PSYC 319: Birth Options and Birth

low birth weight

- highly correlated with pre term birth - when the weight of the baby is under 5.5lbs

effects of anoxia

- if breif: fixable - if extended: can cause brain development problems and seizures

what do most doctors do to try and fix breech position

- most doctors try to move the baby prior to delivery if the baby is seen ahead of time to be in breech position - there's also a medication that can be taken that relaxes uterine muscles so baby can move around

Hannah et. Al Term Breech Trial: Findings

- no difference in: (1) adjustment to motherhood (2) need for medical intervention after hospital discharge (3) sex relations with husbands (4) pain (5) depression (6) breast feeding (7) difficulties with subsequent pregnancies - mothers with C-sections reported more pain in abdomen - mother with vaginal delivery reported more pain in bottom/genital area - mothers with C-sections reported less urine incontinence

Hannah et. Al Term Breech Trial: Conclusions

- no major difference in negative outcomes (at 3 months) associated with C section vs vaginal delivery

infant massage

- parents taught to massage infants even very premature infants - use moderate pressure to massage skin - use exercises with infants, moving and flexing their limbs - this massage has been shown to increase weight in infant

in what ways can the umbilical cord be blocked off from giving oxygen to the baby

- pinched - twisted (maybe because of unusual position) - placent pulls away from uterine wall

NICU

- primary goal of care is to maintain and enhance physical well being through artificial means - not similar to either the womb or home environment (lots of noise, light, many caregivers) - traditionally limits interactions between infants and parents

Hannah et. Al Term Breech Trial: assignment

- randomly assigned to either planned C-section or planned vaginal delivery

studies regarding infants in NICU and parents and infection

- showed that there were no increases in infection rates when infants were handled with their mother - subsequent studies found benefits to parents interacting with infants

kangaroo care

- skin to skin contact with primary caregiver - Initially developed for premature infants in areas where there was a shortage of incubators and health-care workers

risks of home birth

- some studies show a higher rate of neonatal death

Bayley Scale

- standard measure - has two subscales: (1) mental development (2) psychomotor development

stages of labour: stage 2

- the actual birth - contractions push the head of the baby and then the body out through the birth canal

infant or mother mortality

- the most drastic birth complication - less common now then it used to be, but it does still happen since birth is a major bodily event for both the mother and the infant

vertical incision vs horizontal

- vertical is the uncommon one and usually happens if the baby is sideways - if you receive a vertical (also called classical) then for future pregnancies, you can only give birth through C-sections

anoxia

- when the supply of oxygen to the baby from the umbilical cord is cut off before the baby can breathe independently

very low birth weight

- when the weight of the baby is under 3.5 lbs

Feldmen study: results at discharge

with kangaroo care: - mothers showed more positive affect - mothers touched and looked at infants more - infants looked at mother's more - infants were more alert - no difference in vocalization

Hannah et. Al Term Breech Trial: subject

women with frank/breech presentation at term

consequences for preterm birth (the survivability, health problems and developmental delays) are more pronounced for?

very preterm infants

preterm birth

when the baby is born before 36-37 weeks

breech position

when the baby is position feet down

what risks may cause preterm birth to be induced

- get to 26 weeks and something is wrong, better to deliver sooner - mom has high bp and high protein in the urine - placenta feeding baby detached from uterus

statistics on preterm babies

- 8-12% of births are preterm - 8% in Canada - 12% in US - rates in Canada going up but that may be due to multiple birthds

birth is still a mystery but what do we know about how birth happens?

- a release of oxytocin triggers uterine contractions that push the baby out into the world

what is a caesarean section

- an option for birth - when the abdomen is cut open and the baby is delivered through the abdomen

home birth statistics

- approximately 1/200 women deliver at home - 3/4 are planned - 1/4 are unplanned because delivery happens to quickly and there's no time to get to the hospital

very preterm

- born earlier than 32 weeks (so born before 3 months)

Feldman study: results at 6 month

- both low risk and high risk infants who did kangaroo care did better on mental development scale - only improvement for high risk in psychomotor care - maternal sensitivity higher at 6 mos for those who did kangaroo care

Feldman study: results at 3 months:

- both mothers and fathers seem to be providing a more nourishing environment - they respond more - they pay more attention - low risk infants: the moms who did kangaroo infants seem to be less depressed - high risk: has no difference in depression in mothers

stages of labour: stage 3

- contractions push out the placenta, fetal membranes and remainder of the umbilical cord out

survivability of preterm infants

- depends on the hospital - youngest a baby can survive out of the womb is 22 weeks (18 weeks before birth) - the smallest baby was around 0.5lbs

immediate health problems of preterm infants

- difficulty breathing - lung disease - brain complications - seizures - feeding difficulties

benefits of home birth

- fewer medical interventions - less surgeries

Hannah et. Al Term Breech Trial: follow up

- follow up at 3 months post partum with the mothers analyzed according to "intention to treat"

Hannah et. Al Term Breech Trial: long term outcomes?

