Birth and the Newborn Baby: In The New World

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CHAPTER 3

• Birth and the Newborn Baby In The New World

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The Stages of Childbirth
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Stages of Childbirth

• Stage 1 Effacement dilation
• Stage 2 Crowning and delivery
• Stage 3 Placental stage

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Fig. 3-1, p. 51
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Stages of Childbirth

• Stage 1 effacement and dilation
• Begins when uterine contractions efface and
  dilate cervix , causes most childbirth pain
• Longest stage, lasts from few hours to more than
  a day
• Results in the widening of the passageway to 4
  inches (10 centimeters)
• Transition begins head of fetus begins to move
  into the vagina or birth canal

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Stages of Childbirth (contd)

• Stage 2 crowning and delivery
• Babys head crowns when it begins to emerge
  from birth canal
• Contractions stretch the skin around birth canal
  and propel baby along
• Episiotomy takes place
• Lasts from minutes to hours
• Baby emerges from birth canal, and when breathing
  adequately on own, the umbilical cord is clamped
  and severed

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Stages of Childbirth (contd)

• Stage 3 placental stage
• Lasts from minutes to an hour or more
• Placenta separates from the uterine wall and is
  expelled through birth canal
• Episiotomy is sewn (if performed)

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Methods of Childbirth
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Methods of Childbirth

• Midwife-assisted childbirth
• Anesthesia-assisted childbirth
• Natural childbirth
• Prepared childbirth
• Doula-assisted childbirth
• Cesarean section

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Methods of Childbirth (contd)

• Midwife delivery
• Delivers baby in womans home
• More intimate
• Limited access to sophisticated medical
  instruments and anesthetics that may be needed
  during a high-risk delivery such as shoulder
  dystocia or breech birth

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Methods of Childbirth (contd)

• General anesthetics
• Deaden pain by putting the mother to sleep
• Includes tranquilizers and narcotics

• Local anesthetics
• Deaden pain without putting mother to sleep
• Pudendal block numbs the mothers external
  genitals.
• Epidural block and spinal block numb the body
  below the waist by injecting local anesthesia
  into the spinal canal or spinal cord.

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Methods of Childbirth (contd)

• Natural childbirth
• Woman uses no anesthesia

• Prepared childbirth (i.e. Lamaze method)
• Woman is taught breathing and relaxation
  exercises by a coach who will aid her in the
  delivery room

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Methods of Childbirth (contd)

• Doula-assisted childbirth
• Doulas provide social and emotional support
  before and during delivery.
• Doulas may be used when a partner is not
  available.
• Women with doulas present during birth appear to
  have shorter labors than those without.

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Methods of Childbirth (contd)

• Cesarean section (C-section)
• Physician delivers the baby by surgery
• Physician cuts through the mothers abdomen and
  uterus and physically removes the baby
• Mostly used when the health of the baby or mother
  is at stake during delivery

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Birth Problems
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Birth Problems

• Prenatal oxygen deprivation (POD)
• Anoxia absence of oxygen
• Hypoxia less oxygen than required
• Preterm and low-birth-weight (LBW) infants
• Preterm born prior to 37 weeks gestation
• Small for gestational age born at full term, yet
  low birth weight
• Both conditions can lead to
• cognitive, motor, and psychological problems

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Signs of Prematurity

• Preterm babies
• Relatively thin, covered in lanugo and vernix
• Immature muscles
• Weak breathing and sucking reflexes
• May suffer from respiratory distress syndrome
  (RDS)
• May suffer long-term impairments

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Treatment of Preterm Babies

• Preterm babies are kept in incubators
• Maintain temperature controlled environment
• Afforded some protection from disease
• Oxygen has to be monitored because excessive
  oxygen can cause permanent eye injury

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Parents and Preterm Neonates

• Preterm neonates
• look less appealing
• have high-pitched and grating cries
• are more irritable

• Parents of preterm neonates
• do not treat preterm neonates as well as
  full-term neonates
• can find it so demanding to care for such
  children that they have depressing effects for
  mothers

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Intervention Programs

• Preterm infants profit from early stimulation.
• Cuddling, rocking, talking, and singing to
• Massage and kangaroo care
• Many positive effects for early stimulation
• Faster weight gain
• Fewer respiratory problems
• Greater advances

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The Postpartum Period
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Postpartum Period and Maternal Depression

• Some mothers may suffer from postpartum
  depression (PPD).
• Symptoms
• Causes
• Prevalence
• Treatment

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Table 3-2, p. 58
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Bonding

• Bonding refers to formation of parent-infant
  attachment.
• Bonding is essential for the survival and
  well-being of children.

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Characteristics of Neonates
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Assessing Neonates

• Apgar scale used to assess health of baby at
  birth
• A) the general appearance or color of the neonate
  
• P) the pulse or heart rate
• G) grimace
• (the 1-point indicator of reflex
  irritability)
• A) general activity level or muscle tone
• R) respiratory effort, or rate of breathing

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Table 3-3, p. 60
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Assessing Neonates (contd)

• Brazelton Neonatal Behavioral Assessment Scale
• Used to measure neonates reflexes and other
  behavior patterns
• Motor behavior
• Response to stress
• Adaptive behavior
• Control over physiological state

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Neonate Reflexes

• INCLUDE
• Rooting reflex
• Moro reflex
• Grasping reflex
• Stepping reflex
• Babinski reflex
• Tonic-neck reflex

• Reflexes are simple, automatic, stereotypical
  responses elicited by certain types of
  stimulation.
• Demonstrate the neural functioning of neonate
• Absence or weakness of a reflex may indicate
  immaturity, slowed responsiveness, brain injury,
  or retardation.

