Transcript Human Growth & Reproduction

Human Growth and
Reproduction
Conception, Pregnancy, and Childbirth –
Chapter 6
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Identify the physiological elements and processes of conception. Where does conception take
place? How long does the sperm live inside the woman's body? What is process of one sperm
penetrating the egg? (Note: hyaluronidase) 120-121
How can you improve chances of conception? How long do the sperm live in the woman's body.
When should intercourse be timed right? (Position during sex, remain on her back, acidity and
sperm, lubricants and suppositories) 122-123
Differentiate between zygote, embryo, and fetus in terms of gestation. 121-122
Describe the nine months of pregnancy in terms of trimesters: first, second and third trimester;
birth stages: first stage (effacement, dilation ,transition phase), second stage (crowning,
episiotomy); third stage (placenta and fetal membranes expelled). 121-122; 123
Describe the embryonic of development (first eight weeks). Note: ectoderm, endoderm, and
mesoderm) 123
Discuss the function of the placenta and what passes back-and-forth between the baby and the
woman and what does not. (Note: human chloride gonadotropin, umbilical cord, and amniotic
fluid) 123, 125
Differentiate between the fetal developments in the first, second and third trimesters. Why is the
first trimester the most remarkable stage of the three trimesters? When can the gender be
determined? When does quickening or movements of the fetus occur? 125-126
Conception, Pregnancy, and Childbirth –
Chapter 6 (continued)
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Identify what occurs during the first, second and third trimester's of pregnancy for the woman.
What are the early signs of pregnancy? Differentiate between false positives and false-negative
pregnancy tests (Are Braxton-Hicks contractions not part of the labor pains?). Describe and
calculate gestational age using Nagele's rule. Describe physical changes.
Describe psychological changes during pregnancy factors of depression, and social support.126-7
Discuss the father's role in pregnancy. How does prolactin and testosterone relate to father's
paternal behavior? What percent of fathers were ambivalent about fathering?
Discuss sex during pregnancy. What is possible; what is the “safe” period?; what is beneficial?,
and; what couples can do to experience sexual pleasure besides intercourse? 131
Discuss nutrition during pregnancy, and effects of drugs taken during pregnancy. What
psychotropic drugs are used for depression. Which ones are good and which ones are not?131-4
Describe the first, second, and third stages of labor. What is an episiotomy? Discuss the
increase in cesarean section versus vaginal birth. 135-137
Describe the two basic techniques in the Lamaze method. What are some anesthetics in
childbirth, home birth, versus hospital birth? 138
Conception, Pregnancy, and Childbirth –
Chapter 6 (continued)
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Discuss the psychological changes a mother experiences during the postpartum period.
Differentiate between: postpartum blues, postpartum depression, and postpartum psychosis. 141
What are the rates of sex during the postpartum period. How does breast-feeding relate to sexual
activity? 142-144
Identify problem pregnancies including, false pregnancy (pseudocyesis), an ectopic pregnancy
(note: how do some forms of contraception relate to this problem?), and miscarriage. 144-147
Discuss pregnancy induced hypertension (hypertension, preeclampsia, and eclampsia-- a woman
may die!) 145
What is meant by “teratogenic?” Discuss rubella and herpes simplex in the context of viruses
crossing the placental barrier. Identify specific birth defects in the US. and how can these be
discovered? (amniocentesis, chlorionic villus sampling (CVS), Rh incompatibility---What is the
appropriate timing for these tests? What is the “risk” of fetal loss?) 145-147
Discuss infertility in both men and women, including factors and treatments. Identify new
reproductive technologies, including artificial insemination, GIFT, cloning, and test tube babies.
149-153
Sperm reach ovum .and cluster around it
Conception
Conception: a man has an orgasm and ejaculates
inside the woman's vagina; the sperm are
deposited into vagina, there to begin their journey
toward the egg; of the original 200 million sperm,
only about 2000 reach the two containing the egg;
sperm are capable swimming 1 to 3 cm per hour,
although it has been documented that sperm may
survive at the egg within 1 and 1/2 hours after
ejaculation; muscular contractions in the uterus
may help speed them along; for the purposes of
conceiving, is probably best to have intercourse
about every 24 to 48 hours or about four times
during the week in which the women is to ovulate (it
takes a while to manufacture 200 million sperm -- at
least 24 hours). Sperm live inside the woman's
body for up to five days. The egg is capable of
being fertilized for about the first 12 to 24 hours
after ovulation.
