Chapter Eleven: Conceiving Children: Process and Choice


Parenthood as an Option

Becoming Pregnant

Spontaneous and Elective Abortion

The Experience of Pregnancy

A Healthy Pregnancy




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

                                                Contraceptive Technology 15th edition pg. 335-336

your textbook doesn’t make any sense (pg. 330)

“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% of infertility cases            (40%???)

                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…


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



abnormalities of cervix, vagina, uterus, or fallopian tubes

scar tissue from old infections (in tubes, in/around ovaries)

defects in uterine cavity



causes of male infertility

abnormalities in sperm number and/or motility

congenital abnormalities

                vas deferens        


                seminal vesicles


undescended testes


[picture of abnormal sperm]

Medical Embryology 4th edition Jan Langman, M.D., Ph.D. ©1981 The Williams & Wilkins Company p.14


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


frog or fish egg = 1000µm

mammalian egg = 100µm = 0.1mm

small somatic cell diameter = 10µm

Molecular Biology of THE CELL.  p.789

© 1983 by Bruce Alberts et. al.


[picture] human egg and sperm

Copyright Dennis Kunkel.  From website: accessed 3/14/02


[picture of sperm fertilizing egg]

Medical Embryology 4th edition Jan Langman, M.D., Ph.D. ©1981 The Williams & Wilkins Company p.22


[picture of first cell division]

Medical Embryology 4th edition Jan Langman, M.D., Ph.D. ©1981 The Williams & Wilkins Company p.24


[picture of 2 cell stage – blastocyst stage]

Medical Embryology 4th edition Jan Langman, M.D., Ph.D. ©1981 The Williams & Wilkins Company p.29


problems caused by infertility

social isolation from fertile couples




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              p.214


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

[pictures of ICSI] p.216


[3 pictures of ICSI] p.217


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)


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


assisted hatching: IVF or ICSI

and opening the zona pellucida (embryo shell)

to help the embryo hatch and

increase its chances of successful implantation




fragment removal

removing from around the embryo’s cells

adverse fragments of cell debris

which are thought to impair embryo development

definition and picture:


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)



amniocyte hybridized with the AneuVysion 18/X/Y probe

3 blue dots = 3 copies of chromosome 18

1 green dot = 1copy of chromosome X

1 orange dot = 1copy of chromosome Y


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®)



Girl or Boy?

Now You Can Choose.

But Should You?

The New Science of Sex Selection.

January 26, 2004


The Science of Sex Selection

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


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


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 accessed 3/14/02


agency fees                                  accessed 3/14/02

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


these are your ovaries

these are your ovaries on drugs

up to 10x normal size

ready to release multiple eggs


humans are not designed to carry litters

average length of gestation

singleton               39 weeks

twins                      35 weeks

triplets                    33 weeks

quadruplets           29 weeks

pg. 904 Williams Obstetrics19th ed.

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

Newsweek 12/1/97

preemie problems include:

respiratory and digestive disorders, blindness, cerebral palsy, mental retardation

Pictures are from: Atlas of Pediatric Physical Diagnosis

2nd edition © 1992 Gower Medical Publishing

pg. 2.5 and pg. 2.16


Seven from Heaven: The Miracle of the McCaughey Septuplets

By Kenny & Bobbi McCaughey


Bobbi McCaughey

and her Septuplets

(born Nov 19 1997)

(and older sister Mikayla)


The McCaughey septuplets with their parents in 1999

Estimated cost of pregnancy: 1 million dollars

Nathan & Alexis have cerebral palsy

Double take: the story of twins ©2001 Daniel Jussim    photo p.47, text p.45-48


1985 – Patricia Frustaci had seven babies

1 was stillborn

3 died within nineteen days

3 survivors suffered from cerebral palsy & retardation

Double take: the story of twins ©2001 Daniel Jussim    p.45


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

Double take: the story of twins ©2001 Daniel Jussim    p.49


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


do not

become parents


August 13 2001



With this ad, fertility doctors hope to raise awareness

Advancing Age Decreases Your Ability to Have Children


[graphs of statistical trends over time]

1980-2000 increasing number of first births by older women

1995-1998 increasing number of fertility procedures performed

age 27-44 plummeting success of treatments using 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, April 15, 2002

Making Time For A Baby.

Pages 48-55.


