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Deciding whether or not to have a child..

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1 Deciding whether or not to have a child..

2 Self 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?

3 Self 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.

4 Want a baby, think about this!
Make sure everyone is on board with the idea! Income is stable Always 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?

5 Voluntary Childless Among 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.

6 Advantages & 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.

7 Conception

8 Vocabulary Oocyte- An immature reproductive egg or ovum.
Menarche- The beginning of menstruation during puberty; a girls first period Follicular Phase- The early period during a woman’s monthly fertility cycle when the pituitary gland secretes follicle stimulating hormones(FSN) to enhance ovum development.

9 Vocabulary 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.

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11 Conception Ovulation: “The Ovum’s Journey The Sperms Journey
The Ovum-sperm “Rendezvous”

12 If it all goes right you end up with this!!

13 References (CDC, “Fertility,” 2005; Hollander, 2007).
“Childless by Choice” (2001); Connidis & MCMullin (1999).

14 BEGINNING 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.

15 1st Trimester Month 3 Month 1 Month 2
Resembles a tadpole or tiny shrimp Buds of arms and legs begin to appear Heart begins to beat The size of an eraser on a pencil Weighs less then 1 oz Grows to 1 inch long Distinct fingers and toes appear Heart muscle has divided into chambers Facial features are visible Placenta is functioning Now called a fetus Grows to about 3 in. Fingers and toes have nails Fetus begins to move but cannot usually be felt by the mother All vital organs and muscles are formed Weighs about 1.2 oz

16 2nd 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 defined Sex of fetus may now be determined 6 or 7 in. long Weighs around 6 or 7 oz. Increases more movement (rolls, flips, and somersaults Fetus enters a predictable waking-sleeping cycle Mother can definitely feel movements Eyelashes & eyelids appear 8-10 in. long Weigh Nearly 1lb Skin is red and wrinkled & covered with vernix (protective coating) Eyes open and close Lungs are breathing the amniotic fluid in & out Hear sounds from outside world 11-14 in. long Weigh1.5-2 lbs

17 3rd Trimester Month 7 Month 8 Month 9
Taste buds have developed Muscle tone develops through kicking and stretching Clear responses to external sounds Layers of fat are forming beneath the skin Internal organs are maturing quickly High chance of survival if born prematurely 14-16 in. long Weigh about 3 lb. Fetus rotates to head-down position Brain grows quickly Fetus’s kicks and elbow thrusts now become visible from the outside surface Internal organs, except for the lungs, are nearly fully developed Skull bones are flexible 18 in. long Weighs 4-6 lbs Lungs develop fully & ready to breath air Skin typically becomes pink & smooth Turns & settles head down Low in the mother’s uterus, in preparation for birth Fewer noticeable movements 18-22 in long 6-9 lbs

18 Potential Problems in Pregnancy
Common Discomforts SYMPTOM Breast Tenderness Sleeplessness Frequent Urination Varicose Leg Veins Shortness Of Breath Nausea & Vomiting Backache Leg Cramps

19 Serious & Life-threatening Difficulties
Fertilized egg attaches and grow outside the uterus, in the fallopian tube. Tubal Pregnancy High risk of rupture of the fallopian tube, causing internal bleeding, hemorrhaging, and death Causes of ectopic pregnancy is infection with STI such as chlamydia and gonorrhea Normal pregnancy until vaginal bleeding and abdominal pain Must see physician Treatment is a single injection of a medication called methotrexate. 90% unless the zygote is too large. “out of place” Ectopic Pregnancy

20 Serious & Life-threatening Difficulties
Spontaneous abortion – loss of fetus during the first 20 weeks Silent miscarriage – woman unaware of pregnancy; heavy menstrual period Mother’s age Miscarriage Miscarriage Illness or STI Abnormalities of the uterus Hormonal imbalance Environmental toxins Alcohol & cocaine Heavy caffeine intake Radiation

21 Serious & Life-threatening Difficulties
Premature birth Birth of fetus before 37 week Pregnant with more than one fetus the average gestation More prone to learning disabilities, diabetes, hearing impairment, and coronary heart disease Show low cognitive development, attention, perceptual, and motor skills and can continue into later childhood. Preterm Birth Very stressful Sexual activity does not increase the chances of premature birth Sexual 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 mortality PARENTS INFANT Triplets gestation to 32 week Infants require special care in a hospital until healthy enough to be taken home

22 Serious & Life-threatening Difficulties
Baby born with physical abnormality or metabolic dysfunction May result in physical or mental disability Occur less than 1% 2nd Leading cause of infant mortality Testing the fetus while in the uterus for abnormalities decreases the chances of an infant being born with serious problem Over 4,500 specific birth defects have been identified Fetal Abnormalities (Birth Defects)

23 Serious & Life-threatening Difficulties
When a woman drinks alcohol while pregnant Abnormal facial features Small head size Shorter-then-average height Low body weight Poor coordination Hyperactive behavior Difficulty paying attention Poor memory See more on page 345 Any agent that has potential to cause a fetal abnormality Drug & Alcohol Microbe such as measles Chemical antifreeze radiation mercury Most common worldwide Tobacco & Alcohol Teratogen Fatal Alcohol Spectrum Disorders

