John W. Santrock

© 2007 The McGraw-Hill Companies, Inc. All rights reserved.

Slide 1

John W. Santrock

Birth

5


Slide 2

Birth

• What Happens During the Birth Process?

• How Do Low Birthweight Infants Develop?

• What Are Two Widely Used Measures of Neonatal Health and Responsiveness?

• What Happens During the Postpartum Period?


Slide 3

Birth

• Images of Children: A Fantastic Voyage

– Cindy and Tom recount the hours and changes that took place before their son, Tanner Roberts, was born and during his birth process.


Slide 4

Stages of the Birth Process

• First stage– Lasts about 12 to 24 hours; longest stage

•

– Contractions are about 15–20 minutes apart; occur closer together as birth nears

– Contractions dilate cervix to opening about 4 inches

• Allows baby to move from uterus to birth canal

What Happens During the Birth Process?


Slide 5


• Second stage– Approximately 45 minutes to an hour

– Baby moves through cervix and birth canal–

– Mother pushes down, contractions come almost every minute



Slide 6


• Third stage (Afterbirth)– Placenta, umbilical cord, and other

membranes detached and expelled

– Fastest stage; lasts only minutes



Slide 7The Stages of Birth

b

d

a

c

Placenta

Placenta

Vagina Cervix

Uterus

Fig. 5.1


Slide 8

The Fetus/Newborn Transition

• Uterine muscles draw together

• Decreased oxygen supply during contractions is termed anoxia—insufficient oxygen to fetus/newborn

• Stress hormone secretion protects from oxygen deficiency, prepares infant for birth.

• Vernix caseosa (skin grease) protects against heat loss.



Slide 9

Childbirth Strategies and Decisions

• Childbirth setting and attendants

– 99% of U.S. births occur in hospitals

– Over 90% are attended by physicians• Vaginal and cesarean delivery, birthing centers

• Neonatal mortality risk lower when attended by certified midwife rather than physician



Slide 10


• Childbirth setting and attendants

– Doulas: professional trained in childbirth; common in many countries

• Provide physical and emotional support to mother before, during, and after childbirth

• Mother has less pain, anxiety, and depression



Slide 11


• Methods of delivery: medications

– Analgesia: used to relieve pain

– Anesthesia: used in late first-stage labor and during expulsion to block sensation

• Epidural block: numbs from waist down

– Oxytocics: synthetic hormones used to stimulate contractions



Slide 12


• Natural childbirth: attempts to reduce mother’s pain by decreasing fear

• Prepared childbirth: similar to natural childbirth; special breathing technique used in final stages of labor

– Many techniques have been developed



Slide 13


• Cesarean Delivery– Baby removed from uterus through

incision in abdomen when• Baby is in breech or crosswise position• Head too large for mother’s pelvis• Vaginal bleeding has occurred in pregnancy

– Nearly 1 in 4 U.S. births are C-sections



Slide 14


• Family Involvement– Fathers

• More likely to meet with obstetrician• Train to coach mother during labor and birth

– Siblings• Provide with realistic information• Address separation anxiety • Address child’s emotions and behaviors



Slide 15

Preterm and Small- for-Date Infants

• Low-birthweight infant– Weigh less than 5.5 pounds

• Very low: under 3 pounds• Extremely low: under 2 pounds

– Racial/ethnic differences exist– Increased rates in U.S. over last 20 years– Attributed to many causes

How Do Low-Birthweight Infants Develop?


Slide 16

Preterm and Small-for-Date Infants

• Preterm: born 3 weeks or more early– Neurological development continues after

birth about same timetable as if in womb

• Small for date (small for gestational age)– low birthweight for term of pregnancy– High risk of death



Slide 17

Fig. 5.2

Percentage of All U.S. Births That Are Preterm

4

8

12

0

Perc

enta

ge o

f pre

ter m

bir

ths

1992 20021982

12.1

9.510.7

Year


Slide 18

Long-Term Outcomes for Low-Birthweight Infants

• As a group– Have more health and developmental

problems; risks increases as birthweight decreases

• More likely to have learning disability, ADD or ADHD, and breathing problems

– Lower functioning persists in adolescence• Improvement achieved with early interventions


