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Chapter 9 lecture outline

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Chapter 9 – Contraception and Reproduction
9
Contraception and Reproduction
LectureOutline
I. Conception
A. Introduction
1...
Chapter 9 – Contraception and Reproduction
B. People choose abstinence for various reasons, including: waiting until they
...
Chapter 9 – Contraception and Reproduction
2. Even students who know and understand the risks associated with
unprotected ...
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Chapter 9 lecture outline

  1. 1. Chapter 9 – Contraception and Reproduction 9 Contraception and Reproduction LectureOutline I. Conception A. Introduction 1. The processes that affect or permit conception are: a. The creation of sperm, or spermatogenesis, starts in the male at puberty, and the production of sperm is regulated by hormones. b. Sperm cells form in the seminiferous tubules of the testes and are passed into the epididymis, where they are stored until ejaculation. c. A single male ejaculation may contain 500 million sperm. d. To reach its goal, the sperm must move through the acidic secretions of the vagina, enter the uterus, travel up the fallopian tube containing the ovum, then fuse with the nucleus of the egg (fertilization). e. Each woman is born with her lifetime supply of ova; between 300 and 500 eggs eventually mature and leave a woman’s ovaries during ovulation. f. Every month, one or the other of the woman’s ovaries releases an ovum to the nearby fallopian tube. It travels through the fallopian tube until it reaches the uterus. g. An unfertilized egg lives for about 24 to 36 hours, disintegrates, and during menstruation is expelled along with the uterine lining. h. A mature ovum releases the chemical alluring, which attracts the sperm. A sperm is able to penetrate the ovum’s outer membrane because of a protein called fertilin. i. The fertilized egg, called a zygote, travels down the fallopian tube. When it reaches the uterus, about a week after fertilization, it burrows into the endometrium, a process called implantation. 2. Conception can be prevented by contraception. II. Abstinence or Nonpenetrative Sexual Activity A. Abstinence is to abstain from vaginal intercourse and forms of nonpenetrative sexual activity that could result in conception.
  2. 2. Chapter 9 – Contraception and Reproduction B. People choose abstinence for various reasons, including: waiting until they are ready for a sexual relationship; waiting until they find the “right” partner; respecting religious or moral values; enjoying friendships without sexual involvement; recovering from a breakup; or preventing pregnancy and sexually transmitted infection. C. Abstinence is the only form of birth control that is 100 percent effective and risk-free. D. Individuals who choose abstinence from vaginal intercourse often engage in activities sometimes called outercourse, such as kissing, hugging, sensual touching, and mutual masturbation. E. Outercourse has no medical or hormonal side effects; it may prolong sex play and enhance orgasm; it can be used when no other birth control methods are available. III. Contraception A. Introduction 1. Some couples use withdrawal, or coitus interruptus (removal of the penis from the vagina before ejaculation), to prevent pregnancy, even though this is not a reliable form of birth control. 2. Good decisions are based on sound information. 3. You should consult a physician or family planning counselor if you have questions or want to know how certain methods might affects existing of familial medical conditions. 4. Failure rate refers to the number of pregnancies that occur per year for every 100 women using a particular method of birth control. B. The Benefits and Risks of Contraceptives 1. Using birth control is safer and healthier than not using it. 2. If you have any of the following you should talk with your doctor about which types of contraceptives may increase your health risks: a. High blood pressure b. Episodes of depression c. Seizure disorder d. Ectopic pregnancy e. Hepatitis 3. Various methods of birth control have side effects, although pregnancy and childbirth account for much higher rates of medical complications and deaths than any contraceptive. C. Birth Control on Campus 1. 57.1 percent of students–53.9 percent of men and 58.9 percent of women– reported using contraception the last time they had vaginal intercourse.
  3. 3. Chapter 9 – Contraception and Reproduction 2. Even students who know and understand the risks associated with unprotected sex often do not take steps to prevent pregnancy or sexually transmitted disease. IV. Barrier Contraceptives Barrier contraceptives block the meeting of egg and sperm by means of a physical barrier. A. Nonprescription Barriers 1. Condoms a. Advantages of Condoms i. Effective when used correctly ii. Lowers a woman’s risk of pelvic inflammatory disease (PID) and may protect against some urinary tract and genital infections iii. No side effects iv. No prescription required v. Can be carried in a pocket or purse vi. Inexpensive vii. The female condom gives women more control in reducing their risk of pregnancy and STIs and does not require a prescription or medical appointment viii. No effect on a woman’s natural hormones or fertility ix. Female condom can be inserted up to eight hours before sex b. Disadvantages of Condoms i. Requires consistent and diligent use ii. Not 100 percent effective in preventing pregnancy or STIs iii. Risk of manufacturing defects, such as pinsize holes, and breaking or slipping off during intercourse iv. May inhibit sexual spontaneity v. Users or partners may complain about odor, lubrication (too much or too little), feel, taste, difficulty opening the packages, and disposal vi. Some men complain of reduced penile sensitivity or cannot sustain an erection while putting on a condom vii. Some women complain that the female condom is difficult to use, squeaks, and looks odd c. Male Condom i. Covers the erect penis and catches the ejaculate, thus preventing sperm from entering the woman’s reproductive tract d. How the Male Condom Works i. The polyurethane condom has proven to be not as effective as the latex condom for pregnancy prevention.
