Transcript Chapter 6 Lecture Considering Your Reproductive Choices © 2015 Pearson Education, Inc. LEARNING OUTCOMES • Explain how each of the main categories of contraception affects the process.

Chapter 6 Lecture
Considering
Your
Reproductive
Choices
© 2015 Pearson Education, Inc.
LEARNING OUTCOMES
• Explain how each of the main categories of
contraception affects the process of
contraception and understand how the
effectiveness of contraception is measured.
• Compare and contrast the advantages,
disadvantages, and effectiveness of different
barrier methods in preventing pregnancy and
sexually transmitted infections.
• Compare the advantages, risks, and
effectiveness of different hormonal methods in
preventing pregnancy.
© 2015 Pearson Education, Inc.
LEARNING OUTCOMES (cont.)
• Describe the intrauterine contraceptives, their
effectiveness, and their advantages and
disadvantages.
• Describe emergency contraception and how it is
used.
• Explain how behavioral methods of
contraception work and compare their
effectiveness to other methods.
• Describe surgical methods of birth control and
discuss their advantages and disadvantages.
• List the questions you should consider when
choosing a method of contraception.
© 2015 Pearson Education, Inc.
LEARNING OUTCOMES (cont.)
• Summarize the legal decisions surrounding
abortion and the various types of abortion
procedures.
• Discuss the key issues to consider when
thinking about pregnancy and parenthood.
• Describe fetal development and explain the
importance of prenatal care.
© 2015 Pearson Education, Inc.
LEARNING OUTCOMES (cont.)
• Describe the process of labor and delivery,
discuss complications of pregnancy and
childbirth, and identify key features of the
postpartum period.
• Review primary causes of and possible solutions
to infertility.
• Describe the advantages and disadvantages of
adoption.
© 2015 Pearson Education, Inc.
Basic Principles of Birth Control
• Birth Control—also called contraception—refers
to methods of preventing conception.
• Conception occurs where a sperm reaches an
egg, usually in the fallopian tube.
• The following conditions are necessary for
conception:
– A viable egg (ovum)
– A viable sperm
– Access to the egg by the sperm
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Basic Principles of Birth Control (cont.)
• Fertility—A person's ability to reproduce
• Perfect-use failure rate—Number of
pregnancies likely to occur (per 100) in first year
of use of a method if used consistently and
accurately
• Typical-use failure rate—Number of
pregnancies likely to occur (per 100) in first year
of use of a method if not used consistently and
accurately
© 2015 Pearson Education, Inc.
Methods of Birth Control
• Barrier Methods
– Contraceptive methods that block the meeting
of egg and sperm by means of a physical
barrier
• Hormonal Methods
– Contraceptive methods that introduce
synthetic hormones into the woman's system
to prevent ovulation, thicken cervical mucus, or
prevent a fertilized egg from implanting
• Surgical Methods
• Behavioral Methods
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Methods of Birth Control
• Some contraceptive methods can also protect
against sexually transmitted diseases (STIs) to
some degree.
• This is an important factor to consider when
choosing a contraceptive.
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Top Reported Contraceptive Methods
Sexually Active College Students or Their
Partners Used the Last Time They Had
Intercourse
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Barrier Methods
• The Male Condom
– Male condoms come with or without
spermicide and with or without lubrication.
– If desired, users can lubricate their own
condoms with contraceptive foams, creams,
and jellies or other water-based lubricants.
– When used consistently, condoms can be up
to 98 percent effective and protect against
some STIs and HIV.
– Typical use is about 82 percent effective.
– Condoms do not protect against STIs that
may have external areas of infection, such as
herpes.
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How to Use a Male Condom
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Barrier Methods
• The female condom is a single-use soft,
loose-fitting polyurethane sheath meant for
internal vaginal use.
– Used consistently and correctly, female
condoms can be up to 95 percent effective
and can prevent the spread of HIV and other
STIs, including those that can be spread by
external genital contact. It can be inserted up
to 8 hours in advance.
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How to Use a Female Condom
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Contraceptive Effectiveness, STI Protection,
Frequency of Use, and Cost
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Contraceptive Effectiveness, STI Protection,
Frequency of Use, and Cost (cont.)
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Jellies, Creams, Foams, Suppositories, and
Film
• Like both types of condoms, these products do
not require a prescription.
• They kill sperm with nonoxynol-9 (N-9).
• They are most effective when used with a barrier
method and are only 72 percent effective when
used alone.
