Transcript birth and the newborn infant

CHAPTER 3
BIRTH AND THE NEWBORN
INFANT
Learning Objectives
Labor: The Process of Birth Begins
Corticotropin-releasing hormone (CRH)
• Oxytocin and other hormones triggered
• Uterus contracts
Contractions
• Braxton-Hicks
• Labor initiation
Stages of Labor
From Fetus to Neonate
• When is the moment of birth?
• What causes a baby to cry after birth?
• What cultural differences surround the birth of children
worldwide?
APGAR SCALE
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A score is given for each sign at one minute and five minutes after the birth.
If there are problems with the baby, an additional score is given at ten
minutes.
A score of seven to ten is considered normal, whereas four to seven might
require some resuscitative measures, and a baby with an Apgar score
under four requires immediate resuscitation.
More About APGAR Scores
Low scores
• Existing fetal problems or birth defects
• Difficulties related to process of birth
• Temporary deprivation of oxygen (anoxia)
– Wrapped umbilical cord
– Pinched umbilical cord
You must have been a beautiful baby…or were
you?
Introducing the neonate
• Vernix
• Lanugo
• Puffy eyelids
• Blood/other substances
Initial Encounters
True or false
• Newborns who do not spend time bonding with their
parent or parents immediately after birth will
automatically suffer long-term social and emotional
consequences.
Approaches to Childbirth:
Where Medicine and Attitudes Meet
• Variety of strategies and approaches
• No universally accepted single procedure
• No conclusive research evidence that one procedure
significantly more effective than another
What birthing procedures would you choose?
Alternative Birthing Procedures
Lamaze
birthing
techniques
Bradley
Method
Hypnobirthing
Water birthing
Childbirth Attendants: Who Delivers?
• Obstetrician
• Midwife
• Doula
Pain and Childbirth
Interpretation of pain is subjective
• Amounts of pain experienced by women during childbirth
vary
• For some women, the perceived pain is intense and
agonizing; for other women there is little to no perceived
pain
• Many factors affect pain perception, including cultural
ideas of childbirth, fear, number of previous births, fetal
presentation, birthing position, and a woman's natural
pain threshold
Use of Anesthesia and Pain-Reducing Drugs
Kinds
• Epidural anesthesia
• Walking epidural or dual spinal-epidural
Effects
• Mother
– Reduces/eliminates pain associated with labor
– Sometimes slows labor
• Neonate
– Drug strength related to effects on fetus
– May temporarily depress the flow of oxygen to fetus
– Less physiologically responsive, show poorer motor control
during the first days of life after birth, cry more, and may have
more difficulty in initiating breastfeeding
And so…?
• Only minimal risks to the fetus and neonate
• Woman’s request for pain relief at any stage of labor
should be honored
• Proper use has no significant effect on child’s later wellbeing
Do neonates feel pain during birth?
Objective indications of neonate pain at birth:
• Crying
• Facial expressions
• Body movement
• Vital signs
• Serum cortisol, tissue and blood oxygen levels
• Neurobehavioral assessments
Post-delivery Hospital Stay
• By 1990s, average stay for normal birth is 2 days
– Changes prompted by medical insurance companies
• American Academy of Pediatrics recommendation
– Stay in hospital should be no less than 48 hours after
giving birth
What are the advantages and disadvantages
of early dismissal?
Newborn Medical Screening
American College of Medical Genetics
recommendations
• All newborns be screened for 29 disorders, ranging from
hearing difficulties and sickle cell anemia to extremely
rare conditions such as isovaleric academia, a disorder
involving metabolism
Consider this
• If you were the parent of a newborn, would you want to
know if your child had a disorder that might never
become a problem? Why or why not?
Becoming an Informed Consumer of
Development
Dealing with Labor
Be flexible
Communicate
Remember
with health
that labor is . .
care providers
. laborious
Accept
support
Be realistic
and honest
about
reactions to
pain
Focus on the
big picture
Review and Apply
REVIEW
• In the ____ stage of labor, contractions increase in
frequency, duration, and intensity until the baby’s
head is able to pass through the cervix.
• In the ____ stage, the baby moves through the cervix
and birth canal and leaves the mother’s body.
