Birth and the Newborn Baby

How long can normal breathing in newborns be delayed usually not causing any brain damage?

- 10 minutes

Drugs during pregnancy

- 1950's & 1960's natural child birth movement - Many felt that routine use of strong drugs and delivery instruments had robbed them of a precious experience and was often neither necessary nor safe for the baby.

Stage 2: Delivery of the Baby

- 50 minutes for a first baby and 20 minutes in later births - Strong contractions of the uterus continue, but the mother also feels a natural urge to squeeze and push with her abdominal muscles. As she does so with each contraction, she forces the baby down and out. - Baby comes out wet will amniotic fluid and still attached to the umbilical cord

The Apgar Scale Readings

- A combined score of 7 or better indicates that the infant is in good physical condition. - 4 to 6 the baby requires assistance in establishing breathing and other vital signs - 3 or below, the infant is in serious danger and requires emergency medical attention.

Stage 3: Birth of the Placenta

- A few final contractions and pushes causes the placenta to separate from the wall of the uterus and be delivered in about 5 to 10 minutes.

Natural, or prepared child birth

- A group of techniques aimed at reducing pain and medical intervention and making childbirth a rewarding experience. - Participate in 3 activities: - Classes- Knowledge about the birth process reduces a mother's fear - Relaxation and breathing techniques - Labor Coach- husband learns how to help mother through labor. Mothers who are supported during labor have less complications.

Assessing the Newborn's Physical Condition: The Apgar Scale

- A scale used to assess the newborn's physical condition quickly which doctors and nurse uses. - Made at the 1st minute after birth and the 5th minute.

Cesarean Delivery

- A surgical birth makes an incision in the mother's abdomen and lifts the baby out of the uterus. - 37% of births in the United States - Have been warranted by medical emergencies, such as Rh incompatibility, premature separation of the placenta from the uterus, serious maternal illness, infection or baby is in breech position - After a women has a cesarean delivery having a vaginal birth is correlated with slightly increased rates of rupture of the uterus and infant death. - Mother and baby require more time for recovery - Anesthetic may have crossed the placenta, making cesarean newborns sleepy and unresponsive and putting them at increased risk for breathing difficulties.

isolette

- A term baby is cared for in a special Plexiglas- enclosed bed. - Temperature is controlled because these infants cannot yet regulate their own body temperature effectively.

What can happen 72 hours after after the initial brain injury from anoxia?

- Another phase of cell death can occur several hours later - Newborns should be placed in a head-cooling device shortly after birth fro 72 hours to reduce this secondary brain damage - Or newborns can lie on a precooled water balnket

Oxygen Deprivation

- Anoxia- inadequate oxygen supply, along with a build up of harmful acids and deficiency of vital blood substrates, as a result of decreased maternal blood supply during labor and delivery

Small-for-date infants

- Are below their expected weight considering length of pregnancy - Some are full term - more likely to die, catch infections, they are smaller in stature, have lower intelligence scores, less attentive, and show evidence of brain damage. - probably experienced inadequate nutrition before birth

What does the Kauai study tell use?

- As long as birth injuries are not overwhelming a supportive home can restores children's growth

Hormones and pregnancy

- As pregnancy advances, the placenta releases increasing amounts of corticotropin-releasing hormone (CRH), a hormone involved in the stress response. High levels of CRH trigger additional placenta hormone adjustments that induce uterine contractions. And as CRH rises in the fetal bloodstream in the final prenatal weeks, it stimulates fetal production of the stress hormone cortisol, which promotes development of the lungs in preparation for breathing.

Hearing

- At birth, infants prefer complex sounds, such as noises and voices, to pure tones. - Babies a few days old can tell the difference between a variety of sound patterns

The Newborn Baby's Appearance

- Average newborn is 20 inches long and 7 1/2 pounds in weight - Boys tend to be slightly longer and heavier than girls - The head is large in comparison to the trunk and legs.

Consequences for caregiving of Preterm and Low-Birth Weight Infants

- Babies are very sleepy, unresponsive and irritable. - Preterm babies are less often held close, touched, and talked to gently. - At a greater risk for Child Abuse

Preterm and Low-Birth-Weight Infants

- Babies that are born three weeks or more before the end of a full 38-week pregnancy or who weigh less than 5 1/2 pounds. - At risk for many problems - 12% of infants are born early - 8% are born underweight - Problem is highest among poverty-stricken women - African- American babies are especially vulnerable to an early and underweight birth. They have about twice the rates of white or Hispanic infants. - Common in multiple births

Arousal Patterns in relation to development

- Babies who spend more time alert probably receive more social stimulation and opportunities to explore and, therefore, may have a slight advantage in mental development.