24 Embryonic & Fetal Testing
Amniocentesis Require the extraction of a small amount of fluid from the sac surrounding the fetus Chorionic Villus sampling (CVS) A sample of placental tissue Report minor discomfort from these procedures Offered 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 fetus Blood Test can predict some disorder Spina bifida Down syndrome Magnetic resonance imaging (MRI) Fetal abnormalities earlier and accurate Ultrasonic visualization Allow parents and doc. see the fetus and any birth defects

25 Termination of a pregnancy before week 37
ABORTION Termination of a pregnancy before week 37

26 Abortion cont’d Contraception vs. abortion
Spontaneous vs. induced abortion Pro life vs. pro choice

27 Types of abortions Surgical abortions vacuum aspiration
Dialation and evacuation Medial abortions mifepristone Methotrexate

28 Dilation and evacuation

29 Pros Medical surgical High success rate -high success rate
Women in control early and later pregnancies More natural one doctor visit Not invasive less involvement by women Occurs at home

30 cons Medical surgical Only first trimester -invasive procedure
Two doctor visits greater sense of grief Can take days or weeks risk of infection More bleeding

31 REDUCE ABORTIONS ROE VS. WADE PARENTS’ CONSENT FOR MINORS
MORNING AFTER PILL BIRTH CONTROL EDUCATION

32 BIRTH STAGE ONE LABOR Contractions begin
Transition phase-rapid contractions 12-14 hours Breech birth-bottom first

33 Labor stages cont’d Stage two Birth of baby Passage of head Episiotomy
Placenta expelled from uterus with umblical cord detachment

34 Stage one and two of labor

35 Stage three

36 Birth settings Hospitals Birthing centers Home births
Cesarean sections

37 Postpartum Issues & Impaired Fertility

38 “Baby Blues” Normal, relatively mild depressed mood that includes feelings of sadness, crying spells, and extra anxiety Causes: Exhaustion from labor Hormonal shifts Fatigue of nights with little and/or poor sleep Stress of lifestyle change Short-lived, pass within 1-2 weeks May affect fathers too

39 Postpartum Depression (PPD)
PPD- psychological depressive disorder that begins within 4 weeks after childbirth Shares symptoms of other forms of depression: Deep sadness Emotional apathy Withdrawal from family and friends Loss of interest in favorite activities Fatigue Changes in eating habits Feelings of failure or inadequacy

40 Postpartum Depression (PPD), continued
PPD symptoms more severe than depression: Troubling lack of interest in new baby Overly intense worry about baby's welfare Fears of harming infant in some way Often extreme anxiety or panic attacks 10-20% of new moms suffer, of which only 50% are formally diagnosed

41 Postpartum Psychosis A severe form of PPD
A psychological disorder that begins within 4 weeks after childbirth Symptoms can include those of PPD and also: Delusions Hallucinations Extreme mental disorganization Lack of recognition/diagnosis can lead to dire consequences: Pathological neglect of infant Infant abuse Infanticide (murder of infant)

42 PPD Treatments Similar to treatments for other forms of depressive illness Include psychotherapy and antidepressant medication Usually meds not prescribed for nursing mothers- can be secreted in breast milk and harm baby Primary reason why many women with PPD go untreated/forced to stop nursing sooner However, 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 found Benefits of breast-feeding in some cases, for both mother and child, outweigh risks of not treating PPD

43 Sexual Activities After Childbirth
Most women not very eager to engage in sexual activities- exhausted, sore Exact time before women feel ready for sex depends on many factors: Length and difficulty of labor Whether she had an episiotomy Whether birth was vaginal or C-section Most doctors recommend waiting at least 6 weeks after birth to have intercourse Allows for adequate time to heal and for cervix to close so bacteria that may enter vagina during sex can't travel up into uterus Very trying time for some couples

44 Sexual Activities After Childbirth, continued
Couples still want to feel close and intimate with each other but without physical discomfort Non-intercourse activities that couples can do: Kissing Touching Masturbation (individual, shared, for each other) Oral sex Couples should avoid inserting anything into vagina

45 Breast Feeding & Return of Fertility Cycle
Breast feeding- one of the most healthful activities new mother can do for her child Benefits: stronger immune system and resistance to specific diseases After childbirth, a woman's normal menstrual cycle resumes in about 4-6 weeks Lactational amenorrhea: a time of suspended menstruation in breast-feeding mothers How long this lasts depends on: How often they breast-feed Whether or not they are breast-feeding exclusively Common fertility myth: a woman can't get pregnant while she is breast- feeding... This is FALSE!

46 Impaired fertility Chapter 9

47 Infertility - sometimes called “impaired infertility”
-the lack of conception by a heterosexual couple after 12 consecutive months of trying Approximately 10% of couples meet the definition of infertility in the U.S. alone

48 Causes 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.

49 Age and infertility As women enter their 30s and 40s, it may take longer to conceive, but this doesn’t imply that they can’t become pregnant Approximately 45% of women over 40 who wish to get pregnant eventually do, however after the age of 45 the odds become very slim

50 Damaged 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

51 Fertility testing The 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

52 Fertility 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.

53 Infertility 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.

54 Assisted 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 use The cost of theses methods can range from several thousands of dollars to over one hundred thousand dollars

55 In 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

56 Gamete 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.

57 Intracytoplasmic 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.

58 Rates 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.

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