1. Infants, Children, and Adolescents
Eighth Edition
Chapter 4
Birth and the Newborn Baby

2. Learning Objectives (1 of 2)
4.1 Describe the three stages of childbirth, the baby’s adaptation to labor and delivery, and the newborn baby’s appearance.
4.2 Describe natural childbirth and home delivery, noting benefits and concerns associated with each.
4.3 List common medical interventions during childbirth, circumstances that justify their use, and any dangers associated with each.
4.4 What are the risks of oxygen deprivation, preterm birth, and low birth weight, and what factors can help infants who survive a traumatic birth?

3. Learning Objectives (2 of 2)
4.5 Is close parent–infant contact shortly after birth necessary for bonding?
4.6 Describe the newborn baby’s reflexes and states of arousal, including sleep characteristics and ways to soothe a crying baby.
4.7 Describe the newborn baby’s sensory capacities.
4.8 Why is neonatal behavioral assessment useful?
4.9 Describe typical changes in the family after the birth of a new baby, along with interventions that foster the transition to parenthood.

4. The Three Stages of Labor
Figure 4.1: The three stages of childbirth
Figure 4.1

5. The Apgar Scale Score Sign 1 2 Heart rate No heartbeat
Score
Sign 1 2
Heart rate
No heartbeat
Under 100 beats per minute
100 to 140 beats per minute
Respiratory effort
No breathing for 60 seconds
Irregular, shallow breathing
Strong breathing and crying
Reflex irritability
No response
Weak reflexive response
Strong reflexive response
Muscle tone
Completely limp
Weak movements of arms and legs
Strong movements of arms and legs
Color
Blue body, arms, and legs
Body pink with blue arms and legs
Body, arms, and legs completely pink

6. The Apgar Scale (continued)
Score of 7 or better: good condition
Score between 4 and 6: baby needs assistance
Score of 3 or lower: baby is in serious danger and needs medical attention

7. Approaches to Childbirth
Western society:
Before late 1800s → home births
Post-industrial revolution → hospital births
1950s–1960s → movement toward natural childbirth
Today → birth centers (and some home births)

8. Elements of Natural, or Prepared, Childbirth
Classes
Relaxation and breathing techniques
Labor coach

9. Other Natural Childbirth Practices
Doula: a trained lay attendant who provides social support
Delivery positions
Upright: shortens labor and reduces complications
Water birth: relaxes mother, shortens labor, and reduces complications
Home delivery: less than 1% of U.S. births

10. Medical Interventions in Childbirth
Fetal monitoring
Medication
Analgesics
Anesthetics
Instrument delivery
Induced labor
Cesarean delivery

11. Instrument Delivery
Low forceps can injure the baby’ head and the mother’s tissues.
Vacuum extractors increase the risk of:
Bleeding between baby’s skin and skull
Bleeding beneath the baby’s skull
Infant seizures

12. Instrument Delivery
Figure 4.2: Instrument delivery
Figure 4.2

13. Cesarean Delivery
Cesarean deliveries account for 37% of births in the United States.
Cesareans are warranted in medical emergencies such as
Rh incompatibility.
premature separation of the placenta from the uterus.
infection.
baby in breech position.
Many cesareans are unnecessarily performed.

14. Anoxia Oxygen deprivation at birth
Can lead to brain damage or later cognitive, language problems
Cerebral palsy
Causes include:
Squeezing of umbilical cord
Placenta abruptio, placenta previa
Failing to breathe after birth

15. Preventing Brain Cell Death from Anoxia
Additional brain cell death can occur in the hours after birth.
Prevention strategies:
Head-cooling device: reduces brain damage and increases newborn behavioral assessment scores
Precooled water blanket: reduces death and disability rates in the first two years

16. Preterm and Small-for-Date Babies
Born weeks before their due date
May be appropriate weight for length of pregnancy
Small-for-Date
May be born at due date or preterm
Below expected weight for length of pregnancy

17. Rates of Infant Survival and Disability by Length of Pregnancy
Figure 4.3: Rates of infant survival and child disabilities by length of pregnancy
Figure 4.3
(Adapted from Bolisetty et al., 2006.)

18. Preterm Infants
1 to 2 more weeks in the womb can contribute greatly to infant health.
Reduced rates of illness
Fewer costly medical procedures
Shorter hospital stays
More favorable physical and cognitive development

19. Interventions for Preterm Infants
Isolette
Respirator
Feeding tube
Intravenous medication
Special infant stimulation
Kangaroo care
Parent training in caregiving

20. Influence of Intensity of Early Intervention for Low-Income Preterm Babies on Intellectual Functioning at Age 8
Figure 4.4: Influence of intensity of early intervention for low-income, preterm babies on intellectual functioning at age 8
Figure 4.4
(Adapted from Hill, Brooks-Gunn, & Waldfogel, 2003.)

