1. Considering Your Reproductive Choices
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2. LEARNING OUTCOMES
Explain how each of the main categories of contraception affects the process of contraception and understand how the effectiveness of contraception is measured.
Compare and contrast the advantages, disadvantages, and effectiveness of different barrier methods in preventing pregnancy and sexually transmitted infections.
Compare the advantages, risks, and effectiveness of different hormonal methods in preventing pregnancy.
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3. LEARNING OUTCOMES (cont.)
Describe the intrauterine contraceptives, their effectiveness, and their advantages and disadvantages.
Describe emergency contraception and how it is used.
Explain how behavioral methods of contraception work and compare their effectiveness to other methods.
Describe surgical methods of birth control and discuss their advantages and disadvantages.
List the questions you should consider when choosing a method of contraception.
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4. LEARNING OUTCOMES (cont.)
Summarize the legal decisions surrounding abortion and the various types of abortion procedures.
Discuss the key issues to consider when thinking about pregnancy and parenthood.
Describe fetal development and explain the importance of prenatal care.
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5. LEARNING OUTCOMES (cont.)
Describe the process of labor and delivery, discuss complications of pregnancy and childbirth, and identify key features of the postpartum period.
Review primary causes of and possible solutions to infertility.
Describe the advantages and disadvantages of adoption.
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6. Basic Principles of Birth Control
Birth Control—also called contraception—refers to methods of preventing conception.
Conception occurs where a sperm reaches an egg, usually in the fallopian tube.
The following conditions are necessary for conception:
A viable egg (ovum)
A viable sperm
Access to the egg by the sperm
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7. Basic Principles of Birth Control (cont.)
Fertility—A person's ability to reproduce
Perfect-use failure rate—Number of pregnancies likely to occur (per 100) in first year of use of a method if used consistently and accurately
Typical-use failure rate—Number of pregnancies likely to occur (per 100) in first year of use of a method if not used consistently and accurately
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8. Methods of Birth Control
Barrier Methods
Contraceptive methods that block the meeting of egg and sperm by means of a physical barrier
Hormonal Methods
Contraceptive methods that introduce synthetic hormones into the woman's system to prevent ovulation, thicken cervical mucus, or prevent a fertilized egg from implanting
Surgical Methods
Behavioral Methods
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9. Methods of Birth Control
Some contraceptive methods can also protect against sexually transmitted diseases (STIs) to some degree.
This is an important factor to consider when choosing a contraceptive.
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10. Top Reported Contraceptive Methods Sexually Active College Students or Their Partners Used the Last Time They Had Intercourse
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11. Barrier Methods The Male Condom
Male condoms come with or without spermicide and with or without lubrication.
If desired, users can lubricate their own condoms with contraceptive foams, creams, and jellies or other water-based lubricants.
When used consistently, condoms can be up to 98 percent effective and protect against some STIs and HIV.
Typical use is about 82 percent effective.
Condoms do not protect against STIs that may have external areas of infection, such as herpes.
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12. How to Use a Male Condom
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13. Barrier Methods
The female condom is a single-use soft, loose-fitting polyurethane sheath meant for internal vaginal use.
Used consistently and correctly, female condoms can be up to 95 percent effective and can prevent the spread of HIV and other STIs, including those that can be spread by external genital contact. It can be inserted up to 8 hours in advance.
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14. How to Use a Female Condom
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15. Contraceptive Effectiveness, STI Protection, Frequency of Use, and Cost
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16. Contraceptive Effectiveness, STI Protection, Frequency of Use, and Cost (cont.)
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17. Jellies, Creams, Foams, Suppositories, and Film
Like both types of condoms, these products do not require a prescription.
They kill sperm with nonoxynol-9 (N-9).
They are most effective when used with a barrier method and are only 72 percent effective when used alone.
They can be messy, and some people are allergic to N-9.
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18. The Diaphragm with Spermicidal Jelly or Cream
A diaphragm is a shallow latex cup that fits over the cervix, blocking access to the uterus.
Must be fitted for a woman by a trained practitioner.
