Pregnancy and Childbirth

Pregnancy and Childbirth

Chapter 8

© 2012 McGraw-Hill Companies. All Rights Reserved.


Deciding to Become a Parent

• Health and age• Emotional preparedness• Relationships• Financial circumstances

– Two-parent family will spend $8,500-$23,000 per year, per child, depending on total family income

• Future plans– Education, career, and child care plans

• Attitude and aptitude• Beliefs

– Philosophical or religious

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Preconception Care

1. Preexisting conditions2. Medications3. Prior pregnancies4. Age5. Tobacco, alcohol, and caffeine use6. Infections7. HIV8. Diet9. Diethylstilbestrol (DES)10. Multiple births11. Genetic diseases

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Understanding Fertility

• Conception Involves the fertilization of a woman’s ovum (egg)

by a man’s sperm Each month a woman’s ovaries release an egg Takes 3-4 days for the egg to travel through the

fallopian tubes to the uterus If not fertilized, egg will last 24 hours, then disintegrate Typical ejaculate contains millions of sperm Sperm release an enzyme to soften the egg’s exterior Egg and sperm each carry 23 chromosomes

• Twins Fraternal Identical

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© 2012 McGraw-Hill Companies. All Rights Reserved. 5

Figure 8.1 Fertilization and Early Development of the Embryo


Infertility

• Inability to conceive after trying for a year or more• Female infertility

– One of two key causes• Tubal blockage (40%)• Failure to ovulate (40%)• Anatomical abnormalities or benign growths (10%)• Unexplained (chemicals, smoking, age) (10%)• Blocked fallopian tubes are most commonly caused

by pelvic inflammatory disease (PID)– Chlamydia or gonorrhea– Endometriosis

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Infertility

• Male infertility– Accounts for about 20% of infertile couples

• Four main categories– Hypothalamic pituitary disease or congenital disorders– Testicular disease – Disorders of sperm transport– Unexplained

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Infertility Treatment

• Cause of infertility can be determined for about 85% of infertile couples

• Most cases treated with conventional medical therapies or surgery

• Assisted reproductive technology (ART)

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Infertility Treatment

• Artificial intrauterine insemination– Also given fertility drugs prior

• IVF,GIFT, and ZIFT– In vitro fertilization (IVF)– Gamete intrafallopian transfer (GIFT)– Zygote intrafallopian transfer

• Surrogate motherhood• Emotional responses to infertility

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Pregnancy• 3 periods of about 3 months each (13 week trimesters)

• Tests– Home pregnancy tests– Human chorionic gonadotropin (HCG)– Two weeks after fertilization

• Early signs and symptoms– Missed menstrual period– Slight bleeding– Nausea– Breast tenderness– Increased urination– Sleepiness, fatigue, and emotional upset

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Continuing Changes ina Pregnant Woman’s Body

• Uterus size– First 3 months, the uterus enlarges to about

3 times its nonpregnant size– 4th month, large enough to make abdomen protrude– 7th-8th month, pushes up into the rib cage

• Breast changes• Muscles and ligaments stretch• Circulatory system holds higher blood volume• Weight gain

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Figure 8.2 Physiological ChangesDuring Pregnancy


Changes During the Later Stagesof Pregnancy

• Increased needs placed on the mother• Braxton Hicks contractions• Lightening in the 9th month• Emotional responses to pregnancy

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Figure 8.3 The Fetus During theThird Trimester of Pregnancy


Table 8.1 Recommended WeightGain During Pregnancy

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Fetal Development

• First trimester– Blastocyst

• Inner cells divide into three layers• First layer: inner body parts, digestive and respiratory • Middle layer: muscle, bone, blood, kidneys, sex glands• Third layer: skin, hair, nervous tissue• Outermost cells becomes the placenta

– Becomes embryo by end of 2nd week– All major body structures formed between 2nd and 9th

weeks– Becomes fetus by end of 2nd month

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Fetal Development

• Second trimester– Fetus grows to about 14 inches and 1.5 pounds– All body systems are operating

