text:
Caesarean section
|Caesarean section
A team of obstetricians performing a Caesarean section in a modern hospital.
A Caesarean section (often C-section, also other spellings) is a surgical procedure in which one or more incisions are made through a mother's abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies, or, rarely, to remove a dead fetus. A late-term abortion using Caesarean section procedures is termed a hysterotomy abortion and is very rarely performed. The first modern Caesarean section was performed by German gynecologist Ferdinand Adolf Kehrer in 1881.
A Caesarean section is often performed when a vaginal delivery would put the baby's or mother's life or health at risk. Some are also performed upon request.[1][2][3]
C-sections result in a small overall increase in bad outcomes in low risk pregnancies (8.6% of vaginal deliveries and 9.2% of C-sections).[4] The bad outcomes that occur with C-section differ from those that occur with vaginal delivery. Professional societies have established guidelines for non-medically indicated cesarean before 39 weeks.[5]
The rate has risen to 46% in China and to levels of 25% and above in many Asian, European and Latin American countries.[6] The rate has increased in the United States, to 33% of all births in 2012, up from 21% in 1996.[4] Across Europe, there are differences between countries: in Italy the Caesarean section rate is 40%, while in the Nordic countries it is 14%.[7]
- 1 Uses
- 2 Risks
- 3 Types
- 4 Prevention of complications
- 5 Prevention
- 6 Prevalence
- 7 History
- 8 Vaginal birth after Caesarean
- 9 Within Judaism
- 10 References
Caesarean section is recommended when vaginal delivery might pose a risk to the mother or baby. C-sections are also carried out for personal preference but this is not recommended. Planned caesarean sections also known as elective caesarean sections should not be scheduled before 39 weeks gestational age unless there is a medical reason to do so.[8]
A planned or elective caesarean section is an elective surgery, meaning that it is scheduled in advance rather than performed because of an unscheduled emergency. Elective caesarean sections may be performed on the basis of an obstetrical or medical indication, or because of a non-indicated maternal request.[9] Among women in the United Kingdom, Sweden and Australian about 7% preferred C-section as a method of delivery.[9] In cases without medical indications the American College of Obstetricians and Gynecologists recommend a planned vaginal delivery.[10] The National Institute for Health and Care Excellence recommends that if after a women has been provided information on the risk of a planned C-section and she still insists on the procedure it should be provided.[9] If provided this should be done 39 weeks of gestation or later.[10]
Medical indications[edit]
Some medical indications are below. Not all of the listed conditions represent a mandatory indication, and in many cases the obstetrician must use discretion to decide whether a Caesarean is necessary.
Complications of labor and factors impeding vaginal delivery, such as:
- abnormal presentation (breech or transverse positions)
- prolonged labour or a failure to progress (dystocia)
- fetal distress
- cord prolapse
- uterine rupture or an elevated risk thereof
- increased blood pressure (hypertension) in the mother or baby after amniotic rupture
- increased heart rate (tachycardia) in the mother or baby after amniotic rupture
- placental problems (placenta praevia, placental abruption or placenta accreta)
- failed labour induction
- failed instrumental delivery (by forceps or ventouse (Sometimes a trial of forceps/ventouse delivery is attempted, and if unsuccessful, it will be switched to a Caesarean section.)
- large baby weighing >4000g (macrosomia)
- umbilical cord abnormalities (vasa previa, multilobate including bilobate and succenturiate-lobed placentas, velamentous insertion)
Other complications of pregnancy, pre-existing conditions and concomitant disease, such as:
- pre-eclampsia[11]
- previous (high risk) fetus
- HIV infection of the mother
- Sexually transmitted diseases, such as genital herpes (which can be fatal to the baby if the baby is born vaginally)
- previous classical (longitudinal) Caesarean section
- previous uterine rupture
- prior problems with the healing of the perineum (from previous childbirth or Crohn's disease)
- Bicornuate uterus
- Rare cases of posthumous birth after the death of the mother
- Lack of obstetric skill—obstetricians not being skilled in performing breech births, multiple births, etc. (In most situations women can birth vaginally under these circumstances, although planned C-section has a lower risk of infant death for breech births than vaginal delivery.[12] Obstetricians are not always trained in proper procedures for such deliveries, increasing the risk still further.)[13]
- Improper Use of Technology (Electric Fetal Monitoring [EFM])[13][14]
For otherwise healthy twin pregnancies where both twins are head down a trial of vaginal delivery is recommended at between 37 and 38 weeks.[9][15] Vaginal delivery in this case does not worsen the outcome for the infant as compared with C-section.[15] There is controversy on the best method of delivery where the first twin is head first and the second is not.[15] When the first twin is not head down, a C-section is often recommended.[15] Although the second twin typically has a higher frequency of problems, it is not known if a planned C-section affects this.[9] It is estimated that 75% of twin pregnancies in the United States were delivered by Cesarean section in 2008.[16]
Adverse outcomes in low risk pregnancies occur in 8.6% of vaginal deliveries and 9.2% of C-section deliveries.[4]
In those who are low risk the risk of death for Caesarian sections is 13 per 100,000 and for vaginal birth 3.5 per 100,000 in the developed world.[4] The UK National Health Service gives the risk of death for the mother as three times that of a vaginal birth.[17]
In Canada the difference in bad outcome in the mother (e.g. cardiac arrest, wound hematoma, or hysterectomy) was 1.8 additional cases per 100 or three times the risk.[18]
As with all types of abdominal surgeries, a Caesarean section is associated with risks of postoperative adhesions, incisional hernias (which may require surgical correction) and wound infections.[19] If a Caesarean is performed under emergency situations, the risk of the surgery may be increased due to a number of factors. The patient's stomach may not be empty, increasing the anaesthesia risk.[20] Other risks include severe blood loss (which may require a blood transfusion) and postdural-puncture spinal headaches.[19]
Women who had Caesarean sections were more likely to have problems with later pregnancies, and it is recommended that women who want larger families should not seek an elective Caesarean. The risk of placenta accreta, a potentially life-threatening condition, is 0.13% after two Caesarean sections, but increases to 2.13% after four and then to 6.74% after six or more. Along with this is a similar rise in the risk of emergency hysterectomies at delivery.[21]
Women who had just one previous Caesarean section are more likely to have problems with their second birth.[4] Women who delivered their first child by Caesarean delivery had increased risks for malpresentation, placenta previa, antepartum hemorrhage, placenta accreta, prolonged labor, uterine rupture, preterm birth, low birth weight, and stillbirth in their second deliveries. However, some risks may be due to confounding factors related to the indication for the first Caesarean, rather than due to the procedure itself.[22]
Mothers can experience increased incidence of postnatal depression, and can experience significant psychological birth trauma and ongoing birth-related post-traumatic stress disorder after obstetric intervention during the birthing process.[23] Factors like pain in first stage of labor, feelings of powerlessness, intrusive emergency obstetric intervention are important in the development of birth trauma.[23]
Non-medically indicated (elective) childbirth before 39 weeks gestation "carry significant risks for the baby with no known benefit to the mother." Complications from elective cesarean before 39 weeks include: newborn mortality at 37 weeks may be 2.5 times the number at 40 weeks, and was elevated compared to 38 weeks of gestation. These "early term" births were also associated with increased death during infancy, compared to those occurring at 39 to 41 weeks ("full term").[5] Researchers in one study and another review found many benefits to going full term, but "no adverse effects" in the health of the mothers or babies.[5][24]
The American College of Obstetricians and Gynecologists and medical policy makers review research studies and find increased incidence of suspected or proven sepsis, RDS, Hypoglycemia, need for respiratory support, need for NICU admission, and need for hospitalization > 4–5 days. In the case of cesarean sections, rates of respiratory death were 14 times higher in pre-labor at 37 compared with 40 weeks gestation, and 8.2 times higher for pre-labor cesarean at 38 weeks. In this review, no studies found decreased neonatal morbidity due to non-medically indicated (elective) delivery prior to 39 weeks.[5]
In contrast with singleton pregnancies, the medical literature recommends delivery of dichorionic twins at 38 weeks, and monochorionic twins (identical twins sharing a placenta) by 37 weeks due to the increased risk of stillbirth in monochorionic twins who remain in utero after 37 weeks.[25][26] The consensus is that late preterm delivery of monochorionic twins is justified because the risk of stillbirth for post-37 week delivery is significantly higher than the risks posed by delivering monochorionic twins near term (i.e., 36–37 weeks).[27]
The consensus concerning monoamniotic twins (identical twins sharing an amniotic sac), the highest risk type of twins, is that they should be delivered by caesarean section at or shortly after 32 weeks.[28][29][30]
In a research study widely publicized, singleton children born earlier than 39 weeks may have developmental problems, including slower learning in reading and math.[31]
Other risks include:
- Wet lung: Retention of fluid in the lungs can occur if not expelled by the pressure of contractions during labor.[32]
- Potential for early delivery and complications: Preterm delivery is possible if due-date calculation is inaccurate. One study found an increased complication risk if a repeat elective Caesarean section is performed even a few days before the recommended 39 weeks.[33]
- Higher infant mortality risk: In C-sections performed with no indicated risk (singleton at full term in a head-down position), the risk of death in the first 28 days of life has been cited as 1.77 per 1,000 live births among women who had C-sections, compared to 0.62 per 1,000 for women who delivered vaginally.[34]
|This section does not cite any references or sources. (August 2012)
There are several types of Caesarean section (CS). An important distinction lies in the type of incision (longitudinal or latitudinal) made on the uterus, apart from the incision on the skin.
- The classical Caesarean section involves a midline longitudinal incision which allows a larger space to deliver the baby. However, it is rarely performed today, as it is more prone to complications.
- The lower uterine segment section is the procedure most commonly used today; it involves a transverse cut just above the edge of the bladder and results in less blood loss and is easier to repair.
- An unplanned Caesarean section is performed once labour has commenced due to unexpected labor complications.
- A crash/emergent/emergency Caesarean section is performed in an obstetric emergency, where complications of pregnancy onset suddenly during the process of labour, and swift action is required to prevent the deaths of mother, child(ren) or both.
- A planned caesarean (or elective/scheduled caesarean), arranged ahead of time, is most commonly arranged for medical reasons and ideally as close to the due date as possible.
- A Caesarean hysterectomy consists of a Caesarean section followed by the removal of the uterus. This may be done in cases of intractable bleeding or when the placenta cannot be separated from the uterus.
- Traditionally, other forms of Caesarean section have been used, such as extraperitoneal Caesarean section or Porro Caesarean section.
- A repeat Caesarean section is one that is done when a patient had a previous Caesarean section. Typically it is performed through the old scar.
In many hospitals, especially in Argentina, the United States, United Kingdom, Canada, Norway, Sweden, Finland, Australia, and New Zealand, the mother's birth partner is encouraged to attend the surgery to support the mother and share the experience. The anaesthetist will usually lower the drape temporarily as the child is delivered so the parents can see their newborn.
Cesarean section can be performed with single or double layer suturing of the uterine incision.[35] A Cochrane review came to the result that single layer closure compared with double layer closure was associated with a statistically significant reduction in mean blood loss.[36]
Misgav Ladach method[edit]
A modified cesarean section which has been used nearly all over the world in the last 20 years. It was described by Michael Stark, the president of the New European Surgical Academy, at the time he was the director of the Misgav Ladach general hospital in Jerusalem. The method was presented during a FIGO conference in Montréal in 1994[37] and then distributed by the University of Uppsala, Sweden, in more than 100 countries. This method is based on minimalistic principles. He examined all steps in cesarean sections in use, analyzed them for their necessity and, if found necessary, for their optimal way of performance. For the abdominal incision he used the modified Joel Cohen incision and compared the longitudinal abdominal structures to strings on musical instruments. As blood vessels and muscles have lateral sway, it is possible to stretch rather than cut them. The peritoneum is opened by repeat stretching, no abdominal swabs are used, the uterus is closed in one layer with a big needle to reduce the amount of foreign body as much as possible, the peritoneal layers remain unsutured and the abdomen is closed with two layers only. Women undergoing this operation recover quickly and can look after the newborns soon after surgery. There are many publications showing the advantages over traditional cesarean section methods.[38][39]