- follow up study at 2 years - found no differences found between those who delivered vaginally vs. c-section - no differences in ANYTHING

long term health problems of preterm infants

- frequent hospital stays (2-3x more likely to have hospital stays) - eye sight issues

treatment for preterm birth

1) NICU 2) infant massage 3) kangaroo care

Feldman study: what was observed in the infants?

1) at discharge: mother infant interaction, depression inventory, neonatal parental inventory 2) 3 motnhs: home evaluation (both parents), infant temperament 3) 6 months: mother infant interaction, Bayley scale of Infant development

when are C-sections typically used

1) cervix doesn't open wide enough 2) oxygen might get cut off due to position 3) infant's health is at risk 4) mother has infections (sexual infections like herpes or HIV) that could create risk to being passed on to child

what does kangaroo care claim to do?

1) improve temperature regulation 2) improve respiratory patterns 3) increase infant weight gain 4) increase maternal milk production 5) increase maternal feelings of competence, attachment 6) decreases length of hospital stays

what are some possible birth complications?

1) infant or mother mortality 2) anoxia 3) pain to the mother 4) preterm birth

why does preterm birth happen?

1) issues with mother's reproductive system or health 2) multiple births (twins or more) 3) might be induced because mother or fetus is at risk

developmental delays in preterm infants

1) lower IQ 2) learning/school disabilities 3) motor delays -about 1/3 to 2/3 of very premature babies have a learning difficulty

what are the adverse outcomes of being a "small-for-gestational-age" infant?

1) lower IQ, poorer academic performance 2) motor development problems 3) behaviour problems

what are the possible reasons for the benefits that come with Kangaroo care? (Still Feldman study)

1) maybe the effects of proximity vs. separation after birth (sensory input of mother's touch, smell, heartbeat, etc.) 2) skin to skin contact may release oxytocin in the mother 3) transaction model: kangaroo care impacts both the mother and child who then impact each other

what are the eligibility requirements for home birth in BC?

1) mom can't have a pre-existing disease, including heart disease, hypertensive chronic renal disease or type 1 diabetes 2) mom can't have significant disease arising during pregnancy 3) no multiples 4) baby can't be premature 5) mom had no more than 1 c section 6) labour is spontaneous or induced on an outpatient basis 7) mom has not been transferred to delivery hospital from a referring hospital

what are the risks of C sections?

1) more bleeding 2) more infection 3) emotional bonding difficulties - more issues breastfeeding - more post partum depression - more negative feelings

what kind of issues with a mother's reproductive system or health could create the risk of preterm birth?

1) mother having an immature reproductive system (associated risk of premature birth with teen mothers - reproductive system not fully developed) 2) not a lot of time between pregnancies (reasoning: reproductive system doesn't have enough time to heal itself between births) 3) conditions associated with health (drug use, malnutrition, living in poverty, unhealthy lifestyle)

what were some questions/issues that came up with Feldman's study?

1) not a true randomized sample 2) doesn't tell us much about long term affects after 6 months 3) raises questions about the effects of kangaroo care if with non-mothers

Feldman study: method

1) premature infants from two different hospitals were studied - one with kangaroo care, one without 2) infants were observed at discharged, 3, and 6 months

preterm birth is associated with

1) respiratory distress syndrome - because lungs don't produce enough surfactin 2) infection - because immune system hasn't developed fully 3) low birth weight - smaller than average size which is associated with a bunch of negative consequences

why are most children delivered through c section

1) size 2) risk of umbilical cord being blocked 3) inexperience of doctors with breech delivery

why do parents choose home birth?

1) to focus on the introduction of the infant to parent and home environment 2) frustration with the medical system 3) dislike hospitals 4) want to deliver in a familiar and relaxed environment 5) want to be close to newborn after birth 6) want to avoid medical intervention

what are the risks of vaginal delivery?

1) urinary incontinence 2) fecal incontinence 3) flatus incontinence

conclusions of long term effects of the Feldman study

Kangaroo care has a positive "long term" impact on infant-parent interactions and infant cognitive abilities

conclusions about parents who engaged in Kangaroo care in the Feldman study

Parents who had engaged in kangaroo care after birth: 1) provided more stimulating and responsive environments 2) were more sensitive and warm to their infant 3) had lower rates of depression

Feldman study: question

are there long term benefits associated with kangaroo care vs standard care?

why is it difficult to research c section and vaginal delivery?

because it's hard to randomized conditions

stages of labour: stage 1

uterine msucles open the cervix to around 4 inches

what is the best position for a baby before birth

cephalic = head down

incontinence

difficulties keeping bodily fluid under control

Hannah et. al's study on C-section

first randomized study of the outcomes associated with vaginal vs. c section

what does it mean to be small-for-gestational-age

it means that these infants are born with birth weight lower than what is expected for that age

when does birth happen

occurs approximately 9 months after conception (approx 40 weeks)