Pregnancy and Childbirth

Chapter 8

Deciding to Become a Parent

Health and age Emotional preparedness Financial circumstances
Two parent family will spend between $11,000$22,000 per year, per child pending on total family income

Relationship Future plans

Education, career and child care plans

Attitude and aptitude Beliefs

Philosophical or religious
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Preconception Care
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Preexisting conditions. Medications. Prior pregnancy. Age. Tobacco, alcohol , caffeine use. Infections. HIV. Diet. Diethylstilbestrol (DES). Multiple births. Genetic disorders.
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Understanding Fertility
Conception
Involves the fertilization of a womens egg by a mans sperm Each month a womens ovaries release an egg

24 hours if not fertilized

3-4 days - the egg travels through the fallopian tubes Egg not fertilized Millions of sperm Sperm release an enzyme Egg and sperm each carry 23 chromosomes Ovum, blastocyst, embryo, fetus

Fraternal twins and identical twins

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 2010 McGraw-Hill Companies. All Rights Reserved.

Infertility
Female infertility
One of two key causes
Tubal blockage (40%) Failure to ovulate (40%) 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
Hypothlamic pituitary disease Congenital disorders Testicular disease Disorders of sperm

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Infertility Treatment
Intrauterine insemination
Artificial intrauterine insemination

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 (13 week trimesters) Tests
Home pregnancy tests

Human chorionic gonadotropin (HCG) Two weeks after fertilization

Early signs and symptoms Missed menstrual period Softening of the uterus
Hagers sign

Slight bleeding Nausea Breast tenderness Increased urination Sleepiness, fatigue and emotional upset

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 2010 McGraw-Hill Companies. All Rights Reserved.

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Continual Change in the Womens Body

Uterus size
First 3 months, the uterus enlarges to about three times its nonpregnant size 4th month, large enough to make abdominal protrude 7th-8th month, pushes up into the rib cage

Breast changes 8th week 10th week

colostrum

Muscles and Ligaments loosen Weight Gain

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Table 8-2 Recommended Weight Gain During Pregnancy

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Changes During the Later Stages of Pregnancy Increased needs placed on the mother. Braxton hicks contractions. Lightening. Emotional responses to Pregnancy.

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Fetal Development
First Trimester
Blastocyst
Inner cells divide into three layers One layer inner body parts Middle layer muscle, bone, blood, kidneys, and sex glands Third layer skin, hair, and nervous tissue Embryo - End of second week All major body structures are formed between 2nd and 9th week 2nd Month - Fetus

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Fetal Development
Second Trimester

Fetus grows to about 14 inches and 2 pounds

Third Trimester

Fetus gains protective fat layers, Respiratory and Digestive organs develop

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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 (TMS)

Maternal blood test Analyze four hormone levels and compared to appropriate standards

Fetal programming
Conditions in the womb may influence the risk of adult diseases Amniocentesis, CVS, and TMS Chromosomal, genetic and other abnormalities
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The Importance of Prenatal Care

Regular medical checkups Blood tests Prenatal nutrition Avoidance of drugs, and other environmental hazards:
Teratogens
1st trimester Congenital malformations

Alcohol Tobacco Caffeine Drugs STDs and other infections

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The Importance of Prenatal Care

Activity and exercise
Moderate exercise program
30 minutes most days Cardiovascular exercises

Kegal Exercises Prenatal exercise classes

Preparation for childbirth

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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) 5.5 LBS. Infant Mortality 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

Entire process 2-36 hours. First stage of Labor.
Average13 hours for a first birth. Cervix is completely dilated (10 centimeters) Hormonal changes. Contractions. (30 seconds and occur every 15-20 minutes) Mucus plug is expelled and amniotic sac may rupture. Transition:
Contractions may last 60-90 seconds and be 1-3 minutes apart
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Childbirth
Second Stage of Labor
Baby slowly pushed into birth canal Baby squeezes through pelvis Head is usually delivered first Umbilical cord is cut

Third Stage of Labor

Delivery of the placenta Stage typically lasts 5-30 minutes

Apgar Scale of the Baby

Heart rate Respiration Color Reflexes Muscle tone Total score is between 0 and 10
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 2010 McGraw-Hill Companies. All Rights Reserved.

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Pain Relief During Labor and Delivery

Childbirth preparation courses
Breathing and relaxation techniques Lamaze or Bradley

Epidural Narcotics
Fentanyl or demeral Provide less pain relief than a epidural

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Cesarean Deliveries
2006 about 31.1% of babies born in the U.S. Surgical removal of the baby
Babys head too large Mother has a serious health condition Mother who is overweight or diabetes Difficult labor Fetal distress Dangerous infections 90% of cesarean mothers will have subsequent deliveries by cesarean

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Postpartum Period
3 months following childbirth. Critical family adjustment. Vaginal delivery leave hospital 1-3 days. Cesarean section 3-5 days. 6-8 weeks for the mothers reproductive organs to return to prebirth condition Breastfeeding
About 74% of mothers breast-feed Lactation begins about 3 days post childbirth Colostrum prior to lactation American Academy of Pediatrics 6 months exclusively
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Postpartum depression.
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Pregnancy and Childbirth

Chapter 8