Human Growth and Reproduction Conception Pregnancy and Childbirth

Human Growth and Reproduction

Conception, Pregnancy, and Childbirth – Chapter 6 • • Identify the physiological elements and processes of conception. Where does conception take place? How long does the sperm live inside the woman's body? What is process of one sperm penetrating the egg? (Note: hyaluronidase) 120 121 How can you improve chances of conception? How long do the sperm live in the woman's body. When should intercourse be timed right? (Position during sex, remain on her back, acidity and sperm, lubricants and suppositories) 122 123 Differentiate between zygote, embryo, and fetus in terms of gestation. 121 122 Describe the nine months of pregnancy in terms of trimesters: first, second and third trimester; birth stages: first stage (effacement, dilation , transition phase), second stage (crowning, episiotomy); third stage (placenta and fetal membranes expelled). 121 122; 123 Describe the embryonic of development (first eight weeks). Note: ectoderm, endoderm, and mesoderm) 123 Discuss the function of the placenta and what passes back and forth between the baby and the woman and what does not. (Note: human chloride gonadotropin, umbilical cord, and amniotic fluid) 123, 125 Differentiate between the fetal developments in the first, second and third trimesters. Why is the first trimester the most remarkable stage of the three trimesters? When can the gender be determined? When does quickening or movements of the fetus occur? 125 126

Conception, Pregnancy, and Childbirth – Chapter 6 (continued) • • Identify what occurs during the first, second and third trimester's of pregnancy for the woman. What are the early signs of pregnancy? Differentiate between false positives and false negative pregnancy tests (Are Braxton Hicks contractions not part of the labor pains? ). Describe and calculate gestational age using Nagele's rule. Describe physical changes. Describe psychological changes during pregnancy factors of depression, and social support. 126 7 Discuss the father's role in pregnancy. How does prolactin and testosterone relate to father's paternal behavior? What percent of fathers were ambivalent about fathering? Discuss sex during pregnancy. What is possible; what is the “safe” period? ; what is beneficial? , and; what couples can do to experience sexual pleasure besides intercourse? 131 Discuss nutrition during pregnancy, and effects of drugs taken during pregnancy. What psychotropic drugs are used for depression. Which ones are good and which ones are not? 131 4 Describe the first, second, and third stages of labor. What is an episiotomy? Discuss the increase in cesarean section versus vaginal birth. 135 137 Describe the two basic techniques in the Lamaze method. What are some anesthetics in childbirth, home birth, versus hospital birth? 138

Conception, Pregnancy, and Childbirth – Chapter 6 (continued) • • • Discuss the psychological changes a mother experiences during the postpartum period. Differentiate between: postpartum blues, postpartum depression, and postpartum psychosis. 141 What are the rates of sex during the postpartum period. How does breast feeding relate to sexual activity? 142 144 Identify problem pregnancies including, false pregnancy (pseudocyesis), an ectopic pregnancy (note: how do some forms of contraception relate to this problem? ), and miscarriage. 144 147 Discuss pregnancy induced hypertension (hypertension, preeclampsia, and eclampsia a woman may die!) 145 What is meant by “teratogenic? ” Discuss rubella and herpes simplex in the context of viruses crossing the placental barrier. Identify specific birth defects in the US. and how can these be discovered? (amniocentesis, chlorionic villus sampling (CVS), Rh incompatibility What is the appropriate timing for these tests? What is the “risk” of fetal loss? ) 145 147 Discuss infertility in both men and women, including factors and treatments. Identify new reproductive technologies, including artificial insemination, GIFT, cloning, and test tube babies. 149 153

Sperm reach ovum. and cluster around it

Conception: a man has an orgasm and ejaculates inside the woman's vagina; the sperm are deposited into vagina, there to begin their journey toward the egg; of the original 200 million sperm, only about 2000 reach the two containing the egg; sperm are capable swimming 1 to 3 cm per hour, although it has been documented that sperm may survive at the egg within 1 and 1/2 hours after ejaculation; muscular contractions in the uterus may help speed them along; for the purposes of conceiving, is probably best to have intercourse about every 24 to 48 hours or about four times during the week in which the women is to ovulate (it takes a while to manufacture 200 million sperm -- at least 24 hours). Sperm live inside the woman's body for up to five days. The egg is capable of being fertilized for about the first 12 to 24 hours after ovulation. Conception occurs, not in the uterus but in the outer third (the part near the ovary) of the fallopian tube. Sperm swarm around the egg and secrete an enzyme called hyaluronidase.

