Birth and the Newborn Infant

Chapter 4

Birth and the Newborn Infant

Page
Learning Objectives / 63
Key Terms and Concepts / 63
Chapter Outline / 64
Lecture Suggestions / 69

  Childbirth Options

/ 69

  Are There Too Many Cesarean Section Deliveries?

/ 70

  Low-Birthweight Babies

/ 70
Class Activities / 71
Supplemental Reading List / 71
Prentice Hall PowerPoint slides available for download online / 72
Multimedia Ideas / 72
Handouts / 74

Learning Objectives

After reading Chapter 4, students will know how to:

• Describe the normal process of labor and birth.
• Explain how the Apgar scale is used to determine the health of a newborn.
• Discuss the process of bonding between the mother and the newborn.
• Identify options parents have regarding the birthing process.
• Explain the use of anesthesia and other pain-reducing drugs during labor.
• Describe complications that can occur at birth.
• Explain the major causes of preterm and low-birthweight babies, and evaluate why rates vary significantly from country to country.
• Explain the cultural and ethnic differences in infant mortality rates in the United States.
• Describe the symptoms of postpartum depression and the affects on infants.
• Describe the physical, sensory and social capabilities of the newborn.

·  Use classical and operant conditioning as well as observation to evaluate the learning abilities

Key Terms and Concepts

63

neonate

episiotomy

Apgar scale

anoxia

bonding

preterm infants

low-birthweight infants

small-for-gestational-age infants

very-low-birthweight infants

age of viability

postmature infants

cesarean delivery

fetal monitor

infant mortality

stillbirth

reflexes

classical conditioning

operant conditioning

habituation

states of arousal

63

Chapter Outline

I.  Birth

A. The term used for newborns is Neonates.

B. Labor is triggered by a protein called corticotropin-releasing hormone (CRH)

1. This occurs, on average, about 266 days after conception.

2. The hormone oxytocin is released from mother’s pituitary.

3. Braxton-Hicks contractions (false labor) have been occurring since the
4th month.

4. Uterine 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) For first babies, this stage can last 16–24 hours (this varies widely). Subsequent children involve shorter periods of labor.

(3) During the final part of the first stage (transition) the contractions increase to their greatest intensity.

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 incision called an Episiotomy is often made to increase the size of the vaginal opening.

(a) This practice has been criticized in recent years as potentially causing more harm than good.

(b) They are uncommon in developed areas of the world other than the United States.

(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.

(1) There is no evidence that physiological aspects of labor differ cross-culturally.

(2) Expectations about labor and interpretations of its pain do vary from culture to culture.

C. The exact moment of birth occurs when the fetus passes through the vagina and emerges from the mother’s body.

1. Most babies automatically make the transition to using their lungs as the source of oxygen.

a. Most babies spontaneously cry which helps them clear their lungs and breathe on their own.

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

3. 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 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)

b. Each quality is scored 0–2 producing an overall scale score that ranges from 0–10.

(1) The vast majority of neonates score 7 or above.

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

(3) Scores that remain between 0 and 3 after 20 minutes usually indicate the presence of severe problems.

c. Some fetuses experience a restriction of oxygen—Anoxia—which can cause brain damage.

4. Physical appearance and initial encounters

a. Babies are often coated with vernix, a thick, greasy substance which smoothes 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.

(4) There are no lingering reactions to separations immediately following birth, even for those extending for several days. There was just one problem with the notion of a critical period for bonding: Scientific evidence for the notion was lacking. When developmental researchers carefully reviewed the research literature, they found little support for the idea. Although it does appear that mothers who have early physical contact with their babies are more responsive to them than those who don’t have such contact, the difference lasts only a few days. Furthermore, although parents may experience concern, anxiety, and even disappointment, there are no lingering reactions to separations immediately following birth, even for those that extend for
several days.

D. There are a variety of choices for how to give birth and there is no evidence that one method is more effective than another.

1. The traditional birth experience in the United Sates until the early 1970s involved the woman being drugged and giving birth in a delivery room, without the presence of fathers or family members.

2. There are several alternative birthing procedures designed to minimize the need for anesthetics.

a. Lamaze (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) Most mothers and fathers report that a Lamaze birth is a very positive experience.

(3) Low income and minority groups may not take advantage of these methods.

b. Family birthing centers

(1) These are homelike and less foreboding and stressful than a hospital.

(2) Because of their popularity, many hospitals are opening similar birthing rooms of their own.

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

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

1. It reduces pain.

a. On a score of 1–5, 44 percent of women rated childbirth “5” (most painful), 25 percent said “4”.