Both general and regional anaesthesia(spinal, epidural or combined spinal and epidural anaesthesia) are acceptable for use during Caesarean section. Regional anaesthesia is preferred as it allows the mother to be awake and interact immediately with her baby.[40] Other advantages of regional anesthesia include the absence of typical risks of general anesthesia: pulmonary aspiration (which has a relatively high incidence in patients undergoing anesthesia in late pregnancy) of gastric contents and Oesophageal intubation.[41]
Regional anaesthesia is used in 95% of deliveries, with spinal and combined spinal and epidural anaesthesia being the most commonly used regional techniques in scheduled Caesarean section.[42] Regional anaesthesia during Caesarean section is different from the analgesia (pain relief) used in labor and vaginal delivery. The pain that is experienced because of surgery is greater than that of labor and therefore requires a more intense nerve block. The dermatomal level of anesthesia required for Caesarean delivery is also higher than that required for labor analgesia.[41]
General anesthesia may be necessary because of specific risks to mother or child. Patients with heavy, uncontrolled bleeding may not tolerate the hemodynamic effects of regional anesthesia. General anesthesia is also preferred in very urgent cases, such as severe fetal distress, when there is no time to perform a regional anesthesia.
Recovery period[edit]
Typically, the recovery time depends on the patient and her pain tolerance and inflammation levels. Doctors do recommend abstention from strenuous work (e.g., lifting objects over 10 lbs (4.5 kg)., running, walking up stairs, or athletics) for up to six weeks[medical citation needed] , and a waiting period of ~18 months before attempting to conceive another child.[medical citation needed]
Prevention of complications[edit]
Postpartum infection is one of the main causes of morbidity[43][44] and mortality around childbirth, accounting for around 10% of maternal deaths globally.[45] Cesarean section greatly increases the risk of infection and associated morbidity (estimated to be between 5 and 20 times as high[43]). Infection can occur in around 8% of women who have cesareans,[44] largely endometritis, urinary tract infections and wound infections.
Antibiotic prophylaxis is particularly effective for endometritis, preventing as many as 3 out of 4 cases.[43][44] Taking antibiotics before skin incision further reduces the risk for the mother, without increasing adverse effects for the baby.[44]
It is generally agreed that the prevalence of C-section is higher than needed in many countries and physicians are encouraged to actively lower the rate. Some of these efforts include: emphasizing that a long latent phase of labor is not abnormal and thus not a justification for C-section; changing the start of active labor from a cervical dilation of 4 cm to a dilation of 6 cm; and allowing at least 2 hours of pushing for women who have previously given birth and 3 hours of pushing for women who have not previously given birth before labor arrest is considered.[4]
In the United Kingdom, in 2008, the Caesarean section rate was 24%.[46] In Ireland the rate was 26.1% in 2009.[47] The Canadian rate was 26% in 2005–2006.[48] Australia has a high Caesarean section rate, at 31% in 2007.[49] In the United States the rate of C-section is around 33% and varies from 23% to 40% depending on the state in question.[4]
In Italy the incidence of Caesarean sections is particularly high, although it varies from region to region.[50] In Campania, 60% of 2008 births reportedly occurred via Caesarean sections.[51] In the Rome region, the mean incidence is around 44%, but can reach as high as 85% in some private clinics.[52][53]
With nearly 1.3 million stays, Cesarean section was one of the most common procedures performed in U.S. hospitals in 2011. It was the second-most common procedure performed for people ages 18 to 44 years old.[54] Caesarean rates in the U.S. have risen considerably since 1996.[55] The procedure increased 60% from 1996 to 2009. In 2010, the Cesarean delivery rate was 32.8% of all births (a slight decrease from 2009's high of 32.9% of all births).[56] A study found that in 2011, women covered by private insurance were 11% more likely to have a caesarean section delivery those covered by Medicaid.[57]
China has been cited as having the highest rates of C-sections in the world at 46% as of 2008.[58]
Studies have shown that continuity of care with a known carer may significantly decrease the rate of Caesarean delivery[59] but there is also research that appears to show that there is no significant difference in Caesarean rates when comparing midwife continuity care to conventional fragmented care.[60]
More emergency Caesareans—about 66%—are performed during the day rather than during the night.[61]
Changing rates[edit]
In the United States C-section rates have increased from just over 20% in 1996 to 33% in 2011.[4] This increase has not resulted in improved outcomes resulting in the position that C-sections may be done too frequently.[4]
The World Health Organization officially withdrew its previous recommendation of a 15% C-section rates in June 2010. Their official statement read, "There is no empirical evidence for an optimum percentage. What matters most is that all women who need caesarean sections receive them."[62]
The US National Institutes of Health says rises in rates of Caesarean sections are not, in isolation, a cause for concern, but may reflect changing reproductive patterns: "The World Health Organization has determined an "ideal rate" of all cesarean deliveries (such as 15 percent) for a population. One surgeon's opinion[who?] is that there is no consistency in this ideal rate, and artificial declarations of an ideal rate should be discouraged. Goals for achieving an optimal cesarean delivery rate should be based on maximizing the best possible maternal and neonatal outcomes, taking into account available medical and health resources and maternal preferences. This opinion is based on the idea that if left unchallenged, optimal cesarean delivery rates will vary over time and across different populations according to individual and societal circumstances."[63]
The number of C-sections performed has grown, for example, a fourfold increase from 1971 to 1991 (from 4.2 per 100 births).[citation needed] This may be accredited to the improved technology in detecting prebirth distress.[citation needed] Malpractice has been looked into because of the rapid increase. Some argue the higher costs of C-section births compared to regular births make physicians quicker to recommend surgery. Usually, if a doctor makes a recommendation, people are quick to take it to heart and act upon it. The effect of relative C-section price on C-section usage should be examined.
Some have speculated that cesarean section rates have increased due to a relationship between birth weight and maternal pelvis size, positing on the basis of Darwinian-inspired logic that since the advent of successful Caesarean birth over the last 150 years, more mothers with small pelvises and babies with large birth weights have survived and contributed to these traits. However, this idea fails to take into account that historically disproportion in childbirth was caused by maternal malnutrition in childhood, in particular malformed pelvic bones due to childhood rickets. Improved maternal nutrition should have led to increased ease in vaginal birth, not an increase in cesarean sections.[64]
The mother of Bindusara (born c. 320 BCE, ruled 298 – c.272 BCE), the second Mauryan Samrat (emperor) of India, accidentally consumed poison and died when she was close to delivering him. Chanakya, the Chandragupta's teacher and adviser, made up his mind that the baby should survive. He cut open the belly of the queen and took out the baby, thus saving the baby's life.[65][66]
According to the ancient Chinese Records of the Grand Historian, Luzhong, a sixth-generation descendant of the Yellow Emperor, had six sons, all born by "cutting open the body". The sixth son Jilian founded the House of Mi that ruled the State of Chu (c. 1030–223 BCE).[67]
In the Irish mythological text the Ulster Cycle, the character Furbaide Ferbend is said to have been born by posthumous Caesarean section, after his mother was murdered by his evil aunt Medb.
The Babylonian Talmud, an ancient Jewish religious text, mentions a procedure similar to the Caesarean section. The procedure is termed yotzei dofen.[66]
Pliny the Elder theorized that Julius Caesar's name came from an ancestor who was born by Caesarean section, but the truth of this is debated (see the article on the Etymology of the name of Julius Caesar). The Ancient Roman Caesarean section was first performed to remove a baby from the womb of a mother who died during childbirth. Caesar's mother, Aurelia, lived through childbirth and successfully gave birth to her son, ruling out the possibility the Roman ruler and general was born by Caesarean section. His first wife however died in childbirth, giving birth to a stilborn son who might have lived had a caesarean taken place.
The Catalan saint Raymond Nonnatus (1204–1240), received his surname—from the Latin non-natus ("not born")—because he was born by Caesarean section. His mother died while giving birth to him.[68]
An early account of Caesarean section in Iran is mentioned in the book of Shahnameh, written around 1000 AD, and relates to the birth of Rostam, the national legendary hero of Iran.[69][70] According to the Shahnameh, the Simurgh instructed Zal upon how to perform a Caesarean section, thus saving Rudaba and the child Rostam.[71]
Caesarean section usually resulted in the death of the mother; the first recorded incidence of a woman surviving a Caesarean section was in the 1580s, in Siegershausen, Switzerland: Jakob Nufer, a pig gelder, is supposed to have performed the operation on his wife after a prolonged labour.[72] However, there is some basis for supposing that women regularly survived the operation in Roman times.[73] For most of the time since the 16th century, the procedure had a high mortality rate. However, it was long considered an extreme measure, performed only when the mother was already dead or considered to be beyond help. In Great Britain and Ireland, the mortality rate in 1865 was 85%. Key steps in reducing mortality were:
- Introduction of the transverse incision technique to minimize bleeding by Ferdinand Adolf Kehrer in 1881 is thought to be first modern CS performed.
- The introduction of uterine suturing by Max Sänger in 1882
- Modification by Hermann Johannes Pfannenstiel in 1900, see Pfannenstiel incision
- Extraperitoneal CS and then moving to low transverse incision (Krönig, 1912)[clarification needed]
- Adherence to principles of asepsis
- Anesthesia advances
- Blood transfusion
- Antibiotics
European travelers in the Great Lakes region of Africa during the 19th century observed Caesarean sections being performed on a regular basis.[74] The expectant mother was normally anesthetized with alcohol, and herbal mixtures were used to encourage healing. From the well-developed nature of the procedures employed, European observers concluded they had been employed for some time.[74] Dr. James Barry carried out the first successful Caesarean by a European doctor in Africa in Cape Town, while posted there between 1817 and 1828.[75]
The first successful Caesarean section to be performed in America took place in what was formerly Mason County, Virginia (now Mason County, West Virginia), in 1794. The procedure was performed by Dr. Jesse Bennett on his wife Elizabeth.[76]
On March 5, 2000, in Mexico, Inés Ramírez performed a Caesarean section on herself and survived, as did her son, Orlando Ruiz Ramírez.[77] She is believed to be the only woman to have performed a successful Caesarean section on herself.[citation needed]
The Roman Lex Regia (royal law), later the Lex Caesarea (imperial law), of Numa Pompilius (715–673 BCE),[78] required the child of a mother dead in childbirth to be cut from her womb.[79] This seems to have begun as a religious requirement that mothers not be buried pregnant,[80] and to have evolved into a way of saving the fetus, with Roman practice requiring a living mother to be in her tenth month of pregnancy before resorting to the procedure, reflecting the knowledge that she could not survive the delivery.[81] Speculation that the Roman dictator Julius Caesar was born by the method now known as C-section is apparently false.[82] Although Caesarean sections were performed in Roman times, no classical source records a mother surviving such a delivery[79][83] – the earliest recorded survival dates to the 12th century scholar and physician Maimonides (see Commentary to Mishnah Bekhorot 8:2)[citation needed]. The term has also been explained as deriving from the verb caedere, "to cut", with children delivered this way referred to as caesones. Pliny the Elder refers to a certain Julius Caesar (an ancestor of the famous Roman statesman) as ab utero caeso, "cut from the womb" giving this as an explanation for the cognomen "Caesar" which was then carried by his descendents.[79] Nonetheless, even if the etymological hypothesis linking the cesarean section to Julius Caesar is a false etymology, it has been widely believed. For example, the Oxford English Dictionary defines Caesarean birth as "the delivery of a child by cutting through the walls of the abdomen when delivery cannot take place in the natural way, as was done in the case of Julius Caesar".[84] Merriam-Webster's Collegiate Dictionary (11th edition) leaves room for etymological uncertainty with the phrase, "from the legendary association of such a delivery with the Roman cognomen Caesar"[85]
Some link with Julius Caesar or with Roman emperors exists in other languages as well. For example, the modern German, Norwegian, Danish, Dutch, Swedish, Turkish and Hungarian terms are respectively Kaiserschnitt, keisersnitt, kejsersnit,keizersnede, kejsarsnitt, sezeryan, and császármetszés (literally: "Emperor's cut").[86] The German term has also been imported into Japanese (帝王切開 teiōsekkai) and Korean (제왕 절개 jewang jeolgae), both literally meaning "emperor incision". Similar in western Slavic (Polish) cięcie cesarskie, (Czech)císařský řez and (Slovak) cisársky rez (literally "imperial cut"), whereas the south Slavic term is Serbian царски рез and Slovenian cárski réz, which literally means "tzar" cut. The Russian term kesarevo secheniye (Кесарево сечение késarevo sečénije) literally means Caesar's section. The Arabic term (ولادة قيصرية wilaada qaySaríyya) also means "Caesarean birth." The Hebrew term ניתוח קיסרי (nitúakh Keisári) translates literally as Caesarean surgery. In Romania and Portugal, it is usually called cesariana, meaning from (or related to) Caesar.[citation needed]
