Life Span Development Prenatal Development and Birth – Chapter 4 June 15, 2004 Class #3.

Life Span DevelopmentLife Span Development

Prenatal Development and Birth – Chapter 4 Prenatal Development and Birth – Chapter 4

June 15, 2004June 15, 2004Class #3Class #3

The First TrimesterThe First Trimester

Pregnancy is the process referring to the gestation Pregnancy is the process referring to the gestation period of a human beingperiod of a human being

A pregnancy is initiated when a fertile sperm from A pregnancy is initiated when a fertile sperm from a male bonds with a fertile egg from a femalea male bonds with a fertile egg from a female

The period of pregnancy (from the woman's last The period of pregnancy (from the woman's last menstrual cycle to the birth of the child) usually is menstrual cycle to the birth of the child) usually is 40 weeks40 weeks

This 40 weeks is divided into three subperiods, This 40 weeks is divided into three subperiods, known as "trimesters“known as "trimesters“

The first thirteen weeks of pregnancy are referred The first thirteen weeks of pregnancy are referred to as the "first trimester"to as the "first trimester"

Development of the Embryo and FetusDevelopment of the Embryo and Fetus

Obstetricians count "weeks of pregnancy" Obstetricians count "weeks of pregnancy" from the first day of a woman's last from the first day of a woman's last menstrual cycle because there is often no menstrual cycle because there is often no way to determine exactly when conception way to determine exactly when conception occurredoccurred

Embryologists, however, typically describe Embryologists, however, typically describe the developing embryo or fetus by the the developing embryo or fetus by the number of weeks since conception number of weeks since conception

From Zygote to NewbornFrom Zygote to Newborn

Germinal periodGerminal period—first 14 days—first 14 days

Embryonic periodEmbryonic period—3rd through 8th —3rd through 8th

weeksweeks

Fetal periodFetal period—9th week through birth—9th week through birth

Germinal: The First 14 DaysGerminal: The First 14 Days

• Zygote divides and keep dividing (at least Zygote divides and keep dividing (at least

though 3rd doubling they are the same)though 3rd doubling they are the same)

• At this stage (8 cells) differentiationAt this stage (8 cells) differentiation begins begins - early “stem” cells take on distinct characteristicsearly “stem” cells take on distinct characteristics

- they gravitate to locations, foreshadowing the they gravitate to locations, foreshadowing the

type of cells they will becometype of cells they will become

Germinal: The First 14 DaysGerminal: The First 14 Days

• At about a week after conception the At about a week after conception the

multiplying cells separate into two multiplying cells separate into two

massesmasses

- first task of out cells to achieve first task of out cells to achieve

implantationimplantation— embed themselves into — embed themselves into

the nuturant environment of the the nuturant environment of the

uterusuterus

• 60% of all natural conceptions fail to 60% of all natural conceptions fail to

implant; 70% of in vitro procedures fail implant; 70% of in vitro procedures fail

to implantto implant

Development of the Embryo and FetusDevelopment of the Embryo and Fetus

The zygote’s outer part attaches to the The zygote’s outer part attaches to the uterine wall forming the placenta uterine wall forming the placenta

The inner cells are referred to as the embryoThe inner cells are referred to as the embryo By nine weeks, the embryo clearly looks By nine weeks, the embryo clearly looks

human and is now a fetus human and is now a fetus

Role of the PlacentaRole of the Placenta

The placenta carries nourishment and The placenta carries nourishment and oxygen from the mother to the fetus and at oxygen from the mother to the fetus and at the same time screens out many potentially the same time screens out many potentially harmful substancesharmful substances– Unfortunately some get through…Unfortunately some get through…

Fetal Alcohol Syndrome (FAS)Fetal Alcohol Syndrome (FAS)

FAS is a lifelong yet completely preventable set of FAS is a lifelong yet completely preventable set of physical, mental and neurobehavioral birth defects physical, mental and neurobehavioral birth defects associated with alcohol consumption during associated with alcohol consumption during pregnancypregnancy– Alcohol enters the mother’s and the fetus’ bloodstreamAlcohol enters the mother’s and the fetus’ bloodstream

FAS is the leading known cause of mental FAS is the leading known cause of mental retardation and birth defects retardation and birth defects – Small disproportioned head and lifelong brain Small disproportioned head and lifelong brain

abnormalitiesabnormalities

How does a mother’s drinking affect How does a mother’s drinking affect her unborn child?her unborn child?

