Because learning changes everything.

Brand X Pictures/Getty Images

Chapter 6
Pregnancy and Childbirth

Fourteenth Edition

©
2020 McGraw Hill. All rights reserved. Authorized only for instructor use in the classroom.
No reproduction or further distribution permitted without the prior written consent of McGraw Hill.
 FYI

Ovaries release and egg. Other words for an egg are ova or
ovum
Conceptus is the product of conception
• The product of conception is a fertilized egg
• Fertilization creates the conceptus
Endometrium is another word for uterine lining

©
McGraw Hill 2
 Signs of Pregnancy

What are some the signs that a woman may have to indicate
she is pregnancy?

©
McGraw Hill 3
 Conception: Sperm Meets Egg 1

Ovulation takes plays on about day 14 of an average

menstrual cycle.
• Egg is released from the ovary into the body cavity.

cervix secretes mucus that flushes the passageways to

prepare for arrival of the sperm.

Sperm are capable of swimming about 1 inch per hour.

©
McGraw Hill 4
 Figure 1

Sexual intercourse in the man-on-top position, showing the pathway of sperm and egg from
manufacture in the testes and ovary to conception, which typically occurs in the fallopian tube.
Access the text alternative for slide images.

©
McGraw Hill 5
 Figure 2

The structure of a mature human sperm.

Access the text alternative for slide images.

©
McGraw Hill 6
 Conception: Sperm Meets Egg 2

Conception usually occurs in the outer third of the fallopian

tube
• Egg is surrounded by a thin, gelatinous layer called the
zona pellucida.
• Sperm swarm around the egg and secrete an enzyme
called hyaluronidase.
• Dissolves the zona pellucida, permitting one sperm to penetrate.

©
McGraw Hill 7
 Improving the Chances of Conception

Intercourse timed right at ovulation or within five days.

• Primary method is to keep a basal body temperature chart.
• Sperm live inside the woman’s body for up to 5 days, and
the egg can be fertilized within 12 to 24 hours of ovulation.
• It is best to have intercourse two to three times during the
six days of maximum fertility.

Best position is with the woman on her back.

Douches, lubricants, and suppositories can kill sperm or

block their entrance into the uterus.

©
McGraw Hill 8
 A Girl or A Boy?

The sperm determines a child’s

gender
Two types of sex chromosomes
• X
• Y
Ova always carry an X chromosome
Sperm can carry either an X or Y
chromosome
If sperm carrying an X chromosome
fertilizes an ovum, the combination
is XX and the child is a female
If sperm carrying is carrying a Y
chromosome, the combination is XY
and the child is a male

©
McGraw Hill 9
 HCG

After fertilization occurs and the blastocyst stage is reached,

a hormone called human chorionic gonadotropin (HCG) is
released into mother’s bloodstream
HCG stimulates the release of estrogen and progesterone
hormones, which maintain the uterine lining and suppress
ovulation
Some HCG passes into the urine, which is how we confirm
pregnancy when taking a urine test

©
McGraw Hill 10
 Development of the Conceptus 1

zygote: the fertilized egg.

• Cell division begins about 36 hours after conception.
• Zygote passes down the fallopian tube, finally arriving in
the uterus and implanting itself in the uterine wall.
• It takes 3-5 days to travel down the fallopian tube into the
uterus

Figure 4a
This embryo has divided into four cells and
would still be traveling down the fallopian tube.

©
McGraw Hill C
©laude Edelmann/Science Source 11
 Development of the Conceptus 2

In the uterus the

zygote becomes
a blastocyst and
receives
nourishment from
endometrium
The blastocyst
implants itself
into the
endometrium 5-9
days after
fertilization
Once implanted it
is called an
embryo

©
McGraw Hill 12
 Development of the Conceptus

©
McGraw Hill 13
 Development of the Conceptus 2

First eight weeks of gestation is

the embryonic period.
• Conceptus (the product of
conception) is called an
embryo.
• Cells differentiate into layers
that then form the various
organs of the body.
First organ to develop is the Figure 4b
brain The embryo after 4 weeks of development.
The major organs are forming; the bright red,
blood-filled heart is just below the lower jaw.

