Conception, Pregnancy, and Childbirth

Human Sexuality in a World of Diversity, 4Ce
Conception,
Pregnancy, and
Childbirth
Chapter 10
Copyright 2013 Pearson Canada Inc.
10 - 1
Conception
Conception
The union of a sperm cell and ovum
Zona Pellucida
Gelatinous layer that surrounds the ovum
Hyaluronidase
Enzyme that briefly thins the zona pellucida
enabling one sperm to penetrate
10- 2
Infertility and Assisted Reproductive

Technologies
Infertility
Inability to conceive a child
Term isnt applied until a couple has tried to conceive
for more than a year
Can have significant psychological and emotional
effects on individuals and couples
The likelihood of infertility increases with age
15% of couples in North America have problems with
fertility, about one-half succeed in conceiving
10- 3
Applied Knowledge
Optimizing the Chances of Conception

Engaging in coitus within a few hours of
ovulation optimizes the chances of conception.
Some ways to predict ovulation:
Use a basal body temperature chart
Analyze urine or saliva for luteinizing hormone (overthe-counter kits at drugstore)
Track vaginal mucus
Other tips:
Woman: lie still on her back for 60 minutes, with her
knees drawn close to her chest
Man: ejaculate deeply and withdraw in a straight line
10- 4

Technologies
Male Fertility Issues

About 30% infertility issues caused by men
Problems include:
Low sperm counts

Irregularly shaped sperm
Low sperm motility (self-propulsion)
Chronic diseases (e.g., diabetes)
Injuries to the testes
Autoimmune responses
A pituary imbalance and/or thyroid disease
10- 5

Technologies
Female Fertility Issues

Infertility in women has a variety of causes
Irregular ovulation and/or failure to ovulate
Obstructions or malfunctions of the reproductive tract, often
caused by infections or diseases (STIs)
Endometriosis
Many factors can play roles in failure to ovulate (e.g.,

stress, malnutrition)
Ovulation can be induced by fertility drugs
(continued)
10- 6

Technologies
Female Fertility Issues (continued)

Endometriosis
An abnormal condition in which endometrial tissue
is sloughed off into the abdominal cavity, rather than
out of the body during menstruation
This condition is characterized by abdominal pain
and may cause infertility
10- 7

Technologies
Reproductive Technologies
Artificial Insemination
The introduction of sperm into the reproductive tract
through means other than sexual intercourse
In vitro fertilization
A method of conception in which mature ova are
surgically removed from an ovary and placed in a
laboratory dish with sperm
Gamete intrafallopian transfer (GIFT)

A method of conception in which sperm and ova are
inserted into a fallopian tube to encourage conception
10- 8

Technologies
Zygote intrafallopian transfer (ZIFT)
A method of conception in which an ovum is fertilized in a

laboratory dish, then placed in a fallopian tube
Donor IVF
A variation of in vitro fertilization in which an ovum is
taken from one woman, fertilized, and injected into the
uterus or fallopian tube of another woman
Embryonic Transfer
A method of conception in which a female volunteer is
artificially inseminated by the male partner of the intended
mother, then the embryo is removed from the volunteer
and inserted into the uterus of the intended mother
10- 9

Technologies
Intracytoplasmic sperm injection
A method of conception in which a single sperm is
injected directly into an ovum
Surrogate Motherhood
A woman who is impregnated with the sperm of a
prospective father via artificial insemination, carries
the embryo and fetus to term, and then gives the
child to the prospective parents
What is law regarding Surrogacy in Canada?
10- 10

Technologies
Assisted Parenthood for Gays and Lesbians

Many gays and lesbians use reproductive
technologies to become parents
i.e., visit fertility clinics not for infertility
problems but seeking donor sperm and ova
Their counseling needs are different than
heterosexual clients
10- 11

Technologies
Risks of Assisted Reproductive Technologies

Most common risk is multiple gestation, which
increases the risk of premature birth
Other potential risks:
Abnormal placentation
Miscarriage
Gestational diabetes
Hypertensive disorders
Severe fetal/neonatal complications
10- 12

