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1 新婚優生保健手冊 Health Manual for Newlyweds 中英版 Chinese-English

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3 致新婚夫婦的一封信 恭喜您們有情人終成眷屬, 從此組織了新家庭, 共同追求這充滿著希望美滿的婚姻生活 您們是否已經討論過如何來過這幸福的生活? 也許您們因過去的生活 習慣 環境不同而有所差別, 但! 您們必須有計畫的來面對現實, 必須守著共同的規範 本局為協助新婚夫婦能邁向幸福家庭之路, 特印製本 新婚優生保健手冊 此本 新婚優生保健手冊, 就婚姻生活 家庭計畫 懷孕 產前產後 嬰幼兒保健... 等各方面之常識編輯成冊分別敘述, 俾有助新婚夫婦們建立幸福美滿的家庭 祝您們幸福美滿又安康! 臺北市政府衛生局謹誌 臺北市立聯合醫院婦幼院區 中華民國九十四年十月

4 目錄 致新婚夫婦的一封信壹 新婚生活... 6 一 婚姻的意義... 6 二 婚後夫妻生活的協調... 6 ( 一 ) 幸福婚姻的基本要件... 6 ( 二 ) 新婚原則... 7 貳 家庭計畫與幸福家庭... 8 一 家庭計畫的意義... 8 二 家庭計畫與幸福家庭的關係... 8 參 懷孕生理... 9 一 男性的生殖生理... 9 二 女性的生殖生理 三 受精與著床 肆 避孕方法 一 避孕原理 二 避孕方法簡介 三 避孕方法之選擇 四 那裡可以獲得家庭計畫服務 伍 預防不孕症 一 不孕症的成因 二 如何避免不孕症 三 什麼時候您需要看醫生 陸 新婚夫妻應有的優生保健知識與婚前健康檢查... 17

5 柒 產前衛生與保健 一 產前檢查 二 孕期衛生與保健 捌 產後衛生及保健 一 離床的適當時間 二 會陰部的清潔 三 每日沐浴 四 飲食 五 性生活 六 產後檢查 七 產後運動 八 口服避孕藥 玖 哺餵母乳 一 哺餵母乳的好處 三 促進乳汁分泌的方法 四 乳脹的預防與處理 附表 : 一 各種避孕方法之選擇 二 臺北市立聯合醫院 社區健康服務中心地址及電話號碼 三 行政院衛生署評估通過之臺北市人工協助生殖技術機構 四 全民健康保險孕婦產前檢查給付時程 次數及項目 五 優生保健服務項目補助及服務處所 六 臺北市婚前健康檢查服務醫療院所... 34

6 中英文版 新婚優 生保健 手冊 壹 新婚生活 一 婚姻的意義 周禮注: 有夫有婦然後家 家庭的成立始於婚姻 婚姻是男女正式的結合 而家庭是婚姻的結果 一對青年男女從認識而發生感情 經過法定的手續結為夫 婦 組織家庭 一旦成立家庭之後 生兒育女綿延種族 對社會國家負起了承先啟 後的責任 上以繼承祖先的財產教化 下以教養子女 為國育才 其責任是極為重 大的 因此婚姻具有下列幾項功能 1.共渡人生旅程中的苦與樂: 當一對男女互相愛慕而組成家庭 生活在一起 可互相分享彼此的快 樂 更可攜手共渡人生中的生 老 病 死 失業及不如意等經驗而充實人 生 2.具有文化傳遞的功能 一個充溢美滿 理想 安祥的家庭 能為社會孕育下一代 創造新興並 有建設性勝過此代的民族 因此它具有承先啟後傳遞文化的功能 3.符合社會化原則 家庭是組成社會的基本單位 家庭因婚姻而成 而婚姻是使情感與肉體 結合 其關係在社會上 法律上和道德上合法化 也是符合社會化的原則 二 婚後夫妻生活的協調 (一) 幸福婚姻的基本要件 未婚兩人一經結婚之後 既然在神前和人前信誓旦旦 願意患難與共 疾病相依 不論往後環境如何 均願共偕白首 賴以維繫的就是彼此間的愛情 了 有一位社會學家曾經說過 選擇終身伴侶要用極敏銳的眼光和最嚴格的標 準去判斷和物色 但是結婚以後卻該用最低標準和最寬的態度去和你的伴侶相 處 當他是最平凡的人 錯誤缺點是意料中 這話真是至理名言 凡已結婚的 人都應採信並身體力行 此外要使夫婦生活過得更愉快美滿 家庭幸福能維持 久遠 夫婦雙方最好能注意下列各點 1.夫婦要互敬互愛 吾國素禮儀之邦 對夫婦生活講究 相敬如賓 就是要互相尊敬的意 思 同時夫婦間更要彼此相愛 愛情雖然不是幸福婚姻的唯一條件 但是沒 有愛情的婚姻便沒有真正幸福可言 夫婦間如真心相愛 必能彼此體貼 彼 此憐惜 處處以對方感覺為慮 時時以對方的幸福為念 真正幸福的家庭是 雙方經過多年的體貼 多年的忍讓 多年的自我犧牲換取得來的 愛情如美 酒 愈陳愈醇 所謂 白頭偕老之道無他 愛護對方如自己而已! 2.夫婦要互相信任 快樂的婚姻 必須夫婦二人間有完全的信心 人性是多疑的 尤其在愛 情方面最容易發生疑心 一對恩愛夫婦 常常因愛之過切 怕失去對方 反 而疑神疑鬼 由於一種莫須有的心理現象 造成婚姻危機 因此為了避免日 6

7 臺北市立聯合醫院婦幼院區 後的煩惱, 最好在開始時坦白相處, 事無大小都不要隱瞞, 一開始若能開誠佈公, 日久自然能建立堅強的信心, 這樣就能互相信靠, 互相依賴, 凝聚力量, 便不畏外來因素的破壞 3. 夫婦間要忍讓寬容 : 夫妻是兩個獨立的人, 各有獨特的思想 觀念, 及不同的生活習慣, 兩人生活在一起, 難免有意見不一致的 夫婦間對事物的看法, 若有十步的距離, 倘若雙方皆向對方走五步, 步調就能一致了 又如當對方身體過分疲勞或事業不順利時或婦女月經間情緒不好, 在言語行動有不當時, 另一方就要原諒他 寬恕他, 不要和他爭吵 夫妻間切忌爭吵成為習慣, 若夫妻時常發生爭吵, 家庭生活便無幸福可言 4. 注意生活小節 : 許多男女在未婚時彼此都很殷勤體貼, 一旦結婚便不在意 其實一些生活細節, 深深影響了婚姻的幸福與夫婦關係的美滿 人是感情動物, 感情生活佔人生大部分, 夫妻間細小動作, 往往可以使對方得到很大的安慰與快樂 如做丈夫的能記住妻子的生日 結婚紀念日, 或兩人特別值得紀念的日子, 並對她略為表示 ; 做妻子的能經常儀容整潔, 做些先生愛吃的小菜, 每逢星期假日相偕出遊, 或同帶子女出去散步, 皆可增加生活上的情趣, 洋溢著溫馨的氣氛 5. 適齡適量的生育子女 : 多子多孫 及 早生貴子 的農業時代已被工商社會取代, 大群的兒女帶來生活上物質與精神的負擔 父母整日為過重的負擔奔波和操心, 沒有足夠的時間來照顧子女及家庭, 同時夫婦之間也沒有足夠時間溝通與了解, 因而減少家庭之融洽 所以有計畫的生育子女, 將有助於建立幸福家庭 6. 如有需要尋找專家諮詢 : 家庭中發生問題不能自行解決, 最好向專家尋找協助 婚姻諮商者, 在今天繁雜社會中漸現其重要性 一位受過訓練的諮商者, 能提供專業化的諮詢及可行之解決途徑 解析潛在的婚姻危機 在爭執背後, 可能存著深大的不安全感 譬如權力獲取的失望, 或性慾受了挫折, 夫妻若無力處理此類問題, 則應尋求專家們的協助 尋求專家的婚姻指導, 是婚姻成功的鎖鑰 ( 二 ) 新婚原則對人類而言, 性是為了幫助一個男人和一個女人, 表達和經歷他們之間至深之愛的媒介或途徑 只有一夫一妻制的婚姻關係才能發展出真正的愛情 完美的性生活和健全的人格, 可見性是屬於夫妻之間的一種合一經驗 和諧的性生活是需要慢慢適應, 並學習合一的最高境界, 以期能盡情享受歡愉的性 新婚夫婦若在性的適應上遭遇困難時, 不要有太大的挫折感, 雙方只要保有愛心就一定能有所進步 一對相對的夫妻應不斷學習以促進更親密的關係, 為彼此帶來更多的快樂 茲提供一些原則以供參考 : 1. 適應彼此的需要每對夫妻的性生理 心理都有著很大的差異, 自尊與互尊便是維持性生活的要件 丈夫不可拿 性 當作 權利, 妻子也不要拿 性 當作 武器 性生活的開始時, 有些人可能會有痛楚, 有的甚至延至數週或數月 ; 因為婦女的陰道有很多皺紋, 不容易擴大, 但只要習慣後, 性交的痛苦就會消失, 並可享受到性生活的樂趣 7

8 中英文版新婚優生保健手冊 2. 次數 時間 姿勢與地點 性生活的次數無須與他人比較, 並無一定的法則, 不要過分變成例行公事, 或不及而造成彼此關係的緊張 同時, 不要迷信某些食物或廣告藥物, 重要的是應顧及對方的感受, 時間和地點沒有固定的模式, 但不要在最疲倦時從事, 因為它需要感情與體力, 並全心全力的投入 許多夫婦很想知道何種性交姿勢能給他們最大的滿足 其實, 只要夫妻對性有正確的態度, 彼此體貼, 他們很快就會尋獲各種能帶給他們最大的滿足感的姿勢, 而這些姿勢將因時因地而異 夫妻性生活中, 環境的隱密性和情調是很重要的, 隱密才能全然投入, 情調如香水 音樂 燈光都有助於情緒的培養 3. 丈夫的包皮過長及早洩包皮過長, 在興奮膨脹時, 性器官的前端 ( 龜頭 ) 不能完全露在外面, 需要開刀割治 剛結婚沒有性經驗的男性青年, 有的無法達到射精高潮, 有的一到三分鐘即射精 一般人的性交時間約三到十五分, 如果在這個範圍內射精就不算早洩 4. 月經期的性生活月經並不是病, 因此月經期間的性交, 在醫學上並沒有絕對禁忌 不過月經期間, 女人的陰道與子宮因充血 黏膜變軟, 性交不要過分激烈 但為了清潔及健康理由, 月經期間最好避免有性生活 5. 溝通對性的感受夫妻應坦然地藉著口語和非口語的溝通, 來表達彼此對性的感受, 成功的秘訣在於諒解與真誠, 性是一種美好的親密關係, 若太強調技巧, 反而對性生活有損 同時, 避免性的不忠實 ( 外遇 ) 是很重要的課題, 兩人有心共同建立愛的家庭, 如此身心的合而為一才是婚姻的最高境界 貳 家庭計畫與幸福家庭 一 家庭計畫的意義家庭計畫是每一對夫婦, 或將成為夫婦的一對男女, 依照自己的意願 身心健康情況 經濟的基礎和能力與社會國家的需要, 來決定自己家庭將有的子女數, 並利用現有的醫學知識與原理和節育的種種方法, 來達成這種目的, 以使每個小孩都能在父母所期望並有準備的情形下出生, 並奠定小孩日後身心正常發育所需的重要基礎 8 二 家庭計畫與幸福家庭的關係適當婚育年齡為二十二歲至三十歲, 其理由為 : ( 一 ) 從醫學的優生觀點而言, 男女兩性年滿二十歲後在生理特質上俱為成熟 ; 惟因女性限於生理特性在四十九歲後就接近停經, 排卵受孕機率遽降, 同時年滿三十歲後受孕率將降低且容易生育不健康或有缺陷的小孩, 會影響人口素質

9 臺北市立聯合醫院婦幼院區 ( 二 ) 從法律觀點而言, 民法第十二條規定滿二十歲為成年, 其意旨為自然人 達於該年齡後在心智上已漸成熟, 可熟知個人的權利義務而行使法律行 為, 且其在情緒上 心理上已較未成年人更具成熟的人格 ( 三 ) 從社會觀點而言, 結婚 生育是男女兩性共同的責任, 不宜分別訂定男女婚育的差別年齡而造成男尊女卑的不平等現象 其次, 男女兩性在年滿二十歲雖均符成年規定, 然因近年來不論男女性別其受教育年齡普遍延後, 在心智發展及人格之成熟度似未臻完整, 且欠缺社會歷練, 經濟基礎亦較薄弱, 因此適當婚育年齡為二十二歲為理想 適當年齡結婚及生育, 使夫妻在擁有健全的人格 穩定的家庭經濟下, 達到 二個孩子恰恰好, 男孩女孩一樣好 的幸福家庭及人生 ( 資料來源 : 內政部人口政策委員會, 八十四年六月十六日會議 ) 參 懷孕生理 一 男性的生殖生理男性生殖器官包括睪丸 副睪丸 輸精管 精囊 射精管 尿道 球腺 陰莖 陰囊與前列腺 其中陰莖與陰囊稱為外生殖器, 其他的稱為內生殖器 ( 如圖 ) 睪丸是性腺, 左右各一, 位於陰囊內 睪丸的主要功能是製造精子, 在腹膜之下, 經由精索通過腹股溝管進入腹腔, 經過膀胱之上面, 後面和來自精囊之導管匯合成射精管, 使精子經射精管進入尿道, 因此, 它是輸送精子的器官 前列腺是分泌精液的器官 尿道球腺位於前列腺之基部, 可分泌濃稠之牛奶樣液體, 為精液內容之重要部分 陰莖是性交及排尿的器官 男性在二 歲至六 歲之間, 每次射精有三西西至五西西之精液, 在正常情形下每西西精液約有二億到四億的精子 輸尿管精囊 膀胱輸精管 脊骨 直腸 射精管前列腺陰莖尿道龜頭包皮 尿道球腺肛門副睪丸睪丸陰囊 男性生殖器官 9

10 中英文版新婚優生保健手冊 二 女性的生殖生理 女性生殖器官包括卵巢 輸卵管 子宮 陰道 大小陰唇 陰阜 陰蒂 ( 如圖 ) 女性外生殖器指大小陰唇 陰阜 陰蒂 陰道口, 內生殖器子宮 輸卵管 卵巢與陰道 卵巢是性腺, 位於腹腔內, 左右各一個 卵巢是排卵及分泌女性激素, 它可產生兩種最主要的女性激素, 其中一種為動情素, 另一種為黃體素, 動情素有促進女性生殖器官成熟的作用, 黃體素的作用主要是懷孕期間, 保護子宮及胎兒的成長 輸卵管是將卵巢排出的卵輸送至子宮 子宮是一個像梨子一樣中空器官, 是容納胎兒生長及月經發生之器官 陰道是性交器官, 並為胎兒產出及月經流出之通道 大陰唇, 又稱外陰唇, 為皮膚凸起的皺壁, 富有脂肪組織, 大陰唇正中有裂口叫陰裂, 大陰唇之內側陰毛較少而外側較多 小陰唇又稱內陰唇是兩片皺壁, 沒有陰毛 但有脂肪腺 陰阜位於恥骨聯合之上緣, 皮膚上有陰毛 陰蒂在於陰門的上面三角形地方, 由二片小陰唇向上結合而成的突起, 是一個小如豆子與男性陰莖相當, 原同一起源, 感覺極為敏感, 但大小兩者相差很多, 陰莖上面也有包皮 卵巢輸卵管 脊骨 子宮子宮頸 膀胱 恥骨 尿道 陰道 直腸 肛門 女性生殖器官 三 受精與著床 當男女性交達到興奮頂點, 就產生射精, 精液若進入女性陰道, 精子競向子宮內游動, 再進入輸卵管內, 如正好遇到女性之排卵期, 其中最先靠近成熟卵的精子鑽入卵子內, 卵膜隨即變成不滲透性, 以防止其他精子的進入 正常精子與卵子結合成受精卵的位置是在輸卵管末端三分之一部份 ( 如圖 ) 精子進入卵子不久, 頭部開始腫脹, 成為男性初核與卵中的女性初核結合形成受精卵, 受精卵一面分裂成細胞, 一面慢慢往子宮腔移動, 約三至四天抵達子宮後, 發育成一胚囊, 接著其四週產生絨毛狀之滋養細胞層, 在受精後七天可完全植入子宮內膜, 完成著床過程, 以後胚胎在胚囊內發育, 其周圍之絨毛狀滋養細胞層則形成將來之胎盤和胎膜 受精卵平均約經過二百八十天的發育即成長為成熟的胎兒, 分娩時與胎盤一起娩出母體 10

11 臺北市立 聯合醫院 生發上皮 婦幼院區 表皮帶 初級濾胞 成長中之濾胞 成熟濾胞 受精與著床 血管 白體 破裂濾胞 排卵 成熟黃體 黃體細胞 血塊 黃體 初期 受精卵 分裂 受精 桑葚胚 子宮內膜 著床 子宮肌層 繖狀部 成熟濾胞 次級卵母細胞 排卵 肆 避孕方法 一 避孕原理 (一) 男性的睪丸製造精子 女性的卵巢產生卵子 (二) 精子通過輸精管與精液一起排出體外 卵子通過輸卵管到子宮 (三) 性交時 射精到陰道 精子自動游向子宮 在輸卵管內與卵子結合 (四) 受精卵被送到子宮 在子宮內膜著床 這就是懷孕 因此避孕的原理就是以各種方法阻礙懷孕 其原理及方法有 (一) 使卵巢不產生卵子就可避孕 口服避孕藥 (二) 使卵子無法通過輸卵管 使精子無法通過輸精管 以阻止受精 結紮輸卵 管及輸精管等永久避孕法 (三) 使卵子很快地通過輸卵管以致不能受精 或增加子宮的收縮來干擾受精 卵的著床 可免於懷孕 例如子宮內裝置母體樂子宮內避孕器 (四) 使精子不能進入陰道 就不能受精 保險套法及性交中斷法 (五) 在陰道內阻止精子 便可免受精 安全藥片法 安全藥膏法 (六) 阻止精子進入子宮 子宮隔膜法 子宮帽法 (七) 利用不是排卵時期性交就可以避免受精 月經週期法及基礎體溫法 11

