Reproductive System - Male

Scope: Lecture Twenty-Five is the first of three lectures on the reproductive system. This lecture
examines the gross anatomy of the male reproductive system. The scrotum contains the testes,
which produce spermatozoa through the process of spermatogenesis. A series of tubules and ducts
lead the sperm and fluids into the epididymis, where the sperm matures and gains motility. From
there, the sperm passes through the vas deferens to the ejaculalory duct. The lecture also reviews
the functions of the prostate and Cowper's glands, the process of erection and ejaculation, and the
composition of the semen.
I. The major functions of the male reproductive system include the production, storage, and delivery
of spermatozoa and the production, storage, and release of male sex hormones.

II. Embryology

A. External sex organs

1. Five-week-old embryos have undifferentiated sex organs: the genital tubercule, the glans, the
urethral folds, the labioscrotal swelling, and the beginning of the perineum.
2. At 10 weeks, some differentiation has taken place in the glans and the urethral folds and the
perineum has connected to the anus.
3. Just before birth, the sex organs have completely differentiated.
4. In hypospadias, the urethra does not connect to the bladder. This is generally surgically
corrected at birth.

B. Internal sex organs

1. In the undifferentiated stage (5-10 weeks), the gonads, paramesonephric duct, and
mesonephric duct are not developed enough to determine sex.
2. The testes, epididymis, mesonephric duct (later the spermatocord), and prostate then develop in
the male. The mullerian duct degenerates in the male and eventually develops into the fallopian
tubes in the female.
3. Just before birth, the testes descend into the scrotum in the male and the prostate develops.
The sex organs descend in the female as well but remain internal.
C. Hermaphroditism is the development to some degree of both sets of sex organs; it is caused by
chromosomal abnormality.

III. Gross anatomy

A. Scrotum (”bag”)
1. The scrotum holds the testes.
2. The superficial fascia (dartos) under the skin can contract and wrinkle the scrotum, drawing it
nearer the body for warmth.
3. Sperm production is best at about 3 degree Fahrenheit below body temperature.

B. Testes (testicles)
1. The testes develop in the abdomen and descend into the scrotum through the inguinal canal.
2. Failure to descend is called cryptorchidism.
a. This condition, if uncorrected, can lead to sterility.
b. It also increases chances of testicular cancer.
c. It can be corrected by hormone injection (human chorionic gonadotropins) or surgery.
3. Spermatogenesis is the production of spermatozoa in seminiferous tubules, beginning at
puberty.
4. The spermatocord migrates from a retroperitoneal position down through the inguinal canal to
the testes. It contains the pampiniform plexus, the veins of which can swell and suppress sperm
production.
 5. The cremaster is an involuntary muscle that pulls the testes closer to the body for warmth.

C. Ducts
1. The flow of sperm and fluids goes from the seminiferous tubules (tortuous) to the straight
tubules.
2. Rete (network) testes receive fluid and sperm from the straight tubules.
D. Epididymis
1. Efferent ducts lead sperm into epididymis.
2. Sperm matures here for about 2 weeks.
3. Motility increases.
4. The epididymis contains smooth muscle to propel sperm along.
E. Vas deferens (ductus deferens)
1. The vas deferens leads from the epididymis to the prostate.
2. It enters the inguinal canal and penetrates the peritoneal cavity at the inguinal ring.
3. Vas deferens ends in the ejaculatory duct.

F. Spermatogenesis consists of the following stages:

1. Leydig cells (interstitial endocrine cells) secrete testosterone.
2. Spermatogenic cells are the stem cells from which all other cells arise. They mature in the
basement membrane. They are 2N (or diploid; they have the chromosomes of both the mother
and father).
3. The spermatogonia (diploid) move upward and become the primary spermatocytes.
4. The primary spermatocytes divide into secondary spermatocytes (1N, or haploid; they have only
one set of chromosomes).
5. Spermatocytes develop into spermatids connected by the cytoplasmic bridge.
6. Spermatozoa (mature sperm cells; haploid) gradually move from the seminiferous tubules to the
duct lumen as they mature.
7. Spermatogenesis takes 2-3 months. Sertoli cells (sustentacular cells) nourish the developing
spermatozoa.

G. Chromosomes
1. There are 23 pairs of chromosomes.
2. Chromosome 23 has X and Y variants; these are the sex chromosomes.
3. Having three copies of chromosome 21 (trisomy 21) is commonly known as Down syndrome.
4. Spermatogonium divide in a process called mitosis into daughter cells (diploid) and primary
spermatocytes (diploid).
5. DNA replication and random crossing over (between chromosome pairs) mix chromosomal
material to create a new set of chromosomes.
6. In meiosis, primary spermatocytes divide into secondary spermatocytes, each with only one set
of chromosomes (haploid).
7. Extra chromosomal material in cells always causes problems in embryo development.

H. Sperm cells
1. The sperm cell head is pointed to penetrate the egg.
2. The nucleus contains one set of chromosomes.
3. The cell is also full of mitochondria.
4. The tail (flagellum) whips back and forth to propel the sperm out of the body.
5. Motility increases as sperm cells mature.

I. Seminal vesicles
1. The seminal vesicles secrete fluids that nurture and protect the spermatozoa.
2. The ultimate fluid coating, semen, neutralizes the acidity of the female vagina and protects the
sperm.
3. Prostaglandins increase sperm motility.
J. Ejaculatory duct
 1. The ejaculatory duct is formed by the junction of the vas deferens and the seminal vesicles.
2. It forces sperm out into the urethra during ejaculation.

K. Prostate gland
1. The prostate gland lies at the base of the bladder at the outlet for the urethra; it acts like a hand-
warming muff.
2. The ejaculatory duct enters the urethra in the prostate gland.
3. Its secretions help sperm motility and longevity.
L. Cowper's glands
1. Cowper's glands are paired just below the prostate.
2. They secrete a fluid to neutralize the acid environment of the urethra (which is acidic to deter
bacterial growth).
3. Mucous secretion buffers the sperm against injury during ejaculation.
M. Because individual sperm have little chance of survival, each ejaculation contains a million or more
spermatozoa. Also, no single sperm contains enough of the enzyme necessary to penetrate the egg;
thus, many sperm can pool this enzyme.

N. Penis
1. The penis functions as a conduit for urination and ejaculation of semen.
2. The main components of the shaft are:
a. Paired corpora cavernosa, which are spongy collections of pockets that fill with blood
during erection.
b. A single ventral corpus spongiosum.
c. The urethra runs through the corpus spongiosum.
d. Arteries, veins, and nerves.
e. Prepuce (foreskin); the need for circumcision is still hotly debated.

Reproductive System - Female

Scope: This lecture reviews the female reproductive system. We begin by reviewing the anatomy of
the external female genitalia, the vagina, the uterus, the fallopian tubes, and the ovaries. Next we
consider the physiology of the menstrual cycle, fertilization, and early pregnancy. Finally, we examine
the anatomy and physiology of the breast, the various risk factors for breast cancer, and its
treatments.

