In Class Notes 9/10: Classical Conditioning and Maternal Health Insights
Classical Conditioning 🐶
Classical conditioning, also known as Pavlovian conditioning, is a type of learning that occurs through association. This concept was first demonstrated by Russian physiologist Ivan Pavlov in the 1890s.
Pavlov's Experiment
Pavlov's experiment involved ringing a bell every time a dog was about to be fed. Initially, the bell had no effect on the dog, but the food did. However, after repeated pairings of the bell and food, the dog began to salivate in response to the bell alone.
Stimulus | Response |
Food (Unconditioned Stimulus) | Salivation (Unconditioned Response) |
Bell (Neutral Stimulus) | No Response |
Bell + Food | Salivation (Conditioned Response) |
Key Terms
Unconditioned Stimulus (US): A stimulus that naturally elicits a response without any prior learning.
Unconditioned Response (UR): The natural response to an unconditioned stimulus.
Neutral Stimulus (NS): A stimulus that does not naturally elicit a response.
Conditioned Stimulus (CS): A neutral stimulus that, through association with an unconditioned stimulus, comes to elicit a conditioned response.
Conditioned Response (CR): The response to a conditioned stimulus.
"Classical conditioning is a type of learning in which a neutral stimulus becomes associated with an unconditioned stimulus to elicit an unconditioned response."
The Little Albert Experiment 🤱
John Watson and Rosalyn Rayner conducted an experiment on a 9-month-old baby, known as Little Albert, to demonstrate classical conditioning in humans.
The Experiment
Watson and Rayner presented Little Albert with a series of stimuli, including a white rat, a dog, and a rabbit. Initially, the baby showed no fear response to any of these stimuli. However, when a loud noise was paired with the presentation of the white rat, the baby began to cry. After repeated pairings, the white rat alone elicited a fear response in the baby.
Generalization
The fear response was generalized to other stimuli, including a dog, a rabbit, and a white mask worn by Watson.
Ethical Concerns
The Little Albert experiment raises several ethical concerns, including:
Lack of informed consent: The baby's mother was not informed about the experiment, and the baby was not able to provide consent.
Harm to the participant: The experiment caused the baby distress and potentially long-term harm.
Lack of control: The experiment had only one participant and lacked control conditions.
Professional competence: The experiment was not well-designed, and the researchers did not follow proper procedures.
Legacy of the Experiment
Despite its methodological flaws, the Little Albert experiment contributed to the development of behaviorism and our understanding of classical conditioning. It also highlights the importance of ethics in research and the need for informed consent and proper procedures.
Behaviorism 🤖
Behaviorism is a psychological theory that emphasizes the role of environment and learning in shaping behavior. The Little Albert experiment helped to launch the behaviorist movement, which posits that behavior is the result of external stimuli and conditioning.
"Behaviorism is a psychological theory that focuses on observable behavior and the role of environment and learning in shaping behavior."## 🤰♀ Maternal and Infant Mortality Rates in the US
The United States has the worst rate of low birth weight, premature births, infant mortality, and maternal mortality among all industrialized countries.
Comparison to Other Countries
Country | Low Birth Weight Rate | Premature Birth Rate | Infant Mortality Rate | Maternal Mortality Rate |
US | Highest | Highest | Highest | Highest |
Canada | Lower | Lower | Lower | Lower |
Mexico | Lower | Lower | Lower | Lower |
European Countries | Lower | Lower | Lower | Lower |
State-by-State Comparison
The states with the worst statistics for maternal and infant mortality are:
Louisiana
Mississippi
Alabama
The states with the best statistics are:
Vermont
New Hampshire
California
Percentage of Low Birth Weight Babies by State
State | Percentage of Low Birth Weight Babies |
Mississippi | 11.6% |
Louisiana | 11.4% |
Alabama | 11.3% |
Georgia | 10.9% |
South Carolina | 10.8% |
Alaska | 6.4% |
Oregon | 6.5% |
Minnesota | 6.6% |
California | 6.7% |
Maine | 6.8% |
Unplanned Pregnancy Rate
The US has the highest unplanned pregnancy rate in the developed world, with approximately 60% of pregnancies being unplanned. This is compared to less than 10% in most European countries.