Conception occurs, not in the uterus but in the
outer third (the part near the ovary) of the fallopian
tube. Sperm swarm around the egg and secrete an
enzyme called hyaluronidase.
Sperm Meets Egg: The Incredible Journey
When the sperm
penetrates the egg,
the egg
immediately
releases a
chemical creating a
hard “shell”
around it to keep
all other sperm out
The placenta is the lining
of the uterus that the
umbilical cord will attach
to.
While nutrients and
oxygen move across the
placental wall, the
embryo’s blood and the
mother’s blood never
mix
Blastocyst
Uterine lining
The
Blastocyst
embeds into
the uterine
lining, and
begins to
develop the
placenta
Zygote, Conceptus, Fetus
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The fertilized egg is called the zygote and continues to travel down the
fallopian tube; about five to seven days after conception, the massive cells
implants itself in the lining of the uterus.
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For the first eight weeks of gestation, the conceptus is called an embryo;
umbilical cord is form during the fifth week of embryonic development in his
about 55 cm or 20 inches long; the umbilical cord attaches to placenta.
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From eight weeks to birth the conceptus is called a fetus; two membranes
surrounded fetus, the chorion and the amnion, the amnion is filled with a
watery liquid called amniotic fluid, in which the fetus floats and can readily
move; is the amniotic fluid that is sampled when amniocentesis is
performed. Typically the nine months of pregnancy are divided into three
equal periods of three months, called China stirs. Thus the first trimester is
months 1 to 3, the second trimester is months 4 to 6, and a third (or last)
trimester is months 7 to 9.
Four Weeks
After the cluster of cells
attaches to the womb it is
called an embryo.
The embryo is between 1/100
and 4/100 inch long at this
time.
The embryo continues rapid
growth.
6 Weeks
The embryo is about ¼ inch
long and has developed a
head and a trunk.
Structures that will become
arms and legs, called limb
buds, first appear.
A blood vessel forms and
begins to pump blood. This
will develop into the heart and
circulatory system.
At this time, a ridge of tissue
forms down the back of the
embryo. That tissue will
develop into the brain and
spinal cord
* 8 Weeks
•The embryo is about ½ inch
long.
•The heart now has four
chambers.
•Fingers and toes begin to
form.
•Reflex activities begin as the
brain and nervous system
develop.
•Cells begin to form the eyes,
ears, jaws, lungs, stomach,
intestines and liver.
2 cell zygote
The zygote begins
to develop
4 cell zygote
8 cell zygote
16 cell morula
Blastocyst – When zygote divides to 32 cells it
Becomes known as a Blastocyst
Cross Section of a Blastocyst
The Blastocyst begins
to collapse
Day 15
The primitive
streak can be
seen on the left
side of this
embryo.
Day 17
The primitive streak
can still be seen, and
the opposite end of
the embryo is
starting to fold up.
Day 19
The neural tube is seen along
with somites on either side of it.
Somites - zipper-like motion of the neural tube closing together,
three pairs of small bumps form on either side of the closure.
they will form the skeleton and the major muscles of the body.
Thirty-eight pairs of somites will line the neural tube within 2 weeks.
Day 24
Day 22
Day 26
Day 28
5 Week Embryo
5 Week, 4 day Embryo
10 Weeks
The embryo, is about 1 to
1¼ inches long (the head is
about half the length) and
weighs less than ½ ounce.
The beginnings of all key
body parts are present, but
they are not completed.
Structures that will form
eyes, ears, arms and legs
can be seen.
Muscles and skeleton are
developing and the
nervous system becomes
more responsive.
12 Weeks
The fetus is about 2½ inches
long and weighs about ½ ounce.
Fingers and toes are distinct
and have nails.
Hair begins to develop, but
won't be seen until later in the
pregnancy.
The fetus begins small, random
movements, too slight to be felt.
The fetal heartbeat can be detected with a heart
monitor.
All major external body features have appeared.
Muscles continue to develop.
14 Weeks
The fetus is about 3½ inches
long and weighs about 1½
ounces.
The fetus begins to swallow,
the kidneys make urine, and
blood begins to form in the
bone marrow.
Joints and muscles allow full
body movement.
There are eyelids and the
nose is developing a bridge.
External genitals are
developing.
16 Weeks
The fetus is about 4½
inches long and weighs
about 4 ounces.
The head is erect and
the arms and legs are
developed.
The skin appears
transparent. A fine layer
of hair has begun to
grow on the head.
Limb movements
become more
coordinated.
18 Weeks
The fetus is about 5½ inches
long and weighs about 7
ounces.
