Pregnancy and Childbirth

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Understanding Fertility

• Conception – Involves the fertilization of a women’s egg by a man’s

sperm– Each month a women’s ovaries release an egg

• 24 hours if not fertilized– 3-4 days - the egg travels through the fallopian tubes– Egg not fertilized – Millions of sperm– Sperm release an enzyme– Egg and sperm each carry 23 chromosomes– Ovum, blastocyst, embryo, fetus

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Pregnancy• 3 periods of about 3 months (13 week trimesters)• Tests

– Home pregnancy tests– Human chorionic gonadotropin (HCG)– Two weeks after fertilization

• Early signs and symptoms– Missed menstrual period– Softening of the uterus

• Hager’s sign– Slight bleeding– Nausea– Breast tenderness– Increased urination– Sleepiness, fatigue and emotional upset

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Continual Change in the Women’s Body• Uterus size

– First 3 months, the uterus enlarges to about three times its nonpregnant size

– 4th month, large enough to make abdominal protrude– 7th-8th month, pushes up into the rib cage

• Breast changes– 8th week– 10th week

• colostrum

• Muscles and Ligaments loosen• Weight Gain

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Fetal Development

• First Trimester– Blastocyst

• Inner cells divide into three layers• One layer – inner body parts• Middle layer – muscle, bone, blood, kidneys, and sex

glands• Third layer – skin, hair, and nervous tissue

– Embryo - End of second week– All major body structures are formed between 2nd and

9th week– 2nd Month - Fetus

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Fetal Development

• Second Trimester

– Fetus grows to about 14 inches and 2 pounds

• Third Trimester

– Fetus gains protective fat layers, Respiratory and Digestive organs develop

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Diagnosing Fetal Abnormalities

• Ultrasonography (Ultrasound)– High frequency sound waves

• Amniocentesis– Fluid removal from the uterus

• Chorionic Villus sampling– Removal of tiny section of chorionic villi

• Quadruple marker screen (TMS)– Maternal blood test– Analyze four hormone levels and compared to appropriate

standards• Fetal programming

– Conditions in the womb may influence the risk of adult diseases

– Amniocentesis, CVS, and TMS– Chromosomal, genetic and other abnormalities

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The Importance of Prenatal Care

• Regular medical checkups• Blood tests• Prenatal nutrition• Avoidance of drugs, and other environmental hazards:

– Teratogens• 1st trimester • Congenital malformations

– Alcohol– Tobacco– Caffeine– Drugs– STD’s and other infections

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The Importance of Prenatal Care

• Activity and exercise– Moderate exercise program

• 30 minutes most days• Cardiovascular exercises

– Kegal Exercises– Prenatal exercise classes

• Preparation for childbirth

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Complications of Pregnancy and Pregnancy Loss

• Ectopic pregnancy• Spontaneous Abortion, or miscarriage

– Stillbirth• Preeclampsia/eclampsia• Placenta Previa• Placental Abruption• Gestational Diabetes• Preterm Labor• Labor Induction• Low-birth Weight (LBW)

– 5.5 LBS.• Infant Mortality

– SIDS• Coping with loss

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Childbirth

• Choices in childbirth– Who is going to assist with delivery?

• Physician– High risk?

• Certified Nurse-Midwife

– Where is the baby going to be delivered?• Hospital• Home

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Labor and Delivery

• Entire process 2-36 hours.• First stage of Labor.

– Average13 hours for a first birth.– Cervix is completely dilated (10 centimeters)– Hormonal changes.– Contractions. (30 seconds and occur every 15-20

minutes)– Mucus plug is expelled and amniotic sac may rupture.– Transition:

• Contractions may last 60-90 seconds and be 1-3 minutes apart

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Childbirth• Second Stage of Labor

– Baby slowly pushed into birth canal– Baby squeezes through pelvis– Head is usually delivered first– Umbilical cord is cut

• Third Stage of Labor– Delivery of the placenta– Stage typically lasts 5-30 minutes

• Apgar Scale of the Baby– Heart rate– Respiration– Color– Reflexes– Muscle tone– Total score is between 0 and 10

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Pain Relief During Labor and Delivery

• Childbirth preparation courses– Breathing and relaxation techniques– Lamaze or Bradley

• Epidural

• Narcotics– Fentanyl or demeral– Provide less pain relief than a epidural

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Cesarean Deliveries

• 2006 about 31.1% of babies born in the U.S.

• Surgical removal of the baby – Baby’s head too large

– Mother has a serious health condition

– Mother who is overweight or diabetes

– Difficult labor

– Fetal distress

– Dangerous infections

– 90% of cesarean mothers will have subsequent deliveries by cesarean

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Postpartum Period

• 3 months following childbirth.

• Critical family adjustment.

• Vaginal delivery leave hospital 1-3 days.

• Cesarean section 3-5 days.

• 6-8 weeks for the mother’s reproductive organs to return to prebirth condition

• Breastfeeding– About 74% of mothers breast-feed

– Lactation begins about 3 days post childbirth

– Colostrum prior to lactation

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