1. Reproductive Choices: Contraception, Pregnancy, and Childbirth
Chapter Sixteen
Reproductive Choices: Contraception, Pregnancy, and Childbirth

2. Contraceptive Methods
Abstinence
Fertility Awareness Method
Barrier Methods
Condoms
Diaphragm
Cervical cap
Contraceptive Sponge
Intrauterine device (IUD)
Hormonal Contraceptives
Oral pills
Morning after pill
Emergency Contraception
Sterilization
Vasectomy
Tubal ligation

3. Fertility Awareness Methods
(Rhythm Method)
Calendar (calculating the unsafe days of ovulation)
Basal temperature (raise in body temperature could result in ovulation)
Cervical Mucus Method (evaluate consistency of vaginal discharge to predict ovulation)
Sympothermal (combines basal type and mucus together)
Withdrawal (removing the penis from the vagina prior to ejaculation)
These methods are based on abstinence during the window of time around ovulation when a woman is most likely to conceive
See Figure 16.1

5. Barrier Methods Male Condom Spermicide Diaphragm Cervical Cap
Latex or polyurethane
See Figure 16.2
Decreases the risk of contracting a sexually transmitted disease
Spermicide
Chemical agents that kill sperm
Usually comes in a foam or jelly and can be purchased over the counter for $10-15
Diaphragm
Circular rubber dome inserted in the vagina before intercourse; covers the cervix and is applied with spermicide
See Figure 16.4
A Health care provider must correctly fit and provide instructions for use
Cervical Cap
Small cuplike rubber device that covers only the cervix, used with spermicide
See Figure 16.5

6. Current Barrier Methods, cont’d
Female condom
Latex or polyurethane pouch that is inserted into the vagina
See Figure 16.3
Can be purchased at a grocery or drug store for about $2.00
Contraceptive Sponge
Over the counter product that fits over cervix and is used with spermicide to act as a barrier
Removed from the market in 1994, available now in grocery or drug stores

7. Intrauterine Device IUD See Figure 16.7
T-shaped item inserted into the uterus
The world’s popular reversible contraceptive method
Believed to work by altering the uterine and cervical fluids to reduce the chance that sperm will move up into the fallopian tubes
The Copper T-380A (Paragard) and Levonorgestral (Mirena) are available today
Highly effective and requires little maintenance after inserted
Costs $ The copper version can remain in place for up to 10 years
The progesterone version can remain for 5 years
See Figure 16.7

8. Hormonal Contraceptives
Oral Contraceptive Pills, Patches, Injections, Vaginal Rings, and Implants
Works by reducing the ovum development or by reducing ovulation by mimicking hormonal activity of the corpus luteum
Prescribed by a physician
Side effects
Tenderness in breasts
Nausea
Headaches
Spotting
Weight gain
Sex drive fluctuation
Frequent vaginal infections
Mild depression
Advantages
Reduction of certain types of cancers,
Reversibility
Fewer incidences of PID and iron-deficiency anemia

10. Post-Sex Contraception
Known as the morning after pill, estrogen and progesterone combination pill or a progesterone only pill (Preven)
ECP’s (Emergency Contraception Pills) reduce the risk of pregnancies by delaying or inhibiting ovulation when taken within hours of unprotected intercourse
Effective rates improve when taken earlier vs. later
ECP’s do not induce a medical abortion or affect the developing pre-embryos or embryos
Costs range from $15 to $40 per use
These hormones do contain potential side effects

11. Sterilization
A surgical procedure that permanently prevents any future pregnancies
Vasectomy – separation of the vas deferens
Tubal ligation – separation of the fallopian tubes

12. Which Contraceptive Method Is Right For You?
Considerations to evaluate when choosing contraception:
Health Risks
Implications of unplanned pregnancy
STD risk
Relationship type
Affordability
Ease of use
Interference with religious or philosophical expression

