Introduction to Human Sexuality Part II Chapter 15 Conception, Pregnancy, and Birth

CHAPTER 15 Chapter 15 Conception , Pregnancy , and Birth , AND EMERSON WOLFE , LEARNING OUTCOMES Analyze psychosocial and cultural factors impacting abortion , pregnancy and the birthing process and discuss best practices to promote equity within healthcare systems . Demonstrate an understanding of the process of conception including how to enhance the possibility of conception infertility problems and how they might be dealt with spontaneous and elective abortion aspects of a healthy pregnancy sexual interaction during pregnancy stages of childbirth psychological and sexual adjustments postpartum INTRODUCTION This week reading is all about conception , pregnancy and birth . Much of the content we be covering will be physiological , in nature . However , as you go through the material , please keep your intersectional lens on . For example , when we discussing the biology of fertilization , how might environmental conditions influence the process ( conception through intercourse versus ) Or perhaps when we consider pregnancy , how might economic status race impact folks access to prenatal care ?

And when we address issues of birth , note the disparity in how everything from pain care to maternal and infant mortality impact . As with many of these topics in human sexuality , we can marvel at the complexities and wonder of our bodies and their many responses . At the same time , we can challenge the areas in which culture , race , poverty , ethnicity , abilities , and can impede some people opportunities . One more note This chapter is very much a . One of the challenges we had this chapter is finding the balance of maintaining the respectful and safe space that pregnancy and birthing has afforded generations 204

PREGNANCY 205 of women . This is especially true for communities that push back against dominant , white , medical establishments . At the same time , we seek to broaden the language , awareness , and understanding of pregnancy and birth , since so much of the traditional , western approaches have excluded people and families . In that vein , we are embracing the and that we striving to consistently honor our and visionaries of birth who held safe space for women , as well as respectfully embrace our , trans , and diverse families in the amazing process of pregnancy and birth . CONCEPTION Fertilization occurs when a sperm and an oocyte ( egg ) combine and their nuclei fuse . Because each of these reproductive cells is a haploid cell containing half of the genetic material needed to form a human being , their combination forms a diploid cell . This new single cell , called a zygote , contains all of the genetic material needed to form a the egg and half from the sperm . Transit of Sperm Fertilization is a numbers game . During ejaculation , hundreds of millions of sperm ( spermatozoa ) are released into the vagina . Almost immediately , millions of these sperm are overcome by the acidity of the vagina , and millions more may be blocked from entering the uterus by thick cervical mucus . Ofthose that do enter , thousands are destroyed by phagocytic uterine leukocytes . Thus , the race into the uterine tubes , which is the most typical site for sperm to encounter the oocyte , is reduced to a few thousand contenders . to be facilitated by uterine takes from 30 minutes to hours . If the sperm do not encounter an oocyte immediately , they can survive in the uterine tubes for another days . Thus , fertilization can still occur if intercourse takes place a few days before ovulation . In comparison , an oocyte can survive independently for only approximately 24 hours following ovulation . Intercourse more than a day after ovulation will therefore usually not result in fertilization . During thejourney , fluids in the female reproductive tract prepare the sperm for fertilization through a process called capacitation , or priming . The fluids improve the motility of the spermatozoa . They also deplete cholesterol molecules embedded in the membrane of the head of the sperm , thinning the membrane in such a way that will help facilitate the release of the lysosomal ( digestive ) enzymes needed for the sperm to penetrate the exterior once contact is made . Sperm must undergo the process of capacitation in order to have the capacity to fertilize an oocyte . If they reach the oocyte before capacitation is complete , they will be unable to penetrate the oocyte thick outer layer of cells . Contact Between Sperm and Oocyte Upon ovulation , the oocyte released by the ovary is swept uterine tube . Fertilization must occur in the distal uterine tube because an unfertilized oocyte can not survive the to the uterus . As it is swept along the distal uterine tube , the oocyte encounters the surviving sperm , which stream toward it in response to chemical released by the cells of the corona . To reach the oocyte itself , the sperm must penetrate the two protective layers . Eventually , a single sperm makes contact with receptors on the oocyte plasma membrane . The plasma membrane of that sperm then fuses with the plasma membrane , and the head and of the winning sperm enter the oocyte interior . How do sperm penetrate the corona ?