  4. 4. Chapter 9 – Contraception and Reproduction e. Effectiveness of the Male Condom i. The theoretical effectiveness rate for condoms is 97 percent; the actual rate is only 80 to 85 percent. The major reason that condoms have such a low actual effectiveness is that couple doesn’t use them each and every time they have sex. f. Female Condom i. The second-generation female condom, known as FC2, is a strong thin, flexible nitrite sheath or pouch about 6.5 inches long. It consists of flexible polyurethane ring at the closed ends of the pouch. g. How the Female Condom Works i. When properly inserted, the outer ring should rest on the folds of the skin around the vaginal opening, and inner ring (the closed end) should fit against the cervix. h. Effectiveness of the Female Condom i. Properly used, they are believed to be as good as or better than the male condom for preventing infections. 2. Contraceptive Sponge a. How It Works i. The contraceptive sponge acts as a barrier by blocking the entrance to the uterus and absorbing and deactivating sperm. b. Advantages of the Contraceptive Sponge i. Does not require a prescription ii. Easy to carry and use iii. Can be inserted up to 24 hours before intercourse iv. Effective immediately if used correctly v. No effect on fertility vi. Generally cannot be felt by a woman or her partner vii. Can be used by women who are breast-feeding c. Disadvantages of the Contraceptive Sponge i. May be difficult to remove ii. May be less effective in women who have had children iii. No reliable protection against STIs iv. Requires advance planning to place the sponge v. Side effects include vaginal irritation and allergic reactions vi. Should not be used during menstruation vii. Slightly increased risk of toxic shock syndrome 3. Vaginal Spermicides a. Include chemical foams, creams, jellies, vaginal suppositories, gels, and film.
  5. 5. Chapter 9 – Contraception and Reproduction b. Failure rates for vaginal suppositories are as high as 10 to 25 percent. c. Vaginal contraceptive film, a thin two-inch-square film laced with spermicide, is folded and inserted into the vagina, where it dissolves into a stay-in –place gel. d. How They Work i. Spermicides consist of a chemical that kills sperm and potential pathogens and an inert base, such as jelly, cream, foam, or film that holds the spermicide close to the cervix. e. Advantages of Vaginal Spermicides i. Easy to use ii. Effective if used with another form of contraception, such as condoms iii. Reduces the risk of some vaginal infections, PID, and STIs iv. No effect on fertility f. Disadvantages of Vaginal Spermicides i. When used alone, does not protect against STIs ii. Frequent use can increase risk of HIV from an infected partner iii. Insertion interrupts sexual spontaneity iv. May cause irritation v. Some people cannot use them because of an allergic reaction vi. Some users complain that spermicides are messy or interfere with oral–genital contact vii. Spermicidal suppositories that do not dissolve completely can feel gritty B. Prescription Barriers 1. Diaphragm a. The diaphragm is a bowl-like rubber cup with a flexible rim that is inserted into the vagina to cover the cervix and prevent the passage of sperm into the uterus during sexual intercourse. b. How It Works i. Diaphragms are fitted and prescribed by a qualified health-care professional in a range of diameter sizes. ii. A diaphragm should remain in the vagina for at least six hours after intercourse to ensure that all sperm are killed. 2. Cervical Cap a. Like the diaphragm, the cervical cap combined with spermicide serves as both a chemical and physical barrier to block the path of the sperm to the uterus.