13. Unintended Pregnancy Options
The important thing is to see your physician or health provider as soon as possible to discuss the following options:
Carry the pregnancy to term and raise the child
Carry the pregnancy to term and place the child in an adoptive family
Terminate the pregnancy

14. Adoption Adoption provides a permanent family for a child in need
If you are considering adoption, you can choose one of the following:
Open adoption (biological parents choose adoptive parents)
Closed adoption (biological parents do not choose parents)
All forms of adoption require both biological parents relinquish all parental rights
For couples wanting to adopt, international adoptions are becoming increasingly popular in this country

15. Abortion Termination of a pregnancy through the following:
Elective: voluntary termination of a pregnancy
Spontaneous: involuntary termination or miscarriage
Surgical: surgical removal of the contents of the uterus to terminate the pregnancy
Dilation/suction method is the most common method
Medical: use of a pharmaceutical agent to terminate the pregnancy
Mifepristone (formerly known as RU 486)

16. Causes of Infertility Low sperm count Poor sperm motility
Sperm abnormalities
Lack of ovulation
Obstruction of fallopian tubes
STD
Endometriosis

17. Treating Infertility Surgery Fertility drugs Intrauterine Insemination
IVF, GIFT, and ZIFT
in vitro fertilization
gamete intrafallopian transfer
zygote intrafallopian transfer

18. Importance of Prenatal Care
Regular Checkups
Blood tests
Prenatal Nutrition
Avoiding Tobacco products
Caffeine
Avoiding illicit drugs and other environmental agents
Alcohol (FAS)
Accutane (acne medication)
STD’s and other infections
Proper nutrition/exercise

19. Complications in Pregnancy and Pregnancy Loss
Eclampsia: potential life threatening disease which develops during pregnancy, marked by seizures and coma
Miscarriage: usually due to abnormalities in the first few weeks of pregnancy
Preclampsia: blood pressure becomes elevated and can life threatening
Low Birth Weight (LBW): when a baby weighs less than 5.5 lbs
Infant Mortality: death of a child less than one year of age (i.e. SIDS or stillbirth)

20. Diagnosing Problems in a Fetus
About 5% of babies born in the United States have a birth defect
Several tests have been developed to detect abnormalities in a fetus prior to birth
Alpha-Fetoprotein Measurement
Ultrasound
Chromosomal Analysis
Chorionic Villus sampling
Amniocentesis

21. Fetal Development (First Trimester)
Within 30 minutes a fertilized egg goes through many forms of cell division
Blastocyst is formed by the 5th day after fertilization
An embryo is created by the end of the 2nd week from the blastocyst separating into 3 layers
The outermost shell of cells becomes the placenta, umbilical cord, and amniotic sac
By week 12 all major body structures are formed, including the heart, brain, liver, lungs, and sex organs

22. The Second Trimester
Growth improves to about 14 inches and the weight increases to 1.5 lbs.
All body systems are working and the fetal heartbeat can be heard
Fetal movements can be felt by the mother, beginning by the 4th to 5th month

23. The Third Trimester
The fetus gains most of its weight during the last 3 months
Fat layers are acquired during the 8th month as well as acquired immunity from the mother
Importance is placed on providing the fetus with important nutrients
The respiratory and digestive organs are developing at this stage
See Figure 16.10

24. 3 Stages of Labor Effacement/Dilation of the cervix
cervix opens to 10cm during this stage
Delivery of the fetus
“crowning” of the fetus
Delivery of the placenta
within 30 minutes afterbirth is expelled
See Figure 16.11

25. The Postpartum Period A stage of about 3 months following childbirth
It takes 6-8 weeks for a woman’s reproductive organs to return to their prebirth condition
Lactation begins about 3 days after childbirth
The return of menstruation make take up to 6 months depending upon hormonal activity
Fluctuating emotions are the result of hormone level changes and could result in postpartum depression

26. Reproductive Choices: Contraception, Pregnancy, and Childbirth
Chapter Sixteen
Reproductive Choices: Contraception, Pregnancy, and Childbirth