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Conception:Conception: Three trimesters = nine months = prenatal Three trimesters = nine months = prenatal

periodperiod Healthy vs. at risk pregnanciesHealthy vs. at risk pregnancies Importance of intrauterine environmentImportance of intrauterine environment

Stages of ChildbirthStages of Childbirth Normal vs. complicated childbirth, Normal vs. complicated childbirth,

mismanagement.mismanagement. Perinatal period:Perinatal period:

from beginning of labour to 72 hrs. from beginning of labour to 72 hrs. postpartumpostpartum

Breastfeeding:Breastfeeding: advantages for infant advantages for infant

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Conception:Conception: Necessary:Necessary:

• sperm countsperm count• vaginal mucusvaginal mucus• open Fallopian tubesopen Fallopian tubes• normal ovulationnormal ovulation• normal hormonal levelsnormal hormonal levels

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2323rdrd pair of chromosomes: sex pair of chromosomes: sex chromosomeschromosomes

Male sperm smaller and fasterMale sperm smaller and faster Vaginal pH (acid, neutral or alkaline)Vaginal pH (acid, neutral or alkaline) Ovulatory mucus (vaginal) mid-cycle Ovulatory mucus (vaginal) mid-cycle

providesprovides right pHright pH sugars (nutrients)sugars (nutrients) conveyorconveyor

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Only a few hundred sperm arrive where Only a few hundred sperm arrive where egg is, in the Fallopian tube, and surround egg is, in the Fallopian tube, and surround ovum.ovum.

Only one (usually) penetrates ovumOnly one (usually) penetrates ovum Stages of uterine development:Stages of uterine development:

zygote:zygote:• 1-14 days1-14 days

embryo:embryo:• 3-8 weeks3-8 weeks

fetus:fetus:• 9-40 weeks9-40 weeks

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Natural method of conception can failNatural method of conception can fail Most common reason:Most common reason:

STDs in both men and women, which lead to STDs in both men and women, which lead to infertility (e.g. blocked Fallopian tubes or vas infertility (e.g. blocked Fallopian tubes or vas deferens)deferens)

Second reason becoming more common:Second reason becoming more common: ageage

Third reason:Third reason: low number of follicles with eggs at birth (not all low number of follicles with eggs at birth (not all

women are born with the same number, and not women are born with the same number, and not all women have the same rate of ova lossall women have the same rate of ova loss

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Fourth reason:Fourth reason: levels of anti-mullerian hormone (AMH). AMH levels of anti-mullerian hormone (AMH). AMH

is produced by the ovaries (and by testes in is produced by the ovaries (and by testes in men). In females, it interferes with FSH, such men). In females, it interferes with FSH, such that not more than one ovum matures per that not more than one ovum matures per cycle. Elevated AMH correlates with lower cycle. Elevated AMH correlates with lower ovarian reserve: earlier loss of fertility. So, ovarian reserve: earlier loss of fertility. So, AMH can tell you what time it is in your AMH can tell you what time it is in your biological clock. Blood test available.biological clock. Blood test available.

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Reproductive technology can help infertile Reproductive technology can help infertile couplescouples

Most recent dramatic technology:Most recent dramatic technology: CloningCloning

More Established Reproductive More Established Reproductive Technologies:Technologies: Artificial Insemination:Artificial Insemination:

• Introducing sperm into woman’s vagina or uterus by Introducing sperm into woman’s vagina or uterus by artificial meansartificial means

single womansingle woman husband low sperm counthusband low sperm count husband deadhusband dead husband infertile: donor spermhusband infertile: donor sperm lesbian couplelesbian couple

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More Established Reproductive More Established Reproductive Technologies (Cont’d):Technologies (Cont’d): IVF: in vitro fertilization:IVF: in vitro fertilization:

• test tube or Petri dish is used to mix gametes; test tube or Petri dish is used to mix gametes; once dividing, surgically implanted into woman’s once dividing, surgically implanted into woman’s uterusuterus

can use both parents’ gametescan use both parents’ gametes one parent plus donor’sone parent plus donor’s can be implanted in surrogate’s uterus (“rent-a-womb”)can be implanted in surrogate’s uterus (“rent-a-womb”)