Technologies
Adoption
Most adoptions create new loving families
Adopted children may feel less secure than
biological children
The younger the child, the smoother the process
In the 1990s many adoption agencies would not
place children with same-sex couples
Since that time, new legislation has passed in
provinces across Canada granting gay couples
the same rights as heterosexual ones
10- 13

Technologies
Canadian Legislation and Reproductive
Technologies: In 2004, Parliament passed
legislation to regulate reproductive technologies
Main provisions include bans on:
Human cloning
Selection of a babys sex for non-medical purposes
Payment to a surrogate mother
Payment to a sperm donor
One provision permits research using stem cells

from embryos left over from infertility treatments
10- 14
Pregnancy
Early Signs of Pregnancy

Missed period (though this may occur for other reasons)
Some women experience cyclic bleeding or spotting

during pregnancy
Pregnancy Tests
Tests to detect human chorionic gonadotropin (hCG) in the
urine as early as the third week of pregnancy Example:
Home pregnancy kits. Can be taken within a couple of days
of missed period.
Blood test can detect hCG in the blood as early as the eighth
day of pregnancy (5 days before expected pregnancy). Most
reliable test.
10- 15
Pregnancy
Early Effects of Pregnancy

Tenderness in her breasts
Morning sickness (nausea, aversions to specific
foods, and vomiting)
Usually goes away by the 12th week of pregnancy
fatigue, sleeping longer and falling asleep more

easily than usual
Frequent urination
10- 16
Pregnancy
Miscarriage
A spontaneous end to the pregnancy
In most cases, a specific cause is not identified
Known causes include Chromosomal defects in the
fetus and abnormalities of the placenta and uterus
More common among older mothers
75% occur in the first 16 weeks, the great majority
in the first 7 weeks
Couples may feel a deep sense of loss and undergo a
period of mourning
Most women who miscarry are able to carry
subsequent pregnancies to term
10- 17
Pregnancy
Sexual Activity During Pregnancy

Sex is safe throughout the pregnancy, until the
start of labour, as long as the pregnancy
develops normally and the woman has no
complications or history of miscarriage
Women typically experience a decline in desire
in the first trimester, increased desire in the
second trimester, and another decline in the
third
Creativity in terms of positions and behaviours
may be needed
10- 18
Pregnancy
Psychological Changes during Pregnancy

A womans psychological response to pregnancy
reflects her desire to be pregnant, her physical
changes, and her attitudes towards these changes
Financial, social, and psychological resources
are an asset. Lack of these resources may be a
source of stress during the pregnancy
Men respond to pregnancy depending on how
much they want to become parents
10- 19
Prenatal Development
The Germinal Stage

The period of prenatal development before
implantation in the uterus
Period of cell division
3-4 days to get to uterus, 3-4 days before beginning
to implant, implantation takes about a week
Blastocyst
An embryo that consists of a sphere of cells surrounding
a cavity of fluid
10- 20
The Embryonic Stage

The stage of prenatal development that lasts from
implantation through the eighth week
Characterized by differentiation of the major
organ systems
Growth of head and organs close to spinal cord
occurs first
The embryo develops within the amniotic sac
suspended in amniotic fluid, which protects the
fetus
10- 21
The Embryonic Stage (continued)

Placenta
An organ connected to the fetus by the umbilical cord.
The placenta serves as a relay station between the
mother and the fetus, allowing the exchange of
nutrients and wastes
Passes from the womans body after delivery (also
called afterbirth)
Umbilical Cord
A tube that connects the fetus to the placenta
Function:
10- 22
The Fetal Stage

