Chapter 10 Contraception

Historical and Social Perspectives Evidence of contraception since the beginning of recorded history U.S. Contraceptive Efforts 1800s Comstock Laws 1915: Margaret Sanger U.S. Supreme Court Rulings Griswold vs. Connecticut Eisenstadt vs. Baird How does the belief that abstinence is the only moral form of birth control play out today?

Contemporary Issues on Contraception Worldwide contraceptive usage increase Planning for wanted children Physical health of mother Insurance coverage of contraceptives Population growth Cultural gender-role expectations Wide diversity of views among cultures and religious groups

Sharing Responsibility for Contraception Ask about birth control before intercourse Read and discuss options together Attend a class or clinic together Share expenses

Choosing a Birth Control Method Consider effectiveness and cost Consider ease of use and side effects Characteristics of ineffective use

Hormone-Based Contraceptives 4 Basic Types of The Pills Combination pill Triphasic pill Constant dose Progestin-only pill

Other Hormone-Based Contraceptives Vaginal ring Transdermal patch Injected contraceptives

Barrier Methods Male Condom Female Condom Sheath fits over erect penis Female Condom Worn internally by a female Additional protection from condoms

Vaginal Spermicides Can be purchased in pharmacies without a prescription Types Foam, sponge, suppositories, creams, contraceptive film (VCF)

Cervical Barrier Devices Diaphragm Cervical cap FemCap Lea’s Shield

Intrauterine Devices Affect sperm motility and viability Thicken cervical mucous Alter endometrial lining Impair tubal motility

Emergency Contraception Hormone Pills Birth control pills taken within 72 hours of unprotected intercourse Copper-T IUD Inserted up to 5 days after unprotected sex Access issues and advancement

Fertility Awareness Methods Standard days method Mucus method Calendar method Basal body temperature method

Sterilization Most effective method Leading method in U.S. and the world Reversal about 50% effective

Nursing A Less than Effective Method of Birth Control Amenorrhea is common for a brief period after birth while breastfeeding 80% ovulate before first period

Withdrawal Before Ejaculation A Less than Effective Method Difficult to judge when to withdraw Anxiety may lower pleasure Cowper’s gland fluid may carry sperm Any sperm on vulva may travel into vagina/uterus Unreliable

New Directions in Contraception Males Progestin/Testosterone implant or injection Medication to prevent ejaculation during orgasm Reversible vasectomy in clinical trials Females Non-hormonal methods Contraceptive vaccine, vaginal ring, spermicide Spray on contraceptive Spermicide to protect against STIs

Chapter 11 Conceiving Children: Process and Choice

Parenthood as an Option Advantages of Remaining Childless More time for self and partner More financial resources Marriage less stressful More spontaneity More devotion to career

Parenthood as an Option Advantages of Having Children Children give and receive love May enhance relationship Builds self-esteem, sense of accomplishment Greater meaning and satisfaction

Becoming Pregnant Enhancing the Possibility Intercourse just prior to or at ovulation Predicting ovulation Mucus, calendar, BBT methods Ovulation predictor urine tests

Infertility Diagnosis Causes Challenges in relationships More than 6 months of trying = problem Not conceiving after at least 1 year 1 in 6 U.S. couples seek help Causes Complex, hard to determine Unidentifiable in 15% of cases 85-90% of cases can be treated Challenges in relationships

Female Infertility Failure to ovulate regularly Below normal body weight Smoking and substance abuse Infertility increases with age Cervical mucus may destroy sperm Sperm may not reach the egg Fertilized egg may not implant

Male Infertility Abnormal sperm count or motility Caused by poor nutrition Substance abuse Environmental toxins STIs Impaired sperm production Varicocele Congenital abnormalities

Reproductive Technologies Artificial insemination Surrogacy Assisted reproductive technology (ART) In vitro fertilization (IVF, ZIFT, or GIFT) Do you think children conceived by donor sperm and/or egg insemination should be told about this? Why or why not?

Concerns Regarding Reproductive Technologies Expense Legal, ethical, and personal dilemmas 75% failure rate 20-30% end in multiple embryos Health concerns

Pregnancy Detection First signs Nausea/Vomiting: appetite change Light period, spotting, or no period; fatigue; tender breasts Nausea/Vomiting: appetite change Blood or urine for HCG Subtle softening of uterus at 6 weeks

Miscarriage Spontaneous Abortion Occurs in first 20 weeks 10-20% of all pregnancies Emotional impact can be significant Individual or couple may consider grief support

Elective Abortion U.S. Statistics Part 1 25% of U.S. pregnancies end in elective abortion 1% occur after 20 weeks 50% of women will have abortion by age 45

Elective Abortion U.S. Statistics Part 2 Of yearly abortion rates Young, unmarried, white women obtain most 20% married women 60% previously given birth Women with 4+ children are more likely to have an abortion than women with fewer children 43% Protestant; 27% Catholic

Reasons Why Women Decide to Have Elective Abortions Younger women unprepared for motherhood Older women difficulties meeting needs for current children In the U.S. two-thirds of women who have abortions cite financial reasons 60% of abortions occur among those with incomes below $28,000 for a family of 3