12 中英文版新婚優生保健手冊 二 避孕方法簡介 ( 一 ) 適用新婚夫婦的避孕方法 : 1. 口服避孕藥 : (1) 成份 : 是人工合成的動情素與黃體素 ( 助孕酮 ) 依劑型可區分為兩大類, 第一類為單段式口服避 口服避孕藥- 抑制卵巢排卵 孕藥, 其每月份中每一粒藥的劑量完全相同, 欣無妊 蜜無妊 溫不妊等都屬於這一類 第二類為三段式口服避孕藥, 其每月份中二十一粒藥的劑量分為三個階段, 每個階段藥粒顏色不同, 是模擬人體正常生理周期荷爾蒙分泌的型態而做成 其每月份的總劑量是目前口服避孕藥中最低者, 樂無妊就是這一類 (2) 服用方法 : 一般是從月經第一天來洗算起的第五天晚上開始服用第一粒 另外有一種包裝, 其背面印有星期, 其服用方法是月經來洗的第一天晚上就開始從紅色區中正確的星期中取出一粒服用 ( 例如月經是星期一來, 就從紅色區中的星期一取出一粒服用, 然後每天配合星期服用, 不容易漏服 ) 以上兩種方法都是以後每天晚上繼續服用一粒, 直到二十八粒吃完, 接著服用另一包, 中間不可停藥 每包藥中只有二十一粒有避孕藥的成份, 另外七粒白色較大的藥粒沒有避孕藥成份, 只有乳糖 在服用第二粒或第三粒乳糖藥粒時, 月經就會來潮, 月經來潮期間, 仍繼續每晚吃一粒, 直到吃完再繼續服用另一包 服完一包若無月經來潮, 最好停藥先請醫師診察確定沒有懷孕, 等月經來後, 再重新使用 若是產後婦女則在產後滿二十八天起開始服用 (3) 避孕原理 : 抑制排卵, 沒有卵子就不會懷孕 (4) 效果 : 正確服用, 效果高達百分之百 (5) 副作用 : 少數婦女可能發生輕微而短暫的症狀 : 如腸胃不適 嘔吐 噁心 頭痛 頭昏, 但是大部份的人沒有這種副作用 如果有嚴重不適, 須與醫師商討 有心臟病 糖尿病 高血壓 黃疸等則須經醫師指示才可使用 (6) 費用 : 各區健康服務中心 市立聯合醫院洽詢 2. 保險套 : (1) 是用橡膠或乳膠製成的一種非常薄的圓柱型袋狀物 (2) 使用方法 : 性交前陰莖勃起時將保險套套在陰莖上, 然後像穿長襪似的將捲好的保險套一面鬆開, 一面拉向陰莖根部, 如此保險套便包住整個陰莖 ; 房事後於陰莖軟下前將套子取下 保險套通常以使用一次後廢棄為宜, 可用紙張或袋子包好丟掉 保險套避孕方式 (3) 效果 : 如果使用正確, 避孕效果可高達九 % 以上 (4) 費用 : 各區健康服務中心及市立聯合醫院只收手續費 12

13 臺北市立聯合醫院婦幼院區 3. 安全期推算法 : (1) 原理 : 利用月經週期推算容易受孕的危險期, 避免性交以避孕 (2) 施行方法 : 通常女人排卵後, 若未受精, 需經十二天至十六天月經才會來潮 換言之下次月經前第十二至十六天之五天內是屬於排卵期, 加上精蟲可在女性生殖器內活三天, 及卵子可在體內生存一天, 所以下次月經前的第十一至十九天是屬於 危險期, 其他時間則屬於 安全期 但有些婦女的月經週期並不很規則, 為安全計, 於使用月經週期算法以前, 應先有六個月以上的月經紀錄, 再找出記錄中最長週期與最短週期之日期及其容易懷孕期, 而避免在最長及最短週期之容易受孕期內性交以減少受孕機會 (3) 效果 : 僅適用於月經周期很規則的婦女, 因婦女們的身心往往會改變排卵日, 以致婦女們無法預期下次月經來潮日推算排卵的日期 因此避孕效果較差, 失敗率高達二 %~ 四 % 安全期推算避孕方式 4. 基礎體溫法 : (1) 原理 : 健康婦女在排卵時基礎體溫會低些, 排卵後, 體溫就升高, 因此測量基礎體溫, 可知道排卵期, 而於排卵期間避免性交, 即可避孕 (2) 方法 : 基礎體溫的測量, 可以從月經來潮第二天開始, 於每天早晨醒來未作任何活動前, 將婦人體溫計置於舌下量五分鐘, 然後將之記載於記錄表上 平常體溫都維持在一定範圍內, 如有一日體溫降得比平常低, 而次日又升得比平常高些時即為排卵日 由於精子在女性生殖器內可活三天, 故排卵日前後三日為易避孕期 但因排卵前無特別之現象, 那一天體溫會下降無法確知, 為求安全起見, 自月經來潮至體溫下降三天後均屬避孕期, 其他才屬安全期 ( 如圖 ) (3) 效果 : 若高溫三天後, 才有性交, 此之前均禁慾者, 一百個婦女使用一年只有六人失敗, 若溫度未上升前的那一段時間, 只是配合安全期法者, 則其失敗率約增高三倍 13

14 中英文版新婚優生保健手冊 基礎體溫變化圖 ( 二 ) 適用於已婚婦女的子宮內避孕器裝置之避孕方法 : 如果您們已經有了小寶寶, 為了母親身體的復健及嬰兒成長都獲得照顧, 應該間隔數年再懷孕, 除了前述新婚期間的避孕方法 : 口服避孕藥 保險套 安全期法 基礎體溫法可採用外, 尚可選擇子宮內避孕器的裝置, 現為婦女普遍採用的是母體樂等 1. 原理 : 是一種很小的塑膠製品或纏有銅金屬的塑膠品裝在子宮內, 可干擾精子通過子宮進入輸卵管內, 使受精卵不能著床, 以達避孕效果 2. 方法 : 由醫師檢查後裝置, 生產後滿月至六星期左右 ( 產後未避孕之前, 最好禁慾, 並請儘早實施避孕 ) 或月經剛乾淨時, 為適合裝置時間 裝置容易, 效果好可高達百分之九六 - 九八 % 可在公 市 私立婦產科醫院裝置, 其費用依種類而異 母體樂圖 ( 三 ) 適用不再生育的永久性避孕方法有兩種, 即男性輸精管結紮及女性輸卵管結紮, 對決心不再生育的夫婦一方施行手術, 為一勞永逸的永久性避孕法 手術後性腺照常分泌激素, 不影響性生活 輸尿管 精囊膀胱輸精管 脊骨 輸卵管 結紮處 直腸 射精管 結紮處 前列腺陰莖尿道龜頭包皮 尿道球腺肛門副睪丸睪丸陰囊 卵巢 卵巢子宮陰道 14 男性輸精管結紮 女性輸卵管結紮

15 臺北市立 聯合醫院 婦幼院區 (四)其他避孕方法 1.性交中斷法 又稱 外洩法 在性交過程中 男性於快要射精時將陰莖拔 出而射精於陰道外 但由於射精有時很難控制 可能於射精前就有精子流入 陰道內 因此效果並不確實 失敗率極高 常會因來不及而造成意外懷孕 2.安全素片 安全藥膏 性交前五分鐘放入陰道子宮口 可起泡沫 能殺死精 子 或使精子不能活動 阻止精子進子宮腔因而能避孕 如希望迅速泡沫化 時 可先用口水或水潤濕再放入 又安全素片有效時間為三十分鐘 所以如 性交時間超過三十分鐘則應再放入一片 效果不高 約八 而且使用麻 煩 目前較少人使用 如圖 安全藥膏避孕方式 安全素片避孕方式 三 避孕方法之選擇 由上述各種避孕方法的原理 可知避孕方法很多 而且各有優點 到目前為 止 還沒有一種避孕方法是全無缺點的 因此選擇時 必須了解自己身體狀況 需 要和家庭環境 然後選擇適合於自己的方法 在選擇時應注意下列幾點原則 (一) 安全性和副作用 應選安全性大 副作用少者 (二) 可靠性 應選擇避孕效果好 失敗率小的方法 (三) 使用的簡繁 容易使用 而且不需別人教導的最佳 (四) 使用的時間 何時使用 會不會影響性生活 (五) 費用 是否很貴 是否能經常使用 (六) 可復性 一旦停止避孕 能否很快恢復生育力 避孕方法的選擇 除了前面的原則以外 還要不會使夫婦雙方有不正常 不自 然的感覺 更重要的就是不影響到平時的家庭生活 15

16 中英文版新婚優生保健手冊 由於個人的身體狀況及家庭情況各有不同, 可以自行斟酌選擇合用的方法, 舉例各種情況提供參考 :( 如附表一, 各種避孕方法之選擇 ) ( 一 ) 新婚夫婦以口服避孕藥較好, 因為用法簡單, 而且不影響性生活情趣 ( 二 ) 有的人對口服避孕藥特性敏感, 會引起厲害的噁心或嘔吐, 可採用保險套或子宮內避孕器 ( 三 ) 有的人裝子宮內避孕器, 容易脫出或引起月經過多則可改服口服避孕藥或保險套 ( 四 ) 臥室隱蔽性不良, 不宜採用和性交時間有關的方法, 如避孕膏 ( 五 ) 如夫婦都認為此時暫不生育時, 一定要用較可靠的方法, 如口服避孕藥或子宮內避孕器 ( 六 ) 教育程度較低的婦女, 不宜使用安全期計算法, 最好是裝子宮內避孕器 ( 七 ) 月經不規則的婦女絕對不要使用安全期, 因失敗率太高, 最好服用口服避孕藥 ( 兼有調經作用 ) ( 八 ) 體質敏感者適用保險套 安全期法 基礎體溫法 子宮隔膜 ( 九 ) 產後授乳無月經者, 則用保險套 安全素片 安全藥膏 子宮內避孕器裝置 ( 十 ) 丈夫不合作的太太, 以服口服避孕藥或裝置子宮內避孕器較好 ( 十一 ) 對不再生育的人, 結紮手術最理想 以上只是就各種不同情況, 列舉較適合的避孕方法, 提供參考而已, 不過無論採用任何避孕方法, 最好能有恆使用, 不可動輒更改避孕方法, 更不要輕易因朋友或書刊的批評而動搖更改他法, 因為很多懷孕就是在猶豫不決, 經常更改避孕方法時造成的 四 那裡可以獲得家庭計畫服務茲將臺北市的各項家庭計畫服務列述如下, 歡迎大家利用 : ( 一 ) 家庭計畫門診服務 : 1. 各區健康服務中心 : 裝置子宮內避孕器 購買保險套 介紹男女性結紮 口服避孕藥依醫師處方前往合約健保藥局領藥 2. 市立聯合醫院 : 為市民做男女性結紮手術及裝置子宮內避孕器, 依醫師處方領用口服避孕藥及購買保險套 3. 軍公私立大型醫院 : 裝置子宮內避孕器 辦理男女性結紮 4. 開業醫院婦產科或診所 : 裝置子宮內避孕器 男女性結紮手術 ( 二 ) 電話專線服務 : 請洽本市市立聯合醫院 各區健康服務中心 服務電話如附表二, 服務項目包括指導各種避孕方法的選擇, 副作用的處理, 及各項家庭計畫優生保健服務指導 16 ( 三 ) 資料索取或疑難函問 : 請洽各區健康服務中心及市立聯合醫院地址及服務電話如附表二

17 臺北市立 聯合醫院 婦幼院區 伍 預防不孕症 一 不孕症的成因 不孕症之發生率為百分之十至十五 亦即平均十對夫妻內就有一到二對夫妻是 不孕 任何男女雙方心理上 生理上或解剖上的改變 均可能造成不孕 不孕的原因 很多 與夫婦雙方均有關聯 大致上男性與女性在不孕症中所佔的比率幾乎相等 都是四 不明原因佔一 (一)男性不孕症因素 四 1.生殖器發育不全 2.精蟲數目過少 活動力欠佳 或數目與活動力異常 3.精索靜脈曲張 4. 隱睪症患者 或曾患隱睪症 於孩童時期接受手術時期過晚者 5.曾患腮腺炎合併睪丸炎者 6.輸精管阻塞 7.酗酒 吸煙過度 8.藥物 一些麻醉藥物 鴉片 嗎啡等 均會影響內分泌而間接影響精子數 目 活動力 9.工作疲憊 情緒壓力均是造成精液品質不良的原因 (二)女生不孕症因素 四 1.排卵不正常及荷爾蒙失調 長期壓力 酗酒 抽煙 體重過重 藥物或中樞 神經腫瘤等因素影響排卵功能 女性三十五歲以後 卵巢排卵頻度減少及卵 子品質較差 2.輸卵管阻塞 子宮畸形 3.子宮內膜異位 骨盆腔發炎 4.子宮頸分泌黏液異常 5.免疫因素 女性陰道 子宮頸 子宮分泌抗精子之抗體 二 如何避免不孕症 (一)男性 1.避免因不當性關係感染性病 17

18 中英文版 新婚優 生保健 手冊 2.避免接觸有毒物質 如鉛 毒性氣體 農藥等 亦勿濫用麻醉藥品或酗酒及 吸煙 3.避免使陰囊長期暴露於高溫環境 4.紓解情緒壓力 (二) 女性 1.減少骨盆腔發炎的機會 (1)避免婚前性關係導致性病泛濫 (2)勿找密醫施行墮胎手術 造成合併症 2.適當的避孕方法 (1)未生育時最好不使用子宮內避孕器 (2)不輕易做流產手術 3.減少排卵不良的機會 (1)解除工作及情緒的壓力 (2)控制良好體重勿過度肥胖及太瘦 (3)超齡結婚 高齡生育 4.減少子宮內膜異位症的發生 (1)婦女最好不要在三十歲後才結婚生育 (2)晚婚婦女不要避孕太久 5.避免接觸有毒物質 如鉛 毒性氣體 農藥等 亦勿濫用麻醉藥品或酗酒 及吸煙過度 6.減少工作及精神壓力 三 什麼時候您需要看醫生 結婚一年後在無避孕之狀況下 經正常性生活而仍無法受孕者 必需主動找尋 專家解決問題 大部份不孕患者經檢查後 都能找出癥結所在 不孕症醫師可根據病人實際狀 況設計一整套完整的治療計畫 臺北市目前由行政院衛生署評估通過之人工協助生 殖技術機構共十七家 詳附表三 可提供不孕症婦女求診管道 陸 新婚夫妻應有的保健知識 與婚前健康檢查 每一對新婚夫妻若要達成家庭的理想計畫目標 需賴成功之生育計畫來配合 我們知道新婚夫妻之生育能力是很強的 若不採用避孕方法 結婚一年內之受孕率 可達八 左右 但是有些夫妻他們可能一生或暫時不合適生育 而他們可能患有 遺傳性疾病 精神性疾病 傳染性疾病 或其他某些特定疾病或目前仍有經濟困 18

19 臺北市立聯合醫院婦幼院區 難, 或生活不安定等因素, 如果懷孕會將疾病遺傳或傳染給後代, 或是懷孕生產時傷害到母體之生命或健康, 甚而影響及家庭生活 事業前途 因此奉勸即將結婚的男女或新婚夫妻及早做婚前或孕前健康檢查 所謂婚前健康檢查, 就是男女雙方在婚前至醫院諮詢, 醫師會詳問其家族史 個案之過去史, 及檢查目前之健康狀況, 有必要者就會進一步做優生檢查 遺傳性疾病檢查包括家族疾病史 細胞酵素 海洋性貧血篩檢和染色體檢查 傳染性疾病檢查包括檢查結核病 梅毒 愛滋病 B 型肝炎等 對婦女要檢查德國麻疹 海洋性貧血篩檢 精神疾病檢查包括臨床精神科 腦波 遺傳性精神病檢查及心理測驗等 ; 以發現某些不適合生育之夫妻 若發現有嚴重遺傳性疾病 精神疾病, 或其他特定之疾病, 終身不可生育者, 應考慮作結紮手術 有些夫妻可先治療其疾病, 等痊癒後便可計畫生育, 若經健康檢查後認定沒有生育之禁忌時, 亦應依身心 經濟狀況 個別家庭因素等顧慮, 理智的計畫何時生育較合適, 以使每一位小孩均是在父母所期望下出生的, 同時可保母子健康, 家庭幸福 若在婚後不適合或不想生育, 均需採用有效之避孕方法, 例如女性經醫師指示後可服用口服避孕藥, 或男性可使用保險套等, 避免不必要之懷孕 若月經過期二星期左右時, 應前往醫院找婦產科醫師檢查, 以確定是否有懷孕, 且確定是不是正常之子宮內懷孕而非子宮外孕, 或併有其他問題, 例如有卵巢囊腫 子宮肌瘤 子宮畸形等 若有懷孕而不及早在月經過期二星期左右檢查, 一旦事後發現不正常出血, 腹痛情況, 再匆忙找醫師診察, 常會延誤治療或因無先前病歷之參考, 無法即刻有正確之診斷, 對自己反而很不利 故產前檢查應於月經過期二星期左右開始, 以後若無異常可每個月檢查一次, 至懷孕七個月始每二週檢查一次, 到最後一個月時, 每週需要檢查一次 對三十四歲以上高齡孕婦或可能生下缺陷兒的懷孕, 在懷孕初期儘速以產科診斷技術, 早期確定胎兒之健康狀況, 目前有下列數種方法 : 羊膜腔穿刺術, 是利用抽取的羊水, 做染巴體分析及生化物質分析 用超音波術來診斷胎兒, 如無腦兒 侏儒症 連體嬰或胎兒體內之腫瘤 胎兒內視鏡, 可以觀察胎兒外表形態, 及做胎兒血液檢查, 此外可在胎兒身上獲得組織切片來診斷皮膚病變等 分析孕婦血清甲型胎兒蛋白及人類絨毛膜性腺激素, 可偵測胎兒唐氏症之危險機率及是否有神經管缺損 絨毛膜組織 ( 即胎盤的成分 ) 檢查, 於妊娠滿十週吸取微量絨毛進行各種遺傳疾病診斷 胎兒遺傳基因的定位檢查以診斷部份遺傳疾病, 如海洋貧血基因分析 若婦女懷孕後發現有下列情形之一時, 可根據優生保健法之條例, 依其自願施行人工流產 一 本人或其配偶患有礙優生之遺傳性 傳染性疾病或精神疾病者 二 本人或其配偶之四親等以內之血親患有礙優生之遺傳性疾病者 三 有醫學上理由, 足以認定懷孕或分娩有招致生命危險或危害身體或精神健康者 四 有醫學上理由, 足以認定胎兒有畸型發育之虞者 19