• Third trimester– Fetus gains protective fat layers in the 8th month– Respiratory and digestive organs develop– Immunity supplied by mother’s blood

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Figure 8.4 A Chronology of Milestonesin Prenatal Development


Figure 8.5 A Cross-Sectional Viewof the Fetus in the Uterus


Diagnosing Fetal Abnormalities

• Ultrasonography (ultrasound)– High frequency sound waves

• Amniocentesis– Fluid removal from the uterus

• Chorionic villus sampling– Removal of tiny section of chorionic villi

• Quadruple marker screen (QMS)– Maternal blood test

• Fetal programming– Conditions in the womb may influence the risk of adult

diseases

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The Importance of Prenatal Care

• Regular medical checkups• Blood tests• Prenatal nutrition• Avoidance of drugs and environmental hazards:

– Teratogens• First trimester • Congenital malformations

– Alcohol– Tobacco– Caffeine– Drugs– STDs and other infections

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The Importance of Prenatal Care

• Prenatal activity and exercise– Contributes to mental and physical wellness– 30 minutes a day of moderate exercise– Kegel exercises– Prenatal exercise classes

• Preparation for birth

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Complications of Pregnancy and Pregnancy Loss

• Ectopic pregnancy• Spontaneous abortion or miscarriage• Stillbirth• Preeclampsia/eclampsia• Placenta previa• Placental abruption• Gestational diabetes• Preterm labor• Labor induction• Low birth weight (LBW)

– Less than 5.5 pounds at birth• Infant mortality

– Sudden infant death syndrome (SIDS)• Coping with loss

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Childbirth

• Choices in childbirth– Who is going to assist with delivery?

• Physician– High risk?

• Certified nurse-midwife– Where is the baby going to be delivered?

• Hospital• Home

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Labor and Delivery• Three stages: entire process 2-36 hours• First stage of labor

– Averages 13 hours for a first birth– Cervix is completely dilated to 10 centimeters– Contractions last 30 seconds each and occur every 15-20 minutes

at first, more often later on– Mucus plug may be expelled and amniotic sac may rupture (“water

breaking”)– “Transition”

• Strong contractions may last 60-90 seconds and be 1-3 minutes apart• Usually lasts 30-60 minutes• Often the most difficult part of labor

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Labor and Delivery• Second stage of labor

– Baby slowly pushed into birth canal– Baby squeezes through pelvis– Head is usually delivered first (crowning)– Umbilical cord is cut

• Third stage of labor– Delivery of the placenta– Stage typically lasts 5-30 minutes

• Apgar score of the baby’s physical condition– Heart rate– Respiration– Color– Reflexes– Muscle tone– Total score is between 0 and 10

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Figure 8.7 Birth: Labor and Delivery


Pain Relief During Labor and Delivery

• Childbirth preparation courses– Breathing and relaxation techniques– Lamaze or Bradley techniques

• Epidural• Narcotics

– Fentanyl or Demerol– Provide less pain relief than an epidural can provide

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Cesarean Deliveries

• In 2008, about 32.3% of babies born in the U.S. were delivered by cesarean section

• Surgical removal of the baby – Baby’s head too large– Baby in unusual position– Mother has a serious health condition– Mother who is overweight or has diabetes– Difficult labor– Fetal distress– Dangerous infections– 90% of cesarean mothers will have subsequent deliveries by

cesarean

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Postpartum Period• Stage of about 3 months following childbirth• Time of critical family adjustment• After vaginal delivery, leave hospital in 1-3 days• After cesarean section, leave in 3-5 days• Takes 6-8 weeks for the mother’s reproductive organs to

return to prebirth condition• Breastfeeding

– Colostrum secreted prior to lactation– Lactation begins about 3 days post childbirth– Recommended to breastfeed exclusively for 6 months

• Postpartum depression• Attachment

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Pregnancy and Childbirth

Chapter 8


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Pregnancy and Childbirth