Transcript vernix caseosa - McGraw Hill Higher Education

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Chapter 4
Prenatal Development
and Birth
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“There was a star danced and
under that I was born.”
- William Shakespeare
English Playwright, 17th Century
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Learning Goals
1. Describe prenatal development.
2. Discuss the birth process.
3. Explain the changes that take place in the
postpartum period.
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Prenatal Development
and Birth
Prenatal
Development
Birth
The Postpartum
Period
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Prenatal
Development
The Course
Of Prenatal
Development
Teratology and
Hazards to
Prenatal
Development
Prenatal
Development
Cultural Beliefs
About
Pregnancy
Positive
Prenatal
Development
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The Course of Prenatal
Development
• The Germinal Period
• The Embryonic Period
• The Fetal Period
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The Germinal Period
• Occurs in the first 2 weeks after conception.
• By about 1 week after conception, the
zygote is composed of 100 to 150 cells.
• Period includes the creation of the zygote,
continued cell division, and attachment of
the zygote to the uterine wall.
• Implantation, or attachment to the uterine
wall, occurs about 10 days after conception.
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The Differentiation of Cells
• Blastocyst - the inner layer of cells that
develops during the germinal period
and later becomes the embryo
• Trophoblast - the outer layer of cells
that develops during the germinal
period and later provides nutrition and
support for the embryo
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The Embryonic Period
• Occurs from 2 to 8 weeks after
conception
• The rate of cell differentiation
intensifies, support systems for the
cells form, and organs appear
• The name of the mass of cells now
changes from zygote to embryo
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Cell Layers of the Embryo
• Endoderm - inner layer; develops into the
digestive and respiratory systems
• Ectoderm - outermost layer; becomes the
nervous system, sensory receptors (ears,
nose, eyes), and skin parts (hair and nails)
• Mesoderm - middle layer; becomes the
circulatory system, bones, muscles,
excretory system, and reproductive system
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Prenatal Life-Support Systems
• The Placenta - consists of a disk-shaped group of
tissues in which small blood vessels from the
mother and the offspring intertwine but do not join
• The Umbilical Cord - contains two arteries and
one vein, that connects the baby to the placenta
• The Amnion - a bag or envelope that contains a
clear fluid in which the developing embryo floats
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Important Embryonic Developments
•
•
•
•
Third Week - Neural tube develops
21 Days - Eyes begin to appear
24 Days - Heart cells begin to differentiate
Fourth Week - First appearance of the urogenital
system, arm and leg buds appear, chambers of the
heart take shape, blood vessels surface
• Fifth to Eighth Week - Arms and legs differentiate
further, face starts to form, intestinal tract develops,
facial structures fuse
• 8 Weeks - organisms weighs 1/30 ounce, 1 inch long
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Definition of Organogenesis
• The process of organ formation
that takes place during the first
2 months of prenatal
development
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The Fetal Period
• The period that begins 2 months after
conception and lasts, on average, 7 months
• Significant time periods:
– Three months after conception
– The end of the fourth month
– The end of the fifth month
– The end of the sixth month
– The end of the seventh month
– The eighth and ninth months
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Three Months after Conception
• The fetus is 3 in. long and weighs 1 oz.
• The fetus becomes active, moving its arms,
legs, head, and opening and closing its
mouth.
• The face, forehead, eyelids, nose, chin,
upper arms, lower arms, hands, and lower
limbs are all distinguishable.
• The genitals can be distinguished as male or
female.
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The End of the Fourth Month
• The fetus is 6 in. long and weighs 4-7
oz.
• A growth spurt occurs in the body’s
lower parts.
• Prenatal reflexes are stronger.
• Arm and leg movements can be felt by
the mother for the first time.
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The End of the Fifth Month
• The fetus is 12 in. long and weighs
close to 1 lb.
• Structures of skin have formed (such as
toe and finger nails).
• The fetus is more active, and shows a
preference for a particular position in
the womb.
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The End of the Sixth Month
• The fetus is approximately 14 in. long
and weighs about 2 lbs.
• The eyes and eyelids are completely
formed.
