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Chapter Nine

Chapter Nine. Designing Your Reproductive Life Plan. Family Planning. Family Planning is more than a personal and family issue It has health, social, and political implications Women and children have been impacted by: Governments Religious bodies Health care options Political agendas

sylvester-haynes
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Chapter Nine

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  1. Chapter Nine Designing Your Reproductive Life Plan

  2. Family Planning • Family Planning is more than a personal and family issue • It has health, social, and political implications • Women and children have been impacted by: • Governments • Religious bodies • Health care options • Political agendas • Women need access to a variety of reproductive options

  3. Contributes to decreasing poverty for women Provides women more time to spend on education and job opportunities Reduces the number of maternal and infant mortality Reduces global population Reduces the number of teens who give birth (unintended and premature births) Provides adolescents with more opportunities to succeed in life Benefits of Family Planning

  4. Availability of method Prevent having children Reduce STD risks Religious doctrine Decision-making process with partner Health risks Financial and emotional considerations for couples User effectiveness rate Reasons for Selecting a Birth Control Method

  5. Birth Control Methods • Birth control methods are all strategies used to keep from having a baby and include the following: • Contraceptive methods • IUD’s • Emergency contraception • Abortion • Contraceptive choices are methods that prevent fertilization of the ovum such as: • Hormonal methods • Barrier methods • Sterilization See Table 9.1 for comparisons of effectiveness and cost

  6. Abstinence • Abstinence is the only sure method of birth control to prevent an unintended pregnancy or unwanted STIs • Teenagers can be sexually intimate without risking pregnancy or STIs • The latest trend is showing a decline in Abstinence-only programs • These programs are not supported by peer reviewed research for prevention of STIs, HIV/AIDS, and unplanned pregnancies • Furthermore, no research studies have shown abstinence only education to be consistently effective in delaying sexual activity in teens

  7. Fertility Awareness Methods See illustration on next slide

  8. Fertility Awareness (See Figure 9.1)

  9. Barrier Methods • Barrier methods prevent sperm from reaching the fallopian tubes, either by physical or chemical means • Barriers include the following: • Spermicides • Condoms • Diaphragms • Cervical caps • Barrier methods remain popular because of the protection they provide against HIV and other STIs

  10. Barrier Methods, cont’d

  11. Barrier Methods, cont’d

  12. Hormonal Contraceptives • Hormonal contraceptives are convenient, effective, and reversible • However, they provide no protection against HIV and other STI’s • They are solely intended to prevent pregnancy • The primary methods available are: • Oral contraceptives • Norplant • Injections i.e. Depo-Provera, Lunelle • Patch • Ring

  13. Oral Contraceptives

  14. Oral Contraceptives • Oral contraceptives are considered the second most popular form of birth control in the United States • Works by primarily inhibiting ovulation through suppressing FSH and LH • Types: • Combination pills that contain estrogen and progestin • Progestin only types (mini-pill)

  15. Health Benefits of OC’s • Research suggests that Oral contraceptives provide the following benefits: • Protection against epithelial ovarian and endometrial cancer • Lowered risk for ectopic pregnancies and PID • Lighter and less painful menstrual flow • Decreases in iron deficiency anemia

  16. Health Risks Associated with OC’s • Estrogen use is associated with the following side effects: • Nausea • Breast pain and soreness • Fluid retention • Progestin-only pills are associated with: • Increased irregular menstrual cycles • Vaginal bleeding • Other risks with OC’s include: • Blood clots • Strokes • Changes in bone density • Reproductive cancers

  17. Yasmin (contains synthetic progestin, drospirenone) Transdermal Patch (skin patch containing progestin/estrogen) NuvaRing (vaginal insert containing progestin/estrogen) Lunelle (monthly hormone injection) Implanon (progestin-only subdermal implant) Depo-Provera (progestin injection once every 3 months) Other Forms of Hormonal Contraceptives

