1. Pregnancy and Childbirth
Labor, Newborns, Postpartum Issues, Caring for baby

2. Labor

3. Early Labor Baby settles deep into mother’s pelvis (dropping)
Losing the mucus plug
Water breaking
Amniotic fluids’s membrane has broke
Contractions
Tightening and releasing of uterine muscle
Braxton Hicks: weeks before actual labor begins

4. Stages of Labor Stage one: contractions open the cervix
Stage two: the baby is born
Stage three: placenta expelled

5. Stage one: Contractions
Cervix dilates (widens) to four inches (10 cm) by the end of the stage
Cervix thins out
Contractions are approximately 60 seconds long and 5 – 6 minutes apart
As the cervix opens, baby moves down into the lower pelvis
Breech presentations
Baby is not head first
At the end of the stage, contractions last up to 90 seconds and are 2 – 3 minutes apart
Cervix is fully dilated
Transition period

6. Stage two: Here comes baby!
Can last from minutes to hours
Contractions are moving the baby down the birth canal
Skull is soft and flexible to allow for passage (it overlaps)
Episiotomy may be needed
Various birthing positions
Use of forceps

7. Special Delivery! Natural childbirth Often called prepared childbirth
The woman learns about the birthing process so that she knows what to expect
This reduced tension, fear and pain

8. Special Delivery! Bradley method Similar to natural childbirth
Focuses on prenatal care, deep relaxation, little or no medication, and the father is the coach

9. Special Delivery! Lamaze method Named after Dr. Fernand Lamaze
Idea is that women are conditioned to fear childbirth and with Lamaze training, the mother is taught to focus on something other than childbirth
Mother using breathing pattern to keep mind off pain (deep breathing or panting)
Mother and coach, usually father, attend classes to prepare mentally and physically
Mother receive medication if necessary

10. Lamaze via “The Nanny”

11. Special Delivery! Water birth
Mother sits in a tub of warm water, usually heated between 90 & 100 degrees
During active stage of labor
Physical relief for mother
Transition for baby  water temperature is similar to internal temperature of mother
Some hospitals provide or allow it

12. Cesarean birth
Delivery of baby through a surgical incision in the mother’s abdomen
Used when vaginal delivery is unsafe or there are complications
Mother’s pelvis is too small or not shaped correctly
Baby’s head is too large
Baby is in incorrect position for birth
22% of babies are born this way

13. Positioning Squatting Side – lying Hands and knees Upright Standing
Sitting (rocking or on toilet)

14. To drug or not to drug?
Anesthetic: the medication that reduces or eliminates pain
Systematic: an injection into a muscle or vein that relieves tension, pain and/or nausea (i.e. Demerol)
Local
Drug injected to numb the vaginal area when birth is near, an incision needs to be made, or stitches are needed (for example, for episiotomies)

15. To drug or not to drug?
Regional: numbs a larger area or region of the body
Epidural: drug given through a tiny tube placed in the small of the back, just outside the spinal canal
Spinal: drug administered into the spinal canal, side effects similar to epidural, but may be more dangerous and severe
General
Drug given intravenously or by breathing a gas
Leaves you unconscious
Used for surgical deliveries
Has more side effects for mother and baby than other types
i.e., Cesarean

16. Stage three: Placenta Expelling of placenta
Contractions help placenta detach from uterine wall
Can last from two minutes to thirty minutes post – birth

17. Newborns

18. Newborn at birth Begins breathing Umbilical cord is no longer needed
Blood circulating throughout entire bordy
Physical appearance
Wobbly, lopsided and pointed head
Soft spots on head called fontanels
Open spaces where the bones of skull have not yet permanently joined
Fat cheeks
Short, flat nose
Milia
Small, white bumps caused by plugged oil ducts

19. Premature babies Less than 5 ½ pounds or born before 36 weeks
Incubator placement
Heart and lungs monitored

20. Reflexes Rooting reflex Grasp reflex Startle reflex
Automatic response when touched on the lips or cheek
Turns toward touch and begins to suck
Grasp reflex
Newborn’s hand closes around anything that comes in contact with palm
Startle reflex
Legs thrown up, fingers spread, arms extended and then brought rapidly back while the fingers close in a grasping action
Do this in response to a loud noise or a touch on the stomach

21. Postpartum issues

22. Mom post – birth Important for Mommy and baby to bond
Mommy will produce colostrum
First breast milk that has important antibodies to protect against disease
Emotional health

