CHAPTER 4 - Birth and the Newborn Baby

Signs that labor is near: 1. upper uterine contractions aka "false labor", 2. lightening - baby's head drops low into uterus, 3. bloody show - mucus plug that sealed cervix is released as a reddish discharge

Stages of Childbirth

Stage 2: Lasts about 50 minutes for a first baby, mother feels a natural urge to push with her abdominal muscles, baby's head crowns, baby is born.

Stage 3: Placenta separates from the wall of the uterus, placental delivery, brings labor to an end

Stage 1: Transition phase, lasts 12-14 hours with a first birth, contractions cause the cervix to open and dilate

NEWBORN APPEARANCE AND CONDITION

Average newborn is 20 inches long and weighs 7.5 pounds. Head is large so that they can learn very quickly.

APGAR SCALE - score of 7-10: baby is in good physical condition, score from 4-6: baby requires special assistance, score from 1-3, dire emergency.

Characteristics assessed by the APGAR scale

Reflex irritability (sneezing, coughing, grimacing)

Muscle tone

Respiratory effort

Colour

Heart rate

APPROACHES TO CHILDBIRTH: over time, doctors have taken over responsibility for birth and women's knowledge of childbirth declined.

NATURAL OR PREPARED CHILDBIRTH. Goal is to reduce pain and medical intervention.

Women report more favorable attitudes to childbirth

Sitting position is most favored because pushing is easier and more effective, increased supply of oxygen, mother can see delivery and track contraction's effectiveness, reduced likelihood of episiotomy and use pain medication

Home delivery - typically handled by certified midwives, about 1% of women give birth at home

INDUCED LABOR. Labor is started artificially by breaking the amnion (or bag of water) and giving mother synthetic oxytocin to stimulate contractions.

Contractions are longer, harder and closer together, increasing likelihood of inadequate oxygen supply to baby; increased difficulty controlling labor, increased likelihood of medication and chances of assisted delivery

CESAREAN DELIVERY: Doctors makes an incision in the mother's abdomen and lifts the baby out of the uterus.

Circumstances where a C-section is performed: RH incompatibility, premature separation of placenta, serious maternal illness or infection, baby in breech position.

Medical control over childbirth is largely responsible for the rise of C-section deliveries worldwide.

MEDICAL INTERVENTIONS

FETAL MONITORING - electronic instruments tracking baby's heart rate during labor; abnormal heartbeat patterns may indicate baby is in distress.

Controversies with fetal monitoring

Most babies have irregular heart beats - overidentifying babies in trouble

Linked to increase in instrument-assisted deliveries and C-sections

Does not reduce already low rates of baby brain damage or death.

Complaints that devices are uncomfortable and interfere with labor

LABOR AND DELIVERY MEDICATION - some form of medication is used in more than 80% of US births

ANALGESICS - drugs given in mild doses to relieve pain during labor

ANESTHETICS - a stronger type of painkiller that blocks sensation

EPIDURAL ANESTHESIA - pain-relieving drug delivered continuously through a catheter into a small space in the lower spine

Problems with routine use of medication in labor and delivery

Weakens uterine contractions increasing likelihood of C-section

Drugs cross placenta and so babies have lower APGAR scores, are sleepy and withdrawn, suck poorly and are irritable when awake.

INSTRUMENT DELIVERY (forceps or vacuum extractor)

When to use? If mother's pushing during stage 2 of labor does not move baby through birth canal in a reasonable amount of time.

Risk with vacuum extractor: can cause bleeding beneath baby's skin, bleeding within eye and beneath the skull

Risk with forcep use: increased risk of brain damage, and increased risk of injury to mother

BIRTH COMPLICATIONS

OXYGEN DEPRIVATION...ANOXIA refers to inadequate oxygen supply during the birth process.

CEREBRAL PALSY: effects 1:500 kids - varies from mild tremors to severe crippling and mental retardation

PLACENTA ABRUPTIO - premature separation of the placenta

PLACENTA PREVIA - detachment of the placenta resulting from blastocyst implantation so low in the uterus that the placenta covers the cervical opening

PRETERM AND LBW INFANTS - birth weight is the best available predictor of infant survival and healthy development

RESPIRATORY DISTRESS SYNDROME - when baby's lungs are so poorly developed that the air sacs collapse, causing serious breathing difficulties, happens when babies are born six weeks early.

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PROBLEMS ASSOCIATED WITH LBW: brain structural abnormalities, frequent illness, inattention, overactivity, sensory impairments, poor motor coordination, language delays, low IQ scores, deficits in school learning, emotional and behavioral problems.

RATES OF PREMATURE BIRTH: highest among poor women as they are more likely to be undernourished, under stress and exposed to other harmful environmental influences. This a group also unlikely to receive prenatal care.

PRETERM INFANTS: born several weeks or more before their due date. Although small, weight may appropriate for gestational age.

SMALL FOR DATE INFANTS: below expected weight considering length of pregnanccy

Influence on parent behavior: appearance and behavior leads parents to be less sensitive and responsive in caring for babies, leading to increased risk for child abuse.