  18. Emergency Contraception • In 1998, the FDA approved the first combination pill (Preven) • A year later, a progestin pill was developed (Plan B) • ECP’s reduce the risk of pregnancies by delaying or inhibiting ovulation when taken within 120 hours of unprotected intercourse • Effective rates improve when taken earlier vs. later • ECP’s do not induce a medical abortion or affect the developing pre-embryos or embyros Emergency IUP insertion is also considered a choice within 5 days of Unprotected intercourse and reduces pregnancy risk by 99.9%

  19. If woman is pregnant Active liver disease Heart problems Breast cancer diabetes Hypertension Migraine headaches Epilepsy History of blood clotting Contraindications for Hormonal Methods

  20. Intrauterine Devices • The WHO and the AMA have called the IUD one of the safest, most effective and least expensive reversible methods of birth control available • Past history with a faulty brand (Dalkon Shield, 1974) contributed to its lack of popularity in the U.S. as well as its stigma of being associated with abortion and PID’s • The method works by reducing the amount and ability of sperm to reach the egg • Other forms of IUD’s contain hormones, which allows the female to wear the IUD longer compared to others

  21. Sterilization • Vasectomy – separation of the vas deferens • Tubal ligation – separation of the fallopian tubes

  22. Maternal Mortality • Maternal mortality is defined as the death of a woman while pregnant • They are divided into direct and indirect obstetrical deaths • Direct: account for 80% of deaths and results from complications such as incorrect treatment, labor, pregnancy, or omissions, commonly due to hemorrhage • Indirect: result from previous existing diseases or diseases caused by the physiological complications of pregnancy e.g. anemia • The best mechanism to prevent maternal deaths is to improve the status of women

  23. Infant Mortality • Infant mortality is defined as the deaths of infants under 1 year while neonatal mortality is under 28 days • Race and education are important indicators for infant mortality • The primary causes for neonatal and infant mortality are: • Congenital anomalies • Pre-term/low birth weight • SIDS • Respiratory Distress • Complications of Pregnancy

  24. Non-drug use Nutritional planning Exercise Time lapse of one menstrual cycle between contraceptive use and conception Immunizations Folic acid supplements Quit smoking Avoid alcohol beverages Avoid OTC drugs Avoid mega-dosing on nutritional supplements Pre-Pregnancy Planning Pre-pregnancy planning encompasses the following:

  25. Conception • Pregnancy begins with the union of the female egg and the male spermatozoa • A one cell zygote is formed, containing characteristics of both parents • The fallopian tubes provide the environment where cell division begins • After 3 days, the fertilized ovum is transported to the uterus • Once the chorionic villi cover the ovum, hCG (human chorionic gonadotropin) supports the endometrial growth

  26. Amnion • The amnion surrounds the embryo before it starts to evolve • The amnion cavity is a fluid filled space between the amnion and the embryo • It keeps the fetus at an even temperature, cushions, and provides nourishment • By the 4th month, it can be sampled (amniocentesis) for possible genetic abnormalities

  27. Placenta • This is formed during the 3rd month • The function is to supply food to the fetus and connects to the fetus through the umbilical cord • The placenta does the following tasks: • Transfer gases and nutrients • Excretes waste • Transport heat • Produces various proteins and hormones • Brings maternal and fetal blood close together but are completely separate

  28. A missed period A light period or spotting Tender, swollen breasts Fatigue Upset stomach Vomiting Feeling bloated Frequent urination Early Signs of Pregnancy Most home pregnancy tests measure Human Chorionic Gonadotropin (hCG) to determine whether you are truly pregnant. Most tests are accurate.

  29. The heart beings to beat Bones have appeared-head, arms, fingers, legs, and toes The major organs and nervous systems are formed The placenta is formed Hair is starting to grow 20 buds for future teeth have appeared Fetal DevelopmentTable 9.2 (First Trimester)

  30. The fetus grows quickly from now until birth The organs are developing further Eyebrows and fingernails form The skin is wrinkled and covered with fine hair The fetus moves, kicks, sleeps and wakes, swallows, can hear, and can pass urine By the end of this time, the fetus is 11-14 inches long and weighs about 2-2.5 lbs. Fetal DevelopmentTable 9.2 (Second Trimester)

