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Images of Children
• Tanner Roberts’ Birth: A fantastic voyage– Cindy and Tom recount the hours and
changes that took place before their son, Tanner Roberts, was born and during his birth process.
• Contractions, pain medication
• Delivery, breathing on his own
What Happens During Birth?
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
Stages of Birth
• First stage
– Lasts about 12 to 24 hours; longest stage
– Contractions are about 15–20 minutes apart; occur closer together as birth nears
– Contractions dilate cervix to open about 4 in.
• Allows baby to move into birth canal
What Happens During Birth?
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
Stages of Birth
• Second stage– Approximately 45 minutes to an hour– Baby moves through cervix and birth canal– Mother pushes down, contractions come
almost every minute
• Third stage (afterbirth)– Placenta, umbilical cord, and other membranes
detached and expelled– Fastest stage; lasts only minutes
What Happens During Birth?
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
The Stages of Birth
b
d
a
c
Placenta
Placenta
Vagina
Cervix
Uterus
Fig. 4.1
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Childbirth Setting And Attendants
• 99% of U.S. births occur in hospitals• Other options
– Freestanding birth center, home delivery
• Who helps during birth process varies across cultures– 91% of U.S. births attended by physicians– Some exclude fathers from process– Some attended by family members or open to
community
What Happens During Birth?
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
Childbirth Setting And Attendants
• Midwives– Norm in most of world– Attend 8% of U.S. births– U.S. certified nurse midwives
• More time with patient in prenatal visits
• More emphasis on counseling, education
• Provide more emotional support to mother
• Are present during entire birth process
What Happens During Birth?
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
Childbirth Setting And Attendants
• Doulas
– Provide continuous physical, emotional, and educational support before, during, and after childbirth
– Most in U.S. work independently, typically function as part of ‘birthing team’
What Happens During Birth?
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
Methods of Childbirth
• Use of medication during delivery
– Analgesia is used to relieve pain
– Anesthesia is used in late first-stage labor and during expulsion to block sensation
• Epidural block: numbs from waist down
– Oxytocin
• Synthetic hormones stimulate contractions
What Happens During Birth?
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
Methods of Childbirth
• Natural childbirth
– Tries to reduce mother’s pain by reducing fear
• Prepared childbirth (Lamaze method)
– Similar to natural childbirth
– Special breathing technique in final stages of labor
• Many other techniques have developed
What Happens During Birth?
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
Methods of Childbirth
• Other methods to reduce pain and stress during labor and childbirth
– Waterbirth
– Massage
– Acupuncture
– Hypnosis
– Music therapy
What Happens During Birth?
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
Methods of Childbirth
• Cesarean Delivery
– Baby removed from uterus through incision in abdomen when
• Baby is in breech or crosswise position
• Head too large for mother’s pelvis
• Vaginal bleeding has occurred in pregnancy
– U.S. births by C-sections increased since 2002
What Happens During Birth?
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
The Fetus/Newborn Transition
• Anoxia occurs during contractions
– Insufficient oxygen to fetus/newborn
• Stress hormone secretion protects from oxygen deficiency, prepares infant for birth
• Vernix caseosa (skin grease) protects against heat loss
Measures of Neonatal Health
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Neonatal Measurements
• Apgar scale
– Widely used to assess health at 1 and 5 minutes after birth
• Score of 7 to 10 is good, below 3 signals emergency
• Identifies high-risk infants
Measures of Neonatal Health
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Neonatal Measurements
• Brazelton Neonatal Behavioral Assessment Scale (NBAS)– Performed within 24 to 36 hours after birth
• Neurological development, reflexes
• Reactions to people/objects
– Infant is active participant, based on best performance
• “worrisome,” “normal,” and “superior” classifications
Measures of Neonatal Health
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Neonatal Measurements
• Neonatal Intensive Care Unit Network Neurobehavioral Scale
– Offspring of NBAS
• Provides more comprehensive analysis of newborn behavior
• Assesses ‘at risk’ or preterm infant
Measures of Neonatal Health
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Preterm and Small for Date Infants
• Low-birth-weight infant is under 5.5 lbs
– Very low - under 3 lbs
– Extremely low - under 2 lbs
• Preterm – born 3 or more weeks early
• Small for date – birth weight below normal
– Increased use of progestin to prevent preterm births
LBW and Preterm Infant Development
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Consequences of Preterm and LBW
• As a group - more developmental and health problems– Risk increases as gestation age decreases– Norwegian study
• Preterm-birth adolescents at higher risk for language delays, learning problems, and behavior problems/delinquency involvement
LBW and Preterm Infant Development
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
Nurturing Preterm Infants
• Nurturing Preterm Infants
– Intensive enrichment programs can improve short-term outcomes
– Two most popular intervention programs
• Kangaroo care – used by most NICU nurses
• Massage therapy – used by 37% of NICUs
– More touch promotes faster development
LBW and Preterm Infant Development
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
Postpartum Period
• Period after childbirth
– Mother adjusts physically and psychologically to process of childbearing
– Lasts about six weeks
• Involution
– Process by which uterus returns to pre-pregnant size
The Postpartum Period
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Emotional and Psychological Adjustments
• Emotional fluctuations due to
– Hormonal changes, fatigue, inadequate rest
– Inexperience or lack of confidence
– Extensive demands may cause anxiety, depression, coping difficulties
• Postpartum depression– Strong feelings of sadness, anxiety, despair– Gets worse without treatment
The Postpartum Period
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
Emotional and Psychological Adjustments
• Postpartum depression treatments
– Antidepressants
– Psychotherapy; cognitive therapy is best
• Postpartum depression affects
– Mother-infant interaction
– Risk of additional psychological disorders
The Postpartum Period
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
“Baby Blues” Symptoms appear 2 to 3 days after
delivery and subside within 1 to 2 weeks
Postpartum depression Symptoms linger for weeks or months and interfere with
daily functioning
No symptoms
Percentage of U.S. women experiencing “Baby Blues”
and Postpartum Depression
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
Emotional and Psychological Adjustments
• Father’s adjustment– Experiences considerable adjustment and
stress
• Attention for infant decreases couple’s time– Father’s postpartum reactions
• Prenatal involvement can lessen feelings of depression
The Postpartum Period
© 2010 The McGraw-Hill Companies, Inc. All rights reserved.
Bonding
• Close connection, especially physical bond, between parents and newborn in period shortly after birth
– Encouraged by many doctors: “rooming in”
– Little evidence for a critical bonding period, but parents enjoy and can be helpful
– Parent-child interaction climate improved
The Postpartum Period