Birth & Pregnancy Flashcards
What is conception?
fertilization of the egg by the sperm
Describe the stages of conception:
- ovulation occurs: egg is released from the follicle, on approx. day 14 of the cycle.
- The egg is picked up by the fimbriae (finger like structures on the fallopian tube).
- Sperm travels through the cervix and uterus to one of the fallopian tubes (2 to 4 million). The egg must be fertilized with 12-24 hours or it will disintegrate.
- only 2-3 million sperm make it as far as the egg. Since gravity and they can only move 1-3cm every hour, 3000 times their length in distance by the time they reach the egg.
- Sperm follow chemical signals from the egg. The egg is surrounded by a nutritious fluid called the zona pellucida. Sperm has to dissolve the layer to penetrate it using hyaluronidase. This is called capacitation: removal of the plasma membrane overlying the sperm to allow for greater binding between the sperm and the egg.
- The moment conception occurs, the zona thickens to block out all other sperm. This occurs in the fallopian tubes.
- The zygote moves down to the uterus, taking about 5 days
- Zygote implants in the uterus
Explain the difference between the morning after pill and the abortion pill?
You can take the morning after pill within 5 days after sex because of the long process stated above (the sooner you take it the better because this journey doesn’t take everyone 5 days).
The morning after pill is a high dose of regular birth control pills that make the sperm inhabitable.
BUT! if the zygote is already implanted it will not have any affect in which case you would need to take the abortion pill.
What is basal body temperature? How is it used to detect pregnancy?
BBT: the lowest waking temperature.
An abrupt rise in body temperature about the time when ovulation should occur that stays elevated for 2 weeks indicates a high probability that a woman is pregnant. Usually .2 to .4 degree change. But only detectable if a woman was keeping track prior to becoming pregnant.
The rise is temperature is due to the progesterone secreted by the creation of the corpus luteum and later by the placenta.
What are some other early indicators of pregnancy?
tender breasts, nausea, vomiting, frequent urination, fatigue
What is the placenta?
An organ that connects the fetus to the uterine all for gas and nutrients exchange.
Chemical tests, how do they work?
Detect: Human Chorionic gonadotropin (HCG) in women’s urine. You can tell faster with blood because it takes a few.
You can tell this faster with a blood test because it takes longer to be present in urine.
What do doctors look for in a pelvic exam to detect pregnancy?
Hegar’s Sign - soft spot between the uterine body and the cervix
How do you calculate the delivery date with Nagele’s Rule?
Take the day of the first day of the woman’s last menstrual cycle, -3months, +7 days, +1 year.
What is the amniotic sac?
A sac filled with amniotic fluid, that helps to protect the embryo from outside damage and harmful temperature changes.
Explain the 1st trimester
The first 8 weeks of pregnancy is called the embryonic stage.
The placenta and amniotic sac develop
Develops major organs and systems, facial features, feet, hands
Becomes a fetus in week 9
Human physical characteristics develop towards the end, like limbs, digits, testicular tissue, finger nails, toenails - usually able to determine sex by ultrasound
The umbilical cord attaches…
the embryo to the placenta
First trimester effects on the pregnant person.
o Tingling, soreness and fullness in breasts
o Nausea, tiredness, and change in appetite (revulsion or craving)
o “morning sickness” - can actually occur at any time during the day
Women who experience morning sickness…
are less likely to miscarry
what does primiparous mean?
Pregnant for the first time
Describe the second trimester:
Fetal movements can be detected as early as 13-16 weeks or as late as 18-20 weeks, depending if you are a first time mother.
By the fifth month, fetal heartbeat can be heard with a stethoscope
By the sixth month, the fetus is sensitive to light and sound, can open eyes
Fetus is usually viable at 26 weeks (fetus will likely not survive before 26 weeks)
What effects does the second trimester have on the pregnant person?
o Indigestion and constipation because of pressing on organs
o Breasts enlarge with breast milk, nipples darken
o Stretch marks develop on breasts and stomach
o Most women report feeling well during this time as the nausea and vomiting have disappeared after the first trimester
Explain the third trimester:
By the end of the seventh month, the brain and nervous system are complete
Fetus is covered with down-like hair to help regulate body temperature
Average weight for full-term is 7.5lbs
The turns to a head-down position during delivery, called cephalic presentation
What are the effects of the third trimester on the pregnant person?
o Balance becomes an issue because of the shift of weight due to the size of the fetus.
o Backache, leg cramps, frequent urination, or swelling on the hands and feet
o Typical weight gain 25-35 pounds
Is it safe to have sex while pregnant?
