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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

Chapter 7: Pregnancy and Childbirth

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

Bruce King

Slides prepared by: Traci Craig

chapter overview
Chapter Overview
  • Process of conception
  • First Trimester
  • Second Trimester
  • Third Trimester
  • Sexual Intercourse and Pregnancy

Complications of Pregnancy

Nutrition and Exercise

Preparing for Childbirth

Childbirth

Infertility

conception
Conception
  • 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.
conception4
Conception
  • 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.
conception5
Conception
  • 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.
conception6
Conception
  • 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.
conception7
Conception
  • 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.
implantation
Implantation
  • 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
implantation problems
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.
ectopic pregnancy
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
pregnancy
Pregnancy
  • 260-270 days on average
  • Highly variable even within the same couple.
  • “Due Dates” rarely “Birth Dates”
  • 3—Trimesters (3 month periods)
first trimester mother
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
first trimester mother13
First Trimester: Mother
  • Enlarged tender breasts, darkened areolas, enlarged nipples, increase urination, irregular bowel movements, feeling tired and run-down.

3rd month

first trimester embryo fetus
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
first trimester embryo fetus15
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’
second trimester mother
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.
second trimester mother17
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.
second trimester fetus
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
third trimester mother
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.
third trimester fetus
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.
sex during pregnancy
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
sex during pregnancy22
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.
complications of pregnancy
Complications of Pregnancy
  • Teratogens & Critical periods
complications diseases
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.
toxemia of pregnancy
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
smoking
Smoking
  • 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.
alcohol
Alcohol
  • 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
cocaine
Cocaine
  • 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
other drugs
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
rh incompatibility
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.
detecting problems
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.
detecting problems32
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
detecting problems33
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.
fetal surgery
Fetal Surgery
  • Catheterize fetus to drain urine
  • Repairing hernia of diaphragm
  • Bone marrow transplant
  • Corrected spina bifida
  • Future: in utero gene therapy
miscarriage
Miscarriage
  • 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.
nutrition exercise
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
preparing for childbirth
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
lamaze
Lamaze
  • 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’
lamaze39
Lamaze
  • 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
bradley method
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.
leboyer method
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
home birth modern midwifery
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
anesthetics or natural
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.
childbirth
Childbirth
  • 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’
true vs false labor
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
stages of labor
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
stages of labor48
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
stages of labor49
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
stages of labor50
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
stages of labor51
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
episiotomy
Episiotomy
  • 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.
episiotomy53
Episiotomy
  • 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.
problems with childbirth
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
placenta previa
Placenta Previa
  • Implantation in the lower uterus
  • This blocks the cervical opening
  • Prevents vaginal delivery
  • Does not affect the fetus.
cesarean sections
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
preterm infants
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.
breast feeding
Breast-feeding
  • 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
breast feeding59
Breast-feeding
  • 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.
postpartum depression
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
postpartum depression61
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.
sexual intercourse after birth
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
new responsibilities
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.
infertility and impaired fecundity
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.
infertility and impaired fecundity65
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
assisted reproductive technology
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
surrogate motherhood
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
adoption
Adoption
  • 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.
superfertility
Superfertility
  • 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.
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