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ReproductiveChoicesCHAPTER12
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ReproductiveChoicesChoosingacontraceptivemethod◦ AbouthalfofallpregnanciesintheUnitedStatesareunintended◦ Unintendedpregnanciesnearlyalwayscausestressandlifedisruptionandareassociatedwithpoorerhealthoutcomes
Communicatingaboutcontraception◦ YouandyourpartnershoulddecidetogetherhowtobestprotecteachotherfromSTDsandunintendedpregnancy
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WhichContraceptiveMethodIsRightforYou?Considerationstoevaluatewhenchoosingcontraception:◦ Effectiveness◦ Cost◦ Convenience◦ Permanence◦ Safety◦ ProtectionagainstSTIs◦ Consistencywithpersonalvalues
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AbstinenceAbstinenceistheonlyguaranteedmethodofpreventingpregnancyandSTItransmission
◦ Inheterosexualcoupleswhohavevaginalintercourseandusenocontraceptivemethod,85%ofthewomenwillbecomepregnantinoneyear
◦ Abstinencerequirescontrolandcommitment
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HormonalContraceptiveMethodsWorkbypreventingovulationormakingitharderforspermtoreachova,uterineliningaffectedsofertilizedegglesslikelytobeimplanted
Prescribedbyahealthcareprovider
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Potential sideeffects
Breast tenderness,nausea,headaches,spotting,weightgain,sexdrivefluctuation,frequentvaginalinfections,milddepression
Advantages Effective,easytouse,limitedsideeffects, reducesmenstrualcramping,ovariancysts,endometriosis,andriskofcertaincancers
Disadvantages NoprotectionagainstSTIs,minorsideeffects,moodchanges,loweredlibido,headaches
HormonalContraceptiveMethodsTypesofhormonalcontraceptivemethods◦ Birthcontrolpills:mostpopularreversibleformofcontraception
◦ Newoptionsallowwomentoskipmonthlyperiod
◦ Transdermalpatch:releaseestrogenandprogesteroneintobloodstreamviatheskin
◦ Vaginalcontraceptivering:flexibleplasticringplacedinvaginafor21days
◦ Injectablecontraceptive(Depo-Provera):progesteroneshotbyhealthcareprovidereverythreemonths
◦ Contraceptiveimplant:flexibleplasticrodthatcontainsprogesteroneinsertedunderskinoftheupperarmthatslowlyreleasehormones
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SeriousSideEffectsofHormonalContraceptives
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TheIUDIntrauterinedevice(IUD):◦ T-shapediteminsertedintotheuterus◦ Long-actingreversiblecontraceptive◦ Believedtoworkbyalteringtheuterineandcervicalfluidstoreducethechancethatspermwillmoveupintothefallopiantubes
◦ CopperIUDcanbeleftinplacefor10years◦ TheprogesteroneIUDcanremainfor5years◦ WomenwhochosethisbirthcontrolmethodaretaughthowtocheckthattheIUDisproperlylocated;thischeckisdonemonthly
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IUDCorrectlyPositioned
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BarrierMethodsPhysicallyseparatethespermfromthefemalereproductivetract
Toincreaseeffectiveness,sometimesneedaspermicide,achemicalagentthatkillssperm
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Maleandfemalecondom
Latex orpolyurethane Decreases theriskofcontractinganSTI
Diaphragm Circularrubberdomeinsertedinthevaginabeforeintercourse;coversthecervixandisappliedwithspermicide
Ahealthcareprovidermustcorrectlyfitandprovideinstructionsforuse;Riskoftoxicshocksyndrome
BarrierMethods
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Cervicalcap Smallcuplikerubberdevicethatcoversonlythecervix,usedwithspermicide
Ahealthcareprovidermustcorrectlyfitandprovideinstructionsforuse
Contraceptivesponge
Over-the-counterproductthatfitsoverthecervixandisusedwithspermicidetoactasabarrier
Should notbeusedduringmenstruation;maybelesseffectiveinwomenwhohavehadapregnancy;Riskoftoxicshocksyndrome
FertilityAwareness–BasedMethodsContraceptivemethodbasedonabstinence(orusingabarriercontraceptive)duringthewindowoftimearoundovulationwhenawomanismostlikelytoconceive◦ StandardDaysMethod(calculatingtheunsafedaysofovulation)
◦ Womanmusthavearegularcycle
◦ TwoDayMethod(evaluateconsistencyofvaginaldischargetopredictovulation;checkbasalbodytemperature)
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FertilityAwareness–BasedMethods
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WithdrawalWithdrawal:acontraceptivemethodinwhichthemanremoveshispenisfromthevaginabeforeejaculating◦ Successisdependentonaman’sabilitytotellwhenheisabouttoejaculateandtohavetheself-controltowithdrawwithimpendingorgasm
TheAmericanCollegeofObstetricsandGynecologydonotrecommendthismethod
Approximately18to27percentofwomenwillbecomepregnantinayear