Preterm infants

- Born several weeks or more before their due date

Respiratory distress syndrome

- Common in infants born more than six weeks early - Their tiny lungs are so poorly developed that the air sacs collapse, causing serious breathing difficulties. - Mechanical respirators keep many infants alive.

Training Parents in Infant Caregiving Skills

- Economic and personal resources to care for a preterm infant, just a few sessions of coaching is necessary - Infant lives in a stressed economically disadvantaged house-holds, long term intensive intervention is necessary.

Bonding

- Feelings of affection and concern for that infant

States of arousal

- Five states - Degrees of sleep and wakefulness. - Newborns spend about 16 to 18 hours a day asleep - Young babies' sleep-wake cycles are affected more by fullness-hunger than by darkness-light.

Instrument Delivery

- Forceps: metal clamps placed around the babies head to pull the infant from the birth canal. - Vacuum extractor: consists of a plastic cup (placed on the baby's head) attached to a suction tube. - Disadvantages: Forceps: - Using forceps to pull the baby through most or all of the birth canal greatly increases the risk of brain damage - Tear mother's tissues Vacuum extractor: - doubles the risk of bleeding beneath the baby's skin and on the outside of the skull compared with nonassisted deliveries. - Risk of seizures

Newborn Reflexes

- Gradually disappear during the first six months. Researchers believe that this is due to a gradual increase in voluntary control over behavior as the cerebral cortex develops. - Weak or absent reflexes, overly rigid or exaggerated reflexes, and reflexes that persist beyond the point in development when they should normally disappear can signal brain damage

Length of pregnancy and its importance

- Just 7 to 14 more days- from 34 to 35 or 36 weeks- greatly reduces rates of illness, costly medical procedures, and lengthy hospital stays. - Babies born even 1 or 2 weeks early showed slightly lower reading and math scores at a third grade follow-up than children who experienced a full-length prenatal period.

Sitting in an upright position while in labor?

- Labor is slightly shorter because contractions are stronger and pushing is more effective. The baby benefits from a richer supply of oxygen because blood flow to the placenta is increased, and fewer instances of infant heartbeat irregularities occur. - less likely to use pain-relieving medication or to have instrument-assisted deliveries.

Soothing a crying infant

- Lift the baby to the shoulder and rock or walk the baby. - Swaddling- wrapping the baby snugly in a blanket.

Labor

- Means child birth - complex series of hormonal changes initiates the process.

"Kangaroo Care"

- Most readily available intervention for promoting the survival and recovery of preterm babies. - It involves placing the infant in a vertical position position between the mother's breasts or next to the father's chest, so the parent's body functions as a human incubator. - Kangaroo skin-to-skin contact fosters improved oxygenation of the baby's body, temperature regulation, sleep, breastfeeding, alertness, and infant survival. - Provides gentle stimulation of all sensory modalities

Home delivery

- Number of Americans choosing home birth is less than 1%

Free standing birth centers

- Permit greater maternal control over labor and delivery.

Water birth

- Reduced maternal stress, shorter labor, lower episiotomy rate, greater likelihood of medication-free delivery than both back-lying and seated positions. - Posses no risk of infection or safety to mothers or babies as long as it is carefully manged by skilled health professionals

Is low birth weight transmitted across generations?

- Women who were underweight at birth themselves are twice as likely as other women to bear an underweight baby

Taste and Smell

- Relax their facial muscles in response to sweetness, pursue their lips when the taste is sour, and show distinct archlike mouth opening when it is bitter. - During pregnancy,, the amniotic fluid is rich in tastes and smells that vary with the mother's diet. - Young infants will readily learn to prefer a taste that at first evoked either a negative or neutral response.

Anoxia affecting children as they get older?

- Research suggests that the greater the oxygen deprivation, the poorer children's cognitive and language skills in early middle childhood. - Development is severely impaired, the anoxia was probably extreme.

What is the average for childbrith leave in the United States?

- Six weeks of childbirth leave is not enough. When a family is stressed by a baby's arrival, leaves of six weeks or less are linked to increased maternal anxiety, depression, marital dissatisfaction, sense of role overload, and negative interactions with the baby. - United states gives low amounts of childbirth leave compared to other countries

How do fathers change around the time of birth

- Slight increase in prolactin. - Slight increase in estrogens. - drop in Androgens.

