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Outcomes Pregnancy and Childbearing
N-350
1.
2.
3.
4.
Describe conception and the process of cell division after fertilization
Discuss hormonal and fetal changes during pregnancy
Discuss the physiologic effects of pregnancy
Discuss nutritional and weight gain recommendations for pregnancy and exercise
concern during pregnancy
5. Explain the detrimental effect of smoking, alcohol, drugs, and various environmental
risks on pregnancy.
6. Discuss techniques for pre-natal testing and complications of pregnancy.
7. Discuss significant issues surrounding childbirth preparation, labor and delivery,
cesarean section (C-section), and vaginal birth after cesarean section.
8. Discuss the physiological changes of the breast for breastfeeding.
9. Discuss the benefits and complications associated with breastfeeding.
10. Discuss the trends in breastfeeding.
11. Understand postpartum physical and psychological changes
12. Describe the difference between postpartum blues and postpartum depression
13. Define the concepts of fecundity and infertility.
14. Discuss the causes and diagnosis of infertility, including assisted reproductive
technologies.
15. Discuss the emotional effects of infertility.
16. Discuss the prevalence of infertility, its major causes, and the types of treatments
used.
PREGNANCY AND
CHILDBIRTH
Wendy Bonnar WHNP-BC, MSN
N-350
Part One
Introduction
• Over the past 250 years, childbirth changed from
a domestic responsibility to a medical procedure.
• Today, many mothers are choosing to once again
take a more active role in making birth-related
decisions.
• In addition to the obvious biological aspects,
pregnancy and childbirth are greatly influenced
by social, cultural, historical, legal, and ethical
dimensions.
Preconception Care
Preconception care: The steps that a woman
can take before she decides to become
pregnant to ensure that she is in good health
when conception occurs
Folic acid
Proper immunizations
Healthy behaviors
Nutrition
Preconception Care
• If a woman has medical conditions such as lupus,
diabetes, high blood pressure etc. it is a good idea to
consult with and obstetrician before conceiving.
• Certain medical conditions can require work up such
and blood and possibly imaging.
• Women who are obese have an increased risk of
genetic disorders as well as diabetes and
hypertension.
• Obesity is a modifiable risk factor.
• Women who are obese should consult with their
doctor before attempting pregnancy
Key Components
Pregnancy and Conception
• Pregnancy is approximately 280 days from last
menstrual period.
• Conception or fertilization is the union of the male
sperm and female ovum.
Pregnancy
23 chromosomes from sperm +
23 female chromosomes from egg =
46 chromosomes total = ZYGOTE
Phases of Prenatal Development
• Period of the zygote: conception through
implantation
• Period of the embryo: 3rd-8th week, organ
formation, heart beat
• Period of the fetus: 9th week-birth, Rapid
growth, tissue differentiation & organ
formation.
Phases of Prenatal Development
• First 8 weeks: Known as embryo
• 9 weeks to birth: Known as fetus
Early Signs of Pregnancy
Early signs of pregnancy often occur within the
first 6 weeks
• Missed period(s)
• Breast swelling/tenderness
• Fatigue
• Queasiness or nausea/vomiting
• Elevated body temperature
• Mood swings
• Frequent urination
Confirming Pregnancy
• Pregnancy Tests: Test for Human Chorionic
Gonadotropin (hCG), produced by the developing
embryo.
• Home urine pregnancy tests available
• Digital and non-digital
Confirming Pregnancy
• Other Ways To Confirm Pregnancy:
• Clinical pregnancy test
• Performed by clinician
• Urine or blood tests
• Pelvic examination
Hormonal Changes
Fertilization

Follicle-stimulating hormone (FSH) and
luteinizing hormone (LH) produced by the
anterior pituitary gland are suppressed

