Pregnancy and Childbirth

Labor, Newborns, Postpartum Issues,

Caring for baby

LABOR

Early Labor

• Baby settles deep into mother’s pelvis (dropping)

• Losing the mucus plug • Water breaking

– Amniotic fluids’s membrane has broke

• Contractions– Tightening and releasing of uterine

muscle – Braxton Hicks: weeks before actual labor

begins

Stages of Labor

• Stage one: contractions open the cervix

• Stage two: the baby is born

• Stage three: placenta expelled

Stage one: Contractions

• Cervix dilates (widens) to four inches (10 cm) by the end of the stage

• Cervix thins out • Contractions are

approximately 60 seconds long and 5 – 6 minutes apart

• As the cervix opens, baby moves down into the lower pelvis

• Breech presentations – Baby is not head first

• At the end of the stage, contractions last up to 90 seconds and are 2 – 3 minutes apart

• Cervix is fully dilated

• Transition period

Stage two: Here comes baby!

• Can last from minutes to hours • Contractions are moving the baby

down the birth canal • Skull is soft and flexible to allow for

passage (it overlaps) • Episiotomy may be needed • Various birthing positions • Use of forceps

Special Delivery!

• Natural childbirth– Often called

prepared childbirth– The woman learns

about the birthing process so that she knows what to expect

– This reduced tension, fear and pain

Special Delivery!

• Bradley method– Similar to natural

childbirth– Focuses on prenatal

care, deep relaxation, little or no medication, and the father is the coach

Special Delivery!

• Lamaze method – Named after Dr. Fernand Lamaze – Idea is that women are conditioned to fear

childbirth and with Lamaze training, the mother is taught to focus on something other than childbirth

– Mother using breathing pattern to keep mind off pain (deep breathing or panting)

– Mother and coach, usually father, attend classes to prepare mentally and physically

– Mother receive medication if necessary

Lamaze via “The Nanny”

Special Delivery!

• Water birth – Mother sits in a tub of warm water,

usually heated between 90 & 100 degrees

– During active stage of labor – Physical relief for mother – Transition for baby water temperature is

similar to internal temperature of mother– Some hospitals provide or allow it

Cesarean birth

• Delivery of baby through a surgical incision in the mother’s abdomen

• Used when vaginal delivery is unsafe or there are complications– Mother’s pelvis is too small or not

shaped correctly – Baby’s head is too large – Baby is in incorrect position for birth

• 22% of babies are born this way

Positioning

• Squatting

• Side – lying

• Hands and knees

• Upright

• Standing

• Sitting (rocking or on toilet)

To drug or not to drug?

• Anesthetic: the medication that reduces or eliminates pain

• Systematic: an injection into a muscle or vein that relieves tension, pain and/or nausea (i.e. Demerol)

• Local – Drug injected to numb the vaginal area

when birth is near, an incision needs to be made, or stitches are needed (for example, for episiotomies)

To drug or not to drug?

• Regional: numbs a larger area or region of the body – Epidural: drug given

through a tiny tube placed in the small of the back, just outside the spinal canal

– Spinal: drug administered into the spinal canal, side effects similar to epidural, but may be more dangerous and severe

• General– Drug given

intravenously or by breathing a gas

– Leaves you unconscious

– Used for surgical deliveries

– Has more side effects for mother and baby than other types

– i.e., Cesarean

Stage three: Placenta

• Expelling of placenta– Contractions help placenta detach from

uterine wall

• Can last from two minutes to thirty minutes post – birth

NEWBORNS

Newborn at birth

• Begins breathing

• Umbilical cord is no longer needed

• Blood circulating throughout entire bordy

• Physical appearance – Wobbly, lopsided and

pointed head– Soft spots on head

called fontanels • Open spaces where the

bones of skull have not yet permanently joined

– Fat cheeks– Short, flat nose– Milia

• Small, white bumps caused by plugged oil ducts

Premature babies

• Less than 5 ½ pounds or born before 36 weeks

• Incubator placement

• Heart and lungs monitored

Reflexes

• Rooting reflex– Automatic response when touched on the lips or

cheek – Turns toward touch and begins to suck

• Grasp reflex – Newborn’s hand closes around anything that

comes in contact with palm

• Startle reflex – Legs thrown up, fingers spread, arms extended

and then brought rapidly back while the fingers close in a grasping action

– Do this in response to a loud noise or a touch on the stomach

POSTPARTUM ISSUES

Mom post – birth

• Important for Mommy and baby to bond

• Mommy will produce colostrum– First breast milk that has important

antibodies to protect against disease

• Emotional health

Bonding with Baby

Bonding with Mommy• Skin – to – skin contact • Eye – to – eye contact • Talk to your baby • Feeding, especially if

breastfeeding

Bonding with Daddy• Participating in labor

and delivery • Feeding • Reading or singing to

baby • Letting baby touch

you

3 categories

• Baby blues

• Postpartum depression

• Postpartum psychosis

Baby Blues

• Occurs within the first 2 weeks after giving birth

• Between 50 and 80% of all new mothers experience baby blues

• Because this disorder is so common, it is commonly not classified as a postpartum mood disorder

Baby Blues: How can I tell?

