CHAPTER 4: BIRTH & THE NEWBORN BABY

just before childbirth begins

• Dropping or Lightening: The head of the fetus settles in the pelvis.

• Braxton-Hicks Contractions: These are the first uterine contractions, which may be experienced as early as the 6th month of pregnancy.

• Blood Spotting: Blood spotting may occur in vaginal secretions a day or so before labor.

• Rush of Amniotic Fluid: In 1 in 10 women, there is a rush of amniotic fluid from the vagina.

• Prostaglandins Secretion: The placenta and uterus secrete prostaglandins, which excite the uterus muscles and cause contractions.

• Oxytocin Release: As labor progresses, oxytocin is released, stimulating contractions powerful enough to expel the baby.

the stages of childbirth

first stage of childbirth

• Uterine contractions efface and dilate the cervix.

• The first stage can last from a few hours to more than a day.

• Contractions increase in strength, frequency, and regularity.

• The mother may be prepped, including shaving pubic hair and administering an enema.

• Fetal Monitoring: Measuring fetal heart rate and the mother’s contractions.

• If necessary to speed up delivery, forceps or a vacuum extraction tube may be used.

• Transition:

  • Occurs for about 30 minutes.

  • The cervix is nearly fully dilated.

  • The head of the fetus moves into the vagina.

  • Frequent and strong contractions occur.

second stage of childbirth

• Begins when the baby appears at the opening of the birth canal and ends with the birth of the baby.

• Crowning: The baby’s head begins to emerge from the birth canal.

• Episiotomy: May be performed once crowning takes place (controversial and not practiced in Europe).

• The baby’s head and facial features may be misshapen upon birth.

• Once the baby’s head emerges, mucus is suctioned from the baby’s mouth to clear the passageway for breathing.

• The umbilical cord is clamped and severed.

• The newborn may be removed for:

  • Footprinting.

  • ID bracelet placement.

  • Application of antibiotic ointment or drops to the baby’s eyes.

  • Vitamin K injection.

third stage of childbirth

• Referred to as the placenta stage.

• Lasts from minutes to an hour or more.

• The placenta separates from the wall of the uterus and is expelled.

• If an episiotomy was performed, it is sewed.

methods of childbirth

anesthesia

• General Anesthesia:

  • Puts the mother to sleep.

  • Has negative effects on the infant, such as abnormal patterns of sleep and wakefulness and decreased attention/responsiveness shortly after birth.

• Local Anesthetics:

  • Deadens pain without putting the mother to sleep.

  • Has minor depressive effects on neonates shortly after birth.

• Natural Childbirth: No anesthesia is used.

hypnosis and biofeedback

• Hypnobirthing:

  • Women are encouraged to focus on relaxing scenes.

  • Teaches women to associate relaxation with contractions.

• Biofeedback:

  • Feedback is given to the woman on muscle tension and blood pressure.

prepared childbirth

• Lamaze Method:

  • Utilizes breathing and relaxation exercises to lessen fear and pain.

  • Teaches women to associate relaxation with contractions.

• Coach:

  • Aids the mother in the delivery room.

  • Provides social support to the mother during labor.

c-section

• Cesarean Section: The baby is delivered by abdominal surgery.

• Physicians may prefer a C-section to vaginal delivery when:

  • The mother has a small pelvis.

  • There is maternal weakness or fatigue.

  • The baby is too large.

  • The baby is in distress.

  • It may be used to bypass infections in the birth canal.

  • It may be used when the baby is facing the wrong direction.

home birth

• Good candidates for home birth are healthy women with little risk of complication and those who have previously given birth.

• A midwife assesses risk and proximity to emergency care.

birth problems

effects of oxygen deprivation

• Anoxia and Hypoxia: Oxygen deprivation.

  • Prenatal Oxygen Deprivation: Can impair the development of the central nervous system, leading to cognitive, motor problems, and psychological disorders.

  • Oxygen Deprivation at Birth: Predicted problems in learning and memory, and can cause health problems such as early-onset schizophrenia and cerebral palsy.