As you can see , the first sperm to reach the oocyte is never the one to fertilize it . Rather , hundreds of sperm cells must undergo the reaction , each helping to degrade the corona and until a path is created to allow one sperm to contact and fuse with the

206 EMERSON WOLFE , plasma membrane of the oocyte . If you consider the loss of millions of sperm between entry into the vagina and degradation of the , you can understand why a low sperm count can cause infertility . One or more interactive elements has been excluded from this version of the text . You can view them online here on . The Zygote Most of the time , a single egg is released during an ovulation cycle . However , in approximately percent of ovulation cycles , two eggs are released and both are fertilized . Two form , implant , and develop , resulting in the birth of dizygotic ( or fraternal ) twins . Because dizygotic twins develop from two eggs fertilized by two sperm , they are no more identical than siblings born at different times . Much less commonly , a zygote can divide into two separate offspring during early development . This results in the birth of monozygotic ( or identical ) twins . Although the zygote can split as early as the stage , splitting occurs most commonly during the early blastocyst stage , with roughly cells present . These two scenarios are distinct from each other , in that the twin embryos that separated at the stage will have individual placentas , whereas twin embryos that form from separation at the blastocyst stage will share a placenta and a chorionic cavity . In Vitro Fertilization , which stands for in vitro fertilization , is an assisted reproductive technology . In vitro , which in Latin translates to in glass , refers to a procedure that takes place outside of the body . There are many different indications for . For example , someone may produce normal eggs , but the eggs can not reach the uterus because the uterine tubes are blocked or otherwise compromised . There are also challenges with low sperm count , low sperm motility , sperm with an unusually high percentage of morphological abnormalities , or sperm that are incapable of penetrating the of an egg . A typical procedure begins with egg collection . A normal ovulation cycle produces only one oocyte , but the number can be boosted significantly ( to ) by administering a short course of . The course begins with hormone ( which support the development of multiple follicles , and ends with a hormone ( analog that triggers ovulation . Right before the ova would be released from the ovary , they are harvested using oocyte retrieval . In this procedure , ultrasound allows a physician to visualize mature follicles . The ova are aspirated ( sucked out ) using a syringe . In parallel , sperm are obtained from a partner or from a sperm bank . The sperm are prepared by washing to remove seminal fluid because seminal fluid contains a peptide , or , fertilization promoting peptide ) high capacitation of the sperm . The sperm sample is also concentrated , to increase the sperm count per milliliter . Next , the eggs and sperm are mixed in a petri dish . The ideal ratio is sperm to one egg . Ifthere are severe problems with the example , the count is exceedingly low , or the sperm are completely nonmotile ,

PREGNANCY 207 or incapable of binding to or penetrating the sperm can be injected into an egg . This is called sperm injection ( Capillary Tube Insertion by Microscopy is licensed under . The embryos are then incubated until they either reach the stage or the blastocyst stage . In the United States , fertilized eggs are typically cultured to the blastocyst stage because this results in a higher pregnancy rate . Finally , the embryos are transferred to the uterus using a plastic catheter ( tube ) is a relatively new and still evolving technology , and until recently it was necessary to transfer multiple embryos to achieve a good chance of a pregnancy . Today , however , transferred embryos are much more likely to implant successfully , so countries that regulate the industry cap the number of embryos that can be transferred per cycle at two . This reduces the risk of pregnancies . PREGNANCY Pregnancy begins with the fertilization of an egg and continues through to the birth of the individual . The length of time of gestation varies among animals , but is very similar among the great apes human gestation is 266 days , while chimpanzee gestation is 237 days , a is 257 days , and orangutan gestation is 260 days long . The fox has a gestation . Dogs and cats have similar averaging 60 days . The longest gestation for a land mammal is an African elephant at 640 days . The longest among marine mammals are the beluga and sperm whales at 460 days . hours before fertilization , the egg has finished meiosis and becomes a mature oocyte . When fertilized ( at conception ) the egg becomes known as a zygote . The zygote travels through the oviduct to the uterus . The developing embryo must implant into the wall of the uterus within seven days , or it will deteriorate and die . The outer layers of the zygote ( blastocyst ) grow into the endometrium by digesting the endometrial cells , and wound healing of the endometrium closes up the blastocyst into the tissue . Another layer of the blastocyst , the chorion , begins releasing a hormone called human beta chorionic gonadotropin ( which makes its way to the corpus and keeps that structure active . This ensures adequate levels of progesterone that will maintain the endometrium of the uterus for the support of the developing embryo . Pregnancy tests determine the level of in urine or serum . If the hormone is present , the test is positive .

