CHAPTER SEVEN THE BABYS ARRIVAL 7 1 Labor

CHAPTER SEVEN THE BABY’S ARRIVAL

7 -1 Labor and Birth • Signs of labor – losing the mucus plug – seals the cervix to prevent bacteria from entering the uterus. (show or bloody show) • Liquefies as early as a few days before – A trickle or gush of warm fluid may signal onset of labor (breaking of membrane) in most this happens in active labor. • Baby should be delivered within 24 to 48 hours to prevent infection – Contractions – tightening and releasing of the muscle of the uterus (when the uterus contracts it gets shorter and harder…. flex your arm muscle and it gets hard; relax it and it gets soft, the uterus does the same, it shortens and gets harder, holds for a short time, and then relaxes and rests for a few minutes) … after baby born, contractions end • When contractions are strong, regular, close together …get to the hospital • False labor – contractions are not regular, rhythmic, or increasingly stronger, and subside with walking

First Stage of Labor • Contractions make the cervix dilate or widen • Effacement is the thinning of the cervix from ¾ inch to 19 mm (thin as paper) • Transition –cervix fully dilated (4 inches or 10 cm) and baby’s head moves into birth canal.

2 nd Stage of Labor • Crowning: top of head appears at opening of birth canal • Head emerges, changes shape to pass through (skull soft, flexible 5 bones), then shoulders, the rest is easy • In this stage the mom is actively pushing – HOW DOES THIS HAPPEN? ? ? – Hormones “relaxin” cause pelvis ligaments to become very stretchy and the bones in the pelvis are able to stretch open • Episiotomy – cut to widen opening • Forceps – steel tongs to guide movement • Vacuum extraction (stay in shape ladies or your baby will look like an extra from Saturday Night Live)

3 rd Stage • Delivery of the placenta – Labor brief but important – If any part of the placenta is left it can result in bleeding, infection, & serious illness

Cesarean Birth • Surgical incision in mother’s abdomen to deliver baby (6 weeks recovery)

Newborn • Lungs of baby are collapsed in the uterus • Expand during birth & fill with amniotic fluid remaining in baby’s trachea • Squeezing down birth canal forces fluid out and baby breathes air naturally in most cases and any remaining fluid is suctioned out • Heart valve closes over few days and blood circulates to and from lungs where it had bypassed them in the uterus • Umbilical cord stops pulsing, shrinks; it is clamped, tied, and cut off leaving only small stump

Features • Head – wobbly & large ¼ babies length, may be lopsided (two fontanels – openings) • Face may be swollen, fat cheeks, short flat nose, receding chin - best for feeding • Eyes are nearly adult sized – permanent color apparent in several months • Downy hair – lanugo • Vernix – creamy covering removed with water • Milia – baby acne from mom’s hormones

7 -2 The Postnatal Period • Apgar Scale – evaluation done minute after birth (p. 227) rated 0 -2 in: – Heart rate – Breathing – Muscle tone – Reflex to stimulation – Skin color Score of 6 -10 considered normal If score is lower baby may need medical attention

Postnatal Procedures • Baby is examined, weighed, and measured • Identification: baby’s footprint - 2 bracelets with family name on baby’s wrist or ankle and one on mom’s wrist…. hopefully this way you actually take your baby home. • Other tests – Antiseptic eye drops to prevent infection – Vitamin K shot – needed for blood to clot and stop any bleeding – Hearing test – Blood test – PKU, sickle cell anemia, or other conditions

Bonding and Attachment • Studies showing the importance of bonding or forming a strong emotional tie between parents and child brought change in hospital policies. – Most delay cutting the umbilical cord, cleaning the infant, and giving eyedrops to allow child to bond – Baby may be placed in mother’s arms or on her abdomen to hear her familiar heartbeat and voice, or begin nursing. – Nurses or lactation specialists provide advice on nursing. – Colostrum is the first milk produced and will provide valuable antibodies

Bonding • Complete exercise “Strengthening Bonds” on page 229 in your journal

Hospital Stay • Average stay following birth is two or three days – Delays: • Jaundice – baby has yellow skin and whites of eyes – Liver unable to remove chemical naturally produced in blood – Untreated will damage nervous system – Treatment – flourescent light for few hours each day (sunlight helpful) – Rooming-In – baby stays in mother’s room rather than nursery – Legal Documents – birth certificate and applied for by hospital and Social Security number (necessary for parent to claim as an exemption)

Premature Babies • Premature babies are born before 37 weeks of development and weigh less than 5 lbs. 8 oz. • Systems for body temperature, breathing, and feeding not mature • Incubator – special enclosed crib – Oxygen, temperature, and humidity are controlled – Heart and lungs monitored to prevent infection and breathing difficulties – Breast milk best for premie • 2 X protein for growth • Easier to digest • 2 X nutrient that boosts brain and nervous system development • For baby to leave hospital it must be able to control body temperature and gain weight at the same time.

Postnatal Care of the Mother • Mom has gone from pregnant, to birth, to not being pregnant in the course of a day. – Rest – mom should rest when baby does. • Best way for family to help is by taking care of household chores etc. – Exercise – upon doctor’s approval – Nutrition – especially important if breast feeding (plenty of water and liquids) – Medical checkup 4 to 6 weeks later – Depression “baby blues” – talk, don’t isolate

7 -3 A New Family Member • Newborns use senses to learn about their world – Sensitive to sounds, light, and smells • can detect different volumes, lengths, rhythms. (Low-pitched rhythmic sounds soothe them, and are more responsive to women’s voices than men’s. p 237) • Will turn toward the smell of mother • Reflexes – instinctive automatic responses – Lifetime - Sneezing and swallowing – Temporary till baby develops voluntary control: • Rooting reflex – automatic response when touched on lips or cheek baby turns toward touch and begins to suck; stops around 4 months old • Grasp reflex - grips what comes in contact with palm- strong enough to lift baby up by it. It weakens about 3 months and stops at 1 year. • Startle reflex - response to loud noise or to a touch on the stomach. Legs are thrown up, fingers spread, and arms are first extended and then brought back rapidly. (Disappears at about 5 mos. )

Newborn Care • Baby Needs: – Food – Show hunger with whole body, squirming & searching for mother’s breast or bottle. (meeting this need quickly builds trust) – Sleep – average 15 hours, in 6 to 8 periods many with a 5 hour stretch at night – Exercise – wave arms and legs to help muscles and nervous system – Safe, clean & warm – be aware of safety hazards

Needs continued: • Medical care – periodic checkups verify normal development & immunizations • Things to look at, touch, listen to, and play with ( help baby’s learn • Love – need close contact – (feels at ease and secure)

Parent needs: • Parent needs: – Knowledge – Information about infants – Time – Emotional support – Financial planning – Personal health and rest – Privacy & time alone

• Adjusting to new routines: – Takes several weeks to establish a pattern of eating and sleeping • Adjusting to baby is best until baby is more mature • Babies communicate with crying telling parents they are: – – – – Too hot Too cold hungry Uncomfortable Need diaper changed Can’t hear mother’s voice On average they cry one hour a day • Every baby has a different temperament or style of reacting to the world and others – Studies show infants as young as 2 weeks respond in like manner to how parents talk and handle them

pp. 242 - 243 • Read pp 242 -243 and complete the “Following Up” exercises.