Chapter 3 Prenatal Development, Birth, and the Newborn Baby

Learning Outcomes Three periods of prenatal development and milestones Define teratogens and understand influence Impact of maternal factors on prenatal development Discuss medical complications Identify Common medical interventions during childbirth Describe use of APGAR Describe newborn baby’s reflexes Describe ways to sooth a crying baby Describe changes in a family after the birth

Periods of Prenatal Development Period and Length Key Events Zygote (2 weeks) Fertilization Implantation Start of placenta Embryo (6 weeks) Groundwork laid for all body structures and internal organs Fetus (30 weeks) “Growth and finishing” phase

Conception and Implantation Figure 3.1 Female reproductive organs, showing fertilization, early cell duplication, and implantation. Figure 3.1 (From Before We Are Born, 6th ed., by K.L. Moore & T.V.N. Persaud, p. 87. Copyright © 2003, reprinted with permission from Elsevier, Inc.)

Ovulation Video https://youtu.be/NkLUA05ExHA

Sensitive Periods in Prenatal Development Figure 3.2 Sensitive periods in prenatal development Figure 3.2 (Adapted from Before We Are Born, 7th ed., by K.L. Moore & T.V.N. Persaud, p. 313. Copyright © 2008, reprinted with permission from Elsevier, Inc.)

Teratogens Harm done by teratogens is affected by: dose heredity age other negative influences Websites http://depts.washington.edu/terisdb/terisweb/index.html http://mothertobaby.org/ http://www.cdc.gov/preconception/careforwomen/exposures.html http://www.cdc.gov/ncbddd/birthdefects/documents/ncbddd_birth-defects_medicationuseonepager_cdcrole.pdf 7

What period is the most sensitive? Zygote Period Embryotic Period Fetal Period

Teratogenic Substances Drugs: prescription nonprescription illegal Tobacco Alcohol Radiation Environmental pollution Infectious disease © Minerva Studio/Fotolia

Jigsaw Activity Index cards with substance will be passed out to assign you into a random group You will look up the drug impact in book, research from reliable sources on site (e.g., educational institutions). Cite when using outside of book How prevalent is it? How does it harm fetus? Can you find the category level? What is the impact after birth?

Other Maternal Factors in Prenatal Development Nutrition Emotional stress Rh factor incompatibility (p.73) Age Lack of prenatal health care © Dmitry Melnikov/Shutterstock

Infant Mortality in Thirty Nations Figure 3.5 Infant mortality in thirty nations Figure 3.5 (Adapted from U.S. Census Bureau, 2012.)

Importance of Prenatal Care Monitor general health: weight gain capacity of uterus and cervix to support fetus growth of the fetus Treat complications: diabetes preeclampsia © Poznyakov/Shutterstock

Eclampsia/toxemia (ek-lamp'sē-ă), Occurrence of one or more convulsions, not attributable to other cerebral conditions such as epilepsy or cerebral hemorrhage, in a patient with preeclampsia. Farlex Partner Medical Dictionary © Farlex 2012 eclampsia /eclamp·sia/ (ĕ-klamp´se-ah) convulsions and coma, rarely coma alone, occurring in a pregnant or puerperal woman, and associated with hypertension, edema, and/or proteinuria.eclamp´tic

Stages of Childbirth Dilation and effacement of the cervix Delivery of the baby Delivery of the placenta © Monkey Business Images/Shutterstock

Stages of Labor Figure 3.4 A Normal Birth Figure 3.4

The Apgar Scale Table 3.2 (Source: Apgar, 1953.) Table 3.2 The Apgar Scale

Apgar Challenge https://www.wisc-online.com/learn/career- clusters/health-science/nur402/apgar-scoring- challenge

Birth Complications (pg 77-78) Anoxia (oxygen deprivation) (an-ok'sē-ă), Avoid the careless substitution of this word for hypoxia or hypoxemia.Absence or almost complete absence of oxygen from inspired gases, arterial blood, or tissues. [G. an- priv. + oxygen] Farlex Partner Medical Dictionary © Farlex 2012

Breech Birth

Medical Interventions in Childbirth Fetal monitoring Labor and delivery medication analgesics anesthetics Cesarean delivery © ARZTSAMUI/Shutterstock

Reflection – page 78 Describe the features and benefits of natural childbirth. How might use of epidural analgesia negatively affect the parent-newborns relationship? What other considerations should be considered? If you were an expectant parent, would you choose home birth? Why or Why Not?

Preterm and Small-for-Date Infants Born several weeks or more before their due date Weight may be appropriate for length of pregnancy Small-for-Date May be either preterm or full-term Below expected weight for length of pregnancy Which one is more at risk during the first year?

Interventions for Preterm Infants Temperature-controlled isolette Special stimulation: gentle rocking visual or auditory stimulation touch, such as skin-to-skin kangaroo care Parent training in infant caregiving What is kangroo care? Is it effective? © Damon Yancy/Shutterstock

Flex Video http://media.pearsoncmg.com/ab/ab_berk_media /simulation/newborn/index.html

Infant States of Arousal Rapid-eye-movement (REM) sleep Non-rapid-eye-movement (NREM) sleep Drowsiness Quiet alertness Waking activity and crying © Vasilyev Alexandr/Shutterstock

Soothing a Crying Baby Hold on shoulder, rock or walk Swaddle Offer pacifier Massage baby’s body Talk softly or play rhythmic sounds Combine methods How to sooth a crying baby video https://youtu.be/j2C8MkY7Co8 © Jo Tunney/Shutterstock

Newborn Sense of Vision Least developed sense at birth Limited visual acuity Actively explore environment: scan for interesting sights track moving objects Not yet good at discriminating colors © Saylakham/Shutterstock

New Family Adjustment Hormones that facilitate caregiving: oxytocin prolactin estrogens Hormonal effects may depend on experience Challenges of early weeks: new roles changed schedule © ClickPop/Shutterstock

Learning Outcomes Three periods of prenatal development and milestones Define teratogens and understand influence Impact of maternal factors on prenatal development Discuss medical complications Identify Common medical interventions during childbirth Describe use of APGAR Describe newborn baby’s reflexes Describe ways to sooth a crying baby Describe changes in a family after the birth