Master Degree Social Work
This assignment has 3 parts. The first part and second parts are each page, not the same page, the references need under each part. Part 3 needs an introduction and conclusion part.
Objetives Explain the      major stages of fetal development. Describe      at-risk situations for newborns .Describe the      physical, cognitive, and socioemotional development of infants and      toddle.
Assignment Part 1 (200 words)
 Assessment Description  Compare and contrast John Bowlby’s and Mary Ainsworth’s theories of attachment. 
References (2) included chapter class/ The answer is how social worker intervention
 Part 2 (200 words)  Assessment Description  Discuss the risk and protective factors in infancy and toddlerhood. Explain why social workers need to understand these risks.  This discussion question is informed by the following EPAS Standard: 2: Engage Diversity and Difference in Practice
References( 2) included chapter class.The answer is how social worker intervention.
Part 3 Assessment Traits  Requires Lopeswrite  Assessment Description  To understand the factors that impact these stages of human development, access  the “Pregnancy, Birth, Newborn, and Infancy Chart” to help you create your own chart in a separate Word document.  After completing your chart, address the following in an essay (500-750 words), citing three to five scholarly sources to support your claims. Include your Pregnancy, Birth, Newborn, and Infancy Chart as an appendix within your essay:

Describe how      risk factors may change across cultures.
Describe how      these risk factors may vary in diverse family systems (LGBT+ families,      adoptions situations, etc.).
Explain how      this chart can benefit you in your career field in social work.
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2
Conception, P
Prregnanc
egnancyy,
and Chil
Childbir
dbirth
th
Marcia
Mar
cia P. Harrigan and Suzanne M. Baldwin
Chapter Outline
Learning Ob
Learning
Objecti
jectives
ves
Cas
Ca
s e Study 2 .1
.1:: Jenni
Jennifer
fer Brads
Bradsha
haw’
w’s
s Exper
Experien
ience
ce
With
Wit
h IInf
nfer
ertti l it
ityy
Cas
Ca
s e Study 2 .2: Ce
Cecel
celia
ia K i n’
n’s
s St
Strr ugg
uggle
le
With the Op
Options
tions
Cas
Ca
s e Study 2 .3: T he Thompson
Thompsons’
s’
Premature
Premat
ure Birt
Birth
h
Sociocultural
Soci
ocultural Org
Organiza
anizatio
tion
n
of Ch
Childb
ildbea
eari
ring
ng
Conception and Pregnancy
in Context
Childbirth in Context
Childbi
Ch
ildbirr th E duc
ducation
ation
Place of Ch
Chii ldbir
ldbirtth
Who Assi
Assists
sts C hi
hildbir
ldbirtth
Reproducttive Ge
Reproduc
Genet
netics
ics
Genetic Mechanisms
Genetic Counseling
Control
Cont
rol Ove
Overr Concep
Conception
tion and Pr
Preg
egnanc
nancyy
Contraception
Induced Abortion
Infertility Treatment
Fetall D evelopment
Feta
First Trimester
Ferttililiz
Fer
ization
ation and
the E mbr
mbryonic
yonic Pe
Perio
riod
d
T he Feta
Fetall Per
Period
iod
Second Trimester
Third Trimester
Labor and Delivery of the Neonate
Preg
Pr
egnanc
nancyy and the L if
ife
e Cou
Cours
rse
e
At-R
At
-Rii sk Newb
Newbor
orns
ns
Prematurity and Low Birth Weight
Newborn Intensive Care
Major Congenital Anomalies
Conception,
Conce
ption, P reg
regna
nanc
ncyy, and Ch
Chii ldbir
ldbirtth
Under
Un
der Differen
Differentt Circumstances
Substance-Abusing Pregnant Women
Pregnant Women With
Eating Disorders
Pregnant Women With Disabilities
Incarcerated Pregnant Women
HIV-Infected
HIV
-Infected Pregnant Women
Pregnant Transmen
R isk and Pr
Protec
otective
tive Fac
Factors
tors i n Conce
Conception,
ption,
Pregnan
Pre
gnancy
cy,, an
and
d Chil
hildb
dbirth
irth
Implications
Impl
ications for S oc
ocia
iall Work Pr
Pract
actice
ice
Key Te
Terr ms
Active
Act
ive L ea
earn
rnii ng
Web Resources
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Learning Objectives
2.1 Compare one’
one’s
s own emotional and cognitive
reactions to three case studies.