The skin is pink and
transparent and the ears are
clearly visible.
All the body and facial
features are now
recognizable.
The fetus can grasp and move
its mouth.
Nails begin to grow.
The fetus has begun to kick.
Some women feel this
movement.
20 Weeks
The fetus is about 6¼
inches long and weighs
about 11½ ounces.
All organs and structures
are formed
Skin is wrinkled and pink to
reddish in color - thin and close to the blood vessels.
Protective skin coating, (vernix) begins to develop.
Respiratory movements occur - lungs have not
developed enough to permit survival outside the
uterus.
By this time, mothers usually feel the fetus moving.
At this time an ultrasound can often identify the sex of
the fetus.
22 Weeks
The fetus is about 7½ inches
long weighs about one
pound.
It has fingerprints and some
head and body hair.
It may suck its thumb and is more active.
The brain is growing very rapidly.
The fetal heartbeat can be easily heard.
The kidneys start to work.
At 23 weeks, approximately 31% of babies born
survive. Babies born at this age require intensive
care and usually have lifelong disabilities and
chronic health conditions.
24 Weeks
The fetus is about 8¼ inches long and
weighs about 1¼ pounds.
Bones of the ears harden making
sound conduction possible. The fetus
hears mother’s sounds such as
breathing, heartbeat and voice.
The first layers of fat are beginning to
form.
This is the beginning of substantial
weight gain for the fetus.
Lungs continue developing
At 25 weeks, approximately 68% of
babies born survive. Babies born at
this age require intensive care and
usually have life-long disabilities and
chronic health conditions.
26 Weeks
The fetus is about 9 inches long and
weighs about 2 pounds.
The fetus can respond to sound from
both inside and outside the womb.
Reflex movements continue to develop
and body movements are stronger.
Lungs continue to develop.
The fetus now wakes and sleeps.
The skin is slightly wrinkled.
At 27 weeks, approximately 87% of
babies born survive. Babies born at
this age require intensive care and
have an increased risk of
developmental delays and chronic
health conditions.
28 Weeks
The fetus is about 10 inches
long and weighs about 2
pounds, 3 ounces.
Mouth and lips show more
sensitivity.
The eyes are partially open and
can perceive light.
More than 90% of babies born
at this age will survive. Some
survivors have developmental
delays and chronic health
conditions.
30 Weeks
The fetus is about 10½ inches
long and weighs about 3
pounds.
The lungs that are capable of
breathing air, although medical
help may be needed.
The fetus can open and close
its eyes, suck its thumb, cry and
respond to sound.
The skin is smooth.
Rhythmic breathing and body
temperature are now controlled
by the brain.
Most babies born at this age will
survive.
32 Weeks
The fetus is about
11 inches long and
weighs about 3
pounds, 12 ounces.
The connections
between the nerve
cells in the brain
increase.
Fetal development
now centers on
growth.
Almost all babies
born at this age will
survive.
34 Weeks
The fetus is
about 12 inches
long and weighs
about 4½
pounds.
Ears begin to
hold shape.
Eyes open during
alert times and
close during
sleep.
Almost all babies
born at this age
will survive.
36 Weeks
The fetus is about 12
to 13 inches long and
weighs about 5½ to 6
pounds.
Scalp hair is silky and
lies against the head.
Muscle tone has
developed and the
fetus can turn and lift
its head.
Almost all babies born
at this age will
survive.
38 Weeks
The fetus is about 13½ to
14 inches long and
weighs about 6½ pounds.
Lungs are usually mature.
The fetus can grasp
firmly.
The fetus turns toward
light sources.
Almost all babies born at
this age will survive.
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(1) laboratory test for pregnancy are 98 to 99
percent accurate; hCG (human chorionic
gonadotropin secreted by the placenta) in the
woman's urine, seven days after implementation
(just when a period is missed);
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(2) home pregnancy tests have a very high
rate of false negatives ( it tells the woman she is
not pregnant when she really is; thus and other 18
would produce a false negative result; this
compares with an error rate for 1 to 2% of
laboratory test);
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(3) the immunologic test based on the presence of
(human chorionic gonadotropin, secreted by the
placenta) in the woman's urine is very accurate
(these modern urine tests are 98% accurate seven
days after implementation (just when a period is
missed).
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There are also presumptive signs of pregnancy
include amenorrhea, breast tenderness, nausea,
frequent urination, feelings and fatigue,, more
sleep.
Pregnancy Tests
Urine tests can be done at home or in a
doctor's office. Many women first choose a
home pregnancy test (HPT), about a week
after a missed period. Home pregnancy tests
are private and convenient.