I. Genitalia
A. The vulva (volvere = "to wrap around") is also called the pudendum.
1. The prepuce covers the clitoris. Its analog in the male is the foreskin.
2. The clitoris is sensitive to stimulation. Its analog in the male is the glans.
3. Labia majora ("large lips")—-the analog in the male is the scrotal skin and hair.
4. The labia minora ("small lips") secrete oil.

5. The vestibule is located between the labia minora.

a. Hymen
b. Vaginal orifice
c. External urethral orifice
d. Skene's (paraurethral) glands secrete mucous. Their analog in the male is the
prostate.
e. Bartholin's (greater vestibular) glands secrete mucous during intercourse. Their
analog in the male are the Cowper's glands.

B. The mons pubis is a deposition of fat that cushions the pubic bone.
C. The urinary bladder is a wholly extraperitoneal organ that resides in the vesico-uterine pouch.
D. All female reproductive organs, however, are intraperitoneal.

E. The cervix is extraperitoneal (intra-vaginal) and provides easy clinical access to the uterus for
examination or removal.
F. The rectum and bladder are separated in the female by the uterus.
G. Fistulas can form between the bladder and vagina or the rectum and vagina, leading to
inflammation and infection.
H. The vermiform appendix lies almost directly above one ovary. Pelvic inflammatory disease
(tubo-ovarian abscess) causes infections of the tubes and ovaries that can be confused with
appendicitis.

I. The vagina is the conduit for spermatozoa during intercourse.

1. It functions as the birth canal during delivery.
2. It is a potential space, with great elasticity.
3. Its walls are composed of smooth muscle.
4. It has an acid environment to inhibit the growth of bacteria.
5. The cervix of the uterus protrudes into the vaginal vault.

J. The uterus is the conduit for sperm to reach the ovum in the fallopian tube.
1. It is the cradle for development of the fertilized ovum (zygote).
2. It has the following three anatomic sections:
a. Fundus—the superior portion.
b. Corpus— the body and midsection.
c. Cervix—the "neck" protruding into the vagina.
i. The cervical os is the opening of the cervix.
ii. There is a mucous plug in the opening except during the fertile period.

3. The endometrium is the lining of the uterus that covers the muscles.
4. The myometrium is the muscular lining of the uterus.
5. Uterine pathology
a. Uterine cancer is cancer of the endometrium.
b. Fibromas (leiomyomas) are benign tumors of the uterine wall that cause
problems because of their size.
c. Uterine prolapse is excessive downward movement of the uterus, generally
because of age.
d. Cervical cancer (human papilloma virus) is a common sexually transmitted viral
disease.

K. The fallopian tubes are the active conduit for the ovum to reach the uterus.
1. The fallopian tube is the site of fertilization of the ovum about 24 hours after ovulation.
2. It has the following three anatomic parts:
a. Infundibulum—a fimbriated ("fingerlike") opening that swirls to suck the ovum into
the tube when expelled from the ovary into the peritoneal cavity.
b. Ampulla—the mid-portion and widened part.
c. Isthmus—a narrowed portion leading to the uterus.
3. Smooth muscle and cilia propel the ovum distally.
4. The fertilized ovum spends about 1 week in the tube in transit.
5. In a scarred or damaged tube, pregnancy can take place in the tube (ectopic
pregnancy), which can lead to tubal rupture and life-threatening bleeding.

L. The ovaries bear all the precursor ova.

1. Primordial follicles develop into primary follicles that contain oocytes at various stages of
development.
2. Follicular cells nurture the developing oocyte (estrogen).
3. The graafian follicle is the mature follicle at the last stage of oocyte development from
 which the mature ovum emerges.
4. Graafian follicles rupture and release eggs into the fallopian tube. This can sometimes
also release drops of blood into the peritoneal cavity, causing mittelschmerz (abdominal
pain in the middle of the menstrual cycle) for a few hours.
5. Corpus luteum ("yellow body") remains after ovulation and is the source of estrogen,
progesterone, relaxin, and inhibin.
6. Corpus albicans ("white body") is the remains of degenerating follicle.

II. Physiology of menstruation

A. The cycle begins with the first day of bleeding (menses = "month").
B. Menstruation occurs in three phases.
1. The menstrual phase lasts about 5 days.
a. Uterus: Mainly menstrual bleeding.
b. Ovaries: Several secondary follicles begin to mature in both ovaries.
2. The preovulatory phase has the most variable duration, between the end of
menstruation and ovulation.
a. Ovaries: Follicular phase. FSH (follicle-stimulating hormone) stimulates
continued growth of secondary follicles. Only one continues to develop and
becomes a graafian follicle. Migration to surface up to rupture of follicle into
peritoneum. LH (luteinizing hormone) increases at this time.
b. Uterus: Proliferative phase. Endometrium is repaired and arterial supply
increases under estrogen stimulation. Preparation for arrival of fertilized ovum.

3. Ovulation
a. Ovaries: Rupture of graafian follicle and release of ovum. LH peaks just prior to
ovulation; home tests depend on this to predict ovulation 24 hours later.
b. Uterus: Secretory phase. First estrogen, then estrogen and progesterone,
continue to prepare the endometrium to receive the fertilized ovum. Arterial
supply is very rich.
4. The postovulatory phase lasts 14 days and is fairly consistent. Estrogen and
progesterone decline and cause ischemia to the endometrium, which dies and sloughs
off.
5. Birth control pills mimic pregnancy by maintaining high levels of estrogen and
progesterone, which signal the uterus not to release any eggs. This prevents
superfecundation (multiple fertilized eggs), which can lead to spontaneous abortion in
humans.

III. Physiology of fertilization and early pregnancy.

A. Fewer than 1% of the sperm reach the ovum.
B. Fertilization occurs in the fallopian tube 12-24 hours after ovulation.
C. Conception
1. Sperm are viable for 48 hours after ejaculation.
2. The ovum is viable for 24 hours after ovulation.
3. The theoretical window for conception is 36 hours.
D. Cleavage of the fertilized egg produces a two-celled conceptum and then, by the fourth day, the
morula, which has hundreds of cells.

E. The blastocyst, a spear of cells with a hollow center, develops on the fifth day; by the end of the
first week of pregnancy, it has implanted itself into the uterine wall.
F. If the uterine wall is not ready for the blastocyst, the cell mass will be rejected through a normal
menstrual process (missed abortion).
G. The blastocyst and endometrium develop two-layer walls around the seventh day.
H. The implantation process continues to develop layers of tissue and a separate circulatory
system for the embryo.
I. The developing placenta grows a network of capillaries that will eventually exchange blood
 between the mother and embryo.
J. In early development, the placenta exchanges only gases, nutrients, and waste because of
possible differences in blood type between the mother and embryo.
K. Toward the end of pregnancy, the placenta begins to age and can mix the different blood types.
If the blood types are incompatible, problems such as neonatal jaundice can occur.

IV. The breast is technically an organ of reproduction because of its role in nurturing the newborn.
A. The breasts are also called mammary glands.
B. They are actually modified sweat (apocrine) glands capable of secreting milk.
C. Anatomy
1. The basic structural unit is the lobule.
a. The lobule is composed of alveoli lined with secretory cells.
b. Several lobules make up a lobe.
c. There are 15 -20 lobes in each breast.
2. The lobes drain into ducts lined with epithelium. The duct system converges into 6-8
terminal ducts in the nipple.

