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Historical Dimensions of Pregnancy and Childbirth

Explore the historical development of pregnancy and childbirth practices from the 18th century to the present day, including changes in medical interventions, technologies, and societal attitudes. Learn about the signs of pregnancy, hormonal changes, physical and emotional symptoms, and the importance of prenatal care and nutrition.

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Historical Dimensions of Pregnancy and Childbirth

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  1. Chapter 6 Pregnancy and Childbirth

  2. Historical Dimensions Eighteenth century • America—Physicians at births • France—Childbirth moves to hospitals • England—Surgical techniques and development of instruments Nineteenth century • Physician-controlled hospital births • Interventions—Medications, anesthesia, birthing instruments

  3. Historical Dimensions Early twentieth century • Greater technology, medicalization, hospitalization • Greater mystification of childbirth for woman • Controlling fertility Mid- to late twentieth century • Natural-birth relaxation techniques leading toward “prepared births” • 1970s: Benefits of breastfeeding resurfaced • Childbirth = joy and knowledge vs. fear and ignorance

  4. Pregnancy Conception Fertilization = Sperm Cell + Egg Cell = Zygote • Sperm cell: 300 million deposited per ejaculation • Egg cell: 1 egg released per month • Dizygotic twins = fraternal twins • Monozygotic twins = identical twins

  5. Pregnancy 23 chromosomes from sperm + 23 female chromosomes from egg = 46 chromosomes total = ZYGOTE

  6. Sex Chromosomes Sex of individual: XY for male; XX for female Selected sex chromosome abnormalities • Turner syndrome (Monosomy X, XO) • Triple X (XXX) • Klinefelter syndrome (Trisomy XXY) • XYY male

  7. After Conception • Within 36 hours of fertilization: Zygote divides • 1 to 2 days: Blastocyte floats freely before implanting in uterus • Within 3 to 5 days: Reaches uterus and is known as a blastocyte • First 8 weeks: Known as embryo • 9 weeks to birth: Known as fetus

  8. Early Signs of Pregnancy Early signs of pregnancy often occur within the first 6 weeks • Missed period(s) • Breast swelling/tenderness • Fatigue • Queasiness or nausea/vomiting • Elevated body temperature • Mood swings • Frequent urination

  9. Confirming Pregnancy • Pregnancy tests: detect hCG • Home urine pregnancy tests available • Digital and non-digital • Clinical pregnancy test • Performed by clinician • Urine or blood tests • Pelvic examination

  10. Hormonal Changes Fertilization • Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) produced by the anterior pituitary gland are suppressed • Pregnancy-specific hormones increase Implantation • Embryo cells secrete hCG • hCG stimulates corpus luteum to secrete estrogen and progesterone

  11. Hormonal Changes After three months: • Corpus luteum no longer needed; hCG levels decrease • Placenta produces estrogen and progesterone • Fetal adrenal glands produce precursor hormone to be converted into estrogen • Estrogen—regulates progesterone, stimulates fetal maturation (lungs, liver, organs mature), prepare breasts for lactation • Progesterone—suppresses uterine contractions, stimulates alveoli of breasts

  12. Physical and Emotional Symptoms First trimester • Enlarged and tender breasts • Morning sickness (nausea and/or vomiting) • Extreme fatigue • Decreased interest in sex • Moodiness and irritability • Darkening of nipple and areola

  13. Physical and Emotional Symptoms Second trimester • Morning sickness subsides • Gastrointestinal problems (heartburn, gas, constipation) • Gain majority of weight (12–14 pounds) • Breathing problems • Backache • Leg cramps and numbness/tingling of hands • Swollen and bleeding gums • Swelling of feet, hands, and ankles • Braxton-Hicks contractions

  14. Physical and Emotional Symptoms Third trimester • Heartburn and constipation • Leg cramps • Backache • Breathlessness • Braxton-Hicks contractions •  Leukorrhea •  Colostrum • Hemorrhoids • Pelvic and buttock discomfort • Itchy abdomen

  15. A Pregnant Woman’s Body Changes

  16. Fetal Development Terms • Amnion: Fetal sac that envelops the embryo • Amniotic fluid: Provides protection and constant environment for floating embryo • Placenta: Supplies fetus with oxygen and nutrients from maternal bloodstream and filters waste back to mother for disposal

  17. Fetal Growth Fetus – 4-5 Weeks

  18. Fetal Growth Fetus - Near Term

  19. Preconception Care Preconception care: The steps that a woman can take before she decides to become pregnant to ensure that she is in good health when conception occurs Folic acid Proper immunizations Healthy behaviors Nutrition

  20. Prenatal Care- Nutrition • Consume additional 100 calories/day during 1st trimester • Consume additional 300 calories/day 2nd- 3rd trimester • Folic acid • Calcium • Iron • Increase fluid intake • Weight gain: Average 25–35 pounds total

  21. Exercise Benefits • Feel better throughout trimesters • Shorter labor • Quicker recovery Forms • Swimming • Walking • Low-impact aerobics • Kegel exercises

  22. Avoiding Toxic Substances Cigarette smoking • 13% of women smoke during pregnancy • Complications • Lower birthweight • Physical and mental problems for infants • Infertility • Spontaneous abortions (miscarriages) • Ectopic pregnancies • Placental irregularities and intrauterine growth retardation

