chapter 10: becoming parents: choices and challenges
TRANSCRIPT
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Chapter 10:Becoming Parents: Choices and Challenges
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Childbearing Trends
• Crude Birth Rate – the number of children per 1000 women per year
• Fertility Rate – average number of live births per woman, in a given population, per year
• Replacement level – a fertility rate of 2.1
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Figure 10.1: Birth Rates among All Age Groups, 2004
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American MothersTeens• 2004: birthrates for teens reached a historic
low• Decrease is across all groups with rate of
pregnancy among teens decreasing by as much as 47%
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American MothersUnmarried Women• 1.5 million unmarried women gave birth in
2004• Of all births in U.S., 35.7% were to unmarried
women in 2004
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American MothersWomen in their 20s• 20-24 year olds birth rate dropped• 25 – 29 year olds birth rate was the highest
of any group• Women in their 20s are in the peak of their
childbearing years
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American MothersWomen in their 30s and 40s• Birthrates increased• Reflects the cultural trend of delaying
childbearing to establish careers
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Table 10.2: Perceptions of Parenting Inventory: Factors People Consider Before Becoming Parents
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Reproduction• Begins with fertilization– During intercourse, millions of sperm are
ejaculated into the vagina–When sperm reach the ovum, they connect to
its outer layer– Capacitation occurs, allowing the sperm to
penetrate the egg– The outer layer of the egg hardens and makes it
impossible for the sperm to escape
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ConceptionThree Phases• Germinal – begins with the fusion of sperm and egg– cell duplication occurs: genetic information
duplicates itself– cell differentiation: zygote has divided into 8
cells, cells take on genetically determined traits and forms
– blastocyst forms and implants in the uterus
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Infertility-when conception fails
• Sterility – absolute inability to reproduce
• Infertility – inability to conceive after a year of trying
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Women and Infertility• Problems with ovulation are responsible for
most of female infertility• May be due to –hormonal imbalances–Poor nutrition– Intense athletic training–Pituitary gland tumors (rare)
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Other Causes of Infertility• Pelvic Inflammatory Disease (PID)– Caused by sexually transmitted infections– Leading cause of infertility in young women
• Endometriosis– Uterine tissue in other parts of the body• ovaries and fallopian tubes
– Prevents fertilized ovum from embedding in uterine lining
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Men and Infertility• 1/3 of fertility difficulties due to male
reproductive systemsTwo primary forms of infertility1. Azoospermia – no sperm cells are produced2. Oligospermia – few sperm cells are produced
• Adequate number of sperm is 20 million per milliliter of semen
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Men and Infertility
Improving fertility in men• Take proper vitamins and minerals• Limit alcohol intake and stop smoking• Stay cool – testicles need to be cooler than
the rest of the body for healthy sperm production
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Treating Infertility
• Artificial insemination: donor sperm is placed into woman’s vagina, cervix or uterus via syringe
• Sperm are collected through masturbation of the donor and stored in sperm banks
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Assisted Reproductive Technology• In-vitro fertilization (IVF)–woman’s eggs are surgically removed from
her ovary and mixed with man’s sperm in laboratory dish –once growing at normal rate, eggs are
placed in the uterus• Average cost - $12,400 per attempt
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Assisted Reproductive Technology• Gamete intrafallopian transfer (GIFT)–Unfertilized eggs and male’s sperms are
placed in the woman’s fallopian tubes–Designed to foster natural fertilization– Implantation rates are higher for this
technique• Average cost per attempt - $10,000
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Assisted Reproductive Technology• Zygote intrafallopian transfer (ZIFT)• Eggs are fertilized in laboratory dish• Fertilized egg is placed immediately in the
fallopian tubes rather than uterus• Allows the conceptus to travel to the uterus
to implant naturally• Average cost of ZIFT -$10,000 per attempt
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Assisted Reproductive TechnologySurrogacy• When a woman cannot sustain a pregnancy,
embryos are implanted into a surrogate mother who carries the pregnancy to term
• At birth baby is given to biological parents
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The Psychological Impact of Infertility• Infertility is– Distressing– Frustrating– Depressing
• Support groups– National Infertility Association– International Council on Infertility
Information
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Figure 10.2: “Ideal” Family Size
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Figure 10.3: A Month-by-Month Guide to Pregnancy
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Figure 10.3 (continued): A Month-by-Month Guide to Pregnancy
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Pregnancy – BIG changes• Uterus – pear shaped organ between the
bladder and rectum• Capable of holding 500 -1000 times the
volume of its non - pregnant state• 3 parts of the uterus– Fundus: upper rounded portion–Corpus: the body –Cervix: the neck or the opening
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Pregnancy – BIG changes• Placenta –Placenta is attached to the upper portion of
the uterus–5 critical functions• Respiratory• Nutritive• Excretory• Protective• Endocrine
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Pregnancy – BIG changes• Umbilical Cord–3 feet long–2 arteries and 1 vein–Carry blood to and from the placenta–Amnion – outer layer–Wharton’s jelly – fills the spaces between
the arteries, vein and amnion• There are no nerves in the umbilical cord
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Pregnancy – BIG changes• Amniotic Sac –Membrane within the uterus that holds