  6. 6. Chapter 9 – Contraception and Reproduction b. How It Works i. The cervical cap is fitted by a qualified health-care professional. ii. The woman fills it one-third to two-thirds full with spermicide and inserts it by holding its edges together and sliding it into the vagina. The cup is then pressed into the cervix. 3. FemCap a. The FemCap is a non-hormonal, latex-free barrier contraceptive that works with a spermicide. b. How It Works i. A prescription is required to purchase the FemCap. To use the FemCap, apply spermicide to the bowl of the FemCap (which goes over the cervix) to the outer brim, to the groove that will face into the vagina. Insert the squeezed, flattened cap into the vagina with the bowl facing upward. 4. Advantages of Prescription Barriers a. Can be inserted up to six hours before sex b. Doesn’t interrupt sexual activity; can be inserted hours ahead of time c. Usually not felt by either partner d. Can easily be carried in pocket or purse e. No effect on a woman’s natural hormones or fertility f. Cervical caps are an alternative for women who cannot use diaphragms or find them too messy 5. Disadvantages of Prescription Barriers a. Less effective than hormonal contraceptives b. Available by prescription only c. Require advance planning or interruption of sexual activity to position the device before intercourse d. May slip out of place during intercourse e. May be uncomfortable for some women and their partners f. Spermicidal foams, creams, and jellies may be messy, cause irritation, and detract from oral–genital sex g. Some diaphragm users report bladder discomfort, urethral irritation, or recurrent cystitis h. Some cap users find it more difficult to insert and remove, and uncomfortable to wear i. Slightly increased risk of toxic shock syndrome
  7. 7. Chapter 9 – Contraception and Reproduction V. Hormonal Contraceptives A. Introduction 1. Hormonal Contraceptives can provide benefits beyond birth control, including: a. Regular menstrual cycles b. Reduction of menstrual pain and excess bleeding c. Treatment of premenstrual syndrome d. Prevention of migraines e. Decreased risk of endometrial cancer, ovarian cancer, and colorectal cancer f. Treatment of acne and excess facial hair g. Improved bone mineral density B. Oral Contraceptives 1. The pill—the popular term for oral contraceptives—is the method of birth control preferred by unmarried women and by those under age 30. 2. Combination Oral Contraceptives (COCs) a. These pills consist of two hormones, synthetic estrogen and progestin, which play important roles in controlling ovulation and the menstrual cycle. b. Monophasic pills - release a constant dose of estrogen and progestin throughout a woman’s menstrual cycle. c. Multiphasic pills – mimic normal hormonal fluctuations of the natural menstrual cycle by providing different levels of estrogen and progesterone at different times of the month. Multiphasic pills reduce total hormonal dose and side effects. d. Both monophasic and multiphasic pills block the release of hormones that would stimulate the process leading to ovulation. They also make the cervical mucus more hostile to sperm and make implantation of a fertilized egg in the uterine lining more difficult. e. Yasmin contains a unique progestin that works like a mild diuretic and prevents fluid retention. YAZ, a lower-dose 24-day version, can ease emotional and physical premenstrual symptoms. 3. Progestin-Only Pills a. Progestin-only “mini pills” contain only a small amount of progestin and no estrogen. b. The pills prevent pregnancy by thickening cervical mucus, making it hard for sperm to penetrate, and by interfering with implantation of a fertilized egg. c. The risk of heart disease and stroke is lower with progestin-only pills than with any combination pill.
  8. 8. Chapter 9 – Contraception and Reproduction d. Users of progestin-only pills have to be conscientious about taking these pills—not just every day, but at the same time every day. 4. Before Using Oral Contraceptives a. Before starting the pill, a woman should undergo a physical examination that includes a blood pressure test, a breast exam, blood tests, and a urine sample. 5. How they Work a. Oral contraceptives usually come in 28-day packets: 21 of the pills contain hormones, and 7 are “blanks,” included so the women can take a pill every day, even during her menstrual period. 6. A Special Caution a. Common antibiotics, including many of the ones prescribed for dental procedures or skin conditions, may lower the effectiveness of oral contraceptives, particularly low-dose birth control pills. 7. Advantages of Oral Contraceptives a. Extremely effective when taken consistently b. Convenient c. Moderately priced d. Does not interrupt sexual activity e. Reversible within three months of stopping the pill f. Reduces the risk of benign breast lumps, ovarian cysts, iron-deficiency anemia, pelvic inflammatory disease, endometrial cancer, and ovarian cancer g. May relieve painful menstruation 8. Disadvantages of Oral Contraceptives a. In real life, rates of unintended pregnancies among pill users are as high as 2.8 percent in the first year of use and 5.7 percent after three years b. Requires a prescription c. Increases risk of cardiovascular problems, primarily for women over age 35 who smoke and those with high blood pressure or other health problems d. Side effects vary with different brands but include spotting between periods, weight gain or loss, nausea and vomiting, breast tenderness, and decreased sex drive e. Must be taken at the same time every day (especially critical with low- dose estrogen and progestin-only pills) f. No protection against STIs g. Must use a secondary form of birth control for the initial seven days of use
