Chapter 4 Birth and the Newborn Baby: In the New World

1. Chapter 4Birth and the Newborn Baby:In the New World

2. Birth and the Newborn Baby: Truth or Fiction? • The fetus signals the mother when it is ready to be born. • After birth, babies are held upside down and slapped on the buttocks to stimulate independent breathing.

3. Birth and the Newborn Baby: Truth or Fiction? • The way that the umbilical cord is cut determines whether the baby’s “belly button” will be an “inny” or an “outy.” • Women who give birth according to the Lamaze method do not experience pain.

4. Birth and the Newborn Baby: Truth or Fiction? • In the United States, 1 birth in 4 is by cesarean section. • It is abnormal to feel depressed following childbirth.

5. Birth and the Newborn Baby: Truth or Fiction? • Parents must have extended early contact with their newborn children if adequate bonding is to take place. • More children die from sudden infant death syndrome (SIDS) than from cancer, heart disease, pneumonia, child abuse, AIDS, cystic fibrosis and muscular dystrophy combined.

6. Countdown… The Stages of Childbirth

7. What Events Occur just prior to the Beginning of Childbirth? • Dropping or Lightening • Head of fetus settles in pelvis • Braxton-Hicks contractions • First uterine contractions may be experienced as early as 6th month • Blood spotting in vaginal secretions • Day or so before labor • Rush of amniotic fluid from vagina • Occurs in 1 woman in 10

8. What Events Occur just prior to the Beginning of Childbirth? • Beginning of labor may be signaled by indigestion, diarrhea, ache in small or back, and abdominal cramps • Placenta and uterus secretes prostaglandins • excite uterus muscles causing contractions • As labor progresses, oxytocin is released • stimulates contractions powerful enough to expel the fetus

9. What Happens during the First Stage of Childbirth? • Uterine contractions efface and dilate cervix • First stage lasts from a few hours to more than a day • Contractions increase in strength, frequency, and regularity • Mother may be prepped • Shaving pubic hair • Administer enema

10. What Happens during the First Stage of Childbirth? • Fetal monitoring • Measure fetal heart rate and mother’s contractions • If necessary to speed up delivery, forceps or vacuum extraction tube may be used • Transition (about 30 minutes) • Cervix is nearly fully dilated • Head of fetus moves into vagina • Frequent and strong contractions

11. Figure 4.1 The Stages of Childbirth

12. What Happens during the Second Stage of Childbirth? • Begins when baby appears at opening of birth canal • Ends with birth of baby • Baby’s head crowned when it begins to emerge from birth canal • Episiotomy may be performed once crowning takes place • Used to prevent tearing of mother • Controversial and used less frequently

13. Lessons in Observation: Birth • In the video, Lee had her baby in a hospital setting, without fetal monitoring or anesthesia. What are some other approaches to childbirth outlined in your text? • Lee was in labor for 9 hours with her first child, Carter. Is this typical?

14. Lessons in Observation: Birth

15. Lessons in Observation: Birth • Lee and Dan were worried about the size of Carter’s testicles and his somewhat flattened facial features. Describe the newborn baby’s appearance and explain the likely duration of these characteristics. • What does the acronym APGAR stand for?

16. Lessons in Observation: Birth • How are each of the five areas tested by the APGAR rated?Appearance, Pulse, Grimace, Activity, Respiration • Explain the APGAR score ratings in connection with good, fair, and poor condition.

17. Lessons in Observation: Birth • What was Carter’s APGAR score? • Why is this test performed twice, at one minute and at five minutes? • Does the APGAR score predict the future health of a baby?

18. What Happens during the Second Stage of Childbirth? • Once baby’s head emerges from mother, mucus is suctioned from the baby’s mouth • Clears passageway for breathing • Umbilical cord is clamped and severed • Newborn may be removed • Baby is footprinted • ID bracelet is put on baby • Antibiotic ointment or drops are applied to baby’s eyes • Baby receives Vitamin K injection

19. What Happens during the Third Stage of Childbirth? • Also referred to as the placenta stage • Lasts minutes to an hour or more • Placenta separates from the wall of uterus and is expelled • Obstetrician sews episiotomy, if performed

20. Methods of Childbirth

21. How is Anesthesia Used in Childbirth? • General anesthesia • Puts mother to sleep • Negative effects of general anesthesia • Abnormal patterns of sleep and wakefulness • Decreased attention and social responsiveness for at least 6 weeks • Local anesthetics • Deadens pain without putting mother to sleep • Minor depressive effects on neonates shortly after birth

22. What is Prepared Childbirth? • Lamaze method • Utilize breathing and relaxation exercises to lessen fear and pain • Teaches women to associate relaxation with contractions • Coach • Aids the mother in the delivery room • Provides social support to mother during labor • Doula • Experienced female companion provides continuous emotional support during labor • Fewer cesarean deliveries, less anesthesia, and shorter, less painful labors

23. What is the C-section? • Cesarean Section • Delivered by abdominal surgery • Physicians prefer C-section to vaginal delivery • Mother’s small pelvis • Maternal weakness or fatigue • Baby is too large • Baby is in distress • May be used to bypass infections in birth canal from HIV or Herpes

24. How Can a Woman Decide to Deliver Her Baby? • Diversity of birthing options • All-in-one labor, delivery, recovery, and postpartum rooms (LDRPs) • Birthing suite in hospital equipped for uncomplicated birth • Easy access to emergency facilities if needed • Home Birth • Can be fairly safe for healthy women with little risk of complications

