Pregnancy and Childbirth Chapter 8 © 2012 McGraw-Hill Companies. All Rights Reserved.

Deciding to Become a Parent Health and age Emotional preparedness Relationships Financial circumstances –Two-parent family will spend $8,500-$23,000 per year, per child, depending on total family income Future plans –Education, career, and child care plans Attitude and aptitude Beliefs –Philosophical or religious 2

© 2012 McGraw-Hill Companies. All Rights Reserved. Preconception Care 1.Preexisting conditions 2.Medications 3.Prior pregnancies 4.Age 5.Tobacco, alcohol, and caffeine use 6.Infections 7.HIV 8.Diet 9.Diethylstilbestrol (DES) 10.Multiple births 11.Genetic diseases 3

© 2012 McGraw-Hill Companies. All Rights Reserved. Understanding Fertility Conception  Involves the fertilization of a woman’s ovum (egg) by a man’s sperm  Each month a woman’s ovaries release an egg  Takes 3-4 days for the egg to travel through the fallopian tubes to the uterus  If not fertilized, egg will last 24 hours, then disintegrate  Typical ejaculate contains millions of sperm  Sperm release an enzyme to soften the egg’s exterior  Egg and sperm each carry 23 chromosomes Twins  Fraternal  Identical 4

© 2012 McGraw-Hill Companies. All Rights Reserved. 5 Figure 8.1 Fertilization and Early Development of the Embryo

© 2012 McGraw-Hill Companies. All Rights Reserved. Infertility Inability to conceive after trying for a year or more Female infertility –One of two key causes Tubal blockage (40%) Failure to ovulate (40%) Anatomical abnormalities or benign growths (10%) Unexplained (chemicals, smoking, age) (10%) Blocked fallopian tubes are most commonly caused by pelvic inflammatory disease (PID) –Chlamydia or gonorrhea –Endometriosis 6

© 2012 McGraw-Hill Companies. All Rights Reserved. Infertility Male infertility –Accounts for about 20% of infertile couples Four main categories –Hypothalamic pituitary disease or congenital disorders –Testicular disease –Disorders of sperm transport –Unexplained 7

© 2012 McGraw-Hill Companies. All Rights Reserved. Infertility Treatment Cause of infertility can be determined for about 85% of infertile couples Most cases treated with conventional medical therapies or surgery Assisted reproductive technology (ART) 8

© 2012 McGraw-Hill Companies. All Rights Reserved. Infertility Treatment Artificial intrauterine insemination –Also given fertility drugs prior IVF,GIFT, and ZIFT –In vitro fertilization (IVF) –Gamete intrafallopian transfer (GIFT) –Zygote intrafallopian transfer Surrogate motherhood Emotional responses to infertility 9

© 2012 McGraw-Hill Companies. All Rights Reserved. Pregnancy 3 periods of about 3 months each (13 week trimesters) Tests –Home pregnancy tests –Human chorionic gonadotropin (HCG) –Two weeks after fertilization Early signs and symptoms –Missed menstrual period –Slight bleeding –Nausea –Breast tenderness –Increased urination –Sleepiness, fatigue, and emotional upset 10

© 2012 McGraw-Hill Companies. All Rights Reserved. Continuing Changes in a Pregnant Woman’s Body Uterus size –First 3 months, the uterus enlarges to about 3 times its nonpregnant size –4 th month, large enough to make abdomen protrude –7 th -8 th month, pushes up into the rib cage Breast changes Muscles and ligaments stretch Circulatory system holds higher blood volume Weight gain 11

© 2012 McGraw-Hill Companies. All Rights Reserved. 12 Figure 8.2 Physiological Changes During Pregnancy

© 2012 McGraw-Hill Companies. All Rights Reserved. Changes During the Later Stages of Pregnancy Increased needs placed on the mother Braxton Hicks contractions Lightening in the 9 th month Emotional responses to pregnancy 13

© 2012 McGraw-Hill Companies. All Rights Reserved. 14 Figure 8.3 The Fetus During the Third Trimester of Pregnancy

© 2012 McGraw-Hill Companies. All Rights Reserved. Table 8.1 Recommended Weight Gain During Pregnancy 15

