PREGNANCY
conceiving
children: process and choice
parenthood as an option
becoming pregnant
spontaneous and elective
abortion
the experience of
pregnancy
a healthy pregnancy
childbirth
postpartum
parenthood
as an option – choosing
not to have children
couples and individuals have more time for
themselves
more financial resources
more spontaneity in recreational, social,
work patterns
can more fully pursue careers
more time and energy for adult companionship
& intimacy
less stress in marriage / life
parenthood as an option – choosing to have children
children give as well as receive love
couple may grow closer by sharing child
rearing experience
successfully managing parenthood builds self-esteem
and provides a sense of accomplishment
opportunity for discovering new and untapped
dimensions of oneself
can give life greater meaning and
satisfaction
children offer ongoing stimulation and change
sperm viability in the female reproductive
tract is estimated to range from 2 to 7 days (2-3, 2-5days)
lifespan of the ovum estimated
to be 72 hours (24, 48hours)
span of fertility may be from 7 days
before ovulation to 3 days after
your textbook doesn’t make any sense:
“Conception is
most likely to occur [if intercourse occurs] during
a six-day period ending on the day of ovulation”
60 % of couples become pregnant within three
months
as many as one in six U.S. couples
attempting pregnancy experiences fertility problems
defined as not conceiving after at least one
year
approximately 50% (40%???) of
infertility cases involve male factors
secondary infertility
the inability to conceive a second child
occurs in 10% of couples
the cause of infertility remains
unidentified in as many as 15% of cases
causes of female infertility
failure to
ovulate at regular intervals…
age
hormone imbalances
severe vitamin deficiencies
metabolic disturbances
poor nutrition
genetic factors
emotional stress
medical conditions
below normal percentage of
body fat
excessive dieting and exercise
smoking, alcohol and drug
use
environmental toxins
causes of female infertility - continued
cervical mucus may contain antibodies to
partner’s sperm
cervical mucus may form a plug
douching
infections
abnormalities of cervix, vagina, uterus, or fallopian
tubes
scar tissue from old infections (in tubes,
in/around ovaries)
defects in uterine cavity
endometriosis
causes of male infertility
abnormalities in sperm number and/or motility
congenital abnormalities
vas
deferens
epididymus
seminal
vesicles
varicocele
undescended testes
[drawings of abnormal
sperm]
in cases where the sperm count is low
the optimal frequency of ejaculation is
usually every other day during the week the woman is ovulating
to increase the concentration of sperm
a man with a
borderline sperm count
might also want to avoid
taking hot baths, wearing
tight clothing, and
riding bicycles long distances
and avoid using laptops
on the lap
[picture of
relative sizes of:
small somatic cell diameter = 10µm
mammalian egg = 100µm = 0.1mm
frog
or fish egg = 1000µm = 1mm]
[picture of
human egg and sperm]
[picture of
sperm penetrating egg]
[pictures of
one cell becoming two cells]
[picture of
two cells, becoming four cells, becoming morula,
hatching, becoming blastocyst, and
implanting]
[picture of
the journey of the egg from ovary to uterus with timing of milestones
12-24 hours egg is fertilized
3 days zygote arrives at end of fallopian tube
4 days zygote arrives at
large space in uterus
4 ½ - 5 days embryo “hatches” out of “shell”
5 ½ - 6 days embryo implants]
problems caused
by infertility
social isolation from
fertile couples
anger
guilt
loss
sex becomes an
emotionally painful experience
sex becomes stressful
and mechanical
finances become strained
Assisted
Reproductive Technology
(ART)
the techniques of extrauterine
conception
In Vitro Fertilization (IVF)
procedure in which mature eggs are removed from a
woman’s ovary
and fertilized by sperm in a laboratory
dish
[picture of petri dish with droplets containing eggs]
ICSI
– IntraCytoplasmic Sperm Injection
useful in cases of poor
semen quality or quantity
ICSI involves injecting each harvested egg with a
single sperm
fertilization rates
are comparable to IVF fertilization with sperm from normal ejaculation
[picture of
sperm being sucked into needle]
[picture of
couple observing ICSI procedure]
[3 sequential images of ICSI procedure
(1) needle
before penetrating egg
(2) needle
penetrating through membrane of egg
(3) needle
pulled out with sperm now inside the egg]
artificial insemination (AI)
semen is mechanically introduced
into the woman’s vagina, cervix, or uterus
surrogate mother
a woman who is willing to be artificially
inseminated
carries the pregnancy to term, delivers the
child
and gives it to a couple who hired her for
their adoption
(typical fee = $10,000)
Method #/Year Success* Cost
AI 600,000 20-25% $100 (partner sperm)
$300
(donor sperm)
IVF
27,000 23% $6,000-$10,000**
ICSI 1,000 24% $10,000-$12,000
* success rates drop
dramatically after age 40
** donor eggs add $3,000 -
$7,500 to the cost
IVF program costs 10/22/01 (recheck on 5/29/04 prices
unchanged)
Center for Infertility & Reproductive Medicine
Phase 1-Stimulation/Monitoring $1360
Phase 2-Egg Retrieval/Lab
Prep/Professional Fee $1250
Phase 2-Facility/Supplies Fee $750
Phase 3-Embryo Incubation/Processing $1500
Phase 4-Embryo Transfer $425
Total Amount for above $5,285
(does not include medication,
anesthesia, micromanipulation
or embryo
cryopreservation fees.
