1. Chapter 4 Birth and the Newborn Baby: In the New World

2. The Stages of Childbirth
Countdown…
The Stages of Childbirth

3. What Events Occur just prior to the Beginning of Childbirth?
Dropping or Lightening
Head of fetus settles in pelvis
Braxton-Hicks contractions
First uterine contractions may be experienced as early as 6th month
Blood spotting in vaginal secretions
Day or so before labor
Rush of amniotic fluid from vagina
Occurs in 1 woman in 10

4. What Events Occur just prior to the Beginning of Childbirth?
Beginning of labor may be signaled by indigestion, diarrhea, ache in small or back, and abdominal cramps
Placenta and uterus secretes prostaglandins
excite uterus muscles causing contractions
As labor progresses, oxytocin is released
stimulates contractions powerful enough to expel the fetus

5. What Happens during the First Stage of Childbirth?
Uterine contractions efface and dilate cervix
First stage lasts from a few hours to more than a day
Contractions increase in strength, frequency, and regularity
Mother may be prepped
Shaving pubic hair
Administer enema

6. What Happens during the First Stage of Childbirth?
Fetal monitoring
Measure fetal heart rate and mother’s contractions
If necessary to speed up delivery, forceps or vacuum extraction tube may be used
Transition (about 30 minutes)
Cervix is nearly fully dilated
Head of fetus moves into vagina
Frequent and strong contractions

7. Figure 4.1 The Stages of Childbirth
Figure 4.1 The Stages of Childbirth. In the first stage, uterine contractions efface and dilate the cervix to about 4 inches so that the baby may pass. The second stage begins with movement of the baby into the birth canal and ends with birth of the baby. During the third stage, the placenta separates from the uterine wall and is expelled through the birth canal.
Figure 4.1 The Stages of Childbirth

8. What Happens during the Second Stage of Childbirth?
Begins when baby appears at opening of birth canal
Ends with birth of baby
Baby’s head crowned when it begins to emerge from birth canal
Episiotomy may be performed once crowning takes place
Used to prevent tearing of mother
Controversial and used less frequently

9. What Happens during the Second Stage of Childbirth?
Once baby’s head emerges from mother, mucus is suctioned from the baby’s mouth
Clears passageway for breathing
Umbilical cord is clamped and severed
Newborn may be removed
Baby is footprinted
ID bracelet is put on baby
Antibiotic ointment or drops are applied to baby’s eyes
Baby receives Vitamin K injection

10. What Happens during the Third Stage of Childbirth?
Also referred to as the placenta stage
Lasts minutes to an hour or more
Placenta separates from the wall of uterus and is expelled
Obstetrician sews episiotomy, if performed

11. Methods of Childbirth

12. How is Anesthesia Used in Childbirth?
General anesthesia
Puts mother to sleep
Negative effects of general anesthesia
Abnormal patterns of sleep and wakefulness
Decreased attention and social responsiveness for at least 6 weeks
Local anesthetics
Deadens pain without putting mother to sleep
Minor depressive effects on neonates shortly after birth

13. What is Prepared Childbirth?
Lamaze method
Utilize breathing and relaxation exercises to lessen fear and pain
Teaches women to associate relaxation with contractions
Coach
Aids the mother in the delivery room
Provides social support to mother during labor
Doula
Experienced female companion provides continuous emotional support during labor
Fewer cesarean deliveries, less anesthesia, and shorter, less painful labors

14. What is the C-section? Cesarean Section
Delivered by abdominal surgery
Physicians prefer C-section to vaginal delivery
Mother’s small pelvis
Maternal weakness or fatigue
Baby is too large
Baby is in distress
May be used to bypass infections in birth canal from HIV or Herpes

15. How Can a Woman Decide to Deliver Her Baby?
Diversity of birthing options
All-in-one labor, delivery, recovery, and postpartum rooms (LDRPs)
Birthing suite in hospital equipped for uncomplicated birth
Easy access to emergency facilities if needed
Home Birth
Can be fairly safe for healthy women with little risk of complications