Sex Education in the US
Sex education in the US is often inadequate and varies greatly from state to state. Some states, such as Massachusetts, have comprehensive sex education programs, while others, such as Oklahoma, do not provide sex education until high school.
Abstinence-Only Education
Abstinence-only education is a type of sex education that focuses solely on abstinence and does not provide information on contraception or birth control. This type of education has been shown to be ineffective in preventing unplanned pregnancies and STIs.
Comprehensive Sex Education
Comprehensive sex education is a type of sex education that provides information on both abstinence and contraception, as well as other topics such as relationships, communication, and decision-making. This type of education has been shown to be effective in preventing unplanned pregnancies and STIs.
Barriers to Effective Sex Education
Lack of comprehensive sex education programs
Abstinence-only education
Limited access to birth control information
Parental opt-out policies
Awkwardness and discomfort discussing sex with parents or guardians
Importance of Comprehensive Sex Education
Reduces unplanned pregnancies
Reduces STIs
Improves relationships and communication
Empowers individuals to make informed decisions about their health and well-being## 🤰 Pregnancy and Healthcare Access
Barriers to Effective Birth Control
Lack of comprehensive sex education in schools
Limited access to reliable birth control methods, such as IUDs and implants
High cost of birth control, particularly for those without insurance
The Importance of Prenatal Care
Prenatal care refers to the medical care a woman receives during pregnancy, which is essential for monitoring the health of both the mother and the baby.
Regular prenatal care visits can help prevent complications and ensure a healthy pregnancy
However, many women, especially those without insurance, may not receive adequate prenatal care due to financial constraints
Maternal and Infant Mortality Rates
Country | Maternal Mortality Rate (per 100,000 live births) | Infant Mortality Rate (per 1,000 live births) |
United States | 17.4 | 5.8 |
Developed World Average | 12.7 | 3.4 |
The United States has one of the highest maternal and infant mortality rates among developed countries.
Factors Contributing to High Blood Pressure in Young Adults
Genetics: Family history can play a role in high blood pressure
Stress: Chronic stress can contribute to high blood pressure
Diet: Consuming high amounts of sodium, often found in processed and fast food, can increase blood pressure
Healthcare Access Issues
Lack of Health Insurance: Many young adults do not have health insurance, making it difficult to access prenatal care and other medical services
Limited Maternity Coverage: Even with health insurance, some plans may not cover maternity care or may have high out-of-pocket costs
Rural Healthcare Shortages: Rural areas often have limited access to OB-GYNs and maternity services, making it difficult for women to receive adequate care
The Cost of Having a Baby
Type of Delivery | Estimated Cost |
Uncomplicated Pregnancy and Delivery | 15,000−15,000−20,000 |
Complicated Pregnancy and Delivery (C-Section) | 30,000−30,000−40,000 |
The high cost of having a baby can be a significant burden for many families, particularly those without insurance or with limited financial resources.
Consequences of Limited Healthcare Access
Delayed Prenatal Care: Women may not receive timely prenatal care due to financial constraints, leading to a higher risk of complications
Increased Risk of Maternal and Infant Mortality: Limited access to healthcare can increase the risk of maternal and infant mortality, particularly in rural areas with limited medical resources.## 🤰♀ Maternity Leave and Postpartum Care in the US
The United States is the only developed country without guaranteed maternity leave. The closest thing to maternity leave in the US is the Family Medical Leave Act (FMLA), which allows for up to 12 weeks of unpaid leave for employees of companies with more than 50 employees.
Discharge and Postpartum Care
In the US, patients are typically discharged from the hospital quickly due to insurance company rules. This can lead to complications, such as blood clots, that may not be apparent until after discharge.
Type of Delivery | Hospital Stay |
Uncompensated Delivery | 24 hours |
C-Section | 3 days |
In contrast, many other countries provide longer hospital stays to monitor for complications.
Follow-up Care
In most states, there is no follow-up care for discharged mothers and babies. Some countries, such as Great Britain, have implemented programs like mother-baby nurses who visit new mothers at home to check on their health and the baby's health.
🤱♀ The Birth Process
The fetal brain signals the release of hormones that start uterine contractions and labor.
Stages of Labor
Active Labor: The cervix dilates from 4-10 cm, and contractions become more frequent and intense.
Transition: The cervix dilates from 7-10 cm, and contractions are very intense.
