Birth and the Newborn

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14 Νοε 2013 (πριν από 3 χρόνια και 6 μήνες)

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CHAPTER 4

Birth and the Newborn
Baby:

In the New World

Learning Outcomes

LO1

Identify the stages of childbirth.

LO2

Examine different methods of
childbirth.

LO3

Discuss potential problems with
childbirth.

LO4

Describe the postpartum period.

LO5

Describe the characteristics of a
neonate.

© Monalyn Gracia/Photolibrary

TRUTH OR FICTION?


T F

After birth, babies are held upside down and


slapped on the buttocks to stimulate




independent breathing.


T F

The way the umbilical cord is cut determines


whether the baby’s “belly button” will be an



“innie” or an “outie.”


T F

Women who give birth according to the



Lamaze method do not experience pain.


T F

In the U.S., about 3 births in 10 are by



cesarean section.


T F

It is abnormal to feel depressed following



childbirth.


T F

Parents much have extended early contact



with their newborn children if adequate



bonding is to take place.


T F

More children die from Sudden Infant Death


Syndrome (SIDS) than from cancer, heart



disease, pneumonia, child abuse, AIDS, cystic


fibrosis, and muscular dystrophy combined.

Countdown to Childbirth


Fetal position


Early in last month, fetus settles with head in pelvis:
referred to as “dropping or lightening”


First contractions


Braxton
-
Hicks contractions
: false labor


Can start at 6 mos. and tend to increase in later mos.


Amniotic fluid


1 in 10 women experience a bursting of the amniotic sac,
usually at end of 1st stage labor


Other common signs


Indigestion; diarrhea; abdominal cramps; back ache


Fetal hormones


Stimulate placenta and uterus to secrete
PROSTAGLANDINS & OXYTOCIN
to stimulate contractions


LO1 The Stages of Childbirth

© Monalyn Gracia/Photolibrary

Three Stages of Childbirth


STAGE ONE

process…


Contractions
efface & dilate

the cervix


Needs to be 4 inches (10 centimeters) for
passage


Contractions start about 10
-
20 minutes apart at
20
-
40 seconds; when reaching 4
-
5 minutes,
advised to go to hospital or birthing center


Average length of time for
Stage One


About half a day to one day: 1st deliveries are
usually longer


“Prepping”


Pubic area shaved (enema) intended to lower
chances of infection; not mandatory, up to the
attending physician

Three Stages of Childbirth


STAGE ONE

process…(cont.)


Fetal monitoring


Electronic sensors measure fetal heart rate to
alert staff of problem


Helpful equipment


If speeding up delivery is needed, staff may use
forceps or vacuum extraction tube.


Transition


Fetus moves through birth canal; approx. 30
minutes for birth


Three Stages of Childbirth


STAGE TWO…


Crowning


When the babies head begins to emerge


Baby will normally completely emerge within minutes


Average length of time for Stage Two


Shorter than 1st stage: from a few minutes to hours


Epistiotomy


Surgically cutting area between birth canal and anus to
prevent random tearing


Like prepping (enema) is controversial and optional


Use in U.S. dropped: 70% in 1983 to 19% in 2000

Three Stages of Childbirth


STAGE TWO…(cont.)


How baby looks


Head and facial features can be distorted from trauma;
return to normal in time


What happens to baby now


Mucus suctioned from mouth as soon as head emerges


When breathing on own, umbilical cord is clamped and cut
to 3 inches (stump will dry and fall off in about 7
-
10 days).


Baby is foot
-
printed.


ID bracelet is placed on wrist.


Erythromycin (antibiotic ointment) or drops of silver nitrate
placed in eyes to prevent bacterial infections.


Vitamin K injected to help blood clot (newborns do not
make own V
-
K).



Figure 4.2


A Clamped and Severed Umbilical
Cord

Stages of Childbirth


STAGE THREE…


a.k.a “placental” stage


Length of time


Few minutes to an hour or more


During this final stage:


Placenta separates from wall of uterus and is
expelled through birth canal.


Some bleeding is normal.