Facts:Facts:– Through the blood vessels in the placenta, the Through the blood vessels in the placenta, the

mother’s blood supplies the developing baby mother’s blood supplies the developing baby with nourishment and oxygenwith nourishment and oxygen

– If the mother drinks alcohol, the alcohol enters If the mother drinks alcohol, the alcohol enters her blood stream and then, through the her blood stream and then, through the placenta, enters the blood supply of the placenta, enters the blood supply of the growing babygrowing baby So, when a pregnant woman drinks alcohol, so So, when a pregnant woman drinks alcohol, so

does her babydoes her baby

– Alcohol is a Alcohol is a teratogenteratogen, a substance known to , a substance known to be toxic to human developmentbe toxic to human development

Fetal Alcohol Syndrome (FAS)Fetal Alcohol Syndrome (FAS)

Prenatal alcohol exposure does not always result Prenatal alcohol exposure does not always result in FAS—although there is no known safe level of in FAS—although there is no known safe level of alcohol consumption during pregnancyalcohol consumption during pregnancy

Most individuals affected by alcohol exposure Most individuals affected by alcohol exposure before birth do not have the characteristic facial before birth do not have the characteristic facial abnormalities and growth retardation identified abnormalities and growth retardation identified with FAS, yet they have brain and other with FAS, yet they have brain and other impairments that are just as significant impairments that are just as significant

Sad facts…Sad facts…

In addition to mental retardation, individuals with In addition to mental retardation, individuals with FAS may have other neurological deficits such as FAS may have other neurological deficits such as poor motor skills and hand-eye coordinationpoor motor skills and hand-eye coordination

They may also have a complex pattern of They may also have a complex pattern of behavioral and learning problems, including behavioral and learning problems, including difficulties with memory, attention and judgment.difficulties with memory, attention and judgment.

As many as 12,000 infants are born each year As many as 12,000 infants are born each year with FAS with FAS

What if I am pregnant and have been What if I am pregnant and have been drinking?drinking?

If you consumed alcohol before you knew If you consumed alcohol before you knew you were pregnant, stop drinking now!you were pregnant, stop drinking now!– Abstaining from alcohol for the remainder of Abstaining from alcohol for the remainder of

your pregnancy can have a beneficial effect your pregnancy can have a beneficial effect even on functions that might have been affected even on functions that might have been affected by earlier drinkingby earlier drinking

– The sooner you stop drinking, the better the The sooner you stop drinking, the better the chance of having a healthy babychance of having a healthy baby

Smoking cigarettes during pregnancy Smoking cigarettes during pregnancy (US Dept. of Heath and Human Services, 2001)(US Dept. of Heath and Human Services, 2001)

The rate of smoking during pregnancy dropped 33 percent The rate of smoking during pregnancy dropped 33 percent between 1990 and 1999, so that in 1999 just over 12 percent of all between 1990 and 1999, so that in 1999 just over 12 percent of all women reported smoking during their pregnancies, according to a women reported smoking during their pregnancies, according to a new report from the Centers for Disease Control and Preventionnew report from the Centers for Disease Control and Prevention– The greatest success in reducing smoking was for women in The greatest success in reducing smoking was for women in

their late twenties and early thirties, where there was over a 40 their late twenties and early thirties, where there was over a 40 percent drop since 1990 percent drop since 1990

– Teenagers were more likely than women of any other age Teenagers were more likely than women of any other age to smoke while pregnantto smoke while pregnant After experiencing a dramatic 20-percent decline in the first After experiencing a dramatic 20-percent decline in the first

part of the decade, smoking rates among pregnant part of the decade, smoking rates among pregnant teenagers–unlike women of all other ages--increased by 5 teenagers–unlike women of all other ages--increased by 5 percent from 1994 to 1999percent from 1994 to 1999

The highest rate in 1999 (19 percent) was for women 18-19 The highest rate in 1999 (19 percent) was for women 18-19 years of ageyears of age

Smoking during pregnancy is related Smoking during pregnancy is related to violent crimes…to violent crimes…

