3TRUTH OR FICTION?T F After birth, babies are held upside down and slapped on the buttocks to stimulate independent breathing.T F The way the umbilical cord is cut determines whether the baby’s “belly button” will be an “innie” or an “outie.”T F Women who give birth according to the Lamaze method do not experience pain.T F In the U.S., about 3 births in 10 are by cesarean section.T F It is abnormal to feel depressed following childbirth.T F Parents much have extended early contact with their newborn children if adequate bonding is to take place.T F More children die from Sudden Infant Death Syndrome (SIDS) than from cancer, heart disease, pneumonia, child abuse, AIDS, cystic fibrosis, and muscular dystrophy combined.Helpful to open class discussion and stimulate ideas on topics within Chapter 4.Answers are found in notes sections as they are encountered throughout the chapter.
4Countdown to Childbirth Fetal positionEarly in last month, fetus settles with head in pelvis: referred to as “dropping or lightening”First contractionsBraxton-Hicks contractions: false laborCan start at 6 mos. and tend to increase in later mos.Amniotic fluid1 in 10 women experience a bursting of the amniotic sac, usually at end of 1st stage laborOther common signsIndigestion; diarrhea; abdominal cramps; back acheFetal hormonesStimulate placenta and uterus to secrete PROSTAGLANDINS & OXYTOCIN to stimulate contractionsCertain bodily functions take place prior to the onset of labor.
6Three Stages of Childbirth STAGE ONE process…Contractions efface & dilate the cervixNeeds to be 4 inches (10 centimeters) for passageContractions start about minutes apart at seconds; when reaching 4-5 minutes, advised to go to hospital or birthing centerAverage length of time for Stage OneAbout half a day to one day: 1st deliveries are usually longer“Prepping”Pubic area shaved (enema) intended to lower chances of infection; not mandatory, up to the attending physicianEXPLANATION OF TERMS:EFFACE = TO THIN OUTDILATE = WIDEN OR ENLARGEFORCEPS = INSTUMENT THAT FITS AROUND BABY’S HEAD TO PULL IT THROUGH BIRTH CANALVACUUM EXTRACTION TUBE = INSTRUMENT THAT USES SUCTION TO PULL THE BABY THROUGH THE BIRTH CANAL.
7Three Stages of Childbirth STAGE ONE process…(cont.)Fetal monitoringElectronic sensors measure fetal heart rate to alert staff of problemHelpful equipmentIf speeding up delivery is needed, staff may use forceps or vacuum extraction tube.TransitionFetus moves through birth canal; approx. 30 minutes for birth
8Three Stages of Childbirth STAGE TWO…CrowningWhen the babies head begins to emergeBaby will normally completely emerge within minutesAverage length of time for Stage TwoShorter than 1st stage: from a few minutes to hoursEpistiotomySurgically cutting area between birth canal and anus to prevent random tearingLike prepping (enema) is controversial and optionalUse in U.S. dropped: 70% in 1983 to 19% in 2000
9Three Stages of Childbirth STAGE TWO…(cont.)How baby looksHead and facial features can be distorted from trauma; return to normal in timeWhat happens to baby nowMucus suctioned from mouth as soon as head emergesWhen breathing on own, umbilical cord is clamped and cut to 3 inches (stump will dry and fall off in about 7-10 days).Baby is foot-printed.ID bracelet is placed on wrist.Erythromycin (antibiotic ointment) or drops of silver nitrate placed in eyes to prevent bacterial infections.Vitamin K injected to help blood clot (newborns do not make own V-K).ANSWER TO T-F? #1 = After birth, babies are held upside down and slapped on the buttocks to stimulate independent breathing. FICTION; We may see newborns slapped on the buttocks to stimulate breathing in old movies, but suction is the method used in the U.S. today.ANSWER TP T-F? #2 = The way the umbilical cord is cut determines whether the baby’s “belly button” will be an “innie” or an “outie.” FICTION: Belly-button status, is unrelated to the methods of your obstetrician.
10Figure 4.2 – A Clamped and Severed Umbilical Cord This is Figure 4.2 on p. 60 of CDEV
11Stages of Childbirth STAGE THREE… a.k.a “placental” stage Length of timeFew minutes to an hour or moreDuring this final stage:Placenta separates from wall of uterus and is expelled through birth canal.Some bleeding is normal.Obstetrician stitches episiotomy if it was performed.