Elective Abortions Cross-Cultural Analysis Part 1 U.S. has one of the highest abortion rates among developed countries All countries with lower rates provide Comprehensive sex education Easy access to inexpensive birth control and emergency contraception Germany, the Netherlands, and Belgium have 66% lower rates than U.S.; France 50% lower

Elective Abortions Cross-Cultural Analysis Part 2 Highest abortion rates are in countries With severe restrictions on abortion Do not provide the social services for women and children Do not provide sex education and access to contraception

Types of Abortion Procedures Medical abortion Suction curettage Dilation and evacuation (D and E) Prostaglandin induction Late-term abortion (intact dilation and evacuation) Illegal abortion

Medical Abortions Caption: How medical abortions work.

U.S. Abortion Controversy Historical Overview Early American law allowed abortion until quickening (movement of the fetus) 1973: Roe vs. Wade 1977: Hyde Amendment State restrictions or limitations Waiting period, parental notification

U.S. Abortion Controversy Current Debate Majority of Americans believe abortion should remain legal Pro-life goals Pro-choice goals

Experience of Pregnancy Wide range of positive and negative emotions Emotions are affected by physical changes First trimester increased fatigue, nausea, and breast changes Second trimester movement felt; heightened sense of well-being Third trimester increased size; greater discomfort

Pregnancy at Ninth Month Caption: Pregnancy in the ninth month. The uterus and abdomen have increased in size to accommodate the fetus.

Experience of Pregnancy Male Partner Ecstasy to ambivalence to fearfulness Male partner may feel closeness or separation toward female counterpart Concern about financial impact Active involvement helps

Fetal Development First Trimester Zygote: united sperm cell and ovum Blastocyst: multiple cells that implant Heartbeat at 9-10 weeks after last period 2nd month: spinal canal, arms/legs 3rd month: internal organs

Blastocyst Caption: The blastocyst implanted on the uterine wall shown (a) in diagram and (b) in photo taken by a scanning electron microscope.

Fetal Development Second Trimester Sex of fetus can be distinguished External body parts develop including fingernails, eyebrows, and eyelashes Skin covered by fine down-like hair Growth in size Fetal movements (quickening) by end of 4th month By end of 2nd trimester fetus has opened its eyes

Fetal Development Third Trimester Develop size and strength Down-like hair disappears Skin smoother Vernix caseosa protective creamy, waxy substance

Risks to Fetal Development Harmful substances pass to baby via placenta Prescription and non-prescription drugs 1997: viable fetus can be protected under child abuse laws Nicotine, caffeine, alcohol (FAS)

Placenta Caption: The placenta exchanges nutrients, oxygen, and waste products between the maternal and fetal circulatory systems. (a) The placenta attached to the uterine wall. (b) Close-up detail of the placenta.

Prenatal Care Health assessment before pregnancy Good nutrition Adequate rest Routine health care Moderate exercise Prenatal education

Pregnancy after Age 35 Essentially safe with prenatal care Fertility decreases with age Heightened rate of fetal defects due to chromosomal abnormalities

Contemporary Childbirth Prepared childbirth Lamaze Birthplace alternatives Homebirth

First Stage Childbirth 10 to 16 hours in duration Bloody show Water breaks Effacing or thinning of cervix Slight dilation

First Stage Childbirth Caption: (a) first stage labor.

Second Stage Childbirth 30 minutes to 2 hours in duration Begins at full dilation Infant descends through vagina Ends with delivery of baby

Second Stage Childbirth Caption: (b) Second stage labor.

Third Stage Childbirth 20 to 30 minutes in duration Begins at delivery of the baby Placenta separates and is pushed out Ends with delivery of placenta

Third Stage Childbirth Caption: (c) Third stage labor.

Cesarean Section Baby delivered through incision 1970: 5.5% U.S. births by C-section 2006: 31% U.S. births by C-section Higher C-section rates have not improved maternal and infant survival rates

Postpartum Range of feelings from excited and happy to tearful Baby blues affect 75% Postpartum depression (PPD) affect 15% Sleep deprivation heightens stress

Breastfeeding Initial colostrum has protein and antibodies Mature milk “comes in” soon Milk will “dry up” if baby does not suckle at the breast

Advantages to Breastfeeding Digestible food with antibodies Prevents uterine hemorrhage Emotional and sensual experience Promotes bonding

Short-term Disadvantages to Breastfeeding Vaginal dryness due to decreased estrogen Temporary breast tenderness Leaking milk Harder to share feeding duties

Sexual Intercourse After Childbirth Vaginal Birth After lochia flow stops and vaginal area heals 3 to 4 weeks C-section When incision healed When desire returns Varies considerably Often 6 to 8 weeks

Sexual Interaction After Childbirth Activities can include more non-coital and/or affectionate behaviors Factors that interfere Fatigue lowers desire and ability Decreased time due to caring for baby Negative pre-pregnancy attitudes