HUMAN SEXUALITY

Chapter Eleven: 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

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…

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

[picture 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

frog or fish egg = 1000µm

mammalian egg = 100µm = 0.1mm

small somatic cell diameter = 10µm

Molecular Biology of THE CELL. p.789

[picture] human egg and sperm

[picture of sperm fertilizing egg]

[picture of first cell division]

[picture of 2 cell stage – blastocyst stage]

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 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

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

definition: http://www.pbs.org/wgbh/nova/baby/18ways.html

picture: http://www.ivf.com/galart.html

fragment removal

removing from around the embryo’s cells

adverse fragments of cell debris

which are thought to impair embryo development

definition and picture: http://www.pbs.org/wgbh/nova/baby/18ways.html

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)

http://www.pbs.org/wgbh/nova/baby/18ways.html

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: http://www.healthlibrary.com/pgd/biopsy.htm

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

http://www.healthlibrary.com/pgd/pgdtech.htm

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®)

http://www.microsort.net/Informat.htm

NEWSWEEK

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

http://www.adoptioncosts.com accessed 3/14/02

agency fees http://www.adoptioncosts.com 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

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

1985 – Patricia Frustaci had seven babies

1 was stillborn

3 died within nineteen days

3 survivors suffered from cerebral palsy & retardation

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

August 13 2001

TURNING UP THE HEAT

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%

http://www.thehealthpages.com/articles/fertility/flprogram.htm

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

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

http://www.lebanonhealth.com/condi/38944.htm 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

4^th edition

Jan Langman MD PhD

A Child is Born

Lennart Nilsson

TIME

November 11, 2002

Pictures from the book:

From Conception to Birth: A Life Unfolds

Photographer:

Alexander Tsiaras

Writer: Barry Werth

pictures based on

CT scans, MRIs

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

1^st 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)

1^st 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

4wk-0.4cm

6wk-1cm

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)

changes in fundal height with pregnancy

Mosby’s Guide to Physical Examination

Henry M. Seidel et. al.

4^th edition

page 614

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

laminaria

small cylinder of seaweed inserted into cervical os

slowly expands as it absorbs cervical moisture gently opens the os

Williams Obstetrics 19th edition

cervical os

dilated by graduated metal dilators

Williams Obstetrics 19th edition

[drawings] vacuum aspiration

Our bodies, Ourselves

by the Boston Women’s Health Collective

Touchstone edition 2005 p.399

curette

metal instrument

used to scrape uterine wall

Williams Obstetrics 19th edition

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

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 needed

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

Family Practice News - August 15 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 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

3^rd / first cousins 4-8% 4%

2^nd / uncle/niece 17% 8%

1^st / father/daughter 13-23% 21-41%

or brother/sister

Textbook of Gynecology. Larry J. Copeland MD

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] Pregnancy and Birth: Your Questions Answered

2nd trimester

waistline thickens

abdomen protrudes

fetal movements (4th-5th mo)

breasts may begin to secrete colostrums

[picture] Pregnancy and Birth: Your Questions Answered

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

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

marginal placenta placenta previa

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

membranes intact membranes ruptured

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

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] 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] 7^th 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] 10^th 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] 17^th week of pregnancy

end of 4^th month

beginning of 5^th 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] 26^th week of pregnancy

7 ½ 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]

[picture] anencephalic child

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

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

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 4^th edition

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

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

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 chorionic villus sampling (CVS)

Conception, Pregnancy and Birth p.164

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

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

[pictures of hospital, birthing center, home birth]

Rediscovering Birth

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

external monitor fetal scalp electrode

Conception, Pregnancy and Birth p.263

[pictures of External Fetal monitor Record]

baby’s heartbeat

mom’s contractions

Pregnancy and Birth: Your Questions answered

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 19^th edition p. 375

dilation = widening of the os

effacement = flattening & thinning of the cervix

Conception, Pregnancy and Birth p.203, 255

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 19^th 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 19^th edition p.384

placenta

diameter: 8-10 inches

weight: approximately 1 pound

Conception, Pregnancy and Birth p.288

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

episiotomy

incision in the perineum sometimes made

during childbirth

reduces

pressure

on infant’s head

prevents

vaginal tearing

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

forceps

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

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

Anesthesiology:

A Manual for Medical Students

Rhoda D. Levine, M.D.

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

Page 1595

[picture] position for epidural

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

Pregnancy and Birth: Your Questions answered

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

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

http://www.aafp.org/afp/20000401/2093.html

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.

nursing mothers

nursing bra

fully automatic breast pump

with a double-collection kit

breast shells can improve

nipple shape

supplementation devices can

allow adoptive mothers to nurse

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

economical

convenient

better cognitive development

decreased pre-menopausal breast cancer

decreased pre-menopausal ovarian cancer

decreased maternal osteoporosis

http://www.aafp.org/afp/20000401/2093.html

American Academy of Family Physicians

Promoting and Supporting Breast-Feeding

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

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 2^nd edition. Figures 2.62 & 2.63 on page 2.18

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