Obstetrician stitches episiotomy if it was
performed.

LO2 Methods of Childbirth

© Monalyn Gracia/Photolibrary

Methods of Childbirth


Historically


Usually took place in the home, involved family and
perhaps a
midwife


Currently


Home births still pattern in less developed nations


In U.S. now in hospitals or birthing centers


Some argue this “depersonalizes” the experience.


Methods


Anesthesia


Prepared Childbirth


Doulas


Cesarean Section


Methods of Childbirth


ANESTHESIA used to lessen pain.


General Anesthesia


Injection of barbiturate puts mother to sleep.


Reduces initial responsiveness of baby; no long
-
term effects


Tranquilizers


Oral barbiturates and narcotics


Reduces anxiety and perception of pain without inducing
sleep


Local anesthetics


Pudenal block
external genitals deadened with injection


Epidural & Spinal Block: injection to spinal cord that numbs
body below the waist


No anesthetics


Natural childbirth
: no drugs or anesthetics; uses relaxation
and breathing exercises

Methods of Childbirth


LAMAZE METHOD = Prepared
Childbirth


Mother and “Coach”


Mother learns breathing and relaxation methods
to lessen fear and pain and distract from pain.


“Coach” (usually Dad but can be anyone) aids in
delivery room by supporting Mother.

Methods of Childbirth


DOULAS


A non
-
professional person offering social
support during labor.


Women with Doulas appear to have
shorter labor.

Methods of Childbirth


CESAREAN SECTION (C
-
Section)


Process:


Physician delivers baby by abdominal surgery.


Cut through abdomen and uterus and removes
baby


Possible indications for performing:


If mother has small pelvis or weakened from
long labor


Very large baby or multiples


Prevention of circulatory mixing between mother
and baby (prevention of AIDS, genital herpes)


If baby is facing in wrong direction (not head
first: breach birth)

LO3 Birth Problems

© Monalyn Gracia/Photolibrary

Birth Problems


OXYGEN DEPRIVATION


Anoxia
: without oxygen


Hypoxia
: “under” oxygen


Implications:


PRENATTALY: Impaired CNS development; can
cause cognitive & motor skills problems and
psychological disorders


DELIVERY: schizophrenia, cerebral palsy
-

death


Causes:


Diabetes (mother)


Accidents to umbilical cord


Immature respiratory system in baby


Birth Problems


PRETERM AND LOW
-
BIRTH
-
WEIGHT
INFANTS


APPROX. 7% OF ALL BABIES BORN



Preterm
: Birth before 37 weeks (40 normal)
gestation


Common in multiple births


Low
-
birth
-
weight
: Less than 5 lbs


Small for dates
: full term but underweight


Mothers who smoke, do drugs, and receive improper
nutrition place babies at risk.


Babies tend to remain smaller throughout life.


Preterms seem to catch up more.





Preterm & Low
-
birth
-
weight Infants


Risks:


3.25
-

5.5 lbs.


7 times more likely to die


Less than 3.3 lbs.


Nearly 100 times more likely to die


1.65 lbs.


Sex differences


Girls seem to improve more readily than boys


Overall deficiencies


Severity of disabilities reflects extent of deficiencies


Most experience cognitive and motor skills deficiencies


Corticosteriods


Administering to women at risk may increases chances of
survival

Preterm & Low
-
birth
-
weight Infants


Characteristics:


Relatively thin: no baby fat


Lanugo
: fine downy hair


Vernix
: oily white substance


on skin


If more than 6 weeks early, no


nipples & testicles in boys have not descended but
will do so after birth


Muscles are immature; sucking and breathing
reflexes are weak


If more than a month early, may display
respiratory
distress syndrome
(irregular or cessation of
breathing).

© Tracy Dominey/Photo Researchers

Preterm & Low
-
birth
-
weight Infants


Treatment:


Due to physical frailty, often remain
hospitalized in
incubators
.


They maintain a temperature
-
controlled
environment and afford protection from
disease.


Some may receive oxygen, but over
-
oxygenation may cause permanent eye
injury.

