Sexual Health/Pregnancy

Pregnancy is the period where a fetus grows inside the uterus of the mother. Pregnancy starts with conception, and ends with delivery of the baby, or premature termination of the pregnancy.

Childbirth usually occurs about 38 weeks from fertilization, i.e. approximately 40 weeks from the start of the last menstruation. Thus, pregnancy lasts about nine months, although the exact definition of the English word “pregnancy” is a subject of controversy. The term embryo is used to describe the developing human during the initial weeks, and the term fetus is used from about two months of development until birth.

In many societies' medical and legal definitions, human pregnancy is somewhat arbitrarily divided into three trimester periods, as a means to simplify reference to the different stages of fetal development. The first trimester period carries the highest risk of miscarriage (natural death of embryo or fetus). During the second trimester the development of the fetus can start to be monitored and diagnosed. The third trimester often marks the beginning of viability, or the ability of the fetus to survive, with or without medical help, outside of the mother's womb.

Conception
Conception happens when the sperm combine with the egg. This usually normally occurs if a heterosexual couple has vaginal intercourse without contraception, especially if performed in the several days before the woman ovulates. To prevent conception, birth control methods should be used, such as condoms and hormonal contraceptives such as The Pill. Even if a man does not ejaculate inside the vaginal canal, semen released near the vulva can still enter the vagina and fertilize an egg. For this reason, it is possible (although unlikely) for a heterosexual couple to conceive without actually having any vaginal intercourse. Further, it is important to know that contraception may not be completely effective, and conception can still occur, although this is rare if the manufacturers' recommendations are strictly followed.

If a heterosexual couple wants to conceive, they should have natural vaginal intercourse, and neither partner should be taking hormonal contraceptives. Fertility changes over a woman's ovulation period, so it may be helpful to study a fertility awareness method, or use devices called Ovulation Predictor Kits (OPKs). This may help couples know to have intercourse on the woman's most and least fertile days. The Rhythm Method of birth control is not however very effective. If you and your partner want to conceive a baby, it is important to talk about the various factors involved in pregnancy with a trained professional. Neonatal death (death of either mother or baby about the time of birth) was once very common and can still occasionally occur, even when advanced medical attention is available.

About the time that sexual intercourse becomes routine the adult human body prepares itself for pregnancy and parenting regardless of the use of contraceptives. Typically a man may sprout additional body hair and a woman may develop more prominent breasts. These quite severe hormonal changes are likely to have emotional effects, so that the man may become excessively protective and the woman excessively insular (broody) In extreme cases this can lead to post natal depression. Pre-natal classes usually address these psychological changes, and are therefore recommended for both expectant mothers and fathers, especially during the gestation of the first baby.

Parenthood
Having a baby is an important, life-changing moment, and couples should not attempt to conceive without talking about the consequences. A baby requires a lot of effort and patience, and it is a big responsibility to take care of a child for 15 or 20 years until it is entirely self-sufficient.

Having a baby before academic education is complete increases a person's risk of dropping out of school, having a lower-than-average income, and needing government assistance or charity services. Young men who are not mature may not accept the long term responsibilities of fatherhood and become untraceable, and in consequence children born to teenage parents or single mothers tend to be less socialized than regularly parented children and so (statistically at least) at higher risk of committing crimes and going to jail.

It is important for people expecting their first child to have family and friends to support them during this emotionally tumultuous time, when emotions are experienced with extreme force. Arguments and rows are common between couples about this time, and a wide range of mature mediators (parents, older relations, more experienced friends) can greatly reduce fear and confusion that is natural in such an important life-changing period. The desire to run away and abandon one's parental obligation to the new child is common, often severe but always transitory. Both abortion and separation have long term psychological consequences that may be worse than the short-term panic that often provokes such extreme acts.

Know if you are pregnant
It is important to know if you are pregnant or not. Women commonly suspect they are pregnant if they do not get an expected period. During pregnancy, the normal menstrual cycle ceases, and women will not menstruate again until after the pregnancy is over.