  23. Smoking during last trimester

  24. Avoiding Toxic Substances Alcohol • Especially risky in 1st trimester • Fetal alcohol syndrome (FAS) • Growth retardation • Facial malformations • Central nervous system dysfunction • Mental retardation • Increased risk of stillbirth

  25. Avoiding Toxic Substances Alcohol • 1 in 8 pregnant women reports alcohol use • 1 in 50 pregnant women report binge drinking

  26. Avoiding Toxic Substances Other drug use • OTC medications—physician should be consulted before use • Marijuana use—causes smaller, sicker babies; higher risk of stillbirths; crying and trembling in infants • Cocaine use—increases risk of premature birth, stillbirths, and malformations; lower birthweight; smaller head circumference; shorter in length; infant feeding difficulties and sleep disturbances • Heroin—risk of miscarriage, premature delivery, stillbirth, poor fetal growth; withdrawal symptoms at birth; increased risk of SIDS

  27. Avoiding Toxic Substances Environmental risks A pregnant woman should avoid the following as precautionary measures to protect herself and her baby: • Pollutants • Toxic wastes • Heavy metals • Pesticides • Gases • Radiation treatment • Diagnostic X rays • Heat exposure

  28. Prenatal Testing: Screening • 1st Trimester • Ultrasound tests and blood tests to detect Down Syndrome and trisomy 18 • 2nd Trimester • Multiple marker screening • Detailed ultrasound exams

  29. Prenatal Testing: Diagnostic • Chorionic villus sampling (CVS): 10th–12th week • Amniocentesis: 15th–18th week • Fetal blood sampling

  30. Chorionic Villus Sampling Procedure

  31. Amniocentesis Procedure

  32. Complications of Pregnancy Ectopic pregnancy • Occurs in approximately 20 per 1,000 pregnancies • Risk factors related to fallopian tube problems • Fertilized egg grows outside uterine cavity • Abdominal pain, spotting, ruptured fallopian tube, PID • Can be life threatening

  33. Complications of Pregnancy Gestational diabetes • Usually in second half of pregnancy • May or may not have symptoms • Can present problems for mother and baby • Mothers at greater risk for developing type 2 diabetes later in life

  34. Complications of Pregnancy Preterm delivery • Defined as labor before week 37 • Risk factors: • Previous preterm birth • Multiple births • Maternal abnormalities or medical conditions • Late or no prenatal care • Mothers who smoke, drink, use drugs

  35. Complications of Pregnancy Stillbirth • Defined as intrauterine death of fetus • Multiple causes • Multiple symptoms • Counseling important

  36. Complications of Pregnancy Miscarriage • Pregnancy that ends before 20th week • Several factors associated with miscarriage • Symptoms: bleeding and cramping • Causes vary and often aren’t clear

  37. Complications of Pregnancy Preeclampsia • Pregnancy-related high blood pressure • Several other symptoms • Protein in urine; face and hands swelling; sudden weight gain; blurred vision; severe headaches; dizziness; stomach pain • Cure is delivery of the baby

  38. Genetic Disorders and Congenital Abnormalities • Caused in whole or part by variation or mutation of a gene • Over 6,000 abnormalities have been identified • State-based screening programs

  39. Infections in Pregnancy • Gonorrhea, chlamydia, syphilis  miscarriages • Bacterial vaginosis (BV) lower birthweight, higher risk of HIV • Perinatal transmission of AIDS can be reduced by the use of AZT

  40. Infections in Pregnancy • Cytomegalovirus (CMV)  smaller birth size, brain damage, developmental problems, enlarged liver, hearing and vision impairment, malformations • Rubella  birth defects • Group B streptococcus (GBS)  sepsis, pneumonia, meningitis, long-term disabilities, death

  41. Childbirth Preparation

  42. Labor and Delivery Three distinctive signs of labor • Uterine contractions every 5 minutes • Rupture of the membranes: leak of fluids • Bloody show: passage of mucous plug of cervix when cervix dilates Other signs • Diarrhea • Backache • Increased Braxton-Hicks contractions

  43. Three Stages of Labor

  44. Dilation Through Stages of Labor

  45. Labor Support During Childbirth Nondrug strategies: • Comfort measures • Mental strategies • Medication

  46. Pain Relief in Childbirth • Tranquilizers and analgesics • Anesthetics • Epidural: injected through a catheter beside the spinal cord • Spinal: injected directly into the spinal canal • Pudendal: injected into area around the vagina and perineum

  47. Cesarean Delivery • Surgical incisions made in both the wall of the mother’s abdomen and her uterus • Reasons for Cesarean delivery • Fetal distress • Abruptio placentae • Prolapsed umbilical cord • Cephalopelvic disproportion • Fetal position • Multiple births • Obstruction, including placenta previa • “Failure to progress” • Maternal infections

  48. Cesarean Delivery Rates Total Cesarean rates for first births, United States, 1991–2007.

  49. Breastfeeding The Female Breast

  50. 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 • Fewer infant episodes of diarrhea • Fewer infant cases of upper respiratory, ear, and urinary infections • Protects against type 1 diabetes, Crohn’s disease, SIDS, chronic digestive disease, childhood cancers

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