Chapter Twelve
Pregnancy and Birth
Issues Associated with Pregnancy and Birth
 Fertility
 Assisted Reproduction
 A Healthy Pregnancy
 Health Care During Pregnancy
 Problems in the Pregnancy
 Childbirth
 Problems During Birthing
 Postpartum Parenthood
Self Reflection Exercise
 Do you want to have children? Why or why not?
 If you do desire children, at what age would you like
to have your first child? How many children would
you like to have? Why?
 How would you like to have your children spaced?
Why?
 Would you rather have a boy or girl first? How many
boys and girls would you like to have? Why?
 What would you like to name your children? Why?
 Would you dress your girls in pink and boys in blue?
Why or why not?
 How would your parents feel about grandchildren?
Deciding Whether to Have Children
What is your response to these two couples?
Fertility
Conception
Early Signs of Pregnancy
Pregnancy Testing
Sex Selection
Conception: The Incredible Journey
 Our bodies are designed to promote pregnancy
 During ovulation:
A woman’s sexual desire peaks
A mucus plug in the cervix disappears
Cervical mucus thins & creates gaps that
vibrate with the sperm to aid motility and trap
defective sperm; filters bacteria from semen
Female orgasm pushes semen to the uterus
and toward the Fallopian tubes
Semen thickens upon ejaculation to stay in the
vagina for 20 minutes to aid sperm travel
Conception: The Incredible Journey
 The ovum can live for 24 hours
 Sperm can live for 72 hours; less than 1%
can live up to one week
 Pregnancy may occur a few days before or
after ovulation
 The ovum may release chemicals to signal its
location
 If a sperm reaches the ovum, it wriggles
violently
Conception: The Incredible Journey
 Only one sperm fertilizes an ovum by
secreting a chemical that makes a hole in the
ovum coating
 Immediately the ovum coating changes &
does not permit further sperm from entering
 Fertilization takes about 24 hours, usually in
the ampulla
 Zygote – a fertilized ovum
Conception: The Incredible Journey
 About 12 hours after fertilization, the first cell
division occurs & the blastocyst divides every
12 to 15 hours as it travels towards the uterus
 3-4 days after conception, it enters the uterus
& absorbs nutrients from endometrial glands
 6th day after conception, a uterine chemical
dissolves the blastocyst coating, allowing
implantation into the uterine wall, typically the
upper portion
Conception: The Incredible Journey
 After implantation, the blastocyst divides into
two layers, the endoderm & ectoderm,
followed shortly by the mesoderm
 Embryo – developing cell mass of 2-8 weeks
 Amnion – membrane covering the embryo
that fills with protective fluid
 Placenta – attached to the uterine wall, it aids
the fetus in respiration, nutrition, excretion
 Umbilical cord – connects fetus to placenta
Conception: The Incredible Journey
 Multiple births occur in 1 out of 50 couples
 Fraternal twins – two ova are released &
fertilized; 2/3 of twins are fraternal; dizygotic
 May be inherited from the mothers
 More likely with women over 30
 Identical twins – single zygote divides into 2
separate zygotes; monozygotic
 Siamese twins – fail to completely separate
Pregnancy
Early Signs of Pregnancy
 Missing a period, or maybe some spotting
 Breast tenderness, frequent urination, food
aversions
 Morning sickness
50-80% of pregnant women experience
nausea &/or vomiting, any time of the day
Due to increased estrogen & progesterone
irritating the stomach lining
May protect the fetus from illness
Pregnancy Testing: Confirming the
Signs
 Over-the-counter pregnancy tests
 Can be less expensive at a clinic
 The tests measure for human chorionic
gonadotropin (hCG), which is made by
placental cells
 Detection in blood or urine can occur 8-9
days after ovulation
 hCG levels peak in the 2nd & 3rd months
Pregnancy Testing: Confirming the
Signs
 May be inaccurate if tested too soon or after
the 12th week
 False positives may occur with kidney
disease, kidney infection, overactive thyroid,
large doses of tranquilizers, aspirin,
antidepressants, anticonvulsants
 Radioimmunoassay (RIA) blood tests are the
