CHAPTER 3 BIRTH AND THE NEWBORN INFANT Learning

CHAPTER 3 BIRTH AND THE NEWBORN INFANT

Learning Objectives LO 3 -1 What is the normal process of labor? LO 3 -2 Skip LO 3 -3 What complications can occur at birth? LO 3 -4 What are some of the causes, effects, and treatments of birth complications? LO 3 -5 What is postpartum depression? LO 3 -6 What capabilities does the newborn have?

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

APGAR SCALE • • • 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 • Highly variable “presentation”

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

Childbirth Attendants: Who Delivers? • Obstetrician • Midwife • Doula

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 • Proper use has no significant effect on child’s later wellbeing

Neonate w Latin ‘natus’ meaning born w A baby 4 weeks old or younger. w Also called a “newborn” 13

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 1990 s, 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 What does this have to do with developmental psych?

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

BIRTH COMPLICATIONS

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 countries as 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

Preterm Infants: Too Soon, Too Small • Preterm infants, or premature infants, are born prior to 38 weeks after conception. • The average newborn weighs around 3, 400 grams (about 7 1/2 pounds) • low-birth weight infants weigh less than 2, 500 grams (around 5 1/2 pounds). • 7 percent of all newborns in the USA fall into the lowbirth weight category but they account for the majority of newborn deaths. • Small-for-gestational-age infants are infants who, because of delayed fetal growth, weigh 90 percent (or less) of the average weight of infants of the same gestational age. Small-for-gestational-age infants are sometimes also preterm, but may not be.

Very low birth-weight infants Smallest survivors • Most vulnerable; immaturity of their organ systems • Weigh less than 1250 grams (around 2 1/4 pounds) • Or, in womb less than 30 weeks • Eyes may be fused shut, earlobes may look like flaps of skin on the sides of their heads; skin a darkened red color, whatever their race. Risk-reduction strategies • High-quality care • Responsive, stimulating and organized care • Massage

Survival and Gestational Age #/1000 babies born in USA after specified lengths of gestation who survive the first year of life. WHAT? This chart is crap. CDC wants $19 to see original data. Could it actually mean # who die w/ in first year? Population base skews data. Scotland may have had only 2 preemies per year. In USA death in first year is 7/1000 live births

A Better Chart http: //www. cdc. gov/mmwr/preview/mmwrhtml/mm 6205 a 6. htm 24

What causes preterm and low-birth-weight deliveries? • Half of preterm/low birth-weight births unexplained • Difficulties related to mother’s reproductive system • Immaturity of mother’s reproductive system • • General health of mother Smoking Drugs Illness

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

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 • Cultural • Routine use of fetal monitor • Increased profit for MD & hospital due to reimbursement rates • Lower lawsuit risk Risks • Major surgery for mother, longer recovery • Reduced stress-related hormones for neonate • May not trigger normal hormonal release in mothers and babies • Bonding issues

Cesarean Deliveries

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 • Stillbirth, the delivery of a child who is not alive, occurs in less than 1 delivery out of 100 (or 115 depending on source). • Joy that accompanies the birth of a child is completely reversed when a newborn dies • U. S. infant mortality generally declining since 1960 s • Effects on parents: • Enormous impact on family lack of support common; • Sense of loss and grief similar to death of older child. • Juxtaposition of the first dawning of life and an unnaturally early death may make the death particularly difficult to accept and deal with. • Depression • Sometimes PTSD

Moving From the Heights of Joy to the Depths of Despair Postpartum Depression A period of deep depression following the birth of a child • Incidence rate • affects some 10 percent of all new mothers Symptoms Main symptom: an enduring, deep feeling of sadness and unhappiness, lasting in some cases for months or even years. In about 1 in 500 cases, the symptoms are even worse, evolving into a total break with reality. • Causes may be triggered by the pronounced swings in hormone production that occur after birth. During pregnancy, the production estrogen and progesterone increase significantly. However, within the first 24 hours following birth, they plunge to normal levels. This rapid change may result in depression. • Consequences In extremely rare instances, postpartum depression may turn deadly.