2.7 Give examples of different circumstances under
which people become parents.
2.2 Summarize some themes in the sociocultural con
con-text of conception, pregnancy
pregnancy,, and childbirth.
2.8 Give examples of risk factors and protective fac
fac-tors in conception, pregnancy
pregnancy,, and childbirth.
2.3 Recognize important mechanisms of reproduc
reproduc-tive genetics.
2.4 Analyze the ways that humans try to get control
over conception and pregnancy
pregnancy..
2.9 Apply knowledge of conception, pregnancy
pregnancy,, and
childbirth to recommend guidelines for social
work engagement, assessment, intervention, and
evaluation.
2.5 Summarize the major stages of fetal development.
2.6 Describe the special challenges faced by prema
prema-ture and low-birth-weight newborns and new
new-borns with congenital anomalies.
CASE STUDY 2.1
JENNIFER BRADSHAW’S EXPERIENCE WITH INFERTILITY
Jennifer Bradshaw al
always
ways knew she would be a mom.
She remembers being a littl
little
e girl and wrapping up her
favorite
favorit
e doll in her baby blanket. She would rock the doll
and dr
dream
eam about the day when she would have a real
baby of her own. Now, at 36, the dr
dream
eam of having her own
baby is still just a dr
dream
eam as she struggles with inf
infertility
ertility..
Like many women in her age gr
group,
oup, Jennifer spent
her late teens and 20s trying not to get pr
pregnant.
egnant. She
focused on educ
education,
ation, ?nding the right relationship,
?nances, and a car
career
eer.. As an African American woman,
and the ?rst per
person
son in her famil
familyy to earn a graduate
degree,
degr
ee, she wanted to pr
prove
ove that she could be a suc
suc-cessful
ces
sful clinical social work
worker
er.. She thought that when
she wanted to get pr
pregnant,
egnant, it would just happen; that it
would be as easy as scheduling anything else on her cal
cal-endar.. When the time ?nally was right and she and her
endar
husband, Allan, decided to get pr
pregnant,
egnant, they couldn’t.
With every pas
passing
sing month and every negative pr
preg
eg-nancy test, Jennif
Jennifer’
er’s
s frustration gr
grew
ew.. First, she was
frustrated with her
herself
self and had thoughts like What is
wrong with me? Why is this happening to us? and We don’t
deserve this
this.. She would look ar
around
ound and see pregnant
teens and think, Why them and not me? She also was
frustrated with her husband for not understanding how
devastating
devas
tating this was to her and wonder
wondered
ed to herself,
Could it be him with the problem? In addition, she was
frustrated with her famil
familyy and friends and started av
avoid
oid-ing them to escape their comments and the next baby
shower.. Now, she is baby-less and lonely
shower
onely.. It has also
been har
hard
d for Allan. For many men, masculinity is con
con-nected to virility; Allan would not even consider that he
might be the one with the fertility pr
problem,
oblem, ev
even
en though
it is a male-f
male-factor
actor is
issue
sue in about 50% of infertility cases.
After months of struggling to get pr
pregnant,
egnant, multiple
visits to the obstetrician/gynec
obstetrician/gynecologist,
ologist, a lapar
laparoscopic
oscopic
surgery,
sur
gery, a semen analysis, and timed inter
intercourse
course (which
began to feel lik
like
e a chore), and after taking Clomid, a fer
er-tility drug that made her feel horribl
horrible,
e, she and Allan ?nally
accepted
acc
epted that they might need to see a specialis
specialist.
t. She will
never forget the ?rst visit with the reproductiv
eproductive
e endocri
endocri-nologistt (RE). She was expecting a “quick ?x,” thinking
nologis
that the RE would give her some special pills and then
she would get pr
pregnant.
egnant. But, instead, he casually said to
her, “I think your onl
onlyy option is in vitro fertilization [IVF],
which runs about $16,000 per cycl
cycle,
e, including medica
medica-tions.” The RE also told her that for someone in her age
range the succ
success
ess rate would be about 35% to 40%.