16. Birth Problems

17. What are the Effects of Oxygen Deprivation at Birth?
Hypoxia - Prenatal oxygen deprivation
can impair development of central nervous system and psychological disorders
Anoxia - Oxygen deprived at birth
predicted problems in learning and memory
can cause health problems such as early-onset schizophrenia and cerebral palsy

18. What is Meant by the Terms Prematurity and Low Birth Weight?
Premature or preterm baby
Occurs before 37 weeks gestation (normal is 40 weeks)
Low-birth-weight baby
Weighs less than 5.5 pounds
Small for date
Low-birth-weight, although born at full term

19. What Risks are Connected with being Born Prematurely or Low in Birth Weight?
Infant mortality
Neonates weighing 3.25 to 5.5 pounds are 7 times more likely to die than infants of normal weight
Those weighing less than 3.3 pounds are nearly 100 times as likely to die
Delayed neurological development
Lower birth weight – poorer performance throughout school years
Delayed motor development, such as walking
Preschool experience fosters cognitive and social development

20. What Signs are Connected with being Born Prematurely or Low in Birth Weight?
Preterm babies show signs of immaturity
relatively thin
fine, downy hair (lanugo)
oily, white substance on skin (vernix)
Preterms born six weeks or more prior to full term
nipples not yet be emerged
testicles of boys not yet descended into scrotum
Muscles immature and reflexes are weak
Respiratory distress syndrome
walls of air sacs in lungs stick together

21. How are Preterm Infants Treated Following Birth?
Usually remain in hospital incubators
Temperature-controlled environment with protection from infection
Parents often do not treat preterms as well as full term
Less attractive than full-term babies
High-pitched, grating cries
More irritable
Preterms and parent interaction is less even when they are brought home

22. How are Preterm Infants Treated Following Birth?
Interventions for preterm infants
Benefit from external stimulation
Massage
Kangaroo care
Preterm infants exposed to stimulation
Gain weight more rapidly
Show fewer respiratory problems
Make greater advances in motor, intellectual, and neurological development than controls

23. Developing in a World of Diversity
Maternal Mortality and Infant Mortality Around the World

24. The Postpartum Period

25. What Kinds of Problems in Mood do Women Experience during Postpartum Period?
Baby blues
Transient – about 10 days
Postpartum depression (PPD)
Begins one month after delivery and may linger for weeks/months
Major depressive disorder
Psychotic features

26. How Critical is Parental Interaction with Neonates in the Formation of Bonds of Attachment?
Bonding
Formation of bonds of attachment between parent and child
Essential to survival and well being of child
“Maternal sensitive” period
Amount of access to newborn (Klaus & Kennell, 1978)
Extended early contact is not essential for adequate bonding

27. Characteristics of Neonates

28. How do Health Professionals Assess the Health of Neonates?
Apgar scale
Based on five signs of health
Interpretation of scores
7 or above – no danger
below 4 – critical condition
Brazelton Neonatal Behavioral Assessment Scale
Based on four areas of behaviors
Measures reflexes, motor behavior and muscle tone

29. What are Reflexes? Reflexes
Simple, unlearned stereotypical responses, elicited by certain types of stimulation
Survival value
Neural functioning is determined by testing reflex

30. What Kinds of Reflexes are Shown by Neonates?
Rooting
Baby turns head and mouth toward stimulus that strokes the cheek, chin, or corner of mouth
Facilities finding mother’s nipple for sucking
Sucking
Babies will suck almost any object that touches the lips
Will become replaced by voluntary sucking

31. What Kinds of Reflexes are Shown by Neonates?
Moro or startle reflex
Back arches, legs and arms are flung out and then brought back toward chest into a hugging motion
Occurs when baby’s position is suddenly changes or health and neck support is lost
Elicited by loud noises or bumping baby
Usually lost 6 to 7 months after birth