13Methods of Childbirth Historically Currently Methods Usually took place in the home, involved family and perhaps a midwifeCurrentlyHome births still pattern in less developed nationsIn U.S. now in hospitals or birthing centersSome argue this “depersonalizes” the experience.MethodsAnesthesiaPrepared ChildbirthDoulasCesarean SectionMIDWIFE: A PERSON WHO HELPS WOMEN IN CHILDBIRTHEach of the methods listed will be explained in separate slides
14Methods of Childbirth ANESTHESIA used to lessen pain. General AnesthesiaInjection of barbiturate puts mother to sleep.Reduces initial responsiveness of baby; no long-term effectsTranquilizersOral barbiturates and narcoticsReduces anxiety and perception of pain without inducing sleepLocal anestheticsPudenal block external genitals deadened with injectionEpidural & Spinal Block: injection to spinal cord that numbs body below the waistNo anestheticsNatural childbirth: no drugs or anesthetics; uses relaxation and breathing exercises
15LAMAZE METHOD = Prepared Childbirth Methods of ChildbirthLAMAZE METHOD = Prepared ChildbirthMother and “Coach”Mother learns breathing and relaxation methods to lessen fear and pain and distract from pain.“Coach” (usually Dad but can be anyone) aids in delivery room by supporting Mother.ANSWER TO T-F? #3: Women who give birth according t the Lamaze method do not experience pain. Fiction: Women who use Lamaze do experience pain, but they often report less pain and ask for less medication.
16Methods of Childbirth DOULAS A non-professional person offering social support during labor.Women with Doulas appear to have shorter labor.
17CESAREAN SECTION (C-Section) Methods of ChildbirthCESAREAN SECTION (C-Section)Process:Physician delivers baby by abdominal surgery.Cut through abdomen and uterus and removes babyPossible indications for performing:If mother has small pelvis or weakened from long laborVery large baby or multiplesPrevention of circulatory mixing between mother and baby (prevention of AIDS, genital herpes)If baby is facing in wrong direction (not head first: breach birth)ANSWER TO T-F? # 4 = In the U.S., about 3 births in 10 are by C-Section. TRUE: Some 31% of deliveries at C-sections, whereas they accounted for only 1 in 20 births (5%) in Some of the increase is due to advances in medicine. For example, fetal monitors now allow physicians to more readily detect fetal distress. But physicians also perform C-sections because they are concerned about the possibility of malpractice suits if something goes wrong during a v aginal delivery.
19Birth Problems OXYGEN DEPRIVATION Anoxia: without oxygen Hypoxia: “under” oxygenImplications:PRENATTALY: Impaired CNS development; can cause cognitive & motor skills problems and psychological disordersDELIVERY: schizophrenia, cerebral palsy - deathCauses:Diabetes (mother)Accidents to umbilical cordImmature respiratory system in baby
20Birth Problems PRETERM AND LOW-BIRTH-WEIGHT INFANTS APPROX. 7% OF ALL BABIES BORNPreterm: Birth before 37 weeks (40 normal) gestationCommon in multiple birthsLow-birth-weight: Less than 5 lbsSmall for dates: full term but underweightMothers who smoke, do drugs, and receive improper nutrition place babies at risk.Babies tend to remain smaller throughout life.Preterms seem to catch up more.
21Preterm & Low-birth-weight Infants Risks:lbs.7 times more likely to dieLess than 3.3 lbs.Nearly 100 times more likely to die1.65 lbs.Sex differencesGirls seem to improve more readily than boysOverall deficienciesSeverity of disabilities reflects extent of deficienciesMost experience cognitive and motor skills deficienciesCorticosteriodsAdministering to women at risk may increases chances of survival
23Preterm & Low-birth-weight Infants Treatment:Due to physical frailty, often remain hospitalized in incubators.They maintain a temperature-controlled environment and afford protection from disease.Some may receive oxygen, but over-oxygenation may cause permanent eye injury.
24Preterm & Low-birth-weight Infants Parents & Preterm NeonatesPhysically less attractive babiesCries are high pitched and gratingMore irritable, passive, and less socialMothers may feel alienated, harbor guilt, and sense of failure and low self-esteemFear of hurting may discourage handlingPreterms fare better with responsive caring parents
25Preterm & Low-birth-weight Infants Intervention ProgramsStimulation helps preterms developCuddling, rocking, talking, singing, music, mobilesMassage and “kangaroo care” (skin to skin, chest to chest, with parent)Stimulated preterms show fewer respiratory problems, gain weight more rapidly, and make greater advances in motor, intellectual, and neurological development than those not receiving stimulation
28Postpartum PeriodThere is no definitive time period; generally considered the few weeks following deliveryMaternal Depression70% of new mother’s worldwide experience the “baby blues,” generally last about 10 days1 in 5 may experience postpartum depression (PPD), a serious mood disorder.Triggered by sudden drop in estrogen; drugs that increase estrogen levels can help symptomsSymptoms include: serious sadness, hopelessness, helplessness, worthlessness, poor concentration, loss of appetite, and insomnia1 in 500 may experience psychotic symptoms that place child at risk.ANSWER TO T-F? # 5 - It is abnormal to feel depressed following childbirth. FICTION: Actually it is normal to feel depressed following childbirth. The baby blues affect most women in the weeks after delivery. Baby blues and other postpartum mood problems are so common that they are statistically normal.