3. Nipple
a. The nipple is surrounded by areola, which contains smooth muscles that eject
the milk.
b. Ducts empty through the nipple and areola.
4. The breast contains ligaments that support it and is divided into primarily breast tissue
and fat. The amount of fat increases as the body ages.
5. The male breast is similar to the female breast but lacks the ability to secrete milk.
6. Men can get ductal breast cancer, whereas women get both lobular and ductal cancers.
Because of differences in hormones, the male-to-female breast cancer ratio is
approximately 1:100.

D. Physiology and pathology

1. Milk letdown (lactation)
a. Lactation is controlled by oxytocin from the posterior pituitary.
b. Prolactin, estrogen, and progesterone are involved in milk production.
2. Breast cancer
a. Breast cancer is the number-one cancer in women, but it is highly curable if
detected early.
b. It also occurs in men with a similar clinical course.

Pregnancy

A. Fertilization
1. Conception (fertilization)
a. Definition: union of sperm and ovum
b. Conditions necessary for fertilization
1. Maturity of egg and sperm
2. Timing of deposit of sperm
a. Lifetime of ovum is 24 hours
b. Lifetime of sperm in the female genital tract is 72 hours
c. Ideal time for fertilization is 48 hours before to 24 hours after
ovulation
d. Menstruation begins approximately 14 days after ovulation
3. Climate of the female genital tract
a. Vaginal and cervical secretions are less acidic during ovulation
(sperm cannot survive in a highly acidic environment)
 b. Cervical secretions are thinner during ovulation (sperm can
penetrate more easily)
c. Process of fertilization (7-10 days)
1. Ovulation occurs
2. Ovum travels to fallopian tube
3. Sperm travel to fallopian tube
4. One sperm penetrates the ovum
5. Zygote forms (fertilized egg)
6. Zygote migrates to uterus
7. Zygote implants in uterine wall
8. Progesterone and estrogen are secreted by the corpus luteum to maintain
the lining of the uterus and prevent menstruation until placenta starts
producing these hormones; (note: progesterone is a thermogenic hormone
that raises body temperature, an objective sign that ovulation has occurred)

d. Placental development
1. Chorionic villi develop that secrete Human Chorionic Gonadotropin (HCG).
which stimulates production of estrogen and progesterone from the corpus
luteum (production of HCG begins on the day of implantation and can be
detected by the sixth day)
2. Chorionic villi burrow into endometrium, forming the placenta
3. The placenta secretes HCG, human placental lactogen (HPL), and (by
week three) estrogen and progesterone
e. Fetal membranes develop and surround the embryo, fetus
1. Amnion: inner membrane
2. Chorion: outer membrane
3. Umbilical cord
a. Two arteries carrying deoxygenated blood to placenta
b. One vein carrying oxygenated blood to fetus
c. No pain receptors
d. Encased in Wharton’s jelly
e. Covered by chorionic membrane

f. Amniotic fluid
1. Production origins
a. Maternal serum during early pregnancy
b. Fetal urine in greater proportion during latter part of pregnancy
c. Replaced every 3 hours
d. 800-1,200 ml at end of pregnancy
2. Functions
a. Protection from trauma and heat loss
b. Facilitates musculoskeletal development by allowing for movement
of the fetus
c. Facilitates symmetric growth and development
d. Source of oral fluid for fetus
g. Placental transfer of material to and from the fetus
1. Diffusion across membrane (for example: gases, water, electrolytes)
2. Active transport via enzyme activity (for example: glucose, amino acids,
calcium, iron)
3. Pinocytosis: minute particles engulfed and carried across the cell (for
example: fats)
4. Leakage: small defects in the chorionic villi cause slight mixing of maternal
and fetal blood cells
5. Nutrients and wastes are exchanged in the placenta, but the blood does
not intermingle
 B. Fetal Development
1. Pre-embryonic: first two weeks
2. Embryonic: three to seven weeks
3. Fetal: eight to 40 weeks
a. Full term: 38 to 42 weeks
b. Preterm: less than 38 weeks
c. Post-term: more than 42 weeks
C. Terminology
1. Gravida

a. Definition: number of times pregnant, including present pregnancy

b. Variations: primigravida, multigravida
2. Para

a. Definition: number of pregnancies delivered after the age of viability, whether born
alive or dead
b. Variations: nullipara, primipara, multipara
2. Five-digit system
a. G: gravida
b. T: term infants
c. P: preterm
d. A: abortions
e. L: living

Signs of Pregnancy

1. Presumptive (subjective)
a. Amenorrhea: missed periods
b. Nausea and vomiting: morning sickness, probably due to HCG; usually lasts about 3
months
c. Fatigue: first trimester
d. Urinary frequency: caused by enlarging uterus pressing on bladder
e. Breast changes: tenderness and tingling, nipples pronounced, full feeling, increased size,
areola darker
f. Quickening: mother’s perception of fetal movement around 16-18 weeks: fluttering
sensation

2. Probable (objective)
a. Chadwick's sign: bluish coloration of the mucous membranes of the cervix, vagina, and
vulva
b. Goodell's sign: softening of cervix; occurs beginning of the third month
c. Hegar's sign: softening of the isthmus of the uterus, between the body of the uterus and
cervix; occurs about the sixth week
d. Enlargement of abdomen: uterus just above symphysis at 8-10 weeks; at umbilicus at 20-
22 weeks
e. Braxton-Hicks contractions: painless contractions occurring at irregular periods throughout
pregnancy; felt most commonly after 28 weeks
f. Uterine souffle: soft blowing sound; blood flow to placenta same rate as maternal pulse
g. Pregnancy test positive: HCG in serum and urine
h. Ballottement: can push fetus and feel it rebound
i. Pigmentation changes: increased pigmentation, chloasma, linea nigra, and striae
gravidarum
3. Positive
a. Fetal heartbeat: by Doppler at 8-10 weeks
b. Fetal movements: felt by examiner
 c. Fetal outline: on sonogram

D. Assessment of Date of Delivery

1. Nagele's rule: first day of last menstrual period (LMP) minus three months plus seven
days; in most cases, add one year
2. Other parameters: fundal heights, quickening, sonograms

ADAPTATIONS TO PREGNANCY
ADAPTATIONS TO PREGNANCY TRIMESTER INTERVENTIONS
G.I:

