1. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Children Birth 4

2. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Images of Children Tanner Roberts’ Birth: 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. Contractions, pain medication Delivery, breathing on his own What Happens During Birth?

3. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Stages of Birth 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 open about 4 in. Allows baby to move into birth canal What Happens During Birth?

4. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Stages of Birth Second stage –Approximately 45 minutes to an hour –Baby moves through cervix and birth canal –Mother pushes down, contractions come almost every minute Third stage (afterbirth) –Placenta, umbilical cord, and other membranes detached and expelled –Fastest stage; lasts only minutes What Happens During Birth?

5. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. The Stages of Birth b d a c Placenta Vagina Cervix Uterus Fig. 4.1

6. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Childbirth Setting And Attendants 99% of U.S. births occur in hospitals Other options –Freestanding birth center, home delivery Who helps during birth process varies across cultures –91% of U.S. births attended by physicians –Some exclude fathers from process –Some attended by family members or open to community What Happens During Birth?

7. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Childbirth Setting And Attendants Midwives –Norm in most of world –Attend 8% of U.S. births –U.S. certified nurse midwives More time with patient in prenatal visits More emphasis on counseling, education Provide more emotional support to mother Are present during entire birth process What Happens During Birth?

8. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Childbirth Setting And Attendants Doulas –Provide continuous physical, emotional, and educational support before, during, and after childbirth –Most in U.S. work independently, typically function as part of ‘birthing team’ What Happens During Birth?

9. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Methods of Childbirth Use of medication during delivery –Analgesia is used to relieve pain –Anesthesia is used in late first-stage labor and during expulsion to block sensation Epidural block: numbs from waist down –Oxytocin Synthetic hormones stimulate contractions What Happens During Birth?

10. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Methods of Childbirth Natural childbirth –Tries to reduce mother’s pain by reducing fear Prepared childbirth (Lamaze method) –Similar to natural childbirth –Special breathing technique in final stages of labor Many other techniques have developed What Happens During Birth?

11. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Methods of Childbirth Other methods to reduce pain and stress during labor and childbirth –Waterbirth –Massage –Acupuncture –Hypnosis –Music therapy What Happens During Birth?

12. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Methods of Childbirth 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 –U.S. births by C-sections increased since 2002 What Happens During Birth?

13. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. The Fetus/Newborn Transition Anoxia occurs during contractions –Insufficient oxygen to fetus/newborn Stress hormone secretion protects from oxygen deficiency, prepares infant for birth Vernix caseosa (skin grease) protects against heat loss Measures of Neonatal Health

14. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Neonatal Measurements Apgar scale –Widely used to assess health at 1 and 5 minutes after birth Score of 7 to 10 is good, below 3 signals emergency Identifies high-risk infants Measures of Neonatal Health

15. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Apgar scale

16. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Neonatal Measurements Brazelton Neonatal Behavioral Assessment Scale (NBAS) –Performed within 24 to 36 hours after birth Neurological development, reflexes Reactions to people/objects –Infant is active participant, based on best performance “worrisome,” “normal,” and “superior” classifications Measures of Neonatal Health

17. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Neonatal Measurements Neonatal Intensive Care Unit Network Neurobehavioral Scale –Offspring of NBAS Provides more comprehensive analysis of newborn behavior Assesses ‘at risk’ or preterm infant Measures of Neonatal Health

18. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Preterm and Small for Date Infants Low-birth-weight infant is under 5.5 lbs –Very low - under 3 lbs –Extremely low - under 2 lbs Preterm – born 3 or more weeks early Small for date – birth weight below normal –Increased use of progestin to prevent preterm births LBW and Preterm Infant Development

19. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Consequences of Preterm and LBW As a group - more developmental and health problems –Risk increases as gestation age decreases –Norwegian study Preterm-birth adolescents at higher risk for language delays, learning problems, and behavior problems/delinquency involvement LBW and Preterm Infant Development

20. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Nurturing Preterm Infants –Intensive enrichment programs can improve short-term outcomes –Two most popular intervention programs Kangaroo care – used by most NICU nurses Massage therapy – used by 37% of NICUs –More touch promotes faster development LBW and Preterm Infant Development

21. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Postpartum Period Period after childbirth –Mother adjusts physically and psychologically to process of childbearing –Lasts about six weeks Involution –Process by which uterus returns to pre- pregnant size The Postpartum Period

22. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Emotional and Psychological Adjustments Emotional fluctuations due to –Hormonal changes, fatigue, inadequate rest –Inexperience or lack of confidence –Extensive demands may cause anxiety, depression, coping difficulties Postpartum depression –Strong feelings of sadness, anxiety, despair –Gets worse without treatment The Postpartum Period

23. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Emotional and Psychological Adjustments Postpartum depression treatments –Antidepressants –Psychotherapy; cognitive therapy is best Postpartum depression affects –Mother-infant interaction –Risk of additional psychological disorders The Postpartum Period

24. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. “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 Percentage of U.S. women experiencing “Baby Blues” and Postpartum Depression

25. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. Emotional and Psychological Adjustments Father’s adjustment –Experiences considerable adjustment and stress Attention for infant decreases couple’s time –Father’s postpartum reactions Prenatal involvement can lessen feelings of depression The Postpartum Period

26. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 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 The Postpartum Period

27. © 2010 The McGraw-Hill Companies, Inc. All rights reserved. The End 4