BIRTH PLANNING Senior Health

Birth Planning Obstetrician/Gynecologist Maternal-Fetal Specialist 4 years of training in pregnancy, delivery and women health and infertility. Maternal-Fetal Specialist High risk pregnancy specialist with OB/GYN Family Physician General medical care for the whole family. Referral to OB/GYN, only for low risk pregnancy Nurse Mid-wife Licensed registered nurse cares for mother and fetus Trained specifically in delivery of baby and after care. Works with doctor, unless complications.

What is a high risk pregnancy? You have a health problem, such as: Diabetes. Cancer. High blood pressure. Kidney disease. Epilepsy You use alcohol or illegal drugs, or you smoke. You are younger than 17 or older than 35. You are pregnant with more than one baby (multiple pregnancy). You have had three or more miscarriages. Your baby has been found to have a genetic condition, such as Down syndrome, or a heart, lung, or kidney problem. Having a baby with a genetic problem, such as Down syndrome. You have an infection, such as HIV or hepatitis C.

Hospital Birth Up to date medical equipment Medication available Recommended for high risk pregnancy Delivery by doctor OR nurses

Birthing Center Low risk pregnancies Home like setting-usually on hospital grounds Medication free Parents have control of process Receive individual care Labor-Delivery and after care in the same room. No cesarean sections

Home Birth For a healthy, low-risk pregnancy You want to enjoy the comforts of your home and familiar surroundings Labor-Delivery and After care all in same setting Maximum control over birth Share experience with family and friends NO medicine or medical care immediately available Midwives bring necessary equipment

Birth Plan Medications Natural Childbirth Advantage No side effects from medication Experience birth and delivery No medical machines to be hooked up to Disadvantages Pain/Discomfort without medication Point of no return- Medication

Systemic Medications Narcotics or tranquilizer IV into blood stream or injection into muscle Advantage No anesthesia Takes “edge” or reduces anxiety Cope with some pain Disadvantages Doesn’t control all pain Slows down labor Could effect fetus or baby Drowsy & difficulty breathing

Regional Medication Decreases sensation to specific parts of the body. Mother is alert and awake with NO pain waist down. Spinal Tap -Injected in the dura of spinal cord Advantage -Rapid pain relief Disadvantage -Position for injection -Harder to push fetus out -Decrease in blood pressure -Headaches Epidural -injected into sac around spinal cord. Advantage -Awake and alert during labor -Increases energy during delivery Disadvantage -Spotty pain relief -Position for injection position -Loss of sensation of body

Pregnancy and Parenting

Female Anatomy

Fertilization Fertilization is the union of the sperm and the ovum, or egg. This occurs around the time of ovulation in a women. The egg is capable of being fertilized for about 12-24 hours after ovulation. The sperm can live inside a woman’s body for up to 5 days. This occurs in the fallopian tube. As soon as the ovum is fertilized, it is called a zygote.

Fertilization Look Who's Talking

Zygote Once the zygote has formed, a protective membrane around it will prevent more sperm from entering the ovum. As the zygote makes its way to the uterus the cells will divide many times to form a cluster of cells that has a hollow space in the center. This is called a blastocyst.

Blastocyst

Implantation When the blastocyst attaches to the lining of the uterus. The lining of the uterus is made up of layers of tissue that will protect and nourish the fertilized egg. Once implanted the cluster of cells is now called an embryo. The embryo is now the size of a dot on top the letter “i.”

Embryonic Development The cells of the embryo will continue to divide and form 3 layers of tissue. One layer becomes the respiratory and digestive systems. Another layer develops into muscles, bones, blood vessels, and skin. The third layer becomes the nervous system, sense organs and the mouth.

Embryonic Development Con’t The Amniotic Sac will also form at this time. This is a sac filled with fluid that forms and surrounds the developing embryo. It acts as a shock absorber, and insulates the embryo from temperature changes. Placenta – A blood rich tissue developed from an outer layer of cells from the embryo and tissue from the mother. The embryo is connected to the placenta by the umbilical cord. Umbilical cord – a tube through which nutrients and oxygen pass from the mother’s blood into the embryo’s blood. The umbilical cord also carried waste products from the embryo.

Embryonic Development Con’t During the first six weeks the embryo grows rapidly in length and gains weight. At the start of the embryonic period the embryo is about .5-1 inch long. At eight weeks the embryo is 1.5 inches long. At the end of the eighth week the embryo is now called the fetus, and will be called the fetus till birth.

Fetal Development The development of the fetus is now divided into 3 trimesters. 1st trimester – 1 to 3 months 2nd trimester – 4 to 6 months 3rd trimester – 7 to 9 months

1st Trimester During the 1st month: the blood begins circulating, and the brain begins to form but does not function During the 2nd month: the external body parts and internal organs begin to form, genitals also start to form but you can not tell the gender yet. During the 3rd month: the male and female begin to look different, fingers, toes , and nails start to form, the head is about half the size it will be at birth.

1st trimester

2nd Trimester During the 4th month: Muscles move , sweat glands, eyebrows, and eyelashes begin to form. During the 5th month: fetus gets hair, movements can be felt, heartbeat can be heard. During the 6th month: the brain starts to work, eyes open, ears work, finger and footprints form.

