birth are popular around the world, but not in Western Europe. They are often women-only social gatherings.


Some baby showers are directed  at fathers . These may be more oriented towards drinking beer, watching sports, fishing, or playing video games. [ 13 ] [ 14 ]  The primary nature of these gifts is diapers and/or diaper-related items. [ 15 ] [ 16 ]  The organization of the diaper party is typically done by the friends of the father-to-be as a way of helping to prepare for the coming child. These parties may be held at local pubs/bars, a friend's house, or the soon-to-be grandfather's house. [ 15 ] [ 17 ]  In the  United Kingdom , this is called  wetting the baby's head , and is generally more common than baby showers. However, with the growth of American cultural influence – accelerated through celebrities via social media sites like  Instagram  – baby shower decorations are becoming more common in the United Kingdom. [ 18 ]  Wetting the baby's head is traditionally when the father celebrates the birth by having a few drinks and getting drunk with a group of friends.


There has been some controversy over these, with  Judith Martin  calling them a "monstrous imposition", [ 16 ]  although she was referring to the attitude of demanding gifts and not necessarily the male version of a baby shower.


In Hungary, such an event is called a  milking party,   and is held by tradition in favor of the mother to be blessed with breast milk for the newborn. Practically, it is the last day-off of the father for some time as he is expected to stay home to help. No similar domestic custom exists for mothers, such as a baby shower. Gifts for the baby are given on the first visit to his/her home. This, due to health concerns, happens at the appropriate and suitable time for each counterpart.


A  belly cast  is a three-dimensional  plaster  sculpture of a woman's pregnant abdomen as a keepsake of her  pregnancy . It can also be known as a  belly mask ,  pregnancy belly cast , a  pregnant plaster cast , or  prenatal cast .


Belly casts are most often made toward the end of the third trimester of pregnancy, [ 1 ]  though a series of casts may also be made during the pregnancy. They are made by preparing the skin with a coating of  Vaseline  or a similar lubricant and adding strips of wet plaster gauze over the abdomen to make the cast. Some women also cast their breasts, arms, hands and thighs into a full  torso  sculpture. The plaster sets in about 20–30 minutes but some fast-setting strips set in five minutes. Once set, the cast is gently removed by the mother using a wriggling motion. It takes one or two days for the cast to dry completely.


Gesso  can be painted onto the mask after drying to stop it absorbing moisture from the air. Gesso also works as a surface primer for painting and preserving it. The cast can be  decorated  with any number of finishes or designs including the baby's hand and foot prints, or left in its natural state. Most popular decorations include painting and  decoupage , while some belly casts are  mosaicked . [ 2 ]


This sculpture article is a  stub . You can help Wikipedia by  expanding it .


This article related to  art techniques  is a  stub . You can help Wikipedia by  expanding it .


Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives  is a collection of  anthropological  essays that study  birth  and  authoritative knowledge  across sixteen different cultures that was first published in 1998 in the  Journal of Gender Studies . [ 1 ] [ 2 ] [ 3 ]  It "extends and enriches" anthropologist  Brigitte Jordan 's work in the anthropology of birth. [ 4 ]  In 2003, it won the Council on Anthropology and Reproduction book award. [ 5 ]


This collection is edited by  Robbie Davis-Floyd  and  Carolyn Sargent . [ 1 ] [ 6 ]  The book opens with a foreword by  Rayna Rapp [ 6 ] [ 7 ]  and examines in detail the various patterns of birth and how they've changed over time. [ 2 ] [ 8 ]  Not only does the book study child-bearing across cultures, it also looks into the power that biomedical technology holds in the healthcare field. [ 8 ] [ 9 ]


Throughout the collection of essays, the twenty-three authors use authoritative knowledge as a theme to explore the ways it is evidenced and implemented in several different cultures. [ 10 ]  The book has eighteen chapters, creating five distinct parts. [ 3 ] [ 7 ]  Each part of the book takes a look at authoritative knowledge from a new perspective or culture. [ 7 ] [ 8 ] [ 11 ]  The scholars behind the essays themselves come from numerous academic backgrounds. [ 11 ] [ 12 ] [ 9 ]  Davis-Floyd is quoted to have said that the purpose of the book is to "act both as a useful source of information about birth across cultures and as a charter for future research and further growth in the field." [ 13 ]


This section of essays primarily describes how technology is used in the American setting. [ 7 ] [ 8 ]  This part of the book contains  Brigitte Jordan 's essay ("Authoritative Knowledge and Its Construction") along with context for the reader about the other essays in the book. [ 1 ] [ 6 ] [ 11 ]  Brigitte Jordan elaborates on the theme of authoritative knowledge in her book  Birth in Four Cultures: A Cross cultural Investigation of Childbirth in Yucatan, Holland, Sweden and the United States . [ 1 ] [ 2 ] [ 3 ]  Firstly, Jordan elaborates on her idea of authoritative knowledge. [ 1 ] [ 10 ] [ 12 ]  She specifically defines it as follows:


"For any particular domain several knowledge systems may exist, some of which, by consensus, carry more weight than others, either because they explain the state of the world better for the purposes at hand...or because they are associated with a stronger power base." [ 1 ] [ 8 ] [ 9 ]


Jordan also uses her essay to critique the hierarchical use of authoritative knowledge in a birth setting and provide context for the rest of the essays in the book. [ 1 ] [ 2 ] [ 8 ]  This theme is mentioned by other authors throughout the book. [ 8 ] [ 11 ]


Part One also contains an essay by Wenda R. Trevathan titled "An Evolutionary Perspective on Authoritative Knowledge about Birth". [ 6 ] [ 7 ]  This essay compares the human birth process to that of the apes. [ 7 ] [ 12 ] [ 13 ]


This second section of Davis-Floyd and Sargent's edited collection contains four essays. [ 8 ] [ 11 ] [ 12 ]  This set of papers looks at the large scale, macro-factors that effect pre-natal care and childbirth in  Greece ,  Japan  and the  United States . [ 1 ] [ 8 ]  This section of the book also examines the power dynamics that the biomedical field possesses in governing the way that women make choices. [ 1 ] [ 8 ] [ 11 ]


Eugenia Georges writes that in Greece, the ultrasound plays an important role in how a Greek mother views her pregnancy. [ 8 ] [ 11 ] [ 10 ]  For these mothers, authoritative knowledge is perpetuated by the ultrasound machine and the way that these women rely on it. [ 8 ] [ 10 ] [ 12 ]  In America, giving birth is often determined by class, income and authoritative knowledge. [ 8 ] [ 10 ]  This is the topic of Carole H. Browner and Nancy Press's essay ("The Production of Authoritative Knowledge in American Prenatal Care") as well as the essay in the following chapter "What Do Women Want? Issues of Choice, Control and Class in American Pregnancy and Childbirth" written by Ellen Lazarus. [ 6 ] [ 10 ] [ 12 ]  Browner and Press's essay specifically covers the role that bio-medics play in what is perceived as authoritative knowledge for a successful birth. [ 8 ] [ 10 ] [ 13 ]  Ellen Lazarus shows that the lack of knowledge surrounding the technology used in hospitals, especially in terms of the race and class of the patient, combined with the good intentions of all those involved also perpetuates authoritative knowledge. [ 1 ] [ 8 ] [ 10 ]  Lazarus elaborates on how things can go wrong despite the mother-to-be carefully selecting who will be involved in the birthing process. [ 10 ]


The fourth and final essay in this part of the book "Authoritative Knowledge and Birth Territories in Contemporary Japan" by Deborah Cordero Fiedler discusses the role of authoritative knowledge in Japan. [ 6 ] [ 8 ] [ 10 ]  In contrast to the United States, Japan uses technology during birth, however physicians will not immediately intervene. [ 10 ]  Fiedler's findings discuss the role that culture has in impacting birth and motherhood in contemporary Japan. [ 8 ] [ 12 ]


The third section of the book also contains four essays giving examples of women in  North America ,  Nepal ,  Central  and  Eastern Europe  who have given birth and the difficulties they faced. [ 1 ] [ 8 ]  This group of chapters also examines how a top-down community approach and other approaches to childbirth intersect to create the way that authoritative knowledge surrounding this technology came to exist. [ 11 ] [ 12 ] [ 13 ]


Carolyn F. Sargent and Grace Bascope's essay ("Ways of Knowing about Birth in Three Cultures") compares the ways that women view birth practitioners and decisions made during birth in  Texas ,  Jamaica  and the  Yucatan . [ 1 ] [ 6 ]  The author shows the ways that authoritative knowledge is used in certain social / cultural groups in relation to others. [ 1 ] [ 8 ] [ 13 ]  The essay by Shiela Kitzinger ("Authoritative Tough in Childbirth: A Cross-Cultural Approach") explores the way that women experience touch during birth, the different kinds of touch experiences and the ways that authoritative knowledge plays into this experience. [ 6 ] [ 10 ] [ 12 ]


The following essay, by Stacy Leigh Pigg ("Authority in Translation: Finding, Knowing, Naming, and Training 'Traditional Birth Attendants' in  Nepal ") explores how training programs designed to train traditional birth attendants end up creating a unique hierarchy and power relation in Nepal. [ 6 ] [ 8 ] [ 12 ]