23. Bonding with Baby Bonding with Mommy Bonding with Daddy
Skin – to – skin contact
Eye – to – eye contact
Talk to your baby
Feeding, especially if breastfeeding
Participating in labor and delivery
Feeding
Reading or singing to baby
Letting baby touch you

24. 3 categories
Baby blues
Postpartum depression
Postpartum psychosis

25. Baby Blues Occurs within the first 2 weeks after giving birth
Between 50 and 80% of all new mothers experience baby blues
Because this disorder is so common, it is commonly not classified as a postpartum mood disorder

26. Baby Blues: How can I tell?
Weepiness
Mood swings
Irritability
Anxiety
Loneliness
Restlessness
Impatience

27. Baby Blues: Why me? Attributed to: A sudden change in hormones
Emotional and physical hardships of giving birth
Fatigue

28. Baby Blues: How can I get over it?
Exercise
Eat healthy
Take some “me” time
Split up parenting responsibilities, if possible

29. Postpartum Depression
Affects approximately 10% of new mothers
Progresses off of baby blues
If your baby blues lasts longer than 2 weeks

30. Postpartum Depression: Symptoms
Loss of appetite
Insomnia
Intense irritability or anger
Overwhelming fatigue
Lack of joy in life
Feelings of guilt, shame and inadequacy
Difficulty bonding with baby
Thoughts of harming yourself or baby

31. Postpartum Depression: Why me?
Changing hormone levels
Difficulty breastfeeding
Sick baby
fatigue
Risk factors
History of depression
PPD after previous pregnancy
Unplanned/unwanted pregnancy
Marital conflict
Pregnancy/previous stressors
Weak or no support system

32. Postpartum Depression: Help is on the way
Medications
Therapy
Possible hospitalization

33. Postpartum Psychosis The mother loses touch with reality
Afflicts 1 to 2 women per 1,000 live births

34. Postpartum Psychosis: Symptoms
Confusion
Disorientation
Hallucinations
Delusions
Paranoia
Attempts to harm baby and/or self

35. Postpartum Psychosis: Will I be affected?
Risk factors
History of depression
History of psychosis
Previously had PPP with another pregnancy
History of bipolar disorder
History of other medical problems / imbalances

36. Postpartum Psychosis
So will 1 to 2 every 1,000 children be killed by their mothers?
Infanticide is rare
Many PPP sufferers do not act upon their homicidal thoughts
Reportedly occurs in less than 1 per 50,000 live births

37. Postpartum Psychosis Help
Treatment includes
Medications
Therapy
Immediate hospitalization

38. References http://www.mayoclinic.com http://www.alegent.com

39. Postpartum Depression

40. Postpartum Psychosis The Andrea Yates Story

41. Caring for newborn

42. Caring for a newborn Food Sleep Exercise Safety Bathing Medical care
Toys
Love

43. Baby language
Each cry is for something different

44. Temperament Way they react to the world and others
Be sensitive to a baby’s individual style

45. SIDS S udden I nfant D eath S yndrome Also known as “crib death”
Victims are typically healthy infants between 2 weeks and 6 months
Infants die in their sleep with no warning, no cry, and no evidence of pain

46. SIDS To reduce the risk of SIDS Place infants on their backs for sleep
Provide a firm crib, covered by a sheet
Keep soft materials, such as comforters, pillows, and stuffed toys out of the crib
Make sure the sleeping area is a comfortable temperature to keep infants from becoming overheated

47. Shaken Baby Syndrome
Signs and symptoms resulting from violent shaking or shaking and impacting of the head of an infant or small child.

48. Shaken Baby Syndrome What Happens: Why?
The brain rotates within the skull cavity, injuring or destroying brain tissue.
When shaking occurs, blood vessels feeding the brain can be torn, leading to bleeding around the brain.
Blood pools within the skull, sometimes creating more pressure within the skull and possibly causing additional brain damage.
Retinal (back of the eye) bleeding is very common
Babies' heads are relatively large and heavy, making up about 25% of their total body weight. Their neck muscles are too weak to support such a disproportionately large head.
Babies' brains are immature and more easily injured by shaking.
Babies' blood vessels around the brain are more susceptible to tearing than older children or adults.

