Chapter 3

 

Birth and the Newborn Infant

 

 

 

Chapter Outline

 

 

I.        Birth

A.     The term used for newborns is NEONATES.

B.     Labor:The Process of Birth Begins

1.      about 266 days after conception, a protein called corticotropin-releasing hormone (CRH) triggers the process of birth.

2.      the hormone oxytocin is released from mother's pituitary.

3.      Braxton-Hicks contractions have been occurring since the 4th month.

4.      Contractions force the head of the fetus against the cervix.


5.      Labor proceeds in three stages:

a)      The first stage is the longest.

(1)   Uterine contractions occur every 8-10 minutes and last about 30 seconds.

(2)   Contractions increase to their greatest intensity, a period known as transition.

(3)   The motherís cervix fully opens.

(4)   For first babies, this stage can last 16 - 24 hours (this varies widely).

(5)   Subsequent children involve shorter periods of labor.

b)      During the second stage of labor, the baby's head moves through the birth canal.

(1)   This stage typically lasts 90 minutes.

(2)   After each contraction the baby's head emerges more and increases the vaginal opening.

(3)   An EPISIOTOMY is an incision sometimes made to increase the size of the opening of the vagina to allow the baby to pass.

(4)   This stage ends when the baby is born.

c)      The third stage of labor occurs when the child's umbilical cord and placenta are expelled.

(1)   This is the shortest stage.

(2)   Lasts only minutes.

d)      Cultural perspectives color the way that people in a given society view the experience of childbirth.

C.     Birth:From Fetus to Neonate

1.      The exact moment of birth occurs when the fetus passes through the vagina and emerges fromthe mother's body.

2.      As soon as they are born, most babies cry to clear their lungs and begin breathing on their own.

3.      In the U.S., 99 percent of births are attended by professional health care workers (worldwide the figure is 50 percent).

4.      Trained health care workers use the APGAR SCALE, a standard measurement system that looks for a variety of indications of good health in newborns.

a)      The scale was developed by Virginia Apgar in 1953.

b)      The APGAR directs attention to five qualities:

(1)   appearance (color)

(2)   pulse (heart rate)

(3)   grimace (reflex irritability)

(4)   activity (muscle tone)

(5)   respiration (respiratory effort)

c)      Each quality is scored 0-2, producing an overall scale score that ranges from 0 to10.

(1)   Most babies score around 7.

(2)   Scores under 4 need immediate life-saving intervention.

d)      Some fetuses experience a restriction of oxygen -ANOXIA - which can cause brain damage.

5.      Physical appearance and initial encounters

a)      Babies are often coated with vernix, a thick, greasy substance which smooths the passage through the birth canal.

b)      Newborns are often covered with a fine, dark fuzz called lanugo.


c)      Baby's eyelids may be swollen and puffy from an accumulation of liquids during birth.

d)      A matter of considerable controversy is the subject of BONDING - the close physical and emotional contact between parent and child during the period immediately following birth, and argued by some to affect later relationship strength.

(1)   Research on non-humans shows a critical period just after birth when organisms show a readiness to imprint on members of their species present at the time.

(2)   For humans, the theory suggests that the critical period for bonding is soon after birth and requires skin-to-skin contact.

(3)   Scientific evidence for the human critical period for bonding is absent.

D.     Approaches to Childbirth:Where Medicine and Attitudes Meet

1.      There are a variety of choices for how to give birth and no research proves that one method is more effective than another.

2.      There are several alternative birthing procedures.

a)      Lamaze birthing techniques (Dr. Fernand Lamaze)

(1)   The goal is to learn how to deal positively with pain and to relax at the onset of a contraction.

(2)   Low income and minority groups may not take advantage of these natural childbirth techniques.

b)      Leboyer method (Frederick Leboyer)

(1)   Lights are low, after birth the child is placed on mother's stomach and then floated in warm water, umbilical cord is left uncut for awhile.

(2)   Only remnant seen today is that most babies are placed on mothers' stomachs.

c)      Family birthing centers

(1)   Homelike and less foreboding and stressful than hospital.

(2)   The use of birthing centers is becoming increasingly common.

(3)   Some parents use a midwife, a nurse specializing in childbirth, instead of an obstetrician, a physician who specializes in childbirth.

