1. Chapter 10 Contraception

2. 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?

3. 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

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

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

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

7. Other Hormone-Based Contraceptives
Vaginal ring
Transdermal patch
Injected contraceptives

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

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

10. Cervical Barrier Devices
Diaphragm
Cervical cap
FemCap
Lea’s Shield

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

12. 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

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

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

15. 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

16. 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

17. 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

18. Chapter 11 Conceiving Children: Process and Choice

19. 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

20. 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

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

22. 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

23. 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

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

25. 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?

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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. Medical Abortions
Caption: How medical abortions work.

36. 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

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

38. 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

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

40. 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

41. 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

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

43. 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

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

45. 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)

46. 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.

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

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

49. Contemporary Childbirth
Prepared childbirth
Lamaze
Birthplace alternatives
Homebirth

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

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

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

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

54. 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

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

56. 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

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

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

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

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

61. 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

62. 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