LIFE-SPAN DEVELOPMENT

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Children
5
Birth
John W. Santrock
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Birth

• What Happens During the Birth Process?
• How Do Low Birthweight Infants Develop?
• What Are Two Widely Used Measures of Neonatal
  Health and Responsiveness?
• What Happens During the Postpartum Period?

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Birth

• Images of Children A Fantastic Voyage
• Cindy and Tom recount the hours and changes that
  took place before their son, Tanner Roberts, was
  born and during his birth process.

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Stages of the Birth Process
What Happens During the Birth Process?

• First stage
• Lasts about 12 to 24 hours longest stage
• Contractions are about 1520 minutes apart occur
  closer together as birth nears
• Contractions dilate cervix to opening about 4
  inches
• Allows baby to move from uterus to birth canal

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Stages of the Birth Process
What Happens During the Birth Process?

• Second stage
• Approximately 45 minutes to an hour
• Baby moves through cervix and birth canal
• Mother pushes down, contractions come almost
  every minute

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Stages of the Birth Process
What Happens During the Birth Process?

• Third stage (Afterbirth)
• Placenta, umbilical cord, and other membranes
  detached and expelled
• Fastest stage lasts only minutes

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The Stages of Birth
Fig. 5.1
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The Fetus/Newborn Transition
What Happens During the Birth Process?

• Uterine muscles draw together
• Decreased oxygen supply during contractions is
  termed anoxiainsufficient oxygen to
  fetus/newborn
• Stress hormone secretion protects from oxygen
  deficiency, prepares infant for birth.
• Vernix caseosa (skin grease) protects against
  heat loss.

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Childbirth Strategies and Decisions
What Happens During the Birth Process?

• Childbirth setting and attendants
• 99 of U.S. births occur in hospitals
• Over 90 are attended by physicians
• Vaginal and cesarean delivery, birthing centers
• Neonatal mortality risk lower when attended by
  certified midwife rather than physician

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Childbirth Strategies and Decisions
What Happens During the Birth Process?

• Childbirth setting and attendants
• Doulas professional trained in childbirth
  common in many countries
• Provide physical and emotional support to mother
  before, during, and after childbirth
• Mother has less pain, anxiety, and depression

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Childbirth Strategies and Decisions
What Happens During the Birth Process?

• Methods of delivery medications
• Analgesia used to relieve pain
• Anesthesia used in late first-stage labor and
  during expulsion to block sensation
• Epidural block numbs from waist down
• Oxytocics synthetic hormones used to stimulate
  contractions

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Childbirth Strategies and Decisions
What Happens During the Birth Process?

• Natural childbirth attempts to reduce mothers
  pain by decreasing fear
• Prepared childbirth similar to natural
  childbirth special breathing technique used in
  final stages of labor
• Many techniques have been developed

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Childbirth Strategies and Decisions
What Happens During the Birth Process?

• Cesarean Delivery
• Baby removed from uterus through incision in
  abdomen when
• Baby is in breech or crosswise position
• Head too large for mothers pelvis
• Vaginal bleeding has occurred in pregnancy
• Nearly 1 in 4 U.S. births are C-sections

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Childbirth Strategies and Decisions
What Happens During the Birth Process?

• Family Involvement
• Fathers
• More likely to meet with obstetrician
• Train to coach mother during labor and birth
• Siblings
• Provide with realistic information
• Address separation anxiety
• Address childs emotions and behaviors

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Preterm and Small- for-Date Infants
How Do Low-Birthweight Infants Develop?

• Low-birthweight infant
• Weigh less than 5.5 pounds
• Very low under 3 pounds
• Extremely low under 2 pounds
• Racial/ethnic differences exist
• Increased rates in U.S. over last 20 years
• Attributed to many causes

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Preterm and Small-for-Date Infants
How Do Low-Birthweight Infants Develop?

• Preterm born 3 weeks or more early
• Neurological development continues after birth
  about same timetable as if in womb
• Small for date (small for gestational age)
• low birthweight for term of pregnancy
• High risk of death

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Percentage of All U.S. Births That Are Preterm
Fig. 5.2
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Long-Term Outcomes for Low-Birthweight Infants

• As a group
• Have more health and developmental problems
  risks increases as birthweight decreases
• More likely to have learning disability, ADD or
  ADHD, and breathing problems
• Lower functioning persists in adolescence
• Improvement achieved with early interventions

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Cognitive Skills of Students Born with Low or
Normal Birthweight
Fig. 5.3
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Long-Term Outcomes for Low-Birthweight Infants
How Do Low-Birthweight Infants Develop?

