Developmental Health

DEVELOPMENTAL HEALTH

Smoking During Pregnancy

  • Risks of Smoking During Pregnancy:
    • Increases the risks of:
    • Miscarriage
    • Placental separation from the uterus
    • Premature birth
    • Birth defects, such as cleft lip or cleft palate
    • Sudden Infant Death Syndrome (SIDS), which is also increased when smoking after birth
    • Use of e-cigarettes is discouraged during pregnancy due to potential risks
      • Nicotine: Can damage a baby’s developing brain and lungs.
      • Flavourings: Some believed to cause developmental issues, with effects still largely unknown.

Rates of Maternal Smoking During Pregnancy

  • Figure 1.1: Shows the rate of maternal smoking during pregnancy by age and birth year in Canada from 1993-2008:
    • Percentage of mothers (95% CI) who smoked during pregnancy:
    • Age groups considered:
    • 15-19
    • 20-24
    • 25-29
    • 30-34
    • 35-39
    • 40-49
    • Timeframes:
    • 1993-1996
    • 1997-2000
    • 2001-2004
    • 2005-2008
    • All ages (Public Health Agency of Canada)

Alcohol Use During Pregnancy

  • Major Concerns:
    • Leading issue is fetal alcohol spectrum disorders (FASDs), which manifest as:
    • Abnormal facial features
    • Small head
    • Shorter than average height
    • Low body weight
    • Poor coordination
    • Hyperactivity
    • Poor attention
    • Memory issues
    • Learning disabilities
    • Speech and language difficulties
    • Poor reasoning and judgment
    • Vision or hearing problems
    • Problems with heart, kidney, and bone function

Rates of Maternal Alcohol Consumption During Pregnancy

  • Figure 2.1: Illustrates the rate of maternal alcohol consumption during pregnancy by age and birth year in Canada (1993-2008):
    • Percentage of mothers (95% CI) who consumed alcohol during pregnancy:
    • Age groups similar to smoking:
    • 15-19
    • 20-24
    • 25-29
    • 30-34
    • 35-39
    • 40-49
    • Timeframes:
    • 1993-1996
    • 1997-2000
    • 2001-2004
    • 2005-2008
    • All ages (Public Health Agency of Canada)

The Medicalization of Childbirth

  • Historical Context:
    • Before the 1700s:
    • Childbirth predominantly in homes, attended by female friends, relatives, local knowledgeable women.
    • Midwife: The term means "with woman."
    • 1700s:
    • Female midwives experienced a decline in status and portrayed as unenlightened, unhygienic, linked to superstition.
    • Emergence of male midwives replaced female midwives, leading to increased medicalization.
    • Male physicians were called for complications requiring intervention, introducing tools such as obstetric forceps.

The Evolution of Childbirth Practices

  • Early 1900s:
    • Development of obstetrics from practices of male midwives/physicians; most births still at home, setting of 'normal' childbirth standards.
    • Deviations viewed as reasons for medical intervention, leading to management and monitoring of childbirth.
  • Throughout the 1900s:
    • Increase in hospital births; home births dropped to 1% by late 1970s.
    • Technologies like fetal heart rate monitoring, epidural anesthesia for pain management, and caesarean sections became common.
    • The caesarean section has historical roots, once reserved for emergencies post-maternal death; elective use increased in the 1990s.
  • Late 1900s to Early 2000s:
    • Shift from sterile birthing rooms to open labor/delivery rooms allowing family and friends during the birth process, increasing partner involvement.

The Return of Midwives (2010-2020)

  • Return of midwives to the profession is province-dependent in Canada (Canadian Association of Midwives):
    • Registered Midwives by Province (2019):
    • British Columbia: 394 midwives, 25% of births attended.
    • New Brunswick: 2 midwives, 0.7% of births attended.
    • Newfoundland: 4 midwives, no births attended.
    • Prince Edward Island: No midwives, not legal.
    • Yukon: No midwives, legalization pending.

Caesarean Sections

  • Definition: Delivery method through an incision made in the abdominal wall and uterus; considered major surgery.
  • Anesthesia Options: Requires either general anaesthesia or an epidural block.
  • Presence of Partner: May or may not be allowed to witness the surgery.
  • Indications for Caesarean Sections Include:
    • Complications related to vaginal birth.
    • Prevention of HIV or herpes transmission.
    • Obstruction of the birth canal.
    • Physical size of the baby.
    • Abnormal heart rate or other complications.
    • Awkward positioning of the baby.
    • Elective caesarean sections gained popularity in the late 1990s and early 2000s (Society of Obstetricians and Gynaecologists of Canada).

Caesarean Section Rates in Canada (1980-2018)

  • Figure: Trend showing percentage of caesarean sections among all deliveries from 1980 to 2018.

Caesarean Sections by Province

  • Figure 6.1: Rate of caesarean deliveries by province/territory (excluding Quebec) for the 2010-2011 fiscal year:
    • Caesarean deliveries (95% CI) per 100 hospital deliveries, covering:
    • Newfoundland, Prince Edward Island, Nova Scotia, New Brunswick, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia, Yukon, Northwest Territories, Nunavut, Canada.