Can be inserted up to 6 hours before intercourse.
Should be used with spermicidal cream or jelly and left in place 6 to 8 hours after intercourse; additional spermicide should be applied before each subsequent act of intercourse.
Offers protection against some STIs.
Can be 94 percent effective.
Leaving it in place longer than 24 hours or using while menstruating can increase risk of toxic shock syndrome (TSS).
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19. The Proper Use and Placement of a Diaphragm
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20. The Cervical Cap with Spermicidal Jelly or Cream
Latex or silicone cup that fits snugly over the cervix
Must be fitted by a trained practitioner.
Can be inserted up to 6 hours before intercourse.
Should be used with spermicidal cream or jelly and left in place 6 to 8 hours after intercourse.
Offers protection against some STIs.
86 percent effective.
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21. Contraceptive Sponge Made of polyurethane foam, contains nonoxynol-9.
Does not require fitting.
Lasts up to 24 hours; no need to reapply spermicide or insert new sponge for subsequent acts of intercourse within 24-hour period.
Leave in place for at least 6 hours after last act of intercourse.
Limited STI protection, moderate protection against pregnancy, and some risk of TSS.
Typical use effectiveness is 88 percent.
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22. Hormonal Methods Hormonal Contraception
Contains synthetic estrogen and/or progestin.
Introduced into a woman's system to prevent ovulation or fertilized egg from implanting.
Does not protect against STIs.
Available in transdermal, injection, and oral forms.
Requires a prescription.
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23. Oral Contraceptives Prevent ovulation
Combination of synthetic estrogen and progesterone
Must be taken daily
May help lessen menstrual difficulties
Possible health problems include the following:
Blood clots, stroke, heart attack, high blood pressure
With perfect use, 99 percent effective, and with typical use, 91 percent effective.
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24. Progestin-Only Pills
Contain small doses of synthetic progesterone and no estrogen
Taken continuously (no placebo pills)
Good choice for women who
are at high risk for estrogen-related side effects.
have diabetes.
have high blood pressure or cardiovascular conditions.
are older than age 35.
are breast-feeding.
Side effects include irregular menstrual bleeding or spotting, mood changes, changes in sex drive, and headaches.
Important that they be taken at the same time each day
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25. Contraceptive Skin Patch
Ortho Evra is a thin, square, transdermal adhesive patch.
Worn for 1 week, and replaced on the same day of the week for 3 consecutive weeks
Delivers continuous levels of estrogen and progestin through the skin and into the bloodstream
With perfect use, 99.7 percent effective
Offers mostly the same benefits and side effects as combination pills, although easier to remember to use than taking a daily pill
FDA mandated a warning label explaining that patch use exposes women to about 60 percent more total estrogen than if they were taking a typical combination pill.
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26. Vaginal Contraceptive Ring
NuvaRing
A soft and flexible plastic hormonal contraceptive ring
Offers protection for 1 month
Releases a steady flow of estrogen and progestin
With proper use, 99.7 percent effective
Fewer estrogen-related side effects
Possible side effects include increased vaginal discharge and vaginal irritation or infection
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27. Contraceptive Injections
Depo-Provera
A long-acting synthetic progesterone that is injected intramuscularly every 3 months by a health care provider
With typical use, 94 percent effective
Menstrual periods become lighter and may eventually stop
No estrogen-related health risks
Same potential health benefits as progestin-only pills
Common side effects include dizziness, nervousness, headache, and possible loss of bone density
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28. Contraceptive Implants
Implanon
A single-rod implantable capsule that is inserted just beneath the skin on the inner side of a woman's upper underarm
Releases a low, steady dose of progestin for up to 3 years
Effectiveness of percent
Benefits include lightening or cessation of menstrual periods, lack of estrogen-related side effects, and safety for use by breast-feeding women.
Expensive and must be inserted by a clinician
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29. Intrauterine Contraceptives
IUDs are small, plastic, flexible devices that are placed in the uterus and left there for 5 to 10 years at a time.
