Feldman / Child Development, 5th Edition Copyright © 2010 Chapter 4 Birth and the Newborn Infant...

Feldman / Child Development, 5th EditionCopyright © 2010

Chapter 4Birth and the

Newborn Infant

Child DevelopmentFIFTH EDITION

Robert S. FeldmanUniversity of Massachusetts at Amherst


Chapter 4 Key Questions

• What is the normal process of labor?• What complications can occur at birth, and

what are their causes, effects, and treatments?

• What capabilities does the newborn have?


Birth

• Neonate The term used for newborns• The neonate’s outward appearance is caused

by a variety of factors in its journey from the mother’s uterus, down the birth canal, and out into the world.

• We can trace its passage, beginning with the release of the chemicals that initiate the process of labor.


Stages of Labor

First Stage Second Stage Third Stage


Labor Vocab

• Place following words into appropriate stage of labor

*10 cm *Apghar Administered *Longest Stage

*Pushing Process*Baby in Uterus *Baby in Vagina

*Mucous Plug is Released *Bonding between Mother and Child

*Cervix thins out(Effacement) *Afterbirth

*Episiotomy *Corticotropin Hormone released

http://www.medicalvideos.us/play.php?vid=1294


Stages and Vocab

First Stage Second Stage Third Stage

10 cmBaby in UterusContractions BeginEffacement beginsCorticotropin HormoneMucous Plug ReleaseLongest Stage

EpisiotomyBaby in VaginaPushing Process

ApgharBondingAfterbirthAnoxia


Labor: The Processof Birth Begins

• About 266 days after conception, a protein called corticotropin releasing hormone (CRH) triggers the release of various hormones, and the process that leads to birth begins.

• One critical hormone is oxytocin, which is released by the mother’s pituitary gland.

• When the concentration of oxytocin becomes high enough, the mother’s uterus begins periodic contractions.


• Labor proceeds in three stages:• In the first stage of labor, the uterine

contractions initially occur around every 8 to 10 minutes and last about 30 seconds. As labor proceeds, the contractions occur more frequently and last longer.

• Toward the end of labor, the contractions may occur every 2 minutes and last almost 2 minutes. Contractions allow opening of cervix to 10 centimeters



• During the final part of the first stage of labor, the contractions increase to their greatest intensity, a period known as transition.

• During the second stage of labor, which typically lasts around 90 minutes, the baby’s head emerges further with each contraction, increasing the size of the vaginal opening.



• Episiotomy An incision sometimes made to increase the size of the opening of the vagina to allow the baby to pass

• The third stage of labor occurs when the child’s umbilical cord (still attached to the neonate) and the placenta are expelled from the mother

• http://www.babycenter.com/2_live-birth-natural_3656508.bc



Birth: From Fetus to Neonate

• The exact moment of birth occurs when the fetus, having left the uterus through the cervix, passes through the vagina to emerge fully from its mother’s body.

• In most cases, babies automatically make the transition from taking in oxygen via the placenta to using their lungs to breathe air.


The Apgar Scale

• Apgar scale A standard measurement system that looks for a variety of indications of good health in newborns (7-10 – best Under 7- baby requires help breathing and problems evident. Problems during prenatal dev, or during delivery)

• Anoxia A restriction of oxygen to the baby, lasting a few minutes during the birth process, which can produce brain damage


Apgar Scale - page 88


Infants


Physical Appearanceand Initial Encounters

• After assessing the newborn’s health, health-care workers next deal with the remnants of the child’s passage through the birth canal.

• A thick, greasy material called the vernix smoothes the passage through the birth canal; it is no longer needed once the child is born and is easily cleaned away.


• Newborns’ bodies are also covered with a fine, dark fuzz known as lanugo; this soon disappears.



• The newborn’s eyelids may be puffy due to an accumulation of fluids during labor, and the newborn may have blood or other fluids on parts of its body.


Molding and Caput Succedaneum


Jaundice

Build up of bilirubin (Wasteproduct from breakdown ofred blood cells)

Liver is immature and cannot keep up with the breakdown of bilirubin.


Epstein Pearls

Entrapped fluid

in child’s palate


Umbilical Cord


• Bonding Close physical and emotional contact between parent and child during the period immediately following birth, argued by some to affect later relationship strength

• Although mother–child bonding does not seem critical, it is important for newborns to be gently touched and massaged soon after birth.



