Children 5 Birth John W. Santrock

Birth What Happens During the Birth Process? How Do Low Birthweight Infants Develop? What Are Two Widely Used Measures of Neonatal Health and Responsiveness? What Happens During the Postpartum Period?

Birth Images of Children: A Fantastic Voyage Cindy and Tom recount the hours and changes that took place before their son, Tanner Roberts, was born and during his birth process.

Stages of the Birth Process What Happens During the Birth Process? Stages of the Birth Process First stage Lasts about 12 to 24 hours; longest stage Contractions are about 15–20 minutes apart; occur closer together as birth nears Contractions dilate cervix to opening about 4 inches Allows baby to move from uterus to birth canal

Stages of the Birth Process What Happens During the Birth Process? Stages of the Birth Process Second stage Approximately 45 minutes to an hour Baby moves through cervix and birth canal Mother pushes down, contractions come almost every minute

Stages of the Birth Process What Happens During the Birth Process? Stages of the Birth Process Third stage (Afterbirth) Placenta, umbilical cord, and other membranes detached and expelled Fastest stage; lasts only minutes

The Stages of Birth Fig. 5.1 b d a c Placenta Vagina Cervix Uterus

The Fetus/Newborn Transition What Happens During the Birth Process? The Fetus/Newborn Transition Uterine muscles draw together Decreased oxygen supply during contractions is termed anoxia—insufficient oxygen to fetus/newborn Stress hormone secretion protects from oxygen deficiency, prepares infant for birth. Vernix caseosa (skin grease) protects against heat loss.

Childbirth Strategies and Decisions What Happens During the Birth Process? Childbirth Strategies and Decisions Childbirth setting and attendants 99% of U.S. births occur in hospitals Over 90% are attended by physicians Vaginal and cesarean delivery, birthing centers Neonatal mortality risk lower when attended by certified midwife rather than physician

Childbirth Strategies and Decisions What Happens During the Birth Process? Childbirth Strategies and Decisions Childbirth setting and attendants Doulas: professional trained in childbirth; common in many countries Provide physical and emotional support to mother before, during, and after childbirth Mother has less pain, anxiety, and depression

Childbirth Strategies and Decisions What Happens During the Birth Process? Childbirth Strategies and Decisions Methods of delivery: medications Analgesia: used to relieve pain Anesthesia: used in late first-stage labor and during expulsion to block sensation Epidural block: numbs from waist down Oxytocics: synthetic hormones used to stimulate contractions

Childbirth Strategies and Decisions What Happens During the Birth Process? Childbirth Strategies and Decisions Natural childbirth: attempts to reduce mother’s pain by decreasing fear Prepared childbirth: similar to natural childbirth; special breathing technique used in final stages of labor Many techniques have been developed

Childbirth Strategies and Decisions What Happens During the Birth Process? Childbirth Strategies and Decisions Cesarean Delivery Baby removed from uterus through incision in abdomen when Baby is in breech or crosswise position Head too large for mother’s pelvis Vaginal bleeding has occurred in pregnancy Nearly 1 in 4 U.S. births are C-sections

Childbirth Strategies and Decisions What Happens During the Birth Process? Childbirth Strategies and Decisions Family Involvement Fathers More likely to meet with obstetrician Train to coach mother during labor and birth Siblings Provide with realistic information Address separation anxiety Address child’s emotions and behaviors

Preterm and Small- for-Date Infants How Do Low-Birthweight Infants Develop? Preterm and Small- for-Date Infants Low-birthweight infant Weigh less than 5.5 pounds Very low: under 3 pounds Extremely low: under 2 pounds Racial/ethnic differences exist Increased rates in U.S. over last 20 years Attributed to many causes

Preterm and Small-for-Date Infants How Do Low-Birthweight Infants Develop? Preterm and Small-for-Date Infants Preterm: born 3 weeks or more early Neurological development continues after birth about same timetable as if in womb Small for date (small for gestational age) low birthweight for term of pregnancy High risk of death

Percentage of All U.S. Births That Are Preterm 4 8 12 Percentage of preterm births 1992 2002 1982 12.1 9.5 10.7 Year Fig. 5.2

Long-Term Outcomes for Low-Birthweight Infants As a group Have more health and developmental problems; risks increases as birthweight decreases More likely to have learning disability, ADD or ADHD, and breathing problems Lower functioning persists in adolescence Improvement achieved with early interventions

Cognitive Skills of Students Born with Low or Normal Birthweight 20 30 40 50 60 70 80 90 100 10 Overall cognitive skills score Full term normal weight 750 g 750 g – 1,499 g Cognitive Skills of Students Born with Low or Normal Birthweight Fig. 5.3