According to Shahnameh ancient Persian book, the hero Rostam was the first person who was born with this method and term رستمينه (rostamineh) is corresponded to Caesarean.[citation needed] Also, Hindu mythical monkey god Hanuman was born through a similar procedure on her mother Anjani.
Finally, the Roman praenomen (given name) Caeso was said to be given to children who were born via C-section. While this was probably just folk etymology made popular by Pliny the Elder, it was well known by the time the term came into common use.[87]
- The e/ae/æ variation reflects American and British English spelling differences.
- The capital-versus-lowercase variation reflects a style of lowercasing some eponymous terms (e.g., cesarean, eustachian, fallopian, mendelian, parkinsonian, parkinsonism).[88] Capital and lowercase stylings coexist in prevalent usage. Intradocument style consistency is usually advocated.
- Because of (1) the e-vs-ae digraph variation, (2) the related ae-vs-æ typographic ligature variation, (3) the capital-vs-lowercase variation (which is based on the idea of eponymous origin, whether that is historically accurate or not; see eponym > orthographic conventions), and (4) the -ean-vs--ian suffix variation, these factors cross-multiplied in a table cause this word to be one of the very few words in present-day English orthography to have many different normative spellings or orthographic stylings, which amount to 12 from the point of view of character encoding (that is, there are 12 different character strings that are all accepted as normative orthographic representations of this one word):
|C + e
|c + e
|C + ae
|c + ae
|C + æ
|c + æ
Vaginal birth after Caesarean[edit]
While vaginal births after Caesarean (VBAC) are not uncommon today, the rate of VBAC has declined to include less than 10% of births after previous Cesarean.[89][90] Although Caesarean deliveries made up only 5% of births overall in the USA until the mid-1970s, it was commonly believed that for women with previous Caesarean sections, "Once a Caesarean, always a Caesarean". A consumer-driven movement supporting VBAC changed medical practice and led to soaring rates of VBAC in the 1980s and early 1990s, but rates of VBAC dramatically dropped after the publication of a highly publicized scientific study showing worse outcomes for VBACs as compared to repeat Caesarean and the resulting medicolegal changes within obstetrics.[91] In 2010, the National Institutes of Health, U.S. Department of Health and Human Services, and American College of Obstetrics and Gynecology all released statements in support of increasing VBAC access and rates.[92][93][94][95]
In the past, Caesarean sections used a vertical incision which cut the uterine muscle fibres in an up and down direction (a classical Caesarean). Modern Caesareans typically involve a horizontal incision along the muscle fibres in the lower portion of the uterus (hence the term lower uterine segment Caesarean section). The uterus then better maintains its integrity and can tolerate the strong contractions of future childbirth. Cosmetically, the scar for modern Caesareans is below the "bikini line".
Obstetricians and other caregivers differ on the relative merits of vaginal and Caesarean section following a Caesarean delivery; some still recommend a Caesarean routinely, while others do not. In the US, the American College of Obstetricians and Gynecologists (ACOG) modified the guidelines on vaginal birth after previous Caesarean delivery in 1999, 2004, and again in 2010.[96] In 2004, this modification to the guideline included the addition of the following recommendation:
Because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.[97]
In 2010, ACOG modified these guidelines again to express more encouragement of VBAC, but maintained it should still be undertaken at facilities capable of emergency care, though patient autonomy in assuming increased levels of risk should be respected (ACOG Practice Bulletin Number 115, August 2010).
The recommendation for access to emergency care during trial of labor has, in some cases, had a major impact on the availability of VBACs to birthing mothers in the US. For example, a study of the change in frequency of VBAC deliveries in California after the change in guidelines, published in 2006, found the VBAC rate fell to 13.5% after the change, compared with 24% VBAC rate before the change.[98] The new recommendation has been interpreted by many hospitals as indicating a full surgical team must be standing by to perform a Caesarean section for the full duration of a VBAC woman's labor. Hospitals that prohibit VBACs entirely are said to have a 'VBAC ban'. In these situations, birthing mothers are forced to choose between having a repeat Caesarean section, finding an alternate hospital in which to deliver their babies or attempting delivery outside the hospital setting.[99]
Most recently, enhanced access to VBAC has been recommended based on updated scientific data on the safety of VBAC as compared to repeat Caesarean section, including the following recommendation emerging from the NIH VBAC conference panel in March 2010, "We recommend that hospitals, maternity care providers, health care and professional liability insurers, consumers, and policymakers collaborate on the development of integrated services that could mitigate or even eliminate current barriers to trial of labor."[92] The U.S Department of Health and Human Services' Healthy People 2020 initiative includes objectives to reduce the primary cesarean rate and to increase the VBAC rate by at least 10% each.[95]
Within Judaism[edit]
There is a dispute among the poskim (Rabbinic authorities) as to whether a first-born son from a Caesarean section has the laws of a bechor.[100] Traditionally, a male child delivered by Caesarean is not eligible for the Pidyon HaBen dedication ritual.[101][102]
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- ^ "Kiwi caesarean rate continues to rise". Stuff.co.nz. 12 September 2007. Retrieved 22 September 2011.
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- ^ a b c d e f g h i "Safe Prevention of the Primary Cesarean Delivery". merican College of Obstetricians and Gynecologists (the College) and the Society for Maternal-Fetal Medicine. March 2014. Retrieved 20 February 2014.
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- ^ a b c d e National Collaborating Centre for Women's and Children's Health (November 2011). "Caesarean section" (pdf). NICE. Royal College of Obstetricians and Gynaecologist. pp. 70–103. Retrieved 12 June 2014.
- ^ a b American College of Obstetricians and, Gynecologists (Apr 2013). "ACOG committee opinion no. 559: Cesarean delivery on maternal request.". Obstetrics and gynecology 121 (4): 904–7. doi:10.1097/01.AOG.0000428647.67925.d3. PMID 23635708.
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- ^ Hofmeyr, GJ; Hannah, ME (2003). "Planned caesarean section for term breech delivery.". The Cochrane database of systematic reviews (3): CD000166. doi:10.1002/14651858.CD000166. PMID 12917886.
- ^ a b Savage W (2007). "The rising Caesarean section rate: a loss of obstetric skill?". J Obstet Gynaecol 27 (4): 339–46. doi:10.1080/01443610701337916. PMID 17654182.
- ^ Wei Ching T, Kanagalingam D, Hak Koon T (2003). "Rising Caesarean Section Rates–Where Do We Go From Here?". SGH Proceedings 12 (4): 208–12.
- ^ a b c d Biswas, A; Su, LL; Mattar, C (Apr 2013). "Caesarean section for preterm birth and, breech presentation and twin pregnancies.". Best practice & research. Clinical obstetrics & gynaecology 27 (2): 209–19. doi:10.1016/j.bpobgyn.2012.09.002. PMID 23062593.
- ^ Lee HC, Gould JB, Boscardin WJ, El-Sayed YY, Blumenfeld YJ (2011). "Trends in cesarean delivery for twin births in the United States: 1995-2008". Obstet Gynecol 118 (5): 1095–101. doi:10.1097/AOG.0b013e3182318651. PMC 3202294. PMID 22015878.
- ^ "Caesarean Section". NHS Direct. Retrieved 2006-07-26.[dead link]
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- ^ a b Pai, Madhukar (2000). "Medical Interventions: Caesarean Sections as a Case Study". Economic and Political Weekly 35 (31): 2755–61.
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- ^ "Term Pregnancy: A Period of Heterogeneous Risk for Infant Mo... : Obstetrics & Gynecology". Retrieved 2012-07-12.
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- ^ "High perinatal survival in monoamniotic twins managed by prophylactic sulindac, intensive ultrasound surveillance, and Cesarean delivery at 32 weeks' gestation". Retrieved 2014-06-11.
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Hodnett ED; Henderson, Sonja (2008). "WITHDRAWN: Continuity of caregivers for care during pregnancy and childbirth". In Henderson, Sonja. Cochrane Database Syst Rev (4): CD000062. doi:10.1002/14651858.CD000062.pub2. PMID 18843605.
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- ^ WIKIPEDIA Rostam
- ^ Conner, Clifford D., A People's History Of Science : : Miners, Midwives, And "low Mechanicks", pg 3
- ^ Boss J (1961). "THE ANTIQUITY OF CAESAREAN SECTION WITH MATERNAL SURVIVAL: THE JEWISH TRADITION". Medical history 5 (2): 117–31. doi:10.1017/S0025727300026089. PMC 1034600. PMID 16562221.
- ^ a b "Cesarean Section – A Brief History: Part 2". U.S. National Institutes of Health. 25 June 2009. Retrieved 2010-11-27.
- ^ Pain, Stephanie (6 March 2008). "The 'male' military surgeon who wasn't". NewScientist.com. Retrieved 16 March 2008.
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- ^ a b c "Caesarean section?: etymology and early history", South African Journal of Obstetrics and Gynaecology, August 2009 by Pieter W.J. van Dongen
- ^ "As there was a cultural taboo against burying an undelivered woman in Roman and German societies, according to Lex Caesarea..." U Högberg, E Iregren, CH Siven, "Maternal deaths in medieval sweden: an osteological and life table analysis", Journal of Biosocial Science, 1987, 19: 495–503 Cambridge University Press
- ^ University of Virginia Health System, Claude Moore Sciences Health Library, Ancient Gynecology:Caesarean Section
- ^ "Bad Medicine: Misconceptions and Misuses Revealed," by Christopher Wanjek, p. 5 (John Wiley & Sons, 2003)
- ^ "...could not survive the trauma of a Caesarean" Oxford Classical Dictionary, Third Edition, "Childbirth"
- ^ "Caesarean | Caesarian, adj. and n.". OED Online. June 2013. Oxford University Press. 13 June 2013 <http://www.oed.com/view/Entry/26016>.
- ^ Merriam-Webster (2003), Merriam-Webster's Collegiate Dictionary (11th ed ed.), Springfield, Massachusetts, USA: Merriam-Webster, ISBN 978-0-87779-809-5
- ^ For a summary (in German), of an article (also in German) that deals usefully with many of the relevant historical and linguistic questions raised here, go here [2].
- ^ Blumenfeld-Kosinski, Renate. Not of Woman Born: Representations of Caesarean Birth In Medieval and Renaissance Culture (Cornell University Press: 1991; 204 pages) ISBN 0-8014-9974-7: "Appendix: Creative Etymology: Caesarean Section from Pliny to Rousset" (pp. 143-153) presents an excellent history of the legend of caesarean births in Western culture.
- ^ Elsevier (2007). Dorland's Illustrated Medical Dictionary (31st ed.). Philadelphia: Elsevier. ISBN 978-1-4160-2364-7.
- ^ "Cesarean births, repeat (percent)—Health Indicators Warehouse". Healthindicators.gov.
- ^ "Rates for Total Cesarean Section, Primary Cesarean Section and Vaginal Birth After Cesarean Section (VBAC), United States, 1989–2006." Childbirth Connection, 2008. Retrieved 25 September 2008.
- ^ McMahon MJ, Luther ER, Bowes WA, Olshan AF (1996). "Comparison of a Trial of Labor with an Elective Second Cesarean Section". New England Journal of Medicine 335 (10): 689–695. doi:10.1056/NEJM199609053351001. PMID 8703167.
- ^ a b "NIH Vaginal Birth After Cesarean (VBAC) Conference—Panel Statement". Consensus.nih.gov. Retrieved 2013-05-16.
- ^ "Vaginal Birth After Cesarean: New Insights: Structured Abstract". Ahrq.gov. 16 September 2010.
- ^ [3][dead link]
- ^ a b "Maternal, Infant, and Child Health—Healthy People". Healthypeople.gov. 13 September 2012.
- ^ American College of Obstetricians and Gynecologists (ACOG). "Guideline on Vaginal birth after previous cesarean delivery". guideline.gov. Retrieved 2008-02-09.
- ^ American College of Obstetricians and Gynecologists (ACOG). "Guideline on Vaginal birth after previous cesarean delivery: Major Recommendations". guideline.gov. Retrieved 2008-02-09.
- ^ Zweifler J, Garza A, Hughes S, Stanich MA, Hierholzer A, Lau M (2006). "Vaginal birth after cesarean in California: before and after a change in guidelines". Ann Fam Med 4 (3): 228–34. doi:10.1370/afm.544. PMC 1479438. PMID 16735524.
- ^ Rita Rubin (24 August 2005). "Battle lines drawn over C-sections". USA Today. Retrieved 2008-02-09.
- ^ See Chok Yaakov 470:2; Kaf ha-Chayim 470:3; http://www.torah.org/advanced/weekly-halacha/5758/pesach.html
- ^ "Pidyon HaBen - Definition of Pidyon HaBen (Redemption of the Firstborn)". Judaism.about.com. 19 October 2012.
- ^ "Kohanim forever from the sources, who is a cohen, the blessing of the Cohanim,. Mitvah of the cohen, Halacha, Temple service groups, pidyon—redemption of the firstborn". Cohen-levi.org.
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text: The recall of eggs possibly contaminated with salmonella has swelled to 380million. That's almost 32 million cartons. Hundreds of people have beensickened in the outbreak, which currently extends to four states. But therehave been no deaths. The Centers for Disease Control and Prevention isworking with state health departments to investigate the illnesses. All the eggs, which were sold under numerous brand names, came from Wright CountyEgg of Galt, Iowa. The owner of this massive farm has paid millions in fines for violations at other operations. Now, local Health Departments andFederal Investigators are trying to zero in on the exact cause of thecontamination.One of KSFY's medical experts, Dr. Kimberlee McKay with Avera McKennan Hospital explains what salmonella is, how it spreads and when you should go to the doctor if you are experiencing symptoms of being exposed to it.


