Chapter 7: Pregnancy and Childbirth

1. Chapter 7: Pregnancy and Childbirth For use with Human Sexuality Today (4th Ed.) Bruce King Slides prepared by: Traci Craig

2. 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

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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

9. 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.

10. 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

11. Pregnancy • 260-270 days on average • Highly variable even within the same couple. • “Due Dates” rarely “Birth Dates” • 3—Trimesters (3 month periods)

12. 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

13. First Trimester: Mother • Enlarged tender breasts, darkened areolas, enlarged nipples, increase urination, irregular bowel movements, feeling tired and run-down. 3rd month

14. 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

15. 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’

16. 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.

17. 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.

18. 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

19. 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.

20. 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.

21. 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

22. 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.

23. Complications of Pregnancy • Teratogens & Critical periods

24. 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.

25. 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

26. 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.

27. 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

28. 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

29. 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

30. 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.

31. 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.

32. 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

33. 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.

34. Fetal Surgery • Catheterize fetus to drain urine • Repairing hernia of diaphragm • Bone marrow transplant • Corrected spina bifida • Future: in utero gene therapy

35. 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.

36. 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

37. 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

38. 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’

39. 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

40. 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.

41. 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

42. 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

43. 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.

44. 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’

45. 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

46. Stages

47. 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

48. 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

49. 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

50. 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