Preterm & Low
-
birth
-
weight Infants


Parents & Preterm Neonates


Physically less attractive babies


Cries are high pitched and grating


More irritable, passive, and less social


Mothers may feel alienated, harbor guilt, and
sense of failure and low self
-
esteem


Fear of hurting may discourage handling


Preterms fare better with responsive caring
parents

Preterm & Low
-
birth
-
weight Infants


Intervention Programs


Stimulation helps preterms develop


Cuddling, rocking, talking, singing, music,
mobiles


Massage and “kangaroo care” (skin to skin, chest
to chest, with parent)


Stimulated preterms show fewer respiratory
problems, gain weight more rapidly, and make
greater advances in motor, intellectual, and
neurological development than those not
receiving stimulation

Figure 4.3


Stimulating a Preterm Infant

It was once believed that
preterm infants should be left as
undisturbed as possible. Today,
however, it is recognized that
preterm infants usually profit
from various kinds of
stimulation.

© Louie Psihoyos/Science Faction

LO4 The Postpartum Period

© Monalyn Gracia/Photolibrary

Postpartum Period


There is no definitive time period; generally
considered the few weeks following delivery


Maternal Depression


70%
of new mother’s worldwide experience the
“baby blues,”

generally last about 10 days


1 in 5 may experience
postpartum depression
(PPD),
a serious mood disorder.


Triggered by sudden drop in estrogen; drugs that increase
estrogen levels can help symptoms


Symptoms include: serious sadness, hopelessness,
helplessness, worthlessness, poor concentration, loss of
appetite, and insomnia


1 in 500 may experience psychotic symptoms that place
child at risk.

Postpartum Period


Bonding


Attachment bonds are crucial to the
survival and well
-
being of children.


Parent
-
child bonding is a complex process
requiring parent/child familiarization.


Serious maternal depression can delay
bonding.


Women with history of rejection by own
parents can also interfere with bonding.


Parents can adopt children at advanced
ages and still bond with them.


LO5 Characteristics of
Neonates

© Monalyn Gracia/Photolibrary

Characteristics of Neonates


Assessing the Health of Neonates


APGAR Scale


Administered at birth


Measures 5 signs of health


A
ppearance,
P
ulse,
G
rimace,
A
ctivity level,
R
espiratory effort


Scores vary from 0
-
10


7 or above = no danger
-

4 or below = critical, needs
immediate attention


By one minute after birth, most babies reach 8
-
10.


Brazelton Neonatal Behavioral Assessment
Scale


Measures reflexes and behaviors in 4 areas


Motor behavior, Response to Stress, Adaptive behavior,
Control over physiological state.


Table 3.2


The Apgar Scale

Characteristics of Neonates


REFLEXES:

Simple, unlearned responses
to stimuli; adaptive and are normally
replaced with other learned behaviors within
a few months.


ROOTING


Sucking reflex, stimulated by
touching baby’s cheek


MORO


When babies position is suddenly
changed (dropping, loud noises,
bumping, etc.), the back arches and
legs and arms fling outward and back
into chest with hugging motion.


GRASPING or PALMAR


Grabbing or fingers other objects
using 4 fingers (not thumbs)


Characteristics of Neonates


REFLEXES:


STEPPING


Mimics walking; when held up, baby will place
one foot in front of the other as if attempting to
walk


BABINSKI


When bottom of foot is stroked, toes spread in a
fan motion then curl inward.


TONIC
-
NECK


When lying on back with head to one side, arm
and leg will extend toward direction head is
turned, other side will flex.


Characteristics of Neonates


Sensory Capabilities


VISION
-

SIGHT


Nearsighted: see best at 7
-
9 inches


Prefer moving objects: no peripheral
vision


Visual accommodation
(automatic
adjustment of lens for focusing):
neonates show little or none: view as if
through fixed
-
focus camera


Convergence
(inward movement of
eyes to focus on close object):
neonates may exhibit cross
-
eyes or
wall
-
eyes when looking at objects at
close ranges


Degree of color perception remains
open for neonates by 4 mos., however,
most infants can see all visible colors

© Design Pics/Leah Warkentin

Characteristics of Neonates


Sensory Capabilities, cont


AUDITION
-

HEARING


Hearing is present in utero; may play a part in bonding


Prefer sound of mother’s voice over all others after birth; no
preference for father’s voice


Most newborns respond to unusual sounds.


