Chapter Twelve

1. Pregnancy and Birth Chapter Twelve

2. Issues Associated with Pregnancy and Birth • Fertility • Assisted Reproduction • A Healthy Pregnancy • Health Care During Pregnancy • Problems in the Pregnancy • Childbirth • Problems During Birthing • Postpartum Parenthood

3. Self Reflection Exercise • Do you want to have children? Why or why not? • If you do desire children, at what age would you like to have your first child? How many children would you like to have? Why? • How would you like to have your children spaced? Why? • Would you rather have a boy or girl first? How many boys and girls would you like to have? Why? • What would you like to name your children? Why? • Would you dress your girls in pink and boys in blue? Why or why not? • How would your parents feel about grandchildren?

4. Deciding Whether to Have Children What is your response to these two couples?

5. Conception Early Signs of Pregnancy Pregnancy Testing Sex Selection Fertility

6. Conception: The Incredible Journey • Our bodies are designed to promote pregnancy • During ovulation: • A woman’s sexual desire peaks • A mucus plug in the cervix disappears • Cervical mucus thins & creates gaps that vibrate with the sperm to aid motility and trap defective sperm; filters bacteria from semen • Female orgasm pushes semen to the uterus and toward the Fallopian tubes • Semen thickens upon ejaculation to stay in the vagina for 20 minutes to aid sperm travel

7. Conception: The Incredible Journey • The ovum can live for 24 hours • Sperm can live for 72 hours; less than 1% can live up to one week • Pregnancy may occur a few days before or after ovulation • The ovum may release chemicals to signal its location • If a sperm reaches the ovum, it wriggles violently

8. Conception: The Incredible Journey • Only one sperm fertilizes an ovum by secreting a chemical that makes a hole in the ovum coating • Immediately the ovum coating changes & does not permit further sperm from entering • Fertilization takes about 24 hours, usually in the ampulla • Zygote – a fertilized ovum

9. Conception: The Incredible Journey • About 12 hours after fertilization, the first cell division occurs & the blastocyst divides every 12 to 15 hours as it travels towards the uterus • 3-4 days after conception, it enters the uterus & absorbs nutrients from endometrial glands • 6th day after conception, a uterine chemical dissolves the blastocyst coating, allowing implantation into the uterine wall, typically the upper portion

10. Conception: The Incredible Journey • After implantation, the blastocyst divides into two layers, the endoderm & ectoderm, followed shortly by the mesoderm • Embryo – developing cell mass of 2-8 weeks • Amnion – membrane covering the embryo that fills with protective fluid • Placenta – attached to the uterine wall, it aids the fetus in respiration, nutrition, excretion • Umbilical cord – connects fetus to placenta

11. Conception: The Incredible Journey • Multiple births occur in 1 out of 50 couples • Fraternal twins – two ova are released & fertilized; 2/3 of twins are fraternal; dizygotic • May be inherited from the mothers • More likely with women over 30 • Identical twins – single zygote divides into 2 separate zygotes; monozygotic • Siamese twins – fail to completely separate

12. Pregnancy

13. Early Signs of Pregnancy • Missing a period, or maybe some spotting • Breast tenderness, frequent urination, food aversions • Morning sickness • 50-80% of pregnant women experience nausea &/or vomiting, any time of the day • Due to increased estrogen & progesterone irritating the stomach lining • May protect the fetus from illness

14. Pregnancy Testing: Confirming the Signs • Over-the-counter pregnancy tests • Can be less expensive at a clinic • The tests measure for human chorionic gonadotropin (hCG), which is made by placental cells • Detection in blood or urine can occur 8-9 days after ovulation • hCG levels peak in the 2nd & 3rd months

15. Pregnancy Testing: Confirming the Signs • May be inaccurate if tested too soon or after the 12th week • False positives may occur with kidney disease, kidney infection, overactive thyroid, large doses of tranquilizers, aspirin, antidepressants, anticonvulsants • Radioimmunoassay (RIA) blood tests are the most accurate, can detect hCG within a few days after conception

