2. Chapter 4 Key Questions What is the normal process of labor?
What complications can occur at birth, and what are their causes, effects, and treatments?
What capabilities does the newborn have?

3. Birth Neonate The term used for newborns
The neonate’s outward appearance is caused by a variety of factors in its journey from the mother’s uterus, down the birth canal, and out into the world.
We can trace its passage, beginning with the release of the chemicals that initiate the process of labor.

4. Stages of Labor
First Stage Second Stage Third Stage

5. Labor Vocab Place following words into appropriate stage of labor
*10 cm *Apghar Administered *Longest Stage
*Pushing Process *Baby in Uterus *Baby in Vagina
*Mucous Plug is Released *Bonding between Mother and Child
*Cervix thins out(Effacement) *Afterbirth
*Episiotomy *Corticotropin Hormone released

6. Stages and Vocab First Stage Second Stage Third Stage Apghar
Bonding
Afterbirth
Anoxia
10 cm
Baby in Uterus
Contractions Begin
Effacement begins
Corticotropin Hormone
Mucous Plug Release
Longest Stage
Episiotomy
Baby in Vagina
Pushing Process

7. Labor: The Process of Birth Begins
About 266 days after conception, a protein called corticotropin releasing hormone (CRH) triggers the release of various hormones, and the process that leads to birth begins.
One critical hormone is oxytocin, which is released by the mother’s pituitary gland.
When the concentration of oxytocin becomes high enough, the mother’s uterus begins periodic contractions.

8. Labor: The Process of Birth Begins
Labor proceeds in three stages:
In the first stage of labor, the uterine contractions initially occur around every 8 to 10 minutes and last about 30 seconds. As labor proceeds, the contractions occur more frequently and last longer.
Toward the end of labor, the contractions may occur every 2 minutes and last almost 2 minutes. Contractions allow opening of cervix to 10 centimeters

9. Labor: The Process of Birth Begins
During the final part of the first stage of labor, the contractions increase to their greatest intensity, a period known as transition.
During the second stage of labor, which typically lasts around 90 minutes, the baby’s head emerges further with each contraction, increasing the size of the vaginal opening.

10. Labor: The Process of Birth Begins
Episiotomy An incision sometimes made to increase the size of the opening of the vagina to allow the baby to pass
The third stage of labor occurs when the child’s umbilical cord (still attached to the neonate) and the placenta are expelled from the mother

11. Birth: From Fetus to Neonate
The exact moment of birth occurs when the fetus, having left the uterus through the cervix, passes through the vagina to emerge fully from its mother’s body.
In most cases, babies automatically make the transition from taking in oxygen via the placenta to using their lungs to breathe air.

12. The Apgar Scale
Apgar scale A standard measurement system that looks for a variety of indications of good health in newborns (7-10 – best Under 7- baby requires help breathing and problems evident. Problems during prenatal dev, or during delivery)
Anoxia A restriction of oxygen to the baby, lasting a few minutes during the birth process, which can produce brain damage

13. Apgar Scale - page 88

14. Infants

15. Physical Appearance and Initial Encounters
After assessing the newborn’s health, health-care workers next deal with the remnants of the child’s passage through the birth canal.
A thick, greasy material called the vernix smoothes the passage through the birth canal; it is no longer needed once the child is born and is easily cleaned away.

16. Physical Appearance and Initial Encounters
Newborns’ bodies are also covered with a fine, dark fuzz known as lanugo; this soon disappears.

17. The newborn’s eyelids may be puffy due to an accumulation of fluids during labor, and the newborn may have blood or other fluids on parts of its body.

18. Molding and Caput Succedaneum

19. Jaundice Build up of bilirubin (Waste product from breakdown of
red blood cells)
Liver is immature and cannot
keep up with the breakdown of bilirubin.

20. Epstein Pearls
Entrapped fluid in child’s palate

21. Umbilical Cord

22. Physical Appearance and Initial Encounters
Bonding Close physical and emotional contact between parent and child during the period immediately following birth, argued by some to affect later relationship strength
Although mother–child bonding does not seem critical, it is important for newborns to be gently touched and massaged soon after birth.

23. Physical Appearance and Initial Encounters
The physical stimulation they receive stimulates the production of chemicals in the brain that instigate growth.

