Chapter Twelve

1
Chapter Twelve

• Pregnancy and Birth

2
Issues Associated with Pregnancy and Birth

• Fertility
• Assisted Reproduction
• A Healthy Pregnancy
• Health Care During Pregnancy
• Problems in the Pregnancy
• Childbirth
• Problems During Birthing
• Postpartum Parenthood

3
Self Reflection Exercise

• Do you want to have children? Why or why not?
• If you do desire children, at what age would you
  like to have your first child? How many children
  would you like to have? Why?
• How would you like to have your children spaced?
  Why?
• Would you rather have a boy or girl first? How
  many boys and girls would you like to have? Why?
• What would you like to name your children? Why?
• Would you dress your girls in pink and boys in
  blue? Why or why not?
• How would your parents feel about grandchildren?

4
Deciding Whether to Have Children
What is your response to these two couples?
5
Fertility

• Conception
• Early Signs of Pregnancy
• Pregnancy Testing
• Sex Selection

6
Conception The Incredible Journey

• Our bodies are designed to promote pregnancy
• During ovulation
• A womans sexual desire peaks
• A mucus plug in the cervix disappears
• Cervical mucus thins creates gaps that vibrate
  with the sperm to aid motility and trap defective
  sperm filters bacteria from semen
• Female orgasm pushes semen to the uterus and
  toward the Fallopian tubes
• Semen thickens upon ejaculation to stay in the
  vagina for 20 minutes to aid sperm travel

7
Conception The Incredible Journey

• The ovum can live for 24 hours
• Sperm can live for 72 hours less than 1 can
  live up to one week
• Pregnancy may occur a few days before or after
  ovulation
• The ovum may release chemicals to signal its
  location
• If a sperm reaches the ovum, it wriggles violently

8
Conception The Incredible Journey

• Only one sperm fertilizes an ovum by secreting a
  chemical that makes a hole in the ovum coating
• Immediately the ovum coating changes does not
  permit further sperm from entering
• Fertilization takes about 24 hours, usually in
  the ampulla
• Zygote a fertilized ovum

9
Conception The Incredible Journey

• About 12 hours after fertilization, the first
  cell division occurs the blastocyst divides
  every 12 to 15 hours as it travels towards the
  uterus
• 3-4 days after conception, it enters the uterus
  absorbs nutrients from endometrial glands
• 6th day after conception, a uterine chemical
  dissolves the blastocyst coating, allowing
  implantation into the uterine wall, typically the
  upper portion

10
Conception The Incredible Journey

• After implantation, the blastocyst divides into
  two layers, the endoderm ectoderm, followed
  shortly by the mesoderm
• Embryo developing cell mass of 2-8 weeks
• Amnion membrane covering the embryo that fills
  with protective fluid
• Placenta attached to the uterine wall, it aids
  the fetus in respiration, nutrition, excretion
• Umbilical cord connects fetus to placenta

11
Conception The Incredible Journey

• Multiple births occur in 1 out of 50 couples
• Fraternal twins two ova are released
  fertilized 2/3 of twins are fraternal dizygotic
• May be inherited from the mothers
• More likely with women over 30
• Identical twins single zygote divides into 2
  separate zygotes monozygotic
• Siamese twins fail to completely separate

12
Pregnancy
13
Early Signs of Pregnancy

• Missing a period, or maybe some spotting
• Breast tenderness, frequent urination, food
  aversions
• Morning sickness
• 50-80 of pregnant women experience nausea /or
  vomiting, any time of the day
• Due to increased estrogen progesterone
  irritating the stomach lining
• May protect the fetus from illness

14
Pregnancy Testing Confirming the Signs

• Over-the-counter pregnancy tests
• Can be less expensive at a clinic
• The tests measure for human chorionic
  gonadotropin (hCG), which is made by placental
  cells
• Detection in blood or urine can occur 8-9 days
  after ovulation
• hCG levels peak in the 2nd 3rd months

15
Pregnancy Testing Confirming the Signs

• May be inaccurate if tested too soon or after the
  12th week
• False positives may occur with kidney disease,
  kidney infection, overactive thyroid, large doses
  of tranquilizers, aspirin, antidepressants,
  anticonvulsants
• Radioimmunoassay (RIA) blood tests are the most
  accurate, can detect hCG within a few days after
  conception

