PREGNANCY & CHILDBIRTH

6 PREGNANCY & CHILDBIRTH

6 “To everything there is a season, and a time to every purpose under heaven.” - Ecclesiastes -

6 HISTORICAL DIMENSIONS 18th CENTURY • France – midwives • England – development of instruments • America – physicians • “wet nurse” vs. “dry nurse” 19th CENTURY • Interventions – medications, anesthesia, birthing instruments • Hospital births

6 20th CENTURY •  technology, medicalization, hospitalization • Controlling fertility • Natural-birth relaxation techniques • 1970s: Benefits of breastfeeding resurfaced • Childbirth = joy and knowledge vs. fear and ignorance

6 PREGNANCY CONCEPTION • Fertilization = Sperm Cell + Egg Cell = Zygote • Sperm Cell: 50 million produced/day • Egg Cell: 1 egg released/month • Dizygotic Twins = Fraternal Twins • Monozygotic Twins = Identical Twins

6 Selected Sex Chromosome Abnormalities • Normal (XY) • Turner Syndrome (Monosomy X, XO) • Triple X (XXX) • Klinefelter Syndrome (Trisomy XXY) • XXY Male

6 CONFIRMING PREGNANCY Early Signs of Pregnancy • Symptoms often occur in first 6 weeks • Missed period(s) • Breast swelling/tenderness • Fatigue • Queasiness or nausea/vomiting • Elevated body temperature • Mood swings • Frequent urination

6 HORMONAL CHANGES A/ Fertilization: • Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH) produced by anterior pituitary gland is surpressed • Pregnancy-specific hormones increase (hCG and HPL) B/ Implantation: • Embryo cells secrete hCG • Corpus Luteum stimulated and secrete estrogen and progesterone

6 C/ After 3 Months: • hCG levels decrease • Placenta produces estrogen and progesterone • Fetal adrenal glands produce precursor hormone to be converted into estrogen • Estrogen = regulate progesterone, fetal maturation (lungs, liver, organs mature), prepare breasts for lactation • Progesterone = suppresses uterine contractions, stimulates alveoli of breasts • HPL = physical changes in maternal system to accommodate fetus

6 PHYSICAL & EMOTIONAL SYMPTOMS 1st Trimester: • Enlarged and tender breasts • Morning sickness • Extreme fatigue • Decreased interest in sex • Moodiness and irritability • Skin changes • Darkening of nipple and areola

6 2st Trimester: • Morning sickness subsides • Gastrointestinal problems • Gain majority of weight (12-14 lbs) • Breathing problems • Backache • Leg cramps and numbness/tingling of hands • Swollen and bleeding gums • Braxton-Hicks contractions • Striae gravidarum • Chloasma • Linea nigra

6 3rd Trimester: • Heartburn • Constipation • Leg cramps • Backache • Breathlessness • Braxton-Hicks contractions •  Leukorrhea •  Colostrum • Hemorrhoids • Pelvic and buttock discomfort

6 A Pregnant Woman’s Body Changes:

6 FETAL DEVELOPMENT

6 PRENATAL CARE NUTRITION • Consume additional 100 calories/day during 1st trimester • Consume additional 300 calories/day 2nd-3rd trimester • Folic acid • Calcium • Iron •  Fluid intake • Weight Gain: Average 25-35 lbs. total

6 EXERCISE • Benefits: • Feel better throughout trimesters • Shorter labor • Quicker recovery Forms: • Swimming • Walking • Low-impact aerobics • Kegel exercises

6 AVOIDING TOXIC SUBSTANCES Cigarette Smoking: • 12.2% of women smoke during pregnancy • Native Americans (20%) • Hawaiian Americans (14.4%) • White Americans (13.2%) • Complications •  birth-weight • Infertility • Ectopic pregnancies • Placental irregularities and intrauterine growth retardation • Sudden Infant Death Syndrome (SIDS)

6 Fetal Alcohol Syndrome: • 12.8% of all pregnant women drank alcohol • Complications… • Growth retardation • Facial malformations • Central nervous system dysfunction • Mental retardation

6 Environmental Risk: • Pregnant women should avoid the following as precautionary measures to protect herself and baby… • Pollutants • Toxic wastes • Heavy metals • Pesticides • Gases • Radiation treatment • Diagnostic X-rays • Heat exposure

6 Prenatal Testing: • Ultrasound: (6th – 12th weeks) • Maternal Serum Alpha-Fetoprotein Screening (MSAFP): (13th – 20th weeks) • Chorionic Villus Sampling (CVS): (1st Trimester) • Amniocentesis: (15th – 18th weeks) • Rh Incompatibility: (Injection of Rh immune globulin after delivery, during pregnancy, after a miscarriage, after amniocentesis)

