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Chapter 7: Pregnancy and Childbirth. For use with Human Sexuality Today (4 th Ed.) Bruce King Slides prepared by: Traci Craig. Chapter Overview. Process of conception First Trimester Second Trimester Third Trimester Sexual Intercourse and Pregnancy. Complications of Pregnancy

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Chapter 7 pregnancy and childbirth l.jpg

Chapter 7: Pregnancy and Childbirth

For use with Human Sexuality Today (4th Ed.)

Bruce King

Slides prepared by: Traci Craig

Chapter overview l.jpg
Chapter Overview

  • Process of conception

  • First Trimester

  • Second Trimester

  • Third Trimester

  • Sexual Intercourse and Pregnancy

Complications of Pregnancy

Nutrition and Exercise

Preparing for Childbirth



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  • Release of FSHprimary follicle matures to become a Graafian follicle

  • Mid-cycle the Graafian follicle breaks open and releases the egg into the abdominal cavity.

  • Egg is picked up by one of the Fallopian tubes.

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  • Egg moves through Fallopian tube to the uterus3-7 day trip

  • Fertilization is only possible for 24 hours after the egg leaves the ovary.

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  • Male ejaculates 200-300 million sperm into the vagina.

  • Sperm pass through the cervix and uterus into the Fallopian tubes.

  • Fewer than 50 sperm survive to meet the egg in the Fallopian tubes. Live 3-5 days.

  • Sperm undergo capacitation in which their membranes thin so that they can release an enzyme to soften the egg’s outer layers.

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  • Egg then pulls one sperm to it’s surface.

  • Sperm releases enzyme and penetrates the egg’s softened surface.

  • No other sperm are allowed in.

  • Within 24-30 hours the nuclei of sperm and ovum fuse to form a zygote.

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  • Zygotes then undergo cell division.

  • The resulting morula continues to travel to the uterus.

  • At 100 cells with fluid filled centerblastocyst

  • May float in uterus for several days.

  • Size: Smaller than the head of a pin.

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  • The endometrium is receptive to implantation for 4-5 days.

  • 8-11 days after ovulation the blastocyst attaches to the endometrium via vili.

  • The blastocyst is now an embryo.

  • Trophoblastumbilical cord, amnion, chorion, placenta

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Implantation Problems

  • 75% of conceptions fail to implant or are spontaneously aborted within the first 6 weeks.

  • 20% fail prior to detection via pregnancy tests.

  • “weeding out” unhealthy or abnormal blastocysts.

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Ectopic Pregnancy

  • Implantation occurs inside the fallopian tube instead of the uterus. (Rare: cervix, abdomen, ovary implantation)

  • No expansion possiblecan be fatal if continues beyond 8 weeks

  • Rate has quadrupled in the last three decades.

  • Scarring of the Fallopian tubes (result and cause)

  • Treatment: laparoscopic surgery

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  • 260-270 days on average

  • Highly variable even within the same couple.

  • “Due Dates” rarely “Birth Dates”

  • 3—Trimesters (3 month periods)

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First Trimester: Mother

  • Pregnancy tests measure HCG in urine/blood.

  • Morning sicknessnausea and vomiting (any time of the day) –70-90% of women

  • Begins 4-6 weeks after conception peaks at 8-12 weeks.

  • Treatment: crackers, soda water

  • Men: same symptoms –couvade syndrome

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First Trimester: Mother

  • Enlarged tender breasts, darkened areolas, enlarged nipples, increase urination, irregular bowel movements, feeling tired and run-down.

    3rd month

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First Trimester: Embryo-Fetus

  • Cell differntatiaion

  • Embryo grows from the head down and spine outward.

  • Outer layers of the blastocyst nourish and protect

  • Ectoderm—Nervous system, skin, teeth

  • Mesoderm—muscles, skeleton, and blood vessels

  • Endoderm—internal organs

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First Trimester: Embryo-Fetus

  • Wk 3: neural tube is the dominant feature

  • Wk 4: umbilical cord, heart, digestive system

  • Wk 6: ‘tail’tip of the spine and neck and face begin

  • Wk 8: 1 1/8” long, heart pumps, stomach digests, and is a ‘fetus’

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Second Trimester: Mother

  • Mother can feel movements—1st quickening

  • Emotional attachment

  • Less abstract knowledge

  • Figures are changing, worry about not being attractive to partner, abdomen expands, red lines/stretch marks, breast swell and leak, edema, varicose veins, hemorrhoids, appetite increase.

