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Birth and the Newborn

Birth and the Newborn

  • Birth involves hormonal triggers: oxytocin release triggers uterine contractions; when oxytocin concentration is high enough, contractions begin.

  • Firstborn labor duration: typically from 16-24 hours.

  • Transition to lungs: most babies automatically transition to using their lungs; spontaneous crying helps clear lungs and enable breathing on their own.

  • In the US, births in hospitals: 98\%.

Alternative Birthing Methods

  • Lamaze: breathing techniques to cope with painful contractions.

  • Bradley Method: view that birth should not involve medication or medical intervention; spouse/partner acts as main birthing assistant.

  • Hypnobirthing: self-hypnosis for relaxed concentration.

  • Water birthing: giving birth in warm water; belief that warmth and buoyancy soothe birth.

Birthing Practitioners: Doctors

  • Obstetricians (OBs): medical doctors trained to manage high-risk pregnancies and perform surgical procedures like cesarean sections.

  • Family Physician: may provide maternity care and attend births; typically manage low-risk pregnancies; may transfer higher-risk pregnancies to OB/GYNs.

Birthing Practitioners: Midwives

  • Midwives provide prenatal care, attend births, and offer postpartum support; focus on supportive, low-intervention birth experiences.

  • Certified Nurse Midwife (CNM): registered nurse with advanced training in midwifery.

  • Certified Professional Midwife (CPM): not a nurse; trained in midwifery through direct-entry programs; combines education and hands-on clinical experience.

  • Lay Midwife: often self-taught or learned via apprenticeship; may lack formal certification/licensing.

Birthing Practitioners: Doulas

  • Birth Doula: trained in emotional, physical, and informational support during labor and delivery.

  • Postpartum Doula: supports family after birth, including newborn care, breastfeeding assistance, and emotional well-being.

The Apgar Scale

  • Purpose: quick measurement system for assessing health in newborns.

  • Five components: Appearance (color), Pulse, Grimace (reflex), Activity, Respiration.

  • Scoring: typically ranges from 0 to 10; majority score above 7; around 10\% score below 7 and require help to start breathing; scores under 4 indicate need for urgent lifesaving intervention.

Skin-to-Skin Contact

  • Immediately after birth, skin-to-skin contact supports:

    • Temperature regulation

    • Encourages breastfeeding

    • Reduces stress

    • Promotes bonding and attachment

  • Evidence: 1 hour of skin-to-skin contact shows significant decrease in NICU infant stress.

Post-Delivery Hospital Stay

  • Historical trend: in the 1970s, average hospital stay was 4\text{ days}; in the 1990s, 2\text{ days}.

  • Insurance shifts: medical insurance companies advocated for hospital stays of less than 24\text{ hours}.

  • Policy: Congress mandates 48\text{ hours} of coverage post-delivery hospital stay.

Pre-Term Infants and Viability

  • High-risk group: infants under 3.3\text{ pounds} with gestational age less than 30\text{ weeks}; about half of these newborns die.

  • Viability age: now approximately 22\text{ weeks}.

  • Vulnerabilities: gestational age and low birthweight increase vulnerability to infection and respiratory distress syndrome (RDS); majority of preterm infants eventually develop normally, but developmental milestones may proceed more slowly.

Naturalistic Fallacy in Birth/Medicine

  • The Naturalistic Fallacy concerns the idea that what is natural is automatically good or bad, and that natural things are inherently good; and that unnatural things are inherently bad, or vice versa.

Infant Mortality Trends

  • Timeline: infant mortality rates have decreased drastically from the 1800s to 2020.

Vitamin K Shot

  • Babies are born with low levels of Vitamin K, essential for blood clotting.

  • Intervention: a single dose of Vitamin K soon after birth.

  • Risks without shot: about \frac{1}{60} of newborns who do not receive the injection will experience bleeding due to low Vitamin K.

  • Relative risk: newborns who do not get the vitamin K shot are 81\times more likely to experience severe bleeding than those who do receive it.

  • Refusal rates by setting: hospitals 3\%; home births 15\%; birthing centers 31\%.

