Human sexuality; 5

Human Sexuality the fifth in a series of seven classes is given as part of a four college course in human sexuality sponsored jointly by Amherst Mount Holyoke and Smith Colleges and the University of Massachusetts. Today Dr. Phillips aroud a gynecologist at Westover Air Force Base talks about pregnancy and childbirth. Now the first question what we will do tonight is first I would like to make some comments about labor and delivery and about pregnancy. I'm assuming that good markers book has been a resource for most of you. It's an excellent resource you buy the book now and you'll have it for the next 10 years and you use it for the next 10 years. And for 75 cents I don't think it's a very great commitment. Assuming that I'd like to focus stand on several specific aspects of pregnancy. First of all the question

of when does pregnancy occur. Simple answer. You know the first slide. The anatomy as we tried to describe last time the reproductive anatomy of a woman slide shows the vagina the vagina leads to the cervix which is the opening to the uterus. And on either side there is a tube the fallopian tube. If a woman has into cos sperm or left in the vagina the sperm travel into the uterus and into the tube they have the next slide. In this slide you see how the sperm traveled up into the uterus and you'll know in the bottom diagram that there is a tiny spot a little white spot representing the egg an egg in a woman is about the size of a speck of dust sperm microscopic.

In terms of the male Jacqueline it's estimated that a single The Jack U lation the male gives off approximately 500 million sperm so one teaspoon of seminal slow it contains 500 million sperm. You only need one to get pregnant. Now all of. All of the women who become pregnant become pregnant in the tube. And so there is such a thing as a tubal pregnancy for about six days in the average woman. After six days the eye travels down the tube and into the uterus. Now it's not a very short period of time from this slide. It costs sperm and vagina leading to the tube to the next slide of the next line. And that is approximately where a baby develops. I've seen patients who tell me

of the babies in their stomach. Babies aren't in your stomach stomachs very specific place. And I think it might be worth mentioning that I know of one very sophisticated psychiatric social worker who was taught at an early age. Babies grow in height in the woman's stomach from a seed. She's now 33 years old and she won't eat anything with seeds in it. Now it's also important to understand if that's the way that the baby got in the baby's going to go out the same way. And so the joiner is not only where sperm start but vagina is the birth canal. And he this also is a mystery to many women. I've had the experience of examining a patient in labor at the time of the examination. She asked

why I was doing an internal examination of the agile examination and I said I'm examining you to find out what kind of progress you're having in your labor. And the woman was absolutely amazed because she couldn't figure out how I could tell what her progress was. And the reason she gave was that she was sure the baby was coming out of her in the likeness of a naval. So and surprisingly enough I've asked several obstetricians about this and they said yes it's not unusual. I've had the same kind of experience. So that. Ignorance about. Childbirth for your group no longer exists you know how it will work out in the you know how it's out. Now it's a little bit naive to think of pregnancy occurring only as a matter of a sperm going into an egg. I have the next line in the next slide I've tried to

summarize the various kinds of influences that will affect a woman's attitudes and her feelings about not only pregnancy but as indicated in the very center of the slide. Parenthood childbirth sexual response and fertility. That is to say a woman whether consciously or subconsciously thinks a great deal about pregnancy and herself as a pregnant person. She becomes pregnant under various kinds of influences. I've had the interesting experience this semester of seeing six girls all college students all of whom became pregnant and could not understand why they became pregnant until it was pointed out. By the time I'm the sixth girl showed up that all six had just been accepted to graduate school and within that month became pregnant and one of the studies that has been done that I think is very fascinating is that

done at the University of Copenhagen where they showed that for the average woman there is a certain period of time between the beginning of her obvious lation and the time she becomes pregnant. And that any factors which delay the time when she can become pregnant within the social structure tend to lead to a higher incidence of out of wedlock pregnancy. So that in Denmark they have a slightly higher rate of out of wedlock pregnancy than they had before because more girls are spending more time getting an education in the United States this is a rather serious problem. We have babies born out of wedlock at the rate of approximately 18 every 30 minutes. So while we're sitting here. 54 babies are going to be born out of wedlock. It was estimated in that in the state of Connecticut approximately one out of six girls becomes pregnant out of wedlock before the age of 19. So that if every two weeks a thousand girls turn age 13

before that group of a thousand reaches the age of 19 in three months 100 whatever or whatever one in six is one hundred sixty six will become pregnant. Those are the statistics. What are the things that influence this. I think family is a tremendous influence. The grandmother who wants the grandchild or the mother who wants a grandchild one of the very interesting relationships we've seen has been the relationship of hysterectomy in the mother and pregnancy in the daughter. And we've encountered this many many times in these. I'm talking now about unmarried women talking about the audience I'm talking to. And in terms of peer influence this can be important in certain groups in our culture out of wedlock pregnancy is very common. If every girl on the block has become pregnant then the one who hasn't the US stands out and she becomes pregnant. Cultural factors cultural factors are many. If you're 21 or