These are outlined below: )
Medications (estimate) $2500-$3000
Anesthesia (please refer to the anesthesia brochure) $500 minimum
Testicular Sperm Extraction and Cryopreservation
(Scientist Fee Only) $750
(You will be billed separately for the surgeon,
facility and anesthesia fees)
Intracytoplasmic Sperm
Injection (ICSI) $1500
Blastocyst Culture/Incubation $750
Embryo Cryopreservation (billed after cycle complete) $500
Cryopreserved Embryo
Storage (billed separately) $15/month
http://www.ivforlando.com/ivfprogram/costs.htm
assisted hatching:
IVF or ICSI and
opening the zona pellucida
(embryo shell)
to help the embryo hatch and increase its
chances of successful implantation
[picture of
embryo hatching]
fragment removal
removing from around the embryo’s cells
adverse fragments of cell debris
which are thought to impair embryo
development
[picture taken
before fragment removal and picture taken after]
Testicular Sperm
Aspiration (TESA)
obtaining sperm for fertilization by
extracting the cells from the testicle
sometimes from men who previously were thought to
have no sperm (azoospermic men)
Preimplantation Genetic Diagnosis (PGD)
a blastomere is
removed from an 8-cell embryo
DNA is analyzed
by means of fluorescent probes
FISH (fluorescent
in situ hybridization)
[picture of
one cell which has just been removed from an 8-cell embryo]
amniocyte hybridized with the AneuVysion
18/X/Y probe
3 blue dots = 3 copies of chromosome 18
1 green dot = 1 copy of chromosome X
1 orange dot = 1 copy of chromosome Y
[picture of cell with five colored dots inside]
unsorted semen specimens contain approximately
50% X-bearing
sperm
50% Y-bearing
sperm
MicroSort technology
X-bearing sperm =
90% (determined by
DNA analysis)
in X-sorted sample (Xsort®)
Y-bearing sperm = 73% (determined by DNA
analysis)
in Y-sorted samples (Ysort®)
[Newsweek cover with two babies and the
words:
Girl or Boy? Now You Can Choose. But Should You?
The New Science of Sex Selection January 26, 2004]
[picture illustrating how the
process of sperm selection works
1. Sperm stained with fluorescent dye that binds to
chromosomes
2. Laser illuminates dye – X chromosomes glow more
than Y
3. Electrode gives X’s a + charge, Y’s get a – charge.
Charged plates channel sperm]
cost of adopting
domestic public agency adoption: 0 - $2,500
(most public agencies place only children with special needs)
domestic private agency adoption: $4,000 - $30,000
domestic independent adoption: $8,000 - $30,000
intercountry private agency or independent adoption:
$7,000 – $25,000
agency fees
application fee $100 $500
home study and preparation services $700 $2,500
post-placement supervision $200 $1,500
parent physical (each parent) $35 $150
psychiatric evaluation (each parent; if required) $250 $400
attorney fees
document preparation $500 $2,000
petition and court representation to finalize placement $2,500 $12,000
advertising $500 $5,000
birth parent expenses
medical expenses $0(insurance) $10,000-$20,000
living expenses $500 $12,000
legal representation $500 $1,500
counseling $500 $2,000
[picture of
normal ovaries]
these are your ovaries
[picture of
enlarged ovaries]
these are your ovaries on drugs
up to 10x normal size
ready to release multiple eggs
humans are not designed to
carry litters
[picture of
human uterus with four babies inside]
average length of gestation
singleton 39 weeks
twins 35 weeks
triplets 33 weeks
quadruplets 29 weeks
about 30% of pregnancies achieved by
fertility treatments result in multiple births
even if they are born
alive, triplets, quadruplets, and quintuplets are 12x more likely to die within
a year
preemie problems include:
respiratory and digestive
disorders, blindness, cerebral palsy, mental retardation
[picture of
premature baby and picture of baby born after a normal duration inside the
uterus]
[picture of
book cover:
Seven from Heaven
The Miracle of the McCaughey
Septuplets]
Bobbi McCaughey
and her Septuplets
(born Nov 19 1997)
(and older sister Mikayla)
[picture of
pregnant Bobbi]
[picture of
septuplets and Mikayla in strollers]
The McCaughey septuplets with their parents in 1999
estimated cost of pregnancy: 1
million dollars
Nathan & Alexis have cerebral palsy
[picture of
Kenny and Bobbi with the septuplets as toddlers]
1985 – Patricia Frustaci had
seven babies
1 was stillborn
3 died within nineteen days
3 survivors suffered from cerebral palsy &
retardation
[picture of 7 Chukwu babies]
7 surviving Chukwu octuplets, age 7 months
smallest baby died within 1
week of birth
7 survivors hospital charges
were $250,000 each
Mother was confined to bed for 6 weeks
during the last two weeks
the head of her bed was tilted down
most prolific mother
the wife of Feodor Vassilyev
from Shuya, Russia
gave
birth to
69 children in
27 confinements
a total of:
16 pairs of twins