Yes, the amniotic sac protects the fetus as well as a mucus plug at the base of the cervix prevents the movement of bacteria.
Although, if there is a history of miscarriage doctors may tell women to obtain from sex so their orgasms don’t cause contractions early on.
Sexual desire and physiological response has been shown to increase during the second trimester and decrease in the first and third. Maybe because of nausea and then the sheer size of the baby.
The increase in blood to to breasts, pelvice and external genitals could cause discomfort and sensitivity or make sexual activity more enjoyable
Women who were more satisfied with their partner before pregnancy had greater sexual satisfaction than other women, lower rates of fatigue and more positive about becoming a mother.
Pregnancy is not found to be related to a increased number of problems related to sexual functioning `
Many women elect to have an…
M.D deliver their baby
Healthy women cared for by midwives have better maternal and neonatal outcomes like…
o Lower perinatal mortality rates
o Lower caesarean-section (c-section) rates
In Canada, women also expressed far greater satisfaction with their labour and birth if they were assisted by a
midwife
What is engagement?
a few weeks before the fetus is born, it starts dropping so that the widest part of the head is positioned against the pelvic bones
What is effacement?
the cervix begins effacement where the cervix begins to thin and shorten in prep for dilation
What is stage 1 of birth?
Average labour lasts 8.6 hours in a first pregnancy
o About half that time for subsequent pregnancies
Contractions (initially far apart and less frequent) dilate the cervix until it is fully dilated to 10 cm (go to hospital at 5cm), allowing the baby to pass through
Dilation is used to define the three phases of the first stage of labour.
- Early phase: cervix dilates to 4cm; contractions every 15-20 minutes
- Active phase: goes from 4-8cm, contractions are more frequent and intense
- Final phase/transition: shortest & most difficult, lasts 30min or less. cervix dilates to 10cm
What is stage 2 of birth?
The second stage begins when the cervix is fully dilated and the head starts to move into the vaginal canal.
It ends with the birth of the baby.
Women “bear down” to move the baby down the vaginal canal. For first pregnancies usually 80 min, 30min if not.
An episiotomy (incision of the perineum to help with passage of baby) used to be used to reduce tearing but has not been shown to be anymore beneficial.
Once baby is delivered, blood and mucous is sucked from the baby’s nose and mouth to induce breathing.
Babies who passes meconium (first stool) in utero to clear passageways.
What happens during stage 3
- It may last from a few minutes to over an hour
- Sometimes called the “placenta phase”
- Placenta detaches from the uterine walls and is expelled with other material called “afterbirth”
What is an epidural?
injection of local anesthetic into the epidural space of the spinal canal to numb the lower body
What is a spinal block?
injection of local anesthetic into the spinal fluid for numbness in the lower body
Explain C-sections and it purpose
The baby is delivered through an incision made through the abdomen wall of the uterus
There are many reasons for a C-section delivery:
o Baby is too large
o Mother’s pelvis is too narrow
o Baby is in a breech or transverse position
o Umbilical cord will pass through the cervix before the baby
There is evidence that c-sections are being performed way more often than they should be.
What is colostrum?
high-protein, antibody-rich fluid that flows from the breast before the full onset of lactation. Rich with vitamin K
Explain each:
- Postpartum blues: 8-% of women
- Postpartum depression: 10-20%
- Postpartum psychosis: 0.2%
- Postpartum blues: mild depression, anxiety, irritability occurs in the first few days after delivery
- Postpartum depression: severe depression within the first year
- Postpartum psychosis: psychosis occurring within the first 3 months.
