BIRTH and the NEWBORN BABY

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BIRTH and the NEWBORN BABY
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I. THE STAGES OF CHILDBIRTH

• Several signs indicate that labor is near.
• False labor or prelabor occurs when the uterus
  sporadically contracts for several weeks before
  the actual birth.
• About 2 weeks before birth, an event called
  lightening occurs. The babys head drops low into
  the uterus and the cervix softens in preparation
  for delivery.
• The bloody show is the reddish discharge released
  when the cervix widens.

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Stage 1 Dilation and Effacement of the Cervix

• Stage 1 is the longest stage of laborlasting, on
  average, 12 to 14 hours with a first baby and 4
  to 6 hours with later births.
• Dilation and effacement of the cervix is the
  widening and thinning of the cervix resulting in
  a clear pathway from the uterus into the birth
  canal.
• Uterine contractions are forceful and regular.
  Gradually, they get closer together, occurring
  every 2 to 3 minutes, and become more powerful,
  continuing for as long as 60 seconds.
• Transition is reached when the frequency and
  strength of contractions are at their peak and
  the cervix opens completely.

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Stage 2 Delivery of the Baby

• In Stage 2, which lasts approximately 50 minutes
  for a first baby and 20 minutes in subsequent
  births, the infant is born.
• Strong contractions continue, and the mother
  feels a natural urge to squeeze and push with her
  abdominal muscles, forcing the baby down and out.
• An episiotomy is a small incision that increases
  the size of the vaginal opening and permits the
  baby to pass without damaging the mothers
  tissues.
• The babys head crowns when the vaginal opening
  stretches around the entire head.

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Stage 3 Birth of the Placenta

• The final stage lasts about 5 to 10 minutes.
• The final contractions and pushes cause the
  placenta to separate from the uterine wall and be
  delivered.

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Labor and Delivery

• The three stages of labor.

Stage 1
(a) Dilation and Effacement of the Cervix
(b) Transition
Stage 2
(c) Pushing
(d) Birth of the Baby
Stage 3
(e) Delivery of the Placenta
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The Babys Adaptation to Labor and Delivery

• The force of the contractions causes the infant
  to produce high levels of stress hormones.
• Stress hormones send extra blood to the brain and
  heart, helping the infant withstand oxygen
  deprivation. In addition, this helps prepare the
  lungs to breathe, and arouses the infant into
  alertness at birth.

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The Newborn Babys Appearance

• The average newborn is 20 inches long and 7 1/2
  pounds in weight boys tend to be slightly longer
  and heavier than girls.
• The head is large in comparison to the trunk and
  legs, which are short and bowed.
• The round faces, chubby cheeks, large foreheads,
  and big eyes of newborn babies make adults feel
  like picking them up and cuddling them.

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Assessing the Newborns Physical Condition The
APGAR Scale

• Infants who have difficulty making the transition
  to life outside the uterus must be given help at
  once.
• The Apgar Scale is used to assess the infants
  physical condition on 5 criteria, each of which
  is rated from 0 to 2.
• Two Apgar ratings are given, at 1 and 5 minutes
  after birth, since some babies have trouble
  adjusting at first but do quite well after a few
  minutes.

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II. APPROACHES TO CHILDBIRTH

• Childbirth practices vary around the world.
• In large Western nations, childbirth has changed
  over the centuries.
• Before the 1800s, childbirth usually took place
  in the home and was a family-centered event.
• The industrial revolution brought greater
  crowding in cities and new health problems
  consequently, childbirth moved to the hospital.
  Doctors assumed responsibility for childbirth.

• By the 1950s and 1960s, the routine use of
  medical procedures during labor and delivery was
  questioned by many, and the natural childbirth
  movement arose.
• Most hospitals today offer birth centers that are
  family centered and homelike.
• Freestanding birth centers operate independently
  of hospitals and offer less backup medical care.
• A small but growing number of women are choosing
  to have their babies at home.

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Natural, or Prepared, Childbirth

• Natural, or prepared, childbirth is an approach
  designed to reduce pain and medical intervention
  and to make childbirth a rewarding experience for
  parents.

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Natural, or Prepared, Childbirth

• Natural childbirth programs typically consist of
  three parts
• Information about labor and delivery including
  classes that educate parents about the anatomy
  and physiology of labor and delivery.
• Relaxation and breathing techniques that are used
  by the mother to counteract the pain of the
  contractions.
• Training of labor coaches who offer physical and
  emotional support to the mother during the birth.
• Social Support and Natural Childbirth
• Social support is important to the success of
  natural childbirth techniques.
• In one study, mothers with support had fewer
  birth complications and their labors were several
  hours shorter than those without supportive
  companionships.
• Continuous support from a trained companion
  during labor and delivery strengthens these
  outcomes.

