Birth and the Newborn Infant Chapter 3 Robert S. Feldman Copyright © 2011 Pearson Education, Inc. All rights reserved.

Looking Ahead What is the normal process of labor ? What complications can occur at birth, and what are their causes, effects, and treatments? What capabilities does the newborn have?

Labor: The Process of Birth Begins Contractions Braxton-Hicks Labor initiation

Stages of Labor

From Fetus to Neonate When is the moment of birth? What causes a baby to cry after birth? What cultural differences surround the birth of children worldwide?

APGAR SCALE

More About APGAR Scores Low scores Existing fetal problems or birth defects Difficulties related to process of birth Temporary deprivation of oxygen (anoxia) Wrapped umbilical cord Pinched umbilical cord

You must have been a beautiful baby…or were you? Introducing the neonate: Vernix Lanugo Puffy eyelids Blood/other substances

Initial Encounters True or false: Newborns who do not spend time bonding with their parent or parents immediately after birth will automatically suffer long- term social and emotional consequences.

Messages from Massage Physical stimulation after birth Stimulates production of brain chemicals that instigate growth

Approaches to Childbirth Variety of strategies and approaches No universally accepted single procedure No conclusive research evidence that one procedure significantly more effective than another

What birthing procedures would you choose?

Alternative Birthing Procedures Lamaze birthing techniques Bradley Method Hypnobirthing

Childbirth Attendants: Who Helps? Obstetrician Midwife Doula

Pain and Childbirth Interpretation of pain is subjective Amounts of pain experienced by women during childbirth vary For some women, the perceived pain is intense and agonizing; for other women there is little to no perceived pain Many factors affect pain perception, including cultural ideas of childbirth, fear, number of previous births, fetal presentation, birthing position, and a woman's natural pain threshold

Use of Anesthesia and Pain- Reducing Drugs Kinds Epidural anesthesia Walking epidural or dual spinal-epidural Effects Mother Reduces/eliminates pain associated with labor Sometimes slows labor Neonate Drug strength related to effects on fetus May temporarily depress the flow of oxygen to fetus Less physiologically responsive, show poorer motor control during the first days of life after birth, cry more, and may have more difficulty in initiating breastfeeding

And so…? Only minimal risks to the fetus and neonate Woman’s request for pain relief at any stage of labor should be honored Proper use has no significant effect on child’s later well-being

Do neonates feel pain during birth? Objective indications of neonate pain at birth: Crying Facial expressions Body movement Vital signs Serum cortisol, tissue and blood oxygen levels Neurobehavioral assessments

Post-delivery Hospital Stay What are the advantages and disadvantages of early dismissal?

Newborn Medical Screening American College of Medical Genetics recommendations: All newborns be screened for 29 disorders, ranging from hearing difficulties and sickle cell anemia to extremely rare conditions such as isovaleric academia, a disorder involving metabolism Permits early intervention and treatment

Becoming an Informed Consumer of Development Dealing with Labor Be flexible. Communicate with health care providers. Remember that labor is... laborious. Accept support. Be realistic and honest about reactions to pain. Focus on the big picture.

Review and Apply REVIEW Stages I n the ____ stage of labor, contractions increase in frequency, duration, and intensity until the baby’s head is able to pass through the cervix. In the ____ stage, the baby moves through the cervix and birth canal and leaves the mother’s body. In the ____ stage, the umbilical cord and placenta emerge. Immediately after birth, birthing attendants usually examine the neonate using a measurement system such as the ____ scale.

Review and Apply REVIEW ____ birthing options are available to parents today. They may weigh the advantages and disadvantages of ____ drugs during birth. They may choose alternatives to traditional hospital birthing, including the ____ method, the use of a ____ ____, and the use of a ____.

Review and Apply APPLY Why might cultural differences exist in expectations and interpretations of labor? While 99 percent of U.S. births are attended by professional medical workers or birthing attendants, this is the case in only about half of births worldwide. What do you think are some reasons for this, and what are the implications of this statistic ?

BIRTH COMPLICATIONS

What do you think? Why is infant survival less likely in the United States than in other, less developed countries?

International Infant Mortality

Problems During Labor and Delivery Preterm infants Low birth-weight infants Small-for-gestational-age infants

Very low birth-weight infants The smallest survivors Most vulnerable; immaturity of their organ systems Weigh less than 1250 grams (around 2 1/4 pounds)

Survival of the Smallest

What causes preterm and low- birth-weight deliveries? Half of births unexplained Difficulties related to mother’s reproductive system Immaturity of mother’s reproductive system General health of mother

Factors Associated with Increased Risk of Low Birth weight Demographic risk Medical risks predating pregnancy Medical risks in current pregnancy Behavioral and environmental risks Healthcare risks Evolving concepts of risks (See Table 3-2)

Table 3-2. Factors Associated with Increased Risk of Low Birthweight

Post-mature Babies: Too Late, Too Large 2 weeks or more overdue Blood supply from placenta may become insufficient Blood supply to brain may be decreased, leading to the potential of brain damage Labor becomes riskier for larger fetus to pass through birth canal

Cesarean Delivery Baby is surgically removed from uterus Occur most frequently when fetal stress appears More prevalent in older mothers Related to position in birth canal: breech, transverse

True or False? Cesareans are effective medical interventions?