20 中英文版新婚優生保健手冊 五 因被強制性交 誘姦或與依法不得結婚者相姦而受孕者 六 因懷孕或生產, 將影響其心理健康或家庭生活者 未婚之未成年人或禁治產人, 依前項規定施行人工流產, 應得法定代理人之同意 有配偶者, 依前項第六款規定施行人工流產, 應得配偶之同意 但配偶生死不明或無意識或精神錯亂者, 不在此限 我們知道懷孕生產之危險性 ( 每十萬名嬰兒出生中會有六至十名左右產婦死亡 ), 比做早期合法之人工流產之危險性 ( 每十萬次合法早期人工流產約只有一婦女死亡 ), 可以說高得很多, 故在不利於懷孕生產之情況, 應理智的依人工流產合法之條件, 及早找婦產科醫師諮詢處理, 否則將危害到母體生命 健康或出生畸形兒, 影響家庭生活等 當然人工流產之合法化並非鼓勵婦女去做人工流產, 而是更積極做好事先防患不必要之懷孕, 實施有效的避孕 在萬不得已懷孕而又不能將其生下來時, 才可考慮以人工流產來補救 若一切正常, 則除了定期產前檢查外, 孕婦應隨時吸取有關育嬰及孕婦保健知識 懷孕中若有不正常之合併症, 如陰道出血 陰道分泌物有惡臭 血壓高 頭痛 視力模糊 水腫 不正常之腹痛 發高燒 或早期破水 ( 未有陣痛前, 羊膜破裂, 羊水先行流出 ) 等均應隨時找醫師診斷, 不可延誤 生產時儘量找原先定期產前檢查之醫院, 但若懷孕期間併有合併症, 或胎位不正常者, 最好轉至設備較佳之醫院生產較安全 目前各公私立婦產科醫院診所出生之新生兒, 皆可做新生兒篩檢, 以便及早發現一些先天性甲狀腺低能症 苯酮尿症 半乳糖血症 高胱胺酸尿症 葡萄糖六磷酸鹽去氫脢缺乏症 ( 俗稱蠶豆症 ) 等的疾病, 然後及早施行處置或治療, 如此可避免小孩導致低能殘障甚至死亡 生產後, 應鼓勵產婦餵母乳以增進母子親情及嬰兒對疾病之抵抗力, 並應及早做避孕之準備 性生活應於惡露乾淨, 子宮完全恢復方可開始, 通常約在滿月左右, 否則易引起感染或出血 但滿月後要開始性生活之前為了您的健康一定要先做好避孕準備, 且要到生產醫院或衛生所做產後檢查 每位為人父母對往後之嬰兒保健及親職教育更要重視, 以使小孩生下後能有後天之良好照顧及愛的教育, 使每位小孩均是活潑聰明, 身心健全, 將來成為國家有用的人才, 達成夫婦生育之理想及提高全民之素質, 如此家庭和樂 社會安定 經濟發達, 可加速我國邁入先進國家之列 20

21 臺北市立 聯合醫院 婦幼院區 柒 產前衛生與保健 青年男女一旦結為夫婦 成立家庭之後 養兒育女乃當然的責任 雖然每位父 母都希望能生育健康的兒女 但要使兒女身心發育健全 就應從母體受孕之後就開 始 因此對受孕期間孕婦的護理 必須特別注意 因為胎兒的發育有賴於母體的健 康 茲就產婦在產前應注意事項 簡述如下 一 產前檢查 懷孕是家庭中的大事 為了孕婦和胎兒的健康 產前檢查是十分重要的 定期 的產前檢查有助於了解孕婦與胎兒的健康狀況 以及早發現潛在的危險 予以處理 和治療 目前全民健保提供孕婦十次免費產前檢查 以下為您介紹孕婦健康手冊及 孕婦產前檢查項目 (一) 孕婦健康手冊發放 1.孕婦健康手冊由國民健康局印製醫療院所發放 2.使用孕婦健康手冊之保險對象如發生流產時 或生產之時 該本孕婦健康手 冊無須回收 3.凡特約醫院 診所門口明顯處懸掛之全民健康保險醫事服務機構標誌之辦理 業務欄列有 孕婦產前檢查 孕婦皆可前往接受該項服務 4.保險對象相關資料由健保局事後歸戶 如發現有重覆領取手冊或超次檢查 其超出費用由保險對象自行負責 (二) 孕婦產前檢查次數 1.理想產前檢查次數為妊娠二十八週以前每四週一次 妊娠二十九至三十五週 每二週一次 妊娠三十六週以後 每週一次 2.全民健康保險孕婦產前檢查給付十次 其時程分列三階段 妊娠未滿十七週 給付二次 妊娠十七週至未滿廿九週給付二次 妊娠廿九週以後給付六次 接受此項服務 不需繳交部份負擔費用 詳附表四 給付時程可彈性辦 理 惟應避免同一階段有超次之情形 孕婦主動要求做全民健康保險不給付 之超次產前檢查時 得以自費方式辦理 惟如有病情需要 需做必要之超次 產前檢查時 以健保卡按一般就醫程序辦理 並負擔部分負擔費用 (三) 孕婦產前檢查項目 1.例行產檢內容包括 問診 本胎不適症狀如出血 腹痛 頭痛 痙攣等 身體檢查 體重 血壓 宮底高度 胎心音 胎位 水腫 靜脈曲張 實驗室檢查 尿糖 尿蛋白 2.妊娠六至八週 初診時檢查項目包括 問診 個人及家庭疾病史 過去孕產史 本胎不適症狀 身體檢查 體重 身高 血壓 甲狀腺 乳房 骨盆腔檢查 胸部 腹部 等 21

22 中英文版新婚優生保健手冊 實驗室檢查 : 血液及尿液常規 血型 Rh 因子 梅毒血清反應 愛滋病 海洋性貧血篩檢 3. 妊娠二十至二十二週除例行產檢內容外, 並提供一次超音波胎兒檢查, 以偵測出胎兒畸型或生長異常 4. 妊娠三十週左右除例行產檢內容外, 並提供實驗室檢查包括 B 型肝炎抗原 梅毒血清試驗 德麻疹抗體檢查 ( 四 ) 孕婦海洋性貧血篩檢海洋性貧血是一種常見隱性遺傳疾病, 台灣地區有百分之六的人帶有此項疾病基因 ( 帶因者 ), 帶因者通常身體健康, 與一般人無異 海洋性貧血又可分為甲型和乙型, 夫妻如為同型海洋性貧血的帶因者, 則每次懷孕其胎兒有四分之一機會成為重型的患者 罹患甲型重型海洋性貧血的胎兒會胎死腹中或出生不久即死亡, 罹患乙型重型海洋性貧血的胎兒出生三到六個月即會出現貧血現象, 需靠終身輸血及施行排鐵劑來維持生命, 影響患者之生活品質, 對家庭 社會亦是沈重的負擔 預防重於治療, 惟有孕婦接受海洋性貧血篩檢, 才能有效防止重型海洋性貧血胎兒的出生 孕婦海洋性貧血篩檢方法如下 : 1. 一般孕婦只要請醫師特別注意一般產前常規檢查中的平均紅血球體積 (MCV), 如果平均紅血球體積顯著偏低 ( 小於或等於八 ), 則可能為甲型或乙型海洋性貧血的帶因者 2. 孕婦平均紅血球體積小於或等於八 者, 則配偶亦需接受平均紅血球體積之檢查, 若配偶之平均紅血球體積大於八, 則無產下重型海洋性貧血胎兒之虞, 但若配偶之平均紅血球體積小於或等於八, 則此時夫妻必需同時抽血一 西西, 篩檢單位會將您的血液送至確認診斷單位, 以確定是否為同型海洋性貧血帶因者, 假若夫妻為同型帶因者, 則必需進一步作絨毛採樣術或羊膜穿刺術, 以作胎兒之基因診斷 3. 當夫妻經診斷為同型海洋性貧血帶因者, 每次懷孕都有四分之一機會產下重型胎兒, 所以每次懷孕都需做產前遺傳診斷 全民健保已將孕婦平均紅血球體積納入產前常規檢查, 所以孕婦不需額外付費, 政府另補助配偶平均紅血球體積檢查 夫妻基因診斷及胎兒基因診斷等檢查之部分檢驗費用, 詳情可洽本市各市立醫院或各區衛生所 ( 電話 地址詳附表二 ) ( 五 ) 產前遺傳診斷根據醫學文獻的報導, 高齡孕婦生育染色體異常胎兒的機會比年輕孕婦大 如最常見的染色體異常症 唐氏症, 廿歲 ~ 廿四歲的孕婦每一 六 人中有一人會生育唐氏症兒, 卅五歲 ~ 卅九歲卻是每二六 人有一人, 四十歲以上更是每一 人就有一人會生育唐氏症兒, 所以卅四歲以上之高齡孕婦除定期產前檢查外, 應進一步接受羊膜穿刺術, 以早期確定胎兒健康情形 除了高齡孕婦, 以下情況之孕婦亦是生育染色體異常的高危險群, 也應接受羊膜穿刺術, 這些孕婦包括 : 22

23 臺北市立聯合醫院婦幼院區 1. 本人或配偶有遺傳疾病者 2. 曾生育先天性缺陷兒者 3. 家族中有遺傳疾病者 4. 孕婦血清篩檢疑似染色體異常之危險機率大於二百七十分之一者 5. 本胎經超音波篩檢胎兒有異常可能者 上述孕婦可以於門診向醫師詢問有關產前遺傳診斷的目的 方法及安全性, 並可以請醫師預約檢查的時間 目前政府補助部分檢驗費用, 有關檢查地點及補助辦法詳附表五, 或洽本市各市立醫院或各區衛生所 ( 電話 地址詳附表二 ) ( 六 ) 唐氏症胎兒之母血篩檢 染色體是人類遺傳基本單位, 正常人的細胞中有四十六個染色體, 其中除了決定性別的二個染色體 ( 以 XX 或 XY 組合 ) 稱之性染色體外, 其餘的四十四個配對形成廿二對的染色體 所謂 唐氏型 大都是第廿一對的染色體多一個 ; 也就是說有三個染色體廿一 唐氏症 是最常見的染色體異常, 自然發生率平均約每一千個出生嬰兒中會有一個 ( 千分之一 ) 台灣每年有三百到四百個 唐氏症胎兒 以下簡稱 唐氏兒 出生, 故平均一天約有一個出生 據統計二 % 唐氏兒 是年齡大於三十四歲的孕婦所生, 而大部分 ( 八 %) 的 唐氏兒 卻是年齡小於三十四歲的孕婦所生 唐氏兒 最主要是有智力障礙, 也可能同時有許多生理上的合併症 ( 如 : 先天性心臟病 ) 而這一些病患終其一生均須要家人的長期照顧, 造成極大的精神及經濟上的負擔 1. 誰會生出 唐氏兒? 懷孕的婦女每一個人都有機會生出 唐氏兒 生 唐氏兒 的機率會隨著孕婦年齡之遞增而升高 二十歲之孕婦有 1/1528 的機會會生出 唐氏兒, 三十歲之孕婦有 1/909 的機會, 而三十四歲的孕婦則增至 1/270 雖然高齡產婦生出的 唐氏兒 的機會較高, 但是八 % 的 唐氏兒 卻是由小於三十四歲之年輕孕婦所生 因此每一位懷孕的婦女都有機會生出 唐氏兒! 2. 如何篩檢可能懷有 唐氏兒 的孕婦? (1) 年齡大於三十四歲的孕婦於妊娠第十五 ~ 二十二週 ( 理想穿刺週數建議為十六 ~ 十八週 ) 作羊膜腔穿刺術, 除 唐氏兒 外, 亦可發現有無其他染色體異常 (2) 年齡小於三十四歲之年輕孕婦抽取母血檢測甲型胎兒蛋白及絨毛性腺激素 3. 母血篩檢 唐氏兒 的原理據研究結果顯示, 懷有 唐氏兒 之孕婦其血液中甲型胎兒蛋白偏低, 而其血液中之絨毛性腺激素則偏高 因此可以從妊娠第十五 ~ 二十週測得母親血液中甲型胎兒蛋白 絨毛性腺激素值, 經電腦的精密計算可得出母親懷有 唐氏兒 之機率, 一般滿三十四歲的孕婦懷 唐氏兒 的機率為 1/270 23

24 中英文版 新婚優 生保健 手冊 A.二十歲的孕婦平均懷 唐氏兒 的機率為 1/1528 若篩檢發現甲型胎兒蛋白值偏低 絨毛性腺激素值偏高時 經計算若 其懷 唐氏兒 的機率為 1/150時 則這位年輕的孕婦應考慮接受羊 膜腔穿刺術之檢查 以避免生出 唐氏兒 的嬰兒 B.三十二歲孕婦平均懷 唐氏兒 機率為 1/546 若篩檢發現甲型胎兒蛋白值並無偏低 絨毛性腺激素值也沒有偏高 經計算懷 唐氏兒 的機率為1/1556時 則這位孕婦生出 唐氏兒 的 機率相當低 4.母血篩檢是不是可以發現所有的 唐氏兒 因為這是屬於一種非侵襲性之篩選檢查 大概可以檢測出五 六 的 唐氏兒 5.篩檢的最佳時機 篩檢的週數 從懷孕起的第十五 二十週之間 最理想的篩檢週數 懷孕的 第十六 十八週之間最好 6.去那裡做篩檢 於懷孕十五 二十週做產前檢查時 可要求做母血篩檢 唐氏血 例如可至 市立聯合醫院或醫學中心等院所做檢查 凡設籍臺北市懷孕十五 二十週之 婦女 在臺北市立聯合醫院 婦幼 陽明 中興 和平 仁愛 忠孝等院區 作檢驗者臺北市政府有補助(如附表五) 7.如何得知篩檢的結果 孕婦於抽血後二週 回原抽血門診作例行產前檢查時 由門診醫師告知結 果 若抽血檢驗後屬於懷有 唐氏症 胎兒之高危險群時 醫院會先行電話 連絡孕婦 夫婦 前來醫院做進一步檢查與諮詢 二 孕期衛生與保健 胎兒在母親腹內 一切仰賴母親 因此母親在受孕期間 應特別注意自己的日 常生活 起居 飲食 因為有了健康的母親 才有健康的胎兒 (一)飲食 懷孕期間的飲食 應以均衡營養容易消化的食物為原則 因此飲食宜三餐均衡 分配蛋白質 礦物質及維生素含量豐富的食物 如牛乳 肉類 豆類及各種蔬菜 水 果類 並少吃刺激性食物 煙 酒更不應吃 糖及油亦應該減少 有些孕婦在受孕初 期有噁心 嘔吐的現象 可在起床前 先吃一些點心如餅干 麵包等 然後躺在床上 休息三十分鐘 同時將食量減少而增加餐數 如此則可減少晨間嘔吐現象發生 (二)衣著 孕婦衣著以寬鬆 保溫二者兼顧 質料以吸汗為宜 以舒適和實用為主 並要 經常換洗 高跟鞋 束腰 吊襪帶等不宜穿著 孕期應戴上合適乳罩 支持保護乳 房 (三)避免過度疲勞和睡眠不足 妊娠中不可做過分勞累的工作 應避免過度勞累或睡眠不足 平時做慣的輕鬆 工作或家務沒有必要因妊娠而停下來 但以不過度疲勞為原則 這樣對母體的健康 才會有幫助 但如攀高 舉重或提重物 蹲下 長時間彎腰洗衣服 從高處跳下 或快速的奔跑等都應禁止 24

25 臺北市立聯合醫院婦幼院區 ( 四 ) 保持精神愉快 : 懷孕不是病而是一種正常生理現象 所以懷孕時應保持精神安寧與愉快, 少用腦力思考, 避免興奮 憂愁 悲痛等感情上的刺激, 怪異淫靡的戲劇 書刊 圖 書 音樂 故事都不宜觀聽, 因此最好丈夫能時時給予安慰與體貼, 將有益於孕婦的健康與胎兒的發育 ( 五 ) 沐浴 : 妊娠中, 各器官的新陳代謝都比平時來得旺盛, 因此分泌物也較平常增加, 必須每天沐浴 一方面可保持身體清潔, 另一方面可促進血液循環 但無論洗澡或洗腳, 身體不宜過度彎曲, 最好使用淋浴, 外陰道宜保持清潔, 洗澡水不宜過熱 ( 六 ) 口腔衛生 : 懷孕期間因唾液呈酸性且帶黏性, 飲食習慣及飲食次數增加易殘留食物 疲倦 懶散而疏於口腔清潔工作及生理上的變化, 牙齦組織容易腫脹 出血 易引起口腔疾病, 需特別注意口腔衛生 ( 七 ) 預防便秘與腹瀉 : 妊娠中較易發生便秘, 可多吃蔬菜 水果, 多喝水及避免吃易致便秘的食物來防止 腹瀉常是由於飲食不慎所引起的, 如果嚴重的話可刺激子宮收縮而造成流產, 尤其在懷孕初期 所以嚴重的腹瀉, 應找婦產科醫師診治 ( 八 ) 性生活 : 因妊娠而全期禁慾是無此必要的, 妊娠初期較易流產, 所以性生活應稍微節制謹慎 有習慣性流產或早產的症狀的婦女有禁慾的必要 妊娠最安全的時期是由五個月至八個月, 只要動作溫和則可如常, 到妊娠後期, 宜儘量減少, 尤其到分娩預定日, 子宮變得非常敏感, 此時期如不禁慾, 有時會招來早期破水的麻煩 ( 九 ) 運動 : 運動最好是在戶外, 可以盡情的享受新鮮空氣和日光, 同時運動可以使精神穩定, 頭腦安靜, 增進睡眠和食慾, 懷孕期間最好的運動是在新鮮空氣下散步, 它可以激勵全身肌肉的活動, 因此孕婦在整個懷孕的過程中, 都可以應用此項運動 孕婦在懷孕期間, 應該隨時注意保持正確姿勢, 與適度的運動, 因為妊娠期間, 由於胎兒的成長發育, 使得母親的子宮逐月增大, 以致增加腹壁肌肉的負擔, 及身體重心的不平衡, 所以往往會產生疲倦及腰酸背痛的現象 可在醫護人員指導下, 作產前運動, 可減少生產時子宮收縮所引起之疼痛 ( 十 ) 預產期的推算 : 受胎到生產約為二百八十天左右, 其推測方法是從最後一次月經開始的第一天算起, 於月分上加上九個月或減三個月, 再於日期加七天即預產期 如最後一次月經為五月三日, 則預產期為翌年二月十日, 但這日期僅為參考之用, 不一定完全正確 比預產期快二週或慢二週生產均屬正常 25

