1. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 1 John W. Santrock Birth 4

2. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 2 Birth What Happens During the Birth Process? What Are Some Measures of Neonatal Health and Responsiveness? How Do Low Birth Weight And Preterm Infants Develop? What Happens During the Postpartum Period?

3. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 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. What Happens During the Birth Process?

4. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 4 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 What Happens During the Birth Process?

5. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 5 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 What Happens During the Birth Process?

6. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 6 Stages of the Birth Process Third stage (Afterbirth) –Placenta, umbilical cord, and other membranes detached and expelled –Fastest stage; lasts only minutes What Happens During the Birth Process?

7. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 7 The Stages of Birth b d a c Placenta Vagina Cervix Uterus Fig. 4.1

8. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 8 Childbirth Setting And Attendants What Happens During the Birth Process? Childbirth setting and attendants –99% of U.S. births occur in hospital –91% of U.S. births attended by physician –Who helps during birth process varies across cultures Some exclude fathers from process Some attended by family members or open to community

9. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 9 Childbirth Setting And Attendants Midwives: norm in most of world –8% of U.S. births attended by midwives –U.S. certified nurse midwives spend more time with patients in prenatal visits Place emphasis on counseling and education Provide more emotional support to mother Are present during entire birth process What Happens During the Birth Process?

10. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 10 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 the Birth Process? Childbirth Setting And Attendants

11. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 11 Methods of Childbirth 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 –Oxytocin: synthetic hormones used to stimulate contractions What Happens During the Birth Process?

12. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 12 Methods of Childbirth Natural childbirth: attempts to reduce mother’s pain by decreasing fear Prepared childbirth (Lamaze method): similar to natural childbirth; special breathing technique used in final stages of labor –Many techniques have been developed What Happens During the Birth Process?

13. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 13 Methods of Childbirth Other methods to reduce pain and stress during labor and childbirth –Waterbirth –Massage –Acupuncture –Hypnosis –Music therapy What Happens During the Birth Process?

14. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 14 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 –29.1% of U.S. births are C-sections What Happens During the Birth Process?

15. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 15 The Fetus/Newborn Transition 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. What Happens During the Birth Process?

16. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 16 Fathers or partners are more likely to –Meet with obstetrician or caregiver –Attend childbirth preparation classes; train as birthing coach –Be involved in infant’s care after birth Some partners do better than others What Happens During the Birth Process? Family Involvement

17. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 17 Siblings may be present at birth –Involvement may enhance attachment to baby; child should not be forced to attend –Fears of parents Separation anxiety of siblings from mother Children’s daily care shifts to father/partner Less time and attention for siblings What Happens During the Birth Process? Family Involvement

18. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 18 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 What Are Some Measures of Neonatal Health and Responsiveness?

19. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 19 Apgar Scale

20. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 20 Brazelton Neonatal Behavioral Assessment Scale (NBAS) 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 What Are Some Measures of Neonatal Health and Responsiveness?

21. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 21 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 What Are Some Measures of Neonatal Health and Responsiveness?

22. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 22 Preterm and Small for Date Infants Low-birth-weight infant –Weigh less than 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 –1 in 8 born in U.S. today –Risk factors and research How Do Low Birth Weight And Preterm Infants Develop?

23. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 23 Consequences of Low Birth Weight As a group –Have more health and developmental problems; risks increase as birth weight decreases More likely to have learning disability, ADD or ADHD, and breathing problems –Lower functioning persists in adolescence Improvement achieved with early interventions How Do Low Birth Weight And Preterm Infants Develop?

24. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 24 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 How Do Low Birth Weight And Preterm Infants Develop? Consequences of Low Birth Weight

25. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 25 3 lb. 1 oz 3 lb. 7 oz 2 lb. 15 oz 3 lb. 3 oz 3 lb. 5 oz Infant weight 40681221410 Age in days Premature infants who were massaged Premature infants who were not massaged Weight Gain Comparison of Premature Infants Who Were Massaged and Not Massaged Fig. 4.4

26. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 26 Postpartum Period Period after childbirth when the mother adjusts physically and psychologically to process of childbearing –Lasts about six weeks –Involves great deal of adjustment and adaptation; family-centered approach appears best What Happens During the Postpartum Period?

27. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 27 Physical 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 What Happens During the Postpartum Period?

28. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 28 Emotional and Psychological Adjustments Emotional fluctuations due to –Hormonal changes –Fatigue –Inexperience or lack of confidence –Extensive demands may cause anxiety, depression, coping difficulties –Normally lasts weeks after birth What Happens During the Postpartum Period?

29. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 29 ‘Baby Blues’ –Begins days after birth; can last months –Lasts 1–2 weeks without treatment Postpartum depression –Major depressive episode: feelings of anxiety, depression, and despair –Gets worse without treatment What Happens During the Postpartum Period? Emotional and Psychological Adjustments

30. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 30 Postpartum depression treatments –Antidepressants –Psychotherapy; cognitive therapy is best Postpartum depression affects –Mother-infant interaction –Risk of additional psychological disorders What Happens During the Postpartum Period? Emotional and Psychological Adjustments

31. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 31 “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. 4.5 Percentage of U.S. women experiencing “Baby Blues” and Postpartum Depression

32. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 32 Father’s adjustment –Experience considerable adjustment and stress Attention for infant decreases couple’s time –Father’s postpartum reactions: prenatal involvement can lessen feelings of depression What Happens During the Postpartum Period? Emotional and Psychological Adjustments

33. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 33 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 What Happens During the Postpartum Period?

34. © 2009 The McGraw-Hill Companies, Inc. All rights reserved. Slide 34 The End 4