7 sets of triplets
4 sets of quadruplets
born
between 1725 and 1765 (40 years)
only two of the children failed to survive infancy
Guinness
World Records TM 2002 ©Guinness
World Records LTD p.19
after 25 years of scientific advances
70 to 80% of couples who use ART do not become
parents
[Newsweek cover with picture of
pregnant woman and the words:
The Truth About
Fertility
Why More Doctors Are Warning That
Science Can’t Beat the Biological Clock
August 13 2001]
SART – Society
for Assisted Reproductive Technology
percent of cycles resulting in live
births
when using fresh embryos from non-donor oocytes
for women <35 for women >42
2011……..40.1% 2011……..4.2%
2010……..41.7% 2010……..4.1%
2009……..41.4% 2009……..4.2%
2008……..41.3% 2008……..4.1%
2007……..39.9% 2007……..4.6%
2006……..38.8% 2006……..4.3%
2005……..37.1% 2005……..3.5%
2004……..36.6% 2004……..3.9%
2003……..37.5% 2003……..4.5%
[picture of
informational add with the words:
Advancing age decreases your ability to
have children]
[graph showing
that from 1980 to 2000 there has been an increase in first births by older
women]
[graph showing
that from 1995 to 1198 there has been an increase in fertility procedures
performed]
[graph showing
that from age 27 to age 44 there is a dramatic decrease in success of
infertility treatments using a woman’s own eggs]
27y - chance of getting pregnant begins to
decline
42y - 90% of eggs are abnormal, 7.8% chance
of having a baby without using donor eggs
[TIME cover showing a baby on top of
work papers and the words:
Babies vs. Career –
Which should come first for women who want both?
The harsh facts about
fertility.
April 15, 2002]
The
Dangers of Waiting
Older women have a harder time getting
pregnant and face greater risks when they do
[graph showing
pregnancy odds decreasing with age]
[graph showing
ectopic pregnancies increasing with
age]
[graph showing
miscarriages increasing with age]
[graph showing
chromosomal abnormalities increasing
with age]
1998 ART Fertility Clinic Report (CDC)
success rates at various ages: <35 35-37 38-40 40+
fresh embryos - nondonor eggs
live births / cycle 32% 26% 18% 8%
frozen embryos - nondonor eggs
live births / transfer 21% 19% 18% 13%
fresh donor eggs
live births / transfer 42% 44% 40% 41%
pregnancy detection
blood & urine of
pregnant woman contains the hormone human chorionic gonadotropin
(HCG)
secreted by the placenta
at-home urine tests can detect
pregnancy shortly after a missed menstrual period
[picture of
couple celebrating positive pregnancy test]
miscarriage
spontaneous abortion (expulsion of
the fetus from the uterus)
occurring in the first 20 weeks of pregnancy
10 - 20% of known pregnancies end
in miscarriage
“The truth is - as with any death - there is nothing
one can say or do to fix it…”
causes of
spontaneous abortions
specific
cause usually not determined
when
pregnancy tissues are tested
genetic
abnormalities 50 % to 60 %
uterine
defects 10 % to 15 % (weak cervix etc)
hormonal
imbalances 10 % to 15 %
(progesterone deficiency,
high androgen levels
and
imbalances caused by autoimmune diseases etc)
other
causes
infections,
fever, immune response, smoking, caffeine, malnutrition,
cocaine or
crack use, radiation, toxic substances
previous history spontaneous
abortion risk (%)
O 12.7
OO 14.5
OOO 14.5
OOOO 13.1
X 22.8
XX 28.6
XXX 33.3
XXXX 33.3
O = live birth
X = spontaneous
abortion
about 50% of all pregnancies
are unplanned
about 1.3 million
abortions are reported each year in the U.S
factors associated with
higher likelihood of
abortion lower
likelihood
age 18-24 age
35 or older
single married
Hispanic
(2x) or Black (3x) high
income
low income suburban
or rural
covered by Medicaid born-again
or
4
or more children Evangelical
Christian
[pictures of
covers of books/magazines:
Medical Embryology
A Child is Born
TIME Nov 11 2002 issue]
[picture of birth
date calculator (wheel)]
1st day of LMP = Jan 1 (0wk/MD)
probable ovulation = Jan 15 (2wk/MD) =
(0wk/embryologist)
probable implantation = Jan 22 (3wk/MD)
approximate delivery = Oct 8 (40wk/MD) = (38wk/embryologist)
[pictures of
events occuring on
Day 1 fertilization
Day 2 two cell stage
Day 3 morula
Day 4 early blastocyst
Day 5 late blastocyst
Day 6-7 events during first week
including hatching and implantation]
Week
One (3)
[photos of two
celled stage (within hours of fertilization)
and blastocyst stage (1 week)]
[pictures of
events occuring on
Day 8 bilaminar
germ disc
Day 9 trophoblast
with lacunae
Day 10-11 Embryo in uterus 10-11 days
after ovulation
Day 12 maternal and trophoblast
vessels
Day 13 uteroplacental
circulation begins
Day 14 embryonic disc seen from dorsal
with prochordal plate and primitive streak]
Week
Two (4)
[pictures of
events occuring on
Day 15 dorsal aspect of embryo with
primitive streak
Day 16 trilaminar
germ disc with ectoderm, mesoderm, and endoderm