Pushing: The cervix is fully dilated, and the mother pushes the baby out.
Average Labor Time
Firstborn babies: 12 hours (normal up to 24 hours)
Later births: shorter labor time, often tied to genetics
Precipitous Delivery
A precipitous delivery is a very rapid delivery, often occurring in under an hour. This can be a concern for mothers who have a history of rapid deliveries.
👶 Newborn Assessment
After birth, the baby is assessed using the Apgar Scale, which evaluates:
Heart rate
Breathing
Muscle tone
Color
Reflexes
The Apgar Scale is scored from 0-2 in each category, with a total score of 7 or above indicating a healthy baby.
Apgar Score | Interpretation |
7 or above | Healthy baby |
Below 7 | Baby may require medical intervention |
🏥 Medical Intervention
Some common medical interventions during delivery include:
Fetal monitoring: using electrodes to monitor the baby's heartbeat
Oxygen therapy: providing oxygen to the baby
Medication: administering medication to the mother or baby as needed## Labor and Delivery 🤰
Monitoring the Baby's Heart Rate
During contractions, the baby's heart rate is closely monitored to ensure it doesn't drop too much. A significant drop in heart rate can indicate a problem, such as the umbilical cord being wrapped around the baby's neck or the baby grabbing onto the cord and cutting off its own blood supply.
Epidurals
Epidurals are a popular pain relief option for many women during labor. An epidural is an injection given in the spine that numbs the lower part of the body, allowing the woman to remain aware and able to push during labor.
Induced Labor
Induced labor is when medication is given to stimulate contractions and start labor. This is often done if the baby is overdue (past 42 weeks) or if there are concerns about the baby's health.
Cesarean Sections (C-Sections)
A C-section is a surgical delivery where the baby is born through an incision in the mother's abdomen. C-sections are often performed in emergency situations, such as when the baby is in distress or the mother's life is at risk.
Reasons for C-Sections:
Reason | Description |
Multiple births | Twins, triplets, or other multiple births may require a C-section |
Prior C-sections | Women who have had previous C-sections may be required to have a scheduled C-section for subsequent births |
Fetal distress | If the baby is in distress, a C-section may be necessary to ensure the baby's safety |
Advanced maternal age | Women over 35 may be at higher risk for complications during labor and delivery |
Breech baby | If the baby is in a breech position (feet first), a C-section may be necessary to prevent complications |
Newborn Assessment
Newborns are assessed using the Bracelton Neonatal Behavioral Assessment Scale, which evaluates 46 behaviors, including reflexes.
Reflexes:
A reflex is an unlearned, automatic action or movement in response to a stimulus.
Examples of reflexes include:
Rooting reflex: when the baby turns its head towards a stimulus and tries to suck
Sucking reflex: when the baby sucks on a stimulus, such as a finger or pacifier
Grasping reflex: when the baby grips onto a stimulus, such as a finger or object
Bonding and Skin-to-Skin Contact
Bonding between the mother and baby is crucial, especially in the NICU. Skin-to-skin contact, also known as kangaroo care, can help premature babies regulate their heartbeat and promote bonding.
Postpartum Depression
Postpartum depression is a serious condition that can affect new mothers. Risk factors include:
History of depression
Lack of sleep
Physical problems after delivery
Struggles with baby care
Symptoms may include:
Baby blues (mild depression)
Postpartum depression (more severe depression)
Postpartum psychosis (rare but serious condition)## Maternal Mortality in the United States 🤰
Definition of Maternal Mortality
Maternal mortality refers to the death of a woman during pregnancy, childbirth, or in the postpartum period, typically within one year of delivery.
Causes of Maternal Mortality
The major causes of maternal mortality in the United States include:
Cardiovascular disease
Hemorrhage
High blood pressure causing seizures and strokes
Blood clots
Infection
Severe Maternal Morbidity
Severe maternal morbidity refers to life-threatening complications related to pregnancy and childbirth, resulting in significant short-term or long-term health consequences.