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Second Trimester: Mother

  • Mother can feel movements—1st quickening

  • Emotional attachment

  • Less abstract knowledge

  • Figures are changing, worry about not being attractive to partner, abdomen expands, red lines/stretch marks, breast swell and leak, edema, varicose veins, hemorrhoids, appetite increase.

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Second Trimester: Fetus

  • 5th month—heartbeat

  • Responds to sound, light, thumbsucking

  • Sleep and wakes

  • At the end of the 2nd Trimester: 1 foot long and weighs 1 pound

  • If born1 in 10,000 chance of living

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Third Trimester: Mother

  • Walking, sitting, rising, are difficult.

  • Back pain, shift in center of gravity, weight gain (15-40 pounds), frequent urination (4-5 times a night)

  • Indigestion, heartburn, gas, and constipation, sleeping is uncomfortable, leg cramps, naval pushes out, low energy.

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Third Trimester: Fetus

  • 7th month: 15” long, and weighs 1 ½ lb.

  • 8th month: 16-17” long, weighs 4 lb.

  • 9th month: 20” long, weighs 7-7 ½ lb.

  • Covered with lanugo and vernix caseosa.

  • Vernix is allowed to absorb into the skin after birth.

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Sex during Pregnancy

  • Some increase interest: no fear of pregnancy, some women may express sexuality more fully.

  • Some decline in interest:

    • physical discomforttry new positions

    • woman feels unattractivemen do not think so

    • fear of harming the fetusstudies say it’s not harmful through the 8th month

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Sex during Pregnancy

  • Does sex=intercourse?

  • Important for pregnant women to feel loved and supported during this time.

  • Couples should discuss their concerns with each other, to avoid any misunderstandings about why sexual activity has changed.

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Complications of Pregnancy

  • Teratogens & Critical periods

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Complications: Diseases

  • Rubella virusbabies born blind, deaf, intellectually impaired. Vaccinations

  • HIV 20% chance baby will have HIV if mother has HIV

  • Herpesdeath/neurological damage

  • Gonorrhea/chlamydia: blindness

  • Syphilis particularly bad outcome for fetus.

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Toxemia of Pregnancy

  • Early stagespreeclampsia

  • 10% of pregnant women experience it

  • Protein in the urine, high blood pressure, weight gain, and swollen joints

  • Occurs in the last trimester, younger women during first birth.

  • Greater exposure to semenless preeclampsia

  • Treatment: calcium, bed rest, if eclampsia—induce labor prematurely

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  • 12% of pregnant women smoke

  • Associated with low birth weights, miscarriages, ectopic pregnancies, preterm births, infant mortality.

  • Babies have decreased respiratory function

  • Smoking during pregnancy increases risk of SIDs.

  • Second hand smoke can also have bad effects.

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  • Associated with Fetal Alcohol Syndrome

  • Physical deformities, mental retardation, CNS damage and perhaps other organ damage as well.

  • 3rd wk most damage, don’t drink if pregnancy is possible

  • Moderate consumption of alcoholFetal alcohol effect: emotional problems and inability to cope in school.

  • Breast feedinglow rate motor development and coordination

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  • 100,000 babies per year

  • Diminished growth during pregnancy

  • Preterm birth, decreased head circumference

  • Sensory-motor and behavioral deficits, irritability, and disorientation

  • Later learning and behavioral disorders

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Other Drugs

  • Heroin and marijuana also have negative effects.

  • Prescription and over the counter drugs are also harmful

  • Even aspirin can cause fetal circulation problems or complications during delivery

  • Caffeine—reduced birth weights

  • Too much Vitamin A—birth defects

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Rh Incompatibility

  • Rh factor: Rh negative mother and Rh positive baby can have detrimental effects for a second Rh positive child.

  • Rhogam injection can prevent this problem if given immediately after the first child birth or the first miscarriage of a fetus with Rh positive blood.

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Detecting Problems

  • Chorionic Sampling: small tube inserted through the vagina and cervix and removes some hair like cells from the chorion.

  • Viable test from week 8 to week 10

  • Detect chromosomal problems (Down syndrome)

  • Safer celocentesis needle b/w placenta and amniotic sac to retrieve cells.

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Detecting Problems

  • Amniocentesis: hollow needle through abdomen, uterus, and amniotic sac to withdraw amniotic fluid.

  • Viable test after 14th week

  • 1% chance of spontaneous abortion due to this procedure

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Detecting Problems

  • Fetoscopy: tube of fiber optic strands inserted into the amniotic sac to take fetus blood sample

  • Damage to fetus possible

  • Ultrasound: noninvasive, sound waves to create image of fetus

  • Detects malformation of skeletal system, cannot detect genetic defects.

