Stephanie Oliveira 1
Chapter 3: Birth and Newborn Child
The birth process
Oxytocin: Hormone released by pituitary gland that causes labour to begin.
Stage of the Birth Process
Stage 1: Labour- Longest and most taxing stage, averaging about 12 hours
for first births and 6 hours for subsequent births. Contractions increase in
duration, frequency, and intensity, causing the cervix to dilate.
Stage 2: Delivery. Usually takes half and hour to an hour, but there is a wide
variation. The mother pushes, and the baby crowns and then exits the birth
canal and enters the world.
Stage 3: Expelling of Placenta and Umbilical Cord. Contractions continue
as the placenta and umbilical cord is expelled. The process usually takes a
- episiotomy: incision to make the vaginal opening larger during birth
- Failure to progress and breech presentation
o Failure to progress means that the woman has begun the birth
process but it is taking longer than normal.
o Breech presentation- positioning of the fetus so that feet or
buttocks, rather than the head, is positioned to come first out of the
o Cesarean Delivery: (C-section) type of birth in which mother’s
abdomen is cut open and fetus is retrieved directly from uterus.
o Some of the countries that have the lowest rates of C-sections also
have very low rates of birth complications, which seem to indicate
that many C-sections performed in other countries are unnecessary.
o For women who have had a C-section, there is a possibility of having a
vaginal birth with the next baby, a procedure known as a VBAC
(vaginal birth after caesarean section).
Cultural and Historical Variations in Birth Beliefs and Practices
Cultural Variations in Birth Beliefs
Beliefs and Rituals Surrounding Birth
Many traditional cultures have developed beliefs that it puts a woman in a
state of being spiritually unclean
In some cultures, birth must take place away from where most people reside,
so that others will not be contaminated by it.
Many cultures have beliefs that the mother remains unclean long after the
birth and must be kept away from others, for her own sake as well as teirs.
In Traditional Vietnam, the mother as to avoid going out for at least 30 days
after birth, in order not to contaminate the rest of the village or endanger
herself or her infant. Some cultures have rituals for women to purify themselves after birth and
not just non-Western cultures
Meanings of the Placenta.
The placenta is a component of the birth process that has often carried its
own special cultural beliefs.
In some cultures, the methods for disposing the placenta are clear and
simple: burial, burning, or throwing it in a river, or keeping it in a special
place reserved for placentas.
In developed countries the placenta is recognized as having special value as a
course of hormones and nutrients. Hospitals give their placentas to
researchers, or to cosmetic manufacturers who use them to make products
such as hair conditioner.
The placenta is full of nutrients that can provide a boost to an exhausted new
mother about to begin nursing.
Cultural Variations in Birth Practices
Midwives are usually the main birth assistants in rural areas of developing
o The women who are charged with managing the birth process usually
have a special status as midwives.
o Midwives tend to be older women who have had children themselves
but are now beyond childbearing age.
o In some cultures, she receives what she believes to be a supernatural
calling in a dream or a vision. In other culture, the position of midwife
is inherited from mother to daughter.
o Some cultures allow women to volunteer as midwives.
o Typically, the woman who is to be a midwife spend several years in
apprenticeship to be a more experienced midwife before taking the
lead in addicting with birth.
o Most often, the midwife was a highly respected status in her culture,
and is help in high regard for her knowledge and skills.
o In other cultures, midwives have been regarded with contempt or
o In India, Midwives come from the castes that have the lowest status.
Easing the Birth
o When visiting the prospective mother, the midwife typically gives her
and abdominal massage. This is believed to make the birth easier and
it also allows the midwife to determine the position of the fetus.
o The midwife often gives the mother herbal tea, intended to prevent
miscarriage and promote healthy development of the fetus.
o In many cultures in Asia and South America, foods are classified as
“hot” or “cold” and the mother is forbidden from eating “hot” foods. Stephanie Oliveira 3
Chapter 3: Birth and Newborn Child
This helps reassure the expectant mother and enhance her confidence
going into birth process.
o When the women begins to go into labour, the midwife is called, and
the expectant mother’s female relative gather around her.
o During the early part of labour, the midwife may use the intervals
between contractions to explain to the expectant mother what is to
come—how the contractions will come more and more frequently,
how the woman will eventually have to push the baby out, and what
the women’s position should be during the birth.
o The longer the labour, the more exhausted the mother and the greater
the potential danger to mother and child. Consequently, cultures have
created a wide variety of practices intended to speed it up.
o Epidural: the injection of an aesthetic drug into the spinal fluid to
help the mother manage the pain while also remaining alert.
o Another important part of the strategy for easing the birth in many
cultures is the physical position of the mother. In nearly all cultures
some kind of upright position is used, most commonly kneeling or
sitting, followed in prevalence by squatting or standing.
o After birth, typically the baby is laid on the mother’s abdomen until
the placenta an umbilical cord expelled from her uterus.
o A variety of strategies are used to promote delivering the placenta,
such as massage, medication, and rituals involving opening or
expelling, or attempts to make the woman sneeze or vomit.
o After the placenta is expelled, the umbilical cord is cut. Usually the
cord is ties with thread, string, or plant fibre.