Slide 19

Fig. 5.3

Cognitive Skills of Students Born

with Low or Normal

Birthweight

20

0

30

40

50

60

70

80

90

100

10

Ove

rall

cogn

itive

skill

s sco

re

Full term normal weight

750 g 750 g – 1,499 g


Slide 20


• Nurturing Preterm Infants

– Appropriate stimulation may vary

– Massage used throughout history; has led to greater weight gain, improved skills, and better academic performance

–



Slide 21

3 lb. 1 oz

3 lb. 7 oz

2 lb. 15 oz

3 lb. 3 oz

3 lb. 5 oz

Infa

nt w

eigh

t

40 6 8 122 1410Age in days

Premature infants who were massaged

Premature infants who were not massaged

Weight Gain Comparison of Premature Infants Who Were Massaged and Not Massaged

Fig. 5.4


Slide 22


• Nurturing Preterm Infants

– Kangaroo Care: holding preterm infant so there is skin-to-skin contact leads to

• Sleeping longer, more weight gain

• Crying less, earlier hospital discharge

• Longer periods of alertness



Slide 23

Apgar Scale

• Widely used to assess health at 1 and 5 minutes after birth– Performed by nurse/obstetrician

– Total score of 7 to 10 is good

– Score below 3 signals emergency

– Identifies high-risk infants

What Are Three Measures of Neonatal Health and Responsiveness?


Slide 24

Score 0 1 2

Body Color Blue, pale Body pink, extremities blue

Entire body pink

HeartbeatAbsent Slow – less than

100 beats per min.

Fast – 100 to 140 beats per min.

Reflex Irritability

No response

Grimace Coughing, sneezing, crying

Muscle Tone Limp and flaccid

Inactive, weak, some flexion of extremities

Strong, active motion

Respiratory Effort

Breathing for no more than 1 min.

Irregular and slow

Breathing good with normal crying

Apgar Scale


Slide 25

Brazelton Neonatal Behavioral Assessment Scale

• Performed within 24 to 36 hours after birth – Neurological development– Reflexes– Reactions to people

• Infant is active participant– score based on best performance – “worrisome,” “normal,” and “superior”

classifications



Slide 26

Neonatal Intensive Care Unit Network Neurobehavioral Scale

• Offspring of NBAS; provides more comprehensive analysis of newborn behavior– Neurological and stress responses

– Regulatory capacities

– Assesses high-risk infants



Slide 27

Postpartum Period

• Period after childbirth when the mother adjusts physically and psychologically to process of childbirth– Lasts about six weeks

– Influenced by preceding events

What Happens During the Postpartum Period?


Slide 28

Postpartum Adjustments

• Involution: process by which uterus returns to prepregnant size

• Bodily changes– Estrogen and progesterone levels drop– Fatigue is common– Bodily functions return in a few weeks– Exercises are recommended



Slide 29

Postpartum Adjustments

• Emotional and psychological changes – Emotional fluctuations

– Fatigue

– Inexperience or lack of confidence

– Extensive demands may cause anxiety, depression, coping difficulties



Slide 30

Postpartum Depression

• Strong feelings of sadness, anxiety, or despair in new mothers– Excessive worrying– Depression– Extreme changes in appetite– Crying spells– Inability to sleep



Slide 31“Baby Blues” Symptoms appear 2 to 3 days after

delivery and subside within 1 to 2 weeks

Postpartum depression symptoms linger for weeks

or months and interfere with daily functioning

No symptoms

Fig. 5.7

Percentage of U.S. women experiencing “Baby Blues”

and Postpartum Depression


Slide 32

Staying at Home or Working

• Mothers’ wishes vary; decision making is often difficult and agonizing

• Pressures on mothers affect options– Societal– Career– Financial



Slide 33

Father’s Adjustment

• May feel baby comes first and gets all the attention; replaced by the baby– Set aside special time to be together

– Postpartum reaction improved if father attended childbirth classes and was active in delivery



Slide 34

Father’s Adjustment

• Both parents need to be aware of young infant’s developmental needs– Physical

– Psychological

– Emotional



Slide 35

Bonding

• Close connection, especially physical bond, between parents and newborn in period shortly after birth– Encouraged by many doctors: “rooming in”

– Little evidence for a critical bonding period, but parents enjoy and can be helpful

– Parent-child interaction climate improved



Slide 36

The End

5

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John W. Santrock