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Fetal Surgery

  • Catheterize fetus to drain urine

  • Repairing hernia of diaphragm

  • Bone marrow transplant

  • Corrected spina bifida

  • Future: in utero gene therapy

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  • Genetic, anatomic, and hormonal causes

  • infections, autoimmune responses, cigarettes, cocaine

  • No diagnosis until after 3 miscarriages

  • Recurrent miscarriages occur in up to 1% of women

  • Grieving for fathers and mothers.

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Nutrition & Exercise

  • Eat well: good quality foods—every day at least

    • milk/yogurt, eggs & meat, leafy green vegetables, yellow vegetables, whole grains, potato, fresh fruit.

    • Folic Acid

    • Don’t DIET!!

  • Regular exercise: timely deliveries

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Preparing for Childbirth

  • Prenatal examination—including psychology

  • Fathers have a role too!

  • ‘medical model’ births

    • fear-tension-pain cycle.

    • Fear of hospital/strange situation  tension

    • Tensionincrease sensation of pain

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  • Lamaze: Pavlovian association—Create new associations with the sensations of labor

  • Anxiety and fear: pain is subjective, reduce fear through education, pre-register at the hospital, ‘coach’, focal point.

  • Muscle tension: practice relaxing tense muscles, relax when coach says ‘relax’

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  • Stretching muscles: tone up muscles used in labor and delivery

  • Too little oxygen to muscles: Breathing techniques, low-slow or pant-blow

  • Pressure on nerves: massage, ovals on skin of abdomen during contractions, small of back, counter-pressure

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Bradley Method

  • Pain is from culturally learned fear.

  • Childbirth without medication and husbands have a greater role than in Lamaze.

  • Women using this method are more likely to question doctors, and experience less medical interventions.

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Leboyer Method

  • Birth without Violence

  • Low lighting, place baby on mother’s abdomen immediately after delivery, wait to cut umbilical cord.

  • Baby put in warm bath

  • Ease transition from womb to out of womb

  • Hard to find a doctor willing to work with this method

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Home Birth & Modern Midwifery

  • Less expensive to give birth at home

  • Alternative for low risk pregnancies

  • Family present, more natural, more comfortable.

  • ‘Birthing rooms’ in hospitals are trying to compete. Let baby stay in room with mom.

  • Nurse-midwives rather than physicians

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Anesthetics or “Natural”

  • Anesthetics used to alleviate pain for mothermother can’t pushinfant pulled

  • Slapping babiesdrugs make them lethargic

  • Epiduralspinal anesthetic, complications include fever, longer labor, hypotension risk

  • Not a pain endurance contestC-section not equal to failure.

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  • Baby rotates so head is downward

  • Baby dropped (lightening)—feels less pressure on the abdomen and diaphragm

  • Burst of energy—better than she’s felt in months

  • Try to save energy for labor not ‘burn it off’

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True vs. False Labor

  • False labor: Braxton-Hicks contractions subside.

  • Real labor:

    • contractions 10 minutes apart (or less) on a regular basis

    • contractions are 30 seconds long

    • Cervix dilates

    • Cervix effacement

    • Longer with first child

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Stages of Labor

  • Start-up stage

  • 6-13 hours

  • Uterine contractions push fetus toward cervix

  • Cervix dilates, effaces

  • Contractions 1-2 minutes apart, 45-60 seconds long

  • Discharge mucus and blood

  • ‘water breaks’ if not then in the US physician breaks the amniotic sac

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Stages of Labor

  • Transition phase

  • Cervix is almost fully dilated (8-10cm)

  • Severe contractions

  • Nausea, chilled, uncomfortable

  • Women want to quit, feel there is no end.

  • Lasts 40 minutes or so

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Stages of Labor

  • Second stage

  • Cervix is fully dilated and the fetus begins moving through birth canal.

  • Intense desire to push

  • Mothers get ‘second wind’

  • 30-80 minutes

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Stages of Labor

  • Crowning

  • Crown of head leads the way

  • Check the umbilical cord to make sure it isn’t around the neck

  • Baby’s nose and mouth are suctioned

  • Shoulders and body quickly follow

  • Baby cries at birth or is rubbed to start breathing

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Stages of Labor

  • Umbilical cord clamped and cut about 1 ½ inches from the baby’s body (does not cause navel ‘inny’ or ‘outty’)

  • Third stage

    • Placenta detaches from uterus and leavest eh bodyafterbirth

    • If not all expelled then a dilation and curettage is performed.