• A fine layer of hair covers the head.
• A grasping reflex is present.
• Irregular breathing movements occur.
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The End of the Seventh Month
• The fetus is 16 in. long and weighs 3
lbs.
• The fetus is adding body fat.
• The fetus is very active.
• Basic breathing begins.
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The Eighth and Ninth Months
• The fetus grows longer and gains
substantial weight, about another 4 lbs.
• Fatty tissues develop, and the
functioning of organ systems, such as
heart and kidneys, increases.
• At birth, the average American baby is
about 20 in. long and weighs 7 lbs.
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Teratology and
Hazards to Prenatal
Development
Prescription
And
Nonprescription
Drugs
Psychoactive
Drugs
Illegal
Drugs
Incompatible
Blood Types
Environmental
Hazards
Other Maternal
Factors
Paternal
Factors
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• Teratology - The field of study that investigates the
causes of birth defects.
• Teratogen - Any agent that causes a birth defect.
• Numerous teratogens exist, thus almost every fetus
is exposed to at least some.
• Specific teratogens do not usually cause a specific
birth defect.
• It may take a long time for the effects of a teratogen
to show up.
• Only about half of all potential effects appear at birth.
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Factors that influence the severity of the damage to
an unborn child and the type of defect that occurs:
• Dose – the greater the dose, the greater the effect.
• Time of Exposure – Teratogens do more damage
when they occur at some points in development
rather than others.
• Genetic Susceptibility – based upon genotype of
pregnant mother and genotype of the fetus
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Prenatal Sensitivity to
Teratogens
• Sensitivity during
Organogenesis
• Sensitivity during the Fetal
Period
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Sensitivity during Organogenesis
• The probability of a structural defect is
greatest during organogenesis.
• 15 - 25 days after conception, the brain is
most vulnerable.
• 24 - 40 days after conception, the eyes are
most vulnerable.
• 20 - 40 days after conception, the heart is
most vulnerable.
• 24 - 36 days after conception, the legs are
most vulnerable.
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Sensitivity during the Fetal
Period
• Exposure is less likely to cause
anatomical defects.
• Exposure is more likely to stunt
growth.
• Exposure is more likely to create
problems in organ functioning.
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Prescription and
Nonprescription Drugs
• Both can have possible effects on the fetus.
• A tragic example is with the tranquilizer
thalidomide, prescribed in the early 1960s.
• Mothers do not have to be chronic drug
users for the fetus to be harmed.
• Taking the wrong drug at the wrong time is
enough to physically handicap offspring for
life.
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Prescription Drugs that Can
Function as Teratogens
• Antibiotics (streptomycin,
tetracycline)
• Some depressants
• Certain hormones (progestin,
synthetic estrogen)
• Accutane
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Nonprescription Drugs that
Can Function as Teratogens
• Diet Pills
• Aspirin
• Caffeine
– A small increase in the risks for spontaneous abortion
and low birthweight occurs for pregnant women
consuming >150 mg caffeine per day.
– No effects were found for pregnant women who drank
decaffeinated coffee.
– FDA recommends either no caffeine or very little.
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Psychoactive Drugs
• Alcohol
• Nicotine
• Illegal Drugs
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Alcohol
• Heavy Drinking
• Moderate Drinking
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Heavy Drinking during
Pregnancy
• Fetal Alcohol Syndrome (FAS) - A cluster
of abnormalities that appears in the
offspring of mothers who drink alcohol
heavily during pregnancy
– Facial deformities
– Defective limbs, face, and heart
– Below average intelligence, with some cases of mental
retardation
– Adults with FAS found to have a high incidence of
mental disorders, such as depression or anxiety
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Moderate Drinking during
Pregnancy
• “Moderate” is defined as 1 to 2 drinks a day.
• Infants were less attentive and alert, with
effects still present at 4 years of age.
• Study showed that prenatal alcohol exposure
was a better predictor of adolescent alcohol
use and its negative consequences than was
family history of alcohol problems.
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Nicotine
• Fetal and neonatal deaths are higher among
smoking mothers.
