Reproduction and Fertilization

• Oogenesis is the process of mature ovum (egg) formation, yielding one viable ovum per cycle.
• Spermatogenesis is the process of mature sperm formation, beginning at puberty and continuing throughout life, producing millions of sperm daily.
• Fertilization is the fusion of a sperm and egg (oocyte) to form a zygote in the ampulla of the fallopian tube, marking the beginning of embryonic development.
• The corpus luteum is a temporary hormone-secreting body formed on the ovary after ovulation.
• The umbilical cord connects the fetus to the placenta, consisting of two arteries and one vein, surrounded by Wharton's jelly.
• Infertility is defined as the inability to conceive after 12 months (or 6 months for women over 35) of unprotected sex.
• Artificial insemination is a medical procedure where sperm is placed directly into a woman's reproductive system.
• In vitro fertilization (IVF) involves fertilizing an egg by sperm outside the body and transferring the embryo to the uterus.
• Gamete intrafallopian transfer (GIFT) places sperm and egg directly into the fallopian tube for natural fertilization.
• Zygote intrafallopian transfer (ZIFT) involves transferring a fertilized egg (zygote) into the fallopian tube
• Embryo transfer is the transfer of the resulting embryo into the woman's uterus after fertilization.
• A teratogen is any substance or exposure that can cause embryo or fetal developmental abnormality.
• A congenital anomaly is a structural or functional abnormality present at birth.
• Organogenesis is the formation and development of body organs during the first trimester of pregnancy.
• The foramen ovale is an opening between the right and left atria in fetal circulation, shunting oxygenated blood to the left atrium.
• The ductus arteriosus is a temporary blood vessel in the fetus that connects the pulmonary artery to the aorta.
• The ductus venosus is a temporary blood vessel in the fetus that connects the umbilical vein to the inferior vena cava, bypassing the liver.

Follicle Stimulating Hormone (FSH)

• FSH is produced by the anterior pituitary gland.
• During the reproductive cycle in females, FSH stimulates growth and maturation of ovarian follicles and estrogen production.
• During the reproductive cycle in males, FSH stimulates spermatogenesis (sperm production) in the testicles.
• FSH has little to no direct role during pregnancy due to levels dropping significantly.

Luteinizing Hormone (LH)

• LH is synthesized and released by the anterior pituitary gland.
• During the reproductive cycle in females LH triggers ovulation, it surges 24- 36 hrs before ovulation and stimulates ovulation, which is usually around day 14 of the cycle and stimulates the corpus luteum to form to produce progesterone and estrogen.
• During the reproductive cycle in males, LH stimulates Leydig cells in the testes to produce testosterone, and supports sperm production
• LH has little to no role during pregnancy once hCG takes over maintaining the corpus luteum, and this prevents further ovulation to keep the hormonal environment stable.

Estrogen

• Estrogen is produced by the ovaries, adrenal glands, adipose tissue, placenta (during pregnancy), and corpus luteum.
• During the reproductive cycle, it stimulates the growth and maturation of ovarian follicles, promotes thickening of the endometrium, triggers the LH surge, affects cervical mucus, and contributes to the development of secondary sex characteristics.
• During pregnancy, it supports the growth of the uterus, breast, and external genitalia, helps maintain the uterine lining, increases blood flow to the uterus and placenta, prepares the body for lactation, prevents further ovulation, and softens the cervix.

Progesterone

• Progesterone is primarily produced by the corpus luteum and the placenta during pregnancy.
• During the reproductive cycle, it prepares the endometrium for possible pregnancy, maintains the endometrium to support implantation, thickens cervical mucus, inhibits further release of FSH and LH, and its levels drop leading to menstruation if pregnancy does not occur.
• During pregnancy, it maintains the endometrium, prevents uterine contractions, supports breast tissue development, suppresses the mother's immune system, and prepares the body for labor with estrogen.

Human Chorionic Gonadotropin (hCG)

• hCG is produced by trophoblast cells of the developing embryo and later by the placenta during early pregnancy.
• hCG is not produced during the normal menstrual cycle, it only appears after fertilization and implantation occur.
• During pregnancy, it supports the corpus luteum, prevents menstruation, maintains the uterine lining, establishes a suitable environment for the embryo, stimulates testosterone production in male fetuses, and is detected by pregnancy tests.

Human Placental Lactogen (HPL)

• HPL is produced by the placenta, specifically by the syncytiotrophoblast cells.
• HPL is only produced during pregnancy, not during the normal menstrual cycle.
• During pregnancy, it regulates maternal metabolism, causes insulin resistance, promotes lipolysis, prepares breast tissues for lactation, and has growth-promoting effects for the fetus.

