MODULE 1
Life Course Perspective, Conception, Pregnancy, and Childbirth
Human Behavior and the Social Environment
Transitions
They have been found to have more student loan debt, poverty, and unemployment
when compared to the previous two generations at the same age, and it is not yet clear how
these circumstances will affect the long-term trajectories of their lives. Some observers
suggest that cohorts develop strategies for the special circumstances they face. The Millennial
generation is more ethnically diverse than previous cohorts and grew up in a time of great
technological innovation. They have been found to be more tolerant of diversity and more
media-connected than earlier cohorts.
One way to visualize the configuration of cohorts in a given society is by using a
population pyramid, a chart that depicts the proportion of the population in each age group.
As Exhibit 1.4 demonstrates, different regions of the world have significantly different
population pyramids. Global North countries that has both low birth rates and low death rates.
The populations are getting older in these societies, with a declining youthful population.
These countries are becoming increasingly dependent on immigration for a workforce and
taxpayers to support the aging population. Population increase from 2005 to 2050 will be the
result of immigration. Despite the economic necessity of immigrants in societies with aging
populations, in the United States, as in many other affluent countries, there are strong anti-
immigrant sentiments and angry calls to close the borders. The second pyramid in Exhibit 1.4
shows the age distribution for Uganda, one of the less affluent Global South countries that
have high birth rates and shorter life expectancy, leading to a situation in which the majority
of people are young.
In these countries, young people tend to overwhelm labor markets and education
systems, and national standards of living decline. Sex ratios affect a cohort’s marriage rates,
childbearing practices, crime rates, and family stability. Sex ratios can be further unbalanced
by war or death at childbirth or to high rates of either male or female out-migration or in-
migration. A life course perspective is stage like because it proposes that each person
experiences a number of transitions, or changes in roles and statuses that represent a distinct
departure from prior roles and statuses. Each transition changes family statuses and roles and
generally is accompanied by family members’ exits and entrances. We can see the dramatic
effects of birth and death on the Suarez family as Maria entered and Emma exited the family
circle. Health professionals have recently used the life course perspective, the concept of
transitions in particular, to understand role changes that occur in family caregiving of older
adults.
The concept of transitions is also increasingly used to study the
migration/immigration process. Transitions in collectivities other than the family, such as
small groups, communities, and formal organizations, also involve exits and entrances of
members as well as changes in statuses and roles. Some of them make the transition from
undergraduate to graduate student, and in that new status they may take on the new role of
teaching or research assistant.
Trajectories
Each life course transition is embedded in a trajectory that gives form to the life
course. They are entry points to a new life phase. In contrast with transitions, trajectories
involve relatively stable long-term processes and patterns of life, involving multiple
transitions. For example, you may look forward to graduating from your program of social
work study. Graduation is a transition, but it is a transition embedded in a career trajectory
that will probably involve a number of other transitions along the way, such as a licensing
exam, job changes, promotions, and perhaps periods of discontent or burnout. We do not
necessarily expect trajectories to be a straight line, but we do expect them to have some
continuity of direction. Recommend the life course perspective for understanding drug use
trajectories that may include onset of use, acceleration of use, regular use, cessation of use,
and relapse.
A life event is a significant occurrence in a person’s life that may produce serious and
long-lasting effects. The death of the spouse is the life event, but it precipitates a transition
that involves changes in roles and statuses. When we reflect on our own lives, most of us can
quickly recall one or more major life events that had long-lasting impact.
Turning Points
September 11, 2001, as a turning point in her life, there is no doubt that the events of
that day changed the course of her life. A turning point is a time when major change occurs in
the life course trajectory. We sometimes call these "defining moments." Turning points may
occur in the individual life course, but social science researchers also study turning points in
social systems such as families, cultures, organizations, economies, or governments. At the
individual level, the turning point may involve a transformation in how the person views the
self in relation to the world and/or a transformation in how the person responds to risk and
opportunity.
The addition of the concept of turning point is an important way that the life course
perspective departs from traditional developmental theory. Inertia tends to keep us on a
particular trajectory, but turning points add twists and turns or even reversals to the life
course. For example, we expect someone who is addicted to alcohol to continue to organize
his or her life around that substance unless some event becomes a turning point for recovery.
Transitions and life events do not always produce the major change that would constitute a
turning point. However, either a transition or life event may be perceived as a turning point as
time passes.
Life events that make a lasting change on the person’s environment. Some events,
such as migration to a new country, are momentous because they qualify as all three types of
events. The same type of life event may be a turning point for one individual, family, or other
collectivity, but not for another. Another researcher found that myocardial infarction can be a
turning point because it leads to reevaluation of attitudes about self, life, religion, and others.
We have been talking about life events as turning points, but slower moving transitions can
also serve as turning points depending on the individual’s assessment of their importance.
The perceived turning points occurred across the entire life course, but there was
some clustering at midlife, a period in which 32.2% of the reported turning points occurred.
Gender differences have been found in reported turning points in samples of young adults as
well as samples of older adults, with women reporting more turning points in the family
domain and men reporting more turning points in the work domain.
Suarez may not have thought of her decision to take a job in the World Trade Center
as a turning point for her family, because she could not foresee the events of September 11,
2001. Most life course pathways include multiple turning points, some that send life
trajectories off track and others that bring life trajectories back on track. In fact, we could say
that the intent of many social work interventions is to get life course trajectories back on
track. Criminal justice researchers have been interested in learning what types of role
transitions can become turning points in a criminal career, leading to desisting from criminal
activities.
Major Themes of the Life Course Perspective
They suggested that different social, political, and economic contexts of different
historical eras may produce cohort effects when distinctive formative experiences are shared
at the same point in the life course and have a lasting impact on a birth cohort. The same
events of a particular historical era may affect different cohorts in different ways. For
example, Elder’s research on children and the Great Depression found that the life course
trajectories of the cohort that were young children at the time of the economic downturn were
more seriously affected by family hardship than the cohort that were in middle childhood and
late adolescence at the time. Analysis of large data sets by a number of researchers provides
forceful evidence that changes in other social institutions impinge on family and individual
life course trajectories.
Researchers have examined the impact of globalization, declining labor market
opportunities, and rising housing costs on young-adult transitions. These researchers are
finding that transitions associated with young adulthood are occurring later for the current
cohort of young adults than for their parents in many countries, particularly in countries with
weak welfare states. The popular media in the United States has described the relationship
between some parents and their Millennial young adults as helicopter parents and landing pad
kids, suggesting that the intense support offered by many parents to their adult offspring
violates earlier norms of the young-adult transition. One research team found, however, that
young adults who received such intense support reported better psychological adjustment and
life satisfaction than young adults who did not receive such support.
One research team considered a finding from earlier research that military service is a
protective factor for subsequent health and mortality. Researchers who study the impact of
immigration on health point out that immigrants face different social, political, and economic
contexts during different historical eras as conditions change in both their sending and
receiving countries. In addition, shifting immigration policies and shifting attitudes toward
particular immigrant groups change the landscape for immigrants over different historical
eras. Demographers analyze the myriad impacts on human functioning of what they describe
as first and second demographic transitions. The first demographic transition occurred in the
19th century and involved declines in both mortality and fertility.
Life course scholars are interested in the age at which specific life events and
transitions occur, which they refer to as the timing of lives. They may classify entrances and
exits from particular statuses and roles as "off-time" or "on-time," based on social norms or
shared expectations about the timing of such transitions . One research team found that
people diagnosed with cancer at earlier ages had a greater increase in religiosity than people
diagnosed at later ages, suggesting that off-time transitions are more stressful than on time
transitions.
