Download Birth and the Newborn Baby: In the New World

Chapter Three
Stages of Childbirth
 Stage 1 – uterine contractions efface and dilate
cervix; passageway widens to 4 inches (10
centimeters); dilation of cervix responsible for
most of the pain during childbirth; lasts from few
hours to more than a day; subsequent pregnancies
shorter amount of time; women advised to go to
hospital when contractions are 4-5 minutes apart;
prepped refers to shaving pubic hair to lower
chance of infection and help with episiotomy;
enema may be given to prevent involuntary bowel
movement; fetal monitoring may be used; when
cervix fully dilated head of fetus begins to move
into the vagina or birth canal (called transition)
Stages of Childbirth Continued
 Second stage begins when baby appears at the
opening of the birth canal; 2nd stage may last from
minutes to hours; woman taken to delivery room
for the 2nd stage; contractions stretch the skin
around birth canal farther and propel baby; baby’s
head “crowns” when it begins to emerge from birth
canal; episiotomy (prevents random tearing)
occurs once crowning takes place; baby emerges
from birth canal and when breathing adequately
on own, the umbilical cord is clamped and
severed; baby is taken by nurse and goes through
various procedures
Stages of Childbirth Continued
 Stage 3 – called placental stage; lasts from minutes
to an hour or more; placenta separates from the
uterine wall and is expelled through birth canal;
bleeding is normal; obstetrician sews the
episiotomy if one has been performed
Methods of Childbirth
 Midwife may be used; delivers baby in woman’s home;
more intimate; limitation is access to sophisticated
medical instruments and anesthetics that may be
needed during a high risk delivery such as shoulder
dystocia or breech birth
Methods of Childbirth Continued
 Anesthesia may consist of tranquilizers, oral
barbiturates, and narcotics; reduce anxiety and
perception of pain without causing sleep; little
evidence of long-term effects on newborn
 Local anesthetics include pudendal block
(mother’s external genital numbed), epidural
block and spinal block (local anesthesia injected
into the spinal canal or spinal cord to numb body
below the waist); no effects on newborn shown to
linger
Methods of Childbirth Continued
 Woman uses no anesthesia during so-called
natural childbirth; educated about biological
aspects of reproduction and delivery, encouraged
to maintain physical fitness and taught relaxation
and breathing exercises
 Prepared childbirth includes the Lamaze method;
women taught breathing and relaxation exercises
by a coach (most often her partner) who will aid
her in the delivery room with massages, timing
contractions etc.
Methods of Childbirth Continued
 Doulas are used as social and emotional support
before and during delivery; doulas may be used
when a partner is not available; women with
doulas present during delivery tend to have shorter
deliveries than those without
Methods of Childbirth Continued
 Cesarean section (C-section) is when the
physician delivers the baby by abdominal surgery;
physician cuts through the mother’s abdomen and
the uterus and physically removes the baby; mostly
used when concern regarding the health of the
baby or mother is at stake during delivery
Birth Problems
 Anoxia and hypoxia are oxygen deprivation to the
baby in utero
 Prenatal oxygen deprivation (POD) can impair
development of fetus’s CNS, leading to cognitive,
motor and psychological problems (early-onset
schizophrenia and cerebral palsy may occur)
 POD may be caused by maternal disorders such as
diabetes, immaturity of baby’s respiratory system,
accidents involving pressure against umbilical cord
during birth; breech presentation may contribute
to POD
Birth Problems Continued
 Preterm refers to birth before 37 weeks
gestation;
 low birth weight (LBW) is less than 5
pounds;
 if born full term but low in birth weight
baby is said small for dates;
 preterm babies more likely than small for
dates babies to achieve normal heights and
weights; prematurity more common in
multiple births
Birth Problems con’t
 Risks with premature and LBW include:
 higher infant mortality,
 poor neurological development,
 poor cognitive functioning;
 slow motor development
Signs of Prematurity
 Preterm babies relatively thin, have fine hair called
lanugo, and an oily white substance on the skin
known as vernix
 Muscles are premature, breathing and sucking
reflexes weak; baby may suffer from respiratory
distress syndrome (RDS)
 Babies with RDS show poorer development in
cognitive, language, motor skills, and neurological
abnormalities over first 2 years of life
 Corticosteriods injected into mother to increase
babies’ chances of survival
Treatment of Preterm Babies
 Preterm infants usually remain in incubators in
the hospital; incubators maintain temperature
controlled environment and afford some
