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YourHealthTodayChapter12.pptx

12: Reproductive Choices

Your Health Today, 6th edition

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Reproductive Choices

Are you ready to be a parent?

Safe and effective methods of contraception are available

Steps can be taken to increase the likelihood that pregnancy is a positive experience and the baby is healthy

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Communicating About Contraception

About half of all pregnancies in the United States are unintended

Unintended pregnancies nearly always cause stress and life disruption and are associated with poorer health outcomes

Women with unintended pregnancies are less likely to receive adequate prenatal care and are more likely to have babies with low birth weight

You and your partner should decide together how to protect each other from STIs and unintended pregnancy

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Which Contraceptive Method Is Right for You?

Considerations:

Effectiveness

Cost

Convenience

Permanence

Safety

Protection against STIs

Consistency with personal values

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Abstinence

Abstinence is the only guaranteed method of preventing pregnancy and STI transmission

In heterosexual couples who have vaginal intercourse and use no contraceptive method, 85% of the women will become pregnant in one year

Abstinence requires control and commitment

Both partners should be free from sexual coercion

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Hormonal Contraceptive Methods

Hormonal contraceptives deliver hormones to prevent ovulation and discourage implantation of fertilized ova

Prescribed or administered by a health care provider

Advantages: effectiveness, ease of use, limited side effects, and do not permanently affect fertility

Disadvantages: no protection against STIs, minor side effects, rare serious side effects more common in older women

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Hormonal Contraceptive Methods (2)

Types of hormonal contraceptive methods

Birth control pills

Transdermal patch, releasing hormones via the skin

Vaginal contraceptive ring, placed in vagina

Injectable contraceptive (Depo-Provera), every 3 months

Contraceptive implant: flexible plastic rod that contains progesterone inserted under skin of the upper arm that slowly releases hormones

No hormonal methods are available for men

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The IUD

Intrauterine device (IUD): small T-shaped device inserted into the uterus

Long-acting reversible contraceptive

Believed to work by altering the uterine and cervical fluids to reduce the chance that sperm will move up into the fallopian tubes

Women who choose this birth control method are taught how to check that the IUD is properly located each month

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Figure 12.2 T-shaped IUD correctly positioned in the uterus.

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Barrier Methods

Barrier methods of contraception physically separate the sperm from the female reproductive tract

Condoms—male and female—are the only form of contraception that decreases the risk of STIs

Male condom is a sheath rolled down over the erect penis

Female condom is a pouch inserted into the vagina

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Barrier Methods (2)

Vaginal diaphragm: rubber dome inserted into the vagina

Cervical cap: cuplike device that covers the cervix

To increase effectiveness, the diaphragm and cervical cap should be used with spermicide, a chemical agent that kills sperm

Contraceptive sponge: small foam device presaturated with the spermicide nonoxynol-9, moistened, and inserted into the vagina

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Figure 12.3 Use of the diaphragm.

(a) With clean hands, place about 1 tablespoon of spermicide (jelly or cream) in the diaphragm, spreading it around inside the diaphragm and on its rim. (b) Using the thumb and forefinger, compress the diaphragm. Insert it into the vagina, guiding it toward the back wall and up into the vagina as far as possible. (c) With the index finger, check the position of the diaphragm to make sure that the cervix is covered completely and the front of the rim is behind the pubic bone.

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Fertility Awareness–Based Methods

Fertility awareness–based methods are based on abstinence during the window of time around ovulation when a woman is most likely to conceive

Standard days method is a calendar-tracking method used only by women who consistently have a regular cycle that is 26–32 days

Other methods of determining when ovulation has occurred are the temperature method based, cervical mucus method, and symptothermal method

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Figure 12.4 Fertility awareness–based methods.

These methods use the menstrual cycle to determine when fertilization is likely to occur and when unprotected sexual intercourse should be avoided. If a woman does not have a 28-day cycle, the variability in her cycle will be in the part of the cycle from menstruation to ovulation.

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Withdrawal

Withdrawal, or coitus interruptus: the man removes his penis from the vagina before ejaculating

Success is dependent on a man’s ability to tell when he is about to ejaculate and to have the self-control to withdraw with impending orgasm

While not generally recommended as a sole form of contraception, withdrawal may be better than no method at all

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Emergency Contraception

Emergency contraception (EC): morning-after pill, post-sex contraception, backup birth control

Reduces chance of pregnancy by preventing ovulation and fertilization

Most effective if taken within 48–72 hours and must be taken within 5 days of unprotected intercourse

Useful when another method fails (condom breaks, or diaphragm or cervical cap slips)

Will not cause termination of an existing pregnancy and thus is not an abortogenic (not abortion-causing)

Useful in cases of forced sex—rape and incest

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Permanent Contraception

Permanent contraception: surgical procedures that permanently prevents future pregnancies

Vasectomy: male sterilization procedure, involving tying off and severing the vas deferens to prevent sperm from reaching the semen

Tubal ligation or occlusion: female sterilization procedure involving severing and tying off or sealing the fallopian tubes to prevent ova from reaching the uterus

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Figure 12.5 Vasectomy.