Brennan, Grekin, & Mednick (1999)Brennan, Grekin, & Mednick (1999)– Subjects were a birth cohort of 4169 males born Subjects were a birth cohort of 4169 males born

between September 1959 and December 1961 between September 1959 and December 1961 in Copenhagen, Denmarkin Copenhagen, Denmark

– During the third trimester of pregnancy, mothers During the third trimester of pregnancy, mothers self-reported the number of cigarettes smoked self-reported the number of cigarettes smoked dailydaily

– When the male offspring were 34 years of age, When the male offspring were 34 years of age, their arrest histories were checked in the Danish their arrest histories were checked in the Danish National Criminal Register National Criminal Register

Brennan, Grekin, & Mednick (1999)Brennan, Grekin, & Mednick (1999)

Found the following data relating smoking during Found the following data relating smoking during pregnancy to offsprings’ arrest rate for violent pregnancy to offsprings’ arrest rate for violent crimes:crimes:– Mother did not smoke…8%Mother did not smoke…8%– Mother smoked 1-2 cigarettes per day…9%Mother smoked 1-2 cigarettes per day…9%– Mother smoked 3-10 cigarettes per day…11%%Mother smoked 3-10 cigarettes per day…11%%– Mother smoked 10-20 cigarettes per day…15%Mother smoked 10-20 cigarettes per day…15%– Mother smoked > 20 cigarettes/day…18%Mother smoked > 20 cigarettes/day…18%

What do you think of these numbers???What do you think of these numbers???

Embryo: From the Third to the Eighth WeekEmbryo: From the Third to the Eighth Week

First sign of human structure: thin line down First sign of human structure: thin line down

the middle (22 days) that becomes the the middle (22 days) that becomes the neural neural

tube, tube, which eventually forms the central which eventually forms the central

nervous system, including brain and spinal nervous system, including brain and spinal

columncolumn

– fourth weekfourth week head begins to take shape head begins to take shape

heart begins with a miniscule blood vessel that begins to heart begins with a miniscule blood vessel that begins to

pulsatepulsate

Embryo: From the Third to the Eighth WeekEmbryo: From the Third to the Eighth Week

– fifth weekfifth week arm and leg buds appeararm and leg buds appear

tail-like appendage extends from the spinetail-like appendage extends from the spine

– eighth weekeighth week embryo weighs 1 gram and is 1 inch longembryo weighs 1 gram and is 1 inch long

head more rounded; face formedhead more rounded; face formed

all basic organs and body parts (but for sex) presentall basic organs and body parts (but for sex) present

– 20% of all embryos spontaneously abort 20% of all embryos spontaneously abort

nownow

FetusFetus

Called a fetus from 9th week onCalled a fetus from 9th week on

Third MonthThird Month• Sex organs take shape (Y cell sends signal Sex organs take shape (Y cell sends signal

to male sex organs; for females, no signal to male sex organs; for females, no signal

occurs)occurs)- genital organs fully shaped by 12th weekgenital organs fully shaped by 12th week

• All body parts presentAll body parts present

• Fetus can move every part of bodyFetus can move every part of body

• Fetus weighs 3 ounces and is 3 inches longFetus weighs 3 ounces and is 3 inches long

First Trimester: First Trimester: For the MomFor the Mom

There are a wide variety of changes that a woman can There are a wide variety of changes that a woman can experienceexperience

These physical changes can also cause emotional These physical changes can also cause emotional reactionsreactions

Sometimes women during the first trimester notice an Sometimes women during the first trimester notice an energy boost and overwhelming happiness; other women energy boost and overwhelming happiness; other women complain that they are fatigued and emotionally unstable; it complain that they are fatigued and emotionally unstable; it is also possible for women to not even be aware of drastic is also possible for women to not even be aware of drastic fluctuations in their bodies and emotionsfluctuations in their bodies and emotions

Many women worry that these changes during the first Many women worry that these changes during the first trimester may adversely affect the growth of the fetus, but trimester may adversely affect the growth of the fetus, but in most cases they do not threaten the well-being of the in most cases they do not threaten the well-being of the fetusfetus

