Transcript Labor, Birth and the Neonate

Labor, Birth
and the
Neonate
OT 500
Spring 2016
Waiting for Baby…..
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40 weeks plus or minus 2 weeks = full term
Events Occurring Just Prior to the Beginning of
Childbirth
 Dropping or Lightening: head of fetus settles in pelvis
 Braxton-Hicks contractions (false labor) are the first
uterine contractions; they may be experienced as
early as the 6th month
 Blood spotting in vaginal secretions due to pelvic
pressure a day or so before labor
 Rush of amniotic fluid from vagina (water breaks) in
1 in 10 women
 Placenta and uterus secrete prostaglandins which
cause the muscles of the uterus to contract
 As labor progresses, oxytocin is also released
stimulating uterine contractions
3 Stages of Childbirth
 Stage 1 – cervix opens to 4 inches (10
centimeters); Contractions increase in strength,
frequency, and regularity; fetal monitoring
 Lasts from a few hours to a couple of days;
 Ends with transition: head of the fetus moves
into the birth canal/vagina
 Stage 2 – baby’s head, then body, pushed into,
through, and out of the birth canal; mucus
suctioned, umbilical cord clamped and cut
about 3 inches
 Stage 3 – contractions expel placenta (can last
from a few minutes to an hour)
The Stages of Childbirth
Figure 4.1
What Happens at the end of Second Stage of
Childbirth?
 Newborn
often removed by a nurse to be
washed, foot-printed; given an ID
bracelet
 Antibiotic ointment or drops are applied
to baby’s eyes;
 Baby receives Vitamin K injection
Clamped and Severed Umbilical Cord
Figure 4.2
Methods of
Childbirth
How Is Anesthesia Used in Childbirth?
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General anesthesia
 Puts mother to sleep
Negative effects of general anesthesia on infant
 Abnormal patterns of sleep and wakefulness
 Decreased attention and social responsiveness
for at least 6 weeks
Local anesthetics
 Deadens pain without putting mother to sleep
 Minor depressive effects on neonates shortly
after birth
Natural childbirth
 No anesthesia is used
What Is Prepared Childbirth?
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Lamaze method
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Utilize breathing and relaxation exercises to lessen
fear and pain
Teaches women to associate relaxation with
contractions
Coach
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Aids the mother in the delivery room
Provides social support to mother during labor
What Is the C-section?
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Cesarean Section
 Delivered by abdominal surgery
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Physicians prefer C-section to vaginal delivery when:
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1 in 3 births in the US
Mother has small pelvis
Maternal weakness or fatigue
Baby is too large
Baby is in distress
Prior C section (VBAC not an option)
May be used to bypass infections in birth canal
May be used when baby is facing the wrong direction
http://www.mylifetime.com/shows/one-born-everyminute/video/season-2/episode-5/c-sections
Other Newborn procedures
 Cutting
the cord, bathing, anti-biotic eye
ointment; Vitamin K
 Weight, height and head circumference
 Circumcision
 PKU test
 Newborn infant hearing test
 Breastfeeding
Birth Problems
Oxygen deprivation (hypoxia, anoxia)
 Prenatal
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Can impair development of central nervous system
Cognitive, motor problems, and psychological
disorders
 Oxygen
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oxygen deprivation
deprived at birth
Can occur due to maternal disorders, infant’s
immature respiratory system; prolonged
constriction of umbilical cord during birth; breech
presentation
Predicted problems in learning and memory
Can cause health problems such as early-onset
schizophrenia and cerebral palsy
Premature
or preterm baby
 Occurs before 37 weeks
gestation (normal is 40 weeks)
Low-birth-weight baby
Weighs less than 5.5 pounds
What Risks Are Connected with Being Born
Prematurely or with Low-Birth-Weight?
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Infant mortality
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Delayed neurological development
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Neonates weighing 3.25 to 5.5 pounds are 7 times
more likely to die than infants of normal weight
Those weighing less than 3.3 pounds are nearly 100
times as likely to die
Lower birth weight – poorer performance
throughout school years
Delayed motor development, such as walking
What Signs Are Connected with Being Born
Prematurely or with Low-Birth-Weight?