• There exists a higher incidence of preterm
births and lower birthweights.
• Intervention programs designed to get
pregnant women to stop smoking can
reduce some of smoking’s negative effects,
especially by raising birthweights.
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The Research on Smoking
during Pregnancy
• Studies have shown urine samples of newborns
with smoking mothers had substantial amounts of
one of the strongest carcinogens in tobacco smoke
(NNK).
• Another study showed prenatal exposure to
nicotine was related to poorer language and
cognitive skills at 4 years of age.
• Respiratory problems and SIDS are more common
among the offspring of mothers who smoked
during pregnancy.
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Illegal Drugs
• Cocaine
• Marijuana
• Heroin
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Cocaine Use during Pregnancy
• Cocaine exposure during prenatal development is
associated with reduced birthweight, length, and
head circumference.
• Cocaine exposure has been associated with
impaired motor development at 2 years of age.
• Fetal cocaine exposure is also linked with
impaired information processing (poor attentional
skills through 5 years of age; impaired processing
of auditory information after birth).
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Other Related Influences
• Research findings must be interpreted with
caution due to the presence of other factors
in the lives of pregnant women who use
cocaine:
– Poverty
– Malnutrition
– Other substance abuse:cigarettes,
marijuana, alcohol, amphetamines
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Marijuana Use during
Pregnancy
• Associated with increased tremors
and startles among newborns
• Associated with poorer verbal and
memory development at 4 years of
age
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Heroin Use during Pregnancy
• Young infants are addicted and show withdrawal
symptoms characteristic of opiate abstinence:
– Tremors
– Irritability
– Abnormal crying
– Disturbed sleep
– Impaired motor control
• Behavioral problems are still present at 1 yr-old.
• Attention deficits may appear later in development.
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Environmental Hazards
• Radiation: nuclear environments,
X-rays, computer monitors
• Chemicals: carbon monoxide,
mercury, lead, pesticides, PCBs
• Heat: saunas, hot tubs
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Findings on Radiation
Exposure
• Can cause gene mutation
• Can cause chromosomal
abnormalities
• X-rays can effect the developing
embryo most during the first
several weeks after conception.
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Findings on Hazardous
Chemicals
• Early exposure to lead affects children’s
mental development.
• Women who ate PCB-polluted fish were
more likely to have smaller, preterm infants
who reacted slowly to stimuli.
• Prenatal exposure to PCBs has also been
associated with problems in visual
discrimination and short-term memory in
4-year-old children.
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Effects of Exposure to High
Temperatures
• Prolonged exposure to heat in saunas
or hot tubs that raises the mother’s
body temperature creates a fever that
endangers the fetus.
• The high temperature may interfere
with cell division and may cause birth
defects or even fetal death.
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Other Maternal Factors
• Infectious Diseases
• Nutrition
• Emotional States and Stress
• Maternal Age
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Infectious Diseases
• Rubella
• Syphilis
• Genital Herpes
• AIDS
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Rubella
• (or German Measles) Greatest damage occurs
when contracted in the 3rd and 4th weeks of
pregnancy, although infection during the 2nd
month is also damaging.
• A rubella outbreak in the mid 1960s resulted in
30,000 prenatal and neonatal deaths.
• It also caused more than 20,000 infants to be
affected, displaying mental retardation, blindness,
deafness, and heart problems.
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Syphilis
• Syphilis is a sexually transmitted disease.
• It is more damaging in later prenatal development,
4 months or more after conception.
• It damages organs after they are formed, including
– eye lesions (which can cause blindness)
– skin lesions
• If it is present at birth it can cause problems with
the central nervous system and gastrointestinal
tract.
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Genital Herpes
• Newborns contract the virus when they are
delivered through the birth canal of a mother with
genital herpes.
• One-third of babies delivered through an infected
birth canal die.
• One-fourth of babies delivered through an infected
birth canal become brain damaged.
• If an active case of genital herpes is detected close
to a woman’s due date, a cesarean section can be
performed to keep the newborn safe.
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AIDS
• AIDS is a sexually transmitted disease which
destroys the body’s immune system.