• They can be messy, and some people are
allergic to N-9.
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The Diaphragm with Spermicidal Jelly or
Cream
• A diaphragm is a shallow latex cup that fits over the
cervix, blocking access to the uterus.
• Must be fitted for a woman by a trained practitioner.
• Can be inserted up to 6 hours before intercourse.
• Should be used with spermicidal cream or jelly and left in
place 6 to 8 hours after intercourse; additional
spermicide should be applied before each subsequent
act of intercourse.
• Offers protection against some STIs.
• Can be 94 percent effective.
• Leaving it in place longer than 24 hours or using while
menstruating can increase risk of toxic shock syndrome
(TSS).
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The Proper Use and Placement of a
Diaphragm
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The Cervical Cap with Spermicidal Jelly or
Cream
• Latex or silicone cup that
fits snugly over the cervix
• Must be fitted by a trained
practitioner.
• Can be inserted up to 6
hours before intercourse.
• Should be used with
spermicidal cream or jelly
and left in place 6 to 8
hours after intercourse.
• Offers protection against
some STIs.
• 86 percent effective.
© 2015 Pearson Education, Inc.
Contraceptive Sponge
• Made of polyurethane foam,
contains nonoxynol-9.
• Does not require fitting.
• Lasts up to 24 hours; no need to
reapply spermicide or insert new
sponge for subsequent acts of
intercourse within 24-hour period.
• Leave in place for at least 6 hours
after last act of intercourse.
• Limited STI protection, moderate
protection against pregnancy,
and some risk of TSS.
• Typical use effectiveness is
88 percent.
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Hormonal Methods
• Hormonal Contraception
– Contains synthetic estrogen and/or progestin.
– Introduced into a woman's system to prevent
ovulation or fertilized egg from implanting.
– Does not protect against STIs.
– Available in transdermal, injection, and oral
forms.
– Requires a prescription.
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Oral Contraceptives
• Prevent ovulation
• Combination of synthetic estrogen and
progesterone
• Must be taken daily
• May help lessen menstrual difficulties
• Possible health problems include the following:
– Blood clots, stroke, heart attack, high blood
pressure
• With perfect use, 99 percent effective, and with
typical use, 91 percent effective.
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Progestin-Only Pills
• Contain small doses of synthetic progesterone and no
estrogen
• Taken continuously (no placebo pills)
• Good choice for women who
– are at high risk for estrogen-related side effects.
– have diabetes.
– have high blood pressure or cardiovascular
conditions.
– are older than age 35.
– are breast-feeding.
• Side effects include irregular menstrual bleeding or
spotting, mood changes, changes in sex drive, and
headaches.
• Important that they be taken at the same time each day
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Contraceptive Skin Patch
• Ortho Evra is a thin, square, transdermal adhesive
patch.
• Worn for 1 week, and replaced on the same day of the
week for 3 consecutive weeks
• Delivers continuous levels of estrogen and progestin
through the skin and into the bloodstream
• With perfect use, 99.7 percent effective
• Offers mostly the same benefits and side effects as
combination pills, although easier to remember to use
than taking a daily pill
• FDA mandated a warning label explaining that patch use
exposes women to about 60 percent more total estrogen
than if they were taking a typical combination pill.
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Vaginal Contraceptive Ring
• NuvaRing
– A soft and flexible plastic
hormonal contraceptive ring
– Offers protection for 1 month
– Releases a steady flow of
estrogen and progestin
– With proper use, 99.7 percent
effective
– Fewer estrogen-related side
effects
– Possible side effects include
increased vaginal discharge
and vaginal irritation or
infection
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Contraceptive Injections
• Depo-Provera
– A long-acting synthetic progesterone that is injected
intramuscularly every 3 months by a health care
provider
– With typical use, 94 percent effective
– Menstrual periods become lighter and may eventually
stop
– No estrogen-related health risks
– Same potential health benefits as progestin-only pills
– Common side effects include dizziness, nervousness,
headache, and possible loss of bone density
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Contraceptive Implants
• Implanon
– A single-rod implantable capsule that is
inserted just beneath the skin on the inner
side of a woman's upper underarm
– Releases a low, steady dose of progestin for
up to 3 years
– Effectiveness of 99.95 percent
– Benefits include lightening or cessation of
menstrual periods, lack of estrogen-related
side effects, and safety for use by breastfeeding women.