26 中英文版 新婚優 生保健 手冊 (十一)懷孕期危險的徵象 出現下列危險徵象 應立即就醫 1.陰道流血 無論量多或少 2.臉部及手指 小腿浮腫 3.嚴重而連續性的頭痛 4.視力模糊 5.持續性或劇烈的腹痛 6.持續性或嚴重的嘔吐 7.突然發燒及畏寒 8.陰道突然有液體流出 9.尿量明顯減少或小便時有疼痛的灼熱感 10.體重增加太快 11.胎動明顯減少或消失 捌 產後衛生與保健 一 離床的適當時間 正常分娩後約六小時即可下床用餐和排尿 但仍以休息為佳 若順利約三天左 右即可出院 二 會陰部的清潔 產後應以衛生棉遮護會陰以吸收惡露 並隨時更換 且排便後應用溫開水或消 毒水由前往後沖洗 三 每日沐浴 滿月前宜採淋浴 切勿用盆浴 以防細菌進入子宮引起發炎 洗髮後迅速吹乾 即可 四 飲食 應均衡攝取各類食物 產後常口渴 可多飲開水 牛奶及熱粥等易消化食物 五 性生活 惡露乾淨 子宮完全恢復才可行性生活 通常約在產後滿月左右 否則易感染 或出血 六 產後檢查 產後六週即需做產後檢查 可持健保卡按一般就醫程序辦理 以檢查生殖器官 是否已完全恢復 七 產後運動 產後選擇合適運動可增進腹肌收縮 促進子宮收縮 保持美好身材 八 口服避孕藥 滿月後無論有無哺乳 月經來潮之前均可能會懷孕 故不能等月經來潮後才開 始避孕 產後二十八天即應開始服用 26

27 臺北市立聯合醫院婦幼院區 玖 哺餵母乳 一 哺餵母乳的好處 ( 一 ) 吃母奶最營養也最合乎嬰兒的需要, 母奶中含有乳糖和脂肪酸, 是嬰兒腦部發育的基本成分 ( 二 ) 吃母奶最安全, 最衛生也最經濟 ( 三 ) 吃母奶可增加嬰兒對疾病的抗抵力, 初乳含有豐富營養和抗體, 可增強嬰兒對疾病的抵抗力及幫助胎便的排出 ( 四 ) 吃母奶可滿足嬰兒吸吮的本能, 使心理發展健全而平衡, 更可增進母子的親情 ( 五 ) 吃母奶可幫助母親產後子宮的收縮, 促進產婦身體的復原 二 促進乳汁分泌的方法 ( 一 ) 分娩後儘早哺餵母奶 ( 二 ) 除餵母奶外, 避免以牛奶補充 ( 三 ) 依嬰兒的需要採彈性時間哺餵母奶 ( 四 ) 當寶寶不在身邊時, 可用手或擠奶器將乳汁擠出, 並將乳水冰存起來留給寶寶吃 ( 五 ) 正確的吸吮方式及餵奶姿勢 ( 六 ) 餵奶前按摩輸乳竇 ( 七 ) 多喝牛奶, 湯水或進食發奶食物, 例如 : 豬腳 ( 八 ) 每天充足的睡眠及愉快的心情 三 乳脹的預防與處理 ( 一 ) 新生兒出生後即刻的吸吮母奶, 並經常的餵奶, 不另添加牛奶, 不讓新生兒口含奶嘴 ( 二 ) 按摩輸乳竇擠出一些奶水, 使乳房柔軟後再讓嬰兒吸吮, 若有硬塊, 則熱敷後再讓嬰兒吸 ( 三 ) 有時讓嬰兒變換姿勢吸奶 ( 四 ) 母親穿戴合適的胸罩支托 27

28 中英文版新婚優生保健手冊 附表一 : 各種避孕方法之選擇 方法子宮內避孕器 - 母體樂口服避孕藥保險套 圖 形 避孕效果 約 95% 約 98~99% 約 90% 作用 是一種很小的塑膠製品或纏有銅金屬的塑膠品裝在子宮內, 使得受精卵無法著床在子宮內 抑制卵巢排卵 薄乳膠套, 用以套住陰莖, 避免射精時, 精液進入女性體內 優點 1. 普遍安全 2. 避孕效果高 3. 取出後仍能照常生育 4. 費用低廉 5. 裝後如果沒有不舒服情形, 五年換一次即可 6. 性交前不必採任何措施 7. 不會干擾母乳的哺育 1. 普遍安全 2. 避孕效果幾乎百分之百 3. 適合新婚及未生育過的人服用 4. 性交前不必採取任何措施, 不影響性生活 5. 費用低廉, 使用簡單 6. 能使月經規則, 經痛及經血減少 7. 可預防良性乳房疾病和卵巢囊腫 1. 停用時, 仍能照常生育 2. 容易買到 3. 無不良副作用 4. 不需看醫生 5. 簡單易用, 攜帶方便 6. 不僅用於避孕, 還可以預防性病的傳染 注意事項 1. 需由醫生裝置 2. 可能會排出體外 3. 每一百個婦女使用一年中, 約有二個至四個人會懷孕 4. 裝置後一個月 一年要複查, 以後再每年定期檢查一次 5. 對銅敏感的婦女不可使用含銅避孕器 1. 初次服用者, 應先由醫師診療後再服用 2. 每晚必須記得服用, 不可隨便停服, 否則避孕會失敗或引起失血 3. 肝膽疾病 心臟病 高血壓 血液病 肥胖症 血栓性栓塞病症 患有乳癌或生殖器官癌症 抽菸習慣很重的 餵母奶中婦女 懷孕婦女, 不可使用 1. 每次房事前必需套上 2. 保險套使用一次後, 必須丟棄, 不要再用 3. 性交時, 注意保險套要套好, 不要滑下去 射精後馬上將陰莖連同保險套離開陰道, 以免精液溢出 4. 每一百對夫婦使用一年, 約有十人懷孕 副作用 少數人有下列症狀 : 1. 輕微的腹痛 2. 非月經期的出血 3. 月經期血量增加, 天數拉長 4. 白帶增多 5. 腰酸 少數人有下列症狀 : 1. 噁心 嘔吐或胃不舒服 4. 點狀出血 2. 頭痛 頭昏 3. 經血減少或月經不來 4. 點狀出血 5. 乳房脹疼 6. 體重稍微增加 7. 血壓稍微升高 無 備註 上述這些症狀通常在初期身體適應期間較有可能出現 疼痛時, 可服用止痛劑, 如果症狀不消失, 應找醫師檢查 上述這些副作用通常不太厲害, 且會慢慢適應, 如果很厲害或一 二個月仍未消失, 應該找醫師看看, 各公立醫院 衛生所及代發站洽詢 詳情請洽各市立聯合醫院或各區健康服務中心 28

29 臺北市立聯合醫院婦幼院區 方法輸精管結紮 ( 男 ) 輸卵管結紮 ( 女 ) 輸尿管精囊膀胱輸精管 脊骨 直腸 結紮處 圖 形 射精管前列腺陰莖尿道龜頭包皮 結紮處 尿道球腺肛門副睪丸睪丸陰囊 輸卵管 卵巢 陰道 子宮 卵巢 輸卵管 避孕效果 作 用 優 點 約 99.0~99.9% 將男性輸精管剪斷並紮起來, 使射出之精液中不含有精蟲 1. 一勞永逸 安全 2. 手術簡單, 不必住院 3. 避孕效果近百分之百 4. 不影響男性之生理活力 5. 因不會有懷孕之顧慮, 故如同女性結紮, 不干擾性生活 約 99.0~99.9% 將女性輸卵管紮起來, 並剪斷或只紮起來使卵子與精子無法結合而受孕 1. 手術後一勞永逸 2. 避孕效果近百分之百 3. 不影響女性之生理 4. 不會有再懷孕的顧慮, 並且不干擾性生活 注意事項副作用 1. 不想再生育的人, 才可結紮 2. 手術後, 需等到射精十五次以上, 檢查精液中不再有精子時, 才算達到避孕效果 3. 少數結紮, 會再自行接通, 故結紮後太太若發生月經過期十天以上, 請找醫師判斷有無避孕失敗之可能性 若心理成熟的人接受結紮是不會有副作用的 1. 不想再生育的人, 才可結紮 2. 必須手術, 並需短期住院 ( 半天或一天 ) 3. 產後在醫院順便結紮最方便 4. 少數結紮會再自行接通, 故結紮後, 若月經過期十天以上, 請找醫師判斷有無避孕失敗之可能性 若心理成熟的人, 接受結紮是不會有副作用的 備註 詳情請洽各市立聯合醫院或各區健康服務中心 詳情請洽各市立聯合醫院或各區健康服務中心 29

30 中英文版新婚優生保健手冊 附表二 : 臺北市立聯合醫院 健康服務中心地址及電話號碼 單位名稱地址電話 市立聯合醫院仁愛院區仁愛路四段 10 號 市立聯合醫院中興院區鄭州路 145 號 市立聯合醫院和平院區中華路二段 33 號 市立聯合醫院婦幼院區福州街 12 號 ~9 市立聯合醫院陽明院區雨聲街 105 號 市立聯合醫院忠孝院區同德路 87 號 市立萬芳醫院興隆路三段 111 號 市立聯合醫院關渡院區知行路 225 巷 12 號 市立聯合醫院中醫院區昆明街 100 號 松山區健康服務中心信義區健康服務中心大安區健康服務中心中山區健康服務中心中正區健康服務中心 八德路四段 694 號信義路五段 15 號辛亥路三路 15 號松江路 367 號牯嶺街 24 號 ~ 大同區健康服務中心昌吉街 52 號 萬華區健康服務中心文山區健康服務中心內湖區健康服務中心南港區健康服務中心士林區健康服務中心 東園街 152 號木柵路三段 220 號民權東路六段 99 號南港路一段 360 號中正路 439 號 ~ ~ ~ 北投區健康服務中心泉源路 14 號 ~7 30

31 臺北市立聯合醫院婦幼院區 附表三 : 行政院衛生署評估通過之人工協助生殖技術機構 院名電話地址 三軍總醫院 成功路二段 325 號 中山醫院 #251 仁愛路四段 112 巷 11 號 聯絡 陳逸菁簡欣旋 陳寶珠黎慧波 台大醫院 #5159 中山南路 7 號楊友仕 台北長庚醫院 #3347 敦化北路 199 號李佩香 台北榮民總醫院 #201 石牌路二段 201 號張昇平 台北醫學大學附設醫院 #1906~1907 吳興街 250 號 曾啟瑞 台安醫院 #2582 八德路二段 424 號魏曉瑞 馬偕紀念醫院 #3081 中山北路二段 92 號李國光 國泰綜合醫院 #3557 仁愛路四段 280 號陳樹基 程得勝婦產科診所 中山北路二段 106 之 2 號 2 樓 賴英明 新光吳火獅醫院 #3879 士林文昌路 95 號黃建榮 潘世斌婦產科診所 民生東路一段 30 號 3 樓潘世斌 劉志鴻婦產科診所 仁愛路四段 25 號 10 樓劉志鴻 市立聯合醫院和平院區 #2619 中華路二段 33 號吳麗慧 康寧醫院 #6608 成功路五段 420 巷 26 號 萬芳醫院 #2501 興隆路三段 111 號 尹長生邱寶珠 鄧文施雅惠 市立聯合醫院婦幼院區 福州街 12 號張永生 31

32 中英文版新婚優生保健手冊 附表四 : 全民健康保險孕婦產前檢查給付時程 次數及項目 孕期診療次數檢查項目 妊娠第一週 ( 妊娠未滿 17 週 ) 二次 1. 於妊娠第 6 週或第 1 次檢查須包括下列檢查項目 : (1) 問診 : 家庭疾病史 過去疾病史 過去孕產史 本胎不適症狀 (2) 身體檢查 : 體重 身高 血壓 甲狀腺 乳房 骨盆腔檢查 胸部及腹部檢查 (3) 實驗室檢查 : 血液常規 (WBC RBC Plt Hct Hb MCV) 血型 Rh 因子 VDRL 愛滋病 尿液常規 2. 例行產檢 妊娠第二週 ( 妊娠 17 週至未滿 29 週 ) 二次 1. 例行產檢 2. 於妊娠 20 週前後提供一次超音波檢查 妊娠第三週 ( 妊娠 29 週以上 ) 六次 1. 例行產檢 2. 於妊娠 30 週前後提供梅毒檢查 (VDRL) B 型肝炎表面抗原檢查 (HBsAg) B 型肝炎 E 抗原檢查 (HBeAg), 及德國麻疹免疫球蛋白 G 檢查 (Rubella IgG) 等實驗室檢驗 備註 : 1. 例行產檢內容包括 : (1) 問診內容 : 本胎不適症狀如出血 腹痛 頭痛 痙攣等 (2) 身體檢查 : 體重 血壓 腹長 ( 宮底高度 ) 胎心音 胎位 水腫 靜脈曲張 (3) 實驗室檢查 : 尿蛋白 尿糖 2. 德國麻疹免疫球蛋白 G 檢查呈陰性之孕婦, 宜在產候注射德國麻疹疫苗 32

33 臺北市立聯合醫院婦幼院區 附表五 : 優生保健服務項目補助及服務處所 服務項目服務對象補助金額服務處所 新生兒篩檢初檢陽性個案及其家屬 每案補助 250 元 台大 榮總等新生兒篩檢之轉介醫院 優生健康檢查 證明四等親以內或本人疑似罹患遺傳性疾病需進一步檢查者 經羊水檢驗診斷胎兒異常者 最高補助 1, 元, 查費用低於本補助標準, 實報實銷 台大 榮總等指定院所或市立聯合醫院婦幼院區 長庚 台安等衛生署評鑑通過之臨床細胞遺傳學檢驗等單位 婚前健康檢查 設籍臺北市將婚或新婚尚未懷孕之男女, 且為低收入 原住民或身心障礙者, 由醫院認證 補助 1,000 元, 其餘費用由個案自付 台大 榮總 馬偕 長庚 國泰 北醫 臺北市立聯合醫院婦幼 仁愛 和平 中興 陽明 忠孝等院區 萬芳 國軍松山 台安 新光 臺北城區分院 宏恩 博仁等醫院 產前遺傳診斷一. 羊膜腔穿刺羊水分析 1. 三十四歲及以上之孕婦 2. 經診斷或證明下列四種情形之一者 (1) 本人或配偶罹患遺傳性疾病者 (2) 曾生先天異常兒者 (3) 家族有遺傳性疾病者 (4) 孕婦血清篩檢疑似染色體異常之危險機率大於二百七十分之一者 (5) 本胎經超音波篩檢胎兒有異常可能者 補助檢驗費 2,000 元, 其餘費用個案自付 低收入者補助 5,500 元, 餘自付 台大 榮總 長庚 馬偕 三總 北醫 台安 國泰 臺北市立聯合醫院仁愛 婦幼 和平 中興 陽明 忠孝等院區 萬芳 國立護理學院附設醫院 博仁 國技醫院內湖分院 宏恩 國軍松山 新光 協和 李婦產科 柯滄銘婦產科等院所 符合 1. 或 2. 之條件, 且穿刺院所將檢體送衛生署評鑑通過之臨床細胞遺傳學檢驗單位者 二. 絨毛膜取樣或胎兒取血 夫婦為同型之海洋性貧血帶因者之孕婦 台大 榮總 柯滄銘婦產科等衛生署評鑑通過之海洋性貧血確認診斷單位 新生兒先天代謝異常疾病篩檢 出生餵奶滿二十四小時以上至一個月內之新生兒 補助檢驗費 100 元, 其餘費用個案自付 軍 公 市及私立醫療院所懸掛行政院衛生署發給 新生兒先天代謝疾病篩檢院所 招牌者 母血唐氏症篩檢 設籍臺北市懷孕 週之孕婦 每案補助 1,000 元 於市立聯合醫院婦幼 仁愛 和平 中興 陽明 忠孝院區檢驗者 33

34 中英文版新婚優生保健手冊 附表六 : 臺北市婚前健康檢查服務醫療院所 單位名稱應掛科別電話自付費用備註 博仁綜和醫院 婦產科門診 W1-W6 上午 #2231 男約 :3000 元女約 :3000 元 掛號費需另付初診 100 元複診 70 元 國軍松山醫院 航醫部體檢科 W1-W5 全日 #671603~4 男約 :1600 元女約 :1900 元 含掛號費 台安醫院 家醫科 W1-W4 全日 W5 及周日上午 #2667 男約 :2300 元女約 :2300 元 含掛號費 長庚醫院 家醫科 W1-W5 及 W6 上午 ( 包括夜診 ) #3626 男約 :2300 元女約 :2300 元 不需空腹, 但女性最好避開生理期 台北醫學大學附設醫院 家醫科 W1-W5 ( 包括夜診 ) 及 W6 上午 #3131~2 #3113 男約 :1900 元女約 :1900 元 掛號費 285 元 臺北市立聯合醫院仁愛院區 家醫科 W1-W5 及 W6 上午 #3120 男約 :2200 元女約 :2301 元 含掛號費及 G6PD 檢驗費 150 元及精液分析 國泰醫院醫學中心 家醫科約診制 # 男約 :3000 元女約 :4000 元 含掛號費及女性腹部超音波 ( 詳電 ) 宏恩醫院 體檢部 W1-W #831 男約 :2300 元女約 :2300 元 含掛號費, 需空腹 馬偕醫院 16F 健診中心 W1-W #3153 男約 :2120 元女約 :2470 元 含掛號費 臺大醫院 家醫科 W1-W6 全日 ( 包括夜診 ) #7609 男約 :2000 元女約 :2000 元 含掛號費, 需空腹 臺北市立聯合醫院和平院區 家醫科 W1-W6 全日 W1W3W5 夜診 #2126 男約 :1288 元女約 :1458 元 含掛號費及精液分析 臺北市立聯合醫院婦幼院區 家醫科 W1-W6 上午 ( 以 W6 為主 ) #294( 上午 ) 男約 : 女約 : 元 含掛號費及水痘抗體篩檢 臺北市立聯合醫院中興院區 家醫科 W1-W #6246 約男 :2013 元約女 :2183 元 含掛號費及精液分析 萬芳醫院 健診中心 W1 W3W5W6 上午 #5321~2 男女共 9999 元 含掛號費, 但男無精液分析且需空腹 臺北市立聯合醫院忠孝院區 一樓服務台 W1-W6 全日 #6703 男約 :1295 元女約 :1295 元 含掛號費及 G6PD 臺北市立聯合醫院陽明院區 體檢科 W1-W5 及 W6 上午 #6136 男約 :1640 元女約 :1880 元 含掛號費及 G6PD GOT GPT 等精液分析需自費 新光醫院 家醫科第 75 診 W1-W6 上午 #2227 男約 :2320 元女約 :2621 元 含掛號費但德麻 350 元需自費 台北榮總 保健體檢科 W1-W6 上午 男約 :1900 元女約 :2100 元 含掛號費 X-RAY 及傳染性疾病篩檢 上列項目或收費如有更動, 以該院實際作業為準, 本表僅供參考 34