16. Pregnancy Testing: Confirming the Signs • Due date – calculated from the first day of the last menstrual period • Naegeles rule – subtract 3 months from the first day of the last period and add 7 days for a single birth • Rule is most accurate for women with 28-day cycles

17. Sex Selection

18. Sex Selection: Myth and Modern Methods • More male babies are born each year • Male fetuses have higher rates of spontaneous abortion or die before birth • There are many cultural myths for choosing and knowing the gender of an unborn child • There are medical techniques that can aid in choosing and determining fetal sex

19. Sex Selection: Myth and Modern Methods • Microsorting can separate the X and Y sperm, which is then artificially inseminated • Male conception is 50-70% accurate • Female conception is 50-90% accurate • Embryos can be tested and the desired sex embryo then implanted • Amniocentesis involves removal of amniotic fluid through a needle during week 16 or 17; detects chromosomal abnormalities & gender

20. Sex Selection: Myth and Modern Methods • Controversy surrounds gender selection • Male children are typically valued over females in other countries because • They typically care for their aged parents • Girls require dowries to be paid at their marriage • Males carry on the family name • Female infanticide is a problem in rural India and in China

21. What is Assisted Reproduction? Assisted Reproductive Options Assisted Reproduction

22. What Is Assisted Reproduction? • Infertility – the inability to conceive, or impregnate, after one year or regular sexual intercourse without the use of birth control • Infertility may be diagnosed after only 6 months for women over 35 years • About 20% of U.S. couples of reproductive age are infertile; 8-10% in developed countries

23. What Is Assisted Reproduction? • Negative emotions are often experienced with the frustration of infertility • Women tend to be more committed to finding a solution than their partners • Motherhood mandate – there is a problem with a woman if she does not care for a child • Some reproductive problems can be reduced with changing lifestyles, reducing stress, avoiding strenuous exercise, average weight

24. What Is Assisted Reproduction? • 70% of the time the problem can be found in one of the partners • 40% female (ovulation disorders, blocked Fallopian tubes, endometriosis, uterine fibroids, uterine structure, STIs) • 30% male (lack of sperm, reduced or malformed sperm production, STIs) • 20% of the time it is a combined problem • 10% the reason is unknown

25. Assisted Reproductive Options • Fertility Drugs • Surgery • Artificial Insemination • In Vitro Fertilization • Gamete Intra-Fallopian Tube Transfer • Zygote Intra-Fallopian Tube Transfer • Zonal Dissection • Intracellular Sperm Injections • Oocyte and Embryo Transplants • Surrogate Parenting

26. Assisted Reproductive Options • Artificial methods of conception are used by those experiencing infertility, those without a partner, and gay couples • These methods may also cause further stress because they are expensive, time consuming, and may not work • Type of treatment depends on length of infertility, the woman’s age, & likelihood of conceiving without treatment

27. Fertility Drugs • Hormonal irregularities may need to be treated with fertility drugs • The drugs increase ova production, which increases the possibility of multiple births • Possible increased risk of breast and ovarian cancer

28. Surgery • Structural abnormalities in the cervix, vagina, Fallopian tubes, or endometrium may be surgically corrected • Surgery can also be used to remove blockage of the vas deferens or epididymis

29. Artificial Insemination • Insertion of sperm into the vagina, cervix, uterus, or Fallopian tubes without intercourse • Ejaculated sperm is collected via masturbation by the partner or a donor • Sperm banks can freeze treated and washed sperm for up to 10 years • Donor catalogs are available, and sperm is sent to a physician • Fertility drugs are often used in combination

30. In Vitro Fertilization • “Test-tube babies” are conceived in a petri dish, then implanted in the uterus • Fertility drugs encourage the release of many ova and 4-6 are retrieved, although drugs aren’t always used • The ova are put in a dish and mixed with sperm; the zygotes are implanted • Only 5-30% implant, so many are often implanted

31. Gamete Intra-Fallopian Tube Transfer • Ova and sperm are placed in the Fallopian tube before conception • Fertility drugs and sperm washing are also used • Higher implantation rate than in vitro fertilization