First Trimester: First Trimester: For the MomFor the Mom

Some pregnant women notice aches and painsSome pregnant women notice aches and pains Common complaints are back pains, joint aches, Common complaints are back pains, joint aches,

and leg crampsand leg cramps It is essential that the woman rests often in order It is essential that the woman rests often in order

to alleviate these achesto alleviate these aches Almost all women notice that they are more tired Almost all women notice that they are more tired

than usual during the first trimesterthan usual during the first trimester This feeling of fatigue sometimes remains for the This feeling of fatigue sometimes remains for the

duration of the pregnancy, although most women duration of the pregnancy, although most women feel noticeably stronger by the third trimester feel noticeably stronger by the third trimester

““Morning Sickness”Morning Sickness”

Another problem that affects the mother during early Another problem that affects the mother during early pregnancy is nauseapregnancy is nausea

This is a very common problem as it affects almost three-This is a very common problem as it affects almost three-fourths of all pregnant womenfourths of all pregnant women

Most doctors think that "morning sickness" is caused by the Most doctors think that "morning sickness" is caused by the overproduction of hormones (mostly estrogen) that occurs overproduction of hormones (mostly estrogen) that occurs during the early pregnancyduring the early pregnancy

These estrogen hormones then circulate throughout the These estrogen hormones then circulate throughout the bloodstream and affect the bodybloodstream and affect the body

Some doctors think that this excess of hormones causes Some doctors think that this excess of hormones causes the stomach to digest food more slowly, which results in the stomach to digest food more slowly, which results in the nausea and the vomitingthe nausea and the vomiting

Stress and fatigue may also play a part in causing nausea Stress and fatigue may also play a part in causing nausea and vomitingand vomiting

Common Complications During Common Complications During The First TrimesterThe First Trimester

Serious complications that can harm either the Serious complications that can harm either the mother or the baby occur in about a fifth of all mother or the baby occur in about a fifth of all pregnanciespregnancies

There are other common complications that may There are other common complications that may cause alarm in the mother, but that typically do not cause alarm in the mother, but that typically do not impact the success of the pregnancyimpact the success of the pregnancy– For example:For example:

Vaginal bleeding occurs in about 25% of Vaginal bleeding occurs in about 25% of pregnanciespregnancies

Most cases this is not serious Most cases this is not serious

A very risky time…A very risky time…

It is estimated that 10 percent of all It is estimated that 10 percent of all recognized pregnancies spontaneously recognized pregnancies spontaneously abort during the first trimesterabort during the first trimester

The actual number of miscarriages is much The actual number of miscarriages is much higherhigher

Perhaps fifty percent of all conceptions Perhaps fifty percent of all conceptions spontaneously result in miscarriage before spontaneously result in miscarriage before the woman even knows that she is pregnantthe woman even knows that she is pregnant

Second Trimester:Second Trimester:Middle Three MonthsMiddle Three Months

The second trimester of pregnancy encompasses The second trimester of pregnancy encompasses weeks 14 through 27…weeks 14 through 27…– In the fetus: In the fetus:

Growth continues quickly from now until birth Growth continues quickly from now until birth Organs such as the heart and kidneys develop further Organs such as the heart and kidneys develop further Eyebrows and fingernails form Eyebrows and fingernails form The skin is wrinkled and covered with fine hair The skin is wrinkled and covered with fine hair periods of activity and quiet occur as the fetus moves, kicks, periods of activity and quiet occur as the fetus moves, kicks,

sleeps, and wakessleeps, and wakes By the end of the second trimester, the fetus is about 11 to 14 By the end of the second trimester, the fetus is about 11 to 14

inches long and weighs about 2 to 2 1/2 poundsinches long and weighs about 2 to 2 1/2 pounds It can swallow, hear, and urinateIt can swallow, hear, and urinate

Middle Three Months: Middle Three Months:

Preparing to SurvivePreparing to Survive• Heartbeat strongerHeartbeat stronger

• Digestive and excretory systems Digestive and excretory systems

develop more fullydevelop more fully

• Impressive brain growth (6X in size Impressive brain growth (6X in size

and responsive)and responsive)- new new neuronsneurons develop ( develop (neurogenesisneurogenesis))

- synapsessynapses—connections between neurons —connections between neurons

((synaptogenesissynaptogenesis))

Middle Three Months: Middle Three Months:

