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Ch 4. Birth and the Newborn Baby.pdf
Ch 4. Birth and the Newborn Baby.pdf

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York University
PSYC 2110
Vinod Goel

4. Birth and the Newborn Baby Tuesday, June 18, 201312:01 AM The Stages of Childbirth • The placenta releases the hormone CRH which triggers uterine contractions • Signs that labor is near: ○ False labor or prelabor-- upper uterine contractions several weeks before birth ○ Lightening-- the baby's head drops low into the uterus and the cervix softens ○ Bloody show-- the plug of mucus that sealed the cervix during pregnancy is released producing a reddish discharge Stage 1: Dilationand Effacement of the Cervix • Longest stage-- 12-14 hours for first birth, 4-6 hours thereafter • Dilation and effacement of the cervix-- as uterine contractions gradually become more frequent and powerful, they cause the cervix to open (dilate) and thin (efface) , forming a clear channel from the uterus into the birth canal, or vagina • Contractions start out around 10-20 minutes apart, then gradually become stronger and closer together • The climax of Stage 1 is a brief phase called transition-- the frequency and strength of contractions are at their peak and the cervix opens completely ○ Transition is the most uncomfortable part of childbirth Stage 2: Delivery of the Baby • Lasts 50 minutes for first baby, 20 minutes in later births • The mother feels a natural urge to push • Crowing-- the vaginal opening stretches around the entire head Stage 3: Birth of the Placenta • A final few contractions and pushes cause the placenta to separate from the wall of the uterus and be delivered in about 5 to 10 minutes • The placenta is large and weighs 1.5 lbs The Baby's Adaptationto Labor and Delivery • The baby's oxygen supply is temporarily reduced during each contraction • High levels of infant stress hormones help the baby withstand oxygen deprivation by sending a rich supply of blood to the bra in and heart ○ Stress hormones arouse the infant into alertness The NewbornBaby's Appearance • The average newborn is 20 inches long and 7.5 pounds in weight • The head is large and in comparison to the body • The newborn baby's features make them attractive to parents Assessing the Newborn's Physical Condition: The Apgar Scale • To assess the newborn's physical condition quickly, doctors and nurses use the Apgar Scale • A rating of 0, 1, or 2 on each of five characteristics is made up one and again at 5 minutes after birth • A combined score of 7 or better indicates that the infant is in good physical condition • If the score is 3 or below, the infant is in serious danger and requires emergency medical attention Textbook Notes Page 1 • If the score is 3 or below, the infant is in serious danger and requires emergency medical attention • Approaches to Childbirth • Childbirth practices are molded by a society of which mother and baby are a part • In most cultures and women are assisted during labor and delivery • Freestanding birth centers permit greater maternal control over labor and delivery Natural, or Prepared, Childbirth • Natural or prepared childbirth-- a group of techniques aimed at reducing pain and medical intervention and making childbirth as rewarding experience as possib le • A typical natural childbirth program includes 3 activities: ○ Classes ○ Relaxation and breathing techniques ○ Labor coach • Creates a more positive childbirth experience and less pain • Social Supportand NaturalChildbirth ○ Doula-- a trained woman who stays with the mother throughout labor and delivery to promote relaxation  Promotes a shorter labor and positive interaction with the baby after delivery ○ Mothers who are supported during labor less often have surgical deliveries or need medication to control pain • PositionsforDelivery ○ When giving birth at home or in a birth center, mothers are content birds in it upright, sitting position  Favored by research ○ In a hospital women often give birth lying flat on their back with their feet in stirrups ○ Episiotomy-- an incision that increases the size of the vaginal opening ○ Water birth-- the mother sits in a warm tub of water, which supports her weight and relaxes her Home Delivery • Less than 1% of American women give birth at home • Many are handled by certified nurse-midwives who have degrees in nursing and additional training in childbirth management • A safe option when attended by a well-trained doctor or midwife • Complications rarely occur Medical Interventions • Occur in both industrialized and nonindustrialized nations Fetal Monitoring • Fetal monitors are electronic Instruments that track with the baby's heart rate during labor • An abnormal heartbeat pattern may indicate that the baby is in distress and may need to be delivered immediately • Continuous fetal monitoring is used in over 80% of U.S. births • Linked to an increase in the number of instrument and surgical deliveries • Generally safe Labor and Delivery Medication • Some form of medication is used in more than 80% of U.S. births • Analgesics-- drugs used to relieve