  9. 9. Chapter 9 – Contraception and Reproduction C. Extended-Use Pills 1. Prescribed to lessen the number or menstrual cycles for women with asthma, rashes, or other conditions that flare up during their periods. 2. Seasonale and Seasonique are prescription forms of oral contraception that prevent pregnancy as effectively as other birth control pills but produce only four menstrual periods a year. 3. How They Work a. Women take “active” pills continuously for three months. During this time, Seasonale prevents the uterine lining from thickening enough to produce a full menstrual period. b. Every three months, a woman takes one week of inactive pills to produce a “pill period,” which may be lighter than a regular period. 4. Advantages a. Fewer periods b. Tri-monthly periods are usually lighter, with less blood flow 5. Disadvantages a. Similar to those of other oral contraceptives in terms of health risk, costs, and side effects b. No protection from STIs c. More spotting and breakthrough bleeding than with a 28-day pill d. Determining pregnancy is difficult without a monthly period 6. Lybrel, the “No-Period” Pill a. Lybrel works the same way as other combination hormonal birth control pills, but it is taken 365 days without interruption. b. How It Works i. Lybrel stops the body’s monthly preparation for pregnancy by lowering the production of hormones that make pregnancy possible. c. Advantages i. No menstrual periods, cramps, or other symptoms ii. No need to stop taking pills or switch to dummy pills for a week iii. Relief from menstruation-linked conditions such as endometriosis and menstrual migraines d. Disadvantages i. Spotting ii. Health risks similar to those of other combination pills iii. Determining pregnancy is difficult without a monthly period iv. Some women feel that eliminating periods is unnatural
  10. 10. Chapter 9 – Contraception and Reproduction D. Contraceptive Patch 1. The Ortho Evra birth control patch, the first transdermal (through the skin) contraceptive, works like a combination pill but looks like a Band- Aid. 2. How it Works a. A woman applies the patch to her back, upper arm, lower abdomen, or buttocks and changes it every seven days for three weeks. b. Advantages of the Patch i. Good alternative for women who cannot remember, do not like, or have problems swallowing daily pills ii. Highly effective when used correctly iii. Does not interrupt sexual activity iv. Fewer side effects—such as nausea, breakthrough bleeding, and mood swings—than pills v. Fertility returns quickly after you stop using it c. Disadvantages of the Patch i. Must apply a new patch every week ii. Requires a prescription iii. No protection against STIs iv. Increases risk of blood clots, heart attack, and stroke particularly for women who smoke or have certain health conditions v. Less effective in women who weigh more than 198 pounds vi. Some women report breast tenderness, headaches, upper respiratory infections, or self-consciousness wearing the patch vii. Contact lens wearers may experience vision changes viii. Five percent of women report that at least one patch slipped off; two percent report skin irritation ix. Must use another form of birth control for the initial seven days of use E. Contraceptive Vaginal Ring (CVR) 1. The silver-dollar-sized NuvaRing, a 2-inch ring made of flexible, transparent plastic, slowly emits the same hormones as oral contraceptives through the vaginal tissues. 2. How it Works a. The flexible, plastic 2-inch ring compresses so a woman can easily insert it. Each ring stays in place for three weeks, and then is removed for the fourth week of the menstrual cycle. b. Advantages of the NuvaRing i. Under medical supervision, may be safer than birth control pills for women with mild hypertension or diabetes
  11. 11. Chapter 9 – Contraception and Reproduction ii. Less likelihood of pill-related side effects, such as nausea, mood swings, spotting, and cramping iii. No need to remember a daily pill or weekly patch iv. Fertility returns quickly when ring is removed v. Reduced pain during menstrual periods vi. May improve acne and reduce excess body hair vii. Can help prevent menstrual migraines c. Disadvantages of the NuvaRing i. Slight increased risk of blood clots, heart attack, and stroke in women older than 35 who smoke 15 or more cigarettes a day or who have other cardiovascular risk factors ii. Some women do not feel comfortable placing and removing something inside their vagina iii. Possible side effects include vaginal discharge, irritation, and infection iv. Cannot use oil-based vaginal medications for yeast infections while ring is in place v. No protection against STIs F. Intrauterine Contraceptives 1. An intrauterine device (IUD) is a small piece of molded plastic, with a nylon string attached, which is inserted into the uterus through the cervix. 2. The ParaGuard IUD, which contains copper, protects against pregnancy for 12 years. 3. The Mirena intrauterine system consists of a T-shaped device inserted in the uterus by a physician that releases a continuous low dose of progestin and provides five years of protection from pregnancy. 4. How They Work a. A physician must insert the IUD into a woman’s uterus. 5. Advantages of IUDs a. Highly effective at preventing pregnancy b. No need to think about contraception for five years c. Allows sexual spontaneity; neither partner can feel it d. Starts working immediately e. New mothers can breast-feed while using it f. Periods become shorter and lighter or stop altogether g. Low incidence of side effects h. Can be removed at any time 6. Disadvantages of IUDs a. Spotting or breakthrough bleeding in first three to six months b. No protection against STIs