Examples of severe maternal morbidity include:
Blood clots
Seizures
Strokes
Receiving a blood transfusion
End organ damage (e.g., kidney failure)
Preventability of Maternal Mortality and Morbidity
60% of maternal deaths and severe complications are thought to be preventable
Concrete steps and standard procedures can be implemented to prevent these bad outcomes and save women's lives
Examples of preventable measures include:
Timely treatment of high blood pressure with antihypertensive medication
Accurate tracking of blood loss during delivery to detect hemorrhage sooner
The Alliance for Innovation in Maternal Health (AIM) Program 🏥
Overview
The AIM program is a collaborative effort between the American College of Obstetricians and Gynecologists, other health care organizations, researchers, and community organizations to implement standard care practices in hospitals and health systems across the country.
Safety Bundles
Safety bundles are collections of evidence-based practices, protocols, procedures, medications, equipment, and other items targeting specific conditions.
Example of a safety bundle: Hemorrhage Bundle
Cart with emergency equipment (e.g., IV line, oxygen mask, medications)
Accurate measurement of blood loss (e.g., weighing sponges and pads)
Protocols for massive transfusions
Regular trainings and drills
Success Stories
California has seen a 21% reduction in near-death from hemorrhage among hospitals that implemented the hemorrhage bundle in the first year
Racial and Ethnic Disparities in Maternal Mortality and Morbidity 🌎
Statistics
Population | Risk of Pregnancy-Related Death |
Black women | 3-4 times higher than white women |
Black women with a college education | nearly twice as likely to die as white women with less than high school education |
Disparities in Quality of Care
Black women tend to deliver in hospitals with worse outcomes for both black and white women, regardless of patient risk factors
Quality of care in the setting of childbirth is an underlying cause of racial and ethnic disparities in maternal mortality and severe maternal morbidity in the United States
Example: Dr. Shalon Murphy's Story
Dr. Shalon Murphy, a CDC epidemiologist, died from complications of high blood pressure after childbirth despite being seen multiple times by healthcare professionals. Her story highlights the lack of standards in postpartum care and the need for improved quality of care to address racial and ethnic disparities in maternal mortality and morbidity.## 🏥 Quality of Care Across the Care Continuum
High-quality care across the care continuum is crucial for reducing maternal mortality and severe maternal morbidity rates. This type of care involves providing access to safe and reliable contraception throughout women's reproductive lives.
Before Pregnancy
Preconception care: managing chronic illness and optimizing health before pregnancy
Providing access to safe and reliable contraception
During Pregnancy
High-quality prenatal care: regular check-ups and monitoring to ensure a healthy pregnancy
High-quality delivery care: ensuring a safe and healthy delivery for both the mother and the baby
After Pregnancy
Postpartum care: monitoring and addressing the mother's physical and emotional health after delivery
Interpregnancy care: providing care and support between pregnancies to ensure a healthy next pregnancy
🚨 The Importance of High-Quality Care: Maria's Story
Maria's story highlights the importance of high-quality care in preventing maternal mortality and severe maternal morbidity. During her first pregnancy, Maria's elevated blood pressure was not taken seriously, and she suffered a seizure. However, during her second pregnancy, her healthcare team listened to her concerns, monitored her closely, and provided timely interventions, resulting in a healthy delivery.
Key Factors in Maria's Successful Outcome
Factor | Description |
Active listening | Maria's healthcare team listened to her concerns and took them seriously |
Probing questions | Maria's doctor asked smart and probing questions to assess her condition |
Counseling | Maria's doctor counseled her on the signs and symptoms of preeclampsia and the importance of seeking medical attention if she was not feeling well |
Timely interventions | Maria's healthcare team provided timely interventions, including urgent lab tests, monitoring, and IV medication |
Coordinated team effort | Maria's healthcare team worked smoothly together to provide high-quality care |
📊 The Impact of High-Quality Care on Maternal Mortality and Morbidity
"High-quality care across the care continuum can literally spell the difference between life and death."
Providing high-quality care to every pregnant woman in every community can significantly reduce maternal mortality and severe maternal morbidity rates.
The Current State of Maternal Mortality and Morbidity
The United States has unacceptably high rates of maternal deaths and life-threatening complications during delivery
Decades of poor performance on maternal mortality have had devastating consequences for moms, babies, and families
The Path Forward
"The question is, are we as a society ready to value pregnant women from every community?"
