A Perspective

The attainment of typical developmental milestones has a direct impact on the client. Biological, psychological, and social development systems operate together to affect behavior. This chapter will explore some of the major aspects of infancy and childhood that social workers must understand in order to provide information to clients and make appropriate assessments of client behavior.

2-1 Describe the Dynamics of Human Reproduction

LO 1

Chuck and Christine had mixed emotions about the pregnancy. It had been an accident. They were both in their mid-30s and already had a vivacious 4-year-old daughter named Hope. Although Hope had been a joy to both of them, she had also placed serious restrictions on their lifestyle. They were looking forward to her beginning school. Christine had begun to work part-time and was planning to go full-time as soon as Hope turned 5.

Now all that had changed. To complicate the matter, Chuck, a university professor, had just received an exciting job offer in Hong Kong—the opportunity of a lifetime. They had always dreamed of spending time overseas.

Yes, they would have the baby. Once the decision had been made, they were filled with relief and joy. They also decided to take the job in Hong Kong. They would use the knowledge they had about prenatal care, birth, and infancy to maximize the chance of having a healthy, normal baby. They concluded that this baby was a blessing who would improve, not impair, the quality of their lives.

The decision to have children is a serious one. Ideally, a couple should examine all alternatives. Children can be wonderful. Family life can bring pleasurable activities, pride, and fullness to life. On the other hand, children can cause stress. They demand attention, time, and effort and can be expensive to care for. Information about conception, pregnancy, birth, and child rearing can only help people make better, more effective decisions.

2-1aConception

Sperm meets egg; a child is conceived. But in actuality, it is not quite that simple. Many couples who strongly desire to have children have difficulty conceiving. Many others whose last desire is to conceive do so with ease. Some amount of chance is involved.

Conception refers to the act of becoming pregnant. Sperm need to be deposited in the vagina near the time of ovulation.  Ovulation involves the ovary’s release of a mature egg into the body cavity near the end of one of the fallopian tubes. Fingerlike projections called  fimbriae at the end of the fallopian tube draw the egg into the tube. From there, the egg is gently moved along inside the tube by tiny hairlike extensions called  cilia. Fertilization actually occurs in the third of the fallopian tube nearest the ovary.

If a sperm has gotten that far, conception may occur. After  ejaculation, the discharge of semen by the penis, the sperm travels up into the uterus and through the fallopian tube to meet the egg. Sperm are equipped with a tail that can lash back and forth, propelling them forward. The typical ejaculate, an amount of approximately one teaspoon, usually contains 200 to 400 million sperm; however, only 1 in 1,000 of these will ever make it to the area immediately surrounding the egg (Rathus, Nevid, & Fichner-Rathus, 2014). Unlike females, who are born with a finite number of eggs, males continually produce new sperm. Fertilization is therefore quite competitive. It is also hazardous. The majority of these sperm don’t get very far (Hyde & DeLamater, 2017; Rathus et al., 2014). Many spill out of the vagina, drawn by gravity. Others are killed by the acidity of the vagina. Still others swim up the wrong fallopian tube, meaning the one without the egg. Only about 2,000 sperm make it up the right tube. By the time a sperm reaches the egg, it has swum a distance 3,000 times its own length; an equivalent swim for a human being would be more than 3 miles (Hyde & DeLamater, 2017).

Although sperm are healthiest and most likely to fertilize an egg during the first 24 hours after ejaculation, they may survive up to 72 hours in a woman’s reproductive tract; an egg’s peak fertility is within the first 8 to 12 hours after ovulation, although it may remain viable for fertilization for up to 24 hours, and some may remain viable for up to five days (Greenberg, Bruess, & Oswalt, 2017; Newman & Newman, 2015). Therefore, sexual intercourse should ideally occur not more than five days before or one day after ovulation for fertilization to take place (Yarber & Sayad, 2016).

In the fallopian tube, the egg apparently secretes a chemical substance that attracts sperm. The actual fertilization process involves sperm reaching the egg, secreting an enzyme, and depositing it on the egg. This enzyme helps dissolve a gelatinous layer surrounding the egg and allows for the penetration of a sperm. After one sperm has penetrated the barrier, the gelatinous layer undergoes a physical change, thus preventing other sperm from entering it.

Fertilization occurs during the exact moment the egg and sperm combine. Eggs that are not fertilized by sperm simply disintegrate. The genetic material in the egg and sperm combine to form a single cell called a  zygote.

Eggs contain an X chromosome. Sperm may contain either an X or a Y chromosome. Eggs fertilized by a sperm with an X chromosome will result in a female; those fertilized by sperm with a Y chromosome will result in a male.