Pregnancy-specific hormones increase
Implantation

Embryo cells secrete hCG

hCG stimulates corpus luteum to secrete
estrogen and progesterone
Physical and Emotional Symptoms
First trimester
• Enlarged and tender breasts
• Morning sickness (nausea and/or vomiting)
• Extreme fatigue
• Decreased interest in sex
• Moodiness and irritability
• Darkening of nipple and areola
Physical and Emotional Symptoms
Second trimester
• Morning sickness subsides
• Gastrointestinal problems (heartburn, gas,
constipation)
• Gain majority of weight (12–14 pounds)
• Breathing problems
• Backache
• Leg cramps and numbness/tingling of hands
• Swollen and bleeding gums
• Swelling of feet, hands, and ankles
• Braxton-Hicks contractions
Physical and Emotional Symptoms
Third trimester
• Heartburn and constipation
• Leg cramps
• Backache
• Breathlessness
• Braxton-Hicks contractions
•  Leukorrhea
•  Colostrum
• Hemorrhoids
• Pelvic and buttock discomfort
• Itchy abdomen
Fetal Development
Fetal Development
Terms
• Amnion: Fetal sac that envelops the embryo
• Amniotic fluid: Provides protection and
constant environment for floating embryo
• Placenta: Supplies fetus with oxygen and
nutrients from maternal bloodstream and filters
waste back to mother for disposal
Fetal Growth
Fetal
Month
Length
(in inches)
Weight
(in ounces)
1
1/10-1/4
1/7
2
1.2
1/6
3
2-3
1/ 2
4
4-5
2-4
Fetus Approximately 9
Weeks
Fetal Growth
Fetal
Month
Length
(in inches)
Weight
(in pounds)
5
6.5-10
0.75-1.4
6
10-11.5
2.1
7
14-15
2.5-3
8
15-17
4-4.5
Fetus – Near Term
9
16-22
6-9
Calculating Due Date
Naegeles Rule
• The EDD (estimated date of delivery) or EDB (estimated date of
birth) is usually calculated from the menstrual history.
How to calculate:
1. The calculation begins with the First day of the last
menstrual period
2. From this date, go back 3 months
3. Add 7 days to the last date
Example:
1. First day of last menstrual period = March 12.
2. Go back 3 months from March 12 = December 12.
Prenatal Care- Nutrition
• Consume additional 100
calories/day during 1st
trimester
• Consume additional 300
calories/day 2nd- 3rd trimester
• Folic acid
• Calcium
• Iron
• Increase fluid intake
• Weight gain: Average 25–35
pounds total for a normal
weight woman
Exercise
Benefits
• Feel better throughout
trimesters
• Shorter labor
• Quicker recovery
Forms
• Swimming
• Walking
• Low-impact aerobics
• Kegel exercises
Avoiding Toxic Substances
Cigarette smoking
• 13% of women smoke during pregnancy
• Complications
• Lower birthweight
• Physical and mental problems for infants
• Infertility
• Spontaneous abortions (miscarriages)
• Ectopic pregnancies (pregnancies outside the uterus)
• Placental irregularities and intrauterine growth
retardation
• Increased risk of SIDS
Avoiding Toxic Substances
Alcohol
• Especially risky in 1st trimester
• Fetal alcohol syndrome (FAS)
–Growth retardation
–Facial malformations
–Central nervous system dysfunction
–Mental retardation
• Increased risk of stillbirth
Avoiding Toxic Substances
• The fetus is especially vulnerable during the first
trimester of pregnancy, when development of the
central nervous system occurs.
• During this vulnerable period, alcohol-associated
effects on the infant may be more closely related
to peak blood ethanol levels in the mother than to
overall consumption throughout the pregnancy.
Avoiding Toxic Substances
• Because no specific level of alcohol has been
identified as causing FAS, women are advised to
abstain completely from alcohol consumption
throughout pregnancy.
Avoiding Toxic Substances
Other drug use
• OTC medications—physician should be consulted
before use
• Marijuana use—causes smaller, sicker babies; higher
risk of stillbirths; crying and trembling in infants
• Cocaine use—increases risk of premature birth,
stillbirths, and malformations; lower birthweight; smaller
head circumference; shorter in length; infant feeding
difficulties and sleep disturbances
• Heroin—risk of miscarriage, premature delivery,
stillbirth, poor fetal growth; withdrawal symptoms at
birth; increased risk of SIDS
Rubric for Turitin Assignments
Grammar/spelling/punctuation/paragraph structure: 3 points
Correct citation: Correct citation with in the paragraph and correct reference citation:2
points
Reference w/in 5 years from a professional journal, website, or textbook:2 points
Must be at least 300 words: 3 points
201-299
2 point
150-200 words
1 point
Less than 150 words
0 points
1. Your word count should be 300 points, without headings, references etc. In
other words, the paper itself needs to be 300 words minimum.
2. When handing in an assignment you do not need a cover page. Type your response
in the space provided.
3. We need to be able to verify references. If there is an error message or a log in page
points will be taken off. Do not cite a URL for the library for a particular article. It will only
show a log in page when accessed. If your reference is from a library you need to
download the article and attach it to the post.

Be careful copying and pasting URL’s and DOI’s. Make sure you have done so
correctly.
4. When you are citing your textbook with in the paper you need to cite it completely.
Saying “the text” or “our text” is unacceptable. The year of publication needs to be
stated after the authors regardless of the source you are using, in other words any book
not just your text.
5. Use your APA resources in course documents, and look at Guidelines for Written
Work in your syllabus.
6. These are some UNACCEPTABLE references: Forb’s Magazine, Time Magazine,
Men or Women’s fitness, Newsweek, New York Times, any other lay newspaper or
magazine, in print or online. Television stations and T.V. news outlets. ANY Blog, any
source that is used for advertising.

If you are unsure email the instructor.

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