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

2. It may harm the fetus.

a. May temporarily depress oxygen flow

b. Slows labor

c. Neonates are less responsive during the next few days

d. Progress in sitting, standing up and other physical activities is slowed

e. Initial interaction between mother and fetus may be affected

3. Not all studies suggest harmful effects for neonate.

a. No impact on strength, touch sensitivity, activity level, irritability,
or sleep.

b. Most research suggests that drugs as currently used during labor produce only minimal risks to the fetus and neonate.

F. The average hospital stay following normal births has decreased from 3.9 days in 1970
to 2 days in 1993. Many medical insurance companies are pushing for a reduction to
24 hours, though many professionals argue early discharge is related to increased risks.

II.  Birth Complications

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

1. The United States ranks 25th in infant mortality.

2. The main factor in determining the extent of danger is the child’s weight
at birth.

a. The average newborn weighs 3,400 grams (7½ pounds).

b. Low-birthweight Infants weigh less than 2,500 grams (5½ pounds).

c. 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.

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

a. They have difficulty regulating body temperature, are susceptible to infection, and sensitive to environment.

b. They are also susceptible to respiratory distress syndrome (RDS) because of poorly developed lungs.

4. Preterm infants develop more slowly than infants born full term.

a. Although tempo of development often proceeds more slowly, the majority eventually develop normally.

b. Thirty-eight percent have mild problems (learning disabilities, low IQ) which appear by age of six.

B. Very-low-birthweight Infants weigh less than 1,250 grams (2¼ 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.

1. Medical advances have pushed the Age of Viability, or point at which an infant can survive a premature birth, to about 22 weeks.

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

b. Some 50% of the time, very-low-birthweight babies die.

c. Interventions such as “kangaroo care” and messaging can help these infants.

C. Causes of preterm and low-birthweight deliveries:

1. Multiple births

2. Teen (under age 15) and older mothers (over age 35)

3. Mother smoking

4. Mother drinking alcohol or ingesting other drugs

5. Too closely spaced births

6. General health and nutrition of mother

D. Postmature Infants, those still unborn two weeks after the mother’s due date, face several risks.

1. Blood supply from placenta may become insufficient causing brain damage

2. Labor and delivery become more difficult because of increased size of baby.

E. Over a million mothers in the United States today have a Cesarean Delivery, where the baby is surgically removed from the uterus, rather than traveling through the birth canal.

1. Several types of difficulties can lead to cesarean delivery.

a. Fetal distress is most frequent

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

c. Used for transverse position, in which the baby lies crosswise in the uterus

d. When the baby’s head is large

2. The routine use of Fetal Monitors, devices that measure the baby’s heartbeat during labor, has contributed to soaring rates of cesarean deliveries, up
500 percent from the1970s, and has several criticisms.

a. No association between cesarean delivery and successful birth consequences

b. Major surgery and long recovery for mother

c. Risk of infection to mother

d. Easy birth may deter release of certain stress hormones to the baby, which helps prepare infant to deal with stress outside womb

3. In accordance with current recommendations from medical authorities, fetal monitors are no longer employed routinely.

F. Infant Mortality and Stillbirth.

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

a. Infant mortality is defined as death within the first year of life.

b. Infant mortality rates in selected countries. Although the United States has greatly reduced its infant mortality rate in the past 25 years, it ranks only 26th among industrialized countries as of 1996.

c. There are many reasons for the poor rate of newborn survival in the United States.

(1) Higher proportion of people living in poverty and without adequate medical care.

(2) Poor prenatal care in the United States compared to other countries.

G. Postpartum depression, the deep depression following the birth of a child, affects
10 percent of all new mothers.

1. In one out of 500 cases the symptoms evolve into a total break with reality, as in the case of Andrea Yates in Texas who drowned all five of her children.

2. Postpartum depression may be triggered by swings in hormone production that occur after birth.

3. Women with a previous or family history of depression may be more prone to postpartum depression.

H. Overcoming Racial and Cultural Differences in Infant Mortality

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

2. This difference is largely the result of socioeconomic factors: African-American women are significantly more likely than Caucasian women to be living in poverty and to receive less prenatal care.

3. The mortality rate in the United States is almost double that in Singapore, Japan, and Sweden, which are among the countries with the lowest mortality rates of anywhere in the world.

III.  The Competent Newborn

A. Developmentalists have come to realize that the newborn infant is born with many capabilities.

B. Physical Competence

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.

C. Sensory Capabilities

1. Neonates’ visual and auditory systems are not yet fully developed.

a. They can see levels of contrast and brightness.