BIRTH AND THE NEWBORN INFANT

1. Chapter 3 BIRTH AND THE NEWBORN INFANT

2. Learning Objectives

3. Labor: The Process of Birth Begins Corticotropin-releasing hormone (CRH) • Oxytocin and other hormones triggered • Uterus contracts Contractions • Braxton-Hicks • Labor initiation

4. Stages of Labor

5. From Fetus to Neonate • When is the moment of birth? • What causes a baby to cry after birth? • What cultural differences surround the birth of children worldwide?

6. APGAR SCALE • A score is given for each sign at one minute and five minutes after the birth. • If there are problems with the baby, an additional score is given at ten minutes. • A score of seven to ten is considered normal, whereas four to seven might require some resuscitative measures, and a baby with an Apgar score under four requires immediate resuscitation.

7. More About APGAR Scores Low scores • Existing fetal problems or birth defects • Difficulties related to process of birth • Temporary deprivation of oxygen (anoxia) • Wrapped umbilical cord • Pinched umbilical cord

8. You must have been a beautiful baby…or were you? Introducing the neonate • Vernix • Lanugo • Puffy eyelids • Blood/other substances

9. Initial Encounters True or false • Newborns who do not spend time bonding with their parent or parents immediately after birth will automatically suffer long-term social and emotional consequences.

10. Approaches to Childbirth:Where Medicine and Attitudes Meet • Variety of strategies and approaches • No universally accepted single procedure • No conclusive research evidence that one procedure significantly more effective than another

11. What birthing procedures would you choose?

12. Alternative Birthing Procedures

13. Childbirth Attendants: Who Delivers? • Obstetrician • Midwife • Doula

14. Pain and Childbirth Interpretation of pain is subjective • Amounts of pain experienced by women during childbirth vary • For some women, the perceived pain is intense and agonizing; for other women there is little to no perceived pain • Many factors affect pain perception, including cultural ideas of childbirth, fear, number of previous births, fetal presentation, birthing position, and a woman's natural pain threshold

15. Use of Anesthesia and Pain-Reducing Drugs Kinds • Epidural anesthesia • Walking epidural or dual spinal-epidural Effects • Mother • Reduces/eliminates pain associated with labor • Sometimes slows labor • Neonate • Drug strength related to effects on fetus • May temporarily depress the flow of oxygen to fetus • Less physiologically responsive, show poorer motor control during the first days of life after birth, cry more, and may have more difficulty in initiating breastfeeding

16. And so…? • Only minimal risks to the fetus and neonate • Woman’s request for pain relief at any stage of labor should be honored • Proper use has no significant effect on child’s later well-being

17. Do neonates feel pain during birth? Objective indications of neonate pain at birth: • Crying • Facial expressions • Body movement • Vital signs • Serum cortisol, tissue and blood oxygen levels • Neurobehavioral assessments

18. Post-delivery Hospital Stay • By 1990s, average stay for normal birth is 2 days • Changes prompted by medical insurance companies • American Academy of Pediatrics recommendation • Stay in hospital should be no less than 48 hours after giving birth What are the advantages and disadvantages of early dismissal?

19. Newborn Medical Screening American College of Medical Genetics recommendations • All newborns be screened for 29 disorders, ranging from hearing difficulties and sickle cell anemia to extremely rare conditions such as isovaleric academia, a disorder involving metabolism Consider this • If you were the parent of a newborn, would you want to know if your child had a disorder that might never become a problem? Why or why not?

20. Becoming an Informed Consumer of Development

21. Review and Apply

22. Review and Apply

23. Review and Apply

24. BIRTH COMPLICATIONS

25. What do you think? Why is infant survival less likely in the United States than in other, less developed countries?

26. International Infant Mortality While the United States has greatly reduced its infant mortality rate in the past 25 years, it ranks only twenty-third among industrialized countriesas of 2009. What are some of the reasons for this? (Source: The World Factbook, 2009.)

27. Preterm Infants: Too Soon, Too Small Preterm infants • Respiratory distress syndrome (RIDS) Low birth-weight infants Small-for-gestational-age infants Outcomes • Majority of preterm infants eventually develop normally in long run • Tempo of development often proceeds more slowly

28. Very low birth-weight infants Smallest survivors • Most vulnerable; immaturity of their organ systems • Weigh less than 1250 grams (around 2 1/4 pounds) • In womb less than 30 weeks Risk-reduction strategies • High-quality care • Responsive, stimulating and organized care • Massage

29. Survival and Gestational Age

30. What causes preterm and low-birth-weight deliveries? • Half of births unexplained • Difficulties related to mother’s reproductive system • Immaturity of mother’s reproductive system • General health of mother

31. Factors Associated with Increased Risk of Low Birth weight • Demographic risk • Medical risks predating pregnancy • Medical risks in current pregnancy • Behavioral and environmental risks • Healthcare risks • Evolving concepts of risks (See Table 3-2)

32. Factors Associated with Increased Risk of Low Birth Weight

33. Cesarean Delivery: Intervening in the Process of Birth Procedure • Baby is surgically removed from uterus Rationale • Occur most frequently when fetal stress appears • More prevalent in older mothers • In some cases, related to position in birth canal: breech, transverse • Routine use of fetal monitor Risks • Major surgery for mother, longer recovery • Reduced stress-related hormones for neonate

34. Cesarean Deliveries

35. True or False? Cesareans are effective medical interventions?

36. Post-mature Babies: Too Late, Too Large 2 weeks or more overdue • Blood supply from placenta may become insufficient • Blood supply to brain may be decreased, leading to the potential of brain damage • Labor becomes riskier for larger fetus to pass through birth canal

37. Mortality and Stillbirth: The Tragedy of Premature Death • Joy that accompanies the birth of a child is completely reversed when a newborn dies • 1 out of 115 deliveries in U.S. • Enormous impact on family; depression and lack of support common; sometimes PTSD experienced • U.S. infant mortality generally declining since 1960s • Stillbirth resources: • March of Dimes • National Stillbirth Society • MISS Foundation

38. Moving From the Heights of Joy to the Depths of Despair Postpartum Depression • Incidence rate • Symptoms and causes • Consequences

39. When Mothers Are Depressed Depressed Mothers • Display little emotion and act detached and withdrawn Infants • Display fewer positive emotions and withdraw from contact not only with their mothers but with other adults

40. Developmental DiversityOvercoming Racial and Cultural Differences in Infant Mortality

41. Leaving Leave Alone Opportunity to take extended maternity leave can be important ~ Are these always available? Let’s take a look at Table 3-3 for a summary of leave policies in the US and 10 peer nations.

42. Childbirth-Related Leave Policies in the U.S. and 10 Peer Nations

43. Review and Apply

44. Review and Apply

45. Review and Apply

46. THE COMPETENT NEWBORN

47. Neonate, but not novice…completely! Neonates emerge practiced in many types of physical activities Reflexes • Sucking reflex • Swallowing reflex • Rooting reflex • Coughing, sneezing, blinking

48. The Newborn Digestive System Sucking and swallowing reflexes help infants to consume their mother’s milk and are coupled with the newfound ability to digest nutriments • Meconium • Neonatal jaundice

49. Sensory Capabilities: Experiencing the World

50. Sensory Capabilities: Experiencing the World