©
McGraw Hill P
©etit Format/Science Source 14
 Development of the Conceptus 3

First eight weeks of gestation the conceptus is called an

embryo
From 9 weeks until birth, the conceptus is called a fetus

Figure 4c
At 9 weeks the human fetus is recognizable as
a primate. Limbs have formed and ears are
clearly visible.

©
McGraw Hill S
©cience Pictures Ltd./Science Source 15
 Development of the Conceptus 4

Typically the nine months of pregnancy are divided into three

equal trimesters.

By the end of the first trimester

(months 1 to 3) the fetus is
unmistakably human and looks
like a small infant.

Figure 4d
By about 3 months the fetus is approximately
10 centimeters long and weighs about 19
grams. Muscles have formed, which move the
limbs and body.

©
McGraw Hill C
©laude Edelmann/Science Source 16
 The Embryo and Its Support Systems 1

placenta: the mass of tissue that surrounds the conceptus

and nurtures its growth.
• Site of the exchange of substances between the woman’s
blood and the fetus’s.
• Secretes hormones, including human chorionic
gonadotropin (hCG)—the hormone detected in
pregnancy tests.

©
McGraw Hill 17
 The Embryo and Its Support Systems 2

umbilical cord: the tube that connects the fetus to the

placenta about 20 inches in length

• Contains two arteries and one vein that allow the

exchange of oxygen and nutrients between woman and
fetus

Two membranes surround the fetus: the outer chorion and

inner amnion.

Amnion is filled with a water liquid called amniotic fluid, which

maintains the fetus at a constant temperature and cushions it
against possible injury.

©
McGraw Hill 18
 Fetus Development

First Trimester
• Small mass of cells
implanted in the uterus
develops into a fetus
• Development of central
nervous system,
extremities, and organs
• gonads are formed and
differentiated by the end
of the trimester

©
McGraw Hill 19
 Fetal Development

Second trimester:
• By week 18 (in the second trimester), the woman has
been able to feel movement for two to four weeks, and the
physician can detect the fetal heartbeat.

©
McGraw Hill 20
 Fetus Development

Third trimester:
• During month 7, the fetus
turns in the uterus to
assume a head down
position.
• If the turning does not
occur by the time of
delivery, there will be a
breech presentation.

©
McGraw Hill 21
 Table 1 Milestones of Fetal Development
First Trimester Week 28
Weeks 3 and 4 Fat deposits form—gains chubby baby appearance
Development of the head Weeks 29 to birth
Nervous system begins to form Rapid growth
Backbone is constructed
Week 5
Formation of the umbilical cord
Weeks 4 to 8
External body parts develop—eyes, ears, arms, hands,
fingers, legs, feet, and toes
Liver, lungs, pancreas, kidneys, and intestines form and
begin limited functioning
Second Trimester
Week 14
Fetal movement, or quickening
Week 18
Fetal heartbeat detected by examiner
Week 24
Fetus is sensitive to light and sound in utero

Third Trimester

©
McGraw Hill 22
 The Stages of Pregnancy: The First Trimester 1

Symptoms of pregnancy:
• Missed menstrual period.
• Persistent higher temperature with ovulation.
• Breast tenderness, nausea, and vomiting.
• More frequent urination and fatigue

Pregnancy tests:
• Laboratory tests.
• Over-the-counter home pregnancy tests.
• Determination of expected delivery date (EDC).

©
McGraw Hill 23
 The Stages of Pregnancy: The First Trimester 2

Physical changes:
• Large increase in hormone levels, with progesterone
producing fatigue and sleepiness.
• Breast changes, frequent urination, morning sickness
• Vaginal discharges may increase.

Psychological changes:
• Vary according to the woman’s attitude toward the
pregnancy, her economic situation, and the level of social
support.
• Depression is not uncommon, and a woman’s emotional
state can have an effect on the fetus.
©
McGraw Hill 24
 The Stages of Pregnancy: The Second Trimester

Physical changes:
• Awareness of fetal movement (quickening).
• edema: water retention and swelling.
• Colostrum: a thin liquid secreted by the breasts.

Psychological changes:
• Relative calm and well-being.
• Fear of miscarriage diminishes with fetal movement.
• Depression is less likely.
• Women who have had a previous pregnancy may be more
distressed.
©
McGraw Hill 25
 The Stages of Pregnancy: The Third Trimester

Physical changes:
• Uterus has become very large and hard, putting pressure
on a number of other organs.
• Weight gain continues.
• _____________ contractions: painless tightening of the
uterus.
• In a first pregnancy, engagement around two to four weeks
before delivery.