  12. 12. Chapter 9 – Contraception and Reproduction c. Potential side effects include acne, headaches, nausea, breast tenderness, and mood changes d. Increased risk of benign ovarian cysts e. May take up to a year for fertility to return after discontinuation G. Contraception Injection 1. A progestin-only contraceptive is available in the form of a birth control “shot” or injection. 2. Depo-Provera or its newer form, Depo-subQ Provera, must be given every 12 weeks. 3. Because of the risk of significant bone mineral loss, the FDA has recommended that women not use Depo-Provera for longer than two years. 4. How It Works a. The long-acting hormonal contraceptive raises levels of progesterone, thereby simulating pregnancy. The pituitary gland does not produce FSH and LH, which normally cause egg ripening and release. The endometrial lining of the uterus thins, preventing implantation of a fertilized egg. 5. Advantages of Contraceptive Injections a. Because it contains only progestin, it is safe for women who cannot take combination birth control pills b. No risk of user error c. No worry about buying, storing, or using contraceptives d. No need to think about contraception for three months at a time e. Possible protection against endometrial and ovarian cancer f. Can be used by women who are breast-feeding g. May decrease menstrual migraines 6. Disadvantages of Contraceptive Injections a. Must visit a doctor or clinic every three months for injection b. Menstrual cycles become irregular or cease c. Potential side effects include decreased sex drive, depression, headaches, dizziness, frequent urination, allergic reactions, and hair loss or increase in hair growth d. Increased weight gain e. No protection against STIs f. May increase the risk of acquiring chlamydia and gonorrhea compared to women not using a hormonal contraceptive. Scientists do not know the reason for this increased risk g. Delayed return of fertility h. Long-term use may significantly reduce bone density
  13. 13. Chapter 9 – Contraception and Reproduction H. Contraceptive Implants 1. Thin, flexible, plastic implant—about the size of a matchstick—is inserted under the skin of the upper arm to provide birth control that is 99 percent effective for up to three years. 2. Implanon is now available throughout the United States. Nexplanon is a newer version designed for easier insertion and removal. 3. How They Work a. Contraceptive implants work primarily by releasing progestin and suppressing ovulation. 4. Advantages a. Can be used while breast-feeding b. Can be used by women who cannot take estrogen c. Provides continuous long-lasting birth control without sterilization d. No medicine to take every day e. Does not interfere with sexual foreplay f. Ability to become pregnant returns quickly once it is removed 5. Disadvantages a. Irregular bleeding b. Side effects such as dizziness, acne, hair loss, headache, nausea, nervousness, and pain at insertion site c. No protection against STIs d. Change in appetite e. Change in sex drive f. Cysts on the ovaries g. Depression, mood changes h. Discoloring or scarring of the skin over the implant VI. Fertility Awareness Methods A. Overview 1. The different methods of birth control based on a woman’s menstrual cycle are sometimes referred to as natural family planning or fertility awareness methods. 2. How It Works a. The Calendar Method i. Often called the rhythm method; based on counting the woman’s safe days based on her individual menstrual cycle b. Basal-Body-Temperature Method i. Determines the safe days based on the woman’s basal body temperature, which rises after ovulation
  14. 14. Chapter 9 – Contraception and Reproduction c. The Cervical Mucus Method i. Also called the ovulation method; based on observation of changes in the consistency of the woman’s vaginal mucus throughout her menstrual cycle. The period of maximum fertility occurs when the mucus is smooth and slippery 3. Advantages of Fertility Awareness a. No expense b. No side effects c. No need for a prescription, medical visit, or fittings d. Nothing to insert, swallow, or check e. No effect on fertility f. Complies with the teachings of the Roman Catholic Church 4. Disadvantages of Fertility Awareness a. Less reliable than other forms of birth control b. Couples must abstain from vaginal intercourse eight to eleven days a month or use some form of contraception c. Conscientious planning and scheduling are essential d. May not work for women with irregular menstrual cycles e. Some women find the mucus or temperature methods difficult to use VII. Emergency Contraception A. Introduction 1. Emergency contraception (EC) is the use of a method of contraception to prevent unintended pregnancy after unprotected intercourse or the failure of another form of contraception, such as a condom breaking or slipping off. 2. The use of EC has more than doubled in recent years, particularly among women in their early 20s. 3. Emergency contraception provides a second chance to prevent pregnancy following unprotected sexual intercourse or contraceptive failure. 4. How It Works a. ECPs stop pregnancy in the same way as other hormonal contraceptives: They delay or inhibit ovulation, inhibit fertilization, or block implantation of a fertilized egg, depending on a woman’s phase of the menstrual cycle. b. They have no effect once a pregnancy has been established. c. The morning-after pill also may be safe for use as a regular birth control method and may appeal to women who do not have sex regularly and who could use it before or after sex. However, it is not as effective as regular birth control pills, patches, or rings.