(a)    Although relatively rare in the U. S., midwives deliver some 80 percent of babies in other parts of the world.

3.      The use of medication during childbirth has benefits and disadvantages.

a)      It reduces pain.

(1)   On a score of 1-to-5, 44 percent of women rated childbirth "5" (most painful), 25 percent said "4".

(2)   As opposed to other kinds of pain, childbirth pain is a sign that the body is healthy and working normally.

b)      80 percent of women receive some form of pain medication during childbirth.

(1)   One third receive an epidural anesthesia, which produces numbness from the waist down.

(a)    A newer form is known as walking epidural or dual spinal-epidural, which use smaller needles and a system of delivering continuous doses of anesthetic, allowing women to move about more freely during labor.

(b)   It may harm the fetus.

(i)     depresses oxygen flow

(ii)   slows labor

(iii) fetus becomes less responsive

(iv) fetus may have slower motor control

(v)   fetus may be slower to sit and stand during first year

(vi) initial interaction between mother and fetus may be affected

(c)    Not all studies suggest harmful effects for fetus.

4.      Postdelivery Hospital Stay:Deliver, Then Depart?

a)      The average hospital stay following normal births has decreased from an average of 3.9 days in 1970 to 2 days in the 1990s.

b)      The American Academy of Pediatrics states that women should stay in the hospital no less than 48 hours after giving birth.

c)      The U.S. Congress has passed legislation mandating a minimum insurance coverage of 48 hours for childbirth.


II.     Birth Complications

A.     Preterm Infants:Too Soon, Too Small

1.      PRETERM INFANTS, who are born prior to 38 weeks after conception (also known as premature infants), are at high risk for illness and death.

a)      The main factor in determining the extent of danger is the child's weight at birth.

(1)   The average newborn weighs 3,400 grams (7 1/2 pounds).

(2)   LOW-BIRTHWEIGHT INFANTS weigh less than 2,500 grams (5 1/2 pounds).

(3)   Although only 7 percent of all newborns in the U.S. are low-birthweight, they account for the majority of newborn deaths.

(4)   SMALL-FOR-GESTATIONAL-AGE INFANTS, because of delayed fetal growth, weigh 90 percent or less than average weight of infants of the same gestational age.

b)      Premature infants are susceptible to respiratory distress syndrome (RDS) because of poorly developed lungs

c)      Low-birthweight infants are put in incubators, enclosures in which oxygen and temperature are controlled.

(1)   Easily chilled, susceptible to infection, sensitive to environment

d)      Preterm infants develop more slowly than infants born full term.

(1)   60 percent eventually develop normally

(2)   38 percent have mild problems (learning disabilities, low IQ)

2.      VERY-LOW-BIRTHWEIGHT INFANTS weigh less than 1,250 grams (2 1/4 pounds) and, regardless of weight, have been in the womb less than 30 weeks and are in grave danger because of the immaturity of their organ systems.

a)      Medical advances have pushed the AGE OF VIABILITY, or point at which an infant can survive a premature birth, to about 24 weeks.

b)      A baby born earlier than 25 weeks has less than a 50-50 chance of survival.

c)      Costs of keeping very-low-birthweight infants alive are enormous.

d)      Research shows that children who receive more responsive, stimulating, and organized care are apt to show more positive outcomes than children whose care was not as good.

3.      Causes of preterm and low-birthweight deliveries

a)      multiple births


b)      young mothers (under age 15)

c)      too closely spaced births

d)      general health and nutrition of mother

e)      African-American mothers have double the number of low-birthweight babies that Caucasian mothers do.

4.      POSTMATURE INFANTS, those still unborn two weeks after the mother's due date, face several risks.

a)      blood supply to baby's brain may be decreased and cause brain damage

b)      labor and delivery become more difficult

5.      INFANT MORTALITY is defined as death within the first year of life.

a)      U.S. ranks 22nd with 8.5 deaths per 1,000 live births.

b)      Rate is declining since 1960s.

c)      STILLBIRTH is the delivery of a child who is not alive and occurs in less than 1 delivery in 100.

d)      Parents grieve in the same manner as if an older loved one dies.

e)      Depression is a common aftermath.

6.      Over a million mothers in the U.S. today have a CESAREAN DELIVERY, where the baby is surgically removed from the uterus, rather than traveling through the birth canal.

a)      Several types of difficulties can lead to cesarean delivery.

