Transcript Birth and the Newborn Infant

Birth and the Newborn
Infant
Chapter 3
Robert S. Feldman
Copyright © 2011 Pearson Education, Inc. All rights reserved.
Looking Ahead
What is the normal process of labor?
What complications can occur at birth, and
what are their causes, effects, and
treatments?
What capabilities does the newborn have?
Labor: The Process of Birth Begins
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
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 longterm social and emotional consequences.
Messages from Massage
Physical stimulation after birth
Stimulates production of brain chemicals that
instigate growth
Approaches to Childbirth
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
Childbirth Attendants: Who Helps?
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
Kinds
Use of Anesthesia and PainReducing Drugs
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 well-being
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
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
Permits early intervention and treatment
Becoming an Informed Consumer
of Development
Dealing with Labor
Be flexible.
Communicate with health care providers.
Remember that labor is . . . laborious.
Accept support.
Be realistic and honest about reactions to
pain.
• Focus on the big picture.
•
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Review and Apply
REVIEW
Stages
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?
While 99 percent of U.S. births are attended by
professional medical workers or birthing attendants,
this is the case in only about half of births
worldwide.
What do you think are some reasons for this, and what
are the implications of this statistic?
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
Problems During Labor and
Delivery
Preterm infants
Low birth-weight infants
Small-for-gestational-age infants
Very low birth-weight infants
The smallest survivors
Most vulnerable; immaturity of their organ
systems
Weigh less than 1250 grams (around 2 1/4
pounds)
Survival of the Smallest
What causes preterm and lowbirth-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
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)
Table 3-2. Factors Associated with Increased Risk
of Low Birthweight
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
Cesarean Delivery
Baby is surgically removed from uterus
Occur most frequently when fetal stress
appears
More prevalent in older mothers
Related to position in birth canal: breech,
transverse
True or False?
Cesareans are effective
medical interventions?
International Incidence Rate:
Cesarean Deliveries
Mortality and Stillbirth: The
Tragedy of Premature Death
Stillbirth
Resources:
March of Dimes
National Stillbirth Society
MISS Foundation
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.
Table 3-3
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 to act detached
and withdrawn
Infants
Display fewer positive emotions and
withdraw from contact not only with
their mothers but with other adults
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-low-birth
weight babies?
Do you think such interventions should be routine
practice? Why or why not?
Why do you think the United States lacks educational
and health care policies that could reduce infant
mortality rates overall and among poorer people?
What arguments would you make to change this
situation?
THE COMPETENT NEWBORN
Neonate, but not
novice…completely!
Neonates emerge practiced in many types
of physical activities
Reflexes
The Newborn Digestive System
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
From Research to Practice
Circumcision of Newborn Male Infants: The Unkindest
Cut?
PRO
CON
Routinely performed on
many US infants
More recently found to
protect against future
STDs
Risk reduction for urinary
track infection and
penile cancer
Deemed medically
unnecessary by national
medical associations
Can cause bleeding and
infection
May reduce sensation and
sexual pleasure later in life
Do you agree that tradition
alone is enough of a reason to
circumcise a male infant?
What about 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
A Quick Review
Classical conditioning
Operant conditioning
Habituation
(See Table 3-5 for descriptions and
examples)
Table 3-5
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
This provides them with important
foundation for social interaction later in
life
Operant Conditioning
Insert video:
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sych/media/interface/index.htm?atitle=Ope
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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).
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.
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?
Developmental researchers no longer view the
neonate as a helpless, incompetent creature, but
rather as a remarkably competent, developing
human being.
What do you think are some implications of this
change in viewpoint for methods of child rearing
and child care?
EPILOGUE
Before we move on to a more detailed
discussion of infants’ physical development,
return for a moment to the case of the
premature birth of Tamera Dixon, discussed in
the prologue. Using your understanding of the
issues discussed in this chapter, answer the
following questions.
Tamera was born almost four months early. Why
was the fact that she was born alive so surprising?
Can you discuss her birth in terms of “the age of
viability”?
EPILOGUE
What procedures and activities were most likely set
into motion immediately after her birth?
What dangers was Tamera subject to immediately
after birth because of her high degree of
prematurity? What dangers would be likely to
continue into her childhood?
What ethical considerations affect the decision of
whether the high costs of medical interventions for
highly premature babies are justifiable? Who should
pay for those costs?