2Self Discovery Do you want children? If yes, are you ready to have on? Do you currently spend time with children and teens? Do you enjoy it?What are your thoughts on the responsibilities and commitment of parenthood?How do you cope with stress?What are your hopes and fears about parenthood?
3Self discovery Contd..what values and morals would you like to pass on to your children?What are your priorities for your children?What are your thoughts about disciplining children?How will your lifestyle change?Talk to people who have children and to people who have decided not to have children.
4Want a baby, think about this! Make sure everyone is on board with the idea!Income is stableAlways take in to consideration what you will be giving up in order to have children or what could be the consequences.Do the advantages of having children out number the disadvantages of having children in your own personal life?
5Voluntary ChildlessAmong women of childbearing age in the United States, approximately 6-7% define themselves as “voluntary childless” (CDC, “Fertility,” 2005; Hollander, 2007).In child-oriented cultures, these “voluntary childless” women or couples may be viewed negatively by people from their own society or culture.
6Advantages & Disadvantages There are disadvantages and advantages to mostly everything in life, yes that includes having children.** Child-free couples who stay together consistently report great marital satisfaction compared to traditional married couples(with children), but the divorce rate amongst “child-free” couples if larger.
8Vocabulary Oocyte- An immature reproductive egg or ovum. Menarche- The beginning of menstruation during puberty; a girls first periodFollicular Phase- The early period during a woman’s monthly fertility cycle when the pituitary gland secretes follicle stimulating hormones(FSN) to enhance ovum development.
9Vocabulary Contd..Luteal Phase- The later period of a woman’s monthly fertility cycle when the lining of the uterus thickens in preparation for receiving a fertilized ovum if conception has occurred.Seminiferous tubules- Tightly wound microscopic tubes that comprise the testicles in the male, where sperm cells are generated.Zygote- A fertilized ovum or egg moving down the fallopian tube.
14BEGINNING OF PREGNANCY The endometrium (uterine wall) thicken in preparation for the zygote.A fertilized egg moving down the fallopian tube.Divided many times and consists of approx. 90 cells surrounding a fluid filled core, before implanting in the uterine wall.
151st Trimester Month 3 Month 1 Month 2 Resembles a tadpole or tiny shrimpBuds of arms and legs begin to appearHeart begins to beatThe size of an eraser on a pencilWeighs less then 1 ozGrows to 1 inch longDistinct fingers and toes appearHeart muscle has divided into chambersFacial features are visiblePlacenta is functioningNow called a fetusGrows to about 3 in.Fingers and toes have nailsFetus begins to move but cannot usually be felt by the motherAll vital organs and muscles are formedWeighs about 1.2 oz
162nd Trimester Month 4 Month 5 Month 6 11-14 in. long Weigh1.5-2 lbs Increases in movement (Kicking, sucking, and swallowing)Fingers and toes are more clearly definedSex of fetus may now be determined6 or 7 in. longWeighs around 6 or 7 oz.Increases more movement (rolls, flips, and somersaultsFetus enters a predictable waking-sleeping cycleMother can definitely feel movementsEyelashes & eyelids appear8-10 in. longWeigh Nearly 1lbSkin is red and wrinkled & covered with vernix (protective coating)Eyes open and closeLungs are breathing the amniotic fluid in & outHear sounds from outside world11-14 in. longWeigh1.5-2 lbs
173rd Trimester Month 7 Month 8 Month 9 Taste buds have developedMuscle tone develops through kicking and stretchingClear responses to external soundsLayers of fat are forming beneath the skinInternal organs are maturing quicklyHigh chance of survival if born prematurely14-16 in. longWeigh about 3 lb.Fetus rotates to head-down positionBrain grows quicklyFetus’s kicks and elbow thrusts now become visible from the outside surfaceInternal organs, except for the lungs, are nearly fully developedSkull bones are flexible18 in. longWeighs 4-6 lbsLungs develop fully & ready to breath airSkin typically becomes pink & smoothTurns & settles head downLow in the mother’s uterus, in preparation for birthFewer noticeable movements18-22 in long6-9 lbs
18Potential Problems in Pregnancy Common DiscomfortsSYMPTOMBreastTendernessSleeplessnessFrequentUrinationVaricoseLegVeinsShortnessOfBreathNausea&VomitingBackacheLegCramps
19Serious & Life-threatening Difficulties Fertilized egg attaches and grow outside the uterus, in the fallopian tube.Tubal PregnancyHigh risk of rupture of the fallopian tube, causing internal bleeding, hemorrhaging, and deathCauses of ectopic pregnancy is infection with STI such as chlamydia and gonorrheaNormal pregnancy until vaginal bleeding and abdominal painMust see physicianTreatment is a single injection of a medication called methotrexate.90% unless the zygote is too large.“out of place”EctopicPregnancy
20Serious & Life-threatening Difficulties Spontaneous abortion – loss of fetus during the first 20 weeksSilent miscarriage – woman unaware of pregnancy; heavy menstrual periodMother’s ageMiscarriageMiscarriageIllness or STIAbnormalities of the uterusHormonal imbalanceEnvironmental toxinsAlcohol & cocaineHeavy caffeine intakeRadiation
