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PREGNANCY
&
CHILDBIRTH
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“To everything there is a
season, and a time to
every purpose under
heaven.”
- Ecclesiastes -
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HISTORICAL DIMENSIONS
18th CENTURY
France – midwives
England – development of instruments
America – physicians
“wet nurse” vs. “dry nurse”
19th CENTURY
Interventions – medications, anesthesia,
birthing instruments
Hospital births
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20th CENTURY
 technology, medicalization, hospitalization
Controlling fertility
Natural-birth relaxation techniques
1970s: Benefits of breastfeeding resurfaced
Childbirth = joy and knowledge vs. fear and ignorance
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PREGNANCY
CONCEPTION
Fertilization = Sperm Cell + Egg Cell = Zygote
Sperm Cell: 50 million produced/day
Egg Cell: 1 egg released/month
Dizygotic Twins = Fraternal Twins
Monozygotic Twins = Identical Twins
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Selected Sex Chromosome
Abnormalities
 Normal
(XY)
 Turner Syndrome (Monosomy X, XO)
 Triple X (XXX)
 Klinefelter Syndrome (Trisomy XXY)
 XXY Male
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CONFIRMING PREGNANCY
Early Signs of Pregnancy
Symptoms often occur in first 6 weeks
Missed period(s)
Breast swelling/tenderness
Fatigue
Queasiness or nausea/vomiting
Elevated body temperature
Mood swings
Frequent urination
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HORMONAL CHANGES
A/ Fertilization:
1. Follicle-Stimulating Hormone (FSH) and
Luteinizing Hormone (LH) produced by
anterior pituitary gland is surpressed
2. Pregnancy-specific hormones increase (hCG
and HPL)
B/ Implantation:
1. Embryo cells secrete hCG
2. Corpus Luteum stimulated and secrete
estrogen and progesterone
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C/ After 3 Months:
1. hCG levels decrease
2. Placenta produces estrogen and progesterone
3. Fetal adrenal glands produce precursor
hormone to be converted into estrogen
4. Estrogen = regulate progesterone, fetal
maturation (lungs, liver, organs mature),
prepare breasts for lactation
5. Progesterone = suppresses uterine
contractions, stimulates alveoli of breasts
6. HPL = physical changes in maternal system to
accommodate fetus
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PHYSICAL & EMOTIONAL
SYMPTOMS
1st Trimester:
Enlarged and tender breasts
Morning sickness
Extreme fatigue
Decreased interest in sex
Moodiness and irritability
Skin changes
Darkening of nipple and areola
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2st Trimester:
Morning sickness subsides
Gastrointestinal problems
Gain majority of weight (12-14 lbs)
Breathing problems
Backache
Leg cramps and numbness/tingling of hands
Swollen and bleeding gums
Braxton-Hicks contractions
Striae gravidarum
Chloasma
Linea nigra
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3rd Trimester:
Heartburn
Constipation
Leg cramps
Backache
Breathlessness
Braxton-Hicks contractions
 Leukorrhea
 Colostrum
Hemorrhoids
Pelvic and buttock discomfort
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A Pregnant Woman’s Body Changes:
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FETAL DEVELOPMENT
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PRENATAL CARE
NUTRITION
Consume additional 100 calories/day during 1st
trimester
Consume additional 300 calories/day 2nd-3rd trimester
Folic acid
Calcium
Iron
 Fluid intake
Weight Gain: Average 25-35 lbs. total
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EXERCISE
Benefits:
Feel better throughout
trimesters
Shorter labor
Quicker recovery
Forms:
Swimming
Walking
Low-impact aerobics
Kegel exercises
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AVOIDING TOXIC SUBSTANCES
Cigarette Smoking:
12.2% of women smoke during pregnancy
Native Americans (20%)
Hawaiian Americans (14.4%)
White Americans (13.2%)
Complications
 birth-weight
Infertility
Ectopic pregnancies
Placental irregularities and intrauterine growth retardation
Sudden Infant Death Syndrome (SIDS)
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Fetal Alcohol Syndrome:
12.8% of all pregnant women drank alcohol
Complications…
Growth retardation
Facial malformations
Central nervous system dysfunction
Mental retardation
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Environmental Risk:
Pregnant women should avoid the following as
precautionary measures to protect herself and baby…
Pollutants
Toxic wastes
Heavy metals
Pesticides
Gases
Radiation treatment
Diagnostic X-rays
Heat exposure
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Prenatal Testing:
Ultrasound: (6th – 12th weeks)
Maternal Serum Alpha-Fetoprotein Screening (MSAFP):
(13th – 20th weeks)
Chorionic Villus Sampling (CVS): (1st Trimester)
Amniocentesis: (15th – 18th weeks)
Rh Incompatibility: (Injection of Rh immune globulin after
delivery, during pregnancy, after a miscarriage, after
amniocentesis)
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Chorionic Villus Sampling Procedure