• Causes of Oxygen Deprivation:

  • Maternal disorders.

  • Immature respiratory system (baby).

  • Prolonged constriction of the umbilical cord during birth.

  • Breech presentation.

risks of prematurity and low birth weight

• Premature or Preterm Baby: Occurs before 37 weeks gestation (normal is 40 weeks).

• Low-Birth-Weight Baby: Weighs less than 5.5 pounds.

• Small for Date: Low-birth-weight, although born at full term.

• Infant Mortality:

  • Neonates weighing 3.25 to 5.5 pounds are 7 times more likely to die than infants of normal weight.

  • Those weighing less than 3.3 pounds are nearly 100 times as likely to die.

• Delayed Neurological Development:

  • Lower birth weight - poorer school performance.

  • Preschool experience fosters cognitive/social development.

• Delayed Motor Development: such as walking.

• Signs of Immaturity in Preterm Babies:

  • Relatively thin.

  • Fine, downy hair (lanugo).

  • Oily, white substance on skin (vernix).

  • Preterms born six weeks or more prior to full term:

    • Nipples not yet emerged.

    • Testicles of boys not yet descended into scrotum.

  • Immature muscles and weak reflexes.

  • Respiratory distress syndrome: Walls of air sacs in lungs stick together.

treatment of preterm infants

• Usually remain in hospital incubators, which provide a temperature-controlled environment with protection from infection.

• Parents often do not treat preterms as well as full-term babies because they are less attractive, have high-pitched, grating cries, and are more irritable.

• Preterms and parent interaction is less even when they are brought home; preterms with more responsive parents fare better.

• Interventions for Preterm Infants:

  • Benefit from external stimulation.

  • Massage.

  • Kangaroo care.

• Preterm infants exposed to stimulation:

  • Gain weight more rapidly.

  • Show fewer respiratory problems.

  • Make greater advances in motor, intellectual, and neurological development than controls.

the postpartum period

psychological problems postpartum

• Baby Blues: Transient, about 10 days, and do not impair the mother’s functioning.

• Postpartum Depression (PPD):

  • Present in as many as 1 in 5-10 women.

  • Begins one month after delivery and may linger for weeks/months.

  • Major depressive disorder with postpartum onset.

  • May involve psychotic features (1 woman in 500 – 1,000).

parental interaction with neonates in attachment

• Bonding: Formation of bonds of attachment between parent and child; the hours after birth are just one aspect of the bonding process.

• “Maternal sensitive” period: Amount of access to newborn (Klaus & Kennell, 1978); extended early contact is not essential for adequate bonding.

• Parent–child bonding is a complex process involving the desire to have a child and parent–child familiarity.

fathers and newborn bonding

• Australian study with professionally employed new fathers: Newborn bonding via the Internet.

• Swedish study on fathers and bonding with newborns: Assigned primary importance to spending time with the baby and provided positive feelings.

• Bonding is also affected by the father’s relationship with the mother and occurs partly by caring for the baby.

characteristics of neonates

assessment of health

• Apgar Scale: Based on five signs of health; interpretation of scores:

  • 7 or above: no danger.

  • Below 4: critical condition.

• Brazelton Neonatal Behavioral Assessment: Based on four areas of behaviors; measures reflexes, motor behavior, and muscle tone.

• Neonatal Intensive Care Unit Network Neurobehavioral Scale: Used to assess infants at risk.

reflexes

• Reflexes are simple, unlearned stereotypical responses, elicited by certain types of stimulation, and have survival value.

• Neural functioning is determined by testing reflexes.

• Rooting: Baby turns head and mouth toward stimulus that strokes the cheek, chin, or corner of the mouth; facilitates finding the mother’s nipple for sucking.

• Sucking: Babies will suck almost any object that touches the lips and will become replaced by voluntary sucking.

• Moro or Startle Reflex: Back arches, legs and arms are flung out and then brought back toward the chest into a hugging motion; occurs when the baby’s position is suddenly changed or head and neck support is lost; elicited by loud noises or bumping the baby; usually lost 6 to 7 months after birth.