pain • Anesthetics-- a stronger type of pain killer that blocks sensation • Epidural analgesia-- the most common approach to controlling pain during labor, ○ Weakens uterine contractions, prolonging labor and increasing the chances of surgical delivery ○ The drugs cross the placenta causing newborns to be sleepy and withdrawn and irritable when awake Instrument Delivery • Forceps-- metal clamps placed around the infant's head to pull the baby from the birth canal ○ Greatly increases the risk of brain damage • Vacuum extractor-- consists of a plastic cup places on the baby's head attached to a suction tube ○ This can cause bleeding under the skin or within the eye • Instruments are used in 5% of American births InducedLabor • An induced labor is one that is started artificially, usually by breaking the amnion, or bag of waters (an event that typically occurs natural ly in the first stage of labor), and giving the Textbook Notes Page 2 • An induced labor is one that is started artificially, usually by breaking the amnion, or bag of waters (an event that typically occurs natural ly in the first stage of labor), and giving the mother synthetic oxytocin, a hormone that stimulates contractions • About 22% of American labors are induced • Increases the possibility of an inadequate oxygen supply to the baby Cesarean Delivery • A cesarean delivery is a surgical birth; the doctor makes an incision in the mother's abdomen and lifts the baby out of the uterus • 31% of births in the U.S. • Warranted by medical emergencies, such as Rh incompatibility, premature separation of the placenta from the uterus, or seriou s maternal illness or infection • Also justified when the baby is in the breech position-- turned so that the buttocks or feet would be delivered first (about 1 in 25 births) • Women who have had a cesarean should not have a natural birth for later pregnancies as this increases rates of rupture of the uterus and infant death • Medical control over childbirth is largely responsible for the worldwide rise in cesarean deliveries Birth Complications OxygenDeprivation • Cerebral palsy-- a general terms for a variety of impairments in muscle coordination caused by brain damage before, during, or just after birt h ○ Affects 1 out of every 500 American children  10% experienced anoxia-- inadequate oxygen supply • Caused by: ○ Squeezing of the umbilical cord ○ Placenta abruptio-- premature separation of the placenta with a high rate of infant death ○ Placenta previa-- a condition caused by implantation of the blastocyst so low in the uterus that the placenta covers the cervical opening  As the cervix dilates and effaces, part of the placenta may detach • Pleasing anoxic newborns in a head-cooling device shortly after birth for 72 hours substantially reduces brain injury • The greater the oxygen deprivation, the poorer children's cognitive and language skills in early and middle childhood • Many children improve over time • Respiratory distress syndrome occurs in premature infants whose lungs are so underdeveloped that the air sacs collapse, causing serious breathing difficult ies Pretermand Low-Birth-Weight Infants • "Premature" babies are those born 3 week or more before the end of a full 38-week pregnancy or who weigh less than 5.5 pounds • Birth weight is the best available predictor of infant survival and healthy development • Many newborns who weigh less than 3.5 lbs experience difficulties that are not overcome, an effect that becomes stronger as l ength of pregnancy and birth weight decrease ○ E.g., brain structural abnormalities, frequent illness, inattention, overactivity, sensory impairments, poor motor coordination, language delays, low intelligence test scores, deficits in school learning, and behavior and emotional problems • 1 in 13 American infants is born underweight ○ Highest among poverty-stricken women • About 60% of twins and more than 90% of triplets are born underweight • Pretermvs. Small-for-DateInfants ○ About half of those born just after the age of viability have no disability ○ Preterm infants are born several weeks or more before their due date  Their weight may still be appropriate ○ Small-for-date infants are below their expected weight considering length of the pregnancy  Usually more serious problems (e.g., more likely to die, catch infections, show evidence of brain damage, etc. during the first year)  Probably experienced inadequate nutrition before birth • Consequencesfor Caregiving ○ The appearance and behavior of preterm babies can lead parents to be less sensitive and responsive in caring for them (i.e.,they are often scrawny and irritable) ○ Preterm babies are at risk for child abuse ○ How well preterm babies develop has a great deal to do with the parent-child relationship • InterventionsforPretermInfants ○ A preterm infant is cared for in a special Plexiglas-enclosed bed called an isolette  Air is filtered and temperature is carefully controlled ○ Special Infant Stimulation  Special kinds of stimulation can promote faster weight gain, more predictable sleep patter
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