208 EMERSON WOLFE , DAY By Own work , The gestation period is divided into three equal periods or . During the first two to four weeks of the first trimester , nutrition and waste are handled by the endometrial lining through diffusion . As the trimester progresses , the outer layer of the embryo begins to merge with the endometrium , and the placenta forms . This organ takes over the nutrient and waste requirements of the embryo and fetus , with the parent blood passing nutrients to the placenta and removing waste from it . First Trimester Internal organs and body structures begin to develop during the first trimester . By five weeks , limb buds , eyes , the heart , and liver have been basically formed . By eight weeks , the term fetus applies , and the body is essentially formed , as shown in Figure . The individual is about five centimeters ( two inches ) in length and many of the organs , such as the lungs and liver , are not yet functioning . Exposure to any toxins is especially dangerous during the first trimester , as all of the body organs and structures are going through initial development . Anything that affects that development can have a severe effect on the fetus survival . Figure Fetal development is shown at nine weeks gestation . Credit Ed ) Second Trimester During the second trimester , the fetus grows to about 30 ( 12 inches ) as shown in Figure . It becomes active and the mother usually feels the first movements . All organs and structures continue to develop . The placenta has taken over the functions of nutrition and waste and the production of estrogen and progesterone from the corpus , which has degenerated . The placenta will continue functioning up through the delivery of the baby . Figure This fetus is just entering the second trimester , when the placenta takes over more of the functions performed as the baby develops . Credit National Museum of Health and Medicine )

PREGNANCY 209 Third Trimester During the third trimester , the fetus grows to to ( and about 50 ( inches ) long , as illustrated in Figure . This is the period of the most rapid growth during the pregnancy . Organ development continues to birth ( and some systems , such as the nervous system and liver , continue to develop after birth ) Figure There is rapid fetal growth during the third trimester . Credit modification of work by Gray Anatomy ) Maternal Changes During Pregnancy A pregnancy lasts approximately 270 days ( approximately weeks ) from conception to birth . Because it is easier to remember the first day of the last menstrual period ( than to estimate the date of conception , obstetricians set the due date as 284 days ( approximately weeks ) from the This assumes that conception occurred on day 14 of the woman cycle , which is usually a good approximation . The 40 weeks of an average pregnancy are usually discussed in terms of three , each approximately 13 weeks . During the second and third , the the size ofa dramatically to contain the fetus , causing a number changes in the mother ( Figure ) Figure Size of Uterus throughout Pregnancy . The uterus grows throughout pregnancy to accommodate the fetus . of Hormones Virtually all of the effects of pregnancy can be attributed in some way to the influence of , progesterone , and . As the placenta develops and the corpus degenerates during weeks , the placenta gradually takes over as the endocrine organ of pregnancy . The placenta converts weak secreted by the maternal and fetal adrenal glands to , which are necessary for pregnancy to progress . Estrogen levels climb throughout the pregnancy , increasing by childbirth . have the following actions They suppress and production , effectively preventing ovulation . This function is the biological basis of hormonal birth control pills . They induce the growth of fetal tissues and are necessary for the maturation of the fetal lungs and liver . They promote fetal viability by regulating progesterone production and triggering fetal synthesis of cortisol , which helps with the maturation of the lungs , liver , and endocrine organs such as the thyroid gland and adrenal gland . They stimulate maternal tissue growth , leading to uterine enlargement and mammary duct expansion and branching . another hormone secreted by the corpus and then by the placenta , helps prepare the body for childbirth . It increases the elasticity of the symphysis pubis joint and pelvic ligaments , making room for the growing fetus and allowing expansion of the pelvic outlet for childbirth . also helps dilate the cervix during labor .