Preparing to SurvivePreparing to Survive

• Age of viabilityAge of viability—age at which —age at which

preterm baby can possibly preterm baby can possibly

survive (22 weeks)survive (22 weeks)- 26 weeks survival rate about 50%26 weeks survival rate about 50%

. brain maturation critical to viabilitybrain maturation critical to viability

. weight critical to viabilityweight critical to viability

- 28 weeks survival rate about 95%28 weeks survival rate about 95%

Second Trimester: Second Trimester: For the MomFor the Mom

During the second trimester, continuing growth During the second trimester, continuing growth and development in mother and fetus cause many and development in mother and fetus cause many changes to occur: changes to occur: – Women may notice the following: Women may notice the following:

Their abdomen begins to swell. By the end of the second Their abdomen begins to swell. By the end of the second trimester, the uterus is near the rib cage. trimester, the uterus is near the rib cage.

The skin on the abdomen and breasts stretches. Stretch marks The skin on the abdomen and breasts stretches. Stretch marks may be visible. may be visible.

Movements made by the fetus. Known as quickening, this often Movements made by the fetus. Known as quickening, this often occurs sometime around weeks 16 to 20. occurs sometime around weeks 16 to 20.

A dark line forming from the navel down to the middle of the A dark line forming from the navel down to the middle of the abdomen abdomen

Brown, uneven marks on the face or other changes in skin Brown, uneven marks on the face or other changes in skin pigment pigment

Darkening of the area around the nipplesDarkening of the area around the nipples

No more morning sickness…No more morning sickness…

Often, the second trimester delivers a welcome energy Often, the second trimester delivers a welcome energy boost to women and an end to morning sickness. It may boost to women and an end to morning sickness. It may also bring: also bring: – nasal congestion and occasional nose bleeds nasal congestion and occasional nose bleeds – whitish vaginal discharge whitish vaginal discharge – less of a need to urinate often less of a need to urinate often – constipation constipation – increase in appetite increase in appetite – Braxton Hicks contractions in which the uterus becomes hard and Braxton Hicks contractions in which the uterus becomes hard and

tight and then relaxes tight and then relaxes – leg cramps leg cramps – backache backache – fatiguefatigue

Miscarriage is now at a much Miscarriage is now at a much lower risk…lower risk…

Miscarriage in low-risk pregnancies is rare Miscarriage in low-risk pregnancies is rare at this time, but women sometimes have at this time, but women sometimes have other problems in the second trimester, other problems in the second trimester, including: including: – High blood pressureHigh blood pressure– Sugar in the urine. This may be a sign of Sugar in the urine. This may be a sign of

gestational diabetes, a form of diabetes gestational diabetes, a form of diabetes associated with pregnancy associated with pregnancy

– Iron-deficiency anemiaIron-deficiency anemia

Final Three Months— Final Three Months—

Viability to Full TermViability to Full Term The third trimester of pregnancy generally spans The third trimester of pregnancy generally spans

weeks 28 through 40…weeks 28 through 40…

• Maturation of the respiratory and Maturation of the respiratory and

cardiovascular systemscardiovascular systems - critical difference critical difference

• Gains weight—4.5 lbs. in last 10 weeksGains weight—4.5 lbs. in last 10 weeks

Third TrimesterThird Trimester

As the fetus gets bigger, it has less room to kick As the fetus gets bigger, it has less room to kick and stretch, so the movements felt by the mother and stretch, so the movements felt by the mother may decrease may decrease

Fine body hair disappears Fine body hair disappears Most bones harden, but bones of the head stay Most bones harden, but bones of the head stay

soft and flexible for birth soft and flexible for birth As the time for birth approaches, the fetus usually As the time for birth approaches, the fetus usually

moves down into the pelvis and settles into a good moves down into the pelvis and settles into a good positionposition

At 40 weeks, the fetus is considered full term. It is At 40 weeks, the fetus is considered full term. It is about 20 inches long and weighs 6 to 9 pounds about 20 inches long and weighs 6 to 9 pounds