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Crop Calculator for Cornby Randy Shannon
Now, a simple trip to the Android store on your smartphone can help you with your corn crop calculations. Go to the Google Play sto...Read More »


text: Bulk Fuel Native Village of Marshall Number of Tanks for Heating Oil 1 Number of Tanks for Gasoline 1 Total Heating Oil Tank Capacity (gal) 51,600 Total Gasoline Tank Capacity (gal) 50,000 Overall Condition of Tanks Good When Fuel is Delivered June and September How Fuel is Delivered Barge Communications Water Distribution, Source and Treatment Systems City of Marshall Public Water System ID# AK2270273 Primary Source Ground Water System Type Community Water System Population Served 308 Water System Details URL http://dec.alaska.gov:8080/DWW/JSP/WaterSystemDetail.jsp?tinwsys_is_number=911&tinwsys_st_code=AK&wsnumber=AK2270273 Sewage Collection Systems Refuse/Landfill Systems City of Marshall DEC Landfill Permit # 9925-BA001 Landfill Name Marshall Landfill DEC Landfill Classification Class III DEC Landfill Permit Status Expired DEC Landfill Expiration Date 5/2/2005 DEC Landfill URL http://dec.alaska.gov/Applications/EH/SWIMS/ModFacility.aspx?siteId=263 Electric Utility Alaska Village Electric Cooperative - AVEC Power Source Diesel generator PCE Eligible Yes Residential Rate $0.58 per kWh, June 2012 PCE reimbursement rate $0.36 per kWh, June 2012 Residential Rate after PCE $0.22 per kWh, June 2012 Note Wind Turbines installed 3 Rated Wind Capacity Kilowatts 4,500 ISER Community Data Summary https://akenergygateway.alaska.edu/community-data-summary/1405984/ Health Care Visitor Accommodations/Information Local Facilities and Utilities Transportation Facilities Marshall Don Hunter Sr Airport Airport Type Airport Airport Code MDM Airport Owner State Of Alaska-DOT&PF-Northern Region Airport Use Public Airport Ownership Public FAA URL http://nfdc.faa.gov/nfdcApps/airportLookup/airportDisplay.jsp?category=nasr&airportId=MDM Runway-1 ID '07/25 Runway-1 Size 3,200 ft. x 100 ft. Runway Materials/Condition Gravel-Fair Condition Runway-2 Size Public Safety Entities Marshall Volunteer Fire Department Emergency Medical Services No Structural Firefighting Yes Marine Firefighting No Airport Fire/Rescue No Industrial Firefighting No Saint Mary's Alaska State Trooper Post Alaska State Troopers Post Saint Mary's Village Public Safety Officer Village is currently served by an itinerant VPSO. Airlines Arctic Transportation Enplaned Passengers 8 passengers in 2013 Enplaned Freight 57,743 lbs. in 2013 Enplaned Mail 195,243 lbs. in 2013 Bering Air Inc. Enplaned Passengers 14 passengers in 2013 Enplaned Freight 0 lbs. in 2013 Enplaned Mail 0 lbs. in 2013 Era Aviation Enplaned Passengers 5 passengers in 2013 Enplaned Freight 0 lbs. in 2013 Enplaned Mail 0 lbs. in 2013 Grant Aviation Enplaned Passengers 20 passengers in 2013 Enplaned Freight 5 lbs. in 2013 Enplaned Mail 0 lbs. in 2013 Hageland Aviation Service Enplaned Passengers 3,530 passengers in 2013 Enplaned Freight 74,228 lbs. in 2013 Enplaned Mail 617,079 lbs. in 2013 Yute Air Aka Flight Alaska Enplaned Passengers 176 passengers in 2013 Enplaned Freight 881 lbs. in 2013 Enplaned Mail 696 lbs. in 2013 Post Offices Public Libraries