The final essay "Changing Childbirth in Eastern Europe: Which Systems of Authoritative Knowledge Should Prevail?", written by Beverley Chalmers, investigates the highly medicalized birth systems in Europe and which ones play a role in authoritative knowledge. [ 6 ] [ 12 ] [ 13 ]


The fourth part of the book contains four essays, two of which follow the idea about the power that traditional birthing practices like midwifery can hold. [ 8 ] [ 12 ]  This part of the book shows some of the different models through which authoritative knowledge can be employed. [ 11 ] [ 10 ]  It seeks to encapsulate the ways that authoritative knowledge surrounding technology has been resisted in some countries. [ 1 ] [ 13 ]  There are also examples of the ways that mothers receive knowledge via childbirth activists. [ 1 ] [ 13 ]


The first essay in this part is written by Jane Szurek ("Resistance to Technology-Enhanced Childbirth in  Tuscany : The Political Economy of Italian Birth") and discusses the authority of the medical field in  Italy . [ 1 ] [ 6 ]  This essay takes a particular focus on the way that a more medicalized way of birth has been resisted, specifically by birth activists, in this part of the world. [ 12 ]


An essay by  Robbie Davis-Floyd  and  Elizabeth Davis  ("Intuition as Authoritative Knowledge in Midwifery and Home Birth") explores the dangers that American midwives face in their practice and the ways that their knowledge is used as authoritative knowledge. [ 6 ] [ 11 ] [ 12 ]  The specific focus of this chapter is the viability of midwives' intuition as a source of knowledge. [ 9 ] [ 11 ]


The third author in this part of the book, Kenneth C. Johnson, ("Randomized Control Trials as Authoritative Knowledge: Keeping an Ally from Becoming a Threat to  North American  Midwifery Practice") discusses the impact that evidenced-based care has on the use of the randomized control trial and the ways in which this kind of research can impede on the rights of women. [ 8 ] [ 10 ] [ 12 ]


The following essay in this part, written by Marsden Wagner, ("Confessions of a Dissident") explains the perspective that the  World Health Organization  (WHO) has on the care of mothers, only after describing how he got into the field of public health. [ 3 ] [ 6 ]


The final part of the book follows communities and countries that utilize indigenous birthing systems, resist change, and are able to maintain their existing systems of authoritative knowledge. [ 8 ]  The cultures examined are:  Oaxaca ,  Mexico , the Puejehun District,  Sierra Leone , the  Inuit  community, and the Kung of Kalahari. [ 1 ] [ 2 ] [ 13 ]


Paola M. Sesia ("'Women come here on their own when they need to': Prenatal Care, Authoritative Knowledge, and Maternal Health in Oaxaca") explores the birthing practices, particularly massages, that are utilized in Oaxaca. [ 2 ] [ 6 ] [ 12 ]  Amara Jambai and Coral MacCormack ("Maternal Health, War, and Religious Tradition: Authoritative Knowledge in Pujehun District, Sierra Leone") take particular interest in women who give birth in this war stricken region of Sierra Leone. [ 2 ] [ 6 ]  Betty-Anne Daviss ("Heeding Warning from the Canary, the Whale, and the Inuit: A Framework for Analyzing Competing Types of Knowledge about Childbirth") brings North America into the discussion with a focus on birth in the Inuit community in Canada and how traditional practice has been changed by the building of birth centers. [ 2 ] [ 6 ]  Megan Biesele ("An Ideal of Unassisted Birth: Hunting, Healing, and Transformation among the Kalahari Ju/'hoansi") examines Kalahari Ju/'hoansi cultures in  Botswana  and  Namibia , the independence, and the spirituality of birth that exists in these cultures. [ 1 ] [ 6 ] [ 12 ]


Clue  is a menstrual health app developed by the  Berlin -based technology company BioWink GmbH. The app has over 15 million users from 180 countries. The startup has raised over $17 million from backers that include  Union Square Ventures  and Mosaic Ventures.


Clue was co-founded by  Ida Tin , Hans Raffauf, Mike LaVigne and Moritz von Buttlar in 2012. [ 3 ]  BioWink GmbH launched the app in 2013. [ 4 ]  Ida Tin's stated goal was to take female reproductive health “out of taboo land” and to start “a reproductive health revolution.” Tin previously led motorbike tours around the world and wrote a book about her experience. [ 4 ] [ 5 ]


By July 2017, the Clue app had more than 8 million active users on both Android and iOS. [ 5 ] [ 6 ]  Users were representative of more than 180 countries. [ 7 ]  In 2015, BioWink GmbH closed a $7 million Series A funding round led by  Union Square Ventures  and Mosaic Ventures, bringing the company's total funding to $10 million. [ 6 ]  The company was listed as one of Europe's Hottest Startups in 2015 by  Wired UK , [ 8 ]  with Clue being named one of the best apps in 2015 by both Apple and Google. [ 9 ] [ 10 ]


In March 2018, the company launched an editorial site to serve as a resource for accessible and scientific menstrual health information. [ 11 ] [ 12 ]


The Clue mobile application calculates and predicts a user's period, fertile window, and premenstrual syndrome. It also informs users the most or least likely time for becoming pregnant and allows them to track more than 30 health categories, including sex, sleep, pain, exercise, hair, skin, digestion, emotions and energy. [ 13 ]  The app can also explain how pill dosages impact fertility and includes an alarm system to allow for reminders for taking pills. [ 14 ]


In 2015, the company closed a Series A funding round and announced plans to use the proceeds to expand features of the mobile app and hire more staff. [ 6 ]  Clue also partnered with universities such as  Stanford University ,  Columbia University ,  University of Washington , and  University of Oxford  to advance female health research. [ 5 ]


Clue integrated with  Apple Inc. 's  HealthKit  for  iOS 9  in September 2015, allowing data such as body temperature, cervical mucus quality, menstruation, ovulation test results, sexual activity, and spotting directly to the app. [ 15 ] [ 16 ]


In 2016, Clue was available in 15 languages on both iOS and Android. [ 17 ]  That same year, Clue introduced a cycle-sharing feature and in 2017 a pill-tracking option. [ 12 ]


In February 2018, Clue made its app available on the  Fitbit  Ionic smartwatch. [ 18 ]


In  Korean culture ,  conception dreams  ( Korean :  태몽 ;  Hanja :  胎夢 ;  RR :  taemong ;  MR :  t'aemong ) are  dreams  that are said to foretell the  conception  or  birth  of a child, dreamt by the future mother or people close to her. [ 1 ] [ 2 ]


Many Korean women report having such dreams themselves. Popular topics of the dreams include fruit (such apples,  persimmons , cherries, chestnuts), animals (tigers, snakes, goldfish), nature (rivers, rainbows), children and jewels. The dreamer might eat or take fruits, embrace animals, or interact with nature. The topic is believed to influence the  gender  or the future of the baby; for example, fruits are seen as a sign for a baby girl.


The person having the dream can be the mother herself, but close family members such as her mother or the husband can also have conception dreams instead of the mother. Dreams are often considered to be  omens , and sometimes people will "buy" dreams from friends, if they feel it is a good omen or a good conception dream.


Accounts of conception dreams can be found in numerous old histories. One example is the conception dream of  Kim Yushin , from the 6th century  AD , documented in the  Samguk Sagi .


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A  conceptus  (from  Latin :  concipere , to conceive) is an  embryo  and its  appendages  (adnexa), the associated membranes,  placenta , and  umbilical cord ; the products of conception [ 1 ]  or, more broadly, "the product of conception at any point between fertilization and birth." [ 2 ]  The conceptus includes all structures that develop from the zygote, both embryonic and extraembryonic. It includes the embryo as well as the embryonic part of the placenta and its associated membranes:  amnion ,  chorion  ( gestational sac ), and  yolk sac . [ 3 ]


Congenital varicella syndrome  is a rare disease resulting from  Varicella Zoster virus  (VZV) infection during the period of  gestation .  Viremia  during the primary infection can result in  transplacental  transmission of the infection to the developing  fetus . An estimated 25% of fetuses get infected with  varicella  infection when mother has a varicella infection during the  pregnancy  but the risk of developing congenital varicella syndrome is around 2%, therefore majority of the outcomes are normal  newborns . Patients with primary infection before 20 weeks of gestation are at a higher risk of developing the severe form of infection, affecting the  eyes ,  limbs ,  skin  and the  central nervous system . Diagnosis requires a documented history of primary infection in the mother and serial  ultrasound  demonstrating features suggestive of congenital varicella syndrome. There is no definitive treatment, termination of pregnancy in fetuses with severe features is recommended.  Vaccination  to prevent maternal varicella infection and proper counseling to avoid contact with infected people are important for the management options to reduce the incidence of congenital varicella syndrome. [ 1 ]


There is no classification for congenital varicella syndrome.


Congenital varicella syndrome is a rare disease with over 100 cases reported in literature. [ 12 ]


Congenital varicella syndrome is caused by  Varicella zoster virus  (VZV), a human alpha herpes  virus .


