Transcript Stages of Childbirth - Wharton County Junior College

CHAPTER 3
Birth and the Newborn Baby: In The
New World
The Stages of Childbirth
Stages of Childbirth
• Stage 1
Effacement & dilation
• Stage 2
Crowning and delivery
• Stage 3
Placental stage
Fig. 3-1, p. 51
Stages of Childbirth
• Stage 1: effacement and dilation
– Begins when uterine contractions efface and dilate
cervix , causes most childbirth pain
– Longest stage, lasts from few hours to more than a
day
– Results in the widening of the passageway to 4
inches (10 centimeters)
– Transition begins: head of fetus begins to move into
the vagina or birth canal
Stages of Childbirth (cont’d)
• Stage 2: crowning and delivery
– Baby’s head “crowns” when it begins to emerge
from birth canal
– Contractions stretch the skin around birth canal and
propel baby along
– Episiotomy takes place
– Lasts from minutes to hours
– Baby emerges from birth canal, and when breathing
adequately on own, the umbilical cord is clamped
and severed
Stages of Childbirth (cont’d)
• Stage 3: placental stage
– Lasts from minutes to an hour or more
– Placenta separates from the uterine wall and is
expelled through birth canal
– Episiotomy is sewn (if performed)
Methods of Childbirth
Methods of Childbirth
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Midwife-assisted childbirth
Anesthesia-assisted childbirth
Natural childbirth
Prepared childbirth
Doula-assisted childbirth
Cesarean section
Methods of Childbirth (cont’d)
• Midwife delivery
– Delivers baby in woman’s home
– More intimate
– Limited access to sophisticated medical
instruments and anesthetics that may be
needed during a high-risk delivery such as
shoulder dystocia or breech birth
Methods of Childbirth (cont’d)
• General anesthetics:
– Deaden pain by putting the
mother to sleep
– Includes tranquilizers and
narcotics
• Local anesthetics:
– Deaden pain without
putting mother to sleep
– Pudendal block numbs the
mother’s external genitals.
– Epidural block and spinal
block numb the body
below the waist by
injecting local anesthesia
into the spinal canal or
spinal cord.
Methods of Childbirth (cont’d)
• Natural childbirth
– Woman uses no
anesthesia
• Prepared childbirth
(i.e. Lamaze method)
– Woman is taught
breathing and
relaxation exercises
by a coach who will
aid her in the delivery
room
Methods of Childbirth (cont’d)
• Doula-assisted childbirth
– Doulas provide social and emotional support before
and during delivery.
– Doulas may be used when a partner is not available.
– Women with doulas present during birth appear to
have shorter labors than those without.
Methods of Childbirth (cont’d)
• Cesarean section (C-section)
– Physician delivers the baby by surgery
– Physician cuts through the mother’s abdomen and
uterus and physically removes the baby
– Mostly used when the health of the baby or mother is
at stake during delivery
Birth Problems
Birth Problems
• Prenatal oxygen deprivation (POD)
– Anoxia: absence of oxygen
– Hypoxia: less oxygen than required
• Preterm and low-birth-weight (LBW) infants
– Preterm: born prior to 37 weeks gestation
– Small for gestational age: born at full term, yet low
birth weight
• Both conditions can lead to
– cognitive, motor, and psychological problems
Signs of Prematurity
• Preterm babies
– Relatively thin, covered in lanugo and vernix
– Immature muscles
– Weak breathing and sucking reflexes
– May suffer from respiratory distress syndrome (RDS)
– May suffer long-term impairments
Treatment of Preterm Babies
• Preterm babies are kept in incubators
– Maintain temperature controlled environment
– Afforded some protection from disease
– Oxygen has to be monitored because excessive
oxygen can cause permanent eye injury
Parents and Preterm Neonates
• Preterm neonates
– look less appealing
– have high-pitched and
grating cries
– are more irritable
• Parents of preterm
neonates
– do not treat preterm
neonates as well as
full-term neonates
– can find it so
demanding to care for
such children that they
have depressing
effects for mothers
Intervention Programs
• Preterm infants profit from early stimulation.
– Cuddling, rocking, talking, and singing to
– Massage and kangaroo care
• Many positive effects for early stimulation
– Faster weight gain
– Fewer respiratory problems
– Greater advances
The Postpartum Period
Postpartum Period and Maternal Depression
• Some mothers may suffer from postpartum
depression (PPD).
– Symptoms
– Causes
– Prevalence
– Treatment
Table 3-2, p. 58
Bonding
• Bonding refers to formation of parent-infant
attachment.
• Bonding is essential for the survival and wellbeing of children.
Characteristics of Neonates
Assessing Neonates
• Apgar scale used to assess health of baby at
birth
• A) the general appearance or color of the neonate
• P) the pulse or heart rate
• G) grimace
(the 1-point indicator of reflex irritability)
• A) general activity level or muscle tone
• R) respiratory effort, or rate of breathing
Table 3-3, p. 60
Assessing Neonates (cont’d)
• Brazelton Neonatal Behavioral Assessment
Scale
– Used to measure neonates’ reflexes and other
behavior patterns
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•
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Motor behavior
Response to stress
Adaptive behavior
Control over physiological state
Neonate Reflexes
• Reflexes are simple,
automatic, stereotypical
responses elicited by
certain types of
stimulation.
INCLUDE:
•
•
•
– Demonstrate the neural
functioning of neonate
•
– Absence or weakness of a •
reflex may indicate
•
immaturity, slowed
responsiveness, brain
injury, or retardation.