protection from disease; oxygen has to be
monitored because excessive oxygen can cause
permanent eye injury
Parents and Preterm Neonates
 Parents do not treat preterm neonates the same as
full-term babies are treated
 Preterm neonates look less appealing, have high
pitched and grating cries, are more irritable
 Mothers of preterm neonates feel alienated from
babies, harbor feelings of guilt, failure, and low
self-esteem
 Mothers are less sensitive, hold babies at a greater
distance
Intervention Programs
 Preterm infants need early stimulation such as
cuddling, rocking, talking to, singing to and being
exposed to recordings of their mothers’ voices, and
having mobiles in view
 Massage, laying skin to skin and chest to chest
with parent (kangaroo care) excellent stimulation
 Preterm infants exposed to such stimulation gain
weight more rapidly, show fewer respiratory
problems and make greater motor, intellectual and
neurological advances
Postpartum Period and Maternal Depression
 Postpartum refers to the weeks following delivery
 Most mothers are happy and adjust to the
newborn
 Some mothers may suffer from postpartum
depression (PPD) which begins a month after
delivery and may linger for months
 PPD is characterized by serious sadness, feelings of
hopelessness, helplessness, worthlessness,
difficulty concentrating and changes in appetite
(usually loss)
 PPD may be due to drop in estrogen; feelings of
depression prior to delivery may contribute
Postpartum Period and Maternal Depression Continued
 1 in 500 postpartum women experiencing mood
episodes report psychotic features such as
delusional thoughts of the infant being injured or
dying, that the infant is possessed by the devil, or
that the mother has been commanded to kill the
infant
 Treatment includes social support, counseling,
drugs that address estrogen levels and/or
antidepressants
Bonding
 Bonding refers to formation of bonds of
attachment between parents and their children
 Bonding is essential for the survival and well-being
of the children
 Desire to have the child, parent-child familiarity
with one another’s sounds, odors, and tastes, and
caring contribute to bonding
 Serious maternal depression delays bonding;
history of rejection by parents can interfere with
women’s bonding with their own children
Assessing Neonates
 Apgar scale used to assess health of baby at birth;
score can vary from 0 to 10; score 7 and above
indicates baby is not in danger; score below 4
indicates baby is in critical condition and requires
medical attention
 Acronym for APGAR stands for A) the general
appearance or color of the neonate, P) the pulse or
heart rate, G) grimace (the 1-point indicator of
reflex irritability), A) general activity level or
muscle tone and R) respiratory effort, or rate of
breathing
Assessing Neonates Continued
 Brazelton Neonatal Behavioral Assessment Scale
measures neonates’ reflexes and other behavior
patterns; screens neonates for behavioral and
neurological problems by assessing motor
behavior, muscle tone, reflexes, responses to
stress, adaptive behavior and control over
physiological state
Reflexes
 Reflexes are simple, automatic, stereotypical
responses elicited by certain types of stimulation
 Neural functioning of neonate is tested by ability
to demonstrate a reflex; absence or weakness of a
reflex may indicate immaturity, slowed
responsiveness, brain injury, or retardation
 Rooting reflex – baby turns the head and mouth
toward a stimulus that strokes the cheek, chin, or
corner of the mouth; important for locating
mother’s nipple in preparation for sucking; can be
lost if not stimulated
Reflexes Continued
 Moro reflex – back arches and the legs and arms
are flung out and then brought back toward the
chest, with the arms in a hugging motion; can be
elicited when baby’s position is changed or when
support for head and neck is lost; can be elicited
by loud noises, bumping the baby’s crib or jerking
the baby’s blanket; lost within 6 to 7 months after
birth; absence of moro reflex indicates immaturity
or brain damage
Reflexes Continued
 Grasping reflex (palmar reflex) refers to the
increasing tendency to reflexively grasp fingers or
other objects pressed against the palms of their
hands; babies support their own weight this way
 Stepping reflex mimics walking; demonstrated 1–
2 days after birth; disappears 3–4 months of age
 Babinski reflex occurs when underside of foot
from heel to toes is stroked; toes are fanned or
spread
 Tonic-neck reflex is observed when baby is lying
on its back and turns it head to one side
Sensory Capabilities - Vision
 Neonates are nearsighted; can see 7–9 inches from
their eyes
 Can detect movement; prefer moving objects to
stationary objects
 Neonates have little or no visual accommodation;
see through fixed-focus camera
 Unable to converge their eyes on an object that is
close to them
Sensory Capabilities - Hearing