text:
Date of Award
Fall 2011
Degree Type
Degree Name
Master of Science (MSc)
Health Research Methodology
Lehana Thabane
Rick Adachi
Committee Member
Alexandra Papaioannou
Background: Previous studies have found that diabetes is associated with increased risk of fracture; however, the risk of non-traumatic fracture (of any bone) specific to individuals with diabetes across the Canadian population has not been studied.
Methods: Ten years of data from the Canadian Multicenter Osteoporosis study was explored. Logistic regression models were used to study factors associated with a history of previous non-traumatic fracture at study baseline. Cox proportional hazards models were used to explore time-to-incident-fracture during the 10 years of study.
Results: All women and men ≥ 50 years were included in the analyses (n=7753). This included 508 individuals with NIDDM and 98 with IDDM. Mean age was 67 (±9) years and 72% were female. Individuals with diabetes were found to be more likely to have a history of fragility fracture then non-diabetic CaMos participants (odds ratio [OR] =1.21, 95% confidence interval [CI] 1.00,1.46; p=0.04), but were less likely to be treated with bisphosphonate therapy during the 10 year study (OR: 0.58; 95% CI 0.46,0.75; p<0.001). History of a stroke/TIA or hypertension were found to be associated with previous non-traumatic fracture amongst the diabetic population (OR: 1.51; 95% CI 1.20,1.91; p<0.001; and, OR: 1.16; 95% CI 1.04,1.29; p=0.01 respectively).
Conclusions: A treatment care gap exists amongst diabetics in Canada. Individuals with diabetes are at increased risk of non-traumatic fracture, but are less likely to be treated with bisphosphonate therapy. Clinicians can use specific fracture risk factors to identify which diabetics are at highest risk and target interventions accordingly.
Recommended Citation
Fraser, Lisa-Ann, "NON-TRAUMATIC FRACTURES IN INDIVIDUALS WITH DIABETES" (2011). Open Access Dissertations and Theses. Paper 6167.
McMaster University Library