16
Pregnancy Testing Confirming the Signs

• Due date calculated from the first day of the
  last menstrual period
• Naegeles rule subtract 3 months from the first
  day of the last period and add 7 days for a
  single birth
• Rule is most accurate for women with 28-day cycles

17
Sex Selection
18
Sex Selection Myth and Modern Methods

• More male babies are born each year
• Male fetuses have higher rates of spontaneous
  abortion or die before birth
• There are many cultural myths for choosing and
  knowing the gender of an unborn child
• There are medical techniques that can aid in
  choosing and determining fetal sex

19
Sex Selection Myth and Modern Methods

• Microsorting can separate the X and Y sperm,
  which is then artificially inseminated
• Male conception is 50-70 accurate
• Female conception is 50-90 accurate
• Embryos can be tested and the desired sex embryo
  then implanted
• Amniocentesis involves removal of amniotic fluid
  through a needle during week 16 or 17 detects
  chromosomal abnormalities gender

20
Sex Selection Myth and Modern Methods

• Controversy surrounds gender selection
• Male children are typically valued over females
  in other countries because
• They typically care for their aged parents
• Girls require dowries to be paid at their
  marriage
• Males carry on the family name
• Female infanticide is a problem in rural India
  and in China

21
Assisted Reproduction

• What is Assisted Reproduction?
• Assisted Reproductive Options

22
What Is Assisted Reproduction?

• Infertility the inability to conceive, or
  impregnate, after one year or regular sexual
  intercourse without the use of birth control
• Infertility may be diagnosed after only 6 months
  for women over 35 years
• About 20 of U.S. couples of reproductive age are
  infertile 8-10 in developed countries

23
What Is Assisted Reproduction?

• Negative emotions are often experienced with the
  frustration of infertility
• Women tend to be more committed to finding a
  solution than their partners
• Motherhood mandate there is a problem with a
  woman if she does not care for a child
• Some reproductive problems can be reduced with
  changing lifestyles, reducing stress, avoiding
  strenuous exercise, average weight

24
What Is Assisted Reproduction?

• 70 of the time the problem can be found in one
  of the partners
• 40 female (ovulation disorders, blocked
  Fallopian tubes, endometriosis, uterine fibroids,
  uterine structure, STIs)
• 30 male (lack of sperm, reduced or malformed
  sperm production, STIs)
• 20 of the time it is a combined problem
• 10 the reason is unknown

25
Assisted Reproductive Options

• Fertility Drugs
• Surgery
• Artificial Insemination
• In Vitro Fertilization
• Gamete Intra-Fallopian Tube Transfer
• Zygote Intra-Fallopian Tube Transfer
• Zonal Dissection
• Intracellular Sperm Injections
• Oocyte and Embryo Transplants
• Surrogate Parenting

26
Assisted Reproductive Options

• Artificial methods of conception are used by
  those experiencing infertility, those without a
  partner, and gay couples
• These methods may also cause further stress
  because they are expensive, time consuming, and
  may not work
• Type of treatment depends on length of
  infertility, the womans age, likelihood of
  conceiving without treatment

27
Fertility Drugs

• Hormonal irregularities may need to be treated
  with fertility drugs
• The drugs increase ova production, which
  increases the possibility of multiple births
• Possible increased risk of breast and ovarian
  cancer

28
Surgery

• Structural abnormalities in the cervix, vagina,
  Fallopian tubes, or endometrium may be surgically
  corrected
• Surgery can also be used to remove blockage of
  the vas deferens or epididymis

29
Artificial Insemination

• Insertion of sperm into the vagina, cervix,
  uterus, or Fallopian tubes without intercourse
• Ejaculated sperm is collected via masturbation by
  the partner or a donor
• Sperm banks can freeze treated and washed sperm
  for up to 10 years
• Donor catalogs are available, and sperm is sent
  to a physician
• Fertility drugs are often used in combination

30
In Vitro Fertilization

• Test-tube babies are conceived in a petri dish,
  then implanted in the uterus
• Fertility drugs encourage the release of many ova
  and 4-6 are retrieved, although drugs arent
  always used
• The ova are put in a dish and mixed with sperm
  the zygotes are implanted
• Only 5-30 implant, so many are often implanted