Labor and Delivery Medication

- Some form of medication is used in over 60% of U.S. births

Adaptive Value of Reflexes

- Some reflexes have survival value. - Rooting reflex helps a breastfed baby find the mother's nipple. - Swimming reflex helps a baby who is accidentally dropped into water stay afloat, increasing the chances of retrieval by the caregiver.

Causes of Anoxia

- Squeezing of the umbilical cord - Placenta abruptio: premature separation of the placenta, a life-threatening event with a rate of infant death. Factors related include multiple fetuses and teratogens. - Placenta previa: a condition caused by implantation of the blastocyst so low in the uterus that the placenta covers the cervical opening. Factors related include previous cesareans and multiple fetuses. - Placenta abruptio & Placenta previa- account for 1 to 2 percent of births

Induced Labor

- Started artificially, usually by breaking the amnion, or bag of waters, and giving the mother synthetic oxytocin, a hormone that stimulates contractions. - 23% of American labors are induced - Justified when continuing the pregnancy threatens the well-being of mother or baby. - Contractions are longer, harder, and closer together, increasing the possibility of inadequate oxygen supply to the baby. - Mothers find it more difficult to stay in control of an induced labor. - Occasionally induction fails in which case a cesarean delivery is necessary

Transition

- The climax of stage 1 - the frequency and strength of contractions are at their peak and the cervix opens completely. - Most uncomfortable part of childbirth, it is important that the mother relax. Preventing the bruising of the cervix and slow the progress of labor.

Abnormal crying

- The cries of brain-damaged babies and those who have experienced prenatal and birth complications are often shrill, piecing, and shorter in duration than the cries of healthy infants.

Crying

- The first way that babies communicate, letting parents know that they need food, comfort, and stimulation. - Usually cry because of physical needs

The Baby's Adaptation to Labor and Delivery

- The force of the contractions intensifies the baby's production of stress hormones. Unlike during pregnancy, when excessive stress endangers the fetus, during childbirth high levels of infant cortisol and other stress hormones are adaptive. They help the baby withstand oxygen deprivation by sending a rich supply of blood to the brain and heart. Stress hormones arouse the infant into alertness and help prepare the newborn's lungs to breathe.

Rooming in

- The infant stays in the mother's hospital room all or most of the time.

Vision

- The least-developed for the new born baby's senses - Visual structures in both the eye and the brain are not yet fully formed at birth. - Visual acuity: fineness or discrimination is limited - Not yet good at discriminating colors. -

Stage 1 of labor: Dilation and Effacement of the Cervix

- The longest stage - lasts about 12 to 14 hours with a first birth, 4 to 6 hours with later births. - A uterine contraction gradually become more frequent and powerful, they cause the cervix to open (dilate) and thin (efface), forming a clear channel from the uterus into the birth canal, or vagina.

Neonatal Mortality

- The rate of death within the first month of life - Two factors: - serious physical defects - low birth weight

Oxytocin

- Toward the end of pregnancy mothers begin producing higher amounts of it - Causes the breasts to "let down" milk - Induces a calm, relaxed mood, and heightens responsiveness to the baby.

Breech position

- Turned so that the buttocks or feet would be delivered first. - 1 in 25 births - Sometimes a doctor can turn the baby during an early part of labor - head injuries more likely during birth - umbilical cord can cause deprivation of oxygen

Signs that indicate labor is near

- Uterus Contract (False labor or Prelabor) Remain brief and unpredictable for several weeks. - Two weeks before birth- lightening occurred- Joshua's head dropped low into the uterus. Placenta hormone changes causes the cervix to soften - Bloodly show- as the cervix begins to open, the plug of mucus that sealed it during pregnancy is released, producing a red dish discharge. Soon after, uterine contractions become more frequent, and mother and baby have entered the first of three stages of labor.

Approaches to Child Birth

- Village and tribal cultures= have the baby in full view of the entire community - Nonindustrialized cultures= women are assisted-- though not by medical personnel-- during labor and delivery. Birth attendants which are appointed by the village chief and are highly respected members of their communities.

Positions for Delivery

- When natural childbirth is combined with deliver in a birth center or at home, mothers often give birth in an upright, sitting position rather than lying flat on their backs with their feet in stirrups (the traditional hospital delivery room practice) . - Use of special seats to enable an upright birth has become more common.

Cerebral Palsy

- a general term for a variety of impairments in muscle coordination caused by brain damage before, during or just after birth. - The disorder can range from mild tremors to severe physical and mental disability. - 1 in 500 American Children - 10% experience Anoxia

Reflex

- an inborn, automatic response to a particular form of stimulation - new born baby's most obvious organized patterns of behavior.