• Weepiness

• Mood swings

• Irritability

• Anxiety

• Loneliness

• Restlessness

• Impatience

Baby Blues: Why me?

• Attributed to: – A sudden change in hormones

– Emotional and physical hardships of giving birth

– Fatigue

Baby Blues: How can I get over it?

• Exercise

• Eat healthy

• Take some “me” time

• Split up parenting responsibilities, if possible

Postpartum Depression

• Affects approximately 10% of new mothers

• Progresses off of baby blues – If your baby blues lasts longer than 2

weeks

Postpartum Depression: Symptoms

• Loss of appetite

• Insomnia

• Intense irritability or anger

• Overwhelming fatigue

• Lack of joy in life

• Feelings of guilt, shame and inadequacy

• Difficulty bonding with baby

• Thoughts of harming yourself or baby

Postpartum Depression: Why me?

• Changing hormone levels

• Difficulty breastfeeding

• Sick baby

• fatigue

• Risk factors – History of depression – PPD after previous

pregnancy– Unplanned/unwanted

pregnancy – Marital conflict – Pregnancy/previous

stressors – Weak or no support

system

Postpartum Depression: Help is on the way

• Medications

• Therapy

• Possible hospitalization

Postpartum Psychosis

• The mother loses touch with reality

• Afflicts 1 to 2 women per 1,000 live births

Postpartum Psychosis: Symptoms

• Confusion

• Disorientation

• Hallucinations

• Delusions

• Paranoia

• Attempts to harm baby and/or self

Postpartum Psychosis: Will I be affected?

• Risk factors – History of depression – History of psychosis – Previously had PPP with another

pregnancy – History of bipolar disorder – History of other medical problems /

imbalances

Postpartum Psychosis

• So will 1 to 2 every 1,000 children be killed by their mothers?

– Infanticide is rare

– Many PPP sufferers do not act upon their homicidal thoughts

– Reportedly occurs in less than 1 per 50,000 live births

Postpartum Psychosis Help

• Treatment includes

– Medications

– Therapy

– Immediate hospitalization

References

• http://www.mayoclinic.com

• http://www.alegent.com

• http://www.pregnancy-info.net

Postpartum Depression

Postpartum Psychosis The Andrea Yates Story

CARING FOR NEWBORN

Caring for a newborn

• Food

• Sleep

• Exercise

• Safety

• Bathing

• Medical care

• Toys

• Love

Baby language

• Each cry is for something different

Temperament

• Way they react to the world and others

• Be sensitive to a baby’s individual style

SIDS

S udden

I nfant

D eath

S yndrome

• Also known as “crib death”

• Victims are typically healthy infants between 2 weeks and 6 months

• Infants die in their sleep with no warning, no cry, and no evidence of pain

SIDS

• To reduce the risk of SIDS– Place infants on their backs for sleep– Provide a firm crib, covered by a sheet– Keep soft materials, such as comforters,

pillows, and stuffed toys out of the crib– Make sure the sleeping area is a

comfortable temperature to keep infants from becoming overheated

Shaken Baby Syndrome

• Signs and symptoms resulting from violent shaking or shaking and impacting of the head of an infant or small child.

Shaken Baby Syndrome

What Happens: • The brain rotates within the

skull cavity, injuring or destroying brain tissue.

• When shaking occurs, blood vessels feeding the brain can be torn, leading to bleeding around the brain.

• Blood pools within the skull, sometimes creating more pressure within the skull and possibly causing additional brain damage.

• Retinal (back of the eye) bleeding is very common

Why? • Babies' heads are relatively

large and heavy, making up about 25% of their total body weight. Their neck muscles are too weak to support such a disproportionately large head.

• Babies' brains are immature and more easily injured by shaking.

• Babies' blood vessels around the brain are more susceptible to tearing than older children or adults.

