Conception, Pregnancy, & Parenting

Conception, Pregnancy, & Parenting Human Sexuality Rhonda Martin, M.S., R.N.

Parenthood as an option • Advantages of remaining childless • more time for self • more financial resources for self or relationship • more spontaneity re: work, social activities, recreation • more devotion to career; possibly more career fulfillment

Parenthood as an option • Advantages of remaining childless • more time & energy for companionship & intimacy in adult relationship • no conflict over childcare duties • less stressful; may be happier, more satisfying marriage

Parenthood as an option • Advantages to having children • children give & receive love • may enhance relationship as couple shares experience of raising child • builds self-esteem, sense of accomplishment • opportunity to discover new self-dimensions that provide greater meaning & satisfaction

Parenthood as an option • Advantages to having children • ongoing stimulation • adoptive parenting motivated by *overpopulation concerns *desire to give parentless child love & security *infertility

Becoming pregnant • Enhancing the possibility • intercourse just prior to or at ovulation • predicting ovulation *mucus, calendar, BBT methods *ovulation-predictor urine tests

Becoming pregnant • Infertility • Diagnosis • > 6 months of trying = problem • 1 in 6 U.S. couples seek help • Causes • complex, hard to determine • unidentifiable in 15%

Male infertility abnormal sperm count or motility impaired sperm production Female infertility failure to ovulate regularly female may destroy sperm sperm may not reach the egg fertilized egg may not implant Becoming pregnant

Becoming pregnant • Effects on sexuality •  anxiety, depression, & stress  isolation from each other •  inadequacy, anger, guilt, grief  sexual dissatisfaction • treatment s spontaneity, s performance anxiety

Becoming pregnant • Alternatives to intercourse for conception • Intracytoplasmic sperm injection: retrieval of sperm from testes • artificial insemination of sperm into biological or surrogate mother • in vitro fertilization with • transfer into uterus or fallopian tube (ZIFT or GIFT)

Becoming pregnant • Problems with assisted reproduction • expensive • 75% failure rate • 20-30% end in multiple embryos • lack long-term cancer studies

Becoming pregnant • Pregnancy detection • first signs: light period, spotting, or no period; fatigue; tender breasts; nausea/vomiting; appetite change • blood or urine tests for (HCG) • at 6 weeks, subtle softening of uterus

Spontaneous & elective abortion • Miscarriage (spontaneous abortion) • occurs in first 20 weeks • 10-20% of pregnancies • emotional impact can be significant • couple needs grief-support • Elective abortion • ~25% of U.S. pregnancies end in elective abortion; 1% occur > 20 weeks

Spontaneous & elective abortion • Procedures • suction curettage90%, up to 12 wks gestation • dilation & evacuation is safer for 13-21 weeks gestation • prostaglandins, RU486, & other drugs can induce contractions • shared responsibility • discuss feelings of both parents • share expenses • go together to the procedure • no intercourse for at least a week • use effective contraception • discuss post-abortion feelings

Spontaneous & elective abortion • Emotional reactions • anxiety & depression prior to abortion • most have + reactions afterwards • repeated abortions are associated with more emotional distress • men experience hurt, guilt, anger • support from others helps • many other factors affect both men’s & women’s reactions

Spontaneous & elective abortion • Pregnancy risk taking & abortion • reasons for contraceptive risk taking • fear of side effects • guilt about planning to have sex • use of alcohol & drugs • interference with romantic ideals • fear of alienating partner • female passivity conflicts with actively seeking & using BC

Spontaneous & elective abortion • Lack of information • “got away with it” before • proof of fertility, womanhood, manhood, adulthood • bargaining chip for marriage or commitment • plea for help • attempt to punish teen’s parents • life transitions (“last chance”)

Spontaneous & elective abortion • Abortion controversy • historical overview • initially: US allowed abortion until 4-5th month •  ab. Mortality, need for population growth, & emerging independence of  led to 1860s ban • 1973 Roe vs Wade US supreme Court legalized limited abortions • 1977 Hyde Amendment curtailed Medicaid funding for abortions (1993: funds mandated for rape & incest victims)

Spontaneous & elective abortion • 1989 Court ruling in favor of 3 state restrictions or limitations • 1991 Court ruling in favor of gag rule for federally funded clinics (lifted by Clinton adm.) • 1992 court ruling in favor of waiting period, parental notification, detailed medical reporting • laws during Clinton administration improved access slightly

Spontaneous & elective abortion • Abortion controversy • current debate • 1992 survey: 72% believe abortion should remain legal • pro-life goals: national legislation to make abortion illegal: constitutional rights for fetus • pro-choice goals: maintain option for women who need it

For the woman wide range of emotions emotions are affected by physical changes For the man ecstasy to ambivalence to fearfulness concern about financial impact psychosomatic symptoms such as nausea, fatigue, weight gain The experience of pregnancy

The experience of pregnancy • Sexual interaction during pregnancy • pattern: inhibited during 1st & 3rd trimesters with possible resurgence in 2nd trimester: or progressive decline • reasons for declining interest • physical discomfort • feeling unattractive • fear of injuring child

The experience of pregnancy • Reasons for increasing interest • + attitudes about sexuality • planned pregnancy • greater pre-pregnancy arousal • heightened body awareness • greater sense of womanliness •  vasocongestion • more noncoital affection • no restrictions on sexual activity or orgasm unless woman is at risk • modified positions often needed

A healthy pregnancy • Prenatal care can prevent 50% of problems for developing baby • components include • good nutrition, • adequate rest, • routine health care, • moderate exercise, • prenatal education