Sleep is made up of at least how many states?

- at lest two states - Rapid-eye-movement (REM), sleep, brain-wave activity is remarkably similar to that of the waking state. The eyes dart beneath the lids; heart rate, blood pressure, and breathing are uneven; and slight body movements occur. - Non-rapid-eye-movement (NREM) sleep the body is almost motionless, and heart rate, breathing, and brain-wave activity are slow and even. - Alternate but spend far more time in REM state than they every will again. - Researchers believe that stimulation of REM sleep is vital for growth of the central nervous system.

Race-related stressors

- biased treatment at school, at work, or in access to housing-- predict lower birth weight, especially in African-American women

Special Infant Stimulation

- certain kinds of stimulation can help preterm infants develop. - rocking in suspended hammocks - attractive mobile or a tape recording of a heart beat, soft music, or the mother's voice. - touch is an especially important form of stimulation

episiotomy

- incision that increases the size of the vaginal opening

Epidural analgesia

- most common approach to controlling paid during labor - A regional pain-relieving drug is delivered continuously through a catheter into a small space in the lower spine. - Limits pain reduction to the pelvic region - Disadvantages: - Weakens contractions, prolonging labor and the chances of instrument delivery or cesarean (surgical) birth increase. - Exposes newborns to respirator distress - Lower Apgar scores - Sleepy and withdrawn - Suck poorly during feedings - Irritable when awake

Uterine contractions

- open the cervix are forceful and regular - starting out 10 to 20 minutes apart and lasting about 15 to 20 seconds.

Touch

- touch helps stimulate early physical growth. - New born babies respond to touch, especially around the mouth, on the palms and on the soles of the feet. - Infants are highly sensitive to pain. - Physical touch releases endorphins-- painkilling chemicals in the brain.

Sudden infant death syndrome (SIDS)

- unexpected death, usually during the night, of an infant younger than 1 year of age that remains unexplained after thorough investigation. - Show physical problems form the beginning. - Reveal higher rates of prematurity and low birth weight, poor Apgar scores, and limp muscle tone. - Impaired brain functioning - low levels of serotonin (a brain chemical that assists with arousal when survival is threatened) - SIDS babies are also more likely to sleep on their stomachs than on their backs and often are wrapped very warmly in clothing and blankets. - Pacifier use: sleeping babies who suck arouse more easily in response to breathing and heart-rate irregularities

Fetal Monitoring

-Are electronic instruments that track the baby's hear rate during labor. - Abnormal heartbeat pattern may indicate that the baby is in distress due to lack of oxygen and needs to be delivered immediately. - Used in over 85% of U.S. births - Strapped across mothers abdomen during labor - Thread a recording device through the cervix and place it directly under the baby's scalp. - Most infants have some heart beat irregularities during labor-- fetal monitors may identify many babies as in danger who, in fact, are not. - Monitoring is linked to an increase in the number of instrument and cesarean (surgical) deliveries

Apgar signs

Appearance = color Pulse = heart rate Grimace= reflex irritability Activity = muscle tone Respiration = Respiratory effort

Western Nations approaches

Before the late 1800s- birth usually took place at home and was a family-centered event. - The industrial revolution brought greater crowding to cities, along with new health problems- child birth moved from home to hospital.

What is the best available predictor of infant survival and healthy development?

Birth weight

Health issues with Preterm babies

Brain abnormalities, frequent illness, inattention, overactivity, sensory impairments , poor motor coordination, language delays, low intelligence test scores etc.

Certified nurse-midwives

Have degrees in nursing and additional training in childbirth management.

Anesthetics

Stronger type of painkiller that blocks sensation

What does an abnormal increase in maternal CRH in the third trimester of pregnancy indicate?

Premature Birth

Infant Mortality

The number of deaths in the first year of life per 1,000 live births-- an index used around the world to assess the overall health of a nation's children. - The United States has the most up-to-date health-care technology in the world, it has made less progress in reducing infant deaths than many other countries.

Crowning

The vaginal opening had stretched around the entire head

Medical Interventions

Use of medical procedures has reached epic proportions-- in part because of rising rates of multiple births and other high-risk deliveries which are associated with increased maternal age and use of fertility treatments. But births unaffected by these factors are also medicalized.

Analgesics

drugs used to relieve pain, may be given in mild doses during labor to help a mother relax.

Neonatal Behavioral Assessment Scale (NBAS)

evaluates the baby's reflexes, muscle tone, stage changes, responsiveness to physical and social stimuli, and other reactions.