Blood tests are done at your doctor's office,
but are used less often than urine tests.
These tests can detect pregnancy earlier
than a home pregnancy test, or about six to
eight days after ovulation. But with these
tests, it takes longer to get the results than
with a home pregnancy test.
Two types of blood pregnancy tests:is
A qualitative hCG test simply checks to see
if hCG is present. It gives a "yes" or "no"
answer to the question, "Are you pregnant?"
Doctors often order these tests to confirm
pregnancy as early as 10 days after a missed
period. However, some of these tests can
detect hCG much earlier.
A quantitative hCG test (beta hCG)
measures the exact amount of hCG in your
blood. It can find even very low levels of
hCG. Because these pregnancy tests can
measure the concentration of hCG, they may
be helpful in tracking any problems during
pregnancy. They may also be used to rule
out a tubal (ectopic) pregnancy or to monitor
a woman after a miscarriage when hCG
levels fall rapidly.
Stages of
Pregnancy
First trimester (First 12 weeks)
Second trimester (Weeks13 to 26)
Third trimester (Weeks (27 to 38)
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First trimester (First 12 weeks)
issues: missed menstrual period, emotional reaction to becoming
pregnant (if negative – depression, anger and fear; it positive – joy
and eager anticipation! Cyclic bleeding and spotting during early
pregnancy may indicate a potential miscarriage (spontaneous
abortion) optic pregnancy, or false pregnancy (Pseudocyesis) 144
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Expected delivery date (expected date of confinement, EDC);
Nagele’s Rule: take the date of the first day of the last menstrual
period, subtract three months, add seven days, and finally add one
year (e.g., thus if the first day of the last menstrual period was Sept.
10th 2008, the expected delivery date would be June 17, 2009:
subtracting three months was Sept. 10 gives June 10, adding
seven days yields June 17, and adding one year gives June 17,
2009); if the last menstrual period began is not known, an
ultrasound procedure may be used to determine gestational age.
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Second trimester (Weeks13 to 26)
Edema (water retention and swelling) woman becomes aware of
fetal movement (quickening). Women who report more effective
partner support----report less anxiety in the second trimester;
women who have had a previous pregnancy are more distressed
during his time compared to women who have not.
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Third trimester (Weeks (27 to 38)
weight gain and painless contractions. The extreme size of the
uterus puts pressure on the number of other organs, causing some
discomfort (shortness of breath, indigestion). The amount of weight
gain should range from 15 to 40 pounds, depending on the woman's
weight prior to pregnancy., slim women, 28 to 40 pounds; heavy
women 15 to 25 pounds)
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. Psychological Changes 128-9
Psychological well-being is greater among
women who have social support, have higher
incomes, and experience fewer concurrent
stressful life events
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First time mothers reported a significant
increase in dissatisfaction with their
husbands from the second to the third
trimester.
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Wives who reported that higher levels of
affection were exchanged between husband
and wife reported lower levels anxiety and
insomnia in the third trimester.
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Women who led very active lives prior to
becoming pregnant may find fatigue and lack
of energy especially distressing.
Types of Support
Appraisal support (information
and advice)
Esteem support (feedback that
one is valued and respected by
others)
Group-belonging (availability of
social companionship)
Emotional closeness (provision
of intimacy and confiding about
emotions)
Tangible support (financial
assistance, services, or goods)
A B C Theory of Stress
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Couple or Family Crisis and Transitions - Concepts about stress and crisis:
1. Family or couple eustress (positive events, some planned and
others unexpected) or distress(negative events, mostly unplanned
2. Family or couple psychosocial stressor events - unexpected or
anticipated
3. "Crisis" versus "Transition" associated with their stressor events
Crisis involves change, becomes a turning point (distress or eustress), time of
relative instability; i.e., conflict over family roles, demoralizing event (delinquent son
or daughter), unexpected financial problem, diagnosis of a serious illness,
unemployment, teen daughter's premarital pregnancy, death of family member, death
of a spouse, prelude to divorce, etc.
Transition is an expected or predictable change which can "precipitate" family
stress and / or crisis, or predictable crisis (often eustress rather than distress),
adjustment to new roles or circumstances, altercation in the status quo in order to
meet new but "anticipated" changes; i.e., birth of a baby, child leaving for college,
graduation from high school, first day at school, new friends, new activities or
hobbies, retirement, new job, moving to a new location, etc.