Day 17 mesoderm migration
Day 18 cut edge of amnion
Day 19 formation of central nervous
system begins with neural plate folding
Day 20 appearance of somites
Day 21 transverse section through somite region]
Week
Three (5)
[pictures of
events occuring on
Day 22 neural groove closing
Day 23 cranial and caudal neuropores
Day 24-25 villus
formation
Day 26 branchial
arches
Day 27 table correlating approximate
age with number of somites
Day 28 Ear placode,
eye anlage, and arm bud]
Week
Four (6)
[photo of 23
day embryo ]
nervous system starts as a depression, folds into a tube
[photo of 32
day embryo]
embryo no bigger than a ladybug
primitive heart, eyes & blood vessels
arms and legs are flipper-like paddles
[pictures of
events occuring on
Day 29 arm and leg buds
Day 30 developing face
Day 31 tail bud
Day 32 embryo in chorionic cavity
Day 33 amnion, yolk sac, connecting
stalk
Day 34 developing limb buds – elbow,
hand plate, foot plate
Day 35 branchial
arches and clefts]
Week
Five (7)
[picture of
embryo at 40 days]
40 days (5 weeks + 5 days)
human embryo looks no different from pig, chick, or elephant
all have a tail, a yolk sac, rudimentary gills
[pictures of
events happening on
Day 36 physiological umbilical hernia
Day 37 developing face
Day 38 finger rays and foot rays
Day 39 endodermal
derivatives – pharyngeal pouches, foregut, midgut,
hindgut,
pancreas, liver, urinary bladder
Day 40 embryo in utero
– chorionic cavity, amniotic cavity, placenta, yolk sac
Day 41 chorionic villi,
yolk sac, amnion
Day 42 embryo]
Week
Six (8)
[photo of
embryo at 42 days]
42 days (6 wks / 8 wks)
11mm in size
[photos of 6
week embryo (0.4 inches)
and 4 week embryo (0.23 inches)]
[pictures of
events happening on
Day 43 fingers, toe rays
Day 44 developing face – medial nasal
swelling, maxillary swelling, nasolacrimal groove
Day 45 umbilical herniation
Day 46 placenta, decidua
capsularis, yolk sac, uterine lumen
Day 47 fingers
Day 48 toes
Day 49 fetal membranes in third month –
amniotic cavity, placenta]
Week
Seven (9)
[photo of
embryo at week 7/9]
[photo of
embryo at 52 days]
52 days (7 weeks + 3 days) no bigger
than a grape
[pictures of
54 day embryo (1 inch) with location of internal organs shown:
brain, heart, stomach, umbilical cord, esophagus, kidneys, lungs,
vertebrae, liver]
[photo of
fetus at week 8/10]
embryo has become fetus
[photo of
fetus at week 12/14]
84 days (12 wks / 14wks)
fetus has a tiny rib cage, eyes and ears, it can suck its thumb
8.7 cm (3.4 inches)
[pictures of
embryo / fetus at various stages of development]
28d 4wk
4mm 0.16in 6wk-MD
32d 4.6w
4.5mm 0.18in
36d 5.1w 6mm 0.24in
40d 5.7w 8mm 0.31in
42d 6w 11mm 0.43in
44d 6.3w 13-17mm
0.51-0.67in
51d 7.3w
18-22mm 0.71-0.87in
52d 7.4w
22-24mm 0.87-0.94in
56d 8w-PhD 27-31mm 1.06-1.22in 10w-MD
[pictures of
embryo / fetus / baby at various stages of development]
4 wk - 0.4 cm
6 wk - 1 cm
8 wk - 3 cm
12 wks - 8.7 cm - 45
g
38 wks - 36.0 cm -
3,400 g
[pictures of
fetus / baby at various stages of development]
fetal growth
from 11 weeks after
fertilization (13 after LMP)
to 38 weeks after
fertilization (40 after LMP)
[picture
of changing size of uterus during pregnancy
including at 12 weeks the top of the uterus is just a little higher
than the pelvic brim
and at 20 weeks the top of the uterus is close to the umbilicus
(belly button)
and at 36 weeks the top of the uterus is close to the bottom of
the ribcage]
changes in fundal height with pregnancy
[graph
with
Y-axis - Percent of
all abortions in the United States for 1 year
X-axis - Weeks into
pregnancy (full-term pregnancy usually lasts 40 weeks)
Less than 9 weeks 52.2%
9 to 10 weeks 24.7%
11 to 12 weeks 11.9%
13 to 15 weeks 6.2%
16 to 20 weeks 3.9%
20 or more weeks
1.1% ]
7 wk embryo = 9 wks
pregnancy (grape sized)
amniocentesis wk 14-16, results wk 16-18
[graph
with
Y-axis - Percent of
all abortions in the United States for 1 year
X-axis - Weeks into
pregnancy (full-term pregnancy usually lasts 40 weeks)
Less than 9 weeks 52.2%
9 to 10 weeks 24.7%
11 to 12 weeks 11.9%
13 to 15 weeks 6.2%
16 to 20 weeks 3.9%
20 or more weeks
1.1% ]
RU-486 – first 7
weeks only
suction curettage – 7 to 13 weeks after the LMP
D and E – 13 to 21
weeks
laminaria
small cylinder of seaweed inserted into cervical os
slowly expands as it absorbs cervical moisture
gently opens the os
[pictures
of laminaria inserted into cervical os]
cervical os dilated by graduated metal dilators
[picture
of metal dilator entering the os]
vacuum aspiration
[pictures
of vacuum aspiration procedure]
curette
metal instrument used to scrape uterine wall
[picture
of curette about to be inserted]
suction curettage / vacuum
aspiration
7 to 13 weeks
after the LMP (last menstrual period)
(5-11 weeks after
conception)
os
is dilated
contents of uterus are evacuated
