Post on 07-May-2015
Birth & the NeonateBirth & the Neonate
2.42.4
ChildrenChildren
2
Birthing Methods & Delivery Birthing Methods & Delivery OptionsOptions
99% of U.S. births in hospitals99% of U.S. births in hospitals Other optionsOther options
– Freestanding birth centerFreestanding birth center– Home deliveryHome delivery
What Happens During Birth?
Who helps varies across culturesWho helps varies across cultures– 91% U.S. births physicians91% U.S. births physicians– Some exclude fathers Some exclude fathers – Some family members Some family members – Open to communityOpen to community
Birthing Methods & Delivery Birthing Methods & Delivery OptionsOptions
Birthing Methods & Delivery Birthing Methods & Delivery OptionsOptions
Midwives Midwives – Norm, most of worldNorm, most of world– U.S. Attend 8% birthsU.S. Attend 8% births– U.S. certified nurse midwives U.S. certified nurse midwives
Deliver babiesDeliver babies– More time with patient in prenatal visitsMore time with patient in prenatal visits– Counseling, educationCounseling, education– Emotional supportEmotional support
What Happens During Birth?
Birthing Methods & Delivery Birthing Methods & Delivery OptionsOptions
DoulasDoulas– No medical care No medical care
Do not deliver babiesDo not deliver babies
– Support before, during, & after childbirth Support before, during, & after childbirth PhysicalPhysical
EmotionalEmotional
EducationalEducational
– Most in U.S. work independently, typically Most in U.S. work independently, typically function as part of ‘birthing team’function as part of ‘birthing team’
What Happens During Birth?
Birthing Methods & Delivery Birthing Methods & Delivery OptionsOptions
Natural childbirthNatural childbirth– Goal: reduce pain by reducing fearGoal: reduce pain by reducing fear
EducationEducation
Breathing techniquesBreathing techniques
Relaxation techniquesRelaxation techniques
Prepared childbirth (Lamaze method)Prepared childbirth (Lamaze method)– Similar to natural childbirthSimilar to natural childbirth
– Special breathing technique in final stages of Special breathing technique in final stages of laborlabor
What Happens During Birth?
Birthing Methods & Delivery Birthing Methods & Delivery OptionsOptions
Other methods to reduce pain & Other methods to reduce pain & stress during labor & childbirthstress during labor & childbirth
– WaterbirthWaterbirth
– MassageMassage
– AcupunctureAcupuncture
– HypnosisHypnosis
– Music therapyMusic therapy
What Happens During Birth?
Stages of BirthStages of Birth
3 stages of birth3 stages of birth– Stage 1Stage 1
@ 12 - 24 hrs. @ 12 - 24 hrs.
– Stage 2Stage 2 @ 45 min’s - 1 hour@ 45 min’s - 1 hour
– Stage 3Stage 3 Lasts only minutesLasts only minutes
Effacement of the CervixEffacement of the Cervix
BecomesBecomes–ThinnerThinner–ShorterShorter
StartsStarts–Couple weeks before Couple weeks before deliverydelivery
Stages of BirthStages of Birth
11st st stage: Dilation & Effacement of the stage: Dilation & Effacement of the CervixCervix
– @ @ 12 - 24 12 - 24 hrs.hrs. Longest stageLongest stage
– Contractions @ Contractions @ 1515––20 min’s 20 min’s apartapart Closer together as birth nearsCloser together as birth nears
– Contractions dilate cervix to open @ Contractions dilate cervix to open @ 4 4 inchesinches.. Allows baby to move into birth canalAllows baby to move into birth canal
What Happens During Birth?
Stages of BirthStages of Birth
22ndnd stage : Delivery of the stage : Delivery of the
BabyBaby– @ @ 45 min’s - 1 hour45 min’s - 1 hour– Begins when:Begins when:
baby’s head moves through cervix & birth canal baby’s head moves through cervix & birth canal
– Ends when:Ends when: baby completely emergesbaby completely emerges
– Mother pushes down, contractions come @ Mother pushes down, contractions come @ every minuteevery minute
What Happens During Birth?
33rd rd stage: Placenta (afterbirth)stage: Placenta (afterbirth)– Placenta, umbilical cord, & other Placenta, umbilical cord, & other
membranes detached & expelledmembranes detached & expelled– Fastest stageFastest stage
minutesminutes
Stages of BirthStages of Birth
Cesarean SectionCesarean Section
Cesarean DeliveryCesarean Delivery– Baby removed from uterus through Baby removed from uterus through
incision in abdomen whenincision in abdomen when Baby is in breech or crosswise positionBaby is in breech or crosswise position Head too large for mother’s pelvisHead too large for mother’s pelvis Vaginal bleeding has occurred in pregnancyVaginal bleeding has occurred in pregnancy
– U.S. births by C-sections increased since U.S. births by C-sections increased since 20022002
– http://www.youtube.com/watch?v=vjgxKcjnimY
What Happens During Birth?