International Incidence Rate: Cesarean Deliveries

Mortality and Stillbirth: The Tragedy of Premature Death Stillbirth Resources: March of Dimes National Stillbirth Society MISS Foundation

Developmental Diversity Overcoming Racial and Cultural Differences in Infant Mortality

Leaving Leave Alone Opportunity to take extended maternity leave can be important ~ Are these always available? Let’s take a look at Table 3-3 for a summary of leave policies in the US and 10 peer nations.

Table 3-3

Moving From the Heights of Joy to the Depths of Despair Postpartum Depression Incidence rate Symptoms and Causes Consequences

When Mothers Are Depressed Depressed Mothers Display little emotion and to act detached and withdrawn Infants Display fewer positive emotions and withdraw from contact not only with their mothers but with other adults

Review and Apply REVIEW Largely because of ____ ____ ____, preterm infants may have substantial difficulties after birth and later in life. ____ ____ ____ are in special danger because of the ____ of their organ systems. Preterm and low-birth weight deliveries can be caused by ____, ____, and pregnancy-related factors in the ____. ____ (and, because of its relationship with income, race) is also an important factor.

Review and Apply REVIEW ____ deliveries are performed with post mature babies or when the fetus is in ____, in the wrong ____, or unable to progress through ____ ____. Infant ____ rates can be affected by the availability of inexpensive health care and ____ ____ programs for mothers-to-be. Postpartum depression affects about ____ percent of new mothers.

Review and Apply APPLY What are some ethical considerations relating to providing intensive medical care to very-low-birth weight babies? Do you think such interventions should be routine practice? Why or why not? Why do you think the United States lacks educational and health care policies that could reduce infant mortality rates overall and among poorer people? What arguments would you make to change this situation?

THE COMPETENT NEWBORN

Neonate, but not novice…completely! Neonates emerge practiced in many types of physical activities Reflexes

The Newborn Digestive System Meconium Neonatal jaundice

Sensory Capabilities: Experiencing the World Seeing Visual acuity not fully developed but can see to some extent Attend to visual field highest in information and brightness Possess some sense of size constancy Distinguish and show preference for different colors

Sensory Capabilities: Experiencing the World Hearing Clearly capable of hearing, but auditory acuity not completely mature React to and show familiarity with certain kinds of sounds

From Research to Practice Circumcision of Newborn Male Infants: The Unkindest Cut? PRO Routinely performed on many US infants More recently found to protect against future STDs Risk reduction for urinary track infection and penile cancer CON Deemed medically unnecessary by national medical associations Can cause bleeding and infection May reduce sensation and sexual pleasure later in life

Do you agree that tradition alone is enough of a reason to circumcise a male infant?

What about other senses? Senses of touch, smell, and taste are not only present at birth, but are reasonably sophisticated.

Early Learning Capabilities Infants are capable of learning very early through classical conditioning Operant conditioning functions from the earliest days of life

What is habituation? Decrease in response to stimulus that occurs after repeated presentations of same stimulus Most primitive form of learning that occurs in every sensory system

A Quick Review Classical conditioning Operant conditioning Habituation (See Table 3-5 for descriptions and examples)

Table 3-5

After forming a small group, devise a way in which you may use classical conditioning in your social life.

Social Competence: Responding to Others Newborns have capability to imitate others’ behavior This provides them with important foundation for social interaction later in life

Operant Conditioning Insert video: sych/media/interface/index.htm?atitle=Ope rant%20Conditioning&id1=19_1&id2=19_2 &sid=19_1

Form your group again and see which group in class can devise a way in which you can operantly condition your professor! Be creative (smile).

When Neonates and New Parents Jive Review the information in Table 3.6 and consider: The ultimate outcome of the social interactive capabilities of the newborn infant, and the responses such behavior brings about from parents, is to pave the way for future social interactions.

Review and Apply REVIEW ____ are in many ways helpless, but studies of what they can do, rather than what they can’t do, have revealed some surprising capabilities. Newborns’ respiratory and digestive systems begin to function ____ ____. They have an array of ____ to help them eat, swallow, find food, and avoid unpleasant stimuli. Newborns’ ____ ____ includes the ability to distinguish objects in the ____ ____ and to see ____ differences; the ability to hear and to discern familiar ____; and sensitivity to ____, odors, and tastes.

Review and Apply REVIEW The processes of ____ ____, _____ ____, and ____ demonstrate infants’ learning capabilities. Through these processes infants develop the foundations of ____ ____ early.

Review and Apply APPLY Can you think of examples of the use of classical conditioning on adults in everyday life, in such areas as entertainment, advertising, or politics? Developmental researchers no longer view the neonate as a helpless, incompetent creature, but rather as a remarkably competent, developing human being. What do you think are some implications of this change in viewpoint for methods of child rearing and child care ?

EPILOGUE Before we move on to a more detailed discussion of infants’ physical development, return for a moment to the case of the premature birth of Tamera Dixon, discussed in the prologue. Using your understanding of the issues discussed in this chapter, answer the following questions. Tamera was born almost four months early. Why was the fact that she was born alive so surprising? Can you discuss her birth in terms of “the age of viability”?

EPILOGUE What procedures and activities were most likely set into motion immediately after her birth? What dangers was Tamera subject to immediately after birth because of her high degree of prematurity? What dangers would be likely to continue into her childhood? What ethical considerations affect the decision of whether the high costs of medical interventions for highly premature babies are justifiable? Who should pay for those costs?