49. Symptoms of SBS Lethargy / decreased muscle tone Extreme irritability
Decreased appetite, poor feeding or vomiting for no apparent reason
Grab-type bruises on arms or chest are rare
No smiling or vocalization
Poor sucking or swallowing
Rigidity or posturing
Difficulty breathing
Seizures
Head or forehead appears larger than usual or soft-spot on head appears to be bulging
Inability to lift head
Inability of eyes to focus or track movement or unequal size of pupils

50. Consequences of SBS Immediate Long Term
Breathing may stop or be compromised
Extreme irritability
Seizures
Limp arms and legs or rigidity/posturing
Decreased level of consciousness
Vomiting; poor feeding
Inability to suck or swallow
Heart may stop
Death
Learning disabilities
Physical disabilities
Visual disabilities or blindness
Hearing impairment
Speech disabilities
Cerebral Palsy
Seizures
Behavior disorders
Cognitive impairment
Death

51. SHAKEN BABY SYNDROME
Coping with CRYING

52. What do BABIES do? Eat Sleep Have dirty diapers Cry
Most babies cry 2-3 hours a day for the 1st 2 -3 months of life
5 p.m. to Midnight is often a fussy time

53. A parent responding to an infant’s cry is a vital part of
EMOTIONAL NURTURING.
It will help the baby to learn to TRUST and BOND with the parents or caregivers.

54. 4 Basic Cries: … the HUNGRY Cry … the CRY of PAIN
Rhythmical rise & fall - demanding not desperate
… the CRY of PAIN
Loud gasp - shrieks
… the BORED or GRUMBLING CRY
Low pitched - not demanding - increases when ignored
… the ANGRY CRY
Loud - demanding - not a type of cry until about 6 months of age

55. Check to see if Basic Needs are met:
Hungry
Burped
Diaper Change
Clothing Comfortable
Crying to release Stress (Pacifier)
Wants to be held
Room too hot or cold

56. Check to see if baby is SICK-
Temperature
Gums:
swollen - red - drooling (teething)
Ears
Red - warm - draining
Vomiting
Diarrhea
Allergies
Runny nose - red eyes
Clear = Allergies Green = Infection

57. COLIC: Pull legs up to stomach Breast Feeding LACTOSE Intolerance:
stomach problems / gas
Breast Feeding
onions, garlic, broccoli, cauliflower, spicy foods, chocolate, etc.
LACTOSE Intolerance:
√ with doctor / Change formula (soy or goat)
Often Outgrows colic by 3-4 months
more movement and solid food

58. When the Caregiver is tired & Baby Cries a lot:
Natural to feel FRUSTRATED
High Risk of
LOOSING CONTROL
PLAN AHEAD WHAT TO DO!

59. BRAINSTORM ways to
COPE with CRYING

60. SHAKEN BABY SYNDROME:
Term used to describe the many signs and symptoms resulting from the violent shaking of an infant or young child.

65. LEARNING DISABILITIES PHYSICAL DISABILITIES
1) Baby’s brain bangs
against skull.
2) Small blood vessels
are torn - bleeding
3) Blood clots press on
brain.
4) Vertebrae crush the
spinal cord.
BRAIN DAMAGE
RETARDATION
LEARNING DISABILITIES
PHYSICAL DISABILITIES
PARALYSIS
BLINDNESS
and DEATH
may occur.

66. SIGNS & SYMPTOMS of SBS Concussion Vomiting Irritability Lethargy
Trouble feeding
Sleepy
coma

67. STATISTICS: 70% of the perpetrators are MALE
(father, step-father, boyfriend, etc.)
56% of the victims are male babies
Average age of shaking is 3-8 months
26 SBS cases in Utah in year 2000
(up from 13 in 1999)
25% of the SBS victims die immediately after being shaken
75% will live with complications because of the shaking.
SBS is the leading cause of death in infants due to child abuse/neglect.

68. 28% surviving victims return to THEIR HOMES.
11% adopted by GRANDPARENTS
11% placed in FOSTER CARE

69. Dr. William M. Palmer
(Medical Director of the Child Protective Team at Primary Children’s Hospital & University Hospital)
“Most people do not intend to hurt the child. They lose their impulse control; they just want the baby to shut up.”

70. A HAND SLAP on the face of an infant under 15 months can cause similar damage
THROWING a child up in the air and catching it
TWIRLING a child under age 2 by it’s arms or legs
BOUNCING ROUGHLY on knee/foot can also have damaging affect on baby

71. HELPFUL HINTS:
ALWAYS support the neck of infants, babies and small children.
If upset - CALM DOWN before dealing with your child.
When playing, never THROW or TOSS your child.
Screen all babysitters carefully. Know their temperament.

72. Never
Shake a Baby
Or TODDLER!

73. USOE Child Development Curriculum, 1994
The Child Abuse Prevention Center
Davis County Health Dept.