Early stages
You notice that you have lost some fluid, as you have ruptured the membranes around the baby, and labour should start very soon. The Branxton-Hicks contractions (the contractions that occur in the last six weeks or so of pregnancy) wake you more than usual. Soon after the membranes rupture you can feel the first contraction grinding through your abdomen. Every ten to fifteen minutes more contractions occur. Most are mild, but some make you stop in your tracks for a few seconds. When two contractions have occurred only 7 minutes apart, you should head off to hospital. On arrival you change into a nightie and answer questions. Despite it being a meal time you are not in the slightest bit hungry, and you are given an enema to clear your bowels.

Middle stages
The obstetrician calls in to see how you are progressing when the contractions are occurring every 3 or 4 minutes. S/he examines you to assess how far the cervix (the opening into the womb) has opened, how far down the birth canal the baby has progressed, and the position of the baby’s head. This examination will be repeated regularly by doctors and midwives throughout labour. As events progress, you are moved into the delivery room. Sensors are attached through the vagina onto the baby’s head to monitor its health. The contractions become more intense, and if the pain in your tummy doesn’t attack you, the back ache does. Massage can ease the back ache, and breathing exercises you were taught by the physio at the antenatal classes prove remarkably effective in helping you with the more severe contractions. A pain relieving injection or breathing anaesthetic gas on a mask when the contractions start, make them more bearable.

Types :
May be natural through the vagina, interventional through the vagina (eg: forceps, ventouse), or interventional by Caesarean section. Other rarely used techniques exist.

Further information:
Physiotherapists conduct antenatal classes at all maternity hospitals and in many private clinics on what to expect, and how to cope in childbirth. All mothers should attend such classes. Childbirth Education Associations exist in all major cities.

Introduction :
Cancer of the cervix, which is where the womb (uterus) opens into the vagina.

Cause :
Cancer of the cervix is more common in women who have multiple sexual partners, and much more common in women who have been infected with the human pappiloma virus, which causes genital warts. It is very rare in women who are virgins.

Incidence :
One of the more common forms of female cancer.

Investigations :
If a suspicious Pap smear indicates the possibility of cancer of the cervix, the cervix will be more closely examined by a gynaecologist using a colposcope, which is a microscope that is inserted into the vagina. A biopsy of any suspicious areas of the cervix will be taken.

Screening :
All women who are sexually active at any age should have regular Pap smear tests. The doctor will often examine the breasts and check the blood pressure at the same time. The test itself is remarkably simple. A collapsible metal tube, known asa speculum, is introduced into the woman’s vagina. Through this the doctor can see the cervix, and s/he gently twists a wooden stick or fine brush into the opening of the canal through the middle of the cervix.This lifts off a superficial layer of cells. The stick or brush is then wiped across a glass slide to form a smear on the glass. The slide is then sent to a pathologist who examines the smeared cells under a microscope before sending a report to the doctor. In 1996, a new method of slide examination using a sophisticated computer program was introduced. The whole procedure takes less than a minute, and the report is usually available in the next day or two. It is just as important for older women to have the smear test, even after the menopause, every two years.

Course :
There may be no symptoms to indicate that anything is wrong for several years. Then abnormal vaginal bleeding, foul discharge, pain and/or bleeding on intercourse, and discomfort in the lower abdomen may occur.

Treatment :
If a Pap smear test detects an early stage of cancer, it can be easily treated. The abnormal area of the cervix may be burnt away by diathermy or laser, or a cone-shaped area of tissue may be excised. These forms of treatment do not interfere with the woman’s ability to fall pregnant, or function normally in her sexual responses. Only if the cancer has already spread is a hysterectomy required or radiation therapy used.

Complications :
The cancer may spread to the lymph nodes in the pelvis and other organs if not treated soon enough. The uterus, ureters and pelvic nerves are commonly involved in advanced stages.

Outcome :
The prognosis depends on how early the cancer is detected. 99% of early stage cancer is cured, 65% of cases with medium stage survive, but only 5% of those with spread outside the pelvis are alive after five years. Early diagnosis is therefore critical.

Further information:
The Australian Cancer Society has branches in every state which can assist patients, their family and friends with information and support. Palliative Care Associations assist patients with terminal cancer. Oncology clinics are attached to many major public and privatehospitals.

Medical curiosity :
The Papanicolou smear test is named after the Greek/American doctor who developed the procedure in the 1950s. It is abbreviated to "Pap" smear for obvious reasons!

2. Avoid Xeno-oestrogens
Minimise your exposure to chemical oestrogens from petrochemicals, pesticides and pollutants and unnecessary exposure to electromagnetic fields.

3. Avoid the pill
Especially early or prolonged use: overall, women taking the pill have a 25% higher risk of breast cancer.

4. Avoid hormone replacement (HRT)
Taking conventional Hormone Replacement Theraphy (which uses strong/bad oestrogens in combination with synthetic progestogens) increases the risk of breast cancer by around 35-40%. There are many safe and effective natural options (including herbal and plant-based medicines, natural hormone replacement and nutritional strategies) for controlling menopausal symptoms and preventing/reversing osteoporosis.

5. Don’t smoke
Smokers are up to five times as likely as non-smokers to develop breast cancer.

6. Take antioxidant supplements
Including vitamin C, vitamin E and selenium. One study found that women with a family history of breast cancer who consumed the most vitamin E (a mere 10 or more IU per day) had an 80% lower risk of developing breast cancer than those who consumed the least; for women without a family history of breast cancer, higher consumption of vitamin E was associated with a 40% reduction breast cancer risk. Additional supplements recommended for high-risk women and those who have already been treated for breast cancer include vitamin B12, folic acid, vitamin D, coenzyme Q10, di-indolylmethane (DIM), green tea extract and natural progesterone.

7. Use mammography sparingly
Writing in the Lancet medical journal (8 January 2000), researchers from Denmark, after reviewing eight large randomised trials of mammography screening, concluded that the methodologies of the trials used to justify mammography screening programs were seriously flawed, raising doubts about their validity. A large Canadian study (which followed 39,405 women), published in The Journal of the National Cancer Institute (September 2000), found that annual mammogram screening for breast cancer among women over 50 does not reduce the death rate from the disease when compared with women who receive competent physical breast examinations alone.

Detection of breast cancer by screening is, of course, always second best, as it means a failure of prevention. Too often women are lulled into a false sense of security without stopping to consider that mammography does not prevent breast cancer, only detect it once it has arisen - how much better to prevent it in the first place! In addition, radiation from mammography may trigger the very cancer it is meant to detect; the link between radiation and breast cancer is a strong one, and the average dose to each breast from mammography is equivalent to 340 chest x-rays! In the Canadian study (referred to above), women who received mammography had higher rates of advanced breast cancer than those not offered mammography.

Other risks include false negative and false positive results, and possible increased risk of spread of cancer cells due to compression of the breast. If you are a premenopausal woman, there is little justification for screening mammography, and if you are postmenopausal, having mammograms more often than every two years may be counterproductive. However, women of all ages should routinely practice monthly breast self-examinations and preferably have annual clinical examinations.

8. Learn to recognise and manage stress
A number of studies indicate a link between stress and breast cancer. Meditation, taiji (tai chi), qigong (chi kung), yoga and other relaxation techniques are an important part of any wellness program.

9. Take control of your health
Your life is truly in your hands!

Hormones
Breast cancer is a hormonally-driven tumour; its development and growth are stimulated by oestrogens (or at least certain kinds of oestrogens).