Chapter 4 Birth and the Newborn Baby: In the New World

Birth and the Newborn Baby: Truth or Fiction? The fetus signals the mother when it is ready to be born. After birth, babies are held upside down and slapped on the buttocks to stimulate independent breathing.

Birth and the Newborn Baby: Truth or Fiction? The way that the umbilical cord is cut determines whether the baby’s “belly button” will be an “inny” or an “outy.” Women who give birth according to the Lamaze method do not experience pain.

Birth and the Newborn Baby: Truth or Fiction? In the United States, 1 birth in 4 is by cesarean section. It is abnormal to feel depressed following childbirth.

Birth and the Newborn Baby: Truth or Fiction? Parents must have extended early contact with their newborn children if adequate bonding is to take place. More children die from sudden infant death syndrome (SIDS) than from cancer, heart disease, pneumonia, child abuse, AIDS, cystic fibrosis and muscular dystrophy combined.

The Stages of Childbirth Countdown… The Stages of Childbirth

What Events Occur just prior to the Beginning of Childbirth? Dropping or Lightening Head of fetus settles in pelvis Braxton-Hicks contractions First uterine contractions may be experienced as early as 6th month Blood spotting in vaginal secretions Day or so before labor Rush of amniotic fluid from vagina Occurs in 1 woman in 10

What Events Occur just prior to the Beginning of Childbirth? Beginning of labor may be signaled by indigestion, diarrhea, ache in small or back, and abdominal cramps Placenta and uterus secretes prostaglandins excite uterus muscles causing contractions As labor progresses, oxytocin is released stimulates contractions powerful enough to expel the fetus

What Happens during the First Stage of Childbirth? Uterine contractions efface and dilate cervix First stage lasts from a few hours to more than a day Contractions increase in strength, frequency, and regularity Mother may be prepped Shaving pubic hair Administer enema

What Happens during the First Stage of Childbirth? Fetal monitoring Measure fetal heart rate and mother’s contractions If necessary to speed up delivery, forceps or vacuum extraction tube may be used Transition (about 30 minutes) Cervix is nearly fully dilated Head of fetus moves into vagina Frequent and strong contractions

Figure 4.1 The Stages of Childbirth Figure 4.1 The Stages of Childbirth. In the first stage, uterine contractions efface and dilate the cervix to about 4 inches so that the baby may pass. The second stage begins with movement of the baby into the birth canal and ends with birth of the baby. During the third stage, the placenta separates from the uterine wall and is expelled through the birth canal. Figure 4.1 The Stages of Childbirth

What Happens during the Second Stage of Childbirth? Begins when baby appears at opening of birth canal Ends with birth of baby Baby’s head crowned when it begins to emerge from birth canal Episiotomy may be performed once crowning takes place Used to prevent tearing of mother Controversial and used less frequently

Lessons in Observation: Birth In the video, Lee had her baby in a hospital setting, without fetal monitoring or anesthesia. What are some other approaches to childbirth outlined in your text? Lee was in labor for 9 hours with her first child, Carter. Is this typical?

Lessons in Observation: Birth

Lessons in Observation: Birth Lee and Dan were worried about the size of Carter’s testicles and his somewhat flattened facial features. Describe the newborn baby’s appearance and explain the likely duration of these characteristics. What does the acronym APGAR stand for?

Lessons in Observation: Birth How are each of the five areas tested by the APGAR rated? Appearance, Pulse, Grimace, Activity, Respiration Explain the APGAR score ratings in connection with good, fair, and poor condition.

Lessons in Observation: Birth What was Carter’s APGAR score? Why is this test performed twice, at one minute and at five minutes? Does the APGAR score predict the future health of a baby?

