1. Adaptation to EUA To provide an overview of a normal newborn’s adjustment to his/her new environment To understand baby’s behavioural cues Aims:

2. Adaptation to EUA 1. Appreciate the contrast in environment between in-utero and extra uterine 2. Consider the impact on the differences on the baby Learning Outcomes:

3. Learning Outcomes (cont) : 3. Discuss how the midwife can minimise any adverse effects of birth 4. Identify ways in which the care giver can assist developmental progress in the newborn

4. Temperature Respiration CirculationNutrition InfectionProtection/Love Movement Comparison of In Utero & EU Environment

5. Adaptation to EU Life Effects on Baby? How to minimise trauma?

6. Comparison of In Utero & EU Environment Temperature: 37.7 0 C  26.0 0 C Breathing: 1-2 per minute  30-50 pm Obligatory nasal breathers

7. Comparison of In Utero & EU Environment Heart rate: 120-160 per minute  100-120 pm Nutrition: diffusion from mother  Breast feeding / AF

8. Infection & protection: bag of membranes, uterus, maternal abdominal tissue Comparison of In Utero & EU Environment

9. Movements: from about 7/40 Some light penetrates the uterine wall – stimulates activity when very bright Kicking increases in response to mother’s stress/ sounds of high frequency

10. Fetal Circulation & Adaptation to Extra Uterine Life Primitive heart: starts beating at about 4 weeks Circulatory System of fetus: established between 8-12 weeks gestation

11. Fetal Circulation Fetus develops its own blood – fetal blood does not mix with maternal blood Separated by layers of: synciotrophoblast cytotrophoblast walls of capillaries

12. Fetal Circulation

13. Lungs only receive a very tiny proportion of fetal blood Placenta is responsible for blood oxygenation and elimination of waste products

14. Fetal Circulation Three shunts: Ductus arteriosus Ductus venosus Foramen ovale

15. Circulatory Adjustments at birth dramatic fall in pulmonary vascular resistance marked increase in pulmonary blood flow progressive thinning of the walls of the pulmonary arteries

16. Fetal Circulation Fetal StructureAdult Structure Foramen Ovale Fossa Ovalis Umbilical Vein Ligamentum teres Umbilical Arteries Umbilical ligaments, Ductus Venosus Ligamentum venosum Ductus Arteriosum Ligamentum arteriosum

17. Fetal Circulation Consider MW’s Role in Maximising Health

18. Temperature Control Difficult in the newborn due to: -large surface area -poor insulation -wet & exposed body -inability to shiver -immature temp. regulating centre

19. Temperature Control Heat loss through: Conduction Convection Evaporation Radiation

20. Temperature Control Consider M/W’s Role in Maximising Health

21. NEONATAL INFECTION All neonates are susceptible to infection WHY? Diminished immunity

22. NEONATAL INFECTION skin is a poor barrier don’t sweat until 1 month don’t have tears (lysozome is bactericidal) low gastric juice until 4 weeks

23. NEONATAL INFECTION low T lymphocyte function low levels of fetal antibody levels at birth (unless been exposed to intrauterine infection ) invasive procedures (PKU)

24. NEONATAL INFECTION ROUTES OF INFECTION (1)Transplacentally (2) Ascending Infection/ Intrapartum early SROM (3) Postnatally

25. NEONATAL INFECTION Consider M/W’s Role in Maximising Health

26. Emotional Development The development of the baby involves dynamic exchanges within the environment. I n-utero environment Dark Muffled sounds Temp –37.5 0 C

27. Emotional Development Role of the midwife is therefore: to facilitate to enhance a positive environment for optimum health, both physically as well as emotionally

28. Emotional Development Consider the in-utero environment: Dark Muffled sounds Constant contact with mother Temp –37.5 0 C

29. Emotional Development Attachment & Trust – they are the key developmental issues of infancy  The infant-carer dyad is pivotal in this

30. Emotional Development The baby is interested in his surroundings for at least the 1 st hour or so, before going to sleep  Time to CONNECT!!!

31. Emotional Development ‘LOVE & NURTURING’ SKIN TO SKIN CONTACT PREFERENCE FOR FACE RATHER THAN OBJECTS

32. Emotional Development Baby’s control of his environment THUMBSUCKING (don’t cover hands) GAZING ( face distance –22cm/9 inch)

33. Emotional Development Baby’s control of his environment Turning away Positing Hiccups Colour change

34. Emotional Development Carer’s facilitation Hand to Chest Swaddling

35. Emotional Development Adjust light if too bright Do not start a procedure abruptly Hand over chest- stops startles

36. Adaptation to EU Life Conclusion Many adaptations Midwife’s role: minimise stress maximise health