– Expensive and must be inserted by a clinician
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Intrauterine Contraceptives
• IUDs are small, plastic, flexible devices that are
placed in the uterus and left there for 5 to 10
years at a time.
• The exact mechanism by which IUDs work is not
clearly understood, but researchers believe
IUDs affect the way the sperm and the egg
move, thereby preventing fertilization, and/or
affect the lining of the uterus to prevent a
fertilized ovum from implanting there.
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Intrauterine Contraceptives (cont.)
• ParaGard
– A T-shaped plastic device with copper
wrapped around the shaft; does not contain
any hormones and is effective for 10 years
• Mirena
– Effective for 5 years and releases small
amounts of progestin
• IUDs may cause discomfort, heavy menstrual
flow, severe cramps; pose risk of ectopic
pregnancy, pelvic inflammatory disease,
infertility, and tubal infections.
© 2015 Pearson Education, Inc.
ABC News Video: Support for IUDs
Discussion Questions
• What are the risks associated with using IUDs?
• Do you think the changes in the IUD will have a
positive impact on its use?
• Analyze the pros and cons of using the IUD in
contrast to other forms of birth control. When is
the IUD indicated for use? When is it
contraindicated for use? What impact do the
hormones have on the body?
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Emergency Contraception
• Emergency contraception is used to prevent pregnancy
after unprotected intercourse.
– Most effective up to 72 hours after a condom breaks,
sexual assault, or unprotected sex
• Plan B One-Step is now allowed to be on the shelf with
no age restrictions. Generic versions will soon be
available but with age restrictions.
• FDA recently approved ella, which is only available by
prescription and can be taken 5 days after unprotected
intercourse.
• According to recent surveys, 10 percent of sexually
active college students reported using emergency
contraception within the past school year.
© 2015 Pearson Education, Inc.
Behavioral Methods
• Withdrawal (coitus interruptus)
– Removing the penis from the vagina just prior to
ejaculation
– Highly unreliable, offers no protection against STIs
• Abstinence
– Deliberately avoiding intercourse
– Massaging, kissing, solitary masturbation
– Only method that is 100 percent effective against
pregnancy and STIs
• "Outercourse"
– Includes oral/genital sex and mutual masturbation
– Can be 100 percent effective against pregnancy if
male doesn't ejaculate near the vaginal opening
– Not effective against STIs because of possible
oral/genital contact, unless condoms are used
© 2015 Pearson Education, Inc.
Fertility Awareness Methods
• Cervical Mucus Method
– Check color and consistency to determine fertile
times.
– Avoid sexual activity when mucus is present and for
several days afterward.
• Body Temperature Method
– A woman's basal body temperature rises between
0.4 and 0.8 degrees after ovulation.
– Abstain from sexual activity before the temperature
rise until several days after the temperature rise is
observed.
• Calendar Method
– Assumes that ovulation occurs during the midpoint of
the cycle.
• These methods offer no STI protection, and may not
work for women with irregular menstrual periods.
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The Fertility Cycle
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Surgical Methods
• Female Sterilization
– Permanent fertility control
• Tubal ligation—fallopian tubes sealed to block
sperm
– Menstrual cycle continues, released eggs disintegrate
– Essure—placement of microcoils into the fallopian tubes
– Adiana—placement of a soft insert into the fallopian
tubes
• Hysterectomy—major surgery that removes
uterus
• Male Sterilization
• Vasectomy—piece of vas deferens is removed
and ends are tied or sewn shut.
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Female Sterilization: Tubal Ligation
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Male Sterilization
• Frequently done as an outpatient basis and is
less complicated than female sterilization.
• It does not affect sexual performance.
• It is highly effective.
• It offers no protections against STIs.
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Male Sterilization: Vasectomy
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Choosing a Method of Contraception
• How comfortable would I be using a particular
method?
• Will this method be convenient for me and my
partner?
• Am I at risk for the transmission of STIs?
• Do I want to have a biological child in the future?
• How would an unplanned pregnancy affect my
life?
• What are my religious and moral values?
• How much will the birth control method cost?
• Do I have any health factors that could limit my
choice?
© 2015 Pearson Education, Inc.
Abortion
• Roe v. Wade (1973)
– Stated that the "right to privacy founded on
the Fourteenth Amendment's concept of
personal liberty is broad enough to
encompass a woman's decision whether or
not to terminate her pregnancy."
– An abortion can be performed during first
trimester without legal restrictions.