From her clinic
clinical
al practice and her friendship cir
circle,
cle,
Jennifer knows that many women think of in vitr
vitro
o as
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a backup plan when they delay pr
pregnancy
egnancy.. But she is
learning that in vitr
vitro
o is a big deal. First, it is expensiv
expensive.
e.
The $16,000 per cycl
cycle
e does not include the pr
preliminary
eliminary
diagnostic testing, and in Jennif
Jennifer’
er’s
s age group, the
majority of women pursuing IVF will need at least two
IVF cycl
cycles,
es, $32,000 for two tries; thr
three
ee tries brings the
bill up to $48,000. Jennifer has hear
heard
d of coupl
couples
es spend
spend-ing close to $100,000 for infertility tr
treatments.
eatments.
Although about 15 states mandat
mandate
e insurance com
om-panies to co
cover
ver fertility tr
treatments,
eatments, in the state wher
where
e
Jennifer lives, ther
there
e is no fertility coverage mandat
mandate;
e;
consequently,
consequentl
y, her insurance company does not cover any
infertility tr
treatments.
eatments. So at the very leas
least,
t, Jennifer and
Allan would need to come up with $16,000 to give one IVF
cycle
cycl
e a try
try.. It’
It’s
s heartbreaking for them because they don’t
have $16,000, and their par
parents
ents can’t help them out. So
to give IVF ev
even
en one try, they need to borr
borrow
ow the money
money..
They ar
are
e considering taking out a home equity loan to pay
for the needed IVF cy
cycles
cles and know the
theyy are lucky to be in
a position to do that. They have hear
heard
d of people packing
up and moving to st
states
ates with mandated fertility cov
coverage
erage
and/or quitting their jobs and ?nding jobs that carry spe
spe-ci?c insurance that will cover fertility tr
treatments.
eatments. Some
couples
coupl
es are even tr
traveling
aveling abr
abroad
oad for fertility tr
treatments
eatments
that can be had for much les
less
s than in the United States.
Jennifer has hear
heard
d that IVF is physically and emotion
emotion-ally exhausting. First, the in vitr
vitro
o patient is for
forced
ced into
menopause, and then the ovaries ar
are
e hyperstimulated
to release numer
numerous
ous eggs (up to 15 to 17 inst
instead
ead of 1),
which can be painful. The eggs ar
are
e surgicall
surgicallyy extracted,
and ?nally the fertilized embryos are intr
introduced
oduced to the
IVF patient’
patient’s
s body
body.. Throughout this pr
process,
ocess, various
hormone tr
treatments
eatments ar
are
e given via daily injections, mul
mul-tiple bl
blood
ood tests are taken, and at any point during the
procedur
pr
ocedure
e something could go wrong and the IVF cy
cycle
cle
could be call
called
ed off
off.. If all goes well, the IVF patient is left
to keep her ?nger
?ngers
s cr
crossed
ossed for the next 2 weeks waiting
for a positive pr
pregnancy
egnancy test. If the tes
testt is negative, the
treatment
tr
eatment starts ov
over
er again. Jennifer has hear
heard
d that most
women ar
are
e an emotional wreck during the entir
entire
e proces
process
s
because of the high st
stakes
akes and the arti?cial hormones.
