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Chapter 3 Birth and the Newborn Infant
What is the normal process of labor?
For the average mother-to-be, a factor that has yet to be identified triggers labor and the process of birth begins.

This occurs, on average, about 266 days after conception.
More about labor…
When labor is triggered, the hormone oxytocin is released from the mother’s pituitary gland.

High enough concentrations of oxytocin cause the uterus to begin contractions.
Some things to know about contractions…
Contractions force the head of the fetus against the cervix.
Contractions occur to prep the body for labor and delivery.
Braxton-Hicks Contractions (“false labor”)
As birth begins, the uterus contracts repeatedly and with increasing force.
Must become strong enough to propel the fetus down the birth canal.

Labor proceeds in 3 stages:
The 1st stage…
--The longest stage of labor
--Uterine contractions occur every 8-10 minutes, last about 30 seconds.
--For first baby, this stage can last 16 – 24 hours! (varies widely)
--Subsequent children involve shorter periods of labor.

Stages of Labor, continued
The 2nd stage…
The baby’s head moves through the birth canal.
Typically lasts 90 minutes.
After each contraction the baby’s head emerges.
An episiotomy (incision) is sometimes made to increase the size of the opening of the vagina to allow the baby to pass.
This stage ends when the baby is born.
Stages of Labor, continued
The 3rd stage…

This is the shortest stage of labor (lasts only minutes).

Occurs when the child’s umbilical cord and placenta are expelled.



The exact moment of birth occurs when the fetus passes through the vagina and emerges from the mother's body.

The term used for newborns is neonate.
As soon as they are born, most babies cry to clear their lungs and begin breathing on their own.
In the U.S., 99 % of births are attended by professional health care workers (worldwide the figure is 50 percent).



Trained health care workers use the
APGAR SCALE


A standard measurement system that looks for a variety of indications of good health in newborns.

Developed by Virginia Apgar in 1953


The APGAR directs attention to five qualities:

appearance (color)
pulse (heart rate)
grimace (reflex irritability)
activity (muscle tone)
respiration (respiratory effort)





Most babies score around 7.
Scores under 7 require help to start breathing.
Scores under 4 need immediate life-saving intervention.
Scores that stay between 0 and 3 after 20 minutes are an indicator that severe problems are likely to be present.
Parents often place too much emphasis on the specific score.
Low apgar scores may indicate problems or birth defects that were already present in the fetus.
Low apgar scores may also result from difficulties during the birth process.
-ANOXIA - a restriction of oxygen which can cause brain damage




BONDING - the close physical and emotional contact between parent and child during the period immediately following birth, and argued by some to affect later relationship strength.

Bonding
Research on non-humans shows a critical period just after birth when organisms show a readiness to imprint on members of their species present at the time.
For humans, the theory suggests that the critical period for bonding is soon after birth and requires skin-to-skin contact.
Scientific evidence for the human critical period for bonding is ABSENT.
Approaches to Childbirth
Pain and childbirth:
Pain is subjective, unable to be measured objectively.
Childbirth pain is sign the body is working properly--the contractions are needed to expel the baby.
Mother’s difficulty in interpreting the pain causes more anxiety and that, in turn, may make birth more difficult.
Medication Delivery
One-third of woman receive an epidural anesthesia, which produces numbness from the waist down.

A newer form is known as walking epidural or dual spinal-epidural, which use smaller needles and a system of delivering continuous doses of anesthetic, allowing women to move about more freely during labor.

Effects of Pain Medications on Baby
depresses oxygen flow
slows labor
fetus becomes less responsive
fetus may have slower motor control
fetus may be slower to sit and stand during first year
initial interaction between mother and fetus may be affected
**Not all studies suggest harmful effects for fetus.
Lamaze Birthing Techniques (Dr. Fernand Lamaze)
The goal is to learn how to deal positively with pain and to relax at the onset of a contraction.
Low income and minority groups may not take advantage of these methods.
Family Birthing Centers

Homelike and less foreboding and stressful than hospital.
Some parents use a midwife, a nurse specializing in childbirth, instead of an obstetrician, a physician who specializes in childbirth.


Post-delivery Hospital Stay
The average hospital stay following traditional births has decreased from an average of 3.9 days in 1970 to 2 days in 1993.

The U.S. Congress has considered legislation mandating minimum insurance coverage of 48 hours.

The American Academy of Pediatrics states that women should stay in the hospital no less than 48 hours after giving birth.


