Pregnancy and Childbirth

Understanding Fertility Conception Involves the fertilization of a women’s egg by a man’s sperm Each month a women’s ovaries release an egg 24 hours if not fertilized 3-4 days - the egg travels through the fallopian tubes Egg not fertilized Millions of sperm Sperm release an enzyme Egg and sperm each carry 23 chromosomes Ovum, blastocyst, embryo, fetus © 2010 McGraw-Hill Companies. All Rights Reserved.

© 2010 McGraw-Hill Companies. All Rights Reserved. Figure 8-1 Fertilization and early development of the embryo © 2010 McGraw-Hill Companies. All Rights Reserved.

© 2010 McGraw-Hill Companies. All Rights Reserved. Pregnancy 3 periods of about 3 months (13 week trimesters) Tests Home pregnancy tests Human chorionic gonadotropin (HCG) Two weeks after fertilization Early signs and symptoms Missed menstrual period Softening of the uterus Hager’s sign Slight bleeding Nausea Breast tenderness Increased urination Sleepiness, fatigue and emotional upset © 2010 McGraw-Hill Companies. All Rights Reserved.

Continual Change in the Women’s Body Uterus size First 3 months, the uterus enlarges to about three times its nonpregnant size 4th month, large enough to make abdominal protrude 7th-8th month, pushes up into the rib cage Breast changes 8th week 10th week colostrum Muscles and Ligaments loosen Weight Gain © 2010 McGraw-Hill Companies. All Rights Reserved.

© 2010 McGraw-Hill Companies. All Rights Reserved. Figure 8-3 The fetus during the third trimester of pregnancy © 2010 McGraw-Hill Companies. All Rights Reserved.

© 2010 McGraw-Hill Companies. All Rights Reserved. Fetal Development First Trimester Blastocyst Inner cells divide into three layers One layer – inner body parts Middle layer – muscle, bone, blood, kidneys, and sex glands Third layer – skin, hair, and nervous tissue Embryo - End of second week All major body structures are formed between 2nd and 9th week 2nd Month - Fetus © 2010 McGraw-Hill Companies. All Rights Reserved.

© 2010 McGraw-Hill Companies. All Rights Reserved. Figure 8-4 A chronology of milestones in prenatal development © 2010 McGraw-Hill Companies. All Rights Reserved.

© 2010 McGraw-Hill Companies. All Rights Reserved. Fetal Development Second Trimester Fetus grows to about 14 inches and 2 pounds Third Trimester Fetus gains protective fat layers, Respiratory and Digestive organs develop © 2010 McGraw-Hill Companies. All Rights Reserved.

© 2010 McGraw-Hill Companies. All Rights Reserved. Figure 8-5 A cross-sectional view of the fetus in the uterus and an enlargement of the placenta © 2010 McGraw-Hill Companies. All Rights Reserved.

Diagnosing Fetal Abnormalities Ultrasonography (Ultrasound) High frequency sound waves Amniocentesis Fluid removal from the uterus Chorionic Villus sampling Removal of tiny section of chorionic villi Quadruple marker screen (TMS) Maternal blood test Analyze four hormone levels and compared to appropriate standards Fetal programming Conditions in the womb may influence the risk of adult diseases Amniocentesis, CVS, and TMS Chromosomal, genetic and other abnormalities © 2010 McGraw-Hill Companies. All Rights Reserved.

The Importance of Prenatal Care Regular medical checkups Blood tests Prenatal nutrition Avoidance of drugs, and other environmental hazards: Teratogens 1st trimester Congenital malformations Alcohol Tobacco Caffeine Drugs STD’s and other infections © 2010 McGraw-Hill Companies. All Rights Reserved.

The Importance of Prenatal Care Activity and exercise Moderate exercise program 30 minutes most days Cardiovascular exercises Kegal Exercises Prenatal exercise classes Preparation for childbirth © 2010 McGraw-Hill Companies. All Rights Reserved.

Complications of Pregnancy and Pregnancy Loss Ectopic pregnancy Spontaneous Abortion, or miscarriage Stillbirth Preeclampsia/eclampsia Placenta Previa Placental Abruption Gestational Diabetes Preterm Labor Labor Induction Low-birth Weight (LBW) 5.5 LBS. Infant Mortality SIDS Coping with loss © 2010 McGraw-Hill Companies. All Rights Reserved.

© 2010 McGraw-Hill Companies. All Rights Reserved. Childbirth Choices in childbirth Who is going to assist with delivery? Physician High risk? Certified Nurse-Midwife Where is the baby going to be delivered? Hospital Home © 2010 McGraw-Hill Companies. All Rights Reserved.

© 2010 McGraw-Hill Companies. All Rights Reserved. Labor and Delivery Entire process 2-36 hours. First stage of Labor. Average13 hours for a first birth. Cervix is completely dilated (10 centimeters) Hormonal changes. Contractions. (30 seconds and occur every 15-20 minutes) Mucus plug is expelled and amniotic sac may rupture. Transition: Contractions may last 60-90 seconds and be 1-3 minutes apart © 2010 McGraw-Hill Companies. All Rights Reserved.

© 2010 McGraw-Hill Companies. All Rights Reserved. Childbirth Second Stage of Labor Baby slowly pushed into birth canal Baby squeezes through pelvis Head is usually delivered first Umbilical cord is cut Third Stage of Labor Delivery of the placenta Stage typically lasts 5-30 minutes Apgar Scale of the Baby Heart rate Respiration Color Reflexes Muscle tone Total score is between 0 and 10 © 2010 McGraw-Hill Companies. All Rights Reserved.

© 2010 McGraw-Hill Companies. All Rights Reserved. Figure 8-7 Birth: labor and delivery © 2010 McGraw-Hill Companies. All Rights Reserved.

Pain Relief During Labor and Delivery Childbirth preparation courses Breathing and relaxation techniques Lamaze or Bradley Epidural Narcotics Fentanyl or demeral Provide less pain relief than a epidural © 2010 McGraw-Hill Companies. All Rights Reserved.

© 2010 McGraw-Hill Companies. All Rights Reserved. Cesarean Deliveries 2006 about 31.1% of babies born in the U.S. Surgical removal of the baby Baby’s head too large Mother has a serious health condition Mother who is overweight or diabetes Difficult labor Fetal distress Dangerous infections 90% of cesarean mothers will have subsequent deliveries by cesarean © 2010 McGraw-Hill Companies. All Rights Reserved.

© 2010 McGraw-Hill Companies. All Rights Reserved. Postpartum Period 3 months following childbirth. Critical family adjustment. Vaginal delivery leave hospital 1-3 days. Cesarean section 3-5 days. 6-8 weeks for the mother’s reproductive organs to return to prebirth condition Breastfeeding About 74% of mothers breast-feed Lactation begins about 3 days post childbirth Colostrum prior to lactation © 2010 McGraw-Hill Companies. All Rights Reserved.