32. Zygote Intra-Fallopian Tube Transfer • Fertilization occurs outside of the body • The zygote is placed in the Fallopian tube, allowing it to implant naturally • Higher implantation rates than in vitro, but not higher than gamete intra-fallopian tube transfer

33. Zonal Dissection • A microscopic hole is drilled into the ovum or a chemical is used to dissolve the outer shell of the ovum • Problem is that several sperm may enter at the same time and cause developmental problems

34. Intracellular Sperm Injections • A single sperm is injected into the center of an ovum • Helps if sperm counts are low or have low motility • 52% pregnancy rates • The ovum can be damaged • Possible increased risk of genetic defects

35. Oocyte and Embryo Transplants • For women who cannot produce healthy ova • Eggs and embryos from other women may be donated • 25-33% birth rates • Fertility drugs are necessary to synchronize both women’s menstrual cycles • High success rates

36. Surrogate Parenting • Another woman’s uterus is used to carry a pregnancy • Ova and sperm are fertilized outside of the body and the zygote is implanted in the gestational carrier • If the surrogate’s ova is used, the carrier is called a surrogate mother

37. Other Options • Embryos and sperm can be frozen for later use • Often used by those undergoing cancer treatment that want to have children • Sometimes sperm do not survive the thawing • Not all embryos survive the freezing and thawing • It is much more difficult to freeze an ova, they are very vulnerable to chromosomal damage

38. The Prenatal Period: Three Trimesters The Father’s Experience A Healthy Pregnancy

39. The Prenatal Period: Three Trimesters • Pregnancy lasts 40 weeks, and each trimester is about 12-15 weeks long

40. Video: “The Miracle of Life”

41. First Trimester • 1-13 weeks • The fetal heart forms and pumps blood by the end of the first month, as the circulatory system is the first to function • Other systems begin to develop: nervous, digestive, urinary, reproductive, appendages • Liver, kidneys, intestines, lungs begin developing by the end of this trimester • At the end, the fetus is ½ ounce & 3 inches

42. An embryo at 7 to 8 weeks. This embryo is approximately 1 inch long.

43. First Trimester • The woman’s heart pumps more blood, body gains weight, thyroid gland grows, lungs and digestive system work harder • Increases in estrogen & progesterone can cause: fatigue, breast tenderness, constipation, increased urination, nausea, vomiting, food cravings, smell sensitivity • Ultrasound can detect the fetal heartbeat and image as soon as 5 ½ - 6 weeks

44. Second Trimester • 14-28 weeks • Reflexes and tooth buds develop • Ultrasound may pick up gender around 20-22 weeks • Movements can be felt by the mother • Lanugo and vernix cover the fetus to protect it from amniotic fluid • At the end, the fetus is 1¾ pounds & 13 inches

45. At five months, the fetus is becoming more and more lively. It can turn its head, move its face, and make breathing movements. This fetus is approximately 9 inches long.

46. Second Trimester • In the mother, nausea subsides • Fatigue may continue, appetite increases, and other signs show: heartburn, edema, vaginal discharge, skin pigmentation, muscle cramps, varicose veins, hemorrhoids • Increased blood supply & restriction of veins • Positive time for mother, positive emotions, increased sex drive & satisfaction, maternity clothes, feel the baby moving

47. Third Trimester • 28-40 weeks • The fetus develops fat deposits, hiccups • The fetus can suck its thumb and react to light, pain, sounds • 8th month most organ systems are well developed, though the brain continues growing • At the end, the fetus is 7½ pounds & 20 inches

48. A fetus at nine months, ready for birth.

49. Third Trimester • Many symptoms from the second trimester continue and increase in frequency, as blood supply is large, and there is a large weight gain • Backaches, leg cramps, sleep problems, shortness of breath, and Braxton-Hicks contractions may occur • Colostrum may be secreted by the breasts in preparation for breast feeding

50. The Father’s Experience • Upcoming parenting and changes in their partner can make a man feel vulnerable • Joy, anticipation, stress, and anxiety are all common feelings • Fathers are allowed and encouraged to be in U.S. delivery rooms