To improve maternal mortality and morbidity rates, we must:
Value pregnant women from every community
Provide high-quality care across the care continuum
Utilize standard care practices in delivery facilities
Address social determinants of health to achieve equitable health outcomes
In Class Notes 9/10: Classical Conditioning and Maternal Health Insights
Classical Conditioning 🐶
Classical conditioning, also known as Pavlovian conditioning, is a type of learning that occurs through association. This concept was first demonstrated by Russian physiologist Ivan Pavlov in the 1890s.
Pavlov's Experiment
Pavlov's experiment involved ringing a bell every time a dog was about to be fed. Initially, the bell had no effect on the dog, but the food did. However, after repeated pairings of the bell and food, the dog began to salivate in response to the bell alone.
Stimulus | Response |
Food (Unconditioned Stimulus) | Salivation (Unconditioned Response) |
Bell (Neutral Stimulus) | No Response |
Bell + Food | Salivation (Conditioned Response) |
Key Terms
Unconditioned Stimulus (US): A stimulus that naturally elicits a response without any prior learning.
Unconditioned Response (UR): The natural response to an unconditioned stimulus.
Neutral Stimulus (NS): A stimulus that does not naturally elicit a response.
Conditioned Stimulus (CS): A neutral stimulus that, through association with an unconditioned stimulus, comes to elicit a conditioned response.
Conditioned Response (CR): The response to a conditioned stimulus.
"Classical conditioning is a type of learning in which a neutral stimulus becomes associated with an unconditioned stimulus to elicit an unconditioned response."
The Little Albert Experiment 🤱
John Watson and Rosalyn Rayner conducted an experiment on a 9-month-old baby, known as Little Albert, to demonstrate classical conditioning in humans.
The Experiment
Watson and Rayner presented Little Albert with a series of stimuli, including a white rat, a dog, and a rabbit. Initially, the baby showed no fear response to any of these stimuli. However, when a loud noise was paired with the presentation of the white rat, the baby began to cry. After repeated pairings, the white rat alone elicited a fear response in the baby.
Generalization
The fear response was generalized to other stimuli, including a dog, a rabbit, and a white mask worn by Watson.
Ethical Concerns
The Little Albert experiment raises several ethical concerns, including:
Lack of informed consent: The baby's mother was not informed about the experiment, and the baby was not able to provide consent.
Harm to the participant: The experiment caused the baby distress and potentially long-term harm.
Lack of control: The experiment had only one participant and lacked control conditions.
Professional competence: The experiment was not well-designed, and the researchers did not follow proper procedures.
Legacy of the Experiment
Despite its methodological flaws, the Little Albert experiment contributed to the development of behaviorism and our understanding of classical conditioning. It also highlights the importance of ethics in research and the need for informed consent and proper procedures.
Behaviorism 🤖
Behaviorism is a psychological theory that emphasizes the role of environment and learning in shaping behavior. The Little Albert experiment helped to launch the behaviorist movement, which posits that behavior is the result of external stimuli and conditioning.
"Behaviorism is a psychological theory that focuses on observable behavior and the role of environment and learning in shaping behavior."## 🤰♀ Maternal and Infant Mortality Rates in the US
The United States has the worst rate of low birth weight, premature births, infant mortality, and maternal mortality among all industrialized countries.
Comparison to Other Countries
Country | Low Birth Weight Rate | Premature Birth Rate | Infant Mortality Rate | Maternal Mortality Rate |
US | Highest | Highest | Highest | Highest |
Canada | Lower | Lower | Lower | Lower |
Mexico | Lower | Lower | Lower | Lower |
European Countries | Lower | Lower | Lower | Lower |
State-by-State Comparison
The states with the worst statistics for maternal and infant mortality are:
Louisiana
Mississippi
Alabama
The states with the best statistics are:
Vermont
New Hampshire
California
Percentage of Low Birth Weight Babies by State
State | Percentage of Low Birth Weight Babies |
Mississippi | 11.6% |
Louisiana | 11.4% |
Alabama | 11.3% |
Georgia | 10.9% |
South Carolina | 10.8% |
Alaska | 6.4% |
Oregon | 6.5% |
Minnesota | 6.6% |
California | 6.7% |
Maine | 6.8% |
Unplanned Pregnancy Rate
The US has the highest unplanned pregnancy rate in the developed world, with approximately 60% of pregnancies being unplanned. This is compared to less than 10% in most European countries.