Dimensions of Age
Chronological age itself is not the only factor involved in timing of lives. Age-graded
differences in roles and behaviors are the result of biological, psychological, social, and
spiritual processes. Although life course scholars have not directly addressed the issue of
spiritual age, it is an important perspective as well. The preponderance of research on
subjective age has focused on older adults and found that older adults in Western societies
feel younger than their chronological age.
This has not been found to be the case among Chinese oldest old, but recent research
finds that the percentage of China’s oldest old reporting not feeling old has increased in the
past decade. Youthful subjective age was associated with high satisfaction with life and high
self-esteem in this sample. A French research team used a longitudinal design that asked
about subjective age at Time 1 and 4 years later tested for memory performance. They found
that younger subjective age at Time 1 was associated with better memory performance 4
years later.
Other researchers have examined the subjective age of early adolescents, young
adults, and middle-aged adults. One research team found that a sample of Canadian early
adolescents reported slightly older subjective ages, on average, than their chronological ages.
This tendency to feel older than one’s chronological age began at 10.4 years of age and
peaked at 14.1 years. Subjective age in this sample was influenced by pubertal timing, with
late-maturing adolescents reporting a subjective age that was about the same as their
chronological age in contrast to the older subjective age of earlier matures.
Young adults have been found to feel their same age or slightly older. Middle-aged
and older adults’ subjective age is related to their self-reported health, but that is not the case
for younger adults. In their study of 107 organizations, German researchers found that a
workforce that, on average, feels younger than their chronological age is associated with an
improvement in the overall performance of the organization. Life course scholars suggest that
age norms vary not only across historical time and societies but also by gender, race,
ethnicity, and social class within a given time and society.
They have paid particular attention to recent changes in age norms for the transitions
of young adulthood. Although biological age and psychological age are recognized in the life
course perspective, social age receives special emphasis. For instance, life course scholars
use life phases such as middle childhood and middle adulthood, which are based in large part
on social age, to conceptualize human lives from birth to death. Spiritual age indicates the
current position of a person in the ongoing search for meaning, purpose, and moral
relationships.
Michael Bowling appears to be in a different position in his search for life’s meaning
than he was before his stroke. Although life course scholars have not paid much attention to
spiritual age, it has been the subject of study by some developmental psychologists and other
social scientists. In an exploration of the meaning of adulthood edited by Erik Erikson in
1978, several authors explored the markers of adulthood from the viewpoint of a number of
spiritual and religious traditions, including Christianity, Hinduism, Islam, Buddhism, and
Confucianism. James Fowler has presented a theory of faith development, based on 359 in-
depth interviews, that strongly links it with chronological age.
Ken Wilber’s integral theory of consciousness also proposes an association between
age and spiritual development, but Wilber does not suggest that spiritual development is
strictly linear. He notes, as do the contributors to the Erikson book, that there can be
regressions, temporary leaps, and turning points in a person’s spiritual development. Life
course scholars debate whether the trend is toward greater standardization in age-graded
social roles and statuses or toward greater diversification.
Links with Family Members
Researchers have recently examined how women living with hereditary breast and
ovarian cancer risk cope over the life course. One research team studied a sample of women
who had tested positive for a BRCA gene mutation associated with greater risk of breast and
ovarian cancer and found that women cope in different ways at different stages of the adult
life course. Parental hardship has a negative impact on child development, but parents also
provide social capital for their children, in terms of role models and networks of social
support Szydlik, It should also be noted that parents’ lives are influenced by the trajectories
of their children’s lives. One research team found a relationship between the problems of
adult children and the emotional and relational well-being of their parents.
Research participants who reported having adult children with a greater accumulation
of personal and social problems also reported poorer levels of well-being than reported by
participants whose children were reported to have fewer problems. Without longitudinal
research, it is impossible to know which came first, reduced parental well-being or adult child
problems, but this research does lend strong support for the idea that lives are linked across
generations. The pattern of mutual support between older adults and their adult children is
formed by life events and transitions across the life course.
What complicates matters is that family roles must often be synchronized across three
or more generations at once. Similarly, the timing of adult children’s educational, family, and
work transitions often conflicts with the needs of aging parents. When a significant life event
in one generation is juxtaposed with a significant life event in another generation, families
and individual family members are especially vulnerable.
Links with the Wider World
The life course perspective has its origins in Elder’s research on the ways that families
and individuals are linked to situations in the economic institution, and in recent years life
course researchers have been documenting the ways that individual and family life course
trajectories are linked to situations in the labor market, housing market, education system,
and social welfare system . This line of research is well illustrated by one research project
that examined young-adult transitions in Western Europe and Japan. First, changes in the
labor market are driving the delayed departure of young adults from the parental home in
southern Europe and Japan. In the 1980s, when globalization began to produce higher
unemployment, governments in southern Europe and Japan began to loosen their
commitment to lifetime employment.
Unemployment has always been higher in southern Europe than in northern Europe,
but the divergence in young adult transitions in these two European regions is not fully
explained by conditions in the labor market. Second, timing of departure from the parental
home is linked to situations in the housing market. In the United States, there are a number of
housing options for marginally employed young adults, including pooling resources with a
roommate or romantic partner or finding rental housing in a less desirable neighborhood. In
contrast, in the Nordic countries, there is a large rental sector in the housing market, with
only 60% to 65% of the population living in homes they own.
Katherine Newman builds the case that these conditions in the housing market
influence the timing of departure from the parental home. Third, it is often suggested that
there is a linkage between the education system and timing of departure from the parental
home. More specifically, it is argued that young adults who participate in higher education
leave the parental home later than those who do not participate in higher education and that
the trend toward greater participation in higher education is an important factor in the trend
toward later departure from the parental home.
Katherine Newman argues convincingly that it is a confluence of situations in
different societal systems that impact individual and family life trajectories. Using data from
11 European countries, Marc Szydlik has taken a similar look at the influence of the social
welfare system on family solidarity between older adults and their adult children. He found
strong family solidarity across the 11 countries but some differences in how the state and
family are linked across national lines. He found that adult children in countries with strong
social welfare systems provided more practical household help to their aging parents than
adult children in countries with weaker social welfare systems.
On the other hand, adult children in countries with weak social welfare systems
provided more personal care to their aging parents than adult children in countries with
stronger social welfare systems. Szydlik suggests that societies with an aging population need
family-friendly policies to protect family members from excessive demands, noting that
middle-aged adults may get overburdened from the need to care for aging adults while also
supporting their young-adult offspring who are struggling in a labor market becoming
increasingly less secure. Here is another example from the research about how social policy
affects individual and family lives. European countries, one research team found that there is
also an occupational status penalty to motherhood, with motherhood depressing the
occupational status of women over time.
They also found, however, that the motherhood penalty is lower in countries that
provide higher public expenditures on childcare. This is a good example of how links with
family members intersects with links with the wider world. The lifestyles of people in
affluent countries depend on cheap labor and cheap raw products in Africa, South America,
the Caribbean, parts of Asia, and other places. Children and women in impoverished
countries labor long hours to make an increasing share of low-cost products consumed in
affluent countries.
Women migrate from impoverished countries to become the domestic laborers in
affluent countries, allowing women in affluent countries to leave the home to take advantage
of career opportunities and allowing the domestic workers to send the money they make back
home to support their own families. Cross-national research indicates that the social welfare
system has an influence on intergenerational family relationships.