When Mothers Are 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 Long term effects • Children of depressed mothers are more prone to antisocial activities such as violence.

Developmental Diversity First year mortality by race Largest cause: low birth weight

THE COMPETENT NEWBORN Earliest views of newborns focused on the things that they could not do, comparing them rather unfavorably to older members of the human species. Today there is more favorable view. As developmental researchers have begun to understand more about nature of newborns, they have come to realize that infants enter this world with an astounding array of capabilities in all domains of development: physical, cognitive, and social.

Physical Development and Learning in Infancy Neonate focus: n Perceptual Development n Learning n Motor Development 36

Neonate Reflexes: Built-In Responses w Sucking, swallowing, coughing, and blinking w Moving an arm, a leg, or other body part away from a painful stimulus w Attempting to remove a blanket or cloth placed over the face. w Rooting reflex—the baby opens its mouth and actively searches for a nipple. w Responses to voices – Pitch perception 37

Neonate Reflexes: Changes w Neonates also have some reflexes that serve no apparent function w These reflexes are believed to be remnants of humans’ evolutionary past. w During development, some reflexive behaviors (controlled by the lower brain centers) gradually come under the voluntary control of the higher brain centers. w Presence of these reflexes at birth and their disappearance between the 2 nd & 4 th months allow assessment of CNS development. 38

The Newborn Digestive System Sucking and swallowing reflexes help infants consume mother’s milk & are coupled with the ability to digest nutriments Neonatal jaundice • Because the liver, a critical component of the digestive system, does not always work effectively at first, almost half of all newborns develop a distinctly yellowish tinge to their bodies and eyes. • This change in color is a symptom of neonatal jaundice. It is most likely to occur in preterm and low-weight neonates, and it is typically not dangerous. • Treatment most often consists of placing the baby under fluorescent lights or administering medicine.

The Newborn Digestive System cont. Sucking and swallowing reflexes help infants consume mother’s milk & are coupled with the ability to digest nutriments Meconium • Earliest stools composed of materials ingested during the time in the uterus: intestinal epithelial cells, lanugo, mucus, amniotic fluid, bile, and water. • Viscous and sticky like tar, its color usually being a very dark olive green; it is almost odorless. It should be completely passed by the end of the first few days after birth. • Around half of the samples appeared to be dominated by bacteria that produce lactic acid, such as lactobacillus, while the other half mostly contained a family of so-called enteric bacteria, such as Escherichia coli

Neonate Perceptual Development w The five senses, although not fully developed, are functional at birth. w The newborn already has preferences for certain odors, tastes, sounds, and visual configurations. w Hearing is much better developed than vision in the neonate and is functional even before birth. 41

Infant Perceptual Development – Fantz Findings w Fantz’s & others have shown that: – newborns have clear preferences – powers of discrimination – memory recognition – learning ability 42

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

Infant Perceptual Development - Vision w At birth, an infant’s vision is about 20/600 w Typically reaches 20/20 about 2 years old w Newborns focus best on objects about 9 inches away, and they can follow a slowly moving object. w Infants 22 to 93 hours old indicate a preference for their own mother’s face over that of an unfamiliar female. 44

Infant Perceptual Development - Vision w Newborns prefer colored to gray stimuli w Infants can’t distinguish all colors perceived by adults until about 2 months w Then prefer red, blue, green, & yellow 45

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

Neonate Perceptual Development w A newborn is able to turn the head in the direction of a sound and shows a general preference for female voices. w Shortly after birth, infants prefer their own mother’s voice to that of an unfamiliar female. w A preference for the father’s voice over a strange male voice does not develop 47 until later.

What about other senses? Other senses • Senses of touch, smell, and taste are not only present at birth, but are reasonably sophisticated.

Neonate Perceptual Development w Newborns are able to discriminate among and show preferences for certain odors and tastes. w They show a favorable response to sweet tastes and are able to differentiate between salty, bitter, and sour solutions. w Newborns are also sensitive to pain and are particularly responsive to touch, reacting positively to stroking and fondling. 49

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

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