CHAPTER 9 - PREGNANCY & PARENTING Instructor: Wendy Crapo

Used by permission of THE ACADEMY OF NURSING 2355 E S. S.L.C., UT

DECIDING TO BE A PARENT: Race: Highest birthrate = Mexican Americans & Cuban AmericansRace: Highest birthrate = Mexican Americans & Cuban Americans Education: Highest birthrate = only high school educationEducation: Highest birthrate = only high school education Income: Highest from ages = lowest incomeIncome: Highest from ages = lowest income years highest = high income30-44 years highest = high income

BIRTHRATES BY ETHNIC GROUP

Changes in Average Number of Children per Family

Number of Children per Married/Unmarried Women

Households with Children

CHILD-FREE: NOT CHILD LESS Want right mateWant right mate Right time to have childrenRight time to have children Complete educationComplete education Build careerBuild career Establish secure relationshipEstablish secure relationship Money - $300,000 to raise a child (subsequent children are less expensive and sons)Money - $300,000 to raise a child (subsequent children are less expensive and sons) (Missing something they wanted or were supposed to have) Generally well educated and career oriented.

COSTS OF PARENTING “It’s not how much money you parent with that really counts. It’s how you parent.”“It’s not how much money you parent with that really counts. It’s how you parent.” Parents generally spend a three years earning, averaged over the child’s life.Parents generally spend a three years earning, averaged over the child’s life.

PREGNANCY Changes: Couples relationshipCouples relationship May deepen and strengthen the relationshipMay deepen and strengthen the relationship Need to resolve dependency issues and money issuesNeed to resolve dependency issues and money issues Sexuality may increase, decrease – no rules about sex during pregnancySexuality may increase, decrease – no rules about sex during pregnancy Priorities & values changePriorities & values change Roles changeRoles change Mother/daughter relationship (now treated as adult) Physical changes: attractiveness

Fetal Development Month by Month

First Month By the end of the first month, the embryo is about 1/10 of an inch long. The heart, which is no larger than a poppy seed, has begun beating.

Two Months The embryo is about 1 inch long and has distinct, slightly webbed fingers. Veins are clearly visible. The heart has divided into right and left chambers.

Three Months By now the fetus is 2 1/2 to 3 inches long and is fully formed. He has begun swallowing and kicking. All organs and muscles have formed and are beginning to function.

Four Months Your baby is covered with a layer of thick, downy hair called lanugo. His heartbeat can be heard clearly. This is when you may feel your baby's first kick.

Five Months A protective coating called vernix caseosa begins to form on baby's skin. By the end of this month, your baby will be nearly 8 inches long and weigh almost a pound.

Six Months Eyebrows and eyelids are visible. Your baby's lungs are filled with amniotic fluid, and he has started breathing motions. If you talk or sing, he can hear you.

Seven Months By the end of the seventh month, your baby weighs about 3 1/2 pounds and is about 12 inches long. His body is well-formed. Fingernails cover his fingertips.

Eight Months Your baby is gaining about half a pound per week, and layers of fat are piling on. He has probably turned head-down in preparation for birth. He weighs between 4 and 6 pounds.

Nine Months Your baby is a hefty 6 to 9 pounds and measures between 19 and 22 inches. As he becomes more crowded, you may feel him move around less.

Discomforts of Pregnancy

Discomfort Constipation Bleeding gums Backaches What to avoid?ReliefCause Weight gain, posture Massage, warm bath Lying on back, one position for long time Lack of nutritionBrush & floss daily, fruit & veggies Smoking Position of baby, diet Fruits, water Over the counter laxatives Dizziness Move to quicklySlow down, rest Groin pressure Baby pushing down Elevate legs Heavy lifting, stairs if necessary

Discomfort Heartburn Headaches Gas What to avoid?ReliefCause Large meals, diet Eat small meals, exercise Foods that cause gas Hormones, stressScalp massage, warm cloth Processed foods, caffeine Large mealsSmall meals, milk may soothe Spicy foods, meals before bed, lying flat Hemorrhoids Pressure on rectum Warm bath, “Tucks” Insomnia Worries, uncomfortable Warm milk, reading Caffeine, long naps Reading on toilet, constipation