Rooting reflex
Moro reflex
Grasping reflex
Stepping reflex
Babinski reflex
Tonic-neck reflex
• Rooting reflex
– Baby turns head and mouth toward a stimulus that strokes the cheek,
chin, or corner of the mouth; important for locating mother’s nipple in
preparation for sucking; can be lost if not stimulated
• Moro reflex
– Back arches, and the legs and arms are flung out and then brought
back toward the chest, with the arms in a hugging motion; can be
elicited when baby’s position is changed or when support for head and
neck is lost; can be elicited by loud noises, bumping the baby’s crib, or
jerking the baby’s blanket; lost within 6 to 7 months after birth;
absence of Moro reflex indicates immaturity or brain damage
• Grasping reflex (palmar reflex)
– Refers to the increasing tendency to reflexively grasp fingers or other
objects pressed against the palms of hands; babies support their own
weight this way
• Stepping reflex
– Mimics walking; demonstrated 1-2 days after birth and disappears 3-4
months of age
• Babinski reflex
– Occurs when underside of foot from heel to toes is stroked; toes are
fanned or spread
• Tonic-neck reflex
– Observed when baby is lying on its back and turns head to one side
Neonate Sensory Capabilities - Vision
• Infants are nearsighted, seeing best at 7-9 in.
• Can detect movement
– Prefer moving objects to stationary objects
• Have little or no visual accommodation
• See through fixed-focus camera
• Unable to converge their eyes on an object that is close
to them
Neonate Sensory Capabilities - Hearing
• Fetuses respond to sound months before they are born.
• Normal neonates hear well unless their middle ears are
clogged with amniotic fluid.
• Respond to sounds of different amplitude and pitch
– More to high-pitched sounds than to low-pitched sounds
• Discriminate different and new speech sounds
Neonate Sensory Capabilities - Smell
• Can discriminate distinct odors
• Show more rapid breathing patterns and increased
bodily movement in response to powerful odors
• Use smell for mother-infant recognition and attachment
• Neonate’s sensitivity
– Neonatal sensitivity to the smell of milk (Macfarlane)
– 15-day-old infants sensitive to the smell of mother’s underarm
odors vs. odors produced by other milk-producing women
(Porter)
Neonate Sensory Capabilities - Taste
• Show preferences similar to adults
• Discriminate between salty, sour, and bitter tastes, as
suggested by reactions in the lower part of the face
• Sweet solutions have a calming effect on neonates.
Neonate Sensory Capabilities - Touch
• Skin on skin
– provides feelings of comfort and security
– may contribute to bonds of attachment between
infants and their caregivers
• Many reflexes are activated by pressure against the
skin.
Classical and Operant Conditioning of
Neonates
Classical conditioning
• Involuntary responses
are conditioned to new
stimuli.
• Typical study (Lipsitt)
– Neonates taught to blink in
response to a tone
– Indicates they are
equipped to learn
associations in their
environment
Operant conditioning
• Responses can be
strengthened through
reinforcement
• Typical study (DeCasper,
et al.)
– Neonates can be
conditioned to suck on a
pacifier in such a way to
activate a recording of their
mothers reading The Cat
in the Hat
Neonate Sleeping and Waking
• Most neonates spend about 2/3 of their time in
sleep.
– 16 hours per day, not consecutively
• Neonates go through different stages of sleep.
• Typical infant has six cycles of waking and
sleeping in a 24-hour period
Sleeping and Waking (cont’d)
• Neonates spend about half of their sleeping
time in REM sleep, yet will decline as they
develop
– By 6 months, REM sleep accounts for only 30% of
the baby’s sleep
– By 2-3 years, REM drops off to 20-25% of sleep
• Preterm babies spend even more time in REM
sleep.
Table 3-4, p. 65
Fig. 3-6, p. 65
Crying
• Babies cry due to pain and/or discomfort.
• Some crying among babies is universal.
• Parents can distinguish between cries of
hunger, anger, and pain.
• Infants’ crying motivates others to take care of
them.
Crying (cont’d)
• Certain prolonged, high-pitched cries may indicate
health problems.
– Chromosomal abnormalities, infections, fetal malnutrition, and
exposure to narcotics
• Peaks of patterned crying occur in later afternoon and
early evening.
• Response of the caregiver influences crying
• Persistent crying can strain mother-infant relationship
Soothing
• Sucking (breast, bottle, pacifier) has a soothing effect.
• Parents soothe infants by
– picking them up, patting them, caressing and rocking them,
swaddling them, speaking to them in a low voice
• How to soothe an infant is learned via trial and error.
• Crying decreases as the infant matures and learns.
Sudden Infant Death Syndrome (SIDS)
• 2,000 to 3,000 annual US infant deaths from SIDS
• Most common cause of death during the first year
– Mostly occurring between 2 and 5 months of age
• More common among the following:
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babies aged 2-4 months
babies who sleep on their stomachs or sides
premature and LBW infants
male babies
babies from lower SES
African-American babies
babies of teenage mothers
babies whose mothers smoked or used narcotics during or after
pregnancy
Children’s Hospital Boston Study
• Conducted SIDS study to
learn about causes
• Study focused on the
medulla’s role in sleep/wake
cycles
– Compared medullas of babies
that died from SIDS to
medullas of babies that died
from other causes
– Results found SIDS babies’
medullas were less sensitive
to the brain chemical
serotonin; boys’ brains less
sensitive
• Prevention includes
– do not smoke during or after
pregnancy
– do not use narcotics during
pregnancy
– obtain adequate nutrition and
health care
– baby needs to sleep on back
– keep current on SIDS data