21. Health Care for Parents and Newborn Babies
Infant mortality: number of deaths in the first year of life per 1,000 live births.
In spite of technological advances, the United States has made little progress in reducing infant death rates.
Neonatal mortality: number of deaths in the first month.
Low birth weight is the second highest contributor to infant mortality, which is largely preventable.

22. Infant Mortality Around the World
Figure 4.5: Infant mortality in 37 nations
Figure 4.5
(Adapted from U.S. Census Bureau, 2014a.)

23. Birth Complications, Parenting and Resilience
Kauai study: If birth complications are not severe, a supportive home can restore children’s growth.
Some children with troubled home environments are able to overcome birth complications with outside support.

24. Precious Moments After Birth
Oxytocin causes the breasts to “let down” milk, heightens the mother’s responsiveness to baby
Fathers also show hormonal changes that are associated with positive emotional reactions to infants.
But a favorable parent–infant relationship does not depend on immediate bonding.

25. Newborn Reflexes Eye blink Rooting Sucking Swimming Moro Palmar grasp
Tonic neck
Stepping
Babinski

26. Adaptive Value of Newborn Reflexes
Survival
Evoking interaction from caregivers
Motor development

27. Infant States of Arousal
Regular (NREM) sleep
Irregular (REM) sleep
Drowsiness
Quiet alertness
Waking activity and crying

28. The Mysterious Tragedy of Sudden Infant Death Syndrome
SIDS is the leading cause of infant mortality between 1 week and 12 months in industrialized nations.
Its occurrence tends to peak between 2 and 4 months of age, when reflexes decline.

29. Reducing Incidence of SIDS
Quit smoking and taking drugs.
Put babies to sleep on their backs.
Remove soft bedding.
Pacifier use

30. Ways to Soothe a Crying Baby
Hold on shoulder and rock or walk
Swaddle
Pacifier
Talking or rhythmic sounds
Ride in carriage, car, swing
Massage
Combine methods

31. Newborn Sense of Touch
Reflexive response to touch on mouth, palms, soles, genitals
Sensitive to pain
Severe pain can disrupt child’s developing capacity to regulate stress.
Relieve pain with analgesics, sugar, breast milk, gentle holding.

32. Newborn Senses of Taste and Smell
Prefer sweet tastes at birth
Quickly learn to like new tastes
Display odor preferences from birth
Can locate odors and identify mother by smell from birth

33. Newborn Senses of Taste and Smell
Figure 4.6: Examples of facial expressions of newborns exposed to the odor of anise whose mothers’ diets differed in anise-flavored foods during late pregnancy
Figure 4.6
(From B. Schaal, L. Marlier, & R. Soussignan, 2000, “Human Foetuses Learn Odours from Their Pregnant Mother’s Diet,” Chemical Senses, 25, p Reprinted by permission of Oxford University Press, Inc., and Benoist Schaal.)

34. Newborn Sense of Hearing
Can hear a wide variety of sounds at birth
Prefer complex sounds to pure tones
Learn sound patterns within days
Sensitive to voices, and biologically prepared to learn language

35. Newborn Sense of Vision
Least developed of senses at birth
Unable to see long distances or focus clearly
Scans environment and tries to track interesting objects
Color vision becomes adultlike after 4 months.

36. Infant Vision vs. Adult Vision
Figure 4.7: View of the human face by the newborn and the adult
Figure 4.7
(From Kellman & Arterberry 2006; Slater et al., 2010.)

37. Neonatal Behavioral Assessment
Neonatal Behavioral Assessment Scale (NBAS) evaluates a baby’s reflexes, muscle tone, state changes, and responsiveness to physical and social stimuli.
Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) is specially designed for use with newborns at risk for developmental problems.

38. Transition to Parenthood
Gender roles may become more traditional.
Sharing caregiving predicts greater happiness and sensitivity to the baby.
Postponing parenthood until the late twenties or thirties eases transition.

39. Single-Mother Families
40% of U.S. births to single mothers
Most nonmarital births are unplanned.
Adolescents
Low-income women in 20s
Financially secure women ages 30–45 are an exception.

40. Parental Depression and Child Development
8 to 10% of mothers experience chronic depression.
3 to 5% of fathers also report depression after the birth of a child.
Parental depression can have serious negative effects on all domains of child development.
Early treatment is vital.

41. Interventions for New Parents
Prebirth counseling can ease the transition to parenthood.
High-risk parents struggling with poverty or a baby with disabilities benefit from intensive intervention.
Low-income parents may require tangible support (food, money, transportation, affordable child care).

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