(1)   Fetal distress is most frequent.

(2)   Used for breech position, where the baby is positioned feet first in the birth canal.

(3)   Used for transverse position, in which the baby lies crosswise in the uterus.

(4)   When the baby's head is large.

b)      Routine use of FETAL MONITORS, devices that measure the babyís heartbeat during labor, have contributed to soaring rates of cesarean deliveries, up 500 percent from 1970s and has several criticisms.

(1)   no association between cesarean delivery and successful birth consequences

(2)   major surgery and long recovery for mother

(3)   risk of infection to mother

(4)   Easy birth may deter release of certain stress hormones, such as catecholamines, which help prepare infant to deal with stress outside the womb.

(5)   Babies born via cesarean delivery are more prone to breathing problems at birth.

(6)   Mothers who deliver via cesarean birth report less satisfaction with the birthing experience.

(7)   Medical authorities currently recommend avoiding routine use of fetal monitors.

III.   Developmental Diversity:Overcoming Racial and cultural Differences in Infant Mortality

A.     African American babies are twice as likely to die before the age of 1 as white babies.

1.      this may be the result of socioeconomic factors such as poverty which results in poor prenatal care.

2.      The overall infant mortality rate in the U.S. is higher than the rate in many countries.

a)      The U.S. has a higher rate of low-birthweight and preterm deliveries.

b)      The U.S. has more people living in poverty who are less likely to get adequate medical care.

c)      Other countries do a better job providing prenatal care at low cost and even free.

d)      The percentage of pregnant women in the U.S. who receive no prenatal care has increased in the 1990s.

e)      Free or inexpensive health care and basic education could reduce these problems.

IV.  The Competent Newborn

A.     Physical Competence:Meeting the Demands of a New Environment.

1.      REFLEXES are unlearned, organized, and involuntary responses that occur automatically in the presence of certain stimuli.

a)      Sucking and swallowing reflexes permit the neonate to ingest food.

b)      Rooting reflex, which involves the turning in the direction of a source of stimulation near the mouth, guides the infant to the breast and nipple.

2.      The newborn's digestive system produces meconium, a greenish black material that is a remnant of the neonate's days as a fetus.


3.      Because their livers do not work efficiently, many newborns develop neonatal jaundice, a yellowish tint to their bodies and eyes.

B.     Sensory Capabilities:Experiencing the World

1.      Infants' visual and auditory systems are not yet fully developed.

a)      They can see levels of contrast and brightness.

b)      They can tell size consistency and distinguish colors.

c)      They react to sudden sounds and recognize familiar sounds.

2.      They are sensitive to touch.

3.      Their senses of taste and smell are well developed.

C.     Early Learning Capabilities

1.      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, underlies the learning of both pleasurable and undesired responses in the newborn.

2.      OPERANT CONDITIONING, a form of learning in which a voluntary response is strengthened or weakened, depending on its association with positive or negative consequences, functions from the earliest days of life.

3.      HABITUATION, the decrease in the response to a stimulus that occurs after repeated presentations of the same stimulus, is probably the most primitive form of learning and occurs in every sensory system of the infant.

4.      Three factors limit the success of learning during infancy.

a)      The behavioral state the infant must be in a sufficiently attentive state to sense, perceive, and recognize relationships between stimuli and responses.

b)      Natural constraints not all behaviors are physically possible for an infant.

c)      Motivational constraints the response involved must not be so taxing on infants that they simply are unmotivated to respond.

D.     Social Competence:Responding to Others

1.      Infants have the ability to imitate others.

2.      Infants can differentiate between such basic facial expressions as happiness, sadness, and surprise.

3.      Newborns cycle through various STATES OF AROUSAL, different degrees of sleep and wakefulness ranging from deep sleep to great agitation.

 

 

 

 

Key Terms and Concepts

 

 

Neonate†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Postmature infants

Episiotomy††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Cesarean delivery

Apgar scale††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Fetal monitors

Anoxia†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Stillbirth

Bonding†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Infant mortality

Preterm infants††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Reflexes

Low-birthweight infants†††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Classical conditioning

Small-for-gestational-age infants†††††††††††††††††††††††††††††††††††††††††††† Operant conditioning

Very-low-birthweight infants†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Habituation

Age of viability††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† States of arousal