The neonate (newborn) comes into the world after the process of labor:

2. 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

3. 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. The time for this stages varies from woman to woman.

4. Stages of Labor • 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. Alternative birthing methods Lamaze birthing techniques – relaxation techniques used with help of a coach to deal positively with pain Bradley Method – no medicine or medical intervention. Use techniques similar to Lamaze. See doctors as unnecessary Hypnobirthing – Self-hypnosis during delivery.

10. 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

11. 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

13. 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

14. Who delivers? • Doctors • Midwives • Doula

15. 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(22-26 weeks)

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

17. 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 - often results in a cesarean

18. Cesarean Delivery is when the baby is surgically removed from the mother’s uterus Cesarean Cesarean http://www.youtube.com/watch?v=xyN48VnRYUY

19. The Newborn Baby • Size and Appearance • Neonates in the U.S. average about 7 ½ pounds and 20 inches long • Large head ¼ the body length • Red skin • Birthmarks • Receding chin

20. The Newborn Baby • Size and Appearance • Misshapen head (lasts about 1 week) • Soft spots (fontanels) • Lanugo • Vernix caseosa

21. The Newborn Baby • Body Systems • Most babies begin breathing soon after they are exposed to air • If over 5 minutes →anoxia (without oxygen) or hypoxia (low oxygen) • Most other systems begin functioning 4 to 6 hours after delivery • Nourishment • Elimination of waste • Temperature regulation

22. The Newborn Baby • Medical and Behavioral Assessment • Apgar Scale • Appearance (color) • Pulse (heart rate) • Grimace (reflex irritability) • Activity (muscle tone) • Respiration (breathing)

23. The Newborn Baby • States of Arousal and Activity Levels • State of arousal is inborn • Most new babies spend 75% of their time asleep • Alternates between quiet and active sleep • As the child grows into toddlerhood its sleep time decreases • Sleep schedules vary across cultures

24. Complications of Childbirth- And Their Aftermath • Low Birth Weight • Usually from inadequate prenatal nutrition • Preterm (premature) infants → under 37 weeks of gestation • Small-for-date • 12.5 percent of U.S. infants are preterm • 8.1 percent have low birth weight (under 5 ½ pounds)

25. Complications of Childbirth- And Their Aftermath • Low Birth Weight • Factors concerning having a low-birth-weight baby • Demographic and socioeconomic factors • 13.7 percent of African American babies have low birth weight • Medical factors predating the pregnancy • Prenatal behavioral and environmental factors

26. Complications of Childbirth- And Their Aftermath • Low Birth Weight • Immediate treatment and outcomes • Feeding intravenously • Place infant in an isolette • Administering surfactant • Stroking babies

27. Complications of Childbirth- And Their Aftermath • Low Birth Weight • Long-term outcomes • Adult-onset diabetes • Increased risk of cardiovascular disease • In extremely low-birth-weight infants: • Neurological • Sensory • Cognitive • Educational • Behavioral

28. Complications of Childbirth- And Their Aftermath • Postmaturity • 42+ weeks’ gestation • Tend to be long and thin • Complicates labor • Risk of brain damage or death • Induction of labor is common

29. Newborns and Parents • Childbirth and Bonding • Mother-infant bond • Ethological approach-biologically determined. Emphasizes critical and sensitive periods • Evolutionary perspective – parents provide resources that ensure survival • Imprinting • Konrad Lorenz

30. Newborns and Parents • What Do Newborns Need From Their Mother? • Harry Harlow’s experiment • Comfort of close bodily comfort • Father’s Role • Differs by culture • Changed much since mothers began to work outside the home

31. Postpartum problems • Postpartum blues – • happens in the days right after childbirth and normally go away within a few days to a week. A new mother can have sudden mood swings, sadness, crying spells, loss of appetite, sleeping problems, and feel irritable, restless, anxious, and lonely. Symptoms are not severe and treatment isn’t needed.

32. Postpartum depression • can happen anytime within the first year after childbirth. A woman may have a number of symptoms such as sadness, lack of energy, trouble concentrating, anxiety, and feelings of guilt and worthlessness • postpartum depression often affects a woman’s well-being and keeps her from functioning well for a longer period of time. Postpartum depression needs to be treated by a doctor. Counseling, support groups, and medicines are things that can help.

33. Postpartum psychosis • occurs in 1 or 2 out of every 1000 births and usually begins in the first 6 weeks postpartum. • Women who have bipolar disorder or another psychiatric problem called schizoaffective disorder have a higher risk for developing postpartum psychosis. • Symptoms may include delusions, hallucinations, sleep disturbances, and obsessive thoughts about the baby. A woman may have rapid mood swings, from depression to irritability to euphoria.