Discomfort Nosebleeds & Nasal Congestion Mood swings Leg cramps What to avoid?ReliefCause Pressure from baby weight Regular walking Standing in one position for long time HormonesOpen communication Processed foods, caffeine Increased blood volume Cool mist humidifier, more Vitamin C Over the counter nasal sprays Sciatica Pressure on sciatic nerve Massage or physical therapy Acne Diet, sweating, lack of water Wash skin Heavy makeup, too much sun Heavy lifting, climbing ladders

Discomfort Sore ribs Urination Swelling What to avoid?ReliefCause Diet – body holds water Drink water, loose clothes Salt or processed foods Small bladderEmpty bladder Water before bed Baby growthChange positions Half sit-ups Stretch marks Baby growth Good nutrition, oil or creams? Varicose veins Swollen blood vessels Support hose, change positions often Crossing legs, high heeled shoes Spending money on expensive products

PREGNANCY LOSS Spontaneous abortion (miscarriage)Spontaneous abortion (miscarriage) Infant mortality (lowest rate ever but 19 countries still have lower rates)Infant mortality (lowest rate ever but 19 countries still have lower rates) 32,000 babies, under one year, die every year mostly related to poverty32,000 babies, under one year, die every year mostly related to poverty SIDSSIDS Coping with loss – need to experience the grieving process

History of Delivery

Early Forceps developed - many babies died in the early years of their use Before 19th century was uneventful - life went on as normal no pain relief Mid 19th century women feared childbirth - painful or even fatal higher social status less children you had 1800’s - Chloroform was used to relieve women of any pain - it was harmful and even fatal to mother and baby

Mid First successful Cesarean delivery death rate remained high until 20th century 1900’s - Middle class women would be confined until well after the baby was born – –Introduction of Maternity clothes (Lane Bryant)

1920 “Twilight labor” Morphine and scopolamine (general anesthetic) – –(These drugs proved to be harmful to baby and mother) Use of stirrups to prevent any tearing or ripping

1950 and Beyond 1950’s - Use of drugs in “assisted” childbirth becomes popular 1970’s - “Natural” childbirth is newly popular – –Midwife becomes popular 1980’s - Back toward hospital births

CHOICES IN CHILDBIRTH Hospital Birth (read page 319)Hospital Birth (read page 319) Responding with family- centered childbirth and rooming-inResponding with family- centered childbirth and rooming-in Norm is still impersonal birthsNorm is still impersonal births Bright lights, loud noise, monitorsBright lights, loud noise, monitors

Medicalization of Childbirth Hormones given to intensify contractions and shrink uterus after deliveryHormones given to intensify contractions and shrink uterus after delivery Drugs go directly through placenta to baby (may reduce heart & respiratory rates & general responsiveness)Drugs go directly through placenta to baby (may reduce heart & respiratory rates & general responsiveness) Episiotomy (61%)Episiotomy (61%) Research recommended liberal or routine use of episiotomy be abandonedResearch recommended liberal or routine use of episiotomy be abandoned Fetal MonitoringFetal Monitoring

Medicalization of Childbirth continued Helpful in high-risk but not low risk (stethoscope works)Helpful in high-risk but not low risk (stethoscope works) Forceps & Vacuum extractorsForceps & Vacuum extractors Too often used as substitute for patience & skillToo often used as substitute for patience & skill Table births (against gravity)Table births (against gravity) Most cultures use birthing chairs, kneeling, or squattingMost cultures use birthing chairs, kneeling, or squatting C-sections account for ¼ of births in USC-sections account for ¼ of births in US Circumcision?Circumcision?

CHILDBIRTH IS A NATURAL PROCESS Can technology do the job better?Can technology do the job better? Is lower birthrate due to advances in medicine?Is lower birthrate due to advances in medicine? Should pain of childbirth be avoided at all costs?Should pain of childbirth be avoided at all costs? If a child is still born or disabled why do we look for someone to blame?If a child is still born or disabled why do we look for someone to blame? WOMEN NEED TO UNDERSTAND THEY DO HAVE A SAY IN THE BIRTH PROCESS Read article about pain relief

POSTPARTUM PERIOD Biological Hormone dropHormone drop Labor, dehydration, blood lossLabor, dehydration, blood lossPsychological Question abilities as a motherQuestion abilities as a mother OverwhelmedOverwhelmed Social factors Financial & emotional burdenFinancial & emotional burden