Infertility Causes

• Infertility is defined as the inability to conceive after 12 months (or 6 months for women over 35) of unprotected sex.
• STIs can affect both males and females, but more commonly impacts female fertility due to pelvic inflammatory disease.
• Endocrine issues can affect both males and females, with females experiencing PCOS or hypothalamic dysfunctions, and males experiencing low testosterone or elevated prolactin.
• Abnormal sperm morphology affects the sperm's ability to swim and penetrate the egg.
• Ovulatory dysfunction due to hormonal imbalance affects a woman's ability to release a mature egg regularly.
• Progesterone deficiency affects a woman's ability to maintain a pregnancy even if fertilization occurs.
• Structural abnormalities of the reproductive tract: uterine fibroids, uterine septum, intrauterine adhesions, tubal blockage or damage in females, and blocked or absent vas deferens, ejaculatory duct obstruction, or undescended testes in males.

Placenta Functions & Amniotic Sac/Fluid

• The placenta supplies oxygen and nutrients to the fetus, removes waste products, produces hormones, acts as a barrier, and facilitates gas exchange and passive immunity.
• The placenta is fully functional by about 12 weeks gestation, maternal and fetal blood do not mix directly, and is attached to the uterine wall connected to fetus by the umbilical cord
• The amniotic sac protects the fetus from injury, maintains temperature, prevents adhesion, and allows for movement and growth.
• The amnion is the inner layer, forming the amniotic cavity, while the chorion is the outer layer, part of the placenta.
• Amniotic fluid cushions the fetus, maintains temperature, allows for movement, prevents umbilical cord compression, aids in lung development, and acts as a barrier to infection.
• Polyhydramnios is excess amniotic fluid (>1,500-2,000 mL) caused by maternal diabetes, fetal anomalies, or multiple gestation.
• Oligohydramnios is too little amniotic fluid (<500 mL) caused by fetal kidney issues, rupture of membranes, post-term pregnancy, or placental insufficiency.

Umbilical Cord Information & Timeline of Fetal Development

• The umbilical cord includes one umbilical vein (carrying oxygenated blood to the fetus) and two umbilical arteries (carrying deoxygenated blood away from the fetus).
• Wharton's jelly is a protective substance that cushions and prevents compression of the cord veins.
• The heart starts beating at 5-6 weeks gestation.
• The circulatory system is functioning by the end of the 8th week gestation.
• The zygotic period is conception through week 2.
• The embryonic period is weeks 3 through 8, during which organogenesis occurs.
• The fetal period is weeks 9 through 40, the period of growth, refinement, and maturation of organ systems.

Hormones and their functions

• Follicle stimulating hormone (FSH) stimulates follicles in ovary to develop
• Human chorionic somatotropin (hCS or hPL) increases maternal metabolism and nutrition for the fetus
• Luteinizing hormone (LH) triggers ovulation
• Progesterone stimulates endometrial growth -thickening
• Estrogen thins cervical mucous, is important for secondary sex characteristics
• Human Chorionic gonadotropin (hCG) is produced by the fertilized ovum and preserves corpus luteum after fertilization

Ovarian Cycle

• The follicular phase occurs from days 1-14 where follicle stimulating hormone increases and matures the ovum/egg in the ovaries.
• Luteinizing hormone (LH) stimulates ovulation to occur and continue follicular growth.
• Mittelschmerz is mild to moderate pain in the lower abdomen around the time of ovulation, indicating that ovulation has occurred.

Menstrual Cycle

• During the menstrual phase, the functional 2/3 of the endometrium is shed (before ovulation).
• During the proliferative phase, the endometrial lining experiences rapid growth (before ovulation) caused by progesterone.
• During the secretory phase, the endometrium continues swelling (thickening) and increased secretion (after ovulation) caused by progesterone.
• If a woman does not become pregnant around the 25th day of her reproductive cycle, the corpus luteum stops working and begins to degrade which causes the endometrial tissues to slough off.

Infertility causes

• Decreased testosterone
• STI’s
• Spermatogenesis issues
• Wearing tight clothing (can affect sperm production)
• PCOS, endometriosis, pelvic inflammatory disease (PID), obesity, endocrine problems can all affect female fertility.

Infertility treatments

• Lifestyle changes
• Antibiotics
• Medications for ovulatory disorders
• Surgery
• IVF

Assisted fertility techniques

• Zygote intrafallopian transfer (ZIFT) is a procedure in which a fertilized ovum is implanted into the female's reproductive tract

Human Development Phases

• Organogenesis is the process of organ formation, and occurs from 3 - 8 weeks.
• Zygotic phase occurs during conception through wk 2
• Embryonic phase occurs from 3 - 8 weeks
• Fetal phase occurs from 9 weeks to birth

Bonding and Attachment

• Bonding is an emotional feeling between parent and newborn that begins during pregnancy or shortly after birth, and is unidirectional from the parent to the newborn.
• Attachment is an emotional connection that forms between the infant and the child's parents, and is bidirectional from the parent to the infant and from the infant to the parent.