Sex Education in the US
Sex education in the US is often inadequate and varies greatly from state to state. Some states, such as Massachusetts, have comprehensive sex education programs, while others, such as Oklahoma, do not provide sex education until high school.
Abstinence-Only Education
Abstinence-only education is a type of sex education that focuses solely on abstinence and does not provide information on contraception or birth control. This type of education has been shown to be ineffective in preventing unplanned pregnancies and STIs.
Comprehensive Sex Education
Comprehensive sex education is a type of sex education that provides information on both abstinence and contraception, as well as other topics such as relationships, communication, and decision-making. This type of education has been shown to be effective in preventing unplanned pregnancies and STIs.
Barriers to Effective Sex Education
Lack of comprehensive sex education programs
Abstinence-only education
Limited access to birth control information
Parental opt-out policies
Awkwardness and discomfort discussing sex with parents or guardians
Importance of Comprehensive Sex Education
Reduces unplanned pregnancies
Reduces STIs
Improves relationships and communication
Empowers individuals to make informed decisions about their health and well-being## 🤰 Pregnancy and Healthcare Access
Barriers to Effective Birth Control
Lack of comprehensive sex education in schools
Limited access to reliable birth control methods, such as IUDs and implants
High cost of birth control, particularly for those without insurance
The Importance of Prenatal Care
Prenatal care refers to the medical care a woman receives during pregnancy, which is essential for monitoring the health of both the mother and the baby.
Regular prenatal care visits can help prevent complications and ensure a healthy pregnancy
However, many women, especially those without insurance, may not receive adequate prenatal care due to financial constraints
Maternal and Infant Mortality Rates
Country | Maternal Mortality Rate (per 100,000 live births) | Infant Mortality Rate (per 1,000 live births) |
United States | 17.4 | 5.8 |
Developed World Average | 12.7 | 3.4 |
The United States has one of the highest maternal and infant mortality rates among developed countries.
Factors Contributing to High Blood Pressure in Young Adults
Genetics: Family history can play a role in high blood pressure
Stress: Chronic stress can contribute to high blood pressure
Diet: Consuming high amounts of sodium, often found in processed and fast food, can increase blood pressure
Healthcare Access Issues
Lack of Health Insurance: Many young adults do not have health insurance, making it difficult to access prenatal care and other medical services
Limited Maternity Coverage: Even with health insurance, some plans may not cover maternity care or may have high out-of-pocket costs
Rural Healthcare Shortages: Rural areas often have limited access to OB-GYNs and maternity services, making it difficult for women to receive adequate care
The Cost of Having a Baby
Type of Delivery | Estimated Cost |
Uncomplicated Pregnancy and Delivery | 15,000−15,000−20,000 |
Complicated Pregnancy and Delivery (C-Section) | 30,000−30,000−40,000 |
The high cost of having a baby can be a significant burden for many families, particularly those without insurance or with limited financial resources.
Consequences of Limited Healthcare Access
Delayed Prenatal Care: Women may not receive timely prenatal care due to financial constraints, leading to a higher risk of complications
Increased Risk of Maternal and Infant Mortality: Limited access to healthcare can increase the risk of maternal and infant mortality, particularly in rural areas with limited medical resources.## 🤰♀ Maternity Leave and Postpartum Care in the US
The United States is the only developed country without guaranteed maternity leave. The closest thing to maternity leave in the US is the Family Medical Leave Act (FMLA), which allows for up to 12 weeks of unpaid leave for employees of companies with more than 50 employees.
Discharge and Postpartum Care
In the US, patients are typically discharged from the hospital quickly due to insurance company rules. This can lead to complications, such as blood clots, that may not be apparent until after discharge.
Type of Delivery | Hospital Stay |
Uncompensated Delivery | 24 hours |
C-Section | 3 days |
In contrast, many other countries provide longer hospital stays to monitor for complications.
Follow-up Care
In most states, there is no follow-up care for discharged mothers and babies. Some countries, such as Great Britain, have implemented programs like mother-baby nurses who visit new mothers at home to check on their health and the baby's health.
🤱♀ The Birth Process
The fetal brain signals the release of hormones that start uterine contractions and labor.
Stages of Labor
Active Labor: The cervix dilates from 4-10 cm, and contractions become more frequent and intense.
Transition: The cervix dilates from 7-10 cm, and contractions are very intense.