NEWBORN ASSESSMENTNEWBORN ASSESSMENT
PRETERM, LOW BIRTH PRETERM, LOW BIRTH WEIGHT, SMALL-FOR WEIGHT, SMALL-FOR DATEDATE
Preterm & Small-for-Date Preterm & Small-for-Date InfantsInfants
Low-birth-weight infant under 5.5 lbsLow-birth-weight infant under 5.5 lbs
– Very lowVery low - under 3 lbs - under 3 lbs
– Extremely lowExtremely low - under 2 lbs - under 2 lbs
PretermPreterm
– Born 3 or more weeks earlyBorn 3 or more weeks early
Small for dateSmall for date
– May be May be preterm/full termpreterm/full term
– Birth weight below normalBirth weight below normal Increased use of Increased use of progestinprogestin to to prevent preterm birthsprevent preterm births
– Lowered preterm births 1/3Lowered preterm births 1/3
Preterm & Small-for-Date Preterm & Small-for-Date InfantsInfants
Preterm & Small-for-Date Preterm & Small-for-Date InfantsInfants
Consequences of preterm & LBWConsequences of preterm & LBW Most low birth weight infants Most low birth weight infants
– normal & healthynormal & healthy As a groupAs a group
– More developmental & health problemsMore developmental & health problems– Risk increases as gestation age decreasesRisk increases as gestation age decreases Potential problems includePotential problems include
brain injuriesbrain injuries lung & liver diseaseslung & liver diseases learning disabilitieslearning disabilities breathing problemsbreathing problems
Norwegian studyNorwegian study– Preterm-birth adolescents higher risk Preterm-birth adolescents higher risk
for:for: language delayslanguage delays learning problemslearning problems behavior problems/delinquency involvementbehavior problems/delinquency involvement
Consequences of Preterm & Consequences of Preterm & LBWLBW
INFANT CAREINFANT CARE2.52.5
BondingBonding Close connection, especially physical Close connection, especially physical
bond, between parents & newborn in bond, between parents & newborn in period shortly after birthperiod shortly after birth
– Doctors suggest: Doctors suggest: ““rooming in”rooming in”
– Newborn kept in mother's hospital Newborn kept in mother's hospital room
Immediate bonding Immediate bonding
– Not Not necessary for emotional healthnecessary for emotional health Adoption?Adoption?
The Postpartum Period
Postpartum DepressionPostpartum Depression
Period after childbirth Period after childbirth – Mother adjusts physically & psychologically to Mother adjusts physically & psychologically to
process of childbearingprocess of childbearing
– Lasts about @ 6 weeksLasts about @ 6 weeks
Involution Involution – Process by which uterus returns to pre-Process by which uterus returns to pre-
pregnant sizepregnant size
– 5 - 6 weeks 5 - 6 weeks
The Postpartum Period
8. Postpartum Period8. Postpartum Period
Postpartum DepressionPostpartum Depression
Emotional & Psychological Emotional & Psychological AdjustmentsAdjustments
– Emotional fluctuations due to:Emotional fluctuations due to: Hormonal changesHormonal changes
FatigueFatigue
Inadequate restInadequate rest
Inexperience or lack of confidenceInexperience or lack of confidence
Extensive demands may causeExtensive demands may cause– Anxiety, depression, coping difficultiesAnxiety, depression, coping difficulties
The Postpartum Period
Emotional & Psychological Emotional & Psychological AdjustmentsAdjustments
Postpartum depressionPostpartum depression– Strong feelings ofStrong feelings of
SadnessSadness AnxietyAnxiety DespairDespair
– Gets worse without treatmentGets worse without treatment
Emotional and Psychological Emotional and Psychological AdjustmentsAdjustments
Postpartum depression treatmentsPostpartum depression treatments
– AntidepressantsAntidepressants
– Psychotherapy; cognitive therapy is bestPsychotherapy; cognitive therapy is best
Postpartum depression affectsPostpartum depression affects
– Mother-infant interactionMother-infant interaction
– Risk of additional psychological Risk of additional psychological disordersdisorders
The Postpartum Period
Emotional and Psychological Emotional and Psychological AdjustmentsAdjustments
Father’s adjustmentFather’s adjustment– Considerable adjustment & stress Considerable adjustment & stress
Attention on infant decreases couple’s timeAttention on infant decreases couple’s time May feel unneededMay feel unneeded