• The physical stimulation they receive stimulates the production of chemicals in the brain that instigate growth.



Approaches to Childbirth: Where Medicine and Attitudes Meet

• Parents in the Western world have developed a variety of strategies—and some very strong opinions—to help them deal with something as natural as giving birth.

• No single procedure will be effective for all mothers and fathers, and no conclusive research evidence has proven that one procedure is significantly more effective than another.


Alternative Birthing Procedures

• Lamaze birthing techniques (Dr. Ferdinand Lamaze)

• Bradley Method

• Hypnobirthing• Birthing Center• Cesarean Section

http://www.babycenter.com/2_live-birth-c-section-surgery_3656510.bc


Childbirth Attendants:Who Delivers?

• Traditionally, obstetricians, physicians who specialize in delivering babies, have been the childbirth attendants of choice.

• In the last few decades, more mothers have chosen to use a midwife, a childbirth attendant who stays with the mother throughout labor and delivery.

• A doula is trained to provide emotional, psychological, and educational support during birth.


Pain and Childbirth

• Pain is a subjective, psychological phenomenon that cannot be easily measured.

• Consequently, the experience of pain during labor is difficult for women in labor to interpret, thereby potentially increasing their anxiety and making the contractions seem even more painful.


• Ultimately, every woman’s delivery depends on such variables as how much preparation and support she has before and during delivery, her culture’s view of pregnancy and delivery, and the specific nature of the delivery itself

Pain and Childbirth


Use of Anesthesia andPain-Reducing Drugs

• The use of medication during childbirth is a practice that holds both benefits and pitfalls.

• About a third of women who receive anesthesia do so in the form of epidural anesthesia, which produces numbness from the waist down.

• http://www.babycenter.com/2_live-birth-epidural_10314055.bc

• A newer form of epidural, known as a walking epidural or dual spinal-epidural, uses smaller needles and a system for administering continuous doses of anesthetic.


Postdelivery Hospital Stay: Deliver, Then Depart?

• The American Academy of Pediatrics states that except in unusual cases, women should stay in the hospital no less than 48 hours after giving birth.

• Furthermore, the U.S. Congress passed legislation mandating a minimum insurance coverage of 48 hours for childbirth.


Newborn Medical Screening

• The American College of Medical Genetics recommends that 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.

• Genetic screening policies are left up to individual states


Preterm Infants:Too Soon, Too Small

• Preterm infants Infants who are born prior to 38 weeks after conception (also known as premature infants)

• Low-birthweight infants Infants who weigh less than 2,500 grams (around 5 1/2 pounds) at birth

• Small-for-gestational-age infants Infants who, because of delayed fetal growth, weigh 90% (or less) of the average weight of infants of the same gestational age


• Low-birthweight infants are highly vulnerable to infection, and because their lungs have not had sufficient time to develop completely, they have problems taking in sufficient oxygen.

• As a consequence, they may experience respiratory distress syndrome (RDS), with potentially fatal consequences.

• Despite the difficulties they experience at birth, the majority of preterm infants eventually develop normally in the long run.

Preterm Infants:Too Soon, Too Small


Very-Low-Birthweight Infants: The Smallest of the Small

• Very-low-birthweight infants Infants who weigh less than 1,250 grams (around 2 1/4 pounds) or, regardless of weight, have been in the womb fewer than 30 weeks

• Very-low-birthweight babies are in grave danger from the moment they are born, due to the immaturity of their organ systems.


• However, medical advances have led to a higher chance of survival, pushing the age of viability, the point at which an infant can survive prematurely, to about 22 weeks.

• Review chart on page 96 for Survival and Gestational Age

Very-Low-Birthweight Infants: The Smallest of the Small


What Causes Preterm and Low-Birthweight Deliveries?

• About half of preterm and low-birthweight births are unexplained, but several known causes account for the remainder.

• In some cases, premature labor results from difficulties relating to the mother’s reproductive system.

• Multiple Births


• In other cases, preterm and low-birthweight babies are a result of the immaturity of the mother’s reproductive system.

• Factors that affect the general health of the mother all are related to prematurity and low birthweight.

What Causes Preterm and Low-Birthweight Deliveries?