- Nausea/vomiting 1 - Small frequent meals; eat

crackers or dry toast before
getting up in the morning; eat dry
meals; drink liquids between
meals
- Constipation,flatulence and heartburn 2, 3 - Exercise; increase fluid and fiber
in diet; stool softeners if
recommended by physician
- Use soft toothbrush for dental
- Bleeding gums 2, 3
care
- Gallstones 2, 3
- Avoid fatty foods
- Heartburn 2, 3
- Small frequent meals; avoid
spicy, fatty foods; no sodium
bicarbonate as antacid; antacids
as recommended by physician
Urinary Tract: 1, 3 - Void when first urge felt; wear a
- Frequency during first and third pad if leaking
trimester due to pressure on bladder 2, 3
- Increase fluid intake
- Glomerular filtration rate (GFR)
increases (glycosuria)
- Increase in urinary infections
Breasts: 1 - Wear good supportive bra
- Increase in size and nodularity, striae
1
- Tenderness and tingling
2
- Hypertrophy of Montgomery tubercles
2
- Darkening of areola
2, 3
- Colostrum secreted
Vagina: 1, 2, 3 - Report itching and burning to
- Epithelium undergoes hypertrophy and physician
hyperplasia 1
- Increased vascularity - Promote cleanliness by bathing
daily; avoid douching; avoid nylon
- Increased pH; good for growth of
undergarments
Candida (thrush)
- Increase in discharge; leukorrhea is
common
Respiratory System:
- Increase in volume of up to 40-50%
between 16th-34th week
- Diaphragm is pushed upward; ribcage
flares out; breathing changers from    
abdominal to chest
- Increase in oxygen consumption by
15%

ADAPTATIONS TO PREGNANCY

ADAPTATIONS TO PREGNANCY TRIMESTER INTERVENTIONS

Respiratory System (continued)
- Stuffiness, epistaxis, and changes in
voice occur as a result of increase 1 - Cool moist air may help; avoid
estrogen levels over-the-counter decongestants
- Dyspnea 3 and sprays
- Proper posture; sleep with head
propped up
Skin:
- Areola darkens
- Abdominal striae, linea nigra
- Diaphoresis
- Chloasma; mask of pregnancy 2, 3 Daily bathing; powder
- Vascular spider nervi; chest, neck,
arms, and legs
Metabolism/Nutrition:
- Basal metabolic rate increased by
20%
- Water retention; edema 2, 3 - Elevate legs and feet when
sitting; avoid prolonged standing;
do not wear garters or clothing
with restrictive bands around the
legs; avoid crossing legs at knees
- Weight gain; 20-25 lbs
recommended
- Adequate protein intake, especially
for teens
- Increase iron during last eight weeks 2, 3 - Eat well-balanced diet
- Pica: craving for nonnutritive
substance
 Perineum:
- Increased vascularity
- Venous congestion of the perineum
2, 3 - Kegal exercises
Cardiovascular:    

- Cardiac output increases by 30%

- Blood volume progressively
increases and peaks around 30-40
weeks at 47% above pre-pregnant
state
- Plasma volume increases greater
then RBC and hemoglobin, resulting in
"pseudo anemia"
- Pulse rate increases by 10-15
beats/minute; BP drops slightly in
second trimester due to peripheral
dilatation effects of progesterone;
returns to normal by third trimester

ADAPTATIONS TO PREGNANCY

ADAPTATIONS TO PREGNANCY TRIMESTER INTERVENTIONS

Cardiovascular (continued)
- Varicose veins may develop
2, 3 Elevate legs; avoid standing for
long periods of time; avoid
constrictive clothing
Uterus:    
- Growth is influenced by estrogen
- 500 - 1,000 fold increase in capacity
- Cervical secretions form mucus
plug
Endocrine:
- Increase in size and activity of
thyroid
- Increase in size and activity of
anterior lobe of pituitary
- Increase in size and activity of
adrenal cortex Pelvic rock; good body
2, 3
- Increase in production of relaxin mechanics; supportive shoes
causes joint and back pain.

Teratogen

1. Definition: nongenetic factor producing malformations of the fetus; greatest effect on those cells
undergoing rapid growth, thus time is important
 2. Types
a. Chemical agents (for example: insecticides)
b. Radiation
c. Drugs: for example: alcohol, tetracycline (Sumycin), chemotherapeutic agents, phenytoin
(Dilantin), narcotics, nicotine, megavitamins, warfarin (Coumadin), lead, lithium,
carbamazepine (Tegretol), and mercury
d. Bacteria and viruses
1. Syphilis
a. Spirochete does not cross placenta until after 18th week; treat as soon as
possible; can treat later since penicillin does not cross placenta
b. Can cause late abortions, stillbirths, and congenitally infected infants
2. Gonorrhea: causes injury to eyes at birth (ophthalmia neonatorum)

3. T.O.R.C.H.- severe effects on the fetus

a. Toxoplasmosis: protozoan contracted by ingesting raw meat or feces of infected animal
(for example: cats); pregnant women should not change cat litter boxes
b. Rubella: first trimester most serious; causes congenital heart problems, cataracts, hearing
loss; clients cannot receive the rubella vaccine during pregnancy as it is a live virus; if they
receive the immunization in the post-partum period, they must understand that they
should not become pregnant for at least three months
c. Cytomegalovirus (CMV): member of the herpes family; causes congenital and acquired
infection; principal organs affected: liver, brain, and blood
d. Herpes simplex virus, Type 2 (HSV-2)
1. Transmitted to infant vaginally in intrauterine cavity or during delivery; do not
deliver vaginally if active lesions are present
2. Affects blood, brain, liver, lungs. CNS, eyes, skin
3. Perinatal mortality: 96%; 50% of survivors have neurological or visual
abnormalities
4. Chlamydia: causes conjunctivitis and pneumonia in the newborn
5. AIDS
a. Transmitted via breast milk
b. 30% chance of transmission in utero or during deliver
c. Treatment of mother with zidovudine (AZT) while pregnant can reduce chance of
transmission to fetus to approximately 8%

Emotional and Psychological Adaptations to Pregnancy

Development Tasks of Pregnancy

1. First trimester: accept the biological fact of pregnancy; it is common to feel ambivalent early in
pregnancy
2. Second trimester: accept growing fetus as a baby to be nurtured
3. Third trimester, prepare for the birth and parenting of the child

Prenatal Care

A. Assessment
1. Complete history
2. Lab work: complete blood count (CBC), blood type and Rh, Rubella, VDRL/FTA-
ABS/RPR, hepatitis B surface antigen, HIV antibody (with client's consent), alpha fetal
protein (AFP)
3. Vital signs, weight, urine test for protein and glucose
4. Physical exam: fundal height, fetal heart rate (FHR), fetal activity
5. Internal exam
a. Adequate pelvic outlet, signs of pregnancy (First visit)
 b. Cervical changes, especially in last weeks (for example: "ripe cervix")
c. Vaginal smear for Neisseria gonorrhea, chlamydia, group B strep, human
papillomavirus (HPV) cultures, and pap test
6. Psychosocial assessment