The exact mechanism by which IUDs work is not clearly understood, but researchers believe IUDs affect the way the sperm and the egg move, thereby preventing fertilization, and/or affect the lining of the uterus to prevent a fertilized ovum from implanting there.
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30. Intrauterine Contraceptives (cont.)
ParaGard
A T-shaped plastic device with copper wrapped around the shaft; does not contain any hormones and is effective for 10 years
Mirena
Effective for 5 years and releases small amounts of progestin
IUDs may cause discomfort, heavy menstrual flow, severe cramps; pose risk of ectopic pregnancy, pelvic inflammatory disease, infertility, and tubal infections.
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31. ABC News Video: Support for IUDs
Discussion Questions
What are the risks associated with using IUDs?
Do you think the changes in the IUD will have a positive impact on its use?
Analyze the pros and cons of using the IUD in contrast to other forms of birth control. When is the IUD indicated for use? When is it contraindicated for use? What impact do the hormones have on the body?
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32. Emergency Contraception
Emergency contraception is used to prevent pregnancy after unprotected intercourse.
Most effective up to 72 hours after a condom breaks, sexual assault, or unprotected sex
Plan B One-Step is now allowed to be on the shelf with no age restrictions. Generic versions will soon be available but with age restrictions.
FDA recently approved ella, which is only available by prescription and can be taken 5 days after unprotected intercourse.
According to recent surveys, 10 percent of sexually active college students reported using emergency contraception within the past school year.
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33. Behavioral Methods Withdrawal (coitus interruptus)
Removing the penis from the vagina just prior to ejaculation
Highly unreliable, offers no protection against STIs
Abstinence
Deliberately avoiding intercourse
Massaging, kissing, solitary masturbation
Only method that is 100 percent effective against pregnancy and STIs
"Outercourse"
Includes oral/genital sex and mutual masturbation
Can be 100 percent effective against pregnancy if male doesn't ejaculate near the vaginal opening
Not effective against STIs because of possible oral/genital contact, unless condoms are used
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34. Fertility Awareness Methods
Cervical Mucus Method
Check color and consistency to determine fertile times.
Avoid sexual activity when mucus is present and for several days afterward.
Body Temperature Method
A woman's basal body temperature rises between 0.4 and 0.8 degrees after ovulation.
Abstain from sexual activity before the temperature rise until several days after the temperature rise is observed.
Calendar Method
Assumes that ovulation occurs during the midpoint of the cycle.
These methods offer no STI protection, and may not work for women with irregular menstrual periods.
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35. The Fertility Cycle
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36. Surgical Methods Female Sterilization Permanent fertility control
Tubal ligation—fallopian tubes sealed to block sperm
Menstrual cycle continues, released eggs disintegrate
Essure—placement of microcoils into the fallopian tubes
Adiana—placement of a soft insert into the fallopian tubes
Hysterectomy—major surgery that removes uterus
Male Sterilization
Vasectomy—piece of vas deferens is removed and ends are tied or sewn shut.
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37. Female Sterilization: Tubal Ligation
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38. Male Sterilization
Frequently done as an outpatient basis and is less complicated than female sterilization.
It does not affect sexual performance.
It is highly effective.
It offers no protections against STIs.
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39. Male Sterilization: Vasectomy
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40. Choosing a Method of Contraception
How comfortable would I be using a particular method?
Will this method be convenient for me and my partner?
Am I at risk for the transmission of STIs?
Do I want to have a biological child in the future?
How would an unplanned pregnancy affect my life?
What are my religious and moral values?
How much will the birth control method cost?
Do I have any health factors that could limit my choice?
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41. Abortion
Roe v. Wade (1973)
Stated that the "right to privacy founded on the Fourteenth Amendment's concept of personal liberty is broad enough to encompass a woman's decision whether or not to terminate her pregnancy."
An abortion can be performed during first trimester without legal restrictions.
States set conditions for second trimester abortions.
Third semester abortions are ruled illegal unless the mother's life or health is in danger
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42. The Debate over Abortion
Pro-choice
Belief that it is a woman's right to make decisions about her own body and health
Pro-life
Belief that the embryo or fetus is a human being with rights that must be protected
A woman's access to abortion has been challenged in recent years.