Psychological changes:
• Patterns noted earlier continue into the third trimester.
©
McGraw Hill 26
 The Father’s Experience in Pregnancy

Physical changes:
• Couvade syndrome: pregnancy symptoms experienced by
some men.

Psychological changes:
• Many men expect to be actively involved in fathering.
• Early in the pregnancy, fathers want to connect with the
fetus.
• As delivery approaches, worry about the delivery and/or
pain; and many express an increased sense of maturity.

Fathers play an important role in preparing for the baby.

©
McGraw Hill 27
 Diversity in the Contexts of Pregnancy

Many women have babies in family contexts other than the

traditional one of being married to the father.
• Varied relationships with the baby’s father.
• Single mother-to-be with pregnancy as a result of a
reproductive technology.
• In a relationship with another woman.

Marred to the baby’s father is still statistically the most

common context in the U.S., but other possibilities should be
kept in mind.

©
McGraw Hill 28
 Sex during Pregnancy

Given a normal, healthy pregnancy, intercourse can continue

safely.

Most common pattern:

• Decline in frequency of intercourse during the first
trimester.
• Variation in the second trimester.
• Even greater decline in the third trimester.

During the latter stages of pregnancy, the man-on-top

position is probably best abandoned.

©
McGraw Hill 29
 Nutrition during Pregnancy

Diet during pregnancy is extremely important.

• Maintaining a healthy weight.
• protien is important for building new tissues.
• Folic acid is also important for growth.
• iron is needed because the fetus draws off iron for itself.
• Deficiencies of calcium and magnesium are associated
with premature birth and problems for the mother.

Daily consumption of artificially sweetened soft drinks is liked

to an increased likelihood of preterm birth.

©
McGraw Hill 30
 Effects of Substances Taken during Pregnancy 1

Long-term use of antibiotics by the mother may cause

damage to the fetus.

Women should not drink alcohol during pregnancy.

• Any amount may result in a fetal alcohol spectrum
disorder.
• Fetal alcohol syndrome (FAS): a serious growth
deficiency and malformations in the child of a mother who
abuses alcohol during pregnancy.

Men should stop drinking alcohol before attempting to

conceive.

©
McGraw Hill 31
 Effects of Substances Taken during Pregnancy 2

Cocaine use is associated with an increased risk of

premature birth, low birth weight, smaller head
circumference, and cognitive deficit.

Marijuana effects on the fetus are dose-dependent.

• Can include preterm birth, reduced fetal growth and
weight, and cognitive and behavioral effects.
• With legalization in several states, use by pregnant women
is increasing.

Marijuana use is also implicated in infertility.

©
McGraw Hill 32
 Effects of Substances Taken during Pregnancy 3

Steroids can have a variety of problematic effects.

• Synthetic hormone progestin; corticosteroids; excessive
vitamin A; excesses of vitamins D, B6, and K.

Maternal smoking during pregnancy slows fetal growth.

• More likely to be born with cardiovascular anomalies; to be
preterm and low birth weight; and to develop asthma.

Risks associated with psychiatric medications vary.

• Risks and benefits of various treatment options should be
individually assessed.

©
McGraw Hill 33
 Effects of Substances Taken during Pregnancy 4

With many chemical solvents, children exposed prenatally

may exhibit attention deficit/hyperactivity and aggression.

X rays can damage the fetus.

Research suggests drugs taken by men before a conception

may also cause birth defects; and a father’s smoking during
pregnancy, on its own, increases the risk of childhood cancer.

©
McGraw Hill 34
 Birth: The Beginning of Labor

Signs that labor is about to begin vary.

• There may be a discharge of a small amount of bloody
mucus—the plug expelled from the cervical opening.
• In 10% of women, the membranes containing amniotic
fluid rupture, and there is a rush of warm fluid down the
woman’s legs.
• More commonly the amniotic sac does not rupture until the
end of the first stage of labor.
• Braxton-Hicks contractions may increase.

©
McGraw Hill 35
 Birth: First-Stage Labor

Contractions produce effacement (thinning out) and dilation

(opening up) of the cervix.

First-stage labor is itself divided into three stages.