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Natural, or Prepared, Childbirth cont.

• Positions for Delivery
• In birth center or home deliveries, mothers often
  give birth in the upright, sitting position
  rather than lying flat on their backs with their
  feet in stirrups.
• In Europe, women are encouraged to give birth on
  their sides to reduce the need for an episiotomy.
• Research findings favor the sitting position.
  Labor is shortened because pushing is easier and
  more effective. The baby also benefits from a
  richer supply of oxygen because placental blood
  flow is increased.

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Home Delivery

• Mothers who choose home delivery want birth to be
  an important part of family life. In addition,
  most want to avoid unnecessary medical procedures
  and greater control over their own care and that
  of their babies than most hospitals permit.
• Many home births are handled by nurse-midwives
  who have degrees in nursing and training in
  childbirth management.
• When mothers are at risk for any kind of
  complication, the appropriate place for labor and
  delivery is the hospital, where life-saving
  treatment is available.

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III. MEDICAL INTERVENTIONS

• More so than anywhere else in the world,
  childbirth in the United States is a medically
  monitored and controlled event.
• Fetal Monitoring
• Fetal monitors track the babys heart rate during
  labor.
• Fetal monitoring is a safe medical procedure that
  has saved the lives of many babies in high-risk
  situations.
• Nevertheless, the use of fetal monitors is, at
  times, controversial.
• Critics think fetal monitors falsely identify
  babies as being in danger.
• Fetal monitoring is linked to an increase in the
  number of emergency cesarean deliveries.
• Many women complain that the monitors are
  uncomfortable and restrictive.

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Labor and Delivery Medication

• Some form of medication is used in 80 to 95
  percent of births in the United States.
• Analgesics are pain-relieving drugs that help the
  mother relax.

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Labor and Delivery Medication cont.

• Anesthetics are stronger painkillers that block
  sensation.
• Anesthetics weaken uterine contractions during
  the first stage of labor and interfere with the
  mothers ability to feel contractions and push
  during the second stage, prolonging labor.
• Since medications rapidly cross the placenta, the
  newborn may be sleepy and withdrawn, suck poorly
  during feedings, and be irritable when awake.
• Some experts claim the use of medications during
  childbirth has a lasting impact on physical and
  mental development, but their findings have been
  challenged.

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Instrument Delivery

• Forceps are metal clamps placed around the babys
  head to pull the infant from the birth canal.
• A vacuum extractor is a suction tube that is
  attached to a plastic cup placed on the babys
  head.
• Instrument delivery is used when the mothers
  pushing during the second stage of labor does not
  cause the baby to move through the birth canal in
  a reasonable amount of time.
• In the United States, forceps or vacuum
  extractors are used in about 12 percent of
  births. They are used less than 5 percent of the
  time in Europe. Their use can result in head
  injury or brain damage.
• Neither method should be used when the mother can
  be encouraged to deliver normally and there is no
  special reason to hurry.

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Induced Labor

• An induced labor is started artificially by
  breaking the amnion and giving the mother a
  hormone that stimulates contractions.
• This is used when continuing the pregnancy
  threatens the well-being of mother or baby. Too
  often, though, labors are induced for the
  doctors or patients convenience.
• The contractions of an induced labor are often
  longer, harder, and closer together than those of
  a naturally occurring labor.
• Labor and delivery medication is more likely to
  be used in larger amounts, and there is a greater
  chance of instrument delivery.
• The placental hormone CRH helps predict the
  success of induction procedures.

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Cesarean Delivery

• A cesarean delivery is a surgical birth in which
  the doctor makes an incision in the mothers
  abdomen and lifts the baby out of the uterus.
• In 1994, cesareans accounted for 24 percent of
  American births. The rate dropped slightly to 21
  percent in 1999. Still, this is the highest rate
  in the world.
• Cesareans have always been warranted by serious
  medical emergencies. However, surgical delivery
  is not always needed in other instances.
• When babies are in a breech position (turned so
  that the buttocks or feet would be delivered
  first) cesareans are often justified.
• Although the operation is safe, mothers need more
  time for recovery and cesarean newborns are more
  likely to be sleepy and unresponsive and to have
  breathing difficulties.

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IV. BIRTH COMPLICATIONS

• Oxygen Deprivation
• Cerebral palsy is a general term for a variety of
  problemsall involving muscle coordinationresulti
  ng from brain damage before, during, or just
  after birth.
• Anoxia is an inadequate supply of oxygen during
  labor and delivery. It may be caused by squeezing
  of the umbilical cord, placenta abruptio
  (premature separation of the placenta) or
  placenta previa, a condition where the placenta
  covers the cervical opening, causing part of the
  placenta to detach as the cervix dilates and
  effaces.