  31. The fetus kicks and stretches, but as it gets bigger it has less room to move Fine body hair disappears Bones harden, but bones of the head are soft and flexible for delivery The fetus usually settles in a good position for birth At 40 weeks, the fetus will be full term. It is about 20 inches long and weighs 6-9 pounds Fetal DevelopmentTable 9.2 (Third Trimester)

  32. Discussion of maternal nutritional needs, exercise, and drug use History of maternal, paternal, and family Physical exam including ht./wt. and blood pressure Exam of the reproductive organs Estimation of the due date Blood, urine ,and pap tests Pre-natal Care(First initial visit)

  33. Physical exam including ht./wt. and blood pressure Fetal heartbeat, growth, and position Urine test for protein and sugar Possible ultrasound, chorionic villus sampling, maternal serum screening, amniocentesis, anon stress test, a contraction stress test and a biophysical profile Pre-natal Care(subsequent visits) Weekly prenatal checkup are recommended after week 36

  34. Labor Signs • Braxton Hicks contractions increasing in frequency and intensity • Lightening occurs • Amniotic sac ruptures • The 3 stages of labor are: • Uterine contractions 15-20 mins. w/ “bloody show” with full cervix dilation • Crowning of the fetus’ head to fetal expulsion • Placental separation and expulsion

  35. Birthing Options • Midwives • Doulas • In-Hospital Deliveries • Birth Centers • Birthing Positions

  36. Breast-feeding • Breast-feeding has prevented nearly 6 million infant deaths each year world-wide • Advantages are: • Inexpensive • Better nutritional quality • Ability to act as a birth control measure to limit fertility • Reducing ovarian and premenopausal breast cancer • Contains colostrum (initial milk produced by the mother) which helps fight infections

  37. Potential Problems During Pregnancy • Ectopic Pregnancy • Tubal pregnancy • Occurs due to narrowing of the fallopian tubes • Can cause infertility and mortality • Hypertensive disorders • Preeclampsia-elevated blood pressure due to edema and/or proteinuria • Eclampsia-same as above except it progresses to convulsions and/or coma

  38. Infertility • Health providers should determine the cause of having difficulty conceiving • Primary infertility is the inability of a woman to become pregnant within a year of having unprotected intercourse • Secondary infertility is the inability to carry the pregnancy to full term • The most common reasons for primary infertility in women are failure to ovulate or a damaged uterus or fallopian tube while men have low sperm or abnormal counts

  39. Assisted Reproductive Technology (ART) • In vitro fertilization (IVF) • GIFT (gamete intrafallopian transfer) • ZIFT (zygote intrafallopian transfer) • ICSI (intercytoplasmic sperm injection) • The majority of these procedures are IVF (75%) • 69% were performed on women aged 30-39 • The remainder were common among women aged 40 years or older

  40. Other Procedures Used to Promote Motherhood • Donor eggs • Vasovasotomy • Artificial Insemination • Surrogacy • Somatic stem cells

  41. Abortion – Terminationof a Pregnancy • First Trimester Procedures • Menstrual extraction – withdrawendometrial tissue during the 4th-6th week • Vacuum aspiration – 6th-9th week procedure performed the most by dilating the cervix and removing uterine contents • D&C (Dilation & Curettage) - performed during 9th-14th week; dilation of cervix and scraping the wall of the uterine • RU486 (Mifepristone) – blocks the action of progesterone and doesn’t allow implantation to occur

  42. Abortion – Terminationof a Pregnancy, cont’d • Second Trimester Procedures • D&C (Dilation & Curettage) - performed during 13th-15th week; cervix is dilated and contents are removed by suction • Hypertonic Saline procedure – 16th week procedure where saline is administered and the uterus is caused to expel contents • Prostaglandin procedure – hormones cause contractions to expel uterine contents

  43. Adoption • Adoption is an alternative to assisted reproduction or abortion • Adoptions can be ‘open ‘ or ‘closed’` • Couples who are making the decision have a variety of issues to consider • Services can vary from matching children and adoptive parents to educational and support services throughout the parenting years See FYI: Facts on Adoption

  44. Chapter Nine Designing Your Reproductive Life Plan

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