John W. Santrock

1. Children 5 Birth John W. Santrock

2. 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?

3. 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.

4. What Happens During the Birth Process? Stages of the Birth Process • First stage • Lasts about 12 to 24 hours; longest stage • Contractions are about 15–20 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

5. What Happens During the Birth Process? Stages of 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

6. What Happens During the Birth Process? Stages of the Birth Process • Third stage (Afterbirth) • Placenta, umbilical cord, and other membranes detached and expelled • Fastest stage; lasts only minutes

7. Placenta Vagina a b Cervix Placenta Uterus c d The Stages of Birth Fig. 5.1

8. What Happens During the Birth Process? The Fetus/Newborn Transition • Uterine muscles draw together • Decreased oxygen supply during contractions is termed anoxia—insufficient oxygen to fetus/newborn • Stress hormone secretion protects from oxygen deficiency, prepares infant for birth. • Vernix caseosa (skin grease) protects against heat loss.

9. What Happens During the Birth Process? Childbirth Strategies and Decisions • 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

10. What Happens During the Birth Process? Childbirth Strategies and Decisions • 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

11. What Happens During the Birth Process? Childbirth Strategies and Decisions • Methods of delivery: medications • Analgesia: used to relievepain • 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

12. What Happens During the Birth Process? Childbirth Strategies and Decisions • Natural childbirth: attempts to reduce mother’s pain by decreasing fear • Prepared childbirth: similar to natural childbirth; special breathing technique used in final stages of labor • Many techniques have been developed

13. What Happens During the Birth Process? Childbirth Strategies and Decisions • Cesarean Delivery • Baby removed from uterus through incision in abdomen when • Baby is in breech or crosswise position • Head too large for mother’s pelvis • Vaginal bleeding has occurred in pregnancy • Nearly 1 in 4 U.S. births are C-sections

14. What Happens During the Birth Process? Childbirth Strategies and Decisions • 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 child’s emotions and behaviors

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

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

17. 12.1 12 10.7 9.5 8 Percentage of preterm births 4 0 1982 1992 2002 Year Percentage of All U.S. Births That Are Preterm Fig. 5.2

18. 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

19. 100 90 80 70 60 Overall cognitive skills score 50 40 30 20 10 0 750 g 750 g – 1,499 g Full term normal weight Cognitive Skills of Students Born with Low or Normal Birthweight Fig. 5.3

20. How Do Low-Birthweight Infants Develop? Long-Term Outcomes for Low-Birthweight Infants • Nurturing Preterm Infants • Appropriate stimulation may vary • Massage used throughout history; has led to greater weight gain, improved skills, and better academic performance

21. 3 lb. 7 oz Premature infants who were massaged 3 lb. 5 oz Premature infants who were not massaged Infant weight 3 lb. 3 oz 3 lb. 1 oz 2 lb. 15 oz 0 2 4 6 8 10 12 14 Age in days Weight Gain Comparison of Premature Infants Who Were Massaged and Not Massaged Fig. 5.4

22. How Do Low-Birthweight Infants Develop? Long-Term Outcomes for Low-Birthweight Infants • 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

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

24. Apgar Scale

25. What Are Three Measures of Neonatal Health and Responsiveness? Brazelton Neonatal Behavioral Assessment Scale • 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

26. What Are Three Measures of Neonatal Health and Responsiveness? Neonatal Intensive Care Unit Network Neurobehavioral Scale • Offspring of NBAS; provides more comprehensive analysis of newborn behavior • Neurological and stress responses • Regulatory capacities • Assesses high-risk infants

27. What Happens During the Postpartum Period? Postpartum Period • Period after childbirth when the mother adjusts physically and psychologically to process of childbirth • Lasts about six weeks • Influenced by preceding events

28. What Happens During the Postpartum Period? Postpartum Adjustments • 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

29. What Happens During the Postpartum Period? Postpartum Adjustments • Emotional and psychological changes • Emotional fluctuations • Fatigue • Inexperience or lack of confidence • Extensive demands may cause anxiety, depression, coping difficulties

30. What Happens During the Postpartum Period? Postpartum Depression • Strong feelings of sadness, anxiety, or despair in new mothers • Excessive worrying • Depression • Extreme changes in appetite • Crying spells • Inability to sleep

31. “Baby Blues” Symptoms appear 2 to 3 days after delivery and subside within 1 to 2 weeks Postpartum depression symptoms linger for weeks or months and interfere with daily functioning No symptoms Percentage of U.S. women experiencing “Baby Blues” and Postpartum Depression Fig. 5.7

32. What Happens During the Postpartum Period? Staying at Home or Working • Mothers’ wishes vary; decision making is often difficult and agonizing • Pressures on mothers affect options • Societal • Career • Financial

33. What Happens During the Postpartum Period? Father’s Adjustment • 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

34. What Happens During the Postpartum Period? Father’s Adjustment • Both parents need to be aware of young infant’s developmental needs • Physical • Psychological • Emotional

35. What Happens During the Postpartum Period? Bonding • 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

36. Children 5 The End