The Dangers of Waiting

TIME, April 15, 2002 page 53

[graphs of changes with aging]

decreasing odds of pregnancy

increasing ectopic pregnancy

increasing miscarriage

increasing chromosomal abnormalities


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         p.90.91



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 accessed 3/14/02



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

Textbook of Gynecology Larry J. Copeland p. 205


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


Medical Embryology

4th edition

Jan Langman MD PhD

A Child is Born

Lennart Nilsson



November 11, 2002

Pictures from the book:

From Conception to Birth: A Life Unfolds


Alexander Tsiaras

Writer: Barry Werth

pictures based on

CT scans, MRIs

and other techniques manipulated by computer to construct 3-D images


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)


1st day of LMP = July 4 (0wk/MD)

probable ovulation = July 18 (2wk/MD)  = (0wk/embryologist)

probable implantation = July 25 (3wk/MD)

approximate delivery = April 11 (40wk/MD) = (38wk/embryologist)


[drawings] Week One (3)


[pictures] within hours of fertilization                              1 week


[drawings] Week Two (4)


[drawings] Week Three (5)


[drawings] Week Four (6)


[pictures] 23 days

(3 weeks + 2 days)

nervous system   

starts as a depression

folds into a tube  

32 days

(4 weeks + 4 days)

embryo no bigger than a ladybug

primitive heart, eyes & blood vessels

arms and legs are flipper-like paddles


[drawings] Week Five (7)


[picture] 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


[drawings] Week Six (8)


[picture] 42 days

(6 wks / 8 wks)

11mm in size


Week 6/8

[picture] 4 week embryo 0.23”

[picture] 6 week embryo 0.4”


[drawings] Week Seven (9)


[picture] Week 7/9


[picture] 52 days (7 weeks + 3 days) no bigger than a grape


[pictures] 54 days (7wk +5d)

1 inch

brain heart stomach umbilical cord esophagus kidneys lungs vertebrae liver


[picture] Week 8/10

embryo has become fetus


[picture] 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


28d          32d          36d          40d          42d      44d       51d        52d           56d

4wk        4.6w        5.1w        5.7w        6w       6.3w      7.3w      7.4w         8w -PhD

6wk                                                                                                                        10w -MD

4mm  4.5mm  6mm   8mm     11mm    13-17mm 18-22mm   22-24mm      27-31mm

0.16in  0.18in  0.24in  0.31in  0.43in 0.51-0.67in 0.71-0.87in 0.87-0.94in 1.06-1.22in




8wk – 3cm

12 wks 8.7cm 45g

38 wks 36.0cm 3,400g


fetal growth

from 11 weeks after fertilization (13 after LMP)

to 38 weeks after fertilization (40 after LMP)

Williams Obstetrics 19th edition ©1993 Appleton & Lange p.168, 169


changes in fundal height with pregnancy

Mosby’s Guide to Physical Examination

Henry M. Seidel et. al.

4th edition

page 614

©1999 Mosby, Inc.


Percent of all abortions in the United States for 1 year

Weeks into pregnancy (full-term pregnancy usually lasts 40 weeks)

52.2% Less than 9 weeks (embryo <7 weeks)

24.7% 9 to 10 weeks (7-8wks)

                7wk embryo = 9wks pregnancy    grape sized

11.9% 11 to 12 weeks (9-10wks)

6.2 % 13 to 15 weeks (11-13wks)

3.9 % 16 to 20 weeks (14-18wks)

                amniocentesis wk 14-16 results 16-18

1.1     % 20 or more weeks (18 or more)


RU-486 – first 7 weeks only

Suction curettage – 7 to 13 weeks after the LMP

D and E – 13 to 21 weeks



small cylinder of seaweed inserted into cervical os

slowly expands as it absorbs cervical moisture gently opens the os

Williams Obstetrics 19th edition

© 1993 Appleton & Lange  p. 681


cervical os

dilated by graduated metal dilators

Williams Obstetrics 19th edition

© 1993 Appleton & Lange  p. 682


[drawings] vacuum aspiration

Our bodies, Ourselves

©1984, 1992, 1998, 2005

by the Boston Women’s Health Collective

Touchstone edition 2005    p.399



metal instrument

used to scrape uterine wall

Williams Obstetrics 19th edition

© 1993 Appleton & Lange  p. 682


suction curettage / vacuum aspiration

7 to 13 weeks after the LMP (last menstrual period)

(5 – 11 weeks after conception)

os is dilated

contents of the uterus are evacuated

by a small plastic tube

attached to a vacuum aspirator 

local anesthetic often sufficient


D and E (dilatation and evacuation)

13 and 21 weeks 

combination of

                suction equipment

                special forceps


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 needed



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

Family Practice News - August 15 2001


abortion risks

uterine infection

uterine perforation


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                                       p. 146


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 loosing 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)