2nd trimester Fetus is about 8 inches long

3rd Trimester During the 7th month: the fetus adds body fat, moves a lot, responds to sound During the 8th month: less active, still growing in weight and length, nails and bones begin to harden During the 9th month: Lungs and other organs become fully developed (except for brain and reproductive system which won’t fully mature until teen years)

3rd trimester

Ultrasounds 1st Trimester 2nd Trimester 3rd Trimester

How do you know your pregnant? Symptoms include missed menstrual period, breast tenderness, morning sickness, frequent urination. Pregnancy Tests Blood and Urine Tests test for the hCG hormone. Blood tests can test for hCG sooner and are more accurate. (6-8 days after ovulation) Home pregnancy tests are the most accurate one week after a missed period.

Physical Changes 1st trimester: increase in hormones, breast swell, frequent urination, morning sickness, vaginal irritation, fatigue 2nd trimester: morning sickness disappears, constipation, nosebleed may occur, edema (water retention and swelling) 3rd trimester: weight gain (25-35lbs), discomfort, backaches, shortness of breath, swelling, heartburn, frequent urination

Psychological Changes Depression Negative/positive emotions Psychological well being is best among those that have social support. Postpartum depression – also known as the “baby blues,” happens after the birth and consists of mood swings and crying spells. May go away on own, if not the mother will need to seek medical treatment

Father/Partner’s Role Couvade Syndrome – a healthy man whose partner is expecting a baby experiences pregnancy symptoms, “sympathetic pregnancy” Symptoms occur during the 1st and 3rd trimesters and consist of nausea, heartburn, abdominal pain, appetite changes, backaches, etc. Helps with labor – breathing techniques, may hold a leg, and cuts the umbilical cord

Prenatal Care Pregnant women should have regular visits with an OB/GYN or midwife. Blood Tests, pelvic examinations to identify any problems early on Ask questions Nutrition Monitor weight Exercise programs

Prenatal Nutrition The mother to be needs large amounts of micronutrients, especially calcium, Vitamin E, Zinc, and Iron. Iron Deficiency – will cause the fetus to draw its supply from the mother and leave the mother anemic, and exhausted. Zinc Deficiency – malformations of the central nervous system. Eating foods high in Folic Acid (whole grains and fish) reduces the risk of certain birth defects. Spina Bifida – a birth defect where the backbone and the spinal canal do not close before birth

Medicines, Drugs, and Pregnancy Any medication whether over-the-counter or prescription pose a potential danger to the fetus. If illegal drugs are taken during pregnancy the baby can be born addicted and dependent on the drug. Caffeine has been associated with an increased risk of birth defects and other problems. Other harmful substances: food additives, aspirin, antibiotics, toxins, such as carbon monoxide and lead.

Alcohol and Pregnancy Females who drink alcohol during pregnancy may cause permanent damage to the developing baby. Alcohol use had been associated with many birth defects. The alcohol passes from the mother into the bloodstream of the fetus. Fetal Alcohol Syndrome (FAS) – mental retardation, slow growth, and physical defects, such as cleft palate, and hip dislocation.

Fetal Alcohol Syndrome

Tobacco and Pregnancy Babies born to mothers who use tobacco have a greater chance of being born prematurely, and with low birth weights. Babies that weigh less than 5 ½ lbs are at risk for serious health problems. Low birth weight is the leading cause of death in a baby’s first year. Smoking may affect the growth, mental development, and behavior of a child up to age 11. Children also have a higher incidence of respiratory problems, such as bronchitis and pneumonia.

Stages of Labor 1st stage: Dilation- Stretching of the cervix, results from mild contractions. 2nd stage: Begins when the cervix is fully dilated (8-10inches), Passage of the baby through the birth canal, caused by continuing contractions. Crowning – top of the head is visible Episiotomy – incision made to the vaginal entrance 3rd stage: After Birth-contractions continue after the baby is born for 10 to 15 minutes to push out the placenta.

Cesarean Section Also known as a “C-Section” A method of delivering a baby surgically by an incision to the mother’s abdomen and uterus. Reasons: Baby is too large Cervix is not dilating Umbilical cord Excessive bleeding Baby is in distress Baby is in an abnormal position Cesarean Section Clip

Recovery Time Vaginal Birth – 2 days after delivery C-Section – 4 days after delivery

Infertility Infertility refers to a woman’s inability to conceive and give birth to a living child, or man’s inability to impregnate a woman. Causes: Female – Pelvic Inflammatory Disease, Failure to ovulate, blockage of the fallopian tubes, body fat, hormones Male – Infections to the reproductive system caused by STDs, low sperm count, low sperm motility Both – Stress, lack of knowledge

Questions Why do miscarriages happen? 10-25% of all clinically recognized pregnancies will end in a miscarriage Most miscarriage will occur within the first 13 weeks Reasons for miscarriages vary and often can not be identified Examples: chromosomal abnormalities, hormonal problems, lifestyle, problems with implantation, Maternal age Maternal trauma

Questions Birth Defects? 1 in every 33 babies is born with a birth defect. Center for Disease Control Statistics

Questions What is the average number of children parents have? According to 2010 Census 1.88 When do you start to show? Most women start showing between 3 and 4 months Women who have been pregnant before my start showing sooner