. Stressor Overload
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This is a series of unrelated stressor events that occur too rapidly for family members
to cope effectively); "pile up" events - Stressor characteristics:
expected or unexpected
brief or prolonged
external or internal
unclear cultural "norms" for dealing with the stressor event
overtime stressor condition: improves, remains stable, or
deteriorates
ABC-X Model
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Course of family crisis
A = Stressor Event
B = Couple or family's crisis-meeting resources
C = Couple or family's appraisal of the stressor event; each
member's "definition of the situation" (fault or blame,
internal or external, pevious experience with crises, etc.);
interpretations of a stressor event, positive or negative
X = Crisis itself, great or small depends mostly on B and C, not
necessarily the event itself
Double AaBC-Xt model
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Aa = pile up, from previous unresolved crises
t = "strong" or "weak" family systems;
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Strong traits include: mutual acceptance, respect, and shared values, rely
on support for one another, accepting difficulties, work together, all have
input into major decisions and have fostered predictable family routines,
rituals, and other times together;
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Weak traits include: lower sense of common purpose, feeling less in control
of what happens, cope by showing diminished respect or understanding of
one another, hesitant to depend on the family for support and
understanding, they may avoid one another, shifting responsibilities, more
resistant to compromise, little emphasis on family routines or predictable
time together
Disaster or Opportunity
Factors in meeting crises creatively:
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1. positive outlook
2. spiritual values and support groups (four types of support:
informational, emotional, appraisal, instrumental)
3. high self-esteem
4. open, supportive communication
5. adaptability and flexibility
6. informal social support
7. community resources
- Fathers Experience and Support in
Pregnancy
• Father infant bond:
• Men who showed higher levels of responsiveness (in having a baby)
had higher levels of prolactin prenatally and lower levels of
testosterone postnatally. Lower levels of testosterone may facilitate
paternal behavior.
• One study the emotional changes found that 70% of expectant
fathers were initially ambivalent about fathering that gradually
became more positive, in anticipation of the satisfactions to be
derived from being a father. It has been theorized that men who
display and active involvement in planning (father child future
activities) will do best in the father role after the baby is born.
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Move from Golden rule to Titanium rule to Platinum rule (instructor view).
Sex and Nutrition
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Sex During Pregnancy – Intercourse in a normal, healthy pregnancy can continue safely
until four weeks before the baby is due; one study found that recent intercourse and
orgasm was associated with reduced risk of preterm birth;
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The most common reasons women give for decreasing sexual activity during pregnancy include
physical discomfort, feelings of physical unattractiveness, and fear of injuring the unborn child;
women who have positive attitudes about sexuality and who maintain more sexual interest,
activity, and satisfaction during pregnancy than the women with negative attitudes about sexuality;
many women also have increased need for nonsexual affection as pregnancy progresses.
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Nutrition During Pregnancy - those with poor diets had seven times as many threatening
miscarriages and three times as many still births; their labor lasted five hours longer on the
average; a pregnant woman needs enough protein, folic acid (symptoms of folic acid deficiency or
anemia and fatigue), calcium, magnesium, and vitamin A. ; (premature births are associated with
deficiencies and calcium and magnesium)
Effects of Drugs Taken During Pregnancy
• Antibiotics, Alcohol, Cocaine, (marijuana, trycyclic antidepressant
medications (teratogenesis) and birth defects.
• Steroids, Other Drugs, Dads and Drugs ( teratogens) 132-134
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Smoking: one study found evidence that mother smoking during
the first trimester of pregnancy increase or offsprings risk of cancer
in childhood; but a father smoking during pregnancy in the absence
of the mother smoking also increased the risk of childhood cancer.
The Stages of Labor
• 1. First stage of labor: effacement,
violation, transition phase
• 2. Second stage of labor: crowning,
episiotomy
• 3. Third stage of labor: placenta and feel
membranes expelled
Childbirth Options
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Cesarian Section (C Section) reasons that been proposed to explain high rates of
cesarian birth operations: physicians make more money performing cesareans,
there are more older women giving birth and they may have more difficult labors
necessitating cesarians, there are more births to teenagers who also are at risk for
difficult deliveries, fetal monitors are used increasingly and they give the physician
early warning give if the fetus is in distress, necessitating a cesarean to save the
fetus. Up to 60% of women with prior cesarean delivery attempt a subsequent vaginal
birth; however, there is a risk of uterine rupture during the attempt, protect a when
labor is induced using drugs. - Repeat cesarean operations and changes in medical
practices have increased these operations to 89.4% in 2003.