22 years old you're getting to the point where the culture says you're almost at the time when you ought to be producing a baby. And you have to fight it and sometimes it's not easy to fight. There are a part of this attitude of course is important. I've seen patients who've never been pregnant to say they never will be pregnant and when I asked them why. I said because my husband does not want any children. I often ask and usually ask them well did you discuss this before you were married. And they say well no we didn't Who ever thought that the man would never want to have children. And when I asked then well you know there are things you can do that so that you can become pregnant parents as well if he feels that way and I think in a rather intelligent answer if he feels that way and I don't want him to be the father of my children. It's not unusual to meet girls in your group. A lot of very anxious not to be pregnant and never wish to become pregnant.

And I would say that as you explore these feelings this is. An aspect of a stage of development. This stage of development where other things are extremely important for all of those six girls they did decide to go on to graduate school even though the sign they gave out was that of pregnancy. They resolved their pregnancy in other ways. We'll talk about that in two weeks. They. So the point I'm making is that pregnancy in any woman married unmarried is not simply a sperm and an egg. It is very often a psychological phenomenon. Not very well described. It took a psychiatrist to myself something like four months of many many hours of deliberation and arguing to arrive at this kind of a way of

trying to analyze it. I have the lights please. So pregnancy can occur when contraception is not used and contraception is not used even when it's not available when there's ignorance or when the factors are so great that the need to become pregnant is greater than the need not to be pregnant. How do you know when you're pregnant. One of my professors taught tells me or has told me in the past that his wife knew she was pregnant the moment that the egg was fertilized. He says she developed morning sickness right then and there. He can tell you exactly which in in Scotland they were staying at. And from then on for three months she had morning sickness. I've seen patients who have gone to the point of delivering the baby and have told me that they did not believe they were

pregnant. I have delivered one patient who said who came in complaining of abdominal pain and when I delivered her I said well there's your pain Salton is your baby. And she said but I wasn't pregnant. And I said well I said well whose baby is this. And the baby was still attached by the umbilical cord and I showed her the baby and she said it's not my baby. So denial of course can be a tremendous factor. Very often very often a girl will think she is pregnant when she is not. And that is not uncommon in your group if you're five days late for a period you're pregnant. I've recently seen a girl ah within the semester who was convinced that she was pregnant and actually had not had intercourse senior in college going to graduate school. I am.

I sometimes wonder about the graduate school group. And she was absolutely convinced that she was pregnant and it took the whole seminar of students to listen to her story to convince her that she wasn't pregnant. And then the next day she went home pregnancy test and that solved it but she wasn't pregnant. Now the pregnancy test. Of cos. Ah another student I've seen recently I want to mention because she is also a college student and she was pregnant and she was really upset about this and I said to her Well you know if you have intercourse you become pregnant. She said well I hadn't cost. Did you use any method of birth control. No. I said Well and what did you expect she said a lot. She really thought that there was something else you had to do in order to become pregnant. And she was really surprised that she became pregnant. She didn't do that extra little

thing that's necessary for pregnancy to occur and so on. Shit just had intercourse and she became pregnant. Now a pregnancy test is a rather useful diagnostic egg so far as making a real diagnosis of pregnancy we can't make a real diagnosis till we hear a baby's heartbeat or until we see the baby on an X-ray or until their actual movements of the baby. But of the various symptoms of pregnancy and I might say that the college girl who wasn't present had morning sickness and breast tenderness and so on. But she did have periods every month for the three months that she thought she was pregnant. There are ways of taking a urine specimen and testing it and showing that a woman is pregnant. Now we don't slaughter rabbits anymore so don't get upset about it. Occasionally we use frogs for pregnancy tests.