210 EMERSON WOLFE , Weight Gain The second and third of pregnancy are associated with dramatic changes in maternal anatomy and physiology . The most obvious anatomical sign of pregnancy is the dramatic enlargement of the abdominal region , coupled with maternal weight gain . This weight results from the growing fetus as well as the enlarged uterus , amniotic fluid , and placenta . Additional breast tissue and dramatically increased blood volume also contribute to weight gain ( Table ) Surprisingly , fat storage accounts for only approximately ( in a normal pregnancy and serves as a reserve for the increased metabolic demand of breastfeeding . During the first trimester , the parent does not need to consume additional calories to maintain a healthy pregnancy . However , a weight gain of approximately ( per month is common . During the second and third , the mother appetite increases , but it is only necessary for her to consume an additional 300 calories per day to support the growing fetus . Most women gain approximately ( per week . Contributors to Weight Gain During Pregnancy Component Weight ( Weight ( Fetus Placenta and fetal membranes Amniotic fluid Breast tissue Blood Fat Uterus Total Table Changes in Organ Systems During Pregnancy As the body adapts to pregnancy , characteristic changes occur . These changes can sometimes prompt symptoms often referred to collectively as the common discomforts of pregnancy . and Urinary System Changes Nausea and vomiting , sometimes triggered by an increased sensitivity to odors , are common during the first few weeks to months of pregnancy . This phenomenon is often referred to as morning sickness , although the nausea may persist all day . The source of pregnancy nausea is thought to be the increased circulation of related hormones , specifically circulating estrogen , progesterone , and . Decreased intestinal peristalsis may also contribute to nausea . By about week 12 of pregnancy , nausea typically subsides . A common gastrointestinal complaint during the later stages of pregnancy is gastric reflux , or heartburn , which results from the upward , constrictive pressure of the growing uterus on the stomach . The same decreased peristalsis that may contribute to nausea in early pregnancy is also thought to be responsible for related constipation as pregnancy progresses . The downward pressure of the uterus also compresses the urinary bladder , leading to frequent urination . The problem is exacerbated by increased urine production . In addition , the maternal urinary system processes both maternal and fetal wastes , further increasing the total volume of urine .