Sperm Meets Egg: The Incredible Journey

When the sperm penetrates the egg, the egg immediately releases a chemical creating a hard “shell” around it to keep all other sperm out

The placenta is the lining of the uterus that the umbilical cord will attach to. While nutrients and oxygen move across the placental wall, the embryo’s blood and the mother’s blood never mix

Blastocyst Uterine lining The Blastocyst embeds into the uterine lining, and begins to develop the placenta

Zygote, Conceptus, Fetus • The fertilized egg is called the zygote and continues to travel down the fallopian tube; about five to seven days after conception, the massive cells implants itself in the lining of the uterus. • For the first eight weeks of gestation, the conceptus is called an embryo; umbilical cord is form during the fifth week of embryonic development in his about 55 cm or 20 inches long; the umbilical cord attaches to placenta. • From eight weeks to birth the conceptus is called a fetus; two membranes surrounded fetus, the chorion and the amnion, the amnion is filled with a watery liquid called amniotic fluid, in which the fetus floats and can readily move; is the amniotic fluid that is sampled when amniocentesis is performed. Typically the nine months of pregnancy are divided into three equal periods of three months, called China stirs. Thus the first trimester is months 1 to 3, the second trimester is months 4 to 6, and a third (or last) trimester is months 7 to 9.

Four Weeks After the cluster of cells attaches to the womb it is called an embryo. The embryo is between 1/100 and 4/100 inch long at this time. The embryo continues rapid growth.

6 Weeks The embryo is about ¼ inch long and has developed a head and a trunk. Structures that will become arms and legs, called limb buds, first appear. A blood vessel forms and begins to pump blood. This will develop into the heart and circulatory system. At this time, a ridge of tissue forms down the back of the embryo. That tissue will develop into the brain and spinal cord

* 8 Weeks • The embryo is about ½ inch long. • The heart now has four chambers. • Fingers and toes begin to form. • Reflex activities begin as the brain and nervous system develop. • Cells begin to form the eyes, ears, jaws, lungs, stomach, intestines and liver.

2 cell zygote The zygote begins to develop 4 cell zygote

8 cell zygote 16 cell morula

Blastocyst – When zygote divides to 32 cells it Becomes known as a Blastocyst

Cross Section of a Blastocyst

The Blastocyst begins to collapse Day 15 The primitive streak can be seen on the left side of this embryo. Day 17 The primitive streak can still be seen, and the opposite end of the embryo is starting to fold up.

Day 19 The neural tube is seen along with somites on either side of it. Somites - zipper-like motion of the neural tube closing together, three pairs of small bumps form on either side of the closure. they will form the skeleton and the major muscles of the body. Thirty-eight pairs of somites will line the neural tube within 2 weeks.

Day 24 Day 22

Day 26 Day 28

5 Week Embryo 5 Week, 4 day Embryo

10 Weeks The embryo, is about 1 to 1¼ inches long (the head is about half the length) and weighs less than ½ ounce. The beginnings of all key body parts are present, but they are not completed. Structures that will form eyes, ears, arms and legs can be seen. Muscles and skeleton are developing and the nervous system becomes more responsive.

12 Weeks The fetus is about 2½ inches long and weighs about ½ ounce. Fingers and toes are distinct and have nails. Hair begins to develop, but won't be seen until later in the pregnancy. The fetus begins small, random movements, too slight to be felt. The fetal heartbeat can be detected with a heart monitor. All major external body features have appeared. Muscles continue to develop.

14 Weeks The fetus is about 3½ inches long and weighs about 1½ ounces. The fetus begins to swallow, the kidneys make urine, and blood begins to form in the bone marrow. Joints and muscles allow full body movement. There are eyelids and the nose is developing a bridge. External genitals are developing.

16 Weeks The fetus is about 4½ inches long and weighs about 4 ounces. The head is erect and the arms and legs are developed. The skin appears transparent. A fine layer of hair has begun to grow on the head. Limb movements become more coordinated.