6 Chorionic Villus Sampling Procedure

6 Amniocentesis Procedure

6 COMPLICATIONS MISCARRIAGE • 16% of all pregnancies • Pregnancy ends before 20th week of gestation • Bleeding and cramping • Cervix dilates and embryo is released ECTOPIC PREGNANCY • 1 in every 40-100 pregnancies • Occurs 7th-8th week of pregnancy • Fertilized egg grows outside uterine cavity • Abdominal pain, spotting, ruptured fallopian tube, PID

6 PREMATURE LABOR • 10% of all babies are born early • If starts before 37th week • Normal labor lasts for 38 - 42 weeks • Warning signs… • Vaginal bleeding • Abdominal pain • Persistent nausea, vomiting • Unusual thirst • Fever/chills • Facial, feet, or finger swelling • Vaginal fluid leaks • Severe continuous headaches

6 GENETIC DISORDERS & CONGENITAL ABNORMALITIES • Cystic Fibrosis • Down Syndrome • Sickle Cell Anemia • Phenylketonuria (PKU) • Tay-Sachs Disease • Spina Bifida

6 INFECTIONS • Gonorrhea, Chlamydia, Syphilis  Miscarriages • Bacterial Vaginosis (BV)  birth weight,  risk HIV • Perinatal Transmission of AIDS AZT • Cytomegalovirus (CMV)   birth size, brain damage, developmental problems, enlarged liver, hearing and vision impairment, malformations • Group B Streptococcus (GBS)  sepsis, pneumonia, meningitis, long-term disabilities, death

6 CHILDBIRTH PREPARATION

6 LABOR & DELIVERY 3 Distinctive Signs of Labor: • Uterine Contractions = every 5 minutes • Rupture of the Membranes = leak of fluids • Body Show = passage of mucous plug of cervix • = cervix dilates Other Signs: • Diarrhea • Backache •  Braxton-Hicks contractions

6 3 STAGES OF LABOR

6 DILATION THROUGH STAGES OF LABOR

6 PAIN RELIEF IN CHILDBIRTH • Tranquilizers and Analgesics • Anesthetics • Epidural = injected through catheter beside spinal cord • Spinal = injected directly into spinal canal • Pudendal = injected into area around vagina and perineum

6 CESAREAN DELIVERY • Surgical incisions made in both the wall of the mother’s abdomen and her uterus • Reasons: • Cephalopelvic Disproportion • Multiple Births • Placenta Previa • Fetal Distress • Abruptio Placentae • Prolapsed Cord

6 BREASTFEEDING THE FEMALE BREAST

6 BENEFITS OF BREASTFEEDING For Baby: • Breast milk is highly nutritious • Breast milk contains enzymes to aid in infant digestion • Breast milk contains antibodies to protect against infection •  infant episodes of diarrhea •  infant cases of upper respiratory, ear and urinary infections • protect against type 1 diabetes, Crohn’s disease, SIDS, chronic digestive disease, childhood cancers For Mom: • Uterus returns to normal size more quickly • Return to pre-pregnancy weight more quickly •  risk of ovarian and breast cancer, osteoporosis

6 COMPLICATIONS OF BREASTFEEDING • Do not breastfeed if mother… • HIV infected • Untreated active TB • User of alcohol, tobacco, or other drugs • Undergoing cancer therapy/radiation treatment • Mothers may experience difficulties if… • Inverted, flat, raw, or cracked nipples • Severely swollen breasts • Problems with infant latching-on • Pain during latching-on • Mastitis

6 INFERTILITY CAUSES • Female Infertility = 25% to 35% of couples • Male Infertility = 25% to 35% of couples • Azoospermia, Oligospermia DIAGNOSIS • Ovulation Test and Cervical Mucus Test • Postcoital Test • Blood Test • Hysterosalpingogram, Laparoscopic Surgery

6 TREATMENT • Improve quality of cervical mucus = Estrogen • Stimulate ovulation = Clomid, GnRH • Assisted Reproductive Technologies (ART) • In Vitro Fertilization (IVF) • Gamete Intrafallopian Transfer (GIFT) • Zygote Intrafallopian Transfer (ZIFT) • Intracytoplasmic Sperm Injection (ICSI) • Egg Donation • Embryo Transfer • Host Uterus • Surrogacy

6 EMOTIONAL EFFECTS OF INFERTILITY • Anger and resentment towards partners • Guilt and blame towards oneself • Depression and frustration • Miscommunication • Confusion • Grief • Despair • Loss of control

6 EPIDEMIOLOGY LIVE BIRTH RATES PER 1,000 WOMEN IN SPECIFIC GROUPS, U.S.

6 BREASTFEEDING • In 1993 = 58.1% mothers breastfed • In 1998 = 64% mothers breastfed • Whites = 68%, Hispanics = 66%, Blacks = 45% INFERTILITY • 15% of U.S. women of childbearing age sought treatment for infertility • In 2000 = 35,025 babies were born using ART

6 INFORMED DECISION MAKING CHOICES OF ART PROCEDURES IN U.S., 2000

PREGNANCY & CHILDBIRTH