11 Ch 11 Children and Choice

Chapter 11
Conceiving Children:
Process and Choice
Parenthood as an Option
• More people than ever are NOT having children
– 1975 – 9% of women ages 40-44 had no children
– 2010 – 19% “”””””””””””””””””””””””””””””””””
• Advantages of Remaining Childless
– More time for self and partner
– More financial resources absent the costs of parenting
– Marriage less stressful
• Could be due to lack of the stress of childcare decisions
• Could be due to unhappy couples staying together, “for the children”
– More spontaneity in social, work and recreation
– More devotion to career
Parenthood as an Option
• However, when asked, “The rewards of being
a parent are worth it, despite the costs and
work it takes.”
– 98% of Fathers, 97% of Mothers agreed
• Advantages of Having Children
– Children give and receive love
– May enhance relationship as part of sharing child raising
– Success builds self-esteem, sense of accomplishment
– Discovering yourself as a parent can provide greater
meaning and satisfaction to one’s life
Becoming Pregnant
Enhancing the Possibility
• Intercourse just prior to or at ovulation
– Unfertilized egg survives 2 days tops
– Sperm last only 5 days tops
– They have to meet………….
• Predicting ovulation
– Cervical mucus becomes thinner and stretchy
– Calendar
– Basal Body Temp methods
– Ovulation predictor urine tests
• Based on urinary LH
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Infertility
60% of couples conceive in < 3 months
If > 6 months consult a physician
12% of U.S. couples experience fertility problems
Female infertility ~ 40% of the cause
– Infertility increases with age
• Changes rapidly after age 30, 46% higher, age 40 = 95%
– Failure to ovulate regularly
– Cervical mucus may destroy or block sperm
– Sperm may not reach the egg
• Infections, scar tissue
– Fertilized egg may not implant
– Smoking, low body fat, environmental toxins
Infertility
• Male Infertility ~ 40% of the cause (~ 20% is due to both)
– Abnormal sperm count
• Under 15 million/ml semen
– Or motility
• Under 50% motile at 60 min.
– Or morphology
– Impaired sperm production
• Elevated temperature
• Infections
• Smoking, alcohol, drugs
– Cocaine reduces spermatogenesis
– MJ reduces sperm motility
• Environmental factors
Reproductive Technologies
Artificial insemination (AI)
• Insert sperm directly into female reproductive tract
• Partner or donor
Surrogacy = AI or IVF of a woman not part of the couple
• 1000 live births in 2007
• $30K
• 10% of that in India, generates $445 million/annually
Assisted reproductive technology (ART), “test tube babies”
• 1st one in England in 1978, now = 48,000/yr
• In vitro fertilization (IVF) = sperm and egg meet in a dish
– Higher rates of multiple births
– Intracytoplasmic sperm injection (ICSI) = inject one sperm into egg
– $15,000 + per try
Thomas and Nancy Beatie
at home in May 2008 prior
to the birth of their first
child. Thomas is an
incomplete transsexual
who retained his female
organs. Purchased semen
on the internet, did a home
AI and now has three
children. Nancy Beatie is
unable to conceive.
After a two-year,
bicoastal search
of fertility clinics
and egg donors,
Doug Okun, 38,
and Eric
Ethington, 37,
became parents
to twins Elizabeth
and Sophia
thanks to a
surrogate mother.
Janise Wulf, who is 62
years old, holds her 4-dayold baby boy, Adam, born in
February 2006. the
newborn is her 12th child.
She used IVF and hormone
therapy to maintain the
uterine lining.
Reproductive Technologies
• Concerns Regarding Reproductive Technologies
– Legal, ethical, and personal dilemmas
• Extra embryos result from the procedure, what’s to be done
with them?
– Adoption
– Research
– Discard
• Frozen embryos may survive marriage, who gets custody?
• Genetic manipulation may be possible in the near future
– “Designer babies”?
• Elderly people conceiving are more likely to die prior to child
maturation. Should there be an age limit?
Pregnancy Detection
• First signs
– Light period, spotting, or no period; fatigue; tender breasts
• Nausea/Vomiting: appetite change
• Blood or urine for Human Chorionic Gonadotropin (HCG)
– As early as 7 days after a missed period
Miscarriage - Spontaneous Abortion
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Occurs in first 20 weeks
May show as no more than a late, heavy period
10-20% of all pregnancies
Has little impact on subsequent pregnancies
If fetus dies after 20 weeks, “Stillbirth”
– Higher rates for teens and those over 35 years old
• Emotional impact can be significant
– Many couples hold a memorial ceremony
• Individual or couple may consider grief support
Elective Abortion, terminate a pregnancy by medical means
• U.S. Statistics
– 40% of unplanned pregnancies end in elective abortion
– 33% of women will have abortion by age 45
– Of yearly abortion rates
• 50%+ are in their 20’s, 18%+ are by teens
• 61% previously given birth
• 37% Protestant; 28% Catholic
• Decision not an easy one
– “Unprepared for motherhood”
– “Cannot afford one or another child”
– Men may or may not participate but the final decision is with the woman
– Mental health issues following abortion are comparable to
those with an ongoing pregnancy
Elective Abortions, Cross-Cultural Analysis
• U.S. has one of the highest abortion rates among developed
countries
– 21/1,000 reproductive age women have an abortion
– W. Europe = 12/1,000
• All countries with lower rates provide
– Comprehensive sex education
– Easy access to social services, inexpensive birth control and
emergency contraception
• Politics
– Republicans tend to reduce public reproductive services
– Democrats tend to increase them
Types of Abortion Procedures
• 92% of legal abortions happen <12 weeks
– Risks are low = 0.1/100K deaths
– Pregnancy = 11.8/100K deaths
• Medical abortion – pills to end a pregnancy
– “Morning after”, should be called “right after” because it’s
really only good for about 72 hrs, tops.