What Happens during the Second Stage of Childbirth? Once baby’s head emerges from mother, mucus is suctioned from the baby’s mouth Clears passageway for breathing Umbilical cord is clamped and severed Newborn may be removed Baby is footprinted ID bracelet is put on baby Antibiotic ointment or drops are applied to baby’s eyes Baby receives Vitamin K injection

What Happens during the Third Stage of Childbirth? Also referred to as the placenta stage Lasts minutes to an hour or more Placenta separates from the wall of uterus and is expelled Obstetrician sews episiotomy, if performed

Methods of Childbirth

How is Anesthesia Used in Childbirth? General anesthesia Puts mother to sleep Negative effects of general anesthesia Abnormal patterns of sleep and wakefulness Decreased attention and social responsiveness for at least 6 weeks Local anesthetics Deadens pain without putting mother to sleep Minor depressive effects on neonates shortly after birth

What is Prepared Childbirth? Lamaze method Utilize breathing and relaxation exercises to lessen fear and pain Teaches women to associate relaxation with contractions Coach Aids the mother in the delivery room Provides social support to mother during labor Doula Experienced female companion provides continuous emotional support during labor Fewer cesarean deliveries, less anesthesia, and shorter, less painful labors

What is the C-section? Cesarean Section Delivered by abdominal surgery Physicians prefer C-section to vaginal delivery Mother’s small pelvis Maternal weakness or fatigue Baby is too large Baby is in distress May be used to bypass infections in birth canal from HIV or Herpes

How Can a Woman Decide to Deliver Her Baby? Diversity of birthing options All-in-one labor, delivery, recovery, and postpartum rooms (LDRPs) Birthing suite in hospital equipped for uncomplicated birth Easy access to emergency facilities if needed Home Birth Can be fairly safe for healthy women with little risk of complications

Birth Problems

What are the Effects of Oxygen Deprivation at Birth? Hypoxia - Prenatal oxygen deprivation can impair development of central nervous system and psychological disorders Anoxia - Oxygen deprived at birth predicted problems in learning and memory can cause health problems such as early-onset schizophrenia and cerebral palsy

What is Meant by the Terms Prematurity and Low Birth Weight? Premature or preterm baby Occurs before 37 weeks gestation (normal is 40 weeks) Low-birth-weight baby Weighs less than 5.5 pounds Small for date Low-birth-weight, although born at full term

What Risks are Connected with being Born Prematurely or Low in Birth Weight? Infant mortality Neonates weighing 3.25 to 5.5 pounds are 7 times more likely to die than infants of normal weight Those weighing less than 3.3 pounds are nearly 100 times as likely to die Delayed neurological development Lower birth weight – poorer performance throughout school years Delayed motor development, such as walking Preschool experience fosters cognitive and social development

What Signs are Connected with being Born Prematurely or Low in Birth Weight? Preterm babies show signs of immaturity relatively thin fine, downy hair (lanugo) oily, white substance on skin (vernix) Preterms born six weeks or more prior to full term nipples not yet be emerged testicles of boys not yet descended into scrotum Muscles immature and reflexes are weak Respiratory distress syndrome walls of air sacs in lungs stick together

How are Preterm Infants Treated Following Birth? Usually remain in hospital incubators Temperature-controlled environment with protection from infection Parents often do not treat preterms as well as full term Less attractive than full-term babies High-pitched, grating cries More irritable Preterms and parent interaction is less even when they are brought home

How are Preterm Infants Treated Following Birth? Interventions for preterm infants Benefit from external stimulation Massage Kangaroo care Preterm infants exposed to stimulation Gain weight more rapidly Show fewer respiratory problems Make greater advances in motor, intellectual, and neurological development than controls

Developing in a World of Diversity Maternal Mortality and Infant Mortality Around the World

The Postpartum Period

What Kinds of Problems in Mood do Women Experience during Postpartum Period? Baby blues Transient – about 10 days Postpartum depression (PPD) Begins one month after delivery and may linger for weeks/months Major depressive disorder Psychotic features

How Critical is Parental Interaction with Neonates in the Formation of Bonds of Attachment? Bonding Formation of bonds of attachment between parent and child Essential to survival and well being of child “Maternal sensitive” period Amount of access to newborn (Klaus & Kennell, 1978) Extended early contact is not essential for adequate bonding

Characteristics of Neonates

How do Health Professionals Assess the Health of Neonates? Apgar scale Based on five signs of health Interpretation of scores 7 or above – no danger below 4 – critical condition Brazelton Neonatal Behavioral Assessment Scale Based on four areas of behaviors Measures reflexes, motor behavior and muscle tone

What are Reflexes? Reflexes Simple, unlearned stereotypical responses, elicited by certain types of stimulation Survival value Neural functioning is determined by testing reflex