– Father’s postpartum reactionsFather’s postpartum reactions Prenatal involvement can lessen feelings of Prenatal involvement can lessen feelings of
depressiondepression
The Postpartum Period
Infant Nutrition & HealthInfant Nutrition & Health
• Infants in 1 yr. Infants in 1 yr. Triple weightTriple weight
– Increase length 50% Increase length 50% – 50 calories per day 50 calories per day
per lb. of weightper lb. of weight– High-calorie, high-High-calorie, high-
energy foods & fats energy foods & fats very importantvery important NO NONFAT FOODSNO NONFAT FOODS
Infant Nutrition & HealthInfant Nutrition & Health
Healthy infants need:Healthy infants need:– Loving, supportive feeding environmentLoving, supportive feeding environment– Breast milk Breast milk – Gradual increase of chew-&-swallowGradual increase of chew-&-swallow– More fruits & vegetables, less junk foodMore fruits & vegetables, less junk food– Demand feeding becoming more Demand feeding becoming more
popularpopular– Poor dietary patterns can cause Poor dietary patterns can cause
overweightoverweight
Co-sleepingCo-sleeping
Culture and Sleeping ArrangementsCulture and Sleeping Arrangements
– Sharing bed common in many culturesSharing bed common in many cultures
– American Academy of PediatricsAmerican Academy of Pediatrics– Discourages co-sleeping because ofDiscourages co-sleeping because of
StressStressSIDS riskSIDS risk
How Do Infants Grow and Develop Physically?
Sudden Infant Death Sudden Infant Death Syndrome (SIDS)Syndrome (SIDS)
Infant stops breathing, usually during Infant stops breathing, usually during night, and dies without apparent night, and dies without apparent causecause– Highest cause of infant death in U.S.Highest cause of infant death in U.S.– Highest risk is 2 - 4 mo.'s of ageHighest risk is 2 - 4 mo.'s of age– Sleeping on back reduces riskSleeping on back reduces risk– Less common in:Less common in:– bedroom with fanbedroom with fan– infant who sleeps with pacifierinfant who sleeps with pacifier
How Do Infants Grow and Develop Physically?
Sudden Infant Death Sudden Infant Death Syndrome (SIDS)Syndrome (SIDS)
Thoughts?Thoughts?
Sudden Infant Death Sudden Infant Death Syndrome (SIDS)Syndrome (SIDS)
Highest risksHighest risks– Lower birth weightLower birth weight– Siblings with SIDSSiblings with SIDS– Sleep apnea Sleep apnea – Lower SES groupsLower SES groups– Exposure to cigarette smokeExposure to cigarette smoke– Placement in soft beddingPlacement in soft bedding– Abnormal brain stem functioningAbnormal brain stem functioning– African American & Inuit infants African American & Inuit infants
How Do Infants Grow and Develop Physically?
Breast Versus Bottle Breast Versus Bottle FeedingFeeding
Breast milk Breast milk – Fewer gastrointestinal infectionsFewer gastrointestinal infections– Lower respiratory tract infectionsLower respiratory tract infections– Reduces effects of asthma in first 3 mo’sReduces effects of asthma in first 3 mo’s– Reduce risk of skin inflammation Reduce risk of skin inflammation – May lessen likelihood of obesityMay lessen likelihood of obesity– Lowers risk of childhood & adult diabetesLowers risk of childhood & adult diabetes– Less risk of experiencing SIDSLess risk of experiencing SIDS– Claims of no link to allergy preventionClaims of no link to allergy prevention
How Do Infants Grow and Develop Physically?
Malnutrition in InfancyMalnutrition in Infancy
Early weaning can Early weaning can cause deficienciescause deficiencies
Can develop:Can develop:– MarasmusMarasmus– Wasting away of Wasting away of
body tissues body tissues infant’s 1infant’s 1stst yr. yr.
How Do Infants Grow and Develop Physically?
Malnutrition in InfancyMalnutrition in Infancy
KwashiorkorKwashiorkor Deficiency in proteinDeficiency in protein Abdomen, feetAbdomen, feet swollen with waterswollen with water If not fatal, effects If not fatal, effects
detrimentaldetrimental Lowest SESLowest SES Aided by Aided by
supplementary supplementary feedingfeeding
Nonorganic Failure to ThriveNonorganic Failure to Thrive
Child may die Child may die Occurs before 18 mo.'s.Occurs before 18 mo.'s. Denied Denied
– AffectionAffection– Emotional SupportEmotional Support– StimulationStimulation
Harry Harlow experimentHarry Harlow experiment