Pushing: The cervix is fully dilated, and the mother pushes the baby out.
Average Labor Time
Firstborn babies: 12 hours (normal up to 24 hours)
Later births: shorter labor time, often tied to genetics
Precipitous Delivery
A precipitous delivery is a very rapid delivery, often occurring in under an hour. This can be a concern for mothers who have a history of rapid deliveries.
👶 Newborn Assessment
After birth, the baby is assessed using the Apgar Scale, which evaluates:
Heart rate
Breathing
Muscle tone
Color
Reflexes
The Apgar Scale is scored from 0-2 in each category, with a total score of 7 or above indicating a healthy baby.
Apgar Score | Interpretation |
7 or above | Healthy baby |
Below 7 | Baby may require medical intervention |
🏥 Medical Intervention
Some common medical interventions during delivery include:
Fetal monitoring: using electrodes to monitor the baby's heartbeat
Oxygen therapy: providing oxygen to the baby
Medication: administering medication to the mother or baby as needed## Labor and Delivery 🤰
Monitoring the Baby's Heart Rate
During contractions, the baby's heart rate is closely monitored to ensure it doesn't drop too much. A significant drop in heart rate can indicate a problem, such as the umbilical cord being wrapped around the baby's neck or the baby grabbing onto the cord and cutting off its own blood supply.
Epidurals
Epidurals are a popular pain relief option for many women during labor. An epidural is an injection given in the spine that numbs the lower part of the body, allowing the woman to remain aware and able to push during labor.
Induced Labor
Induced labor is when medication is given to stimulate contractions and start labor. This is often done if the baby is overdue (past 42 weeks) or if there are concerns about the baby's health.
Cesarean Sections (C-Sections)
A C-section is a surgical delivery where the baby is born through an incision in the mother's abdomen. C-sections are often performed in emergency situations, such as when the baby is in distress or the mother's life is at risk.
Reasons for C-Sections:
Reason | Description |
Multiple births | Twins, triplets, or other multiple births may require a C-section |
Prior C-sections | Women who have had previous C-sections may be required to have a scheduled C-section for subsequent births |
Fetal distress | If the baby is in distress, a C-section may be necessary to ensure the baby's safety |
Advanced maternal age | Women over 35 may be at higher risk for complications during labor and delivery |
Breech baby | If the baby is in a breech position (feet first), a C-section may be necessary to prevent complications |
Newborn Assessment
Newborns are assessed using the Bracelton Neonatal Behavioral Assessment Scale, which evaluates 46 behaviors, including reflexes.
Reflexes:
A reflex is an unlearned, automatic action or movement in response to a stimulus.
Examples of reflexes include:
Rooting reflex: when the baby turns its head towards a stimulus and tries to suck
Sucking reflex: when the baby sucks on a stimulus, such as a finger or pacifier
Grasping reflex: when the baby grips onto a stimulus, such as a finger or object
Bonding and Skin-to-Skin Contact
Bonding between the mother and baby is crucial, especially in the NICU. Skin-to-skin contact, also known as kangaroo care, can help premature babies regulate their heartbeat and promote bonding.
Postpartum Depression
Postpartum depression is a serious condition that can affect new mothers. Risk factors include:
History of depression
Lack of sleep
Physical problems after delivery
Struggles with baby care
Symptoms may include:
Baby blues (mild depression)
Postpartum depression (more severe depression)
Postpartum psychosis (rare but serious condition)## Maternal Mortality in the United States 🤰
Definition of Maternal Mortality
Maternal mortality refers to the death of a woman during pregnancy, childbirth, or in the postpartum period, typically within one year of delivery.
Causes of Maternal Mortality
The major causes of maternal mortality in the United States include:
Cardiovascular disease
Hemorrhage
High blood pressure causing seizures and strokes
Blood clots
Infection
Severe Maternal Morbidity
Severe maternal morbidity refers to life-threatening complications related to pregnancy and childbirth, resulting in significant short-term or long-term health consequences.