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Susan Grigsby @sksgrigsby's curator insight, March 3, 7:39 AM
There are some really good suggestions here for school librarians. Take a look at the list and, as Doug Johnson would say, find your "sacred cows" among them and see what can be changed.
Elizabeth Hutchinson's curator insight, January 26, 11:02 AM
Great assessment too for school librarians included in this report.


text:
from Fiber Dreams
PDF Digital Download
Have you made this pattern?
Share with the Craftsy community.
I told my tech editor about this pattern a while back, letting her know what I was working on, what to expect to be added to her work queue. A few weeks later I let her know that it was blocking, and was nearly ready for her. I still didn't have a name chosen for the pattern, and so referred to it as that "lacy crescent thing." She thought that was an awesome name for the design, thus proving that at times naming a thing is no more complicated than describing it in its simplest terms.
Shawl is worked back and forth across the length of the scarf starting with the lace border, then transitioning into garter stitch short rows to shape it into a pleasing crescent before it's finished off with a simple frilly edge.
Model: Twist, Yarns of Intrigue Bamboo Sock in large size; 425 yards in 100 grams; 50% superwash merino, 25% bamboo, 25% nylon
Stitch instructions: Charted and written.
31 sts and 45 rows (lace portion only) to 4 inches (10 cm) in lace pattern, blocked
I have knit and crocheted, and done various forms of embroidery and needlepoint since early grammar school. Making things with bits of colored string is so integral to my being that the few times of my life when I don't have *something* on the go feel empty, and without form.


text:
Construction Resources: Visit the fall sale at the store's showroom and indoor slab gallery. The sale is Saturday-Sunday and includes 15 percent off countertops and other merchandise. Construction Resources is located at 224 Rio Circle, Decatur.
For more deals, follow me on Facebook, Twitter and JessicaShops.com!
October 11th, 2012
3:39 pm
[...] an anniversary party with free giveaways, check out the event details. Finally, get an upgrade with Construction Resources and get up to 70% off. For these great deals and more, be sure to pick up the paper every Thursday [...]


text:
Remove a thin slice from the top and bottom of 2 grapefruits, and discard. Set one of the flat sides on the work surface. From top to bottom, following the curve of the fruit, cut away peel and white pith. Holding fruit over bowl, cut along both sides of each segment (close to the membrane) to release. Reserve segments. Squeeze juice from membrane into a measuring cup. Juice the third grapefruit to total 1 1/2 cups juice.
In a medium non-aluminum saucepan, combine juice, brown sugar, and red pepper flakes. Bring to a boil and cook unti syrupy, about 15 minutes (you should have about 1/4 cup). Remove half of the glaze to bowl and let cool to room temperature.
Add 1 cup of grapefruit segments to the pot (reserve remainder for serving); bring to a boil. Cook, stirring occasionally, until segments have broken down and sauce has thickened, about 12 minutes (you should have about 1/4 cup of relish).
Heat broiler with the rack set 4 inches from the top. Line a rimmed baking sheet with aluminum foil. Place salmon fillets on prepared sheet and season with salt and pepper. Brush salmon with reserved glaze and broil, rotating once during cooking, until opaque throughout, 6 to 7 minutes. Serve salmon with relish and reserved grapefruit segments.
really good, easy and healthy. I am not the best fish cooker, and it worked perfectly--moist and flavorful. I served with a side of quinoa pilaf with toasted almonds, pumpkin seeds, sultanas, dried cherries, tossed with a little hazelnut and olive oils, ponzu, s/p. Can't wait to have my leftovers tomorrow!Reply
I loved this recipe!! The flavours were fantastic, the hotness from the red pepper and the tang from the grapefruit were perfect. Very nice with the salmon...Reply
I was really excited to try this recipe because of the sweet, sour and hot flavors. However, when cooking it exactly as described, there was no other flavors than grapefruit and salmon. No suprises. I wouldn't make this again. My husband said it was good but not fantastic and he also liked the presentation.Reply
In the directions for this recipe, you say to follow the "curse of the fruit," but you must mean the "curve of the fruit." It gave me a laugh; thanks!Reply