• A mother can infect her offspring in three ways:
– during gestation across the placenta
– during delivery through contact with maternal body
fluids
– postpartum through breast feeding
• Babies born to infected mothers can be
– infected and symptomatic
– infected but asymptomatic (with the possibility of
developing symptoms up until 15 months of age)
– not infected at all
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Nutrition
• A developing fetus depends completely on its
mother for nutrition, which comes from her blood.
• Important factors of nutritional status are
– total number of calories
– levels of protein, vitamins, and minerals
– folic acid
• A folic acid deficiency is linked with neural tube
defects, such as spina bifida.
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Emotional States and Stress
• Effects on Pregnancy
• Effects on Labor and Delivery
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Effects of Stress on Pregnancy
• Mother’s stress can be transmitted to the fetus.
• When a pregnant woman experiences intense
fears, anxieties, and other emotions, physiological
changes occur.
– respiration
– glandular secretions, such as adrenaline
• These affect the fetus through, for example,
restricting blood flow to the uterine area depriving
the fetus of adequate oxygen.
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Effects of Stress on Labor and
Delivery
• A mother’s emotional state during pregnancy can
influence the birth process.
• An emotionally distraught mother may have
irregular contractions and a more difficult labor.
• This can lead to irregularities in the baby’s oxygen
supply or irregularities after birth.
• Research has found women under stress are four
times as likely to deliver their babies prematurely.
• Research has found that pregnant women who are
optimists have less adverse birth outcomes.
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Maternal Age
• Adolescence
• The Thirties and Beyond
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Adolescence
• Infants born to adolescents are often premature.
• The mortality rate of infants born to adolescent
mothers is double that of infants born to mothers in
their twenties.
• May be due to
– immature reproductive systems
– poor nutrition
– lack of prenatal care
– low SES
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The Thirties and Beyond
• The risk of Down Syndrome increases after
the mother reaches age 30.
• Women have more difficulty getting
pregnant after the age of 30.
• As women remain active, exercise regularly,
and are careful about their nutrition, their
reproductive systems may remain healthier
at older ages.
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Paternal Factors
• Men’s exposure to lead, radiation, certain pesticides, and
petrochemicals may cause abnormalities in sperm that lead
to miscarriage or disease.
• When fathers have a diet low in vitamin C, their offspring
have a higher risk of birth defects and cancer.
• Early findings point to a connection between cocaine use
in fathers and birth defects.
• Fathers’ smoking during pregnancy may lead to lower
birthweight and potential for their offspring developing
cancer.
• Older fathers may place their offspring at risk for certain
birth defects, such as Down syndrome and dwarfism.
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Prenatal Care
• Usually involves a package of medical care services in a
defined schedule of visits
• Often includes educational, social, and nutritional services
• Includes screening for conditions that can affect the baby
or mother
• Is extremely valuable, especially for first-time mothers
• Is very important for women in poverty because it links
them with other social services
• Can motivate women to have positive attitudes toward
pregnancy
• Not all women have access to or seek out adequate
prenatal care
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Cultural Beliefs about
Pregnancy
• Specific actions in pregnancy are often determined
by cultural beliefs.
• Two fundamental views of pregnancy:
– Pregnancy is a medical condition.
– Pregnancy is a natural occurrence.
• It is important for health-care providers to become
aware of health practices of various cultural
groups, along with their health beliefs about
pregnancy and prenatal development.
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Positive Prenatal Development
• In most pregnancies, prenatal
development does not go awry and
development occurs along a positive
path.
• Prospective parents should be careful
to avoid the vulnerabilities to
fetal development.
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Birth
The Birth
Process
Low Birthweight Infants
Measures of Neonatal
Health and
Responsiveness
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The Birth Process
• Stages of Birth
• The Transition from Fetus to
Newborn
• Childbirth Strategies
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The First Stage of Birth
• This is the longest of the three stages, lasting
an average of 12-24 hours.
• Uterine contractions are 15-20 minutes apart
and last up to 1 minute.
• Contractions cause cervix to stretch and open.
• Contractions get closer together as the stage
progresses.