• Most oxygen-deprived newborns remain behind their
  peers in intellectual and motor development
  through early childhood. By the school years,
  most catch up in development.
• Researchers are experimenting with ways to
  prevent ongoing brain damage after birth.
• Respiratory distress syndrome is a disorder of
  preterm infants in which the lungs are so
  immature that the air sacs collapse, causing
  serious breathing difficulties.

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Preterm and Low-Birth-Weight Infants

• Premature babies are those who are born 3 weeks
  or more before the end of a full 38-week
  pregnancy or who weigh less than 5 1/2 pounds at
  birth.
• Research indicates that premature babies are at
  risk for many problems.
• About 1 in 16 infants is born underweight in the
  United States. The problem is highest among
  low-income, ethnic minority pregnant women.

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Preterm and Low-Birth-Weight Infants cont.

• Preterm versus Small-for-Date
• Preterm babies are born several weeks or more
  before their due datetheir weight may be
  appropriate for the amount of time they spent in
  the uterus.
• Small-for-date babies are below their expected
  weight when length of the pregnancy is taken into
  account.
• Small-for-date infants usually have more serious
  problems than preterm infants.

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Preterm and Low-Birth-Weight Infants cont.

• Consequences for Caregiving
• The appearance and behavior of preterm babies can
  lead parents to be less sensitive and responsive
  in caring for them.
• Some mothers are overly stimulating and
  intrusive, trying to obtain a higher level of
  response from a baby who is a passive,
  unrewarding social partner.
• Preterm babies as a group are at risk for child
  abuse, especially those born to isolated,
  poverty-stricken mothers who have difficulty
  managing their own lives and cannot provide good
  nutrition, health care or parenting.
• How well preterm babies develop has a great deal
  to do with the parent-child relationship.

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Preterm and Low-Birth-Weight Infants cont.

• Interventions for Preterm Infants
• Preterm babies are cared for in special beds
  called isolettes that protect infants from
  infection and aid in temperature regulation.
• Physical needs that would ordinarily lead to
  close human contact are met mechanically through
  medical devices.
• Special Infant Stimulation
• Preterm stimulation involving motion, touch, or
  audio awareness promotes growth, more predictable
  sleep patterns, and alertness.
• Close, skin-to-skin contact with the mother
  fosters oxygenation of the babys body, improved
  temperature regulation and feeding, and infant
  survival.
• The amount and kind of stimulation must be
  carefully adjusted to fit the babys individual
  needs.

• Training Parents in Infant Caregiving Skills
• Parenting interventions generally teach parents
  about the infants characteristics and promote
  caregiving skills. When preterm infants develop
  more quickly, parents are likely to interact with
  their baby more effectively.
• When preterm infants live in stressed, low-income
  households, long-term, intensive intervention is
  necessary.
• To sustain gains in very vulnerable children,
  high-quality intervention must continue well
  beyond age 3.

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Preterm and Low-Birth-Weight Infants cont.

• Low birth rate, which is largely preventable,
  and serious physical defects, which often cannot
  be prevented, are largely responsible for the
  relatively high neonatal mortality and infant
  mortality in the United States.

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Postterm Infants

• Since the normal length of pregnancy is 38 weeks,
  infants born after 42 weeks are postterm. About 5
  percent fall into this category.
• The possibility of oxygen deprivation and head
  injuries are increased in postterm births.

• Doctors usually induce labor in postterm
  pregnancies since the likelihood of birth
  complications and infant death rises steeply as
  pregnancy continues past 42 weeks.
• Causes of postterm delivery are still a mystery.

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Understanding Birth Complications

• Research on infants who experienced birth
  complications indicates that, as long as birth
  injuries are not overwhelming, a supportive home
  environment can restore childrens growth.
• When negative factors outweigh positive ones,
  even sturdy newborns can have life-long problems.

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V. PRECIOUS MOMENTS AFTER BIRTH

• Regardless of their SES or whether they
  participated in childbirth classes, fathers
  touch, look at, talk to, and kiss their newborns
  just as much as mothers.
• Bonding is the parents feelings of affection and
  concern for the newborn baby.
• Research indicates that the bonding relationship
  does not depend on a specific period of
  togetherness immediately following the birth.
  Still, contact with the baby after birth might be
  one of several factors that helps build a good
  parentinfant relationship.
• Rooming in is an arrangement in which the newborn
  stays in the mothers hospital room all or most
  of the time.

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VI. THE NEWBORN BABYS CAPACITIES

• Reflexes
• A reflex is an inborn, automatic response to a
  particular form of stimulation.
• Adaptive Value of Reflexes
• Some reflexes have survival value. For example,
  the rooting reflex helps a breast-fed baby find
  the mothers nipple.
• Some reflexes may have had significance in our
  evolutionary past, but no longer serve a special
  purpose (e.g., the Moro reflex).
• Several reflexes help parents and infants
  establish gratifying interaction.