    • Tears in vagina repaired

    • Uterus should then contract and remain constricted

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  • In the US, 43% of women who deliver vaginallyepisiotomy

  • An incision through the perineum

  • Useful if the baby is in distress

  • Women who do not have episiotomies have fewer problems, less urinary tract infections, and less damage to the perineum.

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  • When sewing up the incision ’honeymoon’ stitch or ‘husband’s stitch’

  • Shaving the pubic hairincreased infection

  • Both procedures are unnecessary and potentially should be abandoned as routine procedures.

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Problems with Childbirth

  • 600,000 women die as a result of childbirth every year

  • Breech births—2-4% of all births

    • Feet or buttocks first (not head first)

    • Change position of mom to encourage fetus to move

    • Physician can turn fetus through mother’s abdomen

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Placenta Previa

  • Implantation in the lower uterus

  • This blocks the cervical opening

  • Prevents vaginal delivery

  • Does not affect the fetus.

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Cesarean Sections

  • Incision through abdominal walls and uterine walls to deliver baby

  • 21% of births in the US in 1997

  • Incisions today are horizontalfuture births may be vaginal

  • Check the physician’s attitude about this procedure

  • 31% of American women would prefer C-section

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Preterm Infants

  • 7-10% of all US births

  • Drugs to postpone labor

  • Respiratory Distress Syndrome

  • 80% of 2 ½ pound infants survive

  • Cost is high: $300,000 for a premature infant

  • As children preterm babies may have further problems.

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  • Lactation begins 3 days after birth

  • Prolactin causes production

  • Oxytocin causes ejection

  • Eventually even the infant’s cry can cause ejection.

  • First colostrum, high in protein, immunizes infant for the first three days

  • Average 2 ½ - 3 cups per day

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  • Helps baby deal with gastrointestinal illnesses, respiratory infections, meningitis, skin disease.

  • Helps mother’s uterus contract and stops internal bleeding

  • If a woman does not breast feed then the milk production stops.

  • Father’s should be involved too.

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Postpartum Depression

  • Postpartum blues: depressed mood, confusion, anxiety, crying. Lasts 2-3 wks.

  • Postpartum depression: deeper depression, anxiety, guilt, fatigue, obsessive-compulsive. Ashamed/guilty about inadequacy as a mother

  • Postpartum psychosis: affective symptoms and hallucinations

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Postpartum Depression

  • Hormonal changes, drop in estrogen and progesterone

  • Marital happiness & lack of support contribute to depression

  • Stress factors, low SES, multiple children, little help from partner

  • Influences infant’s emotional, behavioral and cognitive development.

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Sexual Intercourse after Birth

  • Episiotomies can make intercourse more painful, uncomfortable after birth

  • Vaginal bleeding continues for 2-6 weeks in most women.

  • Physicianswait 4-6 weeks

  • Women may worry about appearance

  • Infants are demanding lots of time

  • New role adjustments

  • Wait 18-23 months to get pregnant again

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New Responsibilities

  • Giving birth or being a father does NOT mean a person should have natural parenting ability or ‘instinct’

  • Fathers tend to be upset by decreased sexual activity and mood swings, but do little to alleviate the stress on mothers.

  • Sharing childcare and housekeepingmore happiness within the marriage.

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Infertility and Impaired Fecundity

  • Men over 35 have fewer and lower quality sperm so may take longer to conceive

  • Pollutantsincreased number of boys born with risk for testicular cancer

  • Alternatives: artificial insemination, or intracytoplasmic sperm injection (injecting egg with a single sperm)

  • Seperating X & Y is now possible to attempt to select sex of child.

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Infertility and Impaired Fecundity

  • Structural problems and failure to ovulate

  • Structural problemslaparoscopic surgery

    • Endometriosisscarring

  • Ovulationdrug treatment

    • Increase multiple births

    • Increase risk of ovarian cancer

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Assisted Reproductive Technology

  • In vitro fertilization—eggs and sperm combined then placed in the uterus to implant

  • Gamete Intrafallopian Transfer—egg and sperm inserted into fallopian tube

  • Zygote Intrafallopian Transfer—fertilized eggs into the fallopian tube

  • Major surgery and risk of multiple births

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Surrogate Motherhood

  • Controversial

  • Create a zygote in vitro and have surrogate woman carry the fetus to term

  • Legal issues, laws vary by state

  • Emotional experience and psychological factors should be considered carefully

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  • Demand for children is high

  • Long waits (months or years) to find and adopt a healthy child.

  • Adopting special needs children or children of other nationalities.

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  • World Record: Leontina Albina of Chile gave birth to 59 children

    • Married at 12 and continue to have children until 50

  • Six or more pregnancies increase risk of heart disease and cardiovascular disease.