A 2012 Mississippi law requiring physicians in abortion clinics to have admitting privileges at a local hospital threatened to close the state's only abortion clinic.
North Dakota bans abortions after 6 weeks gestation.
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43. Emotional Aspects of Abortion
The best scientific evidence indicates the risk of mental health problems in adult women is no greater if they have an abortion than if they deliver a baby.
Although a variety of feelings such as regret, guilt, sadness, relief, and happiness are normal, no evidence has shown that an abortion causes long-term psychological trauma.
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44. Methods of Abortions Surgical Abortions Suction Curettage
First trimester
Dilation and Evacuation (D&E)
Second trimester
Prostaglandin or Saline Induction
Hysterotomy
Surgical removal of fetus from the uterus
Used during emergencies
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45. When Women Have Abortions (in weeks from the last menstrual period)
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46. Suction Curettage Abortion
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47. Methods of Abortions (cont.)
Medical Abortions
Mifepristone
Formerly known as RU-486 and currently sold in the United States under the brand name Mifeprex
Known as the "abortion pill"
Steroid hormone that induces abortion by blocking the action of progesterone
Causes uterine contractions that expel the fertilized egg
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48. Looking Ahead to Pregnancy and Parenthood
Before becoming pregnant consider
Your emotional health
Financial evaluation
Physical health: paternal health
Physical health: maternal health
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49. Pregnancy The Process of Pregnancy
Sperm fertilizes an egg in the fallopian tubes.
Zygote multiplies and becomes a blastocyst and travels toward the uterus.
The embryo burrows into the endometrium.
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50. Fertilization
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51. Pregnancy Testing
Pregnancy testing is based on the secretion of human chorionic gonadotropin (HCG).
Home pregnancy tests can be used as early as 2 weeks after conception and are about 99 percent reliable.
If done too early, test may show a false negative.
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52. The Process of Pregnancy
Early Signs of Pregnancy
Missed period, although spotting may occur
Breast tenderness
Emotional upset
Extreme fatigue
Nausea and vomiting (morning sickness), most common in morning, but can occur any time of day
Sleeplessness
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53. Changes in a Woman's Body During Pregnancy
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54. The Process of Pregnancy
First Trimester
Few noticeable changes in woman's body
May urinate more often and experience morning sickness
Embryo differentiates and develops organ systems
At start of third month the embryo is called a fetus, indicating all organ systems are in place.
Second Trimester
Physical changes in the woman's body become more noticeable.
Placenta—The network of blood vessels connected to umbilical cord that carries oxygen and nutrients from mother to fetus and fetal waste products to mother becomes well established.
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55. The Process of Pregnancy (cont.)
Third Trimester
Greatest fetal growth; gains most of its weight
Fetus must get large amounts of calcium, iron, and nitrogen from mother's food intake.
Fat layer develops in eighth month.
Respiratory and digestive organs need further development to avoid complications.
Emotional Changes
Women may experience fear of complications, anxiety, wonder, and excitement over the baby.
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56. Series of Fetoscopic Photographs Showing Development in the First, Second, and Third Trimesters of Pregnancy
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57. Prenatal Care Choosing a Practitioner
Begin regular medical checkups as soon as possible.
Nutrition and Exercise
Pregnant women need additional protein, calories, vitamins, and minerals.
Recommended normal weight gain is 25 to 35 lbs.
Obese women should gain only between 15 and 25 lbs.
Underweight women should gain between 28 and 40 lbs.
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58. Prenatal Care
Exercise is an important factor in overall health during pregnancy.
Drugs and Alcohol
A health care provider should be consulted before the use of any drug, even aspirin.
Maternal consumption of alcohol is detrimental to a growing fetus and may result in fetal alcohol syndrome.
Smoking harms every phase of reproduction.
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59. Prenatal Care (cont.)
Other teratogens include exposure to X-rays, toxic chemicals, heavy metals, pesticides, gases, and other hazardous compounds.
