Chapter 10:Becoming Parents: Choices and Challenges

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

Figure 10.1: Birth Rates among All Age Groups, 2004

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%

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

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

American MothersWomen in their 30s and 40s• Birthrates increased• Reflects the cultural trend of delaying

childbearing to establish careers

Table 10.2: Perceptions of Parenting Inventory: Factors People Consider Before Becoming Parents

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

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

Infertility-when conception fails

• Sterility – absolute inability to reproduce

• Infertility – inability to conceive after a year of trying

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)

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

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

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

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

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

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

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

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

The Psychological Impact of Infertility• Infertility is– Distressing– Frustrating– Depressing

• Support groups– National Infertility Association– International Council on Infertility

Information

Figure 10.2: “Ideal” Family Size

Figure 10.3: A Month-by-Month Guide to Pregnancy

Figure 10.3 (continued): A Month-by-Month Guide to Pregnancy

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

Pregnancy – BIG changes• Placenta –Placenta is attached to the upper portion of

the uterus–5 critical functions• Respiratory• Nutritive• Excretory• Protective• Endocrine

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

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

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

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

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

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

First Trimester - Couple• Women’s emotions are unstable• Mood swings• Relationships are more stable in spite of

emotions of woman

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

Second Trimester - Mother• The best part of pregnancy• Steady weight gain• “Mother line” develops – dark line from

navel to pubic area• Headaches• Constipation

Second Trimester - Couple• Overwhelmed by responsibilities of

parenting• Worries about finances• Women experience increased sexual

pleasure

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

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

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

Third Trimester - Couple• Woman – tired of being pregnant• Fear of labor and delivery

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

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

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

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

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

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

Table 10.3: The Cost of Raising a Child to the Age of 18

Unexpected Outcomes

• Caesarean section – delivery of fetus through incision in abdomen

• ¼ of all babies born in 2004 were by caesarean

Unexpected Outcomes• Medical indications for caesarean– Cephalopelvic disproportion– Breech presentation– Abrupted placenta– Placenta previa– Prolapsed cord–Maternal disease– Fetal distress

Figure 10.4: Loss and Grief Cycle for Parents of Physically Challenged Children

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

• 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. . .

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

Table 10.4: Barrier ContraceptiveMethods