Jennifer and Allan decided to go the IVF route 7
months after visiting the RE. Befor
Before
e they made this deci
deci-sion, howev
however,
er, Jennifer car
carefully
efully track
tracked
ed her BBT (basal
body temperatur
temperature),
e), purchased a high-tech el
electronic
ectronic
fertility monitor, used an ovulation micr
microscope,
oscope, took
multiple fertility supplements, and used sperm-friendly
lubricant during inter
intercourse.
course. Still nothing helped. When
she hear
heard
d that acupunctur
acupuncture
e has been found to incr
increase
ease
the succ
success
ess rate of IVF, she started seeing a fertility
acupuncturist on a weekl
weeklyy basis for both herbal for
or-mulas and acupunctur
acupuncture
e tr
treatments.
eatments. The acupuncture
treatments
tr
eatments and herbs ar
are
e averaging about $100 per
week, also not co
cover
vered
ed by insurance in her state.
Jennifer and Allan have decided to give IVF thr
three
ee
tries, and after that they will mov
move
e on to the next plan,
adoption. They ador
adore
e each other and want more than
anything to have their own biol
biological
ogical little one, but if
they cannot hav
have
e that, they will adopt, and Jennifer will
realize her dr
dream
eam of being a mom.
—Nicole Footen Brom?eld
CASE STUDY 2.2
CECELIA KIN’S STRUGGLE WITH THE OPTIONS
June 9th
9th:: Maybe we just wer
were
e not meant to have
another baby!!! What we have been thr
through
ough is all too
amazing: thr
three
ee miscarriages befor
before
e we had our darling
18-month-old Meridy, plus two mor
more
e miscarriages
since then. Well, at least I know I can get pregnant and
we did have a healthy kid, so why not again?
August 20th
20th:: YEH! This pr
pregnancy
egnancy is going sooo well:
10 weeks along ALREAD
ALREADY!
Y! I am tir
tired,
ed, but I’ve thr
thrown
own
up only onc
once
e and feel sooo much diff
differ
erent
ent fr
from
om the
pregnancies
pr
egnancies I lost!!! Looking back, I kne
knew
w that each one
was not right!!! I felt AWFUL ALL the time!!! But not
this time!!! What a relief!!! Or is it a rewar
eward?
d?
September 1st
1st:: It’
It’s
s been more than a week sinc
since
eI
wrote!!!
wr
ote!!! Today we went for the ultrasound, both of
us thinking it would be so perfect. It wasn’t. How
could this happen to us? What hav
have
e we done or not
done? Haven’t I done ev
everything
erything I could possibl
possiblyy do?
I eat right, steer
steered
ed clear of drugs, and hate any kind
of alc
alcohol!!!
ohol!!! I exer
exercise
cise regularl
regularly!!!
y!!! I am in perfect
health!!! Wham! I can’t believ
believe
e what we wer
were
e told.
I can’t cry lik
like
e this any longer
longer.. Writing about it may
help; it usually does. So, her
here’
e’s
s how it went. We just
sat ther
there
e staring at each other after hearing, “A 1:25
chance of a baby with Down syndr
syndrome.”
ome.” And they
told us, “Don’t worry”! You have to be kidding! We
both insisted that the ne
next
xt step be done right away,
so in 3 (L
(LONG)
ONG) days, we go back again, this time for
something call
called
ed chorionic villus testing!!! Nev
Never
er
heard
hear
d of it.
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September 16th
16th:: I can’t believe this is happening; I feel
so angry, so out of contr
control.
ol. Then I think of Meridy and
that we should just be thankful we hav
have
e her and believe
that our lives can be full, totally complet
omplete
e with just one
kid. But this is not what we want! How can I hold it all
together? I don’t want to cry all the time, especiall
especiallyy at
work!!! I feel lik
like
e such a wuss, and I can’t really tell
anyone, just my husband!!! Worse yet, I don’t think that
we agr
agree
ee that we will terminate the pregnancy
pregnancy.. I feel so
guilty, so alone, so empty
empty.. How can HE say, “Oh, we can
handle that”? I’M the one who arr
arranges
anges childcar
childcare,
e, I’M
the one who stays home if Meridy is sick, tak
takes
es her to
the doctor, buys her clothes, her food. He comes home
to dinner and a smiling kid racing to jump in his arms.