The most important congenital infections, which can be transmitted vertically from mother to fetus are the  TORCH infections . These infections have overlapping features and hence, must be differentiated from congenital varicella syndrome: [ 13 ] [ 14 ]


VZV  infection during  pregnancy  results in a normal newborn birth in majority of the patients, however, in a few patients it can result in congenital varicella syndrome or neonatal varicella or  clinical zoster  during  infancy , the outcomes are dependent on the gestational age of  fetus  at the time of infection. Early gestational period infection via the  transplacental  route can result in congenital varicella syndrome resulting in a  miscarriage ,  abortion  or a  newborn  with features affecting the  limbs ,  eyes ,  central nervous system ,  autonomic nervous system  and present with features such as  low birth weight , cutaneous scarring, limb hypoplasia,  microcephaly , cortical atrophy,  chorioretinitis  and  cataracts . [ 15 ] [ 16 ]


Severe infection of the fetus can result in an  abortion .  Infants  born with signs of congenital varicella syndrome have poor  prognosis  and die during the first few months of life. [ 17 ] [ 15 ]  Infants with milder symptoms can have a normal development and good  prognosis . [ 18 ] [ 19 ]


Congenital varicella infection can result in the following complications: [ 20 ]


Symptoms of primary infection in mother :


Symptoms in the neonate


Physical examination findings suggestive of congenital varicella syndrome include: [ 25 ] [ 26 ]


Table adopted from varicella in fetus and newborn [ 31 ]


The diagnosis of congenital varicella syndrome is based on a documented history of  varicella  infection during the  pregnancy  and the presence of fetal manifestations on  ultrasound . [ 32 ]


Table adopted from Herpes simplex and varicella-zoster virus infections during pregnancy: current concepts of prevention, diagnosis and therapy. Part 2: Varicella-zoster virus infections [ 33 ]


Diagnosis of primary infection in the mother :  In  pregnant  women diagnosis of a primary infection requires a combination of clinical manifestations and series of diagnostic tests. The tests are performed on the samples from the vesicular skin lesions and include the following:


Prenatal diagnosis


Prenatal   MRI  is a useful investigation to assess the extent of  CNS  involvement and to confirm the findings of  ultrasound . [ 40 ]


There are no surgical therapies for treatment of congenital varicella syndrome.


This article incorporates text by Mahshid Mir, Usama Talib, Aravind Reddy Kuchkuntla, Aditya Ganti, Michael Maddaleni and Kalsang Dolma available under the  CC BY-SA 3.0  license.


Couvade  ( [ k u v a d ]   ⓘ ) is a term which was coined by the anthropologist  Edward Burnett Tylor  in 1865 to refer to certain rituals in several cultures that fathers adopt during  pregnancy .


Couvade can be traced to  Ancient Egypt  as a "sacred birth custom, of when a child is born, the man experiences the ritual of 'labor' in which he takes to his bed, and undergoes periods of fasting and purification, and the observance of certain taboos". [ 1 ]


The  Ancient Greek  writer  Plutarch  mentions a report by  Paeon of Amathus  of a custom in  Cyprus  honouring the myth of  Ariadne  (who had died while pregnant) in which a young man would lie down and imitate the crying and gesturing of women during labor. [ 2 ]


The term "couvade" is borrowed from  French , which derives it from the verb  couver  ("to brood, hatch"). The term's use in the modern sense derives from a misunderstanding of an earlier idiom  faire la couvade , which meant "to sit doing nothing". [ 3 ]


An example of couvade was from the  Cantabri , who had a custom in which the father, during or immediately after the birth of a child, took to bed, complained of having labour pains and was accorded the treatment usually shown to women during pregnancy or after childbirth. Similarly, in  Papua New Guinea , fathers built a hut outside the village and mimicked the pains of labour until the baby was born. Similar rituals occur in other cultural groups in  Thailand ,  Albania ,  Russia ,  China ,  India [ 4 ]  and many indigenous groups in  South America . [ 5 ]


In some cultures, " sympathetic pregnancy " is attributed to efforts to ward off demons or spirits from the mother or seek favour of supernatural beings for the child. [ 6 ]  Couvade has been reported by travelers throughout history, including the Greek geographer  Strabo  (3.4.17).


According to  Claude Lévi-Strauss , the custom of couvade reinforces the institution of the family in some societies by "welding" together men and their wives and future children. [ 7 ]


A  dadchelor party ,  man shower  or  baby stag  is a  baby shower  for men. [ 1 ]  It is a celebration of the birth or expected birth of a child, and the transformation of a man into a father. However, the focus tends to be more on allowing the expectant father to have fun before the arrival of the baby. [ 2 ]  The party usually consists of gift-giving and drinking as well as other hobbies that the future father enjoys, and may be organised by the father himself or his friends. [ 3 ]


Earliest mentions of this 21st century concept start in the late 2000s, [ 4 ]  but the trend emerged more prominently in 2011. [ 5 ]  In Quebec, in 2022, the concept was developed further by Alexandre where he notably promptes the gifting of “dad shoes” to the father to be, a strong symbol of fatherhood. In the years before this,  baby showers  often revolved around  mothers-to-be , as they are physically affected by the pregnancy and childbirth. [ 6 ]


In recent years, with improving  gender equality , men have started to hold baby showers or "dadchelor parties" as their own form of enjoyment and celebration. [ 7 ]


The Dadchelor party is a way to celebrate first-time fathers and to provide recognition as they enter parenthood. These parties allow the father-to-be to 'let loose" before the baby is born. [ 7 ]  They consist of stereotypically  masculine  activities to celebrate the father-to-be's promotion to fatherhood. These parties can also be viewed as the "one last pre-fatherhood bash." [ 8 ]  Dadchelor parties can be an extensive celebration, or a simple party. [ 9 ]


The exchange of gifts at a Dadchelor party is optional but often encouraged. Guests will bring gifts that contribute to their night of bonding, or may even pay for the dad-to-be and his travel expenses. Gifts also are exchanged for  alcoholic beverages , for example, " Chuggies  for  Huggies ," where the guests bring  diapers  in exchange for alcohol. [ 10 ]


Decidualization  is a process that results in significant changes to cells of the  endometrium  in preparation for, and during,  pregnancy . This includes morphological and functional changes (the  decidual reaction ) to endometrial stromal cells (ESCs), the presence of decidual  white blood cells  (leukocytes), and vascular changes to maternal arteries. The sum of these changes results in the endometrium changing into a structure called the  decidua . In humans, the decidua is shed during  childbirth . [ 1 ]


Decidualization plays an important role in promoting  placenta formation  between a mother and her fetus by mediating the invasiveness of  trophoblast  cells. It also triggers the production of cellular and molecular factors that result in structural changes, or remodeling, of maternal  spiral arteries . Decidualization is required in some mammalian species where embryo  implantation  and  trophoblast  cell invasion of the endometrium occurs, also known as  hemochorial placentation . This allows maternal blood to come into direct contact with the fetal  chorion , a membrane between the fetal and maternal tissues, and allows for nutrient and gas exchange. However, decidualization-like reactions have also been observed in some species that don't display hemochorial placentation. [ 2 ]


In humans, decidualization occurs after  ovulation  during the  menstrual cycle . After implantation of the embryo, the decidua further develops to mediate the process of placentation. In the event no embryo is implanted, the decidualized endometrial lining is shed or, as is the case with species that follow the  estrous cycle , absorbed. [ 1 ]  In  menstruating species , decidualization is spontaneous and occurs as a result of maternal hormones. In non-menstruating species, decidualization is non-spontaneous, meaning it only happens after there are external signals from an implanted embryo. [ 3 ]


After ovulation, the high levels of  progesterone  initiate the molecular changes leading to decidualization. The process triggers an influx of decidual leukocytes along with morphological and functional changes of ESCs. The changes in the ESCs result in the endometrium developing a secretory lining that produces a variety of proteins,  cytokines , and  growth factors . These secreted factors will regulate the invasiveness of trophoblast cells that eventually form the placental connection if an embryo implants into the decidua. [ 4 ]


One of the identifying features of the decidua is the presence of large numbers of leukocytes that are mostly made up of specialized  uterine natural killer (uNK) cells [ 5 ]  and some  dendritic cells . As the fetus consists of both maternal and paternal  DNA , the decidual leukocytes play a role in suppressing the  immune response  of the mother to prevent treating the fetus as genetically foreign. Outside of their immune functions, the uNK cells and dendritic cells also act as regulators of maternal spiral artery remodeling and ESC differentiation. [ 6 ]


ESCs are the connective tissue cells of the endometrium that are fibroblastic in appearance. However, decidualization causes them to swell up and adopt an  epithelial  cell-like appearance due to the accumulation of  glycogen  and  lipid  droplets. Furthermore, they begin secreting cytokines, growth factors, and proteins like  IGFBP1  and  prolactin , along with  extracellular matrix  (ECM) proteins such as  fibronectin  and  laminin . The increased production of these ECM proteins turns the endometrium into the dense structure known as the decidua, which produces factors that promote trophoblast attachment and inhibit overly aggressive invasion. [ 7 ]


The decidual reaction is seen in very early pregnancy in the generalized area where the  blastocyst  contacts the endometrial  decidua . It consists of an increase in secretory functions of the endometrium at the area of implantation, as well as a surrounding stroma that becomes  edematous . [ 8 ]


