BIRTH AND EARLY INFANCY

CHAPTER 3

BIRTH CHOICES◦ Drugs during labour and delivery

Three common drugs: analgesics (pain reliever), sedatives (tranquilizers), anesthesia (general, local pain blocker)

All drugs during labour pass through the bloodstream through the placenta

Many women choose to avoid drugs – natural, Lamaze method – prepared childbirth classes

◦ Location of Birth Traditional hospital, hospital-based birthing centre,

freestanding birth centre, at home◦ Presence of Fathers at Delivery

Studies show less pain, less medication, delivered sooner, fewer complications

BIRTH

THE PROCESS OF BIRTH

◦ Stages of Labour Stage 1: dilation and effacement

Not uncommon for women to be 80% effaced and 1 to 3 cm dilated when beginning labour

Lasts 8 to 12 hours for first birth, 7 hours for others Stage 2: delivery of the baby

Begins when woman is encouraged to “push” Cervix is fully dilated Some are breech presentations (feet first or bottom first)

4/5 of these are delivered cesarean Stage 3: delivery of the placenta and other material

◦ Complications Many are possible during birth and are associated

with poor developmental outcomes May not be causal (ie. poverty may cause both birth

AND developmental problems Anoxia – insufficiency of oxygen

Umbilical cord fails to supply blood oxygen (up to 20% of newborns experience some form of anoxia

Dislocated shoulders or hips, fractures, paralysis

◦ Cesarean Deliveries: Also called a c-section

Needed because of breech presentations, fetal distress, labour that does not progress, a fetus that is too large, maternal health concerns

Some numbers of c-section procedures is high About 26% of all births in 2002 (US) One reason is woman are now older – benefits outweigh the

risks In Canada, c-sections covered by public health care plan

debate over whether this should continue ¼ of US c-sections were elective

Spares women from vaginal problems C-section is MAJOR surgery – carries other risks

ie. allergic reactions, infection, injuries, blood loss

◦ Assessing the Newborn Customary to assess immediately at birth and 5

minutes after System used is the Agpar score on 5 criteria:

Heart rate, respiratory rate, muscle tone, response to stimulation to the feet, colour

Another test is the Brazelton scale Tests responses to stimulii – reflexes, muscle tone,

alertness, cuddliness, soothing ability The First Greeting

Intense joy, looking into baby’s eyes, tenderness pattern

LOW BIRTH RATE◦ Optimal weight is between 3 to 5 kg (6.6 to 11

lbs.)◦ LBW – low birth weight – under 2.5 kg (5.5 lbs)◦ VLBW – very low – under 1.5 kg (3.3 lbs)◦ ELBW – extremely low – under 1 kg (2.2 lbs)◦ incidence has declined, but is still high – 7%

below 2.5 kg◦ 19% of these are VLBW

◦ Causes of Low Birth Weight Most common is premature birth (preterm infant)

Multiple births especially likely to end in preterm delivery

Also, mothers with illnesses, serious medical condition more likely to deliver preterm

Mostly unplanned, spontaneous labour, but sometimes elected by physicians using c-section

Small-for-date infant Full 38 weeks, but malnutrition, blood flow constriction,

mother’s smoking

◦ Health Status of Low-birthweight Infants Lower levels of responsiveness early on More than 6 weeks premature -> respiratory distress

syndrome Lungs lack surfactant, an important chemical

◦ Long-term Consequences of LBW Lag behind peers for many years, differences persist Some problems do not appear until school age Some are affected, some develop normally Cumulative effects persist into adulthood Premature infants sometimes given “corrected age”

ie. full term 4 month-old is similar to 1 month premature baby who is 5 months old By school age, this should correct itself, but best assessed case-

by-case

Factors that predict development: Weight, gestational age associated with long-term

developmental delays Neonatal health also important

ie. breathing problems, infectious illnesses, brain injuries Gender

Premature boys more likely than girls Parent responses to the child’s development matters

Degree to which parents’ expectations are realistic Parents’ confidence in their ability to manage challenges

REFLEXES AND BEHAVIOURAL STATES◦ Repetoire of behaviours◦ Reflexes:

Adaptive – sucking, swallowing, end first year of life Rooting – automatic turning of head on touch – nursing Primitive – controlled by the medulla and the midbrain Moro – a primitive reflex involving reaction to loud

noises – throwing arms back, arching back Babinski – splay out toes if foot stroked Linked to later behaviour patterns Walking, tonic neck, grasping Important if baby fails to show reflex