35 臺北市立聯合醫院婦幼院區 MEMO 35

36 Health Manual For Newlyweds Table of Content A letter to the newlywed I. Newlywed life Meaning of marriage Coordinating husband and wifeʼs lives after being married..40 (1) Basic elements for happy marriage...40 (2) Rule for newlyweds...42 II. Family plan and happy family Meaning of family plan Relationship between family plan and happy family...44 III. Pregnancy Maleʼs reproductive physiology Femaleʼs reproductive physiology Fertilization and implantation...47 IV. Contraceptive Methods Contraceptive principle Contraceptive method introduction Choosing contraceptive methods Where to get family plan service...55 V. Infertility prevention The cause of infertility How to avoid infertility When do you need to visit a doctor?...57 VI. Health knowledge the newlyweds should have and premarital health examination...57 VII. Prenatal Health Prenatal Check up Health during pregnancy...66

37 VIII. Postnatal Health Best time to leave the bed Cleaning the private area Shower daily Diet Sexual life Postnatal check up Postnatal exercise Oral contraceptive...68 IX. Breastfeeding Advantage of breastfeeding Ways to improve milk secretion Engorgement prevention and care...70 Attachment - Supporting documents 1. Choosing contraceptive methods The addresses and telephone numbers for Taipei City Hospital and Community Health Center Taipei Assisted Reproductive Technology Agency approved by Department of Health, Executive Yuan The payment schedule, number of times and items for prenatal check up Health service subsidy and service center Taipei city service center for premarital health check up...79

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39 A letter to the newlywed Congratulation on your decision to create a new family, and seek after a marriage life that is full of joy together. Have you talked about how to live this happilyever-after live? Maybe you have differences because of your lives, habits and environments in the past; however, you must face the reality, and live the example. Our department has specially printed Health manual for newlyweds to help the newlyweds to find joy in marriage life. This Health manual for newlyweds has been compiled into different volumes in accordance with different subjects, such as marriage life, family plan, pregnancy, prenatal and postnatal, infant and toddler health, to help the newlyweds build a happily-ever-after family. Best wishes For happiness and health! Made by Department of Health, Taipei City Government Taipei City Hospital, Women and Childrenʼs Branch Oct. 2005

40 中英文版新婚優生保健手冊 I. Newlywed life 1. Meaning of marriage Zhouli reads: Husband and wife make a home. A family starts with a marriage, which is male and female being united officially, and the family is the fruit of marriage. A couple falls in love after they met, and become husband and wife through legal procedure, and created a family. Once the family is established, they start having children and take on the social responsibility of carrying on the teaching of our ancestors down to our off springs, and cultivate the talents for our country is the most important responsibility. Therefore, the marriage has the following functions: 1. Share the joy and sorrow of life: When a couple falls in love and created a family, by living together, they can share each otherʼs happiness, and experience the creation, aging process, sickness, unemployment and sorrow together and fulfill the life here on earth 2. Cultural link: A happy, ideal and peaceful family can cultivate the next generation for the society and create new and constructive race, therefore, it is the cultural link for the next generation. 3. Meet the rule of the society: Family is the basic unit that forms a society, and the family is formed by marriage, and marriage is the emotion and physical unity, in which its social, lawful and moral legality has to meet the rule of the society. 2. Coordinating husband and wifeʼs lives after being married (1) Basic elements for happy marriage Since the couple has covenanted before God and witnesses that they are willing to love and cherish each other for better or worse, in sickness and health, therefore, love for each other is what binds both of them. A sociologist said, choosing your better half with the strictest standard and sharpest judgment, however, to live with your better half with the lowest standard and leanest attitude, see that he/she is the most ordinary person that makes the most mistakes, which is so true! People who are married should practice this believe; furthermore, so as to help the couple to have happier family life, the couple should pay attention to the following: 1. Married couple should admire and respect each other: Our nation is a state of ceremonies, and in marriage life, the couple should treat each other with respect, and the couple should admire each other as well. Even though love is not the only requirement for happy marriage, however, the marriage without love is no happiness. 40

41 臺北市立聯合醫院婦幼院區 If the couple truly loves each other, and be thoughtful and cherish each other, and concerns about the other personʼs feeling and thinks of otherʼs happiness first, then truly happy family can be earned by many years of thoughtfulness, patience and sacrifice. Love is like a good wine, the older the better, like the old saying there is not other way to stick to the end of each otherʼs lives, love others like you love yourself! 2. Married couple should trust each other: Married couple must have complete trust between them to have a happy marriage. Being doubtful is one of the human natures, especially when it comes to love. A couple, who loves each other, often has unnecessary suspicions because of the love for each other and acts out of fear of losing each other, however, it is this unnecessary suspicion that causes marriage crisis. Therefore, to avoid the worry later on, it is best to be honest from the beginning, do not hide any thing regardless it is big or small, if it can be dealt with honesty, then it will make their faith strong in each other. This way, the couple may be able to trust each other, and not afraid of outside factor to destroy the marriage. 3. Be forgiving: Husband and wife are two individuals, they each have their unique ideas, concepts and different live styles, and it is unavoidable that they have different opinions when living together. If the distance between them is ten steps away when it comes to their opinion on things, if they can just walk five steps toward each other, they will be at the same place. If one party acts inappropriately because he/she is tired or has unsuccessful career or is in the bad mood during the menstrual cycle, the other party should forgive him/her, and not to argue with him/her. Do not make a habit of arguing between the husband and wife; there would be no happiness in the family if the husband and wife argue a lot. 4.Pay attention to the details in life: Many men and women are thoughtful and loving before they are married, and once they are married, they begin to neglect the details. Actually, some of details in life have great impact on the happiness of the marriage and relationship between the married couple. Human is emotional animal, the emotion life takes up the most of the human life, the little things between couples can offer comfort and joy to the other person. If the husband can remember the wifeʼs birthday, anniversary or specially day between the couple and show affection; if the wife can look nice, make some husbandʼs favorite food, go out during the holidays and weekends, or take kids out for a walk; all these little things can increase the fun and joy in the married life. 5.Raising proper number of children at the proper age: The agricultural era that promotes many children and grandchildren 41

42 中英文版新婚優生保健手冊 and have children early is replaced by the industrial society, large group of children can bring burden into family life financially and mentally. The parents labor and worry for the heavy burden on their shoulders, and do not have enough time to care for children and family, at the same time that there is no sufficient time to communicate with and understand each other, therefore, the harmony is greatly reduced. Moreover, making a plan on raising the children can help building a happy family. 6. Consult a specialist if there is a need: If there are some issues that cannot be resolved in the family, it is best to find a specialist. Marriage consultants have become important in today ʼs society. A trained consultant can offer professional consultation and resolution as well as analysis of the hidden marriage crisis. There may be great insecurity behind the argument. For instances, the disappointment from seeking power, or frustrated sexual desire, if the couple is not able to deal with this type of issues, they should seek the professional help. Seeking professional marriage consultation is the key to marriage success. (2) Rule for newlyweds Ñoái vôùi nhaân loaïiình duïcaø con ñöôøng, moâi giôùi ñeå giuùp ñôõ ngöôfor human, sex is a media or path that helps a man and a woman to express the love between them. Only a marriage between one man and one woman can develop true love, perfect intimate relationship and healthy personality, therefore, we can see sex is a united experience between the couples. A harmonious relationship should be adapted slowly, and learning how to reach the unity between the couple is expected in order to find joy in the relationship. Do not feel too frustrated if the newlywed encounters difficulty in their intimate relationship, the key is to have love for each other to be successful. A couple should learn continually to improve their intimate relationship and bring happiness for each other. Here are some rules for your references: 1. Adapt to each otherʼs need There is big difference in every coupleʼs sexual need physiologically and mentally; self-esteem and respect are the elements to maintain an intimate relationship. Husbands should not treat sex as a right, and wives should not treat sex as weapon. At the beginning of the intimate relationship, some people may experience pain, some of which can least several weeks even months; because there are wrinkles in femaleʼs vagina, which makes it hard to expand, however, after few times, the pain may disappear, and harmonious relationship may be achieved. 2.Number of time, time, position and location The number of times of the intimate life should not be compared with others, and there is no certain rule, do not over do it as daily routine, or under do it and cause the tension between the couple. At the same time, do not be superstitious on certain food or commercial drugs, the most important thing is to consider otherʼs feeling; there is no certain model for time and location, however, do not do it when you are exhausted, because 42

43 臺北市立聯合醫院婦幼院區 it needs emotion and energy as well as full devotion. Many couples want to know which position can bring them the maximum joy, actually, as long as the couple has correct attitude toward sex, and be thoughtful for each other, they can quickly find the position that can bring them the maximum joy, and the position varies depend on the locations. The privacy and mood are very important in the intimate relationship between husband and wife, full devotion needs privacy to happen, and moods, such as perfume, music and light are helpful. 3. Husbandʼs phimosis and prematured ejaculation In phimosis, the male foreskin cannot be pulled back behind the head of glans penis during the excitement, and circumcision may be considered. Sometimes males who are just married and have no sexual experience are unable to reach ejaculation and orgasm, some of them ejaculate within three minutes. Most peopleʼs intercourse time is between three to fifteen minutes, if it occurs within this scope is not prematured ejaculation. 4. Intimate relationship during menstrual cycle Menstrual cycle is not an illness, therefore, there is no prohibition for intercourse during the menstrual cycle in medical field. However, during the menstrual period, because the female vagina and uterus are softened because of the blood and mucus, therefore, the intercourse should not be overexcited. In addition, for sanitary and health reasons, the sexual activity should be avoided during menstrual period. 5. Communication about intimate relationship Husband and wife should communicate honestly to express their feelings about sex, the key to success is the understanding and the honesty, and sex is a good intimate relationship, if the skill is overemphasized, it will harm the sexual life. At the same time, avoiding marital affair is a very important subject, only a family built on the love between the husband and wife, and such unity can reach the high level of marriage. 43

44 中英文版新婚優生保健手冊 II. Family plan and happy family 1. Meaning of family plan Family plan is a plan every married couple, or couple that is going to be married makes according to their desire, mental and physical health, financial ability and demand of the nation and society to decide the number of children they are going to have, and to achieve this goal by the current medical knowledge and principle as well as methods of birth control. So that every child may be born under the parentsʼ expectation and preparation, as well as setting an important foundation for the childʼs physical and mental development in the future. 2. Relationship between family plan and happy family The proper age to start a family is between 22 years of age to 30 years of age, the reasons are as follows: (1) From a eugenic point of view, the physiological characteristics of both genders are mature after 20 years of age. However, the females are facing menopause after 49 years of age, therefore, the chance of getting pregnant is low, meanwhile, the females are not only facing the slim chance of getting pregnant after thirty years of age, they also are easier to have unhealthy or handicapped baby, which may affect the quality of the population. (2) From a legal point of view, the article 12 in Civil Law states that man becomes an adult when he/she reaches 20 years of age, which means that natural man becomes mentally mature after that age, and he/she understands the personal right and obligation to conduct legal act, and he/she is more mature than underage youth emotionally and psychologically. (3) From a social point of view, marriage and having children are responsibilities both genders share. It is not a good idea to set different ages for male and female to get married, so as to avoid the treatment of females as inferior to males. Next, even though both genders are qualified to be adults after they turn 20 years old, however, in recent years, male or female both have widely prolonged the time for education, therefore, their mental development and maturity of their personality seems to be premature, and being lack of social experience and financial foundation, therefore, 22 years of age is proper age to start a family. Getting married and having children at the proper age helps husband and wife to have happy family with two children are good whether they are boys or girls under the circumstances where both husband and wife has healthy personality and steady finance. (Data sources: meeting on June , Population Policy Committee, Ministry of Interior) 44

45 臺北市立聯合醫院婦幼院區 III. Pregnancy 1. Maleʼs reproductive physiology Maleʼs reproductive organs include testicles, spermatic, seminal vesles, ejaculatory duct, urethra, bulbourethral gland, phallus, scrotum and prostate gland. Among them, phallus and scrotum are called external genitalia, and the others are called internal genitalia. (See figure 1). Testicles are sexual glands, which are located in the scrotum, one on each side. The main function of the testicles is to make sperms. Under peritoneum, the sperm goes to abdominal cavity through spermatic cord and inguinal, and over the bladder ejaculatory duct that is formed with the ducts from seminal vesles, and to urethra through ejaculatory duct, therefore, it is an organ that transport the sperms. Prostate gland is an organ that secrets seminal fluid. Bulbourethral gland is located at the bottom of the prostate gland, which secrets thick milky fluid that makes the important part of the seminal fluid. Phallus is an organ that passes urine and intercourses. When the male is between 20 to 60 years of age, the reproductive organs generate 3~5cc of seminal fluid from each ejaculation, and under the normal circumstance, there are two millions to four million sperms in each cc. Ureter Spermatophore Bladder Vas deferens Ejaculatory duct Prostate gland Penis Urethre Balanus Prepuce Backbone Rectum Bulbourethral gland Anus Epididymis Testis Scrotum Male Reproductive System 45

46 中英文版新婚優生保健手冊 2. Femaleʼs reproductive physiology Femaleʼs reproductive organs include ovary, oviduct, uterus, vagina, labia majora, nympha, mons pubis and clitoris (see figure). The femaleʼs external genitalia includes labia majora, nympha, mons pubis, clitoris, vagina entrance, and the internal genitalia includes uterus, oviduct, ovary and vagina. Ovary is the sexual gland that is located in the abdominal cavity, one on each side. Ovary ovulates and secrets female hormone, and it can create two major female hormones, one is estrogen and the other is progesterone. Estrogen helps increase the maturity of the female reproductive organ, and the function of progesterone is to protect the uterus and development of the fetus during the pregnancy. Oviduct is to transport the egg ovulated from ovary to uterus. Uterus is a hollow organ that shapes like a pear, and it is an organ for the fetus to grow in as well as where the menstrual cycle takes place. Vagina is an organ intercourse takes place, it is a channel where fetus is delivered and the menses come out. Nympha is also called external labia, which is a skin folds and forms the outer border that contains fatty tissue. In the middle of the labia majora has an opening, and pubic hair is more on the outside than the inside. Nympha is also called inner labia, which is skin folds into two pieces, no public hair, but has fatty gland. Mons pubis is located on top of the symphasis pubis covered with pubic hair. Clitoris is located on the triangle area on the vulva, the labia merge anteriorly to form the prepuce (foreskin) of the clitoris. This small erectile structure, comparable to the male phallus, becomes very sensitive. However, there is a lot of differences between the two, but the phallus has foreskin on top as well. 3. Fertilization and implantation When the intercourse between male and female reaches orgasm, the ejaculation is generated, if the seminal fluid enters into the femaleʼs vagina, the sperms then Ovary Fallopian tube Backbone Uterus Cervix Bladder Pubis Urethra Vagina Rectum Anus Female Reproductive System 46

47 臺北市立聯合醫院婦幼院區 swim towards uterus, then enter into oviduct; if it enters into the uterus during the period of ovulation, then the sperm that is closest to the matured egg go into the egg, then the egg membrane immediately becomes impermeable to prevent other sperms from coming in. The location where the normal sperm and egg meet is at the end of oviduct about 1/3 length from the end. (See figure) Soon after the sperm enters into the egg, its head started to swell, and become fertilized egg. The fertilized egg then started dividing and swimming toward uterus at the same time, which takes about three to four days to get to the uterus and develops into blastocyst, and it starts to grow chorionic like cell layer, and the fertilized egg can be implanted the inner membrane in the uterus and complete the implantation process. Then the embryo starts to grow in the blastocyst, and the surrounding cell layer forms the future placenta and fetal membrane. It takes about average two hundred and eighty days for the fertilized egg to develop into mature fetus, and it is delivered out of motherʼs body with placenta. Genital epithelium bieåu bì Primary follicle Growing follicle Blood vessel Mature follicle Lean tyep Mature corpus luteum Lutein cell Blood clot Ruptured follicle Ovulation Corpus luteum(primary) Amitosis Oosperm Impregnation Morula Endometrium Nidation Myometrium Graafian follicle Secondary oocyte To ovulate Fimbriae Impregnation and Nidation 47

48 中英文版新婚優生保健手冊 IV. Contraceptive methods 1. Contraceptive principle (1) Maleʼs testicles create sperms, and femaleʼs ovary creates eggs. (2) Sperm is passed out of body with seminal fluid through spermatic, and the egg is transported to the uterus through oviduct. (3) When intercourse, the sperm is ejaculated into vagina, and it swims toward uterus automatically and go into egg in the oviduct. (4) The fertilized egg then is sent to uterus, and implanted in the inner membrane in the uterus, and this is called being pregnant. Therefore, the contraceptive principle is to stop pregnancy with different methods, and they are: (1) Keep ovary from creating egg to stop pregnancy from happening: Oral contraceptive method. (2) Keep the egg from passing the oviduct, and keep the sperm from passing the spermatic to prevent fertilization: permanent contraceptive methods such as tuballigation and vasectomy. (3) Let the egg pass through oviduct so fast that it can not be fertilized, or increase the contraction to interrupt the implantation for fertilized egg: such as placing intrauterine device such as multiload. (4) Keep the sperm from going into vagina to prevent fertilization: condoms and interruptive intercourse. (5) Stop the sperm inside the vagina to prevent fertilization: Safety tablets and ointment. (6) Keep sperm from going into the uterus: diaphragm and cap. (7) Avoid intercourse during the ovulation to prevent fertilization: menstrual cycle calculation and basic body temperature calculation. 2. Contraceptive method introduction (1) Contraceptive method that is suitable for newlyweds: 1. Oral contraceptive methods: (1) Ingredients: it is made by estrogen and progesterone artificially (proges- 48