• Early first-stage labor: contractions far apart.
• Late first-stage labor: contractions more frequent and
intense; dilation of the cervix between 2 and 3 inches.
• Transition phase: contractions very strong; dilation
between 3 and 4 inches; pain and exhaustion.

First stage of labor may last from 2 to 24 hours.

©
McGraw Hill 36
 Dilation and Effacement

©
McGraw Hill 37
 Dilation and Effacement

©
McGraw Hill 38
 Birth: Second-Stage Labor—Delivery

Second-stage labor begins when the cervix is fully dilated

and the baby begins to move into the vagina, or birth canal.
• Lasts from a few minutes to a few hours.
• With each contraction, the baby is pushed farther along.
• episiotomy an incision that may be made in the perineum,
allowing the baby to be delivered more easily.
• Once completely out, the baby takes its first breath of air,
blood flows to the lungs, and the umbilical cord is clamped
and cut off.

©
McGraw Hill 39
 Figure 8

Possible positions of the fetus during birth. (a) A breech presentation (4 percent of births).
(b) A transverse presentation (less than 1 percent). (c) A normal, headfirst or cephalic
presentation (96 percent of births).

©
McGraw Hill 40
 Normal/Cephalic Presentation

Babies need be born head

down and face down
because…
• Decreases the risk of
facial edema, breathing
problems (due to tracheal
and laryngeal trauma),
prolonged labor, fetal
distress, spinal cord
injuries, permanent brain
damage, neonatal death,
and helps with skull
molding

©
McGraw Hill 41
 Birth: Third-Stage Labor

Third-stage labor: the placenta detaches from the walls of

the uterus, and the afterbirth (placenta and fetal membranes)
is expelled.
• May take from a few minutes to an hour.
• Several contractions may accompany the placenta’s
expulsion.

Episiotomy and/or any tears are sewn up.

©
McGraw Hill 42
 Stages of Labor

©
McGraw Hill 43
 Vaginal Birth Video

https://www.youtube.com/watch?v=uMp0wyInTq8

https://www.youtube.com/watch?v=ROCTb1lKBVY

©
McGraw Hill 44
 Cesarean Section (C-Section)

Cesarean section is a method of delivering a baby surgically

by an incision in the abdomen.
• Used when normal vaginal birth is impossible or
undesirable.

Cesarean delivery rates in the United States have been

increasing steadily since 1996.
• In 2009, 33% of all births.
• Associated with higher rates of complications requiring
hospitalization of the mother or infant.

©
McGraw Hill 45
 C-Section Scar

©
McGraw Hill 46
 C-Section Video

https://www.youtube.com/watch?v=m9g8IAB3ZdM

©
McGraw Hill 47
 Childbirth Options: Prepared Childbirth

Most methods of prepared childbirth are based on reducing

fear and tension in order to reduce or eliminate pain.
• Several methods require the woman to be accompanied by
her partner or some other person, who acts as her coach.

______________________: relaxation and controlled

breathing, along with education about pregnancy and
childbirth.

©
McGraw Hill 48
 Childbirth Options: The Use of Anesthetics

Anesthetics have been routine since 1853, when Queen

Victoria gave birth under chloroform anesthesia.

Regional and local anesthetics, which numb only a specific

region, are the most commonly used.

Negative effects of epidural anesthesia can be reduced by

using low dosages.

©
McGraw Hill 49
 Spinal Anesthesia (Epidural)

Epidural Video
©
McGraw Hill 50
 Childbirth Options: Home Birth versus Hospital Birth

Childbirth was one of the first processes to be medicalized in

the United States.

Bucking the trend are advocates of home birth.

• Childbirth should be a joyous, natural human experience.
• Hospitals encourage the use of dangerous interventions.
• Research indicates no significant differences in outcomes.

Unforeseen emergencies can arise, however; and hospital

practices have changed radically.

©
McGraw Hill 51
 After the Baby Is Born: The Postpartum Period 1

Physical changes:
• When the placenta is expelled, estrogen and progesterone
levels drop sharply, then gradually return to normal.
• Hormones associated with breast-feeding increase.
• Exhaustion, along with discomfort from an episiotomy or
lacerations, is common.