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• Rooting reflex
• Baby turns head and mouth toward a stimulus that
  strokes the cheek, chin, or corner of the mouth
  important for locating mothers nipple in
  preparation for sucking can be lost if not
  stimulated
• Moro reflex
• Back arches, and the legs and arms are flung out
  and then brought back toward the chest, with the
  arms in a hugging motion can be elicited when
  babys position is changed or when support for
  head and neck is lost can be elicited by loud
  noises, bumping the babys crib, or jerking the
  babys blanket lost within 6 to 7 months after
  birth absence of Moro reflex indicates
  immaturity or brain damage
• Grasping reflex (palmar reflex)
• Refers to the increasing tendency to reflexively
  grasp fingers or other objects pressed against
  the palms of hands babies support their own
  weight this way
• Stepping reflex
• Mimics walking demonstrated 1-2 days after birth
  and disappears 3-4 months of age
• Babinski reflex
• Occurs when underside of foot from heel to toes
  is stroked toes are fanned or spread
• Tonic-neck reflex
• Observed when baby is lying on its back and turns
  head to one side

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Neonate Sensory Capabilities - Vision

• Infants are nearsighted, seeing best at 7-9 in.
• Can detect movement
• Prefer moving objects to stationary objects
• Have little or no visual accommodation
• See through fixed-focus camera
• Unable to converge their eyes on an object that
  is close to them

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Neonate Sensory Capabilities - Hearing

• Fetuses respond to sound months before they are
  born.
• Normal neonates hear well unless their middle
  ears are clogged with amniotic fluid.
• Respond to sounds of different amplitude and
  pitch
• More to high-pitched sounds than to low-pitched
  sounds
• Discriminate different and new speech sounds

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Neonate Sensory Capabilities - Smell

• Can discriminate distinct odors
• Show more rapid breathing patterns and increased
  bodily movement in response to powerful odors
• Use smell for mother-infant recognition and
  attachment
• Neonates sensitivity
• Neonatal sensitivity to the smell of milk
  (Macfarlane)
• 15-day-old infants sensitive to the smell of
  mothers underarm odors vs. odors produced by
  other milk-producing women (Porter)

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Neonate Sensory Capabilities - Taste

• Show preferences similar to adults
• Discriminate between salty, sour, and bitter
  tastes, as suggested by reactions in the lower
  part of the face
• Sweet solutions have a calming effect on neonates.

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Neonate Sensory Capabilities - Touch

• Skin on skin
• provides feelings of comfort and security
• may contribute to bonds of attachment between
  infants and their caregivers
• Many reflexes are activated by pressure against
  the skin.

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Classical and Operant Conditioning of Neonates

• Classical conditioning
• Involuntary responses are conditioned to new
  stimuli.
• Typical study (Lipsitt)
• Neonates taught to blink in response to a tone
• Indicates they are equipped to learn associations
  in their environment

• Operant conditioning
• Responses can be strengthened through
  reinforcement
• Typical study (DeCasper, et al.)
• Neonates can be conditioned to suck on a pacifier
  in such a way to activate a recording of their
  mothers reading The Cat in the Hat

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Neonate Sleeping and Waking

• Most neonates spend about 2/3 of their time in
  sleep.
• 16 hours per day, not consecutively
• Neonates go through different stages of sleep.
• Typical infant has six cycles of waking and
  sleeping in a 24-hour period

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Sleeping and Waking (contd)

• Neonates spend about half of their sleeping time
  in REM sleep, yet will decline as they develop
• By 6 months, REM sleep accounts for only 30 of
  the babys sleep
• By 2-3 years, REM drops off to 20-25 of sleep
• Preterm babies spend even more time in REM sleep.

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Table 3-4, p. 65
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Fig. 3-6, p. 65
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Crying

• Babies cry due to pain and/or discomfort.
• Some crying among babies is universal.
• Parents can distinguish between cries of hunger,
  anger, and pain.
• Infants crying motivates others to take care of
  them.

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Crying (contd)

• Certain prolonged, high-pitched cries may
  indicate health problems.
• Chromosomal abnormalities, infections, fetal
  malnutrition, and exposure to narcotics
• Peaks of patterned crying occur in later
  afternoon and early evening.
• Response of the caregiver influences crying
• Persistent crying can strain mother-infant
  relationship

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Soothing

• Sucking (breast, bottle, pacifier) has a soothing
  effect.
• Parents soothe infants by
• picking them up, patting them, caressing and
  rocking them, swaddling them, speaking to them in
  a low voice
• How to soothe an infant is learned via trial and
  error.
• Crying decreases as the infant matures and learns.

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Sudden Infant Death Syndrome (SIDS)

• 2,000 to 3,000 annual US infant deaths from SIDS
• Most common cause of death during the first year
• Mostly occurring between 2 and 5 months of age
• More common among the following
• babies aged 2-4 months
• babies who sleep on their stomachs or sides
• premature and LBW infants
• male babies
• babies from lower SES
• African-American babies
• babies of teenage mothers
• babies whose mothers smoked or used narcotics
  during or after pregnancy

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Childrens Hospital Boston Study

• Conducted SIDS study to learn about causes
• Study focused on the medullas role in sleep/wake
  cycles
• Compared medullas of babies that died from SIDS
  to medullas of babies that died from other causes
• Results found SIDS babies medullas were less
  sensitive to the brain chemical serotonin boys
  brains less sensitive

• Prevention includes
• do not smoke during or after pregnancy
• do not use narcotics during pregnancy
• obtain adequate nutrition and health care
• baby needs to sleep on back
• keep current on SIDS data