  15. 15. Chapter 9 – Contraception and Reproduction VIII. Sterilization A. Introduction 1. This is the most popular method of birth control among married couples in the U.S. 2. Sterilization is surgery to end a person’s reproductive capability. B. Male Sterilization 1. The cutting of the vas deferens, the tube that carries sperm from one of the testes into the urethra for ejaculation, is called a vasectomy. 2. During the 15- or 20-minute office procedure, done under a local anesthetic, the doctor makes small incisions in the scrotum, lifts up each vas deferens, cuts it, and ties off the ends to block the flow of sperm. C. Female Sterilization 1. The two terms used to describe female sterilization are tubal ligation (the cutting or tying of the fallopian tubes) and tubal occlusion (the blocking of the tubes). 2. One of the common methods of tubal ligation or occlusion uses laparoscopy, commonly called belly-button or band-aid surgery. 3. Essure a. This involves the placement of small, flexible microcoils into the fallopian tubes via the vagina by a physician. D. Advantages of Sterilization 1. Offers permanent protection against unwanted pregnancy. 2. No effect on sex drive in men or women. Many couples report greater sexual activity and pleasure because they no longer have to worry about pregnancy or deal with contraceptives. 3. Vasectomy and tubal ligation are performed as outpatient procedures, with a quick recovery time. 4. Use of Essure requires no incision, so there is less discomfort and very rapid recovery. Essure may be an option for women with chronic health conditions, such as obesity, diabetes, or heart disease. E. Disadvantages of Sterilization 1. All procedures should be considered permanent and used only if both partners are certain they want no more children 2. No protection against STIs 3. Must use another form of birth control for first three months 4. Many long-term risks remain unknown, but there is no evidence of any link between vasectomy and prostate cancer
  16. 16. Chapter 9 – Contraception and Reproduction IX. Childfree by Choice A. More women and men are deliberately choosing to remain “childfree.” B. Single childfree women tend to be better educated, more cosmopolitan, less religious, and more professional than those in the general population. C. Childfree couples are predominantly urban, well-educated, and upper middle class, with egalitarian and long-running marriages. D. Reasons for not having children are diverse, including: 1. A desire to maintain their freedom and have more time with their partners 2. Career ambitions 3. Concern about overpopulation and the fate of Earth 4. Concern about a hostile work environment for mothers and the inadequacy of day care 5. Disillusionment with the have-it-all hopes of baby boomers and a belief in a have-most-of-it philosophy X. Unwanted Pregnancy A. A woman faced with an unwanted pregnancy—often alone, unwed, and desperate—can find it extremely difficult to decide what to do. B. Giving up her child for adoption is an option for women who do not feel abortion is right for them. XI. Abortion A. Introduction 1. After rising steadily through the 1970s, the number of elective abortions leveled off in the 1980s and has declined since then to approximately 785,000 per year. 2. Although women of all backgrounds have abortions, abortion in the United States is most likely to occur among single women, racial or ethnic minorities, low-income women, and women who have had at least one child. B. Medical Abortion 1. The term medical abortion describes the use of drugs, also called abortifacients, to terminate a pregnancy. C. Other Abortion Methods 1. About two-thirds of all abortions (64 percent) are performed within the first 8 weeks of pregnancy. Only about 1 percent of abortions occur after 20 weeks.
