Reproductive Choices

Chapter 5 Reproductive Choices Learning Outcomes: Describe the process of conception Discuss the problem of infertility and alternate methods of having children Discuss the pros and cons of various methods of contraception Discuss methods of abortion Discuss health issues in pregnancy and prenatal development Describe health issues associated with methods of childbirth Discuss health issues in the postpartum period

Conception Union of a sperm cell and an egg cell Zygote: Fertilized egg Females: XX Males: XY Miscarriages (spontaneous abortions) of male fetuses more prevalent Fertilization normally occurs in a fallopian tube. The zygote travels down to the uterus and implants into the wall.

Infertility Male Fertility Problems Female Fertility Problems Sperm: low count, low motility, irregularly shaped Causes: genetic factors, age, injuries, drugs, blood pressure medications, environmental toxins, stress Female Fertility Problems Irregular ovulation or failure to ovulate, obstructions or malfunctions of reproductive tract, endometriosis, age-related decline of female sex hormones

Increasing Fertility Inducing Ovulation Increasing the sperm count Artificial insemination ICSI (Intracytoplasmic Sperm Injection) Inducing Ovulation IVF (Invitro fertilization) GIFT (game intrafallopian transfer) Donor IVF ZIFT (Zygote intrafallopian transfer) Embryonic Transfer Surrogate Motherhood Adoption

Contraception Consider effectiveness, ease of use, health risks Hormonal Methods progestin or combination of progestin and estrogen Oral contraceptives – “The Pill” Injectable, patches, “morning-after pill” No protection against STIs Health risks for women who smoke, are obese, older, hypertension, or a history of vascular disease Intrauterine Device (IUD)

Contraception Methods Barrier Methods Condoms Latex protect against STIs Less effective than oral contraceptive or IUD Diaphragm Shallow latex cup or dome No protection against STIs Spermicides Contraceptive Sponge Cervical cap

Contraceptive Methods Fertility Awareness (Rhythm Methods) Calendar BBT Ovulation No protection against STIs Low reliability Sterilization Vasectomy Tubal sterilization (tubal ligation) Hysterectomy

Abortion Purposeful termination of pregnancy Methods Vacuum aspiration (90% - safest) Dilation and Curettage (D & C) Dilation and Evacuation (D & E) – 2nd trimester Intra-amniotic infusion – 2nd trimester Intact Dilation and Extraction (intact D & E) RU-486

Pregnancy Early Days Human chorionic gonadotropin (HCG) produced (OTC pregnancy tests – HCG in urine) “morning sickness” Prenatal care important

Stages of Prenatal Development Germinal Stage Conception to implantation Embryonic Stage Implantation to 8th week Neural tube (3 weeks) – importance of folate Fetal Stage 9th week until birth Major organ systems, fingers, toes, external genitals are formed by end of 1st trimester Factors that may adversely affect health of embryo/fetus: drugs, X-rays, environmental contaminants, infectious organisms

Childbirth Three Stages 1st Stage: Labor - contractions efface and dilate cervix, ending with transition 2nd Stage: transition, “hard labor” culminating with delivery 3rd Stage: Delivery/Expelling of Placenta

Methods of Childbirth Anesthetized Childbirth General Local: Blocks – pudendal, epidural, spinal Prepared Childbirth – The Lamaze Method Can be used in combination with anesthetics Cesarean Section 1 in 3 births now done by C-section

Birth Problems Oxygen Deprivation Prenatal hypoxia can impair central nervous system development Prolonged oxygen cutoff at delivery can cause cerebral palsy or death Preterm and Low-Birth Weight Children Preterm < 37 weeks Low birth weight < 5 lbs Neurological and cognitive functioning impaired Muscles are immature, weakened sucking & breathing reflexes Respiratory distress syndrome

The Postpartum Period Postpartum Depression (PPD) “baby blues” normal – generally last 1-2 weeks PPD – more serious and persistent mood changes Symptoms: sadness, hopelessness and helplessness, major changes in appetite, sleep patterns, difficulty concentrating, severe fluctuation in mood Breast-Feeding Versus Bottle Feeding Benefits of Breast-Feeding Reduces risks of infections, and incidence of allergies