Pregnancy

A. Fertilization
1. Conception (fertilization)
a. Definition: union of sperm and ovum
b. Conditions necessary for fertilization
1. Maturity of egg and sperm
2. Timing of deposit of sperm
a. Lifetime of ovum is 24 hours
b. Lifetime of sperm in the female genital tract is 72 hours
c. Ideal time for fertilization is 48 hours before to 24 hours after
ovulation
d. Menstruation begins approximately 14 days after ovulation
3. Climate of the female genital tract
a. Vaginal and cervical secretions are less acidic during ovulation
(sperm cannot survive in a highly acidic environment)
b. Cervical secretions are thinner during ovulation (sperm can
penetrate more easily)
c. Process of fertilization (7-10 days)
1. Ovulation occurs
2. Ovum travels to fallopian tube
3. Sperm travel to fallopian tube
4. One sperm penetrates the ovum
5. Zygote forms (fertilized egg)
6. Zygote migrates to uterus
7. Zygote implants in uterine wall
8. Progesterone and estrogen are secreted by the corpus luteum to maintain
the lining of the uterus and prevent menstruation until placenta starts
producing these hormones; (note: progesterone is a thermogenic hormone
that raises body temperature, an objective sign that ovulation has occurred)

d. Placental development
1. Chorionic villi develop that secrete Human Chorionic Gonadotropin (HCG).
which stimulates production of estrogen and progesterone from the corpus
luteum (production of HCG begins on the day of implantation and can be
detected by the sixth day)
2. Chorionic villi burrow into endometrium, forming the placenta
3. The placenta secretes HCG, human placental lactogen (HPL), and (by week
three) estrogen and progesterone
e. Fetal membranes develop and surround the embryo, fetus
1. Amnion: inner membrane
2. Chorion: outer membrane
3. Umbilical cord
a. Two arteries carrying deoxygenated blood to placenta
b. One vein carrying oxygenated blood to fetus
 c. No pain receptors
d. Encased in Wharton’s jelly
e. Covered by chorionic membrane

f. Amniotic fluid
1. Production origins
a. Maternal serum during early pregnancy
b. Fetal urine in greater proportion during latter part of pregnancy
c. Replaced every 3 hours
d. 800-1,200 ml at end of pregnancy
2. Functions
a. Protection from trauma and heat loss
b. Facilitates musculoskeletal development by allowing for movement
of the fetus
c. Facilitates symmetric growth and development
d. Source of oral fluid for fetus
g. Placental transfer of material to and from the fetus
1. Diffusion across membrane (for example: gases, water, electrolytes)
2. Active transport via enzyme activity (for example: glucose, amino acids,
calcium, iron)
3. Pinocytosis: minute particles engulfed and carried across the cell (for
example: fats)
4. Leakage: small defects in the chorionic villi cause slight mixing of maternal
and fetal blood cells
5. Nutrients and wastes are exchanged in the placenta, but the blood does not
intermingle

B. Fetal Development
1. Pre-embryonic: first two weeks
2. Embryonic: three to seven weeks
3. Fetal: eight to 40 weeks
a. Full term: 38 to 42 weeks
b. Preterm: less than 38 weeks
c. Post-term: more than 42 weeks
C. Terminology
1. Gravida
a. Definition: number of times pregnant, including present pregnancy
b. Variations: primigravida, multigravida
2. Para
a. Definition: number of pregnancies delivered after the age of viability, whether born
alive or dead
b. Variations: nullipara, primipara, multipara
3. Five-digit system
a. G: gravida
b. T: term infants
 c. P: preterm
d. A: abortions
e. L: living

Signs of Pregnancy

1. Presumptive (subjective)
a. Amenorrhea: missed periods
b. Nausea and vomiting: morning sickness, probably due to HCG; usually lasts about 3
months
c. Fatigue: first trimester
d. Urinary frequency: caused by enlarging uterus pressing on bladder
e. Breast changes: tenderness and tingling, nipples pronounced, full feeling, increased size,
areola darker
f. Quickening: mother’s perception of fetal movement around 16-18 weeks: fluttering
sensation

2. Probable (objective)
a. Chadwick's sign: bluish coloration of the mucous membranes of the cervix, vagina, and
vulva
b. Goodell's sign: softening of cervix; occurs beginning of the third month
c. Hegar's sign: softening of the isthmus of the uterus, between the body of the uterus and
cervix; occurs about the sixth week
d. Enlargement of abdomen: uterus just above symphysis at 8-10 weeks; at umbilicus at 20-
22 weeks
e. Braxton-Hicks contractions: painless contractions occurring at irregular periods throughout
pregnancy; felt most commonly after 28 weeks
f. Uterine souffle: soft blowing sound; blood flow to placenta same rate as maternal pulse
g. Pregnancy test positive: HCG in serum and urine
h. Ballottement: can push fetus and feel it rebound
i. Pigmentation changes: increased pigmentation, chloasma, linea nigra, and striae
gravidarum
3. Positive
a. Fetal heartbeat: by Doppler at 8-10 weeks
b. Fetal movements: felt by examiner
c. Fetal outline: on sonogram

D. Assessment of Date of Delivery

1. Nagele's rule: first day of last menstrual period (LMP) minus three months plus seven days;
in most cases, add one year
2. Other parameters: fundal heights, quickening, sonograms

ADAPTATIONS TO PREGNANCY
ADAPTATIONS TO PREGNANCY TRIMESTER INTERVENTIONS
G.I:
- Nausea/vomiting
- Constipation,flatulence and heartburn 2, 3
- Bleeding gums
- Gallstones
- Heartburn
Urinary Tract:
- Frequency during first and third
trimester due to pressure on bladder
- Glomerular filtration rate (GFR)
increases (glycosuria)
- Increase in urinary infections
Breasts:
- Increase in size and nodularity, striae
- Tenderness and tingling
- Hypertrophy of Montgomery tubercles
- Darkening of areola
- Colostrum secreted
Vagina:
- Epithelium undergoes hypertrophy and
hyperplasia
- Increased vascularity
- Increased pH; good for growth of
Candida (thrush)
- Increase in discharge; leukorrhea is
common
Respiratory System:
- Increase in volume of up to 40-50%
1 - Small frequent meals; eat
crackers or dry toast before
getting up in the morning; eat dry
meals; drink liquids between
meals
- Exercise; increase fluid and fiber
in diet; stool softeners if
recommended by physician
- Use soft toothbrush for dental
2, 3
care
2, 3
- Avoid fatty foods
2, 3
- Small frequent meals; avoid
spicy, fatty foods; no sodium
bicarbonate as antacid; antacids
as recommended by physician
1, 3 - Void when first urge felt; wear a
pad if leaking
2, 3
- Increase fluid intake
1 - Wear good supportive bra
1
2
2
2, 3
1, 2, 3 - Report itching and burning to
physician
1
- Promote cleanliness by bathing
daily; avoid douching; avoid nylon
undergarments
   
between 16th-34th week
- Diaphragm is pushed upward; ribcage
flares out; breathing changers from
abdominal to chest
- Increase in oxygen consumption by
15%

ADAPTATIONS TO PREGNANCY

ADAPTATIONS TO PREGNANCY TRIMESTER INTERVENTIONS

Respiratory System (continued)
- Stuffiness, epistaxis, and changes in
voice occur as a result of increase 1 - Cool moist air may help; avoid
estrogen levels over-the-counter decongestants
- Dyspnea 3 and sprays
- Proper posture; sleep with head
propped up
Skin:
- Areola darkens
- Abdominal striae, linea nigra
- Diaphoresis
- Chloasma; mask of pregnancy 2, 3 Daily bathing; powder
- Vascular spider nervi; chest, neck,
arms, and legs
Metabolism/Nutrition:
- Basal metabolic rate increased by
20%
- Water retention; edema 2, 3 - Elevate legs and feet when
sitting; avoid prolonged standing;
do not wear garters or clothing
with restrictive bands around the
legs; avoid crossing legs at knees
- Weight gain; 20-25 lbs recommended
- Adequate protein intake, especially
for teens
- Increase iron during last eight weeks
- Pica: craving for nonnutritive 2, 3 - Eat well-balanced diet
substance
Perineum:
- Increased vascularity
- Venous congestion of the perineum
 2, 3 - Kegal exercises
Cardiovascular:    

