1. Children Birth 4

2. 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?

3. 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?

4. 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?

5. 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

6. Apgar scale

7. 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

8. 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

9. 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

10. 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

11. 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

12. “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

13. 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

14. 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