PREGNANCY 211 Blood volume increases substantially during pregnancy , so that by childbirth , it exceeds its preconception volume by 30 percent , or approximately liters . The greater blood volume helps to manage the demands of fetal nourishment and fetal waste removal . In conjunction with increased blood volume , the pulse and blood pressure also rise moderately during pregnancy . As the fetus grows , the uterus compresses underlying pelvic blood vessels , hampering venous return from the legs and pelvic region . As a result , many pregnant women develop varicose veins or hemorrhoids . During the second half of pregnancy , the respiratory minute volume ( volume of gas inhaled or exhaled by the lungs per minute ) increases by 50 percent to compensate for the oxygen demands ofthe fetus and the increased maternal metabolic rate . The growing uterus exerts upward pressure on the diaphragm , decreasing the volume of each inspiration and potentially causing shortness of breath , or dyspnea . During the last several weeks of pregnancy , the pelvis becomes more elastic , and the fetus descends lower in a process called lightening . This typically dyspnea . The respiratory mucosa swell in response to increased blood flow during pregnancy , leading to nasal congestion and nose bleeds , particularly when the weather is cold and dry . Humidifier use and increased fluid intake are often recommended to counteract congestion . The dermis ( skin ) stretches extensively to accommodate the growing uterus , breast tissue , and fat deposits on the thighs and hips . Torn connective tissue beneath the dermis can cause striae ( stretch marks ) on the abdomen , which appear as red or purple marks during pregnancy that fade to a silvery white color in the months after childbirth . An increase in hormone , in conjunction with , darkens the and creates a line of pigment from the umbilicus to the pubis called the linea nigra ( Figure ) Melanin production during pregnancy may also darken or discolor skin on the face to create a chloasma , or mask of Figure Linea Nigra The linea nigra , a dark medial line running from the umbilicus to the pubis , forms during pregnancy and persists for a few weeks following childbirth . The linea nigra shown here corresponds to pregnancies that are 38 and 22 weeks along . Birth Labor is the physical efforts of expulsion ofthe fetus and the placenta from the uterus during birth ( parturition ) Toward the end of the third trimester , estrogen causes receptors on the uterine wall to develop and bind the hormone oxytocin . At this time , the baby , facing forward and down with the back or crown of the head engaging the cervix ( uterine opening ) This causes the cervix to stretch and nerve impulses are sent to the hypothalamus , which signals for the release of oxytocin from the posterior pituitary . The oxytocin causes the smooth muscle in the uterine wall to contract . At the same time , the placenta releases into the uterus , increasing the contractions . A positive feedback relay occurs between the uterus , hypothalamus , and the posterior pituitary to assure an adequate supply of oxytocin . As more smooth muscle cells are recruited , the contractions increase in intensity and force .

212 EMERSON WOLFE , Stages of Childbirth The process of childbirth can be divided into three stages cervical dilation , expulsion of the newborn , and afterbirth ( Figure ) Cervical Dilation For vaginal birth to occur , the cervix must dilate fully to 10 in enough to deliver the head . The dilation stage is the longest stage of labor and typically takes hours . However , it varies widely and may take minutes , hours , or days , depending in part on whether the mother has given birth before in each subsequent labor , this stage tends to be shorter . Figure Stages of Childbirth The stages of childbirth include Stage , early cervical dilation Stage , full dilation and expulsion ofthe newborn and Stage , delivery ofthe placenta and associated fetal membranes . The position of the newborn shoulder is described relative to the mother . True labor progresses in a positive feedback loop in which uterine contractions stretch the cervix , causing it to dilate and efface , or become thinner . Cervical stretching induces reflexive uterine contractions that dilate and efface the cervix further . In addition , cervical dilation boosts oxytocin secretion from the pituitary , which in turn triggers more powerful uterine contractions . When labor begins , uterine contractions may occur only every minutes and last only seconds however , by the end of this stage , contractions may occur as frequently as every minutes and last for a full minute . Each contraction sharply reduces oxygenated blood flow to the fetus . For this reason , it is critical that a period of relaxation occur after each contraction . Fetal distress , measured as a sustained decrease or increase in the fetal heart rate , can result from severe contractions that are too powerful or lengthy for oxygenated blood to be restored to the fetus . Such a situation can be cause for an emergency birth with vacuum , forceps , or surgically by Caesarian section . The amniotic membranes rupture before the onset of labor in about 12 percent of women they typically rupture at the end of the dilation stage in response to excessive pressure from the fetal head entering the birth canal . Expulsion Stage The expulsion stage begins when the fetal head enters the birth canal and ends with birth of the newborn . It typically takes up to hours , but it can last longer or be completed in minutes , depending in part on the orientation of the fetus . The vertex presentation known as the occiput anterior vertex is the most common presentation and is associated with the greatest ease birth . The fetus faces the maternal spinal cord and the smallest part of the head ( the posterior aspect called the occiput ) exits the birth canal first . In fewer than percent of births , the infant is oriented in the breech presentation , or buttocks down . In a complete breech , both legs are crossed and oriented downward . In a frank breech presentation , the legs are oriented upward . Before the , it was common for breech presentations to be delivered vaginally . Today , most breech births are accomplished by Caesarian section . Vaginal birth is associated with significant stretching of the vaginal canal , the cervix , and the perineum . Until recent decades , it was routine procedure for an obstetrician to numb the perineum and perform an episiotomy , an incision in the posterior vaginal wall and perineum . The perineum is now more commonly allowed to tear on its own during birth . Both an episiotomy and a perineal tear need to be sutured shortly after birth to ensure optimal healing . Although suturing edges of a perineal tear may be more difficult than suturing an episiotomy , tears heal more quickly , are less painful , and are associated with less damage to the muscles around the vagina and rectum .

