Transcript Infancy: Physical Development

CHAPTER 4
Birth and the Newborn
Baby:
In the New World
Learning Outcomes
LO1 Identify the stages of childbirth.
LO2 Examine different methods of
childbirth.
LO3 Discuss potential problems with
childbirth.
LO4 Describe the postpartum period.
LO5 Describe the characteristics of a
neonate.
© Monalyn Gracia/Photolibrary
TRUTH OR FICTION?
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After birth, babies are held upside down and
slapped on the buttocks to stimulate
independent breathing.
The way the umbilical cord is cut determines
whether the baby’s “belly button” will be an
“innie” or an “outie.”
Women who give birth according to the
Lamaze method do not experience pain.
In the U.S., about 3 births in 10 are by
cesarean section.
It is abnormal to feel depressed following
childbirth.
Parents much have extended early contact
with their newborn children if adequate
bonding is to take place.
More children die from Sudden Infant Death
Syndrome (SIDS) than from cancer, heart
disease, pneumonia, child abuse, AIDS, cystic
fibrosis, and muscular dystrophy combined.
Countdown to Childbirth
• Fetal position
– Early in last month, fetus settles with head in pelvis:
referred to as “dropping or lightening”
• First contractions
– Braxton-Hicks contractions: false labor
– Can start at 6 mos. and tend to increase in later mos.
• Amniotic fluid
1 in 10 women experience a bursting of the amniotic sac,
usually at end of 1st stage labor
• Other common signs
– Indigestion; diarrhea; abdominal cramps; back ache
• Fetal hormones
– Stimulate placenta and uterus to secrete
PROSTAGLANDINS & OXYTOCIN to stimulate contractions
LO1 The Stages of Childbirth
© Monalyn Gracia/Photolibrary
Three Stages of Childbirth
• STAGE ONE process…
– Contractions efface & dilate the cervix
• Needs to be 4 inches (10 centimeters) for
passage
• Contractions start about 10-20 minutes apart at
20-40 seconds; when reaching 4-5 minutes,
advised to go to hospital or birthing center
– Average length of time for Stage One
• About half a day to one day: 1st deliveries are
usually longer
– “Prepping”
• Pubic area shaved (enema) intended to lower
chances of infection; not mandatory, up to the
attending physician
Three Stages of Childbirth
• STAGE ONE process…(cont.)
– Fetal monitoring
• Electronic sensors measure fetal heart rate to
alert staff of problem
– Helpful equipment
• If speeding up delivery is needed, staff may use
forceps or vacuum extraction tube.
– Transition
• Fetus moves through birth canal; approx. 30
minutes for birth
Three Stages of Childbirth
• STAGE TWO…
– Crowning
• When the babies head begins to emerge
• Baby will normally completely emerge within minutes
– Average length of time for Stage Two
• Shorter than 1st stage: from a few minutes to hours
– Epistiotomy
• Surgically cutting area between birth canal and anus to
prevent random tearing
• Like prepping (enema) is controversial and optional
• Use in U.S. dropped: 70% in 1983 to 19% in 2000
Three Stages of Childbirth
• STAGE TWO…(cont.)
– How baby looks
• Head and facial features can be distorted from trauma;
return to normal in time
– What happens to baby now
• Mucus suctioned from mouth as soon as head emerges
• When breathing on own, umbilical cord is clamped and cut
to 3 inches (stump will dry and fall off in about 7-10 days).
• Baby is foot-printed.
• ID bracelet is placed on wrist.
• Erythromycin (antibiotic ointment) or drops of silver nitrate
placed in eyes to prevent bacterial infections.
• Vitamin K injected to help blood clot (newborns do not
make own V-K).
Figure 4.2 – A Clamped and Severed Umbilical
Cord
Stages of Childbirth
• STAGE THREE…
– a.k.a “placental” stage
– Length of time
• Few minutes to an hour or more
– During this final stage:
• Placenta separates from wall of uterus and is
expelled through birth canal.
• Some bleeding is normal.
• Obstetrician stitches episiotomy if it was
performed.