Low Birthweight Factors (page 97)


Postmature Babies:Too Late, Too Large

• Postmature infants Infants still unborn 2 weeks after the mother’s due date

• Difficulties involving postmature infants are more easily prevented than those involving preterm babies, since medical practitioners can induce labor artificially if the pregnancy continues too long.


Cesarean Delivery: Interveningin the Process of Birth

• Cesarean delivery A birth in which the baby is surgically removed from the uterus, rather than traveling through the birth canal

• Cesarean deliveries occur most frequently when the fetus shows distress of some sort.

• Page 105 C-Section rates


• Cesarean deliveries are also used in some cases of breech position, in which the baby is positioned feet first in the birth canal.

• A cesarean delivery also presents some risks for the baby.

• Fetal monitor A device that measures the baby’s heartbeat during labor

Cesarean Delivery: Interveningin the Process of Birth


Infant Mortality and Stillbirth:The Tragedy of Premature Death

• Stillbirth The delivery of a child who is not alive, occurring in fewer than 1 delivery in 100

• Infant mortality Death within the first year of life

• Consider rates in the United States and around the world!!! (Page 95)

• https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html = Rates around the world

• http://www.census.gov/statab/ranks/rank17.html = Rates in the United States


Why does US have high Mortality Rate? 10 Leading

Causes in US


Childbirth-Related Leave Policies


Childbirth-RelatedLeave Policies, cont’d


Postpartum Depression:Moving from the Heights ofJoy to the Depths of Despair

• Postpartum depression, a period of deep depression following the birth of a child, affects some 10% of all new mothers.

• Postpartum depression may be triggered by the pronounced swings in hormone production that occur after birth.


• When depressed mothers interact with their infants, they are likely to display little emotion and to act detached and withdrawn.

• This lack of responsiveness leads infants to display fewer positive emotions and to withdraw from contact not only with their mothers but with other adults as well.

Postpartum Depression:Moving from the Heights ofJoy to the Depths of Despair


The Competent Newborn

• As developmental researchers have begun to understand more about the 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 Competence: Meeting the Demands of a New Environment

• The world faced by a neonate is remarkably different from the one it experienced in the womb. (What did the neonate not do on his/her own while in mother’s uterus?)

• Neonates emerge from the uterus practiced in certain types of physical activities.


• Reflexes Unlearned, organized involuntary responses that occur automatically in the presence of certain stimuli

• The sucking reflex and the swallowing reflex permit Kaita to begin right away to ingest food.

• The rooting reflex, which involves turning in the direction of a source of stimulation (such as a light touch) near the mouth, is also related to eating.

Physical Competence: Meeting the Demands of a New Environment


First Encounters Upon Birth page 103


Sensory Capabilities: Experiencing the World

• Although their visual acuity is not fully developed, newborns actively pay attention to certain types of information in their environment.

• Infants can discriminate different levels of brightness.


• There is even evidence suggesting that newborns have a sense of size constancy.

• They seem aware that objects stay the same size even though the size of the image on the retina varies with distance.

• http://video.about.com/babyparenting/Understanding-infant-vision.htm



• In addition to sight and hearing, the other senses also function quite adequately in the newborn.

• It is obvious that newborns are sensitive to touch. (Blowing of air)

• At birth, the senses of smell and taste are also well developed.



Early Learning Capabilities

• Classical conditioning A type of learning in which an organism responds in a particular way to a neutral stimulus that normally does not bring about that type of response

• Operant conditioning A form of learning in which a voluntary response is strengthened or weakened, depending on its association with positive or negative consequences

• Chart on page 106


• Habituation The decrease in the response to a stimulus that occurs after repeated presentations of the same stimulus

Early Learning Capabilities


Learning in Infancy


Social Competence: Responding to Others

• Due to variations in research results, the jury is still out on exactly when true imitation (or exploration) begins, although it seems clear that some forms of imitation begin very early in life.

• Certain characteristics of neonates mesh with parental behavior to help produce a social relationship between child and parent, as well as social relationships with others.


• States of arousal Different degrees of sleep and wakefulness through which newborns cycle, ranging from deep sleep to great agitation

Social Competence: Responding to Others


Social Interaction Factors

Feldman / Child Development, 5th Edition Copyright © 2010 Chapter 4 Birth and the Newborn Infant...

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Transcript of Feldman / Child Development, 5th Edition Copyright © 2010 Chapter 4 Birth and the Newborn Infant...