• By the end of this stage the cervix is dilated to
about 4 inches.
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The Second Stage of Birth
• This stage begins when the baby’s head
starts to move through the cervix and the
birth canal.
• It terminates when the baby completely
emerges from the mother’s body.
• This stage lasts about one and a half hours,
and involves the mother bearing down to
push the baby out.
• Contractions come about every minute and
last about a minute.
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The Third Stage of Birth
• This stage is called “afterbirth” and lasts
only minutes.
• It involves the detachment and expulsion of
the placenta, umbilical cord, and other
membranes.
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The Fetus/Newborn Transition
• Being born involves considerable stress for the baby.
• Anoxia (the condition in which the fetus/newborn has an
insufficient supply of oxygen) can cause brain damage, and
is a concern if delivery takes too long.
• Large quantities of adrenaline and noradrendaline are
secreted to protect the fetus in the event of oxygen
deficiency.
• After the umbilical cord is cut, 25 million air sacs in the
lungs must fill with air.
• The newborn’s bloodstream is redirected through the lungs
and to all parts of the body.
• The baby is born with a protective covering of skin grease
called vernix caseosa which is cleaned off.
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Childbirth Strategies
• Childbirth Setting and
Attendants
• Methods of Delivery
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Childbirth Setting and Attendants
• Ninety-nine percent of all births in the U.S. take place in
hospitals, and 90% are attended by physicians.
• Relatively new birthing rooms approximate a home setting,
yet allow for medical intervention if necessary or desired.
• About 6% of women deliver a baby with the help of a
midwife, most of whom are nurses specially trained in
delivering babies.
• In many other countries, babies are more likely to be born
at home, and women are much more likely to choose a
midwife than a physician.
• A doula is a caregiver who provides continuous physical,
emotional, and educational support before, during, and
after birth.
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Methods of Delivery
• Medicated
• Natural
• Prepared
• Cesarean
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Medicated Childbirth
• The American Academy of Pediatrics recommends
the least possible medication during delivery.
• Three basic kinds of drugs used for labor:
– Analgesia: used to relieve pain (tranquilizers,
barbiturates, narcotics)
– Anesthesia: blocks sensation in an area of the
body, or blocks consciousness (epidural)
– Oxytocics: synthetic hormones that stimulate
contractions (Pitocin)
• Individuals differ as to how drugs affect them.
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Natural Childbirth
• Developed to reduce the mother’s pain by
decreasing her fear through education about
childbirth, breathing methods, and
relaxation techniques during delivery.
• Doctor’s relationship with the mother is an
important aspect of reducing perception of
pain, and doctor should be present during
active labor to provide reassurance.
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Prepared Childbirth
• Developed by French obstetrician,
Ferdinand Lamaze, and is similar to natural
childbirth with the addition of a special
breathing technique to control pushing in
the final stages of labor.
• It also includes a more detailed anatomy
and physiology course.
• Other prepared childbirth techniques have
been developed, combining aspects from
both of these methods and emphasizing
fathers as labor coaches.
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Cesarean Delivery
• The baby is removed from the mother’s uterus
through an incision made in her abdomen.
• Usually performed if the baby is in a breech
position, causing the baby’s buttocks to emerge
from the vagina first.
• Also used if:
– the baby is lying crosswise in the uterus
– the baby’s head is too large to fit through the pelvis
– the baby develops complications
– the mother is bleeding vaginally
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Low-Birthweight Infants
• Low-Birthweight Infants weigh
less than 5 ½ pounds at birth. Two
categories:
– Preterm Infants
– Small for date Infants
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Preterm Infants
• A preterm infant is one who is born 35 weeks or
less after conception.
• A low-birthweight infant is born after a regular
gestation period of 38-42 weeks, but weighs less
than 5 and 1/2 pounds.
• Both are considered high-risk infants.
• A short gestation period does not necessarily harm
an infant, and neurological development continues
after birth on the same timetable.
• Premature infants with a precariously low
birthweight are at high risk for survival.
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Small for date Infants
• Also called ‘small for gestational age infants.
