Process of Labor and Birth Complications

1. Child Development, 3/e by Robert Feldman Chapter 4 Birth and the Newborn Infant Created by Barbara H. Bratsch

2. What is the normal process of labor? • What complications can occur at birth, and • what are their causes, effects, and treatments? • What capabilities does the newborn have?

3. The neonate (newborn) comes into the world after the process of labor: • Corticotropin releasing hormone (CRH) triggers the release • of hormones that start the process leading to birth • Braxton-Hicks contractions, also called “false labor”, • can happen as the uterus contracts to prepare for birth • Uterus contracts intermittently and more intently as birth • becomes more imminent

4. Stages of Labor: • First stage is the longest. Uterine contractions begin about 8-10 minutes apart and last for 30 seconds. This time shortens as the baby approaches the transition from uterus to birth canal through the cervix. • Second stage lasts about 90 minutes and is when the baby travels through the vagina and exits the mother’s body. An episiotomy is a small incision made to increase the size of the opening of the vagina to prevent tearing of the vaginal walls. • Third stage labor is the delivering of the placenta and umbilical cord. This stage happens quickly.

5. Stages of Labor

6. Immediately upon birth, a professional health care worker will do a visual inspection then employ the Apgar Scale. This Apgar Scale measures: appearance pulse grimace activity and respiration at one minute and five minutes after birth to assess any immediate issues. If anoxia (a restriction of oxygen) occurs for a few minutes, brain damage could occur

7. Physical Appearance and Initial Encounters • The neonate is covered by vernix, a thick, greasy substance that covers the entire infant and assists with a smooth passage through the birth canal. The infant is also covered in fuzz, called languno, which soon disappears. • Bonding of parent to infant has its strongest components at this moment after birth. This may have effects on relationship strength during life.

8. Approaches to childbirth Hospital deliveries vs. Home deliveries

9. Lamaze birthing techniques – relaxation techniques used with help of a coach to deal positively with pain Leboyer method – delivery rooms are dimly lit and the newborn is placed immediately on the mom’s stomach then floated in a pool of warm water with the cutting of the umbilical cord occurring later Family birthing centers – homelike setting in which family members are present during birth. Many hospitals now have birthing centers so professional staff are close by but the atmosphere is more like home

10. Pain, Anesthesia, and Pain-Reducing Drugs • Pain is a subjective, psychological phenomenon that cannot be easily measured • Epidural anesthesia produces numbness from the waist down and an inability to walk or push during delivery • Walking epidurals, or dual spinal epidurals, use smaller needles and administer a continuous dose of anesthetic so woman may walk around and have fewer side effects

11. Postdelivery Hospital Stays Mothers are more satisfied with their medical care if they stay longer following a birth than if they are discharged in a day

12. Birth Complications • Preterm (or premature) infants are born less than 38 weeks after conception • Low-birthweight infants weigh less than 2,500 grams (about 5 ½ pounds) • Small-for-gestational-age infants weigh 90% or less than the average weight of babies of the same gestational age • Very-low-birthweight infants weigh less than 1,250 grams (around 2 ¼ pounds) and have been in the womb less than 30 weeks • Age of viability is the point at which an infant can survive a premature birth

13. unknown immaturity of mother’s reproductive system nutrition of mother level of medical care stress economic support Causes of birth complications:

14. Infant Mortality Rates

15. Survival and Gestational Age • Chances of a fetus surviving greatly improve after 28 weeks • Postmature infants are 2 weeks overdue and carry risks of decreasing blood supply from the placenta plus increased risks of labor itself since the child is larger

16. Cesarean Delivery is when the baby is surgically removed from the mother’s uterus

17. Tragedies of Childbirth • Stillbirth – delivery of a child that is not alive. This occurs in less than 1 baby out of 100 • Infant mortality – death within the first year of life

18. The Competent Newborn Reflexes – unlearned, organized involuntary responses that occur automatically in the presence of certain stimuli Sucking reflex Swallowing reflex Rooting reflex Cough, sneeze and blink

19. Early Learning Capabilities • Classical Conditioning – type of learning in which an organism responds in a particular way to a neutral stimulus that normally does not bring about that type of response For example: A hungry baby stops crying when mother picks her up because she has learned to associate being picked up with eating • Operant Conditioning – form of learning in which a voluntary response is strengthened or weakened, depending on its association with positive or negative consequences For example: An infant learns that smiling brings positive attention so they smile more • Habituation – decrease in the response to a stimulus that occurs after repeated presentations of the same stimulus For example: A toy that initially elicited excitement, no longer produces that response after seeing it several more times

20. Social Competence • Infants can discriminate between basic facial expressions of happiness, sadness, and surprise. • All normal newborns can imitate. • States of arousal are various stages of sleep and wakefulness. Infants and adults build relationships around these states.