18 Weeks The fetus is about 5½ inches long and weighs about 7 ounces. The skin is pink and transparent and the ears are clearly visible. All the body and facial features are now recognizable. The fetus can grasp and move its mouth. Nails begin to grow. The fetus has begun to kick. Some women feel this movement.

20 Weeks The fetus is about 6¼ inches long and weighs about 11½ ounces. All organs and structures are formed Skin is wrinkled and pink to reddish in color - thin and close to the blood vessels. Protective skin coating, (vernix) begins to develop. Respiratory movements occur - lungs have not developed enough to permit survival outside the uterus. By this time, mothers usually feel the fetus moving. At this time an ultrasound can often identify the sex of the fetus.

22 Weeks The fetus is about 7½ inches long weighs about one pound. It has fingerprints and some head and body hair. It may suck its thumb and is more active. The brain is growing very rapidly. The fetal heartbeat can be easily heard. The kidneys start to work. At 23 weeks, approximately 31% of babies born survive. Babies born at this age require intensive care and usually have lifelong disabilities and chronic health conditions.

24 Weeks The fetus is about 8¼ inches long and weighs about 1¼ pounds. Bones of the ears harden making sound conduction possible. The fetus hears mother’s sounds such as breathing, heartbeat and voice. The first layers of fat are beginning to form. This is the beginning of substantial weight gain for the fetus. Lungs continue developing At 25 weeks, approximately 68% of babies born survive. Babies born at this age require intensive care and usually have life long disabilities and chronic health conditions.

26 Weeks The fetus is about 9 inches long and weighs about 2 pounds. The fetus can respond to sound from both inside and outside the womb. Reflex movements continue to develop and body movements are stronger. Lungs continue to develop. The fetus now wakes and sleeps. The skin is slightly wrinkled. At 27 weeks, approximately 87% of babies born survive. Babies born at this age require intensive care and have an increased risk of developmental delays and chronic health conditions.

28 Weeks The fetus is about 10 inches long and weighs about 2 pounds, 3 ounces. Mouth and lips show more sensitivity. The eyes are partially open and can perceive light. More than 90% of babies born at this age will survive. Some survivors have developmental delays and chronic health conditions.

30 Weeks The fetus is about 10½ inches long and weighs about 3 pounds. The lungs that are capable of breathing air, although medical help may be needed. The fetus can open and close its eyes, suck its thumb, cry and respond to sound. The skin is smooth. Rhythmic breathing and body temperature are now controlled by the brain. Most babies born at this age will survive.

32 Weeks The fetus is about 11 inches long and weighs about 3 pounds, 12 ounces. The connections between the nerve cells in the brain increase. Fetal development now centers on growth. Almost all babies born at this age will survive.

34 Weeks The fetus is about 12 inches long and weighs about 4½ pounds. Ears begin to hold shape. Eyes open during alert times and close during sleep. Almost all babies born at this age will survive.

36 Weeks The fetus is about 12 to 13 inches long and weighs about 5½ to 6 pounds. Scalp hair is silky and lies against the head. Muscle tone has developed and the fetus can turn and lift its head. Almost all babies born at this age will survive.

38 Weeks The fetus is about 13½ to 14 inches long and weighs about 6½ pounds. Lungs are usually mature. The fetus can grasp firmly. The fetus turns toward light sources. Almost all babies born at this age will survive.

• (1) laboratory test for pregnancy are 98 to 99 percent accurate; h. CG (human chorionic gonadotropin secreted by the placenta) in the woman's urine, seven days after implementation (just when a period is missed); • (2) home pregnancy tests have a very high rate of false negatives ( it tells the woman she is not pregnant when she really is; thus and other 18 would produce a false negative result; this compares with an error rate for 1 to 2% of laboratory test); • (3) the immunologic test based on the presence of (human chorionic gonadotropin, secreted by the placenta) in the woman's urine is very accurate (these modern urine tests are 98% accurate seven days after implementation (just when a period is missed). • There also presumptive signs of pregnancy include amenorrhea, breast tenderness, nausea, frequent urination, feelings and fatigue, , more sleep. Pregnancy Tests Urine tests can be done at home or in a doctor's office. Many women first choose a home pregnancy test (HPT), about a week after a missed period. Home pregnancy tests are private and convenient. Blood tests are done at your doctor's office, but are used less often than urine tests. These tests can detect pregnancy earlier than a home pregnancy test, or about six to eight days after ovulation. But with these tests, it takes longer to get the results than with a home pregnancy test. Two types of blood pregnancy tests: is A qualitative h. CG test simply checks to see if h. CG is present. It gives a "yes" or "no" answer to the question, "Are you pregnant? " Doctors often order these tests to confirm pregnancy as early as 10 days after a missed period. However, some of these tests can detect h. CG much earlier. A quantitative h. CG test (beta h. CG) measures the exact amount of h. CG in your blood. It can find even very low levels of h. CG. Because these pregnancy tests can measure the concentration of h. CG, they may be helpful in tracking any problems during pregnancy. They may also be used to rule out a tubal (ectopic) pregnancy or to monitor a woman after a miscarriage when h. CG levels fall rapidly.