32. What Kinds of Reflexes are Shown by Neonates?
Grasping or palmar reflex
Using four fingers, babies grasp fingers/objects pressed against the palms of their hands
Most babies can support their own weight
Usually lost by 3 to 4 months
Replaced by voluntary grasping at 5 to 6 months

33. What Kinds of Reflexes are Shown by Neonates?
Stepping reflex
Mimic walk when held under arms
Usually disappears by 3 or 4 months

34. What Kinds of Reflexes are Shown by Neonates?
Babinski reflex
Fans or spreads toes in response to stroking foot
Usually disappears at end of first year
Tonic-neck reflex
While lying on back, baby turns head to one side. Arm and leg on that side extend, while opposite side flex.

35. Vision Visual acuity Estimate of 20/600
Best see objects 7 to 9 inches from eyes
Lack peripheral vision of older child
Able to track movement within one day of birth
preference for moving objects

36. Studying Visual Acuity in Neonates: How Well Can They See?
A Closer Look
Studying Visual Acuity in Neonates: How Well Can They See?

37. Vision Visual accommodation Convergence
Self-adjustments made by eye lens to bring objects into focus
Neonates show little or no visual accommodation
Focus on objects 7 to 9 inches away
Convergence
Does not occur until 7 or 8 weeks

38. Hearing Fetuses respond to sound
Neonates respond to amplitude and pitch
Show preference for mothers’ voice
Responsive to sounds and rhythms of speech
Show no preference for specific languages

39. Smell and Taste Smell Taste Well developed at birth
Demonstrate aversion for noxious and preference for pleasant odors
Recognize familiar odors
Taste
Sensitive to different tastes
Demonstrate facial expressions to basic tastes
Prefer sweet tastes

40. Touch and Pain Touch Pain Sensitive to touch
Touch elicits many reflex behaviors
Pain
Less sensitive to pain

41. Or Really Early Childhood “Education”
Learning
Or Really Early Childhood “Education”

42. Can Neonates Learn? Classical Conditioning Operant Conditioning
Involuntary responses are conditioned to a new stimuli
Operant Conditioning
Behavior (reflexes) are modified through reinforcement

43. What Patterns of Sleep are Found among Neonates?
Neonates spend about 16 hours per day in sleep
Typical infants has six cycles of waking and sleeping
REM Sleep
Neonates spend 50% time in REM sleep
Decreases in percentage of REM
6 months – 30%
2 to 3 years – 20 to 25%
NREM Sleep

44. Figure 4.15 REM Sleep and Non-REM Sleep
Figure REM Sleep and NREM Sleep. Neonates spend nearly 50% of their time sleeping in rapid-eye-movement (REM) sleep. The percentage of time spent in REM sleep drops off to 20% - 25% for 2- to 3- year olds. (Source: Roffwarg, et.al., 1966)
Figure 4.15 REM Sleep and Non-REM Sleep

45. Why do Babies Cry? Pain and discomfort
Universal, expressive and functional communication
expressive response to unpleasant feelings
stimulates caregiver response
Distinct causes and patterns of cries
Hunger, anger, pain
Peaks of crying in late afternoon and early evening
Crying produces physiological response in others

46. What Can I do to Stop an Infant from Crying?
Sucking serves as a built-in tranquilizer
Pacifier, sweet solutions
Soothing processes
Pick baby up, patting, caressing, rocking them
Speaking to them in low voice

47. What is SIDS? Sudden Infant Death Syndrome – crib death
Strikes while the baby is sleeping
Most common cause of death in infants between 1 and 12 months
Most likely to occur between 2 and 5 months
Period when reflexive behavior is weakening
Causes of SIDS remains obscure

48. What are the Risk Factors for SIDS?
SIDS is most common among
babies aged 2 to 4 months
babies put to sleep on their stomach
premature and low-birth-weight babies
males
lower SES
African Americans
babies of teenage mothers
babies of mothers who smoked or used narcotics during pregnancy