Begins at the 9th week and continues until birth
Fetus begins to respond to the outside world at this time
By the end of the first trimester, the major organ
systems, fingers, toes, and external genitalia are formed,
gender can be determined, and eyes are clearly
distinguishable
Near the end of the second trimester, the fetus
approaches the age of viability (viability means point at
which the fetus is able to survive outside of the mothers
womb
10- 23
Environmental Influences (outside influences that can

affect a pregnancy)
Maternal diet
Proper nutrition during pregnancy is important to fetal health.
Folic acid is an especially impt. vitamin
Maternal diseases and disorders

Preexisting conditions such as diabetes
Teratogens environmental influences and agents that cause
permanent, harmful, structural alterations of the embryo or fetus
Critical periods of vulnerability

A period when an embryo or fetus is vulnerable to the effects of
a teratogen
Examples:
10- 24
Environmental Influences (continued)

Rubella (German Measles)
A viral infection that can cause mental retardation and
heart disease in an embryo
Syphilis
A sexually transmitted disease caused by a bacterial
infection
HIV/AIDS
A sexually transmitted infection that destroys white blood
cells in the immune system, leaving the body vulnerable
to various opportunistic infections
10- 25

Pregnancy-induced Hypertension
A life-threatening condition characterized by high
blood pressure
Also called pre-eclampsia
Ectopic pregnancy
A pregnancy in which the fertilized ovum becomes
implanted somewhere other than the uterus
(continued)
10- 26

Rh incompatibility
A condition in which antibodies produced by a pregnant
woman are transmitted to the fetus where they may cause
brain damage or death
Maternal drug use

Some widely used drugs, including nonprescription drugs, are
linked to birth abnormalities
Antibiotics can also cause problems
Vitamins
(continued)
10- 27

Narcotics
Can readily pass from mother to fetus
At birth, babies can experience withdrawal
Marijuana
Passes readily from mother to fetus
Can impact childs problem-solving and decisionmaking abilities
(continued)
10- 28
Prenatal Development-Environmental
Influences
Alcohol
Leads to increased risk of
birth defects, infant mortality,
sensory and motor problems,
and mental retardation
40% of children whose
mothers drink during
pregnancy develop fetal
alcohol syndrome (FAS)
A cluster of symptoms
typified by developmental
lags, characteristic facial
features, and smaller-thanaverage body and brain
Copyright 2010 by Pearson Education Canada
Cigarette Smoking
Increases risks of spontaneous
abortion, premature rupturing
of the amniotic sac, stillbirth,
low birth weight, and early
infant mortality
Risks increase with the
amount smoked
Smoking cigarettes and
drinking alcohol place the
child at greater risk than
either practice alone
Secondary smoke may be
absorbed by mother and
passed to fetus
10- 29
Chromosomal and Genetic Abnormalities

A genetic counselor can help assess the risk of
passing genetic defects to a child
Parental blood tests and fetal DNA tests can
detect various disorders and diseases
The risk of giving birth to a child with Downs
Syndrome increases with mothers age
Amniocentesis can detect Downs Syndrome before
birth
10- 30
Childbirth
Dropping or lightening when the fetuss

head settles into the pelvis occurs early in the
ninth month of pregnancy
A day or so before labour begins, a woman may
notice blood in her vaginal secretions and
experience a rush of water from her vagina
(the amniotic sac has burst)
First contractions are called Braxton Hicks
False labour contractions, relatively painless
10- 31
Childbirth
Stages of Childbirth First Stage

Uterine contractions efface (cause to become thin) and dilate
(open or widen) the cervix to about 10 centimetres in diameter
12 to 24 hours is average length for first stage
Initial contractions are mild and widely spaced (at intervals of 10
to 20 minutes) , lasting 20 to 40 seconds
Transition
The process during which the cervix becomes almost fully
dilated and the infants head begins to move into the birth
canal
Contractions come quickly now
Transition lasts for up to 30 minutes
Accompanied by nausea, chills, and intense pain
10- 32
Childbirth
Stages of Childbirth - Second Stage