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Testing the Conceptus for Abnormalities:Testing the Conceptus for Abnormalities: amniocentesis (11-14 weeks)amniocentesis (11-14 weeks) CVS: chorionic villus sampling (villi) (6-8 CVS: chorionic villus sampling (villi) (6-8

weeks)weeks)• ultrasound (12-16 weeks)ultrasound (12-16 weeks)• fetoscopyfetoscopy• blood testblood test

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Physical and Psychological Changes Physical and Psychological Changes During Pregnancy:During Pregnancy: Woman:Woman:

• 11stst trimester: trimester: enlarged, tender breastsenlarged, tender breasts amenorrheaamenorrhea nausea (nausea (⅓ severe,⅓ mild, ⅓ none)⅓ severe,⅓ mild, ⅓ none) sleepiness (⅔)sleepiness (⅔) aversion to some foods, odorsaversion to some foods, odors increased urinary frequency (hormonal)increased urinary frequency (hormonal) mixed emotions, ambivalence, anxiety and exhilarationmixed emotions, ambivalence, anxiety and exhilaration

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Physical and Psychological Changes Physical and Psychological Changes During Pregnancy (Cont’d):During Pregnancy (Cont’d): Woman:Woman:

• 22ndnd trimester: trimester: ““quickening”quickening” increased girthincreased girth well-beingwell-being mostly positive outlook, energymostly positive outlook, energy preparatory behaviors, prenatal classespreparatory behaviors, prenatal classes some who rejected pregnancy accept itsome who rejected pregnancy accept it

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Physical and Psychological Changes Physical and Psychological Changes During Pregnancy (Cont’d):During Pregnancy (Cont’d): Woman:Woman:

• 33rdrd trimester: trimester: large abdomen, awkwardlarge abdomen, awkward lost sleep due to:lost sleep due to:

• frequent urination (weight of uterus on bladder)frequent urination (weight of uterus on bladder)• difficulty turning over in beddifficulty turning over in bed• activity of fetusactivity of fetus

anxiety increases (delivery, birth defects)anxiety increases (delivery, birth defects) differences between fit and unfit womendifferences between fit and unfit women

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Physical and Psychological Changes Physical and Psychological Changes During Pregnancy (Cont’d):During Pregnancy (Cont’d): Woman:Woman:

• 33rdrd trimester (Cont’d): trimester (Cont’d): possible pregnancy complications:possible pregnancy complications:

• edemaedema• proteinuriaproteinuria• hypertensionhypertension• diabetesdiabetes• threatened early labor, etc.threatened early labor, etc.

moodiness, irritability, tirednessmoodiness, irritability, tiredness not universalnot universal

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Physical and Psychological Changes Physical and Psychological Changes during Pregnancy (Cont’d):during Pregnancy (Cont’d): Man:Man:

• economic worrieseconomic worries• feeling left outfeeling left out• ““couvade”:couvade”:

actual changes in hormonal levelsactual changes in hormonal levels before birth more prolactin and cortisolbefore birth more prolactin and cortisol after birth, less testosteroneafter birth, less testosterone related to paternal rolerelated to paternal role

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TERATOGENS:TERATOGENS: anything that causes birth defects (teratos = anything that causes birth defects (teratos =

monster)monster) Critical vs. sensitive periodsCritical vs. sensitive periods Maternal Diseases:Maternal Diseases:

• RubellaRubella• Toxoplasmosis (cat’s feces, raw meat)Toxoplasmosis (cat’s feces, raw meat)• CMVCMV• AIDSAIDS

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TERATOGENS (Cont’d):TERATOGENS (Cont’d): RadiationRadiation Chemicals:Chemicals:

• absorbed through lungs or skinabsorbed through lungs or skin High Temperature:High Temperature:

• hot bathhot bath General Environmental Pollution:General Environmental Pollution:

• what we eat, drink, breathe, touchwhat we eat, drink, breathe, touch

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TERATOGENS (Cont’d):TERATOGENS (Cont’d): Drugs:Drugs:

• prescription, e.g. DES, thalidomideprescription, e.g. DES, thalidomide• OTCOTC• ““recreational”, illegalrecreational”, illegal• caffeinecaffeine• aspirin, etc.aspirin, etc.