Risk ReductionRisk Reduction

Despite complexity, most babies are born Despite complexity, most babies are born

healthyhealthy

Most hazards are avoidableMost hazards are avoidable

TeratologyTeratology—study of birth defects—study of birth defects

– teratogensteratogens—broad range of substances —broad range of substances

that can cause environmental insults that that can cause environmental insults that

may cause prenatal abnormalities or later may cause prenatal abnormalities or later

learning abilitieslearning abilities

Determining RiskDetermining Risk

Risk analysisRisk analysis—weighing of factors that —weighing of factors that

affect likelihood of teratogen causing affect likelihood of teratogen causing

harmharm

Timing of ExposureTiming of Exposure

• Critical period—Critical period—in prenatal in prenatal

development, the time when a development, the time when a

particular organ or other body part particular organ or other body part

is most susceptible to teratogenic is most susceptible to teratogenic

damagedamage- entire embryonic period is criticalentire embryonic period is critical

Amount of ExposureAmount of Exposure

Dose and/or frequencyDose and/or frequency

Threshold effect—Threshold effect—teratogen teratogen

relatively harmless until exposure relatively harmless until exposure

reaches a certain levelreaches a certain level

Amount of ExposureAmount of Exposure

• Interaction effectInteraction effect—risk of harm —risk of harm

increases if exposure to teratogen increases if exposure to teratogen

occurs at the same time as occurs at the same time as

exposure to another teratogen or exposure to another teratogen or

riskrisk

Genetic VulnerabilityGenetic Vulnerability

• Genetic susceptibilities: product of Genetic susceptibilities: product of

genes combined with stressgenes combined with stress

• Folic-acid deficiency may cause Folic-acid deficiency may cause

neural- tube defectsneural- tube defects- occurs most commonly in certain ethnic occurs most commonly in certain ethnic

groups and less often in othersgroups and less often in others

• Males are more genetically vulnerableMales are more genetically vulnerable

Specific TeratogensSpecific Teratogens

No way to predict risk on an individual basisNo way to predict risk on an individual basis

Research has shown possible effects of most Research has shown possible effects of most

common and damaging teratogenscommon and damaging teratogens

AIDS and alcohol extremely damagingAIDS and alcohol extremely damaging

– pregnant women with AIDS transmit it to their pregnant women with AIDS transmit it to their

newborns; high doses of alcohol cause newborns; high doses of alcohol cause FASFAS; ;

alcohol + drug use increase risk to developing alcohol + drug use increase risk to developing

organismorganism

Low BirthweightLow Birthweight

Low BirthweightLow Birthweight (LBW) (LBW)– less than 5 1/2 lbs.less than 5 1/2 lbs.

grows too slowly or weighs less than normalgrows too slowly or weighs less than normal more common than 10 years agomore common than 10 years ago second most common cause of neonatal second most common cause of neonatal

deathdeath

PretermPreterm– birth occurs 3 or more weeks before birth occurs 3 or more weeks before

standard 38 weeksstandard 38 weeks

Small for Gestational AgeSmall for Gestational Age (SGA) (SGA)– maternal illnessmaternal illness– maternal behaviormaternal behavior

cigarette smoking (25% of SGA births)cigarette smoking (25% of SGA births)

– maternal malnutritionmaternal malnutrition poorly nourished before and during poorly nourished before and during

pregnancypregnancy underweight, undereating, and smoking tend underweight, undereating, and smoking tend

to occur togetherto occur together

Low BirthweightLow Birthweight

Factors that affect normal prenatal Factors that affect normal prenatal growthgrowth– quality of medical care, education, quality of medical care, education,

social support, and cultural practicessocial support, and cultural practices

Low BirthweightLow Birthweight

Third Trimester:Third Trimester:For the MomFor the Mom

Women may notice the following:Women may notice the following:– Movements of the fetus can be felt more strongly Movements of the fetus can be felt more strongly – Abdominal pain that may or may not be true labor pains Abdominal pain that may or may not be true labor pains – Shortness of breath because the uterus is pushing Shortness of breath because the uterus is pushing

against the diaphragm. The diaphragm is a flat, strong against the diaphragm. The diaphragm is a flat, strong muscle that aids in breathing. Towards the end of the muscle that aids in breathing. Towards the end of the third trimester, the baby may drop down into a lower third trimester, the baby may drop down into a lower position. This will make it easier for the mother to position. This will make it easier for the mother to breathe breathe

– A need to urinate more often when the baby drops down A need to urinate more often when the baby drops down into a lower position in the pelvis into a lower position in the pelvis

– Yellow, watery fluid leaking from her nipples, known as Yellow, watery fluid leaking from her nipples, known as colustrum colustrum