Describe the APGAR test
It stands for:
Appearance - color = pink
Pulse - heart rate = +100
Grimace - reflex/irritability = good cry
Activity - muscle tone = active flexing/movement
Respiration - repertory effort = good crying
7-10: Infant is healthy
4-6: Need close watch, repeated APGAR
0-3: baby’s survival is in danger
What is exclusive breast feeding?
feeding an infant only breast milk
What does multiple world health organizations recommend?
exclusive breast feeding for the first 6 months, with the introduction of complementary food at 6 months
Research has long talked about the benefits to breast feeding, but what do studies show about siblings?
There has been no shown differing outcomes from children in the same home where one was bottle fed and the other was breast fed.
When does milk production begin?
2-3 days after delivery
What is produced between birth and milk?
colostrum
What hormone stimulates the production of milk?
prolactin
What is needed to eject milk from the breast?
oxytocin
Exclusive breastfeeding delays…
resumption of regular mestrual cycle
What is lactation anovulation?
a lack of ovulation due to breastmilk production
What is amenorrhea?
Suppression or absence of mestruation
What did masters and johnson find in relation to women’s sexuality while breastfeeding?
Women who breastfed were more likely to have higher sexual interest but were more likely to delay resumption of intercourse
Because of the role of oxytocin in contraction of the uterus during an orgasm, what might happen while a woman is breast feeding?
She may orgasm or experience sexual arousal during breastfeeding, but these contractions are working to move the uterus back to pre-pregnancy size
What is an ectopic pregnancy?
Occurs when a fertilized egg impacts somewhere other than in the lining of the uterus.
Most commonly in the obstructed fallopian tube.
They may abort or rupture, seek medical attention immediately
What is another name for miscarriage?
spontaneous abortion
Explain miscarriages
usually occur by the 6th week
Reasons:
Generally, a result of genetic abnormalities
Embryo/fetus is expelled spontaneously
o Heavy cramping & bleeding
XY fetuses are miscarried more than XX
o Usually if there is a problem on one X, the other X can compensate for it
Explain Rh Incompatibility
- Occurs when the woman had Rh-negative blood and the fetus has Rh-positive blood
- Antibodies from the pregnant woman’s blood destroy red blood cells in the fetus
- The risk is low in the first pregnancy but very high in subsequent ones
- People just get a shot to deal with it
What are the three pregnancy induced hypertensions
o 1. Pregnancy-induced hypertension is simply high blood pressure associated with the pregnancy
o 2. Pre-eclampsia includes fluid retention and swelling, Increased risk of fetal death
o 3. Eclampsia may result in convulsions, coma, and even death
Taking folic acid supplements in the first trimester can…
greatly reduce incidences of congenital anomalies resulting from neural tube defects
What are some ways to check for congenital anomalies?
- screen for glycoprotein AFP which indicates a leakage in the wall
- sonographic examination
- amniocentesis is invasive: needle into abdomen into the uterus to get amniotic fluid
- chorionic villi sampling: higher risk of miscarriage
when is a baby considered pre-term?
if born before 37 weeks, primary cause of infant death
Babies who weigh more or less than the appropriate weight for their age are more likely…
to face health and developmental challenges
What is anoxia?
The umbilical cord can be compressed as the baby passes through birth canal, especially if the baby is born in the breech position
Oxygen deprivation can occur, The physician may order a C-section
Stillbirths
- Stillbirths occurs when a baby is born dead within the last trimester of pregnancy
- In developed countries, 5 in 1000 babies are stillborn
- In undeveloped countries, it is 25 in 1000 babies
It can be very hard on relationships when there is a stillbirth. Especially if the mother blames herself, there is also the fact that milk comes in even though there is no baby.
What is primary infertility?
the couple has never been able to conceive
Secondary infertility?
having trouble getting pregnant again
What are the numbers associated with infertility?
1 in 8 couples in Canada had infertility issues
Male infertility affects 1 in 2 men, usually due to low sperm count
Female infertility affects 1 in 12 women, most commonly due to irregular ovulation (normal range of ovulation is 21-36 days)
What is the first step in fertility treatments?
The use of fertility drugs to help produce eggs faster and in larger numbers. May cause a woman’s ovaries to to produce as many as 40 eggs and go into super ovulation
clomid: The drug stimulated the pituitary gland to produce LH and FSH to produce ovulation
HMG: directly stimulated the ovaries to produce eggs
These drug increase the risk for multiple fetuses
The assisted human reproduction act
helps in the maintenance of national standards and policies surrounding, eggs sperm and embryos in fertility clinics.