The decidual reaction occurs only in humans and a few other species. The decidual reaction and decidua are not required for implantation. Evidence can be taken from the fact that in  ectopic pregnancies  and  hysterectomies , implantation can occur anywhere in the abdomino-pelvic cavity. [ 9 ]


Abnormalities in decidualization have been implicated in diseases such as  endometriosis , in which impaired decidualization leads to  ectopic  uterine tissue growth. Lack of decidualization has also been linked to higher rates of  miscarriage . [ 10 ]


Chronic deciduitis , a chronic  inflammation  of the decidua, has been linked with  premature birth . [ 11 ]


The decidualization process is initiated by progesterone, but this requires  cyclic adenosine monophosphate  (cAMP) to act as the initial signalling molecule to sensitize endometrial cells to progesterone. Consequently, human ESCs have been decidualized in culture with  chemical analogs  of cAMP and progesterone together.  In vitro  decidualization results in similar morphological changes to the human ESCs as well as upregulated production of decidualization markers such as  IGFBP1  and  prolactin . [ 7 ]


Mouse models have been extensively used for the identification of the molecular factors required for and involved in decidualization. [ 12 ]


Early pregnancy bleeding  (also called  first trimester bleeding ) is vaginal  bleeding  before 14 weeks of  gestational age . [ 1 ] [ 2 ]  If the bleeding is significant,  hemorrhagic shock  may occur. [ 1 ]  Concern for shock is increased in those who have  loss of consciousness , chest pain,  shortness of breath , or shoulder pain. [ 1 ]


Common causes of early pregnancy bleeding include  ectopic pregnancy ,  threatened miscarriage , and pregnancy loss. [ 1 ] [ 2 ]  Most miscarriages occur before 12 weeks gestation age. [ 2 ]  Other causes include  implantation bleeding ,  gestational trophoblastic disease ,  polyps , and  cervical cancer . [ 1 ] [ 2 ]  Tests to determine the underlying cause usually include a  speculum examination ,  ultrasound , and  hCG . [ 1 ]


Treatment depends on the underlying cause. [ 1 ]  If tissue is seen at the  cervical opening  it should be removed. [ 1 ]  For those in whom the pregnancy is intrauterine and who have  fetal heart sounds ,  watchful waiting  is generally appropriate. [ 3 ]   Anti-D immune globulin  is usually recommended in those who are  Rh-negative . [ 4 ]  Occasionally, surgery is required. [ 1 ]


About 30% of women have bleeding in the  first trimester  (0 to 14 weeks gestational age). [ 1 ] [ 5 ]  Bleeding in the second trimester (12 to 24 weeks gestational age) is less common. [ 6 ]  About 15% of those who realize they are pregnant have a  miscarriage . [ 1 ]   Ectopic pregnancy  occurs in under 2% of pregnancies. [ 1 ]


The differential diagnosis depends on whether the bleeding occurs in the first trimester or in the second or third trimesters.


Obstetric causes of first trimester bleeding include the following:


Obstetric causes of second/third trimester bleeding include the following:


Other causes of early pregnancy bleeding include the following:


Early pregnancy bleeding is usually from a maternal source rather than a fetal one. The maternal source may be a disruption in the vessels of the  decidua  or a lesion in the cervix or vagina. In the earlier stages of pregnancy, the cervix can be vulnerable to bleeding as new blood vessels are being grown. [ 15 ]   Vasa praevia  is a rare condition that can result in bleeding from the fetoplacental circulation. Vasa praevia happens most often when the umbilical cord grows in a way that it directly enters the membrane, and therefore blood vessels that are unprotected by the umbilical cord or placental tissue can rupture and lead to bleeding. [ 16 ]  Another common source of bleeding can be due to abnormal development of the embryo. The most common early fetal abnormality is abnormal number of chromosomes causing loss of the pregnancy and bleeding. [ 17 ]


The initial assessment of vaginal bleeding in early pregnancy must first consider hemodynamic stability and the degree of pain or bleeding.  A hemodynamically unstable individual would necessitate an immediate transfer to the emergency department. It is important to recognize that women may suffer significant blood loss before any signs of hemodynamic instability are evident. [ 18 ]


The initial evaluation of early pregnancy bleeding involves a history and physical examination. [ 19 ]  The relevant history includes determining the gestational age of fetus and characterizing the bleeding. Bleeding that is at least as heavy as menstrual bleeding or associated with clots, tissue, lightheadedness, or pelvic discomfort is associated with increased risks of ectopic pregnancy and spontaneous abortion. [ 19 ]  Discomfort in the middle of the abdomen is more closely associated with spontaneous abortion; discomfort on a side of the abdomen is more closely associated with ectopic pregnancy. Risk factors for ectopic pregnancy or spontaneous abortion should also be considered. [ 19 ]


The physical examination includes assessing vital signs and performing an abdominal and pelvic examination. Signs of hemodynamic instability or peritonitis require emergent intervention. [ 19 ]  A pelvic examination may reveal non-obstetric causes of bleeding such as bleeding from the vagina or cervix. It may also show visible  products of conception  suggestive of an incomplete abortion. [ 19 ]


If the person is stable and a pelvic exam is unrevealing, transvaginal ultrasonography and/or serial measurement of hCG is generally recommended to assess fetal location and viability. [ 19 ]  Reviewed data from observational studies determined that ultrasound examination and hCG concentration could replace pelvic examination in the initial evaluation of early pregnancy bleeding. [ 20 ]  Transvaginal ultrasound is frequently used in the evaluation of bleeding in early pregnancy. [ 21 ]


Before 10 weeks gestation, a slower than normal increase in hCG suggests early pregnancy loss or ectopic pregnancy. [ 19 ]  By approximately 10 weeks, hCG plateaus and ultrasound is preferred to determine the location of the pregnancy (i.e., intrauterine or ectopic). [ 19 ]  In the presence of prior pelvic imaging, fetal heart tracing with  Doppler sonography  is sufficient to assess fetal viability beginning at 10–12 weeks of gestation. Bleeding associated with an intrauterine, viable pregnancy suggests threatened early pregnancy loss. [ 19 ]  Bleeding associated with an intrauterine, nonviable pregnancy suggests early pregnancy loss. [ 19 ]  If the viability of an intrauterine pregnancy is uncertain, repeat ultrasonography coupled with laboratory measurement of progesterone and/or serial hCG can be helpful. [ 19 ]  The absence of either intrauterine or ectopic pregnancy on imaging is suggestive of a complete early pregnancy loss (if the pregnancy was previously seen on imaging) or a pregnancy of unknown location (if the pregnancy was not previously seen on imaging). [ 19 ]


The management of early pregnancy bleeding depends on its severity and cause. [ 1 ]


Women with significant first-trimester bleeding (more than spotting) should have a red blood cell antibody screen. Women who are  Rh-negative  are usually given  anti-D immune globulin  to prevent  RhD isoimmunization . [ 4 ]  Those with significant blood loss who become hemodynamically unstable require rapid intervention. [ citation needed ]


Early pregnancy loss can be treated with watchful waiting, medication, or uterine aspiration based on shared decision-making between the mother and provider. [ 19 ]  For those with incomplete abortion, watchful waiting is the recommended method as more than 90% of these individuals will complete the process spontaneously within four week. [ 22 ]  Women who decide on expectant management may experience more days of bleeding and longer completion time as compared to surgical management. Serious complications of watchful waiting are rare. [ 23 ]  Effective medical management entails 200 mg of oral mifepristone (Mifeprex) followed 24 hours later by 800 mcg of vaginally administered misoprostol. [ 24 ]  Bed rest and progesterone therapy have not been shown to increase the likelihood of a viable outcome. [ 19 ] [ 25 ]


Ectopic pregnancy is treated with  methotrexate  therapy or surgery. Typically, an intramuscular injection of 50 mg per m^2 of methotrexate is given followed by close monitoring of b-hCG levels 4 and 7 days after injection. B-hCG levels should decrease by at least 15% between those two timepoints. [ 26 ]  Surgery is required for individuals who have failed or have contraindications to methotrexate therapy, are experiencing significant blood loss, or have signs of ectopic rupture. [ 1 ]


First trimester bleeding is more common than second or third trimester bleeding. [ 6 ]  First trimester bleeding may be associated with complications in later pregnancy, including placental abruption, smaller estimated fetal weight, stillbirth, and perinatal death. [ 27 ] [ 28 ] [ 29 ]


Embryokines  ( Greek :  embryuon  "embryo" +  kinōs  "movement") are regulatory molecules produced by the oviduct and endometrium in the reproductive tract that modulate  embryonic growth and development . [ 1 ] [ 2 ]


Embryokines include growth factors such as  insulin-like growth factor-1 , and  activin  a  transforming growth factor ;  cytokines  such as  colony stimulating factor 2 , [ 3 ] [ 4 ]  WNT regulatory proteins including  DKK1 ; [ 5 ]  Other small molecule  amino acids  are included that regulate embryonic development through the  mTOR  signalling pathway.  Prostacyclin 1  can activate  peroxisome proliferator-activated receptor 6  to increase  blastocyst  hatching, and  cannabinoids  that can also act to regulate implantation and development. [ 2 ]


Women with  epilepsy  can have safe, healthy  pregnancies  and healthy babies. However, proper planning and care is essential. The goal of planning is to minimize the risk of  congenital malformations  and  neurodevelopmental disorders  for the  fetus  while maintaining the mother's seizure control. [ 1 ]


To reduce the risk of birth defects caused by  anti-seizure medications  (ASMs) and to preserve the mother's health, unplanned pregnancies should be prevented. [ 2 ]


For women taking  hormonal contraceptives , the use of enzyme-inducing ASMs is associated with an elevated risk of unplanned pregnancies.