Use of Anesthetics in Childbirth - pudendal block, injection norms only external
genitals; spinal anesthesia, injection near the spinal cord month the entire birth area
and weighs down; and the caudal block and epidural anesthesia, which are both
administered by injections in the back and produce regional numbing from the belly to
the thighs
Home birth versus hospital birth -- careful medical screening is essential for home
birth; some hospitals allow the father to be present in the operating rooms during
cesarean deliveries. Many hospitals have created birthing centers that contain a set
of homelike rooms.
At the end of four weeks:
Embryo is 1/4 inch in length
Heart, digestive system, backbone and spinal cord begin to form
Placenta (sometimes called "afterbirth") begins developing
The single fertilized egg is now 10,000 times larger than size at conception
At the end of 8 weeks:
Embryo is 1 1/8 inches in length
Eyes, nose, lips, tongue, ears and teeth are forming
Penis begins to appear in boys
Embryo is moving, although the mother can not yet feel movement
Heart is functioning
At the end of 12 weeks:
Fetus is 2 1/2 to 3 inches long
Weight is about 1/2 to 1 ounce
Nails start to develop and
earlobes are formed
Fetus develops recognizable form
Arms, hands, fingers, legs, feet and toes are fully
formed
Eyes are almost fully developed
By this stage, a fetus has developed most of his/her
organs and tissues
Fetal heart rate can be heard at 10 weeks with a special
Doppler instrument
At the end of 4 months:
Fetus is 6 1/2 to 7 inches long
Weight is about 6 to 7 ounces
Fetus is developing reflexes such
as sucking and swallowing. Fetus
may begin sucking his/her thumb
Tooth buds are developing
Sweat glands are forming on palms and soles
Fingers and toes are well defined
Sex is identifiable
Skin is bright pink, transparent and covered with soft, downy hair
Although recognizably human in appearance, the baby would not
be able to survive outside the mother's body
At the end of 5 months:
Fetus is 8 to 10 inches long
Weight is about 1 pound
Hair begins to grow on his/her
head
Soft woolly hair called lanugo will cover its body
(and some may remain until a week after birth
when it is shed)
Mother begins to feel fetal movement
Internal organs are maturing
Eyebrows, eyelids and eyelashes appear
At the end of 6 months:
Fetus is 11 to 14 inches long
Weight is about 1 3/4 to 2 pounds
Eyelids begin to part and eyes open occasionally for short periods of time
Skin is covered with protective coating called vernix
Fetus is able to hiccup
At the end of 7 months:
Fetus is 14 to 16 inches long
Weight is about 2 1/2 to 3 1/2
pounds
Taste buds have developed
Fat layers are forming
Organs are maturing
Skin is still wrinkled and red
If born at this time, he/she will be considered a premature
baby and require special care
At the end of 8 months:
Fetus is 16 1/2 to 18 inches long
Weight is about 4 to 6 pounds
Overall growth is rapid this month
Tremendous brain growth occurs at this time
Most body organs are now developed with the exception of the lungs
Movements or "kicks" are strong enough to be visible from the outside
Kidneys are mature
Skin is less wrinkled
Fingernails now extend beyond fingertips
At the end of 9 months:
Fetus is 19 to 20 inches long
Weight is about 7 to 7 ½
pounds
The lungs are mature
Baby is now fully developed and can survive outside the
mother's body
Skin is pink and smooth
He/she settles down lower in the abdomen in preparation for birth
and may seem less active
You and me “babe”…
40 Weeks
The fetus is about 18
to 20 inches long and
may weigh about 7½
pounds.
At the time of birth, a
baby has more than
70 reflex behaviors,
which are automatic
behaviors necessary
for survival.
The baby is full-term
and ready to be born.
The Miracle of Birth
Health Changes: Postpartum Period 141
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Postpartum blues - women experience mood swings, with periods of
feeling depressed, be irritable, and crying alternating with positive moods.;
these symptoms usually begin a few days after delivery, or the most intense
in one week postpartum and less or disappear by two weeks the postpartum
period between 50 to 80% of women experience these mild blues.
Postpartum depression - is a severe, characterized by depressed mood,
insomnia, tearfulness, feelings of inadequacy, and fatigue. Issues and
begins to three weeks postpartum but may occur anytime after delivery.
Postpartum psychosis -- symptoms include restlessness, irritability, and
sleep disturbance; latter ones include disorganized behavior, mood swings,
delusions and hallucinations. It's onset can be dramatic, within 72 hours of
delivery or four to six weeks postpartum period it is very rare, affecting only
one or two women out of 1000 (Kennedy and Suttenfield, 2001).