BEHAVIOUR IN EARLY INFANCY

◦ Behavioural States States of consciousness Most infants move through these in the same

sequence: Deep sleep to lighter sleep to fussing and hunger and

then to alert wakefulness Once fed, become drowsy and drop back to sleep Every two hours

Neonates – sleep 90% of time By 6 or 8 weeks it decreases, day/night pattern By 6 months, sleeping 14 hours a day Cultural beliefs also a factor

Some parents conduct cosleeping – sleeping in same bed

Crying: Increases at first, then dropping off after 6 weeks Seen across cultures Also, soothing methods seen across cultures Different cries for pain, anger, hunger Each parent learns the patterns of cries 15 to 20% of infants develop colic

Intense bouts of crying totaling 3 or more hours Awake and alert

2 to 3 hours at beginning, at 6 months, longer periods

◦ Physical and Cognitive Abilities Motor skills

Development proceeds from head downwards (cephalocaudal)

Development occurs from trunk outwards (proximodistal)

Repeated and rhythmic limited movements Sensory and Perceptual Abilities

Newborn can do several things: Focus both eyes on same spot (8-10 inches ideal) Hear sounds, discriminate individual voices, loudness,

pitch Taste sweet, sour, bitter and salty, odours, mother’s smell

◦ Classical Conditioning Newborns can be conditioned, but it is difficult Related to feeding is most successful By 3 or 4 weeks old, no longer difficult

◦ Operant Conditioning Behaviour easily increased by use of reinforcements Neurological basis for learning is present at birth

◦ Schematic Learning (Piaget) Schemas are built up over many exposures to experiences –

development of expectancies◦ Habituation

Reduction in strength or vigor of a response to a repeated stimulus ie. an infant will stop looking at something in front of their face

TEMPERMENT AND SOCIAL SKILLS◦ Temperment

Predispositions that form the foundations of personality

Easy child, difficult child, slow-to-warm-up child Shaped, strengthened, bent by child’s relationships

and experiences ie. difficult child will present troublesome behaviour, but

pattern of criticism and punishment will likely have additional consequences

◦ Emergence of Emotional Expression Some rudimentary expressions are visible at birth

ie. half-smile, responding to smiling face, sadness, anger, surprise

◦ Taking Turns Seen in young infants in eating patterns

Mothers can enter by creating an alternating pattern

◦ Adapting to the Newborn Marital satisfaction typically goes down Less prevelant in planned pregnancies than

unplanned, but virtually all experience it

NUTRITION, HEALTH CARE, AND IMMUNIZATIONS◦ Nutrition: a newborn may eat up to 10 times per

day, then down to 5 or 6, and down to 3 by 8 to 12 months of age Up until 4 to 6 months, babies need only breast milk

or formula and supplements Early introduction to solids may interfere with

nutrition Start with cereals, one new food each week, identify

food allergies

HEALTH AND WELLNESS IN EARLY INFANCY

◦ Health Care and Immunizations Frequent check-ups Vaccinations against a variety of diseases

Publicly-funded in Ontario In 1992, only 55% of US children received full

recommended immunizations Public can become complacent

ILLNESSES◦ Diarrhea – common and deadly (especially in

developing countries Viral or bacterial cause, most common is rotavirus Rehydration the best prevention of death

◦ Upper Respiratory Infections Second most common

◦ Average baby has 7 colds in the first year of life Those in day-cares more than those at home The more people the more colds

◦ Ear Infections Most often leads to a doctor

Follows a cold or allergic reaction Congestion in the eustachian tube

In US, as many as 90% have at least one serious infection before 2

The earlier the 1st infection, more likely for further infections

INFANT MORTALITY◦ Sudden Infant Death Syndrome (SIDS)

Sudden and unexpected death Leading cause of death in US in infants more than 1

month of age Unexplained reasons, rates vary from country to

country High in Australia and New Zealand Low in Sweden and Japan

Higher risk: low birth weight, male babies, African American babies, young mother babies, smoking mothers, babies who sleep on stomach on soft surface

◦ Ethnic Differences in Infant Mortality Differences exist across ethnicities in US Lowest among Asian Americans Natives, Hawaiians, and African Americans high

One reason is natives and african Americans 2 to 3 times more likely to suffer congenital abnormalities and low birth weight

poverty in these groups Mortality rates lower in immigrant groups than US

born mothers Even in college-educated mothers, African American

still more likely to die