31
Gamete Intra-Fallopian Tube Transfer

• Ova and sperm are placed in the Fallopian tube
  before conception
• Fertility drugs and sperm washing are also used
• Higher implantation rate than in vitro
  fertilization

32
Zygote Intra-Fallopian Tube Transfer

• Fertilization occurs outside of the body
• The zygote is placed in the Fallopian tube,
  allowing it to implant naturally
• Higher implantation rates than in vitro, but not
  higher than gamete intra-fallopian tube transfer

33
Zonal Dissection

• A microscopic hole is drilled into the ovum or a
  chemical is used to dissolve the outer shell of
  the ovum
• Problem is that several sperm may enter at the
  same time and cause developmental problems

34
Intracellular Sperm Injections

• A single sperm is injected into the center of an
  ovum
• Helps if sperm counts are low or have low
  motility
• 52 pregnancy rates
• The ovum can be damaged
• Possible increased risk of genetic defects

35
Oocyte and Embryo Transplants

• For women who cannot produce healthy ova
• Eggs and embryos from other women may be donated
• 25-33 birth rates
• Fertility drugs are necessary to synchronize both
  womens menstrual cycles
• High success rates

36
Surrogate Parenting

• Another womans uterus is used to carry a
  pregnancy
• Ova and sperm are fertilized outside of the body
  and the zygote is implanted in the gestational
  carrier
• If the surrogates ova is used, the carrier is
  called a surrogate mother

37
Other Options

• Embryos and sperm can be frozen for later use
• Often used by those undergoing cancer treatment
  that want to have children
• Sometimes sperm do not survive the thawing
• Not all embryos survive the freezing and thawing
• It is much more difficult to freeze an ova, they
  are very vulnerable to chromosomal damage

38
A Healthy Pregnancy

• The Prenatal Period Three Trimesters
• The Fathers Experience

39
The Prenatal Period Three Trimesters

• Pregnancy lasts 40 weeks, and each trimester is
  about 12-15 weeks long

40
Video The Miracle of Life
41
First Trimester

• 1-13 weeks
• The fetal heart forms and pumps blood by the end
  of the first month, as the circulatory system is
  the first to function
• Other systems begin to develop nervous,
  digestive, urinary, reproductive, appendages
• Liver, kidneys, intestines, lungs begin
  developing by the end of this trimester
• At the end, the fetus is ½ ounce 3 inches

42

• An embryo at 7 to 8 weeks. This embryo is
  approximately 1 inch long.

43
First Trimester

• The womans heart pumps more blood, body gains
  weight, thyroid gland grows, lungs and digestive
  system work harder
• Increases in estrogen progesterone can cause
  fatigue, breast tenderness, constipation,
  increased urination, nausea, vomiting, food
  cravings, smell sensitivity
• Ultrasound can detect the fetal heartbeat and
  image as soon as 5 ½ - 6 weeks

44
Second Trimester

• 14-28 weeks
• Reflexes and tooth buds develop
• Ultrasound may pick up gender around 20-22 weeks
• Movements can be felt by the mother
• Lanugo and vernix cover the fetus to protect it
  from amniotic fluid
• At the end, the fetus is 1¾ pounds 13 inches

45

• At five months, the fetus is becoming more and
  more lively. It can turn its head, move its
  face, and make breathing movements. This fetus
  is approximately 9 inches long.

46
Second Trimester

• In the mother, nausea subsides
• Fatigue may continue, appetite increases, and
  other signs show heartburn, edema, vaginal
  discharge, skin pigmentation, muscle cramps,
  varicose veins, hemorrhoids
• Increased blood supply restriction of veins
• Positive time for mother, positive emotions,
  increased sex drive satisfaction, maternity
  clothes, feel the baby moving

47
Third Trimester

• 28-40 weeks
• The fetus develops fat deposits, hiccups
• The fetus can suck its thumb and react to light,
  pain, sounds
• 8th month most organ systems are well developed,
  though the brain continues growing
• At the end, the fetus is 7½ pounds 20 inches

48

• A fetus at nine months, ready for birth.