Human Agency in Making Choices
The emphasis on human agency may be one of the most positive contributions of the
life course perspective. Note that the concept of human agency is used by different theorists
in different ways, but when used by life course theorists it refers to "attempts to exert
influence to shape one’s life trajectory”. A look at the discipline of social history might help
to explain why considering human agency is so important to social workers. Social historians
have attempted to correct the traditional focus on lives of elites by studying the lives of
common people.
These findings are consistent with social work approaches that focus on individual,
family, and community strengths. Emphasis on human agency in the life course perspective
has been greatly aided by the work of psychologist Albert Bandura. Bandura proposes that
humans are agentic, meaning they are capable of intentionally influencing their own
functioning and life circumstances. Proxy agency is exercised to influence others who have
greater resources to act on one’s behalf to meet needs and accomplish goals.
Collective agency is exercised on the group level when people act together to meet
needs and accomplish goals. Bandura argues that everyday life requires use of all three
modes of agency. There are many circumstances, such as those just discussed, where
individuals can exercise personal agency to shape situations. However, there are many
situations over which individuals do not have direct control, and they must seek out others
who have greater influence to act on their behalf.
Cultural psychology critics of the concept of human agency argue that it is a culture-
bound concept that does not apply as well in collectivist societies as in individualistic
societies. They argue that individualistic societies operate on a model of disjoint agency,
where agency resides in the independent self. In contrast, collectivist societies operate on a
model of conjoint agency, where agency resides in relationships between interdependent
selves. Markus and Kottayam provide empirical support for their proposal that agency is
experienced differently by members of individualistic and collectivist societies.
They cite several studies providing evidence that European American children
perform better and are more confident if they are allowed to make choices, but Asian
American children perform no better if allowed to make such choices. Markus and Kottayam
do not deny that individuals from collectivist cultures sometimes think in terms of personal
agency and individuals from individualistic cultures sometimes think in terms of collective
agency. They argue, however, that there is a difference in the emphasis placed on these
approaches to agency in different cultures. States, working-class individuals are more likely
than middle-class individuals to follow a conjoint model of agency concerned with
obligations to others.
Engaged in content analysis of 48 social work journals to examine how social work
academic literature deals with the concept of human agency. Clearly, human agency has
limits. They note research indicating that greater perceptions of personal control contribute to
better health among older adults but also propose that agency declines across the life course
because of declining physical functioning. The concepts of proxy agency and collective
agency bring us back to linked and interdependent lives. These concepts add important
dimensions to the discussion of human agency and can serve to counterbalance the extreme
individualism of U. These modes of agency also raise important issues for social workers.
When do we encourage clients to use personal individual agency, when do we use our own
influence as proxy agents for clients, and when is collective agency called for?
Diversity in Life Course Trajectories
Life course researchers have long had strong evidence of diversity in individuals’ life
patterns. Some sociologists have suggested that globalization is leading to less diversity in the
world. However, in their comparative analysis of the work values of Greek. As we attempted
to uncover what is known about human diversity in life course trajectories, we struggled with
terminology to define identity groups. We searched for consistent language to describe
different groups, and we were dedicated to using language that identity groups would use to
describe themselves. However, we ran into challenges endemic to our time related to the
language of diversity. Rather, we use the language of individual researchers when reporting
their studies, because we want to avoid distorting their work.
We hope you will recognize that the ever-changing language of diversity has both
constructive potential to find creative ways to affirm diversity and destructive potential to
dichotomize diversity into the norm and the other. As we strive to provide a global context,
we encounter current controversies about appropriate language to describe different sectors of
the world. World referring to a set of countries that were primarily former colonies of the
First World. This approach has lost favor in recent years because it is thought to suggest
some ranking of the value of the world’s societies. Wallerstein is looking not to rank the
value of societies but to emphasize the ways that some societies exploit other societies. Other
writers divide the world into developed and developing countries, referring to the level of
industrialization, urbanization, and modernization. Although scholars who use those terms
are not necessarily using them to rank the value of different societies, the terms are
sometimes used that way.
Global South. This system of categorization focuses specifically on how some
societies exploit other societies. As with diversity, we attempted to find a respectful language
that could be used consistently throughout the book. Again, we found that different
researchers have used different language and different characteristics to describe categories
of nations, and when reporting on their findings, we have used their own language to avoid
misrepresenting their findings. Life course researchers have recently begun to incorporate
intersectionality theory to understand diversity in life course trajectories. Intersectionality
theory recognizes that all of us are jointly and simultaneously members of a number of
socially constructed identity groups, such as gender, race, ethnicity, social class, sexual
orientation, age, religion, geographical location, and disability/ability identity groups . The
decision to immigrate may involve social, religious, or political persecution, and it
increasingly involves a search for economic gain. Or, as in Phuong Lee’s case, it may involve
war and a dangerous political environment.
The transit experience is sometimes traumatic, as was the case for Phuong Le and her
relatives, who were attacked by pirates and separated, never to see some family members
again. The resettlement experience requires establishment of new social networks, may
involve changes in socioeconomic status, and presents serious demands for acculturating to a
new physical and social environment. Gender, race, social class, and age all add layers of
complexity to the migration experience. Family roles often have to be renegotiated as
children outstrip older family members in learning the new language.
Developmental Risk and Protection
As the life course perspective has continued to evolve, it has more clearly emphasized
the links between the life events and transitions of childhood, adolescence, and adulthood.
Indeed, recent biomedical research has suggested we should look at factors that occur earlier
than childhood, focusing on fetal undernutrition as a contributing factor in late-life cognition
and late-life health conditions such as coronary heart disease, type 2 diabetes, and
hypertension. It is quite an old idea that what happens at one point in the life journey
influences what happens at later points. No doubt you have heard some version of this idea
for most of your life.
However, the idea of earlier life experience affecting later development has taken on
new energy since the explosion of longitudinal research a few decades ago. In longitudinal
research, researchers follow a group of people over a period of time, rather than comparing
different groups at one point in time. This allows them to study individual lives over time,
noting the factors that influence individual life trajectories. Two different research traditions
have examined how early life experiences affect later outcomes, one based in sociology and
the other based in ecological developmental psychology.
The sociological tradition is interested in cumulative advantage/cumulative
disadvantage. As you can see, we are borrowing language from the ecological developmental
tradition. Let’s look first at research that focuses on cumulative advantage/cumulative
disadvantage. Life course scholars have borrowed these concepts from sociologist Robert
Merton to explain inequality within cohorts across the life course.
Leopold found that even in Sweden, a relatively egalitarian country, cumulative
socioeconomic advantage produced health gaps, but the life course pattern of health disparity
was different from the U. Sweden the health gap widened throughout middle adulthood but
came to a halt at the age of 55. Children who do not come from affluent families are more
likely to attend underequipped schools, experience school failure or dropout, begin work in
low-paying sectors of the labor market, experience unemployment, and arrive at old age with
compromised health and limited economic resources. Now let’s look at the other research
tradition. Longitudinal research has also led researchers across several disciplines to study
human lives through the lens of ecological developmental risk and protection.
In the past decade or so, biomedical researchers have proposed an
ecobiodevelopmental framework for studying health and disease across the life course, and
their research has greatly enriched and expanded the ecological developmental risk and
protection approach. They articulate the ways genetic predispositions interact with social and
physical environments to drive development, referring to the human life course as "nature
dancing with nurture over time”. They draw on neuroscience, molecular biology, genomics,
developmental psychology, epidemiology, sociology, and economics to consider how early
life experiences and environmental circumstances can leave a lasting impact on brain
architecture and long-term health. The major focus of ecobiodevelopmental research is on the
ways that early toxic stress disrupts brain development and development in other biological
systems.