With only local anesthesia needed, this surgical procedure offers permanent sterilization. A health care professional makes a small incision or puncture in the scrotum, then ties off and severs the vas deferens, the duct that carries sperm from the testes to the seminal vesicle, where sperm would mix with semen.

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Figure 12.6 Tubal ligation.

This surgical procedure is often performed via laparoscopy, which involves creating two small incisions in the abdomen, one for the scope device and the other for the surgical instruments. The fallopian tubes, through which ova pass from the ovaries to the uterus, are then severed and tied or sealed. It usually requires only local anesthesia.

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Unintended Pregnancy

It is important to see your physician or health provider as soon as possible to discuss options

Carry the pregnancy to term and raise the child

Carry the pregnancy to term and place the child with an adoptive family

Terminate the pregnancy

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Signs of Pregnancy

Prior to the classic sign of pregnancy—missing a period—there are others:

Breast tenderness and swelling, fatigue, nausea and vomiting, light-headedness, mood swings

Ectopic pregnancy: rare and potentially life-threatening complication of early pregnancy

Signs include severe lower abdominal pain or cramping and vaginal spotting

If you experience these signs, see your physician or go to the emergency room immediately

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Deciding to Become a Parent

Are you ready to become a parent? Here are some questions to consider:

What are your long-term plans?

What is the status of your relationship?

Do you feel emotionally mature enough?

What are your financial resources?

If you are the father, do you plan to be involved?

How large is your social support system?

What is your health status and age?

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Adoption

Adoption provides a permanent family for a child in need

Open adoption: biological parents help to choose the adoptive parents

Closed adoption: biological parents do not choose the parents, and the adoption records are sealed

All forms of adoption require both biological parents to relinquish all parental rights

For couples wanting to adopt, international adoptions are becoming increasingly popular in America

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Elective Abortion

Since Roe v. Wade (1973), terminating a pregnancy through elective abortion has been legal in the U.S.

Distinguished from spontaneous abortion, or miscarriage

Some restrictions apply as the pregnancy advances through three trimesters

Debate over abortion is one of the most highly charged political issues of our time

Lowest rates of abortion occur in countries where abortion is legal, and highest rates where it is illegal

Sixty-one percent of women having an abortion have one or more children already

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Elective Abortion (2)

Surgical abortion: surgical removal of the contents of the uterus to terminate the pregnancy

Vacuum aspiration is most common method

Medical abortion: use of a medication to terminate the pregnancy

Mifepristone (formerly known as RU-486)

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Infertility: Causes and Treatment Options

About 12–18% of couples attempting pregnancy are unable to conceive within a year and are considered to have infertility

Causes vary

Genetics, infections, and environmental, chemical, or occupational exposures

Low sperm count or lack of sperm motility

Scarring of the fallopian tubes, endometriosis, or irregular ovulation

Other, unknown causes

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Infertility: Causes and Treatment Options (2)

Treatment ranges from counseling and advice to surgery

Open blocked fallopian tubes

Correct anatomical problems

Fertility (hormonal) drugs

Intrauterine (artificial) insemination

In vitro fertilization

Gamete intrafallopian transfer

Zygote intrafallopian transfer

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Pregnancy Planning

Events and conditions during pregnancy influence the child’s development throughout life

The best time to have a child is influenced by many factors: educational and career plans, relationship status, health issues, and others

The least health risk occurs when women have pregnancies between the age of 18 and 35

Male fertility also declines with age

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Pregnancy Counseling, Nutrition, and Exercise

Prepregnancy counseling typically includes an evaluation of current health status, health behaviors, and family health history

Healthy lifestyle factors before conception help ensure required nutrients are available

Folic acid in food or a supplement is recommended to reduce the risk of neural tube defects

Foodborne infections can have more serious effects in pregnant women, so certain foods should be avoided

Weight gain during pregnancy varies; regular exercise is recommended to maintain muscle strength and circulation

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Maternal Immunizations

Women should be up-to-date on routine vaccinations before pregnancy

Especially important are vaccinations for rubella and hepatitis B

Hepatitis B can be transmitted to the child during pregnancy and delivery (via vertical transmission)

Some infections during pregnancy increase risk of complications for a developing fetus

Toxoplasmosis

Zika

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Medications and Drugs

Most substances the mother ingests eventually reach the fetus

Teratogens cause physical damage or defects

Tobacco and alcohol are the most commonly used drugs during pregnancy

Alcohol use is linked to fetal alcohol syndrome (FAS)

Tobacco use in the home is linked to sudden infant death syndrome (SIDS)

Illicit drugs have a variety of effects on a fetus, depending on the chemical action of the drug

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Prenatal Care and Delivery Choices

