Pregnancy and Childbirth

1. Pregnancy and Childbirth Chapter 8

2. 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

3. Preconception Care • Preexisting conditions • Medications • Prior pregnancies • Age • Tobacco, alcohol, and caffeine use • Infections • HIV • Diet • Diethylstilbestrol (DES) • Multiple births • Genetic diseases

4. 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

5. Figure 8.1 Fertilization and Early Development of the Embryo

6. 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

7. 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

8. 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)

9. 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

10. 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

11. Continuing Changes ina Pregnant Woman’s Body • Uterus size • First 3 months, the uterus enlarges to about3 times its nonpregnant size • 4th month, large enough to make abdomen protrude • 7th-8th month, pushes up into the rib cage • Breast changes • Muscles and ligaments stretch • Circulatory system holds higher blood volume • Weight gain

12. Figure 8.2 Physiological Changes During Pregnancy

13. Changes During the Later Stagesof Pregnancy • Increased needs placed on the mother • Braxton Hicks contractions • Lightening in the 9th month • Emotional responses to pregnancy

14. Figure 8.3 The Fetus During theThird Trimester of Pregnancy

15. Table 8.1 Recommended WeightGain During Pregnancy

16. 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 2nd week • All major body structures formed between 2nd and 9th weeks • Becomes fetus by end of 2nd month

17. 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 8th month • Respiratory and digestive organs develop • Immunity supplied by mother’s blood

18. Figure 8.4 A Chronology of Milestonesin Prenatal Development

19. Figure 8.5 A Cross-Sectional Viewof the Fetus in the Uterus

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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 15-20 minutes at first, more often later on • Mucus plug may be expelled and amniotic sac may rupture (“water breaking”) • “Transition” • Strong contractions may last 60-90 seconds and be 1-3 minutes apart • Usually lasts 30-60 minutes • Often the most difficult part of labor

26. 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

27. Figure 8.7 Birth: Labor and Delivery

28. 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

29. 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

30. 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

31. Pregnancy and Childbirth Chapter 8