  • The Vitamin K Shot is a standard preventive treatment.

Hepatitis B Vaccine

  • Purpose: to protect against Hepatitis B, a serious viral infection that can lead to chronic liver disease, liver cancer, and cirrhosis.

  • Timing: typically given within the first 24 hours of birth.

  • If mother is infected with Hepatitis B: the baby may also receive Hepatitis B immune globulin (HBIG) along with the vaccine.

BCG Vaccine (Tuberculosis)

  • Purpose: to protect against tuberculosis (TB), especially in countries where TB is common.

  • Timing: one of the oldest and most widely used vaccines; given in the first few days after birth.

Screening Tests at Birth

  • Blood Glucose Test: for at-risk babies to check for hypoglycemia (low blood sugar); more common in babies born to mothers with gestational diabetes, premature babies, or low birth weight.

  • Hearing Test: typically a heel-stick blood sample to screen for conditions such as PKU, hypothyroidism, and sickle cell disease.

    • Heel-stick screening is part of standard newborn screening.

Unethical Practices in Birth History

  • Thalidomide Tragedy (1950s–1960s): marketed for nausea/insomnia in pregnancy but caused severe birth defects worldwide; later linked to thousands of malformed limbs.

  • Forced Sterilizations of Women (1900s–1970s): many countries, including the U.S., sterilized marginalized women without their knowledge or consent.

  • Forced Cesarean Section Scandal (1980s–2000s): some hospitals performed cesareans without medical necessity or against mothers’ will, sometimes for convenience or policy reasons.

Postpartum Depression (PPD)

  • Prevalence: affects 10\% of all new mothers.

  • Potential trigger: hormonal influx after birth can lead to detachment and withdrawal of emotion.

  • Severity: 1\text{ in }500 cases can evolve into a break from reality.

Treating Postpartum Depression

  • Talk therapies: CBT (cognitive-behavioral therapy) and IPT (interpersonal therapy).

  • Medication: SSRIs or occasionally hormonal treatments.

  • Supportive measures: sleep and nutrition aids.

  • Severe cases: hospitalization may be necessary if there are risks of harm to mother or baby (e.g., suicidal thoughts, inability to care for the baby).

  • Social support: partner/family involvement is important.

Proximal vs Distal Caregiving

  • Proximal caregiving (baby wearing): increases parental responsiveness, heightens mothers’ perception of subtle cues, and strengthens the parent-infant bond.

  • Distal caregiving: implied as the opposite approach

Newborn Physical Competence

  • Reflexes: unlearned, involuntary responses that occur automatically in response to certain stimuli.

    • Examples: sucking and swallowing reflexes, blinking, coughing.

Newborn Sensory Competence

  • Vision: not fully developed; can distinguish brightness, color, and size.

  • Auditory: respond to sudden and familiar sounds; can recognize mother’s voice from the womb and the prosody of their native language.

  • Taste and smell: well developed at birth.

Habituation in Infants

  • when infants are interested in a stimulus, their heart rate spikes and then lowers.*test question

  • Behavior: infants look longer at things they like; over time, they show less looking as the stimulus becomes less novel.

Measuring Infant Attention

  • Methods include:

    • Heart rate monitoring to define phases of attention.

    • Looking time measured via eye tracking or head turning.

    • High amplitude sucking.

Visual Processing and Brain Areas (A) Diagram Summary

  • Newborn visual processing pathway overview:

    • Visual processing involves subcortical regions such as the superior colliculus, which supports eye movements.

    • Early pathways include LGN (lateral geniculate nucleus) and V1 (primary visual cortex).

    • Age-related changes: at 1 month, subcortical structures (e.g., substantia nigra; basal ganglia) support motor control and fixation behaviors.

  • Behaviors associated with stages: newborns show global features tracking; by 1 month, sticky fixation is noted (obligatory attention).

Age Milestones: 1 Month

  • Brain areas involved: subcortical structures (e.g., substantia nigra; basal ganglia) tied to motor control and sticky fixation.

  • Behaviors: obligatory attention and early visual processing patterns consistent with rapid development of coordinated tracking.