- Cardiac output increases by 30%

- Blood volume progressively increases
and peaks around 30-40 weeks at 47%
above pre-pregnant state
- Plasma volume increases greater then
RBC and hemoglobin, resulting in
"pseudo anemia"
- Pulse rate increases by 10-15
beats/minute; BP drops slightly in
second trimester due to peripheral
dilatation effects of progesterone;
returns to normal by third trimester

ADAPTATIONS TO PREGNANCY

ADAPTATIONS TO PREGNANCY TRIMESTER INTERVENTIONS

Cardiovascular (continued)
- Varicose veins may develop
2, 3 Elevate legs; avoid standing for
long periods of time; avoid
constrictive clothing
Uterus:    
- Growth is influenced by estrogen
- 500 - 1,000 fold increase in capacity
- Cervical secretions form mucus plug
Endocrine:
- Increase in size and activity of
thyroid
- Increase in size and activity of
anterior lobe of pituitary
- Increase in size and activity of
adrenal cortex Pelvic rock; good body
2, 3
- Increase in production of relaxin mechanics; supportive shoes
causes joint and back pain.

Teratogen

1. Definition: nongenetic factor producing malformations of the fetus; greatest effect on those cells
undergoing rapid growth, thus time is important
 2. Types
a. Chemical agents (for example: insecticides)
b. Radiation
c. Drugs: for example: alcohol, tetracycline (Sumycin), chemotherapeutic agents, phenytoin
(Dilantin), narcotics, nicotine, megavitamins, warfarin (Coumadin), lead, lithium,
carbamazepine (Tegretol), and mercury
d. Bacteria and viruses
1. Syphilis
a. Spirochete does not cross placenta until after 18th week; treat as soon as
possible; can treat later since penicillin does not cross placenta
b. Can cause late abortions, stillbirths, and congenitally infected infants
2. Gonorrhea: causes injury to eyes at birth (ophthalmia neonatorum)

3. T.O.R.C.H.- severe effects on the fetus

a. Toxoplasmosis: protozoan contracted by ingesting raw meat or feces of infected animal
(for example: cats); pregnant women should not change cat litter boxes
b. Rubella: first trimester most serious; causes congenital heart problems, cataracts, hearing
loss; clients cannot receive the rubella vaccine during pregnancy as it is a live virus; if they
receive the immunization in the post-partum period, they must understand that they
should not become pregnant for at least three months
c. Cytomegalovirus (CMV): member of the herpes family; causes congenital and acquired
infection; principal organs affected: liver, brain, and blood
d. Herpes simplex virus, Type 2 (HSV-2)
1. Transmitted to infant vaginally in intrauterine cavity or during delivery; do not
deliver vaginally if active lesions are present
2. Affects blood, brain, liver, lungs. CNS, eyes, skin
3. Perinatal mortality: 96%; 50% of survivors have neurological or visual abnormalities
4. Chlamydia: causes conjunctivitis and pneumonia in the newborn
5. AIDS
a. Transmitted via breast milk
b. 30% chance of transmission in utero or during deliver
c. Treatment of mother with zidovudine (AZT) while pregnant can reduce chance of
transmission to fetus to approximately 8%

Emotional and Psychological Adaptations to Pregnancy

Development Tasks of Pregnancy

1. First trimester: accept the biological fact of pregnancy; it is common to feel ambivalent early in
pregnancy
2. Second trimester: accept growing fetus as a baby to be nurtured
3. Third trimester, prepare for the birth and parenting of the child

Prenatal Care
 A. Assessment
1. Complete history
2. Lab work: complete blood count (CBC), blood type and Rh, Rubella, VDRL/FTA-ABS/RPR,
hepatitis B surface antigen, HIV antibody (with client's consent), alpha fetal protein (AFP)
3. Vital signs, weight, urine test for protein and glucose
4. Physical exam: fundal height, fetal heart rate (FHR), fetal activity
5. Internal exam
a. Adequate pelvic outlet, signs of pregnancy (First visit)
b. Cervical changes, especially in last weeks (for example: "ripe cervix")
c. Vaginal smear for Neisseria gonorrhea, chlamydia, group B strep, human
papillomavirus (HPV) cultures, and pap test
6. Psychosocial assessment

you are about to embark on a unique journey inside the body of a pregnant woman as you take this tour you will gain a
deeper understanding of the physical and emotional progression of labor learning about these stages of labor will
increase your confidence as you experience the wonder of childbirth from the very first contraction to the birth of a
precious new life understanding the anatomy of pregnancy will help you recognize the physical changes that occur
during pregnancy labor and birth this image reveals the inside of a pregnant woman with her baby at full term the baby
lives inside of her mother's uterus a strong balloon-shaped muscle that contracts during labor these contractions cause
the bottom part of the uterus called the cervix to thin out and open prior to labor the mucous plug blocks the cervical
opening to protect the baby from the outside environment the cervix opens completely allowing the baby to enter the
birth canal or vagina for birth the placenta is an organ created by a woman's body just for pregnancy that grows into the
wall of the uterus the placenta provides all the hormones needed to maintain the pregnancy and it continually transfers
oxygen and nutrients from the mother's blood to the baby's blood the baby's blood travels to and from the placenta
through the umbilical cord growing out from the placenta is the bag of waters or amniotic sac the water or amniotic fluid
inside the sac cushions the baby in a comfortable warm environment

as a woman nears her delivery her body goes through hormonal and physical changes in preparation for birth these pre-
labor signs let her know that labor may be coming soon these signs can occur from a month or so before birth up until
labor really begins warm-up contractions are a common sign that labor is nearing during the last months of pregnancy
many women notice occasional contractions that come and go with no regular pattern these usually mild sensations also
called braxton hicks contractions are caused by the muscular wall of the uterus gently tightening and relaxing to build
strength for the work of labor and birth unlike contractions during labor these warm-up contractions usually aren't
strong or frequent enough to open the cervix or push the baby down as labor draws near they may become more
uncomfortable i had contractions for six weeks before i actually went into labor they started out not so bad and then
they were very strong even though the Braxton hicks contractions hurt they were not comparable to labor contractions
you must pay special attention to the number of warm-up contractions you experience especially before your pregnancy
is full term if prior to 37 weeks of pregnancy you experience contractions occurring every 15 minutes or less or more
than four to six in one hour call your caregiver there is a possibility that you could be in pre-term labor which might
result in a premature baby you may try emptying your bladder lying down to rest and drinking plenty of fluids to slow or
stop pre-term contractions continue to time your contractions as you rest and contact your caregiver to let him or her
know if they are slowing down lightning also called engagement is another sign that labor is near lightning is the
movement of the baby dropping deeper into the pelvis prior to birth this movement usually occurs about two weeks
prior to labor for first-time moms and up to a few hours before or even during labor for moms who have previously
given birth it's called lightning because moms say they can breathe more easily with the baby lower in the pelvis after
dropping the baby no longer presses against her mother's lungs there is also less pressure on the stomach so pregnant
women may experience an increase in appetite and a decrease in heartburn discomfort there is however more pressure
on the bladder after the baby drops causing women to make more frequent trips to the bathroom when the baby
dropped i felt a lot of pressure baby's head is really down and i have to go to the bathroom many times because of the
pressure another sign that labor may be near is the release of the mucous plug the thick mucus that has kept the uterus
sealed during pregnancy comes out as the cervix begins to thin and open this usually happens a few days or weeks
before labor or at the onset you may notice clear pink or slightly bloody spotting or you may not notice any spotting at
all some women experience the nesting instinct when this occurs women have a surge of energy and an overwhelming
urge to prepare the home for the baby it's a good idea though to try to conserve some of this industrious energy for
labor when i experienced the nesting instinct I really felt the urge to get the house ready as far as cleaning and made
sure all her clothes were in perfect order in the drawers it was crazy other signs that labor may be just around the corner
are a weight loss of one to three pounds increased backache and flu-like symptoms such as diarrhea indigestion and
nausea caused by changing hormones