most accurate, can detect hCG within a few
days after conception
Pregnancy Testing: Confirming the
Signs
 Due date – calculated from the first day of the
last menstrual period
 Naegeles rule – subtract 3 months from the
first day of the last period and add 7 days for
a single birth
 Rule is most accurate for women with 28-day
cycles
Sex Selection
Sex Selection: Myth and Modern Methods
 More male babies are born each year
 Male fetuses have higher rates of
spontaneous abortion or die before birth
 There are many cultural myths for choosing
and knowing the gender of an unborn child
 There are medical techniques that can aid in
choosing and determining fetal sex
Sex Selection: Myth and Modern
Methods
 Microsorting can separate the X and Y sperm,
which is then artificially inseminated
Male conception is 50-70% accurate
Female conception is 50-90% accurate
 Embryos can be tested and the desired sex
embryo then implanted
 Amniocentesis involves removal of amniotic
fluid through a needle during week 16 or 17;
detects chromosomal abnormalities & gender
Sex Selection: Myth and Modern
Methods
 Controversy surrounds gender selection
 Male children are typically valued over
females in other countries because
They typically care for their aged parents
Girls require dowries to be paid at their
marriage
Males carry on the family name
 Female infanticide is a problem in rural India
and in China
Assisted Reproduction
What is Assisted Reproduction?
Assisted Reproductive Options
What Is Assisted Reproduction?
 Infertility – the inability to conceive, or
impregnate, after one year or regular sexual
intercourse without the use of birth control
 Infertility may be diagnosed after only 6
months for women over 35 years
 About 20% of U.S. couples of reproductive
age are infertile; 8-10% in developed
countries
What Is Assisted Reproduction?
 Negative emotions are often experienced with
the frustration of infertility
 Women tend to be more committed to finding
a solution than their partners
 Motherhood mandate – there is a problem
with a woman if she does not care for a child
 Some reproductive problems can be reduced
with changing lifestyles, reducing stress,
avoiding strenuous exercise, average weight
What Is Assisted Reproduction?
 70% of the time the problem can be found in
one of the partners
40% female (ovulation disorders, blocked
Fallopian tubes, endometriosis, uterine
fibroids, uterine structure, STIs)
30% male (lack of sperm, reduced or
malformed sperm production, STIs)
 20% of the time it is a combined problem
 10% the reason is unknown
Assisted Reproductive Options
 Fertility Drugs
 Surgery
 Artificial Insemination
 In Vitro Fertilization
 Gamete Intra-Fallopian Tube Transfer
 Zygote Intra-Fallopian Tube Transfer
 Zonal Dissection
 Intracellular Sperm Injections
 Oocyte and Embryo Transplants
 Surrogate Parenting
Assisted Reproductive Options
 Artificial methods of conception are used by
those experiencing infertility, those without a
partner, and gay couples
 These methods may also cause further stress
because they are expensive, time consuming,
and may not work
 Type of treatment depends on length of
infertility, the woman’s age, & likelihood of
conceiving without treatment
Fertility Drugs
 Hormonal irregularities may need to be
treated with fertility drugs
 The drugs increase ova production, which
increases the possibility of multiple births
 Possible increased risk of breast and ovarian
cancer
Surgery
 Structural abnormalities in the cervix, vagina,
Fallopian tubes, or endometrium may be
surgically corrected
 Surgery can also be used to remove
blockage of the vas deferens or epididymis
Artificial Insemination
 Insertion of sperm into the vagina, cervix,
uterus, or Fallopian tubes without intercourse
 Ejaculated sperm is collected via
masturbation by the partner or a donor
 Sperm banks can freeze treated and washed
sperm for up to 10 years
 Donor catalogs are available, and sperm is
sent to a physician
 Fertility drugs are often used in combination
In Vitro Fertilization
 “Test-tube babies” are conceived in a petri
dish, then implanted in the uterus
