Birth and the Newborn Baby Truth or Fiction

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Chapter 4Birth and the Newborn BabyIn the New
World
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Countdown

• The Stages of Childbirth

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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

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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

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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

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What Happens during the First Stage of Childbirth?

• Fetal monitoring
• Measure fetal heart rate and mothers
  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

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Figure 4.1 The Stages of Childbirth
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What Happens during the Second Stage of
Childbirth?

• Begins when baby appears at opening of birth
  canal
• Ends with birth of baby
• Babys 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

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What Happens during the Second Stage of
Childbirth?

• Once babys head emerges from mother, mucus is
  suctioned from the babys 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
  babys eyes
• Baby receives Vitamin K injection

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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

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Methods of Childbirth
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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

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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

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What is the C-section?

• Cesarean Section
• Delivered by abdominal surgery
• Physicians prefer C-section to vaginal delivery
• Mothers 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

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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

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Birth Problems
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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

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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

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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

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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

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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

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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

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Developing in a World of Diversity

• Maternal Mortality and Infant Mortality Around
  the World

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The Postpartum Period
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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

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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

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Characteristics of Neonates
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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

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What are Reflexes?

• Reflexes
• Simple, unlearned stereotypical responses,
  elicited by certain types of stimulation
• Survival value
• Neural functioning is determined by testing
  reflex

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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 mothers nipple for sucking
• Sucking
• Babies will suck almost any object that touches
  the lips
• Will become replaced by voluntary sucking

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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 babys 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

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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

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What Kinds of Reflexes are Shown by Neonates?

• Stepping reflex
• Mimic walk when held under arms
• Usually disappears by 3 or 4 months

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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.

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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

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A Closer Look

• Studying Visual Acuity in Neonates How Well Can
  They See?

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Vision

• Visual accommodation
• 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

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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

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Smell and Taste

• Smell
• 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

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Touch and Pain

• Touch
• Sensitive to touch
• Touch elicits many reflex behaviors
• Pain
• Less sensitive to pain

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Learning

• Or Really Early Childhood Education

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Can Neonates Learn?

• Classical Conditioning
• Involuntary responses are conditioned to a new
  stimuli
• Operant Conditioning
• Behavior (reflexes) are modified through
  reinforcement

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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

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Figure 4.15 REM Sleep and Non-REM Sleep
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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

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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

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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

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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