Note: risk factors for more severe depression include personal family
to psychiatric orders, unwanted pregnancy, or serious complications
following birth, or lack of social support (2002)
New Reproductive Technologies 149-153
• Artificial Insemination,
• Sperm Banks,
• Embryo Transfer,
Test-Tube Babies
GIFT, ZIFT
Cloning, Gender Selection
Contraception and Abortion
Chapter 7
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21. Regarding oral contraceptives for birth control, what is meant by “failure rate for
perfect users” and the “failure rate for typical users?” 157
22. What hormones does the combination birth control pill containand what is meant
by “21 on, seven off pattern?”156
23. Describe the perfect user failure rate of combination pills and what happens if a
woman forgets to take them for two or three days. Is there a need for a “backup?”
What are some of the other benefits from taking the pill?158
24. What are some of the negative psychological or physiological effects for taking
the pill. 159-160
25. Describe what is meant by triphasic pills or “progestin-only pills.” What is a profile
for woman choosing this option?
26. How effective is the patch (Ortho Evra) and what are its advantages? Describe
the vaginal ring and its effectiveness. 161-162
27. How affecting the is the “emergency contraception (plan B product)?
28. Where the many advantages of Depo-Provera injections? Describe the IUD and
its relative effectiveness what are the advantages and disadvantages of diaphragm’s
and cervical caps?
29. What is the scientific evidence for condoms and reducing SDIs? 169
Contraception and Abortion
Chapter 7 (continued)
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30. Can the female condom be worn at the same time male wears a condom? How effective it is
withdrawal (coitus interruptus)?
31. Describe the calendar method of contraception of the pre-ovulatory safe is calculated. 172173
32.Describe the “no-scalpel vasectomy” procedure and its benefits? Differentiate between female
sterilization options (minilaparotomy, laparoscopy, and trans cervical approach). 175-177
33. What is the percentage of unplanned pregnancies? The author states that “the great majority
of these unwanted pregnancies occurred because sex the active persons fail to use
contraceptives responsibly.” What percent of abortions could have been averted we
contraception? What of adolescence state if they do not use contraceptives? 177-178
34. Differentiate between erotophobia an erotophilia. What are some of the differences between
erotophobes and erotophiles? (information , expectations, fantasy) 178-179
35. Describe the abortion procedures of vacuum aspiration, dilation and evacuation, induced
labor, and hysterotomy. Differentiate between RU-486 or mifepristone and methotrexate. 181, 183
36. Discuss some of the psychological aspects of abortion. Is there any “postabortion syndrome?”
Discuss the Czechoslovakia’s experience when abortion requests were denied. 183
37. Regarding men and abortion, what is meant by “abortion veterans?“ In your view, is an
abortion a woman’s right exclusively? Should it be a societal political decision? 184-185
38. Describe some of the new advances in contraception. Would you advocate a male hormonal
contraception which is a combination of testosterone and progestin (DMPA) used in the DepoProvera shots for women? Describe the female contraception called Nestorone. Would you
advocate injecting liquid silicone into the fallopian tubes which later could be removed if the
woman wishes to become pregnant?
Contraception and Abortion Options
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Condom-Female
Over-the-counter
Condom-Male
Over-the-counter
Contraceptive Patch
Prescription
Depo-Provera
(3-Month Shot of DMPA)
Prescription
Diaphragm
Prescription
Emergency Contraception
Plan B Morning After Pill
Prescription required if under age 17
Implanon Contraceptive Implant
Prescription
Intrauterine Device (IUD)
Prescription
Patch, Contraceptive
Prescription
Pill (Combination Oral Contraceptives)
Prescription
Mini Pill (triphasic pills: Progesterone Only Pills or or Progestin-only pills)
Prescription
Pills for Continuous Use (no periods)
Prescription
Contraception and Abortion Options
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Spermicides: Foam, Jelly, Film, Sponge
Over-the-counter
Vaginal Ring
Prescription
Vasectomy (Male Sterilization)
Prescription
Withdrawal (Pulling Out)
available to all
Breast Feeding
first six months after giving birth
Sex With Less Risk of Pregnancy
available to all
Sterilization
“No scalpel”and vasectomy procedure for men
Female sterilization options: minilaparotomy, laparoscopy, and transcervical approach
Abortion Techniques
Vacuum aspiration, dilation and evacuation, induced labor, and hysterotomy, RU-486 or
mifepristone or methotrexate
Vacuum aspiration: most common- 88% of abortions and are preformed by this method in the first
12 weeks of gestation
Types of Birth Control
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Continuous Abstinence
Natural Family Planning/Rhythm Method
Barrier Methods
Contraceptive Sponge
Diaphragm, Cervical Cap, and Cervical Shield
Female Condom
Male Condom
Hormonal Methods
Oral Contraceptives — Combined pill (“The pill”)
Oral Contraceptives — Progestin-only pill (“Mini-pill”)
The Patch
Shot/Injection
Vaginal Ring
Implantable Devices
Implantable Rods
Intrauterine Devices
Permanent Birth Control Methods
Sterilization Implant
Surgical Sterilization
Emergency Contraception
Prescription Contraception
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Oral contraceptives: the pill, the mini-pill
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Skin patch
Vaginal ring
Diaphragm (your doctor needs to fit one to your shape)
Cervical cap
Cervical shield
Shot/injection (you get the shot at your doctor’s office)
IUD (inserted by a doctor)
Implantable rod (inserted by a doctor)
dental dams –– what are they?