29Postpartum Period Bonding Attachment bonds are crucial to the survival and well-being of children.Parent-child bonding is a complex process requiring parent/child familiarization.Serious maternal depression can delay bonding.Women with history of rejection by own parents can also interfere with bonding.Parents can adopt children at advanced ages and still bond with them.ANSWER TO T-F? # 6 - Parents must have extended early contact with their newborn children if adequate bonding is to take place. FICTION: Despite the Klaus and Kennell studies, which made a brief splash in the 1970’s it is not necessary that parents have extended early contact with their newborn children for adequate bonding to occur.
31Characteristics of Neonates Assessing the Health of NeonatesAPGAR ScaleAdministered at birthMeasures 5 signs of healthAppearance, Pulse, Grimace, Activity level, Respiratory effortScores vary from 0-107 or above = no danger - 4 or below = critical, needs immediate attentionBy one minute after birth, most babies reach 8-10.Brazelton Neonatal Behavioral Assessment ScaleMeasures reflexes and behaviors in 4 areasMotor behavior, Response to Stress, Adaptive behavior, Control over physiological state.
32Table 3.2 – The Apgar ScaleIt is placed in the Clipboard as shown on page 57 of CDEV
33Characteristics of Neonates REFLEXES: Simple, unlearned responses to stimuli; adaptive and are normally replaced with other learned behaviors within a few months.ROOTINGSucking reflex, stimulated by touching baby’s cheekMOROWhen babies position is suddenly changed (dropping, loud noises, bumping, etc.), the back arches and legs and arms fling outward and back into chest with hugging motion.GRASPING or PALMARGrabbing or fingers other objects using 4 fingers (not thumbs)
34Characteristics of Neonates REFLEXES:STEPPINGMimics walking; when held up, baby will place one foot in front of the other as if attempting to walkBABINSKIWhen bottom of foot is stroked, toes spread in a fan motion then curl inward.TONIC-NECKWhen lying on back with head to one side, arm and leg will extend toward direction head is turned, other side will flex.
36Characteristics of Neonates Sensory Capabilities, contAUDITION - HEARINGHearing is present in utero; may play a part in bondingPrefer sound of mother’s voice over all others after birth; no preference for father’s voiceMost newborns respond to unusual sounds.Will respond to different amplitude (height of sound wave - higher = louder) and pitch (frequency of sound wave - higher frequencies make high pitches, low make low sounds); singing in low tones is soothingParticularly responsive to sounds and rhythms of speech but don’t display preference for any specific language; can discriminate differences in speech sounds; appear to be “pre-wired” for language acquisition
37Characteristics of Neonates Sensory Capabilities, contOLFACTORY - SMELLCan discriminate distinct odorsShow rapid breathing patterns and increased movement in responseTurn away from unpleasant odorsSensitive to smell of mother’s milk and mother’s underarm odor, which may contribute to early development of recognition and attachment.
38Characteristics of Neonates Sensory Capabilities, contTASTESensitive to different tastes evident from facial expressionsDiscriminate between salty, sour, and bitterExhibit preference for sweet tastes which seem to be calmingSweet solution increase heart rate but also slow sucking indicating an effort to savor and make the flavor last
39Figure 4.4 – Facial Expressions Elicited by Sweet, Sour, and Bitter Solutions Is Figure 4.4 on pg 72 of CDEV
41Learning: Really Early Childhood “Education” Classical conditioningInvoluntary responses are conditioned to new stimuli.Newborns taught to blink in response to a tone.Blinking (UR) caused by puff of air to eye as a tone was sounded (CS).After repeated pairings, sound of tone caused babies to blink (CR).Conditioned stimuli are specific; capacity to learn is universal.UR = Unconditioned ResponseCS = Conditioned StimulusCR = Conditioned Response
42Learning: Really Early Childhood “Education” Operant conditioningPositive or Negative Reinforcement tends to increase the incidence of a behavior.Use of “reinforcers” to illicit learned behaviorExperiments using sound of mother’s voice as a positive reinforcement were found to modify babies sucking reflexes with a pacifier.Baby learns through operant conditioning.
43Sleeping & Waking Neonates spend about 2/3 (16 hrs) a day sleeping. Adults spend about 1/3 day.But baby does NOT sleep 16 consecutive hours which becomes a challenge for parents.There are a number of differing sleep/wake patterns; individual infants vary but…Most all distribute sleep throughout day and nightTypically show 6 cycles of sleep/wake in 24-hrsNaps usually about 4.5 hrs and awake about 1 hr in betweenSleep time will increase as baby grows, and by 6 mos to 1 yr most will sleep through the night.