1977 Hyde amendment

                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

Textbook of Gynecology. Larry J. Copeland MD

© 1993 W.B. Saunders Company.  p. 183


pregnancy: the woman’s experience

1st trimester

menstruation ceases

breasts size increases

nipples and areola darken



vaginal secretions increased or altered

urination more frequent

bowel movements less regular

[picture] Pregnancy and Birth: Your Questions Answered

©1997, 2002 Dorling Kindersley Limited, London          p.76


2nd trimester

waistline thickens

abdomen protrudes

fetal movements (4th-5th mo)

breasts may begin to secrete colostrums

[picture] Pregnancy and Birth: Your Questions Answered

©1997, 2002 Dorling Kindersley Limited, London          p.80


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] Pregnancy and Birth: Your Questions Answered

©1997, 2002 Dorling Kindersley Limited, London          p.84


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

                                to the pregnancy and baby

                will he be able to handle the increased

                                financial responsibility        [picture] p.162


[pictures of men with pregnant women] p.162, 177


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.

Conception, Pregnancy and Birth p.215 

©Dorling Kindersley Limited, London 1993

Text copyright ©Miriam Stoppard 1993


marginal placenta                 placenta previa

Conception, Pregnancy and Birth p.202  ©Dorling Kindersley Limited, London 1993

Text copyright ©Miriam Stoppard 1993


membranes intact                 membranes ruptured

Conception, Pregnancy and Birth p.253  ©Dorling Kindersley Limited, London 1993

Text copyright ©Miriam Stoppard 1993


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…


                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] day 5 or 6 after fertilization

[picture] the embryo has landed

day 8 – implantation has occurred    p.75, 78


A Child is Born

Lennart-Nilsson, Lars Hamberger

Hardcover edition Sep 2003

Paperback edition Oct 2004


[picture] 7th week of pregnancy

5 week old embryo               p.99


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] 10th week of pregnancy

8 week old fetus

fetal heart beat often audible using Doppler   p.109


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] 17th week of pregnancy

end of 4th month

beginning of 5th month

15 week old fetus

mom might be able to feel kicking     p.133


third-trimester development

fetus increases in size

                7 mo = 4 pounds

                9 mo = 7 pounds plus (on average)


[picture] 26th week of pregnancy

7 ˝ months

24 week old fetus                 p.149


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

Williams Obstetrics 19th edition p.260


[pictures of meningocele & meningomyelocele]

The CIBA Collection of Medical Illustrations

Volume 1 Nervous System Part II

Neurologic and Neuromuscular Disorders p.10


[graph of maternal serum alphafetoprotein levels

increased with spina bifida & anencephaly]

Williams Obstetrics 19th edition ©1993 Appleton & Lange p.942


[picture] anencephalic child

Medical Embryology 4th edition Jan Langman, M.D., Ph.D.

©1981 The Williams & Wilkins Company p.347



a disk-shaped organ

attached to the uterine wall connected to the fetus

by the umbilical cord



waste products

pass between

mother and fetus

through placental cell walls


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


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


Medical Embryology 4th edition

Jan Langman, M.D., Ph.D.

©1981 The Williams & Wilkins Company

p.283, 284, 287


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


detection of birth defects


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       chorionic villus sampling (CVS)

Conception, Pregnancy and Birth p.164

©Dorling Kindersley Limited, London 1993

Text copyright ©Miriam Stoppard 1993


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

Our Sexuality 8th edition Robert Crooks & Karla Baur p355


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




                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


[pictures of hospital, birthing center, home birth]

Rediscovering Birth

©2000 by Sheila Kitzinger

Pocket Books, a division of

Simon & Schuster, Inc.

Photos on pages 174-175, 180-181


In many parts of the world women labor

Predominantly in a squatting position.

9 maanden dagboek by Marianne Amelink, illustrated by Jean Cameron

©1989 Uniebek bv., Postbus 97, 3990 DB Houten


external monitor                    fetal scalp electrode

Conception, Pregnancy and Birth p.263

©Dorling Kindersley Limited, London 1993

Text copyright ©Miriam Stoppard 1993


[pictures of External Fetal monitor Record]

baby’s heartbeat

mom’s contractions

Pregnancy and Birth: Your Questions answered

©1997, 2002 Dorling Kindersley Limited, London          p.168


first-stage labor

8 hours avg. for nulliparous women*

5 hours avg. for parous women*

initial stage of childbirth

regular contractions begin

cervix dilates

*Williams Obstetrics 19th edition p. 375


dilation = widening of the os

effacement = flattening & thinning of the cervix

Conception, Pregnancy and Birth p.203, 255

©Dorling Kindersley Limited, London 1993

Text copyright ©Miriam Stoppard 1993


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

Williams Obstetrics 19th edition p.379


[picture of child being born]