Symptoms of SBS

• Lethargy / decreased muscle tone

• Extreme irritability • Decreased appetite,

poor feeding or vomiting for no apparent reason

• Grab-type bruises on arms or chest are rare

• No smiling or vocalization

• Poor sucking or swallowing

• Rigidity or posturing • Difficulty breathing • Seizures • Head or forehead

appears larger than usual or soft-spot on head appears to be bulging

• Inability to lift head • Inability of eyes to

focus or track movement or unequal size of pupils

Consequences of SBS

Immediate• Breathing may stop or be

compromised • Extreme irritability • Seizures • Limp arms and legs or

rigidity/posturing • Decreased level of

consciousness • Vomiting; poor feeding • Inability to suck or swallow • Heart may stop • Death

Long Term• Learning disabilities • Physical disabilities • Visual disabilities or

blindness • Hearing impairment • Speech disabilities • Cerebral Palsy • Seizures • Behavior disorders • Cognitive impairment • Death

COPING WITH CRYING

SHAKEN BABY SYNDROME

What do BABIES do?

EatSleepHave dirty diapersCry

Most babies cry 2-3 hours a day for the 1st 2 -3 months of life

5 p.m. to Midnight is often a fussy time

A parent responding to an infant’s cry is a vital part of

EMOTIONAL NURTURING.

It will help the baby to learn to TRUST and BOND with the parents or

caregivers.

4 Basic Cries:

… the HUNGRY CryRhythmical rise & fall - demanding not

desperate

… the CRY of PAINLoud gasp - shrieks

… the BORED or GRUMBLING CRYLow pitched - not demanding - increases

when ignored

… the ANGRY CRY Loud - demanding - not a type of cry until

about 6 months of age

Check to see if Basic Needs are met:

HungryBurpedDiaper ChangeClothing ComfortableCrying to release Stress (Pacifier)Wants to be heldRoom too hot or cold

Check to see if baby is SICK-

TemperatureGums:

swollen - red - drooling (teething)Ears

Red - warm - drainingVomitingDiarrheaAllergies

Runny nose - red eyesClear = Allergies Green = Infection

COLIC:

Pull legs up to stomach stomach problems / gas

Breast Feeding onions, garlic, broccoli, cauliflower, spicy foods,

chocolate, etc.

LACTOSE Intolerance: √ with doctor / Change formula (soy or goat)

Often Outgrows colic by 3-4 months more movement and solid food

When the Caregiver is tired & Baby Cries a lot:

Natural to feel FRUSTRATED

High Risk of

LOOSING CONTROL

PLAN AHEAD WHAT TO DO!

BRAINSTORM ways toCOPE with CRYING

SHAKEN BABY SYNDROME:

Term used to describe the many signs and symptoms resulting from the violent shaking of an infant or young child.

1) Baby’s brain bangs against skull. 2) Small blood vessels are torn - bleeding3) Blood clots press on brain.4) Vertebrae crush thespinal cord.

BRAIN DAMAGERETARDATIONLEARNING DISABILITIESPHYSICAL DISABILITIESPARALYSIS BLINDNESSand DEATH may occur.

SIGNS & SYMPTOMS of SBS

ConcussionVomitingIrritabilityLethargyTrouble feedingSleepycoma

STATISTICS:

70% of the perpetrators are MALE (father, step-father, boyfriend, etc.)

56% of the victims are male babies Average age of shaking is 3-8 months 26 SBS cases in Utah in year 2000

(up from 13 in 1999) 25% of the SBS victims die immediately after being

shaken 75% will live with complications because of the shaking. SBS is the leading cause of death in infants due to child

abuse/neglect.

28% surviving victims return to THEIR HOMES.

11% adopted by GRANDPARENTS

11% placed in FOSTER CARE

Dr. William M. Palmer(Medical Director of the Child Protective Team at Primary Children’s

Hospital & University Hospital)

“Most people do not intend to hurt the child. They lose their impulse control; they just want the baby to shut up.”

A HAND SLAP on the face of an infant under 15 months can cause similar damage

THROWING a child up in the air and catching it

TWIRLING a child under age 2 by it’s arms or legs

BOUNCING ROUGHLY on knee/foot can also have damaging affect on baby

HELPFUL HINTS:

ALWAYS support the neck of infants, babies and small children.

If upset - CALM DOWN before dealing with your child.

When playing, never THROW or TOSS your child.

Screen all babysitters carefully. Know their temperament.

Never

Never

Never

NeverShake a BabyOr TODDLER!

USOE Child Development Curriculum, 1994

The Child Abuse Prevention Centerwww.capcenter.org

Davis County Health Dept.brettw@co.davis.ut.us

www.dontshake.com