by a small plastic tube attached to a vacuum aspirator
local anesthetic often sufficient
D and E (dilatation and evacuation)
13 to 21 weeks
combination of
suction equipment
special forceps
curette
general anesthesia usually
required
RU-486 (Mifeprex/Mifeprestone)
first 7 weeks only
visit 1 - RU-486
blocks the hormone progesterone
softens the cervix
breaks down uterine lining
visit 2 - 2
days later Misoprostol
causes uterine contracts
expels any remaining tissue
visit 3 - 2
weeks after RU-486
final check-up
Mifeprestone
FDA approved Sept 2000
shipments began in Dec 2000
average wholesale price = $270
600mg
dose (3 x 200mg pills)
Planned Parenthood of N.Y.City
charges $325 / abortion - regardless of the method chosen
mifeprestone = 12% of procedures
1st 4 mo 2001
abortion risks
uterine infection
uterine perforation
hemorrhage
incomplete removal
anesthesia complications
cervical damage
miscarriage or ectopic pregnancies in future pregnancies
after a
D & C (but not after vacuum aspiration)
RU-486 protocol:
cramping, headaches, nausea, vomiting
prostaglandins can cause respiratory death in asthmatic women
voluntary risks in perspective:
activity chance of death / year
motorcycling 1 in 1,000
automobile driving 1 in 6,000
using tampons 1 in
350,000
having intercourse (PID) 1
in 50,000
nonsmoker using OCPs 1
in 63,000
smoker using OCPs 1 in 16,000
laparoscopic tubal ligation 1 in 67,000
vasectomy 1 in 300,000
continuing pregnancy 1
in 14,300
illegal abortion 1 in 3,000
legal abortion <9 wks 1
in 500,000
legal abortion 9-12 wks 1
in 67,000
legal abortion 13-15 wks 1
in 23,000
legal
abortion >15 wks 1 in 8,700
male partners do not have a
legal right to demand or deny abortion for the woman
58% of women who have an
abortion were using contraception the month they became pregnant
usually condoms or the pill
women are more likely to
take contraceptive risks if…
they feel very guilty about sex
they are using alcohol or drugs
they lack strong self esteem (fear losing partner)
they were abused in childhood
according to Dr. Justin
Richardson, author of
“Everything You Never Wanted Your Kids to Know About
Sex”
88% of girls who take an abstinence pledge break it
as reported in Newsweek
May 31, 2004 p.76
13th century: St. Thomas Aquinas
delineated Catholic Church view
that fetus acquires soul…
40
days after conception for males
90
days after conception for females
1860s Pope Pius IX declared
human life begins at conception
at any stage fetus’s life is equally important to the
mother’s
early American law based on English common law
allowed abortion until the pregnant woman felt fetal movement, or quickening
(usually 4-5mo)
during the 1860s abortion
became illegal in the U.S.
except when necessary to save the woman’s life
1973 Roe v. Wade
legalized
a woman’s right to decide to terminate her pregnancy
before the fetus has
reached the age of viability
viability = the fetus’s ability to survive independently of the
woman’s body (usually 6-7mo)
prohibited
federal Medicaid funds for abortions
1993 Hyde amendment modified
states
required to fund abortions for rape and incest victims
genetic risks of incest pregnancy
degree/relationship premature serious malformations
death in
surviving children
3rd / first cousins 4-8% 4%
2nd / uncle/niece 17% 8%
1st / father/daughter 13-23% 21-41%
or brother/sister
pregnancy: the woman’s experience
1st trimester
menstruation ceases
breasts size increases
nipples and areola darken
nausea
fatigue
vaginal secretions increased or altered
urination more frequent
bowel movements less regular
[picture
of pregnant woman in 1st trimester]
2nd trimester
waistline thickens
abdomen protrudes
fetal movements (4th-5th mo)
breasts may begin to secrete colostrum
[picture
of pregnant woman in 2nd trimester]
3rd trimester
occasional painless uterine contractions
pressure from enlarged uterus may cause discomfort, indigestion,
frequent urination
fetal movements can be seen and felt from outside the abdomen
[picture
of pregnant woman in 3rd trimester]
pregnancy: the man’s experience
fears and concerns a man may have…
will the woman and baby be healthy
will he be a good parent
will he loose his wife’s affection and attention
will he be able to handle the increased financial responsibility
[picture
of man looking at his partner’s protruding abdomen]
[picture
of man smiling at his partner’s protruding abdomen]
[picture
of a man placing his ear and hand on his partner’s protruding abdomen]
sexual interaction during
pregnancy
it is now generally accepted
that in pregnancies with no risk factors
sexual activity and orgasm
may be continued as desired
until the onset of labor
during intercourse, the males thrusting penis is guided safely
away from the uterus by the angle of the vagina
[drawing
of body structures located between penis in vagina and baby in uterus]