21Serious & Life-threatening Difficulties Premature birthBirth of fetus before 37 weekPregnant with more than one fetus the average gestationMore prone to learning disabilities, diabetes, hearing impairment, and coronary heart diseaseShow low cognitive development, attention, perceptual, and motor skills and can continue into later childhood.PretermBirthVery stressfulSexual activity does not increase the chances of premature birthSexual intercourse and orgasm for woman later in pregnancy appear to be lowering the rates of preterm deliveries.Twins gestation to 35 week#1 cause of infant mortalityPARENTSINFANTTriplets gestation to 32 weekInfants require special care in a hospital until healthy enough to be taken home
22Serious & Life-threatening Difficulties Baby born with physical abnormality or metabolic dysfunctionMay result in physical or mental disabilityOccur less than 1%2nd Leading cause of infant mortalityTesting the fetus while in the uterus for abnormalities decreases the chances of an infant being born with serious problemOver 4,500 specific birth defects have been identifiedFetal Abnormalities (Birth Defects)
23Serious & Life-threatening Difficulties When a woman drinks alcohol while pregnantAbnormal facial featuresSmall head sizeShorter-then-average heightLow body weightPoor coordinationHyperactive behaviorDifficulty paying attentionPoor memorySee more on page 345Any agent that has potential to cause a fetal abnormalityDrug & AlcoholMicrobe such as measlesChemicalantifreezeradiationmercuryMost common worldwideTobacco & AlcoholTeratogenFatalAlcoholSpectrumDisorders
24Embryonic & Fetal Testing AmniocentesisRequire the extraction of a small amount of fluid from the sac surrounding the fetusChorionic Villus sampling (CVS)A sample of placental tissueReport minor discomfort from these proceduresOffered the option of these tests, especially blood result are positive in fetal abnormalities.Medical science’s ability to screen for genetic or physical defects of embryo or fetusBlood Test can predict some disorderSpina bifidaDown syndromeMagnetic resonance imaging (MRI)Fetal abnormalities earlier and accurateUltrasonic visualizationAllow parents and doc. see the fetus and any birth defects
25Termination of a pregnancy before week 37 ABORTIONTermination of a pregnancy before week 37
26Abortion cont’d Contraception vs. abortion Spontaneous vs. induced abortionPro life vs. pro choice
27Types of abortions Surgical abortions vacuum aspiration Dialation and evacuationMedial abortionsmifepristoneMethotrexate
38“Baby Blues”Normal, relatively mild depressed mood that includes feelings of sadness, crying spells, and extra anxietyCauses:Exhaustion from laborHormonal shiftsFatigue of nights with little and/or poor sleepStress of lifestyle changeShort-lived, pass within 1-2 weeksMay affect fathers too
39Postpartum Depression (PPD) PPD- psychological depressive disorder that begins within 4 weeks after childbirthShares symptoms of other forms of depression:Deep sadnessEmotional apathyWithdrawal from family and friendsLoss of interest in favorite activitiesFatigueChanges in eating habitsFeelings of failure or inadequacy
40Postpartum Depression (PPD), continued PPD symptoms more severe than depression:Troubling lack of interest in new babyOverly intense worry about baby's welfareFears of harming infant in some wayOften extreme anxiety or panic attacks10-20% of new moms suffer, of which only 50% are formally diagnosed
41Postpartum Psychosis A severe form of PPD A psychological disorder that begins within 4 weeks after childbirthSymptoms can include those of PPD and also:DelusionsHallucinationsExtreme mental disorganizationLack of recognition/diagnosis can lead to dire consequences:Pathological neglect of infantInfant abuseInfanticide (murder of infant)
42PPD TreatmentsSimilar to treatments for other forms of depressive illnessInclude psychotherapy and antidepressant medicationUsually meds not prescribed for nursing mothers- can be secreted in breast milk and harm babyPrimary reason why many women with PPD go untreated/forced to stop nursing soonerHowever, many newer antidepressants (Prozac, Zoloft, Paxil, Lexapro) are safer:They do enter mother's milk but little to none enters infant's system- no adverse effects foundBenefits of breast-feeding in some cases, for both mother and child, outweigh risks of not treating PPD
43Sexual Activities After Childbirth Most women not very eager to engage in sexual activities- exhausted, soreExact time before women feel ready for sex depends on many factors:Length and difficulty of laborWhether she had an episiotomyWhether birth was vaginal or C-sectionMost doctors recommend waiting at least 6 weeks after birth to have intercourseAllows for adequate time to heal and for cervix to close so bacteria that may enter vagina during sex can't travel up into uterusVery trying time for some couples
44Sexual Activities After Childbirth, continued Couples still want to feel close and intimate with each other but without physical discomfortNon-intercourse activities that couples can do:KissingTouchingMasturbation (individual, shared, for each other)Oral sexCouples should avoid inserting anything into vagina
45Breast Feeding & Return of Fertility Cycle Breast feeding- one of the most healthful activities new mother can do for her childBenefits: stronger immune system and resistance to specific diseasesAfter childbirth, a woman's normal menstrual cycle resumes in about 4-6 weeksLactational amenorrhea: a time of suspended menstruation in breast-feeding mothersHow long this lasts depends on:How often they breast-feedWhether or not they are breast-feeding exclusivelyCommon fertility myth: a woman can't get pregnant while she is breast- feeding... This is FALSE!