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EmergencyContraception(ECP)
•Themorning-afterpill orbackupbirthcontrol•Reduceschanceofpregnancybypreventingovulationandfertilization
•Mosteffectiveiftakenwithin48–72hoursandmustbetakenwithin5daysofunprotectedintercourse
•Usefulwhenanothermethodfails(condombreaks,ordiaphragmorcervicalcapslips)
•Willnotcausetheterminationofanexistingpregnancyandisnotanabortogenic (notabortion-causing)
•Usefulincasesofforcedsex—rapeandincest
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SterilizationAsurgicalprocedurethatpermanentlypreventsfuturepregnancies
◦ Vasectomy:malesterilizationprocedure,involvingtyingoffandseveringthevasdeferenstopreventspermfromreachingthesemen
◦ Tubal ligation:femalesterilizationprocedureinvolvingseveringandtyingofforsealingthefallopiantubestopreventovafromreachingtheuterus
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Vasectomy
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TubalLigation
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UnintendedPregnancyItisimportanttoseeyourphysicianorhealthproviderassoonaspossibletodiscussoptions
◦ Carrythepregnancytotermandraisethechild
◦ Carrythepregnancytotermandplacethechildwithanadoptivefamily
◦ Terminatethepregnancy
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SignsofPregnancyPriortotheclassicsignofpregnancy—missingaperiod—thereareothers:
◦ Breasttendernessandswelling,fatigue,nauseaandvomiting,light-headednessormoodswings
Ararecomplicationofearlypregnancyisectopicpregnancy
◦ Signsofectopicpregnancyareseverelowerabdominalpainorcramping;vaginalspotting
◦ Anectopicpregnancyisapotentiallylife-threateningcondition
◦ Ifyouexperiencethesesigns,seeyourphysicianorgototheemergencyroomimmediately
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DecidingtoBecomeaParentAreyoureadytobecomeaparent?Herearesomequestionstoconsider:
◦ Whatareyourlong-termplans?
◦ Whatisthestatusofyourrelationship?
◦ Areyouemotionallymatureenough?
◦ Howareyourfinances?
◦ Howlargeisyoursocialsupportsystem?
◦ Whatisyourhealthstatusandage?
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AdoptionAdoptionprovidesapermanentfamilyforachildinneed
◦ Open adoption:biologicalparentschooseadoptiveparents
◦ Closed adoption:biologicalparentsdonotchooseparents
Allformsofadoptionrequireboth biologicalparentstorelinquishallparentalrights
Forcoupleswantingtoadopt,internationaladoptionsarebecomingincreasinglypopularinAmerica
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ElectiveAbortionSince1973,electiveabortionhasbeenlegalintheUnitedStates;Roev.Wade
◦ Somerestrictionsapplyasthepregnancyadvancesthroughthreetrimesters
Thedebateoverabortionisoneofthemosthighlychargedpoliticalissuesofourtime
Thelowestratesofabortionoccurincountrieswhereabortionislegalandthehighestrateswhereitisillegal
Fifty-ninepercentofwomenhavinganabortionhaveoneormorechildrenalready
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ElectiveAbortionVoluntaryterminationofapregnancy
◦ Surgical:surgicalremovalofthecontentsoftheuterustoterminatethepregnancy
◦ Vacuumaspirationismostcommonmethod
◦ Medical:useofapharmaceuticalagenttoterminatethepregnancy
◦ Mifepristone(formerlyknownasRU-486)
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Infertility:CausesLowspermcount
Poorspermmobility
Obstructionoffallopiantubes◦ STI◦ Endometriosis
Lackofovulation
Abnormalitiesinthecervicalmucusoranatomy
Unknowncauses
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Infertility:TreatmentOptionsSurgery
Fertilitydrugs
Intrauterineinsemination
Invitrofertilization:◦ Gameteintrafallopiantransfer◦ Zygoteintrafallopian transfer
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PregnancyandPrenatalCareEventsandconditionsduringpregnancyinfluencethechild’sdevelopmentthroughoutlife
Pregnancyplanning
◦ Thebesttimetohaveachildisinfluencedbymanyfactors:educationalandcareerplans,relationshipstatus,healthissues,andothers
◦ Theleasthealthriskoccurswhenwomenhavepregnanciesbetweentheageof18and35
◦ Malefertilityalsodeclineswithage
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PregnancyandPrenatalCarePrepregnancycounselingtypicallyincludesanevaluationof:
◦ Currenthealthstatus
◦ Healthbehaviors
◦ Familyhealthhistory
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PregnancyandPrenatalCare
Nutritionandexercise
◦ Preconceptionhealthylifestylefactorshelpensurerequirednutrientsavailable
◦ Foodborneinfectionscanhavemoreseriouseffectsinpregnantwomen;avoidunpasteurizedfoods,softcheese,andraworsmokedseafood
