Chapter 17 - Becoming a Parent
Principles of Personal Health

I. Parenting Issues for Couples

A. Introduction

1. Considerations about becoming parents that couples should discuss:

a. What effect will pregnancy have on us?

b. Why do we want a child?

c. What effect will a child have on our self-image?

d. Can we afford to have and raise a child?

e. How will we divide the responsibilities?

f. How will our careers be affected?

g. How will we rear children concerning religion and discipline?

h. Are we ready to give up much of our freedom?

i. How will we handle being awakened by six o’clock every morning?

j. What plans do we have in case our baby has birth defects?

B. A Parenting Prescription of the Early Years

1. Separate your home and work environments

2. Plan your daily separation from your children

3. Realize that it is okay to feel sad about leaving your child

4. Allow yourself to feel some guilt

5. Share stress with family, support groups, or friends

6. Always include spouse in family activities

7. Don’t feel that you have to be a "Super Parent"

8. Conserve energy for your homelife while you are at work

9. Investigate and understand all parenting options available at your work

10. Resign yourself to some chaos upon returning home from work

11. Hug children for at least a few minutes when you return home

12. Allow and encourage children to help you with chores

13. Make certain each child has some "special time"

14. Understand that stress is normal

II. Pregnancy: An extension of the Partnership

A. Obstacles to Fertilization

1. Acid level of the vagina is destructive to sperm

2. The cervical mucus is thick during most of the menstrual cycle

3. Sperm must locate the cervical opening

4. Half the sperm travel through the wrong fallopian tube

5. The distance sperm must travel is relative long considering their tiny size

6. The sperm’s travel is "upstream"

7. The folds of the tubal walls trap many sperm

B. Aids to Fertilization

1. The number of sperm deposited during ejaculation is astounding

2. Sperm are deposited very near the cervical opening

3. Male accessory glands help make semen nonacidic

4. Uterine contractions aid sperm movement

5. Sperm cells move rather quickly

6. Sperm can live for days after inside the fallopian tube

7. At ovulation, the cervical mucus is thin and watery

C. Signs of Pregnancy

1. Presumptive Signs

a. Missed period

b. Nausea on awakening (morning sickness)

c. Increase in size and tenderness of breasts

d. Darkening of the areolar tissue surrounding the nipples

2. Probable Signs of Pregnancy

a. Increase in frequency of urination

b. Increase in the size of the abdomen

c. Cervix becomes softer by the sixth week

d. Positive pregnancy test

3. Positive Signs of Pregnancy

a. Determination of a fetal heartbeat

b. Feeling of the fetus moving (quickening)

c. Observation of the fetus by ultrasound or optical viewers

D. Agents That Can Damage a Fetus

1. The best advice is to have close contact with an obstetrician and consider the ingestion of any drug during pregnancy

2. Avoid exposure to radiation and Accutane (drug prescribed for acne)

III. Childbirth: The Labor of Delivery

A. Introduction

1. This experience can provide a setting for personal growth for parents

2. During the last few weeks the fetus moves deeper into the pelvic cavity (lightening)

3. The incidence of Braxton Hicks contractions will increase

4. The birth can be divided into three stages

B. Stage One: Effacement and Dilation of the Cervix

1. Uterine contractions attempt to enlarge the cervical opening

2. The cervical opening must dilate to a diameter of ten centimeters

3. The amniotic sac may burst and painful uterine contractions become more intense

4. The end of stage one is called transition (often the most painful part of the entire birth - and the shortest)

5. Until full dilation to ten centimeters, women are cautioned not to "push"

C. Stage Two: Delivery of the Fetus

1. The second stage is entered when the cervix is fully dilated

2. The mother is encouraged to help push the baby out during the contractions

3. This stage may last up to two hours in first births

4. Crowning- when the baby’s head is first seen at the vaginal opening

5. The baby’s head generally appears first and the rest of the body soon follows

6. Most babies appear bluish at first until regular breathing has begun

D. Stage Three: Delivery of the Placenta

1. The uterus will initiate a series of contractions to expel the placenta (afterbirth)

2. Postpartum- the period after the birth of a baby during which the uterus returns to its prepregnancy size

E. Cesarean Deliveries

1. Procedure in which the fetus is surgically removed from the uterus through the abdominal wall

2. Some medical experts support this kind of delivery when any of the following factors are present;

a. The fetus is improperly positioned

b. The mother’s pelvis is too small

c. The fetus is especially large

d. The fetus shows signs of respiratory or cardiac distress

e. The umbilical cord is compressed

f. The placenta is being delivered before the fetus

g. the mother’s health is at risk

IV. Complications in Pregnancy and Childbirth (unusual if woman has healthy diet, is avoiding agents that damage the fetus, and is following the "doctors orders"):

A. Eptopic pregnancy- The embryo implants outside the uterus

B. Miscarriage- Early miscarriage is very common

C. Gestational diabetes- Temporary condition in which the mother’s body does not produce enough insulin

D. Hyperemesis gravidarum- Excessive vomiting during pregnancy

E. Preeclampsia- The woman’s blood pressure becomes elevated during pregnancy

F. Eclampsia- The final stage of preeclampsia

G. Intrauterine growth retardation- Insufficient growth of the fetus

H. Premature rupture of the membranes- "Breaking of the water" occurs prematurely

I. Premature labor- Labor that begins after the fetus is considered viable and before term

J. Fetal distress- A category of fetal problems such as the lack of oxygen

V. Preconceptional Counseling

A. Genetic counseling should be considered when either partner falls into any of the following categories:

1. History of multiple spontaneous abortions

2. Consangunity (partners are related by blood)

3. Birth defects in the patient of families

4. Ethnic background with increased risk of recessive genetic disease

5. Maternal age of thirty-five of more

6. Paternal age of fifty-five or more

7. Positive maternal test for Down syndrome

8. Positive maternal test for an open neural tube defect

9. Carrying a gene for a recessive disease

10. Exposure to a known or suspected teratogenic agent (capable of causing birth abnormality)

VI. Infertility (About one in six couples has a problem with infertility)

A. Enhancing Fertility

1. Approaches can be used to increase sperm counts: periodic cold packs on the scrotum and replacement of tight underwear with boxer shorts

B. Artificial Insemination

1. Near the time of ovulation, collected samples of sperm are deposited near the woman’s cervical opening

C. Surgical Remedies

1. Infertility in women centers mostly on obstructions in the reproductive tract and the inability to ovulate

2. Microsurgical techniques may correct some complications

3. Fertility drugs can help alter the menstrual cycle to produce ovulation

D. Reproductive Technology

1. Sometimes referred to as "test-tube" procedure

2. Surgically retrieving ova from the woman and combining them with sperm in a glass dish

3. The fertilized ova are transferred into the uterus

E. Surrogate Parenting

1. Legal and ethical issues surrounding this method have not been fully resolved

2. An infertile couple make a contract with a woman who will be artificially inseminated with semen from the expectant father

3. The surrogate carries the fetus to term and returns the baby to the parents

VII. Options for Infertile Couples

A. Introduction

1. Support groups have been established to assist couples with infertility problems

2. Barrier methods of contraception with a spermicide may cut the risk of infertile dramatically

3. The use of an IUD should be carefully considered

4. The risk of multiple partners should encourage responsible sexual activity

5. Maintain overall good health and have regular checkups

B. Adoption

1. Adopted children represent about 2 percent of all children in the U.S.

2. Independent adoptions now surpass those arranged by social service agencies

C. Foster Parenting

1. Children in foster care has risen steadily since the mid-1980s

2. Foster parenting has presented a variety of ethical and legal issues

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