Begins after transition when the cervix is fully dilated and the
baby begins to move into the birth canal
Crowning when the babys head is visible at the vaginal
opening
Full emergence ends the second stage of childbirth, which lasts
from a few minutes to a few hours
Episiotomy
A surgical incision in the perineum that widens the
birth canal, preventing random tearing during childbirth
Incision can cause infection and pain, creating
discomfort and itching as it heals
In Canada, the number of episiotomies is decreasing
10- 33
Childbirth
Stages of Childbirth - Third Stage

Can last from a few minutes to an hour or more
During this stage the placenta is expelled and the
uterus begins the process of contracting
The attending physician now sews up the episiotomy
or any tears in the perineum
10- 34
Childbirth
Methods of Childbirth
Until the 20th century, childbirth usually happened at
home and involved the mother, a midwife, family, and
friends
Today there are many options:
Medicated childbirth
Prepared childbirth (the Lamaze Method)
Caesarean section
Rates of C-section are increasing concerning because
they are more dangerous and take more time to recover
from
10- 35
Childbirth
Birth Difficulties
Preterm and Low-Birth-Weight Children
Preterm if born before 37 weeks of gestation
Low-birth-weight if weighs less than 2 500 grams
Stillbirth
When a baby is born dead
Can be connected with fetal abnormalities, infection, the
mothers medical condition, and pregnancy complications
Majority of cases have no clear cause
Can cause post-traumatic stress disorder in parents
10- 36
The Postpartum Period

Normal Postpartum
The weeks after delivery are

called the postpartum period
First few days are happy ones
About 70% of new mothers
experience periods of tearfulness,
sadness, and irritability called the
baby blues
Common caused by
hormone changes
Last for about 10 days
Postpartum depression
(PPD)
1 in 5 women experience PPD

Begins within four weeks of
delivery
May linger for weeks or months
Symptoms
Serious sadness, feelings of
hopelessness and
helplessness, feelings of
worthlessness, difficulty
concentrating, major changes
in appetite and sleep patterns
May be caused by an interaction
of psychological and hormonal
factors
10- 37
Lesbian Mothers
Also at risk for maternal depression
May experience more stress than heterosexual
mothers because they receive less support from
their own parents and because of societal prejudices
May experience less difficulty because pregnancies
are likely to be planned and the division of childcare labour is more equal than among heterosexual
couples
10- 38
The Postpartum Period - Breastfeeding

Health Canada and the
Canadian Paediatric
Society recommend
breastfeeding as the
preferred method of
feeding infants because it
provides optimal
nutritional, immunological,
and emotional benefits for
the childs growth and
development
87% of Canadian mothers
breastfeed
Mothers who do not

breastfeed typically give
medical reasons
May also find it
unappealing or find bottle
feeding easier
Can also transmit HIV

from mother to infant
Women who breastfeed
more likely to experience
decreased sexual desire
than women who bottle
feed
Hormonal reasons, vaginal
dryness, increased fatigue
10- 39
Resumption of Ovulation and Menstruation

For close to a month, women experience a
reddish vaginal discharge called lochia
Non-nursing mothers resume menstrual cycles
approx. two to three months postpartum
Ovulation occurs before the first menstrual cycle
10- 40
Resumption of Sexual Activity

Depends on a couples level of sexual interest, the
healing of episiotomies and other injuries, fatigue,
the recommendations of physicians, and tradition
Obstetricians usually advise a six-week waiting
period for safety and comfort
Return of sexual interest and activity may take
longer for some couples
Satisfied couples prior to birth are likely to be
satisfied after birth
10- 41
Birth Rates
Birth rates in Canada have
varied considerably over
time
High after Second World
War (3.6 children per
woman)
Lower after the
introduction of the birth
control pill reaching an
all-time low in 2000
Canadian women today

have an average of 1.54
children (below the level
needed to replace the
population)
Why is birth rate lower now