Researchers are discovering how environmental conditions and early life experiences
influence "when, how, and to what degree" specific genes are actually activated. Recently,
gerontologists in the life course tradition have tried to integrate the cumulative
advantage/disadvantage and the ecological developmental risk and protection streams of
inquiry. Shipped present a cumulative inequality theory. They propose that advantage and
disadvantage are created across multiple levels of systems, an idea similar to the
multidimensional aspect of the ecological risk and protection approach.
They also propose that "disadvantage increases exposure to risk but advantage
increases exposure to opportunity”. They further submit that "life course trajectories are
shaped by the accumulation of risk, available resources, and human agency”. It is important
to note that neither cumulative advantage/disadvantage theory nor the ecological
developmental risk and protection approach argue that early deprivations and traumas
inevitably lead to a trajectory of failure. Research on cumulative advantage/disadvantage is
finding that cumulative processes are reversible under some conditions, particularly when
human agency is exercised, resources are mobilized, and environmental conditions open
opportunities.
For example, it has been found that when resources are mobilized to create
governmental safety nets for vulnerable families at key life transitions, the effects of
deprivation and trauma on health are reduced. In the ecological developmental risk and
protection stream of inquiry, protective factors provide the antidote to risk factors and
minimize the inevitability of a trajectory of failure. Researchers in this tradition have begun
to recognize the power of humans to use protective factors to assist in a self-righting process
over the life course to fare well in the face of adversity, a process known as resilience. The
life course perspective and the concept of cumulative disadvantage are beginning to influence
community epidemiology, which studies the prevalence of disease across communities.
Researchers in this tradition are interested in social and geographical inequalities in
the distribution of chronic disease. They suggest that risk for chronic disease gradually
accumulates over a life course through episodes of illness, exposure to unfavorable
environments, and unsafe behaviors, which they refer to as a chain-of-risk model. They are
also interested in how some experiences in the life course can break the chain of risk.
Perspective
It encourages greater attention to the impact of historical and sociocultural change on
human behavior, which seems particularly important in rapidly changing global societies. At
the same time, with its attention to human agency, the life course perspective is not as
deterministic as some earlier theories and acknowledges people’s strengths and capacity for
change. Life course researchers are also finding strong evidence for the malleability of risk
factors and the possibilities for preventive interventions. With attention to the diversity in life
course trajectories, the life course perspective provides a good conceptual framework for
culturally sensitive practice.
And finally, the life course perspective lends itself well to research that looks at
cumulative advantage and cumulative disadvantage, adding to our knowledge about the
impact of power and privilege and subsequently suggesting strategies for social justice. To
answer questions about how people change and how they stay the same across a life course is
no simple task, however. Although attention to diversity may be the greatest strength of the
life course perspective, heterogeneity may be its biggest challenge. The life course
perspective, like other behavioral science perspectives, searches for patterns of human
behavior.
Along with trying to understand patterns, social workers must try to understand the
unique circumstances of every case situation. This is true of all existing social and behavioral
science research. I would suggest, however, that there is nothing inherent in either the basic
conceptions or the major themes of the life course perspective that make it inappropriate for
use to understand human behavior at a global level. This is particularly true if human agency
is understood to include proxy agency and collective agency, conjoint as well as disjoint
agency.
Another possible limitation of the life course perspective is a failure to adequately
link the micro world of individual and family lives to the macro world of social institutions
and formal organizations. Social and behavioral sciences have, historically, divided the social
world up into micro and macro and studied them in isolation. The life course perspective was
developed by scholars like Glen Elder Jr. It can probably be said that the life course
perspective does a better job than most other behavioral science theories in this regard.
Integration With a Multidimensional, Multitheoretical Approach
The Council on Social Work Education notes that social work practice is guided by
"knowledge based on scientific inquiry”. " It further states that "social workers understand
that evidence that informs practice derives from multi-disciplinary sources and multiple ways
of knowing" and that social workers understand theories of human behavior and the social
environment" and use that knowledge to engage with, assess, intervene with, and evaluate
practice with individuals, families, groups, organizations, and communities. The life course
perspective was derived from and is continually informed by multidisciplinary research,
using both qualitative and quantitative methods as well as historical analysis.
The life course perspective has many implications for social work practice, including
the following. Engage clients to make sense of their unique life journeys so they can use that
understanding to improve their current situations. Where appropriate, use life event
inventories to assess the level of stress in a client’s life. Be aware of the potential to develop
social work interventions that can serve as turning points that help individuals, families, small
groups, communities, and organizations get back on track.
Work with the media to keep the public informed about the impact of changing social
conditions on individuals, families, communities, and formal organizations. Use existing
multidisciplinary research on risk, protection, and resilience to assess and intervene with
individuals and families and to develop community-based prevention programs. One research
team found that 99% of young-adult respondents to a survey on turning points reported that
there had been turning points in their lives. If they answer no, ask about whether they see
their life as a straight path or a path with twists and turns. Suarez, Michael Bowling, and
Phuong Le with Rutter’s three types of life events that can serve as turning points and
Heaven’s five conditions under which a transition can become a turning point. This may be
you, a friend, a coworker, a family member, or a character from a book or movie.
No doubt you use the Internet in many ways and know your way around it. I hope that
when you find something in this book that confuses or intrigues you, you will use the
incredibly rich resources of the Internet to do further exploration. To help you get started with
this process, each chapter of this textbook contains a list of Internet resources and websites
that may be useful in your search for further information. Readers should be aware that the
information contained in websites may not be truthful or reliable and should be confirmed
before being used as a reference.
Many of the Internet sites listed in each chapter contain links to other Internet sites
containing more information on the topic. You should use several search engines when
researching a topic, for each will retrieve different Internet sites. Summarize some themes in
the sociocultural context of conception, 2.3 Recognize important mechanisms of reproductive
genetics. Analyze the ways that humans try to get control over conception and pregnancy.
Give examples of risk factors and protective factors in conception, 2.9 Apply knowledge of
conception, pregnancy, and childbirth to recommend guidelines for social work engagement,
assessment, intervention, and evaluation.
Jennifer Bradshaw’s Experience with Infertility
Jennifer Bradshaw always knew she would be a mom. Now, at 36, the dream of
having her own baby is still just a dream as she struggles with infertility. Like many women
in her age group, Jennifer spent her late teens and 20s trying not to get pregnant. As an
African American woman, and the first person in her family to earn a graduate degree, she
wanted to prove that she could be a successful clinical social worker.
When the time finally was right and she and her husband, Allan, decided to get
pregnant, they couldn’t. With every passing month and every negative pregnancy test,
Jennifer’s frustration grew. In addition, she was frustrated with her family and friends and
started avoiding them to escape their comments and the next baby shower. After months of
struggling to get pregnant, multiple visits to the obstetrician/gynecologist, a laparoscopic
surgery, a semen analysis, and timed intercourse, and after taking Clamed, a fertility drug that
made her feel horrible, she and Allan finally accepted that they might need to see a specialist.
