Chapter 3

Woman’s age (over 35)

Woman’s age (over 35)

• Decreased rate of conceiving • Increase in chromosomal disorders • Increase in pregnancy related health risks

Woman’s age(teen)

• Inadequate prenatal care • Substance use

Conception

When a single sperm cell unites with an ovum in a process called fertilization

Prenatal Development

• Lasts for approximately 266 days • Beginning with fertilization and ending with birth • Divided into three periods

Germinal period

Takes place during the first two weeks after conception • Creation of fertilized egg • Cell division • Attachment of zygote to uterine wall

Embryonic period

Occurs from two to eight weeks after conception • The rate of cell differentiation intensifies, and the mass of cells is now called embryo. • Three layers of cells: endoderm, mesoderm, and ectoderm (inner, middle, and outer layers). • Rate of cell differentiation intensifies • Support systems for cells form

Organogenesis

The process of organ formation

Fetal period

• Lasts about seven months (from month 2-birth) • Fetus is viable at about 6 months after conception (Age of viability: 26 weeks) At birth, the average American baby weighs 7½ pounds and is about 20 inches long

The Brain

Basic architecture of the brain takes place prenatally during first two trimesters

1. Neural tube

2. Neurogenesis

3. Neural Migration

4. Neural Connectivity Third trimester and first two years of life are characterized by increased brain connectivity and functioning Born with 20 to 100 billion neurons

teratogen

Any agent that can potentially cause a birth defect or negatively alter cognitive or behavioral outcomes Severity of damage from teratogens depends on: Dosage Genetic Susceptibility Time of exposure

Common teratogens

Drugs Incompatible blood types Environmental pollutants Infectious diseases Nutritional deficiencies Maternal stress Advanced material and paternal age Environment pollutants

Prenatal Care

Defined Schedule of visits for medical care Screening for manageable conditions and treatable diseases that can affect baby or mother Often includes comprehensive education, social, and nutritional services Especially valuable for first-time mothers and woman in poverty

Ultrasounds

Noninvasive procedure in which high-frequency sound waves are directed into pregnant woman’s abdomen Echo from sounds creates a visual representation of fetus Screens for head growth, organ defects, chromosomal abnormalities, and neural tube defects

Fetal MRI

Magnetic resonance imaging uses a powerful magnet and radio waves to generate detailed image of body’s organs and structures Clearer, more detailed image than ultrasound

chorionic villus sampling

Tiny tissue sample is removed from the placenta Analyzed for genetic defects and chromosome abnormalities

amniocentesis

Sample of amniotic fluid withdrawn by syringe and tested for chromosome or metabolic disorders

Maternal Blood Screening

Triple screen blood test used to determine elevated risk for birth defects

Endoscopic Fetoscopy

Fiber optic endoscope used to visualize the fetus, sample fetal cells, & perform fetal surgery

Test Tube screening

Screens embryos prior to implantation in women’s uterus

Medical Therapy

Administration of vitamins Specific medication treatment for disorder Direct fetal administration

Surgery

Used to address life threatening problems for the fetus

Genetic Engineering

Gene therapy

Stages of Birth

Beginning of uterine contractions • 15 to 20 minutes apart • Cervix stretches and opens to 10 centimeters • Baby begins to move through birth canal • Contractions come almost every minute • Mother bears down to push the baby out • Afterbirth • Placenta, umbilical cord, and membranes detached and expelled

Childbirth Setting and Attendants

In United States, 98.7% of births take place in hospitals • Mothers receive assistance from fathers/birth coaches • Midwifery • Midwives, rather than doctors, deliver babies • Doulas • Caregiver who provides physical, emotional, and educational support for mother before, during, and after childbirth

Medication

Analgesia - Drugs used to relieve pain • Anesthesia • Used late in first-stage labor and during delivery • Epidural block – regional anesthetic that numbs body from waist down • Oxytocin • Synthetic hormone used to stimulate contractions

natural childbirth

No drugs given to relieve pain or assist in birth process • Mother uses breathing and relaxation techniques during delivery

Prepared Childbirth

• Developed by French obstetrician Lamaze • Special breathing technique to control pushing in final stages of labor • More detailed education about anatomy and physiology

Non medicated techniques to relieve pain

• Waterbirth • Massage • Acupuncture

Caesarean delivery

• Normally, baby’s head is delivered first • Breech position – its buttocks are the first to emerge from birth canal • Breech births can cause respiratory problems for baby • In a caesarean delivery, the baby is removed from uterus through an incision in mother’s abdomen • Increased number of C-sections (5% in 1969 to 29.1% in 2004)

Agar scale

• Used to assess the health of newborns at one and five minutes after birth • Given a score from 0 to 10 • 0-2 for each of 5 categories • Heart rate, respiratory effort, muscle tone, body color, and reflex irritability evaluated

Low birth weight infants

• Infants that weigh less than 5½ pounds at birth • Very low birth weight: less than 3 pounds 4 ounces. • Extremely low birth weight: less than 2 pounds 3 ounces.

Preterm infants

Infants born three weeks or more before pregnancy has reached full term

Small for date infants

• Infants whose birth weights are below normal for the length of pregnancy • May be preterm or full term

Kangaroo care

• Skin-to-skin contact in which the baby, wearing only a diaper, is held upright against the parent’s bare chest • Neonatal intervention practiced with preterm infants

Bonding

Forming a close connection, especially a physical bond between parents and their newborn, in the period shortly after birth

The Postpartum Period

Period after childbirth that lasts for about six weeks or until mother’s body has returned to a pre-pregnancy state Physical Adjustments Emotional and Psychological adjustments Bonding

The Postpartum period Physical Changes

Fatigue Loss of sleep Hormonal Changes Involution

Emotional and Psychological Adjustments

Feelings of anxiety, upset, or depression that come and go for several months following birth Without treatment, feelings go away after a few weeks

Postpartum Depression

• Major depressive episode that occurs about 4 weeks after delivery • Strong feelings of sadness, anxiety, despair, trouble coping with daily tasks • May worsen without treatment

Bonding

the formation of a connection, especially a physical bond between parents and their newborn shortly after birth.

Rooming- in arrangement

The baby remains in the mother’s room most of the time during its hospital stay