Chapter 5 Birth and the Newborn Baby

1. Chapter 5Birth and the Newborn Baby

2. How Birthing Has Changed • Childbirth as a female social ritual to a medicalized experience. • The medicalization of childbirth has had social and emotional costs • Other birth methods • Home birth, midwife Cultural variations

3. Some statistics about childbirth in the US (CDC) • In 2005, 4,105,000 babies were born in the US. • The mean age for women having their first baby in 2003 is 25.2 yrs • Birthrate for older women (>35) higher than past 3 decades; births to teens (3%) at an all time low. • Likelihood of multiple births currently 31.5 per 1000 women.

4. Childbirth by age in Maryland

5. Childbirth by Ethnicity/Race in Maryland, 2001-2003 average

7. Childbirth • Dilation and effacement of the cervix (Stage 1) • (average 12-14 hours first birth; 4-6 hrs for later births) • Delivery of the baby (Stage 2) • (Average 50 minutes first birth; 20 minutes later births) • Birth of the placenta (Stage 3) • (Average 5-10 minutes)

8. The Birth Process • Methods of Delivery • Cesarean delivery • Vaginal delivery • Natural childbirth • Lamaze method of prepared childbirth • Social and cultural attitudes

9. Rate of Cesarean births in the US

10. The Newborn Baby • The first 4 weeks of life is the neonatal period • Size and Appearance • An average newborn in the U.S. is 20 inches long and weighs 7.5 pounds • Distinctive features: head size, hair, skin colorcast • Body systems • After birth, all of the baby's systems and functions must operate on their own

11. Medical and Behavioral Assessment: Apgar Scale One minute and five minutes after birth, most babies are assessed using the Apgar scale(sum of ratings 0-2 for each dimension; below 5 indicates need for immediate medical attention) • Appearance – color • Pulse – heart rate • Grimace – reflex irritability • Activity – muscle tone • Respiration – breathing

12. Medical and Behavioral Screening: NBAS The Brazelton Neonatal Behavioral Assessment Scale (NBAS) assesses neonates' responsiveness to their physical and social environment, identifies problems in neurological functioning, and predicts future development

14. Complications of Childbirth • Birth trauma may be caused by anoxia (oxygen deprivation), diseases or infections, or physical injury • Electronic fetal monitoring • Low birthweight babies (preterm & small for date) • Immediate treatments and outcomes

15. Infant States • States of Arousal and Activity Levels • Babies have an internal "clock," which regulates their daily cycles of eating, sleeping, elimination, and even moods States • Regular sleep • Irregular sleep • Drowsiness • Alert inactivity • Waking activity and crying

16. Changes in States • During the first few months, states change often, but by five months they are more predictable. • Babies vary in how frequently they change states and in how smoothly they make transitions.

17. Childbirth and Bonding • Infant-mother bond occurs soon after birth • Imprinting in animals has been equated to the infant-mother bonding by ethologists • A critical period for bonding does not exist for human beings

18. Early Intervention • For intervention to have lasting effects, it needs to continue beyond age 3 • Babies who had more than one risk factor (such as poor neonatal health combined with having a mother who was not educated) fared the worst • The Kauai study • Resilience of children • Protective factors – three categories of factors that tended to reduce impact of early stress in childhood