Pregnancy and Childbirth - Exam 1

Traditional Midwife

for low risk pregnancies

attends home births that are women centered

low rate of intervention

trained by other midwives

Certified Nurse Midwife

for low risk pregnancies

attend home births that are women centered

low rate of interventions

Traditional Midwife

for low risk pregnancies

attends home births that are women centered

low rate of intervention

trained by other midwives

Certified Nurse Midwife

for low risk pregnancies

attend home births that are women centered

low rate of interventions

OB/GYN

work with any risk level

attend at birth centers or hospitals

high rate of interventions like c-sections and pain medication

Family Practitioner

work with low to moderate risk level

attend hospital births

can be both the baby and mothers doctor

Doula

a trained professional who provides continuous physical, emotional, and informational support to their client before, after, and during major life events like birth and death

Birth Doula

support you during labor and delivery

Postpartum Doula

helps new parents in their homes with the adjustment and help take care of mother and baby

Death Doula

help people transition from living to death, stay with people during the dying process and help grieving families

Safety Surrounding Birth

home births have better safety numbers, but they also don’t handle any high risk births

people who select home births are usually highly educated, have more lower or higher socioeconomic status, see birth as a healthy everyday event, have healthy lifestyles, are more health conscious, and are more active agents with their bodies

Control Surrounding Birth

hospitals can result in a loss of this which can lead to postpartum anxiety and depression

Intervention Surrounding Birth

drugs

surgical: episiotomy or c-sections

Midwife Model of Care

based on the fact that pregnancy and birth are normal life events, and that they pregnant person is not sick or injured

monitor the physical, psychological and social well being of the person throughout the childbearing cycle

provide the person with individualized education, counseling, and prenatal care, continuous hands on assistance during labor, delivery, and postpartum

minimize technological interventions

identify and refer people who require obstetrical attention

Periods of Embryonic Development

1. germinal period

2. embryonic period

3. fetal period

Germinal Period

conception to week 2

most people are unaware that they are in this stage

fertilization takes place in the fallopian tube

zygote = fertilized egg

cell divides and divides

day 5 it forms a hollow ball of cells called a blastocyst and it attaches to the wall at day 9

forms amnion, chorion, yolk sac, placenta, and umbilical cord

inner cell mass detaches and forms the embryonic disk

Ectoderm

outermost layer that makes outer body layers like skin, hair, and nails, also makes neural tube

Endoderm

becomes the gut

Mesoderm

(between the 2 other layers)

becomes the muscles and skeleton including the heart and blood

Placenta

provides nutrients, oxygen, and antibodies to baby

takes away waste products

screens many but not all harmful agents

is screened in hospitals to ensure its healthy and intact

some people eat it and say it reduced pain, has anti-aging properties, and helps milk production - not researched or approved

Embryonic Period

week 2 to week 8

sensitive period

most of the body’s systems form like the central nervous system (brain and spinal cord), heart, limbs, and the digestive tract

production and migration of neurons to brain begin, embryo can move

Teratogens

a substance that can cause birth defects or increase the risk of them developing

especially vulnerable during a period of rapid development

embryonic period is when most serious defects could form since body system foundations are being laid down

ex: maternal diseases and prescription or nonprescription drugs

Rubella German Measles

symptoms vary

cause hearing and vision damage, heart abnormalities, nervous system damage causing cognitive defects, cerebral palsy, and still birth

Herpes

ex: chicken pox

can cause a smaller head, vision problems, low birth rate, central nervous system damage causing cognitive defects, and seizure disorders

if mother has genital sores at birth, a c-section is required

Toxoplasmosis

a disease carried by cats that can be avoided by mothers not changing litter boxes

causes cognitive defects, short gestation, hydrocephalus (spinal fluid causing brain pressure), seizure disorders, cerebral palsy

DES

prescribed to pregnant women with a history of losing pregnancies to prevent miscarriages = this drug never did that

resulted in younger girls with cervical cancer and fertility issues and younger boys with testicular cancer

Thalidomide

prescribed for nausea during pregnancy

wasn’t approved in the US

caused babies to be born without arms or legs

Aspirin

prescribed for headaches and pain and sometimes blood thinning

caused heart defects, low birth rate, and hemorrhaging

Caffeine

ex: coffee, tea, and chocolate

at lower levels of consumption its not harmful

in chickens it caused neural tube and branching defects, in rats it stunted growth, and in humans caused babies to have poor muscle tone and lower activities levels with higher rates of stillbirth

stays in fetus body for about 18 hours

Cocaine

fetuses cannot metabolize it so it stays in their system for longer

resulted in no sense of empathy - not replicated

issues with genital systems, central nervous systems like intraventricular hemorrhage, short gestation, and low birth rate