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Reflexes

• Reflexes and the Development of Motor Skills
• A few reflexes form the basis for motor skills
  that will develop later. For example, the tonic
  neck reflex may prepare the baby for voluntary
  reaching.
• If the stepping reflex is exercised regularly,
  babies are likely to walk several weeks earlier
  than if it is not practiced.
• The Importance of Assessing Newborn Reflexes
• Researchers believe the disappearance of most
  newborn reflexes during the first 6 months of
  life is due to the infants gradual increase in
  voluntary control over behavior.
• Reflexes provide a way of assessing the health of
  the babys nervous system.

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States

• States of arousal are different degrees of sleep
  and wakefulness infants move in and out of 5
  states throughout the day and night.
• Striking individual differences in daily rhythms
  exist that affect parents attitudes toward and
  interactions with baby.

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States cont.

• Sleep
• During irregular rapid-eye-movement (REM) sleep,
  the brain and parts of the body are activeeyes
  dart beneath the lids and heart rate, blood
  pressure, and breathing are uneven.
• REM sleep accounts for 50 percent of the
  newborns sleep time.
• During regular non-rapid-eye-movement (NREM)
  sleep, the body is quiet, and heart rate,
  breathing, and brain wave activity are slow and
  regular.
• Young infants are believed to have a special need
  for the stimulation of REM sleep because they
  spend little time in the alert stateREM sleep
  seems to be the way the brain stimulates itself.
• Rapid eye movements protect the health of the
  eye.
• Observations of sleep states can help identify
  central nervous system abnormalities.

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States cont.

• Crying
• Crying is the first way that babies communicate
  their physical needs.
• Crying stimulates strong feelings of arousal and
  discomfort in men and women, parents and
  nonparents.
• Various methods can be used to calm a crying
  infant.
• The cries of brain-damaged babies and those who
  have experienced prenatal and birth complications
  are often shrill and piercing.

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Sensory Capacities

• Touch
• Touch helps stimulate physical and emotional
  development.
• Sensitivity to touch, pain, and temperature
  change is present at birth.

• Taste
• Babies are born with the ability to communicate
  their taste preferences.
• Infant facial expressions indicate they can
  distinguish among several tastes.

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Sensory Capacities cont.

• Smell
• The responsiveness of infants to the smell of
  certain foods is similar to that of adults, which
  suggests that some odor preferences are innate.
• A newborn infant is attracted to the odor of her
  own mothers lactating breast. This helps her to
  find a food source and to identify her own mother.

• Hearing
• Newborns prefer complex sounds such as voices and
  noises.
• There are only a few speech sounds that newborns
  cannot discriminate, and their ability to
  perceive speech sounds outside their language is
  more precise than an adults.
• Newborns prefer speech that is high-pitched and
  expressive.

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Sensory Capacities cont.

• Vision
• Vision is the least mature of the newborn babys
  senses.
• Newborns cannot focus their eyes very well and
  their visual acuity, or fineness of
  discrimination, is limited. Still, newborns
  explore their environment by scanning it for
  interesting sights and tracking moving objects.
• They prefer colored rather than gray stimuli.

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Neonatal Behavioral Assessment

• The Neonatal Behavioral Assessment Scale (NBAS)
  is a test developed by T. Berry Brazelton to
  assess the babys reflexes, state changes,
  responsiveness to stimuli, and other reactions.
• Newborn behavior and parenting styles combine to
  shape development. Thus, changes in NBAS scores
  over the first week or two of life provide the
  best estimate of a babys ability to recover from
  the stress of birth.
• The NBAS has also been used to help parents get
  to know their infants.

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VII. THE TRANSITION TO PARENTHOOD

• The mother needs to recover from childbirth and
  adjust to massive hormonal shifts in her body.
• The father needs to become a part of this new
  threesome while supporting the mother in her
  recovery.

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Changes in the Family System

• The demands of new parenthood often lead to a
  mild decline in a couples marital satisfaction.
• Parenthood also causes husbands and wives to
  assume more traditional gender roles.

• Women typically experience a more difficult
  period of adaptation to new parenthood.
• Postponing childbearing until the late twenties
  or thirties eases the transition to parenthood.
• Fathers participation in infant care enhances
  the marital relationship.

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Parent Interventions

• Special interventions exist to ease the
  transition to parenthood, such as couples groups
  for low-risk parents or programs that enhance
  social support and the parent-child relationship
  for high-risk parents.
• When couples try to support each others needs,
  the stress caused by the birth of a baby remains
  manageable.