 Fetuses respond to sound months before they are
born
 Middle and inner ear normally reach mature
shapes and sizes before birth
 Neonates hear well unless middle ears are clogged
with amniotic fluid
 Neonates respond to sounds of different ampliture
and pitch
 Respond to high-pitched sounds than to lowpitched sounds; singing in low-pitch soothes
neonate; prefer their own mother’s voice
 Neonates discriminate different and new speech
sounds
Sensory Capabilities - Smell
 Neonates can discriminate distinct odors; show
more rapid breathing patterns and increased
bodily movement in response to powerful odors
 Nasal preferences same as that of older children
and adults
 Neonates use smell for mother-infant recognition
and attachment
 Breast-fed 15-day-old infants prefer their mother’s
underarm odors to odors produced by other milkproducing women
Sensory Capabilities - Taste
 Neonates respond to different tastes the same way
as adults respond
 Neonates discriminate between salty, sour, and
bitter tastes, as suggested by reactions in the lower
part of the face
 Sweet solutions have a calming effect on neonates;
sweeter solutions increase the heart rate
Sensory Capabilities - Touch
 Skin on skin for the neonate provides feelings of
comfort and security which may contribute to
bonds of attachment between infants and their
caregivers
 Many reflexes are activated by pressure against the
skin
Classical and Operant Conditioning of Neonates
 Neonates involuntary responses are conditioned to
new stimuli
 Neonates respond to classical and operant
conditioning principles (ex: Lipsitt study, 2002)
 Neonates can be operantly conditioned to suck on
a pacifier in such a way to activate a recording of
their mothers reading The Cat in the Hat
Sleeping and Waking
 Most neonates sleep about 16 hours per day
 Neonates go through different stages of sleep
 Typical infant has six cycles of waking and sleeping
in a 24-hour period
 Longest nap typically reaches 4 ½ hours; neonate
is usually awake for little more than 1 hour during
each cycle
 Number of hours of sleep needed decreases as
neonate ages to sleeping through the night
between 6 months of age to 1 year
Sleeping and Waking Continued
 Neonates spend about half of their time sleeping
in REM sleep; by 6 months REM sleep accounts for
only 30% of the baby’s sleep; 2–3 years REM drops
off to 20–25% of sleep
 Hypothesized that neonates create stimulation by
means of REM sleep, which most closely parallels
the waking state in terms of brain waves
 Preterm babies spend even more time in REM
sleep
Crying
 Babies cry due to pain and/or discomfort
 Some crying among babies is universal
 Parents can distinguish between cries of hunger,
anger, and pain
 Loud, insistent cry associated with flexing and
kicking of the legs may indicate colic (pain
resulting from gas or other sources of distress in
the digestive tract); baby may hold breath and
then cry again; colic disappears between 3rd and 6th
month
 Infants’ crying motivates others to take care of
them
Crying Continued
 Certain high-pitched cries may indicate health
problems; patterns of crying may be indicative of
chromosomal abnormalities, infections, fetal
malnutrition, and exposure to narcotics
 Cri du chat (French for “cry of the cat”) – genetic
disorder produces abnormalities in the brain,
atypical facial features, and a high-pitched,
squeaky cry
 Peaks of patterned crying occur in later afternoon
and early evening
 Response of the caregiver influences crying
 Persistent crying can strain mother-infant
relationship
Soothing
 Sucking (breast, bottle, pacifier) has a soothing
effect
 Parents soothe infants by picking them up, patting
them, caressing and rocking them, swaddling
them, speaking to them in a low voice
 How to soothe an infant is learned via trial and
error
 Crying decreases as the infant matures and learns
Sudden Infant Death Syndrome (SIDS)
 Between 2,000 and 3,000 infants die from SIDS in
the USA each year
 Most common death during the first year, most of
these deaths occur between 2 and 5 months of age
 Most frequent: babies aged 2–4 months; babies
who sleep on their stomachs or sides; premature
and LBW infants; male babies; African American
babies; babies of teenage mothers; babies whose
mothers smoked during or after pregnancy and
babies of mothers who used narcotics during
pregnancy
Children’s Hospital Boston Study
 Children’s Hospital Boston conducted SIDS study
to learn about causes
 Study focused on the medulla due to its role in
sleep/wake cycles; compared medullas of babies
that died from SIDS to medullas of babies that
died from other causes
 SIDS babies’ medullas less sensitive to the brain
chemical serotonin; boys’ brains less sensitive
 Prevention includes: no smoking during or after
pregnancy, do not use narcotics during pregnancy,
obtain adequate nutrition, baby needs to sleep on
back, keep current on SIDS data