• In the ____ stage, the umbilical cord and placenta
emerge.
• Immediately after birth, birthing attendants usually
examine the neonate using a measurement system
such as the ____ scale.
Review and Apply
REVIEW
• ____ birthing options are available to
parents today.
• They may weigh the advantages and
disadvantages of ____ drugs during birth.
• They may choose alternatives to traditional
hospital birthing, including the ____
method, the use of a ____ ____, and the
use of a ____.
Review and Apply
APPLY
• Why might cultural differences exist in
expectations and interpretations of labor?
BIRTH COMPLICATIONS
What do you think?
Why is infant survival less likely in the United
States than in other, less developed countries?
International Infant Mortality
While the United States
has greatly reduced its
infant mortality rate in the
past 25 years, it ranks
only twenty-third
among industrialized
countriesas of 2009.
What are some of the
reasons for this?
(Source: The World
Factbook, 2009.)
Preterm Infants: Too Soon, Too Small
Preterm infants
– Respiratory distress syndrome (RIDS)
Low birth-weight infants
Small-for-gestational-age infants
Outcomes
• Majority of preterm infants eventually develop normally in
long run
• Tempo of development often proceeds more slowly
Very low birth-weight infants
Smallest survivors
• Most vulnerable; immaturity of their organ systems
• Weigh less than 1250 grams (around 2 1/4 pounds)
• In womb less than 30 weeks
Risk-reduction strategies
• High-quality care
• Responsive, stimulating and organized care
• Massage
Survival and Gestational Age
What causes preterm and low-birth-weight
deliveries?
• Half of births unexplained
• Difficulties related to mother’s reproductive system
• Immaturity of mother’s reproductive system
• General health of mother
Factors Associated with Increased Risk of Low
Birth weight
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Demographic risk
Medical risks predating pregnancy
Medical risks in current pregnancy
Behavioral and environmental risks
Healthcare risks
Evolving concepts of risks
(See Table 3-2)
Factors Associated with Increased Risk of Low
Birth Weight
Cesarean Delivery: Intervening in the Process
of Birth
Procedure
• Baby is surgically removed from uterus
Rationale
• Occur most frequently when fetal stress appears
• More prevalent in older mothers
• In some cases, related to position in birth canal: breech,
transverse
• Routine use of fetal monitor
Risks
• Major surgery for mother, longer recovery
• Reduced stress-related hormones for neonate
Cesarean Deliveries
True or False?
Cesareans are effective medical interventions?
Post-mature Babies: Too Late, Too Large
2 weeks or more overdue
• Blood supply from placenta may become insufficient
• Blood supply to brain may be decreased, leading to the
potential of brain damage
• Labor becomes riskier for larger fetus to pass through
birth canal
Mortality and Stillbirth: The Tragedy of
Premature Death
• Joy that accompanies the birth of a child is completely
reversed when a newborn dies
• 1 out of 115 deliveries in U.S.
• Enormous impact on family; depression and lack of support
common; sometimes PTSD experienced
• U.S. infant mortality generally declining since 1960s
• Stillbirth resources:
– March of Dimes
– National Stillbirth Society
– MISS Foundation
Moving From the Heights of Joy to the Depths
of Despair
Postpartum Depression
• Incidence rate
•
Symptoms and causes
•
Consequences
When Mothers Are Depressed
Depressed Mothers
• Display little emotion and act detached and withdrawn
Infants
• Display fewer positive emotions and withdraw from
contact not only with their mothers but with other adults
Developmental Diversity
Overcoming Racial and Cultural Differences in Infant
Mortality
Leaving Leave Alone
Opportunity to take extended maternity leave can be
important
~
Are these always available?
Let’s take a look at Table 3-3 for a summary of leave
policies in the US and 10 peer nations.
Childbirth-Related Leave Policies in the U.S.
and 10 Peer Nations
Review and Apply
REVIEW
• Largely because of ____ ____ ____, preterm
infants may have substantial difficulties after birth
and later in life.
• ____ ____ ____ are in special danger because of
the ____ of their organ systems.
• Preterm and low-birth weight deliveries can be
caused by ____, ____, and pregnancy-related
factors in the ____. ____ (and, because of its
relationship with income, race) is also an important
factor.