the fetus–When the sac ruptures, labor begins
• Amniotic Fluid–Clear fluid in the sac produced from baby’s
urine, amniotic cells, secretions from lungs, sloughed off skin cells
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Pregnancy Trimesters
• First trimester – first 12 weeks • Second trimester – weeks 13 - 26• Third trimester – weeks 27 – 40
• Babies born prior to 37th week are considered pre-term
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The First Trimester• Rapid cell differentiation• 4 weeks – embryo ¼ inch long• 7 weeks – less that 1” with beating heart,
eyes, nose, arms, legs, digestive system• 9 weeks – embryo reaches status of fetus• 12 weeks – 3” long, 3 ounces–Completely formed with all of the
anatomical structures and organs
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The First Trimester - Baby• During first trimester fetus is susceptible to
environmental influences• Teratogens –Mother’s lifestyle: cigarette smoking,
alcohol consumption, street drugs, HIV/AIDS infection, STDs, diabetes, viral infections– Exposure to teratogens can cause major
anatomical abnormalities
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The First Trimester - Mother• Presumptive signs of pregnancy –Cessation of menstrual cycle– Feeling of fatigue– Full breasts due to increased blood supply–Nausea and vomiting
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First Trimester - Couple• Women’s emotions are unstable• Mood swings• Relationships are more stable in spite of
emotions of woman
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Second Trimester – Baby• Quickening – movements of the fetus
around 20th week• Begins to develop hair• Soft downy hair – lanugo• Begins to suck and swallow• Skeleton begins to harden• Skin covered with waxy coating – vernix• 12 – 4 inches long
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Second Trimester - Mother• The best part of pregnancy• Steady weight gain• “Mother line” develops – dark line from
navel to pubic area• Headaches• Constipation
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Second Trimester - Couple• Overwhelmed by responsibilities of
parenting• Worries about finances• Women experience increased sexual
pleasure
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Third Trimester - Baby• Begins the 7th month of pregnancy• Baby develops fatty tissue• 15 inches long• Weighs 2 ½ pounds• Digestive and respiratory systems still
developing• 8th month – brain and nervous system nearly
developed
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Third Trimester - Baby• 9th month – baby will gain 1–2 pounds per
week• Will weigh 6–10 pounds• Will reach length of 20–23 inches
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Third Trimester - Mother• During last month – mother should feel at
least 10 fetal movements from breakfast to dinner
• Experiences more and more fatigue• Increased pressure on the bladder and
persistent backache• Colostrum is secreted from the nipples• Braxton-Hicks contractions occur
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Third Trimester - Couple• Woman – tired of being pregnant• Fear of labor and delivery
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Labor and Delivery• Divided in four stages• Stage 1 – cervix becomes thinner, called
effacing, dilates to allow baby to pass into birth canal
• Phase 1 (pre) Labor: 0 – 3 centimeters• Contractions 5 – 15 minutes apart
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Labor and Delivery• Phase 2 – active labor (4–7 centimeters)• Most challenging part• Contractions 3 – 4 minutes apart• Baby descends further into the birth canal• May last 3 – 5 hours
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Labor and Delivery• Phase 3 – transition (8 – 10 centimeters)• Transition presents the most physically
challenging• Contractions 2 – 3 minutes apart• Descent of the baby causes severe backache
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Birth• Stage 2 – pushing and delivery• Uterine contractions: mother pushes –
sometimes takes 2 hours• Episiotomy – surgical cut in the perineum
that facilitates birth and avoids tears that may occur
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Birth• Stage 3 – delivery of the placenta• 5 – 30 minutes after delivery of the baby• Placenta separates from the uterine wall• Stage 4 – recovery – first 2 -3 hours through
24 hours• Postpartum depression may occur due to
hormonal fluctuations following birth
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Sex and Relationship Satisfaction• Couples are encouraged to wait 6 weeks after
childbirth to have intercourse• Allows episiotomy to heal• Sexual desire lower for mother for about the
first year after birth• Some new mothers experience pain during
first intercourse after delivery• All of the changes place stress on the new
parents
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Table 10.3: The Cost of Raising a Child to the Age of 18
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Unexpected Outcomes
• Caesarean section – delivery of fetus through incision in abdomen
• ¼ of all babies born in 2004 were by caesarean
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Unexpected Outcomes• Medical indications for caesarean– Cephalopelvic disproportion– Breech presentation– Abrupted placenta– Placenta previa– Prolapsed cord–Maternal disease– Fetal distress
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Figure 10.4: Loss and Grief Cycle for Parents of Physically Challenged Children
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When everything is not perfect. . .• Physically challenged baby (see Loss and Grief
Cycle for parents of physically challenged children)
Pregnancy loss • Miscarriage: loss of a fetus or embryo before the
20th week of pregnancy• Early miscarriage: loss of fetus before the 12th
week• Late miscarriage: loss of fetus between 12th and
20th week
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• Stillbirth – death of fetus after the 20th week of pregnancy
• Only about 14% of fetuses die during the labor and birth process, 86% die before labor has begun
When everything is not perfect. . .
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Neonatal Death• Neonatal Death – premature birth is a cause
or contributor of about 20% of all neonatal deaths–When a baby dies within the first 28 days
of life–Most common cause is birth defect
• Respiratory Death Syndrome – babies born before 30 weeks have high risk of brain bleeds
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Table 10.4: Barrier ContraceptiveMethods