2-1bDiagnosis of Pregnancy

Pregnancy can be diagnosed by using laboratory tests, by observing the mother’s physical symptoms, or by performing a physical examination. Early symptoms of pregnancy can include increase in basal body temperature that lasts for up to 3 weeks, breast tenderness, feelings of fatigue, and nausea (Hyde & DeLamater, 2017). Many women first become aware of the pregnancy when they miss a menstrual period. However, women also can miss periods as a result of stress, illness, or worry about possible pregnancy. Some pregnant women will even continue to menstruate for a month or even more. Therefore, lab tests are often needed to confirm a pregnancy. Such lab tests are 98 to 99 percent accurate and can be performed at a Planned Parenthood agency, a medical clinic, or a physician’s office (Hyde & DeLamater, 2017; Rathus et al., 2014).

Most pregnancy tests work by detecting human chorionic gonadotropin (HCG) in a woman’s urine or blood. HCG is a hormone secreted by the  placenta (the tissue structure that nurtures a developing embryo). Laboratory tests can detect HCG as early as eight days after conception (Greenberg et al., 2014).

The use of home pregnancy tests (HPTs) has become quite common. Like some laboratory tests, they measure HCG levels in urine. They are very convenient, relatively inexpensive and can be used as early as the first day a menstrual period was supposed to start. However, they are more likely to be accurate if administered after more time has passed.

Most HPTs function in a similar fashion. The user holds a stick in the urine stream or collects urine in a cup and dips the stick into it. Most tests have a results window indicating whether a woman is pregnant or not. Most tests also stress retaking the test a few days or a week later to confirm its accuracy.

Because HCG increases as the pregnancy progresses, HPTs become more accurate as time goes on. “Many home pregnancy tests claim to be 99 percent accurate on the day you miss your period. Although research suggests that most home pregnancy tests don’t consistently spot pregnancy this early, home pregnancy tests are considered reliable when used according to package instructions one week after a missed period” (Mayo Clinic, 2013c).

Although HPTs can be highly accurate, there is room for error. If instructions are not followed perfectly, results can be faulty. For instance, exposure to sunlight, accidental vibrations, using an unclean container to collect urine, or examining results too early or too late all can end in an erroneous diagnosis. False negatives (i.e., showing that a woman is not pregnant when she really is) are more common than false positives (i.e., showing that a woman is pregnant when she really is not). Regardless, it is suggested that a woman confirm the results either by waiting a week and administering another HPT or by having a laboratory diagnosis performed. Early knowledge of pregnancy is important either to begin early health care or to make a decision about terminating a pregnancy.

2-1cFetal Development during Pregnancy

An average human pregnancy lasts about 266 days after conception (Papalia & Martorell, 2015). However, there is a great amount of variability in the length of pregnancies among mothers. It is most easily conceptualized in terms of trimesters, or three periods of three months each. Each trimester is characterized by certain aspects of fetal development.

The First Trimester

The first trimester is sometimes considered the most critical. Because of the embryo’s rapid differentiation and development of tissue, the embryo is exceptionally vulnerable to the mother’s intake of noxious substances and to aspects of the mother’s health.

By the end of the first month, a primitive heart and digestive system have developed. The basic initiation of a brain and nervous system is also apparent. Small buds that will eventually become arms and legs are appearing. In general, development starts with the brain and continues down through the body. For example, the feet are the last to develop. In the first month, the embryo bears little resemblance to a baby because its organs have just begun to differentiate.

The embryo begins to resemble human form more closely during the second month. Internal organs become more complex. Facial features including eyes, nose, and mouth begin to become identifiable. The 2-month-old embryo is less than an inch long and weighs about one-third of an ounce.

During the first trimester, the mother experiences various symptoms. This is primarily due to the tremendous increase in the amount of hormones her body is producing. Symptoms frequently include tiredness, breast enlargement and tenderness, frequent urination, and food cravings. Some women experience nausea, referred to as morning sickness.

The optimal weight gain depends on the woman’s height and her weight prior to pregnancy. For example, a woman who is underweight before pregnancy might require a greater weight gain to maintain a healthy pregnancy.

Being underweight or overweight poses risks to the fetus. Too little weight gain due to malnutrition can result in low infant birth weight, increased risk of mental or motor impairment, and a higher risk of infant mortality (Berk, 2013; Newman & Newman, 2015). Being overweight either before or during pregnancy can increase the risk of miscarriage and other complications during pregnancy and birth (Chu et al., 2008), in addition to birth defects (Stothard, Tenant, Bell, & Rankin, 2009).