Midwives Versus Doctors
o In the west, as in other cultures, most births throughout most of
history were administered by midwives. The role of midwife was
widely valued and respected. Most did their work for little or no pay,
although families often present them with a gift after birth.
o This began to change in the 15 century, as a witch-hunting fervor
swept over Europe. In 1486 an influential witch-hunting manual was
published by two monks, declaring that “No one does more harm to
the Catholic faith than midwives.”
o In the early 18 century a new challenge arose to the status of
midwives. Medical schools were established throughout Europe, and
many of the new doctors considered delivering babies to be the
domain of physicians.
o Forceps: pair of tongs used to extract the baby’s head from the womb
o Obstetrics: field of medicine that focuses on prenatal care and birth.
The 20 Century Slow Progress
o Natural childbirth: approach to childbirth that avoids medical
technologies and interventions o Electronic fetal monitoring (EFM): method that tracks the fetus’s
heartbeat, either externally through the mother’s abdomen or directly
by running a wire through the cervix and placing a sensor on the
The Neonate’s Health
Fontanels: soft spots on the skill between loosely joined pieces of the skill
that shift during birth process to assist passage through the birth canal.
Neonate: newborn baby, up to 4 weeks old
Neonatal jaundice: yellowish pallor common in the first few days of life due
to immaturity of the liver.
o The most effective treatment is a simple one, phototherapy, which
incolves exposing the neonate to coloured light; blue works best.
Measuring Neonatal Health
Anoxia: deprivation of oxygen during birth process and soon after that can
result in serious neurological damage within minutes.
The Apgar Scale: neonatal assessment scale with five subsets:
Score 0 1 2
Appearance (body Blue and pale Body pink, but Entire body pink
colour) extremities blue
Pulse( Heart rate) Absent Slow—less than 100 Fast—100-140 beats
beats per minute per minute
Grimace (Reflex No response Grimace Coughing, sneezing,
irritability) and crying
Activity (Muscle Limp and Flaccid Week, inactive, but Strong, active motion
tone) some flexion of
Respiration No breathing for Irregular and slow Good breathing with
(breathing) more than 1 minute normal crying.
The Brazelton Scale
Brazelton Neonatal Behavioural Assessment Scale (NBAS): 27 item scale
of neonatal functioning with overall ratings “worrisome,” “normal,” and
Usually performed about a day after birth but can be given any time in the
first 2 months.
Predicts future development if it is given a day after birth and then a week
For at risk nenates as well as others, the NBAs can help inform parents about
the abilities and characteristics of their infants.
The NBAs has also been used in research to examine differences among
neonates across cultures and how those differences interact with parenting
practices. Stephanie Oliveira 5
Chapter 3: Birth and Newborn Child
Low Birth Rate
Low birth weight: term for neonates weighing less than 2,500 grams (5.5
Preterm: babies born at 37 weeks gestation or less
Small for date: term applied to neonates who weigh less than 90% of other
neonates who were born at the same gestational age.
In developing countries, the main cause for low birth weight is that mothers
are frequently malnourished, in poor health, and receive little or no prenatal
In developed countries, the primary cause of low weight is the mothers
Consequences of Low Birth Rate
Very low birth weight: term for neonates who weigh less than 1,500 grams
(3.3 lbs) at birth.
Extremely low birth weight: term for neonates who weigh less than 1,000
grams (about 2.2 lbs) at birth.
Surfactant: substance in lungs that promotes breathing and keeps the air
sacs in the lungs from collapsing.
Treatment for Low birth Weight Babies.
Kangaroo care: recommended care for preterm and low birth weight
neonates, in which mothers or fathers are advised to place the baby skin to
skin on their chests for 2-3 hours a day for early weeks of life.
It helps newborns stabilize and regulate bodily functions such as heart rate,
breathing, body temperature and sleep-wake cycles.
Preterm infants treated with kangaroo care are more likely to survive their
first year, and they have longer periods of sleep, cry less, and gain weight
faster than other preterm infants.
The other traditional method of infant care that is helpful for low-birth
weight babies is infant massage. In the West, infant massage developed
because low birth weight babies are often placed in an isolette, a covered,
sterile chamber that provides oxygen and a controlled temperature.
The isolette protects neonates from infection but also cuts them off from
sensory and social stimulation.
Preterms neonates who receive 3 15-minute massages a day in their first
days of life gain weight faster than other preterm babies, and they are more
active and alert.
In adolescence, low birth weight predicts relatively low intelligence-test
scores and greater likelihood of repeating a grade.
In adulthood, low birth weight predicts brain abnormalities, attention
deficits, and low educational attainment. Physical Functioning of the Neonate
Neonatal sleeping patterns
Rapid eye movement (REM) sleep: phase of the sleep cycle in which a
persons eyes move back and fourth rapidly under the eyelids; persons in
REM sleep experience other physiological changes as well.
In adults, REM sleep is the time when dreams take place.
Neonates brain wave’s look similar to waking brain waves, but for infants the