Chapter Thirteen

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

2. 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 Contraceptive Methods

3. Fertility Awareness Methods See Figure 16.1

5. Barrier Methods

6. Current Barrier Methods, cont’d

7. Intrauterine Device See Figure 16.7

8. Hormonal Contraceptives

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 48-72 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. 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 Importance of Prenatal Care

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. Chapter Thirteen Reproductive Choices: Contraception, Pregnancy, and Childbirth