Modern over-the-counter pregnancy tests are just as accurate as tests at a doctor's office. Pregnancy tests become accurate between one and three weeks after the last act of intercourse (or other sexual contact in which semen came near the woman's vagina). There are two reasons for this delay. First, sperm can live for up to five days before fertilizing an egg. Thus, a woman may have sex on Monday and not become pregnant until Friday. Second, a newly created embryo does not implant in the woman's uterus until six to twelve days after fertilization. Before implantation, there is no method available to detect pregnancy.

Many women occasionally have longer menstrual cycles ("late periods") without being pregnant. Stress will delay ovulation, and menstruation does not happen until about two weeks after ovulation. Women who frequently have longer menstrual cycles may worry needlessly about being pregnant. These women may benefit from fertility awareness, which allows them to predict the length of even irregular cycles.

If you are pregnant, it is important that you see a doctor. Pregnant women should receive prenatal care, to protect their own health, and the health of their unborn babies. Pregnant women have different nutritional needs from non-pregnant women.

Women who take folic acid supplements before becoming pregnant significantly lower the risk of certain birth defects. As half of pregnancies in the United States are unplanned, all sexually active women should take folic acid supplements.

Stages of Pregnancy
Pregnancy begins with fertilization, when the sperm from the man join with the egg from a woman. Fertilization, also called conception, occurs in the fallopian tubes, and the newly created embryo will continue to develop in the fallopian tubes for several days. Six to twelve days after fertilization, the embryo will embed itself into the uterine wall, where it will begin secreting hormones that can be detected by pregnancy tests. Because pregnancy cannot be detected before implantation, some groups define conception, the beginning of pregnancy, as the time of implantation.

Doctors count the beginning of pregnancy as the first day of the woman's last menstrual period (LMP). Because ovulation happen on average two weeks after menstruation, a newly created embryo is already two weeks old! It is normal and common for ovulation to happen earlier or later in the menstrual cycle, however, so often age estimates based on LMP will be wrong. Sometimes doctors will do an ultrasound of an early pregnancy to estimate its age (based on size of the embryo). This measurement is more accurate than calculation from a woman's LMP.

Development of all major proto-organs is complete seven weeks after fertilization, about nine weeks LMP. At this point, the embryo is called a fetus. The fetus continues to develop until the end of pregnancy.

The average pregnancy lasts 40 weeks from a woman's last menstrual period (this would be 38 weeks from fertilization). Pregnancy lengths of between 38 and 42 weeks are considered normal. Any baby born before 38 weeks is considered premature, and is at increased risk for health problems. Pregnant women should ask their doctor to describe the symptoms of premature labor, and should call their doctor or go to the hospital if they are worried they might be in premature labor.

Miscarriage
Over 25% of pregnancies end in miscarriage, almost all in the first trimester. Some of these miscarriages may occur without a woman ever knowing she is pregnant. While there are medical treatments for later-term pregnancies that threaten to miscarry, there are no known treatments for early miscarriages. It is believed that most early miscarriages are caused by chromosomal defects in the embryo or fetus.

Sometimes a miscarriage is 'incomplete', meaning some embryonic or fetal tissue is left inside the woman. This tissue can become infected, which is a serious health concern for the woman. Women who know they have miscarried should be monitored by a doctor to verify that the miscarriage was complete. The doctor might make sure the levels of pregnancy hormone (hCG) in the woman's blood have dropped. An ultrasound could also be performed to see that the woman's uterus was empty. Even if the doctor is not concerned about infection, the woman may want to finish the process of miscarriage without waiting the weeks it sometimes takes to occur naturally. A procedure called Dilation and Curettage(D&C) may be used to remove the contents of the uterus.

Type
There are two ways to give birth to a baby: vaginally and by C-section (the "C" stands for "caesarian," because people used to think this was how Julius Caesar was born.) Vaginal birth is where the baby is pushed out the woman's vagina. C-section is where an incision is made in the woman's abdomen, and surgeons pull the baby out.

The average woman will recover from a vaginal birth about three times faster than from a C-section. A C-section is major abdominal surgery, and like all surgeries, it carries risks such as infection and blood loss.

In case of birth complications, however, C-sections can be lifesaving to both mother and baby.

Birth options
Most women give birth to their babies in a hospital. Hospitals have the most up-to-date technology and have surgical teams available to deliver babies by C-section if necessary.

