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Conception, Pregnancy, and Childbirth – Chapter 6 • Identify the physiological elements and processes of conception. Where does conception take place? How long does the sperm live inside the woman's body? What is process of one sperm penetrating the egg? (Note: hyaluronidase) 120-121 • How can you improve chances of conception? How long do the sperm live in the woman's body. When should intercourse be timed right? (Position during sex, remain on her back, acidity and sperm, lubricants and suppositories) 122-123 • Differentiate between zygote, embryo, and fetus in terms of gestation. 121-122 • Describe the nine months of pregnancy in terms of trimesters: first, second and third trimester; birth stages: first stage (effacement, dilation ,transition phase), second stage (crowning, episiotomy); third stage (placenta and fetal membranes expelled). 121-122; 123 • Describe the embryonic of development (first eight weeks). Note: ectoderm, endoderm, and mesoderm) 123 • Discuss the function of the placenta and what passes back-and-forth between the baby and the woman and what does not. (Note: human chloride gonadotropin, umbilical cord, and amniotic fluid) 123, 125 • Differentiate between the fetal developments in the first, second and third trimesters. Why is the first trimester the most remarkable stage of the three trimesters? When can the gender be determined? When does quickening or movements of the fetus occur? 125-126
Conception, Pregnancy, and Childbirth – Chapter 6 (continued) • Identify what occurs during the first, second and third trimester's of pregnancy for the woman. What are the early signs of pregnancy? Differentiate between false positives and false-negative pregnancy tests (Are Braxton-Hicks contractions not part of the labor pains?). Describe and calculate gestational age using Nagele's rule. Describe physical changes. • Describe psychological changes during pregnancy factors of depression, and social support.126-7 • Discuss the father's role in pregnancy. How does prolactin and testosterone relate to father's paternal behavior? What percent of fathers were ambivalent about fathering? • Discuss sex during pregnancy. What is possible; what is the “safe” period?; what is beneficial?, and; what couples can do to experience sexual pleasure besides intercourse? 131 • Discuss nutrition during pregnancy, and effects of drugs taken during pregnancy. What psychotropic drugs are used for depression. Which ones are good and which ones are not?131-4 • Describe the first, second, and third stages of labor. What is an episiotomy? Discuss the increase in cesarean section versus vaginal birth. 135-137 • Describe the two basic techniques in the Lamaze method. What are some anesthetics in childbirth, home birth, versus hospital birth? 138
Conception, Pregnancy, and Childbirth – Chapter 6 (continued) • Discuss the psychological changes a mother experiences during the postpartum period. Differentiate between: postpartum blues, postpartum depression, and postpartum psychosis. 141 • What are the rates of sex during the postpartum period. How does breast-feeding relate to sexual activity? 142-144 • Identify problem pregnancies including, false pregnancy (pseudocyesis), an ectopic pregnancy (note: how do some forms of contraception relate to this problem?), and miscarriage. 144-147 • Discuss pregnancy induced hypertension (hypertension, preeclampsia, and eclampsia-- a woman may die!) 145 • What is meant by “teratogenic?” Discuss rubella and herpes simplex in the context of viruses crossing the placental barrier. Identify specific birth defects in the US. and how can these be discovered? (amniocentesis, chlorionic villus sampling (CVS), Rh incompatibility---What is the appropriate timing for these tests? What is the “risk” of fetal loss?) 145-147 • Discuss infertility in both men and women, including factors and treatments. Identify new reproductive technologies, including artificial insemination, GIFT, cloning, and test tube babies. 149-153
. Sperm reach ovum and cluster around it
Conception Conception: a man has an orgasm and ejaculates inside the woman's vagina; the sperm are deposited into vagina, there to begin their journey toward the egg; of the original 200 million sperm, only about 2000 reach the two containing the egg; sperm are capable swimming 1 to 3 cm per hour, although it has been documented that sperm may survive at the egg within 1 and 1/2 hours after ejaculation; muscular contractions in the uterus may help speed them along; for the purposes of conceiving, is probably best to have intercourse about every 24 to 48 hours or about four times during the week in which the women is to ovulate (it takes a while to manufacture 200 million sperm -- at least 24 hours). Sperm live inside the woman's body for up to five days. The egg is capable of being fertilized for about the first 12 to 24 hours after ovulation. Conception occurs, not in the uterus but in the outer third (the part near the ovary) of the fallopian tube. Sperm swarm around the egg and secrete an enzyme called hyaluronidase.