49
Third Trimester

• Many symptoms from the second trimester continue
  and increase in frequency, as blood supply is
  large, and there is a large weight gain
• Backaches, leg cramps, sleep problems, shortness
  of breath, and Braxton-Hicks contractions may
  occur
• Colostrum may be secreted by the breasts in
  preparation for breast feeding

50
The Fathers Experience

• Upcoming parenting and changes in their partner
  can make a man feel vulnerable
• Joy, anticipation, stress, and anxiety are all
  common feelings
• Fathers are allowed and encouraged to be in U.S.
  delivery rooms

51
Health Care During Pregnancy

• Exercise and Nutrition
• Drugs and Alcohol
• Pregnancy in Women over 30
• Sex during Pregnancy

52
Exercise and Nutrition

• Exercise during pregnancy should not exceed
  prepregnancy exercise levels
• Light exercise is suggested water exercise
• Although the implanted embryo is difficult to
  dislodge, some sports are to be avoided water
  skiing, horseback riding, racquet sports, scuba
  diving, contact sports
• Avoid reduced blood flow to the uterus
• Drink a lot of water

53
Exercise and Nutrition

• Increased protein, iron, calcium, folic acid, and
  vitamin b6 are needed in pregnancy
• 300 more calories per day are also necessary for
  a healthy pregnancy
• Poor nutrition may cause low birth weight babies
  and problems for the infant, such as
  cardiovascular disease, hypertension, and
  diabetes
• Prenatal vitamins are often recommended

54
Drugs and Alcohol

• Many substances should be avoided during
  pregnancy to avoid fetal defects caffeine,
  nicotine, alcohol, marijuana, other drugs
• Fetal Alcohol Syndrome (FAS) an undersized and
  mentally deficient infant due to a mother
  drinking heavily during pregnancy
• 11 of U.S. women smoke while pregnant,
  increasing risk of spontaneous abortion, low
  birth weight, low iron, brain damage,
  prematurity Drugs and Alcohol

55
Pregnancy in Women over 30

• An increasing number of women are delaying
  childbearing for educational career goals
• Delayed pregnancy risks spontaneous abortion,
  first-trimester bleeding, low birth weight,
  increased labor time, c-section
• Chromosomal abnormalities increase for women over
  30 and men over 55
• Sharp decline in fertility for women after 40

56
Sex during Pregnancy

• Sex is safe for most with uncomplicated
  pregnancies, as is orgasm, until the last few
  weeks of pregnancy
• Both partners may have changes in sexual desire
• Fear of injuring the fetus is often cited as a
  reason for decreased sexual interest
• Some positions are difficult and this restricts
  the variety of intercourse

57
Problems in the Pregnancy

• Ectopic Pregnancies
• Spontaneous Abortions
• Chromosomal Abnormalities
• Rh Incompatibility
• Toxemia

58
Ectopic Pregnancies

• The zygote implants outside of the uterus
• 2 of U.S. pregnancies are ectopic
• 97 of ectopic pregnancies occur in the Fallopian
  tubes
• 3 occur in the cervix, ovaries, abdomen
• Increased risk for ectopic pregnancies if had
  STIs, a smoker, previous ectopic pregnancy
• Symptoms abdominal pain, cramping, bleeding,
  nausea, dizziness, fainting

59

• In an ectopic pregnancy, the fertilized ovum
  implants outside the uterus. In most cases, it
  remains inside the Fallopian tube.

60
Spontaneous Abortions

• A natural termination of a pregnancy before fetal
  survival a miscarriage
• 10 of diagnosed pregnancies miscarry
• 20-40 are miscarried before diagnosis
• Most miscarry because of a chromosomal
  abnormality
• Other reasons uterine capability, stress, poor
  nutrition, drugs, pelvic infection, defective
  sperm

61
Spontaneous Abortions

• Symptoms bleeding, cramps, lower back pain
• Menstruation usually returns in 3 months
• Future pregnancies can be normal

62
Chromosomal Abnormalities

• Chromosomal abnormalities may be detected by
  amniocentesis, chorionic villus sampling,
  maternal-serum alpha-fetoprotein screening
• CVS piece of chorionic tissue is tested as
  early as 10-11 weeks
• Risk of miscarriage limb damage
• MSAFP blood test at 16-18 weeks
• Blood samples can also be drawn from the
  umbilical cord