PREGNANCY 213 Upon birth of the newborns head , an obstetrician will aspirate mucus from the mouth and nose before the newborns first breath . Once the head is birthed , the rest of the body usually follows quickly . The umbilical cord is then , and a cut is made between the clamps . This completes the second stage of childbirth . Afterbirth The delivery of the placenta and associated membranes , commonly referred to as the afterbirth , marks the final stage of childbirth ( Figure ) After expulsion of the newborn , the myometrium continues to contract . This movement shears the placenta from the back of the uterine wall . It is then easily delivered through the vagina . Continued uterine contractions then reduce blood loss from the site of the placenta . Delivery of the placenta marks the beginning of the postpartum period of approximately weeks immediately following childbirth during which the pregnant person body gradually returns to a state . If the placenta does not birth spontaneously within approximately 30 minutes , it is considered retained , and the obstetrician may attempt manual removal . If this is not successful , surgery may be required . It is important that the obstetrician examines the expelled placenta and fetal membranes to ensure that they are intact . If fragments of the placenta remain in the uterus , they can cause postpartum hemorrhage . Uterine contractions continue for several hours after birth to return the uterus to its size in a process called involution , which also allows the abdominal organs to return to their locations . Breastfeeding facilitates this process . Figure Human Afterbirth ( Placenta ) Public domain , via Commons Pregnancy and Birthing Challenges Miscarriages Unfortunately , some instances of pregnancy do not end in a healthy birth . Miscarriage , or spontaneous pregnancy loss before 28 weeks of gestation , occurs in up to percent of pregnancies ( Chapman , Ford , 2018 Bellhouse , 2018 ) The majority of these miscarriages tend to occur before 12 weeks ( often before women realize they pregnant ) Nearly half ofall miscarriages have no known cause , leading to widespread about frequency . In cases where there is a known cause , half are attributed to chromosomal abnormalities . Consequently , most miscarriages are largely out of the control of the expectant parent . Additionally , most miscarriages do not inform the parent past or future success in bringing a baby to ( et al , 2018 ) In addition to some confusion regarding prevalence and frequency of miscarriage rates , there are often mixed responses to families impacted by miscarriage from the medical community , the general public , family members and friends . In so many ways , pregnancy loss is a time when many people need emotional support from those around them . There are a number of agencies and hospital facilitated programs now in place to support families who experienced loss . Partners are often a huge source of support , but research also identifies the need for more public discourse and education around pregnancy loss generally , which boosts for all members of the families involved ( Bellhouse , 2018 ) Abortion The issues surrounding abortion , the deliberate termination of a pregnancy , remain highly charged throughout the United States and around the globe . In the US , there were over abortions in 2018 reported to the Centers for Disease Control ( a rate of abortions per women aged years (