The following hormonal contraceptives are preferred for women with epilepsy, especially if they are on enzyme-inducing ASMs. [ 3 ]


Patients should avoid estrogen for the first six postpartum weeks to avoid  deep vein thrombosis .


There do not appear to be any differences in pregnancy rates, time to conceive, or pregnancy outcomes in women with epilepsy compared to the general population. Women with epilepsy experience  infertility  at the same rate as women who do not have epilepsy and may need to consider  fertility treatment  to help them get pregnant.


Women with epilepsy who have been actively trying to get pregnant for six months or longer should see a fertility specialist like an  OB-GYN  ( Obstetrics  and  Gynecology ) or  reproductive endocrinologist .


Clinicians should pay particular attention to anti-seizure medication (ASM) levels in patients undergoing ART (e.g.,  egg retrieval , egg preservation or  IVF ) For example, estrogen can be a common component of some fertility regimens, and its use may reduce  lamotrigine  levels. [ 4 ]


For most patients with epilepsy, the risk of passing the disease to a child is only slightly higher than the risk of a member of the general population having a child with epilepsy (1–2%). Specifically, the  hereditary  rates for patients with:


The above statistics do not apply if a person has a known genetic cause of their epilepsy. In those cases, the risks of passing on epilepsy to a child may be significantly higher. Some indications that epilepsy may have a genetic cause are:


Several studies [ 2 ]  following children exposed to ASMs during pregnancy found that:


Valproic acid exposure during the first 13 weeks of pregnancy has been associated with adverse neurodevelopmental outcomes (cognitive and behavioral) in children when compared to children born to mothers without epilepsy and children born to mothers taking other ASMs. Specifically, children exposed to valproic acid during pregnancy may exhibit lower  IQ , lower verbal abilities, and have an increased risk of autism spectrum disorder. [ 7 ]  Risk of major congenital malformations that exposure to valproic acid may impact is generally complete by 13 weeks of pregnancy.


Limited data is available about the neurodevelopment of children born to patients who take other ASMs during pregnancy.


Topiramate  and  zonisamide [ 8 ]  exposure during pregnancy has been linked to a risk of infants being born small for their  gestational age .


Monthly monitoring of anti-seizure medication (ASM) levels is important for minimizing the possibility of seizures during pregnancy. Pregnancy can increase ASM clearance, and the extent of clearance changes will vary from patient to patient, so frequent monitoring and adjustment of medication dosages can help maintain optimal seizure control and support the safety and health of both patient and fetus. [ 9 ]


Maintaining seizure control is crucial throughout the pregnancy of a person with epilepsy, including during labor and delivery.


Tonic-clonic seizures  or any type of seizure with impaired awareness can result in falls or  car wrecks , leading to multiple complications in obstetric patients, including:


Any type of convulsive seizure resulting in trauma could cause fetal heart rate changes and lactic acid build-up. [ 10 ]


Throughout the pregnancy, the patient's OB or other pregnancy care providers should assess the patient for an increase in all types of seizures, including:


An uptick in milder seizures also should be tracked, as this can often signal an increased likelihood of convulsive seizures.


Pregnant patients with epilepsy should keep track of their seizure activity and report all breakthrough seizures, regardless of severity, to their healthcare providers.


Sleep deprivation , which often happens in the third trimester of pregnancy and the postpartum period, is a common seizure trigger (particularly for frontal lobe and idiopathic generalized epilepsy seizures). Pregnant women with epilepsy should collaborate with their healthcare providers and support system to develop a comprehensive sleep plan during their second trimester.


Research shows that different ASMs are associated with different levels of  teratogenic  risk. For best outcomes, women with epilepsy need to start planning for pregnancy with their clinician 12 months in advance, as it can take 3–12 months to switch or adjust their ASM if they are on an ASM with a higher level of teratogenic risk. [ 2 ]


When switching ASMs or adjusting dosages, the goal is to identify the lowest effective ASM dosage that will pose the least teratogenic risk to the fetus while maintaining the patient's seizure control. [ 11 ]  This transition should start well before pregnancy — for those who will undergo major changes in their ASM regimen, this could be as much as 12 months before the patient attempts to become pregnant.


Most ASMs may require higher doses during pregnancy due to changes in drug clearance. However, women with epilepsy should reduce these increased doses in the first few weeks after giving birth to prevent potential  toxicity . Symptoms of toxicity include dizziness, vomiting, and blurry/double vision.


The postpartum tapering plan may involve maintaining a slightly higher ASM dose than pre-pregnancy levels. The higher dose can protect the patient from the effects of sleep deprivation and added stressors during the postpartum period. For most ASMs, the initial step is to hold at the delivery dose for 48 hours. After this period, a gradual tapering process should be implemented over the appropriate interval for the specific ASM, typically lasting three weeks.


There is little evidence to suggest that ASM exposure from  breast milk  has clinical effects on newborns and several studies examined the neurodevelopment of babies exposed to ASMs via breast milk and the results were positive.


Babies of nursing mothers who take  benzodiazepines , barbiturates, and  clobazam  should be carefully monitored for wakefulness and growth. More testing is needed to determine the neurodevelopmental effects of these drugs on babies.


When patients stop breastfeeding, their ASM distribution levels may change; it is important to assess and carefully monitor ASM levels before, during, and after pregnancy.


Extravillous trophoblasts   (EVTs) , are one form of differentiated  trophoblast  cells of the  placenta . They are invasive  mesenchymal  cells which function to establish critical tissue connection in the developing placental-uterine interface. EVTs derive from  progenitor   cytotrophoblasts  (CYTs), as does the other main trophoblast subtype,  syncytiotrophoblast  (SYN). They are sometimes called  intermediate trophoblast . [ 1 ]


EVTs that derive from CYT cells on the surface of placental  chorionic villi  that come into contact with the uterine wall - at the placental bed - begin to express the  HLA-G  antigen. [ 2 ]  Extravillous trophoblast (EVT) cells migrate from anchoring villi, and invade into the decidua basalis. Their main function is remodelling the uterine spiral arteries, to achieve an increase in the spiral artery diameter of from four to six times. This changes them from high-resistance low-flow vessels into large dilated vessels that provide good perfusion, and oxygenation to the developing placenta. When invasion is shallow it is inadequate, the arteries remain narrow at their openings into the intervillous space, and is the cause of pre-eclampsia, fetal growth restriction and still birth. [ 3 ] [ 4 ] [ 5 ]


EVT are a low-incidence  (<5% of trophoblasts), but critical and multifunctional, subtype of trophoblast in the placenta.


As the placenta forms and the cytotrophoblast layer grows and extends, distal villous CYT differentiate to cell column CYT which eventually detach and invade deeply to the maternal decidua as interstitial EVTs. [ 6 ]  These EVTs anchor placental villi to the maternal decidua. Shallow implantation of EVT is associated with poor  placentation  and  preeclampsia . Endovascular EVTs are also major regulators of oxygenation during early placental development. Initially, they plug maternal  spiral arteries  to maintain hypoxia and prevent blood perfusion. [ 7 ] [ 8 ]  This protects the  fetus  and placenta from oxidative stress during early development in the  histiotrophic  (glandular nutrition) stage. As fetal nutrition switches to the  hemotrophic  (blood-derived nutrition) stage, EVT plugs dissolve and perfusion of maternal blood begins, allowing further development of both the fetus and placenta. [ 9 ] [ 5 ]


Cells that will eventually become extraembryonic placental trophoblasts are derived from the  trophectoderm . As the trophectoderm separates from the inner cell mass during  blastulation , early trophoblasts begin to form the placenta. [ 10 ]  Later in placental development, both interstitial and endovascular EVTs form as underlying progenitor cell column CYTs undergo  epithelial to mesenchymal transition  (EMT). [ 11 ]  This cellular process continually occurs as the CYT layer replenishes extravillous trophoblasts. EMT of CYT to EVT in the placenta is strongly controlled by the transcription factor T-cell factor 4 ( TCF4 ) which is  Wnt -dependent. [ 12 ]  Canonical  Wnt signaling  pathways have many downstream development-related transcription factor gene targets, including TCF4. Since developing placental trophoblasts do not necessarily follow canonical EMT, it has been suggested that a placental trophoblast-specific hybrid EMT is a separate iteration. [ 11 ]


Placental trophoblast subtypes can be distinguished by certain markers that are exclusive to each subtype. Transition from  epithelial  CYT to  mesenchymal  EVT can be tracked by a loss of  E-cadherin  and gain of  N-cadherin . EVTs can also be distinguished by expression of  human leukocyte antigen G  (HLA-G), which is not expressed by other placental trophoblasts. [ 13 ]  As other trophoblast subtypes in the placental are epithelial, mesenchymal markers like  vimentin  and  fibronectin  can also be used for identification. These markers, however, are not specific to EVT and can also stain  stromal cells  in the placenta. [ 13 ]  As trophoblasts develop, they express different  integrins . Whereas CYT can be identified by  ITGA6 , EVTs strongly express  ITGA5 . [ 14 ]  The existing  in vitro  EVT models detailed below recapitulate these markers and staining to varying degrees of accuracy.