 Fertility drugs encourage the release of many
ova and 4-6 are retrieved, although drugs
aren’t always used
 The ova are put in a dish and mixed with
sperm; the zygotes are implanted
 Only 5-30% implant, so many are often
implanted
Gamete Intra-Fallopian Tube Transfer
 Ova and sperm are placed in the Fallopian
tube before conception
 Fertility drugs and sperm washing are also
used
 Higher implantation rate than in vitro
fertilization
Zygote Intra-Fallopian Tube Transfer
 Fertilization occurs outside of the body
 The zygote is placed in the Fallopian tube,
allowing it to implant naturally
 Higher implantation rates than in vitro, but not
higher than gamete intra-fallopian tube
transfer
Zonal Dissection
 A microscopic hole is drilled into the ovum or
a chemical is used to dissolve the outer shell
of the ovum
 Problem is that several sperm may enter at
the same time and cause developmental
problems
Intracellular Sperm Injections
 A single sperm is injected into the center of
an ovum
 Helps if sperm counts are low or have low
motility
 52% pregnancy rates
 The ovum can be damaged
 Possible increased risk of genetic defects
Oocyte and Embryo Transplants
 For women who cannot produce healthy ova
 Eggs and embryos from other women may be
donated
 25-33% birth rates
 Fertility drugs are necessary to synchronize
both women’s menstrual cycles
 High success rates
Surrogate Parenting
 Another woman’s uterus is used to carry a
pregnancy
 Ova and sperm are fertilized outside of the
body and the zygote is implanted in the
gestational carrier
 If the surrogate’s ova is used, the carrier is
called a surrogate mother
Other Options
 Embryos and sperm can be frozen for later
use
 Often used by those undergoing cancer
treatment that want to have children
 Sometimes sperm do not survive the thawing
 Not all embryos survive the freezing and
thawing
 It is much more difficult to freeze an ova, they
are very vulnerable to chromosomal damage
A Healthy Pregnancy
The Prenatal Period: Three Trimesters
The Father’s Experience
The Prenatal Period: Three Trimesters
 Pregnancy lasts 40 weeks, and each
trimester is about 12-15 weeks long
Video: “The Miracle of Life”
First Trimester
 1-13 weeks
 The fetal heart forms and pumps blood by the
end of the first month, as the circulatory
system is the first to function
 Other systems begin to develop: nervous,
digestive, urinary, reproductive, appendages
 Liver, kidneys, intestines, lungs begin
developing by the end of this trimester
 At the end, the fetus is ½ ounce & 3 inches
An embryo at 7 to 8 weeks. This embryo is approximately 1 inch long.
First Trimester
 The woman’s heart pumps more blood, body
gains weight, thyroid gland grows, lungs and
digestive system work harder
 Increases in estrogen & progesterone can
cause: fatigue, breast tenderness,
constipation, increased urination, nausea,
vomiting, food cravings, smell sensitivity
 Ultrasound can detect the fetal heartbeat and
image as soon as 5 ½ - 6 weeks
Second Trimester
 14-28 weeks
 Reflexes and tooth buds develop
 Ultrasound may pick up gender around 20-22
weeks
 Movements can be felt by the mother
 Lanugo and vernix cover the fetus to protect it
from amniotic fluid
 At the end, the fetus is 1¾ pounds & 13
inches
At five months, the fetus is becoming more and more lively. It can turn its head, move its face, and
make breathing movements. This fetus is approximately 9 inches long.
Second Trimester
 In the mother, nausea subsides
 Fatigue may continue, appetite increases,
and other signs show: heartburn, edema,
vaginal discharge, skin pigmentation, muscle
cramps, varicose veins, hemorrhoids
 Increased blood supply & restriction of veins
 Positive time for mother, positive emotions,
increased sex drive & satisfaction, maternity
clothes, feel the baby moving
Third Trimester
 28-40 weeks
 The fetus develops fat deposits, hiccups
 The fetus can suck its thumb and react to
light, pain, sounds
 8th month most organ systems are well
developed, though the brain continues
growing
 At the end, the fetus is 7½ pounds & 20
inches
A fetus at nine months, ready for birth.