marginal placenta
[drawing
of marginal placenta]
placenta previa
[drawing
of placenta previa]
membranes intact
[drawing
of intact membranes]
membranes ruptured
[drawing
of ruptured membranes]
women who are at risk for bleeding or premature labor
will likely be advised to refrain from sex / orgasm
coitus or orgasm should not occur if the following happen…
spotting
vaginal
or abdominal pain
amniotic
sac (“water bag”) breaks
first-trimester development
zygote = single cell resulting from the union of sperm and egg
blastocyst
= multicellular descendant of the united sperm and
ovum that implants on the wall of the uterus
[pictures
of zygote and blastocyst]
day 5 or 6 after fertilization
[picture
of embryo “hatching”]
the embryo has landed
day 8 – implantation has occurred
[picture
of implanted embryo]
A Child is Born
Lennart Nilsson and Lars Hamberger
[picture
of book cover]
7th week
of pregnancy
5 week old embryo
[picture
of embryo in uterus]
first-trimester development - continued
9-10 weeks after a woman’s last menstrual period
fetal heart-beat can be heard
with a special ultrasound stethoscope (Doppler)
[picture
of growth stages of embryo and fetus changing in size during 40 weeks]
10th week
of pregnancy
8 week old fetus
fetal heart beat often audible using Doppler
[picture
of fetus in uterus]
first-trimester development - continued
2nd month - spinal canal and rudimentary arms and legs form,
as do the beginnings of recognizable eyes, fingers, and toes
3rd month - liver, kidneys, intestines, and lungs
begin limited functioning in 3-inch fetus
second-trimester development
in the 4th month the sex of the fetus can often be
distinguished
by the end of the 4th month fetal movements, or quickening can
be felt
[picture
of growth stages of fetus changing in size during 40 weeks]
4 months = 16 weeks from LMP = 14 weeks from conception
17th week of
pregnancy
end of 4th month
beginning 5th month
15 week old fetus
mom might be able to feel kicking
[picture
of fetus in uterus]
third-trimester development
fetus increases in size
7 mo = 4 pounds
9 mo = 7 pounds plus (on
average)
26th week
of pregnancy
7 1/2 months
24 week old fetus
[picture
of fetus in uterus]
prenatal care
prevent or promptly manage problems
birth
defects
premature
deliveries
maternal
death
ensure optimal health and nutrition
test for immunity to rubella (before getting pregnant)
test for HIV virus to prevent transmission to fetus
lack of prenatal care increases the risk of
low
birth weight
lung
disorders
brain
damage
abnormal
growth patterns
neural-tube defects prevalence
studied in infants of women who used multivitamins
with folic acid during the first 6 weeks of pregnancy
compared to women who didn’t
with folic acid 0.9 / 1000
without folic acid 3.3 / 1000
Types of spina bifida aperta with
protrusion of spinal contents
Meningocele
Meningomyelocele
Spina bifida with central cicatrix
[pictures
of spina bifida]
Maternal serum alphafetoprotein
level
(Multiples of the
median)
[Graph of overlapping
curves showing distribution of maternal alphafetoprotein
levels
lowest values = unaffected
intermediate values = open spina bifida
highest levels = anencephaly]
anencephalic child
[picture
of anencephalic child]
placenta
a disk-shaped organ attached to the uterine wall
connected to the fetus by the umbilical cord
nutrients
oxygen
waste products
pass between mother and fetus through placental cell walls
[picture
of placenta]
many substances ingested by the mother easily cross through the
placenta
certain medications
tobacco and alcohol
illegal drugs
are all dangerous to the developing fetus
[picture
of placenta]
smoking during pregnancy
reduces amount of oxygen in bloodstream
increases miscarriage and fetal / infant death
infants often weigh less
50 -70% greater
chance of cleft lip or palate
significantly lower developmental scores
increased incidence of reading disorders
more respiratory diseases
[pictures
of cleft lip and cleft palate]
use of alcohol during pregnancy
fetal alcohol syndrome (FAS)
leading
cause of birth defects & developmental disabilities in the U.S.
alcohol use can cause
intrauterine
death
spontaneous
abortion
premature
birth
congenital
heart defects
damage
to brain and nervous system
numerous
physical malformations
babies may be born addicted and experience withdrawal after
birth
children with FAS
continue
to be small in size
developmentally
delayed
exhibit
behavior problems
Mother with
3-year-old son
Dublin, Ireland
Mom drank a bottle of
vodka a day until 2 months into the pregnancy.
Malcolm’s kidneys
& stomach didn’t work at birth. He was tube-fed until 14 months old.
He was born with
damaged corneas and droopy eyelids.
He has typical FAS
facial features: small wide-set eyes, thin upper lip, short upturned nose,
receding chin.
