1. Children 5
Birth
John W. Santrock

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 Happens During the Postpartum Period?

3. 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.

4. 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

5. 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

6. 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

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

8. 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.

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. Percentage of All U.S. Births That Are Preterm4 8 12
Percentage of preterm births
1992
2002
1982
12.1
9.5
10.7
Year
Fig. 5.2

18. 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

19. Cognitive Skills of Students Born with Low or Normal Birthweight20 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

20. 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

21. 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

22. 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

23. 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

24. Apgar Scale 1 2 Score Body Color Blue, pale1 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

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

35. 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

36. Children 5
The End