labor usually begins between the 37th and 42nd weeks of pregnancy no one knows exactly what triggers labor to start
but it likely involves a shift in hormones contractions that become stronger longer and closer together signal that labor is
beginning these labor contractions don't go away when you lie down or change your activity and they continue to
increase in intensity each one lasting at least 30 seconds start timing the length and frequency of some of your
contractions so you can inform your caregiver about your progress seven and a half points apart in between contractions
how long was that it was a minute and a half contraction approximately my labor began it was about 2 30 in the morning
and i woke up and i was having strong contractions like to the point that i had to breathe through them and they were
about every 10 minutes apart and they were much stronger in my lower back there was less tightening of my abdomen
as i was up more they got progressively stronger and closer together and that's how I know i was really in labor in about
12 percent of women the bag of waters breaks before contractions occur signaling that labor will soon begin a tear in
the bag or amniotic sac causes the water or amniotic fluid to leak out in most cases only the water from around the
baby's head is released the remaining water will cushion the baby until birth and some of it may gradually leak out
during labor for the majority of women the bag will break later on during labor if your water breaks call your caregiver
they will ask the color odor amount and time of the rupture use the acronym coat to remember what you'll need to
notice if your water breaks if you're not sure whether your waters have broken you should still call your caregiver he or
she may want you to come in and be checked the stages of labor are divided into three distinct parts first stage in which
contractions cause the cervix to thin out and open completely second stage which involves pushing in the birth of the
baby and third stage the delivery of the placenta a baby makes an amazing journey during labor from inside her mother
to the outside world and just as every mom and baby is different every labor is unique many factors come into play that
affect how this journey unfolds and how long it lasts in fact the total length of labor can vary widely from as little as six
hours to 24 hours or more labor is usually longer for first-time moms and shorter for second-time moms while average
lengths for the different stages are provided in this program keep in mind that the length of your labor may be quite
different

the first stage of labor when the cervix dilates completely is usually the longest lasting an average of 14 hours for first-
time moms and eight hours for second time moms the first stage is further divided into three phases early labor active
labor and transition these phases blend together as part of a whole experience and moms may not always be aware that
they are passing from one phase to the next during first stage early labor the upper part of the uterus contracts this
causes the cervix the bottom of the uterus to start to efface meaning to thin out the contractions also cause the cervix to
start to dilate meaning to open in early labor the cervix dilates to about three centimeters contractions during early
labor may last only 30 to 45 seconds the time between contractions is measured from the beginning of one contraction
to the beginning of the next in early labor contractions occur at irregular intervals varying from five to thirty minutes
apart and slowly become more regular as early labor progresses if you're awakened during the night by early labor
contractions it's a good idea to try to go back to sleep

well for early labor in the beginning i

i was trying to continue

resting and sleeping and once i realized

that was not going to work for me

i came downstairs and i started sitting

on

a birthing ball this early phase

typically lasts

6 to 12 hours for first-time moms

since this is usually the longest phase

of the first stage

women often feel more comfortable during

early labor if they stay at home

it's also important to eat drink and

rest as much as possible to prepare for

the challenges of

active labor ahead

okay

if it's hard to rest it may help to

change positions and continue light

activity

walking for me was really nice it was

dawn it was

the sun was just starting to come up it

was still kind of gray and it was very

peaceful and quiet

just felt like a really calm kind of

natural way to start the whole process

the stages of labor are marked by more

than physical changes

a woman also experiences a range of

emotions

during early labor many women feel

relieved and excited because the births

of their babies are near

[Music]

partners and support people play a large

role in helping moms stay comfortable

during the different stages of labor

during the early labor i was just um

overwhelmed with all kind of uh

emotions and everything and i just

really wanted to

offer all my support and just be there

for her and

just encourage her in early labor

support people can help mom rest and

relax

take a walk with her and involve her in

books card games or other light

activities

we went to the nursery and looked at all

the newborns and

we were going to be the parents of a

child soon and we were just excited

a change in the intensity and regularity

of contractions signals to the mother

that she is progressing to first stage

active labor first stage active labor

lasts an average of three to five hours

remember this is only an average and

having a shorter or longer active phase

is perfectly normal

[Music]

contractions during active labor last 45

to 60 seconds each

and are three to five minutes apart

women are usually advised to come to the

hospital or birthing center when their

contractions are five minutes apart

but always call your caregiver and

follow his or her instructions on when

to go to the hospital

during active labor the upper uterus

continues to contract

with each contraction this upper portion

grows thicker and stronger

these more intense and frequent

contractions cause the cervix to dilate

at a faster rate
and may cause spots of blood called show

[Music]

during this active phase the cervix

dilates from three to seven centimeters

when women arrive at the hospital or

birthing center the nurse

or primary care provider will likely

assess dilation by doing a vaginal exam

if the bag of waters did not break at

the onset of labor

it may break any time from active labor

through pushing due to the force of

contractions

it's really important to me when i was

in active labor and really dealing with

those contractions that people were

staying quiet

because it was really hard for me to

focus when there was noise outside of

just my little bubble but having aaron's

voice in my ear counting and telling me

i could do it

really helps to bring me back to center

emotionally

women in this active phase begin to

concentrate more seriously on their

labor

they may also be more dependent on

others and experience wavering

self-confidence

[Music]