But now everything is rather sophisticated and so the approach. This is my portable pregnancy test kit. You sink when a woman is pregnant. She produces a particular kind of hormone and this hormone can be injected into an animal and an antibody to this protein can be formed. Well very simply that if you take your own from and this is from a volunteer who believes that she is not pregnant so you will find out in the second. You very very simply you take a drop of urine. And if you add to the drop of urine a drop of

the antibody to the protein of pregnancy. Then if the protein of pregnancy is present in the current one will neutralize the other one is the antigen. The other is the antibody. Then if you take the antigen out and add it. And if the woman is not pregnant you should find that since the Sante body has not been neutralized. You get a big clump of set of sediment really. Which is what we have. So and I don't know if you can see that but there's a blob on there. So we don't have a pregnancy. We have. The right. And you see a pregnancy test is not very complicated

can be done in a doctor's office and it's a very simple thing to do why do I show you a pregnancy test. Well one of the statistics that's very interesting in this country is that abortionists who have published the results of their work and that has been done have shown that about 10 percent of the women who come to them for an abortion are not pregnant. They were not pregnant to begin with and since abortion is a rather major public health problem in this country right the major cause of death in this country is if we had any other disease in this country where we had a million cases a year you could imagine the outcry if we had a million cases of polio year or a million cases of meningitis a year. But with abortion where we do have a million cases a year things have to be done to try and cut down on the number one way to cut out 10 percent of the criminal abortions is to set up pregnancy testing which is very simple to do. And as you see there is such a method. And then at least that group of women will go running to abortionists

unnecessarily. Well what do you do when you become pregnant. Get married. That's one thing that you could do. About a quarter of the women in this country will have a baby each year or marriage became married excuse me about a fifth married when they discovered they were pregnant and our teen age group in most areas where this is been studied we find that 50 percent of the brides are pregnant so one thing that you do when you become become pregnant realize that you're pregnant is that you become married. But another thing that you could do is have an abortion and that is something which a very large number of American women do not legally criminally. It's something we'll talk about two weeks from now. But it is a fact of life. And that's what we're talking about in this cause. So we have a million of the four million women who become pregnant running out they have a criminal abortion.

One of the things that you ought to do when you become pregnant is to obtain prenatal care and obtaining prenatal care. I think a pretty good idea to go to a doctor who looks after you during your pregnancy checks your blood pressure make sure you don't develop any problems there listens to your baby make sure it's growing developing the way it should and you know in this country our statistics as to the results of labor and delivery. In other words how many babies that are born live and how many of the born don't. Our statistics are terrible United States ranks every time they rank them we get lower and lower on the list. Last time I saw the list it was we were 14th. There was some indication that we may drop down to 16th in the world. Of all countries in the world our results of pregnancy rate somewhere around 14. And so if for every thousand babies that a boy 1 we have twenty two babies that die

quite a contrast to the Scandinavian countries or to Holland where about 4 13 out of a thousand babies die. That represents approximately 40000 babies a year in this country. That is if we had the same perinatal mortality rate in this country as the Scandinavians have it's as the Israelis have as the Dutch have we would have 40000 more babies lives. One of the studies that was done at Yale indicated that if a woman just came for prenatal care if she had seven visits and the cost of her pregnancy seen by a doctor checked if there was a problem that it was resolved that the mortality rate of the babies was dropped from 20 to per thousand. To fourteen thousand in other words just obtaining ongoing prenatal care during pregnancy was enough to give that group the equivalent of the best results in the world. I don't think I can make any stronger plea for

obtaining prenatal care. One of the major questions that comes up is that of sharing the pregnancy. Who do you share the pregnancy with who share the pregnancy with you family. Certainly you first share it with your husband or boyfriend. You share it with other children in the family and then of course you share with an obstetrician the husband. I think the husband should have something to do with planning the pregnancy. I know some husbands who won't let their wives take the pill because they want family planning in their house to be under their control. And when the male pill comes along then and there it's not very far off. I guess they are the ones who will that will be taking the pill. Another question about relations with the husband is relations with the husband sexual intercourse during pregnancy. You get all kinds of advice mother in laws have lots of advice. Friends have lots of advice and no one has the right advice.