She was expecting a "quick fix," thinking that the RE would give her some special
pills and then she would get pregnant. From her clinical practice and her friendship circle,
Jennifer knows that many women think of in vitro as a backup plan when they delay
pregnancy. Jennifer has heard of couples spending close to $100,000 for infertility
treatments. So at the very least, Jennifer and Allan would need to come up with $16,000 to
give one IVF cycle a try. They have heard of people packing up and moving to states with
mandated fertility coverage and/or quitting their jobs and finding jobs that carry specific
insurance that will cover fertility treatments. Some couples are even traveling abroad for
fertility treatments that can be had for much less than in the United States.
Jennifer has heard that IVF is physically and emotionally exhausting. Throughout this
process, various hormone treatments are given via daily injections, multiple blood tests are
taken, and at any point during the procedure something could go wrong and the IVF cycle
could be called off. If all goes well, the IVF patient is left to keep her fingers crossed for the
next 2 weeks waiting for a positive pregnancy test. Jennifer has heard that most women are
an emotional wreck during the entire process because of the high stakes and the artificial
hormones.
Jennifer and Allan decided to go the IVF route 7 months after visiting the BBT,
purchased a high-tech electronic fertility monitor, used an ovulation microscope, took
multiple fertility supplements, and used sperm-friendly lubricant during intercourse. When
she heard that acupuncture has been found to increase the success rate of IVF, she started
seeing a fertility acupuncturist on a weekly basis for both herbal formulas and acupuncture
treatments.
Within days of discovering she was pregnant, Felicia Thompson’s husband, Will,
suddenly deployed to a combat zone. Through e-mails, occasional cell phone calls, and
Skype, Felicia told Will details about the changes she experienced with the pregnancy, but his
world was filled with smoke, dirt, bombs, and danger, punctuated with periods of boredom.
Six months into the pregnancy, Felicia’s changing figure was eliciting comments from her
coworkers in the office where she worked part time as an office administrator. She avoided
all news media as well as "war talk" at the office to protect herself from worry and anxiety.
Yet even the sound of an unexpected car pulling up to the front of her home produced
chills of panic. Her best friend only recently had experienced what every military wife fears
may happen. Then, with dawn hours away, Felicia woke to cramping and blood. With 14
more weeks before her delivery date, Felicia was seized with fear. Wishing that Will were
there, Felicia fervently prayed for herself and her fetus. Felicia knew everything would be
fine if only she could feel her son kick. The pediatrician spoke of the risks of early delivery,
and suddenly the doctors were telling her to push her son into the world. About an hour after
giving birth, Felicia saw Paul for the first time.
It mattered because Paul may not even be alive by the time Will found out he was
born. If he were granted permission for emergency leave, it could be days of arduous travel,
waiting for space on any military plane, before he landed somewhere in the United States.
Thirteen days after his arrival, Paul took his first breath by himself. Now that her baby was
off the ventilator, she watched Paul periodically miss a breath, which would lead to a
decreased heart rate followed by monitors flashing and beeping. Will arrived home 2 days
later. Although Paul would spend the next 10 weeks in the hospital, Will had 14 days before
starting the journey back to his job. Paul’s struggle to survive was the most exhilarating yet
terrifying rollercoaster ride of his parents’ lives. Now Felicia dreaded the phone as well as the
sound of an unfamiliar car.
Paul was followed by the long trip home to the empty nursery. Felicia feared the
arrival of a car with officers in it, and Will dreaded a Red Cross message that his son had
died. Great joy and equally intense anxiety pervaded Paul’s homecoming day. After spending
53 days in the NICU and still weighing only 4 pounds, 13 ounces, Paul was handed to his
mother. In the past 53 days, the social worker has helped Felicia answer her questions,
understand the unfamiliar medical language of the health care providers, and understand and
cope with the strong emotions she is experiencing. The social worker also helped during the
transition of Will’s arrival from war and his departure back to war. Understanding the
dynamics of the NICU, families in crisis, and the needs of the military family separated by an
international conflict is critical to providing this family the level of support they need to
manage their multifaceted role transitions. These three stories tell us that conception,
pregnancy, and childbirth are experienced in different ways by different people.
The biological processes vary little for the vast majority of women and their families,
but researchers continue to study the psychological, social, and spiritual dimensions of
childbearing. This chapter presents a multidimensional overview of current knowledge about
conception, pregnancy, and childbirth gleaned from the literatures of anthropology, genetics,
medicine, nursing, psychology, social work, and sociology. As you read, keep in mind that all
elements of childbearing have deep meaning for a society. We can draw on the social
constructionist perspective to think about this. This perspective proposes that social reality is
created when people, in social interaction, develop shared meaning, a common understanding
of their world. States are in the midst of an ongoing national debate about health care policy,
and social workers will need to monitor the impact of proposed policies on the well-being of
women and their families during the childbearing years.
The birth rate has declined, resulting in smaller families. Teen pregnancy is at a
historic low. There are greater variations in family values and sexual mores than in previous
generations. Parents are less subject to traditional gender-role stereotyping. It is becoming
much more common for gay and lesbian individuals and couples to become parents. These
trends have prompted considerable debate over how our society should define family. The
family operates at the intersection of society and the individual.
It too is influenced by religious orientations, social customs, changing values,
economics, and even political ideologies. Progressive Era when the Red Cross set up hygiene
and health care classes for women as a public health initiative. Bureau, created as a new
federal agency to inform women about personal hygiene and birth, published a handbook
titled Prenatal Care, emphasizing the need for medical supervision during pregnancy Barker,
Photo 2.1 Societal views of pregnancy in the United States have changed from simply
waiting to being actively involved in nurturing the mother’s and baby’s health. Childbirth
education, as a formal structure, took hold in the United States and other wealthy countries in
the 1960s, fueled by the women’s and grassroots consumer movements. Pioneers in the
childbirth education movement were reacting against the increasing medicalization of
childbirth, and they encouraged women to regain control over the childbirth process. Early
childbirth education classes were based on books by Grandly Dick-Read, Childbirth without
Fear, and French obstetrician Dr. Fernand Lamaze, Painless Childbirth.
Lamaze proposed that women could use their intellect to control pain while giving
birth if they were informed about their bodies and used relaxation and breathing techniques.
Pioneers in the childbirth education movement believed that such childbirth classes would
provide the knowledge and skills women needed to change maternity practices, and indeed,
the movement had an impact on the development of family-centered maternity practices such
as the presence of fathers in labor and delivery and babies rooming with mothers after birth.
Over time, childbirth education became institutionalized and was taught in large classes
based in hospitals. There have been many societal changes in the 50 years since childbirth
education was formalized, and in 2007, DeVry’s and DeVry’s suggested that childbirth
education as it currently exists fits the ethos of the 1960s but is out of step with current
societal trends.
Here are some examples of how the experience of pregnancy and childbirth has
changed since the early days of the childbirth education movement. Pregnant women had few
sources of information about pregnancy and birth in the 1960s, but women today are
overloaded with information from multiple sources. Survey of women’s childbearing
experiences found that besides maternity care providers and childbirth education classes,
women reported getting information from online resources by using a number of devices,
including smartphone and tablet. Two out of three women received weekly educational e-
mail messages, and one quarter received regular text messages about pregnancy and
childbirth. Other researchers have found that women rely heavily on the Internet and reality
television shows with a birth theme for this information. Women also make use of a plethora
of books on pregnancy-based topics and learn from friends and family. Unfortunately,
women may need help in sorting out inaccurate and out-of-date information from any of these
sources. The current generation of pregnant women is more likely than the earlier cohort of
pregnant women to be involved in a variety of health promotion activities that will help them
manage childbirth.