Review and Apply
REVIEW
• ____ deliveries are performed with post mature
babies or when the fetus is in ____, in the
wrong ____, or unable to progress through
____ ____.
• Infant ____ rates can be affected by the
availability of inexpensive health care and ____
____ programs for mothers-to-be.
• Postpartum depression affects about ____
percent of new mothers.
Review and Apply
APPLY
• What are some ethical considerations relating
to providing intensive medical care to very-lowbirth weight babies?
• Do you think such interventions should be
routine practice? Why or why not?
THE COMPETENT NEWBORN
Neonate, but not novice…completely!
Neonates emerge practiced in many types of physical
activities
Reflexes
• Sucking reflex
• Swallowing reflex
• Rooting reflex
• Coughing, sneezing, blinking
The Newborn Digestive System
Sucking and swallowing reflexes help infants to consume
their mother’s milk and are coupled with the newfound
ability to digest nutriments
•Meconium
•Neonatal jaundice
Sensory Capabilities: Experiencing the World
Seeing
• Visual acuity not fully developed but can see to
some extent
• Attend to visual field highest in information and
brightness
• Possess some sense of size constancy
• Distinguish and show preference for different
colors
Sensory Capabilities: Experiencing the World
Hearing
• Clearly capable of hearing, but auditory acuity
not completely mature
• React to and show familiarity with certain kinds
of sounds
What about other senses?
Other senses
• Senses of touch, smell, and taste are not only
present at birth, but are reasonably
sophisticated.
Early Learning Capabilities
• Infants are capable of learning very early through
classical conditioning
• Operant conditioning functions from the earliest days
of life
What is habituation?
• Decrease in response to stimulus that occurs after
repeated presentations of same stimulus
• Most primitive form of learning that occurs in every
sensory system
Three Basic Processes of Learning
After forming a small group, devise a way in
which you may use classical conditioning in
your social life.
Social Competence: Responding to Others
• Newborns have capability to imitate others’ behavior
• Jury is out on exactly when true imitation begins
• This provides them with important foundation for social
interaction later in life
• Ultimate outcome of the social interactive capabilities of
the newborn infant, and the responses such behavior
brings about from parents, is to pave the way for future
social interactions
When Neonates and New Parents Jive
Review the information in Table 3.6 and consider
• The ultimate outcome of the social interactive
capabilities of the newborn infant, and the responses
such behavior brings about from parents, is to pave the
way for future social interactions.
Factors That Encourage Social Interaction
between Full-Term Newborns and Their Parents
Form your group again and see which group in
class can devise a way in which you can
operantly condition your professor!
Be creative (smile).
Review and Apply
REVIEW
• ____ are in many ways helpless, but studies of what they
can do, rather than what they can’t do, have revealed
some surprising capabilities.
• Newborns’ respiratory and digestive systems begin to
function ____ ____. They have an array of ____ to help
them eat, swallow, find food, and avoid unpleasant stimuli.
• Newborns’ ____ ____ includes the ability to distinguish
objects in the ____ ____ and to see ____ differences; the
ability to hear and to discern familiar ____; and sensitivity
to ____, odors, and tastes.
Review and Apply
REVIEW
• The processes of ____ ____, _____ ____, and
____ demonstrate infants’ learning capabilities.
• Through these processes infants develop the
foundations of ____ ____ early.
Review and Apply
APPLY
• Can you think of examples of the use of
classical conditioning on adults in everyday life,
in such areas as entertainment, advertising, or
politics?
EPILOGUE
Before we move on to a more detailed discussion of infants’
physical development, let’s return for a moment to the case of
the postmature birth of Jasmine Araujo, discussed in the
prologue.
•Using your understanding of the issues discussed in this
chapter, answer the following questions.
•Jasmine was born about two weeks late. What complications
could have arisen had her birth been delayed much further?
•If large to pass through the birth canal, what could be done?
What additional complications might have arisen?
EPILOGUE
• In what ways might the prenatal social support that
Natali received from her family have been helpful? What
other kinds of prenatal care might have contributed to
Jasmine’s healthy birth?
• Describe what Jasmine’s experiences following birth
would have been like.