What would a child with Down syndr
syndrome
ome be like? I can’t
bear to think of standing ther
there
e holding this child while
HE plays with Meridy
Meridy.. Bills!!! I haven’t ev
even
en thought
about that! Our life is gr
great
eat now, but I work to pr
provide
ovide
extras!!! I love my job. I lov
love
e my kid. I lo
love
ve my husband.
I HA
HATE
TE what is happening. If I don’t work, our lives ar
are
e
drastically
drastic
ally changed!!! Not an option: I carry the health
insurance; he is self-empl
self-employed.
oyed. Perhaps this is all a
mistake,
mistak
e, you know, one of those “f
“false
alse positives” wher
where
e
I will get a call that all is just ?ne or the
theyy report
reported
ed
someone else’
else’s
s test!!! Right! Wishful thinking!!! Who
could begin to under
understand
stand wher
where
e I AM COMING FROM?
I know my famil
family!!!
y!!! They would never “get it”; I would
be SOOOO judged if the wor
word
d “abort” passed my lips,
even by my mom, and we ar
are
e sooo close!!! But not on
this!!! And in this small, small town EVEERYONE would
know what I DID!!! Who can pos
possibly
sibly help me—help
us—with this mess?
CASE STUDY 2.3
THE THOMPSONS’ PREMA
PREMATURE
TURE BIRTH
Within days of discov
discovering
ering she was pr
pregnant,
egnant, Felicia
Thompson’s
Thompson’
s husband, Will, suddenly depl
deployed
oyed to a com
om-bat zone. Thr
Through
ough e-mails, occasional cell phone calls,
and Skype, Felicia told Will details about the changes
she experienc
experienced
ed with the pregnancy, but his world was
?lled with smok
smoke,
e, dirt, bombs, and danger, punctuated
with periods of bor
boredom.
edom. Six months into the pr
preg
eg-nancy, Felicia’
elicia’s
s changing ?gure was eliciting comments
from
fr
om her cowork
coworkers
ers in the of?ce wher
where
e she worked part
time as an of?ce administr
administrator
ator.. With weeks of nausea
and fatigue behin
behind
d her, she was experiencing a general
sense of well-being. She avoided all news media as well
as “war talk” at the of?ce to pr
protect
otect herself fr
from
om worry
and anxiety
anxiety.. Yet ev
even
en the sound of an unexpected car
pulling up to the fr
front
ont of her home produced chills of
panic. Was this the time when the of?cers would come
to tell her that Will had been kill
killed
ed or wounded in com
com-bat? Her best friend onl
onlyy rec
recently
ently had experienc
experienced
ed what
every military wif
wife
e fears may happen.
Then, with dawn hours away, Felicia woke to cramp
cramp-ing and blood. With 14 mor
more
e weeks befor
before
e her delivery
date, Felicia was seized with fear
fear.. Wishing that Will
were
wer
e there, Felicia fervently prayed for herself and her
fetus. The ambulanc
ambulance
e ride to the hospital became a
blur of pain mixed with feelings of unreality
unreality.. When she
arrived in the labor and delivery suite, mask
masked
ed individu
individu-als in scrubs took contr
control
ol of her body while demanding
answers to a seemingl
seeminglyy endless number of ques
questions.
tions.
Felicia knew everything would be ?ne if only she could
feel her son kick. Why didn’t he kick? The pediatrician
spoke of the risks of earl
earlyy delivery, and suddenly the
doctors wer
were
e telling her to push her son into the world.
In the newborn intensive car
are
e unit (NICU), a ?urry of
activity revol
evolved
ved ar
around
ound baby boy Thompson. Born weigh
weigh-ing only 1 pound 3 ounc
ounces,
es, this tiny red baby’
baby’s
s immatur
immature
e
systems wer
were
e unprepar
unprepared
ed for the demands of the extr
extra
auterine world. He was immediatel
immediatelyy connected to a ven
ven-tilator, intravenous lines wer
ere
e placed in his umbilicus
and arm, and monitor leads wer
were
e placed on all availabl
available
e
surfaces.
surfac
es. Nameles
Nameless
s to his car
caregivers,
egivers, the baby, whom his
parents
par
ents had alr
already
eady named Paul, was now the recipient
of some of the most advanc
advanced
ed technologic
technological
al interven
interven-tions availabl
available
e in modern medicine. About an hour after
giving birth, Felicia saw Paul for the ?r
?rst
st time. Lying on
a str
stretcher,
etcher, she tried to ?nd resemblanc
resemblance
e to Will, who is
of Anglo heritage, or her
herself,
self, a light-skinned Latina, in
this tiny form. Felicia’
elicia’s
s breathing synchr
synchronized
onized to Paul
Paul’’s
as she willed him to keep ?ghting.