[picture
of Malcolm and his mother]
mouse fetus - normal
[picture]
mouse fetus exposed to alcohol - eye damage, stunted brain,
facial deformities
[picture]
3-year-old, Sweden
[picture]
6-year-old, Seattle
[picture]
10-year-old, Chicago
[picture]
15-year-old, Sweden
[picture]
17-year-old, Seattle
[picture]
Fetal Alcohol Effect (FAE)
impaired memory
brief attention span
poor judgment
poor capacity to learn from experience
The Preventable
Tragedy - FETAL ALCOHOL SYNDROME
text and photographs by George Steinmetz
National Geographic Vol. 181. No. 2.
February 1992 (pp
36-39)
detection of birth defects
amniocentesis
amniotic fluid removed from the uterus
tested to determine if certain fetal birth defects exist
done during week 14-16
chromosome analysis can take 2-3 weeks
chorionic villus sampling (CVS)
small sample of the chorionic villi is
removed for analysis
can be done as early as week 10
rare risks
damage to fetus, induced miscarriage, infection
amniocentesis
[drawing
of procedure]
chorionic villus sampling
[drawing
of procedure]
rate of fetal defects
due to chromosomal abnormalities
(such
as Down syndrome)
before age 30: 2.6 / 1000 1/385
at age 35: 5.6 / 1000 1/179
at age 40: 15.8
/ 1000 1/63
at age 45: 53.7
/ 1000 1/19
the full term of pregnancy usually lasts about 40 weeks from
the last menstrual period
(38 weeks from
conception)
prepared childbirth
birth following an education process
that can involve
information
exercises
breathing
working
with a labor coach
birthplace alternatives
hospital births
most hospitals now have birthing rooms with a homelike
atmosphere
birthing centers
may be adjacent to hospitals or separate, freestanding
organizations
home births
few physicians or certified nurse-midwives will assist with
home births when hospitals are available
[picture
of woman on table in operating room]
[picture
of inside a beautiful birthing center]
[picture
of mom at home in a birthing pool with husband and son talking to her]
in many parts of the world women labor predominantly in a
squatting position
[woman
in labor pictured in two alternative positions]
external monitor
[picture
of external monitoring equipment]
fetal scalp electrode
[picture
of fetal scalp electrode]
baby’s heartbeat
[picture
of record on paper monitoring strip that is produced during labor]
mom’s contractions
[picture
of record on paper monitoring strip that is produced during labor]
[picture
of couple in hospital room where woman is in labor]
first-stage labor
8 hours avg. for nulliparous women
5 hours avg. for parous women
initial stage of childbirth
regular contractions begin
cervix dilates
[picture
of three stages of labor]
dilation = widening of the os
effacement = flattening & thinning of the cervix
[pictures
of dilation and effacement]
second-stage labor
50 minutes median duration in nuliparas
20 minutes median duration in multiparas
middle stage of labor
infant descends through the vaginal canal
[picture
of three stages of labor]
[photos
of second-stage labor]
[photo
of couple admiring newborn child]
[photo
of dad cutting umbilical cord]
third-stage labor
usually placenta separates within 5 minutes of delivery of the
infant
last stage of childbirth
placenta separates from uterine wall
placenta comes out of vagina
afterbirth = placenta & amniotic sac after expulsion
[picture
of three stages of labor]
placenta
diameter: 8-10 inches
weight: approx. 1 pound
[photos
of placenta]
cesarean section
a childbirth procedure
in which the infant is removed through an incision in the
abdomen and uterus
[drawings
of cesarean section procedure]
[photos
of couple in operating room during cesarean delivery]
episiotomy
incision in the perineum sometimes made during childbirth
reduces pressure on infant’s head
prevents vaginal tearing
[picture
of episiotomy being sutured and picture of badly torn vagina which will be
difficult to suture]
forceps
instrument shaped like salad tongs sometimes used to assist infant out
[drawing
of forceps-assisted delivery]
vacuum extraction
vacuum cup on baby’s head helps pull the infant
[drawing
of vacuum-assisted delivery]
epidural anesthesia
used for
surgical
procedures
labor pains
caudal block
can be an alternative when infection is present in the lumbar
area
or if the L vertebrae are deformed
[drawing
of spinal cord in vertebral canal]
lumbar puncture sites
interspaces between L3 - L4 or L4 - L5
spinal cord ends approximately L1 / L2
[pictures
of proper needle placement]
[photo
and drawing of epidural procedure]
postpartum period
first
several weeks following birth
time of
physical and psychological adjustment
time of
intensified emotional highs and lows
“baby
blues”
short-lived
tearfulness and mood swings
occurs
in about 80% of new mothers
postpartum depression (PPD)
affects 15% of mothers
insomnia
anxiety
panic
attacks
hopelessness
at its most extreme
women
lose interest in their babies
or
develop obsessive thoughts about harming themselves or their babies
right after birth breasts produce colostrum
rich in antibodies and protein
milk production begins 1-3 days after birth
[picture
of mom with baby who is breastfeeding]
breast feeding
provides antibodies
induces uterine contractions
can be a positive experience (emotional and sensual)
provides close physical contact with the baby
[picture
of baby’s mouth near nipple which is squirting milk]
estrogen-containing birth control pills
should not be used (they decrease milk quantity and
quality)
use progestin-only pills or foam or condoms
[picture
of couple with breast feeding twins]
relative risk of formula feeding vs. breast-feeding
illness relative
risk
allergies, eczema 2 to 7 times
urinary tract infections 2.6 to 5.5 times
inflammatory bowel disease 1.5
to 1.9 times
diabetes, type 1 2.4 times
gastroenteritis 3
times
hodgkin’s
lymphoma 1.8
to 6.7 times
otitis
media 2.4
times
haemophilus
influenzae meningitis 3.8 times
necrotizing enterocolitis 6 to 10 times
pneumonia/lower resp. tract infect. 1.7
to 5 times
respiratory syncytial virus infect. 3.9
times
sepsis 2.1
times
sudden infant death syndrome 2.0 times
relative risk of formula feeding vs. breast-feeding
illness relative
risk
industrial-world hospitalization 3 times
developing-country morbidity 50 times
developing-country mortality 7.9
times
cradling her nursing son, a mother returns to the family after
gathering nuts
[picture
of mom breastfeeding the toddler perched on her hip]
Are You Mom Enough?