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TERATOGENS (Cont’d):TERATOGENS (Cont’d): Smoking:Smoking:

• nicotinenicotine CO:CO:

• 200 times more affinity to Hgb than oxygen200 times more affinity to Hgb than oxygen

• oxygen supply compromised (5% less)oxygen supply compromised (5% less)• decreases sperm motility:decreases sperm motility:

lower fertilitylower fertility

• less progesterone:less progesterone: miscarriagesmiscarriages

• placental problemsplacental problems• higher morbidity and mortality higher morbidity and mortality

from 9/1000 to 33/1000from 9/1000 to 33/1000

• higher rates of cleft palate and hare liphigher rates of cleft palate and hare lip

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TERATOGENS (Cont’d):TERATOGENS (Cont’d): Alcohol:Alcohol:

• FASD (fetal alcohol spectrum disorder)FASD (fetal alcohol spectrum disorder) brain abnormalities:brain abnormalities:

• learning difficultieslearning difficulties• ADDHADDH• mental retardation, etc.mental retardation, etc.

possible damage to eyes, ears, immune system, internal possible damage to eyes, ears, immune system, internal organs, joints, limbsorgans, joints, limbs

low birth weightlow birth weight increased prematurity, miscarriage and stillbirth riskincreased prematurity, miscarriage and stillbirth risk

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TERATOGENS (Cont’d):TERATOGENS (Cont’d): Alcohol:Alcohol:

• FASD (fetal alcohol spectrum disorder) (Cont’d)FASD (fetal alcohol spectrum disorder) (Cont’d) growth retardationgrowth retardation facial and cranial malformationsfacial and cranial malformations dose and timing relateddose and timing related no safe doseno safe dose there is no cure for FASDthere is no cure for FASD leading cause of leading cause of preventablepreventable mental retardation mental retardation

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TERATOGENS (Cont’d):TERATOGENS (Cont’d): Dose Related:Dose Related: Interactions: hard to tell main effectsInteractions: hard to tell main effects

• Possible effects:Possible effects: miscarriagemiscarriage stillbirthstillbirth low birth weightlow birth weight irritability, hard to sootheirritability, hard to soothe shorter attention span (learning)shorter attention span (learning) tremorstremors digestive difficultiesdigestive difficulties

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TERATOGENS (Cont’d):TERATOGENS (Cont’d): Possible effects (cont’d):Possible effects (cont’d):

• organ malformationorgan malformation• sluggishnesssluggishness• future cancersfuture cancers• visual impairmentvisual impairment• skeletal malformationskeletal malformation• brain developmentbrain development• genital abnormalitiesgenital abnormalities• prematurityprematurity

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TERATOGENS (Cont’d):TERATOGENS (Cont’d): Possible effects (cont’d):Possible effects (cont’d):

• respiratory difficultiesrespiratory difficulties• illnessesillnesses• microcephaliamicrocephalia• heart defectsheart defects• breach births (more C-sections)breach births (more C-sections)

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TERATOGENS (Cont’d):TERATOGENS (Cont’d): THERE ARE NO TOTALLY SAFE THERE ARE NO TOTALLY SAFE

DRUGS!DRUGS! Most vulnerable:Most vulnerable:

• brain, CNSbrain, CNS learning problemslearning problems ADHDADHD

Most common mechanism:Most common mechanism:• oxygen deprivationoxygen deprivation

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TERATOGENS (Cont’d):TERATOGENS (Cont’d): Maternal stress:Maternal stress:

• acute or chronic (worse)acute or chronic (worse) adrenaline, corticosteroids:adrenaline, corticosteroids:

• compromise oxygen supply for infantcompromise oxygen supply for infant

• after birth:after birth: digestive problemsdigestive problems low birth weightlow birth weight irritabilityirritability

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TERATOGENS (Cont’d):TERATOGENS (Cont’d): Maternal age:Maternal age:

• no more obstetrical complications (if healthy)no more obstetrical complications (if healthy)• increased Down’s syndromeincreased Down’s syndrome

Paternal age: Increasing evidence:Paternal age: Increasing evidence:• autism (over 40)autism (over 40)• schizophrenia (over 50)schizophrenia (over 50)• cognitive problemscognitive problems• miscarriagemiscarriage• fertility downfertility down• other effectsother effects

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TERATOGENS (Cont’d):TERATOGENS (Cont’d): All these teratogenic variations can:All these teratogenic variations can:

• affect maternal-infant interactionaffect maternal-infant interaction

and causeand cause• abuseabuse• neglectneglect• rejectionrejection

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Maternal Nutrition:Maternal Nutrition: First trimester:First trimester:

• usually not an issue – special casesusually not an issue – special cases Second trimester:Second trimester:

• qualityquality Third trimester:Third trimester:

• quality and quantityquality and quantity Important:Important:

• Folic acid: prevents neural tube defects (eg. spina Folic acid: prevents neural tube defects (eg. spina bifida)bifida)

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Maternal Nutrition (Cont’d):Maternal Nutrition (Cont’d): Infant Optimal Weight:Infant Optimal Weight:

• 77½ - 8 lbs. (European stock)½ - 8 lbs. (European stock) Low Birth Weight:Low Birth Weight:

• 5½ lbs. or 2,500 g5½ lbs. or 2,500 g Montreal Diet Dispensary, Agnes Higgins:Montreal Diet Dispensary, Agnes Higgins:

• 500 extra daily calories:500 extra daily calories: 1 qt. milk1 qt. milk 1 egg1 egg 1 orange1 orange

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Prenatal Care Essential:Prenatal Care Essential: Toxemia:Toxemia:

• increased blood pressureincreased blood pressure• fluid retentionfluid retention• edemaedema• can lead to eclampsia (fatal)can lead to eclampsia (fatal)

Gestational DiabetesGestational Diabetes

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Sex During PregnancySex During Pregnancy Woman’s comfort with own body Woman’s comfort with own body

important:important: 11stst Trimester: Trimester:

• tiredness, nauseatiredness, nausea Male partner:Male partner:

• MOTHER imageMOTHER image• fear of damaging babyfear of damaging baby

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Sex During Pregnancy (Cont’d):Sex During Pregnancy (Cont’d): 22ndnd Trimester: Trimester:

• buoyant, well-being, vaginal mucusbuoyant, well-being, vaginal mucus Individual differences:Individual differences:

• some women feel sexy, others notsome women feel sexy, others not• about 5about 5thth month: belly. Unattractive? month: belly. Unattractive?

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Sex During Pregnancy (Cont’d):Sex During Pregnancy (Cont’d): 33rdrd Trimester: Trimester:

• abdomen large, awkwardabdomen large, awkward• new positions for sexnew positions for sex• edema, tiredness, lack of sleep, too hot, hard to edema, tiredness, lack of sleep, too hot, hard to

breathebreathe

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Sex During Pregnancy (Cont’d):Sex During Pregnancy (Cont’d): Important:Important:

• Level of fitness, activity, diet, general healthLevel of fitness, activity, diet, general health• Colostrum: some men uncomfortableColostrum: some men uncomfortable• Issue of “fatness”Issue of “fatness”• Fear of premature laborFear of premature labor• Some men turned offSome men turned off

Orgasm will only trigger labour if baby ready Orgasm will only trigger labour if baby ready to be bornto be born

Mechanism: oxytocinMechanism: oxytocin

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Review oxytocin functions:Review oxytocin functions: orgasmorgasm uterine contractionsuterine contractions bondingbonding milk ejection reflexmilk ejection reflex when people touch each other oxytocin is when people touch each other oxytocin is

releasedreleased