Stages of Pregnancy First trimester (First 12 weeks) Second trimester (Weeks 13 to 26) Third trimester (Weeks (27 to 38) • • First trimester (First 12 weeks) issues: missed menstrual period, emotional reaction to becoming pregnant (if negative – depression, anger and fear; it positive – joy and eager anticipation! Cyclic bleeding and spotting during early pregnancy may indicate a potential miscarriage (spontaneous abortion) optic pregnancy, or false pregnancy (Pseudocyesis) 144 • Expected delivery date (expected date of confinement, EDC); Nagele’s Rule: take the date of the first day of the last menstrual period, subtract three months, add seven days, and finally add one year (e. g. , thus if the first day of the last menstrual period was Sept. 10 th 2008, the expected delivery date would be June 17, 2009: subtracting three months was Sept. 10 gives June 10, adding seven days yields June 17, and adding one year gives June 17, 2009); if the last menstrual period began is not known, an ultrasound procedure may be used to determine gestational age. • • Second trimester (Weeks 13 to 26) Edema (water retention and swelling) woman becomes aware of fetal movement (quickening). Women who report more effective partner support report less anxiety in the second trimester; women who have had a previous pregnancy are more distressed during his time compared to women who have not. • • Third trimester (Weeks (27 to 38) weight gain and painless contractions. The extreme size of the uterus puts pressure on the number of other organs, causing some discomfort (shortness of breath, indigestion). The amount of weight gain should range from 15 to 40 pounds, depending on the woman's weight prior to pregnancy. , slim women, 28 to 40 pounds; heavy women 15 to 25 pounds) •

• • . Psychological Changes 128 9 Psychological well being is greater among women who have social support, have higher incomes, and experience fewer concurrent stressful life events • First time mothers reported a significant increase in dissatisfaction with their husbands from the second to the third trimester. • Wives who reported that higher levels of affection were exchanged between husband wife reported lower levels anxiety and insomnia in the third trimester. • Women who led very active lives prior to becoming pregnant may find fatigue and lack of energy especially distressing. Types of Support Appraisal support (information and advice) Esteem support (feedback that one is valued and respected by others) Group belonging (availability of social companionship) Emotional closeness (provision of intimacy and confiding about emotions) Tangible support (financial assistance, services, or goods)

A B C Theory of Stress • • • Couple or Family Crisis and Transitions Concepts about stress and crisis: 1. Family or couple eustress (positive events, some planned and others unexpected) or distress(negative events, mostly unplanned 2. Family or couple psychosocial stressor events unexpected or anticipated 3. "Crisis" versus "Transition" associated with their stressor events Crisis involves change, becomes a turning point (distress or eustress), time of relative instability; i. e. , conflict over family roles, demoralizing event (delinquent son or daughter), unexpected financial problem, diagnosis of a serious illness, unemployment, teen daughter's premarital pregnancy, death of family member, death of a spouse, prelude to divorce, etc. Transition is an expected or predictable change which can "precipitate" family stress and / or crisis, or predictable crisis (often eustress rather than distress), adjustment to new roles or circumstances, altercation in the status quo in order to meet new but "anticipated" changes; i. e. , birth of a baby, child leaving for college, graduation from high school, first day at school, new friends, new activities or hobbies, retirement, new job, moving to a new location, etc.