©
McGraw Hill 52
 After the Baby Is Born: The Postpartum Period 2

Psychological changes:
• Many women experience some degree of depression.
• Postpartum blues: mood swings, feeling depressed,
irritability, and crying alternating with positive moods.
• Postpartum depression: mild to moderate depression
with insomnia, tearfulness, feelings of inadequacy, and
fatigue; experienced by 8% to 15% of women.
• Postpartum psychosis: rare, severe depression.
• Postpartum depression and psychosis should be treated.

Fathers, too, sometimes experience depression.

©
McGraw Hill 53
 After the Baby Is Born: Attachment to the Baby

Mother’s attachment (bond) to the infant begins even before

it is born.

Feelings of nurturance grow during pregnancy and increase

further at birth.

©
McGraw Hill 54
 After the Baby Is Born: Sex Postpartum

Couples should wait at least two weeks before resuming

intercourse.

Fatigue of both parents may influence the resumption of

sexual activity.

Breast-feeding women report significantly less sexual activity

and lower sexual satisfaction.
• Possibly because lactation suppresses estrogen
production, which results in decreased vaginal lubrication.

©
McGraw Hill 55
 Breast-Feeding 1

prolactin stimulates the breasts to produce milk.

oxytocin stimulates the breasts to eject milk.

• Produced in response to the infant’s sucking.
• Also promotes maternal behavior and reduces anxiety.

Breasts initially secrete colostrum, which is high in protein

and provides temporary immunity to disease.

Harmful substances ingested by the mother may be

transmitted through the milk to the infant.

©
McGraw Hill 56
 Breast-Feeding 2

Breast milk is the ideal food for a baby, associated with

numerous positive outcomes.
• American Academy of Pediatrics recommends exclusive
breast-feeding for the first six months, followed by
breast-feeding plus food in the next six months.
• Educational programs improve rates of initiation and
maintenance of breast-feeding at six months.

Breast-feeding has several advantages for the mother.

• Both physical and psychological.

©
McGraw Hill 57
 Breast-Feeding

©
McGraw Hill 58
 Problem Pregnancies 1

ectopic pregnancy: the fertilized egg implants somewhere

other than the uterus.

Pseudocyesis, or false pregnancy: the woman believes she

is pregnant and shows the signs and symptoms but is not
pregnant.

©
McGraw Hill 59
 Problem Pregnancies 2

Pregnancy-induced hypertension includes three increasingly

serious conditions:
• Hypertension—elevated blood pressure alone.
• preeclampsia—elevated blood pressure accompanied by
generalized edema (fluid retention and swelling) and
proteinuria (protein in the urine).
• Eclampsia—the woman has convulsions, may go into a
coma, and may die.

©
McGraw Hill 60
 Problem Pregnancies 3

Certain viruses can cross the placental barrier.

• Rubella (German measles), herpes simplex.

Certain factors can cause defects in the fetus.

• Testing and genetic counseling allow a pregnant woman to
make an informed choice about how to proceed.
• Amniocentesis: a sample of amniotic fluid is taken.
• Chorionic villus sampling: a sample of cells is taken
from the chorionic villus.

©
McGraw Hill 61
 Prenatal Testing

Amniocentesis
• Removes a small sample of the amniotic fluid
that surrounds the fetus

• Test for genetic birth defects (hemophilia and

muscular dystrophy)

• Can no be done until second trimester

• Cannot detect all defects

• If defect is discovered a woman can choose to

terminate her pregnancy

• 1% chance procedure can harm baby

• Only done on woman who have a high risk of

bearing a child with a birth defect (already had
a child with a birth defect, over the age of 35, What is an amniocentesis?
carrier of a genetic defect)
©
McGraw Hill 62
 Figure 13

Schematic diagram of hormonal control of estrogen secretion and ovum production by the
ovaries (during the follicular phase of the menstrual cycle). Note how similar the feedback
loop is to the one in males.
Access the text alternative for slide images.