49 臺北市立聯合醫院婦幼院區 terone). There are two types, the first type is one step oral contraceptive medication, the dosage for each tablet every month is the same, Neovlar, Microgynon and Winstop are in this category. The second type is threestage oral contraceptive medication, the dosage for the twenty-one tablets in one month can be divided into three stages; the colors for the tablets in each stage are different. It imitates the type of hormones secreted during the normal physiological cycle. The total amount of dosage of Logynon each month is the lowest among all oral contraceptive medication. (2) Instruction: The first tablet is taken on the fifth night from the first day of the menstrual cycle. Some of the package has weekdays printed on its back, and its instruction is to take one from the correct week in the red area on the first night of the menstrual cycle. (For instance, if the menstrual cycle starts on Monday, then take one tablet on Monday in the red area, then each day follows the corresponding week, and not miss a day). Take one pill a day each night for twenty-eight days, then start on another package, do not miss any pills. In each package, only twenty-one pills have ingredients that has contraceptive effect inside, the other seven bigger white pills have not ingredients that has contraceptive effect, just lactose. When taking the second or the third lactose tablet, the menstrual cycle should begin. During the menstrual cycle, it should be taken each night until it is taken completely before taking another package. If the menstrual period did not start after the entire package is gone, it is best to stop the medication, and consult the doctor, and make sure that you are not pregnant. You may restart again after the menstrual cycle begins. It should be taken on the 28th days after birth for woman who has delivered a child. (3) Contraceptive principle: stop ovulation, if there is no egg, there is no pregnancy. (4) Effect: If it is taken correctly, the effect may be as high as one hundred percent. (5) Side effect: Few women may experience light and temporary discomfort: such as stomach discomfort, vomiting, nausea, headache, dizziness, however, most of the people do not have this type of side effect. If there is serious discomfort, it must be discussed with physician. People with heart disease, diabetes, hypertension and jaundice should take it under the direction of the physician. (6) Cost: Contact your local health centers and city hospitals. Oral Contraceptives 49

50 中英文版新婚優生保健手冊 2. Condom (1) It is a thin cylinder bag that is made out of rubber or emulsion. (2) Instruction: Place the condom on the phallus when it is erected before intercourse, then pull down the condom like unrolling the stockings toward the end of phallus, so that the condom can cover the entire phallus; take the condom off before the comdom phallus is softened after intercourse. Condom is used once each time, wrap it in the paper or in the bag and throw it away. (3) Effect: If it is taken correctly, the effect may be as high as ninety percent. (4) Cost: Health centers and city hospitals only charge service fee. 3. Safety calculation: (1) Principle: it is calculated by the menstrual Sun. Mon. Tues. Wed. Thu. Fri. Sat. cycle to determine the period that is easy to get pregnant to avoid conception. Beginning of menstruate (2) Instruction: Usually after ovulation, if the woman is not pregnant, her menstrual cycle would start after 12~16 days. Another words, Ovulation from the 12th to 16th day before the next menstrual cycle is ovulation period, and with the sperm may survive in the female reproductive organ for three days, and the egg can Expected next menstruate survive one day, therefore, the eleventh to nineteenth day before the next menstrual cycle is dangerous period, and rest of time is safe period. However, some womenʼs menstrual cycle is very irregular, so to be on the safe side, you should have the menstrual cycle recorded for six month or more, then find the longest cycle and the shortest cycle and the period that is easies to get pregnant, and avoid intercourse during that period to reduce the chance of being pregnant. (3) Effect: it is only good for women who have regular menstrual cycle. Because the womanʼs mood can change the date of ovulation, therefore, it is hard for women to predict the next ovulation. Therefore, the contraceptive effect is low, and the fail rate is as high as 20%/40%. Menstrual Cycle 1 days 3 days 5 days 10 days 50 2 nd Safety period Possible to get pregnant Safety period Beginning of this menstruate Sperm Iives 3 days Ovulation day Ovum lives 1 day Beginning of next menstrual Safety Calculation

51 臺北市立聯合醫院婦幼院區 4. Basic body temperature calculation: (1) Principle: The body temperature for a health woman is generally lower during ovulation, after ovulation, the temperature will increase, therefore, when taking the body temperature, you make find out the ovulation, and avoid intercourse during ovulation to prevent pregnancy. (2) Instruction: You may take body temperature on the second day of menstrual cycle; place the thermometer under the womanʼs tongue for five minute in the morning before doing any activity, and then record on the chart. Normally the body temperature is maintain in a certain scope, if one day the body temperature is lower than usual, and the next day, it is higher than usual, then it is the ovulation day. Because the sperm can survive three days in the femaleʼs reproductive organ, therefore three days before and after ovulation are the period t hat is easy to avoid conception. However, there is no special signs before ovulation, therefore, there is really no way to find out which day the temperature is going drop, so to be on the safe side, from the menstrual cycle to three days after body temperature drops are period that should avoid conception, the rest is safety period. (See figure) (3) Effect: Among people who only have intercourse three days after the high temperature, only six out of one hundred fail each year. If it is done during the time before the temperature arises, and just use safety period, the failing rate increase three times higher. Basal body temperature Calendar Month Day High temperature period Low temperature period Ovulation day Day Safety period calculation Menstruation 2 nd Safety period Dangerous period Menstrual cycle Safety period Next menstrual cycle Basic body temperature calculation (2) Contraceptive method for women who are married: If you have baby already, for the health of the mother and growth of the infant, the pregnancy should take place after few years, besides the contraceptive methods mentioned for the newlywed period: monthly oral contraceptive pill, condoms, safety period and basic body temperature calculation, there is still IUD, and currently, the most widely used by women is multiload. 1. Principle: It is to place a very small plastic or plastic wrapped with copper in the uterus to interrupt sperm from going through uterus to oviduct, and to keep fertilized egg from being implanted to avoid conception. 2. Mehods: It should be placed by the doctor after examination, and the best 51

52 中英文版新婚優生保健手冊 time to place it is one month after childbirth to six weeks (before taking contraceptive measure after child birth, it is best to be abstinence, and to take contraceptive measure early) or right after the menstrual cycle. It is easy to place, and the effect is as high as 96% -98%). It can be done in the public and private obstetric hospital, and the cost varies.. IUD (3) Permanent contraception: For male, it is vasectomy, and for female, it is tuballigation, the operation is designed for couple determined not to have any more children. The sexual gland secrets normally after operation, therefore, it does not affect sexual life. (4) Other contraceptive methods: Ureter Spermatophore Bladder Vas deferens Backbone Rectum Ejaculatory duct Prostate gland Penis Urethre Balanus Prepuce Location of ligation Bulbourethral gland Anus Epididymis Testis Scrotum Male fallopian tube location of ligation Location of ligation Fallopian tube Ovary Ovary Uterus Vagina Female fallopian tube location of ligation 52

53 臺北市立聯合醫院婦幼院區 1. Interruptive intercourse: it is done by male taking the phallus out and ejaculating outside the vagina during the intercourse. However, it is hard to control during the ejaculation, and the sperm may enter the vagina before ejaculation, therefore, the effect is not good, and the failing rate is high, and it often causes accidental pregnancy because the timing. 2. Safety tablet and ointment: place it in the vagina five minutes before intercourse will start foaming and kill the sperm, or cause the sperms to be immobile and keep sperm from going into the uterus. If fast foaming is desired, it may be wetted with saliva or water before placing it inside, the effective time for the tablet is thirty minutes, therefore, if the intercourse is over thirty minutes, you should place another one. The effect is low, which is about 80%, and is inconvenient, so there are not many people using it today. (See figure) Safety ointment contraceptive method Safety tablet contraceptive method 3. Choosing the contraceptive methods According to the principles mentioned above, we know that there are many ways to avoid conception, and each of them has advantages, however, until now, there is no one method that is perfect. Therefore, you must first understand your physical condition, need and family environment, and then choose a method that is right for you. There are few rules when choosing the method: (1) Safety and side effect: you should choose the method that is safest and has fewer side effects. (2) Reliability: you should choose the method that has good contraceptive effect and low failing rate. (3) Convenience: It should be easy to use, and doest not need otherʼs instruction. (4) Use time: Would it affect the intimate activity? 53

54 中英文版新婚優生保健手冊 (5) Cost: is it expensive, does it needs to be used often? (6) Flexibility: can the fertility be restored once stopped using the contraception. Besides the rule mentioned above, when choosing the methods, you should consider if it will cause the unnatural or abnormal feeling between both parties, and the most important thing is whether it would affect the family life. Because every oneʼs physical condition and family circumstance is different, therefore, you should choose the one that is right for you, take the following circumstances for example: (see attachment 1 choosing contraceptive method) (1) Oral contraceptive pill is better for newlywed, because it is easy to use, and it will not affect the intimate relationship. (2) Some people are allergic to the oral pill, and cause serious nausea and vomiting, so it is better use condom or IUD. (3) Some people with IUD experience loose or large amount of menses, therefore, they may want to consider oral pill or condoms. (4) Privacy in the bedroom is not good, therefore, it should not be the method requires timing, such as spermicide. (5) If both husband and wife believe the time is not right for pregnancy and want to find a reliable method, they may want to consider oral pill or IUD. (6) Women with lower education are not good for safety calculation, so IUD is better for them. (7) Women with irregular menstrual cycle should not use safety calculation, because of the high failure rate, therefore, the oral pill is better (and it can adjust the menstrual cycle as well) (8) People with sensitive mass should consider condom, safety period, body temperature and diaphragm. (9) People who breastfeed after delivery and no menstrual cycle should consider condom, safety tablets, ointment and IUD. (10) Wife with uncooperative husband should consider oral pill or IUD. (11) For people do not want to have childbirth, the vasectomy and tuballigation is best. The above circumstances are listed for reference, regardless what method you choose, the key is to use persistently, and not change often because friends or publicationʼs criticism. Because many pregnancies are caused during the indecisive time when the methods are changed often. 54

55 臺北市立聯合醫院婦幼院區 4. Where to get family plan service The service offered in Taipei for family plan is explained as follows: (1) Family plan outpatient service: 1. Health Center in the local area: Placing Intrauterine Device, purchase condoms, vasectomy and tuballigation introduction, filling the oral contraceptive methods prescription at the health insurance pharmacy. 2. Taipei City Hospital: Perform the vasectomy and tuballigation for residents of the city as well as placing intrauterine device, filling the oral contraceptive methods prescription at the health insurance pharmacy and purchase condoms. 3. Military, public and private hospital: Placing intrauterine device as well as vasectomy and tuballigation. 4. Practicing hospital or clinic: Placing intrauterine device as well as vasectomy and tuballigation. (2) Telephone service: Please contact our City Hospital, Health Center in local area, service phone numbers are listed in attachment 2, the services includes choosing contraceptive methods, care for the side effect as well as family plan health service. (3) For brochures or questions: Please contact the Health Centers and Taipei City Hospital by the addresses and service phone numbers listed in attachment 2. 55

56 中英文版新婚優生保健手冊 V. Infertility prevention 1. The cause of infertility The infertility rate is 10 to 15 percents, which means one to two couples out of ten are infertile. Any psychological, physiological or anatomical change on the male or female can cause infertile, and the causes for infertility are many, and they involve both husband and wife. Generally, the ratio of male and female infertility is almost the same, which is 40%, and unknown reason is 10%. (1) Male infertility factor (40%) 1. Reproductive organ hypoplasia. 2. Insufficient number of spermatozoa, less active, or abnormal number and activity. 3. Varicocele. 4. Patient with cryptorchidism, or who has suffered cryptorchidism and had late operation in childhood. 5. Person who has mumps with complication of orchitis. 6. Ejaculatory duct obstruction. 7. Alcoholic and chain smoker. 8. Medication, some anesthetic (opium and morphine) are the factors that affect endocrine and indirectly affect the number of the spermatozoa and activity. 9. Exhaustion and stress are the factors that cause poor sperm quality. (2) Female infertility factors (40%) 1. Abnormal ovulation and hormone unbalance: factors like long term stress, alcoholic, smoker, overweight, medication or central nerve tumor affect the ovulation function. After 35 years of age, the frequency of the ovulation reduces and the quality of the egg is lower. 2. Fallopian duct obstruction, and uterus malformation. 3. Endometriosis and pelvic inflammatory disease. 4. Abnormal cervix mucus secretion. 5. Immunity factor: Female vagina, cervix and uterus secrets the antibody that is antispermatozoa. 56

57 臺北市立聯合醫院婦幼院區 2. How to avoid infertility (1) Male 1. Avoid improper sexual relationship and cause sexually transmitted diseases. 2. Avoid toxic substance, such as lead, poisonous gas and pesticide, and do not abuse anesthetic or drink alcohol and smoke. 3. Avoid making scrotum exposed in high temperature. 4. Relief stress. (2) Female 1. Reduce the chance of getting pelvic inflammatory diseases: 1) Avoid premarital sexual relationship, because it may cause sexually transmitted disease. 2) Do not find an unlicensed doctor for abortion; it may cause complication. 2. Proper contraception: 1) Do not use intrauterine device before having childbirth. 2) Do not have abortion.. 3. Reduce the chance of poor ovulation: 1) Relief work and emotional stress. 2) Control your weight, and not have be overweight or underweight. 3) Married in older age, and having childbirth in older age. 4. Reduce the occurrence of endometriosis: 1) For women, it is better to be married and have children before 30 years of age. 2) Woman who is married late should not have long period of birth control. 5. Avoid toxic substances, such as lead, toxic gas and pesticide, do not abuse anesthetic or alcohol and smoke. 6. Reduce work and mental stress. 3. When do you need to visit a doctor Couple, who is married and has normal intimate relationship under no birth control, is unable to become fertile should consult the specialist to solve this issue. Most of the infertile patients are able to find the problem after the exam, and the specialist can design a set of treatment plan according to the patient ʼs actual circumstances. There are currently 17 Assisted Reproductive Technology agencies that are approved by the Department of Health Executive Yuan in Taipei (see attachment 3) for infertile women to seek treatment 57

58 中英文版新婚優生保健手冊 VI. Health knowledge the newlyweds should have and premarital health examination If the newlywed wants to achieve their family plan, they need to have a successful plan. We know that the newlyweds have strong procreative ability; therefore, if they do not use birth control, the chance of getting pregnant is about 80%. However, it may be a good idea for some couples not to have children after a while or even a lifetime, because they may have genetic illness, psychiatric illness, infectious disease, or other certain disease or currently have financial difficulty, or unstable life, therefore, the pregnancy may pass the illness to or infect the next generation, or it may be harmful to the life and health of the mother during the pregnancy, and sometime even may affect the family life and career. Therefore, we strongly suggest the couple that is going to get married or newlyweds to do a premarital or prenatal check up. The so called premarital check up is to have both man and woman to go to the hospital for consultation before they are married, and the physician will ask for their family history, history of individual cases, and the current health condition, and further do the eugenic check up if necessary. The genetic illness check up includes family medical history, cellular enzyme, thalassemia screening and chromosome check up. The infectious check up includes tuberculosis, syphilis, AIDS and hepatitis B. As for women, the exams include rubella, thalassemia. The psychiatric check up includes clinic psychiatric, brain wave, genetic psychiatric illness and psychological test; these tests are designed to discover whether the couple should have children. If there are serious genetic diseases, psychiatric illnesses or other particular disease found in the coupleʼs family, they should consider having a vasectomy or tuballigation. Some couple may first treat the disease, and then have family plan after the disease is cured, and after the test results confirm the health condition is suitable for having children, so that every child is born under the parentsʼ expectation, and to ensure the health of both mother and baby, and family. If the couple should not or does not want to have baby, they must use effective contraception, for instance, the female may take oral contraceptives after instruction from the physician, or the male may use condom, to avoid necessary pregnancy. If the femaleʼs menstrual cycle is two weeks late, she should pay a visit to the doctors in obstetric and Gyn to see if she is pregnant, and to confirm that it is normal pregnancy instead of ectopic pregnancy, or complication of other problems, such as ovarian cyst, myoma uteri, uterus malformation. If the female is pregnant and has not gone for a check up after the menstrual cycle is two weeks late, once the abnormal bleeding or abdominal pain occurs, it often will delay the treatment or not able to have correct diagnose. Therefore, the prenatal check up should begin at the time the menstrual cycle is two weeks late, and if everything is normal, the check up may set for once a month, and once every two weeks after seventh month, and once a week at the last month. 58

59 臺北市立聯合醫院婦幼院區 As for pregnant woman that is over 34 years of age or the pregnancy that may have child with birth defect should confirm the health condition of the fetus as soon as possible at the beginning of the pregnancy by obstetric diagnostic technology, there are several methods mentioned below that are being used currently: Amniocentesis, which is to use the amniotic fluid taken out of the body to do a chromosome analysis and bio-chemical substance analysis. Use ultrasound to make diagnose for fetus, such as anencephaly, dwarfism, Siamese twins or tumor in the fetus. Fetal endoscopic can observe the form of the fetus, and offer fetal blood sample as well as obtaining tissue sections to observe the pathological skin change. Analyze alpha-fetoprotein in maternal serum and human chorionic gonadotropin, which can detect the risk of getting Down Syndrome and whether the Spina Bidida. Chorionic villus tissue(which is ingredient of placenta)sample, which can be performed after ten weeks of pregnancy, takes chorionic villi sample for the diagnosis of all genetic diseases. Genetic exam to diagnose the genetic disease, such as thalassemia analysis. Induced abortion may be performed for a pregnant woman, subject to her own accord, if she has been diagnose or proven to meet any one of the following: 1. She or her spouse acquires genetic, infectious or psychiatric disease detrimental to eugenics. 2. Anyone with the fourth degree kin relative of herself or her spouse acquires a genetic disease detrimental to eugenics. 3. By medical consideration, pregnancy or delivery is considered in lethal risk to her or detrimental to her physical or mental health. 4. By medical consideration, the fetus is considered teratogenesis risky. 5. The pregnancy is the result of rape, statutory rape or unlawful sexual intercourse. 6. The pregnancy or deliver is likely to affect her mental health or family life. Induced abortion to an unmarried minor or an interdicted woman according to the proceeding provisions shall be subject to her legal guardianʼs consent. Induced abortion to an married woman according to paragraph 6 above shall be subject to her spouseʼs consent unless her spouse leaves his whereabouts unknown, become unconscious or deranged. We understand the danger of being pregnant (6-10 pregnant women died per one hundred thousand baby born), compare to the danger of having induced abortion (only one woman died from one hundred thousand legal abortion), it is much higher. Therefore, under the circumstances where the pregnancy is unwise, the 59