Third Trimester
 Many symptoms from the second trimester
continue and increase in frequency, as blood
supply is large, and there is a large weight
gain
 Backaches, leg cramps, sleep problems,
shortness of breath, and Braxton-Hicks
contractions may occur
 Colostrum may be secreted by the breasts in
preparation for breast feeding
The Father’s Experience
 Upcoming parenting and changes in their
partner can make a man feel vulnerable
 Joy, anticipation, stress, and anxiety are all
common feelings
 Fathers are allowed and encouraged to be in
U.S. delivery rooms
Health Care During
Pregnancy
Exercise and Nutrition
Drugs and Alcohol
Pregnancy in Women over 30
Sex during Pregnancy
Exercise and Nutrition
 Exercise during pregnancy should not exceed
prepregnancy exercise levels
 Light exercise is suggested; water exercise
 Although the implanted embryo is difficult to
dislodge, some sports are to be avoided:
water skiing, horseback riding, racquet
sports, scuba diving, contact sports
 Avoid reduced blood flow to the uterus
 Drink a lot of water
Exercise and Nutrition
 Increased protein, iron, calcium, folic acid,
and vitamin b6 are needed in pregnancy
 300 more calories per day are also necessary
for a healthy pregnancy
 Poor nutrition may cause low birth weight
babies and problems for the infant, such as
cardiovascular disease, hypertension, and
diabetes
 Prenatal vitamins are often recommended
Drugs and Alcohol
 Many substances should be avoided during
pregnancy to avoid fetal defects: caffeine,
nicotine, alcohol, marijuana, other drugs
 Fetal Alcohol Syndrome (FAS) – an
undersized and mentally deficient infant due
to a mother drinking heavily during pregnancy
 11% of U.S. women smoke while pregnant,
increasing risk of spontaneous abortion, low
birth weight, low iron, brain damage, &
prematurity Drugs and Alcohol
Pregnancy in Women over 30
 An increasing number of women are delaying
childbearing for educational & career goals
 Delayed pregnancy risks: spontaneous
abortion, first-trimester bleeding, low birth
weight, increased labor time, c-section
 Chromosomal abnormalities increase for
women over 30 and men over 55
 Sharp decline in fertility for women after 40
Sex during Pregnancy
 Sex is safe for most with uncomplicated
pregnancies, as is orgasm, until the last few
weeks of pregnancy
 Both partners may have changes in sexual
desire
 Fear of injuring the fetus is often cited as a
reason for decreased sexual interest
 Some positions are difficult and this restricts
the variety of intercourse
Problems in the Pregnancy
Ectopic Pregnancies
Spontaneous Abortions
Chromosomal Abnormalities
Rh Incompatibility
Toxemia
Ectopic Pregnancies
 The zygote implants outside of the uterus
 2% of U.S. pregnancies are ectopic
 97% of ectopic pregnancies occur in the
Fallopian tubes
 3% occur in the cervix, ovaries, abdomen
 Increased risk for ectopic pregnancies if had
STIs, a smoker, previous ectopic pregnancy
 Symptoms: abdominal pain, cramping,
bleeding, nausea, dizziness, fainting
In an ectopic pregnancy, the fertilized ovum implants outside the uterus. In most cases, it remains
inside the Fallopian tube.