The dental dam is a square piece of rubber that is used by dentists during oral
surgery and other procedures. It is not a method of birth control. But it can be used to
help protect people from STIs, including HIV, during oral-vaginal or oral-anal sex. It is
placed over the opening to the vagina or the anus before having oral sex. You can
buy dental dams at surgical supply stores.
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The Pill
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The Pill (seleted types)
A. With combination birth control pills (sometimes called oral contraceptives) such as Loestrin and Ovcon, the
woman takes a pill that contains estrogen and progestin (a synthetic progesterone), both at doses higher than
natural levels, for 21 days. Then she takes no pill or a placebo for seven days, after which she repeats the cycle.
B. How It Works - The pill works mainly by preventing ovulation. During a natural menstrual cycle, the low levels
of estrogen during and just after the menstrual period trigger the pituitary to produce FSH, which stimulates the
process of ovulation. The woman starts taking the birth control pills on about day 5 of her cycle. Thus just
when estrogen levels would normally be low, they are artificially made high. This high level of estrogen inhibits
Follicule Stimulating Hormone production, and the message to ovulate is never sent out. The high level of
progesterone inhibits Luteinzing Hormone production, further preventing ovulation.
The progestin provides additional backup effects.
1. It keeps the cervical mucus very thick, making it difficult for sperm to get through, and it changes the lining of
the uterus in such a way that even if a fertilized egg arrived, implantation would be unlikely.
2. When the estrogen and progestin are withdrawn after day 21, the lining of the uterus disintegrates, and
withdrawal bleeding or menstruation occurs, although the flow is typically reduced because the progestin has
inhibited development of the endometrium.
3. Hormonally, the action of the pill produces a condition much like pregnancy, when hormone levels are also high,
preventing further ovulation and menstrual periods. Thus it is not too surprising that some of the side effects of the
pill are similar to the symptoms of pregnancy.
Effectiveness (Failure rate calculation; and failure rate
for typical and perfect users)
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1. If 100 women use a contraceptive method for one year, the number of them who become pregnant during that
first year of use is called the failure rate or pregnancy rate.
2. That is, if 5 women out of 100 become pregnant during a year of using contraceptive A, then A's failure rate is 5
percent. Effectiveness is 100 minus the failure rate; thus contraceptive A would be said to be 95 percent effective.
3. We can also talk about two kinds of failure rates: the failure rate for perfect users and the failure rate for
typical users. The perfect-user failure rate refers to studies of the best possible use of the method—for example,
when the user has been well-taught about the method, uses it with perfect consistency, and so on. The failure rate
for typical users is just that—the failure rate when people actually use the method, perhaps imperfectly when they
forget to take a pill or do not use a condom every time.
4. The good news is that if you are very responsible about contraception, you can anticipate dose to the perfectuser failure rate for yourself. The use of combination pills is one of the most effective methods of birth control. The
perfect-user failure rate is 0.1 percent (that is, the method is essentially 100 percent effective), and the typical-user
failure rate is 5 percent.
5. Failures occur primarily as a result of forgetting to take a pill for two or more days. If a woman forgets to take a
pill, she should take it as soon as she remembers and take the next one at the regular time; this does not appear
to increase the pregnancy risk appreciably. If she forgets for two days, she should take two pills as soon as she
remembers and then two the next day; however, the chances of pregnancy are now increased and a back-up
method of contraception should be used. If she forgets for three or more days, she should switch to some other
method of birth control for the remainder of that cycle.