  17. 17. Chapter 9 – Contraception and Reproduction 2. Suction curettage a. Usually done from 7 to 13 weeks after the last menstrual period, involves the gradual dilation (opening) of the cervix, often by inserting into the cervix one or more sticks of laminaria (a sterilized seaweed that absorbs moisture and expands, thus gradually stretching the cervix). b. The laminaria is removed and the physician inserts a suction tip into the cervix, and the uterine contents are drawn out via a vacuum system. c. A curette is used for scrapping and to check for complete removal of contents of the uterus. XII. The Psychological Impact of Abortion A. Introduction 1. The primary emotion of women who have just had an abortion is relief. Although many women also express feelings of guilt or sadness. 2. The best predictor of psychological well-being after abortion is a woman’s emotional well-being prior to pregnancy. B. Politics of Abortion 1. Abortions were legal in the United States until the 1860s. 2. In 1973, the U.S. Supreme Court, following a 1970 ruling on the case of Roe v. Wade by the New York Supreme Court, said that an abortion in the first trimester of pregnancy was a decision between a woman and her physician and was protected by privacy laws. 3. The Supreme Court upheld a federal law banning partial birth abortions, which are performed in the later stages of pregnancy and involves collapsing the skull to allow a fetus to slip easily from the birth canal. XIII. Pregnancy A. Overview 1. Pregnancy and birthrates in the United States have declined to the lowest rate ever recorded. 2. Pregnancy rates have fallen for women in their teens and 20s, while they have increased for women in their late 30s and early 40s. B. Preconception Care 1. Preconception care—the enhancement of a woman’s health and well- being prior to conception in order to ensure a healthy pregnancy and baby—includes risk assessment, health promotion, and interventions to reduce risk.
  18. 18. Chapter 9 – Contraception and Reproduction C. Home Pregnancy Tests 1. Home pregnancy tests detect the presence of human chorionic gonadotropin (hCG), which is secreted as the fertilized egg implants in the uterus. D. Prenatal Care 1. A Healthy Diet a. Doctors have long recommended a well-balanced diet that provides a complete variety of key nutrients. b. In addition, pregnant women should: i. Make sure they are getting an adequate level of folic acid in order to prevent neural tube defects. ii. Avoid soft unpasteurized cheeses to prevent Listeria infections, which can be harmful to a fetus. iii. Eat a diet rich in fruit and vegetables, which provides an additional benefit: a lower risk of premature birth. iv. Increase their caloric intake to ensure adequate nutrition for the fetus but not put on so much weight that it increases the risks to their own health and their baby’s. v. Not avoid any specific foods unless they are allergic to them. Recent research suggests that eating nuts during pregnancy lowers a child’s risk of having a nut allergy—as long as the mother is not allergic herself 2. Exercise a. The proven benefits of light to moderate exercise during pregnancy include a greater sense of well-being, enhanced mood, shorter labor, and fewer obstetric complications. 3. Avoid Smoking and Smoke a. Smoking and exposure to secondhand smoke during pregnancy puts a woman and her unborn child in jeopardy. 4. Don’t Use Alcohol or Drugs a. Alcohol and illegal drugs are clear threats to an unborn child. However, even some common prescription drugs, such as acetaminophen and antidepressants, can pose short- and long-term risks. E. How a Woman’s Body Changes During Pregnancy 1. The woman’s uterus becomes slightly larger, and the cervix becomes softer and bluish due to increased blood flow. 2. Progesterone and estrogen trigger changes in the milk glands and ducts in the breasts, increasing size and tenderness. 3. More frequent need to urinate.
  19. 19. Chapter 9 – Contraception and Reproduction 4. As the pregnancy progresses, the woman’s skin stretches as her body shape changes, her center of gravity changes as her abdomen protrudes, and her internal organs shift as the baby grows. F. How a Baby Grows 1. When a zygote reaches the uterus, it’s still smaller than the head of a pin. 2. Once nestled into the spongy uterine lining, it becomes an embryo. 3. The embryo takes on an elongated shape, rounded at one end. A sac called the amnion envelops it. 4. As water and other small molecules cross the amniotic membrane, the embryo floats freely in the absorbed fluid, cushioned from shocks and bumps. 5. At nine weeks, the embryo is called a fetus. 6. A special organ, the placenta, forms. Attached to the embryo by the umbilical cord, the placenta supplies the growing baby with fluid and nutrients from the maternal bloodstream and carries waste back to the mother’s body for disposal. G. Complications of Pregnancy 1. Perinatology, or maternal-fetal medicine, focuses on the special needs of high-risk mothers and their unborn babies. 2. Ectopic Pregnancy a. In this type of pregnancy, the fertilized egg remains in the fallopian tube instead of traveling to the uterus. 3. Miscarriage a. Also called spontaneous abortion. b. About 10 to 20 percent of pregnancies end in miscarriage, or spontaneous abortion, before the 20th week of gestation. 4. Infections a. Rubella is the infectious disease most clearly linked to birth defects. b. Cytomegalovirus is the most common prenatal infection today. i. This infection produces mild flu-like symptoms in adults but can cause brain damage, retardation, liver disease, cerebral palsy, hearing problems, and other malformations in unborn babies. 5. Genetic Disorders a. Every individual has an estimated four to six defective genes, but the chances of passing them on to a child are slim. b. The child of a parent with an abnormal dominant gene has a 50 percent likelihood of inheriting it. c. A mother’s age has long been associated with increased risk of chromosomal disorders such as Down syndrome. More recently,