LO2 Methods of Childbirth
© Monalyn Gracia/Photolibrary
Methods of Childbirth
• Historically
– Usually took place in the home, involved family and
perhaps a midwife
• Currently
– Home births still pattern in less developed nations
– In U.S. now in hospitals or birthing centers
• Some argue this “depersonalizes” the experience.
• Methods
–
–
–
–
Anesthesia
Prepared Childbirth
Doulas
Cesarean Section
Methods of Childbirth
• ANESTHESIA used to lessen pain.
– General Anesthesia
• Injection of barbiturate puts mother to sleep.
– Reduces initial responsiveness of baby; no long-term effects
– Tranquilizers
• Oral barbiturates and narcotics
• Reduces anxiety and perception of pain without inducing
sleep
– Local anesthetics
• Pudenal block external genitals deadened with injection
• Epidural & Spinal Block: injection to spinal cord that numbs
body below the waist
– No anesthetics
• Natural childbirth: no drugs or anesthetics; uses relaxation
and breathing exercises
Methods of Childbirth
• LAMAZE METHOD = Prepared
Childbirth
– Mother and “Coach”
• Mother learns breathing and relaxation methods
to lessen fear and pain and distract from pain.
• “Coach” (usually Dad but can be anyone) aids in
delivery room by supporting Mother.
Methods of Childbirth
• DOULAS
– A non-professional person offering social
support during labor.
– Women with Doulas appear to have
shorter labor.
Methods of Childbirth
• CESAREAN SECTION (C-Section)
– Process:
• Physician delivers baby by abdominal surgery.
• Cut through abdomen and uterus and removes
baby
– Possible indications for performing:
• If mother has small pelvis or weakened from
long labor
• Very large baby or multiples
• Prevention of circulatory mixing between mother
and baby (prevention of AIDS, genital herpes)
• If baby is facing in wrong direction (not head
first: breach birth)
LO3 Birth Problems
© Monalyn Gracia/Photolibrary
Birth Problems
• OXYGEN DEPRIVATION
– Anoxia: without oxygen
– Hypoxia: “under” oxygen
– Implications:
• PRENATTALY: Impaired CNS development; can
cause cognitive & motor skills problems and
psychological disorders
• DELIVERY: schizophrenia, cerebral palsy death
– Causes:
• Diabetes (mother)
• Accidents to umbilical cord
• Immature respiratory system in baby
Birth Problems
• PRETERM AND LOW-BIRTH-WEIGHT
INFANTS
– APPROX. 7% OF ALL BABIES BORN
– Preterm: Birth before 37 weeks (40 normal)
gestation
• Common in multiple births
– Low-birth-weight: Less than 5 lbs
– Small for dates: full term but underweight
• Mothers who smoke, do drugs, and receive improper
nutrition place babies at risk.
• Babies tend to remain smaller throughout life.
• Preterms seem to catch up more.
Preterm & Low-birth-weight Infants
• Risks:
– 3.25 - 5.5 lbs.
• 7 times more likely to die
– Less than 3.3 lbs.
• Nearly 100 times more likely to die
– 1.65 lbs.
– Sex differences
• Girls seem to improve more readily than boys
– Overall deficiencies
• Severity of disabilities reflects extent of deficiencies
• Most experience cognitive and motor skills deficiencies
– Corticosteriods
• Administering to women at risk may increases chances of
survival
• Characteristics:
– Relatively thin: no baby fat
– Lanugo: fine downy hair
– Vernix: oily white substance
on skin
– If more than 6 weeks early, no
nipples & testicles in boys have not descended but
will do so after birth
– Muscles are immature; sucking and breathing
reflexes are weak
– If more than a month early, may display respiratory
distress syndrome (irregular or cessation of
breathing).
© Tracy Dominey/Photo Researchers
Preterm & Low-birth-weight Infants
Preterm & Low-birth-weight Infants
• Treatment:
– Due to physical frailty, often remain
hospitalized in incubators.
– They maintain a temperature-controlled
environment and afford protection from
disease.
– Some may receive oxygen, but overoxygenation may cause permanent eye
injury.
