1. Prenatal Development & Birth Chapter 3

2. Conception Strategies – The old fashioned way – In vitro – Surrogate – Artificial insemination Following ovulation, fertilization occurs in fallopian tube Cell division occurs in the zygote Flows into uterus

3. Prenatal Development Germinal Stage – Fertilized egg not yet implanted in the uterus – Upon initial cell division the fertilized egg becomes a zygote – At approximately 12 days following fertilization, zygote is implanted in the lining of the uterus – Cells specialize into what will become organs

4. Prenatal Development Embryonic Stage – Differentiation of tissues into what will become organs (organogenesis) – Movements to stimuli based on “hard-wired” reflexes; – Critical period of pregnancy in that as organogenesis occurs, anomalies can result in miscarriage – Umbilical cord and placenta develop and provide nutrition and oxygen to and remove waste from the embryo – Developmental patterns: Cephalocaudal Patterns Proximodistal Patterns

5. Prenatal Development Fetal Period – Begins approximately 8 weeks post fertilization – Organogenesis is complete – At approximately 3 months, genitalia can be identified – At approximately 4 months, movements can be felt by the mother – At approximately 7 months fetus may be “viable” (can survive outside the womb with nutrition and temperature regulation support).

6. Brain Development during Prenatal Period and Beyond Growth: brain cells develop from the neural tube across the prenatal period and into infancy Migration: brain cells migrate or move from the center of the developing brain to the periphery Elaboration: – connections among the axons and dendrites of the cells are based on genetics during the prenatal period; – postnatal experience (nurture) enhances and inhibits elaboration (e.g. first 6 months of life the infant is particularly “wired” to learn sounds of language)

7. Risks during Prenatal Development Teratogens: Toxins that impact the developing organism prenatally – Nicotine—increased heart rate; low birth weight – Alcohol—fetal alcohol syndrome (mental retardation, physical abnormalities) – Rubella (German measles)—can be transmitted from pregnant mother to fetus; can result in blindness, other physical problems, and death – HIV—without medication can be transmitted from pregnant mother to fetus – Psychoactive drugs—multiple effects

8. Risks during Prenatal Development Maternal Anxiety and Stress during late pregnancy related to: – Attentional problems – Reactions to novelty Maternal Age (extremely young and older) STD’s – Herpes – HIV/AIDS – Syphilus

9. Critical Periods in Gestation Points at which key transitions occur tend to be the most critical – Attachment to the uterine wall – Organogenesis tends to most vulnerable to major “malformations.” (Germinal Stage) – Chronic exposure to toxins during fetal stage linked to delay in fetal growth and deficits in intellectual potential (fetal stage)

10. Father’s Role Health of Sperm—toxins, radiation, drugs and alcohol Supportive partner—emotional support, support for alcohol & tobacco free pregnancy Support and encourage access to health care

11. Birth Process Stage 1: – Dilation Early labor – Initial irregular uterine contractions – Dilation or Effacing of the cervix to begin the birthing process Active labor – Contractions become more regular and intense – Go to the birthing center/hospital – Cervix continues to efface

12. Birth Process Stage 2 – “Push” mode – Fetus enters birth canal – Birth occurs Stage 3 – Contractions continue through delivery of placenta

13. Birth Process: Birthing Options Lamaze Method – Focusing – Relaxation – Breathing – Knowledge and understanding – Partner and shared experience

14. Birth Process: Birthing Options Leboyer Method – Alternative context – Home-like atmosphere – Neonate is placed on the mother’s chest with umbilical cord in place Home birth – Screened for potential complications – Birthing professional present (e.g. Midwife, Nurse Practitioner) – Family/Partner involved

15. Birth Process: Birthing Options Drugs during labor & delivery – Overall, minimizing use of drugs during labor and delivery is best – General impact on neonate and infant is short term – More fragile (preterm, low birth weight) infants at greatest risk for negative outcomes with drugs – Drugs reduce mother’s ability to “push” during labor and delivery

16. Birth Process: Birthing Options Maternal comfort and safety is most important in selecting birthing option Pregnancy complications can limit safe options Prenatal health – Emotional support – Nutrition – Exercise – Prenatal health care

17. Neonatal Condition Apgar (1 minute & 5 minutes; Scores: 0, 1, or 2) – Heart rate. – Skin color. – Muscle tone (judged by whether the newborn's arms and legs are flexed or limp). – Breathing. – Reflex irritability (judged by whether the newborn cries or reacts when the skin is stroked or touched).

18. Neonatal Condition Phenylketonuria (PKU) test for neonates Hearing Antibiotic eyedrops Vitamin Injections Early breast feeding provides antibodies Caring, supportive, safe, and healthy environment