Transcript Theories of Infant Development

Childbirth and
Newborn Health
Fogel
Chapter 4
Created by Ilse DeKoeyer-Laros, Ph.D.
Overview Chapter 4
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The Childbirth Experience
The Baby at Birth: Health and Risk
Birth Complications
Perinatal Mortality
Family and Society
Experiential Exercises
The Childbirth Experience
Labor & Delivery
Labor occurs in three
stages:
1. the opening of the
cervix
2. the passage of the
infant through the
vagina
3. the birth of the
placenta
Stages 1 & 2
The Childbirth Experience
Labor & Delivery
Medical technologies bring risks & benefits (used
more in the U.S. than in Europe):
– Fetal monitoring
• does not produce healthier infants with fewer complications &
should only be used in high-risk deliveries
– Forceps
• may cause brain and spinal cord injuries if used during early
phases of labor (high forceps)
– Vacuum extraction
• risks are lower than with cesarean section or high forceps
The Childbirth Experience
Labor & Delivery
• In 2004, 29% of births were C-sections
– Necessary under some medical conditions
– Not recommended when unnecessary – recovery
takes much longer
• C-sections may be done for doctors’
convenience but this is hard to prove
• There seem to be no ill effects of C-sections
compared to vaginal deliveries
The Childbirth Experience
Labor & Delivery
• Drugs can speed labor & ease pain
• Risks are generally short term & include:
– Epidurals: mothers may develop fevers & are at
increased risk for postpartum depression
– Mothers may not remember details of the birth
– Newborns exposed to analgesia (pain relief) were
slower to respond to breastfeeding, had higher
temperatures & cried more
– General anesthetics can affect newborns’ vulnerable
organs (esp. CNS)
The Childbirth Experience
Alternatives to Hospital Births
• Birthing Centers reduce the need for medical
interventions & increase maternal satisfaction
• Home births in the U.S. are no more risky than
hospital births (for low-risk births)
Picture from: http://www.birthspirit.org/homebirth.htm
The Childbirth Experience
Alternatives to Hospital Births
Midwives and doulas
– Can shorten labor, reduce
medical interventions, and
increase satisfaction &
breast-feeding
Picture from: afterconception.com
The Childbirth Experience
Alternatives to Hospital Births
Behavioral pain reduction
– upright birthing positions
reduce birth complications
(e.g., forceps, episiotomies) &
pain, shorten labor
– Lamaze system of exercise,
breathing, & massage: less
pain medication and fewer
episiotomies used
Picture from: yoga4birthandtherapy.com/page4.htm
The Baby at Birth
The Newborn
Has a unique appearance; needs to learn to selfregulate (e.g., temperature)
– large head, bowed legs, “baby face,” fontanels, and skin
may be coated with vernix caseosa & be yellowish due
to jaundice
– usually lose weight in the first
few days due to the loss of
meconium and drinking
colostrum instead of milk
Picture from: http://commons.wikimedia.org/wiki/Image:HumanNewborn.JPG#file
Original from EN:WP
The Baby at Birth
The Newborn
Newborn brain:
– virtually all the nerve cells in the brain are present, but
they have not developed very far
– during the first year, the brain doubles in size – this is
mostly due to the development of a protective sheath
around the nerve pathways (myelination), as well as
by an increase in neural connections
– the cells that receive fewer inputs and connections
will eventually die
The Baby at Birth
Newborn Assessment
Three types of assessments:
– Screening assessments (e.g., Apgar) give an indication
of the newborn’s ability to survive and whether there are
any immediate medical needs
– Neurological assessments test for problems in the
newborn’s central and peripheral nervous system, such
as major brain, spinal cord, or sensory damage
– Behavioral assessments are used to rate the presence
and strength of behavioral responses to stimulation and
spontaneous activity
The Baby at Birth
Apgar Scale
Area
0
1
2
Heart Rate
Absent
Slow (<100)
Rapid (>100)
Respiration
Absent
Irregular
Good, crying
Muscle Tone
Flaccid
Weak
Strong, well
flexed
Color
Pale
Body pink,
extremities
blue
All pink
Nasal tickle
No Response
Grimace
Cough, sneeze
Heel prick
No Response
Mild Response
Foot
withdrawal, cry
Reflex
irritability
Birth Complications
• Perinatal problems account for a large
proportion of later deficits
– 3-5 children in 1,000 show severe developmental
problems before entering school
– about 85% of these can be attributed to prenatal and
perinatal causes
• Often, perinatal complications can be overcome
with a supportive social & physical environment
Birth Complications
Gestational Age
< 37 weeks
Premature
37 weeks or more
Full term
Weight less than expected for
gestational age
Intrauterine growth retardation
Weight appropriate for gestational
age
Birthweight
< 1,000 grams
Extremely low birthweight (ELBW)
1,000 - 1,500 gr.
Very low birthweight (VLBW)
1,500 - 2,500 gr.