Preterm & Low-birth-weight Infants
• Parents & Preterm Neonates
– Physically less attractive babies
– Cries are high pitched and grating
– More irritable, passive, and less social
– Mothers may feel alienated, harbor guilt, and
sense of failure and low self-esteem
– Fear of hurting may discourage handling
– Preterms fare better with responsive caring
parents
Preterm & Low-birth-weight Infants
• Intervention Programs
– Stimulation helps preterms develop
• Cuddling, rocking, talking, singing, music,
mobiles
• Massage and “kangaroo care” (skin to skin, chest
to chest, with parent)
• Stimulated preterms show fewer respiratory
problems, gain weight more rapidly, and make
greater advances in motor, intellectual, and
neurological development than those not
receiving stimulation
Figure 4.3 – Stimulating a Preterm Infant
It was once believed that
preterm infants should be left as
undisturbed as possible. Today,
however, it is recognized that
preterm infants usually profit
from various kinds of
stimulation.
© Louie Psihoyos/Science Faction
LO4 The Postpartum Period
© Monalyn Gracia/Photolibrary
Postpartum Period
• There is no definitive time period; generally
considered the few weeks following delivery
• Maternal Depression
– 70% of new mother’s worldwide experience the
“baby blues,” generally last about 10 days
– 1 in 5 may experience postpartum depression
(PPD), a serious mood disorder.
• Triggered by sudden drop in estrogen; drugs that increase
estrogen levels can help symptoms
• Symptoms include: serious sadness, hopelessness,
helplessness, worthlessness, poor concentration, loss of
appetite, and insomnia
• 1 in 500 may experience psychotic symptoms that place
child at risk.
Postpartum Period
• Bonding
– Attachment bonds are crucial to the
survival and well-being of children.
– Parent-child bonding is a complex process
requiring parent/child familiarization.
– Serious maternal depression can delay
bonding.
– Women with history of rejection by own
parents can also interfere with bonding.
– Parents can adopt children at advanced
ages and still bond with them.
LO5 Characteristics of
Neonates
© Monalyn Gracia/Photolibrary
Characteristics of Neonates
• Assessing the Health of Neonates
– APGAR Scale
• Administered at birth
• Measures 5 signs of health
– Appearance, Pulse, Grimace, Activity level, Respiratory effort
• Scores vary from 0-10
• 7 or above = no danger - 4 or below = critical, needs
immediate attention
• By one minute after birth, most babies reach 8-10.
– Brazelton Neonatal Behavioral Assessment
Scale
• Measures reflexes and behaviors in 4 areas
– Motor behavior, Response to Stress, Adaptive behavior,
Control over physiological state.
Table 3.2 – The Apgar Scale
Characteristics of Neonates
• REFLEXES: Simple, unlearned responses
to stimuli; adaptive and are normally
replaced with other learned behaviors within
a few months.
– ROOTING
• Sucking reflex, stimulated by
touching baby’s cheek
– MORO
• When babies position is suddenly
changed (dropping, loud noises,
bumping, etc.), the back arches and
legs and arms fling outward and back
into chest with hugging motion.
– GRASPING or PALMAR
• Grabbing or fingers other objects
using 4 fingers (not thumbs)
Characteristics of Neonates
• REFLEXES:
– STEPPING
• Mimics walking; when held up, baby will place
one foot in front of the other as if attempting to
walk
– BABINSKI
• When bottom of foot is stroked, toes spread in a
fan motion then curl inward.
– TONIC-NECK
• When lying on back with head to one side, arm
and leg will extend toward direction head is
turned, other side will flex.
Characteristics of Neonates
– VISION - SIGHT
• Nearsighted: see best at 7-9 inches
• Prefer moving objects: no peripheral
vision
• Visual accommodation (automatic
adjustment of lens for focusing):
neonates show little or none: view as if
through fixed-focus camera
• Convergence (inward movement of
eyes to focus on close object):
neonates may exhibit cross-eyes or
wall-eyes when looking at objects at
close ranges
• Degree of color perception remains
open for neonates by 4 mos., however,
most infants can see all visible colors
© Design Pics/Leah Warkentin
• Sensory Capabilities
Characteristics of Neonates
• Sensory Capabilities, cont
– AUDITION - HEARING
• Hearing is present in utero; may play a part in bonding
– Prefer sound of mother’s voice over all others after birth; no
preference for father’s voice
• Most newborns respond to unusual sounds.