As EVTs are a critical cellular subtype of the placenta and their dysfunction is associated with a myriad of gestational illnesses, [ 15 ]  they are an attractive topic for research. Acquisition of this  primary cell  type from sensitive tissues can be difficult and inconsistent. First and second trimester placental tissue must usually be obtained from elective abortions, a designation requiring more  NIH  documentation and oversight. [ 16 ]  Tissue from term placentas is more readily available but cannot be used to address questions related to early development and dynamics. Dissociation of trophoblasts from other cell types in placental tissue can be procedurally difficult and pure trophoblast subtype populations take great lengths to obtain. Then, the resulting primary trophoblast cells can then only be kept in culture for a few days. Thus, there is a high demand for accurate cell lines to model primary placental trophoblasts. The  immortalized  cell line HTR-8/SVneo is commonly used to model EVTs. Newer  multipotent  trophoblast stem cell systems can be induced to differentiate into HLA-G+ EVT from CYT. [ 13 ]  Systems of placental  organoids  can also grow invasive EVT when cultured in  Matrigel . [ 17 ]  Each of these options varies in their utility and accuracy to primary EVTs. As research groups continue to develop better techniques of recapitulating primary cells  in vitro,  proper modeling of placental EVTs remains a goal of the field.


False pregnancy  (or  pseudocyesis , from the Greek  pseudes  "false" and  kyesis  "pregnancy") [ 1 ]  is the appearance of clinical or  subclinical  signs and symptoms associated with  pregnancy  although the individual is not physically carrying a fetus. [ 2 ]  The mistaken impression that one is pregnant includes signs and symptoms such as tender breasts with secretions, abdominal growth, delayed  menstrual periods , and subjective feelings of a moving fetus. [ 2 ]   Examination ,  ultrasound , and  pregnancy tests  can be used to rule out false pregnancy. [ 1 ]


False pregnancy has a prominent psychiatric component as well as  physical manifestations of pregnancy . [ 2 ]  It can be caused by trauma (either physical or mental), a chemical imbalance of hormones, [ 2 ] [ 3 ]  and some medical conditions. [ 1 ]  Contributing psychological factors include a strong desire for pregnancy or misinterpretation of objective bodily sensations. [ 2 ] [ 3 ]  Although rare, [ 1 ]  men can experience false pregnancy symptoms, [ 2 ]  called  Couvade syndrome  or "sympathetic pregnancy", which can occur when their significant other is pregnant and dealing with pregnancy symptoms. [ 3 ]   Psychotherapy ,  pharmacotherapy  with  antidepressants  or  antipsychotics ,  hormonal therapy , and  uterine curettage  are sometimes needed as treatment. [ 1 ]


While extremely rare in the United States because of the frequent use of  medical imaging , in developing regions such as India and sub-Saharan Africa, the incidence of false pregnancy is higher. [ 2 ] [ 3 ]  Rural areas see more instances of false pregnancy because such women are less often examined by a health care professional or midwife during the duration of believed pregnancy. [ 2 ]


In the  Diagnostic and Statistical Manual of Mental Disorders  ( DSM-5 ), false pregnancy is a  somatic symptom disorder ; it is listed as "not elsewhere classified", meaning it is in a category by itself, different from other somatic symptom disorders such as  functional neurological symptom disorder  (formerly known as  conversion disorders ). [ 2 ]  The word  pseudocyesis  comes from the Greek words  pseudes  which means "false" and  kyesis  which means "pregnancy". [ 1 ]


False pregnancy is sometimes referred to as "delusional pregnancy", but the distinction between the two conditions is inexact. [ 3 ]  Delusional pregnancy is typically used when there are no physical signs of pregnancy, but false pregnancy can also be delusional. [ 4 ] [ 5 ]  Some authors consider the two conditions can be used interchangeably for research purposes. [ 3 ] [ 5 ]


The symptoms of pseudocyesis are similar to the symptoms of a true pregnancy. [ 1 ]  Signs of false pregnancy include  amenorrhea  (missed periods),  galactorrhea  (flow of milk from breast), breast enlargement, weight gain, abdominal growth, sensations of fetal movement and contractions, [ 1 ]  nausea and vomiting, [ 1 ]  changes in the  uterus  and  cervix , [ 1 ]  and frequent urination. [ 3 ]


Abdominal distention is the most common symptom. [ 2 ]  In pseudocyetic abdominal swellings, the abdomen becomes uniformly swollen, and the  navel  stays inverted. The wall of the abdomen adopts a muscular, tympanic character. [ 2 ]


Duration of symptoms typically ranges from several weeks to nine months. [ 1 ]


The exact mechanisms behind false pregnancy are not completely understood, but psychological and endocrine components may play a substantial role. Women who experience false pregnancy often experience related feelings of stress, fear, anticipation, and general emotional disturbance. [ 3 ]  These strong emotions, along with dysfunctional changes in hormonal regulation, can significantly increase  prolactin  levels. Prolactinemia (high prolactin levels) can lead to many of the symptoms of true pregnancy, such as amenorrhea, galactorrhea, and tender breasts. [ 2 ] [ 3 ]  Heightened activity of the  central nervous system  may contribute to the  abdominal distension , sensations of fetal movement, and assumed  contraction  pains experienced by many women with false pregnancy. [ 2 ]


Endocrine  changes observed in pseudocyesis include a decrease in  dopamine  levels, increase in  nervous system  activity, or dysfunction in the  central nervous system . [ 1 ]  These changes may be responsible for  amenorrhea ,  galactorrhea , and  hyperprolactinemia  seen in falsely pregnant women. [ 2 ]  Elevated sympathetic activity has been linked to the increase in abdominal size as well as the apparent feel of fetal movement and contractions. [ 2 ]


How abdominal distension develops is not fully understood and several causes have been proposed. A buildup in fat around the  abdominal cavity , heavy  constipation , habitual  lordosis , and other causes may produce the appearance of a distended abdomen, and the resulting swelling can remain for months. After women with false pregnancy are placed under  anesthesia , or are successfully persuaded that they are not pregnant, the distention promptly disappears, indicating that the proposed mechanisms are supplementary factors behind, but not the ultimate causes of, abdominal swelling. [ 2 ]  Manipulation of abdominal wall muscles, such as the  diaphragm , is the most likely contributor to abdominal distention. For example, continuously contracting the diaphragm may give the appearance of a distended abdomen while forcing the intestinal units downwards. [ 2 ]  The sensations of fetal movement may also be related to contractions of the abdominal wall due to  peristalsis , or movements of the  gastrointestinal tract . [ 6 ]


About one in six false pregnancies is potentially influenced by concomitant medical or surgical conditions including  gallstones , abdominal tumors,  hyperprolactinaemia , constipation, tubal cysts, and  esophageal achalasia . [ 5 ]


Psychiatric disorders , such as  anxiety  or  mood disorders ,  personality disorders , and  schizophrenia  are common among women with false pregnancy, and may be linked to its development. [ 1 ]  Some women with  depression  may gain weight due to decreased physical activity and poor eating habits. [ 1 ]   Antipsychotics  can induce pregnancy-like symptoms such as amenorrhea, galactorrhea, breast tenderness, and weight gain via raising prolactin levels. [ 3 ]


Psychological factors are associated with false pregnancy, including a strong desire for pregnancy; a misunderstanding of sensory changes in the body (for example, bloating or increased pressure on the pelvis); and  depressive disorders  that can lead to changes in the neuroendocrine system. [ 7 ]  Other social factors impacting include low educational status, marital issues, unstable relationship patterns, history of  partner abuse ,  social deprivation ,  poverty , lower socioeconomic status, and unemployment. [ 1 ]  Other factors such as mental and physical trauma—like experiencing a  miscarriage , infertility, loss of child, or sexual abuse—can manifest false pregnancy. [ 8 ]  Symptoms may arise in women who are experiencing grief after loss in their reproductive abilities, rejecting the idea of motherhood and pregnancy, or facing challenges in gender identity. [ 1 ]  Other psychological factors include  recurrent miscarriages , stress of imminent  menopause ,  tubal ligation  (sterilization surgery), and  hysterectomy . [ 1 ]


Evaluation required to confirm false pregnancies includes a  pelvic exam , a blood or urine  pregnancy test , and an  ultrasound . [ 8 ] [ 9 ] [ 10 ]  A pelvic exam can show if conception has occurred, blood and urine can be tested for hormones released in pregnancy, and ultrasound shows the absence of the fetus. An ultrasound can accurately distinguish between a false and true pregnancy. [ 8 ]  There is no universal laboratory profile for women with false pregnancy; measured concentrations for  prolactin ,  progesterone ,  follicle stimulating hormone ,  estrogen , and  luteinizing hormone  vary widely. [ 6 ] [ 11 ]