Will respond to different
amplitude

(height of sound wave
-

higher = louder) and
pitch
(frequency of sound wave
-

higher frequencies make high pitches, low make low
sounds); singing in low tones is soothing


Particularly responsive to sounds and rhythms of speech
but don’t display preference for any specific language; can
discriminate differences in speech sounds; appear to be
“pre
-
wired” for language acquisition


Characteristics of Neonates


Sensory Capabilities, cont


OLFACTORY
-

SMELL


Can discriminate distinct odors


Show rapid breathing patterns and increased
movement in response


Turn away from unpleasant odors


Sensitive to smell of mother’s milk and mother’s
underarm odor, which may contribute to early
development of recognition and attachment.


Characteristics of Neonates


Sensory Capabilities, cont


TASTE


Sensitive to different tastes evident from facial
expressions


Discriminate between salty, sour, and bitter


Exhibit preference for sweet tastes which seem
to be calming


Sweet solution increase heart rate but also slow
sucking indicating an effort to savor and make the
flavor last




Figure 4.4


Facial Expressions Elicited by
Sweet, Sour, and Bitter Solutions

Characteristics of Neonates


Sensory Capabilities, con’t


TOUCH & PAIN


Important to learning and communication for
babies


Sensation of skin to skin contact appears to
provide comfort and contribute to bonding with
caregivers


Many reflexes are activated


by pressure against the skin


Rooting, Sucking, Babinski,


and Grasping

© Image Source Black/Jupiterimages

Learning: Really Early Childhood
“Education”


Classical conditioning


Involuntary responses are conditioned to
new stimuli.


Newborns taught to blink in response to a tone.


Blinking (UR) caused by puff of air to eye as a
tone was sounded (CS).


After repeated pairings, sound of tone caused
babies to blink (CR).


Conditioned stimuli are specific; capacity to learn
is universal.

Learning: Really Early Childhood
“Education”


Operant conditioning


Positive or Negative Reinforcement tends to
increase the incidence of a behavior.


Use of “reinforcers” to illicit learned behavior


Experiments using sound of mother’s voice as a
positive reinforcement were found to modify
babies sucking reflexes with a pacifier.


Baby learns through operant conditioning.

Sleeping & Waking


Neonates spend about 2/3 (16 hrs) a day
sleeping.


Adults spend about 1/3 day.


But baby does NOT sleep 16 consecutive hours
which becomes a challenge for parents.


There are a number of differing sleep/wake
patterns; individual infants vary but…


Most all distribute sleep throughout day and
night


Typically show 6 cycles of sleep/wake in 24
-
hrs


Naps usually about 4.5 hrs and awake about 1
hr in between


Sleep time will increase as baby grows, and by 6
mos to 1 yr most will sleep through the night.


Table 4.3


States of Sleep and Wakefulness
in Infancy

Sleeping & Waking


REM and Non
-
REM Sleep


REM
: periods of sleep where eye movement is
observed under closed eyelids


80% of adults report dreaming when in this stage of
sleep and are difficult to awaken

© Adam Przezak/iStockphoto.com

Sleeping & Waking


REM and Non
-
REM Sleep


EEG brain waves resemble waking states


a.k.a = Paradoxical Sleep


Neonates spend about 1/2 sleep time in REM



Preterm babies spend even more time in REM


By 6 mos., about 30%; and 2
-
3 yrs about 20
-
25%


Function in neonates: REM may be used to stimulate
brain activity needed for creation of proteins for
development of neurons and synapses.



Non
-
REM
: all other stages of sleep in sleep
cycle

Figure 4.5


REM Sleep and Non
-
REM Sleep

Sleeping & Waking


Crying


Frequency & times of
day


Most crying bouts
occur late p.m. & early
evenings


Most will produce
same amount for first
9 months but they
gradually decrease in
length of time


If crying is ignored first
9 wks, it appears to
decrease 2nd 9 wks.