When the sperm penetrates the egg, the egg immediately releases a chemical creating a hard “shell” around it to keep all other sperm out
The placenta is the lining of the uterus that the umbilical cord will attach to. While nutrients and oxygen move across the placental wall, the embryo’s blood and the mother’s blood never mix
The Blastocyst embeds into the uterine lining, and begins to develop the placenta Blastocyst Uterine lining
Zygote, Conceptus, Fetus • The fertilized egg is called the zygote and continues to travel down the fallopian tube; about five to seven days after conception, the massive cells implants itself in the lining of the uterus. • For the first eight weeks of gestation, the conceptus is called an embryo; umbilical cord is form during the fifth week of embryonic development in his about 55 cm or 20 inches long; the umbilical cord attaches to placenta. • From eight weeks to birth the conceptus is called a fetus; two membranes surrounded fetus, the chorion and the amnion, the amnion is filled with a watery liquid called amniotic fluid, in which the fetus floats and can readily move; is the amniotic fluid that is sampled when amniocentesis is performed. Typically the nine months of pregnancy are divided into three equal periods of three months, called China stirs. Thus the first trimester is months 1 to 3, the second trimester is months 4 to 6, and a third (or last) trimester is months 7 to 9.
Four Weeks After the cluster of cells attaches to the womb it is called an embryo. The embryo is between 1/100 and 4/100 inch long at this time. The embryo continues rapid growth.
6 Weeks The embryo is about ¼ inch long and has developed a head and a trunk. Structures that will become arms and legs, called limb buds, first appear. A blood vessel forms and begins to pump blood. This will develop into the heart and circulatory system. At this time, a ridge of tissue forms down the back of the embryo. That tissue will develop into the brain and spinal cord
2 cell zygote The zygote begins to develop 4 cell zygote
16 cell morula 8 cell zygote
Blastocyst – When zygote divides to 32 cells it Becomes known as a Blastocyst
The Blastocyst begins to collapse Day 17 The primitive streak can still be seen, and the opposite end of the embryo is starting to fold up. Day 15 The primitive streak can be seen on the left side of this embryo.
Day 19 The neural tube is seen along with somites on either side of it. Somites - zipper-like motion of the neural tube closing together, three pairs of small bumps form on either side of the closure. they will form the skeleton and the major muscles of the body. Thirty-eight pairs of somites will line the neural tube within 2 weeks.
Day 24 Day 22
Day 26 Day 28
5 Week Embryo 5 Week, 4 day Embryo
10 Weeks The embryo, is about 1 to 1¼ inches long (the head is about half the length) and weighs less than ½ ounce. The beginnings of all key body parts are present, but they are not completed. Structures that will form eyes, ears, arms and legs can be seen. Muscles and skeleton are developing and the nervous system becomes more responsive.
12 Weeks The fetus is about 2½ inches long and weighs about ½ ounce. Fingers and toes are distinct and have nails. Hair begins to develop, but won't be seen until later in the pregnancy. The fetus begins small, random movements, too slight to be felt. The fetal heartbeat can be detected with a heart monitor. All major external body features have appeared. Muscles continue to develop.
14 Weeks The fetus is about 3½ inches long and weighs about 1½ ounces. The fetus begins to swallow, the kidneys make urine, and blood begins to form in the bone marrow. Joints and muscles allow full body movement. There are eyelids and the nose is developing a bridge. External genitals are developing.
16 Weeks The fetus is about 4½ inches long and weighs about 4 ounces. The head is erect and the arms and legs are developed. The skin appears transparent. A fine layer of hair has begun to grow on the head. Limb movements become more coordinated.