• Nurturing Preterm Infants
• Appropriate stimulation may vary
• Massage used throughout history has led to
  greater weight gain, improved skills, and better
  academic performance

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Weight Gain Comparison of Premature Infants Who
Were Massaged and Not Massaged
Fig. 5.4
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Long-Term Outcomes for Low-Birthweight Infants
How Do Low-Birthweight Infants Develop?

• Nurturing Preterm Infants
• Kangaroo Care holding preterm infant so there is
  skin-to-skin contact leads to
• Sleeping longer, more weight gain
• Crying less, earlier hospital discharge
• Longer periods of alertness

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Apgar Scale
What Are Three Measures of Neonatal Health and
Responsiveness?

• Widely used to assess health at 1 and 5 minutes
  after birth
• Performed by nurse/obstetrician
• Total score of 7 to 10 is good
• Score below 3 signals emergency
• Identifies high-risk infants

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Apgar Scale
Score 0 1 2
Body Color Blue, pale Body pink, extremities blue Entire body pink
Heartbeat Absent Slow less than 100 beats per min. Fast 100 to 140 beats per min.
Reflex Irritability No response Grimace Coughing, sneezing, crying
Muscle Tone Limp and flaccid Inactive, weak, some flexion of extremities Strong, active motion
Respiratory Effort Breathing for no more than 1 min. Irregular and slow Breathing good with normal crying
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Brazelton Neonatal Behavioral Assessment Scale
What Are Three Measures of Neonatal Health and
Responsiveness?

• Performed within 24 to 36 hours after birth
• Neurological development
• Reflexes
• Reactions to people
• Infant is active participant
• score based on best performance
• worrisome, normal, and superior
  classifications

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Neonatal Intensive Care Unit Network
Neurobehavioral Scale
What Are Three Measures of Neonatal Health and
Responsiveness?

• Offspring of NBAS provides more comprehensive
  analysis of newborn behavior
• Neurological and stress responses
• Regulatory capacities
• Assesses high-risk infants

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Postpartum Period
What Happens During the Postpartum Period?

• Period after childbirth when the mother adjusts
  physically and psychologically to process of
  childbirth
• Lasts about six weeks
• Influenced by preceding events

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Postpartum Adjustments
What Happens During the Postpartum Period?

• Involution process by which uterus returns to
  prepregnant size
• Bodily changes
• Estrogen and progesterone levels drop
• Fatigue is common
• Bodily functions return in a few weeks
• Exercises are recommended

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Postpartum Adjustments
What Happens During the Postpartum Period?

• Emotional and psychological changes
• Emotional fluctuations
• Fatigue
• Inexperience or lack of confidence
• Extensive demands may cause anxiety, depression,
  coping difficulties

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Postpartum Depression
What Happens During the Postpartum Period?

• Strong feelings of sadness, anxiety, or despair
  in new mothers
• Excessive worrying
• Depression
• Extreme changes in appetite
• Crying spells
• Inability to sleep

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Percentage of U.S. women experiencing Baby
Blues and Postpartum Depression
Fig. 5.7
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Staying at Home or Working
What Happens During the Postpartum Period?

• Mothers wishes vary decision making is often
  difficult and agonizing
• Pressures on mothers affect options
• Societal
• Career
• Financial

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Fathers Adjustment
What Happens During the Postpartum Period?

• May feel baby comes first and gets all the
  attention replaced by the baby
• Set aside special time to be together
• Postpartum reaction improved if father attended
  childbirth classes and was active in delivery

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Fathers Adjustment
What Happens During the Postpartum Period?

• Both parents need to be aware of young infants
  developmental needs
• Physical
• Psychological
• Emotional

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Bonding
What Happens During the Postpartum Period?

• Close connection, especially physical bond,
  between parents and newborn in period shortly
  after birth
• Encouraged by many doctors rooming in
• Little evidence for a critical bonding period,
  but parents enjoy and can be helpful
• Parent-child interaction climate improved

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Children
5

• The End