© 2010 The McGraw-Hill Companies, Inc. All rights reserved. Children Birth 4.

© 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Children

Birth

4


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?


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



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



The Stages of Birth

b

d

a

c

Placenta

Placenta

Vagina

Cervix

Uterus

Fig. 4.1


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




• 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




• 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’



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




• 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




• Other methods to reduce pain and stress during labor and childbirth

– Waterbirth

– Massage

– Acupuncture

– Hypnosis

– Music therapy




• 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



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


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



Apgar scale



• 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




• Neonatal Intensive Care Unit Network Neurobehavioral Scale

– Offspring of NBAS

• Provides more comprehensive analysis of newborn behavior

• Assesses ‘at risk’ or preterm infant



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


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



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



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


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




• Postpartum depression treatments

– Antidepressants

– Psychotherapy; cognitive therapy is best

• Postpartum depression affects

– Mother-infant interaction

– Risk of additional psychological disorders



“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



• 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



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 End

4

© 2010 The McGraw-Hill Companies, Inc. All rights reserved. Children Birth 4.

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children birth

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entire birth process

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stages of birth b d

stage labor

stage afterbirth placenta

pain medication delivery