63
Chromosomal Abnormalities

• Risk for abnormalities increases with a womans
  age
• Most common is Down syndrome, where there is an
  extra 21st chromosome
• 1/1000 live births

64

• Mothers Age and Risk of Chromosomal Abnormality

65
Rh Incompatibility

• Rh factor natural part of red blood cells in
  some people
• If the mother is Rh- baby is Rh (from the
  father), fetal blood that comes in contact with
  her blood during delivery (not pregnancy) will
  cause her to create antibodies
• This can affect future pregnancies
• Rhogam is given to her after delivery to prevent
  the formation of antibodies

66
Toxemia

• 6-7 of women experience toxemia, or preeclampsia
  in the last 2-3 months
• Symptoms rapid weight gain, fluid retention,
  increased blood pressure, protein in the urine
• If not controlled, eclampsia can result, which
  includes convulsions, coma, in 15 of cases,
  death
• Primarily affects those that lacked good prenatal
  care

67
Childbirth

• Preparing for Birth
• Birthplace Choices
• Inducing the Birth
• Birthing Positions
• Stages of Childbirth

68
Childbirth

• Normal birth occurs 3 weeks before to 2 weeks
  after the due date
• 4 are born on the due date in the U.S.
• Early deliveries more likely if female fetus,
  mother exercised during pregnancy, mother has
  shorter menstrual cycles
• More babies born between July October and
  between 1 7 a.m.
• Pitocin or nipple stimulation may hasten labor

69
Preparing for Birth

• Lamaze similar birthing classes increase
  knowledge and reduce anxiety
• They teach what to expect and how to control pain
  with breathing and massage
• Anxiety during labor increases pain, discomfort,
  fatigue
• Engagement fetus moves to head down position a
  few weeks before birth 97 of the time

70
Birthplace Choices

• 80 of births worldwide occur at home
• Home birth is as safe as hospital delivery for
  low-risk pregnancies
• Most babies in the U.S. are born in hospitals
• Some hospitals have more comfortable birthing
  centers available

71
Inducing the Birth

• Drugs can be given to induce, and hasten the
  progression of, labor
• May create more painful and prolonged
  contractions
• Birth may occur a few hours to days after
  induction
• In 1998, 19 of U.S. births were induced
• Reasons past due date, avoid having a large
  baby, labor is not progressing, scheduling

72
Birthing Positions

• In the U.S., most hospitals use a semi-reclined
  position with feet in stirrups
• One possible reason for this position is that it
  is easier for doctors
• A woman on her hands knees or who is squatting
  widens her pelvis cervix and using gravity to
  aid in the delivery
• Underwater birth can make labor less painful for
  women and less traumatic for infants

73
Stages of Childbirth

• Stage One Cervical Effacement Dilation
• Stage Two Expulsion of the Fetus
• Stage Three Expulsion of the Placenta

74
Stage One

• Can last 20 minutes to 24 hours
• This stage is longer in first births
• Cervix dilates the os goes from 0 to 10 cm
• Cervix thins out (effacement)
• Early labor
• Amniotic sac ruptures
• Cervix dilates to 4-5 cm
• Contractions last 30-60 seconds with 5-20 minute
  intervals

75
Stage One

• Active labor
• Contractions last 1 minutes, are more intense,
  and occur every 1-3 minutes
• Cervix dilates to 8 cm
• Transition
• Very intense, long, frequent contractions
• Cervix dilates to 10 cm
• Fetus moves to pelvic base, creating an urge to
  push

76
Stage One

• The woman produces endorphins, pain reducing
  hormones
• Pain medications may also be given, though they
  may cause drowsiness or nausea and may affect the
  fetus
• Relaxation techniques, breathing, acupuncture
  have been used to provide relief
• Fetal monitoring checks for fetal distress
  through the abdomen or the fetuss scalp

77
Stage Two

• Contractions become less intense, last 60 seconds
  every 1-3 minutes
• Episiotomies are performed in 40 of U.S. births,
  though they are controversial
• While pushing during contractions, the babys
  head appears (crowning)
• When the face appears, mucus fluid are removed
  from the mouth nostrils

78
Stage Two

• Umbilical cord is cut after the first breath
• Eye drops are put in the babys eyes to prevent
  bacterial infection
• Newborn is placed on the mothers chest to begin
  bonding
• Apgar test may be performed to check the well
  being of the infant

