Study Notes for Chapter 3 - Pregnancy, Birth, and the Newborn

Human Behavior in the Social Environment: A Multidimensional Perspective - Chapter 3: Pregnancy, Birth, and the Newborn

Chapter Overview

• This chapter delves into the multifaceted aspects surrounding pregnancy, childbirth, and the initial stages of newborn development. It explores the biological, emotional, and environmental factors that contribute to maternal and infant health and societal implications related to these stages.

Chapter Objectives

Objectives (1 of 2)

• Ethical Considerations: Critically evaluate ethical dilemmas faced by parents upon learning they are pregnant.

• Biological Hazards: Identify the biological hazards, risks, and complications associated with pregnancy.

• Environmental Effects: Describe relevant environmental effects on prenatal development, including:

  • Parent nutrition

  • Substance use

  • Emotional states

• Challenges of Newborns: Discuss the challenges associated with newborns (e.g., premature birth, infants with neonatal abstinence syndrome, infants with disabilities).

• Social Strengths: Identify social strengths (e.g., community resources) that can support successful family adaptation.

Objectives (2 of 2)

• Developmental Tasks: Describe the key developmental tasks in the newborn period, including:

  • Sensitive periods for bonding/attachment

  • Use of the Brazelton Neonatal Assessment Scale (BNAS) for understanding response patterns of neonates.

Developmental Themes

Confirmation of Pregnancy

• Confirmation of pregnancy can be shocking, triggering a range of emotions regardless of whether it is planned or unplanned.

• Psychological Tasks: Initial tasks include coming to terms with the pregnancy, accepting the reality of gestation, and emotional auto-regulation.

• Unplanned pregnancies can heighten stress due to the need for additional decision-making.

• Young, unmarried women may face significant social stigma.

Examination Areas for Expectant Parents

• Five areas are critical when interfacing with expectant parents:

  • Attachments and Commitments: Consider their emotional ties.

  • Mental Representation of the Fetus: Assess how the fetus is envisioned.

  • History of Support: Evaluate previous social and professional support.

  • History of Loss: Acknowledge past losses that may affect current pregnancy.

  • Sense of Security: Establish feelings of safety and stability.

Adjustment for Fathers and Mothers

• Pregnancy presents adjustments for both mothers and fathers.

• Mothers face postpartum physical changes, and the demands of new parenthood can alter relationship dynamics.

• Employment Considerations: The Family Medical Leave Act (FMLA) allows eligible employees up to 12 weeks of unpaid leave for childbirth or adoption.

Unintended Pregnancies

• According to the UN’s sexual and reproductive health agency (UNFPA, 2022), nearly half of pregnancies worldwide are unintended, raising significant social work considerations.

Abortion and Miscarriage

• Abortion: Often a challenging and distressing choice for women, with social workers playing a supportive role during decision-making.

• Miscarriage: Defined as the spontaneous loss of a fetus before the 20th week of pregnancy, sometimes referred to as spontaneous abortion.

• Post-20 weeks losses are termed stillbirths.

Biophysical Dimension

Growth and Development

• The menstrual cycle culminates in the ovulation of a mature egg approximately two weeks after the onset of menstruation. Fertilization occurs in the fallopian tube, resulting in a zygote, which travels to the uterus for implantation.

• Upon implantation, the zygote becomes an embryo.

Physical Development of the Fetus

• The stages of labor include:

  • First Stage: Cervix dilation ranges from 0 to 10 cm. This stage can last from 12 to 14 hours and has two phases:

  • Latent phase: Mild contractions and slow dilation.

  • Active phase: Stronger contractions and faster cervical change.

  • Second Stage: Delivery of the baby when the cervix is fully dilated (10 cm). This stage lasts between 10 minutes to over 3 hours.

  • Third Stage: Delivery of the placenta, lasting 5 to 30 minutes.

  • Fourth Stage: Recovery and bonding, where the mother is closely monitored for complications.

Prepared Childbirth

Pain and Coping Strategies

• Pain Factors: The pain of childbirth arises mainly from cervical dilation and pressure during delivery.

• Pain Relief Options:

  • Medications: Early analgesics help in managing contractions.

  • Epidural Block: Considered the gold standard for pain relief; this method allows mothers to stay awake while numbing the lower body. It may be associated with increased rates of instrumental births.

  • Prenatal Exercise: Strengthens muscles and enhances flexibility to reduce discomfort.

  • Support Persons: The presence of doulas and continuous support can significantly improve birth experiences and outcomes.

Newborn Evaluations

Apgar Score

• Newborns undergo an Apgar assessment at one and five minutes post-birth. The evaluation includes:

  • Heart Rate:

  • 0 = No heartbeat

  • 1 = Fewer than 100 beats per minute

  • 2 = 100–140 beats per minute

  • Breathing:

  • 0 = No breathing

  • 1 = Irregular shallow breathing

  • 2 = Regular strong breathing and crying

  • Muscle Tone:

  • 0 = Limp

  • 1 = Weak flexion of arms and legs

  • 2 = Strong flexion of arms and legs

  • Color:

  • 0 = Blue body

  • 1 = Body pink, blue extremities

  • 2 = Body and extremities pink

  • Reflexes:

  • 0 = No response

  • 1 = Weak reflexive response

  • 2 = Strong reflexive responses like sneezing or crying.

Complications of Pregnancy

Early Pregnancy Complications

• Morning Sickness: Nausea and vomiting caused by hormonal changes, specifically elevated hCG and estrogen levels.

• Vaginal Bleeding: Early vaginal bleeding can indicate potential miscarriage; later bleeding can signal placental issues or complications such as placenta previa.

• Preeclampsia: High blood pressure after 20 weeks with protein in urine, requiring careful monitoring to prevent severe outcomes for mother and child.

• Gestational Diabetes: Develops during pregnancy impacting maternal and neonatal health.

Environmental Effects on Prenatal Development

Critical Factors

• Maternal Age: Advanced maternal age (>35) elevates risks for chromosomal abnormalities and complications.

• Multiple Gestations: Increased risks associated with carrying multiples necessitate closer prenatal care.

• Maternal Nutrition: Adequate nutrition is vital for fetal growth, particularly folic acid and iron, to mitigate potential defects and underdevelopment.

• Maternal Drug Use: Teratogens can adversely affect prenatal development, leading to instances like Neonatal Abstinence Syndrome (NAS) which requires medical management after delivery.

Problems in Newborns

• Hyperbilirubinemia (Jaundice): Excess bilirubin leads to yellowing; can evolve into severe complications if untreated.

• Hypoglycemia: Low blood sugar levels that require prompt treatment to avert lasting harm.

• Cerebral Hemorrhage: Premature infants are at increased risk for brain bleeds.

• Infections: Various infections during or after childbirth can pose severe risks to the newborn.

Psychological and Social Considerations

• Emotional responses of mothers post-birth, including sensitivity periods for bonding, are crucial for later infant development and maternal mental health, fostering secure attachment and resilience.

• The role of social support systems including community programs and healthcare interventions plays a vital role in postpartum recovery and infant care.

Multicultural and Ethical Considerations

• Understanding cultural beliefs and practices surrounding childbirth and maternal health, as well as addressing disparities in maternal and infant health outcomes in various populations, is essential for effective social work practices.