©
McGraw Hill 63
 Prenatal Testing

Chorionic villus sampling

• CVS utilizes either a
catheter or needle to biopsy
placental cells
• Tests for genetic birth
defects
• Can be done in first
trimester
• 1% chance procedure can
harm baby

©
McGraw Hill 64
 Prenatal Testing

Amniocenteses vs. CVS

Considered safer because it Done in 1st trimester in
is done in the 2nd trimester pregnancy
Very accurate Very accurate
Fluid is tested for genetic Detects genetic abnormalities
abnormalities, neural tube but can not detect neural tube
defects, infection, lung defects
development, and Rh Risks such as a miscarriage
incompatibility are slightly higher
Detects chromosome Procedure is more painful
problems
Test is used if the fetus has a
higher risk for genetic defects
©
McGraw Hill 65
©
McGraw Hill 66
 Problem Pregnancies 4

Rh incompatibility can be problematic in subsequent

pregnancies.
• Rh factor is a substance in the blood, present in an Rh
positive (Rh+) person and absent in an Rh negative (Rh−)
person.
• If some Rh+ blood from a baby during birth gets into a
mother’s Rh− blood, antibodies form in the mother—and
can then cause risk to the fetus of a subsequent pregnancy.

©
McGraw Hill 67
 Problem Pregnancies 5

miscarriage, or spontaneous abortion: termination of a

pregnancy before the fetus is viable, as a result of natural
causes.

Numerous maternal factors are associated with a major

complication: premature labor and delivery.
• Prior to 37 weeks’ gestation.
• Babies are much less likely to survive, and if they survive
they are particularly susceptible to respiratory infections.
• Disability occurs in 60% of survivors born at 26 weeks and

30% of those born at 31 weeks.

©
McGraw Hill 68
 Infertility 1

Infertility: a woman’s inability to conceive and give birth to a

living child, or a man’s inability to impregnate a woman.
• Couple is considered infertile if they have not conceived
after one year of frequent, unprotected intercourse, or
after six months if the woman is over 35.
• Can be caused by individual factors or a combination of
factors in both the man and the woman.

Infertile couples may experience psychological stress and

relationship conflict.

©
McGraw Hill 69
 Infertility 2

Causes in females: Causes in males:

• PID (pelvic inflammatory • Infections in the
disease). reproductive system
• Most common cause of
caused by sexually
infertility in women. transmitted infections.
• Problems with ovulation. • Low sperm count or low
motility.
• Blockage of fallopian
tubes. • Exposure to toxic agents,
alcohol and marijuana,
• Cervical mucus that prescription drugs.
blocks the passage of
sperm (hostile mucus). • Obesity and age.

©
McGraw Hill 70
 Infertility 3

Infertile couples may be subjected to a good deal of

psychological stress and conflict in their marriage.

Many physicians and clinics specialize in evaluating and

treating infertility.
• Drug treatments.
• Microsurgery.
• Assisted reproductive technologies.

In one study, among couples seeking treatment, 65%

subsequently achieved a pregnancy with no treatment.

©
McGraw Hill 71
 Assisted Reproductive Technologies 1

artificial insemination: artificially placing semen in the

vagina to produce a pregnancy.

Sperm banks: storage of frozen sperm.

©
McGraw Hill 72
 Assisted Reproductive Technologies 2

embryo transfer: a fertilized, developing egg is transferred

from the uterus of one woman to the uterus of another.

©
McGraw Hill 73
 Assisted Reproductive Technologies 2

Test-tube babies—or in vitro fertilization (IVF): sperm and

egg are united outside the human body.
• Resulting embryo is then implanted in the uterus of a
woman and carried to term.
• Intra-cytoplasmic sperm injection (ICSI): one sperm is
injected directly into the cytoplasm of the egg.

©
McGraw Hill 74
 Assisted Reproductive Technologies 4

Gender selection is controversial.

• Some scientists fear that the result would be a great
imbalance in our population.
• Home or “natural” methods do not reliably affect gender.
• Laboratory procedures include the Micro-Sort method and
preimplantation genetic diagnosis (PGD) with ART.

Prenatal genetic diagnosis similarly has problematic

implications.
• Especially, whether it should be used to determine which
fetuses to abort.

©
McGraw Hill 75
 Gender Selection Video

https://www.youtube.com/watch?v=zNoM--mBbC0

©
McGraw Hill 76
 Review and Discuss

What substances, if taken during pregnancy,

threaten the fetus?

How does sexual activity change in the

months following childbirth?

What reproductive problem can result from

untreated STIs?

©
McGraw Hill
 End of Main Content

Because learning changes everything. ®

www.mheducation.com

©
2020 McGraw Hill. All rights reserved. Authorized only for instructor use in the classroom.
No reproduction or further distribution permitted without the prior written consent of McGraw Hill.