[picture
of mom breastfeeding young boy while posing for TIME magazine cover]
[pictures
of breast feeding moms]
nursing mothers
[picture
of mom breastfeeding while talking on the phone and taking notes]
[picture
of mom breastfeeding while socializing with a pregnant woman]
nursing bra
[picture
of nursing bra]
fully automatic breast pump with a double-collection kit
[picture of
breast pump being used]
breast shells can improve nipple shape
[picture of
breast shell in place around nipple]
supplementation devices can allow adoptive mothers to nurse
[picture of
mother nursing a baby using a supplementation device]
sources of information for nursing moms
friends who have nursed
books on nursing
lactation consultants
local support groups
La Leche
League International
the internet
[picture of book
cover – “The Nursing Mother’s Companion”]
additional benefits of breast-feeding
mother-infant bonding
uterus gets smaller faster
economical
convenient
better cognitive development
decreased pre-menopausal breast cancer
decreased pre-menopausal ovarian cancer
decreased maternal osteoporosis
examples of non-nutritional components of breast milk
http://www.unu.edu/unupress/food/8ZF174e/8F174E04.htm
antimicrobial factors: Secretory IgA,
IgM, IgG / lactoferrin / lysozyme /
complement C3 / leucocytes / bifidus factor / lipids
and fatty acids / antiviral mucins, GAGs /
oligosaccharides / growth factors: epidermal growth factor (EGF) / nerve
growth factor (NGF) / insulin-like growth factor (IGF) / transforming growth
factor (TGF) / taurine / polyamines cytokines and
anti-inflammatory factors: tunour necrosis factor
/ interleukins / interferon – γ / prostaglandins / α1-antichymotrypsin
/ α1-antitrypsin / platelet-activating factor: acetyl hydrolase digestive enzymes: amylase / bile
acid-stimulating esterase / bile acid-stumalting
lipases / lipoprotein lipase hormones: feedback inhibitor of lactation
(FIL) / insulin / prolactin / thyroid hormones /
corticosteroids, ACTH / oxytocin / calcitonin / parathyroid hormone / erythropoietin transporters:
lactoferrin (Fe) / folate
binder / IgF binder / thyroxine
binder / corticosteroid binder potentially harmful substances: viruses
(e.g., HIV) / aflatoxins / trans-fatty acids /
nicotine, caffeine / food allergens / PCBs, DDT, dioxins / radioisotopes /
drugs other: casomorphins / δ-sleep
peptides / nucleotides / DNA, RNA
typical content of human and cow’s milk
http://www.unu.edu/unupress/food/8ZF174e/8F174E04.htm
content human milk cow’s milk
fat
total (g/100ml) 4.2 3.8
fatty acids < 8C (%) trace 6
polyunsaturated fatty acids (%) 14 3
protein
total (g/100ml) 1.1 3.3
casein 0.4 0.3 2.5
Α-lactalbumin 0.3 0.1
lactoferrin 0.2 trace
IgA 0.1 0.003
IgG 0.001 0.06
lysozyme 0.05 trace
serum albumin 0.05 0.03
Β-lactoglobulin - 0.3
typical content of human and cow’s milk
http://www.unu.edu/unupress/food/8ZF174e/8F174E04.htm
content human milk cow’s milk
carbohydrate (g/100ml)
lactose 7.0 4.8
oligosaccharides 0.5 0.005
minerals (g/100ml)
calcium 0.030 0.125
phosphorus 0.014 0.093
sodium 0.015 0.047
potassium 0.055 0.155
chlorine 0.043 0.103
breast milk is more digestible than formula
breast-milk stool
yellow, soft, mild smelling
consistency of pea soup
[picture of
open diaper with breast-milk stool]
formula stool
darker, firmer
more offensive odor
[picture of
open diaper with formula stool]
sexual interaction after childbirth
intercourse can resume
when flow of reddish uterine discharge (lochia)
stopped
when episiotomy incisions or vaginal tears have healed
usually about three to four weeks
most couples wait to resume intercourse
after six to eight weeks following birth
research finds high levels of sexual difficulties
following childbirth
vaginal dryness
painful intercourse
fatigue
concern that baby may cry during sexual activity
J