Later, alone in her room, she was ?ooded with
fear, grief, and guilt. What had she done wr
wrong?
ong? Could
Paul’’s prematur
Paul
premature
e birth have been caused by paint
fumes fr
from
om decorating his room? Fr
From
om her anxiety
and worry about Will?
The Red Cr
Cross
oss sent the st
standard
andard mes
message
sage to Will.
Was he in the ?eld? Was he at headquarter
headquarters?
s? It matter
mattered
ed
because Paul may not even be alive by the time Will found
out he was born. How would he receive the news? Who
would be nearby to comf
comfort
ort him? Would the command
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allow him to come home on emer
emergency
gency leave? If he wer
were
e
granted permis
permission
sion for emer
emergency
gency leave, it could be days
of ar
arduous
duous travel, waiting for space on any military plane,
before
befor
e he landed somewhere in the Unit
United
ed States. Felicia
knew that Will would be given priority on any plane av
avail
ail-able; even admirals and generals step aside for men and
women returning home to meet a family crisis. But, then
again, the command may consider his mission so essen
essen-tial that only of?cial noti?c
noti?cation
ation of Paul
Paul’’s death would
allow him to return home.
Thirteen days after his arrival, Paul took his ?rst
breath
br
eath by himself
himself.. His hoarse, faint cry pr
provoked
ovoked both
ecstasy and terr
terror
or in his mother
mother.. A few days earlier
Felicia had been noti?ed by the Red Cr
Cross
oss that her hus
hus-band was on his way home, but information was not
available
availabl
e regarding his arriv
arrival
al date. Now that her baby
was off the ventilator, she watched Paul periodicall
periodicallyy
miss a br
breath,
eath, which would lead to a decr
decreased
eased heart
rate followed by monit
monitors
ors ?ashing and beeping. She
longed for Will
Will’’s physical pr
presence
esence and support.
Will arrived home 2 days later
later.. He walked into the
NICU having spent the last 72 hours ?ying. He started
the trip being deliver
delivered
ed to the airport in an armed con
con-voy and landed stateside to ?nd the world seemingl
seeminglyy
unchanged fr
from
om his departur
departure
e months befor
before.
e. Although
Paul would spend the ne
next
xt 10 weeks in the hospital, Will
had 14 days befor
before
e starting the journey back to his job.
Paul’’s struggl
Paul
struggle
e to survive was the most exhilarating
yet terrifying roller-coas
oller-coaster
ter ride of his par
parents’
ents’ lives.
Shattered
Shatter
ed hopes were mended, onl
onlyy to be reshattered
SOCIOCULTURAL ORGANIZA
SOCIOCULTURAL
ORGANIZATION
TION
OF CHILDBEARING
These three stories tell us that conception, pregnancy
pregnancy,,
and childbirth are experienced in different ways by dif
dif-ferent people. The biological processes vary little for the
vast majority of women and their families, but resear chers continue to study the psychological, social, and
spiritual dimensions of childbearing. This chapter pres
pres-ents a multidimensional overview of current knowledge
about conception, pregnancy
pregnancy,, and childbirth gleaned
from the literatures of anthropology
anthropology,, genetics, medi cine, nursing, psychology
psychology,, social work, and sociology
sociology..