. Stressor Overload • • This is a series of unrelated stressor events that occur too rapidly for family members to cope effectively); "pile up" events Stressor characteristics: expected or unexpected brief or prolonged external or internal unclear cultural "norms" for dealing with the stressor event overtime stressor condition: improves, remains stable, or deteriorates

ABC X Model • • • . Course of family crisis A = Stressor Event B = Couple or family's crisis meeting resources C = Couple or family's appraisal of the stressor event; each member's "definition of the situation" (fault or blame, internal or external, pevious experience with crises, etc. ); interpretations of a stressor event, positive or negative X = Crisis itself, great or small depends mostly on B and C, not necessarily the event itself

Double Aa. BC Xt model • • • Aa = pile up, from previous unresolved crises t = "strong" or "weak" family systems; • Strong traits include: mutual acceptance, respect, and shared values, rely on support for one another, accepting difficulties, work together, all have input into major decisions and have fostered predictable family routines, rituals, and other times together; • Weak traits include: lower sense of common purpose, feeling less in control of what happens, cope by showing diminished respect or understanding of one another, hesitant to depend on the family for support and understanding, they may avoid one another, shifting responsibilities, more resistant to compromise, little emphasis on family routines or predictable time together

Disaster or Opportunity Factors in meeting crises creatively: • • • 1. positive outlook 2. spiritual values and support groups (four types of support: informational, emotional, appraisal, instrumental) 3. high self esteem 4. open, supportive communication 5. adaptability and flexibility 6. informal social support 7. community resources

- Fathers Experience and Support in Pregnancy • Father infant bond: • Men who showed higher levels of responsiveness (in having a baby) had higher levels of prolactin prenatally and lower levels of testosterone postnatally. Lower levels of testosterone may facilitate paternal behavior. • One study the emotional changes found that 70% of expectant fathers were initially ambivalent about fathering that gradually became more positive, in anticipation of the satisfactions to be derived from being a father. It has been theorized that men who display and active involvement in planning (father child future activities) will do best in the father role after the baby is born. • Move from Golden rule to Titanium rule to Platinum rule (instructor view).

Sex and Nutrition • Sex During Pregnancy – Intercourse in a normal, healthy pregnancy can continue safely until four weeks before the baby is due; one study found that recent intercourse and orgasm was associated with reduced risk of preterm birth; • The most common reasons women give for decreasing sexual activity during pregnancy include physical discomfort, feelings of physical unattractiveness, and fear of injuring the unborn child; women who have positive attitudes about sexuality and who maintain more sexual interest, activity, and satisfaction during pregnancy than the women with negative attitudes about sexuality; many women also have increased need for nonsexual affection as pregnancy progresses. • Nutrition During Pregnancy those with poor diets had seven times as many threatening miscarriages and three times as many still births; their labor lasted five hours longer on the average; a pregnant woman needs enough protein, folic acid (symptoms of folic acid deficiency or anemia and fatigue), calcium, magnesium, and vitamin A. ; (premature births are associated with deficiencies and calcium and magnesium)

Effects of Drugs Taken During Pregnancy • Antibiotics, Alcohol, Cocaine, (marijuana, trycyclic antidepressant medications (teratogenesis) and birth defects. • Steroids, Other Drugs, Dads and Drugs ( teratogens) 132 134 • Smoking: one study found evidence that mother smoking during the first trimester of pregnancy increase or offsprings risk of cancer in childhood; but a father smoking during pregnancy in the absence of the mother smoking also increased the risk of childhood cancer.

The Stages of Labor • 1. First stage of labor: effacement, violation, transition phase • 2. Second stage of labor: crowning, episiotomy • 3. Third stage of labor: placenta and feel membranes expelled

Childbirth Options • • Cesarian Section (C Section) reasons that been proposed to explain high rates of cesarian birth operations: physicians make more money performing cesareans, there are more older women giving birth and they may have more difficult labors necessitating cesarians, there are more births to teenagers who also are at risk for difficult deliveries, fetal monitors are used increasingly and they give the physician early warning give if the fetus is in distress, necessitating a cesarean to save the fetus. Up to 60% of women with prior cesarean delivery attempt a subsequent vaginal birth; however, there is a risk of uterine rupture during the attempt, protect a when labor is induced using drugs. Repeat cesarean operations and changes in medical practices have increased these operations to 89. 4% in 2003. Use of Anesthetics in Childbirth pudendal block, injection norms only external genitals; spinal anesthesia, injection near the spinal cord month the entire birth area and weighs down; and the caudal block and epidural anesthesia, which are both administered by injections in the back and produce regional numbing from the belly to the thighs Home birth versus hospital birth careful medical screening is essential for home birth; some hospitals allow the father to be present in the operating rooms during cesarean deliveries. Many hospitals have created birthing centers that contain a set of homelike rooms.