60 中英文版新婚優生保健手冊 couple should consult the physician in Obstetric and Gyn department according to the condition of the legal abortion, otherwise, there may be danger to the life and health of the mother, or having a deformed baby, and affects family life. Of course, legalizing the abortion is not to encourage women to have abortion, it is to prevent necessary pregnancy beforehand and implement effective contraception. Induced abortion is considered only when the pregnancy is unavoidable, and the baby should not be delivered. If everything is well, beside regular prenatal check up, the pregnant woman should be learning about nursing and pregnancy health. Consult the physician immediately if there is abnormal complication, such as vagina bleeding, odor in vaginal secretion, hypertension, headache, blurry vision, edema, abnormal abdominal pain, high fever, or premature rupture of membranes (Amnion rupture, amniotic fluid comes out before contraction begins). It is best to deliver the baby at the hospital where you have the prenatal check up, however, if there is complication during the pregnancy, or malpresentation, it is safer to deliver your baby at the hospital with better equipment. The newborns who were born in the public or private hospital and clinic today can have neonatal screening done, so that some diseases, such as congenital hypothyroidism, phenylketonuria, galactosemia, homocystinuria, glucose-6-phosphate dehydrogenase, can be detected and treated early to keep child from becoming disabled and even death. After delivery, the peurperant should be encouraged to breastfeed to improve the bond between mother and baby as well as increasing babyʼs resistance for disease, and she should start preparing contraception early. Sexual activity should not begin until lochia is cleaned and the uterus is recovered, which is about one month, otherwise it may cause infection or bleeding. However, after one month and before you begin your sexual activity, for your health sake, you should prepare for contraception, and you should go back to the hospital or health center for postnatal check up. Every parent should take the infantʼs health and parenting education seriously, so that the child may have good care and love education after birth, and every child may be active and smart with physical and mental health, and to become useful for the country. Furthermore, he/she may be the parentsʼ dream and improve citizenʼ s quality, such harmonious family, stable society and prosperous economy should speed up our countryʼs pace to be in the list of advance countries. 60

61 臺北市立聯合醫院婦幼院區 VII. Prenatal Health Once the couple is married and starts a family, raising children becomes a responsibility, even though it is every parentʼs dream to have healthy children, nevertheless, raising a physical and mental healthy child should start inside the motherʼs womb. Therefore, the care for pregnant womb during the pregnancy is important, because the development of the fetus is depending on the health of the mother. The special care peurperant should pay attention to before delivery is explained as follows: 1. Prenatal check up Mang thai laø vieäc troïng ñaïi cuûa gia ñình, ñeå ngöôøi phuï nöõ mang thai Pregnancy is a big thing in the family, for the health of the pregnant woman and the fetus, the prenatal check up is very important. Regular prenatal check up is to under the health condition of the pregnant woman and fetus, and to find the potential risk early, and to offer care and treatment. Currently, National Health Insurance offers pregnant women ten free prenatal check ups, and the followings are the pregnant womanʼs health manual and prenatal check up: (1) Pregnant womenʼs health manual distribution 1. Pregnant womenʼs health manual is printed by Bureau of Health Promotion, and distributed by hospitals. 2. If the person, who is using the pregnant womenʼs health manual, had a miscarriage or has delivered a baby, she can still keep the manual. 3. Pregnant women may go to any hospital or clinic that has the sign says prenatal check up with the mark of the national health insurance medical service on it. 4. The information of the insured party should be filed at the Bureau of Health Promotion, in the event that the insured party picked up the manual twice or more or having over limitation of the prenatal check up, the extra expenses should be paid by the insured party. (2) Number of the prenatal check up 1. The ideal prenatal check up is once every four weeks before twenty-eight weeks of pregnancy; once every two weeks between 29 to 35 weeks of pregnancy; once a week after 36 weeks of pregnancy. 2. National Health Insurance pays ten prenatal check ups, the schedule is set forth in three stage as follows: two check ups paid before the 17 weeks of pregnancy, two check-ups paid between the 17 to 29 weeks of pregnancy, six check-ups paid after 29 weeks of pregnancy. Accepting this service, the party should not pay co-pay (see attachment 4). The payment 61

62 中英文版新婚優生保健手冊 schedule is flexible, try to avoid over the limit in the same stage. In the event that the pregnant woman requested national health insurance and not paying for over limit prenatal check up, she should be charged with self-pay; if the need arises, and the over limit prenatal check-up is necessary, she may use her health insurance card according to regular hospital procedure, and pay for the co-pay. (3) Prenatal check ups 1. The routine check up includes : Problem: Discomfort such as bleeding, abdominal pain, headache and seizure. Physical check up: Weight, blood pressure, fundal height, fetal sound, edema and varicose vein. Lab exam: urine glucose, proteinuria. 2. Six to eight weeks of pregnancy, the initial check up should include : Interview: Personal and family medical history, history of pregnancy and discomfort during this pregnancy. Physical check up: Weight, height, blood pressure, thyroid gland, breasts, pelvic exam, chest and abdominal area. Lab exam: Blood and urine routine, blood type, Ph factor, VDRL, AIDS and thalassemia screening. 3. Twenty to twenty-two weeks of pregnancy : Besides routine check up, it also offers one ultra sound check up to detect the if the fetus is deformed or has abnormal growth. 4. Thirty weeks of pregnancy : Beside routine check up, it offers lab exam, which includes Hepatitis B antigen, VDRL and rubella igg. (4) Pregnant womanʼs thalassemia screening Thalassemia is a common recessive genetic disease, there are about 6% of people in Taiwan area has this type of disease gene (carrier), and the carrier is usually health physically. Thalassemia can be divided into type A and type B, if the husband and wife both are same type of thalassmia carriers, then the fetus from every pregnancy has 25% chance to become a thalassemia major. Fetus who suffers from type A thalassemia major will die in the womb or suffer death after birth, and fetus who suffers from type B thalssemia major would have anemia from third to the sixth month after birth, and it needs life long transfusion or iron chilating agent to maintain life, which affects patientʼs life as well as burdening the family and society heavily. The prevention is better than treatment, only by pregnant woman taking the thalassemia screening to prevent the birth of the thalassemia major fetus effectively. The methods of thalassemia are as follows: 1. Regular pregnant woman can just ask the doctor to watch for the average MCV during regular check up, if the average MCV is low (lower or equal 62

63 臺北市立聯合醫院婦幼院區 to 80), then she may be type A or type B thalassemia carrier. 2. If the pregnant womanʼs MCV is lower or equal to 80, then her spouse must take average MCV exam, if the spouseʼs average MCV is higher or equal to 80, then they do not have to worry about having a thalassemi major; however, if the average spouseʼs average MCV is lower or equal to 80%, then the husband and wife must have 10cc of blood sample taken at the same time, and the screening unit will take your blood sample to the correct diagnostic unit to confirm whether the husband and wife are same type thalassemia carrier. If the husband and wife are the same type carrier, then Chorionic villus sampling and amniocentesis should be performed to diagnose the fetusʼs gene. 3. Every pregnancy has 25% of chance to have thalassemia major fetus when the husband and wife are diagnosed with same type thalassemia, therefore, the prenatal genetic diagnose should be performed during every pregnancy. National Health Insurance has included pregnant womanʼs average MCV exam into regular prenatal care; therefore, the pregnant woman should not pay extra expenses, and the government will subsidize for part of the spouseʼ s average MCV exam, husband and wifeʼs genetic diagnosis and the fetusʼs genetic diagnosis. For detailed information, please contact Taipei City Hospital or local Health Centers (Their phone numbers and addresses are listed in attachment 2). (5) Prenatal genetic diagnosis According to the report from medical journal, the older pregnant woman has higher risk of having fetus that has chromosome anomaly than the younger pregnant woman. For instance, the most common seen chromosome anomaly/ Down syndrome, one out of sixteen hundred 20 years old/ 24 years old pregnant women would have Down syndrome baby, but one out of two hundred and sixty 35/39 years old pregnant women would have Down syndrome baby, and one out of one hundred 40 years old pregnant women would have Down syndrome baby; therefore, beside regular prenatal check, pregnant woman who is over 34 years of age should take amniocentesis to confirm the fetusʼs health early. Beside older pregnant women, the pregnant women who have the following condition belongs to high risk group that may have chromosome anomaly as well, therefore they should take amniocentesis, these pregnant women include: 1. She or her spouse has genetic disease; 2. Person who has had baby with congenital defect; 3. Person who has family member with genetic disease; 4. The risk of chromosome anomaly from pregnant womanʼs serum screening is higher than 1/ This fetus may have abnormality through ultrasound screening. The pregnant women mentioned above may consult physician in outpatient service about the purpose, method and safety of prenatal genetic diagnose, and they can schedule the appointment with the doctors. Currently, the gov- 63

64 中英文版新婚優生保健手冊 ernment subsides partial examination expenses, please see attachment 5 for location and subsidy information, or contact our City Hospital or local Health Center (phones and addresses see attachment 2). (6) Maternal Serum Screening for Down Syndrome baby: Chromosome is the basic unit of human genetics; there are 46 chromosomes in the cell of normal person, besides two chromosomes that decide the gender (XX or XY) are called sex chromosomes, and 22 pairs of chromosomes are formed from the rest of 44. The so-called Down syndrome has one extra chromosome in the 2lst pair, which means there are three chromosomes in 21st pair instead of two. Down syndrome is the most common chromosome anomaly, the ration is one out of 1000 (1/1000). There are three hundred to four hundred Down syndrome babies in Taiwan each year, therefore, it is about one a day. The statistic shows that 20% of the Down Syndrome babies are born to pregnant women who are older than 34 years of age, and the most of them (80%) are born to pregnant women who are younger than 34 years of age. Down syndrome baby mainly is mentally retarded, and they may have many complications physically (such as congenital heart disease). And these patients need to be cared for by their family for life, which causes tremendous mental and financial burden. 1. Who would have Down syndrome baby? Every pregnant woman may have chance of having Down syndrome baby. The chance of having Down syndrome baby increases along with the age of the pregnant woman. 20 year-old pregnant woman has 1/1528 of chance to have Down syndrome baby, and 30 year-old pregnant women has 1/909 of chance, and 34 year-old pregnant womanʼs chance increases to 1/270. Even though the older pregnant woman has higher risk of having Down syndrome baby, however, 80% of Down syndrome babies are born to younger pregnant woman who is younger than 34 years old. Therefore, every pregnant woman has chance of having Down syndrome baby! 2. How to screen for pregnant woman who may be pregnant with Down Syndrome Baby? (1) Pregnant woman who is 34 years old and older Amniocentesis should be performed at the fifteen/twenty-two weeks of pregnancy (it is better to be performed at 16/18 weeks), besides checking for Down syndrome, it can also check for other chromosome anomaly. (2) Pregnant woman who is younger than 34 years old Maternal serum sample taken of type I AFP and HCG Principle of maternal serum screening for down syndrome According to study, type I AFP in the blood of the pregnant woman who is pregnant with Down syndrome baby is generally lower, and the HCG in her blood is generally higher. Therefore, the type I AFP and HCG may be tested in the motherʼs blood in the fifteen/twenty weeks of pregnancy, and the chance of the mother who may have down syndrome baby is calculated

65 臺北市立聯合醫院婦幼院區 from the computer, and the chance for pregnant woman who is 34 years old and older is 1/270. A. The chance for pregnant woman who is twenty years old to have Down syndrome baby 1/1528 If type I AFP is lower and HCG is higher in the screening, and the chance for having Down syndrome baby after calculation is 1/150, then this young pregnant should consider amniocentesis to avoid having Down syndrome baby. B. The chance for pregnant woman who is 32 years old t o have Down Syndrome baby 1/546 If type I AFP is not lower and HCG is not higher in the screening, and the chance for having Down syndrome baby after calculation is1/1556, then the chance for this pregnant woman to have Down syndrome baby is quite low. 4. Can maternal serum screening find all Down syndrome babies This is a non-invasive screening, which may detect 50%/60% of Down syndrome babies. 5. The best time for screening Time for screening: Between the 15 th to 20 th week of pregnancy. The best time for screening: It is best to have the screening between the 16 th to 18 th week of pregnancy. 6. Where to get the screening? The maternal serum for Down syndrome screening can be performed at the 15th/20th weeks of pregnancy when you go for prenatal check up, you may go to City Hospital or Medical centers. Any woman, who is 15~20 weeks pregnant, established residency in Taipei City may be eligible for the governmental subsidy at Taipei City Hospital: Women and children, Yangming, Chongxiing, Hoping, Jen-Ai and Chongxiao. (See attachment 5). 7. How do you find the result of the screening? Two weeks after the blood sample of the pregnant woman is taken, and when she go back to the outpatient service for routine check up, and the physician in outpatient service would notify the result; if the result of the sample shows that she belongs to high risk group of whom may have Down syndrome baby, the hospital would notify the pregnant woman (husband and wife) to come to the hospital for further check up and consultation. 2. Health during pregnancy The fetus relies on the mother when it is in the motherʼs womb, therefore, during the pregnancy, the mother should pay special attention on her daily life and diet, because if the mother is healthy, the fetus can be healthy, too. (1) Diet : The diet during the pregnancy should base on the food that is easy to digest, therefore, the diet should be three balanced meals with the food that is full of protein, mineral and vitamin, such as milk, meat, beans and all vegetables and fruit, and should avoid spicy food, cigarette and wine, 65

66 中英文版新婚優生保健手冊 and should reduce the amount of sugar and grease. Some pregnant women experience nausea and vomiting, and these symptoms may be reduced by eating some snacks, such as crackers, bread, before getting out of bed, then bed rest for thirty minutes, at the same time, reduce the amount of the food, and increase the number of meals. (2) Dress: Maternity should be comfortable and warm, and the material should have good absorption; it should be comfortable and practical, and clean it often. The pregnant women should not wear high heel shoes, waist binder and suspender stockings. The pregnant women should wear proper bras during the pregnancy to support the breasts. (3) Avoid exhaustion and insufficient rest: Do not work to be exhausted during the pregnancy, and the pregnant woman should avoid exhaustion or insufficient rest. The regular light work or house work should not be stopped during the pregnancy, however, exhaustion should be avoided. However, the work that requires climbing, lifting or carrying heavy object, squatting, bending to wash clothes for a long time, jumping from high level or running speedily. (4) Relax and be happy: Pregnancy is not an illness, and it is a normal physiological state. Therefore, you should be happy and relaxed, try not to think to much, avoid excitement, depression and sorrow, and should avoid entertainments, such as unnatural drama, books, publications, music and story; and it is best that husband can offer comfort and be thoughtful to help the development of the fetus and the health of the pregnant woman. (5) Shower : During the pregnancy, the metabolism of all organs is more productive, therefore, the secretion is more than usual, and daily shower is necessary. On one hand, it can keep the body clean; on the other hand, it can improve the blood circulation. However, regardless of washing the body or washing the feet, it is best not to bend the body too much, and it is best to shower, the private area should be kept clean and the water should not be too hot. (6) Oral health: During the pregnancy, because of the saliva is acidic and sticky, the pregnant womanʼs eating habits and number of diet has increase, food, exhaustion, idleness that causes overlooking the cleaning of the month, physiological change, swelling gums, bleeding and easily to have oral disease, therefore, you should pay special attention to oral health. 66 (7) Constipation and diarrhea prevention: Constipation occurs easier during the pregnancy, therefore, it can be prevented by eating more vegetables, fruit, drink more water and avoid food that causes constipation. Diarrhea is caused by the careless diet, if the condition is serious, it may stimulate the contraction and cause miscarriage, especially during the beginning of the pregnancy. Therefore, you should

67 臺北市立聯合醫院婦幼院區 consult the physician in Obstetric and Gyn. when serious diarrhea occurs. (8) Intimate relationship: Abstinence because of pregnancy is unnecessary; because it is easy to have miscarriage during the beginning of the pregnancy, therefore, the sexual activity should be carefully restricted. Only the women who have habitual miscarriage or symptoms of premature birth need to be ascetic. The safest period in the pregnancy is from the 5th month to 8th month, and it should be careful and gentle as usual; at the end of the pregnancy, it should be reduced, especially on the due date, the uterus becomes very sensitive, at this time if you are not ascetic, it may sometimes cause premature ruptur. (9) Exercise: It is best to exercise outdoors, that way you may enjoy fresh air and sunshine, at the same time, this exercise can refresh your mind and clear your head, improve the sleep and appetite; the best exercise during the pregnancy is walking in the refresh air, it can stimulate the muscles, therefore, pregnant woman should do this exercise during the entire pregnancy. During the pregnancy, pregnant woman should keep correct posture and proper exercise. Because the development of the fetus, the motherʼs womb grows month after month during the pregnancy, and cause the burden on the muscle of the abdominal wall, and physical unbalance, therefore, it would create exhaustion and sore back. You may do the prenatal exercise under the instruction of the medical staffs to reduce the pain caused during the contraction. (10) Estimated Date of Confinement: It takes about 280 days from conception to delivery, and it is estimated from the first day of the last menstrual period, and add nine months on top of that month, or minus three months and add seven days. If the last menstrual cycle is May 3rd, then the estimated date of confinement should be February 10th the following year, however, this date is for references only, it is not definitely correct. Two weeks early or later than the estimated date of confinement is normal. (11) Signs of danger during pregnancy: Please see the doctor immediately in the following signs occur : 1. Vagina bleeding, regardless of the amount. 2. Swelling on the face and finger and calf. 3. Severe and constant headache. 4. Blurry vision. 5. Constant or severe abdominal pains. 6. Vomiting constantly or severely. 7. Sudden fever and chill. 8. Sudden secretion from vagina. 9. Amount of urine is obviously reduced or burning feeling during urination. 10.Weight increase too much too fast. 11. Fetal movement reduced or disappeared. 67

68 中英文版新婚優生保健手冊 VIII. Postnatal Health 1. Best time to leave the bed The pregnant woman can get out of bed to eat and to pass urine six hours after normal delivery, however, it is still best to rest, if everything went well, she may be discharged after three days. 2. Cleaning the private area You should use maxi pad to absorb lochia after delivery, and change it often; and use warm water or sterile water to clean it from front to back after passing stool. 3. Shower daily It is best to use shower instead of bath before the month of confinement is up to prevent the bacteria from invading the womb and cause infection. Blow-dries the hair quickly after was. 4. Diet You should eat all type of food. Because you may feel thirst more often, so eat the food that is easy to digest such as water, milk and hot rice soup. 5. Sexual life Sexual life should not start until the lochia is cleaned and uterus is recovered, which is about one month after delivery, otherwise, it may cause infection or bleeding easily. 6. Postnatal Check up Postnatal check up should be done six weeks after the delivery; you may have the reproductive organ checked to see if it is recovered by taking your health insurance card and follow the regular procedure. 7. Postnatal exercise Choosing proper exercise may increase abdominal muscle contraction, improve contraction and keep good figure after delivery. 8. Oral contraceptive method Sau khi ñaày thaùng baát luaän laø coù hay khoâng coù cho con buù, tröôùc khi Regardless of breastfeeding or not, you may get pregnant after month of confinement and before the menstrual cycle, therefore, you can not start using contraceptive after the menstrual cycle starts, and it should be taken twenty-eight days after delivery. 68

