© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 1 John W. Santrock Birth 5

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 2 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 Are Two Widely Used Measures of Neonatal Health and Responsiveness? What Happens During the Postpartum Period?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 3 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 What Happens During the Birth Process?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 4 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 What Happens During the Birth Process?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 5 Stages of the Birth Process Third stage (Afterbirth) –Placenta, umbilical cord, and other membranes detached and expelled –Fastest stage; lasts only minutes What Happens During the Birth Process?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 6 The Stages of Birth b d a c Placenta Vagina Cervix Uterus Fig. 5.1

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 7 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. What Happens During the Birth Process?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 8 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 What Happens During the Birth Process?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 9 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 What Happens During the Birth Process?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 10 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 What Happens During the Birth Process?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 11 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 What Happens During the Birth Process?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 12 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 What Happens During the Birth Process?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 13 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 What Happens During the Birth Process?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 14 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 How Do Low-Birthweight Infants Develop?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 15 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 How Do Low-Birthweight Infants Develop?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 16 Fig. 5.2 Percentage of All U.S. Births That Are Preterm Percentage of preterm births Year

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 17 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

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 18 Fig. 5.3 Cognitive Skills of Students Born with Low or Normal Birthweight Overall cognitive skills score Full term normal weight 750 g 750 g – 1,499 g

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 19 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 – How Do Low-Birthweight Infants Develop?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 20 3 lb. 1 oz 3 lb. 7 oz 2 lb. 15 oz 3 lb. 3 oz 3 lb. 5 oz Infant weight Age in days Premature infants who were massaged Premature infants who were not massaged Weight Gain Comparison of Premature Infants Who Were Massaged and Not Massaged Fig. 5.4

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 21 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 How Do Low-Birthweight Infants Develop?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 22 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 What Are Three Measures of Neonatal Health and Responsiveness?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 23 Score 012 Body Color Blue, paleBody pink, extremities blue Entire body pink Heartbeat AbsentSlow – less than 100 beats per min. Fast – 100 to 140 beats per min. Reflex Irritability No response GrimaceCoughing, 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 Apgar Scale

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 24 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 What Are Three Measures of Neonatal Health and Responsiveness?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 25 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 Are Three Measures of Neonatal Health and Responsiveness?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 26 Postpartum Period Period after childbirth when the mother adjusts physically and psychologically to process of childbirth –Lasts about six weeks –Influenced by preceding events What Happens During the Postpartum Period?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 27 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 What Happens During the Postpartum Period?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 28 Postpartum Adjustments Emotional and psychological changes –Emotional fluctuations –Fatigue –Inexperience or lack of confidence –Extensive demands may cause anxiety, depression, coping difficulties What Happens During the Postpartum Period?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 29 Postpartum Depression Strong feelings of sadness, anxiety, or despair in new mothers –Excessive worrying –Depression –Extreme changes in appetite –Crying spells –Inability to sleep What Happens During the Postpartum Period?

© 2007 The McGraw-Hill Companies, Inc. All rights reserved. Slide 30 “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 Percentage of U.S. women experiencing “Baby Blues” and Postpartum Depression