One trend in maternity care is to provide group appointments for prenatal care,
incorporating education and group support along with maternity checkups. Research shows
that some women prefer group care and have better pregnancy and birth outcomes when
participating in group care. The current cohort of pregnant women are more likely to be
unmarried than was true 50 years ago. The emphasis on husband involvement in traditional
models of childbirth education may not resonate with many of these women. The current
population of pregnant women is much more culturally diverse than the White, middle-class
women for whom childbirth education was designed. Research indicates that childbirth
education classes are still made up largely of White, middle-class women. Many new
technological and pharmaceutical childbirth interventions have been introduced in the past 15
years, and many contemporary pregnant women prefer high-tech, pain-free, and scheduled
birth. This is not a good fit with models of childbirth education from the earlier era that
discourage medical intervention.
There is some evidence, however, that today’s women are given little choice in
whether to use medical interventions. A number of government initiatives promote access to
childbirth resources, initiated by the Maternity Care Access Act of 1989, which provided
support for low-income women. Healthy People 2000, 2010, and 2020, an effort by the
federal government to enhance the nation’s health, supports prenatal education. The research
is inconclusive about whether childbirth education classes in the traditional model produce
better pregnancy and childbirth outcomes, and there are mixed results as to whether the
father’s role is enhanced through childbirth education.
In a recent review of randomized trials of childbirth education, one research team
found that the evidence indicates that expectant fathers who participated in childbirth
education reported lower parenting stress 3 months after birth than expectant fathers who did
not participate in childbirth education. As childbirth education branches from the traditional
classroom model to home-based services and interactive media presentations, it is important
for social workers to help parents negotiate the changing landscape to make the choice that
fits them the best while ensuring that the educational needs of parents of all racial and ethnic
groups, economic circumstances, disabilities, and localities are met Linn, Wilson, & Fake,
Large changes in the place of childbirth have occurred in many parts of the world in the past
century. In 1900, almost all births in the United States and other countries occurred outside of
hospitals, usually at home. Today, in high- and moderate-income countries, labor wards in
hospitals are the usual settings for childbirth.
In the early part of the 20th century, the feminist movement advocated for hospital
childbirth because it was considered to be safer than home birth, but beginning in the 1960s,
feminists began to advocate for less invasive deliveries in more friendly environments that
give women more choices over their care. United States and other wealthy countries, a
variety of institutional care settings have been developed, ranging from freestanding birth
centers located near a hospital to more home-like birthing rooms within hospital labor
departments. In some of these countries, birthing shelters provide dormitory rooms near
hospitals so that women can receive emergency care during childbirth if the need arises.
Although alternatives to conventional hospital settings, such as birthing centers and home-
like birthing rooms, have been somewhat slow to develop in the United States, they are not
considered controversial, and available research indicates some benefits and no drawbacks to
them.
Women giving birth in such settings have reduced likelihood of medical interventions,
increased likelihood of spontaneous vaginal birth, and increased satisfaction. Home birth has
been very controversial, however. American College of Obstetricians and Gynecologists
issued a policy statement that protested in-home births and asserted that acceptable levels of
safety were only available in the hospital. Academy of Pediatrics, who noted that babies born
during a planned home birth have a two- to threefold increased risk of death. In response, in
2012, three major midwifery groups strongly endorsed the practice of home delivery and
challenged the medical profession to consider the advantages of a woman delivering her
neonate in the sanctity of her home. In 2014, most midwives worked in a hospital setting, 3%
worked in birthing centers, and 2.7% attended home deliveries. One research team examined
the qualitative research on fathers’ involvement with childbirth published from 1999 to 2009.
They felt frustrated about their helplessness to relieve their partner’s pain, they felt good
when they could support their partner but bad when they did not feel supported by the
childbirth team, and they found the transition to fatherhood to be profoundly life changing. In
the past 3 decades, birth doulas have become a part of the childbirth experience for increasing
numbers of women.
Recognition of the need for genetics knowledge is not new to social work. In fact,
Mary Richmond advocated that a social worker "get the facts of heredity," in the face of
marriage between close relatives, miscarriage, tuberculosis, alcoholism, mental disorder,
nervousness, epilepsy, cancer, deformities or abnormalities, or an exceptional ability. As
genetic knowledge continued to grow, the National Association of Social Workers
established Standards for Integrating Genetics into Social Work Practice in 2003. Genetic
research continues around the world, with future findings that will impact social work
practice. Chromosomes and genes are the essential components of the hereditary process. As
you can see in Exhibit 2.1, when the sperm penetrates the ovum, the parents’ chromosomes
combine to make a total of 46 chromosomes arrayed in 23 pairs. The genes constitute a
"map" that guides the protein and enzyme reactions for every subsequent cell in the
developing person and across the life course. Thus, almost every physical trait and many
behavioral traits are influenced by the combined genes from the ovum and sperm.
Pairs
The Human Genome Project researchers estimated that there are 20,000 to 25,000
genes in human DNA, with a broad range of total genes across all chromosomes. Ongoing
research has reduced the number of genes to 19,000 to 20,000, instead of the 20,000 to
25,000 originally identified. Every person has a unique genotype, or array of genes, unless
the person is an identical twin. Yet the environment may influence how each gene pilots the
growth of cells. The exception is the last pair of chromosomes, the sex chromosomes, which,
among other things, determine sex. The ovum can contribute only an X chromosome to the
23rd pair, but the sperm can contribute either an X or a Y and therefore determines the sex of
the developing person. A gene on one sex chromosome that does not have a counterpart on
the other sex chromosome creates a sex-linked trait. A gene for red/green color blindness, for
example, is carried only on the X chromosome.
When an X chromosome that carries this gene is paired with a Y chromosome, which
could not carry the gene, red/green color blindness is manifested. Whether genes express
certain traits depends on their being either dominant or recessive. Traits governed by
recessive genes will only be expressed if the responsible gene is present on each chromosome
of the relevant pair. In contrast, traits governed by dominant genes will be expressed even if
only one chromosome has the gene.
When the genes on a chromosome pair give competing yet controlling messages, they
are called interactive genes, meaning that both messages may be followed to varying degrees.
Such evaluation could lead to difficult decisions ranging from abortion to preparation for
parenting a child with a disability. However, these options typically are laced with economic,
political, legal, ethical, moral, and religious considerations. Ethical issues related to genetic
engineering have an impact not only at the individual and family levels but also at the societal
level. For example, when we are able to manipulate genes at will, we must be on guard
against genetic elitism.
It is one thing to use genetic engineering to eliminate such inherited diseases as
sickle-cell anemia but quite another to use it to select the sex, body type, or coloring of a
child. As increasing numbers of persons gain the ability to control conception, plan
pregnancy, and control pregnancy outcomes, social workers need to protect the interests of
those who lack the knowledge and other resources to do so. One way that humans exercise
human agency is to attempt to get control over conception and pregnancy. The desire to plan
the timing of childbearing is an ancient one, as is the desire to stimulate pregnancy in the
event of infertility. Contraception and induced abortion have probably always existed in
every culture but continue to generate much controversy.
Although there is evidence that many women of the world want to control conception
and pregnancy, unintended pregnancy is a global problem, estimated to be 40% of all
pregnancies worldwide. About 45% of all pregnancies in the United States are unintended.
The unintended pregnancy rate is significantly higher in the United States than in many other
wealthy nations. A greater percentage of unintended pregnancies are reported by teenagers,
women aged 18 to 24, cohabiting women, low-income and less educated women, and
minority women.