Pregnant women should visit their health care provider regularly for prenatal care

Midwives usually take patients who are at low risk for medical or pregnancy complications

Your family physician may provide pregnancy-related care, and some deliver babies in birthing centers or hospitals

Obstetricians are trained to handle all kinds of pregnancies, from low risk to high risk

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Complications of Pregnancy

U.S. rates of maternal and infant death are higher than the rates in 16 peer countries

Approximately 15–50% of all pregnancies end in miscarriage, most during the first trimester

Gestational diabetes occurs in some women midway thought the pregnancy

Women with gestational diabetes are advised to exercise, control their diet, and monitor glucose levels

Complications of Pregnancy (2)

Preeclampsia: dangerous condition characterized by high blood pressure, fluid retention, possible kidney and liver damage, and potential fetal death

Signs include facial swelling, headaches, blurred vision, nausea, and vomiting

Can progress to eclampsia, a potentially life-threatening condition marked by seizures and coma

Complications of Pregnancy (3)

Complications for the child:

Approximately 1.2% of all pregnancies end in infant death

Half of these deaths occur before the fetus is born

80% occur before the 28th week

Stillbirth: infant death before or at the time of expected birth

After birth, the leading cause of death are preterm birth, low birth weight, and SIDS

Fetal Development

Within 30 minutes of fertilization the single-celled fertilized ovum (zygote) starts to divide

Week 2 to week 8 is the embryonic period: formation of embryo, placenta, and amniotic sac

By 8 weeks, all major body systems and organs are present in rudimentary form; by 16 weeks, the mother can feel fetal movements; 26 weeks, eyes are open; and at 30 weeks a layer of fat begins forming under the skin

Fetus has excellent chance of survival at 36 weeks

Full term occurs at 38 weeks

Diagnosing Problems in a Fetus

About 5% of babies born in the United States have a birth defect

Several tests have been developed to detect abnormalities in a fetus prior to birth

Ultrasound

Chromosomal analysis

Amniocentesis

Chorionic villus sampling (CVS)

Labor and Delivery

Labor begins when hormonal changes in the fetus and the mother cause strong uterine contractions

Early first stage: cervix thins and begins to open

Second stage: baby moves downward through the pelvis, cervix, and into the vagina; head emerges, followed by the shoulders and body

Third stage: contractions continue, and placenta (afterbirth) is expelled

Certain difficulties for mother and baby suggest use of a cesarean section (C-section): surgical delivery

Figure 12.8 Labor and delivery.

(a) In the first stage of labor, the cervix thins and dilates, ending with (b) the transition phase. (c) Delivery of the baby occurs in the second stage. (d) In the third stage, the placenta is expelled.

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Newborn Screening

Babies are evaluated at birth to determine whether they require any medical attention or will need developmental support later

The Apgar scale is used as a quick measure of the baby’s physical condition

Most babies are pronounced healthy and taken home within 24 to 48 hours of birth

The Postpartum Period

The first few weeks or months of parenthood are a period of profound adjustment as parents learn how to care for their newborn (or neonate)

Issues for the newborn that deserve attention:

Growth and nutrition

Illness and vaccinations

Adjustment and attachment

Attachment: deep emotional bond that develops between an infant and its primary caregivers

The Postpartum Period (2)

About 13% of women experience depression in the first year after giving birth, referred to as postpartum depression

Can be due to hormone changes, broken sleep patterns, self-doubt, a sense of loss of control, and changes in support systems

Can contribute to feelings of sadness, restlessness, loss of interest, guilt, difficulty focusing, and withdrawal

Effective treatments exist; partners should be aware of signs and symptoms

In Review

What are the commonly available contraceptive methods?

What are the options in the event of unintended pregnancy?

What are the options when a couple cannot conceive?

What are the basics of prenatal care?

What happens during prenatal development?

What happens during labor and delivery?

What concerns arise during the postpartum period?

Appendix A

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Figure 12.4 Fertility Awareness Methods Appendix

Days 1 to 7 of a 28-day menstrual cycle are when menstruation occurs and it is relatively safe to have unprotected intercourse

On days 8 through 13, the days immediately preceding ovulation, unprotected intercourse should not occur

On days 15 through 19, the days immediately following ovulation, unprotected intercourse should not occur

Days 20 to 28, it is once again relatively safe to have unprotected intercourse

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Figure 12.8 Labor and Delivery Appendix

In the early first stage, the cervix thins and begins to open; light bleeding may occur, and the amniotic sac may rupture

In the late first stage, or transition phase, contractions become stronger and more frequent; when the cervix is completely open with a diameter of about 10 centimeters, it is ready for passage of the baby’s head

In the second stage, the baby moves downward through the pelvic area, past the cervix, and into the vagina; the baby’s head emerges first, followed by the shoulders and the rest of the body

In the third stage, the placenta (afterbirth) detaches and is expelled

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