Long-Term Outcomes for Low-Birthweight Infants How Do Low-Birthweight Infants Develop? Long-Term Outcomes for Low-Birthweight Infants Nurturing Preterm Infants Appropriate stimulation may vary Massage used throughout history; has led to greater weight gain, improved skills, and better academic performance

Weight Gain Comparison of Premature Infants Who Were Massaged and Not Massaged 3 lb. 1 oz 3 lb. 7 oz 2 lb. 15 oz 3 lb. 3 oz 3 lb. 5 oz Infant weight 4 6 8 12 2 14 10 Age in days Premature infants who were massaged Premature infants who were not massaged Fig. 5.4

Long-Term Outcomes for Low-Birthweight Infants How Do Low-Birthweight Infants Develop? Long-Term Outcomes for Low-Birthweight Infants Nurturing Preterm Infants Kangaroo Care: holding preterm infant so there is skin-to-skin contact leads to Sleeping longer, more weight gain Crying less, earlier hospital discharge Longer periods of alertness

What Are Three Measures of Neonatal Health and Responsiveness? Apgar Scale Widely used to assess health at 1 and 5 minutes after birth Performed by nurse/obstetrician Total score of 7 to 10 is good Score below 3 signals emergency Identifies high-risk infants

Apgar Scale 1 2 Score Body Color Blue, pale 1 2 Body Color Blue, pale Body pink, extremities blue Entire body pink Heartbeat Absent Slow – less than 100 beats per min. Fast – 100 to 140 beats per min. Reflex Irritability No response Grimace Coughing, sneezing, crying Muscle Tone Limp and flaccid Inactive, weak, some flexion of extremities Strong, active motion Respiratory Effort Breathing for no more than 1 min. Irregular and slow Breathing good with normal crying

Brazelton Neonatal Behavioral Assessment Scale What Are Three Measures of Neonatal Health and Responsiveness? Brazelton Neonatal Behavioral Assessment Scale Performed within 24 to 36 hours after birth Neurological development Reflexes Reactions to people Infant is active participant score based on best performance “worrisome,” “normal,” and “superior” classifications

Neonatal Intensive Care Unit Network Neurobehavioral Scale What Are Three Measures of Neonatal Health and Responsiveness? Neonatal Intensive Care Unit Network Neurobehavioral Scale Offspring of NBAS; provides more comprehensive analysis of newborn behavior Neurological and stress responses Regulatory capacities Assesses high-risk infants

What Happens During the Postpartum Period? Period after childbirth when the mother adjusts physically and psychologically to process of childbirth Lasts about six weeks Influenced by preceding events

Postpartum Adjustments What Happens During the Postpartum Period? Postpartum Adjustments Involution: process by which uterus returns to prepregnant size Bodily changes Estrogen and progesterone levels drop Fatigue is common Bodily functions return in a few weeks Exercises are recommended

Postpartum Adjustments What Happens During the Postpartum Period? Postpartum Adjustments Emotional and psychological changes Emotional fluctuations Fatigue Inexperience or lack of confidence Extensive demands may cause anxiety, depression, coping difficulties

Postpartum Depression What Happens During the Postpartum Period? Postpartum Depression Strong feelings of sadness, anxiety, or despair in new mothers Excessive worrying Depression Extreme changes in appetite Crying spells Inability to sleep

Percentage of U.S. women experiencing “Baby Blues” and Postpartum Depression “Baby Blues” Symptoms appear 2 to 3 days after delivery and subside within 1 to 2 weeks Postpartum depression symptoms linger for weeks or months and interfere with daily functioning No symptoms Fig. 5.7

Staying at Home or Working What Happens During the Postpartum Period? Staying at Home or Working Mothers’ wishes vary; decision making is often difficult and agonizing Pressures on mothers affect options Societal Career Financial

What Happens During the Postpartum Period? Father’s Adjustment May feel baby comes first and gets all the attention; replaced by the baby Set aside special time to be together Postpartum reaction improved if father attended childbirth classes and was active in delivery

What Happens During the Postpartum Period? Father’s Adjustment Both parents need to be aware of young infant’s developmental needs Physical Psychological Emotional

What Happens During the Postpartum Period? Bonding Close connection, especially physical bond, between parents and newborn in period shortly after birth Encouraged by many doctors: “rooming in” Little evidence for a critical bonding period, but parents enjoy and can be helpful Parent-child interaction climate improved

Children 5 The End