A healthy pregnancy - Fetal development • First Trimester • zygote = sperm + egg • blastocyst + multiple cells that implant • 7-8 weeks: can detect heartbeat • 8 weeks: spinal canal, arms/legs, fingerts/toes, eyes • 3rd month: internal organs

A healthy pregnancy - Fetal development • Second Trimester • sex of fetus can be determined • fingernails, eyebrows, eyelashes • fine, downy hair all over body • developing size & refined features • fetal movements at the end of 4th month • end of 5th month: 1 pound, head hair, fat • 6th month: eyes open

A healthy pregnancy - Fetal development • Third Trimester • developing size & strength • weight gain from 4-7 pounds • downy hair begins to disappear • skin becomes smoother & is covered with a waxy (cheesy) substance

A healthy pregnancy • Risks to fetal development • harmful substances pass to baby • many prescription drugs • many nonprescription drugs • illegal, addictive drugs *1997 South Carolina Supreme Court ruled that viable fetus can be protected under child abuse laws • nicotine & caffeine • alcohol

A healthy pregnancy • Detection of birth defects • amniocentesis (14-16 weeks) • chorionic villus sampling (10 weeks) • Pregnancy after age 35 • 20% of childbearing women in US •  rate of fetal defects due to chromosomal abnormalities • essentially safe with prenatal care

Early signs: bloody show water bag breaks effacing or thinning of cervix slight dilation Labor: (10-16 hrs) regular contractions early labor (0-4 cm) active labor (4-8 cm) transition labor (8-10 cm) Childbirth - First Stage

Childbirth - Second Stage • From full dilation to delivery of baby • infant descends through vagina • 30 minutes to 2 hours • feels good to push

Childbirth - Third Stage • From delivery of baby to delivery of placenta • placenta separates & is pushed out • 20-30 minutes

Childbirth • Contemporary childbirth • preparation for birth • Dick-Read’s fear-tension-pain cycle replaced with education-relaxation-coping strategies • Lamaze’s philosophy is similar • expectant fathers are considered essential & are welcomed • trained birth attendants(Doula) are associated with shorter labor, less pain medication, fewer cesarean surgeries, & greater satisfaction

Childbirth • Birthplace alternatives • hospitals with birthing rooms set up with homelike atmosphere • birthing centers are freestanding with access to hospital for complications • home birth: medical controversy with restrictive laws re: who can provide birthing care

Childbirth • Medical interventions: pros & cons • medications • local drugs provide the least pain relief & have the fewest effects on labor, birth, & baby • narcotics provide slightly more pain relief, but pass quickly to baby • regional drugs (e.g., epidurals) provide the most pain relief, but can slow labor, delivery, & can eventually pass to baby

Childbirth • Episiotomy (cutting perineum) • routine use has more risks than benefits • decreases pushing time, may reduce pressure on baby’s head • woman can be taught how to decrease her need for episiotomy • Delivery assistance can be provided • forceps • vacuum extraction

Childbirth • Cesarean surgery (c-section) • baby delivered through incision in lower abdomen & uterus • reasons: very slow progress, large fetal head, maternal illness, fetal distress, improper position of baby in pelvis • procedure: mother is usually given regional medication & remains awake; father is often welcome to attend • subsequent vaginal birth after cesarean (VBAC) is possible • controversy over  US cesarean rate (20-25%)

Postpartum • Emotional adjustment • range of feelings from excited & happy to tearful • postpartum blues affects 26-85% • true postpartum depression is much lower (10-15%) • sleep deprivation heightens stress • relationship, siblings often affected

Postpartum • Breastfeeding • types of milk • initial colostrum has protein & antibodies • mature milk “comes in” within a few days • milk will “dry up” if baby does not suckle at the breast • inhibits ovulation in women who exclusively breastfeed without supplements of formula

Advantages digestible with antibodies prevents uterine hemorrhage emotional & sensual experience may  sexual interest Short-term disadvantages vaginal dryness d/t  level of estrogen temporary breast tenderness leaking milk harder to share feeding duties or leave baby with sitter Postpartum - breastfeeding

Postpartum - Sexual interaction after childbirth • when to resume • after lochia flow stops & vaginal area heals (3-4 weeks) • after cesarean incision heals • when desire return (varies considerably; often 6-8 weeks) • Factors that interfere • fatigue s desire & ability • baby’s demands s time • negative pre-pregnancy attitudes about sex • activities can include more noncoital behaviors & more affectionate ones

Preselecting the baby’s sex: technology & cross-cultural issues • Ancient methods • infanticide • superstitions about actions during intercourse • Laboratory techniques • separation of X from Y bearing sperm • successful selection rate of 80% • Selective abortion in countries with strong preference for male child • illegal, but still occurs • economic, religious, & cultural factors play a role

A comparison of African American’s & Whites’ attitudes about legal abortions • For women of childbearing age, no differences between whites & African Americans • For men, abortion support has  over last 16 yrs., but less so for African American men • Older white women held strongest prochoice position (symbolic issue that grows with age) • Older African American women held weakest prochoice position (practical issue that no longer applies); also may be linked to issue of genocide

Assisted reproductive technology & post menopause pregnancy • Ova are donated by younger woman; hormones are used to help the older woman maintain the pregnancy • Older men have always been able to reproduce; they are rarely critized • General population does not support reproductive assistance for older women

“Literature is mostly about having sex and not having children. Life is the other way around.” David Lodge

Conception, Pregnancy, & Parenting