Pregnancy, Birth, and the Newborn Chapter 5 Unit 2

1. Pregnancy, Birth, andthe Newborn Chapter 5Unit 2 Michelle Fischer, ACSW, LSW, MSW

2. Nice job on the discussion board last week! Keep up the good work! Don’t forget to review the seminar archive if you missed our seminar last week.

3. This week you will be reading about pregnancy. Why do you think it is important for HSPs (human services professionals) to be aware of and understand the dynamics of pregnancy?

4. Here are a few things for you to think about as we go through the seminar and you read the chapter: How does preparing for childbirth benefit the process of labor and delivery? What are the potential consequences when a pregnant woman suffers physical abuse? How might poverty affect the developing infant? How does the mother’s emotional state during pregnancy affect her infant? What are the concerns surrounding multiple gestations (twins, triplets, etc.)? What are the consequences of substance abuse during pregnancy?

5. Why do we need to assess expectant parents?

6. What should we assess? • Attachments and commitments • How are they are mentally representing the fetal infant? • Is the father involved? What is his role? • Past history of social and professional support • History of loss • Sense of security

7. Biophysical Development What are some of the milestones of fetal development? Here is a month by month overview…

8. Biophysical Development – 1 month The amniotic sac is a water-tight sac that forms around the fertilized egg.  It helps cushion the growing embryo throughout pregnancy. The placenta also develops during the 1st trimester. The placenta is a round, flat organ that transfers nutrients from the mother to the baby, and transfers waste from the baby. A primitive face takes form with large dark circles for eyes. The mouth, lower jaw, and throat are developing. Blood cells are taking shape, and circulation will begin. By the end of the first month, the embryo is about 1/10 of an inch long. The heart, which is no larger than a poppy seed, has begun beating.

9. First month of development http://www.uen.org/Lessonplan/preview.cgi?LPid=4016

10. Biophysical Development – 2 months • The third through eighth weeks of growth are called the embryonic stage, during which the embryo develops most major body organs. • During this process, the embryo is especially vulnerable to damaging substances, such as alcohol, and infectious diseases. • By the end of the 8th week the embryo is about 1 inch long and has distinct, slightly webbed fingers. • Veins are clearly visible. The heart has divided into right and left chambers.

11. 8 weeks: http://www.uen.org/Lessonplan/preview.cgi?LPid=4016

12. Biophysical Development – 3 months By the end of the third month of pregnancy, the baby is fully formed. The baby has arms, hands, fingers, feet, and toes and can open and close its fists and mouth. Fingernails and toenails are beginning to develop and the external ears are formed. The beginnings of teeth are forming. The baby's reproductive organs also develop, but the baby's gender is difficult to distinguish on ultrasound. The circulatory and urinary systems are working and the liver produces bile.

13. http://www.uen.org/Lessonplan/preview.cgi?LPid=4016

14. Biophysical Development – 4 months The baby's fingers and toes are well-defined; eyelids, eyebrows, eyelashes, nails, and hair are formed. Teeth and bones become denser in the 2nd trimester. The baby can even suck his or her thumb, yawn, stretch, and make faces. The nervous system is starting to function at this point in pregnancy. The reproductive organs and genitalia are now fully developed and an ultrasound may reveal the baby’s sex By the end of the fourth month, the baby is about 6 inches long and weighs about 4 ounces.

15. Biophysical Development – 5 months • The fetus measures about 5.6 to 6.4 inches from crown to rump and weighs about 9 ounces. • The baby can hear sounds by now – the mom’s voice, heart and stomach growling, as well as sounds outside the body. • It will cover its ears with its hands if a loud sound is made near you, and it may even become startled and "jump." • The baby is moving often, too -- twisting, turning, wiggling, punching and kicking.

16. 5 months http://www.uen.org/Lessonplan/preview.cgi?LPid=4016

17. Biophysical Development – 6 months By the end of the sixth month, the baby is about 12 inches long and weighs about 2 pounds. Lanugo, a soft fine hair, covers his or her shoulders, back, and temples. This hair protects the baby and is usually shed at the end of the baby's first week of life. His or her skin is reddish in color, wrinkled, and veins are visible through the baby's translucent skin. Baby's finger and toe prints are visible. The eyelids begin to part and the eyes open. If born prematurely, the baby may survive after the 23rd week of pregnancy with intensive care.