– States set conditions for second trimester
abortions.
– Third semester abortions are ruled illegal
unless the mother's life or health is in danger
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The Debate over Abortion
• Pro-choice
– Belief that it is a woman's right to make decisions
about her own body and health
• Pro-life
– Belief that the embryo or fetus is a human being with
rights that must be protected
• A woman's access to abortion has been challenged in
recent years.
– A 2012 Mississippi law requiring physicians in
abortion clinics to have admitting privileges at a local
hospital threatened to close the state's only abortion
clinic.
– North Dakota bans abortions after 6 weeks gestation.
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Emotional Aspects of Abortion
• The best scientific evidence indicates the risk of
mental health problems in adult women is no
greater if they have an abortion than if they
deliver a baby.
• Although a variety of feelings such as regret,
guilt, sadness, relief, and happiness are normal,
no evidence has shown that an abortion causes
long-term psychological trauma.
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Methods of Abortions
• Surgical Abortions
– Suction Curettage
• First trimester
– Dilation and Evacuation (D&E)
• Second trimester
– Prostaglandin or Saline Induction
• Second trimester
– Hysterotomy
• Surgical removal of fetus from the uterus
• Used during emergencies
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When Women Have Abortions (in weeks
from the last menstrual period)
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Suction Curettage Abortion
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Methods of Abortions (cont.)
• Medical Abortions
– Mifepristone
• Formerly known as RU-486 and currently sold in
the United States under the brand name Mifeprex
• Known as the "abortion pill"
• Steroid hormone that induces abortion by blocking
the action of progesterone
• Causes uterine contractions that expel the
fertilized egg
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Looking Ahead to Pregnancy and
Parenthood
• Before becoming pregnant consider
– Your emotional health
– Financial evaluation
– Physical health: paternal health
– Physical health: maternal health
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Pregnancy
The Process of Pregnancy
• Sperm fertilizes an egg in the fallopian tubes.
• Zygote multiplies and becomes a blastocyst and
travels toward the uterus.
• The embryo burrows into the endometrium.
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Fertilization
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Pregnancy Testing
• Pregnancy testing is based on the secretion of
human chorionic gonadotropin (HCG).
• Home pregnancy tests can be used as early as
2 weeks after conception and are about 99
percent reliable.
• If done too early, test may show a false
negative.
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The Process of Pregnancy
• Early Signs of Pregnancy
– Missed period, although spotting may occur
– Breast tenderness
– Emotional upset
– Extreme fatigue
– Nausea and vomiting (morning sickness),
most common in morning, but can occur any
time of day
– Sleeplessness
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Changes in a Woman's Body During
Pregnancy
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The Process of Pregnancy
• First Trimester
– Few noticeable changes in woman's body
– May urinate more often and experience morning
sickness
– Embryo differentiates and develops organ systems
– At start of third month the embryo is called a fetus,
indicating all organ systems are in place.
• Second Trimester
– Physical changes in the woman's body become more
noticeable.
– Placenta—The network of blood vessels connected
to umbilical cord that carries oxygen and nutrients
from mother to fetus and fetal waste products to
mother becomes well established.
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The Process of Pregnancy (cont.)
• Third Trimester
– Greatest fetal growth; gains most of its weight
– Fetus must get large amounts of calcium,
iron, and nitrogen from mother's food intake.
– Fat layer develops in eighth month.
– Respiratory and digestive organs need further
development to avoid complications.
• Emotional Changes
– Women may experience fear of
complications, anxiety, wonder, and
excitement over the baby.
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Series of Fetoscopic Photographs Showing
Development in the First, Second, and Third
Trimesters of Pregnancy
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Prenatal Care
• Choosing a Practitioner
– Begin regular medical checkups as soon as
possible.
• Nutrition and Exercise
– Pregnant women need additional protein,
calories, vitamins, and minerals.
– Recommended normal weight gain is
25 to 35 lbs.
– Obese women should gain only between 15
and 25 lbs.
– Underweight women should gain between 28
and 40 lbs.
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Prenatal Care
• Exercise is an important factor in overall health
during pregnancy.
• Drugs and Alcohol
– A health care provider should be consulted
before the use of any drug, even aspirin.
– Maternal consumption of alcohol is
detrimental to a growing fetus and may result
in fetal alcohol syndrome.
– Smoking harms every phase of reproduction.
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Prenatal Care (cont.)
