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 mother’s 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 from the
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
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
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.
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
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
(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)
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
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 baby’s 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
a)
The
b)
The
c)
Other countries do a better job providing prenatal care at low cost and
even free.
d)
The percentage of pregnant women in the
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