Spontaneous Abortions
 A natural termination of a pregnancy before
fetal survival; a miscarriage
 10% of diagnosed pregnancies miscarry
 20-40% are miscarried before diagnosis
 Most miscarry because of a chromosomal
abnormality
 Other reasons: uterine capability, stress, poor
nutrition, drugs, pelvic infection, defective
sperm
Spontaneous Abortions
 Symptoms: bleeding, cramps, lower back
pain
 Menstruation usually returns in 3 months
 Future pregnancies can be normal
Chromosomal Abnormalities
 Chromosomal abnormalities may be detected
by amniocentesis, chorionic villus sampling, &
maternal-serum alpha-fetoprotein screening
 CVS – piece of chorionic tissue is tested as
early as 10-11 weeks
Risk of miscarriage & limb damage
 MSAFP – blood test at 16-18 weeks
 Blood samples can also be drawn from the
umbilical cord
Chromosomal Abnormalities
 Risk for abnormalities increases with a
woman’s age
 Most common is Down syndrome, where
there is an extra 21st chromosome
1/1000 live births
Mother’s Age and Risk of Chromosomal Abnormality
Rh Incompatibility
 Rh factor – natural part of red blood cells in
some people
 If the mother is Rh- & baby is Rh+ (from the
father), fetal blood that comes in contact with
her blood during delivery (not pregnancy) will
cause her to create antibodies
 This can affect future pregnancies
 Rhogam is given to her after delivery to
prevent the formation of antibodies
Toxemia
 6-7% of women experience toxemia, or
preeclampsia in the last 2-3 months
 Symptoms: rapid weight gain, fluid retention,
increased blood pressure, protein in the urine
 If not controlled, eclampsia can result, which
includes convulsions, coma, & in 15% of
cases, death
 Primarily affects those that lacked good
prenatal care
Childbirth
Preparing for Birth
Birthplace Choices
Inducing the Birth
Birthing Positions
Stages of Childbirth
Childbirth
 Normal birth occurs 3 weeks before to 2
weeks after the due date
 4% are born on the due date in the U.S.
 Early deliveries more likely if female fetus,
mother exercised during pregnancy, mother
has shorter menstrual cycles
 More babies born between July & October
and between 1 & 7 a.m.
 Pitocin or nipple stimulation may hasten labor
Preparing for Birth
 Lamaze & similar birthing classes increase
knowledge and reduce anxiety
 They teach what to expect and how to control
pain with breathing and massage
 Anxiety during labor increases pain,
discomfort, & fatigue
 Engagement – fetus moves to head down
position a few weeks before birth 97% of the
time
Birthplace Choices
 80% of births worldwide occur at home
 Home birth is as safe as hospital delivery for
low-risk pregnancies
 Most babies in the U.S. are born in hospitals
 Some hospitals have more comfortable
birthing centers available
Inducing the Birth
 Drugs can be given to induce, and hasten the
progression of, labor
 May create more painful and prolonged
contractions
 Birth may occur a few hours to days after
induction
 In 1998, 19% of U.S. births were induced
 Reasons: past due date, avoid having a large
baby, labor is not progressing, scheduling
Birthing Positions
 In the U.S., most hospitals use a semireclined position with feet in stirrups
 One possible reason for this position is that it
is easier for doctors
 A woman on her hands & knees or who is
squatting widens her pelvis & cervix and
using gravity to aid in the delivery
 Underwater birth can make labor less painful
for women and less traumatic for infants
Stages of Childbirth
 Stage One: Cervical Effacement & Dilation
 Stage Two: Expulsion of the Fetus
 Stage Three: Expulsion of the Placenta
Stage One
 Can last 20 minutes to 24 hours
 This stage is longer in first births
 Cervix dilates – the os goes from 0 to 10 cm
 Cervix thins out (effacement)
 Early labor –
Amniotic sac ruptures
Cervix dilates to 4-5 cm
Contractions last 30-60 seconds with 5-20
minute intervals
Stage One
 Active labor
Contractions last 1+ minutes, are more
intense, and occur every 1-3 minutes
Cervix dilates to 8 cm
 Transition
Very intense, long, & frequent contractions
Cervix dilates to 10 cm
Fetus moves to pelvic base, creating an
urge to push
Stage One
 The woman produces endorphins, pain
reducing hormones
 Pain medications may also be given, though
they may cause drowsiness or nausea and
may affect the fetus
 Relaxation techniques, breathing, &
acupuncture have been used to provide relief
 Fetal monitoring checks for fetal distress
through the abdomen or the fetus’s scalp
Stage Two
 Contractions become less intense, last 60
seconds every 1-3 minutes
 Episiotomies are performed in 40% of U.S.