• Will respond to different amplitude (height of sound wave higher = louder) and pitch (frequency of sound wave higher frequencies make high pitches, low make low
sounds); singing in low tones is soothing
• Particularly responsive to sounds and rhythms of speech
but don’t display preference for any specific language; can
discriminate differences in speech sounds; appear to be
“pre-wired” for language acquisition
Characteristics of Neonates
• Sensory Capabilities, cont
– OLFACTORY - SMELL
• Can discriminate distinct odors
• Show rapid breathing patterns and increased
movement in response
• Turn away from unpleasant odors
• Sensitive to smell of mother’s milk and mother’s
underarm odor, which may contribute to early
development of recognition and attachment.
Characteristics of Neonates
• Sensory Capabilities, cont
– TASTE
• Sensitive to different tastes evident from facial
expressions
• Discriminate between salty, sour, and bitter
• Exhibit preference for sweet tastes which seem
to be calming
– Sweet solution increase heart rate but also slow
sucking indicating an effort to savor and make the
flavor last
Figure 4.4 – Facial Expressions Elicited by
Sweet, Sour, and Bitter Solutions
Characteristics of Neonates
• Sensory Capabilities, con’t
• Important to learning and communication for
babies
• Sensation of skin to skin contact appears to
provide comfort and contribute to bonding with
caregivers
• Many reflexes are activated
by pressure against the skin
– Rooting, Sucking, Babinski,
and Grasping
© Image Source Black/Jupiterimages
– TOUCH & PAIN
Learning: Really Early Childhood
“Education”
• Classical conditioning
– Involuntary responses are conditioned to
new stimuli.
• Newborns taught to blink in response to a tone.
• Blinking (UR) caused by puff of air to eye as a
tone was sounded (CS).
• After repeated pairings, sound of tone caused
babies to blink (CR).
• Conditioned stimuli are specific; capacity to learn
is universal.
Learning: Really Early Childhood
“Education”
• Operant conditioning
– Positive or Negative Reinforcement tends to
increase the incidence of a behavior.
– Use of “reinforcers” to illicit learned behavior
• Experiments using sound of mother’s voice as a
positive reinforcement were found to modify
babies sucking reflexes with a pacifier.
• Baby learns through operant conditioning.
Sleeping & Waking
• Neonates spend about 2/3 (16 hrs) a day
sleeping.
– Adults spend about 1/3 day.
– But baby does NOT sleep 16 consecutive hours
which becomes a challenge for parents.
– There are a number of differing sleep/wake
patterns; individual infants vary but…
• Most all distribute sleep throughout day and
night
• Typically show 6 cycles of sleep/wake in 24-hrs
• Naps usually about 4.5 hrs and awake about 1
hr in between
• Sleep time will increase as baby grows, and by 6
mos to 1 yr most will sleep through the night.
Table 4.3 – States of Sleep and Wakefulness
in Infancy
Sleeping & Waking
• REM and Non-REM Sleep
– REM: periods of sleep where eye movement is
observed under closed eyelids
– 80% of adults report dreaming when in this stage of
sleep and are difficult to awaken
© Adam Przezak/iStockphoto.com
Sleeping & Waking
• REM and Non-REM Sleep
– EEG brain waves resemble waking states
• a.k.a = Paradoxical Sleep
• Neonates spend about 1/2 sleep time in REM
– Preterm babies spend even more time in REM
– By 6 mos., about 30%; and 2-3 yrs about 20-25%
– Function in neonates: REM may be used to stimulate
brain activity needed for creation of proteins for
development of neurons and synapses.
– Non-REM: all other stages of sleep in sleep
cycle
Figure 4.5 – REM Sleep and Non-REM Sleep
Sleeping & Waking
• Crying
– Frequency & times of
day
• Most crying bouts
occur late p.m. & early
evenings
• Most will produce
same amount for first
9 months but they
gradually decrease in
length of time
• If crying is ignored first
9 wks, it appears to
decrease 2nd 9 wks.