44Table 4.3 – States of Sleep and Wakefulness in Infancy this is table 3.3 on p. 62 of CDEV
46Sleeping & Waking REM and Non-REM Sleep EEG brain waves resemble waking statesa.k.a = Paradoxical SleepNeonates spend about 1/2 sleep time in REMPreterm babies spend even more time in REMBy 6 mos., about 30%; and 2-3 yrs about 20-25%Function in neonates: REM may be used to stimulate brain activity needed for creation of proteins for development of neurons and synapses.Non-REM: all other stages of sleep in sleep cycle
47Figure 4.5 – REM Sleep and Non-REM Sleep This is Figure 3.5 on p. 63 of CDEV - this should be a chart showing States of Sleep and Wakefulness in Infancy (in print out it was labeled 4.3)
49Sleeping & Waking Crying, cont Causes Recognizing types Main reason is pain but also helps clear respiratory systems of fluids and stimulate the circulatory systemRecognizing typesMost parents soon learn to interpret different types of crying patterns for hunger, anger or..PAIN: sudden, loud, insistent, accompanied by flexing and kicking legsCan indicate colic (gas & distress in digestive tract)Can be severe and persistent; lasting hours sometimesColic generally disappears by 3-6 mos.Some high-pitched cries indicate other serious problemsChromosomal abnormalities, infections, malnutrition, exposure to narcotics, etc.
50Sleeping & Waking Soothing Methods Pacifier: sucking appears to be an innate tranquilizer; as is sucking on something sweetCaregivers: soothe by picking up the baby, patting, caressing, rocking, swaddling, and speaking in low tonesTry to ascertain cause of distressLearn by trial and error what each baby prefersSome parents worry that responding to cries will “spoil” the baby and they will not learn to engage in “self-soothing” behaviors to go to sleepAs infants mature, crying is replaced by verbal requests for intervention.
51Sudden Infant Death Syndrome (SIDS) a.k.a Crib Death Defined:A disorder of infancy that strikes while baby sleeps.Typically baby is in perfect health and is found dead next morning with no sign that baby struggled or was in painBaby just stops breathing for unknown reasons.ANSWER TO T-F? # 7: TRUE: More children die from Sudden Infant Death Syndrome (SIDS) than from cancer, heart disease,, pneumonia, child abuse, AIDS, cystic fibrosis, and muscular dystrophy combined. (Lipsitt, 2003)
52Sudden Infant Death Syndrome (SIDS) a.k.a Crib Death Most Prevalent in:Babies age 2-4 monthsBabies put to sleep on tummies or sidesPremature and low-birth-weight babiesMale babiesBabies in lower socioeconomic status familiesBabies in African American familiesAfrican American babies twice as likelyBabies of teenage mothersBabies whose mothers smoked during or after pregnancy or used drugs during pregnancy
53Sudden Infant Death Syndrome (SIDS) a.k.a Crib Death Causes:Still unknown but recent (2006) study at Boston Children’s Hospital show:Medullas of SIDS victims were less sensitive to the chemical serotoninSerotonin is chemical that keeps the medulla responsive.The medulla is an area in the brainstem involved in basic functions such as breathing and sleep/wake cycles.The problem was seen more in brains of boys, accounting for the higher incidence in male babies.
54Figure 4.6 – The MedullaTHE MEDULLA - This is Figure 4.6 on p. 76 of CDEV
55Sudden Infant Death Syndrome (SIDS) a.k.a Crib Death Lowering Risk: “The Safe Sleep Top 10”Prevention should begin during pregnancyDon’t smoke or use drugsNational Institute of Child Health and Human Development (NICHD,2006) suggest:1. Always place baby on back to sleep2. Place baby on firm sleep surface free of quilts, pillows, or other soft surfaces3. Keep toys and loose bedding out of crib and keep any other items away from babies face
56Sudden Infant Death Syndrome (SIDS) a.k.a Crib Death Lowering Risk: “The Safe Sleep Top 10”4. Do not allow smoking around the baby5. Keep baby’s sleep area close to, but separate from, others’ sleep areas. Baby should not sleep in a bed or on a couch or armchair with anyone.6. Use a clean, dry pacifier when putting baby to sleep; don’t force baby to take it7. Do not let baby get too warm or overheat during sleep; dress in light clothing and keep temperature comfortable
57Sudden Infant Death Syndrome (SIDS) a.k.a Crib Death Lowering Risk: “The Safe Sleep Top 10”8. Avoid products that claim to reduce risk of SIDS; most have not been tested for effectiveness or safety9. Do not use home monitors to reduce risk of SIDS. Refer questions to your health care provider.10. Reduce the chance that flat spots will develop on baby’s head: provide “tummy time” while baby is awake and being watched. Change direction baby sleeps in crib weekly.