Alcohol

causes fetal alcohol spectrum disorder

problems with memory, attention span, vision, and hearing

can also affect facial features resulting in wide set eyes, smaller head shape, and flatter nasal regions

Marijuana

causes hypertension, preeclampsia, weight gain at dangerous levels, placenta abruption (seperation to early), and gestational diabetes

THC binds to placental enzymes and affects development

Heroin

babies are born addicted and go through withdrawal

have unusual high pitched cries

Smoking and E Cigarettes

damages placenta, low birth rate, increased risk of SIDS, prone to respiratory infections, higher risk for childhood cancers like leukemia, body system inflammation, and immune system problems

Fetal Period

week 8 and on

period of growth and maturation

quickening occurs around 16th week = mother feels fetus moving

viability (can survive outside womb) is achieved around 24 weeks = could be issues with lung maturity and obtaining oxygen before this

rapid brain development, a layer of fat grows under the skin, antibodies transfer to baby, and fetus flips in preparation for birth, vernix prevents chapping

Birth Stage 1

14-16 hours

dilation and effacement

transition: nausea, urge to push, diarrhea

Birth Stage 2

1 hour

pushing and birth

Birth Stage 3

15-30 minutes

delivery of the placenta = get more painful the more children you have

C-Section

rates are at an all time high - 32.4% of births in the US in 2023, the average should be around 15%

lowest rates in Israel, Norway, and Iceland who have different maternal care and use midwives primarily

complication are 5-10 times more likely than vaginal birth

ex: infection, hemorrhage, embolism, anesthesia problems or reactions, injuries to other organs, rupture, future difficulty with births (higher rate of still births), adhesions, scarring, obstructed bowels, and future birth problems like rupture, placenta accrete (grows into uterine wall), and placenta previa

Eye Blink Reflex

shine bright light at eyes or clap near the head

infant quickly closes eyes

permanent, protects infant from strong stimulation

Rooting Reflex

stroke cheek near corner of mouth

infants head turns toward source of stimulation

disappears around week 3 (voluntary after)

helps infants find the nipple

Sucking Reflex

place finger in infants mouth

infant sucks finger rhythmically

replaced by voluntary sucking after 4 months

permits feeding

Moro Reflex

hold infant horizontally on back and let head drop slightly or loud sound against surface supporting infant

infant makes “embracing” motion by arching back, extending legs, throwing arms outward and then bringing them into body

disappears around 6 months

may have helped infant cling to mother in past

Palmar Grasp Reflex

place finger in infants hand and press against palm

infant spontaneously grasps palm

disappears at 3-4 months

prepares infant for voluntary grasping

Tonic Neck Reflex

turn baby’s head to one side while infant is awake on their back

infant lies in “fencing” motion with one arm in front of eyes and the other is flexed

disappears around 4 months

may prepare infant for voluntary reaching

Stepping Reflex

hold infant under arms and allow bare feet to touch a flat surface

infant lifts one foot after another in a stepping motion

disappear around 2 months in heavier babies and later in lighter ones

prepares infant for voluntary walking

Babinski Reflex

stroke sole of foot from toe toward heel

toes fan out and curl as foot twists in

disappears at about 8-12 months

unknown function

Regular NREM Sleep

infant is at full rest and has little to no body activity

eyelids are closed, no eye movement occurs, relaxed face, and breathing is slow and regular

Irregular REM Sleep

gentle limb movements, occasional stirring, and facial grimacing

eyelids are closed but with occasional rapid eye movements, irregular breathing

Drowsiness

infant is either falling asleep or waking up

body is less active than in irregular sleep but more active than regular sleep

eyes open and closed with a glazed look, faster breathing

Quiet Alertness

infants body is relatively inactive with open eyes and is attentive

even breathing

Waking Activity and Crying

infant shows frequent bursts of uncoordinated body activity

irregular breathing, face is either relaxed or wrinkled, crying may occur

Apgar Scale

a way to access newborn physical appearance

0 = no heartbeat, no breathing for 60 seconds, no response, completely limp, and fully blue

1 = under 100 heart beats per minute, irregular shallow breathing, weak reflexive response, weak arm and leg movement, and pink body with blue extremities

2 = 100-140 beats per minute, strong breathing and crying, strong reflexive response, strong arm and leg movement, and fully pink