– Her navel sticking outHer navel sticking out

Third Trimester:Third Trimester:For the MomFor the Mom

During the third trimester, certain discomforts and mood During the third trimester, certain discomforts and mood changes may occur: changes may occur: – fatigue or extra energy, or alternate periods of both fatigue or extra energy, or alternate periods of both – increasingly heavy white vaginal discharge increasingly heavy white vaginal discharge – more mild lower abdominal pains with uterine tightening and then more mild lower abdominal pains with uterine tightening and then

relaxing relaxing – more or less of an appetite more or less of an appetite – constipation, heartburn, indigestion, gas, and bloating constipation, heartburn, indigestion, gas, and bloating – headaches, dizziness, or faintness headaches, dizziness, or faintness – more trouble sleeping more trouble sleeping – itchy abdomen itchy abdomen – varicose veinsvaricose veins– swelling of the legs, feet, and hands swelling of the legs, feet, and hands – increasing clumsiness as shape and balance changes increasing clumsiness as shape and balance changes – anxiety, impatience, and restlessness anxiety, impatience, and restlessness – irritability and unusual sensitivityirritability and unusual sensitivity

The Birth ProcessThe Birth Process

Hormones in mother’s brain signals Hormones in mother’s brain signals processprocess

Contractions begin: strong and regular at Contractions begin: strong and regular at 10 minutes apart10 minutes apart– average labor for first births is 8 hoursaverage labor for first births is 8 hours

Assessment—Assessment—Apgar scaleApgar scale– five factors, 2 points eachfive factors, 2 points each

heart rateheart rate breathingbreathing colorcolor muscle tonemuscle tone reflexesreflexes score of 7 or better: normalscore of 7 or better: normal score under 7: needs help breathingscore under 7: needs help breathing score under 4: needs urgent critical carescore under 4: needs urgent critical care

The Newborn’s First The Newborn’s First MinutesMinutes

VariationsVariations Parents ReactionParents Reaction

– preparation for birth, physical and preparation for birth, physical and emotional support, position and size of emotional support, position and size of fetus, and practices of mother’s culturefetus, and practices of mother’s culture

Medical AttentionMedical Attention– birth in every developed nation has medical birth in every developed nation has medical

attentionattention– 22% of births in U.S. are cesarean section22% of births in U.S. are cesarean section

removal of fetus via incisions in mother’s abdomen removal of fetus via incisions in mother’s abdomen and uterus and uterus

– is medical intervention always necessary?is medical intervention always necessary?

Birth ComplicationsBirth Complications

Cerebral PalsyCerebral Palsy– brain damage causing difficulties in muscle brain damage causing difficulties in muscle

control, possibly affecting speech or other control, possibly affecting speech or other body movementsbody movements

AnoxiaAnoxia– lack of oxygen that, if prolonged, can cause lack of oxygen that, if prolonged, can cause

brain damage or death brain damage or death

First Intensive Care . . . First Intensive Care . . . Then HomeThen Home

At the Hospital At the Hospital – many hospitals provide regular massage many hospitals provide regular massage

and soothing stimulation; ideally, parents and soothing stimulation; ideally, parents share in caregivingshare in caregiving

At HomeAt Home– complications, e.g., minor medical crises complications, e.g., minor medical crises – cognitive difficulties may emerge, but cognitive difficulties may emerge, but

high-risk infants can develop normallyhigh-risk infants can develop normally

Strong family support Strong family support Fathers play a crucial roleFathers play a crucial role

– may help wives abstain from drugs or may help wives abstain from drugs or alcoholalcohol

– can reduce maternal stresscan reduce maternal stress Parental alliance—Parental alliance—commitment by both commitment by both

parents to cooperate in raising childparents to cooperate in raising child– helps alleviate helps alleviate postpartum depressionpostpartum depression

Mothers, Fathers and a Mothers, Fathers and a Good StartGood Start

Parent-infant bondParent-infant bond—strong, loving —strong, loving connection that forms as parents hold, connection that forms as parents hold, examine, and feed their newbornexamine, and feed their newborn– immediate contact not needed for this to immediate contact not needed for this to

occuroccur

Mothers, Fathers and a Mothers, Fathers and a Good StartGood Start