As you read, keep in mind that all elements of child
child-bearing have deep meaning for a society. We can draw
on the social constructionist perspective to think about
this. This perspective proposes that social reality is cre ated when people, in social interaction, develop shared
meaning, a common understanding of their world (you
with the next tel
telephone
ephone call from the NICU. No
Now
w Felicia
dreaded
dr
eaded the phone as well as the sound of an unfamiliar
car.. For Felicia, each visit to Paul was foll
car
followed
owed by the
long trip home to the empty nur
nursery
sery.. For Will, stationed
thousands of miles away, ther
there
e was uncertainty, guilt,
helplessness,
helples
sness, and sometimes an overwhelming sense
of inadequacy
inadequacy.. Felicia fear
feared
ed the arrival of a car with
of?cers in it, and Will dr
dreaded
eaded a Red Cros
Cross
s message
that his son had died.
Great
Gr
eat joy and equally int
intense
ense anxiety pervaded Paul
Paul’’s
homecoming day
day.. After spending 53 days in the NICU
and still weighing onl
onlyy 4 pounds, 13 ounces, Paul was
handed to his mother
mother.. She made sure that a video was
made so that Will could shar
share
e in this moment. With
more
mor
e questions than answers about her son’
son’s
s futur
future
e
and her ability to tak
take
e car
care
e of him, Felicia took their
baby to his new home.
For the NICU social worker at the milit
military
ary hospital,
the major goal is to support the family as they face this
challenging tr
transition
ansition to par
parenthood.
enthood. In the past 53 days,
the social worker has helped Felicia answer her ques
ques-tions, understand the unf
unfamiliar
amiliar medical language of the
health car
care
e provider
providers,
s, and understand and cope with the
strong
str
ong emotions she is experiencing. The social worker
also helped during the transition of Will
Will’’s arrival fr
from
om
war and his departur
departure
e back to war
war.. Understanding the
dynamics of the NICU, families in crisis, and the needs of
the military famil
familyy separated by an international con?ict
is critical to pr
providing
oviding this famil
familyy the level of support they
need to manage their multifac
multifaceted
eted rol
role
e transitions.
can read more about this in the chapter Theoretical
Perspectives on Human Behavior in Dimensions of Human
Behavior: Person and Environment
Environment).
). Meanings about and
expectations for human behavior vary across time, place,
and culture. Cultural groups develop common under
standings about all aspects of procreation: the condi
condi-tions under which it should happen; whether, and if
so how, to control it; proper behavior of the pregnant
woman and her family system; and the where and how
of childbirth. Pregnancy and childbearing practices are
changing with advances in technology and increased
diversity in the population of childbearing age. We in
the United States are in the midst of an ongoing national
debate about health care policy, and social workers will
need to monitor the impact of proposed policies on the
well-being of women and their families during the child
bearing years.
In the United States, the social meaning of child
child-bearing has changed rather dramatically in several ways
over the past several decades:
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•
Various options for controlling reproduction
are more available and accessible but oftentimes
only to the economically advantaged.
•
Childbirth is more commonly delayed, and
more people are seeking fertility treatment and
remaining involuntarily childless.
•
The marriage rate has declined, and more
children are born to unmarried mothers.
•
The birth rate has declined, res
resulting
ulting in smaller
families.
•
Teen pregnancy is at a historic low
low..
•
There are greater variations in family values and
sexual mores than in previous generations.
•
Parents are less subject to traditional gender-role
stereotyping.
•
It is becoming much more common for gay
and lesbian individuals and couples to become
parents.
These trends have prompted considerable debate
over how our society should de?ne family. The family
operates at the intersection of society and the individ ual. For most people it serves as a safe haven and cradle
of emotional relationships. It is both the stage and par
par-tial script for the unfolding of the individual life course.
Conception and Pregnanc
Pregnancyy in Con
Context
text
Childbirth
Childbir
th in Context
Throughout
history,,
history
families—and
particularly
women—have passed on to young girls the traditions
of childbirth practices. These traditions are increas ingly shaped by cultural, institutional, and technologi
technologi-cal changes. The multiple in?uences on and changing
nature of childbirth practices are exempli?ed in three
related issues: childbirth education, place of childbirth,
and who assists childbirth.