69 臺北市立聯合醫院婦幼院區 IX. Breastfeeding 1. Advantage of breastfeeding (1). Breast milk is the most nutritious and best milk to meet babyʼs need, because the breast milk contains lactose and fatty acid, which are the basic ingredients for babyʼs brain to develop. (2) It is safest, most sanitary and most economical to breast feed. (3) Breastfeeding can increase the babyʼs resistance for disease; colostrums contain rich nutrients and antibody, which can improve the babyʼs resistant ability for disease and it can help remove meconium. (4) Breastfeeding can satisfy the babyʼs sucking instinct, and can help develop healthy and balance mind and improve the bond between mother and baby. (5) Breastfeeding can help the contraction after birth and improve the recovery of the peurperantʼs body. 2. Ways to improve milk secretion (1) Breastfeed as early as possible after delivery. (2) Avoid use milk to substitute for breast milk. (3) Breastfeed flexibly according to babyʼs need. (4) When the baby is not around, use hand or breast pump to express the milk and store it for baby to eat later. (5) Correct sucking and feeding position. (6) Massage milk duct before feeding. (7) Drink more milk, soup or eat milk stimulating food, such as pig feet. (8) Sufficient rest each day and happy mood. 3. Engorgement prevention and care (1) The newborn can start sucking breast milk right after birth; feed the baby often, do not add milk, and do not let the newborn use pacifier. (2) Express some milk by massaging the milk duct to soften the breasts before let baby suck, if it is hard, place hot towel on it before letting baby suck. (3) Let baby change the sucking position sometimes. (4) Use proper bras to support. 69

70 中英文版新婚優生保健手冊 Attachment 1. Choosing contraceptive methods. Methods Intrauterine contraception Multiload Oral contraception Condom Diagram Contraceptive effect About 95% About 98~99% About 90% Functions It is a very small plastic product or plastic product with copper wrap around it to be placed inside the uterus, so that fertilized egg would not able to land in the uterus. Keep ovaries from ovulating. Thin plastic cover to be placed on the penis to avoid ejecting semen inside the femaleʼs body. Advantages 1.Safe and convenient. 2.Hhighly effective. 3.You are still fertile after taking it off. 4.Economical. 5.If there is no discomfort after it is installed, you donʼt need to change it. 6.No procedure is taken before sexual activity. 7.IT would not interfere with breastfeeding. 1.Safe. 2.The effect is almost 100 percent. 3.It is good for newly weds and people without birth giving experience. 4.No procedure is taken before sexual activity, so that it would not affect sexual activity. 5.Economical and easy to use. 6.It regulates the menstrual cycle, pain and reduces the amount of blood. 7.It can prevent benign breast disease or ovarian cyst. 1.You are still fertile when stop using it. 2.Easy to buy. 3.No side effects. 4.No doctor consultation needed. 5.Easy to use and c o n v e n i e n t t o carry. 70

71 臺北市立聯合醫院婦幼院區 Attention 1.It should be installed by the physician. 2.It can be removed out of body out of every hundred women gets pregnant a year. 4.Return for follow up one month and every other year after it is installed, then once every year. 5.Women who are allergic to copper should not use contraceptive method that contains copper. 1.The first time user should consult a doctor before taking the pill. 2.It must be taken every night, you cannot stop occasionally. 3.It is not suitable for people with liver and gall disease, heart disease, hypertension, blood disease, obesity, thromboembolisms, breast cancer or cancer found in reproductive organs, are heavy smoker, are breastfeeding, are pregnant. 1.Put it on before the activity. 2.Dispose it after use, do not reuse. 3.Make sure it is put on correctly during the intercourse. Pull the penis out of vagina along with the condom in case the semen leaks out of condom. 4.About ten people out of one hundred couples use this method get pregnant Side effect Few people have the following symptoms: lowing symptoms: Few people have the fol- 1.Slight stomach pain. 1.Nausea, vomiting or upset stomach. 2.Bleeding outside the menstrual cycle. 2.Headache and dizziness. 3.The amount of menstrual blood increases 3.Amount of menstrual blood is reduced or and length increases stopped. as well. 4.Spotty. 4.Increase in mucus. 5.Sore back. 5.Engorgement. 6.Slight weight increase. 7.Slight blood pressure increase. None Note The above-mentioned s y m p t o m s u s u a l l y appear during the beg i n n i n g, T a k e p a i n reliever when you are experiencing pain, if the symptom persists, you should consult a doctor. The above-mentioned side It can be used not only effect is usually mild, and it for contraceptive, but would be adjusted slowly. If also can prevent sexually transmitted dis- it is very serious or persists after one or two months, ease. you should consult a doctor. You can pick it up at You can pick it up at city city hospitals and community health center, hospitals and community health center and the dealers. and dealers. 71

72 中英文版新婚優生保健手冊 Methods Vasectomy (Male) Tuballigation (Female) Diagram Ureter Spermatophore Bladder Vas deferens Ejaculatory duct Prostate gland Penis Urethre Balanus Prepuce Backbone Rectum Location of ligation Bulbourethral gland Anus Epididymis Testis Scrotum Fallopian tube Location of ligation Ovary Ovary Uterus Vagina Contraceptive effect About 99.0~99.9% About 99.0~99.9% Functions Cut and tie the maleʼs vas deferens, so that semen produced does not contain sperm. Tie the femaleʼs tubes and cut them or just tie them, so that the egg would not be fertilized with sperm Advantages Attention 1.One-step. 2.The procedure is simple, no hospital stay needed. 3.The effect is almost 100 percent. 4.It does not affect the maleʼs biological state and energy. 5. No longer concern with pregnancy; like tuballigation, it does not interfere with sexual life. 1. Only people do not desire to be have any more children should use this method 2.It would take effect after 15 ejections after the surgery, and make sure there is no sperm inside the semen. 3. Few tuballigations would open itself, so if your wifeʼs menstrual cycle is ten days late, please consult your doctor. 1.One-step. 2.The effect is almost 100 percent. 3.It does not affect the femaleʼs biological state. 4.No longer concern with pregnancy; it does not interfere with sexual life 1.Only people do not desire to be pregnant again should use this method. 2.It is a surgery, you must stay in the hospital for 1 2 day or one day. 3.It is best to do it after delivery in the hospital for convenience. 4.Few tuballigations would open itself, so if the menstrual cycle is ten days late, please consult your doctor. Side effect Ghi Chuù If the person receives vasectomy is mature, there would not be side effects. There is financial option for tuballigation. Please see You can pick it up at city hospitals and community health center for detail. If the person receives tubaligation is mature, there would not be side effects There is financial option for tuballigation. Please see You can pick it up at city hospitals and community health center for detail. 72

73 臺北市立聯合醫院婦幼院區 Attachment 2 The addresses and phone numbers for Taipei City Hospital and Health Centers Unit Address Telephone Taipei City Hospital Jen-Ai Branch No. 10, Sec. 4, Jen-Ai Rd Taipei City Hospital Zhongxing Branch No. 145, Chengchou Rd Taipei City Hospital Hoping Branch No. 33, Sec. 2, Chonghua Rd Taipei City Hospital Women and children Branch Taipei City Hospital Yangming Branch Taipei City Hospital Zhongxiao Branch Taipei Municipal WanFang Hospital Taipei City Hospital Gan-dau Branch Taipei City Hospital Chinese Medicine Branch No. 12, Fuchou St ~9 No. 105, Yushang St No. 87, Tongde Rd No. 111, Sec. 3, Singlung Rd No. 12, Lane 225, Chixing Rd No. 110, Kuenming St Songshan District Health Center Xinyi District Health Center Daan District Health Center Zhongshan District Health Center Chongcheng District Health Center No. 694, Sec. 4, Bade Rd. No. 15, Sec. 5 Sinyi Rd No. 15, Sec. 3, Sinhai Rd. 7-1 F, No. 367, Songjiang Rd. No 24, Guling St ~ Datong District Health Center No. 52, Changji St Wanhua District Health Center Wenshan District Health Center Neihu District Health Center Nangang District Health Center Shilin District Health Center No. 152, Tongyuan St. No. 220, Sec. 3, Muzha Rd. No. 99, Sec. 6, Minquan E. Rd. No. 360, Sec. 1, Nangang Rd. No. 439, Chongcheng Rd ~ ~ ~ Pei Tou District Health Center No. 14, Chengyuan Rd ~7 73

74 中英文版新婚優生保健手冊 Attachment 3 Taipei Assisted Reproductive Technology Agency approved by Department of Health, Executive Yuan Hospital Telephone Address Contact Tri-Service General Hospital No. 325, Sec. 2, Chenggung Rd Yi-jing Chen, Hisnshiuan Jian Chung Shan Hospital #251 No. 11, Lane 112, Sec. 4, Jen-ai Rd. Bao-chu Chen, Huipo Li National Taiwan University Hospital #5159 No. 7, Chongshan S. Rd You-shih Ynag Taipei Chang Gung Hospital #3347 No. 199, Tunhua N. Rd Pei-hsiang Li Taipei Veterans General Hospital #201 No. 201, Sec. 2, Shihpai Rd Sheng-ping Chang Taipei Medical University Hospital #1906 #1907 Tai-an Hospital #2582 No. 250, Wusing Rd No. 424, Sec. 2, Bade Rd Chi-jui Tseng Hsiao-jui Wei Mackay Memorial Hospital #3081 N o. 9 2, S e c. 2, Chongshan N. Rd Kuo-kuang Li Cathay General Hospital #3557 No. 280, Sec. 4, Jenai Rd Shu-chi Chen Chung De-Sheng Obstetric Gyn. Clinic F, No , Sec. 2, Chongshan N. Rd Ying-ming Lai Shin Kong Wu Ho-su Memorial Hospital #3879 No. 95, Wenchang Rd, Shihlin Chien-jung Huang Pan Shi-bing Obstetric Gyn. Clinic F, No. 30, Sec. 1, Monsheng E. Rd Ping-chang Chen Liu Chi-hong obstetric Gyn. Clinic F, No. 25, Sec. 4, Jen-ai Rd Chi-hong Liu Taipei City Hospital Hoping Branch #2619 N o. 3 3, S e c. 2, Chonghua Rd. Li-hui Wu Kang-ning General Hospital #6608 No. 26, Lane 420, Sec. 5, Chenggung Rd Chang-sheng Yi Pao-chu Chiu WanFang Hospital #2501 No Sec. 3, Sinnlung Rd Wen Teng Shi Ya-hui 74 Taipei City Hospital Women and Children Branch No. 12, Fuchou St. Yung-sheng Chang

75 臺北市立聯合醫院婦幼院區 Attachment 4 The payment schedule, number of times and items for prenatal check up Length of pregnancy N u m b e r of check ups Check ups The first phase of pregnancy (not yet 17 weeks) Twice 1. The first check up or the check up at the sixth week of the pregnancy must include the following service: (1) Interview: Family medical history, medical history, history of pregnancy and discomforts. (2) Physical check up: weight, height, blood pressure, thyroid, breasts, pelvic exam, chest and abdominal. (3) Lab exam: Regular blood exam (WBC RBC Plt Hct Hb MCV), blood type, Rh factor, VDRL, AIDS and urine analysis. 2. Routine prenatal check-up. Second phase of pregnancy (from 17 weeks to 29 weeks) Twice 1. Routine prenatal check-up. 2. One ultrasound after 20 weeks of pregnancy. Third phase of pregnancy (over 29 weeks) Six times 1. Routine prenatal check-up. 2.Lab exams such VDRL, HbsAg, HbeAg, and Rubella IgG around the 30 weeks of pregnancy. Note: 1. Routine check up includes: (1) Interview: Discomforts such as bleeding, abdominal pain, headache and seizure. (2) Physical check up: Weight, blood pressure, fundal height, fetal sounds, presentation, edema and varicose vein. (3) Lab examination: Urine protein and urine glucose. 2. Pregnant woman whose Rubella IgG exam shows negative should have rubella vaccine after delivery. 75

76 中英文版新婚優生保健手冊 Attachment 5 Health service subsidy and health center Service Who Subsidy Service Center Eugenic health check up Newborns whose results of first newborn screening showing positive and their family $250 each case Referral hospital for newborn screening like National Taiwan University Hospital, Veteranʼs general hospital. People or relatives who are suspected to have genetic disease and needs to have further examination. People with result of abnormal fetus after amniotic fluid examination. The maximum subsidy is $1,500, and if the examination fee is lower than our subsidy guideline, it should be reimbursed according to the actual expense. Appointed hospitals such as National Taiwan University Hospital and Veteranʼs General Hospital, or hospitals such as Taipei City Hospital women and childrenʼs branch, Chang Gung, Tai-an that is clinical cytogenetics examination approved by Department of Health. Premarital health check up Males and females, who are residents of Taipei City, are going to be married or newlywed but not yet been pregnant, who has low income, is an aborigines or mentally retarded and has been approved by the hospitals. $1,000, the rest should be paid for by the individuals. National Taiwan University Hospital, Veteranʼs General Hospital, McKay, Chang Gung, Cathay, Taipei Medical University Hospital, Taipei City Hospital Women and Children Branch, Jen-Ai Branch, Hoping Branch, Chongxing Branch, Yangming Branch, Chongxiao Branch, WanFang, Songshan Armed Force Hospital, Tai-An, Shin Kong, Taipei Regional Hospital, Country Hospital and Pojen General Hospital. 76

77 臺北市立聯合醫院婦幼院區 Prenatal genetic diagnosis 1.Amniocentesis amniotic analysis 2. Chorionic villus sampling or fatal blood sampling 1.Pregnant woman who is 34 years of age or older. 2. One of the following circumstance after diagnosis or proof (1) Patient or spouse suffers from genetic disease. (2) Patient who has child with congenital disorder (3) Patient who has genetic disease in the family. (4) The risk of pregnant womanʼs chromosome anomaly is higher than 1/270 after the serum screening. (5) This fetus may have disorder after ultra sound screening, and qualify for condition 1 and 2, and the hospital that perform amniocentesis sends the sample to the exam unit that is clinical cytogenetics examination approved by Department of Health. Pregnant woman and her spouse both are same type thalassemia carrier. $2,000 subsidy for lab cost, the rest should be paid by the patients. $5, 500 subsidy for low-income patient, the rest should be paid by the patient. National Taiwan University Hospital, Veteran General hospital, Chang gung, McKay, Tri-service general, Taipei Medical University Hospital, Tai-an, Cathay, Taipei City hospital Jen-Ai Branch, Women and children Branch, Hoping Branch, Chongxing, Yangming, Chongxiao, Wanfang, National Taipei College of Nursing Hospital, Pojen, 國技醫院內湖分院, Country General, Songshan Armed Force Hospital, Shin Kong, Cheiho, Lee Obstetric and Gyn and Ke, Tsang-ming Obstetric and Gyn. Clinic. Hospitals such as National Taiwan University Hospital, Veteran General Hospital and Ke, tsang-ming Obstetric and Gyn. Clinic that have been approved by Department of Health for thalassemia examination. Neonatal Inherited Metabolic Disorders Screening Newborn that has been fed after birth and is over 24 hours to one month old. $100 subsidy for lab cost, the rest should be paid by the patient. Military, public, city and private hospitals that have sign read neonatal inherited metabolic disorder screening facility that is issued by Department of Health Executive Yuan. Maternal Serum Down Syndrome Screening Woman who is weeks pregnant and is a resident in Taipei City. $ p e r case Taipei City Hospital Women and children branch, Jen-Ai, Ho- Branch. 77

78 中英文版新婚優生保健手冊 Attachment 6 Taipei City Service Centers for Premarital Check Up Name of facility Department registration Telephone Self-pay Note Pojen General Hospital Obstetric and Gyn. Department Outpatient Center W1-W6 AM Male approximately:$3000 Female approximately:$3000 Registration fee not included First time $100 Follow up $70 Songshan Armed Force Hospital Physical division, aviation medicine department W1-W5 All day ~4 Male approximately:$1600 Female approximately:$1900 Registration included Tai-An Hospital Family medicine W1-W4 All day W5 and Sunday Morning Male approximately:$2300 Female approximately:$2300 Registration included Cheng Gung Hospital Family medicine W1-W5 and W6 AM (including evening) Male approximately:$2300 Female approximately:$2300 No fasting needed Female should avoid come here during menstrual period Taipei Medical University Hospital Family Medicine W1-W5 (including evening) and W6 AM ~3 Male approximately:$1900 Female approximately:$1900 Registration fee $285 Taipei City Hospital Jen-Ai Family Medicine W1-W5 and W6 AM Male approximately:$2200 Female approximately:$2301 Registration included 及 G6PD Lab fee $150 and sperm analysis Cathay Medical Center Family Medicine Appointment system ~1 Male approximately:$3000 Female approximately:$4000 Registration included and female ultrasound (call for detail) Country Hospital Physical exam department W1-W Male approximately:$2300 Female approximately:$2300 Registration included, Fasting needed McKay Hospital 16F Health Center W1-W Male approximately:$2120 Female approximately:$2470 Registration included National Taiwan University Hospital Family Medicine W1-W All day (including evening) Male approximately:$2000 Female approximately:$2000 Registration included, Fasting needed 78

79 臺北市立聯合醫院婦幼院區 Taipei City Hospital Hoping Family Medicine W1-W6 All day W1W3W5 Evening hour Male approximately:$1288 Female approximately:$1458 Registration included and sperm analysis Taipei City Hospital Women and Children Branch Family Medicine W1-W6 AM (mainly W6) (AM) Male approximately:$ Female approximately:$ Registration included and chicken pox antibody screening Taipei City Hospital Chongxing Family MedicineW1-W Male approximately:$2013 Female approximately:$2183 Registration included and sperm analysis WanFang Hospital Health center W1W3W5W6 AM ~2 Male and female total $9999 Registration included, no sperm analysis for male and fasting needed Taipei City Hospital Chongxiao Customer Service 1F W1-W6 All day Male approximately:$1295 Female approximately:$1295 Registration included 及 G6PD Taipei City Hospital Yangming Ohysical exam department W1-W5 and W6 AM Male approximately:$1640 Female approximately:$1880 Registration included 及 G6PD GOT GPT Sperm analysis extra Shin Kong Hospital Family Medicine No. 75 W1-W6 AM Male approximately:$2320 Female approximately:$2621 Registration included Rubella is $350 extra Veteranʼs General Hospital Taipei Health care and physical exam department W1-W6 AM Male approximately:$1900 Female approximately:$2100 Registration included X-RAY and infectious disease screening The services and charges mentioned above are subject to change, and it should be based on the actual operation in the hospital, this list is for reference only. 79