Learning

• Incidental learning occurs through observing others in the role, recall own parents, movies, TV, websites, support groups.
• Intentional learning occurs through formal instructions, parenting classes, demonstration, videos.

Hunger Cues

• Early hunger cues include stirring, mouth opening, and turning head seeking/rooting -- the baby is saying "I'm hungry".
• Mid hunger cues include stretching, increasing physical movement, and hand to mouth -- the baby is saying "I'm really hungry".
• Late hunger cues include crying, agitated baby movements, and colour turning red -- the baby is saying "calm me, than feed me".

Conditions

• Sudden infant death syndrome (SIDS) is used to describe the sudden and unexpected death of a baby less than a year old in which the cause was not obvious before investigation.
• Abusive head trauma (AHT) (shaken baby syndrome) is a serious brain injury that occurs when an infant or young child is violently shaken, causing the brain to move back and forth within the skull.

Breastfeeding Anatomy

• Myoepithelial cells are like tiny muscles around the milk glands that squeeze milk out when the baby nurses, found around the alveoil.
• Alveolus/Alveolar glands are the milk factory in the breast where milk is made and stored.
• Lactiferous ducts are like milk highways that carry milk from the milk-making sacs (alveoli) to the nipple so the baby can nurse.
• Milk flows from the alveoli → lactiferous ducts → nipple
• Montgomery tubercles are little bumps on the areola that keep the nipple moisturized and help guide the baby to the breast.

Milk Types

• Foremilk is produced and stored between feedings and released at the beginning of the feeding session, and has a higher water content.
• Hindmilk is produced during the feeding session and released at the end of the session, and has a higher fat content.
• Colostrum is thick, clear to yellowish breast fluid, which precedes milk production, and contains proteins, nutrients, and immune globulins. It is produced prenatally as early as the second trimester and before lactation in the first days after birth
• Mature milk is produced in great volume approximately 12 days after birth.

Breastfeeding: Evaluating & Problems

• LATCH assesses breastfeeding using a numerical score to given to each of the areas: L: latch, A: audible swallowing, T: type of mother's nipple, C: comfort, H: hold or position of newborn at breast
• Breast engorgement is distention of milk glands
• Mastitis is inflammation or infection of the breast
• Colic is used to describe uncontrollable crying in healthy infants under the age of 5 mos

Enhancing/Hampering Transition to Parenthood

• The desire to be parents is a deeply personal and intrinsic feeling, nurses can explore feelings and offer counseling if there are concerns, but can not change the desire itself.
• Nurses can not change the past in regards to previous life experiences, but they can help parents process and cope through therapeutic communications and support.
• For a couple’s relationship, nurses can encourage open communication, provide counseling referrals, or offer parenting classes to help couples work as a team.
• While nurses can't change income and financial concerns, they can refer families to resources, social services, WIC, or community programs to ease financial burdens.
• Nurses provide teaching, parenting education, and health literacy support that empower parents regardless of formal education.
• Nurses can help identify or build support networks by referring parents to support groups, home health visits, or community resources.
• Age is not modifiable, but nurses can tailor education and support based on developmental generational needs

Mercer's theory on maternal role attainment

• Commitment occurs before birth
• Acquaintance occurs early weeks after birth
• Moving towards a new normal occurs during the first 4 months after birth
• Achieve maternal identity occurs after 4 months

Reva Rubin theory on Maternal adaptation

• Taking-in phase is a period of dependent behaviors, occurs during the first 24 to 48 hrs after birth, where the mother is more focused on rest, food, and pain.
• Taking-hold phase is the movement between dependent and independent behaviors, follows the taking-in phase and can last weeks. This phase is the best time to do discharge teaching, as they are eager to learn. they become more interested in learning about infant care, breastfeeding, and parenting.
• Letting-go phase is the movement from independence to the new role of mother is fluid and interchangeable with the taking-hold phase. This is where the focus shifts to adjusting to new family roles, changes in relationship with parter, and giving up previous lifestyle.