Low birthweight (LBW)
Birth Complications
Prematurity
• Largest category of birth complications
• Causes include
– Prenatal smoking and alcohol use
– Poor prenatal maternal health or nutrition
– Exceptional stress and persistent family discord
– Infertility treatments that produce multiple births
– Low maternal weight gain also contribute to the
incidence of low birthweight
Picture from: piesenlatierra.wordpress.com/tag/smoking/
Birth Complications
Prematurity
• Infants born prematurely are at risk for health,
motor, and intellectual problems, both in the
short term and in the long term
• The youngest and smallest babies run the most
risk of complications and death
– ELBW babies
– Babies born under 32 weeks gestational age
Youngest Baby to Survive
Baby Amillia Taylor
born at 21 weeks, 6 days (October, 2006)
9 1/2 inches long & weighed less than 10 ounces (283 gram)
See www.msnbc.msn.com/id/17304274/site/newsweek/from/ET/
Birth Complications
Prematurity
Short-term effects
– newborn death, esp. ELBW babies (67%)
– more likely to have lack of oxygen during birth,
jaundice, physical and mental impairments
– gestational age is a better indicator of developmental
status than birth age (e.g., feeding, sleeping)
Birth Complications
Prematurity
Long-term effects
– shorter & smaller than full-term individuals
– many preemies have deficits that last until middle
childhood & adolescence
• problems with behavior, emotional maturity, cognitive functions
& educational performance, language, perceptual and motor
functions, serious illnesses, and mental retardation
• highest risk with VLBW, extreme illness, or stress within the
family
Birth Complications
Prematurity
Born in 1989 after just 27 weeks of gestation, Madeline weighed only 9.9
ounces. She entered high school as an honor student and enjoys playing
her violin and rollerblading.
See www.cbc.ca/.../2004/08/19/preemie040819.html
Birth Complications
Prematurity
Successful intervention depends on gestational
age & health
– medical interventions (NICU) are improving
– behavioral procedures are extremely effective in
improving health & weight gain at low cost
• e.g., vestibular-proprioceptive stimulation (rocking, breathing
teddy bear); sucking on a pacifier; massage; kangaroo care
– parent education is also effective
Perinatal Mortality
• Poverty & disease are the biggest causes of
infant mortality worldwide
• Perinatal deaths can often be prevented by
– supplemental nutrition for mothers & infants
– breast-feeding
– growth monitoring
– rehydration
– immunization
Picture from: breastcrawl.org
Perinatal Mortality
• Parents who lose an infant can be expected to
grieve in the usual manner
– they should be helped through this process by
medical personnel and family
• Euthanasia – the act of causing a painless death
or of letting someone die naturally – is
controversial if used for newborns with birth
defects
Family and Society
• In general, the moods of men and women after
childbirth are stable & positive
– most women adjust to the birth of their children
rapidly and without long-term psychological effects
– most fathers maintain positive attitudes and show a
desire to be involved in the nurture of the newborn
• Post-partum blues are normal & last only a few
hours or days
Family and Society
Postpartum Depression
8-15% of mothers suffer from postpartum
depression
– dysphoric mood, disturbances of sleep or appetite,
fatigue, feelings of guilt, & suicidal thoughts
– linked to prenatal factors such as life stresses, a
perceived lack of support, poor marital adjustment,
depressed mood, & a history of psychiatric illness
– need greater emotional support from their partners &
have lower levels of marital satisfaction compared to
nondepressed women
Family and Society
Each society has its own unique way of welcoming
newborns into the world
This involves a variety
of rituals that ensure
the health of the
newborn & mother and
carry a blessing for a
happy life
Family and Society
Breastfeeding
• Breastfeeding is recommended
until at least 12 months
– In 2003, more than 72% of US mothers breastfed at
birth, declining to only 16% at 12 months
• Benefits for mothers:
– faster weight loss, lower breast cancer risk
• Benefits for infants:
– fussier, but more optimal physiological functioning
– lower risk of infections, cancer, & possibly other
diseases, allergies, and obesity
– breast-fed infants get talked to, smiled at, touched,
looked at, & rocked more during feeding
Picture from: eideard.wordpress.com/2008/08/12/breastfeeding-study-shows-most-american-moms-quit-early
On the Web
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www.dona.com
www.lalecheleague.org
www.breastfeeding.com
www.chss.iup.edu/postpartum
www.sbpep.org
Experiential Exercises:
Feeling Helpless
• Find a friend or relative with a good sense of
humor and ask him or her to feed you with a
spoon and give you a drink from a cup or glass.
• Try out your repertoire of non-verbal and nongestural communication skills!
– fuss, cry, make faces, wiggle, turn toward or away, to
communicate what you want or don’t want, or like or
do not like, about the way they are feeding you
Experiential Exercises:
Receiving & Giving Touch
• Choose a partner and find a chair – get to know each
other for a few minutes
• One person sits and the other stands behind
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when standing, look at the person in front of you with a soft gaze
place your hands gently on your partner’s shoulders (2 min)
gently move your hands to another area (2 min)
experiment with letting your grip go very loose or more intense,
then return to the middle ground
– say “goodbye” to your partner with your hands
– close your eyes and notice how your feel
• Change roles silently and repeat
• Discuss in pairs