At the end of four weeks: Embryo is 1/4 inch in length Heart, digestive system, backbone and spinal cord begin to form Placenta (sometimes called "afterbirth") begins developing The single fertilized egg is now 10, 000 times larger than size at conception

At the end of 8 weeks: Embryo is 1 1/8 inches in length Eyes, nose, lips, tongue, ears and teeth are forming Penis begins to appear in boys Embryo is moving, although the mother can not yet feel movement Heart is functioning

At the end of 12 weeks: Fetus is 2 1/2 to 3 inches long Weight is about 1/2 to 1 ounce Nails start to develop and earlobes are formed Fetus develops recognizable form Arms, hands, fingers, legs, feet and toes are fully formed Eyes are almost fully developed By this stage, a fetus has developed most of his/her organs and tissues Fetal heart rate can be heard at 10 weeks with a special Doppler instrument

At the end of 4 months: Fetus is 6 1/2 to 7 inches long Weight is about 6 to 7 ounces Fetus is developing reflexes such as sucking and swallowing. Fetus may begin sucking his/her thumb Tooth buds are developing Sweat glands are forming on palms and soles Fingers and toes are well defined Sex is identifiable Skin is bright pink, transparent and covered with soft, downy hair Although recognizably human in appearance, the baby would not be able to survive outside the mother's body

At the end of 5 months: Fetus is 8 to 10 inches long Weight is about 1 pound Hair begins to grow on his/her head Soft woolly hair called lanugo will cover its body (and some may remain until a week after birth when it is shed) Mother begins to feel fetal movement Internal organs are maturing Eyebrows, eyelids and eyelashes appear

At the end of 6 months: Fetus is 11 to 14 inches long Weight is about 1 3/4 to 2 pounds Eyelids begin to part and eyes open occasionally for short periods of time Skin is covered with protective coating called vernix Fetus is able to hiccup

At the end of 7 months: Fetus is 14 to 16 inches long Weight is about 2 1/2 to 3 1/2 pounds Taste buds have developed Fat layers are forming Organs are maturing Skin is still wrinkled and red If born at this time, he/she will be considered a premature baby and require special care

At the end of 8 months: Fetus is 16 1/2 to 18 inches long Weight is about 4 to 6 pounds Overall growth is rapid this month Tremendous brain growth occurs at this time Most body organs are now developed with the exception of the lungs Movements or "kicks" are strong enough to be visible from the outside Kidneys are mature Skin is less wrinkled Fingernails now extend beyond fingertips

At the end of 9 months: Fetus is 19 to 20 inches long Weight is about 7 to 7 ½ pounds The lungs are mature Baby is now fully developed and can survive outside the mother's body Skin is pink and smooth He/she settles down lower in the abdomen in preparation for birth and may seem less active

You and me “babe”…

40 Weeks The fetus is about 18 to 20 inches long and may weigh about 7½ pounds. At the time of birth, a baby has more than 70 reflex behaviors, which are automatic behaviors necessary for survival. The baby is full term and ready to be born.

The Miracle of Birth

Health Changes: Postpartum Period 141 • • Postpartum blues - women experience mood swings, with periods of feeling depressed, be irritable, and crying alternating with positive moods. ; these symptoms usually begin a few days after delivery, or the most intense in one week postpartum and less or disappear by two weeks the postpartum period between 50 to 80% of women experience these mild blues. Postpartum depression is a severe, characterized by depressed mood, insomnia, tearfulness, feelings of inadequacy, and fatigue. Issues and begins to three weeks postpartum but may occur anytime after delivery. Postpartum psychosis symptoms include restlessness, irritability, and sleep disturbance; latter ones include disorganized behavior, mood swings, delusions and hallucinations. It's onset can be dramatic, within 72 hours of delivery or four to six weeks postpartum period it is very rare, affecting only one or two women out of 1000 (Kennedy and Suttenfield, 2001). Note: risk factors for more severe depression include personal family to psychiatric orders, unwanted pregnancy, or serious complications following birth, or lack of social support (2002)