For those pregnancies resulting in birth, unintended births are associated with delayed
or no prenatal care, smoking during pregnancy, low birth weight, and no breastfeeding.
Unintended pregnancy and birth are also associated with increased likelihood of perinatal
depression, psychological aggression, and neglect in mothers and physical aggression in
fathers. The range of birth control options available today provides women and men in many
parts of the world with the ability to plan pregnancy and childbirth more than ever before.
Women of reproductive age use some form of contraception, and 99.1% of sexually active
women use a contraceptive during their lifetime.
However, it is estimated that 214 million women in low-income countries who don’t
want to get pregnant have no access to contraceptives. Researchers have found that highly
restrictive abortion laws do not lead to fewer abortions. Global data indicate that the abortion
rate is lowest in regions of the world that have liberal abortion laws. Abortion laws do make a
difference, however, in whether abortion is safe or unsafe. Three years later, in 1976, the
Hyde Amendment limited federal funding for abortion, and the Supreme Court ruled in 1989,
in Webster v. Reproductive Health Services, that Medicaid could no longer fund abortions,
except in cases of rape, incest, or life endangerment. Renewed annually, this ban on the use
of federal funds for abortion has now extended to all federal employees and women in the
military and the Indian Health Service. With much of the decision making related to abortion
left to the states, there is wide variation in who has access to abortion, when, how, and at
what cost.
Data from 2013 indicate that 89% of abortions in the United States are performed
during the first 12 weeks of pregnancy, 10% from 13 to 20 weeks, and 1.3% after 21 weeks.
Recent controversy regarding procedures for terminating a pregnancy after fetal viability has
called attention to ethical and legal dilemmas that are being addressed in the legal system, by
most religions, and in other parts of U. White women receive 39% of abortions, non-Hispanic
Black women receive 28%, and Hispanic women receive 25%. Women who have never
married and are not cohabiting receive 46% of abortions, and 59% are obtained by women
who have one or more children. About half, 49%, of women obtaining abortions have
incomes 100% below the federal poverty level. Two types of abortion are available to
women. Medication abortion. Medication abortion is the term used to refer to an abortion
brought about by medication taken to end pregnancy. The number of medication abortions
increased from 2001 to 2011 while the overall number of abortions declined.
There are several surgical options, depending on how far along a woman is in her
pregnancy. The standard first-trimester vacuum aspiration, also called D&A is the type most
frequently performed in the first 16 weeks after the woman’s last period. A suction device is
threaded through the cervix to remove the contents of the uterus. This involves instruments,
such as forceps, to empty the uterus.
Regardless of the timing or type of abortion, most women should be carefully
counseled before and after the procedure. One research team found that more than 85% of
women reported feeling at least one negative reaction, such as grief, guilt, sadness, or sorrow,
after having an abortion. These negative reactions were offset by positive reactions, and over
85% of the women also reported feeling relief, happiness, and satisfaction. Another research
team found that women who had risk factors such as physical or sexual abuse prior to
abortion were more likely to have mental health issues after abortion.
They also found that women with prior mood and anxiety disorders were more likely
to have multiple abortions. It is important for social workers working with clients with
unintended pregnancy to assess for prior traumatic experiences as well as know the current
federal and state legalities and resources, especially when clients have limited income.
Infertility, the inability to create a viable embryo after 1 year of intercourse without
contraception, is a major life stressor. Because both male and female factors are involved,
determining infertility prevalence rates is challenging. It is estimated that one in four couples
in low-income countries struggle with infertility and that 12.1% of women in the United
States have reduced fertility and 6.7% are infertile. It is estimated that one third of the
problems reside in the man and one third in the woman. Sometimes no cause can be found
MedlinePlus, Jennifer Bradshaw poignantly conveys her emotional distress about infertility,
but we don’t know much about what her husband was experiencing. Although it is thought
that infertility causes emotional distress to both women and men, little is known about the
impact on men.
Recent research indicates that men with the most infertility distress are likely to see
infertility as an attack on their masculinity and perceived need to maintain emotional control.
Available research indicates that infertility places women at risk for depression, anxiety,
substance abuse, social stress, isolation, and marital dissatisfaction. Women have traditionally
sought informal support whereas men have focused on the financial impact of infertility.
Social support, specifically a positive marital relationship, has been found to be positively
associated with increased coping skills, but the process of disclosing one’s infertility to others
can increase anxiety.
Both the experience of infertility and the treatment of infertility can cause emotional
distress. The causes of infertility are many and complex. Infertility, like other aspects of
human behavior, is multidetermined. Fertility decreases as men and women age. There are
racial differences in infertility in the United States, with Black and Hispanic women having
twice the rate but using infertility services significantly less than White women. Women may
be advised to lose or gain weight or to modify exercise habits to maximize the chances of
ovulation and pregnancy. Medications may be used to help women ovulate, to treat infections
in both men and women, and to treat ejaculation problems in men. Surgeries may be used to
correct structural problems in the reproductive systems of both men and women.
ART is any fertility treatment in which both eggs and embryos are handled. As
demonstrated by the Jennifer Bradshaw case, by the time a couple considers the use of ART,
they have often struggled with infertility for some time, emotionally and physically, and may
be desperate. The woman is treated with a drug that causes the ovaries to produce multiple
eggs. Mature eggs are surgically removed from the woman and combined with sperm in a
dish in the lab. Healthy embryos are then implanted in the woman’s uterus. This method is
often used when a woman’s fallopian tubes are blocked or a man produces too few sperm.
Some clinics allow partial or complete refunds if pregnancy does not occur with higher-
priced multiple-cycle plans, a practice referred to as "shared risk”. Success rates vary, but
most clinics suggest that with a single cycle of IVF, there is a 40% success rate for women
age 34 and younger, 4% for women age 40, and 1% for women age 44.
Previously frozen eggs may also be used, but the rate of success decreases.
Intracytoplasmic sperm injection. ICSI is typically used for couples when there are serious
problems with the sperm. A couple may use donor eggs to be fertilized with the sperm of the
male partner and then have the fertilized egg placed in the uterus of the female partner. The
resulting child will be genetically related to the egg donor and the male partner. Another
option is to implant a gestational carrier with the couple’s embryo produced through IVF.
This option may be used when the woman can produce healthy eggs but is unable to carry a
pregnancy to term. Donor eggs or sperm may also be used in IVF to produce the embryo,
which is then placed in the gestational carrier.
The costs of using a gestational carrier can easily reach $100,000 because insurance
usually does not cover the medical costs of the pregnancy Herron, Intrauterine insemination.
Healthy sperm are collected, washed, and concentrated, then placed directly into the uterus
through a fine tube inserted through the cervix around the time the ovary releases one or more
eggs. It is the primary treatment for male infertility. It is also the treatment of choice for
lesbian couples and single parents, using sperm of a male donor.
The sperm of the male partner of a couple may also be placed in the uterus of a
surrogate who gestates and carries the pregnancy for the couple. The resulting child will be
biologically related to the male partner and the surrogate, but not to the female partner in the
couple. Some centers continue to incubate the embryos in a laboratory setting because this
method allows direct observation of the embryos. Many women feel that this method is more
natural and provides emotional bonding.
Uterine transplantation is another infertility treatment that is on the frontier. The
embryos are harvested and checked at the 8-cell growth level, and those with genetic defects
are not implanted. Another issue is what should happen to unused embryos created by IVF.
There are also questions about whether embryos created by IVF should be allowed to be
selected based on gender or specific physical traits.