24. Approaches to Childbirth: Where Medicine and Attitudes Meet
Parents in the Western world have developed a variety of strategies—and some very strong opinions—to help them deal with something as natural as giving birth.
No single procedure will be effective for all mothers and fathers, and no conclusive research evidence has proven that one procedure is significantly more effective than another.

25. Alternative Birthing Procedures
Lamaze birthing techniques (Dr. Ferdinand Lamaze)
Bradley Method
Hypnobirthing
Birthing Center
Cesarean Section

26. Childbirth Attendants: Who Delivers?
Traditionally, obstetricians, physicians who specialize in delivering babies, have been the childbirth attendants of choice.
In the last few decades, more mothers have chosen to use a midwife, a childbirth attendant who stays with the mother throughout labor and delivery.
A doula is trained to provide emotional, psychological, and educational support during birth.

27. Pain and Childbirth
Pain is a subjective, psychological phenomenon that cannot be easily measured.
Consequently, the experience of pain during labor is difficult for women in labor to interpret, thereby potentially increasing their anxiety and making the contractions seem even more painful.

28. Pain and Childbirth
Ultimately, every woman’s delivery depends on such variables as how much preparation and support she has before and during delivery, her culture’s view of pregnancy and delivery, and the specific nature of the delivery itself

29. Use of Anesthesia and Pain-Reducing Drugs
The use of medication during childbirth is a practice that holds both benefits and pitfalls.
About a third of women who receive anesthesia do so in the form of epidural anesthesia, which produces numbness from the waist down.
A newer form of epidural, known as a walking epidural or dual spinal-epidural, uses smaller needles and a system for administering continuous doses of anesthetic.

30. Postdelivery Hospital Stay: Deliver, Then Depart?
The American Academy of Pediatrics states that except in unusual cases, women should stay in the hospital no less than 48 hours after giving birth.
Furthermore, the U.S. Congress passed legislation mandating a minimum insurance coverage of 48 hours for childbirth.

31. Newborn Medical Screening
The American College of Medical Genetics recommends that all newborns be screened for 29 disorders, ranging from hearing difficulties and sickle-cell anemia to extremely rare conditions such as isovaleric academia, a disorder involving metabolism.
Genetic screening policies are left up to individual states

32. Preterm Infants: Too Soon, Too Small
Preterm infants Infants who are born prior to 38 weeks after conception (also known as premature infants)
Low-birthweight infants Infants who weigh less than 2,500 grams (around 5 1/2 pounds) at birth
Small-for-gestational-age infants Infants who, because of delayed fetal growth, weigh 90% (or less) of the average weight of infants of the same gestational age

33. Preterm Infants: Too Soon, Too Small
Low-birthweight infants are highly vulnerable to infection, and because their lungs have not had sufficient time to develop completely, they have problems taking in sufficient oxygen.
As a consequence, they may experience respiratory distress syndrome (RDS), with potentially fatal consequences.
Despite the difficulties they experience at birth, the majority of preterm infants eventually develop normally in the long run.

34. Very-Low-Birthweight Infants: The Smallest of the Small
Very-low-birthweight infants Infants who weigh less than 1,250 grams (around 2 1/4 pounds) or, regardless of weight, have been in the womb fewer than 30 weeks
Very-low-birthweight babies are in grave danger from the moment they are born, due to the immaturity of their organ systems.

35. Very-Low-Birthweight Infants: The Smallest of the Small
However, medical advances have led to a higher chance of survival, pushing the age of viability, the point at which an infant can survive prematurely, to about 22 weeks.
Review chart on page 96 for Survival and Gestational Age

36. What Causes Preterm and Low-Birthweight Deliveries?
About half of preterm and low-birthweight births are unexplained, but several known causes account for the remainder.
In some cases, premature labor results from difficulties relating to the mother’s reproductive system.
Multiple Births

37. What Causes Preterm and Low-Birthweight Deliveries?
In other cases, preterm and low-birthweight babies are a result of the immaturity of the mother’s reproductive system.
Factors that affect the general health of the mother all are related to prematurity and low birthweight.