New Reproductive Technologies 149 153 • Artificial Insemination, • Sperm Banks, • Embryo Transfer, Test Tube Babies GIFT, ZIFT Cloning, Gender Selection

Contraception and Abortion Chapter 7 • • • 21. Regarding oral contraceptives for birth control, what is meant by “failure rate for perfect users” and the “failure rate for typical users? ” 157 22. What hormones does the combination birth control pill containand what is meant by “ 21 on, seven off pattern? ” 156 23. Describe the perfect user failure rate of combination pills and what happens if a woman forgets to take them for two or three days. Is there a need for a “backup? ” What are some of the other benefits from taking the pill? 158 24. What are some of the negative psychological or physiological effects for taking the pill. 159 160 25. Describe what is meant by triphasic pills or “progestin only pills. ” What is a profile for woman choosing this option? 26. How effective is the patch (Ortho Evra) and what are its advantages? Describe the vaginal ring and its effectiveness. 161 162 27. How affecting the is the “emergency contraception (plan B product)? 28. Where the many advantages of Depo Provera injections? Describe the IUD and its relative effectiveness what are the advantages and disadvantages of diaphragm’s and cervical caps? 29. What is the scientific evidence for condoms and reducing SDIs? 169

Contraception and Abortion Chapter 7 (continued) • • • 30. Can the female condom be worn at the same time male wears a condom? How effective it is withdrawal (coitus interruptus)? 31. Describe the calendar method of contraception of the pre ovulatory safe is calculated. 172 173 32. Describe the “no scalpel vasectomy” procedure and its benefits? Differentiate between female sterilization options (minilaparotomy, laparoscopy, and trans cervical approach). 175 177 33. What is the percentage of unplanned pregnancies? The author states that “the great majority of these unwanted pregnancies occurred because sex the active persons fail to use contraceptives responsibly. ” What percent of abortions could have been averted we contraception? What of adolescence state if they do not use contraceptives? 177 178 34. Differentiate between erotophobia an erotophilia. What are some of the differences between erotophobes and erotophiles? (information , expectations, fantasy) 178 179 35. Describe the abortion procedures of vacuum aspiration, dilation and evacuation, induced labor, and hysterotomy. Differentiate between RU 486 or mifepristone and methotrexate. 181, 183 36. Discuss some of the psychological aspects of abortion. Is there any “postabortion syndrome? ” Discuss the Czechoslovakia’s experience when abortion requests were denied. 183 37. Regarding men and abortion, what is meant by “abortion veterans? “ In your view, is an abortion a woman’s right exclusively? Should it be a societal political decision? 184 185 38. Describe some of the new advances in contraception. Would you advocate a male hormonal contraception which is a combination of testosterone and progestin (DMPA) used in the Depo Provera shots for women? Describe the female contraception called Nestorone. Would you advocate injecting liquid silicone into the fallopian tubes which later could be removed if the woman wishes to become pregnant?

Contraception and Abortion Options • • • • • • Condom-Female Over the counter Condom-Male Over the counter Contraceptive Patch Prescription Depo-Provera (3 -Month Shot of DMPA) Prescription Diaphragm Prescription Emergency Contraception Plan B Morning After Pill Prescription required if under age 17 Implanon Contraceptive Implant Prescription Intrauterine Device (IUD) Prescription Patch, Contraceptive Prescription Pill (Combination Oral Contraceptives) Prescription Mini Pill (triphasic pills: Progesterone Only Pills or or Progestin-only pills) Prescription Pills for Continuous Use (no periods) Prescription

Contraception and Abortion Options • • • • • Spermicides: Foam, Jelly, Film, Sponge Over the counter Vaginal Ring Prescription Vasectomy (Male Sterilization) Prescription Withdrawal (Pulling Out) available to all Breast Feeding first six months after giving birth Sex With Less Risk of Pregnancy available to all Sterilization “No scalpel”and vasectomy procedure for men Female sterilization options: minilaparotomy, laparoscopy, and transcervical approach Abortion Techniques Vacuum aspiration, dilation and evacuation, induced labor, and hysterotomy, RU 486 or mifepristone or methotrexate Vacuum aspiration: most common 88% of abortions and are preformed by this method in the first 12 weeks of gestation