• Includes those infants whose birthweight is below
normal when the length of the pregnancy is
considered.
• Small for date infants may be preterm or full term.
• Inadequate nutrition and smoking by pregnant
women are main factors for producing small to
date infants.
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Long-Term Outcomes for LowBirthweight Infants
• Most low-birthweight infants are normal and
healthy; as a group they have more health and
developmental problems.
• The number and severity of problems increase as
birthweight decreases.
• With the improved survival rates of such infants
come increases in severe brain damage.
• Lower brain weight is associated with greater
likelihood of brain injury.
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Long-Term Outcomes for LowBirthweight Infants
• Low-birthweight infants are also more likely to
have lung or liver diseases.
• School age children who were low-birthweight
babies are more likely to have learning disabilities,
attention deficit disorder, or breathing problems
like asthma.
• Children born very low in birthweight have more
learning problems and lower levels of
achievement in reading and math than moderately
low-birthweight children.
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Measures of Neonatal Health
and Responsiveness
• The Apgar Scale
• The Brazelton Neonatal
Behavioral Assessment Scale
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The Apgar Scale
• A method widely used to assess the health of newborns at
1 and 5 minutes after birth.
• It evaluates infants’
– heart rate
– respiratory effort
– muscle tone
– body color
– reflex irritability
• Obstetrician or nurse assesses the newborn and gives a
score of 0, 1, or 2 on each item.
• A score of 7-10 is good, 5 indicates possible
developmental difficulties, 3 or below signals an
emergency.
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The Brazelton Neonatal Behavioral
Assessment Scale
• Performed within 24-36 hours after birth to evaluate
neurological development, reflexes, and reactions to
people.
• The newborn is rated on each of 27 items, contributing to
four categories: physiological, motoric, state, and
interaction.
• Babies are also given global classification such as
“worrisome,” “normal,” “superior.”
• Parents are shown the importance of social interaction
with their infant, and how to positively respond to their
baby.
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The Pospartum
Period
What Is the
Postpartum
Period?
Physical
Adjustments
Emotional and
Psychological
Adjustments
Bonding
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What Is the Postpartum Period?
• The period after childbirth or delivery
• Woman’s body adjusts, physically and psychologically, to
the process of childbearing.
• Lasts about 6 weeks, body returns to near prepregnant state.
• Influenced by what precedes it—method and circumstances
of delivery affect speed of readjustment
• Adjustment and adaptation include:
- learning to care for baby - recovering from childbirth
- caring for baby
- learning to feel good as mother
- father caring for wife
- father learning to care for baby
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Physical Adjustments
• Involution is the process by which the uterus returns to its
prepregnant size, 5-6 weeks after birth.
• Nursing the baby helps contract the uterus rapidly.
• Menstruation begins 4-8 weeks after delivery if she is not
breast-feeding.
• Breast-feeding causes a delay in menstruation for several
months, but ovulation can still occur.
• Physicians usually recommend refraining from sexual
intercourse for approximately 6 weeks following birth.
• Exercise is recommended for the postpartum period, as are
relaxation techniques to relax and refresh the mother.
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Emotional and Psychological
Adjustments
• Emotional fluctuations are common for the mother in the
postpartum period and can be caused by
– hormonal changes
– fatigue
– inexperience/lack of confidence with the baby
– the extensive time and demands of caregiving
• Mothers may benefit from professional help in dealing
with their problems if difficulties persist.
• Fathers undergo postpartum adjustment as well, in
caregiving and with concerns that the baby comes first and
gets all the mother’s attention.
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Bonding
• Bonding is the occurrence of close contact, especially
physical, between parents and newborn in the period
shortly after birth.
• This is a critical time when an important emotional
attachment is formed that provides a foundation for
optimal development in years to come.
• Research supports the importance of bonding, but
challenges the significance of the first few days of life as a
critical period.
• Close contact does bring tremendous pleasure, and can set
in motion a climate for improved interaction after the
mother and infant leave the hospital.
• Many hospitals offer a “rooming in” arrangement, in which
the baby remains in the mother’s room for most of its
hospital stay.