– RU486, use up to 9 weeks along
– 99% effective < 7 weeks, 91% @ 8 weeks.
– Side effects include headache, cramping, nausea, vomiting
– Many women have no side effects
Types of Abortion Procedures
• Suction curettage
– Used for pregnancies from 7 – 13 weeks along
– Just like it sounds, under anesthesia, a suction tube is inserted
into the uterus and the contents are suctioned out
– Rare complications include infection, perforation, bleeding,
incomplete evacuation
• Dilation and evacuation (D and E)
– 13 to 21 weeks, but higher risk factors
– Suction, forceps + curettage
• Prostaglandin induction into uterus to induce contractions
• Late-term abortion (intact D and E)
– 20 to 24 weeks
– Used when her health is at risk or fetal abnormalities exist
– AKA, “Partial Birth Abortion”, but this is not technically correct
Types of Abortion Procedures
• Illegal abortion
– 21.6 million/yr worldwide
– 47,000 women’s deaths
– Millions with reproductive damage
– Drink turpentine, bleach, livestock manure tea to induce
contractions
– Insert herbs, sticks, coat hangers, bones into uterus to induce
– Such attempts have been recorded for centuries
Abortion supporters (47%) and opponents (47%)
usually believe very strongly in their positions.
Deaths from abortion declined
dramatically after legalization.
Experience of Pregnancy
• Mothers
– Wide range of positive and negative emotions
– Emotions are affected by physical changes
• Fathers
– Ecstasy to ambivalence to fearfulness
– Male partner may feel closeness or separation toward
female counterpart
– Concern about financial impact
– Active involvement helps
Fetal Development, First Trimester, 0-13 weeks
• Zygote: united sperm cell and ovum in fallopian tube
– Rolls slowly toward the uterus while dividing
• 1 week = Blastocyst: multiple cells that implant
• Heartbeat at 9-10 weeks after last period
• 2nd month: spinal canal, arms/legs
• 3rd month: internal organs
HUMAN DEVELOPMENT: ONE MONTH
All early vertebrate embryos resemble these human embryos
Note the tail, pharyngeal gill arches, and paddle-like limb buds
HUMAN DEVELOPMENT: ONE MONTH
HUMAN EMBRYO: EARLY ORGAN DEVELOPMENT
EXTRAEMBRYONIC MEMBRANES
Chorion
Allantois
Amnion
HUMAN DEVELOPMENT: THREE MONTHS
Note the extraembryonic membranes and
other support structures
Fetal development at 9 weeks.
the fetus is connected to the
placenta by the umbilical cord.
The placenta exchanges nutrients, oxygen, and waste
products between the maternal and fetal circulatory systems
Fetal Development, Second Trimester, 4th month+
• Sex of fetus can be distinguished
• External body parts develop including fingernails, eyebrows,
and eyelashes
• Skin covered by fine down-like hair
• Growth in size to about 1+ lb.
• Fetal movements (quickening) by end of 4th month
• By end of 2nd trimester fetus has opened its eyes
HUMAN DEVELOPMENT: FIVE MONTHS
Fetal Development, Third Trimester
• Develop size and strength
– 7-12 lbs.
– Mom gains 25-35 lbs.
• Down-like hair disappears
• Skin smoother
• Vernix caseosa
– protective creamy, waxy substance
Prenatal Care
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Health assessment before pregnancy
Good nutrition + folic acid
Adequate rest
Routine health care
Moderate exercise
Prenatal education
Increased risk of fetal chromosomal
abnormalities after 40 years old
• Increased risks to mother after age 35
Contemporary Childbirth
• Prepared childbirth
– Lamaze
– Bradley
• Birthplace alternatives
– Birthing centers with midwives
• Homebirth
• C-sections
– 1 in 3 births
Childbirth, AKA tax deduction arrival
• First stage
– 10 to 16 hours in duration 1st time, 4-8 hrs 2nd time
– Effacement or thinning of cervix
– “Bloody show” as the cervix dilates toward 10 cm
– “Water breaks” as the amniotic sac ruptures
• Second stage
– 30 minutes to 2 hours in duration
– Begins at full dilation
– Baby enters vaginal canal
– Ends with delivery of baby
• Third stage
– 20 to 30 minutes in duration
– Begins at delivery of the baby
– Ends with delivery of placenta
THE BABY EMERGES IN THE SECOND STAGE OF BIRTH
THE HEAD IS NORMALLY DELIVERED FIRST
THE BODY SLIDES OUT AFTER THE HEAD EMERGES
A NEWBORN BABY AND A PLACENTA
The placenta (afterbirth) is delivered in the third stage of birth
Here the umbilical cord is still attached to baby and placenta
Postpartum
• Range of feelings from excited and happy to tearful
• Baby blues affect 75%
– Mood swings lasting ~10 days
• Postpartum depression (PPD) affect 15%
– Insomnia, anxiety, hopelessness
– Loss of interest in the child/thoughts of harm
• Sleep deprivation heightens stress
• Advantages
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Breastfeeding
Digestible food with antibodies
Prevents uterine hemorrhage
Lower SIDS
Higher IQ
Emotional and sensual experience
Promotes bonding
• Disadvantages
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Vaginal dryness due to decreased estrogen
Temporary breast tenderness
Leaking milk
Harder to share feeding duties
Sexual Interaction After Childbirth
• Vaginal Birth
– After lochia flow stops and vaginal area heals from
lacerations or episiotomy
– 3 to 4 weeks
• C-section
– When incision healed
• When desire returns and
it’s comfortable
– Varies considerably
– Often 6 to 8 weeks
• Activities can include more non-coital and/or
affectionate behaviors
• But, expect it to maybe be pretty bad for awhile
• End