Examples of severe maternal morbidity include:
Blood clots
Seizures
Strokes
Receiving a blood transfusion
End organ damage (e.g., kidney failure)
Preventability of Maternal Mortality and Morbidity
60% of maternal deaths and severe complications are thought to be preventable
Concrete steps and standard procedures can be implemented to prevent these bad outcomes and save women's lives
Examples of preventable measures include:
Timely treatment of high blood pressure with antihypertensive medication
Accurate tracking of blood loss during delivery to detect hemorrhage sooner
The Alliance for Innovation in Maternal Health (AIM) Program 🏥
Overview
The AIM program is a collaborative effort between the American College of Obstetricians and Gynecologists, other health care organizations, researchers, and community organizations to implement standard care practices in hospitals and health systems across the country.
Safety Bundles
Safety bundles are collections of evidence-based practices, protocols, procedures, medications, equipment, and other items targeting specific conditions.
Example of a safety bundle: Hemorrhage Bundle
Cart with emergency equipment (e.g., IV line, oxygen mask, medications)
Accurate measurement of blood loss (e.g., weighing sponges and pads)
Protocols for massive transfusions
Regular trainings and drills
Success Stories
California has seen a 21% reduction in near-death from hemorrhage among hospitals that implemented the hemorrhage bundle in the first year
Racial and Ethnic Disparities in Maternal Mortality and Morbidity 🌎
Statistics
Population | Risk of Pregnancy-Related Death |
Black women | 3-4 times higher than white women |
Black women with a college education | nearly twice as likely to die as white women with less than high school education |
Disparities in Quality of Care
Black women tend to deliver in hospitals with worse outcomes for both black and white women, regardless of patient risk factors
Quality of care in the setting of childbirth is an underlying cause of racial and ethnic disparities in maternal mortality and severe maternal morbidity in the United States
Example: Dr. Shalon Murphy's Story
Dr. Shalon Murphy, a CDC epidemiologist, died from complications of high blood pressure after childbirth despite being seen multiple times by healthcare professionals. Her story highlights the lack of standards in postpartum care and the need for improved quality of care to address racial and ethnic disparities in maternal mortality and morbidity.## 🏥 Quality of Care Across the Care Continuum
High-quality care across the care continuum is crucial for reducing maternal mortality and severe maternal morbidity rates. This type of care involves providing access to safe and reliable contraception throughout women's reproductive lives.
Before Pregnancy
Preconception care: managing chronic illness and optimizing health before pregnancy
Providing access to safe and reliable contraception
During Pregnancy
High-quality prenatal care: regular check-ups and monitoring to ensure a healthy pregnancy
High-quality delivery care: ensuring a safe and healthy delivery for both the mother and the baby
After Pregnancy
Postpartum care: monitoring and addressing the mother's physical and emotional health after delivery
Interpregnancy care: providing care and support between pregnancies to ensure a healthy next pregnancy
🚨 The Importance of High-Quality Care: Maria's Story
Maria's story highlights the importance of high-quality care in preventing maternal mortality and severe maternal morbidity. During her first pregnancy, Maria's elevated blood pressure was not taken seriously, and she suffered a seizure. However, during her second pregnancy, her healthcare team listened to her concerns, monitored her closely, and provided timely interventions, resulting in a healthy delivery.
Key Factors in Maria's Successful Outcome
Factor | Description |
Active listening | Maria's healthcare team listened to her concerns and took them seriously |
Probing questions | Maria's doctor asked smart and probing questions to assess her condition |
Counseling | Maria's doctor counseled her on the signs and symptoms of preeclampsia and the importance of seeking medical attention if she was not feeling well |
Timely interventions | Maria's healthcare team provided timely interventions, including urgent lab tests, monitoring, and IV medication |
Coordinated team effort | Maria's healthcare team worked smoothly together to provide high-quality care |
📊 The Impact of High-Quality Care on Maternal Mortality and Morbidity
"High-quality care across the care continuum can literally spell the difference between life and death."
Providing high-quality care to every pregnant woman in every community can significantly reduce maternal mortality and severe maternal morbidity rates.
The Current State of Maternal Mortality and Morbidity
The United States has unacceptably high rates of maternal deaths and life-threatening complications during delivery
Decades of poor performance on maternal mortality have had devastating consequences for moms, babies, and families
The Path Forward
"The question is, are we as a society ready to value pregnant women from every community?"
To improve maternal mortality and morbidity rates, we must:
Value pregnant women from every community
Provide high-quality care across the care continuum
Utilize standard care practices in delivery facilities
Address social determinants of health to achieve equitable health outcomes