© iStockphoto.com

Sleeping & Waking


Crying, cont


Causes


Main reason is pain but also helps clear respiratory
systems of fluids and stimulate the circulatory system


Recognizing types


Most parents soon learn to interpret different
types of crying patterns for hunger, anger or..


PAIN: sudden, loud, insistent, accompanied by flexing
and kicking legs


Can indicate colic (gas & distress in digestive tract)


Can be severe and persistent; lasting hours sometimes


Colic generally disappears by 3
-
6 mos.


Some high
-
pitched cries indicate other serious problems

»
Chromosomal abnormalities, infections, malnutrition,
exposure to narcotics, etc.

Sleeping & Waking


Soothing


Methods


Pacifier: sucking appears to be an innate tranquilizer; as is
sucking on something sweet


Caregivers: soothe by picking up the baby, patting,
caressing, rocking, swaddling, and speaking in low tones


Try to ascertain cause of distress


Learn by trial and error what each baby prefers


Some parents worry that responding to cries will
“spoil” the baby and they will not learn to engage in
“self
-
soothing” behaviors to go to sleep


As infants mature, crying is replaced by verbal
requests for intervention.


Sudden Infant Death Syndrome (SIDS)
a.k.a Crib Death


Defined:


A disorder of infancy that strikes while baby
sleeps.


Typically baby is in perfect health and is
found dead next morning with no sign that
baby struggled or was in pain


Baby just stops breathing for unknown
reasons.



Sudden Infant Death Syndrome (SIDS)
a.k.a Crib Death


Most Prevalent in:


Babies age 2
-
4 months


Babies put to sleep on tummies or sides


Premature and low
-
birth
-
weight babies


Male babies


Babies in lower socioeconomic status families


Babies in African American families


African American babies twice as likely


Babies of teenage mothers


Babies whose mothers smoked during or after
pregnancy or used drugs during pregnancy

Sudden Infant Death Syndrome (SIDS)
a.k.a Crib Death


Causes:


Still unknown but recent (2006) study at Boston
Children’s Hospital show:


Medullas

of SIDS victims were less sensitive to the
chemical
serotonin



Serotonin is chemical that keeps the medulla responsive.


The medulla is an area in the brainstem involved in basic
functions such as breathing and sleep/wake cycles.


The problem was seen more in brains of boys, accounting
for the higher incidence in male babies.

Figure 4.6


The Medulla

Sudden Infant Death Syndrome (SIDS) a.k.a
Crib Death


Lowering Risk: “The Safe Sleep Top 10”


Prevention should begin during pregnancy


Don’t smoke or use drugs


National Institute of Child Health and Human
Development (NICHD,2006) suggest:


1. Always place baby on back to sleep


2. Place baby on firm sleep surface free of
quilts, pillows, or other soft surfaces


3. Keep toys and loose bedding out of crib
and keep any other items away from
babies face


Sudden Infant Death Syndrome (SIDS)
a.k.a Crib Death


Lowering Risk: “The Safe Sleep Top 10”

4. Do not allow smoking around the baby

5. Keep baby’s sleep area close to, but
separate from, others’ sleep areas. Baby
should not sleep in a bed or on a couch
or armchair with anyone.

6. Use a clean, dry pacifier when putting
baby to sleep; don’t force baby to take it

7. Do not let baby get too warm or overheat
during sleep; dress in light clothing and
keep temperature comfortable

Sudden Infant Death Syndrome (SIDS)
a.k.a Crib Death


Lowering Risk: “The Safe Sleep Top 10”

8. Avoid products that claim to reduce risk
of SIDS; most have not been tested for
effectiveness or safety

9. Do not use home monitors to reduce risk
of SIDS. Refer questions to your health
care provider.

10. Reduce the chance that flat spots will
develop on baby’s head: provide “tummy
time” while baby is awake and being
watched. Change direction baby sleeps
in crib weekly.