47Infertility - sometimes called “impaired infertility” -the lack of conception by a heterosexual couple after 12 consecutive months of tryingApproximately 10% of couples meet the definition of infertility in the U.S. alone
48Causes of Impaired fertility 25% due to a male sperm factor (low number, poor quality, or low motility)20% due to female ovarian problem ( no ovulation or poor quality ova)14% due to a female tubal problem (fallopian tube blockage)41% due to other problems, or there are no identifiable problems in either partner.
49Age and infertilityAs women enter their 30s and 40s, it may take longer to conceive, but this doesn’t imply that they can’t become pregnantApproximately 45% of women over 40 who wish to get pregnant eventually do, however after the age of 45 the odds become very slim
50Damaged or blocked fallopian tubes Caused by one of two conditions:- untreated sexually transmitted infections, such as chlamydia or gonorrhea, may lead to pelvic inflammatory disease, which may in turn damage or block the fallopian tubes-endometriosis, which is when uterine tissue cells are growing outside the uterus, potentially affecting the passage of sperm through the fallopian tubes
51Fertility testingThe main test for the male is the semen analysis- a sample of the mans semen is analyzed microscopically to check for adequate numbers, movement, and formation of the man’s sperm cells.For women, tests may include a hysterosalpingogram aka HSG – which is an x-ray that allows the doctor to view the interior of the uterus and fallopian tubes to check for malformations or blockages
52Fertility testing cont. If a doctor wants to have a more direct look into the ovaries a laparoscopy is performed, which is where a tube with a very small camera and light is inserted through a very small incision in the abdomen. They are usually performed under general or spinal anesthesia.By moving the camera inside the abdomen, the doctor is able to visually examine the woman’s reproductive anatomy to check for any abnormalities.
53Infertility treatments Various treatments have been developed that enhance the chances of conception via sexual intercourse.Clomiphene citrate has been developed to stimulate ovulation in women and the drug may also assist in sperm count production and quality in men.Intrauterine insemination (artificial insemination) is the simple process of inserting a small tube through the woman’s cervix and injecting sperm cells directly into the uterus.
54Assisted reproductive technology ART- these technologies represent a “brave new world” of reproduction and are constantly being researched, modified, and improved. They are various treatments to help infertile women or couples to become pregnant and have a child.Four methods of ART are currently in useThe cost of theses methods can range from several thousands of dollars to over one hundred thousand dollars
55In vitro fertilization (IVF) This technique is best known as the one to produce “test tube babies.” It is the process in which ova (eggs) are extracted from the woman’s ovaries during a laparoscopy, fertilized with a sperm in a shallow dish in the lab, and then placed into her uterus through her cervix approximately three days later.IVF is typically used when a woman’s fallopian tubes are blocked or missing
56Gamete intrafallopian transfer & Zygote intrafallopian transfer (GIFT)- Fertilization occurs naturally in the fallopian tube . Eggs are retrieved from the ovaries and mixed with the sperm in the lab, but then the sperm and eggs are transferred directly to the fallopian tubes for conception using laparoscopic surgery(ZIFT)- combines IVF and GIFT. The process for harvesting and fertilizing the ova is the same as IVF, but instead of transferring the zygotes to the uterus they are placed in the fallopian tube using laparoscope.
57Intracytoplasmic sperm injection (ICSI)- This method was developed to assist a couple when the man’s sperm production is very low, the cells have poor shape or quality or other problems exist with the sperm or semen. A single sperm cell from the man is injected using a microscopic needle directly into each harvested egg from the woman. The resulting is then transferred after a few days into the mother’s uterus.All this method requires is a minimum of one viable sperm cell.
58Rates of Success for ART Successful pregnancies from various ART methods have been steadily climbing over the past quarter century and have doubled over the past decade.The combined pregnancy rate for all ART methods is approaching 50% for women under 35 , but unfortunately the rates are dropping for women in their 40s.