So far as I can see from the studies that have been done. Ah well study cases in literature and my own experience of having studied patients who have had intercourse regularly through pregnancy is that into cos there is no confrontation to having sexual relations during pregnancy. If you wish to get comfortable with the relationship exist with your husband then you have intercourse during pregnancy and that means until the time you go into labor and in fact our recent studies show that it seems to help labor and delivery. I mentioned that before. A husband comes into the picture when it comes to the time of delivery. Well here a little bit more about that in a few minutes. What about other children. I think that pregnancy is perhaps the most ideal time for sex education in the home. A woman who has a 3 year old son 3 year old daughter becomes pregnant. Here is the perfect vehicle. Here is where you say baby grows in the uterus on the

stump. There is an opening between a woman's legs and the baby is born. You can when the child who's 3 years old asks What's the baby like now. Here's the opportunity to show how a baby develops inside of you. And so the child instead of being separated from the sibling it's developing comes to understand it. Another important thing about other children and the baby is an understanding that here's a rival being born one. There is going to be problems and resentment and one of the things that the baby that the child at home is expecting is a playmate. It's not expecting a little lump to make some mass has to be cleaned all the time and takes up most of the mother's time. And so once the childhood home sense of this there is a real reaction and I find

it's unusual to see the family where you don't get some kind of reaction in the you know the children. And it's important to realize this. You're not the only one going through this when it happens to you. It's a universal reaction and your awareness of the other child's feelings are extremely important. Now when it comes to delivery or delivery of a baby nowadays is a is a procedure which has gone through many changes and we think that at this time we have developed very safe approaches and a very good understanding of what happens with labor and delivery. A woman comes to the hospital a doctor cares for her he watches her during labor and delivery when she is when she is in labor and she is in pain. She is made comfortable. She's made comfortable with the philosophy the philosophy is that the woman should be comfortable. But the Labor should not be impeded. And the baby

should not be harmed. And so when a woman says I'm uncomfortable and I want you know a hundred tons of narcotics you very simply say that I can't give you this medication in a few minutes whatever it's going to be I will be able to help you. And I want you to be patient and you stay at the bedside and you help her through whatever it is 15 20 minutes a half an hour of that. That discomfort and then you plan your labor and delivery safely. I think the worst thing is when the patient forces a doctor or demands a doctor to give her medication which he knows is against good judgment in the labor and delivery that you will see the patient is given a kind of anesthesia called saddle block anesthesia. That's something we might talk about a little bit later. But I want you to understand what's being done. It is a kind of anesthesia

where the nerves supply to the area where the baby is being born on to the john is numbed. And so the patient does not feel anything in that area. The vagina can deliver the baby. I cock can be made the cut that we make is called an APC army. Forceps can be used in a moment you'll see what you mean by forceps instruments to help the baby be born. The forceps actually are instruments which protect the baby from the bones of the mother. Because women have a rather shocked arch of bones at the very opening to the vagina and so it's a baby's head goes right against that. It can be injured and flustered so use more to protect the baby not just to make a quick delivery. In fact faucets are usually used quite a while after a woman is ready for delivery and soley for the purpose of easing the delivery. And that's what you'll see you'll see in the film just how easy the baby is born. One of the things that's not shown in the film is a husband in the delivery room and

what I. You see because the general policy in this country is that husbands are not allowed in the delivery room. I spent some time in Holland a year and a half ago and there were all deliveries are at home 70 percent of the women in Holland live at home. And everybody's in the delivery room the husband is there the children are there everybody helps you sleep. And it's a family affair. And it's interesting you know that in Holland they have the best Parry made on what tally right the best infant survival in the whole world. Under those circumstances. And now two married couples who have just had children discuss with a doctor throughout various aspects of childbirth. You know I've asked two couples who've just had a bit me to come and tell us what the true scoop is the I've asked them just to come to give you an idea here. They've seen the film now so they have an idea of what labor and delivery is like. And.

I think that the one element of course that's missing there is you the personal element and I think that that's very important. So why don't we start with you Maureen and just tell us the kinds of feelings now tatoos and you having what you think's important to say about pregnancy for one of the fellas. I think I made deliveries. But until you have a baby yourself. That's the real feeling of it. I could talk about for today and you would never really know what it was like to have a baby because it's a very thrilling thing. I think the thrill in the emotional experience is completely left out of film of course. But that's a big part of it. That's the most exciting part of it I think to see your own baby when it's born and to be awake and to be able to look at it and see a scream you know it is a glowing mass and that's exactly what it is it's just the greatest feeling in your whole life.