25. Birth Problems

26. What are the Effects of Oxygen Deprivation at Birth? • Hypoxia - Prenatal oxygen deprivation • can impair development of central nervous system and psychological disorders • Anoxia - Oxygen deprived at birth • predicted problems in learning and memory • can cause health problems such as early-onset schizophrenia and cerebral palsy

27. What is Meant by the Terms Prematurity and Low Birth Weight? • Premature or preterm baby • Occurs before 37 weeks gestation (normal is 40 weeks) • Low-birth-weight baby • Weighs less than 5.5 pounds • Small for date • Low-birth-weight, although born at full term

28. What Risks are Connected with being Born Prematurely or Low in Birth Weight? • Infant mortality • Neonates weighing 3.25 to 5.5 pounds are 7 times more likely to die than infants of normal weight • Those weighing less than 3.3 pounds are nearly 100 times as likely to die • Delayed neurological development • Lower birth weight – poorer performance throughout school years • Delayed motor development, such as walking • Preschool experience fosters cognitive and social development

29. What Signs are Connected with being Born Prematurely or Low in Birth Weight? • Preterm babies show signs of immaturity • relatively thin • fine, downy hair (lanugo) • oily, white substance on skin (vernix) • Preterms born six weeks or more prior to full term • nipples not yet be emerged • testicles of boys not yet descended into scrotum • Muscles immature and reflexes are weak • Respiratory distress syndrome • walls of air sacs in lungs stick together

30. How are Preterm Infants Treated Following Birth? • Usually remain in hospital incubators • Temperature-controlled environment with protection from infection • Parents often do not treat preterms as well as full term • Less attractive than full-term babies • High-pitched, grating cries • More irritable • Preterms and parent interaction is less even when they are brought home

31. How are Preterm Infants Treated Following Birth? • Interventions for preterm infants • Benefit from external stimulation • Massage • Kangaroo care • Preterm infants exposed to stimulation • Gain weight more rapidly • Show fewer respiratory problems • Make greater advances in motor, intellectual, and neurological development than controls

32. Developing in a World of Diversity Maternal Mortality and Infant Mortality Around the World

33. The Postpartum Period

34. What Kinds of Problems in Mood do Women Experience during Postpartum Period? • Baby blues • Transient – about 10 days • Postpartum depression (PPD) • Begins one month after delivery and may linger for weeks/months • Major depressive disorder • Psychotic features

35. How Critical is Parental Interaction with Neonates in the Formation of Bonds of Attachment? • Bonding • Formation of bonds of attachment between parent and child • Essential to survival and well being of child • “Maternal sensitive” period • Amount of access to newborn (Klaus & Kennell, 1978) • Extended early contact is not essential for adequate bonding

36. Characteristics of Neonates

37. How do Health Professionals Assess the Health of Neonates? • Apgar scale • Based on five signs of health • Interpretation of scores • 7 or above – no danger • below 4 – critical condition • Brazelton Neonatal Behavioral Assessment Scale • Based on four areas of behaviors • Measures reflexes, motor behavior and muscle tone

38. What are Reflexes? • Reflexes • Simple, unlearned stereotypical responses, elicited by certain types of stimulation • Survival value • Neural functioning is determined by testing reflex

39. What Kinds of Reflexes are Shown by Neonates? • Rooting • Baby turns head and mouth toward stimulus that strokes the cheek, chin, or corner of mouth • Facilities finding mother’s nipple for sucking • Sucking • Babies will suck almost any object that touches the lips • Will become replaced by voluntary sucking

40. What Kinds of Reflexes are Shown by Neonates? • Moro or startle reflex • Back arches, legs and arms are flung out and then brought back toward chest into a hugging motion • Occurs when baby’s position is suddenly changes or health and neck support is lost • Elicited by loud noises or bumping baby • Usually lost 6 to 7 months after birth

41. What Kinds of Reflexes are Shown by Neonates? • Grasping or palmar reflex • Using four fingers, babies grasp fingers/objects pressed against the palms of their hands • Most babies can support their own weight • Usually lost by 3 to 4 months • Replaced by voluntary grasping at 5 to 6 months

42. What Kinds of Reflexes are Shown by Neonates? • Stepping reflex • Mimic walk when held under arms • Usually disappears by 3 or 4 months

43. What Kinds of Reflexes are Shown by Neonates? • Babinski reflex • Fans or spreads toes in response to stroking foot • Usually disappears at end of first year • Tonic-neck reflex • While lying on back, baby turns head to one side. Arm and leg on that side extend, while opposite side flex.

44. Vision • Visual acuity • Estimate of 20/600 • Best see objects 7 to 9 inches from eyes • Lack peripheral vision of older child • Able to track movement within one day of birth • preference for moving objects

45. A Closer Look Studying Visual Acuity in Neonates: How Well Can They See?

46. Vision • Visual accommodation • Self-adjustments made by eye lens to bring objects into focus • Neonates show little or no visual accommodation • Focus on objects 7 to 9 inches away • Convergence • Does not occur until 7 or 8 weeks

47. Hearing • Fetuses respond to sound • Neonates respond to amplitude and pitch • Show preference for mothers’ voice • Responsive to sounds and rhythms of speech • Show no preference for specific languages

48. Smell and Taste • Smell • Well developed at birth • Demonstrate aversion for noxious and preference for pleasant odors • Recognize familiar odors • Taste • Sensitive to different tastes • Demonstrate facial expressions to basic tastes • Prefer sweet tastes

49. Touch and Pain • Touch • Sensitive to touch • Touch elicits many reflex behaviors • Pain • Less sensitive to pain

50. Learning Or Really Early Childhood “Education”