CHAPTER 3CHAPTER 3

Birth and the Newborn Baby: In The Birth and the Newborn Baby: In The New WorldNew World

The Stages of ChildbirthThe Stages of Childbirth

Stages of Childbirth

• Stage 1 Effacement & dilation

• Stage 2 Crowning and delivery

• Stage 3 Placental stage

Fig. 3-1, p. 51

Stages of Childbirth

• Stage 1: effacement and dilation– Begins when uterine contractions efface and dilate

cervix , causes most childbirth pain

– Longest stage, lasts from few hours to more than a day

– Results in the widening of the passageway to 4 inches (10 centimeters)

– Transition begins: head of fetus begins to move into the vagina or birth canal

Stages of Childbirth (cont’d)

• Stage 2: crowning and delivery– Baby’s head “crowns” when it begins to emerge from

birth canal

– Contractions stretch the skin around birth canal and propel baby along

– Episiotomy takes place

– Lasts from minutes to hours

– Baby emerges from birth canal, and when breathing adequately on own, the umbilical cord is clamped and severed

Stages of Childbirth (cont’d)

• Stage 3: placental stage– Lasts from minutes to an hour or more

– Placenta separates from the uterine wall and is expelled through birth canal

– Episiotomy is sewn (if performed)

Methods of ChildbirthMethods of Childbirth

Methods of Childbirth

• Midwife-assisted childbirth• Anesthesia-assisted childbirth• Natural childbirth• Prepared childbirth• Doula-assisted childbirth• Cesarean section

Methods of Childbirth (cont’d)

• Midwife delivery– Delivers baby in woman’s home– More intimate– Limited 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 (cont’d)

• General anesthetics:– Deaden pain by putting the

mother to sleep– Includes tranquilizers and

narcotics

• Local anesthetics:– Deaden pain without

putting mother to sleep– Pudendal block numbs the

mother’s external genitals.– Epidural block and spinal

block numb the body below the waist by injecting local anesthesia into the spinal canal or spinal cord.

Methods of Childbirth (cont’d)

• Natural childbirth

– Woman uses no anesthesia

• Prepared childbirth (i.e. Lamaze method)

– Woman is taught breathing and relaxation exercises by a coach who will aid her in the delivery room

Methods of Childbirth (cont’d)

• Doula-assisted childbirth

– Doulas provide social and emotional support before and during delivery.

– Doulas may be used when a partner is not available.

– Women with doulas present during birth appear to have shorter labors than those without.

Methods of Childbirth (cont’d)

• Cesarean section (C-section)

– Physician delivers the baby by surgery

– Physician cuts through the mother’s abdomen and uterus and physically removes the baby

– Mostly used when the health of the baby or mother is at stake during delivery

Birth ProblemsBirth Problems

Birth Problems

• Prenatal oxygen deprivation (POD)– Anoxia: absence of oxygen– Hypoxia: less oxygen than required

• Preterm and low-birth-weight (LBW) infants– Preterm: born prior to 37 weeks gestation– Small for gestational age: born at full term, yet low

birth weight

• Both conditions can lead to – cognitive, motor, and psychological problems

Infant Deaths

Signs of Prematurity

• Preterm babies– Relatively thin, covered in lanugo and vernix

– Immature muscles

– Weak breathing and sucking reflexes

– May suffer from respiratory distress syndrome (RDS)

– May suffer long-term impairments

Treatment of Preterm Babies

• Preterm babies are kept in incubators

– Maintain temperature controlled environment

– Afforded some protection from disease

– Oxygen has to be monitored because excessive oxygen can cause permanent eye injury

Prematurity

Parents and Preterm Neonates

• Preterm neonates– look less appealing

– have high-pitched and grating cries

– are more irritable

• Parents of preterm neonates– do not treat preterm

neonates as well as full-term neonates

– can find it so demanding to care for such children that they have depressing effects for mothers

Intervention Programs

• Preterm infants profit from early stimulation. – Cuddling, rocking, talking, and singing to– Massage and kangaroo care

• Many positive effects for early stimulation– Faster weight gain– Fewer respiratory problems– Greater advances

The Postpartum PeriodThe Postpartum Period

Postpartum Period and Maternal Depression

• Some mothers may suffer from postpartum depression (PPD).

– Symptoms

– Causes

– Prevalence

– Treatment

Table 3-2, p. 58

Bonding

• Bonding refers to formation of parent-infant attachment.

• Bonding is essential for the survival and well-being of children.