It's very wonderful your delivery will not do you think. She totally changed tone to delivery it was a breech delivery. And. I wonder if you could comment on a couple. It wasn't much different Thank goodness. Can you hear can you hear her right. So maybe that's because it's a microphone. I had a breech delivery but I did not find it complicated. Fortunately I have a doctor like Dr. surreal to be with me and to help me through delivery. I wonder if you could tell us what it was like for you. Because as I recall you had not seen any of the other deliveries is that right. She's the first lady we had seen something I had wanted to see earlier with other children and hadn't had the opportunity yet so my producers you know

your husband are not in your living room. I mean you know I mean I don't mind violence of I'm involved in it but don't like to sit back and watch it. I was absolutely fascinated with the delivery was taking place. And after the delivery was over I walked out of the delivery room and crashed in the hall. It's an experience that I'm glad I undertook in spite of the accident. It's an embarrassment. It's an embarrassing accident. Enough as it is but when an Army officer passes out an Air Force hospital. There is some aggravation to the embarrassment. Well even though you went through that kind of experience what would you advise other fellows I would advise I definitely definitely observe the delivery if possible. It may give you a closer feeling of kinship if possible

with the child and much much more. Consciousness of what your wife has gone through. Huge spectacle really is. Can the girls tell us about pain during labor and delivery. Well I can say that there is pain that you and I don't know that I didn't expect there or they wouldn't be but there was that was Labor's a very good word for what he goes for because it's exactly what you do I don't think you sit by passively you work at delivering your baby you really work hard to push and strain and it's exhausting you figure you just can't go for another man. But hours go by and you're working trying to get a baby new Somehow you forget about what you did before and I guess that's why you have a second baby by the OS. But Labor is really a very good word for what you do. There's a poem that's increasing your given medication when you need it.

I was pretty alert to the whole thing I was awake through delivery and I was glad I was really a coward when it comes to crime I don't call it crime well at all. But I seem to manage through it by going here all know what else to say about it. Now what's the best part about having a baby or going through a pregnancy. From your lips I guess actually you're seeing the baby bring that baby home. Did you have different kinds of anesthesia with your deliveries. Yes I did. I wonder if you could compare them for us. I would get dressed I had a style flat and with the second I had to split everybody in the audience when they saw that needle going the back sort of trying to crawl under the seat. Is that what it's like when you get it was almost under the seat with the Mysore that felt like.

When you're there and you know that this is going to help well you're all for it. I was just up I did say give it to me and I was ready for it. But it was not quite as bad out of the film showed it believe me. What other types of fantasy should have you have had when I had this Bino and then you can explain what I had for Keith John what she had was called Terry Dural anaesthesia and it's a type of anesthesia which is being used more and more. It's a type of anesthesia which can be given before a woman is ready for delivery you notice that the saddle block was given in the delivery room. Very dearly to see who can be given several hours before delivery and it does not slow the labor and women can be quite comfortable. Even though she's still in labor and when she would receive her and her own would. How would you describe the way you felt.

I feel fine. I was fully aware of what was going on and I was very pleased with it. And I had no aftereffects at all. Yes I find that women who are most upset about delivery nowadays are those who will completely knocked out or given medication where they don't remember anything. It's a pretty important time in your life and you have no idea of what happened. It is the kind of thing that I personally am against and. Many patients have said to me that you know it's really weird that I don't remember what happened. I think that is one of the advantages of the type of anesthesia you receive what you receive the search time. No anaesthesia not really. I had done some guests at the end but that was about all uses on nitric oxide.

I usually use that's laughing gas. Some patients just laugh. Although most react in that their pain is somewhat relieved. However that is pretty close to having no anesthesia. What's it like to deliver a baby with no anesthesia. Our student said that she would call it a natural childbirth which means practically speaking no anesthesia. How do you feel about that. I'm all for a little bit of help but again I'm not all that brave I think you're brave enough to go through with that. Having a child and if you're aware of what's going on why shouldn't you receive a little help at the end. Well there are lots of questions and other of the comments that you want to make. Yes. Well I have a question and as far as what are some things that can go wrong in delivery of a child. Well sometimes a woman doesn't have enough room for a baby to come through or sometimes the

baby is in a position such that it's difficult to deliver. And as a result of that you have to deliver the baby bias's Arion section Zarian means that you make an opening in the abdomen through the uterus and remove the baby that way. This is Erin is done with varying frequency in different parts of our country. I detail about three and a half percent statistically three and a half percent of the deliveries are by scissoring S.. Now they're not always for the factor of a baby. Not enough room for a baby. Sometimes they are because the placenta is coming first. You see if the placenta the afterbirth is coming first then it can cause bleeding or certainly it can cut off the oxygen supply to the baby. Sometimes this area into done because the baby indicates to us as we follow the patient in labor that the baby is in distress. The sign usually is that its