In some cases, false pregnancy symptoms may mask underlying medical conditions such as abdominal tumors, central nervous tumors, ovarian cysts, or gallstones. Medical tests and imaging are recommended to rule out potentially life-threatening conditions. [ 5 ]


Delusional pregnancy is distinct from false pregnancy; although the distinction is "blurred", [ 3 ]  physical signs of pregnancy are not present in delusional pregnancy, [ 12 ]  while false pregnancy includes symptoms of true pregnancy. [ 4 ]  According to Gogia  et al.  (2020), false pregnancy "involves a false belief that one is pregnant, but differs from delusional pregnancy in that it is a psychosomatic rather than psychotic or purely delusional belief". [ 5 ]  In delusional pregnancy, schizophrenia accounts for more than a third of cases. [ 4 ]


The symptoms of false pregnancy can be misinterpreted by the individual as a true pregnancy when the symptoms are actually caused by diseases (like hormone-secreting tumors,  alcoholic liver disease ,  cholecystitis ,  urinary tract infection ,  gallstones ) or exposure to a substance (like a medication), [ 2 ]  or other conditions like constipation. [ 1 ]


Additional interventions such as  psychotherapy  and  pharmacotherapy  are sometimes needed. [ 1 ]  Psychotherapy may be used when individuals have difficulty coming to terms with their false pregnancy, or remain symptomatic after knowing their false diagnosis. It allows patients to confront reality and accept the symptoms as illusions and provides an opportunity resolve other psychological stressors and trauma that may be implicated in manifestations of false pregnancy. [ 13 ]


There is no direct evidence for treating false pregnancy with pharmacotherapy, but medications may be used to restore  hormonal  and  neurotransmitter  imbalances which are implicated in physical manifestations of false pregnancy. [ 1 ]  Reduction in  catecholamine  levels have been observed in people with symptoms such as hyperprolactinemia and abdominal distentions. [ 2 ]  For most people, psychotherapy, pharmacotherapy (with antidepressants or antipsychotics), hormonal therapy, and uterine tissue removal is adequate to treat the condition. [ 1 ]


Antipsychotics have been shown to increase lactation and amenorrhea, [ 14 ]  and can trigger delusions. [ 5 ]  The delusion may be resolved with medication changes or adjustments. [ 5 ]  When underlying medical conditions or surgical conditions including gallstones, abdominal tumors, hyperprolactinemia, and constipation are identified, treatment may reduce the severity of the delusion. [ 5 ]


The rate of pseudocyesis in the United States has declined significantly since 1940. The rate in 1940 of one occurrence for approximately every 250 pregnancies had dropped by 2007 to between one and six occurrences for every 22,000 births. [ 1 ]  In Nigeria, the frequency of false pregnancies was 1 in 344 true pregnancies, and in Sudan false pregnancies were reported to be 1 in 160. [ 1 ]  There were about 550 cases documented in the literature as of 2016 [update] , with most cases in those between the ages of 20 and 44. [ 12 ]


Women of reproductive age comprise the majority of pseudocyesis occurrences. [ 3 ]  About 80% of women who experience pseudocyesis are married. [ 3 ]  False pregnancies are more common in societies with certain cultures and religions, particularly in areas where there is a high degree of pressure for women to have multiple children, and for those children  to be male . [ 1 ]


Although rare, pseudocyesis occurs more commonly in  developing countries . It is reported more frequently in countries that place heavy emphasis on fertility and  childbearing ; such pronatalist beliefs are often highly prominent in developing countries. In  sub-Saharan Africa [ clarify ] , a woman is allowed to share her husband's property only if she bears children. In these countries (and other developing nations), infertile women often experience abuse, blame, and discrimination. Societal factors enforce the importance of female fertility in these countries, thus possibly contributing to pseudocyesis rates. [ 3 ]


In addition to men, mothers of pregnant women may experience  Couvade syndrome , and a woman can experience multiple episodes of pseudocyesis in her lifetime. [ 15 ]


The perception of false pregnancy has evolved over time. In the late 17th century, French obstetrician  François Mauriceau  believed that the enlarged abdomens of falsely pregnant patients were caused by bad air. Physicians slowly began to acknowledge other potential causes of pseudocyesis, including its origin in the mind and in the body. In 1877, a physician named Joshua Whittington Underhill observed that physical symptoms can convince a woman of pregnancy, or a "disordered brain" can convince her that ordinary abdominal pains or bowel movements are instead fetal movements. The idea that pseudocyesis could result from a woman's perception of herself led to investigation into the role of emotions in cases of pseudocyesis. An investigator in the early 20th century observed that strong emotions can dry a woman's milk supply. The investigator went on to infer that the opposite was also true, and it was believed that strong emotions could bring about its production in women who are not pregnant. Alternatively, some physicians questioned the legitimacy of pseudocyesis as a condition. For instance, French obstetrician Charles Pajot stated in the 19th century, "there are no false pregnancies, only false diagnoses." [ 16 ] [ 17 ]


In the mid-1960s, a woman who appeared to be in labor was not properly examined because delivery appeared imminent; it was thought that her water broke but the expelled liquid was urine. [ 18 ] [ 19 ]  In 2010, a woman in the United States who was suspected of being in labor was given a  C-section  but there was no fetus. [ 20 ]


Gynecologist  John Dewhurst  studied the sequence of the supposed miscarriages of  Anne Boleyn , second wife of  King Henry VIII of England , which followed the birth of her first child,  Elizabeth , in September 1533 and the series of reported miscarriages that followed. Excluding the miscarriage of a male child of almost four months' gestation in January 1536, he postulated that, instead of a series of miscarriages, Anne was experiencing pseudocyesis (false pregnancies), a condition "occur[ing] in women desperate to prove their fertility.". [ 21 ]  Anne's step-daughter  Mary Tudor  had a false pregnancy. After coming to terms with it, she reportedly believed that God had not made her pregnant because she had not sufficiently punished  heretics . [ 16 ] [ 17 ]


Anna O  ( Josef Breuer 's patient as mentioned in 1895 by Breuer and  Sigmund Freud  in  Studies on Hysteria ), experienced false pregnancy in the context of preexisting mental health problems. [ 22 ] [ 23 ]  After being diagnosed with  hysteria , she believed she was pregnant by Breuer, her therapist. She even believed she was in labor as she was trying to have another session with Breuer. [ 22 ]  More recent publications suggest she had central neurological signs with a chronic cough that improved during high altitude stays. Those characteristics, as well as the ineffectiveness of psychoanalytic cures, seem to indicate a more organic diagnosis such as tuberculous meningitis or tuberculous encephalitis with partial temporal epileptic component. [ 23 ]


Fetal movement  refers to motion of a  fetus  caused by its own  muscle  activity. Locomotor activity begins during the late  embryological  stage and changes in nature throughout  development . Muscles begin to move as soon as they are  innervated . These first movements are not reflexive, but arise from self-generated nerve impulses originating in the  spinal cord . As the  nervous system  matures, muscles can move in response to stimuli. [ 1 ]


Generally speaking, fetal motility can be classified as either elicited or spontaneous, and spontaneous movements may be triggered by either the spine or the brain. Whether a movement is supraspinally determined can be inferred by comparison to movements of an  anencephalic  fetus. [ 2 ]


This article primarily deals with voluntary and  reflex  movements. Ages are given as age from fertilization rather than as  gestational age .


Some sources contend that there is no voluntary movement until after birth. [ 3 ]    Other sources say that purposive movement begins months earlier. [ 4 ]   3D ultrasound  has been used to create motion pictures of fetal movement, which are called "4D ultrasound". [ 5 ]


Even before the fetal stage begins, a six-week-old human  embryo  can arch its back and neck. [ 6 ]  By seven weeks, movement in the arms and legs can be detected by  ultrasound . [ 6 ]


The parts of the fetal brain that control movement will not fully form until late in the second trimester, and the first part of the third trimester. [ 7 ]  Control of movement is limited at birth, and purposeful voluntary movements develop during the long period up until puberty. [ 8 ]   According to an overview produced by the  Royal College of Physicians of Edinburgh , purposive movement begins at about 18 weeks, gradually replacing reflex movements, and purposeful voluntary movements then develop further after birth. [ 4 ]


In these early movements, the limbs move together; they begin to move independently by the ninth week as the controlling  neurons  in the spinal cord develop. [ 9 ]  At week 11, the fetus can open its mouth and suck its fingers; at week 12, it begins to  swallow   amniotic fluid . [ 10 ]


In addition to sideward bendings of the head, complex and generalized movements occur at the beginning of the fetal stage, with movements and startles that involve the whole body. [ 11 ]  Movement of hands, hips and knees have been observed at nine weeks, [ 12 ]  stretches and yawns at ten weeks, [ 13 ]  and isolated limb movements beginning shortly thereafter. [ 14 ]


