Female Sexuality

Pregnancy & Childbirth

Dr. Suzanna Rose

PREGNANCY

I. First trimester (weeks 0-12)

A. Fertilization and implantation

B. Placenta development

• drugs, toxins can pass through
• waste products from fetus carried to mother's uterine veins

C. Fetal development - by 3 months

• head growth
• internal organs function
• limbs move
• 3 inches and 1 oz

D. Physical changes in mother

• increase in hormones
• breast swell and tingle
• "morning sickness" in 75%
• frequent urination; constipation
• fatigue and sleepiness (sedative effects of progesterone)
• weight gain: 2-4 lbs

E. Psychological changes

• "sick role" (for some women)
• depression and fatigue
• elation

F. Sexual activity - 25% of women show decreased interest but frequency of sexual activity unchanged

II. Second trimester - 13- 24 weeks

A. Fetal development - by 6th month

• open eyes
• long hair on head
• fat is developing
• 14 inches, 2 lbs
• immature respiratory system
• if born, poor chance of survival

B. Physical changes in mother

• waist begins to bulge, abdomen protrudes
• bustline expands
• frequent urination stops
• water retention
• constipation, hemorrhoids, nose bleeds
• nipples may get darker
• may salivate or sweat more
• may get varicose veins
• wk 19, some women produce colostrum
• Weight gain: 9-12 lbs

C. Psychological changes

• positive emotions
• some are anxious about appearance/others proud
• woman treated as abnormal
  • "novelty response"
  • more interpersonal distance

D. Sexual activity

• heightened sensuality
• Preferred position for intercourse changes

III. Third trimester (weeks 25-36)

A. Changes in fetus -

8th month

• skin wrinkles disappear
• shift to head-down position

9th month

• fetus is less active
• organ systems function
• eyes are blue (or black); colors don't develop until exposure to light
• fetus has acquired antibodies from mother
• 21 inches, 7 lbs

B. Physical changes in mother

• extreme size of uterus puts pressure on internal organs
• indigestion common
• large blood volume in heart
• back pain
• pelvic joints separate and change posture
• Braxton-Hicks contractions: strengthen uterine muscles
• weight gain 9-12 lbs

C. Psychological change

• increased stress
• impatience
• anxieties about birth and delivery

D. Sexual activity

• declines throughout trimester
• Risk of orgasm in last month not clear

IV. Prenatal care

• Nutrition
• Exercise
• Teratogens
  • alcohol - Fetal alcohol syndrome
  • cigarette smoking
  • drugs - legal and illegal
  • Diseases -
    • Rubella (Geman measles)
    • Toxoplasmosis (undercooked meat or exposure to contamination with cat droppings
  • Other - radiation or excessive heat
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CHILDBIRTH

I. Process of childbirth

A. Labor, or parturition

1. First stage of labor

• 1st birth: last 8-18 HR
• Later births: 4-8 HR
• initial uterine contractions are short and mild every 10-20 mins
• Frequency, intensity, duration increase
• Final contractions may be painful.

2. Late stage one, transition stage

• cervix completes dilation
• cervix stretches over baby's head
• contractions: 60-90 secs. long every 2-3 mins.
• phase lasts 30-60 mins.

3. 2nd Stage

cervix fully open

baby moves into vagina (crowning)

duration: 50 mins. in first delivery; 20 mins. in later ones

4. 3rd stage

uterine contractions stop briefly following birth

placenta and afterbirth are expelled

C. Episiotomy

1. incision through skin and muscles in the perineum-performed in 2/3 of US births

D. C-section, cesarean section

1. fetus is delivered through a horizontal incision in abdominal and uterine walls

2. advisable when

• fetus in improperly aligned
• multiple fetuses
• fetal distress
• mother has an active herpes type II infection

II. Types of delivery process

A. Bradley and Lamaze methods - couple learns about birthing process and various breathing and relaxation techniques

B. Managed childbirth - labor is controlled by practitioner at hospital or clinic or birthing center

C. Home birth -physician or certified nurse-midwife should be present

D. Leboyer approach - put baby in warm bath after delivery

A. Bonding

B. Post-partum emotions

1. 80% experience post-partum "blues"

2. 10% experience post-partum depression

C. Breast-feeding

1. Advantages of breast milk

• contains essential nutrients
• contains disease fighting antibodies
• may prevent diarrhea
• readily available, clean and right temperature

2. Advantages of bottle-feeding

• working mothers
• unpleasant for some women
• difficult for some women

3. bonding with infant can happen either way.

IV. Prenatal diagnostic tests

A. Amniocentesis

• Amniotic fluid is sampled with a needle
• 16-18 wks; cells cultured for 4 wks
• detects chromosomal abnormalities, and child's sex

B. Chorionic villus sampling (CVS)

• 4 wks; few days for culture
• also detects chromosomal abnormalities, and child's sex
• no longer associated with high miscarriage rates

C. Ultrasonography

• high frequency, ultrasound waves
• fetal age, position, viability, multiple pregnancies, child's sex

D. Alpha-fetoprotein (AFP) screening

• maternal blood test
• neurological problems (hydrocephalus, spina bifida, Down syndrome)

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