Chapter 6 Lecture

Health: The Basics

Tenth Edition

Considering Your
Reproductive Choices
 OBJECTIVES
• Compare the different types of contraceptive methods
and their effectiveness in preventing pregnancy and
sexually transmitted infections.
• Summarize the legal decisions surrounding abortion and
the various types of abortion procedures.
• Discuss key issues to consider when planning a
pregnancy.
• Explain the importance of prenatal care and the physical
and emotional aspects of pregnancy.
• Describe the basic stages of childbirth and the methods
and complications that can arise during labor and
delivery.
• Review primary causes of and possible solutions to
infertility.
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 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

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 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
• Some contraceptive methods can also protect
against sexually transmitted diseases (STIs) to
some degree.

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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 85% 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% 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.
– Typical use effectiveness is 79%.

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 How to Use a Female Condom

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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 71% 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.
• 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.

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 The Today Sponge

• Made of polyurethane foam,

contains spermicide
• 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

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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:
– Blood clots, stroke, heart attack, high
blood pressure
• With perfect use, 99.7% effective,
and with typical use, 92% 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 one week, and replaced on the same day of the
week for three consecutive weeks
• Delivers continuous levels of estrogen and progestin
through the skin and into the bloodstream
• With perfect use, 99.7% 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% 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 one month
• Releases a steady flow of estrogen
and progestin
• With proper use, 99.7% 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 three months by a health care
provider
• With typical use, 97% 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%
• Benefits include lightening or cessation of menstrual
periods, lack of estrogen-related side effects, and safety
for use by breast-feeding 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
5-10 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.
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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
• Three brands are available: Plan B One-Step and Next
Choice are both available OTC for those 17 and over,
and ella is available only by prescription.
• According to recent surveys, 10.1% of sexually active
college students reported using emergency
contraception within the past school year.
• A copper-wrapped IUD may also be used as emergency
contraception if inserted within 5 days of intercourse.

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 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% effective against pregnancy and STIs
• "Outercourse"
– Includes oral/genital sex and mutual masturbation
– Can be 100% 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

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 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: 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?

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 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.
– States now have the right to impose restrictions on abortions –
some states have banned them in publically funded clinics.
– Some states have laws requiring parental notification before a
teen can obtain an abortion.
– The U.S. Congress has banned access to an abortion for all
women who receive federally funded health care.

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 Emotional Aspects of Abortion

• In a longitudinal study of more than 5,000

women who had had abortions, the best
predictor of a woman's emotional well-being
following an abortion was her emotional well-
being prior to the procedure.
• 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
– Hysterectomy
• 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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 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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 Planning a Pregnancy

• Before becoming pregnant consider

– Your emotional health
– Maternal health
– Paternal health
– Financial status

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 Pregnancy

• Preconception Care
– The key to preconception care is to combine
the best medical care, healthy behaviors,
strong support, and safe environments at
home and work.
– Usually begins at week 11 or 12, but the fetus
is most susceptible to developing problems in
the first 4-10 weeks.

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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 85-95% 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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 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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 Things to Avoid While Pregnant
• Drugs and Alcohol
– First trimester fetus is very vulnerable to teratogenic (birth
defect–causing) effects of drugs, environmental chemical, X-
rays, and diseases.
– Fetal alcohol syndromes include mental retardation, slowed
nerve reflexes, and small head size.
• Smoking
– Increased risk of complications, premature birth, low birth weight,
stillbirth, infant mortality, development of cleft lip and palate
– Research reveals that secondhand smoke may be as
detrimental as the mother's smoking.
• Other Teratogens
– Avoid X-rays, toxic chemicals, heavy metals, pesticides, and
gases.
– Do NOT clean cat litter boxes as toxoplasmosis can cause
stillbirth and birth defects.
– Rubella, HIV, genital herpes are other risk factors.

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 Pregnancy
• Maternal Age
– A decline in both the quality and viability of eggs after
age 35
– Increase in the incidence of Down syndrome
• Prenatal Testing and Screening
– Ultrasonography or ultrasound
– Chorionic villus sampling (CVS)
– The triple marker screen (TMS)
– Amniocentesis
• Amniocentesis
– Recommended for women over age 35, between
weeks 14-18. Screens for birth defects such as Down
syndrome.

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 The Birth Process

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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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 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%
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 4 to 6 weeks after delivery.

• Women experience fluctuating emotions.
• Postpartum depression
– Affects about 10% of 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
breast-feeding 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 one in six 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
– Mumps virus

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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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 Adoption

• About 2% of the adult population have

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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