214 EMERSON WOLFE , Reeves , 2020 ) Over half of the abortions ( in 2018 occurred among women in their . Interestingly , 2018 was the first year in almost a decade where there was a slight increase in the rate ( across measure ) Overall , the total number of reported abortions , abortion rate , and abortion ratio decreased 22 from ( et al , 2020 ) For more details on the data , which outlines age of parent , gestational periods , and more can be found here and below . Despite the seminal decision Roe Wade ( 1973 ) which protects a pregnant person liberty to choose to have an abortion without government prohibition , a number of states have enacted more stringent measures restricting access to abortion healthcare . In 2020 , alone , 26 additional abortion restrictions were implemented across the US ( Institute , 2020 ) Interestingly , states with the most limitations in access to abortion care also tend to have the most conservative ( or absence ) of sex education , the highest rates of unintended pregnancies and the lowest indicators of ( 2016 , 2018 ) Caesarean Section Cesarean section ( the surgical operation to remove an infant out of their pregnant parent body , has been part of human culture since ancient times ( 1998 ) Since 1996 , have been on an almost steady rise in the United States . In 2018 , approximately ( ofall births occurred through cesarean delivery ( Martin , Hamilton , Driscoll , 2019 ) There is no question that can save lives both of parents and children . However , there is a rising concern that many of these procedures are unnecessary , causing needless risk of complications to both mother and baby , as well as potential implications ( following the first , there is a low probability , 10 , of later vaginal delivery Martin , 2014 ) One of the ongoing criticisms about the high rate of is that it is primarily financially driven in terms of payout to , rather than due to patient care . Considering that a costs twice as much as a vaginal delivery , the economic boon for attending medical can be high . On the public side ofthings , almost half of US births are compensated through Medicaid ( with double the payout for , Graves , Shah , 2018 ) Added to that , one found that are more likely to be performed on privately insured women as compared with women using public health insurance coverage ( Goodman , da Costa , Juni , 2017 ) Thankfully , more efforts are being examined and implemented to reduce unnecessary births via cesarean section ( et al , 2018 ) DISPARITIES IN PRENATAL AND CARE Racial and ethnic disparities in maternal care have been an issue in the United States for generations . Just as we discussed in last week reading , abuse against black and brown bodies has been excessive and consequential . In terms of prenatal and care , there have been ongoing discrepancies in care , resulting in inexcusable outcomes . Nearly a quarter of black women experience delays in their prenatal healthcare and they are almost twice as likely to experience pregnancy complications ( Parker , Keith , Lee , 2019 ) Among industrialized nations , the US has the highest level of maternal deaths ( 2020 ) Wang and her colleagues ( 2021 ) reported that black women are three to four times more likely to die of related causes compared to White women . A black or indigenous person is up to times more likely to die in pregnancy or up to a year after pregnancy than their white peer ( 2020 ) This disparity is akin to what we saw in the ( 2020 ) importantly , when controlling for other variables , such as education , status , accessibility , findings consistently suggest that lived experiences , in the form of racial , influence Black women use of health care , particularly services ( et al , 2019 ) Despite advances in healthcare , antibiotics , surgical processes , and accessibility , the data provides a stark reality of rampant , systemic

PREGNANCY 215 inequity . As and ( 2020 ) note , The US has to intentionally focus on disparities between Black and white women , in particular by naming and seeking to reduce the impacts of structural racism ( 12 ) Please see the Commonwealth Fund recent briefing here . There is a great deal of work to do to rectify the massive inequities facing this country . There are a variety of initiatives at both and the national level to address the disparities in care . To see a state by state comparison , go . The Centers for Disease Control also has launched the Hear Her To be clear , the disparities in maternal health are not the result of any one , single factor . It at the intersection of sexism and racism , that many women of color are not being heard or seen . The initiatives noted above are a very small part in rectifying this . Continued efforts to name and eliminate structural racism , as well as provide comprehensive health care for pregnant bodies , are essential . CONCLUSION This week reading covers a wide range of concepts related to conception , pregnancy , and birth . Additionally , we highlighted some of the major disparities of care for . There are other marginalized populations that need further examination individuals with disabilities and gender nonconforming folks . There are also other stakeholders that were omitted from this section partners , surrogates , midwives , and . Finally , some considerations about lactation and postpartum adjustments can be explored further . Still , hopefully you got a solid introduction into the brilliance of conception , the marvel of pregnancy and birth , as well as the pressing issue of our time building equity into the healthcare ofall people . LICENSES College . 2019 ) Anatomy physiology . Textbook content produced by is licensed under a Creative Commons Attribution License license . College . 2018 ) Biology , Textbook content produced by is licensed under a Creative Commons Attribution License license . Adaptations Reformatted . Added learning objectives . Modified content for language , application to subject and cohesion . Updated sources . All Rights Reserved , Levine , A . 2015 , May ) How in vitro fertilization ( works Video . and brian a levine how In vitro fertilization works ?