18 Weeks The fetus is about 5½ inches long and weighs about 7 ounces. The skin is pink and transparent and the ears are clearly visible. All the body and facial features are now recognizable. The fetus can grasp and move its mouth. Nails begin to grow. The fetus has begun to kick. Some women feel this movement.
20 Weeks The fetus is about 6¼ inches long and weighs about 11½ ounces. All organs and structures are formed Skin is wrinkled and pink to reddish in color - thin and close to the blood vessels. Protective skin coating, (vernix) begins to develop. Respiratory movements occur - lungs have not developed enough to permit survival outside the uterus. By this time, mothers usually feel the fetus moving. At this time an ultrasound can often identify the sex of the fetus.
22 Weeks The fetus is about 7½ inches long weighs about one pound. It has fingerprints and some head and body hair. It may suck its thumb and is more active. The brain is growing very rapidly. The fetal heartbeat can be easily heard. The kidneys start to work. At 23 weeks, approximately 31% of babies born survive. Babies born at this age require intensive care and usually have lifelong disabilities and chronic health conditions.
24 Weeks The fetus is about 8¼ inches long and weighs about 1¼ pounds. Bones of the ears harden making sound conduction possible. The fetus hears mother’s sounds such as breathing, heartbeat and voice. The first layers of fat are beginning to form. This is the beginning of substantial weight gain for the fetus. Lungs continue developing At 25 weeks, approximately 68% of babies born survive. Babies born at this age require intensive care and usually have life-long disabilities and chronic health conditions.
26 Weeks The fetus is about 9 inches long and weighs about 2 pounds. The fetus can respond to sound from both inside and outside the womb. Reflex movements continue to develop and body movements are stronger. Lungs continue to develop. The fetus now wakes and sleeps. The skin is slightly wrinkled. At 27 weeks, approximately 87% of babies born survive. Babies born at this age require intensive care and have an increased risk of developmental delays and chronic health conditions.
28 Weeks The fetus is about 10 inches long and weighs about 2 pounds, 3 ounces. Mouth and lips show more sensitivity. The eyes are partially open and can perceive light. More than 90% of babies born at this age will survive. Some survivors have developmental delays and chronic health conditions.
30 Weeks The fetus is about 10½ inches long and weighs about 3 pounds. The lungs that are capable of breathing air, although medical help may be needed. The fetus can open and close its eyes, suck its thumb, cry and respond to sound. The skin is smooth. Rhythmic breathing and body temperature are now controlled by the brain. Most babies born at this age will survive.
32 Weeks The fetus is about 11 inches long and weighs about 3 pounds, 12 ounces. The connections between the nerve cells in the brain increase. Fetal development now centers on growth. Almost all babies born at this age will survive.
34 Weeks The fetus is about 12 inches long and weighs about 4½ pounds. Ears begin to hold shape. Eyes open during alert times and close during sleep. Almost all babies born at this age will survive.
36 Weeks The fetus is about 12 to 13 inches long and weighs about 5½ to 6 pounds. Scalp hair is silky and lies against the head. Muscle tone has developed and the fetus can turn and lift its head. Almost all babies born at this age will survive.
38 Weeks The fetus is about 13½ to 14 inches long and weighs about 6½ pounds. Lungs are usually mature. The fetus can grasp firmly. The fetus turns toward light sources. Almost all babies born at this age will survive.