79
Stage Three

• Contractions continue after the birth
• The placenta (after-birth) is expelled about 30
  minutes after the birth
• All of the placenta must be expelled
• If there was an episiotomy or tearing, the woman
  is sewn up

80
Problems During Birthing

• Premature Birth
• Breech Birth
• Stillbirth
• Cesarean Section Delivery

81
Premature Birth The Hazards of Early Delivery

• Premature births occur before the 37th week
• 8 of U.S. births are premature
• Prematurity increases the risk of defects
  infant mortality
• Reasons early labor or rupture of amniotic sac,
  maternal or fetal problems, multiple fetuses,
  smoking during pregnancy, alcohol drug use,
  poor nutrition or weight gain, infections,
  teenage pregnancy, heavy labor

82
Breech Birth Feet First into the World

• Breech position the fetus has the feet or
  buttocks towards the cervix
• Occurs in 3-4 of births
• Some doctors can rotate the fetus for vaginal
  delivery, or even deliver it safely in this
  position
• Cesarean section may be performed for the safety
  of the baby and mother

83

• In 3 to 4 of births, the fetus is in the breech
  position, with feet and buttocks against the
  cervix.

84
Stillbirth Sad Circumstance

• Stillbirth - a fetus that dies after 20 weeks
• Causes birth defects, placental problems,
  umbilical cord accidents, infections, maternal
  diabetes or high blood pressure
• Typically the woman goes into labor about 2 weeks
  after the fetus has died

85
Cesarean Section (C-Section) Delivery

• The baby is delivered through an incision in the
  abdominal wall
• 21 of U.S. deliveries, which is an increase from
  a few decades ago
• Reasons for the increase women waiting longer to
  have children, easier safer procedure, fear of
  malpractice suits

86
Cesarean Section (C-Section) Delivery

• Necessary when baby is too large, woman cannot
  push, placenta previa, cervix does not fully
  dilate, fetal distress
• Procedure occurs in an operating room under
  general anesthesia or an epidural
• Lasts 20-90 minutes
• Requires longer hospital stay
• Can become pregnant and deliver vaginally in the
  future

87
Postpartum Parenthood

• More Physical Changes for the Mother
• Postpartum Psychological Changes
• Sexuality for New Parents
• Breast-Feeding the Baby

88
More Physical Changes for the Mother

• 6 weeks after birth, the uterus returns to its
  original shape
• This may be sooner in breast-feeding women
• Bloody discharge lasts for at least a week after
  delivery
• May be advised to take sitz baths if an
  episiotomy or tear occurred during delivery

89
Postpartum Psychological Changes

• Most women are exhausted and experience minor
  sadness due to increased responsibility,
  physiological changes, exhaustion, hormonal
  changes such as a sudden drop in progesterone
• Postpartum depression severe case of sadness
  with crying spells anxiety
• Postpartum psychosis most severe cases that
  include mental disturbances

90
Sexuality for New Parents

• Most are advised to wait 6 weeks before resuming
  intercourse to insure no infection occurs
• Sex may be safe in 2 weeks if there was an
  uncomplicated vaginal delivery
• Cesarean section incisions heal in about 2 weeks
  and intercourse is safe at this time
• 3 months postpartum, most return to original
  levels of desire excitement

91
Breast-Feeding the Baby

• Infant shows a rooting reflex within an hour
  after birth, signaling hunger
• Sucking triggers flow of milk from the breast
  through receptors in the nipples
• These receptors signal to the pituitary to
  produce prolactin
• Oxytocin is also produced, which helps
  contractions of the uterus to shrink the uterus

92
Breast-Feeding the Baby

• Colostrum the fluid produced by the breasts in
  the first few days of breastfeeding that
  strengthens the babys immune system
• American Academy of Pediatrics recommends
  exclusive breast-feeding for 6 months,
  continued for at least one year
• World Health Organization recommends exclusive
  breast-feeding for 4-6 months, continued for at
  least 2 years

93
Breast-Feeding the Baby

• At 6 months, only 29 of American women
  breast-feed
• Natural age of weaning is 2 1/2 years, and the
  maximum is 6-7 years

94
Class Exercise Discuss Handout 12.2