Ways to support parents adapting to parenthood

• Give emotional support by encouraging parents to express feeling and concerns, validate their emotions and normalize challenges of new parenthood, be an active listener and provide nonjudgmental support.
• Education and skill-building by teaching newborn care, provide breastfeeding or formula-feeding support, educate on signs of postpartum complications for both parent and baby, reinforce infant cues and ways to bond
• Encouraging bounding via promote skin-to-skin, support eye contact, talking, and gentle touch, teach about infant temperament and behavior.
• Screen for PPD and anxiety, teach coping skills for stress and fatigue, provide referrals to counseling or support groups if needed.
• Involve the partner by educating partners on how they can help and bond with baby, encourage shared responsibilities in baby care, acknowledge partner's transition and emotional needs as well
• Provide info on lactation consultant, WIC, parenting classes, or home visiting nurses, encourage follow-up pediatric and postpartum visits, offer phone numbers for 24 hr nurse advice or crisis lines.

Postpartum Conditions

• Postpartum blues or baby blues is present during the first 2-3 weeks after delivery and lasts a few days. Symptoms include anger, anxiety, mood swings, sadness, weepy, difficulty sleeping and eating (but still able to care for self and infant).
• Postpartum depression present within the first 6-12 months after delivery. Symptoms include depressed mood or loss of interest or pleasure in daily activities, insomnia, excessive fatigue, loss of appetite, decreased affection towards baby, anxiety/fear/panic, uncontrolled crying, loss of hope, unable to concentrate (can't care for self or newborn).
• Postpartum psychosis is rare, the onset of this is rapid and can occur as early as 2-3 days after birth. Symptoms include paranoia, delusions, hallucinations, disorganized speech, catatonic behaviors, mood swings, extreme agitation, distraught feeling about newborn, confused thinking, belief that she or newborn may die.
• Paternal depression is present during the first 6 months after childbirth. Symptoms include being irritable, overwhelmed, frustrated, indecisive, avoiding social situations, increased alcohol and or drug use
• Screenings and recognition, counseling or psychotherapy, encourage healthy coping strategies.

Teaching styles & Hunger Cues

• Discharge teaching is an example of intentional/ formal teaching
• Early signs of hunger include the rooting reflex where the baby turns their head towards a touch on the check or mouth , stirring from sleep or waking quietly , opening mouth or turning head side-to-side -- the baby is saying "I'm hungry".
• Mid signs of hunger include stretching and increased physical movements -- the baby is saying "I'm really hungry".
• Late signs of hunger include crying and agitated body movements -- the baby is saying "calm me, then feed me".

Breastfeeding/Formula Feeding

• A baby who is breastfed needs to be burped after feedings
• Breastfeeding advantages to the mother includes reduced risk of breast & ovarian cancer and osteoporosis, increased work productivity at job & less "sick" time off for children, if gestational diabetic, decreased risk of developing type 2, weight loss in postpartum period, and helps with uterine involution
• Breastfeeding advantages to the baby are that it helps protect from SIDS, respiratory problems, type 1 & 2 diabetes, obesity, and diarrhea
• The alveolus’s function is for milk production.It stores the milk until the baby latches and suckles, triggering its release into the milk ducts.
• Oxytocin from the posterior pituitary gland causes the myoepithelial cells to contract
• When the myoepithelial cells contract it forces the milk out from the alveolus into the ducts and then out through the nipple (milk ejection).
• The lactiferous duct openings are at the tip of the nipple
• Montgomery tubercles (areolar glands) are sebaceous glands and secret oily secretions.
• Prolactin stimulates milk production, and is produced by the anterior pituitary gland.
• Foremilk contains more protein and water that is needed for neurologic development in the newborn.
• The baby sucking on the mother's breast will stimulate the anterior pituitary gland to produce prolactin
• Hindmilk contains more fats and carbs, and makes a baby feel "full" and helps the baby gain weight.

Breastfeeding Complications

• Common breastfeeding complications include nipple soreness and altered skin integrity, engorgement, and mastitis (inflammation)
• Correct the infant's latch, after feedings let the nipples air dry for a few minutes and use lanolin or vitamin E on nipples after feedings to help with nipple soreness and altered skin integrity.
• Preventing sore/cracked nips as well as completely emptying breast during prevent mastitis.
• If engorgement occurs, DO NOT stop breastfeeding, but wear a supportive bra, use warm packs or showers before feeding, medicine for pain, frequent feedings, pump/express milk if unable to feed newborn and use ice packs or cold cabbage leaves between feedings
• Currently using street drugs, with active/untreated TB, with active herpes simplex lesion on breast, If HIV positive with a high viral load and not being treated, while receiving chemo or radiation treatments.
• The side-lying is the most comfortable breastfeeding position for a woman with a cesarean delivery and a painful episiotomy.
• Instruct a woman who is bottle feeding her newborn on how to deal with breast engorgement by wearing a supportive bra, to NOT express milk or put baby on breast, to have no nipple stimulation, and to use cabbage leaves for relieve of discomfort