Pregnancy Tests • (1) laboratory test for pregnancy are 98 to 99 percent accurate; hCG (human chorionic gonadotropin secreted by the placenta) in the woman's urine, seven days after implementation (just when a period is missed); • (2) home pregnancy tests have a very high rate of false negatives ( it tells the woman she is not pregnant when she really is; thus and other 18 would produce a false negative result; this compares with an error rate for 1 to 2% of laboratory test); • (3) the immunologic test based on the presence of (human chorionic gonadotropin, secreted by the placenta) in the woman's urine is very accurate (these modern urine tests are 98% accurate seven days after implementation (just when a period is missed). • There are also presumptive signs of pregnancy include amenorrhea, breast tenderness, nausea, frequent urination, feelings and fatigue,, more sleep. Urine tests can be done at home or in a doctor's office. Many women first choose a home pregnancy test (HPT), about a week after a missed period. Home pregnancy tests are private and convenient. Blood tests are done at your doctor's office, but are used less often than urine tests. These tests can detect pregnancy earlier than a home pregnancy test, or about six to eight days after ovulation. But with these tests, it takes longer to get the results than with a home pregnancy test. Two types of blood pregnancy tests:is A qualitative hCG test simply checks to see if hCG is present. It gives a "yes" or "no" answer to the question, "Are you pregnant?" Doctors often order these tests to confirm pregnancy as early as 10 days after a missed period. However, some of these tests can detect hCG much earlier. A quantitative hCG test (beta hCG) measures the exact amount of hCG in your blood. It can find even very low levels of hCG. Because these pregnancy tests can measure the concentration of hCG, they may be helpful in tracking any problems during pregnancy. They may also be used to rule out a tubal (ectopic) pregnancy or to monitor a woman after a miscarriage when hCG levels fall rapidly.
Stages of Pregnancy • First trimester (First 12 weeks) • issues: missed menstrual period, emotional reaction to becoming pregnant (if negative – depression, anger and fear; it positive – joy and eager anticipation! Cyclic bleeding and spotting during early pregnancy may indicate a potential miscarriage (spontaneous abortion) optic pregnancy, or false pregnancy (Pseudocyesis) 144 • Expected delivery date (expected date of confinement, EDC); Nagele’s Rule: take the date of the first day of the last menstrual period, subtract three months, add seven days, and finally add one year (e.g., thus if the first day of the last menstrual period was Sept. 10th 2008, the expected delivery date would be June 17, 2009: subtracting three months was Sept. 10 gives June 10, adding seven days yields June 17, and adding one year gives June 17, 2009); if the last menstrual period began is not known, an ultrasound procedure may be used to determine gestational age. • Second trimester (Weeks13 to 26) • Edema (water retention and swelling) woman becomes aware of fetal movement (quickening). Women who report more effective partner support----report less anxiety in the second trimester; women who have had a previous pregnancy are more distressed during his time compared to women who have not. • Third trimester (Weeks (27 to 38) • weight gain and painless contractions. The extreme size of the uterus puts pressure on the number of other organs, causing some discomfort (shortness of breath, indigestion). The amount of weight gain should range from 15 to 40 pounds, depending on the woman's weight prior to pregnancy., slim women, 28 to 40 pounds; heavy women 15 to 25 pounds) First trimester (First 12 weeks) Second trimester (Weeks13 to 26) Third trimester (Weeks (27 to 38)
Types of Support • . Psychological Changes 128-9 • Psychological well-being is greater among women who have social support, have higher incomes, and experience fewer concurrent stressful life events • First time mothers reported a significant increase in dissatisfaction with their husbands from the second to the third trimester. • Wives who reported that higher levels of affection were exchanged between husband and wife reported lower levels anxiety and insomnia in the third trimester. • Women who led very active lives prior to becoming pregnant may find fatigue and lack of energy especially distressing. Appraisal support (information and advice) Esteem support (feedback that one is valued and respected by others) Group-belonging (availability of social companionship) Emotional closeness (provision of intimacy and confiding about emotions) Tangible support (financial assistance, services, or goods)
A B C Theory of Stress Couple or Family Crisis and Transitions - Concepts about stress and crisis: • 1. Family or couple eustress (positive events, some planned and others unexpected) or distress(negative events, mostly unplanned • 2. Family or couple psychosocial stressor events - unexpected or • anticipated • 3. "Crisis" versus "Transition" associated with their stressor events • Crisis involves change, becomes a turning point (distress or eustress), time of relative instability; i.e., conflict over family roles, demoralizing event (delinquent son or daughter), unexpected financial problem, diagnosis of a serious illness, unemployment, teen daughter's premarital pregnancy, death of family member, death of a spouse, prelude to divorce, etc. • Transition is an expected or predictable change which can "precipitate" family stress and / or crisis, or predictable crisis (often eustress rather than distress), adjustment to new roles or circumstances, altercation in the status quo in order to meet new but "anticipated" changes; i.e., birth of a baby, child leaving for college, graduation from high school, first day at school, new friends, new activities or hobbies, retirement, new job, moving to a new location, etc.