What Kinds of Reflexes are Shown by Neonates? Rooting Baby turns head and mouth toward stimulus that strokes the cheek, chin, or corner of mouth Facilities finding mother’s nipple for sucking Sucking Babies will suck almost any object that touches the lips Will become replaced by voluntary sucking

What Kinds of Reflexes are Shown by Neonates? Moro or startle reflex Back arches, legs and arms are flung out and then brought back toward chest into a hugging motion Occurs when baby’s position is suddenly changes or health and neck support is lost Elicited by loud noises or bumping baby Usually lost 6 to 7 months after birth

What Kinds of Reflexes are Shown by Neonates? Grasping or palmar reflex Using four fingers, babies grasp fingers/objects pressed against the palms of their hands Most babies can support their own weight Usually lost by 3 to 4 months Replaced by voluntary grasping at 5 to 6 months

What Kinds of Reflexes are Shown by Neonates? Stepping reflex Mimic walk when held under arms Usually disappears by 3 or 4 months

What Kinds of Reflexes are Shown by Neonates? Babinski reflex Fans or spreads toes in response to stroking foot Usually disappears at end of first year Tonic-neck reflex While lying on back, baby turns head to one side. Arm and leg on that side extend, while opposite side flex.

Vision Visual acuity Estimate of 20/600 Best see objects 7 to 9 inches from eyes Lack peripheral vision of older child Able to track movement within one day of birth preference for moving objects

Studying Visual Acuity in Neonates: How Well Can They See? A Closer Look Studying Visual Acuity in Neonates: How Well Can They See?

Vision Visual accommodation Convergence Self-adjustments made by eye lens to bring objects into focus Neonates show little or no visual accommodation Focus on objects 7 to 9 inches away Convergence Does not occur until 7 or 8 weeks

Hearing Fetuses respond to sound Neonates respond to amplitude and pitch Show preference for mothers’ voice Responsive to sounds and rhythms of speech Show no preference for specific languages

Smell and Taste Smell Taste Well developed at birth Demonstrate aversion for noxious and preference for pleasant odors Recognize familiar odors Taste Sensitive to different tastes Demonstrate facial expressions to basic tastes Prefer sweet tastes

Touch and Pain Touch Pain Sensitive to touch Touch elicits many reflex behaviors Pain Less sensitive to pain

Or Really Early Childhood “Education” Learning Or Really Early Childhood “Education”

Can Neonates Learn? Classical Conditioning Operant Conditioning Involuntary responses are conditioned to a new stimuli Operant Conditioning Behavior (reflexes) are modified through reinforcement

What Patterns of Sleep are Found among Neonates? Neonates spend about 16 hours per day in sleep Typical infants has six cycles of waking and sleeping REM Sleep Neonates spend 50% time in REM sleep Decreases in percentage of REM 6 months – 30% 2 to 3 years – 20 to 25% NREM Sleep

Figure 4.15 REM Sleep and Non-REM Sleep Figure 4.15 REM Sleep and NREM Sleep. Neonates spend nearly 50% of their time sleeping in rapid-eye-movement (REM) sleep. The percentage of time spent in REM sleep drops off to 20% - 25% for 2- to 3- year olds. (Source: Roffwarg, et.al., 1966) Figure 4.15 REM Sleep and Non-REM Sleep

Why do Babies Cry? Pain and discomfort Universal, expressive and functional communication expressive response to unpleasant feelings stimulates caregiver response Distinct causes and patterns of cries Hunger, anger, pain Peaks of crying in late afternoon and early evening Crying produces physiological response in others

What Can I do to Stop an Infant from Crying? Sucking serves as a built-in tranquilizer Pacifier, sweet solutions Soothing processes Pick baby up, patting, caressing, rocking them Speaking to them in low voice

What is SIDS? Sudden Infant Death Syndrome – crib death Strikes while the baby is sleeping Most common cause of death in infants between 1 and 12 months Most likely to occur between 2 and 5 months Period when reflexive behavior is weakening Causes of SIDS remains obscure

What are the Risk Factors for SIDS? SIDS is most common among babies aged 2 to 4 months babies put to sleep on their stomach premature and low-birth-weight babies males lower SES African Americans babies of teenage mothers babies of mothers who smoked or used narcotics during pregnancy