Maternal Bonding

Characteristics of NeonatesCharacteristics of Neonates

Assessing Neonates

• Apgar scale used to assess health of baby at birth

• 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• R) respiratory effort, or rate of breathing

Table 3-3, p. 60

Assessing Neonates (cont’d)

• Brazelton Neonatal Behavioral Assessment Scale – Used to measure neonates’ reflexes and other

behavior patterns• Motor behavior• Response to stress• Adaptive behavior• Control over physiological state

New Development

Neonate Reflexes

• Reflexes are simple, automatic, stereotypical responses elicited by certain types of stimulation.– Demonstrate the neural

functioning of neonate– Absence or weakness of a

reflex may indicate immaturity, slowed responsiveness, brain injury, or retardation.

INCLUDE:

• Rooting reflex• Moro reflex• Grasping reflex• Stepping reflex• Babinski reflex• Tonic-neck reflex

• Rooting reflex – Baby turns 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

• 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

• Grasping reflex (palmar reflex) – Refers to the increasing tendency to reflexively grasp fingers or other

objects pressed against the palms of hands; babies support their own weight this way

• Stepping reflex – Mimics walking; demonstrated 1-2 days after birth and 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 – Observed when baby is lying on its back and turns head to one side

The Rooting Reflex

p60

Neonate Sensory Capabilities - Vision

• Infants are nearsighted, seeing best at 7-9 in.

• Can detect movement– Prefer moving objects to stationary objects

• Have little or no visual accommodation

• See through fixed-focus camera

• Unable to converge their eyes on an object that is close to them

Neonate Sensory Capabilities - Hearing

• Fetuses respond to sound months before they are born.

• Normal neonates hear well unless their middle ears are clogged with amniotic fluid.

• Respond to sounds of different amplitude and pitch– More to high-pitched sounds than to low-pitched sounds

• Discriminate different and new speech sounds

Neonate Sensory Capabilities - Smell

• Can discriminate distinct odors

• Show more rapid breathing patterns and increased bodily movement in response to powerful odors

• Use smell for mother-infant recognition and attachment

• Neonate’s sensitivity

– Neonatal sensitivity to the smell of milk (Macfarlane)

– 15-day-old infants sensitive to the smell of mother’s underarm odors vs. odors produced by other milk-producing women (Porter)

Neonate Sensory Capabilities - Taste

• Show preferences similar to adults

• 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.

Taste

Neonate Sensory Capabilities - Touch

• Skin on skin – provides feelings of comfort and security – may contribute to bonds of attachment between

infants and their caregivers

• Many reflexes are activated by pressure against the skin.

Innate Reflexes

Classical and Operant Conditioning of Neonates

Classical conditioning• Involuntary responses

are conditioned to new stimuli.

• Typical study (Lipsitt)– Neonates taught to blink in

response to a tone– Indicates they are

equipped to learn associations in their environment

Operant conditioning• Responses can be

strengthened through reinforcement

• Typical study (DeCasper, et al.)– Neonates can be

conditioned to suck on a pacifier in such a way to activate a recording of their mothers reading The Cat in the Hat

Neonate Sleeping and Waking

• Most neonates spend about 2/3 of their time in sleep.– 16 hours per day, not consecutively

• Neonates go through different stages of sleep.

• Typical infant has six cycles of waking and sleeping in a 24-hour period

Sleeping

Sleeping and Waking (cont’d)

• Neonates spend about half of their sleeping time in REM sleep, yet will decline as they develop

– By 6 months, REM sleep accounts for only 30% of the baby’s sleep

– By 2-3 years, REM drops off to 20-25% of sleep

• Preterm babies spend even more time in REM sleep.

Table 3-4, p. 65

Fig. 3-6, p. 65

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.

• Infants’ crying motivates others to take care of them.

Crying (cont’d)

• Certain prolonged, high-pitched cries may indicate health problems.– Chromosomal abnormalities, infections, fetal malnutrition, and

exposure to narcotics

• 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)

• 2,000 to 3,000 annual US infant deaths from SIDS

• Most common cause of death during the first year– Mostly occurring between 2 and 5 months of age

• More common among the following:– babies aged 2-4 months– babies who sleep on their stomachs or sides – premature and LBW infants– male babies– babies from lower SES– African-American babies– babies of teenage mothers– babies whose mothers smoked or used narcotics during or after

pregnancy

Children’s Hospital Boston Study

• Conducted SIDS study to learn about causes

• Study focused on the medulla’s role in sleep/wake cycles– Compared medullas of babies

that died from SIDS to medullas of babies that died from other causes

– Results found SIDS babies’ medullas were less sensitive to the brain chemical serotonin; boys’ brains less sensitive

• Prevention includes

– do not smoke during or after pregnancy

– do not use narcotics during pregnancy

– obtain adequate nutrition and health care

– baby needs to sleep on back– keep current on SIDS data

SIDS