births, though they are controversial
 While pushing during contractions, the baby’s
head appears (crowning)
 When the face appears, mucus & fluid are
removed from the mouth & nostrils
Stage Two
 Umbilical cord is cut after the first breath
 Eye drops are put in the baby’s eyes to
prevent bacterial infection
 Newborn is placed on the mother’s chest to
begin bonding
 Apgar test may be performed to check the
well being of the infant
Stage Three
 Contractions continue after the birth
 The placenta (after-birth) is expelled about 30
minutes after the birth
 All of the placenta must be expelled
 If there was an episiotomy or tearing, the
woman is sewn up
Problems During Birthing
Premature Birth
Breech Birth
Stillbirth
Cesarean Section Delivery
Premature Birth: The Hazards of Early
Delivery
 Premature births occur before the 37th week
 8% of U.S. births are premature
 Prematurity increases the risk of defects &
infant mortality
 Reasons: early labor or rupture of amniotic
sac, maternal or fetal problems, multiple
fetuses, smoking during pregnancy, alcohol &
drug use, poor nutrition or weight gain,
infections, teenage pregnancy, heavy labor
Breech Birth: Feet First into the World
 Breech position – the fetus has the feet or
buttocks towards the cervix
 Occurs in 3-4% of births
 Some doctors can rotate the fetus for vaginal
delivery, or even deliver it safely in this
position
 Cesarean section may be performed for the
safety of the baby and mother
In 3% to 4% of births, the fetus is in the breech position, with feet and buttocks against the cervix.
Stillbirth: Sad Circumstance
 Stillbirth - a fetus that dies after 20 weeks
 Causes: birth defects, placental problems,
umbilical cord accidents, infections, maternal
diabetes or high blood pressure
 Typically the woman goes into labor about 2
weeks after the fetus has died
Cesarean Section (C-Section) Delivery
 The baby is delivered through an incision in
the abdominal wall
 21% of U.S. deliveries, which is an increase
from a few decades ago
 Reasons for the increase: women waiting
longer to have children, easier & safer
procedure, fear of malpractice suits
Cesarean Section (C-Section) Delivery
 Necessary when: baby is too large, woman
cannot push, placenta previa, cervix does not
fully dilate, fetal distress
 Procedure occurs in an operating room under
general anesthesia or an epidural
Lasts 20-90 minutes
Requires longer hospital stay
Can become pregnant and deliver
vaginally in the future
Postpartum Parenthood
 More Physical Changes for the Mother
 Postpartum Psychological Changes
 Sexuality for New Parents
 Breast-Feeding the Baby
More Physical Changes for the Mother
 6 weeks after birth, the uterus returns to its
original shape
 This may be sooner in breast-feeding women
 Bloody discharge lasts for at least a week
after delivery
 May be advised to take sitz baths if an
episiotomy or tear occurred during delivery
Postpartum Psychological Changes
 Most women are exhausted and experience
minor sadness due to increased
responsibility, physiological changes,
exhaustion, hormonal changes such as a
sudden drop in progesterone
 Postpartum depression – severe case of
sadness with crying spells & anxiety
 Postpartum psychosis – most severe cases
that include mental disturbances
Sexuality for New Parents
 Most are advised to wait 6 weeks before
resuming intercourse to insure no infection
occurs
 Sex may be safe in 2 weeks if there was an
uncomplicated vaginal delivery
 Cesarean section incisions heal in about 2
weeks and intercourse is safe at this time
 3 months postpartum, most return to original
levels of desire & excitement
Breast-Feeding the Baby
 Infant shows a rooting reflex within an hour
after birth, signaling hunger
 Sucking triggers flow of milk from the breast
through receptors in the nipples
 These receptors signal to the pituitary to
produce prolactin
 Oxytocin is also produced, which helps
contractions of the uterus to shrink the uterus
Breast-Feeding the Baby
 Colostrum – the fluid produced by the breasts
in the first few days of breastfeeding that
strengthens the baby’s immune system
 American Academy of Pediatrics
recommends exclusive breast-feeding for 6
months, & continued for at least one year
 World Health Organization recommends
exclusive breast-feeding for 4-6 months, &
continued for at least 2 years
Breast-Feeding the Baby
 At 6 months, only 29% of American women
breast-feed
 Natural age of weaning is 2 1/2 years, and
the maximum is 6-7 years
Class Exercise: Discuss Handout 12.2