38. Low Birthweight Factors (page 97)

39. Postmature Babies: Too Late, Too Large
Postmature infants Infants still unborn 2 weeks after the mother’s due date
Difficulties involving postmature infants are more easily prevented than those involving preterm babies, since medical practitioners can induce labor artificially if the pregnancy continues too long.

40. Cesarean Delivery: Intervening in the Process of Birth
Cesarean delivery A birth in which the baby is surgically removed from the uterus, rather than traveling through the birth canal
Cesarean deliveries occur most frequently when the fetus shows distress of some sort.
Page 105 C-Section rates

41. Cesarean Delivery: Intervening in the Process of Birth
Cesarean deliveries are also used in some cases of breech position, in which the baby is positioned feet first in the birth canal.
A cesarean delivery also presents some risks for the baby.
Fetal monitor A device that measures the baby’s heartbeat during labor

42. Infant Mortality and Stillbirth: The Tragedy of Premature Death
Stillbirth The delivery of a child who is not alive, occurring in fewer than 1 delivery in 100
Infant mortality Death within the first year of life
Consider rates in the United States and around the world!!! (Page 95) 
= Rates around the world
  = Rates in the United States

43. Why does US have high Mortality Rate? 10 Leading Causes in US

44. Childbirth-Related Leave Policies

45. Childbirth-Related Leave Policies, cont’d

46. Postpartum Depression: Moving from the Heights of Joy to the Depths of Despair
Postpartum depression, a period of deep depression following the birth of a child, affects some 10% of all new mothers.
Postpartum depression may be triggered by the pronounced swings in hormone production that occur after birth.

47. Postpartum Depression: Moving from the Heights of Joy to the Depths of Despair
When depressed mothers interact with their infants, they are likely to display little emotion and to act detached and withdrawn.
This lack of responsiveness leads infants to display fewer positive emotions and to withdraw from contact not only with their mothers but with other adults as well.

48. The Competent Newborn
As developmental researchers have begun to understand more about the nature of newborns, they have come to realize that infants enter this world with an astounding array of capabilities in all domains of development: physical, cognitive, and social.

49. Physical Competence: Meeting the Demands of a New Environment
The world faced by a neonate is remarkably different from the one it experienced in the womb. (What did the neonate not do on his/her own while in mother’s uterus?)
Neonates emerge from the uterus practiced in certain types of physical activities.

50. Physical Competence: Meeting the Demands of a New Environment
Reflexes Unlearned, organized involuntary responses that occur automatically in the presence of certain stimuli
The sucking reflex and the swallowing reflex permit Kaita to begin right away to ingest food.
The rooting reflex, which involves turning in the direction of a source of stimulation (such as a light touch) near the mouth, is also related to eating.

51. First Encounters Upon Birth page 103

52. Sensory Capabilities: Experiencing the World
Although their visual acuity is not fully developed, newborns actively pay attention to certain types of information in their environment.
Infants can discriminate different levels of brightness.

53. Sensory Capabilities: Experiencing the World
There is even evidence suggesting that newborns have a sense of size constancy.
They seem aware that objects stay the same size even though the size of the image on the retina varies with distance.

54. Sensory Capabilities: Experiencing the World
In addition to sight and hearing, the other senses also function quite adequately in the newborn.
It is obvious that newborns are sensitive to touch. (Blowing of air)
At birth, the senses of smell and taste are also well developed.

55. Early Learning Capabilities
Classical conditioning A type of learning in which an organism responds in a particular way to a neutral stimulus that normally does not bring about that type of response
Operant conditioning A form of learning in which a voluntary response is strengthened or weakened, depending on its association with positive or negative consequences
Chart on page 106

56. Early Learning Capabilities
Habituation The decrease in the response to a stimulus that occurs after repeated presentations of the same stimulus

57. Learning in Infancy

58. Social Competence: Responding to Others
Due to variations in research results, the jury is still out on exactly when true imitation (or exploration) begins, although it seems clear that some forms of imitation begin very early in life.
Certain characteristics of neonates mesh with parental behavior to help produce a social relationship between child and parent, as well as social relationships with others.

59. Social Competence: Responding to Others
States of arousal Different degrees of sleep and wakefulness through which newborns cycle, ranging from deep sleep to great agitation

60. Social Interaction Factors