© iStockphoto.com
Sleeping & Waking
• Crying, cont
– Causes
• Main reason is pain but also helps clear respiratory
systems of fluids and stimulate the circulatory system
– Recognizing types
– Most parents soon learn to interpret different
types of crying patterns for hunger, anger or..
• PAIN: sudden, loud, insistent, accompanied by flexing
and kicking legs
–
–
–
–
Can indicate colic (gas & distress in digestive tract)
Can be severe and persistent; lasting hours sometimes
Colic generally disappears by 3-6 mos.
Some high-pitched cries indicate other serious problems
» Chromosomal abnormalities, infections, malnutrition,
exposure to narcotics, etc.
Sleeping & Waking
• Soothing
– Methods
• Pacifier: sucking appears to be an innate tranquilizer; as is
sucking on something sweet
• Caregivers: soothe by picking up the baby, patting,
caressing, rocking, swaddling, and speaking in low tones
– Try to ascertain cause of distress
– Learn by trial and error what each baby prefers
– Some parents worry that responding to cries will
“spoil” the baby and they will not learn to engage in
“self-soothing” behaviors to go to sleep
– As infants mature, crying is replaced by verbal
requests for intervention.
Sudden Infant Death Syndrome (SIDS)
a.k.a Crib Death
• Defined:
– A disorder of infancy that strikes while baby
sleeps.
– Typically baby is in perfect health and is
found dead next morning with no sign that
baby struggled or was in pain
– Baby just stops breathing for unknown
reasons.
Sudden Infant Death Syndrome (SIDS)
a.k.a Crib Death
• Most Prevalent in:
–
–
–
–
–
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Babies age 2-4 months
Babies put to sleep on tummies or sides
Premature and low-birth-weight babies
Male babies
Babies in lower socioeconomic status families
Babies in African American families
• African American babies twice as likely
– Babies of teenage mothers
– Babies whose mothers smoked during or after
pregnancy or used drugs during pregnancy
Sudden Infant Death Syndrome (SIDS)
a.k.a Crib Death
• Causes:
– Still unknown but recent (2006) study at Boston
Children’s Hospital show:
• Medullas of SIDS victims were less sensitive to the
chemical serotonin
• Serotonin is chemical that keeps the medulla responsive.
• The medulla is an area in the brainstem involved in basic
functions such as breathing and sleep/wake cycles.
• The problem was seen more in brains of boys, accounting
for the higher incidence in male babies.
Figure 4.6 – The Medulla
Sudden Infant Death Syndrome (SIDS) a.k.a
Crib Death
• Lowering Risk: “The Safe Sleep Top 10”
– Prevention should begin during pregnancy
• Don’t smoke or use drugs
– National Institute of Child Health and Human
Development (NICHD,2006) suggest:
• 1. Always place baby on back to sleep
• 2. Place baby on firm sleep surface free of
quilts, pillows, or other soft surfaces
• 3. Keep toys and loose bedding out of crib
and keep any other items away from
babies face
Sudden Infant Death Syndrome (SIDS)
a.k.a Crib Death
• Lowering Risk: “The Safe Sleep Top 10”
4. Do not allow smoking around the baby
5. Keep baby’s sleep area close to, but
separate from, others’ sleep areas. Baby
should not sleep in a bed or on a couch
or armchair with anyone.
6. Use a clean, dry pacifier when putting
baby to sleep; don’t force baby to take it
7. Do not let baby get too warm or overheat
during sleep; dress in light clothing and
keep temperature comfortable
Sudden Infant Death Syndrome (SIDS)
a.k.a Crib Death
• Lowering Risk: “The Safe Sleep Top 10”
8. Avoid products that claim to reduce risk
of SIDS; most have not been tested for
effectiveness or safety
9. Do not use home monitors to reduce risk
of SIDS. Refer questions to your health
care provider.
10. Reduce the chance that flat spots will
develop on baby’s head: provide “tummy
time” while baby is awake and being
watched. Change direction baby sleeps
in crib weekly.