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Amniocentesis Procedure
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COMPLICATIONS
MISCARRIAGE
16% of all pregnancies
Pregnancy ends before 20th week of gestation
Bleeding and cramping
Cervix dilates and embryo is released
ECTOPIC PREGNANCY
1 in every 40-100 pregnancies
Occurs 7th-8th week of pregnancy
Fertilized egg grows outside uterine cavity
Abdominal pain, spotting, ruptured fallopian tube, PID
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PREMATURE LABOR
10% of all babies are born early
If starts before 37th week
Normal labor lasts for 38 - 42 weeks
Warning signs…
Vaginal bleeding
Abdominal pain
Persistent nausea, vomiting
Unusual thirst
Fever/chills
Facial, feet, or finger swelling
Vaginal fluid leaks
Severe continuous headaches
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GENETIC DISORDERS &
CONGENITAL ABNORMALITIES
Cystic Fibrosis
Down Syndrome
Sickle Cell Anemia
Phenylketonuria (PKU)
Tay-Sachs Disease
Spina Bifida
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INFECTIONS
Gonorrhea, Chlamydia, Syphilis  Miscarriages
Bacterial Vaginosis (BV)   birth weight,  risk
HIV
Perinatal Transmission of AIDS AZT
Cytomegalovirus (CMV)   birth size, brain
damage, developmental problems,
enlarged liver, hearing and vision
impairment, malformations
Group B Streptococcus (GBS)  sepsis, pneumonia,
meningitis, long-term disabilities, death
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CHILDBIRTH
PREPARATION
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LABOR & DELIVERY
3 Distinctive Signs of Labor:
1. Uterine Contractions = every 5 minutes
2. Rupture of the Membranes = leak of fluids
3. Body Show = passage of mucous plug of cervix
= cervix dilates
Other Signs:
 Diarrhea
 Backache
  Braxton-Hicks contractions
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3 STAGES OF LABOR
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DILATION THROUGH STAGES OF LABOR
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PAIN RELIEF IN CHILDBIRTH
Tranquilizers and Analgesics
Anesthetics
Epidural = injected through catheter beside spinal
cord
Spinal = injected directly into spinal canal
Pudendal = injected into area around vagina and
perineum
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CESAREAN DELIVERY
Surgical incisions made in both the wall of the
mother’s abdomen and her uterus
Reasons:
Cephalopelvic Disproportion
Multiple Births
Placenta Previa
Fetal Distress
Abruptio Placentae
Prolapsed Cord
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BREASTFEEDING
THE FEMALE BREAST
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BENEFITS OF BREASTFEEDING
For Baby:
Breast milk is highly nutritious
Breast milk contains enzymes to aid in infant digestion
Breast milk contains antibodies to protect against infection
 infant episodes of diarrhea
 infant cases of upper respiratory, ear and urinary infections
 protect against type 1 diabetes, Crohn’s disease, SIDS, chronic
digestive disease, childhood cancers
For Mom:
Uterus returns to normal size more quickly
Return to pre-pregnancy weight more quickly
 risk of ovarian and breast cancer, osteoporosis
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COMPLICATIONS OF BREASTFEEDING
 Do not breastfeed if mother…
HIV infected
Untreated active TB
User of alcohol, tobacco, or other drugs
Undergoing cancer therapy/radiation treatment
 Mothers may experience difficulties if…
Inverted, flat, raw, or cracked nipples
Severely swollen breasts
Problems with infant latching-on
Pain during latching-on
Mastitis
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INFERTILITY
CAUSES
Female Infertility = 25% to 35% of couples
Male Infertility = 25% to 35% of couples
Azoospermia, Oligospermia
DIAGNOSIS
Ovulation Test and Cervical Mucus Test
Postcoital Test
Blood Test
Hysterosalpingogram, Laparoscopic Surgery
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TREATMENT
Improve quality of cervical mucus = Estrogen
Stimulate ovulation = Clomid, GnRH
Assisted Reproductive Technologies (ART)
In Vitro Fertilization (IVF)
Gamete Intrafallopian Transfer (GIFT)
Zygote Intrafallopian Transfer (ZIFT)
Intracytoplasmic Sperm Injection (ICSI)
Egg Donation
Embryo Transfer
Host Uterus
Surrogacy
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EMOTIONAL EFFECTS OF INFERTILITY
Anger and resentment towards partners
Guilt and blame towards oneself
Depression and frustration
Miscommunication
Confusion
Grief
Despair
Loss of control
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EPIDEMIOLOGY
LIVE BIRTH RATES PER 1,000 WOMEN
IN SPECIFIC GROUPS, U.S.
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BREASTFEEDING
 In 1993 = 58.1% mothers breastfed
In 1998 = 64% mothers breastfed
Whites = 68%, Hispanics = 66%, Blacks = 45%
INFERTILITY
15% of U.S. women of childbearing age sought
treatment for infertility
In 2000 = 35,025 babies were born using ART
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INFORMED
DECISION MAKING
CHOICES OF ART PROCEDURES IN U.S., 2000
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