Birth Complications
PRETERM INFANTS, who are born prior to 38 weeks after conception (also known as premature infants), are at high risk for illness and death.

The main factor in determining the extent of danger is the child's weight at birth.
Birthweight
The average newborn weighs 3,400 grams (7 1/2 pounds).

LOW-BIRTHWEIGHT INFANTS weigh less than 2,500 grams (5 1/2 pounds). Although only 7% of newborns fall into this category, they account for the majority of newborn deaths.

SMALL-FOR-GESTATIONAL-AGE INFANTS, because of delayed fetal growth, weigh 90 percent or less than average weight of infants of the same gestational age.


Are put in incubators, enclosures in which oxygen and temperature are controlled.
Easily chilled, susceptible to infection, sensitive to environment.
Susceptible to respiratory distress syndrome (RDS) because of poorly developed lungs.


Preterm Infants (too small, too soon)
Develop more slowly than infants born full term.

60 percent eventually develop normally.

38 percent have mild problems (learning disabilities, low IQ).

Very-Low-Birthweight Infants (the smallest of the small)
Weigh less than 1,250 grams (2 1/4 pounds) and, regardless of weight, have been in the womb less than 30 weeks and are in grave danger because of the immaturity of their organ systems.

Costs of keeping very-low-birthweight infants alive are enormous.




Causes of Preterm & Low Birthweight Deliveries
Multiple births
Teen (under age 15)
Too closely spaced births
General health and nutrition of mother
Nutrition
Level of medical care
Stress
Economic support


Postmature Infants (too late, too large)
Those still unborn two weeks after the mother's due date, face several risks.

Blood supply to baby's brain may be decreased and cause brain damage.

Labor and delivery become more difficult.

Over a million mothers in the U.S. today have a CESAREAN DELIVERY, where the baby is surgically removed from the uterus, rather than traveling through the birth canal.
Several types of difficulties can lead to cesarean delivery.
-General fetal distress is most frequent.
-Used for breech position, where the baby is positioned feet first in the birth canal.
-Used for transverse position, in which the baby lies crosswise in the uterus.
-When the baby's head is large.



Fetal Monitors—devices that measure the baby's heartbeat during labor; have contributed to soaring rates of cesarean deliveries, up 500 % from 1970s.
Criticisms of fetal monitors:
No association between Cesarean delivery and successful birth consequences.
Major surgery and long recovery for mother.
Risk of infection to mother.
Easy birth may deter release of certain stress hormones, such as catecholamines, which help prepare infant to deal with stress outside womb.

Infant Mortality
Defined as death within the first year of life.

Rate has been declining since 1960s.

In 1990s, the overall rate in the U.S. was 8.5 deaths per 1,000 births.

Reasons for higher rate than many countries include high proportion of poverty, poor prenatal care.
Race and Infant Mortality
Stillbirth
The delivery of a child who is not alive.
Occurs in less than 1 delivery in 100.
Parents grieve in the same manner as if an older loved one dies.
Depression is a common aftermath.

Postpartum Depression
Period of depression following the birth of a child.

Affects 10 percent of mothers.

Deep feeling of sadness and unhappiness lasting for months.

One in 500 cases include break with reality, like Andrea Yates.

Can cause emotional problems for infants.
The Competent Newborn
Developmentalists have come to realize that the newborn infant is born with many capabilities.

Reflexes are unlearned, organized, and involuntary responses that occur automatically in the presence of certain stimuli.
Sucking and swallowing reflexes permit the neonate to ingest food.
Rooting reflex, which involves the turning in the direction of a source of stimulation near the mouth, guides the infant to the breast and nipple.

Physical Competence
The newborn's digestive system produces meconium, a greenish black material.
A remnant of the neonate's days as a fetus.
Allows the digestive tract to begin to process newly ingested nourishment.

Because their livers do not work efficiently, many newborns develop neonatal jaundice, a yellowish tint to their bodies and eyes.


Sensory Capabilities
Infants' visual and auditory systems are not yet fully developed.
-They can see levels of contrast and brightness.
-They can tell size consistency and distinguish colors.
-They react to sudden sounds and recognize familiar sounds.

They are sensitive to touch.

Their senses of taste and smell are well developed.



Social Competence: Responding to Others
Infants have the ability to imitate others.
Infants can differentiate between such basic facial expressions as happiness, sadness, and surprise.
Newborns cycle through various STATES OF AROUSAL, different degrees of sleep and wakefulness ranging from deep sleep to great agitation.
Social interaction of infants paves way for future social interactions.