Types of Birth Control • • • • • Continuous Abstinence Natural Family Planning/Rhythm Method Barrier Methods Contraceptive Sponge Diaphragm, Cervical Cap, and Cervical Shield Female Condom Male Condom Hormonal Methods Oral Contraceptives — Combined pill (“The pill”) Oral Contraceptives — Progestin only pill (“Mini pill”) The Patch Shot/Injection Vaginal Ring Implantable Devices Implantable Rods Intrauterine Devices Permanent Birth Control Methods Sterilization Implant Surgical Sterilization Emergency Contraception

Prescription Contraception • • : Oral contraceptives: the pill, the mini pill • • • Skin patch Vaginal ring Diaphragm (your doctor needs to fit one to your shape) Cervical cap Cervical shield Shot/injection (you get the shot at your doctor’s office) IUD (inserted by a doctor) Implantable rod (inserted by a doctor) dental dams –– what are they? The dental dam is a square piece of rubber that is used by dentists during oral surgery and other procedures. It is not a method of birth control. But it can be used to help protect people from STIs, including HIV, during oral vaginal or oral anal sex. It is placed over the opening to the vagina or the anus before having oral sex. You can buy dental dams at surgical supply stores. •

The Pill • • • The Pill (seleted types) A. With combination birth control pills (sometimes called oral contraceptives) such as Loestrin and Ovcon, the woman takes a pill that contains estrogen and progestin (a synthetic progesterone), both at doses higher than natural levels, for 21 days. Then she takes no pill or a placebo for seven days, after which she repeats the cycle. B. How It Works The pill works mainly by preventing ovulation. During a natural menstrual cy cle, the low levels of estrogen during and just after the menstrual period trigger the pituitary to pro duce FSH, which stimulates the process of ovula tion. The woman starts taking the birth control pills on about day 5 of her cycle. Thus just when estro gen levels would normally be low, they are artifi cially made high. This high level of estrogen inhibits Follicule Stimulating Hormone production, and the message to ovulate is never sent out. The high level of progesterone in hibits Luteinzing Hormone production, further preventing ovulation. The progestin provides additional backup ef fects. 1. It keeps the cervical mucus very thick, mak ing it difficult for sperm to get through, and it changes the lining of the uterus in such a way that even if a fertilized egg arrived, implantation would be unlikely. 2. When the estrogen and progestin are withdrawn after day 21, the lining of the uterus disintegrates, and withdrawal bleeding or menstruation occurs, although the flow is typically reduced because the progestin has inhibited development of the endometrium. 3. Hormonally, the action of the pill produces a condition much like pregnancy, when hormone levels are also high, preventing further ovulation and menstrual periods. Thus it is not too surprising that some of the side effects of the pill are similar to the symptoms of pregnancy.

Effectiveness (Failure rate calculation; and failure rate for typical and perfect users) • • • 1. If 100 women use a contraceptive method for one year, the number of them who become pregnant during that first year of use is called the failure rate or pregnancy rate. 2. That is, if 5 women out of 100 become pregnant during a year of using contraceptive A, then A's failure rate is 5 percent. Effectiveness is 100 minus the failure rate; thus con traceptive A would be said to be 95 percent effec tive. 3. We can also talk about two kinds of failure rates: the failure rate for perfect users and the failure rate for typical users. The perfect user failure rate refers to studies of the best possible use of the method—for example, when the user has been well taught about the method, uses it with perfect consistency, and so on. The failure rate for typical users is just that—the failure rate when people ac tually use the method, perhaps imperfectly when they forget to take a pill or do not use a condom every time. 4. The good news is that if you are very re sponsible about contraception, you can anticipate dose to the perfect user failure rate for yourself. The use of combination pills is one of the most effective methods of birth control. The perfect user failure rate is 0. 1 percent (that is, the method is essentially 100 percent effective), and the typical user failure rate is 5 percent. 5. Failures occur primarily as a result of forgetting to take a pill for two or more days. If a woman forgets to take a pill, she should take it as soon as she re members and take the next one at the regular time; this does not appear to increase the pregnancy risk appreciably. If she forgets for two days, she should take two pills as soon as she remembers and then two the next day; however, the chances of preg nancy are now increased and a back up method of contraception should be used. If she forgets for three or more days, she should switch to some other method of birth control for the remainder of that cycle.