Caesarean Sections vs. Vaginal Birth

  • Benefits of Vaginal Birth:
    • Reduced blood loss.
    • Reduced risk of injury and infection.
    • Avoidance of surgical complications.
    • Shorter hospital stays.
    • More rapid recovery and less pain.
  • Complications of Caesarean Sections Affecting Babies:
    • Increased likelihood of breathing difficulties in premature births.
    • Potential risk of neonatal skin cuts during surgery (rare).
    • (Society of Obstetricians and Gynaecologists of Canada)

Complications of Caesarean Sections Affecting Mothers

  • Potential Complications:
    • Infection of the wound.
    • Endometritis (inflammation of uterine lining).
    • Increased risk of blood clots.
    • Increased bleeding (twice that of vaginal births).
    • Urinary tract infections.
    • Decreased bowel function.
    • Higher likelihood of health risks in future pregnancies (including increased likelihood of requiring another caesarean section).
    • Recovery delays and prolonged hospital stays post-birth.
    • Recommendations against heavy lifting for at least 6 weeks (Society of Obstetricians and Gynaecologists of Canada).

Breastfeeding

  • Recommendations:
    • Exclusive breastfeeding for the first 6 months is advised.
    • Continuation of breastfeeding up to 2 years or more, alongside age-appropriate solid foods.
  • Advantages of Breastmilk:
    • Easy digestion for the baby.
    • Unique production tailored to the baby's growth needs.
    • Enhances the mother-baby bond.
    • Provides health protections for mothers against breast and ovarian cancer, osteoporosis.
    • Cost-effective for families.
  • Colostrum:
    • The first breast milk post-birth containing vital antibodies that protect the infant's digestive system, may reduce allergy risk (Public Health Agency of Canada).

Provincial Variations in Breastfeeding

  • Figure 3.4: Rates of exclusive breastfeeding reported by mothers in Canada for six months or longer in 2005, 2007-2008, and 2009-2010:
    • Breakdown by provinces and territories showing changes over time.

Infant Mortality (Under 1 Year)

  • Statistics (2017): Infant mortality rate in Canada was 4.5 per 1000 live births (Public Health Agency of Canada).
    • Causes of mortality involved:
    • Congenital malformations: 1.3 deaths per 1000 live births; define structural or functional abnormalities during intrauterine development.
    • Sudden infant death: 0.3 deaths per 1000 live births; described as unexplained death of healthy infants, typically occurring during sleep, possibly due to brain abnormalities modulating breathing and arousal.
    • Trends in SIDS: Significant decline observed over the last decade.

Variations in Infant Mortality by Province

  • Statistics:
    • British Columbia: 3.4 per 1000 live births.
    • Nunavut: 17.7 per 1000 live births (Public Health Agency of Canada).

Childhood Mortality (Aged 1-11)

  • Leading Causes:
    • Injuries (both intentional and unintentional) are the predominant mortality cause for youth aged 1-17:
    • 25.8% of female deaths vs. 34.8% of male deaths.
    • Rate equals 4.9 deaths per 100,000 per year.
    • Primary causes of injury-related deaths:
      • Motor-vehicle collisions (17%)
      • Drowning (15%)
      • Breathing threats (11%)

Childhood Morbidity

  • Chronic Diseases:
    • Asthma prevalence among children aged 4-11 recorded at 16% as of 2000, with increasing rates noted.
    • Obesity: 27.9% of children aged 12-17 categorized as obese or overweight in 2017, showing a consistent rise.
    • Diabetes: 0.3% of youth aged 1-9 had diabetes in 2005-2006, predominantly Type 1, but Type 2 rates increasing alongside obesity trends.
  • Infectious Diseases:
    • Vaccination rates: 25% of children did not receive full doses of diphtheria, whooping cough, and tetanus vaccines by age two.
    • 1.5% of children had never received any vaccinations.

Mental Health of Children

  • Statistics:
    • Up to 20% of Canadian children affected by mental disorders.
    • 29% of First Nations children on reserve aged 0-11 experiencing behavioral/emotional problems (2002-2003).
  • Major Concerns:
    • Prevalence of:
    • Depression and anxiety: lifetime prevalence of 11% (ages 15-24).
    • Bullying and discrimination: 20% of youth aged 15-17 report experiences of cyberbullying/cyberstalking.
    • Suicide: Second leading cause of death in ages 1-17; 14% of youth aged 15-24 reported suicidal thoughts; females twice as likely to consider it.
    • Less than 20% of children receive appropriate treatment.

Long-Term Impact of Childhood Mental Health Issues

  • Mental and emotional difficulties in childhood can have enduring effects throughout life:
    • Reduced overall health, productivity, and quality of life.
    • Early delinquent behaviors may correlate with later criminality, substance use, and mental health disorders in subsequent childhood/adulthood.
    • Specific statistics for children aged 2-5:
    • 14.7% exhibit high emotional/anxiety issues.
    • 14.2% display aggression/opposition/conduct disorder symptoms.
    • 6.6% exhibit high levels of hyperactivity/inattention.

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