• Grasping or Palmar Reflex: Using four fingers, babies grasp fingers/objects pressed against the palms of their hands; most babies can support their own weight; usually lost by 3 to 4 months; replaced by voluntary grasping at 5 to 6 months.

• Stepping Reflex: Mimics walking when held under arms; usually disappears by 3 or 4 months.

• Babinski Reflex: Fans or spreads toes in response to stroking the foot; usually disappears at the end of the first year.

• Tonic-Neck Reflex: While lying on the back, the baby turns head to one side; the arm and leg on that side extend, while the opposite side flexes.

vision

• Visual Acuity: Estimate of 20/600; best see objects 7 to 9 inches from eyes; lack peripheral vision of an older child; able to track movement within one day of birth; preference for moving objects.

• Visual Accommodation: Self-adjustments made by the eye lens to bring objects into focus; neonates show little or no visual accommodation; focus on objects 7 to 9 inches away.

• Convergence: Does not occur until 7 or 8 weeks.

• Color Perception: At birth, cones are less well developed than rods.

  • Cones transmit sensations of color.

  • Rods transmit sensations of light and dark.

  • Infants younger than 1 month lack the ability to discriminate color.

  • At 2 months, they require large-color differences.

  • At 4 months, they can see most if not all colors.

hearing

• Fetuses respond to sound.

• Neonates respond to amplitude and pitch.

• Show preference for mothers’ voices.

• Responsive to sounds and rhythms of speech and show no preference for specific languages.

smell & taste

• Smell:

  • Well-developed at birth.

  • Demonstrate aversion for noxious odors and preference for pleasant odors.

  • Recognize familiar odors.

• Taste:

  • Sensitive to different tastes.

  • Demonstrate facial expressions in response to tastes.

  • Prefer sweet tastes.

touch & pain

• Touch: Sensitive to touch; touch elicits many reflex behaviors.

• Pain: Past belief that neonates are not sensitive to pain; neonates are not cognitively equipped to ruminate about pain; conditionable - distress when confronted with a situation that previously presented itself as painful.

learning & neonates

• Classical Conditioning: Involuntary responses are conditioned to a new stimuli.

• Operant Conditioning: Behaviors (reflexes) are modified through reinforcement; requires rapid administration of reinforcers (e.g., The Cat in the Hat study - modified sucking reflexes).

patterns of sleep

• Neonates spend about 16 hours per day in sleep; a typical infant has six cycles of waking and sleeping; by 6 months, many infants begin to sleep through the night.

• REM Sleep:

  • Neonates spend 50% of their time in REM sleep.

  • At six months - 30%; 2 to 3 years - 20 to 25%.

• Non-REM Sleep: Four stages.

• Neonates may utilize REM sleep to stimulate the brain.

why do babies cry?

• Pain and discomfort. Close physical contact is the most helpful maternal response.

• Universal, expressive, and functional communication; expressive response to unpleasant feelings stimulates caregiver response.

• Crying produces a physiological response in others.

• Distinct causes and patterns of cries (hunger, anger, pain).

• Crying from colic can be severe and persistent; peaks of crying in late afternoon and early evening.

soothing a crying baby

• Physical contact is soothing.

• Sucking serves as a built-in tranquilizer (pacifier, sweet solutions).

• Soothing processes: Pick the baby up, patting, caressing, rocking them; speaking to them in a low voice.

sudden infant death syndrome SIDS

what is SIDS?

• Sudden Infant Death Syndrome – crib death; strikes while the baby is sleeping.

• More common among babies between the ages of 2 and 4 months.

• More common among babies who sleep on their stomachs.

• The causes of SIDS remain obscure (Children’s Hospital Boston Study).

risk factors for SIDS

• SIDS is most common among:

  • Babies aged 2 to 4 months.

  • Babies put to sleep on their stomach.

  • Premature and low-birth-weight babies.

  • Males.

  • Families of lower SES.

  • Bottle-fed babies.

  • African Americans.

  • Babies of teenage mothers and babies of mothers who smoked or used narcotics during pregnancy.