Two specific age-related risks are miscarriage and Down syndrome.
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60. Prenatal Care (cont.) Prenatal Testing and Screening
Ultrasonography or ultrasound
Chorionic villus sampling (CVS)
The triple marker screen (TMS)
The quad screen
The integrated screen
Amniocentesis
Recommended for women over age 35, between weeks 14 and 18. Screens for birth defects such as Down syndrome.
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61. Childbirth Managing Labor Pain medication Lamaze method
Cesarean Section (C-section)
Surgical procedure most often used if labor lasts too long or baby is in physiological distress
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62. The Birth Process
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63. Complications of Pregnancy and Childbirth
Preeclampsia and Eclampsia
Preeclampsia is characterized by high blood pressure, protein in the urine, and edema.
Left untreated, preeclampsia can cause strokes and seizures, a condition known as eclampsia.
Miscarriage, or spontaneous abortion, occurs in percent of pregnancies, usually during the first trimester.
Ectopic Pregnancy
An ectopic pregnancy is the implantation of a fertilized egg outside the uterus, usually in the fallopian tube or sometimes in the pelvic cavity. Ectopic pregnancies must be terminated since the blastocyst cannot survive and there is risk to the mother.
Stillbirth
The death of a fetus after the 20th week of pregnancy
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64. The Postpartum Period Usually lasts 6 weeks after delivery.
Women experience fluctuating emotions.
Postpartum depression
Affects about 1 in 7 new mothers
Disabling mood swings, no energy, crying, guilt, depression
Should seek professional help
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65. Breast-Feeding Colostrum
Secreted first few days before milk "comes in"
Contains vital antibodies necessary to help baby fight potential infections
American Academy of Pediatrics recommends breast-feeding for 6 to 12 months.
Advantages of breast-feeding
Babies have fewer illnesses and recover more quickly when ill.
Children are less likely to be obese.
Children have fewer allergies throughout their lives.
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66. Infant Mortality
Infant death can be caused by birth defects, low birth weight, injuries, or unknown causes.
Sudden infant death syndrome is the unexpected death of a child under 1 year of age. Causes are unknown, but to modify risk, parents are advised to
Lay infants on their backs on a firm surface.
Not allow smoking around infants.
Give the baby a clean pacifier.
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67. Infertility Affects 1 in 10 American couples Causes in Women
Polycystic ovary syndrome is the leading cause of infertility.
Endometriosis
Pelvic inflammatory disease (PID)
Causes in Men
Low sperm count
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68. ABC News Video: What Are the Reasons for Infertility?
Discussion Questions
What method is used to bypass tubal infertility?
A couple in their 30's is having difficulty conceiving over the course of a year. Describe the steps in the process this couple should take when determining infertility.
When do you recommend a couple consult a fertility specialist if they suspect they are having difficulty conceiving?
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69. Infertility Treatments
Fertility Drugs
Stimulate ovulation in women who are not ovulating
Side effects include headaches, fatigue, and hot flashes
Can trigger the release of more than one egg
Alternative Insemination
A woman inseminated with partner's sperm or sperm obtained through a sperm bank (known as in vitro fertilization, or IVF)
Assisted Reproductive Technology (ART)
Intracytoplasmic sperm injection (ICSI)—sperm is injected into egg
Gamete intrafallopian transfer (GIFT)—"harvest" egg and place in fallopian tube with sperm
Zygote intrafallopian transfer (ZIFT)—combines IVF and GIFT
Nonsurgical Embryo Transfer and Other Techniques
A donor egg is fertilized by the man's sperm and implanted in the woman's uterus.
Embryo adoption programs
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70. Gestational Surrogacy
Many couples conceive by infertility treatments, but some cannot sustain a pregnancy.
Surrogacy is an option in which a woman is hired to carry another person's pregnancy.
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71. Adoption About 2 percent of the adult population has adopted children.
Confidential adoption occurs when neither the birth parents nor the adoptive parents know about each other.
Open adoption occurs when birth parents and adoptive parents know something about each other.
Both parties must agree to the level of openness, and all levels are not available in every state.
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