[picture of couple holding newborn] p.194


[picture of dad cutting cord] p.195


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

Williams Obstetrics 19th edition p.384



diameter: 8-10 inches

weight: approximately 1 pound

Conception, Pregnancy and Birth p.288

©Dorling Kindersley Limited, London 1993

Text copyright ©Miriam Stoppard 1993


cesarean section

a childbirth procedure

in which the infant is removed through an incision

in the abdomen and uterus

Williams Obstetrics 19th edition p. 601


[pictures of C-section team and parents]         p.200-201



incision in the perineum sometimes made

during childbirth



on infant’s head


vaginal tearing

Williams Obstetrics 19th edition p.390 and p.388



medical instrument shaped like salad tongs

designed to clasp the baby’s head

sometimes used to assist the infant out of the birth canal

Williams Obstetrics 19th edition p. 561


vacuum extraction

placing a vacuum cup on the emerging baby’s head

can be used to help pull the infant through the birth canal

Williams Obstetrics 19th edition p. 572

Pregnancy and Birth: Your Questions Answered

©1997, 2002 Dorling Kindersley Limited, London          p.194


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


A Manual for Medical Students

Rhoda D. Levine, M.D.

©1984 J.B. Lippincott Company

Page 25


lumbar puncture sites

interspaces between

L3 - L4   or   L4 - L5

spinal cord ends

approximately L1 / L2

Textbook of Pediatric Emergency Medicine

Gary R. Fleisher and Stephen Ludwig editors

©1993 Williams & Wilkins

Page 1595


[picture] position for epidural

[drawing – placement of catheter through hollow needle into epidural space]

Pregnancy and Birth: Your Questions answered

©1997, 2002 Dorling Kindersley Limited, London          p.162


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



                panic attacks


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


breast feeding

provides antibodies

induces uterine contractions

can be a positive experience

                (emotional and sensual)

provides close physical contact

                with the baby

[picture] p.202


estrogen-containing birth control pills

should not be used (they decrease milk quantity and quality)

Use progesterone-only pills or foam or condoms.

[picture] p.202


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

American Academy of Family Physicians

Promoting and Supporting Breast-Feeding


cradling her nursing son,

a mother returns to the family

after gathering nuts

The Bushmen:

Gentle Nomads Of Africa’s Harsh Kalahari.

By Elizabeth Marshall Thomas

Illustrations by the Marshall Kalahari Expeditions.

In Vanishing Peoples of the Earth page 74.

©1968 National Geographic Society


nursing mothers

The Nursing Mother’s Companion 3rd revised edition ©1995 Kathleen Huggins, R.N.,M.S.pages 136, 8


nursing bra                                           

fully automatic breast pump

with a double-collection kit

The Nursing Mother’s Companion 3rd revised edition ©1995 Kathleen Huggins, R.N.,M.S.pages 19, 153


breast shells can improve

nipple shape

supplementation devices can

allow adoptive mothers to nurse

The Nursing Mother’s Companion 3rd revised edition ©1995 Kathleen Huggins, R.N.,M.S.pages 16, 80


sources of information for nursing moms

friends who have nursed

books on nursing

lactation consultants

local support groups

La Leche League International

the Internet

The Nursing Mother’s Companion

third revised edition

Kathleen Huggins, R.N.M.S.


additional benefits of breast-feeding

mother-infant bonding                                  

uterus gets smaller faster   



better cognitive development

decreased pre-menopausal breast cancer                   

decreased pre-menopausal ovarian cancer                 

decreased maternal osteoporosis

American Academy of Family Physicians

Promoting and Supporting Breast-Feeding


examples of non-nutritional components of breast milk

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

content                                           human milk          cow’s milk


total (g/100ml)                                       4.2                           3.8

fatty acids < 8C (%)                             trace                       6

polyunsaturated fatty acids (%)        14                            3


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

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

Food and nutrition bulletin – Volume 17, Number 4, December 1996

Constituents of human milk

Ann Prentice


breast milk is more digestible than formula

breast-milk stool

yellow, soft, mild smelling

consistency of pea soup

formula stool

darker, firmer

more offensive odor

Atlas of Pediatric Physical Diagnosis 2nd edition.       Figures 2.62 & 2.63 on page 2.18

Edited by Basil J. Zitelli & Holly W. Davis ©1992 Gower Medical Publishing


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


                concern that baby may cry during sexual activity