  20. 20. Chapter 9 – Contraception and Reproduction research has linked a father’s age of 45 or older to several neuro- psychiatric disorders. 6. Premature Labor a. Approximately 8 percent of all babies are born too soon (before the 37th week of pregnancy). b. The warning signs of premature labor include a dull, low backache; a feeling of tightness or pressure on the lower abdomen; and intestinal cramps, sometimes with diarrhea. XIV. Childbirth A. Preparing for Childbirth 1. Women who attend prenatal classes are less likely to undergo caesarean deliveries and more likely to breast-feed. 2. An epidural block involves injecting an anesthetic into the membrane around the spinal cord, numbing the lower body. 3. A spinal block involves the injection going directly into the spinal canal and numbs the lower body. B. Labor and Delivery 1. There are three stages of labor. a. The First Stage i. This stage (early or latent phase) starts with effacement (thinning) and dilation (opening up) of the cervix. ii. During this time the amniotic sac of fluids usually breaks a sign that the woman should call her doctor. iii. Contractions go from being not uncomfortable to the most difficult during this stage. iv. This stage ends when the cervix is dilated to about 8 centimeters. b. The Second Stage i. During this stage of labor, the cervix is completely dilated, during which the baby moves into the vagina, or birth canal, and out of the mother’s body. ii. This stage can take up to an hour or more. iii. Strong contractions may last 60 to 09 second and occur every two to three minutes. iv. An episiotomy—an incision from the lower end of the vagina toward the anus to enlarge the vaginal opening as the baby’s head appears, or crowns—may be performed by a doctor. v. The baby can be in a more difficult position, facing up rather than down, or with the feet or buttocks first (a breech birth), and a cesarean birth may then be necessary.
  21. 21. Chapter 9 – Contraception and Reproduction c. The Third Stage i. During this stage of labor, the uterus contracts firmly after the birth of the baby and, usually within five minutes, the placenta separates from the uterine wall. C. Caesarean Birth 1. In a caesarean delivery (also referred to as a caesarean section, or C- section), the doctor lifts the baby out of the woman’s body through an incision made in the lower abdomen and uterus. 2. The most common reason for caesarean birth is failure to progress, a vague term indicating that labor has gone on too long and may put the baby or mother at risk. XV. Infertility A. Introduction 1. The World Health Organization defines infertility as the failure to conceive after one year of unprotected intercourse. 2. Affects one in six couples in the United States. 3. In women, the most common causes of sub-fertility or infertility are age, abnormal menstrual patterns, suppression of ovulation, and blocked fallopian tubes. 4. Male sub-fertility or infertility is usually linked to either the quantity or the quality of sperm, which may be inactive, misshapen, or insufficient. 5. Infertility can have an enormous emotional impact. B. Options for Infertile Couples 1. The odds of successful pregnancy range from 30 to 70 percent, depending on the specific cause of infertility. 2. One result of successful infertility treatments has been a boom in multiple births. 3. Artificial Insemination a. The introduction of viable sperm into the vagina by artificial means. 4. Assisted Reproductive Technology (ART) a. The most common ART procedure is in vitro fertilization (IVF), which involves removing the ova from a woman’s ovary and placing the woman’s egg and her mate’s sperm in a laboratory dish for fertilization. After several days, if the egg shows signs of development, it is returned to the woman’s uterus.
  22. 22. Chapter 9 – Contraception and Reproduction XVI. Adoption A. Adoption matches would-be parents yearning for youngsters to love with infants or children who need loving. B. Census records indicate that there are currently 1.6 million adopted children in the United States. Key Terms adoption amnion artificial insemination barrier contraceptives blastocyst caesarean delivery cervical cap coitus interruptus conception condom contraception diaphragm ectopic pregnancy embryo emergency contraception (EC) failure rate fertilization fetus implantation infertility intrauterine device (IUD) labor laparoscopy medical abortion minipill, progestin-only pill miscarriage monophasic pill multiphasic pill oral contraceptives placenta preconception care premature labor rhythm method rubella spermatogenesis sterilization suction curettage tubal ligation tubal occlusion vaginal contraceptive film (VCF) vaginal spermicide vasectomy zygote

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