Child Birth and the Newborn Baby The Three

Child Birth and the Newborn Baby

The Three Stages of Labor Figure 4. 1

The Apgar Scale © Photomak | Dreamstime. com • Appearance • Pulse • Grimace

The Apgar Scale Table 4. 1 Copyright © 2012 Pearson Education, Inc. All Rights

Approaches to Childbirth • Attitudes and practices molded by society • Western society: – Before late 1800 s→home births – Post-industrial revolution→hospital births – 1950 s– 1960 s→movement toward natural childbirth – Today→birth centers (& some home births)

Elements of Natural, or Prepared, Childbirth § Classes § Relaxation and • breathing techniques § Labor coach – Social support – Difference between midwife and Doula? © Frank Boston | Dreamstime. com Copyright © 2012 Pearson Education, Inc. All Rights Reserved.

Other Natural Childbirth Practices § Positions for delivery might include sitting upright or using a birthing stool. § Water births are associated with shorter labors and a greater likelihood of a medication-free delivery than other approaches. § North American women choosing home delivery remain a small percentage (1%). Figure 4. 2

Medical Interventions in Childbirth • Fetal monitoring • Medication § Analgesics § Anesthetics © Alvera | Dreamstime. com • Instrument delivery • Induced labor • Cesarean delivery Copyright © 2012 Pearson Education, Inc. All Rights Reserved.

Instrument Delivery Figure 4. 3 Copyright © 2012 Pearson Education, Inc. All Rights

Cesarean Delivery • Cesarean deliveries, rare 40 years ago, now account for 31% of births in the United States • Cesareans are warranted in medical emergencies such as – – Rh incompatibility. premature separation of the placenta from the uterus. infection. baby in breech position.

Cesarean Delivery • Many are ELECTIVE Cesarean deliveries • Why have them? • --doctor and family convenience • Higher risk of complications; infant death • due date may have been inaccurate • brain, heart, lungs and immune system mature at different rates

The Business of Being Born • 2008 documentary

Anoxia Oxygen deprivation at birth Can lead to brain damage or later cognitive, language problems n Cerebral palsy Causes include: n Squeezing by umbilical cord n Placenta abruptio, placenta previa n Failing to breathe after birth n Respiratory distress syndrome in preterm infants

Preventing Brain Cell Death from Anoxia • Researchers are experimenting with ways to prevent this secondary damage. – Anoxic newborns placed in a head-cooling device shortly after birth for 72 hours substantially reduced brain injury and increased their assessment scores. – Precooled water blankets are also being used to reduce the rates of death and severe disabilities.

Rates of Infant Survival and Disability by Length of Pregnancy Figure 4. 4 Copyright

Preterm and Small-for-Date Babies • Preterm • Small-for-Date § Born weeks before their due date (< 37 wks) § May be appropriate weight for length of pregnancy § May be born at due date or preterm § Below expected weight for length of pregnancy § Some small-for-date babies have weakened abilities to manage stress. Copyright © 2012 Pearson Education, Inc. All Rights

Interventions for Preterm Infants § § § § Isolette Respirator Feeding tube Intravenous medication Special infant stimulation Kangaroo skin-to-skin contact Parent training in caregiving Copyright © 2012 Pearson Education, Inc. All Rights Reserved. © Juan Carlos Herrera Arango | Dreamstime. com

Influence of Early Intervention for Low-Income, Preterm Babies on Intellectual Functioning at Age 8

Health Care for Parents and Newborn Babies • Infant mortality: In spite of the most upto-date technology in the world, the United States has made little progress in reducing infant death rates. • Neonatal mortality: Low birth weight is the second highest contributor to infant mortality, and it is largely preventable.

Figure 4. 6 Infant Mortality Around the World Copyright © 2012 Pearson Education, Inc.

Precious Moments After Birth © Jkha | Dreamstime. com § Oxytocin causes the breasts to “let down” milk, heightens the mother’s response to baby § First-time fathers also show hormonal changes that are associated with positive emotional reactions to infants. § But parent–infant relationship not dependent upon immediate bonding Copyright © 2012 Pearson Education, Inc. All Rights Reserved.

Newborn Reflexes § Eye blink § Withdrawal § Rooting § Sucking § Swimming § Moro § Palmar grasp § Tonic neck § Stepping § Babinski

Infant States of Arousal § Regular sleep § Irregular sleep § Drowsiness § Quiet alertness § Waking activity and crying © Atm 2003 | Dreamstime. com

The Mysterious Tragedy of Sudden Infant Death Syndrome § SIDS is the leading cause of infant mortality between 1 week and 12 months in industrialized nations. § Its occurrence tends to peak between 2 and 4 months of age. Copyright © 2012 Pearson Education, Inc. All Rights

Reducing Incidence of SIDS § Quit smoking and taking drugs. § Put babies to sleep on their backs. § Remove bedclothes. § Pacifiers are another protective measure.

Ways to Soothe a Crying Baby n Hold on shoulder and rock or walk n Swaddle n Pacifier n Soothing sounds n Ride in carriage, car, swing n Massage n Combine methods n Let cry for short time © Jperagine | Dreamstime. com Copyright © 2012 Pearson Education, Inc. All Rights Reserved.

Newborn Sense of Touch • Reflexive response to touch on mouth, palms, soles, genitals • Sensitive to pain § Pain can affect later behavior. § Relieve pain with anesthetics, sugar, gentle holding

Newborn Senses of Taste and Smell § Prefer sweet tastes at birth § Quickly learn to like new tastes § Have odor preferences from birth § Can locate odors and identify mother by smell from birth Figure 4. 7 Copyright © 2012 Pearson Education, Inc. All Rights Reserved.

Newborn Sense of Hearing § Can hear a wide variety of sounds at birth § Prefer complex sounds to pure tones § Learn sound patterns within days § Sensitive to voices and biologically prepared to learn language Copyright © 2012 Pearson Education, Inc. All Rights Reserved. © Lihui | Dreamstime. com

Newborn Sense of Vision § Least developed of senses at birth © Aaron Belford | Dreamstime. com § Unable to see long distances, focus clearly § Scan environment and try to track interesting objects § Color vision improves in first two months. Copyright © 2012 Pearson Education, Inc. All Rights Reserved.

Neonatal Behavioral Assessment • Neonatal Behavioral Assessment Scale (NBAS) evaluates a baby’s reflexes, muscle tone, state changes, responsiveness to physical and social stimuli (developed by T. Berry Brazelton). • Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) is specially designed for use with newborns at risk for developmental problems.

Single Mother Families • 39% of babies in United States born to single mothers • Most nonmarital births are unplanned. – Unprepared, adolescent teens – Low-income women in 20 s – Exception is financially secure women ages 30– 45 © Crystal Craig | Dreamstime. com

Parental Depression and Child Development § Eight to 10% of first-time mothers experience postpartum depression after the birth of their baby. § Three to 5% of fathers also report depression after the birth of a child. § Parental depression can have a negative effect on a child’s world view. § Early treatment/pre-birth intervention is vital.