By about the twelfth week, the fetus is able to kick and curl its toes, and may grasp its feet or scratch itself with its fingernails. [ 10 ]  It can also move in response to a  touch  on its skin. [ 15 ]  Also starting about week 12, the  thoracic diaphragm  moves up and down as if the fetus were breathing, but this movement disappears about week 16 and does not resume until the third trimester. [ 16 ]


Movements such as kicking continue, and the mother usually feels movement for the first time, an event called  quickening , during the fifth month. [ 17 ]  Around this time, limb movements become more complex, with flexing of the  joints  and ribs. This activity assists with proper joint development. [ 15 ]   Women who have already given birth have more relaxed uterine muscles that are consequently more sensitive to fetal motion, and for them fetal motion can sometimes be felt as early as 14 weeks. [ 18 ]


By about week 21, the fetus begins to develop a regular schedule of movement. [ 17 ]  The  startle reflex  is present in half of all fetuses by week 24 and in all fetuses by week 28. [ 19 ]  Movement is restricted around this time because the fetus has grown so large it has little space for kicking or changing body position. [ 20 ]


In later pregnancy, a complex motion called "stepping" develops. This movement consists of circular "bicycling" motion of legs, which helps the fetus move to a head-down  position  in preparation for birth. [ 15 ]


Fetuses aged 14 to 18 weeks show a pronounced  circadian rhythm  in their activity level, which can be detected both by fetal  electrocardiogram  and by measuring locomotor activity. Active and quiet periods for the fetus do not correspond to those of the mother; fetuses are most active from 9 a.m. to 2 p.m. and again from 7 p.m. to 4 a.m. [ 21 ]  During the last four to six weeks before  birth , most of the fetus's kicking and jabbing movements occur while it is  sleeping  lightly. [ 22 ]


After quickening, a pregnant woman may choose to count the number and types of movements she feels her fetus make. This tally is informally known as a  kick count . The  American Pregnancy Association  states that advantages of conducting kick counts range from giving a pregnant woman an opportunity to bond with her baby to reducing the risk of  stillbirth ; kick counts are especially recommended in  high risk pregnancies . [ 23 ]  However, instructing women to monitor fetal movements is potentially associated with increased maternal anxiety. [ 24 ]  70% of pregnancies with a single episode of reduced fetal movements are uncomplicated. [ 24 ] [ 25 ]


In the UK, the Royal College of Obstetricians and Gynaecologists say that if you think your baby has stopped moving or is moving less and you are over 28 weeks pregnant you should contact your midwife. Do not wait until the next day to contact the hospital or midwife. [ 26 ]


The  fetal origins hypothesis  (differentiated from the  Developmental Origins of Health and Disease  hypothesis, which emphasizes environmental conditions both before and immediately after birth) proposes that the period of gestation has significant impacts on the developmental health and wellbeing outcomes for an individual ranging from infancy to adulthood. The effects of fetal origin are marked by three characteristics: latency, wherein effects may not be apparent until much later in life; persistency, whereby conditions resulting from a fetal effect continue to exist for a given individual; and genetic programming, which describes the 'switching on' of a specific gene due to prenatal environment. [ 1 ]  Research in the areas of economics, epidemiology, and epigenetics offer support for the hypothesis. [ 2 ]


The fetus was once believed to be immune to harmful environmental toxins passed from the mother via the placenta. Stemming from this belief, some pregnant women of the early to mid 20th century consumed in drinking of alcohol, ingesting of medications, and  smoked cigarettes.  This easy going attitude about pregnancy was challenged, however, by findings relating substances ingested by a mother to tragic outcomes for a fetus. The birth defects crisis due to the medication thalidomide in the 1960s, where thousands of children were born with defects ranging from brain damage to truncated and missing arms and legs is an example of how a seemingly miracle medication supposed to prevent morning sickness instead had disastrous consequences. [ 3 ]  Similarly, in 1971, a drug known as DES,  diethylstilbestrol , when taken by pregnant women, was found to be causing an incredibly rare cancer,  clear-cell adenocarcinoma of the vagina  in young girls when the cancer was traditionally only found to affect those of post-menopausal age. [ 2 ]  This finding, in particular, demonstrates that events occurring during gestation are capable of impacting future health into adulthood. As perhaps the most well-known fetal risk, It wasn't until 1973 that fetal alcohol syndrome was first formally diagnosed, and not until 1989 that the United States government began requiring warning labels directed at pregnant women to be in place on all alcoholic beverages for sale. [ 2 ]  While the risks associated with certain substances have been well documented during pregnancy, the fetal origins hypothesis goes beyond medical substances to expand upon the effects of maternal stress, obesity, influenza, nutrition, and pollution on a developing fetus. [ 2 ]


Epidemiologist  David Barker  was the earliest proponent of the theory of fetal origins of adult disease, prompting the theory to be denoted as "Barker's hypothesis". In 1986, Barker published findings proposing a direct link between prenatal nutrition and late-onset coronary heart disease. [ 4 ]  He had noticed that the poorest areas of England were the same areas with the highest rates of heart disease, unearthing the predictive relationship between low birth weight and adult disease. His findings were met with criticism, mainly because at the time heart disease was considered to be predominantly determined by lifestyle and genetic factors. Since Barker's initial findings, the results have been replicated in diverse populations of Europe, Asia, North American, Africa, and Australia. [ 2 ]  In explanation of such findings, Barker suggests that fetuses learn to adapt to the environment they expect to enter into once outside of the womb. Essentially, all transmissions entering the placenta act as "postcards" giving the fetus clues as to the outside world, preparing its physiology appropriately. [ 2 ]  This can be an adaptive mechanism, when fetal conditions accurately represent the world of birth; alternatively, it can be a harmful mechanism, when fetal conditions of plenitude or scarcity do not match the world of birth and the child has been physiologically predisposed to inhabit an environment where expected resources are drastically different from reality. [ citation needed ]


The  thrifty phenotype  hypothesis proposes that a low availability of nutrients during the prenatal stage followed by an improvement in nutritional availability in early childhood causes an increase risk of metabolic disorders, including Type II diabetes, as a result of permanent changes in the metabolic processing of glucose-insulin determined in utero. [ 5 ]  This predominantly affects poor communities, where maternal malnutrition may be rampant, in turn causing fetuses to be biologically programmed to expect sparse nutritional environments. But, once in the world, the readily accessible processed foods consumed are unable to be processed efficiently by individuals who had their metabolic systems pre-set to expect scarcity. This difference between expected nutritional deficits and actual food surplus results in obesity and eventually Type II Diabetes. [ 6 ]  Janet Rich-Edwards, an epidemiologist at Harvard Medical School, initially set out to disprove the fetal origins theory with her database of over 100,000 nurses. Instead, she found that the results hold: a strong relationship exists between low birth weight and later coronary heart disease and stroke. [ 7 ]


Pregnancy outcomes can impact the well-being of a society. Comparisons between the children who were in gestation during the  1918 flu pandemic  and those in gestation immediately before or after the health crisis show marked differences between the two groups on census data. Across all socioeconomic measures, those who were fetuses during the crisis attained lower educational achievement, income, and socioeconomic status. Specifically, individuals affected were 15% less likely to graduate high school, 15% more likely to be poor, and 20% more likely to be disabled as adults. Even federal welfare payments were higher for the gestational cohort than those born before or after the flu hit. [ 2 ]  The same economic researcher, Douglas Almond, has investigated other historical situations affecting particular cohorts of fetuses: children born during or immediately following the  Chernobyl nuclear disaster  explosion, and China's  Great Leap Forward  (which resulted in a deadly famine). Both prenatally exposed groups suffered lower cognitive abilities and reduced employment levels. [ 2 ]  Such outcomes can have lasting impacts on the productivity and economic security of a society for an entire generation of individuals, and perhaps even continue to affect future descendants through changes in gene expression. [ citation needed ]


Epigenetics refers to the study of the behavior of genes, and how gene expression can be altered by the environment without changes made in DNA. This is believed to be particularly possible during prenatal development, and both stress and diet have been known to cause changes to a fetus. [ 8 ]  Findings linking maternal exposure to pollution with poor health outcomes for children are possibly linked to the altering of gene expression. [ 2 ]  Additionally, studies focusing on maternal weight show gene altering may be occurring. Women who are overweight at the time of pregnancy have children that are more likely to be overweight themselves. This could be due to the genetic heritability of genes related to obesity. But, siblings born to these same women after they had weight reduction surgery were no more likely to be overweight than the rest of the general population. The metabolic nature of the children was completely different, despite being born to the same mother, supporting the idea that the gestational environment strongly influences future outcomes. [ 2 ]  In discussing the epigenetics findings of fetal origins, Princeton University's Janet Currie says, "The long-vaunted distinction between nature and nurture is therefore outdated and unhelpful. Poor nurture during pregnancy can worsen the hand that nature has dealt." [ 9 ]


Epidemiological research, or the study of the health and disease patterns of certain populations, allow for controls not possible in other research avenues. When a significant situation, disaster, or event occurs across a given population, it can be assumed that the entire population is affected, thus generalizing findings across all demographics in a given group. Certain historical events provide epidemiological support for the  Developmental Origins of Health and Disease , including the Dutch Hunger Winter and the Holocaust. [ citation needed ]