heartbeat is irregular and there will be a time in the not too distant future when all babies will be monitored. Why and have their electric cardiogram recorded right through the labor. This is done at the Alpha on four patients every day of setup and when they come in in labor they are booked up to the central monitor and one nurse can sit and watch the heart rate to the four babies. And if a baby should develop a problem of not getting enough oxygen or some other type of problem then assess Arion might have to be done. Why might a baby not get enough oxygen. Well not infrequently it has to do with the oxygen going through the cord to the baby. Then there are some patients who are high risk patients. The patient who develops toxemia pregnancy excessive weight gain and high blood pressure which in turn changes the afterbirth and the oxygen supply to the baby. Such a patient may develop problems during

pregnancy. Now we spend 4 years of specialty training and we spend. The rest of our lives studying the problems so it's hard in you know 45 seconds to condense it. I'll say this that in a healthy population that is. And remember the test is experience. My own experience as students and interns or in large city hospitals and in New York where many patients would come in who had no prenatal care patients who were severely anemic patients who had infections all kinds of problems. And it's been quite a contrast for me now in the military to see a healthy group of patients patients who come from the military for prenatal care and quite frankly in a total of three hundred fifty deliveries that I've done in the almost two years that I've been at

Westover I've had to do two says Aryan sections and three hundred fifty deliveries. Now this is unheard of at Bellevue Hospital or say Vincent's Hospital where we receive dog training so and so in a healthy group. The complications a nowheres near what you read in the broad statistics for the country. And. It's very encouraging to me to see that you do get some results. Is it necessary to have any drugs at all during labor. Did you have any drugs during your life. Mark you can bury it you were given one injection at least according to the record I have and that was simply a tranquilizer you were given no pain medication during your labor. I've had many patients who tend to liver with no drugs. I think though that one of the major problems that you get is the girl who has

gone through a course of prepared childbirth psychologically she is geared for having the baby with no medication at all. I think it's wrong for a woman to decide that she doesn't need anything get to a point of labor away she does need help. And after all I got you know we have this tremendous array of things that we can do to make labor and delivery a comfortable pleasurable experience and for the woman not to take advantage of that. I think it's a mistake. What about the reaction of the other children to the baby. As you mentioned earlier they wanted plaything to come home and they get a five pound sack a shoulder to master it just sits there and makes noise and the oldest girl is eight and she's most helpful taking care of the child and the others are as well but it was

somewhat of a letdown at first I didn't ever. So I want to talk to him play wouldn't you know you can't join the join a playing group right away. I think that they are real though. Yeah baby. And we see no problem with the other. They are not resentful at all. All right the children of the stimulus. Having another child one of the things I seen lately my son keeps telling us when there's a brother coming once a sister coming. And is this a fact is this an influence. I do understand your comment but I'm just wondering you know so many things influence a couple to the decision of to have a baby. Economics certainly but personal relations are often an important part of it. And I'm what I'm asking is whether the other children in the house. Were an influence. I'm sure they are. Subconsciously perhaps but if they were

if they were totally on really too much to cope with I think that would put you off having more children. And if they're growing up to be good good home citizens. Then your reactions to it or your inclination to have much of an issue certainly for any variable What is the reaction of the wife to having a husband in the delivery room. Well I was aware that my husband was in the labor room with me. He was holding my hand and doctors are always counting my contractions. I was not aware that he was in the delivery room until after the baby was born. And then I looked up and I recognized the eyes between the cap and the mask and I was quite old and I think it was a feeling that I could never express. There is a general reaction online about half of the patients I

deliver husbands choose to come into the delivery room. Obviously I don't tell any husband you have to come into the delivery room. I ran into an interesting experience in Yugoslavia where a solution to the out of wedlock pregnancy was that the obstetrician in the community had all the fathers of the babies come and sit in the delivery room next to him and after that they didn't impregnate anyone else. He said he said his cure for out of wedlock pregnancy was 100 percent. But. In my experience the husbands who come to the delivery room find this a very strong family bond. They've shared something that is really unique. Just Friday I delivered a baby and the patient Sussman did not want to go to delivery room but another woman was living at the same time and this other fellow said to him Well why don't you go you're going to miss the greatest thing in the fells at all not

me. So I said to him Well let's strike a compromise. And I put a chair in the door looking into the delivery room. I said you sit there and watch. And if you don't feel well and you want to leave just get up and leave. The next thing I knew I looked up and there he was taking pictures and he had a flashcard. And all I heard and all I heard for the next three days was boy really glad to talk me into it. I saw that. In many ways the experience turns out to be even a stronger one for the man than for the woman. I liked your letter made Phillips in which he said I hope that my accident doesn't mean that all the husbands won't be allowed to go to the living room because it is such an important experience.