Women may also birth in a birth center. These centers tend to provide more support for women seeking to avoid medical interventions (such as drugs for pain control), and are almost always run by midwives. Many birth centers are attached to hospitals, so the resources of the hospital are readily available in case of complications. Some birth centers have a "Know Your Midwife" scheme, where during their pregnancy women get to meet the midwives that will be with them for their birth.

Depending on where they live, women may also be able to find a midwife that will attend a birth at their home. In this way women get to know really well the person who will help them at the birth of their baby. Some women who plan to birth at home will transfer to a hospital to receive pain medicines or for other medical assistance. Most midwives who offer home births will provide follow-up care for up to 6 weeks after the baby is born. Studies of planned home births in low-risk pregnancies have shown that they are just as safe as planned hospital births.

Keeping healthy
Not every pregnancy is straight-forward, and this is why it is important that pregnant women receive pre-natal care. These days many women are offered tests during their pregnancy to determine how things are going, and whether they need help keeping themselves and their babies healthy. Women may be offered blood or urine tests to check for gestational diabetes, and ultrasounds to check on the growth of the baby - different places test for different things and it is always good to ask questions before consenting to any procedure.

People today know that drug, alcohol and tobacco use during pregnancy can create problems for the mother and the baby, and most health care providers will have strategies to help pregnant women where this is an issue.

Morning Sickness
During pregnancy, especially in the first trimester, women are often nauseous and may throw up. While this condition is called 'morning' sickness, it may occur at any time of day.

Eating frequent small meals and snacks may help reduce the severity of morning sickness. In extreme cases, IV fluids and anti-nausea drugs may be needed to protect the woman's health.

Several natural and mild drug remedies exist to treat morning sickness. Natural remedies include an increase in vitamin B12 intake and using ginger. Vitamin B12 can be increased by drinking red raspberry leaf tea or through an oral vitamin.

Ectopic Pregnancy
An ectopic pregnancy occurs when an embryo implants in a location other than the uterus. Most commonly, this is in a fallopian tube (a "tubal pregnancy"), but embryos may also implant in the abdominal cavity or an ovary. Tubal pregnancies, if allowed to continue, will burst and threaten the woman's life due to internal bleeding.

Multiple Births
Sometimes a woman can be pregnant with more then one child at a time. 2 fetuses are called "twins", 3 are called "triplets", and 4 are called "quadruplets". If the fetuses are identical, it means that they are split from a single fertilized egg, and therefore have the same DNA. Fetuses that are fraternal are the result of multiple eggs that were released simultaneously, and each fertilized by different sperm.

Couples who are having difficulty conceiving a child may resort to fertility treatments. Fertility treatments known as injectables can cause many eggs to be released, and therefore create the potential for multiple births. If in vitro fertilization is used, the woman and her doctor might choose to place many embryos into the woman's uterus. It is not unheard of for a couple on such treatments to have groups of 5 babies or more simultaneously, although couples are offered selective reduction (abortion of one or more fetuses to decrease health risks to the remaining fetuses) for any pregnancy higher than twin.

Adoption
A couple may decide it is not in their best interest, or in the interest of their child, to raise a baby. These couples may choose to make an adoption plan for their baby. In an adoption, the birth parents terminate their parental rights so that another couple may parent the child. Adoption is considered one of the three options (in addition to abortion or raising a child) available to women and couples who experience unplanned or unwanted pregnancy.

Couples who cannot have children themselves often consider adopting a child or children. Also, couples who have a child or children of their own may want to help other children through adoption. Single people may also choose to grow their family through adoption.

Adoption may be done through a government agency, a private agency, or through a "private adoption." Government and private agencies require single people or couples considering adoption to go through a home study, where a caseworker evaluates their ability to parent a child. Government agencies typically handle adoption cases where the child was abandoned or removed from the parents due to abuse or neglect. Private agencies typically handle adoption cases where the birth parents choose to make an adoption plan. In countries where private adoption is legal, the birth parents choose a couple to adopt their child without any formal evaluation process.

Abortion
Women may decide it is not in their best interest to continue the pregnancy. Abortion means a doctor helps a woman end the pregnancy, which kills the developing embryo or fetus. Abortion may not be legal in all jurisdictions, and aborting a pregnancy at certain times in the pregnancy might be illegal as well.