INTERVENTIONS FOR PRETERM BABIES: 1. Meet needs mechanically via and isolette to help with thermoregulation and breathing; 2. KANGAROO CARE - placing infant vertically skin to skin with parent so parents acts as human incubator.

Benefits of Kangaroo Care: Increased oxygenation and temperature regulation, increased sleep, alertness, breast-feeding rates and survival. Provides infant with gentle stimulation.

INFANT MORTALITY - number of deaths in the first year of life per 1000 births. Leading causes are widespread poverty and weak health care programs

NEONATAL MORTALITY - rate of death in the first month of life. Leading causes are serious physical defects and LBW

Factors linked to lower infant mortality rates

EMPLOYMENT LEAVE

UNIVERSAL, HIGH-QUALITY HEALTH CARE

PRENATAL VISITS

OTHER SOCIAL SERVICES

Parents and Families after birth trauma

DIFFICULTIES: Poverty, family disorganization, mentally ill parents

FAVORABLE OUTCOMES: supportive home, attractive personal characteristics, positive relationships with extended family

Capacities of Newborn Babies

REFLEX - inborn, automatic response to a particular form of stimulation; help babies' muscles rehearse and remember what those movements feel like for later; largely disappear around four months.

MORO - startle reflect that helps infant cling to mother

PALMAR GRASP - spontaneous grasp of adult's finger

SWIMMING - helps infant survive if dropped into water

TONIC NECK - infant lies in a "fencing position"

SUCKING - permits feeding

STEPPING - prepares infant for voluntary walking

ROOTING - helps infant find nipples

BABINSKI - when the sole of the foot is stroked, the toes fan out and curl

EYE BLINK - protects infant from strong stimulation

Important to assess reflex to allow accurate ID of abnormal CNS function; allows for intervention and support for children and families

INFANT STATES OF AROUSAL

REGULAR or NREM SLEEP - infant is at full rest and shows little or no body activity. Eyelids are closed, no eye movements occur, the face is relaxed, and breathing is slow and regular

IRREGULAR OR REM SLEEP - gentle limb movements, occasional stirring, and facial grimacing occurs. Breathing is irregular.

DROWSINESS - infant is either falling asleep or waking up. Eyes open and close, have glazed look when open.

WAKING ACTIVITY AND CRYING: Bursts of uncoordinated body activity. Face many be relaxed or tense and wrinkled. Crying may occur.

QUIET ALERTNESS - Infant's body is relatively inactive, with eyes open and attentive

Infants spend so much time in REM sleep because it is vital to CNS growth (they get little stimulation) and oxygenation of eye tissues

Cries of traumatized babies are shrill, piercing and short in duration - parents often get frustrated, angry and resentful.

COLIC - intense crying and difficulty calming down in babies before 6 months

SUDDEN INFANT DEATH SYNDROME (SIDS): unexpected death (often during the night) of an infant younger than a year that remains unexplained after thorough investigation; leading cause of infant mortality

Risk factors for SIDS: prematurity, maternal cigarette smoking, baby sleeping on stomach, poor APGAR scores, respiratory infection, impaired brain functioning, prenatal drug abuse, being wrapped very warmly, living in poverty

SENSORY CAPACITIES OF NEWBORNS

TOUCH

SIGHT: least mature of baby's senses. Cannot focus their eyes well and so cannot see detail far. They can recognize faces, but their details are blurry, have poorly developed color vision.

SMELL: have innate odor preferences; survival value allows babies to find food and protects the young from predators by helping mothers and babies ID each other

HEARING: babies prefer complex sounds, can discriminate between almost all speech sounds of any human language, prefer speech that is high-pitched, expressive with a rising tone at the ends of phrases and sentences and a pause before continuing

TASTE: babies have taste preferences and communicate them through facial expressions

NEONATAL BEHAVIORAL ASSESSMENT

NEONATAL BEHAVIORAL ASSESSMENT SCALE (NBAS) - measures baby's reflexes, muscle tone, state changes, responsiveness to physical and social stimuli.

NEONATAL INTENSIVE CARE UNIT NETWORK NEUROBEHAVIORAL SCALE (NNNS) - specifically designed to evaluate newborns at risk for developmental problems

Given to infants all over the world - taught us lots about individual and cultural differences in newborn behavior

Can increase positive interaction with babies when parents understand their babies better

Newborn behavior and parenting styles combine to shape development

TRANSITION TO PARENTHOOD

Changes to families

ADDED FINANCIAL RESPONSIBILITIES

GENDER ROLES BECOME MORE TRADITIONAL

CONSTANT CAREGIVING

LESS TIME FOR COUPLES TO DEVOTE TO ONE ANOTHER

Waiting to have children means that parents have pursued occupational goals and gain life experience, which seems to make everyone more enthusiastic and willing to participate (more excited about baby)

MATERNAL DEPRESSION: often known as PPD, interventions are therapy and antidepressant medications

Short term effects on infant: Poor sleep for babies, less attentive to their surroundings, high levels of cortisol

Long term effects on infant if depression is persistent: parents view infants negatively, use inconsistent discipline, adjustment concerns, neglect experiences, developmental delays, irritability, attachment difficulties

PATERNAL DEPRESSION - strong predictor of child behavior problems