Not only does a pregnant woman need to eat more, but the quality of food also needs careful monitoring and attention. It is especially important for pregnant women to get enough protein, iron, calcium, and folic acid (a B vitamin), in addition to other vitamins and minerals (Berk, 2013; Kail & Cavenaugh, 2013). As Hyde and DeLamater (2017) explain,

Protein is important for building new tissues. Folic acid is also important for growth; symptoms of folic acid deficiency are anemia [low red blood cell count] and fatigue. A pregnant woman needs much more iron than usual, because the fetus draws off iron for itself from the blood that circulates to the placenta. Muscle cramps, nerve pains, uterine ligament pains, sleeplessness, and irritability may all be symptoms of a calcium deficiency. (p. 127)

Drugs and Medication

Because the effects of many drugs on the fetus are unclear, pregnant women are cautioned to be wary of drug use. Drugs may cross the placenta and enter the bloodstream of the fetus. Any drugs should be taken only after consultation with a physician. The effects of such drugs usually depend on the amount taken and the gestation stage during which they are taken. This is especially true for the first trimester, when the embryo is very vulnerable.

Teratogens are substances, including drugs, that cause malformations in the fetus. Certain drugs can cause malformations of certain body parts or organs. The so-called thalidomide babies of the early 1960s provide a tragic example of the potential effects of drugs. Thalidomide, a type of tranquilizer used to ease morning sickness, was found to produce either flipper-like appendages in place of arms or legs, or no arms or legs at all.

A variety of prescription drugs can produce teratogenic effects. These include antibiotics such as tetracycline and streptomycin, Accutane (an acne drug), and some antidepressants (Rathus et al., 2014; Santrock, 2016). Generally speaking, women should avoid taking drugs or medications during pregnancy and while breastfeeding unless such medication is absolutely necessary.

Even nonprescription, over-the-counter drugs such as Aspirin (acetylsalicylic acid) or caffeine should be consumed with caution (Santrock, 2016). Aspirin can cause bleeding problems in the fetus (Steinberg et al., 2011a). Coffee, tea, colas, and chocolate all contain caffeine. The research findings concerning the effects of caffeine on a fetus have been mixed (Maslova, Bhattacharya, Lin, & Michels, 2010; Minnes, Lang, & Singer, 2011; Rathus, 2014a). However, some research results have revealed a greater risk of low birth weight (Rathus, 2014a; Santrock, 2016). Even vitamins should be consumed with care and only under a physician’s supervision (Rathus et al., 2014; Steinberg et al., 2011a). An expectant mother’s best bet is to be cautious.

Ethical Question 2.1

2-1eDrugs of Abuse

Illegal drugs, such as cocaine (a powerful stimulant) and heroin (an opioid), can cause significant problems during a pregnancy (Newman & Newman, 2015). Both of these substances can cause infertility, problems with the placenta resulting in the fetus not receiving enough food or oxygen, preterm labor, or death of the fetus via miscarriage or stillborn birth. Babies may be premature, or have low birth weight, heart defects, birth defects, or infections such as hepatitis or AIDS (March of Dimes, 2013). A significant problem is when the baby develops  Neonatal Abstinence Syndrome (NAS). In NAS, the baby is born addicted to the addictive drugs the mother used during her pregnancy and goes through withdrawal at birth. These babies have a tendency to have lower birth weights, breathing problems, sleep difficulties, seizures, and birth defects, and may require a longer stay in the hospital. Signs and symptoms of NAS include body shakes, seizures, excessive crying, trouble sleeping, fever, inability to gain weight, and overall fussiness. All of these symptoms may need to be treated with medications, fluids, or higher-calorie feedings (March of Dimes, 2015).

Marijuana may also cause problems during a pregnancy (Papalia & Martorell, 2015). Studies link marijuana use with premature birth, low birth weight, increased chance of stillbirth, withdrawal symptoms in the baby, and problems with brain development (March of Dimes, 2016). Ingredients in marijuana can also pass to a child during breastfeeding; therefore, it is recommended that breastfeeding moms refrain from marijuana use (March of Dimes, 2016).

Note, however, that it is difficult to separate out the direct effects of specific drugs because of the numerous other factors involved (e.g., an impoverished environment or use of other potentially harmful substances by the mother).

Smoking

Numerous studies associate smoking with low birth weight, preterm births, breathing difficulties, fetal death, and crib death (Rathus, 2014a; Santrock, 2016; Shaffer & Kipp, 2010; Yarber & Sayad, 2013). Even secondhand smoke is thought to pose a danger to the fetus (Rathus, 2014a). Some research found a relationship between a mother’s smoking during pregnancy and a child having behavioral and emotional problems when the child reaches school age (Papalia & Martorell, 2017; Rathus, 2014a).

Studies have also found that a father’s smoking during pregnancy may affect the health of the child (Hyde & DeLamater, 2017).

Age