than in past generations?
Improved access to safe,
effective contraception
More women completing
post-secondary education
More women want to
work full-time so choose
to limit their number of
children
Financial constraints
Becoming more socially
acceptable in Western
society to choose not to
have children
10- 42
Teen Pregnancy
Percentage of Canadian teens who become pregnant
each year has declined sharply since the 1970s
Factors that influence teen pregnancy rates:
Compositional factors (e.g., demographic aspects of the
population, which province the teen lives in)
Province with highest rate:
Distal factors (e.g., economic inequality)
Proximal factors (e.g., contraceptive use)
Teens have greater access to information and
contraception, may feel more comfortable purchasing
contraception
High quality sex education increases contraception use
10- 43
Teen Pregnancy
Sexual Orientation and Teen Pregnancy

Pregnancy rates are higher among sexually
active gay, lesbian and bisexual teenagers than
among heterosexual teenagers
Many gay and lesbian teenagers, fearing
stigmatization because of their sexual orientations,
engage in heterosexual sex to mask their preferences
Some want to experiment to see if they can cure
themselves
Sexual assault can also lead to pregnancy among
lesbian youth
10- 44

Conception, Pregnancy, and Childbirth

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Human Sexuality in a World of Diversity, 4Ce

Copyright 2013 Pearson Canada Inc.

Human Sexuality in a World of Diversity, 4Ce

Copyright 2013 Pearson Canada Inc.

Human Sexuality in a World of Diversity, 4Ce

Infertility and Assisted Reproductive

Copyright 2013 Pearson Canada Inc.

Human Sexuality in a World of Diversity, 4Ce

Optimizing the Chances of Conception

Human Sexuality in a World of Diversity, 4Ce

Infertility and Assisted Reproductive

Male Fertility Issues

Low sperm counts

Copyright 2013 Pearson Canada Inc.

Human Sexuality in a World of Diversity, 4Ce

Infertility and Assisted Reproductive

Female Fertility Issues

Many factors can play roles in failure to ovulate (e.g.,

Copyright 2013 Pearson Canada Inc.

Human Sexuality in a World of Diversity, 4Ce

Infertility and Assisted Reproductive

Female Fertility Issues (continued)

Copyright 2013 Pearson Canada Inc.

Human Sexuality in a World of Diversity, 4Ce

Infertility and Assisted Reproductive

Gamete intrafallopian transfer (GIFT)

Human Sexuality in a World of Diversity, 4Ce

Infertility and Assisted Reproductive

Zygote intrafallopian transfer (ZIFT)

A method of conception in which an ovum is fertilized in a

Copyright 2013 Pearson Canada Inc.

Human Sexuality in a World of Diversity, 4Ce

Infertility and Assisted Reproductive

Copyright 2013 Pearson Canada Inc.

Human Sexuality in a World of Diversity, 4Ce

Infertility and Assisted Reproductive

Assisted Parenthood for Gays and Lesbians

Copyright 2013 Pearson Canada Inc.

Human Sexuality in a World of Diversity, 4Ce

Infertility and Assisted Reproductive

Risks of Assisted Reproductive Technologies

Copyright 2013 Pearson Canada Inc.

Human Sexuality in a World of Diversity, 4Ce

Infertility and Assisted Reproductive

Human Sexuality in a World of Diversity, 4Ce

Infertility and Assisted Reproductive

One provision permits research using stem cells

Human Sexuality in a World of Diversity, 4Ce

Early Signs of Pregnancy

Some women experience cyclic bleeding or spotting

Human Sexuality in a World of Diversity, 4Ce

Early Effects of Pregnancy

fatigue, sleeping longer and falling asleep more

Human Sexuality in a World of Diversity, 4Ce

Human Sexuality in a World of Diversity, 4Ce

Sexual Activity During Pregnancy

Human Sexuality in a World of Diversity, 4Ce

Psychological Changes during Pregnancy

Copyright 2013 Pearson Canada Inc.

Human Sexuality in a World of Diversity, 4Ce

The Germinal Stage

Copyright 2013 Pearson Canada Inc.

Human Sexuality in a World of Diversity, 4Ce