Childbirth Education
It is probably accurate to say that education to prepare
women for childbirth has been evolving for a very long
time, but a formal structure of childbirth education is a
relatively new invention. In the United States, the early
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iStockphoto.com/Rawpixel
Rawpixel
The three case studies at the beginning of this chap
chap-ter remind us that emotional reactions to conception
may vary widely
widely.. The Thompsons’ conception brought
anxiety and then joy
joy,, in contrast to Jennifer Bradshaw’
Bradshaw’ss
frustration and lost dreams followed by her rising hope fulness; Cecelia Kin feels caught between her own values
and wishes and those of important people in her life. The
conception experience is in?uenced by expectations the
parents learned growing up in their own families of birth
as well as by many other factors, including the parents’
ages, health, marital status, and social status; cultural
expectations; peer expectations; school or employment
circumstances; the social-political-economic context;
and prior experiences with conception and childbear ing, as well as the interplay of these factors with those of
other people signi?cant to the mother and father
father..
The conception experience may also be in?uenced
by organized religion. The policies of religious groups
re?ect different views about the purpose of human
sexual expression, whether for pleasure, procreation,
or perhaps both. Many mainstream religions, in their
policy statements, specify acceptable sexual behaviors
(Kurtz, 2016). Unwanted conception may be seen as
an act of carelessness, promiscuity, or merely God’s
will—perhaps
wil
l—perhaps even punishment for wrongdoing. These
beliefs are usually strongly held and have become pow erful fodder for numerous social, political, economic,
and religious debates related to conception, such as
the continued debates about abortion legislation in the
United States and around the globe.
Just as the experience of conception has varied over
time and across cultures, so has the experience of preg nancy. It too is in?uenced by religious orientations,
social customs, changing values, economics, and even
political ideologies. For example, societal expectations
of pregnant women in the United States have changed,
from simply waiting for birth to actively seeking to
maintain the mother’s—and hence the baby’s—health,
preparing for the birth process, and sometimes even
trying to in?uence the baby’s cognitive and emotional
development while the baby is in the uterus.
PHOTO 2.
2.1
1 Soc
ocie
ieta
tall v ie
iews
ws of pr
preg
egna
nanc
ncyy in the Uni
nited
ted S ta
tate
tes
s ha
have
ve
chan
ch
ange
ged
d fr
from
om sim
imply
ply waiti
iting
ng to be
being
ing ac ti
tivv ely i nv
nvolv
olved
ed i n nu
nurrtu
turrin
ing
g the
mother’s and baby’s health.
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6
roots of formal childbirth education were established
during the Progressive Era when the Red Cross set up
hygiene and health care classes for women as a public
health initiative. In 1912, the U.S. Children’
Children’ss Bureau,
created as a new federal agency to inform women about
personal hygien
hygiene
e and birth, published a handbook titled
Prenatal Care
Care,, emphasizing the need for medical supervi sion during pregnancy (Barker
(Barker,, 1998).
Childbirth education, as a formal structure, took hold
in the United States and other wealthy countries in the
1960s, fueled by the women’s and grassroots consumer
movements. Pioneers in the childbirth education move ment were reacting against the increasing medicalization
of childbirth, and they encouraged women to regain
control over the childbirth process. Early childbirth edu
cation classes were based on books by Grantly Dick-Read
(1944), Childbirth Without Fear
Fear,, and French obstetrician
Dr. Fernand Lamaze (1958), Painless Childbirth. Lamaze
proposed that women could use their intellect to control
pain while giving birth if they were informed about their
bodies and used relaxation and breathing techniques.
Early classes involved small groups meeting outside the
hospital during late pregnancy and emphasized unmedi cated vaginal birth. Pioneers in the childbirth education
movement believed that such childbirth classes would
provide the knowledge and skills women needed to
change maternity practices, and indeed, the movement
had an impact on the development of family-centered
maternity practices such as the presence of fathers in
labor and delivery and babies rooming with mothers
after birth. Over time, childbirth education became insti
tutionalized and was taught in large classes based in hos
hos-p