Sexual intercourse results in the release of an average of 200 million to 300 million
sperm. Their life span is relatively short, and their journey through the female reproductive
tract is fraught with hazards. Thus, only about one or two in 1,000 of the original sperm reach
the fallopian tubes, which lead from the ovaries to the uterus. Typically, only one sperm
penetrates the ripened ovum, triggering a biochemical reaction that prevents entry of any
other sperm.
The zygote continues to divide and begins an approximately 7-day journey to the
uterus. Following implantation in the uterine wall, the zygote matures into an embryo. The
placenta, which acts like a filter between the mother and the growing embryo, also forms.
Amniotic fluid in the uterus protects the embryo throughout the pregnancy. Researchers have
discovered that offspring of women who were either obese or pregnant during a famine were
at significantly increased risk for developing schizophrenia. Is thiocyanate and cruciferous
vegetables, beta-carotenes, and carotenoid lycopene’s have been found to promote healthy
cellular growth in the fetus. States result in an ectopic pregnancy. Women older than 35 have
a 3.5%greater chance of an ectopic pregnancy.
Women who experience one ectopic pregnancy have higher rates of future ectopic
pregnancies and infertility. Chlamydia, the most commonly occurring sexually transmitted
disease, increases the risk for an ectopic pregnancy. With advancements in ultrasound
technology and microsurgery, the maternal mortality rates in cases of ectopic pregnancy have
decreased. The treatment for ectopic pregnancy is either medication to terminate the
pregnancy or surgery.
By about the 8th week after fertilization, the embryo implanted in the uterine wall is
mature enough to be called a fetus, or unborn baby, and the mother is experiencing signs of
her pregnancy. Usually the mother has now missed one or two menstrual periods, but if her
cycle was irregular, this may not be a reliable sign. A multigravida, or woman who has had a
previous pregnancy, often recognizes the signs of excessive fatigue and soreness in her
breasts as a sign of pregnancy. Approximately 80% of women experience nausea and
vomiting during the first trimester, as was the case for Felicia Thompson.
It has been found that women are at a greater risk for morning sickness if there is a
low protein intake. Some early studies have demonstrated that there may be positive benefits
in stabilizing early fetal nutrition when a woman experiences morning sickness. Hyperemesis
gravid arum occurs in about 1% of all pregnant women and is characterized by excessive and
persistent nausea and vomiting. Teaching the mother progressive muscle relaxation along
with medication management has been shown to reduce HG.
From the 7th to 12th week, the fetal heart rate can be heard using an At 12 weeks, the
sex of the fetus usually can be detected, and the face is fully formed. The fetus is moving
within the mother, but it is still too early for her to feel the movement. Newly pregnant
women often feel ambivalence. Maternal depression, occurring in 10% of pregnant women,
increases the rate of prematurity, low birth weight, intrauterine growth restriction, and
postnatal complications.
Parents who have previously miscarried may have a heightened concern for the well-
being of this fetus. Miscarriage, or spontaneous abortion, is a pregnancy loss prior to 20
weeks of gestation and is most prevalent in the first trimester. Approximately 17% of
pregnancies end in miscarriage, 18% in medical abortion, and 65% in live birth. Recurrent
miscarriage, three or more consecutive miscarriages, occurs in 1% of women and carries a
higher risk for maternal and fetal complications. Sometimes the causes of miscarriage are not
clear, but researchers have identified a number of potential causes. It is estimated that about
half of all miscarriages are caused by abnormalities in the genetic makeup of the fetus.
Chronic conditions such as uncontrolled diabetes, thyroid disease, high BMI, and other
underlying maternal health conditions increase the risk of miscarriage, as do smoking and
alcohol use. These symptoms do not always mean a woman is having a miscarriage, and
sometimes miscarriage happens with no symptoms.
Women may take medication to help the body pass the miscarriage, and sometimes
surgery is needed to complete the miscarriage. Counseling of women who struggle with
miscarriages focuses on genetics and the biopsychological needs of the woman and her
family. Social workers need to understand the possibility of both short-term and long-term
grief following a pregnancy loss and attachment issues that might arise during subsequent
pregnancies. They should be prepared to talk with women about whether a subsequent
pregnancy is planned, the importance the mother attributes to motherhood, and fertility
issues.
By the 16th week, the fetus is approximately 19 centimeters long and weighs 100
grams. The most rapid period of brain development is during the second trimester. In recent
years, there have been controversies about pregnant women eating fish, but recent evidence
shows that eating fish during the second trimester may have a positive effect on fetal
birthweight. The second trimester is generally a period of contentment and planning for most
women, as it seems to have been for Felicia Thompson.
Fetal differentiation, whereby the mother separates the individuality of the fetus from
her own personhood, is usually completed by the end of this trimester. Many fathers too
begin to relate to the fetus as a developing offspring. Some fathers enjoy the changing shape
of the woman’s body, but others may struggle with the changes. Unless there are specific
contraindications, sexual relations may continue throughout the pregnancy, and some men
find the second trimester a period of great sexual satisfaction. Often during the second
trimester the pregnant woman also experiences a return of her prepregnancy level of sexual
desire. The third trimester is critical for continued fetal development and preparation for
birth. The mother must be able to effectively meet both her nutritional needs and those of the
growing fetus. Women who have excessive weight gain are at risk for preterm delivery and
higher rates of cesarean section.
Spouses who smoke increase the nicotine level in the nonsmoking pregnant woman,
even if the spouse smokes outside. The provision of in-home services early in the pregnancy
to encourage smoking cessation has been shown to be effective in reducing the incidence of
smoking during the third trimester. More than 30% of women are iron-deficient by the third
trimester, placing the neonate at risk for anemia. In addition, maternal stress can reduce
fetoplacental blood flow and fetal weight gain. Today, a 3-D diffusion tensor image MRI can
be used to visualize the movement in the fetal brain. By 24 weeks, the fetus is considered
viable in many hospitals. In spite of fetal viability, parents are not usually prepared for
childbirth early in the third trimester. The tasks of the fetus during the third trimester are to
gain weight and mature in preparation for delivery.
As delivery nears, the increased weight of the fetus can cause discomfort for the
mother, and often she looks forward to delivery with increasing anticipation. The amniotic
fluid is usually released during this stage, and the mother feels regular contractions that
intensify in frequency and strength as labor progresses. Many factors determine the length of
this stage, including the number of pregnancies the mother has experienced, the weight of the
fetus, the anatomy of the mother, the strength of the contractions, and the relaxation of the
mother in the process. Near the end of this phase, "transition" occurs, marked by a significant
increase in the intensity and frequency of the contractions and by heightened maternal
emotionalism.
The second stage is delivery, when the neonate is expelled from the mother. If the
newborn is born breech or is transverse and cannot be turned prior to birth, the mother may
require a cesarean section. Typically, within 1 hour after delivery, the placenta, the remaining
amniotic fluid, and the membrane that separated the fetus from the uterine wall are delivered
with a few contractions. If the newborn breastfeeds immediately, the hormone oxytocin is
released to stimulate these contractions.
Following birth, the neonate undergoes rapid physiological changes, particularly in its
respiratory and cardiac systems. Prior to birth, oxygen is delivered to the fetus through the
umbilical vein, and carbon dioxide is eliminated by the two umbilical arteries. Although the
fetus begins to breathe prior to birth, breathing serves no purpose until after delivery. The
neonate’s first breath, typically in the form of a cry, creates tremendous pressure within the
lungs, which clears amniotic fluid and triggers the opening and closing of several shunts and
vessels in the heart.