The healthiest time for a woman to have a baby is two years after she's been married. You know we then we have to understand what that means because in this country that means that most women will have be having their babies when they are 22 or 23 years of age. If everybody married at age 20 have the babies at two years later then. The family situation is the stable list. And the results of the best. There is a change in the danger of pregnancy if the woman is under the age of 18 or over the age of 35. Now the 41 year old patient comes to me and says I've just been married and I want to have a baby. I say to her that you have an increased risk of having a miscarriage that you have an increased risk of having a baby that will be a Mongol although it's a very small risk and that if you

add up all of the various kinds of complications that you could have then the odds are about 95 out of 100 that you'll have a perfectly normal pregnancy and you have to assume this risk. Now many women feel a lot that they're willing to assume that yes at age 40. I just feel that a 5 percent risk is pretty significant and that they don't want to take it. Is that an answer to question and back. Well there is an increased risk after a fourth pregnancy. We know that in terms of complications such as infection or premature babies the higher rate of dead babies that after the fourth delivery there are gray to complications. Now that's got to be interpreted because most of the

culture who have more than four babies are on the poor. And among the poor they don't receive adequate care. And so you find you have more complications. Do you know which single group in our culture has the largest families. They are the Catholic population with a college education. That there has. That's the group that has the largest families and the smallest families in our population on the negro groups who have a college education. Do you have any weird feelings during pregnancy that you can explain. I wonder if the girls can tell us. I do have a lot of with with very very strange. I wanted sweets fudge sundaes a little the night. Constantly in Cape and ice cream so you see in Flushing I really crave them if I didn't get them I listed them as.

Not unlike that perhaps that's good but that's it really is very much so much feelings related to food smells of food also ignores any other point I would be sick on the spot and I didn't just dislike them in their office and the smell pass in front of my nose like somebody didn't like it I was very very sick and might have been something that I like to feel like I'm pregnant and so I'm going to stuck to the line was pregnant or not. We clean the living room love I think once because I was sure the snow was in the rug and every time I walked in the house I become sick. Or and I could smell that's not what it was like heard of other people also clean their drugs because I thought the smell was in the bag. A lot of a lot of women tell me that they lose that taste for smoking during pregnancy. And I feel like making up a gold medal to give them

and say oh you can win this gold medal as long as you stop smoking. How much does a woman have to curtail our activities during pregnancy. It was a very restrictive one. You know I I did not have too much of a weight problem and I have three children who were a great deal I skating. So instead of just sitting around I tried to try to dissipate most of the time with them and I enjoy exercise and I enjoy walking a great deal and I think that I've always felt this with all the other pregnancies. If you keep up with the exercise exercising walking a great deal I think you can help. It makes for an easy delivery but I advise patients that they should do whatever they're accustomed to doing. If you horseback riding horseback ride if you can skate and ski and until you go into labor you know that that swimming is good exercise during pregnancy that certainly

bathing. Tom Batts throughout pregnancy until the time you go into labor one of the major areas is a question of intercourse during pregnancy as I've said before. We show new patient can have intercourse until she goes into labor there are changes in feelings about into cos. I wonder if that's what you were referring to before. No one there. That a woman has a really tremendous shifts in her desire for sexual relations during pregnancy and very important for a man to understand that that there may be times when this is really something that she is not interested in. And it's wrong that time to have any kind of sexual relations and other times she may find that she has a greater design than she'd ever had before and a life and has a little trouble coping with this and starts to wonder if she's some fiend. But. But these these are rather natural reactions that many many patients have asked me about and

that Dr masters comments about. Well we started 10 minutes late so we can end 10 minutes late and I'm sorry we don't have time for any other questions. Human Sexuality. The fifth in a series of seven classes given as part of a four college course in human sexuality sponsored jointly by Amherst Mount Holyoke and Smith Colleges and the University of Massachusetts today. Dr. Philips around a gynecologist from Westover Air Force Base talked about pregnancy and childbirth. This seven part series on human sexuality was produced by WFC are five College Radio in Amherst Massachusetts.

Thank.

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