© 2012 McGraw-Hill Companies. All Rights Reserved. Fetal Development First trimester –Blastocyst Inner cells divide into three layers First layer: inner body parts, digestive and respiratory Middle layer: muscle, bone, blood, kidneys, sex glands Third layer: skin, hair, nervous tissue Outermost cells becomes the placenta –Becomes embryo by end of 2 nd week –All major body structures formed between 2 nd and 9 th weeks –Becomes fetus by end of 2 nd month 16

© 2012 McGraw-Hill Companies. All Rights Reserved. Fetal Development Second trimester –Fetus grows to about 14 inches and 1.5 pounds –All body systems are operating Third trimester –Fetus gains protective fat layers in the 8 th month –Respiratory and digestive organs develop –Immunity supplied by mother’s blood 17

© 2012 McGraw-Hill Companies. All Rights Reserved. 18 Figure 8.4 A Chronology of Milestones in Prenatal Development

© 2012 McGraw-Hill Companies. All Rights Reserved. 19 Figure 8.5 A Cross-Sectional View of the Fetus in the Uterus

© 2012 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 (QMS) –Maternal blood test Fetal programming –Conditions in the womb may influence the risk of adult diseases 20

© 2012 McGraw-Hill Companies. All Rights Reserved. The Importance of Prenatal Care Regular medical checkups Blood tests Prenatal nutrition Avoidance of drugs and environmental hazards: –Teratogens First trimester Congenital malformations –Alcohol –Tobacco –Caffeine –Drugs –STDs and other infections 21

© 2012 McGraw-Hill Companies. All Rights Reserved. The Importance of Prenatal Care Prenatal activity and exercise –Contributes to mental and physical wellness –30 minutes a day of moderate exercise –Kegel exercises –Prenatal exercise classes Preparation for birth 22

© 2012 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) –Less than 5.5 pounds at birth Infant mortality –Sudden infant death syndrome (SIDS) Coping with loss 23

© 2012 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 24

© 2012 McGraw-Hill Companies. All Rights Reserved. Labor and Delivery Three stages: entire process 2-36 hours First stage of labor –Averages 13 hours for a first birth –Cervix is completely dilated to 10 centimeters –Contractions last 30 seconds each and occur every minutes at first, more often later on –Mucus plug may be expelled and amniotic sac may rupture (“water breaking”) –“Transition” Strong contractions may last seconds and be 1-3 minutes apart Usually lasts minutes Often the most difficult part of labor 25

© 2012 McGraw-Hill Companies. All Rights Reserved. Labor and Delivery Second stage of labor –Baby slowly pushed into birth canal –Baby squeezes through pelvis –Head is usually delivered first (crowning) –Umbilical cord is cut Third stage of labor –Delivery of the placenta –Stage typically lasts 5-30 minutes Apgar score of the baby’s physical condition –Heart rate –Respiration –Color –Reflexes –Muscle tone –Total score is between 0 and 10 26

© 2012 McGraw-Hill Companies. All Rights Reserved. 27 Figure 8.7 Birth: Labor and Delivery

© 2012 McGraw-Hill Companies. All Rights Reserved. Pain Relief During Labor and Delivery Childbirth preparation courses –Breathing and relaxation techniques –Lamaze or Bradley techniques Epidural Narcotics –Fentanyl or Demerol –Provide less pain relief than an epidural can provide 28

© 2012 McGraw-Hill Companies. All Rights Reserved. Cesarean Deliveries In 2008, about 32.3% of babies born in the U.S. were delivered by cesarean section Surgical removal of the baby –Baby’s head too large –Baby in unusual position –Mother has a serious health condition –Mother who is overweight or has diabetes –Difficult labor –Fetal distress –Dangerous infections –90% of cesarean mothers will have subsequent deliveries by cesarean 29

© 2012 McGraw-Hill Companies. All Rights Reserved. Postpartum Period Stage of about 3 months following childbirth Time of critical family adjustment After vaginal delivery, leave hospital in 1-3 days After cesarean section, leave in 3-5 days Takes 6-8 weeks for the mother’s reproductive organs to return to prebirth condition Breastfeeding –Colostrum secreted prior to lactation –Lactation begins about 3 days post childbirth –Recommended to breastfeed exclusively for 6 months Postpartum depression Attachment 30

Pregnancy and Childbirth Chapter 8 © 2012 McGraw-Hill Companies. All Rights Reserved.