This restricts people’s ability to select for sex, transplant non-human egg/sperm, paying a donor, selling or cloning embryos.
What is artificial insemination (AI)?
Uses a thin, flexible catheter to insert sperm directly into the vagina or uterus
What is In vitro fertilization (IVF)?
Surgically removing the eggs from the woman’s ovaries
Fertilizing them with sperm in the laboratory
Injecting fertilized egg into woman’s uterus
Have to take a ton of hormones prior
What is Gamete intrafallopian transfer (GIFT)?
Eggs and sperm are collected and deposited directly into woman’s fallopian tubes, which allows for natural fertilization to occur and not the selection of the best egg.
What is Zygote intrafallopian transfer (ZIFT)
o A fertilized egg is transferred directly to a fallopian tube to allow for natural implantation
o Different from IVF because IVF lets it develop more
What is the greatest risk of assisted human reproduction?
having more than one fetus in the uterus at a time
A normal gestational period is 40 weeks, but with even quadruplets it can be…
30 weeks
What is multifetal pregnancy reduction?
procedure to remove one or more of the fetuses from a woman’s womb in order to increase the change that the pregnancy will continue safely
Who make up a great portion of AHR services?
LGBTQ people
Abortion in Canada has been legal when medically necessary since
1969
Abortion has been legal without restrictions since
1988 but is hard to access in many places
Supposed to be part of provincially funded healthcare, but is not in NB
o Can go to the hospital in Moncton and have it covered but you need a doctor’s approval which is illegal
o Can go to the clinic in Fredericton but need to pay out of pocket
Who fought for women’s rights to control their bodies for many years?
Dr. Henry Morgentaler
Where is abortions very difficult to get to in Canada?
in northern provinces and none on PEI
What did Barack Obama say about abortion?
We should try to prevent unintended pregnancies by providing appropriate education to our youth, nobody’s pro-abortion
What the procedure for a surgical abortion?
- Ultrasound confirms the number of weeks of pregnancy
- Cervix is examined using a speculum.
- The cervix is numbed with an injection of local anesthetic (clinic) or through a general anesthetic (hospital).
- The physician gradually dilates the cervix.
- A small, hollow tube attached to an aspirator machine is inserted in the uterus to remove the contents.
- A curette (scraping the sides of the uterus) ensures that no tissue remains in the uterus.
What are two methods of surgical abortions?
Vacuum aspiration
o Removal of the uterine contents via suction
o Used during the first trimester
Dilation and Evacuation (D & E)
o Cervix is dilated prior to vacuum aspiration
o Uterine contents are removed with forceps
What is the medical abortion procedure?
An ultrasound is often performed to ensure the pregnancy is not beyond 9 weeks’ gestation
Patient is given two types of pills…
1) First is Mifepristone – blocks progesterone which keeps the pregnancy going
2) Second is misoprostol tablets, 2 days later, take Misoprostol tablets:
Relaxes cervix
Induces miscarriage
Free in NB
What are some activist organizations doing?
mailing mifegysmo pills to people – mostly targeted to other countries with extreme limited access
What do studies indicate about women’s knowledge of how far along they are?
- women can be trusted to know when they are pregnant and how far along they are – no need for ultrasounds
- Extremely safe
What are people’s psychological reactions to getting an abortion?
The majority are satisfied, would do it again and are not experiencing depression
What is reproductive justice?
The human right to maintain personal bodily autonomy, have children, not have children and parent the children we have in safe and sustainable communities
What needs to change in the fight of abortion?
Shift from a focus on individualistic “choice” to access for all, shift to a societal issue
We are Ignoring the reality of harm against people of colour perpetuated by the state. For example:
o Residential schools
o Forced sterilization
o Police violence
What does it mean to have reproductive justice for all?
Reproductive Justice benefits everyone Bodily autonomy Children when wanted o Contraception o No forced sterilization o Access to abortion Healthcare for pregnant people and children Support for raising children Healthy environments