support persons can help by providing

words of encouragement

assisting her in changing positions

often and using the relaxation and pain

management techniques that work best for

her

also make sure the labor room is quiet

and comfortable

and help her rest in between

contractions

i think it wasn't until very late in

active labor that i started feeling a

little bit unraveled and

definitely not doing anywhere near as

much work as beck was but

just feeling very very worn out and a

little bit

helpless too i think that you know as

supportive as you can try and be that

there ultimately there's nothing you can

do to to make the contraction pass

quicker or anything like that

as first stage active labor progresses

the baby starts a process called

internal rotation in order to fit

through the bottom of the pelvis and

into the birth canal

the baby's head needs to turn and face

the mother's back

this is called the anterior position

in some births the baby's head turns to

the posterior position

which means she faces the front of the

pelvis

if this happens her head puts added

pressure on the mother's back

which may cause painful back labor and

slower progress

due to the force of contractions the

shape of the pelvis

and the use of productive labor

positions a posterior baby may turn on

her own to the anterior position prior

to birth

the third and final phase of first stage

labor is called

transition transition is considered the

most

intense part of labor but also the

shortest usually lasting between 30

minutes

and two hours

during the transition stage i couldn't

get comfortable the nurse

told me to try some moaning you take a

deep breath

in and they go

just relax contractions during

transition

intensify quickly and have two or more

peaks

they last 60 to 90 seconds each

and they are one to three minutes apart

allowing moms very little rest in

between

during transition the forceful

contractions caused the top of the

uterus to grow

thick and strong enough to push the baby

down

contractions also cause the cervix to

dilate completely

from seven to ten centimeters

[Music]

due to the intensity of transition it is

not uncommon for women to experience hot

flashes

chills shaking nausea or vomiting

because of these challenges a woman in

transition
often feels irritable disoriented and

increasingly dependent on others

emotionally i felt

completely drained during the transition

phase

and i i knew that i was

heading toward the end but i didn't feel

like i had much

left to give but i knew i had to just

keep working through it and keep

breathing and

plugging along

[Music]

partners and helpers can assist mom in

focusing during contractions

by using direct eye contact and short to

the point directions

they can also encourage her to rest in

between contractions

and give her extra emotional support to

keep her from getting discouraged during

this intense period

it may help to remind her that each

contraction brings her closer to the

birth of her baby

[Music]

during her transition phase of labor

the pain got more intense for her so i

was massaging her lower back

more and not so much massaging just a

solid pressure

[Music]

just stand there and give her moral

support tell her she's doing a great job

tell her you know she's gonna get

through us it'll

all be over soon

transition causes the cervix to dilate

fully and labor then progresses to

second stage

some women experience a resting period

of about 20 minutes between the

transition stage and the first

second stage contraction the second

stage when the mother pushes and gives

birth can be as short as 20 minutes

or last as long as two or three hours or

more

second stage contractions last 45 to 90

seconds each

and are three to five minutes apart

giving mothers more rest

in between than she had during

transition as a second stage contraction

builds in intensity
most women feel a strong urge to bear

down and push

i felt a lot of pressure and

i called the nurse and she said well do

you feel like you need to push

and i said i don't know and then with

the next contraction i said oh yes i do

i do have the urge to push and a lot of

people compare it to

feeling like you have to have a bowel

movement but felt like i just got a push

to relieve the pressure

the range of emotions experienced by

women entering the pushing stage can be

overwhelming they may feel relief and

energy from a second wind

or if pushing is prolonged this

excitement may be mixed with feelings of

exhaustion

and frustration pushing was a huge

relief

for me because it was like i know that

there is going to be an

end to this plus it really actually felt

good to push

and i could tell that there was progress

so it was emotionally more satisfying

for me
during second stage partners can help

mom change into comfortable productive

positions

second stage is also an important time

for support persons to provide

focus and emotional support tell her

you're doing great

you're almost there or just a few more

pushes

and remind her to rest between pushes

by this point in labor the top of the

uterus is very thick

and pushes on the baby with each

contraction enabling the baby to move

through the pelvis this is called

descent

descent is determined by pelvic station

which is the position of the baby's head

in relation to the spines of the pelvis

the baby's position is measured in plus

or minus centimeters from these spines

during most of pregnancy she is in the

negative range

after lightening she is usually even

with the spines at the zero station

and gradually during labor she drops

into the positive range

during second stage the baby must

progress to the plus four or five

station for birth

as the mother pushes with each

contraction the baby's head descends and

then slips back slightly between

contractions

to help the head descend more easily the

baby's skull is made up of five

separate bony plates

[Music]

these plates mold together to help the

head fit through the birth canal

giving many newborn babies a cone-shaped

head for a few days after birth

i use the mirror this time so i can see

the progress

i feel oh there it is come on

the top of the baby's head is visible as

it emerges and slips back

the baby's head crowns when it stretches

the vaginal opening to the fullest

this squeezes the head so it does not

slip back anymore in between

contractions

during crowning mothers often feel a

burning sensation in the perineum

the skin between the vaginal opening and

the anus
everybody was telling me that the head

could crown so i reached down and was

able to actually feel his head

and it was more like a burning like a

warm burning sensation

more so than it had been before he

crowned

after crowning comes the birth of the

head the baby's head extends and her

chin lifts

allowing the crown through and out the

birth canal

her head starts emerging face down and

then turns

to line up with her shoulders which are

still inside of her mother

with the next push one shoulder comes

out and then the next

after the shoulders are out the rest of

the baby slips out

and she is born

[Music]

i just felt grateful and now i have him

in my arm

and i can see his face yeah i feel that

this is mommy and this is my son

i feel that that vine

after birth the umbilical cord is

clamped and then cut

there are no nerve endings in the cord

so the baby doesn't feel anything

i was crying a lot it was a release

because

i wasn't pregnant anymore and it was

really happy because i finally had my

son

and i was finally able to really start

this phase of my life that i've been

waiting for for nine months

about

five to twenty minutes after the baby's

birth comes the third stage of labor

the delivery of the placenta the sudden

shrinking of the uterus after birth

separates the placenta from the uterine

wall a contraction signals the mother

that it is time to push the placenta out

after delivery the doctor or midwife

checks to be sure that the entire

placenta has been expelled

[Music]

by this time the mother is usually

feeling joyful

and relieved at the same time she may

also feel quite

tired

uh totally for the placenta it wasn't

so hard uh i just

felt a little construction

and then you just push a little bit

and it's out yeah

to help the uterus contract and prevent

excessive bleeding

the care provider may massage the top of

the abdomen which can be uncomfortable

for the mother

the uterus contracts to about the size

of a cantaloupe in the hours after birth

the uterus continues to contract and

reaches its usual pear size about six

weeks later

the mother may feel slightly

uncomfortable after pains as the uterus

contracts

breastfeeding as soon as possible after

the baby's birth

helps this process along

[Music]

breastfeeding for the first time was a

very

spiritual experience i had a very strong

sense of connectedness

you just feel like you're part of the

cycle of life

mother and child

[Music]

you've reached the end of your journey

through the stages of labor

from the first signs of pre-labor

through breastfeeding your newborn

your body is specially designed to birth

and nurture your baby

trust your own body and follow your

instincts as you experience your

own birth miracle

actually having my son and going through

childbirth

has really changed me in that i know how

much more i can do

i am more secure in my mothering because

i know that i

went through that so i can endure all of

these other things

it's just something that you know is

undescribable it's just

everything positive how are you

daddy's doing fine how are you doing

sweetie

it's it's just an amazing life

transforming

experience and then you have this

beautiful child

afterward that is a part of your life

that you never knew was missing

it just instantly becomes this is how

life

is supposed to be