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PregnancyandPrenatalCareWomenshouldbeup-to-dateonroutinevaccinationsbefore pregnancy
◦ EspeciallyimportantarevaccinationsforrubellaandhepatitisB
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PregnancyandPrenatalCareMedicationsanddrugs:
◦ Mostsubstancesthemotheringestseventuallyreachthefetus
◦ Tobaccoandalcoholarethemostcommonlyuseddrugsduringpregnancy
◦ Illicitdrugshaveavarietyofeffectsonafetus,dependingonthechemicalactionofthedrug
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PregnancyandPrenatalCareRegularhealthcareprovidervisits
◦ Midwivesusuallytakepatientswhoareatlowriskformedicalorpregnancycomplications
◦ Yourfamilyphysicianmayprovidepregnancy-relatedcare,andsomedeliverbabiesinbirthingcentersorhospitals
◦ Obstetriciansaretrainedtohandleallkindsofpregnancies,fromlowrisktohighrisk
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ComplicationsofPregnancyApproximately15–50%ofallpregnanciesendinmiscarriage,mostduringthefirsttrimester
Gestationaldiabetes occursinsomewomenmidwaythoughtthepregnancy◦ Womenwithgestationaldiabetesareadvisedtoexercise,controltheirdiet,andmonitorglucoselevels
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ComplicationsofPregnancyPreeclampsia:dangerousconditioncharacterizedbyhighbloodpressure,fluidretention,possiblekidneyandliverdamage,andpotentialfetaldeath
◦ Signsincludefacialswelling,headaches,blurredvision,nausea,andvomiting
◦ Canprogresstoeclampsia,apotentiallylife-threateningconditionmarkedbyseizuresandcoma
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ComplicationsofPregnancyComplicationsofpregnancyforthechild◦ Approximately1.2%ofallpregnanciesendininfantdeath
◦ Halfofthesedeathsoccurbeforethefetusisborn◦ 80%occurbeforethe28thweek
◦ Afterthebirth,theleadingcauseofdeatharepretermbirth,lowbirthweight,andSIDS
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FetalDevelopmentWithin30minutesoffertilizationthesingle-celledfertilizedovum(zygote)startstodivide
Week2toweek8isembryonicperiod,formationofembryo,placenta,andamnioticsac
Byweek8,allmajorbodysystemsandorgansarepresentinrudimentaryform
By16weeks,mothercanfeelfetalmovements
At26weeks,eyesareopen,andat30weeksalayeroffatbeginsformingundertheskin
Fetushasexcellentchanceofsurvivalat36weeks;fulltermoccursat38weeks
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FetalDevelopment
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DiagnosingProblemsinaFetusAbout5%ofbabiesbornintheUnitedStateshaveabirthdefect
Severaltestshavebeendevelopedtodetectabnormalitiesinafetuspriortobirth◦ Ultrasound◦ Chromosomalanalysis
◦ Chorionicvillussampling(CVS)◦ Amniocentesis
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LaborandDeliveryLaborbeginswhenhormonalchangesinthefetusandthemothercausestronguterinecontractions
Earlyfirststage:cervixthinsandbeginstoopenSecondstage:babymovesdownwardthroughthepelvis,cervix,andintothevagina;heademerges,followedbytheshouldersandbodyThirdstage:contractionscontinue,andplacenta(afterbirth)isexpelled
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LaborandDelivery
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NewbornScreeningBabiesareevaluatedatbirthtodeterminewhethertheyrequireanymedicalattentionorwillneeddevelopmentalsupportlater
TheApgarscaleisusedasaquickmeasureofthebaby’sphysicalcondition
Mostbabiesarepronouncedhealthyandtakenhomewithin24to48hoursofbirth
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ThePostpartumPeriodThefirstfewweeksormonthsofparenthoodareaperiodofprofoundadjustmentasparentslearnhowtocarefortheirnewborn
Issuesforthenewbornthatdeserveattentioninclude:
◦ Growthandnutrition,illnessandvaccinations,adjustmentandattachment
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ThePostpartumPeriodAbout13%ofwomenexperiencedepressioninthefirstyearaftergivingbirth
◦ Canbeduetohormonechanges,brokensleeppatterns,self-doubt,asenseoflossofcontrol,andchangesinsupportsystems
◦ Cancontributetofeelingsofsadness,restlessness,lossofinterest,guilt,difficultyfocusing,andwithdrawal
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ClassActivity
ShouldtheU.S.ProvidePaidFamilyLeaveAftertheBirthofaChild?
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WrapUpWhatarethecommonlyavailablecontraceptivemethods?
Whataretheoptionsintheeventofunintendedpregnancy?
Whataretheoptionswhenacouplecannotconceive?
Whatarethebasicsofprenatalcare?
Whathappensduringprenataldevelopment?
Whathappensduringlaboranddelivery?
Whatconcernsariseduringthepostpartumperiod?
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