Pregnancy, Birth, and the Newborn

Assessing Expectant Parents

• Attachments and commitments

• How they are mentally representing the fetal infant

• Past history of social and professional support

• History of loss

• Sense of security

• Work and Parental leave policies

Biophysical Dimension

• Stages of Prenatal Development

  1. Ovum: 1-4 weeks

     • Zygote (fertilized ovum) implants in uterine lining

Stages of Prenatal Development (cont.)

• Embryo: 2-7 weeks

  • 90% formed (basic structures in place)

  • Critical period: Embryo is most vulnerable to environment

• Fetus: 8-40 weeks

  • Refinement and growth of basic structures (last 2 months stores fat)

  • At 24 weeks has a chance of survival outside the womb

• Term Pregnancy

  • Early Term: 37 weeks 0 days to 38 weeks 6 days

  • Full Term: 39 weeks 0 days to 40 weeks 6 days

  • Late Term: 41 weeks 0 days to 41 weeks 6 days

  • Post Term: 42 weeks and beyond

Prenatal Life Support Systems

1. The Placenta

   • Small molecules pass between mother and embryo

2. The Umbilical Cord

   • Connects embryo to placenta

3. The Amnion

   • Bag in which embryo floats

Abortion

• The spontaneous or induced ending of pregnancy

• 75% of spontaneous abortions occur in the first 12 weeks

• Not all vaginal bleeding is a miscarriage

• Social worker plays supportive role, separating personal from professional values

• Women have less regret and emotional problems when the choice is not forced

Stages of Labor

• First Stage: 12 to 14 hours

  • Cervix dilates to 10 cm

• Second Stage: 10 minutes to 3+ hours

  • Baby delivered

• Third Stage: 5-30 minutes

  • Placenta delivered

• Fourth Stage: 1-3 hours

  • Recovery (family) time

  • “Golden hour” (skin to skin is critical for bonding and growth and development of the baby)

Newborns

• Weight: 5.5 – 9.5 lbs, cone-shaped head

• Apgar score: adaptation to life outside womb

  • Assessed at 1 & 5 minutes after birth

  • Evaluates: Heart rate, breathing, reflex, muscle tone, color (scored 0, 1 or 2 for each category)

  • 7-10: considered good

  • 5-7: poor (may need medical intervention)

  • Score of 0-4 at 5 min: likely associated with neurological defects

Biophysical Hazards

• Complications of Pregnancy

  • Frequent vomiting or hyperemesis gravidarum

  • Vaginal bleeding

    • Can lead to spontaneous abortion in early pregnancy

  • Vaginal bleeding in later pregnancy

    • e.g., placenta previa when the placenta separates from the wall of the uterus.

  • Toxemia

    • Due to protein in the urine

  • Eclampsia

  • Gestational diabetes

  • Intrauterine growth retardation (IUGR)

Biophysical Hazards (cont.)

• Maternal Age

  • 18-35 ideal biological age

• Nutrition

  • Extra 300 calories a day (25-30 lbs)

  • Last 3 months high in protein

• Maternal stress & illness

• Multiple gestations are riskier and have younger gestational ages

• Sexually transmitted illnesses can be transferred

Biophysical Hazards: Drug Use

• Teratogen: Any agent (substance) that causes a birth defect

  • Increases chance of miscarriage, low birth weight, cognitive abilities, etc.

• Drug use can cause addicted infants

  • Have difficulty actively engaging in their environment (increased risk for abuse)

• Alcohol: biggest preventable cause of developmental disabilities

• Importance of prenatal testing

  • Drug testing, ultrasound (identify anomalies)

  • May require ethical decisions of whether to terminate pregnancy

Prenatal Testing

• Ultrasound or sonogram

• Alpha-fetoprotein blood screening

• Amniocentesis

• Chorionic villus sample (CVS)

• Timing and safety of administration of these different types of tests

• Non-invasive testing based on cell-free DNA analyses

• Ethical dilemmas

  • Terminating pregnancy if fetus has major birth defect

Birth Complications

• Anoxia and potential causes

• Meconium aspiration and potential respiratory complications

• Malpresentation

• Perinatal difficulties such as cord wrapped around the neck

• Prolonged labor

High-Risk Infants

• Low birth weight (< 5 \frac{1}{2} lbs)

• Prematurity (< 38 weeks)

• Intrauterine growth retardation (prenatal deprivation that retards growth)

• Increased risk for many developmental disabilities

• Need support for child and parents

Consequences of Premature Birth

• Respiratory distress syndrome (RDS)

  • Treatment for RDS must be provided with caution to avoid complications

  • Retinopathy caused by high oxygen levels

  • RDS children often placed on ventilators

  • Bronchopulmonary dysplasia (BPD): a complication seen in children placed on ventilators

Psychological Dimension

• Fetus responds to pain, light, touch, taste

• At 26 weeks responds to sound vibration

• Demonstrates habituation (learning)

• Recognizes mothers voice at birth

• Mothers emotions affect the fetus

  • Depression/anxiety related to lower birth weight

• 10% of time spent in quiet alert state

• Learn to recognize when baby has had enough, particularly in NICU

• Brazelton Neonatal Assessment Scale (BNAS) < 1 month of age

  • Assess reactivity and regulation (Baby IQ)

Newborn Characteristics

• Can focus on objects

• Prefer contrasting, complex patterns

• Prefer high pitched sounds, such as a female voice

• Prefer sweet over salty, acidic, or bitter

• Can imitate facial expressions, such as sticking out their tongue

Attitudes, Emotions, and Regulation

• Colic: prolonged bouts of crying in the late afternoon and evening

  • Lasts from approximately two weeks to four months of age, peaking around six weeks of age.

  • The "rule of three" to diagnose colic in otherwise healthy and well-nourished babies:

    • Crying occurs for more than three hours per day

    • For more than three days per week

    • For more than three weeks

  • Organic causes of colic account for less than 5% of cases (e.g., constipation, lactose intolerance, meningitis, abuse).

  • Primarily, the causes of colic are gastrointestinal, psychosocial, or neurodevelopmental.

Newborn States

• Quiet alert

• Active alert

• Crying state

• Drowsiness state

• Quiet sleep

• Active sleep

• Infants use sleep to control environment

Newborn Reflexes

• Rooting

• Walking

• Crawling

• Palmar Grasp

• Doll's eye

• Moro

• Babinski

• Tonic Neck

Psychological Strengths & Hazards

• Sensitive period just after birth for bonding – the “golden hour”

• Importance of early mother-infant contact has impacted hospital birthing practices, including skin-to-skin contact and breastfeeding encouragement

• 15-20% experience post partum depression and anxiety

• Babywearing as a therapeutic tool

Social Dimension

• Healthy babies need support & stimulation in the home

• Intervention programs provide support, education, & encourage prenatal care (decreases risk of abuse)

• Cultural differences among newborns: African Amer vs. White or Latino babies

Infant Mortality Rates

• Rates of infant mortality in U.S. are higher than most developed nations

• Mortality rates were 6.1% for White infants, 14.1% for Black infants (1996); Hispanic infant mortality is similar to Whites

• The primary reason for death among white infants was congenital abnormalities and for African American infants was low birth weight

• What contributes to these differences?

• What are some policy implications?

Social Strengths & Hazards

• Social Risk factors

  • Poverty

  • Domestic Violence

    • 1 in 4 women are physically abused during pregnancy

    • Increases risk of miscarriage, low birth weight/preterm labor

Prenatal Information to Obtain During an Assessment

• Gestation

• Birth

• Newborn