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About Camp
Girl Scout Camp is a totally awesome place for all girls entering grades K-12. Our trained and experienced staff will help ensure you have the time of your life while at camp.
There's no need to worry if you're not a Girl Scout yet.
We're super excited to have you join us and it's no problem to
get registered when you sign up for camp.
Register Online | Download Financial Assistance Form
Day Camp Registration Form | Resident Camp Registration Form


text:
Leslie R. Weatherhead
Adjunct Professor
Adjunct Professor
- B.A., University of Oregon, Honors College, 1977
- J.D., University of Washington Law School, 1980
Biographical Information
Leslie Weatherhead has been a principal in the Spokane law firm of Witherspoon, Kelley, Davenport & Toole. He practices in the areas of Commercial litigation (Business, Antitrust, Securities, Environmental) and white collar criminal litigation.
From 1980-83, he served as Deputy Prosecutor and Special Assistant United States Attorney, Territory of Guam
He is an adjunct professor of Trial Advocacy.
- "Letting Judges Judge, The Myth of Judicial Activism," Oregon State Bar Bulletin (May 1999).
- Chapter 8, "Administrative Investigations," Washington Administrative Law Practice Manual (1992).
- "What is An Indian Tribe? – The Question of Tribal Existence," VIII American Indian Law Journal I (1980).
Teaching Area
- Trial Advocacy Lab


text:
- Posted by Maegan
- 1 Comment
- in Digital Scrapbooking
February was a rough month at our house. I am so ready for warm weather and spring flowers, and for the cold weather and germs to be gone. Eden was stay-in-bed-with-a-high-fever (and double ear infection) sick for a solid week, and of course wanted her mommy with her 24/7. On the plus side, while she slept and/or watched Barbie: A Perfect Christmas over and over, I was able to finish my digital 2009 P365 album. That is 6 months worth of layouts, my friends! I have never been this productive EVER.
Here is the completed album, if you are interested. (Make sure you select "Click to See Full Screen" for easier viewing.) My timing couldn't have been more perfect. I finished the photo book up just in time to take advantage of Inkubook's 45% off sale. Sweet! I now have 2009 and 2010 safely tucked away for Zoë and Eden when the graduate, or get married. I haven't decided yet.
Create your own Photobooks with Inkubook.com!
No, I still haven't been following the "Twelve" lesson plan, but I am loving the class. The daily inspiration emails from Stacy have been giving me some excellent layout ideas (that I have been jotting down, by category). I also created a "Twelve" playlist on my phone and have been listening to the audio messages in the car while I run errands. Why didn't I think of that sooner?! I'm actually all caught up at the moment and have been enjoying them so much that I am going to download The Paperclipping Digi Show podcast. I've heard great things about it but never listened. What are your favorite podcasts?
I also tackled my "Photos I Love" albums in Feburary. I have never printed any of my favorite photos. Isn't that terrible? I took advantage of the 8×8 sale at Persnickety Prints and ordered 95 photos! They aren't scrapbooked in any way, simply slid into the page protectors. Most of the photos don't have a particular story attached to them, they just happen to be photos that I love of my family. For those that do have a special story, I am going to write the story down and slip it behind the photo with a ribbon attached to make it easy for people to pull out the journaling.
Tune in tomorrow and I will tell you why I haven't bothered to print out my favorite photos until now.


text: I LOVE this bathroom that has been popping up on design blogs over the past few days. It is a powder room in the penthouse of this 1970s Mexican colonial-style building features a glass-bottomed floor over an abandoned 15-story elevator shaft (according to Apartment Therapy). I love the unique idea of using a historic detail of the home and incorporating it into the design. It would be great to have a feature like this in my home – I'd love it, but I'm not sure my fiancé or my Dad would be too thrilled with the idea. So, for now, I can just dream and appreciate the view in this photo!


text:
HOLMES BEACH, Fla., Nov. 8 (UPI) — A Florida plumber who discovered $20,000 in an air return duct at a vacant home said he never even considered keeping the cash.
Jerry LaLiberte, 62, of Holmes Beach said he pulled the grate off the vent Oct. 20 and two foil-wrapped packets of cash fell to the ground, WFTS-TV, Tampa, reported Monday.
"I was scared. It scared me. My hands were shaking," LaLiberte said. "I wasn't sure what to do, to tell the truth."
LaLiberte said he immediately called his bosses at Air & Energy air-conditioning, plumbing and electrical service and they in turn got in contact with police and the owners of the house.
"The old homeowner was a widow who stashed money all over her house," said Stewart Moon of Air & Energy. "When she died she told her children where everything was. Apparently, she missed some places."
Moon said police asked them not to reveal the location of the house.
"The police are just afraid that people are going to go tear the house down looking for more cash," Moon said.
LaLiberte said he does not consider himself extraordinary.
"I think it's a shame that I should be a big hero for doing the right thing. That everybody should do," he said.


text:
"This baby shower invitation was so easy to personalize and turned out even better than the example displays. I have already had people "rsvping" and commenting how absolutely adorable it is. The paper quality is superior, the printing is perfect, the colors are even better than than they appear and the graphic is so sweet. Best of all the price was amazing. I got so much for so little."
"This invitation is beautiful! I wanted something special for our daughter's first birthday and I got exactly what I hoped for. Being that she was a preemie, this invite has special meaning for us and we couldn't be happier with this product! I highly recommend it!"
"The images are even better than I expected after viewing online. The printing and delivery were quick. The overall aesthetic is gorgeous."
"This card came out so cute/ i changed around the font and some of the colors a little but that was just my preference. I have gotten a ton of compliments!"
"Lots of space to personalize (including back) - easy to order. Finished product was on good quality paper, colors were solid - very professional. Prompt delivery. Overall, I was completely satisfied!"


text:
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A.Martin Holladay, editor
of Energy Design Update, responds: The R-value
of 3/8-inch-thick foil-faced bubble wrap is about
1.3. The R-value of 3/8-inch-thick foil-faced
expanded polystyrene foam is about 1.6.
By contrast, 2 inches of extruded polystyrene
insulation has an R-value of 10.
Bubble-wrap manufacturers who claim their
product matches the performance of 2 inches of
rigid foam are breaking the law.
In 2004 and 2005, the Federal Trade Commission
sent out a series of letters to manufacturers of
foil-faced bubble pack, warning, "The FTC staff is
aware that certain claims have been made in the
marketplace for foil-faced bubble pack products (or
similar reflective or radiant barrier products)
installed under concrete slabs. In the staff's
view, it may be misleading for industry members to
suggest that such foil products will reflect
radiant heat when installed under concrete.
"It is well accepted that reflective insulations
and radiant barrier products must have an air space
adjacent to the reflective material to be
effective. Such air spaces are unlikely to exist
under concrete slabs.
"Accordingly, it is unlikely that the reflective
qualities of these products will yield any
significant benefits when they are installed under
slabs. …
"In the staff's view, advertising that suggests
otherwise could harm the ability of builders and
other consumers to make appropriate insulation
Foil-faced bubble wrap is a product in search of
an application. The product has too low an R-value
to provide much benefit under a concrete slab;
moreover, the foil facing provides no benefit under
a slab beyond that of a vapor barrier.
Although some manufacturers of foil-faced bubble
pack recommend installing the product under roof
sheathing to reduce summer heat gain in an attic,
there are cheaper, foil-only products that serve
that purpose just as well.
In other applications — crawlspaces,
above-grade walls, and attic floors — the
R-value of conventional insulation (for example,
rigid foam, fiberglass batts, and cellulose) per
dollar invested will be considerably higher than
that of foil-faced bubble pack.
Building Envelope
Thicker headers and side rails, foam-filled channels, and dual perimeter seals improve...
Q. Do any I-joist manufacturers still use plywood webs? At my local lumberyard, I was...
Martin Holladay
Q. Which home heating fuel is usually cheaper, oil or propane?
What are the guidelines for determining box size, and how can you prevent overcrowding?
Contractor education requirements, bolts for attaching sills to foundations,...
When building a house with a loft accessed by a code-compliant stair, does a second,...
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2014 Hanley Wood Media, Inc. All rights reserved.