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Preterm babies show signs of immaturity
 Relatively thin
 Fine, downy hair (lanugo)
 Oily, white substance on skin (vernix)
Preterms born six weeks or more prior to full term
 Nipples not yet emerged
 Testicles of boys not yet descended into
scrotum
Muscles immature and reflexes are weak
Respiratory distress syndrome
 Walls of air sacs in lungs stick together
How Are Preterm Infants Treated Following
Birth?
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Usually remain in hospital incubators/isolette
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Temperature-controlled environment with protection
from infection; Oxygen; close monitoring of vital signs
Bonding with preterm infants may be challenged
because
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Less attractive than full-term baby
High-pitched, grating cries
More irritable
How Are Preterm Infants Treated
Following Birth?
 Carefully
controlled
external/environmental stimulation
 Massage
 Kangaroo care
 Parental support
 Feeding interventions if necessary
The Postpartum
Period
What Kinds of Problems in Mood Do Women
Experience During Postpartum Period?
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Baby blues
 Transient – about 10 days
 Do not impair mother’s functioning
Postpartum depression (PPD)
 Present in as many as 1 in 5-10 women
 Begins one month after delivery and may linger
for weeks/months
 Major depressive disorder rare but can occur
involving psychotic features (1 woman in 500 –
1,000)
How Critical Is Parental Interaction with
Neonates in the Formation of Bonds of
Attachment?
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Bonding
 Formation of bonds of attachment between parent
and child, but hours after birth are just one aspect of
bonding process
 Extended early contact is not essential for adequate
bonding
 Parent – child bonding is a complex process
involving the desire to have a child; ability of the
caregiver to read infant cues and be responsive in a
consistent, timely, sensitive, appropriate manner
Characteristics
of Neonates
How Do Health Professionals Assess
the Health of Neonates?
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Apgar scale (taken at 1 and 5 minutes) based on 5
signs: appearance (color); heart rate;
grimace/reflex irritability; activity level/muscle tone;
respiration
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Brazelton Neonatal Behavioral Assessment Scale
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Interpretation of scores
 7 or above – no danger
 Below 4 – critical condition
Based on four areas of behaviors
Measures reflexes, motor behavior, and muscle tone
Neonatal Intensive Care Unit Network
Neurobehavioral Scale (assesses infants at risk)
Primitive Reflexes
 Reflexes
 Simple,
unlearned stereotypical
responses, elicited by certain types of
stimulation
 Serve some survival functions
 Neural functioning is determined by
testing reflex; neurodevelopment age
Reflexes Shown by Neonates
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Rooting Reflex
 Baby turns head and mouth toward stimulus that
strokes the cheek, chin, or corner of mouth
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Sucking Reflex
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Babies will suck almost any object that touches the lips;
eventually replaced by voluntary sucking
Moro or startle reflex
 Occurs when baby’s position is suddenly changed or
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head and neck support is lost; Can also be elicited
by loud noises or bumping the baby
Back arches, legs and arms are flung out and then
brought back toward chest into a hugging motion
Usually lasts for 6 to 7 months after birth
More Reflexes
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Grasping or palmar reflex
 Using four fingers, babies grasp fingers/objects pressed
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Stepping reflex
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Mimics walking when held under arms
Usually disappears by 3 or 4 months
Babinski reflex
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against the palms of their hands
Usually lost by 3 to 4 months and replaced by voluntary
grasping at 5 to 6 months
Fans or spreads toes in response to stroking foot
Usually disappears at end of first year
Asymmetrical Tonic-neck reflex (ATNR)
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While lying on back, baby turns head to one side. Arm
and leg on that side extend, while opposite side flex.
Asymmetrical Tonic Neck Reflex
(Archer’s, Fencing Pose)
http://library.med.utah.edu/pedine
urologicexam/
Vision
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Visual acuity
 Estimate of 20/600
 Best see objects 7 to 9 inches from eyes
 Lack peripheral vision of older child
 Able to track movement within one day of birth;
Preference for moving objects
Visual accommodation
 Self-adjustments made by eye lens to bring objects into
focus
 Neonates show little or no visual accommodation; can
focus on objects 7 to 9 inches away
Convergence does not occur until 7 or 8 weeks
Color perception: At birth, not sure how well infants see
color; Cones which perceive color are less developed
than rods, which transmit light/dark
Convergence of the Eyes
Figure 4.5
Hearing
 Fetuses
respond to sound, and neonates
respond to various amplitudes and pitches
 Show preference for mothers’ voices
 Responsive to sounds and rhythms of speech
 Show no preference for specific languages
Smell and Taste
 Smell
 Well-developed
at birth
 Demonstrate aversion for noxious and
preference for pleasant odors
 Recognize familiar odors
 Taste
 Sensitive to different tastes
 Demonstrate facial expressions in
response to tastes
 Prefer sweet tastes
Touch and Pain
 Touch
(tactile sense)
 Sensitive to touch
 Touch elicits many reflex behaviors
 Pain
 Past belief that neonates are not sensitive
to pain; Neonates not cognitively
equipped to ruminate about pain..but
they feel it!