• Other teratogens include exposure to X-rays,
toxic chemicals, heavy metals, pesticides,
gases, and other hazardous compounds.
• Two specific age-related risks are miscarriage
and Down syndrome.
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Prenatal Care (cont.)
• Prenatal Testing and Screening
– Ultrasonography or ultrasound
– Chorionic villus sampling (CVS)
– The triple marker screen (TMS)
– The quad screen
– The integrated screen
• Amniocentesis
– Recommended for women over age 35,
between weeks 14 and 18. Screens for birth
defects such as Down syndrome.
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Childbirth
• Managing Labor
– Pain medication
– Lamaze method
• Cesarean Section (C-section)
– Surgical procedure most often used if labor
lasts too long or baby is in physiological
distress
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The Birth Process
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Complications of Pregnancy and Childbirth
• Preeclampsia and Eclampsia
– Preeclampsia is characterized by high blood
pressure, protein in the urine, and edema.
– Left untreated, preeclampsia can cause strokes and
seizures, a condition known as eclampsia.
• Miscarriage, or spontaneous abortion, occurs in 15-20
percent of pregnancies, usually during the first trimester.
• Ectopic Pregnancy
– An ectopic pregnancy is the implantation of a
fertilized egg outside the uterus, usually in the
fallopian tube or sometimes in the pelvic cavity.
Ectopic pregnancies must be terminated since the
blastocyst cannot survive and there is risk to the
mother.
• Stillbirth
– The death of a fetus after the 20th week of pregnancy
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The Postpartum Period
• Usually lasts 6 weeks after delivery.
• Women experience fluctuating emotions.
• Postpartum depression
– Affects about 1 in 7 new mothers
– Disabling mood swings, no energy, crying,
guilt, depression
– Should seek professional help
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Breast-Feeding
• Colostrum
– Secreted first few days before milk "comes in"
– Contains vital antibodies necessary to help baby fight
potential infections
• American Academy of Pediatrics recommends breastfeeding for 6 to 12 months.
• Advantages of breast-feeding
– Babies have fewer illnesses and recover more
quickly when ill.
– Children are less likely to be obese.
– Children have fewer allergies throughout their lives.
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Infant Mortality
• Infant death can be caused by birth defects, low
birth weight, injuries, or unknown causes.
• Sudden infant death syndrome is the unexpected
death of a child under 1 year of age. Causes are
unknown, but to modify risk, parents are advised to
– Lay infants on their backs on a firm surface.
– Not allow smoking around infants.
– Give the baby a clean pacifier.
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Infertility
• Affects 1 in 10 American couples
• Causes in Women
– Polycystic ovary syndrome is the leading
cause of infertility.
– Endometriosis
– Pelvic inflammatory disease (PID)
• Causes in Men
– Low sperm count
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ABC News Video: What Are the
Reasons for Infertility?
Discussion Questions
• What method is used to bypass tubal infertility?
• A couple in their 30's is having difficulty
conceiving over the course of a year. Describe
the steps in the process this couple should take
when determining infertility.
• When do you recommend a couple consult a
fertility specialist if they suspect they are having
difficulty conceiving?
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Infertility Treatments
• Fertility Drugs
– Stimulate ovulation in women who are not ovulating
– Side effects include headaches, fatigue, and hot flashes
– Can trigger the release of more than one egg
• Alternative Insemination
– A woman inseminated with partner's sperm or sperm obtained
through a sperm bank (known as in vitro fertilization, or IVF)
• Assisted Reproductive Technology (ART)
– Intracytoplasmic sperm injection (ICSI)—sperm is injected into
egg
– Gamete intrafallopian transfer (GIFT)—"harvest" egg and place
in fallopian tube with sperm
– Zygote intrafallopian transfer (ZIFT)—combines IVF and GIFT
• Nonsurgical Embryo Transfer and Other Techniques
– A donor egg is fertilized by the man's sperm and implanted in
the woman's uterus.
– Embryo adoption programs
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Gestational Surrogacy
• Many couples conceive by infertility treatments,
but some cannot sustain a pregnancy.
• Surrogacy is an option in which a woman is
hired to carry another person's pregnancy.
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Adoption
• About 2 percent of the adult population has
adopted children.
• Confidential adoption occurs when neither the
birth parents nor the adoptive parents know
about each other.
• Open adoption occurs when birth parents and
adoptive parents know something about each
other.
– Both parties must agree to the level of
openness, and all levels are not available in
every state.
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