text:
Bob4419 Wrote:
May 19, 2012 2:26 PM
-- Though it may seem quaint today, the architecture of ancient morality and religion intuitively embodied a quantum-like understanding of human freedom, self-determination, spontaneity, and creativity. Freedom and spontaneity are presupposed in the notion that a person CAN be viewed as "owning" enough of his own behavior to call him responsible for it. Objectification and stereotyping efface freedom and spontaneity in rendering inherently finite and quantifiable objects. The notion of personal reesponsiblity is founded on what is, to empirical methods, an absurdity and a self-contradiction. Basing policy decisions solely on the empirical perspectives of social science is how modernity nudges human society toward socialism and communism.


text:
Academic Rigor
Dorm Life
Food and Dining
Bang for the buck
Clubs and Activities
Greek Life
Campus Safety
A hidden gem among California Schools. Seems mostly like a locals' school, although there are some out-of-town students. Has good programs in Business, Computer Science, and Criminal Justice, among others. I had a very good feeling about this school when I walked around the campus. Clean, well-organized school. Consider it!
To find more tips for prospective students, what to do for fun and whether this school is great for a particular type of student read the 234 reviews for California State University-Sacramento
Curious about something that isn't answered here? Feel free to ask California State University-Sacramento a question
It's a very big campus. Many restaurants to choose from. Great grass area to sit, lay, or take a nap before your next class.Read More
Sac State is a medium-sized campus surrounded by restaurants, public transit, and lots and lots of trees. The college includes nature, a gym, and a free psychologist to help you when young adult life feels overwhelming. Keep in mind that certain majors are impacted, so it's best to make sure the one you want is available.Read More
Sacramento State is a wonderful school to get an education. The faculty are very helpful in every way they can be, and the campus is beautiful. One downfall is the impaction of students.Read More
CSUS is a great school with a friendly, professional staff and a laid-back atmosphere. It does not have the typical college experience feel to it, but it is the perfect choice for those who need to work while going to school. The business program is excellent and is a good value for the tuition.Read More
Its really nice I went there to take my English and math placement test. I didn't get to see the dorms but i couldn't. I got to see almost all of the campus and its really nice.Read More
Sac State is a great school to attend. Everyone from the students to the staff are extremely helpful. The environment is calm but fun and the way the professors teach the academics are easy if you attend class and pay attention.Read More
A premier campus with a diverse student body and a lot of activities that will keep you busy in your free time when you don't have homework.You will make friendships that may last a lifetime. A campus you should apply to.Read More
Sacramento State has everything you need. I am still discovering all the things that the campus offers from a bike shop to recreational pool hours. The university is full of options for each student to get involved in and feel at home.Read More
Sacramento state is a great campus. The fall time is the most beautiful time for Sacramento as the leaves of the trees are changing colors and the campus is look alive and vibrant. The professors are typically very helpful and kind allowing educational goals to be reached.Read More


text:
Fewer hours, fewer benefits
September 21, 2000
Part-time employees are much less likely than full-time employees to receive most workplace benefits.
In 1996-97, only 29 percent of part-time employees received paid leave for holidays, compared with 85 percent of full-time employees; 35 percent of part-timers got paid vacation time, versus 91 percent of full-timers.
Among part-time employees, 11 percent participated in medical care benefits and 8 percent in dental care—the corresponding full-time figures were 70 percent and 45 percent. Part-time employees participated in life insurance benefits at a rate of 11 percent and retirement plans at a rate of 20 percent, compared with 74 percent and 62 percent, respectively, for those working full time.
In general, lower participation in benefits among part-time workers may result from their not having been offered the benefit. For insurance and retirement benefits, however, lower participation also may stem from the fact that the lower pay of part-time workers would make them less able to pay for their share of such employer-provided benefits, causing them to decline coverage.
These data on benefits are the products of the Employee Benefits Survey. Read more in "Private Sector Employee Benefits, 1996-97" (PDF 38K), Ann C. Foster, Compensation and Working Conditions, Summer 2000.
Bureau of Labor Statistics, U.S. Department of Labor, The Editor's Desk, Fewer hours, fewer benefits on the Internet at http://www.bls.gov/opub/ted/2000/sept/wk3/art04.htm (visited September 22, 2014).
Spotlight on Statistics: Productivity
This edition of Spotlight on Statistics examines labor productivity trends from 2000 through 2010 for selected industries and sectors within the nonfarm business sector of the U.S. economy. Read more »


text:
PT Golden Energy Mines Tbk
Bituminous Coal And Lignite Surface Mining Indonesia
| Jakarta Stock Exchange: GEMS
PT Golden Energy Mines Tbk engages in the coal mining and trading activities. The company operates through two business segments: Coal Mining and Coal Trading. It produces bituminous and sub-bituminous coal products. The company was founded on March 13, 1997 and is headquartered in Jakarta, Indonesia.


text:
Share your comments
Please look after mom : a novel
Kyung-Sook Shin
Adult Fiction SIN
Kyung-Sook Shin
Adult Fiction SIN
Summary: Follows the efforts of a family to find the mother who went missing from Seoul Station and their sobering realizations when they recall memories that suggest she may not have been happy.
Be the first to add a comment! Share your thoughts about this title. Would you recommend it? Why or why not?
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text: SHEBOYGAN, Wis. (WHBL) - An incident which occurred one year ago has prompted a Sheboygan church to put up 100 bright red signs with the simple message "Jesus Loves You." Last year James Madison student Dexter Thielhelm was allowed to hand out Valentine's candy, but only after he removed the message "Jesus Loves You" due to Sheboygan Area School District policy. Pastor Christian Gugel of the Good Shepherd Lutheran Church said the incident at James Madison Elementary School, which is right across the street from the church, made a lasting impression, so this year the church is putting up its own signs to share that gospel message. Gugel said, "We knew we could share that message in the quiet way that it is by putting these signs in the neighborhood around the church and in our church's member's yard and the church yard." Pastor Gugel said a donation from a family in the congregation is paying for the signs.


text:
Credits & Info
- Views
- 3,739
- Score
- 4.24 / 5.00
- Date
- 02/14/2013
- Category
- Illustration
- File Info
- 601 x 850 px
- 529.2 kb
- Tags
- demon
- tcg
- inferno
- digital-painting
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Author Comments
Finally finished the inferno version of the demoness (http://www.newgrounds.co m/art/view/qikalain/demon ess?context=ratings:etm.u ser:3499086.scouted:.offs et:17)
I had to rush it this time, as the deadline is coming near and I have some other projects going on besides.
Rated 4 / 5 stars Mar 21, 2014
Awesome.. I see you have the same problem as me with the legs :). We just cant make them right!
Rated 4 / 5 stars Feb 14, 2013
so Demoness does that not mean it s female
cus it looks more like a normal ``male´´ demon
I tried to make it look both male and female, as I think a demon doesn't have to look like it belongs to one gender. Anyway i tried to give it some more female hips and thin legs, so it looks more female. I guess that did not work out too well :D


text:
The Louisiana
State Police said Thanksgiving proved to be a deadly holiday on roadways across
the state.
reported 14 people died in 13 crashes during the week.
One of the
deadly wrecks was in the Baton Rouge area.
Head, 29, of Maringouin died in a single-car accident on I-10 West near mile
marker 146, which is in West Baton Rouge Parish near the Iberville Parish line,
early Wednesday morning.
to reports, the car veered off the road and eventually ended up in some trees.
believe speed was a factor in the crash.
LSP said
although Head was wearing his seatbelt, he was partially ejected.
Lafayette area saw the most deadly wrecks of anywhere else in the state.
Six people
died in six separate crashes. One of the victims was a pedestrian, while
another was a motorcyclist.
Two people
were killed in a wreck in the Lake Charles area.
person was killed in an accident in the Alexandria area.
Two people
died in two crashes in the Monroe area.
Two other
people died in two wrecks in the Mandeville area.
said seven of the people killed over the holiday were not properly buckled and
two of the crashes involved impaired drivers.
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