 Conditionable – distress when confronted
with situation that previously presented
itself as painful
Can Neonates Learn?
 Classical
Conditioning
 Involuntary responses are conditioned to a
new stimuli
 Operant Conditioning
 Behavior (reflexes) are modified through
reinforcement
 Requires rapid administration of reinforcers
 The Cat and the Hat study – modified
sucking reflexes
 SIMPLE CAUSE AND EFFECT
Why Babies Cry?
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Pain and discomfort: Close physical contact most helpful
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Universal, expressive, and functional communication
maternal response
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Distinct causes and patterns of cries
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Expressive response to unpleasant feelings; get a caregiver
response
Hunger, anger, pain: HALT (Hungry, Angry, Lonely or Tired)
Peaks of crying in late afternoon and early evening
Crying produces physiological response in others
How can we stop the crying??
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Sucking serves as a built-in tranquilizer; Pacifier, sweet
solutions
Swaddling
Shushing; Speaking to them in low voice
Rhythmic movement
Pick baby up, patting, caressing, rocking them
Dealing with the cause
Sleep and the Newborn
Neonates spend about 16 hours
per day in sleep with 6 wake-sleep
cycles o
- By 5-6 months, many infants
begin to sleep through the night
(meaning 5 – 6 hours)
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Neonates spend 50% time in REM
sleep; 6 months – 30%; 2 to 3 years –
20 to 25%; Neonates may utilize
REM sleep to stimulate the brain
- Various states of arousal or
wakefulness; calm-alert is nice!
REM Sleep and Non-REM Sleep
Figure 4.8
Co-Sleeping, Bed Sharing and
the Family Bed
 Bed
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Sleeping in the same bed with baby
 “The
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Sharing
Family Bed”
A conscious caregiver decision to share
sleep and a bed with baby
 Co-Sleeping
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Generally sleeping near baby – within
reach but not necessarily in the same bed
Risks
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Suffocation, Entrapment
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term co- sleeping can make transition into
crib or bed more difficult, especially when
breastfeeding.
 American Association of Pediatrics (AAP) does
not endorse co-sleeping
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Increased risk to child
Links co-sleeping to SIDS
Recommends room sharing, but not bed sharing
So Why share a Bed with a baby?
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Sleep Deprivation – it may be the only way
everyone gets some sleep; cozy; easier; baby is
comforted by physical contact
Easier to breastfeed during the night
It’s practiced in many other cultures
Behavior is hard to change, even in the face of
evidence
Some evidence suggests:
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Babies who bed share with caregivers learn to regulate
their breathing from caregiver – guards against SIDS
Babies who co-sleep develop secure attachment, and
have other positive developmental outcomes
Shaken baby Syndrome
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Rapid shaking of baby resulting in damage to
central nervous system; Non-accidental head injury
Babies have limited neck and trunk control, and a
proportionally large head in relation to their body
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Can not guard again rapid movement
Brain bounces in the head with the shaking
movement
Results in long term effects on development
Loss of vision or impairment
 Cerebral palsy
 Cognitive and motor delays
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SIDS: Sudden Infant Death
Syndrome – crib death
 Happens
while the baby is sleeping
 More common among babies between
ages 2 and 4 months when reflexive
behavior is weakening
 More common among babies who sleep
on their stomachs
 Causes of SIDS remains obscure
 Other risk factors: males, low birth weight;
lower SES, bottle-fed, African American,
teenage mothers, born to mothers who
smoke or use drugs
Reducing the Risks of SIDS
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AAP recommends:
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Back to sleep, tummy to play
Room sharing, not bed sharing
Breastfeeding
Use a pacifier
Firm sleeping surface, free of soft bedding with a tight
sheet
Avoid overheating baby
Routine immunizations
Avoid exposure to tobacco smoke, alcohol or illicit
drugs
No use of breathing monitors (false security)