. Stressor Overload • This is a series of unrelated stressor events that occur too rapidly for family members to cope effectively); "pile up" events - Stressor characteristics: • expected or unexpected • brief or prolonged • external or internal • unclear cultural "norms" for dealing with the stressor event • overtime stressor condition: improves, remains stable, or • deteriorates
ABC-X Model • . Course of family crisis • A = Stressor Event • B = Couple or family's crisis-meeting resources • C = Couple or family's appraisal of the stressor event; each • member's "definition of the situation" (fault or blame, • internal or external, pevious experience with crises, etc.); • interpretations of a stressor event, positive or negative • X = Crisis itself, great or small depends mostly on B and C, not • necessarily the event itself
Double AaBC-Xt model • Aa = pile up, from previous unresolved crises • t = "strong" or "weak" family systems; • Strong traitsinclude: mutual acceptance, respect, and shared values, rely on support for one another, accepting difficulties, work together, all have input into major decisions and have fostered predictable family routines, rituals, and other times together; • Weak traitsinclude: lower sense of common purpose, feeling less in control of what happens, cope by showing diminished respect or understanding of one another, hesitant to depend on the family for support and understanding, they may avoid one another, shifting responsibilities, more resistant to compromise, little emphasis on family routines or predictable time together
Disaster or Opportunity Factors in meeting crises creatively: • 1. positive outlook • 2. spiritual values and support groups (four types of support: • informational, emotional, appraisal, instrumental) • 3. high self-esteem • 4. open, supportive communication • 5. adaptability and flexibility • 6. informal social support • 7. community resources
- Fathers Experience and Support in Pregnancy • Father infant bond: • Men who showed higher levels of responsiveness (in having a baby) had higher levels of prolactin prenatally and lower levels of testosterone postnatally. Lower levels of testosterone may facilitate paternal behavior. • One study the emotional changes found that 70% of expectant fathers were initially ambivalent about fathering that gradually became more positive, in anticipation of the satisfactions to be derived from being a father. It has been theorized that men who display and active involvement in planning (father child future activities) will do best in the father role after the baby is born. • Move from Golden rule to Titanium rule to Platinum rule (instructor view).
Sex and Nutrition • Sex During Pregnancy – Intercourse in a normal, healthy pregnancy can continue safely until four weeks before the baby is due; one study found that recent intercourse and orgasm was associated with reduced risk of preterm birth; • The most common reasons women give for decreasing sexual activity during pregnancy include physical discomfort, feelings of physical unattractiveness, and fear of injuring the unborn child; women who have positive attitudes about sexuality and who maintain more sexual interest, activity, and satisfaction during pregnancy than the women with negative attitudes about sexuality; many women also have increased need for nonsexual affection as pregnancy progresses. • Nutrition During Pregnancy - those with poor diets had seven times as many threatening miscarriages and three times as many still births; their labor lasted five hours longer on the average; a pregnant woman needs enough protein, folic acid (symptoms of folic acid deficiency or anemia and fatigue), calcium, magnesium, and vitamin A. ; (premature births are associated with deficiencies and calcium and magnesium)
Effects of Drugs Taken During Pregnancy • Antibiotics, Alcohol, Cocaine, (marijuana, trycyclic antidepressant medications (teratogenesis) and birth defects. • Steroids, Other Drugs, Dads and Drugs ( teratogens) 132-134 • Smoking: one study found evidence that mother smoking during the first trimester of pregnancy increase or offsprings risk of cancer in childhood; but a father smoking during pregnancy in the absence of the mother smoking also increased the risk of childhood cancer.
The Stages of Labor • 1. First stage of labor: effacement, violation, transition phase • 2. Second stage of labor: crowning, episiotomy • 3. Third stage of labor: placenta and feel membranes expelled