Creative Commons International . 2019 , July 31 ) positions to ease labor pain Video . watch ?

License All Rights Reserved . License Terms Standard YouTube license . Centers for Disease Control and Prevention . Campaign Video . watch ?

Creative Commons Attribution License . 2016 , November 18 ) Miracle of life months in minutes Video . watch ?

License All Rights Reserved . License Terms Standard YouTube license . Nucleus Medical Media ( 2013 , January 31 ) Fertilization Video . License All Rights Reserved . License Terms Standard YouTube license . 2020 , October 10 ) The surprising effects of pregnancy Video . watch ?

Creative Commons International . References , Castillo , Wolfe , 2019 ) Black Maternal Health Research Best Practices for the Conduct of Research with , for , and by Black Mamas . 14 , 393 .

216 EMERSON WOLFE , Bellhouse , 2018 ) one of those things people do seem to talk about women experiences of social support following miscarriage a qualitative study . women health , 18 ( Young , Wise , Poe , Johnson , Womble , 2019 ) Anatomy and physiology . Byrnes , Hickey , 2016 ) care for women with disabilities clinical considerations . for Nurse Practitioners , 12 ( Centers for Disease Control Prevention . 2020 ) Hear her campaign . National Center for Chronic Disease Prevention and Health Promotion , Division of Reproductive Health . Clark , Douglas , Choi , 2018 ) Biology , Edition . A . Seed , 2017 ) mortality in the United States , Obstetrics and Gynecology , 130 ( Pregnancy Related Mortality in the United States , 2020 ) Maternal mortality in the United States A primer . The Commonwealth Fund . mer , 2017 ) midwifery , a history and a lament . of Economics and Sociology , 76 ( Institute . 2020 ) State policies on abortion . Goodman , da Costa , ini , 2017 ) Caesarean sections and private insurance systematic review and . open , Reeves , 2020 ) Abortion States , 2018 . Surveillance Summaries , 69 ( Graves , Shah , 2018 ) Cesarean Delivery Rates and Costs of Childbirth in a State Medicaid Program After Implementation of a Blended Payment Policy . Medical care , 56 ( Light , 2014 ) Transgender men who experienced pregnancy after gender transitioning . Obstetrics Gynecology , 124 ( Martin , Hamilton , Driscoll , 2019 ) Births Final Data for 2018 . National vital statistics reports from the Centers for Disease Control and Prevention , National Center for Health Statistics , National Vital Statistics System , 68 ( 13 ) 2020 ) Our mothers are dying The current state of maternal mortality in i and the United States . of Health Social Welfare , 79 ( 10 ) 302 . 2016 ) versus The relationship between state abortion policy and child being in the United States . Health Care for Women International , 37 ( 2016 ) Transgender men and pregnancy . Obstetric Medicine , Martin , A . 2014 ) Trends in cesarean delivery in the United States , National vital statistics reports from the Centers for Disease Control and Prevention , National Center for Health Statistics , National Vital Statistics System , 63 ( 1998 ) Cesarean section A brief history . Shorter , Sammel , A . 2020 ) Racial Disparities in mental health outcomes among women with early pregnancy loss . Obstetrics and Gynecology , 137 (

PREGNANCY 217 , Parker , Keith , Lee , 2019 ) Skin tone matters Racial and delayed prenatal care . of Preventive Medicine , 57 ( Chapman , Ford , 2018 ) Examining about miscarriage in US of Prenatal Psychology Health , 32 ( Wang , Glazer , Howell , A . 2020 ) Racial and ethnic disparities in severe maternal morbidity A qualitative study of women experiences of care . Women Health Issues . casa (