18. http://www.uen.org/Lessonplan/preview.cgi?LPid=4016

19. Biophysical Development – 7 months At the end of the seventh month of pregnancy, fat begins to be deposited on the baby. The baby is about 14 inches long and weighs from about 2 – 4 pounds. The baby's hearing is fully developed and he or she changes position frequently and responds to stimuli, including sound, pain, and light. If born prematurely, the baby would probably survive after the seventh month of pregnancy.

20. Biophysical Development – 8 months The baby, who is now about 18 inches long and weighs as much as about 5 pounds, will continue to mature and develop reserves of body fat. Moms may notice that the baby is kicking more. Baby's brain is developing rapidly at this time, and he or she can see and hear. Most internal systems are well developed, but the lungs may still be immature. He has probably turned head-down in preparation for birth.

21. 8 – 9 months http://www.uen.org/Lessonplan/preview.cgi?LPid=4016

22. Biophysical Development – 9 months Towards the end of the third trimester, the baby continues to grow and mature: the lungs are nearly fully developed. The baby's reflexes are coordinated so he or she can blink, close the eyes, turn the head, grasp firmly, and respond to sounds, light, and touch. The baby's position changes to prepare itself for labor and delivery. The baby drops down in your pelvis, and usually his or her head is facing down toward the birth canal. By the end of this month of pregnancy, the baby is about 18 to 20 inches long and weighs about 7 pounds.

23. http://www.uen.org/Lessonplan/preview.cgi?LPid=4016

24. Labor • The opening of the cervix – or dilation, about twelve to fourteen hours • At full dilation, the second stage begins • The second stage is when the baby is born – takes from ten minutes to three hours or more • The third stage involves the delivery of the placenta

25. Normal Newborns • Weigh between 5 ½ and 9 ½ pounds • APGAR score between 7 and 10 • APGAR given at 1 and 5 minutes • APGAR looks at the newborn’s adaptation to life outside the womb • Test evaluates the baby’s skin color, heart rate, response to stimulation, muscle tone, and breathing effort

26. Complications of Pregnancy • Frequent vomiting or hyperemesis gravidarum • Vaginal bleeding – can lead to spontaneous abortion in early pregnancy • Vaginal bleeding in later pregnancy – e.g., placenta previa when the placenta separates from the wall of the uterus. • Toxemia – due to protein in the urine • Eclampsia

27. Other Abnormalities of Pregnancy • Gestational diabetes-at risk for maternal and fetal complications • Polyhydramnios-too much amniotic fluid • Intrauterine growth retardation (IUGR)-small because of prenatal deprivation; at risk for learning disabilities

28. Maternal Risk Factors • Maternal age • Maternal nutrition • Maternal illness • Maternal drug use • Aspirin: bleeding problems in mother or infant • Caffeine: low birth weight, IUGR, premature birth • Alcohol: prenatal/postnatal growth retardation, developmental delays, etc. • Tobacco: IURG, premature birth, stillbirth, low birth weight, SIDS, etc.

29. Prenatal Testing • Ultrasound or sonogram • Alpha-fetoprotein blood screening • Amniocentesis • Chorionic villus sample (CVS) • Timing and safety of administration of these different types of tests • Ethical dilemmas – terminating pregnancy if fetus has major birth defect

30. Birth Complications • Anoxia and potential causes • Meconium aspiration and potential respiratory complications • Malpresentation • Perinatal difficulties such as cord raped around the neck • Prolonged labor

31. Consequences of Premature Birth • Respiratory distress syndrome (RDS) • Treatment for RDS must be provided with caution to avoid complications • Retinopathy caused by high oxygen levels • RDS children often placed on ventilators • Bronchopulmonary dysplasia (BPD) – a complication seen in children placed on ventilators

32. Teen pregnancy • What are the characteristics of adolescent mothers who learn to care for their infants? • What are some of the challenges teen parents face?

33. Infant Mortality • Rates of infant mortality in U.S. are higher than most developed nations • Mortality rates were 6.1% for white infants, 14.1% for African American infants (1996); Hispanic infant mortality is similar to whites’ • The primary reason for death among white infants was congenital abnormalities and for African American infants was low birth weight • What contributes to these differences?

34. Social Hazards to Prenatal and Perinatal Development • Poverty • High levels of environmental stress • Drug use • Mother’s low self-esteem, need for affection • Alcohol use • Few economic resources, little emotional support • Domestic violence • Social isolation, poor health habits

35. Family Violence • 1 in 4 women are physically abused at some point during pregnancy • This abuse increases the risks of: • Preterm labor • Low birth weight • Miscarriage

36. That was a lot of information! • Any questions?