In the third trimester, the fetus continues to grow, developing the size and strength it will need to live on its own (I Figure 11.4). It increases in weight from 4 pounds in the 7th month to an average of over 7 pounds at birth. The downlike hair covering its body disappears, and head hair continues growing. The skin becomes smooth rather than wrinkled. The fetus is covered with a protective creamy, waxy substance called the vernix caseosa vernix caseosa (VER-niks ka-see-OH-suh).

A waxy, protective substance on the fetus’s skin.

Prenatal Care

Some of the problems with fetal development are genetic and unpreventable, but the mother’s own general good health, good nutrition, adequate rest and exercise, and abstinence from alcohol and recreational drugs are crucial to providing the best envi­ronment for fetal development and for her own physical well-being during pregnancy and childbirth (Hannon, 2009). The Your Sexual Health box, "Folic Acid and Fetal Development," describes what every woman of childbearing age needs to be doing right now for the health of a future pregnancy.

Thorough prenatal care also involves health care and childbirth education. It is impor­tant for a woman to have a complete physical examination and health assessment before becoming pregnant, or as soon as she knows she is pregnant. She should also have a test to determine her immunity to rubella (German measles), a disease that can cause severe

chapter 11

Fetus — Uterus –

Bladder

Cervix – Clitoris – Vagina –

I Figure 11.4 Pregnancy in the 9th month. The uterus and abdomen have increased in size to accommodate the fetus.

fetal defects if the mother contracts it while she is pregnant. An HIV test should also be done before or during pregnancy, because HIV can be transmitted to the developing fetus during pregnancy, and therapies are available to prevent mother-to-child transmis­sion of HIV and to improve maternal and infant health (Lalleman et al., 2011).

Unfortunately, in the United States many babies are born without adequate prenatal care, a situation that increases the chance that problems will occur, including low birth weight, lung disorders, brain damage, and abnormal growth patterns. These problems can have lifelong effects (Lundgren et al., 2011). Women most likely to delay obtaining adequate prenatal care are unmarried African American or Hispanic American indi­viduals under age 20 who have not graduated from high school and are uninsured or on Medicaid. They typically live in low-income neighborhoods with crowded clinics and a shortage of doctors’ offices (Bloche, 2004).

Furthermore, statistics indicate that three to four times as many African Ameri­can women as Hispanic American or White women die from childbirth complications (S. Johnson, 2011). Because of the poor access to health care for people without health insurance or adequate government-funded clinics, the United States compares unfavor­ably with other countries in maternal and infant mortality rates. Forty-nine countries have lower maternal mortality rates and 41 have lower infant mortality rates than does the United States (Larsen, 2007).

The fate of pregnant women in developing countries is severe: A total of 99% of all maternal deaths occur in developing countries, mainly in sub-Saharan Africa and South

Conceiving Children: process and Choice

YOUR SEXUAL

HEALTH

Asia. For every 1,000 births, 74 women in developing countries die, compared to 7 in devel­oped countries (World Health Organization, 2009). Afghanistan has the world’s highest rate of maternal mortality, and more than 85% of women give birth with no medical help; 1 in 19 babies dies in the first month of life (Streib, 2011). Substandard health-care ser­vices, poverty, lack of education, women’s underlying poor health, and gender-related fac­tors resulting in women’s lack of decision-making power in their families all contribute to these high mortality rates (UN Department of Public Information, 2010).